Pub Date : 2024-07-31DOI: 10.1016/j.cgh.2024.07.013
Sung Won Chung, Hyun Jun Um, Won-Mook Choi, Jonggi Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee
Background and aims: Whether tenofovir or entecavir has different effects on the prevention of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) in secondary and tertiary preventive settings is still a matter of debate. This study aimed to compare the long-term prognosis of HCC between tenofovir and entecavir in patients with chronic hepatitis B.
Methods: Chronic hepatitis B patients diagnosed with HCC between November 2008 and December 2018 and treated with either entecavir or tenofovir at a tertiary center in Korea were included. The effect of tenofovir compared with entecavir on the prognosis of HBV-related HCC was assessed using multivariable-adjusted Cox and propensity score (PS)-matched analyses. Various predefined subgroup analyses were conducted.
Results: During a median follow-up period of 3.0 years, the mortality rate for entecavir-treated patients (n = 3469) was 41.2%, while tenofovir-treated patients (n = 3056) had a mortality rate of 34.6%. Overall survival (OS) was better in the tenofovir group (adjusted hazard ratio [aHR], 0.79; P < .001), which were consistently observed in the PS-matched analysis. The magnitude of the risk difference in OS was more prominent 2 years after the diagnosis of HCC (aHR, 0.50; P < .001) than 2 years before (aHR, 0.88; P = .005), and it was more pronounced in patients with earlier HCC stages. In all subgroups, except for those with shorter life expectancy, such as those with compromised liver function, tenofovir was associated with better OS compared with entecavir.
Conclusions: Among patients with HBV-related HCC, those treated with tenofovir had a better prognosis than those treated with entecavir, particularly among those with prolonged survival.
{"title":"Tenofovir Is Associated With a Better Prognosis Than Entecavir for Hepatitis B Virus-Related Hepatocellular Carcinoma.","authors":"Sung Won Chung, Hyun Jun Um, Won-Mook Choi, Jonggi Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee","doi":"10.1016/j.cgh.2024.07.013","DOIUrl":"10.1016/j.cgh.2024.07.013","url":null,"abstract":"<p><strong>Background and aims: </strong>Whether tenofovir or entecavir has different effects on the prevention of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) in secondary and tertiary preventive settings is still a matter of debate. This study aimed to compare the long-term prognosis of HCC between tenofovir and entecavir in patients with chronic hepatitis B.</p><p><strong>Methods: </strong>Chronic hepatitis B patients diagnosed with HCC between November 2008 and December 2018 and treated with either entecavir or tenofovir at a tertiary center in Korea were included. The effect of tenofovir compared with entecavir on the prognosis of HBV-related HCC was assessed using multivariable-adjusted Cox and propensity score (PS)-matched analyses. Various predefined subgroup analyses were conducted.</p><p><strong>Results: </strong>During a median follow-up period of 3.0 years, the mortality rate for entecavir-treated patients (n = 3469) was 41.2%, while tenofovir-treated patients (n = 3056) had a mortality rate of 34.6%. Overall survival (OS) was better in the tenofovir group (adjusted hazard ratio [aHR], 0.79; P < .001), which were consistently observed in the PS-matched analysis. The magnitude of the risk difference in OS was more prominent 2 years after the diagnosis of HCC (aHR, 0.50; P < .001) than 2 years before (aHR, 0.88; P = .005), and it was more pronounced in patients with earlier HCC stages. In all subgroups, except for those with shorter life expectancy, such as those with compromised liver function, tenofovir was associated with better OS compared with entecavir.</p><p><strong>Conclusions: </strong>Among patients with HBV-related HCC, those treated with tenofovir had a better prognosis than those treated with entecavir, particularly among those with prolonged survival.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1016/j.cgh.2024.05.052
Silvia Sookoian, Yaron Rotman, Luca Valenti
Recent advances in the genetics of metabolic dysfunction-associated steatotic liver disease (MASLD) are gradually revealing the mechanisms underlying the heterogeneity of the disease and have shown promising results in patient stratification. Genetic characterization of the disease has been rapidly developed using genome-wide association studies, exome-wide association studies, phenome-wide association studies, and whole exome sequencing. These advances have been powered by the increase in computational power, the development of new analytical algorithms, including some based on artificial intelligence, and the recruitment of large and well-phenotyped cohorts. This review presents an update on genetic studies that emphasize new biological insights from next-generation sequencing approaches. Additionally, we discuss innovative methods for discovering new genetic loci for MASLD, including rare variants. To comprehensively manage MASLD, it is important to stratify risks. Therefore, we present an update on phenome-wide association study associations, including extreme phenotypes. Additionally, we discuss whether polygenic risk scores and targeted sequencing are ready for clinical use. With particular focus on precision medicine, we introduce concepts such as the interplay between genetics and the environment in modulating genetic risk with lifestyle or standard therapies. A special chapter is dedicated to gene-based therapeutics. The limitations of approved pharmacological approaches are discussed, and the potential of gene-related mechanisms in therapeutic development is reviewed, including the decision to perform genetic testing in patients with MASLD.
