{"title":"Letter: Assessing the prognostic value of agile 3+ and agile 4 scores in predicting chronic kidney disease development in patients with metabolic dysfunction-associated steatotic liver disease","authors":"Zhenzhi Qin, Yan Xu","doi":"10.1111/apt.18287","DOIUrl":"https://doi.org/10.1111/apt.18287","url":null,"abstract":"This article is linked to Jung et al paper. To view this article, visit https://doi.org/10.1111/apt.18213","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236961","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 would like to thank Dr Kozarek for his very interesting editorial<span><sup>1</sup></span> on our study entitled ‘Long-term Clinical Outcomes of Extracorporeal Shockwave Lithotripsy and Endoscopic Retrograde Cholangiopancreatography for Pancreatic Duct Stone Treatment in Patients with Chronic Pancreatitis’<span><sup>2</sup></span> that aimed to explore the short- and long-term efficacies of extracorporeal shockwave lithotripsy for pancreatic stones (P-ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) for painful chronic pancreatitis (CP). We totally agree that the efficacy of P-ESWL and ERCP seemed better than several previous studies.<span><sup>3-6</sup></span> The discordance should be attributed to the several factors. First of all, the heterogeneity in treatment protocols across different studies may lead to variations in therapeutic efficacy. We have treated patients with CP according to the guidelines as much as possible,<span><sup>7, 8</sup></span> yet some studies have not.<span><sup>4, 5</sup></span> For instance, the stone diameter was bigger in these studies, which represented the difficulty of P-ESWL and ERCP.<span><sup>4, 5</sup></span> The frequent stent exchanges performed every 2–4 months<span><sup>6</sup></span> could also influence the efficacy since the guidelines suggest treating painful patients with a single plastic stent for one uninterrupted year.<span><sup>7, 8</sup></span> The unified treatment protocol may help the comparison of the efficacy in the future. Next, the studies including Dr Kozarek's et al.'s<span><sup>3</sup></span> study and several randomized controlled trials (RCTs)<span><sup>4-6</sup></span> shared a common feature in that they only included patients with severe pain. Patients with severe pain may be experiencing refractory pain with central sensitization. However, patients with CP in our country have different pain patterns compared with other countries. The majority of patients suffered from recurrent acute pancreatitis, recurrent acute pancreatitis and recurrent pain, and <5% of patients complained of chronic pain. The proportion of analgesics usage was much lower than in western countries, which also proved the low rate of chronic pain in our centre. In our analysis, we included all patients experiencing pain who had indication for P-ESWL and ERCP, including those with mild to severe pain. This broader inclusion may be the major reason for the higher pain relief rate observed compared to the aforementioned studies. Furthermore, the proportion of patients who smoke and drink in these studies was much higher than in our centre, leading to differences in treatment efficacy. As reported in a recent study, consumption of alcohol and tobacco were independent predictors of persistent pain after successful ESWL.<span><sup>9</sup></span> Dr Kozarek et al.<span><sup>3</sup></span> also reported smoking cessation could improve narcotic pain medication use. Although our study did not yie
{"title":"Editorial: Does ESWL-ERCP for pancreatic duct stone removal change the natural course of symptomatic chronic calcific pancreatitis? Authors' reply","authors":"Yu Liu, Liang-Hao Hu","doi":"10.1111/apt.18284","DOIUrl":"10.1111/apt.18284","url":null,"abstract":"<p>We would like to thank Dr Kozarek for his very interesting editorial<span><sup>1</sup></span> on our study entitled ‘Long-term Clinical Outcomes of Extracorporeal Shockwave Lithotripsy and Endoscopic Retrograde Cholangiopancreatography for Pancreatic Duct Stone Treatment in Patients with Chronic Pancreatitis’<span><sup>2</sup></span> that aimed to explore the short- and long-term efficacies of extracorporeal shockwave lithotripsy for pancreatic stones (P-ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) for painful chronic pancreatitis (CP). We totally agree that the efficacy of P-ESWL and ERCP seemed better than several previous studies.