Alimentary Pharmacology & Therapeutics最新文献

{"title":"Impact of Nonalcoholic Fatty Liver Disease on the Survival of People Living With HIV.","authors":"Juan Macias, Mario Frias, Juan Antonio Pineda, Diana Corona-Mata, Anais Corma-Gomez, Antonio Rivero-Juarez, Marta Santos, Miguel García-Deltoro, Antonio Rivero, Carmen Ricart-Olmos, Alejandro Gonzalez-Serna, Luis Miguel Real","doi":"10.1111/apt.18413","DOIUrl":"10.1111/apt.18413","url":null,"abstract":"<p><strong>Background: </strong>Nonalcoholic fatty liver disease (NAFLD) is an increasing concern for people living with HIV (PLWH). However, information on the impact of NAFLD on the prognosis of PLWH is very scarce.</p><p><strong>Aims: </strong>To investigate the influence of NAFLD on the overall and liver-related mortality in PLWH.</p><p><strong>Methods: </strong>PLWH followed in three Spanish centres were included in a prospective cohort at the date of the first transient elastography evaluation. Survival data were recorded, and the causes of death were centrally monitored. The risk of all-cause death and liver-related death was evaluated by applying time-to-event analyses.</p><p><strong>Results: </strong>A total of 2151 PLWH were included in the cohort and followed for a median (Q1-Q3) of 7.3 (3.5-10.4) years. There were 174 (8.1%) deaths. The probability of overall death and liver-related death was associated with liver stiffness measurement (LSM) and with FibroScan-AST (FAST) score. Among 844 PLWH with potential for NALFD, LSM was independently associated with all-cause mortality (adjusted hazard ratio [AHR], by 1 kPa increase: 1.06; 95% confidence interval [95% CI]: 1.04-1.08; p < 0.001). In a separate model and after adjustment, FAST score ≥ 0.67 was related to survival (AHR: 1.87; 95% CI: 1.40-2.50; p < 0.001). The AUROC (95% CI) of the models were based on LSM, 0.812 (0.739-0.885); and FAST, 0.825 (0.753-0.897) (p = 0.386).</p><p><strong>Conclusions: </strong>For PLWH, advanced liver fibrosis increases the risk of overall death and liver-related death. LSM and the FAST score are similar predictors of survival for PLWH with potential for NAFLD.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":"550-557"},"PeriodicalIF":6.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737968","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}

{"title":"Coronary Artery Disease and Major Adverse Cardiovascular Events in People With Hepatic Steatosis at Low Atherosclerotic Cardiovascular Disease Risk.","authors":"Julia Karady, Thomas Mayrhofer, Borek Foldyna, Michael T Lu, Nandini Meyersohn, Udo Hoffmann, Oluwafemi Balogon, Neha Pagidipati, Svati Shah, Pamela S Douglas, Maros Ferencik, Kathleen Corey","doi":"10.1111/apt.18415","DOIUrl":"10.1111/apt.18415","url":null,"abstract":"<p><strong>Background: </strong>Hepatic steatosis (HS) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥ 7.5% are associated with increased risk for cardiovascular events.</p><p><strong>Aim: </strong>To assess underlying coronary artery disease (CAD) and major adverse cardiovascular event (MACE) among those with and without HS at different ASCVD risk.</p><p><strong>Methods: </strong>We evaluated stable chest pain patients receiving coronary computed tomography (CT) in the PROMISE trial. HS and CAD endpoints were defined on coronary CT. MACE was defined as unstable angina, non-fatal myocardial infarction, and all-cause death. Multivariable Cox regression, adjusting for CAD characteristics, assessed the association of HS with MACE for ASCVD < 7.5%.</p><p><strong>Results: </strong>One thousand two hundred and four of 3702 (32.5%) patients were at ASCVD < 7.5% and 20.3% (244/1204) of them had HS. Individuals with HS were younger (54.3 ± 5.2 vs. 55.8 ± 5.2; p < 0.001), more often males (40.2% [98/244] vs. 27.1% [260/960]; p < 0.001), had more risk factors/person (2.06 ± 0.89 vs. 1.93 ± 0.91; p = 0.047). CAD characteristics were similar between HS vs. non-HS patients at ASCVD < 7.5% and ASCVD ≥ 7.5% (all p > 0.05). Patients with HS had greater MACE rate compared to non-HS patients (ASCVD < 7.5%: 3.75%[9/244] vs. 1.5% [14/960]; p = 0.027 and ASCVD ≥ 7.5%: 4.7% [33/696] vs. 3.1% [56/1802]; p = 0.043). In patients without HS, MACE rate was higher in the ASCVD ≥ 7.5% vs. < 7.5% (3.1% [56/1802] vs. 1.5% [14/960]; p = 0.011). In patients with HS, MACE rates were not significantly different between ASCVD ≥ 7.5% vs. < 7.5% (4.7% [33/696] vs. 3.7% [9/244]; p = 0.484). In ASCVD < 7.5%, HS predicted MACE (aHR:2.34, 95%CI:1.01-5.43; p = 0.048), independent of CAD characteristics.</p><p><strong>Conclusions: </strong>Individuals with HS at ASCVD < 7.5% risk had similar CAD characteristics as patients without HS at < 7.5% ASCVD risk, yet experienced comparable MACE rates as those at ASCVD ≥ 7.5%.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":"558-569"},"PeriodicalIF":6.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749397","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}

