UEG Week Recordings UEG Week Posters Online courses Guidelines Mistakes in... Podcasts Webinars
new
Gut Guide online
Visit ueg.eu Create myUEG account Log In
Visit ueg.eu Create myUEG account Log In

Filters:

UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Mistakes in alcoholic liver disease and how to avoid them

Helena Cortez-Pinto, Pedro Marques Da Costa

Summary

AI Generated

Alcohol consumption is the most prevalent cause of liver cirrhosis in Europe and the third leading risk factor for overall mortality, accounting for approximately half a million deaths annually worldwide.

  • Alcoholic liver cirrhosis represents 50% of all cirrhosis cases globally according to the World Health Organization.
  • Alcoholic liver disease is multifaceted with several cofactors influencing its progression.
  • Patients with alcohol abuse can simultaneously have viral hepatitis B or C, alpha-1 antitrypsin deficiency, or haemochromatosis.
  • This material provides epidemiological context on the burden of alcohol-related liver disease in Europe and globally.
Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

Alcohol consumption is the most prevalent aetiology for liver cirrhosis in Europe and the third leading risk factor for overall mortality.1,2 In fact, alcoholic liver cirrhosis accounts for almost half a million deaths a year worldwide, corresponding to 50% of all cases of cirrhosis, according to the World Health Organization (WHO).3 Alcoholic liver disease (ALD) is multifaceted, with several cofactors influencing its progression. Patients abusing alcohol can simultaneously have viral hepatitis B or C, or a genetic disease, such as alpha-1 antitrypsin deficiency or haemochromatosis.

Topics

Hepatobiliary

Citation

Marques da Costa P and Cortez-Pinto H. Mistakes in alcoholic liver disease and how to avoid them. UEG Education 2017: 17; 10–14.

Published

2024

More Like This:

Mistakes in hepatitis C and how to avoid them

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino Gonçalo Alexandrino, Ana Catarina Garcia

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic Miroslav Vujasinovic

Mistakes in acute jaundice and how to avoid them

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis Georgios Papatheodoridis, Spyridon Siakavellas

Mistakes in acute severe ulcerative colitis and how to avoid them

Mistakes in acute severe ulcerative colitis and how to avoid them

David Laharie David Laharie

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Antonio Facciorusso Antonio Facciorusso

Mistakes in chronic hepatitis B management and how to avoid them

Mistakes in chronic hepatitis B management and how to avoid them

Patrick Kennedy Patrick Kennedy, Upkar S. Gill

UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

More Like This:

Mistakes in hepatitis C and how to avoid them

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino Gonçalo Alexandrino, Ana Catarina Garcia

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic Miroslav Vujasinovic

Mistakes in acute jaundice and how to avoid them

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis Georgios Papatheodoridis, Spyridon Siakavellas

Mistakes in acute severe ulcerative colitis and how to avoid them

Mistakes in acute severe ulcerative colitis and how to avoid them

David Laharie David Laharie

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Antonio Facciorusso Antonio Facciorusso

Mistakes in chronic hepatitis B management and how to avoid them

Mistakes in chronic hepatitis B management and how to avoid them

Patrick Kennedy Patrick Kennedy, Upkar S. Gill

UEG Standards and Guidelines
Consensus
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Guideline

ABSTRACT

This international, multidisciplinary consensus report represents the first effort to systematically define and characterize fatty pancreas. A key outcome of this endeavor was the recommendation to adopt “fatty pancreas” as the standardized and inclusive term to describe all forms of fat accumulation in the pancreas. This terminological consensus provides a critical foundation for unified reporting and clinical communication. Another major contribution of the report is the consensus on diagnostic imaging findings, which was based on radiological and endoscopic modalities. The proposed criteria aim to enhance consistency in clinical assessment and support the development of standardized research protocols. In addition to establishing terminology and diagnostic frameworks, the report also synthesizes current knowledge across a wide range of relevant domains. These include the etiology and epidemiology of fatty pancreas, as well as its associations with alcohol consumption, smoking, acute and chronic pancreatitis, pancreatic exocrine insufficiency, type 2 diabetes mellitus, and surgical outcomes. The potential links between fatty pancreas and neoplastic conditions such as intraductal papillary mucinous neoplasms and pancreatic cancer are also addressed, alongside the current understanding of its metabolic implications (beta-cell function and glucose homeostasis) and treatment strategies. Throughout the consensus process, a consistent theme emerged: the limited availability of high-quality, prospective clinical data. Therefore, many of the recommendations in this report are based on expert consensus rather than strong empirical evidence. As such, the statements require rigorous prospective validation before they can be adopted into routine clinical practice. This underscores a critical need for further research, particularly studies aimed at clarifying causal relationships, validating diagnostic tools, and determining the clinical relevance of fatty pancreas across diverse patient populations. This report serves as both a summary of our current understanding and a roadmap for future investigations, aiming to close existing knowledge gaps and guide evidence-based clinical practice in this emerging field.