<span><sup>3-6</sup></span> The discordance should be attributed to the several factors. First of all, the heterogeneity in treatment protocols across different studies may lead to variations in therapeutic efficacy. We have treated patients with CP according to the guidelines as much as possible,<span><sup>7, 8</sup></span> yet some studies have not.<span><sup>4, 5</sup></span> For instance, the stone diameter was bigger in these studies, which represented the difficulty of P-ESWL and ERCP.<span><sup>4, 5</sup></span> The frequent stent exchanges performed every 2–4 months<span><sup>6</sup></span> could also influence the efficacy since the guidelines suggest treating painful patients with a single plastic stent for one uninterrupted year.<span><sup>7, 8</sup></span> The unified treatment protocol may help the comparison of the efficacy in the future. Next, the studies including Dr Kozarek's et al.'s<span><sup>3</sup></span> study and several randomized controlled trials (RCTs)<span><sup>4-6</sup></span> shared a common feature in that they only included patients with severe pain. Patients with severe pain may be experiencing refractory pain with central sensitization. However, patients with CP in our country have different pain patterns compared with other countries. The majority of patients suffered from recurrent acute pancreatitis, recurrent acute pancreatitis and recurrent pain, and <5% of patients complained of chronic pain. The proportion of analgesics usage was much lower than in western countries, which also proved the low rate of chronic pain in our centre. In our analysis, we included all patients experiencing pain who had indication for P-ESWL and ERCP, including those with mild to severe pain. This broader inclusion may be the major reason for the higher pain relief rate observed compared to the aforementioned studies. Furthermore, the proportion of patients who smoke and drink in these studies was much higher than in our centre, leading to differences in treatment efficacy. As reported in a recent study, consumption of alcohol and tobacco were independent predictors of persistent pain after successful ESWL.<span><sup>9</sup></span> Dr Kozarek et al.<span><sup>3</sup></span> also reported smoking cessation could improve narcotic pain medication use. Although our study did not yie","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":null,"pages":null},"PeriodicalIF":6.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.18284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236369","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}
<p>As someone who has performed extracorporeal shock wave lithotripsy and endoscopic retrograde cholangiopancreatography (ESWL/ERCP) for obstructing pancreatic duct (PD) stones for over 3 decades, I was intrigued to review the experience by Liu et al.<span><sup>1</sup></span> from the largest pancreatic referral centre in China. Retrospectively reviewing over 2000 patients with chronic pancreatitis (CP) enrolled in a prospective database between 2011 and 2018 (mean follow-up 6.7 years), they report complete stone extraction in approximately 74% of patients. In the prospective portion of this mixed observational study (9/2023–3/2024), there was significant improvement in patient-reported outcomes and complete pain remission in 70% of patients. The authors also documented a transition from patients' original presentation (2/3 recurrent pain or recurrent acute pancreatitis and another 27% with both). Study limitations include failure to measure faecal elastase, which underestimates exocrine pancreatic insufficiency. Moreover, the incidence of recurrent stones and pseudocysts is likely higher as 719/1843 (39%) patients in the prospective portion did not undergo CT or MR imaging. Nevertheless, only 8.8% of patients underwent further invasive treatment, which is impressive and surpasses published experience from our institution in which 85% of our patients had improved quality of life post-treatment at a mean follow-up of 4.8 years.<span><sup>2</sup></span> However, all patients were taking narcotics at baseline, and despite narcotic reduction, only 50% were completely pain-free. Moreover, 29% underwent an interval ERCP (84%) or pancreatic surgery (16%). The current study also surpassed the outcomes of multiple randomised controlled trials comparing ESWL-ERCP to pancreatic surgery for refractory pain or recurrent clinical pancreatitis.