{"title":"PCAB Safety: Balancing Potential Long‐Term Risks With Short‐Term Benefits","authors":"Stephanie Owyang, Wai‐Kit Lo","doi":"10.1111/apt.18507","DOIUrl":"https://doi.org/10.1111/apt.18507","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"5 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987499","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}

{"title":"Letter: Addressing Gaps in Hospital‐Based Hepatitis C Screening—Insights and Recommendations","authors":"Zhen Deng, Lincheng Duan, Kai Wang","doi":"10.1111/apt.18460","DOIUrl":"https://doi.org/10.1111/apt.18460","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"20 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987500","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}

{"title":"Inflammatory Potential of the Diet and Risk of Crohn's Disease and Ulcerative Colitis","authors":"Antoine Meyer, Simon S. M. Chan, Mathilde Touvier, Chantal Julia, Anne Tjønneland, Cecilie Kyrø, Christina C. Dahm, Verena A. Katzke, Matthias B. Schulze, Rosario Tumino, Carlotta Sacerdote, Giovanna Masala, Bas Oldenburg, Marcela Guevara, Luis Bujanda, Natalia A. Cabrera Castro, Tammy Y. N. Tong, Alicia K. Heath, Mélanie Deschasaux-Tanguy, Serge Hercberg, Pilar Galan, Yahya Mahamat-Saleh, Gianluca Severi, Franck Carbonnel, Aurélien Amiot","doi":"10.1111/apt.18497","DOIUrl":"https://doi.org/10.1111/apt.18497","url":null,"abstract":"Association between dietary factors and the risk of developing inflammatory bowel disease (IBD) has been studied extensively. However, identification of deleterious dietary patterns merits further study.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"54 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987153","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}

{"title":"Early Dynamics of Portal Pressure Gradient After TIPS Insertion Predict Mortality","authors":"P. A. Reuken, A. Franz, T. H. Wirtz, C. Ripoll, R. Aschenbach, U. Teichgräber, M. R. Pollmanns, M. Kiehntopf, S. Keil, C. Kuhl, P. C. Schulze, C. Trautwein, T. Bruns, A. Stallmach, A. Zipprich","doi":"10.1111/apt.18503","DOIUrl":"https://doi.org/10.1111/apt.18503","url":null,"abstract":"BackgroundTransjugular intrahepatic portosystemic shunt (TIPS) placement leads to a reduction in portal pressure and an improvement in survival in patients with recurrent and refractory ascites and variceal haemorrhage. Prediction of post‐TIPS survival is primarily determined by factors identified before the TIPS procedure, as data collected during or after TIPS implantation are limited. The aim of the study was to evaluate the influence of early hemodynamic changes after TIPS placement on survival, in order to refine post TIPS management.MethodsIn this prospective bicentric study, consecutive patients (<jats:italic>n</jats:italic> = 105) undergoing TIPS placement for ascites or variceal haemorrhage underwent measurement of portal pressure gradient (PPG) immediately at TIPS insertion (PPG0) and 24 h later (PPG24h) and the ΔPPG was calculated from PPG24h and PPG0 (ΔPPG = PPG24h‐PPG0). Kaplan–Meier survival analysis and uni‐ and multivariable regression analyses were conducted to identify survival predictors.ResultsPatients with lack of increased ΔPPG exhibited poorer 90‐day and 1‐year survival compared to patients with increased ΔPPG. This worse survival was independent of The Model for End‐Stage Liver Disease (MELD) score, Child‐Pugh score, bilirubin levels, creatinine and the Freiburg index of post‐TIPS survival (FIPS) &gt; 0.92. Among these patients with poorer outcome, elevated bilirubin (&gt; 25 μmol/L) further distinguished survivors from non‐survivors.ConclusionLack of increased ΔPPG post‐TIPS insertion identifies a high‐risk patient group with worse survival. We propose incorporating this second PPG measurement and determining ΔPPG into clinical practice to identify these patients early and tailor post‐TIPS patient care.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"36 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142986270","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}

