Browsing by Author "Díaz Piga, Luis Antonio"

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    Academic excellence in Latin America : social accountability of medical schools
    (2020) Puschel Illanes, Klaus; Riquelme Pérez, Arnoldo; Sapag Muñoz de la Peña, Jaime; Moore Clive, Philippa María; Díaz Piga, Luis Antonio; Fuentes López, Eduardo; Jiménez de la Jara, Jorge; Burdick, W.; Norcini, J.; Campos, H.; Valdez, J. E.; Llosa, M. P.; Lamus-Lemus, F.; Yulitta, H.; Grez, M.
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    Actualizaciones en el manejo general de pacientes postrasplante hepático y de sus complicaciones más frecuentes
    (2024) Díaz Piga, Luis Antonio; Villalón Friedrich, Alejandro Andrés; Ochoa, Gabriela; García Castillo, Sergio Adrián Nicolas; Severino Cuevas, Nicolás Felipe; Ayares Campos, Gustavo Ignacio; Idalsoaga Ferrer, Francisco Javier; Dib Marambio, Martín Javier; Briceño Valenzuela, Eduardo Andrés; Viñuela Fawaz, Eduardo Andrés; Martínez Castillo, Jorge Arturo; Jarufe Cassis, Nicolás Patricio; Rabagliati Borie, Ricardo Miguel; Meneses Quiroz, Luis Andrés; Muñoz Schuffenegger, Pablo; Vargas Domínguez, José Ignacio; Espino Espino, Alberto Antonio; Vera Alarcón, María Magdalena; Benítez Gajardo, Carlos Esteban; Wolff Rojas, Rodrigo Mauricio; Norero Muñoz, Blanca Gabriela; Barrera Álvarez, Francisco Benjamín; Soza Ried, Alejandro; Arrese Jiménez, Marco Antonio; Arab Verdugo, Juan Pablo
    Liver transplantation (LT) is a cost-effective therapy for advanced liver disease. Although LT significantly improves long-term survival, it requires strict control of immunosuppressants and their potential complications. Several available immunosuppressive drugs include glucocorticoids, calcineurin inhibitors, mycophenolate, mTOR inhibitors, and anti-CD25 antibodies. These drugs act particularly in T lymphocytes, depleting them, deviating their traffic, or blocking their response pathways. The main complications after LT include renal failure and infectious, immunological, biliary, vascular adverse events, metabolic, cardiovascular, and neoplastic diseases, especially during the first months. Bacteria, viruses, and fungi can cause infections in these patients. Prophylaxis against Herpes simplex virus, Varicella zoster virus, Cytomegalovirus, Pneumocystis jirovecii, Candida spp., and Aspergillus spp. should be considered according to the presence of risk factors. Among immunological complications, acute cellular rejection is common (30% of LT) but usually responds to immunosuppressive escalation. Also, chronic rejection appears in 3-17% of LT, but only half of the recipients respond to increased immunosuppressants. Appropriate treatment of the underlying etiology is essential, especially in autoimmune diseases, hepatitis B and C virus infection. Lifestyle changes must be encouraged in all patients, and alcohol consumption avoided (especially in alcohol use disorder). Due to the increased risk of cancer, neoplasms must be actively monitored, as well as osteoporosis and other metabolic disorders such as diabetes and cardiovascular disease.
