Alimentary Pharmacology & Therapeutics最新文献

{"title":"Editorial: Revolutionising Steatotic Liver Disease Diagnosis With Phosphatidylethanol","authors":"Karen Cheuk-Ying Ho, Lung-Yi Mak","doi":"10.1111/apt.18529","DOIUrl":"10.1111/apt.18529","url":null,"abstract":"<p>The recent re-naming and reclassification of ‘non-alcoholc fatty liver disease (NAFLD)’ to steatotic liver disease (SLD) subcategories aims to clarify the different aetiologies associated with liver fat accumulation, particularly alcohol consumption and/or metabolic dysfunction [<span>1</span>]. A novel entity, coined as ‘metabolic and alcohol related/associated liver disease (MetALD)’ was introduced to capture individuals whose alcohol intake exceeds traditional NAFLD thresholds but not yet meet the thresholds of alcohol-related liver disease (ALD) [<span>1</span>]. The shift in terminology highlights the complexity between alcohol consumption and metabolic dysfunction on pathophysiology, natural course and treatment implications in SLD. Accurate quantification of alcohol consumption is therefore crucial. However, current alcohol consumption estimations rely solely on patients' self-report, where underreporting is common leading to misclassification. An objective alcohol biomarker is pivotal in providing an accurate assessment of an individual's drinking pattern. Phosphatidylethanol (PEth) levels in the blood is a promising biomarker that has garnered significant attention in the field of alcohol research. Being an abnormal phospholipid that is only formed in the presence of ethanol, not only it is easily measured in blood, but it also has a long detection window lasting for 2–4 weeks.</p><p>Tavaglione et al. conducted a cross-sectional study to compare PEth with other indirect alcohol biomarkers for the diagnosis of MetALD versus metabolic dysfunction-associated steatotic liver disease (MASLD) in 374 subjects who were obese (body mass index [BMI] ≥ 25 kg/m<sup>2</sup>) with imaging-confirmed SLD (magnetic resonance imaging-proton density fat fraction or transient elastography). Alcohol use was quantified using a questionnaire (AUDIT score and Lifetime Drinking History) and DSM-V criteria. PEth was shown to have high diagnostic accuracy in the detection of MetALD (AUROC 0.81, 95% CI 0.73–0.89) with the optimal cut-off level of 25 ng/mL. It showed superiority over traditional biomarkers including aspartate aminotransferase/alanine aminotransferase ratio, mean corpuscular volume, gamma glutamyltransferase and ALD/NAFLD index (<i>p</i> < 0.05) in diagnosing MetALD in a cohort of SLD. A positive linear correlation between PEth levels and daily alcohol intake and AUDIT score was also demonstrated [<span>2</span>].</p><p>This paper provides timely insight into the role of using biomarkers in redefining subcategories of SLD. The results align with recent compelling evidence affirming the accuracy of utilising blood PEth levels to predict the quantity of alcohol consumption [<span>3</span>], and the recent joint position statement to recommend its use [<span>4</span>]. Given that PEth is derived from human erythrocytes, the precision of PEth measurements may be impacted by conditions such as cirrhosis, anaemia, or hypersplenism [<span>5</span>]. S","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 6","pages":"1069-1070"},"PeriodicalIF":6.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.18529","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143417460","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: Revolutionising Steatotic Liver Disease Diagnosis With Phosphatidylethanol—Authors' Reply","authors":"Federica Tavaglione, Rohit Loomba","doi":"10.1111/apt.70006","DOIUrl":"10.1111/apt.70006","url":null,"abstract":"<p>We thank Ho and Mak for their positive comments on our recently published work, in which we demonstrate that phosphatidylethanol (PEth) is an accurate, quantitative, objective, blood-based alcohol biomarker for diagnosing the newly defined metabolic dysfunction and alcohol-related liver disease (MetALD) [<span>1</span>]. Leveraging a well-characterised United States (U.S.) cohort of 374 community-dwelling individuals with overweight or obesity and steatotic liver disease (SLD) assessed through advanced magnetic resonance imaging (MRI) techniques [<span>2</span>], we showed that PEth exhibited a robust diagnostic accuracy in differentiating MetALD from metabolic dysfunction-associated steatotic liver disease (MASLD) (AUROC 0.81, 95% CI 0.73–0.89) with an optimal cut-off of 25 ng/mL, and outperformed indirect alcohol biomarkers, including aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, gamma glutamyltransferase (GGT), mean corpuscular volume (MCV) and the ALD/non-alcoholic fatty liver disease index (ANI).</p><p>PEth is an abnormal cellular membrane phospholipid formed in human erythrocytes exclusively during alcohol ingestion. Specifically, PEth is synthesised from phosphatidylcholine through a transphosphatidylation reaction catalysed by the enzyme phospholipase D only in the presence of ethanol (Figure 1) [<span>3</span>].