Clinical Gastroenterology and Hepatology最新文献

{"title":"AGA Clinical Practice Update on GI Manifestations and Autonomic or Immune Dysfunction in Hypermobile Ehlers-Danlos Syndrome: Expert Review","authors":"Qasim Aziz , Lucinda A. Harris , Brent P. Goodman , Magnus Simrén , Andrea Shin","doi":"10.1016/j.cgh.2025.02.015","DOIUrl":"10.1016/j.cgh.2025.02.015","url":null,"abstract":"<div><h3>Description</h3><div>The purpose of this Clinical Practice Update Expert Review is to describe key principles in the evaluation and management of patients with disorders of gut-brain interaction (DGBI) and hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSDs) with coexisting postural orthostatic tachycardia syndrome (POTS) and/or mast cell activation syndrome (MCAS).</div></div><div><h3>Methods</h3><div>This expert review was commissioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of <em>Clinical Gastroenterology and Hepatology</em>. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.</div></div><div><h3>Best Practice Advice 1</h3><div>Clinicians should be aware of the observed associations between hEDS or HSDs and POTS and/or MCAS and their overlapping gastrointestinal (GI) manifestations; while theoretical explanations exist, experimental evidence of the biological mechanisms that explain relationships is limited and evolving.</div></div><div><h3>Best Practice Advice 2</h3><div>Testing for POTS/MCAS should be targeted to patients presenting with clinical manifestations of POTS/MCAS, but universal testing for POTS/MCAS in all patients with hEDS/HSDs is not supported by the current evidence.</div></div><div><h3>Best Practice Advice 3</h3><div>Gastroenterologists seeing patients with DGBI should inquire about joint hypermobility and strongly consider incorporating the Beighton score for assessing joint hypermobility into their practice as a screening tool; if the screen is positive, gastroenterologists may consider applying 2017 diagnostic criteria to diagnose hEDS (<span><span>https://www.ehlers-danlos.com/wp-content/uploads/2017/05/hEDS-Dx-Criteria-checklist-1.pdf</span><svg><path></path></svg></span>) or offer appropriate referral to a specialist where resources are available.</div></div><div><h3>Best Practice Advice 4</h3><div>Testing for POTS through postural vital signs (eg, symptomatic increase in heart rate of 30 beats/min or more with 10 minutes of standing during an active stand or head-up tilt table test in the absence of orthostasis) and referral to specialty practices (eg, cardiology or neurology) for autonomic testing should be considered in patients with hEDS/HSDs and refractory GI symptoms who also report orthostatic intolerance after exclusion of medication side effects and appropriate lifestyle or behavioral modifications (eg, ","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 8","pages":"Pages 1291-1302"},"PeriodicalIF":11.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092963","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":"Rethinking Post-colonoscopy Colorectal Cancer Risk: Endoscopist Performance Versus Presence of High-risk Polyps.","authors":"Nanette S van Roermund, Veerle M H Coupé, Manon C W Spaander, Monique E van Leerdam, Evelien Dekker, Joep E G IJspeert","doi":"10.1016/j.cgh.2025.03.026","DOIUrl":"10.1016/j.cgh.2025.03.026","url":null,"abstract":"<p><strong>Background and aims: </strong>Current post-polypectomy guidelines set intervals based solely on features of resected polyps. Despite the well-known inverse relationship between both adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSPDR) with post-colonoscopy colorectal cancers (PCCRCs), both quality indicators are not considered when determining surveillance intervals.</p><p><strong>Methods: </strong>We used colonoscopy data from 2014 to 2020 performed for a positive fecal immunochemical test in the Dutch colorectal cancer screening program. Individuals were categorized into having high-risk polyps or no/low-risk polyps resected. The association between 3-year PCCRC-risk and presence of high-risk polyps and either ADR or PSPDR was studied with Cox proportional hazard regression. Secondly, endoscopists were categorized into low/medium/high ADR and PSPDR to enable stratified analysis.</p><p><strong>Results: </strong>A total of 239,217 individuals were included; 74,289 had high-risk polyps resected at baseline and 202 had PCCRC within the subsequent 3 years. Presence of high-risk polyps was not associated with PCCRC-risk (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.75-1.35), whereas ADR and PSPDR showed a strong association with PCCRC (per point increase HR, 0.94; 95% CI, 0.92-0.96; HR, 0.92; 95% CI, 0.89-0.95, respectively). For individuals with no/low-risk polyps but examined by endoscopists with low ADR, the HR of PCCRC was 2.11 (95% CI, 1.21-3.65), as compared with individuals with high-risk polyps but examined by endoscopists with high ADR.