Pub Date : 2024-08-12DOI: 10.1016/j.cgh.2024.07.021
Antonio Facciorusso, Daryl Ramai, Jahnvi Dhar, Jayanta Samanta, Saurabh Chandan, Paraskevas Gkolfakis, Stefano Francesco Crinò, Marcello Maida, Andrea Anderloni, Ivo Boskoski, Konstantinos Triantafyllou, Mario Dinis-Ribeiro, Cesare Hassan, Lorenzo Fuccio, Marianna Arvanitakis
Background and aims: Limited evidence exists regarding the impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on upper endoscopy. Therefore, a meta-analysis was conducted to comprehensively review the available evidence on this subject.
Methods: A systematic bibliographic search was carried out until May 2024. Pooled estimates were analyzed using a random-effects model, with results presented as odds ratio (OR) and 95% confidence interval (CI). The primary outcome assessed was the rate of retained gastric content (RGC), while secondary outcomes included rates of aborted and repeated procedures, adverse event rate, and rates of aspiration.
Results: This analysis included 13 studies involving a total of 84,065 patients. Patients receiving GLP-1RA therapy exhibited significantly higher rates of RGC (OR, 5.56; 95% CI, 3.35 to 9.23), a trend that was consistent among patients with diabetes (OR, 2.60; 95% CI, 2.23 to 3.02). Adjusted analysis, accounting for variables such as sex, age, body mass index, diabetes, and other therapies, confirmed the elevated rates of RGC in the GLP-1RA user group (adjusted OR, 4.20; 95% CI, 3.42 to 5.15). Furthermore, rates of aborted and repeated procedures were higher in the GLP-1RA user group (OR, 5.13; 95% CI, 3.01 to 8.75; and OR, 2.19; 95% CI, 1.43 to 3.35; respectively). However, no significant differences were found in AE and aspiration rates between the 2 groups (OR, 4.04; 95% CI, 0.63 to 26.03; and OR, 1.75; 95% CI, 0.64 to 4.77; respectively).
Conclusion: Use of GLP-1RAs is associated with increased retention of gastric contents and more frequent aborted procedures during upper endoscopy. However, the adverse event and aspiration rates do not seem different; therefore, adjusting fasting time instead of routinely withholding GLP-1RAs could be reasonable in these patients.
{"title":"Effects of Glucagon-Like Peptide-1 Receptor Agonists on Upper Gastrointestinal Endoscopy: A Meta-Analysis.","authors":"Antonio Facciorusso, Daryl Ramai, Jahnvi Dhar, Jayanta Samanta, Saurabh Chandan, Paraskevas Gkolfakis, Stefano Francesco Crinò, Marcello Maida, Andrea Anderloni, Ivo Boskoski, Konstantinos Triantafyllou, Mario Dinis-Ribeiro, Cesare Hassan, Lorenzo Fuccio, Marianna Arvanitakis","doi":"10.1016/j.cgh.2024.07.021","DOIUrl":"10.1016/j.cgh.2024.07.021","url":null,"abstract":"<p><strong>Background and aims: </strong>Limited evidence exists regarding the impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on upper endoscopy. Therefore, a meta-analysis was conducted to comprehensively review the available evidence on this subject.</p><p><strong>Methods: </strong>A systematic bibliographic search was carried out until May 2024. Pooled estimates were analyzed using a random-effects model, with results presented as odds ratio (OR) and 95% confidence interval (CI). The primary outcome assessed was the rate of retained gastric content (RGC), while secondary outcomes included rates of aborted and repeated procedures, adverse event rate, and rates of aspiration.</p><p><strong>Results: </strong>This analysis included 13 studies involving a total of 84,065 patients. Patients receiving GLP-1RA therapy exhibited significantly higher rates of RGC (OR, 5.56; 95% CI, 3.35 to 9.23), a trend that was consistent among patients with diabetes (OR, 2.60; 95% CI, 2.23 to 3.02). Adjusted analysis, accounting for variables such as sex, age, body mass index, diabetes, and other therapies, confirmed the elevated rates of RGC in the GLP-1RA user group (adjusted OR, 4.20; 95% CI, 3.42 to 5.15). Furthermore, rates of aborted and repeated procedures were higher in the GLP-1RA user group (OR, 5.13; 95% CI, 3.01 to 8.75; and OR, 2.19; 95% CI, 1.43 to 3.35; respectively). However, no significant differences were found in AE and aspiration rates between the 2 groups (OR, 4.04; 95% CI, 0.63 to 26.03; and OR, 1.75; 95% CI, 0.64 to 4.77; respectively).</p><p><strong>Conclusion: </strong>Use of GLP-1RAs is associated with increased retention of gastric contents and more frequent aborted procedures during upper endoscopy. However, the adverse event and aspiration rates do not seem different; therefore, adjusting fasting time instead of routinely withholding GLP-1RAs could be reasonable in these patients.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981792","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 : 2024-08-10DOI: 10.1016/j.cgh.2024.06.047
