BMJ Open Gastroenterology最新文献

{"title":"Development and internal validation of the AGATE hybrid score for pre-endoscopic risk stratification in acute upper gastrointestinal bleeding: a single-centre, retrospective cohort study.","authors":"Yavuz Özden, Ömer Yüzügülen, Ferhat Omurca","doi":"10.1136/bmjgast-2025-002217","DOIUrl":"10.1136/bmjgast-2025-002217","url":null,"abstract":"<p><strong>Objective: </strong>To compare five established pre-endoscopic risk scores in acute upper gastrointestinal bleeding (AUGIB) and to derive a hybrid score (Acute Gastrointestinal Bleeding ABC-GBS Triage Evaluation (AGATE)) integrating mortality prediction and triage utility.</p><p><strong>Methods: </strong>We conducted a single-centre retrospective cohort study at Kayseri City Hospital, Kayseri, Türkiye, including 5000 consecutive adults with endoscopically confirmed AUGIB (January 2020-January 2025). The primary outcome was 30-day mortality; secondary outcomes were therapeutic intervention and 30-day rebleeding. Age-Blood tests-Comorbidities (ABC), Mental status-ASA class-Pulse-Albumin-Systolic blood pressure-Haemoglobin (MAP(ASH)), Haematemesis-Heart rate-Haemoglobin-Blood pressure-Blood urea nitrogen, Glasgow-Blatchford score (GBS) and Albumin, INR, Mental status, Systolic blood pressure, Age ≥65 were calculated at presentation. AGATE was derived using multivariable logistic regression for the composite end point (mortality or intervention) and internally validated with 1000 bootstrap resamples.</p><p><strong>Results: </strong>Mortality was 9.2% (460/5000), intervention was required in 71.0% (3550/5000) and rebleeding occurred in 14.5% (725/5000). For mortality, ABC (area under the receiver operating characteristic curve (AUROC) 0.83, 95% CI 0.80 to 0.86) and MAP(ASH) (AUROC 0.81, 95% CI 0.78 to 0.84) demonstrated the highest discrimination; for intervention, GBS (AUROC 0.78, 95% CI 0.74 to 0.82) and MAP(ASH) (AUROC 0.77, 95% CI 0.73 to 0.80) demonstrated the highest discrimination. AGATE achieved AUROCs of 0.85 (95% CI 0.82 to 0.87) for mortality and 0.80 (95% CI 0.77 to 0.82) for intervention. For the composite end point, AGATE outperformed GBS (AUROC 0.86, 95% CI 0.83 to 0.88 vs 0.77 95% CI 0.74 to 0.80; p<0.001), with an optimism-corrected AUROC of 0.843. Using a low-risk cut-off (≤5), AGATE classified 38% (1900/5000) as low risk (0.3% mortality, 4.0% intervention), compared with 15% (750/5000) for GBS ≤1.</p><p><strong>Conclusion: </strong>AGATE provides balanced pre-endoscopic triage by integrating predictors from ABC and GBS, expanding the low-risk group while maintaining very low short-term mortality. Prospective external validation in independent multicentre settings is required.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of mirikizumab in ulcerative colitis: real-world data from the Latium Net.","authors":"Marco Murgiano, Paola Balestrieri, Emma Calabrese, Gionata Fiorino, Stefano Festa, Daniela Pugliese, Federica Di Vincenzo, Pierluigi Puca, Simone Parello, Valeria Vespasiano, Alice Colella, Irene Marafini, Francesca Profeta, Elisa Foscarini, Alfredo Papa, Loris Riccardo Lopetuso, Giovanni Monteleone, Michele Cicala, Antonio Gasbarrini, Lucrezia Laterza, Franco Scaldaferri","doi":"10.1136/bmjgast-2025-002232","DOIUrl":"10.1136/bmjgast-2025-002232","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness and safety of mirikizumab in patients with ulcerative colitis in clinical practice.</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter cohort study across five Italian inflammatory bowel disease centers. Patients initiating mirikizumab between November 2024 and May 2025 were included. The primary endpoint was steroid-free clinical remission (SFCR) at 12 weeks, defined as the absence of rectal bleeding and near-normal stool frequency without corticosteroids. Secondary outcomes included clinical response (≥30% improvement in stool frequency and rectal bleeding), biochemical response (normalisation of fecal calprotectin (FCP) and C-reactive protein (CRP)), and safety (any adverse events). Follow-up at 24 weeks was assessed when available. Subgroup analyses were performed according to prior exposure to biologics (including ustekinumab) and induction regimen.