Alimentary Pharmacology & Therapeutics最新文献

{"title":"Effect of Nucleos(t)ide Analogues Withdrawal on Survival Outcomes in Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure","authors":"Yanxue Lin, Xueping Yu, Huimin Lin, Jiajia Han, Yan Yan, Xiaoting Zhao, Yijie Lin, Zixuan Huang, Yinyin Zheng, Yahong Gao, Wenjin Yuan, Meifang Zhou, Jiming Zhang, Dawu Zeng","doi":"10.1111/apt.70213","DOIUrl":"https://doi.org/10.1111/apt.70213","url":null,"abstract":"Nucleos(t)ide analogues (NA) withdrawal is an important cause of hepatitis B virus (HBV) infection relapse or flare, potentially triggering HBV-related acute-on-chronic liver failure (HBV-ACLF). Although both NA withdrawal and spontaneous severe acute exacerbation (SAE) of chronic hepatitis B are recognised HBV-ACLF triggers, comparative evidence regarding their distinct clinical trajectories remains absent. This multicenter retrospective cohort study sought to determine whether NA withdrawal independently predicts adverse outcomes in HBV-related ACLF compared to SAE-induced cases.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"3 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176979","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":"Functional Dyspepsia and Its Subgroups: Prevalence and Impact in the Rome IV Global Epidemiology Study","authors":"J. Tack,&nbsp;O. S. Palsson,&nbsp;S. I. Bangdiwala,&nbsp;J. Schol,&nbsp;F. Carbone,&nbsp;K. Van Den Houte,&nbsp;B. Broeders,&nbsp;D. Drossman,&nbsp;D. L. Dumitrascu,&nbsp;X. Fang,&nbsp;S. Fukudo,&nbsp;U. C. Ghoshal,&nbsp;J. Kellow,&nbsp;R. Khatun,&nbsp;E. Okeke,&nbsp;E. M. Quigley,&nbsp;M. Schmulson,&nbsp;M. Simrén,&nbsp;W. E. Whitehead,&nbsp;P. Whorwell,&nbsp;A. D. Sperber","doi":"10.1111/apt.70189","DOIUrl":"10.1111/apt.70189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Functional dyspepsia (FD) is one of the most common disorders of gut–brain interaction (DGBI). Varying reported population prevalences probably reflect different definitions and methodological approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To study the prevalence and impact of FD and its subgroups in an internet survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 54,127 respondents from 26 countries completed the survey including the Rome IV diagnostic questionnaire, Patient Health Questionnaire-4 (PHQ-4), PHQ-12, PROMIS Global-10, demographics, and medical history. Respondents reporting a history of relevant organic disease, or fulfilling criteria for self-induced or cyclic vomiting, or cannabinoid hyperemesis were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Rome IV FD prevalence was 7.2% (range 2.2%–12.3%), significantly higher in women and decreased with age. The most prominent subtype was postprandial distress syndrome (PDS) (66.6%). Rome IV IBS was found in 26.1% of those fulfilling FD criteria. Functional heartburn and chronic nausea and vomiting criteria were fulfilled in, respectively, 9.0% and 7.0%. Fulfilling FD symptom criteria was significantly associated with increased prevalence of anxiety and depression and with lower quality of life and higher healthcare seeking behaviour.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rome IV FD is one of the most prevalent DGBI globally. Across countries, it is associated with female sex, younger age, psychological distress, reduced quality of life, and higher health care utilisation. PDS is the dominant subgroup. Overlapping other DGBI are present in a minority.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 3","pages":"330-339"},"PeriodicalIF":6.