Gut and Liver最新文献

{"title":"Extracellular Vesicle Proteomics in Gastric Cancer: Moving Beyond Early Detection.","authors":"Kwanjoo Lee, Jun-Young Seo","doi":"10.5009/gnl260332","DOIUrl":"10.5009/gnl260332","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"20 5","pages":"709-710"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967861","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":"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":"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":"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}

{"title":"Short-Term Impact of Fine Particulate Matter on Hepatic Decompensation in Cirrhosis: A Nationwide Case-Crossover Study.","authors":"Yewan Park, Suna Kang, Jihee Nam, Jin Lee, Hwamin Woo, Hyunsoo Kim, Sung-Won Kang, Juhee Cho, Danbee Kang, Geum-Youn Gwak","doi":"10.5009/gnl260039","DOIUrl":"https://doi.org/10.5009/gnl260039","url":null,"abstract":"<p><strong>Background/aims: </strong>Cirrhosis is a leading cause of morbidity and mortality, and acute decompensation represents a pivotal event in its natural history. While long-term exposure to air pollution has been associated with liver disease progression, evidence on short-term effects remains limited. We investigated whether daily fluctuations in fine particulate matter (PM_2.5) trigger acute decompensation in patients with cirrhosis.</p><p><strong>Methods: </strong>We conducted a nationwide, time-stratified case-crossover study using the Korean National Health Insurance Service database. Adults with cirrhosis from 2006 to 2021 were included. Emergency department (ED) visits for decompensation, including ascites, variceal bleeding, hepatic encephalopathy, jaundice, or hepatorenal syndrome, served as case days. Control days were matched (same month and weekday). Daily PM_2.5 concentrations were assigned to residential districts using a 1-km grid. Conditional logistic regression was used to estimate odds ratios (ORs), adjusting for temperature, humidity, holidays, and weekday/weekend.</p><p><strong>Results: </strong>We analyzed 29,167 patients with cirrhosis (mean age, 59.9 years; 73.1% male) who presented to the ED with hepatic decompensation. Each interquartile range increase in PM_2.5 was associated with a higher risk of decompensation (adjusted OR, 1.02; 95% confidence interval, 1.00 to 1.04). Participants in the highest exposure quintile had 5% higher odds of decompensation than those in the lowest quintile. Lagged exposure analyses indicated attenuation of associations with longer averaging windows. Subgroup analyses revealed no significant interactions.</p><p><strong>Conclusions: </strong>Short-term elevations in ambient PM_2.5 levels were associated with an increased risk of acute hepatic decompensation requiring ED visits. Notably, daily air quality fluctuations may contribute to clinically significant events in this vulnerable population.</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":"148792171","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":"Clinical Usefulness of Computed Tomography Enterography as a Diagnostic Modality for Isolated Terminal Ileitis.","authors":"Woojin Ahn, Jung Hyun Ji, Seoyoon Choi, So Jung Han, Jihye Park, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Jae Jun Park","doi":"10.5009/gnl250584","DOIUrl":"https://doi.org/10.5009/gnl250584","url":null,"abstract":"<p><strong>Background/aims: </strong>Guidelines for further diagnostic evaluation in patients with isolated terminal ileitis have not been established. Although computed tomography enterography (CTE) is an established modality for small bowel evaluation, its diagnostic value in this setting remains unclear. This study aimed to evaluate the diagnostic utility of CTE in patients with isolated terminal ileitis identified during ileocolonoscopy and to identify patient subgroups most likely to benefit from additional CTE evaluation.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of 98 patients who were diagnosed with terminal ileitis without colonic abnormalities during ileocolonoscopy at a tertiary referral center between October 2005 and July 2021. A positive CTE finding was defined as the presence of a lesion in the proximal small bowel beyond the terminal ileum. Independent predictors of positive CTE findings were evaluated using logistic regression analysis.</p><p><strong>Results: </strong>The mean patient age was 43.8 years, and 59.2% were male. Positive CTE findings were identified in 48 patients (49.0%). The most common final diagnosis among these patients was Crohn's disease (n=36, 75.0%). Multivariate analysis revealed that an elevated erythrocyte sedimentation rate (>10 mm/hr) (odds ratio [OR], 3.057; p=0.040), older age (>60 years) (OR, 7.392; p=0.002), and mucosal erythema in the terminal ileum on ileocolonoscopy (OR, 12.078; p=0.030) were independent predictors of positive CTE findings.</p><p><strong>Conclusions: </strong>Approximately half of patients with isolated terminal ileitis had positive CTE findings, with Crohn's disease being the most frequent final diagnosis. CTE may be particularly useful in patients with elevated erythrocyte sedimentation rate (>10 mm/hr), age >60 years, or mucosal erythema in the terminal ileum.</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":"148792194","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 Prognostic Role of Acute-on-Chronic Liver Failure in Acute Variceal Bleeding: A Multicenter Retrospective Study in Australia.","authors":"Kai Yang, Jinhua Qin, Wubin Guo","doi":"10.5009/gnl260216","DOIUrl":"https://doi.org/10.5009/gnl260216","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759753","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}