{"title":"Letter: Using Anti-HBs Titers to Tailor HBV Reactivation Monitoring in Patients With Solid Tumours-Authors' Reply.","authors":"Hans L Tillmann,Shiva Poola,MaryKate Kratzer","doi":"10.1111/apt.70541","DOIUrl":"https://doi.org/10.1111/apt.70541","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"22 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014929","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>Cirrhosis is an important cause of mortality worldwide, and the number is expected to rise over the next decade [<span>1</span>]. However, linkage-to-care has been a significant hurdle for patients with cirrhosis, leading to suboptimal diagnosis, as a recent study reported more than 85% of patients being unaware of their conditions [<span>2</span>]. Disparities are common in the healthcare system, hindering patients' engagement in clinical care, which ultimately affects the prognosis [<span>3</span>]. Although some hindering factors have been identified, a few have focused on this from a patient's perspective.</p> <p>In the current issue, Chai et al. conducted a survey study on 1332 patients with cirrhosis who have attended at least one clinic visit from four U.S. health systems, including one safety-net health system, one Veterans Affairs (VA) centre, and two tertiary referral centres, to investigate the patient-reported barriers linked to clinical care [<span>4</span>]. They were mostly non-Hispanic White, Hispanic, and Black, and had Child-Pugh class A cirrhosis (62.2%). Among all barriers, time to travel to the clinic (22.7%), long waiting time for appointments (21.6%), and difficulty scheduling clinic visits (19.2%) were the top three barriers reported. Those from the VA and safety-net system, who usually have lower socioeconomic status, had more trouble identifying the appropriate healthcare providers, scheduling, and arranging transportation to appointments compared to those at the tertiary centres. These findings were generally similar across subgroups classified by ethnicity, liver disease aetiology, and severity of cirrhosis.</p> <p>The study had the advantage of recruiting respondents from four centres from different healthcare systems in the U.S. The results were complementary to other studies reporting barriers linking to clinical care, including those from clinicians' perspectives, [<span>5</span>] in which both the perceptions from healthcare providers and patients should be addressed to enhance clinical care engagement. The results from these studies can benefit the development of adjunct pathways to streamline the management of patients with cirrhosis, including better resource allocation and development of care pathways for self-management of symptom control to alleviate some logistical barriers to clinical care, [<span>6, 7</span>] and digital healthcare algorithms that can mitigate the overburdened healthcare system [<span>8</span>]. Nonetheless, the study results require careful interpretation in some areas. First, the survey was conducted only in the U.S. among those who spoke English or Spanish, and hence the results may not be generalizable to the rest of the world with different ethnicities and healthcare systems, particularly to the Asia-Pacific region, where the burden of cirrhosis is the highest [<span>9</span>]. Only 26.4% of the potential patients responded and completed the survey, which could lead to biases as t
{"title":"Editorial: Linking Patients With Cirrhosis to Clinical Care—The Hurdles and Way Forward","authors":"Jimmy Che-To Lai, Junlong Dai","doi":"10.1111/apt.70540","DOIUrl":"https://doi.org/10.1111/apt.70540","url":null,"abstract":"<p>Cirrhosis is an important cause of mortality worldwide, and the number is expected to rise over the next decade [<span>1</span>]. However, linkage-to-care has been a significant hurdle for patients with cirrhosis, leading to suboptimal diagnosis, as a recent study reported more than 85% of patients being unaware of their conditions [<span>2</span>]. Disparities are common in the healthcare system, hindering patients' engagement in clinical care, which ultimately affects the prognosis [<span>3</span>]. Although some hindering factors have been identified, a few have focused on this from a patient's perspective.</p>\u0000<p>In the current issue, Chai et al. conducted a survey study on 1332 patients with cirrhosis who have attended at least one clinic visit from four U.S. health systems, including one safety-net health system, one Veterans Affairs (VA) centre, and two tertiary referral centres, to investigate the patient-reported barriers linked to clinical care [<span>4</span>]. They were mostly non-Hispanic White, Hispanic, and Black, and had Child-Pugh class A cirrhosis (62.2%). Among all barriers, time to travel to the clinic (22.7%), long waiting time for appointments (21.6%), and difficulty scheduling clinic visits (19.2%) were the top three barriers reported. Those from the VA and safety-net system, who usually have lower socioeconomic status, had more trouble identifying the appropriate healthcare providers, scheduling, and arranging transportation to appointments compared to those at the tertiary centres. These findings were generally similar across subgroups classified by ethnicity, liver disease aetiology, and severity of cirrhosis.