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Article ; Online: Portosinusoidal vascular disorder: A paradigm shift.

Téllez, Luis / Donate, Jesús / Albillos, Agustín

2024 Volume 162, Issue 9, Page(s) 439–447

Abstract: The term portosinusoidal vascular disorder (PSVD) refers to a clinical-pathological entity that encompasses those patients with intrahepatic vascular damage without cirrhosis at risk of developing severe complications of portal hypertension. Numerous ... ...

Title translation	Enfermedad vascular portosinusoidal: un cambio de paradigma.
Abstract	The term portosinusoidal vascular disorder (PSVD) refers to a clinical-pathological entity that encompasses those patients with intrahepatic vascular damage without cirrhosis at risk of developing severe complications of portal hypertension. Numerous systemic diseases, genetic disorders, and toxic agents have been associated with this pathology, making its diagnosis an important clinical challenge. The recent description of uniform diagnostic criteria and a better understanding of its pathophysiology will allow for better identification of patients, even in early stages of the disease. Although there is currently no effective etiological treatment available, early diagnosis allows for the development of preventive strategies for some severe complications of portal hypertension.
MeSH term(s)	Humans ; Hypertension, Portal/diagnosis ; Hypertension, Portal/etiology ; Hypertension, Portal/complications ; Hypertension, Portal/therapy ; Portal Vein ; Vascular Diseases/diagnosis ; Vascular Diseases/etiology
Language	Spanish
Publishing date	2024-02-01
Publishing country	Spain
Document type	Journal Article ; Review
ZDB-ID	411607-0
ISSN	1578-8989 ; 0025-7753
ISSN (online)	1578-8989
ISSN	0025-7753
DOI	10.1016/j.medcli.2023.11.018
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Article ; Online: Beta-blockers in the era of precision medicine in patients with cirrhosis.

Albillos, Agustín / Krag, Aleksander

Journal of hepatology

2022 Volume 78, Issue 4, Page(s) 866–872

Abstract: For decades, non-selective beta-blockers (NSBBs) have been the standard of care for the primary and secondary prevention of bleeding from oesophageal varices. However, several questions regarding the best clinical use of NSBBs remain unanswered and new ... ...

Abstract	For decades, non-selective beta-blockers (NSBBs) have been the standard of care for the primary and secondary prevention of bleeding from oesophageal varices. However, several questions regarding the best clinical use of NSBBs remain unanswered and new data continue to emerge. Herein, we aim to delineate the therapeutic window of NSBBs in cirrhosis from a more individualised perspective. We address the current controversy of widening the therapeutic window and prescribing NSBBs to all patients with clinically significant portal hypertension. Although transient elastography is useful to rule-in clinically significant portal hypertension, we lack robust data supporting the use of NSBBs in patients without varices. While most data are based on propranolol, accumulating evidence suggests that carvedilol is superior and should be the first-line treatment until the decompensated stage. The clinical risk-to-benefit ratio appears to deteriorate in advanced decompensated stages and the risk of harm is high in patients with refractory ascites, low blood pressure and renal impairment, which clinically define closure of the therapeutic window. We also critically review non-invasive surrogates and biomarkers for predicting the haemodynamic response to NSBBs and confirm that the absence of reliable non-invasive methods is one of the main challenges facing the field.
MeSH term(s)	Humans ; Precision Medicine ; Gastrointestinal Hemorrhage/prevention & control ; Adrenergic beta-Antagonists/therapeutic use ; Liver Cirrhosis/complications ; Liver Cirrhosis/drug therapy ; Hypertension, Portal/etiology ; Hypertension, Portal/complications ; Esophageal and Gastric Varices/drug therapy ; Esophageal and Gastric Varices/etiology
Chemical Substances	Adrenergic beta-Antagonists
Language	English
Publishing date	2022-12-15
Publishing country	Netherlands
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	605953-3
ISSN	1600-0641 ; 0168-8278
ISSN (online)	1600-0641
ISSN	0168-8278
DOI	10.1016/j.jhep.2022.12.005
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Zs.A 2027: Show issues

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Article ; Online: Non-selective beta-blockers in patients with ascites: The complex interplay among the liver, kidney and heart.

Téllez, Luis / Albillos, Agustín

Liver international : official journal of the International Association for the Study of the Liver

2022 Volume 42, Issue 4, Page(s) 749–761

Abstract: Non-selective beta-blockers (NSBBs) are the cornerstone of the primary and secondary prophylaxis of variceal bleeding in cirrhotic patients. They additionally prevent ascites development and death in compensated patients with clinically significant ... ...

