Alimentary Pharmacology & Therapeutics最新文献

{"title":"Editorial: Risk of Incident Type 2 Diabetes and Prediabetes in Patients With Direct Acting Antiviral-Induced Cure of Hepatitis C Virus Infection—Authors' Reply","authors":"Yu-Ping Chang, Jia-Horng Kao, Chen-Hua Liu","doi":"10.1111/apt.70065","DOIUrl":"10.1111/apt.70065","url":null,"abstract":"<p>We sincerely appreciate Drs. Tamaki and Kurosaki's insightful comments on our work regarding the clinical impact of incident type 2 diabetes (T2D) and prediabetes among patients with direct-acting antiviral (DAA)-induced viral clearance [<span>1, 2</span>]. While hepatitis C virus (HCV) infection can be eradicated using a short course of potent oral antiviral agents, the presence of T2D or prediabetes has been demonstrated to be adversely associated with liver-related outcomes, including hepatocellular carcinoma (HCC), hepatic decompensation and fibrosis progression [<span>3-5</span>]. Additionally, current evidence also shows that T2D and prediabetes are key driving cardiometabolic risk factors (CMRFs) in the development of metabolic dysfunction-associated steatotic liver disease (MASLD), which indirectly affects HCC development [<span>4</span>]. Because our findings reveal that the age-standardised incidence rates (ASIRs) of T2D and prediabetes among patients following DAA-induced viral cure remain substantial, early detection of incident T2D or prediabetes in at-risk populations, along with timely lifestyle, medical or surgical interventions for those diagnosed with T2D or prediabetes, is crucial to improving long-term health-related outcomes.</p><p>Among the HCV viremic carriers, both MASLD and old age are highly associated with hyperferritinemia [<span>6</span>]. This is consistent with a recent report demonstrating a strong link between MASLD, T2D and hyperferritinemia in non-HCV individuals [<span>7</span>]. Moreover, patients who achieve HCV cure through antiviral therapies exhibit a more favourable time-dependent trend in ferritin dynamics compared to those who do not achieve viral cure. This reflects the benefits of resolving hepatic inflammation and fibrosis following viral eradication [<span>8</span>]. The complex interplay among MASLD, hyperferritinemia, T2D/prediabetes, and age in influencing long-term hepatic and extrahepatic outcomes following HCV cure warrants further in-depth research.</p><p>In addition to early detection of T2D and prediabetes through rigorous surveillance, maintaining well-controlled glycemic status through various interventions is essential for patients diagnosed with T2D or prediabetes to achieve favourable hepatic and cardiovascular outcomes [<span>9</span>]. The use of glucagon-like peptide-1 receptor (GLP1R) agonists, alone or in combination with glucagon receptor (GCGR) or glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, may benefit glycemic control in these patients. Additionally, the effects of combining selective thyroid hormone receptor-beta (THR-β) or fibroblast growth factor 21 (FGF21) agonists in patients with significant hepatic fibrosis warrant further investigation [<span>10</span>].</p><p><b>Yu-Ping Chang:</b> writing – review and editing, writing – original draft. <b>Jia-Horng Kao:</b> writing – review and editing, writing – original draft. <b>Chen-Hua Liu:</b> writing","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 9","pages":"1553-1554"},"PeriodicalIF":6.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526426","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":"Effects of a 12-Week Mediterranean-Type Time-Restricted Feeding Protocol in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Randomised Controlled Trial—The ‘CHRONO-NAFLD Project’","authors":"Sofia Tsitsou,&nbsp;Triada Bali,&nbsp;Magdalini Adamantou,&nbsp;Aristi Saridaki,&nbsp;Kalliopi-Anna Poulia,&nbsp;Dimitrios S. Karagiannakis,&nbsp;Emilia Papakonstantinou,&nbsp;Evangelos Cholongitas","doi":"10.1111/apt.70044","DOIUrl":"10.1111/apt.