Journal of Gastroenterology and Hepatology最新文献

Background and aims: Cellular senescence is a hallmark of several liver diseases, including primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC). Senescent cholangiocytes exhibit a senescence-associated secretory phenotype (SASP), characterized by profibroinflammatory mediator release. Current cost-effective biomarkers predicting disease progression, particularly for PSC, are limited and often lack mechanistic relevance. We sought to define a plasma biomarker signature for PSC and PBC.

Methods: Plasma from early- and late-stage PSC and PBC, alcoholic liver disease (ALD), inflammatory bowel disease (IBD) patients, and healthy controls was analyzed. Seventy-one analytes were quantified using Luminex Multiplex Immunoassay or enzyme-linked immunosorbent assay (ELISA). Principal component analysis (PCA) identified key patterns. Findings from the PSC cohort were then applied to additional cohorts.

Results: Second principal component (PC2) (17 analytes, 17.1% variability) best separated PSC from controls. ANOVA showed significant differences in PC2 between early PSC vs. controls (p = 0.0001), late PSC vs. controls (p < 0.0001), and early vs. late PSC (p < 0.0001). PC2 analytes also distinguished early PBC vs. controls (p < 0.0332), late PBC (p < 0.0001), and ALD (p < 0.0001), and early vs. late PBC (p < 0.0001), but not IBD vs. controls (p = 0.119). Logistic regression using PC2 demonstrated strong discrimination of early- and late-stage PSC (AUC = 0.86) and control vs. early-stage PSC (AUC = 0.83).

Conclusion: This is the first study to define a plasma SASP biomarker signature associated with cholestatic liver disease. These analytes track disease stage and represent both mechanistic indicators and potential clinical trial endpoints.

Magnetic resonance imaging has gained increasing attention as a surveillance tool for hepatocellular carcinoma in high-risk populations due to its superior sensitivity for detecting early-stage tumors compared with ultrasound. However, the widespread use of complete contrast-enhanced MRI in routine surveillance has been limited by its long acquisition time and high cost. Abbreviated magnetic resonance imaging has emerged as a practical and effective alternative, offering improved sensitivity over ultrasound while reducing scan time and resource use compared with complete magnetic resonance imaging. Abbreviated magnetic resonance imaging protocols include only the sequences most essential for hepatocellular carcinoma detection and are generally classified into three categories: hepatobiliary-phase abbreviated magnetic resonance imaging using gadoxetic acid, dynamic contrast-enhanced abbreviated magnetic resonance imaging, and noncontrast abbreviated magnetic resonance imaging. This review summarizes the diagnostic performance, clinical applicability, and advantages and limitations of each abbreviated magnetic resonance imaging approach, as well as strategies for interpretation and reporting. Recent prospective studies have provided high-level evidence supporting the clinical utility of abbreviated magnetic resonance imaging, reinforcing its potential role in hepatocellular carcinoma surveillance for high-risk patients. To maximize its effectiveness, careful patient selection and consideration of cost-effectiveness are essential. A risk-adapted surveillance tailored to individual patient characteristics may represent the most efficient strategy for integrating abbreviated magnetic resonance imaging into routine practice, which this review also explores.

Background: Fontan-associated liver disease (FALD) is a long-term complication after Fontan surgery, and the development of hepatocellular carcinoma (HCC) in relatively young patients has become a major clinical concern. This study aimed to clarify the diagnostic triggers, clinicopathological characteristics, treatment strategies, and outcomes of FALD-HCC.

Methods: We retrospectively reviewed 297 patients with FALD who visited our department between 2003 and 2025. Among them, 28 patients (9.4%) developed HCC. Diagnostic triggers, tumor characteristics, initial treatment modalities, and clinical courses were analyzed.

Results: HCC developed at a median age of 32.6 years, with an interval of 26.1 years after Fontan surgery. Diagnosis was triggered by tumor marker elevation, including alpha-fetoprotein and/or des-gamma-carboxy prothrombin, in 46.4% of patients, routine surveillance imaging in 35.7%, and symptom-driven imaging in 17.9%. Most patients had a single tumor, frequently located in the peripheral liver. At diagnosis, 71.5% were classified as stage I or II disease. Histological evaluation, available in selected cases, revealed variable tumor differentiation and advanced fibrosis in noncancerous liver tissue. Initial treatments included hepatic resection, transcatheter arterial chemoembolization, stereotactic body radiotherapy, proton beam therapy, systemic therapy, or palliative care alone in patients with advanced liver failure. Three-year survival rates were favorable, reaching 100% in patients treated with hepatic resection or stereotactic body radiotherapy.

