Gut and Liver最新文献

{"title":"A Terpene Preparation for the Pharmacological Prevention of Common Bile Duct Stone Recurrence after Endoscopic Clearance: A Randomized Pilot Trial.","authors":"Won Jae Yoon, Tae Yoon Lee, Chang-Hwan Park, Dong Wook Lee, Jung Wan Choe, Jong Jin Hyun, Young Koog Cheon","doi":"10.5009/gnl260137","DOIUrl":"https://doi.org/10.5009/gnl260137","url":null,"abstract":"<p><strong>Background/aims: </strong>Endoscopic retrograde cholangiopancreatography with stone extraction is the standard treatment for common bile duct (CBD) stones. However, few studies have evaluated medical strategies to reduce CBD stone recurrence after endoscopic clearance. We performed a prospective, multicenter, randomized pilot trial to explore the potential effect of a terpene preparation in this setting.</p><p><strong>Methods: </strong>Thirty patients who had undergone endoscopic management of CBD stones within 4 weeks were enrolled from four Korean university hospitals and randomized 1:1 to receive either the terpene preparation (200 mg three times daily for 24 weeks) or no medication. The primary outcome was the recurrence of CBD stones at 48 weeks confirmed by imaging. The analysis was performed according to the per-protocol principle.</p><p><strong>Results: </strong>Twenty-one patients (9 in the treatment group and 12 in the control group) completed the study; attrition was 40.0% and 20.0%, respectively. Baseline characteristics were comparable between the groups, although the maximal CBD diameter was numerically greater in the treatment group (12.3 mm vs 9.3 mm; p=0.074). No CBD stone recurrence occurred in the treatment group, whereas recurrence occurred in two patients in the control group. The absolute risk difference was -16.7% (95% confidence interval, -37.8% to 4.4%; Fisher exact, p=0.486).</p><p><strong>Conclusions: </strong>In this pilot trial, no CBD stone recurrence occurred in the treatment group despite a numerically higher baseline anatomic risk, whereas two of 12 control-group patients experienced recurrence. The trial was not powered to detect a treatment effect; therefore, no conclusions regarding efficacy can be drawn. The primary contribution is to inform the feasibility and design of a confirmatory trial. (cris.nih.go.kr, KCT0002289).</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224098","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":"Nationwide Claims-Based Incidence and Associated Factors of Adverse Events after Gastric Endoscopic Submucosal Dissection.","authors":"Jung-Wook Kim, Jae-Young Jang, Tae-Hee Lee, Hyuk Soon Choi, Yu Kyung Cho","doi":"10.5009/gnl260159","DOIUrl":"https://doi.org/10.5009/gnl260159","url":null,"abstract":"<p><strong>Background/aims: </strong>Most data on adverse events (AEs) following gastric endoscopic submucosal dissection (ESD) originate from high-volume expert centers, limiting their generalizability to routine clinical practice. Population-level claims-based evidence on AEs after gastric ESD remains limited, although such data cannot fully account for lesion- and procedure-specific risk factors.</p><p><strong>Methods: </strong>We conducted a nationwide, retrospective cohort study using claims data from the Korean Health Insurance Review and Assessment Service. All patients who underwent ESD for gastric neoplastic lesions between 2013 and 2017 were included. Claims-defined AEs-including bleeding, perforation, pneumonia, and intensive care unit (ICU) admission within 30 days-were assessed, along with subsequent gastric surgery within 90 days. Multivariable logistic regression was used to identify factors associated with each outcome.</p><p><strong>Results: </strong>A total of 83,871 gastric ESD procedures were performed in 76,181 patients. The incidence of bleeding was 16.6%, whereas perforation (0.17%), pneumonia (0.65%), and ICU admission (0.94%) were uncommon. Older age was associated with a lower risk of bleeding but a higher risk of pneumonia and ICU admission, particularly among patients aged ≥80 years. Among the antithrombotic agents included in the analysis, warfarin was associated with bleeding and clopidogrel was associated with ICU admission. Procedures performed at general hospitals were associated with higher risks of multiple AEs compared with those performed at tertiary centers. Overall, 3.9% of patients underwent additional gastric surgery, almost exclusively among those with gastric cancer.</p><p><strong>Conclusions: </strong>In this nationwide population-based claims study, claims-defined AEs after standard-indication gastric ESD were associated with patient-level and institution-level variables available in administrative data (cris.nih.go.kr, KCT0011604).