Gut and Liver最新文献

{"title":"Multi-Database Pharmacovigilance Analysis of Gastroesophageal Reflux Disease Associated with GLP-1 Receptor Agonists: A Cross-National Signal Validation Study.","authors":"Jeong-Gyu Choi, Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee","doi":"10.5009/gnl260189","DOIUrl":"https://doi.org/10.5009/gnl260189","url":null,"abstract":"<p><strong>Background/aims: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for type 2 diabetes and obesity. Gastrointestinal adverse events are common; however, the association with gastroesophageal reflux disease (GERD) has not been validated across diverse populations. We aimed to assess GERD signals associated with GLP-1 RAs using disproportionality analysis across three national adverse event reporting systems.</p><p><strong>Methods: </strong>We analyzed FAERS, JADER, and Canada Vigilance. GLP-1 RAs were compared against dipeptidyl peptidase-4 inhibitors as active comparators. GERD was identified using MedDRA preferred terms. Reporting odds ratios (RORs) with 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed by drug, age, and sex.</p><p><strong>Results: </strong>Among 260,417 GLP-1 RA reports, significant GERD signals were detected across all databases: FAERS (ROR, 2.83; 95% CI, 2.39 to 3.35; 9,245 vs 139), JADER (4.76; 95% CI, 2.45 to 9.27; 19 vs 16), and Canada Vigilance (2.91; 95% CI, 1.97 to 4.31; 206 vs 29). All signals met both ROR and proportional reporting ratio detection criteria. Drug-specific analyses revealed the strongest signals for semaglutide across all databases (3.44 to 6.93), followed by liraglutide (2.36 to 5.90), tirzepatide (2.76 to 5.77), and dulaglutide (2.35 to 3.32). Exenatide showed an inverse association in FAERS (ROR, 0.60; 95% CI, 0.46 to 0.77). Age-stratified analysis demonstrated increasing signal strength with age (≥65 years: ROR, 3.01; p-trend=0.028). Sensitivity analysis confirmed consistent signal directions.</p><p><strong>Conclusions: </strong>This first multi-database pharmacovigilance analysis confirms consistent GERD signals for GLP-1 RAs across Western and Asian populations, demonstrating approximately 2- to 5-fold higher reporting. Clinicians need to monitor for reflux symptoms during GLP-1 RA therapy, particularly in elderly patients.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873846","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":"Safety of Endoscopic Ultrasound-Guided Biliary Drainage in Patients with Distal Malignant Biliary Obstruction with Large-Volume Ascites.","authors":"Takehiko Koga, Yusuke Ishida, Akihisa Ohno, Ryota Sagami, Yoshitaka Nakamura, Makoto Hinokuchi, Kosuke Takahashi, Hidefumi Nishikori, Nao Fujimori, Yasuhisa Hiroshima, Hiroki Taguchi, Shinichi Hashimoto, Eisuke Ozawa, Hiroaki Tsuji, Naoaki Tsuchiya, Takanori Kitaguchi, Keisuke Matsumoto, Makoto Fukuyama, Tatsuro Nii, Fumihito Hirai","doi":"10.5009/gnl260042","DOIUrl":"https://doi.org/10.5009/gnl260042","url":null,"abstract":"<p><strong>Background/aims: </strong>The safety and efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with large-volume ascites (LVA) remain unclear. We aimed to evaluate the safety of EUS-BD in patients with distal malignant biliary obstruction complicated by LVA.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients with distal malignant biliary obstruction who underwent EUS-BD. Pre-procedural computed tomography images were reviewed to identify patients with LVA, which was defined as ascites extending to the perihepatic region. The primary outcome was the safety of EUS-BD.</p><p><strong>Results: </strong>Among 1,524 patients with distal malignant biliary obstruction, 156 (10.2%) had LVA. EUS-BD was performed in 43 patients in whom endoscopic retrograde cholangiopancreatography failed or was infeasible. The technical and clinical success rates for EUS-BD were 97.7% and 81.4%, respectively. Adverse events (AEs), severe AEs, and intra-abdominal AEs (bile leak and peritonitis) occurred in 34.9%, 9.3%, and 18.6% of the patients, respectively. In the multivariate analysis, peritoneal dissemination was identified as an independent risk factor for overall AEs (odds ratio, 4.57; 95% confidence interval, 1.01 to 20.65; p=0.04). In the subgroup analysis, the perihepatic ascites thickness on axial computed tomography images was significantly greater in patients with intra-abdominal AEs than in those without AEs (p<0.01). The receiver operating characteristic curve analysis showed that the perihepatic ascites thickness predicted intra-abdominal AEs (area under the curve, 0.82; optimal cutoff, 15.5 mm). Fourteen patients (32.6%) died during the index hospitalization without discharge, with a median post-procedural survival of 1.8 months.</p><p><strong>Conclusions: </strong>EUS-BD may be associated with a high risk of AEs in patients with LVA, warranting a careful selection of patients.