Revista Espanola De Enfermedades Digestivas最新文献

{"title":"Is fluoroscopy necessary for oesophageal SEMS placement? A retrospective cohort study.","authors":"Luís Miguel Relvas, Tânia Gago, Sónia Barros, Isabel Carvalho, Margarida Portugal, Francisco Velasco, Paulo Caldeira, Bruno Peixe","doi":"10.17235/reed.2025.11330/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11330/2025","url":null,"abstract":"<p><strong>Introduction: </strong>Self-expanding metal stents (SEMS) are widely used for the palliation of malignant esophageal conditions, including strictures, fistulas, and extrinsic compression. Placement may be guided by fluoroscopy (FC), direct endoscopy (EC), or both. However, few studies have directly compared the outcomes of these techniques.</p><p><strong>Objective: </strong>To compare the safety and efficacy of SEMS placement under endoscopic versus fluoroscopic control in a real-world clinical setting.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of adult patients who underwent esophageal SEMS placement between January 2011 and December 2023. Patients were assigned to either the EC or FC group based on fluoroscopy availability. Outcomes included technical success, complication rates (early and late), and overall survival.</p><p><strong>Results: </strong>A total of 103 patients were included (mean age 69.4 years; 79% male), with 43 receiving SEMS under EC and 60 under FC. The primary indication was malignant esophageal stricture (91.3%). Technical success was achieved in 97% of EC cases and 100% of FC cases. Early complications occurred in 53% of EC and 49% of FC patients (p = 0.70), including chest pain (40.7%), vomiting (22.3%), and stent migration (5.8%). Late complications occurred in 28% of EC and 31% of FC cases (p = 0.74), most commonly tumor overgrowth (14.6%) and stent migration (10.7%). Thirty-day mortality was 2.3% in the EC group and 0% in the FC group (p = 0.31). Median survival was 102 days (EC) vs. 113 days (FC) (p = 0.44).</p><p><strong>Conclusions: </strong>SEMS placement under both endoscopic and fluoroscopic control is safe and effective, with no significant differences in complication rates, technical success, or survival. Endoscopic guidance may be a viable alternative to fluoroscopy in experienced hands, particularly in resource-limited settings.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peroral endoscopic myotomy in pediatric triple a syndrome: report of three cases.","authors":"Ali Cagatay Bozkına, Abdullah Murat Buyruk","doi":"10.17235/reed.2025.11589/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11589/2025","url":null,"abstract":"<p><p>Triple A (Allgrove) syndrome is a rare autosomal recessive disorder characterized by adrenal insufficiency, alacrima, and achalasia. Although peroral endoscopic myotomy (POEM) is increasingly used for pediatric achalasia, its role in Triple A-related cases remains poorly defined. We report three genetically confirmed pediatric patients (aged 11-16 years) with Triple A syndrome and refractory achalasia who underwent POEM following unsuccessful pneumatic dilatation and/or botulinum toxin injection. Clinical characteristics, procedural details, and short-term outcomes were evaluated. All three patients presented with long-standing dysphagia, regurgitation, and vomiting, with Eckardt scores of 12 at admission and body mass indices ranging from 15.6 to 17.4 kg/m². Posterior POEM was performed using a 5 o'clock approach, with submucosal tunnel lengths of 10-25 cm and myotomy lengths of 6-18 cm esophageal plus 3 cm gastric. Procedures lasted 40-65 minutes, with no intraoperative complications. Oral intake was resumed within 24 hours and all patients were discharged within 30-43 hours. At 2-4 months follow-up, all remained asymptomatic with Eckardt scores of 0. POEM appears to be a safe and effective therapeutic option for Triple A-related achalasia in pediatric patients who fail conventional therapies. Our series, the largest reported to date in this population, supports the consideration of POEM as a durable minimally invasive treatment. Longer-term follow-up and multicenter experience are needed to confirm these findings.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesenchymal stem cell-derived exosomes for complex perianal fistula ‒ A systematic review and single-arm meta-analysis.","authors":"Fang Cheng, Xia Chen, Ying Liao","doi":"10.17235/reed.2025.11470/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11470/2025","url":null,"abstract":"<p><strong>Objectives: </strong>We performed a single-arm meta-analysis to evaluate the efficacy and safety of MSC-Exos in the treatment of complex PFs.</p><p><strong>Methods: </strong>This systematic review followed PRISMA guidelines and included studies published up to March 20, 2025. We searched four databases for studies evaluating efficacy and/or safety of MSC-Exos for complex PFs. Analyses were performed using R statistical software version 4.4.0.