Alimentary Pharmacology & Therapeutics最新文献

{"title":"P-CAB vs. PPI for Upper Gastrointestinal Bleeding Prevention in Patients With Atherothrombotic Disease on Antithrombotic Therapy: A CDM Cohort Study.","authors":"Min Joo Yoon, Soyoung Lee, Hye-Kyung Jung, Min-Ho Kim, Suna Yu, Eui Sun Jeong, Chung Hyun Tae","doi":"10.1111/apt.70719","DOIUrl":"https://doi.org/10.1111/apt.70719","url":null,"abstract":"<p><strong>Background: </strong>Randomised trials have suggested the benefit of potassium-competitive acid blockers (P-CABs) is superior to proton pump inhibitors (PPIs) for ulcer recurrence in high-risk aspirin users. However, real-world comparative effectiveness across diverse antithrombotic regimens remains poorly defined.</p><p><strong>Objective: </strong>We evaluated P-CABs versus PPIs for preventing upper gastrointestinal (GI) bleeding in patients with acute atherothrombotic disease and using antithrombotic therapy.</p><p><strong>Design: </strong>This retrospective cohort study utilised hospital-based Common Data Model data (2018-2024). Patients with acute cardiovascular or cerebrovascular disease receiving antithrombotic therapy who initiated a PPI or P-CAB were included. Drug exposure was modelled as a time-varying variable to mitigate immortal-time bias. The primary outcome was upper GI bleeding, analysed via time-dependent Cox regression adjusted for age, sex, comorbidities, and concomitant medications.</p><p><strong>Results: </strong>Among 2255 patients (PPI: 1726; P-CAB: 529) in which 53 upper GI bleeding events occurred during a median follow-up of 637 days. P-CAB use was associated with a significantly lower risk of upper GI bleeding than PPIs (incidence rate 5.7 vs. 25.8 per 1000 person-year; adjusted hazard ratio [HR] 0.22, 95% CI 0.06-0.75, p = 0.016). P-CABs showed a profound reduction in moderate-to-severe upper GI bleeding (HR 0.11, 95% CI 0.02-0.60; p = 0.011). Notably, no bleeding events occurred in P-CAB users with high antithrombotic burden (≥ 2 agents).</p><p><strong>Conclusions: </strong>In patients receiving antithrombotic therapy, P-CABs are associated with a significantly lower risk of clinically significant GI bleeding compared to PPIs. These findings support P-CABs as a potent acid-suppressive strategy for gastroprotection in high-risk populations.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855585","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":"Editorial: Refining the Natural History of MASLD by Imaging-Based Markers: The GOLDMINE Study.","authors":"Federico Perna, Angelo Armandi","doi":"10.1111/apt.70714","DOIUrl":"https://doi.org/10.1111/apt.70714","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831392","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":"Letter: Interpreting Faecal SCFA Enrichment in IBS-D-Metabolic Signal or Transit-Related Marker?","authors":"Longying Zhang, Lifen Zhao, Lina Liu","doi":"10.1111/apt.70717","DOIUrl":"https://doi.org/10.1111/apt.70717","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831365","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":"Editorial: Bile Acids Under Bulevirtide: A Pharmacodynamic Signature, Not a Prognostic Biomarker.","authors":"Apichat Kaewdech, Pimsiri Sripongpun","doi":"10.1111/apt.70707","DOIUrl":"https://doi.org/10.1111/apt.70707","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831432","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":"Rifaximin Improves Cognitive Performance and Reduces Cirrhosis-Related Adverse Events in Covert Hepatic Encephalopathy: A Randomized Controlled Trial.","authors":"Hiroki Inada, Toshinori Toyota, Haruki Uojima, Etsuko Iio, Takao Miwa, Satoshi Miuma, Shiho Miyase, Takahiro Mizuta, Daiki Maeda, Katsuya Nagaoka, Satoshi Narahara, Sotaro Kurano, Kentaro Tanaka, Yoko Yoshimaru, Takehisa Watanabe, Shuichiro Iwasaki, Hisashi Hidaka, Kazuhiro Sugi, Hiroko Setoyama, Masahito Shimizu, Jiro Nakayama, Yasuhito Tanaka","doi":"10.1111/apt.70712","DOIUrl":"https://doi.org/10.1111/apt.70712","url":null,"abstract":"<p><strong>Background: </strong>Covert hepatic encephalopathy (CHE) is associated with cognitive impairment and adverse clinical outcomes; however, randomized evidence supporting therapeutic intervention remains limited.