We once again bring you a curated selection of the many new developments in gastroenterology and hepatology that may impact our patient management at some point in the future.
One common question in routine practice is the best time point for endoscopy of patients with upper gastrointestinal bleeding (UGIB). A new study by Guo et al. may provide an answer. In this retrospective cohort study, outcomes from acute non-variceal bleeding were better if endoscopy was performed between 6 and 24 hours after admission, and worse if it was performed earlier than 6 hours or between 24 and 48 hours after admission. Over-the-scope clips (OTSC) are an option for hemostasis in patients with rebleeding following conventional endoscopic therapy. A randomized study now demonstrates that OTSC therapy is even significantly superior to standard endoscopic treatment as primary therapy of UGIB in selected cases with a high risk of rebleeding (Meier et al.). Glucagon-like peptide-1 (GLP-1) agonists represent very effective pharmacological treatment options for obesity. Supporting this claim is a phase 3 study showing that once-weekly injection of the GLP-1 analogue tirzepatide can result in a major and sustained reduction in body weight and improvement in cardiovascular end points (Jastreboff et al.). [...]
The need for updated treatment algorithms for inflammatory bowel disease is increasing as more new small molecules and biologics become available. In the SEAVUE study, a direct comparison of the anti-interleukin (IL)-12/IL-23 antibody ustekinumab versus the anti-TNF antibody adalimumab in Crohn’s disease patients revealed that ustekinumab induces disease remission with equivalent efficacy and within a comparable time frame (Sands et al.). The anti-IL-23 antibody risankizumab has also now been shown to be another effective and well-tolerated treatment option for Crohn’s disease that will soon become available for prescription (D’Haens et al.). A new study on the selective JAK1 inhibitor upadacitinib versus placebo for the treatment of ulcerative colitis reports that this novel drug can induce remission very rapidly and effectively (Danese et al.).
Endoscopic therapy has become established in routine practice as the standard approach to necrotizing pancreatitis. A long-term follow-up of a cohort from a randomized trial in infected necrotizing pancreatitis patients who were treated either by endoscopy or by minimally invasive surgery revealed no differences in mortality or major complications. However, the endoscopic approach was associated with a lower long-term rate of pancreaticocutaneous fistulas and fewer reinterventions (Onnekink et al.).
To date, the predictors of long-term outcomes in autoimmune hepatitis have been inadequately defined. A recent multicenter study now reports that low aminotransferases but not normalized immunoglobulin G (IgG) during treatment (after 6, 12, 24 or 36 months) are associated with favorable outcomes (Biewenga et al.). Umbilical hernia repair often results in decompensation in patients with cirrhosis and end-stage liver disease. A new study suggests that placement of a transjugular intrahepatic portosystemic shunt (TIPS) may be beneficial for patients in this specific setting (Malik et al.). A current meta-analysis on surveillance for hepatocellular carcinoma (HCC) in cirrhosis patients has confirmed that this approach can confer a major benefit with regard to early detection, curative treatment receipt, and survival (Singal et al.). At the same time, another study has shown that shortening the surveillance interval from 6 months to 3 months in patients at high risk of HCC does not result in an added benefit (Pelizzaro et al.).
We wish you a happy and fruitful new year even with the challenging political developments around the world. Stay healthy and stay hopeful!
Christoph Neumann-Haefelin and Peter Hasselblatt
Department of Internal Medicine II, Medical University Clinic of Freiburg (Germany)