The 30% elastography rule is weaker than the guideline implies

The edition in brief

Four findings for the gastroenterology and hepatology desk, plus one regulatory action. AASLD guidance allows a fall in liver stiffness on transient elastography to stand as a non-invasive marker of treatment response in metabolic dysfunction-associated steatohepatitis. This analysis tested it directly in 160 adults with biopsy-proven MASH and stage 2-3 fibrosis, all of whom had paired elastography and biopsy at two time points within a phase 2b trial of pegozafermin. A relative decline of 30% or more detected fibrosis regression with an area under the curve of 0.68 (95% CI 0.58-0.77), and was independently associated with regression after adjustment (odds ratio 4.23, 95% CI 1.79-10.38). In a separate validation cohort of 48 patients from the United States and Singapore the area under the curve was 0.62 (95% CI 0.48-0.76), an interval that includes chance. A meta-analysis of 48 randomised trials and 48,765 patients with type 2 diabetes found no association between SGLT2 inhibitors and gastrointestinal neoplasms overall (odds ratio 1.10, 95% CI 0.84-1.44, I-squared 0%), nor at any individual site. About half the trials followed patients for a year or less and cancers were captured as adverse events rather than adjudicated endpoints. Caregivers of 8,000 children aged 0-17 in China, Italy, Mexico and the USA completed a Rome V survey: 28.0% of children met criteria for a disorder of gut-brain interaction, falling from about 41% at ages 0-3 to 22% in adolescents. A Swedish register followed 124,387 patients with IBD and 1,213,641 matched comparators. Two or more affected first-degree relatives raised colorectal cancer incidence by 2.69 per 1,000 person-years; early-onset family history added little. The FDA approved a supplement to Dr Reddy's generic omeprazole application on 27 August.