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1. International survey among hepatologists and pulmonologists on the hepatic hydrothorax: plea for recommendations

Author

Jean-François David Cadranel, Isabelle Ollivier-Hourmand, Jacques Cadranel, Thierry Thevenot, Honoré Zougmore, Eric Nguyen-Khac, Christophe Bureau, Manon Allaire, Jean-Baptiste Nousbaum, Véronique Loustaud-Ratti, Xavier Causse, Philippe Sogni, Bertrand Hanslik, Marc Bourliere, Jean-Marie Peron, Nathalie Ganne-Carrie, Thong Dao, Dominique Thabut, Bernard. Maitre, Nabil Debzi, Ryad Smadhi, Roger Sombie, Raimi Kpossou, Olivier Nouel, Julien Bissonnette, Isaac Ruiz, Mourad Medmoun, Sergio Negrin Dastis, Pierre Deltenre, Florent Artru, Chantal Raherison, Laure Elkrief, and Tristan Lemagoarou

Subjects
Hepatic hydrothorax, Therapeutic pleural puncture, Albumin infusion, Spontaneous bacterial empyema, Talcage pleurodesis, Indwelling pleural catheter, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Abstract Background The Hepatic hydrothorax is a pleural effusion related to portal hypertension; its diagnosis and therapeutic management may be difficult. The aims of this article are which follows: To gather the practices of hepatogastroenterologists or pulmonologists practitioners regarding the diagnosis and management of the hepatic hydrothorax. Methods Practitioners from 13 French- speaking countries were invited to answer an online questionnaire on the hepatic hydrothorax diagnosis and its management. Results Five hundred twenty-eight practitioners (80% from France) responded to this survey. 75% were hepatogastroenterologists, 20% pulmonologists and the remaining 5% belonged to other specialities. The Hepatic hydrothorax can be located on the left lung for 64% of the responders (66% hepatogastroenterologists vs 57% pulmonologists; p = 0.25); The Hepatic hydrothorax can exist in the absence of clinical ascites for 91% of the responders (93% hepatogastroenterologists vs 88% pulmonologists; p = 0.27). An Ultrasound pleural scanning was systematically performed before a puncture for 43% of the responders (36% hepatogastroenterologists vs 70% pulmonologists; p

Published
2023
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2. Community-based respondent-driven sampling as a strategy for drug use surveillance in a large French urban area

Author

Hélène Donnadieu, Catherine Quillet, Morgana D’Ottavi, Joëlle Castellani, Anne Debellefontaine, Sylvain Guichard, René Baglioni, Nicolas Langendorfer, Vincent Faucherre, Bertrand Hanslik, Edouard Tuaillon, Didier Laureillard, and Nicolas Nagot

Subjects
Respondent-driven sampling survey, Drug use, Addiction care, Heroin, Methamphetamine, Access-to-care, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Understanding drug use and behavior within the PWUD population is crucial to adapt harm reduction and prevention strategies, and provide improved addiction and medical treatment. However, in most countries such as France, the knowledge of drug use behaviors is likely biased as it originates from addiction centers which are attended by only an unknown proportion of PWUD. The objectives of this study were to describe drug use behavior in a population of active PWUD in the urban area of Montpellier, South of France. Methods We implemented a community-based respondent-driven sampling survey (RDSS), a validated strategy to obtain a representative sample of a population, to recruit PWUD in the city. Adult individuals reporting frequent psychoactive drug use other than cannabis, with confirmation by urine test, were eligible. Beside HCV and HIV testing, trained peers interviewed participants on their drug consumption and behavior using standardized questionnaires. Fifteen seeds launched the RDSS. Results During the 11 weeks of the RDSS, 554 actives PWUD were consecutively included. They were mostly men (78.8%), had a median age of 39 years, and only 25.6% had a stable living place. On average, participants consumed 4.7 (± 3.1) different drugs, and 42.6% smoked free-base cocaine. Unexpectedly, heroin and methamphetamine were consumed by 46.8% and 21.5% of participants, respectively. Among the 194 participants injecting drugs, 33% declared sharing their equipment. Conclusion This RDSS highlighted a high consumption of heroin, crack and methamphetamine in this PWUD population. These unexpected results can be explained by low attendance to addiction centers, the source of drug use reports. Despite free care and risk reduction equipment in the city, sharing was very frequent among injectors, challenging the current program of harm reduction.

Published
2023
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3. An observational, prospective, multicenter study on the utilization and effectiveness of elbasvir–grazoprevir treatment association for chronic hepatitis C in France (ZEPHYR study)

Author

Jean‐Pierre Bronowicki, Patrick Miailhes, Bertrand Hanslik, Denis Ouzan, Dominique Larrey, Ghassan Riachi, Régine Truchi, Vincent Jouannaud, Dan Pospait, Armand Abergel, Xavier Causse, Stéphanie Perot, Jérémy Skrzypski, Astrid De Hautecloque, Axelle Spampinato, Philippe Mariot, Philippe Sogni, and the Zephyr Study group

Subjects
elbasvir/grazoprevir association, hepatitis C virus, real‐world evidence study, sustained virologic response, Medicine
Abstract

Abstract Background and Aim The efficacy and safety profiles of elbasvir–grazoprevir (EBR/GZR) has been established in more than 10 clinical trials. However, the characteristics of patients treated in routine clinical practice may differ. The present study was therefore designed to assess the real‐life effectiveness of EBR/GZR therapy in the general population and among subgroups with a high hepatitis C virus (HCV) prevalence in France. Methods The Zephyr study was designed as a French, multicentre, prospective, observational study on EBR/GZR use and effectiveness in current practice in chronic hepatitis C patients. These results are based on data regarding the adult patients who received at least one dose of EBR/GZR between December 2017 and June 2019 in 67 French hospitals and clinics. Results Overall, 478 patients were included. The Full Analysis Set corresponded to the 467 patients who met all the inclusion criteria and none of the exclusion criteria. Gender was balanced and the mean age was 55.7 ± 13.3 years. The patients were mainly treatment‐naive (89.5%) and infected with Genotype 1b (70.4%). Among the 75 patients with HCV Gt1a genotype, 56% had HCV RNA ≥ 800,000 IU/ml. F3–F4 fibrosis stage involved 24.2% of our population. Our subgroups were distributed among 110 migrants (23.6%), 58 (15.3%) using opioid agonist treatment, including people who inject drugs, 30 (6.8%) with chronic kidney disease Stages 3–5, 9 (1.9%) with an inherited blood disorder, and 4 (0.9%) coinfected with HIV. The remaining 269 (58.7%) were included in the general population subgroup. Overall, sustained virologic response 12 weeks after the end of treatment reached 98.0% and remained consistent among genotype, HCV RNA values, fibrosis stage, and the subgroup of interest. The rate of Alcohol Use Disorders Identification Test‐Consumption​​​ and Life Habit questionnaire completion was high at each visit, with data suggesting alcohol consumption decrease and an improvement in quality of life. Conclusions Using real‐world evidence data on a French population representative of HCV patients, we confirmed the results obtained during EBR/GZR development program.

