Sai Kiran Kuchana, Raj Vuppalanchi, Archita P. Desai
{"title":"Letter on: ‘Impact of Frailty on the Prognosis of Patients With Liver Cirrhosis Undergoing Insertion of a TIPS ’","authors":"Sai Kiran Kuchana, Raj Vuppalanchi, Archita P. Desai","doi":"10.1111/apt.70545","DOIUrl":"https://doi.org/10.1111/apt.70545","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"29 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101413","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}
Christian Labenz, Martin A. Kabelitz, Simon J. Gairing, Lisa Sandmann, Benjamin Maasoumy
{"title":"Letter on: ‘Impact of Frailty on the Prognosis of Patients With Liver Cirrhosis Undergoing Insertion of a TIPS ’. Authors' Reply","authors":"Christian Labenz, Martin A. Kabelitz, Simon J. Gairing, Lisa Sandmann, Benjamin Maasoumy","doi":"10.1111/apt.70554","DOIUrl":"https://doi.org/10.1111/apt.70554","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"57 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101430","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: Rifaximin Versus Low FODMAP Diet in IBS : What the Primary Endpoint Does Not Tell Us","authors":"Luisa Bertin, Edoardo Vincenzo Savarino","doi":"10.1111/apt.70533","DOIUrl":"https://doi.org/10.1111/apt.70533","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"67 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071540","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: A Patient Centric Approach to Tapering Steroids in Steroid Responsive Moderate to Severely Active Ulcerative Colitis. Authors' Reply.","authors":"Amol N Patil,Ankit Kumar,Vishal Sharma","doi":"10.1111/apt.70552","DOIUrl":"https://doi.org/10.1111/apt.70552","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"73 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069979","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}
David Beaton,Mahmoud Mohamed,Linda Sharp,Keith Pohl,Matthew Rutter
BACKGROUNDThe UK has adopted faecal immunochemical testing (FIT) to triage symptomatic colonoscopy referrals.OBJECTIVEQuantify diagnostic yield and independent effects of FIT, age, sex and symptoms on polyp and cancer detection in symptomatic colonoscopy.DESIGNNationwide analysis of prospectively collected colonoscopy reports (June 2023-August 2025) from the National Endoscopy Database. Symptomatic procedures, including iron-deficiency anaemia (IDA), were identified and diagnostic yields calculated. Mixed-effects logistic regression estimated adjusted odds ratios (aORs) with age, sex, symptom group and FIT. Post-estimation margins modelled cancer yield by age, FIT and symptoms.RESULTSAnalysis of 447,109 symptomatic colonoscopies, with FIT recorded in 202,219 (45.2%). Overall cancer yield was 1.9% (95% CI, 1.8-1.9). Cancer yield was 3.8% (95% CI, 3.7-3.9) in FIT ≥ 10, including 2.5% (95% CI, 2.3-2.7) at age 40-49 and 0.6% (95% CI, 0.5-0.7) at age 16-39; yield in FIT < 10 was 0.3% (95% CI, 0.2-0.3). FIT concentration showed a strong, graded association with cancer risk, weaker association with large polyps, and minimal association with small polyps. IDA was associated with higher cancer risk versus rectal bleeding (aOR 2.2, 95% CI, 2.0-2.3; p < 0.01). With FIT < 10, cancer yield exceeded 1% only in IDA patients aged > 80 and remained < 0.5% otherwise. A model combining FIT, age, and IDA detected > 94% of cancers while reducing colonoscopy demand by > 40%.CONCLUSIONThis national analysis demonstrates the superiority of FIT-based triage over symptom-based referral, with FIT ≥ 10 identifying high-risk patients, including those aged 40-49, while FIT < 10 indicated very low risk.
