Gut and Liver最新文献

{"title":"Comparative Clinical Outcomes of Various Colorectal Endoscopic Submucosal Dissection Techniques: A Systematic Review and Network Meta-Analysis.","authors":"Seung Min Hong, Jung Won Lee, Jae Hyun Kim, Hyun Jung Kim, Seun Ja Park, Byung Soo Kwan","doi":"10.5009/gnl250559","DOIUrl":"https://doi.org/10.5009/gnl250559","url":null,"abstract":"<p><strong>Background/aims: </strong>Traction-assisted endoscopic submucosal dissection (T-ESD), hybrid ESD (H-ESD), pocket-creation method ESD (P-ESD), and underwater ESD (U-ESD) were introduced to overcome the limitations of conventional ESD (C-ESD). We conducted a systematic review and network meta-analysis to compare the clinical outcomes of different colorectal ESD techniques.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) comparing various ESD techniques (C-ESD, T-ESD, H-ESD, P-ESD, U-ESD) were included. Procedure time, dissection speed, <i>en bloc</i> resection, complete resection, perforation, and delayed bleeding were compared using network meta-analysis.</p><p><strong>Results: </strong>Sixteen RCTs involving 1,536 patients were included. T-ESD had a shorter procedure time (mean difference [MD], -25.17; 95% confidence interval [CI], -34.09 to -16.24). Dissection speed was faster with T-ESD (MD, 6.19; 95% CI, 2.12 to 10.26; surface under the cumulative ranking curve [SUCRA], 74.6) and H-ESD had a high SUCRA (73.0) for dissection speed. Based on the SUCRA rankings, T-ESD (81.4) and P-ESD (55.8) ranked higher for <i>en bloc</i> resection, while U-ESD (74.5) and T-ESD (65.2) ranked higher for complete resection. H-ESD consistently ranked lower than C-ESD for <i>en bloc</i> resection (6.5), complete resection (23.3), and delayed bleeding (23.6) according to SUCRA values. Regarding safety outcomes, T-ESD showed the most favorable SUCRA ranking for perforation (73.6), and U-ESD showed the most favorable SUCRA ranking for delayed bleeding (74.9).</p><p><strong>Conclusions: </strong>T-ESD ranked higher according to SUCRA values across multiple efficacy and safety outcomes. U-ESD ranked favorably for complete resection and delayed bleeding based on SUCRA values. H-ESD had a higher SUCRA value for dissection speed but ranked lower for <i>en bloc</i> resection, complete resection, and delayed bleeding.</p>","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":"148759206","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":"Cost-Effectiveness of Various First-Line <i>Helicobacter pylori</i> Eradication Regimens in Korea: Analysis of the Korean Registry on the Current Management of <i>H. pylori</i> (K-Hp-Reg).","authors":"Joon Sung Kim, Yuri Jeong, Jae Gyu Kim, Hankil Lee","doi":"10.5009/gnl260087","DOIUrl":"https://doi.org/10.5009/gnl260087","url":null,"abstract":"<p><strong>Background/aims: </strong>Current Korean guidelines recommend five different strategies for first-line eradication. No study has compared the cost-effectiveness of these five strategies in Korea.</p><p><strong>Methods: </strong>A decision tree model was developed to assess the costs and eradication outcomes of the five first-line eradication strategies. Empirical regimens included 14-day clarithromycin-based triple therapy (CTT), 10-day sequential therapy (ST), 10-day concomitant therapy (CT), and bismuth quadruple therapy (BQT). Tailored therapy (TT) was defined as resistance-guided treatment, in which patients with clarithromycin-resistant infections received 7-day BQT and those without resistance received 7-day CTT. Eradication rates were derived from the Korean nationwide <i>Helicobacter pylori</i> registry.</p><p><strong>Results: </strong>Among the empirical regimens, 14-day CTT showed the lowest eradication rate and highest cost. In contrast, ST, CT, and BQT demonstrated lower costs and higher eradication rates than 14-day CTT. TT achieved an overall eradication rate of 88.9% at a total cost of USD 221.91, which was higher than that of any empirical regimen. Compared with BQT, TT was associated with higher costs and lower eradication rates. Compared with ST, CT, and CTT, TT incurred higher costs but achieved higher eradication rates, with incremental cost-effectiveness ratios ranging from USD 3.82 to USD 21.34 per 1% increase in eradication rate.