Eur J Gastroenterol Hepatol [JOURNAL]
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200 papers
Comparison of precut endoscopic mucosal resection and endoscopic submucosal dissection in the management of colorectal polyps: a systematic review and meta-analysis.
Saeed A, Yousuf S, Zain A … +12 more , Kashif M, Mahmood S, Hayat U, Beran A, Saleem N, Xiao Y, Kumar A, Schlachterman A, Kowalski T, Radlinski M, Muniraj T, Kamal F
Eur J Gastroenterol Hepatol · 2026 Jun · PMID 41604553 · Publisher ↗
BACKGROUND: Studies comparing precut endoscopic mucosal resection (EMR-P) and endoscopic submucosal dissection (ESD) for the management of colorectal polyps have reported conflicting results. In this meta-analysis, we ha...
BACKGROUND: Studies comparing precut endoscopic mucosal resection (EMR-P) and endoscopic submucosal dissection (ESD) for the management of colorectal polyps have reported conflicting results. In this meta-analysis, we have compared outcomes of EMR-P and ESD. METHODS: Several databases were reviewed from inception to 15 December 2024 to identify studies comparing EMR-P and ESD for colorectal polyps. Our outcomes of interest were en bloc and complete histologic resection, procedure time, perforation, and bleeding. For the outcomes of en bloc and complete histologic resection, we performed subgroup analyses including greater than or equal to 20 mm polyps and 20-30 mm polyps. We calculated the pooled odds ratio (OR) with 95% confidence intervals (CIs) for categorical variables and mean difference with 95% CI for continuous variables. RESULTS: We included nine studies comprising 1460 patients. The rate of en bloc resection was significantly lower in the EMR-P group (OR: 0.15, 95% CI: 0.09-0.23). The rate of complete histologic resection was significantly lower in the EMR-P group (OR: 0.50, 95% CI: 0.26-0.94). There was no significant difference in rates of en bloc and complete histologic resection between groups for 20-30 mm polyps. Procedure time was significantly shorter in the EMR-P group (Mean difference [MD]: -29.05, 95% CI: -37.04 to -21.06). There was no significant difference in adverse events such as bleeding and perforation between groups. CONCLUSION: Our meta-analysis demonstrates the superiority of ESD over EMR-P in achieving higher rates of en bloc and complete resection for colorectal polyps without increasing the risk of adverse events except for 20-30 mm polyps, where the outcomes were comparable between groups.
Comparing nurse-assisted outpatient follow-up with standard care among patients with decompensated liver cirrhosis: a systematic review and meta-analysis.
Guo J, Wang Y, Liu X … +1 more , Wang X
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41604551 · Full text
Nurse-assisted care has been shown to improve outcomes in these patients when compared with standard care. This study aimed to compare nurse-assisted outpatient follow-up with standard care in patients with decompensated...
Nurse-assisted care has been shown to improve outcomes in these patients when compared with standard care. This study aimed to compare nurse-assisted outpatient follow-up with standard care in patients with decompensated liver failure. MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials (RCTs) comparing specialized or nurse-assisted care with standard care in patients with decompensated liver cirrhosis. Outcomes of interest were mortality, 30-day readmission, model for end-stage liver disease (MELD) score, Child-Pugh score, and mean number of hospital stays. Evaluations were reported as risk ratios and mean differences, with 95% confidence intervals (CIs) using weighted random-effects models. The analysis included 668 patients from seven studies (three RCTs and four observational studies). Compared with standard care, nursing and multidisciplinary care showed no significant reduction in mortality (risk ratio: 0.78, 95% CI: 0.53-1.16, P = 0.12, I ² = 69%); however, upon subgroup analysis according to type of study significant reduction was noted among RCTs [risk ratio: 0.53, 95% CI: 0.30-0.94, P = 0.03, I ² = 0%). Meta-analysis also showed a significant reduction in 30-day readmission rates (risk ratio: 0.39, 95% CI: 0.25-0.59, P < 0.0001, I ²=0%), which were consistent upon subgroup analysis. There was no significant difference in Child-Pugh score (mean difference: 0.07, 95% CI: -0.79 to 0.93, P = 0.83, I ² = 0%), MELD score (mean difference: 0.17, 95% CI: -1.33 to 1.67, P = 0.82, I ² = 0%) and mean difference in number of hospital stay (mean difference: -1.59, 95% CI: -5.68 to 2.51, P = 0.45, I ² = 89%). Results were consistent upon subgroup analysis except for the mean number of hospital stays, which showed a significant reduction among observational studies (mean difference: -4.20, 95% CI: -8.18 to -0.22, P = 0.04).
Cardiovascular outcomes and subclinical atherosclerosis in metabolic-associated steatotic liver disease: long-term follow-up from a specialized outpatient cohort.
Nogueira PMM, Marques CEC, Vieira BC … +8 more , Leite NC, Equi CM, Cardoso ACF, Wajsbrot NB, M do Nascimento E, de B Pereira B, de Oliveira GMM, Villela-Nogueira CA
Eur J Gastroenterol Hepatol · 2026 May · PMID 41604550 · Publisher ↗
BACKGROUND AND AIMS: Cardiovascular disease is the main cause of mortality in metabolic-associated steatotic liver disease (MASLD). This study evaluated both observed and predicted cardiovascular outcomes using the Frami...
