The edition · Gastroenterology & Hepatology
Lactulose cut falls in cirrhosis patients who had never had overt encephalopathy
LiveSMART found lactulose, with or without tele-delivered tai chi, reduced injurious and non-injurious falls in cirrhosis with portal hypertension; a multi-target blood test found three times as many early liver cancers as ultrasound but missed its specificity target; and family history raised colorectal cancer risk in IBD by the same absolute amount as in everyone else.
The edition in brief
In LiveSMART, 230 adults with cirrhosis and portal hypertension but no prior overt hepatic encephalopathy were randomised to lactulose or enhanced usual care for 12 weeks, then to TeleTai-Chi or exercise education. Lactulose users had fewer injurious falls (3.5% vs 8.5%) and non-injurious falls (15.0% vs 26.5%) with no excess adverse events (win ratio 2.3), and lactulose followed by tai chi beat usual care (win ratio 2.7). In the prospective ALTUS study of 2,293 people under HCC surveillance, a multi-target HCC blood test detected 66.7% of early-stage cancers against 22.2% for ultrasound, but its specificity of 81.8% narrowly missed the 82% target and fell well below ultrasound's 98.6%. A Swedish register study of 124,387 people with IBD found family history of colorectal cancer added a similar absolute risk as in matched comparators, greatest with two or more affected relatives, while early-onset family history added little. And a 2026 review puts chronic liver disease at over 1.5 billion people and 2.4 million deaths a year from cirrhosis and liver cancer, with alcohol and MASLD increasingly driving the burden.
A multi-target blood test detected early liver cancer three times as often as ultrasound, with more false positives
A multi-target blood test found far more early HCC than ultrasound, but with many more false positives; keep ultrasound surveillance for now and use CT or MRI when ultrasound views are inadequate.
In IBD, multiple affected relatives — not early-onset family history — added the most colorectal cancer risk
In IBD, ask how many first-degree relatives have had colorectal cancer — multiple affected relatives carried the largest extra risk.
Liver disease in 2026: 1.5 billion affected and 2.4 million deaths a year
Liver disease is increasingly driven by alcohol and metabolic dysfunction together — assess both, and find fibrosis early.
Covert hepatic encephalopathy: the cirrhosis patient who keeps falling
In cirrhosis, falls may be the first sign of covert hepatic encephalopathy — screen with a one-minute animal naming test.
Lactulose reduced falls in cirrhosis without prior overt encephalopathy; adding tele-tai chi helped further
Offer lactulose, plus balance exercise such as tai chi, to patients with cirrhosis and portal hypertension at risk of falls — even if they have never had overt encephalopathy.
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