Gut and Liver最新文献

{"title":"Novel Efferocytosis-Related Prognostic Signature for Hepatocellular Carcinoma Patients Undergoing Transarterial Chemoembolization.","authors":"Xiangpang Xie, Bingru Zheng","doi":"10.5009/gnl250253","DOIUrl":"https://doi.org/10.5009/gnl250253","url":null,"abstract":"<p><strong>Background/aims: </strong>Transarterial chemoembolization (TACE) is a key treatment for hepatocellular carcinoma (HCC). However, patient outcomes after TACE are heterogeneous, and robust prognostic biomarkers are needed. This study aimed to develop an efferocytosis-related prognostic signature to stratify HCC patients and others undergoing TACE treatment.</p><p><strong>Methods: </strong>Liver cancer data were obtained from The Cancer Genome Atlas, and the GSE14520 dataset was used for validation. Differential analysis identified five efferocytosis-related genes associated with response to TACE. Consensus clustering of HCC samples revealed molecular subtypes, and differences in immune cell infiltration were analyzed. A prognostic model was developed using univariate Cox regression, least absolute shrinkage and selection operator, and multivariate Cox regression, and a nomogram was constructed. Gene expression was validated via quantitative polymerase chain reaction and immunohistochemistry. Single-sample gene set enrichment analysis was performed, a competing endogenous RNA network was constructed, and immune and drug sensitivity differences between risk groups were analyzed.</p><p><strong>Results: </strong>A prognostic signature consisting of TYRO3, CD14, and TREM2 was established and validated for HCC patients, including those who underwent TACE treatment. High-risk patients exhibited significantly lower survival rates than low-risk patients. High-risk patients also exhibited distinct immune characteristics, including differences in immune checkpoint expression, immune cell infiltration, and immune function scores. Additionally, the high-risk group showed higher sensitivity to four drugs, with CD14 expression negatively correlated with sensitivity to vandetanib and cabozantinib.</p><p><strong>Conclusions: </strong>This study developed a model based on efferocytosis-associated characteristics to predict the prognosis of HCC patients and those undergoing TACE treatment, thereby facilitating the formulation of personalized treatment plans.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Gastric Neoplasms in Patients with Autoimmune Gastritis: A Systematic Review and Meta-Analysis.","authors":"Yong Hwan Ahn, Tae-Se Kim, Min-Ji Kim, Jun Haeng Lee","doi":"10.5009/gnl250515","DOIUrl":"https://doi.org/10.5009/gnl250515","url":null,"abstract":"<p><strong>Background/aims: </strong>Autoimmune gastritis (AIG) underlies type 1 gastric neuroendocrine tumors (NETs) and pernicious anemia (PA), a late-stage manifestation of AIG. Although PA is a risk factor for gastric cancer (GC), the independent neoplastic risk of AIG and the modifying role of <i>Helicobacter pylori</i> infection remain uncertain. We evaluated the risk of gastric neoplasms in patients with AIG and assessed associations with PA and <i>H. pylori</i> exposure.</p><p><strong>Methods: </strong>A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review and meta-analysis were performed. PubMed, EMBASE, and the Cochrane Library were searched for studies of gastric neoplasms in adults with AIG or PA. Pooled incidence rates and risk estimates were calculated. Between-study heterogeneity was explored by using meta-regression. Publication bias, sensitivity, and <i>H. pylori</i>-stratified subgroup analyses were performed.</p><p><strong>Results: </strong>In patients with AIG, pooled incidence rates (per 1,000 person-years) were 2.08 for GC, 5.35 for dysplasia, and 14.56 for NETs. The GC incidence was not statistically significant overall but became significant in sensitivity analyses when the Rugge <i>et al.</i> cohort was excluded. The dysplasia and NET incidence rates were significantly elevated. In patients with PA, GC risk was consistently elevated (relative risk, 2.78; standardized incidence ratio, 2.69). Meta-regression analysis identified age and diagnostic criteria as contributors to GC heterogeneity. Patients with <i>H. pylori</i>-positive AIG showed a trend toward reduced GC and NET risks.