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1. INTERNET NEWS BS.NGUYỄN ĐĂNG SẢNG PK.TIÊU HÓA GAN MẬT

2. Retrospective Analysis Confirms Tetracycline Quadruple as Best Helicobacter pylori Regimen in the USA Background Declining Helicobacter pylori (H. pylori) eradication rates have prompted a switch in first-line therapy from standard triple (PPI, clarithromycin, and amoxicillin) to bismuth-based quadruple therapy. A caveat of the ACG 2017 H. pylori treatment guidelines was a paucity of recent US eradication data. Aim To determine Rhode Island H. pylori eradication data, in the largest US study from the last two decades. Methods Electronic records were queried for patients with H. pylori infection diagnosed by pathology, urea breath test, or stool antigen from 2015 to 2017. Demographics, diagnostic test, treatment regimen, and test of cure were extracted. Eradication rates were calculated, and treatment regimens were compared.

3. Results A total of 1710 patients were identified (64% female): 825 (46%) diagnosed by breath test, 755 (42%) by biopsy, and 191 (12%) by stool antigen. Full data were obtained on 1101 patients. Seven regimens were used: quadruple (64%), triple (25%), doxycycline quadruple (5%), and miscellaneous (6%). Quadruple was superior to triple: (85% vs. 75%, P = 0.002), quadruple 14 days versus triple 14 days (87% vs. 79%, P = 0.0052), quadruple 10 days versus triple 10 days (77% vs. 67%, P = 0.33). Increased therapy length improved eradication (quadruple 14 days  vs. 10 days, 87% vs. 77%, P = 0.002; triple 14 days  versus 10 days 79% vs. 67%, P = 0.13). Finally, substituting doxycycline for tetracycline yielded lower eradication (85% vs. 67%, P = 0.006). Conclusion Quadruple therapy is superior to triple therapy within the Rhode Island population. Fourteen-day therapy achieves superior eradication compared to 10-day therapy, and doxycycline is inferior to tetracycline for quadruple therapy. Our findings support adherence to ACG and international guidelines advising 14-day quadruple therapy.

4. Low‐dose aspirin can reduce colorectal cancer mortality after surgery: A 10‐year follow‐up of 13 528 colorectal cancer patientsJoseph J Y Sung Jason M W Ho Felix C H Chan Kelvin K F TsoiFirst published: 04 December 2018 https://doi.org/10.1111/jgh.14562

5. Background and AimThe chemopreventive effect of aspirin in colorectal cancer (CRC) is well studied, but its benefit in patients after CRC diagnosis and surgery is unclear. This study aims to investigate the effects of low‐dose aspirin use in mortality among CRC patients after surgery.MethodsPatients were analyzed in two cohorts: (i) patients taking aspirin before CRC diagnosis and continued or discontinued aspirin after surgery and (ii) patients, who never used aspirin before CRC diagnosis, received or did not receive aspirin after surgery. CRC‐related mortality and all‐cause mortality were the primary and secondary outcomes. Sub‐distribution hazard ratio (SHR) for competing‐risk CRC mortality was fitted to adjust for other causes of death; hazard ratio (HR) was used to compare all‐cause mortality.ResultsA total of 13 528 CRC patients were included. Among 3292 patients with regular aspirin use before CRC diagnosis, 2658 (80.7%) continued aspirin and 634 (19.3%) discontinued aspirin after surgery. Continuous use of aspirin significantly reduced CRC‐related mortality (SHR: 0.69, 95% confidence interval [CI]: 0.59–0.81) and all‐cause mortality (HR: 0.61, 95% CI: 0.55–0.68). Among 10 236 patients who did not use aspirin before CRC diagnosis, 1054 patients (10.3%) received aspirin after surgery and 9182 (89.7%) did not. Aspirin initiated after surgery reduced CRC‐related mortality (SHR: 0.88, 95% CI: 0.80–0.98) and all‐cause mortality (HR: 0.87, 95% CI: 0.81–0.94).ConclusionsIrrespective of aspirin use before surgery for CRC, low‐dose aspirin after surgery lowers risk of both CRC‐related mortality and overall mortality.

