Gut and Liver最新文献

{"title":"Repurposing of Antiplatelet Agent: Cilostazol for the Treatment of Alcohol-Related Liver Disease.","authors":"Jong Ryeol Eun, Seung Up Kim","doi":"10.5009/gnl240295","DOIUrl":"10.5009/gnl240295","url":null,"abstract":"<p><p>Alcohol-related liver disease (ALD) is a serious global health concern, characterized by liver inflammation and progressive fibrosis. There are no Food and Drug Administration-approved drugs, thus effective treatments are needed. Severe alcoholic hepatitis (AH) is the most severe manifestation of ALD, with a 28-day mortality rate ranging from 20% to 50%. For decades, pentoxifylline, an antiplatelet agent, has been used off-label for the treatment of severe AH owing to its tumor necrosis factor-α inhibition properties. However, the STOPAH trial did not reveal the survival benefit of pentoxifylline. Consequently, pentoxifylline is no longer recommended as the first-line therapy for severe AH. In contrast, cilostazol is widely used as an antiplatelet agent in cardiovascular medicine and demonstrates promising results. Cilostazol is a selective phosphodiesterase type 3 inhibitor, whereas pentoxifylline is non-selective. Recent studies using experimental models of alcohol-induced liver injury and other liver diseases have yielded promising results. Although cilostazol shows promise for hepatoprotective effects, it has not yet been evaluated in human clinical trials. In this review, we will explore the mechanism underlying the hepatoprotective effects of cilostazol, along with the pathophysiology of alcohol-induced liver injury, addressing the pressing need for effective therapeutic options for patients with ALD.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"318-326"},"PeriodicalIF":3.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Risk Factors, and Outcomes of Chronic Antibiotic-Refractory Pouchitis in Korean Patients with Ulcerative Colitis.","authors":"Ji Eun Baek, Jung-Bin Park, June Hwa Bae, Min Hyun Kim, Seung Wook Hong, Sung Wook Hwang, Jong Lyul Lee, Yong Sik Yoon, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Chang Sik Yu, Suk-Kyun Yang, Sang Hyoung Park","doi":"10.5009/gnl240226","DOIUrl":"10.5009/gnl240226","url":null,"abstract":"<p><strong>Background/aims: </strong>The study investigated the incidence, risk factors, and clinical outcomes of chronic antibiotic-refractory pouchitis (CARP) in Korean patients with ulcerative colitis (UC).</p><p><strong>Methods: </strong>This single-center retrospective study included patients with UC who underwent total proctocolectomy with ileal pouch-anal anastomosis at the Asan Medical Center in Korea between January 1987 and December 2022. The primary outcomes were endoscopic remission and pouch failure. The Cox's proportional hazard model was used to identify the risk factors for CARP.</p><p><strong>Results: </strong>The clinical data of 232 patients were analyzed. The most common cause of surgery was steroid refractoriness (50.9%), followed by dysplasia/colorectal cancer (26.7%). Among 74 patients (31.9%) with chronic pouchitis (CP), 31 (13.4%) had CARP, and 43 (18.5%) had chronic antibiotic-dependent pouchitis (CADP). The most frequent endoscopic phenotype was focal inflammation of the pouch (CP, 47.3%; CARP, 35.5%; CADP, 55.8%). Patients with CARP were less likely to use concomitant probiotics than patients with CADP (29.0% vs 72.1%, p<0.01). The endoscopic remission rate of CP, CARP, and CADP was 14.9%, 9.7%, and 18.6%, respectively. The pouch failure rate associated with CP, CARP, and CADP was 13.5%, 16.1%, and 11.6%, respectively. Current smoking status (adjusted hazard ratio [aHR], 2.96; 95% confidence interval [CI], 1.27 to 6.90; p=0.01) and previous use of biologics/small molecules (aHR, 2.40; 95% CI, 1.05 to 5.53; p=0.04) were significantly associated with CARP development.</p><p><strong>Conclusions: </strong>UC patients who were current smokers and previously used biologics/small molecules had a higher risk of developing CARP. Concomitant use of probiotics was less likely to be associated with CARP development.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"388-397"},"PeriodicalIF":3.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Donor Age on Liver Transplant Outcomes in Patients with Acute-on-Chronic Liver Failure: A Cohort Study.","authors":"Jie Zhou, Danni Ye, Shenli Ren, Jiawei Ding, Tao Zhang, Siyao Zhang, Zheng Chen, Fangshen Xu, Yu Zhang, Huilin Zheng, Zhenhua Hu","doi":"10.5009/gnl230143","DOIUrl":"10.5009/gnl230143","url":null,"abstract":"<p><strong>Background/aims: </strong>Liver transplantation is the most effective treatment for the sickest patients with acute-on-chronic liver failure (ACLF). However, the influence of donor age on liver transplantation, especially in ACLF patients, is still unclear.</p><p><strong>Methods: </strong>In this study, we used the data of the Scientific Registry of Transplant Recipients. We included patients with ACLF who received liver transplantation from January 1, 2007, to December 31, 2017, and the total number was 13,857. We allocated the ACLF recipients by age into group I (donor age ≤17 years, n=647); group II (donor age 18-59 years, n=11,423); and group III (donor age ≥60 years, n=1,787). Overall survival (OS), graft survival, and mortality were compared among the three age groups and the four ACLF grades. Cox regression was also analyzed.