Alimentary Pharmacology & Therapeutics最新文献

{"title":"Editorial: Patient Reported Outcomes Provide Insight Into Disease Severity for People Living With Primary Sclerosing Cholangitis","authors":"Aisha Alawi, Gideon M. Hirschfield","doi":"10.1111/apt.70223","DOIUrl":"https://doi.org/10.1111/apt.70223","url":null,"abstract":"<p>Primary sclerosing cholangitis (PSC) is a rare autoimmune liver disease (AILD) of unknown aetiology. It is a progressive disease that leads to cirrhosis and liver failure with no curative therapy other than liver transplantation [<span>1</span>]. The physical burden and uncertainty associated with PSC have a significant impact on patient quality of life (QOL) [<span>2, 3</span>]. However, insufficient studies have investigated this [<span>4, 5</span>]. Tan et al. sought to characterise the impact of the disease on QOL in PSC patients living in Australia and investigate the relationship between demographics, disease, and patient reported outcomes (PROs).</p>\u0000<p>The group conducted a prospective observational cohort study with patients from nine tertiary liver centres in Australia. In total, 55 adult patients with PSC were recruited. Each participant was provided with a baseline PSC QOL questionnaire. Those with concomitant IBD also completed an IBD questionnaire. Clinical data was collected for all patients [<span>6</span>] (Figure 1).</p>\u0000<figure><picture>\u0000<source media=\"(min-width: 1650px)\" srcset=\"/cms/asset/c76ddf5f-d9dc-4a93-aae0-d678cb686042/apt70223-fig-0001-m.jpg\"/><img alt=\"Details are in the caption following the image\" data-lg-src=\"/cms/asset/c76ddf5f-d9dc-4a93-aae0-d678cb686042/apt70223-fig-0001-m.jpg\" loading=\"lazy\" src=\"/cms/asset/37aa292b-3648-4d25-8987-8fef35e9ddb3/apt70223-fig-0001-m.png\" title=\"Details are in the caption following the image\"/></picture><figcaption>\u0000<div><strong>FIGURE 1<span style=\"font-weight:normal\"></span></strong><div>Open in figure viewer<i aria-hidden=\"true\"></i><span>PowerPoint</span></div>\u0000</div>\u0000<div>Patient reported symptoms (created in https://BioRender.com).</div>\u0000</figcaption>\u0000</figure>\u0000<p>Results showed that fatigue was the most commonly reported symptom. Overall scores for the PSC PRO were low and IBD questionnaire high, indicating disease did not have a significant impact on QOL in this cohort. A positive correlation was found between PSC and IBD symptoms in patients. Decompensated cirrhosis and a history of cholangitis were associated with lower QOL. This is the first study to find an association with the latter [<span>6</span>]. Unlike in previous studies, older age was protective, and both sex and PSC phenotype were not associated with QOL [<span>4-6</span>]. However, the fact that concomitant IBD did not affect QOL, while cirrhosis was found to have a negative impact, is in line with previous work [<span>4, 5</span>].</p>\u0000<p>Several limitations affect this study's generalisability. To begin with, the small cohort mainly consists of patients with less severe disease. In addition, patients from tertiary centers typically differ in their clinical characteristics when compared to other patients [<span>7</span>]. The study also strictly enrolled English-speaking individuals, meaning results do not represent the experience of marginalised groups. The cross-sectional nature of this study also fail","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"36 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278433","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: Endomysial Antibodies for a No-Biopsy Diagnosis of Coeliac Disease—The Jury Is Still Out","authors":"Mohamed G. Shiha, Hugo A. Penny","doi":"10.1111/apt.70191","DOIUrl":"https://doi.org/10.1111/apt.70191","url":null,"abstract":"<p>Studies in children and adults have shown that immunoglobulin (Ig)A anti-tissue transglutaminase (tTG) antibody levels ≥ 10× upper limit of normal are highly specific for a diagnosis of coeliac disease and may obviate the need for histological confirmation in approximately 30% of patients [<span>1, 2</span>]. Given that many patients prefer to avoid endoscopy [<span>3</span>], the ‘no-biopsy’ approach to diagnosis is an area of interest with the potential to improve patient experience and reduce associated healthcare costs.