{"title":"Real-World Performance of FIT Triage for Symptomatic Colonoscopy: Analysis of the UK National Endoscopy Database (NED).","authors":"David Beaton,Mahmoud Mohamed,Linda Sharp,Keith Pohl,Matthew Rutter","doi":"10.1111/apt.70537","DOIUrl":"https://doi.org/10.1111/apt.70537","url":null,"abstract":"BACKGROUNDThe UK has adopted faecal immunochemical testing (FIT) to triage symptomatic colonoscopy referrals.OBJECTIVEQuantify diagnostic yield and independent effects of FIT, age, sex and symptoms on polyp and cancer detection in symptomatic colonoscopy.DESIGNNationwide analysis of prospectively collected colonoscopy reports (June 2023-August 2025) from the National Endoscopy Database. Symptomatic procedures, including iron-deficiency anaemia (IDA), were identified and diagnostic yields calculated. Mixed-effects logistic regression estimated adjusted odds ratios (aORs) with age, sex, symptom group and FIT. Post-estimation margins modelled cancer yield by age, FIT and symptoms.RESULTSAnalysis of 447,109 symptomatic colonoscopies, with FIT recorded in 202,219 (45.2%). Overall cancer yield was 1.9% (95% CI, 1.8-1.9). Cancer yield was 3.8% (95% CI, 3.7-3.9) in FIT ≥ 10, including 2.5% (95% CI, 2.3-2.7) at age 40-49 and 0.6% (95% CI, 0.5-0.7) at age 16-39; yield in FIT < 10 was 0.3% (95% CI, 0.2-0.3). FIT concentration showed a strong, graded association with cancer risk, weaker association with large polyps, and minimal association with small polyps. IDA was associated with higher cancer risk versus rectal bleeding (aOR 2.2, 95% CI, 2.0-2.3; p < 0.01). With FIT < 10, cancer yield exceeded 1% only in IDA patients aged > 80 and remained < 0.5% otherwise. A model combining FIT, age, and IDA detected > 94% of cancers while reducing colonoscopy demand by > 40%.CONCLUSIONThis national analysis demonstrates the superiority of FIT-based triage over symptom-based referral, with FIT ≥ 10 identifying high-risk patients, including those aged 40-49, while FIT < 10 indicated very low risk.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"397 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056493","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}
Ana Alberola,Adolfo de Salazar,Ana Fuentes,Raquel Carracedo,Marta Illescas-López,María Del Carmen Rodríguez Baños,Carolina Freyre,Berta Becerril,Isabel Viciana,Inmaculada López-Rodríguez,Natalia Montiel,Ana María Domínguez Castaño,María Pilar Luzón-García,Encarnación Ramírez Arellano,Carmen Liébana-Martos,Francisco Franco Álvarez de Luna,María Del Carmen Lozano,Begoña Palop,Antonio Sampedro,Ana Belén Pérez,Sonia Algarate,Susana Rojo Alba,Pablo Fraile,Dolores Ocete,María Jesús Alcaraz,Juan Carlos Rodríguez,Francisco Javier Hernández-Felices,Olalla Martínez,Victoria Domínguez,Nieves Orta,Dolores Gómez,Carmen Cortell,Jorge Camacho,Susana Sabater,Luis Ángel Iglesias Sánchez,Yasmina Martín,Aldara Vallejo,Lourdes Molina,María Aroca,Beatriz Castro,Magdalena Lara,María José Pena,Ana Rodríguez-Fernández,Alejandro González Praetorius,José Joaquín Blas,Alicia Beteta,César Gómez,María José Rodríguez,Soledad Illescas,Melanie Abreu,Julio García Díez,Inocencio Beltrán,Marta Sandoval Torrientes,Ruth Sáez,Teresa Martín,Pilar Tajada Alegre,Belén Lorenzo,María Teresa García Valero,Isabel Jiménez Sansegundo,Susana García-de Cruz,Sonsoles Garcinuño,Miguel Ángel Sáiz,Santiago Muñoz,Isabel Fernández,Helena Miriam Lorenzo Juanes,María Reyes Vidal-Acuña,Luz María Moldes,Noelia Calvo,Matilde Trigo,María José Gude,Patricia Ordóñez,Sandra Cortizo,Miriam Blasco,Mayra Sigcha,Iker Falces,Juan Carlos Galán,Ana Arribi,Roberto Alonso,Asunción Iborra,María Jesús Del Amor Espín,Eva Cascales,Cayetano Pérez,Pablo Fernández,María Dolores Navarro,María Luz Nuñez,Jorge Galán Ros,Luis Javier Gil-Gallardo,Ana Miqueleiz,Gabriel Reina,Luis Elorduy,Mikele Macho,Carmen Gómez,Paloma Liendo,Yolanda Salicio,Antonio Aguilera,Federico García
