Alimentary Pharmacology & Therapeutics最新文献

{"title":"Editorial: Inflammatory Bowel Disease and Dietary Emulsifiers—A Conundrum That Continues","authors":"Stephanie Gold, Natasha Haskey, Maitreyi Raman","doi":"10.1111/apt.70112","DOIUrl":"10.1111/apt.70112","url":null,"abstract":"<p>The impact of ultra-processed foods (UPFs) on inflammatory bowel disease (IBD) pathogenesis is increasingly recognised [<span>1-3</span>]. Clinical and preclinical studies link UPFs, including dietary emulsifiers, to dysbiosis, mucous layer disruption and immune activation [<span>1, 2</span>]. Since the increasing consumption of processed foods has been linked to increased incidence and prevalence of chronic disease, including IBD, the influence of UPF consumption on IBD-related outcomes is of major interest [<span>1</span>].</p><p>Fitzpatrick et al. [<span>4</span>] conducted a double-blinded randomised controlled trial in patients with active ileal Crohn's disease. Nineteen participants received either a high emulsifier diet (HED) or low emulsifier diet (LED) for 4 weeks. There were no significant differences in improvement in clinical disease activity, intestinal ultrasound findings or quality of life between the two groups. The authors concluded that the findings did not support the current recommendations for patients to avoid dietary emulsifiers.</p><p>Controlled feeding studies, such as this [<span>4</span>], provide an opportunity to isolate and assess the impact of specific food components. Notable strengths of this study included its blinded, randomised design; carefully formulated dietary interventions; and integration of clinical biomarkers and patient-reported outcomes to evaluate effectiveness.</p><p>The study also had several limitations. The small sample and high dropout rate (> 20%, with 10 patients on HED and nine on LED) limit the ability to draw definitive conclusions about the impact of emulsifiers versus other dietary components, or disease activity on gastrointestinal symptoms. Moreover, the short dietary intervention period may not have been long enough to see the full impact of the emulsifiers, especially in this small cohort.</p><p>Moreover, the study lacked formal assessment of dietary quality and other potential confounding dietary components. While the diets followed ‘healthy eating guidelines’, standardised dietary assessment tools such as the Healthy Eating Index or the Mediterranean Diet Score could have identified differences beyond emulsifier content [<span>5-9</span>]. Emulsifier quantification was also limited with no distinction between naturally occurring and synthetic emulsifiers (e.g., polysorbate 80 vs. egg yolks), despite their potential for differing effects on the microbiome [<span>10</span>]. Furthermore, NOVA classification of the actual rather than recommended food intake would have provided a more accurate diet assessment.</p><p>Despite the reported high adherence to the diets based on food diaries, it remains unclear how many patients were fully compliant during the intervention. Assessing dietary compliance is crucial, particularly in a study with so few participants. Additionally, while the diets were designed to meet energy requirements, all patients experienced weight loss, which may be s","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 12","pages":"1961-1962"},"PeriodicalIF":6.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889428","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: Clarifying the Synergistic Mechanisms of Mediterranean Diet and Time-Restricted Feeding in MASLD Management","authors":"Weixiong Zhu,&nbsp;Wence Zhou","doi":"10.1111/apt.70154","DOIUrl":"10.1111/apt.70154","url":null,"abstract":"<p>The CHRONO-NAFLD trial by Tsitsou et al. [<span>1</span>] provides valuable insights into combining Mediterranean diet (MD) and time-restricted feeding (TRF) for metabolic dysfunction-associated steatotic liver disease (MASLD). While the study demonstrates comparable weight loss across groups and superior glycemic benefits with early TRF, three critical questions warrant further discussion to contextualise these findings.</p><p>First, the caloric restriction confounder limits mechanistic interpretation. All groups followed a hypocaloric MD (−500 kcal/day), which itself drives weight loss and metabolic improvements. Prior studies show that TRF's benefits on hepatic steatosis and insulin sensitivity are most pronounced in ad libitum feeding models [<span>2</span>]. By superimposing TRF on caloric restriction, the independent effects of circadian alignment may be obscured. Future trials should isolate TRF's impact by comparing isocaloric TRF vs. non-TRF arms.