Philip N. Okafor

Importance: Chronic liver disease requires sustained engagement with the health system, which co-occurring social and functional risks may disrupt. Whether these risks form reproducible patterns with different mortality associations is uncertain. Objective: To identify social and functional risk patterns among US adults with chronic liver disease and evaluate their associations with all-cause mortality. Design, Setting, and Participants: Nationally representative cohort study of National Health Interview Survey sample adults interviewed from 2011 through 2018 and linked to the National Death Index through 31 December 2019. Participants were aged 18 years or older, eligible for mortality linkage, reported a chronic liver condition, and had no baseline liver cancer. Exposures: Latent class membership derived from 7 binary indicators: poverty, food insecurity, uninsurance, cost-related delayed care, no usual place of care, single-adult household status, and activity limitation. A complete 0- to 7-item count was a secondary exposure. Main Outcomes and Measures: All-cause mortality. Survey-weighted Cox models estimated hazard ratios (HRs) with sequential demographic, clinical, and liver-specific adjustment. Prespecified sensitivity analyses used 20 multiple imputed data sets, sampling-weighted pseudo-likelihood latent class models, complete-case re-estimation, a fixed 5-year horizon, and class-by-age interaction testing. Results: Among 3407 adults (weighted mean age, 54.0 years; 49.4% female), 529 deaths occurred over 17,297.6 person-years (median follow-up, 5.0 years [IQR, 3.0–7.0]). Four classes were retained: low social and access burden (weighted prevalence, 63.1%); functional limitation with financial strain (13.2%); poverty, single-adult household, and functional limitation (15.0%); and uninsurance with major access barriers (8.7%). Compared with the low-burden class, the functional-limitation/financial-strain class had higher adjusted mortality (HR, 1.95; 95% CI, 1.34–2.82; p < 0.001); the other 2 classes did not differ significantly. Sampling-weighted latent class analysis after multiple imputation reproduced 97.2% of modal assignments, and the association persisted with attenuation (HR, 1.55; 95% CI, 1.08–2.22; p = 0.02). Each additional risk was associated with higher mortality (exact count: HR, 1.24 [95% CI, 1.13–1.36]; imputed count: HR, 1.19 [95% CI, 1.10–1.29]). The class-by-age interaction was not significant (p = 0.41). Conclusions and Relevance: Among US adults with self-reported chronic liver disease, social and functional adversity was both cumulative and patterned. A profile combining functional limitation, food insecurity, and cost-related delayed care had the clearest independent mortality association despite largely retained insurance coverage. These profiles are not a validated clinical score, but the findings argue against reliance on any single indicator, particularly insurance status, as a marker of vulnerability.

There is a paucity of outcome data among homeless individuals with inflammatory bowel diseases (IBD). We reported rates of homelessness among inpatients wi

Significance: Hepatic encephalopathy (HE) occurs in 20–80% of patients with liver cirrhosis, impacting attention, memory, processing speed, and visuospatial skills. HE standard-of-care psychometric assessments are time-consuming and require staff training. Oculometrics may provide a fast, non-invasive brain health assessment that can be self-administered in a medical environment. Purpose: We investigated whether an oculometric assessment could measure the severity of HE as accurately as standard-of-care psychometric methods. Methods: Forty-eight participants (19 with decompensated cirrhosis, 10 with compensated cirrhosis, 19 controls) completed a previously validated five-minute oculometric test and the standard-of-care psychometric hepatic encephalopathy (PHE) battery. The oculometric test consists of following a dot as it moves across a computer screen and generates 10 metrics including a summary score called nFit. The PHE battery entails five standard cognitive tests, generating seven metrics including a PHE composite score (PHES). Results: The oculometric summary score, nFit, correlated with the current diagnostic standard, the PHES (r = 0.51, p < 0.001), the presence or absence of HE as determined by PHES composite (r = −0.44, p < 0.001), as well as the severity of cirrhosis (r = −0.59, p < 0.001). Additionally, performance on both nFit and PHES distinguished compensated (ROC: nFit: 0.71, PHES: 0.68) and decompensated (ROC: nFit: 0.88, PHES: 0.85) patient groups from control participants comparably. Finally, compared to participants with decompensated cirrhosis, control participants had better scores for almost all oculometrics: acceleration, catch-up saccade amplitude, proportion smooth, direction noise, and speed noise. Conclusions: Patients with liver disease showed impairment on multiple aspects of visual processing compared to a control group. These functional visual processing impairments correlate with the presence or absence of HE, showing significant sensitivity in distinguishing people with HE from controls. Oculometric tests provide a quick, non-invasive functional assessment of brain health in patients with liver disease, with sensitivity indistinguishable from standard-of-case psychometric tests.

