Table of Contents
Overview
Definition and Scope
Hepatology is defined as the branch of medicine that focuses on the study of the liver, gallbladder, biliary tree, and pancreas, as well as the management of their disorders. This field encompasses the investigation of liver structure, function, and diseases, including the molecular mechanisms underlying hepatic diseases and the assessment of toxicology during drug development.[3.1] Hepatology plays a crucial role in addressing liver health, as healthcare providers in this specialty conduct tests to evaluate liver function and develop treatment plans for patients with liver-related concerns.[4.1] Hepatology is the branch of medicine that focuses on the study and management of disorders related to the liver, gallbladder, biliary tree, and pancreas.[3.1] While it is sometimes considered a sub-specialty of gastroenterology due to overlapping areas of study, the field has experienced significant growth, resulting in the emergence of specialists who concentrate exclusively on liver diseases in certain regions.[5.1] The scope of hepatology includes a variety of liver conditions, which can arise from factors such as viral infections, toxic exposure, and metabolic disorders, including alcohol or medication overuse and nonalcoholic fatty liver disease (NAFLD).[15.1] Importantly, most types of liver disease do not cause symptoms in their early stages, making them "silent" or asymptomatic.[15.1] By the time symptoms appear, the liver may already be damaged, underscoring the critical role of hepatologists in diagnosing and managing liver conditions.[12.1]Importance of Hepatology in Medicine
Hepatology is increasingly recognized as a critical area of public health, primarily due to the significant global burden of liver diseases, which result in approximately two million deaths annually.[27.1] These diseases encompass a wide spectrum of etiologies, including lifestyle choices and pre-existing comorbidities, as well as exposure to environmental toxins.[27.1] In response to this pressing health challenge, the Liver Health is Public Health initiative aims to elevate liver health to its rightful place on the global public health agenda. This initiative will focus on educating the public about liver health and disease prevention, while also paving the way for best practices that consider the diverse needs of different populations.[9.1] By addressing these factors, the initiative seeks to improve overall liver health outcomes and reduce the incidence of liver-related diseases.[9.1] Moreover, the interplay between liver function and pharmacokinetics underscores the importance of hepatology in personalized medicine. Variations in liver function among individuals can significantly affect drug metabolism, leading to altered pharmacokinetics that may necessitate dosage adjustments.[46.1] Hepatic dysfunction is prevalent in critically ill patients, affecting a substantial percentage of this population, and complicating medication management.[47.1] Understanding these dynamics is essential for healthcare providers to mitigate potential adverse effects and optimize therapeutic outcomes in patients with compromised liver function.[46.1] Hepatology is an essential discipline within medicine that addresses liver diseases and their complex mechanisms. Recent evidence suggests that environmental toxins, including organochlorine pesticides and aflatoxins, are significant contributors to liver disease, particularly hepatocellular carcinoma (HCC).[25.1] The mechanisms leading to HCC following exposure to these environmental stressors are primarily indirect, as they are associated with inflammation resulting from chronic liver disease. This inflammation, along with metabolic pressures, promotes the accumulation of genetic and epigenetic alterations in hepatocytes.[23.1] Furthermore, various environmental factors, such as diet, alcohol consumption, drugs, exercise, and stress, play a crucial role in regulating these processes.[24.1] Both mechanistic and population studies have established connections between environmental exposures and liver disease, highlighting the need for a comprehensive approach in hepatology that incorporates these findings into public health strategies.[28.1] While a detailed discussion of all known environmental associations with liver disease is beyond the scope of this review, it is vital to acknowledge the importance of these factors in the prevention and management of liver diseases.[28.1]History
Early Discoveries and Developments
The history of hepatology is deeply intertwined with ancient civilizations, particularly the Babylonians and Assyrians, who placed significant importance on the liver in their medical practices. In the second and first millennia B.C., these cultures engaged in the practice of "inspecting a liver" as a means of making critical decisions, highlighting the liver's perceived significance in both health and divination.[48.1] This early focus on the liver laid foundational beliefs that would influence subsequent medical theories. The medical practices of ancient Babylon revolved around a combination of magic and incantations, with limited scientific methodology. Despite this, the Babylonians made early observations regarding anatomy, particularly concerning the liver, which they referred to frequently in their texts.[64.1] Their medical writings, primarily preserved through Assyrian copies, reflect a rudimentary understanding of symptoms and a plethora of remedies, suggesting a long-standing experiential knowledge among physicians.[65.1] As the field of hepatology evolved, significant contributions emerged from notable figures and institutions. One pivotal development was the establishment of the Liver Unit at the Royal Free Hospital in London, founded by Dame Sheila Sherlock. This institution became a center for the investigation and treatment of liver diseases, marking a significant advancement in the field.[49.1] Additionally, the contributions of René Theophile Hyacinthe Laennec, who coined the term "cirrhosis," further enriched the understanding of liver pathology and diagnosis.[50.1]Landmark Studies in Hepatology
Landmark studies in hepatology have significantly shaped the understanding and management of liver diseases over the years. One of the earliest documented approaches to liver disease treatment dates back to the 1800s, where the recommended treatment for fatty liver included increased exercise and a reduction in fatty foods, starch, sugar, and alcohol consumption.[52.1] This historical perspective highlights the long-standing recognition of lifestyle factors in liver health. In antiquity, the practice of hepatoscopy, known as hēpatoskōpia, was a prevalent method among various ancient civilizations, including the Babylonians, Etruscans, Greeks, and Romans. This practice involved inspecting the liver to seek knowledge of the future through supernatural means, rather than assessing the organ's physiological performance.[53.1] The concept of hepatocentrism emerged from these early practices, positing the liver as the central organ of the human being. This medical doctrine originated in ancient populations, particularly within the Mesopotamian civilization, and continued to influence Western medical thought.[54.1] Furthermore, cultural beliefs surrounding liver health, including the etiology of conditions, the acceptability of symptoms, and their impact on strength and vitality, vary significantly across different cultures. These variations can lead to differential stigmatization of gastrointestinal conditions and symptoms, highlighting the importance of cultural context in the treatment and management of liver diseases.[55.1] In recent decades, hepatology has experienced significant advancements, particularly in the treatment of hepatitis C virus (HCV), which has been recognized as the most important breakthrough in the field over the past decade.[56.1] The development of effective therapies for HCV has transformed patient care and outcomes, marking a revolutionary change in the management of liver diseases.[58.1] Additionally, there has been notable progress in the therapy for hepatocellular carcinoma (HCC), driven by advances in interventional radiology, radiotherapy, and expanded surgical and transplant criteria.[57.1] Recent innovations in immunotherapy also offer promising options for patients who are not candidates for traditional therapies.[57.1] Furthermore, liver transplantation, once considered radical and risky, has now become a standard of care for patients with end-stage liver disease, associated with excellent long-term survival.[59.1] While these advancements are commendable, it is essential to recognize that the burden of liver disease remains a significant challenge.[59.1] Liver transplantation has also evolved from a risky procedure to a standard of care for patients with end-stage liver disease, demonstrating excellent long-term survival rates.[60.1] This evolution reflects decades of innovation and breakthroughs in the field, which continue to reshape the landscape of liver disease management. Furthermore, the integration of non-invasive diagnostics and personalized treatment strategies, informed by genetic markers, has enhanced the ability to detect and manage liver diseases effectively.[62.1]Recent Advancements
Diagnostic Innovations
