Hepatology Forum最新文献

{"title":"Acute on chronic liver failure in erythropoietic protoporphyria: A case report and review of the literature.","authors":"Amith Viswanath, Rohan T Thomas, Santosh Kumar E, Uday George Zachariah, Sheethal K Jose, Meera Thomas, Thomas Alex Kodiatte","doi":"10.14744/hf.2025.36953","DOIUrl":"10.14744/hf.2025.36953","url":null,"abstract":"<p><p>Erythropoietic protoporphyria (EPP) is a disease caused by an inborn error of heme biosynthesis. It manifests as painful photosensitivity in childhood. Liver disease occurs due to the deposition of protoporphyrin. Cholestasis due to protoporphyrin leads to a vicious cycle of worsening, which can lead to liver failure. A 29-year-old woman presented with a three-month history of intermittent low-grade fever and a one-month history of jaundice. She had a history of painful blisters over the skin in childhood that started at two years of age and progressed to multiple contractures from healed ulcers by five years of age. She also had splenomegaly on examination. Her blood tests showed pancytopenia, hyperbilirubinemia, and elevated liver enzymes. Tropical fever workup was negative. Autoimmune hepatitis was considered, as antinuclear antibodies (ANA) were positive with elevated immunoglobulin G (IgG). Skin biopsy showed features suggestive of lipoid proteinosis. However, on review with Periodic Acid-Schiff-diastase (PAS-D) staining, a close mimic, EPP was considered a possibility. Liver biopsy showed features of EPP with infiltration with refractile brown pigment showing bright-red birefringence on polarizing microscopy. Next-generation sequencing (NGS) confirmed EPP with a ferrochelatase enzyme coding gene mutation. The patient developed pneumonia during hospitalization and developed acute on chronic liver failure (ACLF) grade 3a, as defined by the European Association for the Study of the Liver (EASL), with ascites and encephalopathy. She was treated with photoprotective measures, ursodeoxycholic acid, antibiotics, and supportive care. The family was counseled regarding options for sequential hepatic and bone marrow transplants. She was managed with the best supportive care.</p>","PeriodicalId":29722,"journal":{"name":"Hepatology Forum","volume":"7 3","pages":"288-291"},"PeriodicalIF":2.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discriminative performance of non-invasive scoring systems for VCTE-defined steatosis and fibrosis in patients with psoriasis.","authors":"Sehnaz Yuksel, Tulin Ergun, Osman Cavit Ozdogan, Yesim Ozen Alahdab, Veysi Yilmaz, Gozde Atmaca, Umit Kara, Coskun Ozer Demirtas","doi":"10.14744/hf.2026.91757","DOIUrl":"https://doi.org/10.14744/hf.2026.91757","url":null,"abstract":"<p><strong>Background and aim: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is more prevalent in patients with psoriasis. Reliable non-invasive tools are needed to evaluate hepatic steatosis and to identify patients at risk for significant liver fibrosis. This study aimed to assess the discriminative performance of commonly used non-invasive scoring systems for identifying patients with vibration-controlled transient elastography (VCTE)-defined significant liver fibrosis and hepatic steatosis in patients with psoriasis.</p><p><strong>Materials and methods: </strong>A total of 113 patients with psoriasis were prospectively enrolled. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed using VCTE. Significant fibrosis (F2-F4) was defined as LSM ≥8 kPa, and significant steatosis (S2-S3) as CAP ≥259 dB/m. The discriminative performance of non-invasive fibrosis and steatosis scores was evaluated using area under the receiver operating characteristic (AUROC) curves.</p><p><strong>Results: </strong>Of the 113 patients, 76 (67%) were diagnosed with MASLD following VCTE assessment. The body mass index, aspartate aminotransferase-alanine aminotransferase ratio, and diabetes (BARD) score (AUROC=0.692) showed the highest performance in identifying significant fibrosis, while FIB-4, aspartate aminotransferase to platelet ratio index, non-alcoholic fatty liver disease fibrosis score (NFS), and steatosis-associated fibrosis estimator (SAFE) demonstrated lower predictive accuracy. Among patients with MASLD, the SAFE score (AUROC=0.776), followed by the BARD score (AUROC=0.716), yielded the highest discriminative performance. The SAFE score showed the highest negative predictive value (95%) for ruling out significant fibrosis in MASLD patients. For detecting significant steatosis, the fatty liver index (FLI) score (AUROC=0.867) provided the highest performance, while hepatic steatosis index (HSI) (AUROC=0.813) and metabolic dysfunction-associated fatty liver disease screening score (MAFLD-S) (AUROC=0.833) also demonstrated good discriminative ability.