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Mediterranean diet (MD) is considered the best dietary approach for patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Recently, time-restricted feeding (TRF) has gained attention for its lifestyle compatibility and health benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to compare the effects of a hypocaloric MD with a 10-h TRF protocol to an unrestricted MD in MASLD patients with overweight/obesity and evaluate differences between early and late TRF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This 12-week randomised controlled trial in MASLD patients with overweight/obesity consisted of three groups, all following a hypocaloric Mediterranean-type diet. The control group had no eating time restrictions. The early TRF (eTRF) and late TRF (lTRF) groups had a 10-h eating window, from 8 AM to 6 PM and from 12 PM to 10 PM, respectively. Various health parameters were measured. Compliance was tracked via food diaries, and an 8-week follow-up occurred post-intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-nine MASLD individuals (27 males; 52.9 years; body mass index 32.1 kg/m²) completed the trial (control, <i>n</i> = 19; eTRF, <i>n</i> = 20; lTRF, <i>n</i> = 20). All groups showed significant 12-week reductions in body weight, anthropometry and blood pressure. Glycated haemoglobin A_1c and insulin resistance, as measured by the Matsuda index, homeostatic model assessment for insulin resistance and fasting glucose-to-insulin ratio, improved in the eTRF group at 12 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study corroborates the efficacy of MD in ameliorating cardiometabolic risk factors such as body weight and blood pressure in MASLD patients. The combination with an eTRF protocol may improve glycaemic control (NCT05866744).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The study is registered at clinicaltrials.gov (NCT05866744)</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 8","pages":"1290-1309"},"PeriodicalIF":6.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517930","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: Beyond Clinical Trials—Real-World Data Suggest Usefulness of GLP-1 RAs in MASLD Treatment. Authors' Reply","authors":"Chia-Chih Kuo,&nbsp;Min-Hsiang Chuang,&nbsp;Chun-Hsien Li,&nbsp;Ya-Wen Tsai,&nbsp;Po-Yu Huang,&nbsp;Hsing-Tao Kuo,&nbsp;Chih-Cheng Lai","doi":"10.1111/apt.70063","DOIUrl":"10.1111/apt.70063","url":null,"abstract":"&lt;p&gt;We sincerely appreciate the opportunity to respond to the invited editorial by Candels and Strnad discussing our study on the effectiveness of GLP-1 receptor agonists (GLP-1 RAs) in metabolic dysfunction-associated steatotic liver disease (MASLD) [&lt;span&gt;1, 2&lt;/span&gt;]. We are grateful for their insightful commentary and for highlighting the strengths of real-world data in capturing long-term outcomes beyond the constraints of clinical trials. We acknowledge their concerns regarding the short follow-up period and potential bias from including patients with advanced hepatic fibrosis at baseline. To address these concerns, we conducted this retrospective study to evaluate the effect of GLP-1 RAs on MASLD patients with a lower fibrosis burden at baseline.&lt;/p&gt;&lt;p&gt;As in our previous studies [&lt;span&gt;2-4&lt;/span&gt;], we utilised the TriNetX Research Network, a multinational and multi-institutional database. We identified patients with MASLD and type 2 diabetes (T2D) from this database. We included only those who had undergone abdominal ultrasound imaging (CPT 1010775) and had no prior diagnostic codes for hepatic fibrosis or cirrhosis (ICD-10 K74), representing a population with a lower likelihood of pre-existing significant fibrosis. We then identified patients with their first prescription for either a GLP-1 RA or a sodium-glucose cotransporter-2 inhibitor (SGLT2i) and conducted a propensity score-matched (PSM) cohort study to balance baseline characteristics between the two groups. We measured the risk of major adverse liver outcomes (MALOs), a composite endpoint consisting of decompensated cirrhosis events, hepatocellular carcinoma, and liver transplantation during the follow-up period.&lt;/p&gt;&lt;p&gt;After PSM, 5993 individuals remained in each of the GLP-1 RA and SGLT2i groups for outcome analyses, with a mean follow-up time of 34.9 months. Compared to SGLT2i new users, GLP-1 RA new users showed a significantly lower risk of MALOs (hazard ratio [HR], 0.77; 95% CI: 0.59–0.99, Table 1). The GLP-1 RA group also demonstrated significantly lower risks of all-cause mortality (HR, 0.72; 95% CI: 0.72–0.85) and decompensating events (HR, 0.78; 95% CI: 0.59–1.00). Additionally, the GLP-1 RA group showed non-significantly lower risks of variceal bleeding, hepatic encephalopathy, ascites-related complications, hepatocellular carcinoma, and liver transplant (Table 1).