Tag Archives: CIRRHOSIS
AASLD Liver Meeting 2015

AASLD Liver Meeting 2015




For the next several days, liver disease experts from around the world will be in San Francisco learning and sharing the latest developments in liver disease at the annual Liver Meeting.

Today, the one-day postgraduate course covered common clinical conditions, including non-alcoholic fatty liver disease, hepatitis C, liver cancer/hepatocellular carcinoma, and complications of cirrhosis, including volume overload/ascites, malnutrition, and hepatic encephalopathy.

More updates will be posted through the meeting.

Dr. Joe Galati

Liver Meeting 2015




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Nonalcoholic Fatty Liver Disease: What You Need to Know? Dr. Rashid Khan Explains

Nonalcoholic Fatty Liver Disease: What You Need to Know? Dr. Rashid Khan Explains

Dr. Rashid Khan, Hepatologist at Liver Specialists of Texas, guest edited this blog entry on Fatty Liver Disease.

Obesity and Fatty Liver Disease

Obesity and Fatty Liver

In my 9 years of medical practice, it still does not cease to amaze me, that the public as well as the general physician’s perspective on fatty liver disease could be so wrong.

Every day of the week I see at least 10 patients with fatty liver, who have been told by their family physician that fatty liver is “no big deal”, and it is nothing to worry about. I tell them it is “ absolutely something to worry about”. Let me explain why.

Nonalcoholic fatty liver disease is a condition where there is fat accumulation in the liver of people who drink little or no alcohol.This condition is very common and generally causes no signs or symptoms, and generally no complications. Most people feel “OK” with this condition.

A wide range of diseases and conditions can increase your risk of nonalcoholic fatty liver disease, including: gastric bypass surgery, high cholesterol, high levels of triglycerides in the blood, metabolic syndrome, polycystic ovary syndrome, sleep apnea, diabetes, hypothyroidism, and of course, obesity.

In some people with fatty liver, the fat that accumulates can cause inflammation and scarring in the liver. This form of nonalcoholic fatty liver disease is called nonalcoholic steatohepatitis, commonly called NASH. In its most severe form, fatty liver can progress to liver cirrhosis (scarring), liver failure, and even liver cancer. About 20% of patients with fatty liver disease related steatohepatitis can progress to liver cirrhosis, so the risk is not trivial. In these such cases, liver transplant is discussed, and may be the only option to survive.

Evaluation of fatty liver begins with simple blood tests to assess liver function. These blood tests are the ALT, AST, bilirubin, and possibly alkaline phosphatase.

Unfortunately, many times these liver tests are elevated, and ignored by both physician and patient. These elevated (and abnormal) liver tests may be the first indication that trouble is brewing in the liver. This is almost always followed by some sort of liver imaging test, such as an ultrasound, CT scan or MRI of the liver and abdomen. If I suspect a more advanced stage of fatty liver disease, I will recommend we perform a liver biopsy, a procedure that involves removing a small sample of tissue from the liver, and examining it under a microscope to look for signs of inflammation and scarring.

Unfortunately, despite extensive research in this field, no single standard and targeted therapy exists for fatty liver disease in 2015. In other words , no medication is currently the perfectly effective treatment for fatty liver disease. Almost always my patient will ask me , “Hey Doc, what pill can I take to fix this problem? And I reply there is none.

So we typically work to reduce the risk factors that have caused the fatty liver disease which are well known as I have eluded to above. If the patient is obese, we ask them to lose weight. Weight loss can be tough in the modern day lifestyle, but a committed approach involving caloric reduction and increasing physical activity usually works. Patients with diabetes and or high cholesterol are placed on medications to better control these disorders of their metabolism.

No alternative medicine treatments are proven to cure nonalcoholic fatty liver disease. The use of herbs, and many other widely available over the counter supplements not only don’t work, but can be dangerous. Some studies have shown that natural substances such as Vitamin E and coffee may help to reduce the damage caused by inflammation. However, more research is needed, and patients should discuss the use of these substances with their liver specialist.