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    Advancements in MELD Score and Its Impact on Hepatology
    (Thieme Medical Publishers, Inc., 2024) Hudson, David; Valentin Cortez, Francisco Javier; Hurtado Díaz de León, Ivonne; Malhi, Gurpreet; Rivas, Angélica; Afzaal, Tamoor; Rad, Mahsa Rahmany; Díaz Piga, Luis Antonio; Khan, Mohammad Qasim; Arab Verdugo, Juan Pablo
    There continues to be an ongoing need for fair and equitable organ allocation. The Model for End-Stage Liver Disease (MELD) score has evolved as a calculated framework to evaluate and allocate patients for liver transplantation objectively. The original MELD score has undergone multiple modifications as it is continuously scrutinized for its accuracy in objectively representing the clinical context of patients with liver disease. Several refinements and iterations of the score have been developed, including the widely accepted MELD-Na score. In addition, the most recent updated iteration, MELD 3.0, has been created. The MELD 3.0 calculator incorporates new variables such as patient sex and serum albumin levels and assigns new weights for serum sodium, bilirubin, international normalized ratio, and creatinine levels. It is anticipated that the use of MELD 3.0 scores will reduce overall waitlist mortality and enhance access for female liver transplant candidates. However, despite the emergence of the MELD score as one of the most objective measures for fair organ allocation, various countries and healthcare systems employ alternative methods for stratification and organ allocation. This review article will highlight the origins of the MELD score, its iterations, the current MELD 3.0, and future directions for managing liver transplantation organ allocation.
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    Alcohol-Related Liver Disease in Latin America: Local Solutions for a Global Problem
    (John Wiley and Sons Inc, 2020) Díaz Piga, Luis Antonio; Roblero Cum, Juan Pablo; Bataller, Ramon; Arab Verdugo, Juan Pablo
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    Alcohol‐Attributable Cancer: Update From the Global Burden of Disease 2021 Study
    (2025) Danpanichkul, Pojsakorn; Pang, Yanfang; Díaz Piga, Luis Antonio; White, Trenton M.; Sirimangklanurak, Supapitch; Auttapracha, Thanida; Suparan, Kanokphong; Syn, Nicholas; Jatupornpakdee, Pimtawan; Saowapa, Sakditad; Ng, Cheng Han; Kaewdech, Apichat; Lui, Rashid N.; Fallon, Michael B.; Yang, Ju Dong; Louvet, Alexandre; Noureddin, Mazen; Liangpunsakul, Suthat; Jepsen, Peter; Lazarus, Jeffrey V.; Arab, Juan Pablo; Wijarnpreecha, Karn
    Background and AimsAlcohol is a major risk factor for cancer development. Our study aimed to provide the updated global, regional and national burden of alcohol-attributable cancer.Approach and ResultsWe analysed the Global Burden of Disease Study 2021 to determine the death and age-standardised death rate (ASDR) from alcohol-attributable cancer and the change of these measures between 2000 and 2021 (reflected as annual percent change [APC]), classified by region, nation and country's developmental status, which is based on the sociodemographic index (SDI).ResultsIn 2021, there were 343,370 deaths globally from alcohol-attributable cancer, which was an increase from 2000 by 51%. Alcohol-attributable cancer accounted for 3.5% of all cancer deaths. Among alcohol-attributable cancer, liver cancer (27%) accounted for the highest mortality from alcohol, followed by oesophageal (24%) and colorectal cancer (16%). From 2000 to 2021, ASDR from alcohol-attributable cancer decreased (APC: −0.66%). Regionally, from 2000 to 2021, the fastest-growing ASDR was observed in South Asia. Classified by SDI, low (APC: 0.33%) and low-to-middle SDI countries (APC: 1.58%) exhibited an uptrend in ASDR from alcohol-attributable cancer. While the ASDR from all other cancers decreased, ASDR from early-onset (15–49 years) lip and oral cavity cancer increased (APC: 0.40%).ConclusionsFrom 2000 to 2021, although the ASDR from alcohol-attributable cancer declined, the total number of deaths continued to rise. This trend was accompanied by variations across sociodemographic groups and cancer types, particularly gastrointestinal cancers. Urgent efforts are needed both globally and at regional levels to address the burden of alcohol-attributable cancers.
