Gut and Liver最新文献

Background/aims: Subcutaneous (SC) vedolizumab (VDZ) has recently become available for patients with inflammatory bowel disease (IBD) in Korea. This retrospective observational study aimed to evaluate the clinical outcomes and safety of switching from intravenous (IV) to SC VDZ.

Methods: Patients with IBD who switched from IV to SC VDZ between 2023 and 2024 were included. The primary outcome was the 24-week persistence rate of SC VDZ. Secondary outcomes included clinical factors associated with SC VDZ persistence, safety profiles, subsequent treatment courses after discontinuation of SC VDZ, and recapture success rate after reverting to IV VDZ.

Results: A total of 101 patients with IBD (72 with ulcerative colitis [UC] and 29 with Crohn's disease) were included. After 24 weeks, 72 patients (71.3%) maintained SC VDZ. Corticosteroid use at switching was the strongest predictor of 24-week SC VDZ failure in both the overall IBD cohort (p=0.018) and in patients with UC (p=0.027) in multivariable analyses. Kaplan-Meier analysis showed that patients with UC with intensified IV dosing intervals (p=0.021), failure to clinical remission (p=0.038), or concomitant corticosteroid use at switching (p<0.001) were more likely to discontinue SC VDZ. Injection-site reactions occurred in 24 patients (23.8%). A total of 34 patients (33.7%) discontinued SC VDZ; 19 resumed IV VDZ; and 13 initiated another advanced therapy. The recapture success rate after reverting to IV VDZ was 73.7%, with higher success in those who discontinued because of injection-site reactions or poor adherence.

Conclusions: SC VDZ persistence is significantly influenced by disease activity at the time of switching.

Background/aims: There is currently insufficient evidence to recommend one oral hypoglycemic agent over another for diabetic patients to reduce hepatic steatosis or prevent advanced fibrosis. We aimed to evaluate the efficacy of dipeptidyl peptidase-4 inhibitors (DPP-4i) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in patients with type 2 diabetes mellitus (DM) and metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods: This study included diabetic patients with steatotic liver disease who newly received either a DPP-4i or an SGLT-2i as a second-line treatment between 2014 and 2021 at a single tertiary hospital. MASLD was categorized as MASLD-H (radiologic steatosis with a hepatic steatosis index [HSI]>36) or MASLD-I (radiologic steatosis only). Changes in the HSI and fibrosis-4 (FIB-4) index were compared at 1 and 3 years after treatment initiation.

Results: A total of 3,493 patients were consecutively enrolled, with 3,001 receiving DPP-4i treatment and 492 receiving SGLT-2i treatment. After applying propensity score matching, the SGLT-2i group showed a significantly greater reduction in the HSI than the DPP-4i group in the DM-MASLD population at both 1 year (DM-MASLD-H: DPP-4i vs SGLT-2i, -1.4% vs -3.7%, p<0.001; DM-MASLD-I: -1.3% vs -3.8%, p<0.001) and 3 years (DM-MASLD-H: -2.0% vs -4.0%, p=0.001; DM-MASLD-I: -2.4% vs -4.2, p=0.025). The FIB-4 indices of both groups increased; however, the increase at year 1 was more significant in the DPP-4i than in the SGLT-2i group (DM-MASLD-H: 11.4% vs 5.2%, p<0.001; DM-MASLD-I: 10.7% vs 4.3%, p=0.014).

Conclusions: In patients with DM-MASLD, SGLT-2i treatment was associated with a greater reduction in hepatic steatosis and delayed fibrotic progression than DPP-4i treatment.

Background/aims: This study aimed to evaluate the effectiveness of fibrin glue application in reducing bleeding after endoscopic submucosal dissection (ESD) in the general patient population.

Methods: This randomized controlled trial enrolled 262 patients who underwent ESD for gastric neoplasms. The participants were randomized into the fibrin glue group (n=133) or the control group (n=129). The primary outcome was the post-ESD bleeding rate, which was compared between the two groups. Additionally, exploratory subgroup analyses were conducted for high-risk patients, which included patients taking antithrombotic agents (ATAs) and patients with resected specimens measuring 4 cm or greater.

Results: In the modified intention-to-treat population (n=252), the overall bleeding rate occurred in 10.7% of cases, including 10.3% of patients in the fibrin glue group and 11.1% of patients in the control group (p=0.839). In the per-protocol population (n=248), the bleeding rates were 10.3% in the fibrin glue group and 10.7% in the control group (p=1.000). Among ATA users, the overall bleeding rate was 18.0%, including 9.5% of patients in the fibrin glue group and 24.1% of patients in the control group (p=0.271). Among ATA users with specimens measuring 4 cm or larger, the overall bleeding rate was 18.4%, including 12.5% of patients in the fibrin glue group and 22.7% of patients in the control group (p=0.675).

Conclusions: Routine application of fibrin glue after ESD did not significantly reduce postoperative bleeding. Although the results of subgroup analyses suggested a potential reduction in early bleeding among high-risk patients, these findings warrant further investigation.

Background/aims: Gastrointestinal diseases present a significant global health challenge and greatly impact healthcare expenditures. Despite alcohol, tobacco, and coffee being universally recognized risk factors for various gastrointestinal disorders, the exact causal linkages have not been clarified because of the predominance of observational studies on this topic. Mendelian randomization (MR) was used to explore to what extent alcohol, tobacco, and coffee increase the risk of developing 13 upper and lower gastrointestinal diseases.

