Congratulations, Mattias! Your recognition is hugely deserved. Keep up the excellent work!

I haven't been able to find NICE guidance about this question, but BSG guidelines do recommend biopsy "if systemic treatment is being considered".
www.bsg.org.uk/getmedia/076...

EASL guidelines: “In patients with cirrhosis, HBV infection or a previous diagnosis of HCC, a liver nodule can be diagnosed non-invasively as HCC when major features are observed with dynamic contrast-enhanced CT, MRI or ultrasound (CEUS)”.

These are ESMO guidelines, not EASL. The justification is that it’s important to have the correct diagnosis. I am paraphrasing, but that IS the justification.

As if this area wasn't difficult enough already... I'm sure it will be a hot topic for discussion among the good people of ISHEN at the Montreal meeting in October. ishen.org/ishen-2025/

We typically begin at 40mg prednisolone and taper fast at first (till we reach 15mg, say), then more slowly as azathioprine kicks in. We still use azathioprine rather than MMF.

For those who - like me - wondered what the figure shows, it's "Lifetime alcohol use in 15-year-olds by country (top 10)". I had hoped it was "adolescent sobriety", but unfortunately it wasn't... We Danes take comfort in knowing that our alcohol consumption is declining and has been for many years.

Well done, Merle and Hannes. Yes, we definitely need to know more about the logistics and expected outcomes of fibrosis screening for patients, GPs, and hospitals.

Congratulations! Well done. The risk of HCC seemed to be higher for those with MASLD cirrhosis, but I assume that's because of their older age and higher proportion of men.

I have followed Vinay for many years, and I used to like his podcast. That ended during Covid. It seems that science became heavily politicized then and still is. His book “Ending medical reversal” is good and has instructive examples of science being wrong (despite good intentions). No rants then…

This is a figure of age-specific incidence rates of alcohol-related liver disease in Denmark, by birth cohort. It shows that generations born after 1960 have had lower age-specific incidence rates than earlier generations (so far, at least). This is from pubmed.ncbi.nlm.nih.gov/33442297/ (OA.)

I suspect the analysis includes prevalent cancers, i.e., those that are diagnosed within a few months after PSC diagnosis. They are important, too, of course, but may inflate the incidence rate (which is more relevant for decisions about cancer surveillance during follow-up).