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Resumen: La enfermedad hepática alcohólica (EHA) es una entidad clinicopatológica ocasionada por el consumo excesivo y crónico de alcohol. La enfermedad incluye un amplio espectro de anomalías celulares y tisulares que pueden causar daño agudo sobre crónico (hepatitis alcohólica) o crónico (fibrosis, cirrosis, cáncer hepatocelular), teniendo un gran impacto en la morbimortalidad en todo el mundo. El alcohol es metabolizado principalmente en el hígado. Durante el metabolismo del alcohol son generados metabolitos tóxicos como el acetaldehído y las especies reactivas de oxígeno. En el intestino el consumo de alcohol puede producir disbiosis y alteración de la permeabilidad intestinal, promoviendo la translocación de productos bacterianos y provocando la producción de citocinas proinflamatorias en el hígado, lo cual perpetúa la inflamación local durante la evolución de la EHA. Diferentes grupos de estudio han reportado alteraciones de la respuesta inflamatoria a nivel sistémico, sin embargo es difícil encontrar reportes que contengan un compendio de las células y citocinas involucradas en la fisiopatología de la enfermedad desde sus etapas tempranas. En este trabajo de revisión se describe el papel de los mediadores inflamatorios involucrados en la progresión de la EHA, desde los patrones de consumo de riesgo hasta etapas avanzadas de la enfermedad, con la finalidad de comprender la implicación de la desregulación inmunológica en la fisiopatología de esta enfermedad. Abstract: Alcoholic liver disease (ALD) is a clinical-pathologic entity caused by the chronic excessive consumption of alcohol. The disease includes a broad spectrum of anomalies at the cellular and tissual level that can cause acute-on-chronic (alcoholic hepatitis) or chronic (fibrosis, cirrhosis, hepatocellular cancer) injury, having a great impact on morbidity and mortality worldwide. Alcohol is metabolized mainly in the liver. During alcohol metabolism, toxic metabolites, such as acetaldehyde and oxygen reactive species, are produced. At the intestinal level, alcohol consumption can cause dysbiosis and alter intestinal permeability, promoting the translocation of bacterial products and causing the production of inflammatory cytokines in the liver, perpetuating local inflammation during the progression of ALD. Different study groups have reported systemic inflammatory response disturbances, but reports containing a compendium of the cytokines and cells involved in the pathophysiology of the disease, from the early stages, are difficult to find. In the present review article, the role of the inflammatory mediators involved in ALD progression are described, from risky patterns of alcohol consumption to advanced stages of the disease, with the aim of understanding the involvement of immune dysregulation in the pathophysiology of ALD.

Alcoholic liver disease (ALD) is a clinical-pathologic entity caused by the chronic excessive consumption of alcohol. The disease includes a broad spectrum of anomalies at the cellular and tissual level that can cause acute-on-chronic (alcoholic hepatitis) or chronic (fibrosis, cirrhosis, hepatocellular cancer) injury, having a great impact on morbidity and mortality worldwide. Alcohol is metabolized mainly in the liver. During alcohol metabolism, toxic metabolites, such as acetaldehyde and oxygen reactive species, are produced. At the intestinal level, alcohol consumption can cause dysbiosis and alter intestinal permeability, promoting the translocation of bacterial products and causing the production of inflammatory cytokines in the liver, perpetuating local inflammation during the progression of ALD. Different study groups have reported systemic inflammatory response disturbances, but reports containing a compendium of the cytokines and cells involved in the pathophysiology of the disease, from the early stages, are difficult to find. In the present review article, the role of the inflammatory mediators involved in ALD progression are described, from risky patterns of alcohol consumption to advanced stages of the disease, with the aim of understanding the involvement of immune dysregulation in the pathophysiology of ALD. Resumen: La enfermedad hepática alcohólica (EHA) es una entidad clínico-patológica, ocasionada por el consumo excesivo y crónico de alcohol. La enfermedad incluye un amplio espectro de anomalías a nivel celular y tisular que pueden causar daño agudo sobre crónico (hepatitis alcohólica) o crónico (fibrosis, cirrosis, cáncer hepatocelular), teniendo un gran impacto en la morbilidad y mortalidad a nivel mundial. El alcohol es metabolizado principalmente en el hígado. Durante el metabolismo del alcohol son generados metabolitos tóxicos como el acetaldehído y las especies reactivas de oxígeno. A nivel intestinal, el consumo de alcohol puede producir disbiosis y alteración de la permeabilidad intestinal, promoviendo la translocación de productos bacterianos, y provocando la producción de citocinas proinflamatorias en el hígado, lo cual perpetua la inflamación local durante la evolución de la EHA. Diferentes grupos de estudio han reportado alteraciones de la respuesta inflamatoria a nivel sistémico, sin embargo, es difícil encontrar reportes que contengan un compendio de las células y citocinas involucradas en la fisiopatología de la enfermedad desde sus etapas tempranas. En este trabajo de revisión se describe el papel de los mediadores inflamatorios involucrados en la progresión de la EHA, desde los patrones de consumo de riesgo hasta etapas avanzadas de la enfermedad, con la finalidad de comprender la implicación de la desregulación inmunológica en la fisiopatología de esta enfermedad.

Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago. Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma. In this second part of the document, the topics related to the treatment of HCC are presented. Resumen: El Carcinoma Hepatocelular (CHC) se presenta cada vez más frecuentemente como una de las principales complicaciones de cirrosis, su principal factor de riesgo. La última década ha presentado modificaciones en su incidencia, relacionadas con una transición epidemiológica en la etiología de la cirrosis, con disminución en la prevalencia de hepatitis C y aumento en la etiología relacionada con la enfermedad por hígado graso no alcohólico (EHNA), además del desarrollo del CHC en hígado no cirrótico por EHNA. Se han identificado marcadores genéticos asociados a la enfermedad, así como avances en vigilancia y diagnóstico. En relación al tratamiento, el perfeccionamiento de técnicas quirúrgicas, tanto relacionadas con resección como trasplante; y radiológicas en estadios curativos permite mejorar la supervivencia de los pacientes candidatos a este abordaje; y finalmente, hay cambios radicales en el abordaje sistémico con expectativas mucho más optimistas cuando se comparan con lo disponible hace una década. Es por eso que la Asociación Mexicana de Hepatología decidió realizar el II Consenso Mexicano de Carcinoma Hepatocelular, en el cual se hizo una revisión actualizada de la evidencia disponible nacional e internacional sobre la epidemiología, factores de riesgo, vigilancia, diagnóstico y tratamiento de la enfermedad; con el objetivo de ofrecer al médico mexicano una revisión actualizada sobre los diferentes tópicos de esta enfermedad. En esta segunda parte del documento se presenta los tópicos relacionados con el tratamiento del CHC.

Resumen: El carcinoma hepatocelular (CHC) se presenta cada vez más frecuentemente como una de las principales complicaciones de cirrosis, su principal factor de riesgo. La última década ha presentado modificaciones en su incidencia, relacionadas con una transición epidemiológica en la etiología de la cirrosis, con disminución en la prevalencia de hepatitis C y aumento en la etiología relacionada con la enfermedad por hígado graso no alcohólico (EHNA), además del desarrollo del CHC en hígado no cirrótico por EHNA. Se han identificado marcadores genéticos asociados a la enfermedad, así como avances en vigilancia y diagnóstico. Con relación al tratamiento, el perfeccionamiento de técnicas quirúrgicas, tanto relacionadas con la resección como con el trasplante, y radiológicas en estadios curativos permite mejorar la supervivencia de los pacientes candidatos a este abordaje, y, finalmente, hay cambios radicales en el abordaje sistémico con expectativas mucho más optimistas cuando se comparan con lo disponible hace una década. Es por eso que la Asociación Mexicana de Hepatología decidió realizar el II Consenso Mexicano de Carcinoma Hepatocelular, en el cual se hizo una revisión actualizada de la evidencia disponible nacional e internacional sobre la epidemiología, factores de riesgo, vigilancia, diagnóstico y tratamiento de la enfermedad; con el objetivo de ofrecer al médico mexicano una revisión actualizada sobre los diferentes tópicos de esta enfermedad. En esta segunda parte del documento se presentan los tópicos relacionados con el tratamiento del CHC. Abstract: Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago. Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma. In this second part of the document, the topics related to the treatment of HCC are presented.