Methods: Genetic data from large genome-wide association studies including GSCAN, FinnGen, UK Biobank, IIBDGC, GERA, and other consortia were used for both univariable and multivariable MR analyses. Single-nucleotide polymorphisms were used as instrumental variables and sensitivity analyses were conducted to identify potential pleiotropic effects.

Results: Genetically predicted smoking was positively associated with esophageal cancer, Crohn's disease, gastric ulcer, irritable bowel syndrome, and gastroesophageal reflux risk, but was negatively associated with celiac disease risk. Alcohol intake was positively correlated with both esophageal cancer and chronic gastritis risk. These findings were confirmed by multivariable MR analyses, albeit with some variations. Coffee consumption was linked to esophageal cancer, but the association became nonsignificant after adjusting for hot beverage consumption.

Conclusions: This comprehensive MR study suggests that alcohol and tobacco consumption are associated with the occurrence of several gastrointestinal diseases. These results support the need for public health initiatives to reduce smoking and alcohol abuse, with the aim of preventing both upper and lower gastrointestinal diseases.

Hepatitis C virus (HCV) clearance markedly reduces the risk of hepatocellular carcinoma (HCC); however, HCC continues to develop in a subset of patients, particularly in those with advanced fibrosis or cirrhosis. Leading hepatology societies, including Asian Pacific Association for the Study of the Liver, European Association for the Study of the Liver, American Association for the Study of Liver Diseases, Korean Association for the Study of the Liver, Taiwan Association for the Study of the Liver, and Japan Society of Hepatology, have issued divergent guidelines for HCC surveillance after sustained virologic response, which reflects variations in regional patient populations, healthcare infrastructure, and policy priorities. While traditional risk stratification primarily centers on histological staging of fibrosis, an array of additional host-related factors, including age, sex, alcohol use, metabolic comorbidities, and genetic and epigenetic profiles, further influence individual HCC risks. Recently developed predictive models aim to improve risk discrimination and inform tailored surveillance intervals. Concurrently, health economic analyses support the continuation of surveillance in high-risk populations. Nonetheless, the optimal surveillance frequency and criteria for patient selection remain matters of ongoing debates. This review synthesizes current controversies across international guidelines, presents an evaluation of the supporting evidence for varied surveillance strategies, highlights emerging tools for individualized risk assessment, and discusses cost-effectiveness considerations to inform personalized, evidence-based HCC surveillance in the post-HCV cure landscape.

Background/aims: Data on hepatitis C virus (HCV) infection among people who use drugs (PWUD) in South Korea is limited. This study investigated the prevalence, clinical characteristics, and treatment rates of HCV infection among PWUD.

Methods: From August 2022 to May 2024, 342 PWUD were prospectively enrolled in four hospitals covering 95% of PWUD care in Korea. Blood tests and questionnaires were conducted. If the anti-HCV antibody test was positive, a reflex test for HCV RNA was performed. The clinical characteristics were compared according to anti-HCV or HCV RNA positivity.

Results: Among these patients (median age, 46 years; men, 76%; injection drug user, 92%; syringe sharing, 56%), the prevalence of anti-HCV and HCV RNA was 31.3% and 10.5%, respectively. Abnormal aspartate aminotransferase or alanine aminotransferase levels were found in 24.6% of patients, and fibrosis-4 >3.25 was detected in 4.4% of patients. Anti-HCV positivity was independently associated with age (odds ratio [OR], 1.074), duration of injection drug use (OR, 1.060), sharing of syringes (OR, 3.510), and very low monthly income (OR, 2.598). Among anti-HCV positive patients, the treatment rate was significantly higher in the HCV RNA negative group (71.8%) than in the RNA positive group (16.7%). The only independent factor related to treatment uptake was having Medical Aid, which reimbursed 100% of the antiviral treatment (OR, 10.912; 95% confidence interval, 2.024 to 58.848; p=0.005).

Conclusions: Among PWUD in South Korea, the anti-HCV and HCV RNA prevalence rates were 31.3% and 10.5%, respectively. Only half of the anti-HCV positive PWUD received antiviral treatment. Treatment uptake was related to direct-acting antiviral affordability, suggesting a need for public support.

Background/aims: Within metabolic dysfunction and alcohol-associated liver disease (MetALD), there exists a continuum where the condition can conceptually shift between being metabolic dysfunction-associated steatotic liver disease (MASLD) and alcoholic liver disease. However, alcohol use disorder (AUD) can be included in these diagnoses. The aim of this study was to investigate the prevalence and clinical characteristics of misclassified AUD among patients with MASLD and MetALD.

Methods: The study included a total of 3,362,552 participants from the 2011 to 2012 National Health Screening Program. Steatotic liver disease was defined as having a hepatic steatosis index score of 36 or higher. Significant alcohol intake was calculated on the basis of self-report questionnaire responses. AUD was defined as having received medical care for an alcohol-related condition at least once during the study period. The mean follow-up period for participants was 9.8 years.

Results: MASLD and MetALD prevalence were 23.8% and 1.9%, respectively. AUD was identified in 1.1% (8,481 individuals) of MASLD and 4.7% (2,989 individuals) of MetALD cases. Misclassified AUD was associated with significantly higher all-cause and liver-related mortality. Adjusted hazard ratios for liver-related mortality were 6.53 for AUD misclassified as MASLD and 6.98 for AUD misclassified as MetALD. Extrahepatic cancer mortality risk was also elevated (adjusted hazard ratio: 1.33 in MASLD and 1.44 in MetALD).

Conclusions: A significant number of AUD cases were misclassified as MASLD and MetALD in cross-sectional assessment of alcohol consumption. Patients with AUD misclassified as MASLD or MetALD had higher liver-related mortality than the pure MASLD and MetALD groups.