The edition · Gastroenterology & Hepatology
Pancreatic enzymes did nothing for pain in chronic pancreatitis, and a 30% fall in liver stiffness is a weaker signal than the guideline implies
An Indian randomised trial closes the question of whether non-enteric-coated enzyme replacement relieves pancreatic pain; a 30% decline in transient elastography detects fibrosis regression in MASH with an AUC of 0.68; 48 trials find no excess gastrointestinal cancer with SGLT2 inhibitors; and surveillance colonoscopy at five years holds against three.
The edition in brief
A 24-week double-blind placebo-controlled trial at two Indian academic centres randomised 107 adults with chronic pancreatitis and chronic abdominal pain to non-enteric-coated pancreatic enzyme replacement or placebo for 12 weeks. There was no between-group difference in Izbicki pain score at 12 weeks (-2.5, 95% CI -9.3 to 4.2; p=0.49), and findings were similar at 24 weeks. A prospective study of 160 adults with biopsy-proven MASH and stage 2-3 fibrosis, drawn from a phase 2b pegozafermin trial with paired biopsies and elastography, found a 30% or greater relative decline in liver stiffness detected fibrosis regression with an area under the curve of 0.68 (95% CI 0.58-0.77), falling to 0.62 (0.48-0.76) in a separate validation cohort of 48 patients; the decline was independently associated with regression (adjusted OR 4.23, 1.79-10.38). A meta-analysis of 48 randomised trials totalling 48,765 patients with type 2 diabetes found no association between SGLT2 inhibitors and gastrointestinal neoplasms overall (OR 1.10, 95% CI 0.84-1.44, I-squared 0%) or at any individual site, though about half the trials had a year or less of follow-up and cancers were captured as adverse events rather than adjudicated endpoints. The FDA has approved a supplement to a generic omeprazole application. The edition closes on EPoS II, in which a first surveillance colonoscopy at five years after high-risk adenoma removal was noninferior to three years at interim analysis.
Pancreatic enzyme replacement did not relieve pain in chronic pancreatitis
Stop expecting pancreatic enzyme replacement to relieve pain in chronic pancreatitis; keep it for documented exocrine insufficiency.
A 30% fall in liver stiffness detects fibrosis regression in MASH about two-thirds of the time
A 30% drop in liver stiffness makes fibrosis regression more likely but does not establish it — do not treat it as a substitute for histology in decisions that matter.
No excess gastrointestinal cancer with SGLT2 inhibitors across 48 trials
There is no randomised signal linking SGLT2 inhibitors to gastrointestinal cancer — enough to stop the drug being questioned on those grounds, not enough to call long-term safety settled.
FDA approves a supplement to a generic omeprazole application
Nothing changes clinically from this approval; the proton pump inhibitor work in clinic is recording an indication and setting a review date.
In chronic pancreatitis, check the fat-soluble vitamins and the bone density
Add vitamin D and bone densitometry to the annual review in chronic pancreatitis with exocrine insufficiency; the deficiency is silent until it fractures.
Surveillance colonoscopy at five years after high-risk adenoma removal was noninferior to three
For high-risk adenomas as defined here, extend the first surveillance interval to five years — and spend the released endoscopy capacity on symptomatic patients.
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