Acute-on-chronic liver failure (ACLF): pathophysiological mechanisms and clinical management.
Nature 2025
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✳️ The Top Five Recommendations Physicians and Patients Should question include:
▶️ Don't order serum ammonia to diagnose or manage hepatic encephalopathy (HE).
▶️ Don't routinely transfuse fresh frozen plasma, vitamin K, or platelets to reverse abnormal tests of coagulation in patients with cirrhosis prior to abdominal paracentesis, endoscopic variceal band ligation, or any other minor invasive procedures.
▶️ Don't order HFE genotyping based on serum ferritin values alone to diagnose hereditary hemochromatosis.
▶️ Don't perform computed tomography (CT) or magnetic resonance imaging (MRI) routinely to monitor benign focal liver lesions.
▶️ Don't repeat hepatitis C viral load testing in an individual who has established chronic infection, outside of anti- viral treatment.
▶️ Don't order serum ammonia to diagnose or manage hepatic encephalopathy (HE).
▶️ Don't routinely transfuse fresh frozen plasma, vitamin K, or platelets to reverse abnormal tests of coagulation in patients with cirrhosis prior to abdominal paracentesis, endoscopic variceal band ligation, or any other minor invasive procedures.
▶️ Don't order HFE genotyping based on serum ferritin values alone to diagnose hereditary hemochromatosis.
▶️ Don't perform computed tomography (CT) or magnetic resonance imaging (MRI) routinely to monitor benign focal liver lesions.
▶️ Don't repeat hepatitis C viral load testing in an individual who has established chronic infection, outside of anti- viral treatment.
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metabolic-dysfunction-associated-steatotic.pdf
6.2 MB
Metabolic dysfunction-associated steatotic liver disease and steatohepatitis-associated hepatocarcinoma preclinical models.
nature reviews gastroenterology & hepatology Jan 2026
Effect of prebiotics on gastrointestinal symptoms and quality of life in children with intestinal failure: A pilot study.
PDF
Journal of Pediatric Gastroenterology and Nutrition August 2025
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✳️ The Challenge of Anticoagulation in Liver Cirrhosis
▶️ A systematic review that included 11 studies determined there was a significantly increased risk of pulmonary embolism and DVT) in patients with cirrhosis compared with controls
▶️ patients with cirrhosis are at a higher risk of developing DVT than the general population - An even higher risk is reported in patients with cirrhosis due to non-alcoholic steatohepatitis
▶️ patients with cirrhosis who suffer from concomitant AF have higher in-hospital mortality rates compared to those who do not. DOACs prescribed in sub-therapeutic doses,are effient, in terms of both bleeding and thrombotic complications
▶️ patients with decompensated cirrhosis experiencing some level of chronic kidney disease (CKD) in a percentage of > 45% in a recent study ,Regarding CKD, recent guidelines regarding the management of atrial fibrillation encourage the use of DOACs even in patients with a glomerular filtration rate (GFR) of 15 to 30 mL/min, in a reduced dose
▶️ AC DOACs is safe and effective in patients with cirrhosis. AC may in future be regarded as a therapeutic regimen for patients with cirrhosis, preventing decompensation and increasing survival.
▶️ The European Association for the Study of the Liver (EASL) recommends that patients with cirrhosis who are at risk of VTE receive LMWH
▶️ Each DOAC has a different hepatic excretion rate (, 65 percent for rivaroxaban, , and 75 percent for apixaban), but warfarin has a 100 percent hepatic excretion rate, implying more predictable pharmacokinetics for DOACs in liver cirrhosis
▶️ Anticoagulant therapy should not be used in patients with Child–Pugh Class C, which has a 1-year survival rate of less than 50% without a liver transplant.
▶️ An INR greater than 2.0 was previously thought to protect against VTE; however, more recent observations have disproved this theory.-It only evaluates the activity of several procoagulant components (FI, FII, FV, FVII, and FX), and not the activity of anticoagulant proteins C and S; therefore, INR does not appear to be a viable tool for monitoring hemostasis in cirrhotic patients.
▶️ the use of rivaroxaban, should be generally avoided in Child Pugh class B and C]. rivaroxaban showed higher rates of hepatotoxicity than other DOAC]. Apixaban owns a more favorable profile because its risk of drug-induced liver injury (DILI) is lower
▶️ A systematic review that included 11 studies determined there was a significantly increased risk of pulmonary embolism and DVT) in patients with cirrhosis compared with controls
▶️ patients with cirrhosis are at a higher risk of developing DVT than the general population - An even higher risk is reported in patients with cirrhosis due to non-alcoholic steatohepatitis
▶️ patients with cirrhosis who suffer from concomitant AF have higher in-hospital mortality rates compared to those who do not. DOACs prescribed in sub-therapeutic doses,are effient, in terms of both bleeding and thrombotic complications
▶️ patients with decompensated cirrhosis experiencing some level of chronic kidney disease (CKD) in a percentage of > 45% in a recent study ,Regarding CKD, recent guidelines regarding the management of atrial fibrillation encourage the use of DOACs even in patients with a glomerular filtration rate (GFR) of 15 to 30 mL/min, in a reduced dose
▶️ AC DOACs is safe and effective in patients with cirrhosis. AC may in future be regarded as a therapeutic regimen for patients with cirrhosis, preventing decompensation and increasing survival.
