2017 · Podcast

GI Pearls – September 1-15 2017 – Episode 9

Show Notes for September 1-15 2017  Episode 009
  1. Asthma Is Associated With Subsequent Development of Inflammatory Bowel Disease: A Population-based Case–Control Study  – CGH
  2. Laboratory predictors of bleeding and the effect of platelet and RBC transfusions on bleeding outcomes in the PLADO trial – Blood
  3. Therapeutic endoscopy-related GI bleeding and thromboembolic events in patients using warfarin or direct oral anticoagulants: results from a large nationwide database analysis – Gut
  4. Major Bleeding Risk During Anticoagulation with Warfarin, Dabigatran, Apixaban, or Rivaroxaban in Patients with Nonvalvular Atrial Fibrillation. – J of Managed Care & Spec Pharm
  5. Oral administration of conditioned medium obtained from mesenchymal stem cell culture prevents subsequent stricture formation after esophageal submucosal dissection in pigs. – GIE
  6. High Dietary Intake of Specific Fatty Acids Increases Risk of Flares in Patients With Ulcerative Colitis in Remission During Treatment With Aminosalicylates – CGH
  7. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Inherited Polyposis Syndromes – Dis of Col and Rectum.
  8. Measurement Bias of Polyp Size at Colonoscopy – Dis of Col and Rectum.
  9. Chronic Pancreatitis and Pancreatic Cancer Risk: A Systematic Review and Meta-analysis – Am J Gastro.
  10. Rural and Urban Residence During Early Life is Associated with Risk of Inflammatory Bowel Disease – AmJGastro
  11. What’s new in Rome IV – Neurogastro & Motility
  12. Fecal Calprotectin Levels Predict Histological Healing in Ulcerative Colitis – IBD Journal
  13. Weight and Metabolic Outcomes 12 Years after Gastric Bypass – NEJM
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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.
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