Clinical Gastroenterology and Hepatology最新文献

{"title":"Differential Effects of Cardiometabolic Risk Factors on All-cause Mortality in United States Adults With Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD).","authors":"Matthew Dukewich, Jennifer L Dodge, Liyun Yuan, Norah A Terrault","doi":"10.1016/j.cgh.2025.09.003","DOIUrl":"10.1016/j.cgh.2025.09.003","url":null,"abstract":"<p><strong>Background & aims: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is defined by abnormalities in cardiometabolic risk factors (CMRFs). Characterizing the contribution of individual CMRFs to clinical outcomes may guide prioritization of interventions. We evaluated the association of individual CMRFs with all-cause mortality in United States adults with MASLD.</p><p><strong>Methods: </strong>Participants in the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and continuous NHANES (1999-2018) were linked to mortality data through 2019. Adults >20 years of age were included if their Fatty Liver Index (FLI) >60 and they had at least one CMRF (overweight/obesity, glucose intolerance, high blood pressure, triglycerides, or low high-density lipoprotein [HDL]). Cox regression analyzed risk of all-cause mortality adjusted for age, sex, and Fibrosis-4 (FIB-4).</p><p><strong>Results: </strong>Among 21,872 participants included (mean age, 50 years; 53% male), the mean body mass index (BMI) was 33.6 kg/m² with a median of 3 CMRF (99.5% overweight/obese, 55% glucose intolerance, 58% high blood pressure, 67% triglycerides, 40% low HDL). In adjusted analysis of individual CMRF, high blood pressure (adjusted hazard ratio [aHR], 1.39; 95% confidence interval [CI], 1.24-1.55; P < .001), glucose intolerance (aHR, 1.26; 95% CI, 1.16-1.38; P < .01), and low HDL (aHR, 1.15; 95% CI, 1.05-1.26; P = .003) exerted significant risks for mortality. When stratifying the overweight/obesity CMRF by discrete BMI ranges, a significantly greater risk for mortality was seen with BMI 35 to 40 kg/m² (aHR, 1.18; 95% CI, 1.02-1.36; P = .03), BMI 40 to 45 kg/m² (aHR, 1.55; 95% CI, 1.24-1.94; P < .001), and BMI >45 kg/m² (aHR, 1.64; 95% CI, 1.27-2.14; P < .001) compared with those with a BMI 25 to 30 kg/m². In age-adjusted analysis, the number of CMRFs was associated with greater risk for mortality (aHR, 1.15 per additional CMRF; 95% CI, 1.10-1.20; P < .001) CONCLUSIONS: The differential risk for mortality between individual CMRFs supports distinct clinical profiles in MASLD. This study found that high blood pressure and glucose intolerance exerted the greatest risk for all-cause mortality in those with MASLD, suggesting a role for prioritization of CMRF optimization.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091188","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":"Long-term Results of Drug Treatment for Crohn's Disease Strictures.","authors":"Grace C Lovett, Julien D Schulberg, AmyL Hamilton, Emily K Wright, Bronte A Holt, Tom R Sutherland, Alyson L Ross, Michael A Kamm","doi":"10.1016/j.cgh.2025.09.014","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.09.014","url":null,"abstract":"<p><strong>Background and aim: </strong>Recent controlled data from the STRIDENT study suggest that in the short-term drug treatment effectively relieves symptoms and improves bowel wall morphology. Here we present the long-term results of this clinical trial, identifying predictors of treatment outcomes.</p><p><strong>Methods: </strong>Patients with symptomatic Crohn's disease strictures were randomized 2:1 to high dose adalimumab induction followed by 40mg fortnightly plus thiopurine, with dose increase at 4 and/or 8 months if evidence of persisting inflammation, or standard dose adalimumab monotherapy. Baseline stricture MRI risk score was assessed: pre-stenotic dilation ≥30mm, stricture length >50mm and bowel wall thickness ≥10mm (each factor assigned a score of 1). Patients were assessed at 12 months for clinical response (reduction in the 14-day obstructive symptom score). Follow up interviews were performed at a minimum of 4 years.