IBD prevalence and incidence rates are high in Tasmania, comparable to data from other Australasian studies and those from Northern Europe and America. Poorer twelve month clinical outcomes occurred in complicated CD, with greater use of healthcare resources. This article is protected by copyright. All rights reserved.

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Introduction For the first time in nearly half a century, fatty liver disease has undergone a change in name and definition, from the exclusive term, non-alcoholic fatty liver disease (NAFLD), to the inclusion-based, metabolic-associated fatty liver disease (MAFLD). This has led investigators across the globe to evaluate the impact the nomenclature change has had on the epidemiology and natural history of the disease. Methods This systematic review provides a comprehensive overview on how the shift in name and diagnostic criteria has influenced point prevalence in different geographic regions, as well as morbidity and mortality risk, whilst highlighting gaps in the literature that need to be addressed. Conclusions MAFLD prevalence is higher than NAFLD prevalence, carries a higher risk of overall mortality, with greater granularity in risk-stratification amongst MAFLD subtypes. Graphical abstract

Upper gastrointestinal bleeding from oesophageal or gastric varices is an important medical condition in patients with portal hypertension. Despite the emergence of a number of novel endoscopic and radiologic therapies for oesophagogastric varices, controversy exists regarding the indication, timing and modality of therapy. The aim of this review is to provide a concise and practical evidence-based overview of these issues.

LINKED CONTENTThis article is linked to Forrest et al and Forrest & Goldin papers. To view these articles, visit https://doi.org/10.1111/apt.16157 and https://doi.org/10.1111/apt.16559

AIM: This retrospective study of 85 cirrhotics aimed to identify variables during the first 24 hours of intensive care unit (ICU) admission predicting mortality up to 30 days of hospital discharge, and to analyse the prognostic accuracy of common severity scores in predicting mortality. MATERIALS AND METHODS: Eighty-five patients with liver cirrhosis admitted to ICU at the Royal Hobart Hospital, a regional Australian center, from 2007 to 2013 inclusive were identified using International Classification of Disease coding and data extracted from medical records. Predictors of mortality were determined via logistic regression and the prognostic accuracy of 5 severity scores calculated by their area under the receiver-operating curve. These included 2 scores commonly used in liver disease; Child Pugh and Model for End-Stage Liver Disease (MELD); as well as 3 scores designed in the intensive care setting: Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology (SAPS II) and Acute Physiology and Chronic Health Evaluation (APACHE II). RESULTS: Significant variables predicting short-term mortality included infection (excluding spontaneous bacterial peritonitis), requirement for inotropes or mechanical ventilation, elevated creatinine, decreased Glasgow Coma Scale, decreased pH and elevated white cell count. However the presence of cirrhosis-specific complications such as hepatic encephalopathy, variceal bleeding and spontaneous bacterial peritonitis did not predict mortality and liver-specific prognostic severity scores (Child Pugh and MELD) performed more poorly than the other severity scores designed for the ICU setting. CONCLUSIONS: ICU admission for cirrhotics should not be deemed futile in the presence of hepatic dysfunction alone; cardiorespiratory, neurological and renal dysfunction should be taken into account. ICU-specific severity scores better prognosticate shortterm mortality compared to liver-specific scores.

Question: A 44-year-old woman with known decompensated alcohol-related cirrhosis and portal hypertension presented with a single day history of painless bleeding per rectum. Her medical history was unremarkable beyond the chronic liver disease, but had disease-related complications of ascites, esophageal varices managed prophylactically through a banding eradication program, hepatic encephalopathy, and a prior episode of steroid-responsive alcoholic hepatitis. She had no history of abdominal surgery and had remained abstinent for 2 months before presentation.At presentation, she was hemodynamically unstable, with tachycardia (pulse rate 110 bpm) and systolic hypotension (90 mm Hg). Initial hemoglobin was 54 g/L, platelet count 200 Â 10 9 /L, and international normalized ratio was 1.7.Emergent contrast-enhanced computed tomography scan (Figure A), colonoscopy (Figure B), and mesenteric angiography (Figure C) were undertaken, with diagnostic features demonstrated. What is the cause of this patient's lower gastrointestinal bleeding? Look on page 835 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI.

Introduction Gastric adenocarcinoma is a known complication of partial gastrectomy. Jaundice from gastric adenocarcinoma usually occurs in the setting of hepatic nodal or parenchymal metastasis. This case demonstrates an unusual level of biliary obstruction from gastric adenocarcinoma. Case presentation An 84-year-old Caucasian man was diagnosed as having a new gastric adenocarcinoma at the level of the gastroenteric anastomosis of a prior Billroth II gastrectomy after presenting with painless jaundice. He had a non-dilated biliary tree on radiographic imaging despite evidence of large bile duct obstruction on liver biopsy. The obstruction was managed with endoscopic wire-guided stenting of the malignant tumor. Conclusions The unusual finding of a non-dilated biliary tree in the face of obstructive jaundice is likely to have resulted from the unusual post-surgical anatomy and hence distal level of obstruction. Endoscopic duodenal stenting is a novel method of managing obstructive jaundice in gastric adenocarcinoma.