Tag: Cirrhosis

2020 · Podcast

GI Pearls – June 2020 – Episode 41 Gastroenterology Literature Review

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Show notes for Episodes 41 – June 2020

  1. Discrepancy between self-reported and actual colonoscopy polypectomy practices for the removal of small polyps – GIE
  2. AGA Guidelines on the management of Moderate to Severe Ulcerative Colitis – Gastro 
  3. Resistance training increases muscle strength and muscle size in patients with liver cirrhosis. – CGH
  4. Reduced incidence of Hepatic encephalopathy and higher odds of resolutions associated with eradication of HCV – CGH
  5. Ammonia Levels do not guide clinical management of patients with hepatic encephalopathy caused by cirrhosis. – Am J Gastro
  6. Low-Value Levels: Ammonia Testing Does not Improve the Outcomes of HE. – Am J Gastro
  7. Young adults and metachronous neoplasia: risks for future advanced adenomas and large serrated polyps compared with older adults – GIE
  8. Changing patters in the epidemiology and outcomes of IBD in the UK – 2000-2018 – AP&T 
  9. Use of Fecal Occult Blood Testing as a Diagnostic Tool for Clinical Indications: SRMA – Am J Gastro
  10. Low incidence of aerodigestive cancers in patients with negative results from colonoscopies, regardless of findings from stool DNA tests. – CGH 
  11. Endoscopic retrieval of magnetic foreign body ingestions with  a nasal bridle: description of a novel technique – GIE
  12. Underwater versus conventinal endoscopic resection of nondiminutive nonpedunculated colorectal lesions: RCT – GIE
  13. Cancer Prevention With Aspirin in Hereditary Colorectal Cancer (Lynch Syndrome), 10-year Follow-Up – Lancet
  14. AGA and Allergy Immunology Guidelines for EOE – Gastro

Podcast

GI Pearls – March 2019 – Episode 30 Gastroenterology Literature Review

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Show Notes for March 2019 – Episode 30

Sorry, but I was sick, so episode is shorter, and … late.

  1. Evaluation of adenomas per colonoscopy and adenomas per positive participant as new quality parameters in screening colonoscopy – GIE
  2. Adherence to Recommended Inpatient Hepatic Encephalopathy  Workup – J Hosp Med
  3. Clinical ipact and Safety of Anticoagulants for portal vein thrombosis – Am J Gastro
  4. Fracture risk in Patients with IBD: Nationwided population cohort study – Am J Gastro
  5. Comparing adenoma and polyp miss rates for total underwater colonoscopy versus standard CO2 – randomized trial using tandem colonoscopy approach.–  GIE
  6. Increasing adenoma detection rate in the right side of the colon comparing retroflexion with a second forward view: review – GIE
  7. Effects of bowel preparation on the human gut microbiome and metabolome– Scientific Reports
Podcast

GI Pearls – December 2018 – Episode 27 Gastroenterology Literature Review

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Show Notes for December 2018 – Episode 27

  1. Efficacy of ustekinumab for inducing endoscopic healing in patients with Crohn’s disease – Gastro
  2. Association of Oral Anticoagulants and Proton Pump Inhibitor Cotherapy With Hospitalization for Upper Gastrointestinal Tract Bleeding – JAMA
  3. Clinician Guide to Microbiome Testing – Dig Dis Sci
  4. Stopping 5-ASA in patients with UC starting biolocig therapy does not increase risk of adverse clinical outcomes – Gut Journal
  5. Effect of Aspirin on disability-free survival in the healthy elderly. – NEJM
  6. Hyperbaric oxygen therapy for UC patients hospitalized for moderate-severe flares – Am J Gastro
  7. Mortality due to cirrhosis and liver cancer in the United  States, 1999-2016: observational study – BMJ 
  8. No association between screening for HCC and reduced cancer-related mortality in patietns with Cirrhosis –  Gastro
  9. Exposure concentrations of infants breastfed by women receiving biologic therapies for IBD  – Gastro
  10. Comparative effectiveness and safety of Bariatric Procedures for Weight loss – Annals of IM
  11. Risk of esophageal adenocarcinoma after anti-reflux surgery in patients with GERD – Jama Oncology
  12. Guideline – Screening for CRC in individuals with family history of nonhereditary colorectal cancer or adenoma – Gastro
2018 · Podcast

GI Pearls – September 2018 – Episode 24 Gastroenterology Literature Review

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Show Notes for September 2018 – Episode 24
  9. Beyond O&P Times Three – Am J Gastro
Podcast

GI Pearls – August 2018 – Episode 23

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Show Notes for August 2018 – Episode 23
  10. Crohn’s giudelines – Am J Gastro

Yes there are no podcasts between May 2018 and August 2018.