BACKGROUND AND AIMS: Cardiovascular disease is the main cause of mortality in metabolic-associated steatotic liver disease (MASLD). This study evaluated both observed and predicted cardiovascular outcomes using the Framingham risk score in a MASLD cohort and assessed subclinical atherosclerosis via carotid and femoral Doppler, along with its correlates at follow-up. METHODS: Retrospective cohort included MASLD individuals under long-term optimized clinical management. Baseline Framingham scores were calculated, and observed major adverse cardiovascular events incidence was compared with predicted rates. Carotid and femoral Doppler assessed intima-media thickness and plaques. Machine learning identified factors associated with subclinical atherosclerosis. RESULTS: Between October 2023 and February 2025, 147 patients were included [median follow-up 8 (4-12) years; age 62 (55-67) years; 78% women]. The baseline Framingham score was 15.9% (7.3-24.8). At follow-up, cardiovascular events (nonfatal stroke, myocardial infarction, and heart failure) occurred in 5.3% of patients, below predicted rates, with an incidence of 6.8 per 1000 person-years. Subclinical atherosclerosis, defined by carotid or femoral plaques, was found in 77% of patients. Arterial hypertension was a reliable risk factor for plaque formation across all vascular territories. In cases with single-territory involvement, platelet count, and alanine aminotransferase levels were also associated. For patients with plaques in both carotid and femoral regions, age and insulin use emerged as additional predictors (all P < 0.05). CONCLUSION: In MASLD patients under optimized clinical treatment, the incidence of cardiovascular events was lower than predicted by the Framingham score, although subclinical atherosclerosis remained highly prevalent at the end of follow-up.
Clinical course and prognostic risk factors of SARS-CoV-2 vaccine-related hepatitis: differentiating severe acute respiratory syndrome coronavirus 2 vaccine-associated liver injury from autoimmune hepatitis.
Malino D, Codoni G, Kirchner T … +40 more , Engel B, Villamil AM, Efe C, Stättermayer AF, Weltzsch JP, Sebode M, Bernsmeier C, Lleo A, Gevers TJG, Kupčinskas L, Castiella A, Pinazo J, De Martin E, Bobis I, Sandahl TD, Pedica F, Invernizzi F, Del Poggio P, Bruns T, Kolev M, Semmo N, Bessone F, Giguet B, Poggi G, Ueno M, Jang H, Elpek GÖ, Soylu NK, Cerny A, Wedemeyer H, Matter MS, Uzun S, Matilla-Cabello G, Vergani D, Mieli-Vergani G, Lucena MI, Andrade RJ, Zen Y, Taubert R, Terziroli Beretta-Piccoli B
Eur J Gastroenterol Hepatol · 2026 May · PMID 41604546 · Publisher ↗
BACKGROUND AND AIM: Reported cases of acute liver injury with autoimmune features post-COVID-19 vaccination raise questions about whether this represents vaccine-triggered autoimmune hepatitis (AIH) or self-limiting drug...
BACKGROUND AND AIM: Reported cases of acute liver injury with autoimmune features post-COVID-19 vaccination raise questions about whether this represents vaccine-triggered autoimmune hepatitis (AIH) or self-limiting drug-induced autoimmune-like hepatitis (DI-ALH). We report follow-up data to determine if the disease course is self-limiting or immunosuppression-dependent. METHODS: Members of the International AIH Group and the European Reference Network on Hepatological Diseases who contributed cases to our original cohort provide follow-up data at 6 months, 12 months, and at last follow-up. RESULTS: Sixty-two patients (median age 56 years, 35 female) were included (median follow-up: 22.8 months). Fifty-eight (93%) received steroids ± azathioprine/mycophenolate. Four died of non-liver-related causes. Transaminases normalization rates were 71, 92, and 90% at 6 months, 12 months, and last follow-up, respectively. Twenty-four had a DI-ALH-like course, with ALT normalization and no relapse with or without ( n = 4) a short (<9 months) immunosuppressive treatment. Nineteen had an AIH-like course, with relapse after discontinuation ( n = 11) or persistent ALT elevation despite treatment ( n = 8). Nineteen were unclassified. Risk factors for AIH-like progression included a higher revised AIH score, advanced fibrosis, and severe interface hepatitis. CONCLUSION: Most cases resemble DI-ALH, which we propose naming severe acute respiratory syndrome coronavirus 2 vaccine-associated liver injury, but a significant subset requires long-term immunosuppression, resembling classical AIH.
Detectability of hepatitis B virus DNA in peripheral blood mononuclear cells following long-term nucleos(t)ide analogue therapy-induced sustained viral suppression.
Abu Rahma MZ, Hassan EA, Hasanain AFA … +4 more , Omar MAM, Mekky MA, El-Mokhtar MA, Sayed HI
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41604545 · Publisher ↗
OBJECTIVE: Hepatitis B virus (HBV) can persist in peripheral blood mononuclear cells (PBMCs) as an extrahepatic reservoir in treatment-naive patients; however, its persistence during long-term nucleos(t)ide analogue ther...
