The edition · Gastroenterology & Hepatology
A simpler rule to skip variceal screening in liver cancer
A non-invasive rule for ruling out varices in hepatocellular carcinoma, the joint AASLD-AGA guideline on primary biliary cholangitis, saroglitazar for fatty liver in polycystic ovary syndrome, and an etanercept licence supplement.
The edition in brief
The edition closes on an Italian derivation study with Austrian validation in patients with hepatocellular carcinoma (HCC) and compensated advanced chronic liver disease. The Baveno VI criteria missed 8.5% of varices and 6% of high-risk varices in this group. A new rule, SAPHE-R, combining liver stiffness of 16 kPa or less, platelets of at least 160 × 10⁹/L and ALBI grade 1, missed about 4% of varices and 3% of high-risk varices, and would have spared about 15% to 18% of endoscopies. A joint AASLD and AGA guideline on primary biliary cholangitis makes six recommendations, covering PBC-specific antinuclear antibodies when antimitochondrial antibodies are negative, ursodeoxycholic acid first line, liver stiffness for prognosis, PPAR agonists after an inadequate response, linerixibat for moderate to severe itch, and ursodeoxycholic acid after transplant. A phase 2a trial in 60 women with polycystic ovary syndrome and fatty liver found saroglitazar, a PPAR alpha/gamma agonist approved in India, reduced liver fat on MRI more than placebo over 24 weeks. FDA records an administrative supplement to the etanercept licence. The pearl covers diagnostic paracentesis in cirrhosis.
AASLD and AGA set out six recommendations for primary biliary cholangitis
Start UDCA in PBC, check response and liver stiffness, and escalate early when response is inadequate.
Saroglitazar reduced liver fat in women with PCOS and fatty liver
Saroglitazar reduced liver fat in women with PCOS in a small trial; lifestyle remains first line and pregnancy safety is unknown.
FDA records a supplement to the etanercept licence
This is an administrative licence change; the clinical point is that new bowel symptoms on etanercept need investigation.
Tap the ascites in every admitted patient with cirrhosis
Perform a diagnostic paracentesis in every admitted patient with cirrhosis and ascites; SBP is often silent.
A stiffness, platelet and ALBI rule ruled out varices in liver cancer
In HCC with compensated advanced liver disease, consider SAPHE-R rather than Baveno VI to decide who can skip variceal screening endoscopy.
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