Alimentary Pharmacology & Therapeutics最新文献

{"title":"Obesity Is Associated With Worsened Outcomes in Patients With Ulcerative Colitis on Advanced Therapies: A Propensity Matched Cohort Study From the U.S.","authors":"Aakash Desai, Priya Sehgal, Himsikhar Khataniar, James D. Lewis, Francis A. Farraye, Gary R. Lichtenstein, Gursimran S. Kochhar","doi":"10.1111/apt.18513","DOIUrl":"https://doi.org/10.1111/apt.18513","url":null,"abstract":"Obesity has been linked to a more severe phenotype in patients with ulcerative colitis (UC).","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"277 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020911","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: Enhancing HCC Surveillance: GES Score Represents an Innovative Simple Effective Tool for Risk Stratification, Patient Safety and Reduced Anxiety—Authors' Reply","authors":"Gamal Shiha,&nbsp;Riham Soliman","doi":"10.1111/apt.18494","DOIUrl":"10.1111/apt.18494","url":null,"abstract":"<p>We would like to express our appreciation to Dr. Gueye, World Hepatitis Alliance Afro Regional Board Member and Honour President of Saafara Hépatites Sénégal, for his insightful letter on the advantages of the General Evaluation Score (GES) in hepatocellular carcinoma (HCC) surveillance [<span>1</span>].</p><p>We agree with him that the GES score simplicity and practicality as a bedside tool make it accessible and easy to use in clinical practice [<span>2, 3</span>]. The ability to individualise surveillance using readily available routine blood tests, without reliance on costly or uncommon serum biomarkers that are not regularly performed in clinical practice [<span>4</span>], is a significant advantage. The low cost or no cost of the GES score, derived from routine laboratory tests that are already part of standard clinical care, ensures its practicality for widespread implementation, especially in developing countries where public health funds are limited.</p><p>The emphasis on reducing patient anxiety through tailored surveillance intervals further underscores the patient-centred approach of the GES scoring system. High-risk patients benefit from more frequent monitoring, ensuring timely intervention, while low-risk patients avoid unnecessary procedures, minimising their physical, emotional and financial burdens. I fully support initiatives advocating for its broader application and look forward to further studies affirming its value in diverse patient populations.</p><p>The authors' declarations of personal and financial interests are unchanged from those in the original article [<span>5</span>].</p><p><b>Gamal Shiha:</b> conceptualization, investigation, writing – review and editing, project administration, supervision. <b>Riham Soliman:</b> writing – original draft, methodology, data curation.</p><p>This article is linked to Shiha et al papers. To view these articles, visit https://doi.org/10.1111/apt.18291 and https://doi.org/10.1111/apt.18434.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 5","pages":"913-914"},"PeriodicalIF":6.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.18494","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020913","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: Enhancing HCC Surveillance–GES Score Represents an Innovative Simple Effective Tool for Risk Stratification, Patient Safety and Reduced Anxiety","authors":"Ibrahima Gueye","doi":"10.1111/apt.18434","DOIUrl":"10.1111/apt.18434","url":null,"abstract":"<p>We read with interest the article by Shiha et al., titled ‘Individualized HCC Surveillance Using Risk Stratification Scores in Advanced Fibrosis and Cirrhotic HCV Patients Who Achieved SVR: A Prospective Study’ [<span>1</span>].</p><p>As a board member of World Hepatitis Alliance representing African region and as a patient who developed cirrhosis, I was fortunate to receive liver transplantation in time following diagnosis of HCC at early stage. I am particularly encouraged by the development of the General Evaluation Score (GES) as a practical, easy to use, bedside and effective tool for stratifying the risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV)-related liver cirrhosis. The GES represents a significant advancement in our ability to safely monitor at-risk patients while optimising the allocation of healthcare resources.</p><p>This prospective study by Shiha et al. [<span>1</span>] individualised patient surveillance according to the calculated GES is particularly suitable for developing countries with limited healthcare facilities and public health funds.</p><p>In high-risk patients, we recognise the critical role of tailored surveillance. By employing more frequent follow-ups, the use of GES facilitates the early detection of HCC, significantly enhancing the efficacy of available treatments. For patients at low risk, shiha et al.'s strategy reduces the frequency of surveillance visits, limiting their exposure to potentially harmful diagnostic procedures, which in turn decreases their anxiety and financial strain. Intermediate-risk patients are monitored according to established guidelines, ensuring they receive appropriate care without unnecessary interventions.