BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of chronic liver disease.The prevalence and disease burden of NAFLD are projected to exponentially increase resulting in significant healthcare e...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of chronic liver disease.The prevalence and disease burden of NAFLD are projected to exponentially increase resulting in significant healthcare expenditures and lower healthrelated quality of life.To date,there are no approved pharmacotherapies for NAFLD or non-alcoholic steatohepatitis(NASH).Semaglutide has glycemic and weight loss benefits that may be advantageous for patients with NAFLD.AIM To investigate the efficacy and safety of semaglutide in patients with NAFLD.METHODS MEDLINE,CENTRAL,and EMBASE were searched from inception to May 1,2023,to identify eligible randomized controlled trials(RCTs).Meta-analysis was performed using random effects model expressing continuous outcomes as mean differences(MD)or standardized MDs(SMD),and dichotomous outcomes as odds ratios(OR)with 95%confidence intervals(CI).Statistical heterogeneity was assessed using the Cochran’s Q test and I2 statistic.RESULTS Three RCTs involving 458 patients were included.Semaglutide increased the likelihood of NASH resolution(OR:3.18,95%CI:1.70,5.95;P<0.001),improvement in steatosis(OR:2.83,95%CI:1.19,6.71;P=0.03),lobular inflammation(OR:1.81,95%CI:1.11,2.96;P=0.02),and hepatocellular ballooning(OR:2.92,95%CI:1.83,4.65;P<0.001),but not fibrosis stage(OR:0.71,95%CI:0.15,3.41;P=0.67).Radiologically,semaglutide reduced liver stiffness(SMD:-0.48,95%CI:-0.86,-0.11;P=0.01)and steatosis(MD:-4.96%,95%CI:-9.92,0.01;P=0.05).It also reduced alanine aminotransferase(MD:-14.06 U/L,95%CI:-22.06,-6.07;P<0.001)and aspartate aminotransferase(MD:-11.44 U/L,95%CI:-17.23,-5.65;P<0.001).Semaglutide led to improved cardiometabolic outcomes,including decreased HgA1c(MD:-0.77%,95%CI:-1.18,-0.37;P<0.001)and weight loss(MD:-6.53 kg,95%CI:-11.21,-1.85;P=0.006),but increased the occurrence of GIrelated side effects(OR:3.72,95%CI:1.68,8.23;P=0.001).Overall risk of serious adverse events was similar compared to placebo(OR:1.40,95%CI:0.75,2.62;P<0.29).CONCLUSION Semaglutide is effective in the treatment of NAFLD while maintaining a well-tolerated safety profile.Future studies are required to evaluate its effects on fibrosis regression and different phases of NAFLD.展开更多
BACKGROUND The global incidence of cirrhosis and luminal gastrointestinal cancers are increasing.It is unknown if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer.Such an association would...BACKGROUND The global incidence of cirrhosis and luminal gastrointestinal cancers are increasing.It is unknown if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer.Such an association would have significant clinical implications,particularly for cancer screening prior to liver transplantation.AIM To investigate the incidence of luminal gastrointestinal cancers in patients with underlying cirrhosis.METHODS An electronic search was conducted to study the incidence of luminal gastrointestinal cancers in patients with cirrhosis.Study-specific standardized incidence ratios(SIR)along with corresponding 95%CI for both overall cancer incidence and luminal cancer incidence were analyzed using a random-effects model.Subgroup analysis was performed based on cirrhosis etiology and location of luminal malignancy.RESULTS We identified 5054 articles;4 studies were selected for data extraction.The overall incidence of all cancers was significantly higher in patients with cirrhosis,with an SIR of 2.79(95%CI:2.18–3.57).When stratified by cirrhosis etiology,the incidence of luminal cancers remained significantly elevated for alcohol(SIR=3.13,95%CI:2.24–4.39),Primary Biliary Cholangitis(SIR=1.40,95%CI:1.10–1.79),and unspecified cirrhosis(SIR=3.52,95%CI:1.87–6.65).CONCLUSION The incidence of luminal gastrointestinal cancer is increased amongst patients with cirrhosis.Oral cavity,pharyngeal and esophageal cancer had increased incidence across all cirrhosis etiologies compared to gastric and colorectal cancer.Therefore,increased screening of luminal cancers,and in particular these upper luminal tract subtypes,should be considered in this population.展开更多
