Despite a significant worldwide decline, gastric cancer remains a common cause of cancer death. The decline has been multifactorial and preceded the fall in Helicobacter pylori prevalence. The initial decline was associated with changes in food preservation and availability, especially of fresh fruits and vegetables, followed by a decline in the primary etiologic factor, H. pylori. Gastric cancer incidence remains high in East Asia, intermediate in Latin America, and low in developed countries. Significant racial/ethnic variability exists. The rapid decline in incidence in East Asia will continue as primary and secondary prevention strategies are implemented. The incidence in Latin America is unlikely to decline significantly over the next few decades given high H. pylori prevalence in the young. Ultimately, global H. pylori eradication will be needed to largely eliminate gastric cancer.

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The association of chronic liver disease with respiratory symptoms and hypoxia is well recognized. Over the last century, three pulmonary complications specific to chronic liver disease have been characterized: hepatopulmonary syndrome (HPS), portopulmonary hypertension (POPH), and hepatic hydrothorax (HH). The development of portal hypertension is fundamental in the pathogenesis of each of these disorders. HPS is the most common condition, found in 5%-30% of cirrhosis patients, manifested by abnormal oxygenation due to the development of intrapulmonary vascular dilatations. The presence of HPS increases mortality and impairs quality of life, but is reversible with liver transplantation (LT). POPH is characterized by development of pulmonary arterial hypertension in the setting of portal hypertension, and is present in 5%-10% of cirrhosis patients evaluated for LT. Screening for POPH in cirrhosis patients eligible for LT is critical since severe POPH is a relative contraindication for LT. Patients with moderate POPH, who respond adequately to medical therapy, may benefit from LT, although sufficient controlled data are lacking. HH is a transudative pleural effusion seen in 5%-10% of cirrhosis patients, in the absence of cardiopulmonary disease. Diagnosis of HH should prompt consideration for LT, which is the ultimate treatment for HH. Conservative management includes salt restriction and diuretics, with thoracentesis and transjugular intrahepatic portosystemic shunt (TIPS) as second-line therapeutic options. (HEPATOLOGY 2014;59:1627-1637 Hepatopulmonary SyndromeThe hepatopulmonary syndrome (HPS) is defined by an oxygenation defect caused by the development of intrapulmonary vascular dilatation (IPVD) in patients with either advanced liver disease and/or portal hypertension. Impaired oxygenation in HPS is reflected by a widened age-corrected alveolar-arterial oxygen gradient (P[A-a]O 2 ) on room air, with or without hypoxemia. 1 Cirrhosis, irrespective of the underlying cause, is the most common hepatic condition associated with HPS. However, HPS may also develop in noncirrhotic portal hypertension and ischemic hepatitis.2,3 HPS may occur in patients with coexisting cardiopulmonary conditions and further exacerbate existing respiratory symptoms and hypoxemia in these patients. 4 PathogenesisThe appearance of IPVD underlies the development of HPS. This vascular abnormality consists of diffuse or localized dilated abnormal pulmonary capillaries and, less commonly, pleural and pulmonary arteriovenous communications which result in impaired oxygenation of venous blood as it passes through the pulmonary circulation.5 Nitric oxide (NO), a potent vasodilator, has been linked to IPVD. Increased levels of exhaled NO derived from the lung are seen in cirrhosis patients with HPS, which normalize after liver transplantation (LT). 6Chronic common bile duct ligation in the rat results in biliary cirrhosis, and recapitulates the physiologic changes of human HPS. The majority of what is Abbreviations: ABG, arterial blood gas; ...

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Background Non-alcoholic fatty liver disease (NAFLD) is increasingly common in the adult population. In the United States, the overall burden of NAFLD is unknown due to challenges with population-level NAFLD detection. The purpose of this study was to estimate prevalence of NAFLD and significant NAFLD fibrosis and identify factors associated with them in the U.S. Methods Data came from the 2017–2018 cycle of National Health and Nutrition Examination Survey. We defined NAFLD by controlled attenuation parameter (CAP) scores of ≥248 dB/m in absence of excessive alcohol use and viral hepatitis. We defined significant fibrosis as Vibration controlled transient elastography (VCTE) liver stiffness measurements (LSM) value ≥7.9 kPa. We calculated the adjusted odds ratio (OR) and 95% confidential intervals (CI) for associations with NAFLD and significant NAFLD fibrosis using multivariable logistic regression. Results Overall, among 4,024 individuals aged ≥20 years included in the analysis, 56.7% had NAFLD by CAP. In comparison, when defined by elevated liver enzymes, NAFLD prevalence was 12.4%. The prevalence of significant NAFLD fibrosis by VCTE LSM was 14.5%. NAFLD prevalence increased with age, was higher among men than women and among Hispanics compared with non-Hispanic whites. Individuals who were obese, had metabolic syndrome (MetS) and type 2 diabetes were more likely to have NAFLD compared to those that who were not obese or without MetS/diabetes. Inadequate physical activity (OR = 1.57, 95% CI: 1.18–2.08) was also a factor associated with NAFLD. MetS, high waist circumstance, diabetes and hypertension were independently associated with significant NAFLD fibrosis. Conclusions NAFLD and significant NAFLD fibrosis are highly prevalent in U.S. general population.

Divergent trends for gastric cancer incidence were observed in the USA. Incidence rates, particularly for non-cardia gastric cancer, were stable or increasing among persons aged <50 years.

Current recommendations for high-dose AA starting at birth are not associated with improved growth or neurodevelopmental outcomes.

Trials of probiotics have been shown to be helpful in some of these, not in others, and more work is needed in others. We review recent work done in these areas.