Elliot Tapper

Elliot Tapper

@ebtapper.bsky.social

Hepatologist. #LiverSky / LiverLand. #MedSky. #cirrhosis Academic Chief of Hepatology at University of Michigan. Editor, Hepatology Communications. Kid Chauffeur

2.5K followers439 following502 posts

Elliot Tapper reposted

Rob Brierley
@robbrierley.bsky.social

New at The Lancet Public Health - Targeting alcohol use in high-risk population groups: a US microsimulation study of beverage-specific pricing policies www.thelancet.com/journals/lan... #alcohol #LiverSky #MedSky

thelancet.comTargeting alcohol use in high-risk population groups: a US microsimulation study of beverage-specific pricing policiesDisproportionate increases in retail prices for the cheapest beverages, beer and spirits, might lead to a greater decline in consumption among high-risk groups. Pricing policies could thus be used as ...

Elliot Tapper reposted

Pierre Gholam MD
@livermd.bsky.social

More #efruxifermin data this time in #MASH F2/F3 fibrosis @ 96 weeks ✅ Efficacy w/ dose dependent response (sort of) and NITs consistent ↔️ not crazy about mITT though it is mentioned no paired bx= non responders ⬇️ dose dependent reduction in bone mineral density #liversky

BaladoCritique : club de lecture médical@baladocritique.bsky.social

"Safety and efficacy of once-weekly efruxifermin versus placebo in metabolic dysfunction-associated steatohepatitis (HARMONY): 96-week results from a multicentre, randomised, double-blind, placebo-controlled, phase 2b trial. Publié ce jour dans @thelancet.com www.thelancet.com/journals/lan...

thelancet.comSafety and efficacy of once-weekly efruxifermin versus placebo in metabolic dysfunction-associated steatohepatitis (HARMONY): 96-week results from a multicentre, randomised, double-blind, placebo-cont...Efruxifermin resulted in greater improvements in fibrosis than placebo after 96 weeks, warranting further investigation in phase 3 trials.

Elliot Tapper reposted

josh farkas 💊
@pulmcrit.bsky.social

my take on procal: 1. zero role in ED, shouldn't be used to start ABX 2. CAN be super helpful in first 24 hr after ICU admit to help disprove sepsis in complex cases (eg aspiration pneumonitis or atelectasis masquerading as PNA). helps stop ABX & redirect. 3. not helpful in limiting ABX duration

REBEL EM@rebel-em.bsky.social

📉 Does trending biomarkers help stop antibiotics sooner safely in sepsis? 👀 More here: https://wp.me/pdrP8b-5mL #FOAMed #EMIMCC #MedSky

Elliot Tapper reposted

thecurbsiders.bsky.social
@thecurbsiders.bsky.social

🚨 High Yield Infographic Alert! Elevated PTT? Think bleeding history. 🟢 Non-bleeders: APS, contact factor deficiencies, heparin. 🔴 Bleeders: Hemophilias, vWD, factor VIII inhibitors. Not all prolonged PTTs mean bleeding risk. #MedEd #Hematology #FOAMed #ElevatedPTT #TheCurbsiders

Elliot Tapper reposted

Pierre Gholam MD
@livermd.bsky.social

Jaume Bosch No one, and I mean no one, made more seminal contributions to the measurement, interpretation & clinical applications of HVPG, the prognostic impact of CSPH and its rx. Truly in the pantheon of all time greatest hepatologists and a kind, generous person on top. RIP #liversky

Elliot Tapper
@ebtapper.bsky.social

There was great enthusiasm for “palliative care” when it was associated with longer survival in lung cancer However many of trials launched in its wake wrongly assumed that the consult itself was the active ingredient. For PC to help, the consultant needs proven tools to address the symptoms

Elliot Tapper
@ebtapper.bsky.social

Cardiovascular risk estimates miss the mark in people with MASH Heart disease is the most important risk for patients with MASH but the commonly used risk equations just don’t work New paper in the red journal @amcollegegastro.bsky.social journals.lww.com/ajg/abstract...

journals.lww.comCardiovascular risk assessment tools are insufficient for... : Official journal of the American College of Gastroenterology | ACGtudy sought to determine the accuracy of the FRS, PCE, and PREVENT in a real-world cohort of patients with MASLD. Methods: This analysis included US adults ≥ age 30 with MASLD in the TARGET-NASH st...
Elliot Tapper
@ebtapper.bsky.social

Hepatic encephalopathy is horrible It can present as disorientation and coma. But often causes poor quality of life, falls, and other trauma We want to prevent it. How can we predict it?