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873873","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":"Metabolic Dysfunction-Associated Steatotic Liver Disease: Current Treatment Strategies and Novel Therapies.","authors":"Anoushka Shenoy, Aijaz Ahmed, Donghee Kim","doi":"10.5009/gnl260175","DOIUrl":"https://doi.org/10.5009/gnl260175","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a challenging multi-system global health problem, affecting approximately one-third of the world's population. Lifestyle modifications remain the cornerstone of MASLD management, which poses challenges in this population. The recent US Food and Drug Administration approval of resmetirom and semaglutide for the treatment of metabolic dysfunction-associated steatohepatitis with fibrosis signifies a substantial transformation in the therapeutic landscape. Other new therapeutic options are emerging, with encouraging phase 3 data from several agents spanning diverse mechanisms of action. This review summarizes the contemporary non-pharmacological and pharmacological approaches to MASLD.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864585","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":"CTLA-4 as a Double-Edged Sword in Colorectal Cancer: Molecular Insights into Immune Checkpoint Suppression and Therapeutic Targeting.","authors":"Husin Thamrin, Gondo Mastutik, Muhammad Miftahussurur","doi":"10.5009/gnl260025","DOIUrl":"https://doi.org/10.5009/gnl260025","url":null,"abstract":"<p><p>Colorectal cancer (CRC) remains a major global health burden and ranks third among the most commonly diagnosed malignancies and the second leading cause of cancer-related mortality worldwide. Its development arises through successive molecular and cellular alterations driven by cumulative genetic mutations, environmental exposure, and immune dysregulation. Among immune regulators, cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) plays dual roles in CRC progression. On one hand, CTLA-4 preserves immune homeostasis by restraining excessive T-cell activation through competitive binding with CD80/CD86. This regulatory function is mediated by attenuated T-cell receptor signaling, dominance over CD28-mediated co-stimulation, and sustained activity of regulatory T cells to maintain peripheral tolerance. On the other hand, this inhibitory mechanism facilitates tumor immune evasion and contributes to cancer progression by limiting effector T-cell proliferation, reducing cytotoxic activity, and promoting immune exhaustion within the tumor microenvironment. Therapeutically, antibodies such as ipilimumab and tremelimumab leverage these roles by blocking CTLA-4 to restore antitumor immunity. However, the downstream signaling cascades following CTLA-4 activation and the detailed molecular basis of tremelimumab-mediated modulation are not yet fully understood. More detailed understanding of these dual-role mechanisms through integrative molecular, cellular, and structural analyses may help refine immune checkpoint blockade strategies and improve therapeutic outcomes in CRC patients.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864664","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":"Sex Differences in Growth Recovery among Children with Crohn's Disease.","authors":"Dong-Uk Kim, Jin Soo Moon, Yeoun Joo Lee, Yon Ho Choe, Hyeji Lim, Minsoo Shin, Soon Chul Kim, Hye Ran Yang, Eell Ryoo, Yoo Min Lee, Ji-Sook Park, Ki Soo Kang, Tae Hyeong Kim, Seak Hee Oh, Ben Kang, So Yoon Choi, Yoon Lee, Ju Young Chang, Jae Sung Ko, Jung Ok Shim","doi":"10.5009/gnl250605","DOIUrl":"https://doi.org/10.5009/gnl250605","url":null,"abstract":"<p><strong>Background/aims: </strong>Growth impairment remains a major concern in pediatric Crohn's disease (pCD) patients, yet long-term growth trajectories and sex-specific treatment responses have not been adequately characterized.</p><p><strong>Methods: </strong>This study investigated 2-year growth trajectories and determinants of catch-up growth from a nationwide registry in Korea. Growth outcomes were analyzed in 533 children with pCD using multivariable linear regression and generalized additive models (GAM).</p><p><strong>Results: </strong>At diagnosis, 16.1% and 4.1% of patients had weight-for-age and height-for-age z-scores less than -2, respectively. Weight recovery was more readily achieved than linear growth during follow-up (median z-score change: 0.61, p<0.001 vs -0.01, p=0.582). Females presented with lower baseline weight z-scores than males (-1.00 vs -0.63; p=0.001) but displayed superior weight recovery (0.81 vs 0.51; p<0.001) and significant height recovery (0.09 vs -0.08 in males; p<0.001). In the multivariable analysis, the baseline weight z-score, platelet count, albumin, and disease activity predicted weight recovery (R²=26.3%), while the baseline height z-score was the strongest predictor of height recovery. The GAM analysis suggested that infliximab use was associated with enhanced height recovery (β=0.104, p=0.045), with benefits observed primarily in females aged <14 years (β=0.339, p=0.044).