Background: Predictive biomarkers are needed to identify individuals with metabolic dysfunction–associated steatotic liver disease (MASLD), at high risk for HCC. Our study aimed to determine whether the detection of circulating bacterial DNA could be associated with HCC development in MASLD patients with liver cirrhosis. Methods: We developed a multicenter prospective cohort of patients with cirrhosis undergoing surveillance for HCC by contrast-enhanced magnetic resonance imaging. In a nested cohort study, we performed 16S rRNA sequencing of cell-free DNA extracted from 343 longitudinal plasma samples collected from 151 MASLD patients with cirrhosis. Among the 151 patients, 25 developed HCC during follow-up. Results: Following in silico decontamination approaches, variations in circulating bacterial DNA profiles were significantly associated with HCC development, cirrhosis severity, and male gender. Many of the identified taxa were well-known human-associated bacteria. Patients who developed HCC during follow-up showed an enrichment in Tsukamurella and Bacteroides, and depletion of Natronomonas. Associations with HCC development remained for the identified bacteria, after adjusting for cirrhosis severity and male gender. Acidobacteriota, Tsukamurella, and Staphylococcaceae showed markedly improved prediction of HCC within 12 months prior to diagnosis [Acidobacteriota: AOR=2.87 (1.36–6.04), p=0.006; Tsukamurella: AOR=2.80 (1.34–5.85), p=0.006; Staphylococcaceae: AOR=2.52 (1.19–5.36), p=0.016]. Circulating bacterial DNA profiles associated with male gender and cirrhosis severity were different from those observed for HCC and showed considerable overlap in significant taxa. These included enrichment of the lineage Gammaproteobacteria, Enterobacterales, and Rheinheimera. Conclusions: The identified circulating bacterial DNA signatures may have utility in personalized approaches to HCC surveillance in MASLD patients.

Background and Aim: Gastric cancer is a health concern and contributes to cancer‐related deaths. Gastric intestinal metaplasia (GIM) is a premalignant lesion of gastric cancer. Currently, factors associated with GIM regression are under‐investigated. This study aims to assess the rate of GIM regression and identify factors associated with it.Methods: This study was conducted at Medstar Washington Hospital Center. We included patients who had GIM between January 2015 and December 2020. Population was divided into GIM persistence or regression. Data included demographics, esophagogastroduodenoscopy findings, Helicobacter pylori status, and laboratory results. Statistical analyses included Kaplan–Meier and Cox proportional models to explore predictors of GIM regression.Results: Among 2375 patients, 9.1% had GIM. Notably, 85 patients had GIM regression and 132 patients had persistent GIM. African Americans constituted (75%) of the regression group and (76%) of the persistence group. Peptic ulcer disease (PUD) was noted in 12.9% of the regression group at baseline, and 5.9% at follow‐up; the persistence group showed 11.4% at baseline and 5.3% at follow‐up (P = 0.89). Regression analysis revealed that the presence of PUD was associated with a higher rate of regression (hazard ratio [HR] 2.46, P = 0.013). Smoking status showed lower rates of regression (HR 0.54 and 0.62, P = 0.038 and 0.169). On gastric mapping, African Americans, Hispanics, and individuals of other races/ethnicities displayed lower rates of GIM regression (HR 0.68, 0.78 and 0.69).Conclusion: PUD was associated with a higher rate of GIM regression, while smoking showed lower regression rates. Results provide insights into factors influencing GIM regression in African American population and may inform future surveillance and treatment strategies.

The American Association for the Study of Liver Diseases recommends regular surveillance with ultrasonography (US) and alpha-feto protein every 6 months for patients at high risk of hepatocellular carcinoma (HCC). However, US is considered to be less effective than cross-sectional imaging modalities like computed tomography and magnetic resonance imaging for detecting early HCC. Limited data exist on the overall survival and receipt of curative treatment for patients undergoing surveillance with different imaging modalities. We retrospectively reviewed patients (n = 1954) diagnosed with HCC between January 2011 and June 2021. Patients who developed HCC while on strict semiannual surveillance were included in the study. We estimated survival using the Kaplan-Meier method and compared the outcomes on different modalities of imaging using the Log Rank test. We used univariate and multivariate Cox model to evaluate factors affecting survival. A total of 183 patients developed HCC on semiannual surveillance with Imaging (115 with contrast-enhanced magnetic resonance imaging, 34 with multiphasic computed tomography and 34 with US) and alpha-feto protein. No significant difference was noted in overall survival or transplant-free survival based on the imaging modality employed for surveillance for at-risk patients. No correlation was found between the type of imaging modality for surveillance and receipt of curative treatment. Using surveillance program rigorously in at-risk patients, we did not find any association between the imaging modality and clinical outcomes in patients with HCC. It is likely that adherence to surveillance program irrespective of imaging modalities is more effective to influence the outcome, but it needs further studies.