</p><p>Second, the lack of circadian biomarker data (e.g., melatonin, cortisol rhythms) leaves a key knowledge gap. TRF's efficacy likely depends on synchronising food intake with endogenous circadian clocks regulating hepatic metabolism [<span>3</span>]. The differential glycemic outcomes between eTRF and lTRF groups suggest timing-specific effects on insulin signalling pathways, potentially mediated by clock gene modulation (e.g., BMAL1, PER2). Including circadian phase assessments would clarify whether clinical benefits correlate with restored rhythmicity.</p><p>Lastly, heterogeneity in baseline metabolic dysfunction (e.g., 34% with diabetes, 61% with metabolic syndrome) may have diluted intervention effects. Subgroup analyses stratified by glycemic status or fibrosis severity could identify patients most likely to benefit from TRF-MD synergy. For instance, prediabetic patients showed greater HbA1c reductions in eTRF (−0.3%), aligning with evidence that circadian interventions preferentially improve early dysmetabolism [<span>4</span>].</p><p>While this trial confirms MD's foundational role in MASLD, unravelling the chronobiological mechanisms of TRF and personalising its application remain critical next steps.</p><p><b>Weixiong Zhu:</b> conceptualization, writing – original draft, investigation. <b>Wence Zhou:</b> writing – review and editing, funding acquisition.</p><p>This article is linked to Tsitsou et al papers. To view these articles, visit https://doi.org/10.1111/apt.70044 and https://doi.org/10.1111/apt.70178.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 12","pages":"1981-1982"},"PeriodicalIF":6.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889435","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: Inflammatory Bowel Disease and Dietary Emulsifiers—A Conundrum That Continues. Authors' Reply","authors":"Jessica A. Fitzpatrick,&nbsp;Peter R. Gibson,&nbsp;Emma P. Halmos","doi":"10.1111/apt.70148","DOIUrl":"10.1111/apt.70148","url":null,"abstract":"&lt;p&gt;Editors,&lt;/p&gt;&lt;p&gt;We currently work in a clinical environment where expert IBD organisations and clinicians recommend that patients with Crohn's disease avoid emulsifiers. Unfortunately, these recommendations are based upon preclinical data that have not been translated to human real-world food intake. We have questioned the wisdom of providing non-evidence-based recommendations that demonise food components, just as we did for gluten in patients with self-reported non-coeliac gluten sensitivity [&lt;span&gt;1&lt;/span&gt;]. Hence, we undertook a randomised double-blinded study in patients with active ileal Crohn's disease providing diets differing only in the emulsifier content (natural and synthetic) as found in the food supply—an interrogation of IBD recommendations that deter ingestion of dietary emulsifiers [&lt;span&gt;2&lt;/span&gt;]. The results showed no evidence of a difference in objective and symptomatic outcomes according to the dietary emulsifier content.&lt;/p&gt;&lt;p&gt;We concur with some of the limitations raised by Gold et al. in their editorial on that report [&lt;span&gt;3&lt;/span&gt;]. First, 4 weeks may not have been long enough to see the impacts of emulsifiers. Yet, in 4 weeks we saw significant clinical and objective benefits of both diets. Intestinal inflammation in Crohn's disease can respond quickly to therapy. Exclusive enteral nutrition (EEN) reduces inflammation in two weeks [&lt;span&gt;4&lt;/span&gt;] and ustekinumab can reduce bowel wall thickness on intestinal ultrasound by 9.6% in 5 weeks [&lt;span&gt;5&lt;/span&gt;]. We saw reduction of 34% and 15% on bowel wall thickness on the high and low emulsifier diets, respectively, in 4 weeks. Second, we recognise the small sample size was exacerbated by the withdrawal of 20%, mostly within days of the dietary intervention due to intolerable symptoms and, incidentally, greater systemic inflammation (higher serum C-reactive protein). However, this withdrawal rate was modest in comparison to other dietary trials, such as the landmark Crohn's Disease Exclusion Diet with partial enteral nutrition compared with EEN, where 34% of 40 participants withdrew [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Scepticism around the dietary quality of prospectively designed and prepared diets used in the study was somewhat surprising, especially as the diets were matched for all components and met healthy eating guidelines. Dietary quality may be a mechanism for the improvement in outcomes, but is not a confounder between the two intervention diets. Likewise, adherence was high when all meals were provided (supported by food diaries) and these diets underwent pre-trial evaluation for adherence, tolerance and blinding [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We strongly disagree that the study was limited by the lack of objective outcomes that directly reflect intestinal inflammation. Gastrointestinal ultrasound is validated for this purpose [&lt;span&gt;8&lt;/span&gt;] and is more practical and, particularly for a transmural disease, more relevant than mucosal healing.&lt;/p&gt;&lt;p&gt;We urge clinicians to stop de","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 12","pages":"1963-1964"},"PeriodicalIF":6.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889426","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: Non-Cirrhotic MASLD-Related HCC—Is It Time to Rethink HCC Surveillance Guidelines?","authors":"Janakan Selvarajah,&nbsp;Ashok S. Raj","doi":"10.1111/apt.70084","DOIUrl":"10.1111/apt.70084","url":null,"abstract":"&lt;p&gt;We commend Tan et al. [&lt;span&gt;1&lt;/span&gt;] for raising concerns about the impact of Fibrosis-4 (FIB-4) Index based screening on metabolic dysfunction-associated steatotic liver disease (MASLD)-related hepatocellular carcinoma (HCC). In their retrospective study, 13% of HCC patients had a low FIB-4 score, which if used prospectively in primary care, would classify them as ‘low risk MASH’ according to American Association for the Study of Liver Diseases and American Gastroenterological Association guidelines, with a recommendation to have a re-evaluation in 1–3 years by FIB-4 only. These patients would miss out on HCC surveillance. This raises the question of how can we better evaluate the risk of HCC in these ‘low risk MASH’ subjects?&lt;/p&gt;&lt;p&gt;Even though it is now well recognised that HCC occurs in non-cirrhotic MASLD with Tan et al. demonstrating 38% of MASLD-related HCC occurring in non-cirrhotic patients, suitable screening guidelines are still lacking in this population. It is not cost-effective to screen all MASLD subjects in primary care with 6-monthly ultrasound or cross-sectional imaging. Although FIB-4 was not developed as a HCC screening tool, as Tan et al. point out, it serves as a gateway for referral to specialist centres, where they are more likely to get imaging-based surveillance, simply by being referred [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In the study by Tan et al., 26% of non-cirrhotic MASLD-related HCC had a low FIB-4 score. In this population, HCC is more likely to occur in those with significant fibrosis. Therefore, it would be interesting to know the prevalence of a low FIB-4 score in those with advanced (≥ F2) versus early (F0-1) fibrosis-related HCC. Dynamic FIB-4 testing [&lt;span&gt;3&lt;/span&gt;] to look for a progressive change over time is more predictive of those at risk of severe liver disease in the MASLD population, and it would be interesting to know how this applies to non-cirrhotic MASLD in regard to HCC risk.&lt;/p&gt;&lt;p&gt;As the authors allude, Fibroscan-based screening using a cut-off of LSM &gt; 8 kPa to screen for ‘at-risk MASH’ would identify an additional 10% of those misclassified by FIB-4 [&lt;span&gt;4&lt;/span&gt;]. In fact, a recent prospective study by Forlano et al. [&lt;span&gt;5&lt;/span&gt;] showed that Fibroscan-based screening in primary care was not only cost-effective but also the screening test associated with the best quality-adjusted life year gain in those with type 2 diabetes and MASLD.&lt;/p&gt;&lt;p&gt;Additionally, Agile 3+ and Agile 4 (FibroScan®) scores based on vibration-controlled transient elastography (VCTE) could also be applied to non-cirrhotic MASLD-related HCC as it has shown excellent diagnostic accuracy in identifying F3 or greater fibrosis [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;As authors recognise, it has been shown in previous research that FIB-4 performs suboptimally in people with T2D and MASLD; however, in their study, diabetes and obesity were not consistent predictors of low FIB-4 in MASLD-related HCC. This could be explained by FIB-4 having both","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 11","pages":"1849-1850"},"PeriodicalIF":6.