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Editorial: Efficacy of Pharmacological Compared With Dietary Therapy for Patients With Irritable Bowel Syndrome—It Is Nice to Have a Choice. Authors' Reply 社评：肠易激综合征患者的药理学与饮食疗法的疗效比较——有选择的感觉真好。作者的回复

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Alimentary Pharmacology & Therapeutics

Pub Date : 2025-11-24 DOI: 10.1111/apt.70469

Kee Huat Chuah, Qing Yuan Loo, Audrey Joe Chii Loh, Jing Yi Leong, Wah Loong Chan, Xin Hui Khoo, Kim Leng Wong, Sarala Panirsheeluam, Vicraman Natarajan, Ai Kah Ng, Hazreen Abdul Majid, Sanjiv Mahadeva

<p>We thank Drs Halmos and Gibson for their interest in our paper [<span>1, 2</span>]. We are truly privileged to receive their recognition—particularly as they are part of the Monash University team that originally developed and introduced the low FODMAP diet globally [<span>3</span>]. Their editorial succinctly captured the essence of our study and highlighted that it provides clinicians and patients with an additional therapeutic option for IBS [<span>1, 2</span>].</p><p>Although both the low FODMAP diet and rifaximin were effective, each therapy has its own advantages and limitations. Rifaximin demonstrated relatively faster symptom improvement and offers the convenience of a finite treatment duration although its long-term efficacy remains uncertain. In contrast, the low FODMAP diet empowers patients and supports long-term self-management, but is more complex to implement and requires guidance from specially trained dietitians.</p><p>In real-world practice, clinicians must balance multiple factors when managing IBS including practicality, accessibility, affordability and patient preference. Dietary therapy, while effective, faces considerable challenges in many low- and middle-income countries. Limited availability of trained dietitians, financial constraints and variations in healthcare infrastructure restrict widespread adoption of structured dietary interventions [<span>4</span>]. Moreover, many adults with IBS struggle with diet adherence because of work commitments, reliance on prepared or outside food, or not cooking for themselves, all of which make long-term compliance difficult.</p><p>Acceptance of dietary therapy also varies across regions. A study from Maastricht showed that younger patients tend to favour diet-based approaches, whereas older patients prefer pharmacological treatment [<span>5</span>]. In contrast, survey data from Asia—including multi-country IBS surveys—indicate that clinicians in the region generally favour pharmacological therapies [<span>6</span>]. These cultural- and practice-based differences may influence therapeutic decision-making and the overall uptake of dietary strategies in IBS management.</p><p>A useful parallel can be drawn from the management of diabetes: dietary modification is fundamental and effective, yet often challenging to sustain in daily life. In practice, the best outcomes occur when dietary measures are complemented by medications [<span>7</span>]. Similarly, in IBS, dietary and pharmacological therapies should be viewed as complementary rather than competing strategies, each contributing to individualised, patient-centred care. Future studies evaluating whether combination therapy yields superior outcomes compared with single-modality treatment would be particularly valuable.</p><p>Our study included patients regardless of IBS subtype to better reflect real-world clinical practice. The efficacy of both rifaximin and the low FODMAP diet was greater in non-constipation IBS subtypes, suppo

