GI Signals - Hepatology

Global epidemiology of metabolic and alcohol-associated liver disease: risk factors, natural history and clinical implications.

Mon, 24 Aug 2026 19:12:09 +0000

Nature reviews. Gastroenterology & hepatology. Systematically screen patients with cardiometabolic risk factors (obesity, diabetes) and any alcohol use for MetALD using risk-based approach: simple blood-based non-invasive fibrosis tests (e.g., FIB-4, AST-to-ALT ratio), imaging, and advanced serum biomarkers of fibrosis. Measure phosphatidylethanol when alcohol history is uncertain or under-reported. Recognize that MetALD carries substantially higher progression risk than MASLD alone and warrants more aggressive surveillance and treatment strategies.

Higher Off-Therapy Relapse Risk with Tenofovir Alafenamide than Entecavir in Non-cirrhotic HBeAg-Negative Chronic Hepatitis B: Insights from End-of-Treatment qHBsAg Stratification.

Mon, 24 Aug 2026 19:12:09 +0000

Digestive diseases and sciences. For non-cirrhotic HBeAg-negative patients actively being considered for treatment discontinuation, entecavir showed substantially lower post-cessation relapse risk than TAF. ETV clinical relapse ranged from 0% (HBsAg <2) to 25% (HBsAg ≥3 log10 IU/mL) and was stratified by end-of-treatment quantitative HBsAg; TAF relapse remained uniformly high. This is an observational comparison among patients who discontinued; it does not guide drug selection at treatment initiation.

Large-scale AI-guided liver malignancy diagnosis: multicenter study and a single-arm trial.

Mon, 24 Aug 2026 19:12:09 +0000

Nature medicine. Consider AI-augmented contrast-enhanced CT as a potential enhancement to standard ultrasound and AFP surveillance for MASLD patients with cirrhosis, pending prospective head-to-head comparative outcomes.

Gaps in the Cascade of Care Contribute to Poor Liver Cancer Outcomes Among People Living With Hepatitis B: A Multicenter Observational Cohort Study.

Mon, 24 Aug 2026 19:12:09 +0000

Journal of gastroenterology and hepatology. Systematically link HBV patients to specialist care for antiviral therapy and surveillance before HCC develops. In this Australian cohort of HBV-HCC cases (89% male, 60% Asian ethnicity), specialist care linkage was associated with substantially higher antiviral treatment uptake (adjusted OR 8.4, 95% CI 4.3-16.1, p<0.001); generalization to other populations and healthcare systems remains uncertain.

Liver resection after atezolizumab and bevacizumab versus maintenance therapy for locally advanced hepatocellular carcinoma (TALENTOP): a multicentre, open-label, randomised, phase 3 trial.

Mon, 24 Aug 2026 19:12:09 +0000

Lancet (London, England). For carefully selected advanced HCC patients with macrovascular invasion but without extrahepatic metastasis who achieve PR or SD on induction atezolizumab plus bevacizumab, surgical evaluation for resection may be considered (open-label trial, Chinese multi-center; benefits demonstrated on time-to-treatment-failure, not yet overall survival; safety profile incomplete pending full adverse event reporting). This challenges the paradigm of macrovascular invasion as an absolute contraindication to resection; however, guideline-level endorsement is pending.

ROTEM-guided blood product transfusion in patients with cirrhosis having invasive procedures: a randomized controlled trial.

Mon, 24 Aug 2026 19:12:09 +0000

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. In cirrhotic patients with abnormal INR or platelet counts undergoing invasive procedures, implement ROTEM-guided transfusion protocols instead of routine prophylactic transfusion to reduce unnecessary blood product exposure while maintaining hemostatic safety; adoption requires ROTEM availability and institutional protocol support.

Effect of high dose N-acetyl cysteine supplementation on markers of oxidative stress and insulin resistance in non-diabetic patients with metabolic dysfunction associated steatotic liver disease: a randomized controlled trial.

Thu, 20 Aug 2026 18:40:03 +0000

BMC gastroenterology. Do not add NAC to lifestyle counseling for MASLD. Although NAC was safe and well-tolerated, it provided no additional benefit over lifestyle intervention alone for fibrosis, insulin resistance, oxidative stress, or steatosis indices. Lifestyle modification remains the evidence-based foundation.

A First-in-Human study of AHB-137, an unconjugated antisense oligonucleotide, in healthy subjects and patients with chronic hepatitis B.

Thu, 20 Aug 2026 18:40:03 +0000

Hepatology (Baltimore, Md.). No clinical action yet: Phase 1 study in a pre-selected patient population. Efficacy in typical CHB and optimal dosing remain to be determined in Phase 2-3 trials.

Xenobiotic-Induced Liver Injury in the United States: A 25-Year Retrospective Analysis of National Poison Data System.

Thu, 20 Aug 2026 18:40:03 +0000

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Counsel patients taking acetaminophen on the hepatotoxic risk and overdose potential, particularly those using over-the-counter analgesics. Screen for acetaminophen use when evaluating unexplained transaminitis or ALT/AST elevation >100 U/L, given acetaminophen-alone products now account for one-third to one-half of medication-related liver injury cases.

