This review provides a practical and comprehensive overview of non-pharmacological interventions for metabolic-associated fatty liver disease (MASLD), focusing on dietary and exercise strategies. It highlights the effectiveness of coffee consumption, intermittent fasting, and Mediterranean and ketogenic diets in improving metabolic and liver health. The review emphasizes the importance of combining aerobic and resistance training as a critical approach to reducing liver fat and increasing insulin sensitivity. Additionally, it discusses the synergy between diet and exercise in enhancing liver parameters and the role of gut microbiota in MASLD. The paper underscores the need for a holistic, individualized approach, integrating diet, exercise, gut health, and patient motivation. It also highlights the long-term benefits and minimal risks of lifestyle interventions compared to the side effects of pharmacological and surgical options. The review calls for personalized treatment strategies, continuous patient education, and further research to optimize therapeutic outcomes in MASLD management.

Background: Hepatitis B virus (HBV) infection causes liver disease, including hepatocellular carcinoma. Controlling viral activity is crucial to reducing complications. Tenofovir may offer benefits over entecavir, but it is unclear if switching from entecavir to tenofovir improves outcomes. This study assesses the clinical impact of switching to tenofovir therapy for chronic HBV infection.Methods: Following the PRISMA guidelines, we conducted a literature search within the Cochrane Library, PubMed, MEDLINE, Embase, and Scopus for studies of patients with HBV infection who were switched to tenofovir from entecavir or were maintained on entecavir. Both formulations of tenofovir, that is, tenofovir disoproxil fumarate and tenofovir alafenamide were included and analyzed in subgroup analysis. Meta‐analyses were performed with RevMan 5.4 using a random‐effects model, with statistical significance set at p < 0.05.Results: A total of eight studies, comprising 833 patients, were included in the meta‐analysis. Tenofovir showed a significantly higher likelihood of achieving complete virological response (RR 5.60; 95% CI 3.51–8.94; p < 0.00001) and a greater reduction in HBV DNA levels (MD −1.03 log IU/mL; 95% CI −1.69 to −0.36; p = 0.002) compared to entecavir. However, there was no significant difference in HBsAg reduction or HBeAg seroconversion between the two groups. ALT reductions were not statistically significant overall, although entecavir showed better outcomes in subgroup analysis.Conclusion: Switching from entecavir to tenofovir improves virological response and reduces HBV DNA levels, but shows no significant advantage in HBsAg reduction, HBeAg seroconversion, or overall, ALT reduction.

Objective: Peroxisome proliferator‐activated receptor (PPAR) agonists are agents used for patients with primary biliary cholangitis (PBC) who do not respond to conventional agents like ursodeoxycholic acid (UDCA). This meta‐analysis aimed to assess the safety and efficacy of PPAR agonists, including fibrates and selective PPAR agonists, on biochemical response and safety outcomes in patients with primary biliary cholangitis who were non‐responders to UDCA.Methods: We searched various electronic databases, including MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov, to retrieve randomized controlled trials (RCTs) comparing PPAR agonists to placebo in patients with PBC.Results: Our meta‐analysis, including 12 RCTs involving 973 patients, showed that PPAR agonists, including fibrates and selective PPAR agonists, significantly reduce mean alkaline phosphatase (ALP) levels from baseline to follow‐up as compared to placebo. They also increase the number of patients with the composite biochemical response (RR 5.51; 95% CI: 2.80, 10.86) and normalize ALP levels with a reduction in pruritus NRS Score and the incidence of pruritus. There was no significant change between the two groups when assessing the mean change in total bilirubin, adverse events, serious adverse events, or mean change in PBC‐40 score.Conclusion: In conclusion, our research underscores the potential of novel PPAR agonists in improving biochemical markers in PBC, particularly in patients unresponsive to UDCA. However, further studies with larger sample sizes, longer follow‐up durations, and a focus on patient‐centered outcomes are necessary. Additionally, exploring combination therapies and mechanistic insights will help us fully realize the therapeutic potential of PPAR agonists in PBC.