</p><p><strong>Results: </strong>A total of 95 patients were included (mean age 49.9±16.9 years; 50.5% male); 12.6% were biologic naïve and 17 (17.9%) received extended induction. At week 12, 43.2% of patients (41/95) achieved SFCR, 61.1% (58/95) clinical response, and 32/95 (33.7%) biochemical remission. SFCR rates were similar between biologic-naïve and biologic-experienced patients (42.6% vs 43.8%, p=0.906). SFCR rates were 36.2% and 88.2% in patients receiving extended and standard induction, respectively (p=0.002). At week 24, prior ustekinumab exposure was associated with numerically lower SFCR, although this difference was not statistically significant (38.5% vs 73.7%; OR=0.22, 95% CI 0.05 to 1.01, p=0.052). Changes in biomarkers were not statistically significant at week 12 (CRP Δ-0.08 mg/dL, p=0.464; FCP Δ-249 µg/g, p=0.127). Three patients discontinued treatment due to lack of efficacy. No adverse events were observed.</p><p><strong>Conclusion: </strong>Mirikizumab demonstrated meaningful clinical effectiveness and a favourable safety profile in a real-world setting, including in biologic-experienced patients.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transarterial chemoembolisation-based combination therapy as a potential new standard for intermediate-stage hepatocellular carcinoma in the targeted immunotherapy era.","authors":"Shuanggang Chen, Lujun Shen, Han Qi, Pan Hu, Fei Cao, Lin Xie, Yujia Wang, Weijun Fan","doi":"10.1136/bmjgast-2025-002154","DOIUrl":"10.1136/bmjgast-2025-002154","url":null,"abstract":"<p><p>Transarterial chemoembolisation (TACE) is the standard therapy for intermediate-stage hepatocellular carcinoma (HCC); however, its efficacy is limited by significant tumour heterogeneity. Recent landmark trials (EMERALD-1 and LEAP-012) demonstrated that adding targeted immunotherapy to TACE significantly improves progression-free survival compared with TACE alone. However, the inconsistent overall survival (OS) benefit, particularly in LEAP-012, highlights the necessity for precision patient stratification. Key determinants of outcomes include tumour burden, liver function, microvascular invasion (MVI), systemic inflammation, immune status and comorbidities. For patients with low tumour burden, optimised locoregional therapies can achieve higher complete response rates. For high tumour burden, multimodal strategies are required, with increasing evidence supporting TACE plus targeted therapy with or without immunotherapy. MVI-positive HCC derives added benefit from adjuvant tyrosine kinase inhibitors (TKIs) after TACE, while dynamic liver function monitoring is crucial for safety, especially in patients with Child-Pugh B. Future directions should focus on developing and validating robust multidimensional stratification models. These models should integrate key established determinants-such as tumour burden, liver function reserve, MVI, systemic inflammatory/immune status, alpha-fetoprotein (AFP) and comorbidities-with promising emerging biomarkers (eg, circulating tumour DNA). Concurrent efforts are needed to optimise combination regimens and conduct health-economic evaluations. Global collaboration and cost-effectiveness analyses are essential to prioritise high-benefit subgroups (eg, those with high tumour burden, MVI positivity and/or mild inflammation, active immune status alongside preserved liver function and limited comorbidities) for intensive combination therapy while avoiding overtreatment in lower-benefit populations.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the enhanced liver fibrosis test to identify disease in at-risk populations.","authors":"Alex Hinkson, Jacob Feathers, Jason Punnamkuzhy, Firuza Dzhakangirli, Ian Alston Rowe, Richard Parker","doi":"10.1136/bmjgast-2025-002048","DOIUrl":"10.1136/bmjgast-2025-002048","url":null,"abstract":"<p><strong>Objective: </strong>Steatotic liver disease is common and has increased prevalence among those with type II diabetes mellitus or hazardous alcohol use. Identifying individuals with advanced liver disease early through screening may afford timely opportunities to reduce disease progression. This study assesses the application of non-invasive tests in at-risk populations to identify clinically important disease.</p><p><strong>Methods: </strong>The enhanced liver fibrosis (ELF) test and liver stiffness measurement (LSM) were used as non-invasive means to assess risk of fibrosis in two at-risk populations in Leeds, UK. Patients in a community diabetes clinic and patients with hazardous alcohol use attending alcohol treatment services between March 2019 and March 2020 were offered ELF testing alongside routine review. Those with ELF ≥9.5 were offered LSM.</p><p><strong>Results: </strong>In total, 972 patients were assessed, of whom 325 underwent both ELF and LSM. Patients referred from the diabetes clinic were typically older and had higher body mass index values, while alanine aminotransferase and serum bilirubin values were higher in those referred from alcohol services. Forty-five per cent of patients referred from the diabetes service had an ELF score below 9.5, and only 7.9% undergoing LSM had readings ≥15 kPa. Seventy-two per cent of patients referred from the alcohol service had ELF scores below 9.5, with 31% subsequently having LSM values ≥15 kPa.