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Elliot Tapper
@ebtapper.bsky.social

Here's how I put it together And if you treat based on poor quality of life you can go back and ask "do you feel better" "are you falling less" and that helps a lot! (BABS - a score with bilirubin, albumin; OGTT - a physiological test / glutamine challenge)

Elliot Tapper
@ebtapper.bsky.social

Key points 1. Think about who is at risk for hepatic encephalopathy. 2. Don't anchor on a specific number. Make decisions with the impact on the patient in mind 3. Re-evaluate treatment strategies using patient reported outcomes like quality of life and falls

Elliot Tapper
@ebtapper.bsky.social

Hepatic encephalopathy is horrible It can present as disorientation and coma. But often causes poor quality of life, falls, and other trauma We want to prevent it. How can we predict it?

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Elliot Tapper
@ebtapper.bsky.social

So what can we do about it? Think about WHY people develop HE Disease severity, Sarcopenia, and so on Find the high risk group and then treat them? Studies are ongoing For now we need to make sure our decisions are based on something where we know the patient is benefiting.

Elliot Tapper
@ebtapper.bsky.social

Hepatic encephalopathy is horrible It can present as disorientation and coma. But often causes poor quality of life, falls, and other trauma We want to prevent it. How can we predict it?

View full thread
Elliot Tapper
@ebtapper.bsky.social

Second, a cutoff diagnostic of covert HE is just ... a number. And it is based on cognitive performance Cognitive performance is impacted by so many things! Cutoffs on one validated test from Wisconsin would classify CONTROLS as sick in Virginia! WHY????

Elliot Tapper
@ebtapper.bsky.social

It turns out that comorbidities, specific causes of liver disease, and demographics impact performance on cognitive testing The problem is that the cutoff for 'disease' is not based on the risk of overt HE. And it is based on selected patients without many comorbidities!

Elliot Tapper
@ebtapper.bsky.social

Hepatic encephalopathy is horrible It can present as disorientation and coma. But often causes poor quality of life, falls, and other trauma We want to prevent it. How can we predict it?

View full thread
Elliot Tapper
@ebtapper.bsky.social

Hepatic encephalopathy is horrible It can present as disorientation and coma. But often causes poor quality of life, falls, and other trauma We want to prevent it. How can we predict it?

Elliot Tapper
@ebtapper.bsky.social

Many people know about cognitive testing to predict hepatic encephalopathy The classic is a collection of timed paper-pencil tests. There are easier tools like the EncephalApp Stroop or animal naming test. You get a number and determine abnormal values by comparison to controls

Elliot Tapper reposted

Pedro Ochoa-Allemant
@ochoaallemantmd.bsky.social

🚨Check out our new study in @jhepatology.bsky.social ❗️ Using natural language processing to identify >350,000 patients with #steatosis, we demonstrated that cause-specific mortality differs between #MASLD #MetALD and #ALD www.journal-of-hepatology.eu/article/S016...

journal-of-hepatology.euCause-specific mortality in patients with steatotic liver disease in the United StatesCauses of death across steatotic liver disease (SLD) subtypes remain incompletely characterized in routine clinical practice. We aimed to quantify and compare cause-specific mortality in SLD.
Elliot Tapper
@ebtapper.bsky.social

There are two articles in NEJM this year that say naltrexone is 'contraindicated for cirrhosis'. This saddens me. It is not supported by an evidence. Alcohol is 'contraindicated for cirrhosis'. That is supported by evidence

Hanna Blaney, MD, MPH@blaneymd.medsky.social

An important message on naltrexone in patients with liver disease: ✅Naltrexone can help reduce alcohol use without harming the liver. 🚫Alcohol DOES harm the liver. We do not need any more barriers to treat patients with AUD➕ALD! @nejm.org @ebtapper.bsky.social www.nejm.org/doi/full/10....

Elliot Tapper reposted

Jonathan G. Stine, MD MSc, FACP
@jonathanstinemd.bsky.social

It was an absolute delight to contribute to this high-impact work with @tom-marjot.bsky.social and @mattarmstrong95.bsky.social in which we review all things #MASLD and #Muscle! If you're looking for holiday weekend reading, look no further: journals.lww.com/hepcomm/page... @ebtapper.bsky.social

journals.lww.comSkeletal muscle and MASLD: Mechanistic and clinical insights : Hepatology Communications, which all converge on the liver to drive disease progression and adverse patient outcomes. This review explores the mechanistic links between skeletal muscle and MASLD, including the role of abnorma...