Alimentary Pharmacology & Therapeutics最新文献

{"title":"Portal Hypertensive Gastropathy and MELD-Na Score Predict Recurrent Gastrointestinal Bleeding After TIPSS: An ALTA Group Study.","authors":"Kelly Hu, Mai Sedki, Allison Kwong, Andrew Kesselman, Kanti Pallav Kolli, Giuseppe Morelli, Erin Spengler, Adnan Said, Jennifer Lai, Archita Desai, Sonali Paul, Catherine Frenette, Michael Fallon, Margarita German, Elizabeth Verna, Justin Boike, Dyanna Gregory, Bartley Thornburg, Lisa VanWagner, Aparna Goel","doi":"10.1111/apt.18362","DOIUrl":"https://doi.org/10.1111/apt.18362","url":null,"abstract":"<p><strong>Background: </strong>Transjugular intrahepatic portosystemic shunt (TIPSS) is highly effective for treatment of variceal bleeding; however, factors contributing to rebleeding complications remain unclear.</p><p><strong>Aims: </strong>In this study, we aim to determine risk factors for recurrent portal hypertensive gastrointestinal bleeding following TIPSS.</p><p><strong>Methods: </strong>Utilising the Advancing Liver Therapeutic Approaches multicentre database, we retrospectively identified adult patients who underwent TIPSS for secondary prophylaxis of variceal bleeding and had a gastrointestinal rebleeding event within 1 year. We developed multivariable logistic regression models to identify clinical/procedural characteristics associated with rebleeding.</p><p><strong>Results: </strong>We identified 476 patients, predominately middle-aged (mean age 57), male (62%) and White (65%), with mean MELD-Na 16. 16% (n = 77) had a rebleeding event; these patients were more likely to be male (p = 0.016), with higher serum creatinine (p = 0.005), MELD-Na (p = 0.0002), portal hypertensive gastropathy on pre-TIPSS upper endoscopy (p = 0.000) and with higher incidence of TIPSS revision (p = 0.000). There were no significant differences in type of TIPSS endoprosthesis, concurrent embolotherapy, and post-TIPSS pressure gradients between those who experienced rebleeding and those who did not. After adjusting for TIPSS revision, multivariable analysis revealed MELD-Na and presence of portal hypertensive gastropathy on pre-TIPSS endoscopy were independently associated with rebleeding.</p><p><strong>Conclusions: </strong>In this retrospective analysis of a multicentre, nationally representative database, we found that apart from TIPSS-related factors, high MELD-Na and portal hypertensive gastropathy on pre-TIPSS endoscopy were independent predictors of rebleeding within 1 year following TIPSS. These variables may be used to identify high-risk patients who may require additional monitoring following TIPSS.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581120","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: Stopping NUCs—When to Restart NUCs for the Best Outcome?","authors":"Melanie Urbanek-Quaing, Markus Cornberg","doi":"10.1111/apt.18370","DOIUrl":"https://doi.org/10.1111/apt.18370","url":null,"abstract":"&lt;p&gt;The standard treatment of chronic hepatitis B virus (HBV) infection, nucleos(t)ide analogues (NUC), is usually long-term, as HBsAg loss is rarely achieved, which signifies functional cure. Recent evidence suggests that selected HBeAg-negative individuals with prolonged viral suppression and no advanced liver fibrosis can discontinue NUC therapy before HBsAg loss [&lt;span&gt;1&lt;/span&gt;]. Studies, including a prospective randomised trial, show a higher chance of HBsAg loss after discontinuing NUC therapy [&lt;span&gt;2, 3&lt;/span&gt;]. However, HBsAg loss rates vary by patient origin and HBsAg levels. Caucasians have higher HBsAg loss rates (up to 41%) when levels are &lt; 1000 IU/mL, while Asian patients achieve significant HBsAg loss when levels are &lt; 100 IU/mL [&lt;span&gt;4&lt;/span&gt;]. Immunological events, marked by transient ALT increases after NUC discontinuation, may trigger HBsAg loss, though the exact mechanisms are unclear [&lt;span&gt;5, 6&lt;/span&gt;]. The appropriate time to restart NUC therapy remains debated. Premature re-treatment may inhibit beneficial flares, whereas delayed re-treatment could lead to immune exhaustion, or possibly severe hepatic flares. Studies show conflicting results regarding ALT flares and HBsAg loss [&lt;span&gt;6, 7&lt;/span&gt;], highlighting the complexity.&lt;/p&gt;\u0000&lt;p&gt;Against this background, the ‘Nuc-Stop Study’ from Norway, Sweden, Denmark and Ethiopia aimed to assess two strategies for restarting NUC therapy [&lt;span&gt;8&lt;/span&gt;]. This prospective trial involved 127 HBeAg-negative, non-cirrhotic patients with at least 24 months of viral suppression. Participants discontinued antiviral therapy and were randomly assigned to either a low-threshold or high-threshold group for restarting therapy, based on HBV DNA and ALT values (Figure 1). The primary endpoint was HBsAg loss within 36 months post-therapy. The study showed no statistically significant difference in HBsAg loss between the low-threshold (4.7%) and high-threshold (12.7%) groups. However, the study was underpowered due to the sample size calculation, which assumed HBsAg loss would occur in 20% of the high-threshold group and only 1% of the low-threshold group. The overall HBsAg loss rate was 8.7%, lower than in earlier studies [&lt;span&gt;9&lt;/span&gt;]. Importantly, all cases of HBsAg loss occurred in patients with HBsAg &lt; 1000 IU/mL, among whom the HBsAg loss rate was indeed higher in the high-threshold group (53.3%) than in the low-threshold group (11.5%), indicating a possible strategic benefit.