Spleen stiffness of 40 kPa or less can spare endoscopy in non-cirrhotic portal vein thrombosis

The edition in brief

In chronic portal vein thrombosis without cirrhosis, current practice is endoscopy for everyone. A 16-centre VALDIG study with derivation (159) and validation (187) cohorts found spleen stiffness by transient elastography was the only independent predictor of high-risk varices; a cut-off of 40 kPa or less had 96–97% negative predictive value and could spare 41–43% of endoscopies, missing 3–5% of high-risk varices. A Danish cohort of 354,624 adults found alcohol accounted for about 60% of cirrhosis; 10-year risk rose from 0.14% at 1–7 drinks a week to 4.6% above 42. Obesity, diabetes and hypertension raised risk up to 28 drinks a week but not beyond, and smoking raised it at every level. A single-centre Korean trial in 79 patients found seven-day fexuprazan triple therapy eradicated H. pylori at rates similar to 14-day rabeprazole triple therapy (80% vs 82%), with eradication above 90% only in clarithromycin-susceptible strains. A 17,485-patient meta-analysis linked DPYD c.2194G>A and c.496A>G, outside most testing panels, to severe fluoropyrimidine toxicity. FDA's database lists a supplement to the adalimumab-aqvh (Yusimry) application.