我们感谢Halmos和Gibson博士对我们的论文感兴趣[1,2]。我们真的很荣幸得到他们的认可，特别是因为他们是莫纳什大学团队的一员，他们最初开发并在全球范围内引入了低FODMAP饮食。他们的社论简洁地抓住了我们研究的精髓，并强调它为临床医生和患者提供了IBS的额外治疗选择[1,2]。虽然低FODMAP饮食和利福昔明都是有效的，但每种疗法都有自己的优点和局限性。利福昔明表现出相对较快的症状改善，并提供了有限治疗时间的便利性，尽管其长期疗效仍不确定。相比之下，低FODMAP饮食赋予患者权力并支持长期自我管理，但实施起来更复杂，需要经过专门培训的营养师的指导。在现实世界的实践中，临床医生在管理肠易激综合征时必须平衡多种因素，包括实用性、可及性、可负担性和患者偏好。饮食疗法虽然有效，但在许多低收入和中等收入国家面临相当大的挑战。训练有素的营养师数量有限、财政限制和医疗保健基础设施的变化限制了结构性饮食干预措施的广泛采用[10]。此外，许多患有肠易激综合症的成年人很难坚持饮食，因为他们有工作要做，依赖现成的或外面的食物，或者不自己做饭，所有这些都使得长期坚持饮食变得困难。对饮食疗法的接受程度也因地区而异。马斯特里赫特大学的一项研究表明，年轻患者倾向于以饮食为基础的治疗方法，而老年患者更喜欢药物治疗。相比之下，来自亚洲的调查数据（包括多国IBS调查）表明，该地区的临床医生普遍倾向于药物治疗。这些基于文化和实践的差异可能会影响治疗决策和肠易激综合征管理中饮食策略的整体吸收。从糖尿病的管理中可以得出一个有用的类比：饮食调整是基本和有效的，但在日常生活中往往难以维持。在实践中，当饮食措施辅以药物治疗时，效果最好。同样，在肠易激综合征中，饮食和药物治疗应被视为互补而非相互竞争的策略，每一种都有助于个性化、以患者为中心的护理。未来评估联合治疗是否优于单模治疗的研究将特别有价值。我们的研究纳入了不考虑IBS亚型的患者，以更好地反映现实世界的临床实践。利福昔明和低FODMAP饮食对非便秘型IBS的疗效更大，支持目前的指南[8,9]。葡萄糖氢呼气试验（HBT）不能预测治疗结果。这可能是由于电力不足造成的。与接受低FODMAP饮食的患者相比，HBT阳性患者的利福昔明显示出更大的症状改善趋势。IBS- d患者和更严重的IBS患者更容易出现小肠细菌过度生长，这表明HBT在这些亚组中可能有更大的效用。蔡基华：构思，写作-原稿。清元娄：写作-审稿和编辑。赵智洛：写作-评论和编辑。梁静怡：写作-评论和编辑。陈华龙：写作-评论和编辑。邱新慧：写作-评论和编辑。金冷王：写作-评论和编辑。Sarala Panirsheeluam：写作-评论和编辑。维克拉曼·纳塔拉扬：写作——评论和编辑。吴艾嘉：写作-评论和编辑。Hazreen Abdul Majid：写作-评论和编辑。Sanjiv Mahadeva：写作——评论和编辑，概念化。作者没有什么可报告的。作者的个人和经济利益声明与原文b[2]没有变化。本文链接到Chuah等人的论文。要查看这些文章，请访问https://doi.org/10.1111/apt.70420和https://doi.org/10.1111/apt.70452.Data分享不适用于本文，因为在当前研究中没有生成或分析数据集。

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引用次数: 0

Editorial: Remission Ambition—How Far Should We Push in Older Adults? 社论：缓解野心——我们应该在老年人中推进多远？

IF 7.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Alimentary Pharmacology & Therapeutics

Pub Date : 2025-11-20 DOI: 10.1111/apt.70463

Gloria Lin, Brigid S. Boland

引用次数: 0

Editorial: Remission Ambition—How Far Should We Push in Older Adults? Authors' Reply 社论：缓解野心——我们应该在老年人中推进多远？作者的回复

IF 7.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Alimentary Pharmacology & Therapeutics

Pub Date : 2025-11-20 DOI: 10.1111/apt.70471

Catherine Z. Tang, Adam S. Faye

引用次数: 0

Clinical Trial: Immunogenicity of Double-Dose Versus Standard-Dose of Hepatitis B Virus Vaccine in Inflammatory Bowel Disease 临床试验：双剂量与标准剂量乙型肝炎病毒疫苗对炎症性肠病的免疫原性。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Alimentary Pharmacology & Therapeutics

Pub Date : 2025-11-20 DOI: 10.1111/apt.70470

Anupam Kumar Singh, Roop Kishor Soni, Vaneet Jearth, Ashutosh Ishan Yadav, Chhagan Lal Birda, Abhirup Chatterjee, Jimil Shah, Ritin Mohindra, Amol N. Patil, Vikas Suri, Vishal Sharma, Arun Kumar Sharma, Usha Dutta

Background

Immunogenic response to hepatitis B virus (HBV) vaccine in patients with inflammatory bowel disease (IBD) is variable and often suboptimal.

Aim

To compare the immunogenicity of standard-dose (20 μg) vs. double-dose (40 μg) HBV vaccination in patients with IBD.