<span><sup>3-5</sup></span></p><p>Why this discordance? Sixty percent of the patients in the current series were classified as idiopathic CP (? smoking<span><sup>6-8</sup></span>), and in contrast to most Western series, <30% were alcohol related. Moreover, only 9.2% took analgesics prior to ESWL-ERCP and only 4% complained of chronic pain. Finally, in contrast to most other series in which stones were associated with PD strictures, 50% of patients had isolated main PD stones without strictures. This suggests that either CP may be different in Asia or that patients were treated earlier in the course of their disease. The fact that 20% had clinical steatorrhoea and a quarter were diabetic at enrolment does not answer this question, nor does the subsequent development of new diabetes or clinical steatorrhoea in an additional 18% at follow-up.</p><p>Perhaps this population is comparable to that reported by the Asian Institute of Gastroenterology which has reported their experience in over 5000 patients.<span><sup>9</sup></span> If so, we should all reassess our outcomes as this group's most recent prospective, randomised
{"title":"Editorial: Does ESWL-ERCP for pancreatic duct stone removal change the natural course of symptomatic chronic calcific pancreatitis?","authors":"Richard Kozarek","doi":"10.1111/apt.18253","DOIUrl":"10.1111/apt.18253","url":null,"abstract":"<p>As someone who has performed extracorporeal shock wave lithotripsy and endoscopic retrograde cholangiopancreatography (ESWL/ERCP) for obstructing pancreatic duct (PD) stones for over 3 decades, I was intrigued to review the experience by Liu et al.<span><sup>1</sup></span> from the largest pancreatic referral centre in China. Retrospectively reviewing over 2000 patients with chronic pancreatitis (CP) enrolled in a prospective database between 2011 and 2018 (mean follow-up 6.7 years), they report complete stone extraction in approximately 74% of patients. In the prospective portion of this mixed observational study (9/2023–3/2024), there was significant improvement in patient-reported outcomes and complete pain remission in 70% of patients. The authors also documented a transition from patients' original presentation (2/3 recurrent pain or recurrent acute pancreatitis and another 27% with both). Study limitations include failure to measure faecal elastase, which underestimates exocrine pancreatic insufficiency. Moreover, the incidence of recurrent stones and pseudocysts is likely higher as 719/1843 (39%) patients in the prospective portion did not undergo CT or MR imaging. Nevertheless, only 8.8% of patients underwent further invasive treatment, which is impressive and surpasses published experience from our institution in which 85% of our patients had improved quality of life post-treatment at a mean follow-up of 4.8 years.<span><sup>2</sup></span> However, all patients were taking narcotics at baseline, and despite narcotic reduction, only 50% were completely pain-free. Moreover, 29% underwent an interval ERCP (84%) or pancreatic surgery (16%). The current study also surpassed the outcomes of multiple randomised controlled trials comparing ESWL-ERCP to pancreatic surgery for refractory pain or recurrent clinical pancreatitis.<span><sup>3-5</sup></span></p><p>Why this discordance? Sixty percent of the patients in the current series were classified as idiopathic CP (? smoking<span><sup>6-8</sup></span>), and in contrast to most Western series, <30% were alcohol related. Moreover, only 9.2% took analgesics prior to ESWL-ERCP and only 4% complained of chronic pain. Finally, in contrast to most other series in which stones were associated with PD strictures, 50% of patients had isolated main PD stones without strictures. This suggests that either CP may be different in Asia or that patients were treated earlier in the course of their disease. The fact that 20% had clinical steatorrhoea and a quarter were diabetic at enrolment does not answer this question, nor does the subsequent development of new diabetes or clinical steatorrhoea in an additional 18% at follow-up.</p><p>Perhaps this population is comparable to that reported by the Asian Institute of Gastroenterology which has reported their experience in over 5000 patients.<span><sup>9</sup></span> If so, we should all reassess our outcomes as this group's most recent prospective, randomised ","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":null,"pages":null},"PeriodicalIF":6.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.18253","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236370","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}