OBJECTIVE: Hepatitis B virus (HBV) can persist in peripheral blood mononuclear cells (PBMCs) as an extrahepatic reservoir in treatment-naive patients; however, its persistence during long-term nucleos(t)ide analogue therapy with sustained serum viral suppression remains unclear. This study aimed to evaluate the frequency and predictors of HBV DNA detectability in PBMCs of chronic hepatitis B (CHB) patients following long-term nucleos(t)ide analogue therapy-induced sustained serum viral suppression. METHODS: Eighty-eight CHB patients, on long-term tenofovir disoproxil fumarate ( n = 44) or entecavir ( n = 44) with greater than 2 years of sustained viral suppression, were enrolled. PBMCs were tested for HBV DNA by quantitative PCR. Clinical and laboratory data were analyzed to identify predictors of PBMC HBV DNA detection. Receiver operating characteristic analysis assessed the performance of posttreatment serum quantitative hepatitis B surface antigen (qHBsAg). RESULTS: HBV DNA was detected in PBMCs of eight (9.1%) patients, equally distributed between treatment groups. Pretreatment hepatitis B e-antigen (HBeAg) positivity predicted PBMC HBV DNA detection ( P = 0.036). PBMC HBV DNA-positive patients were older males with worse baseline liver chemistry and advanced fibrosis. Posttreatment qHBsAg was higher in PBMC HBV DNA-positive patients (139.5 vs. 21.5 IU/ml; P < 0.001) and strongly correlated with PBMC viral load ( r = 0.905, P = 0.002); qHBsAg greater than 89 IU/ml predicted PBMC HBV DNA detection with high accuracy. CONCLUSION: HBV DNA may persist in PBMCs despite long-term nucleos(t)ide analogue therapy-induced sustained viral suppression. Pretreatment HBeAg positivity and elevated posttreatment qHBsAg can help identify patients at risk, highlighting the need to monitor extrahepatic reservoirs in CHB management.
Epstein-Barr virus infection increases the risk for inflammatory bowel disease.
Buchner AM, Kohen R, Sonnenberg A
Eur J Gastroenterol Hepatol · 2026 May · PMID 41549853 · Publisher ↗
BACKGROUND: Previous studies have suggested that infection with Epstein-Barr virus (EBV) plays a role in the etiology of Hodgkin lymphoma, multiple sclerosis, systemic lupus erythematosus (SLE), Crohn's disease, and ulce...
BACKGROUND: Previous studies have suggested that infection with Epstein-Barr virus (EBV) plays a role in the etiology of Hodgkin lymphoma, multiple sclerosis, systemic lupus erythematosus (SLE), Crohn's disease, and ulcerative colitis. We investigated whether a history of infectious mononucleosis, a well-known marker of early EBV exposure, is also associated with these diagnoses. METHODS: In case-control studies, we examined the concurrence of infectious mononucleosis, Hodgkin lymphoma, multiple sclerosis, SLE, Crohn's disease, and ulcerative colitis in the same patients, using the University of Pennsylvania Health System (UPHS) electronic database. Patients diagnosed with infectious mononucleosis, Hodgkin lymphoma, multiple sclerosis, Crohn's disease, or ulcerative colitis were identified by their corresponding International Classification of Diseases, 10 th Revision. We compared the observed concurrence of each two diagnoses with their expected frequencies in the overall UPHS population by calculating odds ratios and their corresponding 95% confidence intervals. RESULTS: The UPHS database from 2000 to 2024 contained a total of 3 955 827 unique patients. Among these individuals, 10 462 were diagnosed with infectious mononucleosis, 5552 with Hodgkin lymphoma, 16 777 with multiple sclerosis, 18 475 with Crohn's disease, and 22 830 with ulcerative colitis. A prior history of infectious mononucleosis carried a 1.8-7.1-fold increased risk for concurrent Hodgkin lymphoma, multiple sclerosis, SLE, Crohn's disease, or ulcerative colitis. Moreover, anyone of the five diagnoses Hodgkin lymphoma, multiple sclerosis, SLE, Crohn's disease, ulcerative colitis was significantly associated with the concurrence of any other diagnosis from the same group. CONCLUSION: The six diagnoses, infectious mononucleosis, Hodgkin lymphoma, multiple sclerosis, SLE, Crohn's disease, and ulcerative colitis tended to cluster in the same patient population. These results support the hypothesis that these diagnoses share a common etiology, most likely related to EBV infection during early lifetime.
Prognostic value of easy Albumin-Bilirubin score in liver cirrhosis: a comparison with established scoring systems.
Liu J, Wei YS
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41549846 · Full text
BACKGROUND AND AIMS: Accurate prognostication critical for managing liver cirrhosis. Existing tools [Child-Pugh, model for end-stage liver disease (MELD), MELD-sodium (MELD-Na), Albumin-Bilirubin (ALBI), and platelet ALB...
BACKGROUND AND AIMS: Accurate prognostication critical for managing liver cirrhosis. Existing tools [Child-Pugh, model for end-stage liver disease (MELD), MELD-sodium (MELD-Na), Albumin-Bilirubin (ALBI), and platelet ALBI (PALBI)] have limitations, including subjectivity, complexity, and reliance on logarithmic transformations. Simplified easy-ALBI (EZ-ALBI), a prognostic factor in hepatocellular carcinoma, is understudied in cirrhosis. The present study aimed to evaluate its prognostic value in cirrhosis, compare it with established scores, assess its consistent long-term performance, and define its clinical utility for risk stratification. METHODS: This retrospective study enrolled 501 cirrhotic patients (June 2018-June 2020), with a median follow-up of 42.3 months (interquartile range: 28.6-56.8 months); follow-up was terminated on 30 June 2025. EZ-ALBI was compared with Child-Pugh, MELD-Na, ALBI, and PALBI using correlation, survival (Kaplan-Meier), Cox regression, and receiver operating characteristic analyses. RESULTS: EZ-ALBI strongly correlated with ALBI ( r = 0.9460, P < 0.001). EZ-ALBI grade 3 was associated with shorter survival (29.9 vs. 65.5 months, P < 0.001) and served as an independent prognostic factor (hazard ratio = 3.944, 95% confidence interval: 1.772-8.777, P < 0.05). Its prognostic accuracy was consistent across 6-60 months (areas under the curves: 0.738-0.832), long-term performance (36-60 months) was comparable to MELD, MELD-Na, and ALBI, and outperformed Child-Pugh and PALBI in specific periods. CONCLUSION: The EZ-ALBI score is a simple, objective, and reliable prognostic tool for patients with liver cirrhosis, with consistent predictive value across follow-up periods, supporting its clinical utility for risk stratification. Notably, EZ-ALBI's simplicity (no logarithmic transformations) significantly enhances its practicality for bedside risk stratification, a key advantage in clinical practice.