BACKGROUNDHepatitis delta virus accelerates liver disease progression in chronic hepatitis B, yet remains underdiagnosed. Guidelines recommend double reflex diagnostic testing with antibody testing followed by viral load testing, but uptake remains inconsistent.AIMSTo evaluate double reflex diagnostic implementation in Spain during the retrospective phase of the Spain Double Reflex Diagnostic study.METHODSNationwide, multicenter retrospective analysis of individuals positive for hepatitis B surface antigen (2022-2024) from 80 centers. Laboratory data included hepatitis B surface antigen, hepatitis delta virus antibody and hepatitis delta virus viral load. Uptake rates, hepatitis delta virus antibody positivity, viral load confirmation and viral load-confirmed prevalence were calculated with 95% confidence intervals.RESULTSAmong 65,763 individuals positive for hepatitis B surface antigen, hepatitis delta virus antibody testing uptake increased from 55.1% (54.4-55.8) in 2022 (n = 18,986) to 72.5% (71.9-73.1) in 2023 (n = 22,463) and 85.8% (85.1-86.4) in 2024 (n = 24,314; p < 0.0001). Antibody positivity remained stable (5.6%, 4.9%, 5.3%). Viral load confirmation among antibody-positive patients improved from 72.6% in 2022 to 90.8% in 2023 and 91.0% in 2024. Viral load-confirmed prevalence among antibody-positive individuals was 40.3% in 2022, 31.6% in 2023, and 30.1% in 2024. Regional heterogeneity was marked, with several autonomous communities achieving near-universal uptake (> 95%).CONCLUSIONBetween 2022 and 2024, double reflex diagnostic implementation expanded rapidly, demonstrating national feasibility and describing hepatitis D virus seroprevalence. However, regional inequities persist. Sustained uptake will require standardised reflex protocols, harmonization of viral load assays and continuous training to reduce underdiagnosis and improve care of coinfected patients.
{"title":"Nationwide Implementation of Double Reflex Testing for Hepatitis Delta in Spain: Results From the Retrospective Phase of the Spain-DDR Study.","authors":"Ana Alberola,Adolfo de Salazar,Ana Fuentes,Raquel Carracedo,Marta Illescas-López,María Del Carmen Rodríguez Baños,Carolina Freyre,Berta Becerril,Isabel Viciana,Inmaculada López-Rodríguez,Natalia Montiel,Ana María Domínguez Castaño,María Pilar Luzón-García,Encarnación Ramírez Arellano,Carmen Liébana-Martos,Francisco Franco Álvarez de Luna,María Del Carmen Lozano,Begoña Palop,Antonio Sampedro,Ana Belén Pérez,Sonia Algarate,Susana Rojo Alba,Pablo Fraile,Dolores Ocete,María Jesús Alcaraz,Juan Carlos Rodríguez,Francisco Javier Hernández-Felices,Olalla Martínez,Victoria Domínguez,Nieves Orta,Dolores Gómez,Carmen Cortell,Jorge Camacho,Susana Sabater,Luis Ángel Iglesias Sánchez,Yasmina Martín,Aldara Vallejo,Lourdes Molina,María Aroca,Beatriz Castro,Magdalena Lara,María José Pena,Ana Rodríguez-Fernández,Alejandro González Praetorius,José Joaquín Blas,Alicia Beteta,César Gómez,María José Rodríguez,Soledad Illescas,Melanie Abreu,Julio García Díez,Inocencio Beltrán,Marta Sandoval Torrientes,Ruth Sáez,Teresa Martín,Pilar Tajada Alegre,Belén Lorenzo,María Teresa García Valero,Isabel Jiménez Sansegundo,Susana García-de Cruz,Sonsoles Garcinuño,Miguel Ángel Sáiz,Santiago Muñoz,Isabel Fernández,Helena