10-year follow-up results of the European Achalasia Trial: a multicentre randomised controlled trial comparing pneumatic dilation with laparoscopic Heller myotomy
Conclusions
PD and LHM are equally effective even after 10 years of follow-up with limited risk to develop gastro-oesophageal reflux. Based on these data, we conclude that PD and LHM can both be proposed as initial treatment of achalasia. (Source: Gut)
Source: Gut - March 7, 2024 Category: Gastroenterology Authors: Boeckxstaens, G., Elsen, S., Belmans, A., Annese, V., Bredenoord, A. J., Busch, O. R., Costantini, M., Fumagalli, U., Smout, A. J. P. M., Tack, J., Vanuytsel, T., Zaninotto, G., Salvador, R. Tags: Gut Oesophagus Source Type: research
Thyroid hormone receptor-beta agonists: new MASLD therapies on the horizon
Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading chronic liver disease worldwide in the past decade.1 The spectrum of liver diseases in MASLD ranges from metabolic dysfunction-associated simple steatosis to steatohepatitis (MASH), advanced fibrosis, cirrhosis and hepatocellular carcinoma. The pathophysiology of MASLD involves many diverse pathways, including lipotoxicity, insulin resistance, gut dysbiosis, dietary factors, and innate and adaptive immunity, all reflecting the critical aspects of the disease process.2 3 Liver inflammation and progressive fibrosis, as ob...
Source: Gut - March 7, 2024 Category: Gastroenterology Authors: Byrne, C. D., Targher, G., Tilg, H. Tags: Gut Leading article Source Type: research
Fatal intestinal disease: a case of recurrent lower gastrointestinal bleeding
Clinical presentation A 69-year-old man was admitted to our hospital with abdominal pain, fever and massive bloody stool for the last 3 days, but no pathergy, genital and oral ulcers. Blood pressure was 86/54 mm Hg, respiratory rate 24 breaths/min, heart rate 126 beats/min. Subsequent laboratory findings were as follows: white blood cells 10.06x109/L, C reactive protein 47.5 mg/L, albumin 28.2 g/L and haemoglobin 77 g/L. HLA-B51 was positive. The abdominal contrast-enhanced CT scan revealed the presence of strip-like high-density shadows in the ileocecal region (figure 1A). Emergency surgery was performed. Intraoperative e...
Source: Gut - March 7, 2024 Category: Gastroenterology Authors: Dai, C., Huang, Y.-h. Tags: GUT Snapshot, Gut Editor ' s quiz: GI snapshot Source Type: research
ForePass endoscopic bypass device for obesity and insulin resistance--metabolic treatment in a swine model
WHAT IS ALREADY KNOWN ON THIS SUBJECTMetabolic surgery (MS) is a highly effective treatment for obesity and type 2 diabetes, leading to sustained weight loss over time. Notably, MS can reverse several obesity-related comorbidities such as chronic inflammation, hypertension and non-alcoholic fatty liver diseases, including nonalcoholic steatohepatitis (NASH). WHAT ARE THE NEW FINDINGS We showed that ForePass influences glucose kinetics, enhancing insulin-mediated whole-body glucose uptake, hepatic insulin sensitivity and insulin clearance. Moreover, ForePass modifies plasma metabolites and the variety and structure of faeca...
Source: Gut - March 7, 2024 Category: Gastroenterology Authors: Angelini, G., Galvao Neto, M., Boskoski, I., Caristo, M. E., Russo, S., Proto, L., Previti, E., Olsson, L., Aggarwal, H., Pezzica, S., Ferrari, E., Bove, V., Genco, A., Bornstein, S., Tremaroli, V., Gastaldelli, A., Mingrone, G. Tags: Open access, Gut Endoscopy news Source Type: research
New facet of CARs: HBV-specific CARs as inhibitors of virus morphogenesis and release
Although safe and effective vaccines against HBV (hepatitis B virus) are available, there are worldwide more than 2 billion people who had an HBV infection and about 250 million people suffering from chronic HBV infection. Chronic HBV infection is a major cause for liver diseases such as fibrosis, cirrhosis and hepatocellular carcinoma (HCC). It is estimated that about 800 000–1 000 000 people die each year due to the consequences of chronic HBV infection.1 Moreover, in almost all HBV-associated HCCs integrated HBV-DNA is found. Therapy options at present are limited and based on nucleoside/nucleotide analogues and i...