</p><p><strong>Conclusions: </strong>An individual's PCCRC risk in the initial years is primarily influenced by endoscopist performance, rather than the presence of high-risk polyps. To reduce PCCRCs, besides ensuring appropriate surveillance intervals, it is crucial to monitor and audit endoscopist quality indicators.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093063","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":"Primary Pancreatic Small Round Cell Sarcoma.","authors":"Ming Zhao, Xi Zhou, Jing Shan","doi":"10.1016/j.cgh.2025.04.018","DOIUrl":"10.1016/j.cgh.2025.04.018","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093062","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":"pH Impedance Monitoring on Proton Pump Inhibitor Therapy Impacts Management Decisions in Proven GERD but not in Unproven GERD.","authors":"C Prakash Gyawali, Benjamin D Rogers, Rena Yadlapati, Sabine Roman, Dustin A Carlson, John Pandolfino","doi":"10.1016/j.cgh.2025.02.032","DOIUrl":"10.1016/j.cgh.2025.02.032","url":null,"abstract":"<p><strong>Background and aims: </strong>Ambulatory reflux monitoring off proton pump inhibitors (PPIs) is useful in unproven gastroesophageal reflux disease (GERD). In this prospective clinical trial, we evaluated if on-PPI pH-impedance monitoring provides value in unproven GERD.</p><p><strong>Methods: </strong>Patients with typical reflux symptoms with incomplete PPI response were studied both off PPI (wireless pH monitoring) and on PPI (pH-impedance monitoring) at 2 tertiary care centers. Patients and investigators were blinded to reflux testing findings, and patients were asked to self-resume PPI for uncontrolled symptoms despite rescue antacids. Data analysis determined if on-PPI pH-impedance findings correlated with off-PPI acid exposure time (AET) or influenced PPI-related decision making.</p><p><strong>Results: </strong>Of 79 patients, all 26 (32.9%) with refractory GERD metrics on-PPI had proven GERD off-PPI. In 60 patients with proven GERD off-PPI, 56.7% had no ongoing GERD on PPI. No on-PPI pH-impedance findings predicted PPI decision making among conclusive, borderline, or no reflux (P = .872); AET (P = .107); reflux episodes numbers (P = .113); mean nocturnal baseline impedance (P = .621); and reflux-symptom association categories (P = .363). In multivariable linear and logistic regression models, off-PPI AET modestly predicted refractory GERD (odds ratio, 1.34; 95% confidence interval, 1.11-1.63; P = .003), and reflux episode numbers were borderline in predicting conclusive GERD off-PPI (odds ratio, 1.00; 95% confidence interval, 1.00-1.10; P = .04).</p><p><strong>Conclusions: </strong>A minority of symptomatic patients will have refractory GERD evidence on pH-impedance monitoring on PPI; this strategy risks missing over half of the cohort with proven GERD if testing off PPI is unavailable. Our findings support documenting GERD off PPI first in PPI nonresponders and restricting on-PPI pH-impedance monitoring to identify refractory GERD only in patients with proven GERD with persisting symptoms.</p><p><strong>Clinicaltrials: </strong>gov, Number: NCT03202537.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093058","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 of Metabolic Comorbidities With Fibrosis Severity and Fibrosis Regression in Patients With Chronic Hepatitis B.","authors":"Lisa M van Velsen, Lesley A Patmore, Jordan J Feld, Henry L Y Chan, Teerha Piratvisuth, Rong-Nan Chien, Edo J Dongelmans, Vedran Pavlovic, Leland J Yee, Willem Pieter Brouwer, Audrey Lau, Bettina E Hansen, Maria Buti, Qing Xie, Keyur Patel, Scott K Fung, Harry L A Janssen, Milan J Sonneveld","doi":"10.1016/j.cgh.2025.04.024","DOIUrl":"10.1016/j.cgh.2025.04.024","url":null,"abstract":"<p><strong>Background and aims: </strong>The presence of metabolic comorbidities is associated with a higher risk of liver-related events in chronic hepatitis B (CHB) patients. However, the association between presence of metabolic comorbidities and the severity of biopsy-proven liver fibrosis is yet unknown.</p><p><strong>Methods: </strong>Data from CHB patients from 2 tertiary clinics and 8 clinical trials was analyzed. We studied the association between presence of metabolic comorbidities with severity of liver fibrosis in untreated patients, and with fibrosis regression or progression in biopsies taken after initiation of antiviral therapy.