Published
2023
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4. Hepatitis C virus infection impacts work productivity and fatigue: An epidemiologic real-life study

Author

Victor de Ledinghen, Bertrand Hanslik, Joseph Moussalli, Si Nafa Si Ahmed, Denis Ouzan, and Dominique Larrey

Subjects
France, Quality of life, Tiredness, Active life impairment, Specialties of internal medicine, RC581-951
Abstract

Introduction and Objective: Hepatitis C virus (HCV) infection and treatment impact the patient's daily life and work productivity. Until recently, treatments were associated with side effects and insufficient virologic and hepatic results.This study evaluated fatigue, work productivity, and treatment modalities in patients with HCV infection. Materials and methods: This cross-sectional, non-interventional, multicenter study was conducted in real-life settings between March and December 2015 at 109 sites in France. Results: Data from 1269 patients were evaluable. The mean patient age was 55.8 ± 12.5 years; 53.3% (676) patients were male. A total of 80.1% (1015) of patients were Caucasian and 62.3% (791) had a genotype 1 infection, 34.2% (433) had at least one comorbidity and 15.6% (198) had ≥1 clinical sign/symptom. Illicit drug use was the main route of HCV transmission and accounted for 36.8% (466) of all infections. Fibrosis stage F0/F1 was reported in 41.4% (525) of patients. A majority of patients (60.4%, 764) had never been treated. In patients previously treated, 85.8% (430) received ribavirin and pegylated interferon and only 13.4% (67) direct-acting antivirals.The mean percent of global impairment due to health was highest (34.8 ± 30.9%) in patients 18–45 years of age. The prevalence of active employed patients with a total fatigue score ≥ its median value (45/160) was 38.6%. The mean percent work time missed due to health was 9.6 ± 23.6% for working patients of 18–45 years of age and 7.3 ± 21.8% for working patients of 45–65 years of age. The mean overall prevalence of employed patients with impairment due to health issues was 21.8 ± 26.8%. The prevalence of patients with a reduced work activity of ≥50% due to their health status was 32.1%. Conclusion: These data reinforce the request for improved disease management in France, allowing patients with HCV infection to increase work productivity, reduce fatigue, and, hopefully, cure their disease.

Published
2019
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5. An observational, prospective, multicenter study on the utilization and effectiveness of elbasvir–grazoprevir treatment association for chronic hepatitis C in France (ZEPHYR study)

Author

Jean-Pierre, Bronowicki, Patrick, Miailhes, Bertrand, Hanslik, Denis, Ouzan, Dominique, Larrey, Ghassan, Riachi, Régine, Truchi, Vincent, Jouannaud, Dan, Pospait, Armand, Abergel, Xavier, Causse, Stéphanie, Perot, Jérémy, Skrzypski, Astrid, De Hautecloque, Axelle, Spampinato, Philippe, Mariot, and Philippe, Sogni

Subjects
Original Research
Abstract

BACKGROUND AND AIM: The efficacy and safety profiles of elbasvir–grazoprevir (EBR/GZR) has been established in more than 10 clinical trials. However, the characteristics of patients treated in routine clinical practice may differ. The present study was therefore designed to assess the real‐life effectiveness of EBR/GZR therapy in the general population and among subgroups with a high hepatitis C virus (HCV) prevalence in France. METHODS: The Zephyr study was designed as a French, multicentre, prospective, observational study on EBR/GZR use and effectiveness in current practice in chronic hepatitis C patients. These results are based on data regarding the adult patients who received at least one dose of EBR/GZR between December 2017 and June 2019 in 67 French hospitals and clinics. RESULTS: Overall, 478 patients were included. The Full Analysis Set corresponded to the 467 patients who met all the inclusion criteria and none of the exclusion criteria. Gender was balanced and the mean age was 55.7 ± 13.3 years. The patients were mainly treatment‐naive (89.5%) and infected with Genotype 1b (70.4%). Among the 75 patients with HCV Gt1a genotype, 56% had HCV RNA ≥ 800,000 IU/ml. F3–F4 fibrosis stage involved 24.2% of our population. Our subgroups were distributed among 110 migrants (23.6%), 58 (15.3%) using opioid agonist treatment, including people who inject drugs, 30 (6.8%) with chronic kidney disease Stages 3–5, 9 (1.9%) with an inherited blood disorder, and 4 (0.9%) coinfected with HIV. The remaining 269 (58.7%) were included in the general population subgroup. Overall, sustained virologic response 12 weeks after the end of treatment reached 98.0% and remained consistent among genotype, HCV RNA values, fibrosis stage, and the subgroup of interest. The rate of Alcohol Use Disorders Identification Test‐Consumption​​​ and Life Habit questionnaire completion was high at each visit, with data suggesting alcohol consumption decrease and an improvement in quality of life. CONCLUSIONS: Using real‐world evidence data on a French population representative of HCV patients, we confirmed the results obtained during EBR/GZR development program.

Published
2022

6. Subclinical proximal tubulopathy in hepatitis B: The roles of nucleot(s)ide analogue treatment and the hepatitis B virus

Author

Thierry Poynard, Guillaume Lassailly, Juliette Foucher, Manh-Thông Dao, Xavier Duval, Isabelle Hourmand-Ollivier, Séverine Hommel, Vincent Di Martino, Pierre-Henri Bernard, Dominique Larrey, Nathalie Boyer, Anais Labrunie, Marc Bardou, Paul Carrier, Marilyne Debette-Gratien, Marie Essig, Eric Nguyen-Khac, Armand Abergel, Victor de Ledinghen, Véronique Loustaud-Ratti, Claire Vanlemmens, Nathalie Ganne-Carrié, Anne Gervais, Jean-Baptiste Hiriart, Fouchard-Hubert Isabelle, Christine Aurières, Pauline Pinet, Thierry Thevenot, Jérémie Jacques, Philippe Mathurin, Dominique Thabut, Christophe Renou, Daniel Cohen, Marianne Maynard, Valérie Canva, Julien Vergniol, Bertrand Hanslik, Anaïs Brayette, Sophie Alain, Matthieu Schnee, Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges], CHU Limoges, Pôle Universitaire d’Addictologie en Limousin, CH Esquirol [Limoges] (CH Esquirol), Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Plate forme de bioinformatique et biostatistique (CEBIMER), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Anti-infectieux : supports moléculaires des résistances et innovations thérapeutiques (RESINFIT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Génomique fonctionnelle des tumeurs solides = Functional Genomics of Solid Tumors [CRC] (FunGeST), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des Maladies infectieuses et tropicales [CHU Limoges], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hepatology, Hopital, Physiopathologie des Maladies Inflammatoires de l'Intestin, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Services de Maladies Infectieuses et Tropicales [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Bordeaux [Bordeaux], Service d'Hépato-gastro-entérologie et oncologie digestive (CHU de Bordeaux), CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Paris School of Economics (PSE), Université Paris 1 Panthéon-Sorbonne (UP1)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École des hautes études en sciences sociales (EHESS)-École des Ponts ParisTech (ENPC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Paris Jourdan Sciences Economiques (PJSE), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre d'Investigation Clinique 1432 (Dijon) - Module Plurithématique : Périnatalité Cancérologie Handicap et Ophtalmologie (CIC-P803), Université de Bourgogne (UB)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA), Normandie Université (NU), Service d'Hépatologie [CHRU Besançon], Hôpital Haut-Lévêque [CHU Bordeaux], Hôpital Claude Huriez [Lille], CHU Lille, Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d’Hépatologie [Hôpital Beaujon], Hôpital Beaujon [AP-HP], Université Paris Cité (UPCité), Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Service d'Hépato-Gastro-Entérologie, CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Service de gastroentérologie (CHD Vendee - Hopital Les Oudairies, La Roche Sur Yon), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Hôpital Saint-Éloi [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), Épidémiologie et recherches translationnelles sur les maladies rénales et cardiovasculaires (EPREC) (U1018 (Équipe 5)), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Service Néphrologie/Dialyse [AP-HP Ambroise-Paré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPC)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPC), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Université Paris Cité (UPC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPC), Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], and Hôpital Charles Nicolle [Rouen]-CHU Rouen