</p>\u0000<p>In this issue of <i>Alimentary Pharmacology & Therapeutics</i>, Maimaris and colleagues present the findings of a retrospective/prospective study evaluating the accuracy of endomysial antibodies (EMA) in combination with clinical risk stratification to support a no-biopsy diagnosis of adult coeliac disease [<span>4</span>]. A positive EMA test had a specificity and a positive predictive value (PPV) of 100% for a diagnosis of coeliac disease, suggesting that this may be a suitable alternative to IgA-tTG testing in this no-biopsy approach. However, EMAs are typically identified in serum using indirect immunofluorescence, which is more costly and labour-intensive than conventional tTG-based immunoassays; this methodology is also subject to inter-observer variability. Importantly, the EMA test also lacks a quantitative readout, which is a central tenet of the no-biopsy approach, as low titre IgA-tTG levels (i.e.,1-5× upper limit of normal) confer less specificity for the duodenal inflammation typical of coeliac disease than high titre levels (i.e., ≥ 10× upper limit of normal) [<span>5</span>], despite both being identified as a positive result.</p>\u0000<p>Notably, all patients with a positive EMA result were diagnosed with coeliac disease in this study. However, patients with potential coeliac disease—defined by positive serology without duodenal villous atrophy—were included within this group. If these individuals were re-classified as false positives, the specificity would fall from 100% to 93.7%, and the PPV would fall from 100% to 87.4%, based on a disease prevalence/pre-test probability of 31%. On the one hand, does this matter if the end goal is a gluten-free diet? On the other hand, serology will normalise in up to a third of patients with potential coeliac disease despite ongoing gluten exposure [<span>6</span>]. Therefore, it is important not to blur the lines between the two conditions. Indeed, this is one of the limitations of the no-biopsy approach, which should be balanced against the shortcomings of the serology-biopsy pathway before either is considered for diagnosis.</p>\u0000<p>Beyond this, the study provides reassuring data on the safety of avoiding upper gastrointestinal endoscopy in patients with positive coeliac serology, as no major concomitant pathology was identified among those with a positive EMA regardless of their age or the presence of alarm symptoms. Conversely, most non-coeliac enteropathies we","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"221 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278703","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: Endomysial Antibodies for a No-Biopsy Diagnosis of Coeliac Disease—The Jury Is Still out. Authors' Reply","authors":"Stiliano Maimaris, Annalisa Schiepatti, Federico Biagi","doi":"10.1111/apt.70234","DOIUrl":"https://doi.org/10.1111/apt.70234","url":null,"abstract":"<p>We appreciate the editorial by Drs Shiha and Penny [<span>1</span>] on our study [<span>2</span>] concerning endomysial antibodies and clinical risk stratification for biopsy-sparing coeliac disease diagnosis. We acknowledge that endomysial antibodies present some drawbacks, including higher cost and need for trained personnel, potentially limiting their use. Our study's excellent endomysial antibody results [<span>2</span>] reflect extensive experience with this assay and may not generalise to less experienced centres. However, endomysial antibodies offer some advantages over tissue transglutaminase antibodies. First, endomysial antibodies exhibited 99.7% specificity for coeliac disease in a meta-analysis of 34 studies [<span>3</span>]. Second, while requiring skilled interpretation, endomysial antibodies are an objective measure, unlike tissue transglutaminase antibodies, which show significant inter-assay variability [<span>4</span>].</p>\u0000<p>We agree that managing potential coeliac disease within a biopsy-sparing framework remains an open question depending on patients' clinical features. A meta-analysis of 17 studies found that nearly 90% of potential coeliac disease patients improve on a gluten-free diet [<span>5</span>]. Thus, in symptomatic, endomysial antibody-positive patients, a gluten-free diet is warranted, so distinguishing symptomatic potential coeliac disease from conventional coeliac disease is of limited importance. For the minority of asymptomatic adult potential coeliac disease patients identified via screening, the decision for a gluten-free diet versus monitoring on a gluten-containing diet remains case-by-case. However, in our experience, most adopt a gluten-free diet due to associated autoimmune conditions or family environment. Patients also generally prefer a gluten-free diet over endoscopic follow-up, rarely maintaining a gluten-containing diet long-term.</p>\u0000<p>The issue is further complicated by ultra-short coeliac disease, which requires bulb biopsies to differentiate from potential coeliac disease [<span>6</span>]. However, bulb biopsies are not routinely performed, and obtaining ≥ 4 biopsies can already be considered an achievement [<span>7</span>]. A meta-analysis estimated ultra-short coeliac disease prevalence at 9.2% among coeliac disease patients, increasing with the number of bulb biopsies taken [<span>8</span>]. A large portion of ultra-short coeliac disease patients may be misdiagnosed as potential coeliac disease if only the second portion of the duodenum is biopsied. Collectively, these render distinguishing between potential coeliac disease, ultra-short coeliac disease, and other coeliac disease forms of questionable clinical significance.