Alimentary Pharmacology & Therapeutics最新文献

{"title":"Editorial: Assessing the Prognosis of Patients With HBV and ACLF—Comorbidities Matter. Authors' Reply","authors":"Jiong Yu, Xinyi Chen, Guoqiang Cao, Qiaoling Pan, Chenjie Huang, Rui Luo, Xiaoqing Lu, Xiaoxiao Chen, Tan Li, Haijun Huang, Jian Wu, Lanjuan Li, Hongcui Cao","doi":"10.1111/apt.18392","DOIUrl":"https://doi.org/10.1111/apt.18392","url":null,"abstract":"<p>We extend our sincere gratitude to Dr. Francesco Paolo Russo and Alberto Ferrarese for their thorough evaluation and professional insights on our study [<span>1</span>]. We are gratified by their recognition of the potential of the age-adjusted Charlson Comorbidity Index for Hepatitis B Virus-Related Acute-on-Chronic Liver Failure (aCCI-HBV-ACLF) score in enhancing the accuracy of short-term and medium-term prognostic predictions, particularly in integrating comorbidity factors and reducing variability among clinicians [<span>2</span>].</p>\u0000<p>Previous research has established that multiple comorbidities are strongly associated with poor prognosis, with extrahepatic complications such as chronic renal failure and diabetes significantly elevating the mortality risk in patients with liver disease [<span>3-5</span>]. However, the relatively low incidence of these comorbidities presents challenges in fully incorporating them into prognostic models. Although the aCCI was initially designed for long-term prognostic evaluation, study has underscored its relevance in evaluating the prognosis of liver disease patients [<span>6</span>]. Similarly, our further analysis demonstrated that in the short-term prognosis of patients with HBV-related ACLF, nearly all comorbidities included in the aCCI are significantly correlated with short-term survival outcomes (Table 1). For instance, cardiovascular diseases were associated with a 287% increase in the 28-day mortality risk and a 267% increase in the 90-day mortality risk. Additionally, patients with chronic obstructive pulmonary disease, connective tissue diseases, diabetes, moderate to severe renal disease, tumours and haematological diseases exhibited substantially increased mortality risks. In contrast, although peptic ulcer disease showed a certain increase in risk, it did not reach statistical significance (<i>p</i> > 0.05).</p>\u0000<div>\u0000<header><span>TABLE 1. </span>Relationships between comorbidity and 28-day mortality and 90-day mortality in patients with HBV-ACLF.</header>\u0000<div tabindex=\"0\">\u0000<table>\u0000<thead>\u0000<tr>\u0000<th rowspan=\"2\">Variables</th>\u0000<th rowspan=\"2\">Total (<i>n</i>)</th>\u0000<th colspan=\"3\">28-day mortality</th>\u0000<th colspan=\"3\">90-day mortality</th>\u0000</tr>\u0000<tr>\u0000<th style=\"top: 41px;\">Events (%)</th>\u0000<th style=\"top: 41px;\">HR (95% CI)</th>\u0000<th style=\"top: 41px;\"><i>p</i> value</th>\u0000<th style=\"top: 41px;\">Events (%)</th>\u0000<th style=\"top: 41px;\">HR (95% CI)</th>\u0000<th style=\"top: 41px;\"><i>p</i> value</th>\u0000</tr>\u0000</thead>\u0000<tbody>\u0000<tr>\u0000<td>Total</td>\u0000<td>1238</td>\u0000<td>295 (23.8)</td>\u0000<td></td>\u0000<td></td>\u0000<td>397 (32.1)</td>\u0000<td></td>\u0000<td></td>\u0000</tr>\u0000<tr>\u0000<td colspan=\"8\">Cardiovascular diseases<sup>a</sup></td>\u0000</tr>\u0000<tr>\u0000<td style=\"padding-left:2em;\">Yes</td>\u0000<td>31</td>\u0000<td>22 (71.0)</td>\u0000<td rowspan=\"2\">3.87 (2.51, 5.98)</td>\u0000<td rowspan=\"2\">< 0.001</td>\u0000<td>24 (77.4)</td>\u0000<td rowspan=\"2\">3.67 (2.42, 5.56)</td>\u0000<td rowspan=\"2\">< 0.001</td>\u0000</tr>\u0000<tr>\u0000<td style=\"padding-left:2em;\">No</td>\u0000<td>1207<","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"46 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610347","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: Insulin-Like Growth Factor-1 in Cirrhosis Is Linked to Hepatic Dysfunction and Fibrogenesis and Predicts Liver-Related Mortality","authors":"Okasha Tahir, Muhammad Muzamil Rafique, Abdul Ghani Khan, Asia Rajab, Umama Alam, Muhammad Umar, Laiba Shamim, Ayesha Hidayat","doi":"10.1111/apt.18366","DOIUrl":"https://doi.org/10.1111/apt.18366","url":null,"abstract":"<p>We read the article published in your esteemed journal titled, “Insulin-like growth factor-1 in cirrhosis is linked to hepatic dysfunction and fibrogenesis and predicts liver-related mortality” by Hartl et al. with great interest. We appreciate the authors for investigating the prognostic role of insulin-like growth factor-1 (IGF-1) in advanced chronic liver disease (ACLD) patients [<span>1</span>]. While the study provides valuable insights, we believe certain limitations warrant further discussion.