In the previous issue, we discussed current treatment approaches for appendicitis. Beyond managing acute inflammation, an appendectomy may also affect the course of ulcerative colitis. This hypothesis was tested in the randomized ACCURE trial, which evaluated the role of appendectomy in maintaining remission in patients with ulcerative colitis. In patients who were already in remission, the combination of appendectomy plus maintenance therapy significantly reduced the frequency of disease flare-ups within one year compared to maintenance therapy alone (ACCURE Study Group). 

Immunochemical fecal occult blood tests (iFOBT) and colonoscopy are both established methods for colorectal cancer screening. The COLONPREV study, conducted in Spain, investigated different invitation strategies for colorectal cancer screening. Invitations for biennial iFOBT were accepted significantly more often than invitations for colonoscopy. Moreover, iFOBT-based screening was not inferior to colonoscopy in terms of colorectal cancer mortality after 10 years of follow-up (Castells et al.). The GLP-2 analogue teduglutide has been used for several years in the treatment of short bowel syndrome but requires daily injections. Glepaglutide is a novel long-acting GLP-2 analogue. In a phase 3 trial, injections of glepaglutide twice weekly or once weekly led to significant clinical improvement in patients with short bowel syndrome and significantly reduced their need for parenteral nutrition compared to placebo (Jeppesen et al.).

Long-term pharmacological treatment options for autoimmune pancreatitis and other IgG4-related diseases have been limited to date. Inebilizumab, an antibody targeting CD19⁺ B cells, was evaluated in a phase 3 trial involving patients with IgG4-related diseases, including autoimmune pancreatitis. The study demonstrated a significantly lower relapse rate in the treatment group compared to placebo (10% vs. 60% within one year), as well as a higher likelihood of achieving flare-free remission (Stone et al.). 

The optimal timing for initiating treatment in chronic hepatitis B virus infection remains a subject of ongoing controversy. Interim results from a large-scale study, in which therapy was initiated earlier than recommended by existing guidelines, have shown that early treatment may prevent clinically relevant liver-related endpoints. These findings suggest that current indications for treatment may change in the long term (Lim et al.). The extent to which environmental factors contribute to liver disease remains difficult to quantify. In a large cohort study, Ran et al. were able to correlate data on air pollution with plasma metabolites and associate these findings with the presence of MASLD. While modifiable risk factors are certainly more relevant in the pathogenesis of MASLD, the study provides evidence that air pollution may also influence liver disease (Ran et al.). In the intensive care of patients with acute liver failure, the effect of extracorporeal liver support and plasmapheresis remains controversial. A recent study from the United Kingdom found that plasmapheresis influenced hemodynamic parameters but did not significantly improve overall survival. It remains an open and interesting question to what extent etiology-specific effects may play a role in this context (Burke et al.).

We hope you find these articles, along with the other publications summarized in this issue, both stimulating and informative.

Yours sincerely,

Peter Hasselblatt and Tobias Böttler
Department of Internal Medicine II, University Medical Center Freiburg (Germany)