Alimentary Pharmacology & Therapeutics最新文献

{"title":"Pruritus Is Frequent and Persistent and Impacts Quality of Life Among Patients With Primary Sclerosing Cholangitis","authors":"Richard Dean,&nbsp;Maryam Yazdanfar,&nbsp;Joseph Zepeda,&nbsp;Isha J. Patel,&nbsp;Cynthia Levy,&nbsp;Craig Lammert,&nbsp;Raghav Bordia,&nbsp;Duru Cosar,&nbsp;Katherine Specht,&nbsp;Daniel Pratt,&nbsp;Stuart C. Gordon,&nbsp;Lisa Forman,&nbsp;Fawzy Barry,&nbsp;Michael Li,&nbsp;Usha Gungabissoon,&nbsp;Megan M. McLaughlin,&nbsp;Christopher L. Bowlus","doi":"10.1111/apt.70931","DOIUrl":"10.1111/apt.70931","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pruritus is a common and burdensome symptom in patients with primary sclerosing cholangitis (PSC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To determine the prevalence of pruritus in PSC, its clinical associations, and its impact on quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with PSC were assessed for pruritus using the Worst Itch Numerical Rating Scale (WI-NRS) and 5-D Itch scale, and for quality of life using SF-36 and PSC-PRO. Participants reporting moderate to severe pruritus (WI-NRS ≥ 4) within 6 months of enrollment completed longitudinal assessments for up to 6 months. Those with inflammatory bowel disease (IBD) completed the Simple Clinical Colitis Activity Index (P-SCCAI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median age was 43 years, 61% were male and 75% had IBD. Moderate to severe itch over the prior 7 days was reported by 24%, increasing to 38% over the prior 6 months. Greater pruritus was associated with cirrhosis (<i>p</i> = 0.01), alkaline phosphatase (<i>p</i> = 0.0001), total bilirubin (<i>p</i> = 0.0006) and lower albumin (<i>p</i> = 0.01). Among patients with IBD, itch severity was associated with colitis activity (<i>p</i> = 0.01). Pruritus associated with impaired quality of life on the SF-36 (<i>r</i>_s = −0.47) and PSC-PRO (<i>r</i>_s = 0.69). Longitudinally, pruritus varied markedly with 86.5% of patients reporting moderate to severe pruritus in the past 6 months experiencing severe itch at least once over 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pruritus is common, clinically meaningful and fluctuates over time in PSC. Its strong impact on quality-of-life underscores the need for standardized assessment and development of more effective therapies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1288-1297"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70931","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754349","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":"Screen-Detected Coeliac Disease in a Nationally Representative Cohort: Health Indicators, Long-Term Outcomes and Mortality","authors":"Iida Ahonen,&nbsp;Kalle Kurppa,&nbsp;Heini Huhtala,&nbsp;Katri Kaukinen,&nbsp;Laura Kivelä,&nbsp;Juha Taavela","doi":"10.1111/apt.70917","DOIUrl":"10.1111/apt.70917","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Population-based screening for coeliac disease could reduce underdiagnosis, but benefits and harms remain debated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We studied health outcomes in screen-detected coeliac disease patients at diagnosis and following a long-term gluten-free diet.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected from Health 2000 and 2011 studies representing the Finnish population. Coeliac disease was screened in 6339 individuals by transglutaminase and endomysial antibodies, with dual seropositivity as the diagnostic criterion, histologically validated in this cohort. Survey-weighted analyses enabled population-level results. The follow-up cohort comprised those participating in both time points. Mortality was assessed between 2000 and 2017.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At screening, 92 (1.5%) undiagnosed coeliac disease patients and 6216 non-coeliac controls were identified. Patients were less often smokers (11% vs. 22%, <i>p</i> = 0.014), more often had a history of pre-eclampsia (13% vs. 5%, <i>p</i> = 0.037) and anaemia (14% vs. 6%, <i>p</i> = 0.012), and lower ferritin (29 vs. 68 ng/mL, <i>p</i> &lt; 0.001), with an altered lipid profile including lower total cholesterol, LDL-C, and ApoB but higher atherogenic ratios. At 11-year follow-up, mental health, quality of life, and cardiometabolic markers were comparable between treated coeliac disease patients (<i>n</i> = 50) and non-coeliac controls (<i>n</i> = 3226). Mortality did not differ after adjustment for age and sex (HR 0.77, 95% CI 0.45–1.33).