Subjects
Hepatitis B virus, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Population, Renal function, medicine.disease_cause, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Nucleoside analogues, Internal medicine, medicine, Cumulative incidence, Renal insufficiency, education, education.field_of_study, Hepatology, business.industry, Proximal tubulopathy, Incidence (epidemiology), Hazard ratio, Entecavir, Hepatitis B, medicine.disease, 030220 oncology & carcinogenesis, Prospective Study, 030211 gastroenterology & hepatology, business, Biomarkers, medicine.drug
Abstract

International audience; BACKGROUND The recommended monitoring tools for evaluating nucleot(s)ide analogue renal toxicity, such as estimated glomerular filtration rate (eGFR) and phosphatemia, are late markers of proximal tubulopathy. Multiple early markers are available, but no consensus exists on their use. AIM To determine the 24 mo prevalence of subclinical proximal tubulopathy (SPT), as defined with early biomarkers, in treated vs untreated hepatitis B virus (HBV)-monoinfected patients. METHODS A prospective, non-randomized, multicenter study of HBV-monoinfected patients with a low number of renal comorbidities was conducted. The patients were separated into three groups: Naive, starting entecavir (ETV) treatment, or starting tenofovir disoproxil (TDF) treatment. Data on the early markers of SPT, the eGFR and phosphatemia, were collected quarterly. SPT was defined as a maximal tubular reabsorption of phosphate/eGFR below 0.8 mmoL/L and/or uric acid fractional excretion above 10%. The prevalence and cumulative incidence of SPT at month 24 (M24) were calculated. Quantitative data were analyzed using analyses of variance or Kruskal-Wallis tests, whereas chi-squared or Fisher's exact tests were used to analyze qualitative data. Multivariate analyses were used to adjust for any potential confounding factors. RESULTS Of the 196 patients analyzed, 138 (84 naive, 28 starting ETV, and 26 starting TDF) had no SPT at inclusion. At M24, the prevalence of SPT was not statistically different between naive and either treated group (21.1% vs 30.7%, P < 0.42 and 50.0% vs 30.7%, P = 0.32 for ETV and TDF, respectively); no patient had an eGFR lower than 50 mL/min/1.73 m(2) or phosphatemia less than 0.48 mmoL/L. In the multivariate analysis, no explanatory variables were identified after adjustment. The cumulative incidence of SPT over 24 mo (25.5%, 13.3%, and 52.9% in the naive, ETV, and TDF groups, respectively) tended to be higher in the TDF group vs the naive group (hazard ratio: 2.283, P = 0.05). SPT-free survival at M24 was 57.6%, 68.8%, and 23.5% for the naive, ETV, and TDF groups, respectively. The median survival time without SPT, evaluated only in the TDF group, was 5.9 mo. CONCLUSION The prevalence and incidence of SPT was higher in TDF-treated patients compared to naive patients. SPT in the naive population suggests that HBV can induce renal tubular toxicity.

Published
2020
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7. Nonalcoholic fatty liver disease: opinions, population served, and management from a sample of French hepato(gastroentero)logists (PERSEPT study)

Author

Alexandre, Pariente, Isabelle, Rosa, Sébastien, Dharancy, and Bertrand, Hanslik

Subjects
Liver Cirrhosis, Diabetes Mellitus, Type 2, Liver, Non-alcoholic Fatty Liver Disease, Biopsy, Humans, Fibrosis, Hepatitis
Abstract

The three-fold objective of this study was to describe the opinions, the population served, and tools used for the management of nonalcoholic fatty liver disease (NAFLD) by French hepato(gastro)enterologists (HGEs).Seventy-five French HGEs working in hospitals or in private practice, who regularly managed patients with NAFLD, completed three questionnaires: one about their opinions about disease management, one on the 10 first patients with NAFLD they saw in February 2020, and the third about the first five patients meeting the 2016 European Association for the Study of the Liver criteria for specialist referral.Management of NAFLD was seen as challenging, complex, time-consuming, and frustrating. Available treatments were considered to be unsatisfactory by most participants. In the whole population studied (671 patients), 41% were obese, 50% overweight, 49% had type 2 diabetes, 61% dyslipidemia, 51% arterial hypertension, 57% nonalcoholic steato-hepatitis (NASH), 37% advanced fibrosis, and 19% cirrhosis. In the subgroup of 313 patients needing specialist referral, the use of liver biopsy was low (30%) and decreasing, whereas vibration-controlled transient elastometry was high (66%) and increasing; blood fibrosis tests were rarely used. NASH was usually diagnosed without liver biopsy. Nutritional counseling was provided to 3/4 patients, physical activity counseling in 1/5. A personalized therapeutic project was defined in less than one-third of patients. Ursodeoxycholic acid and vitamin E were used in a minority of patients.The management of NAFLD is not considered satisfactory by French HGE who care for a relatively severe population. Noninvasive assessment of fibrosis and multidisciplinary management should be improved.

Published
2022

8. Non-invasive diagnosis and follow-up of primary biliary cholangitis

Author

Pascal Potier, Marie Decraecker, Florence Tanné, Christophe Bureau, Victor de Lédinghen, Nathalie Ganne-Carrié, Bertrand Hanslik, M. Bourlière, Alexandra Heurgue, Christophe Corpechot, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de référence des Maladies Vasculaires du Foie [Paris] (FILFOIE), Centre de référence pour les maladies biliaires inflammatoires et les hépatites auto-immunes [Paris] (CRMBIHAI), Health Care Provider of the European Reference Network onRare Liver Disorders (ERN-Liver), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Reims (CHU Reims), Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Centre Hospitalier Régional d'Orléans (CHRO), Centre Montpellierain des maladies du foie et de l’appareil digestif [Montpellier] (C2MFAD), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Bordeaux Research In Translational Oncology [Bordeaux] (BaRITOn), Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Saint-Joseph [Marseille], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Dupuis, Christine, and École pratique des hautes études (EPHE)

Subjects
medicine.medical_specialty, Cirrhosis, Hepatology, business.industry, Cholangitis, Liver Cirrhosis, Biliary, [SDV]Life Sciences [q-bio], Non invasive, Gastroenterology, Autoantibody, medicine.disease, Chronic inflammatory disease, PBC, [SDV] Life Sciences [q-bio], Bile Ducts, Intrahepatic, Liver stiffness, Internal medicine, Chronic cholestasis, medicine, Portal hypertension, Humans, business, Histological examination, Follow-Up Studies
Abstract

International audience; Non-invasive diagnosis and follow-up of primary biliary cholangitis Summary Primary biliary cholangitis (PBC) is a chronic inflammatory disease of the intrahepatic bile ducts [1]. It is characterised biologically by chronic cholestasis associated with the presence of specific autoantibodies, and histologically by lesions of nonsuppurative destructive cholangitis. If left untreated it can progress to cirrhosis, portal hypertension and liver failure. Diagnosis, staging and follow-up are largely based on non-or minimally-invasive assessment (blood tests, ultrasound, liver stiffness measurement). Histological examination of the liver and upper gastrointestinal endoscopy are sometimes necessary, but their indications remain limited. The purpose of this chapter is to provide the clinicians with what should be known about the non-invasive assessment of PBC and to provide specific recommendations for clinical practice.