</p><p><strong>Results: </strong>We analyzed biopsies from 3179 untreated CHB patients. Median age was 37 years, 57.6% were hepatitis B e antigen positive, with median hepatitis B virus DNA of 7.30 logIU/mL. Overweight (29.4% vs 19.0%; P < .001), hypertension (40.7% vs 23.2%; P < .001), diabetes (42.2% vs 23.6%; P < .001), and dyslipidemia (42.9 vs 23.6%; P < .001) were associated with a higher risk of advanced fibrosis, with the highest risk observed in patients with multiple comorbidities. Findings were consistent in multivariable analysis (1 comorbidity: adjusted odds ratio [aOR], 1.115; ≥2 comorbidities: aOR, 1.627; P = .006). Regression to nonadvanced fibrosis, after treatment initiation, was more often observed in patients without metabolic comorbidities (43.1%), compared with patients with 1 (31.6%) or ≥2 comorbidities (17.0%) (P = .005). Findings were consistent in multivariable analysis (1 comorbidity: aOR, 0.792; ≥2 comorbidities: aOR, 0.260; P = .025). The risk of progression to advanced fibrosis was highest in patients with ≥2 comorbidities (14.3% vs 4.6%; P = .001).</p><p><strong>Conclusions: </strong>Presence of metabolic comorbidities in untreated CHB patients is associated with more severe liver fibrosis and, after initiation of antiviral therapy, with less fibrosis regression and a higher risk of fibrosis progression.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093043","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":"Fulminant Clostridioides difficile Infection Following Fecal Microbiota Spores Compared to Fecal Microbiota Transplant.","authors":"Trevor S Barlowe, Shivani Desai, Ariel E Sanderford, Thomas Holowka, Anne F Peery, Sarah K Mcgill","doi":"10.1016/j.cgh.2025.03.027","DOIUrl":"10.1016/j.cgh.2025.03.027","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093052","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":"Proactive Drug Monitoring Versus Clinically Based Dosing for Endoscopic Healing in Pediatric Crohn's Disease Receiving Infliximab.","authors":"Ben Kang, Eun Sil Kim, Sujin Choi, Byung-Ho Choe, Jin Soo Moon, Jae Sung Ko, Sangjun Sohn, Yeoun Joo Lee, Yiyoung Kwon, Mi Jin Kim, Tae Yeon Jeon, So Mi Lee, Seunghyun Lee, Youngcheol Ju, Yon Ho Choe","doi":"10.1016/j.cgh.2025.04.025","DOIUrl":"10.1016/j.cgh.2025.04.025","url":null,"abstract":"<p><strong>Background & aims: </strong>Proactive dosing based on therapeutic drug monitoring (TDM) of adalimumab is associated with higher rates of sustained corticosteroid-free clinical remission (SCFCR) in children with Crohn's disease (CD) than that with reactive TDM. We aimed to investigate whether proactive dosing of infliximab (IFX) based on TDM is associated with higher rates of endoscopic healing (EH) in pediatric patients with CD than that with clinically based dosing.</p><p><strong>Methods: </strong>We conducted a non-blinded, randomized controlled trial of 112 biologic-naïve children with CD who had responded to IFX induction treatment at 4 centers in South Korea between July 2017 and November 2020. Patients were randomly assigned to receive dosing based on proactive TDM (proactive arm) or clinically based dosing (clinical arm). The primary endpoint was EH at week 54.</p><p><strong>Results: </strong>The primary endpoint was achieved in 80.0% (40/50) of the proactive arm and 57.1% (28/49) of the clinical arm (P = .025). SCFCR was achieved in 69.6% (39/56) of the clinical arm and 89.3% (50/56) of the proactive arm at week 54 of treatment (P = .019). According to the multivariate logistic regression analysis, the intervention group (proactive arm vs clinical arm) was an independent factor associated with EH (odds ratio, 3.48; 95% confidence interval, 1.26-10.43; P = .019) and SCFCR (odds ratio, 5.50; 95% confidence interval, 1.72-21.61; P = .007).</p><p><strong>Conclusions: </strong>Dosing based on proactive TDM was superior to clinically based dosing in terms of EH in a randomized controlled trial of pediatric CD. Trial identifier: cris.nih.go.kr: KCT0005190.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086056","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":"Feasibility and Acceptability of Noninvasive Stool Testing for Surveillance of Colorectal Polyps in Older Adults.","authors":"Suzannah J Luft, Mirjana Stevanovic, Christopher M Navas, Douglas J Robertson, Prabhjot Kaur, Audrey H Calderwood","doi":"10.1016/j.cgh.2025.03.023","DOIUrl":"10.1016/j.cgh.2025.03.023","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085936","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":"Simplifying Diagnosis of Bile Acid Diarrhea With Clinical and Biochemical Measurements on Blood and Single Stool Sample.","authors":"Saam Dilmaghani, Camille Lupianez-Merly, Joelle BouSaba, Priya Vijayvargiya, Irene Busciglio, Monique Ferber, Paula Carlson, Leslie J Donato, Michael Camilleri","doi":"10.1016/j.cgh.2025.02.031","DOIUrl":"10.1016/j.cgh.2025.02.031","url":null,"abstract":"<p><strong>Background and aims: </strong>Diagnosis of bile acid diarrhea (BAD) has been based on 48-hour fecal BA excretion; serum 7αC4 (C4) has been used to screen for BAD. Optimal diagnostic cutoffs for C4 and biochemical measurements in a single stool sample are unknown. We sought to examine the relationship between total BA concentration (TBAc) and percent primary BA (%PBA) in a single stool sample and serum C4 in patients with and without BAD and explore performance characteristics of stool consistency and biochemical (serum C4 and single-stool BA) parameters for diagnosis of BAD compared with gold standard 48-hour fecal BA.