</p>\u0000<p>The study had the advantage of recruiting respondents from four centres from different healthcare systems in the U.S. The results were complementary to other studies reporting barriers linking to clinical care, including those from clinicians' perspectives, [<span>5</span>] in which both the perceptions from healthcare providers and patients should be addressed to enhance clinical care engagement. The results from these studies can benefit the development of adjunct pathways to streamline the management of patients with cirrhosis, including better resource allocation and development of care pathways for self-management of symptom control to alleviate some logistical barriers to clinical care, [<span>6, 7</span>] and digital healthcare algorithms that can mitigate the overburdened healthcare system [<span>8</span>]. Nonetheless, the study results require careful interpretation in some areas. First, the survey was conducted only in the U.S. among those who spoke English or Spanish, and hence the results may not be generalizable to the rest of the world with different ethnicities and healthcare systems, particularly to the Asia-Pacific region, where the burden of cirrhosis is the highest [<span>9</span>]. Only 26.4% of the potential patients responded and completed the survey, which could lead to biases as t","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"1 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000952","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}
BACKGROUNDClassic bismuth quadruple therapy (BQT)-the combination of a proton pump inhibitor, bismuth, tetracycline, and metronidazole-is a standard regimen for treating Helicobacter pylori infection.AIMSThis review addresses practical questions regarding its current role in managing the infection.METHODSA comprehensive bibliographic search was conducted to identify studies evaluating the efficacy, safety and optimization of BQT in different clinical contexts.RESULTSBQT is a cornerstone of H. pylori eradication, combining agents with complementary mechanisms of action and maintaining high efficacy even in the presence of antibiotic resistance. Optimal acid suppression with a double proton pump inhibitor dose twice daily maximises therapeutic success. When tetracycline is unavailable, minocycline may serve as an alternative, whereas doxycycline is not recommended due to lower efficacy. Ten-day regimens achieve eradication rates comparable to 14-day courses, with similar or better tolerability. The three-in-one single-capsule formulation simplifies administration, enhances adherence, and maintains high efficacy (> 90%). BQT is endorsed as first-line therapy in most international guidelines, particularly in regions with clarithromycin resistance exceeding 15%, and remains the most reliable rescue option after failure of clarithromycin- or fluoroquinolone-based regimens. It is also the treatment of choice for patients with penicillin allergy. The regimen is generally well tolerated, with mostly mild, transient and gastrointestinal adverse events.CONCLUSIONSBQT remains the most effective, safe, and practical regimen for H. pylori eradication, ensuring high cure rates across diverse resistance patterns and clinical settings. Simplified formulations further improve convenience and adherence, reinforcing its role as a globally applicable therapy.
{"title":"Review Article: Classic Bismuth Quadruple Therapy for Helicobacter pylori Infection-Questions Focused on Clinical Practice.","authors":"Javier P Gisbert,Pablo Parra,Olga P Nyssen","doi":"10.1111/apt.70535","DOIUrl":"https://doi.org/10.1111/apt.70535","url":null,"abstract":"BACKGROUNDClassic bismuth quadruple therapy (BQT)-the combination of a proton pump inhibitor, bismuth, tetracycline, and metronidazole-is a standard regimen for treating Helicobacter pylori infection.AIMSThis review addresses practical questions regarding its current role in managing the infection.METHODSA comprehensive bibliographic search was conducted to identify studies evaluating the efficacy, safety and optimization of BQT in different clinical contexts.RESULTSBQT is a cornerstone of H. pylori eradication, combining agents with complementary mechanisms of action and maintaining high efficacy even in the presence of antibiotic resistance. Optimal acid suppression with a double proton pump inhibitor dose twice daily maximises therapeutic success. When tetracycline is unavailable, minocycline may serve as an alternative, whereas doxycycline is not recommended due to lower efficacy. Ten-day regimens achieve eradication rates comparable to 14-day courses, with similar or better tolerability. The three-in-one single-capsule