Metabolic dysfunction-associated fatty liver disease increases the risk of sleep abnormalities: an analysis of the National Health and Nutrition Examination Survey 2017-2020.
Mostafa AM, Fouad Y, AbdAllah M … +3 more , Abdeltawab D, Pan Z, Eslam M
Eur J Gastroenterol Hepatol · 2026 Jun · PMID 41549826 · Publisher ↗
BACKGROUND: The connection between metabolic dysfunction-associated fatty liver disease (MAFLD) and sleep issues remains unclear. This study seeks to explore the relationship between sleep duration, associated disorders,...
BACKGROUND: The connection between metabolic dysfunction-associated fatty liver disease (MAFLD) and sleep issues remains unclear. This study seeks to explore the relationship between sleep duration, associated disorders, and MAFLD. METHODS: A cross-sectional study utilized data from the National Health and Nutrition Examination Survey spanning from 2017 to March 2020. The MAFLD cohort was characterized by the presence of hepatic steatosis (controlled attenuation parameter ≥ 264) and metabolic dysfunction based on international guidelines. Exclusion for participants under 18 years old, those with incomplete elastography tests, heavy alcohol users, positive hepatitis C virus and hepatitis B virus status, or those lacking necessary data for MAFLD diagnosis or the sleep questionnaire. Logistic regression analysis was employed to identify significant risk factors for sleep abnormalities. RESULTS: The prevalence of MAFLD was found to be 41.4%. Participants diagnosed with MAFLD experienced shorter sleep duration, snoring, and snoring that included breathing difficulties, and increased daytime sleepiness. When controlling for age, sex, and ethnicity, MAFLD emerged as an independent risk factor for abnormal sleep duration [odds ratio (OR): 1.7, 95% confidence interval (CI): 1.5-2.1, P < 0.001], sleep troubles (OR: 1.4, 95% CI: 1.2-1.7, P < 0.001), daytime sleepiness (OR: 1.23, 95% CI: 1.05-1.4, P = 0.007), and snoring (OR: 1.2, 95% CI: 1.02-1.5, P = 0.02), as well as snoring associated with breathing difficulties (OR: 1.3, 95% CI: 1.05-1.7, P = 0.04). CONCLUSION: MAFLD increases the risk of shorter sleep duration and various sleep disorders. Further research is required to elucidate the mechanisms mediating this association.
Utility of colon capsule endoscopy in colorectal cancer and post-polypectomy surveillance.
Ibrahim H, Dequaire J, Abdelwahed A … +2 more , Jardine R, Watson A
Eur J Gastroenterol Hepatol · 2026 Jun · PMID 41524604 · Publisher ↗
OBJECTIVES: Surveillance colonoscopy is recommended for follow up of colorectal cancer and polyps. It has, however, a low yield in this setting and presents a significant strain on endoscopy capacity. Colon capsule endos...
OBJECTIVES: Surveillance colonoscopy is recommended for follow up of colorectal cancer and polyps. It has, however, a low yield in this setting and presents a significant strain on endoscopy capacity. Colon capsule endoscopy (CCE) is an alternative diagnostic. We aimed to determine the utility of this test in surveillance patients. METHODS: A retrospective analysis of a prospectively collated service evaluation data was conducted looking at all surveillance CCE patients in NHS Highland. The primary outcomes were the need for follow up endoscopy and capacity saved. Secondary outcomes included the CCE completion rate, and patient specific factors that contribute to an unsuccessful CCE or the need for a follow up endoscopy. RESULTS: One hundred forty-six patients underwent surveillance CCE between May 2023 and January 2025. Ninety-three (63.7%) required follow up endoscopy. Capacity saved was up to 35.2% of the time slots that would have otherwise been used if all had undergone colonoscopy. Opiate use was associated with CCE failure. Polyp, as opposed to cancer, surveillance and a history of multiple polyps on previous endoscopy were associated with increased follow up rate. CONCLUSION: CCE resulted in endoscopy capacity savings in this surveillance cohort, but it should be used selectively in view of the high follow up investigation rate. The benefit may be improved with careful patient selection and the exclusion of patients on opiates, tricyclic antidepresants, or who have a history of polyposis.
Impact of sarcopenia on outcomes in liver transplant recipients: a nationwide analysis.
Lin J, Dhruve R, Singh C … +3 more , Bhupal SS, Sohal A, Roytman M
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41524603 · Publisher ↗
BACKGROUND: Sarcopenia is linked to adverse outcomes in patients undergoing liver transplantation (LT), including higher post-transplant complication rates and mortality rates. The current study aims to assess the impact...
