What is new in the field of alcohol-associated liver disease? Our feature article in this month’s issue of Gastroenterology & Hepatology explores this question. Dr Avesh J. Thuluvath and Dr Steven Flamm examine recent nomenclature changes and the current understanding of the pathophysiology of alcohol-associated liver disease. The authors also discuss direct and indirect biomarkers of alcohol use as well as the importance of interdisciplinary care. Additionally, the authors examine alcohol use disorder–directed treatment as well as liver-directed treatment of patients with alcohol-associated liver disease, including alcohol-associated hepatitis. The role of early liver transplant and a number of promising emerging therapies in this field are also reviewed.
Our Advances in Endoscopy column examines the role of endoscopic papillectomy in the management of ampullary adenomas. Dr Fateh Bazerbachi discusses how ampullary adenomas should be evaluated before endoscopic resection and then reviews different techniques for performing a papillectomy such as en bloc snare resection and underwater papillectomy, as well as challenges that may be encountered. His discussion also covers issues such as how intraductal extension impacts endoscopic therapy, potential adverse events, risk factors for recurrence, and the timing of surgical intervention.
Antibiotic prophylaxis in patients with cirrhosis is explored in this month’s Advances in Hepatology column. Dr Andres Duarte-Rojo discusses when prophylactic antibiotics are traditionally used in patients with cirrhosis, including those who present with gastrointestinal bleeding and those who have less advanced liver disease. Other topics of discussion include antibiotic preferences, optimal duration, and real-world adherence to the current guidelines.
Emerging risk scores in metabolic dysfunction-associated steatohepatitis are highlighted in our MASH in Focus column. Dr Winston Dunn explains why novel risk scores—such as the Steatosis-Associated Fibrosis Estimator score, LiverRisk score, ALADDIN score, and LiverPRO—have been developed recently. His discussion also includes comparisons of these new scores with the Fibrosis-4 score, where these scores fit in clinical practice, and the feasibility of busy clinicians calculating and using them on a routine basis.
Finally, our Advances in IBS column features an interview with Dr Eric Shah on the evaluation of evacuation disorders. He discusses the impact of the London classification and Rome V criteria, the pros and cons of traditional assessments for evacuation disorders, and the importance of predicting response to pelvic floor physical therapy or biofeedback therapy. He also examines RED, a novel rectal expulsion device, and its impact on chronic constipation management and shares his thoughts on improving the management of patients with evacuation disorders.
I hope that you enjoy these articles and find them interesting and clinically useful.
Sincerely,
Gary R. Lichtenstein, MD, FACG, AGAF, FCCF, FACP