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Diagnosis of Chronic Hepatitis B in the United States: A Population-Based, Retrospective Cohort Study From 2007 to 2021","authors":"Michael H. Le,&nbsp;Joanne K. Liu,&nbsp;KeeSeok Lee,&nbsp;Ramsey Cheung,&nbsp;Mindie H. Nguyen","doi":"10.1111/apt.70193","DOIUrl":"10.1111/apt.70193","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Underdiagnosis of chronic hepatitis B (CHB) remains a major problem in the United States (USA), with &gt; 80% of CHB patients remaining undiagnosed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To determine the prevalence of late diagnosis of CHB and resultant liver complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective analysis of the Truven MarketScan database (1/2007–12/2021) included more than 250 million privately insured persons. The index date was the date of the first liver complication (cirrhosis, hepatocellular carcinoma [HCC], or liver transplant). Late diagnosis was defined as the diagnosis of CHB 2 years prior to or after the index date. Adults aged ≥ 18 years with a diagnosis of CHB and ≥ 12 months of insurance coverage prior to the index date were included. Exclusion criteria included &gt; 90 days break of insurance coverage within 12 months before the index date and receipt of nonliver transplant within 5 years of the index date.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>2608 persons met inclusion criteria with a mean age of 54.8 years and 70.3% were male. 1999 (76.6%) had a late diagnosis of CHB, of whom 889 (44.5%) were diagnosed at or within 6 months of the index complication, and 1510 (75.5%) did not have a documented visit with a provider to the index date. Late diagnosis rate remained stable between 2009 (73.8%) and 2017 (74.2%, <i>p-trend</i> = 0.937<i>)</i>. In the late diagnosis group, complications included cirrhosis (<i>n</i> = 1820, 91.0%), decompensated cirrhosis (<i>n</i> = 1630, 81.5%), HCC (<i>n</i> = 615, 30.8%) and liver transplant (<i>n</i> = 288, 14.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Approximately three-fourths of patients diagnosed with CHB in the USA had a late diagnosis. Increased screening efforts must be made to prevent poor clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 3","pages":"340-348"},"PeriodicalIF":6.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144137048","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":"Network Meta-Analysis: Efficacy of Biological Therapies and Small Molecules as Maintenance Therapy in Ulcerative Colitis","authors":"Brigida Barberio,&nbsp;David J. Gracie,&nbsp;Christopher J. Black,&nbsp;Alexander C. Ford","doi":"10.1111/apt.70209","DOIUrl":"10.1111/apt.70209","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Numerous biologics and small molecules are licensed as maintenance therapy for ulcerative colitis (UC). Differences in the design of randomised controlled trials (RCTs) have not been considered when comparing efficacy between them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To examine the relative efficacy of biologics and small molecules by network meta-analysis according to trial design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched the literature to 27 February 2025 for RCTs. We judged efficacy using clinical remission, endoscopic improvement, endoscopic remission, or corticosteroid-free remission and according to previous exposure or non-exposure to advanced therapies. Random effects model with data reported as pooled relative risks (RR) with 95% confidence intervals (CI); drugs ranked by <i>p</i>-score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 28 RCTs, 16 re-randomising 6568 patients and 12 treating through 3771 patients. In re-randomised studies, upadacitinib 30 mg o.d. ranked first for clinical remission (RR of failure to achieve clinical remission = 0.52; 95% CI 0.44–0.61, <i>p</i>-score 0.99) and endoscopic improvement (RR = 0.43; 95% CI 0.35–0.52, <i>p</i>-score 0.99). Vedolizumab 300 mg 4-weekly ranked first for endoscopic remission (RR = 0.73; 95% CI 0.64–0.84, <i>p</i>-score 0.92) and guselkumab 200 mg 4-weekly first for corticosteroid-free remission (RR = 0.40; 95% CI 0.28–0.55, <i>p</i>-score 0.95). In treat-through studies, etrasimod 2 mg o.d. ranked first for clinical remission (RR = 0.73; 95% CI 0.64–0.83, <i>p</i>-score 0.88) and infliximab 10 mg/kg 8-weekly first for endoscopic improvement (RR = 0.64; 95% CI 0.56–0.74, <i>p</i>-score 0.94).