GI Pearls – March 2018 – Episode 18

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

GI Pearls – January 2018 – Episode 15

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

GI Pearls – October 1-15 2017 – Episode 11

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

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

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!


  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.