Pub Date : 2025-09-19DOI: 10.1016/j.clinre.2025.102689
Maria Pina Dore , Elettra Merola , Giovanni Mario Pes
Helicobacter pylori remains a major cause of gastritis. Rising antibiotic resistance worldwide has undermined traditional therapies, leading to the decline of standard clarithromycin-based triple therapy, necessitating new treatment strategies. In this review, we summarize advances in H. pylori pharmacotherapy, including the use of novel agents (e.g., the potassium-competitive acid blocker vonoprazan and rifabutin-containing regimens), optimized regimens (such as 10–14 day bismuth quadruple therapy), and adjunctive approaches (probiotics). We highlight region-specific challenges, such as developing countries with high H. pylori prevalence and limited resources, where eradication rates with standard therapies can be extremely low. We also discuss how personalized approaches, including antibiotic susceptibility testing, local resistance surveillance, and even artificial intelligence (AI)-driven decision tools, can guide regimen choice (triple vs. quadruple vs. salvage) to maximize success. Cost considerations are also addressed, noting that expensive treatments, may limit their use especially in low-resource settings. Finally, we outline future directions, such as integrating AI into clinical support systems and expanding access to diagnostics, to improve H. pylori management, patient adherence, maximize treatment efficacy, minimize antimicrobial misuse, and improve global eradication success rates.
{"title":"Advances and future perspectives in the pharmacological treatment of Helicobacter pylori infection: Taking advantage from artificial intelligence","authors":"Maria Pina Dore , Elettra Merola , Giovanni Mario Pes","doi":"10.1016/j.clinre.2025.102689","DOIUrl":"10.1016/j.clinre.2025.102689","url":null,"abstract":"<div><div><em>Helicobacter pylori</em> remains a major cause of gastritis. Rising antibiotic resistance worldwide has undermined traditional therapies, leading to the decline of standard clarithromycin-based triple therapy, necessitating new treatment strategies. In this review, we summarize advances in <em>H. pylori</em> pharmacotherapy, including the use of novel agents (e.g., the potassium-competitive acid blocker vonoprazan and rifabutin-containing regimens), optimized regimens (such as 10–14 day bismuth quadruple therapy), and adjunctive approaches (probiotics). We highlight region-specific challenges, such as developing countries with high <em>H. pylori</em> prevalence and limited resources, where eradication rates with standard therapies can be extremely low. We also discuss how personalized approaches, including antibiotic susceptibility testing, local resistance surveillance, and even artificial intelligence (AI)-driven decision tools, can guide regimen choice (triple vs. quadruple vs. salvage) to maximize success. Cost considerations are also addressed, noting that expensive treatments, may limit their use especially in low-resource settings. Finally, we outline future directions, such as integrating AI into clinical support systems and expanding access to diagnostics, to improve <em>H. pylori</em> management, patient adherence, maximize treatment efficacy, minimize antimicrobial misuse, and improve global eradication success rates.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102689"},"PeriodicalIF":2.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gut dysbiosis emerged as a potential metabolic dysfunction-associated steatotic liver disease (MASLD) trigger due to leaky gut and LPS leakage (endotoxemia). MASLD attracts attention from the scientific community due to the non-existence of a specific treatment, the intimate connection to obesity, and its multiple triggers. In this context, physical exercise is a relevant non-pharmacological strategy. However, different intensities and periodicities can produce divergent results, and their impact on the gut-liver axis remains unraveled. Therefore, this comprehensive review outlines the contribution of exercise (MICT or HIIT) to modulating the gut-liver axis in experimental obesity models, with a focus on the intestinal barrier and hepatic mitochondrial and endoplasmic reticulum (ER) homeostasis. The effects of both exercise protocols are likely related to restoring tight junctions and improving gut permeability. Ceased endotoxemia alleviates MASLD by targeting the endoplasmic reticulum (ER) and mitochondria, countering disturbances caused by glucolipotoxicity and inflammation, like ER stress and mitochondrial dyshomeostasis. Although HIIT is superior to MICT in enhancing gut structure and microbiota diversity and possibly mitigating MASLD due to reduced adiposity and improved insulin sensitivity, regular exercise should be encouraged to counter the obesity pandemic by modulating the gut-liver axis.