</p><p><strong>Aim: </strong>To evaluate the efficacy of rifaximin (RFX) as a treatment for CHE.</p><p><strong>Methods: </strong>In this multicentre, open-label randomized controlled trial, patients with CHE associated with liver cirrhosis were randomized (1:1) to receive RFX or no treatment and followed for 12 weeks. The primary endpoint was the change in Stroop test performance. Secondary endpoints included NCT-B scores, serum ammonia levels, cirrhosis-related adverse events, and gut microbiota composition.</p><p><strong>Results: </strong>Fifty patients were randomized and completed follow-up. Stroop test performance improved significantly in the RFX group (p = 0.006) but not in controls (p = 0.400), with a trend toward greater improvement with RFX (Δ Stroop test: -4.45 ± 7.12 vs. -0.98 ± 5.74 s; p = 0.056). Among patients not receiving synthetic disaccharides at baseline, improvement was significantly greater with RFX (Δ Stroop test: -3.73 ± 5.96 vs. -0.80 ± 5.86 s; p = 0.049). No significant changes were observed in NCT-B scores or serum ammonia levels. Cirrhosis-related adverse events were significantly reduced in the RFX group (p = 0.006). Overall, gut microbial diversity did not differ between groups; however, RFX selectively altered specific taxa, including loss of the [Eubacterium] brachy group.</p><p><strong>Conclusions: </strong>RFX improved cognitive performance assessed by the Stroop test and reduced cirrhosis-related adverse events in patients with CHE. These randomized data support RFX as an effective therapeutic option and highlight the Stroop test as a sensitive endpoint for treatment response.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147830595","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":"Letter: Geographic Transportability of Shingles Risk With Advanced IBD Therapies.","authors":"Guofu Mao, Haizhen Lan","doi":"10.1111/apt.70710","DOIUrl":"https://doi.org/10.1111/apt.70710","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831383","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":"Secular Trend in Glycaemic Management in Type 2 Diabetes Patients With and Without Cirrhosis Between 2000 and 2023: A Territory-Wide Cohort Study.","authors":"Mary Yue Wang, Sherlot Juan Song, Nana Peng, Grace Lai-Hung Wong, Vincent Wai-Sun Wong, Jimmy Che-To Lai, Terry Cheuk-Fung Yip","doi":"10.1111/apt.70705","DOIUrl":"https://doi.org/10.1111/apt.70705","url":null,"abstract":"<p><strong>Background and aims: </strong>With the change in antidiabetic medications, the trend of glycaemic management is still unclear for type 2 diabetes mellitus (T2DM) patients, especially those with cirrhosis. We aimed to examine secular trends in glycaemic control and antidiabetic medication usage among T2DM patients with or without cirrhosis.</p><p><strong>Methods: </strong>We retrospectively included T2DM adult patients with or without cirrhosis from 2000 to 2023 in Hong Kong, and excluded those with type 1 diabetes. Serial laboratory measurements in each of the five consecutive periods (2000-2004, 2005-2009, 2010-2014, 2015-2019, and 2020-2023) were compared by time-weighted average. The percentages of patients who achieved haemoglobin A_1c (HbA_1c) < 7% and fasting blood glucose < 7.2 mmol/L, as well as the trend of antidiabetic medication usage and hypoglycaemia incidence, were examined.</p><p><strong>Results: </strong>Of 1,206,233 patients with T2DM (mean age 63.1 years, 52.0% males), 1,143,033 (94.8%), 45,208 (3.7%) and 17,992 (1.5%) had no cirrhosis, compensated and decompensated cirrhosis, respectively. All patients with or without cirrhosis had increasing proportions of patients achieving HbA_1c target over the years, with compensated cirrhosis group having the best control (from 2000-04 to 2020-23: non-cirrhosis group: 39.2% to 65.9%, compensated cirrhosis group: 49.3% to 75.8%, decompensated cirrhosis group: 47.6% to 64.6%). The probability of achieving glycaemic targets increased over time in all groups. Insulin was the predominant agent in decompensated cirrhosis group, with an increasing incidence of hypoglycaemia.