&lt;/p&gt;\u0000&lt;figure&gt;&lt;picture&gt;\u0000&lt;source media=\"(min-width: 1650px)\" srcset=\"/cms/asset/80075d63-cdbd-4232-a53f-71ce12520437/apt18370-fig-0001-m.jpg\"/&gt;&lt;img alt=\"Details are in the caption following the image\" data-lg-src=\"/cms/asset/80075d63-cdbd-4232-a53f-71ce12520437/apt18370-fig-0001-m.jpg\" loading=\"lazy\" src=\"/cms/asset/5df29959-27fc-4daa-be41-0137f88f299f/apt18370-fig-0001-m.png\" title=\"Details are in the caption following the image\"/&gt;&lt;/picture&gt;&lt;figcaption&gt;\u0000&lt;div&gt;&lt;strong&gt;FIGURE 1&lt;span style=\"font-weight:normal\"&gt;&lt;/s","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"6 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580642","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: Disentangling Early-Life Antibiotics and Infections as Risk Factors for the Development of Childhood IBD.","authors":"Katherine L Stone, Adam S Faye","doi":"10.1111/apt.18374","DOIUrl":"https://doi.org/10.1111/apt.18374","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142566587","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: Global Prevalence of Coeliac Disease in Type 1 Diabetes.","authors":"Sahand Karimzadhagh, Elahe Abbaspour, Maryam Shahriarinamin, Pourya Shamsi, Selvana Poursadrolah, Mehrdad Khorasani, Mahzad Daghighi, Arash Malek, Jouan Taheri Talesh, Govind K Makharia, Mohammad Rostami-Nejad","doi":"10.1111/apt.18373","DOIUrl":"https://doi.org/10.1111/apt.18373","url":null,"abstract":"<p><strong>Background: </strong>Coeliac disease (CD) is common in patients with type 1 diabetes (T1D), but prevalence varies globally due to differing screening protocols. There have been substantial changes in screening guidelines over the past two decades.</p><p><strong>Aim: </strong>To evaluate CD prevalence in patients with T1D, focusing on screening studies using antitissue transglutaminase (anti-tTG) antibody.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, Embase and Scopus for studies published up to 11 December 2023 using keywords related to CD and diabetes. We used random-effects models for overall prevalence and all subgroups, with heterogeneity assessed using Cochran's Q test and the I² statistic performed in STATA 18.</p><p><strong>Results: </strong>We included 106 articles involving 65,102 T1D patients across 40 countries. The pooled CD seroprevalence and confirmed CD prevalence were 9% (95% confidence interval, CI, 8%-10%) and 6% (95% CI 5%-7%), respectively. The prevalence was higher in females and children. Denmark, Saudi Arabia and Libya exhibited the highest prevalence (11%), followed by India and Egypt (10%). Belgium, France, Germany, South Africa and the United States had the lowest prevalence (2%). High-income countries showed significantly a lower CD prevalence than middle-income countries (p = 0.03). Meta-regression based on the Human Development Index (HDI) indicated that countries with higher HDI have lower seroprevalence and confirmed CD prevalence.</p><p><strong>Conclusion: </strong>Approximately 1 in 16 patients globally and 1 in 12 patients in Asia and the Middle East with T1D has CD. We suggest that all patients with T1D should be screened for CD.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142574812","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: Navigating the Beta-Blocker Dilemma in Advanced Liver Cirrhosis-When Is the Right Time to Discontinue? Authors' Reply.","authors":"Ting Wang, Deli Zou, Xingshun Qi","doi":"10.1111/apt.18371","DOIUrl":"https://doi.org/10.1111/apt.18371","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142574810","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: Navigating the Beta-Blocker Dilemma in Advanced Liver Cirrhosis-When Is the Right Time to Discontinue?","authors":"Louise J M Alferink, Robert J de Knegt","doi":"10.1111/apt.18334","DOIUrl":"https://doi.org/10.1111/apt.18334","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142574793","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: The Prognostic Role of IGF-1 in Chronic Liver Disease.","authors":"Muhammad Osama, Safiyyah Ubaid, Maryam Ubaid","doi":"10.1111/apt.18339","DOIUrl":"https://doi.org/10.1111/apt.18339","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142566682","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: Assessing the Durability of Treatment Effects: Long-Term Outcomes of ESWL and ERCP for Pancreatic Duct Stones in Chronic Pancreatitis.","authors":"Wei-Zhen Tang, Bo-Yuan Deng, Tai-Hang Liu","doi":"10.1111/apt.18321","DOIUrl":"https://doi.org/10.1111/apt.18321","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142566555","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: Analysis of 'Faecal Biomarkers for Diagnosis and Prediction of Disease Course in Treatment-Naive Patients With IBD'.","authors":"Yuxiang Chen, Wenjian Hu, Fengfeng Qin","doi":"10.1111/apt.18312","DOIUrl":"https://doi.org/10.1111/apt.18312","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142566622","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: Assessing the Durability of Treatment Effects: Long-Term Outcomes of ESWL and ERCP for Pancreatic Duct Stones in Chronic Pancreatitis-Authors' Reply.","authors":"Yu Liu, Liang-Hao Hu","doi":"10.1111/apt.18333","DOIUrl":"https://doi.org/10.1111/apt.18333","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142566679","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}