Alimentary Pharmacology & Therapeutics最新文献

{"title":"Diagnostic Accuracy of an Add-On, Blood-Based Screening Test for Colorectal Cancer in Two Established Screening Programmes","authors":"Tim L. Kortlever, Enea Ferlizza, Mattia Lauriola, Francesco Borrelli, Alberto Porro, Manon C. W. Spaander, Patrick M. Bossuyt, Luigi Ricciardiello, Evelien Dekker","doi":"10.1111/apt.70141","DOIUrl":"https://doi.org/10.1111/apt.70141","url":null,"abstract":"CELTiC is a blood-based test consisting of a panel of four mRNAs (<i>CEACAM6</i>, <i>LGALS4</i>, <i>TSPAN8</i> and <i>COL1A2</i>) associated with colorectal cancer (CRC). CELTiC has a high sensitivity (90%) for detecting advanced neoplasia (AN) when compared to faecal immunochemical test (FIT)-negative subjects.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"78 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813902","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":"Three-Dimensional Transjugular Intrahepatic Portosystemic Shunt Geometry Predicts Shunt Dysfunction","authors":"Carsten Meyer, Markus Kimmann, Katharina Böhm, Sebastian Nowak, Alba Maria Paar Pérez, Jörn Arne Meier, Sara Noemi Reinartz Groba, Juliana Gödiker, Frank Erhard Uschner, Feras Sanoubara, Johannes Chang, Jonel Trebicka, Alois Martin Sprinkart, Michael Praktiknjo","doi":"10.1111/apt.70133","DOIUrl":"https://doi.org/10.1111/apt.70133","url":null,"abstract":"Patients with decompensated cirrhosis are at risk of portal hypertension-related complications, such as refractory ascites or variceal bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) insertion is the most effective treatment to reduce portal hypertension. However, patients are at risk for TIPS dysfunction.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"93 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806183","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":"Immigration Factors and Monitoring of Chronic Hepatitis B Infection Among Foreign-Born: The FOCUS-HBV Multicentre Cohort","authors":"Kali Zhou, Ariel Lee, Christopher Wong, Amol S. Rangnekar, Ariana Chen, James Ajokubi, Andrea I. Keller, Coleman I. Smith, Asif A. Hitawala, Maria Mironova, Harish Gopalakrishna, Jaha Norman-Wheeler, Marc G. Ghany, Jennifer L. Dodge, Norah A. Terrault, Christine C. Hsu","doi":"10.1111/apt.70123","DOIUrl":"https://doi.org/10.1111/apt.70123","url":null,"abstract":"Immigrants are the largest subgroup living with chronic hepatitis B (HBV) infection in the United States. It is not well understood how immigration and associated social and cultural factors impact adherence to HBV monitoring.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"59 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806182","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: Inflammatory Potential of the Diet and Risk of Crohn's Disease and Ulcerative Colitis","authors":"Zhidong Zhou,&nbsp;Nanren Sun,&nbsp;Qiang Liu","doi":"10.1111/apt.70124","DOIUrl":"10.1111/apt.70124","url":null,"abstract":"&lt;p&gt;The study by Meyer et al. [&lt;span&gt;1&lt;/span&gt;] based on the large EPIC cohort, employed rigorous statistical methods and utilised the Inflammatory Score of the Diet (ISD) to assess the impact of diet on the risk of inflammatory bowel disease (IBD). A key finding was that a high ISD score was significantly associated with an increased risk of Crohn's disease (CD), particularly among women, providing valuable dietary guidance for high-risk populations.&lt;/p&gt;&lt;p&gt;Despite the significance of this study, we would like to highlight some limitations.&lt;/p&gt;&lt;p&gt;First, the number of food items included in the Food Frequency Questionnaires (FFQs) across different centres ranged from 98 to 2059, indicating substantial variation in dietary diversity. However, the authors did not appear to have adjusted for region or centre as a covariate in subsequent analyses. This discrepancy may introduce systematic bias in ISD calculations across centres, potentially affecting the overall results. We suggest that future studies calculate ISD separately for each centre or standardise FFQ data across different regions to improve data comparability.&lt;/p&gt;&lt;p&gt;Second, the study examined the association between multiple dietary factors and IBD risk but did not appear to have applied false discovery rate correction or Bonferroni adjustment for multiple comparisons. This increases the risk of Type I errors, which may compromise the robustness of the conclusions. Future studies should employ appropriate statistical correction methods in multiple comparison analyses to reduce the likelihood of false positive results.