</p><p><strong>Conclusion: </strong>Glycaemic control improved in T2DM patients irrespective of cirrhosis status. Further research is needed to determine the impact of sustained control on hepatic and extrahepatic outcomes.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147830830","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":"Editorial: UDCA Dosing in PBC - Between Guideline Adherence and Clinical Reality.","authors":"Helena Hernández-Évole, María Carlota Londoño","doi":"10.1111/apt.70703","DOIUrl":"https://doi.org/10.1111/apt.70703","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831378","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":"Superior Efficacy of Tenofovir Alafenamide Compared With Entecavir in Reducing Hepatitis B Surface Antigen: A Multicentre Propensity Score-Matched Study Using Linear Mixed-Effects Models.","authors":"Takashi Kumada, Masanori Atsukawa, Norio Itokawa, Taeang Arai, Hidenori Toyoda, Akihito Tsubota, Tsunamasa Watanabe, Makoto Chuma, Kentaro Matsuura, Atsushi Hiraoka, Toshifumi Tada, Koichi Takaguchi, Keizo Kato, Hiroshi Abe, Joji Tani, Toru Ishikawa, Chikara Ogawa, Toru Asano, Tsunekazu Oikawa, Yoshihiro Matsumoto, Tomoyuki Akita, Junko Tanaka","doi":"10.1111/apt.70704","DOIUrl":"https://doi.org/10.1111/apt.70704","url":null,"abstract":"<p><strong>Background and aims: </strong>Entecavir and tenofovir alafenamide fumarate are potent nucleos(t)ide analogues used to treat chronic hepatitis B; however, their differential effects on hepatitis B surface antigen expression decline remain unclear. In this multicentre study, we aimed to examine the hepatitis B surface antigen-reducing effects.</p><p><strong>Methods: </strong>Treatment-naïve chronic hepatitis B patients who received entecavir (n = 491) or tenofovir alafenamide fumarate (n = 463) were enrolled. After 1:1 propensity score matching for sex, baseline hepatitis B surface antigen, hepatitis B e-antigen status, hepatitis B virus deoxyribonucleic acid, fibrosis-4 score, and the presence of hepatocellular carcinoma, data from 334 patients per group were analysed. Linear mixed-effects models were used to assess longitudinal changes over 4 years.</p><p><strong>Results: </strong>Tenofovir alafenamide fumarate was associated with a greater decline in hepatitis B surface antigen compared to entecavir, with significant differences at 1, 3, and 4 years. Its superiority was most pronounced in patients aged < 65 years, those without cirrhosis, those with baseline hepatitis B surface antigen ≥ 3.0 log IU/mL, those with either negative or positive hepatitis B e-antigen, and those with baseline hepatitis B virus deoxyribonucleic acid < 4.4 log IU/mL. Both treatments achieved comparable virological suppression and alanine aminotransferase normalisation. The estimated glomerular filtration rate showed a transient decline with tenofovir alafenamide fumarate in year 1, which subsequently diminished and may partly reflect the inhibition of tubular creatinine secretion.</p><p><strong>Conclusions: </strong>This evidence supports personalised treatment selection for functional cure.</p><p><strong>Trial registration: </strong>The UMIN Clinical Trials Registry 000034362.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147808739","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":"Letter: The Risk and Outcomes of Gastrointestinal Bleeding in Patients Using Warfarin or Direct Oral Anticoagulants.","authors":"Jiaqi Shen, Fangfang Huang","doi":"10.1111/apt.70706","DOIUrl":"https://doi.org/10.1111/apt.70706","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147808722","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}