</p><p><strong>Conclusions: </strong>This Asian cohort study with the largest population to date demonstrates that weight recovery precedes linear growth, with females showing superior catch-up. Notably, our findings highlight a selective association between infliximab treatment and height recovery in females younger than 14 years, suggesting sex- and age-specific differences in the treatment response that warrant further investigation. (Clinical trial registration: Korea Clinical Research Information Service KCT0008723).</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864646","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":"Metabolic Dysfunction-Associated Steatotic Liver Disease and Vascular Complications: Associations with Serum Testosterone Levels in a Korean Multicenter Male Cohort.","authors":"Hyo Jung Cho, Seong Hee Kang, Hye Yeon Chon, SungA Bae, Eunju Kim, Seong Kyun Na, Su Jin Kim, Dooyeon Kim, Hye Ri Ahn, Huigyeong Kim, Soon Sun Kim, Jae Youn Cheong, Soon Koo Baik, Young Kul Jung, Hyung Joon Yim","doi":"10.5009/gnl250585","DOIUrl":"https://doi.org/10.5009/gnl250585","url":null,"abstract":"<p><strong>Background/aims: </strong>We investigated the associations of testosterone levels with metabolic dysfunction-associated steatotic liver disease (MASLD) and vascular complications in a large Korean male cohort. Despite the high global prevalence of MASLD and significant morbidity from cardiovascular disease, the interplay among testosterone levels, MASLD, and vascular outcomes remains unclear, particularly in Asian populations.</p><p><strong>Methods: </strong>This cross-sectional study analyzed 1,167 men from the Korean Health Screening-Based MASLD Registry. MASLD was defined as imaging-confirmed steatosis with metabolic dysfunction. Log2-transformed testosterone levels were analyzed using logistic regression adjusted for metabolic risk factors to evaluate associations with MASLD, advanced fibrosis (Fibrosis-4 index [FIB-4] ≥1.3), carotid plaques, and cerebrovascular accidents (CVAs).</p><p><strong>Results: </strong>Among the 1,167 men (mean age 57.0 years), 730 (62.6%) had MASLD. These patients had lower testosterone levels than non-MASLD men did (223.5 ng/dL vs 347.5 ng/dL; p<0.001) and showed adverse metabolic features. Higher testosterone levels were independently associated with reduced risk of MASLD (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.85 to 0.94; p<0.001). Among the MASLD patients, higher testosterone levels were linked to a significantly lower prevalence of carotid plaques (OR, 0.77; 95% CI, 0.73 to 0.81) and CVAs (OR, 0.75; 95% CI, 0.67 to 0.82). The associations remained robust across sensitivity analyses with adjustments for obesity, diabetes, and dyslipidemia. No significant association was observed with advanced fibrosis (FIB-4 ≥1.3).</p><p><strong>Conclusions: </strong>Low testosterone levels are independently associated with MASLD and its vascular complications but not with advanced fibrosis. Serum testosterone levels may serve as a practical biomarker for metabolic and vascular risk stratification in MASLD patients, warranting validation in prospective and interventional studies. (ClinicalTrials.gov identifier NCT06843421).</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864654","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":"Subtype-Specific Mortality and Cardiovascular Burden in HIV Patients with Steatotic Liver Disease: A Korean National Cohort Study.","authors":"Jihun Song, Seogsong Jeong, Jihwan Bang, Won Kim","doi":"10.5009/gnl250555","DOIUrl":"https://doi.org/10.5009/gnl250555","url":null,"abstract":"<p><strong>Background/aims: </strong>Steatotic liver disease (SLD) is an emerging comorbidity among people living with human immunodeficiency virus (PLWH), but its subtype-specific burden remains unclear. We aimed to evaluate the prevalence of SLD and its associations with mortality, cardiovascular diseases, and liver cirrhosis (LC).</p><p><strong>Methods: </strong>This retrospective cohort study included 4,597 Korean PLWH using data from the National Health Insurance Service (2013-2022). SLD was defined using the fatty liver index (≥30) and categorized into metabolic dysfunction-associated SLD (MASLD), alcohol-associated liver disease (ALD), and metabolic dysfunction-associated ALD (MetALD). Outcomes were all-cause mortality, cardiovascular diseases, and LC, analyzed using multivariable Cox proportional hazards and Fine-Gray competing risk models.