&lt;/p&gt;&lt;p&gt;Third, a preliminary statistical power assessment suggested that the study's overall power, including both men and women, was low (~5%), with both groups falling below the recommended 80% threshold. Therefore, the lack of a significant association in men may be attributable to limited power rather than a true absence of a sex-specific effect. Furthermore, the non-significant interaction test between ISD and sex may be influenced by the overall low power rather than indicating the absence of a differential effect. Future studies should consider larger sample sizes, particularly in men, to enhance power and provide a more definitive evaluation of the impact of ISD on CD risk.&lt;/p&gt;&lt;p&gt;Finally, environmental factors like early antibiotic use, gastrointestinal infections, breastfeeding, diet, and smoking can alter gut microbiota and trigger immune activation in IBD-prone individuals [&lt;span&gt;2&lt;/span&gt;]. Although the study adjusted for BMI, smoking, physical activity, and alcohol, it lacked adjustment for key confounders such as antibiotic use, breastfeeding history, and prior gastrointestinal infections.&lt;/p&gt;&lt;p&gt;Despite these limitations, this study remains a valuable contribution to the exploration of dietary influences on IBD. Future research may further enhance causal inference by integrating repeated dietary assessments and incorporating additional potential confounders. We appreci","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 10","pages":"1733-1734"},"PeriodicalIF":6.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143798179","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: How to Interpret Clinical Impact of Viral Replication Activity for Postoperative Recurrence of HBV-Related HCC","authors":"Beom Kyung Kim","doi":"10.1111/apt.70118","DOIUrl":"10.1111/apt.70118","url":null,"abstract":"&lt;p&gt;Hepatitis B virus (HBV) is a major driver of hepatocellular carcinoma (HCC) [&lt;span&gt;1, 2&lt;/span&gt;]. Baseline viral load, as reflected in serum HBV-DNA levels, is a key risk factor for hepatocellular carcinoma (HCC) even in patients undergoing antiviral therapy (AVT) [&lt;span&gt;3&lt;/span&gt;]. There is no doubt that entecavir or tenofovir can induce complete virological response by reducing serum HBV-DNA level rapidly. Nevertheless, somewhat paradoxical findings were observed; patients with ‘moderate’ baseline viral load, particularly around 6 log&lt;sub&gt;10&lt;/sub&gt; IU/mL, demonstrated the highest on-treatment HCC risk, compared to those with ‘high’ baseline viral load (≥ 8.00 log&lt;sub&gt;10&lt;/sub&gt; IU/mL) [&lt;span&gt;3&lt;/span&gt;]. One of the plausible mechanisms is that ‘moderate’ baseline viral load, in reference to ‘high’ baseline viral load, might signify a condition of transition from immune-tolerant to immune-active phase, leading to more heightened necroinflammation and/or increased integration of HBV-DNA into human genomes. However, to date, whether this phenomenon extends to postoperative HCC recurrence remains unclear.&lt;/p&gt;&lt;p&gt;In this issue, Heo et al. [&lt;span&gt;4&lt;/span&gt;] evaluated the relationship between baseline viral load and postoperative HCC recurrence. A key finding is the differential impact of baseline viral load on HCC recurrence based on cirrhosis status. Among cirrhotic patients, the ongoing-AVT group had a lower HCC recurrence risk than the initiation-AVT group, particularly within the first 2 years post-surgery. This suggests that prolonged pre-operative viral suppression by AVT may improve postoperative outcomes, emphasising the need for early and sustained AVT use, especially in cirrhotic patients. However, among non-cirrhotic patients, overall HCC recurrence rates were comparable between the two groups. Another noteworthy finding is the non-linear parabolic association between baseline viral load and HCC recurrence in non-cirrhotic patients. In other words, patients with moderate viral loads (5.00–5.99 log10 IU/mL HBV-DNA) exhibited the highest HCC recurrence risk, mirroring findings from prior studies by the same research group [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Despite these insights, several important questions remain. First, discrepancies exist between this study and previous research. A separate study performed in South Korea reproducibly reported comparable outcomes between ongoing-AVT and initiation-AVT groups. It is most likely owing to the retrospective natures of both studies, introducing several kinds of bias [&lt;span&gt;3, 5&lt;/span&gt;]. So, further studies with well-controlled cohorts are required. Second, it remains unclear how the conclusion by Heo et al. [&lt;span&gt;4&lt;/span&gt;] will modify the current practice guidelines. While the necessity of AVT for detectable HBV-DNA in cirrhotic patients is widely accepted, the implications for non-cirrhotic patients require further discussion [&lt;span&gt;6, 7&lt;/span&gt;]. Third, tumour biology must be considered when discussing postop","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 10","pages":"1717-1718"},"PeriodicalIF":6.