{"title":"Genetics of Metabolic Dysfunction-associated Steatotic Liver Disease: The State of Art Update.","authors":"Silvia Sookoian, Yaron Rotman, Luca Valenti","doi":"10.1016/j.cgh.2024.05.052","DOIUrl":"10.1016/j.cgh.2024.05.052","url":null,"abstract":"<p><p>Recent advances in the genetics of metabolic dysfunction-associated steatotic liver disease (MASLD) are gradually revealing the mechanisms underlying the heterogeneity of the disease and have shown promising results in patient stratification. Genetic characterization of the disease has been rapidly developed using genome-wide association studies, exome-wide association studies, phenome-wide association studies, and whole exome sequencing. These advances have been powered by the increase in computational power, the development of new analytical algorithms, including some based on artificial intelligence, and the recruitment of large and well-phenotyped cohorts. This review presents an update on genetic studies that emphasize new biological insights from next-generation sequencing approaches. Additionally, we discuss innovative methods for discovering new genetic loci for MASLD, including rare variants. To comprehensively manage MASLD, it is important to stratify risks. Therefore, we present an update on phenome-wide association study associations, including extreme phenotypes. Additionally, we discuss whether polygenic risk scores and targeted sequencing are ready for clinical use. With particular focus on precision medicine, we introduce concepts such as the interplay between genetics and the environment in modulating genetic risk with lifestyle or standard therapies. A special chapter is dedicated to gene-based therapeutics. The limitations of approved pharmacological approaches are discussed, and the potential of gene-related mechanisms in therapeutic development is reviewed, including the decision to perform genetic testing in patients with MASLD.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1016/j.cgh.2024.07.012
Marvin Chinitz
{"title":"Proton Pump Inhibitors Are Recommended for Patients on Dual Antiplatelet Agents and Also for Patients on Anticoagulant Plus Aspirin.","authors":"Marvin Chinitz","doi":"10.1016/j.cgh.2024.07.012","DOIUrl":"10.1016/j.cgh.2024.07.012","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1016/j.cgh.2024.07.014
Grace E Kim, Uzma D Siddiqui
{"title":"Double Wire Cannulation and Mechanical Lithotripsy in Billroth II With Therapeutic Gastroscope.","authors":"Grace E Kim, Uzma D Siddiqui","doi":"10.1016/j.cgh.2024.07.014","DOIUrl":"10.1016/j.cgh.2024.07.014","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1016/j.cgh.2024.07.017
Julia L Gauci, Anthony Whitfield, Renato Medas, Clarence Kerrison, Francesco Vito Mandarino, David Gibson, Timothy O'Sullivan, Oliver Cronin, Sunil Gupta, Brian Lam, Varan Perananthan, Luke Hourigan, Simon Zanati, Rajvinder Singh, Spiro Raftopoulos, Alan Moss, Gregor Brown, Amir Klein, Lobke Desomer, David J Tate, Steven J Williams, Eric Y Lee, Nicholas Burgess, Michael J Bourke
Background and aims: Endoscopic submucosal dissection is increasingly promoted for the treatment of all large nonpedunculated colorectal polyps (LNPCPs) to cure potential low-risk cancers (superficial submucosal invasion without additional high-risk histopathologic features). The effect of a universal en bloc strategy on oncologic outcomes for the treatment of LNPCPs in the right colon is unknown. We evaluated this in a large Western population.