Recent advancements in hepatology have significantly enhanced diagnostic capabilities, particularly in the assessment and management of liver diseases. One of the key areas of innovation is the use of advanced imaging techniques for the preoperative evaluation of liver transplant candidates. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are now the primary modalities employed for this purpose, allowing for detailed assessment of vascular and biliary anatomy, which is crucial for successful graft harvesting and transplantation.[116.1] Furthermore, the implementation of radiation-reducing protocols and advanced imaging techniques for evaluating parenchymal fat and iron content has improved the safety and efficacy of these diagnostic procedures.[115.1] In addition to imaging advancements, the integration of artificial intelligence (AI) in analyzing body composition metrics has shown promise in predicting postoperative outcomes for liver transplant recipients. AI-enabled tools applied to pre-transplant abdominal CT scans have been utilized to quantify clinical frailty data, thereby enhancing the preoperative assessment process.[114.1] This approach not only aids in candidate selection but also has implications for improving post-transplant outcomes. Chronic hepatitis B (CHB) infection represents a significant public health challenge, as it can progress to severe complications such as cirrhosis and hepatocellular carcinoma (HCC) in high-risk patients, particularly those exhibiting high viral replicative activity or advanced fibrosis.[121.1] The quantification of HBV DNA is essential for guiding treatment decisions and monitoring treatment response, as it may also indicate the emergence of resistance variants.[123.1] Recent advancements in technology have facilitated the measurement of various components of the viral cycle in the blood, which aids in assessing viral activity and informs therapeutic strategies.[122.1] Furthermore, non-invasive serum biomarkers have emerged as valuable tools for managing CHB, providing a promising approach to monitor disease progression and tailor treatment for affected individuals.[121.1] The exploration of the gut microbiome's relationship with liver disease has also emerged as a significant area of research. Specific patterns of gut microbiota have been associated with various liver diseases, including alcoholic and non-alcoholic liver diseases, and have been shown to impact disease progression through metabolic product production and modulation of host immune responses.[125.1] Understanding these connections provides important insights into the pathophysiology of liver diseases and may lead to personalized treatment approaches in hepatology.[126.1]Cutting-Edge Treatments
Recent advancements in hepatology have led to the development of cutting-edge treatments that significantly enhance the management of liver diseases. One notable area of progress is the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs), such as semaglutide, which have shown promising results in treating metabolic dysfunction-associated steatohepatitis (MASH). In a placebo-controlled randomized phase II trial, patients receiving semaglutide demonstrated a resolution of MASH without worsening fibrosis at a rate of 59%, compared to only 17% in the placebo group, indicating a substantial therapeutic benefit.[100.1] These agents not only reduce liver fat content and injury indices but also promote the resolution of steatohepatitis and slow the progression of hepatic fibrosis.[101.1] In addition to advancements in pharmacotherapy, the field of interventional endoscopy has seen significant innovations that improve the diagnosis and management of liver diseases. Endoscopic ultrasound (EUS) has emerged as a promising technique, offering excellent diagnostic yield and safety, particularly for focal lesions and portal hypertension.[96.1] EUS-guided imaging and biopsy techniques have been recognized for their effectiveness, making them a potential first-line option in selected cases of liver disease.[95.1] Furthermore, the integration of artificial intelligence and advanced endoscopic resection techniques is paving the way for enhanced therapeutic options in endohepatology, expanding the scope of endoscopic interventions beyond traditional applications.[94.1] Recent advances in drug therapy have heralded a new horizon of novel therapeutic approaches for chronic hepatitis B virus (HBV) infection, with several promising antiviral and immunomodulatory agents currently in preclinical or clinical testing.[102.1] This is particularly important as hepatitis B affects over 250 million chronic carriers globally and is responsible for more than 800,000 deaths annually, despite the availability of a safe and effective vaccine.[103.1] Traditional treatments, such as nucleoside analogues, have significant drawbacks and often fail to completely eradicate the virus.[103.1] The ongoing research into these innovative therapies aims to enhance treatment efficacy and improve patient outcomes in the management of chronic HBV infection.[102.1]In this section:
Liver Diseases
Common Liver Disorders
Liver diseases include a range of conditions that can significantly affect liver function and overall health. Hepatitis is the most prevalent form, but there is a rising incidence of non-alcoholic fatty liver disease (NAFLD) and liver disease linked to excessive alcohol consumption, both recognized as major health concerns.[127.1] NAFLD, characterized by fat accumulation in the liver without inflammation or damage to liver cells, can progress to more severe conditions like cirrhosis and liver failure if left unmanaged.[128.1] [129.1] In addition to fatty liver disease, genetic liver diseases, though less common, can significantly impact liver health. These include hemochromatosis, Wilson's disease, and Alpha-1 antitrypsin deficiency, which may result from inherited genetic alterations and lead to various complications affecting liver function.[131.1] [131.1] Chronic liver disease is a significant health issue, ranking as the tenth leading cause of death in the United States as of 2022, with nearly 55,000 fatalities.[133.1] This category encompasses various conditions, some of which can be managed or reversed, while others may lead to serious complications.[130.1] Misconceptions about liver disease are common; for example, many believe only chronic alcohol consumers are at risk. In reality, liver disease can result from multiple factors, including viral infections, autoimmune diseases, and genetic disorders.[136.1] Addressing these misconceptions is crucial for public awareness and education regarding liver health.[138.1]Impact on Global Health
Community engagement is pivotal in the success of public health campaigns targeting liver diseases, especially chronic viral hepatitis. Defined as a collaborative process with groups connected by proximity, interests, or situations, it supports their well-being and fosters relationships among stakeholders, enhancing the ability to address health-related issues effectively, leading to positive health impacts and outcomes.[153.1] [154.1] This engagement can significantly reduce stigma associated with liver diseases, facilitate the dissemination of crucial health messages, and empower communities to take proactive steps towards health improvement.[153.1] By involving community members in planning and implementing health initiatives, campaigns can be tailored to the specific needs and contexts of the populations they serve, thereby increasing their effectiveness and reach.[154.1] The World Health Organization (WHO) describes community engagement as "a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes."[154.1] Engaging communities in health promotion fosters collaboration and enhances the effectiveness of initiatives aimed at improving health and well-being.[154.1] By leveraging the strengths and insights of community members, public health efforts can be more widely accepted and impactful, ultimately leading to better health outcomes for individuals at risk of liver diseases.[154.1]Treatment Approaches
Medical Treatments
Chronic hepatitis B (CHB) is a significant global health issue, affecting over 240 million individuals and leading to high liver-related morbidity and mortality. Recent advancements in therapeutic strategies for CHB have focused on combination therapies that target multiple viral mechanisms, with studies exploring the efficacy of drugs like ABI-H0731 in conjunction with nucleos(t)ide analogs such as entecavir.[189.1] In the realm of autoimmune hepatitis (AIH), treatment typically involves immunomodulators and steroids. However, a subset of patients may not respond adequately to these conventional therapies, prompting the exploration of alternative biological therapies for those who are refractory.[174.1] Recent comparative studies have indicated that mycophenolate mofetil (MMF) may offer higher clinical benefit rates and lower rates of therapeutic failure compared to traditional treatments, suggesting a potential shift in first-line treatment guidelines for AIH.[176.1] Precision medicine aims to tailor treatment based on individual patient characteristics, such as genetic makeup and disease phenotype, and is being explored in hepatology to identify biomarkers for disease stratification and treatment response, which holds the promise of more effective and personalized therapeutic interventions.[173.1] Advancements in omics technologies and artificial intelligence (AI) methodologies are fueling progress towards personalized diagnosis, prognosis, and treatment strategies in this field.[184.1] However, implementing precision medicine on a broad scale faces numerous challenges, including technological and ethical issues, as well as economic and accessibility barriers.[187.1] A significant obstacle to the implementation of precision medicine for hepatocellular carcinoma (HCC) patients is the reluctance to perform diagnostic biopsies, primarily due to the high sensitivity and specificity of diagnostic imaging combined with α-fetoprotein, as well as the associated risk of tumor seeding via the biopsy tract.[185.1]Lifestyle and Supportive Care