Luke N Hanna, Sulak Anandabaskaran, Nusrat Iqbal, Jeroen Geldof, Jean-Frédéric LeBlanc, Anders Dige, Lilli Lundby, Séverine Vermeire, André D'Hoore, Bram Verstockt, Gabriele Bislenghi, Danny De Looze, Triana Lobaton, Dirk Van de Putte, Antonino Spinelli, Michele Carvello, Silvio Danese, Christianne J Buskens, Krisztina Gecse, Roel Hompes, Marte Becker, Jarmila van der Bilt, Wilhelmus Bemelman, Shaji Sebastian, Gordan Moran, Amy L Lightner, Serre-Yu Wong, Jean-Frédéric Colombel, Benjamin L Cohen, Stefan Holubar, Nik S Ding, Cori Behrenbruch, Kapil Sahnan, Ravi Misra, Phillip Lung, Ailsa Hart, Phil Tozer
Background & aims: Perianal fistulation is a challenging phenotype of Crohn's disease, with significant impact on quality of life. Historically, fistulae have been classified anatomically in relation to the sphincter complex, and management guidelines have been generalized, with lack of attention to the clinical heterogenicity seen. The recent 'TOpClass classification system' for perianal fistulizing Crohn's disease (PFCD) addresses this issue, and classifies patients into defined groups, which provide a focus for fistula management that aligns with disease characteristics and patient goals. In this article, we discuss the clinical applicability of the TOpClass model and provide direction on its use in clinical practice.
Methods: An international group of perianal clinicians participated in an expert consensus to define how the TOpClass system can be incorporated into real-life practice. This included gastroenterologists, inflammatory bowel disease surgeons, and radiologists specialized in PFCD. The process was informed by the multi-disciplinary team management of 8 high-volume fistula centres in North America, Europe, and Australia.
Results: The process produced position statements to accompany the classification system and guide PFCD management. The statements range from the management of patients with quiescent perianal disease to those with severe PFCD requiring diverting-ostomy and/or proctectomy. The optimization of medical therapies, as well as the use of surgery, in fistula closure and symptom management is explored across each classification group.
Conclusion: This article provides an overview of the system's use in clinical practice. It aims to enable clinicians to have a pragmatic and patient goal-centered approach to medical and surgical management options for individual patients with PFCD.
{"title":"Perianal Fistulizing Crohn's Disease: Utilizing the TOpClass Classification in Clinical Practice to Provide Targeted Individualized Care.","authors":"Luke N Hanna, Sulak Anandabaskaran, Nusrat Iqbal, Jeroen Geldof, Jean-Frédéric LeBlanc, Anders Dige, Lilli Lundby, Séverine Vermeire, André D'Hoore, Bram Verstockt, Gabriele Bislenghi, Danny De Looze, Triana Lobaton, Dirk Van de Putte, Antonino Spinelli, Michele Carvello, Silvio Danese, Christianne J Buskens, Krisztina Gecse, Roel Hompes, Marte Becker, Jarmila van der Bilt, Wilhelmus Bemelman, Shaji Sebastian, Gordan Moran, Amy L Lightner, Serre-Yu Wong, Jean-Frédéric Colombel, Benjamin L Cohen, Stefan Holubar, Nik S Ding, Cori Behrenbruch, Kapil Sahnan, Ravi Misra, Phillip Lung, Ailsa Hart, Phil Tozer","doi":"10.1016/j.cgh.2024.06.047","DOIUrl":"10.1016/j.cgh.2024.06.047","url":null,"abstract":"<p><strong>Background & aims: </strong>Perianal fistulation is a challenging phenotype of Crohn's disease, with significant impact on quality of life. Historically, fistulae have been classified anatomically in relation to the sphincter complex, and management guidelines have been generalized, with lack of attention to the clinical heterogenicity seen. The recent 'TOpClass classification system' for perianal fistulizing Crohn's disease (PFCD) addresses this issue, and classifies patients into defined groups, which provide a focus for fistula management that aligns with disease characteristics and patient goals. In this article, we discuss the clinical applicability of the TOpClass model and provide direction on its use in clinical practice.