Annals of hepatology最新文献

{"title":"EFFICACY AND SAFETY OF ILEAL BILE ACID TRANSPORTER INHIBITORS IN ADULTS WITH AUTOIMMUNE CHOLESTATIC LIVER CONDITIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"Igor Silveira Boechat ,&nbsp;Rodolfo Augusto Rezende Assis ,&nbsp;Carlos Alberto Leitão Neto Monteiro ,&nbsp;Yohanna Idsabella Rossi ,&nbsp;Marina Leite de Assis Bezerra Cavalcanti ,&nbsp;Guilherme Grossi Lopes Cançado","doi":"10.1016/j.aohep.2025.101996","DOIUrl":"10.1016/j.aohep.2025.101996","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Autoimmune cholestatic liver diseases (ACLD), including primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), involve chronic bile duct injury and impaired bile flow, reducing quality and expectancy of life. Pruritus affects 20–70% of patients and is often resistant to treatment. Ileal bile acid transporter (IBAT) inhibitors, which reduce intestinal bile acid reabsorption, have emerged as a promising option for relieving cholestatic itch. This systematic review and meta-analysis evaluated the efficacy and safety of IBAT inhibitors in adults with ACLD.</div></div><div><h3>Materials and Methods</h3><div>A systematic review was conducted according to PRISMA guidelines using PubMed, Embase, and Cochrane-CENTRAL. Included studies enrolled adults with ACLD and pruritus lasting ≥12 weeks, treated with IBAT inhibitors. The primary outcome was change in pruritus severity (5-D Itch Scale). Secondary outcomes included sleep disturbance, serum bile acids, hepatic enzymes, and adverse events. Heterogeneity was assessed with I² and Cochrane Q tests.</div></div><div><h3>Results</h3><div>Three studies (n = 180)—two randomized controlled trials and one non-randomized study—met inclusion criteria. Most patients were female (78%), diagnosed with PBC (85%), and treated with linerixibat (77%). IBAT inhibitors significantly reduced pruritus scores (mean difference: -4.93; 95% CI: -6.26 to -3.59; p &lt; 0.0001) and improved sleep quality (mean difference: -8.12; 95% CI: -13.54 to -2.70; p = 0.0033). Biochemical changes included decreased serum bile acids, autotaxin, and FGF19, and increased C4. AST and GGT levels declined, while ALT and bilirubin remained stable. Adverse events occurred in 89.7% of participants, mainly diarrhea (22.7%), abdominal pain (18.2%), and nausea (12.2%). Serious adverse events were rare (2.2%).</div></div><div><h3>Conclusions</h3><div>IBAT inhibitors significantly improved pruritus and sleep in adults with ACLD, with an acceptable safety profile. These findings support their potential as a novel treatment for cholestatic pruritus.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101996"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154659","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":"STATIN-INDUCED LIVER INJURY: DATA FROM URUGUAYAN PROSPECTIVE HEPATOTOXICITY REGISTRY.","authors":"Yamila Montaño Rodríguez ,&nbsp;María Noel Boldrini ,&nbsp;Verónica Guido ,&nbsp;Sara Pillajo ,&nbsp;Paula Chiodi ,&nbsp;Adriana Sánchez ,&nbsp;Nelia Hernández","doi":"10.1016/j.aohep.2025.101999","DOIUrl":"10.1016/j.aohep.2025.101999","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Statins, widely used for cardiovascular prevention, have been linked to idiosyncratic drug-induced liver injury (DILI). To characterize their clinical features, cases attributed to statins reported to the Uruguayan Hepatotoxicity Registry (UHR) were analyzed.</div></div><div><h3>Materials and Methods</h3><div>We conducted a descriptive observational study of DILI cases attributed to statins and reported to the UHR between November 2015 and April 2025. Variables assessed included age, sex, type of statin, latency, biochemical pattern, hypersensitivity features, jaundice, severity, and clinical outcomes.</div></div><div><h3>Results</h3><div>Among 197 DILI cases reported to the UHR, 14 (7.1%) were attributed to statins, predominantly atorvastatin (12 cases). Atorvastatin dose ranged from 10 to 80 mg, and rosuvastatin (the remaining 2 cases) dose was 20 mg. The mean age was 65.1 years. Latency varied widely (mean: 156 days), with the shortest latency (21 days) in the two patients treated with 80 mg of atorvastatin. Liver enzyme normalization occurred in nine patients (mean: 60 days), eight recovered within 180 days, and one at 202 days. One patient had persistent abnormalities at 231 days, while four cases had incomplete follow-up (&lt;180 days). Eosinophilia was the only hypersensitivity feature identified; no cases showed autoimmune-like hepatitis. Detailed characteristics are presented in the attached table.