Methods

We randomised patients with IBD 1:1 to receive standard- or double-dose HBV vaccine at 0, 1 and 6 months. Anti-HBs titres were measured 1 month after the third dose. The primary outcome was an adequate immune response (AIR; anti-HBs titre > 10 IU/L). Secondary outcomes included an effective immune response (EIR; anti-HBs titre > 100 IU/L) and seroconversion stratified by disease activity.

Results

We randomised 45 patients to the standard-dose and 43 to the double-dose. Overall, 63 patients (71.6%) achieved AIR, and 51 (57.9%) achieved EIR. Both AIR (88.4% vs. 55.6%, p = 0.001) and EIR (69.8% vs. 46.7%, p = 0.028) rates were significantly higher with the double-dose. Among patients receiving immunosuppressive therapy, double-dose vaccination demonstrated significantly higher AIR (87.5% vs. 45.2%, p < 0.001) and EIR (65.6% vs. 35.5%, p = 0.017), while differences were not significant in those without immunosuppression. On multivariable analysis, predictors of AIR included double-dose vaccination (odds ratio [OR] 11.63; 95% confidence interval [CI] 2.63–51.46) and anti-TNFs (OR 0.03; 95% CI 0.002–0.6). Double-dose vaccination was also associated with higher odds of achieving EIR (OR 3.52; 95% CI 1.04–11.92).

Conclusions

Double-dose HBV vaccination significantly improved AIR and EIR over standard-dose. These findings support a double-dose strategy to optimize seroconversion in patients with IBD, especially those receiving immunosuppressive therapy.

背景：炎症性肠病（IBD）患者对乙型肝炎病毒（HBV）疫苗的免疫原性反应是可变的，而且往往不是最佳的。目的比较标准剂量（20 μg）与双剂量（40 μg） HBV疫苗接种对IBD患者的免疫原性。方法：我们将IBD患者按1:1随机分组，分别在0、1和6个月时接受标准剂量或双剂量HBV疫苗。第三次给药后1个月测定抗hbs滴度。主要结果是足够的免疫应答（AIR；抗hbs滴度bbb10 IU/L）。次要结果包括有效的免疫应答（EIR；抗hbs滴度> 100 IU/L）和按疾病活动性分层的血清转化。结果将45例患者随机分为标准剂量组和43例双剂量组。总体而言，63例（71.6%）患者达到AIR， 51例（57.9%）患者达到EIR。AIR （88.4% vs. 55.6%, p = 0.001）和EIR （69.8% vs. 46.7%, p = 0.028）均显著高于双剂量组。在接受免疫抑制治疗的患者中，双剂量疫苗接种显著提高了AIR （87.5% vs. 45.2%, p < 0.001）和EIR (65.6% vs. 35.5%, p = 0.017)，而在未接受免疫抑制治疗的患者中差异无统计学意义。在多变量分析中，AIR的预测因子包括双剂量疫苗接种（优势比[OR] 11.63； 95%可信区间[CI] 2.63-51.46）和抗tnf （OR 0.03; 95% CI 0.002-0.6）。双剂量疫苗接种也与较高的EIR发生率相关（OR 3.52; 95% CI 1.04-11.92）。结论与标准剂量相比，双剂量HBV疫苗接种可显著提高AIR和EIR。这些发现支持双剂量策略来优化IBD患者的血清转化，特别是那些接受免疫抑制治疗的患者。

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引用次数: 0

Clinical Trial: Hepatitis B Virus Genotype and a Combination of End-of-Treatment Biomarkers Predict Severe Flares After Nucleos(t)ide Analogue Cessation 临床试验：乙型肝炎病毒基因型和治疗结束生物标志物的组合预测核苷类似物停止后的严重急性发作

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Alimentary Pharmacology & Therapeutics

Pub Date : 2025-11-19 DOI: 10.1111/apt.70465

Arno Furquim d’Almeida, Axelle Vanderlinden, Stefan Bourgeois, Jean-Pierre Mulkay, Thomas Sersté, Mathieu Struyve, Baro Deressa, Dirk Sprengers, Marie de Vos, Jos Callens, Bao Shihao, Hendrik Reynaert, Pierre Deltenre, Filip Janssens, Sergio Negrin-Dastis, Peter Stärkel, Hans Orlent, Guy Van Roey, Xavier Verhelst, Christophe Moreno, Jean Delwaide, Christophe Van Steenkiste, Wim Verlinden, Isabelle Colle, Marie-Laure Plissonnier, Benoît Kabamba Mukadi, Barbara Testoni, Fabien Zoulim, Veerle Matheeussen, Thomas Vanwolleghem

Background

Nucleos(t)ide analogue (NUC) cessation can induce a functional cure in chronic hepatitis B virus (HBV) infections, but severe post-cessation virologic relapses (SVRel) and severe biochemical flares (SBF) frequently occur.