</p><p>Given the physiopathology underlying PEth formation and degradation, Ho and Mak astutely highlighted that factors such as anaemia, cirrhosis and drinking patterns may significantly influence PEth levels [<span>4</span>]. However, a handful of studies have specifically investigated the impact of these conditions on PEth levels. Limited evidence suggests that the elimination of PEth, rather than its formation, may be affected by conditions that alter red blood cell turnover and the presence of cirrhosis [<span>3, 5, 6</span>]. Additional research is required to fully address these questions.</p><p>Regarding drinking patterns, PEth has shown potential as a biomarker for identifying excessive drinking episodes and binge drinking behaviours, but this area of research warrants further investigation in the SLD population [<span>3, 7</span>]. Notably, another important question that needs to be addressed clearly is the exact quantity of ethanol that must be consumed over a specific time period to yield a positive PEth test [<span>3</span>].</p><p>In conclusion, a body of evidence from studies conducted in medical settings outside of SLD, such as screening in emergency departments, alcohol detoxification programs, pre-employment medical examinations, liver transplant evaluation and forensic context, demonstrated that PEth is a reliable biomarker for detecting heavy alcohol consumption [<span>7-9</span>]. Our study represents an initial effort within the setting of the newly defined SLD to support PEth as a quantitative, objective biomarker for identifying SLD subcategories and enhancing SLD subclassificatio","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 6","pages":"1071-1072"},"PeriodicalIF":6.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143418436","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: Clinical Trial: Treatment of Functional Dyspepsia According to Subtype Compared With Empirical Proton Pump Inhibitor","authors":"Shoko Miyahara, Takeshi Yamashina, Takehiro Ohyama, Masahiro Banno","doi":"10.1111/apt.70011","DOIUrl":"10.1111/apt.70011","url":null,"abstract":"<p>The study by Chuah et al. [<span>1</span>] offers valuable insight that can significantly influence daily outpatient practice. The findings, while valuable, suggest that certain aspects of the study's design and scope could benefit from further refinement to guide future research effectively.</p><p>First, the absence of blinding and a placebo group may have contributed to an overestimation of the observed efficacy in both intervention and control arms due to the well documented influence of placebo and nocebo effects in patients with functional dyspepsia (FD) [<span>2</span>]. While the authors stated that both groups received active medical therapy, and thus any placebo or nocebo effects might have been distributed similarly, this assumption requires further investigation. Open-label designs can lead to psychological biases and may confound results.</p><p>Second, patients with severe anxiety or depression, defined as requiring medication or experiencing daily functional impairment, were excluded. However, the criteria for exclusion were not clearly defined. This lack of clarity raises concerns about potential bias, particularly if patients with mild symptoms were excluded. As FD is frequently associated with coexisting mental health conditions [<span>3</span>], understanding the proportions of patients with mild mental health problems in both groups would have provided valuable context. The lack of this information may limit the interpretation of the study's findings and applicability to real-world clinical settings.</p><p>Third, the <i>post hoc</i> analysis provides useful insights into responder rates by subtype, particularly in those with epigastric pain syndrome and postprandial distress syndrome (EPS-PDS) overlap. However, the lack of detailed statistical considerations for this analysis may limit the clarity and reliability of these findings. As with all <i>post hoc</i> analyses, spurious associations are possible, so these results should be interpreted with care.</p><p>Furthermore, the small sample size of certain subtypes, such as EPS, may have influenced the statistical power and reliability of the outcomes. Future studies could benefit from incorporating randomised allocation within subtypes or using stratified analyses to better explore subtype-specific effects. Increasing the sample size would also strengthen the findings and provide a clearer understanding of the role of subtypes in treatment outcomes.</p><p>In conclusion, this study has the potential to significantly influence routine FD care. Addressing the four points discussed above could further enhance its impact and contribute significantly to shaping future strategies for the treatment of FD in clinical practice.