Introduction and Objectives: IL-1β is a proinflammatory key cytokine that participates in the progression of liver disease. Its antagonist IL-1RA mediates damage limitation; its increase is associated with positive effects on chronic liver diseases. This study aimed to evaluate the concentration of IL-1β and IL-1RA in subjects with alcoholic liver disease (ALD), chronic hepatitis C (CHC) and non-alcoholic fatty liver disease (NAFLD). Materials and Methods: A cross-sectional and multicenter study was carried out, which included alcoholic subjects (OH), alcoholic cirrhosis (CiOH) and alcoholic hepatitis (HA); patients with CHC and NAFLD were compared against subjects without criteria for alcohol drinking habits (CT). IL-1β and IL-1RA were quantified by Multiplex-MERCK©. For statistical analysis, SPSS V.22 were used, Mann-Whitney U, p

Introduction and Objectives: We recently published that in the serum of patients with chronic Hepatitis C, there are high concentrations of inactive Matrix Metalloproteinases (MMP). However, the MMP has not been studied in other liver diseases. This study aimed to evaluate serum concentrations of MMP-7 in different hepatic etiologies and according to fibrosis stage. Materials and Methods: A cross-sectional and multicenter study was carried out, including subjects with alcoholism (WHO criteria), without (OH) and with liver injury (cirrhosis, CiOH); diagnosed by clinical, biochemical data, non-alcoholic fatty liver (NAFLD) and chronic Hepatitis C (CHC). Transitional elastography (Fibroscan) was performed in NAFLD and CHC, considering mild fibrosis (MF: F0, F1, F2) and advanced fibrosis (AF: F3, F4). As controls, subjects without alcohol consumption (CT) were recruited. For the quantification of MMP-7, Multiplex-MERCK© was used. Statistical analysis was performed using SPSS V.22 using Mann Whitney U, p

Introduction: The sofosbuvir-velpatasvir (SOF/VEL) combination is a direct-acting antiviral therapy that is authorized and available in Mexico, making the performance of a real-world multicenter study that evaluates the sustained virologic response at 12 weeks post-treatment a relevant undertaking. Methods: A retrospective review of the case records of 241 patients seen at 20 hospitals in Mexico was conducted to assess hepatitis C treatment with the SOF/VEL combination (n = 231) and the sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) combination (n = 10). The primary efficacy endpoint was the percentage of patients that achieved SVR at 12 weeks after the end of treatment. Results: Overall SVR was 98.8% (95% CI 97.35–100%). Only three patients did not achieve SVR, two of whom had cirrhosis and a history of previous treatment with peg-IFN. Of the subgroups analyzed, all the patients with HIV coinfection, three patients with genotype 3, and the patients treated with the SOF/VEL/RBV combination achieved SVR. The subgroups with the lower success rates were patients that were treatment-experienced (96.8%) and patients with F1 fibrosis (95.5%). The most frequent adverse events were fatigue, headache, and insomnia. No serious adverse events were reported. Conclusion: Treatments with SOF/VEL and SOF/VEL/RBV were highly safe and effective, results coinciding with those of other international real-world studies. Resumen: Introducción: La combinación de sofosbuvir-velpatasvir (SOF/VEL) es una terapia antiviral de acción directa que está autorizada y disponible en México. Esto hace que la evaluación de la respuesta virológica sostenida (RVS) 12 semanas después del tratamiento, por medio de la realización de una revisión multicentro en el mundo real, sea una tarea relevante. Métodos: Se efectuó una revisión retrospectiva de los registros de 241 casos de pacientes atendidos en 20 hospitales en México para evaluar el tratamiento contra la hepatitis C con la combinación SOF/VEL (n = 231) y sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) (n = 10). El objetivo de eficacia primario fue el porcentaje de pacientes que lograron la RVS 12 semanas posterior a la finalización del tratamiento. Resultados: En general, la RVS fue de 98.8% (IC 95% 97.35 a 100%). Solo tres pacientes no lograron la RVS, de los cuales dos padecían cirrosis y una tenía historia previa de tratamiento con interferón pegilado (peg-IFN). De los subgrupos analizados, todos los casos con infección de virus de la inmunodeficiencia humana (VIH), tres con genotipo 3 y aquellos tratados con la combinación SOF/VEL/RBV, lograron RVS. Los subgrupos con tasas menores de éxito fueron los pacientes que tenían experiencia con tratamiento (96.8%) y pacientes con fibrosis F1 (95.5%). Los eventos adversos más frecuentes fueron fatiga, cefalea e insomnio. No se reportaron eventos adversos graves. Conclusión: Los tratamientos con SOF/VEL y SOF/VEL/RBV fueron altamente seguros y efectivos y los resultados coinciden con los de otros estudios internacionales realizados en el mundo real.

Resumen: Introducción: La combinación de sofosbuvir-velpatasvir (SOF/VEL) es una terapia antiviral de acción directa que está autorizada y disponible en México. Esto hace que la evaluación de la respuesta virológica sostenida (RVS) 12 semanas después del tratamiento, por medio de la realización de una revisión multicentro en el mundo real, sea una tarea relevante. Métodos: Se efectuó una revisión retrospectiva de los registros de 241 casos de pacientes atendidos en 20 hospitales en México para evaluar el tratamiento contra la hepatitis C con la combinación SOF/VEL (n = 231) y sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) (n = 10). El objetivo de eficacia primario fue el porcentaje de pacientes que lograron la RVS 12 semanas posterior a la finalización del tratamiento. Resultados: En general, la RVS fue de 98.8% (IC 95% 97.35 a 100%). Solo tres pacientes no lograron la RVS, de los cuales dos padecían cirrosis y una tenía historia previa de tratamiento con interferón pegilado (peg-IFN). De los subgrupos analizados, todos los casos con infección de virus de la inmunodeficiencia humana (VIH), tres con genotipo 3 y aquellos tratados con la combinación SOF/VEL/RBV, lograron RVS. Los subgrupos con tasas menores de éxito fueron los pacientes que tenían experiencia con tratamiento (96.8%) y pacientes con fibrosis F1 (95.5%). Los eventos adversos más frecuentes fueron fatiga, cefalea e insomnio. No se reportaron eventos adversos graves. Conclusión: Los tratamientos con SOF/VEL y SOF/VEL/RBV fueron altamente seguros y efectivos y los resultados coinciden con los de otros estudios internacionales realizados en el mundo real. Abstract: Introduction: The sofosbuvir-velpatasvir (SOF/VEL) combination is a direct-acting antiviral therapy that is authorized and available in Mexico, making the performance of a real-world multicenter study that evaluates the sustained virologic response at 12 weeks post-treatment a relevant undertaking. Methods: A retrospective review of the case records of 241 patients seen at 20 hospitals in Mexico was conducted to assess hepatitis C treatment with the SOF/VEL combination (n = 231) and the sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) combination (n = 10). The primary efficacy endpoint was the percentage of patients that achieved SVR at 12 weeks after the end of treatment. Results: Overall SVR was 98.8% (95% CI 97.35-100%). Only three patients did not achieve SVR, two of whom had cirrhosis and a history of previous treatment with peg-IFN. Of the subgroups analyzed, all the patients with HIV coinfection, three patients with genotype 3, and the patients treated with the SOF/VEL/RBV combination achieved SVR. The subgroups with the lower success rates were patients that were treatment-experienced (96.8%) and patients with F1 fibrosis (95.5%). The most frequent adverse events were fatigue, headache, and insomnia. No serious adverse events were reported. Conclusion: Treatments with SOF/VEL and SOF/VEL/RBV were highly safe and effective, results coinciding with those of other international real-world studies.

Introduction and Aims: Insulin-like growth factor 1 is modulated by the insulin-like growth factor-binding proteins (IGFBPs) that are synthesized in the liver. The aim of the present study was to evaluate the concentrations of IGFBPs 1–7 in patients with chronic hepatitis C and study their association with fibrosis stage. Patients and methods: A prospective, cross-sectional study was conducted that included patients with chronic hepatitis C. The stages of fibrosis were determined through FibroTest and FibroScan and the patients were compared with a control group. Serum levels of IGFBPs 1–7 were quantified through multiple suspension arrays. The Kruskal-Wallis test, Mann-Whitney U test, Spearman’s correlation, and ROC curves were used for the statistical analysis. Results: Upon comparing the patients and controls, the highest concentrations were found in IGFBPs 1, 2, 4, and 7 (p = 0.02, 0.002, 0.008, and

Resumen: Introducción y objetivos: El factor de crecimiento tipo insulinoide 1 es modulado por las proteínas de unión al factor de crecimiento de tipo insulinoide (IGFBP); dichas proteínas son sintetizadas en el hígado. El objetivo de este trabajo fue evaluar las concentraciones de IGFBP-1 a IGFBP-7 en pacientes con hepatitis C crónica y estudiar la asociación con el grado de fibrosis. Pacientes y métodos: : Estudio prospectivo, transversal. Se incluyeron pacientes con hepatitis C crónica. El grado de fibrosis se determinó por medio de Fibrotest y Fibroscan, y los pacientes se compararon con un grupo control. Los niveles séricos de IGFBP-1 a IGFBP-7 fueron cuantificados por arreglo en suspensión múltiple. Para el análisis estadístico se utilizaron las pruebas Kruskal-Wallis, U de Mann-Whitney, correlación de Spearman y curvas ROC. Resultados: Al comparar entre pacientes y controles, las concentraciones fueron más altas en las IGFBP-1, -2, -4 y -7 (p = 0.02, p = 0.002, p = 0.008 y p

