A new joint PBC guideline, and why Baveno VI misses varices in liver cancer

The edition in brief

Today's gastroenterology and hepatology edition opens with an Italian study in Hepatology (22 October) of 598 patients with hepatocellular carcinoma and compensated advanced chronic liver disease. Baveno VI criteria missed 8.5% of varices and 6% of high-risk varices. A new rule, SAPHE-R — liver stiffness of 16 kPa or less, platelets of 160 or more and ALBI grade 1 — missed about 4% of varices, validated in a Vienna cohort, though it spared fewer endoscopies. A phase 2a trial in 60 women with PCOS and MASLD found saroglitazar 4 mg reduced liver fat on MRI by about 15% relative to baseline over 24 weeks, against no change on placebo, with lower liver enzymes and lipids; the per-protocol analysis covered 48 women. On the regulatory side, the FDA records an administrative supplement to the etanercept licence. The pearl is albumin with large-volume paracentesis. The practice changer is the joint AGA/AASLD guideline on primary biliary cholangitis (Gastroenterology, 1 November). Its six recommendations cover PBC-specific antinuclear antibodies for suspected disease without antimitochondrial antibodies, ursodeoxycholic acid as first-line therapy, liver stiffness for prognosis, PPAR agonists for inadequate response or intolerance to UDCA, linerixibat for moderate to severe pruritus, and UDCA after transplantation to reduce recurrence. Certainty of evidence ranged from moderate to very low. Access to PPAR agonists and linerixibat in India is limited, so optimising UDCA and assessing response remain the core of care.