Eur J Gastroenterol Hepatol [JOURNAL]
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200 papers
Fully covered metal stents as a risk factor for acute cholecystitis in patients with biliary stricture: a multicenter retrospective study.
Khoury T, Benson AA, Goldsztein M … +7 more , Mubariki N, Nubani A, Greener T, Awadie H, Mahamid M, Lisotti A, Sbeit W
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41925049 · Publisher ↗
OBJECTIVE: This study investigated the prevalence and risk factors for acute cholecystitis following the placement of fully covered self-expandable metal stents (FC-SEMS) during endoscopic retrograde cholangiopancreatogr...
OBJECTIVE: This study investigated the prevalence and risk factors for acute cholecystitis following the placement of fully covered self-expandable metal stents (FC-SEMS) during endoscopic retrograde cholangiopancreatography into the common bile duct (CBD), across patients with various indications. We aimed to evaluate whether FC-SEMS placement increases the risk of acute cholecystitis and to identify associated risk factors. METHODS: In this retrospective, multicenter study, 365 medical records from multiple hospitals were reviewed. All patients underwent FC-SEMS placement for biliary strictures. Demographic and clinical data, including complications, were collected. Logistic regression analysis was performed to assess associations between acute cholecystitis and variables such as gallbladder stones, CBD stones, CBD diameter, and stent length. RESULTS: Acute cholecystitis occurred in 8.8% of patients. On univariate analysis, the presence of gallbladder stones and smaller CBD diameter were significantly associated with increased risk of acute cholecystitis (P = 0.01 and P = 0.02, respectively). Shorter stents (40-60 mm) were associated with a markedly higher incidence of acute cholecystitis (10.4%) compared to longer stents (70-100 mm) (1.5%; P = 0.02). Multivariate logistic regression revealed that gallbladder stones (odds ratio: 4.2; 95% confidence interval: 1.76-9.85; P = 0.001) and reduced CBD diameter (odds ratio: 0.88; 95% confidence interval: 0.79-0.98; P = 0.02) independently predicted acute cholecystitis among the subgroup of patients with 40-60 mm long stents. Patients who developed acute cholecystitis had significantly longer follow up durations (279.5 vs. 176.8 days; P < 0.05). CONCLUSION: FC-SEMS placement, particularly with shorter stents, is associated with an increased risk of acute cholecystitis, especially in patients with gallbladder stones and narrower CBD diameters. These findings underscore the need for careful patient selection, individualized stent sizing, and extended follow up in high-risk populations.
Comparative efficacy and safety of bi-flanged metal stents versus lumen-apposing metal stents for endoscopic drainage of pancreatic fluid collections: a systematic review and meta-analysis.
Shahzil M, Faisal MH, Khan MH … +6 more , Abid SF, Shehzadi M, Faisal MS, Chaudhary AJ, Warraich MS, Maranki JL
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41925047 · Publisher ↗
INTRODUCTION: Pancreatic fluid collections (PFCs), particularly walled-off necrosis, are common complications of acute pancreatitis that often require endoscopic drainage. Bi-flanged metal stents (BFMS; NAGI; Taewoong Me...
INTRODUCTION: Pancreatic fluid collections (PFCs), particularly walled-off necrosis, are common complications of acute pancreatitis that often require endoscopic drainage. Bi-flanged metal stents (BFMS; NAGI; Taewoong Medical, Gyenoggi-do, Korea) and electrocautery-enhanced lumen-apposing metal stents (LAMS; AXIOS, Boston Scientific Corporation, Marlborough, Massachusetts, USA) are frequently used, but comparative data remain limited. This study aims to compare the efficacy and safety of BFMS and LAMS in the endoscopic drainage of PFCs. METHODS: This meta-analysis followed the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comprehensive database searches were conducted through November 2024 to identify studies comparing BFMS and LAMS for endoscopic ultrasound-guided drainage of PFCs. Outcomes were pooled using a random-effects model with RevMan Web, and statistical significance was defined as a P value less than 0.05. RESULTS: Three studies (n = 627; 329 BFMS and 298 LAMS) met inclusion criteria. No significant differences were observed between BFMS and LAMS for technical success [odds ratio (OR): 1.16; 95% confidence interval (CI): 0.55-2.43] or clinical success (OR: 0.97; 95% CI: 0.51-1.87). Similarly, there were no differences in walled-off necrosis recurrence (OR: 2.01; 95% CI: 0.17-24.02), number of direct endoscopic necrosectomy sessions (OR: 0.52; 95% CI: 0.05-5.12), or mean number of endoscopic procedures (mean difference: 0.18, 95% CI: 2.08-2.45). Adverse events were also comparable between groups, including bleeding (OR: 0.64), infection (OR: 1.18), stent migration (OR: 1.83), and stent occlusion/dysfunction (OR: 1.71). CONCLUSION: BFMS and LAMS provide equivalent efficacy and safety in the endoscopic ultrasound-guided drainage of PFCs. Either stent type represents a viable therapeutic option. Further large-scale prospective studies are warranted to refine stent selection strategies.
Early identification of the need for biliary drainage in acute calculous cholangitis: a prospective cohort study.