▶️ The European Association for the Study of the Liver (EASL) recommends that patients with cirrhosis who are at risk of VTE receive LMWH
▶️ Each DOAC has a different hepatic excretion rate (, 65 percent for rivaroxaban, , and 75 percent for apixaban), but warfarin has a 100 percent hepatic excretion rate, implying more predictable pharmacokinetics for DOACs in liver cirrhosis
▶️ Anticoagulant therapy should not be used in patients with Child–Pugh Class C, which has a 1-year survival rate of less than 50% without a liver transplant.
▶️ An INR greater than 2.0 was previously thought to protect against VTE; however, more recent observations have disproved this theory.-It only evaluates the activity of several procoagulant components (FI, FII, FV, FVII, and FX), and not the activity of anticoagulant proteins C and S; therefore, INR does not appear to be a viable tool for monitoring hemostasis in cirrhotic patients.
▶️ the use of rivaroxaban, should be generally avoided in Child Pugh class B and C]. rivaroxaban showed higher rates of hepatotoxicity than other DOAC]. Apixaban owns a more favorable profile because its risk of drug-induced liver injury (DILI) is lower
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Steatosis.pdf
6.8 MB
Is liver steatosis a disease or the emperor’s new clothes?
EASL jan 2026
AGA_Clinical_Practice_Update_on_Inpatient_Management_of_Adults_With.pdf
3.6 MB
AGA Clinical Practice Update on Inpatient Management of Adults With Inflammatory Bowel Disease: Expert Review
AGA February 2026
The Optimal Timing and Effectiveness of a Transparent Cap in the Endoscopic Removal of Bony Foreign Bodies From the Esophagus.
PDF
ACG jan 2026
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✳️ Hyperammonemia predicts the development of liver-related events in a prospective cohort of stable cirrhosis patients and the external validation of the AMMON-OHE score
1. Hyperammonemia predicts liver complications
- Patients with ammonia levels ≥ upper limit of normal (AMN ≥ULN) had a 4.92-fold higher risk of developing liver-related events (LRE) within 1 year
- 64.5% of patients with elevated ammonia developed complications vs. only 10% with normal levels
2. Predictive power across cirrhosis stages
- Ammonia predicted complications in both compensated and decompensated cirrhosis
- Patients with compensated cirrhosis and high ammonia had similar risk to decompensated patients with normal ammonia (~25%)
3. Superior to traditional scoring systems
- Ammonia alone had better predictive accuracy (AUROC 0.892) than MELD score (0.783) and comparable to Child-Pugh score (0.885)
4. Clinical implications
- Ammonia predicts multiple complications beyond hepatic encephalopathy: ascites, infections, variceal bleeding
- Not affected by kidney disease or muscle loss (sarcopenia)
- Can be measured with a simple blood test in outpatient settings
Open Access
1. Hyperammonemia predicts liver complications
- Patients with ammonia levels ≥ upper limit of normal (AMN ≥ULN) had a 4.92-fold higher risk of developing liver-related events (LRE) within 1 year
- 64.5% of patients with elevated ammonia developed complications vs. only 10% with normal levels
2. Predictive power across cirrhosis stages
- Ammonia predicted complications in both compensated and decompensated cirrhosis
- Patients with compensated cirrhosis and high ammonia had similar risk to decompensated patients with normal ammonia (~25%)
3. Superior to traditional scoring systems
- Ammonia alone had better predictive accuracy (AUROC 0.892) than MELD score (0.783) and comparable to Child-Pugh score (0.885)
4. Clinical implications
- Ammonia predicts multiple complications beyond hepatic encephalopathy: ascites, infections, variceal bleeding
- Not affected by kidney disease or muscle loss (sarcopenia)
- Can be measured with a simple blood test in outpatient settings
Open Access
AASLD February 2026
✳️ Rifaximin reduces rehospitalization risk in patients with cirrhosis and overt hepatic encephalopathy
▶️ Conclusion: Rifaximin reduces the risk of readmissions for hepatic encephalopathy. One of the clearest cases where RCT-based effect sizes are reproducible in trials.
Open Access
▶️ Conclusion: Rifaximin reduces the risk of readmissions for hepatic encephalopathy. One of the clearest cases where RCT-based effect sizes are reproducible in trials.
Open Access
AASLD February 2026
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