</div></div><div><h3>Conclusions</h3><div>Statin-related DILI represented a small proportion of UHR cases, despite high population exposure and their classification as high-potential hepatotoxins (category A). This may suggest underreporting or underdiagnosis. Nonetheless, clinical presentation was generally mild, and outcomes were favorable following drug discontinuation, although follow-up was incomplete in several cases.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101999"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154751","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":"REAL-WORLD EFFECTIVENESS OF URSODEOXYCHOLIC ACID AND FIBRATES IN URUGUAYAN PATIENTS WITH PRIMARY BILIARY CHOLANGITIS","authors":"Noel Boldrini Arce ,&nbsp;Yamila Montaño ,&nbsp;Patricia Etchandy ,&nbsp;Daniela Chiodi ,&nbsp;Adriana Sánchez ,&nbsp;Nelia Hernández","doi":"10.1016/j.aohep.2025.102000","DOIUrl":"10.1016/j.aohep.2025.102000","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>A considerable proportion of patients with primary biliary cholangitis (PBC) fail to achieve an adequate biochemical response to standard therapy with ursodeoxycholic acid (UDCA), which is associated with a poorer prognosis. This study aimed to evaluate the biochemical efficacy and tolerability of combining fibrates with UDCA in a cohort of Uruguayan patients with PBC.</div></div><div><h3>Materials and Methods</h3><div>A retrospective and descriptive cohort study was conducted. Adult patients with PBC who had persistently elevated alkaline phosphatase (ALP) levels after one year of UDCA treatment (13–15 mg/kg/day) and were subsequently treated with bezafibrate, fenofibrate, or ciprofibrate between 2018 and 2025 were included. Liver function tests were assessed at one and three months. The primary outcome was the ALP value at three months. Complete response was defined as normalization (ALP ≤ 1 × upper limit of normal [ULN]) and partial response as a reduction from baseline without normalization.</div></div><div><h3>Results</h3><div>Twenty patients (17 women, mean age 51.4 years) met inclusion criteria (see Table). Eleven patients received fenofibrate (160–200 mg/day), seven bezafibrate (200–400 mg/day), and two ciprofibrate (100 mg/day). Three patients discontinued fibrates before three months due to hepatotoxicity (ALTx5 ULN). Among the remaining 17 patients, eight achieved complete response, six showed partial improvement (24–76% improvement from baseline), and three had no biochemical change.</div></div><div><h3>Conclusions</h3><div>UDCA-fibrate combination therapy was associated with biochemical improvement in the majority of patients. However, the notable rate of hepatotoxicity warrants caution. Larger studies with extended follow-up are needed to validate these findings.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102000"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154752","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":"CORE MUTATIONS IN THE HBEAG-NEGATIVE STAGE ARE KEY DETERMINANTS OF HEPATITIS B VIRUS REPLICATION","authors":"Selene Leuzzi ,&nbsp;Cecilia Garcia ,&nbsp;Diego Flichman ,&nbsp;Maria Mercedes Elizalde","doi":"10.1016/j.aohep.2025.101990","DOIUrl":"10.1016/j.aohep.2025.101990","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The natural history of chronic HBV infection is characterized by distinct stages resulting from virus-host interactions. In this context, a late and pivotal event is HBeAg seroconversion, marked by the abrogation of HBeAg expression, a significant reduction in viral load, and the accumulation of mutations throughout the genome. While HBeAg abrogation is associated with mutations in the BCP and preCore regions, these mutations do not, per se, account for the observed reduction in viral load. Our aim was to unravel, at the molecular level, the drivers involved in the HBV replication rate.