Background & Aims Concurrent to development of more effective drugs for treatment of hepatitis C virus (HCV), infection, there has been an increase in the incidence of non-alcoholic fatty liver disease (NAFLD). Data indicate that liver transplantation prolongs survival times of patient with acute hepatitis associated with alcoholic liver disease (ALD). We compared data on disease prevalence in the population with data from liver transplantation waitlists to evaluate changes in the burden of liver disease in the United States. Methods We collected data on the prevalence of HCV from the National Health and Nutrition Examination Survey (NHANES), from the 2010 and 2013–2014 cycles. We also collected data from the HealthCore Integrated Research Database on patients with cirrhosis and chronic liver failure (CLF) from 2006 through 2014, and data on patients who received transplant from the United Network for Organ Sharing (UNOS), from 2003 through 2015. We determined percentages of new waitlist members and transplant recipients with HCV infection, stratified by indication for transplant, modeling each calendar year as a continuous variable using the Spearman rank correlation, non-parametric test of trends, and linear regression models. Results In an analysis of data from the NHANES (2013–2014), we found that the proportion of patients with a positive HCV antibody who had a positive HCV RNA was 0.5 (95% CI, 0.42–0.55); this value was significantly lower than in 2010 (0.64; 95% CI, 0.59–0.73) (P=.03). Data from the HealthCore databased revealed significant changes (P<.05 for all), over time, in percentages of patients with compensated cirrhosis (decreases in percentages of patients with cirrhosis from HCV or ALD, but increase in percentages of patients with cirrhosis from non-alcoholic steatohepatitis [NASH]), CLF (decreases in percentages of patients with CLF from HCV or ALD, with an almost 3-fold increase in percentage of patients with CLF from NASH), and hepatocellular carcinoma (HCC) (decreases in percentages of patients with HCC from HCV or ALD and a small increase in HCC among persons with NASH). Data from the UNOS revealed that among patients new to the liver transplant waitlist, or undergoing liver transplantation, for CLF, there was a significant decrease in the percentage with HCV infection and increases in percentages of patients with NAFLD or ALD. Among patients new to the liver transplant waitlist, or undergoing liver transplantation, for HCC, proportions of those with HCV infection, NAFLD, or ALD did not change between 2003 and 2015 Conclusions In an analysis of 3 different databases (NHANES, HealthCore, and UNOS), we found the proportion of patients on the liver transplant waitlist or undergoing liver transplantation for chronic HCV infection to be decreasing, and fewer patients to have cirrhosis or CLF. However, the percentages of patients on the waitlist or receiving liver transplants for NASH or ALD are increasing, despite different relative burdens of disease among the entire population of patie...

NART is a safe to use for RPS, but its effect toward survival and local control remains unclear. Without randomized control trials, common reporting criteria for pro- and retrospective studies are needed to allow comparison between studies. J. Surg. Oncol. 2016;113:628-634. © 2016 Wiley Periodicals, Inc.

Background and Aims: Chronic opioid effects on the esophagus are poorly understood. We investigated whether opioids were associated with increased prevalence of esophageal motility disorders.Methods: A retrospective study of all patients undergoing high-resolution manometry (HREM) at the Yale Gastrointestinal Motility Lab between January 2014 and August 2019. Data were extracted from the electronic medical record after studies were reviewed by two motility specialists using the Chicago Classification v.3.0. We compared the manometric results of patients who use opioids to those who do not and adjusted for type and dose of opioids using a 24 h Morphine Milligram Equivalents (MME) scale to compare patients taking low or high amounts of opioids.Results: Four manometric abnormalities were significantly different between the opioid and non-opioid users. Achalasia type III, esophagogastric junction outflow obstruction (EGJOO), and distal esophageal spasm (DES) (p < 0.005, p < 0.01, and p < 0.005, respectively) were common among opioid users, whereas ineffective esophageal motility (IEM) was more common among non-opioid users (p < 0.01). The incidence of EGJOO was significantly higher in opioid users compared to non-opioid users (p < 0.001). Lastly, IRP, DCI, and distal latency were significantly different between the two groups.Patients in the high MME group had significantly greater IRP, DCI, and lower distal latency than non-opioids (p < 0.001). Also, achalasia type III and DES were more common in the high but not the low MME group.Conclusions: Opioid use is associated with multiple abnormalities on esophageal motility and these effects may be dose-dependent.

INTRODUCTION: It is thought that regurgitation is brought on by changes in esophageal pressure ultimately causing a transient relaxation in the lower esophageal sphincter (LES) with resultant regurgitation. However, it is unknown if the severity of regurgitation symptoms experienced by a patient are related to the basal LES pressure. Our hypothesis is that patients with more severe regurgitation symptoms have lower basal LES pressures. METHODS: A retrospective chart review was completed on all patients referred to our tertiary care hospital for esophageal manometry testing with impedance in 2016. Basal LES pressure (as measured on manometry), regurgitation severity (as reported on pre-manometry patient questionnaire), age, and sex were recorded for each patient. Only patients who reported both regurgitation symptoms and specified severity were included in the final analyses. Mean LES pressures were compared between regurgitation severities and P-values were calculated for all pairwise comparisons. RESULTS: Of the 354 patients referred for manometry, 167 patients (41 males, mean age 54.6; 126 females, mean age 55.6) endorsed regurgitation. Of those 167 patients, 62 reported their symptoms as “mild”, 61 as “moderate”, 29 as “severe”, and 15 as “very severe”. The average LES pressure was 33.22 mmHg for those with mild regurgitation, 27.98 for moderate, 23.94 for severe, and 19.02 for very severe (P = 0.03). There was also a statistically significant difference in LES pressures between mild and severe regurgitation (P=0.03) and mild and very severe regurgitation (P = 0.01). CONCLUSION: Overall, it is known that transient relaxations in LES pressure lead to regurgitation. However, we aimed to assess if there is a difference in basal LES pressures amongst patients who experience regurgitation symptoms, as perhaps a lower basal pressure makes a patient more prone to experiencing more severe regurgitation. There was a statistically significant difference in basal LES pressures amongst patients with varying severities of regurgitation. Future studies should look at pH testing to note if there is an actual increase in proximal acid exposure in patients with lower basal LES pressures and more severe regurgitation.

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