<p>Many plants have the ability to make toxins in order to protect themselves against plant-eating animals. Over time, herbivores, physiologically and anatomically designed for eating plants, will avoid these poisonous plants. Some plants can be toxic except processed in a certain way. Toxic effects of undercooked kidney beans in France were recently reported, due to phytohaemagglutinin, a plant lectin, not destroyed due to undercooking.<span><sup>1</sup></span> Choi and co-workers in the Drug-induced liver injury network (DILIN) published an interesting report on a cohort of patients with acute liver injury due to plant-based food supplement (PBS).<span><sup>2</sup></span> The DILIN has contributed immensely on the knowledge on acute liver injury, due to prescription drugs as well as on Herbal and Dietary Supplements since it was initiated in 2004.<span><sup>3</sup></span> Some landmark papers have increased our understanding on hepatotoxicity of green tea extract,<span><sup>4</sup></span> garcinia cambogia<span><sup>5</sup></span> and turmeric.<span><sup>6</sup></span> Interestingly, the median latency from ingestion of the PBS in the current study<span><sup>2</sup></span> was only 3 days, whereas the median latency of green tea extract containing supplements was 72 days,<span><sup>4</sup></span> garcinia cambogia 51 days<span><sup>5</sup></span> and turmeric supplements 86 days,<span><sup>6</sup></span> indicating an immune-mediated injury. The short latency of the PBS suggests, as the authors point out, a toxic effect characterised by abdominal pain (59%), nausea, fever, itching and rash (12%) but diarrhoea was not reported. Approximately, 50% had jaundice at presentation, 24% hospitalised but no serious consequences were observed. Interestingly, the ALT level at presentation was the peak value in all except one of the 17 patients, suggesting a very rapid resolution of liver injury and liver enzymes normalised in all patients. The quick resolution is very unusual for <i>idiosyncratic</i> DILI, which often takes weeks or months to resolve, but rather resembles liver injury associated with hypoxic hepatitis (HH).<span><sup>7</sup></span> In HH, the recovery of ischaemic/hypoxic nature of the injury, after stabilisation of the patient is related to the half time of ALT which is 2–3 days and AST 1–2 days. The authors speculated that the liver injury was due to an oxidant injury, related to the metabolism of baikiain found in Tara flour, into reactive metabolites, similar to hepatotoxicity associated with acetaminophen. The only liver biopsy seems to point towards another type of injury which revealed an acute hepatitis, mild ductular reaction, mild lymphocytic and eosinophilic portal inflammation.<span><sup>2</sup></span> This is perhaps not highly suggestive of oxidant injury and rather points towards allergic reaction, with eosinophilic portal inflammation as well as itching and rash in symptomatic patients. The presence of eosinophilia has bee
{"title":"Editorial: Plants against animals","authors":"Einar S. Björnsson","doi":"10.1111/apt.18146","DOIUrl":"https://doi.org/10.1111/apt.18146","url":null,"abstract":"<p>Many plants have the ability to make toxins in order to protect themselves against plant-eating animals. Over time, herbivores, physiologically and anatomically designed for eating plants, will avoid these poisonous plants. Some plants can be toxic except processed in a certain way. Toxic effects of undercooked kidney beans in France were recently reported, due to phytohaemagglutinin, a plant lectin, not destroyed due to undercooking.<span><sup>1</sup></span> Choi and co-workers in the Drug-induced liver injury network (DILIN) published an interesting report on a cohort of patients with acute liver injury due to plant-based food supplement (PBS).<span><sup>2</sup></span> The DILIN has contributed immensely on the knowledge on acute liver injury, due to prescription drugs as well as on Herbal and Dietary Supplements since it was initiated in 2004.<span><sup>3</sup></span> Some landmark papers have increased our understanding on hepatotoxicity of green tea extract,<span><sup>4</sup></span> garcinia cambogia<span><sup>5</sup></span> and turmeric.