New Acute Liver Failure Guidelines Featured in the July Issue of AJG

The July issue of The American Journal of Gastroenterology includes new ACG Clinical Guidelines on Acute Liver Failure, addressing a time-sensitive condition gastroenterologists and hepatologists may encounter. The issue also highlights new clinical science and reviews including therapies and management options for hepatitis D, alpha-gal allergy, cyclic vomiting syndrome, and EHR burden differentiations by subspecialty and training. This month we also published articles on Barrett’s esophagus, H. pylori infection and treatment, primary biliary cholangitis, chronic hepatitis B, and more.

Several articles are highlighted below and access to any articles from this issue, or past issues, is available upon request. The College is also able to connect members of the press with study authors or outside experts who can comment on the articles.

Acute Liver Failure Guidelines
Shingina, et al.
These clinical guidelines highlight the importance of comprehensive testing to exclude underlying chronic liver disease, clarify contributing factors to properly diagnose Acute Liver Failure, and provide treatment as quickly as possible. The guidelines also provide recommendations for liver biopsy, transplantation (LT), and pharmacological interventions. The authors note that, “ALF is a medical emergency and is potentially reversible if recognized and treated early. ALF must be differentiated from [acute-on-chronic liver failure] and decompensated cirrhosis because management is vastly different. ALF affects multiple organs and carries high short-term mortality, making timely transfer to the transplant center a priority early on in patient management. Patients at high risk of death have excellent prognosis after lifesaving LT.” 

Exercise Training Is Associated With Treatment Response in Liver Fat Content by Magnetic Resonance Imaging Independent of Clinically Significant Body Weight Loss in Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis
Stone, et al.
In this review and analysis of randomized controlled trials in adults with NAFLD, the authors identified a  ≥30% reduction in MRI-measured liver fat, independent of total weight loss. An exercise dose of at least 750 metabolic equivalents of task-min/week (e.g., 150 min/week of brisk walking) seems required to achieve treatment response.

Patients With Crohn’s Disease and Permanent Ileostomy Are Universally Excluded From Clinical Trials: A Systematic Review
Vuyyuru, et al.
In this systematic review, the authors investigated whether patients with Crohn’s disease and permanent ileostomy have been included in clinical trials to evaluate biologics and small molecules. They found that, universally, these patients have been excluded from pharmaceutical trials of biologics and small molecules, based on the 81 trials from MEDLINE, Embase, and Cochrane library databases, indicating that, “There is an urgent need to identify barriers to enrollment and develop eligibility and outcome measures enabling the inclusion of patients with CD and PI into clinical trials.”

About the American College of Gastroenterology

Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of over 18,000 individuals from 86 countries. The College’s vision is to be the preeminent professional organization that champions the prevention, diagnosis, and treatment of digestive disorders, serving as a beacon to guide the delivery of the highest quality, compassionate, and evidence-based patient care. The mission of the College is to enhance the ability of our members to provide world class care to patients with digestive disorders and advance the profession through excellence and innovation based upon the pillars of Patient Care, Education, Scientific Investigation, Advocacy and Practice Management. www.gi.org

 

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