</p><p><strong>Conclusion: </strong>In patients with psoriasis, commonly used non-invasive fibrosis scores showed limited discrimination for VCTE-defined significant fibrosis, but they may have value as rule-out tools in low-prevalence settings. In contrast, FLI, HSI, and MAFLD-S showed good discrimination for VCTE-defined significant hepatic steatosis.</p>","PeriodicalId":29722,"journal":{"name":"Hepatology Forum","volume":"7 3","pages":"277-287"},"PeriodicalIF":2.1,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acetaminophen toxicity: Patterns of liver injury, effects on hospital length of stay, and the need for inpatient psychiatric care.","authors":"Nazli Begum Ozturk, Ben L Da, Ghideon Ezaz, Thomas D Schiano","doi":"10.14744/hf.2026.99845","DOIUrl":"https://doi.org/10.14744/hf.2026.99845","url":null,"abstract":"<p><strong>Background and aim: </strong>Acetaminophen toxicity is the most common cause of acute liver failure (ALF) in the United States. Among patients with acetaminophen toxicity, a vast majority have intentional overdose and concurrent psychiatric comorbidities. We aimed to analyze patient characteristics, patterns of overdose, and outcomes in patients with acetaminophen overdose at our liver transplantation (LT) center.</p><p><strong>Materials and methods: </strong>Patients ≥18 years of age with acetaminophen overdose between 2011 and 2020 at our institution were identified. Patient demographics, clinical and laboratory data, patterns of overdose (intentional vs. unintentional), psychiatric comorbidities, need for admission to inpatient psychiatry service, transplant wait listing, need for transplantation, and death were assessed. Categorical variables are presented as counts with percentages, continuous variables as median with interquartile range IQR (Q1-Q3), and p<0.05 was considered significant.</p><p><strong>Results: </strong>A total of 165 (118 female, 47 male) patients were admitted with acetaminophen toxicity. Seventy-one (43.0%) patients met criteria for ALF. The median age was 32 years (IQR 25-49), and 112 (67.9%) patients had concurrent psychiatric comorbidities. Ninety-six (58.2%) patients had intentional overdose, while 69 (41.8%) patients had unintentional overdose. Twenty-three (13.9%) patients were listed for LT, and seven (4.2%) patients underwent LT. Eighty-one (49.1%) patients were subsequently admitted to the inpatient psychiatry service. Eleven (6.7%) patients died, five of whom were on the LT list. There was no significant difference in LT listing between patients with and without psychiatric comorbidities.</p><p><strong>Conclusion: </strong>The majority of the patients with acetaminophen overdose survived to discharge. Most cases of acetaminophen overdose were intentional and were significantly associated with the presence of a psychiatric comorbidity. Intentional and unintentional overdoses had similar rates of ALF. Inpatient psychiatric hospitalization was frequently required, particularly for patients with intentional overdose.</p>","PeriodicalId":29722,"journal":{"name":"Hepatology Forum","volume":"7 3","pages":"256-261"},"PeriodicalIF":2.1,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TASL practice guidance for the diagnosis and management of metabolic dysfunction-associated steatotic liver disease (MASLD).","authors":"Yusuf Yilmaz, Gupse Adali, Ilkay Ergenc, Eda Kaya, Dilara Turan Gokce, Caglayan Keklikkiran, Mujdat Zeybel, Gediz Dogay Us, Bulent Degertekin, Ramazan Idilman, Ulus Salih Akarca, Zeki Karasu, Sabahattin Kaymakoglu, Nurdan Tozun, Ahmet Uygun","doi":"10.14744/hf.2026.44190","DOIUrl":"https://doi.org/10.14744/hf.2026.44190","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and represents a major and growing public health challenge in Türkiye. This guidance provides an updated, clinically oriented overview of the definition, epidemiology, screening, diagnosis, risk stratification, and management of MASLD, with particular emphasis on evolving nomenclature, non-invasive diagnostic pathways, and current treatment strategies. The document addresses the full clinical spectrum of disease, from steatosis and metabolic dysfunction-associated steatohepatitis (MASH) to advanced fibrosis, cirrhosis, hepatocellular carcinoma, and liver transplantation. The guidance also incorporates evidence and practice considerations relevant to the Turkish population, including local epidemiology, resource availability, and implementation challenges in real-world care. Finally, areas of uncertainty and evidence gaps are highlighted to support future research and locally relevant policy development.