Alimentary Pharmacology & Therapeutics最新文献

{"title":"Clinical Trial: Treatment of Functional Dyspepsia According to Subtype Compared With Empirical Proton Pump Inhibitor","authors":"Kee Huat Chuah, Qing Yuan Loo, Wen Xuan Hian, Xin Hui Khoo, Sarala Panirsheeluam, Nurhidayah Binti Mohammad Jubri, Vicraman Natarajan, Stanley Khoo, Sanjiv Mahadeva","doi":"10.1111/apt.18418","DOIUrl":"https://doi.org/10.1111/apt.18418","url":null,"abstract":"International guidelines recommend contrasting initial treatment strategies for functional dyspepsia (FD).","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"3 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758580","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: Updated COVID-19 Boosters—Tailoring Protection for Patients With IBD","authors":"James L. Alexander, Freddy Caldera","doi":"10.1111/apt.18379","DOIUrl":"https://doi.org/10.1111/apt.18379","url":null,"abstract":"<p>Patients with inflammatory bowel disease (IBD) treated with immunosuppressive agents are at increased risk of vaccine-preventable diseases [<span>1</span>]. During the COVID-19 pandemic, guidelines advised the prioritisation of immunosuppressed patients with IBD for extended primary and booster vaccination courses against SARS-CoV-2. The emergence of omicron variants and sub-variants, coupled with waning immunity, indicates that waves of SARS-CoV-2 infection pose an ongoing public health challenge, particularly for vulnerable patient groups [<span>2</span>]. Certain immunosuppressive therapies used in IBD and other immune-mediated inflammatory disorders, including anti-tumour necrosis factor (TNF) agents and Janus kinase (JAK) inhibitors, are associated with a blunted humoral immune response and an increased risk of breakthrough infection [<span>3, 4</span>].</p>\u0000<p>Woelfel et al. evaluated patients from the STAR SIGN study who had received at least three doses of original mRNA vaccines to determine protection against the current JN.1 variant and evaluated a small subgroup who had received a fourth booster XBBB1.5 recommended during 2023–2024 [<span>5</span>]. They found that neutralisation failure against JN.1 was ubiquitous despite prior vaccination and breakthrough infection but was somewhat mitigated in the small group that received XBB.1.5-adapted booster. Multi-variable modelling implicates anti-TNF treatment as being associated with a greater than 50% reduction in anti-JN.1 neutralising antibodies. As the authors noted, these findings fall short of implying that immunosuppressed patients with IBD who do not receive variant-adapted boosters are at a greater risk of adverse outcomes from infection with JN.1. Nonetheless, this re-emphasises the importance of regular, variant-adapted booster vaccination against SARS-CoV-2 in immunosuppressed patients with IBD, particularly those receiving anti-TNF therapy.</p>\u0000<p>Variant-adapted booster vaccines have been developed to combat the evolving SARS-CoV-2 variant landscape [<span>6</span>]. However, the determination of the groups that should receive such vaccines varies by jurisdiction. In June 2024, the US Centers for Disease Control and Prevention recommended that all individuals aged 6 months and older receive an updated vaccine targeting the JN.1 variant or KP.2 strain [<span>6</span>]. This recommendation was based on evidence that providing an updated 2023–2024 COVID-19 booster offered effectiveness against various outcomes, including symptomatic infection, hospitalisation and critical illness [<span>6</span>]. Moreover, this updated booster provided protection against COVID-19-related thromboembolic events [<span>7</span>]. Conversely, the United Kingdom Committee on Vaccination and Immunisation now advises a targeted approach that includes clinical risk groups such as immunosuppressed individuals with IBD [<span>8</span>] Amid this situation, there is growing vaccine hesitancy and complac","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"13 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142760065","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":"Black Race is Associated with Decreased Exposure to Advanced Therapies and Worse Outcomes in Individuals with Ulcerative Colitis","authors":"Caya McFalls, Lara Chaaban, Joanna Melia","doi":"10.1111/apt.18405","DOIUrl":"https://doi.org/10.1111/apt.18405","url":null,"abstract":"For people diagnosed with ulcerative colitis (UC), racial disparities exist both in access to medications and clinical outcomes.