</p><p><strong>Conclusions: </strong>AIG was associated with increased risks of dysplasia and NETs, and GC risk might be underestimated in the presence of substantial heterogeneity. PA was associated with a higher risk of GC. Endoscopic surveillance may be considered in patients with AIG, particularly for dysplasia, NET, and GC risks in those with concomitant PA.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Cardiometabolic Risk Burden Predicts Adverse Outcomes in Patients with MASLD-Related Hepatocellular Carcinoma.","authors":"Yeonhong Do, Young Hyeon Ahn, Young Chang, Jeong-Ju Yoo, Sae Hwan Lee, Soung Won Jeong, Sang Gyune Kim, Jae Young Jang, Young Seok Kim, Hong Soo Kim, Keungmo Yang, Tom Ryu","doi":"10.5009/gnl250591","DOIUrl":"https://doi.org/10.5009/gnl250591","url":null,"abstract":"<p><strong>Background/aims: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a rapidly growing cause of hepatocellular carcinoma (HCC); however, the prognostic implications of the cumulative cardiometabolic risk factor (CMRF) burden remain unclear.</p><p><strong>Methods: </strong>In this single-center retrospective cohort, we identified 94 patients with MASLD-related HCC after excluding other etiologies of liver disease. The modified CMRF count (based on eight routinely available variables) was calculated, and the patients were stratified according to the count (<5 or ≥5). In addition to baseline data, survival was assessed by the Kaplan-Meier log-rank test, and prognostic factors were evaluated by Cox regression.</p><p><strong>Results: </strong>A higher CMRF burden was associated with older age, a greater cumulative tumor diameter, and a higher level of protein induced by vitamin K absence or antagonist-II (PIVKA-II), but not with the level of alpha-fetoprotein. Patients with a CMRF count ≥5 had significantly worse overall survival (OS) and recurrence-free survival (RFS). In the Cox models, a CMRF count ≥5 was associated with poor OS; the association with RFS was evident in univariate analysis but was attenuated after adjustment. Among individual factors, hypertension was independently associated with OS, whereas diabetes lost significance after adjustment. The level of triglycerides was not a prognostic factor, while higher high-density lipoprotein cholesterol levels were associated with better OS and RFS by the Kaplan-Meier method.</p><p><strong>Conclusions: </strong>The cumulative metabolic burden, represented by a modified CMRF count, was associated with larger tumors, a higher PIVKA-II level, and inferior survival in patients with MASLD-related HCC.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Chronic Hepatitis B and Metabolic Dysfunction-Associated Steatotic Liver Disease Paradox: Friend or Foe?","authors":"Shang-Chin Huang, Tai-Chung Tseng","doi":"10.5009/gnl250444","DOIUrl":"https://doi.org/10.5009/gnl250444","url":null,"abstract":"<p><p>Chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) frequently coexist, yet their interplay remains complex and paradoxical. Emerging evidence suggests that hepatic steatosis may suppress hepatitis B virus replication and lower the risks of cirrhosis, hepatocellular carcinoma, and mortality. In contrast, an accumulation of cardiometabolic risk factors, the defining feature of MASLD, has been consistently associated with relatively poor liver-related outcomes in CHB. This apparent contradiction raises questions about the mechanistic, causal role of steatosis and the optimal strategies for managing CHB patients with metabolic dysfunctions. In this concise review, we summarize current evidence from mechanistic, clinical, and population-based studies on the dual impact of MASLD on the natural history of CHB. We also discuss the potential underlying mechanisms, identify key knowledge gaps, and propose a clinically relevant framework for personalized risk stratification and treatment decision-making that integrates both viral and metabolic factors.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Switching from Entecavir to Tenofovir Alafenamide in Chronic Hepatitis B: A Multicenter Randomized Trial in Korea.","authors":"Hyunjae Shin, Moon Haeng Hur, Yang Hyun Baek, Chun Kyon Lee, Yong Kyun Cho, June Sung Lee, Jae Yoon Jeong, Yong Jin Jung, Ja Kyung Kim, Moon Young Kim, Yeon Seok Seo, Woo Jin Chung, Moon Soo Koh, Jeong-Han Kim, Yun Bin Lee, Eun Ju Cho, Jeong-Hoon Lee, Su Jong Yu, Jung-Hwan Yoon, Yoon Jun Kim","doi":"10.5009/gnl250479","DOIUrl":"https://doi.org/10.5009/gnl250479","url":null,"abstract":"<p><strong>Background/aims: </strong>Tenofovir alafenamide (TAF) has emerged as a safe and effective alternative to entecavir (ETV) in the management of chronic hepatitis B (CHB). We aimed to evaluate the efficacy and safety of switching to TAF compared with maintaining ETV in patients with CHB who had achieved virologic suppression on ETV.