&lt;/p&gt;&lt;p&gt;These findings indicate the potential protective effects of GLP-1 RAs against MALOs in MASLD patients with a lower fibrosis burden. These additional analyses strengthen our initial findings and demonstrate that the beneficial impact of GLP-1 RAs extends beyond patients with advanced fibrosis to a broader MASLD population. This reinforces the clinical utility of GLP-1 RAs in MASLD management, complementing evidence from a randomised controlled trial [&lt;span&gt;5&lt;/span&gt;] and supporting their consideration in hepatology practice [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In conclusion, we appreciate the opportunity to engage in th","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 8","pages":"1402-1403"},"PeriodicalIF":6.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518498","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":"Steatotic Liver Disease Prevalence in China: A Population-Based Study and Meta-Analysis of 17.4 Million Individuals","authors":"Zhenqiu Liu,&nbsp;Jiayi Huang,&nbsp;Luojia Dai,&nbsp;Huangbo Yuan,&nbsp;Yanfeng Jiang,&nbsp;Chen Suo,&nbsp;Li Jin,&nbsp;Tiejun Zhang,&nbsp;Xingdong Chen","doi":"10.1111/apt.70051","DOIUrl":"10.1111/apt.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Steatotic liver disease (SLD), including metabolic dysfunction-associated SLD (MASLD), has emerged as a leading cause of chronic liver disease in China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aimed to provide a comprehensive and updated description of SLD prevalence in China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We described the prevalence, subgroup distribution, and clinical characteristics of SLD in the Taizhou Study of Liver Diseases (T-SOLID). Additionally, we searched for studies reporting SLD prevalence in five databases. Eligible data were analysed using a generalised linear mixed model. Linear regression was applied to estimate the annual average percentage change (AAPC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 28,623 participants in T-SOLID, 30.8% were diagnosed with SLD, among which 83.8% were classified as MASLD. Prevalence of SLD increased from 22.1% in 2018 to 36.7% in 2021. The meta-analysis included 792 publications and 17,404,296 subjects. Nationwide, the pooled SLD prevalence rose from 23.8% (95% CI 21.9%–25.9%) during 2001–2010 to 27.9% (26.0%–29.8%) during 2016–2023 in the general population (AAPC = 2.56, <i>p</i> &lt; 0.0001), equating to approximately 402.0 million cases. An increase in SLD prevalence was observed in subpopulations by region, sex, and age, and in high-risk groups. Northeast China had the highest prevalence (35.0%). Males had a higher prevalence rate than females (35.0% vs. 20.6%). SLD prevalence increased with age, ranging from 8.1% in children and adolescents to 31.8% in the elderly. Meta-regression identified calendar period, age, sex, geographical area, and residence area as significant determinants of SLD prevalence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The ubiquitously rising prevalence of SLD in Chinese populations underscores the urgent need for targeted public health interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 7","pages":"1110-1122"},"PeriodicalIF":6.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514107","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":"Differential Characteristics and Survival Outcomes of Patients With Cirrhosis According to Underlying Liver Aetiology.","authors":"Yu Shi, Nicholas Chien, Ashley Fong, Vy H Nguyen, Surya Teja Gudapati, Angela Chau, Sally Tran, Linda Henry, Ramsey Cheung, Changqing Zhao, Minjuan Jin, Mindie H Nguyen","doi":"10.1111/apt.70059","DOIUrl":"https://doi.org/10.1111/apt.70059","url":null,"abstract":"<p><strong>Background and aims: </strong>Updated data on the survival of patients with cirrhosis are limited, especially for subgroups by specific liver disease aetiology. To inform practice, future modelling studies, and public health planning, our study aimed to provide updated and granular data on survival outcomes of patients with cirrhosis stratified by liver disease aetiology. We also assessed their changes over time.