</p><p><strong>Conclusion: </strong>Steatotic liver disease is relatively common in those with risk factors and particularly those drinking excess alcohol. Strategies for identifying at-risk individuals may help to increase early diagnosis, though care must be taken when selecting appropriate tests.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the effect of single dose antibiotic prophylaxis compared with a multiday regimen in liver transplant recipients undergoing routine endoscopic retrograde cholangiopancreatography: a retrospective, single-centre, registry-based cohort study with a historical control group.","authors":"Jessica Seeßle, Lara Ruhberg, Marietta Kirchner, Patrick Michl, Christian Rupp, Peter Sauer, Uta Merle","doi":"10.1136/bmjgast-2025-002200","DOIUrl":"10.1136/bmjgast-2025-002200","url":null,"abstract":"<p><strong>Objective: </strong>Biliary complications, particularly anastomotic strictures, are common after liver transplantation (LT). The recommended duration of antibiotic prophylaxis after routine endoscopic retrograde cholangiopancreatography (ERCP) for LT patients varies across international guidelines and literature. Therefore, this study aimed to evaluate the impact of a single-dose antibiotic prophylaxis on the post-ERCP cholangitis rate, overall antibiotic exposure and potential risk factors for cholangitis in this cohort.</p><p><strong>Methods: </strong>We conducted a single-centre, registry-based, non-interventional cohort study at the Department of Gastroenterology, Heidelberg University Hospital, to investigate the impact of a newly introduced standard operating procedure (SOP) involving a periinterventional single-dose prophylaxis (SOP cohort, n=54 procedures) compared with a historical cohort (n=100 procedures) that received a multiday regimen. Following its implementation in January 2019, the SOP cohort included all routine ERCPs from January 2019 to May 2020, whereas the historical cohort comprised procedures from March 2015 to August 2017. The diagnosis and severity grading of cholangitis were based on the adapted Tokyo Guidelines.</p><p><strong>Results: </strong>The duration of the periinterventional antibiotic therapy differed significantly between cohorts, with a median of 0.33 days in the SOP cohort and 4 days in the historical cohort (p<0.001). Despite this reduction, there was no significant difference in the rate of post-ERCP cholangitis between the two cohorts (without dilation: 9.5% vs 17.4%, p=0.67)-even in procedures involving dilation (20.3% vs 25.8%, p=0.53). Moreover, univariate analysis did not identify any significant risk factors for the development of post-ERCP cholangitis, including the performance of dilation (p=0.32).</p><p><strong>Conclusion: </strong>In our study, a significant reduction in periinterventional antibiotic duration did not increase post-ERCP cholangitis risk, even with dilation. This suggests shorter regimens can be safely implemented.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 2026 IBD UK Standards of healthcare service design and delivery for adults and children living with Crohn's disease and ulcerative colitis.","authors":"Christopher A Lamb, Catherine Picton, Ian Arnott, Pearl Avery, Debra Attwood, Saswata Banerjee, Sarah Bayliss, Graham Bell, Gauraang Bhatnagar, Caroline Brocklehurst, Vicky Buckley, Valerio Celentano, Rachel Dodd, Amy Gittins, Katie Keetarut, Gayle Martin, Rafeeq Muhammed, Marianne Radcliffe, Fiona Rees, Ruth Rudling, Clare Tibbatts, Jessica Turner, Catherine Winsor, Nathaniel Woo, Lisa Younge, Christian P Selinger, A Barney Hawthorne","doi":"10.1136/bmjgast-2025-002227","DOIUrl":"10.1136/bmjgast-2025-002227","url":null,"abstract":"<p><strong>Objective: </strong>Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, requires consistent high-quality care to reduce variation in patient experience and improve outcomes. The IBD Standards previously published in 2009, 2013 and 2019 have provided an aspirational framework for best practice. Since 2019, two rounds of national benchmarking with patient engagement, healthcare professional (HCP) consultation and new evidence have highlighted areas for quality improvement (QI). We aimed to develop the 2026 IBD UK Standards of healthcare for adults and children, ensuring they reflect current and aspirational best practice and to support future QI initiatives.