Gut and Liver最新文献

{"title":"Global, Regional, and National Burden of Liver Cancer from 1990 to 2021 and Projections to 2050: A Global Burden of Disease Study 2021.","authors":"Dohwi Yun, Seohyun Hong, Kyeongeun Kim, Sooji Lee, Yesol Yim, Seoyoung Park, Yeona Jo, Seung Ha Hwang, Damiano Pizzol, Junyang Jung, Masoud Rahmati, Selin Woo, Dong Keon Yon","doi":"10.5009/gnl250311","DOIUrl":"10.5009/gnl250311","url":null,"abstract":"<p><strong>Background/aims: </strong>This study assessed the burden of liver cancer (LC) and its major risk factors from 1990 to 2021, with projections to 2050.</p><p><strong>Methods: </strong>The global and regional LC burden from 1990 to 2021 was extracted from the Global Burden of Disease Study 2021, and stratified by age, sex, Sociodemographic Index (SDI), region, and etiological category. Trends for the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year rate (ASDR) were evaluated using estimated annual percentage changes. Attributable risk factors, including alcohol use, drug use, a high body mass index, tobacco use, and high fasting plasma glucose levels, were examined. Projections of the LC burden to 2050 were modeled under baseline and hypothetical risk elimination scenarios.</p><p><strong>Results: </strong>The global ASMR of LC remained stable, from 5.86 per 100,000 population (95% uncertainty interval [UI], 5.38 to 6.46) in 1990 to 5.65 (95% UI, 5.13 to 6.30) in 2021. Regions with an initially high ASMR showed increases until the early 2000s, then decreased. The LC burden increased sharply with age and was consistently higher in males, particularly in high-SDI regions. Mortality varied by etiology, with hepatitis B virus as the leading cause, followed by hepatitis C virus and alcohol use. Major risk factors were alcohol and tobacco use among males and drug and alcohol use among females. By 2050, the ASMR and ASDR of LC are projected to reach 6.23 per 100,000 population (95% UI, 4.94 to 8.09) and 158.91 (95% UI, 125.34 to 210.28), respectively, but could decrease to 5.32 (95% UI, 4.21 to 6.95) and 135.33 (95% UI, 106.74 to 179.05) under improved metabolic and behavioral risk scenarios.</p><p><strong>Conclusions: </strong>Despite public health interventions, LC is estimated to maintain a significant global burden.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"681-693"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360463","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":"A Scoping Review of Endoscopic Assessment Considering Disease Extent in Ulcerative Colitis: Insights for the Artificial Intelligence Era.","authors":"Yasuharu Maeda, Shin-Ei Kudo, Takanori Kuroki, Yurie Kawabata, Katsuro Ichimasa, Masashi Misawa, Noriyuki Ogata, Kazuo Ohtsuka","doi":"10.5009/gnl260078","DOIUrl":"10.5009/gnl260078","url":null,"abstract":"<p><p>Conventional endoscopic indices for ulcerative colitis (UC) primarily assess the most severely affected segment, potentially underestimating the cumulative inflammatory burden across the colon. Consequently, there is increasing interest in assessment methods that incorporate both disease severity and spatial extent, including emerging artificial intelligence (AI)-based approaches. The aim of this study was to map and critically evaluate current evidence on endoscopic indices that integrate disease extent in UC, including both conventional and AI-assisted approaches. Original studies in which patients with UC were evaluated via endoscopic approaches for disease activity, severity, or extent and clinically relevant outcomes were reported. Non-original articles and studies of other diseases were excluded. PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials were searched for studies published between January 2000 and December 2025. Two reviewers independently screened studies and extracted data. Findings were synthesized narratively due to heterogeneity. Twenty-one studies were included: eight addressed index development or validation, 11 evaluated clinical outcomes, and four investigated AI-assisted assessments, with some studies contributing to multiple categories. Extent-based indices showed stronger correlations with biomarkers and histological activity than conventional focal scores, although their ability to predict relapse was inconsistent. AI-based systems enabled automated assessment of inflammatory distribution, improving reproducibility and showing promising clinical associations, but external validation remains limited. Extent-integrated endoscopic assessment provides a more comprehensive evaluation of disease burden in UC patients and may improve risk stratification and treatment monitoring. However, methodological heterogeneity and limited prospective validation hinder clinical implementation. Further standardization and multicenter studies are needed.