Alimentary Pharmacology & Therapeutics最新文献

{"title":"Letter: Predictors of Corticosteroid Response in Alcohol-Related Hepatitis—Authors' Reply","authors":"Francisco Idalsoaga, Luis Antonio Díaz, Ramon Bataller, Juan Pablo Arab","doi":"10.1111/apt.70095","DOIUrl":"10.1111/apt.70095","url":null,"abstract":"<p>Severe alcohol-associated hepatitis (AH) is a condition that bears a high short-term mortality [<span>1</span>], and corticosteroids are currently the only available therapy for patients with this disease [<span>2</span>]. However, given the well-documented adverse effects associated with corticosteroid use, it is clinically relevant to identify patients who will benefit the most from this treatment [<span>3</span>]. In our recent study [<span>4</span>], through a multinational analysis, we evaluated the performance of different dynamic models (defined as those using laboratory data from at least two time-points) to predict 30- and 90-day mortality in patients with severe AH. Our results revealed that the Lille day 7 score (Lille-7) was the most accurate model for predicting both 30-day and 90-day mortality. The Lille day 4 score (Lille-4) and the Trajectory of serum bilirubin (TSB) also demonstrated moderate predictive value. Interestingly, no significant differences were found when comparing Lille-7, Lille-4 and TSB.</p><p>We appreciate the letter from Forrest et al. regarding our paper and their comments on the prognostic utility of the delta neutrophil-to-lymphocyte ratio (NLR) in patients with AH [<span>5</span>]. Although the original study by Forrest et al. [<span>6</span>], on the neutrophil-to-lymphocyte ratio (NLR) was primarily designed to identify patients who were likely to benefit from corticosteroid treatment, the use of delta NLR has been explored in multiple disease scenarios with significant inflammatory components, such as AH [<span>7</span>]. In fact, its utility has been assessed in various contexts, including living donor liver transplantation and graft survival [<span>8</span>], as well as its association with increased mortality in patients with hepatocellular carcinoma [<span>9</span>]. Furthermore, a study conducted in France that included 116 patients with cirrhosis admitted to the ICU found that the use of delta NLR was also an independent predictor of mortality at 28 days [<span>10</span>]. However, when specifically evaluated in AH in our study, this score did not demonstrate predictive power for mortality at 30 or 90 days, particularly in patients receiving corticosteroids.</p><p>The use of TSB as a predictor of mortality had been validated in AH, specifically in patients before corticosteroid treatment [<span>11</span>]. In our study, when using this model as a dynamic score during the use of steroids, it was useful to predict mortality at 30 and 90 days. Interestingly, no significant differences were observed when comparing TSB to Lille-7, and it also demonstrated comparable performance to Lille-4. Both TSB and Lille-4 are valuable tools for risk stratification in patients with severe AH. Thus, although Lille-7 remains the most validated dynamic score, shortening the assessment period to 4 days may have a good discriminatory ability, reducing unnecessary exposure to corticosteroids. Finally, there is a clear ne","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 9","pages":"1571-1572"},"PeriodicalIF":6.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660551","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":"The Impact of Setons on Perianal Fistula Outcomes in Patients With Crohn's Disease Treated With Anti-TNF Therapy: A Multicentre Study","authors":"Jeffrey McCurdy, Javeria Munir, Simon Parlow, Gagan Sambhi, Jacqueline Reid, Russell Yanofsky, Talal Alenezi, Joseph Meserve, Kuan-Hung Yeh, Brenda Becker, Zubin Lahijanian, Anas Hussam Eddin, Ranjeeta Mallick, Tim Ramsay, Greg Rosenfeld, Ali Bessissow, Talat Bessissow, Vipul Jairath, David H. Bruining, Blair Macdonald, Siddharth Singh","doi":"10.1111/apt.70081","DOIUrl":"https://doi.org/10.1111/apt.70081","url":null,"abstract":"We aimed to assess the impact of setons on perianal fistula outcomes in patients with perianal fistulising Crohn's disease (PFCD) treated with anti-TNF therapy.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"72 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640652","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: Can We Prevent Inflammatory Bowel Disease? Authors' Reply","authors":"Fai Fai Ho, Irene Xin-Yin Wu, Vincent Chi Ho Chung","doi":"10.1111/apt.70093","DOIUrl":"10.1111/apt.70093","url":null,"abstract":"<p>We sincerely appreciate the insightful comments from Ho and Mak regarding our recent study [<span>1</span>], which highlights the potential of lifestyle modification as a primary preventive strategy for inflammatory bowel disease (IBD) [<span>2</span>]. Utilising data from 105,715 participants aged 40–70 years in the UK Biobank Study, our analysis demonstrated a significant association between adherence to a combination of healthy lifestyle behaviours—never smoking, optimal sleep duration, high levels of vigorous physical activity, high dietary quality and moderate alcohol intake—and a reduced risk of incident IBD, including both Crohn's disease and ulcerative colitis [<span>2</span>]. Even after adjusting for potential confounders, participants adhering to one, two or three to five healthy lifestyle behaviours exhibited adjusted hazard ratios (95% confidence intervals) of 0.75 (0.59–0.97), 0.72 (0.56–0.92) and 0.50 (0.37–0.68), respectively (<i>p</i> for trend < 0.001), compared with those who engaged in none of these behaviours [<span>2</span>].