</p><p><strong>Results: </strong>In the initial 12-month study, 52 patients were randomised to the intensive and 25 to the standard treatment arm, with 64 of 77 (83%) completing at least 12 months of therapy while 13 (17%) withdrew: 8 for surgical treatment and 5 for other reasons. Following study completion at 12 months 12/77 (16%) patients required endoscopic dilation and 22/77 (29%) patients required surgery. Clinical responders had a lower rate of surgical resection compared to non-responders (20% vs 52%, P < 0.001). The stricture MRI risk score predicted surgery free survival (OR 2.34; 95%CI 1.32-4.16, P = 0.004).</p><p><strong>Conclusion: </strong>The clinical response to adalimumab is durable in a majority of patients beyond four years of therapy. In patients with symptomatic Crohn's disease strictures, drug treatment is a viable initial treatment.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091168","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 of Fibrosis and Applicability of Lab-based Noninvasive Tests From Primary to Tertiary Care.","authors":"Georg Semmler, Paul Thöne, Jan Embacher, Philipp Hruska, Lucie Simonis, Katharina Stopfer, Laurenz Fritz, Fiona Köck, Lorenz Balcar, Benedikt S Hofer, Bernhard Wernly, Sophie Gensluckner, Michael Strasser, Andreas Völkerer, Katrine Lindvig, Maja Thiele, Sarah Wernly, Robert Winker, Thomas Reiberger, Mattias Mandorfer, Michael Trauner, Christian Datz, Thomas-Mathias Scherzer, Elmar Aigner","doi":"10.1016/j.cgh.2025.09.008","DOIUrl":"10.1016/j.cgh.2025.09.008","url":null,"abstract":"<p><strong>Background & aims: </strong>Knowing the prevalence of fibrosis, the accuracy of noninvasive tests, and their applicability in referral strategies of individuals screened or surveilled for steatotic liver disease is crucial for individual and policy decision making.</p><p><strong>Methods: </strong>Five cohorts spanning primary to tertiary care between 2016 and 2024 were retrospectively included: individuals from the general population (colonoscopy screening, n = 1197, cohort I; primary care); at-risk individuals with metabolic dysfunction (overweight n = 1333, cohort II; prediabetes, n = 996, cohort III; secondary care); and subjects referred to hepatology clinics (n = 2397/n = 2598, cohort IV/V; tertiary care).</p><p><strong>Results: </strong>Mean controlled attenuation parameter was 262 to 294 dB/m, and 41% to 64% showed hepatic steatosis. Suspected fibrosis (liver stiffness measurement [LSM] ≥8 kPa) was found in 6.4% of cohort I, 7.3%/6.8% of cohort II/III, and 21%/30% of cohort IV/V, whereas advanced fibrosis (≥12 kPa) was rare (1.2% in cohort I, 1.4%/0.8% in cohorts II/III, and 12%/17% in cohorts IV/V, respectively). The prevalence of fibrosis was especially high in subjects with obesity or diabetes, but not in overweight or prediabetes. Sensitivity of Fibrosis-4 index ≥1.3 for liver stiffness measurement ≥8 kPa was low in primary and secondary care (33%-44%) with simultaneously low positive predictive value (8.3%-12%), and overall low accuracy (area under the precision recall curve [AUPRC], 0.09-0.15). LiverPRO (AUPRC, 0.12-0.24) and LiverRisk score (AUPRC, 0.13-0.24) were numerically more accurate, with LiverPRO being the most sensitive and LiverRisk score the most specific first-line test. In tertiary care, LiverPRO was comparatively accurate, but more sensitive than Fibrosis-4 index.</p><p><strong>Conclusion: </strong>Prevalence of fibrosis in contemporary patients with steatotic liver disease was ∼7% in primary/secondary care, being especially pronounced in individuals with diabetes or obesity. LiverPRO and LiverRisk score optimize referral pathways.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085128","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":"Performance of Fecal Immunochemical Test in Individuals With Personal history of Polyps and Family History of Colorectal Cancer: A Systematic Review.","authors":"Rahul Karna, Mohammad Bilal, Tarek Nayfeh, Azizullah Beran, Ruchir Paladiya, Himsikhar Khataniar, Ravishankar Ranganatha, Nicole Theis-Mahon, Samir Gupta, Aasma Shaukat","doi":"10.1016/j.cgh.2025.09.013","DOIUrl":"10.1016/j.cgh.2025.09.013","url":null,"abstract":"<p><strong>Background & aims: </strong>There is limited information regarding performance of fecal immunochemical test (FIT) in post-polypectomy surveillance, or for screening individuals with a family history of colorectal cancer (CRC). We conducted a systematic review to assess current evidence regarding diagnostic performance of one time FIT in increased risk populations.