</p><p><strong>Conclusions: </strong>BQT demonstrated the most favorable cost-effectiveness among the first-line regimens recommended by the Korean guidelines. Although TT proved to be more cost-effective than CTT, it did not demonstrate superior cost-effectiveness compared with BQT.</p>","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":"148759752","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":"Comparative Outcomes of Rifaximin Monotherapy and Lactulose in Cirrhosis: A Multicenter Cohort Study.","authors":"Mohamad Mahdi Osman, Omar T Sims, Dian J Chiang","doi":"10.5009/gnl260099","DOIUrl":"https://doi.org/10.5009/gnl260099","url":null,"abstract":"<p><p>Hepatic encephalopathy (HE) is a frequent complication of cirrhosis. Lactulose is guideline-recommended first-line therapy, whereas rifaximin is typically used adjunctively or when lactulose is not tolerated. We compared real-world outcomes of rifaximin monotherapy versus lactulose monotherapy for secondary HE prophylaxis. Using the TriNetX research network, we identified adults with cirrhosis (K74.6) and HE (K76.82) prescribed rifaximin or lactulose monotherapy, excluding patients with liver transplant, end-stage renal disease, or combination therapy. The index date was the first qualifying prescription after cirrhosis and HE documentation. After 1:1 propensity score matching for demographics, comorbidities, liver disease severity, polyethylene glycol-3350 use, and Model for End-Stage Liver Disease components, 1,734 matched pairs were analyzed. Outcomes were assessed using Cox proportional hazards models. Compared with lactulose, rifaximin was associated with lower all-cause mortality (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.60 to 0.79), hospitalization (HR, 0.46; 95% CI, 0.41 to 0.51), and SBP (HR, 0.29; 95% CI, 0.15 to 0.53), with similar recurrent HE (HR, 1.05; 95% CI, 0.94 to 1.16). These observational findings are hypothesis-generating and warrant prospective comparative and cost-effectiveness studies.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578435","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":"Temporal Association of Combined AFP-L3 and PIVKA-II with Early Recurrence after Hepatocellular Carcinoma Resection.","authors":"Dong Yun Kim, Ye Jin Jeong, Jun Yong Park, Sang Hoon Ahn, Do Young Kim","doi":"10.5009/gnl260028","DOIUrl":"https://doi.org/10.5009/gnl260028","url":null,"abstract":"<p><strong>Background/aims: </strong>Hepatocellular carcinoma (HCC) recurrence after curative resection is classified into early recurrence (≤24 months), reflecting aggressive tumor biology, and late recurrence (>24 months), representing <i>de novo</i> carcinogenesis. We investigated whether preoperative dual positivity for <i>Lens culinaris</i> agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) independently predicts early recurrence and whether this association is temporally specific.</p><p><strong>Methods: </strong>This retrospective cohort study included 431 patients who underwent curative resection for HCC between 2010 and 2023 at a single tertiary center. Dual positivity was defined as AFP-L3 ≥15% and PIVKA-II ≥100 mAU/mL. The primary outcome was early recurrence-free survival. Late recurrence was assessed using landmark analysis in patients who were recurrencefree at 24 months (n=258). Multivariable Cox proportional hazards regression was performed adjusting for clinical and tumor characteristics.</p><p><strong>Results: </strong>During a median follow-up of 36.0 months, 100 patients (23.2%) developed early recurrence and 73 (16.9%) developed late recurrence. Dual positivity was independently associated with early recurrence (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.44 to 3.93; p<0.001) but not with late recurrence (HR, 0.92; 95% CI, 0.39 to 2.15; p=0.844). The 24-month cumulative incidence of recurrence was 39.2% for dual-positive patients compared with 19.2% in the low-risk group. This association remained consistent across sensitivity analyses using alternative biomarker cutoffs and across most clinical subgroups.