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nationally screened adults with undiagnosed coeliac disease showed iron deficiency and anaemia. Long-term dietary treatment did not adversely affect quality of life or cardiometabolic health and may prevent complications. Furthermore, mortality was comparable to the general population. The results suggest a favourable benefit-harm balance for population-based screening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1248-1259"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70917","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700260","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 Outcomes After Percutaneous Coronary Intervention in Patients With Cirrhosis: A Multicentre National Study","authors":"Dhir Gala,&nbsp;Sameer Rao,&nbsp;Manas Gunani,&nbsp;Kajol Shah,&nbsp;Anand V. Kulkarni,&nbsp;Karn Wijarnpreecha,&nbsp;Daniel Q. Huang,&nbsp;Pojsakorn Danpanichkul,&nbsp;Ahmed Al-Khazraji,&nbsp;Kaveh Hajifathalian,&nbsp;Vivek Lingiah,&nbsp;Paul Gaglio,&nbsp;Nikki Duong,&nbsp;Christine Gerula","doi":"10.1111/apt.70896","DOIUrl":"10.1111/apt.70896","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery disease (CAD) is common in cirrhosis patients because of shared risk factors, including metabolic syndrome and alcohol use; however, outcomes after percutaneous coronary intervention (PCI) remain poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate outcomes after PCI in patients with cirrhosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using TriNetX US Collaborative Network data from 2015 to 2024. Adults undergoing PCI were stratified by cirrhosis status, with outcomes including gastrointestinal bleeding, ischaemic events, and all-cause mortality. Within the cirrhosis cohort, we evaluated effect modification by aetiology, disease severity, and antiplatelet strategy at 30 days after PCI. One-to-one propensity score matching adjusted for demographics and comorbidities, with results reported as relative risks and 95% confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 3351 patients with cirrhosis undergoing PCI matched 1:1 to controls, cirrhosis was associated with higher 1-year gastrointestinal bleeding (16.14% vs. 8.12%; <i>p</i> &lt; 0.0001) and mortality (13.97% vs. 10.41%; <i>p</i> &lt; 0.0001). Decompensated cirrhosis had higher gastrointestinal bleeding and mortality than compensated disease, while alcohol-associated cirrhosis had higher gastrointestinal bleeding than metabolic dysfunction-associated steatotic liver disease (MASLD) cirrhosis. In a 30-day landmark analysis, antiplatelet monotherapy (aspirin or P2Y12 inhibitors) had lower 1-year gastrointestinal bleeding (10.31% vs. 20.77%; <i>p</i> &lt; 0.0001) and mortality (9.46% vs. 12.89%; <i>p</i> = 0.04) without increased stent restenosis compared with dual antiplatelet therapy (DAPT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cirrhosis confers substantially higher bleeding and mortality after PCI, particularly in decompensated disease. Antiplatelet monotherapy after 30 days was associated with less bleeding and improved survival, supporting abbreviated DAPT in this high-risk group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1219-1233"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70896","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672959","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: HBV Reactivation During Immunosuppressive Therapy—Is ‘Low Risk’ Truly Low Risk?","authors":"Eleni Myrto Trifylli,&nbsp;Nikolaos Papadopoulos","doi":"10.1111/apt.70787","DOIUrl":"10.1111/apt.70787","url":null,"abstract":"&lt;p&gt;Hepatitis B virus reactivation (HBVr) remains a clinically significant complication associated with immunosuppressive and anti-neoplastic therapies [&lt;span&gt;1&lt;/span&gt;]. The expanding use of immunosuppressive, biologic and targeted therapies has transformed the management of malignant, autoimmune and inflammatory diseases while extending concern for HBV reactivation beyond traditionally recognized high-risk settings such as anti-CD20 therapy [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Although preventive strategies have substantially evolved over the last decade, important uncertainties remain regarding the true magnitude of HBVr risk across several immunosuppressive settings [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;Alimentary Pharmacology &amp; Therapeutics&lt;/i&gt;, Ikeuchi et al. [&lt;span&gt;5&lt;/span&gt;] address this important knowledge gap by providing valuable real-world evidence through a large nationwide analysis of Japanese patients with resolved or presumed resolved HBV infection who were not receiving antiviral prophylaxis and were treated with a broad spectrum of immunosuppressive and chemotherapeutic agents.