Annals of hepatology最新文献

{"title":"Serum IL-6 is a prognostic biomarker for advanced hepatocellular carcinoma treated with atezolizumab and bevacizumab","authors":"Lorenz Kocheise ,&nbsp;Jan Kempski ,&nbsp;Yunhe Tang ,&nbsp;Lorenz Balcar ,&nbsp;Victoria Berger ,&nbsp;Miriam Tomczak ,&nbsp;Joao Gorgulho ,&nbsp;Ramsha Masood ,&nbsp;Franziska Giehren ,&nbsp;Constantin Schmidt ,&nbsp;Jan P. Sutter ,&nbsp;Thorben W. Fruendt ,&nbsp;Francesca Pagani ,&nbsp;Sophie Wulf ,&nbsp;Julian Kött ,&nbsp;Saskia Domanig ,&nbsp;Anastasios Giannou ,&nbsp;Tanja Bedke ,&nbsp;Jöran Lücke ,&nbsp;Tao Zhang ,&nbsp;Kornelius Schulze","doi":"10.1016/j.aohep.2025.102138","DOIUrl":"10.1016/j.aohep.2025.102138","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Immunotherapy with atezolizumab/bevacizumab (atezo/bev) is an established first-line treatment for patients with non-resectable hepatocellular carcinoma (HCC). Despite notable successes, only a subset of patients shows treatment response, highlighting the need for biomarkers to identify those likely to benefit from this therapy.</div></div><div><h3>Materials and Methods</h3><div>In this biomarker study, 143 patients with atezo/bev-treated HCC were enrolled across three European centers. Baseline cytokine levels were measured using a flow cytometric multiplex bead assay. Overall survival (OS) analysis, reported as hazard ratios (HR), was conducted in an unbiased manner, with patients divided into a discovery cohort (one center, 63 patients) and a validation cohort (two centers, 80 patients).</div></div><div><h3>Results</h3><div>Our cohorts show typical baseline characteristics of Western HCC patients, with alcohol-related liver disease (35.0 %) and hepatitis C (21.7 %) as the main HCC etiologies. Elevated serum IL-6 (cut-off 18.22 pg/ml) was associated with poor OS in both the discovery (HR 2.6, 95 % CI 1.2–5.6, p = 0.013) and validation cohorts (HR 2.4, 95 % CI 1.3–4.4, p = 0.005). Multivariate analysis confirmed elevated IL-6 to be a significant prognostic biomarker of poor OS (HR 2.1, 95 % CI 1.1–3.9, p = 0.021) after adjusting for established risk factors.</div></div><div><h3>Conclusions</h3><div>We identify elevated serum IL-6 levels as prognostic biomarker in patients with advanced HCC in Western countries. Importantly, this association was independent of infection with viral hepatitis, thus extending the previously reported associations between IL-6 and treatment response in East Asian cohorts.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102138"},"PeriodicalIF":4.4,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pruritus in primary biliary cholangitis: insights from the German PBC registry across secondary and tertiary care","authors":"Toni Herta ,&nbsp;Annegret Franke ,&nbsp;Tobias Müller ,&nbsp;Kerstin Stein ,&nbsp;Heike Bantel ,&nbsp;Rainer Günther ,&nbsp;Gerald Denk ,&nbsp;Philipp A. Reuken ,&nbsp;Jörn M. Schattenberg ,&nbsp;Uwe Naumann ,&nbsp;Tobias Böttler ,&nbsp;Andreas Weber ,&nbsp;Stefan Zeuzem ,&nbsp;Matthias Hinz ,&nbsp;Robin Greinert ,&nbsp;Christoph Berg ,&nbsp;Thaddäus Till Wissniowski ,&nbsp;Karl-Georg Simon ,&nbsp;Jonel Trebicka ,&nbsp;Rüdiger Behrens ,&nbsp;Andreas E. Kremer","doi":"10.1016/j.aohep.2025.102140","DOIUrl":"10.1016/j.aohep.2025.102140","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Pruritus is a frequent and burdensome symptom in patients with primary biliary cholangitis (PBC), significantly affecting quality of life. Despite its clinical relevance, data on the prevalence and management, particularly across different levels of healthcare, remain limited. We aimed to assess prevalence, severity, and treatment of pruritus in PBC patients across secondary and tertiary care.