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Background: High inflammatory bowel disease (IBD) rates have been reported in Australasia, but no state-wide studies have yet been performed. Aims: This study estimates the one-year incidence and point prevalence of IBD in the state of Tasmania, Australia. It also reports clinical outcomes after twelve months of diagnosis in an incident cohort. Methods: A prospective, population-based study was performed collecting prevalent and incident state-wide cases from 1st June 2013 to 31st May 2014. Case data were identified from specialist doctors, pathology databases and hospital records. Age-standardised rates (ASRs) were calculated based on World Health Organization 2000 standard population characteristics. Incident cases were followed up twelve months after diagnosis. Results: There were 1719 prevalent cases: ASRs for IBD, Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU) prevalence were 303.9, 165.5, 131.4 and 6.9 per 100,000 respectively. Prevalent CD cases were younger, with greater immunomodulator/biologic use and bowel resections. There were 149 incident cases: ASRs for IBD, CD, UC and IBDU incidence were 29.5, 15.4, 12.4, and 1.7 per 100,000 respectively. Incident CD cases were more likely than UC or IBDU to require escalation of medical therapy, hospitalisation, and bowel resection especially among those with penetrating or stricturing disease. They had longer duration of symptoms prior to diagnosis. Conclusions: IBD prevalence and incidence rates are high in Tasmania, comparable to data from other Australasian studies and those from Northern Europe and America. Poorer twelve month clinical outcomes occurred in complicated CD, with greater use of healthcare resources.

Background and aimsPatients with chronic hepatitis C infection have high rates of major depressive disorder. The reasons for this are multifactorial, but social and demographic factors do not entirely explain the increased burden. Direct neuropathologic effect of the virus in the development of depression has been postulated but the mechanisms remain unclear. Single nucleotide polymorphisms (SNPs) in FKBP5 (protein product FKBP51), a co-chaperone of the glucocorticosteroid receptor, have been associated with greater severity of affective disorders. We examined the interaction between FKBP5 SNPs and chronic hepatitis C infection in patients with and without depressive symptoms.Methodsforty-one subjects completed quality of life and psychiatric questionnaires. Thirteen patients were classified as depressed on the Hospital Anxiety and Depression Scale depression sub-score (HADS-D ≥11). FKBP51 protein expression, FKBP5 mRNA and FKBP5 SNP analysis was compared between those with and without depression.ResultsThere were no statistically significant differences between the groups in demographics, medical co-morbidities or substance use. A moderate negative correlation (Spearman rho -0.53, pConclusionLevels of FKBP5 mRNA and FKBP51 are lower in hepatitis C patients with depression and further exploration of this interaction is required.

Patients with chronic hepatitis C virus (HCV) infection experience a range of symptoms including depression, fatigue and neurocognitive deficits, impairing quality of life. Depression, in particular, may be reactive to increased psychosocial stress, and the physical symptoms of advanced HCV or associated comorbidities. However, even patients at an early stage of HCV infection, with minimal hepatic inflammation or comorbidities, report more depressive symptoms and fatigue than the general population. Similarly, specific neurocognitive deficits occur in early stage HCV infection and are independent of the presence of depression or encephalopathy. Therefore, intracerebral neurobiological changes associated with HCV may potentially explain these symptoms. These changes may arise from infiltration of the brain by peripherally induced cytokines, as well as direct neuropathic effects of HCV viral particles penetrating the blood-brain barrier. These phenomena parallel those reported in human immunodeficiency virus (HIV) infection. HCV-associated intracerebral changes include upregulated inflammatory responses, altered neurotransmitter levels, hormonal dysregulation, and release of neurotoxic substances. These may subsequently lead to abnormal neuronal conduction and function in areas of the brain governing affective responses, emotional processing, motivation, attention and concentration. Although direct-acting antiviral medications lead to high rates of HCV clearance, intracerebral changes may not be subsequently reversed and symptoms of depression, fatigue and neurocognitive deficits may persist. There is an ongoing role for multidisciplinary care and pharmacotherapy to manage these symptoms in HCV patients. Furthermore, there may be opportunities for future therapies to specifically target and ameliorate HCV-associated intracerebral changes.