Evidence suggests that outcomes are poorer among patients from historically marginalized racial and ethnic backgrounds. The impact of patient racial and ethnic diversity on gastrointestinal outcomes is understudied. To investigate the impact of patient racial/ethnic diversity on gastrointestinal disease (GI) outcomes. Using the 2019 National Inpatient Sample (NIS), hospital inpatient racial/ethnic diversity was defined as the percentage of Hispanic or Native American discharges. We included gastrointestinal bleeding, inflammatory bowel diseases, gastrointestinal obstruction, cirrhosis, and alcohol-associated hepatitis. Logistic regression was used to predict outcomes [major complications (MCC), long length of stay, high total charges], controlling for age, gender, location, income quartile, hospital size, and region. Our cohort included 537,830 hospitalizations. In the unadjusted analyses, MCC rates were higher among Hispanic (24.8%) and Native American patients (30.4%), compared to Whites (18.3%). In adjusted analyses, compared to Whites, Hispanic [adjusted odds ratio (OR) 1.21, 95% Confidence Interval (CI) 1.15-1.28] and Native American patients [OR 1.25, (95% CI) 1.09-1.43] had higher MCC rates. As hospital Hispanic diversity increased, MCC for Hispanics improved [OR 0.93, (95% CI) 0.87-1.14] and were even better among Native American patients as their diversity increased [OR 0.83, (95% CI) 0.73-0.94] (Table 1). A similar trend was observed in the 2018 validation cohort. Increasing hospital inpatient Hispanic and Native American diversity is associated with better outcomes for these groups. Further research is needed on the impact cultural competence and linguistic concordance on gastrointestinal outcomes.

Kaposi sarcoma (KS), an angioproliferative neoplasm driven by human herpesvirus 8, predominantly affects patients with acquired immune deficiency syndrome (AIDS) or those on immunosuppressive therapy. Gastrointestinal involvement in KS is underreported, with limited literature highlighting its clinical significance and morphological diversity on endoscopy. This case report illustrates the complexities of diagnosing and managing gastrointestinal KS in an AIDS patient who presented with upper gastrointestinal bleeding. The diagnosis was established through the characteristic endoscopic appearance of the lesions, supported by histopathological confirmation. This case emphasizes the variable endoscopic manifestations of KS, ranging from linear ulcers to nodular lesions, and underscores the necessity for heightened clinical vigilance and multiple deep biopsies to avoid false‐negative results. Treatment options, primarily palliative, include highly active antiretroviral therapy, chemotherapy, and radiation, yet the prognosis remains poor with high short‐term mortality. This report contributes to the sparse literature on gastrointestinal KS, advocating for increased awareness and early intervention to potentially improve outcomes in this patient population.