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In network meta-analysis, upadacitinib and etrasimod were consistently efficacious as maintenance therapy in UC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 1","pages":"4-21"},"PeriodicalIF":6.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Supporting the Role of Enzyme Therapy in Management of Coeliac Disease—Authors' Reply","authors":"Erin R. Bonner,&nbsp;Werner Tschollar,&nbsp;Robert Anderson,&nbsp;Sulayman Mourabit","doi":"10.1111/apt.70205","DOIUrl":"10.1111/apt.70205","url":null,"abstract":"<p>We thank Prof. Macrae for his supportive letter [<span>1</span>] regarding our review.</p><p>As emphasised in our article [<span>2</span>], dietary supplements claiming to digest gluten, or gluten immunogenic peptides, are not approved as treatments for coeliac disease. Indeed, there is no pharmaceutical that has regulatory approval as a treatment for coeliac disease. Furthermore, the draft guidance from the FDA highlights that treatment receiving approval would be in conjunction with a gluten-free diet. There remain safety concerns that a product claim of protection against gluten could be interpreted by patients as a licence to liberalise their gluten-free diet.</p><p>Many investigational products for coeliac disease have shown promise in preclinical and early clinical trials but failed in larger studies employing robust patient-reported outcome instruments to assess symptoms and rigorous quantitative histology. It would be concerning if Gluteguard were marketed as an enzyme supplement intended to mitigate accidental or intentional gluten exposure in patients with coeliac disease without robust multiple independent clinical trials to support disease-specific therapeutic claims.</p><p>Prof. Macrae's statement that ‘Enzyme therapies like caricain offer protection against gluten before it triggers immune responses’ [<span>1</span>] is concerning to us because it implies that Gluteguard is a ‘therapy’ with confirmed clinical benefits. While the small clinical ‘proof-of-concept’ studies involving Gluteguard are interesting, development of this product over the past 20+ years would appear to be as a dietary supplement but not as a safe and effective therapeutic. As such, therapeutic claims for Gluteguard are at best premature.</p><p>The level of scientific evidence required for therapeutic claims is significantly higher than that of academic publication, no matter how high or low the reputation of a medical journal.</p><p>The authors' declarations of personal and financial interests are unchanged from those in the original article [<span>2</span>].</p><p><b>Erin R. Bonner:</b> writing – review and editing. <b>Werner Tschollar:</b> writing – review and editing. <b>Robert Anderson:</b> writing – original draft. <b>Sulayman Mourabit:</b> writing – original draft.</p><p>The authors declare no conflicts of interest.</p><p>This article is linked to Bonner et al. papers. To view these articles, visit, https://doi.org/10.1111/apt.70014 and https://doi.org/10.1111/apt.70182.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 1","pages":"103-104"},"PeriodicalIF":6.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of a Second JAK Inhibitor in Ulcerative Colitis: The J2J Multicentre Study","authors":"Mathilde Osty,&nbsp;Romain Altwegg,&nbsp;Mélanie Serrero,&nbsp;Alban Benezech,&nbsp;Albane Lecomte,&nbsp;Guillaume Cadiot,&nbsp;Lucine Vuitton,&nbsp;Anne Wampach,&nbsp;Stéphane Nancey,&nbsp;Anthony Buisson,&nbsp;Catherine le Berre,&nbsp;Clea Rouillon,&nbsp;Cyrielle Gilletta,&nbsp;Felix Goutorbe,&nbsp;Mathurin Fumery,&nbsp;Nassim Hammoudi,&nbsp;Ludovic Caillo,&nbsp;Mathias Vidon,&nbsp;Nadia Arab,&nbsp;Gaelle Sickersen,&nbsp;Maryan Cavicchi,&nbsp;Sophie Vieujean,&nbsp;Maeva Charkaoui,&nbsp;Nicolas Richard,&nbsp;Pauline Wils,&nbsp;Bénédicte Caron,&nbsp;Aurélien Amiot,&nbsp;Alexandre