The edition · Gastroenterology & Hepatology
Half of 'immune tolerant' hepatitis B is not tolerant for five years
A 951-patient international cohort followed 13 years finds 51% transition to immune active disease within five years, with high-normal ALT tripling the risk; a blood test outperforms ultrasound for small hepatocellular carcinoma; and the IBD-with-IBS overlap finally gets a name.
The edition in brief
The gastroenterology and hepatology desk opens with the RADICAL consortium's natural-history study of strictly defined immune-tolerant chronic hepatitis B — 951 patients, median age 33, median follow-up 13 years. The probability of transition to immune active disease was 51% by five years, 67% by ten and 72% by fifteen, with baseline ALT of 20-30 U/L carrying a subdistribution hazard ratio of 1.744 and above 30 U/L a ratio of 3.130; progression to significant fibrosis was 6.3% and hepatocellular carcinoma 1.1% at fifteen years. A prospective blinded multicentre validation study in 1,268 adults with cirrhosis found the HelioLiver Dx cell-free DNA blood test detected 47.8% of hepatocellular carcinomas against 28.3% for ultrasound, and 28.6% of lesions 2 cm or smaller against 0% for ultrasound, with specificity of 87.6% against 93.9%. A joint Rome Foundation and IOIBD consensus establishes 'IBD with IBS-like symptoms' as the preferred term and endorses psyllium, short-term low-FODMAP diet, targeted drugs and brain-gut behavioural therapy. A meta-analysis of five studies in 630 liver transplant recipients found normothermic machine perfusion reduced early postoperative complications by 40%. A pearl covers the first colonoscopy after a positive faecal test. The edition closes with a network meta-analysis of 76 trials ranking patient navigation and mailed faecal immunochemical test outreach as the most effective ways to raise colorectal cancer screening uptake.
Immune tolerance is a phase most patients leave within five years
In an HBeAg-positive patient with 'normal' ALT above 20 U/L, review in months rather than a year — half will become immune active within five.
A blood test found the small liver cancers ultrasound missed entirely
Treat ultrasound's failure to find any small tumour as the actionable finding, and consider a blood test where adherence to scanning is the problem.
The IBD patient in remission who still hurts now has a name for it
Before escalating therapy in a symptomatic IBD patient, prove the inflammation is active — and if it is not, treat the symptoms as their own diagnosis.
Machine perfusion cut early complications after liver transplant by 40%
Where a unit is deciding whether to invest in normothermic perfusion, the early-complication evidence is now consistent — but graft survival data are not yet in.
A positive faecal test means colonoscopy, not a repeat faecal test
Send every positive faecal immunochemical test straight to colonoscopy, and never repeat the test to confirm it.
Patient navigation and posting the test kit beat everything else
If your screening uptake is below 30%, post the faecal test kit to eligible patients rather than inviting them to choose a test.
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