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Maddrey's Discriminant Function: Deciding Steroid Candidacy in Alcohol-Associated Hepatitis
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Maddrey's Discriminant Function: Deciding Steroid Candidacy in Alcohol-Associated Hepatitis

A 47-year-old man with a 20-year history of heavy drinking is admitted with new jaundice, a total bilirubin of 9.8 mg/dL, and a prothrombin time nine seconds above control. He has no ascites, no encephalopathy, and no signs of active bleeding. The team's first question isn't whether he has alcoholic hepatitis - the history and labs already answer that. The question is whether he needs prednisolone, and Maddrey's discriminant function is the number that answers it.Maddrey's discriminant function was never built to predict who lives and who dies from alcohol-associated hepatitis in general. It was built for one narrower, more useful purpose: identifying which patients had enough to gain from corticosteroid therapy that the risk was worth taking. That distinction gets lost constantly on the wards, where a DF gets calculated, filed as "severe," and used loosely as a catch-all severity marker instead of what it actually is - a steroid-eligibility gate with a single, specific cutoff. Clinicians who treat it as a general prognostic score end up either under-treating patients who clear the threshold or, more often, anchoring on a DF above 32 as sufficient justification for steroids without checking the contraindications that make that decision reversible. The formula itself is simple; using it correctly is not.

Maddrey's Discriminant Function: Deciding Steroid Candidacy in Alcohol-Associated Hepatitis
July 15, 2026•GastroAGI Team
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Left Lateral vs Supine Positioning for EUS-Guided Portal Pressure Measurement: Does Position Matter?

Left Lateral vs Supine Positioning for EUS-Guided Portal Pressure Measurement: Does Position Matter?

IntroductionEndoscopic ultrasound-guided portal pressure gradient measurement, or EUS-PPG, is an emerging technique for evaluating portal hypertension. Instead of relying only on indirect assessment, EUS-PPG allows direct pressure measurement by accessing the portal vein and hepatic vein under EUS guidance. A recent review describes EUS-PPG as a modality in which portal pressure is measured by introducing a needle into the hepatic vein and portal vein.Traditionally, portal pressure assessment has been dominated by hepatic venous pressure gradient, or HVPG, which remains the established reference standard for portal hypertension assessment. But as EUS-based hepatology interventions expand, the details of technique matter: patient position, sedation, needle stability, coughing, safety, and measurement reproducibility.A new study in Gastrointestinal Endoscopy asked a practical but important question: Can EUS-PPG be performed reliably in the left lateral position, or does the patient need to be supine?This question matters because routine EUS is commonly performed in the left lateral position, while EUS-PPG has often been performed in the supine position. If left lateral positioning produces comparable PPG values, it could simplify workflow and potentially reduce procedure-related challenges.

July 15, 2026•GastroAGI Team
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Alcohol-Associated Hepatitis Is Rising, But the Global Data Gap Remains Large

Alcohol-Associated Hepatitis Is Rising, But the Global Data Gap Remains Large

IntroductionAlcohol-associated hepatitis is one of the most severe clinical presentations of alcohol-associated liver disease. It can present acutely with jaundice, systemic inflammation, hepatic decompensation, infection risk, renal dysfunction, and high short-term mortality. Yet despite its clinical severity, the population-level epidemiology of alcohol-associated hepatitis has remained surprisingly difficult to define.A new systematic review published in Clinical Gastroenterology and Hepatology addresses this gap by examining population-based studies reporting the incidence and prevalence of alcohol-associated hepatitis from 2000 to 2025. The review included 11 population-based studies from seven countries and found highly variable incidence estimates, ranging from 1.02 per 100,000 inhabitants in Iceland to 98.5 per 100,000 inhabitants in the United States.The key message is not simply that alcohol-associated hepatitis is increasing. The deeper issue is that our ability to measure its burden remains inconsistent across countries, health systems, coding definitions, and study methods.