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    An artificial intelligence-generated model predicts 90-day survival in alcohol-associated hepatitis: A global cohort study
    (2024) Dunn, Winston; Li, Yanming; Singal, Ashwani K.; Simonetto, Douglas A.; Díaz Piga, Luis Antonio; Idalsoaga Ferrer, Francisco Javier; Ayares, Gustavo; Arnold Alvaréz, Jorge Ignacio; Ayala-Valverde, Maria; Perez, Diego; Gomez, Jaime; Escarate, Rodrigo; Fuentes López, Eduardo; Ramirez-Cadiz, Carolina; Morales-Arraez, Dalia; Zhang, Wei; Qian, Steve; Ahn, Joseph C.; Buryska, Seth; Mehta, Heer; Dunn, Nicholas; Waleed, Muhammad; Stefanescu, Horia; Bumbu, Andreea; Horhat, Adelina; Attar, Bashar; Agrawal, Rohit; Cabezas, Joaquin; Echavaria, Victor; Cuyas, Berta; Poca, Maria; Soriano, German; Sarin, Shiv K.; Maiwall, Rakhi; Jalal, Prasun K.; Higuera-de-la-Tijera, Fatima; Kulkarni, Anand V.; Rao, P. Nagaraja; Guerra-Salazar, Patricia; Skladany, Lubomir; Kubanek, Natalia; Prado, Veronica; Clemente-Sanchez, Ana; Rincon, Diego; Haider, Tehseen; Chacko, Kristina R.; Romero, Gustavo A.; Pollarsky, Florencia D.; Restrepo, Juan C.; Toro, Luis G.; Yaquich, Pamela; Mendizabal, Manuel; Garrido, Maria L.; Marciano, Sebastian; Dirchwolf, Melisa; Vargas, Victor; Jimenez, Cesar; Hudson, David; Garcia-Tsao, Guadalupe; Ortiz, Guillermo; Abraldes, Juan G.; Kamath, Patrick S.; Arrese, Marco; Shah, Vijay H.; Bataller, Ramon; Arab, Juan P.
    Background and Aims: Alcohol-associated hepatitis (AH) poses significant short-term mortality. Existing prognostic models lack precision for 90-day mortality. Utilizing artificial intelligence in a global cohort, we sought to derive and validate an enhanced prognostic model. Approach and Results: The Global AlcHep initiative, a retrospective study across 23 centers in 12 countries, enrolled patients with AH per National Institute for Alcohol Abuse and Alcoholism criteria. Centers were partitioned into derivation (11 centers, 860 patients) and validation cohorts (12 centers, 859 patients). Focusing on 30 and 90-day postadmission mortality, 3 artificial intelligence algorithms (Random Forest, Gradient Boosting Machines, and eXtreme Gradient Boosting) informed an ensemble model, subsequently refined through Bayesian updating, integrating the derivation cohort's average 90-day mortality with each center's approximate mortality rate to produce posttest probabilities. The ALCoholic Hepatitis Artificial INtelligence Ensemble score integrated age, gender, cirrhosis, and 9 laboratory values, with center-specific mortality rates. Mortality was 18.7% (30 d) and 27.9% (90 d) in the derivation cohort versus 21.7% and 32.5% in the validation cohort. Validation cohort 30 and 90-day AUCs were 0.811 (0.779-0.844) and 0.799 (0.769-0.830), significantly surpassing legacy models like Maddrey's Discriminant Function, Model for End-Stage Liver Disease variations, age-serum bilirubin-international normalized ratio-serum Creatinine score, Glasgow, and modified Glasgow Scores (p < 0.001). ALCoholic Hepatitis Artificial INtelligence Ensemble score also showcased superior calibration against MELD and its variants. Steroid use improved 30-day survival for those with an ALCoholic Hepatitis Artificial INtelligence Ensemble score > 0.20 in both derivation and validation cohorts. Conclusions: Harnessing artificial intelligence within a global consortium, we pioneered a scoring system excelling over traditional models for 30 and 90-day AH mortality predictions. Beneficial for clinical trials, steroid therapy, and transplant indications, it's accessible at: https://aihepatology.shinyapps.io/ALCHAIN/.