Aims

To identify predictive biomarkers for patients at highest risk for SVRel and SBF.

Methods

In the multicentre prospective COIN-B trial, start-of-treatment HBeAg-negative, long-term virologically suppressed patients without advanced fibrosis are followed up for 72 weeks after NUC cessation. We performed a predefined exploratory analysis of the associations between HBV genotype, or end-of-treatment (EOT) biomarkers (HBcrAg, HBV RNA, HBsAg, and anti-HBc IgG) and SVRel (HBV DNA > 5 log IU/mL) or SBF (ALT > 10× ULN) within 48 weeks post-cessation.

Results

Of 91 recruited patients, 85 completed 48 weeks of follow-up. SVRel and SBF occurred in 36 (42.4%) and 21 (24.7%) patients, respectively. Genotypes C, D, and E were associated with higher relapse and flare rates, whereas none of the 18 genotype A patients developed SBF. In multivariate analysis, SVRel was independently associated with detectable HBcrAg (aOR 3.93, p = 0.01), and SBF with non-A genotype (aOR 19.03, p = 0.018), detectable HBV RNA (aOR 7.84, p = 0.005), and lower anti-HBc IgG levels (aOR 0.31, p = 0.016). A risk stratification tool, the COBRA score, was developed incorporating HBcrAg, HBV RNA, and anti-HBc IgG. A score ≥ 2 identified patients at increased risk, with 80.0% sensitivity and 90.7% NPV for SBF.

Conclusions

HBV genotype and EOT biomarkers, including HBcrAg, HBV RNA, and anti-HBc IgG predict SVRel and SBF following NUC cessation. The COBRA score enables pragmatic, individualised risk stratification.

Trial Registration

ClinicalTrials.gov identifier: NCT04779970, EudraCT: 2021-001003-32

背景：停止使用核苷类似物（NUC）可以诱导慢性乙型肝炎病毒（HBV）感染的功能性治愈，但经常发生严重的戒烟后病毒学复发（SVRel）和严重的生化发作（SBF）。目的确定SVRel和SBF最高风险患者的预测性生物标志物。方法在多中心前瞻性COIN - B试验中，开始治疗的HBeAg阴性、长期病毒学抑制的无晚期纤维化患者在NUC停止后随访72周。我们对停药后48周内HBV基因型或治疗结束（EOT）生物标志物（HBcrAg、HBV RNA、HBsAg和抗HBc IgG）与SVRel （HBV DNA > 5 log IU/mL）或SBF （ALT > 10× ULN）之间的相关性进行了预先定义的探索性分析。结果在91名被招募的患者中，85名完成了48周的随访。SVRel和SBF分别发生36例（42.4%）和21例（24.7%）。基因型C、D和E与较高的复发和爆发率相关，而18例基因型A患者均未发生SBF。在多变量分析中，SVRel与可检测的HBcrAg （aOR 3.93, p = 0.01）、非A基因型SBF （aOR 19.03, p = 0.018）、可检测的HBV RNA （aOR 7.84, p = 0.005）和较低的抗HBc IgG水平（aOR 0.31, p = 0.016）独立相关。我们开发了一种风险分层工具，即COBRA评分，纳入HBcrAg、HBV RNA和抗HBc IgG。评分≥2分表明患者风险增加，SBF的敏感性为80.0%，NPV为90.7%。结论：HBV基因型和EOT生物标志物，包括HBcrAg、HBV RNA和抗HBc IgG，可预测NUC停止后的SVRel和SBF。COBRA评分可以实现实用的、个性化的风险分层。临床试验注册：ClinicalTrials.gov编号：NCT04779970，草案编号：2021‐001003‐32