</p>\u0000<p>Firstly, the small sample size of 269 patients does not reflect the global heterogeneity of cirrhosis patients, which potentially limits the generalizability of the findings. Studies with larger sample sizes, ideally ranging from 500 to 1000 patients, would offer more statistically robust conclusions. This is particularly important given the various etiologies of cirrhosis, such as metabolic dysfunction-associated steatohepatitis (MASH), alcohol-related liver disease, and viral hepatitis, which affect IGF-1 levels differently [<span>2</span>]. Expanding the cohort to include a more diverse population could improve the validity of the findings.</p>\u0000<p>Secondly, the potential confounding variables such as obesity and diabetes are not addressed by the authors, which could distort the interpretation of IGF-1 as a measure of the severity of liver diseases. For instance, Aleidi et al. found that type 2 diabetes is associated with significantly lower IGF-1 levels, irrespective of liver function. By not controlling for these metabolic factors, the study may misattribute changes in IGF-1 levels to liver dysfunction alone. Future studies should include these factors in multivariate models to provide a clearer understanding of IGF-1's role in cirrhosis [<span>3</span>].</p>\u0000<p>Lastly, the median follow-up period of 604 days may be insufficient to capture the full progression of cirrhosis and its complications, such as hepatocellular carcinoma and liver-related mortality. Studies like Saeki et al. have demonstrated the importance of long-term follow-up, using a median duration of 57.1 months to assess the prognostic value of IGF-1 [<span>4</span>]. Given the slow progression of cirrhosis, a follow-up period of at least 5 years would provide a more comprehensive evaluation of IGF-1's predictive power and help capture critical outcomes such as development of hepatocellular carcinoma, survival rates, and complications like hepatic encephalopathy.</p>\u0000<p>Future studies should address these limitations by incorporating a larger sample size, extending follow-up periods, and accounting for potential confounding factors such as diabetes and obesity. Doing so will not only strengthen the study's findings but also provide deeper insights into the long-term outcomes of cirrhosis management and the prognostic value of IGF-1 across diverse populations. Ultimately, this will contribute to improved patient outcomes and more refined therapeutic approaches.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"162 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610346","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: Assessing the Prognosis of Patients With HBV and ACLF—Comorbidities Matter","authors":"Francesco Paolo Russo, Alberto Ferrarese","doi":"10.1111/apt.18361","DOIUrl":"https://doi.org/10.1111/apt.18361","url":null,"abstract":"&lt;p&gt;Acute-on-chronic liver failure (ACLF) is a severe condition characterised by high short-term mortality, requiring rapid diagnosis, prompt treatment of trigger factors and appropriate prognostic evaluation to guide patients towards the best therapeutic options. Although several scores, such as the model for end-stage liver disease (MELD) and the CLIF-C ACLF score, have been proposed over time to assess short-term prognosis, their predictive accuracy remains suboptimal, partly due to heterogeneous diagnostic criteria and the inability to account for underlying comorbidities that significantly affect patient outcomes [&lt;span&gt;1, 2&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Chen et al. [&lt;span&gt;3&lt;/span&gt;] aimed to improve prognostic accuracy in patients with hepatitis B (HBV)-related ACLF. They analysed a retrospective cohort of 906 HBV patients with ACLF according to the Asian Pacific criteria and proposed a new score, the age-adjusted Charlson Comorbidity Index (aCCI)-HBV-ACLF score. This score incorporates the aCCI [&lt;span&gt;4&lt;/span&gt;] along with key clinical indicators (neutrophil count, INR, serum bilirubin). The novel score accurately predicted short- and mid-term mortality, with areas under the