Source: Gut - March 7, 2024 Category: Gastroenterology Authors: Hildt, E., Hu, J. Tags: Open access, Gut Commentary Source Type: research
Clinical applications of circulating HBV RNA as a potential surrogate biomarker for intrahepatic cccDNA transcriptional activity
There is a close link between diagnostic and therapeutic approaches. The more precise the biomarker, the more accurately we can predict treatment outcomes. The efficacy of the hepatitis C virus (HCV) RNA biomarker in anticipating both early treatment response and post-treatment cure in HCV infections stands as a prime exemplar. Curing hepatitis B virus (HBV) infection, characterised as the persistent loss of hepatitis B surface antigen (HBsAg) (termed a functional cure), is now a top priority in the management of HBV infection. Despite employing highly sophisticated and efficacious drugs, our progress towards this curative...
Source: Gut - March 7, 2024 Category: Gastroenterology Authors: Yu, X., Pfefferkorn, M., van Bömmel, F., Zhang, X., Berg, T. Tags: Gut Commentary Source Type: research
Beyond a liver-gut focus: the evolution of gastroenterology and hepatology in challenging the obesity and steatotic liver disease paradigm
We read with great interest the paper by Camilleri and El-Omar ‘10 reasons that gastroenterologists and hepatologists should be treating obesity’1 and concur that these clinicians are pivotal in addressing the prevailing obesity crisis. We agree that in developing this scope of practice, inherent professional and systemic challenges will need to be overcome and believe that the authors’ well-articulated points could be expanded towards alternative approaches to dealing with the obesity epidemic. This will involve clinicians traversing perceived specialty boundaries and actively engaging in obesity managem...
Source: Gut - March 7, 2024 Category: Gastroenterology Authors: Brennan, P. N., Zelber-Sagi, S., Allen, A. M., Dillon, J. F., Lazarus, J. V. Tags: Open access, Gut Commentary Source Type: research
Inflammatory bowel diseases: are we ready to recommend a preventive diet for infants?
Environmental factors throughout life play a critical role in the development of IBD (Crohn’s disease (CD), UC). The past decade has witnessed an acceleration of environmental research in IBD with several landmark prospective cohorts identifying dietary and other lifestyle determinants of disease. In parallel, we have also made substantial progress in identifying how the environment contributes to IBD through microbiome-dependent and microbiome-independent effects. Adding to this literature is a study in Gut examining the impact of early life diet on risk of IBD.1 Guo et al use the All Babies in Southeast Sweden stud...
Source: Gut - March 7, 2024 Category: Gastroenterology Authors: Ananthakrishnan, A. N. Tags: Press releases, Gut Commentary Source Type: research
SARS-CoV-2 and the liver: clinical and immunological features in chronic liver disease
Luxenburger H, Thimme R. SARS-CoV-2 and the liver: clinical and immunological features in chronic liver disease. Gut 2023;72:1783-94
The correct legend for figure 4 should be:
Effect of booster vaccination on the adaptive immune response in LTR and AIH patients (A) Booster vaccination significantly improves the SARS-CoV- 2-specific antibody response in AIH, while the frequency of T cells remains stable. (B) Booster vaccination significantly improves the SARS-CoV-2- specific antibody response in LTR, while the frequency of T cells remains stable. (C) After two RNA vaccine doses, the CD4+T cell subset distribution is altered...
Source: Gut - March 7, 2024 Category: Gastroenterology Tags: Gut Correction Source Type: research
Significant underestimation of preventive effects in colorectal cancer screening trial
Morgan et al recently pointed out that, while colorectal cancer (CRC) remains a highly frequent cancer worldwide, trends in CRC incidence are decreasing markedly in some countries,1 which may largely be attributed to endoscopic screening.2 We; therefore, read with great interest the recently published follow-up results of the Nordic-European Initiative on Colorectal Cancer (NordICC) trial, suggesting a presumably smaller than expected protective effect of screening colonoscopy to prevent CRC. After 10-year follow-up, CRC incidence was reduced by 18% in the intention-to-screen analysis, comparing the intervention versus the...