Comoglu E, Acehan F, Altiparmak E … +1 more , Ates I
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41925043 · Publisher ↗
OBJECTIVES: Early identification of patients with acute calculous cholangitis (AC) who will require biliary drainage at emergency department presentation is essential for appropriate triage and timely intervention; howev...
OBJECTIVES: Early identification of patients with acute calculous cholangitis (AC) who will require biliary drainage at emergency department presentation is essential for appropriate triage and timely intervention; however, reliable predictors of drainage requirement remain incompletely defined. METHODS: In this prospective study conducted between August 2022 and March 2023 at a tertiary referral center, 213 adult patients diagnosed with AC according to the Tokyo Guidelines 2018 were enrolled. Patients were categorized according to whether biliary drainage was performed during hospitalization. Baseline clinical and laboratory variables obtained at presentation were analyzed to identify independent predictors of drainage requirement using multivariate logistic regression adjusted for Tokyo Guidelines 2018 severity. RESULTS: Of 213 patients, 145 (68.1%) underwent biliary drainage. History of cholecystectomy [odds ratio (OR): 5.782, 95% confidence interval (CI): 1.266-26.416, P = 0.024], the absence of concomitant pancreatitis (OR: 7.745, 95% CI: 3.341-17.957, P < 0.001), total bilirubin (OR: 1.184, 95% CI: 1.027-1.365, P = 0.020), and procalcitonin (OR: 1.040, 95% CI: 1.005-1.076, P = 0.023) were independently associated with drainage requirement. The combined predictive model demonstrated acceptable discrimination (area under the curve: 0.790, P < 0.001). Optimal cutoffs were 3.6 mg/dl for total bilirubin and 3 μg/l for procalcitonin. During the 3-month follow-up after discharge, recurrent AC occurred in 12 patients (5.6%) and did not differ between groups. CONCLUSION: Readily available parameters at emergency department presentation may facilitate early risk stratification for biliary drainage in AC and may enhance individualized decision-making when integrated into routine clinical assessment. External validation in larger multicenter cohorts is warranted before routine clinical implementation.
Efficacy and safety of home-based exercise in patients with sarcopenia complicated by liver cirrhosis.
Sugiyama Y, Ishizu Y, Yokoyama S … +8 more , Yamamoto K, Ito T, Imai N, Yamamura T, Ishikawa T, Furukawa K, Honda T, Kawashima H
Eur J Gastroenterol Hepatol · 2026 Jul · PMID 41925039 · Publisher ↗
OBJECTIVES: Sarcopenia is a common complication in patients with liver cirrhosis and is associated with reduced quality of life and poor prognosis. Exercise and nutritional therapy are recommended; however, their efficac...
OBJECTIVES: Sarcopenia is a common complication in patients with liver cirrhosis and is associated with reduced quality of life and poor prognosis. Exercise and nutritional therapy are recommended; however, their efficacy in patients with cirrhosis-associated sarcopenia remains unclear. This study evaluated the efficacy and safety of a home-based exercise program in this population. METHODS: In this prospective, single-arm study, 20 patients with cirrhosis and sarcopenia underwent a 12-week home-based program combining elastic band resistance training, walking, and nutritional therapy. The primary outcome was a change in 6-m walking speed at a normal pace. Secondary outcomes included handgrip strength, skeletal muscle index, short physical performance battery (SPPB) score, adherence, and safety. RESULTS: Seventeen participants completed the intervention. In the overall cohort, no significant improvements were observed in the walking speed, handgrip strength, skeletal muscle index, or SPPB score. In an exploratory post-hoc analysis of participants with greater than or equal to 80% adherence ( n = 12), improvements were observed in handgrip strength ( P = 0.034) and SPPB score ( P = 0.016), with a trend toward improved walking speed ( P = 0.077). Factors associated with high adherence included better lower limb function and a lower prevalence of severe sarcopenia. No serious exercise-related adverse events were observed. CONCLUSION: The 12-week home-based exercise and nutritional intervention did not demonstrate clinically meaningful improvements in the overall cohort. Exploratory post-hoc analyses suggest potential functional benefits among participants with high adherence.
Long-term effects of L-carnitine on hyperammonemia and hepatic encephalopathy in patients with liver cirrhosis: a multicenter retrospective study.
Tani J, Moriya A, Tomonari T … +20 more , Ogawa C, Tsutsui A, Morishita A, Sakamoto T, Tai H, Yano R, Nakahara M, Oura K, Tadokoro T, Fujita K, Mimura S, Himoto T, Tanaka H, Imado R, Manabe T, Takuma K, Nagano T, Takaguchi K, Takayama T, Kobara H
Eur J Gastroenterol Hepatol · 2026 Jun · PMID 41870958 · Publisher ↗
OBJECTIVE: Long-term efficacy data for L-carnitine in managing blood ammonia concentration (BAC) and preventing hepatic encephalopathy recurrence remain limited. This multicenter study examined the long-term effects of L...