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"198 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752824","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: Extending the Measurement of Inflammatory Bowel Disease Severity to Include Patient Important Outcomes—Authors' Reply","authors":"Akhilesh Swaminathan, Miles P. Sparrow, Richard B. Gearry","doi":"10.1111/apt.18421","DOIUrl":"https://doi.org/10.1111/apt.18421","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"69 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142753669","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: Extending the Measurement of Inflammatory Bowel Disease Severity to Include Patient Important Outcomes","authors":"Angela J. Forbes","doi":"10.1111/apt.18410","DOIUrl":"https://doi.org/10.1111/apt.18410","url":null,"abstract":"<p>I enjoyed reading the article by Swaminathan et al. highlighting the noninflammatory burden of IBD [<span>1</span>]. The inclusion of quality-of-life measures such as fatigue, psychological symptoms, sexual function and disability would certainly add value to disease-driven treat-to-target outcomes. With several validated questionnaires available (and listed in table 2 of their article [<span>1</span>]), the inclusion of quality-of-life indicators in disease severity indices may be relatively easy for researchers to implement. The use of these types of measures for IBD is further normalised in clinical practice by their inclusion in patient management software such as Crohn's Colitis Care (CCCare) [<span>2</span>]. To reduce respondent burden and simplify the analysis, it may be tempting to use streamlined ‘short form’ versions of questionnaires, which have a limited number of questions and/or constrained multiple-choice answers. However, it should be noted that the use of different validated quality-of-life measures can lead to different conclusions as demonstrated in a study on life after proctocolectomy for ulcerative colitis [<span>3</span>]. Furthermore, it is unclear whether the existing quality-of-life measures go far enough to capture and reflect the factors that matter to patients themselves. Patients' expectations are growing with many wanting to express their preferences through shared decision-making. Patient preferences have become even more relevant in the current environment as new therapeutics are being introduced with limited prognostic indicators available to predict response or guide sequencing choices around these new medications [<span>4</span>].</p>\u0000<p>Qualitative methods such as focus groups provide another approach to elicit information about the factors that are important to patients. Schoefs et al. used this technique to describe unmet needs and determine the treatment outcomes relevant to patients with IBD [<span>5</span>]. Their results emphasised factors such as the psychological burden of ‘uncertainty’, which included worries about unpredictable symptoms and urgency, medications losing efficacy, the need for future ostomy surgery and the risk of nutritional deficiencies and intestinal failure as a result of repeated surgeries [<span>5</span>]. Other factors, such as changes in physical appearance and weight gain, were seen as major issues reducing quality of life [<span>5</span>]. The importance placed on these factors by patients can be contrasted with the often physician-determined quality-of-life indicators that appear in standardised surveys. If the real drivers of patient quality of life are not understood or acknowledged, it will be a continuing struggle to truly improve quality of life from a patient perspective.</p>\u0000<p>Another way to incorporate patient preferences and perspectives is through the inclusion of patient advocates as part of project teams. This partnership approach is commonly used when resear","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"259 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752846","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":"Coronary Artery Disease and Major Adverse Cardiovascular Events in People With Hepatic Steatosis at Low Atherosclerotic Cardiovascular Disease Risk.","authors":"Julia Karady, Thomas Mayrhofer, Borek Foldyna, Michael T Lu, Nandini Meyersohn, Udo Hoffmann, Oluwafemi Balogon, Neha Pagidipati, Svati Shah, Pamela S Douglas, Maros Ferencik, Kathleen Corey","doi":"10.1111/apt.18415","DOIUrl":"https://doi.org/10.1111/apt.18415","url":null,"abstract":"<p><strong>Background: </strong>Hepatic steatosis (HS) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥ 7.5% are associated with increased risk for cardiovascular events.</p><p><strong>Aim: </strong>To assess underlying coronary artery disease (CAD) and major adverse cardiovascular event (MACE) among those with and without HS at different ASCVD risk.</p><p><strong>Methods: </strong>We evaluated stable chest pain patients receiving coronary computed tomography (CT) in the PROMISE trial. HS and CAD endpoints were defined on coronary CT. MACE was defined as unstable angina, non-fatal myocardial infarction, and all-cause death. Multivariable Cox regression, adjusting for CAD characteristics, assessed the association of HS with MACE for ASCVD < 7.5%.