<span><sup>6</sup></span> Interestingly, the median latency from ingestion of the PBS in the current study<span><sup>2</sup></span> was only 3 days, whereas the median latency of green tea extract containing supplements was 72 days,<span><sup>4</sup></span> garcinia cambogia 51 days<span><sup>5</sup></span> and turmeric supplements 86 days,<span><sup>6</sup></span> indicating an immune-mediated injury. The short latency of the PBS suggests, as the authors point out, a toxic effect characterised by abdominal pain (59%), nausea, fever, itching and rash (12%) but diarrhoea was not reported. Approximately, 50% had jaundice at presentation, 24% hospitalised but no serious consequences were observed. Interestingly, the ALT level at presentation was the peak value in all except one of the 17 patients, suggesting a very rapid resolution of liver injury and liver enzymes normalised in all patients. The quick resolution is very unusual for <i>idiosyncratic</i> DILI, which often takes weeks or months to resolve, but rather resembles liver injury associated with hypoxic hepatitis (HH).<span><sup>7</sup></span> In HH, the recovery of ischaemic/hypoxic nature of the injury, after stabilisation of the patient is related to the half time of ALT which is 2–3 days and AST 1–2 days. The authors speculated that the liver injury was due to an oxidant injury, related to the metabolism of baikiain found in Tara flour, into reactive metabolites, similar to hepatotoxicity associated with acetaminophen. The only liver biopsy seems to point towards another type of injury which revealed an acute hepatitis, mild ductular reaction, mild lymphocytic and eosinophilic portal inflammation.<span><sup>2</sup></span> This is perhaps not highly suggestive of oxidant injury and rather points towards allergic reaction, with eosinophilic portal inflammation as well as itching and rash in symptomatic patients. The presence of eosinophilia has bee","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":null,"pages":null},"PeriodicalIF":6.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.18146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230919","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}
Optimal glycaemic control has well-established health benefits in patients with diabetes mellitus (DM). It is uncertain whether optimal glycaemic control can benefit liver-related outcomes.
{"title":"Glycaemic control is a modifiable risk factor for hepatocellular carcinoma and liver-related mortality in patients with diabetes","authors":"Xianhua Mao, Ka-Shing Cheung, Jing-Tong Tan, Lung-Yi Mak, Chi-Ho Lee, Chi-Leung Chiang, Ho-Ming Cheng, Rex Wan-Hin Hui, Wai K. Leung, Man-Fung Yuen, Wai-Kay Seto","doi":"10.1111/apt.18254","DOIUrl":"https://doi.org/10.1111/apt.18254","url":null,"abstract":"Optimal glycaemic control has well-established health benefits in patients with diabetes mellitus (DM). It is uncertain whether optimal glycaemic control can benefit liver-related outcomes.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142160926","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}
Maya Granot, Uri Kopylov, Nurit Loberman-Nachum, Alexander Krauthammer, Chaya Mushka Abitbol, Shomron Ben-Horin, Batia Weiss, Yael Haberman
Previous studies highlighted a more extensive phenotype for paediatric-onset than adult-onset inflammatory bowel disease (IBD). However, most lacked long-term follow-up, and some were conducted before the era of biologics.
{"title":"Differences in disease characteristics and treatment exposures between paediatric and adult-onset inflammatory bowel disease using a registry-based cohort","authors":"Maya Granot, Uri Kopylov, Nurit Loberman-Nachum, Alexander Krauthammer, Chaya Mushka Abitbol, Shomron Ben-Horin, Batia Weiss, Yael Haberman","doi":"10.1111/apt.18264","DOIUrl":"https://doi.org/10.1111/apt.18264","url":null,"abstract":"Previous studies highlighted a more extensive phenotype for paediatric-onset than adult-onset inflammatory bowel disease (IBD). However, most lacked long-term follow-up, and some were conducted before the era of biologics.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142166632","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}
To prevent complications of paediatric ulcerative colitis (UC), it is critical to understand their predictors. The Paediatric Inflammatory Bowel Disease Ahead (PIBD Ahead) program identified the relevant outcomes and their potential predictors. However, external validation of these results in larger cohorts is required.