</p><p><strong>Methods: </strong>We analysed 8726 consecutive adult patients with cirrhosis who presented at Stanford university medical center during 1/2005-1/2022.</p><p><strong>Results: </strong>8726 Patients had the following etiologies: hepatitis C virus (HCV) (28.1%), hepatitis B virus (HBV) (4.8%), alcohol-associated (ALD, 33.3%), metabolic-associated steatotic liver disease (MASLD) (9.5%), autoimmune (9.6%), cryptogenic (8.2%) and other etiologies (6.5%). Patients with cryptogenic cirrhosis had the lowest overall 5-, 10-, and 15-year cumulative survival (57.5%, 34.3% and 21.4%), as well as for liver and nonliver-related death, followed by ALD, MASLD, HCV, and autoimmune, while HBV patients had the best survival (86.0%, 70.1% and 65.1%), respectively. On multivariable Cox regression, cryptogenic cirrhosis (vs. HBV) was associated with the highest risk of all-cause death (aHR: 2.24, 95% CI 1.67-3.00), followed by MASLD and ALD (all p < 0.001). Post-2010 time was associated with a 33% lower risk of all-cause death (p = 0.0011); While in the post-2010 period, MASLD (vs. HBV) was associated with the highest risk of all-cause death (aHR: 1.92, 95% CI 1.32-2.80, p < 0.001) followed by cryptogenic and ALD.</p><p><strong>Conclusions: </strong>Survival outcomes in patients with cirrhosis varied by aetiology and have changed over time, which should be taken into account for future practice guidelines and modelling studies.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514086","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":"Women's Health Disorders in a Coeliac Disease Population After Diagnosis-A Nationwide Cohort Analysis.","authors":"Rama Nanah, Claire Jansson-Knodell, Arjun Chatterjee, Robana Nanah, M Housam Nanah, Jehad Almasri, Andrew Ford, Osama Hamid, Ahmed Telbany, Alberto Rubio-Tapia","doi":"10.1111/apt.70053","DOIUrl":"https://doi.org/10.1111/apt.70053","url":null,"abstract":"<p><strong>Background: </strong>There is a female predominance of diagnosed coeliac disease with sex-related differences in clinical presentation. Delayed menarche, infertility and pregnancy complications have been linked to poor nutritional status and autoimmune mechanisms, but women's health data in coeliac disease are scant and contradictory.</p><p><strong>Aim: </strong>To describe rates of women's health disorders in US patients with coeliac disease.</p><p><strong>Methods: </strong>We used TriNetX, a database of 80 healthcare organisations, for a retrospective observational analysis. Coeliac disease was identified using ICD-10 code (K90.0) and positive coeliac serology. Women aged 10-60 years with coeliac disease were compared to ambulatory women without a diagnosis of coeliac disease or positive coeliac serology. We divided women into age groups matched by propensity score.</p><p><strong>Results: </strong>We identified > 25,000,000 outpatient women without coeliac disease, and 9368 with coeliac disease. Patients with coeliac disease were younger (mean 25 vs. 28.5 years) and had lower mean BMI (24.6 vs. 26.1). Women with coeliac disease had higher odds of later women's health conditions including absent/rare menstruation (4.6% vs. 2.0%; OR 2.34), infertility (1.4% vs. 0.9%; OR 1.69), polycystic ovarian syndrome (3.3% vs. 1.0%; OR 3.2), menopausal disorders (4.3% vs. 1.56%; OR 285) and primary ovarian failure (0.96% vs. 0.16%; OR 6.25).</p><p><strong>Conclusions: </strong>Women with coeliac disease have higher frequencies of subsequent women's health disorders related to ovarian function, menstruation, fertility and menopause. Clinicians should be aware of these associations to detect women's health disorders during longitudinal coeliac care and promptly refer for a multidisciplinary approach with obstetrics and gynaecology.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514191","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":"Multicentre Study of 10,369 Symptomatic Patients Comparing the Diagnostic Accuracy of Colon Capsule Endoscopy, Colonoscopy and CT Colonography","authors":"James Turvill,&nbsp;Monica Haritakis,&nbsp;Scott Pygall,&nbsp;Emily Bryant,&nbsp;Harriet Cox,&nbsp;Greg Forshaw,&nbsp;Crispin Musicha,&nbsp;Victoria Allgar,&nbsp;Robert Logan,&nbsp;Mark McAlindon","doi":"10.1111/apt.70046","DOIUrl":"10.1111/apt.