</p><p><strong>Results: </strong>The prevalence of SLD was 45.7%, predominantly MASLD (86.5%), followed by Met-ALD (9.7%) and ALD (3.8%). SLD prevalence in PLWH was not higher than that in matched controls. Over a median 6-year follow-up, SLD was associated with increased mortality (adjusted hazard ratio, 1.53; 95% confidence interval [CI], 1.03 to 2.29). ALD was linked to higher stroke risk (adjusted subdistribution hazard ratio [aSHR], 3.10; 95% CI, 1.04 to 9.20), and MetALD to higher LC risk (aSHR, 5.72; 95% CI, 1.48 to 22.10).</p><p><strong>Conclusions: </strong>As SLD is significantly associated with mortality in PLWH, integrated management focusing on liver health, metabolic dysfunction, and alcohol use is essential to reduce adverse outcomes.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864582","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: Reply.","authors":"Eunae Cho, Chang Hwan Park","doi":"10.5009/gnl260169","DOIUrl":"https://doi.org/10.5009/gnl260169","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792212","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":"Baseline and Longitudinal MASLD Status Is Associated with Increased Risk of Pyogenic Liver Abscess.","authors":"Han Ah Lee, Na Ryung Choi, Chung Gyo Seo, Hyungmi An, Jae Yoon Jeong, Hwi Young Kim","doi":"10.5009/gnl260081","DOIUrl":"https://doi.org/10.5009/gnl260081","url":null,"abstract":"<p><strong>Background/aims: </strong>Pyogenic liver abscess (PLA) is a severe infectious disease with significant morbidity and mortality risk. We investigated the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and the incidence of PLA and related complications.</p><p><strong>Methods: </strong>We analyzed data from 2,951,003 adults aged 40 to 64 years who underwent health examinations between 2009 and 2010 using the Korean National Health Insurance Service database. Hepatic steatosis was defined as a fatty liver index ≥30, and MASLD was identified based on established criteria. Changes in MASLD status over a 4-year follow-up period were evaluated for their impact on PLA risk.</p><p><strong>Results: </strong>Over a median follow-up of more than 14 years, the incidence rate of PLA was 27.2 per 100,000 person-years versus 13.3 per 100,000 person-years in the MASLD and non-steatotic liver disease (non-SLD) groups, respectively. Compared to non-SLD, MASLD was significantly associated with an increased risk of PLA (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.45 to 1.61) and its complications (HR, 1.72; 95% CI, 1.27 to 2.33). In the 4-year follow-up analysis, compared to individuals without any SLD at both baseline and follow-up, individuals with persistent MASLD had a higher risk of PLA (HR, 1.61; 95% CI, 1.49 to 1.74), followed by those whose MASLD regressed to non-SLD (HR, 1.38; 95% CI, 1.23 to 1.53) and those who developed MASLD during follow-up (HR, 1.27; 95% CI, 1.13 to 1.43). Other metabolic SLD categories also showed a higher risk of PLA than the non-SLD group.</p><p><strong>Conclusions: </strong>MASLD is significantly associated with an increased risk of PLA and related complications, with the highest risk observed in individuals with persistent MASLD.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792153","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":"Diagnostic Performance of Serum-Ascites Albumin Gradient: A Systematic Review and Meta-Analysis.","authors":"Jeong Eun Song, Yeonjung Ha, Young Chang, Jeong-Ju Yoo","doi":"10.5009/gnl260180","DOIUrl":"https://doi.org/10.5009/gnl260180","url":null,"abstract":"<p><p>Ascites is a common complication of advanced liver disease, and accurate etiologic differentiation remains essential for clinical management. The serum-ascites albumin gradient (SAAG) is widely used to distinguish portal hypertensive from non-portal hypertensive ascites; however, its diagnostic performance across different clinical contexts has not been consistently established. We conducted a systematic review and meta-analysis of 47 studies involving 5,070 patients to evaluate the diagnostic accuracy of SAAG. Using a bivariate random-effects model, the pooled sensitivity and specificity were 0.889 (95% confidence interval [CI], 0.847 to 0.920) and 0.818 (95% CI, 0.752-0.870), respectively, with an area under the hierarchical summary receiver operating characteristic (HSROC) curve of 0.881. In subgroup analyses, SAAG showed excellent performance in identifying portal hypertension (area under the HSROC curve=0.936) and high specificity for malignant ascites, whereas its utility for predicting variceal bleeding was limited. Despite substantial heterogeneity and evidence of publication bias, the overall findings were consistent. These results support the continued use of SAAG as a practical and reliable first-line diagnostic tool in patients with ascites, particularly for confirming portal hypertension and excluding malignancy, while highlighting its limitations in other clinical settings.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792198","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}