OBJECTIVE: Long-term efficacy data for L-carnitine in managing blood ammonia concentration (BAC) and preventing hepatic encephalopathy recurrence remain limited. This multicenter study examined the long-term effects of L-carnitine on BAC, hepatic encephalopathy-related events, and clinical outcomes in patients with liver cirrhosis. METHODS: Of 444 patients who received L-carnitine between April 2012 and March 2021, we enrolled 242 patients with hyperammonemia or hepatic encephalopathy (median Child-Pugh score 9) in this retrospective study across four institutions. RESULTS: Median BAC decreased from baseline 123 μg/dl to 95.5, 88, 83, 96, and 86 μg/dl at 12, 24, 48, 96, and 192 weeks, respectively (all P < 0.05). BAC normalization occurred at a median of 100 days overall, but significantly faster at 63 days with initial doses more than 1500 mg/day versus 4.7 months with less than or equal to 1500 mg/day ( P = 0.0034). Among 113 patients followed for 2 years pre- and posttreatment, hepatic encephalopathy-related hospitalizations decreased dramatically from 183 to 62 ( P < 0.001). Cumulative hepatic encephalopathy-related event incidence at 6, 12, and 24 months was 15.5, 18.1, and 23.7%, respectively. Model for End-Stage Liver Disease scores improved significantly at 1 year ( P = 0.0059). Multivariate analysis identified ascites, albumin-bilirubin score, and HCC as independent prognostic factors for survival. Only 2.1% of patients experienced mild, transient gastrointestinal adverse events (all grade 1). CONCLUSION: Long-term L-carnitine administration effectively reduces BAC and hepatic encephalopathy-related hospitalizations with excellent safety. Higher initial doses (>1500 mg/day) achieve more rapid BAC normalization and should be considered for patients with significant hyperammonemia.
Diagnostic and prognostic performance of the fibrotic nonalcoholic steatohepatitis index in patients with metabolic dysfunction-associated steatotic liver disease.
Zhang W, Li M, Luo Y … +2 more , Wen Z, Huang J
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41870956 · Publisher ↗
BACKGROUND AND AIMS: Identifying patients with fibrotic metabolic dysfunction-associated steatohepatitis (MASH) is crucial in order to refer them to specialist care as fibrotic MASH represents one of the major inclusion...
BACKGROUND AND AIMS: Identifying patients with fibrotic metabolic dysfunction-associated steatohepatitis (MASH) is crucial in order to refer them to specialist care as fibrotic MASH represents one of the major inclusion criteria for clinical trials. This study evaluated the diagnostic and prognostic value of the fibrotic nonalcoholic steatohepatitis index (FNI) in the representative US population. METHODS: The FNI was assessed in National Health and Nutrition Examination Survey (NHANES) 2017-2020 (cross-sectional; n = 6520) for fibrotic MASH detection, using FibroScan-AST score-defined cases. Prognostic value was examined in NHANES III (1988-1994; n = 6166) with mortality follow-up through 2019. Receiver operating characteristic analysis evaluated diagnostic accuracy. Cox models assessed associations between FNI and all-cause, cardiovascular, and diabetes-related mortality. Correlations with the triglyceride-glucose (TyG) index and cardiometabolic risk burden were analyzed. RESULTS: FNI showed excellent diagnostic accuracy for fibrotic MASH (area under the curve [AUC] = 0.937), outperforming FIB-4 (AUC = 0.697). In NHANES III, elevated FNI (≥0.33) was independently associated with higher risk of all-cause [hazard ratio = 3.19; 95% confidence interval (CI): 2.56-3.97], cardiovascular (hazard ratio = 6.43; 95% CI: 3.32-12.47), and diabetes-related mortality (hazard ratio = 25.15; 95% CI: 10.56-59.89). FNI correlated positively with TyG (R = 0.458, P < 0.001) and increased progressively with the number of cardiometabolic risk factors. CONCLUSION: FNI is a robust, noninvasive marker that identifies individuals with fibrotic MASH and stratifies mortality risk. Its integration into clinical and public health practice may improve early detection and risk-guided management of metabolic liver disease.
Total biopsy via endoscopic submucosal dissection is useful for the diagnosis of neoplastic lesions in patients with ulcerative colitis.
Oiwa K, Yamamura T, Nakamura M … +14 more , Maeda K, Sawada T, Ishikawa E, Murate K, Takada Y, Hirose T, Iida T, Mizutani Y, Yamao K, Ishizu Y, Ishikawa T, Furukawa K, Honda T, Kawashima H
Eur J Gastroenterol Hepatol · 2026 May · PMID 41870950 · Publisher ↗
OBJECTIVE: Ulcerative colitis-associated neoplasia (UCAN) and sporadic neoplasia require different treatment strategies; their differential diagnosis is based on endoscopic findings and biopsy results. However, accurate...