Please e-mail me at info at gipearls.com if you have suggestions for papers to discuss, or comments/concerns.

Podcast

GI Pearls – March 2018 – Episode 18

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Show Notes for March 2018 – Episode 18
  1. Effect of Hot Tea Consumption and Its  Interactions With Alcohol and Tobacco Use on the Risk for Esophageal  Cancer – Ann Int Med
  2. IDSA guidelines for C.diff – IDSA
  3. Effect of Low-Fat vs Low-Carbohydrate Diet on  12-Month Weight Loss in Overweight Adults – JAMA
  4. Patients with familial adenomatous polyposis harbor colonic biofilms containing tumorigenic bacteria – Science
  5. Accumulation of Heavy Metals in People on a Gluten-Free Diet – CGH
  6. Fructans, rather than gluten, indluces symptoms in patients with Non-celiac Gluten sensitivity. – Gastro
  7. Predictors of post-colonoscopy emergency department use – GIE
  8. Vedolizumab Concentrations in the Breastmilk of nursing Mothers with IBD – Gastro
  9. Low Rates of GI and Non-GI complications for Screening and Surveillance Colonoscopies -Gastro
  10. Hepatitis B virus reactivation during direct-acting antiviral therapy for Hep C – The Lancet Gastro
  11. Disagreement among gastroenterologists using the Mayo and Rutgeerts Endoscopic scores. – IBD Journal
  12. Noninvasive imaging biomarker assessment of  liver fibrosis by elastography in NAFLD – Nat Rev GI&Hep
Podcast

GI Pearls – January 2018 – Episode 15

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Show Notes for January 2018 – Episode 15
  1. Colonoscopy Surveillance After Colorectal Cancer Resection – JAMA
  2. Glucocorticosteroids for people with alcoholic hepatitis. Cochrane Database Syst Rev 2017
  3. Effects of liraglutide on weight, satiation, and gastric functions in obesity: a randomised, placebo-controlled pilot trial – Lancet Gastro
  4. Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults – JAMA
  5. Platelet Count Does Not Predict Bleding in Cirrhotic Patients: Results from the PRO-LIVER Study – Am J Gastro
  6. Number of ROM on a colonic transit study does not correlate w/ symptom severity or QOL in chronic constipation – Neurogastro & Motility
  7. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev
  8. Going from A to Z – Clinical Problem Solving – NEJM
  9. Gavage of fecal sampels from patients with CRC promotes intestinal carcinogenesis in Germ-Free and Conventional Mice – Gastro
  10. A rare cause of Diarrhea and Polyposis – Gastro
  11. Effectiveness of endoscopic treatments for colonic diverticular bleeding – GIE
  12. Dietary trehalose enhances virulence of epidemic Clostridium difficile – Nature
2017

GI Pearls – October 1-15 2017 – Episode 11

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Show Notes for October 1-15, 2017  Episode 011
  1. Postcolonoscopy mortality: Bowel preparation to blame? – GIE
  2. Prevalence of hypokalemia before and after bowel preparation for colonoscopy in high-risk patients – GIE
  3. Prevalence of Anemia 10 Years After Roux-en-Y Gastric Bypass in a Single Veterans Affairs Medical Center – Jama Surgery
  4. Risk of Postop Complications Among IBD paietns treated Preop with Vedolizumab – Am J Gastro
  5. Physician Characteristics Associated with Higher Adenoma Detection Rate – GIE
  6. Electrolyte Disturbances in Patients with Chronic Alcohol-Use Disorders  – NEJM
  7. Hereditary Colorectal Polyposis and Cancer Syndromes: A Primer on Diagnosis and Management. – Am J Gastro
  8. Calcium Oxalate Crystals in Ethylene Glycol Toxicity – NEJM
  9. Celiac Disease and Autoimmunity — The Missing Ingredient– NEJM
  10. Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis – CGH
  11. The risk of hepatocellular carcinoma is decreasing after the first 5 years of tx – Hepatology
  12. Aristolochic acids and their derivatives are widely implicated in liver cancers in Taiwan and throughout Asia – Science -TM
  13.  Hepatitis C Virus Screening in New York – MMWR
  14. Outbreak of Campylobacter jejuni – MMWR
2017 · Podcast

GI Pearls – September 1-15 2017 – Episode 9

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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
Article · CGH · Uncategorized

HCC in the absence of Cirrhosis

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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.