{"title":"Clinical Trial: Hepatitis B Virus Genotype and a Combination of End-of-Treatment Biomarkers Predict Severe Flares After Nucleos(t)ide Analogue Cessation","authors":"Arno Furquim d’Almeida, Axelle Vanderlinden, Stefan Bourgeois, Jean-Pierre Mulkay, Thomas Sersté, Mathieu Struyve, Baro Deressa, Dirk Sprengers, Marie de Vos, Jos Callens, Bao Shihao, Hendrik Reynaert, Pierre Deltenre, Filip Janssens, Sergio Negrin-Dastis, Peter Stärkel, Hans Orlent, Guy Van Roey, Xavier Verhelst, Christophe Moreno, Jean Delwaide, Christophe Van Steenkiste, Wim Verlinden, Isabelle Colle, Marie-Laure Plissonnier, Benoît Kabamba Mukadi, Barbara Testoni, Fabien Zoulim, Veerle Matheeussen, Thomas Vanwolleghem","doi":"10.1111/apt.70465","DOIUrl":"10.1111/apt.70465","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nucleos(t)ide analogue (NUC) cessation can induce a functional cure in chronic hepatitis B virus (HBV) infections, but severe post-cessation virologic relapses (SVRel) and severe biochemical flares (SBF) frequently occur.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To identify predictive biomarkers for patients at highest risk for SVRel and SBF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the multicentre prospective COIN-B trial, start-of-treatment HBeAg-negative, long-term virologically suppressed patients without advanced fibrosis are followed up for 72 weeks after NUC cessation. We performed a predefined exploratory analysis of the associations between HBV genotype, or end-of-treatment (EOT) biomarkers (HBcrAg, HBV RNA, HBsAg, and anti-HBc IgG) and SVRel (HBV DNA > 5 log IU/mL) or SBF (ALT > 10× ULN) within 48 weeks post-cessation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 91 recruited patients, 85 completed 48 weeks of follow-up. SVRel and SBF occurred in 36 (42.4%) and 21 (24.7%) patients, respectively. Genotypes C, D, and E were associated with higher relapse and flare rates, whereas none of the 18 genotype A patients developed SBF. In multivariate analysis, SVRel was independently associated with detectable HBcrAg (aOR 3.93, <i>p</i> = 0.01), and SBF with non-A genotype (aOR 19.03, <i>p</i> = 0.018), detectable HBV RNA (aOR 7.84, <i>p</i> = 0.005), and lower anti-HBc IgG levels (aOR 0.31, <i>p</i> = 0.016). A risk stratification tool, the COBRA score, was developed incorporating HBcrAg, HBV RNA, and anti-HBc IgG. A score ≥ 2 identified patients at increased risk, with 80.0% sensitivity and 90.7% NPV for SBF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HBV genotype and EOT biomarkers, including HBcrAg, HBV RNA, and anti-HBc IgG predict SVRel and SBF following NUC cessation. The COBRA score enables pragmatic, individualised risk stratification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT04779970, EudraCT: 2021-001003-32</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"63 3","pages":"352-361"},"PeriodicalIF":6.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553261","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}

引用次数: 0

Editorial: Understanding How Social Determinants of Health Impact Mortality in MASLD —Insights From a National Analysis 社论：了解健康的社会决定因素如何影响MASLD的死亡率-来自国家分析的见解

IF 7.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Alimentary Pharmacology & Therapeutics

Pub Date : 2025-11-18 DOI: 10.1111/apt.70461

Joyce Lui, Yesung Kweon, Mohamed I. Elsaid

引用次数: 0

Editorial: Understanding How Social Determinants of Health Impact Mortality in MASLD —Insights From a National Analysis. Authors' Reply 社论：了解健康的社会决定因素如何影响MASLD的死亡率-来自国家分析的见解。作者的回复

IF 7.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Alimentary Pharmacology & Therapeutics

Pub Date : 2025-11-18 DOI: 10.1111/apt.70472

Donghee Kim, Pojsakorn Danpanichkul, Karn Wijarnpreecha, Rohit Loomba, Aijaz Ahmed

引用次数: 0

Editorial: Mitigating the Risk of Adverse Pregnancy Outcomes in Women With Inflammatory Bowel Disease and Chronic Liver Disease. 社论：减轻炎症性肠病和慢性肝病妇女不良妊娠结局的风险。

IF 7.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Alimentary Pharmacology & Therapeutics

Pub Date : 2025-11-17 DOI: 10.1111/apt.70444

Yooyun Chung,Jeremy Shanika Nayagam

引用次数: 0

Editorial: Mitigating the Risk of Adverse Pregnancy Outcomes in Women With Inflammatory Bowel Disease and Chronic Liver Disease-Authors' Reply. 社论：减轻炎症性肠病和慢性肝病妇女不良妊娠结局的风险作者回复