formulation simplifies administration, enhances adherence, and maintains high efficacy (> 90%). BQT is endorsed as first-line therapy in most international guidelines, particularly in regions with clarithromycin resistance exceeding 15%, and remains the most reliable rescue option after failure of clarithromycin- or fluoroquinolone-based regimens. It is also the treatment of choice for patients with penicillin allergy. The regimen is generally well tolerated, with mostly mild, transient and gastrointestinal adverse events.CONCLUSIONSBQT remains the most effective, safe, and practical regimen for H. pylori eradication, ensuring high cure rates across diverse resistance patterns and clinical settings. Simplified formulations further improve convenience and adherence, reinforcing its role as a globally applicable therapy.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"124 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994877","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}
Davide Roccarina, Rosario La Delfa, Francesco Vizzutti
{"title":"Editorial: TIPS in the Era of Aging and Metabolic Comorbidity: Rethinking Risks and Rewards","authors":"Davide Roccarina, Rosario La Delfa, Francesco Vizzutti","doi":"10.1111/apt.70496","DOIUrl":"https://doi.org/10.1111/apt.70496","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"5 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986322","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}
Michelle Spaan, Adriaan J. van der Meer, Raoel Maan
<p>With great interest we read the editorial by Roccarina et al. in <i>Alimentary Pharmacology & Therapeutics</i> [<span>1</span>], which highlights the importance of risk stratification using real-world data in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement. The authors rightly emphasise that patient selection remains crucial, particularly with respect to post-TIPS hepatic encephalopathy (HE), which significantly affects morbidity and quality of life. Moreover, it provides a compelling and timely reflection on how shifting epidemiology in chronic liver disease necessitates a reassessment of current TIPS practices. The authors underline that factors like diabetes mellitus, obesity, and cardiovascular comorbidities will increasingly dominate the clinical landscape. Hepatologists are indeed confronted with a patient population that is older, has more comorbidities, and impaired physiological resilience.</p> <p>In line with this perspective, we would like to add observations from our cohort of patients with cirrhosis undergoing TIPS [<span>2</span>]. We retrospectively extracted detailed baseline characteristics from the medical charts, encompassing not only demographic data and measures of liver disease severity but also extrahepatic comorbidities. While diabetes mellitus was present in approximately one third of patients, about 8% of the patients were familiar with coronary artery disease (CAD). This prevalence is comparable to the ~8% reported by the American Heart Association in the general U.S. population [<span>3</span>].</p> <p>Interestingly, we observed an association between the presence of CAD and the occurrence of post-TIPS HE. This association appeared to be independent of diabetes mellitus, age, and MELD-Na score, but was only evident for overall HE and not for severe HE with hospitalisation. Due to the relatively low absolute number of patients with CAD, this variable could not be robustly incorporated into the multivariable analyses at this time, which limits definitive conclusions. Still, it may be hypothesized that cardiovascular comorbidities such as CAD indeed increase the susceptibility to post-TIPS hepatic encephalopathy, potentially by reducing cerebral reserve or impairing neurovascular adaptation following TIPS. This highlights the need to incorporate cardiovascular disease evaluation into future post-TIPS HE risk assessment studies. Importantly, as was recently highlighted, the prevalence of CAD is increased in patients with metabolic dysfunction–associated steatotic liver disease (MASLD) [<span>4</span>].</p> <p>Furthermore, potential pharmacological factors deserve consideration. Statins are increasingly recognised for their potential benefits in preventing decompensation in patients with cirrhosis, beyond their established cardiovascular benefits [<span>5</span>]. Whether they influence post-TIPS outcomes—including HE—remains an intriguing and clinically relevant ques