Lifestyle modifications play a crucial role in the management of liver diseases, particularly nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB). Evidence suggests that lifestyle interventions, including dietary changes and increased physical activity, are the primary treatments for NAFLD, emphasizing the importance of weight loss in improving health outcomes.[202.1] Furthermore, the management of comorbidities, such as cardiometabolic conditions, alongside lifestyle changes is essential for effective treatment.[202.1] In patients with chronic hepatitis B (CHB), effective lifestyle management is crucial to prevent the incidence of non-alcoholic steatohepatitis (NASH).[179.1] The burden of chronic hepatitis B is predominantly experienced in resource-limited countries, where a significant number of individuals remain undiagnosed and untreated, making it challenging to meet the elimination targets set by the World Health Organization (WHO).[180.1] In 2016, the WHO launched a strategic plan aimed at eliminating hepatitis B virus (HBV) by 2030, following the release of its first guidelines for the prevention, diagnosis, care, and treatment of people living with CHB.[182.1] However, progress towards this goal has been slow, and many countries are still far from achieving the necessary elimination targets.[180.1] Community engagement and education are integral to enhancing the effectiveness of public health initiatives aimed at preventing liver diseases. Programs such as the Hepatitis Outreach Network (HONE) focus on at-risk populations, including immigrants and minority groups, providing essential screening and linking them to care.[197.1] Additionally, organizations like the Hepatitis B Foundation offer training and educational resources to raise awareness about hepatitis B and delta.[196.1] These initiatives underscore the importance of tailored educational programs in improving health outcomes for vulnerable populations. Moreover, the rising prevalence of metabolic-associated steatotic liver disease (MASLD) highlights the need for targeted prevention strategies, particularly for racial and ethnic minorities and those from low socioeconomic backgrounds.[201.1] Addressing lifestyle factors is critical, as high-risk behaviors significantly influence the transition from healthy states to chronic liver disease.[199.1] Therefore, sustained efforts in lifestyle modification, combined with community support and education, are essential components of effective hepatology care.In this section:
Interdisciplinary Relationships
Hepatology and Gastroenterology
The integration of genetic data into hepatology has significantly influenced the field, particularly through initiatives like Hepatology Genome Rounds. This interdisciplinary approach aims to incorporate genomic data into clinical practice, enhancing the understanding of chronic liver diseases and facilitating optimal patient management and prognostication.[216.1] Over the past decade, whole-exome sequencing (WES) has proven invaluable in uncovering the genetic etiologies of various liver diseases, thereby shaping future research directions and treatment protocols.[213.1] The utility of whole exome sequencing (WES) extends beyond initial analyses; for patients in whom WES does not produce actionable variants, reanalysis of the exome is indicated every 1-2 years. This recommendation is based on the rapid growth in available genetic data, including updates to human genome alignment, variant calling, and annotation programs, as well as new genetic variant classification and genotype-phenotype correlation information from other laboratories.[214.1] If reanalysis identifies variants of uncertain significance (VUSs) or heterozygous variants in genes associated with recessive diseases, these cases should undergo clinical correlation in Hepatology Genome Rounds.[214.1] The Hepatology Genome Rounds series was established with the vision that individual genomic analysis and its review in a multidisciplinary forum would aid in understanding the development of chronic liver disease, thereby facilitating optimal patient management and prognostication.[216.1] The integration of genetic data into electronic health records (EHRs) offers significant advantages for clinical practices, teaching clinical genetics, and conducting genetic research, while also providing potential cost and time savings.[215.1] However, the complexity of genetic data, along with the differences between genetic and other clinical data, presents challenges that complicate this integration process.[215.1] In hepatology, the incorporation of multi-omics data—including genomics, proteomics, and metabolomics—can enhance our understanding of liver diseases by elucidating the intricate interactions between genetic predisposition and environmental factors.[212.1] This integrative approach is particularly valuable in the context of metabolic-associated fatty liver disease (MAFLD), where it can reveal the multifaceted nature of disease mechanisms.[212.1]Collaboration with Other Medical Fields
Collaboration among various medical specialties is essential for the effective management of hepatological conditions, particularly hepatocellular carcinoma (HCC) and metabolic dysfunction-associated steatotic liver disease (MASLD). A multidisciplinary approach is emphasized in the management of HCC, which involves the coordinated efforts of hepatologists, surgeons, interventional radiologists, oncologists, and other specialists. This collaboration is crucial for tailoring treatment strategies based on individual patient needs, disease stage, and comorbidities, ultimately optimizing patient outcomes and enhancing the overall care experience.[223.1] The establishment of multidisciplinary clinics (MDCs) has gained momentum in the medical field, particularly in oncology, due to their ability to streamline complex care and improve patient outcomes.[211.1] In the context of HCC, the HCC Multidisciplinary Team (MDT) at Temple University Hospital, formed in 2008, exemplifies this model by integrating various specialists to provide comprehensive care.[217.1] Current international guidelines advocate for multidisciplinary discussions at every stage of HCC management, from diagnosis to treatment planning, underscoring the necessity of diverse expertise in addressing the complexities of the disease.[221.1] Moreover, the integration of specialties such as cardiology, endocrinology, and internal medicine has become increasingly important in managing MASLD, which is often associated with cardiovascular disease.[229.1] This interdisciplinary collaboration facilitates a deeper understanding of the interplay between liver disease and other systemic conditions, allowing for the development of personalized management strategies that address both hepatic and cardiovascular health.[229.1]In this section:
Research And Future Directions
Emerging Technologies in Hepatology
Emerging technologies in hepatology are transforming the understanding and treatment of liver diseases, particularly through the use of liver organoids. These three-dimensional cultures replicate key features of human liver function and pathology, thereby revolutionizing the field by enabling human-relevant disease modeling, CRISPR gene editing, and high-throughput drug screening.[264.1] One of the intrinsic advantages of liver organoids is their physiological relevance, as they recapitulate the cellular microenvironment and heterogeneity of the human liver, closely mimicking in vivo conditions.[266.1] This capability is especially valuable in chronic disease studies, where the need for accurate models is critical. Additionally, liver organoids demonstrate higher sensitivity and suitability for long-term studies, enhancing their predictive value in drug and nanomaterial toxicity testing.[265.1] The integration of liver organoids with microfluidic devices further facilitates the simulation of the liver microenvironment, thereby advancing high-throughput drug screening methodologies.[265.1] Liver organoids offer intrinsic advantages, including higher sensitivity and suitability for long-term studies, which enhance their predictive value in drug and nanomaterial toxicity testing.[265.1] The integration of liver organoids with microfluidic devices further enables the simulation of the liver microenvironment, facilitating high-throughput drug screening.[265.1] Despite their promise for development as a tissue replacement therapy for patients with end-stage liver disease, efficient methods for introducing organoids into host livers have yet to be established.[267.1] Continued research and development efforts are crucial to address these existing challenges and advance liver organoid technology towards clinical translation, ultimately benefiting patients and improving liver-related healthcare outcomes.[268.1] Recent advancements in the treatment of non-alcoholic fatty liver disease (NAFLD) have highlighted the complexity of this condition, which involves excessive lipid deposition in the liver and is often associated with obesity, diabetes, dyslipidemia, and other metabolic disorders.[260.1] Several pharmacological therapies have emerged as promising options for non-alcoholic steatohepatitis (NASH), including THR-ß-selective agonists, antidiabetic drugs, and FGF21 agonists, which have demonstrated efficacy in improving inflammation and fibrosis while maintaining a long-term safety profile.[259.1] NAFLD encompasses a spectrum of hepatic pathology, ranging from simple steatosis to more severe conditions such as cirrhosis and hepatocellular carcinoma.[261.1] The management of NAFLD is increasingly being informed by recent guidelines that emphasize the importance of addressing both the liver disease and the associated metabolic disorders.[261.1] Given the serious health implications of NAFLD, ongoing research continues to seek new therapeutic options to address this prevalent condition.[263.1] Furthermore, emerging therapies for hepatocellular carcinoma and cholangiocarcinoma are also shaping the future landscape of hepatology. Clinical trials involving engineered herpes simplex virus VG161 have indicated a good safety profile and promising efficacy in advanced liver cancer.[270.1] Additionally, a phase 2 trial exploring a triplet blockade of interleukin-27, PD-L1, and VEGF pathways has shown manageable safety and promising antitumor activity, warranting further exploration.[271.1] The focus on precision medicine, immunotherapy, and targeted therapies in cholangiocarcinoma highlights the urgent need for effective treatment approaches, given the poor prognosis associated with this group of malignancies.[273.1]Promising Areas of Research