</p><p><strong>Conclusions: </strong>Preoperative dual positivity for AFP-L3 and PIVKA-II was associated with early but not late recurrence after curative resection for HCC, suggesting temporal specificity of this biomarker combination. Prospective validation studies are warranted.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578438","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":"The Effect of Tegoprazan for Prevention of Iatrogenic Ulcer Bleeding after Endoscopic Submucosal Dissection: A Noninferiority Randomized Clinical Trial.","authors":"Joon Sung Kim, Byung-Wook Kim, Kwang Bum Cho, Jae Young Jang, Hyuk Soon Choi, Gwang Ho Baik, Soo-Jeong Cho, Wan Sik Lee, Hee Seok Moon, Joo Young Cho","doi":"10.5009/gnl260117","DOIUrl":"https://doi.org/10.5009/gnl260117","url":null,"abstract":"<p><strong>Background/aims: </strong>Proton pump inhibitors (PPIs) effectively reduce bleeding in patients after endoscopic submucosal dissection (ESD). Tegoprazan, a potassium-competitive acid blocker, provides stronger acid suppression than PPIs do; however, its efficacy in preventing post-ESD bleeding has rarely been studied. The aim of this study was to compare the effects of tegoprazan and pantoprazole on post-ESD bleeding.</p><p><strong>Methods: </strong>In this randomized, multicenter trial, patients undergoing ESD for gastric epithelial neoplasms were randomly assigned to two groups; each received tegoprazan (50 mg once daily for 28 days) or pantoprazole (40 mg intravenously for 48 hours and orally once daily for 26 days). Adverse events and serum gastrin levels were assessed as safety outcomes.</p><p><strong>Results: </strong>The per-protocol set comprised 238 patients (117 tegoprazan, 121 pantoprazole). Noninferiority (within an 8.3% margin) in the post-ESD bleeding rates within 4 weeks was confirmed (risk difference, -6.30%; 95% confidence interval [CI], -14.67% to 2.07%; p=0.0003), with rates of 9.40% (11/117) and 15.70% (19/121) for the tegoprazan and pantoprazole groups, respectively. The bleeding rates within 24 hours were 5.98% (7/117) and 10.74% (13/121), respectively (risk difference, -4.76%; 95% CI, -11.75% to 2.23%). No significant differences were observed in adverse events or serum gastrin levels between the groups.</p><p><strong>Conclusions: </strong>Tegoprazan was non-inferior to pantoprazole in its effectiveness in preventing post-ESD bleeding, with comparable safety profiles. Notably, administering oral tegoprazan can potentially shorten the length of hospital stay and reduce medical costs, supporting its potential clinical value. Tegoprazan is expected to replace high-dose intravenous PPI therapy for patients after ESD (CRIS registration: KCT0006850).</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578410","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 Hormone Receptor Profiling Reveals an Association between Estrogen Receptor β-NRF2 Signaling and Improved Outcomes in Colorectal Cancer Patients.","authors":"Yonghoon Choi, Nayoung Kim, Chin-Hee Song, Hyeon Jeong Oh","doi":"10.5009/gnl250538","DOIUrl":"https://doi.org/10.5009/gnl250538","url":null,"abstract":"<p><strong>Background/aims: </strong>Colorectal cancer (CRC) shows clear sex-related differences influenced by hormonal and molecular factors, with estrogen generally exerting a protective effect through estrogen receptor beta (ERβ). The nuclear factor erythroid 2-related factor 2 (NRF2) pathway, a key regulator of oxidative stress and immune responses, may interact with estrogen signaling; however, this relationship in CRC patients remains poorly understood.</p><p><strong>Methods: </strong>A total of 300 patients with histologically confirmed CRC, 37 patients with colorectal adenomas, and 35 control subjects were prospectively enrolled. Colonic tissue samples were subjected to immunohistochemical staining for ERα, ERβ, androgen receptor, and NRF2. The associations of ER expression with clinicopathological variables, tumor stage, and survival outcomes were evaluated using chi-square tests, Pearson correlation analysis, Cox proportional hazards regression models, and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>ERβ expression was significantly lower in patients with advanced-stage, metastatic, and poorly differentiated CRC, whereas