6. Risk of Colorectal Cancer in Patients With Acute DiverticulitisA Systematic Review and Meta-analysis of Observational Studies Jeremy Meyer,* ,‡ Lorenzo A. Orci,* ,‡ Christophe Combescure,§ AlexandreBalaphas,* ,‡ Philippe Morel,* ,‡ Nicolas C. Buchs,* ,‡ and FrédéricRis* ,‡ *Division of Digestive and Transplantation Surgery, University Hospitals of Geneva, Genève, Switzerland; ‡ Unit of Surgical Research, University of Geneva, Genève, Switzerland; and § Division of Clinical Epidemiology, University Hospitals of Geneva, Genève, Switzerland BACKGROUND & AIMS: We performed a systematic review and meta-analysis to assess the prevalence of colorectal cancer in patients with acute diverticulitis. METHODS: We searched MEDLINE from inception through November 2nd, 2017 for studies reporting the prevalence of colorectal cancer in patients with diverticulitis, identified based on the protocol CRD42017083272. This systematic review was conducted in accordance to the MOOSE guidelines. Pooled prevalence values were obtained by random effects models and robustness was tested by leave-one out sensitivity analyses. Heterogeneity was assessed using the Q-test and quantified based on I2 value. The critical appraisal of included studies was performed using the Newcastle-Ottawa scale. RESULTS:

7. Risk of Colorectal Cancer in Patients With Acute Diverticulitis: RESULTS: Our final analysis included 31 studies, comprising 50,445 patients. The pooled prevalence of colorectal cancer was 1.9% (95% CI, 1.5%–2.3%). Patients with complicated diverticulitis had a significantly higher risk for colorectal cancer (prevalence, 7.9%; 95% CI, 3.9%–15.3%) than patients with uncomplicated diverticulitis (prevalence, 1.3%; 95% CI, 0.1%–2%), corresponding to a pooled prevalence ratio of 6.7 (95% CI, 2.5–18.3). Subgroup analyses did not find significant difference in prevalence when separately pooling studies according to ranking on the Newcastle-Ottawa scale, geographical location or length of follow-up. Meta-regression did not find any association between age and colorectal cancer. Among patients who underwent endoscopy, the pooled prevalence of polyps was 22.7% (95% CI, 19.6%–26.0%), of advanced adenomas was 4.4% (95% CI, 3.4%–5.8%), of adenomas was 14.2% (95% CI, 11.7%–17.1%), and of hyperplastic polyps was 9.2% (95% CI, 7.6%–11.2%).CONCLUSION: In a meta-analysis of observational studies of patients with acute diverticulitis, we found the pooled prevalence of colorectal cancer to be 1.9%. The risk of colorectal cancer was significantly higher in patients with complicated diverticulitis than in patients with uncomplicated diverticulitis.

8. the prevalence of anxiety and depression in patients with irritable bowel syndrome Mohammad Zamani1,2 | Shaghayegh Alizadeh‐Tabari1 | Vahid ZamaniReceived: 28 March 2019  |  First decision: 25 April 2019  |  Accepted: 8 May 2019Summary Background: Irritable bowel syndrome (IBS) is a common and potential disabling func‐ tional gastrointestinal disorder. Studies have revealed a possible association between IBS and psychological problems, such as anxiety and depression. Existing systematic reviews have addressed only the levels of anxiety or depression in patients with IBS. Aim: To investigate systematically the prevalence of anxiety or depression in IBS patientsMethods: A literature search was conducted using the related keywords from the bibliographic databases of Embase, PubMed, Scopus, Web of Science and POPLINE published until 1 January 2019 with no language restriction. Studies reporting the prevalence of anxiety/depressive symptoms/disorders in adult (≥15 years) IBS pa‐ tients were evaluated. The pooled prevalence, odds ratio (OR) and 95% CI were cal‐ culated using stata software. Results