Conclusions: When FALD-HCC was detected at an early stage through surveillance, a broad range of treatment options, including locoregional therapies, could be applied and were associated with favorable clinical outcomes. Although selection bias limits direct comparison, treatment of FALD-HCC should be considered.

Background/aims: Benefits of the Mediterranean diet (MD) in reducing hepatic steatosis among individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) have been well established. This study aims to evaluate the relationship between MD adherence and liver fibrosis among the MASLD population.

Methods: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey 2017 to March 2020. Individuals with MASLD were identified based on the vibration-controlled transient elastography-defined steatosis. Participants' MD adherence was evaluated using the alternate Mediterranean diet (aMED) score, with higher scores indicating greater adherence. Risk of significant liver fibrosis was compared between low, moderate, and high aMED groups.

Results: Of 2672 MASLD participants, 27.2%, 42.3%, and 30.6% were categorized into low, moderate, and high aMED groups, respectively. After adjusting for the number of cardiometabolic risk factors (CMRFs), physical activity, and other covariates, participants in the high aMED group were associated with a lower risk of significant liver fibrosis compared with those in the low aMED group (aMED 5-9 vs. aMED 0-2: OR = 0.662, 95% confidence interval [CI]: 0.660-0.663; p for trend < 0.0001). In the sensitivity analyses, the protective association of higher MD adherence against the risk of significant liver fibrosis weakened with higher cardiometabolic burden (aMED 5-9: aOR 0.582, 95% CI: 0.580-0.584 [4-5 CMRFs] vs. aOR 0.383, 95% CI: 0.380-0.386 [1 CMRF]).

Conclusions: In MASLD patients, higher MD adherence was associated with lower risk of significant liver fibrosis. Our findings support the recommendation of the MD as a crucial lifestyle intervention to lower the risk of liver fibrosis in this population.

Background: Functional dyspepsia (FD) is a common gastrointestinal disorder that significantly impacts patients' quality of life. Over a decade ago, the Asian Neurogastroenterology and Motility Association (ANMA) and the Asian Pacific Association of Gastroenterology (APAGE) jointly developed the first Asian consensus report on FD. In this consensus report, members of ANMA and APAGE provide updated recommendations on the definition, diagnosis, epidemiology, pathophysiology, and management of FD, focusing on Asian populations.

Methods: The task force members conducted a systematic literature review and used a modified Delphi process to develop updated consensus statements. Based on members' feedback, statements that failed to reach at least 80% consensus in the first round of voting were revised. Revisions included rephrasing for clarity, incorporating additional evidence, and subgroup voting during a second round of discussion at a hybrid meeting.

Results: The task force developed 32 statements covering key aspects of FD. Major updates include new insights into the pathophysiology and emerging treatment options. The task force acknowledged that the limited scope and heterogeneity of available studies limit definitive conclusions about the utility of some emerging therapies such as probiotics and potassium-competitive acid blockers in FD management.

Conclusions: The second Asian Consensus Report on FD provides updated evidence-based recommendations to improve the diagnosis and management of FD in clinical practice, particularly in the Asian setting.

Background: Gastrointestinal (GI) cancers contribute significantly to the global disease burden, yet their impact on adolescents and young adults (AYAs; ages 15-39) remains understudied. This study aimed to quantify the global burden of GI cancers in AYAs and assess associated risk factors.

Methods: Data on GI cancers, including esophageal, stomach, colorectal, gallbladder and biliary tract, pancreatic, and liver cancers, were retrieved from the Global Burden of Disease (GBD) Study 2021. Socio-demographic index (SDI)-related disparities in incidence and death were analyzed using Spearman correlation and health inequality assessments. Temporal trends were assessed using average annual percentage changes, with future projections by 2045 made using Nordpred models. Risk factors contributing to GI cancer prevalence were evaluated.

Results: In 2021, GI cancers accounted for 156 033 new cases and 84 623 deaths among AYAs, with the highest burden observed in East Asia. Age-standardized incidence rate (ASIR) increased, whereas age-standardized death rate (ASDR) decreased with rising SDI levels. Males and individuals aged 35-39 experienced a heavier GI cancer burden. From 1990 to 2021, both ASIR and ASDR for GI cancers declined, with projections indicating further decreases by 2045. The prevalence rate of GI cancers was positively associated with risk factors, including elevated cholesterol, obesity, physical inactivity, tobacco use, and alcohol consumption.

Conclusion: Despite a global decline in GI cancer burden, substantial disparities remain across regions, sexes, and age groups. Risk factors continue to drive the GI cancer burden. Targeted policies and prevention strategies for high-risk groups are crucial to effectively reduce this burden.