Abstract	Non-selective beta-blockers (NSBBs) are the cornerstone of the primary and secondary prophylaxis of variceal bleeding in cirrhotic patients. They additionally prevent ascites development and death in compensated patients with clinically significant portal hypertension. After ascites onset, NSBBs remain beneficial for preventing further decompensations. However, as the cirrhosis progresses, the inflammation increases, systemic vasodilatation worsens, ascites turns refractory and cardiodynamic equilibrium becomes extremely fragile. In this scenario, NSBBs can critically impair the cardiac reserve and facilitate a haemodynamic breakdown, imperilling renal perfusion. Consequently, NSBB treatment should be carefully monitored or even avoided in such patients, and other options for portal hypertension management should be considered. In the present review, we explore the effects of NSBBs in patients with ascites and discuss the complex interplay among their hepatic, systemic and renal haemodynamic effects in this scenario.
MeSH term(s)	Adrenergic beta-Antagonists/therapeutic use ; Ascites/complications ; Ascites/drug therapy ; Esophageal and Gastric Varices/complications ; Esophageal and Gastric Varices/drug therapy ; Gastrointestinal Hemorrhage/drug therapy ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/prevention & control ; Humans ; Kidney ; Liver Cirrhosis/complications ; Liver Cirrhosis/drug therapy
Chemical Substances	Adrenergic beta-Antagonists
Language	English
Publishing date	2022-02-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2102783-3
ISSN	1478-3231 ; 1478-3223
ISSN (online)	1478-3231
ISSN	1478-3223
DOI	10.1111/liv.15166
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Zs.A 1632: Show issues

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Article ; Online: The shaping of gut immunity in cirrhosis.

Muñoz, Leticia / Caparrós, Esther / Albillos, Agustín / Francés, Rubén

Frontiers in immunology

2023 Volume 14, Page(s) 1139554

Abstract: Cirrhosis is the common end-stage of chronic liver diseases of different etiology. The altered bile acids metabolism in the cirrhotic liver and the increase in the blood-brain barrier permeability, along with the progressive dysbiosis of intestinal ... ...

Abstract	Cirrhosis is the common end-stage of chronic liver diseases of different etiology. The altered bile acids metabolism in the cirrhotic liver and the increase in the blood-brain barrier permeability, along with the progressive dysbiosis of intestinal microbiota, contribute to gut immunity changes, from compromised antimicrobial host defense to pro-inflammatory adaptive responses. In turn, these changes elicit a disruption in the epithelial and gut vascular barriers, promoting the increased access of potential pathogenic microbial antigens to portal circulation, further aggravating liver disease. After summarizing the key aspects of gut immunity during homeostasis, this review is intended to update the contribution of liver and brain metabolites in shaping the intestinal immune status and, in turn, to understand how the loss of homeostasis in the gut-associated lymphoid tissue, as present in cirrhosis, cooperates in the advanced chronic liver disease progression. Finally, several therapeutic approaches targeting the intestinal homeostasis in cirrhosis are discussed.
MeSH term(s)	Humans ; Intestines ; Liver Cirrhosis/pathology ; Intestinal Mucosa ; Liver Diseases/metabolism
Language	English
Publishing date	2023-04-14
Publishing country	Switzerland
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2023.1139554
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Article: Evolving portal hypertension through Baveno VII recommendations.

Mendizabal, Manuel / Cançado, Guilherme Grossi Lopes / Albillos, Agustín

Annals of hepatology

2023 Volume 29, Issue 1, Page(s) 101180

Abstract: The Baveno VII consensus workshop has provided several novel recommendations regarding the management of patients with clinically significant portal hypertension (CSPH). The expert panel summarized the existing data into simple clinical rules to aid ... ...

Abstract	The Baveno VII consensus workshop has provided several novel recommendations regarding the management of patients with clinically significant portal hypertension (CSPH). The expert panel summarized the existing data into simple clinical rules to aid clinicians in their clinical practice. The use of non-invasive tests (NITs), especially liver stiffness measurement (LSM), have gain an important role in daily practice. The use of LSM alone or in combination with platelet count can be used to rule-in and rule-out compensated advanced chronic liver disease (cACLD) and CSPH. Further decompensation events were defined as a prognostic stage associated with an even higher mortality than that associated with first decompensation. Moreover, the term hepatic recompensation was introduced in Baveno VII consensus implying a partial or complete regression of the functional and structural changes of cirrhosis after the removal of the underlying etiology. This review will summarize the reader main aspects of Baveno VII consensus regarding the use of NITs in cACLD, analyze further decompensation events, and evaluate recent recommendations for prophylaxis and management of liver decompensation events.
MeSH term(s)	Humans ; Esophageal and Gastric Varices/diagnosis ; Esophageal and Gastric Varices/etiology ; Esophageal and Gastric Varices/therapy ; Hypertension, Portal/complications ; Hypertension, Portal/diagnosis ; Liver Cirrhosis/complications ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/therapy ; Prognosis ; Elasticity Imaging Techniques
Language	English
Publishing date	2023-11-19
Publishing country	Mexico
Document type	Review ; Journal Article
ZDB-ID	2188733-0
ISSN	1665-2681
ISSN	1665-2681
DOI	10.1016/j.aohep.2023.101180
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Zs.A 6221: Show issues