Methods: A prospective cohort of patients referred for endoscopic resection (ER) of LNPCPs was analyzed. Patients found to have cancer after ER and those referred directly to surgery were included. The primary outcome was to determine the proportion of right colon LNPCPs with low-risk cancer.
Results: Over 180 months until June 2023, 3294 sporadic right colon LNPCPs in 2956 patients were referred for ER at 7 sites (median size 30 [interquartile range 15] mm). A total of 63 (2.1%) patients were referred directly to surgery, and cancer was proven in 56 (88.9%). A total of 2851 (96.4%) of 2956 LNPCPs underwent ER (median size 35 [interquartile range 20] mm), of which 75 (2.6%) were cancers. The overall prevalence of cancer in the right colon was 4.4% (n = 131 of 2956). Detailed histopathologic analysis was possible in 115 (88%) of 131 cancers (71 after ER, 44 direct to surgery). After excluding missing histopathologic data, 23 (0.78%) of 2940 sporadic right colon LNPCPs were low-risk cancers.
Conclusions: The proportion of right colon LNPCPs referred for ER containing low-risk cancer amenable to endoscopic cure was <1%, in a large, multicenter Western cohort. A universal endoscopic submucosal dissection strategy for the management of right colon LNPCPs is unlikely to yield improved patient outcomes given the minimal impact on oncologic outcomes.
{"title":"Prevalence of Endoscopically Curable Low-Risk Cancer Among Large (≥20 mm) Nonpedunculated Polyps in the Right Colon.","authors":"Julia L Gauci, Anthony Whitfield, Renato Medas, Clarence Kerrison, Francesco Vito Mandarino, David Gibson, Timothy O'Sullivan, Oliver Cronin, Sunil Gupta, Brian Lam, Varan Perananthan, Luke Hourigan, Simon Zanati, Rajvinder Singh, Spiro Raftopoulos, Alan Moss, Gregor Brown, Amir Klein, Lobke Desomer, David J Tate, Steven J Williams, Eric Y Lee, Nicholas Burgess, Michael J Bourke","doi":"10.1016/j.cgh.2024.07.017","DOIUrl":"10.1016/j.cgh.2024.07.017","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic submucosal dissection is increasingly promoted for the treatment of all large nonpedunculated colorectal polyps (LNPCPs) to cure potential low-risk cancers (superficial submucosal invasion without additional high-risk histopathologic features). The effect of a universal en bloc strategy on oncologic outcomes for the treatment of LNPCPs in the right colon is unknown. We evaluated this in a large Western population.</p><p><strong>Methods: </strong>A prospective cohort of patients referred for endoscopic resection (ER) of LNPCPs was analyzed. Patients found to have cancer after ER and those referred directly to surgery were included. The primary outcome was to determine the proportion of right colon LNPCPs with low-risk cancer.</p><p><strong>Results: </strong>Over 180 months until June 2023, 3294 sporadic right colon LNPCPs in 2956 patients were referred for ER at 7 sites (median size 30 [interquartile range 15] mm). A total of 63 (2.1%) patients were referred directly to surgery, and cancer was proven in 56 (88.9%). A total of 2851 (96.4%) of 2956 LNPCPs underwent ER (median size 35 [interquartile range 20] mm), of which 75 (2.6%) were cancers. The overall prevalence of cancer in the right colon was 4.4% (n = 131 of 2956). Detailed histopathologic analysis was possible in 115 (88%) of 131 cancers (71 after ER, 44 direct to surgery). After excluding missing histopathologic data, 23 (0.78%) of 2940 sporadic right colon LNPCPs were low-risk cancers.</p><p><strong>Conclusions: </strong>The proportion of right colon LNPCPs referred for ER containing low-risk cancer amenable to endoscopic cure was <1%, in a large, multicenter Western cohort. A universal endoscopic submucosal dissection strategy for the management of right colon LNPCPs is unlikely to yield improved patient outcomes given the minimal impact on oncologic outcomes.</p><p><strong>Clinicaltrials: </strong>gov, Numbers: NCT01368289, NCT02000141.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1016/j.cgh.2024.07.009
Gustav Jakobsson, Mats Talbäck, Niklas Hammar, Ying Shang, Hannes Hagström
Background and aims: The study sought to examine which biomarkers have the best predictive capabilities for future alcohol-related liver cirrhosis (ARLC) in a general population setting.