IF 7.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Alimentary Pharmacology & Therapeutics

Pub Date : 2025-11-17 DOI: 10.1111/apt.70467

Jessica D Lee,Konstantinos Papamichael,Lauren T Grinspan,Adam S Cheifetz,Melissa Spiel,Tatyana Kushner,Loren G Rabinowitz

引用次数: 0

Gastrointestinal Cancer Risk in Steatotic Liver Diseases: MASLD , MetALD and ALD 脂肪变性肝病的胃肠癌风险：MASLD， MetALD和ALD

IF 7.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Alimentary Pharmacology & Therapeutics

Pub Date : 2025-11-15 DOI: 10.1111/apt.70466

Nobuharu Tamaki, Takefumi Kimura, Shun‐Ichi Wakabayashi, Naoki Tanaka, Namiki Izumi, Rohit Loomba, Masayuki Kurosaki

Background Steatotic liver disease (SLD), which encompasses metabolic dysfunction‐associated SLD (MASLD), MASLD with increased alcohol intake (MetALD) and alcohol‐associated liver disease (ALD), is recognised as a risk factor for gastrointestinal cancers. However, the comparative risk of gastrointestinal cancers among MASLD, MetALD and ALD remains unclear. Methods We used a Japanese, nationwide, health insurance claims database between 2005 and 2024, encompassing approximately 10 million individuals and conducted a nationwide, population‐based cohort study including 978,607 patients with MASLD, 366,152 with MetALD, 152,721 with ALD and 4,884,398 control individuals. The primary outcome was the incidence of gastrointestinal cancers, including hepatocellular carcinoma (HCC), biliary tract cancer, oesophageal cancer, gastric cancer, colorectal cancer and pancreatic cancer. Results Compared to controls, the adjusted hazard ratios (HRs) for HCC ranged from 3.55 to 5.39 across the MASLD, MetALD and ALD and from 1.45 to 1.66 for biliary tract cancer. The risks of both HCC and biliary tract cancer were significantly elevated in all SLD subgroups compared to controls. For oesophageal, gastric and colorectal cancers, the aHRs ranged from 0.75 to 1.26 in MASLD, from 1.09 to 1.44 in MetALD and from 1.13 to 2.48 in ALD, indicating increasing risk with greater alcohol consumption. The risk of pancreatic cancer was comparable to that in controls for both MetALD and ALD. Conclusions Patients with SLD, including MASLD, MetALD and ALD, have a significantly higher risk of gastrointestinal cancers compared to the controls. The degree of risk varies according to the underlying liver disease subtype, particularly in relation to alcohol consumption. These findings underscore the importance of implementing risk‐stratified cancer screening strategies in patients with SLD.

脂肪变性肝病（SLD），包括代谢功能障碍相关的SLD （MASLD）、酒精摄入增加（MetALD）和酒精相关肝病（ALD），被认为是胃肠道癌症的危险因素。然而，MASLD、MetALD和ALD之间胃肠道癌症的比较风险尚不清楚。方法：我们使用了日本2005年至2024年间的全国性健康保险索赔数据库，涵盖了大约1000万人，并进行了一项全国性的、基于人群的队列研究，包括978,607名MASLD患者、366,152名MetALD患者、152,721名ALD患者和4,884,398名对照个体。主要观察指标是胃肠道肿瘤的发生率，包括肝细胞癌（HCC）、胆道癌、食管癌、胃癌、结直肠癌和胰腺癌。结果与对照组相比，MASLD、MetALD和ALD的HCC校正风险比（hr）在3.55 - 5.39之间，胆道癌在1.45 - 1.66之间。与对照组相比，所有SLD亚组中HCC和胆道癌的风险均显著升高。对于食管癌、胃癌和结直肠癌，MASLD的ahr范围为0.75至1.26，MetALD的ahr范围为1.09至1.44，ALD的ahr范围为1.13至2.48，表明饮酒越多，风险越高。患胰腺癌的风险与MetALD和ALD的对照组相当。结论：与对照组相比，包括MASLD、MetALD和ALD在内的SLD患者发生胃肠道癌症的风险明显更高。风险程度因潜在的肝脏疾病亚型而异，特别是与饮酒有关。这些发现强调了在SLD患者中实施风险分层癌症筛查策略的重要性。

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