Objectives: The aim of this study was to study the prevalence of exocrine pancreas insufficiency (EPI) at a population level and the subsequent risk of pancreatic ductal adenocarcinoma (PDAC). Materials and Methods: Using TriNetX (a database of over 79 million US residents), we included patients ≥18 years with EPI (identified via ICD-10 codes) and continuous follow-up from 2016–2022. Patients with prior pancreas resection and PDAC before an EPI diagnosis were excluded. The primary outcome was EPI prevalence. Secondary outcomes included imaging utilization, PDAC risk, and pancreatic enzyme replacement therapy (PERT) utilization. We performed 1:1 propensity score matching (PSM) of patients with EPI versus patients without an EPI diagnosis. Results: The population prevalence of EPI was 0.8% (n = 24,080) with a mean age of 55.6 years. After PSM, PDAC risk among patients with EPI was twice as high compared with patients without EPI (aHR, 1.97; 95% CI, 1.66–2.36). This risk persisted even after excluding patients with a history of acute or chronic pancreatitis (adjusted odds ratio, 4.25; 95% CI, 2.99–6.04). Only 58% (n = 13, 390) of patients with EPI received PERT. No difference was observed in PDAC risk between patients with EPI on PERT and those not on PERT (aHR, 1.10; 95% CI, 0.95–1.26; P = 0.17). Conclusions: Despite a low prevalence, patients with EPI may have a higher risk of PDAC, and majority with EPI were not on PERT. PERT did not impact incident PDAC risk after an EPI diagnosis.

BACKGROUND: The impact of English proficiency on gastrointestinal bleeding (GIB) outcomes remains unclear. In this analysis, we compare inpatient GIB outcomes between patients with English as their primary language (EPL) and those with a primary language other than English (PLOE). METHODS: Using the 2019 State Inpatient Databases for New Jersey, Maryland, and Michigan, we created an analysis cohort of GIB hospitalizations using International Classification of Diseases, 10th Revision codes. Patients were stratified by primary language (EPL vs PLOE) and type of bleeding (variceal upper GI bleeding [VUGIB], nonvariceal upper GI bleeding [NVUGIB], and lower GI bleeding (LGIB)]. Regression analyses were used to compare mortality, 30-day readmissions, and length of stay. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. P < 0.05 was considered statistically significant. RESULTS: In the cohort, 5.5%–10% of the patients spoke a primary language other than English. Endoscopy utilization was lower among patients with PLOE vs EPL for NVUGIB (17.2% vs 21.2%, P < 0.001) and LGIB (26.3% vs 29.2%, P = 0.027). Patients with PLOE had higher odds of dying of VUGIB (aOR 1.45, 95% CI 1.16–2.48) and LGIB (aOR 1.71, 95% CI 1.22–2.12). Patients with PLOE were also more likely to be readmitted after NVUGIB (aOR 1.75, 95% CI 1.64–1.81). However, after controlling for the percentage of patients with PLOE discharged from each hospital, the disparities in mortality and readmissions were no longer detected. DISCUSSION: Disparities exist in GIB outcomes among patients with PLOE, but these gaps narrow at hospitals with higher percentages of patients with PLOE. Cultural and linguistic competence may improve outcomes in this vulnerable group.

Background and Aim: The impact of the Coronavirus disease‐2019 (COVID‐19) pandemic on patients with liver disease is not well described at the population level in the United States. We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years.Methods: Using the National Inpatient Sample (2018–2020), we explored year‐to‐year and 2020 month‐to‐month trends in hospitalizations, length of stay, and inpatient mortality for liver‐related complications including cirrhosis, alcohol‐associated liver disease (ALD) and alcoholic hepatitis using regression modeling. We reported relative change (RC) in the study period.Results: Decompensated cirrhosis hospitalizations decreased in 2020 compared with 2019 (RC: −2.7%, P < 0.001) while all‐cause mortality increased by 15.5% (P < 0.001). Hospitalizations for ALD increased compared with pre‐pandemic years (RC: 9.2%, P < 0.001) with a corresponding increase in mortality in 2020 (RC 25.2%, P = 0.002). We observed an increase in liver transplant surgery mortality during the peak months of the pandemic. Importantly, mortality from COVID‐19 was higher among patients with decompensated cirrhosis (adjusted odds ratio [OR] 1.72, 95% confidence interval [CI] [1.53–1.94]), Native Americans (OR 1.76, 95% CI [1.53–2.02]), and patients from lower socioeconomic groups.Conclusions: Cirrhosis hospitalizations decreased in 2020 compared with pre‐pandemic years but were associated with higher all‐cause mortality rates particularly in the peak months of the COVID‐19 pandemic. In‐hospital COVID‐19 mortality was higher among Native Americans, patients with decompensated cirrhosis, chronic illnesses, and those from lower socioeconomic groups.