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Nonalcoholic fatty liver disease (NAFLD) is a multisystemic disease and a rapidly growing cause of chronic liver disease in children and adults worldwide. Diagnosis and management of extrahepatic manifestations of NAFLD, including cardiovascular disease (CVD), type 2 diabetes mellitus, metabolic syndrome, chronic kidney disease, obstructive sleep apnea, polycystic ovarian syndrome, hypothyroidism, psoriasis, and extrahepatic malignancy are crucial for the treatment of patients with NAFLD. The leading cause of death in NAFLD is primarily from CVD, followed by liver-related mortality, extrahepatic cancer, liver cancer, and diabetes-related mortality. Therefore, clinicians need to identify high-risk patients earlier in the disease course and be aware of the extrahepatic manifestations of NAFLD to improve liver disease outcomes. In this review, we focus on the monitoring and management of the extrahepatic manifestations of NAFLD.
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Korean J Hepatol 2009;15(1):70-79. Published online March 31, 2009
Backgrounds/Aims The ultimate goal of antiviral therapy using interferon/pegylated interferon combined with ribavirin in chronic C-viral hepatitis is to achieve a sustained virologic response (SVR). Several studies have shown that the reappearance rate of hepatitis C virus (HCV) RNA in serum after the achievement of an SVR is less than 1%; the durability of an SVR in Korean patients is not known. The aim of this study was to determine the durability of the virologic response in chronic hepatitis C patients with an SVR to antiviral therapy. Methods: A total of 156 patients who were treated successfully with interferon/peginterferon and ribavirin were evaluated retrospectively. Patients received either subcutaneous conventional interferon alpha 3×10(6) units three times a week or subcutaneous pegylated interferon (α-2a: 180 μg, α-2b: 80-100 μg) once a week in combination with ribavirin at 600-1,200 mg daily (depending on body weight). Patients with HCV genotype 1 were treated for 48 weeks, whereas those with non-genotype 1 were treated for 24 weeks. Results: Eighty-two patients underwent treatment with conventional interferon and ribavirin, whereas 74 patients were treated with pegylated interferon and ribavirin. An SVR was achieved in 73 patients (73/156, 46.8%). HCV RNA reappeared in eight patients (8/73, 11.0%, detected by qualitative PCR), including one patient with persistent viremia (1/73, 1.4%). Conclusions: Reappearance of HCV RNA after earlier achievement of an SVR might appear more frequently than previously reported. Close follow-up of these patients is recommended and the implication of temporary viremia should be determined in the future. (Korean J Hepatol 2008;15:70-79)
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Risk of Late Relapse or Reinfection With Hepatitis C Virus After Achieving a Sustained Virological Response: A Systematic Review and Meta-analysis Bryony Simmons, Jawaad Saleem, Andrew Hill, Richard D. Riley, Graham S. Cooke Clinical Infectious Diseases.2016; 62(6): 683. CrossRef
Efficacy of Peginterferon and Ribavirin Combination Therapy of Chronic Hepatitis C: A Pooled Analysis Soo Yong Park, Min Young Rim, In Ku Yo, Min Su Ha, Ju Seung Kim, Ji Won Lee, Young Kul Jung, Oh Sang Kwon, Yun Soo Kim, Duck Joo Choi, Ju Hyun Kim The Korean Journal of Gastroenterology.2012; 60(5): 306. CrossRef
Longitudinal changes of the laboratory data of chronic hepatitis C patients with sustained virological response on long‐term follow‐up D. Maruoka, F. Imazeki, M. Arai, T. Kanda, K. Fujiwara, O. Yokosuka Journal of Viral Hepatitis.2012;[Epub] CrossRef
Chronic Hepatitis C Jae Young Jang, Raymond T. Chung Gut and Liver.2011; 5(2): 117. CrossRef
Durability of a sustained virologic response in patients with chronic hepatitis C treated with peginterferon and ribavirin Kyung-Ah Kim The Korean Journal of Hepatology.2011; 17(1): 84. CrossRef
Durability of antiviral therapy for chronic hepatitis C after achieving sustained virological response Jeong Heo The Korean Journal of Hepatology.2011; 17(3): 180. CrossRef
Durability of a sustained virological response in chronic hepatitis C patients treated with pegylated interferon alfa and ribavirin Sang Bun Choi, Youn Jae Lee, Jae Ik Lee, Young Jin Song, Byoung Jin Choi, Jong Han Kim, Eun Uk Jung, Sung Jae Park, Sang Heon Lee, Ji Hyun Kim, Jung Sik Choi, Sam Ryong Jee, Sang Yong Seol The Korean Journal of Hepatology.2011; 17(3): 183. CrossRef