{"title":"Predicting complications in paediatric ulcerative colitis: A longitudinal multicentre cohort study","authors":"Merle Claßen, Benjamin Schiller, Jan Däbritz","doi":"10.1111/apt.18262","DOIUrl":"https://doi.org/10.1111/apt.18262","url":null,"abstract":"To prevent complications of paediatric ulcerative colitis (UC), it is critical to understand their predictors. The Paediatric Inflammatory Bowel Disease Ahead (PIBD Ahead) program identified the relevant outcomes and their potential predictors. However, external validation of these results in larger cohorts is required.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142166627","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}
Carolyn Singleton,Allie Carter,Brittany Baker,Emma Jones,Kelsey Green,Craig Lammert,Lauren D Nephew
BACKGROUND AND AIMSDiminished quality of life has been well characterized in patients with autoimmune hepatitis (AIH); however, the full spectrum of unmet needs is unclear. We hypothesized that there is a high burden of health-related unmet needs in patients with AIH, and this burden differs by socioeconomic status (SES).METHODSMembers of the Autoimmune Hepatitis Association were invited online and by email to complete a modified version of the Systemic Lupus Erythematosus Patient Needs Questionnaire. Demographic and clinical data were also captured. Low SES was defined as annual household income <30 k, education level below high school, or moderate-high concern for transportation, food or housing. Multivariable logistic regression assessed the association between unmet health-related needs and SES.RESULTSThere were 433 participants; 89.8% identified as women, 16.2% lived outside the US, and 25.6% were classified as low SES. Over 70% of respondents reported at least one moderate-high need in the health-related unmet need domains. In multivariable logistic regression, patients in the low-SES group reported significantly higher odds of unmet needs compared to the moderate-high-SES group: for adequate information about side effects (OR 1.64, 95% CI 1.06-2.53, p = 0.026), opportunity to speak with others with AIH (OR 2.34, 95% CI 1.50-3.66, p < 0.001), healthcare professionals acknowledging patient emotions (OR 2.41, 95% CI 1.56-3.74, p < 0.001) and being taken seriously by medical providers (OR 2.09, 95% CI 1.34-3.28, p = 0.001).CONCLUSIONThere is a high burden of health-related unmet needs in all patients with AIH that is exacerbated by low SES.
背景和目的自身免疫性肝炎（AIH）患者生活质量下降的特点已得到很好的描述；但是，未满足需求的全部范围尚不清楚。我们假设自身免疫性肝炎患者的健康相关需求未得到满足的负担很重，而且这种负担因社会经济地位（SES）的不同而不同。方法通过在线和电子邮件邀请自身免疫性肝炎协会会员填写修改版的系统性红斑狼疮患者需求问卷。同时还收集了人口统计学和临床数据。低社会经济地位的定义是家庭年收入低于 30 000 美元，教育程度低于高中，或对交通、食品或住房有中度至高度的担忧。多变量逻辑回归评估了未满足的健康相关需求与 SES 之间的关联。结果共有 433 名参与者，其中 89.8% 为女性，16.2% 居住在美国以外，25.6% 被归类为低 SES。超过 70% 的受访者在与健康相关的未满足需求领域中至少报告了一项中度-高度需求。在多变量逻辑回归中，与中高社会经济地位组相比，低社会经济地位组患者报告的未满足需求的几率明显更高：关于副作用的充分信息（OR 1.64，95% CI 1.06-2.53，p = 0.026）、与其他 AIH 患者交谈的机会（OR 2.34，95% CI 1.50-3.66，p < 0.001）、与其他 AIH 患者交谈的机会（OR 2.34，95% CI 1.50-3.66，p < 0.001）。66, p < 0.001）、医护人员承认患者的情绪（OR 2.41, 95% CI 1.56-3.74, p < 0.001）以及被医疗服务提供者认真对待（OR 2.09, 95% CI 1.34-3.28, p = 0.001）。
{"title":"Low socioeconomic status exacerbates unmet health-related needs in patients with autoimmune hepatitis.","authors":"Carolyn Singleton,Allie Carter,Brittany Baker,Emma Jones,Kelsey Green,Craig Lammert,Lauren D Nephew","doi":"10.1111/apt.18235","DOIUrl":"https://doi.org/10.1111/apt.18235","url":null,"abstract":"BACKGROUND AND AIMSDiminished quality of life has been well characterized in patients with autoimmune hepatitis (AIH); however, the full spectrum of unmet needs is unclear. We hypothesized that there is a high burden of health-related unmet needs in patients with AIH, and this burden differs by socioeconomic status (SES).METHODSMembers of the Autoimmune Hepatitis Association were invited online and by email to complete a modified version of the Systemic Lupus