Introduction and objective: Hepatitis C virus and alcoholism are the main causes of Chronic Liver Disease. (1) The increase of CXCL-8 has been correlated with mortality in alcoholic hepatitis (AH), while in Chronic Hepatitis C (CHC) with the disease severity. (2) The IFN-γ has an anti-viral and anti-fibrotic function. There are few comparative studies in patients regarding the production of these mediators and their possible implication in liver damage. The objective is to evaluate the concentrations of CXCL-8 and IFN-γ in the serum of AH, alcoholic cirrhosis (CiOH) and CHC patients. Materials and methods: A multicenter cross-sectional study was carried out. Four participant groups were included: AH, CiOH, CHC and control group (CT). For the quantification of CXCL-8 and IFN-γ a multiple suspension array assay (Milliplex®-MERCK©) was used. Statistical analysis was performed by the SPSS V.22 software using Mann-Whitney-U-test. A p-value

Introduction and objective: Alcohol hepatitis (AH) is a clinical syndrome in patients with excessive and chronic alcohol consumption. Ethanol metabolism produces free radicals: reactive oxygen species (ROS) and reactive nitrogen species (RNS). This contributes to cellular damage in AH. The malondialdehyde (MDA) and carbonylated proteins are markers of oxidative damage in lipids and proteins. Our objective is to evaluate the levels of serum MDA and carbonylated proteins in AH patients with. Materials and methods: This transversal study included 147 individuals divided into two groups: the control group (n=100), which consists of individuals with alcohol consumption ≤ 10 g/day and AUDIT score ≤ 7, and the group with AH patients (n=47). We measured the serum levels of MDA (thiobarbituric acid method) and carbonylated proteins (DNPH reaction). The statistical analysis was performed by the Windows SPSS v22 software. Data were expressed as mean values ± SEM. Comparisons were carried out by analysis of variance (ANOVA). A p-value

Introduction and Objectives: The damage caused by alcohol consumption generates liver fibrosis, which is characterized by the accumulation of extracellular matrix (ECM); To limit the liver damage, MMP-2 and MMP-9 gelatinases are produced as mediators to degrade ECM products. Their importance in liver damage proposes them as possible markers and target molecules in the diagnosis of alcohol consumption, as well as in alcoholic liver disease [1]. The objective of this work is to evaluate the serum concentrations of MMP-2 and MMP-9 gelatinases in subjects with different patterns of alcohol consumption and in alcoholic liver disease patients. Materials and methods: A cross-sectional study was carried out in which subjects with different patterns of alcohol consumption were included. The inclusion was according to the AUDIT, DSM-IV, and clinical and biochemical data of liver disease: risk (Ri), abuse (Ab), dependence (OH), cirrhosis due to alcohol (CiOH) and alcoholic hepatitis (HA). A group without alcohol consumption (TC) was also included for comparison. For the quantification of MMP-2 and MMP-9, a multiple suspension assay (Milliplex®-MERCK ©) was used. Statistical analysis was performed using SPSS V.22 software using Mann Whitney U. P

Introduction and Objectives: Non alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (ALD) are the most common emergent causes of chronic liver disease; they evolve from simple steatosis, steatohepatitis, fibrosis/cirrhosis and hepatocellular carcinoma. Knowing the factors that influence their development and screening can improve the prognosis of these patients. Objective: To determine the prevalence of incidental findings of fatty liver in necropsies performed for all causes of mortality and to analyze the main characteristics of these patients. Materials and Methods: Type and design of the study: Observational, descriptive, transversal study. Procedure: All necropsy records for all causes of mortality registered at the Pathology Department in our center in the last 10 years were reviewed (January 2010 – December 2019). We search the following findings: “liver steatosis,” “steatohepatitis,” degree of fibrosis/cirrhosis, “atherosclerosis,” “heavy alcohol intake,” “diabetes, obesity, dyslipidemia, metabolic syndrome.” We used descriptive and analytical statistics: X2, exact Fisher´s test, univariate and multivariate logistic regression models. Results: 4557 necropsies were registered. Fatty liver was found in 6.4% of the cases. 53.3% were women; 51±15 years old; There was simple steatosis in 156 cases (53.6%) and steatohepatitis with necroinflammatory activity in 135 (46.4%). A 49.8% presented liver fibrosis (F1=38 [13.1%]; F2=48 [16.5%]; F3=15 [5.2%]; F4=44 [15.1%]). The etiology through clinical history and histological findings compatible with alcoholic liver injury occurred in 67 cases (23%), NAFLD in 98 (33.7%), mixed type (NAFLD+ALD) in 19 (6.5%), the etiology could not be identified in 107 (36.8%). The multivariate analysis showed alcohol intake as the main risk factor for necroinflammation (OR=2.58; ICal95%= 1.52-4.38; p

Introduction and Objectives: The virus of hepatitis C (HCV) and alcoholic liver disease (ALD), are of the main causes of liver disease mortality. There is a need to determine biomarkers, serum cytokines are candidates since they participate in the immunopathogenesis of these diseases by activating the inflammatory process. Increased serum levels of IL-10 and TNF-α have been reported in cirrhosis and have been associated with progression to hepatocellular carcinoma. While TNF-α has become a key factor in the inflammatory process with high circulating levels in alcoholic hepatitis (HA). The objective of this work is to evaluate the serum levels of IL-10 and TNF-α in patients with chronic hepatitis C and ALD. Materials and methods: A cross-sectional and multicenter study. Patients with chronic Hepatitis C (CHC) and CiOH (cirrhotic by alcohol) and alcoholic hepatitis (HA) with criteria for alcoholism (WHO) were included, personalized survey, clinical and biochemical evidence of ALD was recorder. The groups were compared with subjects with a negative viral panel obtained from the CT blood bank (controls). IL-10 and TNF-α from serum was quantified using the multiple suspension arrangement method (Milliplex®-MERCK ©). Statistical analysis was performed using SPSS software version 22 using Mann Whitney U test. It was considered statistically significant p

Introduction and Objectives: Diagnosis of liver disease (LD) is essential for the treatment and management of patients. The use of non-invasive methodologies is necessary despite the availability of direct-acting antivirals, some reports has been showed that treated patients can progress to cellular hepatocarcinoma (HCC). Continuous sampling that will evaluate liver tissue before and after treatment are essential for the prognosis of LD. Objective: To determine the sensitivity and specificity of insulin-like growth factor binding proteins (IGFBP) in the different stages of fibrosis in hepatitis C Material and methods: A prospective, cross-sectional, observational study. The study included patients with CHC that were treatment naïve. The stages of fibrosis were classified as F0, 16 F1, F2, F3, or F4, according to international guidelines, through the FibroTest® and/or FibroScan® Patients with at-risk alcohol consumption (AUDIT>8), and without concordance between fibrosis diagnostic methods employed, and comorbidities were not included. Serum was obtained and multiple suspension array technology (Millipore®) was used to evaluated IGFBP-1,2, 3, 4, 5, 6, 7. Chi-square test, Mann-Whitney U test. Logistic regression models, odds ratios (ORs) and 5% confidence intervals were determined. Results: A total of 128 patients diagnosed with CHC and 123 CT were included. Fibrosis stages were classified as follows: F0 (n=18), F1 (n=16), F2 (n=20), F3 (n=25), and F4 (n=48). IGFBP-1 to -7 showed an evident increment in patients mainly at F3 and F4. IGFBP-7 allows discriminate F3 vs F4 (72% sensibility, 62.5% specificity and cut of value of 2.74), whereas IGFBP-4 discriminates F3 vs F4 (83% sensibility, 68% specificity and cut of value of 14.68). P

Resumen: El objetivo del Consenso Mexicano para el Tratamiento de la Hepatitis C fue el de desarrollar un documento como guía en la práctica clínica con aplicabilidad en México. Se tomó en cuenta la opinión de expertos en el tema con especialidad en: gastroenterología, infectología y hepatología. Se realizó una revisión de la bibliografía en MEDLINE, EMBASE y CENTRAL mediante palabras claves referentes al tratamiento de la hepatitis C. Posteriormente se evaluó la calidad de la evidencia mediante el sistema GRADE y se redactaron enunciados, los cuales fueron sometidos a voto mediante un sistema modificado Delphi, y posteriormente se realizó revisión y corrección de los enunciados por un panel de 34 votantes. Finalmente se clasificó el nivel de acuerdo para cada oración. Esta guía busca dar recomendaciones con énfasis en los nuevos antivirales de acción directa y de esta manera facilitar su uso en la práctica clínica. Cada caso debe ser individualizado según sus comorbilidades y el manejo de estos pacientes siempre debe ser multidisciplinario. Abstract: The aim of the Mexican Consensus on the Treatment of Hepatitis C was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitis C treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary. Palabras clave: Consenso, Agentes antivirales de acción directa, Regímenes libres de interferón, Ribavirina, Keywords: Consensus, Direct-acting antiviral agents, Interferon-free regimens, Ribavirin

Introduction: Patients with cirrhosis are at risk of malnutrition and this has been recognized as a predictor of morbidity and mortality. The aim of this study was to compare the frequency of serious complications (variceal bleeding, ascites, hepatic encephalopathy and infections) between cirrhotic patients with and without malnutrition. Subjects and methods: An observational, analytic, cross-sectional study. The nutritional status of cirrhotic patients was evaluated according to Subjective Global Assessment (SGA). Characteristics of cirrhotic patients with and without malnutrition were compared. Results: 103 cirrhotic patients were included, 58 (56.3%) were women; the media of age was 55 ± 12.2 years. According to SGA, 45 patients (43.7%) were classified as well-nourished, and 58 (56.3%) as malnourished. The development of serious complications was related to nutritional status. Malnourished patients had higher frequency of development of ascites (67.2% vs. 42.2%, P = 0.01, OR = 2.8; 95% CI: 1.3–6.3) and infections (21.4% vs. 6.7%, P = 0.03, OR = 4.5; 95% CI: 1.2–16.6). Conclusions: The presence of serious complications, such as, ascites and development of bacterial and fungal infections, was more frequent between cirrhotic patients with malnutrition than in those well-nourished.