BACKGROUND: Sarcopenia is linked to adverse outcomes in patients undergoing liver transplantation (LT), including higher post-transplant complication rates and mortality rates. The current study aims to assess the impact of sarcopenia on outcomes in LT recipients. METHODS: The National Inpatient Sample Database 2016-2020 was used to identify LT recipients. Patients were categorized into two groups based on the presence or absence of sarcopenia. Data were collected on patient demographics, etiology of liver disease, and decompensation of liver disease. The outcomes studied include in-hospital mortality, shock, acute kidney injury (AKI), ICU stay, and LT-related complications. The impact of sarcopenia was assessed using multivariate logistic/linear regression analysis. RESULTS: Of the 170 650 LT recipients included in the analysis, 24 525 (14.4%) had sarcopenia. After adjusting for confounding factors, sarcopenia was associated with a higher odds of in-hospital mortality [adjusted odds ratio (aOR), 2.16; 95% confidence interval (CI), 1.83-2.56; P < 0.001], shock (aOR, 2.18; 95% CI, 1.92-2.48; P < 0.001), AKI (aOR, 1.4; 95% CI, 1.32-1.49; P < 0.001), ICU stay (aOR, 2.23; 95% CI, 1.98-2.52; P < 0.001), LT-related complications (aOR, 1.47; 95% CI, 1.23-1.75; P < 0.001), longer length of stay (adj. coefficient, 4.71 days; 95% CI, 4.31-5.10; P < 0.001), and total hospitalization charges (adj. coefficient-$56 359.88; 95% CI, $49 737.17-$62 982.58; P < 0.001). CONCLUSION: We noted that sarcopenia is associated with worse outcomes and higher resource utilization in LT recipients, highlighting the need for early detection and targeted interventions.
Effect of statin use on prognostic outcomes in hepatocellular carcinoma following liver surgery: a systematic review and meta-analysis.
Saisa D, Mustika S, Fachrureza M … +5 more , Surya SC, Rampengan D, Lele JAJMN, Nojaid A, Hogipranata MO
Eur J Gastroenterol Hepatol · 2026 May · PMID 41524602 · Publisher ↗
Hepatocellular carcinoma (HCC) recurrence remains a significant clinical challenge, even among patients who undergo surgical treatment. Although statins exhibit anticancer properties through several biologically plausibl...
Hepatocellular carcinoma (HCC) recurrence remains a significant clinical challenge, even among patients who undergo surgical treatment. Although statins exhibit anticancer properties through several biologically plausible mechanisms, robust clinical evidence supporting their role in preventing HCC recurrence is still limited. This meta-analysis aimed to evaluate the impact of statin use on the prognostic outcomes of patients undergoing either liver transplantation or surgical resection. This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and identified relevant studies from electronic databases, including PubMed , Cochrane Library , Scopus , EBSCOhost , and ProQuest . The quality of the included studies was appraised using the Newcastle-Ottawa Scale tool. A meta-analysis was performed by estimating the hazard ratio (HR) with a 95% confidence interval (CI). A total of 15 studies encompassing 37 160 patients were included, with most evaluating statin use after surgical resection. The overall quality assessment yielded a low risk of bias. Our findings highlight a significant benefit of statin use following either liver transplant or resection, showing a significant improvement in overall survival (HR, 0.50; 95% CI, 0.40-0.61; P < 0.001). Moreover, further analysis also revealed that statins were associated with improved recurrence-free survival of HCC (HR, 0.56; 95% CI, 0.49-0.65; P < 0.001). Our study suggests that statins exert a protective effect, reflected in improved survival and reduced HCC recurrence. These findings support the potential role of statins as an adjunctive therapy in HCC management, potentially improving long-term outcomes. Further research is needed to confirm survival outcomes and safety. p.
Empirical first- and second-line eradication regimens for Helicobacter pylori adult-infected patients: a National Survey among Italian gastroenterologists and general practitioners.
Gatta L, Scarpignato C, Zullo A … +13 more , Marrocco W, Chiriatti A, Grosso A, Lambiase C, Vassallo R, Bartoletti P, Monica F, Manta R, Scotti S, Soncini M, Usai-Satta P, Bellini M, Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and the Italian Federation of General Practitioners (FIMMG)
Eur J Gastroenterol Hepatol · 2026 May · PMID 41524597 · Publisher ↗
OBJECTIVE: Despite national and international guidelines on Helicobacter pylori management, limited evidence exists on how these recommendations are applied in routine clinical practice. This nationwide survey, conducted...