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    Baveno VI and Expanded Baveno VI criteria successfully predicts the absence of high-risk gastro-oesophageal varices in a Chilean cohort
    (2020) Gaete Celis, María Isabel; Díaz Piga, Luis Antonio; Arenas Fajardo, Cristian Alexis; Gonzalez, K.; Cattaneo, M.; Soza, Alejandro; Arrese, Marco; Barrera Martínez, Francisco; Arab Verdugo, Juan Pablo; Benítez, Carlos; Fuster, F.; Henriquez, R.
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    Burnout en médicos residentes de especialidades y subespecialidades: estudio de prevalencia y variables asociadas en un centro universitario
    (2017) Díaz Piga, Luis Antonio; Arab Verdugo, Juan Pablo; Núñez Palma, Carolina Verónica; Robles García, Camila; Bitrán Carreño, Marcela; Nitsche Royo, María Pía; Riquelme Pérez, Arnoldo; González Tugas, Matías; Hoyl Moreno, María Trinidad; Lopetegui Lazo, Marcelo; Torres Lisboa, Patricio; Véliz Lagos, Daniela
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    Clinical trial design, biomarkers and end points in metabolic and alcohol-related liver disease
    (2025) Díaz Piga, Luis Antonio; Thiele, Maja; Louvet, Alexandre; Lee, Brian P.; Ajmera, Veeral; Tavaglione, Federica; Hsu, Cynthia L.; Huang, Daniel Q.; Pose, Elisa; Bataller, Ramon; McClain, Craig; Mellinger, Jessica; Tincopa, Monica; Mitchell, Mack C.; Ratziu, Vlad; Rinella, Mary E.; Sarin, Shiv K.; Shah, Vijay H.; Szabo, Gyongyi; Wong, Vincent Wai-Sun; Bansal, Meena B.; Leggio, Lorenzo; Kamath, Patrick S.; Krag, Aleksander; Sanyal, Arun J.; Arrese, Marco; Arab Verdugo, Juan Pablo; Anstee, Quentin M.; Mathurin, Philippe; Loomba, Rohit
    Metabolic and alcohol-related liver disease (MetALD) is a newly defined entity within the spectrum of steatotic liver disease, characterized by the interplay of cardiometabolic risk factors and alcohol consumption. The evolving epidemiology and complex pathophysiology of MetALD present unique challenges and opportunities for clinical trial design. Inclusion criteria should require simultaneous evidence of metabolic dysfunction (at least two cardiometabolic features) and verified quantifiable alcohol exposure recorded over the preceding 3–6 months. Traditional histological end points are limited by invasiveness, sampling error and interpretative variability. Thus, imaging modalities, serum-based fibrosis biomarkers and quantitative measures of alcohol intake are gaining relevance as non-invasive, reproducible and patient-centric end points aiming to improve trial feasibility. Furthermore, incorporating alcohol biomarkers, stratifying patients by metabolic risk factor burden, and using adaptive designs of trials might enhance the precision and generalizability of MetALD clinical trials. Although uncertainties remain regarding optimal patient selection criteria, event rates and the dynamic interplay between metabolic dysfunction and alcohol intake, ongoing research efforts aim to refine diagnostic criteria, standardize methodologies and validate novel end points. These advances will ultimately accelerate drug development, improve trial efficiency and foster interventions to treat MetALD.