</p><p>In conclusion, the GES represents a significant advancement in the field of HCC surveillance, particularly for developing countries. Its simplicity, suitability for real-life application and ability to individualise screening plans make it a valuable tool for improving patient outcomes and optimising healthcare resources, while enhancing patient safety and comfort. Therefore, we advocate for its wider validation and adoption in developing countries, particularly across Africa, to support patient organisations and healthcare providers in their efforts to combat HCC effectively.</p><p><b>Ibrahima Gueye:</b> writing – original draft, writing – review and editing.</p><p>The author declares no conflicts of interest.</p><p>This article is linked to Shiha et al papers. To view these articles, visit https://doi.org/10.1111/apt.18291 and https://doi.org/10.1111/apt.18494.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 5","pages":"911-912"},"PeriodicalIF":6.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.18434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020910","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":"Review Article: Rome Foundation Working Team Report: Consensus Statement on the Design and Conduct of Behavioural Clinical Trials for Disorders of Gut–Brain Interaction","authors":"Helen Burton-Murray,&nbsp;Livia Guadagnoli,&nbsp;Kendra Kamp,&nbsp;Inês A. Trindade,&nbsp;Lynda H. Powell,&nbsp;Magnus Simrén,&nbsp;Brjánn Ljótsson,&nbsp;Laurie Keefer","doi":"10.1111/apt.18482","DOIUrl":"10.1111/apt.18482","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Brain–gut behaviour therapies (BGBT) have gained widespread acceptance as therapeutic modalities for the management of disorders of gut–brain interaction (DGBI). However, existing treatment evaluation methods in the medical field fail to capture the specific elements of scientific rigour unique to behavioural trial evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To offer the first consensus on the development and testing of BGBT in DGBI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An international, interdisciplinary team of experts developed a consensus statement heavily informed by best practice recommendations for behavioural clinical trials for chronic diseases, organised by a selected treatment development model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We suggest an existing behavioural treatment development model that has an iterative progression aligned with the drug development model with nuances specific to BGBT. We describe the iterative phases through initial discovery and experimental work, assembly of a mechanistic pathway and candidate treatment components, treatment refinement and optimisation, initial proof-of-concept, feasibility of clinical trials and, finally, confirmatory efficacy and effectiveness testing. We delineate recommendations for and provide examples that lend themselves to gastroenterologists planning to develop or test BGBT, reviewing proposals for or results from BGBT studies or writing management guidelines for DGBI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This working team report facilitates a shared understanding of the elements of scientific rigour necessary for BGBT development and could support future standards on which BGBT are evaluated in gastroenterology.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 5","pages":"787-802"},"PeriodicalIF":6.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991462","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":"Retrospective Cohort Study: Scope for Improvement—Barriers to Post-Polypectomy Surveillance in the Integrated Technologies for Improved Polyp Surveillance Cohort","authors":"Charlotte Mathews, Aleena Nauman, Mark Johnstone, Reiss Stoops, Alexander Tham, Emma C. Parsons, Kathryn A. Robb, William Sloan, Gerard Lynch, Joanne Edwards, Stephen T. McSorley","doi":"10.1111/apt.18514","DOIUrl":"https://doi.org/10.1111/apt.18514","url":null,"abstract":"Adherence to post-polypectomy surveillance is poor despite evidence that it is associated with lower risk of future colorectal cancer.