OBJECTIVE: Despite national and international guidelines on Helicobacter pylori management, limited evidence exists on how these recommendations are applied in routine clinical practice. This nationwide survey, conducted by the Italian Association of Hospital Gastroenterologists and Endoscopists and the Italian Federation of General Practitioners (FIMMG), aimed to identify the empirical first- and second-line treatments most commonly recommended in Italy. METHODS: Members of societies were invited via email to anonymously complete an original 20-item questionnaire. Ten therapeutic regimens were proposed, with treatment durations classified as 7, 10, or 14 days. Respondents reported the type of proton-pump inhibitor (PPI) used, total daily dose (mg/day), and whether probiotics and/or lactoferrin were recommended. PPI doses were standardized according to acid inhibition potency and categorized as low, standard, or high. RESULTS: Among the 1262 respondents [358 gastroenterologists (GEs) and 904 general practitioners (GPs)], the first-line regimen most frequently prescribed was the triple therapy with PPI, clarithromycin and amoxicillin (35.2%; 12% of GEs vs. 44.4% of GPs; P < 0.0001), followed by bismuth quadruple therapy - three-in-one capsule (BQT-TSC: 31.2%; 51.4 vs. 23.3%, P < 0.001), and sequential therapy (21.7%; 26.8 vs. 19.7%, P < 0.001). For second-line, BQT-TSC was the most prescribed regimen (53.1%; GEs versus GSs: not statistically significant). 10-day courses and low-dose PPIs predominated, and approximately 1/3 of respondents recommended probiotics. CONCLUSION: Empirical regimen selection, PPI dosing, and probiotic use frequently diverged from guideline recommendations. These findings highlight the need to align clinical practice with evidence-based standards to improve eradication rates, optimize cost-effectiveness, and preserve healthcare resources.
Risk factors and clinical course of inflammatory bowel disease in patients receiving cancer therapy.
Natha C, Colli Cruz C, Vemulapalli V … +21 more , Sullivan A, Naz S, Ahuja R, Haque K, Zhou E, Haydel J, Quirk N, Wali S, Takigawa K, Prasad P, Peddireddy A, Shi K, Lu E, Lee AM, Julia Moura Nascimento Santos M, Junek K, Silva N, Pabani A, Philpott J, Thomas AS, Wang Y
Eur J Gastroenterol Hepatol · 2026 Jun · PMID 41524591 · Publisher ↗
BACKGROUND: Inflammatory bowel disease (IBD) is associated with chronic inflammation and increased malignancy risk; however, data on the effects of cancer therapies on the clinical course of IBD are limited. We evaluated...
BACKGROUND: Inflammatory bowel disease (IBD) is associated with chronic inflammation and increased malignancy risk; however, data on the effects of cancer therapies on the clinical course of IBD are limited. We evaluated the effects of cancer therapies on IBD activity and oncologic outcomes. METHODS: This single-center, retrospective study was conducted at a tertiary care cancer center and included patients with IBD and malignancy who received cancer therapy 2015-2023. Patient characteristics and comparisons between patients who did and did not develop gastrointestinal adverse events (GI AEs) related to cancer therapy are presented. RESULTS: The cohort included 1153 patients, predominantly white (85.3%) and female (51.6%). GI AEs occurred in 296 (25.7%) patients. Those who developed GI AEs had more hematologic malignancies (21.6 vs. 14.6%; P = 0.005), stage III-IV cancer (55.1 vs. 45.6%; P < 0.0001), immune checkpoint inhibitor (ICI) use (19.6 vs. 10.7%; P < 0.0001) and active baseline IBD status before cancer therapy (20.0 vs. 14.5%; P = 0.025). Stage III-IV disease (hazard ratio: 2.9, P < 0.0001), GI AEs (hazard ratio: 1.3, P = 0.008), GI AE-related hospitalization (hazard ratio: 2.1, P < 0.0001), and ICI (hazard ratio: 2.0, P < 0.0001) were associated with decreased survival. CONCLUSION: Concurrent management of IBD and cancer poses clinical challenges, particularly with the higher risk of GI AEs (25.7%) that is associated with active baseline IBD status and ICI use. These interactions may compromise treatment and survival. Further research is warranted to clarify the long-term impact of cancer therapies on IBD progression and outcomes.
The prognostic value of protein induced by vitamin K absence or antagonist-II in hepatocellular carcinoma patients undergoing surgical resection.
Feng H, Xiao J, Li Z … +3 more , Wei Q, Li B, Ren L
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41524590 · Full text
OBJECTIVE: The main objective of this study is to investigate the prognostic value of serum protein induced by vitamin K absence or antagonist-II (PIVKA-II) in predicting postoperative outcomes for hepatocellular carcino...
OBJECTIVE: The main objective of this study is to investigate the prognostic value of serum protein induced by vitamin K absence or antagonist-II (PIVKA-II) in predicting postoperative outcomes for hepatocellular carcinoma (HCC) patients after surgical resection. METHODS: Serum PIVKA‑II levels were compared between early‑stage (stage I+II) and advanced‑stage (stage III+IV) HCC patients. Correlations between PIVKA‑II and clinicopathological features were examined. Kaplan‑Meier curves were plotted to assess overall survival (OS) and recurrence‑free survival (RFS) by PIVKA‑II levels. Receiver operating characteristic (ROC) analysis compared the predictive performance of PIVKA‑II and α ‑fetoprotein (AFP), with DeLong 's test evaluating differences in area under the curve. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors for postoperative survival and recurrence. RESULTS: Serum PIVKA‑II levels were significantly elevated in HCC patients compared with controls ( P < 0.01), and were higher in advanced‑stage than early‑stage HCC ( P < 0.01). PIVKA‑II correlated significantly with tumor diameter, tumor node metastasis classification, lymph node infiltration, distant metastasis, differentiation, and complication incidence (all P < 0.05). Patients with high PIVKA‑II (≥100 mAU/ml) had shorter median OS and RFS than those with low levels (<100 mAU/ml) ( P < 0.01). PIVKA‑II outperformed AFP in predicting 5‑year survival and recurrence ( P < 0.05), and combined use improved predictive accuracy ( P < 0.05). Multivariate Cox regression identified PIVKA‑II ≥100 mAU/ml as an independent prognostic factor for both OS and RFS ( P < 0.05). CONCLUSION: Our study confirms that serum PIVKA-II can serve as a prognostic predictor for HCC patients after surgical treatment.
