Conclusions: The majority of veterans are receiving EV screening, however only one-third are receiving EV screening per AASLD guidelines. Of these patients, the majority had been previously seen in a gastroenterology and hepatology clinic and median time from diagnosis to screening was a prompt 26 days. Our study highlights the importance of specialty clinic access as providers are otherwise relying on clinical cues (i.e. decompensation) to prompt referral for endoscopy. Disclosures: Norah Terrault – Advisory Committees or Review Panels: Eisai, Biotest; Consulting: BMS, Merck; Grant/Research Support: Eisai, Biotest, p38 inhibitors clinical trials Vertex, Gilead, AbbVie, Novartis, Merck The following people have nothing to disclose:
Varun Saxena, Jennifer A. Flem-ming, Hui Shen, Alexander Monto, Catherine Rongey Background: Physical exercise (PE) in cirrhosis is restricted due to sarcopenia, leg edema, ascites, and cardiopulmonary complications. A major concern regarding PE is the increase in hepatic venous pressure gradient (HVPG), as previously observed in two studies evaluating acute changes in hepatic hemodynamics. However, there are no studies evaluating the effect of chronic PE on HVPG. Aim: To evaluate the changes in HPVG in cirrhotic
patients undergoing a supervised physical training program. Material and methods: As part of a randomized, open label clinical trial, we included 23 cirrhotics (17 males), with 11 allocated to the exercise group (E= physical exercise + nutritional therapy), and 12 to control (C= nutritional therapy). Physical exercise program (PEP) consisted of 40-supervised sessions including stationary bicycle selleck kinase inhibitor and kine-siotherapy over 14 weeks, with a target heart rate of 60-80% the maximum predicted. All patients with varices were on beta-blockers. Clinical (leg cramps, hepatic encephalopathy) and biochemical (blood ammonia) data, HPVG, and treadmill stress test were assessed pre and post-intervention. Ammonias were collected before each treadmill test, after its completion, and at 11:00, 13:00, and 15:00 hrs.U Mann-Whitney and X2 were used as appropriate.Friedman test was performed for pre and post differences.
Results:Main etiology of cirrhosis was hepatitis C infection (30%). All patients were Child A/B check details (15/8), mean MELD was10±2.9. There were no significant differences in baseline demographic, clinical and biochemical characteristics between groups. Adherence to the PEP was >80% in all patients. Baseline HVPG (mmHg) median values were 14.5(11-18.5) and 11.5 (3.5-17.5); and final HVPG values were 11.5 (8.5-16.75) and 14 (9-22) for the E and C groups, respectively. This corresponded to a decrease in HVPG of -2.5 (-5.25 to 2) for the E group, and an increase of 4 (0.25 to 8)for the C group (p=0.007).There was no difference in the AUC for ammonia before and after the PEP, when E and C groups were compared: initial treadmill test (426 ± 183 and 488 ± 255 for E group, p=0.