Liver highlights from DDW 2018: 13 reports on NAFLD, HCV, microbiome

This year at the Digestive Disease Meeting, physicians noted a significant increase in studies focused on the growing obesity epidemic and the gut microbiome as related to gastrointestinal complications. Additionally, the meeting included several presentations on nonalcoholic fatty liver disease treatment, outcomes in hepatitis C and hepatitis B, early detection of liver cancer, and reviews on recent obesity and gut microbiome studies.

Healio presents the following hepatology highlights from DDW 2018.

Homeless veterans with HCV diagnosed, treated via PCP outreach

Researchers identified a cohort of homeless veterans who successfully completed hepatitis C treatment and achieved sustained virologic response, including patients with polysubstance use, according to a presentation at Digestive Disease Week 2018.

Omar Bakr, MD, from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues were able to engage marginalized veterans who had previously been difficult to access with more traditional methods after integrating HCV care into the Homeless Patient Aligned Care Teams, or HPACT — an established interprofessional patient-centered medical home employed by the VA. Read more

Call to action: Tailor lifestyle interventions for NAFLD to patients

Lifestyle interventions such as diet and exercise are a critical part of prevention and treatment of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, more so than pharmacotherapy or endoscopic interventions at this moment, according to an expert at Digestive Disease Week 2018.

“My task today is to get everyone reinvigorated about the role of diet and exercise in the treatment of NAFLD and NASH,” Monica Konerman, MD, director of the Michigan Medicine NAFLD Clinic, said during her presentation. “With all of the new trials in pharmacotherapy and the exciting bariatric endoscopic interventions, people don’t tend to get as excited about diet and exercise, but hopefully that will change.” Read more

To mitigate burnout, physicians must prioritize, protect goals

Women in medicine often feel “used up” and have a reduced sense of accomplishment because of professional and personal burnout, according to a presentation by the interim-chief at the University of Washington School of Medicine, here at Digestive Disease Week 2018.

“Burnout is a work-related syndrome where the impact is detrimental in three domains of our professional lives,” Karen F. Murray, MD, said, noting the domains are emotional exhaustion, depersonalization, and reduced personal accomplishment. Read more

DDW 2018 review: Obesity treatment integral to gastroenterology care

In this exclusive video perspective from Digestive Disease Week 2018, Sarah Streett, MD, from the Stanford University Medical Center and outgoing chair of the AGA Practice Management and Economics Committee, reviews obesity-focused data presented at the meeting and obesity’s importance in gastroenterology and hepatology.

“We know obesity is integral to the development of so many disorders that we take care of, and yet most of us don’t focus on it as a potentially modifiable risk factor for gastrointestinal diseases,” Streett told Healio Gastroenterology and Liver Disease. “What we saw here is that obesity is now really integrated into GI practice in terms of understanding pathophysiology.” Read more

Plasma assay of methylated DNA markers detects liver cancer

In this exclusive video perspective from Digestive Disease Week 2018, John B. Kisiel, MD, a gastroenterologist from the Mayo Clinic in Rochester, Minn., shares results of a study in which plasma assay of methylated DNA markers detected hepatocellular carcinoma across all stages.

“These are markers we discovered as part of a larger set in an experiment that sequenced DNA extracted from frozen tissue specimens from patients at Mayo Clinic,” Kisiel told Healio Gastroenterology and Liver Disease. “The aim of the present study was to validate these markers in a larger cohort that included a spectrum of stages of disease, including early-stage patients who would be potentially curable.” Read more

Multiparametric MRI identifies hallmarks of NASH

Multiparametric magnetic resonance imaging identified and stratified patients with nonalcoholic fatty liver disease and nonalcoholic steatohepatitis at a population level, according to a study presented at Digestive Disease Week 2018.

“We’re trying to find a noninvasive way to identify these patients at risk for disease progression,” Stephen A. Harrison, MD, medical director of Pinnacle Clinical Research, San Antonio, said during his presentation. The way we estimated this NAFLD and NASH prevalence was using multiparametric MRI, specifically corrected T1 and proton density fat fraction.” Read more

Expert reviews clinical liver disease take-aways from DDW 2018

In this exclusive video perspective from Digestive Disease Week 2018, Steven L. Flamm, MD, chief of the Liver Program at Northwestern University Feinberg School of Medicine in Illinois, reviews some of the important clinical presentations in liver disease from the meeting.