La desnutrición en el paciente cirrótico se asocia a mayor morbi-mortalidad; sin embargo, su diagnóstico es complejo por lo que el objetivo del estudio fue evaluar el estado nutricional empleando distintos métodos. Se evaluaron pacientes adultos con cirrosis hepática de origen alcohólico que acudieron a la Clínica de Hígado del Hospital General de México. Se aplicó un recordatorio de 24 horas y antropometría, herramientas de tamizaje (Malnutrition Universal Screening Tool, Nutritional Risk Screening-2002) y de diagnóstico nutricional específica para pacientes con cirrosis hepática (Royal Free Hospital Global Assessment). Se incluyeron 62 pacientes y 51,6% fueron hombres. La desnutrición por área muscular de brazo fue de 31,3% en hombres y de 10% en mujeres, y por área grasa de brazo fue de 23,3% en mujeres y 3,1% en hombres (p < 0. 05). Con las herramientas de tamizaje se obtuvieron porcentajes de riesgo de desnutrición de 43,5% y 54,8% respectivamente, vs 1,6% identificado con peso bajo por Índice de Masa Corporal. Con la herramienta de diagnóstico nutricional Royal Free Hospital Global Assessment se identificó 45,2% de pacientes con desnutrición. Los pacientes con desnutrición tuvieron un aporte energético y proteico significativamente menor respecto a los bien nutridos: 19,7 kcal/kg y 0,89 g/kg vs 30 kcal/kg y 1,25 g/kg respectivamente (p < 0,005). La desnutrición es una complicación frecuente en los pacientes con cirrosis hepática. Los hombres presentan mayor afección en la reserva muscular y las mujeres en la reserva de tejido adiposo corporal. El Índice de Masa Corporal no es una buena herramienta para la detección de desnutrición. Es recomendable emplear herramientas con indicadores de composición corporal como el Royal Free Hospital Global Assessment.Malnutrition in the cirrhotic patient is associated to a higher morbidity and mortality rate; however, the diagnosis is complex, so the study objective was to assess the nutritional status using different methods. Adult patients with alcoholic liver cirrhosis treated in the Liver Clinic of the Mexico's General Hospital were evaluated. Anthropometric measurements and a 24 hours recall were made; screening tools (Malnutrition Universal Screening Tool, Nutritional Risk Screening-2002) and a method for assessing nutritional status specifically in cirrhotic patients (Royal Free Hospital Global Assessment) were used. We included 62 patients, 51.6% of them were men. Malnutrition by arm muscle area was 31.3% in men and 10% in women, and by arm fat area was 23.3% in women and 3.1% in men (p < 0.05). With the screening tools the percentages of malnutrition risk were 43.5% and 54.8% respectively, vs. 1.6% identified as "low weight" with the Body Mass Index. With the Royal Free Hospital Global Assessment tool the percentage of malnutrition was 45.2%. Patients with malnutrition had an energy and protein intake significantly lower than the well-nourished: 19.7 kcal/kg and 0.89 g/kg vs 30 kcal/kg and 1.25 g/kg (p < 0.005). Malnutrition is a common complication in patients with liver cirrhosis. Men have higher depletion of muscle mass and women a higher loss of body fat. The Body Mass Index is not a reliable tool for assessing malnutrition. It's advisable to use tools with indicators of body composition such as the Royal Free Hospital Global Assessment.

Resumen: Introducción: El terreno del paciente con cirrosis que requiere una intervención quirúrgica ha sido poco explorado. En México, a la fecha no contamos con un posicionamiento formal o recomendaciones de expertos que ayuden a la toma de decisiones clínicas en este contexto. Objetivos: Revisar la evidencia existente sobre el riesgo, pronóstico, precauciones, cuidados especiales y manejo o proceder específico para los pacientes con cirrosis que requieren ser intervenidos quirúrgicamente o mediante procedimientos invasivos, para emitir recomendaciones por un panel experto, basadas en la mejor evidencia publicada para la atención oportuna, de calidad, eficiente y con el menor riesgo posible en este grupo específico de pacientes. Resultados: Se obtuvieron 27 recomendaciones, en donde se abordan el terreno preoperatorio, el escenario transoperatorio y el seguimiento y cuidados postoperatorios. Conclusiones: La valoración y el cuidado del paciente con cirrosis que requiere un procedimiento quirúrgico o invasivo mayor debe estar a cargo de un equipo multidisciplinario que brinde soporte al cirujano durante todo el perioperatorio; este equipo debe incluir al anestesiólogo, al hepatólogo, al gastroenterólogo y al nutriólogo clínico. En el paciente descompensado puede ser necesario involucrar especialistas en nefrología, ya que la función renal es un parámetro implicado también en el pronóstico de estos pacientes. Abstract: Introduction: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. Aims: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. Results: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. Conclusions: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

Introduction: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. Aims: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. Results: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. Conclusions: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients. Resumen: Introducción: El terreno del paciente con cirrosis que requiere de una intervención quirúrgica ha sido poco explorado. En México, a la fecha no contamos con un posicionamiento formal o recomendaciones de expertos que ayuden a la toma de decisiones clínicas en este contexto. Objetivos: Revisar la evidencia existente sobre el riesgo, pronóstico, precauciones, cuidados especiales y manejo o proceder específico para los pacientes con cirrosis que requieren ser intervenidos quirúrgicamente o mediante procedimientos invasivos, para emitir recomendaciones por un panel experto, basadas en la mejor evidencia publicada para la atención oportuna, de calidad, eficiente y con el menor riesgo posible en este grupo específico de pacientes. Resultados: Se obtuvieron 27 recomendaciones, en donde se abordan el terreno preoperatorio, el escenario transoperatorio y el seguimiento y cuidados postoperatorios. Conclusiones: La valoración y cuidado del paciente con cirrosis que requiere un procedimiento quirúrgico o invasivo mayor, debe estar a cargo de un equipo multidisciplinario que brinde soporte al cirujano, durante todo el perioperatorio, este equipo debe incluir al anestesiólogo, hepatólogo, gastroenterólogo, nutriólogo clínico. En el paciente descompensado, puede ser necesario involucrar especialistas en nefrología ya que la función renal es un parámetro implicado también en el pronóstico de estos pacientes.

Resumen: La ecografía en el punto de atención (POCUS) se refiere a la utilización del ultrasonido (US) mediante dispositivos ultrasonográficos de bolsillo, al pie de la cama del paciente, con el objetivo de establecer un diagnóstico o dirigir un procedimiento y responder a una cuestión clínica de forma inmediata, su finalidad es ampliar la exploración física, no sustituir la evaluación ultrasonográfica convencional. POCUS ha evolucionado como un complemento del examen físico siendo adoptado por distintas especialidades médicas, incluyendo la hepatología. Se elaboró una síntesis de evidencia narrativa sobre las aplicaciones de POCUS en hepatología, describiendo la utilidad de POCUS en el diagnóstico de cirrosis hepática, enfermedad hepática esteatósica asociada a disfunción metabólica (MASLD, por sus siglas en inglés), cirrosis descompensada y el diagnóstico de hipertensión portal, así como las más recientes aplicaciones de POCUS en la evaluación hemodinámica del paciente con cirrosis hepática en estado crítico, otras enfermedades hepáticas y guía ultrasonográfica de procedimientos.POCUS podría formar parte de la práctica clínica diaria de gastroenterólogos y hepatólogos, simplificando la evaluación inicial de los pacientes y optimizando el manejo clínico. Su accesibilidad, facilidad de uso y bajo perfil de efectos adversos la hacen una herramienta útil para el médico propiamente entrenado en el escenario clínico adecuado, por lo que el objetivo de esta revisión fue describir la evidencia que existe sobre la utilidad de POCUS en la práctica clínica diaria de gastroenterólogos y hepatólogos. Abstract: Point-of-care ultrasound (POCUS) refers to the use of ultrasound imaging through pocket-sized sonographic devices at the patient's bedside, to make a diagnosis or direct a procedure and immediately answer a clinical question. Its goal is to broaden the physical examination, not to replace conventional ultrasound studies. POCUS has evolved as a complement to physical examination and has been adopted by different medical specialties, including hepatology. A narrative synthesis of the evidence on the applications of POCUS in hepatology was carried out, describing its usefulness in the diagnosis of cirrhosis of the liver, metabolic dysfunction-associated steatotic liver disease (MASLD), decompensated cirrhosis, and portal hypertension. The review also encompasses more recent applications in the hemodynamic evaluation of the critically ill patient with cirrhosis of the liver, patients with other liver diseases, as well as in the ultrasound guidance of procedures.POCUS could make up part of the daily clinical practice of gastroenterologists and hepatologists, simplifying the initial evaluation of patients and optimizing clinical management. Its accessibility, ease of use, and low adverse event profile make POCUS a useful tool for the properly trained physician in the adequate clinical setting. The aim of this review was to describe the available evidence on the usefulness of POCUS in the daily clinical practice of gastroenterologists and hepatologists.