Recent advancements in hepatology have highlighted several promising areas of research that are shaping the future of liver disease diagnosis, treatment, and prevention. One significant development is the emergence of liver organoids, which have revolutionized the field by enabling disease modeling, drug screening, and regenerative medicine applications. This innovative approach allows researchers to study liver diseases in a more precise manner, facilitating the exploration of new therapeutic options.[252.1] In addition to organoid research, there have been notable advancements in the treatment of viral hepatitis, particularly through comparative effectiveness research. This research compares various treatment modalities, such as neoadjuvant chemoimmunotherapy and chemoradiotherapy, to assess their impact on tumor regression and long-term survival in patients with gastrointestinal and pancreatic cancers.[251.1] Such studies are crucial for optimizing treatment strategies and improving patient outcomes. Moreover, the integration of translational research within hepatology is gaining momentum. Research teams are conducting long-term outcome studies that leverage existing National Institutes of Health (NIH) infrastructure to collaborate with basic scientists. This collaboration aims to bridge the gap between laboratory findings and clinical applications, enhancing the overall understanding of liver diseases and their management.[253.1] Public health initiatives are crucial for advancing hepatology research and addressing the challenges posed by viral hepatitis, particularly in underserved populations. The Centers for Disease Control and Prevention (CDC) envisions the elimination of viral hepatitis as a global public health threat and has established four key strategic directions to achieve this goal. These include providing technical assistance and leadership for global viral hepatitis elimination initiatives and creating sustainable partnerships to facilitate collaborative approaches.[254.1] The Viral Hepatitis National Strategic Plan: A Roadmap to Elimination 2021-2025 outlines a comprehensive framework aimed at eliminating viral hepatitis as a public health threat in the United States by 2030.[255.1] This plan emphasizes the implementation of universal hepatitis C screening guidelines, hepatitis B testing, and the expansion of access to prevention and treatment services across various healthcare settings.[256.1] Additionally, it seeks to improve the quality of care for individuals with viral hepatitis, ensuring that those in vulnerable populations, including people who use drugs and those in correctional settings, receive appropriate treatment and support.[257.1]References
[3] Hepatology - Wikipedia — Hepatology is the branch of medicine that incorporates the study of liver, gallbladder, biliary tree, and pancreas as well as management of their disorders. Although traditionally considered a sub-specialty of gastroenterology, rapid expansion has led in some countries to doctors specializing solely on this area,
[4] What Is Hepatology? - Verywell Health — Liver Health Liver Health Hepatology is the study of liver disease and related conditions. This type of healthcare provider will do tests to check your liver health and help create a treatment plan. You’ll be referred to hepatology if your healthcare provider is concerned about your liver function. Oftentimes, a hepatologist will order more testing to get a picture of your liver health. If you’re not feeling well or are concerned about your liver health, your first step is to see a primary care provider. At the hepatology appointment, a healthcare provider will ask about your health and likely order imaging, including more blood tests, ultrasound, and possibly a liver biopsy. Liver disease. General hepatology for liver disease.
[5] What Is Hepatology? Medical Conditions, Procedures & More - Healthline — Hepatology is sometimes considered a branch of gastroenterology because both specialties encompass some of the same organs. A gastroenterologist can help diagnose and treat similar conditions, but
[9] Liver Health is Public Health - Global Liver Institute — In response to the need, the Liver Health is Public Health initiative will elevate liver health to its rightful place on the global public health agenda. It will educate the public about liver health and disease prevention and will pave the way for best practices that account for differences in:
[12] Liver disease - NHS — Symptoms of liver disease. Most types of liver disease do not cause any symptoms in the early stages. Once you start to get symptoms of liver disease, your liver is already damaged and scarred. This is known as cirrhosis. Symptoms of cirrhosis include: feeling very tired and weak all the time; loss of appetite - which may lead to weight loss
[15] Signs of Liver Damage: Stomach, Itching, Other Clues - Verywell Health — A range of conditions, including alcohol or medication overuse, nonalcoholic fatty liver disease (NAFLD), and chronic infections, can damage your liver. However, the early signs of liver damage are subtle, and the initial stages of liver disease are "silent," or asymptomatic. By the time you recognize symptoms, your liver is already
[23] The exposome and liver disease - how environmental factors affect liver ... — The mechanisms leading to HCC following exposure to environmental stressors are mostly indirect and related to the inflammation generated by the evolution of chronic liver disease, during which inflammation and metabolic pressures favour the accumulation of epigenetic and genetic alterations in hepatocytes. 95,97,98 Toxin exposure can also
[24] Genetic, metabolic and environmental factors involved in the ... — However, such processes are regulated by environmental factors, including diet, alcohol, drugs, exercise and stress. Growing evidence suggests that epigenetic alterations are correlated with a wide range of chronic disorders, including liver diseases. ... Nonalcoholic fatty liver disease: molecular mechanisms for the hepatic steatosis. Clin Mol
[25] Environmental Risk Factors Implicated in Liver Disease: — viral hepatitis, and non-alcoholic liver disease are major risk factors for liver disease worldwide (7), recent evidence indicates that environmental toxins (organochlorine pesticides, aflatoxins, microcystins) contribute to liver disease. Pesticides, chemicals used to manage and treat pests, have been linked to human cancers (8). The agricultural
[27] Environmental Risk Factors Implicated in Liver Disease: A Mini-Review — Liver disease is a global health issue, resulting in about two million deaths per year. It encompasses a wide spectrum of varied or unknown etiologies, ranging from lifestyle choices to pre-existing comorbidities. In recent decades, exposure to environmental toxins and subsequent liver health outcom …
[28] Studying the Exposome to Understand the Environmental Determinants of ... — Both mechanistic and population studies have identified links between environmental exposures and liver disease. Although an exhaustive discussion of all the known environmental associations with liver disease is outside the scope of this review, these have been summarized in Table 3, some of which will be highlighted in the following sections.
[46] Effects of liver disease on pharmacokinetics. An update — Effects of liver disease on pharmacokinetics. Search in PubMed Search in PubMed A detailed knowledge of the particular isoenzyme involved in the metabolism of a drug and the impact of liver disease on that enzyme can provide a rational basis for dosage adjustment in patients with hepatic impairment. According to the available data, the kinetics of many drugs are altered by liver disease to an extent that requires dosage adjustment; the problem is to quantify the required changes. Hepatic disease and drug pharmacokinetics. Pharmacokinetic drug interactions in liver disease: An update. Search in PubMed Search in PubMed Search in PubMed Search in PubMed Search in PubMed Search in PubMed Search in PubMed Search in PubMed Search in PubMed Search in PubMed
[47] Drugs and the liver - PMC — Hepatic dysfunction is not uncommon within the intensive care setting affecting 11–54% of critically ill patients depending on definitions used.9 There is currently no tool akin to renal clearance to indicate degree of liver dysfunction.13 Therefore clinicians use liver function blood tests, international normalized ratio (INR), serum albumin and clinical scores such as the Child Pugh score act as a surrogate for function. NSAIDs are contraindicated for systemic use in most liver disease patients, because of increased bioavailability, the high risk of precipitating gastrointestinal bleeding and renal failure.20 Pregabalin and gabapentin are not metabolized in the liver and can be considered for use.
[48] History of Hepatology - SpringerLink — The history of hepatology is much more than the "history of one organ". Many events in the history of man have been influenced by the liver. In the second and first millenia B.C. the Babylonians and Assyrians attached great importance to "inspecting a liver" before important decisions were taken (Fig. 1).
