Management of liver diseases: Current perspectives

Abstract

There is increasing incidence and prevalence of acute and chronic liver diseases (CLDs) all over the world which influence the quality of life and can give rise to life threatening complications. The burden of advanced liver disease due to hepatitis B has been controlled by antivirals but its eradication is difficult soon. Highly effective directly acting antiviral therapy has reduced the burden of hepatitis C but is partially offset by increasing IV drug abuse. Non-alcoholic fatty liver disease pandemic is on and there is recent alarming increase in alcohol related liver disease, both of which have no drug cure apart from control of the risk factors. Genetic factors have been identified in progression of all forms of CLD. Due to better management of complications of CLD, the life span of patients have increased spiking the number of hepatocellular carcinoma (HCC) and patients needing liver transplantation (LT). The present severe acute respiratory syndrome coronavirus pandemic has affected the outcome CLD including LT in addition to causing acute hepatitis. Better diagnostics and therapeutics are available for liver fibrosis, portal hypertension, HCC and post LT management and many drugs are under trial. The present review summarises the current scenario of the epidemiology and the advances in diagnosis and treatment of liver diseases including their complications like portal hypertension, HCC and LT.

Hepatoprotective Effect of a New FFAR1 Agonist—N-Alkylated Isobornylamine

“…[ 2 ]. In the period 2007–2017, the age-standardized prevalence of cirrhosis and chronic liver diseases increased by 10.4% with 1.5 billion cases in 2017 [ 3 ].…”

COVID-19, Possible Hepatic Pathways and Alcohol Abuse—What Do We Know up to 2023?

“…Nevertheless, with the rapidly increasing number of new COVID-19 cases, our knowledge became more detailed-even in the area of hepatology. Because of the significant prevalence of CLD worldwide (112 million people according to the Global Burden of Disease (GBD) Study from 2017), the observation of the direct influence of coronavirus infection on its course is of crucial importance [174][175][176][177][178]. According to available data, it can be assumed that liver involvement is not a typical occurrence in COVID-19 patients and if it develops, usually, the course of liver injury is mild and transient, with no need for pharmacological treatment.…”

Gut microbiota modulation as an alternative in the management of non-alcoholic fatty liver disease and obesity

“…Regarding the pharmacological approach, as it was aforementioned, there is no current medical treatment approved for facing NAFLD, excluding those aimed to treat its risk factors 97 . However, due to its high relationship with T2DM and obesity, some antiobesity and anti-diabetic drugs, always in combination with lifestyle interventions, have been proposed as an alternative 41,48 .…”

“…Altogether, these are only a few examples of the number of drugs that are now being under research, with many of them in phase II and III of clinical trials 97 , but with an undefined and unestablished approved guidelines for NAFLD.…”

“…NAFLD es una enfermedad multifactorial cuya patogénesis, según la teoría del múltiple impacto, es un proceso complejo en el que diferentes factores, como la alteración del metabolismo lipídico, la resistencia a la insulina, la inflamación, el estrés de retículo endoplásmico, el estrés oxidativo, la disfunción mitocondrial, la alteración de la microbiota intestinal y la disrupción del eje intestino-hígado, junto con la predisposición genética, participan de forma paralela y sinérgica en la aparición y desarrollo de la enfermedad58,61 . Actualmente, la principal recomendación médica para hacer frente a NAFLD se basa en el cambio en el estilo de vida, implementando estrategias nutricionales y la práctica de ejercicio físico91 .De este modo, no existe tratamiento farmacológico específico aprobado hoy en día para esta enfermedad, aunque sí existen numerosos fármacos que están siendo investigados para tal fin, principalmente aquellos enfocados al tratamiento de obesidad y diabetes, dada la estrecha relación de NAFLD con estas enfermedades41,48,97 .En los últimos años, se ha identificado la alteración de la microbiota intestinal como un factor contribuyente a la aparición y desarrollo de obesidad y NAFLD, planteándose incluso posibles alternativas terapéuticas basadas en la modulación de la misma. La microbiota intestinal se define como el conjunto de microorganismos (arqueas, virus, hongos y, mayoritariamente, bacterias) que habitan en el tracto digestivo y que desempeñan un papel esencial para la salud del huésped 108 .…”