Background and Aims: HDV infection leads to the most aggressive form of human viral hepatitis for which there is no FDA-approved therapy. PEG IFN-lambda-1a (Lambda) has previously demonstrated a good tolerability profile in HBV and HCV patients compared to PEG IFN-alfa. The goal of Phase 2 LIMT-1 trial was to evaluate the safety and efficacy of Lambda monotherapy in patients with HDV. Approach and Results: An open-label study of Lambda 120 or 180 mcg, administered once weekly by subcutaneous injections for 48 weeks, followed by 24 weeks of posttreatment follow-up. Thirty-three patients were allocated to Lambda 180 mcg (n=14) or 120 mcg (n=19). Baseline mean values: HDV RNA 4.1 log10 IU/mL (SD±1.4); ALT 106 IU/L (35–364); and bilirubin 0.5 mg/dL (0.2–1.2). Intention-to-treat rates of virologic response to Lambda 180 mcg and 120 mcg, 24 weeks following treatment cessation were 5 of 14(36%) and 3 of 19 (16%), respectively. The posttreatment response rate of 50% was seen in low BL viral load (≤4 log10) on 180 mcg. Common on-treatment adverse events included flu-like symptoms and elevated transaminase levels. Eight (24%) cases of hyperbilirubinemia with or without liver enzyme elevation, leading to drug discontinuation, were mainly observed in the Pakistani cohort. The clinical course was uneventful, and all responded favorably to dose reduction or discontinuation. Conclusions: Treatment with Lambda in patients with chronic HDV may result in virologic response during and following treatment cessation. Clinical phase 3 development of Lambda for this rare and serious disease is ongoing.

Sex and gender can affect the prevalence and prognosis of diseases. Our aim was to assess similarities and differences for males and females who underwent an upper endoscopy, with regards to indications and results. We reviewed all upper endoscopy reports from 2012 to 2016. Data regarding demographics, indications, and procedure findings were collected. The upper endoscopy findings were compared regarding the most common indications: gastroesophageal reflux, abdominal pain, gastrointestinal bleeding, and anemia. We investigated 12,213 gastroscopies among males (age, 56.7 ± 17.4) and 15,817 among females (age, 56.0 ± 17.3, p = 0.002). Males who underwent an upper endoscopy for gastroesophageal reflux had higher rates of esophagitis (7.7% vs. 3.4%, p < 0.001) and Barret’s esophagus (4.4% vs. 1.5%, p < 0.001). Females who underwent an upper endoscopy for abdominal pain had a higher rate of hiatal hernia, whereas males had higher rates of esophagitis, helicobacter pylori infection, gastritis, gastric ulcer, duodenitis, and duodenal ulcer (p < 0.001). Gastrointestinal bleeding as an indication for upper endoscopy showed that helicobacter, duodenitis, and duodenal ulcers are more common among males compared to females (p < 0.001). Males with anemia who underwent an upper endoscopy had higher rates of esophagitis (p = 0.021) gastritis (p = 0.002), duodenitis (p < 0.001), and duodenal ulcer (p < 0.001). We found significant differences regarding the pathological gastroscopy findings between males and females in relation to the different indications.

Background/Objectives: Eosinophilic esophagitis (EoE) is an increasingly recognized chronic immune-mediated inflammatory disease of the esophagus. Data on the real-world diagnosis and management practices among gastroenterologists in Israel is scarce. This study aimed to describe current diagnostic and treatment practice patterns for eosinophilic esophagitis among Israeli gastroenterologists, and to identify areas of concordance with, and variability relative to, international recommendations. Methods: A nationwide, cross-sectional, internet-based survey was conducted among gastroenterologists from the Israeli Gastroenterology Association (IGA) and the Israeli Society of Pediatric Gastroenterology, Hepatology and Nutrition between February and April 2024. We used a structured 28-item questionnaire covering physician demographics, diagnostic practices and treatment strategies of EoE. Responses were analyzed for the entire cohort and compared across subgroups based on physician characteristics. Results: Of the 540 eligible gastroenterologists, 114 (22%) completed the survey. Almost all responders (97%) would obtain esophageal biopsies in the case of dysphagia even without typical endoscopic findings. Similarly, 94% of the responders would obtain esophageal biopsies in the case of typical endoscopic findings even without dysphagia. About 86 (75%) were familiar with the Endoscopic Reference Score (EREFS) system. Proton pump inhibitors were the most prescribed first-line treatment (92%), followed by dietary interventions (40%) and topical steroids (17%). As compared with adult gastroenterologists, pediatric gastroenterologists were more likely to obtain biopsies, use the EREFS and initiate treatment before histologic confirmation was obtained. Overall, practices showed broad concordance with international recommendations (>75% of respondents). Conclusions: In this cross-sectional survey, it was demonstrated that diagnostic and treatment practices for EoE among Israeli gastroenterologists were broadly concordant with international recommendations. However, several areas of inconsistency across different provider subgroups were identified. These gaps can be managed through educational programs that will improve standardization of management in EoE.