</p><p><strong>Methods: </strong>A comprehensive search of multiple databases was conducted to assess studies reporting performance of a one-time FIT as screening or surveillance tool in individuals at increased risk of CRC.</p><p><strong>Results: </strong>We identified 3 studies reporting on 8817 individuals with personal history of polyps who underwent FIT testing. For CRC detection, one-time FIT showed sensitivity ranging from 27.6% to 100.0% and specificity ranging from 55.9% to 94.1% with variable test thresholds and index polyp histology. We identified 12 studies reporting on 5525 individuals with family history of CRC. One-time FIT showed a sensitivity ranging from 25.0% to 100.0% and specificity ranging from 83.1% to 92.0%, with variable test thresholds and family history characteristics.</p><p><strong>Conclusion: </strong>Current evidence is limited to adequately assess diagnostic performance of FIT in individuals with family history of CRC, or as follow-up after polypectomy.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085147","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":"Morphometric Quantification of Steatosis and Fibrosis in Metabolic Liver Disease Associated With Type 2 Diabetes.","authors":"Oliver Fourati, Pauline Manchon, Phillipe Garteiser, Laurent Castera, Marco Dioguardi Burgio, Bernard Van Beers, Pierre Bedossa, Miguel Albuquerque, Thierry Poynard, Cédric Laouenan, Dominique Valla, Valéri Paradis","doi":"10.1016/j.cgh.2025.09.011","DOIUrl":"10.1016/j.cgh.2025.09.011","url":null,"abstract":"<p><strong>Background & aims: </strong>Liver biopsy remains the reference standard for diagnosing steatohepatitis in metabolic dysfunction-associated steatotic liver disease (MASLD), but its use is limited by interobserver variability. Morphometric analysis offers continuous and objective quantification of steatosis and fibrosis, potentially overcoming these limitations.</p><p><strong>Methods: </strong>We compared morphometric quantification of steatosis and fibrosis to noninvasive imaging in 233 patients with type 2 diabetes mellitus (T2DM) enrolled in the QUID-NASH project. Steatosis was assessed by magnetic resonance imaging-proton density fat fraction (MRI-PDFF), and liver stiffness by magnetic resonance elastography (MRE) and vibration-controlled transient elastography (VCTE). Morphometry was performed on biopsy slides measuring steatosis proportionate area (SPA) and collagen proportionate area (CPA).</p><p><strong>Results: </strong>Steatosis grade was related to SPA (P < .0001), which was significantly correlated with %PDFF (rho: 0.88; 95% confidence interval [CI], 0.82-0.91). Median SPA increased from 0.85% in Grade 0 to 19.85% in Grade 3; MRI-PDFF values ranged from 4.25% to 33.67%. Fibrosis stage was related to CPA and weakly correlated with liver stiffness measurement (LSM) by MRE (rho: 0.26; 95% CI, 0.12-0.39), and moderately with LSM by VCTE (rho: 0.52; 95% CI, 0.42-0.61). Fibrosis stage was significantly associated with CPA (P < .0001), which increased from 3.17% in stage 0 to 18.05% in stage 4.</p><p><strong>Conclusions: </strong>Our study demonstrates the relevance of quantitative morphometric assessment of steatosis and fibrosis in patients with T2DM and MASLD. Such an easily applicable approach could be used in routine practice to better characterize 2 cardinal features of the disease and to improve monitoring.