</p><p>Given the increasing incidence of IBD worldwide, particularly in newly industrialised nations [<span>3</span>], Ho and Mak aptly underscore the urgent need for effective preventive strategies to mitigate disease burden and reduce healthcare system pressures [<span>1</span>]. Despite the growing recognition of lifestyle factors in disease prevention, current consensus guidelines predominantly emphasise diagnosis and treatment for IBD rather than comprehensive prevention strategies [<span>6, 4</span>]. IBD is a multifactorial disease influenced by genetic predisposition, environmental exposures and gut microbiota composition [<span>7</span>]. Our findings highlight the collective benefits of multiple healthy lifestyle behaviours in lowering IBD risk and suggest that lifestyle modification may attenuate the impact of etiological factors on disease development.</p><p>To effectively implement IBD prevention, primary healthcare providers must play a pivotal role in facilitating health behaviour change during routine consultations, as they often serve as the first point of contact within the healthcare system [<span>8, 9</span>]. The World Health Organisation advocates for the use of the ‘5As’ framework (Ask, Advise, Assess, Assist and Arrange), which can be seamlessly integrated into healthcare delivery at all levels, to guide primary care practitioners in delivering brief, structured counselling on health risk factors [<span>10</span>]. Beyond individual clinical efforts, fostering a supportive macro-environment is essential to encourage the adoption and maintenance of healthy behaviours. This necessitates coordinated action from national and local authorities. In the UK, national guidelines on behaviour change urge policymakers and healthcare commissioners to contribute actively to the design and implementation of evidence-based, sustainable interventions [<span>5</span>]. These efforts should b","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 9","pages":"1561-1562"},"PeriodicalIF":6.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640653","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: Can We Prevent Inflammatory Bowel Disease?","authors":"Agnes Hiu Yan Ho, Joyce Wing Yan Mak","doi":"10.1111/apt.70071","DOIUrl":"10.1111/apt.70071","url":null,"abstract":"<p>Inflammatory Bowel Disease (IBD), characterised by chronic inflammation of the gastrointestinal tract, can lead to a range of disabling symptoms and complications that impact both young and elderly individuals. It was observed that not only is the prevalence of IBD increasing in urbanised regions across the globe, but the incidence of IBD in newly industrialised regions has been rising as well [<span>1</span>]. The increasing burden of this chronic disease poses significant challenges to our healthcare systems. The exact causes of IBD remain unclear, but recent studies have identified several modifiable environmental risk factors that contribute to its development [<span>2</span>]. One approach to mitigating these risks is through the adoption of a healthy lifestyle.</p><p>In the present study, Ho et al. studied the association of healthy lifestyle behaviours and risks of IBD development using the data from more than 100,000 individuals aged 40–70 from the UK Biobank [<span>3</span>]. The authors identified five lifestyle behaviours, including never smoking, optimal sleep, high levels of vigorous physical activity, high dietary quality, and moderate alcohol intake, as critical factors in mitigating IBD development. The most fascinating finding was that adopting a combination of healthy lifestyle behaviours, but not a single individual healthy behaviour, was associated with a greater reduction in the risk of developing both CD and UC. Although IBD mainly affects the young population, there is a bimodal pattern of disease onset, with another peak occurring between 60 and 70 years of age. With the increasing prevalence of elderly-onset IBD, which has been shown to exhibit disease activity at least as complex as that of adult-onset IBD [<span>4</span>], this study could still provide important insights on important preventive strategies against IBD.