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885073","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":"Increased Risk of Cardiovascular Events After Coronary Interventions in Inflammatory Bowel Disease: A Nationwide Matched Cohort Study","authors":"Ramin Ebrahimi,&nbsp;Fahim Ebrahimi,&nbsp;Jan Hendrik Niess,&nbsp;Ali Mahdi,&nbsp;Shaojie Chen,&nbsp;Davide Di Vece,&nbsp;Weiwei Bian,&nbsp;Alexander Kutz,&nbsp;Anders Forss","doi":"10.1111/apt.70162","DOIUrl":"10.1111/apt.70162","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Inflammatory bowel diseases (IBD) have been associated with an increased long-term risk of coronary artery disease due to chronic systemic inflammation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the risk of major adverse cardiovascular events (MACE) after coronary interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this nationwide cohort study of adults undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) (2012–2022), patients with IBD were propensity score-matched 1:10 to comparators without IBD. The primary outcome was MACE, a composite of acute myocardial infarction, stroke, hospitalisation for heart failure, or mortality. Secondary outcomes included each MACE component, 30-day all-cause readmission, revascularisation and in-hospital outcomes including intensive care unit admission and length of hospital stay. We calculated hazard ratios (HRs) and incidence rates (IRs) using Cox proportional hazards modelling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 987 patients with IBD and 9571 matched comparators. After a median follow-up of 3.5 years, MACE occurred in 488 patients with IBD (49.4%, IR: 96.5/10,000 person-years [PY]) and in 3857 matched comparators (40.3%, IR: 68.9/10,000 PY); HR 1.37 (95% CI, 1.24–1.52). This equates to one additional MACE for every 36 patients with IBD over 10 years. The risk of each MACE component was increased, except for stroke. There were no differences between IBD subtypes or coronary intervention (PCI <i>vs.</i> CABG). Risks were highest in older individuals and elective interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with IBD were at 37% higher risk of MACE after coronary intervention, indicating a need for intensified cardiovascular risk reduction in these high-risk individuals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 12","pages":"1904-1912"},"PeriodicalIF":6.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885071","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: TB-CD Puzzle—Is tNGS the Final Piece?","authors":"Abhishek Yadav,&nbsp;Arpita Agrawal,&nbsp;Uday Kiran Mangipudi","doi":"10.1111/apt.70072","DOIUrl":"10.1111/apt.70072","url":null,"abstract":"&lt;p&gt;We read with keen interest the recent article by Ye et al. [&lt;span&gt;1&lt;/span&gt;] entitled “Crohn's Disease with Latent Tuberculosis Infection or Intestinal Tuberculosis (ITB): Rapid Discrimination by Targeted Next—Generation Sequencing”. We feel that this work represents important progress in discriminating ITB and CD. Not only do the authors demonstrate targeted next generation sequencing (tNGS) on intestinal tissue as a useful strategy to discriminate ITB from CD with latent tuberculosis, but they also demonstrate the validity of use of early mucosal response as early discriminator when the initial evaluation is unhelpful. This study further validates the approach of assessing early mucosal response at 2 months after initiation of anti-tubercular therapy (ATT) trial for patients having diagnostic dilemma between ITB &amp; CD [&lt;span&gt;2&lt;/span&gt;]. This approach of utilising a short duration ATT trial, reduces the impact of unnecessary ATT exposure on natural course of CD [&lt;span&gt;3&lt;/span&gt;]. There are two tools which appear particularly impressive in discriminating ITB and CD at present, and apart from tNGS, the use of multiplex PCR appears to be a sensitive approach to diagnose ITB [&lt;span&gt;4&lt;/span&gt;]. Future studies should assess the comparative performance of these two approaches in solving the TB-CD puzzle.