Gut and Liver最新文献

{"title":"Reconsidering First-Line Therapy for Clarithromycin-Resistant <i>Helicobacter pylori</i> in Korea: The Role of Bismuth-Augmented Triple Therapy.","authors":"Jae Kak Park, Cheal Wung Huh","doi":"10.5009/gnl260236","DOIUrl":"10.5009/gnl260236","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"20 5","pages":"711-712"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967839","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":"Effects of Chemotherapy on Survival Outcomes in Older Patients with Metastatic Pancreatic Cancer: A Nationwide Population-Based Study.","authors":"Kangju Son, Byung Kyu Park, Chan Su Park, Joung-Ho Han, Kyong Joo Lee","doi":"10.5009/gnl250551","DOIUrl":"10.5009/gnl250551","url":null,"abstract":"<p><strong>Background/aims: </strong>Clinical data on chemotherapy outcomes in older patients with pancreatic cancer are limited. This population-based study aimed to evaluate the effects of chemotherapy on survival outcomes in older patients with metastatic pancreatic cancer (mPC).</p><p><strong>Methods: </strong>Data from the National Health Insurance Service linked to the Korea Central Cancer Registry (2012 to 2019) were used. We assessed chemotherapy utilization and overall survival (OS) across various age groups and chemotherapy regimens.</p><p><strong>Results: </strong>Among 20,549 patients with mPC, 8,652 received chemotherapy, including 711 and 163 patients aged 76-80 and ≥81 years, respectively. In the chemotherapy group, the median OS (mOS) was 9, 8, 7, and 6 months for the 21-70, 71-75, 76-80, and ≥81-year age groups, respectively (p<0.001). In contrast, untreated patients had an mOS of only 2 months across all age groups. Propensity score matching for patients aged ≥76 years revealed that chemotherapy was associated with a significantly longer mOS compared with no treatment (7 months vs 2 months: hazard ratio, 0.3; 95% confidence interval, 0.271 to 0.333; p<0.001). Among patients treated with gemcitabine plus nab-paclitaxel, the mOS was 11, 10, 9, and 7 months across the age groups, respectively (p<0.001). For those receiving the FOLFIRINOX regimen, the mOS was 12, 11, and 10 months in patients aged 21-70, 71-75, and 76-80 years, respectively (p=0.001).</p><p><strong>Conclusions: </strong>These real-world data suggest that chemotherapy is effective in older patients with mPC. Notably, chemotherapy with gemcitabine plus nab-paclitaxel and FOLFIRINOX provided substantial survival benefits even in patients aged 76-80 years, with only marginal differences compared to younger cohorts.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"893-903"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217631","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":"Preclinical Analysis of Bone Marrow-Derived Stem Cell Therapy Response and Transcriptomic Overlap Analysis in a Severe Alcoholic Hepatitis Mouse Model.","authors":"Soonchang Hong, Seul Ki Han, Mi Ra Lee, Taesic Lee, Soon Koo Baik, Jin Suk Lee, Moon Young Kim","doi":"10.5009/gnl250425","DOIUrl":"10.5009/gnl250425","url":null,"abstract":"<p><strong>Background/aims: </strong>Severe alcoholic hepatitis (SAH) is a life-threatening form of alcoholic liver disease resulting in high short-term mortality. Mesenchymal stem cells (MSCs) have potent immunomodulatory effects and have been evaluated in various clinical trials for the treatment of chronic liver diseases. However, clinical evidence in patients with alcoholic hepatitis remains scarce, and the underlying mechanisms of MSCs in this population are not yet fully understood.</p><p><strong>Methods: </strong>An integrative meta-analysis identified conserved transcriptomic signatures of alcoholic hepatitis. These signatures were validated in an ethanol-induced murine model. A mouse model of SAH was induced via subacute ethanol exposure (5 g/kg) combined with thioacetamide injection. MSCs were administered at two concentrations (5×10⁵ or 1×10⁶ cells), depending on the treatment group.</p><p><strong>Results: </strong>In the animal model, MSCs treatment visibly alleviated liver injury induced by thioacetamide and ethanol. Significant reductions in tumor necrosis factor-α (p<0.05) and α-smooth muscle actin (p<0.01) levels were observed, accompanied by notable changes in inducible nitric oxide synthase, interleukin-1β, and transforming growth factor-β1 levels. From the meta-analysis, seven upregulated and 17 downregulated genes were identified. Subsequent quantitative polymerase chain reaction and Western blot analyses consistently validated four upregulated genes that demonstrated overlapping expression patterns across both the meta-analysis and in vivo experiments.