</p><p><strong>Methods: </strong>Based on data from patients with BAD, irritable bowel syndrome with diarrhea (IBS-D), and healthy control subjects, we assessed correlations among stool and serum measurements. Machine learning models (based on data from 30 patients with BAD, 8 patients with IBS-D, and 26 healthy control subjects) were trained on 25 bootstrapped random samples, the superior model was identified, and optimal cutoffs of biological measurements to diagnose BAD were summarized.</p><p><strong>Results: </strong>There were correlations between serum C4 and %PBA (R = 0.284, P < .001), and between %PBA and TBAc (R = 0.49, P < .001). Using a %PBA of 1.05% (25th percentile in BAD), the %PBA distinguished BAD from IBS-D (odds ratio, 3.06; 95% confidence interval, 1.35-7.46; P = .01). The multivariate logistic regression model had superior balance of variance and bias. Optimal cutoffs for predicting BAD using logistic regression were 4.5% PBA (P = .023) and 1.88 μmol/g TBAc (P = .016). Serum C4 >24 ng/mL and PBA >4.6% individually had 57% and 75.8% positive predictive value, respectively, but together had a 90.1% positive predictive value. Stool consistency was less informative.</p><p><strong>Conclusions: </strong>New diagnostic cutoffs based on serum C4 and single-stool TBAc and % PBA provide potential alternatives for diagnosing BAD. Further validation is warranted.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086060","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":"Incidence and Clinical Significance of Recompensation After HCV Cure.","authors":"Georg Semmler, Sabela Lens, Álvaro Hidalgo, Sonia Alonso López, Maria Perez-Perez, Elton Dajti, Martin Kabelitz, Paola Zanaga, Benedikt Silvester Hofer, Zoe Marino, Marisa Luisa Manzano, Isabel Payeras, Monica Pons, Angelo Bruni, Alberto Zanetto, Lukas Burghart, Dominik Ecker, Lucie Simonis, Anna Pocurull, Laurenz Fritz, Cristina Collazos, Daniela Neumayer, Lorenz Balcar, Mathias Jachs, Thomas Reiberger, Francesco Paolo Russo, Benjamin Maasoumy, Joan Genesca, Rafael Bañares, Xavier Forns, Inmaculada Fernandez, Mattias Mandorfer","doi":"10.1016/j.cgh.2025.04.026","DOIUrl":"10.1016/j.cgh.2025.04.026","url":null,"abstract":"<p><strong>Background and aims: </strong>Baveno VII has proposed criteria for cirrhosis recompensation, but their prognostic significance in decompensated patients cured of hepatitis C virus (HCV) deserves further investigation. Thus, we studied the incidence and impact of recompensation after HCV cure as well as its predictors.</p><p><strong>Methods: </strong>A total of 2570 patients with advanced chronic liver disease (ACLD) from 10 European centers were retrospectively included, including 2209 and 361 patients with compensated ACLD and decompensated cirrhosis who achieved sustained virologic response to direct-acting antivirals (DAAs). The association between achieving recompensation and clinical outcomes (hepatocellular carcinoma [HCC], portal vein thrombosis [PVT], and [liver-related] death) was investigated.</p><p><strong>Results: </strong>During a median follow-up of 8.4 years from treatment initiation, 132 patients (36.6%) achieved recompensation. Lower albumin levels and diabetes were negatively associated with achieving recompensation. The incidence rates of liver-related death (4.2 vs 8.8 per 100 patient-years) and PVT (2.7 vs 5.4) were substantially lower after recompensation vs in the nonrecompensated state, while HCC incidence remained high (3.9 vs 5.5). Compared with decompensated cirrhosis, achieving recompensation was independently associated with decreased risks of subsequent liver-related death (adjusted hazard ratio, 0.384; 95% confidence interval, 0.225-0.655) and of PVT (adjusted hazard ratio, 0.421; 95% confidence interval, 0.224-0.759), but both risks remained higher than in compensated ACLD. Importantly, HCC incidence was not reduced as compared with decompensated cirrhosis.</p><p><strong>Conclusions: </strong>Recompensation after HCV cure is associated with substantially decreased risks of (liver-related) mortality and PVT, but not of HCC.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086019","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}