“As usual, there are presentations across the gamut of liver disease at DDW,” Flamm told Healio Gastroenterology and Liver Disease. “They include the topics of hepatitis B, hepatitis C, autoimmune hepatitis, liver cancer, liver transplantation and many other pertinent topics to your practice.” Read more

Statins underused in patients with NAFLD

Statins have been underused in patients with nonalcoholic fatty liver disease who had abnormal liver tests despite having appropriate indications for their use, especially among patients with concomitant diabetes, according to a study presented at Digestive Disease Week 2018.

“We’ve known for a long time that statins are safe in patients with underlying liver disease — this has been published for years — but what I noticed in clinical practice is that I’m still getting referrals for patients with elevated liver enzymes,” Sonal Kumar, MD, MPH, from the New York Presbyterian Hospital Cornell, told Healio Gastroenterology and Liver Disease. “Statins have a risk of hepatotoxicity, but the risk is not increased with patients with underlying liver disease. So, I wanted to find out if this is just something I’ve been seeing at my institution or if this is a more generalized issue.” Read more

Relapse after LT for alcoholic liver disease more common in younger patients

Relapse to alcohol use after liver transplantation for alcoholic liver disease was more common among younger patients, according to a study presented at Digestive Disease Week 2018.

“Alcoholic liver disease is the second most common indication for liver transplant,” Mohanad Turki Ali Al-Qaisi, MD, from the Mayo Clinic in Phoenix, Ariz., said in his presentation. “Timing of alcohol relapse after LT can have a detrimental impact on patient survival.” Read more

Expert highlights gut microbiome studies from DDW 2018

In this exclusive video perspective from Digestive Disease Week 2018, Purna Kashyap, MD, from the Mayo Clinic in Rochester, Minn., highlights some key presentations focused on the gut microbiome.

“As a researcher as well as a clinician interested in the role of gut bacteria, I have found the last two days really stimulating with really new areas within the role of gut microbiota,” Kashyap told Healio Gastroenterology and Liver Disease. “Just last night, there was a session looking at gut microbiota and behavior, especially the role in autism, and it’s fascinating to see how microbes can have an effect far away from where they live,” he said, referring to a presentation by Ruth Ann Luna, PhD. Read more

HCV outcomes worse for patients with public insurance, Medicaid

In this exclusive video perspective from Digestive Disease Week 2018, Zobair M. Younossi, MD, chairman of the department of medicine at Inova Fairfax Hospital in Virginia, discusses insurance coverage and mortality in patients with hepatitis C in the U.S.

“Patients with hepatitis C have different demographics ... and certain ethnic groups, as well as those that are uninsured. When you look at the type of insurance patients with hepatitis C have, they were more uninsured and had higher rates of public insurance than private,” Younossi told Healio Gastroenterology and Liver Disease. Read more

Exclusion from HBV therapy by AASLD criteria often leads to adverse outcomes

Nearly half of patients with hepatitis B who developed adverse outcomes did not meet AASLD guideline treatment criteria at presentation and one-quarter never met guideline criteria prior to development of adverse events, according to a study presented at Digestive Disease Week 2018.

“Although there have been periodic updates to keep pace with new evidence, guideline treatment eligibility criteria are still based on the serum HBV DNA and aminotransferase level, HBV e antigen status and presence of cirrhosis,” Dong Hyun Lee, MD, from Stanford University in California, said in his presentation. “These surrogate markers of liver disease cannot predict long-term outcomes of all chronic HBV patients and precise levels are uncertain below which adverse outcomes may not develop.” Read more

Metabolomics profile identifies coronary artery disease risk in NAFLD

Non-targeted metabolomics profile determined which patients with nonalcoholic fatty liver disease had comorbid coronary artery disease, according to a study presented at Digestive Disease Week 2018.