Durability of Sustained Virologic Response in Chronic Hepatitis C: Analysis of Factors Related to Relapse after Sustained Virologic Response with Peginterferon Plus Ribavirin Combination Therapy Jang Eun Lee, Na Ri Yoon, Jin Dong Kim, Myeong Jun Song, Jung Hyun Kwon, Si Hyun Bae, Jong Young Choi, Sung Won Jeong, Seung Kew Yoon The Korean Journal of Gastroenterology.2011; 57(3): 173. CrossRef
Long-Term Effects of Antiviral Therapy in Patients with Chronic Hepatitis C Tatehiro Kagawa, Emmet B. Keeffe Hepatitis Research and Treatment.2010; 2010: 1. CrossRef
Background/Aims Combination therapy with peginterferon and ribavirin is a standard therapy for western patients with chronic hepatitis C; however, its efficacy remains unclear in East Asian patients. We evaluated the efficacy and safety of administering peginterferon alfa-2a plus ribavirin in native Korean patients with chronic hepatitis C. Methods: Seventy-five patients with detectable HCV RNA (52.0% male, median age: 50.8 years) were eligible for the study. The patients were treated with peginterferon alfa-2a 180 mcg/week plus ribavirin 800 mg/day for 24 weeks (for genotype non-1, n=46) or 1000-1200 mg/day for 48 weeks (for genotype 1, n=29). The early virologic response (EVR), the end of treatment virologic response (ETVR), the sustained virologic response (SVR), the biochemical response and the adverse event were analyzed. Results: EVR was seen in 86.2% of the patients with genotype 1. The ETVR was 58.6% in the genotype 1 group and 84.8% in the genotype non-1 group (P=0.02). The overall SVR was 70.7%: 55.2% in the genotype 1 group and 80.4% in the non-1 group (P=0.04). The sustained biochemical response was 64.0%. Multivariate analysis showed that the baseline HCV RNA level (Odds ratio: 0.045, 95% CI: 0.011-0.183, P<0.001) and genotype (Odds ratio: 0.247, 95% CI: 0.063-0.969, P=0.045) had an independent effect on the SVR. Neutropenia, anemia, flu-like symptoms and itching were the common adverse events. Aggravated liver function led to discontinuation of therapy for six patients. Dose modification in twenty-nine patients was effective without producing a significant reduction of the SVR. Conclusions: Our data suggest that the efficacy of peginterferon plus ribavirin therapy in Koreans is comparable to those from studies on Western patients as an initial treatment for chronic hepatitis C patients. The baseline HCV RNA level and the genotype can be significant factors influencing the SVR. (Korean J Hepatol 2006;12:31-40)
Jeong Chul Seo, M.D., Won Joong Jeon, M.D., Sung Soon Park, M.D., Seok Hyung Kim, M.D.1,
Ki Man Lee, M.D., Hee Bok Chae, M.D., Seon Mee Park, M.D. and Sei Jin Youn, M.D.
Background/Aims Although many individual cases of toxic hepatitis have been reported in Korea, there are few comprehensive systematic studies on acute toxic hepatitis. The first aim of this study is to investigate the frequency and clinical characteristics of acute toxic hepatitis patients. The second aim of this study is to investigate the efficacy of steroid therapy for immunoallergic idiosyncrasy. Methods: Between March 1998 and March 2004 forty eight patients were included in this study. The medical records were reviewed retrospectively. Acute toxic hepatitis was diagnosed by score of more than 3 in RUCAM criteria. All the patients were tested for hepatitis A, B and C. Other tests included antibodies to CMV and EBV, ANA, AMA and SMA. Results: Seventy-three percent of the patients were female and the mean age of the patients was 47. Twenty cases of acute toxic hepatitis (42%) were related to prescribed medications. The other causes were herbs (35%) and traditional therapeutic preparations (23%). Common symptoms were jaundice (35%), fatigue (10%), fever (9%) and abdominal pain (9%). The biochemical pattern of hepatotoxicity was divided into three groups: hepatocellular (81%), mixed (13%), and cholestatic types (6%). Three patients who have prolonged and severe jaundice were classified into immunoallergic idiosyncrasy based upon clinical and histologic findings. Prednisolone was prescribed in all three cases whose bilirubin levels had been higher than 15 mg/dL for at least 7 days. Jaundice and the laboratory findings rapidly improved within 8 days since the treatment began. Conclusions: In a demographic point of view, most patients of acute toxic hepatitis were middle aged women. Jaundice was the most commonly observed symptom. Prescribed drugs were the most common cause of acute toxic hepatitis. Although most cases of toxic hepatitis will recover with supportive care after cessation of the causative agent, steroid treatment may be helpful for the patients with severe jaundice patients who have immunoallergic idiosyncrasy. (Korean J Hepatol 2006;12:74-81)