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079760","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":"Association Between Sustained Virological Response and Adverse Liver-related Events in Patients With Decompensated Hepatitis C Virus Cirrhosis.","authors":"Lisa M van Velsen, Lisette A P Krassenburg, Grishma Hirode, Kosh Agarwal, Graham R Foster, Zillah Cargill, Raoel Maan, Michael P Manns, Heiner Wedemeyer, Markus Cornberg, Robert J de Knegt, Gonzalo Crespo, Jose L Calleja, Alnoor Ramji, Giuseppina Brancaccio, Maria Cristina Morelli, Ilaria Lenci, Chiara Mazzarelli, Raffaella Vigano, Paolo Angeli, Patrizia Burra, Maria Francesca Donato, Paola Carrai, Silvia Martini, Paolo Caraceni, Francesco Paolo Russo, Harry L A Janssen, Bettina E Hansen, Adriaan J van der Meer, Jordan J Feld, Milan J Sonneveld","doi":"10.1016/j.cgh.2025.09.006","DOIUrl":"10.1016/j.cgh.2025.09.006","url":null,"abstract":"<p><strong>Background & aims: </strong>Sustained virological response (SVR) improves prognosis in patients with chronic hepatitis C virus (HCV) with compensated cirrhosis, but whether a similar benefit can be obtained in decompensated patients is controversial. We studied the association between SVR and liver-related events (LREs) in patients with decompensated HCV cirrhosis.</p><p><strong>Methods: </strong>We included patients with decompensated HCV cirrhosis (Child-Turcotte-Pugh [CTP] ≥7 and/or history of decompensation) treated with direct-acting antivirals. The association between SVR and LREs, and between SVR-related change in Model for End-stage Liver Disease (MELD) score and LREs were assessed.</p><p><strong>Results: </strong>In total, 914 patients were included, with a median age of 54.7 years; 45% had alcohol use disorder, 87% CTP-B, and the median MELD score was 12.1. SVR was achieved in 834 patients (91.2%), with a median follow-up of 28 months. The 3-year cumulative incidence of LREs was 47.5% in patients with SVR compared with 58.6% in those without (P < .001). Findings were consistent in multivariable analysis (adjusted hazard ratio [aHR], 0.692; P = .011). SVR was associated with a reduced risk of LREs in patients with a pretreatment MELD <15 (44.4% vs 57.6%; aHR, 0.601; P = .004), but not among patients with MELD ≥15 (62.8% vs 58.9%; aHR, 0.936; P = .801). Among patients with SVR, a ≥2-point decrease in MELD was observed in 23.4% and was not associated with a reduced risk of LREs (52.1% vs 50.7%; P = .473). Findings were consistent in multivariable analysis (aHR, 0.730; P = .122), and in patients with a pretreatment MELD score ≥15.</p><p><strong>Conclusions: </strong>SVR was associated with a reduced risk of LREs in patients with decompensated HCV cirrhosis with a MELD score <15, whereas no clinical benefit was observed in those with higher MELD scores despite an SVR-associated MELD decrease.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079823","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":"Small Intestinal Stricture With Intense ¹⁸F-FDG PET Activity Caused by Endometriosis.","authors":"Ichiro Mizushima, Yohei Mikami, Takanori Kanai","doi":"10.1016/j.cgh.2025.09.012","DOIUrl":"10.1016/j.cgh.2025.09.012","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069191","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":"Novel HBV Biomarkers-Guided NA Withdrawal Strategy Promotes HBsAg Clearance in Asian CHB Patients: A Randomized Controlled Trial.","authors":"Rong Fan, Rui Deng, Qing Xie, Fang Wang, Xieer Liang, Hong Ma, Huiying Rao, Yanhang Gao, Chunxiu Zhong, Qing Guo, Sheng Shen, Ya Xu, Xingyu Lu, Hongbo Gao, Honglian Bai, Xiaoguang Dou, Jian Sun","doi":"10.1016/j.cgh.2025.09.009","DOIUrl":"10.1016/j.cgh.2025.09.009","url":null,"abstract":"<p><strong>Background & aims: </strong>Nucleos(t)ide analogue (NA) discontinuation promotes hepatitis B surface antigen (HBsAg) clearance among European patients with chronic hepatitis B virus (HBV) infection. The efficacy and safety of a novel HBV biomarker-guided NA withdrawal strategy among Asian patients was evaluated in this multicenter randomized controlled trial.</p><p><strong>Methods: </strong>NA-experienced patients achieving HBsAg <200 IU/mL and undetectable HBV DNA for ≥12 months with HBV RNA or hepatitis core-related antigen undetectable were randomized 2:1 to stop or continue NA therapy. Ninety patients were included in final modified intention-to-treat analysis (60 in the NA-Stop group and 30 in the NA-Continue group). Cumulative rates of HBsAg loss and relapse were evaluated at week 144.