</p>","PeriodicalId":29722,"journal":{"name":"Hepatology Forum","volume":"7 3","pages":"177-214"},"PeriodicalIF":2.1,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13478548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WHO 2024 Hepatitis B Guidelines: No more gray zone for low- and middle-income countries? An evaluation.","authors":"Shanmugam Saravanan, Ramachandran Vignesh, Esaki M Shankar, Raju Sivadoss, Sathasivam Sivamalar, Vijayakumar Velu, Pachamuthu Balakrishnan, Arcot R Venkateswaran","doi":"10.14744/hf.2026.46055","DOIUrl":"https://doi.org/10.14744/hf.2026.46055","url":null,"abstract":"<p><p>The World Health Organization (WHO) has established targets to reduce the incidence rates of viral hepatitis by 90% and the death rate by 65% by 2030. However, despite global efforts, a substantial treatment gap persists, with merely 3% of eligible patients worldwide receiving antiviral therapy as of 2022. With more than 254 million people living with chronic HBV infection and approximately 1.1 million related deaths annually, the updated 2024 WHO guidelines significantly expand treatment eligibility to help achieve this objective. This review discusses how the new changes would benefit gray zone patients, particularly those in low- and middle-income countries (LMICs) who were historically excluded from therapy. By introducing age-based thresholds, incorporating non-invasive grading methods, and persistent ALT elevation to the treatment network, the 2024 guidelines promise broader inclusion. This review highlights the significance of these changes and evaluates the potential impact on the gray zone patients in resource-limited settings.</p>","PeriodicalId":29722,"journal":{"name":"Hepatology Forum","volume":"7 3","pages":"236-240"},"PeriodicalIF":2.1,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of rifaximin in fructose-induced steatohepatitis in rats.","authors":"Mevlut Kiyak","doi":"10.14744/hf.2026.58657","DOIUrl":"https://doi.org/10.14744/hf.2026.58657","url":null,"abstract":"","PeriodicalId":29722,"journal":{"name":"Hepatology Forum","volume":"7 3","pages":"310"},"PeriodicalIF":2.1,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the Letter to the Editor: \"Albumin in hepatic encephalopathy: Evidence, prioritization, and the affordability gap in decompensated cirrhosis\".","authors":"Ana Carolina Covre Coan, Vanio Antunes do Livramento Junior, Alonzo Armani Prata, Natália Junkes Milioli, Tulio L Correa, Otávio Cosendey Martins, Pedro Romeiro, Elísio Santos Bulhões Júnior, André Milani Reis, Matheus Vanzin Fernandes","doi":"10.14744/hf.2026.65364","DOIUrl":"10.14744/hf.2026.65364","url":null,"abstract":"","PeriodicalId":29722,"journal":{"name":"Hepatology Forum","volume":"7 3","pages":"308-309"},"PeriodicalIF":2.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Albumin in hepatic encephalopathy: Evidence, prioritization, and the affordability gap in decompensated cirrhosis.","authors":"Mohammad Saquib Alam, Nagma Khatoon","doi":"10.14744/hf.2026.21555","DOIUrl":"https://doi.org/10.14744/hf.2026.21555","url":null,"abstract":"","PeriodicalId":29722,"journal":{"name":"Hepatology Forum","volume":"7 3","pages":"306-307"},"PeriodicalIF":2.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the Letter to the Editor: \"Effects of rifaximin in fructose-induced steatohepatitis in rats\".","authors":"Nese Cabuk Celik, Rumeysa Yilmaz Goc, Ibrahim Halil Bahcecioglu, I Hanifi Ozercan, Mehmet Tuzcu, Necip Ilhan, Kazim Sahin","doi":"10.14744/hf.2026.21462","DOIUrl":"10.14744/hf.2026.21462","url":null,"abstract":"","PeriodicalId":29722,"journal":{"name":"Hepatology Forum","volume":"7 3","pages":"311"},"PeriodicalIF":2.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body composition in glucagon-like peptide-1 receptor agonist therapy: Absolute loss, relative changes, and outcomes.","authors":"Sang Chen, Wen-Yue Liu, Giovanni Targher, Christopher D Byrne, Yusuf Yilmaz, Ming-Hua Zheng","doi":"10.14744/hf.2026.84986","DOIUrl":"https://doi.org/10.14744/hf.2026.84986","url":null,"abstract":"","PeriodicalId":29722,"journal":{"name":"Hepatology Forum","volume":"7 3","pages":"215-217"},"PeriodicalIF":2.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}