NAFLD is one of the most important causes of liver disease worldwide and will probably emerge as the leading cause of end-stage liver disease in the coming decades, with the disease affecting both adults and children. The epidemiology and demographic characteristics of NAFLD vary worldwide, usually parallel to the prevalence of obesity, but a substantial proportion of patients are lean. The large number of patients with NAFLD with potential for progressive liver disease creates challenges for screening, as the diagnosis of NASH necessitates invasive liver biopsy. Furthermore, individuals with NAFLD have a high frequency of metabolic comorbidities and could place a growing strain on health-care systems from their need for management. While awaiting the development effective therapies, this disease warrants the attention of primary care physicians, specialists and health policy makers.

/pdf/global-burden-of-nafld-and-nash-trends-predictions-risk-2rbbbzfuoo.pdf

Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention

https://www.journal-of-hepatology.eu/article/S0168-8278(18)32388-2/pdf

Burden of liver diseases in the world

https://research.birmingham.ac.uk/portal/files/98025484/1_s2.0_S0168827820302014_main.pdf

A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement.

There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia–Pacific region, where HCC is one of the leading public health problems. Since the “Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines” meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments.

/pdf/asia-pacific-clinical-practice-guidelines-on-the-management-3qdf1cp1jm.pdf

Asia–Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update

Non-alcoholic fatty liver disease - A global public health perspective.

Comment to: “EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease”

Refeeding syndrome (RS) is a life-threatening condition first described in severe malnourished prisoners of the Second World War1. This syndrome is defined as electrolyte and fluid shifts associated with metabolic abnormalities developed during nutritional support. RS hallmark is hypophosphatemia, but also includes hypomagnesemia, hypokalemia, vitamin deficiencies, abnormal glucose metabolism and fluid retention. Prolonged fasting is the most important risk factor and RS may be precipitated by oral, enteral or parenteral nutrition4,5. The authors describe a case of RS in the gastroenterology ward exemplifying the importance of recognizing this underreported condition in patients with digestive pathology under nutritional therapy.

https://www.scielo.br/j/abcd/a/WjccKnZyz8sG4pr4vYmDQPp/?format=pdf&lang=en

Refeeding syndrome in a patient with an obstructive pancreatic cancer: an emerging complication of artificial nutrition in the gastroenterology ward.

1289P Quality of death in cancer patients managed by gastroenterologists

We present the case of a 57-year-old man who was admitted for weight loss (>15% in 4 months) and recurrent vomiting. His medical history included type II diabetes mellitus and a gastroduodenal surgery 15 years before due to complicated peptic ulcer disease. On admission, he was malnourished and severely dehydrated. An abdominal computed tomography showed marked gastric distension due to partially occlusive heterogeneous luminal content in the antrum and proximal duodenum. On upper gastrointestinal endoscopy, a Billroth I partial gastrectomy was observed. A bulky bezoar extending from the distal body to the gastroduodenal anastomosis was identified and successfully broken up in fragments of <2 cm, using foreign body forceps and a polypectomy snare, after through-the-scope irrigation and needle injection with Coca-Cola® (Figure 1a, b). After the procedure, a solid diet was restarted. The patient became asymptomatic and was discharged the following day. He was advised to ingest large amounts of Coca-Cola® for a few weeks. After 3 days, he was readmitted because of recurrent vomiting, dehydration, and oral feeding intolerance. On endoscopy, his stomach was empty, but a striking distension of the duodenum and jejunum, filled by liquid and undigested material, prevented mucosal examination. Total parenteral nutrition was started to control malnutrition, and a magnetic resonance enterography performed 1 week later showed a 5.6×3.8-cm bezoar in the distal

/pdf/small-bowel-obstruction-after-endoscopic-fragmentation-of-a-me9j379dq6.pdf

Manuela Canhoto

Papers

Comment to: “EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease”

Refeeding syndrome in a patient with an obstructive pancreatic cancer: an emerging complication of artificial nutrition in the gastroenterology ward.

1289P Quality of death in cancer patients managed by gastroenterologists

Small bowel obstruction after endoscopic fragmentation of a gastric bezoar: An unexpected complication.

1278P How do hospitalized patients with chronic liver disease, with and without hepatocellular carcinoma, die? End-of-life quality analysis