{"title":"Gut-liver axis: An emerging target for exercise in obesity management","authors":"Laura Alexia Ramos-da-Silva , Henrique Souza-Tavares , Gabriela Rodrigues Medeiros , Nathan Soares Dantas-Miranda , Gabrielle Lima-de-Figueiredo , Daiana Araujo Santana-Oliveira , Flavia Maria Silva-Veiga , Fabiane Ferreira Martins , Vanessa Souza-Mello","doi":"10.1016/j.clinre.2025.102687","DOIUrl":"10.1016/j.clinre.2025.102687","url":null,"abstract":"<div><div>Gut dysbiosis emerged as a potential metabolic dysfunction-associated steatotic liver disease (MASLD) trigger due to leaky gut and LPS leakage (endotoxemia). MASLD attracts attention from the scientific community due to the non-existence of a specific treatment, the intimate connection to obesity, and its multiple triggers. In this context, physical exercise is a relevant non-pharmacological strategy. However, different intensities and periodicities can produce divergent results, and their impact on the gut-liver axis remains unraveled. Therefore, this comprehensive review outlines the contribution of exercise (MICT or HIIT) to modulating the gut-liver axis in experimental obesity models, with a focus on the intestinal barrier and hepatic mitochondrial and endoplasmic reticulum (ER) homeostasis. The effects of both exercise protocols are likely related to restoring tight junctions and improving gut permeability. Ceased endotoxemia alleviates MASLD by targeting the endoplasmic reticulum (ER) and mitochondria, countering disturbances caused by glucolipotoxicity and inflammation, like ER stress and mitochondrial dyshomeostasis. Although HIIT is superior to MICT in enhancing gut structure and microbiota diversity and possibly mitigating MASLD due to reduced adiposity and improved insulin sensitivity, regular exercise should be encouraged to counter the obesity pandemic by modulating the gut-liver axis.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102687"},"PeriodicalIF":2.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-09DOI: 10.1016/j.clinre.2025.102685
Syed Muhammad Mehdi Zaidi , Qunoot Irfan , Rahmah Javed , Zulekha Khalid , Hamna Khan , Muhammad Hasan Ashraf , Mustafa Hassan Alvi , Faiq Wahid , Sana Zehra , Zainab Abbas
Introduction
Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) is prevalent amongst children and adolescents. Despite higher incidence, effective treatment options for this population are controversial. This Meta-analysis aims to evaluate the effects of all non-invasive treatment modalities available for MASLD.
Methods
This study includes PubMed, Cochrane Library, and Embase searches (January 2010 to July 2025) for Randomised Controlled Trials (RCTs), evaluating different treatment modalities of MASLD in pediatrics and adolescent population. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Primary outcomes were Aspartate Aminotransferase (AST), Triglycerides (TGs) and Low-Density Lipoproteins (LDL). Secondary outcomes were Alanine Aminotransferase (ALT), Gamma-Glutamyl Transferase (GGT), High-Density Lipoprotein (HDL) and adverse effects. Data were analyzed using Revman 5.3. Continuous values were pooled using the standard mean difference (SMD). Sensitivity analysis was performed to reduce heterogeneity. This study was registered with PROSPERO, CRD42024596682.
Results
We included 31 RCTs, having 1722 participants. Multiple treatment modalities were identified and categorized into dietary intervention, supplementation, drug intervention and exercise. We further categorized dietary intervention into low-sugar diet, low-fat diet and mediterranean diet and compared against different controls. The low-sugar diet showed significant improvement in TG levels against placebo/usual diet [-2.44,95 %CI:3.61,-1.27] and in AST levels against low-fat diet [-1.02, 95 %CI –1.88, -0.16]. LDL levels showed significant change when probiotics were administered against placebo [-0.33, 95 % CI:0.65,0.00].
Conclusion
Supplements and Dietary intervention have shown improvement in liver enzymes and lipid profile. However, more research is required to evaluate the dosage and adverse effects associated with these interventions.