</p><p><strong>Conclusions: </strong>MSCs therapy significantly attenuates liver injury, inflammation, and fibrosis in SAH model mice. The observed messenger RNA-protein expression mismatches highlight the complexity of molecular regulation in acute hepatitis and underscore the importance of multilevel analysis in evaluating stem cell therapy. These results provide valuable insights into the mechanisms of MSC-mediated liver repair and suggest key targets for MSC therapy and response assessment in SAH.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"824-836"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988825","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":"Metabolic Dysfunction-Associated Steatotic Liver Disease: Current Treatment Strategies and Novel Therapies.","authors":"Anoushka Shenoy, Aijaz Ahmed, Donghee Kim","doi":"10.5009/gnl260175","DOIUrl":"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":"728-744"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575885/pdf/","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":"OA","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":"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":"848-858"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575907/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Cancer Risks and Noninvasive Predictors in MASLD, MetALD, and ALD: A Longitudinal Analysis.","authors":"Hana Park, Ji Young Lee, Ja Eun Koo, Jong Soo Lee, Sungwon Park, Hye Won Park, Hye-Sook Chang, Hong-Kyu Kim, Jaewon Choe, Ju Hyun Shim","doi":"10.5009/gnl260186","DOIUrl":"10.5009/gnl260186","url":null,"abstract":"<p><strong>Background/aims: </strong>The recently proposed classification of steatotic liver disease (SLD) comprises metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol-related liver disease (ALD). Long-term cancer risk across these phenotypes remains incompletely characterized, and was investigated in this study.</p><p><strong>Methods: </strong>This longitudinal cohort study included 43,994 adults who underwent health check-ups in 2010-2011. Liver steatosis was diagnosed by ultrasonography. The Fibrosis-4 (FIB-4) and steatosis-associated fibrosis estimator (SAFE) scores were evaluated as predictors of cancer incidence.</p><p><strong>Results: </strong>Over a median 10.5 years (398,202 person-years), 3,169 cancers occurred (795.8 per 100,000 person-years). Versus no SLD, overall cancer risk was elevated in ALD (incidence rate ratio [IRR], 1.38; 95% confidence interval, 1.08 to 1.79) but not MASLD or MetALD. Hepatocellular carcinoma risk increased across all SLD groups, most strongly in the MetALD and ALD groups, with a more modest association in the MASLD group that was attenuated in sensitivity analyses. ALD was associated with an elevated risk of esophageal cancer (IRR, 5.98) and stomach cancer (IRR, 2.41), and MetALD with an increased risk of stomach cancer (IRR, 1.61). FIB-4 and SAFE showed dose-response associations with cancer that were substantially attenuated after age adjustment, persisting mainly at the highest categories.</p><p><strong>Conclusions: </strong>Cancer risk differs across MASLD, MetALD, and ALD, with alcohol-related phenotypes carrying the highest burden. Noninvasive fibrosis indices such as FIB-4 and SAFE may help stratify risk-though largely age-related-and could inform risk-based surveillance in SLD.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"20 5","pages":"880-892"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967494","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":"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":"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":"814-823"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575904/pdf/","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":"OA","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, Kyungdo Han, Sung Geun Kim","doi":"10.5009/gnl250140","DOIUrl":"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":"765-775"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575905/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fourteen-Day Amoxicillin- or Tetracycline-Containing Bismuth Quadruple Therapy versus 14-Day Metronidazole-Based Triple Therapy as the Treatment for Clarithromycin-Resistant <i>Helicobacter pylori</i> Infection: A Multicenter Randomized Controlled Trial.","authors":"Myeongseok Koh, Cheol Woong Choi, Dae Gon Ryu, Seung Jung Yu, Sung Eun Kim, Kyoungwon Jung, Bong Eun Lee, Moon Won Lee, Dong Chan Joo, Jin Lee, Ra Ri Cha, Sam Ryong Jee","doi":"10.5009/gnl250435","DOIUrl":"10.5009/gnl250435","url":null,"abstract":"<p><strong>Background/aims: </strong>Combination therapy comprising a proton pump inhibitor (PPI), amoxicillin, and metronidazole (PAM) is used to treat clarithromycin-resistant <i>Helicobacter pylori</i> in the Republic of Korea, but eradication rates are decreasing due to an increasing incidence of clarithromycin resistance. We compared PAM, bismuth compounds plus PAM (PAM-B), and the combination of PPI, bismuth compounds, metronidazole, and tetracycline (PBMT) to determine whether PAM-B can achieve an eradication rate higher than that of PAM and comparable to that of PBMT.