</p><p>While previous studies mainly focus on the effect of individual environmental factors in IBD development [<span>5</span>], this study provides a new insight: no single lifestyle factor holds a magic bullet. Instead, the combined impact of healthy lifestyle choices creates a powerful protective effect. IBD is a complex, multi-factorial disease where dysbiosis of the gut microbiome, environmental factors, and host genetics are implicated in disease development. Diet and host immune responses determine gut microbial composition and function. Excessive intake of specific macronutrients enriched in a Western diet promotes experimental gut inflammation by perturbation of host–microbe commensalism [<span>6</span>]. Physical activity, on the contrary, influences the composition and diversity of the microbiome, reducing inflammation and intestinal permeability [<span>7</span>]. Sleep, often overlooked, also plays a critical role, as disruptions to the sleep–wake cycle can significantly alter the gut microbiome's function and resilience [<span>8</span>]. The gut microbiome, in turn, produces metabolites an","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 9","pages":"1559-1560"},"PeriodicalIF":6.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640654","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":"Association Between Viral Replication Activity and Postoperative Recurrence of HBV-Related Hepatocellular Carcinoma","authors":"Subin Heo, Jiwon Yang, Jeayeon Park, Rex Wan-Hin Hui, Byeong Geun Song, In-Hye Song, Young-In Yoon, Tan-To Cheung, Sung Won Chung, Jonggi Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Wai-Kay Seto, Jeong-Hoon Lee, Won-Mook Choi","doi":"10.1111/apt.70085","DOIUrl":"https://doi.org/10.1111/apt.70085","url":null,"abstract":"Baseline viral replication activity influences the risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B virus (HBV) infection.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"16 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635117","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: Prevalence of Suspected Metabolic Dysfunction-Associated Liver Disease in Adolescents in the United States Using Updated Diagnostic Criteria—Authors' Reply","authors":"Sheila L. Noon, Tin Bo Nicholas Lam, Jeffrey B. Schwimmer","doi":"10.1111/apt.70092","DOIUrl":"10.1111/apt.70092","url":null,"abstract":"<p>We appreciate the editorial by Bonn and Xanthakos [<span>1</span>] discussing our recent study on the prevalence and predictors of suspected MASLD in US adolescents [<span>2</span>]. Their commentary highlights the importance of MASLD in paediatrics and reinforces the key questions that remain about its clinical and research application. While the transition in nomenclature from NAFLD to MASLD provides a more structured definition, its implementation in children requires further investigation.</p><p>A challenge in paediatric MASLD is misdiagnosis, especially in children with obesity whose liver disease is unrelated to steatosis. Hildreth et al. showed how autoimmune hepatitis can present with obesity, elevated ALT, and imaging findings that mimic steatosis, resulting in an erroneous MASLD diagnosis [<span>3</span>]. Conversely, our study found that 20.2% of adolescents with elevated ALT had no cardiometabolic risk factors, raising concerns that some children with liver disease may remain undetected under the updated criteria. Further complicating diagnosis, paediatric MASLD exhibits distinct histologic features, with a greater tendency for periportal inflammation and fibrosis than the pericentral pattern seen in adults [<span>4</span>]. These differences suggest MASLD in children involves unique developmental and metabolic pathways, reinforcing the need for paediatric-specific research rather than assuming direct parallels with adult disease.</p><p>Distinguishing association from causation is another key challenge in MASLD. While the definition links hepatic steatosis to metabolic dysfunction, it is unclear whether one drives the other. Hepatic fat accumulation in preschool-aged children, as described by Goyal et al., challenges the assumption that metabolic dysfunction is always the initiating factor [<span>5</span>]. If it were, it should precede hepatic steatosis. However, steatosis can appear before insulin resistance, dyslipidemia, or hypertension, suggesting it may contribute to metabolic dysfunction. Alternatively, both may share early-life determinants, such as prenatal exposures, epigenetic modifications, or perinatal nutrition patterns. Resolving these uncertainties requires longitudinal studies tracking hepatic steatosis from early childhood and would rely on repeated measures of hepatic steatosis. Currently, the only validated non-invasive tool for measuring hepatic steatosis in children is MRI-PDFF [<span>6, 7</span>]. Integrating this technology would allow us to determine whether steatosis precedes, predicts, or parallels metabolic dysfunction and help identify windows for intervention and stratify risk.</p><p>The inclusion of waist circumference in MASLD criteria aims to improve specificity by capturing central adiposity [<span>8</span>]. Malki et al. demonstrated that visceral adiposity is the strongest predictor of hepatic steatosis, supporting waist circumference as a potential surrogate [<span>9</span>]. However, our study ","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 9","pages":"1557-1558"},"PeriodicalIF":6.