9. . the prevalence of anxiety and depression in patients with irritable bowel syndrome Results: A total of 14 926 articles were initially screened, and finally 73 papers were included. The prevalence rates of anxiety symptoms and disorders in IBS patients were 39.1% (95% CI: 32.4‐45.8) and 23% (95% CI: 17.2‐28.8) respectively. The ORs for anxiety symptoms and disorders in IBS patients compared with healthy subjects were 3.11 (95% CI: 2.43‐3.98) and 2.52 (95% CI: 1.99‐3.20) respectively. The preva‐ lence estimates of depressive symptoms and disorders in IBS patients were 28.8% (95% CI: 23.6‐34) and 23.3% (95% CI: 17.2‐29.4) respectively. The ORs for depres‐ sive symptoms and disorders in IBS patients compared to healthy subjects were 3.04 (95% CI: 2.37‐3.91) and 2.72 (95% CI: 2.45‐3.02) respectively.Conclusion: Patients with IBS have a three‐fold increased odds of either anxiety

10. July 05, 2019 Reuters Health) - Men who eat at least two servings a week of yogurt may be lowering their risk for colorectal cancera recent study suggests.Researchers examined data on 32,606 male and 55,743 female health professionals who had a colonoscopy between 1986 and 2012. Study participants provided detailed information about their health, lifestyle, eating and exercise habits every four years.Over that time, there were 5,811 cases of colorectal adenomas in men and 8,116 in women.

11. Compared to men who didn't eat any yogurt, those who had at least two servings weekly were 19% less likely to develop conventional adenomas and 26% less likely to develop adenomas with the highest malignant potential."Our data provide novel evidence for the role of yogurt in the early stage of colorectal cancer development," said study coauthor Dr. Yin Cao of Washington University School of Medicine in St. Louis."The findings, if confirmed by future studies, suggest that yogurt might serve as a widely acceptable modifiable factor, which could complement colorectal cancer screening and reduce risk of adenoma among the unscreened," Cao said by email.Yogurt consumption has been linked to a lower risk of colon and rectal cancer in previous studies, and some scientists think this may be because yogurt promotes the growth of healthy bacteria in the gut. But less is known about how yogurt might impact the potential for people to develop

12. Efficacy of Probiotics and Synbiotics in Patients with Nonalcoholic Fatty Liver Disease: A Meta-AnalysisAuthorsLiang LiuPing LiEmail authorYiqi LiuYilian ZhangDigestive Diseases and SciencesISSN: 0163-2116 (Print) 1573-2568 (Online)ReviewFirst Online: 15 June 201915

13. Abstract:Background and Aim :Extensive epidemiological evidence suggests that nonalcoholic fatty liver disease (NAFLD) is the primary chronic liver disease worldwide. However, some studies have showed conflicting results on the effects of probiotics and synbiotics supplementation. Therefore, we conducted a systematic review and meta-analysis to investigate the effectiveness of the supplementation in subjects with NAFLD.Methods:We searched systematically PubMed, Cochrane, and Embase databases up to April 2018 and checked manually the bibliography of the original articles. The quality of the studies was evaluated using the Cochrane Risk of Bias Tool.Results:This study analyzed 15 randomized, controlled trials involving 782 patients with NAFLD. Probiotics and synbiotics supplementation could significantly improve liver steatosis, alanine aminotransferase, aspartate aminotransferase, triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein, homeostasis model assessment-insulin resistance, liver stiffness and tumor necrosis factor-alpha (all P < 0.05). But the supplementation could not ameliorate body mass index (mean difference [MD] = −0.00; 95% confidence interval [CI]: −0.22 to 0.22, P = 0.99), waist circumference (MD = −0.01; 95% CI −0.03 to 0.02, P = 0.57) and fasting blood sugar (standard mean difference [SMD] = −0.10; 95% CI −0.32 to 0.12, P = 0.39)Conclusion:We present clear evidence for the benefit of probiotics and synbiotics supplementation for liver steatosis, liver enzymes, lipid profiles and liver stiffness in patients with NAFLD.