</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224108","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":"Mortality Risk in Steatotic Liver Disease Stratified by Cardiometabolic Risk Factors and Alcohol Consumption: A Nationwide Cohort Study.","authors":"Yewan Park, Jooyi Jung, Seungbong Han, Hyeyeon Hong, Gi-Ae Kim","doi":"10.5009/gnl260003","DOIUrl":"https://doi.org/10.5009/gnl260003","url":null,"abstract":"<p><strong>Background/aims: </strong>Steatotic liver disease (SLD) has emerged as a new nomenclature; however, the long-term outcomes of SLD associated with its subtypes have been understudied. We aimed to investigate the all-cause and cause-specific mortality risk across SLD subtypes.</p><p><strong>Methods: </strong>Health checkup results of 2,049,641 Korean individuals were analyzed. SLD was defined as a Fatty Liver Index ≥30. Mortality risks in metabolic dysfunction-associated SLD (MASLD), metabolic dysfunction and alcohol-related liver disease (MetALD), and alcohol-associated liver disease (ALD) were investigated considering cardiometabolic risk factors (CMRFs) and alcohol consumption. Multivariable Cox proportional hazards models were used to calculate the adjusted hazard ratios (HRs).</p><p><strong>Results: </strong>Compared with no SLD, MASLD (HR, 1.28; 95% confidence interval [CI], 1.24 to 1.30), MetALD (HR, 1.40; 95% CI, 1.36 to 1.44), and ALD (HR, 1.70; 95% CI, 1.65 to 1.75) showed higher risks of all-cause mortality. All subtypes had an increased cause-specific mortality risk from liver-related disease, extrahepatic cancer, and cardiovascular disease, with liver-related mortality being the most prominent (HR, 2.57; 95% CI, 2.36 to 2.80 for MASLD; HR, 4.34; 95% CI, 3.93 to 4.78 for MetALD; HR, 6.23; 95% CI, 5.65 to 6.91 for ALD). The cumulative incidence of all-cause mortality increased as the number of CMRFs increased in all subtypes. The number of CMRFs affecting the mortality risk was the most pronounced in MASLD but the least pronounced in ALD.</p><p><strong>Conclusions: </strong>This study demonstrated that MASLD, MetALD, and ALD had an increased risk of all-cause and cause-specific mortality compared with no SLD. The impact of the number of CMRFs on mortality risk was most pronounced in MASLD, calling for more customized management strategies.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192462","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":"Long-Term Oncological Outcomes after Endoscopic Submucosal Dissection of Superficial Esophageal Cancer.","authors":"Tae Jun Kim, Yang Won Min, Young Eun Oh, Tae-Se Kim, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee","doi":"10.5009/gnl260160","DOIUrl":"https://doi.org/10.5009/gnl260160","url":null,"abstract":"<p><strong>Background/aims: </strong>Long-term data on the cumulative risk of lymph node metastasis (LNM), particularly after non-curative resection, remain limited. This study aimed to analyze long-term outcomes and clarify the risk of LNM.</p><p><strong>Methods: </strong>This retrospective study included 892 patients (951 cases) who underwent endoscopic submucosal dissection for superficial esophageal cancer. Extraesophageal recurrence-free survival (RFS) and overall survival (OS) were analyzed based on pathological strata, including depth of invasion and lymphovascular invasion (LVI).</p><p><strong>Results: </strong>In the observation group, the 5-year RFS and OS rates were 95.6% (95% confidence interval [CI], 92.8% to 97.3%) and 91.4% (95% CI, 88.2% to 93.8%) for mucosal/LVI-negative, and 92.7% (95% CI, 73.7% to 98.1%) and 84.9% (95% CI, 72.9% to 91.9%) for submucosal/LVI-negative subgroups, respectively. Conversely, the submucosal/LVI-positive group showed lower 5-year RFS (51.9%; 95% CI, 16.4% to 78.8%) and OS rates (61.4%; 95% CI, 29.9% to 82.2%) (p<0.001). Additional surgery was associated with higher 5-year RFS and OS rates of 76.1% (95% CI, 59.8% to 86.4%) and 87.5% (95% CI, 71.9% to 94.7%), respectively, in the submucosal/LVI-positive subgroup. The LNM risk in mucosal cases was primarily synchronous. However, the submucosal/LVI-positive group exhibited a cumulative increase in LNM detection, with the rate increasing from 28.3% at the time of surgery to 50.0% during follow-up.</p><p><strong>Conclusions: </strong>Esophageal endoscopic submucosal dissection achieves excellent long-term outcomes for curative resection. Non-curative cases, particularly those with submucosal invasion and LVI, exhibit an evolving LNM risk over time. These high-risk patients may be considered for additional treatment when medically suitable, alongside meticulous, long-term oncological surveillance.