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635119","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: Prevalence of Suspected Metabolic Dysfunction-Associated Steatotic Liver Disease in Adolescents in the United States Using Updated Diagnostic Criteria","authors":"Julie Bonn, Stavra A. Xanthakos","doi":"10.1111/apt.70067","DOIUrl":"10.1111/apt.70067","url":null,"abstract":"<p>In 2023, diagnostic criteria for metabolic dysfunction-associated steatotic liver disease (MASLD) were updated to require hepatic steatosis with one or more cardiometabolic risk factors, including overweight, obesity, dysglycaemia, dyslipidaemia or hypertension [<span>1</span>]. Prior diagnosis of nonalcoholic fatty liver disease (NAFLD) focused primarily on excluding other aetiologies and did not require cardiometabolic risk factors. Among US adolescents in the National Health Examination and Nutrition Surveys (NHANES) 2011–2018, an estimated 16.5% had NAFLD [<span>2</span>]; however, the prevalence of MASLD under the new diagnostic criteria remained uncertain.</p><p>To estimate the prevalence of MASLD among US adolescents, Noon et al. [<span>3</span>] evaluated the association of elevated ALT level, a validated biomarker for hepatic steatosis [<span>4</span>], with cardiometabolic risk factors in a 2011–2020 NHANES sample of youth, ages 12–19 years. Among the 14.6% with elevated ALT (Figure 1), 77% met cardiometabolic criteria for MASLD (11% overall), defined as paediatric overweight/obesity, elevated waist circumference, triglyceride, fasting glucose, haemoglobin A1C levels and/or low high-density lipoprotein. Body mass index had the strongest association with elevated ALT. Among those without cardiometabolic risks, 0.7% had viral hepatitis, 1.9% had potential medication hepatotoxicity, and 20.2% had cryptogenic hepatitis.</p><p>The 11% prevalence of MASLD was one third lower than the recent estimate of NAFLD in adolescents (16.5%) [<span>2</span>], although concordance could not be fully assessed without imaging or biopsy confirmation of hepatic steatosis. Notably, a substantial proportion with elevated ALT (23%) lacked any cardiometabolic risk factors, with 88% of these having cryptogenic elevation. Overall, 7% of adolescents with healthy weight and no other cardiometabolic risk factors had elevated ALT. Conversely, 50% of adolescents with normal ALT had at least one cardiometabolic risk factor. Without validated liver imaging (MRI proton-density fat fraction in children [<span>5</span>]), abnormal hepatic steatosis could not be assessed. One open question is whether childhood onset of hepatic steatosis may precede the later development of hepatitis or cardiometabolic risk factors. The lack of longitudinal follow-up and precise magnetic resonance liver imaging precludes answering this question in NHANES.</p><p>Another key limitation is the lack of information on alcohol use in this publicly available NHANES dataset. In a 2022 national survey of US adolescents, 15% reported drinking alcohol in the past month, and 8% reported binge drinking [<span>6</span>]. Further research is needed to fully characterise patterns of alcohol use and associations with ALT elevation, cardiometabolic risk factors and hepatic steatosis in adolescents [<span>7</span>]. This study could also not ascertain monogenic metabolic disorders that can mimic MASLD. While","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 9","pages":"1555-1556"},"PeriodicalIF":6.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635118","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: Coeliac Disease and Women's Reproductive Health: A Lifelong Challenge","authors":"C. Ciacci, A. Santonicola","doi":"10.1111/apt.70087","DOIUrl":"https://doi.org/10.1111/apt.70087","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"5 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627529","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: Linking Overt Hepatic Encephalopathy Post-TIPS to Mortality!","authors":"Anjan Kumar, Margaret L. P. Teng, Anand V. Kulkarni","doi":"10.1111/apt.70005","DOIUrl":"10.1111/apt.70005","url":null,"abstract":"<p>Transjugular intrahepatic portosystemic shunt (TIPS) placement is an effective therapy for portal hypertension-related complications and has significant survival benefits for patients with recurrent/refractory ascites and variceal bleeding [<span>1</span>]. Although procedure-related mortality is low (< 1%), common post-TIPS complications, which affect quality of life, include overt hepatic encephalopathy (OHE), decrease in liver function and cardiopulmonary dysfunction [<span>2</span>]. Around 30%–50% of patients develop an episode of HE post-TIPS, with 10% developing disabling HE requiring recurrent hospitalisations [<span>3, 4</span>]. However, the impact of post-TIPS OHE on mortality remains unclear.</p><p>Xiang et al. conducted a large multicentre retrospective cohort study comprising 3262 patients with cirrhosis underwent TIPS for variceal bleeding [<span>5</span>]. Post-TIPS OHE occurred in 33.2% of patients, of which 631 (19.3%) patients subsequently died. It was found that post-TIPS OHE independently predicted long-term mortality (beyond 24 months), but not short-term mortality within 6 months. Additionally, development of post-TIPS OHE within 1 month was associated with higher long-term mortality. The authors must be lauded for this exceptional long-term follow-up study, which provides invaluable insights into HE and mortality.