</div></div><div><h3>Patients and Methods</h3><div>Within the German PBC registry, the intensity and management of pruritus were assessed cross-sectionally by treating physicians using a standardized 4-point verbal rating scale (absent, mild, moderate, severe), as well as by analyzing prescribed antipruritic medications.</div></div><div><h3>Results</h3><div>Pruritus was reported in 23 % (<em>n</em> = 120/515) of patients and classified as mild, moderate, or severe in 59 (49 %), 41 (34 %), and 20 (17 %) cases, respectively. The prevalence of pruritus was 27 % (n = 96/360) for tertiary versus 16 % (n = 24/155) for secondary care (p = 0.006). Moderate or severe pruritus was observed in 13.3 % (n = 48/360) of patients at tertiary centers compared to 8.4 % (n = 13/155) at secondary centers (p = 0.137). Antipruritic therapies were used in only 22.5 % (n = 27/120) patients with pruritus, with bezafibrate being the most frequently prescribed medication (63 %, n = 17/27). Patients with pruritus were more likely to receive antipruritic therapies in tertiary than secondary care: 26 % (n = 25/96) vs. 8 % (n = 2/24) (p = 0.098).</div></div><div><h3>Conclusions</h3><div>Pruritus in patients with PBC is common and under-treated in the real-world scenario. Assessment and management vary by healthcare level, highlighting the need for standardized care and greater awareness of treatment options across all settings.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102140"},"PeriodicalIF":4.4,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparisons of global incidence and risk factor profiles of hepatocellular carcinoma and intrahepatic cholangiocarcinoma","authors":"Tianhao Wu ,&nbsp;Mingyi Du ,&nbsp;Tiejun Zhang ,&nbsp;Xingdong Chen ,&nbsp;Zhenqiu Liu","doi":"10.1016/j.aohep.2025.102139","DOIUrl":"10.1016/j.aohep.2025.102139","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), the most prevalent primary liver cancer subtypes, present significant global health challenges. We aimed to comprehensively compare their incidence rates, risk factors, and potential preventability.</div></div><div><h3>Materials and Methods</h3><div>We analyzed liver cancer histological subtypes from Cancer Incidence in Five Continents Volume XII and assessed 85 modifiable risk factors for HCC and iCCA using the UK Biobank data. We calculated population attributable fraction to assess the population preventability of the cancers.</div></div><div><h3>Results</h3><div>Incidence data from 49 countries revealed a moderate positive correlation between the incidences of HCC and iCCA (ρ=0.41, P=0.003), with the highest rates observed in the Republic of Korea (15.6 <em>vs</em> 3.3 per 100,000, respectively). The global variation of HCC incidence was more pronounced than iCCA. After applying a Bonferroni correction for p-value, we identified 42 modifiable risk factors for HCC (n=470) and eight for iCCA (n=508). The effects of nearly all risk factors were more pronounced for HCC than for iCCA. Up to 83.3 % of HCC cases could be attributed to modifiable risk factors, although the preventable fraction varied across subpopulations. By contrast, only 37.7 % of iCCA cases were attributable to such factors, and the preventable fraction remained consistent across subgroups.</div></div><div><h3>Conclusions</h3><div>Our findings reveal the distinct yet partly overlapping epidemiological characteristics of HCC and iCCA, emphasizing the urgent need to clarify risk factors for iCCA. However, these findings may not be globally applicable, as modifiable risk factors can differ across regions due to varying exposures.