Podcast

GI Pearls – November-December 2017 – Episode 13

Show Notes for November-December 2017 – Episode 13
  1. Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study – GUT
  2. Association Between Use of Thiopurines or Tumor Necrosis Factor Antagonists Alone or in Combination and Risk of Lymphoma in Patients With IBD – JAMA
  3. Complications of Bariatric Surgery: What You Can Expect to See in Your GI Practice – Am Journal Gastro
  4. Oversuse of Repeat Upper Endoscopy in the Veterans Health Administration: A Retrospective Analysis – Am Journal Gastro
  5. Estrogen replacement reduces risk and increases survival time in of women with HCC – CGH
  6. Hepatitis C virus testing for case identification in persons born during 1945–1965: Results from three randomized controlled trials. –  Hepatology
  7. Population based paternity rate and partner birth outcomes among Utah men with IBD – Am J Gastro
  8. Agreement between home-based Measurement of stool calprotectin and ELISA Results for Monitoring Inflammatory Bowel Disease Activity – CGH
  9. Prevalence of Eosinophilic Gastroenteritis and Colitis in a Population-based Study – CGH
  10. Tongxie Formula Reduces Symptoms of Irritable Bowel Syndrome – CGH
  11. Chromoendoscopy for Surveillance in Ulcerative Colitis and Crohn’s Disease: A Systematic Review of Randomized Trials – CGH
  12. Long-Term Efficacy and Safety of Cyclosporine in a Cohort of Steroid-Refractory Acute Severe Ulcerative Colitis Patients from the ENEIDA Registry (1989–2013): A Nationwide Multicenter Study – Am J 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.