2017 · CGH · Podcast

GI Pearls – October 16 – November 10 2017 – Episode 12

Show Notes for October 16- November 10 – Episode 12

  1. A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: a multicentre randomised controlled trial  – GUT.
  2. Impact of preprocedure simethicone on adenoma detection rate during colonoscopy – Endoscopy
  3. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial – The Lancet – Gastro
  4. Modifiable factors associated with patient-reported pain during and after screening colonoscopy – Gut
  5. Accuracy and Safety of the Cytosponge for Asessment of Histologic Activity in EOE: Two center study – Am J Gastro
  6. Air Insufflation May Still be Ideal For Adenoma Detection – Am J Gastro
  7. Patients with Crohn’s Disease with High Body Mass Index Present More Frequent and Rapid Loss of Response to Infliximab – IBD journal
  8. Anesthesia Assistance in outpatient colonoscopy and risk of aspiration pneumonia, bowel perforation, and splenic injury. – Gastro
  9. Increased Risk for Mother-to-Infant Transmission of HCV Among Medicaid Recipience – Wisconsin – MMWR
  10. Upper gastrointestinal complications following ablation therapy for atrial fibrillation – NeuroGastro&Motility
  11. Hemorrhagic angiodysplasia of the digestive tract – GIE
  12. Colorectal cancer screening with the fecal immunochemical test in persons aged 30 to 49 years: focusing on the age for commencing screening – GIE
2017 · CGH · Podcast

GI Pearls – September 15-30 2017 – Episode 10

Show Notes for September 15-30, 2017  Episode 010
  1. Global Burden of Disease Study 2016 – Lancet
  2. Proton Pump Inhibitors Decrease Phlebotomy Need in HFE Hemochromatosis: Double-Blind Randomized Placebo-Controlled Trial – Gastro
  3. Influence of Age and Eosinophilic Esophagits on Esophageal Distensibility in a Pediatric cohort – Am J Gastro
  4. Long-Term CRC Incidence After Negative Colonoscopy in the State of Utah: Teh effect of Family History. – Am J Gastro
  5. Fecal Incontinence Is associated with Mortality Among Older Adults with Complex Needs – Am J Gastro
  6. Screening for Occult Cancer in Patients with Unprovoked Venous Thromboembolism – Annals of IM
  7. The Durability of Antireflux Surgery – JAMA
  8. Association of prophylactic endotracheal intubation in critically ill patients with upper GI bleeds and cardiopulmonary unplanned events – GIE
  9. Age of red cells for transfusion and outcomes in critically ill adults. – NEJM
  10. The Natural History of Sever Acute Liver Injury – Am J Gastro
  11. Esophageal Dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis – GIE
2017 · Article · Case-Control · CGH · Podcast · Study

GI Pearls Episode 8 – Last two weeks of August 2017 Gastroenterology Literature Review

Show Notes for last two weeks of August 007

  1. Celiac Disease and Nonceliac Gluten Sensitivity – Jama
  2. Comparison of Infliximab and Adalimumab in Biologic-Naive Patients With Ulcerative Colitis: A Nationwide Danish Cohort Study – Clin Gastro Hep
  3. Use of Thiopurines During Conceptions and Pregnancy is Not Associated with Adverse Pregnancy Outcomes or Health of Infants at One year in a Prospective Study – CGH
  4. Efficacy of Rectal Tacrolimus for Induction Therapy in Patients With Resistant Ulcerative Proctitis – CGH
  5. Use of Liver Imaging and Biopsy in Clinical Practice – NEJM
  6. Hospital-Level Balloon Tamponade Use is Associated with Increased Mortality for All Patients Presenting with Acute Variceal Hemorrhage – Liver international
  7. Clinical Predictors of the Risk of Early Colectomy in Ulcerative Colitis: A Population-based Study – IBD journal
  8. High-Quality Diets Associate With Reduced Risk of Colorectal Cancer: Analyses of Diet Quality Indexes in the Multiethnic Cohort – CGH
  9. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study – The Lancet
  10. Efficacy of dietary and physical activity intervention in non-alcoholic fatty liver disease: a systematic review. – BMJ – Gastro
  11. Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease: Systematic Review and Meta-analysis of Clinical and Observational Studies – Gastro
  12. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis – Gastro
  13. Undetectable negative tissue transglutaminase IgA antibodies predict mucosal healing in treated coeliac disease patients – Alimentary Phar and Ther
  14. Death of a Farm Worker After Exposure to Manure Gas in an Open Air Environment – MMWR
2017 · Article · CGH · Podcast · Study

GI Pearls Episode 7 – First two weeks of August 2017 Gastroenterology Literature Review