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    Clinical Trial to Assess the Safety and Tolerability of Anti-IL 23 Monoclonal Antibody Guselkumab in Patients With Alcohol-Associated Liver Disease
    (2025) Díaz Piga, Luis Antonio; Morris, Sheldon; Dave, Shravan; Kim, Susy M.; Sarik, Wathnita; Richards, Lisa; Madamba, Egbert; Bettencourt, Ricki; Fulinara, Christian; Pham, Thuy; Miller, Grant; Carvalho-Gontijo Weber, Raquel; Momper, Jeremiah D.; He, Feng; Jain, Sonia; Jamieson, Catriona; Kisseleva, Tatiana; Brenner, David; Loomba, Rohit
    BackgroundThere are no FDA-approved therapies for alcohol-associated liver disease (ALD). Preclinical studies indicate that blocking IL-23/IL-17 signalling may reverse liver injury. Guselkumab, an IL-23-specific antibody approved for psoriasis, may be beneficial for ALD. AimsWe aimed to assess the safety and tolerability of guselkumab in patients with ALD. MethodsThis phase-1 dose-escalation study included patients with >= 2 DSM-5 criteria for alcohol use disorder, significant steatosis (MRI-PDFF >= 8%) and MRE < 3.63 kPa (to exclude advanced disease). Guselkumab was given subcutaneously on Days 1 and 29 in 30, 70 or 100 mg dose cohorts. Primary endpoints were adverse events (AEs) and dose-limiting toxicity. ResultsWe enrolled 13 patients (three 30 mg, three 70 mg, and seven 100 mg). Eleven completed the study and two early discontinued in the 100 mg group. Of them, 77% were men, and the median age was 53 [IQR 49-61] years. The median MRI-PDFF and MRE were 18.4% [IQR 8.4%-34.0%] and 2.5 [2.2-2.6] kPa, respectively. The most frequent AEs were hyperuricemia (13%, mild only) and elevated lipase (11%, mild and moderate). There were no serious adverse events or significant variations in liver enzymes. There was a suppression of peripheral interleukin (IL)-17, IL-23, IL-1b and TNF-alpha in the 70 and 100 mg groups, and a significant decrease in alcohol consumption over time (AUDIT-C: 6 [3-7] vs. 5 [1-6], p = 0.023). Conclusions Guselkumab is safe in doses up to 100 mg and may reduce inflammation markers in ALD. These findings support further phase 2 studies to evaluate the efficacy of guselkumab in ALD, particularly in patients with severe phenotypes.
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    Colangiopancreatografía retrógrada endoscópica con papilotomía de urgencia versus tratamiento conservador en pancreatitis aguda grave por cálculos biliares (APEC trial): un estudio aleatorizado multicéntrico
    (2021) Ruíz-Esquide Soto, Magdalena; Reyes Pérez, Catalina; Rodríguez Gutiérrez, Javier Ignacio; Díaz Piga, Luis Antonio; Riquelme Pérez, Arnoldo; Pimentel Muller, Fernando
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    Comparison Between Dynamic Models for Predicting Response to Corticosteroids in Alcohol-Associated Hepatitis: A Global Cohort Study
    (WILEY, 2025) Idalsoaga Ferrer, Francisco Javier; Díaz Piga, Luis Antonio; Guizzetti, Leonardo; Dunn, Winston; Mehta, Heer; Arnold, Jorge; Ayares Campos, Gustavo Ignacio; Mortuza, Rokhsana; Mahli, Gurpreet; Islam, Alvi H.; Sarin, Shiv K.; Maiwall, Rakhi; Zhang, Wei; Qian, Steve; Simonetto, Douglas; Singal, Ashwani K.; Elfeki, Mohamed A.; Ramirez-Cadiz, Carolina; Cabezas, Joaquin; Echavarria, Victor; Cots, Meritxell Ventura; La Tijera, Maria Fatima Higuera-De; Abraldes, Juan G.; Al-Karaghouli, Mustafa; Jalal, Prasun K.; Ali Ibrahim, Mohamad; Garcia-Tsao, Guadalupe; Goyes, Daniela; Skladany, Lubomir; Havaj, Daniel J.; Sulejova, Karolina; Selcanova, Svetlana Adamcova; Rincon, Diego; Shah, Vijay H.; Kamath, Patrick S.; Arrese, Marco; Bataller, Ramon; Arab, Juan Pablo
    Several dynamic models predict mortality and corticosteroid response in alcohol-associated hepatitis (AH), yet no consensus exists on the most effective model. This study aimed to assess predictive models for corticosteroid response and short-term mortality in severe AH within a global cohort. We conducted a multi-national study of patients with severe AH treated with corticosteroids for at least 7 days, enrolled between 2009 and 2019. Dynamic models-Lille-4, Lille-7, trajectory of serum bilirubin (TSB), and neutrophil-to-lymphocyte ratio (NLR)-were used to estimate 30- and 90-day mortality. Lille-7 demonstrated the highest accuracy for both 30- and 90-day mortality.