{"title":"Editorial: TIPS in the Era of Aging and Metabolic Comorbidity—Rethinking Risks and Rewards. Authors Reply","authors":"Michelle Spaan, Adriaan J. van der Meer, Raoel Maan","doi":"10.1111/apt.70531","DOIUrl":"https://doi.org/10.1111/apt.70531","url":null,"abstract":"<p>With great interest we read the editorial by Roccarina et al. in <i>Alimentary Pharmacology & Therapeutics</i> [<span>1</span>], which highlights the importance of risk stratification using real-world data in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement. The authors rightly emphasise that patient selection remains crucial, particularly with respect to post-TIPS hepatic encephalopathy (HE), which significantly affects morbidity and quality of life. Moreover, it provides a compelling and timely reflection on how shifting epidemiology in chronic liver disease necessitates a reassessment of current TIPS practices. The authors underline that factors like diabetes mellitus, obesity, and cardiovascular comorbidities will increasingly dominate the clinical landscape. Hepatologists are indeed confronted with a patient population that is older, has more comorbidities, and impaired physiological resilience.</p>\u0000<p>In line with this perspective, we would like to add observations from our cohort of patients with cirrhosis undergoing TIPS [<span>2</span>]. We retrospectively extracted detailed baseline characteristics from the medical charts, encompassing not only demographic data and measures of liver disease severity but also extrahepatic comorbidities. While diabetes mellitus was present in approximately one third of patients, about 8% of the patients were familiar with coronary artery disease (CAD). This prevalence is comparable to the ~8% reported by the American Heart Association in the general U.S. population [<span>3</span>].</p>\u0000<p>Interestingly, we observed an association between the presence of CAD and the occurrence of post-TIPS HE. This association appeared to be independent of diabetes mellitus, age, and MELD-Na score, but was only evident for overall HE and not for severe HE with hospitalisation. Due to the relatively low absolute number of patients with CAD, this variable could not be robustly incorporated into the multivariable analyses at this time, which limits definitive conclusions. Still, it may be hypothesized that cardiovascular comorbidities such as CAD indeed increase the susceptibility to post-TIPS hepatic encephalopathy, potentially by reducing cerebral reserve or impairing neurovascular adaptation following TIPS. This highlights the need to incorporate cardiovascular disease evaluation into future post-TIPS HE risk assessment studies. Importantly, as was recently highlighted, the prevalence of CAD is increased in patients with metabolic dysfunction–associated steatotic liver disease (MASLD) [<span>4</span>].</p>\u0000<p>Furthermore, potential pharmacological factors deserve consideration. Statins are increasingly recognised for their potential benefits in preventing decompensation in patients with cirrhosis, beyond their established cardiovascular benefits [<span>5</span>]. Whether they influence post-TIPS outcomes—including HE—remains an intriguing and clinically relevant ques","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"177 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972277","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}
Elisa Pinto,Filippo Pelizzaro,Vittorio Simeon,Laura Bucci,Martina Gambato,Alessandro Vitale,Angelo Sangiovanni,Giuseppe Cabibbo,Giorgia Ghittoni,Gianluca Svegliati-Baroni,Sara Boninsegna,Franco Trevisani,Francesco Giuseppe Foschi,Bernardo Stefanini,Carlo Saitta,Francesco Azzaroli,Fabio Marra,Gianpaolo Vidili,Andrea Mega,Giacomo Zaccherini,Maurizia Rossana Brunetto,Sara Grasselli,Francesca Romana Ponziani,Filomena Morisco,Rodolfo Sacco,Donatella Magalotti,Gerardo Nardone,Maria Di Marco,Andrea Martini,David Sacerdoti,Fabio Farinati,Edoardo G Giannini,Francesco Paolo Russo,
BACKGROUNDIn patients with hepatocellular carcinoma (HCC), extrahepatic progression (EHP) has a known dismal meaning. We evaluated the incidence and risk factors of EHP in HCC patients treated with transarterial chemoembolization (TACE), and the predictive role of tumour burden.METHODSFrom the ITA.LI.CA database, 890 HCC patients undergoing first-line TACE were included. Tumour burden score (TBS) was calculated and, after identification of the best cut-point value, incidence and predictors of EHP were compared between TBS-low and TBS-high groups. Independent predictors of EHP at the first progression episode or at any time during follow-up were identified through multivariable Cox analysis.RESULTSAfter TACE, 7.2% of patients experienced EHP at the first progression episode, while the overall EHP rate during the follow-up was 26.1%. The best cut-point for TBS was 3.66. TBS-high group (> 3.66) showed a significantly higher proportion of EHP both at first progression (10.4% vs. 3.6%; p < 0.001) and overall (32.6% vs. 18.7%; p < 0.001) compared to the TBS-low group. Moreover, TBS-high patients had shorter progression-free survival and overall survival. TBS-high and AFP levels emerged as independent predictors of EHP at the first progression episode and during the follow-up, and their combined evaluation accurately stratified patients for their risk of EHP.CONCLUSIONExtrahepatic dissemination is infrequent in HCC patients treated with TACE. TBS is easily calculable and helps in identifying patients at higher risk of metastasis development.