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>During the COVID-19 pandemic, NHS England introduced colon capsule endoscopy (CCE) at scale to support the recovery of endoscopy. Symptomatic patients referred with suspected colorectal cancer (CRC) and a faecal immunochemical test (FIT) ≤ 100 μg Hb/g faeces were offered CCE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate the safety, diagnostic accuracy and utility of CCE in this setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consenting patients, referred on a suspected CRC pathway with FIT ≤ 100 μg Hb/g faeces, were offered CCE, colonoscopy or CT colonography. Each cohort was to be age-, sex-, symptom- and FIT-matched. We performed a paired comparison of findings in those who required colorectal endoscopy after CCE and recorded clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited 4878 patients for CCE, 5025 for colonoscopy and 466 for CT colonography patients. CCE was safely tolerated by 98.4% of patients. CCE identified a matched mass lesion in all patients with CRC when the examination was complete and adequately prepared. More polyps ≥ 10 mm and 6–9 mm were detected by CCE than by colonoscopy or CT colonography. Per-patient sensitivities for polyps ≥ 10 mm and 6–9 mm were 97% in those with a paired, complete and adequately prepared CCE than colonoscopy. Completion (74%) and bowel preparation adequacy rates (74%) were poorer than those of colonoscopy and CTC (both 88%). However, CCE usefully performed a filter function in 86% of patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CCE is safe and accurate for the diagnosis of colorectal disease. In the suspected CRC pathway, its ‘filter function’ complements existing colorectal diagnostic services by creating additional capacity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 9","pages":"1532-1544"},"PeriodicalIF":6.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514091","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: Surveillance Colonoscopy for Detection of Neoplasia in Inflammatory Bowel Disease—Is Dye-Based Chromoendoscopy Always the Final Answer?","authors":"Andrea Cassinotti,&nbsp;Lorenzo Canova","doi":"10.1111/apt.70027","DOIUrl":"10.1111/apt.70027","url":null,"abstract":"&lt;p&gt;Surveillance colonoscopy has been recommended in patients with inflammatory bowel disease (IBD) for over 20 years to manage their risk of colorectal neoplasia. However, many aspects of a high-quality examination are still debated [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Advances in endoscopic technology and evolving clinical paradigms, including updated nomenclature for serrated lesions and more accurate diagnostic criteria for lesion characterisation, have challenged our technical approach to endoscopic surveillance in IBD [&lt;span&gt;2&lt;/span&gt;]. Consequently, purely statistical comparisons between different surveillance strategies may be methodologically weak when they involve technologies and protocols that are too heterogeneous due to the numerous variables influencing their application.&lt;/p&gt;&lt;p&gt;Shehab et al. presented a network meta-analysis (NMA) including 22 randomised controlled trials and three prospective cohort studies covering nine different technologies used for neoplasia detection in IBD [&lt;span&gt;3&lt;/span&gt;]. They concluded that dye-based chromoendoscopy (DCE), especially with high-definition (HD), HD-white light endoscopy with segmental reinspection (HD-WLE-SR) and chromoendoscopy-guided endomicroscopy (CEM) outperformed other methods, including virtual chromoendoscopy (VCE), which includes Narrow Band Imaging (NBI), Fuji Intelligent Colour Enhancement (FICE) and i-SCAN, with similar results between HD-WLE-SR and DCE.