gastroendonews.com
The Independent Monthly Newspaper for Gastroenterologists
Volume 72, Number 8 • August 2021
Cause for Optimism In Stubborn Problem Of Intestinal Fibrosis
HEPATOLOGY IN FOCUS
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ntestinal fibrosis, one of the most stubborn challenges in managing inflammatory bowel disease, may soon meet its match. A raft of research into intestinal antifibrotics, the launch of a global consortium tackling the problem, and the first clinical trial of a novel antifibrotic are some of many causes for optimism, experts say. “There’s a lot happening now, and the future is bright for the treatment and prevention of fibrosis,” said Florian Rieder, MD, who heads a lab at the Lerner Research Institute at Cleveland Clinic in Ohio. An estimated 30% of patients with Crohn’s disease and 5% of those with ulcerative colitis develop symptomatic fibrostenosis, often requiring hospitalization and surgery, which itself leads to a cycle of strictures and surgeries. However, research presented at the 2021 virtual Digestive Disease Week, and several other developments are providing hope for patients at risk for intestinal fibrosis. In one study presented at DDW (abstract Su479), Dr. Rieder and his colleagues examined the effects of recombinant human milk fat globule-EGF factor 8 (rhMFGE8), which has antifibrotic effects in the liver and heart, on fibrosing and nonfibrosing intestinal tissues. They used mesenchymal cells taken from patients with Crohn’s disease and ulcerative colitis, as well as from healthy controls. After exposing the extracellular matrix (ECM) that promotes fibrosis—and more specifically the human intestinal myofibroblasts (HIMFs) that make up the ECM—to rhMFGE8, they found that expression of MFGE8 in fibrotic Crohn’s disease tissue was significantly elevated, but it did not lead to an antifibrotic effect. “This suggests that in Crohn’s disease, sensitizing HIMF
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ew research has found that nearly half of patients who receive care at Veterans Health Administration hospitals have risk factors for liver disease. Yet, fewer than 10% of patients with these risk factors and markedly abnormal fibrosis scoring or transient elastography receive a diagnosis of cirrhosis.
The investigators hope to use these data to encourage population-level screening for advanced liver disease, an effort they say may ultimately enable earlier intervention. “Unfortunately, many of our patients with cirrhosis see Undiagnosed, page 14
New Dialysis Machine May Reverse Liver Failure
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ope may be on the horizon for people who have acute-on-chronic liver failure, according to results from an early-phase international, multicenter study. Researchers have found that DIALIVE, a novel liver dialysis device, is safe and effective in this group of patients, significantly increasing the proportion
see Fibrosis, page 38
of them who recover from organ failure and shortening the time required to do so. “DIALIVE is a mechanical liver device, which hits at the heart of what we believe are the two most important pathobiological mechanisms which drive see DIALIVE, page 8
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