ROC curve of 0.859, 0.869 and 0.868 for 28-day mortality, and 0.822, 0.850 and 0.888 for 90-day mortality in the training, internal validation and external validation cohorts, respectively, outperforming all available scores. Major strengths of this predictive model include the objective assessment of clinical and laboratory values, which reduces inter-clinician variability, and the inclusion of comorbidities. Moreover, although the score demonstrated only a slight increase in prognostic accuracy compared to the CLIF-C ACLF score in predicting 28-day outcomes, the clinical gain was more significant at 90 days, underscoring the potential impact of comorbidities on medium-term outcomes.&lt;/p&gt;\u0000&lt;p&gt;While the findings are promising, the score has several limitations. First, it has been tested only in Asian populations, raising questions about its generalizability across other ethnicities. Moreover, ACLF was diagnosed according to the Asian Pacific criteria [&lt;span&gt;5&lt;/span&gt;], where liver failure is the primary factor. This explains why the new score identified two of the four factors as liver-specific (bilirubin and INR), whereas other factors that carry significant weight in other prognostic scores were not included.&lt;/p&gt;\u0000&lt;p&gt;Regarding the aCCI score, it appears that most points were derived from underlying liver disease across all analysed cohorts. Except for diabetes, none of the other factors included in the aCCI had a prevalence greater than 3%. This may partially undermine the aCCI's effectiveness as a tool for assessing extrahepatic comorbidities in HBV-ACLF patients. Furthermore, it should be noted that the aCCI was originally designed to estimate long-term mortality but has been considered a short-term prognostic tool in the manuscript by Chen et al. Some variables (e.g. AIDS, lymphoma) m","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"13 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610348","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: Bowel Preparation Quality in Patients With Crohn's Disease","authors":"Tamar Schildkraut, Nik (John) S. Ding, John David Chetwood","doi":"10.1111/apt.18350","DOIUrl":"https://doi.org/10.1111/apt.18350","url":null,"abstract":"&lt;p&gt;Adequate bowel preparation is crucial for optimal visualisation and lesion detection and remains a key determinant of colonoscopy quality [&lt;span&gt;1, 2&lt;/span&gt;]. Up to one-quarter of colonoscopies are conducted with inadequate bowel preparation, leading to reduced diagnostic yield and detection of nonpolypoid flat lesions, prolonged procedure time and an increased burden of repeat colonoscopies [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Several validated scales exist for the assessment of bowel preparation quality, however, an area of unmet need is validated scores for patients with inflammatory bowel disease (IBD), where endoscopy is essential to diagnosis, disease assessment, management and cancer surveillance. The presence of strictures, severe inflammation and insufficient bowel preparation may present a unique challenge to colonoscopy quality in IBD. Additionally, various adverse predictors of poor bowel preparation have been identified in IBD patients [&lt;span&gt;4-6&lt;/span&gt;]. There is a clear need for robust and reproducible colonoscopy quality control measures in this sub-population [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Solitano et al. evaluated the performance of four existing bowel preparation quality instruments—Boston Bowel Preparation Scale (BBPS), a modified BBPS (mBBPS), Harefield Cleansing Scale, and Bowel Cleansing Assessment Scale—in 50 endoscopy videos with Crohn's disease (CD) [&lt;span&gt;8&lt;/span&gt;]. Their findings demonstrated ‘moderate’ to ‘substantial’ inter-rater and intra-rater reliability, and high correlation coefficients between instruments and the visual analogue scale. An important finding is that all instruments performed well in terms of overall reliability and the authors concluded that instrument selection for use in clinical practice should be based on familiarity and local practice.