&lt;/p&gt;&lt;p&gt;The finding in favour of HD-WLE with SR is interesting because it would provide an alternative to DCE that would simplify surveillance. However, this result stems from the inclusion of just one study [&lt;span&gt;4&lt;/span&gt;]. Equally interesting is the good performance of CEM, although supported by older proof-of-concept studies that used endoscope-based confocal laser endomicroscopy (eCLE) currently no longer commercially available [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;What is the clinical message? Does DCE remain the only appropriate, yet unloved, surveillance tool? Should we ultimately abandon the hope of using VCE, a tool both easy to activate and widely available in many endoscopy units, despite evidence from some head-to-head studies demonstrating its non-inferiority to DCE? Notably, NBI appeared inferior to DCE based on studies limited by the use of non-magnified instruments and by diagnostic criteria that later proved to be inaccurate (i.e. Kudo's) in IBD. Conversely, FICE was not inferior to DCE, noting that the only included study stressed the need to use specific diagnostic criteria to better enhance the accuracy of this technology [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Could the recurrent supremacy of DCE in many NMAs be attributed to operational factors that a purely statistical approach fails to capture? In this regard, Toruner et al. analysed technical and clinical aspects influencing the quality of surveillance colonoscopy: among all, the “time factor” dominated (i.e. the attention devoted), not only in chronometric terms [&lt;span&gt;6&lt;/span&gt;]. That same “time fa","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 7","pages":"1250-1251"},"PeriodicalIF":6.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485828","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: Surveillance Colonoscopy for Detection of Neoplasia in Inflammatory Bowel Disease—Is Dye-Based Chromoendoscopy Always the Final Answer? Authors' Reply","authors":"Mohammad Shehab,&nbsp;Ahmed Al-Hindawi,&nbsp;Talat Bessissow","doi":"10.1111/apt.70057","DOIUrl":"10.1111/apt.70057","url":null,"abstract":"&lt;p&gt;We appreciate the thoughtful editorial by Drs. Cassinotti and Canova [&lt;span&gt;1&lt;/span&gt;], which raised pertinent questions about the landscape of endoscopic surveillance in inflammatory bowel disease (IBD).&lt;/p&gt;&lt;p&gt;Our network meta-analysis reviewed published data on IBD dysplasia detection technologies [&lt;span&gt;2&lt;/span&gt;]. We acknowledge that significant heterogeneity exists. Our paper highlighted variability in protocols, nomenclature and patient populations, amongst others; this is the best that can be done with the available data. It reflected the inherent challenges in standardising large-scale surveillance studies in an evolving field. Notwithstanding the aforementioned limitations, the data deemed dye-based chromoendoscopy (DCE) superior.&lt;/p&gt;&lt;p&gt;While attractive for its ease of use, available data on virtual chromoendoscopy (VCE), particularly magnified narrow-band imaging, are limited. Until further evidence clarifies VCE's performance relative to DCE, we view it as a reasonable alternative in the absence of DCE expertise. Regarding confocal endomicroscopy, we agree that its utility is limited by a lack of commercialisation.&lt;/p&gt;&lt;p&gt;DCE's advantage is in revealing subtle, previously unmasked mucosal abnormalities [&lt;span&gt;3, 4&lt;/span&gt;]. The editorial raises an interesting point regarding the ‘time factor’ or ‘devoted attention’ potentially contributing to DCE's effectiveness. The study by Toruner et al. investigated white light endoscopy (WLE) and suggested that longer procedural times may improve colonic representativeness through more evenly spaced random biopsies [&lt;span&gt;5&lt;/span&gt;]. However, this pertains to flat dysplasia, an endoscopically invisible subtype detected primarily by random biopsies rather than active mucosal inspection. Thus, the increased time probably reflects stricter protocol adherence rather than a deliberate search for abnormalities.&lt;/p&gt;&lt;p&gt;Indeed, initial results of high-definition WLE with segmental re-inspection (HDWLE-SR) are drawn from one promising study [&lt;span&gt;6&lt;/span&gt;]. If proven to be a successful alternative to DCE, it could simplify workflows and encourage wider adoption, considering endoscopists' familiarity with HD-WLE. Segmental re-inspection may exemplify the ‘attention’ that enhances detection. HDWLE-SR's success may also stem from being conducted primarily at expert centres with highly experienced IBD endoscopists, increasing the likelihood of identifying missed regions upon re-inspection. Nonetheless, replication and validation are necessary before reaching strong conclusions.