Abstract:
:Pruritus is a common symptom with primary biliary cholangitis. Research has focused on refining understanding of the neurohumoral pathways involved in transduction of pruritus from peripheral cutaneous receptors to the central nervous system, and identifying modulating drugs. Current treatments have variable efficacy and safety. Because of the deleterious effects on quality of life or debilitation, many patients necessitate individualized therapeutic approaches; clinicians may need to consider invasive treatment options. This article highlights various therapeutic interventions, from general measures to invasive strategies, and novel agents under investigation, providing clinicians with the management tricks of the trade.
journal_name
Clin Liver Disjournal_title
Clinics in liver diseaseauthors
Carrion AF,Rosen JD,Levy Cdoi
10.1016/j.cld.2018.03.005subject
Has Abstractpub_date
2018-08-01 00:00:00pages
517-532issue
3eissn
1089-3261issn
1557-8224pii
S1089-3261(18)30030-8journal_volume
22pub_type
杂志文章,评审abstract::It is no secret that the health care environment today is motivated by the underlying, largely economic impetus of managed care. This is particularly evident within the organ transplantation community, where third party payers hope to minimize their financial risk by relying more and more on "centers of excellence" ne...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(05)70272-5
更新日期:1997-08-01 00:00:00
abstract::Nonalcoholic fatty liver disease is emerging as the most common cause of chronic liver disease worldwide. This trend is, in part, secondary, to the growing incidence of obesity, type 2 diabetes, and metabolic syndrome. Other risk factors include age, gender, race/ethnicity, genetic predisposition, and polycystic ovari...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2017.08.008
更新日期:2018-02-01 00:00:00
abstract::Nonsteroidal anti-inflammatory drugs are among the most common drugs associated with drug-induced liver injury, with an estimated incidence of between 3 and 23 per 100,000 patient years. Nimesulide, sulindac, and diclofenac seem to be associated with the highest risk and the only risk factor consistently identified is...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2007.06.004
更新日期:2007-08-01 00:00:00
abstract::Hepatobiliary dysfunction associated with the use of total parenteral nutrition is a commonly recognized phenomenon occurring in up to 90% of patients on long-term therapy. Reasons for these abnormalities, both supported by research as well as theoretical possibilities are explored. Practical guidelines considered use...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(05)70368-8
更新日期:1998-02-01 00:00:00
abstract::Non-alcoholic fatty liver disease (NAFLD) is common and may progress to end-stage liver disease. Liver-related morbidity and mortality occur almost exclusively in patients whose disease progresses to advanced fibrosis and cirrhosis. Presence and severity of liver fibrosis seem the most important indicators of long-ter...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2007.02.004
更新日期:2007-02-01 00:00:00
abstract::Nonalcoholic fatty liver disease (NAFLD) is a common liver disorder that can be divided into benign steatosis or nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). Elastography and scoring systems based on clinical features and routine biochemical testing can be used to assess fibrosis in patient...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2017.08.006
更新日期:2018-02-01 00:00:00
abstract::Autoimmune liver diseases have much in common with each other, and there are clear associations with genetic haplotypes. Elegant studies have shown autoimmune liver disease induced by viruses and drugs. Although there is evidence for nonimmunological events precipitating immune disease, especially in primary sclerosin...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(05)70005-2
更新日期:1998-05-01 00:00:00
abstract::This article discusses direct-acting antiviral agents that target hepatitis C virus replication, their mechanism of action, strengths, and weaknesses. In addition, varying strategies using combinations of these agents are discussed. ...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2015.06.002
更新日期:2015-11-01 00:00:00
abstract::Liver dysfunction is common in both the critically ill and postoperative patient. Metabolic derangements secondary to sepsis, poor hepatic perfusion, total parenteral nutrition, in addition to hemodynamic and anesthetic-induced changes that occur during surgery, can cause liver damage ranging from small self-limited a...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2010.09.004
更新日期:2011-02-01 00:00:00
abstract::Liver transplantation in pediatrics has become an accepted modality of treatment in end-stage liver disease and irreversible acute liver failure. Biliary atresia is the most common indication requiring liver transplantation in children. The diagnosis and causes of acute liver failure in children differ from those in a...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2007.04.001
更新日期:2007-05-01 00:00:00
abstract::Primary biliary cirrhosis (PBC) is characterized by the presence of high-titer disease specific autoantibodies directed against mitochondrial antigens (AMA) of the inner mitochondrial membrane, that are members of the 2-oxo acid complex. Among numerous other autoantibodies found in PBC the focus of ongoing studies is ...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(03)00104-1
更新日期:2003-11-01 00:00:00
abstract::Serologic assays for HBV are the mainstay diagnostic tools for HBV infection. However, the advent of molecular biology-based techniques has added a new dimension to the diagnosis and treatment of patients with chronic HBV infection. Over the past decade, improvements in molecular technology, permitting detection of as...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2004.02.001
更新日期:2004-05-01 00:00:00
abstract::HCV infection becomes persistent in many patients who are otherwise immune competent. There is increasing support for potential contribution of innate immune response and viral interference with its components to the subsequent outcome. As for the adaptive immune response, humoral immunity may be largely ineffective d...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(02)00068-5
更新日期:2003-02-01 00:00:00
abstract::Bile acid synthetic defects are uncommon disorders that cause progressive cholestatic liver disease that is often lethal in infancy or early childhood. Five specific primary defects have been described. Diagnosis is based on mass spectrometry of urine and serum. Pathogenesis of liver injury is related to persistent re...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(05)70144-6
更新日期:2000-11-01 00:00:00
