In adults, guidelines recommend biochemical, endoscopic, and sometimes radiographic assessments

PPIs, although it may be related to a greater risk of decompensation and infection, can have a protective effect in terms of survival if prescribed according to appropriate indications

when PPI exposure is evaluated as a binary variable, there was no association with all-cause mortality. In contrast, by adopting categorical models accounting for exposure dose and cumulative dose to PPIs, a significant association (P > .001) between PPIs exposure and increased all-cause mortality has been highlighted.

despite a marginal 4% increase in the risk of all cause death in PPIs users, the PPIs reduce the risk of death when gastrointestinal bleeding is considered as the only cause of death

Considering that liver cirrhosis is per se a condition in which it is common to find alterations in the intestinal microbiome, anemia, encephalopathy, and a greater susceptibility to infections

increased risk of fractures, interstitial nephritis, hepatic encephalopathy, anemia, and cognitive decline, most of the available data are based on observational studies and, therefore, could be susceptible to interpretation bias.5, 6, 7, 8, 9 Despite a large number of studies, the overall quality of evidence for PPIs adverse effects is low to very low

essentially linked to 2 mechanisms: the first is a direct consequence of the mechanism of action of the PPIs on gastric parietal cells, which determines hypochlorhydria and reflex hypergastrinemia with consequent reduction of absorption of important nutrients, including vitamin B12, calcium, and iron; the second mechanism is linked to the metabolism of the PPIs that, similar to other classes of drugs, occurs mainly in the liver through the cytochrome P450

Giardia is a common cause of watery diarrhea that can be readily treated.

fecal calprotectin with a threshold of 50 μg/g yields the optimal performance. Among studies using this threshold, the pooled sensitivity for IBD was 0.81 (95% confidence interval [CI], 0.75–0.86) and the pooled specificity was 0.87 (95% CI, 0.78–0.92)

Finally, one unblinded controlled study evaluated the impact of enoxaparin on the risk of portal vein thrombosis in persons with ascites.80 Anticoagulation was associated with decreased thrombosis and also SBP, likely by decreasing bacterial translocation.

First, effectiveness is questionable. Trials in this space have had mixed results.75, 76 There are observational data suggesting that rifaximin may reduce the incidence of SBP, but these have not been confirmed in randomised trial.

A prospective French study conducted among 180 severely obese patients with biopsy-proven NASH who underwent bariatric surgery revealed that 84% of patients had resolution of NASH 5 years after surgery.

with compensated cirrhosis may avoid a screening oesophagogastroduodenoscopy (EGD) if their liver stiffness on vibration controlled transient elastography is <20 kPa and the platelet count is >150,000.

In appropriate candidates, typically Child score <12 and bilirubin<5.8 g/dl with preserved cardiac function, TIPS increases the odds of freedom from paracentesis and even survival.72 The risk of HE is increased after TIPS but is not a contraindication.

Beyond that, both under-dilation the TIPS (6 mm vs 8 mm) and rifaximin prior to TIPS may improve the risk of HE

There are emerging reports regarding the role of Sodium-Glucose Cotransporter 2 (SGLT-2) inhibitors wherein patients with diabetes and refractory ascites can experience improvements in volume status with add-on SGLT-2 inhibitors.71 Controlled trials are needed.

Gynecomastia may worsen on spironolactone for which a switch to eplerenone (50 mg roughly equivalent to 100 mg spironolactone) or amiloride (10 mg/100 mg spironolactone) could be considered

Weight loss is gradual as ascites clearance occurs at a maximum of 1 L/day

Sodium restriction can be efficacious but is only effective in 14% of patients. Adherence is limited and is often associated with unintended protein/calorie restriction.66, 67 This is likely due to gaps in patient education.

Oral l-ornthine/l-aspartate (LOLA) is associated with improved cognitive function in small trials which do not compare to other therapies.59 Intravenous LOLA was recently associated with hastened recovery from overt HE compared to lactulose and rifaximin.60 While LOLA did not improve length of stay, it was associated with a reduction in 28-day mortality from 42% to 16%, which raises important questions about the population studied.

Given that muscle is critical for the metabolism of systemic ammonia,52 all patients with HE are recommended to consume 1 g dietary protein per kilogram actual bodyweight.53 As patients with cirrhosis often have inadequate hepatic gluconeogenesis, fasting should be avoided and all patients should consume high-calorie/high-protein night-time or early-morning snack.

recent data has emerged refining the thresholds for patients with NASH cirrhosis,51 with a platelet count >110,000/mm3 and LSM < 30 kPa for M probe, and platelet count >110,000/mm3 and LSM < 25 kPa for XL probe

Gastrointestinal tract lesions are not uncommon in NF1 [6] and are reported in 10 to 25% of all cases

Many of the clinical and neoplastic manifestations of NF1 are related to age [8]. The most common clinical manifestations are “café au lait” spots, neurofibromas, Lisch nodules (defined as pigmented hamartomatous nodular aggregates of dendritic melanocytes affecting the iris) and axillary or inguinal freckling (increased number of freckles, small circular spots on the skin that are darker than the surrounding skin, because of deposits of melanin)

Regarding cirrhosis, not only a single disease but also various causes, such as hepatitis viruses, alcohol, fatty liver, and many complications, including the whole disease state, are closely related to liver cancer.

Musharakah

hypothesis-ros - strategies to generate messages and parameters for the Robot Operating System.

Projects extending Hypothesis¶ Hypothesis has been eagerly used and extended by the open source community. This page lists extensions and applications; you can find more or newer packages by searching PyPI by keyword or filter by classifier, or search libraries.io.

var$coord

annotations

<img alt="" class="t u v ig aj" src="https://viahtml.hypothes.is/proxy/im_/https://miro.medium.com/max/672/0*QBiGnj5d2TWUYBey.png" width="336" height="253" srcset="https://viahtml.hypothes.is/proxy/https://miro.medium.com/max/552/0*QBiGnj5d2TWUYBey.png 276w, https://viahtml.hypothes.is/proxy/https://miro.medium.com/max/672/0*QBiGnj5d2TWUYBey.png 336w" sizes="336px" role="presentation"/>Scaling the line down to 1 unit.

VCTE and FIB4 accurately stratify the risk of LREs in NAFLD. These non-invasive tests are alternatives to liver biopsy

How I Approach It: Eosinophilic GI Diseases Beyond EoE.

Statin exposure is associated with reduced development of acute on chronic liver failure in a veterans affairs cohort.

A Prospective Trial with Long Term Follow-up of Patients With Severe, Steroid-Resistant Ulcerative Colitis Who Received Induction Therapy With Cyclosporine and Were Maintained With Vedolizumab.

Managing bleeding risk following cold snare polypectomy in patients receiving direct-acting oral anticoagulants.

sofosbuvir (400 mg)/velpatasvir (100 mg) with weight-based ribavirinc

clinical

GIM

specific for >2cm adenomatous polyps located in the proximal colon

OGIB

but not steatosis

ACG Clinical Guidelines: Management of Benign Anorectal Disorders.

Grading

not appropriate for Grading of Recommendations

These guidelines are meant to be broadly applicable and should be viewed as the preferred, but not the only

visceral factors vs centrally