&lt;/p&gt;&lt;p&gt;We would also like to point out some issues of concern in respect to the current study—the authors, while evaluating the tNGS as a novel tool for ITB diagnosis, used a positive result in tNGS as a component of defining the gold standard for ITB diagnosis. Obviously, this is methodologically fallacious, as a new test should be tested against a gold standard (a composite reference standard in this case). Furthermore, we are intrigued by the low sensitivity of TB-PCR [22% (95% CI 12%–36%)] in comparison to previous studies where IS6110 primer has a pooled sensitivity of 47% [&lt;span&gt;5&lt;/span&gt;]. The authors have not specified which primers were used for TB-PCR in their study. It also raises a question of whether formalin fixed, paraffin embedded (FFPE) biopsy samples were used for PCR study, while fresh biopsy specimens have been used for tNGS. Could this be the reason behind the greater sensitivity of tNGS in detecting tuberculosis? Since there is time-dependent physical degradation of DNA in FFPE tissue, it could affect the success rate of the amplification. Further, ITB patients in this study were treated with ATT for 1-year duration, as per local guidelines, which is questionable since a Cochrane review [&lt;span&gt;6&lt;/span&gt;] has found no evidence to suggest that six-month treatment regimens are inadequate for treating people that have ITB.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Abhishek Yadav:&lt;/b&gt; writing – original draft, writing – review and editing. &lt;b&gt;Arpita Agrawal:&lt;/b&gt; formal analysis. &lt;b&gt;Uday Kiran Mangipudi:&lt;/b&gt; conceptualization.&lt;/p&gt;&lt;p&gt;The authors declare no conflicts of interest.&lt;/p&gt;&lt;p&gt;This article is linked to Ye et al paper. To view this article, visit https://doi.org/1","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 11","pages":"1847-1848"},"PeriodicalIF":6.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884989","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: Post‐HCV Cure, Precision Assessment of Liver Stiffness and Diabetes Risk in Maternal Populations—A Critical Research Need","authors":"Zihe Guan, Yang Liu, Xinming Chen, Xiwei Yang","doi":"10.1111/apt.70164","DOIUrl":"https://doi.org/10.1111/apt.70164","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"8 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884694","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: Post‐HCV Cure, Precision Assessment of Liver Stiffness and Diabetes Risk in Maternal Populations—A Critical Research Need. Authors' Reply","authors":"Yu‐Ping Chang, Jia‐Horng Kao, Chen‐Hua Liu","doi":"10.1111/apt.70171","DOIUrl":"https://doi.org/10.1111/apt.70171","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"8 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884798","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: Seton Use in Perianal Fistulising Crohn's Disease. Authors' Reply","authors":"Jeffrey D McCurdy,&nbsp;Blair Macdonald,&nbsp;Greg Rosenfeld,&nbsp;Talat Bessissow,&nbsp;Vipul Jairath,&nbsp;David H. Bruining,&nbsp;Siddharth Singh","doi":"10.1111/apt.70170","DOIUrl":"10.1111/apt.70170","url":null,"abstract":"&lt;p&gt;We thank Mr. Anand and Mr. Tozer for their interest in our study [&lt;span&gt;1, 2&lt;/span&gt;] and for their ongoing contributions to the field of perianal fistulising Crohn's disease (PFCD) through the TOpClass consortium. Several important considerations were raised in their editorial that require further explanation.&lt;/p&gt;&lt;p&gt;We agree that a limitation of our retrospective study was our inability to assess for abscess recurrence directly. However, most patients with clinically relevant abscesses present to hospital or undergo surgical drainage. Since each of these parameters was included in our composite primary endpoint of major adverse fistula outcomes (MAFO), we believe it is likely that our study captured most clinically relevant abscesses. Despite this, we acknowledge that subclinical abscesses, those that drain spontaneously, or those that are less severe and treated with antibiotics alone would have been missed. Therefore, future prospective studies with patient-reported outcome measures and access to point of care imaging modalities such as endoanal or transperineal ultrasound would help to determine more accurately if the rates of abscess recurrence differ substantially based on the presence of setons.