The prevalence of chronic hepatitis C virus (HCV) infection among incarcerated individuals in the United States is estimated to be between 12-31%. HCV treatment during incarceration is an attractive option due to improved access to healthcare and directly observed therapy. We compared incarcerated and non-incarcerated HCV-infected patients evaluated for treatment at a single academic center between January 1, 2002 and December 31, 2007. During this period, 521 non-incarcerated and 388 incarcerated patients were evaluated for HCV treatment. 319 (61.2%) non-incarcerated patients and 234 (60.3%) incarcerated patients underwent treatment with pegylated interferon and ribavirin. Incarcerated patients were more likely to be male, African-American race, and have a history of alcohol or intravenous drug use. Treated incarcerated patients were less likely to have genotype 1 virus and were less likely to have undergone previous treatment. There was a similar prevalence of co-infection with HIV in both groups. A sustained viral response (SVR) was achieved in 97 (42.9%) incarcerated patients compared to 115 (38.0%) non-incarcerated patients (p=0.304). Both groups had a similar proportion of patients that completed a full treatment course. Stepwise logistic regression was conducted and the final model included full treatment course, non-genotype 1 virus, younger age at treatment start, and negative HIV status. Incarceration status was not a significant predictor when added to this model (p = 0.075). Conclusion In a cohort of HCV-infected patients managed in an academic medical center ambulatory clinic, incarcerated patients were as likely to be treated for HCV and as likely to achieve an SVR as non-incarcerated patients.

CT colonography has adenoma miss rates similar to miss rates historically found with optical colonoscopy, with most missed adenomas being <10 mm and sessile in shape.

Summary The aim of this study was to evaluate the detection of colonic neoplasia in an average‐risk population of SOT recipients. Studies regarding colonic neoplasia in solid organ transplantation (SOT) recipients have demonstrated mixed results due to the inclusion of above average‐risk patients. We performed a case–control study of 102 average‐risk SOT recipients who underwent screening colonoscopy, compared with an average‐risk, age and sex‐matched control group (n = 287). Cancer rates were compared with an age‐matched cohort from the National Cancer Institute’s Survival, Epidemiology, and End Results (SEER) database. There was no difference in number of patients with adenomas (P = 1.00). There was no difference in polyps per patient (P = 0.31). Although the number of advanced lesions (excluding adenocarcinoma) between groups did not differ (P = 0.25), there were two adenocarcinomas identified in the SOT group and none in the control group (P = 0.068). Detection of colorectal cancer was an unexpected finding in the SOT cohort and was more likely when compared to age‐matched cancer incidence generated by the SEER database. These results suggest no increased adenoma detection in SOT recipients, but with more cases of colorectal cancer than anticipated. Given previous, larger, transplant database studies demonstrating increased colorectal cancer rates, more frequent screening may be justified.

Although colonoscopic or histopathologic abnormalities are common in the solid organ transplant recipient with diarrhea, the findings rarely lead to a specific diagnosis or management change. Colonoscopy with biopsy should be performed only after noninvasive testing for infectious diarrhea and a thorough review and adjustment of medications. In many patients, a trial of antidiarrheal medication is warranted before colonoscopy.

In AP a serum lipase of >10,000 U/L at presentation is a useful marker and portends a biliary etiology while virtually excluding alcoholic AP. Therefore, if ultrasonography is negative for stones in this population, these data suggest workup with MRCP or EUS is warranted to evaluate for microlithiasis or sludge given the high likelihood of occult stone disease in these individuals.