Surveillance imaging detects hepatocellular adenomas and carcinomas in individuals with Fontan circulation.
Rubadeux D, Debnath P, Bari K … +9 more , Bonn JA, Dillman JR, Eichelbrenner F, Opotowsky AR, Palermo JJ, Schooler GR, Smith CA, Trout AT, Morin CE
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41524589 · Publisher ↗
PURPOSE: To describe institutional surveillance practices for hepatic neoplasms in people with Fontan circulation and report the number and types of biopsied lesions identified. METHODS: We retrospectively analyzed surve...
PURPOSE: To describe institutional surveillance practices for hepatic neoplasms in people with Fontan circulation and report the number and types of biopsied lesions identified. METHODS: We retrospectively analyzed surveillance liver imaging, serum alpha-fetoprotein (AFP), and histopathology in individuals with Fontan circulation cared for at our hospital between 2013 and 2022. Clinical information and subsequent management were reviewed. Imaging for hepatocellular adenomas (HCAs) and malignant lesions was assessed for key diagnostic features. RESULTS: A total of 1110 liver imaging studies were performed in 686 individuals. Twenty-eight focal liver lesions (in 23 patients) were biopsied: 10 focal nodular hyperplasia-like lesions, seven HCA, seven hepatocellular carcinomas (HCCs), one cholangiocarcinoma, one hamartoma, one posttransplant lymphoproliferative disorder lesion, and one hemangioma. Two HCAs demonstrated malignant transformation to HCC. Median ages at diagnosis were 17.5 years for HCA and 26.6 years for malignant tumors. Most HCAs (5/7) and HCCs (5/7) were initially detected with MRI. Only three of seven patients with HCC had elevated AFP prebiopsy. Imaging features - including arterial phase hyperenhancement, washout, fat content, and hepatobiliary phase hypointensity - substantially overlapped between HCAs and HCCs. Among patients with malignant neoplasms ( n = 8), four died, three underwent percutaneous therapy followed by heart-liver transplantation, and one underwent ablation alone. CONCLUSION: Surveillance imaging in this cohort of children and adults with Fontan circulation identified hepatocellular neoplasms in patients as young as 15 years old. MRI detected most lesions, AFP was often normal in HCC, and substantial imaging overlap between HCAs and HCCs reinforces the need for multidisciplinary review to guide diagnosis and management.
A preoperative predictive model-based scoring system for assessing postoperative bleeding after percutaneous liver biopsy.
Wang P, Zhu T, Cheng Z … +1 more , Huang J
Eur J Gastroenterol Hepatol · 2026 May · PMID 41524588 · Publisher ↗
OBJECTIVE: Percutaneous liver biopsy (PLB) is the gold standard for diagnosing liver diseases, yet postoperative bleeding remains the most common and severe complication, constraining its clinical application. Accurate p...
OBJECTIVE: Percutaneous liver biopsy (PLB) is the gold standard for diagnosing liver diseases, yet postoperative bleeding remains the most common and severe complication, constraining its clinical application. Accurate prediction of postoperative bleeding risk is essential to enhance PLB safety. METHODS: This study first used multivariate regression analysis in a retrospective cohort to identify independent risk factors associated with postoperative bleeding after PLB. Based on these factors, a preoperative bleeding risk scoring system was further developed, and its performance was analyzed across subgroups defined by different clinical indications. Finally, the model and scoring system were prospectively validated in an external cohort to assess generalizability. RESULTS: Multivariable analysis identified lesion type, portosystemic shunt (PSS), and total bilirubin as independent risk factors, and a significant interaction between lesion type and PSS status was observed. The bleeding-prediction model was: logit( P ) = -3.5 + (1.223 × lesion type) + (1.018 × PSS) + (0.454 × total bilirubin) + (1.523 × lesion type × PSS). The scoring system derived from these factors showed a marked increase in postoperative bleeding rate with rising scores and demonstrated good discrimination in both the standard-indication group (the area under the receiver operating characteristic curve = 0.892) and the super-indication group (the area under the receiver operating characteristic curve = 0.846). External validation further confirmed robust generalizability across populations. CONCLUSION: The preoperative bleeding-prediction model and risk scoring system developed in this study can accurately predict postoperative bleeding after PLB, enhance PLB safety, and support optimization of preoperative assessment and postoperative management in clinical practice for diverse patient groups effectively.
A multilevel analysis of the genetic association between inflammatory bowel disease and primary sclerosing cholangitis.
Tang L, Mo J, Ouyang J … +1 more , Li W
Eur J Gastroenterol Hepatol · 2026 May · PMID 41524586 · Publisher ↗
BACKGROUND: Inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) are recognized as interconnected immune disorders, necessitating comprehensive genetic analysis. METHODS: The research employed genome...