</p><p><strong>Results: </strong>The analysis of three studies included in this study suggested that MSC-Exos were effective in achieving complete healing in 57% of patients with complex PFs (95% confidence interval (CI) 0.43, 0.76). The pooled data further indicated that MSC-Exos could achieve complete healing in 68% of complex fistula tracts (95% CI 0.59, 0.80). Pooled analysis also showed that 86% (95% CI 0.75,0.98) of patients with complex PFs achieved clinical response post treatment, whereas 18% (95% CI 0.09, 0.37) demonstrated no clinical response after MSC-Exos treatment. Subgroup analysis revealed a higher healing rate (HR) in patients with Crohn's disease (CD) compared to those without CD (60% vs. 57%, respectively), with no statistically significant differences (P > 0.05). Notably, neither systemic nor local adverse effects have been reported in any study.</p><p><strong>Conclusion: </strong>This meta-analysis highlights the efficacy and safety of local administration of MSC-Exos in patients with complex PFs, offering valuable evidence to guide future clinical practice.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection of early gastric adenocarcinoma of fundic gland type.","authors":"Ming Zhong, Wei Wei, Huang Zhong, Hang Gong, Tingyu Wang","doi":"10.17235/reed.2025.11551/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11551/2025","url":null,"abstract":"<p><p>A 57-year-old woman presented to our department, complaining of abdominal pain for 1 week. Esophagogastroduodenoscopy (EGD) revealed a 0.3 × 0.4 cm, slightly elevated lesion located on the greater curvature of the upper gastric body, classified as type 0-IIa (superficial elevated). Narrow-band imaging (NBI) demonstrated brownish discoloration of the lesion's surface with a branching vascular pattern of dilated capillaries. Histopathological examination of the EGD biopsy revealed a gastric adenocarcinoma of fundic gland type. The observed cancerous lesion was treated via endoscopic submucosal dissection (ESD). Post-ESD histopathology confirmed a gastric adenocarcinoma of fundic gland type (histologic grade E). The tumor measured 2.8 mm in maximum diameter and focally invaded the submucosa, with the deepest invasive front extending 0.4 mm below the muscularis mucosae. Both lateral and vertical resection margins were free of carcinoma.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the clinical reasoning of GPT-4o, a multimodal generative artificial intelligence model, in 18 public gastroenterology case studies.","authors":"Alejandro García-Rudolph, Elena Hernández-Pena, Nuria Del Cacho, Claudia Teixido-Font, Marc Navarro-Berenguel, Eloy Opisso","doi":"10.17235/reed.2025.11369/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11369/2025","url":null,"abstract":"<p><strong>Introduction and aim: </strong>Although generative language models have been extensively studied in the field of digestive diseases, further progress requires addressing underexplored aspects such as linguistic bias, the evaluation of clinical reasoning underlying model responses, and the use of realistic clinical material in non-English-speaking contexts. The aim of this study was to evaluate the accuracy of GPT-4o in answering clinical questions in Spanish and to qualitatively analyze its errors.</p><p><strong>Methods: </strong>We used the most recent official board examination for Specialist in Gastroenterology (Spain, 2023), focusing on its practical section, which includes 18 real clinical cases described through text and images, totaling 50 multiple-choice questions (200 options in total). Forty-nine valid questions were analyzed, excluding one withdrawn by the organizing committee. GPT-4o answered 39 questions correctly (79.6%). No significant differences were observed between questions with clinical images (22/29 correct) and those without images (17/20 correct).</p><p><strong>Results: </strong>Twenty percent of the answers were incorrect. In those cases, the model was prompted to provide its reasoning, which was then qualitatively analyzed by a team of experts. Errors were associated with inappropriate therapeutic generalizations, confusion regarding diagnostic or therapeutic sequencing, poor integration of contextual information, unawareness of contraindications, and omission of key temporal criteria in clinical decision-making.</p><p><strong>Conclusions: </strong>Clinical images did not increase the error rate; however, the observed failures revealed that the model tends to omit information already provided (such as clinical context or temporal criteria), thereby compromising the quality of its reasoning.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Surveillance Warranted for Presumed Branch-Duct IPMNs Diagnosed at Age 75 or Older? A Single-Center Retrospective Cohort Study.","authors":"José Lariño Noia, Yessica Domínguez Novoa, Mónica Otero Iglesias, Martiño Loureiro Veira, Marco Galego Fernández, Alberto Rama Fernández, Daniel de la Iglesia, Julio Iglesias García, Enrique Domínguez Muñoz","doi":"10.17235/reed.2025.11376/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11376/2025","url":null,"abstract":"<p><strong>Introduction: </strong>Incidental cystic pancreatic lesions are increasingly detected in the aging population, with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) being the most common. This study aimed to evaluate the benefits of implementing a surveillance program in patients diagnosed with presumed BD-IPMN at the age of 75 years or older.