Alimentary Pharmacology & Therapeutics最新文献

{"title":"Letter: Is Routine ECG Monitoring Redundant During Terlipressin Therapy in HRS-AKI?","authors":"Xing Wang","doi":"10.1111/apt.70330","DOIUrl":"https://doi.org/10.1111/apt.70330","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"18 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153421","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":"Research Communication: The Cumulated Spontaneous Portosystemic Shunts (SPSS) Area Decreases After TIPS and Impacts on Prognosis.","authors":"Marlene Hintersteininger,Theresa Müllner-Bucsics,Susanna Riegler,Nina Dominik,Georg Kramer,Christian Sebesta,Paul Thöne,Ulrika Asenbaum,Lukas Reider,Maria Schoder,Michael Trauner,Mattias Mandorfer,Thomas Reiberger,Lukas Hartl,Katharina Lampichler","doi":"10.1111/apt.70381","DOIUrl":"https://doi.org/10.1111/apt.70381","url":null,"abstract":"We evaluated the dynamics of spontaneous portosystemic shunts (SPSS) after transjugular intrahepatic portosystemic shunt (TIPS). Ninety patients with covered TIPS placement and contrast-enhanced CT scans before and after TIPS were included. Total SPSS area and total shunt area (including TIPS) were assessed. Median SPSS area (67.2-15.7 mm2; p < 0.001) decreased after TIPS, while total shunt area remained unchanged (67.2-75.8 mm2; p = 0.170). Relative SPSS area decrease was an independent protective factor for mortality (asHR: 0.19; 95% CI: 0.04-0.88; p = 0.034). In conclusion, SPSS decrease after TIPS and relative SPSS area change is independently linked to survival, while total shunt area remains unaltered.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"3 6 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127179","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":"Systematic Review: Ultrasound Goes Echo—Decarbonising Inflammatory Bowel Disease Care Through Intestinal Ultrasound","authors":"Sara Massironi, Alessandra Zilli, Federica Furfaro, Mariangela Allocca, Laurent Peyrin‐Biroulet, Vipul Jairath, Silvio Danese","doi":"10.1111/apt.70385","DOIUrl":"https://doi.org/10.1111/apt.70385","url":null,"abstract":"BackgroundInflammatory bowel disease (IBD) is a chronic, resource‐intensive condition requiring repeated diagnostic assessments. Healthcare contributes ~5% of global greenhouse gas emissions, and key diagnostic tools in IBD—gastrointestinal (GI) endoscopy, computed tomography (CT) and magnetic resonance imaging (MRI)—are associated with substantial environmental impacts. The environmental burden of these diagnostic pathways, however, remains underappreciated.AimTo systematically assess the carbon footprint and environmental impact of diagnostic imaging modalities commonly used in IBD, with particular focus on intestinal ultrasound (IUS) as a sustainable, low‐carbon alternative.MethodsA systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus and Embase were searched from inception to May 2025 for studies reporting the environmental impact of diagnostic modalities relevant to IBD care (GI endoscopy, CT, MRI and IUS). Studies providing quantitative or qualitative data on carbon footprint, energy consumption, waste generation or sustainability metrics were included. Data were synthesised narratively.ResultsThirty‐one studies were included. GI endoscopy generates approximately 7.8–56.4 kg CO<jats:sub>2</jats:sub>‐equivalent per procedure, largely driven by transportation, energy use and disposables. CT carries a carbon footprint of 7–10 kg CO<jats:sub>2</jats:sub>e per procedure in direct life cycle assessments, while broader institutional and modelling estimates extend this to ~20 kg CO<jats:sub>2</jats:sub>e depending on throughput, protocol and energy sources. MRI is substantially more energy‐intensive, ranging from 17–22 kg CO<jats:sub>2</jats:sub>e per scan in most studies, and up to 200–300 kg CO<jats:sub>2</jats:sub>e for high‐field (3T) systems when full life cycle impacts are included. In contrast, IUS produces only 0.5–1.5 kg CO<jats:sub>2</jats:sub>e per scan, with minimal energy demand and negligible waste. IUS enables point‐of‐care assessments, reducing patient travel and associated emissions.ConclusionGI endoscopy, CT and MRI are indispensable in IBD care but carry considerable environmental costs. The broader adoption of IUS offers a clinically effective, low‐carbon alternative that can contribute to more sustainable IBD management, aligning with planetary health goals.