</p>\u0000<p>Our findings on the safety of a biopsy-sparing approach are perhaps most crucial and generalise beyond specific serological tests. The lack of major concomitant pathology in coeliac disease patients diagnosed in our study [<span>2</span>] is reassuring, suppor","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"9 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278434","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":"Predicting Hepatic Decompensation in Patients With Metabolic Dysfunction Associated Steatotic Liver Disease-Related Cirrhosis: The ABID-LSM Model.","authors":"Luis Calzadilla Bertot, Anna Sòria, Alba Jimenez-Masip, Isabel Serra, Teresa Broquetas, Mercedes Vergara, Adrià Rodriguez, Carles Aracil, Cautar El Maimouni, Sergio Muñoz-Martinez, Jose A Carrión, Albert Pardo, Juan M Pericàs, Isabel Graupera, Leon A Adams","doi":"10.1111/apt.70215","DOIUrl":"https://doi.org/10.1111/apt.70215","url":null,"abstract":"<p><strong>Background & aims: </strong>Predicting the risk of hepatic decompensation guides prognostication and therapy; however, it is challenging in patients with cirrhosis due to metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to improve a previously developed predictive tool of hepatic decompensation in MASLD cirrhosis (ABIDE) by incorporating liver stiffness measurement (LSM).</p><p><strong>Methods: </strong>A multi-centre retrospective cohort of patients with compensated cirrhosis due to MASLD was identified, with decompensation incidence assessed using competing risk regression. The prognostic accuracy of a modified ABIDE model incorporating LSM (ABID-LSM) was assessed using time-dependent AUC (tAUC) and compared with other predictive models.</p><p><strong>Results: </strong>Out of 388 patients, 273 (70.4%) had available LSM. Hepatic decompensation occurred in 54 (20%) patients during follow-up (median 31 months, range: 20-60). The predictive accuracy at 5 years of ABID-LSM (tAUC 0.80) was better than ABIDE (tAUC 0.75, p = 0.03) and LSM (tAUC 0.63, p < 0.001). The ABID-LSM model calibrated well (slope 0.99) with excellent overall performance (Integrated Brier Score 0.15). A cut-off of 8.1 separated those at high and low risk of hepatic decompensation at 5 years (24% vs. 5%, respectively, sHR = 4.8, p < 0.001). The ABID-LSM model had better predictive ability at 5 years than ALBI, FIB-4, NAFLD Decompensation Risk Score and ANTICIPATE models (all p < 0.001) as well as hepatic vein pressure gradient measurement (tAUC 0.78 vs. 0.71, p < 0.001, n = 60).</p><p><strong>Conclusions: </strong>The ABID-LSM model has greater accuracy in predicting hepatic decompensation in patients with cirrhosis due to MASLD than existing predictive models. If externally validated, ABID-LSM may identify those who benefit from pharmacotherapy and close monitoring.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256834","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":"Effects of Screening Colonoscopy on Colorectal Cancer Mortality: Lessons From Comparative Analyses of Randomised Trials.","authors":"Hermann Brenner, Dmitry Sergeev, Thomas Heisser, Michael Hoffmeister","doi":"10.1111/apt.70231","DOIUrl":"https://doi.org/10.1111/apt.70231","url":null,"abstract":"<p><p>NordICC, the first randomised trial on long-term effects of screening colonoscopy, failed to demonstrate a significant reduction in colorectal cancer (CRC) mortality. We compared reported 10-year CRC mortality results from NordICC with those of NORCCAP, a similarly designed pragmatic sigmoidoscopy trial. In NORCCAP, differences in CRC mortality only began to emerge after 9.5 years of follow-up, rapidly increased thereafter and were approximately 4-fold as high after 12 years than after 10 years. Other sigmoidoscopy trials yielded similar 11- to 12-year results. Our analysis suggests that the apparent negative CRC mortality results of NordICC primarily reflect insufficient follow-up time.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256833","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: Time to EXIT? When Less Is More in IBD Management","authors":"Kunio Asonuma, Taku Kobayashi","doi":"10.1111/apt.70211","DOIUrl":"https://doi.org/10.1111/apt.70211","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"172 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237730","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: Time to EXIT? When Less Is More in IBD Management. Authors' Reply","authors":"María José Casanova, María Chaparro, Javier P. Gisbert","doi":"10.1111/apt.70230","DOIUrl":"https://doi.org/10.1111/apt.70230","url":null,"abstract":"&lt;p&gt;We thank Drs. Asonuma and Kobayashi [&lt;span&gt;1&lt;/span&gt;] for highlighting our