Shear wave elastography demonstrates similar risk stratification performance to vibration-controlled transient elastography in FIB-4-based two-step algorithms for MASLD.

Thu, 20 Aug 2026 18:40:03 +0000

Hepatology (Baltimore, Md.). SWE demonstrated similar performance to VCTE for MASLD risk stratification. If SWE is available at your institution, this study supports its use as an alternative to VCTE. If your institution is implementing an elastography program and choosing between modalities, either is supported by this evidence; decide based on cost, operator expertise, and availability. Ongoing VCTE use does not require change.

The Malaysian Society of Gastroenterology and Hepatology Consensus Statements on Prevention and Early Detection of Hepatocellular Carcinoma in Malaysia.

Thu, 20 Aug 2026 18:40:03 +0000

Journal of gastroenterology and hepatology. Pursue 6-monthly ultrasound and serum AFP surveillance for at-risk patients; use noninvasive fibrosis assessment in primary care settings to identify patients requiring surveillance and ensure referral to specialist hepatology care; establish clear multidisciplinary referral pathways.

Impact of Intestinal Colonization with Clostridioides difficile on Clinical Outcomes in Alcohol-associated Hepatitis.

Thu, 20 Aug 2026 18:40:03 +0000

Clinical and translational gastroenterology. Asymptomatic C. difficile colonization serves as a marker of disease severity and infection risk in hospitalized AH. If detected (whether through surveillance or incidentally), it identifies a higher-risk subset warranting closer monitoring for complications and a lower threshold for intervention. Whether routine screening or treatment of asymptomatic colonization improves outcomes remains unproven.

Review Article: Fibrosis Reversal in Metabolic Dysfunction-Associated Steatohepatitis-The Promise of Emerging Therapeutics.

Thu, 20 Aug 2026 18:40:03 +0000

Alimentary pharmacology & therapeutics. Resmetirom and semaglutide have conditional approval for MASH with F2-F3 fibrosis and improve fibrosis stage in one-quarter to one-third of patients. Consider these agents for patients with F2-F3 fibrosis, recognizing the demonstrated benefit is fibrosis improvement; whether this translates to clinical outcomes (cirrhosis prevention, transplant reduction, mortality) remains unproven, a critical gap the authors acknowledge.

Neighbourhood Deprivation Is Associated With Greater Mortality in Patients With Alcohol-Associated Liver Disease.

Thu, 20 Aug 2026 18:40:03 +0000

Alimentary pharmacology & therapeutics. This observational finding documents a substantial health disparity in ALD outcomes by neighborhood socioeconomic status. While the study does not test a specific clinical intervention, the result warrants awareness that your ALD patients from lower-income neighborhoods face significantly higher mortality risk independent of their comorbidities or insurance type. Consider whether your practice provides adequate access to addiction medicine support, social work consultation, and assistance addressing practical barriers such as transportation and insurance navigation for patients from socioeconomically disadvantaged areas.

Pruritus Is Frequent and Persistent and Impacts Quality of Life Among Patients With Primary Sclerosing Cholangitis.

Thu, 20 Aug 2026 18:40:03 +0000

Alimentary pharmacology & therapeutics. Ask PSC patients systematically about pruritus; 38% report moderate-to-severe symptoms strongly associated with cirrhosis and cholestasis markers. Assess using validated scales (WI-NRS, 5-D Itch scale) and recognize pruritus as an indicator of disease severity and quality-of-life burden. No new therapies identified, but findings underscore the existing treatment gap.

BEACON-HCC: Best evidence and north american consensus on treatment allocation for hepatocellular carcinoma.

Thu, 20 Aug 2026 21:35:47 +0000

Hepatology (Baltimore, Md.). Be aware of BEACON-HCC as emerging North American expert consensus on HCC treatment allocation that prioritizes newer modalities (TARE, EBRT, systemic-locoregional combinations) and refined prognostic factors (tumor burden, vascular invasion) beyond BCLC 2025. Prospective validation against clinical outcomes is planned; do not adopt as primary guidance until this evidence materializes.

The dynamic spectrum of steatotic liver disease: the global perspective.

Thu, 20 Aug 2026 21:35:47 +0000

Nature reviews. Gastroenterology & hepatology. Systematically screen all patients with steatotic liver disease for alcohol use using objective biomarkers such as phosphatidylethanol rather than patient report alone, structurally evaluate cardiometabolic risk factors (obesity, type 2 diabetes, hypertension, dyslipidemia), perform non-invasive fibrosis assessment, and crucially, reassess these factors repeatedly over time rather than applying static diagnostic labels once. Management should integrate alcohol reduction strategies, metabolic optimization, and liver-directed therapies in a multidisciplinary approach. Note that most emerging pharmacotherapies for metabolic steatohepatitis exclude patients with concurrent alcohol use, creating a gap between trial populations and real-world practice.

Hepatic Steatosis and Low-Density Lipoprotein Cholesterol Response After Statin Initiation: A Prospective Cohort Analysis.