[49] 50 years of Hepatology: The Royal Free Hospital School of Hepatology — The history of Hepatology cannot be written without including the history of the Liver Unit at the Royal Free Hospital in London, founded by Dame Sheila Scherlock. The notable contributions and teachings of the Royal Free Hospital's School of Hepatology - "a centre for the investigation and treatment of liver disease" - are
[50] A History of the Assessment of Liver Performance - PMC — In what must surely be the all‐time most celebrated footnote 39 in the History of Hepatology, René Theophile Hyacinthe Laennec (1781‐1826), who had invented the stethoscope and made major contributions to the pathological understanding and diagnosis of diseases of the chest, coined the neologism "cirrhosis" that as a devoted classicist
[52] Historical narrative from fatty liver in the nineteenth century to ... — Treatment of fatty liver in the 1800s was increased exercise plus reduction of fatty food, starch, sugar and alcohol. ... Natural history of nonalcoholic fatty liver disease: a prospective follow-up study with serial biopsies. Hepatol ... The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American
[53] A History of the Assessment of Liver Performance - PMC — Patrick S. Kamath. History From Ancient To Modern. In antiquity, inspection of the liver, hepatoscopy (hēpatoskōpia, from the Greek ηπατοσκόπια), was a common method among Babylonians, Etruscans, Greeks (Fig. 1), and Romans to use the liver to seek knowledge of the future using supernatural means, 1 but not for the purpose of assessing the performance of this royal organ.
[54] (PDF) "I Miss My Liver." Nonmedical Sources in the History of ... — Hepatocentrism was a medical doctrine that considered the liver the center of the whole human being. It originated in ancient populations (Mesopotamic civilization) and persisted in Western
[55] Cultural considerations in gastroenterology: barriers to care and a ... — Cultural beliefs about the etiology of a condition, acceptability of symptoms, prognosis, and impact on strength and vitality vary across cultures and can thus differentially impact stigmatization. GI conditions or symptoms themselves may be stigmatized, and various aspects of a patient's cultural identity or the broader culture in which they
[56] The past 10 years of gastroenterology and hepatology ... - Nature — Scott L. Friedman. Without question, the stunning advances in hepatitis C therapies represent the most important advance in hepatology in the past decade.
[57] Advances and Future Directions in the Treatment of ... - PubMed — Fortunately, there has been significant progress in therapy for HCC in the past few decades, namely due to advances in interventional radiology, radiotherapy, and expanded surgical and transplant criteria. Recent advances in immunotherapy also provide promising options for patients who are not candidates for other therapies.
[58] Special Issue "Advances in Gastrointestinal and Liver Disease: From ... — In the next few lines, we want to summarize the most important breakthroughs in the field of gastroenterology and hepatology in the last years. Hepatis C virus (HCV) treatment is the most important revolution of the past eight years.
[59] Breakthroughs in hepatology — Liver trans-plantation, once viewed as radical and risky, is now a standard of careinpatients with end-stage liverdisease and is associated with excellent long-term survival. We are indeed the beneficiaries of decades of innovation and breakthroughs. While we celebrate these triumphs, we concurrently recog-nise that liver disease burden remains
[60] Lesson learnt from 60 years of liver transplantation: Advancements ... — Abstract Over the past six decades, liver transplantation (LT) has evolved from an experimental procedure into a standardized and life-saving intervention, reshaping the landscape of organ transplantation. Driven by pioneering breakthroughs, technological advancements, and a deepened understanding of immunology, LT has seen remarkable progress. Some of the most notable breakthroughs in the
[62] Diagnosis and Treatment of Liver Disease: Current Trends and Future ... — Liver diseases, ranging from viral hepatitis and non-alcoholic fatty liver disease (NAFLD) to cirrhosis and hepatocellular carcinoma (HCC), pose significant global health challenges. The heightened risk of HCC in advanced liver disease stages further underscores the urgency of effective diagnostic and therapeutic interventions. Through continued research, technological advancements, and a commitment to holistic patient care, we pave the way for a future where liver diseases are detected early, managed effectively, and, ultimately, prevented. In liver health, understanding genetic markers enables healthcare providers to customize diagnostic approaches, predict disease trajectories, and optimize treatment strategies for each patient . Identifying characteristics that predict response to antiviral medicines in hepatitis or immunomodulatory treatments in autoimmune liver diseases allows for a personalized approach that maximizes efficacy and minimizes side effects .
[64] Ancient Babylonian Medicine - Health and Fitness History — Ancient Babylonian medicine revolved heavily around magic and incantations with little scientific process aside from diagnoses and prognoses. ... This information is revealed primarily through Assyrian copies of Babylonian texts thought to originate in the first half of the 2nd millennium BC. ... Babylonians would even use the word "liver
[65] THE MEDICINE OF THE BABYLONIANS AND ASSYRIANS ... - ScienceDirect — The medicine cf Babylonia-Assyria reaches its limit in the description of the symptoms, but. on the other hand, this lack of differentiation in the diagnosis is com- pensated for by the large number of remedies proposed, which it is fair to presume reflect the experience spread over long periods which taught the physicians to be prepared for
[94] Therapeutic endoscopy: Recent updates and future directions — This review article aims to shed light on the recent advances and future trajectories of therapeutic endoscopy, focusing on pivotal areas such as third space endoscopy, endoscopic resection techniques, artificial endoscopy, endoscopic ultrasound (EUS), the integration of artificial intelligence (AI), and endoscopic anti-reflux therapies. This article endeavours to illuminate the prospective directions in the field of therapeutic endoscopy, with an emphasis on critical areas such as third space endoscopy (TSE), advanced endoscopic resection techniques, applications of artificial intelligence (AI) in endoscopy, endoscopic ultrasound (EUS), and the nascent disciplines of endoscopic anti-reflux procedures (EART), and robotic endoscopy. Safety and efficacy of underwater versus conventional endoscopic mucosal resection for colorectal polyps: systematic review and meta-analysis of RCTs
[95] Diagnostic and therapeutic role of endoscopic ultrasound in liver ... — EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases. ... therapeutic methods for managing GV include medical techniques, endoscopic interventions, and interventional radiology-guided procedures, such as transjugular intrahepatic portosystemic shunt
[96] A State-of-the-Art Review on the Evolving Utility of Endoscopic ... — EUS-guided imaging and biopsy techniques in liver diseases have shown consistent favorable promising results among the reports through the literature, with an excellent diagnostic yield and safety profile, especially in the context of focal lesions and portal hypertension. ... The application of EUS in the diagnosis of liver diseases is a
[100] Glucagon-like peptide-1 receptor agonists and risk of major adverse ... — A placebo-controlled randomised phase II trial of 320 patients with MASH reported that the proportion achieving MASH resolution without worsening fibrosis after 72 weeks was more than tripled in the arm receiving 0.4 mg of the GLP1 agonist semaglutide compared with placebo (59% vs 17%). 14 We followed patients with any chronic liver disease and
[101] GLP-1 Receptor Agonists in Non-Alcoholic Fatty Liver Disease: Current ... — GLP-1 receptor agonists have been shown to be effective in reducing body weight, liver injury indices, and liver fat content. Several evidences also suggest that these drugs are able to promote the resolution of steatohepatitis in a non-negligible proportion of patients with NASH and to reduce progression of hepatic fibrosis.