Objective: While most individuals with gallstone disease remain asymptomatic, symptoms of gallstone disease range from biliary pain to acute cholecystitis. Surgery is a popular choice of treatment, but evidence has also suggested conservative management as a safe and viable approach. We aim to investigate the evidence on conservative management versus early cholecystectomy for the management of gallstone disease.Methods: We searched electronic databases to retrieve and include all randomized controlled trials (RCTs) that analyzed the efficacy and safety of conservative management versus early cholecystectomy in the management of gallstone disease. The revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0) was used to assess the risk of bias in the included studies. We calculated risk ratios (RR) along with the 95% confidence intervals (95% CI) for all the outcomes. The random‐effects model was used in our analysis.Results: A total of 11 RCTs were included in our meta‐analysis. We found no statistically significant difference between conservative management and early cholecystectomy regarding the incidence of total intraoperative complications (RR 0.45; 95% CI: 0.14–1.42), total postoperative complications (RR 0.85; 95% CI: 0.48–1.50), total surgical complications (RR 0.68; 95% CI: 0.43–1.10), and mortality (RR 1.24; 95% CI: 0.81–1.89). The conservative management group was associated with a statistically significant higher incidence of total biliary complications (RR 3.63; 95% CI: 2.07–6.37), biliary colic (RR 2.75; 95% CI: 1.23–6.15), and common bile duct (CBD) stones (RR 3.96; 95% CI: 1.46–10.71). There was no difference in the incidence of biliary pancreatitis (RR 1.46; 95% CI: 0.49–4.35) and cholangitis (RR 1.52; 95% CI: 0.47–4.89).Conclusion: According to our meta‐analysis, conservative management offers no benefit over early cholecystectomy for gallstone disease; it increases the incidence of biliary complications in patients with gallstone disease. More studies are needed to better ascertain the role of conservative management in the management of gallstone disease.

Objectives: Linaclotide, a guanylyl cyclase‐C agonist, may enhance efficacy and tolerability when combined with polyethylene glycol (PEG) for bowel preparation. This meta‐analysis evaluated linaclotide plus PEG versus PEG alone for bowel preparation prior to colonoscopy.Methods: Randomized controlled trials (RCTs) including adults undergoing colonoscopy that compared linaclotide plus PEG with PEG alone for bowel preparation were identified via database search up to March 2024. Statistical analysis was performed in RevMan Web using random‐effects models.Results: Eleven RCTs were analyzed. Adequate bowel preparation rate was comparable (risk ratio [RR] 1.01, 95% confidence interval [CI] 0.98–1.04; I² = 23%), as was cecal intubation rate (RR 1.01, 95% CI 1.00–1.01). Subgroup analyses showed that compared with 3‐L PEG alone, 2‐L PEG plus linaclotide was non‐inferior, while 3‐L PEG plus linaclotide was superior regarding bowel preparation adequacy (RR 1.11, 95% CI 1.01–1.23) and total Boston Bowel Preparation Scale (BBPS) score (mean difference 0.44, 95% CI 0.04–0.85). Right and left colon BBPS scores were also higher with linaclotide. Polyp detection rate improved significantly in the 3‐L PEG plus linaclotide subgroup (RR 1.78, 95% CI 1.32–2.40), whereas adenoma detection rate and withdrawal time were comparable. Linaclotide reduced abdominal pain, bloating, nausea, and sleep disturbance, and increased willingness to repeat colonoscopy.Conclusions: Linaclotide with PEG provides comparable overall bowel cleansing to PEG alone while reducing adverse events and improving patient acceptance. Importantly, 2‐L PEG plus linaclotide was non‐inferior compared with 3‐L PEG, whereas 3‐L PEG plus linaclotide showed superiority over 3‐L PEG alone, supporting its use in low‐volume bowel preparation strategies.