</p><p><strong>Methods: </strong>In this multicenter, randomized, open-label, active-controlled, noninferiority clinical trial conducted at 13 Korean centers, 196 CHB patients who had experienced virologic suppression after ≥24 weeks of ETV therapy were randomized 1:1 to switch to TAF (n=95) or continue on ETV (n=101). The primary endpoint was the proportion of patients with hepatitis B virus (HBV) DNA <29 IU/mL at week 48 (per-protocol set). Secondary endpoints included alanine aminotransferase (ALT) normalization, hepatitis B surface antigen and hepatitis B e antigen serologic responses, and safety outcomes.</p><p><strong>Results: </strong>Among 188 patients in the per-protocol set (89 TAF, 99 ETV), the HBV suppression rate at week 48 was 100.0% in the TAF group and 99.0% in the ETV group (difference, 1.03%; one-sided 97.5% confidence interval, -0.96 to infinity). ALT normalization rates at week 48 were comparable between groups (55.0% in TAF vs 38.7% in ETV; p=0.26; American Association for the Study of Liver Diseases criteria). Hepatitis B e antigen seroconversion rates were also similar at week 48 (0.0% vs 12.5%; p=0.21). Safety profiles, including renal function, did not significantly differ between the two groups.</p><p><strong>Conclusions: </strong>Switching from ETV to TAF was noninferior to continuing ETV in maintaining virologic suppression, with comparable biochemical, serologic, and safety outcomes. (ClinicalTrials. gov identifier NCT06000657).</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on Creation of a Durable Conduit with a Novel Self-Expandable Metal Stent for Stone Extraction in Endoscopic Retrograde Cholangiopancreatography: A Pilot Study.","authors":"Koji Takahashi","doi":"10.5009/gnl260080","DOIUrl":"https://doi.org/10.5009/gnl260080","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Role of Acute-on-Chronic Liver Failure in Acute Variceal Bleeding: A Multicenter Retrospective Study in Australia.","authors":"Rajiv Kurup, Huu Hoang Hiep Dao, Pei-Yu Lin, Scott Read, Wai-See Ma, Jacob George, Golo Ahlenstiel","doi":"10.5009/gnl250341","DOIUrl":"https://doi.org/10.5009/gnl250341","url":null,"abstract":"<p><strong>Background/aims: </strong>Acute variceal bleeding (AVB) is a life-threatening complication of cirrhosis that can precipitate acute-on-chronic liver failure (ACLF), leading to poor outcomes. This multicenter retrospective study evaluated the impact of ACLF on the long-term outcomes of patients admitted with AVB and compared the performance of prognostic scores in predicting 1-year mortality.</p><p><strong>Methods: </strong>A total of 168 patients with cirrhosis admitted with AVB between January 2013 and December 2022 were included. ACLF was diagnosed using the Chronic Liver Failure-Consortium Organ Failure (CLIF-C OF) score at admission and reassessed at 48 hours. Prognostic scores including the Child-Pugh, AIMS65, and CLIF-C model scores were evaluated. Multivariable logistic regression analysis was performed to identify predictors of 6-week rebleeding, and Kaplan-Meier analysis was conducted to assess survival outcomes.</p><p><strong>Results: </strong>ACLF was present at admission in 21 patients (12.5%) and developed within 48 hours in two (1.2%). Although ACLF at admission was associated with a higher unadjusted 1-year mortality rate, it was not independently predictive after adjusting for hepatic reserve (Child-Pugh score) and age (hazard ratio, 0.97; 95% confidence interval, 0.32 to 2.94; p=0.951). The Child-Pugh score was the strongest predictor of the 1-year mortality rate (area under the receiver operating characteristic curve=0.718). The absence of hepatic encephalopathy independently predicted 6-week rebleeding (p=0.015). Endoscopy timing (<12 hours vs ≥12 hours) did not influence the 6-week mortality rate, rebleeding, or the 1-year survival rate in either the ACLF or non-ACLF group.</p><p><strong>Conclusions: </strong>Although ACLF identifies patients with AVB at high risk, it primarily reflects the severity of the underlying liver dysfunction rather than serving as an independent predictor. Management should prioritize stabilization and optimization prior to endoscopy and individualized follow-up to evaluate transplant candidacy.