According to the World Health Organization, approximately 20 million people worldwide are infected annually with the hepatitis E virus (HEV). There are four main genotypes of HEV. Genotype 1 and genotype 2 are common in developing countries and are transmitted by contaminated water from a fecal–oral route. Genotype 3 and genotype 4 are common in developed countries and can lead to occasional transmission to humans via undercooked meat. Hepatitis E virus 1 and HEV3 can lead to fulminant hepatitis, and HEV3 can lead to chronic hepatitis and cirrhosis in immunocompromised patients. The majority of patients with HEV infection are asymptomatic and usually have spontaneous viral clearance without treatment. However, infection in immunocompromised individuals can lead to chronic HEV infection. Both acute and chronic HEV infections can have extrahepatic manifestations. No specific treatment is required for acute HEV infection, no treatment has been approved in chronic infection, and no HEV vaccine has been approved by the (United States) Food and Drug Administration. This review focuses on the molecular virology (HEV life cycle, genotypes, model systems, zoonosis), pathogenesis, clinical manifestation, and treatment of chronic HEV infection, especially in immunocompromised patients, to provide clinicians a better understanding of the global distribution of these infections and the significant effect they can have on immunocompromised patients.

Gallstones commonly develop after Roux-en-Y gastric bypass and other bariatric surgery; however, incidence of gallstone development after SG has not been adequately studied. We conducted a retrospective cohort study of patients who underwent SG at two institutions from January 1, 2011 to December 31, 2012. Patients with previous cholecystectomy, preexisting gallstones, gallbladder polyps, or the absence of preoperative abdominal imaging were excluded. Follow-up abdominal ultrasonography was performed once the patients achieved 80-lb weight loss, became symptomatic, or reached one-year post-surgery. The incidence of gallstones and symptomatic gallstones and/or bile sludge was calculated. Different parameters of early and late postoperative weight loss were compared between the patients who developed gallstones and those who did not. During the study period, 253 underwent laparoscopic sleeve gastrectomy. Ultimately, 96 patients met inclusion criteria and were evaluated. The incidence of gallstone formation was 47.9% (46/96), and the incidence of symptomatic gallstones was 22.9% (22/96). None of the weight loss parameters during the early and late postoperative period were significantly different between the patients who developed gallstones and those who did not. Gallstones are a common complication after rapid weight loss from SG. Our data suggest that gallstone formation during the weight loss period is not associated with amount or rate of weight loss both during the early or late postoperative period.

Background: The study compared the readability, grade level, understandability, actionability, and accuracy of standard patient educational material against artificial intelligence chatbot-derived patient educational material regarding cirrhosis. Methods: An identical standardized phrase was used to generate patient educational materials on cirrhosis from 4 large language model-derived chatbots (ChatGPT, DocsGPT, Google Bard, and Bing Chat), and the outputs were compared against a pre-existing human-derived educational material (Epic). Objective scores for readability and grade level were determined using Flesch-Kincaid and Simple Measure of Gobbledygook scoring systems. 14 patients/caregivers and 8 transplant hepatologists were blinded and independently scored the materials on understandability and actionability and indicated whether they believed the material was human or artificial intelligence-generated. Understandability and actionability were determined using the Patient Education Materials Assessment Tool for Printable Materials. Transplant hepatologists also provided medical accuracy scores. Results: Most educational materials scored similarly in readability and grade level but were above the desired sixth-grade reading level. All educational materials were deemed understandable by both groups, while only the human-derived educational material (Epic) was considered actionable by both groups. No significant difference in perceived actionability or understandability among the educational materials was identified. Both groups poorly identified which materials were human-derived versus artificial intelligence-derived. Conclusions: Chatbot-derived patient educational materials have comparable readability, grade level, understandability, and accuracy to human-derived materials. Readability, grade level, and actionability may be appropriate targets for improvement across educational materials on cirrhosis. Chatbot-derived patient educational materials show promise, and further studies should assess their usefulness in clinical practice. Export

Background and Aim: Bleeding from gastric varices is a catastrophic event and poses difficulty in management. The efficacy and safety of cyanoacrylate injection remain unclear. We performed a systematic review and meta‐analysis to evaluate the effect of endoscopic cyanoacrylate injection in the management of gastric varices.Methods: We conducted a comprehensive search of MEDLINE, Embase, Web of Science, Scopus databases, and Cochrane Database of Systematic Reviews through November 2020 and manually reviewed the literature. Trial‐specific risk ratios (RRs) were estimated and pooled using random‐effect model meta‐analysis.Results: We included seven randomized controlled trials (six for secondary prophylaxis and one for primary prophylaxis) at low risk of bias in which 126 deaths were reported among 583 patients with gastric varices. All studies reported the use of N‐butyl‐2‐cyanoacrylate glue. Cyanoacrylate use was associated with significantly lower all‐cause mortality (RR, 0.59; 95% confidence interval [CI], 0.36–0.98; I² = 41%) and rebleeding rate after hemostasis (RR, 0.49; 95% CI, 0.35–0.68, I² = 0%) compared with any other treatment approach not involving cyanoacrylate. When cyanoacrylate was compared with each individual treatment approach (propranolol only, band ligation, sclerotherapy with alcohol or ethanolamine), data comprised sparse limited comparative conclusions. The use of cyanoacrylate injection was not associated with an increase in serious adverse events. The quality of evidence is moderate, graded down due to the small number of events and wide CIs.Conclusion: The use of endoscopic cyanoacrylate injection therapy for gastric varices may be associated with lower all‐cause mortality and better hemostasis compared with other therapies.