2018 · Podcast

GI Pearls – September 2018 – Episode 24 Gastroenterology Literature Review

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

GI Pearls – March 2018 – Episode 19

Show Notes for March 2018 – Episode 18

On this epsiode I interview Jay Luther, MD from Massachusetts General Hospital on his Editorial on liver transplantation for alcoholic hepatitis.

Other papers:

 

Podcast

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
Podcast

GI Pearls – December 2017 – Episode 14

Show Notes for December 2017 – Episode 14
  1. Efficacy of a 4-Food Elimination Diet for Children With Eosinophilic Esophagitis  -CGH
  2. How to obtain and use chromoendoscopy dyes for surveillance colonoscopy in inflammatory bowel disease: a technical guide – GIE
  3. Endoscopy in inflammatory bowel disease: advances in dysplasia detection and management – GIE
  4. Endoscopy in inflammatory bowel disease: advances in disease management – GIE
  5. Randomized sham-controlled trials in endoscopy: a systematic review and meta-analysis of adverse events – GIE
  6. Cause, Pathogenesis, and Treatment of Nonalcoholic Steatohepatitis  – NEJM
  7. Balloon enteroscopy versus spiral enteroscopy for small-bowel disorders: a systematic review and meta-analysis – GIE
  8. Association between an increase in blood urea nitrogen at 24 hours and worse outcomes in acute nonvariceal upper GI bleeding – GIE
  9. Role of capsule endoscopy and fecal biomarkers in small bowel Crohn’s disease to assess remission and predict relapse. GIE
  10. The Evolution of Procedural Competency in Internal Medicine Training – Jama Int Med
  11. Risk of Gastrointestinal Bleeding in Patients Taking Non-Vitamin K antagonist anticoagulants – CGH
  12. Major Bleeding Risk During Anticoagulation with Warfarin, Dabigatran, Apixaban, or Rivaroxaban in Patients with Nonvalvular Atrial Fibrillation. – J of Managed Care & Spec Pharm
  13. Effects of the 2009 Medical Cannabinoid Legalization Policy on Hospital Use for Cannabinoid Dependency and Persistent Vomiting – CGH
2017 · CGH · Podcast · Study

GI Pearls Episode 5 – Last two weeks of June 2017

Show Notes for 2017 Second two weeks of June 005
  1. Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis – CGH
  2. Incidence and Prevalence of Crohn’s Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010 – CGH
  3. Fecal Immunochemical Test Detects Sessile Serrated Adenomas and Polyps With a Low Level of Sensitivity – CGH
  4. Comparison of Two Intensive Bowel Cleansing Regimens in Patients With Previous Poor Bowel Preparation: A Randomized Controlled Study. – GIE
  5. Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management – ACG
  6. Disentangling the Association between Statins, Cholesterol, and Colorectal Cancer: A Nested Case-Control Study – PLOS Medicine
  7. Association of Gastric Acid Suppression With Recurrent Clostridium difficile InfectionA Systematic Review and Meta-analysis – JAMA Internal Med
  8. Amanita phalloides Mushroom Poisonings — Northern California, December 2016 – MMWR June 2017
  9. Wild Mushrooms: An Exclusive Delicacy or Last Meal – ACG
  10. Treatment of NASH: What Helps Beyond Weight Loss? – ACG
  11. Small intestinal bacterial overgrowth and Celiac disease: A systematic review with pooled-data analysis – Neurogastro & Motility
2017

Episode 1 – April 2017

Only one Podcast this month. Will be uploaded soon once I figure out RSS feed stuff.

Show notes for 2017 April 001

List of articles cited

  1. Patients With Barrett’s Esophagus and Persistent Low-grade Dysplasia Have an Increased Risk for High-grade Dysplasia and Cancer.”  GIE
  2. Gastrointestinal Safety of Direct Oral Anticoagulants: A Large Population-Based Study” – Gastroenterology
  3. Western Dietary Pattern Increases, and Prudent Dietary Pattern Decreases, Risk of Incident Diverticulitis in a Prospective Cohort Study” – Gastroenterology
  4. Asymptomatic Carriers Contribute to Nosocomial Clostridium difficile Infection: A Cohort Study of 4508 Patients” – Gastroenterology
  5. Prevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-analysis” – Gastroenterology
  6. Ultrasound-Mediated Delivery of RNA to Colonic Mucosa of Live Mice” – Gastroenterology
  7. Recommendations on Fecal Immunochemical Testing to Screen for Colorectal Neoplasia: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer” – Gastroenterology

 

As always, send me comments, articles to consider, and follow me on twitter GI_Pearls 

 

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.