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Sombat Treeprasertsuk, Emmanouil Sinakos, Jill Keach and Keith D. Lindor

Abstract

Background: The American Association for the Study of Liver Disease (AASLD) guideline recommends cholecystectomy for GB polyps of any size in patients with PSC without strong supporting evidence.

Objective: Evaluate the predictors of malignancy and outcomes of PSC patients with GB polyps.

Methods: We identified 86 patients with PSC and GB polyps at the Mayo Clinic, Rochester, MN between January 1, 2000 and August 31, 2009 using a computerized record system. Twenty-six patients were excluded due to indefinite diagnosis or inadequate follow up data.

Results: Of the 2281 patients with PSC, 60 patients (2.6%) were diagnosed as having GB polyps with a median age of 49.8 years; 67% were male. The median follow up from the diagnosis of GB polyps to the last follow-up was 3.5 years. Thirty-one patients (52%) subsequently underwent cholecystectomy and eight of 31 patients (25.8%) developed malignant GB lesions. Low-grade dysplasia of the GB was seen in two (6.4%). Twenty-nine patients without cholecystectomy had a median follow up of 4.8 years and none of them developed a malignant GB lesion during follow-up. By multivariable logistic analysis, the size of GB polyps at baseline was associated with malignant GB lesions or GB dysplasia (OR = 7.0; 95%CI 2.0-25.1).

Conclusions: One third of GB polyps in patients with PSC who underwent cholecystectomy become malignant or developed dysplasia. A GB polyp at first diagnosis of at least 1 cm in size was a good predictor for malignant lesions of GB or GB dysplasia. In PSC patients with comorbidities who had GB polyp size at first diagnosis less than 1 cm, careful monitoring of the progression of GB polyp size over time with periodical assessment by ultrasound may be an option.

Open access

Sombat Treeprasertsuk, Abel Romero-Corral, Virend K. Somers, Justo Sierra-Johnson, Keith D. Lindor, Paul Angulo and Francisco Lopez-Jimenez

Abstract

Background: Differences in body fat (BF) distribution in patients with normal body mass index (BMI) with elevated alanine aminotransferase (ALT) remains poorly described.

Objective: To determine the relationship between total BF, waist circumference (WC), insulin resistance (IR), and cardiometabolic risk profile in subjects with elevated ALT and normal BMI.

Methods: We analyzed cross-sectional data from 4,914 US participants in the third National Health and Nutrition Examination Survey database, who were ≥20 years of age, had normal BMI, and had body composition assessed by bioimpedance.

Results: Mean ± SD age was 41.4 ± 0.3 years, and 58% participants were women. BF was 20 ± 0.1% in men and 29.9 ± 0.1% in women. As total BF increased by tertiles, there was a tendency towards a higher prevalence of nonalcoholic fatty liver disease in men (6.1%, 6.5%, 9.5%, P = 0.13), but not in women (8.7%, 8.2%, 10.7%, P = 0.71). As WC increased by tertiles, there was a higher prevalence of elevated ALT in men (2.6%, 8.6%, 6.6%, P < 0.0001), but not in women. As ALT increased, men had significantly higher levels of nonhigh density lipoprotein cholesterol (HDL-C), increased apolipoprotein B, increased IR, and lower levels of C-reactive protein, whereas, women had higher levels of non-HDL-C and increased IR.

Conclusion: In subjects with normal BMI, increased WC is associated with a higher prevalence of elevated ALT in men, but not in women. Higher levels of ALT correlated with a poor cardiometabolic risk profile.