Miriam Lorenzo Juanes,María Reyes Vidal-Acuña,Luz María Moldes,Noelia Calvo,Matilde Trigo,María José Gude,Patricia Ordóñez,Sandra Cortizo,Miriam Blasco,Mayra Sigcha,Iker Falces,Juan Carlos Galán,Ana Arribi,Roberto Alonso,Asunción Iborra,María Jesús Del Amor Espín,Eva Cascales,Cayetano Pérez,Pablo Fernández,María Dolores Navarro,María Luz Nuñez,Jorge Galán Ros,Luis Javier Gil-Gallardo,Ana Miqueleiz,Gabriel Reina,Luis Elorduy,Mikele Macho,Carmen Gómez,Paloma Liendo,Yolanda Salicio,Antonio Aguilera,Federico García","doi":"10.1111/apt.70543","DOIUrl":"https://doi.org/10.1111/apt.70543","url":null,"abstract":"BACKGROUNDHepatitis delta virus accelerates liver disease progression in chronic hepatitis B, yet remains underdiagnosed. Guidelines recommend double reflex diagnostic testing with antibody testing followed by viral load testing, but uptake remains inconsistent.AIMSTo evaluate double reflex diagnostic implementation in Spain during the retrospective phase of the Spain Double Reflex Diagnostic study.METHODSNationwide, multicenter retrospective analysis of individuals positive for hepatitis B surface antigen (2022-2024) from 80 centers. Laboratory data included hepatitis B surface antigen, hepatitis delta virus antibody and hepatitis delta virus viral load. Uptake rates, hepatitis delta virus antibody positivity, viral load confirmation and viral load-confirmed prevalence were calculated with 95% confidence intervals.RESULTSAmong 65,763 individuals positive for hepatitis B surface antigen, hepatitis delta virus antibody testing uptake increased from 55.1% (54.4-55.8) in 2022 (n = 18,986) to 72.5% (71.9-73.1) in 2023 (n = 22,463) and 85.8% (85.1-86.4) in 2024 (n = 24,314; p < 0.0001). Antibody positivity remained stable (5.6%, 4.9%, 5.3%). Viral load confirmation among antibody-positive patients improved from 72.6% in 2022 to 90.8% in 2023 and 91.0% in 2024. Viral load-confirmed prevalence among antibody-positive individuals was 40.3% in 2022, 31.6% in 2023, and 30.1% in 2024. Regional heterogeneity was marked, with several autonomous communities achieving near-universal uptake (> 95%).CONCLUSIONBetween 2022 and 2024, double reflex diagnostic implementation expanded rapidly, demonstrating national feasibility and describing hepatitis D virus seroprevalence. However, regional inequities persist. Sustained uptake will require standardised reflex protocols, harmonization of viral load assays and continuous training to reduce underdiagnosis and improve care of coinfected patients.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"18 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056848","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: A Patient Centric Approach to Tapering Steroids in Steroid Responsive Moderate to Severely Active Ulcerative Colitis.","authors":"Ganesh Bhat,Athish Shetty","doi":"10.1111/apt.70546","DOIUrl":"https://doi.org/10.1111/apt.70546","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"72 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069992","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}