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102139"},"PeriodicalIF":4.4,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic consumption, genetic risk and incidence of metabolic dysfunction-associated steatotic liver disease: a prospective cohort study","authors":"Ziming Zheng ,&nbsp;Yumei Huang ,&nbsp;Jijuan Zhang ,&nbsp;Jinchi Xie ,&nbsp;An Pan ,&nbsp;Yunfei Liao ,&nbsp;Yu Zhang","doi":"10.1016/j.aohep.2025.102136","DOIUrl":"10.1016/j.aohep.2025.102136","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The association between antibiotic consumption and the risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD) remains ambiguous. This study aimed to investigate this relationship within a large prospective cohort from the UK Biobank.</div></div><div><h3>Patients and Methods</h3><div>We conducted a prospective cohort study of 143,279 adults aged 40 to 70 years, among whom 1477 were diagnosed with MASLD for the first time. Multivariate Cox proportional hazards regression models were employed to assess the data. The genetic risk score (GRS) for MASLD was derived from five single-nucleotide variants, and mediation analysis was performed to evaluate the role of metabolic syndrome (MetS).</div></div><div><h3>Results</h3><div>Our findings demonstrated that individuals with antibiotic exposure during childhood or adolescence exhibited a significantly higher risk of developing MASLD compared to those without antibiotic exposure (<em>P</em> &lt; 0.001, HR 1.39; 95 % CI 1.21–1.59). No significant interaction was observed between antibiotic consumption and genetic predisposition for MASLD. Mediation analysis revealed that MetS and central obesity accounted for 21.98 % and 13.55 % of the association between early-life antibiotic exposure and MASLD, respectively (<em>P</em> &lt; 0.001), particularly in women (<em>P</em> for interaction = 0.031).</div></div><div><h3>Conclusions</h3><div>Long-term antibiotic exposure in early life was significantly associated with a higher risk of developing MASLD, and this association persisted after adjustment for genetic predisposition factors.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102136"},"PeriodicalIF":4.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations of MELD and MELD 3.0 for prognostication in patients with cirrhosis hospitalized with acute decompensation: an analysis of the ATTIRE trial","authors":"Nikolaj Torp,&nbsp;Nick Freemantle,&nbsp;Mads Israelsen,&nbsp;Aleksander Krag,&nbsp;Alastair O’Brien","doi":"10.1016/j.aohep.2025.102137","DOIUrl":"10.1016/j.aohep.2025.102137","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102137"},"PeriodicalIF":4.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective surveillance reveals high rates of antimicrobial resistance in urinary tract infections among patients with cirrhosis.","authors":"Carolina Vazquez ,&nbsp;Gonzalo Gómez Perdiguero ,&nbsp;Esteban González Ballerga ,&nbsp;Ilse Pardo Ivirico ,&nbsp;Camila M. Briz ,&nbsp;Agustín Di Santo ,&nbsp;Maria D. Murga ,&nbsp;Ana Palazzo ,&nbsp;Lorena Notari ,&nbsp;Josefina Pages ,&nbsp;Julia Brutti ,&nbsp;Brenda Osso Sánchez ,&nbsp;Manuel Mendizabal ,&nbsp;Margarita Anders ,&nbsp;Diego H. Giunta ,&nbsp;Gisela Gualano ,&nbsp;Agostina Romero ,&nbsp;Alina Zerega ,&nbsp;Pablo Calzetta ,&nbsp;Martín Elizondo ,&nbsp;Sebastián Marciano","doi":"10.1016/j.aohep.2025.102135","DOIUrl":"10.1016/j.aohep.2025.102135","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>As antimicrobial resistance rises, selecting appropriate empirical antibiotics for treating urinary tract infections (UTIs) has become complex. This study aimed to estimate the antimicrobial susceptibility patterns of microorganisms that cause UTIs in patients with cirrhosis.</div></div><div><h3>Materials and Methods</h3><div>This study analyzed UTI episodes in patients with cirrhosis from Argentina and Uruguay (Dec 2020–July 2024). The coordinating center reviewed all antibiograms.