Source: Gut - February 23, 2024 Category: Gastroenterology Authors: Heisser, T., Hoffmeister, M., Brenner, H. Tags: Open access, Gut PostScript Source Type: research
Gastric cancer risk in autoimmune gastritis: evidence versus opinion
We thank Waldum for his interest in our study on autoimmune gastritis, reflected in his letter ‘The conclusion that autoimmune gastritis does not predispose to gastric cancer (GC) is unproven.’1 2 Science rarely allows conclusive statements. However, some statements are supported by evidence, while others are opinions. This is a crucial epistemological distinction of which we should always be aware: arguments supported by evidence are a vital part of the scientific discourse, whereas opinions foster both adequate studies and unproductive diatribes that may erode the trust in science. We believe that our manuscr...
Source: Gut - February 23, 2024 Category: Gastroenterology Authors: Rugge, M., Genta, R. M., Malfertheiner, P., Graham, D. Y. Tags: Gut PostScript Source Type: research
Over-the-scope clips versus standard therapy in upper gastrointestinal bleeding
We read with high interest the randomised controlled trial (RCT) of Chan et al investigating over-the-scope clips (OTSC) versus standard therapy for the prevention of rebleeding in large (≥1.5 cm) peptic ulcers.1 However, this study and some aspects of study design deserve further critical evaluation and interpretation. One hundred patients with peptic ulcer bleeding and lesion size ≥1.5 cm were randomised to OTSC or standard treatment. In the intention-to-treat analysis, the primary endpoint of clinical rebleeding within 30 days was achieved in 10% with OTSC vs 18% with standard therapy. The difference was statistic...
Source: Gut - February 23, 2024 Category: Gastroenterology Authors: Meier, B., Schmidt, A., Caca, K. Tags: Gut PostScript Source Type: research
Haemorrhoidal disease reduces the risk of diverticular disease and irritable bowel syndrome: a Mendelian randomisation study
Zheng et al1 reported the first genome-wide association study (GWAS) to identify genetic risk factors of haemorrhoidal disease (HEM). In the study, the authors observed that HEM patients had a higher incidence of gastrointestinal domains, particularly diverticular disease and irritable bowel syndrome (IBS). Subsequently, they concluded the standpoint by analysing healthcare records, diagnoses and medication datasets. Nevertheless, such associations reported in the epidemiological study are often unreliable estimates of causal effects and can be interfered with by confounding or other forms of bias.2 To evaluate the causali...
Source: Gut - February 23, 2024 Category: Gastroenterology Authors: Zhu, Z., Chen, X., Wang, C., Zhang, S., Cheng, L. Tags: Gut PostScript Source Type: research
GI highlights from the literature
Basic scienceProspective genomic profiling of intestinal metaplasia Huang K, Ma H, Chong R et al. Spatiotemporal genomic profiling of intestinal metaplasia reveals clonal dynamics of gastric cancer progression. Cancer Cell 2023; 4112:2019–2037.e8. doi: 10.1016/j.ccell.2023.10.004 Gastric intestinal metaplasia (IM) is the precursor condition of gastric adenocarcinoma (GA). Surprisingly, limited genomics studies have been performed and were entirely retrospective. Here, the first major prospective genomic profiling of IM was performed. Biopsies taken over 5 years from 682 patients (644 with IM, 38 without) across the c...
Source: Gut - February 23, 2024 Category: Gastroenterology Authors: Smith, P. J. Tags: Gut JournalScan Source Type: research
Early-life exposures and the microbiome: implications for IBD prevention
The early-life period is one of microbiome establishment and immune maturation. Early-life exposures are increasingly being recognised to play an important role in IBD risk. The composition of functions of the gut microbiome in the prenatal, perinatal, and postnatal period may be crucial towards development of health or disease, including IBD, later in life. We herein present a comprehensive summary of the interplay between early-life factors and microbiome perturbations, and their association with risk of IBD. In addition, we provide an overview of host and external factors in early life that are known to impact gut micro...
Source: Gut - February 23, 2024 Category: Gastroenterology Authors: Zhang, L., Agrawal, M., Ng, S. C., Jess, T. Tags: GUT Recent advances in basic science, Gut Source Type: research