</div></div><div><h3>Materials and Methods</h3><div>Full-lenght HBV genome obtained from plasma samples of one HBeAg-positive patient and three HBeAg-negative patients was extracted, amplified and cloned. The replicative capacity and HBsAg antigen expresion of these clones and the chimeras obtained through core gene exchanges was evaluated in vitro.</div></div><div><h3>Results</h3><div>The incorporation of the wild-type (WT) core protein into HBeAg-negative genomes restored all viral replication intermediates (cccDNA, pgRNA, rcDNA, and capsid-associated DNA) to levels comparable to those of the WT virus and vice versa (Figure 1). Furthermore, a regulatory role of mutations in the core protein was observed in the modulation of HBsAg expression and secretion (Figure 2).</div></div><div><h3>Conclusions</h3><div>HBV viral load is a critical factor in the progression of chronic hepatitis B and its associated adverse outcomes. Mutations identified subsequent to HBeAg seroconversion are frequently found within the core region, and these mutations demonstrate a strong association with both HBV-DNA replication capacity and HBsAg expression levels.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101990"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154150","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":"AUTOIMMUNE HEPATITIS IN LATIN AMERICA: INSIGHTS FROM THE ALLATIN COHORT","authors":"Ludmila Resende Guedes ,&nbsp;Guilherme Grossi Lopes Cançado ,&nbsp;Janaína Luz Narciso Schiavo ,&nbsp;Luciana Costa Faria ,&nbsp;Ezequiel Ridruejo ,&nbsp;Maria Lucia Ferraz ,&nbsp;Margarita Anders ,&nbsp;Lorena Castro Solari ,&nbsp;Alejandra Maria Villamil ,&nbsp;Harlim Rodríguez ,&nbsp;Nicolas Ortiz ,&nbsp;Eira Cerda Reyes ,&nbsp;Esteban Horacio Gonzalez Dominguez ,&nbsp;Rodrigo Zapata ,&nbsp;Débora Raquel Benedita Terrabio ,&nbsp;Paulo Lisboa Bittencourt ,&nbsp;Pablo Andrés Coste Murillo ,&nbsp;Emilia Vera Pozo ,&nbsp;Leonardo de Lucca Schiavon ,&nbsp;Artur Maia de Castro Miranda ,&nbsp;Cláudia Alves Couto","doi":"10.1016/j.aohep.2025.101975","DOIUrl":"10.1016/j.aohep.2025.101975","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease associated with significant morbidity. Non-white ethnicity has been described as an independent predictor of adverse outcomes. Previous studies suggest a more severe disease phenotype in Latin America. We aim to describe the presentation, treatment, and outcomes of AIH in Latin America.</div></div><div><h3>Materials and Methods</h3><div>Retrospective, ongoing, multicenter cohort study (ALLATIN) including 515 patients with autoimmune hepatitis from Brazil (246), Argentina (108), Chile (71), Ecuador (28), Cuba (22), Mexico (21), Costa Rica (10), and Peru (1).</div></div><div><h3>Results</h3><div>Most patients were female (82.5%), with type 1 AIH (90.9%) and a mean age at diagnosis of 42.8±19.2 years. At disease presentation, the most reported symptom was jaundice (42.3%), followed by asthenia (25.3%), abdominal pain (19.8%), arthralgia (10.0%) and pruritus (9.8%). Clinical signs of portal hypertension were seen in 16.1% at diagnosis. Acute presentation occurred in 39.3%, predominantly as acute icteric hepatitis(72.2%), while 42% were asymptomatic. At the first biopsy, 42.9% of patients had advanced fibrosis (F3–F4), 35.0% were cirrhotic on ultrasound, and 26.6% had clinically significant portal hypertension. The preferred first line therapy was prednisone (96.5%) and azathioprine (91.9%). Biochemical remission was achieved in 68.4% (data from 336 patients) at 6 months and 55.7% at 12 months and 55.7% (data from 329 patients) at 12 months. Among patients who achieved a biochemical response within the first year, most responded within the first 6 months. Reported second-line therapies were mycophenolate mofetil (63.6%), tacrolimus (13.6%), cyclosporine (13.6%), chloroquine (6.8%), and rituximab (2.3%). In a mean follow up of 6.72±6.0 years, 3.9% underwent liver transplantation and 3.1% died.</div></div><div><h3>Conclusions</h3><div>Despite a high burden of advanced liver disease at presentation, the ALLATIN cohort shows comparable treatment response rates to European populations. These findings highlight the importance of ethnicity, healthcare access, and early diagnosis in shaping AIH outcomes.