背景：在肝细胞癌（HCC）患者中，肝外进展（EHP）有一个已知的令人沮丧的含义。我们评估了经动脉化疗栓塞（TACE）治疗的HCC患者EHP的发病率和危险因素，以及肿瘤负荷的预测作用。方法从ITA.LI.CA数据库中，纳入890例接受一线TACE治疗的HCC患者。计算肿瘤负荷评分（tumor burden score， TBS），在确定最佳切点值后，比较TBS-低组和TBS-高组EHP的发病率和预测因素。通过多变量Cox分析确定首次进展发作或随访期间任何时间EHP的独立预测因子。结果TACE治疗后，7.2%的患者在首次进展发作时发生EHP，而随访期间的总体EHP发生率为26.1%。TBS的最佳临界值为3.66。与TBS-low组相比，TBS-high组（> 3.66）在首次进展时（10.4% vs. 3.6%, p < 0.001）和总体（32.6% vs. 18.7%, p < 0.001）的EHP比例均显著高于TBS-low组。此外，tbs -高患者的无进展生存期和总生存期较短。tbs -高水平和AFP水平在首次进展发作和随访期间成为EHP的独立预测因素，它们的综合评估准确地对患者的EHP风险进行了分层。结论肝外播散在TACE治疗的HCC患者中少见。TBS很容易计算，有助于识别转移发展风险较高的患者。
{"title":"Tumour Burden Score as a Predictor of Extrahepatic Progression After Transarterial Chemoembolization for Hepatocellular Carcinoma: An Observational Multicenter Study.","authors":"Elisa Pinto,Filippo Pelizzaro,Vittorio Simeon,Laura Bucci,Martina Gambato,Alessandro Vitale,Angelo Sangiovanni,Giuseppe Cabibbo,Giorgia Ghittoni,Gianluca Svegliati-Baroni,Sara Boninsegna,Franco Trevisani,Francesco Giuseppe Foschi,Bernardo Stefanini,Carlo Saitta,Francesco Azzaroli,Fabio Marra,Gianpaolo Vidili,Andrea Mega,Giacomo Zaccherini,Maurizia Rossana Brunetto,Sara Grasselli,Francesca Romana Ponziani,Filomena Morisco,Rodolfo Sacco,Donatella Magalotti,Gerardo Nardone,Maria Di Marco,Andrea Martini,David Sacerdoti,Fabio Farinati,Edoardo G Giannini,Francesco Paolo Russo, ","doi":"10.1111/apt.70534","DOIUrl":"https://doi.org/10.1111/apt.70534","url":null,"abstract":"BACKGROUNDIn patients with hepatocellular carcinoma (HCC), extrahepatic progression (EHP) has a known dismal meaning. We evaluated the incidence and risk factors of EHP in HCC patients treated with transarterial chemoembolization (TACE), and the predictive role of tumour burden.METHODSFrom the ITA.LI.CA database, 890 HCC patients undergoing first-line TACE were included. Tumour burden score (TBS) was calculated and, after identification of the best cut-point value, incidence and predictors of EHP were compared between TBS-low and TBS-high groups. Independent predictors of EHP at the first progression episode or at any time during follow-up were identified through multivariable Cox analysis.RESULTSAfter TACE, 7.2% of patients experienced EHP at the first progression episode, while the overall EHP rate during the follow-up was 26.1%. The best cut-point for TBS was 3.66. TBS-high group (> 3.66) showed a significantly higher proportion of EHP both at first progression (10.4% vs. 3.6%; p < 0.001) and overall (32.6% vs. 18.7%; p < 0.001) compared to the TBS-low group. Moreover, TBS-high patients had shorter progression-free survival and overall survival. TBS-high and AFP levels emerged as independent predictors of EHP at the first progression episode and during the follow-up, and their combined evaluation accurately stratified patients for their risk of EHP.CONCLUSIONExtrahepatic dissemination is infrequent in HCC patients treated with TACE. TBS is easily calculable and helps in identifying patients at higher risk of metastasis development.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"21 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961496","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}
BACKGROUNDCholestasis is a frequent phenomenon in patients with burn injury and linked with impaired outcomes.AIMSTo explore longitudinal trajectories of cholestasis and validate the proposed definition of burn-associated cholestasis (BAC).METHODS532 patients admitted to an intensive care unit (ICU) for burn injury over a 10-year timeframe were included in this single-center, retrospective cohort study. Burn severity, ICU treatment, and laboratory parameters were longitudinally collected from admission to discharge or death.RESULTSMedian total body surface area burned was 15% and 234 patients (44%) had severe burn (≥ 20%). 118 patients (22%) met the proposed criteria of BAC while 41%, 30%, and 68% developed elevated alkaline phosphatase, bilirubin, and gamma-glutamyl transferase, respectively. BAC was associated with burn severity, ketamine use, mechanical ventilation, and parenteral nutrition, and 85% of cases occurred in patients exposed to ketamine, mechanical ventilation, and parenteral nutrition. Hyperbilirubinemia (≥ 2× upper-limit-of-normal, i.e., BAC subtype B/C) was independently associated with mortality adjusting for burn severity, critical illness severity, and ICU-specific treatment. However, bilirubin alone provided better discrimination, especially regarding excess deaths after ≥ 7 days (Harrel's C: 0.80-0.83). Concordant increases in bilirubin and alkaline phosphatase/gamma-glutamyl transferase allow for early identification of an at-risk population. Developing hyperbilirubinemia until Day 14 identified a subgroup with severely impaired prognosis (survival at 90 days: 46% vs. 95%).CONCLUSIONSCholestasis is frequent following burn injury. Prognosis is determined by bilirubin dynamics independently of disease and burn severity. Hyperbilirubinemia is associated with excess mortality ≥ 7 days after surviving burn injury.