BACKGROUND: Inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) are recognized as interconnected immune disorders, necessitating comprehensive genetic analysis. METHODS: The research employed genome-wide association study (GWAS) data pertinent to IBD and PSC. Initially, linkage disequilibrium score regression alongside SUPERGNOVA was utilized to assess their genetic correlation. The genetic overlap between these two conditions was subsequently evaluated using the conditional/conjunctional false discovery rate (cond/conjFDR) approach. Shared loci pertinent to IBD and PSC were discerned through both conjFDR and multitrait analysis of GWAS (MTAG) techniques. Finally, transcriptome-wide association studies were executed at the tissue level to investigate enriched tissues and expressed genes. RESULTS: A substantial overall correlation was identified at the genome-wide level between IBD (including Crohn's disease and ulcerative colitis) and PSC. Locally, correlations were prominent as both diseases exhibited enrichment across various chromosomes, with chromosome 9 being particularly noteworthy. The conditional quantile-quantile plot derived from the conjFDR analysis indicated genetic overlap between the two diseases. Using an integrated approach involving conjFDR and MTAG analyses, 15, 12, and 6 shared loci were detected for IBD, Crohn's disease, and ulcerative colitis with PSC, respectively. Furthermore, concurrent enrichment of IBD and PSC was found in seven tissues (spleen, terminal ileum of the small intestine, whole blood, lung, Epstein-Barr virus-transformed lymphocytes, transverse colon, and adipose visceral omentum). CONCLUSION: This study provides genetic evidence for the comorbidity of IBD and PSC, enhancing our understanding of the pathophysiological aspects of both diseases.
Barrett's esophagus-associated genetic loci in African Americans: a case-control study using the All of Us Research Program.
Rao A, Byun J, Thrift AP … +1 more , El-Serag HB
Eur J Gastroenterol Hepatol · 2026 Jun · PMID 41524576 · Full text
BACKGROUND AND AIMS: Barrett's esophagus is the only known precursor lesion to esophageal adenocarcinoma (EAC). Barrett's esophagus and EAC are less common in African Americans than in non-Hispanic Whites. Studies in Eur...
BACKGROUND AND AIMS: Barrett's esophagus is the only known precursor lesion to esophageal adenocarcinoma (EAC). Barrett's esophagus and EAC are less common in African Americans than in non-Hispanic Whites. Studies in European populations have identified Barrett's esophagus-associated risk loci; however, none have examined loci in African Americans cohorts. We conducted a case-control targeted replication study to investigate previously identified Barrett's esophagus risk loci in an African Americans cohort in the All of Us (AoU) Research Program. METHODS: We abstracted phenomic and genomic data from 108 African Americans with Barrett's esophagus and 778 African Americans controls in the AoU database. We examined 16 single-nucleotide polymorphisms (SNPs) identified in individuals of European origin in the largest Barrett's esophagus genome-wide association study to date. We conducted a logistic regression, adjusting for age, sex, and global ancestry, to assess associations between SNPs and Barrett's esophagus/control status. RESULTS: Of 16 SNPs examined, logistic regression analysis showed three SNPs (rs42202, rs62217, and rs848092) were associated with Barrett's esophagus risk at Bonferroni-adjusted significance ( P < 3.1e-3) and in the same direction as previously reported. One SNP, rs2701111, met significance but showed a discordant association with Barrett's esophagus in African Americans. The association with the remaining 12 SNPs was not replicated. Effect sizes were generally larger for each SNP in our African Americans cohort. CONCLUSION: This study evaluated 16 Barrett's esophagus-associated SNPs in African Americans and confirmed associations for only three Barrett's esophagus-associated variants shared across populations. The nonreplication of most loci and differences in association patterns suggest distinct genetic factors influence Barrett's esophagus in admixed populations. These findings underscore the need for discovery and replication in diverse populations.
Effect of multistrain probiotics on symptom severity in irritable bowel syndrome: a systematic review and meta-analysis of irritable bowel syndrome-symptom severity score outcomes.
Anwar DFF, Salma ZN, Oktaviani SD … +6 more , Adiyatma FN, Tauhid FM, Mustofa A, Saputra PBT, Karimah R, Alkaff FF
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41433106 · Full text
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder with varying symptom severity. Although probiotics are frequently used for IBS management, the effects of multistrain probiotic interventions on IBS sy...
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder with varying symptom severity. Although probiotics are frequently used for IBS management, the effects of multistrain probiotic interventions on IBS symptom severity, as measured by the IBS symptom severity score (IBS-SSS), remain unclear. This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, compared multistrain probiotics with placebo in patients with IBS, focusing on IBS-SSS outcomes. Risk of bias was assessed using the Risk of Bias 2.0 tool, and meta-analysis was performed with Review Manager 5.4.1. From the 1858 screened records, 12 studies involving 1303 participants were included. Multistrain probiotics significantly reduced total IBS-SSS scores [mean difference = -43.66, 95% confidence interval (CI): -65.89 to -21.44, P = 0.0001, I ² = 99%]. Significant improvements were also found in IBS-SSS subscores, including number of days with pain (mean difference = -7.38, 95% CI: -11.86 to -2.89, P = 0.001, I ² = 100%), bloating (-5.62, 95% CI: -10.76 to -0.48, P = 0.03, I ² = 100%), bowel habit satisfaction (-11.90, 95% CI: -19.21 to -4.59, P = 0.001, I ² = 99%), and quality of life (QoL) (-11.99, 95% CI: -16.3 to -7.60, P < 0.00001, I ² = 91%); however, changes in abdominal pain scores and IBS-specific QoL were not statistically significant. High heterogeneity prompted sensitivity analyses to identify contributing factors. Overall, multistrain probiotics significantly reduced IBS-SSS and its subscores but did not significantly improve QoL compared with placebo.
Letter to the editor.
Supovec E, Drobne D
Eur J Gastroenterol Hepatol · 2026 Jan · PMID 41364015 · Publisher ↗
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