publication on long-term outcomes following anti-TNF withdrawal in patients with inflammatory bowel disease in remission [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;As they noted, our randomised controlled trial (EXIT) and its extended follow-up study found no significant differences in relapse rates at 1 year and over the longer term between patients who discontinued or continued anti-TNF therapy [&lt;span&gt;2, 3&lt;/span&gt;]. We acknowledge that these results contrast with previous randomised trials such as HAYABUSA, STOP-IT, and SPARE, which reported higher relapse rates following anti-TNF withdrawal [&lt;span&gt;4-6&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Several key differences distinguish EXIT from these earlier trials. Primarily, EXIT included only highly selected patients who had maintained deep, stable remission for at least 6 months on standard-dose anti-TNF combined with immunomodulators, without prior risk factors such as intestinal resection or significant endoscopic lesions [&lt;span&gt;2&lt;/span&gt;]. Conversely, the cohorts of HAYABUSA, STOP-IT, and SPARE enrolled more heterogeneous patient populations, had shorter anti-TNF exposure times, did not uniformly include concomitant immunomodulator therapy, and only STOP-IT was double-blinded [&lt;span&gt;4-6&lt;/span&gt;]. Moreover, all participants in EXIT continued stable immunomodulator therapy before and after randomisation. While retrospective studies have suggested a protective role for immunomodulators post-withdrawal of a biologic, prospective randomised data are limited [&lt;span&gt;2, 4-8&lt;/span&gt;]. In EXIT and EXIT long-term, the consistent use of immunomodulators potentially mitigated post-withdrawal flares, thereby minimising differences in relapse rates between treatment arms.&lt;/p&gt;\u0000&lt;p&gt;Our findings suggest that a carefully monitored anti-TNF discontinuation strategy, with planned treatment resumption upon relapse, is effective in carefully selected patients. This aligns with real-world evidence, which also reported high remission recapture rates after treatment resumption [&lt;span&gt;9, 10&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;We agree with Drs. Asonuma and Kobayashi that future research should focus on identifying optimal candidates for anti-TNF withdrawal and retreatment. Planned anti-TNF withdrawal may be safe in highly selected patients in stable, deep remission on combined therapy, provided rigorous biomarker monitoring (faecal calprotectin and C-reactive protein) is conducted, especially during the first year after discontinuation. Moreover, rapid access to anti-TNF therapy upon relapse is crucial to successfully recapturing remission. This strategy should not be routinely applied but should rather be individualised, carefully weighing patient preferences, risk profiles, and commitment to frequent monitoring.&lt;/p&gt;\u0000&lt;p&gt;Crucially, this “exit” strategy should be reserved for motivated patients willing to undergo stringent monitoring. However, for broader IBD populations—especially those with previous surgeries, ","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"16 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237863","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":"Outcomes Associated With Anti‐Depressant Use in Patients With Inflammatory Bowel Disease","authors":"Bharati Kochar, Lara Chaaban, Lynn Kobeissi, Alexandra Fuss, Prasanna Challa, Joanna Melia, Ashwin Ananthakrishnan","doi":"10.1111/apt.70229","DOIUrl":"https://doi.org/10.1111/apt.70229","url":null,"abstract":"BackgroundAlthough depression is prevalent among people with inflammatory bowel diseases (IBD), the impact of treating depression is unknown.MethodsWe conducted a retrospective study in an electronic‐health record‐based cohort. We identified patients with IBD using ≥ 2 diagnosis codes, and patients with depression using ≥ 1 diagnosis code. The exposure was a medication for the treatment of IBD. We assessed IBD‐related hospitalizations, surgery, and emergency room (ER) visits after the index date of depression code or initiation of depression medication. We constructed multivariable logistic regression models to determine the odds of the outcome.ResultsWe identified 4052 patients with IBD and depression with a median age of 49 years. In this cohort, 39% did not receive medication for depression while 61% were treated with an antidepressant not commonly prescribed for pain. Patients with IBD treated for depression were less likely to have an IBD‐related ER visit than patients with IBD and depression not treated for depression (aOR: 0.63, 95% CI: 0.44–0.90). However, patients who were treated for depression were also more likely to be hospitalised (aOR: 1.40, 95% CI: 1.20–1.62), be treated with a corticosteroid (aOR: 1.34, 95% CI: 1.16–1.55) and have surgery for IBD (aOR: 1.42, 95% CI: 1.17–1.71).ConclusionsAntidepressant use is associated with reduced ER utilisation in patients with IBD. There were also increased hospitalisations, corticosteroid treatment, and surgery, which may reflect a more aggressive disease course associated with depression. Treating depression in patients with IBD may reduce healthcare costs by decreasing ER visits.