July 15, 2026•GastroAGI Team
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BSG 2026 Adult Coeliac Disease Guideline: What Gastroenterologists Need to Know

BSG 2026 Adult Coeliac Disease Guideline: What Gastroenterologists Need to Know

IntroductionThe British Society of Gastroenterology has released its 2026 guideline on the diagnosis and management of adult coeliac disease, updating standards for a condition that remains common, under-recognised, and clinically heterogeneous. The guideline was developed by a multidisciplinary panel and focuses on evidence-based diagnosis, long-term management, follow-up, nutritional assessment, and refractory coeliac disease care.For gastroenterologists, this update is important because coeliac disease is no longer just a “positive serology plus duodenal biopsy” diagnosis in every adult. The guideline acknowledges newer evidence around serology-based diagnosis, gluten challenge, follow-up intensity, mucosal healing, bone health, vaccination, and referral pathways for complex disease.The practical message is not that biopsy has become obsolete. Rather, the guideline moves adult coeliac care toward a more individualised model: test correctly, biopsy when needed, use no-biopsy diagnosis only in selected circumstances, support the gluten-free diet properly, and identify patients who need structured long-term review.

July 15, 2026•GastroAGI Team
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Sphingolipid Metabolism and KRAS in Pancreatic Cancer: A New Translational Signal

Sphingolipid Metabolism and KRAS in Pancreatic Cancer: A New Translational Signal

IntroductionPancreatic ductal adenocarcinoma remains one of the most difficult cancers in GI oncology. Despite progress in systemic therapy, surgery, molecular profiling, and supportive care, pancreatic cancer continues to be defined by late diagnosis, aggressive biology, early metastasis, and limited durable treatment responses.One of the central biological drivers of pancreatic cancer is KRAS signaling. KRAS-mutant biology has long been recognized as fundamental to pancreatic carcinogenesis, but targeting KRAS directly has historically been challenging. The emergence of mutant-selective KRAS inhibitors has renewed interest in understanding what allows KRAS-driven tumors to survive, signal, adapt, and resist therapy.A new Gut study adds an important mechanistic layer to this discussion. The article, titled “Dysregulated sphingolipid metabolism drives pancreatic carcinogenesis through plasma membrane Kras enrichment,” explores how altered sphingolipid metabolism may influence KRAS localization and oncogenic signaling in pancreatic ductal adenocarcinoma.The study focuses on SMPD1, also known as acid sphingomyelinase, an enzyme involved in sphingolipid metabolism. SMPD1 converts sphingomyelin to ceramide, a lipid involved in membrane structure and signaling regulation.For clinicians, the key point is not that SMPD1 is ready to become a therapeutic target tomorrow. The more useful takeaway is that pancreatic cancer biology may depend not only on genetic drivers such as KRAS, but also on the lipid environment that helps organize oncogenic signaling at the cell membrane.

July 13, 2026•GastroAGI Team
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Risk-Based Follow-Up After HCC Ablation: Toward Smarter Surveillance After Curative Therapy

Risk-Based Follow-Up After HCC Ablation: Toward Smarter Surveillance After Curative Therapy

IntroductionHepatocellular carcinoma, or HCC, remains one of the most recurrence-prone cancers managed by hepatologists, gastroenterologists, interventional radiologists, surgeons, and oncology teams.For selected patients with early-stage HCC, local ablation can be a curative-intent therapy. However, the clinical challenge does not end once complete ablation is achieved. The next question is just as important: how should these patients be followed after treatment?A new JHEP Reports article titled “A risk-based post ablation follow-up strategy for hepatocellular carcinoma” addresses this question. The article was available online on July 6, 2026, as an in-press journal pre-proof.The study is clinically relevant because many HCC follow-up pathways still rely on fixed imaging intervals. The article notes that after ablation, patients were recommended routine follow-up at intervals of 3–6 months during the first 2 years and every 6–12 months thereafter.That approach is simple, but it may not be optimal for everyone.