Erythematosus Patient Needs Questionnaire. Demographic and clinical data were also captured. Low SES was defined as annual household income <30 k, education level below high school, or moderate-high concern for transportation, food or housing. Multivariable logistic regression assessed the association between unmet health-related needs and SES.RESULTSThere were 433 participants; 89.8% identified as women, 16.2% lived outside the US, and 25.6% were classified as low SES. Over 70% of respondents reported at least one moderate-high need in the health-related unmet need domains. In multivariable logistic regression, patients in the low-SES group reported significantly higher odds of unmet needs compared to the moderate-high-SES group: for adequate information about side effects (OR 1.64, 95% CI 1.06-2.53, p = 0.026), opportunity to speak with others with AIH (OR 2.34, 95% CI 1.50-3.66, p < 0.001), healthcare professionals acknowledging patient emotions (OR 2.41, 95% CI 1.56-3.74, p < 0.001) and being taken seriously by medical providers (OR 2.09, 95% CI 1.34-3.28, p = 0.001).CONCLUSIONThere is a high burden of health-related unmet needs in all patients with AIH that is exacerbated by low SES.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142165922","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>I read with interest the study conducted by McPherson et al,<span><sup>1</sup></span> which aimed to evaluate the concordance between non-invasive fibrosis tests (NITs)-based clinician fibrosis assessment and histology in patients with metabolic dysfunction-associated steatotic liver disease. While the manuscript title suggests that the authors assessed the reliability of experienced hepatologists in staging liver fibrosis using combinations of NITs, the study goal was actually to differentiate advanced fibrosis (stages F3–F4) from F0 to F2. This focus is understandable, given the increased risk of adverse hepatic and extrahepatic outcomes associated with F3–F4.<span><sup>2, 3</sup></span> However, the study could have been further strengthened by incorporating a separate analysis of the accuracy of hepatologists in identifying patients with F2–F3 fibrosis. The results of such an investigation would have been particularly relevant for trials of investigational drugs. Accordingly, at-risk metabolic dysfunction-associated steatohepatitis (MASH), defined as a non-alcoholic fatty liver disease activity score of four or more with at least one point in each of its components, combined with F2–F3 fibrosis, currently represents the target study population in most phase IIb/III clinical trials.<span><sup>4, 5</sup></span> Unfortunately, accurately diagnosing at-risk MASH remains a significant challenge in both research settings and clinical practice.<span><sup>5</sup></span> The accuracy of NITs tends to decrease when distinguishing between adjacent fibrosis stages, particularly in the intermediate range.<span><sup>6</sup></span> Therefore, a specific analysis of F2–F3 fibrosis in the study by McPherson et al<span><sup>1</sup></span> would have been highly valuable.</p><p>Another observation is that while integrating physical examination findings, biochemical markers, radiographic imaging and endoscopic results can improve the accuracy of NITs in detecting F3–F4 fibrosis,<span><sup>7</sup></span> the same level of improvement may not be observed for earlier fibrosis stages (F2–F3). Shedding light on this additional issue in the study by McPherson et al<span><sup>1</sup></span> would have provided critical information, considering that in most clinical trials, over half of the patients in the screening population are excluded, with incompatible histological features being the most common reason for screening failure.<span><sup>5</sup></span> Within a clinical trial framework, a comprehensive examination of NIT combinations across all fibrosis stages is expected to yield substantial benefits in the future. Beyond the methodology employed by McPherson et al,<span><sup>1</sup></span> which is limited to distinguishing stages F3–F4 from F0 to F2, the incorporation of a more granular examination of F2–F3 fibrosis has the potential to facilitate the exclusion of individuals with non-at-risk MASH or cirrhosis, thereby enriching clinical trial populations. Such
