The edition · Gastroenterology & Hepatology
Spleen stiffness can spare endoscopy in non-cirrhotic portal vein thrombosis
A 40 kPa cut-off missed about 5% of high-risk varices and avoided four in ten endoscopies. Also: how alcohol and metabolic risk combine in cirrhosis, machine perfusion for liver grafts, seven-day P-CAB therapy for H. pylori, and an FDA supplement for an adalimumab biosimilar.
The edition in brief
In 346 patients with chronic portal vein thrombosis without cirrhosis across 16 VALDIG centres, a spleen stiffness of 40 kPa or less on transient elastography ruled out high-risk varices with a negative predictive value of 96–97%. It would have avoided 41–43% of screening endoscopies while missing 3–5% of high-risk varices. A Danish cohort of 354,624 adults attributed about 60% of cirrhosis to alcohol; obesity, diabetes and hypertension raised risk mainly at up to 28 drinks a week, while smoking added risk at every level. A meta-analysis of 8 trials (984 liver transplants) found hypothermic oxygenated perfusion halved early allograft dysfunction and reduced non-anastomotic strictures and retransplantation compared with cold storage. A small Korean trial found 7-day fexuprazan triple therapy eradicated H. pylori about as often as 14-day rabeprazole triple therapy (80.0% vs 82.1%). The FDA's database lists a supplement dated 28 August 2026 to the licence of YUSIMRY, an adalimumab biosimilar; the record does not state its content. Today's pearl: check clarithromycin resistance, or use a regimen that does not rely on it, before prescribing triple therapy.
Alcohol drives most cirrhosis; metabolic risk matters most at moderate intake
Treat alcohol reduction as the main cirrhosis prevention target; in moderate drinkers, also manage obesity, diabetes, hypertension and smoking.
Hypothermic oxygenated perfusion improved early liver graft outcomes across 8 trials
Hypothermic oxygenated perfusion reduces early graft dysfunction and biliary strictures in deceased donor liver transplantation and is worth adopting where resources allow.
Seven days of fexuprazan triple therapy matched 14 days of rabeprazole triple therapy for H. pylori
A 7-day P-CAB regimen matched 14-day PPI triple therapy, but both cured only about 80%; avoid empirical clarithromycin triple therapy where resistance is common.
FDA records a supplement to the YUSIMRY (adalimumab-aqvh) licence
No change to IBD prescribing follows from this FDA supplement; check the updated YUSIMRY label if you use the product.
Don't give clarithromycin triple therapy blind
Avoid empirical clarithromycin triple therapy for H. pylori; use bismuth quadruple or susceptibility-guided therapy and confirm eradication.
Spleen stiffness of 40 kPa or less spares endoscopy in portal vein thrombosis without cirrhosis
In chronic portal vein thrombosis without cirrhosis, a spleen stiffness of 40 kPa or less can safely defer screening endoscopy in about four in ten patients.
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