</p><p><strong>Results: </strong>The 1-, 3-, and 5-year OS rates were 89.6%, 85.5%, and 82.0% in group I; 89.4%, 83.4%, and 78.2% in group II; and 86.8%, 78.4%, and 71.4% in group III, respectively (p<0.001). When we analyzed the different effects of donor age on OS with different ACLF grades, in groups II and III, we observed statistical differences. Finally, the cubic spline curve told us that the relative death rate changed linearly with increasing donor age.</p><p><strong>Conclusions: </strong>Donor age is related to OS and graft survival of ACLF patients after transplantation, and poorer results were associated with elderly donors. In addition, different donor ages have different effects on recipients with different ACLF grades.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"398-409"},"PeriodicalIF":3.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Potential Role of the Rapid Urease Test with the Sweeping Method in the Gray Zone of the Urea Breath Test after <i>Helicobacter pylori</i> Eradication.","authors":"Ji Hyun Kim, Ji Min Kim, Bumhee Park, Sun Gyo Lim, Sung Jae Shin, Kee Myung Lee, Gil Ho Lee, Choong-Kyun Noh","doi":"10.5009/gnl240470","DOIUrl":"10.5009/gnl240470","url":null,"abstract":"<p><strong>Background/aims: </strong>Although the urea breath test (UBT) is widely used as a representative monitoring test after <i>Helicobacter pylori</i> eradication, false-negative results can occur because of the gray zone related to its cutoff value. This study aimed to compare the diagnostic performances of the rapid urease test (RUT), the RUT with sweeping method, and the UBT, and to investigate the role of the sweeping method in the gray zone of UBT values.</p><p><strong>Methods: </strong>We retrospectively reviewed 216 patients who received standard first-line <i>H. pylori</i> eradication treatments (n=216). All participants underwent to testing using the sweeping method and UBT on the same day. The sensitivity, specificity, and accuracy were analyzed to compare the two methods.</p><p><strong>Results: </strong>The sensitivity (0.537 vs 0.806, p=0.002) and accuracy (0.843 vs 0.870, p=0.026) of the UBT were inferior to those of the sweeping method. A total of 31 individuals tested positive for <i>H. pylori</i> according to the UBT, whereas 54 individuals tested positive according to the sweeping method. In the group for which the gold standard definition indicated <i>H. pylori</i> positivity but UBT results were negative (n=31), all individuals had a UBT value under 2.5‰. In the multivariate logistic regression model, a UBT value of 1.4‰ to 2.5‰ increased the risk of false-negative results by 6.5 times (odds ratio, 6.5; 95% confidence interval, 2.077 to 20.288; p=0.001).</p><p><strong>Conclusions: </strong>After <i>H. pylori</i> eradication, false-negative results can occur for individuals undergoing the UBT, primarily for values below the UBT cutoff. The RUT with the sweeping method can potentially help detect <i>H. pylori</i> in the gray zone of the UBT, improving diagnostic accuracy.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"355-363"},"PeriodicalIF":3.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of Caudate Lobectomy in Intrahepatic Cholangiocarcinoma Involving the Hepatic Hilus.","authors":"Boram Lee, YoungRok Choi","doi":"10.5009/gnl250198","DOIUrl":"10.5009/gnl250198","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"19 3","pages":"301-302"},"PeriodicalIF":3.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the Treatment Landscape for Widespread Superficial Esophageal Squamous Cell Neoplasia.","authors":"Moon Won Lee, Gwang Ha Kim","doi":"10.5009/gnl250084","DOIUrl":"10.5009/gnl250084","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"19 3","pages":"305-306"},"PeriodicalIF":3.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pyloric Dysfunction: A Review of the Mechanisms, Diagnosis, and Treatment.","authors":"Hee Kyong Na, Andrew A Li, Andres Gottfried-Blackmore, Alexander J Podboy, Micaela M Esquivel, Abel A Joseph, Linda Nguyen, Joo Ha Hwang","doi":"10.5009/gnl240421","DOIUrl":"10.5009/gnl240421","url":null,"abstract":"<p><p>Pyloric dysfunction is defined as hypertonia or spasm of the pyloric sphincter. The pylorus plays a key role in gastric emptying, but its function remains incompletely understood. Most studies have focused on gastroparesis regardless of the underlying pathophysiology. Few studies have reported pyloric dysfunction in patients with gastroparesis, and the diagnostic and treatment modalities for pyloric dysfunction are not well established. Recently developed diagnostic modalities assessing pyloric function, such as high-resolution antroduodenal manometry and endoluminal functional lumen imaging, are currently being evaluated. A variety of therapeutic interventions targeting the pylorus, including pharmacologic agents, intrapyloric botulinum injection, endoscopic balloon dilation, stent insertion, surgical pyloroplasty, and gastric peroral endoscopic pyloromyotomy, have been proposed. Among these, gastric peroral endoscopic pyloromyotomy has emerged as a novel, minimally invasive therapy with demonstrated efficacy and safety for refractory gastroparesis. This article reviews the pathophysiology of pyloric dysfunction and the potential diagnostic and therapeutic modalities based on the latest literature.