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using a prospective registry of patients diagnosed incidentally with presumed BD-IPMN at ≥75 years of age. Patients were categorized into two groups: Group A, who underwent clinical and imaging follow-up, and Group B, with no surveillance. Clinical records were reviewed to assess pancreatic cancer incidence, overall survival, and mortality.</p><p><strong>Results: </strong>Among 434 patients with BD-IPMN, 93 met inclusion criteria (42 in Group A; 51 in Group B). The mean age was 77 years in Group A and 79.2 years in Group B (p=0.016). The mean cyst size was 15.6 mm in Group A and 14.6 mm in Group B (p=0.56). No cases of pancreatic cancer were identified in Group A, while one case occurred in Group B (p=1.0). Five patients died in each group (p=1.0). Overall survival was comparable between groups (HR 0.8; 95% CI: 0.22-2.94; p=0.74).</p><p><strong>Conclusions: </strong>Presumed incidental BD-IPMNs diagnosed at ≥75 years of age rarely progress to pancreatic cancer. In patients with cysts <2 cm and without high-risk features, surveillance does not appear to confer a survival benefit and may therefore be unnecessary.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"117 ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of the gastroenterologist in the comprehensive management of people living with obesity. SEPD Position Paper.","authors":"Javier Crespo, Conrado M Fernández Rodríguez, María Dolores Martín Arranz, Luis Téllez, Federico Argüelles-Arias, Aitor Orive, Eduard Espinet","doi":"10.17235/reed.2025.11636/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11636/2025","url":null,"abstract":"<p><p>Obesity represents the most prevalent chronic metabolic disease and one of the greatest healthcare and social challenges of our time. Its close association with multiple digestive disorders-including metabolic dysfunction-associated steatotic liver disease (MASLD), various digestive cancers, inflammatory bowel disease, and gastroesophageal reflux disease-positions the gastroenterologist as a key actor in its detection, stratification, and comprehensive management. The SEPD position statement underscores the need to move beyond a complication-centered approach and to establish the gastroenterology consultation as a privileged entry point for the care of individuals living with obesity. SEPD advocates for a digestive-centered framework that integrates prevention, advanced diagnostics, pharmacological therapies, endoscopy, and surgery within a continuum of care led by gastroenterologists. Distinctively, the position statement incorporates metabolic endoscopy as a minimally invasive and cost-effective alternative, serving as a bridge between pharmacological treatment and surgery-an area in which Spanish gastroenterologists have developed recognized expertise and international leadership. It also promotes a stigma-free approach, calling for respectful and equitable language as part of the society's explicit ethical commitment. Furthermore, SEPD emphasizes the importance of real-world registries focused on digestive outcomes, fostering collaborative research and the generation of evidence applicable to both clinical practice and health policy. Taken together, this document reaffirms SEPD's clinical, scientific, and social commitment in the fight against obesity, advancing an innovative, person-centered, interdisciplinary, and humanistic approach aimed at transforming healthcare delivery and decisively contributing to the improvement of digestive and overall population health.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"117 ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of dual advanced therapy in inflammatory bowel disease ‒ A multicenter series from Galicia, Spain.","authors":"M ª Teresa Diz-Lois Palomares, Carmen Pradera Cibreiro, Carmen Cabezal Iglesias, Manuel Barreiro de Acosta, Jesús Martínez Cadilla, Emilio Estévez Prieto, Rocío Ferreiro-Iglesias, Daniel Carpio López, Ana Echarri Piudo","doi":"10.17235/reed.2025.11430/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11430/2025","url":null,"abstract":"<p><strong>Background: </strong>Approximately one-third of patients with inflammatory bowel disease (IBD) do not achieve disease control despite the incorporation of new advanced therapies in recent years. The combination of two advanced therapies (AT) can overcome this therapeutic ceiling; therefore, these therapies have been empirically tested in real-life clinical practice, but evidence is lacking on how and when to combine them.</p><p><strong>Methods: </strong>A multicenter retrospective study was designed, reviewing cases treated with dual advanced therapy (DAT). We describe its characteristics, effectiveness, adverse effects, and examine whether any variables are associated with effectiveness.