Method: This population-based cohort study includes approximately 35% of the inhabitants of Stockholm County who had left a blood sample at an outpatient visit in primary care or occupational health screening from 1985 to 1996. All subjects with a blood sample measurement of alanine aminotransferase and aspartate aminotransferase (AST) were included, exclusions were made for persons with known liver disease. We ascertained incident ARLC by linkage to Swedish national health registers between to the end of 2011. Associations between biomarkers and incident ARLC were analyzed with Cox regression models and discrimination was assessed using C-statistics.
Results: In all, 537,230 adult subjects were included. The mean age was 45 years and 53% were men. During a mean follow-up of 19.0 years, 2725 (0.51%) subjects developed ARLC. The biomarkers with the highest discrimination (C-index) for incident ARLC at 5 years were: AST (0.89), mean corpuscular volume (0.88), and γ-glutamyltransferase (0.81). Scoring systems including Fibrosis-4 (0.86) and the AST/alanine aminotransferase ratio (0.81) performed similarly well. The negative predictive value for ARLC was generally high (∼99.6%) across biomarkers, using routine clinical cutoffs to identify pathological values. However, positive predictive values were generally low (0.6%-15.9%).
Conclusions: Biomarkers commonly used in primary care settings are highly associated with incident ARLC in the general population. Elevation of these commonly available biomarkers should prompt consideration of further investigation of a possible high level of alcohol consumption.
{"title":"Biomarkers for Prediction of Alcohol-Related Liver Cirrhosis: A General Population-Based Swedish Study of 537,250 Individuals.","authors":"Gustav Jakobsson, Mats Talbäck, Niklas Hammar, Ying Shang, Hannes Hagström","doi":"10.1016/j.cgh.2024.07.009","DOIUrl":"10.1016/j.cgh.2024.07.009","url":null,"abstract":"<p><strong>Background and aims: </strong>The study sought to examine which biomarkers have the best predictive capabilities for future alcohol-related liver cirrhosis (ARLC) in a general population setting.</p><p><strong>Method: </strong>This population-based cohort study includes approximately 35% of the inhabitants of Stockholm County who had left a blood sample at an outpatient visit in primary care or occupational health screening from 1985 to 1996. All subjects with a blood sample measurement of alanine aminotransferase and aspartate aminotransferase (AST) were included, exclusions were made for persons with known liver disease. We ascertained incident ARLC by linkage to Swedish national health registers between to the end of 2011. Associations between biomarkers and incident ARLC were analyzed with Cox regression models and discrimination was assessed using C-statistics.</p><p><strong>Results: </strong>In all, 537,230 adult subjects were included. The mean age was 45 years and 53% were men. During a mean follow-up of 19.0 years, 2725 (0.51%) subjects developed ARLC. The biomarkers with the highest discrimination (C-index) for incident ARLC at 5 years were: AST (0.89), mean corpuscular volume (0.88), and γ-glutamyltransferase (0.81). Scoring systems including Fibrosis-4 (0.86) and the AST/alanine aminotransferase ratio (0.81) performed similarly well. The negative predictive value for ARLC was generally high (∼99.6%) across biomarkers, using routine clinical cutoffs to identify pathological values. However, positive predictive values were generally low (0.6%-15.9%).</p><p><strong>Conclusions: </strong>Biomarkers commonly used in primary care settings are highly associated with incident ARLC in the general population. Elevation of these commonly available biomarkers should prompt consideration of further investigation of a possible high level of alcohol consumption.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1016/j.cgh.2024.07.010
Fernando Magro, Laurent Peyrin-Biroulet, Bruce E Sands, Silvio Danese, Vipul Jairath, Martina Goetsch, Abhishek Bhattacharjee, Joseph Wu, Diogo Branquinho, Irene Modesto, Brian G Feagan
Background & aims: Histologic remission, a potentially important treatment target in ulcerative colitis (UC), is associated with favorable long-term outcomes. Etrasimod is an oral, once-daily, selective sphingosine 1-phosphate (S1P)1,4,5 receptor modulator for the treatment of moderately to severely active UC. This post-hoc analysis of the ELEVATE UC program evaluated the efficacy of etrasimod according to histologic and composite (histologic/endoscopic/symptomatic) endpoints and examined their prognostic value.