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"9 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142990521","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":"Network Meta-Analysis: Comparison of Endoscopic Dysplasia Detection Technologies in Inflammatory Bowel Disease","authors":"Mohammad Shehab,&nbsp;Ahmed Al-Hindawi,&nbsp;Fatema Alrashed,&nbsp;Sanjay Murthy,&nbsp;Raf Bisschops,&nbsp;Frank Hoentjen,&nbsp;Alan Barkun,&nbsp;Siddharth Singh,&nbsp;Talat Bessissow","doi":"10.1111/apt.18500","DOIUrl":"10.1111/apt.18500","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Novel colorectal cancer endoscopic surveillance techniques for inflammatory bowel disease (IBD) have recently been developed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Compare the efficacy of currently available techniques for dysplasia detection in colonic IBD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic literature search from inception to March 2024 for randomized controlled trials (RCTs) or prospective cohort studies enrolling adults with IBD and having surveillance colonoscopy for dysplasia screening. Primary outcome was the number of dysplastic lesions (per-lesion analysis). Secondary outcome was the number of patients with dysplasia (per-patient analysis). We assessed endpoints using the frequentist NMA random effect model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 25 studies (22 RCTs). 4837 patients met eligibility criteria (850 total dysplastic lesions; 105 with advanced dysplasia). Nine different screening techniques were studied. In per-lesion analysis, dye-based chromoendoscopy (DCE) ranked the highest (83%) per SUCRA ranking. DCE was superior to HD-WLE (OR, 1.78; 95% CI, 1.06–3.00). There were no significant differences between NBI and DCE, HD-WLE with SR or CEM in head-to-head comparisons. In a sub-analysis confined to ulcerative colitis (UC), DCE ranked highest (98%) with per-lesion analysis, and was superior to NBI (OR, 1.69; 95% CI, 1.03–2.77).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HD-WLE-SR, DCE and CEM demonstrated superiority over other techniques for detection of dysplasia in colonic IBD. DCE was superior for dysplasia detection in colonic IBD. DCE was superior to HD-WLE in colonic IBD. DCE was the best technique in UC. Further studies to compare HD-WLE-SR and NBI with DCE are warranted to ascertain performance equivalency and define the optimal surveillance technique.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 6","pages":"938-949"},"PeriodicalIF":6.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988731","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: Safety and Effects of Direct Oral Anticoagulants for Portal Vein Thrombosis","authors":"Nina Kimer,&nbsp;Lise Hobolth,&nbsp;Lise Lotte Gluud","doi":"10.1111/apt.18512","DOIUrl":"10.1111/apt.18512","url":null,"abstract":"&lt;p&gt;Portal vein thrombosis (PVT) is a serious complication in chronic liver disease, mainly occurring in patients with portal hypertension [&lt;span&gt;1&lt;/span&gt;]. The pathophysiology of PVT includes a combination of venous stasis, hypercoagulability and endothelial dysfunction, leading to reduced portal flow velocity and stagnation of blood in the splanchnic circulation [&lt;span&gt;2, 3&lt;/span&gt;]. PVT is associated with a range of complications in cirrhosis, including variceal bleeding and ascites and PVT may become a contraindication for liver transplantation [&lt;span&gt;4&lt;/span&gt;]. Many cases are asymptomatic and detected incidentally during routine imaging. Symptomatic presentations include abdominal pain, worsening ascites or gastrointestinal bleeding. Treatment aims at achieving recanalisation with anticoagulation [&lt;span&gt;5&lt;/span&gt;]. The safety of anticoagulation in cirrhosis requires consideration, especially in those with coagulopathy or varices.&lt;/p&gt;&lt;p&gt;Acute-on-chronic PVT involves thrombus formation superimposed on a background of long-standing partial obstruction, often presenting more subtly but with potential for worsening liver function. PVT in people without cirrhosis is mainly acute and often due to an acquired or inherited prothrombotic condition [&lt;span&gt;5, 6&lt;/span&gt;]. Although treatment principles are similar, non-cirrhotic cases generally have fewer risks related to coagulopathy, altering the safety and efficacy profile of anticoagulation therapy. In a study of 102 patients with acute PVT without cirrhosis, recanalisation of the portal vein was achieved in 39% following anticoagulation with vitamin K antagonists (VKA) and nine experienced gastrointestinal bleeding [&lt;span&gt;6&lt;/span&gt;]. Treating PVT with direct oral anticoagulants (DOACs) offers several advantages over VKA including a more predictable effect eliminating the need for frequent monitoring. In a meta-analysis of 10 observational studies and one randomised trial including patients with cirrhosis and PVT, DOACs were associated with recanalisation in 87% [&lt;span&gt;7&lt;/span&gt;]. Premkumar et al. report their experience with dabigatran for benign PVT [&lt;span&gt;8&lt;/span&gt;]. The rate of recanalisation was assessed for 72 patients with cirrhosis and 47 without cirrhosis receiving dabigatran. Comparison groups consisted of 28 patients (18 with cirrhosis) who declined treatment and six patients with CP &gt; 10 who received VKA. Recanalisation occurred in 56 (47.1%) patients treated with dabigatran and more frequently in acute compared to acute-on-chronic PVT. The large proportion of patients with acute on chronic PVT may partly explain the relatively low number of patients who achieved recanalisation. A large number of patients were identified through screening for portal hypertension rather than based on symptoms or incidental findings, which may impact results.