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    Experiencia de educación continua en línea en gastroenterología para médicos no especialistas
    (2019) Isbej Esposito, Lorena Pilar; Uribe Monasterio, Javier Andrés; Carrasco, Olga; Villarroel, Isaac; Pizarro Rojas, Margarita Alicia; Jirón, María Isabel; Sanhueza, Edgar; Álvarez Lobos, Manuel; Hernández Rocha, Cristian Antonio; Rollán, Antonio; Monsalve Valenzuela, Ximena Bernardita; Díaz Piga, Luis Antonio; Cerda, María Alejandra; Kramer, Tomás; Munizaga, Fernando; Riquelme Pérez, Arnoldo
    Background: Continuing education is essential for health professions and online courses can be a good way for professional development. Aim: To describe the experience with online courses for continuing education in hepatology and gastroenterology and to analyze their educational impact. Material and Methods: A three years’ experience in courses on liver diseases and digestive tract is described. Their curricular design, methodology, and the educational impact was analyzed using the four levels of the Kirkpatrick’s model. Results: On average, there were 321 students per course (2015-2017). 94% were Chilean and 6% from abroad (20 countries). In the educational impact analysis, in level 1 “reaction”: 93% said that the course fulfilled their expectations and 92% would recommend it. In level 2 “learning”: 42% approved the courses. Level 3 “behavior” was not evaluated and level 4 “organizational change” highlighted that the traditional face-to-face continuing education model of Chilean Gastroenterology Society (SChG) changed to full distance model in these three courses, with 1284 students from South America, Asia and Europe, in a 3-years-period. Additionally, these programs were included in the Medical Society of Santiago (SMS) continuing education agenda. Conclusions: The alliance between the SMS and the SChG generated on line courses that meet the educational needs of physicians and medical students, with excellent results and student perception.
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    Follow-up of gallbladder polyps in a high-risk population of gallbladder cancer: a cohort study and multivariate survival competing risk analysis
    (Elsevier B.V., 2021) Candia Balboa, Roberto Andrés; Viñuela Morales, Macarena Rocío; Chahuán Abde, Javier Nicolás; Díaz Piga, Luis Antonio; Gándara, Vicente; Errázuriz Gastellu, Pedro; Bustamante Herrera, Luis Felipe Alberto; Villalón Friedrich, Alejandro Andrés; Huete Garín, Alvaro; Crovari Eulufi, Fernando; Briceño Valenzuela, Eduardo Andrés
    The risk of neoplasia in gallbladder polyps seems to be low, but the evidence from populations at high-risk of gallbladder cancer is limited. We aimed to estimate the risk and to identify the factors associated with neoplastic polyps in a high-risk Hispanic population. Methods: A retrospective cohort was recruited between January 2010 and December 2019 at a Chilean university center. Multivariate survival analyses were conducted. Fine–Gray models were fitted to account for competing risks. Covariate adjustment was conducted using propensity scores. The main outcome was the development of gallbladder adenomas or adenocarcinoma. Results: Overall, 748 patients were included, 59.6% underwent cholecystectomy. The median follow-up of patients not subjected to cholecystectomy was 54.7 months (12–128.6 months). Seventeen patients (2.27%) developed the outcome. After adjustment by age, sex, intralesional blood flow, lithiasis and gallbladder wall thickening, only polyp size (≥10 mm, adjusted-HR: 15.01, 95%CI: 5.4–48.2) and number of polyps (≥3 polyps, adjusted-HR: 0.11, 95%CI: 0.01–0.55) were associated with neoplasia. Conclusion: In a Hispanic population at high-risk for gallbladder cancer, gallbladder polyps seem to have a low risk of neoplasia. Polyp size was the main risk factor, while having multiple polyps was associated with an underlying benign condition.
