#MASH #HBV #prognostic #regression #liver #damage
No treatment is currently available for the treatment of steatohepatitis linked to metabolic syndrome (Mash). Drug candidates, such as resmetirom, lead to hepatic histological improvement; but their effect on the hard mortality criterion remains unestablished. Health authorities have proposed intermediate evaluation criteria: remission of Mash without worsening of fibrosis, or improvement of fibrosis. New data support the usefulness of these criteria. Thus, by describing the benefits of bariatric surgery after 15 years of follow-up, the Braves study carried out by a team from Lille also confirms that improving Mash also makes it possible to improve the long-term prognosis of operated patients.
Brave, conducted between 1994 and 2021, showed the superiority of bariatric surgery over traditional dietary interventions in eligible obese patients, with beneficial effects on the overall mortality of the operated cohort, as well as on the hepatic and cardiovascular complications of patients. Mash. Data leading to the ability to “Assimilate this disease to a form of tissue expression of metabolic syndrome”, commented Dr Guillaume Lassailly (Lille CHRU). However, long-term data from this study were not yet established among Mash patients. All had a liver biopsy at inclusion, then one year later in those with Mash.
New results, presented at the congress, showed that at 15 years, the death rate was higher in subjects who had Mash at inclusion (survival of 83.9% vs. 92.7% among non-Mash patients). ), in those who had stage F2 fibrosis or more (79.8 vs 94%), and in those who had Mash or persistent fibrosis at 1 year (70.8% vs 88.4%). Loss of BMI between 0 and 1 year and severity of fibrosis were the main risk factors for persistence of Mash. “Remission of Mash without worsening of fibrosis appears to be a reliable substitution criterion in the context of bariatric surgeryconcluded the specialist. They show the importance of the histological response in predicting survival.”
Continue to maintain post-HCV liver monitoring
Screening for hepatocellular carcinoma (HCC) is recommended in people who have recovered from chronic hepatitis C and who have advanced fibrosis or cirrhosis, since the risk persists significantly. However, non-invasive tests (NIT) suggest a regression of these damage post-healing. So is this monitoring still necessary in these patients? To find out if it would be possible to stop monitoring certain patients, a study was carried out using two ANRS cohorts (Hepather from 2012, CirVir from 2006). Liver fibrosis dynamics were assessed both by liver histology and TNI, and were correlated with progression to HCC. As a reminder, these TNI (Fib4, APRI and elastometry) are established from routine constants established in biology (transaminases, platelets, age of patients, etc.).
The analysis included more than 8,000 patients who achieved a sustained virological response, of whom 3,500 had cirrhosis. 3.6% developed HCC, on average after a follow-up of 62 months. As expected, cases of cancer were more numerous as the liver damage was severe. In those who initially had cirrhosis, tests showed regression whether or not the patients later developed cancer. Some had even achieved TNI scores belonging to the lowest quartile. The residual risk remained approximately 1.5% in these subjects. Also, “most HCCs would not have been detected if the surveillance of these apparently “reversing” patients had been stoppedcommented Professor Pierre Nahon (Avicenne hospital, Bobigny) during the scientific plenary. The dynamics of TNI therefore does not make it possible to predict histological evolution or to identify thresholds below which current screening strategies could be modified. he concluded, urging not to modify strategies in the absence of new data.
Crohn’s disease, pancreatic cancer… What to remember from the last French-speaking hepato-gastroenterology days
Summary of the congress:
– Crohn’s disease, pancreatic cancer… What to remember from the last French-speaking hepato-gastroenterology days
– French recommendations for Crohn’s disease
– MASH, HBV: what is the prognostic value of regression of liver damage?
– Functional intestinal disorders: the place of probiotics and non-drug approaches clarified
– Pancreatic cancer: a link with exposure to pesticides identified in France
– Celiac disease: 4 out of 5 cases are atypical or frustrating
