Clinical Gastroenterology and Hepatology最新文献

{"title":"Pharmacological Strategies for the Management of Severe Alcohol-associated Hepatitis: A Systematic Review and Meta-analysis","authors":"Alvi H. Islam, Claudia Alvizuri, Hailemichael Desalegn, Emily Stephenson, Francisco Idalsoaga, Luis Antonio Diaz, John K. MacDonald, Gene Y. Im, Ashwani K. Singal, Vipul Jairath, Mohammad Qasim Khan, Juan Pablo Arab","doi":"10.1016/j.cgh.2025.05.016","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.05.016","url":null,"abstract":"Alcohol-associated hepatitis (AH) is a severe form of alcohol-associated liver disease, with a short-term mortality of up to 50% within three months. The aim of this systematic review was to determine the optimal pharmacological treatment for severe AH that results in better survival outcomes.","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"12 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addition of AFP Improves Sensitivity of Ultrasound for Early-Stage HCC Detection in Patients with Cirrhosis","authors":"Akash Patel, Darine Daher, Sruthi Yekkaluri, Michelle Ng, Nicole E. Rich, Amit G. Singal","doi":"10.1016/j.cgh.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.05.010","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"30 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Janus kinase (JAK) inhibitor-induced acne in inflammatory bowel disease – an international, multicenter, retrospective cohort study","authors":"Sailish Honap, Maria José Temido, Eathar Shakweh, Fakhirah Badrulhisham, Natalie Shields, Sonia Mehta, Jodie McBride, Mathieu Uzzan, Milan Lukáš, Mathurin Fumery, Akira Nogami, Taku Kobayashi, Stephane Nancey, Joana Camões Neves, João Martins Mendes, Birte-Antina Wegener, Emilie Bergereau, Rita Fernandes, Anish John Kuriakose Kuzhiyanjal, Sophie Vieujean, Ashley Spencer, Samantha Baillie, Maria Manuel Estevinho, Inês Simão, Catarina O’Neill, Madalina Gututui, Ellen Thompson, Amina Jama, Ningyu Chai, Polychronis Pavlidis, Ferdinando D'Amico, Jimmy Limdi, Fernando Magro, Shaji Sebastian, Jonathan Digby-Bell, Gareth C. Parkes, Shahida Din, Ailsa Hart, Laurent Peyrin-Biroulet, JAKne International Study Group","doi":"10.1016/j.cgh.2025.04.031","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.04.031","url":null,"abstract":"JAK inhibitor-associated acne is a common but poorly understood adverse event. This study aimed to investigate the epidemiology, clinical characteristics, and treatment outcomes of this condition in patients with inflammatory bowel disease (IBD).","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"42 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Antidiabetic Drug Classes on the Risk of Liver-Related Events in Individuals With T2D and MASLD.","authors":"Yu Shi, Seung Up Kim, Terry Cheuk-Fung Yip, Emmanuel Tsochatzis, Salvatore Petta, Atsushi Nakajima, Hannes Hagström, Elisabetta Bugianesi, Wah-Kheong Chan, Jérôme Boursier, Boon-Bee George Goh, Arun J Sanyal, Manuel Romero-Gomez, José Luis Calleja, Victor de Lédinghen, Philip Noel Newsome, Jian-Gao Fan, Michelle Lai, Laurent Castéra, Céline Fournier, Hye Won Lee, Grace Lai-Hung Wong, Grazia Pennisi, Masato Yoneda, Ying Shang, Angelo Armandi, Marc de Saint-Loup, Clemence M Canivet, Kevin Kim-Jun Teh, Amon Asgharpour, Rocio Gallego-Durán, Elba Llop, Carmen Lara-Romero, Mandy Sau-Wai Chan, Sara Mahgoub, Huapeng Lin, Wen-Yue Liu, Giovanni Targher, Christopher D Byrne, Vincent Wai-Sun Wong, Ming-Hua Zheng","doi":"10.1016/j.cgh.2025.06.001","DOIUrl":"10.1016/j.cgh.2025.06.001","url":null,"abstract":"<p><strong>Background: </strong>We investigated the use of type 2 diabetes (T2D) medications, including pioglitazone, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and sodium-glucose cotransporter-2 (SGLT-2) inhibitors, in individuals with T2D and metabolic dysfunction-associated steatotic liver disease (MASLD), and explored the effect of these medications on long-term risk of liver-related events (LREs) and progression of liver stiffness in a retrospective cohort study.