&lt;/p&gt;&lt;p&gt;Using administrative claims and laboratory data spanning 2008–2022, the authors evaluated more than 9000 patients with undetectable HBV DNA at baseline who underwent serial monitoring without antiviral prophylaxis. The Japanese monitoring-based strategy provided important real-world insight into HBVr incidence in the absence of universal antiviral prophylaxis [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Several findings deserve emphasis. Notably, the study confirms the robustness of current guideline-based risk stratification. Anti-CD20 therapy demonstrated the highest HBVr incidence [&lt;span&gt;7&lt;/span&gt;]. Measurable HBVr incidence was also observed with tyrosine kinase inhibitors, anthracycline-containing regimens and other targeted therapies [&lt;span&gt;8, 9&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Particular attention should be given to corticosteroid exposure. Current guidelines classify corticosteroid-associated risk according to dose and duration, with low-dose and short-term administration considered low risk [&lt;span&gt;2, 3&lt;/span&gt;]. However, the present study identified clinically meaningful HBVr even among patients receiving low-dose or shorter courses of corticosteroids, with some cases progressing to hepatitis. These findings should not necessarily be interpreted as evidence that current guidelines substantially underestimate corticosteroid-related risk. As acknowledged by the authors, many patients received concomitant immunosuppressive therapies, and enhanced surveillance may have increased the detection of low-level viraemia. Nevertheless, the study emphasizes an increasingly important concept: HBVr risk is dynamic rather than binary. In real-world practice, cumulative immunosuppression, overlapping therapies, host factors and monitoring intensity may influence HBVr risk more than isolated drug classifications alone [&lt;span&gt;10&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Despite management at large centres, a proportion of patie","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1298-1299"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70787","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148196772","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: MASLD In Primary Care—Risk-Stratification as the First Step to Treatment","authors":"Niharika Samala","doi":"10.1111/apt.70841","DOIUrl":"10.1111/apt.70841","url":null,"abstract":"&lt;p&gt;Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with significant hepatic and extrahepatic clinical outcomes, including mortality [&lt;span&gt;1, 2&lt;/span&gt;]. Notably, a subgroup with MASLD has a pronounced increase in risk of liver-related events, earning the name “at-risk metabolic dysfunction-associated steatohepatitis (MASH)” [&lt;span&gt;3-5&lt;/span&gt;], and understandably deemed to be most likely to benefit from clinical interventions. However, the silence of MASLD until progression to liver failure challenges the timely identification of at-risk MASH. The conditionally FDA-approved pharmacotherapy, currently indicated only for individuals with “non-cirrhotic at-risk MASH”, has compelled us to switch from passive identification to active risk-stratification to find individuals at risk for MASLD with advanced fibrosis. In individuals with cardiometabolic risk factors, AASLD recommends FIB-4-guided risk-stratification, with referral to gastroenterology for individuals at high risk, or second-tier testing with the Enhanced Liver Fibrosis (ELF) test or transient elastography for intermediate risk and continued cardiometabolic optimization for those at low risk for advanced fibrosis.