Non-alcoholic fatty liver disease (NAFLD), a clinical syndrome that is predicted to affect millions of people worldwide, will become the next global epidemic. The natural course of this disease, including its subtype, non-alcoholic steatohepatitis (NASH), is not clearly defined, especially in the US minority populations. The aim of this review is to report the global epidemiology of NAFLD, with emphasis on US minority populations on the basis of database searches using using Pubmed and other online databases. The US Hispanic population is the most disproportionately affected ethnic group with hepatic steatosis whereas African-Americans are the least affected. Genetic disparities involved in lipid metabolism seem to be the leading explanation for the lowest incidence and prevalence of both NAFLD and NASH in African-Americans.

With mortality rates of liver cancer doubling in the last 20 years, this disease is on the rise and has become the fifth most common cancer in men and the seventh most common cancer in women. Hepatocellular carcinoma (HCC) represents approximately 90% of all primary liver cancers and is a major global health concern. Patients with HCC can be managed curatively with surgical resection or with liver transplantation, if they are diagnosed at an early stage. Unfortunately, most patients with HCC present with advanced stages of the disease and have underlying liver dysfunction, which allows only 15% of patients to be eligible for curative treatment. Several different treatment modalities are available, including locoregional therapy radiofrequency ablation, microwave ablation, percutaneous ethanol injection, trans-arterial chemoembolization, transarterial radio-embolization, cryoablation, radiation therapy, stereotactic radiotherapy, systemic chemotherapy, molecularly targeted therapies, and immunotherapy. Immunotherapy has recently become a promising method for inhibiting HCC tumor progression, recurrence, and metastasis. The term "Immunotherapy" is a catch-all, encompassing a wide range of applications and targets, including HCC vaccines, adoptive cell therapy, immune checkpoint inhibitors, and use of oncolytic viruses to treat HCC. Immunotherapy in HCC is a relatively safe option for treating patients with advanced disease in the USA who are either unable to receive or failed sorafenib/lenvatinib therapy and thus may offer an additional survival benefit for these patients. The purpose of this review is to elaborate on some of the most recent advancements in immunotherapy.

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Background: There is limited data on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with Inflammatory Bowel Diseases (IBD). Aim: The aim of this study is to assess safety and efficacy of the ERCP in IBD patients who underwent ERCP for a variety of reasons in a national inpatient data base. Method: The National Inpatient Sample (NIS) is the largest all-payer inpatient database consisting of approximately 20% of all inpatient admissions to nonfederal hospitals in the United States. Data from the years 2009 to 2014 were collected. Patients older than 18 years with a diagnosis of IBD who had undergone ERCP (nZ1519) were included. Case-control 2:1 matching was done based on gender, age, race and Charlson Comorbidity Index (CCI) for IBD patients. Complications and mortality were evaluated for IBD patients against case-controls. Results were adjusted via logistic regression analyses to obtain adjusted odds ratios (aOR) for different outcomes. IBM Statistical Package for the Social Sciences (SPSS) version 25 was used for statistical analysis. Results: Between 2009 and 2014 there were 1519 patients with IBD aged older than 18 years who had undergone an ERCP. Baseline patient demographics are presented in Table 1. Age, sex, CCI, and race were all matched without statistically significant differences between cases and controls. We used the binary logistic regression models for mortality and post ERCP complications. We found significant differences between IBD and non-IBD patients for post-ERCP pancreatitis (aOR 13.38, 95% CI 1.45-1.24) and post-ERCP Infection (aOR 1.21, CI 1.01-1.45). However, there was no significant differences between IBD and non-IBD patients for post-ERCP mortality (aOR 1.29, 95% CI 0.73-2.71), post-ERCP cholecystitis (aOR 2.11, 95% CI 0.76-5.84), post-ERCP perforation (aOR 4.01, 95% CI 0.36-44.27), or post-ERCP bleeding (aOR 0.72, 95% CI 0.28-1.83). Conclusion: IBD appears an independent risk factor for post-ERCP pancreatitis and post-ERCP infection. However, limitation of the study is that NIS is an administrative database which predisposes to errors from coding inaccuracies as well as obscurement of temporal relationships between outcomes and diseases. More prospective research would be useful to confirm our findings.