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Show notes for Episode 49 for April 2021
- Effectiveness of Oral Vancomycin for Prevention of Healtchare Facility-onset C.diff infection in Targeted Patients during Systemic antibiotic Exposure – Clinical ID
- The Detrimental Effects of oral Vancomycin – Letter to Editor – Clinical ID
- Linked color imaging focused on Neoplasm detection in the Upper GI tract – randomised trial – Annals of Internal Medicine
- AGA clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review
- Comparative effectiveness and harms of antibiotics for outpatient diverticulitis: Two nationwide cohort studies. Ann Intern Med
- Effects of Tenofovir vs Entecavir on Risk of HCC in patients with chronic HBV infection: A SRMA – CGH
- Factors that affect adequacy of Colon cleansing for colonoscopy in Hospitalized Patients – CGH
- ACG Clinical Guidelines: Colorectal Cancer Screening 2021
We often talk to
our 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!
- Glad to know that we are aware of major risk factors for HCC even in the absence of cirrhosis.
- No evidence as of yet to expand the risk pool to screen patients without evidence of cirrhosis.
- If chemoprevention is ever developed, now we know a good population to apply it in ( ex – Maybe Metformin?.
- 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.