&lt;/p&gt;\u0000&lt;p&gt;This is an important study to support the use of these instruments as reliable and valid measures of bowel preparation quality in CD—particularly in those with active luminal disease, with 72.5% of the procedures having an SES-CD score &gt; 3. Areas for further exploration include the instruments' ease of use, and the degree of ambiguity in interpreting the scores for each instrument. These factors were not discussed in this paper, however, would be highly relevant in clinical practice and informing consensus guidelines. Furthermore, the observed numerical differences in correlation scores would be of interest to explore in further large studies.&lt;/p&gt;\u0000&lt;p&gt;Important study limitations include the small sample size, which makes it challenging to comment on the applicability of these findings to specific CD subgroups. We look forward to further studies evaluating the reliability of quality scales particularly in penetrating, stricturing, and perianal fistulising CD cohorts with active proctitis. The cohort heterogeneity presents another limitation in applying these data to the general CD population. For instance, assessing colon preparation scores in a cohort that includ","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"11 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601696","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: Bowel Preparation Quality in Patients With Crohn's Disease—Authors' Reply","authors":"Virginia Solitano, Guangyong Zou, Vipul Jairath","doi":"10.1111/apt.18394","DOIUrl":"https://doi.org/10.1111/apt.18394","url":null,"abstract":"&lt;p&gt;We thank Dr. Schildkraut et al. for their thoughtful commentary and the acknowledgment of the importance of our study in demonstrating that existing bowel preparation quality assessment instruments, typically used in the general population, are also reliable and valid for patients with Crohn's disease (CD) [&lt;span&gt;1&lt;/span&gt;]. The implications of these findings are that instrument selection for use in clinical practice should be based on familiarity and local practice. The ease of use and interpretability of these instruments are critical for effective clinical application and need further exploration. Instruments that are simple to administer and reduce ambiguity in score interpretation could significantly enhance clinician confidence, making them more suitable for routine practice and future guideline development. Our results also support the inclusion of patients with CD in studies to evaluate novel bowel preparation formulations, which are historically conducted on healthy subjects [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;The 50 endoscopy videos evaluated in our study included recordings of 34 colonoscopies with terminal ileal evaluation, 14 colonoscopies, and two flexible sigmoidoscopies, involving a total of 40 patients with CD. We rigorously justified the sample size using formal sample size calculation as outlined by Zou [&lt;span&gt;3&lt;/span&gt;]. We adhered to the fundamental principle that a study too small may lack the power to adequately address the research question, while an overly large study can result in unnecessary use of resources and may raise ethical concerns. In this study, assuming an intraclass correlation coefficient of 0.80, scoring 50 videos by three central readers provided over 86% probability of obtaining a one-sided 95% lower bound exceeding 0.65, meeting the “substantial” agreement threshold per Landis and Koch's criteria [&lt;span&gt;4&lt;/span&gt;]. We also highlight that this estimate was conservative, as we ultimately analysed the data using a two-way random effects model, which is more efficient and yields stronger reliability estimates [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;At diagnosis, disease location was ileocolonic in 38.5%, colonic in 15.4% and ileal in 12.8% of patients. Disease behaviour was non-stricturing/non-penetrating in 46.1%, penetrating in 20.5%, and stricturing in 7.7% of patients. We acknowledge that our study population was heterogeneous, reflecting the real-world diversity of patients with CD compared to the general population. This heterogeneity, while presenting interpretive challenges, is an inherent characteristic of CD and underscores the importance of evaluating novel bowel preparation formulations within this group [&lt;span&gt;5&lt;/span&gt;]. We concur with the authors that there is a need for further research specifically targeting the CD population to better understand not only the reliability of bowel preparation instruments but also the effectiveness of novel bowel preparation formulations, particularly in subgroups