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Article ; Online: Reply to: "Anticoagulation to prevent disease progression in patients with cirrhosis".

Albillos, Agustín / Guerrero, Antonio / Téllez, Luis

Journal of hepatology

2023 Volume 79, Issue 3, Page(s) e125–e126

MeSH term(s)	Humans ; Liver Cirrhosis/complications ; Anticoagulants/adverse effects ; Blood Coagulation ; Disease Progression ; Portal Vein
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-06-09
Publishing country	Netherlands
Document type	Letter ; Comment
ZDB-ID	605953-3
ISSN	1600-0641 ; 0168-8278
ISSN (online)	1600-0641
ISSN	0168-8278
DOI	10.1016/j.jhep.2023.05.040
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Article ; Online: The Role of the Gut-Liver Axis in Metabolic Dysfunction-Associated Fatty Liver Disease.

Martín-Mateos, Rosa / Albillos, Agustín

Frontiers in immunology

2021 Volume 12, Page(s) 660179

Abstract: The complex interplay between the gut microbiota, the intestinal barrier, the immune system and the liver is strongly influenced by environmental and genetic factors that can disrupt the homeostasis leading to disease. Among the modulable factors, diet ... ...

Abstract	The complex interplay between the gut microbiota, the intestinal barrier, the immune system and the liver is strongly influenced by environmental and genetic factors that can disrupt the homeostasis leading to disease. Among the modulable factors, diet has been identified as a key regulator of microbiota composition in patients with metabolic syndrome and related diseases, including the metabolic dysfunction-associated fatty liver disease (MAFLD). The altered microbiota disrupts the intestinal barrier at different levels inducing functional and structural changes at the mucus lining, the intercellular junctions on the epithelial layer, or at the recently characterized vascular barrier. Barrier disruption leads to an increased gut permeability to bacteria and derived products which challenge the immune system and promote inflammation. All these alterations contribute to the pathogenesis of MAFLD, and thus, therapeutic approaches targeting the gut-liver-axis are increasingly being explored. In addition, the specific changes induced in the intestinal flora may allow to characterize distinctive microbial signatures for non-invasive diagnosis, severity stratification and disease monitoring.
MeSH term(s)	Animals ; CCR5 Receptor Antagonists/therapeutic use ; Dysbiosis/immunology ; Dysbiosis/microbiology ; Gastrointestinal Microbiome/immunology ; Humans ; Imidazoles/therapeutic use ; Intestinal Mucosa/immunology ; Intestinal Mucosa/metabolism ; Intestinal Mucosa/microbiology ; Liver/immunology ; Liver/metabolism ; Liver/pathology ; Metabolic Syndrome/drug therapy ; Metabolic Syndrome/immunology ; Metabolic Syndrome/metabolism ; Non-alcoholic Fatty Liver Disease/drug therapy ; Non-alcoholic Fatty Liver Disease/immunology ; Non-alcoholic Fatty Liver Disease/metabolism ; Sulfoxides/therapeutic use
Chemical Substances	CCR5 Receptor Antagonists ; Imidazoles ; Sulfoxides ; cenicriviroc (15C116UA4Y)
Language	English
Publishing date	2021-04-16
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2021.660179
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Article: Update on the diagnosis and management of portal hypertension in cirrhosis according to the Baveno VII Consensus Conference recommendations.

Téllez, Luis / Guerrero, Antonio / Albillos, Agustín

Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

2022 Volume 114, Issue 9, Page(s) 534–542

Abstract: Development of portal hypertension is the most critical hallmark in the natural history of advanced chronic liver disease, as it is responsible for most liver decompensations. Correct risk stratification allows the design of personalized treatment ... ...