Published
2022
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9. Reaching Hard-to-Reach People Who Use Drugs: A Community-Based Strategy for the Elimination of Hepatitis C

Author

Nicolas Nagot, Morgana D’Ottavi, Catherine Quillet, Anne Debellefontaine, Joëlle Castellani, Nicolas Langendorfer, Bertrand Hanslik, Sylvain Guichard, René Baglioni, Vincent Faucherre, Edouard Tuaillon, Georges-Philippe Pageaux, Didier Laureillard, and Hélène Donnadieu-Rigole

Subjects
Infectious Diseases, Oncology
Abstract

Background Elimination of hepatitis C virus (HCV) among people who use drugs (PWUD) remains a challenge even in countries in which HCV care is provided free of cost. We assessed whether an innovative community-based, respondent-driven sampling (RDS) survey, coupled with HCV screening and immediate treatment, could be efficient to detect and cure current PWUD with chronic HCV in a large city of Southern France. Methods At a community site with peers, PWUD (cannabis not included) were enrolled after confirmation by a urine drug test. Participants were then screened for hepatitis B virus, HCV, and human immunodeficiency virus and benefited from onsite HCV treatment evaluation and prescription. Peer support was provided during treatment, and a systematic visit was scheduled 12 weeks after the end of treatment. The cost of the intervention was estimated. Results Five hundred fifty-four participants were enrolled. Most were male (78.8%) with a median age of 39 years (interquartile range, 33–46). Cocaine (73.1%) and heroine (46.8%) were the main drugs consumed. Overall, 32.6% of PWUD (N = 181) were HCV seropositive, 49 (27.1%) of which had detectable HCV ribonucleic acid and were thus eligible for treatment. Ten of these patients had severe fibrosis. Hepatitis C virus treatment was initiated for 37 (75.5%) patients, 30 (81.1%) of whom completed their treatment and 27 (73.0%) achieved sustained viral response at week 12. The total cost was 161 euros € per screened patient and 1816€ per patient needing treatment. Conclusions A community-based RDS survey approach, involving peers, proved efficient and cost-effective to reach and cure PWUD for HCV. This innovative strategy could be key for the final step of HCV elimination. Clinical trial registration. ClinicalTrials.gov, NCT04008927.

Published
2021

10. Non-invasive diagnosis and follow-up of primary sclerosing cholangitis

Author

Pascal Potier, Victor de Lédinghen, Christophe Bureau, Jérôme Gournay, Nathalie Ganne-Carrié, Florence Tanne, Charlotte Bouzbib, M. Bourlière, Alexandra Heurgue, Eric Nguyen-Khac, Olivier Chazouillères, and Bertrand Hanslik

Subjects
medicine.medical_specialty, Colorectal cancer, Biliary cirrhosis, Cholangitis, Sclerosing, digestive system, Gastroenterology, Inflammatory bowel disease, Primary sclerosing cholangitis, Cholangiography, Cholestasis, Internal medicine, medicine, Humans, Cholangiopancreatography, Endoscopic Retrograde, Endoscopic retrograde cholangiopancreatography, Hepatology, medicine.diagnostic_test, business.industry, medicine.disease, Inflammatory Bowel Diseases, digestive system diseases, Bile Ducts, Intrahepatic, Bile Duct Neoplasms, Sample collection, business, Follow-Up Studies
Abstract

Primary sclerosing cholangitis (PSC) is a rare and chronic cholestatic liver disease of unknown cause commonly associated with inflammatory bowel disease (IBD) and characterized by progressive obliterative fibro-inflammation of the biliary tree. Although the natural course is highly variable, PSC is often progressive, leading to biliary cirrhosis and its complications. In addition, PSC is a condition harbouring broad neoplastic potential with increased susceptibility for the development of both biliary and colon cancer. As in other chronic liver diseases, non-invasive methods play a major role in the diagnosis and monitoring of PSC. MR cholangiography is the key exam for the diagnosis and has replaced diagnostic endoscopic retrograde cholangiopancreatography (ERCP). A strict and standardised protocol for carrying out MR cholangiography is recommended. Liver stiffness measured by FibroScan® correlates with the degree of liver fibrosis, has a prognostic value and should be repeated during follow-up. Invasive methods still play an important role, especially ERCP which is indicated for therapeutic purposes or for endo-biliary sample collection in suspected cholangiocarcinoma (following discussion in a multidisciplinary team meeting) and total colonoscopy which is recommended at the initial diagnosis of any PSC and annually in patients with IBD.

Published
2021

11. Non-invasive diagnosis and follow-up of autoimmune hepatitis

Author

Charlotte Bouzbib, M. Bourlière, Alexandra Heurgue, Jérôme Gournay, Christophe Bureau, Sara Lemoinne, Bertrand Hanslik, Victor de Lédinghen, Nathalie Ganne-Carrié, Eric Nguyen-Khac, CHU Amiens-Picardie, Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), DESSAIVRE, Louise, Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Montpellierain des maladies du foie et de l’appareil digestif [Montpellier] (C2MFAD), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Bordeaux Research In Translational Oncology [Bordeaux] (BaRITOn), Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Saint-Joseph [Marseille], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Lemoinne, Sara, and École Pratique des Hautes Études (EPHE)

Subjects
medicine.medical_specialty, [SDV]Life Sciences [q-bio], Cholangitis, Sclerosing, Disease, Autoimmune hepatitis, Chronic liver disease, overlap syndrome, Gastroenterology, Primary sclerosing cholangitis, Biliary disease, Liver disease, immune system diseases, Internal medicine, medicine, Humans, Hepatology, autoimmune hepatitis, business.industry, Liver Cirrhosis, Biliary, Autoantibody, Overlap syndrome, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, medicine.disease, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, digestive system diseases, [SDV] Life Sciences [q-bio], Hepatitis, Autoimmune, business, Follow-Up Studies
Abstract

International audience; Autoimmune hepatitis (AIH) is a liver disease characterised by necrotico-inflammatory lesions of hepatocytes, the presence of specific autoantibodies and response to corticosteroid treatment. AIH must be considered in any patient with acute or chronic liver disease. As there is no pathognomonic sign of AIH, the diagnosis is based on a combination of clinical, biological, immunological and histological findings, after excluding other causes of liver disease. The clinical and biological presentation of AIH is variable and AIH can be associated with an autoimmune biliary disease, primary biliary cholangitis or primary sclerosing cholangitis in an overlap syndrome. For these reasons, diagnosis of AIH can be challenging. Even if liver histology remains essential in the diagnosis of AIH, non-invasive tests can be used at different steps of the management of AIH: diagnosis of AIH, notably diagnosis of an overlap syndrome, assessment of severity of AIH, searching for extra-hepatic disease frequently associated to AIH, evaluation of response to therapy, decision of treatment withdrawal. This review aims to provide practical guidelines for the use of non-invasive tests for the diagnosis and the follow-up of AIH. (C) 2021 Published by Elsevier Masson SAS.