14. Therapeutic effects of Silybum marianum in the treatment of liver fibrosis and cirrhosisAsim Awan.Asian Journal of Medical SciencesISSN 2467-9100 eISSN 2091-0576 AbstractBackground: Cirrhosis is the late, symptomatic stage of chronic liver disease which occurs when scar tissue (fibrosis) largely replaces healthy liver tissue, compromising the function of the organ and predisposing to liver failure and hepatocellular carcinoma. It is mainly caused by hepatitis B and C virus infections or prolonged excessive consumption of alcohol.Aims and Objective: To study the therapeutic effects of Silybum marianum on liver fibrosis and cirrhosis in patients with chronic hepatitis C virus infection with Child Pugh Stage A& B.Materials and Methods: In this study 119 patients were treated for 6 months with Silybum marianum, their Liver stiffness measurements were carried out through Fibroscan, which is a non-invasive technique to assess liver fibrosis. Liver Fibrosis Scores viz; Aspartate aminotransferase/platelet ratio index(APRI) and fibrosis index based on four factors(FIB-4) were also employed at baseline and end of treatment.

15. Therapeutic effects of SilybumResults: Pre-treatment Liver Stiffness Measurement (LSM) score was 22.54 kilopascals(kPa) and post treatment was 17.30 kPa, a statistically significant change of 5.24 kPa (P ˂ 0.01) was observed, the mean percent change was 23.24%, its impact was observed in all METAVIR stages. Of the 72 (60.5%) patients with LSM ≥ 12.5 kPa (cirrhosis) at baseline 23 (32%) proved to have no cirrhosis (≥ 1 decrease in fibrosis stage) at post treatment. Similarly, 19 patients moved to stage F0-F1, 28 patients in F2 and 23 in F3. Overall fibrosis stage was improved (≥ 1 decrease in fibrosis stage) in 46 (38.7%) of 119 patients after 6 months of treatment. Serum fibrosis scores APRI and FIB-4 significantly decreased in comparison to baseline values. APRI values drooped from 1.24 to 0.83. FIB-4 score changed from 3.90 to 2.10.Conclusion: Our result suggests significant improvement with Silybummarianum in the patients status of liver fibrosis and cirrhosis associated with hepatitis C related chronic liver disease. Silybummarianum shows therapeutic effect in real life setting on the entire aspect of disease, as evaluated with the fibroscan and serum fibrosis score.

16. Medscape Logo.GastroenterologyCharacteristics and Outcome of Hepatocellular Carcinoma in Patients With NAFLD Without CirrhosisBonnie Bengtsson; Per Stål; StaffanWahlin; Niklas K. Björkström; HannesHagströmDISCLOSURES Liver International. 2019;39(6):1098-1108. ADD TO EMAIL ALERTSAbstractBackground and Aims: Non-alcoholic fatty liver disease (NAFLD) is a growing cause of hepatocellular carcinoma (HCC). In NAFLD, HCC occurs more commonly in the absence of cirrhosis compared with other liver diseases; yet, patients with non-cirrhotic NAFLD-HCC are poorly characterized. Here, we characterized a large cohort of HCC cases and assessed the outcomes of patients with non-cirrhotic NAFLD-HCC.Methods: We identified all cases of HCC treated at the Karolinska University Hospital, Stockholm, Sweden from 2004 to 2017. Patient charts were manually reviewed for variable extraction. Cases were followed passively for all-cause and HCC-related mortality until the end of April 2018. Cox regression was performed to estimate mortality rates and identify mortality risk factors in patients with non-cirrhotic NAFLD-HCC

17. Results: Totally, 1562 cases with HCC were identified. Of these, 225 (14.4%) had NAFLD-HCC, of which 83 (37%) did not have cirrhosis. Compared with patients with cirrhotic NAFLD-HCC, patients with non-cirrhotic NAFLD-HCC were older (74 vs 70 years, P < 0.001), had a lower prevalence of type 2 diabetes (T2DM) (66% vs 80%, P = 0.02), larger tumours, less frequently underwent liver transplantation (0% vs 11%, P = 0.002), but more frequently underwent resection (35% vs 8%, P < 0.001). Mortality was similar (aHR for non-cirrhotic NAFLD-HCC vs cirrhotic NAFLD-HCC 0.93, 95% CI 0.58-1.51, P = 0.78). Parameters independently associated with increased mortality included the Barcelona Clinic Liver Cancer stage, number of tumours, lower albumin and presence of T2DM.Conclusions: Patients with non-cirrhotic NAFLD-HCC differ from those with cirrhosis in age, tumour size and allocated treatments. Despite these differences, survival is similar.