&lt;/p&gt;&lt;p&gt;In the current issue, Adams et al. examine the prevalence of probable at-risk MASH (using Fibrosis NASH Index (FNI)) and FIB-4 index-defined risk for advanced fibrosis among individuals with metabolic risk factors in primary care practices in Victoria, Australia, using two large linked data repositories—Primary Care Audit, Teaching and Research Open Network (PATRON) (de-identified electronic medical records) and Victorian Admitted Episodes Dataset (VAED) [&lt;span&gt;6&lt;/span&gt;]. Of the third with metabolic dysfunction, the authors identified that one in five (4.3%) were at high-risk of advanced fibrosis and one in six (18%) were at intermediate-risk and would need additional risk-stratification. Nearly a quarter (24.3%) of those with metabolic dysfunction, and half with type-2 diabetes had at-risk MASH. We see comparable estimates of at-risk MASH (13.6%) and cirrhosis (5.6%) in individuals with type-2 diabetes in the U.S. [&lt;span&gt;7&lt;/span&gt;], and advanced fibrosis (3.3%) from pooled studies [&lt;span&gt;8&lt;/span&gt;]. Importantly, the authors found a strikingly high burden of probable at-risk MASH (25% vs. 15.5%) and high-risk for advanced fibrosis (5.4% vs. 4.4%) among individuals living in index of relative socioeconomic disadvantage (IRSD)-determined areas with the worst socio-economic disadvantage, compared to those living in areas with the least socio-economic disadvantage [&lt;span&gt;6&lt;/span&gt;]. This finding is consistent with emerging evidence linking food insecurity, limited access to healthy foods, and neighbourhood-level deprivation with MASLD outcomes [&lt;span&gt;9, 10&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Taken together, MASLD is a major public health burden that disproportionately affects individuals facing socio-economic disadvantage. Adams et al.'s paper reinforces that primary care ","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1300-1301"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440906","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: Mind the Gap—Peripheral Immune Signatures of HBV Cirrhosis in an Underserved Population","authors":"Martin Feuerherd","doi":"10.1111/apt.70842","DOIUrl":"10.1111/apt.70842","url":null,"abstract":"&lt;p&gt;In this issue of AP&amp;T, MacLeod et al. [&lt;span&gt;1&lt;/span&gt;] provide a dissection of the peripheral immune landscape of hepatitis B virus (HBV)-related cirrhosis in Ethiopia. Chronic hepatitis B (CHB) is the leading cause of cirrhosis, which itself is the main driver of hepatocellular carcinoma. The need is large in sub-Saharan Africa: the WHO Global Hepatitis Report 2026 estimates an HBsAg prevalence of 5%–7.9% in Ethiopia, one of 10 countries accounting for 69% of the 1.1 million annual HBV deaths [&lt;span&gt;2&lt;/span&gt;]. Nevertheless, HBV immunity remains understudied across the continent, from the influence of host background to the pathogenicity of circulating genotypes.&lt;/p&gt;&lt;p&gt;This cross-sectional study compared the immune milieu across clinical phases of chronic HBV: low-replicative infection, the grey zone, and hepatitis (ALT &gt; 50) with HBV-related cirrhosis. Of 1000 screened samples from an Ethiopian hospital, 488 met inclusion criteria (treatment-naïve, HIV and HCV negative) and 287 passed quality thresholds (measured cell counts) after high-dimensional flow cytometric phenotyping. The resulting dataset is a valuable resource in itself. Three findings stand out. First, cirrhosis was associated with relative lymphopenia and monocytosis. Second, the NK, CD4 T- and B-cell compartments were skewed towards naïve at the expense of mature, effector phenotypes. Third, activation (CD38+ HLA-DR+) of NK, CD4 and CD8 T cells correlated with the degree of cirrhosis.&lt;/p&gt;&lt;p&gt;These peripheral signatures acquire meaning in context with the intrahepatic compartment. In tissue, cirrhosis is marked by scar-associated macrophages and expanded effector-memory CD4 T cells [&lt;span&gt;3&lt;/span&gt;], with monocyte-to-macrophage differentiation diverging in fibrosis [&lt;span&gt;4&lt;/span&gt;]. Transcriptomic re-analysis reports enriched monocytes, NK and activated CD4 T cells [&lt;span&gt;5&lt;/span&gt;]. In HBV-related cirrhosis specifically, livers accumulate mature and lose naive cells [&lt;span&gt;6&lt;/span&gt;]. MacLeod's peripheral data from cirrhosis supply the mirror image: an increase of immature cells in the circulation [&lt;span&gt;1&lt;/span&gt;]. Taken together, these data suggest that mature effector cells home to the cirrhotic liver, leaving an immature pool in the periphery, while low-grade endotoxemia possibly drives the observed systemic immune activation. It remains unclear whether this phenomenon is impacted by HBV infection since the extent of cirrhosis-reshaped immunity presents a challenge to isolate HBV-related signatures.