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797727","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: Inflammatory Potential of the Diet and Risk of Crohn's Disease and Ulcerative Colitis. Authors' Reply","authors":"Antoine Meyer,&nbsp;Aurélien Amiot","doi":"10.1111/apt.70138","DOIUrl":"10.1111/apt.70138","url":null,"abstract":"<p>We thank Drs. Zhou, Sun Liu for their interest in our study [<span>1, 2</span>]. We suggest that a high inflammatory score of the diet (ISD) is associated with a higher risk of developing Crohn's disease (CD) but not ulcerative colitis (UC).</p><p>First, Zhou et al. suggested that results might be biased as the number of food items included In the Food Frequency Questionnaires ranged from 98 to 2059 across centres. However, this potential bias was taken into account by stratifying the analyses by centre as stated in the statistical analysis section of the manuscript.</p><p>Second, Zhou et al. stated that no false discovery rate was performed for multiple comparisons. However, in our study, there was only one exposure (inflammatory score of the diet) for two outcomes (CD and UC). Correcting for false discovery rate does not modify our results (P_trend = 0.009 for CD and 0.208 for UC) [<span>3</span>]. Additional analyses according to sex or to items of the inflammatory score of the diet are only exploratory and do not require adjustment for multiple testing [<span>4</span>].</p><p>Third, Zhou et al. suggested that our analyses were underpowered to study an interaction between the ISD and sex for this risk of CD/UC, and that we should include a larger sample size, particularly men. However, the EPIC cohort is one of the largest cohorts worldwide as 394,255 participants from eight European countries, including 268,599 women and 125,656 men were included in the analyses. Even if a population as large as possible is desirable, this objective seems difficult to achieve. As the interaction tests for ISD between women and men and the risk of developing CD were not significant (<i>p</i> = 0.44 for quartile 2, 0.99 for quartile 3, and 0.66 for quartile 4), a differential effect of ISD between women and men is unlikely.</p><p>Finally, Zhou et al. mentioned that the analyses were not adjusted for some confounders such as antibiotic use, breastfeeding history, and prior gut infections. Indeed, these potential confounding factors were not available in our database. Therefore, as in all non-randomised epidemiology studies, residual confounding cannot be excluded.</p><p>In conclusion, our results suggest that a high inflammatory score of the diet is associated with a higher risk of developing CD but not UC. These results are in agreement with those reported in another study that used similar methodology with another inflammatory score (empirical dietary inflammatory pattern) [<span>5</span>].</p><p><b>Antoine Meyer:</b> conceptualization, validation, writing – original draft. <b>Aurélien Amiot:</b> validation, conceptualization, writing – review and editing.</p><p>This article is linked to Meyer and Zhou et al. papers. To view these articles, visit https://doi.org/10.1111/apt.18497 and https://doi.org/10.1111/apt.70124.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 10","pages":"1735-1736"},"PeriodicalIF":6.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143798178","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: How to Interpret Clinical Impact of Viral Replication Activity for Postoperative Recurrence of HBV-Related HCC—Authors' Reply","authors":"Subin Heo,&nbsp;Won-Mook Choi","doi":"10.1111/apt.70143","DOIUrl":"10.1111/apt.70143","url":null,"abstract":"&lt;p&gt;We sincerely thank Kim for his insightful editorial on our recent study [&lt;span&gt;1, 2&lt;/span&gt;] and for recognising its key findings—particularly the differential impact of the timing of antiviral treatment (AVT) on hepatocellular carcinoma (HCC) recurrence after curative resection according to cirrhosis status, and the observation of a non-linear parabolic association between hepatitis B virus (HBV) DNA levels and postoperative recurrence risk in non-cirrhotic patients. We also welcome the opportunity to further elaborate on our findings and to address the important discussion points raised by Kim in his editorial.