</p><p><strong>Methods: </strong>A multidisciplinary working group of 18 HCPs and 4 people with lived experience assessed the 59 IBD standards from 2019, categorising them as needing no change, minor or major amendment or deletion. New standards were developed through iterative drafting and consensus review, with feedback incorporated from 47 external HCPs and a patient workshop. The 2026 standards remain aspirational, structured across seven domains: the IBD service, pre-diagnosis, newly diagnosed, flare management, surgery, inpatient care and ongoing care.</p><p><strong>Results: </strong>The 2026 IBD UK Standards comprise 60 statements: 6 unchanged from 2019, 48 updated, 7 deleted and 6 new. Key themes include multidisciplinary, coordinated care with defined leadership; age-appropriate transition pathways; timely referral from primary care, access to diagnostic tests, treatments and surgery; patient-centred care, including better communication, personalised care plans, shared decision-making and support for self-management; holistic assessment and management of physical, nutritional and psychological need; QI and audit supported by electronic systems; research participation and innovation.</p><p><strong>Conclusions: </strong>The 2026 IBD UK Standards provide a contemporary aspirational framework to drive consistent, high-quality, personalised care across the UK. They aim to reduce inequality, improve experience and outcomes through support for patient-centred shared decision-making, national benchmarking, service development, patient involvement and QI.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dyssynergia phenotypes in obstructed defecation: insights from Fecobionics assessment.","authors":"Wenbo Li, Mingyang Hou, Yi Li, Houde Yu, Yuqin He, Haibin Yao, Shili Xiao, Kaijun Liu, Xin Fu, Liangzhi Wen, Zhiyong Huang, Min Yang","doi":"10.1136/bmjgast-2025-002212","DOIUrl":"10.1136/bmjgast-2025-002212","url":null,"abstract":"<p><strong>Objective: </strong>Obstructed defecation syndrome (ODS) is a chronic constipation subtype. Conventional tests are limited by non-physiological conditions and poor correlation with symptoms. This study investigated anorectal dynamics and dyssynergia phenotypes in patients with ODS using Fecobionics.</p><p><strong>Methods: </strong>This study was designed as a prospective observational study including 10 control subjects and 25 patients with ODS. All measurements were performed according to a predefined protocol. All patients with ODS underwent clinical evaluation, anorectal manometry (ARM) and defecography. Fecobionics recorded anorectal pressures, sensation and expulsion performance. Expulsion dynamics were further analysed using preload-afterload diagrams to characterise dyssynergia subtypes.</p><p><strong>Results: </strong>Compared with the control group, the ODS group showed prolonged expulsion time (76 (23-120) vs 18.7 s (10.6-34), p<0.01), reduced effective propulsive force (P_delta) (26.2 (8.6-35.9) vs. 48.2 cmH₂O (32.5-88.0), p<0.01), increased number of contractions (7 (4-14) vs 2.5 (1.3-3.8), p<0.01) and higher paradoxical contraction rates (71% (50-100) vs 0% (0-44), p<0.01). ARM during attempted evacuation (push) demonstrated lower anal relaxation rates in the ODS group (16% (12-37) vs 36% (27-44), p<0.03). Correlation analyses demonstrated that impaired Fecobionics metrics were associated with greater symptom burden. Three dyssynergia phenotypes were identified: multiple simultaneous contractions, insufficient or delayed anal relaxation and persistently elevated outlet pressure.</p><p><strong>Conclusion: </strong>Fecobionics enables integrated and physiologically relevant assessment of anorectal function and identifies distinct dyssynergia phenotypes in ODS, reflecting heterogeneous mechanisms of outlet obstruction with implications for individualised management.</p><p><strong>Study registration: </strong>ChiCTR2300078807.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiviral treatment and statin use and risk of decompensated cirrhosis in patients with hepatitis C: a time-dependent analysis of a retrospective cohort study.","authors":"Kimberly A Brown, Stuart C Gordon, Yichu Wang, Trueman Wu, Sheri Trudeau, Loralee B Rupp, Yihe G Daida, Mark A Schmidt, Mei Lu","doi":"10.1136/bmjgast-2025-001946","DOIUrl":"10.1136/bmjgast-2025-001946","url":null,"abstract":"<p><strong>Objective: </strong>Sustained virological response (SVR) in patients with hepatitis C virus (HCV) is associated with slower progression of cirrhosis. Likewise, statin treatment is associated with delayed cirrhosis progression, but most studies of statin use in chronic liver disease include patients with multiple disease aetiologies. We use a unique time-dependent analysis to evaluate the interplay between antiviral treatment and statin use and the risk of decompensated cirrhosis (DC) among patients with HCV over time.