Elzafir Elsheikh, PhD, from the Betty and Guy Beatty Center for Integrated Research, Inova Health System in Virginia, and colleagues prospectively enrolled patients with NAFLD scheduled for coronary angiography who underwent hepatic ultrasound. The researchers used serum samples for non-targeted metabolomics analysis using liquid chromatography-mass spectrometry coupled technique. Read more

This year at the Digestive Disease Meeting, physicians noted a significant increase in studies focused on the growing obesity epidemic and the gut microbiome as related to gastrointestinal complications. Additionally, the meeting included several presentations on nonalcoholic fatty liver disease treatment, outcomes in hepatitis C and hepatitis B, early detection of liver cancer, and reviews on recent obesity and gut microbiome studies.

Healio presents the following hepatology highlights from DDW 2018.

Homeless veterans with HCV diagnosed, treated via PCP outreach

Researchers identified a cohort of homeless veterans who successfully completed hepatitis C treatment and achieved sustained virologic response, including patients with polysubstance use, according to a presentation at Digestive Disease Week 2018.

Omar Bakr, MD, from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues were able to engage marginalized veterans who had previously been difficult to access with more traditional methods after integrating HCV care into the Homeless Patient Aligned Care Teams, or HPACT — an established interprofessional patient-centered medical home employed by the VA. Read more

Call to action: Tailor lifestyle interventions for NAFLD to patients

Lifestyle interventions such as diet and exercise are a critical part of prevention and treatment of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, more so than pharmacotherapy or endoscopic interventions at this moment, according to an expert at Digestive Disease Week 2018.

“My task today is to get everyone reinvigorated about the role of diet and exercise in the treatment of NAFLD and NASH,” Monica Konerman, MD, director of the Michigan Medicine NAFLD Clinic, said during her presentation. “With all of the new trials in pharmacotherapy and the exciting bariatric endoscopic interventions, people don’t tend to get as excited about diet and exercise, but hopefully that will change.” Read more

To mitigate burnout, physicians must prioritize, protect goals

Women in medicine often feel “used up” and have a reduced sense of accomplishment because of professional and personal burnout, according to a presentation by the interim-chief at the University of Washington School of Medicine, here at Digestive Disease Week 2018.

“Burnout is a work-related syndrome where the impact is detrimental in three domains of our professional lives,” Karen F. Murray, MD, said, noting the domains are emotional exhaustion, depersonalization, and reduced personal accomplishment. Read more

PAGE BREAK

DDW 2018 review: Obesity treatment integral to gastroenterology care

In this exclusive video perspective from Digestive Disease Week 2018, Sarah Streett, MD, from the Stanford University Medical Center and outgoing chair of the AGA Practice Management and Economics Committee, reviews obesity-focused data presented at the meeting and obesity’s importance in gastroenterology and hepatology.

“We know obesity is integral to the development of so many disorders that we take care of, and yet most of us don’t focus on it as a potentially modifiable risk factor for gastrointestinal diseases,” Streett told Healio Gastroenterology and Liver Disease. “What we saw here is that obesity is now really integrated into GI practice in terms of understanding pathophysiology.” Read more

Plasma assay of methylated DNA markers detects liver cancer

In this exclusive video perspective from Digestive Disease Week 2018, John B. Kisiel, MD, a gastroenterologist from the Mayo Clinic in Rochester, Minn., shares results of a study in which plasma assay of methylated DNA markers detected hepatocellular carcinoma across all stages.

“These are markers we discovered as part of a larger set in an experiment that sequenced DNA extracted from frozen tissue specimens from patients at Mayo Clinic,” Kisiel told Healio Gastroenterology and Liver Disease. “The aim of the present study was to validate these markers in a larger cohort that included a spectrum of stages of disease, including early-stage patients who would be potentially curable.” Read more

Multiparametric MRI identifies hallmarks of NASH

Multiparametric magnetic resonance imaging identified and stratified patients with nonalcoholic fatty liver disease and nonalcoholic steatohepatitis at a population level, according to a study presented at Digestive Disease Week 2018.

“We’re trying to find a noninvasive way to identify these patients at risk for disease progression,” Stephen A. Harrison, MD, medical director of Pinnacle Clinical Research, San Antonio, said during his presentation. The way we estimated this NAFLD and NASH prevalence was using multiparametric MRI, specifically corrected T1 and proton density fat fraction.” Read more

Expert reviews clinical liver disease take-aways from DDW 2018

In this exclusive video perspective from Digestive Disease Week 2018, Steven L. Flamm, MD, chief of the Liver Program at Northwestern University Feinberg School of Medicine in Illinois, reviews some of the important clinical presentations in liver disease from the meeting.