&lt;/p&gt;&lt;p&gt;The study design has limits. Whole blood was stabilized in situ (Cytodelics) and shipped abroad for analysis, improving comparability but altering some markers versus fresh blood [&lt;span&gt;7&lt;/span&gt;]. Only 0.6 mL whole blood were available, mitigated by excluding samples with fewer than 10,000 CD45&lt;sup&gt;+&lt;/sup&gt; lymphocytes. Restricting the study cohorts by excluding, for instance, low-viremia patients with inflammation does not represent the full heterogeneity of CHB but facil","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1302-1303"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70842","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388559","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":"Anti-Integrin αvβ6 Autoantibodies Distinguish Ulcerative Colitis From Crohn's Disease With High Diagnostic Accuracy and Outperform ANCA and ASCA Status: A Prospective Cross-Sectional Study","authors":"Samuel Truniger,&nbsp;David Waber,&nbsp;Joel Dütschler,&nbsp;Marius König,&nbsp;Jakob Heimer,&nbsp;Peter Schönenberger,&nbsp;Seraina Koller,&nbsp;Isabelle Kamm,&nbsp;Regine Garcia Boy,&nbsp;Christina Lins,&nbsp;Claudia Krieger,&nbsp;Nicola Fabian Frei,&nbsp;Simon Woelfel,&nbsp;Matthias Friedrich,&nbsp;Alfred Mahr,&nbsp;Stephan Brand","doi":"10.1111/apt.70926","DOIUrl":"10.1111/apt.70926","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Reliable biomarkers to distinguish ulcerative colitis (UC) from Crohn's disease (CD) remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To assess the diagnostic accuracy of anti-integrin αvβ6 autoantibodies for differentiating UC from CD and to compare their performance with anti-neutrophil cytoplasmic antibodies (ANCA) and anti-<i>Saccharomyces cerevisiae</i> antibodies (ASCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective cross-sectional study in patients with UC and CD, serum anti-integrin αvβ6 autoantibodies, ASCA, and ANCA were measured and clinical data were collected. The primary outcome was the accuracy of anti-integrin αvβ6 antibodies in distinguishing UC from CD. Secondary analyses compared their performance with ASCA and ANCA status and across IBD subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 224 patients were included (UC: <i>n</i> = 106, CD: <i>n</i> = 118, male: 63.8%, median age: 43.5 years). Patients with indeterminate colitis were excluded. At a cut-off of 2.44 U/mL, anti-integrin αvβ6 autoantibodies demonstrated a diagnostic accuracy of 86.5%, with a sensitivity of 85.8% and specificity of 87.1%. In a multivariate logistic regression analysis, these autoantibodies were independently associated with UC (OR 36.18, 95% CI 17.0–83.0, <i>p</i> = 4.86 × 10⁻¹⁹) and demonstrated superior diagnostic performance compared to ANCA and ASCA status (Akaike information criterion 184.8 vs. 252.4). Positivity rates followed a gradient across the Montreal classification, increasing from ileal (L1: 7.9%) and ileocolonic (L3: 8.1%) CD towards colonic CD (L2: 43.8%) and UC: 85.8% (<i>p</i> = 2.04 × 10⁻³¹).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Anti-integrin αvβ6 autoantibodies demonstrate high diagnostic accuracy and outperform conventional serological markers in distinguishing UC from CD. Importantly, this study provides the first direct comparison with ANCA and ASCA status within the same patient cohort.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1260-1273"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148767504","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: Anti-Integrin αvβ6 Autoantibodies for Distinguishing Ulcerative Colitis From Crohn's Disease: Authors' Reply","authors":"Samuel Truniger,&nbsp;Stephan Brand","doi":"10.1111/apt.71002","DOIUrl":"10.1111/apt.71002","url":null,"abstract":"&lt;p&gt;We thank Drs. Muramoto, Kuwada, and Shiokawa for their thoughtful editorial and for placing our findings in the broader context of emerging serological biomarkers in inflammatory bowel disease (IBD) [&lt;span&gt;1, 2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We particularly appreciate their emphasis on the comparative design of our study. Previous investigations established anti-integrin αvβ6 autoantibodies as a promising marker of ulcerative colitis (UC), including during the preclinical phase [&lt;span&gt;3, 4&lt;/span&gt;]. By assessing anti-integrin αvβ6 alongside ANCA and ASCA in the same individuals with established UC or Crohn's disease (CD), we were able to compare their diagnostic performance under identical clinical conditions, with anti-integrin αvβ6 showing substantially greater discriminatory capacity.