{"title":"Characterisation and Prognostic Implication of Cholestasis After Burn Injury.","authors":"Lorenz Semmler,Georg Semmler,Andreas Langa,Sebastian Rihl,Sebastian Hofstetter,Melissa-Patricia Mateas,Kevin Dilmen,Anton Borger,Paul Supper,Patrick Haselwanter,Emina Halilbasic,Christian Zauner,Albert Stättermayer,Gerald Ihra,Christine Radtke,Mathias Anselm Schneeweiss-Gleixner,Michael Trauner","doi":"10.1111/apt.70505","DOIUrl":"https://doi.org/10.1111/apt.70505","url":null,"abstract":"BACKGROUNDCholestasis is a frequent phenomenon in patients with burn injury and linked with impaired outcomes.AIMSTo explore longitudinal trajectories of cholestasis and validate the proposed definition of burn-associated cholestasis (BAC).METHODS532 patients admitted to an intensive care unit (ICU) for burn injury over a 10-year timeframe were included in this single-center, retrospective cohort study. Burn severity, ICU treatment, and laboratory parameters were longitudinally collected from admission to discharge or death.RESULTSMedian total body surface area burned was 15% and 234 patients (44%) had severe burn (≥ 20%). 118 patients (22%) met the proposed criteria of BAC while 41%, 30%, and 68% developed elevated alkaline phosphatase, bilirubin, and gamma-glutamyl transferase, respectively. BAC was associated with burn severity, ketamine use, mechanical ventilation, and parenteral nutrition, and 85% of cases occurred in patients exposed to ketamine, mechanical ventilation, and parenteral nutrition. Hyperbilirubinemia (≥ 2× upper-limit-of-normal, i.e., BAC subtype B/C) was independently associated with mortality adjusting for burn severity, critical illness severity, and ICU-specific treatment. However, bilirubin alone provided better discrimination, especially regarding excess deaths after ≥ 7 days (Harrel's C: 0.80-0.83). Concordant increases in bilirubin and alkaline phosphatase/gamma-glutamyl transferase allow for early identification of an at-risk population. Developing hyperbilirubinemia until Day 14 identified a subgroup with severely impaired prognosis (survival at 90 days: 46% vs. 95%).CONCLUSIONSCholestasis is frequent following burn injury. Prognosis is determined by bilirubin dynamics independently of disease and burn severity. Hyperbilirubinemia is associated with excess mortality ≥ 7 days after surviving burn injury.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"34 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961497","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}
Daniel Q. Huang, Zhongjie Zhang, Rajkumar Dorajoo, Chiea Chuen Khor, Yen Thi‐Hai Pham, Renwei Wang, Jaideep Behari, Jian‐Min Yuan, Woon‐Puay Koh, Hung N. Luu
Background and Aims PNPLA3 variants are associated with increased hepatocellular carcinoma (HCC) risk. We examined the association between a combination of the PNPLA3 I148M genotype and clinical risk factors with HCC risk using data from a large, ongoing, population‐based, prospective cohort study, the Singapore Chinese Health Study. Approach and Results This study included 24,979 participants (54.2% female). The primary outcome was incident HCC. Fine‐Grey models were used to examine the association between a combination of the PNPLA3 I148M genotype and clinical risk factors and risk of HCC. After a median follow‐up of 19.8 years, we identified 214 HCC incident cases. Males who were homozygous carriers for PNPLA3 I148M (adjusted hazard ratio [aHR] = 9.23, 95% confidence interval [CI]: 4.81–17.70) had a nine‐fold risk of HCC, while heterozygous male carriers (aHR 4.83, CI: 2.63–8.89) had a five‐fold risk of HCC, compared to non‐carrier females. Homozygous carriers who were overweight (aHR = 2.92, 95% CI: 1.74–4.89) had a three‐fold risk of HCC compared to non‐carriers who were not overweight. Participants with diabetes and who were homozygous carriers (aHR 2.83, 95% CI: 1.21–6.61) had an approximately three‐fold risk of HCC compared to non‐carriers without diabetes. Conclusion The frequency of rs738409‐G alleles was associated with a dose‐dependent increase in HCC risk and was independent of other clinical risk factors. Among participants who were male, overweight, and those with diabetes, the risk of HCC was further elevated among those with rs738409‐G alleles. These data may be helpful for the development of future risk stratification strategies.