<p>We sincerely thank Hofer and colleagues for their insightful commentary [<span>1</span>] on our study describing the concept of ‘unstable recompensation’ in hepatitis B virus (HBV)-related decompensated cirrhosis [<span>2</span>]. Their letter thoughtfully underscores the evolving paradigm of hepatic recompensation as a dynamic process, wherein serial assessment of laboratory markers provides superior prognostic information compared with static baseline evaluations.</p><p>Importantly, we appreciate the insightful emphasising the monitoring of hepatic function trajectories rather than a baseline level. Whether MELD predicts hepatic recompensation appears to be highly dependent on the disease state at the time of assessment. In the previous studies by Hofer et al., patients were evaluated during a relatively stable phase after a period of effective etiological control, in which higher MELD values most likely reflected impaired and largely irreversible hepatic functional reserve, thereby being associated with a lower likelihood of recompensation [<span>3</span>]. In contrast, in our study, higher baseline MELD levels may largely reflect acute necroinflammatory activity and disease instability, representing a potentially reversible process rather than fixed hepatic dysfunction. Accordingly, longitudinal changes in hepatic function markers provide more meaningful information for characterising recompensation trajectories. Moreover, predictors of recompensation vary across etiologies: albumin ≥ 34 g/L at 24 weeks in HBV cirrhosis [<span>4</span>], lymphocyte-to-monocyte ratio in primary biliary cholangitis [<span>5</span>], and IgG, bilirubin, and platelet levels in autoimmune hepatitis [<span>6</span>].</p><p>Furthermore, regarding portal hypertension, our study found that patients whose initial decompensation subtype was variceal bleeding had lower recompensation rates and a worse prognosis compared to those presenting with ascites [<span>7</span>]. This indicates that portal hypertension may persist despite clinical improvement. In terms of non-invasive monitoring, our data showed that baseline platelet counts correlate with stable recompensation, but 6-month trajectories do not provide additional prognostic value, which may reflect the delayed or incomplete reversibility of portal hypertension despite clinical recompensation as the authors mentioned.</p><p>We also appreciate the authors' discussion of the concept of ‘unstable recompensation’. Our proposed concept of ‘unstable recompensation’ emerged from long-term patient monitoring and highlights that recompensation is neither binary nor unidirectional, but a changing state requiring serial evaluation. While Baveno VII and expansion of Baveno VII recompensation criteria recommend a one-year assessment window [<span>8, 9</span>], our previous data suggest that extending observation to 2 years may better capture long-term stability [<span>10</span>], indicating that optimal timing for evaluation
{"title":"Letter: Trajectories of Hepatic Function Markers Enable Early Prediction of Hepatic Recompensation—Authors' Reply","authors":"Shuai Xia, Bingqiong Wang, Xiaoning Wu, Hong You","doi":"10.1111/apt.70542","DOIUrl":"10.1111/apt.70542","url":null,"abstract":"<p>We sincerely thank Hofer and colleagues for their insightful commentary [<span>1</span>] on our study describing the concept of ‘unstable recompensation’ in hepatitis B virus (HBV)-related decompensated cirrhosis [<span>2</span>]. Their letter thoughtfully underscores the evolving paradigm of hepatic recompensation as a dynamic process, wherein serial assessment of laboratory markers provides superior prognostic information compared with static baseline evaluations.