Point-of-care ultrasound (POCUS) refers to the use of ultrasound imaging through pocket-sized sonographic devices at the patient’s bedside, to make a diagnosis or direct a procedure and immediately answer a clinical question. Its goal is to broaden the physical examination, not to replace conventional ultrasound studies. POCUS has evolved as a complement to physical examination and has been adopted by different medical specialties, including hepatology. A narrative synthesis of the evidence on the applications of POCUS in hepatology was carried out, describing its usefulness in the diagnosis of cirrhosis of the liver, metabolic dysfunction-associated steatotic liver disease (MASLD), decompensated cirrhosis, and portal hypertension. The review also encompasses more recent applications in the hemodynamic evaluation of the critically ill patient with cirrhosis of the liver, patients with other liver diseases, as well as in the ultrasound guidance of procedures.POCUS could make up part of the daily clinical practice of gastroenterologists and hepatologists, simplifying the initial evaluation of patients and optimizing clinical management. Its accessibility, ease of use, and low adverse event profile make POCUS a useful tool for the properly trained physician in the adequate clinical setting. The aim of this review was to describe the available evidence on the usefulness of POCUS in the daily clinical practice of gastroenterologists and hepatologists. Resumen: La ecografía en el punto de atención (POCUS) se refiere a la utilización del ultrasonido (US) mediante dispositivos ultrasonográficos de bolsillo, al pie de la cama del paciente, con el objetivo de establecer un diagnóstico o dirigir un procedimiento y responder a una cuestión clínica de forma inmediata, su finalidad es ampliar la exploración física, no sustituir la evaluación ultrasonográfica convencional. POCUS ha evolucionado como un complemento del examen físico siendo adoptado por distintas especialidades médicas, incluyendo la hepatología. Se elaboró una síntesis de evidencia narrativa sobre las aplicaciones de POCUS en hepatología, describiendo la utilidad de POCUS en el diagnóstico de cirrosis hepática, enfermedad hepática esteatósica asociada a disfunción metabólica (MASLD, por sus siglas en inglés), cirrosis descompensada y el diagnóstico de hipertensión portal, así como las más recientes aplicaciones de POCUS en la evaluación hemodinámica del paciente con cirrosis hepática en estado crítico, otras enfermedades hepáticas y guía ultrasonográfica de procedimientos.POCUS podría formar parte de la práctica clínica diaria de gastroenterólogos y hepatólogos, simplificando la evaluación inicial de los pacientes y optimizando el manejo clínico. Su accesibilidad, facilidad de uso y bajo perfil de efectos adversos la hacen una herramienta útil para el médico propiamente entrenado en el escenario clínico adecuado, por lo que el objetivo de esta revisión fue describir la evidencia que existe sobre la utilidad de POCUS en la práctica clínica diaria de gastroenterólogos y hepatólogos.

Introduction and Objectives: Chronic liver disease (CLD) is considered an important health problem worldwide. The production of IL-10 regulated the hepatic inflammation. Whereas TGF-β plays a crucial role during the progression of CLD, promoting the dysregulated production of extracellular matrix in the liver. However, the role of TGF-β1, 2, and 3 and IL-10 in CLD is not completely understood. To evaluate the circulatory values of TGF-β1, 2, and 3 and IL-10 in hepatitis C virus (HCV), Non-alcoholic fatty liver disease (NAFLD) and alcoholic cirrhosis (OHCi) and control subjects (CT). Materials and Patients: A prospective, cross sectional, observational and multicentric study. HCV (n=33), NAFLD (n=33) and OHCi patients (n=22) and CT (n=26) were enrolled. The anthropometric variables, detailed clinical history and biochemical parameters were considered. TGF-β1, 2, and 3 and IL-10 (pg/mL) were evaluated using multiple suspension arrays. Kruskal-Wallis and Mann-Whitney U test were used for the statistical analysis. The study has the approval of the Research and Ethics Commissions with code FM/DI/135/2017 and the Research Ethics Committee of the Hospital General de México Dr. Eduardo Liceaga with code DI/16/107/03/031 as well the consent informed of the patients. Results: The age of CT group was estimated at 33 yrs., while the average of the different hepatopathies was 47 yrs. Male predominance was marked in OHCi and CT, but in NAFLD the distribution of women was similar. Multiple comparison analysis revealed that serum levels of TGF-β1, 2, and 3 did not present statistical differences in each CLD group. Nevertheless, TGF-β2 isoform showed significant difference in NAFLD and OHCi vs. CT (pNAFLD>HCV showing correlation with the increment of the ratio of 4.4, 2.7, and 2.3 folds compared to CT, respectively. Conclusions: Our data showed no differential changes of TGF-β1, 2, and 3 in accordance with CLD. The up regulation of TGF-β2 isoform could be related to different inflammatory responses in NAFLD and OHCi. On the other hand, IL-10 was upregulated in all the chronic conditions reflecting its role as pro-inflammatory mediator.

Introduction and Objectives: Spontaneous bacterial peritonitis (SBP) is a severe complication that can occur in patients with cirrhosis and is associated with high mortality rates. Evaluating SBP as a risk factor in the outcome of patients with cirrhosis is important because it helps understand the impact of this complication on the overall prognosis of these patients. Therefore, the objective of this study is to identify risk factors, treatment outcomes, and mortality rates associated with SBP in this population. Materials and Patients: A retrospective and analytical study was conducted on patients with cirrhosis who developed SBP. The cause of cirrhosis and Child-Pugh score were evaluated. They were classified into early responders (ER) (more than 25% decrease in polymorphonuclear cells on the second day of effective antibiotic treatment), development of renal injury, acute-on-chronic liver failure (ACLF), and 28-day mortality. Statistical analysis included evaluating the mortality rate using the Kaplan-Meier curve, log-rank test, considering significance at p ≤ 0.05. Renal injury, ACLF, and non-early responders were independently compared. Results: A total of 79 patients were included in the study, 40 males (50.63%) and 39 females (49.36%). Alcohol-related in 49.36% of cases. Child-Pugh C was found in 67 cases (84.81%). Antibiotics were cephalosporins in 66 cases (84.81%) and carbapenems in 13 cases (16.45%). There were 6 deaths among early responders and 29 among non-early responders, with a mean survival of 25.76 days for early responders versus 9.78 days for non-early responders, p < 0.001 (Figure 1). Regarding Acute-on-Chronic Liver Failure (ACLF), there were 2 deaths in patients without ACLF and 33 deaths in patients with ACLF. The mean survival for patients without ACLF was 26.93 days, compared to 14.6 days for those with ACLF, p < 0.001. Patients without renal injury had 3 deaths, while those with renal injury had 32 deaths. The mean survival for patients without renal injury was 25.65 days, compared to 16.17 days for those with renal injury, p < 0.001 (Figure 2) Conclusions: SBP in patients with cirrhosis is associated with a high mortality rate. However, several factors such as treatment response, the presence of ACLF, and renal injury have a significant impact on patient survival.

Introduction and Objectives: First-line direct-acting antiviral agents (DAAs) achieved a sustained viral response (SVR) in >95%, failure to follow the scheme is rare and the option of retreatment with sofosbuvir/velpatasvir/voxilaprevir does not exist in our setting, therefore although G/P is considered an alternative, it is the only available option. There are few reports evaluating it; due to this, we describe the frequency and characteristics of patients with failure to first-line DAA schemes and the result of retreatment with G/P during the period from January 2017 to January 2023 in 3 tertiary hospital centers. Materials and Patients: The intentional search for cases with failure to achieve SVR with first-line DAAs was carried out in 2 Mexican reference centers and one Ecuadorian center during the period from January 2017 to January 2023. Characteristics and results of patients treated with the scheme were documented. of G/P. No conflict of interest was reported by the researchers. Results: From a total of 2,397 HCV-infected patients treated with the first-line DAA scheme, without cirrhosis or with compensated cirrhosis, a total of 9 patients presented virological failure, the average age was 52.4 years, five women and four men, of these, six patients had fibrosis grade F4, 3 of them F1, the predominant genotype was 1a, the initial regimens were SOF/VEL or SOF/LED in the majority, only one case used Paritaprevir/Ritonavir/Ombitasvir/Dasabuvir + Ribavirin, all the patients re-treated with G/P had SVR at 12 weeks, no resistance profile was routinely performed, adverse effects were mild, and were reported in 22.2% of the total, none of them abandoned treatment. Conclusions: First-line DAAs are effective; virological failure in our sample is lower (0.37%) than reported in the literature. G/P is an effective and safe scheme for retreatment of patients with failure without cirrhosis or with compensated cirrhosis (100% response in our study), without serious adverse effects, which makes it possible to eliminate and meet the WHO 2030 goals.

