Alcohol-associated liver disease is a leading cause of mortality and morbidity worldwide. Patients with alcohol-associated liver disease are often diagnosed at advanced stage and disease spectrum including alcoholic hepatitis, a severe manifestation with a high short-term mortality. Corticosteroid, recommended first-line treatment for patients with alcoholic hepatitis, is a very suboptimal treatment. Although the use of early liver transplantation has increased with consistent benefit in select patients with alcoholic hepatitis, its use remains heterogeneous worldwide due to lack of uniform selection criteria. Over the last decade, several therapeutic targets have evolved of promise with ongoing clinical trials in patients with cirrhosis and alcoholic hepatitis. Even with availability of effective medical therapies for alcohol-associated liver disease, long-term outcome depends on abstinence from alcohol use in any spectrum of alcohol-associated liver disease. However, alcohol use disorder treatment remains underutilized due to several barriers even in patients with advanced disease. There is an urgent unmet need to implement and promote integrated multidisciplinary care model with hepatologists and addiction experts to provide comprehensive management for these patients. In this review, we will discuss newer therapies targeting liver disease and therapies targeting alcohol use disorder in patients with alcohol-associated liver disease.

Context Cholangiocarcinoma (CCA), a malignancy of the biliary tract epithelium is of increasing importance due to its rising incidence worldwide. There is a lack of data on cirrhosis in intrahepatic CCA (iCCA) and how it affects overall survival and prognosis. Objectives The primary objective of this study was to examine if there were differences in survival outcomes between iCCA patients with concomitant cirrhosis and those without cirrhosis. Methods The National Cancer Database (NCDB) was used to identify and study patients with iCCA from 2004 to 2017. The presence of cirrhosis was defined using CS Site-Specific Factor 2 where 000 indicated no cirrhosis and 001 indicated the presence of cirrhosis. Descriptive statistics were utilized for patient demographics, disease staging, tumor, and treatment characteristics. Kaplan-Meier (KM) method with log-rank test and a multivariate logistic regression model was used to assess if the presence of cirrhosis in iCCA was associated with survival status and long-term survival (60 or more months after diagnosis). Results There were 33,160 patients with CCA in NCDB (2004–2017), of which 3644 patients were diagnosed with iCCA. One thousand fifty-two patients (28.9%) had cirrhosis as defined by Ishak Fibrosis score 5–6 on biopsy and 2592 patients (71.1%) did not meet the definition for cirrhosis. Although in univariate analyses using KM/log-rank tests showed a survival advantage for non-cirrhotic patients, there was no statistically significant association found between cirrhosis and survival status (OR = 0.82, p = 0.405) or long-term survival (OR = 0.98, p = 0.933) when multivariate analysis was used. iCCA patients with cirrhosis and Stage 1 tumor had the highest median OS (132 months) vs 73.7 months in the non-cirrhotic arm, while patients with stage IV disease who had cirrhosis had half the survival time of those without. Our data thus indicates that the presence of cirrhosis is not an independent prognostic factor for survival.

Background:The endoscopic Mayo score (MS) is the most frequent score used for the evaluation of inflammatory activity in Ulcerative Colitis (UC), varying from 0 to 3 points. Recently the DUBLIN score (DS) emerged, which varies from 0 to 9 points and results from the product of the MS and the disease extent, according to Montreal classification, E1-E3. In this study we aimed to evaluate and compare the predictive ability of MS and DS for long term treatment failure. Methods: A retrospective and unicentric study was conducted, including patients with left-sided or extensive UC, asymptomatic and without the need for steroid therapy or therapy changes in the 6 months prior to undergoing total colonoscopy with calculation of MS and DS. Treatment failure was evaluated, defined by the need for therapy changes and/or hospitalization because of disease exacerbation, over a follow-up period of a minimum of 24 months and a maximum of 84 months. Results: A total of 204 patients were included, 104 (51%) females and with a mean age at diagnosis of 36.4 6 12.7 years. In the initial evaluation, 48 (23.5%) were being treated with anti-TNFa medication. The mean values of MS were 1.0 6 1.1 points and of DS were 2.2 6 2.6 points. During follow-up, 32 (15.7%) patients experienced treatment failure and patients initially treated with anti-TNFa medication had 2.3 times higher risk of treatment failure (P 5 0.042). MS values (AUC 0.809; P , 0.001; with sensitivity of 0.938 and specificity of 0.529 for values equal or superior to 1) and DS values (AUC 0.789; P , 0.001; with sensitivity of 0.844 and specificity of 0.581 for values equal or superior to 2) had good discriminative abilities in predicting treatment failure. There were no statistically significant differences in the discriminative ability between both scores (P 5 0.340). Conclusion(s): MS and DS had good discriminative abilities in predicting treatment failure. However, the integration of the disease extent in the DS as a complement of MS in the evaluation of UC was not associated with a higher predictive ability of long term treatment failure.

e16192 Background: Cholangiocarcinoma (CCA), a malignancy of the biliary tract epithelium, is of increasing importance due to its rising incidence worldwide. However, it also remains one of the most lethal malignances with a survival rate ranging between 6-16 months. Despite poor outcomes, palliative care remains underutilized in CCA. Determining outcomes, and differences in various CCA types remains crucial in helping patients and clinicians make goal of care decisions with regards to aggressive treatment. Objectives:The objective of this study is to compare survival outcomes between intrahepatic (iCCA) and extrahepatic cholangiocarcinoma (eCCA). In addition, it aims to compare the utilization palliative care in either subtype, considering the high morbidity and mortality of the disease. Methods: Pooled cross-sectional observational study of the2004-2017 National Cancer Database (NCDB), which contains almost 400,000 records. The study population included de-identified records of patients with CCA; ages 18-90. Descriptive statistics (frequency, means, and standard deviations) were used. For survival analyses, the Kaplan-Meier method with log-rank test and a multivariate Cox regression model was used. Results: A total of 53,054 patients with CCA were identified. Of which, 63.4% had iCCA and 36.7% of patients had eCCA. There were statistically significant differences between the two cohorts in regard to sex, race/ethnicity, as well as in Charlson Co-Morbidity score. 65.2% of iCCA patients had advanced clinical stages III/IV as compared to 62.5% of eCCA patients. Higher percentage of iCCA patients had bone metastasis (7.8% vs 4.6 %, p < 0.001), pulmonary metastasis (11.5% vs 7.8%; p <0.001) and tumor size greater than 5 cm (62.1% vs 20.7%, p <0.001) compared to eCCA. Regarding treatment, patients with iCCA were more likely to receive multi-agent chemotherapy (35.0% vs 26.2 %, p<0.001). Although statistically significant differences for primary site surgical intervention (25.5% vs 25.0%, p<0.001), as well as for immunotherapy (6% vs 5.4%, p= 0.048), was found, they were not clinically significant. Patients with eCCA had a higher 90-day mortality (11.4% vs 8.2%, p <0.001), with 21% less likelihood of survival compared to iCCA patients (AOR:0.79, CI:0.74-0.84). Palliative care remained underutilized, with a lower utilization in iCCA (15.7% vs 12.5%, p <0.001). Conclusions: Our study demonstrated that iCCA patients have better survival outcomes compared to eCCA patients. This could be due to biological/genomic differences which warrant future investigation. Future clinical trials could also stratify for the location of CCA. Despite CCA’s poor prognosis, palliative care remained underutilized, with lower utilization rates in iCCA compared to eCCA.

Figure 1. Axial CTA abdomen venous phase showing aneurysmal communication (red arrow) between right portal vein (yellow arrow) and middle hepatic vein (green arrow) in segment 6 of the liver.