&lt;/p&gt;&lt;p&gt;None of the patients treated with VKA and 6 (21.4%) without treatment experienced spontaneous recanalisation. The overall adverse event rate of dabig","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 6","pages":"1061-1062"},"PeriodicalIF":6.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.18512","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988732","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":"Head-to-Head Comparison Between Phosphatidylethanol Versus Indirect Alcohol Biomarkers for Diagnosis of MetALD Versus MASLD: A Prospective Study","authors":"Federica Tavaglione,&nbsp;Maral Amangurbanova,&nbsp;Alexander H. Yang,&nbsp;Monica A. Tincopa,&nbsp;Veeral Ajmera,&nbsp;Lisa Richards,&nbsp;Christian Butcher,&nbsp;Christie Hernandez,&nbsp;Egbert Madamba,&nbsp;Seema Singh,&nbsp;Ricki Bettencourt,&nbsp;Claude B. Sirlin,&nbsp;Rohit Loomba","doi":"10.1111/apt.18506","DOIUrl":"10.1111/apt.18506","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The current subclassification of steatotic liver disease (SLD) relies on validated questionnaires, such as Alcohol Use Disorders Identification Test (AUDIT) and Lifetime Drinking History (LDH), which, while useful, are impractical and lack precision for their use in routine clinical practice. Phosphatidylethanol (PEth) is a quantitative, objective alcohol biomarker with high sensitivity and specificity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To assess the diagnostic accuracy of PEth for differentiating metabolic dysfunction and alcohol-associated liver disease (MetALD) from metabolic dysfunction-associated steatotic liver disease (MASLD) in a large, population-based, prospective, multiethnic cohort of individuals with overweight or obesity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a cross-sectional analysis of a prospective study including 374 adults with overweight or obesity residing in Southern California who had SLD as defined by MRI-PDFF ≥ 5%. The clinical research visit included medical history, biochemical and PEth testing, standardised validated questionnaires (including AUDIT and LDH), physical examination, and advanced imaging using MRI-PDFF and MRE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 374 adults with SLD, the prevalence of MASLD, MetALD, and ALD was 90.1%, 6.4%, and 3.5%, respectively. PEth had a robust diagnostic accuracy in the detection of MetALD (AUROC 0.81, 95%CI 0.73–0.89) and the Youden cut-off was 25 ng/mL. In head-to-head comparative efficacy analysis, PEth was both statistically and clinically superior to all previously used indirect alcohol biomarkers for diagnosing MetALD, including aspartate aminotransferase/alanine aminotransferase ratio, mean corpuscular volume, gamma glutamyltransferase, and ALD/NAFLD index (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PEth outperforms previously used non-invasive tests in differentiating MetALD from MASLD and has the potential to change clinical practice by enhancing the subclassification of SLD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 6","pages":"1043-1054"},"PeriodicalIF":6.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988785","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: PCAB Safety: Balancing Potential Long-Term Risks With Short-Term Benefits","authors":"Stephanie Owyang,&nbsp;Wai-Kit Lo","doi":"10.1111/apt.18507","DOIUrl":"10.1111/apt.18507","url":null,"abstract":"&lt;p&gt;Potassium-competitive acid blockers (PCABs), such as vonoprazan, provide more rapid, potent and prolonged acid suppression than proton pump inhibitors (PPIs), and as such may offer advantages in the treatment of GERD and other acid-related disorders. PPI-related adverse effects, including enteric infection, pneumonia, and micronutrient deficiencies, have been attributed primarily to gastric acid suppression [&lt;span&gt;1&lt;/span&gt;], which raises concerns that treatment-emergent adverse events (TEAEs) could be more profound with PCAB use.&lt;/p&gt;&lt;p&gt;The current study by Howden et al. [&lt;span&gt;2&lt;/span&gt;] found that vonoprazan is well-tolerated, with a safety profile comparable to PPIs. This is based on an assessment of TEAEs across 14 clinical trials of vonoprazan compared with lansoprazole, esomeprazole or placebo, in addition to post-marketing data from 2014–2023. While the short-term safety of vonoprazan seems supported, the study's mean exposure duration of 142 days (20 weeks/5 months) and maximum duration of 260 weeks (5 years) may offer an incomplete assessment of the longer-term safety profile. Notably, several PPI-associated TEAEs can only be fully evaluated after chronic exposure, including bone fracture, vitamin B12 deficiency and gastric malignancy.