Clinical Liver Disease

Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG) are distinct entities with some overlapping properties that have both challenged medical, endoscopic, and surgical therapies owing to the lack of a complete understanding of their respective pathophysiology. Each patient with chronic gastrointestinal bleeding and suspected lesions should be categorized in the appropriate group, because the management is significantly different. Drs. Tekola and Caldwell address the clinical characteristics and management approach for each.

: Portal hypertension is a common complication of cirrhosis and is the result of increased intrahepatic resistance and splanchnic and systemic hemodynamic changes. Elevated portal pressure leads to the formation of portosystemic laterals, which comprise gastroesophageal varices. Once varices have developed, they tend to enlarge and may eventually bleed. Drs. Simonetto and Shah discuss the important and much-debated topic of the management of esophageal varices.

Ectopic varices represent a clinical challenge because they are difficult to localize, and at present, there are no clear guidelines on the management of ectopic varices due to the diversity of presentation and absence of randomized controlled trials. Drs. Sarin and Kumar review etiology, prevalence, clinical presentation, and management strategies.

Acute variceal bleeding is a severe complication of portal hypertension and causes 70% of all upper gastrointestinal bleeding episodes in patients with liver cirrhosis. Drs. Reverter and García-Pagán address general management and hemostatic treatments, including vasoactive therapy, endoscopic therapy, and rescue therapies

The prevention of rebleeding is a cornerstone of the management of portal hypertension in patients with cirrhosis. Listen to Drs. Merkel and Montagnese review the recommendations from the AASLD guidelines and other studies addressing the pharmacological, endoscropic, and interventional treatments available.

Many liver and vascular diseases cause portal hypertension in children, which may give rise to severe and life-threatening complications, including hemorrhaging from esophageal varices, ascites, hepatopulmonary syndrome, portopulmonary hypertension, and hepatic encephalopathy. Dr. Ling addresses current strategies for effective prevention and management of portal hypertension and its complications in children, while making the case that there is a pressing need for high-quality, multicenter and international pediatric studies to advance the clinical care provided to affected pediatric patients.

Despite a major improvement in its management over the past 2 decades, the rupture of esophageal varices (EVs) remains a common and severe complication of cirrhosis with a mortality rate still reaching 20%. Screening for EVs is crucial because it provides the ability to reduce the risk of a first bleeding episode. Drs. Lemoinne and Thabut discuss the who, when, and how of EV screening.

Portal hypertension and its related consequences are the leading causes of illness and death in patients with advanced liver disease. Drs. Koh and Heller provide an overview of the approach to the diagnosis of portal hypertension and address its underlying pathophysiological and etiological features.

The use of laparoscopic techniques in the treatment of cancer has grown in acceptance over the last decade, as the initial concerns of comprising oncological principles and port-site metastases in laparoscopic resections have largely proven unfounded. However, the use of laparoscopic techniques in liver resection for hepatocellular carcinoma has not been fully embraced.

In many circumstances, the specificity of imaging characteristics may be sufficient to establish a diagnosis of hepatocellular carcinoma. Drs. Russo and Wald review when imaging alone is adequate for diagnosing HCC and when biopsy is needed.

Prognosis for patients with hepatocellular carcinoma depends on tumor stage at diagnosis, with curative options only available for patients diagnosed at an early stage. Drs. Rahimi, Yopp, and Singal review the best available evidence supporting HCC surveillance and discuss future trends in surveillance..

Drs. Liapi and Geschwind present an overview of some novel local therapies for unresectable hepatocellular carcinoma that have been introduced recently to the medical community or are currently under preclinical and initial clinical testing..

Hepatocellular carcinoma is the most rapidly increasing cause of cancer mortality with poor prognosis in the United States. Molecular biomarkers are emerging as a way to enable effective, personalized patient management with limited medical resources. Dr. Hoshida reviews molecular risk factors of HCC development, molecular subclasses of aggressive HCC tumor, and the need for clinical translation of molecular indicators of HCC risk.

Hepatocellular carcinoma is the third most common cause of cancer-related deaths worldwide, and each year, approximately 750,000 new cases are diagnosed. As the incidence of liver cancer continues to rise, effective surveillance programs are necessary in order to maximize patient outcomes which require effective identification of HCC risk factors.

The Barcelona Clinic Liver Cancer (BCLC) staging system was designed to stratify patients according to outcome while simultaneously linking it with treatment indication. Drs. Forner, Rodriguez-Lopez, and Reig highlight the advantages to the BCLC staging system, while also addressing areas for further refinement.

Drs. Chaiteerakij and Roberts summarize the current understanding of the pathogenesis of hepatocellular carcinoma and HCC tumor biology gained from recent studies using NGS technology to analyze HCC tumors. They also discuss potential strategies for harnessing this new information to improve therapy for patients with advanced HCC.

Dr. Cabrera discusses the planned, ongoing, and completed clinical trials for advanced HCC. A brief overview of recent failures and ongoing clinical studies with emerging molecular targeted agents along with future perspectives is covered.

Recent studies suggest that for optimum clinical outcomes, management of hepatocellular carcinoma necessitates the most reliable classification of tumors, including histopathologic evaluation. Dr. Brunt discusses current criteria, useful immunohistochemistry stains, and differential diagnostic considerations for hepatocellular carcinoma..

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and is a major global health problem. Dr. Agarwal discusses risk factors, surveillance, and management strategies for the primary care provider.

Hepatitis B can lead to several severe clinical outcomes, including cirrhosis, hepatic decompensation, and hepatocellular carcinoma. While the establishment of a risk prediction tool for various clinical outcomes for patients with HBV is still in a preliminary phase, the use and refinement of these prediction tools may supply HBV patients with a comprehensive individualized management measure based on the risk perspectives. Drs. Yang and Chen explain..