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Advances in our understanding of hepatic fibrosis have provoked great excitement over the prospect of effective antifibrotic therapy. This Viewpoint looks at how far the field has advanced, what the remaining obstacles are, and whether antifibrotic therapy might soon become a clinical reality for patients with chronic liver disease.
Nutritional support is an established and routine part of patient management. Conventionally, enteral nutrition is preferred to parenteral nutrition, because studies have indicated that enteral nutrition causes fewer complications. In this Review, the author critically analyzes the available data that compare these administration routes, and suggests that the effect of hyperglycemia, energy intake and obesity are perhaps more important than the route of nutrition in determining outcome.
The authors of this Review discuss the increased risk of morbidity and mortality associated with surgery in patients with underlying liver disease, and describe the essential role that preoperative assessment has in these patients. The nature and severity of the underlying liver disease and the type of surgery being undertaken are all considered and guidelines for preoperative assessment provided.
Although the introduction of parenteral nutrition revolutionized the care of premature babies, long-term parenteral nutrition incurs the risk of life-threatening hepatic complications. The authors of this Review discuss the fundamentals of parenteral nutrition associated cholestasis, animal models of the disease, transporters crucial for bile acid homeostasis, and the molecular pathogenesis of this life-threatening condition.