Nuzzo,&nbsp;David Laharie,&nbsp;Julien Kirchgesner,&nbsp;Mathieu Uzzan,&nbsp;GETAID-J2J group","doi":"10.1111/apt.70199","DOIUrl":"10.1111/apt.70199","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>While three Janus kinase inhibitors (JAKi) have demonstrated efficacy in ulcerative colitis (UC), scarce data exist regarding JAKi intraclass switching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the effectiveness and safety of a second JAK inhibitor in UC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a multicentre, retrospective, observational cohort including patients with moderate to severe UC who received a second-line of JAKi after failure or intolerance of a first. The primary outcome was steroid-free clinical remission (SFCR) at Weeks 8–14, defined as a partial Mayo score of 2 or less with no individual sub-score above 1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 169 patients from 28 participating centres, 105 received upadacitinib, 54 filgotinib and 10 tofacitinib as a second-line of JAKi. Overall, 81/169 achieved SFCR at Weeks 8–14: 58/105 with upadacitinib, 18/54 with filgotinib and 5/10 with tofacitinib (<i>p</i> = 0.03). In the multivariate analysis, upadacitinib was independently associated with higher odds of SFCR than filgotinib (OR = 3.15, 95% CI [1.52–6.79]). With a median follow-up duration of 96 days, drug persistence at 6 months was 72.8% with upadacitinib, 57.2% with filgotinib and 66.7% with tofacitinib (<i>p</i> = 0.099). 24.3% of patients (41/169) experienced at least one adverse event leading to treatment withdrawal in 9 patients (5%). No cases of death, cancer, or major acute cardiovascular events were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A second-line of JAKi provided clinical remission in about half of patients after induction, and was well tolerated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 4","pages":"430-439"},"PeriodicalIF":6.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Supporting the Role of Enzyme Therapy in Management of Coeliac Disease","authors":"Finlay Macrae","doi":"10.1111/apt.70182","DOIUrl":"10.1111/apt.70182","url":null,"abstract":"&lt;p&gt;I appreciate the opportunity to comment on the review article by Bonner et al. [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The article rightly highlights the duodenum as the site where enzymatic interaction with gluten will be most beneficial. The caricain-based supplement was the first technology proposing the small intestine as the site of enzyme activity through extensive in vitro studies and clinical trials. The product formulation involves the combination of an acid-resistant coating and superdisintegrant excipients to ensure rapid release of the enzyme in the duodenum, post gastric emptying. There it neutralises partially digested gluten immunogenic peptides (GIPs) in conjunction with brush border peptidases before symptoms and immune activation occur.&lt;/p&gt;&lt;p&gt;Caricain (EC 3.4.22.30) is a well-characterised cysteine endopeptidase derived from &lt;i&gt;Carica papaya&lt;/i&gt; which cleaves proline-rich motifs in gluten [&lt;span&gt;2&lt;/span&gt;]. It offers a high degree of protection against the toxic action of gliadin on rat liver lysosomes [&lt;span&gt;3&lt;/span&gt;], mimicking pathological alterations to lysosomes seen in the mucosa of the small intestine [&lt;span&gt;4&lt;/span&gt;]. Caricain rapidly digests GIPs in pepsin trypsin-treated gliadin [&lt;span&gt;5&lt;/span&gt;] and also extensively hydrolyses Wheat ⍺-Amylase Trypsin Inhibitors (ATIs) [&lt;span&gt;6&lt;/span&gt;]. Unlike exopeptidases (DPPIV), which inefficiently degrade gluten [&lt;span&gt;5, 7&lt;/span&gt;] caricain rapidly degrades GIPs into non-immunogenic fragments, including the 33-mer, under physiologically relevant conditions (pH 3–7) and is stable to the action of gastric proteases, trypsin, and pepsin [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Missing from the