Editor's Note: From June 5-8, 2024, the European Association for the Study of the Liver (EASL) Annual Meeting was held in Milan, Italy. Over 7,000 hepatology experts from around the world gathered for this academic event. On the first day, the conference focused on various fields including chronic hepatitis B, cirrhosis, and portal hypertension. Hepatology Digest invited two young experts from the Chinese University of Hong Kong, Professor Terry Yip and Dr. Jimmy Che-To Lai, to share their insights and experiences.Hepatology Digest: This year’s EASL conference is very exciting. Can you share some highlights from June 5th and any updates in your areas of interest?
Dr. Jimmy Lai: Thank you for inviting me to this interview. Yesterday’s schedule was indeed very packed. The morning started with a postgraduate course followed by a special session on vascular liver diseases, particularly focusing on cirrhosis, portal hypertension, and portal vein thrombosis. The sessions provided a comprehensive overview of the disease spectrum, with a focus on the use of special medications such as anticoagulants. We discussed the current knowledge on portal vein thrombosis and other complications related to portal hypertension in both cirrhotic and non-cirrhotic patients. One key question is whether the use of anticoagulants can improve clinical outcomes and survival rates for patients with compensated and decompensated cirrhosis. We need to determine if anticoagulants can have a positive effect and improve patient survival. Overall, I found the discussions very enlightening and gained a deeper understanding of cirrhosis and portal hypertension.
Professor Terry Yip: Yes, I think Jimmy has summarized the day very well. I attended a special session on controversies in the management of chronic hepatitis B. Professors Norah Terrault from the USA, George Papatheodoridis from Greece, and Lai Wei-hung from Hong Kong presented a comprehensive overview of the current evidence in treating chronic hepatitis B patients. Professor Norah Terrault summarized the current guidelines and future directions for managing chronic hepatitis B, highlighting that the new WHO guidelines have lowered the treatment initiation threshold, allowing patients with ALT levels above the upper limit of normal by 1-fold to be considered for treatment, which is a more relaxed standard compared to previous guidelines. This trend means more patients will receive treatment, which is a positive change. Professor George Papatheodoridis shared insights on combining interferon with new HBV treatment drugs. Despite interferon’s side effects, it may reappear as part of combination therapy in the future. Professor Lai Wei-hung discussed the challenges of stopping treatment and managing “gray area” patients who are not clearly defined by current clinical guidelines, making treatment and management more challenging. We look forward to the new guidelines from EASL and AASLD expected later this year, which will provide updated recommendations and possibly change treatment standards and the management of “gray area” patients.
Hepatology Digest: What have you focused on at this conference? Which studies left a deep impression on you?
Dr. Jimmy Lai: I focused on cirrhosis and portal hypertension. I saw many posters on acute and chronic liver failure, basic science, pathophysiology, and hepatorenal syndrome. These studies provide an important background for future clinical research. Another highlight is the Baveno criteria, especially Baveno VII. Some recommendations and evidence need strengthening, and we need more research to solidify these recommendations, such as the use of spleen stiffness measurement and whether these criteria apply to specific populations. These are questions that future research needs to answer.
Professor Terry Yip: I focused deeply on HBV research, especially studies on “gray area” patients. Understanding the natural history of these patients is crucial for understanding disease progression and developing risk stratification methods. In the poster area, I observed studies on the progression of “gray area” patients to hepatocellular carcinoma (HCC) or reversion to non-active carrier status. These insights help us identify high-risk patients likely to develop cirrhosis or HCC and those who may become inactive carriers. For “gray area” patients, understanding their natural history and progression patterns is essential for developing personalized treatment plans. Some patients may transition to an inactive carrier stage, while others may need timely therapeutic intervention. Thus, in-depth studies of these patient groups help us better manage and treat HBV patients.
Additionally, I noticed a significant amount of research on non-invasive diagnostic assessments for early screening of the general population in the field of metabolic-associated fatty liver disease (MAFLD), such as serum biomarker-dependent tests like the FIB-4 index. However, studies indicate that the accuracy of these assessments can be affected by various factors, such as the patient’s diabetes status or glycated hemoglobin (A1C) level. Therefore, further improvement of non-invasive diagnostic assessment methods is necessary. Researchers are exploring new methods, such as machine learning and artificial intelligence, which may significantly enhance MAFLD patient management, making treatment more precise and effective.
In summary, research in HBV and MAFLD is continuously advancing, especially in improving prediction accuracy and personalized treatment. These advancements help us better understand and treat these diseases, providing patients with better quality of life and health outcomes.
Hepatology Digest: How do you feel about attending this year’s EASL conference, and what are your takeaways?
Dr. Jimmy Lai: This conference has been very rewarding. The speakers combined old knowledge with the latest findings, providing a comprehensive learning experience. Additionally, the conference offered valuable opportunities for networking and exploring new concepts and ideas. I hope to leverage these collaborations in the future to advance the field and provide better clinical care for our patients.
Professor Terry Yip: The EASL conference always benefits me greatly. The quality of expert lectures, oral presentations, and posters is very high, providing important insights for future liver disease research and collaboration. Interacting with international researchers also provided valuable learning opportunities. As a young researcher, I highly cherish such opportunities and look forward to continuing to participate in such academic events in the future.