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews: CRD420251088016","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"53 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116154","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":"Exploration of Multiple Non-Invasive Tests for Assessing Response to Treatment in a Semaglutide Phase 2b Trial in Patients With MASH.","authors":"Louise Maymann Nitze,Vlad Ratziu,Arun J Sanyal,Vincent Wai-Sun Wong,Clare Balendran,Jan Fleckner,Mette Skalshøi Kjær,Niels Krarup,Quentin M Anstee","doi":"10.1111/apt.70376","DOIUrl":"https://doi.org/10.1111/apt.70376","url":null,"abstract":"BACKGROUNDNon-invasive tests (NITs) are not currently approved as biomarkers of treatment response for patients with metabolic dysfunction-associated steatohepatitis (MASH).AIMThis retrospective study explored a panel of NITs for assessing response to semaglutide treatment in patients with MASH randomised in a phase 2b trial (NCT02970942).METHODSThe present study was performed using the completer population (268 patients), defined as all patients who were randomised, remained on treatment throughout the trial, and had liver biopsy and NIT results at baseline and week 72. Semaglutide treatment arms were analysed as one semaglutide pooled group. Multiple NITs (alanine transaminase, aspartate transaminase [AST], controlled attenuation parameter, CK18-M30/M65, SomaSignal nonalcoholic steatohepatitis tests, FibroScan-AST, NIS-4, metabolomics advanced steatohepatitis fibrosis score, fibrosis-4 index, liver stiffness measure [LSM], enhanced liver fibrosis [ELF], PRO-C3 and ADAPT) were assessed. Treatment response was evaluated by NITs using either mean changes, responder groups, or risk categories from baseline to week 72.RESULTSSemaglutide treatment led to significant reductions versus placebo in all NIT scores from as early as 28 weeks. More patients had MASH improvement and fewer had fibrosis progression versus placebo when assessed by a 20% NIT response (0.5 U for ELF); among patients with baseline LSM > 8 kPa and ELF > 9.8 U, a larger proportion achieved LSM < 8 kPa and ELF < 9.8 kPa with semaglutide versus placebo.CONCLUSIONNITs may be used for assessing a treatment response in patients with MASH. Further studies should confirm the treatment effect of NITs and evaluate the association of NIT changes to outcomes.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"21 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117143","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":"Cost-Utility Analysis of Biomarker-Based vs. USG + AFP Strategies for HCC Surveillance in Chronic Hepatitis B.","authors":"Tanat Saeoui,Chayanis Kositamongkol,Ratthanan Chantrakul,Pimsiri Sripongpun,Naichaya Chamroonkul,Chanon Kongkamol,Pochamana Phisalprapa,Apichat Kaewdech","doi":"10.1111/apt.70386","DOIUrl":"https://doi.org/10.1111/apt.70386","url":null,"abstract":"BACKGROUNDThe standard surveillance for hepatocellular carcinoma (HCC) involves ultrasound (USG) with alpha-fetoprotein (AFP) every 6 months. However, limitations, such as restricted access, radiologist shortages, and uncertain cost-effectiveness, persist.AIMSWe assessed the cost-effectiveness of traditional and biomarker-based HCC surveillance strategies in patients with chronic hepatitis B (CHB).METHODSA Markov model simulated a cohort of patients with CHB to evaluate the cost-effectiveness of various surveillance strategies: USG + AFP, GAAD, GALAD, ASAP, and no surveillance. Input parameters were sourced from literature and Thai healthcare data. The analysis adopted a societal perspective and lifetime horizon, calculating incremental cost-effectiveness ratios (ICERs) in Thai Baht (THB) per quality-adjusted life year (QALY) gained. Sensitivity analyses assessed robustness.RESULTSASAP every 6 months was the most cost-effective strategy, with ICERs of 102,443 THB (~2957 USD) per QALY versus ASAP every 12 months and 76,447 THB (~2207 USD) per QALY versus no surveillance. Although GAAD and GALAD every 6 months achieved similar QALYs, they were dominated due to higher costs. Annual surveillance improved cost-effectiveness but remained inferior to ASAP every 6 months. USG + AFP every 6 months incurred the highest lifetime cost (166,253 THB, ~4800 USD). Sensitivity analyses confirmed the robustness of ASAP every 6 months, with key drivers including biomarker costs, HCC stage utilities, and incidence rates.CONCLUSIONSASAP every 6 months is the most cost-effective HCC surveillance strategy for patients with CHB and may be particularly suitable for resource-limited settings. Biomarker-based surveillance should be prioritised to improve outcomes and optimise resource use.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"89 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117142","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":"Non-Response to Obeticholic Acid Is Associated With Heightened Risks of Developing Clinical Events in Primary Biliary Cholangitis.","authors":"Nadir Abbas,Rachel Smith,Ellina Lytvyak,Miki Scraravaglio,Neil Halliday,Amal Almahroos,Nadia Eden,Diane Lloyd-Madden,Sanchit Sharma,James Ferguson,Jessica K Dyson,Douglas Thorburn,David Jones,Aldo J Montano-Loza,Marco Carbone,Pietro Invernizzi,George Mells,Emma L Culver,Palak J Trivedi","doi":"10.1111/apt.70378","DOIUrl":"https://doi.org/10.1111/apt.70378","url":null,"abstract":"OBJECTIVEBiochemical non-response to ursodeoxycholic acid, as a first-line therapy, is associated with a heightened risk of clinical events in primary biliary cholangitis (PBC). Herein, we determine whether biochemical non-response to second-line therapy in obeticholic acid (OCA) is also predictive of long-term event-free survival.DESIGNData were collected from patients who initiated OCA at large, high-volume centres in the UK, Italy, and Canada between August 2017 and 2019, with follow-up continuing until June 