“As usual, there are presentations across the gamut of liver disease at DDW,” Flamm told Healio Gastroenterology and Liver Disease. “They include the topics of hepatitis B, hepatitis C, autoimmune hepatitis, liver cancer, liver transplantation and many other pertinent topics to your practice.” Read more

PAGE BREAK

Statins underused in patients with NAFLD

Statins have been underused in patients with nonalcoholic fatty liver disease who had abnormal liver tests despite having appropriate indications for their use, especially among patients with concomitant diabetes, according to a study presented at Digestive Disease Week 2018.

“We’ve known for a long time that statins are safe in patients with underlying liver disease — this has been published for years — but what I noticed in clinical practice is that I’m still getting referrals for patients with elevated liver enzymes,” Sonal Kumar, MD, MPH, from the New York Presbyterian Hospital Cornell, told Healio Gastroenterology and Liver Disease. “Statins have a risk of hepatotoxicity, but the risk is not increased with patients with underlying liver disease. So, I wanted to find out if this is just something I’ve been seeing at my institution or if this is a more generalized issue.” Read more

Relapse after LT for alcoholic liver disease more common in younger patients

Relapse to alcohol use after liver transplantation for alcoholic liver disease was more common among younger patients, according to a study presented at Digestive Disease Week 2018.

“Alcoholic liver disease is the second most common indication for liver transplant,” Mohanad Turki Ali Al-Qaisi, MD, from the Mayo Clinic in Phoenix, Ariz., said in his presentation. “Timing of alcohol relapse after LT can have a detrimental impact on patient survival.” Read more

Expert highlights gut microbiome studies from DDW 2018

In this exclusive video perspective from Digestive Disease Week 2018, Purna Kashyap, MD, from the Mayo Clinic in Rochester, Minn., highlights some key presentations focused on the gut microbiome.

“As a researcher as well as a clinician interested in the role of gut bacteria, I have found the last two days really stimulating with really new areas within the role of gut microbiota,” Kashyap told Healio Gastroenterology and Liver Disease. “Just last night, there was a session looking at gut microbiota and behavior, especially the role in autism, and it’s fascinating to see how microbes can have an effect far away from where they live,” he said, referring to a presentation by Ruth Ann Luna, PhD. Read more

HCV outcomes worse for patients with public insurance, Medicaid

In this exclusive video perspective from Digestive Disease Week 2018, Zobair M. Younossi, MD, chairman of the department of medicine at Inova Fairfax Hospital in Virginia, discusses insurance coverage and mortality in patients with hepatitis C in the U.S.

“Patients with hepatitis C have different demographics ... and certain ethnic groups, as well as those that are uninsured. When you look at the type of insurance patients with hepatitis C have, they were more uninsured and had higher rates of public insurance than private,” Younossi told Healio Gastroenterology and Liver Disease. Read more

PAGE BREAK

Exclusion from HBV therapy by AASLD criteria often leads to adverse outcomes

Nearly half of patients with hepatitis B who developed adverse outcomes did not meet AASLD guideline treatment criteria at presentation and one-quarter never met guideline criteria prior to development of adverse events, according to a study presented at Digestive Disease Week 2018.

“Although there have been periodic updates to keep pace with new evidence, guideline treatment eligibility criteria are still based on the serum HBV DNA and aminotransferase level, HBV e antigen status and presence of cirrhosis,” Dong Hyun Lee, MD, from Stanford University in California, said in his presentation. “These surrogate markers of liver disease cannot predict long-term outcomes of all chronic HBV patients and precise levels are uncertain below which adverse outcomes may not develop.” Read more

Metabolomics profile identifies coronary artery disease risk in NAFLD

Non-targeted metabolomics profile determined which patients with nonalcoholic fatty liver disease had comorbid coronary artery disease, according to a study presented at Digestive Disease Week 2018.

Elzafir Elsheikh, PhD, from the Betty and Guy Beatty Center for Integrated Research, Inova Health System in Virginia, and colleagues prospectively enrolled patients with NAFLD scheduled for coronary angiography who underwent hepatic ultrasound. The researchers used serum samples for non-targeted metabolomics analysis using liquid chromatography-mass spectrometry coupled technique. Read more