</p><p><strong>Methods: </strong>We enrolled 7867 individuals with T2D and MASLD from 16 tertiary referral centers between February 2004 and January 2023. We recorded the use of pioglitazone, GLP-1RAs, and SGLT-2 inhibitors and analyzed the effects of these antihyperglycemic medications on the risk of developing incident LREs and the progression of liver stiffness over a median of 5.1 years of follow-up.</p><p><strong>Results: </strong>Pioglitazone, GLP-1RAs and SGLT-2 inhibitors were prescribed to 1238 (15.7%), 863 (11.0%), and 2386 (30.3%) individuals with T2D and MASLD, respectively. A significant increase in the utilization of GLP-1RAs and SGLT-2 inhibitors was observed from 2010-2017 to 2017-2023, with pioglitazone and SGLT-2 inhibitors being prescribed more frequently in Asian countries than in Western countries (pioglitazone: 17.9% vs 3.8%; SGLT-2 inhibitors: 34.4% vs 7.3%; P < .001). After propensity score matching, in competing risk models, SGLT-2 inhibitor use was significantly associated with a lower risk of developing both LREs (subdistribution hazard ratio, 0.23; 95% confidence interval, 0.08-0.69, P = .009) and liver stiffness progression (hazard ratio, 0.54; 95% confidence interval, 0.35-0.86, P = .008) after adjusting for potential confounders.</p><p><strong>Conclusions: </strong>SGLT-2 inhibitor use is more prevalent among Asian than Western individuals. SGLT-2 inhibitors are associated with a lower risk of LREs in individuals with T2D and MASLD.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Ultrasound-Guided Through-the-Needle Biopsy for the Diagnosis of Cholangiocarcinoma (With Video).","authors":"Zhenyun Gong, Duanmin Hu, Guilian Cheng","doi":"10.1016/j.cgh.2025.02.036","DOIUrl":"10.1016/j.cgh.2025.02.036","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking the Belch Barrier: Improving our Understanding of Retrograde Cricopharyngeal Dysfunction (R-CPD).","authors":"Daniel Cates, Rena Yadlapati","doi":"10.1016/j.cgh.2025.02.037","DOIUrl":"10.1016/j.cgh.2025.02.037","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Impact of Social Risk in Patients With Inflammatory Bowel Diseases: National Estimates from the United States.","authors":"Seo Hyun Kim, Yuchen Qi, Matthew P Banegas, Michael D Kappelman, Nghia H Nguyen, Brigid S Boland, Carlos Lago Hernandez, Ronghui Xu, Siddharth Singh","doi":"10.1016/j.cgh.2025.03.031","DOIUrl":"10.1016/j.cgh.2025.03.031","url":null,"abstract":"<p><strong>Background and aims: </strong>Social risks are individual-level factors associated with adverse health outcomes. We determined the prevalence and impact of social risks on healthcare use among patients with inflammatory bowel diseases (IBDs) in the United States.</p><p><strong>Methods: </strong>In the U.S. National Health Interview Survey 2023, we estimated social risks across 6 domains (food insecurity, financial hardship, housing instability, transportation needs, education and employment, discrimination) in adults with IBD. We evaluated the association between burden of social risk (0 of 6 domains [none], 1 of 6 domains [mild], 2 of 6 domains [moderate], and ≥3 of 6 domains [severe]), unplanned healthcare utilization (emergency department and/or hospitalization), and medication nonadherence, accounting for differences in age, sex, race/ethnicity, insurance, income, and comorbidities.</p><p><strong>Results: </strong>Of 572 people included in the survey (mean age 56 years; 57% female; 81% non-Hispanic White [NHW], 12.9% Hispanic), 64% (95% confidence interval [CI], 59%-69%) experienced social risk across 1 or more domains (food insecurity, 22%; financial hardship, 28%; housing instability, 14%; transportation needs, 9%; education and employment, 9%; discrimination, 41%). Prevalence of severe social risk was higher in racial and ethnic minority groups (non-Hispanic Black vs Hispanic vs NHW: 37% vs 28% vs 12%). A higher burden of social risk was associated with higher risk of unplanned healthcare utilization (severe vs none: odds ratio, 3.5; 95% CI, 1.2-10.2) and cost-related medication nonadherence (OR, 11.8; 95% CI, 2.7-52.1), after accounting for income and insurance status.