Proton-pump inhibitors (PPIs) have been a major pillar of pharmacological treatment of erosive esophagitis for several decades. However, modern potassium-competitive acid blockers such as vonoprazan inhibit acid production even more potently. In a phase 3 study, treatment with vonoprazan was more effective than lansoprazole at healing erosions and maintaining remission. This superiority was observed particularly among patients with more severe erosive esophagitis (Laine et al.). The growing number of pharmacological treatment options for luminal Crohn’s disease raises questions concerning the relative efficacies of the individual medications. In a network meta-analysis on the treatment of luminal Crohn’s disease, treatment with infliximab (5 mg/kg body weight) was the most effective option for induction of remission when all patients were analyzed, whereas upadacitinib (30 mg/day) was the most effective option for maintaining remission. However, risankizumab (600 mg) was superior in stratified analyses of biologic-naive and biologic-exposed patients (Barberio et al.). [...]
Acute severe ulcerative colitis is a serious condition requiring close interdisciplinary coordination to reach treatment decisions for gastroenterological care. According to a recent cohort study, the colectomy rate among patients with acute severe colitis has dropped by nearly half over the past 25 years and is now only 8–15% worldwide. A 4-point score comprising serum concentrations of C-reactive protein and albumin together with endoscopic activity reliably predicts response to steroid treatment (Adams et al.). While the coronavirus pandemic may be over, the long-term consequences of COVID-19 on the gastrointestinal tract remain largely unknown. Two new studies suggest that COVID-19 patients are at a significantly greater risk of suffering from irritable bowel syndrome (Marasco et al. and Golla et al. ).
Diagnosing pancreatic cysts by imaging remains a challenge, as few diagnostic tests are available for pancreatic cyst fluid. A next-generation sequencing panel of 22 genes was recently reported to be specific and sensitive for various types of pancreatic cysts and advanced neoplasia arising from mucinous cysts. Moreover, the results from this study also revealed the wide range of genomic alterations present in pancreatic cysts as well as their clinical impact. Such DNA sequencing techniques are likely to see increasing utilization in the diagnosis and treatment of pancreatic cysts (Paniccia et al.).
A large case-control study has reported that patients with inflammatory bowel disease (IBD) are at a much higher risk of metabolic-associated fatty liver disease (MAFLD), which is independent of classical metabolic risk factors such as body mass index or type 2 diabetes (Rodriguez-Duque et al.). Patients with chronic hepatitis C who have diabetes mellitus are at a high risk of developing hepatocellular carcinoma (HCC) even after successful antiviral therapy. Metformin appears to greatly reduce the risk of HCC in these patients (Tsai et al.). To date, the incidence of and risk factors for portal vein thrombosis remain poorly defined for patients without cirrhosis. A new study reports that recurrent thrombosis may be asymptomatic, requiring targeted screening for detection. Factor VIII values of ≥ 150% may help identify individuals at high risk of recurrent thrombosis who might benefit from long-term anticoagulation (Baiges et al.). While immune checkpoint inhibitors (ICIs) can cause severe immune-mediated hepatitis, a recent prospective study suggests that retreatment with ICIs – even the same ICI – may actually be a feasible option. Liver injury did not recur in up to 65% of retreated patients (Riveiro-Barciela et al.).
We hope you enjoy this literature selection and wish you a pleasant summer!
Christoph Neumann-Haefelin and Peter Hasselblatt
Department of Internal Medicine II, Medical University Clinic of Freiburg (Germany)