Background: Remote patient monitoring (RPM) is an emerging focus in health care, and specialized programs may reduce medical costs, supplement in-office visits, and improve patient satisfaction. In this study, we describe the development, feasibility, and early outcomes of an RPM program for patients with decompensated cirrhosis. Methods: Forty-six patients were offered enrollment at the time of hospital discharge in the cirrhosis RPM program (CiRPM), of which 41 completed at least 30 days of monitoring. Participants were mailed remote monitoring equipment and a tablet to be used for patient-reported outcomes. Alerts were continuously monitored by virtual nursing staff who could perform targeted interventions. A cohort of historical controls (n = 74) was created for comparison using inverse probability of treatment weighting. Results: Patients were enrolled in the program for a mean of 83.9 days, with 28 (68%) completing the full 90-day program. Participants uploaded vital signs and responded to symptom-based questionnaires on 93% of the monitored days. On end-of-program surveys, over 75% of patients expressed satisfaction with the program. Gender, age, and MELD-Na were similar between CiRPM and weighted control groups. The 90-day readmission rate was 34% in CiRPM and 47% in weighted controls. In the CiRPM group, 12% of subjects had 2 or more admissions, compared to 37% in the weighted control group. Conclusion: This study demonstrates the feasibility of a cirrhosis-specific RPM program. Overall, patient satisfaction and utilization of the CiRPM was high. Future studies are needed to confirm the impact of RPM on the reduction of hospital readmissions in decompensated cirrhosis. Export

Sarcopenia is common in patients with liver disease and both sarcopenia and short telomeres are associated with mortality, however their relationship in patients with liver disease remains unknown. A cohort of 16,072 adults from the National Health and Nutrition Examination Survey from 1999 to 2006 was analyzed. Liver disease was defined by aminotransferases and classified into etiology-based categories. Sarcopenia was defined by dual-energy x-ray absorptiometry. All analyses were conducted separately on each multiple imputation data set and combined via Rubin’s rules. P-values for group comparisons were calculated by testing logistic regression parameter estimates. Cox proportional hazards regression was used for mortality analysis with mortality data available until 2015. Sarcopenia was present in 9.5% of patients with liver disease. Age, race, income, education, physical inactivity, and certain medical comorbidities were associated with sarcopenia. Patients with liver disease and sarcopenia had significantly shorter telomeres than patients with liver disease without sarcopenia when unadjusted for age. The interaction between telomere length and sarcopenia was significantly associated with all-cause mortality. The implications of telomere length on all-cause mortality in patients with liver disease varied by age and sarcopenia status. Shorter telomeres appear to be more highly associated with increased mortality in older patients without sarcopenia.

Cirrhosis is a prevalent condition affecting more than 100 million people globally and carrying significant morbidity and mortality related to the development of portal hypertension and hepatic decompensation. Current treatment is primarily targeted at identifying chronic liver disease early and preventing the progression of fibrosis by treating the underlying etiology of liver disease. Treatment options for patients with advanced fibrosis are limited, and the only drug class approved for the prevention of hepatic decompensation remains nonselective beta-blockers. There are several pharmacological therapies being developed in both preclinical and clinical trials to explore their efficacy in preventing first hepatic decompensation. Most studies evaluate primary endpoints reflective of disease severity and portal hypertension, such as changes in HVPG or fibrosis stage based on histology or imaging. While many drugs are being investigated, much work is still needed to identify treatment targets with effective outcomes to move the needle in the field of cirrhosis management. This narrative review will address the current state of cirrhosis therapies, including potential new therapeutic targets, and provide direction on future advancements that will improve our current treatment paradigm and lead to better outcomes for those burdened with cirrhosis.

Patients with inflammatory bowel disease (IBD) frequently ask their providers for nutritional or dietary recommendations; however, providers are limited in both time and knowledge to adequately address their questions. In this single-center study, we sought to improve provider experiences with nutrition counseling for patients seen in a dedicated IBD clinic. To understand the current state, providers, including gastroenterology fellows, attendings, and advanced practice providers were surveyed regarding their experiences with nutritional recommendations in a dedicated IBD clinic. Following the pre-intervention survey, we worked with registered dieticians on how to address key concerns and developed an informational handout based upon current guidelines. After displaying handouts in clinical workspaces for 5 weeks, providers were surveyed again to evaluate their response. All 22 respondents (100%) in the pre-intervention survey either agreed or strongly agreed that IBD patients have unique nutritional requirements. A majority (72%) strongly agreed that the clinic would benefit from more access to dieticians. Additionally, 41% of providers either strongly disagreed or disagreed that they had enough time to address nutritional concerns. Post-intervention, 57% of respondents (8/14) reported that they found the handouts helpful. A significant number of providers reported improvement in their comfort level discussing nutrition and dietary recommendations with IBD patients, with tmean Likert score increasing from 3.5 to 4.1 (P = .01). In this quality improvement study, we identified key issues preventing providers from addressing patient desire for nutritional counseling and developed a novel awareness campaign that significantly improved provider confidence in discussing nutritional recommendations with their IBD patients.