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Latest News on Hepatitis C Cures

For tonight’s broadcast of Your Health First, Dr. Rashid Khan joins me to discuss the latest news on fatty liver disease, and the new therapies for hepatitis C, which results in a cure rate of over 95% of the cases. You can listed to the audio from the three segments here.


Dr. Rashid Khan and Dr. Joe Galati Discuss Liver Disease: Part 1 by Your Health First Radio on Mixcloud

Dr. Rashid Khan and Dr. Galati Discuss Fatty Liver Disease: Your Health First Part II by Your Health First Radio on Mixcloud

Hepatitis C: Dr. Rashid Khan and Dr. Joe Galati Discuss-Your Health First Interview Part III by Your Health First Radio on Mixcloud

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New Hepatitis C Cure FDA Approved: Daclatasvir for Genotype 3 Patients

This past week, the FDA gave approval to Bristol-Myers Squibb and their first drug in the hepatitis C market. Daclatasvir was given FDA approval for patients with the genotype 3 variety of chronic hepatitis C. Daclatasvir, commercially available as Daklinza, is approved to be taken with previously approved sofosbuvir (Sovaldi)-manufactured by Gilead-in this two-drug combination. Of note, Ribavirin nor interferon are required in the combination.

Published cure rates, also know as sustained virologic response (SVR) range from 86-90%. If you are non-cirrhotic, and naive to therapy, one can expect a 96% SVR. Unfortunately, prior treatment failures with past combinations, plus the presence of cirrhosis, carries a poor response rate of 63% in this most difficult group of patients.

For more information on hepatitis C and current therapies available, visit our website at Liver Specialists of Texas .

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Alcoholic Liver Disease: What You Need to Know-The Basics

Our latest video covers the basic aspects of alcohol related liver disease, and the complications of excessive alcohol intake. In general, there are three areas of concern:

1. The development of alcoholic fatty liver disease

2. The development of acute alcoholic hepatitis

3. Alcoholic cirrhosis

The major point to understanding is that all alcoholic drinks (servings) have about the same amount of alcohol in them. Thus, 1-beer, 1-glass of wine, and 1-serving of spirit (i.e. vodka, rum, gin, etc) all have approximately 10-12 grams of alcohol in them. Alcohol is alcohol, regardless of the volume, color, or taste.

The other key point to remember, is that the amount of alcohol daily is different for men and women. For women, one serving/day is the limit; two for men. Period. Above this, you run the risk of complications.

View our latest video.

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New Hepatitis C Drug Approved: Janssen’s Hepatitis C Drug Simeprevir Now Available

This past week, the FDA gave approval to Janssen’s new drug to treat hepatitis C. Simeprevir, commercially know as OLYSIO, is the first new hepatitis C drug since the release of telapravir (Incevik) and boceprevir (Victrelis) in 2011. Simeprevir is a  NS3/4A protease inhibitor, used in combination with interferon and ribavirin.

The release of simeprevir marks the beginning of a new wave of direct acting antiviral agents against the hepatitis C virus. Additional drugs are set for FDA approval, including the Gilead drug sofosbuvir in early December 2013.

Most of the new hepatitis C drugs will have a number of features in common. These include:

  • Very high cure rate, in the 80-90% range – lower in null and non-responders
  • Less side effects
  • Shorter duration of treatment
  • Less pills to take each day
  • Cirrhosis reduces response rates
  • Less drug-drug interactions
  • Genotype 1 subtype differences exist

Looking at the dosing of simeprevir, I have attached the official product insert that describes how the drug will be doses. Several points to consider:

  • This is an interferon/ribavirin based therapy
  • Patients with genotype 1 need additional screening for the NS3 Q80K polymorphism
  • Those with this variant have a decreased response rate to the therapy, and should be considered for an alternative therapy
  • The initial dosing is 12 weeks of simeprevir with interferon and ribavirin, followed by an additional 12 or 36 weeks of interferon and ribavirin combination therapy.
  • There are drug-drug interaction which have to be monitored closely
  • FDA approval is for genotype 1 patients only

While the release of simeprevir is welcomed, it has not provided the proverbial “home-run” we have been looking for in our quest to cure hepatitis C. In well selected patients, achieving a better than 80% cure rate is available. The concerns I have relate to the Q80K polymorphism noted above. This will be an additional step required in screening our patients. Additionally, in patients with prior non-response or null responders, as well as those with cirrhosis, these patients will still require a full 48 week of interferon and ribavirin. One of the goals of the next generation of hepatitis C therapies is reduced interferon exposure, or complete elimination. Simeprevir does not fully meet this goal.