{"title":"Letter: Addressing Gaps in Hospital-Based Hepatitis C Screening—Insights and Recommendations. Authors' Reply'","authors":"Alberto Ferrarese, Francesco Paolo Russo","doi":"10.1111/apt.18505","DOIUrl":"https://doi.org/10.1111/apt.18505","url":null,"abstract":"&lt;p&gt;We would like to thank Dr Deng and colleagues for their valuable comments on our recently published work in this Journal [&lt;span&gt;1&lt;/span&gt;]. We would like to clarify a few aspects in the light of the hypotheses proposed in their recent commentary [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;The authors noted that our paper did not adequately address the comorbidities of the 109 patients with a positive hepatitis C (HCV) viral load. For this study, we were able to obtain the ICD-9 discharge codes; however, these may only partially capture the patients' comorbidities and. The association between HCV infection and cardiovascular and metabolic disorders is well-described [&lt;span&gt;3&lt;/span&gt;]. However, we believe that patient comorbidities should not serve as a basis for stratifying individuals in an in-hospital screening campaign. Given the excellent safety profile of direct-acting antiviral agents, the presence of significant comorbidities does not substantially limit access to treatment. Moreover, a targeted screening approach is inconsistent with the universal in-hospital screening model we advocate, which seeks to identify the largest possible number of positive patients. This universal approach also has the potential to reduce socio-economic barriers and health inequalities, particularly in Italy, where the public healthcare system could, hopefully in the near future, support its implementation.&lt;/p&gt;\u0000&lt;p&gt;Dr Deng and colleagues pointed out that only 17.5% of all hospitalised patients underwent in-hospital screening during the calendar year 2022. We acknowledge that this is a potential limitation in our paper. However, the number of samples collected (&lt;i&gt;n&lt;/i&gt; = 11,355) is substantial and provides valuable epidemiological insights. As our study was designed prospectively, it was not possible to retrospectively include unscreened patients, particularly those who declined informed consent. The relatively low percentage of screened patients may likely reflect limited awareness of the issue among both patients and healthcare providers. In this regard, our study can serve as a starting point to raise awareness at multiple levels. The gender differences observed in our study could potentially be attributed to the higher life expectancy of women than of men in Italy, a trend that has remained consistent over the years [&lt;span&gt;4&lt;/span&gt;]. Additionally, it is well-established that men have a higher risk of disease progression to cirrhosis, which may explain why liver-related mortality has likely affected more men than women in previous decades [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Finally, the authors correctly observed that 61/109 (66%) patients were not treated at our centre. However, this does not necessarily indicate a loss to follow-up. In 15 cases (24.5%), antiviral treatment was postponed due to severe extra-hepatic comorbidities, 7 patients (11.4%) refused to start therapy and 4 (6.5%) died during the same hospitalisation. In only 5 cases (8.1%), the reason for treatment postponement cou","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"23 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987144","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}

{"title":"Meta-Analysis: Exclusive Enteral Nutrition in Adults With Ulcerative Colitis","authors":"Matthew K. W. Chu, Alice S. Day, Lani Broad, Samuel P. Costello, Suzanne Edwards, Robert V. Bryant","doi":"10.1111/apt.18495","DOIUrl":"https://doi.org/10.1111/apt.18495","url":null,"abstract":"Exclusive enteral nutrition (EEN) is an established dietary therapy for Crohn's disease but its role in ulcerative colitis remains unclear.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"20 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987150","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}