abstract::Decision analysis helps evaluate competing strategies under conditions of uncertainty in a wide variety of clinical settings. Despite some limitations, decision trees and Markov models remain essential tools for medical decision analysts. These techniques allow comparison of competing management strategies in a quanti...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2004.12.004
更新日期:2005-05-01 00:00:00
abstract::Primary biliary cirrhosis and primary sclerosing cholangitis share some clinical features with autoimmune hepatitis, but when features of autoimmune hepatitis are present, prognosis can be affected and immunosuppressive treatment warranted. The presence of severe interface hepatitis in primary biliary cirrhosis porten...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2012.12.006
更新日期:2013-05-01 00:00:00
abstract::Artificial liver-support devices attempt to bridge patients with fulminant hepatic failure until either a suitable liver allograft is obtained for transplantation or the patient's own liver regenerates sufficiently to resume normal function. It is thought that toxins contribute to the clinical picture of fulminant hep...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(05)70172-0
更新日期:2001-05-01 00:00:00
abstract::Hepatic changes resulting from the regular ingestion of alcohol are many and include fat infiltration, alcoholic hepatitis, and cirrhosis. Only 10% to 15% of chronic alcoholics develop liver disease. Women are more susceptible. An area of considerable importance is the high prevalence of concomitant infection with hep...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(05)70099-4
更新日期:2000-02-01 00:00:00
abstract::Liver biopsy is used to determine the pathogenesis of liver dysfunction after liver transplantation. One or more causative factors may be identified on biopsy. The pathologist must be familiar with the histopathology of acute rejection to differentiate it from other potential complications, including biliary obstructi...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(02)00003-x
更新日期:2002-05-01 00:00:00
abstract::In the intersection of alcohol ingestion with the law, medical ethics, and public safety, physicians are often unsure about how to proceed. Physicians' primary focus should be on patient education with an ethical and legal duty to warn the patient of the adverse effects of alcohol. Warning third parties of potential h...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2018.09.002
更新日期:2019-02-01 00:00:00
abstract::The pathogenesis of HCC is poorly understood at present. There is insufficient understanding to propose a robust general model of hepatic carcinogenesis, partly because pathogenic host and environmental factors show significant regional variation, making such generalization difficult. Figure 4 is a model based on data...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(05)70154-9
更新日期:2001-02-01 00:00:00
abstract::There have been major advances in the field of hepatitis B (HBV) over the last few decades. These advances have resulted in the understanding of the natural history of chronic HBV infection, effective vaccines against the virus, sensitive assays for screening and monitoring of treatment, and effective treatments for v...
journal_title:Clinics in liver disease
pub_type: 历史文章,杂志文章,评审
doi:10.1016/j.cld.2010.05.003
更新日期:2010-08-01 00:00:00
abstract::The incidence of newly acquired hepatitis C infection has diminished in the United States. This decline is largely because of a decrease in cases among IDUs for reasons that are unclear and, to a lesser extent, to testing of blood donors for HCV. The virus is transmitted by blood, and such transmission now occurs prim...
journal_title:Clinics in liver disease
pub_type: 共识发展会议,杂志文章,评审
doi:10.1016/s1089-3261(02)00078-8
更新日期:2003-02-01 00:00:00
abstract::In conclusion, the natural history of chronic HCV infection has not yet been fully defined. Current data suggest that the process runs an indolent course during the first two decades after initial infection, accounting for modest morbidity and mortality. Serious sequelae are more likely to emerge as the disease proces...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/s1089-3261(05)70323-8
更新日期:1997-11-01 00:00:00
abstract::Hepatic stellate cells (HSC) play an important role in liver fibrogenesis. They are also key players in liver regeneration as part of the stem cell niche of hepatocytes and hepatic progenitor cells. They produce growth stimulating and inhibiting factors for these epithelial cell compartments. In addition, recent studi...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2008.07.014
更新日期:2008-11-01 00:00:00
abstract::This article introduces one of the most diverse classes of direct-acting antivirals for hepatitis C, the nucleoside and non-nucleoside NS5B polymerase inhibitors. Through a systematic review of the published literature, we describe their structure, mechanism of action, issues with resistance, and clinical effectivenes...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2011.05.003
更新日期:2011-08-01 00:00:00
abstract::Combination therapy with beta-blockers and endoscopic band ligation (EBL) is the standard prophylaxis of esophageal variceal rebleeding in cirrhosis. Beta-blockers are the backbone of combination therapy, since their benefit extend to other complications of portal hypertension. EBL carries the risk of post-banding ulc...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2014.01.007
更新日期:2014-05-01 00:00:00
abstract::Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure used in the management of complications of portal hypertension. Although the most robust evidence supports the use of TIPS as salvage therapy in variceal hemorrhage, secondary prophylaxis of variceal bleeding, and treatment of refract...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2019.07.004
更新日期:2019-11-01 00:00:00
abstract::In this article, the 4 phases of chronic HBV infection are reviewed and the factors that are associated with disease progression and the development of hepatocellular carcinoma (HCC) and cirrhosis are discussed. Also discussed is what is known to date about how to identify persons at the highest risk of developing HCC...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2010.05.007
更新日期:2010-08-01 00:00:00
abstract::Although hepatic encephalopathy (HE) is prevalent in the cirrhotic population, it has also been considered a potentially reversible condition. Liver transplantation represents the ultimate reversal of the decompensated cirrhotic state and should provide the best option for the reversibility of HE. However, the neurolo...
journal_title:Clinics in liver disease
pub_type: 杂志文章,评审
doi:10.1016/j.cld.2011.12.004
更新日期:2012-02-01 00:00:00