{"title":"Letter: Beyond advanced fibrosis—The critical need for assessing NITs performance in identifying F2–F3 fibrosis","authors":"Yusuf Yilmaz","doi":"10.1111/apt.18171","DOIUrl":"10.1111/apt.18171","url":null,"abstract":"<p>I read with interest the study conducted by McPherson et al,<span><sup>1</sup></span> which aimed to evaluate the concordance between non-invasive fibrosis tests (NITs)-based clinician fibrosis assessment and histology in patients with metabolic dysfunction-associated steatotic liver disease. While the manuscript title suggests that the authors assessed the reliability of experienced hepatologists in staging liver fibrosis using combinations of NITs, the study goal was actually to differentiate advanced fibrosis (stages F3–F4) from F0 to F2. This focus is understandable, given the increased risk of adverse hepatic and extrahepatic outcomes associated with F3–F4.<span><sup>2, 3</sup></span> However, the study could have been further strengthened by incorporating a separate analysis of the accuracy of hepatologists in identifying patients with F2–F3 fibrosis. The results of such an investigation would have been particularly relevant for trials of investigational drugs. Accordingly, at-risk metabolic dysfunction-associated steatohepatitis (MASH), defined as a non-alcoholic fatty liver disease activity score of four or more with at least one point in each of its components, combined with F2–F3 fibrosis, currently represents the target study population in most phase IIb/III clinical trials.<span><sup>4, 5</sup></span> Unfortunately, accurately diagnosing at-risk MASH remains a significant challenge in both research settings and clinical practice.<span><sup>5</sup></span> The accuracy of NITs tends to decrease when distinguishing between adjacent fibrosis stages, particularly in the intermediate range.<span><sup>6</sup></span> Therefore, a specific analysis of F2–F3 fibrosis in the study by McPherson et al<span><sup>1</sup></span> would have been highly valuable.</p><p>Another observation is that while integrating physical examination findings, biochemical markers, radiographic imaging and endoscopic results can improve the accuracy of NITs in detecting F3–F4 fibrosis,<span><sup>7</sup></span> the same level of improvement may not be observed for earlier fibrosis stages (F2–F3). Shedding light on this additional issue in the study by McPherson et al<span><sup>1</sup></span> would have provided critical information, considering that in most clinical trials, over half of the patients in the screening population are excluded, with incompatible histological features being the most common reason for screening failure.<span><sup>5</sup></span> Within a clinical trial framework, a comprehensive examination of NIT combinations across all fibrosis stages is expected to yield substantial benefits in the future. Beyond the methodology employed by McPherson et al,<span><sup>1</sup></span> which is limited to distinguishing stages F3–F4 from F0 to F2, the incorporation of a more granular examination of F2–F3 fibrosis has the potential to facilitate the exclusion of individuals with non-at-risk MASH or cirrhosis, thereby enriching clinical trial populations. Such","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":null,"pages":null},"PeriodicalIF":6.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.18171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142160927","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}
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