[102] Review of Current and Potential Treatments for Chronic Hepatitis B ... — Recent advances in drug therapy have heralded a new horizon of novel therapeutic approaches for chronic HBV infection, with several promising antiviral and immunomodulatory agents currently in preclinical or clinical testing. ... Byrne R, Carey I, Agarwal K. Tenofovir alafenamide in the treatment of chronic hepatitis B virus infection
[103] Recent Advances in Hepatitis B Treatment - PubMed — Hepatitis B virus infection affects over 250 million chronic carriers, causing more than 800,000 deaths annually, although a safe and effective vaccine is available. ... ide analogues, have major drawbacks and fail to completely eradica … Recent Advances in Hepatitis B Treatment Pharmaceuticals (Basel). 2021 May 1;14(5):417. doi: 10.3390
[114] Automated abdominal CT imaging biomarkers and clinical ... - Springer — Objective To quantify the potential of fully automated CT-based body composition metrics and clinical frailty data in predicting liver transplant recipient postoperative outcomes. Methods AI-enabled body composition tools were applied to pre-transplant abdominal CT scans in a retrospective cohort of first-time deceased-donor liver transplant recipients. Clinical frailty data (Fried frailty
[115] Pretransplantation Imaging Workup of the Liver Donor and Recipient — Liver transplantation requires thorough preoperative imaging. Contrast enhanced computed tomography (CT) and MR imaging are the main modalities utilized for this purpose. Radiation-reducing protocols, advanced imaging techniques for evaluation of parenchymal fat and iron content, and 3-dimenionsal and volumetric reformations are routinely used. The helpful diagnostic radiologist has a complete
[116] Expectations from imaging for pre-transplant evaluation of living donor ... — Detailed pre-operative assessment of the vascular and biliary anatomy is crucial for safe and successful harvesting of the graft and transplantation. Computed tomography (CT) and magnetic resonance imaging (MRI) are currently the imaging modalities of choice in pre-operative evaluation.
[121] Novel biomarkers for the management of chronic hepatitis B — As chronic hepatitis B (CHB) can progress to cirrhosis and hepatocellular carcinoma (HCC), it is important to manage CHB to prevent HCC development in high-risk patients with high viral replicative activity or advanced fibrosis. Serum biomarkers are noninvasive and valuable for the management of CHB.
[122] The role of different viral biomarkers on the management of chronic ... — Chronic hepatitis B infection is a major public health challenge. With the advancement in technology, various components of the viral cycle can now be measured in the blood to assess viral activity. In this review article, we summarize the relevant data of how antiviral therapies impact viral biomarkers, and discuss their potential implications.
[123] Newer Diagnostic Virological Markers for Hepatitis B Virus Infection — Quantitation of HBV DNA is essential for guiding treatment decisions, monitoring treatment response and may indicate the emergence of resistance variants. ... Seto WK, Fung J, et al. New biomarkers of chronic Hepatitis B. Gut Liver. 2019;13(6):589-595. doi: 10.5009/gnl18425. ... Sun F, Xia W, Ouyang Y. Research progress on detection methods
[125] Human Gut Microbiome and Liver Diseases: From Correlation to Causation ... — Specific patterns of gut microbiota have been identified in liver diseases with different causes, including alcoholic, non-alcoholic, and virus induced liver diseases, or even at different stages, ranging from steatohepatitis, fibrosis, cirrhosis, to hepatocellular carcinoma. Gut microbiota has been shown to impact liver diseases through producing metabolic products and modulating host immune responses . | Mutlu et al., 2012, Am J Physiol Gastrointest Liver Physiol | Human sigmoid mucosa biopsy | ALD | Multitag-pyrosequencing | The first study showing the association between alcohol consumption and microbiome using non-culture method in human. 213.Li Z., Yang S., Lin H., Huang J., Watkins P.A., Moser A.B., Desimone C., Song X.Y., Diehl A.M. Probiotics and antibodies to TNF inhibit inflammatory activity and improve nonalcoholic fatty liver disease.
[126] Host-microbiome interactions: Gut-Liver axis and its ... - Nature — An understanding of connections between gut microbiome and liver has provided important insights into the pathophysiology of liver diseases. Since gut microbial dysbiosis increases gut
[127] Types of Liver Disease: Causes, Symptoms, & Treatment - Verywell Health — Hepatitis is the most common form of liver disease. However, recent data points to non-alcoholic fatty liver disease and liver disease caused by alcohol overuse as other types of liver disease that are on the rise.
[128] The most common liver diseases — This type of fatty liver disease is not related to heavy alcohol use. When there is fat build up, but before there is any inflammation or liver cell damage, it is called simple fatty liver. ... The most common genetic liver diseases are hemochromatosis, Wilson's disease and Alpha-1 antitrypsin deficiency.
[129] Liver Disease: Types of Liver Problems, Causes, and More - Healthline — Several autoimmune conditions involve your immune system attacking cells in your liver, including:
[130] Liver Disease: Types of Liver Problems and Their Causes - WebMD — What Is Liver Disease? Some types of liver disease, like hepatitis C, can often be cured. Types of Liver Disease There are several types of liver disease. Itâs most common among people who drink a lot for a long time, but you donât have to be dependent on alcohol to get alcohol-associated liver disease. This the most serious alcohol-associated liver disease. Liver Disease Symptoms Can Liver Disease Be Reversed? Liver Disease in Children Liver Disease Causes Liver Disease Diagnosis Liver Disease Treatment Liver Disease: What You Can Do at Home What are the most serious liver diseases? All liver diseases are serious, but cirrhosis is quite serious. What is the first stage of liver disease? More on Fatty Liver Disease
[131] What are some different types of liver diseases? - Medical News Today — Some types of liver disease may result from inheriting genetic alterations. Genetic liver disease is typically less common than other forms of liver disease. Genetic liver conditions can lead to
[133] Expanding the National Approach to Chronic Disease Education and ... — Chronic liver disease. Background: Chronic liver disease is the progressive deterioration of healthy liver function. In 2022, it was the 10 th leading cause of death in the United States, accounting for nearly 55,000 deaths. Funded project: LIVERWISE: Healthy Liver, Healthy Life! Recipient: National Alliance for Hispanic Health Approach: Through community-driven efforts, LIVERWISE aims to
[136] Separating Gastroenterology Myths from Reality in Liver Disease ... — One of the most common misconceptions is that only chronic alcohol consumers fall prey to liver disease. Although heavy alcohol use is a significant risk factor for liver damage, it is not the sole cause. Liver disease can also stem from various other causes like viral infections (hepatitis B and C), autoimmune diseases, genetic disorders
[138] Get the Facts - Exposing 5 Common Myths About Liver Disease — To increase awareness, five of the most frequently encountered misconceptions about liver disease are revealed and corrected. Liver disease severity ranges dramatically; it can be reversible, mild and manageable, or it can progress in severity into a debilitating and fatal condition. ... 5 of the Most Common Liver Disease Myths.
[153] Expanding community engagement and advocacy in chronic viral hepatitis — Community engagement and advocacy are important to drive development and improvement of service delivery for chronic viral hepatitis. Community engagement is defined as the process of working collaboratively with groups of people affiliated by proximity, interests, or situations to support their wellbeing.1 Appropriate community engagement can help to reduce stigma, disseminate messages, and
[154] Community engagement: a health promotion guide for universal health ... — WHO has defined community engagement as "a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes". There are undeniable benefits to engaging communities in promoting health and wellbeing.
[173] Hepatology: Role, Diseases and Treatments - Medicover Hospitals — Precision medicine aims to tailor treatment based on individual patient characteristics, such as genetic makeup and disease phenotype. In hepatology, precision medicine approaches are being explored to identify biomarkers for disease stratification and treatment response. This approach holds the promise of more effective and personalized
[174] Evaluation of biological therapies in autoimmune hepatitis: A case ... — Background: Autoimmune hepatitis (AIH) is typically treated with immunomodulators and steroids. However, some patients are refractory to these treatments, necessitating alternative approaches. Biological therapies have recently been explored for these difficult cases.
[176] Advancements in autoimmune hepatitis management: Perspectives for ... — Recent comparative studies have shown higher CBR rates, lower therapeutic failure rates, and reduced intolerance in the MMF group. These findings may influence future guidelines, potentially leading to a significant modification in the first-line treatment of autoimmune hepatitis.