&lt;/p&gt;&lt;p&gt;There are a number of variables that clinicians should consider when selecting potential candidates to forgo seton placement. First, our study design included patients who initiated their first anti-TNF therapy for active perianal Crohn's disease. As a result, our study population mainly comprised patients who were early on in their disease course. Second, we observed a potential protective role of setons (although not statistically significant) in a subgroup of patients with abscesses detected by pre-treatment MRI. As a result, the ability to forgo seton insertion may be most applicable for patients with first presentation PFCD without an abscess, or those with an abscess that drains spontaneously and where the goal of treatment is curative. Due to a paucity of literature pertaining to patterns of PFCD on initial presentation and the natural history of PFCD in the era of biologic therapies, it is unclear what proportion of patients with new PFCD would meet these criteria.&lt;/p&gt;&lt;p&gt;Future studies characterising the breadth of variability in PFCD complexity and severity, along with the proportion with associated abscesses in modern day PFCD at the time of disease onset, will help to determine the proportion of patients who might be suitable to forgo seton insertion. Finally, due to the potential for residual uncontrolled confounding, our results should be interpreted with caution. As a result, we agree with Mr. Anand and Mr. Tozer that future randomised controlled studies are needed to confirm our findings.&lt;/p&gt;&lt;p&gt;The authors declarations of personal and financial interests are unchanged from those in the original article [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;&lt;b&gt;Jeffrey D McCurdy:&lt;/b&gt; conceptualization, writing – original draft. &lt;b&gt;Blair Macdonald:&lt;/b&gt; writin","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 12","pages":"1959-1960"},"PeriodicalIF":6.6,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880339","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":"Alcohol‐Attributable Cancer: Update From the Global Burden of Disease 2021 Study","authors":"Pojsakorn Danpanichkul, Yanfang Pang, Luis Antonio Díaz, Trenton M. White, Supapitch Sirimangklanurak, Thanida Auttapracha, Kanokphong Suparan, Nicholas Syn, Pimtawan Jatupornpakdee, Sakditad Saowapa, Cheng Han Ng, Apichat Kaewdech, Rashid N. Lui, Michael B. Fallon, Ju Dong Yang, Alexandre Louvet, Mazen Noureddin, Suthat Liangpunsakul, Peter Jepsen, Jeffrey V. Lazarus, Juan Pablo Arab, Karn Wijarnpreecha","doi":"10.1111/apt.70163","DOIUrl":"https://doi.org/10.1111/apt.70163","url":null,"abstract":"Background and AimsAlcohol is a major risk factor for cancer development. Our study aimed to provide the updated global, regional and national burden of alcohol‐attributable cancer.Approach and ResultsWe analysed the Global Burden of Disease Study 2021 to determine the death and age‐standardised death rate (ASDR) from alcohol‐attributable cancer and the change of these measures between 2000 and 2021 (reflected as annual percent change [APC]), classified by region, nation and country's developmental status, which is based on the sociodemographic index (SDI).ResultsIn 2021, there were 343,370 deaths globally from alcohol‐attributable cancer, which was an increase from 2000 by 51%. Alcohol‐attributable cancer accounted for 3.5% of all cancer deaths. Among alcohol‐attributable cancer, liver cancer (27%) accounted for the highest mortality from alcohol, followed by oesophageal (24%) and colorectal cancer (16%). From 2000 to 2021, ASDR from alcohol‐attributable cancer decreased (APC: −0.66%). Regionally, from 2000 to 2021, the fastest‐growing ASDR was observed in South Asia. Classified by SDI, low (APC: 0.33%) and low‐to‐middle SDI countries (APC: 1.58%) exhibited an uptrend in ASDR from alcohol‐attributable cancer. While the ASDR from all other cancers decreased, ASDR from early‐onset (15–49 years) lip and oral cavity cancer increased (APC: 0.40%).ConclusionsFrom 2000 to 2021, although the ASDR from alcohol‐attributable cancer declined, the total number of deaths continued to rise. This trend was accompanied by variations across sociodemographic groups and cancer types, particularly gastrointestinal cancers. Urgent efforts are needed both globally and at regional levels to address the burden of alcohol‐attributable cancers.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"9 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880318","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}