</p><p><b>Shoko Miyahara:</b> conceptualization, writing – original draft, writing – review and editing, formal analysis. <b>Takeshi Yamashina:</b> writing – review and editing, formal analysis, supervision. <b>Takehiro Ohyama:</b> writing – review and editing, fo","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 6","pages":"1086-1087"},"PeriodicalIF":6.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412530","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: Clinical Trial: Treatment of Functional Dyspepsia According to Subtype Compared With Empirical Proton Pump Inhibitor: Authors' Reply","authors":"Kee Huat Chuah, Sanjiv Mahadeva","doi":"10.1111/apt.70025","DOIUrl":"10.1111/apt.70025","url":null,"abstract":"<p>We thank Dr. Miyahara et al. for their interest in our paper [<span>1</span>] and for their constructive comments [<span>2</span>]. We agree that certain aspects of the study design could be improved to enhance its robustness.</p><p>Placebo-controlled studies are widely regarded as the gold standard for evaluating the efficacy and safety of drugs. However, in the context of functional dyspepsia (FD), numerous placebo-controlled trials have already been conducted. Additionally, well-conducted meta-analyses have pooled these studies to report on treatment outcomes [<span>3</span>].</p><p>The unique design of our study aimed to address the utility of treatment strategies for FD according to subtypes, compared to empirical proton pump inhibitor (PPI) therapy [<span>1</span>]. The Rome IV consensus recommends subdividing FD into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) subtypes. This symptom-based subdivision reflects the putative differences in pathophysiology and may inform tailored treatment approaches [<span>4</span>]. The first Asian consensus on FD has also adopted this subtype-based approach to treatment [<span>5</span>]. In contrast, American and Canadian guidelines suggested empiric PPI therapy for all patients with FD [<span>6</span>]. However, it is unclear which treatment strategy is superior. Our findings provide a valuable alternative to PPI in FD, specifically the use of prokinetics. While PPIs are generally considered safe, widespread overuse has raised concerns about potential adverse effects [<span>7</span>].</p><p>Our study was underpowered to provide definitive conclusions on treatment efficacy for individual FD subtypes. However, randomized controlled trials have demonstrated that prokinetics perform better than placebo in FD [<span>8</span>]. Our study included a representative distribution of FD subtypes, with most patients presenting with PDS or PDS-EPS overlap, reflecting global subtype trends. Our findings suggest that a prokinetic is at least as effective as PPIs for these subtypes. However, our study was not designed to determine the optimal treatment for the EPS subtype independently [<span>1</span>].</p><p>Miyahara and colleagues expressed concern that we did not exclude “mild” psychological disorders, which may have influenced our study findings. However, the significance of mild psychological disorders in FD and DGBI remains uncertain. In a cross-sectional study of patients with FD, we demonstrated that only higher anxiety scores, as assessed by the Hospital Anxiety and Depression Scale (HADS), were associated with more severe dyspepsia symptoms; lower HADS scores showed no significant correlation [<span>9</span>]. Furthermore, in a longitudinal study of patients with DGBI in secondary care, we found that poorer symptom improvement at follow-up was associated with clinically diagnosed anxiety and depression [<span>10</span>]. Based on these findings, it is reasonable to assume that mild","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 6","pages":"1088-1089"},"PeriodicalIF":6.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412531","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":"Clinical Trial to Assess the Safety and Tolerability of Anti-IL 23 Monoclonal Antibody Guselkumab in Patients With Alcohol-Associated Liver Disease.","authors":"Luis Antonio Diaz, Sheldon Morris, Shravan Dave, Susy M Kim, Wathnita Sarik, Lisa Richards, Egbert Madamba, Ricki Bettencourt, Christian Fulinara, Thuy Pham, Grant Miller, Raquel Carvalho-Gontijo Weber, Jeremiah D Momper, Feng He, Sonia Jain, Catriona Jamieson, Tatiana Kisseleva, David Brenner, Rohit Loomba","doi":"10.1111/apt.70026","DOIUrl":"https://doi.org/10.1111/apt.70026","url":null,"abstract":"<p><strong>Background: </strong>There are no FDA-approved therapies for alcohol-associated liver disease (ALD). Preclinical studies indicate that blocking IL-23/IL-17 signalling may reverse liver injury. Guselkumab, an IL-23-specific antibody approved for psoriasis, may be beneficial for ALD.</p><p><strong>Aims: </strong>We aimed to assess the safety and tolerability of guselkumab in patients with ALD.</p><p><strong>Methods: </strong>This phase-1 dose-escalation study included patients with ≥ 2 DSM-5 criteria for alcohol use disorder, significant steatosis (MRI-PDFF ≥ 8%) and MRE < 3.63 kPa (to exclude advanced disease). Guselkumab was given subcutaneously on Days 1 and 29 in 30, 70 or 100 mg dose cohorts. Primary endpoints were adverse events (AEs) and dose-limiting toxicity.