&lt;/p&gt;&lt;p&gt;First, the impact of AVT timing on HCC recurrence after curative therapy has long been debated [&lt;span&gt;3, 4&lt;/span&gt;], likely due to variations across studies in the stages of HCC included, whether only surgically treated cases were analysed or non-surgical treatments such as local ablative therapy were also included, and differences in the proportion of patients with cirrhosis. To enhance both the internal and external validity of our findings, we analysed a large-scale multinational cohort of 2384 patients with BCLC stage 0 or A HBV-related HCC who underwent curative resection, and demonstrated a differential effect of AVT timing based on cirrhosis status—one of the cornerstone findings of our study [&lt;span&gt;1&lt;/span&gt;], and notably, a distinction that has not been clearly delineated in previous studies [&lt;span&gt;3, 4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, while current guidelines support AVT initiation in cirrhotic patients with any detectable HBV DNA level—a recommendation further reinforced by our findings—our study also suggests that the timing of AVT in non-cirrhotic patients, particularly those with moderate HBV DNA levels between 5 and 7 log&lt;sub&gt;10&lt;/sub&gt; IU/mL, warrants further investigation [&lt;span&gt;5&lt;/span&gt;], given the potential ongoing impact of viral replication activity-associated genome integration and clonal hepatocyte expansion on not only the development but also the recurrence of HCC [&lt;span&gt;6, 7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Third, although we adjusted for major tumour pathological features—such as microvascular invasion and the presence of satellite nodules—using detailed histopathologic data, we recognise that our study is limited in its ability to capture the full complexity of tumour biology. Specifically, as a retrospective clinical study, our analysis could not comprehensively address the dynamic interplay among viral, host, and environmental factors, nor their roles in shaping the tumour microenvironment and influencing disease progression [&lt;span&gt;8&lt;/span&gt;]. We fully agree that further research is needed to elucidate these multifactorial interactions and their contributions to tumour biology.&lt;/p&gt;&lt;p&gt;Despite the inherent limitations of being a retrospective study, we believe that our study meaningfully extends the discussion on viral dynamics and the optimal timing of AVT from the secondary to the tertiary preventive setting of HCC. The editorial di","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 10","pages":"1719-1720"},"PeriodicalIF":6.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143798180","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 on “Association Between Viral Replication Activity and Postoperative Recurrence of HBV-Related Hepatocellular Carcinoma”–Authors' Reply","authors":"Subin Heo, Won-Mook Choi","doi":"10.1111/apt.70144","DOIUrl":"https://doi.org/10.1111/apt.70144","url":null,"abstract":"<p>We appreciate the interest of Qian et al. in our study [<span>1, 2</span>] on the association between viral replication activity and postoperative recurrence of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), and we welcome the opportunity to address the issues raised.</p>\u0000<p>First, the greater effect of preoperative antiviral therapy (AVT) in reducing recurrence among cirrhotic patients may be attributed to previous studies demonstrating a more substantial risk reduction for HCC in cirrhotic patients compared to non-cirrhotic patients [<span>3, 4</span>]. Regarding the impact of viral replication on early versus late recurrence, the timing of AVT had a more pronounced effect on early recurrence, likely due to its association with tumour aggressiveness, including microvascular invasion (MVI). In contrast, baseline HBV DNA levels had a lasting influence on both early and late recurrence, possibly reflecting the long-term effects of HBV-induced “field effect” and epigenetic modifications, as you noted.</p>\u0000<p>Second, our findings do not contradict previous studies suggesting a dose-dependent relationship between HBV replication and HCC development [<span>5</span>]. Rather, by complementing previous studies with a greater number of patients with very high HBV DNA levels (above 5 log₁₀ IU/mL) and HBeAg positivity—who were difficult to analyse in earlier studies—we observed a non-linear, parabolic association between HBV DNA levels and HCC risk [<span>6, 7</span>], which may be attributed to hepatocyte clonal expansion, host genome integration and differences in background liver inflammation associated with HBV DNA levels, as outlined in the Discussion section of our study. In addition, we would like to highlight recent evidence suggesting that HBsAg⁺ hepatocytes, which produce surface antigen from integrated HBV DNA, may undergo clonal expansion more readily than HBV core⁺ hepatocytes with high cccDNA levels, possibly due to reduced CD8⁺ T cell infiltration that allows immune escape and confers a survival advantage [<span>8</span>].</p>\u0000<p>Third, as you noted, the proportion of patients with MVI was higher in the initiation–AVT group compared with the ongoing–AVT group, which we adjusted for using propensity score matching and multivariable regression analyses. A mediation analysis to determine whether the effect of AVT timing on HCC recurrence is direct or mediated through MVI would be valuable.</p>\u0000<p>Finally, although the impact of AVT and postoperative adjuvant therapies on HCC recurrence was beyond the scope of our study and therefore not specifically addressed, we agree that further research aimed at reducing recurrence is warranted, given the high rate of HCC recurrence even after curative treatment.