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Background: Patients with decompensated cirrhosis face poor prognosis and increased mortality risk. Rifaximin, a non‐absorbable antibiotic, has been shown to have beneficial effects in preventing complications and improving survival in these patients. However, the underlying mechanisms of rifaximin's effects remain unclear. Methods: We obtained fecal samples from decompensated cirrhotic patients undergoing rifaximin treatment and controls, both at baseline and after 6 months of treatment. Shotgun metagenome sequencing profiled the gut microbiome, and untargeted metabolomics analyzed fecal metabolites. Linear discriminant and partial least squares discrimination analyses were used to identify differing species and metabolites between rifaximin‐treated patients and controls. Results: Forty‐two patients were enrolled and divided into two groups (26 patients in the rifaximin group and 16 patients in the control group). The gut microbiome's beta diversity changed in the rifaximin group but remained unaffected in the control group. We observed 44 species with reduced abundance in the rifaximin group, including Streptococcus_salivarius, Streptococcus_vestibularis, Haemophilus_parainfluenzae, etc. compared to only four in the control group. Additionally, six species were enriched in the rifaximin group, including Eubacterium_sp._CAG:248, Prevotella_sp._CAG:604, etc., and 14 in the control group. Furthermore, rifaximin modulated different microbial functions compared to the control. Seventeen microbiome‐related metabolites were altered due to rifaximin, while six were altered in the control group. Conclusion: Our study revealed distinct microbiome‐metabolite networks regulated by rifaximin intervention in patients with decompensated cirrhosis. These findings suggest that targeting these specific metabolites or related bacteria might be a potential therapeutic strategy for decompensated cirrhosis. [ABSTRACT FROM AUTHOR]

Objectives: Covert hepatic encephalopathy (CHE) negatively affects the health‐related quality of life and increases the risk of overt HE (OHE) in patients with liver cirrhosis. However, the impact of CHE on long‐term patient outcomes remains controversial. This study aimed to explore the association between CHE and disease progression and survival among cirrhotic patients. Methods: This was a single‐center prospective study that enrolled 132 hospitalized patients with cirrhosis, with an average follow‐up period of 45.02 ± 23.06 months. CHE was diagnosed using the validated Chinese standardized psychometric hepatic encephalopathy score. Results: CHE was detected in 35.61% cirrhotic patients. During the follow‐up, patients with CHE had a higher risk of developing OHE (log‐rank 5.840, P = 0.016), exacerbation of ascites (log‐rank 4.789, P = 0.029), and portal vein thrombosis (PVT) (log‐rank 8.738, P = 0.003). Cox multivariate regression analyses revealed that CHE was independently associated with the occurrence of OHE, exacerbation of ascites, and PVT. Furthermore, patients with progression of cirrhosis were more likely to be diagnosed as CHE (log‐rank 4.462, P = 0.035). At the end of the follow‐up, patients with CHE had a lower survival rate compared to those without CHE (log‐rank 8.151, P = 0.004). CHE diagnosis (hazard ratio 2.530, P = 0.008), together with elder age and higher Child–Pugh score, were risk factors for impaired survival in cirrhotic patients. Conclusion: CHE is associated with disease progression and poor survival in patients with cirrhosis, indicating that CHE may serve as an independent predictor of poor prognosis among these patients. [ABSTRACT FROM AUTHOR]

Keywords: high resolution manometry; laparoscopic Hill repair; Gastroesophageal reflux disease; lower esophageal sphincter pressure EN high resolution manometry laparoscopic Hill repair Gastroesophageal reflux disease lower esophageal sphincter pressure 1576 1578 3 06/16/21 20210601 NES 210601 Introduction The laparoscopic Hill repair (LHR) for gastroesophageal reflux disease (GERD) sutures the collar sling musculature to the preaortic fascia.[1] A technical difficulty of LHR is how to accurately evaluate the tightness of Hill sutures. The Hill suture tightness defined as intraoperative LESP of 25-35 mmHg is safe and practicable for the treatment of GERD based on the short-term outcomes. Methods A prospective analysis was performed on 25 GERD patients who underwent bougie-free LHR with real-time continuous HRM under the standard pneumoperitoneum pressure of 12 mmHg. [Extracted from the article]