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101975"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154319","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":"IMPACT OF HEPATITIS A VACCINATION IN PRIORITY ADULT GROUPS AS AN OUTBREAK CONTAINMENT STRATEGY IN BRAZIL","authors":"Isabelle Cristine de Jesus Macedo ,&nbsp;Aline Alves da Silva ,&nbsp;Nathalia da Silva Cruz ,&nbsp;Elton Carlos de Almeida ,&nbsp;Ana Paula Maciel Gurski ,&nbsp;Joao Vitor da Mota Silva ,&nbsp;Carla Francisca dos Santos Cruz ,&nbsp;Ana Monica de Mello ,&nbsp;Mário Peribanez Gonzalez ,&nbsp;Jose Nilton Neris Gomes ,&nbsp;Leonardo Carrara Matsuura","doi":"10.1016/j.aohep.2025.102043","DOIUrl":"10.1016/j.aohep.2025.102043","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Viral hepatitis A (HAV) is an infection primarily transmitted via the fecal-oral route. In 2016, the World Health Organization observed an increase in HAV cases in low-endemicity countries, associated with oral-anal sexual practices.</div><div>To evaluate the outcome of hepatitis A vaccination in adults from priority groups as a strategy for containing the hepatitis A outbreak.</div></div><div><h3>Materials and Methods</h3><div>A document analysis of state technical reports and technical notes from the Ministry of Health addressing epidemiological outbreaks in two Brazilian capitals was conducted.</div></div><div><h3>Results</h3><div>In Brazil, there were HAV outbreaks in São Paulo (2017) and Curitiba (2024), with similar characteristics and a predominance of cases in adult males via sexual transmission. In São Paulo, an increase in cases was noted, with 786 reported cases, 80% of which were among individuals aged 18 to 39. In 2018, a reactive vaccination campaign against HAV was initiated, leading to a reduction in cases in subsequent years. In Curitiba, 315 cases were confirmed between 2023 and 2024, with 71.1% of cases in adults aged 20-39. The same strategy was initiated in June 2024, resulting in an 80% reduction in the absolute number of cases by November 2024.</div></div><div><h3>Conclusions</h3><div>In response to the identified outbreaks, the Ministry of Health developed strategies for adults in priority groups and implemented HAV vaccination for these groups, achieving effective outbreak control. In May 2025, given the positive outcomes, the HAV vaccine was incorporated for all users of HIV Pre-Exposure Prophylaxis (PrEP) as a preventive measure.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102043"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154335","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":"MELD 3.0 PERFORMANCE: EXTERNAL VALIDATION IN A LATIN AMERICAN TRANSPLANT LIVER COHORT","authors":"Josefina Pages Maronese ,&nbsp;Federico Piñero ,&nbsp;Graciela Castro Narro ,&nbsp;Yahvé Iván López Méndez ,&nbsp;Ignacio Roca ,&nbsp;Nicolas Dominguez ,&nbsp;Fernando Cairo ,&nbsp;Angelo Z. Mattos ,&nbsp;Natalia Baumgartner Ayres ,&nbsp;Bertha Eliana Cárdenas Ramírez ,&nbsp;Estefania Liza Baca ,&nbsp;Julio Benitez Perez ,&nbsp;Alejandra Villamil ,&nbsp;Alexandra Ginesta ,&nbsp;Rodrigo Zapata ,&nbsp;Gustavo Pereira ,&nbsp;Florencia Antinucci ,&nbsp;Aldo Torre Delgadillo ,&nbsp;Marcelo Silva ,&nbsp;Manuel Mendizabal","doi":"10.1016/j.aohep.2025.101954","DOIUrl":"10.1016/j.aohep.2025.101954","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The MELD 3.0 score has demonstrated superior discriminatory performance for predicting 90-day waitlist mortality among liver transplant (LT) candidates in the US. This study aimed to validate the MELD 3.0 in a Latin American cohort.</div></div><div><h3>Materials and Methods</h3><div>Retrospective cohort study including adults LT candidates listed between 2016-2023 across five Latin American countries. Baseline data were registered at listing. Cox regression model was performed, with 90-day mortality as the primary outcome and LT as censored observation. Discriminative performance was assessed using Harrell´s c-index for MELD, MELD-Na and MELD 3.0. Net Reclassification Index (NRI) was also calculated.