18. High risk of clinical events in untreated HBeAg‐negative chronic hepatitis B patients with high viral load and no significant ALT elevationGwangHyeon Choi Gi‐Ae Kim Jonggi Choi Seungbong Han Young‐Suk LimFirst published: 28 May 2019 https://doi.org/10.1111/apt.15311Volume 50, Issue 2July 2019Summary BackgroundIt remains unknown whether antiviral treatment for HBeAg‐negative chronic hepatitis B (CHB) patients having high viral loads without significant elevation of alanine aminotransferase (ALT) levels would reduce the risks of clinical events.Aim:Tocompare clinical outcomes of high viral load CHB patients untreated for normal or mildly elevated ALT vs those treated for ALT ≥ 2 upper limit of normal (ULN).MethodsThis historical cohort study included 5414 HBeAg‐negative CHB patients without cirrhosis at a tertiary hospital in Korea from 2000 to 2013. Inactive phase was defined as serum hepatitis B virus [HBV] DNA < 2000 IU/mL and persistently normal ALT (n = 3572). High viral load (HBV DNA ≥ 2000 IU/mL) patients were classified into three phases by ALT levels: Replicative (persistently normal ALT, n = 900); Mildly active (ALT 1‐2ULN, n = 396); and Active (ALT ≥ 2ULN, n = 546) phases. All Active phase patients were treated with nucleos(t)ide analogues.

19. ResultsThe mean age of the patients was 47 years without a significant difference among the groups. Compared with the treated Active phase group, the untreated Replicative phase group showed a significantly higher risk of hepatocellular carcinoma (HCC; HR 1.76; 95% CI 1.00 ‐ 3.10, P = 0.05) and death/transplantation (HR 2.14; 5% CI 1.09 ‐ 4.21, P = 0.03) by propensity score‐matched analysis. The untreated mildly active phase patients had further increase in risk of HCC and death/transplantation compared with the treated Active phase group by unadjusted, PS‐matched, competing risks, and multivariable‐adjusted analyses.ConclusionsUntreated high viral load HBeAg‐negative CHB patients without significant ALT elevation had higher risks of clinical events than treated Active phase patients with elevated ALT.

20. Association between Helicobacter pylori infection and nonalcoholic fatty liver diseasea systemic review and meta-analysisNing, Longuia; Liu, Rongqiangb; Lou, Xinhea; Du, Haojiea; Chen, Wenguoa; Zhang, Fenminga; Li, Shaa; Chen, Xueyanga; Xu, GuoqiangaEuropean Journal of Gastroenterology & Hepatology: July 2019 - Volume 31 - Issue 7 - p 735–742doi: 10.1097/MEG.0000000000001398

21. Article Metrics Although clinical studies have shown possible links of Helicobacter pylori infection with the development of nonalcoholic fatty liver disease (NAFLD), the results remain controversial. The aim of this meta-analysis is to investigate the association between H. pylori infection and NAFLD. A comprehensive search of relevant studies was performed up to November 2018. Data on H. pylori infection in NAFLD patients and controls were extracted. Odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Twelve studies involving 27 400 NAFLD patients and 60 347 controls were included. The pooled overall OR of H. pylori infection in NAFLD patients compared with controls was 1.36 (95% CI: 1.22–1.53, I2=89.6%, P=0.000). Meta-regression and subgroup analysis showed that the sample size and the case–control ratio may have accounted for some of the heterogeneity. When stratified by publication year, the diagnostic method used for H. pylori, and Newcastle–Ottawa Scale scores, the OR remained significant. However, possible publication bias was observed. Of the 12 studies, six had carried out multivariable analysis after adjusting for potential confounders. The pooled results from these studies still indicated a higher risk of NAFLD in patients infected with H. pylori (OR=1.17, 95% CI: 1.01–1.36, I2=72.4%, P=0.003). There is a 36% increased risk of NAFLD in patients with H. pylori infection. Further studies are warranted to investigate whether eradication of H. pylori is useful in the prevention and treatment of NAFLD.