Publishers

European Society for Paediatric Gastroenterology, Hepatology and Nutrition logoThe European Society for Clinical Nutrition and Metabolism logoEuropean Society for Primary Care Gastroenterology logoEuropean Society of Pathology logoEuropean Society of Gastrointestinal Endoscopy logoEuropean Society of Gastrointestinal and Abdominal Radiology logoEuropean Association for the Study of the Liver logoEuropean Pancreatic Club logo
European Society for Paediatric Gastroenterology, Hepatology and Nutrition, The European Society for Clinical Nutrition and Metabolism, European Society for Primary Care Gastroenterology, European Society of Pathology, European Society of Gastrointestinal Endoscopy, European Society of Gastrointestinal and Abdominal Radiology, European Association for the Study of the Liver, European Pancreatic Club

Guideline

Consensus

Topics

Pancreas

Citation

United European Gastroenterology Journal, 2026; 14:e70185

Published

2026

More Like This:

Mistakes in hepatitis C and how to avoid them

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino Gonçalo Alexandrino, Ana Catarina Garcia

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic Miroslav Vujasinovic

Mistakes in acute jaundice and how to avoid them

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis Georgios Papatheodoridis, Spyridon Siakavellas

Mistakes in acute severe ulcerative colitis and how to avoid them

Mistakes in acute severe ulcerative colitis and how to avoid them

David Laharie David Laharie

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Antonio Facciorusso Antonio Facciorusso

Mistakes in chronic hepatitis B management and how to avoid them

Mistakes in chronic hepatitis B management and how to avoid them

Patrick Kennedy Patrick Kennedy, Upkar S. Gill

UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Mistakes in acute jaundice and how to avoid them

Spyridon Siakavellas, Georgios Papatheodoridis

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

Jaundice can be caused by abnormalities in any of the steps comprising the formation, metabolism and excretion of bilirubin. In addition, these processes may be functioning properly, but jaundice can be seen because of an obstruction of the biliary tree at any point, from its intrahepatic origins to its end at the ampulla of Vater. For this reason, it is clear that numerous conditions can result in jaundice. When faced with a patient presenting with jaundice a reasonable and careful diagnostic approach is, therefore, warranted to elucidate the underlying cause of this sign. Conventional wisdom may be that “jaundice by itself never killed anyone,” but it is imperative to find the cause as soon as possible, as prompt intervention saves lives in many cases.

Topics

Hepatobiliary

Citation

Siakavellas S and Papatheodoridis G. Mistakes in acute jaundice and how to avoid them. UEG Education 2018; 18: 24–26.

Published

2025

More Like This:

Mistakes in hepatitis C and how to avoid them

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino Gonçalo Alexandrino, Ana Catarina Garcia

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic Miroslav Vujasinovic

Mistakes in acute jaundice and how to avoid them

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis Georgios Papatheodoridis, Spyridon Siakavellas

Mistakes in acute severe ulcerative colitis and how to avoid them

Mistakes in acute severe ulcerative colitis and how to avoid them

David Laharie David Laharie

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Antonio Facciorusso Antonio Facciorusso

Mistakes in chronic hepatitis B management and how to avoid them

Mistakes in chronic hepatitis B management and how to avoid them

Patrick Kennedy Patrick Kennedy, Upkar S. Gill

UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Mistakes in acute severe ulcerative colitis and how to avoid them

David Laharie

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

Ulcerative colitis (UC) is a lifelong inflammatory bowel disease (IBD) of unknown origin characterized by alternating flare and remission periods. An acute severe episode, so-called acute severe UC (ASUC), may happen in approximately one-quarter of patients during their life.1 Notably, more than 25% of ASUC episodes correspond to the index presentation of the disease. Patients with ASUC should be promptly identified by the modified Truelove and Witts criteria recommended by the most recent international guidelines and admitted rapidly to a digestive unit. Indeed, ASUC is a life-threatening condition still leading to a 1% death rate in Western countries. In the current article, we will discuss the most frequent and/or relevant mistakes in managing patients admitted for an ASUC episode and how to avoid them. The manuscript is based on the available evidence and expert opinion when evidence is lacking.

Topics

IBD

Citation

David Laharie. Mistakes in acute severe ulcerative colitis and how to avoid them. UEG Education 2023; 23: 19-21.