&lt;/p&gt;&lt;p&gt;Given WLE's limitations in detecting flat lesions, current guidelines recommend random four quadrant and targeted biopsies [&lt;span&gt;7&lt;/span&gt;]. Yet, DCE and VCE comparators often employ targeted-only approaches. Perhaps the real clinical utility of DCE or VCE lies in reducing the biopsy burden for patients, endoscopists and pathologists while maintaining diagnostic performance. The value of non-targeted biopsies has been questioned [&lt;s","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 7","pages":"1252-1253"},"PeriodicalIF":6.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485871","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: Association of Antibiotic Exposure With Microscopic Colitis—Authors' Reply","authors":"Máté Szilcz,&nbsp;Jonas W. Wastesson,&nbsp;David Bergman,&nbsp;Kristina Johnell,&nbsp;Jonas F. Ludvigsson","doi":"10.1111/apt.70056","DOIUrl":"10.1111/apt.70056","url":null,"abstract":"&lt;p&gt;We thank Drs. Tome and Pardi for their editorial on our study examining the association between antibiotic exposure and microscopic colitis (MC) [&lt;span&gt;1&lt;/span&gt;]. We appreciate their careful literature review and insightful discussion regarding potential confounding factors that may influence the observed relationship between drug exposures and MC.&lt;/p&gt;&lt;p&gt;As the editorial highlighted, studies investigating medications associated with MC have consistently encountered challenges in disentangling causation from confounding. We aimed to address this through a self-controlled design [&lt;span&gt;2&lt;/span&gt;], in which cases acted as their own controls, thereby mitigating important confounders, such as genetic predisposition, that are difficult to account for in traditional cohort studies [&lt;span&gt;3&lt;/span&gt;]. In studies where external controls are necessary, matching by clinical characteristics and healthcare engagement patterns can further reduce confounding, thereby strengthening causal inference. However, we acknowledge that detection bias remains a consideration. Patients experiencing gastrointestinal symptoms on certain medications (e.g., antibiotics) may be more likely to undergo endoscopic evaluation, thereby increasing MC detection.&lt;/p&gt;&lt;p&gt;Medication exposures often occur in combination, particularly in older adults. These combinations (e.g., antibiotics combined with non-steroidal anti-inflammatory drugs or proton pump inhibitors) may amplify gastrointestinal side effects. The interplay of multiple drugs further complicates the challenge of establishing a direct causal link between any single medication and MC. Future research should investigate the impact of polypharmacy on MC incidence and severity, ideally through prospective, longitudinal studies with a rigorous selection of control groups.&lt;/p&gt;&lt;p&gt;Looking ahead, comprehensive studies are needed to understand how various drugs alter the intestinal environment, contributing to MC development. One potential option is investigating the gut microbiome's role and how antibiotic-induced dysbiosis may prime the colonic mucosa for an aberrant immune response. Incorporating stool metagenomics, mucosal immunologic markers, and detailed pharmacokinetic/pharmacodynamic data into prospective studies could provide crucial insights into the pathophysiology of MC. Such investigations may pave the way for precision medicine approaches, enabling targeted interventions based on microbiome profiles, immune pathways, or genetic predispositions to prevent or mitigate MC in high-risk individuals [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Large-scale data analyses using real-world evidence and electronic health record-based pharmacoepidemiologic studies could help to identify at-risk subgroups effectively. This might include older adults with multiple comorbidities, individuals with specific genetic or immune backgrounds, or patients requiring complex drug regimens. By leveraging big data analytics, future research could move beyond broad assoc","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"61 9","pages":"1549-1550"},"PeriodicalIF":6.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485872","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}