July 10, 2026•GastroAGI Team
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VTE After Endoscopic Sleeve Gastroplasty: Rare Event, Important Safety Signal

VTE After Endoscopic Sleeve Gastroplasty: Rare Event, Important Safety Signal

IntroductionEndoscopic sleeve gastroplasty, or ESG, is increasingly becoming part of the therapeutic landscape for patients with obesity. It offers a less invasive, incisionless option compared with surgical bariatric procedures and is now moving further into mainstream metabolic endoscopy practice.A new article in Gastrointestinal Endoscopy addresses an important safety question: how often does venous thromboembolism occur after ESG, and what are current prophylaxis patterns?The study, titled “Venous Thromboembolism Following Endoscopic Sleeve Gastroplasty,” was authored by Benjamin M. Moy, Rolando Barajas, Chloe Savino, and Allison R. Schulman. It was published online ahead of print in Gastrointestinal Endoscopy, with DOI 10.1016/j.gie.2026.06.065.This is clinically relevant because ESG is expanding at the same time that obesity medicine, bariatric endoscopy, and metabolic care pathways are rapidly evolving. As more patients undergo ESG, endoscopists need practical data on uncommon but potentially serious adverse events.

July 10, 2026•GastroAGI Team
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MELD-Na Score: How to Interpret It and When It Changes the Transplant Conversation

MELD-Na Score: How to Interpret It and When It Changes the Transplant Conversation

A 58-year-old woman with alcohol-related cirrhosis is admitted for worsening ascites. Her creatinine and INR are stable compared to three months ago, and on a quick glance, her chart looks unremarkable. Her sodium, though, has dropped from 135 to 128 mEq/L over that same window. Her MELD score barely moved. Her MELD-Na score jumped six points. The transplant team's tone in the room changed before the labs were even fully explained to the family - and that shift, the gap between what MELD says and what MELD-Na says, is exactly what this post walks through.

July 9, 2026•GastroAGI Team
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MASLD Onset Age and Type 2 Diabetes Risk: Why Earlier Fatty Liver May Matter More

MASLD Onset Age and Type 2 Diabetes Risk: Why Earlier Fatty Liver May Matter More

IntroductionMetabolic dysfunction-associated steatotic liver disease, or MASLD, is no longer viewed as an isolated liver condition. It is increasingly understood as part of a broader metabolic disease network involving obesity, insulin resistance, dyslipidemia, hypertension, cardiovascular risk, and type 2 diabetes.A new article in Clinical Gastroenterology and Hepatology examines an important and clinically intuitive question: does the age at which MASLD begins influence the future risk of type 2 diabetes?The study, titled “Association of metabolic dysfunction-associated steatotic liver disease onset age with risk of incident type 2 diabetes,” was published by Huo and colleagues in 2026. The available PubMed-indexed conclusion reports that MASLD onset at any age was associated with increased risk of type 2 diabetes, with earlier onset conferring progressively greater risk.This is not just an epidemiologic detail. For gastroenterologists and hepatologists, it raises a practical question: should younger patients with MASLD be treated as a higher-risk metabolic group even before diabetes develops?

July 9, 2026•GastroAGI Team
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First-Line Infliximab in Pediatric Crohn’s Disease: What the 5-Year TISKids Follow-Up Means

First-Line Infliximab in Pediatric Crohn’s Disease: What the 5-Year TISKids Follow-Up Means

IntroductionThe question of when to start biologic therapy in pediatric Crohn’s disease remains one of the most important clinical decisions in pediatric IBD care.For years, many children with Crohn’s disease were treated with a conventional step-up approach: nutritional therapy or corticosteroids for induction, followed by immunomodulators, with biologics introduced later if disease activity persisted or recurred. But this strategy has increasingly been challenged by the concept of early intensive therapy, especially in children with moderate-to-severe disease or high-risk features.A new 5-year follow-up from the TISKids trial, published in Clinical Gastroenterology and Hepatology, revisits this debate by comparing first-line infliximab with conventional therapy in pediatric Crohn’s disease. The study is titled “Randomized trial comparing 5-year follow-up of first-line infliximab to conventional therapy in paediatric Crohn’s disease.” It assessed whether the early advantage of first-line infliximab translates into sustained long-term disease control.

July 9, 2026•GastroAGI Team
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