{"title":" PNPLA3 Genotype and Clinical Factors Impact Hepatocellular Carcinoma Risk: Findings From a Prospective Cohort Study","authors":"Daniel Q. Huang, Zhongjie Zhang, Rajkumar Dorajoo, Chiea Chuen Khor, Yen Thi‐Hai Pham, Renwei Wang, Jaideep Behari, Jian‐Min Yuan, Woon‐Puay Koh, Hung N. Luu","doi":"10.1111/apt.70532","DOIUrl":"https://doi.org/10.1111/apt.70532","url":null,"abstract":"Background and Aims <jats:italic>PNPLA3</jats:italic> variants are associated with increased hepatocellular carcinoma (HCC) risk. We examined the association between a combination of the <jats:italic>PNPLA3</jats:italic> I148M genotype and clinical risk factors with HCC risk using data from a large, ongoing, population‐based, prospective cohort study, the Singapore Chinese Health Study. Approach and Results This study included 24,979 participants (54.2% female). The <jats:italic>primary outcome</jats:italic> was incident HCC. Fine‐Grey models were used to examine the association between a combination of the <jats:italic>PNPLA3</jats:italic> I148M genotype and clinical risk factors and risk of HCC. After a median follow‐up of 19.8 years, we identified 214 HCC incident cases. Males who were homozygous carriers for <jats:italic>PNPLA3</jats:italic> I148M (adjusted hazard ratio [aHR] = 9.23, 95% confidence interval [CI]: 4.81–17.70) had a nine‐fold risk of HCC, while heterozygous male carriers (aHR 4.83, CI: 2.63–8.89) had a five‐fold risk of HCC, compared to non‐carrier females. Homozygous carriers who were overweight (aHR = 2.92, 95% CI: 1.74–4.89) had a three‐fold risk of HCC compared to non‐carriers who were not overweight. Participants with diabetes and who were homozygous carriers (aHR 2.83, 95% CI: 1.21–6.61) had an approximately three‐fold risk of HCC compared to non‐carriers without diabetes. Conclusion The frequency of rs738409‐G alleles was associated with a dose‐dependent increase in HCC risk and was independent of other clinical risk factors. Among participants who were male, overweight, and those with diabetes, the risk of HCC was further elevated among those with rs738409‐G alleles. These data may be helpful for the development of future risk stratification strategies.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"3 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145955134","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}
Veeral Ajmera, Raj Vuppalanchi, Mandana Khalili, Muhammad Y. Sheikh, Joseph Risser, Samuel Klein, Monica Tincopa, Egbert Madamba, Seema Singh, Harris Siddiqi, Diana Cortez‐Moreno, Darryl Contrano, Heather Hofflich, Ruth Abeles, Ottar Lunde, Eduardo Grunvald, Ricki Bettencourt, Feng He, Sonia Jain, Lisa Richards, Rohit Loomba
Background/Aims Non‐invasive test (NIT)‐based assessment of eligibility and treatment response with semaglutide is needed to inform clinical practice guidance. Therefore, utilising a randomised, placebo‐controlled study design, we evaluated the utility of NITs to assess eligibility and treatment response in patients with suspected at‐risk MASH randomised to semaglutide versus placebo. Methods In this multicentre, randomised, double‐blind placebo‐controlled 52‐week trial, patients meeting AASLD criteria for MASLD with BMI ≥ 27 kg/m 2 , or BMI ≥ 25 kg/m 2 and prediabetes or type 2 diabetes with liver stiffness by VCTE ≥ 8 kPa and a FAST score ≥ 0.5 were randomised to either semaglutide 2.4 mg subcutaneously weekly or placebo. The primary outcome was change in the FAST score at end of treatment from baseline. Other endpoints included changes in body weight, MRI‐PDFF, ALT and HbA1c. Results Fifty‐five participants were randomised (55% women, 