Background: Glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) improve glycemic control and promote weight loss but may increase gastric residue, raising concerns during esophagogastroduodenoscopy (EGD). African American patients remain underrepresented in research on these agents. Methods: We performed a retrospective cohort study at a single tertiary referral center, including adults (≥ 18 years) undergoing elective EGD. Participants were divided into two groups based on documented GLP‐1 RA use within 7 days of EGD versus no use. Outcomes included the presence of residual gastric contents, procedure abortion due to gastric residue, procedural bleeding, and post‐procedural hospitalization. We applied multiple imputation for missing data and entropy balancing for covariate adjustment, reporting odds ratios (OR) and 95% confidence intervals (CI). Results: Among 1408 participants, 270 used GLP‐1 RAs. Compared to non‐users, GLP‐1 RA users had a higher mean body mass index (33 vs. 30 kg/m ² ) and hemoglobin A1c (7.43% vs. 6.54%). In the adjusted analysis, GLP‐1 RA treatment was not significantly associated with increased gastric content (OR, 1.52; 95% CI, 0.58–3.99; p = 0.395) or other procedural complications. Conversely, GLP‐1 RA use was linked to lower post‐procedural hospitalization rates (OR, 0.19; 95% CI, 0.06–0.58; p = 0.004). Conclusion: In this predominantly African American cohort, recent GLP‐1 RA therapy did not significantly elevate intra‐procedural risk or necessitate procedure abortion. These findings suggest that routine discontinuation of GLP‐1 RAs prior to EGD may not be universally required, especially for patients benefiting from improved metabolic control. Larger prospective studies are warranted to inform guideline updates for diverse patient populations.

Introduction: Lower gastrointestinal bleeding (LGIB) frequently leads to emergency department (ED) visits and hospitalizations, encompassing a spectrum of outcomes from spontaneous resolution to intrahospital mortality. Aim: The purpose of this study was to validate a scoring system designed to identify cases of low‐risk LGIB, allowing for safe discharge from the ED. Methods: A retrospective analysis of all gastrointestinal bleeding cases presented at three EDs in 2020 was conducted, focusing specifically on patients with LGIB. The SHA ₂ PE score incorporates factors such as systolic blood pressure, hemoglobin levels, use of antiplatelet or anticoagulant medications, pulse rate, and episodes of bright blood per rectum. Results: Out of 1112 patients presenting with LGIB to the ED, 55 were hospitalized, 20 required blood transfusions, 15 underwent colonoscopies, one underwent interventional radiology procedures, and two patients died. Employing a SHA ₂ PE score with a cutoff value of 1 yielded a specificity of 78.5% (95% CI (confidence interval) [75.8–81.0]), sensitivity of 76.8% (95% CI [63.6–87.0]), positive predictive value (PPV) of 17.0% (95% CI [12.6–22.2]), and negative predictive value (NPV) of 98.3% (95% CI [97.2–99.1]) for predicting the need for hospitalization and intrahospital intervention. When considering return visits to the ED within 7 days with the same presentation, the score demonstrated a specificity of 78.8% (95% CI [76.0–81.3]), sensitivity of 68.6% (95% CI [56.4–79.1]), PPV of 19% (95% CI [14.3–24.4]), and NPV of 97.2% (95% CI [95.8–98.2]). Conclusions: The SHA ₂ PE score demonstrates potential in predicting cases of low‐risk LGIB, offering a high NPV for hospitalization, the need for intrahospital intervention, and return visits to the ED. However, these findings should be interpreted cautiously given the low prevalence of interventions and limitations in the study’s population and design.