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Smoking, Alcohol Use and Exercise on Underweight after Gastrectomy: A Nationwide Cohort Study of Gastric Cancer Patients in Korea.","authors":"Yoon Ju Jung, Kyung Do Han, Sung Geun Kim","doi":"10.5009/gnl250140","DOIUrl":"https://doi.org/10.5009/gnl250140","url":null,"abstract":"<p><strong>Background/aims: </strong>Weight loss following gastric cancer (GC) surgery is a prevalent and significant long-term complication that impacts the patient's oncologic prognosis and quality of life. The impact of lifestyle changes after surgery with regard to regular exercise, smoking, and alcohol consumption on weight loss have not been fully explored. We studied the factors associated with underweight (body mass index <18.5 kg/m²) after gastrectomy, focusing on variation across sex and age groups.</p><p><strong>Methods: </strong>We utilized a population-based cohort provided by the Korean National Health Insurance Service, which included cancer screening data. In total, 27,854 patients who underwent GC surgery between 2010 and 2016 were included.</p><p><strong>Results: </strong>Among the 27,854 patients in the study cohort, 3,064 (11.0%) were underweight. Female sex (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.55 to 1.96; p<0.001) was a significant risk factor for becoming underweight postoperatively. Engaging in regular exercise (OR, 0.73; 95% CI, 0.60 to 0.89; p=0.002) and ceasing smoking (OR, 0.31; 95% CI, 0.13 to 0.78; p<0.001) emerged as substantial preventive factors against becoming underweight, particularly in female patients. Exercise (OR, 0.76; 95% CI, 0.65 to 0.89; p=0.001) proved more beneficial for patients aged <65 years.</p><p><strong>Conclusions: </strong>Smoking cessation and regular exercise are associated with a reduced risk of postoperative underweight in GC patients following gastrectomy.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Dynamic Nature of Renal Failure in Acute-on-Chronic Liver Failure: Sequence Matters.","authors":"Hae Lim Lee","doi":"10.5009/gnl250521","DOIUrl":"https://doi.org/10.5009/gnl250521","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Failure versus Organ Failure in Acute-on-Chronic Liver Failure: Sequence and Consequence.","authors":"Young Chang, Jae Young Jang, Soung Won Jeong, Do Seon Song, Hee Yeon Kim, Young Kul Jung, Tae Hyung Kim, Hyung Joon Yim, Eileen L Yoon, Ki Tae Suk, Jeong-Ju Yoo, Sang Gyune Kim, Moon Young Kim, Sung-Eun Kim, Jung-Hee Kim, Jung Gil Park, Won Kim, Dong Joon Kim","doi":"10.5009/gnl250299","DOIUrl":"https://doi.org/10.5009/gnl250299","url":null,"abstract":"<p><strong>Background/aims: </strong>Acute-on-chronic liver failure (ACLF) is characterized by the acute decompensation of the liver in patients with preexisting chronic liver disease or cirrhosis, often resulting in multiorgan failure and high short-term mortality. This study aimed to investigate the sequence of organ failures, particularly liver and renal failure, and their impact on the short-term survival in ACLF patients.</p><p><strong>Methods: </strong>We analyzed data from 1,765 patients in a prospective Korean ACLF cohort, focusing on the timing of liver and renal failures. Overall survival (OS) was assessed using Kaplan-Meier survival analysis with the log-rank test, and multivariate analysis was performed using a Cox proportional hazards model.</p><p><strong>Results: </strong>Patients with initial liver failure had significantly worse OS compared to those without liver failure (adjusted hazard ratio [aHR], 3.6; p=0.008), and those who developed liver failure during the disease course had an even poorer prognosis (aHR, 5.7; p=0.002). There was no significant difference in OS between patients without renal failure and those with initial renal failure (aHR, 0.8; p=0.508). However, renal failure that developed during hospitalization was associated with a worse prognosis (aHR, 1.9; p=0.056). Patients with initial renal failure had significantly better OS than those with initial liver failure (aHR 2.4, p=0.040).</p><p><strong>Conclusions: </strong>Organ failure developing during hospitalization is more detrimental than failure present at admission. ACLF with initial renal failure has a better prognosis than ACLF with initial liver failure. ACLF patients with initial renal failure have a 28-day survival rate exceeding 90% if renal failure is present initially; however, this rate significantly decreases if renal failure occurs during hospitalization.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}