Published
2021
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14. International French-speaking multicentre practice survey on hepatic hydrothorax (HH) : Results of the 'Hep Hep' study among 529 hepatogastroenterologist (HG) or pneumologist (PN) respondents

Author

Nathalie Ganne-Carrié, Eric Nguyen-Khac, Laure Elkrief, Isabelle Ollivier, Jean-Baptiste Nousbaum, Chantal Raherison, Marc Bourlière, Jean-François Cadranel, Véronique Loustaud-Ratti, Christophe Bureau, Xavier Causse, Manon Allaire, Jean-Marie Péron, Philippe Sogni, Bernard Maitre, Thong Dao, Bertrand Hanslik, Tristan Le Magoarou, Thierry Thevenot, Cadranel Jacques, Groupe Hospitalier Public du Sud de l'Oise [Creil] (GHPSO), Theranoscan [CHU Tenon] (GRC 4), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Pneumologie = Pneumologie - Oncologie Thoracique - Maladies Pulmonaires Rares [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Hépatologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Soins Primaires, Santé Publique, Registre des cancers de Bretagne Occidentale (SPURBO), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Centre Hospitalier Régional d'Orléans (CHRO), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Saint-Joseph [Marseille], Génomique fonctionnelle des tumeurs solides = Functional Genomics of Solid Tumors [CRC] (FunGeST), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
medicine.medical_specialty, Hepatic hydrothorax, business.industry, Internal medicine, [SDV]Life Sciences [q-bio], Medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2021
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15. Management of primary biliary cholangitis: results from a large real-life observational study in France and Belgium

Author

and Descript, Armand Garioud, Study Groups, Jean-Pierre Arpurt, Descript, Jean Henrion, Olivier Chazouillères, Christophe Corpechot, Alexandre Pariente, Christophe Renou, Isabelle Rosa, Xavier Causse, and Bertrand Hanslik

Subjects
Male, medicine.medical_specialty, Cholagogues and Choleretics, Cirrhosis, Disease, Gastroenterology, Belgium, Internal medicine, Albumins, medicine, Humans, Stage (cooking), Retrospective Studies, Hepatology, medicine.diagnostic_test, business.industry, Liver Cirrhosis, Biliary, Ursodeoxycholic Acid, Retrospective cohort study, Bilirubin, Middle Aged, medicine.disease, Ursodeoxycholic acid, Liver biopsy, Portal hypertension, Female, France, Transient elastography, business, medicine.drug
Abstract

BACKGROUND AND AIMS To assess the characteristics, care, treatment response, and outcomes of primary biliary cholangitis (PBC) patients recently followed-up by hepato-gastroenterologists in various French and Belgian healthcare settings. METHODS This retrospective cohort study included patients with PBC who recently visited 79 hepato-gastroenterologists in France and Belgium. Data were collected at the time of diagnosis and at last visit and were compared according to biochemical response (BR) to ursodeoxycholic acid (UDCA) (BR), using Paris I-II criteria, and clinical outcomes. RESULTS A total of 436 patients (mean age at diagnosis 57 years, 88% females, median follow-up 5.2 years) were included. Liver biopsy, transient elastography, or none of these two procedures were performed at baseline in 216 (50%), 194 (45%), and 107 (25%) patients, respectively. Late-stage disease (histological stage III or IV, or transient elastography ≥9.6 kPa, or bilirubin >17 µM and albumin

Published
2020

16. Hepatitis C virus infection impacts work productivity and fatigue: An epidemiologic real-life study

Author

Joseph Moussalli, Victor de Ledinghen, Dominique Larrey, Si Nafa Si Ahmed, Bertrand Hanslik, Denis Ouzan, and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)

Subjects
Male, Quality of life, Work, medicine.medical_specialty, Health Status, Hepatitis C virus, [SDV]Life Sciences [q-bio], Specialties of internal medicine, Efficiency, Disease, medicine.disease_cause, Antiviral Agents, Severity of Illness Index, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Pegylated interferon, Internal medicine, Humans, Medicine, Disease management (health), Tiredness, Fatigue, Aged, Retrospective Studies, Work productivity, Hepatology, business.industry, Incidence, Ribavirin, General Medicine, Hepatitis C, Chronic, Middle Aged, Prognosis, medicine.disease, Comorbidity, 3. Good health, Cross-Sectional Studies, RC581-951, chemistry, 030220 oncology & carcinogenesis, Active life impairment, Female, 030211 gastroenterology & hepatology, France, business, Follow-Up Studies, medicine.drug
Abstract

Introduction and Objective Hepatitis C virus (HCV) infection and treatment impact the patient's daily life and work productivity. Until recently, treatments were associated with side effects and insufficient virologic and hepatic results. This study evaluated fatigue, work productivity, and treatment modalities in patients with HCV infection. Materials and methods This cross-sectional, non-interventional, multicenter study was conducted in real-life settings between March and December 2015 at 109 sites in France. Results Data from 1269 patients were evaluable. The mean patient age was 55.8 ± 12.5 years; 53.3% (676) patients were male. A total of 80.1% (1015) of patients were Caucasian and 62.3% (791) had a genotype 1 infection, 34.2% (433) had at least one comorbidity and 15.6% (198) had ≥1 clinical sign/symptom. Illicit drug use was the main route of HCV transmission and accounted for 36.8% (466) of all infections. Fibrosis stage F0/F1 was reported in 41.4% (525) of patients. A majority of patients (60.4%, 764) had never been treated. In patients previously treated, 85.8% (430) received ribavirin and pegylated interferon and only 13.4% (67) direct-acting antivirals. The mean percent of global impairment due to health was highest (34.8 ± 30.9%) in patients 18–45 years of age. The prevalence of active employed patients with a total fatigue score ≥ its median value (45/160) was 38.6%. The mean percent work time missed due to health was 9.6 ± 23.6% for working patients of 18–45 years of age and 7.3 ± 21.8% for working patients of 45–65 years of age. The mean overall prevalence of employed patients with impairment due to health issues was 21.8 ± 26.8%. The prevalence of patients with a reduced work activity of ≥50% due to their health status was 32.1%. Conclusion These data reinforce the request for improved disease management in France, allowing patients with HCV infection to increase work productivity, reduce fatigue, and, hopefully, cure their disease.