</p><p><strong>Results: </strong>Patients enrolled were 45.9 ± 10.2 years of age, with a median 9.4 years (interquartile range, 6.0-13.0 years) of treatment. Baseline characteristics between the two groups were balanced, with a median HBsAg level of 1.7 and 1.8 log₁₀ IU/mL in the NA-Stop and NA-Continue groups, respectively (P = .224). Compared with patients in the NA-Continue group, NA-stoppers showed an increased 144-week cumulative incidence of HBsAg clearance (25.9% vs 4.2%; P = .013) and more profound HBsAg decline during follow-up (0.90 log₁₀ IU/mL vs 0.46 log₁₀ IU/mL; P = .056). Cumulatively, 38.6% and 20.2% of patients experienced virological and clinical relapse after stopping NAs, with 16 patients retreated and no serious adverse events occurring. Subgroup analysis revealed that hepatitis B e antigen-negative patients with baseline HBsAg level <100 IU/mL had a more favorable response following NA withdrawal, achieving an HBsAg loss rate of 40.0%.</p><p><strong>Conclusions: </strong>Asian patients with long-term HBV suppression benefit from NA discontinuation guided by novel HBV markers, which provides rationale for finite NA treatment. ClincialTrials.gov, Number: NCT04519359.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069183","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 Optimal Cutoffs of Liver Stiffness Measurement for Staging Fibrosis in On-treatment Patients With Chronic Hepatitis B.","authors":"Xiaoning Wu, Jialing Zhou, Yameng Sun, Chenghai Liu, Lingyi Zhang, Xinxin Zhang, Hong Zhao, Mingyi Xu, Yongpeng Chen, Hongxin Piao, Xudong Liu, Huichun Xing, Huiguo Ding, Mei Yang, Wei Jiang, Bingqiong Wang, Shuyan Chen, Tongtong Meng, Zhiying He, Hao Wang, Xiaojuan Ou, Jidong Jia, Hong You","doi":"10.1016/j.cgh.2025.05.029","DOIUrl":"10.1016/j.cgh.2025.05.029","url":null,"abstract":"<p><strong>Background & aims: </strong>Liver stiffness measurement (LSM) cutoffs for diagnosis of liver fibrosis in untreated patients with chronic hepatitis B (CHB) have been well-established. However, the applicability and the optimal LSM cutoffs for patients undergoing antiviral therapy remain unclear.</p><p><strong>Methods: </strong>Adults with CHB who had LSM and liver biopsy on the same day during antiviral therapy were enrolled from 2 clinical studies and their extension observations (NCT01938820, NCT01943617, NCT01938781, and NCT03777969). Liver fibrosis was evaluated according to the METAVIR and Ishak scoring system. The performance of LSM measured by vibration-controlled transient elastography (VCTE) devices was estimated using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>A total of 754 patients were enrolled and randomly divided into derivation and validation sets in a ratio of 2:1. Among them, 75.9% of patients (572/754) were male, with a median age of 42.1 years (interquartile range [IQR], 34.0-49.0 years). The median treatment duration was 1.5 years (IQR, 1.0-2.5 years). The cutoffs of LSM for diagnosis of ≥F2, ≥F3, and F4 during antiviral treatment were 7.6 kPa, 7.6 kPa, and 9.0 kPa, respectively, with a sensitivity of 57.5%, 79.2%, and 74.4%, and a specificity of 86.1%, 73.0%, and 77.2%. The area under the receiver operating characteristic curve (AUROC) for diagnosing ≥F2, ≥F3, and F4 were 0.753 (95% confidence interval [CI], 0.712-0.790), 0.818 (95% CI, 0.778-0.848), and 0.815 (95% CI, 0.755-0.846), respectively.</p><p><strong>Conclusion: </strong>The optimal cutoffs for diagnosing ≥F2/F3 and F4 in on-treatment patients with CHB were 7.6 kPa and 9.0 kPa. These cut-offs could be reliably and repeatedly applied for long-term monitoring of patients with CHB under antiviral therapy.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063448","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":"Reply.","authors":"Wei Zhang, Ruiqi Li, Yuzheng Zhuge, Feng Zhang","doi":"10.1016/j.cgh.2025.09.010","DOIUrl":"10.1016/j.cgh.2025.09.010","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069125","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}