This is a review article on hepatic encephalopathy, a frequent complication of advanced chronic liver disease, summarizing several clinical, diagnostic and management issues. The spectrum of this potentially reversible central nervous system disturbance extends from subclinical malfunctions to hepatic coma and may present in neurological and/or psychiatric manifestations. It is associated with a reduced quality of life, life-expectancy, and a huge personal and societal burden for the individuals, their relatives and for the healthcare system. Several reviews and recommendations have been published on different aspects of its pathology and management. The pathology is not completely explored, no complete agreement on the classification and diagnosis, and the prevention and therapy are not completely solved. However, there is a wide consensus regarding its negative prognostic value as well as regarding importance of early recognition and early effective treatment of overt manifestations and precipitating conditions.
The current situation on fecal transplantation in Hungary
The procedure of treating chronic diarrhoea, which has been used in the fourth century, has recently come back into focus. Fecal Microbiota Transplantation (FMT) has become known as an alternative and effective treatment for refractory Clostridioides difficile infections. Due to the complex composition of the stool, it is difficult to examine and is not in line with precision medicine so popular today. Despite this, we have more and more data available about its effectiveness and the development and gain ground of more and more quality management systems compatible technologies are becoming known. In this paper, we briefly summarize the current developments and directions in fecal transplantation in Hungary.
Összefoglaló közlemények / Reviews
Use of immunosuppressive and biological therapy in inflammatory bowel disease
The management of inflammatory bowel disease has changed dramatically with the development of immunosuppressive and biological therapies. Recent literature suggest that the impact of biological and immunomodulatory therapy on the natural history of disease might be dependent on the timing of their introduction. However, the challenge remains to identify patients for whom early effective treatment would provide the most beneficial outcome, protecting individuals with milder disease phenotype from unnecessary risks and potential side effects. The aim of this review is to highlight the therapeutic options for moderate to severe IBD currently available in Hungary, to summarize our current knowledge on the optimal timing of their initiation, and to propose a treatment algorithm that can be used in everyday patient care.
Összefoglaló közlemények / Reviews
Good practice for anticoagulant and antiplatelet treatment in gastrointestinal bleeding
Antithrombotic treatment significantly increases the risk of bleeding in the gastrointestinal tract. The associated mortality is partly due to circulatory stasis, shock, ischemia owing to hemorrhage and partly due to thromboembolic complications resulting from the interruption of antithrombotic therapy for the reason of hemorrhage. Timing of early endoscopy is an important aspect of treatment. In severe, life-threatening bleeding, it may be necessary to suspend anticoagulation. In the case of vitamin K antagonists, it is recommended to give prothrombin complex concentrate, fresh frozen plasma should be used only in the absence of this. For direct acting oral anticoagulants, specific antidotes or, if these are not available, also prothrombin complex concentrate is proposed. Acetyl-salicylic acid should not be omitted in controlled bleeding, nor in the case of dual antiplatelet therapy, but the second agent should be suspended for a while. The prevention of thromboembolism is also essential in gastrointestinal bleeding, and therefore the reintroduction of anticoagulation is justified after the bleeding has stopped. If the risk of rebleeding is high, it is recommended to restart anticoagulants after day 7, and within 4-7 days in case of low risk.