{"title":"Treatment modalities for metabolic dysfunction-associated steatotic liver disease (MASLD) in children and adolescent: A systematic review and meta-analysis of randomized controlled trials","authors":"Syed Muhammad Mehdi Zaidi , Qunoot Irfan , Rahmah Javed , Zulekha Khalid , Hamna Khan , Muhammad Hasan Ashraf , Mustafa Hassan Alvi , Faiq Wahid , Sana Zehra , Zainab Abbas","doi":"10.1016/j.clinre.2025.102685","DOIUrl":"10.1016/j.clinre.2025.102685","url":null,"abstract":"<div><h3>Introduction</h3><div>Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) is prevalent amongst children and adolescents. Despite higher incidence, effective treatment options for this population are controversial. This Meta-analysis aims to evaluate the effects of all non-invasive treatment modalities available for MASLD.</div></div><div><h3>Methods</h3><div>This study includes PubMed, Cochrane Library, and Embase searches (January 2010 to July 2025) for Randomised Controlled Trials (RCTs), evaluating different treatment modalities of MASLD in pediatrics and adolescent population. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Primary outcomes were Aspartate Aminotransferase (AST), Triglycerides (TGs) and Low-Density Lipoproteins (LDL). Secondary outcomes were Alanine Aminotransferase (ALT), Gamma-Glutamyl Transferase (GGT), High-Density Lipoprotein (HDL) and adverse effects. Data were analyzed using Revman 5.3. Continuous values were pooled using the standard mean difference (SMD). Sensitivity analysis was performed to reduce heterogeneity. This study was registered with PROSPERO, CRD42024596682.</div></div><div><h3>Results</h3><div>We included 31 RCTs, having 1722 participants. Multiple treatment modalities were identified and categorized into dietary intervention, supplementation, drug intervention and exercise. We further categorized dietary intervention into low-sugar diet, low-fat diet and mediterranean diet and compared against different controls. The low-sugar diet showed significant improvement in TG levels against placebo/usual diet [-2.44,95 %CI:3.61,-1.27] and in AST levels against low-fat diet [-1.02, 95 %CI –1.88, -0.16]. LDL levels showed significant change when probiotics were administered against placebo [-0.33, 95 % CI:0.65,0.00].</div></div><div><h3>Conclusion</h3><div>Supplements and Dietary intervention have shown improvement in liver enzymes and lipid profile. However, more research is required to evaluate the dosage and adverse effects associated with these interventions.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102685"},"PeriodicalIF":2.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gaucher disease (GD), the most common lysosomal storage disorders, is characterized by glucocerebroside accumulation within macrophages, leading to multisystem involvement including organomegaly, cytopenias, and bone disease. This study aimed to assess the presence and extent of hepatic, splenic, and bone marrow (BM) fibrosis in GD1 patients by using transient elastography (FibroScan®). Analysis a series of 26 adult GD1 patients, both treatment-naïve and enzyme replacement therapy (ERT) treated, was evaluated for liver and spleen stiffness. Eight patients with persistent cytopenia and hepatosplenomegaly underwent BM biopsy. Median liver and spleen stiffness were 4.8 kPa and 26 kPa, respectively. Mild liver fibrosis was identified in 77% of patients, moderate fibrosis in 15%, and cirrhosis in 7.7%, with comparable prevalence between naïve and treated groups. Splenic fibrosis was observed in 54% of patients, more frequently among those receiving ERT. A strong correlation was found between hepatic and splenic fibrosis, as well as between organ stiffness and fibrosis severity. Bone marrow fibrosis was detected in 75% of biopsied patients. These findings indicate that fibrotic progression may persist despite ERT and is not limited to the liver. Integrating non-invasive fibrosis assessment into routine GD1 monitoring may improve early detection and management of this disease complications.