</p><p>Importantly, we appreciate the insightful emphasising the monitoring of hepatic function trajectories rather than a baseline level. Whether MELD predicts hepatic recompensation appears to be highly dependent on the disease state at the time of assessment. In the previous studies by Hofer et al., patients were evaluated during a relatively stable phase after a period of effective etiological control, in which higher MELD values most likely reflected impaired and largely irreversible hepatic functional reserve, thereby being associated with a lower likelihood of recompensation [<span>3</span>]. In contrast, in our study, higher baseline MELD levels may largely reflect acute necroinflammatory activity and disease instability, representing a potentially reversible process rather than fixed hepatic dysfunction. Accordingly, longitudinal changes in hepatic function markers provide more meaningful information for characterising recompensation trajectories. Moreover, predictors of recompensation vary across etiologies: albumin ≥ 34 g/L at 24 weeks in HBV cirrhosis [<span>4</span>], lymphocyte-to-monocyte ratio in primary biliary cholangitis [<span>5</span>], and IgG, bilirubin, and platelet levels in autoimmune hepatitis [<span>6</span>].</p><p>Furthermore, regarding portal hypertension, our study found that patients whose initial decompensation subtype was variceal bleeding had lower recompensation rates and a worse prognosis compared to those presenting with ascites [<span>7</span>]. This indicates that portal hypertension may persist despite clinical improvement. In terms of non-invasive monitoring, our data showed that baseline platelet counts correlate with stable recompensation, but 6-month trajectories do not provide additional prognostic value, which may reflect the delayed or incomplete reversibility of portal hypertension despite clinical recompensation as the authors mentioned.</p><p>We also appreciate the authors' discussion of the concept of ‘unstable recompensation’. Our proposed concept of ‘unstable recompensation’ emerged from long-term patient monitoring and highlights that recompensation is neither binary nor unidirectional, but a changing state requiring serial evaluation. While Baveno VII and expansion of Baveno VII recompensation criteria recommend a one-year assessment window [<span>8, 9</span>], our previous data suggest that extending observation to 2 years may better capture long-term stability [<span>10</span>], indicating that optimal timing for evaluation ","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"63 5","pages":"772-773"},"PeriodicalIF":6.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056495","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}
Benedikt Silvester Hofer, Jan Embacher, Georg Semmler, Thomas Reiberger
<p>Hepatic recompensation has emerged as a distinct stage of cirrhosis [<span>1</span>], supporting the concept of disease regression even in the stage of decompensated cirrhosis once the underlying aetiological driver is controlled or removed [<span>2</span>]. Although previous studies have consistently demonstrated improved outcomes following recompensation [<span>3-6</span>], baseline predictors of a patient's recompensation likelihood vary across cohorts, aetiologies, and clinical scenarios.</p><p>Although liver disease severity has consistently been identified as a key determinant of recompensation [<span>3-5</span>], the predictive value of hepatic function markers appears context-dependent. For instance, while lower MELD robustly predicted recompensation in clinically stable patients [<span>3, 5</span>], higher MELD was linked to increased recompensation rates in patients with ongoing hepatic necroinflammation due to viral hepatitis [<span>6</span>].