</p><p><strong>Results: </strong>We enrolled 13 patients (three 30 mg, three 70 mg, and seven 100 mg). Eleven completed the study and two early discontinued in the 100 mg group. Of them, 77% were men, and the median age was 53 [IQR 49-61] years. The median MRI-PDFF and MRE were 18.4% [IQR 8.4%-34.0%] and 2.5 [2.2-2.6] kPa, respectively. The most frequent AEs were hyperuricemia (13%, mild only) and elevated lipase (11%, mild and moderate). There were no serious adverse events or significant variations in liver enzymes. There was a suppression of peripheral interleukin (IL)-17, IL-23, IL-1b and TNF-α in the 70 and 100 mg groups, and a significant decrease in alcohol consumption over time (AUDIT-C: 6 [3-7] vs. 5 [1-6], p = 0.023).</p><p><strong>Conclusions: </strong>Guselkumab is safe in doses up to 100 mg and may reduce inflammation markers in ALD. These findings support further phase 2 studies to evaluate the efficacy of guselkumab in ALD, particularly in patients with severe phenotypes.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412527","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: Direct‐Acting Agents and Risk of Hepatocellular Carcinoma—The End of Controversy","authors":"Vincent Haghnejad, Jean‐Pierre Bronowicki","doi":"10.1111/apt.70032","DOIUrl":"https://doi.org/10.1111/apt.70032","url":null,"abstract":"&lt;p&gt;In 2016, a small retrospective study suggesting that direct-acting agent (DAA) therapy may increase the risk of HCC recurrence created considerable uncertainty around DAA therapy and HCC risk [&lt;span&gt;1&lt;/span&gt;]. This uncertainty has persisted for many years despite the publication of subsequent contradictory studies [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;In this issue, El Serag et al. analysed over 65,000 veterans with compensated cirrhosis, distinguishing between patients treated with DAAs, interferon (IFN) and those who remained untreated [&lt;span&gt;4&lt;/span&gt;]. The primary objective of the study was twofold: to compare the risk of HCC between DAA-treated and untreated patients, and between DAA- and IFN-treated groups. Rigorous adjustment for factors such as comorbidities, monitoring practices, and healthcare utilisation strengthened the robustness of the analysis.&lt;/p&gt;\u0000&lt;p&gt;The results are clear. Patients treated with DAAs had a 30% lower risk of de novo HCC compared to untreated patients (adjusted hazard ratio: 0.70). When comparing DAA and IFN treatments, there was no significant difference in the risk of HCC (adjusted hazard ratio: 0.98). These results held up in sensitivity analyses, including exclusion of early-onset HCC and propensity score matching to control for baseline differences. The results should help to dispel any remaining doubts on the subject, which are still reflected in the latest EASL recommendations on HCC, in contrast to those of the AASLD [&lt;span&gt;5, 6&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;This study also highlights the unique benefits of DAAs in high-risk populations. Unlike IFN, which was largely inaccessible to patients with severe liver disease or multiple comorbidities, DAAs showed remarkable efficacy even in patients with advanced disease. In particular, patients treated with DAAs were on average 7 years older, had more alcohol/drug use and medical comorbidities, more portal hypertension, and were more likely to have a longer duration of chronic HCV infection. Despite these challenges, tumour characteristics were more favourable in DAA patients, who were more likely to be diagnosed at earlier stages and with smaller tumours than both untreated and IFN-treated patients.&lt;/p&gt;\u0000&lt;p&gt;This study confirms that despite virological cure, cirrhotic patients remain at risk of de novo HCC. This underlines the importance of continued screening for HCC, probably for life [&lt;span&gt;5, 6&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;It is also important to treat cirrhosis to reduce the risk of cirrhosis decompensation [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;An Indian study of 1150 patients with decompensated cirrhosis, mainly infected with genotype 3, showed a virological response rate of only 80%. SVR-12 resulted in recompensation in only 24.7% of patients over 4 years of follow-up. Despite SVR-12, 19% of patients developed new hepatic decompensation and 2.9% developed hepatocellular carcinoma [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;As the study shows, DAAs have transformed treatment by offering high cure rates with minimal side effect","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"130 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401609","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":"Challenges in Histological Endpoints for MASH Therapies: An Exercise in Statistical Modelling","authors":"Amrik Shah, Leigh MacConell, Alexander