</p><p><strong>Methods: </strong>An international group of perianal clinicians participated in an expert consensus to define how the TOpClass system can be incorporated into real-life practice. This included gastroenterologists, inflammatory bowel disease surgeons, and radiologists specialized in PFCD. The process was informed by the multi-disciplinary team management of 8 high-volume fistula centres in North America, Europe, and Australia.</p><p><strong>Results: </strong>The process produced position statements to accompany the classification system and guide PFCD management. The statements range from the management of patients with quiescent perianal disease to those with severe PFCD requiring diverting-ostomy and/or proctectomy. The optimization of medical therapies, as well as the use of surgery, in fistula closure and symptom management is explored across each classification group.</p><p><strong>Conclusion: </strong>This article provides an overview of the system's use in clinical practice. It aims to enable clinicians to have a pragmatic and patient goal-centered approach to medical and surgical management options for individual patients with PFCD.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970784","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 : 2024-08-06DOI: 10.1016/j.cgh.2024.05.050
Tasnim Ahmed, Loren G Rabinowitz, Adam Rodman, Tyler M Berzin
{"title":"Generative Artificial Intelligence Tools in Gastroenterology Training.","authors":"Tasnim Ahmed, Loren G Rabinowitz, Adam Rodman, Tyler M Berzin","doi":"10.1016/j.cgh.2024.05.050","DOIUrl":"10.1016/j.cgh.2024.05.050","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912051","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 : 2024-08-01DOI: 10.1016/j.cgh.2023.11.015
{"title":"Fecal Calprotectin Profiles in Crohn's Disease: A Longitudinal Data Analysis","authors":"","doi":"10.1016/j.cgh.2023.11.015","DOIUrl":"10.1016/j.cgh.2023.11.015","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138456067","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 : 2024-08-01DOI: 10.1016/j.cgh.2023.12.021
{"title":"Ambulatory Endoscopic Submucosal Dissection for Gastrointestinal Neoplasms: Trends and Associated Factors in the United States","authors":"","doi":"10.1016/j.cgh.2023.12.021","DOIUrl":"10.1016/j.cgh.2023.12.021","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139101647","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 : 2024-08-01DOI: 10.1016/j.cgh.2024.02.009
Background & Aims
We assessed Modified Multiplier Simple Endoscopic Score for Crohn’s Disease (MM-SES-CD) and Simple Endoscopic Score for Crohn’s Disease (SES-CD) thresholds that are best associated with low likelihood of long-term disease progression.
Methods
Data from 61 patients with early Crohn’s disease (CD) who participated in the CALM long-term extension study were used as the derivation cohort and validated using the McMaster inflammatory bowel disease database (n = 99). The primary outcome was disease progression (new internal fistula/abscess, stricture, perianal fistula or abscess, CD-related hospitalization or surgery) since the end of the CALM trial. Optimal MM-SES-CD and SES-CD thresholds were determined using the maximum Youden index. Receiver operating characteristic curve analyses compared threshold scores of remission definitions on disease progression.
Results
In the derivation cohort, based on the maximum Youden index, the optimal thresholds associated with a low likelihood of disease progression were MM-SES-CD <22.5 and SES-CD <4. A significantly greater proportion of patients with a MM-SES-CD ≥22.5 had disease progression as compared with patients in the derivation cohort with MM-SES-CD <22.5 (10/17 [58.8%] vs 3/44 [6.8%]; P < .001). Similarly, a significantly greater number of patients with SES-CD ≥ 4 had disease progression compared with those with a SES-CD <4 (11/25 [44.0%] vs 2/36 [5.6%]; P < .001). Compared with other clinical or endoscopic remission definitions, which demonstrated poor to fair accuracy, MM-SES-CD <22.5 performed the best for predicting disease progression (area under the curve = 0.81; 95% confidence interval, 0.68-0.94; P < .001). These thresholds were confirmed in the validation cohort.
Conclusion
Achievement of MM-SES-CD <22.5 or SES-CD <4 in patients with ileocolonic or colonic CD is associated with low risk of disease progression and may be suitable targets in clinical trials and practice for endoscopic healing.