</p><p><strong>Conclusions: </strong>Social risks are prevalent in adults with IBD and negatively impact healthcare utilization and medication nonadherence. Efforts to routinely identify and address social risks in patients with IBD should be part of standard clinical care.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival With and Without Liver Transplantation in Critically Ill Patients With Cirrhosis: A 20-Year Experience.","authors":"William Bernal, Therese Bittermann, Roosey Sheth, Francesca Trovato, Mark J McPhail, Pervez Khan, Stacey Calvert, Tasneem Pirani, Sameer Patel, Robert Loveridge, Christopher Willars, Georg Auzinger, Julia A Wendon","doi":"10.1016/j.cgh.2025.04.029","DOIUrl":"10.1016/j.cgh.2025.04.029","url":null,"abstract":"<p><strong>Background & aims: </strong>In 2015, we reported the outcome of patients with cirrhotic chronic liver disease with unplanned admission to a specialist single-center Liver Intensive Therapy Unit (LITU) demonstrating progressive improvement in short-term survival. We investigated if this and long-term survival had continued to improve, and its relation to use and outcome of liver transplantation (LT).</p><p><strong>Methods: </strong>A retrospective cohort study of consecutive adult patients with cirrhosis and unplanned emergent first LITU admission January 2000 to March 2020. Demographic and clinical variables were obtained at admission; acute-on-chronic liver failure (ACLF) grade was categorized as 0 (no ACLF), 1 or 2, or 3. Transplant-free survival (TFS) and LT practices were characterized and survival compared using time-to-event analysis.</p><p><strong>Results: </strong>The cohort comprised 1688 patients (62% male; median age 52 years [interquartile range, 43-60 years]) with Model for End-Stage Liver Disease score 28 (interquartile range, 18-37); 23% had no ACLF, 39% had ACLF 1 or 2, and 37% had ACLF 3; TFS closely related to ACLF grade (P < .001). LITU TFS was 51.9% in 2000 to 2009, increasing to 70.6% in 2010 to 2020 (P < .001); improvement for ACLF 3 was smaller: 31.0% to 45.8%, (P < .001). There was no difference in TFS survival in 2010 to 2014 vs 2015 to 2020. Long-term TFS was poor with <20% of patients alive without LT 1 year after LITU admission. During follow-up, 280 underwent LT: the proportion transplanted increased from 12.6% in 2000 to 2009 to 20.2% in 2010 to 2020, with 1- and 5-year post-transplant survival of 91% and 81.9%.</p><p><strong>Conclusions: </strong>TFS has now plateaued with need for novel interventions to improve survival in ACLF. LT is infrequently utilized but has excellent outcomes. ACLF survivors should be closely followed up with strong consideration given for transplant assessment.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Vasopressin Biomarker Copeptin is Linked to Systemic Inflammation and Refines Prognostication in Decompensated Cirrhosis.","authors":"Lukas Hartl, Marlene Hintersteininger, Benedikt Simbrunner, Mathias Jachs, Benedikt Silvester Hofer, David Josef Maria Bauer, Nina Dominik, Michael Schwarz, Lorenz Balcar, Georg Kramer, Annarein J C Kerbert, Minneke J Coenraad, Thierry Thevenot, Richard Moreau, Jonel Trebicka, Joan Clària, Rodrig Marculescu, Michael Trauner, Mattias Mandorfer, Thomas Reiberger","doi":"10.1016/j.cgh.2025.04.030","DOIUrl":"10.1016/j.cgh.2025.04.030","url":null,"abstract":"<p><strong>Background & aims: </strong>Copeptin, an arginine-vasopressin biomarker, may confer prognostic information in patients with advanced chronic liver disease (ACLD).</p><p><strong>Methods: </strong>Patients with ACLD included in the Vienna Cirrhosis Study (NCT03267615) between January 2017 and April 2023 and available copeptin levels were prospectively recruited and classified into 6 predefined clinical ACLD stages from S0 (subclinical portal hypertension) to S5 (further decompensation). A prognostic score (MELD-copeptin score) in patients with decompensated ACLD (dACLD) was developed in a derivation cohort (n = 150) and validated in an internal (n = 148) and an external validation cohort (n = 771).