Published
2019
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17. Integration of an Addiction Team in a Liver Transplantation Center

Author

Hélène Donnadieu-Rigole, Francis Navarro, Pascal Perney, Astrid Herrero, Stéphanie Faure, Laura Jaubert, Lucie Gamon, Georges-Philippe Pageaux, Thibault Mura, Bertrand Hanslik, José Ursic-Bedoya, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Pathogénèse et contrôle des infections chroniques (PCCI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC), Université Montpellier 1 (UM1)-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), and Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)

Subjects
Male, medicine.medical_specialty, media_common.quotation_subject, medicine.medical_treatment, Aftercare, Addiction, 030230 surgery, Liver transplantation, Severity of Illness Index, Liver transplantation (LT), Cohort Studies, End Stage Liver Disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Severity of illness, Secondary Prevention, Humans, Medicine, Liver Diseases, Alcoholic, media_common, Patient Care Team, Transplantation, Hepatology, Alcohol Abstinence, business.industry, Middle Aged, Abstinence, Disability pension, Liver Transplantation, 3. Good health, Alcoholism, Addiction medicine, Alcohol-use disorder (AUD), [SDV.TOX]Life Sciences [q-bio]/Toxicology, Disease Progression, Female, 030211 gastroenterology & hepatology, Surgery, business, Alcohol consumption, Addiction Medicine, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Cohort study
Abstract

International audience; Up to 50% of liver transplantation (LT) recipients with known or clandestine alcohol-use disorder (AUD) before surgery return to alcohol use after LT. However, only severe alcohol relapse, which varies in frequency from 11% to 26% of patients, has an impact on longterm survival and significantly decreases survival rates after 10 years. Therefore, it is crucial to identify patients with the highest risk of severe relapse in order to arrange specific, standardized monitoring by an addiction team before and after LT. The aims of this study were to describe the effects of combined management of AUD on the rate of severe alcohol relapse and to determine the risk factors before LT that predict severe relapse. Patients transplanted between January 2008 and December 2014 who had met with the LT team's addiction specialist were included in the study. Patients who exhibited alcohol-related relapse risk factors received specific addiction follow-up. A total of 235 patients were enrolled in the study. Most of them were men (79%), and the mean age at the time of the LT was 55.7 years. Severe relapse occurred in only 9% of the transplant recipients. Alcohol-related factors of severe relapse were a pretransplant abstinence of 6 months and family, legal, or professional consequences of alcohol consumption, whereas the nonalcohol-related factors were being single and being eligible for a disability pension. In conclusion, the integration of an addiction team in a LT center may be beneficial. The addiction specialist can identify patients at risk of severe relapse in the pretransplantation period and hence arrange for specific follow-up.

Published
2019
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18. Major changes in the number and indications of liver biopsy for chronic liver diseases over one decade in France

Author

Jean-Baptiste Nousbaum, Jean-François Cadranel, Bertrand Hanslik, and Maelenn Gouillou

Subjects
Image-Guided Biopsy, medicine.medical_specialty, Time Factors, Biopsy, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Chronic hepatitis, Predictive Value of Tests, Risk Factors, Internal medicine, Humans, Medicine, Practice Patterns, Physicians', Chronic viral hepatitis C, Ultrasonography, Interventional, Retrospective Studies, Hepatology, medicine.diagnostic_test, business.industry, Liver Diseases, Patient Selection, Clinical Practice, Ultrasound guidance, Liver, Health Care Surveys, 030220 oncology & carcinogenesis, Liver biopsy, Chronic Disease, Practice Guidelines as Topic, Ambulatory, 030211 gastroenterology & hepatology, France, Guideline Adherence, business
Abstract

AIMS French clinical practice guidelines on the use of liver biopsy (LB) published in 2002 focused on ultrasound guidance (USG) and ambulatory LB. The aims of this study were as follows: (i) to evaluate the number and indications for LB for chronic liver diseases and (ii) to evaluate LB modalities according to French clinical practice guidelines. Data recorded included the number and indications for LB, procedures, use of USG, and complications. RESULTS A total of 131 centers participated: 8741 LB were performed versus 12 000 in 1997; ambulatory LB was performed in 48.6% of cases (vs. 27% in 1997; P

Published
2016
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19. Baveno-VI–Guided Prediction of Esogastric Varices in Primary Biliary Cholangitis

Author

Christophe Renou, Bertrand Hanslik, Jean-Pierre Arpurt, Olivier Chazouillères, J. Henrion, Alexandre Pariente, Christophe Corpechot, Isabelle Rosa, and Xavier Causse

Subjects
medicine.medical_specialty, Patients, Hepatology, Liver Cirrhosis, Biliary, business.industry, Cholangitis, Sclerosing, Gastroenterology, MEDLINE, Esophageal and Gastric Varices, Varicose Veins, Varicose veins, medicine, Humans, Radiology, medicine.symptom, business, Varices
Published
2019
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20. Hepatogastroenterologists’ knowledge of inactive carriers and immunotolerant hepatitis B virus patients in France

Author

Xavier, Causse, Jean-François, Cadranel, Pascal, Potier, Bertrand, Hanslik, Jacques, Denis, Christophe, Renou, Patrick, Delasalle, and Zarka, Yves

Subjects
Male, Health Knowledge, Attitudes, Practice, HBsAg, Pediatrics, medicine.medical_specialty, Reproductive Techniques, Assisted, Viremia, medicine.disease_cause, Hepatitis B, Chronic, Pregnancy, Surveys and Questionnaires, Immune Tolerance, medicine, Humans, Hepatitis B e Antigens, Practice Patterns, Physicians', Pregnancy Complications, Infectious, Hepatitis B virus, Hepatitis B Surface Antigens, Hepatology, biology, business.industry, Gastroenterology, Alanine Transaminase, Middle Aged, Viral Load, Hepatitis B, medicine.disease, HBeAg, Alanine transaminase, Population Surveillance, Carrier State, biology.protein, Female, France, alpha-Fetoproteins, business, Viral load
Abstract

BACKGROUND Before the 2012 revision of the EASL guidelines for the management of hepatitis B virus infection, we conducted a survey to determine how French nonacademic hepatogastroenterologists defined inactive hepatitis B virus carriers and immunotolerant patients. METHODS We asked 680 hepatogastroenterologists to complete a simple survey consisting of 11 multiple-choice questions. RESULTS The participation rate was 32%. HBeAg positivity was not identified as a key criterion for the diagnosis of immunotolerance by 61.9% of the respondents. A total of 82.5 and 75.9% of the respondents identified repeatedly normal alanine transaminase levels and repeatedly low viremia (

Published
2015
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21. Albumin Use in Patients With Cirrhosis in France: Results of the 'ALBU-LIVE' Survey: A Case for Better EASL Guidelines Diffusion and/or Revision

Author

Teresa Antonini, Alexandre Louvet, Brigitte Bernard-Chabert, Vincent Jouannaud, Arnaud Pauwels, H. Labadie, Jean-Baptiste Nousbaum, Jacques Denis, Jean-François Cadranel, N. Talbodec, Xavier Amiot, Victor de Ledinghen, Nicolas Carbonell, Laurent Alric, Vincent Leroy, Laure Elkrief, Thong Dao, Thierry Thevenot, Dominique Thabut, Bertrand Hanslik, Christophe Bureau, Gilles Macaigne, Philippe Sogni, Armand Garioud, Hortensia Lison, and Armand Abergel