{"title":"Multiorgan fibrosis in Gaucher disease type I: an unmet goal of enzyme replacement therapy","authors":"Zufit Hexner-Erlichman , Nimer Assy , Nayaf Habashi , Awni Yousif , Hanna Rosenbaum","doi":"10.1016/j.clinre.2025.102677","DOIUrl":"10.1016/j.clinre.2025.102677","url":null,"abstract":"<div><div>Gaucher disease (GD), the most common lysosomal storage disorders, is characterized by glucocerebroside accumulation within macrophages, leading to multisystem involvement including organomegaly, cytopenias, and bone disease. This study aimed to assess the presence and extent of hepatic, splenic, and bone marrow (BM) fibrosis in GD1 patients by using transient elastography (FibroScan®). Analysis a series of 26 adult GD1 patients, both treatment-naïve and enzyme replacement therapy (ERT) treated, was evaluated for liver and spleen stiffness. Eight patients with persistent cytopenia and hepatosplenomegaly underwent BM biopsy. Median liver and spleen stiffness were 4.8 kPa and 26 kPa, respectively. Mild liver fibrosis was identified in 77% of patients, moderate fibrosis in 15%, and cirrhosis in 7.7%, with comparable prevalence between naïve and treated groups. Splenic fibrosis was observed in 54% of patients, more frequently among those receiving ERT. A strong correlation was found between hepatic and splenic fibrosis, as well as between organ stiffness and fibrosis severity. Bone marrow fibrosis was detected in 75% of biopsied patients. These findings indicate that fibrotic progression may persist despite ERT and is not limited to the liver. Integrating non-invasive fibrosis assessment into routine GD1 monitoring may improve early detection and management of this disease complications.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 8","pages":"Article 102677"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.clinre.2025.102681
Saqlain Haider
{"title":"Proton pump inhibitors versus H2-receptor antagonists in cirrhotic patients: A clinical case and literature perspective","authors":"Saqlain Haider","doi":"10.1016/j.clinre.2025.102681","DOIUrl":"10.1016/j.clinre.2025.102681","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 8","pages":"Article 102681"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.clinre.2025.102675
Siv Fonnes , Sarah Mollerup , Sarah Juel Paulsen , Andreas Munk Petersen , Barbara Juliane Holzknecht , Henrik Westh , Jacob Rosenberg
Purpose
Diagnosing appendicitis is difficult. An infectious origin has been proposed, therefore signals from the microbiome could be a potential diagnostic measure. The aim was to evaluate the diagnostic potential of the rectal microbiome in patients with suspected appendicitis.
Methods
We included adult Danish patients with suspected appendicitis undergoing appendectomy in a prospective, observational cohort study. Patients were first grouped as patients with and without appendicitis according to histopathological findings, and second, as having uncomplicated or complicated appendicitis according to the surgical report. Rectal swabs were analysed with shotgun metagenomics. The outcomes were alpha diversity, beta diversity, and differential abundance of bacteria.
Results
Rectal swabs from 220 patients were analysed: 49 patients without appendicitis, 111 patients with uncomplicated and 60 patients with complicated appendicitis, respectively. Across all groups, both the alpha and beta diversity were similar. The relative abundance of bacterial genera and species was also similar across all groups. Thus, the three groups of patients had similar rectal microbiomes.
Conclusion
The rectal microbiome in adult patients with suspected appendicitis was similar and does not seem to have the potential to be used to diagnose neither appendicitis nor the severity of appendicitis preoperatively.