</p><p><strong>Methods: </strong>Using data from the US-based retrospective Chronic Hepatitis Cohort Study, we evaluated the impact of time-varying antiviral treatment status and statin use on risk of DC after propensity score weighting for HCV treatment selection bias. We used a pseudo-observation approach to compress data into discrete time intervals using 1 year as the landmark interval (INT), where each 'INT' has a value of 0 (at index) through 15 (15 years postindex) or the date of last follow-up. Time from the index date to the event of incident DC was the main outcome of interest. Death was considered a competing risk.</p><p><strong>Results: </strong>A total of 16 275 patients with HCV (with 93 343 intervals) were observed (2006-2018), with 1718 incidents of DC and 2398 deaths. By year 15, the proportion of patients without antiviral treatment decreased from 36% to 11%; statin use increased from 12% to 28%. Compared with no antiviral treatment, SVR was associated with reduced risk of DC (SVR: adjusted HR (aHR) 0.17, 95% CI 0.14 to 0.21). Statin use was also associated with lower risk of decompensation (aHR 0.68, 95% CI 0.58 to 0.80) independent of cirrhosis status; such reduced risks varied but were sustained across treatment status groups. Additional risk factors included body mass index >25, male sex and multiple comorbidities.</p><p><strong>Conclusions: </strong>Both SVR and statin treatment were associated with reduced risk of decompensation in patients with HCV. These findings may inform clinical management to reduce the risk of DC among patients with HCV.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147526903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing global equity in liver disease research funding: the case of metabolic dysfunction-associated and alcohol-associated liver disease.","authors":"Daniel J Huynh, Matthew Obusan, Jinny Lu, Omar Albhaisi, Somaya Albhaisi","doi":"10.1136/bmjgast-2025-002236","DOIUrl":"10.1136/bmjgast-2025-002236","url":null,"abstract":"","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiomic characterisation of the clinical efficacy of guselkumab induction therapy in ulcerative colitis.","authors":"Amy Hart, Sunandini Sridhar, Swati Venkat, Tae Lee, Joshua J Rusbuldt, Dylan Richards, Christopher Sisk, Dan Horowitz, Lynn Tomsho, Arun K Kannan, Darren Ruane, Koen Van den Berge, David T Rubin, Bruce E Sands, Gert De Hertogh, Kuan-Hsiang G Huang, Matthew Germinaro, Dan Cua, Dawn Waterworth, Tom C Freeman, Marion L Vetter, Bradford McRae, Bram Verstockt, Patrick Branigan","doi":"10.1136/bmjgast-2025-002153","DOIUrl":"10.1136/bmjgast-2025-002153","url":null,"abstract":"<p><strong>Objective: </strong>Selective inhibition of interleukin (IL)-23 through antagonism of the IL-23p19 subunit has demonstrated clinical efficacy in inflammatory bowel disease, but the molecular changes underlying the efficacy outcomes have not yet been described. Here, we provide a detailed evaluation of the cellular and molecular changes associated with guselkumab treatment in patients with moderately to severely active ulcerative colitis (UC) from the QUASAR Phase IIb induction study.</p><p><strong>Methods: </strong>In this double-blind, placebo-controlled, dose-ranging induction study, patients (n=313) were randomised (1:1:1) to receive intravenous guselkumab 200 or 400 mg or placebo at weeks 0, 4, and 8. Colon biopsy samples were collected at weeks 0 and 12, enabling molecular profiling by bulk RNA sequencing (RNA-seq, n=257), single-cell RNA sequencing (n=52), and flow cytometry (n=30). Serum proteomic profiling was also performed at weeks 0, 4, and 12 (n=302).</p><p><strong>Results: </strong>Guselkumab treatment significantly reduced pro-inflammatory serum proteins by week 4 with continued decline through week 12, compared with placebo. Unsupervised analysis of tissue gene modules revealed significant changes in transcriptional states related to pro-inflammatory and epithelial repair pathways, which were most pronounced in patients who achieved histological-endoscopic mucosal improvement (HEMI) at week 12, an important tissue-based end point. Single-cell analyses supported a decrease in the cellular abundance of pro-inflammatory and an increase in mucosal cell types in tissue following treatment.</p><p><strong>Conclusion: </strong>This analysis of guselkumab in UC demonstrated changes in key pathways and cell types that are associated with achieving important clinical end points including HEMI at week 12.</p><p><strong>Trial registration number: </strong>NCT04033445.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}