review of Bonner et al. are two important peer-reviewed reports of randomised, double-blind, placebo-controlled clinical studies published in an international searchable journal. The first study evaluated caricain's efficacy in dermatitis herpetiformis. Despite a substantial gluten challenge (6 g/day for 14 days), supplementation with caricain demonstrated significant protective effects with an 81% reduction in skin lesion area (19.5 to 3.7 cm&lt;sup&gt;2&lt;/sup&gt;; &lt;i&gt;p&lt;/i&gt; = 0.02), 71% decrease in new lesions, and 38% decline in pruritus compared to placebo [&lt;span&gt;8&lt;/span&gt;]. The second study investigated the effects of caricain supplementation in patients with coeliac disease in remission undergoing a controlled gluten challenge for 42 days. Overall symptom scores and five individual symptoms (well-being, fatigue, nausea/vomiting, stomach pain and cramps, at day 14) favoured caricain over placebo (&lt;i&gt;p&lt;/i&gt; &lt; 0.01 for each). Dropouts occurred almost exclusively in the group randomised to placebo, due to the clinical effects of the gluten challenge; those randomised to caricain tolerated the challenge well [&lt;span&gt;9&lt;/span&gt;]. Indeed, the large, statistically significant effects were secured even with a small sample size. The observed protective effects support caricain's intended role to mitigate the effects of inadvertent gluten expo","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 1","pages":"101-102"},"PeriodicalIF":6.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70182","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Breath Profiling in MASLD—A Step Towards Better Risk Stratification","authors":"Takefumi Kimura","doi":"10.1111/apt.70185","DOIUrl":"10.1111/apt.70185","url":null,"abstract":"&lt;p&gt;Metabolic dysfunction–associated steatotic liver disease (MASLD) has become a major global health concern, affecting approximately 25%–30% of adults worldwide [&lt;span&gt;1&lt;/span&gt;]. Although recent reclassification efforts have clarified its diagnostic criteria [&lt;span&gt;2&lt;/span&gt;], identifying patients at the highest risk of disease progression using simple, non-invasive methods remains a major unmet need [&lt;span&gt;3, 4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In a proof-of-concept study, Sinha et al. [&lt;span&gt;5&lt;/span&gt;] investigated exhaled breath analysis using an electronic nose (eNose) to address this challenge. They showed that volatile organic compound (VOC) profiles could distinguish MASLD patients from healthy controls with 100% sensitivity (96% cross-validation), independent of age or sex. Critically, the authors applied unbiased clustering of breath profiles—without relying on clinical assumptions—to identify three distinct MASLD subgroups with different 5-year outcomes. Among these, Cluster 2 was associated with a markedly worse prognosis: 42% developed cirrhosis progression or liver-related complications, 67% showed evidence of portal hypertension and 12.5% died from liver-related causes. Despite similar baseline characteristics, Cluster 2 patients had significantly higher serum hyaluronic acid levels and poorer glycaemic control compared to other groups. These findings suggest that breath-based signatures may detect latent metabolic derangements not captured by conventional markers.&lt;/p&gt;&lt;p&gt;While eNose technology has gained traction in respiratory medicine, being applied to diseases such as asthma, COPD and lung cancer [&lt;span&gt;6, 7&lt;/span&gt;], its use in liver disease remains in its infancy. The current study represents an important early step in translating breathomics—a broader field encompassing eNose approaches—into hepatology, where existing non-invasive biomarkers often lack precision.