20% with diabetes). Mean (SD) age, BMI, and FAST at baseline were 48.8 (14) years, 40.2 (15) kg/m 2 , 0.62 (0.12), respectively. The semaglutide group had a significantly greater reduction in FAST compared with placebo (−0.28 vs. −0.12; p = 0.002). More semaglutide recipients achieved ≥ 5% weight loss (64% vs. 8.3%; p < 0.001) and ≥ 30% reduction in MRI‐PDFF (60% vs. 17%; p = 0.047). Semaglutide led to a significantly greater reduction in ALT, AST, GGT, HbA1c and LDL cholesterol ( p < 0.05). Gastrointestinal‐related adverse events were common but not significantly different between the two groups ( p = 0.59). Conclusions A NIT‐based approach to identify at‐risk MASH patients for semaglutide treatment is feasible and effective. This study provides RCT data showing that FAST, ALT, AST and MRI‐PDFF can be used to monitor treatment response.
{"title":"Clinical Trial: Semaglutide Versus Placebo in NIT ‐Assessed MASH —A Multicenter Randomised Placebo‐Controlled Trial ( SAMARA )","authors":"Veeral Ajmera, Raj Vuppalanchi, Mandana Khalili, Muhammad Y. Sheikh, Joseph Risser, Samuel Klein, Monica Tincopa, Egbert Madamba, Seema Singh, Harris Siddiqi, Diana Cortez‐Moreno, Darryl Contrano, Heather Hofflich, Ruth Abeles, Ottar Lunde, Eduardo Grunvald, Ricki Bettencourt, Feng He, Sonia Jain, Lisa Richards, Rohit Loomba","doi":"10.1111/apt.70516","DOIUrl":"https://doi.org/10.1111/apt.70516","url":null,"abstract":"Background/Aims Non‐invasive test (NIT)‐based assessment of eligibility and treatment response with semaglutide is needed to inform clinical practice guidance. Therefore, utilising a randomised, placebo‐controlled study design, we evaluated the utility of NITs to assess eligibility and treatment response in patients with suspected at‐risk MASH randomised to semaglutide versus placebo. Methods In this multicentre, randomised, double‐blind placebo‐controlled 52‐week trial, patients meeting AASLD criteria for MASLD with BMI ≥ 27 kg/m <jats:sup>2</jats:sup> , or BMI ≥ 25 kg/m <jats:sup>2</jats:sup> and prediabetes or type 2 diabetes with liver stiffness by VCTE ≥ 8 kPa and a FAST score ≥ 0.5 were randomised to either semaglutide 2.4 mg subcutaneously weekly or placebo. The primary outcome was change in the FAST score at end of treatment from baseline. Other endpoints included changes in body weight, MRI‐PDFF, ALT and HbA1c. Results Fifty‐five participants were randomised (55% women, 20% with diabetes). Mean (SD) age, BMI, and FAST at baseline were 48.8 (14) years, 40.2 (15) kg/m <jats:sup>2</jats:sup> , 0.62 (0.12), respectively. The semaglutide group had a significantly greater reduction in FAST compared with placebo (−0.28 vs. −0.12; <jats:italic>p</jats:italic> = 0.002). More semaglutide recipients achieved ≥ 5% weight loss (64% vs. 8.3%; <jats:italic>p</jats:italic> < 0.001) and ≥ 30% reduction in MRI‐PDFF (60% vs. 17%; <jats:italic>p</jats:italic> = 0.047). Semaglutide led to a significantly greater reduction in ALT, AST, GGT, HbA1c and LDL cholesterol ( <jats:italic>p</jats:italic> < 0.05). Gastrointestinal‐related adverse events were common but not significantly different between the two groups ( <jats:italic>p</jats:italic> = 0.59). Conclusions A NIT‐based approach to identify at‐risk MASH patients for semaglutide treatment is feasible and effective. This study provides RCT data showing that FAST, ALT, AST and MRI‐PDFF can be used to monitor treatment response.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"44 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145955133","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}
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