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"511-523"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217611","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":"Shared Enterotypes and Divergent Microbial Signatures in Pediatric and Adult Crohn's Disease.","authors":"Kwang Woo Kim","doi":"10.5009/gnl260198","DOIUrl":"10.5009/gnl260198","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"20 4","pages":"502-504"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436625","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 Promise of Machine Learning-Guided Adjuvant Chemotherapy for Resected Gallbladder Cancer.","authors":"Kihwan Choi","doi":"10.5009/gnl260229","DOIUrl":"10.5009/gnl260229","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"20 4","pages":"505-506"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436683","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":"High Cardiometabolic Risk Burden Predicts Adverse Outcomes in Patients with MASLD-Related Hepatocellular Carcinoma.","authors":"Yeonhong Do, Young Hyeon Ahn, Young Chang, Jeong-Ju Yoo, Sae Hwan Lee, Soung Won Jeong, Sang Gyune Kim, Jae Young Jang, Young Seok Kim, Hong Soo Kim, Keungmo Yang, Tom Ryu","doi":"10.5009/gnl250591","DOIUrl":"10.5009/gnl250591","url":null,"abstract":"<p><strong>Background/aims: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a rapidly growing cause of hepatocellular carcinoma (HCC); however, the prognostic implications of the cumulative cardiometabolic risk factor (CMRF) burden remain unclear.</p><p><strong>Methods: </strong>In this single-center retrospective cohort, we identified 94 patients with MASLD-related HCC after excluding other etiologies of liver disease. The modified CMRF count (based on eight routinely available variables) was calculated, and the patients were stratified according to the count (<5 or ≥5). In addition to baseline data, survival was assessed by the Kaplan-Meier log-rank test, and prognostic factors were evaluated by Cox regression.</p><p><strong>Results: </strong>A higher CMRF burden was associated with older age, a greater cumulative tumor diameter, and a higher level of protein induced by vitamin K absence or antagonist-II (PIVKA-II), but not with the level of alpha-fetoprotein. Patients with a CMRF count ≥5 had significantly worse overall survival (OS) and recurrence-free survival (RFS). In the Cox models, a CMRF count ≥5 was associated with poor OS; the association with RFS was evident in univariate analysis but was attenuated after adjustment. Among individual factors, hypertension was independently associated with OS, whereas diabetes lost significance after adjustment. The level of triglycerides was not a prognostic factor, while higher high-density lipoprotein cholesterol levels were associated with better OS and RFS by the Kaplan-Meier method.</p><p><strong>Conclusions: </strong>The cumulative metabolic burden, represented by a modified CMRF count, was associated with larger tumors, a higher PIVKA-II level, and inferior survival in patients with MASLD-related HCC.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"655-664"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837195","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":"Age-Related Microbial Differences in Newly Diagnosed Crohn's Disease Reveal the Distinct Enrichment of Oral-Associated Taxa in Pediatric Patients.","authors":"Yun-Seok Jeong, Kyeong Ok Kim, Yong Eun Park, Yoo Jin Lee, Jeongkuk Seo, Tae-Woo Kim, Bo-Hyung Kim, Sung-Vin Yim, Hyun Sik Kim, Jae-Yun Lee, Jin-Woo Bae, Byung-Ho Choe, Ben Kang, Chang Kyun Lee","doi":"10.5009/gnl260027","DOIUrl":"10.5009/gnl260027","url":null,"abstract":"<p><strong>Background/aims: </strong>Crohn's disease (CD) presents differently by age of onset, but the microbial distinctions between pediatric and adult CD are currently unclear.</p><p><strong>Methods: </strong>In this study, the gut microbiota of fecal samples collected from newly diagnosed patients with CD (n=88; pediatric 44, adult 44) and their age- and sex-matched healthy controls (HCs, n=112) was analyzed using 16S rRNA gene amplicon sequencing. Differential abundance analysis was performed using MaAsLin2 to identify age-specific microbial signatures, and enterotypes were classified using Dirichlet multinomial mixture modeling.</p><p><strong>Results: </strong>Both pediatric and adult patients with CD exhibited shared dysbiosis characterized by reduced alpha diversity (p<0.001), enrichment of CD-associated pathobionts, such as <i>Enterobacteriaceae</i> and <i>Enterococcaceae</i>, and depletion of short-chain fatty acid-producing taxa within <i>Ruminococcaceae</i> and <i>Lachnospiraceae</i>. Notably, enterotyping revealed that individuals with CD converged toward a shared, pathobiont-dominated enterotype regardless of age, overriding the age-dependent stratification observed in HCs. Despite this shared convergence, differences in age-stratified comparisons were observed. Adult CD patients exhibited enrichment of resident pathobionts such as <i>Ruminococcus gnavus</i> and <i>Clostridium innocuum</i>, whereas pediatric CD patients exhibited unique and pronounced enrichment of <i>Pasteurellaceae, Neisseriaceae, and Gemellaceae</i> (false discovery rate <0.1).</p><p><strong>Conclusions: </strong>In newly diagnosed patients, CD is characterized by shared dysbiosis and convergence toward a disease-specific enterotype across age groups. However, this was accompanied by distinct microbial features, specifically, the enrichment of taxa previously reported as prevalent in the oral microbiome in children versus resident pathobionts in adults. These findings suggest that age at disease onset is associated with age-stratified differences in microbial profiles in CD.