</p><p>Xia et al. [<span>7</span>] now provide insights into recompensation in decompensated hepatitis B virus (HBV) cirrhosis, reporting a recompensation rate of 78% and providing data on the context-specific role of laboratory markers of hepatic function and portal hypertension. They also introduce the term ‘unstable recompensation’ to describe patients who either experienced another decompensating event after recompensation or achieved recompensation only after multiple decompensating events. The ‘unstable recompensated’ patients comprised 31% of the recompensated cohort and had an intermediate prognosis compared to those with stable recompensation or ongoing decompensation.</p><p>Patients who achieved stable recompensation not only exhibited more pronounced hepatic inflammation (higher transaminases) at baseline, but also a higher baseline MELD and Child-Pugh score—primarily driven by elevated bilirubin levels. Simultaneously, those with stable recompensation also showed the largest reductions in bilirubin, MELD, and Child-Pugh score at 6 months, thus supporting the hypothesis that elevated baseline transaminases and bilirubin seem to reflect a severe and acute but potentially reversible necroinflammatory process rather than chronic (and thus, less reversible) hepatic functional impairment. Moreover, despite similar baseline albumin levels, albumin increased most substantially in patients with stable recompensation. Accordingly, while there was no link between baseline albumin and the likelihood of recompensation, albumin re-assessed at 6 months was a predictor of recompensation. These findings reinforce the proposed value of monitoring dynamic changes in hepatic function to predict recompensation, which is consistent with the association of on-treatment albumin levels in HBV [<span>6, 8</span>] and changes in MELD and albumin after 90 days of abstinence in alcohol-related cirrhosis [<span>9</span>].</p><p>Conversely, baseline platelet count was higher in patients with stable recompensation
肝脏再代偿已成为肝硬化[1]的一个独特阶段，一旦潜在的病因驱动因素得到控制或移除[1]，即使在失代偿期的肝硬化阶段，也支持疾病消退的概念。尽管先前的研究一致表明，再代偿后的预后得到改善[3-6]，但患者再代偿可能性的基线预测因素因队列、病因和临床情况而异。虽然肝病严重程度一直被认为是再代偿的关键决定因素[3-5]，但肝功能标志物的预测价值似乎与环境有关。例如，虽然较低的MELD有力地预测了临床稳定患者的再代偿[3,5]，但较高的MELD与病毒性肝炎引起的持续肝坏死炎症患者的再代偿率增加有关。现在，Xia等人对失代偿期乙型肝炎病毒（HBV）肝硬化的再代偿进行了深入研究，报告了78%的再代偿率，并提供了肝功能和门静脉高压症实验室标志物在特定情境下的作用的数据。他们还引入了术语“不稳定的补偿”来描述在补偿后经历另一次失代偿事件或仅在多次失代偿事件后才获得补偿的患者。“不稳定补偿”患者占补偿队列的31%，与稳定补偿或持续失代偿的患者相比，预后中等。获得稳定再补偿的患者不仅在基线时表现出更明显的肝脏炎症（转氨酶升高），而且基线MELD和Child-Pugh评分也更高，这主要是由胆红素水平升高引起的。同时，那些具有稳定的再补偿的患者在6个月时胆红素、MELD和Child-Pugh评分的降低幅度最大，因此支持了这样的假设，即基线转氨酶和胆红素升高似乎反映了严重的急性但潜在可逆的坏死炎症过程，而不是慢性（因此不可逆）肝功能损害。此外，尽管基线白蛋白水平相似，但在稳定的再代偿患者中白蛋白增加最多。因此，虽然基线白蛋白与再代偿的可能性之间没有联系，但在6个月时重新评估白蛋白是再代偿的预测因子。这些发现强化了监测肝功能动态变化以预测再代偿的价值，这与治疗期间HBV白蛋白水平[6,8]与酒精相关性肝硬化患者戒断90天后MELD和白蛋白变化的相关性是一致的。相反，稳定的再代偿患者的基线血小板计数较高，这支持门脉高压严重程度对再代偿可能性的影响[3,6]。与MELD和白蛋白相比，反复测量血小板计数的变化在稳定、不稳定代偿患者和持续失代偿患者之间没有显著差异，这与血小板减少可能在代偿后持续存在的证据一致，即使临床显著的门脉高压解决了[10]。总的来说，我们要祝贺Xia等人的创新方法，该方法评估了获得代偿的患者肝功能实验室标志物的动态预后联系。由于失代偿性肝硬化表现时的肝功能可能（暂时）受到坏死性炎症的影响，因此在病因学治疗下临床稳定一段时间后重新评估实验室评估的预后价值可能更有价值。本尼迪克特·西尔维斯特·霍弗：构思，写作-原稿，写作-审查和编辑。Jan Embacher：概念化，写作-审查和编辑。格奥尔格·塞姆勒：概念化，写作-评论和编辑。Thomas Reiberger：概念化，写作-审查和编辑，监督。作者没有什么可报道的。得到了Ipsen和Falk的旅行支持。j。e。没什么可透露的。G.S.收到了狄索林的演讲酬金。T.R.获得了艾伯维、勃林格殷格翰、吉利德、Intercept/Advanz Pharma、默沙杜、迈尔制药、飞利浦医疗、Pliant、西门子和W. L. Gore & Associates的赠款支持，艾伯维、Echosens、吉利德、Intercept/Advanz Pharma、罗氏、默沙杜、W. L. Gore & Associates的演讲奖金，艾伯维、Astra Zeneca、拜耳、勃林格殷格翰、吉利德、Intercept/Advanz Pharma、默沙杜、Resolution Therapeutics、西门子的咨询/顾问委员会费用；以及来自艾伯维、勃林格殷格翰、福克制药、吉利德和罗氏的差旅支持。本文链接至Xia等人的论文。要查看这些文章，请访问https://doi.org/10.1111/apt.70430和https://doi.org/10.1111/apt.70542。 数据共享不适用于本文，因为在当前研究期间没有生成或分析数据集。
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