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Serum albumin, Serum Albumin, Human, Gastroenterology, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Spontaneous bacterial peritonitis, Hepatorenal syndrome, Internal medicine, medicine, Paracentesis, Humans, Hypoalbuminemia, Prospective Studies, Medical prescription, Practice Patterns, Physicians', Prospective cohort study, Infusions, Intravenous, Aged, medicine.diagnostic_test, biology, business.industry, Gastroenterologists, Middle Aged, medicine.disease, 3. Good health, Treatment Outcome, 030220 oncology & carcinogenesis, Health Care Surveys, Practice Guidelines as Topic, biology.protein, 030211 gastroenterology & hepatology, Female, France, Guideline Adherence, Hyponatremia, business
Abstract

Introduction The use of human albumin for the management of cirrhosis has increased. Recommendations have been published for therapeutic paracentesis (TP), spontaneous bacterial peritonitis (SBP), and type 1 hepatorenal syndrome (HRS). The goal of this survey was to assess the prescription practices of French hepatogastroenterologists. Methods All hepatogastroenterologists were contacted. The questionnaire evaluated (1) the use of albumin in validated indications and (2) the prescription of albumin for nonvalidated clinical situations. Results Responses were analyzed from 451 (50.1%) practitioners. The mean age was 40 years (range, 24 to 67 y). Physicians practiced in a university hospital (47.7%) or a general hospital (45.8%). There were 56.7% senior practitioners. Overall 99.6% of the practitioners compensated for TP. Albumin was used by 87.8% of the physicians, with a fixed dose being used by 84.6%. For SBP, 94% of the physicians used albumin concomitantly with antibiotics. The recommended protocol was followed by 56.2% of the practitioners: more often by senior university hospital practitioners than by senior general hospital practitioners (P=0.015). About 66.5% used albumin infusion for the diagnosis of HRS: used more often by senior university hospital practitioners (P=0.0006). Albumin was used concomitantly with vasopressor treatment by 84%; the dose and the duration varied considerably. About 23.5% used albumin for severe bacterial infection, 47.9% for severe hyponatremia, 43.9% for severe hypoalbuminemia, and 65.9% for hydrothorax. Conclusions In this large French survey, albumin is only prescribed in accordance with recommendations for TP. The schedule for SBP is followed by only 56% of the practitioners. The use of albumin for HRS is not adapted to recommendations, which are not well known, suggesting that they should be more diffused.

Published
2017

22. THU-123-No effect of alcohol consumption or dependence on treatment outcome in chronic hepatitis C patients treated with Elbasvir/Grazoprevir in a real-world setting

Author

Amir Guidoum, Armand Abergel, E. Estrabaud, Patrick Miailhes, Axelle SpampinatoMs, Philippe Sogni, Camille Liautard, Stéphanie Perot, Bertrand Hanslik, Denis Ouzan, Dan Pospait, Vincent Jouannaud, Jérémy Skrzypski, Jean-Pierre Bronowicki, Régine Truchi, and Dominique Larrey

Subjects
medicine.medical_specialty, Hepatology, Chronic hepatitis, business.industry, Internal medicine, Treatment outcome, medicine, Elbasvir, Grazoprevir, business, Alcohol consumption
Published
2019
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23. Covered self-expandable biliary stents for the treatment of bleeding after ERCP

Author

Pierre Blanc, Dimitri Christophorou, P. Bauret, Michael Bismuth, Bertrand Hanslik, Jean-Christophe Valats, Natalie Funakoshi, and Anne Dorandeu

Subjects
Male, medicine.medical_specialty, MEDLINE, Prosthesis Design, Cohort Studies, Sphincterotomy, Endoscopic, Coated Materials, Biocompatible, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Aged, Retrospective Studies, Aged, 80 and over, Cholangiopancreatography, Endoscopic Retrograde, Cholestasis, Common bile duct, business.industry, Self expandable, Hemostasis, Endoscopic, Gastroenterology, Retrospective cohort study, Equipment Design, Middle Aged, Biocompatible material, Surgery, medicine.anatomical_structure, Metals, Hemostasis, Biliary stent, Female, Stents, Gastrointestinal Hemorrhage, business, Cohort study
Published
2013
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25. Safety and efficacy of combination therapy with peginterferon alfa-2a (40kD) and ribavirin in the outpatient setting: prospective analysis of 197 patients with chronic hepatitis C viral infection

Author

Bernard Filoche, T. Fontanges, Bertrand Hanslik, Patrick Delassalle, Denis Ouzan, Jean-Marc Combis, Jean-Paul Jacques, Catherine Chandelier, Catherine Douvin, Hervé Desmorat, and Sylvain Beorchia

Subjects
Adult, Male, medicine.medical_specialty, Combination therapy, Interferon alpha-2, Antiviral Agents, Polyethylene Glycols, law.invention, chemistry.chemical_compound, Randomized controlled trial, law, Internal medicine, Ribavirin, Ambulatory Care, Humans, Medicine, Prospective Studies, Adverse effect, Aged, Aged, 80 and over, business.industry, Gastroenterology, Interferon-alpha, General Medicine, Hepatitis C, Hepatitis C, Chronic, Middle Aged, medicine.disease, Recombinant Proteins, Surgery, Clinical trial, Regimen, chemistry, Drug Therapy, Combination, Female, Safety, business, Peginterferon alfa-2a, medicine.drug
Abstract

Summary Objectives Combination therapy using peginterferon alfa-2a (40 kD) plus ribavirin achieves viral eradication in nearly 60% of patients with chronic hepatitis C viral infection. However, because of the numerous side effects, use of the combination regimen might be restricted for patients consulting private practitioners specialized in hepatogastroenterology. Patients and method Conducted in this specific context, this prospective clinical trial investigated the safety and efficacy of combination therapy in 197 patients. Therapy was given in compliance with the recommendations of the French consensus conference on hepatitis C treatment. Results Commonly reported adverse effects were noted in 90% of patients, most occurring during the first three months, with a stable prevalence thereafter and resolution after treatment end. The most frequent adverse events were asthenia (35 to 37.5% according to the treatment group pruritus (25 to 26.3%) and flu-like syndrome (19 to 21.7%). A depressive syndrome was reported in 20 to 21% of patients. Grade 4 neutropenia was exceptional and never led to severe infections. At intent-to-treat analysis, the rate of sustained virological response was 54.8% for the entire population. It was 71.1% for patients with genotypes 2 or 3 (mainly treated for 24 weeks) and 44.6% for patients with genotype 1 (all treated 48 weeks). Conclusion The characteristic features of combination therapy observed in the context of private hepatogastroenterology consultations are similar to those observed in randomized clinical trials.