</p><p><strong>Results: </strong>One thousand two hundred and four of 3702 (32.5%) patients were at ASCVD < 7.5% and 20.3% (244/1204) of them had HS. Individuals with HS were younger (54.3 ± 5.2 vs. 55.8 ± 5.2; p < 0.001), more often males (40.2% [98/244] vs. 27.1% [260/960]; p < 0.001), had more risk factors/person (2.06 ± 0.89 vs. 1.93 ± 0.91; p = 0.047). CAD characteristics were similar between HS vs. non-HS patients at ASCVD < 7.5% and ASCVD ≥ 7.5% (all p > 0.05). Patients with HS had greater MACE rate compared to non-HS patients (ASCVD < 7.5%: 3.75%[9/244] vs. 1.5% [14/960]; p = 0.027 and ASCVD ≥ 7.5%: 4.7% [33/696] vs. 3.1% [56/1802]; p = 0.043). In patients without HS, MACE rate was higher in the ASCVD ≥ 7.5% vs. < 7.5% (3.1% [56/1802] vs. 1.5% [14/960]; p = 0.011). In patients with HS, MACE rates were not significantly different between ASCVD ≥ 7.5% vs. < 7.5% (4.7% [33/696] vs. 3.7% [9/244]; p = 0.484). In ASCVD < 7.5%, HS predicted MACE (aHR:2.34, 95%CI:1.01-5.43; p = 0.048), independent of CAD characteristics.</p><p><strong>Conclusions: </strong>Individuals with HS at ASCVD < 7.5% risk had similar CAD characteristics as patients without HS at < 7.5% ASCVD risk, yet experienced comparable MACE rates as those at ASCVD ≥ 7.5%.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749397","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: Why Assessment of ChILI Severity Accurately Matters?","authors":"Mar Riveiro-Barciela, Guruprasad P. Aithal","doi":"10.1111/apt.18385","DOIUrl":"https://doi.org/10.1111/apt.18385","url":null,"abstract":"<p>In a timely study, Hountondji et al. [<span>1</span>] highlight an important limitation of the Common Terminology Criteria for Adverse Events (CTCAE) classification, which is widely used by oncologists in the management of checkpoint inhibitor-induced liver injury (ChILI). Authors found Drug-induced Liver Injury International Expert Working Group (DILI-IEWG) classification of severity had superior performance characteristics in predicting acute liver injury (compared with CTCAE and Model for End-stage Liver Disease) [<span>2</span>]. One of the reasons for inferior performance of CTCAE is because the latter overestimates severity of ChILI as life-threatening on the basis of alanine transaminase levels of 20-fold upper limit normal alone in isolation of other clinical criteria; this leads to avoidable hospital admissions [<span>3</span>]. In contrast, DILI-IEWG was able to predict 3 months of mortality while v5 of the CTCAE that incorporates total bilirubin was not able to [<span>1</span>].</p>\u0000<p>Majority of patients with ChILI are started on high-dose corticosteroid therapy based entirely on CTCAE grading despite lack of evidence in its support [<span>4</span>]. A recent study highlights the value of liver biopsy and incorporation of severity of inflammation on liver histology into decision-making regarding corticosteroid therapy in patients with ChILI [<span>5</span>]; following this strategy, two-thirds of patients classified as having severe ChILI were spared of corticosteroid therapy. Early identification of poor outcome is crucial for planning management of ChILI since these patients are not candidates for liver transplantation in case of acute liver failure development [<span>6</span>].</p>\u0000<p>Although Hountondji et al. [<span>1</span>] focus on the accuracy of methods of grading severity of ChILI, overestimation of severity of this adverse event may lead to unnecessary, prolonged and high dose of corticosteroid therapy in some with consequent complications [<span>4</span>].</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"196 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142742788","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: Critical Insights on a Nationwide Cohort Study of Inflammatory Bowel Disease, Histological Activity and Fracture Risk","authors":"Saad Khan, Aqsa Munir, Fathimathul Henna, Syeda Mashal Fatima, Zulfiqar Ahmad","doi":"10.1111/apt.18336","DOIUrl":"https://doi.org/10.1111/apt.18336","url":null,"abstract":"<p>I am writing in response to the paper ‘A Nationwide Cohort Study of Inflammatory Bowel Disease, Histological Activity, and Fracture Risk’ by Mårild et al. published in Alimentary pharmacology and therapeutics [<span>1</span>]. This study explores the link between fracture risk and histological activity in inflammatory bowel disease (IBD). Using a large cohort of 54,591 IBD patients and comprehensive national health data, the study finds that persistent histological inflammation slightly increases fracture risk compared to histological remission.