Thirty-five years of thymosin trials in hepatitis B, and Cochrane cannot tell you whether it works

The edition in brief

A Cochrane review of thymosin-alpha 1 in chronic hepatitis B included 10 randomised trials and 1,349 participants from Bangladesh, China, Italy, Korea, Singapore and Taiwan, published between 1991 and 2018. The pooled estimates look favourable — all-cause mortality risk ratio 0.53 (95% CI 0.29 to 0.96), serious adverse events 0.72 (0.53 to 0.99) — but certainty was graded very low for every outcome except serious adverse events, which was low, and no ongoing trials were found. An American Gastroenterological Association clinical practice update sets out fifteen best-practice statements for ampullary neoplasms, covering side-viewing assessment, a minimum of six biopsies because 20 to 40 per cent harbour malignancy, criteria for endoscopic papillectomy, and a surveillance schedule to five years. A prospective study of 21 patients after ileal pouch-anal anastomosis, contributing 130 samples over a year, found that metronidazole with either ciprofloxacin or doxycycline dropped faecal calprotectin from 728 to 265 micrograms per gram and reduced bacterial exotoxin genes, with both rebounding by six weeks, while antibiotic resistance gene abundance rose without gaining diversity. Single-cell sequencing of rectal biopsies from 31 patients with Crohn's disease identified a TL1A-driven signature in perianal fistulising disease that is independent of luminal inflammation and persists under anti-TNF therapy. A narrative review argues the postoperative disease-free window mirrors preclinical Crohn's disease and shares predictive biomarkers with it. A pearl covers hepatitis B screening before immunosuppression.