Methods: Patients with moderately to severely active UC were randomized 2:1 to once-daily oral etrasimod 2 mg or placebo. Histologic and composite endpoints, including disease clearance (endoscopic/histologic/symptomatic remission), were assessed at Weeks 12 (ELEVATE UC 52; ELEVATE UC 12) and 52 (ELEVATE UC 52). Logistic regressions examined associations between baseline and Week 12 histologic/composite endpoints and Week 52 outcomes.
Results: At Weeks 12 and 52, significant improvements with etrasimod vs placebo were observed in histologic/composite outcomes, including endoscopic improvement-histologic remission and disease clearance. The proportion of patients treated with etrasimod achieving clinical remission at Week 52 was higher among those with disease clearance at Week 12 vs those without disease clearance (73.9% [17/23] vs 28.3% [71/251]). Histologic improvement and endoscopic improvement at Week 12 were moderately and strongly associated with clinical remission at Week 52 (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.27-4.41; and OR, 6.36; 95% CI, 3.47-11.64, respectively). Histologic remission and endoscopic improvement at Week 12 were strongly associated with endoscopic improvement-histologic remission at Week 52 (OR, 3.21; 95% CI, 1.70-6.06 and OR, 5.47; 95% CI, 2.89-10.36, respectively).
Conclusions: Etrasimod was superior to placebo for achievement of stringent histologic and composite endpoints.
{"title":"Endoscopic, Histologic, and Composite Endpoints in Patients With Ulcerative Colitis Treated With Etrasimod.","authors":"Fernando Magro, Laurent Peyrin-Biroulet, Bruce E Sands, Silvio Danese, Vipul Jairath, Martina Goetsch, Abhishek Bhattacharjee, Joseph Wu, Diogo Branquinho, Irene Modesto, Brian G Feagan","doi":"10.1016/j.cgh.2024.07.010","DOIUrl":"10.1016/j.cgh.2024.07.010","url":null,"abstract":"<p><strong>Background & aims: </strong>Histologic remission, a potentially important treatment target in ulcerative colitis (UC), is associated with favorable long-term outcomes. Etrasimod is an oral, once-daily, selective sphingosine 1-phosphate (S1P)<sub>1,4,5</sub> receptor modulator for the treatment of moderately to severely active UC. This post-hoc analysis of the ELEVATE UC program evaluated the efficacy of etrasimod according to histologic and composite (histologic/endoscopic/symptomatic) endpoints and examined their prognostic value.</p><p><strong>Methods: </strong>Patients with moderately to severely active UC were randomized 2:1 to once-daily oral etrasimod 2 mg or placebo. Histologic and composite endpoints, including disease clearance (endoscopic/histologic/symptomatic remission), were assessed at Weeks 12 (ELEVATE UC 52; ELEVATE UC 12) and 52 (ELEVATE UC 52). Logistic regressions examined associations between baseline and Week 12 histologic/composite endpoints and Week 52 outcomes.</p><p><strong>Results: </strong>At Weeks 12 and 52, significant improvements with etrasimod vs placebo were observed in histologic/composite outcomes, including endoscopic improvement-histologic remission and disease clearance. The proportion of patients treated with etrasimod achieving clinical remission at Week 52 was higher among those with disease clearance at Week 12 vs those without disease clearance (73.9% [17/23] vs 28.3% [71/251]). Histologic improvement and endoscopic improvement at Week 12 were moderately and strongly associated with clinical remission at Week 52 (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.27-4.41; and OR, 6.36; 95% CI, 3.47-11.64, respectively). Histologic remission and endoscopic improvement at Week 12 were strongly associated with endoscopic improvement-histologic remission at Week 52 (OR, 3.21; 95% CI, 1.70-6.06 and OR, 5.47; 95% CI, 2.89-10.36, respectively).