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"327-345"},"PeriodicalIF":3.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"15-Year Trends in Hepatocellular Carcinoma: Epidemiology, Treatment, and Outcomes from a Hospital-Based Registry.","authors":"Songgyung Kim, Jina Park, Won-Mook Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Ki-Hun Kim, Jonggi Choi","doi":"10.5009/gnl240599","DOIUrl":"https://doi.org/10.5009/gnl240599","url":null,"abstract":"<p><strong>Background/aims: </strong>Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality, particularly in Korea. We analyzed trends in the epidemiology, tumor characteristics, treatment modalities, and outcomes of HCC over the past 15 years, using a large-scale hospital-based registry.</p><p><strong>Methods: </strong>We examined Asan Medical Center HCC registry data on 21,699 treatment-naïve patients with HCC diagnosed between 2009 and 2023. Patients were categorized into four periods based on their year of diagnosis: period 1 (2009-2011), period 2 (2012-2015), period 3 (2016-2019), and period 4 (2020-2023). HCC staging followed the Barcelona Clinic Liver Cancer (BCLC) system.</p><p><strong>Results: </strong>The prevalence of hepatitis B virus declined continuously from 74.9% to 61.2%, with an increase in nonviral etiologies. The median age at diagnosis increased from 56 years in period 1 to 62 years in period 4, with increased comorbidities such as diabetes and hypertension. Early-stage HCC detection improved, with more patients diagnosed at BCLC stage 0 or A. The use of systemic therapy, particularly atezolizumab-bevacizumab treatment, increased from 2020, especially among patients with BCLC stage C. The 5-year survival rate improved significantly from 44.0% in period 1 to 65.2% in period 3, with overall survival rates increasing across all stages except BCLC stage D. Patients with hepatitis B virus-related HCC experienced the best outcomes. Recurrence rates after curative treatment gradually decreased over time.</p><p><strong>Conclusions: </strong>Over the past 15 years, significant advancements in the early detection and treatment of HCC in Korea have led to improved survival outcomes. These findings underscore the need for ongoing clinical strategy evolution to address the changing landscape of HCC.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077706","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":"Optimizing Infliximab Use in Real-World Inflammatory Bowel Disease: Insights from a Population Pharmacokinetic Model Integrating Intravenous and Subcutaneous Formulations.","authors":"Sung Hoon Jung, Sang-Bum Kang","doi":"10.5009/gnl250154","DOIUrl":"10.5009/gnl250154","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"19 3","pages":"299-300"},"PeriodicalIF":3.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut-Liver Axis: The Role of Intestinal Microbiota and Their Metabolites in the Progression of Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Chao Cui, Shuai Gao, Jingfei Shi, Kai Wang","doi":"10.5009/gnl240539","DOIUrl":"https://doi.org/10.5009/gnl240539","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as one of the most prevalent chronic liver diseases globally, and its pathogenesis is closely linked to the imbalance of intestinal microbiota and their metabolites. This article reviews the mechanisms through which intestinal microbiota influence the progression of MASLD via the gut-liver axis, elaborating on the complex roles of immune cell hyperactivation, impaired intestinal barrier function, and intestinal microbial metabolites such as short-chain fatty acids and bile acids. The imbalance of intestinal microbiota not only directly promotes the development of MASLD but also further exacerbates disease progression through abnormalities in their metabolites. Various novel therapeutic strategies are being actively developed on the basis of gut-liver axis theory, including probiotic/prebiotic/synbiotic treatment, fecal microbiota transplantation, and targeted drug therapy. These strategies aim to precisely regulate microbial homeostasis and improve glucose and lipid metabolism, thereby alleviating hepatic inflammation and fibrosis and optimizing the therapeutic outcomes of patients with MASLD. In the future, as research progresses, we will further uncover the interaction mechanisms between intestinal microbiota and MASLD and continuously explore more effective treatment methods, with the goal of improving the prognosis and quality of life for MASLD patients.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999216","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}