&lt;/p&gt;&lt;p&gt;&lt;i&gt;Bone fracture&lt;/i&gt; has been associated with PPI use of at least 7 years, but not less than 6 years [&lt;span&gt;3&lt;/span&gt;]; thus, the duration of vonoprazan exposure in this analysis may not be sufficient to detect an increased incidence of fractures. The associated mechanism may be due to calcium and magnesium malabsorption, which occurs over 5–10 years [&lt;span&gt;4&lt;/span&gt;]. Additionally, while the impact of PPI on bone mineral density is controversial, the timing of osteoporosis development in women can exceed 10 years [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;&lt;i&gt;Vitamin B12&lt;/i&gt; can take 3–5 years to deplete in the body, usually presenting with no or minimal symptoms in the short term and can take additional years to decades to manifest clinically as glossitis, anaemia or neuropsychiatric dysfunction [&lt;span&gt;6&lt;/span&gt;], though the association between chronic PPI use and dementia remains controversial [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;&lt;i&gt;Gastric malignancy&lt;/i&gt; often arises as a subacute process, with a median time to progression of 6.1 years from nondysplastic gastric intestinal metaplasia to adenocarcinoma [&lt;span&gt;8&lt;/span&gt;]. Risk of gastric cancer increased with cumulative PPI dose as well as longer duration of therapy (&gt; 3 years) [&lt;span&gt;9&lt;/span&gt;], though this association was inconsistent across studies and may involve various mechanisms, including &lt;i&gt;H. pylori&lt;/i&gt; infection and alterations in GI microbiota [&lt;span&gt;10&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Of note, other serious adverse events that were identified as potentially related to vonoprazan use by investigators included acute cholangitis, diverticulitis, malignancies, acute thyroiditis, atrial fibrillation and transient loss of consciousness. Additional evaluation is needed to determine the frequen","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 5","pages":"909-910"},"PeriodicalIF":6.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.18507","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987499","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":"Inflammatory Potential of the Diet and Risk of Crohn's Disease and Ulcerative Colitis","authors":"Antoine Meyer,&nbsp;Simon S. M. Chan,&nbsp;Mathilde Touvier,&nbsp;Chantal Julia,&nbsp;Anne Tjønneland,&nbsp;Cecilie Kyrø,&nbsp;Christina C. Dahm,&nbsp;Verena A. Katzke,&nbsp;Matthias B. Schulze,&nbsp;Rosario Tumino,&nbsp;Carlotta Sacerdote,&nbsp;Giovanna Masala,&nbsp;Bas Oldenburg,&nbsp;Marcela Guevara,&nbsp;Luis Bujanda,&nbsp;Natalia A. Cabrera Castro,&nbsp;Tammy Y. N. Tong,&nbsp;Alicia K. Heath,&nbsp;Mélanie Deschasaux-Tanguy,&nbsp;Serge Hercberg,&nbsp;Pilar Galan,&nbsp;Yahya Mahamat-Saleh,&nbsp;Gianluca Severi,&nbsp;Franck Carbonnel,&nbsp;Aurélien Amiot","doi":"10.1111/apt.18497","DOIUrl":"10.1111/apt.18497","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Association between dietary factors and the risk of developing inflammatory bowel disease (IBD) has been studied extensively. However, identification of deleterious dietary patterns merits further study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the risk of developing Crohn's disease (CD) and ulcerative colitis (UC) according to the inflammatory score of the diet (ISD) in the multinational European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used validated food frequency questionnaires collected at baseline to compute ISD scores. We estimated the association between ISD score and risks of CD and UC risks using Cox models stratified by centre, sex and age. We adjusted for smoking status, BMI, physical activity, energy intake, educational level and alcohol intake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 394,255 individuals including 184 incident cases of CD and 459 of UC after median follow-up of 13.6 years (4,889,910 person-years). High ISD scores were associated with a higher risk of CD (fourth vs. first quartile-adjusted HR: 1.88, 95% CI: 1.14–3.10; <i>p</i>-trend &lt; 0.01) but not of UC (adjusted HR: 0.85, 95% CI: 0.63–1.15; <i>p</i>-trend 0.21). For CD, this association was mainly observed for women (adjusted HR: 2.14, 95% CI: 1.17–3.91; <i>p</i>-trend &lt; 0.01). On subgroup analyses, those differences were mainly driven by low intakes of fibre, mono-unsaturated fatty acids, vitamin C, magnesium, onion and alcohol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A high ISD score is associated with a higher risk of developing CD but not UC. These results should be taken into account in high-risk populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 6","pages":"1032-1042"},"PeriodicalIF":6.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987153","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}