[179] Chronic hepatitis B infection with concomitant hepatic steatosis ... — The evidence indicates that CHB patients should manage their lifestyle to prevent the incidence of NASH. ... future studies will provide novel strategies for the clinical management and treatment of CHB concomitant with NAFLD. ... Thyroid function is associated with non-alcoholic fatty liver disease in chronic hepatitis B-infected subjects. J
[180] The 2024 updated WHO guidelines for the prevention and management of ... — Progress towards global elimination of hepatitis B virus (HBV) has been slow and most countries are far from reaching the elimination targets set out by the World Health Organization (WHO). The burden of chronic hepatitis B is mainly borne by resource-limited countries where only a minority of people living with HBV are diagnosed and treated and international guidelines are hardly applicable
[182] The 2024 updated WHO guidelines for the prevention and management of ... — In 2016, following the release of its first guidelines for the prevention, diagnosis, care and treatment of people living with chronic hepatitis B (CHB), the World Health Organization (WHO) launched a strategic plan to eliminate hepatitis B virus (HBV) by 2030. 1, 2 However, almost a decade after this major public health initiative, and with only 6 years left to accelerate the HBV elimination
[184] Artificial intelligence applied to 'omics data in liver disease ... - Gut — Advancements in omics technologies and artificial intelligence (AI) methodologies are fuelling our progress towards personalised diagnosis, prognosis and treatment strategies in hepatology. This review provides a comprehensive overview of the current landscape of AI methods used for analysis of omics data in liver diseases. We present an overview of the prevalence of different omics levels
[185] Precision Medicine for Hepatocellular Carcinoma: Clinical Perspective — However, one of the major obstacles to implementing precision medicine for HCC patients is a reluctance to perform diagnostic biopsies . One reason for this is that diagnostic imaging combined with α-fetoprotein is highly sensitive and specific for HCC. Another reason is the risk of tumor seeding via the biopsy tract .
[187] Challenges in Implementing Precision Medicine — Despite its potential, implementing precision medicine on a broad scale faces numerous challenges. These range from technological and ethical issues to economic and accessibility barriers. This blog will explore the key obstacles hindering the widespread adoption of precision medicine and propose practical solutions to overcome these barriers.
[189] Future of Chronic Hepatitis B Infection Therapies - Gastro Hep Advances — The future of CHB treatment is headed toward the use of combination therapy, where different drugs target different modes of HBV infection and may require up to 4 viral targets. A CpAM known as ABI-H0731 has been studied in combination with a NA (entecavir).
[196] Online Training - Hepatitis B Foundation — The Hepatitis B Foundation and HepBcommunity.org provide this training hub for people around the world who want to participate in awareness of and education/programming on hepatitis B and hepatitis delta (hepatitis D). The core curriculum offers a personalized certificate upon completion of the course.
[197] About the Hepatitis Outreach Network (HONE) - Icahn School of Medicine ... — Hepatitis Outreach Network (HONE) is a community viral hepatitis prevention, screening and link to care program focused on adult, immigrant, and minority groups in New York City who are at risk for chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV). The goals and objectives of HONE are to:
[199] The role of lifestyle factors on comorbidity of chronic liver disease ... — We found that high-risk lifestyle factors played a key role in all disease transition stages from healthy to first CLD (FCLD), to liver-cardiometabolic comorbidity (LCC), and then to death, with different magnitude of associations. Lifestyle factors showed stronger associations with transition from baseline to FCLD than from FCLD to LCC.
[201] Lifestyle and Pharmacologic Approaches to Prevention of Metabolic ... — The rising number of individuals with MASLD at risk for HCC underscores the need for effective prevention strategies in this population. MASLD-related HCC disproportionately impacts racial and ethnic minority and low socioeconomic status populations, also exacerbating disparities in liver disease burden and mortality. 67 Whereas hepatitis B virus vaccination and anti-viral treatment programs
[202] AGA Clinical Practice Update on Lifestyle Modification Using Diet and ... — Lifestyle modifications, which include diet and physical activity to achieve weight loss, are the cornerstone of treatment for NAFLD. Additionally, restriction or elimination of alcohol consumption and optimal management of cardiometabolic comorbidities are also highly important.
[211] The rise of multidisciplinary clinics in hepatology: A practical, how ... — Multidisciplinary clinics (MDCs) are gaining momentum throughout the medical field, having initially been pioneered in oncology clinics due to their inherent ability to streamline complex care and improve both patient outcomes and the patient care experience. Liver transplant and hepatobiliary tumor …
[212] PDF — hepatology through the integration of multi-omics data. This approach combines genomics, proteomics, metabolomics, and other -omics data to provide a comprehensive molecular understanding of liver diseases. In MAFLD, integrative multi-omics unravels the complex interplay between genetic predisposition, environmental factors, and metabol-
[213] Hepatology Genome Rounds: An interdisciplinary approach to integrate ... — Hepatology Genome Rounds: An interdisciplinary approach to integrate genomic data into clinical practice David H. Chung 1, Melanie Zheng , Allen E. Bale2, Sílvia Vilarinho ,3* Summary In the last decade, the utility of whole-exome sequencing in uncovering genetic aetiologies of a variety of liver diseases has been demonstrated.
[214] Hepatology Genome Rounds: An interdisciplinary approach to integrate ... — Lastly, for patients in whom WES does not produce any actionable variants, reanalysis of the exome is indicated every 1-2 years,(30-32) given the rapid growth in available genetic data, updates to human genome alignment, variant calling, and annotation programs, human liver single cell atlases(33, 34), and new genetic variant classification and genotype-phenotype correlation information by other laboratories.(35) If VUSs or heterozygous variants in genes associated with recessive diseases(28) result from reanalysis, these cases should undergo clinical correlation in Hepatology Genome Rounds (Figure 1).
[215] Integrating Genetic Data into Electronic Health Records: Medical ... — The integration of genetic data into the EHRs can be useful for clinical practices, teaching clinical genetics, conducting genetic research, and saving time and cost. However, given the complexity of genetic data and the differences between these data and other clinical data, the process of integration seems difficult .
[216] Hepatology Genome Rounds: An interdisciplinary approach to integrate ... — Hepatology Genome Rounds: vision and goals Our Hepatology Genome Rounds series was launched with the vision that individual genomic analysis and its review and dis-cussion in a multidisciplinary forum would assist in under-standing why an individual develops chronic liver disease, facilitating optimal patient management and prognostication.
[217] Multidisciplinary management of hepatocellular carcinoma: a model for ... — A multidisciplinary model is a useful approach in the management of hepatocellular carcinoma (HCC) to coordinate, individualize, and optimize care. The HCC Multidisciplinary Team (MDT) at Temple University Hospital was established in 2008 and comprises hepatologists, interventional radiologists, transplant surgeons, oncologists, residents
[221] PDF — Summary of the role and effectiveness of multidisciplinary treatment approaches in current international guidelines of HCC Study societies EASL 6 (2018) BCLC 7 (2022) KLCA-NCC 8 (2022) AASLD 9 (2023) Diagnosis and staging Recommends local multidisciplinary board discussion for tiny typical lesions Multidisciplinary approach is key from diagnosis to treatment strategy For probable HCC, consider follow-up imaging or biopsy within 3 months Multidisciplinary discussion for treatment plan Advises multidisciplinary discussion for optimal follow-up of LR-4 observation and consideration of biopsies for LR-4 and LR-5 Emphasizes multidisciplinary tumor board for tumor staging Team composition Implies involvement of various specialties Includes expert radiologists, interventional radiologists, radiation oncologists, pathologists, nurses, clinicians, surgeons, palliative care specialists, and social workers Includes hepatologists, gastroenterologists, surgeons, radiologists, oncologists, and other medical practitioners Includes hepatologists, radiologists, pathologists, surgeons, oncologists, nurses, social workers, and palliative care providers Treatment Multidisciplinary teams for tailored treatment options Multidisciplinary discussions for best treatment option due to heterogeneity Multidisciplinary approach key to improving satisfaction, reducing progression, prolonging survival Managed in multidisciplinary care setting Specific treatment Considerations Stage migration strategy pending multidisciplinary decision No single surgical modality suits all HCC presentations A multidisciplinary approach is essential TACE should be considered for patients with segmental portal vein tumor invasion in multidisciplinary team sessions The use of SIRT vs.