&lt;/p&gt;&lt;p&gt;The study's strengths include the use of a well-characterised MASLD cohort, standardised breath collection protocols and long-term clinical follow-up. Notably, the risk stratification emerged solely from exhaled VOC patterns, rather than traditional fibrosis scores or clinical comorbidities, highlighting the biological relevance of breath profiles. However, certain limitations should be acknowledged. The cohort size was small, and external validation in larger and more diverse populations is essential. Comparative studies with established non-invasive tools such as transient elastography or serum-based fibrosis markers would also help position eNose technology within clinical workflows. Nonetheless, the results are compelling. Conventional metabolic markers—such as those used to define MASLD—may predict cardiovascular outcomes but are less reliable for forecasting liver-specific risks [&lt;span&gt;8, 9&lt;/span&gt;]. Recent large-scale studies confirm that MASLD patients, including those who are lean or only mildly overweight, can silently progress to advanced liver disease [&lt;span&gt;10&lt;/span&gt;]. B","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 2","pages":"218-219"},"PeriodicalIF":6.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distribution, Characteristics, and Natural History of Diverse Types of Indeterminate Chronic Hepatitis B: A REAL-B Study","authors":"Rui Huang,&nbsp;Ai-Thien Do,&nbsp;Hidenori Toyoda,&nbsp;Jie Li,&nbsp;Satoshi Yasuda,&nbsp;Pei-Chien Tsai,&nbsp;Ming-Lun Yeh,&nbsp;Huy Trinh,&nbsp;Angela Chau,&nbsp;Daniel Q. Huang,&nbsp;Eiichi Ogawa,&nbsp;Takanori Ito,&nbsp;Ritsuzo Kozuka,&nbsp;Masanori Atsukawa,&nbsp;Sebastián Marciano,&nbsp;Takashi Honda,&nbsp;Tsunamasa Watanabe,&nbsp;Norio Itokawa,&nbsp;Carmen Monica Preda,&nbsp;Cheng-Hao Tseng,&nbsp;Ana Barreira,&nbsp;Kaori Inoue,&nbsp;Hirokazu Takahashi,&nbsp;Haruki Uojima,&nbsp;Keigo Kawashima,&nbsp;Yao-Chun Hsu,&nbsp;Raluca Ioana Marin,&nbsp;Irina Sandra,&nbsp;Masatoshi Ishigami,&nbsp;Jiayi Li,&nbsp;Jian Zhang,&nbsp;Son Do,&nbsp;Mayumi Maeda,&nbsp;Dong-Hyun Lee,&nbsp;Wan-Long Chuang,&nbsp;Chia-Yen Dai,&nbsp;Jee-Fu Huang,&nbsp;Chung-Feng Huang,&nbsp;Ramsey Cheung,&nbsp;Maria Buti,&nbsp;Yasuhito Tanaka,&nbsp;Man-Fung Yuen,&nbsp;Masaru Enomoto,&nbsp;Adrian Gadano,&nbsp;Seng Gee Lim,&nbsp;Ming-Lung Yu,&nbsp;Chao Wu,&nbsp;Mindie H. Nguyen","doi":"10.1111/apt.70194","DOIUrl":"10.1111/apt.70194","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Chronic hepatitis B (CHB) with indeterminate phase comprises a heterogeneous group of patients. We determined the prevalence of indeterminate CHB overall and characterised novel types and phase transition probabilities of novel types of indeterminate CHB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>CHB patients were enrolled retrospectively from 24 centres (9 countries/regions). Indeterminate phase was defined based on the AASLD 2018 guidance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort included 8375 patients with a mean age of 45.0 ± 13.7 years, 22.5% HBeAg-positive, and median ALT and HBV DNA of 30 U/L and 4.3 ± 2.2 log₁₀IU/mL, respectively. Of the total cohort, half (47.2%) were in the indeterminate phase; and of these, the most prevalent group among HBeAg-positive patients was Type 2 (ALT 1–2 × ULN, HBV DNA≥ 20,000 IU/mL; 12.6%), while in HBeAg-negative patients it was Type 6 (ALT&lt;ULN, HBV DNA≥ 2000 IU/mL; 30.1%). Among the 1530 indeterminate patients with long-term follow-up, the 10-year cumulative incidence of phase transition to immune tolerant, immune active and immune inactive phases were 6.5%, 32.1% and 64.3%, respectively. The majority (73.2%) of Type 2 indeterminate patients transitioned to the immune active phase, while only 16.5% of Type 8 (HBeAg-negative, ALT 1–2 × ULN, HBV DNA &lt; 2000 IU/mL) did.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Indeterminate CHB can be classified into 10 types, with the most prevalent type being those with HBeAg-negative, HBV DNA ≥ 2000 IU/mL and ALT&lt;ULN (30.1%). The most prevalent HBeAg-positive patients with ALT 1–2 × ULN and HBV DNA ≥ 20,000 IU/mL type was also the most likely to transition to the immune-active phase (73.2% by year-10). The monitoring and management of CHB patients with the indeterminate phase should be individualised according to their types.