{"title":"A prospective cohort study of the rectal microbiome in patients with suspected appendicitis","authors":"Siv Fonnes , Sarah Mollerup , Sarah Juel Paulsen , Andreas Munk Petersen , Barbara Juliane Holzknecht , Henrik Westh , Jacob Rosenberg","doi":"10.1016/j.clinre.2025.102675","DOIUrl":"10.1016/j.clinre.2025.102675","url":null,"abstract":"<div><h3>Purpose</h3><div>Diagnosing appendicitis is difficult. An infectious origin has been proposed, therefore signals from the microbiome could be a potential diagnostic measure. The aim was to evaluate the diagnostic potential of the rectal microbiome in patients with suspected appendicitis.</div></div><div><h3>Methods</h3><div>We included adult Danish patients with suspected appendicitis undergoing appendectomy in a prospective, observational cohort study. Patients were first grouped as patients with and without appendicitis according to histopathological findings, and second, as having uncomplicated or complicated appendicitis according to the surgical report. Rectal swabs were analysed with shotgun metagenomics. The outcomes were alpha diversity, beta diversity, and differential abundance of bacteria.</div></div><div><h3>Results</h3><div>Rectal swabs from 220 patients were analysed: 49 patients without appendicitis, 111 patients with uncomplicated and 60 patients with complicated appendicitis, respectively. Across all groups, both the alpha and beta diversity were similar. The relative abundance of bacterial genera and species was also similar across all groups. Thus, the three groups of patients had similar rectal microbiomes.</div></div><div><h3>Conclusion</h3><div>The rectal microbiome in adult patients with suspected appendicitis was similar and does not seem to have the potential to be used to diagnose neither appendicitis nor the severity of appendicitis preoperatively.</div></div><div><h3>Trial registration</h3><div>NCT03349814 (clinicaltrials.gov)</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 8","pages":"Article 102675"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.clinre.2025.102684
Syeda Verisha Batool , Noor Fatima , Rabia Asim
{"title":"Hepatitis B and C in Pakistan: A silent crisis demanding urgent action","authors":"Syeda Verisha Batool , Noor Fatima , Rabia Asim","doi":"10.1016/j.clinre.2025.102684","DOIUrl":"10.1016/j.clinre.2025.102684","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 8","pages":"Article 102684"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.clinre.2025.102688
Vincent Zimmer , Karin Reitnauer
{"title":"Colon single-strip sign: an uncommon ischemic signature lesion","authors":"Vincent Zimmer , Karin Reitnauer","doi":"10.1016/j.clinre.2025.102688","DOIUrl":"10.1016/j.clinre.2025.102688","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 8","pages":"Article 102688"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background and Aims</h3><div>Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related mortality worldwide and in the United States. In recent decades, there has been a growing emphasis on end-of-life care delivered in home or hospice settings, yet detailed contemporary insights into how these patterns differ by sex, race/ethnicity, region, and urbanization remain sparse. This study aimed to characterize the trends in the proportion of HCC descendants receiving home or hospice care over a 25-year period, using data derived from the CDC WONDER database.</div></div><div><h3>Methods</h3><div>Data for HCC-related mortality were obtained from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database by ICD-10 code (C22.0), covering the years from 1999 to 2024. The analysis focused on the proportion of home or hospice deaths relative to the total number of HCC-related deaths. Trends were examined for the overall population as well as stratified by race/ethnicity, sex, census region, and urbanization. Trend analysis was conducted using Joinpoint 5.30 to identify significant changes in the temporal patterns.</div></div><div><h3>Results</h3><div>The overall proportion of patients with HCC who died at home or in hospice increased steadily over the study period, rising from approximately 40.19% in 1999 to 54.67% in the most recent year, with an overall aggregate proportion around 47.6%. Among the different racial and ethnic groups, Non-Hispanic White decedents showed a notable increase from 44.57% to 58.04%, while Non-Hispanic Black decedents increased from 27.38% to 44.91%, and Hispanic decedents from 39.17% to 51.38%. Both female and male patients experienced rising trends in home or hospice deaths, with females increasing from 41.67% to 54.48% and males from 39.64% to 54.73%. Regional variations were evident, with the South consistently reporting the highest proportions of home or hospice deaths, starting at 42.71% in 1999 and reaching 58.38% in the latest data, while the Northeast exhibited comparatively lower rates. A similar upward trend between 1999 and 2020 was observed in both rural and urban areas, with rural settings increasing from 41.16% to 58.81% and urban settings from 40.04% to 59.86%.</div></div><div><h3>Conclusion</h3><div>In conclusion, our study highlights both obvious progress and persistent disparities in end-of-life care in HCC patients in the US. Significant disparities do exist between racial/ethnic groupings and geographical areas, despite a significant increase in home/hospice utilization. Multiple interventions which intend to remove barriers to healthcare access, enhance cultural competence palliative care administration, and apply policy reforms to support concurrent palliative and disease-modifying therapies will be necessary to achieve health equity. Ensuring that all patients have fair access to high-quality end-of-life care sh