OBJECTIVE: Ulcerative colitis-associated neoplasia (UCAN) and sporadic neoplasia require different treatment strategies; their differential diagnosis is based on endoscopic findings and biopsy results. However, accurate diagnosis is sometimes difficult. Similarly, it is often challenging to evaluate invasion depth. Recently, their diagnosis has become possible pathologically, following endoscopic UCAN resection. This study investigated whether endoscopic submucosal dissection (ESD) is useful as a treatment or diagnostic (total biopsy) modality for neoplastic lesions within the inflammatory region in patients with ulcerative colitis. METHODS: We retrospectively reviewed the characteristics, accuracy of endoscopic diagnosis, results of ESD, adverse events, and changes in therapeutic strategy after ESD for 27 neoplastic lesions (15 UCANs and 12 sporadic neoplasias) occurring within the inflammatory region of ulcerative colitis in patients at our institution between January 2016 and September 2023. RESULTS: UCANs had significantly more non-polypoid morphology ( P = 0.037) and inflammation around the neoplasia ( P = 0.010). The diagnostic accuracy for low-grade dysplasia was higher in sporadic neoplasias than in UCANs. ESD results ( en bloc resection/R0 resection) were similar between UCANs (100%/86.7%) and sporadic neoplasias (91.7%/83.3%). The incidence of intraoperative perforation and delayed bleeding was comparable. In eight lesions (29.6%), accurate pathological diagnosis via ESD prompted changes in the pre-ESD treatment strategy. Notably, surgical resection was avoided in three lesions (11.1%), including one UCAN lesion reclassified from high-grade dysplasia to low-grade dysplasia and two sporadic neoplasia lesions initially diagnosed as UCANs. CONCLUSION: ESD results of patients with ulcerative colitis were acceptable. ESD may be a useful modality for optimal treatment planning.
Associations between 12 insulin resistance surrogates with metabolic dysfunction-associated steatotic liver disease risk and all-cause mortality: data from the NHANES III (1988-1994).
Yue Z, Zhang Y, Zhang J … +3 more , Alimjan K, Wu Z, Shi L
Eur J Gastroenterol Hepatol · 2026 Jun · PMID 41870948 · Full text
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) has been shown to be intimately linked to the presence of insulin resistance. This study aimed to comprehensively evaluate 12 insulin resistanc...
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) has been shown to be intimately linked to the presence of insulin resistance. This study aimed to comprehensively evaluate 12 insulin resistance surrogates in relation to MASLD risk and all-cause mortality, utilizing nationwide data from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994). METHODS: This study analyzed 10 303 adults aged greater than or equal to 20 years from the NHANES III (1988-1994) cohort, identifying 2199 individuals with MASLD. The mortality data for this cohort were collected from the National Death Index. Twelve surrogate markers of insulin resistance were evaluated, including triglyceride-glucose (TyG) index, TyG-BMI, TyG-waist circumference, TyG-waist-to-height ratio, C-reactive protein-triglyceride-glucose index, atherogenic index of plasma (AIP), AIP-BMI, AIP-waist circumference, AIP-waist-to-height ratio, estimated glucose disposal rate (eGDR), metabolic score for insulin resistance, and homeostatic model assessment of insulin resistance (HOMA-IR). Statistical analyses employed logistic regression and Cox proportional hazards models to assess associations. Additionally, restricted cubic splines (RCSs) and Kaplan-Meier curves were utilized alongside subgroup and sensitivity analyses. Predictive performance was examined using receiver operating characteristic analysis and machine learning (XGBoost). RESULTS: Among 10 303 participants, MASLD prevalence was 21.3%. In models that have undergone full adjustment, eGDR was negatively correlated with the risk of MASLD [odds ratio = 0.827, 95% confidence interval (CI): 0.780-0.878], while all other indices showed positive associations. In 2199 MASLD patients with 1015 deaths during follow-up, TyG-related indices, C-reactive protein-triglyceride-glucose index, and HOMA-IR were significant correlates with higher all-cause mortality, whereas eGDR was inversely correlated (hazard ratio = 0.887, 95% CI: 0.844-0.933). Two sensitive analyses further supported the overall results in the overall models. The RCS curve exhibited nonlinear dose-response relationships for several indices. XGBoost analyses identified eGDR as the strongest predictor of mortality among insulin resistance surrogates, second only to age. CONCLUSION: Most insulin resistance surrogates were significantly associated with both MASLD risk and mortality, while eGDR emerged as a robust protective factor with superior predictive performance. These results emphasize the pivotal role of insulin resistance in MASLD and highlight eGDR as a promising noninvasive tool for stratifying risk and predicting adverse outcomes in clinical and public health settings.
Positive conversion of latent tuberculosis screening in patients with inflammatory bowel disease on antitumor necrosis factor alpha drugs: a systematic review and meta-analysis.
Rzetelna H, Santo P, de Souza HSP … +2 more , Nichols J, Zaltman C
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41870946 · Publisher ↗
Inflammatory bowel disease (IBD) patients undergoing antitumor necrosis factor-alpha (anti-TNF) therapy are at increased risk of developing tuberculosis (TB), making screening before anti-TNF initiation mandatory. Repeat...