higher ERβ expression was more frequent in those with right-sided and early-stage CRC and was associated with higher body mass indices and lower metastatic rates. High ERβ expression correlated with significantly improved overall and cancer-specific survival (p=0.005 and p=0.010, respectively). A strong positive correlation was observed between ERβ and NRF2 expression (r=0.717, p<0.001), suggesting a mechanistic link between estrogen signaling and antioxidative pathways. ERα expression was low and inconsistent, whereas androgen receptor expression correlated with a favorable survival trend but lacked independent prognostic value.</p><p><strong>Conclusions: </strong>High ERβ expression was associated with favorable tumor characteristics and improved survival in CRC, supporting a tumor-suppressive role potentially mediated through interaction with the NRF2 antioxidative pathway (ClinicalTrials.gov identifier: NCT05638542).</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578390","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":"Data-Informed Intuition in Hepatology: Integrating Evidence, Context, and Clinical Reasoning.","authors":"Jin Dong Kim, Mi Na Kim, Do Young Kim","doi":"10.5009/gnl260075","DOIUrl":"10.5009/gnl260075","url":null,"abstract":"<p><p>Artificial intelligence and data-driven models are changing hepatology, but expert clinical judgment remains essential. Liver diseases are complex and evolve over time, requiring reasoning that links numerical data with clinical context. We propose data-informed intuition (DII), a conceptual framework bridging evidence-based medicine with clinical experience and reflective reasoning. Instead of presenting a validated prediction model, it proposes DII as an integrative scaffold for clinical reasoning that can be examined and revised. DII is viewed as a trainable skill that improves with data feedback, not mere guesswork. Clinicians continually calibrate their judgment as patient information accumulates. In hepatology, DII helps interpret disease trajectories, adapt predictive scores to context, and handle uncertainty in liver transplantation, hepatocellular carcinoma, acute liver failure, and related conditions. The DII framework describes eight axes (time, rate, magnitude, pattern, context, causality, integration, and uncertainty) that make visible how data and intuition interact in clinical reasoning. Integrating DII into fellowship training and artificial intelligence-assisted systems could nurture clinicians who combine algorithmic precision with human insight. This perspective summarizes the conceptual basis, clinical uses, and educational value of DII, and outlines both a research agenda for its empirical testing and a path toward data-informed professionalism in hepatology.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"533-538"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217560","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":"Comparative Effectiveness of a Prophylactic Application for the Prevention of Postpolypectomy Bleeding in Pedunculated Colonic Polyps: A Network Meta-Analysis.","authors":"Jae Hyun Kim, Jung Won Lee, Hyun Jung Kim, Seun Ja Park","doi":"10.5009/gnl250460","DOIUrl":"10.5009/gnl250460","url":null,"abstract":"<p><strong>Background/aims: </strong>Postpolypectomy bleeding (PPB) is a major complication of pedunculated colonic polyps. Various prophylactic interventions, including clips, endoloops, and epinephrine injections, have been proposed to prevent PPB; however, their comparative effectiveness remains unclear. This study aimed to evaluate the efficacy of these interventions through a network meta-analysis.