Applying MARS treatments to patients with acute exacerbation of chronic liver disease can detoxify blood, improve cerebral circulation, and reduce brain edema, as reflected by the reduction in intracranial pressure and jugular bulb oxygen saturation values in our patients. A partial reversal of the characteristic hyperdynamic circulation was also achieved. Despite our encouraging results, further testing is needed to determine the reliability of the system.

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Reference 21 should be corrected to the following:Cotton PB, Durkalski V, Romagnuolo J et al. Eff ect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy: the EPISOD randomized clinical trial . JAMA 2014; 311; 2101-2109.

SUPPLEMENT nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nWe demonstrated a 65.5 % overall survival rate in eight consecutive patients suffering from acute exacerbation of chronic liver disease following treatment with the MARS detoxication system. This study joins other reports concerning the utility of the MARS system in supporting patients with liver failure. In contrast to the regular methods of hemodiafiltration, this system was designed to remove both low and middle molecular weight water soluble substances as well as albumin bound molecules.Indeed, serum levels of ammonia, as well as bilirubin were significantly reduced following the treatment.

In this case series, we have described several cases of CD in patients over the age of 60 with a varied spectrum of manifestations. We have also found a significant lag in diagnosis and treatment. We believe that it is important to promote the identification of CD as a possible culprit in varied clinical conditions in the elderly population.