Anshuman Elhence

Bio: Anshuman Elhence is an academic researcher from AIIMS, New Delhi. The author has contributed to research in topics: Gastric antral vascular ectasia & Gastrointestinal bleeding. The author has an hindex of 1, co-authored 5 publications receiving 3 citations. Previous affiliations of Anshuman Elhence include All India Institute of Medical Sciences.

COVID-19 in patients with cirrhosis: understanding adverse impact.

Abstract: We read with great interest the article by Bajaj et al 1 comparing the outcomes of hospitalised patients with COVID-19+cirrhosis with that of patients with cirrhosis alone and COVID-19 alone. The authors found that the risk of mortality in patients with COVID-19+cirrhosis was not significantly higher than in patients with cirrhosis alone, though it was higher than patients with COVID-19 alone. The findings of the current study add to the existing understanding of the effects of COVID-19 in patients with cirrhosis;2–5 however, interpretation of such results must be mindful of two facts: first, the study subjects were not properly matched with regard to the severity of cirrhosis; and second, small and unbalanced sample size comparisons may lead to erroneous conclusions. Model for end-stage liver disease (MELD) score is a reliable marker of severity of liver disease and predictor of mortality in patients with cirrhosis. In this study, patients with COVID-19+cirrhosis had …

Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding

Abstract: Background/Objective There is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with COVID-19 amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. Methods In this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22 April to 22 July 2020, were included. Results The mean age of patients was 45.8±12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis-21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. Conclusion Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient’s condition, response to treatment, resources and the risks involved, on a case to case basis.

Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding

Abstract: Background /Objective: There is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with COVID-19 amid concerns about the risk of transmission during endoscopic procedures We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19 Methods In this retrospective analysis, 24 of 1342 (1 8%) patients with COVID-19, presenting with GI bleeding from 22 April to 22 July 2020, were included Results The mean age of patients was 45 8±12 7 years;17 (70 8%) were males;upper GI (UGI) bleeding: lower GI (LGI) 23:1 Twenty-two (91 6%) patients had evidence of cirrhosis- 21 presented with UGI bleeding while one had bleeding from hemorrhoids Two patients without cirrhosis were presumed to have non-variceal bleeding The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73 9%) and terlipressin in 4 (17 4%) patients All patients with UGI bleeding received proton pump inhibitors and antibiotics Packed red blood cells (PRBCs), fresh frozen plasma and platelets were transfused in 14 (60 9%), 3 (13 0%) and 3 (13 0%), respectively The median PRBCs transfused was 1 (0-3) unit(s) The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy At 5-day follow-up, none rebled or died Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge Three (12 5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay Conclusion Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient's condition, response to treatment, resources and the risks involved, on a case to case basis

Management of Portal Hypertension.

Abstract: Portal hypertension is the cause of the clinical complications associated with cirrhosis. The primary complications of portal hypertension are ascites, acute variceal bleed, and hepatic encephalopathy. Hepatic venous pressure gradient measurement remains the gold standard test for diagnosing cirrhosis-related portal hypertension. Hepatic venous pressure gradient more than 10 mmHg is associated with an increased risk of complications and is termed clinically significant portal hypertension (CSPH). Clinical, laboratory, and imaging methods can also aid in diagnosing CSPH non-invasively. Recently, deep learning methods have been demonstrated to diagnose CSPH effectively. The management of portal hypertension is always individualized and is dependent on the etiology, the availability of therapies, and the degree of portal hypertension complications. In this review, we discuss the diagnosis and management of cirrhosis-related portal hypertension in detail. Also, we highlight the history of portal hypertension and future research areas in portal hypertension.

Risk of New-Onset Liver Injuries Due to COVID-19 in Preexisting Hepatic Conditions—Review of the Literature

Abstract: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacted the world and caused the 2019 coronavirus disease (COVID-19) pandemic. The clinical manifestations of the virus can vary from patient to patient, depending on their respective immune system and comorbidities. SARS-CoV-2 can affect patients through two mechanisms: directly by targeting specific receptors or by systemic mechanisms. We reviewed data in the latest literature in order to discuss and determine the risk of new-onset liver injuries due to COVID-19 in preexisting hepatic conditions. The particular expression of angiotensin-converting enzyme 2 (ACE2) receptors is an additional risk factor for patients with liver disease. COVID-19 causes more severe forms in patients with non-alcoholic fatty liver disease (NAFLD), increases the risk of cirrhosis decompensation, and doubles the mortality for these patients. The coinfection SARS-CoV-2—viral hepatitis B or C might have different outcomes depending on the stage of the liver disease. Furthermore, the immunosuppressant treatment administered for COVID-19 might reactivate the hepatic virus. The high affinity of SARS-CoV-2 spike proteins for cholangiocytes results in a particular type of secondary sclerosing cholangitis. The impact of COVID-19 infection on chronic liver disease patients is significant, especially in cirrhosis, influencing the prognosis and outcome of these patients.