{"title":"Evolving end-of-life care patterns for hepatocellular carcinoma in the United States: A 25-year national analysis of disparities in home and hospice utilization","authors":"Mohamed Elnaggar , Ibrahim Hassan , Hatem Eltaly , Ayah Obeid , Raffi Karagozian","doi":"10.1016/j.clinre.2025.102686","DOIUrl":"10.1016/j.clinre.2025.102686","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related mortality worldwide and in the United States. In recent decades, there has been a growing emphasis on end-of-life care delivered in home or hospice settings, yet detailed contemporary insights into how these patterns differ by sex, race/ethnicity, region, and urbanization remain sparse. This study aimed to characterize the trends in the proportion of HCC descendants receiving home or hospice care over a 25-year period, using data derived from the CDC WONDER database.</div></div><div><h3>Methods</h3><div>Data for HCC-related mortality were obtained from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database by ICD-10 code (C22.0), covering the years from 1999 to 2024. The analysis focused on the proportion of home or hospice deaths relative to the total number of HCC-related deaths. Trends were examined for the overall population as well as stratified by race/ethnicity, sex, census region, and urbanization. Trend analysis was conducted using Joinpoint 5.30 to identify significant changes in the temporal patterns.</div></div><div><h3>Results</h3><div>The overall proportion of patients with HCC who died at home or in hospice increased steadily over the study period, rising from approximately 40.19% in 1999 to 54.67% in the most recent year, with an overall aggregate proportion around 47.6%. Among the different racial and ethnic groups, Non-Hispanic White decedents showed a notable increase from 44.57% to 58.04%, while Non-Hispanic Black decedents increased from 27.38% to 44.91%, and Hispanic decedents from 39.17% to 51.38%. Both female and male patients experienced rising trends in home or hospice deaths, with females increasing from 41.67% to 54.48% and males from 39.64% to 54.73%. Regional variations were evident, with the South consistently reporting the highest proportions of home or hospice deaths, starting at 42.71% in 1999 and reaching 58.38% in the latest data, while the Northeast exhibited comparatively lower rates. A similar upward trend between 1999 and 2020 was observed in both rural and urban areas, with rural settings increasing from 41.16% to 58.81% and urban settings from 40.04% to 59.86%.</div></div><div><h3>Conclusion</h3><div>In conclusion, our study highlights both obvious progress and persistent disparities in end-of-life care in HCC patients in the US. Significant disparities do exist between racial/ethnic groupings and geographical areas, despite a significant increase in home/hospice utilization. Multiple interventions which intend to remove barriers to healthcare access, enhance cultural competence palliative care administration, and apply policy reforms to support concurrent palliative and disease-modifying therapies will be necessary to achieve health equity. Ensuring that all patients have fair access to high-quality end-of-life care sh","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 8","pages":"Article 102686"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.clinre.2025.102676
Ali Jaan , Mostafa Suhail Najim , Adeena Maryyum , Qurat Ul Ain Muhammad , Effa Zahid , Umer Farooq , Ashish Dhawan , Haseeba Javed , Byron Cryer , Sushil Ahlawat
Introduction
Cholecystectomy (CCY) is generally advocated for patients presenting with acute cholangitis (AC) to ensure definitive management and prevent recurrence. The optimal timing for cholecystectomy (CCY), however, remains to be determined. This study aims to comprehend the clinical outcomes and financial implications of performing a CCY during index admission.
Methods
We conducted a retrospective cohort study using data from the Nationwide Readmission Database (2016–2020). Adult patients admitted with a diagnosis of AC were categorized based on whether CCY was performed during index admission and were further stratified by severity per the Tokyo Guidelines. Mortality, resource utilization, and readmission rates were analyzed using a multivariate Cox regression model. STATA 14.2 was utilized for statistical analysis.