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 3","pages":"349-358"},"PeriodicalIF":6.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103783","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: Helicobacter pylori and Eosinophilic Oesophagitis—Lost in Definition?","authors":"Fernanda Cristofori,&nbsp;Vanessa Nadia Dargenio,&nbsp;Ruggiero Francavilla","doi":"10.1111/apt.70179","DOIUrl":"10.1111/apt.70179","url":null,"abstract":"&lt;p&gt;We read with interest the meta-analysis by Spinelli et al. which reported a 46% lower risk of eosinophilic oesophagitis (EoE) and oesophageal eosinophilia in individuals infected with &lt;i&gt;Helicobacter pylori&lt;/i&gt; [&lt;span&gt;1&lt;/span&gt;]. While we commend the authors for their contributions, the decision to group EoE and oesophageal eosinophilia may have introduced bias, as these entities have dissimilar diagnostic criteria. According to the most recent clinical guideline, EoE can be diagnosed in the setting of symptoms of oesophageal dysfunction that are absent in oesophageal eosinophilia, plus an eosinophil-predominant infiltrate in the oesophagus [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The presence of oesophageal dysfunction is of primary importance in the diagnosis of EoE, especially since oesophageal eosinophilia (&gt; 15 eosinophils per high-power field) can be found in up to 1.1% of the general population [&lt;span&gt;3&lt;/span&gt;]. Consequently, oesophageal eosinophilia on routine biopsies may be incidental, as in other conditions [&lt;span&gt;2, 3&lt;/span&gt;]. Oesophageal eosinophilia alone is a histological feature that does not constitute a diagnosis of EoE. These conditions should be analysed separately [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In the present meta-analysis, only 9 out of 19 studies employed a diagnostic definition consistent with current consensus criteria for EoE. Six studies included patients with oesophageal eosinophilia alone, three enrolled mixed populations and one did not specify the criteria used to define EoE or oesophageal eosinophilia. This heterogeneity in case definition may have introduced a significant risk of misclassification bias. Adopting more rigorous inclusion criteria, along with subgroup analyses based on clearly defined diagnostic categories, would have enhanced the accuracy and interpretability of the findings, thereby clarifying the actual impact of &lt;i&gt;H. pylori&lt;/i&gt; infection on EoE. Notably, oesophageal eosinophilia can be asymptomatic or can present with non-specific symptoms that overlap with other oesophageal disorders, such as gastro-oesophageal reflux disease. In some cases, it may not necessitate specific treatment beyond clinical surveillance [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Moreover, the analysis revealed significant heterogeneity among included studies, especially when comparing the incidence of EoE in patients exposed to &lt;i&gt;H. pylori&lt;/i&gt; versus those unexposed. This suggests that the results should be interpreted cautiously.&lt;/p&gt;&lt;p&gt;Finally, the data collected did not allow for a distinction between current and past &lt;i&gt;H. pylori&lt;/i&gt; infection in most studies. Consequently, the analysis could not evaluate the impact of eradication therapies on the association between &lt;i&gt;H. pylori&lt;/i&gt; and EoE, which is an important factor in understanding the relationship.&lt;/p&gt;&lt;p&gt;The meta-analysis highlights the need for future longitudinal and mechanistic studies, detailed subgroup analyses, evaluation of eradication therapy effects, and ongoing surveillance of &lt;i&gt;H. pyl","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 2","pages":"232-233"},"PeriodicalIF":6.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}