GiT Updates and More

AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals

Liver disease in pregnancy

Portal vein thrombosis in cirrhosis

Ulcerative Colitis in Remission Endoscopic view of the colon in a patient with ulcerative colitis: Pic(1) - The mucosa shows light, line-shaped scars with a loss of the normal vascular pattern indicating previous ulcerations. There are no signs of active inflammation. Pic(2) -The colonic mucosa shows a reticulated pattern due to scarring. The typical vascular pattern and haustral folds are missing. There are no signs of active inflammation. Pic(3) - The right side of the colon shows a loss of haustra and a diminished vascular pattern, both of which indicate previous exacerbations. On the left side of the colon, the haustral folds and vascular pattern are normal. There are no signs of active inflammation.

diagnosis of UC & Crohn's disease

🔸 Ulcerative Colitis 🔸 Transabdominal ultrasound of the descending colon : The four layers of the intestine remain distinguishable (despite thickening of the intestinal wall) in ulcerative colitis as only the mucosa and submucosa are affected. The intestinal lumen also appears hypoechoic due to acute inflammation.

🔸Pseudopolyps in advanced ulcerative colitis 🔸 Endoscopic view of the colon : There are multiple raised areas of normal mucosal tissue resulting from mucosal regeneration and hyperplasia.

🔸 Active ulcerative colitis 🔸 Endoscopic view of the colon : The mucosa appears erythematous and edematous, indicating active inflammation. The vascular pattern has been lost and minor spontaneous hemorrhage is visible. A fibrin-covered ulceration and several pseudopolyps are visible.

🔸 Acute Ulcerative Colitis 🔸 Endoscopic view of the sigmoid colon : The mucosa is erythematous and edematous. There is a loss of superficial vascular markings. Several linear, semi-confluent ulcerations are visible.

🔸Acute ulcerative colitis🔸 Endoscopic view of the colon : The mucosa is erythematous and edematous. There is a loss of superficial vascular markings. Mucosal granularity and ulcerations (examples indicated by green overlay) are visible.

🔖SUMMARY🔖 Age-dependent differences in FIB-4 predictions of fibrosis : 🔸The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing, particularly among older adults, with significant rises expected in advanced fibrosis cases by 2030. 🔸Older patients with MASLD are at a higher risk for liver-related complications and all-cause mortality compared to younger patients, particularly those aged 60 to 74. 🔸The Fibrosis 4 (FIB-4) index is a crucial tool for assessing liver fibrosis risk in MASLD, with a score of ≥1.3 prompting further evaluation and a score of >2.67 indicating the need for direct referral to hepatology. 🔸Age significantly influences FIB-4 scores, which can lead to misinterpretation of fibrosis risk, as older patients may have higher scores due to age-related factors despite unchanged liver health. 🔸The study suggests that using a FIB-4 threshold of 2.0 for patients aged 65 and older may be inadequate, as it has lower negative predictive value (NPV) compared to the standard threshold of 1.3. 🔸Data indicates that the majority of patients referred for MASLD assessment are under 50, highlighting a potential gap in referrals for older adults. 🔸The research emphasizes that while FIB-4 is widely used, its interpretation must consider age to avoid misclassification of fibrosis risk, particularly in older populations. 🔸The association between FIB-4 scores and liver stiffness measurements (VCTE) varies with age, suggesting that age impacts the predictive value of FIB-4, especially at higher thresholds. 🔸The study supports maintaining the FIB-4 threshold of <1.3 for ruling out advanced fibrosis in older adults, as it demonstrated superior NPV compared to a higher threshold. 🔸The findings call for refined guidelines on the use of FIB-4 in older patients with MASLD to improve risk stratification and avoid unnecessary referrals or missed diagnoses.

Active Ulcerative Colitis Endoscopic view of the colon: The mucosa appears inflamed and shows several fibrin deposits. The normal vascular pattern and haustral folds of the colon are no longer visible.