22. Systematic review with a meta-analysis: clinical effects of statins on the reduction of portal hypertension and variceal haemorrhage in cirrhotic patients BMJ Volum 9, issue 7Background Statins may improve outcomes in patients with cirrhosis. We performed a systematic review and meta-analysis to evaluate the effect of statins on patients with cirrhosis and related complications, especially portal hypertension and variceal haemorrhage.Methods Studies were searched in the PubMed, Embase and Cochrane library databases up to February 2019. The outcomes of interest were associations between statin use and improvement in portal hypertension (reduction >20% of baseline or <12 mm Hg) and the risk of variceal haemorrhage. The relative risk (RR) with a 95% CI was pooled and calculated using a random effects model. Subgroup analyses were performed based on the characteristics of the studies.

23. Results: Eight studies (seven randomised controlled trials (RCTs) and one observational study) with 3195 patients were included. The pooled RR for reduction in portal hypertension was 1.91 (95% CI, 1.04 to 3.52; I2=63%) in six RCTs. On subgroup analysis of studies that used statin for 1 month, the RR was 2.01 (95% CI, 1.31 to 3.10; I2=0%); the pooled RR for studies that used statins for 3 months was 3.76 (95% CI, 0.36 to 39.77; I2=75%); the pooled RR for studies that used non-selective beta-blockers in the control group was 1.42 (95% CI, 0.82 to 2.45; I2=64%); the pooled RR for studies that used a drug that was not reported in the control group was 4.21 (95% CI, 1.52 to 11.70; I2=0%); the pooled RR for studies that used simvastatin was 2.20 (95% CI, 0.92 to 5.29; I2=69%); RR for study using atorvastatin was 1.82 (95% CI, 1.00 to 3.30). For the risk of a variceal haemorrhage, the RR based on an observational study was 0.47 (95% CI, 0.23 to 0.94); in two RCTs, the pooled RR was 0.88 (95% CI, 0.52 to 1.50; I2=0%). Overall, the summed RR was 0.64 (95% CI, 0.42 to 0.99; I2=6%).Conclusion:Statins may improve hypertension and decrease the risk of variceal haemorrhage according to our assessment. However, further and larger RCTs are needed to confirm this conclusion.

24. Medscape LogoGastroenterologyInfusion of Evidence: The Albumin Effect in Cirrhosis Becomes ClearerDavid A. Johnson, MDDISCLOSURES July 10, 20190Read Comments Patients with cirrhosis have a significant reduction in cardiovascular and cardiopulmonary function. Arteriolar dilation, particularly in the splanchnic circulation, leads to a lessened arterial volume with a subsequent reduction in cardiac output. This "hypovolemia" can lead to resultant activation of compensatory neurohumoral pathways, which can affect renal perfusion and function. These cardiovascular compromises are integral in the decompensation of ascites and renal failure seen in patients with advanced cirrhosis.A recently published two-part study[1] provides yet more evidence that using albumin infusions to target normal serum levels can have a significantly positive role in combating these effects in patients with decompensated cirrhosis, with and without bacterial infections. Although the ultimate goal of these dual studies is to assess the value of short- and long-term albumin at preventing acute liver failure or mortality in this population, the results offered in this report provide crucial new insights into just how IV albumin may impart these benefits.