In the days to come, I will post additional information on sofosbuvir. For now, these are the highlights to consider (refer to this FDA document for additional details):

  • Sofosbuvir will likely receive FDA approval for Genotype 1,2,3, and 4 patients with hepatitis C
  • Interferon-free treatment in genotype 2 and 3 for 12 weeks
  • Sofosbuvir combined with interferon and ribavirin in genotype 1 and 4 for 12 to 16 weeks

This treatment strategy is far different than the simeprevir treatment noted above.

Looking further, we will eventually have all interferon-free protocols. It is anticipated that as additional new drugs are approved, they will be combined (example sofosbuvir and simeprevir), allowing us to treat a wide range of patients, safely, and with a cure rate many of us may have never envisioned 20 years ago.

For a consultation to see if you are a candidate for these new drugs, contact Lexa at our office at 713-794-0700 and visit our webpage for additional information.

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Annual Liver Meetings -AASLD- in Washington, DC This Week

Annual Liver Meetings -AASLD- in Washington, DC This Week


The annual Liver Meetings are taking place in Washington, DC, and I will report back on the breakthroughs, specifically those related to hepatitis C, cirrhosis, fatty liver, and liver cancer and transplant.

This far, discussion regarding the new hepatitis C therapies continue to report on the impact of new therapies on the cure rates we have been seeing in clinical studies. In addition to the new Gilead drug soon to be released, the FDA is favorably evaluating Simeprevir another soon to be approved hepatitis C drug.

Another popular topic yesterday and today has been non-alcoholic fatty liver disease (NAFLD and NASH). The take home message for both patients and physicians is that those individuals with obesity, diabetes, fatty liver, plus fibrosis on their biopsy have the greatest risk for serious complications.

I will update the blog as new developments are available.

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Second Opinion in Hepatitis: Videoconferencing Between Houston and the World

Each week, I receive dozens of e-mails from followers of our social media sites (Twitter, YouTube, FaceBook, Your Health First, and Liver Specialists of Texas) seeking assistance regarding some form of liver disease they are suffering from, or one of their relatives. I usually respond back with some direction they should head in, or ask if they are available to travel to Houston for a face-to-face evaluation.

As technology improves, the availability of videoconferencing has never been easier. Working with Houston based software developers, there is now the opportunity to participate in a second opinion program with experts in liver disease in our practice. Because there is such variability in everyone’s home or work connectivity to the internet, we plan on supplying you with the needed technology to connect.

The savings of not having to travel to Houston, hotel and food charges, lost wages, and time, makes this an economically sensible alternative.

Second opinions in all aspects of liver disease will be available, including abnormal liver tests, fatty liver disease, hepatitis C, hepatitis B, cirrhosis, liver cancer, alcohol related liver disease, liver transplant, hemochromatosis, and autoimmune disease of the liver. The cost for this service will be based on a minimum of a 30 minute consultation, allowing for additional time at 15 minute increments. Medical records, x-ray reports and films, biopsies, and past consultations will be reviewed.

Feedback on this program is important to us. Please let us know what you think.

For additional information, contact Dee at (713) 634-5103.

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Should Alcoholics Be Allowed to Receive Liver Transplants?

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Alcohol, Liver, Cirrhosis and Transplant: Dr. Galati Discusses

A segment that I recorded for this weeks Your Health First was with Dr. Howard Monsour. who’s the Chief of hepatology at Houston Methodist. In this two-part interview, we discussed various aspects of alcoholic liver disease, effects of acetaminophen on the liver, and the difference between men and women in their alcohol consumption.

As noted in prior posts, the issue of liver transplant in patients with alcoholism and alcoholic cirrhosis is controversial, but when carefully reviewed, their outcomes following transplant are equal or better than other diseases we transplant livers for.

Watch the video interview here.

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