Inflammatory bowel disease (IBD) patients undergoing antitumor necrosis factor-alpha (anti-TNF) therapy are at increased risk of developing tuberculosis (TB), making screening before anti-TNF initiation mandatory. Repeated screening during treatment is not yet recommended because of a lack of studies to support this practice. We aimed to determine the proportion of patients who develop latent TB during anti-TNF therapy. We systematically searched studies from MEDLINE, Embase, and Lilacs, and performed a single-arm meta-analysis investigating the positive conversion rate in IBD patients under anti-TNF therapy with previous negative TB screening. We calculated the combined proportion with 95% confidence interval, using the random-effects model. A P value less than 0.05 was considered statistically significant for subgroup differences. We included 13 studies from nine countries with 1153 patients. The overall positive conversion rate was 9.20%. Portugal had 18.01% of positive conversion, Spain 4.51%, and the USA 1.11%. Tests for subgroup differences were statistically significant for subgroup analysis by country and consistency of test used (performig same test as baseline). Subgroup analyses by continent, study design, or specific test (tuberculin skin test or interferon-gamma release assay) showed no statistical difference. Meta-regression analysis showed a significant positive association between positive conversion and TB incidence. In conclusion, IBD patients on anti-TNF therapy can have a positive conversion rate of 9.20%. Higher conversion rates were seen in European and Asian studies compared with those in the Americas (particularly the USA). TB prevention strategies should, therefore, be individualized and based on geographic location and risk factors.
Chest X-ray prior to biological treatment in inflammatory bowel diseases: it is not only about tuberculosis - a case report and literature review.
Binder IMH, Brynskov J, Attauabi M
Eur J Gastroenterol Hepatol · 2026 Jul · PMID 41870914 · Publisher ↗
BACKGROUND: Biological treatments have substantially improved management of inflammatory bowel disease, but their profound immunosuppressive effects necessitate infection screening before initiation. Current guidelines r...
BACKGROUND: Biological treatments have substantially improved management of inflammatory bowel disease, but their profound immunosuppressive effects necessitate infection screening before initiation. Current guidelines recommend chest X-ray (CXR) alongside Mycobacterium tuberculosis testing. While this approach is widely accepted, the necessity of routine CXR in patients without tuberculosis (TB) risk factors has recently been questioned in low-incidence regions. METHODS: We report a rare case of a patient with ulcerative colitis undergoing routine preinfliximab CXR revealing an apical right-lung infiltrate, that was not suspected based on clinical assessment and negative interferon-gamma release assays testing. In addition, we summarize the existing literature on invasive aspergillosis associated with tumor necrosis factor alpha inhibitors. RESULTS: The patient had minimal clinical symptoms of pulmonary infection and remained afebrile with consistently normal C-reactive protein levels. Nevertheless, routine pretreatment CXR demonstrated an apical right-lung infiltrate, leading to cancelation of planned infliximab initiation. Subsequent analyses of bronchoalveolar fluid and sputum identified two strains of Aspergillus fumigatus . Despite prolonged antifungal therapy, the patient ultimately required a right-lung lobectomy. A comprehensive literature review identified three fatal cases of invasive aspergillosis following tumor necrosis factor alpha inhibitors, underscoring the clinical importance of detecting serious pulmonary infections prior to treatment initiation. CONCLUSIONS: Our case is, to our knowledge, the first report in inflammatory bowel disease to illustrate that CXR may uncover potentially life-threatening infections beyond TB in patients with limited clinical and biochemical signs of infection, supporting its continued role in prebiologic treatment workflows even in low-TB prevalence settings.
Comprehensive management of modifiable factors and all-cause mortality in patients with metabolic dysfunction-associated steatotic liver disease.
Zhang J, Wang B, Wang Z … +3 more , Feng F, Naren, Ge H
Eur J Gastroenterol Hepatol · 2026 Jun · PMID 41870912 · Publisher ↗
BACKGROUND AND AIMS: To assess the association between comprehensive control of modifiable factors and all-cause mortality in metabolic dysfunction-associated steatotic liver disease (MASLD) patients, explore effect modi...
BACKGROUND AND AIMS: To assess the association between comprehensive control of modifiable factors and all-cause mortality in metabolic dysfunction-associated steatotic liver disease (MASLD) patients, explore effect modification by liver fibrosis, sex, and age, and compare mortality risk between MASLD patients with different control levels and the non-MASLD population. METHODS: This retrospective cohort study included 15 802 MASLD patients from US National Health and Nutrition Examination Survey 2003-2018. A comprehensive management score was constructed based on seven modifiable factors (blood pressure, glucose, lipids, inflammation, smoking, alcohol, physical activity). Patients were categorized into low, intermediate, and high control groups. Multivariable Cox models, likelihood ratio tests, and stratified analyses were used to assess associations and effect modifications. RESULTS: Over 7.8 years median follow-up, 1524 deaths occurred. Compared with low control, high control was associated with 34% lower mortality [hazard ratio = 0.66, 95% confidence interval (CI): 0.54-0.81], with a 21% risk reduction per control level increment (hazard ratio = 0.79, 95% CI: 0.72-0.86). The effect was not modified by liver fibrosis ( P -interaction = 0.75) but was significantly modified by sex ( P < 0.001): risk reduction was 46% in females (hazard ratio = 0.54, 95% CI: 0.37-0.79) and 21% in males (hazard ratio = 0.79, 95% CI: 0.62-0.99). No age interaction was found ( P = 0.14). Compared with non-MASLD population, high-control MASLD patients had 32% lower mortality (hazard ratio = 0.68, 95% CI: 0.61-0.76). Sensitivity analyses confirmed robustness. CONCLUSION: Comprehensive management of modifiable factors was significantly associated with lower mortality in MASLD patients, independent of liver fibrosis and more pronounced in females. High-level control may enable survival outcomes superior to the general population.