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192176","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":"Optimal Safety Margins and Scoring System for Endoscopic Submucosal Dissection of Crawling-Type Early Gastric Cancer.","authors":"Jin Won Chang, Jun Chul Park, Da Hyun Jung, Eun Hwa Kim, Ga Hee Kim, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee","doi":"10.5009/gnl250484","DOIUrl":"https://doi.org/10.5009/gnl250484","url":null,"abstract":"<p><strong>Background/aims: </strong>Crawling-type adenocarcinoma (CTAC) is a subtype of gastric cancer characterized by lateral spreading, which makes margin assessment challenging. We aimed to evaluate the risk factors and characteristics of CTAC and provide guidance for achieving optimal resection margins during endoscopic submucosal dissection (ESD).</p><p><strong>Methods: </strong>This retrospective study analyzed prospectively collected data from 4,788 patients who underwent ESD for early gastric cancer between January 2012 and December 2023. The endoscopic and histopathological features of CTAC and the factors associated with lateral margin positivity (LMP) were identified.</p><p><strong>Results: </strong>Overall, 199 patients (4.2%) were classified as having CTAC. The CTAC group had a significantly higher LMP rate than the non-CTAC group (20.6% vs 4.2%; p<0.001). Risk factors for LMP in patients with CTAC were identified using logistic regression, and a scoring system was developed: 3 points, non-greater curvature side; 1 point, lesion long axis ≥20 mm; 2 points, expected minimum safety margin <5 mm; and 1 point, expected minimum safety margin 5-10 mm. Patients were categorized into low-risk (0-1 point, 2.6% LMP rate), moderate-risk (2-4 points, 18.8% LMP rate), and high-risk (5-6 points, 48.5% LMP rate) groups. Compared to the low-risk group, the moderate-risk group had an odds ratio of 8.538 (95% confidence interval, 1.116 to 65.355; p=0.039), and the high-risk group had an odds ratio of 34.824 (95% confidence interval, 4.263 to 284.466; p=0.001) for exhibiting LMP.</p><p><strong>Conclusions: </strong>Lesion size, location, and safety margins influenced the risk of LMP, emphasizing the importance of optimizing safety margins during ESD for CTAC.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192663","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":"Incidence and Longitudinal Trajectory of <i>de novo</i> Hepatic Steatosis after Pancreatoduodenectomy: A Prospective Cohort Study Using Transient Elastography.","authors":"Jonggi Choi, Woohyung Lee, Jae Hoon Lee, Ki Byung Song, Song Cheol Kim, Dae Wook Hwang, Han Chu Lee","doi":"10.5009/gnl260279","DOIUrl":"https://doi.org/10.5009/gnl260279","url":null,"abstract":"<p><strong>Background/aims: </strong><i>De novo</i> hepatic steatosis is a recognized complication following pancreaticoduodenectomy (PD); however, its incidence and longitudinal course remain poorly defined. We prospectively evaluated the incidence, temporal trajectory, and risk factors for <i>de novo</i> hepatic steatosis after PD using vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP).</p><p><strong>Methods: </strong>Consecutive patients scheduled for PD at Asan Medical Center between October 2020 and October 2023 were prospectively enrolled. Patients with baseline CAP ≥250 dB/m, preexisting diabetes mellitus, viral hepatitis, or significant alcohol consumption were excluded. <i>De novo</i> hepatic steatosis was defined as CAP ≥275 dB/m on follow-up VCTE. Assessments were performed at 6, 12, 18, and 24 months after surgery. The primary outcome was cumulative incidence at 12 months.</p><p><strong>Results: </strong>Of 116 enrolled patients, 100 were eligible and 92 underwent at least one postoperative CAP measurement. The cumulative incidence of <i>de novo</i> hepatic steatosis at 12 months was 28.7% (95% confidence interval [CI], 18.6% to 37.6%). Point prevalence peaked at 3 months (20.3%) and declined to 13.1% at 24 months. Among patients with steatosis at 12 months, 55.6% showed resolution by 24 months. Preoperative body mass index was an independent predictor of steatosis development (adjusted hazard ratio, 1.41 per 1 kg/m²; 95% CI, 1.13 to 1.76; p=0.003).</p><p><strong>Conclusions: </strong><i>De novo</i> hepatic steatosis developed in approximately one-quarter of patients after PD and showed a partially reversible course. Higher preoperative body mass index and adjuvant chemotherapy independently predicted its development, supporting systematic postoperative hepatic surveillance using VCTE.