New competitive potassium channel blockers such as vonoprazan represent potent alternatives to proton-pump inhibitors and are currently being investigated in numerous clinical trials. In a study on Helicobacter pylori eradication therapy, treatment with vonoprazan plus high-dose amoxicillin was not inferior to bismuth-containing quadruple therapy and was associated with significantly fewer adverse effects (Qian et al.). Most studies on H. pylori eradication are conducted in Asia, and their results are of only limited applicability to the European setting and routine care in Europe. This is particularly true for rescue therapies following the failure of first-line and second-line therapy. An analysis of a European registry has confirmed that third-line eradication therapy has suboptimal outcomes in routine care in Europe. Adequate response rates were only achieved with bismuth-containing quadruple therapy or amoxicillin-levofloxacin regimens under certain conditions (Burgos-Santamaría et al.). Long-term improvement in eradication outcomes can be expected with guideline-compliant use of bismuth-containing quadruple therapy. [...]
The sphingosine 1-phosphate receptor modulator ozanimod has been used for many years to treat ulcerative colitis. The recently developed drug etrasimod was shown in the ELEVATE studies to be a highly effective and safe alternative to ozanimod (Sandborn et al.). Nonetheless, many new medicines remain hampered by limited efficacy against inflammatory bowel disease, leading to increasing investigation of combination regimens in clinical trials. The results of the VEGA study on ulcerative colitis suggest that combination therapy with the interleukin-23 antibody guselkumab and the tumor necrosis factor antibody golimumab may be more effective or more rapidly effective than monotherapy with either agent alone (Feagan et al.). Lifestyle recommendations and pharmacological therapy are often not sufficiently effective against chronic constipation. However, mechanical bowel stimulation using a vibrating capsule may help relieve constipation. In a phase 3 trial, a colonic vibrating capsule ingested orally once daily was significantly more effective than placebo at treating chronic constipation. The capsule was safe and well tolerated (Rao et al.). Treatment with trifluridine-tipiracil (FTD-TPI) is a third- line therapy for patients with advanced metastatic colorectal cancer. In a phase 3 trial, a combination of FTD-TPI plus bevacizumab led to significantly longer overall survival than did monotherapy with FTD-TPI (Prager et al.).
Endoscopic transmural drainage has become well established in the routine treatment of walled-off pancreatic necrosis. Many of these procedures are performed using lumen-apposing metal stents (LAMS), which allow shorter interventions but come with higher costs and, in some cases, an increased risk of bleeding. A small, randomized study has now shown that transmural drainage using LAMS with an internal diameter of 20 mm is not superior to traditional endoscopic drainage using the double pigtail technique. The number of necrosectomies, the length of hospital stay, and the rates of complications were similar between both methods (Gásdal Karstensen et al.).
The incidence of acute severe non-A-E hepatitis (NAEH) in children increased worldwide in 2022. This global “epidemic” of NAEH has been linked to adenovirus infections. A recent analysis from Hannover and Essen in Germany reports an increasing incidence of NAEH at both centers since 2019. However, adenoviruses were not involved in this phenomenon, pointing to other potential triggers of similar NAEH cases (Leiskau et al.). A new longitudinal cohort study in patients with rheumatoid arthritis or psoriasis suggests that the risk of liver fibrosis from long-term methotrexate (MTX) therapy may previously have been overestimated. In this cohort, neither cumulative MTX dose nor duration of treatment was associated with elevated liver stiffness. In contrast, age and body mass index were independently associated with elevated liver stiffness (Atallah et al.). Patients with metabolic syndrome who undergo liver resection for hepatocellular carcinoma have a higher risk of postoperative complications, including death. A new online model allows patients to be carefully selected based on baseline characteristics, liver function, and type of surgery (Berardi et al.).
We wish you enjoyable reading and a pleasant autumn!
Christoph Neumann-Haefelin and Peter Hasselblatt
Department of Internal Medicine II, Medical University Clinicof Freiburg (Germany)