NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #178

Joe Krenitsky

In this article, we take a close look at enhanced enteral nutrition (EN) protocols, including volumebased feeding (VBF), which have been highly promoted. Evidence suggests that some enhanced EN protocols may be harmful to some critically ill adult patients and should be avoided. Although observational studies have reported an association between delayed provision of goal nutrition and compromised patient outcomes, interventional studies have reported more compromised outcomes than benefits from early goal nutrition and VBF in critically ill adult patients.

DISPATCHES FROM THE GUILD CONFERENCE, SERIES #15

Guadalupe Garcia-Tsao

Cirrhosis is the end result of any chronic liver disease and is an entity that progresses across different prognostic stages, the most important being the compensated (asymptomatic) and the decompensated (symptomatic) stages. Here, we discuss these stages, defined by the absence or presence of overt complications of cirrhosis, specifically variceal hemorrhage, ascites and encephalopathy.1 Each stage has entirely different prognosis, predictors of death and predominant pathogenic mechanisms and therefore should be managed separately both in research and in practice.

A SPECIAL ARTICLE

Sheryl Rosa, Walisbeth Class, Henry DeJesus, Doris H. Toro

The incidence of hepatocellular carcinoma (HCC) due to hepatitis C virus (HCV) infection has been rising worldwide as well as in the United States. Current American Association for the Study of Liver Disease (AASLD) guidelines recommend performing an abdominal ultrasound in cirrhotic patients every six months for early detection of HCC. The main objective of this study was to retrospectively evaluate a population diagnosed with HCC secondary to HCV in the Veterans Administration (VA) Caribbean Healthcare system and to determine if screening strategies were applied appropriately. Secondary aims were to describe certain patient characteristics upon diagnosis of HCC and determine the median survival time of this population. It was found that in 95.4% of the cases, the diagnosis of HCC was incidental, and not part of a surveillance strategy. More so, the median survival after diagnosis was only 10 months. These findings should help raise awareness of the importance of HCC surveillance in cirrhotic patients with or without HCV.

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