</p><p><strong>Methods: </strong>We searched the MEDLINE, EMBASE, and Cochrane CENTRAL databases for randomized controlled trials that compared the effectiveness of clips, endoloops, and epinephrine injection in the prevention of PPB in pedunculated polyps with a head diameter ≥10 mm. Primary outcomes included immediate and delayed PPB. Data synthesis was performed with the netmeta package in R, which integrates direct and indirect evidence and yields odds ratios (ORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Of 601 identified studies, 11 trials involving 2,096 patients were included. In the network meta-analysis, endoloops (OR, 0.23; 95% CI, 0.08 to 0.63), clips (OR, 0.25; 95% CI, 0.14 to 0.48), and epinephrine injection (OR, 0.33; 95% CI, 0.11 to 0.96) were significantly more effective than no treatment in the prevention of immediate bleeding. Combinations of endoloops or clips with epinephrine injection also demonstrated satisfactory efficacy. For delayed bleeding, no significant differences were observed among the interventions or between each intervention and no treatment, which may be due to the small number of events across studies. According to surface under the cumulative ranking curve rankings, endoloops plus epinephrine injection was the most effective method for preventing immediate PPB, followed by endoloops and clips alone.</p><p><strong>Conclusions: </strong>This network meta-analysis supports the use of endoloops with epinephrine as the most effective strategy for preventing immediate bleeding after resection of pedunculated colonic polyps, while current measures remain insufficient for delayed bleeding.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"587-595"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988871","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":"Long-Term Proton Pump Inhibitor Use and Gastric Cancer Risk: Interpreting Population-Based Evidence.","authors":"Hae Won Yoo","doi":"10.5009/gnl260247","DOIUrl":"10.5009/gnl260247","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"20 4","pages":"497-498"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436631","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":"Muscle Mass as a Causal Factor in MASLD: Insights from a Genome-Wide Association Study and Bidirectional Mendelian Randomization Using Data from the Korean Genome and Epidemiology Study.","authors":"Kiook Baek, Jung Gil Park, Yu Rim Lee, Soo Young Park, Young Oh Kweon, Won Young Tak","doi":"10.5009/gnl250100","DOIUrl":"10.5009/gnl250100","url":null,"abstract":"<p><strong>Background/aims: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging global health concern due to its increasing prevalence and associated risk of severe complications. Although body composition, such as fat and muscle mass, has been linked to MASLD, evidence on the causality of this relationship remains limited. This study investigated the potential causal relationships between body composition and MASLD using epidemiological methods.</p><p><strong>Methods: </strong>Data from the Korean Genome and Epidemiology Study were analyzed. MASLD patients were defined according to the hepatic steatosis index (≥36) and the fibrosis 4 index (≥1.30); individuals with both of these values in normal ranges were considered nonpatients. Body composition was assessed according to fat mass, muscle mass, and the waist-to-hip ratio using bioelectrical impedance analysis. Genome-wide association studies were conducted to identify single-nucleotide polymorphisms (SNPs) linked to body composition and MASLD. These SNPs were then used as instrumental variables in bidirectional Mendelian randomization (MR) analysis to determine causality.</p><p><strong>Results: </strong>A total of 258 MASLD patients and 3,498 nonpatients were included. The MR analysis showed that individuals in the lowest tertile of muscle mass had a higher prevalence of MASLD than those in the 2nd and 3rd tertiles (odds ratio, 1.57; 95% confidence interval, 1.09 to 2.27; p=0.02), whereas the reverse causal effect of MASLD on muscle mass was not significant. No significant causal relationships were identified between fat mass or the waist-to-hip ratio and MASLD, although these analyses were limited by several statistical constraints, such as relatively low F-statistics and potential heterogeneity.</p><p><strong>Conclusions: </strong>The findings demonstrate that muscle mass exerts a causal effect on the prevalence of MASLD, suggesting that modulating muscle mass could serve as an effective strategy for managing the disease.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"613-623"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981502","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}