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"1 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236837","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":"Factors Associated With Underutilization of Antiviral Therapy in Preventing Hepatitis B Virus-Related Hepatocellular Carcinoma","authors":"Jia-Ling Wu, Ying-Nan Tsai, Cheng-Hao Tseng, Shang-Chen Tseng, Chih-Wen Lin, Chih-Lung Hung, Mindie H. Nguyen, Jaw-Town Lin, Yao-Chun Hsu","doi":"10.1111/apt.70224","DOIUrl":"https://doi.org/10.1111/apt.70224","url":null,"abstract":"Deaths from hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) are projected to increase through 2030. Underutilisation of antiviral therapy may contribute to this concerning trend but empirical data remain sparse.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"10 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237864","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 on “Association Between Viral Replication Activity and Postoperative Recurrence of HBV-Related Hepatocellular Carcinoma”","authors":"Dong Hyun Kim, Hye Won Lee","doi":"10.1111/apt.70210","DOIUrl":"https://doi.org/10.1111/apt.70210","url":null,"abstract":"&lt;p&gt;We read with great interest the article by Heo et al. [&lt;span&gt;1&lt;/span&gt;] exploring the association between baseline viral replication activity and postoperative recurrence of HBV-related hepatocellular carcinoma (HCC). The authors are to be commended for their thoughtful stratification based on cirrhosis status and detailed analysis of baseline hepatitis B virus (HBV) DNA levels, addressing a clinically relevant gap given that antiviral therapy initiation is still largely restricted to patients with elevated alanine aminotransferase levels despite evidence of hepatocarcinogenesis occurring without significant inflammation [&lt;span&gt;2-4&lt;/span&gt;]. Their work provides valuable evidence that could inform future refinements in antiviral therapy initiation and postoperative surveillance strategies.&lt;/p&gt;\u0000&lt;p&gt;While the study presents significant advances, several aspects warrant further discussion. First, although the recurrence risk patterns were elegantly illustrated, some internal variations were noted. Among cirrhotic patients, initiation-antiviral therapy (AVT) was associated with a significantly higher risk of early recurrence compared to ongoing-AVT, whereas no difference was observed for late recurrence. However, within the initiation-AVT group, the plateau-shaped association between baseline HBV DNA levels and recurrence risk became more pronounced during late recurrence. This may reflect the inherent challenges of capturing long-term recurrence dynamics within a relatively short median follow-up period of 4.9 years [&lt;span&gt;5, 6&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Second, we observed that the subgroup with low baseline HBV DNA levels (&lt; 3.30 log&lt;sub&gt;10&lt;/sub&gt; IU/mL) demonstrated a paradoxical profile—higher rates of significant inflammation yet lower recurrence risk in non-cirrhotic patients. As this subgroup constituted more than half of the non-cirrhotic cohort after matching, a separate analysis of this population could provide insights into biological heterogeneity beyond cirrhosis status alone. Incorporating additional stratification by markers such as platelet count, fibrosis stage, or composite scores (e.g., mPAGE-B) might enhance future risk models [&lt;span&gt;7, 8&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Third, information regarding the use of postoperative adjuvant therapies, such as intensified antiviral regimens, immune checkpoint inhibitors, targeted therapies, or transarterial chemoembolization, could further be detailed in the study. As these interventions are increasingly integrated into the management of HCC and can significantly influence recurrence dynamics, accounting for their use is critical for isolating the true impact of baseline viral replication activity. Clarifying these aspects would strengthen the causal inferences drawn from the observed associations [&lt;span&gt;9&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Lastly, while the authors excluded patients who initiated AVT more than 3 months after surgery, prior evidence suggests that even delayed AVT initiation can confer survival benefits by suppressing","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"402 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228906","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}