</p><p><strong>Results: </strong>We described 29 DAT regimens in 24 patients, with a median duration of 7 months (IQR 0.5-43 months). Overall clinical remission was 41.1% (36% when DAT was indicated for refractory IBD, and 60% when it was indicated for an immune-mediated inflammatory diseases (IMID) and IBD). Endoscopic/radiological response was 31.6% of the evaluated patients (n = 19). In 17 cases (58.6%), DAT was discontinued, although in 3 of these due to deep remission. The median survival without discontinuation due to inefficacy or adverse events was 20 months. No differences in effectiveness were detected based on the combined mechanisms of action, or on the strategy of adding new versus recycled AT.</p><p><strong>Conclusions: </strong>Empirical use of DAT in refractory IBD may lead to clinical remission in approximately one-third of patients. Remission rates appeared more effective when DAT is used to simultaneously treat IBD and an IMID. However, further data are needed before specific recommendations can be made regarding type or timing strategy for DAT.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving definition of pancreatic exocrine insufficiency ‒ Implications for diagnosis and treatment in clinical practice.","authors":"Ana García García de Paredes, Juan Enrique Domínguez Muñoz","doi":"10.17235/reed.2025.11517/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11517/2025","url":null,"abstract":"<p><p>Pancreatic exocrine insufficiency (PEI) is a syndrome of maldigestion caused by insufficient intraluminal pancreatic enzyme activity, leading to nutritional deficiencies and impaired quality of life. Recent European guidelines have redefined PEI, recognizing it as a multifactorial condition not limited to reduced pancreatic secretion, but also involving functional digestive failure in various clinical contexts, including pancreatic and non-pancreatic diseases. This editorial reviews the key implications of this revised definition for clinical practice, emphasizing a comprehensive diagnostic approach based on clinical context, pancreatic function tests, symptoms, and nutritional markers. Furthermore, it underscores the importance of rational prescription of pancreatic enzyme replacement therapy (PERT), aiming to optimize patient outcomes while avoiding unnecessary treatment. This updated perspective on PEI promotes more accurate diagnosis, targeted therapy, and improved healthcare resource allocation.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective validation of the EASL-EASD algorithm for risk stratification in patients with metabolic dysfunction-associated steatotic liver disease and type 2 diabetes.","authors":"Clara Amiama Roig, Miriam Romero, Noemí González, Laura Guerra Pastrián, Elena Palacios Lázaro, Pilar Castillo Grau, Marta Abadía Barno, Araceli García Sánchez, Alexa Pamela Benítez, Mariana Serres, Carmen Amor, Irene González Díaz, Antonio Buño, Antonio Olveira, María Patricia Sanz","doi":"10.17235/reed.2025.11545/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11545/2025","url":null,"abstract":"<p><strong>Background and aim: </strong>Individuals with type2 diabetes are at increased risk of severe metabolic dysfunction-associated steatotic liver disease(MASLD). The European Association for the Study of Diabetes(EASD) recently proposed a two-step algorithm for risk stratification and referral, developed in collaboration with the European Association for the Study of the Liver(EASL), but its real-world performance remains unassessed.</p><p><strong>Methods: </strong>In prospective study, adult patients with type2 diabetes attending our Diabetology clinic were consecutively assessed using FIB-4 index. Those with FIB-4≥1.3 underwent further evaluation in collaboration with Hepatology, including transient elastography(TE), abdominal ultrasound, ELF score, exclusion of other liver diseases, and liver biopsy when indicated. Patients with known liver disease or type 1 diabetes were excluded. At-risk individuals were defined as those with TE≥8kPa or FIB-4>2.67. Advanced liver disease was defined as fibrosis stage ≥F3 on biopsy, TE>12kPa, or ultrasound evidence of cirrhosis. A contemporary population-based cohort of over 12000 individuals served as a reference for MASLD severity.</p><p><strong>Results: </strong>Between Q4 2024 and Q1 2025, 1108 patients were screened; 984 remained eligible. Of these, 736(74.8%) had FIB-4<1.3 and 248(25.2%;95% CI:22.5-27.9) had elevated FIB-4(1.3-2.67 in 182;>2.67 in 66). Among the latter, 53(21.4%;95% CI: 16.7-26.9) had previously undiagnosed advanced MASLD, with prevalence exceeding that in the reference population. An additional 15patients(6%) had other significant liver diseases: autoimmune hepatitis, primary biliary cholangitis, viral hepatitis...Overall, the algorithm identified advanced liver disease of any aetiology in 27.4%.</p><p><strong>Conclusions: </strong>About one in five patients with FIB-4≥1.3 had advanced MASLD. The EASL-EASD algorithm supports early detection and referral.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}