</p><p><strong>Results: </strong>Among 475 patients with ACLD, 177 were compensated, whereas 298 were decompensated. Median levels of copeptin increased with progressive ACLD severity (S0, 7.5 pmol/L vs S5, 14.3 pmol/L; P < .001). Copeptin (adjusted Beta, 0.10; P < .001) was independently associated with interleukin-6 levels in dACLD. In dACLD, copeptin was linked to higher risk of further decompensation (adjusted subdistribution hazard ratio, 1.01; 95% confidence interval, 1.00-1.01; P = .039), acute-on-chronic liver failure (adjusted subdistribution hazard ratio, 1.01; 95% confidence interval, 1.01-1.02; P < .001), and liver-related death (adjusted subdistribution hazard ratio, 1.01; 95% confidence interval, 1.01-1.02; P < .001) independently of relevant cofactors. The MELD-copeptin score yielded higher area under the receiver operating characteristics (AUROCs) for liver-related events than the MELD-Na score in the internal validation cohort, accurately predicting liver-related death at 6 months (AUROC, 0.777 vs MELD-Na, 0.673), 1 year (AUROC, 0.784 vs MELD-Na, 0.661), and 2 years of follow-up (AUROC, 0.741 vs MELD-Na, 0.636). Similarly, the MELD-copeptin score consistently yielded higher AUROCS for the development of liver-related death and acute-on-chronic liver failure at 3, 6, and 12 months of follow-up in the external validation cohort.</p><p><strong>Conclusions: </strong>In patients with dACLD, copeptin is independently linked to systemic inflammation. The MELD-copeptin score identifies patients with dACLD at risk for impaired clinical outcomes.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Noninvasive Biomarkers and Imaging for Evaluating Postoperative Recurrence in Crohn's Disease.","authors":"Sunil Samnani, Christina M Ray, Priyanka Gill, Levi Stein, Katherine A Buhler, Rupert W Leong, Rebecca L Smith, Peter De Cruz, Gilaad G Kaplan, Cynthia H Seow, Cathy Lu, Leonardo Guizzetti, Frank Hoentjen, John K Marshall, Siddharth Singh, Remo Panaccione, Kerri L Novak, Christopher Ma","doi":"10.1016/j.cgh.2025.03.030","DOIUrl":"10.1016/j.cgh.2025.03.030","url":null,"abstract":"<p><strong>Background & aims: </strong>Colonoscopy is recommended to monitor for Crohn's disease (CD) recurrence after surgical resection. However, repeated colonoscopy is invasive and resource-intensive. We conducted a systematic review and meta-analysis to evaluate the pooled diagnostic accuracy of noninvasive biomarkers and imaging measures for detecting endoscopic CD recurrence, as compared with colonoscopy.</p><p><strong>Methods: </strong>A systematic review was conducted to January 31, 2024, to identify studies evaluating the diagnostic accuracy of C-reactive protein (CRP), fecal calprotectin, computed tomography and magnetic resonance enterography, or intestinal ultrasound (IUS) compared with colonoscopy for detecting CD recurrence. Estimates of sensitivity, specificity, and positive and negative likelihood ratios were pooled using a random-effects hierarchical summary receiver operating characteristic model.</p><p><strong>Results: </strong>A total of 17 studies (N = 1080) evaluated inflammatory biomarkers and 20 studies (N = 1053) assessed imaging measures. The pooled sensitivity and specificity of CRP (threshold, 5.0 mg/L) were 0.45 (95% confidence interval [CI], 0.33-0.58) and 0.83 (95% CI, 0.68-0.92), respectively. Fecal calprotectin (threshold, 50 μg/g) was moderately sensitive 0.76 (95% CI, 0.70-0.82) but less specific 0.66 (95% CI, 0.56-0.75). Sensitivity for computed tomography enterography/magnetic resonance enterography and IUS was 0.89 (95% CI, 0.73-0.96) and 0.92 (95% CI, 0.75-0.96); specificity was 0.65 (95% CI, 0.43-0.82) and 0.76 (95% CI, 0.52-0.90), respectively. Using optimized radiographic parameters for IUS, specificity was improved to 0.85 (95% CI, 0.71-0.93).</p><p><strong>Conclusion: </strong>The high sensitivity of fecal calprotectin (<50 μg/g) and cross-sectional imaging can help reduce the need for invasive and costly colonoscopy monitoring for CD recurrence after surgery. Applying optimal definitions of sonographic recurrence by IUS parameters may further improve specificity for making therapeutic decisions without endoscopy.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}