</p><p>A recent multicentre prospective study by Nardelli et al. reported that <i>episodic</i> post-TIPS OHE was not associated with higher mortality [<span>6</span>]. However, the percentage of patients with <i>persistent</i> post-TIPS OHE was significantly higher among patients who died. It is worth noting that median follow-up in this study was 30 months, slightly less than the 1077 days (~35 months) in Yi's study. A subsequent meta-analysis of seven cohort studies comprising 1712 patients showed that post-TIPS HE was associated with increased risk of mortality [<span>7</span>]. Yi's observation is hence in line with current literature, and the large cohort size adds credence to the link between post-TIPS HE and mortality. Additionally, Hartl et al. supported the observation that early onset of post-TIPS OHE within 1 month was linked with higher mortality [<span>8</span>].</p><p>Short-term mortality post-TIPS is predominantly driven by liver function, portal hypertension and stent-related complications, thereby suggesting a lack of association between post-TIPS OHE and short-term mortality. Only history of ascites and diameter of TIPS stent were significantly associated with mortality at 6 months, which suggests that these patients had an existing significant degree of portal hypertension not fully correctable by TIPS. Furthermore, 43.4% of patients who died within 12 months had stent dysfunction, which may exacerbate portal hypertension-related complications.</p><p>The study has numerous limitations. First, a higher proportion of patients with OHE had variceal bleeding, which may have been the trigger fo","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 7","pages":"1238-1239"},"PeriodicalIF":6.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619029","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: No Biochemical Relapse Is Associated With the Highest Off-Therapy HBsAg Loss Rate—Authors' Reply","authors":"Ying-Nan Tsai, Yao-Chun Hsu","doi":"10.1111/apt.70083","DOIUrl":"10.1111/apt.70083","url":null,"abstract":"<p>We thank Professors Jeng and Liaw for their interest in our study [<span>1, 2</span>]. We agree that ALT elevation following cessation of nucleos(t)ide analogues (NAs) in patients with chronic hepatitis B (CHB) is not associated with higher HBsAg seroclearance rates. In our study, we found that elevated serum ALT analysed as a time-varying variable was not associated with HBsAg seroclearance regardless of whether the threshold was set at the upper limit of normal (ULN), two-time ULN (clinical relapse) or five-time ULN (acute flares). These findings further examine and validate the results reported in their study [<span>3</span>].</p><p>They noted that the 10-year cumulative incidence of HBsAg seroclearance in the current study (12.4%) was lower than that in our previous research and other studies [<span>3, 4</span>]. We acknowledge that the incidence of HBsAg seroclearance could be underestimated in this real-world retrospective study because HBsAg was not regularly measured following a prespecified protocol in routine clinical practice, unlike in a prospective research setting with selected participants. Moreover, the apparent inconsistency might result from differences in analytical approaches. For instance, observation for HBsAg loss was censored on the resumption of antiviral treatment without considerations of competing risks in our prior study [<span>4</span>]. This approach would yield a significantly higher estimate of HBsAg loss rate as shown in the current study (figure S2). Since retreatment is unlikely independent of the probability of HBsAg seroclearance, analysing it as non-informative censoring may lead to an overestimation of HBsAg seroclearance incidence [<span>5</span>]. Regardless, our sensitivity analyses employing different approaches to estimate HBsAg seroclearance incidence consistently confirmed no association between ALT elevation and HBsAg loss.</p><p>The current study did not specifically investigate the association between retreatment and subsequent HBsAg seroclearance. Nevertheless, a recent randomised study reported that delaying retreatment by adopting a higher threshold did not increase the chance of HBsAg seroclearance in HBeAg-negative patients who stopped NA therapy after a minimum 24 months of viral suppression. They found no patients with an end-of-treatment HBsAg level greater than 1000 IU/mL would clear HBsAg during follow-up, irrespective of the assignment to higher or lower retreatment thresholds [<span>6</span>]. Only patients with EOT HBsAg level below 1000 IU/mL had a chance of HBsAg seroclearance, suggesting that the likelihood of HBsAg seroclearance was already determined by the HBsAg level at treatment cessation, whether or not antiviral therapy was resumed for clinical relapses.</p><p>We fully agree on the importance of rigorous monitoring and timely retreatment to ensure the safety of patients who stop NA therapy [<span>7</span>]. However, acute flare-ups induced by NA withdrawal can progress ra","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 8","pages":"1424-1425"},"PeriodicalIF":6.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619027","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}