</p>\u0000<p>While the study offers valuable insights, some methodological concerns should be noted. The findings may lack generalizability, as disease activity is measured only through biopsy histology. Biopsy results can vary based on biopsy techniques and pathologist interpretations across clinical settings. Additionally, although the authors considered some confounders like comorbidities and corticosteroid use, they did not account for factors such as lifestyle choices (e.g., physical activity and calcium intake) or genetic predispositions to bone density loss, both of which can influence fracture risk.</p>\u0000<p>Histological inflammation in IBD is widely recognised to elevate short-term fracture risk by compromising bone health [<span>2</span>]. Research shows that IBD induces systemic inflammation by altering the regulatory protein profile in osteocytes—cells central to bone resorption and formation—which may lead to IBD-related bone loss [<span>2</span>]. Other variables, such as male sex and low BMI, are also associated with a higher fracture risk [<span>3</span>]. Moreover, the risk is notably greater in patients with Crohn's disease compared to those with ulcerative colitis, emphasising the need for focused evaluation in this subgroup [<span>4</span>]. Interestingly, some studies suggest that, unlike adults, children with IBD may not experience a heightened fracture risk, paving the way for further research and discussion [<span>5</span>].</p>\u0000<p>Mårild et al. present valuable evidence on the link between histological activity and fracture risk in IBD. Nevertheless, a more detailed investigation integrating lifestyle influences, genetic susceptibility and clinical complexities is needed to better define the risk profile. Our assessment underscores the importance of broadening the focus of future studies beyond histological evaluations to encompass a holistic approach that considers multiple determinants of bone health. Such initiatives would not only refine fracture risk predictions but also support the development of targeted interventions to prevent osteoporosis and enhance the well-being of IBD patients, addressing a critical yet often overlooked facet of IBD management.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"17 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142742792","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: Integrating Psychological Profiles Into Dietary Interventions for IBS-Commentary on HADS Scores and Treatment Efficacy.","authors":"Chia-Wei Chen, Lien-Chung Wei","doi":"10.1111/apt.18396","DOIUrl":"https://doi.org/10.1111/apt.18396","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737972","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":"Impact of Nonalcoholic Fatty Liver Disease on the Survival of People Living With HIV.","authors":"Juan Macias, Mario Frias, Juan Antonio Pineda, Diana Corona-Mata, Anais Corma-Gomez, Antonio Rivero-Juarez, Marta Santos, Miguel García-Deltoro, Antonio Rivero, Carmen Ricart-Olmos, Alejandro Gonzalez-Serna, Luis Miguel Real","doi":"10.1111/apt.18413","DOIUrl":"https://doi.org/10.1111/apt.18413","url":null,"abstract":"<p><strong>Background: </strong>Nonalcoholic fatty liver disease (NAFLD) is an increasing concern for people living with HIV (PLWH). However, information on the impact of NAFLD on the prognosis of PLWH is very scarce.</p><p><strong>Aims: </strong>To investigate the influence of NAFLD on the overall and liver-related mortality in PLWH.</p><p><strong>Methods: </strong>PLWH followed in three Spanish centres were included in a prospective cohort at the date of the first transient elastography evaluation. Survival data were recorded, and the causes of death were centrally monitored. The risk of all-cause death and liver-related death was evaluated by applying time-to-event analyses.</p><p><strong>Results: </strong>A total of 2151 PLWH were included in the cohort and followed for a median (Q1-Q3) of 7.3 (3.5-10.4) years. There were 174 (8.1%) deaths. The probability of overall death and liver-related death was associated with liver stiffness measurement (LSM) and with FibroScan-AST (FAST) score. Among 844 PLWH with potential for NALFD, LSM was independently associated with all-cause mortality (adjusted hazard ratio [AHR], by 1 kPa increase: 1.06; 95% confidence interval [95% CI]: 1.04-1.08; p < 0.001). In a separate model and after adjustment, FAST score ≥ 0.67 was related to survival (AHR: 1.87; 95% CI: 1.40-2.50; p < 0.001). The AUROC (95% CI) of the models were based on LSM, 0.812 (0.739-0.885); and FAST, 0.825 (0.753-0.897) (p = 0.386).</p><p><strong>Conclusions: </strong>For PLWH, advanced liver fibrosis increases the risk of overall death and liver-related death. LSM and the FAST score are similar predictors of survival for PLWH with potential for NAFLD.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737968","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}