Introduction and Objectives: Alcoholic liver and non-alcoholic liver disease causes liver disease. Dual damage has been gaining great relevance. Insulin growth factor binding proteins (IGFBPs) regulate the signaling pathways of IGF; IGFBP-3 have emerged as promising biomarkers in HGNA; however, in alcohol intake and dual damage has not been previously reported the levels of IGFBPs. To demonstrate the changes in the serum levels of IGFBP-1, 3 and 7 in alcohol consumption, NAFLD and dual insult Materials and Patients: Prospective, cross-sectional and multicenter study; approved by the research and ethics commission of the UNAM and the General Hospital of Mexico. A clinical history was taken and an informed consent was requested. IGFBP-1, 3 and 7 were evaluated in alcoholism (OH), alcoholic liver disease (cirrhosis (CiOH)), alcoholic hepatitis (AH), NAFLD, dual patients and control group (CT) using multiple suspension arrays. Kruskal-Wallis, Mann-Whitney U test were used for the statistical analysis. Results: The data showed that alcohol dependence increased the serum levels of IGFBP-1, 3 and 7 (ng/mL) vs. CT, and vs. the other hepatopathies as follows OH>AH>CiOH>HGNA>Dual. Whereas in CiOH the levels of IGFBP-1, 3 and 7 were reduced vs. CT, but a slight increment was observed in AH; however, it never reached similar values to CT. On the other hand, in NAFLD the serum concentrations of all the IGFBPs evaluated were downregulated vs. CT. Conclusions: The serum levels of IGFBPs were regulated in a differential manner in accordance with the negative liver stimuli, these changes were more evident in alcoholism The dual stimulus showed the clear synergistic effects of alcohol consumption and diet in IGFBP regulation. IGFBPs could be used as biomarkers or targets in the control of different hepatopathies.

Introduction and Objectives: Prevalence of patients with decompensated cirrhosis with requirement of liver transplantation (LT) has increased in our country. A significant percentage of patients with this condition belongs to a geriatric population, which could contraindicate LT, although trends in other countries indicate that the results of LT in geriatric patients are excellent.To assess one-year survival of LT patients over 60 years Materials and Patients: Retrospective, observational, and analytical study of patients over 60 years who underwent LT, evaluating survival, cold ischemia time (CIT), hot ischemia time (HIT), and donor age (DA), compared with a group of patients under 60 years who underwent LT.We evaluated survival over time in months with a follow-up at one year of recipients under 60 years and older than 60 using the Kaplan-Meier curve and the log-rank test, with a significant alpha level

Introduction and Objectives: Hepatocellular carcinoma (HCC) is the most common malignant tumor in patients with advanced cirrhosis, posing a significant challenge to the healthcare system. Treatment involves a multidisciplinary approach; however, advanced disease limits the available options. Effectiveness and outcomes can differ depending on the stage of the disease, the patient's functional reserve, and other factors. This study aims to describe the clinical characteristics, staging, treatment, and outcomes of patients with HCC at a third-level hospital Materials and Patients: A retrospective, descriptive study of HCC patients. Demographic variables, treatment received according to the Barcelona Clinic Liver Cancer (BCLC) staging system, and treatment response according to the Response Evaluation Criteria in Solid Tumors (RECIST) were evaluated. Descriptive statistics with measures of central tendency and dispersion were performed. Results: The study included 50 patients (20 females, 30 males; mean age 62 ±8). Etiology of cirrhosis: MAFLD (19), alcohol-related (14), Hepatitis C (11), and other causes (6). The average MELD score was 12.5 ±6.22, and the MELD-Na score was 14.7 ±5.44. BCLC staging: A (9), B (28), C (4), D (9). Eligible for treatment (30), categorized as Child-Pugh A(2), B(22), C(6). Radiological treatment (21) included Transarterial Chemoembolization (TACE) in 13 cases, ablation (4), and a combination TACE/Ablation (4). Medical treatment with Lenvatinib (1). Combination of medical and radiological treatments (3). TACE followed by transplantation (4), and transplantation alone (1). Treatment response evaluation: Complete response (4), partial response (9), stable disease (7), and progression (8). The 3-month mortality rate was 8.3%. Conclusions: In our group, most of the patients were males, with a relatively equal distribution between compensated and decompensated cirrhosis. MAFLD was the most prevalent etiology, and a significant portion of cases presented at an intermediate stage (BCLC B), qualifying them as candidates for treatment. The response rates to treatment were 13% for complete response and 30% for partial response. Furthermore, the calculated mortality rate at 3 months was relatively low.

Introduction and Objectives: : Patients with hepatic cirrhosis (HC) are at risk of developing acute kidney injury (AKI) due to multiple factors. The main types of AKI are hypovolemia, acute tubular necrosis (ATN), and urinary obstruction. Common causes of HC include MAFLD, alcohol consumption, viral and autoimmune diseases, which may have a different role in the risk for AKI and mortality. This study aims to assess the etiology of cirrhosis in the development of acute kidney injury (AKI) and mortality. Materials and Patients: Retrospective, analytical, observational study of patients with CH, analyzing etiology, type of AKI, and mortality. Statistical analysis: Using the Log-Rank test, the Kaplan-Meier curve was performed considering death at 28 and 90 days to assess the mortality rate associated with etiology. The Chi-square test with Bonferroni correction was conducted to evaluate the association between etiology and type of AKI; a significance level of ≤ 0.05 was considered. Results: A total of 201 patients with CH were included, 106 of them being male (52.73%), with an average age of 55 ± 10.4 years. Child-Pugh classification distribution was as follows: A: 25 (12.43%), B: 70 (34.82%), and C: 106 (52.73%). The average MELD-Na score was 21.8 ± 9.45 points. The cumulative mortality rate at 28 days was 18.4% (37); the comparison by etiology showed statistical significance with a Chi-square test of 13.23 (4), p=0.01. The mean survival for MAFLD was 27.7, alcohol-related was 23.8, autoimmune was 24.1, viral was 25.92, and dual etiology was 22.56, with an overall survival of 24.88. The comparison at 90 days was significant, with a Chi-square test of 10.46 (4), p=0.033, and a cumulative mortality rate of 24.4% (49). The mean survival for MAFLD was 86.82, alcohol-related was 70.02, autoimmune was 67.03, viral was 80.07, dual etiology was 66.56, and the overall survival was 74.84. Association tests between etiology and type of renal injury showed statistical significance, with a Chi-square test of 29.65 (8), p=

Introduction and Objectives: Chronic liver disease is increasingly prevalent, the causes range from MAFLD, alcohol consumption, HCV, autoimmune disease, and others. They develop complications such as: portal hypertension with esophageal and gastric varices, hepatic encephalopathy, ascites, renal injury, among others, conditioning the final stage of the disease and death; therefore, knowing the factor that has the greatest impact on mortality is relevant. To evaluate which decompensations are associated with higher mortality in patients with cirrhosis of different etiologies. Materials and Patients: Retrospective, analytical, observational study of patients with cirrhosis. To determine the factors associated with 28- and 90-day mortality, proportional hazard curves were performed for COX with encephalopathy, gastrointestinal bleeding, ascites, renal injury, ACLF and infection, with absence of the factor as reference. Considering significant α ≤0.05, SPSS-V 25.0 was used Results: 200 patients, men 53%, women 47%. Etiology: alcohol 86, MAFLD 58, autoimmune 27, dual 16 and HCV 13; 37 died at 28 days and 49 at 90 days. Cumulative mortality rate 28 days 18.4%, 90 days 24.4%, with CHI square test for the model was significant, 109.34 (10), p

Introduction and Objectives: Liver abscess (HA) is currently a rare entity, the prevalence is low, the epidemiological transition from amoebic to pyogenic in recent years may have modified its characteristics and outcome. Therefore, knowing its presentation, evolution, management and outcome is relevant. Describe the characteristics and outcome of patients with liver abscess Materials and Patients: Retrospective and observational study of patients diagnosed with HA, epidemiological variables, presentation, treatment, drainage, and outcome were evaluated. Descriptive statistics were performed with measures of central tendency and dispersion Results: Records of patients with HA were reviewed, in a period from 2018 to 2023. A total of 103 patients with HA were included, age 48.3 ± 15.7, 70% men and 30% women, 84.5% pyogenic and 14.5% amoebic with 0.9% of deaths. 25.2% of the patients were diabetic. 42.7% were single liver abscesses, the most frequent location was segment VII in 50.4%. Regarding antibiotic treatment, 80.4% were treated with metronidazole and ceftriaxone, followed by carbapenems in 14.5%. Of the total number of patients, 73.7% required percutaneous drainage, 60.1% underwent culture, of the identified agents E. Coli was the most frequent in 9.7%. Only one patient died due to septic shock. Conclusions: The most frequent etiology of HA is now pyogenic, much higher than amebic, mortality is low, the outcome is healing without sequelae with the use of antimicrobials and percutaneous drainage.