Direct acting antiviral (DAA) regimens containing ritonavir have been developed to treat hepatitis C, with fewer side effects than that by interferon-based regimens. However prescribers must be aware of drug–drug interactions. There are multiple reports of iatrogenic Cushing syndrome (CS) caused by ritonavir, when used to treat human immunodeficiency virus, increasing the bioavailability of exogenous steroids by inhibiting cytochrome p450 enzymes in the liver and gut wall and thus reducing steroid metabolism. We herein report a novel scenario of CS due to interaction between ritonavir for hepatitis C treatment and oral budesonide for autoimmune hepatitis.

AIM: This retrospective study of 85 cirrhotics aimed to identify variables during the first 24 hours of intensive care unit (ICU) admission predicting mortality up to 30 days of hospital discharge, and to analyse the prognostic accuracy of common severity scores in predicting mortality. MATERIALS AND METHODS: Eighty-five patients with liver cirrhosis admitted to ICU at the Royal Hobart Hospital, a regional Australian center, from 2007 to 2013 inclusive were identified using International Classification of Disease coding and data extracted from medical records. Predictors of mortality were determined via logistic regression and the prognostic accuracy of 5 severity scores calculated by their area under the receiver-operating curve. These included 2 scores commonly used in liver disease; Child Pugh and Model for End-Stage Liver Disease (MELD); as well as 3 scores designed in the intensive care setting: Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology (SAPS II) and Acute Physiology and Chronic Health Evaluation (APACHE II). RESULTS: Significant variables predicting short-term mortality included infection (excluding spontaneous bacterial peritonitis), requirement for inotropes or mechanical ventilation, elevated creatinine, decreased Glasgow Coma Scale, decreased pH and elevated white cell count. However the presence of cirrhosis-specific complications such as hepatic encephalopathy, variceal bleeding and spontaneous bacterial peritonitis did not predict mortality and liver-specific prognostic severity scores (Child Pugh and MELD) performed more poorly than the other severity scores designed for the ICU setting. CONCLUSIONS: ICU admission for cirrhotics should not be deemed futile in the presence of hepatic dysfunction alone; cardiorespiratory, neurological and renal dysfunction should be taken into account. ICU-specific severity scores better prognosticate short-term mortality compared to liver-specific scores.

Esophageal obstruction from soluble fiber laxatives, such as karaya gum, has been rarely reported in the literature. However, as such preparations are widely commercially available, it is important for gastroenterologists to be aware of their potential to form a bezoar in the esophagus due to swelling on contact with liquid. This report highlights such a case and discusses its challenging management.

This qualitative study explored how members of the Dinka South Sudanese community in West Melbourne perceive diabetes within the context of their broader health circumstances. These perceptions may guide health services aiming to prevent diabetes and chronic disease. 3 focus groups were conducted with 25 participants. Recorded discussions were transcribed and interrogated through a grounded theory approach. Diabetes and chronic diseases were familiar to participants, but issues they claimed not to understand well. The Australian social environment was seen to propagate unhealthy lifestyle changes, while experiences with Australian health services were dissatisfying. Mental distress was perceived as significantly detracting from the community's health. Preventative health interventions in this community, while emphasising education and healthy lifestyle behaviours, should also acknowledge underlying socio-historical contexts and the psychiatric burden of forced migration.

To determine characteristics and prognostic predictors of patients with hepatocellular carcinoma (HCC) in association with non-alcoholic fatty liver disease (NAFLD).We reviewed the records of all patients with NAFLD associated HCC between 2000 and 2012. Data collected included demographics; histology; presence or absence of cirrhosis, size and number of HCC, alpha-fetoprotein, body mass index (BMI), and the presence of diabetes, hypertension, or dyslipidaemia.Fifty-four patients with NAFLD associated HCC were identified. Mean age was 64 years with 87% male. Fifteen percent (8/54) were not cirrhotic. 11%, 24% and 50% had a BMI of25 kg/m2, 25-29 kg/m2 and ≥30 kg/m2 respectively. Fifty-nine percent were diabetic, 44% hypertensive and 26% hyperlipidaemic. Thirty-four percent of the patients had ≤1 of these risk factors. Non-cirrhotics had a significantly larger mean tumour diameter at diagnosis than cirrhotics (P=0.041). Multivariate analysis did not identify any other patient characteristics that predicted the size or number of HCC.HCC can develop in NAFLD without cirrhosis. At diagnosis such tumours are larger than those in cirrhotics, conferring a poorer prognosis.