Faculty Bibliography

Background: Chronic hepatitis C (CHC) and non-alcoholic steatohepatitis (NASH) are both associated with impairment of healthrelated quality of life (HRQL). The most profound impairment is usually seen in patients with cirrhosis.
Aim(s): To compare HRQL scores in patients with cirrhosis due to CHC to NASH.
Method(s): Patients with CHC and NASH and compensated cirrhosis completed SF-36, CLDQ, and Work Productivity and Activity questionnaires while off-treatment.
Result(s): We included 1460 patients with NASH or CHC and cirrhosis: 57.4 +/- 8.2 years, 44% male, 40% history of psychiatric disorders, 50% employed (all p>0.05 between NASH and CHC). Cirrhotic patients with NASH had higher BMI (mean 33.8 vs. 28.2) and more type 2 diabetes (77% vs. 18%) (p<0.01). Patients with NASH had lower HRQL in Physical Functioning, Bodily Pain, General Health domains, and Physical Summary of SF-36 (by 3.6-4.4 points on a 0-100 scale, all p<0.01). Despite this, patients with CHC had lower Mental Health score of SF-36 (mean 69.5 vs. 73.0) and Emotional score of CLDQ (mean 4.9 vs. 5.3 on a 1-7 scale), and higher Activity Impairment score of WPAI (0.27 vs. 0.19) (all p<0.002). In multivariate regression analysis, after adjustment for demographic and clinical parameters, having NASH was independently associated with lower physical HRQL scores (beta - 3.6 to - 4.3 for SF-36 domains) and higher mental health-related scores (beta +3.8 for Mental Health of SF-36, +0.33 for Emotional of CLDQ) (all p<0.01).
Conclusion(s): Patients with NASH and cirrhosis have more impairment of their physical health-related scores than demographically similar patients with hepatitis C

Primary biliary cholangitis (PBC) is a chronic, cholestatic, autoimmune disease with a variable progressive course. PBC can cause debilitating symptoms including fatigue and pruritus and, if left untreated, is associated with a high risk of cirrhosis and related complications, liver failure, and death. Recent changes to the PBC landscape include a name change, updated guidelines for diagnosis and treatment as well as new treatment options that have recently become available. Practicing clinicians face many unanswered questions when managing PBC. To assist these healthcare providers in managing patients with PBC, the American College of Gastroenterology (ACG) Institute for Clinical Research & Education, in collaboration with the Chronic Liver Disease Foundation (CLDF), organized a panel of experts to evaluate and summarize the most current and relevant peer-reviewed literature regarding PBC. This, combined with the extensive experience and clinical expertise of this expert panel, led to the formation of this clinical guidance on the diagnosis and management of PBC.