Adjuvant camrelizumab for hepatocellular carcinoma patients with high risk of recurrence after curative hepatectomy: a retrospective multicenter study.
Lin LP, Su JY, Dong XF … +16 more , Yang FQ, Su Z, Peng N, Liu SP, Chen K, Luo M, Yang DL, Ye PH, Wang XP, Zhou LC, Mo ZY, Deng KH, Zou YH, Liang WM, Zhong JH, Ma L
Eur J Gastroenterol Hepatol · 2026 May · PMID 41870909 · Publisher ↗
BACKGROUND AND AIMS: The role of adjuvant programmed cell death-1 (PD-1) inhibitors following curative hepatectomy in patients with hepatocellular carcinoma (HCC) at high risk of recurrence remains controversial. This st...
BACKGROUND AND AIMS: The role of adjuvant programmed cell death-1 (PD-1) inhibitors following curative hepatectomy in patients with hepatocellular carcinoma (HCC) at high risk of recurrence remains controversial. This study aims to evaluate the efficacy and safety of camrelizumab (a PD-1 inhibitor) as adjuvant therapy in these patients. METHODS: This retrospective, single-arm study conducted across eight medical centers from April 2019 to January 2024 enrolled 82 HCC patients at high-risk recurrence, who received camrelizumab (200 mg) as monotherapy or in combination with tyrosine kinase inhibitors (TKIs). The primary endpoint was recurrence-free survival (RFS), while secondary endpoints included overall survival (OS) and adverse events. Propensity score matching (PSM) was utilized to adjust for potential confounders. RESULTS: The median follow-up duration was 27.0 months (interquartile range: 21.6-44.5). The median RFS was 28.7 months (95% confidence interval: 18.1-39.3), and the corresponding RFS rates at 12, 24, and 36 months were 68.3, 57.9, and 46.7, respectively. The median OS was not reached, with OS rates at 12, 24, and 36 months being 92.7, 90.0, and 82.1%, respectively. Among the patients, 56 received camrelizumab in combination with TKIs, while 26 received camrelizumab alone. Compared with monotherapy, combination therapy demonstrated no significant advantages in either RFS or OS. Similar results were obtained after PSM. Among all patients, the most common grade 3 or 4 adverse events were reactive cutaneous capillary endothelial proliferation (9.8%), hand-foot syndrome (4.9%), and hypertension (4.9%). CONCLUSION: Adjuvant camrelizumab may improve the prognosis of patients with HCC at high risk of recurrence after curative hepatectomy. Combination therapy with TKIs may be unnecessary.
Clinical presentation, anti-tTG IgA levels, and histological severity in adult celiac disease.
Karakan G, Böyük B, Erman H … +2 more , Irmak R, Canoğlu D
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41870907 · Publisher ↗
BACKGROUND: Adult celiac disease may present with atypical or nonspecific symptoms. Although the diagnostic value of anti-tissue transglutaminase IgA (anti-tTG IgA) in relation to histological severity has been well-esta...
BACKGROUND: Adult celiac disease may present with atypical or nonspecific symptoms. Although the diagnostic value of anti-tissue transglutaminase IgA (anti-tTG IgA) in relation to histological severity has been well-established in pediatric cases, data in adults remain limited. OBJECTIVE: To evaluate the association between anti-tTG IgA levels and histological severity according to the Marsh-Oberhuber classification in adult celiac patients, and to assess the diagnostic performance of anti-tTG IgA in predicting advanced mucosal damage. METHODS: A total of 228 adult patients with celiac disease who underwent duodenal biopsy between 2017 and 2022 were included retrospectively. Clinical features, laboratory parameters, serological markers, histopathological findings were recorded. Patients were classified according to anti-tTG IgA titers as high-titer (≥10 times the upper limit of normal) or low-titer positive. RESULTS: Anti-tTG IgA levels showed a significant stepwise increase with higher Marsh grades. Anti-tTG IgA levels and disease duration were independent predictors of Marsh score. Higher anti-tTG IgA levels were associated with an increased likelihood of advanced histological damage, whereas longer disease duration was associated with lower Marsh scores. Receiver operating characteristic curve analysis demonstrated diagnostic performance of anti-tTG IgA for predicting Marsh score greater than or equal to 2 (area under the curve = 0.836, 95% confidence interval: 0.781-0.883; P < 0.0001). A cutoff value of less than 93.2 RU/ml yielded a sensitivity of 76.73% and a specificity of 83.33%. CONCLUSION: Anti-tTG IgA is associated with histological severity in adult celiac disease and demonstrate diagnostic accuracy for predicting clinically significant mucosal damage. We suggest that anti-tTG IgA may serve as a useful adjunctive marker for estimating histological involvement in adults.
Medication adherence level and its predictors among inflammatory bowel disease sufferers in a resource-strained healthcare setting.
