1 / 21

Institute of Liver & Biliary Sciences

APASL STC CAIRO 2014. Institute of Liver & Biliary Sciences. APASL working party on Liver Fibrosis. Dedicated to Excellence in Patient Care, Teaching & Research in Liver & Biliary Diseases. Five years after the first consensus: what is new and what we need?. Dr. S K Sarin

elisha
Download Presentation

Institute of Liver & Biliary Sciences

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. APASL STC CAIRO 2014 Institute of Liver & Biliary Sciences APASL working party on Liver Fibrosis Dedicated to Excellence in Patient Care, Teaching & Research in Liver & Biliary Diseases Five years after the first consensus: what is new and what we need? Dr. S K Sarin shivsarin@gmail.com A Deemed University Vasant Kunj, New Delhi, India www.ilbs.in

  2. ILBS : Residents

  3. ILBS : Faculty

  4. I have no particular talent…I am merely inquisitive

  5. APASL – Hepatic Fibrosis Working Party Meeting: New Delhi June 11-13, Cairo Making of Guidelines 2014 PurposeProcess Level of evidenceGrade of recommendation

  6. STEP 2 Selection of experts by the APASL Working Party on Hepatic Fibrosis STEP 3 Prioritize Issues STEP 4 Assigning issues to a group of experts for systemetic review STEP 5 Circulation of the systemic reviews and draft consensus based on evidence and recommendations

  7. Purpose of Guidelines • To assist physicians, patients, health-care providers, and health-policy makers worldwide in informed decision-making process according to evidence based data. • Where all resources and therapies are available. • Adapt to local needs, capacities and costs • Research

  8. Then and Now: Evidence Based 2008 2014 and Beyond GRADE system • Oxford syatem

  9. Grade Classification: level of evidence

  10. GRADE System

  11. GRADE System

  12. Hepatic Fibrosis: Assessment 2008 2014 and beyond Liver Biopsy qFibrosis, CPA (Collagen Proportion area) Portal Pressure/ HVPG Correlation with fibrosis , New classification, outcome Computerized Endoscopic Manometery, Variceal Pressure Monitor • Liver Biopsy • Fibrosis Semi-Quantification • HVPG • Correlation with Fibrosis

  13. Hepatic Fibrosis: Assessment 2008 2014 and Beyond Non-invasive Markers APRI, Fibrotest, ELF, Fibrospect Fibrometer, Fibrofast Fib4, Forn’s Index NAFLD Fibrosis Score (Age, BMI, diabetes/IGTT, Platelet, Alb, AST/ALT ratio • Non-invasive markers • APRI, ELF (EuropenanLiv Fib) • Fibrotest, Fibrospect • Hepascore • Fibrometer • Fibrofast

  14. Hepatic Fibrosis: Serum Markers 2008 2014 Serum Markers + vWF CK18 • Serum Markers • Hyaluronic acid, MMP3 inhibitor, PIIIP, laminin

  15. Hepatic Fibrosis: Assessment 2008 2014 Non Invasive Microbubble US CEUS Fibroscan CAP LSM Spleen stiffness Liver spleen ratio ARFI SSWE MR elastography Breath tests 13C Methacetin BT • Non invasive • Doppler • Microbubble US • CEUS • Fibroscan

  16. Reversibility of Hepatic Fibrosis 2014 Fibrosis regression not synonymous with reversibility of cirrhosis Significant fibrosis reduction/reversal NASH cirrhosis (post-metabolic surgery) HBV (Tenofovir), • Fibrosis regression not synonymous with reversibility of cirrhosis • Architecture, vascular shunts ,function don’t return to normal

  17. Hepatic Fibrosis: Serum Markers • Serum Markers • Hyaluronic acid, MMP3 inhibitor, PIIIP, laminin • Serum Markers + • vWF • CK18

  18. Hepatic Fibrosis: New Therapies • Therapies- Inhibitors • Loxl2 (Gilead) • TGFαv6 – STX100 • Pirfenidone (TGF , p38) • LPA1 – (fibroblast migration) • IL4, IL13 (tralokinumab) • Agonists • PRM-151 (Amyloid P) agonist, resolves fibrosis

  19. Challenges • Time short, AASLD • Challenges • End-points of fibrosis assessment not clear • Biomarkers, breath tests – not there • Pathobiology and genesis of fibrosis !

  20. What we want to achieve in Cairo ! • Systematic reviews in each area needed • General, disease based, Rewrite most of the articles • GRADE system, Evidence based • APASL recommendations purposeful, • Include some, could not attend

More Related