2024. Biochemical non-response was defined by POISE criteria. Clinical events were defined as hepatic decompensation, referral for transplantation, hepatocellular carcinoma, or death.RESULTSOur cohort consisted of 336 patients (29% with cirrhosis), of whom n = 150 (45%) discontinued OCA over 48 months. Over 851 patient-years of OCA use, without the addition of another PBC therapy, n = 230, n = 192, n = 158 and n = 150 patients completed 12, 24, 36 and 48 months follow-up, respectively. Of this cohort, 37%, 48%, 63% and 55% attained biochemical response, with 7%, 14%, 25% and 19% normalising ALP (p < 0.01; all comparisons vs. baseline). Over 4 years, 64 patients experienced a clinical event. Twelve-month biochemical non-response associated with a heightened risk of clinical events (hazard ratio [HR]: 4.50; 95% CI: 1.74-20.23), as did cirrhosis (HR: 20.24, 10.15-40.32), hyperbilirubinaemia (HR: 2.55, 1.71-3.76), hypoalbuminaemia (HR: 0.92, 0.90-0.96) and thrombocytopenia (HR: 0.99, 0.98-0.99). The prognostic utility of biochemical non-response (HR: 3.29, 1.72-14.96) and cirrhosis (HR: 19.67, 5.09-76.08) persisted on multivariable analyses.CONCLUSIONBiochemical response stratifies risk of clinical events in PBC patients under OCA treatment. Whilst response rates increase over time, discontinuation rates underscore the need for newer treatment paradigms.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"78 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103518","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: Mortality Trends and Risk Factors in Severe Alcohol-Associated Hepatitis.","authors":"Mushfiqur R Siddique,Muzzafar Haque,Francisco Idalsoaga,Luis Antonio Diaz,Gene Im,Ashwani K Singal,Stephen Hoang,Mohammad Qasim Khan,Juan Pablo Arab","doi":"10.1111/apt.70383","DOIUrl":"https://doi.org/10.1111/apt.70383","url":null,"abstract":"BACKGROUNDSevere alcohol-associated hepatitis (sAH) is a life-threatening condition. Despite advances in clinical management, prognosis remains poor and long-term effectiveness of available therapies is uncertain. We conducted a systematic review and meta-analysis to evaluate short-term mortality (28, 60, and 90-day) trends in sAH over the past five decades.METHODSWe searched PubMed, EMBASE, and Scopus from database inception to February 2024 for studies reporting 28, 60, and 90-day mortality in patients with sAH. Pooled mortality estimates were calculated using a random-effects meta-regression model. We assessed heterogeneity using the I2 statistic and explored sources of heterogeneity through subgroup and meta-regression analyses. Separate Bayesian mixed-effects binomial models were used to estimate the posterior distribution of mortality probability, updated sequentially across calendar time.RESULTS34 studies comprising 1586 patients with sAH were included. Pooled mortality rates were 26.8% (95% CI: 21.0%-33.5%) at 28 days, 35.1% (95% CI: 28.3%-42.5%) at 60 days, and 43.7% (95% CI: 34.6%-53.3%) at 90 days. Mortality increased steadily with follow-up time. Substantial heterogeneity was observed, as expected in pooled proportion meta-analysis (I2 > 80%). Although cumulative Bayesian analysis showed that average 28-day mortality declined from over 50% in the 1970s to ~25% after 2000, a formal decade-based analysis indicated no statistically credible improvement in short-term mortality was detected overall in the past four decades. In multivariable models adjusting for follow-up time, the Model for End-Stage Liver Disease (MELD) score was significantly associated with mortality.CONCLUSIONSShort-term mortality in sAH remains high and has not improved in recent decades. These findings highlight the urgent need for effective therapies, improved patient selection for early liver transplantation, and better prognostic tools to guide clinical decision-making.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"16 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089842","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: Drug-Induced Autoimmune-Like Hepatitis-A Trigger on the Disease Spectrum. Authors' Reply.","authors":"Pinelopi Arvaniti,Xavier Forns,Maria-Carlota Londoño","doi":"10.1111/apt.70380","DOIUrl":"https://doi.org/10.1111/apt.70380","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"6 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077728","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: Drug-Induced Autoimmune-Like Hepatitis-A Trigger on the Disease Spectrum.","authors":"Yusa Pan,Jianjun Ding","doi":"10.1111/apt.70372","DOIUrl":"https://doi.org/10.1111/apt.70372","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"37 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077729","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: Managing the Moving Target-Dose Adjustments in Inflammatory Bowel Disease. Authors' Reply.","authors":"Cristina Rubín de Célix,María Chaparro,Javier P Gisbert","doi":"10.1111/apt.70379","DOIUrl":"https://doi.org/10.1111/apt.70379","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"73 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071765","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}