48 WORLD GASTROENTEROLOGY NEWS JULY 2016 Editorial | Expert Point of View | Gastro 2016: EGHS-WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events IgG4 Related Disease (IgG4-RD) Roger Chapman (University of Oxford) IgG4-RD is comprised of a col-lection of disorders affecting various organs, including the pancreas and bile ducts. Elevated levels of IgG4 antibodies and histological find-ings of plasma cells with a positive stain of IgG4 are common features. Radiological findings can mimic other disorders, e.g. adenocarcinoma of the pancreas or the bile ducts, and PSC with elevated levels of IgG4 is a differential diagnosis, complicating diagnostics. The diagnostic HISORt criteria are based on histological find-ings, imaging of the pancreas, elevated levels of s-IgG4, involvement of other organs, and response to steroid therapy. Professor Chapman recom-mends measurement of S-IgG4 in all patients with PSC or other disorders of the pancreas and bile ducts. Acute Kidney Injury (AKI) Zbigniew Konopski (OUS) AKI can be reversible, but it is important to recognize in the set-ting of decompensated liver disease and portal hypertension since each episode of AKI is associated with increased mortality and deterioration of kidney function. An algorithm for early detection and manage-ment of AKI focusing on alterations in kidney function was presented. Levels of creatinine may overestimate kidney function in the setting of cirrhosis, thus this algorithm focuses on dynamic alteration of creatinine rather than absolute threshold levels. AKI stage 1 (AKI1) is characterized by an increase in creatinine of >50% from baseline or an increase of 26.5 µmol/L within 48 hours, AKI2 by a 2-3 fold increase in creatinine from baseline, and AKI3 a 3-fold increase from baseline or a serum creatinine level of >356 µmol/L. Progression of AKI from one stage to another should lead to prompt intervention with rehydration, withdrawal of diuretics and nephrotoxic substances, and the administration of albumin. Hepatore-nal syndrome is defined as AKI2-3 and absence of treatment response or structural kidney damage and should lead to treatment with terlipressin Baveno VI Consensus Guidelines Bjørn Hofstad (OUS) The Baveno guidelines deal with the management of complications of portal hypertension. The use of endoscopy, transient elastography, and measurement of hepatic venous pressure gradient are important tools to stratify risk and indicate relevant preventive measures. Bleeding from esophageal or gastric varices should lead to administration of antibiot-ics, terlipressin, and erythromycin in order to empty the stomach. Gastroscopy should be performed within 12 hours with band ligation of esophageal varices and tissue adhesive of gastric varices. Bleeding stent and transjugular intrahepatic portosystem-ic shunt (TIPS) should be considered in many cases. Blood transfusion should only be given if necessary to secure hemodynamic stability (i.e. up to 7.5 g /dl of hemoglobin in the absence of ischemic heart disease). Prevention/treatment of hepatic encephalopathy should be considered. β-blockers should be administered carefully to patients with hypotension and not to patients with severe throm-bocytopenia, severe decompensation, and refractory ascites. European Association for the Study of the Liver (EASL) Guidelines for the Management of AIH Eyvind Paulssen (University of Tromsø, University Hospital of Northern Nor-way) Professor Paulssen gave a com-prehensive summary of the EASL Guidelines. A key point was that withdrawal of treatment should not be attempted before 2-3 years and always preceded by liver biopsy since inflammatory activity may be present despite normalized biochemical liver tests. Continuous follow-up with liver tests after withdrawal is crucial. Presentation of Ongoing Projects Asgeir Johannesen (Vestre Viken Hospital) leads a project in collabora-tion with St. Paul’s Hospital Medical Millenium College in Addis Ababa, Ethiopia. The project aims to develop and implement a strategy for treat-ment and surveillance of patients with Hepatitis B in Ethiopia, also evaluat-ing other factors potentially influenc-ing the high prevalence of liver disease in the country such as pesticides, aflatoxin, and the use of Khat. Håvard Midgard (Akershus Uni-versity Hospital) is writing his PhD dissertation on the treatment of Hepa-titis C among active intravenous drug users. The prevalence and mortality of advanced liver disease increase in this group as they get older. Treat-ment with new direct acting antivirals in this group seems to give sustained virological response in line with results in other populations. Adher-ence seems to exceed expectations. Treatment of intravenous drug users may have a great impact on future incidence of hepatitis C, but the big-gest challenge is to organize treatment in this group. The next Norwegian National Liver Meeting is expected to take place in Oslo week 11, 2017.
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