</div></div><div><h3>Results</h3><div>A total of 277 UTI episodes in 233 patients were included (community-acquired: 119, healthcare-associated: 68, and nosocomial: 90). <em>Escherichia coli</em> and <em>Klebsiella pneumoniae</em> were the predominant pathogens (70.6 %, <em>n</em> = 202). Multidrug resistance and extensive drug resistance were observed in 51.6 % and 11.6 % of the episodes, respectively. Carbapenemase-producing organisms were particularly prevalent in nosocomial infections (30.3 %, 95 % CI: 21.5–40.8). In community-acquired UTIs, coverage rates for ceftriaxone, cefepime, and piperacillin-tazobactam ranged from 60–70 %. Aminoglycosides (82.2 %, 95 %CI: 74.1–88.2) and carbapenems (90.0 %, 95 %CI: 83.0–94.2) provided coverage exceeding 80 %. For nosocomial UTIs, carbapenems demonstrated suboptimal coverage; in contrast, adequate coverage was observed with ceftazidime-avibactam plus aztreonam (83.0 %, 95 %CI: 73.4–89.6) or plus vancomycin (76.1 %, 95 %CI: 65.9–84.0).</div></div><div><h3>Conclusions</h3><div>The study highlights alarming antimicrobial resistance, particularly in nosocomial UTIs. Traditional antibiotics, such as ceftriaxone for community-acquired UTIs and carbapenems or piperacillin/tazobactam for nosocomial infections, fail to provide sufficient empirical coverage. More comprehensive approaches to empirical treatment, such as combination therapies or newer antibiotics targeting resistant pathogens, are needed.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102135"},"PeriodicalIF":4.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multinational survey of physician knowledge about management of chronic hepatitis C","authors":"Mohamed El-Kassas ,&nbsp;Yusuf Yilmaz ,&nbsp;Chun-Jen Liu ,&nbsp;Marlen I.Castellanos Fernández ,&nbsp;Yuichiro Eguchi ,&nbsp;Khalid Al-Naamani ,&nbsp;Doaa Abdeltawab ,&nbsp;Mohammed A. Medhat ,&nbsp;Wah-Kheong Chan ,&nbsp;Stuart Gordon ,&nbsp;Vasily Isakov ,&nbsp;Ming Lung Yu ,&nbsp;Maria Buti ,&nbsp;George V. Papatheodoridis ,&nbsp;Fatema Nader ,&nbsp;Andrei Racila ,&nbsp;Linda Henry ,&nbsp;Maria Stepanova ,&nbsp;Zobair M. Younossi ,&nbsp;the Global Liver Council","doi":"10.1016/j.aohep.2025.102134","DOIUrl":"10.1016/j.aohep.2025.102134","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Up-to-date knowledge of hepatitis C virus (HCV) management among healthcare providers is crucial for improving patient outcomes. This study evaluates physicians' awareness, attitudes, self-efficacy, perceptions, and barriers related to current HCV management guidelines and post-treatment follow-up.</div></div><div><h3>Materials and Methods</h3><div>We invited healthcare providers treating HCV patients to complete a 48-question survey regarding their practices, guideline familiarity, and related attitudes.</div></div><div><h3>Results</h3><div>The survey was completed by 183 physicians from 8 countries, including hepatologists (32 %), gastroenterologists (39 %), internal medicine specialists (12 %), and infectious disease specialists (16 %). The majority (95 %) were aware of at least one treatment guideline, with the EASL guideline cited by 84 % and the AASLD guideline by 72 %. Most (94 %) believed post-HCV treatment follow-up was effective for detecting complications, and 93 % recommended continued follow-up. Although 90 % felt well-informed about guidelines, 39 % reported encountering inconsistencies. Sixty-one percent recognized that HCV elimination reduces the rate of decompensation but does not abolish the risk of hepatocellular carcinoma (HCC). Overall, 86 % acknowledged the need for follow-up in patients who achieved sustained virological response (SVR), with the most commonly recommended intervals being six months for non-cirrhotic patients and three months for cirrhotic patients. Minimal barriers to follow-up were reported, with only 1.6 % to 4.4 % not discussing its benefits due to time or resource constraints.