Thu, 20 Aug 2026 21:35:47 +0000

Journal of gastroenterology and hepatology. Use standard statin dosing in MASLD for cardiovascular prevention. Hepatic steatosis does not impair LDL-C response and should not prompt dose modification or additional monitoring adjustments.

Noninvasive Detection of MASH and Fibrotic Burden Using Ultrasound-Derived LIID and LSM in MASLD: A Multicenter Study.

Thu, 20 Aug 2026 21:35:47 +0000

Journal of gastroenterology and hepatology. Consider iLivTouch-derived LIID and LSM as alternative non-invasive tools for identifying MASH and staging fibrosis when FIB-4, VCTE, MRE, or ELF are unavailable or discordant.

Treatment Goals for Primary Biliary Cholangitis, an Australian Perspective.

Thu, 20 Aug 2026 21:35:47 +0000

Journal of gastroenterology and hepatology. For PBC patients on UDCA, assess ALP at 1 year; if ALP ≥1.67x ULN (or bilirubin 1-2x ULN) in Australia, escalate to second-line therapy including PPAR agonists, fenofibrate, or obeticholic acid (subject to precautions). Also escalate if inadequate biochemical response or bothersome symptoms. At diagnosis, identify high-risk patients (male, age <45, ALP >1.5x ULN, anti-gp210 positive, or significant fibrosis) for closer monitoring and earlier therapy consideration.

BEAT-B Study (Behavior, Aspirations, and Treatment Needs): A Mixed-Methods Study of Patient Values, Preferences, and Barriers to Care Among People Living With Chronic Hepatitis B in South and Southeast Asia.

Thu, 20 Aug 2026 21:35:47 +0000

Journal of gastroenterology and hepatology. Educate patients and families that HBV is lifelong (80% don't understand). Involve families in care planning. Target additional support to high-risk non-adherers: less educated, without family support, or rural residents. Simplify care pathways and improve affordability, especially in endemic regions.

Liver-on-a-Chip: Applications for clinical modeling of liver disease using microscale systems.

Thu, 20 Aug 2026 21:35:47 +0000

Hepatology (Baltimore, Md.). No clinical action yet: this is a review of preclinical technology platforms. LOC systems are research tools that may eventually improve drug development by predicting hepatotoxicity in human-relevant conditions, but they have no direct bedside diagnostic or therapeutic application.

MAFLD/MASLD: Past, Present, and Future.

Thu, 20 Aug 2026 21:35:47 +0000

Journal of gastroenterology and hepatology. Discuss resmetirom or semaglutide with eligible MASH patients. Consult the product labeling for efficacy, safety, and selection criteria.

Albumin in the Management of Hepatorenal Syndrome-Acute Kidney Injury: Is There Ever Too Much?

Thu, 20 Aug 2026 21:35:47 +0000

Digestive diseases and sciences. In infection-triggered HRS-AKI with high disease severity (MELD >29, stage 3 AKI present in 67% of cohort), high-dose albumin (>50 g/day, mean 66 g/day) was not associated with increased respiratory failure compared to standard dosing (2/54, 3.7% vs. 2/89 standard-dose patients, 2.2%), prolonged hospital stay, or reduced 6-month survival (p=0.141). The respiratory failures observed were related to infection complications (pneumonia, aspiration), not albumin toxicity. Respiratory failure concern alone should not restrict albumin dosing in this severely ill population. Limitation: observational study with severity-based allocation; patients assigned to high-dose albumin had higher baseline MELD, stage 3 AKI, and infection-driven AKI, yet similar outcomes-reassuring but does not establish that higher-dose benefit extends to less-severe HRS-AKI.

Effect of high dose N-acetyl cysteine supplementation on markers of oxidative stress and insulin resistance in non-diabetic patients with metabolic dysfunction associated steatotic liver disease: a randomized controlled trial.

Thu, 20 Aug 2026 21:35:47 +0000

A First-in-Human study of AHB-137, an unconjugated antisense oligonucleotide, in healthy subjects and patients with chronic hepatitis B.

Thu, 20 Aug 2026 21:35:47 +0000

Hepatology (Baltimore, Md.). No clinical action yet: Phase 1 study in a pre-selected patient population. Efficacy in typical CHB and optimal dosing remain to be determined in Phase 2-3 trials.

Xenobiotic-Induced Liver Injury in the United States: A 25-Year Retrospective Analysis of National Poison Data System.

Thu, 20 Aug 2026 21:35:47 +0000

Shear wave elastography demonstrates similar risk stratification performance to vibration-controlled transient elastography in FIB-4-based two-step algorithms for MASLD.

Thu, 20 Aug 2026 21:35:47 +0000

The Malaysian Society of Gastroenterology and Hepatology Consensus Statements on Prevention and Early Detection of Hepatocellular Carcinoma in Malaysia.

Thu, 20 Aug 2026 21:35:47 +0000

The Association of Free Testosterone Levels With Frailty Metrics in Advanced Chronic Liver Disease.