The edition · Gastroenterology & Hepatology
Saroglitazar met its biochemical endpoint in PBC after inadequate response to ursodeoxycholic acid
EPICS-III reported biochemical response in 57% on saroglitazar against 10% on placebo at 52 weeks. Also: what follows a child's first variceal bleed, a machine-learning elastography score for portal hypertension, and computer-aided detection in routine colonoscopy.
The edition in brief
Today's gastroenterology and hepatology edition closes on EPICS-III, a phase 2b/3 trial of saroglitazar, a dual PPAR alpha/gamma agonist, in primary biliary cholangitis with inadequate response to or intolerance of ursodeoxycholic acid. In 148 patients over 52 weeks, biochemical response was 56.7% with saroglitazar 1 mg against 9.8% with placebo, and alkaline phosphatase normalised in 8.2% against none; itch improvement at 24 weeks was not sustained. An international study of 345 children after a first variceal haemorrhage found 6-week mortality of 4.1%, with worse outcomes in cirrhosis, biliary atresia with poor bile flow, decompensation and after sclerotherapy. A machine-learning score combining liver and spleen stiffness with clinical variables cut the indeterminate zone for clinically significant portal hypertension to 12% from 48% with Baveno VII criteria in external validation. A cluster-randomised rollout of computer-aided detection across US veterans' facilities raised adenoma detection by 4.2 percentage points. The pearl covers the first hours of an acute variceal bleed.
A child's first variceal bleed: low early mortality, but outcome depends on the diagnosis
After a child's first variceal bleed, establish the cause quickly: portal vein thrombosis carries a good outlook, while cirrhosis and biliary atresia need early specialist referral.
Machine-learning elastography score shrank the portal hypertension grey zone to 12%
Combining spleen and liver stiffness with clinical data may classify most patients for portal hypertension without pressure measurement; keep using Baveno VII until it is validated prospectively.
Computer-aided detection raised adenoma detection by about four points in routine colonoscopy
Computer-aided detection modestly increased adenoma detection in routine practice; treat it as an aid alongside, not instead of, good technique.
Acute variceal bleeding: the first hours
In suspected variceal bleeding, give a vasoactive drug and antibiotics first, transfuse restrictively, and scope within 12 hours.
Saroglitazar in PBC: biochemical response in 57% against 10% on placebo
For PBC with inadequate response to ursodeoxycholic acid, saroglitazar produced biochemical response in most patients and is an option to consider where licensed.
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