</p><p><strong>Methods: </strong>This prospective multicenter study enrolled patients with clarithromycin-resistant <i>H. pylori</i> infections in the Busan and Gyeongsangnam-do of the Republic of Korea between December 2022 and February 2024.</p><p><strong>Results: </strong>In the intention-to-treat (ITT) analysis, the eradication rate was significantly lower in the PAM group (68.2%) than in the PAM-B group (84.8%, p=0.024), whereas the difference from the PBMT group (81.8%) was not significant (p=0.070). The rate remained lowest in the PAM group (75.4%) in the per-protocol (PP) analysis (PAM-B, 96.5%, p=0.001; PBMT, 94.6%, p=0.004). Eradication rates were comparable between the PAM-B and PBMT groups in both the ITT (p=0.640) and PP analyses (p=0.633). Nausea and vomiting were significantly less frequent in the PAM-B group than in the PBMT group (6.8% vs 25.0%; p=0.007). Severe adverse events were rare, and all symptoms resolved after treatment discontinuation.</p><p><strong>Conclusions: </strong>PAM-B yielded eradication rates higher than those of PAM and comparable to those of PBMT, with no significant increase in the incidence of adverse events, suggesting the potential of PAM-B as a first-line treatment for clarithromycin-resistant <i>H. pylori</i> infection. Further large-scale studies are needed to validate these results. Registered retrospectively with the Clinical Research Information Service (CRIS; KCT0012265).</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"20 5","pages":"756-764"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967815","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":"Increased Heart Failure Risk with Gastric Cancer Progression: A Nationwide Population-Based Cohort Study.","authors":"Seunghan Lee, Mi Jin Oh, Bokyung Kim, Yoon Jin Choi, Kyungdo Han, Soo-Jeong Cho","doi":"10.5009/gnl250209","DOIUrl":"10.5009/gnl250209","url":null,"abstract":"<p><strong>Background/aims: </strong>Advances in gastric cancer treatment have improved survival rates, which has led to a growing interest in the risk of non-cancer-related conditions, particularly cardiovascular diseases. This study aimed to investigate the risk of heart failure in patients with gastric cancer according to their initial cancer stage.</p><p><strong>Methods: </strong>We conducted a nationwide, population-based, retrospective cohort study using the Cancer Public Library Database of Korea. Patients diagnosed with gastric cancer between 2012 and 2019 were enrolled and followed until the end of 2020. Heart failure development was defined as a new diagnosis of heart failure that required hospitalization. Based on the Surveillance, Epidemiology, and End Results Program staging for gastric cancer, patients were classified into three groups: localized, regional, and distant stages.</p><p><strong>Results: </strong>Of the 202,347 patients in the study, 16,004 (7.9%) developed heart failure during a median follow-up period of 3.6 years. The cumulative incidence of heart failure significantly increased with worsening gastric cancer stage (log-rank, p<0.001). After adjusting for age, sex, diabetes status, hypertension status, dyslipidemia status, income, residential area, and initial treatment modality, with the localized stage as the reference group, the hazard ratio for heart failure was 1.52 (95% confidence interval [CI], 1.46 to 1.58) for patients in the regional stage group and 2.87 (95% CI, 2.69 to 3.07) for those in the distant stage group.</p><p><strong>Conclusions: </strong>In patients with gastric cancer, the risk of heart failure requiring hospitalization increased with worsening cancer stage. Even in young patients and those without metabolic risk factors, close monitoring for heart failure development following cancer treatment is essential.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"776-786"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862854","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}