Alcohol is a hepatotoxin that is commonly consumed worldwide and is associated with a spectrum of liver injury including simple steatosis or fatty liver, alcoholic hepatitis, fibrosis, and cirrhosis. Alcoholic liver disease (ALD) is a general term used to refer to this spectrum of alcohol-related liver injuries. Excessive or harmful alcohol use is ranked as one of the top five risk factors for death and disability globally and results in 2.5 million deaths and 69.4 million annual disability adjusted life years. All patients who present with clinical features of hepatitis or chronic liver disease or who have elevated serum elevated transaminase levels should be screened for an alcohol use disorder. The diagnosis of ALD can generally be made based on history, clinical and laboratory findings. However, the diagnosis of ALD can be clinically challenging as there is no single diagnostic test that confirms the diagnosis and patients may not be forthcoming about their degree of alcohol consumption. In addition, clinical findings may be absent or minimal in early ALD characterized by hepatic steatosis. Typical laboratory findings in ALD include transaminase levels with aspartate aminotransferase greater than alanine aminotransferase as well as increased mean corpuscular volume, gamma-glutamyltranspeptidase, and IgA to IgG ratio. In unclear cases, the diagnosis can be supported by imaging and liver biopsy. The histological features of ALD can ultimately define the diagnosis according to the typical presence and distribution of hepatic steatosis, inflammation, and Mallory-Denk bodies. Because of the potential reversible nature of ALD with sobriety, regular screening of the general population and early diagnosis are essential.

BackgroundHepatitis C (HCV) knowledge is limited in injection drug users (IDU). Vulnerable populations including IDUs are disproportionally affected by HCV. Effective HCV education can potentially reduce disparity in HCV prevalence and its outcome in this population.AimThis study aimed to assess the impact of formal HCV education and factors associated with improved HCV knowledge in the vulnerable population.MethodsOver 18 months, 201 HCV-infected patients underwent a 2-h standardized education and completed demographic and pre- and post-education questionnaires.ResultsPatient characteristics were: 69% male, mean age 49 ± 10, 49% White (26% AA, 10% Latino), 75% unemployed, 83% high school education and above, 64% were IDU, and 7% were HIV co-infected. On multivariate analysis, baseline knowledge scores were higher in patients with at least a high school education (coef 7.1, p = 0.045). Baseline knowledge scores were lower in African Americans (coef −12.3, p = 0.004) and older patients (coef −0.7, p = 0.03). Following HCV education, the overall test scores improved significantly by 14% (p = 0.0001) specifically in the areas of HCV transmission (p = 0.003), general knowledge (p = 0.02), and health care maintenance (p = 0.004). There was a high compliance with liver specialty clinic attendance following education.ConclusionsFormal HCV education is effective in improving HCV knowledge. Although White race, younger age, and higher education were predictors of having more HCV knowledge prior to education, all patients independent of racial background had a significant improvement in their knowledge after education. Therefore, promoting effective HCV education among vulnerable populations may be an important factor in reducing the disparities in HCV disease.

Background Patients in rural communities are less likely to receive treatment for their hepatitis C (HCV) infection. Telemedicine (TM) consultation can close the gap of access to specialists in remote and under-served areas. Aim To determine treatment response and side-effect profiles among HCV patients treated with pegylated interferon and ribavirin via TM consultation in different rural locations in Northern California compared with patients treated in traditional hepatology office visits. Methods We performed a retrospective analysis of 80 HCV patients treated at different TM sites (TM, n = 40) and at the University of California Davis Hepatology Clinic (HC, n = 40) between 2006 and 2010, comparing baseline characteristics and clinical outcomes. Results At baseline, response to therapy was similar for patients in both groups. Sustained virological response (SVR) was similar in both groups (TM: 55 vs. HC: 43 %; p = 0.36), and a higher proportion of patients treated via telemedicine completed treatment (TM: 78 vs. HC: 53 %; p = 0.03). TM patients had many more visits per week of therapy (TM: 0.61 vs. HC: 0.07; p < 0.001). Neutropenia, GI side effects, fatigue, depression, weight loss, insomnia, and skin rash were similar in both groups. For HC patients incidence of anemia was significantly higher (53 %) than for the TM group (25 %; p = 0.02). Conclusions The two groups had equivalent SVR. For the TM group therapy completion was superior and incidence of anemia was lower. This initial study suggests that, as a group, patients with HCV, can be safely and effectively treated via telemedicine.

The proportion of HCC cases diagnosed early, and the 2- and 5-year survival trends of all HCC patients have increased in California since 1988. It is not entirely clear whether better diagnostic imaging or better surveillance has led to these findings and whether earlier diagnosis has led to improved patient survival. This increase in survival among patients with HCC may be correlated with the innovation of new treatments and most importantly that patients are being diagnosed earlier to receive such treatments.

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