</p><p><strong>Conclusions: </strong>Etrasimod was superior to placebo for achievement of stringent histologic and composite endpoints.</p><p><strong>Clinicaltrials: </strong>gov, Number: NCT03945188; ClinicalTrials.gov, Number: NCT03996369.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1016/j.cgh.2024.06.046
Sachin Wani, Jingwen Zhang, Lydia D Foster, Valerie Durkalski-Mauldin, B Joseph Elmunzer
{"title":"Trainee Participation and Outcomes in High-risk Endoscopic Retrograde Cholangiopancreatography: A Secondary Analysis of the Stent Versus Indomethacin Trial.","authors":"Sachin Wani, Jingwen Zhang, Lydia D Foster, Valerie Durkalski-Mauldin, B Joseph Elmunzer","doi":"10.1016/j.cgh.2024.06.046","DOIUrl":"10.1016/j.cgh.2024.06.046","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1016/j.cgh.2024.07.008
Neehar D Parikh, Patricia Jones, Reena Salgia, Irun Bhan, Lauren T Grinspan, Janice H Jou, Kali Zhou, Prasun Jalal, Giorgio Roccaro, Amol S Rangnekar, Jihane N Benhammou, Anjana Pillai, Neil Mehta, Joel Wedd, Ju Dong Yang, Amy K Kim, Andres Duarte-Rojo, Omobonike O Oloruntoba, Amit Tevar, Jennifer S Au, Yamile Blain, Sanjana Rao, Onofrio A Catalano, Sara Lewis, Mishal Mendiratta-Lala, Kevin King, Lekha Sachdev, Edward W Lee, Jill Bruno, Ihab Kamel, Celestina Tolosa, Karissa Kao, Tarek Badawi, Eric M Przybyszewski, Lisa Quirk, Piyush Nathani, Brandy Haydel, Emily Leven, Nicole Wong, Robert Albertian, Ariana Chen, Fuad Z Aloor, Islam B Mohamed, Ahmed Elkheshen, Charles Marvil, Gerard Issac, Joseph W Clinton, Stephanie M Woo, Jung Yum, Erin Rieger, Alan L Hutchison, Don A Turner, Manaf Alsudaney, Perla Hernandez, Ziyi Xu, Abdullah Khalid, Bethany Barrick, Bo Wang, Elliot B Tapper, Wei Hao, Amit G Singal
Background & aims: Noninvasive variceal risk stratification systems have not been validated in patients with hepatocellular carcinoma (HCC), which presents logistical barriers for patients in the setting of systemic HCC therapy. We aimed to develop and validate a noninvasive algorithm for the prediction of varices in patients with unresectable HCC.
Methods: We performed a retrospective cohort study in 21 centers in the United States including adult patients with unresectable HCC and Child-Pugh A5-B7 cirrhosis diagnosed between 2007 and 2019. We included patients who completed an esophagogastroduodonoscopy (EGD) within 12 months of index imaging but before HCC treatment. We divided the cohort into a 70:30 training set and validation set, with the goal of maximizing negative predictive value (NPV) to avoid EGD in low-risk patients.
Results: We included 707 patients (median age, 64.6 years; 80.6% male; 74.0% White). Median time from HCC diagnosis to EGD was 47 (interquartile range, 114) days, with 25.0% of patients having high-risk varices. A model using clinical variables alone achieved an NPV of 86.3% in the validation cohort, whereas a model integrating clinical and imaging variables had an NPV 97.4% in validation. The clinical and imaging model would avoid EGDs in more than half of low-risk patients while misclassifying 7.7% of high-risk patients.
