Joon Ho Moon

Simple Tests to Predict Hepatic Fibrosis in Nonalcoholic Chronic Liver Diseases

BACKGROUND/AIMS Several simple tests for hepatic fibrosis employ indirect markers. However, the efficacy of using direct and indirect serum markers to predict significant fibrosis in clinical practice is inconclusive. We analyzed the efficacy of a previously reported indirect marker of hepatic fibrosis - the aspartate aminotransferase to platelet ratio index (APRI) - in patients with nonalcoholic chronic liver diseases (CLDs). METHODS A total of 134 patients who underwent a percutaneous liver biopsy with a final diagnosis of chronic hepatitis B (n=93), chronic hepatitis C (n=18), or nonalcoholic fatty liver disease (n=23) were enrolled. A single-blinded pathologist staged fibrosis from F0 to F4 according to the METAVIR system, with significant hepatic fibrosis defined as a METAVIR fibrosis score of >/=2. RESULTS The mean area under the receiver operating characteristic curve (AUROC) of APRI for predicting significant fibrosis in nonalcoholic CLDs was 0.84 [95% confidence interval (CI), 0.78-0.91]. APRI yielded the highest mean AUROC in the patients with chronic hepatitis B (0.85; 95% CI, 0.771-0.926). The positive predictive value of APRI >/=1.5 for predicting significant fibrosis was 89%. The negative predictive value of APRI <0.5 for excluding significant fibrosis was 80%. CONCLUSIONS APRI might be a simple and noninvasive index for predicting significant fibrosis in nonalcoholic CLDs.

Ischemic Colitis Associated with Segmental Arteriovenous Malformation Mimicking Inflammatory Bowel Disease in a Familial Adenomatous Polyposis Patient

Vascular lesions of the colon are being recognized with increasing frequency as a cause of lower intestinal hemorrhage in the elderly [1–3]. Colonic arteriovenous malformation (AVM) is also known as vascular ectasia or angiodysplasia, and it is thought to be caused by degenerative changes [1, 4]. Unlike small vascular abnormalities such as vascular ectasia or angiodysplasia, AVMs have several distinguishing characteristics based on the analyses of various reported cases [4–6]: they are not restricted to the elderly, are usually solitary, can be identified endoscopically, are not confined to the right colon, and are larger. We report a case of segmental AVM in a patient with familial adenomatous polyposis (FAP) that presented as a chronic limited colitis mimicking inflammatory bowel disease. While initial biopsies were suggestive of an ischemic etiology, the final diagnosis was made on surgical resection.