我们评估了克罗恩病改良乘法简易内镜评分(MM-SES-CD)和与疾病长期进展可能性低最相关的 SES-CD 阈值。61名早期克罗恩病患者参加了CALM长期扩展研究,他们的数据被用作衍生队列,并通过麦克马斯特IBD数据库(n=99)进行了验证。主要结果是CALM试验结束后的疾病进展(新的内瘘/脓肿、狭窄、肛周瘘或脓肿、CD相关住院或手术)。最佳 MM-SES-CD 和 SES-CD 阈值使用最大尤登指数确定。接收者操作特征曲线分析比较了疾病进展的缓解定义阈值评分。在衍生队列中,根据最大尤登指数,与疾病进展可能性低相关的最佳阈值为 MM-SES-CD <22.5和 SES-CD <4。与衍生队列中MM-SES-CD<22.5的患者相比,MM-SES-CD≥22.5的患者出现疾病进展的比例明显更高[10/17(58.8%) vs. 3/44(6.8%),p<0.001]。同样,与SES-CD<4的患者相比,SES-CD≥4的患者中出现疾病进展的人数明显增多[11/25(44.0%) vs. 2/36(5.6%),p<0.001]。其他临床或内窥镜缓解定义的准确性从较差到一般不等,相比之下,MM-SES-CD <22.5在预测疾病进展方面表现最佳[AUC:0.81 (95%CI:0.68-0.94),p<0.001]。这些阈值在验证队列中得到了证实。回结肠或结肠 CD 患者的 MM-SES-CD <22.5 或 SES-CD <4 与疾病进展的低风险相关,可能是临床试验和实践中内镜愈合的合适目标。
{"title":"Defining Endoscopic Remission in Crohn’s Disease: MM-SES-CD and SES-CD Thresholds Associated With Low Risk of Disease Progression","authors":"","doi":"10.1016/j.cgh.2024.02.009","DOIUrl":"10.1016/j.cgh.2024.02.009","url":null,"abstract":"<div><h3>Background & Aims</h3><p>We assessed Modified Multiplier Simple Endoscopic Score for Crohn’s Disease (MM-SES-CD) and Simple Endoscopic Score for Crohn’s Disease (SES-CD) thresholds that are best associated with low likelihood of long-term disease progression.</p></div><div><h3>Methods</h3><p>Data from 61 patients with early Crohn’s disease (CD) who participated in the CALM long-term extension study were used as the derivation cohort and validated using the McMaster inflammatory bowel disease database (n = 99). The primary outcome was disease progression (new internal fistula/abscess, stricture, perianal fistula or abscess, CD-related hospitalization or surgery) since the end of the CALM trial. Optimal MM-SES-CD and SES-CD thresholds were determined using the maximum Youden index. Receiver operating characteristic curve analyses compared threshold scores of remission definitions on disease progression.</p></div><div><h3>Results</h3><p>In the derivation cohort, based on the maximum Youden index, the optimal thresholds associated with a low likelihood of disease progression were MM-SES-CD <22.5 and SES-CD <4. A significantly greater proportion of patients with a MM-SES-CD ≥22.5 had disease progression as compared with patients in the derivation cohort with MM-SES-CD <22.5 (10/17 [58.8%] vs 3/44 [6.8%]; <em>P</em> < .001). Similarly, a significantly greater number of patients with SES-CD ≥ 4 had disease progression compared with those with a SES-CD <4 (11/25 [44.0%] vs 2/36 [5.6%]; <em>P</em> < .001). Compared with other clinical or endoscopic remission definitions, which demonstrated poor to fair accuracy, MM-SES-CD <22.5 performed the best for predicting disease progression (area under the curve = 0.81; 95% confidence interval, 0.68-0.94; <em>P</em> < .001). These thresholds were confirmed in the validation cohort.</p></div><div><h3>Conclusion</h3><p>Achievement of MM-SES-CD <22.5 or SES-CD <4 in patients with ileocolonic or colonic CD is associated with low risk of disease progression and may be suitable targets in clinical trials and practice for endoscopic healing.</p></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S154235652400212X/pdfft?md5=76e3fae763d76fe4ce26a78db90f0aab&pid=1-s2.0-S154235652400212X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139994408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.cgh.2023.12.016
{"title":"Liver-Related Events in NASH (MASH): From Subgroup Stratification to Individual Risk Prediction","authors":"","doi":"10.1016/j.cgh.2023.12.016","DOIUrl":"10.1016/j.cgh.2023.12.016","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139034630","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 : 2024-08-01DOI: 10.1016/j.cgh.2024.02.005
{"title":"Dysphagia and Regurgitated Mass","authors":"","doi":"10.1016/j.cgh.2024.02.005","DOIUrl":"10.1016/j.cgh.2024.02.005","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899440","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 : 2024-08-01DOI: 10.1016/j.cgh.2024.03.045
Background & Aims
The aim of this study was to determine whether liver fibrosis is associated with heart failure in a general population cohort, and if genetic polymorphisms (PNPLA3 rs738409; TM6SF2 rs58542926), linked to increased risk of liver fibrosis and decreased risk of coronary artery disease, modify this association.