&lt;/p&gt;&lt;p&gt;We agree that the clinically most relevant next step is to evaluate anti-integrin αvβ6 in patients whose IBD subtype remains uncertain. However, indeterminate colitis accounts for only approximately 6% of adult IBD cases [&lt;span&gt;5&lt;/span&gt;]. At this prevalence, approximately 2000 patients with IBD would be required to obtain an indeterminate colitis cohort comparable in size to the 118 patients with CD in our study, highlighting the need for large prospective multicentre cohorts.&lt;/p&gt;&lt;p&gt;Our observations also support an increasingly nuanced view of IBD classification. Genetic and immunological data indicate considerable biological overlap between traditionally defined disease categories [&lt;span&gt;6&lt;/span&gt;]. This concept is further supported by the recent identification of neutralising autoantibodies against interleukin-10 in a distinct subgroup of patients with IBD, strongly associated with HLA-DRB1*01:03, providing a striking link between genetic susceptibility, autoimmunity, and intestinal inflammation [&lt;span&gt;7&lt;/span&gt;]. In our cohort, anti-integrin αvβ6 positivity was considerably more frequent in colonic than ileal CD [&lt;span&gt;2&lt;/span&gt;]. Given that indeterminate colitis shares features with both UC and colonic CD [&lt;span&gt;6&lt;/span&gt;], anti-integrin αvβ6 autoantibodies alone may therefore not resolve every diagnostically ambiguous case. Conversely, the marked separation between UC and ileal CD suggests that its diagnostic value may differ across the IBD phenotypic spectrum.&lt;/p&gt;&lt;p&gt;The ongoing INTERCEPT programme will further evaluate serological and other biomarkers for identifying individuals at risk of developing IBD [&lt;span&gt;8&lt;/span&gt;]. Such prospective studies may help to determine how emerging biomarkers can ultimately contribute not only to disease classification, but also to prediction and potentially prevention.&lt;/p&gt;&lt;p&gt;In conclusion, anti-integrin αvβ6 autoantibodies represent a promising addition to IBD serology beyond conventional ANCA and ASCA testing. The key question is whether their strong discrimination in established UC and CD translates into meaningful diagnostic benefit for patients in whom disease classification remains uncertain.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Samuel Truniger:&lt;/b&gt; conceptu","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1310-1311"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.71002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014860","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: Randomised Placebo-Controlled Trial of Methylcellulose and Psyllium Gels on Inulin-Induced Colonic Gas","authors":"Neele Dellschaft,&nbsp;Alaa Alhasani,&nbsp;Joshua E. S. J. Reid,&nbsp;Caroline L. Hoad,&nbsp;Elizabeth Gates,&nbsp;Molly Whymark,&nbsp;Gleb Yakubov,&nbsp;Luca Marciani,&nbsp;Frederick J. Warren,&nbsp;Amisha Modasia,&nbsp;Abi Spicer,&nbsp;Colin Crooks,&nbsp;Maura Corsetti,&nbsp;Penny A. Gowland,&nbsp;Robin Spiller","doi":"10.1111/apt.70964","DOIUrl":"10.1111/apt.70964","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>People with irritable bowel syndrome (IBS) often restrict their intake of FODMAPs because of associated gas and abdominal discomfort. Psyllium, a gel-forming fibre, reduces colonic gas after inulin ingestion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to determine whether methylcellulose, a low-cost, non-fermentable gelling agent, widely used in food manufacture, could be formulated to match psyllium's physical properties and similarly moderate colonic fermentation of inulin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>3-way randomised cross-over study giving 15 g inulin with 15 g methylcellulose, psyllium or maltodextrin (placebo) in 22 healthy volunteers. Participants underwent hourly MRI scans for 6 h and serial breath hydrogen measurements for 24 h when a final MRI scan was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Methylcellulose and psyllium gels did not significantly alter AUC_{0–360 min}, however, they were associated with less colonic gas after the gels reached the colon (AUC_{180–360 min}, <i>p</i> = 0.02). The gels increased AUC_{0–240 min} of small bowel free water (<i>p</i> &lt; 0.0001 and 0.048, respectively), methylcellulose effect&gt;psyllium (<i>p</i> = 0.0005). Both increased colon chyme wateriness (T1AC, AUC_{180–360 min}, <i>p</i> &lt; 0.0001) and volume of hydrated fibre in colon (AUC_{180–360 min}, <i>p</i> &lt; 0.0001 and 0.0009, respectively). Both parameters were greater after methylcellulose than psyllium (<i>p</i> = 0.01 and 0.02, respectively). 