</div></div><div><h3>Results</h3><div>We included 1,013 patients: mean age 51 years (±11.8); 41.4% females, 25.8% obese, 58.1% ascites and 38.3% had encephalopathy were present in 58.1% and 38.3% of cases, respectively. Median MELD score was 16.9 (IQR 13.3–21.1), MELD-Na 18.3 (IQR 14.6–24), and MELD 3.0 19.5 (IQR 15.1–24.8). At 90 days, 26.3% underwent LT and 66.8% remained on the waitlist. The mortality incidence was 29.4 deaths per 1,000 patient-months, with a cumulative mortality of 8.3% (95% CI 6.6–10.4%) at 3 months. Hazard ratios for 90-day mortality were: MELD 1.15 (95% CI 1.12-1.19), MELD-Na 1.16 (95% CI 1.13-1.20), and MELD 3.0 1.15 (95% CI 1.12-1.19). Harrell’s c-index showed no significant differences (Table 1).NRI showed no significant improvement in risk reclassification using MELD 3.0.</div></div><div><h3>Conclusions</h3><div>In a region showing high waitlist mortality, MELD 3.0 did not demonstrate superior predictive performance over MELD or MELD-Na. These findings highlight the need for regional validation of predictive models before implementation in transplant priorization policies.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101954"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154469","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":"PROJECTED CLINICAL AND ECONOMIC BURDEN OF METABOLIC DYSFUNCTION–ASSOCIATED STEATOHEPATITIS IN BRAZIL: A 20-YEAR FORECAST ACROSS TYPE 2 DIABETES STATUS","authors":"Zobair Younossi ,&nbsp;James M. Paik ,&nbsp;Cristiane A. Villela-Nogueira ,&nbsp;Claudia Pinto Oliveira ,&nbsp;Fatema Nader ,&nbsp;Linda Henry ,&nbsp;Mário Guimarães Pessoa","doi":"10.1016/j.aohep.2025.102035","DOIUrl":"10.1016/j.aohep.2025.102035","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Type 2 diabetes (T2D) is an important risk factor for metabolic dysfunction–associated steatohepatitis (MASH) and its complications.</div><div>Explore long-term impact economic burden of MASH among adults by T2D status.</div></div><div><h3>Patients and Methods</h3><div>Markov model simulated the natural history of patients with MASH in Brazil over a 20-year horizon (2021–2040). Transition probabilities were calibrated to align with Brazil’s national data for cirrhosis, hepatocellular carcinoma (HCC), liver transplantation (LT), obesity, and T2D. The model incorporated competing mortality risks (liver-related, cardiovascular, and other causes). Baseline estimates of direct medical costs (outpatient care, diagnostics, hospitalizations, procedures, medications) were estimated by disease stage using national sources, including the Fiocruz Observatory database and Brazil’s health system profile. Costs are reported in 2020 USD, adjusted using IMF inflation projections.</div></div><div><h3>Results</h3><div>From 2021 to 2040, MASH prevalence among adults in Brazil is projected to rise from 7.19% to 7.52%. In the general population, the prevalence of MASH-related cirrhosis will increase from 0.63% to 0.99%, while MASH-related HCC, -LT and -liver deaths will increase from 0.50 to 1.02, 0.17 to 0.38 and 10.08 to 13.46 per 100,000. The proportion of MASH cases with T2D will increase from 25.3% to 30.8%. Among MASH-cirrhosis patients, this proportion will increase from 23.9% to 27.8%. Annual MASH-related direct medical costs will rise from $3.41 billion in 2021 to $9.81 billion by 2040, with the proportion attributable to T2D increasing from 30.7% to 40.1% (Figure).</div></div><div><h3>Conclusions</h3><div>Clinical and economic burden of MASH in Brazil is expected to rise with increasing share attributable to T2D.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102035"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154406","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":"STOP PPIS - NO REDUCTION IN BLEEDING OR MORTALITY AFTER ENDOSCOPIC BANDING LIGATION FOR ESOPHAGEAL VARICES IN CIRRHOTICS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS","authors":"Gustavo André Pedral Diniz Leite ,&nbsp;Bernardo de Faria Moraes ,&nbsp;Gabriel André Pedral Diniz Leite ,&nbsp;Maria Luisa Motta Fonseca ,&nbsp;Rodolfo Augusto Assis Rezende ,&nbsp;Guilherme Grossi Lopes Cançado","doi":"10.1016/j.aohep.2025.102024","DOIUrl":"10.1016/j.aohep.2025.102024","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Proton pump inhibitors (PPIs) are frequently prescribed to reduce bleeding and mortality after endoscopic band ligation (EBL) of esophageal varices in cirrhotic patients. However, the clinical benefit remains uncertain. This meta-analysis aims to determine whether PPI therapy reduces bleeding and mortality within 8 weeks following EBL of esophageal varices in cirrhotic patients, compared to non-use.