OBJECTIVE: Wisteria floribunda agglutinin‐positive Mac‐2‐binding protein (WFA+‐M2BP) is a novel glycobiomarker for evaluating liver fibrosis, but less is known about its role in liver cirrhosis (LC). This study aimed to investigate the utility of WFA+‐M2BP in evaluating liver function and predicting prognosis of cirrhotic patients. METHODS: We retrospectively included 197 patients with LC between 2013 and 2016. Serum WFA+‐M2BP and various biochemical parameters were measured in all patients. With a median follow‐up of 23 months, liver‐related complications and deaths of 160 patients were recorded. The accuracy of WFA+‐M2BP in evaluating liver function, predicting decompensation and mortality were measured by the receiver operating characteristic (ROC) curve, logistic and Cox's regression analyses, respectively. RESULTS: WFA+‐M2BP levels increased with elevated Child–Pugh classification, especially in patients with hepatitis B virus (HBV) infection. ROC analysis confirmed the high reliability of WFA+‐M2BP for the assessment of liver function using Child–Pugh classification. WFA+‐M2BP was also significantly positively correlated with the model for end‐stage liver disease (MELD) score. Multivariate logistic regression analysis indicated WFA+‐M2BP as an independent predictor of clinical decompensation for compensated patients (odds ratio 11.958, 95% confidence interval [CI] 1.876–76.226, P = 0.009), and multivariate Cox's regression analysis verified WFA+‐M2BP as an independent risk factor for liver‐related death in patients with HBV infection (hazards ratio 10.596, 95% CI 1.356–82.820, P = 0.024). CONCLUSION: Serum WFA+‐M2BP is a reliable predictor of liver function and prognosis in LC and could be incorporated into clinical surveillance strategies for LC patients, especially those with HBV infection. [ABSTRACT FROM AUTHOR]

OBJECTIVE This study aimed to evaluate easily available computed tomography (CT)-based parameters for assessing the presence and severity of cirrhosis and predicting complications in Chinese patients with cirrhosis. METHODS CT-based morphological indices were determined in 167 patients with cirrhosis and 244 healthy volunteers. The correlation of morphological indices with Child-Pugh score and cirrhotic complications was analyzed using Spearman's correlation analysis. The area under the receiver operating characteristic curve (AUROC) was used to analyze the diagnostic performance of the indices. Sensitivity and specificity were determined. RESULTS Patients with cirrhosis had a lower total liver volume (TLV) and a larger total splenic volume (SV) than healthy individuals. There was a significant difference in the portal venous diameter, splenic venous diameter and portal venous cross-sectional area between the two groups. A low TLV/SV ratio was strongly associated with liver cirrhosis; with a cut-off value of 4.27 for the diagnosis of cirrhosis TLV/SV had a sensitivity of 87.7% and a specificity of 84.9%, and AUROC of 0.921. Further analysis showed that TLV/SV was accurate in discriminating between mild and moderate/severe cirrhosis and could be used for predicting complications of cirrhosis. CONCLUSION The easily available parameters of CT can accurately evaluate the severity of cirrhosis in Chinese patients. [ABSTRACT FROM AUTHOR]

Objective The efficacy of corticosteroids in drug-induced liver injury (DILI) remains controversial. We aimed to determine whether corticosteroids were beneficial for severe DILI. Methods This was a single-center retrospective study of patients with DILI enrolled between January 2010 and May 2015. Results Of the 203 patients enrolled, 53 were treated with corticosteroids. The baseline characteristics of patients received corticosteroids were more severe than that of the non-corticosteroid group. Subgroup analyses indicated that almost all patients who died had the higher 50% quartile of total bilirubin (TB) levels. Among the 50-75% quartile of TB level, no patient in the corticosteroids group but 3 (15.0%) of 20 patients in the non-corticosteroid group died ( P = 0.261). With the highest 25% quartile of TB level, four patients in the corticosteroids group and four in the non-corticosteroids group died ( P = 0.405). Corticosteroid therapy improved the recovery rate from 77.4% to 87.9% in the higher 50% quartile of TB values ( P = 0.331). More interestingly, corticosteroid administration hastened the resolution of liver injury by shortening the duration of peak TB to 50% reduction from 17 to 12 days ( P < 0.05). Additionally, multivariate analysis revealed that the TB levels and cholestatic injury type were the two independent factors associated with a poor outcome of DILI. Conclusions Corticosteroids are not detrimental to DILI, but instead ameliorate liver injury and improve patient survival. Short-time use of corticosteroids is strongly recommended for severe DILI patients with hyperbilirubinemia. [ABSTRACT FROM AUTHOR]