Conclusions: A model incorporating clinical and imaging data can accurately predict the absence of high-risk varices in patients with HCC and avoid EGD in many low-risk patients before the initiation of systemic therapy, thus expediting their care and avoiding treatment delays.
{"title":"Development and Validation of a Noninvasive Model for the Detection of High-Risk Varices in Patients with Unresectable HCC.","authors":"Neehar D Parikh, Patricia Jones, Reena Salgia, Irun Bhan, Lauren T Grinspan, Janice H Jou, Kali Zhou, Prasun Jalal, Giorgio Roccaro, Amol S Rangnekar, Jihane N Benhammou, Anjana Pillai, Neil Mehta, Joel Wedd, Ju Dong Yang, Amy K Kim, Andres Duarte-Rojo, Omobonike O Oloruntoba, Amit Tevar, Jennifer S Au, Yamile Blain, Sanjana Rao, Onofrio A Catalano, Sara Lewis, Mishal Mendiratta-Lala, Kevin King, Lekha Sachdev, Edward W Lee, Jill Bruno, Ihab Kamel, Celestina Tolosa, Karissa Kao, Tarek Badawi, Eric M Przybyszewski, Lisa Quirk, Piyush Nathani, Brandy Haydel, Emily Leven, Nicole Wong, Robert Albertian, Ariana Chen, Fuad Z Aloor, Islam B Mohamed, Ahmed Elkheshen, Charles Marvil, Gerard Issac, Joseph W Clinton, Stephanie M Woo, Jung Yum, Erin Rieger, Alan L Hutchison, Don A Turner, Manaf Alsudaney, Perla Hernandez, Ziyi Xu, Abdullah Khalid, Bethany Barrick, Bo Wang, Elliot B Tapper, Wei Hao, Amit G Singal","doi":"10.1016/j.cgh.2024.07.008","DOIUrl":"10.1016/j.cgh.2024.07.008","url":null,"abstract":"<p><strong>Background & aims: </strong>Noninvasive variceal risk stratification systems have not been validated in patients with hepatocellular carcinoma (HCC), which presents logistical barriers for patients in the setting of systemic HCC therapy. We aimed to develop and validate a noninvasive algorithm for the prediction of varices in patients with unresectable HCC.</p><p><strong>Methods: </strong>We performed a retrospective cohort study in 21 centers in the United States including adult patients with unresectable HCC and Child-Pugh A5-B7 cirrhosis diagnosed between 2007 and 2019. We included patients who completed an esophagogastroduodonoscopy (EGD) within 12 months of index imaging but before HCC treatment. We divided the cohort into a 70:30 training set and validation set, with the goal of maximizing negative predictive value (NPV) to avoid EGD in low-risk patients.</p><p><strong>Results: </strong>We included 707 patients (median age, 64.6 years; 80.6% male; 74.0% White). Median time from HCC diagnosis to EGD was 47 (interquartile range, 114) days, with 25.0% of patients having high-risk varices. A model using clinical variables alone achieved an NPV of 86.3% in the validation cohort, whereas a model integrating clinical and imaging variables had an NPV 97.4% in validation. The clinical and imaging model would avoid EGDs in more than half of low-risk patients while misclassifying 7.7% of high-risk patients.</p><p><strong>Conclusions: </strong>A model incorporating clinical and imaging data can accurately predict the absence of high-risk varices in patients with HCC and avoid EGD in many low-risk patients before the initiation of systemic therapy, thus expediting their care and avoiding treatment delays.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1016/j.cgh.2024.07.005
Shanghao Liu, Xuanwei Jiang, Junliang Fu, Vincent Wai-Sun Wong, Victor W Zhong, Xiaolong Qi
{"title":"Baseline and Dynamic MAF-5 Score to Predict Liver Fibrosis and Liver-Related Events in General Population With MASLD.","authors":"Shanghao Liu, Xuanwei Jiang, Junliang Fu, Vincent Wai-Sun Wong, Victor W Zhong, Xiaolong Qi","doi":"10.1016/j.cgh.2024.07.005","DOIUrl":"10.1016/j.cgh.2024.07.005","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}