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"55 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789857","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":"Da Qian, Chaoshen Wu, Danhao Tao","doi":"10.1111/apt.70137","DOIUrl":"https://doi.org/10.1111/apt.70137","url":null,"abstract":"&lt;p&gt;We read the paper “Association Between Viral Replication Activity and Postoperative Recurrence of HBV-Related Hepatocellular Carcinoma”, published in Alimentary Pharmacology &amp; Therapeutics, with great interest [&lt;span&gt;1&lt;/span&gt;]. We appreciate Heo et al.'s efforts in investigating the impact of HBV replication on HCC recurrence, particularly the stratification based on antiviral therapy (AVT) initiation timing. This study provides valuable insights into postoperative recurrence patterns. However, after careful evaluation, we have concerns regarding the study's methodology and interpretation, which may affect the reliability of its conclusions and prompted this letter.&lt;/p&gt;\u0000&lt;p&gt;First, the study suggests that preoperative antiviral therapy (AVT) reduces recurrence risk in cirrhotic patients but not in non-cirrhotic patients. However, this conclusion may be influenced by differences in baseline liver disease severity rather than a direct effect of viral suppression. The study could benefit from a deeper stratification based on liver function metrics such as the ALBI score or fibrosis stage, beyond the simple cirrhosis vs. non-cirrhosis classification. Additionally, while the authors argue that late recurrence is less influenced by viral replication, this perspective may underestimate the role of long-term HBV-induced epigenetic modifications in tumour recurrence [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Second, the reported parabolic relationship between HBV DNA levels (5–7 log10 IU/mL) and recurrence risk in non-cirrhotic patients is an interesting finding, but its biological interpretation remains speculative. The proposed mechanism of clonal selection and immune escape lacks direct validation. Incorporating additional molecular markers, such as circulating tumour DNA, HBV integration sites, or inflammatory cytokine profiles, would strengthen this hypothesis. Furthermore, the observed peak recurrence risk at moderate viral loads contradicts prior studies that suggested a dose-dependent relationship between HBV replication and HCC progression [&lt;span&gt;3&lt;/span&gt;]. Addressing this discrepancy with mechanistic insights is crucial.&lt;/p&gt;\u0000&lt;p&gt;Third, microvascular invasion (MVI), a well-established predictor of HCC recurrence, differs significantly between the ongoing-AVT and initiation-AVT groups (22.5% vs. 33.2%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). While the authors apply propensity-score matching, residual confounding cannot be ruled out. More rigorous approaches, such as inverse probability weighting or mediation analysis, could clarify whether viral replication independently influences recurrence or is merely a surrogate for more aggressive tumour biology.&lt;/p&gt;\u0000&lt;p&gt;Finally, while the study highlights the importance of early AVT initiation, it does not address whether intensifying post-resection antiviral regimens or combining AVT with adjunctive therapies (e.g., immune checkpoint inhibitors, targeted therapies) could offer superior benefits. Given the high recurrence rates despite AVT","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"60 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789910","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":"Risk of De Novo Inflammatory Bowel Disease in Patients With Psoriasis and Psoriatic Arthritis Treated With IL-17A Inhibitors: A Population-Based Study","authors":"Saqr Alsakarneh, Omar Al Ta’ani, Razan Aburumman, Inas Mikhail, Jana G. Hashash, Francis A. Farraye","doi":"10.1111/apt.70139","DOIUrl":"https://doi.org/10.1111/apt.70139","url":null,"abstract":"IL-17 inhibitors effectively treat psoriasis and psoriatic arthritis but may increase the risk of inflammatory bowel disease (IBD). We assessed their association with IBD compared to apremilast. Utilising the TriNetX database, we analysed patients with psoriasis or ankylosing spondylitis initiating IL-17 inhibitors or apremilast. We used propensity score matching and Cox models to estimate IBD risk. Among 13,216 matched patients per group, 142 developed IBD with IL-17 inhibitors versus 60 with apremilast (aHR = 2.50, 95% CI: 1.85–3.39). IL-17 inhibitors increase IBD risk, necessitating careful patient selection and monitoring.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"35 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789854","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}