Show Notes for 2017 First two weeks of August 007

  1. The colonoscopist’s guide to the vocabulary of colorectal neoplasia: histology, morphology, and management – GIE
  2. Use of enteroscopy for the detection of malignant and premalignant lesions of the small bowel in complicated celiac disease: a meta-analysis – GIE
  3. Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis – GIE
  4. Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy – GIE
  5. Randomized controlled trial of scleroligation versus band ligation alone for eradication of gastroesophageal varices – GIE
  6. Endoscopic multiple biopsy and rapid diagnosis by in situ fixation and histopathologic processing – GIE
  7. Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk of Colorectal Cancer: A Meta-analysis – Jama:Int Med
  8. Older Adults’ Views and Communication Preferences About Cancer Screening Cessation – Jama Int Med
  9. Celiac Disese and Nonceliac Gluten Sensitivity – A Review – JAMA
  10. Board Review Vignette: PPP Syndrome: Pancreatitis, Panniculitis, Polyarthritis – Am J Gastro
  11. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection – Journal of Hepatology
  12. The impact of a Prior Diagnosis of Barrett’s Esophagus on Esophageal Adenocarcinoma Survival – Am J Gastro
  13. Old Farts – Fact or Fiction? Results From a Population-Based Survey of 16,000 Americans Examining the Association Between Age and Flatus – CGH
2017 · CGH · Podcast · Study

GI Pearls Episode 5 – Last two weeks of June 2017

Show Notes for 2017 Second two weeks of June 005
  1. Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis – CGH
  2. Incidence and Prevalence of Crohn’s Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010 – CGH
  3. Fecal Immunochemical Test Detects Sessile Serrated Adenomas and Polyps With a Low Level of Sensitivity – CGH
  4. Comparison of Two Intensive Bowel Cleansing Regimens in Patients With Previous Poor Bowel Preparation: A Randomized Controlled Study. – GIE
  5. Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management – ACG
  6. Disentangling the Association between Statins, Cholesterol, and Colorectal Cancer: A Nested Case-Control Study – PLOS Medicine
  7. Association of Gastric Acid Suppression With Recurrent Clostridium difficile InfectionA Systematic Review and Meta-analysis – JAMA Internal Med
  8. Amanita phalloides Mushroom Poisonings — Northern California, December 2016 – MMWR June 2017
  9. Wild Mushrooms: An Exclusive Delicacy or Last Meal – ACG
  10. Treatment of NASH: What Helps Beyond Weight Loss? – ACG
  11. Small intestinal bacterial overgrowth and Celiac disease: A systematic review with pooled-data analysis – Neurogastro & Motility
2017 · CGH · Podcast

GI Pearls Episode 2 – First two weeks of May 2017

Show Notes for 2017 May 1- 15 002

 This one is a bit noisy. Not the Best Microphone. Sorry. 

List of articles cited

  1. Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis NEJM
  2. Thiazolidinediones and Advanced Liver Fibrosis in Nonalcoholic Steatohepatitis  – Jama Internal Medicine
  3. Tenapanor Treatment of Patients With Constipation-Predominant Irritable Bowel Syndrome: A Phase 2, Randomized, Placebo-Controlled Efficacy and Safety Trial  The AmJ of Gastro
Article · CGH · Uncategorized

HCC in the absence of Cirrhosis

We often talk to
Hepatocellular_carcinoma_1.jpgour patients with cirrhosis regarding the risk of HCC, and putting aside the debate as to the efficacy of screening for such, most of our patients get the ultrasound twice yearly, +/- AFP every so often, and we cross our fingers and hope for the best, given how non-existent effective therapy for HCC is (other than resection).

This article in CGH – which regained the title of my second most favorite GI journal this week, is an article from the Texan folks, discussing HCC in the absence of cirrhosis.

This is a review of the Veteran’s Affairs database (boy would I love to get my hands on that!), 2005-2011 diagnoses of HCC, which was limited to 1500 random charts (obtained from a total of 10,695 HCC diagnoses).

~80% of the patients diagnosed with HCC had cirrhosis. Which means ~20% did not. Who are these remaining folks?

Many had metabolic syndrome, NAFLD, but some had no risk factors whatsoever.  It is interesting that in the cohort of 43 patients with what authors defined as “No cirrhosis – very high probability” – many still had some fibrosis.

In any case, logistic regression to look for associations and risk factors for HCC in absence of cirrhosis was conducted. Results:

NAFLD, HCV, HBV, Alcohol abuse, Metabolic syndrome, Others (hemochromatosis, autoimmune hepatitis, A1-AT deficiency). Idiopathic – only in 13 out of 194 patients!

Conclusions: 

  1. Glad to know that we are aware of major risk factors for HCC even in the absence of cirrhosis.
  2. No evidence as of yet to expand the risk pool to screen patients without evidence of cirrhosis.
  3. If chemoprevention is ever developed, now we know a good population to apply it in ( ex – Maybe Metformin?.
  4. It would be nice to have a large data dump of such patients on a national level, and include other variables in analysis, such as factors associated with good outcome or poor outcome. I suppose we can wait for the next paper.