</div></div><div><h3>Materials and Methods</h3><div>The search was conducted in PubMed, Web of Science and CENTRAL in January 2025. Randomized controlled trials (RCTs) comparing PPI use after EBL in cirrhotic patients versus non-use were included. The primary outcome was bleeding, and,the secondary, was mortality, both within 8 weeks. Two independently students extracted data and assessed risk of bias, using the Cochrane Risk of Bias tool (RoB 2). Relative risks (RRs) with 95% CI were calculated by random-effects model.</div></div><div><h3>Results</h3><div>Four RCTs including 445 cirrhotic patients who underwent EBL were included. All studies contributed to the primary outcome and three of them, including 268 patients, to the secondary outcome. In pooled analysis, PPI use was not associated with a reduced risk of bleeding within 8 weeks (RR 0.71; 95% CI: 0.39 - 1.30; I² = 0.0%), or mortality (RR 0.75; 95% CI: 0.23 - 2.53; I² = 0.0%).</div></div><div><h3>Conclusions</h3><div>This meta-analysis indicates that PPI therapy after EBL for esophageal varices in cirrhotic patients has no evidence of reducing risk of bleeding or death compared to non-use and discourages the indiscriminate use of PPIs when no proven benefit exists.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102024"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154494","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":"NON-INVASIVE ASSESSMENT OF STEATOHEPATITIS AND LIVER FIBROSIS IN THE POPULATION AT RISK FOR METABOLIC STEATOTIC LIVER DISEASE","authors":"Laís Siqueira Maia ,&nbsp;Juliana Rodrigues Caldas ,&nbsp;Rodrigo Nogueira Alonso ,&nbsp;Juliana de Albuquerque Magella Mussnich ,&nbsp;Maria Paula Silva Bernardes ,&nbsp;João Marcello Neto de Araújo ,&nbsp;Luis Guillermo Coca Velarde ,&nbsp;Maria Auxiliadora Nogueira Saad ,&nbsp;Débora Vieira Soares ,&nbsp;Priscila Pollo-Flores","doi":"10.1016/j.aohep.2025.102018","DOIUrl":"10.1016/j.aohep.2025.102018","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The overall global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is 30%, with a higher prevalence in Latin America (44,4%). Metabolic dysfunction-associated steatohepatitis (MASH) is a spectrum of MASLD that can progress to advanced fibrosis, cirrhosis, hepatic decompensation and hepatocellular carcinoma. Non-invasive tests (NITs) can help identify and monitor the progression of MASH, as well as predict the risk of liver-related outcomes.</div><div>To evaluate the association between steatohepatitis, liver fibrosis and progression predictors using non-invasive tests in the population at risk for MASLD.</div></div><div><h3>Materials and Methods</h3><div>A prospective observational study based on the analysis of cross-sectional data from adults in a tertiary hospital who provided informed consent. Inclusion criteria were age between 18 and 75 years and the presence of type 2 diabetes, obesity or metabolic syndrome. The NITs used were FIB 4 index, ultrassonography Fatty Liver Index (FLI), transient elastography and shear wave elastography. Data were analyzed using R and were submitted to the non-parametric Mann-Whitney or Wilcoxon tests. A significant level of 5% was adopted.</div></div><div><h3>Results</h3><div>This study included 131 patients. Of these, 81 (61.8%) had steatohepatitis (FLI≥ 4), 35 (26.7%) significant fibrosis (F≥ 2) and 17 (12.9%) advanced fibrosis (F≥ 3). Gamma-glutamil transferase (GGT) was the only serum biomarker with a statistically significant correlation with both steatohepatitis (p = 0.01582) and significant fibrosis (p = 0.0217). Data are described in table1.</div></div><div><h3>Conclusions</h3><div>GGT was significantly associated with the presence of steatohepatitis and significant fibrosis, suggesting that GGT may serve as an additional marker to alert clinicians to the presence of MASH and fibrosis.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102018"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154575","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}