This study aims to investigate the efficacy and safety of rifaximin in cirrhosis patients with hepatic encephalopathy. A total of 57 Japanese patients treated with rifaximin between November 2016 and December 2017 were included in this retrospective study. The coma scale scores of the Inuyama classification were significantly better at 4, 8, and 15 days than at baseline. The median blood concentration of ammonia decreased from 148 (107-189) μg/dl at baseline to 99 (71-142) and 123 (80-168) μg/dl at 1 and 3 months (P = 0.048 and P = 0.236), respectively. The 3-month, 6-month, and 1-year cumulative probabilities of recurrent hepatic encephalopathy were 24.6% [95% confidence interval (CI) 14.3-36.4], 40.8% (95% CI 27.8-53.3), and 42.7% (95% CI 29.4-53.3), respectively. Diarrhea and abdominal pain of grade 1were observed in one (1.8%) and two (3.5%) patients, respectively. Rifaximin treatment could be efficacious and safe for Japanese patients with hepatic encephalopathy.

We report a case of acute hepatitis E caused by contaminated blood products in a patient who had experienced hepatitis E virus (HEV) infection in the past. A 74-year-old man received blood transfusion for aortic valve replacement. Although HEV RNA was negative, anti-HEV IgG was positive before blood transfusion, indicating that he had experienced HEV infection in the past. Liver dysfunction was noted 2 months after the blood transfusion. Serological data revealed that anti-HEV IgA and HEV RNA were positive and that the genotype of HEV was 3b. In addition, HEV RNA was detected in a residual sample of the transfused blood. Because the partial nucleotide sequence of HEV isolated from the patient was almost identical to that of the transfused blood, we diagnosed him with acute hepatitis E caused by HEV-contaminated blood. Therefore, further screening is warranted to prevent hepatitis E caused by blood transfusion.

Although hepatic abscesses caused by Edwardsiella tarda are rare, they can become severe if there is an underlying disease. Therefore, they should be observed with caution. A 79-year-old woman who had recovered from chronic hepatitis C and with a history of left hepatic lobectomy for intrahepatic stones was admitted to our hospital with chief complaints of chills and fever. Abdominal computed tomography revealed the presence of a 57-mm abscess at S5/8. Abdominal ultrasonography performed 6 days before admission did not indicate a liver abscess. Edwardsiella tarda was detected in blood culture samples that were collected upon admission. Administration of TAZ/PIPC was initiated, and percutaneous transhepatic abscess drainage was performed the day after admission. Edwardsiella tarda was also detected in the pus. In patients with underlying diseases, such as chronic liver disease after biliary tract reconstruction, E. tarda infection may be rapidly exacerbated, necessitating immediate intervention.

In this retrospective study, serial liver biopsy was performed to investigate the efficacy of sodium-glucose co-transporter-2 (SGLT2) inhibitor (SGLT2i) in patients with non-alcoholic steatohepatitis (NASH) complicated by type 2 diabetes mellitus. A total of three cases, wherein SGLT2i was introduced, were evaluated by examining liver histology obtained at three points, during pretreatment, 24 weeks after the start of the treatment, and 3 years or more after the start of the treatment. All of the three cases showed worsening condition upon physical examination. However, one of the three cases indicated worsening histological findings during the 3rd biopsy than at pretreatment, but the other two cases had maintained histological improvement. In conclusion, the long-term histological impacts of SGLT2i in patients with NASH showed various findings, regardless of worsening condition upon physical examination. Furthermore, large-scale prospective studies are needed to determine the long-term impact of SGLT2i on the histological features in patients with NASH.