Zewdu WS, Zerihun TE, Emiru ZA … +8 more , Dagnew SB, Moges TA, Mussie DA, Ferede YA, Anberbr SS, Alemu MA, Melese TB, Kassaw AT
Eur J Gastroenterol Hepatol · 2026 Aug · PMID 41870905 · Publisher ↗
BACKGROUND: Despite novel breakthroughs in the inflammatory bowel disease (IBD) therapeutics armamentarium, nonadherence remains an invisible epidemic. However, its prevalence and determining features were unknown within...
BACKGROUND: Despite novel breakthroughs in the inflammatory bowel disease (IBD) therapeutics armamentarium, nonadherence remains an invisible epidemic. However, its prevalence and determining features were unknown within resource-strained healthcare settings. METHODS: A hospital-based cross-sectional study was conducted on adults with IBD from December 2023 to July 2024. A standardized questionnaire and medical record review checklist were used to gather data. Multiple ordinal logistic regression analysis was used to adjudicate potential covariates. A variable was deemed statistically significant if its adjusted odds ratio had a P value of below 0.05 at 95% confidence interval. RESULTS: This study comprised 237 patient cohort (age: mean ± SD, 53.81 ± 6.71 years). Among them, 32.9, 29.96, and 37.14% were low, medium, and high adherents, respectively. Just under half (43.05%) of participants had a high medication regimen complexity score (mean ± SD, 19.46 ± 2.11). Health insurance status, active disease state, medication regimen complexity score, stigma, comorbidity status, adverse drug reactions, and polypharmacy were the potential predictors identified in the final model. CONCLUSION: Nearly two-thirds of the study's cohort exhibited suboptimal medication adherence, highlighting a significant clinical concern. Policymakers could consider developing key strategies such as integrating pharmacists and Medication Regimen Complexity Index-65 into IBD chronic care, and leveraging a validated, local-language adherence assessment tool offer a powerful approach to optimize treatment adherence among IBD sufferers.
Lower drug clearance of adalimumab is associated with proactive therapeutic drug monitoring and mucosal healing in patients with inflammatory bowel disease.
Deyhim T, Saraga A, Gade A … +8 more , Geeganage G, Soliman MA, Zullow S, Rabinowitz LG, Grossberg LB, Cheifetz AS, Dervieux T, Papamichael K
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41870904 · Publisher ↗
OBJECTIVES: There are limited data regarding adalimumab (ADM) clearance in inflammatory bowel disease (IBD). The aim of this study was to identify factors associated with ADM clearance and to assess its association with...
OBJECTIVES: There are limited data regarding adalimumab (ADM) clearance in inflammatory bowel disease (IBD). The aim of this study was to identify factors associated with ADM clearance and to assess its association with mucosal healing. METHODS: This single-center, retrospective study included consecutive patients with IBD who received maintenance ADM therapy and underwent therapeutic drug monitoring (TDM) between January 2018 and May 2023. Drug clearance was determined using a nonlinear mixed-effect model with Bayesian priors. Mucosal healing was defined as an endoscopic Mayo score 1 or less; for ulcerative colitis, no ulcerations for patients with Crohn's disease, or a Rutgeerts score of i1 or less for patients with an ileocolonic resection for Crohn's disease and was evaluated within 3 months from TDM. RESULTS: The study population consisted of 263 patients with IBD (74% Crohn's disease) who underwent a total of 515 TDM tests (388 proactive). Multivariable linear regression analysis identified that proactive TDM was associated with lower ADM clearance [beta coefficients (β): -0.173, 95% confidence interval (CI): -0.180 to -0.088, P < 0.001], while BMI (β: 0.125, 95% CI: 0.005-0.013, P < 0.001), prior biologic exposure (β: 0.087, 95% CI: 0.022-0.112, P = 0.004), and antibodies to ADM (β: 0.676, 95% CI: 0.628-0.750, P < 0.001) were associated with higher ADM clearance. Receiver operating characteristic analysis identified an ADM clearance threshold of 0.301 L/day (area under the receiver operating characteristic curve: 0.731; 95% CI: 0.654-0.808; P < 0.001; sensitivity: 61%; specificity: 78%) distinguishing patients with or without mucosal healing. CONCLUSION: This study demonstrated that lower ADM clearance is associated with proactive TDM and mucosal healing in patients with IBD.
Investigating aspirin and post-colonoscopy colorectal cancer and cancer-specific mortality risk: a Swedish Register Study 2007-2016.
Forsberg A, Widman L, Andreasson A
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41870898 · Publisher ↗
OBJECTIVE: Acetylsalicylic acid (ASA) has been linked to reduced incidence and mortality in colorectal cancer (CRC), although its sex-specific effects remain unclear. Post-colonoscopy colorectal cancer (PCCRC), is a CRC...