</div></div><div><h3>Conclusions</h3><div>The surveyed physicians demonstrated a strong awareness of the current HCV guidelines but indicated potential gaps in knowledge and inconsistencies. Continuous education and support are essential to enhance adherence to HCV management protocols.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102134"},"PeriodicalIF":4.4,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piloting eLearning initiatives: Computer-based training and telementoring for viral hepatitis care in public primary care setting","authors":"Janus P. Ong ,&nbsp;Geohari Hamoy ,&nbsp;Eric David B. Ornos ,&nbsp;Vanessa Co-Tanco ,&nbsp;Joy Gillera ,&nbsp;Jhunnel Macalanda ,&nbsp;Jae-Ann Sumalo","doi":"10.1016/j.aohep.2025.102133","DOIUrl":"10.1016/j.aohep.2025.102133","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Chronic viral hepatitis remains a major global public health challenge. The WHO launched the Global Health Sector Strategy on Viral Hepatitis in 2016, emphasizing health equity. Digital learning offers a promising solution to barriers in achieving hepatitis elimination. This study describes a digital learning initiative to strengthen primary care capacity for viral hepatitis management in the Philippines.</div></div><div><h3>Materials and Methods</h3><div>The initiative utilized asynchronous computer-based training (CBT) on the <em>HepLearn</em> platform and synchronous telementoring via <em>HepTalks.</em> The CBT was developed collaboratively with the Department of Health, WHO, Hepatology Society of the Philippines, and University of the Philippines Manila. The course addressed essential hepatitis B and C topics. Telementoring paired primary care physicians with specialists from the Hepatology Society of the Philippines using Zoom for interactive case discussions. Eight one-hour sessions were conducted, each starting with expert-led didactic lectures followed by case discussions.</div></div><div><h3>Results</h3><div>Evaluation included quantitative and qualitative methods: surveys, pre- and post-test assessments, and feedback forms. Among 189 enrollees, 111 (58.7 %) completed <em>HepLearn</em>. Mean pre-test score was 2.63 ± 0.29, rising to 7.09 ± 1.90 post-test (p&lt;0.001), demonstrating significant knowledge gain. Participant feedback indicated high satisfaction (72 % to 98 %) with course content. Thirteen physicians participated in <em>HepTalks</em>. Confidence in viral hepatitis care increased significantly, with 67 % expressing strong agreement that the sessions helped them provide better care.</div></div><div><h3>Conclusions</h3><div>This integrated eLearning approach demonstrates potential for scalable digital education to enhance hepatitis care in primary and remote communities. eLearning should be a strategy for eliminating viral hepatitis by 2030.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102133"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fenofibrate in managing cholestatic pruritus in paediatric patients.","authors":"Jesús Quintero-Bernabeu, Javier Juamperez-Goñi, Cristina Padrós-Fornieles, Mauricio Larrarte-King, Simone Mameli, Lis Vidal-Valdivia, Susana Clemente-Bautista, Aurora Fernández-Polo, José Andrés Molino-Gahete, Maria Mercadal-Hally","doi":"10.1016/j.aohep.2025.102132","DOIUrl":"10.1016/j.aohep.2025.102132","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Cholestatic pruritus is a difficult-to-manage symptom in cholestatic disorders. This study presents our experience with fenofibrate for treating refractory cholestatic pruritus in paediatric patients.</p><p><strong>Materials and methods: </strong>We conducted a retrospective review involving patients under 18 with moderate to severe pruritus (5D Itch score >15), unresponsive to conventional treatments. Fenofibrate was administered at 100 mg/20 kg daily, with a maximum dose of 100 mg for those under 20 kg. A good response was defined as a >50 % reduction in the 5D Itch score, with partial relief as a 25-50 % reduction.