such as those with pen","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"36 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601701","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":"Real-Time Assessment of H. pylori Infection to Guide Molecular Antibiotic Resistance Testing: A Combined Endoscopy-Gastric Juice Analysis Approach","authors":"Riccardo Vasapolli, Florent Ailloud, Beate Spießberger, Peter Malfertheiner, Sebastian Suerbaum, Christian Schulz","doi":"10.1111/apt.18378","DOIUrl":"https://doi.org/10.1111/apt.18378","url":null,"abstract":"<i>Helicobacter pylori</i> antibiotic resistance is the most relevant cause of treatment failure. Antibiotic susceptibility testing (AST) allows for selecting the appropriate eradication regimen.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"42 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599904","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":"Favourable Prognosis of Patients With Untreated HBeAg‐Negative Chronic Hepatitis B Virus Infection With HBsAg < 100 IU/mL","authors":"Jian Wang, Zhiyi Zhang, Shengxia Yin, Shaoqiu Zhang, Li Zhu, Yifan Pan, Tao Fan, Fei Cao, Ye Xiong, Chao Jiang, Guiyang Wang, Yue Yang, Bei Jia, Jiacheng Liu, Juan Xia, Xiaomin Yan, Jie Li, Chuanwu Zhu, Xingxiang Liu, Yuxin Chen, Chao Wu, Rui Huang","doi":"10.1111/apt.18383","DOIUrl":"https://doi.org/10.1111/apt.18383","url":null,"abstract":"BackgroundSerum hepatitis B surface antigen (HBsAg) &lt; 100 IU/mL has been recently proposed as one of the key criteria of ‘partial cure’ in patients with chronic hepatitis B virus (HBV) infection. We analysed the clinical prognosis of hepatitis B e antigen (HBeAg)‐negative untreated patients with HBsAg &lt; 100 IU/mL and normal alanine aminotransferase (ALT) levels.MethodsFive hundred and twenty‐one untreated patients with HBeAg negativity, HBsAg &lt; 100 IU/mL and normal ALT levels were included from three hospitals. Spontaneous HBsAg seroclearance, phase transition, liver fibrosis progression and hepatocellular carcinoma (HCC) development were analysed.ResultsThe median age was 43.0 years, and 62.2% of the patients were male. After a median follow‐up of 25.0 months, 52 (10.0%) patients achieved spontaneous HBsAg seroclearance. The annual HBsAg seroclearance rate is 4.2%. Patients with baseline HBsAg ≤ 10 IU/mL (adjusted hazard ratio [aHR] = 3.490, <jats:italic>p</jats:italic> &lt; 0.001) and male sex (aHR = 1.980, <jats:italic>p</jats:italic> = 0.041) were more likely to achieve HBsAg seroclearance. Only 4 (0.8%) and 23 (4.8%) patients transitioned to the immune escape phase and HBeAg‐negative indeterminate phase, respectively. Baseline serum HBsAg &gt; 10 IU/mL (aHR = 3.846, <jats:italic>p</jats:italic> = 0.034) and detectable HBV DNA (aHR = 2.672, <jats:italic>p</jats:italic> = 0.023) were associated with transition to the HBeAg‐negative indeterminate phase. No patient developed HCC or had fatal outcomes.ConclusionsHBeAg‐negative patients with serum HBsAg &lt; 100 IU/mL and normal ALT levels had a favourable prognosis. HBsAg ≤ 10 IU/mL and male sex were associated with a higher rate of HBsAg seroclearance, while HBsAg &gt; 10 IU/mL and detectable HBV DNA were associated with a higher risk of transition to the indeterminate phase.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"10 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599314","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":"Meta‐Analysis: Prevalence of Frailty and Associated Adverse Events in Inflammatory Bowel Diseases","authors":"Isabel Carbery, Oliver Todd, Matthew Hale, Christopher J. Black, Andrew Clegg, Christian P. Selinger","doi":"10.1111/apt.18390","DOIUrl":"https://doi.org/10.1111/apt.18390","url":null,"abstract":"BackgroundThe number of adults aged over 60 years with inflammatory bowel disease (IBD) is increasing. Frailty, rather than chronological age, may be a better predictor of adverse health outcomes.AimsTo summarise current knowledge about frailty in adults with IBD including the prevalence and associations of frailty and IBD‐related adverse outcomes.MethodsWe performed an electronic search of MEDLINE, EMBASE and EMBASE Classic databases using search terms for IBD and frailty from inception to 14 February 2024. All studies involving adults aged ≥ 16 with a confirmed diagnosis of IBD that included a frailty assessment were eligible for inclusion.ResultsWe included 23 