Introduction and Objectives: Cirrhosis is a prevalent disease worldwide, with complications such as acute kidney injury (AKI) that increase the risk of fatal outcomes. A high BUN/creatinine ratio (IBC) has been associated with mortality in other diseases Therefore, evaluating this index in patients with cirrhosis could predict mortality. To determine whether a high BUN/creatinine ratio is associated with mortality in patients with cirrhosis and AKI. Materials and Patients: Retrospective analysis was conducted on a cohort of cirrhotic patients with and without AKI, calculating the IBC and assessing its association with mortality. Results: A total of 201 patients with cirrhosis were included, of whom 106 were male (52.73%), with a mean age of 55±10.4 years. The distribution of Child Pugh scores was as follows: A (25, 12.43%), B (70, 34.82%), and C (106, 52.73%); the mean MELD-Na score was 21.8±9.45. The cumulative mortality rate at 28 days was 37 (18.4%) and at 90 days was 39 (24.4%). The model was not significant at 28 days but was significant at 90 days with a X2 value of 48.18 (2) and p20 mg/dl vs. 20 mg/dl) could predict mortality in patients with cirrhosis, as the odds ratios at 28 and 90 days were significant.

Introduction and Objectives: Patients with decompensated cirrhosis are at risk of variceal hemorrhage, which increases the risk of mortality. Validated scales exist to assess this risk, but there is currently no scale that evaluates the risk of variceal hemorrhage and death simultaneously. The MELDNa AGIB (acute gastrointestinal bleeding) scale incorporates sodium (Na) levels, albumin levels, the corrected QT interval (QTc), and a history of hemorrhage to calculate mortality at 6 weeks. While it has been evaluated in other centers, further studies are needed to validate its utility. To evaluate the MELDNa-AGIB scale for predicting the risk of mortality in decompensated cirrhotic patients. Materials and Patients: This was a retrospective, analytical, observational study conducted on a cohort of patients with decompensated cirrhosis and variceal hemorrhage. The MELDNAAGIB scale was calculated for each patient and compared with other scoring systems, including MELD, MELD NA, MELD LACTATE, and MELD 3.0, to assess its effectiveness. Statistical analysis involved the construction of ROC curves to determine the prognostic value of each scoring system in predicting mortality among patients with variceal bleeding. A significance level of p456ms) as calculated using the Fridericia formula, and 67.2% had a history of previous variceal hemorrhage. The MELDNa-AGIB scale demonstrated an area under the receiver operating characteristic (AUROC) curve of 0.849 (95% confidence interval: 0.681-0.950, p=0.004), with a sensitivity of 87.5% and specificity of 83% when a cutoff point of 17 was applied for MELDNa-AGIB. The AUROC for predicting mortality was significantly lower for MELD/Lactate. Conclusions: Although the study group was small, the MELDNaAGIB scale showed significant performance in predicting 6-week mortality in patients who developed variceal hemorrhage.

Introduction and Objectives: Hepatic encephalopathy (HE) is one of the most frequent complications of cirrhosis, minimal hepatic encephalopathy (MHE) is the initial stage and is characterized by the fact that it has no clinical data, its diagnosis is made with neuropsychological tests, the MHE produces a deterioration in the quality of life of patients and an increased risk of accidents. Hence, it is relevant to diagnose. Performing neuropsychological tests requires prolonged time, so validating an MHE count test that is easy, reproducible, and in less time is recommended. The simplified-animal naming test (S-ANT) test is performed by asking the patient to nominate 20 animals in one minute. In the reference cutoff for the non-Mexican population, a score lower than 15 suggests MHE.We aimed to assess the validity of the S-ANT scale as a screening test in patients with cirrhosis without overt HE. Materials and Patients: We present a prospective, descriptive, and analytical study of patients with cirrhosis of different etiology without overt HE who underwent S-ANT, PHES, and Flicker tests. We determine the area under the receiver operator characteristic (AUROC) curve to validate the S-ANT test. MHE was detected if the PHES and Flicker tests were abnormal.We compared the S-ANT scores of both groups with and without MHE with the student's t-test for independent groups. Sensitivity (S) and specificity (SE) were calculated with the AUROC cutoff point for MHE. Results: Detection of MHE was in 12/83 patients (14.5%); 43 (51.83%) women, mean age 52.7 ± 7.5 years, median schooling 8.3 years (range 0-17), the etiology of cirrhosis was: 39 (47.0%) alcohol, 9 (28.9%) primary biliary cirrhosis, 17 (20.5%) metabolic fatty liver, 18 (21.7%) hepatitis C virus According to Child-Pugh: 57 (68.7%) A, 25 (30.1%) B, and 1 (1.2%) C. The mean S-ANT for non-MHE was 19.35±5.4, and for MHE, 14.7±5.6, p=0.024 AUROC was significant .760 (.577- .942, 95%CI); p=0.037 with S=83% and SE=77% cutoff= 17.5 words, which is higher than for other populations. Conclusions: In the Mexican population, S-ANT reliably discriminates against patients with cirrhosis without overt HE with cognitive impairment, confirmed by PHES and Flicker test

Introduction and Objectives: Hepatic encephalopathy (HE) is a common and serious complication of cirrhosis, associated with high morbidity and mortality. Ammonia and inflammation are the main triggers of HE. The use of L-ornithine-L-aspartate (LOLA) provides precursor substances for glutamine synthesis in perivenous cells, accelerating ammonia detoxification.This study aims to evaluate the efficacy and safety of intravenous L-ornithine-L-aspartate (LOLA) in patients with grade III-IV hepatic encephalopathy (HE). Materials and Patients: Retrospective and analytical study of patients with grade III-IV hepatic encephalopathy (HE).All patients received intravenous LOLA 50 g for up to 48 hours, excluding those with renal failure. Descriptive statistics with measures of central tendency and dispersion were performed. Improvement was considered when HE regressed by at least one grade, and adverse events were evaluated. Results: A total of 32 patients were included, with a mean age of 55 years ± 9.6. There were 13 females (40.6%) and 19 males (59.4%). Eight patients (25%) were classified as Child-Pugh B, while 24 patients (75%) were classified as Child-Pugh C. The mean MELD score was 19.03 ± 6.08, and the mean MELD NA score was 7.19 ± 7.19. The most common etiology was alcohol-related (43.8%), followed by MAFLD (29.1%) and viral (9.5%). All patients had grade III hepatic encephalopathy. The precipitating factors were sepsis (53%), hemorrhage (25%), constipation (12.5%), diuretics (6.3%), and electrolyte imbalance (3.1%). A total of 24 patients (75%) responded to the treatment, while 8 patients (25%) did not. Nineteen patients were found to have some degree of acute-on-chronic liver failure (ACLF). No adverse events were reported. Conclusions: The use of intravenous LOLA for the treatment of grade III-IV hepatic encephalopathy iseffective and safe. These results support the use of LOLA as a therapeutic option in the management of hepatic encephalopathy in this patient population.

Introduction and Objectives: : The development of acute kidney injury (AKI) in cirrhotic patients is of multifactorial origin, including urinary tract infection, diuretics, portal hypertension, shock, etc. Another important factor is cholemic nephrosis, it is considered when total bilirubin exceeds 20 mg/dl, this implies that bile pigments damage the distal tubule with deterioration of renal function, increasing morbidity and mortality. This study aimed to evaluate the levels of hyperbilrubinemia in the development of AKI and its association with biomarkers of renal failure. Materials and Patients: : Retrospective and analytical study of a cohort of cirrhotic patients, to evaluate the development of AKI associated with bilirubin levels. Statistical analysis: A binary logistic regression model was performed considering bilirubin (greater than 20), NGAL (greater than 150) and cystatin (greater than 0.95) as associated factors. The significance of the model was considered with an alpha level less than 0.05. Results: 109 patients were included, 45 women 64 men, age 54.67 ± 11.6, Child Pugh A: 2, B: 29, C: 78. The binary logistic model was significant W(1)=11.089, p=0.001. The OR for bilirubin was 4.37 (1.168-16.35, 95% CI P=.027), for NGAL OR 2.7 (1.08-6.71, 95% CI; p=.032), cystatin 0.64 (0.35-11.66, CI 95%; p=0.764) not significant. Conclusions: Hyperbilirubinemia increases the risk of developing AKI by up to 4 times. The useful biomarker for AKI was NGAL.

Introduction and Objectives: Orlistat is a drug widely used in overweight/obese patients, while the combination with l-carnitine could offer an improvement in its effectiveness. To our knowledge, the effect of this combination on the quality of life of overweight patients has not been determined.To evaluate the effects on the quality of life of patients who took the combination of orlistat and l-carnitine at 4 and 8 weeks of treatment. Materials and Patients: : We evaluated the quality of life (Short Form-36) in 16 patients [41.81±8.26 (37.77-45.86) years, 81% women] undergoing pharmacotherapy of the combination of orlistat and l-carnitine (once a day) at 4 and 8 weeks of treatment. Data express mean±SD and 95%IC or percentages as correspond. We use paired Student t Test, two tails with an alpha=0.05. Results: Patients lowered their weight by about 3%. Patients show improvement in body pain, general health, vitality and in both Mental [45.68±6.51 (42.49-48.86) vs. 49.88±3.21 (48.31-51.46), p=0.02] and Physical [59.4±8.92 (55.03-63.77) vs. 63.36±9.64 (58.63-68.08), p=0.01) summaries. Conclusions: These results suggest a beneficial effect of the combination of Orlistat and l-carnitine on the treatment of overweight. Further studies compared with placebo and standard care are required.