OBJECTIVE: Acetylsalicylic acid (ASA) has been linked to reduced incidence and mortality in colorectal cancer (CRC), although its sex-specific effects remain unclear. Post-colonoscopy colorectal cancer (PCCRC), is a CRC diagnosed after a colonoscopy negative for cancer. The aim of this study was to explore the sex-specific effects of ASA on cancer-specific mortality risk in in CRC in general and in PCCRC specifically. METHODS: This retrospective register-based study analyzed the conditional CRC-specific survival in 22 270 Swedish patients who underwent colonoscopy, including 1647 PCCRCs. The analyses were stratified on sex. RESULTS: ASA use was associated with lower CRC mortality in men but not in women, hazard ratio (HR) = 0.85, 95% confidence interval (CI): 0.72-0.99, P = 0.043 for men and HR = 1.13, 95% CI: 0.93-1.37, P = 0.230 for women. Notably, ASA use in women, but not in men, with PCCRC was linked to increased mortality risk; HR for interaction PCCRC × ASA in women = 1.60, 95% CI: 1.02-2.51, P = 0.040 and HR for interaction PCCRC × ASA in men = 0.81, 95% CI: 0.50-1.32, P = 0.41. CONCLUSION: These exploratory analyses suggest sex-specific differences in the effect of ASA on CRC outcomes, particularly in PCCRC. Further research is needed to elucidate underlying the mechanisms and optimize chemopreventive strategies.
Burden of premature mortality from colorectal cancer among Asian Americans: years of life lost analysis.
Tariq MA, Malik AF
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41811777 · Publisher ↗
Abstract loading — click title to view on PubMed.
Usefulness of the clip-with-line method for difficult biliary cannulation in Billroth II gastrectomy.
Ou S, Xu C, Chen Z … +2 more , Li Z, Du L
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41811776 · Publisher ↗
Abstract loading — click title to view on PubMed.
Comparison of clinical outcomes in cirrhotic patients presenting with acute variceal and nonvariceal gastrointestinal bleeding.
Guimarães A, Pacheco-Cassamá J, Carvalho T … +2 more , Rodrigues Â, Costa D
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41811775 · Publisher ↗
BACKGROUND/AIMS: In patients with advanced chronic liver disease, acute gastrointestinal bleeding can be classified as acute variceal bleeding or nonvariceal bleeding. We aim to compare clinical outcomes between variceal...
BACKGROUND/AIMS: In patients with advanced chronic liver disease, acute gastrointestinal bleeding can be classified as acute variceal bleeding or nonvariceal bleeding. We aim to compare clinical outcomes between variceal and nonvariceal bleeding in patients with advanced chronic liver disease and to identify predictors of liver-related death following variceal bleeding. METHODS: Retrospective, observational, and unicenter study. Patients with advanced chronic liver disease presenting with acute gastrointestinal bleeding between 2016 and 2022 were divided into variceal and nonvariceal bleeding groups. Complications, rebleeding, further decompensation, and liver-related death were compared. RESULTS: In total, 154 patients were included. Nonvariceal bleeding group (n = 57) was older (P < 0.001), with higher model for end-stage liver disease-sodium (MELD-Na) (P = 0.016) and ascites at admission (P = 0.033). In-hospital mortality (P = 0.101), complications (P = 0.362), rebleeding (P = 0.102), further decompensation (P = 0.112), and liver-related death in the follow-up (P = 0.112) were similar between groups. In the variceal bleeding group, MELD-Na predicted liver-related death within 30 (P < 0.001) and 90 days (P < 0.001). Variceal bleeding, whether as a first or further decompensation event, was associated with similar risks of 30-day readmission and liver-related death. CONCLUSION: There were no significant differences in outcomes between groups. In the variceal bleeding group, MELD-Na was an independent predictor of liver-related death within 30 and 90 days.
Applicator preferences for subcutaneous biologics in inflammatory bowel disease: influence on patient satisfaction and willingness to switch treatment.
Prodanova D, Janeva A, Drobne D … +1 more , Novak G
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41811774 · Publisher ↗
BACKGROUND: Subcutaneous biologics administered with various applicator types are widely used to treat inflammatory bowel disease (IBD). The aim was to determine the applicator characteristics most important to patients...
BACKGROUND: Subcutaneous biologics administered with various applicator types are widely used to treat inflammatory bowel disease (IBD). The aim was to determine the applicator characteristics most important to patients and to assess whether these factors influence their willingness to switch biologic therapy. METHODS: This prospective and cross-sectional study included 50 patients with IBD on maintenance treatment with subcutaneous biological drugs (adalimumab, golimumab, and vedolizumab). The patients completed a questionnaire regarding the applicators they were using and were afterwards presented with other applicators in order to fulfill a second questionnaire including questions about the possibility to change the biological drug due to a different applicator. RESULTS: The click at the end of application was considered as the best characteristic of their applicators in 64% of the patients. The transparent window (30% of patients), the click at the end of application (24%), faster and easier (20%) application were characteristics that were important after seeing other applicators. Patients' satisfaction with their current applicator decreased after seeing other available applicators (P < 0.001). However, 82% would continue to use the same applicator. More than half (52%) would consider changing the current biological drug for a biosimilar due to a different applicator with better characteristics. CONCLUSION: The type of applicator was determined as important for patients, as they would consider changing it if other applicators were presented to them before the start of therapy. Thus, before choosing a subcutaneous biosimilar it would be reasonable to present all types of applicators to patients to individually select the most suitable one.
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