observational studies involving 1,893,448 adults. Risk of bias was low for 18 studies and moderate for five. Twelve methods of frailty assessment were used, the most common being the Hospital Frailty Risk Score. Pooled prevalence of frailty in IBD patients was 18% (95% confidence interval (CI) 12.4%–25.6%). Meta‐analysis of unadjusted events data demonstrated that frailty increased the risk of infection‐related admissions following treatment in two studies (relative risk (RR) 1.9; 95% CI 1.2–3.0), post‐operative morbidity in three (RR 2.0; 95% CI 1.4–2.7) and mortality in seven (RR 4.3; 95% CI 2.6–7.4).ConclusionsFrailty is common in patients with IBD and is associated with IBD‐related adverse outcomes including infection‐related admissions following treatment, post‐operative morbidity and death. Future work should focus on developing risk assessment tools to better support decision making for older people with frailty and IBD.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"740 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599313","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 Motivation to Reduce Alcohol Use Among Patients With Chronic Liver Disease","authors":"Derek D. Satre, Dhweeja Dasarathy, Steven L. Batki, Michael J. Ostacher, Hannah R. Snyder, William Hua, Priti Parekh, Amy M. Shui, Ramsey Cheung, Alexander Monto, Robert J. Wong, Jennifer Y. Chen, Meimei Liao, Michele Tana, Po‐Hung Chen, Christina G. Haight, Taylor Fakadej, Mandana Khalili","doi":"10.1111/apt.18387","DOIUrl":"https://doi.org/10.1111/apt.18387","url":null,"abstract":"Background and AimsAlcohol use is prevalent among hepatology clinic patients with chronic liver disease (CLD). We explored factors associated with the importance and confidence dimensions of motivation to reduce drinking.MethodsParticipants (<jats:italic>N</jats:italic> = 121) with unhealthy alcohol use (i.e., over NIH guidelines) receiving care in hepatology clinics from a safety‐net hospital (SN, <jats:italic>N</jats:italic> = 54) and two Veterans Affairs Healthcare Systems (VA, <jats:italic>N</jats:italic> = 67) were enrolled in an alcohol intervention trial from March 2022 through October 2023. Baseline assessments included Generalised Anxiety Disorder (GAD‐7), Patient Health Questionnaire (PHQ‐8), Alcohol Use Disorders Identification Test (AUDIT), COVID‐19 stress; and measures of importance and confidence to decrease alcohol use (readiness rulers, scales of 1–10). Liver disease aetiology and severity were extracted from electronic health records. We performed multivariable linear regression models with forward selection to assess pre‐specified variables' associations with importance and confidence.ResultsThe sample was 84% male, 40% Latino, 31% White, 18% Black and 11% other races; median age was 61 years. Median (Q1–Q3) AUDIT score was 16 (12–24), importance was 9 (6–10) and confidence was 8 (5–9). On multivariable analysis, VA site (vs. SN) participants had a 0.97‐point lower importance score (<jats:italic>p</jats:italic> = 0.02); higher symptoms of depression (PHQ‐8 score ≥ 10 vs. &lt; 10) and AUDIT scores (for each point increase) were associated with higher importance score (estimates 1.2 and 0.08, <jats:italic>p</jats:italic> &lt; 0.05, respectively). Liver disease aetiology and severity were not significantly associated with outcomes.ConclusionsDepression, alcohol problem severity and treatment site may influence motivation to reduce alcohol use and could inform future hepatology‐based interventions.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"155 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599400","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":"Cholate Shunt, Oral Cholate Challenge and Endoscopic Lesions of Portal Hypertension: The SHUNT-V Study","authors":"Mitchell Shiffman, K. Rajender Reddy, Michael D. Leise, Kamran Qureshi, Alastair D. Smith, Steve Helmke, John Kittelson, Michael P. McRae, Joanne C. Imperial, Gregory T. Everson","doi":"10.1111/apt.18386","DOIUrl":"https://doi.org/10.1111/apt.18386","url":null,"abstract":"The accuracy of current criteria for ruling out large oesophageal varices (LEV) and other endoscopic lesions of portal hypertension (PH) may be compromised by obesity and MASLD/MASH.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"7 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599905","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}