Liberman, Adrian M. Di Bisceglie, David Shapiro","doi":"10.1111/apt.70023","DOIUrl":"https://doi.org/10.1111/apt.70023","url":null,"abstract":"BackgroundRegulatory‐accepted efficacy endpoints for nonalcoholic steatohepatitis (NASH; recently updated to metabolic‐dysfunction associated steatohepatitis, MASH) clinical trials include fibrosis improvement with no worsening of NASH or NASH resolution with no worsening of fibrosis determined by liver biopsy using the NASH Clinical Research Network criteria. These endpoints involve the scoring of four liver histology parameters, all of which are associated with significant inter−/intra‐reader variability. Since few trials have shown positive results with these endpoints, we evaluated the effects of imprecision in histologic scoring on trial results from a statistical perspective.MethodsEstimating the probability (sensitivity) of accurately scoring histology is based on the relationship between measures of agreement and sensitivity. We simulated kappa values for a range of sensitivities. Then, using published kappa values from NASH trials, we selected corresponding sensitivities for histology parameters. Finally, simulations assuming a range of “overscore” and “underscore” probabilities were conducted to estimate the dilution of the true effect size.ResultsSimulations for 2‐arm trials with sample sizes of 400 (mix of stage 2/3 fibrosis) subjects showed ~50% dilution of the true effect size for both approvable endpoints due to scoring imprecision. Such dilution remains constant regardless of sample size.ConclusionImprecise histologic scoring disproportionately impacts the ‘superior’ arm as the error is proportional to the true response rate. This dilution of effect size should be considered when weighing the clinical benefit and the overall risk–benefit profile in the review of NASH studies. This argues for the adoption of non‐invasive biomarkers rather than histologic endpoints.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"78 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401610","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":"Prevalence and Predictors of Suspected Metabolic Dysfunction‐Associated Steatotic Liver Disease in Adolescents in the United States","authors":"Sheila L. Noon, Lauren F. Chun, Tin Bo Nicholas Lam, Nhat Quang N. Thai, Winston Dunn, Jeffrey B. Schwimmer","doi":"10.1111/apt.70022","DOIUrl":"https://doi.org/10.1111/apt.70022","url":null,"abstract":"BackgroundNomenclature for steatotic liver disease has been updated to include metabolic dysfunction‐associated steatotic liver disease (MASLD), which requires the presence of hepatic steatosis and at least one cardiometabolic risk factor. The prevalence of MASLD in adolescents is understudied.AimTo determine the prevalence of suspected MASLD among adolescents in the United States and to examine the relationships between elevated alanine aminotransferase (ALT) and cardiometabolic risk factors.MethodsA cross‐sectional analysis of the National Health and Nutrition Examination Survey from 2011 to 2020 was conducted for adolescents aged 12–19 years. Elevated ALT was defined using sex‐specific biological upper limits: &gt; 26 U/L for males and &gt; 22 U/L for females. Suspected MASLD was identified by elevated ALT and at least one cardiometabolic risk factor. Adolescents with elevated ALT were categorised as having suspected MASLD, elevated ALT due to other causes or cryptogenic ALT elevation.ResultsOverall, 14.6% of adolescents had elevated ALT. Of these, 77.2% had suspected MASLD, 20.2% had cryptogenic ALT elevation, 1.9% took hepatotoxic medications and 0.7% had viral hepatitis. Body mass index had the strongest association with elevated ALT (OR 3.55), followed by high triglycerides (OR 2.09), low HDL cholesterol (OR 2.05) and high blood pressure (OR 1.93).ConclusionsMost adolescents with elevated ALT met MASLD criteria, yet a portion lacked cardiometabolic risk factors or other identifiable causes. These results support the adoption of MASLD criteria in adolescents while indicating a need for further research into cryptogenic ALT elevation in paediatric populations.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"10 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401608","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: The Relevance of Hepatic Flares and Quantitative Hepatitis B Surface Antigen After Stopping HBV Polymerase Inhibitors-Authors' Reply.","authors":"Ying-Nan Tsai, Jia-Ling Wu, Yao-Chun Hsu","doi":"10.1111/apt.70033","DOIUrl":"https://doi.org/10.1111/apt.70033","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412529","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: The Relevance of Hepatic Flares and Quantitative Hepatitis B Surface Antigen After Stopping HBV Polymerase Inhibitors.","authors":"Stefan Mauss","doi":"10.1111/apt.70009","DOIUrl":"https://doi.org/10.1111/apt.70009","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412528","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}