25. In the first part of this study, researchers conducted a pilot proof-of-concept analysis involving 18 patients without bacterial infection who were randomly assigned to receive high-dose (1.5 g/kg infusion weekly) or low-dose albumin (1 g/kg every 2 weeks) albumin over 12 weeks. They observed that high-dose but not low-dose albumin was associated with significant improvements in circulatory and left ventricular function, as measured in the outcomes of pulmonary capillary wedge pressure, cardiac index, left ventricular stroke, and systolic volumes. Of note, these beneficial effects were not associated with a worsening of cardiac preload or portal hypertension (assessed by hepatic venous pressure).In the second part of the study, researchers randomly assigned 118 patients hospitalized with decompensated cirrhosis and acute bacterial infections, unrelated to spontaneous bacterial peritonitis, to receive antibiotics alone or in combination with two separate doses of albumin (1.5 g/kg on day 1 and 1.0 g/kg on day 3). As in the first part of this study, researchers observed beneficial effects of albumin infusion on markers/regulators of systemic inflammation, specifically cytokines, chemokines, growth factors, and endothelial dysfunction.

26. Why Albumin Might Work in CirrhosisAlthough there are a number of reports on the benefits of IV albumin, few have investigated the pathophysiologic explanation for why it occurs. This new study fills that void by adding compelling and substantive information on the potential reasons that IV albumin has beneficial effects on cardiocirculatory dysfunction, systemic inflammation, and immune function. Increased systemic inflammation has a major role in hepatic decompensation.[2] The ability of albumin to bind to proinflammatory molecules makes intrinsic sense in understanding its value in mitigating risk in the decompensated cirrhosis-associated inflammatory and circulatory organ dysfunction. It is important to note that this new analysis found that high- but not low-dose albumin was associated with these favorable improvements in immunologic effect.This study did not include assessments to measure whether patients experienced improved function. Future studies will hopefully explore whether such outcomes accompany these physiologic improvements, to better understand the clinical value of albumin in this population.Although we await more data from ongoing studies in this area, in my view, these findings, coupled with the ANSWER trial demonstrating an amazing reduction in mortality,[3] strongly support considering programmatic administration of IV albumin in patients with uncomplicated decompensated cirrhosis as a potential new standard of care.

27. Saturday, July 20, 2019News & Perspective Drugs & Diseases CME & Education Academy Video Journal of Viral Hepatitis Diabetes Poses a Higher Risk of Hepatocellular Carcinoma and Mortality in Patients With Chronic Hepatitis BA Population-based Cohort StudyYu-Chiau Shyu; Ting-Shuo Huang; Cheng-Hung Chien; Chau-Ting Yeh; Chih-Lang Lin; Rong-Nan ChienDisclosures J Viral Hepat. 2019;26(6):718-726.

28. Abstract:Diabetes mellitus may be a risk factor of HCC development in chronic hepatitis B infected patients and affect the all-cause mortality. This study aimed to examine whether DM was associated with the development of HCC with CHB and affected the all-cause mortality. A total of 2966 CHB patients newly diagnosed with DM in 2000 were retrieved from the Longitudinal Cohort of Diabetes Patients database and used propensity scores matching based on age, sex-gender, alcohol-related liver disease and baseline liver cirrhosis to compare with the non-DM patients from the Taiwanese National Health Insurance Research Database. The CHB patients with DM compared to the non-DM had significantly increased (3.3%) risk for HCC development and significantly increased (2.8%) risk of HCC-related mortality. Interestingly, the all-cause mortality was significantly higher in the DM cohort (16.9%) compared to the non-DM cohort (8.2%). In a multivariable transition-specific Cox model to investigate the adjusted hazard ratio of CHB patients with DM or non-DM during the transitions from start to HCC was 1.35; 95% CI (1.16-1.57) and from HCC to death was 1.31; 95% CI (1.06-1.62). All-cause mortality between CHB patients with DM or non-DM during the transitions from start to death was 2.32; 95% CI (1.84-2.92). Taken together, DM is an independent risk factor associated with increasing disease development of HCC, HCC-related mortality and all-cause mortality in CHB patients. This study may provide a clinical strategy for strict DM control in order to reduce the risk of disease development in CHB patients.

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