[223] Multidisciplinary approach for HCC patients: hepatology for the ... — Hepatocellular carcinoma (HCC) is a complex and heterogeneous disease, often associated with underlying conditions, like cirrhosis or other relevant co-morbidities that worsen the prognosis and make the clinical management more challenging. Current recommendations emphasize the importance of a multidisciplinary approach for the management of HCC patients and stress the crucial role of careful
[229] Interdisciplinary perspectives on the co-management of metabolic ... — This Review takes an interdisciplinary approach, drawing on hepatology, cardiology, endocrinology, and metabolic and internal medicine specialists to help to delineate the intricate interplay between MASLD and coronary artery disease. It sheds light on novel opportunities for targeted interventions and personalised management strategies.
[251] Gastroenterology and Hepatology - JAMA Network — Explore the latest in gastroenterology and hepatology, including recent advances in treatment of viral hepatitis and of GI and pancreatic cancers. ... This comparative effectiveness research study compares the associations of neoadjuvant chemoimmunotherapy and neoadjuvant chemoradiotherapy with tumor regression and long-term survival in
[252] Liver organoids: Current advances and future applications for ... — Instead, liver organoids have revolutionized the field of hepatology, extending their influence into various domains of precision and molecular medicine. ... we focus on recent advancements in liver organoid research and their applications, including disease modeling, drug screening, and regenerative medicine. ... recent research has explored
[253] About Our Research - Clinical Hepatology Research Section - NIDDK — Our research team conducts long-term outcome and proof-of concept studies that provide opportunity for translational research, for which the existing NIH infrastructure is ideally conducive. Within this environment, the team has collaborated extensively with basic scientists in the Liver Diseases Branch (LDB) and NIH to complement our clinical
[254] CDC Collaborates Worldwide to Eliminate Viral Hepatitis — Vision: CDC's overall vision is to eliminate viral hepatitis as a global public health threat. Strategic directions: CDC has four key strategic directions building toward our vision. Provide technical assistance and leadership for global viral hepatitis elimination initiatives. Create sustainable partnerships with collaborative approaches to eliminate viral hepatitis.
[255] Viral Hepatitis National Strategic Plan - HHS.gov — The Viral Hepatitis National Strategic Plan: A Roadmap to Elimination 2021-2025 (Viral Hepatitis Plan or Plan) provides a framework to eliminate viral hepatitis as a public health threat in the United States by 2030. Learn more about the Plan. Vision
[256] Viral Hepatitis National Strategic Plan Overview - HHS.gov — Viral Hepatitis National Strategic Plan Overview | HHS.gov Viral Hepatitis National Strategic Plan Overview The Plan provides goal-oriented objectives and strategies that can be implemented by a broad mix of stakeholders at all levels and across many sectors, both public and private, to reverse the rates of viral hepatitis, prevent new infections, improve care and treatment and ultimately eliminate viral hepatitis as a public health threat in the United States. Seeks to implement universal hepatitis C screening guidelines, hepatitis B testing, and linkage to care in a range of settings and expand the capacity of the public health and provider workforce to provide viral hepatitis prevention, testing, care and treatment services Subscribe to email updates for the latest information about viral hepatitis.
[257] Viral Hepatitis National Strategic Plan Goals, Objectives, and ... — Viral Hepatitis National Strategic Plan Goals, Objectives, and Strategies | HHS.gov Strategy 1.4.1 Educate communities and individuals about substance use disorders, available prevention, harm reduction and treatment options, and associated risks including transmission of viral hepatitis, HIV, and STIs. Strategy 1.4.2 Expand access to viral hepatitis prevention and treatment services by providing screening, vaccination, and linkage to care in a broad range of health care delivery and community-based settings. Objective 2.2: Improve the quality of care and increase the number of people with viral hepatitis who receive and continue (hepatitis B) or complete (hepatitis C) treatment, including people who use drugs and people in correctional settings
[259] Recent updates on pharmacologic therapy in non-alcoholic fatty liver ... — An update on current pharmacological therapies for non-alcoholic fatty liver disease is summarized in Figure. Several agents, including THR-ß-selective agonist, antidiabetic drugs, and FGF21 agonists show promise as new therapeutics for NASH, and their efficacy in improving both inflammation and fibrosis, with a long-term safety profile, is
[260] Advancements in the treatment of non-alcoholic fatty liver disease ... — Non-alcoholic fatty liver disease (NAFLD) is a series of diseases, involving excessive lipid deposition in the liver and is often accompanied by obesity, diabetes, dyslipidemia, abnormal blood pressure, and other metabolic disorders. ... this review article has comprehensively discussed the research advancements in NAFLD treatment in recent
[261] Advancements in Diagnostic and Therapeutic Interventions of Non ... — Fatty liver disease encompasses a spectrum of hepatic pathology, ranging from simple steatosis to non-alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma, and end-stage liver disease. The most recent guidelines suggest the management and treatment of patients with NAFLD considering both the liver disease and the associated metabolic
[263] What's New in the Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD ... — Non-alcoholic fatty liver disease (NAFLD) is a serious health problem due to its high incidence and consequences. In view of the existing controversies, new therapeutic options for NAFLD are still being sought. Therefore, the aim of our review was to evaluate the recently published studies on the tr …
[264] Liver organoids: Current advances and future applications for ... — Instead, liver organoids have revolutionized the field of hepatology, extending their influence into various domains of precision and molecular medicine. These 3D cultures, capable of replicating key features of human liver function and pathology, have opened new avenues for human-relevant disease modeling, CRISPR gene editing, and high
[265] Advances in liver organoids: replicating hepatic complexity for ... — The intrinsic advantages of liver organoids include higher sensitivity and suitability for long-term studies, which enhance the predictive value in drug and nanomaterial toxicity testing. The integration of liver organoids with microfluidic devices enables the simulation of the liver microenvironment and facilitates high-throughput drug screening.
[266] Liver organoids: Current advances and future applications for hepatology — One of the key advantages of liver organoids in disease modeling is their physiological relevance. Unlike 2D culture systems and animal models, liver organoids recapitulate the cellular microenvironment and heterogeneity of the human liver in a context that closely mimics in vivo conditions. This capability is particularly valuable in chronic
[267] Direct Orthotopic Implantation of Hepatic Organoids - PMC — Liver organoids show promise for development as a tissue replacement therapy for patients with end-stage liver disease, but efficient methods for introducing organoids into host livers have not been established. In this study, we aimed to develop a surgical technique to implant hepatic organoids into the liver and assess their engraftment. Methods
[268] Liver organoids: From 3D printing to biomedical applications — Continued research and development efforts are crucial to address the existing challenges and advanced liver organoid technology towards clinical translation, ultimately benefiting patients and improving liver-related healthcare outcomes.
[270] Oncolytic virus VG161 in refractory hepatocellular carcinoma — Results of a multicentre phase 1 clinical trial evaluating treatment with the engineered herpes simplex virus VG161 in advanced liver cancer indicate a good safety profile and promising efficacy.
[271] Treatment Strategies for Advanced Hepatocellular Carcinoma From ASCO GI ... — A retrospective study including patients with advanced hepatocellular carcinoma (HCC) who received first-line atezolizumab plus bevacizumab (ate + bev) at 4 centers in Taiwan showed promising overall survival (OS) rates at 3, 4, and 5 years. In an open-label phase 2 trial involving patients with unresectable, locally advanced, or metastatic HCC, Li et al found that triplet blockade of interleukin (IL)-27, programmed death-ligand 1 (PD-L1), and vascular endothelial growth factor (VEGF) pathways using casdozokitug combined with ate + bev “continues to show a manageable safety profile with promising antitumor activity… that warrants continued exploration,” and no new safety signals were identified.5 What are the potential clinical implications of these findings, and what further studies are ongoing or planned regarding this regimen?
[273] Emerging Therapies for Advanced Cholangiocarcinoma: An Updated ... — Cholangiocarcinoma is a group of malignancies with poor prognosis. Treatments for the management of advanced-stage cholangiocarcinoma are limited, and the 5-year survival rate is estimated to be approximately 5-15%, considering all tumor stages. There is a significant unmet need for effective new treatment approaches.