Editorial
Dear colleagues,
Apart from endoscopic argon plasma coagulation (APC) there have been few drug therapy approaches to gastrointestinal bleeding due to small intestinal angiodysplasia to date, which is clinically often challenging. A randomized controlled trial showed that therapy with octreotide significantly reduced the number of transfusions and endoscopic interventions within a year compared to standard therapy (Goltstein et al.). The detection of gastric metaplasia in the distal esophagus raises the question of its malignant potential and efficient endoscopic prevention strategies. A prospective surveillance study in the UK showed that gastric metaplasia of the distal esophagus has a significantly different clinical course and genetic pattern than intestinal metaplasia and a significantly lower malignant potential. For this reason, it appears to be questionable whether patients with gastric metaplasia need preventive care comparable to patients with Barrett’s esophagus (Black et al.). [...]
Multiple publications in this edition concern new approaches to colorectal cancer screening. In a large-scale prospective study, an innovative multitarget stool DNA test showed superior sensitivity for colorectal cancer and advanced precancerous lesions than an immunological test of fecal blood, albeit with lower specificity (Imperiale et al.). A cell-free DNA blood-based test also showed good sensitivity of 83% for the detection of colorectal cancer in an average risk population for colorectal cancer screening, but only of 13% for the detection of advanced precancerous lesions (Chung et al.).
It is assumed that for inflammatory bowel disease (IBD), early consistent therapy with biologics had a favorable impact on the disease progression. This was only partially confirmed by the results of a nationwide study in Israel. While in patients with Crohn’s disease, early initiation of biologics was associated with a moderately lower risk of later Crohn’s-associated surgery and steroid dependency, in patients with ulcerative colitis, it had no influence on colectomy or steroid dependency rates (Lujan et al.). In this context, it is interesting that while in the LOVE-CD study, in which the response to vedolizumab was significantly better in patients with Crohn’s disease and “early” (disease less than 2 years) initiation of therapy, in the LOVE-UC study of patients with early and late ulcerative colitis no significant differences were detected with regard to clinical, endoscopic, and histological outcomes in response to vedolizumab therapy (Vermeire et al.).
The treatment of acute necrotizing pancreatitis should not end with the discharge from the hospital. A cohort study conducted in the Netherlands showed that patients with acute pancreatitis often experience recurrence, require interventions, and develop endocrine and exocrine pancreatic insufficiency. Extensive (> 50%) pancreatic parenchymal necrosis seems to be an important predictor of the long-term need for interventions and complications during follow-up (Hollemans et al.).
A current meta-analysis of morbidity and mortality in patients coinfected with hepatitis B and hepatitis delta virus shows that patients with HDV-RNA-positive status have a significantly greater risk of (decompensated) liver cirrhosis, hepatocellular carcinoma (HCC), liver transplantation, and liver-related mortality. These findings emphasize the importance of consistently screening patients with hepatitis B for coinfection with the hepatitis delta virus (Gish et al.). In patients with metabolic dysfunction-associated steatotic liver disease (MASLD), serum ferritin levels are typically elevated. A current study shows that the hyperferritinemia predicts the long-term prognosis and is associated with increased risk of liver-related events and all-cause mortality (Armandi et al.). A current open-label controlled randomized trial on induction therapy for autoimmune hepatitis suggests that mycophenolate mofetil is superior to azathioprine as induction therapy for autoimmune hepatitis in combination with prednisolone, with better tolerability (Snijders et al.).
We hope you find these articles, along with the other publications summarized in this issue, both stimulating and informative.
Yours sincerely,
Christoph Neumann-Haefelin and Peter Hasselblatt
Department of Internal Medicine II, Medical University Clinic of Freiburg (Germany)
Passing the baton
For the past 10 years, I have had the pleasure of putting together a collection of abstracts on sensational developments in hepatology for the Falk Gastro Review Journal. These have included the revolution in hepatitis C therapy, the development of immunotherapy for hepatocellular carcinoma (HCC), and the development of the first targeted therapy for hepatitis delta. Effective September 2024, I will be starting my new position as a professor of gastroenterology and hepatology at the University of Cologne (Germany), where I will be succeeding Prof. Dr. Tobias Goeser. By tradition, the editor of the Falk Gastro Review Journal is based in Freiburg. I am delighted to pass on the hepatology editorial work to my long-standing colleague and the future head of the Gerok Liver Center in Freiburg, Prof. Dr. Tobias Böttler. Thank you for being such loyal readers, and I extend my gratitude to the Falk Foundation team for their outstanding support.
Sincerely,
Christoph Neumann-Haefelin
Christoph Neumann-Haefelin
Peter Hasselblatt