Published

2023

More Like This:

Mistakes in hepatitis C and how to avoid them

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino Gonçalo Alexandrino, Ana Catarina Garcia

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic Miroslav Vujasinovic

Mistakes in acute jaundice and how to avoid them

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis Georgios Papatheodoridis, Spyridon Siakavellas

Mistakes in acute severe ulcerative colitis and how to avoid them

Mistakes in acute severe ulcerative colitis and how to avoid them

David Laharie David Laharie

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Antonio Facciorusso Antonio Facciorusso

Mistakes in chronic hepatitis B management and how to avoid them

Mistakes in chronic hepatitis B management and how to avoid them

Patrick Kennedy Patrick Kennedy, Upkar S. Gill

UEG Standards and Guidelines
Clinical Practice Guideline
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Antonio Facciorusso

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Guideline

Abstract

This Technical and Technology Review from the European Society of Gastrointestinal Endoscopy (ESGE) represents an update of the previous document on the technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology, including the available types of needle, technical aspects of tissue sampling, new devices, and specimen handling and processing. Among the most important new recommendations are:

ESGE recommends end-cutting fine-needle biopsy (FNB) needles over reverse-bevel FNB or fine-needle aspiration (FNA) needles for tissue sampling of solid pancreatic lesions; FNA may still have a role when rapid on-site evaluation (ROSE) is available.

ESGE recommends EUS-FNB or mucosal incision-assisted biopsy (MIAB) equally for tissue sampling of subepithelial lesions ≥20 mm in size. MIAB could represent the first choice for smaller lesions (<20 mm) if proper expertise is available.

ESGE does not recommend the use of antibiotic prophylaxis before EUS-guided tissue sampling of solid masses and EUS-FNA of pancreatic cystic lesions.

Publisher

European Society of Gastrointestinal Endoscopy logo
European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Endoscopy

Citation

Endoscopy 2025; 57(04): 390-418

Published

2025

More Like This:

Mistakes in hepatitis C and how to avoid them

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino Gonçalo Alexandrino, Ana Catarina Garcia

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic Miroslav Vujasinovic

Mistakes in acute jaundice and how to avoid them

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis Georgios Papatheodoridis, Spyridon Siakavellas

Mistakes in acute severe ulcerative colitis and how to avoid them

Mistakes in acute severe ulcerative colitis and how to avoid them

David Laharie David Laharie

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Antonio Facciorusso Antonio Facciorusso

Mistakes in chronic hepatitis B management and how to avoid them

Mistakes in chronic hepatitis B management and how to avoid them

Patrick Kennedy Patrick Kennedy, Upkar S. Gill

UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Mistakes in chronic hepatitis B management and how to avoid them

Patrick Kennedy, Upkar S. Gill

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

Hepatitis B virus (HBV) infection is the most common chronic viral infection in the world. Despite the availability of a preventative vaccine, more than 250 million people worldwide are chronically infected with HBV. The complications of chronic HBV infection—cirrhosis and hepatocellular cancer (HCC)—account for more than 850,000 deaths per year. HBV is transmitted haematogenously and sexually, with the majority of HBV infections being transmitted vertically (or perinatally) in high prevalence regions. HBV infection acquired at birth or in early childhood results in chronicity in >95% of cases, whereas only 5–10% of those who are infected in adulthood will progress to chronic infection. 

Topics

Hepatobiliary

Citation

Gill US and Kennedy PTF. Mistakes in chronic hepatitis B management and how to avoid them. UEG Education 2019; 19: 22–24 

Published

2019

More Like This:

Mistakes in hepatitis C and how to avoid them

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino Gonçalo Alexandrino, Ana Catarina Garcia

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic Miroslav Vujasinovic

Mistakes in acute jaundice and how to avoid them

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis Georgios Papatheodoridis, Spyridon Siakavellas

Mistakes in acute severe ulcerative colitis and how to avoid them

Mistakes in acute severe ulcerative colitis and how to avoid them

David Laharie David Laharie

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Antonio Facciorusso Antonio Facciorusso

Mistakes in chronic hepatitis B management and how to avoid them

Mistakes in chronic hepatitis B management and how to avoid them

Patrick Kennedy Patrick Kennedy, Upkar S. Gill

The global reference point for the digestive health community

Platform Publisher

United European Gastroenterology

Wickenburggasse 1 1080 Vienna, Austria

Contact us

support@ueg.eu

ueg.eu

T: +43 1 997 1639

Legal

Terms & Conditions

Imprint

Privacy Policy

Explore

My Bookmarks

My recommendations

My fields of interest

© 2026 United European Gastroenterology

Change fields of interest

These fields are selected based on the interests in your myUEG profile.
Click the item to unselect it. You can select multiple items.