Elliot Tapper

Hepatologist @michiganliver @vaannarbor; #cirrhosis; encephalopathy; frailty; quality improvement; father; husband. #livertwitter Co-EIC of @HepCommJournal

[Elliot Tapper @ebtapper]

@bocchi_pietro No way

In alc hep, there is no harm and probable benefit from NAC

Basically Everyone gives it in undifferentiated acute liver failure at least at first

[Elliot Tapper @ebtapper]

1/

WHAT the heck is GGT?

#tweetorial #livertwitter #medtwitter

[Hepatology Communications @HepCommJournal]

📑 🤖 #AI-generated draft hepatology e-consults show promise‼️

⭐️83% provided appropriate case-specific recommendations
⚠️ 10% contained misleading/incorrect
⚠️ 3.4% posed risk of severe harm
🚨Human oversight remains essential🚨
#OpenAccess @egnij

https://t.co/VnmTjLEKzi

[Elliot Tapper @ebtapper]

One day soon I will use SMART in the design of a survey study and look forward to that experience but for now I will stick with 1:1

[Elliot Tapper @ebtapper]

It is hard to replace the 1:1 RCT

There was - is there still? - enthusiasm for micro randomization & SMART in clinical research.

1. These designs get problematic if your proposed trial has a longer duration (at risk for censoring), especially if enrolling sick patients

[Elliot Tapper @ebtapper]

2. Power calculations are generally done based on the first randomization especially in cost-constrained environments

3. Conclusions involving the later randomizations are often murky and very difficult to communicate

[Hepatology Communications @HepCommJournal]

📑 Clinical outcomes in #MetALD compared with #ALD in patients referred for liver transplant evaluation❕
#OpenAccess #LiverX

https://t.co/Jba504AVnm

[Hepatology Communications @HepCommJournal]

📑 #Porphyrias: Pathophysiology and clinical management recommendations for hepatologists‼️
#OpenAccess #LiverX

https://t.co/jMfzSMzRLk

[Jen Lai @JenLaiLiverDoc]

1/ It's #MalnutritionAwarenessWeek. Malnutrition is common in cirrhosis, and we've known it for decades. What we haven't done is build it into routine care the way we did carvedilol and pHTN. We need to routinely screen for it and proactively manage it when present.

[Hepatology Communications @HepCommJournal]

📑 AI-assisted🤖, single-fiber digital pathology quantification of changes in liver fibrosis after bariatric surgery‼️
#LiverX #OpenAccess

https://t.co/mkvPeli74i

[Elliot Tapper @ebtapper]

I forgot about Jeremy - big blunder

@jlouissaint89 is an AE and he runs the social media

[Elliot Tapper @ebtapper]

The updated impact factor for @HepCommJournal is now 6.2, up 35% from the prior year

On the clinical side we have had the same crew of AEs from the start. Neehar, @IanARowe, @DoctorSharad, @BloomPringle, and @DrLChina

This year Lok went to hepatology and we welcomed @ponnivp

[Elliot Tapper @ebtapper]

I forgot about Jeremy - big blunder

@jlouissaint89 is an AE and he runs the social media

[Elliot Tapper @ebtapper]

The updated impact factor for @HepCommJournal is now 6.2, up 35% from the prior year

On the clinical side we have had the same crew of AEs from the start. Neehar, @IanARowe, @DoctorSharad, @BloomPringle, and @DrLChina

This year Lok went to hepatology and we welcomed @ponnivp

[Elliot Tapper @ebtapper]

@CardioNP Well very few people have seen that. It is exceedingly rare. Conversely, antibiotic liver failure is much more common and people still use augmentin or Bactrim. Acute liver failure also has nothing to do with mildly elevated ALT

Something special about statins

[Elliot Tapper @ebtapper]

Liverphobia? What’s the word for saying treatment should be stopped or mot prescribed when liver enzymes are elevated?

I ask because I see this all the time. Classic example is statins and it is probably one of the reasons why people with mash have more heart attacks.

[Elliot Tapper @ebtapper]

I once saw a patient with unstable schizophrenia after their antipsychotic was stopped because it raised the ALT.

We need to band together and stop this

[Elliot Tapper @ebtapper]

@ginorthshore @GI_Pearls @nourish @DCharabaty @PerelmansPearls @DrBloodandGuts @AmCollegeGastro @AmerGastroAssn That would be a good service

However what you received is very upsetting!

[Elliot Tapper @ebtapper]

@nickmmark @TheSGEM Most of those medicines are temporizing?

Lasix is my go to whereas the evidence for one time doses of lokelma or kayexalate are lacking (at least when I last looked).

I also try to use therapies which don’t carry a sodium load

I cause (and fix) a lot of potassium disorders

[Hepatology Communications @HepCommJournal]

📑 We use #albumin frequently in #cirrhosis, but how well does the evidence actually hold up? 🤔

This systematic review & meta-analysis examines albumin use across cirrhosis complications‼️
#LiverX #OpenAccess

https://t.co/s94sWCXr7X

[Hepatology Communications @HepCommJournal]

📑 Hepatitis B treatment response and factors associated with #HBV treatment success: A population-based study in Rwanda‼️
#LiverX #OpenAccess

https://t.co/RsK71UjRSB