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Background and Objectives: To investigate the long-term efficacy of rifaximin (RFX) for hyperammonemia and efficacy for refractory ascites in patients with cirrhosis. Materials and Methods: We enrolled 112 patients with liver cirrhosis who were orally administered RFX in this study. Changes in the clinical data of patients were evaluated up to 36 months after RFX administration. The primary endpoint was a change in blood ammonia levels. Secondary endpoints included changes in clinical symptoms, Child–Pugh (CP) score, number of hospitalizations, degree of refractory ascites, adverse events, and the relationship between RFX administration and the renin-angiotensin-aldosterone system. Results: An improved rate of overt hepatic encephalopathy (HE) of 82.7% was observed 3 months after RFX administration, which significantly induced a progressive decrease in blood ammonia concentration and an improved CP score up to 36 months. No serious RFX treatment-related adverse events were observed. 36.5% in patients after RFX administration improved refractory ascites. After RFX administration, patients with satisfactory control of hepatic ascites without addition of diuretic had lower renin concentration than those with poor control (p < 0.01). At less than 41 pg/mL renin concentration, the control of refractory ascites was significantly satisfactory (p < 0.0001). Conclusions: RFX reduced blood ammonia concentration and improved hepatic spare ability and the quality of life of patients with long-term HE to up to 36 months. Our study revealed the effects of RFX against refractory ascites, suggesting that renin concentration may be a predictive marker for assessing ascites control.

We report a case of anorexia nervosa (AN) with gastroesophageal varices (GEV) in a 36-year-old woman. The patient presented to our hospital with progressive bloating due to severe ascites. She had no history of alcohol intake. Esophagogastroduodenoscopy and enhanced computed tomography revealed GEV and multiple hepatic nodules, respectively. The histological examination of a liver biopsy specimen revealed similar features to nonalcoholic fatty liver disease and showed hyperplastic nodules that were suspected to be related to the uneven distribution of portal blood flow in the liver. In conclusion, patients with long-term AN should undergo abdominal imaging to detect signs of portal hypertension.

We herein report a case of coagulation necrosis with granulation and eosinophilic infiltration of the liver. A 37-year-old woman was diagnosed with a new mass lesion in the liver 1 month after breast cancer surgery and admitted for a further examination. Because the tumor occurred immediately after surgery, it was considered essential to determine whether or not it was a metastatic liver tumor from breast cancer. A percutaneous liver tumor biopsy revealed eosinophilic granuloma of the liver, which is considered to have a high possibility of visceral larva migrans with suspected gnathostomiasis infection. A detailed medical history and histological diagnosis are important for making a differential diagnosis.

Porphyria cutanea tarda (PCT) is commonly diagnosed in cases where multiple hyperechoic nodules are observed in the liver. Pathologically, these nodules associated with PCT are focal fatty deposits. We report here, seven cases of PCT with fatty changes over multiple foci in the liver. Furthermore, the characteristics of ultrasonography (US) findings of 32 previously reported cases are summarized. The US features of these nodules showed a homogenous hyperechoic or hyperechoic rim pattern, partial confluence, and no mass effect in the vascular structures. Because multiple hyperechoic liver nodules occasionally mimic malignancies, and because their diagnosis can be challenging, clinicians should consider checking urine porphyrin levels to rule out PCT when such nodules are observed on US.

BACKGROUND Gastrointestinal varices are dilated submucosal veins in the gastrointestinal lumen associated with portal hypertension and represent important complications of liver cirrhosis (LC). Gastrointestinal variceal bleeding has serious life-threatening outcomes; although hemostatic therapy is possible in many cases, there are only a few studies reporting the detailed course of patients with variceal bleeding after hemostatic therapy and the transition of hemostatic therapy. This study aimed to evaluate the long-term outcomes of endoscopic hemostatic therapy for gastrointestinal variceal bleeding and of the transition of hemostatic therapy.METHODS A total of 125 patients who underwent emergency hemostatic therapy for gastrointestinal variceal bleeding between April 2006 and June 2020 were included. Data on the bleeding site, therapeutic method, primary therapeutic success rate, cumulative survival rates, factors associated with prognosis, recurrence rates, re-bleeding rates after treatment, and causes of re-bleeding were analyzed. Additionally, patients were classified into two groups: the previous term and the latter term. Patients’ background, therapeutic method, and treatment results were compared between the groups.RESULTS Overall, 94.4% had cirrhosis. The average Child-Pugh (CP) score (CPS) was 8.90. The rate of successful primary hemostasis was 98.4%, and 5.6% died within two weeks, all with a CPS ≥9. The respective one- and five-year survival rates for CP grade A/B were 81.3% and 55.4%, while those for CP grade C were 58.1% and 17.8%. CP grade C or hepatocellular carcinoma was significantly associated with poor prognosis. In total, 21.6% experienced variceal re-bleeding, and 62.9% of variceal re-bleeding cases were triggered by alcohol consumption. There was no significant difference in survival between patients with and without variceal re-bleeding. There was no significant difference in post-treatment survival between the previous and latter terms. In the latter term, the number of cases caused by alcohol consumption increased.CONCLUSIONS The hemostasis rate for variceal bleeding was high. Multidisciplinary treatment and continuation of proper management after treatment are crucial. Alcohol consumption increased variceal re-bleeding in the post-direct-acting antivirals era.