{"title":"Disparities in Alcohol-Associated Liver Disease Hospital Encounters Amongst a Texas-Based Cohort of Patients","authors":"Thomas G. Cotter, Ahmad Anouti, Bill Zhang, Elias D. Rady, Mausam Patel, Suraj Patel, Daniel J. Ellis, Sarah R. Lieber, Nicole E. Rich, Jacqueline G. O'Leary, Mack C. Mitchell, Amit G. Singal","doi":"10.1111/apt.18477","DOIUrl":"https://doi.org/10.1111/apt.18477","url":null,"abstract":"Alcohol-associated liver disease (ALD) disproportionately impacts men, racial and ethnic minorities, and individuals of low socioeconomic status; however, it's unclear how recent increases in ALD burden have impacted these disparities. We aimed to describe trends in racial, ethnic and socioeconomic disparities in alcohol-associated hospital encounters.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"37 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988425","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}

{"title":"Editorial: HBeAg-Positive Chronic Hepatitis B With Low HBsAg Levels—Exploring Clinical Significance of preS2 Deletion Mutations","authors":"Ying-Nan Tsai, Yao-Chun Hsu","doi":"10.1111/apt.18480","DOIUrl":"https://doi.org/10.1111/apt.18480","url":null,"abstract":"&lt;p&gt;Chronic hepatitis B virus (HBV) infection typically follows a natural history that includes phases of ‘immune tolerance’ and hepatitis B e antigen (HBeAg) clearance [&lt;span&gt;1&lt;/span&gt;]. HBeAg positivity usually indicates active replication and is associated with high viral load and elevated hepatitis B surface antigen (HBsAg) levels in patients with chronic hepatitis B (CHB) [&lt;span&gt;2&lt;/span&gt;]. However, the conventional phases cannot characterise all HBeAg-positive patients. A subset of these HBeAg-positive patients exhibit low HBsAg levels, accompanied by complex virological and immunological profiles, and tends to develop aggressive liver fibrosis and cirrhosis [&lt;span&gt;3, 4&lt;/span&gt;]. Additionally, different HBV genes and mutations are linked to diverse serological and clinical characteristics, including antigen seroconversion, response to antiviral treatment, vaccine escape, liver fibrosis status and the development of hepatocellular carcinoma (HCC) [&lt;span&gt;5&lt;/span&gt;]. The mechanisms underlying the clinical presentation of HBeAg-positive CHB with low HBsAg levels remain unclear.&lt;/p&gt;\u0000&lt;p&gt;In a recent study published in the journal, Chen et al. enrolled 171 treatment-naïve HBeAg-positive CHB patients with HBsAg concentrations below 1000 IU/mL, to investigate potential explanations by analysing their virological and immunological characteristics [&lt;span&gt;6&lt;/span&gt;]. Liver fibrosis severity was measured using non-invasive fibrosis indices. The results revealed that these patients had lower HBV DNA concentrations, higher rates of anti-HBs and anti-HBe positivity, elevated fibrosis scores and a predominance of genotype C. Moreover, there was a higher prevalence of viral quasispecies variants associated with the preS2 deletion. Notably, patients with preS2 deletion mutations exhibited higher fibrosis scores compared to both those infected with the wild-type virus, and HBeAg-positive CHB patients with high HBsAg concentration. They concluded that preS2 deletion mutants might enable HBV to evade host immunity and contribute to liver disease progression. These findings suggest that these patients warrant greater medical attention.&lt;/p&gt;\u0000&lt;p&gt;Extrapolating findings from this retrospective study should be approached cautiously. Potential confounding factors, such as host genetics or environmental influences, [&lt;span&gt;7, 8&lt;/span&gt;] may contribute to fibrosis or immune modulation and were not fully accounted for in this study. It remains unclear whether preS2 deletion mutations arise as a result of liver disease progression, or alternatively, causally contribute to it. Moreover, in vitro experiments may not fully replicate the intricate host immune interactions occurring in vivo and disease progression. To further clarify the role of preS2 deletions in the natural history of CHB, prospective cohort studies that longitudinally track the emergence of preS2 deletions are needed to establish a clear temporal association with clinical outcomes such as fibrosis progression or HCC. ","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"4 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981740","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}