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    Global epidemiology of alcohol-related liver disease, liver cancer, and alcohol use disorder, 2000–2021
    (2025) Danpanichkul, Pojsakorn; Díaz Piga, Luis Antonio; Suparan, Kanokphong; Tothanarungroj, Primrose; Sirimangklanurak, Supapitch; Auttapracha, Thanida; Blaney, Hanna L.; Sukphutanan, Banthoon; Pang, Yanfang; Kongarin, Siwanart; Idalsoaga, Francisco; Fuentes-López, Eduardo; Leggio, Lorenzo; Noureddin, Mazen; White, Trenton M.; Louvet, Alexandre; Mathurin, Philippe; Loomba, Rohit; Kamath, Patrick S.; Rehm, Jürgen; Lazarus, Jeffrey V.; Wijarnpreecha, Karn; Arab Verdugo, Juan Pablo
    Background/Aims Alcohol represents a leading burden of disease worldwide, including alcohol use disorder (AUD) and alcohol-related liver disease (ALD). We aim to assess the global burden of AUD, ALD, and alcohol-attributable primary liver cancer between 2000–2021. Methods We registered the global and regional trends of AUD, ALD, and alcohol-related liver cancer using data from the Global Burden of Disease 2021 Study, the largest and most up-to-date global epidemiology database. We estimated the annual percent change (APC) and its 95% confidence interval (CI) to assess changes in age-standardized rates over time. Results In 2021, there were 111.12 million cases of AUD, 3.02 million cases of ALD, and 132,030 cases of alcohol-attributable primary liver cancer. Between 2000 and 2021, there was a 14.66% increase in AUD, a 38.68% increase in ALD, and a 94.12% increase in alcohol-attributable primary liver cancer prevalence. While the age-standardized prevalence rate for liver cancer from alcohol increased (APC 0.59%; 95% confidence interval [CI] 0.52 to 0.67%) over these years, it decreased for ALD (APC –0.71%; 95% CI –0.75 to –0.67%) and AUD (APC –0.90%; 95% CI –0.94 to –0.86%). There was significant variation by region, socioeconomic development level, and sex. During the last years (2019–2021), the prevalence, incidence, and death of ALD increased to a greater extent in females. Conclusions Given the high burden of AUD, ALD, and alcohol-attributable primary liver cancer, urgent measures are needed to prevent them at both global and national levels.
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    Inherited Genetic Risk of Liver Fibrosis in Lean Versus Nonlean Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD)
    (John Wiley & Sons Ltd., 2025) Tesfai, Kaleb; Díaz Piga, Luis Antonio; Arab, Juan Pablo; Arrese, Marco; Idalsoaga, Francisco; Ayares, Gustavo; Agrawal, Saaket; Barreyro, Fernando Javier; Gadano, Adrian; Marciano, Sebastián; Martínez Morales, Jorge; Villela‐Nogueira, Cristiane; Leite, Nathalie; Salles, Gil; Regina Cardoso, Claudia; Alves Couto, Claudia; Theodoro, Rafael; Monteiro. Mísia Joyner de Sousa Dias; Oliveira, Claudia P.; Pessoa, Mario G.; Alvares‐da‐Silva, Mario Reis; Huang, Daniel Q.; Madamba, Egbert; Singh, Seema; Lokanadham, Snigdha; Bettencourt, Ricki; Richards, Lisa M.; Khera, Amit V.; Loomba, Rohit; Ajmera, Veeral
    Introduction Previous studies have revealed conflicting results regarding liver fibrosis risk in lean metabolic dysfunction–associated steatotic liver disease (MASLD). We aimed to compare the risk of significant fibrosis in lean versus nonlean MASLD and identify fibrosis-associated factors in lean MASLD. Methods The study was a cross-sectional analysis of prospectively enrolled adults with MASLD. Individuals with lean MASLD were age- and sex-matched with nonlean MASLD. Fibrosis assessment included vibration-controlled transient elastography, magnetic resonance elastography and liver biopsy. A genetic risk score (GRS), summating the effect alleles of PNPLA3 and TM6SF2 minus the protective HSD17B13 genotype, was estimated to consider inherited genetic risk across BMI categories. Results were validated in an external Latin American cohort.ResultsThe mean ( SD) age of 312 included participants with MASLD was 58.3  11.6 years and 69.2% were female. 