</p><p><strong>Results: </strong>Between May 2017 and May 2023, 25 patients were treated, with a median treatment duration of 24.2 months. Pruritus reduction at 2 weeks, 1, 3, 6, and 12 months was 36.8 %, 52.2 %, 53.6 %, 57.1 %, and 60.8 %, respectively. After 12 months, 64 % (16/25) achieved >50 % improvement, and 16 % (4/25) showed partial relief. Fenofibrate significantly reduced serum bile acids, AST, ALT, bilirubin, cholesterol, and triglycerides, without affecting elastography. No serious adverse events occurred.</p><p><strong>Conclusions: </strong>Fenofibrate shows potential in managing pruritus in paediatric patients with cholestatic diseases, warranting further investigation through randomized clinical trials to assess its efficacy and safety.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102132"},"PeriodicalIF":4.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and etiologic trends of hepatocellular carcinoma in cirrhotic patients in Mexico: a multicenter retrospective study (2018–2024)","authors":"Nahum Méndez-Sánchez ,&nbsp;Mariana M. Ramírez-Mejía ,&nbsp;Carlos Cortez-Hernández ,&nbsp;Elianee M. Tovar-Bojorquez ,&nbsp;Raúl Contreras-Omaña ,&nbsp;Juan D. Monsiváis-Morales ,&nbsp;Jacqueline Cordova-Gallardo ,&nbsp;Mauricio Castillo-Barradas ,&nbsp;Nubia Guzmán-Rodríguez ,&nbsp;María S. González-Huezo ,&nbsp;Adrian Sandez-Araiza ,&nbsp;Eira Cerda-Reyes ,&nbsp;Stefanny Cornejo-Hernández ,&nbsp;Beatriz Barranco-Fragoso ,&nbsp;Ana D. Cano-Contreras ,&nbsp;José M. Remes-Troche ,&nbsp;Fatima Higuera-de-la-Tijera ,&nbsp;José L. Pérez-Hernández ,&nbsp;Norberto Chávez-Tapia ,&nbsp;Francisco J. Valentin-Cortez ,&nbsp;Heriberto Rodríguez-Hernández","doi":"10.1016/j.aohep.2025.102131","DOIUrl":"10.1016/j.aohep.2025.102131","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatocellular carcinoma (HCC) represents a major complication of chronic liver disease and an emerging public health challenge in Mexico. As the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) continues to increase, a comprehensive understanding of the current epidemiological landscape of HCC has become increasingly important. This study aims to describe the epidemiologic features and etiologic distribution of HCC in patients with cirrhosis in Mexico using multicenter data collected from 2018 to 2024.</div></div><div><h3>Materials and Methods</h3><div>We conducted a multicenter retrospective study of 2182 patients with cirrhosis diagnosed between 2018 and 2024 across 13 tertiary care hospitals in northern, central, and southern Mexico. HCC was identified using standardized imaging and/or histological criteria. Data on demographics, cirrhosis etiology and clinical characteristics were collected.</div></div><div><h3>Results</h3><div>Among 2182 patients with cirrhosis (mean age 61 ± 12 years; 53.8 % female), 8.8 % (<em>n</em> = 194) developed HCC. Prevalence was higher in women (55.1 %) and in older adults, with 78.3 % of HCC cases occurring in individuals aged ≥60 years. In women, HCC peaked between ages 70–79, while in men it peaked between 60 and 69 years. Regional differences were observed, with the highest prevalence in central Mexico (10.4 %) and the lowest in the south (3.8 %) (p &lt; 0.001). MASLD was the leading etiology (39.1 %), followed by HCV (33.0 %) and ALD (18.6 %).</div></div><div><h3>Conclusions</h3><div>These findings highlight the growing impact of MASLD as the leading cause of HCC in patients with cirrhosis in Mexico, with notable age, sex and regional disparities. Understanding these patterns is essential to inform targeted prevention and early detection strategies.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102131"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}