Abstract	Development of portal hypertension is the most critical hallmark in the natural history of advanced chronic liver disease, as it is responsible for most liver decompensations. Correct risk stratification allows the design of personalized treatment strategies. In addition, the dynamic nature of chronic liver disease requires a refinement of both invasive and non-invasive diagnostic methods at every stage. Treatment with non-selective beta blockers and suppression of the etiologic factor improve portal hypertension and decrease the probability of decompensation in high-risk patients. Patients admitted for variceal hemorrhage also benefit from personalized management, where insertion of a preventive TIPS plays a relevant role.
MeSH term(s)	Adrenergic beta-Antagonists/therapeutic use ; Esophageal and Gastric Varices/diagnosis ; Esophageal and Gastric Varices/etiology ; Esophageal and Gastric Varices/therapy ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/therapy ; Humans ; Hypertension, Portal/complications ; Hypertension, Portal/diagnosis ; Liver Cirrhosis/complications
Chemical Substances	Adrenergic beta-Antagonists
Language	English
Publishing date	2022-09-15
Publishing country	Spain
Document type	Journal Article
ZDB-ID	1070381-0
ISSN	1130-0108 ; 0212-7512
ISSN	1130-0108 ; 0212-7512
DOI	10.17235/reed.2022.8868/2022
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Zs.B 199: Show issues

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Article ; Online: Sepsis in Patients With Cirrhosis Awaiting Liver Transplantation: New Trends and Management.

Martin Mateos, Rosa / Albillos, Agustín

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

2019 Volume 25, Issue 11, Page(s) 1700–1709

Abstract: Bacterial infections are more frequent and severe in patients with advanced liver disease and, therefore, in liver transplant candidates. The increased risk of infection in these patients parallels the severity of the immune dysfunction associated with ... ...

Abstract	Bacterial infections are more frequent and severe in patients with advanced liver disease and, therefore, in liver transplant candidates. The increased risk of infection in these patients parallels the severity of the immune dysfunction associated with cirrhosis, which is related to systemic inflammation and progressive immunodeficiency. Other factors contribute to this risk, such as genetic polymorphisms, proton pump inhibitor overuse, the numerous invasive procedures and hospitalizations these patients go through, or the immunosuppressive effects of malnutrition or alcohol abuse. Bacterial infections have a great impact on disease progression and significantly increase mortality rates before and after liver transplantation. Mechanisms leading to organ failure in sepsis are associated not only with the hemodynamic derangement but also with an excessive inflammatory response triggered by infection. Furthermore, prophylactic and empirical antibiotic treatment strategies in patients with cirrhosis are being modified according to the growing prevalence of multidrug-resistant bacteria in the past decade. Also, new criteria have been introduced for the diagnosis of sepsis and septic shock. These new definitions have been validated in patients with cirrhosis and show a better accuracy to predict in-hospital mortality than previous criteria based on systemic inflammatory response syndrome. Accurate prophylaxis and early identification and treatment of bacterial infections are key to reducing the burden of sepsis in patients with cirrhosis awaiting liver transplantation.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis/standards ; Bacterial Infections/complications ; Bacterial Infections/diagnosis ; Bacterial Infections/drug therapy ; Bacterial Infections/microbiology ; Disease Progression ; Drug Resistance, Multiple, Bacterial ; Hospital Mortality ; Humans ; Liver Cirrhosis/complications ; Liver Cirrhosis/immunology ; Liver Cirrhosis/mortality ; Liver Cirrhosis/surgery ; Liver Transplantation ; Practice Guidelines as Topic ; Sepsis/epidemiology ; Sepsis/immunology ; Sepsis/microbiology ; Sepsis/prevention & control ; Treatment Outcome ; Waiting Lists/mortality
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-09-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2006866-9
ISSN	1527-6473 ; 1527-6465
ISSN (online)	1527-6473
ISSN	1527-6465
DOI	10.1002/lt.25621
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Article: A novel EUS-guided rescue therapy for non-drainable walled-off pancreatic necrosis.

Sánchez Aldehuelo, Rubén / Albillos, Agustin / Vazquez-Sequeiros, Enrique

Gastroenterologia y hepatologia

2021 Volume 45 Suppl 1, Page(s) 83–84

MeSH term(s)	Drainage ; Endosonography ; Humans ; Necrosis ; Pancreatitis, Acute Necrotizing/diagnostic imaging ; Pancreatitis, Acute Necrotizing/drug therapy ; Pancreatitis, Acute Necrotizing/surgery ; Stents ; Ultrasonography, Interventional
Language	Spanish
Publishing date	2021-03-19
Publishing country	Spain
Document type	Case Reports ; Journal Article
ZDB-ID	632502-6
ISSN	0210-5705
ISSN	0210-5705
DOI	10.1016/j.gastrohep.2021.01.015
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