Gastroenterology

Rising resistance and microbiome concerns demand precision H. pylori management

This Gastroenterology review highlights that global clarithromycin, metronidazole, and fluoroquinolone resistance now undermines traditional empiric H. pylori regimens. The authors advocate susceptibility-guided or resistance-informed therapy as the cornerstone of eradication, rather than legacy triple therapies. They emphasize that eradication regimens substantially perturb gastric and intestinal microbiota and expand the antimicrobial resistome, raising stewardship concerns. Adjunctive probiotics and N-acetylcysteine provide only modest gains in eradication or tolerability and should not distract from regimen optimization. 1

Bile-duct NGS substantially improves diagnosis and targeting of neoplastic strictures

In 2,116 ERCP patients, bile-duct NGS (BiliSeqV2/V3) achieved 82% sensitivity and 98% specificity for diagnosing neoplastic strictures. Standard pathology alone reached 44% sensitivity and 99% specificity, so NGS nearly doubled sensitivity while preserving specificity. Combining NGS with pathology increased sensitivity to 88% with 97% specificity, supporting a complementary diagnostic approach. Sensitivity gains were notable in high-risk subgroups, including primary sclerosing cholangitis, Hispanic patients, and germline mutation carriers. 2

Two-step FIB-4→VCTE algorithm stratifies fibrosis and liver events in T2D with MASLD

This Gut study evaluated the guideline-endorsed FIB-4 followed by vibration-controlled transient elastography in 4,781 patients with T2D and MASLD. In the biopsy cohort, using liver stiffness <8 and >12 kPa after FIB-4 classified about two-thirds as low-risk and one-quarter as high-risk with 71% accuracy for advanced fibrosis. In the prognostic cohort, the same thresholds yielded 5-year liver-related event incidences around 1% in low and intermediate groups versus nearly 12% in high-risk patients. Refining intermediate FIB-4 cases with liver stiffness <10 and >15 kPa reduced the indeterminate group to 5.6% without losing prognostic discrimination. 3

Semaglutide reduces MACE and improves fatty liver index in high–fibrosis-risk patients

This prespecified SELECT analysis examined once-weekly semaglutide in obese, non-diabetic patients with atherosclerotic disease at increased fibrosis risk by FIB-4. Across fibrosis-risk strata, semaglutide reduced major adverse cardiovascular events by roughly 21–26% versus placebo, with numerically larger reductions at highest FIB-4 levels. Over 104 weeks, semaglutide produced a 28% greater decrease in fatty liver index than placebo, suggesting improved steatosis risk profile. These data support GLP-1 agonists as dual-purpose agents addressing cardiovascular and hepatic risk in appropriate obese patients without diabetes. 4