Introduction and Objectives: Alcoholic Hepatitis (AH) causes acute inflammation of the liver. The prognosis depends on the recovery of the liver from rapid improvement to multi-organ failure and death. There are scales that establish the prognosis and respond to steroid in AH, based on biochemical markers, none uses lactate levels. The lactate level in a patient with hepatitis may be increased. To determine if the MELD-Lactate scale is better than MELD for predicting with greater accuracy the severity and early mortality in patients with Alcoholic Hepatitis. Materials and Patients: Retrospective, retrollective and analytical study, from 2019 to 2022. The variables were obtained with laboratories upon admission, including lactate levels. The area under the curve for sensitivity and specificity was calculated for predictive scales and MELD-lactate to determine mortality at 28 and 90 days. Results: Include 70 patients, 59 men (84.2%) and 11 women (15.7%), age 43.2 ±9.8 years. The mortality at 28 days was 19 patients (27.1%) and at 90 days it was 18 patients (25.7%), a total of 37 (52%). The area under the curve for MELD-Lactate was in general mortality 0.823; 0.705-0.941 (sensibility 81.8% specificity 72.4%), at 28 days 0.874; 0.780-0.968 (sensibility 88.9%; specificity 71.3%) and 90 days there was no significance, compared with MELD which was general mortality 0.741; 0.603-0.878 (sensibility 81.8% specificity 66.1%), at 28 days MELD 0.766; 0.615-.916 (sensibility 88.9% specificity 63.3%) and at 90 days there was no significance, with the rest of the scales (MELD 3.0, ABIC, Maddrey, MELD- Na and Glasgow, it was less than that of MELD-Lactate. (Figure 1,2). Conclusions: Patients with severe AH have higher mortality, either early or late. In our study we showed that the MELD-lactate scale may be a better prognostic scale for early mortality in patients with alcohol hepatitis, since it showed a better performance than all the other scales used, although these results must be confirmed in other hospital centers, we can recommend their use.

Introduction and Objectives: Autoimmune liver disease is classified into 3 well-defined entities: autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis, there is a group of patients who show characteristics of more than one entity and is called overlap syndrome (OS), according to the Paris criteria they are classified, the prevalence of overlap in our country is low. We describe the clinical and biochemical characteristics of patients with OS treated at the liver clinic at the Hospital General de México. Materials and Patients: It is a retrospective and descriptive study, records of the autoimmune liver disease consultation were reviewed, searching for patients with OS using the Paris criteria in the period 2014-2023, descriptive statistics were performed with measures of central tendency and dispersion using SPSS 25.0. Results: 22 patients were included, all of them with liver biopsy, 95% women aged 47 ± 12.6 years, the most common phenotype was PBC/HAI (59%). The time to diagnosis from initial manifestations ranged from 1 to 6 years, the most frequent tests were ANA (81%), AMA (63%), ASMA (18%) and LKM1 (18%), Immunoglobulin G levels on average 2048 ±643.8. The most frequent comorbidities were systemic sclerosis, arterial hypertension and hypothyroidism, the predominant symptoms were fatigue and pruritus reported in 36%; 90% were cirrhotic, Child Pugh A 70%, B 25% and C 5%. The most frequent decompensation was variceal hemorrhage (22.7%), 4.7% reported portal thrombosis, and 2 patients were transplanted. Conclusions: Overlap syndromes are rare, we found the majority of patients are women with advancend stage of liver disease, the most frequent overlapping is PBC/HAI with a high proportion of positive serology tests and concordant biopsy, two patients underwent liver transplantation. It is important to always look for this rare syndrome.

Introduction and Objectives: Alcoholic hepatitis (AH) is an acute liver inflammation associated with excessive alcohol consumption. The pharmacological treatment for AH is corticosteroids. There is a study that has proposed calculating the Lille model on day 4 (Lille-4), which apparently has comparable accuracy to the Lille model calculated on day 7 (Lille-7). However, this finding has not been validated. Therefore our objective is to determine if Lille-4 is equivalent to Lille-7 in predicting 28-day mortality in patients with probable severe alcoholic hepatitis (AH) as defined by the 2016 consortium criteria sponsored by NIAAA. Materials and Patients: Observational, prospective, ambidirectional, analytical cohort study conducted from January 2010 to April 2023. We collected clinical and biochemical variables upon admission, calculated Lille models, assessed response and 28-day mortality. Comparative analyses were performed based on survival versus mortality. Sensitivity, specificity, PPV, NPV, and accuracy of the models were calculated. Results: A total of 327 patients were included, 297 (90.8%) being male. Mean age was 43.4±9.3 years. The 50th percentile for alcohol consumption was 320 g/day (5th-95th percentile: 100.8-662). At day 28, 207 patients (63.3%) died. Upon admission, the patients who died showed a significant difference compared to survivors in: Maddrey (90 [95%CI: 81-99] vs. 70 [95%CI:65-75]; p0.45 had a sensitivity (S) of 78% and specificity (E) of 45% in predicting early mortality. Lille-4 model had an AUROC of 0.68 [0.63-0.74], where a value >0.45 had an S of 81% and E of 54% (Figure 1). Conclusions: Lille-7 is the model with the highest accuracy, according to the obtained AUROC, for predicting early mortality in severe alcoholic hepatitis (AH). Therefore, the determination of total bilirubin should not be done prematurely (before day 7), and steroid therapy should be provided to patients for up to 7 days to classify treatment response.

Introduction and Objectives: MAFLD is a highly prevalent cause of chronic liver disease, present in 70% of overweight people, 70% of diabetics, and 90% of morbidly obese people. It is the hepatic manifestation of the metabolic syndrome, defined by the presence of central obesity, insulin resistance, hyperlipidemia, hyperglycemia, and hypertension. The development of liver fibrosis is secondary to several factors, steatosis being one of them. To evaluate the correlation of steatosis with hepatic fibrosis in patients with metabolic syndrome using transition elastography. Materials and Patients: Patients older than 18 years who met MALFD criteria were included, transition elastography was performed to calculate CAP and kilopascals, steatosis degree and fibrosis degree were calculated according to the myfibroscan application, for statistical analysis Pearson's bivariate correlations were used between CAP and kilopascal values. The association between the degree of steatosis and fibrosis was performed using the chi-square test. Was considered significant at p < 0.05. Results: 94 patients were included, 20 men (21.3%), 74 women (78.7%), mean age 40.5 ± 10.02, CAP 300.6 ± 63.4, kilopascals 6.4 ± 2.7, steatosis grade S0: 8, S1: 8, S2: 20, S3: 58, degree of fibrosis F0: 58, F1: 14, F2:14, F3: 6, F4:2. The correlation between CAP and kilopascals was moderate and significant RHO=0.343 P =0.001. A significant association was found between the degree of steatosis and that of fibrosis chi-square (12) =25.1, p=0.015. The proportions were 50% (S0:F0), 16% (S1:F3), 50% (S2:F3), 100% (S3:F4). Conclusions: The correlation between steatosis and fibrosis is moderate, implying that there are other factors that influence the development of fibrosis and its progression, so metabolic control and other factors in patients with MALFD are highly relevant to prevent fibrosis progression.

La coexistencia de colitis ulcerativa crónica idiopática (CUCI) y la infección por el virus de inmunodeficiencia humana (VIH) es un fenómeno poco común que involucra una compleja interacción entre la respuesta inmunitaria del colon y la inmunosupresión causada por el VIH. Estudios previos han generado resultados contradictorios sobre el impacto de esta coinfección en el curso de la CUCI. Este estudio retrospectivo y descriptivo tiene como objetivo analizar las características clínicas de tres pacientes con CUCI e infección por VIH tratados en la Clínica de Enfermedad Inflamatoria Intestinal del Hospital General de México Dr. Eduardo Liceaga. Nuestros resultados muestran que los tres pacientes con coexistencia de CUCI y VIH experimentaron el inicio de la enfermedad inflamatoria intestinal (EII) de manera temprana en sus vidas. La CUCI fue la primera en manifestarse en la mayoría de los casos. Además, en dos de los pacientes el diagnóstico de VIH se realizó durante un periodo de recaída de la CUCI o cuando se evidenció una falta de respuesta al tratamiento convencional para la CUCI, lo que llevó a considerar la opción de iniciar una terapia biológica. Las características clínicas, bioquímicas, endoscópicas e histológicas presentaron una notable heterogeneidad entre los pacientes. Nuestros resultados sugieren una compleja interacción entre la CUCI y el VIH, lo que plantea interrogantes sobre la relación entre ambas condiciones y el momento adecuado para la detección del VIH en pacientes con EII. Además, resaltan la importancia de un enfoque integral en el manejo de estos pacientes con el objetivo de mejorar su calidad de vida.