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192934","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":"Frequency and Risk Factors for Difficult-to-Treat Inflammatory Bowel Disease among Patients Receiving Advanced Therapies in a Korean Tertiary-Care Cohort.","authors":"Jung Hyun Noh, Ho-Kyoung Lee, Yu Kyung Jun, Jinju Choi, Yonghoon Choi, Cheol Min Shin, Young Soo Park, Nayoung Kim, Hyuk Yoon","doi":"10.5009/gnl260144","DOIUrl":"https://doi.org/10.5009/gnl260144","url":null,"abstract":"<p><strong>Background/aims: </strong>Inflammatory bowel diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis (UC), show variable treatment responses. Data on the prevalence and clinical predictors of difficult-to-treat IBD (DTT-IBD) among Asians receiving advanced therapies (ATs) remain limited. This study evaluated the proportion of DTT-IBD and its risk factors in a Korean IBD cohort.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of a prospectively maintained tertiary-care cohort including patients with UC or CD who received at least one AT. Kaplan-Meier analysis, log-rank tests, and Cox proportional hazards regression were used to identify factors associated with DTT-IBD. DTT-IBD was defined as multidrug failure (MF; failure after ≥2 ATs with different mechanisms) or multiple resections (MR; recurrence after ≥2 intestinal resections in CD patients).</p><p><strong>Results: </strong>Among 512 patients, 130 (25.4%) met the MF DTT-IBD criteria. The cumulative probability of MF increased from 5.3% at 1 year to 51.1% at 10 years in UC patients, and from 0.4% to 37.1% in CD patients. Starting ATs within 2 years of UC diagnosis and older age increased the risk of MF DTT-IBD. In CD patients, risk factors included older age and vedolizumab as first-line AT. Among CD patients undergoing a second surgery, the cumulative risk of MR DTT-IBD reached approximately 50% at 1 year, 86.4% at 5 years, and >93% at 10 years.</p><p><strong>Conclusions: </strong>MF DTT-IBD occurred in one-quarter of patients. Timing of AT initiation and age in UC and therapy type and age in CD patients were key predictors. High MR DTT-IBD risk in CD patients underscores the need for proactive monitoring and early strategies.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165269","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":"Long-Term Outcomes According to a Device-Assisted Enteroscopy Strategy after Capsule Endoscopy in Patients with Small Bowel Bleeding: A Nationwide Population-Based Cohort Study.","authors":"Joo Hye Song, Jung Rock Moon, Hyun Gun Kim, Jin-Oh Kim, Jung-Bin Park, Seong Ran Jeon, Ji Sung Lee","doi":"10.5009/gnl260143","DOIUrl":"https://doi.org/10.5009/gnl260143","url":null,"abstract":"<p><strong>Background/aims: </strong>Although the use of device-assisted enteroscopy (DAE) has increased, few large-scale studies have examined long-term outcomes focused on small bowel (SB) bleeding. We analyzed National Health Insurance Service data to evaluate the clinical utility of DAE in patients with SB bleeding who underwent capsule endoscopy.</p><p><strong>Methods: </strong>We included a cohort of 11,690 patients who underwent capsule endoscopy for SB bleeding (identified using ICD-10 codes) between 2014 and 2022. Patients were categorized into three groups: no DAE, diagnostic DAE, and therapeutic DAE. We assessed four major outcomes, including the probability and factors associated with SB rebleeding, severe SB rebleeding, rebleeding-related mortality, and all-cause mortality.</p><p><strong>Results: </strong>Of 11,690 patients, 5,211 were included in the analysis (no DAE, n=4,960; diagnostic DAE, n=173; therapeutic DAE, n=78). The probability of SB rebleeding and severe SB rebleeding was highest in the therapeutic DAE group, followed by the diagnostic DAE and no DAE groups (p<0.001), with 7-year rebleeding probabilities of 19.8%, 15.8%, and 5.0%, respectively. Rebleeding-related and all-cause mortality were also highest in the therapeutic DAE group, followed by the diagnostic DAE and no DAE groups (p<0.001 for both), with 7-year rebleeding-related mortality probabilities of 9.3%, 5.9%, and 2.7%, respectively. Risk factors for both rebleeding-related and all-cause mortality included age, male sex, liver cirrhosis, and malignancy.</p><p><strong>Conclusions: </strong>Patients who require therapeutic DAE for SB bleeding remain at increased long-term risk of rebleeding and mortality. These findings likely reflect their greater underlying disease burden and highlight the need for individualized long-term surveillance and careful management of comorbidities, even after therapeutic intervention.