A 63-year-old HBsAg-positive male patient was admitted for the evaluation of a liver mass that was detected on ultrasonography. Spiral computed tomography (CT) revealed infiltrative hepatocellular carcinoma (HCC) in the right hepatic lobe with main portal vein tumor thrombosis. His liver function was Child-Pugh class A and the serum alpha fetoprotein level was 7,400 ng/mL. Transarterial chemoembolization (TACE) via the right hepatic artery was performed. Following 3 sessions of TACE every 2 months, spiral CT revealed no evidence of viable tumor. The thrombi within the main portal vein disappeared with performing localized hepatic infarction at the site of the previous tumor. He is still alive 15 months after the third TACE without evidence of recurred tumor and his liver function remains well preserved. This case suggests that TACE might be effective and safe even in the patients with infiltrative HCC with main portal vein tumor thrombosis, if the extent of the tumor is limited and the liver function and portal flow via the collaterals are preserved. (Korean J Hepatol 2006;12:107-111)
Primary biliary cirrhosis (PBC) is a chronic cholestatic autoimmune liver disease that predominantly affects middle-aged women. It is characterized by slowly progressive destruction of the small intrahepatic bile ducts together with portal inflammation, and this initially leads to fibrosis and later to cirrhosis. It is currently accepted that the pathogenesis of PBC is multifactorial with genetic and environmental factors interplaying to determine the disease onset and progression. In addition to antimitochondrial antibody (AMA), which is the hallmark of PBC and is detected in at least 90% of the patients, other autoantibodies (antinuclear antibody, anti-smooth muscle antibody and rheumatoid factor, etc.) may also be found in the patients. There is no correlation between the titer of AMAs and the disease severity. Most patients are diagnosed either during the asymptomatic phase of PBC or after presenting with non-specific symptoms. Pruritus and fatigue are the most common symptoms of PBC. The prognosis of PBC has improved significantly during the last few decades. Patients are now diagnosed earlier in its clinical course, they are more likely to be asymptomatic at diagnosis and they are more likely to receive medical treatment. A wide variety of drugs have been assessed for the treatment of this condition: such immunosuppressive agents as corticosteroids, cyclosporine and azathioprine have a weak effect on the disease’s natural history. Ursodeoxycholic acid (UDCA) is the only currently approved medical treatment. For PBC patients with end-stage liver disease or an unacceptable quality of life, liver transplantation is the only accepted therapeutic option. Early diagnosis and treatment of PBC are important because effective treatment with UDCA has been shown to delay disease progression and improve rate survival in the early stage.
Background/Aims Sclerosing hepatocellular carcinoma (HCC) is an unusual subtype of HCC that is
characterized by an embedded dense fibrous stroma in the tubular neoplastic structures. We aimed to
assess the surgical approaches and outcomes of sclerosing HCC. Methods: We retrospectively analyzed
the clinicopathologic features of 6 patients with sclerosing HCC who underwent surgical treatment at Asan
Medical Center between July 1989 and December 2005. Results: Six HCC patients with sclerosing HCC were
diagnosed out of the total 1390 HCC patients (0.43%) during the study period. The mean age was 58 years and
4 patients were male. Weight loss and abdominal pain were the most common symptoms. The serum calcium
and phosphorus levels were normal in all the patients. All of them were hepatitis B surface antigen-positive,
but none was positive for hepatitis C. All the lesions were solitary. The tumor size ranged from 45 to 150 mm
in diameter (median size: 81 mm). We performed right trisegmentectomy (n=1), central bisegmentectomy (n=1),
right anterior segmentectomy (n=1), ex-vivo resection and autotransplantation (n=1) and right posterior
segmentectomy (n=2). The median overall survival and disease free-survival periods were 24 months and 9.5
months, respectively. Conclusions: The incidence of sclerosing HCC was very low. Sclerosing HCC was often
not correctly diagnosed before an operation, but performing resection prolonged the patients’ survival and their
prognosis was not worse than that for ordinary HCC. Our experience implicates that aggressive surgical
treatment for sclerosing HCC is beneficial for patient survival. (Korean J Hepatol 2006;12:412-419)