44 (14.1%) individuals were lean, 90 (28.9%) were overweight, 90 (28.9%) had class I obesity and 88 (28.1%) had class II or greater obesity. The prevalence of significant fibrosis was 27.3% in lean and 31.1% in nonlean (p = 0.653). Individuals with a high GRS had a higher prevalence of significant fibrosis compared to patients with low GRS (36.5% vs. 25.2%, p = 0.043) and the prevalence of significant fibrosis was similar in lean and nonlean patients with high GRS (31.3% vs. 37.1%, p = 0.645). The Latin American cohort exhibited similar results. Conclusions The prevalence of significant fibrosis and the effect of GRS were similar in lean and nonlean MASLD, highlighting that lean MASLD patients may have a comparable risk to overweight and obese MASLD.
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    Inpatient Hepatology Consultation: A Practical Approach for Clinicians
    (2023) Díaz Piga, Luis Antonio; Pages, Josefina; Mainardi, Victoria; Mendizabal, Manuel
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    Latin American Association for the Study of the Liver (ALEH) guidance of preoperative care in liver transplantation: referral criteria, patient assessment, and waiting list management
    (2025) Mainardi, Victoria; Pages, Josefina; Menéndez, Josemaría; Zapata, Rodrigo; Díaz Piga, Luis Antonio; Marciano, Sebastián; Cairo, Fernando; Padilla-Machaca, Martin; Tenorio, Laura; Urzúa, Álvaro; Navarro, Lucía; Domínguez, Nicolás; Coste, Pablo; Mendizábal, Manuel; Martínez, Jorge; López, Sergio; Varón, Adriana; Alfeu de Medeiros Fleck, jr; Abad Gonzáles, Jhon; Restrepo, Juan Carlos; Codes, Liana; Lisboa Bittencourt, Paulo; Pérez Figueroa, Norma Marlene; Castro-Narro, Graciela; Terrabuio, Débora Raquel B.; Pessoa, Mário Guimarães; Girala, Marcos; Schiavon, Leonardo Lucca; Aguilera, Edgard; Valenzuela Aguilera, Kenia; Samada, Marcia; Gerona, Solange; Villamil, Alejandra
    Liver transplantation (LT) is the standard of care therapy for patients with decompensated cirrhosis, early-stage hepatocellular carcinoma, acute liver failure, and other expanding indications. Latin America is a highly heterogeneous region characterized by an uneven distribution of socio-economic conditions and irregular access to health resources, and consequently LT activity varies across it. This current guidance of preoperative care in LT represents a collaborative effort to assess and standardize preoperative evaluation of liver transplant candidates in Latin America. It is the first position paper of the special interest group on LT of the Latin American Association for the Study of the Liver (ALEH), which draws evidence-based comprehensive recommendations regarding who to refer, the LT assessment and how to manage the patient on the waiting list, taking into consideration their applicability in Latin America.
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    Letter: Optimising public health policies to combat alcohol-associated liver disease in youth—Authors' reply
    (2024) Danpanichkul, Pojsakorn; Tothanarungroj, Primrose; Díaz Piga, Luis Antonio; Arab Verdugo, Juan Pablo; Liangpunsakul, Suthat; Wijarnpreecha, Karn
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    Letter: Predictors of Corticosteroid Response in Alcohol-Related Hepatitis-Authors' Reply
    (2025) Idalsoaga Ferrer, Francisco Javier; Díaz Piga, Luis Antonio; Bataller, Ramon; Arab Verdugo, Juan Pablo