Published
2007
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26. P1266 : Human albumin use in cirrhotic patients in France: Results of the national 'Albu-live' survey

Author

Jacques Denis, Xavier Amiot, C. Bureau, D. Valla, Isabelle Ollivier-Hourmand, N. Carbonnel, Brigitte Bernard-Chabert, Alexandre Louvet, Olivier Chazouillères, Jean-Claude Trinchet, Alexandre Pariente, Laurent Alric, D. Zanditenas, Christophe Renou, Thierry Paupard, Vincent Leroy, G.-P. Pageaux, Stanislas Pol, Thierry Poynard, P. Mathurin, Jean-Pierre Zarski, L. Bettan, B. Lesgourgues, V. de Ledinghen, Vincent Jouannaud, Denis Ouzan, T. Fontanges, Michael Bismuth, Armando Abergel, H. Labadie, L. Elkrief, Thierry Thevenot, Dominique Thabut, Thong Dao, K. Dupont, R. Bader, Xavier Causse, N. Talbodec, Gilles Macaigne, Bertrand Hanslik, I. Rosa-Hézode, P. Nahon, Armand Garioud, Hortensia Lison, Arnaud Pauwels, Dominique Guyader, Jean François Cadranel, Philippe Sogni, Agents pathogènes et inflammation - UFC (EA 4266) ( API ), Université de Franche-Comté ( UFC ), Hydrosystèmes et bioprocédés ( UR HBAN ), Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture ( IRSTEA ), Institut d'astrophysique spatiale ( IAS ), Université Paris-Sud - Paris 11 ( UP11 ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ), Service d'hépatologie médicale [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Matière et Systèmes Complexes ( MSC ), Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Service des maladies du foie, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-Centre Hospitalier Universitaire de Rennes, Foie, métabolismes et cancer, Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Hydrosystèmes et bioprocédés (UR HBAN), Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA), Institut d'astrophysique spatiale (IAS), Université Paris-Sud - Paris 11 (UP11)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Matière et Systèmes Complexes (MSC (UMR_7057)), Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire [Rennes]-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Hydrosystèmes et Bioprocédés (UR HBAN), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Université Paris-Sud - Paris 11 (UP11)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Centre National d’Études Spatiales [Paris] (CNES), Matière et Systèmes Complexes (MSC), Service des maladies du foie [CHU Rennes], Centre Hospitalier Universitaire [Rennes], and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
medicine.medical_specialty, Hepatology, [ SDV ] Life Sciences [q-bio], business.industry, [SDV]Life Sciences [q-bio], Emergency medicine, medicine, Human albumin, Intensive care medicine, business, ComputingMilieux_MISCELLANEOUS, 3. Good health
Abstract

International audience; no abstract

Published
2015
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27. Retreatment of hepatitis C virus daa failures in real life: easy and difficult to cure patients

Author

P. Cerdan, S. Beorchia, Denis Ouzan, S. Baesjou, M. Bourlière, P. Delasalle, Philippe Halfon, P. Toulemonde, M. Antoni, G. Lefolgoc, C. Bonny, Nathalie Boyer, Christophe Renou, Bertrand Hanslik, Hélène Joly, J. Liautard, T. Fontanges, Solange Bresson-Hadni, and Guillaume Penaranda

Subjects
Hepatology, business.industry, Hepatitis C virus, In real life, Medicine, business, medicine.disease_cause, Virology
Published
2017
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29. P0822 : Safety And efficacy of sofosbuvir containing regimens for hepatitis C: Community treatment of a real world population with advanced liver fibrosis

Author

P. Cerdan, Denis Ouzan, M. Antoni, B. Serge, C. Castelnau, S. Boussoukouya, P. Delasalle, S. Beorchia, T. Fontanges, Hélène Joly, P. Toulemonde, Jérémie Jacques, Bertrand Hanslik, Guillaume Penaranda, C. Bonny, Nathalie Boyer, and S. Bresson-Hadni

Subjects
medicine.medical_specialty, Hepatology, Sofosbuvir, business.industry, Liver fibrosis, Internal medicine, medicine, Hepatitis C, business, medicine.disease, Gastroenterology, medicine.drug
Published
2015
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30. Gestion des effets secondaires de la trithérapie en pratique libérale

Author

Bertrand Hanslik

Abstract

Le degre de fibrose est la plupart du temps, le premier element decisionnel dans l'indication therapeutique. Il y a une indication therapeutique chez tout patient presentant une fibrose significative (F2, F3, F4). Chez les malades ne presentant qu’une fibrose faible (F0 ou F1), l'indication therapeutique peut etre retenue sur la presence d'autres criteres comme la forte motivation du patient, des criteres d'evolutivite (dont comorbidites), ou une symptomatologie clinique invalidante. La discussion therapeutique doit actuellement tenir compte de la future disponibilite de molecules, pan genomiques ou pas, ayant une efficacite accrue, une prise simplifiee et des effets indesirables moins frequents.

Published
2012
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31. 342 MAJOR TRENDS IN LIVER BIOPSY PRACTICES IN FRANCE: RESULTS OF A MULTICENTER NATIONWIDE 2009 SURVEY AND COMPARISON WITH 1997 PRACTICES

Author

Jean-Baptiste Nousbaum, Jean François Cadranel, and Bertrand Hanslik

Subjects
medicine.medical_specialty, Cirrhosis, Hepatology, medicine.diagnostic_test, business.industry, Overweight, medicine.disease, Gastroenterology, Internal medicine, Liver biopsy, Cohort, Medicine, In patient, medicine.symptom, business, Viral hepatitis, Significant fibrosis
Abstract

liver biopsy (mean length 28±8mm), the AUROCs for significant fibrosis (F ≥ 2) were 0.82 (95%CI 0.70–0.89) among 84 patients with viral hepatitis and 0.84 (95%CI 0.72–0.91) among the patients with NAFLD. The AUROC for the diagnosis of cirrhosis (11% of cases) in the entire cohort was 0.94 (95%CI 0.89–0.96) and was not significantly different when patients with IQR/med ≥30% were excluded. The optimal LSM cut-off value for the diagnosis of cirrhosis was 14.0kPa (sensitivity 0.92, specificity 0.86, LR+ 6.3, PPV 0.45, NPV 0.99). Conclusions: The new FibroScan XL probe allows LSM in the vast majority of overweight patients, and has similar diagnostic performance for the detection of significant fibrosis and cirrhosis as previously described in patients with chronic viral hepatitis and NAFLD.

Published
2011
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32. Pralina : étude de pratiques dans les Hépatopathies stéatosiques Non alcooliques réalisée auprès des hépato-gastro-entérologues libéraux

Author

Corinne Bonny, François Kohler, Bertrand Hanslik, and null Commission hépatologie du CREGG

Subjects
Pathology, medicine.medical_specialty, Medical treatment, Puncture Biopsy, business.industry, Advanced stage, medicine.disease, Gastroenterology, Fibrosis, Internal medicine, Nonalcoholic fatty liver disease, medicine, Steatosis, Steatohepatitis, Hepatic fibrosis, business
Abstract

Biology, biomarkers of hepatic fibrosis, imaging and Fibroscan® have opened new perspectives to differentiate common steatosis from steatohepatitis potentially contributing to the development of fibrosis. Liver puncture biopsy remains inevitable if a discrepancy arises between the tests and in the case of an advanced stage. It thus allows for intensifying the medical treatment combining insulin-sensitizing agents and antifibrotic therapy.

Published
2011
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