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"575-586"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328858","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":"Varices and Hemorrhagic Events during Atezolizumab-bevacizumab Treatment: Reassurance with Caveats for Prognosis.","authors":"Hae Lim Lee","doi":"10.5009/gnl250628","DOIUrl":"10.5009/gnl250628","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"509-510"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147364798","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":"Tegoprazan for the Prevention of Nonsteroidal Anti-Inflammatory Drug-Induced Peptic Ulcers: Ready to Challenge Proton Pump Inhibitors?","authors":"Je Seong Kim","doi":"10.5009/gnl260224","DOIUrl":"10.5009/gnl260224","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"20 4","pages":"499-501"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436643","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":"Real-World Application of a Machine Learning-Based Early Recurrence Model for Guiding Adjuvant Chemotherapy Use in Patients with Gallbladder Cancer.","authors":"Won-Gun Yun, Youngmin Han, Yoon Soo Chae, Young Jae Cho, Hye-Sol Jung, Joon Seong Park, Jin-Young Jang, Wooil Kwon","doi":"10.5009/gnl250552","DOIUrl":"10.5009/gnl250552","url":null,"abstract":"<p><strong>Background/aims: </strong>Although recent randomized controlled trials have reported the efficacy of adjuvant chemotherapy for resected biliary tract cancer, discrepancies remain between recommendations and real-world practice. Therefore, we aimed to assess the efficacy of adjuvant chemotherapy in patients with gallbladder cancer and used machine learning-based risk stratification to predict recurrence to avoid unnecessary chemotherapy.</p><p><strong>Methods: </strong>Patients who underwent surgery between 2005 and 2022 and were histologically diagnosed with stage 2 or above gallbladder cancer were included. The patients were stratified by risk of early recurrence according to the machine learning-based algorithm suggested by Catalano and colleagues.</p><p><strong>Results: </strong>Among 395 patients, 204 (51.6%) and 191 (48.4%) were determined to have a low and high risk of early recurrence, respectively. Although the 5-year overall survival rates were not significantly different between the adjuvant chemotherapy and surveillance groups (87.2% vs 83.3%; p=0.233) in the low-risk patients, the adjuvant chemotherapy was associated with a significantly higher 5-year overall survival rate in the high-risk patients (52.1% vs 37.8%; p=0.003).</p><p><strong>Conclusions: </strong>Machine learning-based prediction of early recurrence is helpful in selecting patients who may benefit from adjuvant chemotherapy. These findings may help reduce medical expenses by avoiding unnecessary adjuvant chemotherapy in patients with low risk of early recurrence.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"694-703"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294803","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 Fibrosis 5 Score and the Risk of Liver-Related Events in the General Population.","authors":"Byeong Geun Song, Goeun Park, Myung Ji Goh, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Dong Hyun Sinn","doi":"10.5009/gnl250626","DOIUrl":"10.5009/gnl250626","url":null,"abstract":"<p><strong>Background/aims: </strong>The metabolic dysfunction-associated fibrosis 5 (MAF-5) tool has been proposed for identifying individuals at high risk of liver fibrosis, but its ability to predict liver-related events (LREs) remains unknown. We aimed to evaluate the ability of MAF-5 to predict LREs and assess whether modifications could enhance its predictive capacity.</p><p><strong>Methods: </strong>A retrospective cohort of 62,625 adults without cancer, organ transplantation, chronic viral hepatitis, or heavy alcohol intake was followed for LREs (hepatocellular carcinoma and/or liver cirrhosis complications). The MAF-5 score was calculated and compared with other non-invasive liver fibrosis biomarkers. We also assessed whether modifying the MAF-5 score could improve LRE prediction.</p><p><strong>Results: </strong>During a median follow-up of 11.2 years, 147 patients developed LREs. The MAF-5 scores were used to stratify participants by LRE risk into low-, intermediate-, and high-risk categories, with incidence rates of 0.108, 0.576, and 1.520 cases per 1,000 person-years, respectively. Age was identified as an independent risk factor for LREs, and therefore, we developed an age-modified MAF-5 (aMAF-5) score, which showed improved performance (C-index: 0.870 vs 0.818; integrated area under the curve: 0.858 vs 0.784). Within the same MAF-5 category, LRE risk varied according to the aMAF-5 score. The use of \"either positive\" criteria improved sensitivity (from 0.412 to 0.765) and decreased specificity (from 0.944 to 0.830), while \"both positive\" criteria improved specificity and reduced sensitivity. Both scores performed well regardless of age, sex, or metabolic syndrome status.</p><p><strong>Conclusions: </strong>The MAF-5 score allows effective stratification of LRE risk. The aMAF-5 score further improves risk stratification. These scores identify individuals at risk of LREs who may benefit from enhanced surveillance.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"645-654"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294808","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}