Results
Of 29,241 adult patients with AC, 4319 (14.77 %) underwent CCY during the index admission. Patients with index admission CCY had lower comorbidity index and AC severity compared to those without index admission CCY (P < 0.01). Significantly lower in-hospital mortality (adjusted hazard ratio (aHR) 0.40, P < 0.01), 30-day and 90-day readmission rates (aHR 0.49 and 0.48 respectively, P < 0.01) were observed for the index CCY group. Reduced mortality and improved readmission rates were persistent on subgroup analysis for severe and non-severe cholangitis patients.
Conclusion
Our findings advocate the effectiveness of index admission CCY in lowering mortality and readmission rates, irrespective of AC severity. These findings highlight the need for future prospective studies and updated guidelines on surgical intervention in AC management.
摘要胆囊切除术（CCY）通常被提倡用于急性胆管炎（AC）的患者，以确保明确的管理和防止复发。然而，胆囊切除术（CCY）的最佳时机仍有待确定。本研究旨在了解在住院期间实施CCY的临床结果和经济意义。方法采用全国再入院数据库（2016-2020）的数据进行回顾性队列研究。诊断为AC的成年患者根据入院时是否行CCY进行分类，并根据东京指南的严重程度进一步分层。使用多变量Cox回归模型分析死亡率、资源利用率和再入院率。采用STATA 14.2进行统计分析。结果29241例成年AC患者中，4319例（14.77%）在入院时接受了CCY治疗。入院CCY患者的合并症指数和AC严重程度均低于未入院CCY患者（P < 0.01）。指数CCY组住院死亡率（校正危险比（aHR） 0.40, P < 0.01）、30天和90天再入院率（aHR分别为0.49和0.48,P < 0.01）均显著降低。在亚组分析中，严重和非严重胆管炎患者的死亡率和再入院率持续降低。结论：我们的研究结果表明，与AC严重程度无关，指数入院CCY在降低死亡率和再入院率方面是有效的。这些发现强调了未来前瞻性研究和更新手术干预治疗AC指南的必要性。
{"title":"Safety and efficacy of index admission cholecystectomy in severity-stratified acute cholangitis hospitalizations","authors":"Ali Jaan , Mostafa Suhail Najim , Adeena Maryyum , Qurat Ul Ain Muhammad , Effa Zahid , Umer Farooq , Ashish Dhawan , Haseeba Javed , Byron Cryer , Sushil Ahlawat","doi":"10.1016/j.clinre.2025.102676","DOIUrl":"10.1016/j.clinre.2025.102676","url":null,"abstract":"<div><h3>Introduction</h3><div>Cholecystectomy (CCY) is generally advocated for patients presenting with acute cholangitis (AC) to ensure definitive management and prevent recurrence. The optimal timing for cholecystectomy (CCY), however, remains to be determined. This study aims to comprehend the clinical outcomes and financial implications of performing a CCY during index admission.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the Nationwide Readmission Database (2016–2020). Adult patients admitted with a diagnosis of AC were categorized based on whether CCY was performed during index admission and were further stratified by severity per the Tokyo Guidelines. Mortality, resource utilization, and readmission rates were analyzed using a multivariate Cox regression model. STATA 14.2 was utilized for statistical analysis.</div></div><div><h3>Results</h3><div>Of 29,241 adult patients with AC, 4319 (14.77 %) underwent CCY during the index admission. Patients with index admission CCY had lower comorbidity index and AC severity compared to those without index admission CCY (<em>P</em> < 0.01). Significantly lower in-hospital mortality (adjusted hazard ratio (aHR) 0.40, <em>P</em> < 0.01), 30-day and 90-day readmission rates (aHR 0.49 and 0.48 respectively, <em>P</em> < 0.01) were observed for the index CCY group. Reduced mortality and improved readmission rates were persistent on subgroup analysis for severe and non-severe cholangitis patients.</div></div><div><h3>Conclusion</h3><div>Our findings advocate the effectiveness of index admission CCY in lowering mortality and readmission rates, irrespective of AC severity. These findings highlight the need for future prospective studies and updated guidelines on surgical intervention in AC management.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 8","pages":"Article 102676"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144920178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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