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of chronic liver disease.The prevalence and disease burden of NAFLD are projected to exponentially increase resulting in significant healthcare expenditures and lower healthrelated quality of life.To date,there are no approved pharmacotherapies for NAFLD or non-alcoholic steatohepatitis(NASH).Semaglutide has glycemic and weight loss benefits that may be advantageous for patients with NAFLD.AIM To investigate the efficacy and safety of semaglutide in patients with NAFLD.METHODS MEDLINE,CENTRAL,and EMBASE were searched from inception to May 1,2023,to identify eligible randomized controlled trials(RCTs).Meta-analysis was performed using random effects model expressing continuous outcomes as mean differences(MD)or standardized MDs(SMD),and dichotomous outcomes as odds ratios(OR)with 95%confidence intervals(CI).Statistical heterogeneity was assessed using the Cochran’s Q test and I2 statistic.RESULTS Three RCTs involving 458 patients were included.Semaglutide increased the likelihood of NASH resolution(OR:3.18,95%CI:1.70,5.95;P<0.001),improvement in steatosis(OR:2.83,95%CI:1.19,6.71;P=0.03),lobular inflammation(OR:1.81,95%CI:1.11,2.96;P=0.02),and hepatocellular ballooning(OR:2.92,95%CI:1.83,4.65;P<0.001),but not fibrosis stage(OR:0.71,95%CI:0.15,3.41;P=0.67).Radiologically,semaglutide reduced liver stiffness(SMD:-0.48,95%CI:-0.86,-0.11;P=0.01)and steatosis(MD:-4.96%,95%CI:-9.92,0.01;P=0.05).It also reduced alanine aminotransferase(MD:-14.06 U/L,95%CI:-22.06,-6.07;P<0.001)and aspartate aminotransferase(MD:-11.44 U/L,95%CI:-17.23,-5.65;P<0.001).Semaglutide led to improved cardiometabolic outcomes,including decreased HgA1c(MD:-0.77%,95%CI:-1.18,-0.37;P<0.001)and weight loss(MD:-6.53 kg,95%CI:-11.21,-1.85;P=0.006),but increased the occurrence of GIrelated side effects(OR:3.72,95%CI:1.68,8.23;P=0.001).Overall risk of serious adverse events was similar compared to placebo(OR:1.40,95%CI:0.75,2.62;P<0.29).CONCLUSION Semaglutide is effective in the treatment of NAFLD while maintaining a well-tolerated safety profile.Future studies are required to evaluate its effects on fibrosis regression and different phases of NAFLD.
文摘BACKGROUND The global incidence of cirrhosis and luminal gastrointestinal cancers are increasing.It is unknown if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer.Such an association would have significant clinical implications,particularly for cancer screening prior to liver transplantation.AIM To investigate the incidence of luminal gastrointestinal cancers in patients with underlying cirrhosis.METHODS An electronic search was conducted to study the incidence of luminal gastrointestinal cancers in patients with cirrhosis.Study-specific standardized incidence ratios(SIR)along with corresponding 95%CI for both overall cancer incidence and luminal cancer incidence were analyzed using a random-effects model.Subgroup analysis was performed based on cirrhosis etiology and location of luminal malignancy.RESULTS We identified 5054 articles;4 studies were selected for data extraction.The overall incidence of all cancers was significantly higher in patients with cirrhosis,with an SIR of 2.79(95%CI:2.18–3.57).When stratified by cirrhosis etiology,the incidence of luminal cancers remained significantly elevated for alcohol(SIR=3.13,95%CI:2.24–4.39),Primary Biliary Cholangitis(SIR=1.40,95%CI:1.10–1.79),and unspecified cirrhosis(SIR=3.52,95%CI:1.87–6.65).CONCLUSION The incidence of luminal gastrointestinal cancer is increased amongst patients with cirrhosis.Oral cavity,pharyngeal and esophageal cancer had increased incidence across all cirrhosis etiologies compared to gastric and colorectal cancer.Therefore,increased screening of luminal cancers,and in particular these upper luminal tract subtypes,should be considered in this population.
