Introduction

Non-alcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease. NAFLD may lead to the development of non-alcoholic steatohepatitis, which further may progress to fibrosis, cirrhosis and hepatocellular carcinoma. Quantitative ultrasonography (QUS) has been recently introduced in to clinical settings as a method for the assessment of hepatic steatosis.

Aims & Methods

To investigate correlation of tissue attenuation imaging and tissue scatter distribution imaging with biochemical markers of NAFLD. This cross-sectional study included patients treated at the Gastroenterohepatology Clinic of the University Clinical Centre of Serbia, diagnosed with NAFLD. Demographic, etiological, biochemical, clinical, ultrasonographic, and endoscopic features were analyzed in all patients. Tissue attenuation imaging and tissue scatter distribution imaging was assessed using the QUS feature of the SAMSUNG RS80A device with a convex probe. The measurement reliability was determined using the Reliable Measurement Index (RMI) and Interquartile Range (IQR).

Results

Our study included 50 patients, among them 51% were male gender, while 49% were female gender, average age of 48 years. Mean TAI values were 0.65±0.16, mean TSI values were 94.01±12.8. There was statistically significant positive correlation between the values of cholesterol levels and these two scores (R=0.732, P<0.05). Furthermore there was statistically significant positive correlation between the values of HOMA IR with these two scores (R=0.866, P<0.05). Moreover these score were in positive correlation with GGT levels (R=0.669, P<0.05).

Conclusion

​Our results support the usage of quantitative ultrasonography as a tool for the assessment and diagnosis establishment of NAFLD.

Disclosure

No conflict of interest to disclose

Introduction

Nonalcoholic fatty liver disease (NAFLD) is a widespread metabolic disorder associated with intestinal dysbiosis, low-grade systemic inflammation, and small intestinal bacterial overgrowth (SIBO). Targeting the gut-liver axis through microbiome-modulating therapies may represent a promising approach to disease management.

Aims & Methods

The aim was to investigate gut microbiota alterations in NAFLD patients and assess the efficacy of microbiota-based therapy on metabolic, inflammatory, and structural liver parameters. The study included 152 NAFLD patients and 47 controls. Gut microbiota composition was evaluated using qRT-PCR, and SIBO was diagnosed via hydrogen breath testing. The therapeutic protocol included rifaximin (200 mg TID for 14 days), Saccharomyces boulardii CNCM I-745 (1 capsule BID for 30 days), and essential phospholipids (600 mg TID for 30 days). Liver function tests, inflammatory markers, and steatometry were assessed before and after treatment.

Results

Alterations in gut microbiota composition indicative of dysbiosis—including increased Firmicutes/Bacteroides ratio and Actinobacteria abundance—were identified in NAFLD. Strong correlations emerged between the F/B index and triglycerides (r = 0.78), TNF-α (r = 0.77), and between Actinobacteria and hsCRP (r = 0.66). SIBO rates declined significantly post-treatment (51% → 17%). Liver enzymes, inflammatory markers, and steatometric parameters improved substantially (p<0.05).

Conclusion

Microbiota-targeted therapy combining rifaximin, S. boulardii, and phospholipids effectively corrected dysbiosis, reduced inflammation, improved metabolic parameters, and promoted liver structural recovery in NAFLD patients. These findings support incorporating microbiome-focused interventions into routine clinical practice for NAFLD. ​

Introduction

96-98% of patients survive acute pancreatitis (AP), but in the post-AP phase, patients are at high risk of morbidity and mortality. It has been shown that pancreatic exocrine insufficiency can occur after AP.

Aims & Methods

We aimed to investigate the rate, risk factors, and the effect of pancreatic enzyme replacement therapy (PERT) for PEI in patients with AP. The study protocol was registered on PROSPERO (CRD42024516403). We conducted a systematic search on 5 February 2024 in three databases (PubMed, EMBASE, and CENTRAL). We included in the analysis studies reporting on risk factors and PERT efficacy in PEI associated with AP. Pooled proportion and odds ratios (OR) with a 95% confidence interval (CI) were calculated using a random effect model.

Results

Fifty-six articles were included in our meta-analysis. Among 17896 patients with AP, the pooled proportion of PEI was 20 % ([CI]: 15–26). The odds of PEI development were two-fold higher in severe acute pancreatitis (OR=2.44, [CI]: 0.98–6.11) compared with mild or moderate AP and three times higher after necrosectomy compared to patients without necrosectomy (OR=3.26, [CI]: 1.6–6.64). There was no significant difference between the odds of PEI among AP patients with necrosis (OR=1.43, [CI]: 0.32–6.45) and those without necrosis. However, the odds of PEI were twice as high in patients with infected necrosis (OR=2.13, [CI]: 0.93–4.87) than in patients with sterile necrosis. Pancreatic enzyme replacement therapy was prescribed for 22% ([CI]: 16–30) of patients after AP.

Conclusion

One in five patients with AP develops PEI. The rate is higher in patients with severe AP, infected necrosis, or who need necrosectomy. Patients with AP should be screened for PEI to allow timely PERT administration.

Introduction

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver condition globally, closely associated with increased cardiovascular morbidity and mortality. Despite preserved left ventricular ejection fraction (LVEF), patients with NAFLD may exhibit subclinical cardiac dysfunction. Speckle tracking echocardiography (STE) offers sensitive myocardial strain assessment, surpassing conventional LVEF measurements. This systematic review and meta-analysis aimed to evaluate the association between NAFLD and subclinical left ventricular systolic dysfunction using STE-derived strain parameters.

Aims & Methods

A comprehensive literature search was conducted in PubMed, EMBASE, and Scopus. Observational studies assessing NAFLD patients using STE-derived myocardial strain parameters were included. Quality assessment was performed using the Newcastle-Ottawa Scale. Primary outcomes were the mean differences (MD) in global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global apical strain (GAS), and related strain rate indices between NAFLD spectrum patients and controls.

Results

Sixteen studies involving 8,359 participants were included. NAFLD patients exhibited significant reductions in GLS (MD: -2.043; 95% CI: -2.868, -1.218), GAS (MD: -3.706; 95% CI: -4.999, -2.413), and GCS (MD: -1.415; 95% CI: -2.893, 0.064) compared to controls. The reductions were more pronounced in individuals with moderate/severe NAFLD and those with concomitant type 2 diabetes mellitus (GLS MD: -4.385; 95% CI: -5.400, -3.369 in diabetic NAFLD vs. diabetic controls). Subgroup analysis also demonstrated a stepwise impairment in strain parameters from simple steatosis to non-alcoholic steatohepatitis (NASH). Importantly, LVEF remained preserved across all groups, underscoring the subclinical nature of the observed dysfunction.

Conclusion

This meta-analysis confirms the presence of subclinical left ventricular systolic dysfunction in NAFLD patients, detectable via STE despite normal LVEF. Myocardial strain parameters, particularly GLS, offer valuable early indicators of cardiac impairment. Routine integration of STE in NAFLD management may enable timely cardiovascular risk stratification and intervention.