Methods
Using UK Biobank data, we prospectively examined the relationship between noninvasive fibrosis markers (nonalcoholic fatty liver disease [NAFLD] fibrosis score [NFS], Fibrosis-4 [FIB-4] and aspartate transaminase [AST] to platelet ratio index [APRI]) and incident hospitalization/death from heart failure (n = 413,860). Cox-regression estimated hazard ratios (HRs) for incident heart failure. Effects of PNPLA3 and TM6SF2 on the association between liver fibrosis and heart failure were estimated by stratifying for genotype and testing for an interaction between genotype and liver fibrosis using a likelihood ratio test.
Results
A total of 12,527 incident cases of heart failure occurred over a median of 10.7 years. Liver fibrosis was associated with an increased risk of hospitalization or death from heart failure (multivariable adjusted high-risk NFS score HR, 1.59; 95% confidence interval [CI],1.47-1.76; P < .0001; FIB-4 HR, 1.69; 95% CI, 1.55-1.84; P < .0001; APRI HR, 1.85; 95% CI, 1.56-2.19; P < .0001; combined fibrosis scores HR, 1.90; 95% CI, 1.44-2.49; P < .0001). These associations persisted for people with metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with alcohol consumption (Met-ALD), and harmful alcohol consumption. PNPLA3 rs738409 GG and TM6SF2 rs58542926 TT did not attenuate the positive association between fibrosis markers and heart failure. For PNPLA3, a statistically significant interaction was found between PNPLA3 rs738409, FIB-4, APRI score, and heart failure.
Conclusion
In the general population, serum markers of liver fibrosis are associated with increased hospitalization/death from heart failure. Genetic polymorphisms associated with liver fibrosis were not positively associated with elevated heart failure risk.
{"title":"Liver Fibrosis Assessed Via Noninvasive Tests Is Associated With Incident Heart Failure in a General Population Cohort","authors":"","doi":"10.1016/j.cgh.2024.03.045","DOIUrl":"10.1016/j.cgh.2024.03.045","url":null,"abstract":"<div><h3>Background & Aims</h3><p>The aim of this study was to determine whether liver fibrosis is associated with heart failure in a general population cohort, and if genetic polymorphisms (<em>PNPLA3</em> rs738409; <em>TM6SF2</em> rs58542926), linked to increased risk of liver fibrosis and decreased risk of coronary artery disease, modify this association.</p></div><div><h3>Methods</h3><p>Using UK Biobank data, we prospectively examined the relationship between noninvasive fibrosis markers (nonalcoholic fatty liver disease [NAFLD] fibrosis score [NFS], Fibrosis-4 [FIB-4] and aspartate transaminase [AST] to platelet ratio index [APRI]) and incident hospitalization/death from heart failure (n = 413,860). Cox-regression estimated hazard ratios (HRs) for incident heart failure. Effects of <em>PNPLA3</em> and <em>TM6SF2</em> on the association between liver fibrosis and heart failure were estimated by stratifying for genotype and testing for an interaction between genotype and liver fibrosis using a likelihood ratio test.</p></div><div><h3>Results</h3><p>A total of 12,527 incident cases of heart failure occurred over a median of 10.7 years. Liver fibrosis was associated with an increased risk of hospitalization or death from heart failure (multivariable adjusted high-risk NFS score HR, 1.59; 95% confidence interval [CI],1.47-1.76; <em>P</em> < .0001; FIB-4 HR, 1.69; 95% CI, 1.55-1.84; <em>P</em> < .0001; APRI HR, 1.85; 95% CI, 1.56-2.19; <em>P</em> < .0001; combined fibrosis scores HR, 1.90; 95% CI, 1.44-2.49; <em>P</em> < .0001). These associations persisted for people with metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with alcohol consumption (Met-ALD), and harmful alcohol consumption. <em>PNPLA3</em> rs738409 GG and <em>TM6SF2</em> rs58542926 TT did not attenuate the positive association between fibrosis markers and heart failure. For <em>PNPLA3</em>, a statistically significant interaction was found between <em>PNPLA3</em> rs738409, FIB-4, APRI score, and heart failure.</p></div><div><h3>Conclusion</h3><p>In the general population, serum markers of liver fibrosis are associated with increased hospitalization/death from heart failure. Genetic polymorphisms associated with liver fibrosis were not positively associated with elevated heart failure risk.</p></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1542356524004087/pdfft?md5=c3dddbb8b931ef54079dccf30ebc591e&pid=1-s2.0-S1542356524004087-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.cgh.2023.11.026
{"title":"What the New Definition of MASLD Left Behind: Dual Etiology With Viral Hepatitis","authors":"","doi":"10.1016/j.cgh.2023.11.026","DOIUrl":"10.1016/j.cgh.2023.11.026","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138469274","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}