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168400","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":"Autoimmune Hepatitis: 2026 Update.","authors":"Kazumichi Abe, Atsushi Tanaka","doi":"10.5009/gnl260326","DOIUrl":"https://doi.org/10.5009/gnl260326","url":null,"abstract":"<p><p>Autoimmune hepatitis (AIH) is an autoimmune liver disease characterized by immune-mediated hepatocellular destruction. This review provides a comprehensive update on the changes in the clinical landscape of and advancements in therapy for AIH up to 2026. Recent epidemiological data indicate a significant increase in both the incidence and prevalence of AIH worldwide, emphasizing potential shifts in environmental triggers and heightened disease awareness. Diagnosing AIH remains intricate owing to atypical manifestations; however, the newly updated 2025 European Association for the Study of the Liver clinical practice guidelines introduce refined simplified diagnostic criteria that incorporate contemporary laboratory platforms and international pathology standards to enhance real-world sensitivity. Immunosuppressive therapy continues to be the cornerstone of management. Corticosteroids remain the standard first-line treatment, while the upfront combination of prednisolone and mycophenolate mofetil is increasingly recommended alongside conventional azathioprine regimens. Achieving a complete biochemical response-defined as the normalization of transaminases and immunoglobulin G within 6 to 12 months-has emerged as a powerful, universally recognized surrogate endpoint for long-term prognosis, strongly predicting lower liver-related mortality and transplantation rates across both Western and Asian cohorts. Furthermore, this review addresses complex clinical entities, including drug-induced autoimmune-like hepatitis secondary to novel immunotherapies or vaccinations, and the phenotypic continuum of the primary biliary cholangitis-AIH overlap syndrome. Finally, we highlight the clinical utility of emerging, highly specific diagnostic biomarkers, such as anti-docking protein 2 antibodies-a promising candidate for seronegative cases, pending external multicenter validation-and outline essential directions for future AIH research.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165434","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":"Seroprevalence and Clinical Characteristics of Hepatitis D Virus Infection in Korean Patients with Chronic Hepatitis B, Liver Cirrhosis, and Hepatocellular Carcinoma.","authors":"Min Kyung Park, Yun-Sook Lim, Eun Ju Cho, Jeayeon Park, Yun Bin Lee, Jeong-Hoon Lee, Su Jong Yu, Jung-Hwan Yoon, Mikyung Lee, Anna Lee, Yun-Tae Kim, Hwaryung Chung, Gwang Hyeon Choi, Jin-Wook Kim, Eun Sun Jang, Sook-Hyang Jeong","doi":"10.5009/gnl260141","DOIUrl":"https://doi.org/10.5009/gnl260141","url":null,"abstract":"<p><strong>Background/aims: </strong>Hepatitis delta virus (HDV) coinfection exacerbates clinical outcomes in chronic hepatitis B (CHB) patients. With emerging HDV-targeted therapeutics, accurate prevalence and clinical impact data are essential. In this study, the seroprevalence, clinical significance, and molecular characteristics of HDV were assessed in South Korean patients across the spectrum of liver disease.</p><p><strong>Methods: </strong>This two-center retrospective study included 526 patients with CHB: non-cirrhotic CHB (n=100), cirrhotic CHB (liver cirrhosis, n=100), and hepatocellular carcinoma (HCC; n=326). Serum samples (2012 to 2024) were analyzed for anti-HDV antibodies and HDV RNA using commercial assays and quantitative reverse-transcription polymerase chain reaction, followed by full-length genomic sequencing.</p><p><strong>Results: </strong>The median patient age was 58.0 years, and 71.3% of the patients were male. The overall anti-HDV seroprevalence was 2.7% (14/526). Prevalence did not differ significantly across disease groups: 2.0% in non-cirrhotic CHB, 4.0% in cirrhotic CHB, and 2.5% in HCC (p=0.733). Notably, in HCC patients, anti-HDV seroprevalence was significantly higher in advanced stages (Barcelona Clinic Liver Cancer [BCLC] C-D) than in very early-to-intermediate stages (BCLC 0-B) (5.3% vs 0.9%; p=0.024). HDV RNA was detected in only one patient (0.2% of the total cohort; 7.1% of anti-HDV-positive patients). Phylogenetic analysis characterized the first full-length HDV genotype 1 genome in South Korea, which clustered with East Asian strains.</p><p><strong>Conclusions: </strong>Anti-HDV seroprevalence in Korean CHB patients is 2.7%, whereas viremic prevalence is 0.2%. Anti-HDV positivity is linked to male sex and advanced HCC stage. These findings emphasize the need for HDV screening in patients with advanced liver disease.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108786","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}