24 h measurements of breath hydrogen were not different between groups (AUC_0–24 h, <i>p</i> = 1.0) but were reduced by psyllium in the 0–6-h period <i>p</i> = 0.008.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Methylcellulose and psyllium reduce colonic gas produced by inulin after the gels reach the colon. Methylcellulose increases the water content of both the small and large bowel more than psyllium. This additional effect may allow improved tolerance of FODMAPs, particularly in IBS patients with constipation.</p>\u0000 \u0000 <p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06291272</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1197-1206"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946724","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: Amino Acid Imbalance and Prognosis in Cirrhosis","authors":"Takanobu Iwadare,&nbsp;Takefumi Kimura","doi":"10.1111/apt.70981","DOIUrl":"10.1111/apt.70981","url":null,"abstract":"&lt;p&gt;Prognostic assessment in cirrhosis relies mainly on measures of hepatic dysfunction and its clinical consequences. The Child-Pugh and Model for End-Stage Liver Disease (MELD) scores remain central to risk stratification, but neither directly captures the systemic metabolic changes that accompany progressive liver failure [&lt;span&gt;1&lt;/span&gt;]. Amino acid imbalance may provide complementary information.&lt;/p&gt;&lt;p&gt;Utakata and colleagues examined the prognostic relevance of the branched-chain amino acid-to-tyrosine ratio (BTR) in 541 patients with cirrhosis. During a median follow-up of 3.5 years, 129 patients died. Lower BTR remained independently associated with mortality after adjustment for established prognostic factors, including the Child-Pugh score. Five-year survival was 62.5% in patients with BTR ≤ 4.4 compared with 87.0% in those with BTR &gt; 4.4. More importantly, when BTR was separated into its components, lower branched-chain amino acid (BCAA) concentrations and higher tyrosine concentrations were each independently associated with mortality. The association was also observed for liver-related mortality in a Fine-Grey competing-risk analysis, strengthening the relevance of BTR to liver-related outcomes [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;This distinction is biologically relevant. BCAAs are involved in protein synthesis, energy metabolism and skeletal muscle function. In cirrhosis, skeletal muscle also contributes to ammonia disposal, increasing the metabolic demand placed on muscle. Lower BCAA concentrations may therefore reflect not only nutritional status but also altered muscle metabolism and reduced functional reserve [&lt;span&gt;3, 4&lt;/span&gt;]. In contrast, aromatic amino acids such as tyrosine are predominantly metabolised in the liver. Higher tyrosine concentrations may more directly reflect impaired hepatic metabolic capacity and portosystemic shunting [&lt;span&gt;2, 5&lt;/span&gt;]. Taken together, these findings suggest that BTR should not be viewed solely as a nutritional index. Rather, it may integrate complementary metabolic signals from skeletal muscle and the liver. The independent associations of BCAA and tyrosine with mortality suggest that amino acid profiling captures a metabolically distinct dimension of risk in cirrhosis.&lt;/p&gt;&lt;p&gt;Several questions remain. An independent association with mortality does not necessarily establish incremental prognostic value. Whether adding BTR, BCAA, or tyrosine to MELD or Child-Pugh improves discrimination, calibration, or reclassification requires direct testing. Serial measurements may also be more informative than a single baseline value and could clarify whether changes in amino acid profiles track disease progression or treatment response. External validation is warranted given the retrospective Japanese cohort and use of local reference cut-offs [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Prognostic association should also be distinguished from therapeutic effect. The association between low BCAA concentrations and mortality does no","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1312-1313"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70981","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957986","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}