Endoscopic-Directed Trans-Gastric Retrograde Cholangiopancreatography in Patients With Roux-en-Y gastric Bypasses
The research provides evidence that EDGE for endoscopic retrograde cholangiopancreatography yields good treatment outcomes in patients with RYGBs. The AE rate is significantly lower with 20-mm versus 15-mm LAMS; thus, the former is likely preferable.
KEY FINDINGS: The research provides evidence that EDGE for endoscopic retrograde cholangiopancreatography yields good treatment outcomes in patients with RYGBs. The AE rate is significantly lower with 20-mm versus 15-mm LAMS; thus, the former is likely preferable.
BACKGROUND: Endoscopic ultrasound-directed trans-gastric retrograde cholangiopancreatography (EDGE) is a new procedure for treating pancreaticobiliary diseases in patients with Roux-en-Y gastric bypass (RYGB). The aim of this meta-;analysis was to determine the overall outcomes and safety of EDGE.
DETAILS: Authors performed a computerized search of the main databases, including PubMed, EMBASE, Cochrane Library, and Science Citation Index, through October 2022. The main outcome measures examined in the meta-analysis were technical and clinical success rates and overall adverse event (AE) rate, especially the lumen-apposing metal stent (LAMS) dislodgement rate. AE rates were assessed according to LAMS size (15 vs. 20 mm), number of stages (single vs. two) and access route (gastrogastric vs. jejuno-gastric). Fourteen trials with a total of 574 patients who had undergone 585 EDGE procedures were included in this study. The cumulative technical and clinical success and AE rates were 98%, 94%, and 14%, respectively. The commonest AE was LAMS dislodgement (rate 4%). The overall AE rate was lower in the 20-mm LAMS than in the 15-mm LAMS group (odds ratio [OR]=5.79; 95% confidence interval [CI]: 2.35 to 14.29). There were no significant differences in AE rate between number of stages (OR=1.36; 95% CI: 0.51 to 3.64) or differing access routes (OR=1.03; 95% CI 0.48 to 2.22).
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Source: Tong, S., Tianjie, C., Jing, W., et al. (2023). Endoscopic-Directed Trans-Gastric Retrograde Cholangiopancreatography in Patients With Roux-en-Y gastric Bypasses: A Meta-Analysis. Journal of Clinical Gastroenterology. 2023; 57(9): 871-878. Published: September, 2023. DOI: 10.1097/MCG.0000000000001864.
IL-17 Inhibitors Not Associated With Increased IBD Risk in Hidradenitis Suppurativa
A systematic review and meta-analysis of 24 studies found that inflammatory bowel disease events were rare among patients with hidradenitis suppurativa receiving IL-17 inhibitors. In randomized trials, new-onset IBD occurred in 0.23% of patients receiving IL-17 inhibitors versus 0% with placebo, with no significant difference between groups. The findings are reassuring but support continued monitoring because event numbers were low and reporting was inconsistent.
KEY FINDINGS: IBD events were uncommon among patients with HS receiving IL-17 inhibitors, and randomized trial data did not demonstrate a significant increase in IBD risk compared with placebo. The higher incidence observed in nonrandomized studies may reflect differences in patient populations, follow-up, or other sources of bias and should not be interpreted as evidence of causation. Because event numbers were low and reporting of IBD outcomes was inconsistent, continued monitoring remains important, particularly in patients with existing or suspected IBD. The findings support the use of IL-17 inhibitors in HS while emphasizing the need for further prospective data on gastrointestinal outcomes.
BACKGROUND: Interleukin-17 (IL-17) inhibitors are increasingly used to treat moderate to severe hidradenitis suppurativa (HS), but concern remains about their potential relationship with inflammatory bowel disease (IBD), particularly Crohn disease and ulcerative colitis. Because patients with HS already have an elevated background risk of IBD, it can be difficult to determine whether IBD events occurring during IL-17 inhibitor therapy are treatment-related or reflect the underlying disease. This systematic review and meta-analysis evaluated the incidence of IBD among patients with HS receiving IL-17 inhibitors and compared event rates with placebo in randomized clinical trials.
DETAILS: The investigators searched PubMed, Embase, and the Cochrane CENTRAL database from inception through November 2025. Twenty-four studies met the inclusion criteria, comprising 10 randomized clinical trials, 11 nonrandomized studies, and 3 case reports. Overall, the analysis included 3,015 patients with HS treated with an IL-17 inhibitor. Outcomes included new-onset IBD, worsening of preexisting IBD, IBD subtype, clinical features, and time to IBD onset.
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Across the 10 randomized clinical trials, new-onset IBD occurred in 6 of 2,572 patients receiving IL-17 inhibitors (0.23%) compared with 0 of 1,066 patients receiving placebo through week 16. The pooled risk difference was 0.002 (95% CI, -0.003 to 0.007), indicating no statistically significant difference between treatment and placebo groups.
In the nonrandomized studies, 7 new-onset IBD events were reported among 469 patients, corresponding to a crude incidence of 1.49%. The pooled incidence was 3.90% (95% CI, 2.30%-6.50%). Across randomized trials, long-term extension studies, and nonrandomized studies, 17 new-onset IBD cases and 4 IBD flares were reported.
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Source: Cutrona, M., Jolkovsky, E. L., Romanelli, S., et al. Inflammatory Bowel Disease and Interleukin-17 Inhibitors in Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis. JAMA Dermatology. 2026; Published: September 9, 2026. DOI: 10.1001/jamadermatol.2026.3373.
Multi-Analyte Blood Test Improves Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis
In adults with cirrhosis, HelioLiver Dx demonstrated superior sensitivity to ultrasound for HCC detection, including small lesions, while maintaining non-inferior specificity. The blood-based test detected 47.8% of all HCC versus 28.3% with ultrasound and 28.6% versus 0% for lesions less than or equal to 2 cm, meeting both prespecified co-primary endpoints.
KEY FINDINGS: In a prospective multicenter validation study of 1,268 adults with cirrhosis, HelioLiver Dx demonstrated greater sensitivity than ultrasound for HCC detection, including small lesions. Sensitivity was 47.8% versus 28.3% for all HCC and 28.6% versus 0% for lesions ≤2 cm. Although specificity was lower with HelioLiver Dx, the test met prespecified criteria for superior sensitivity and non-inferior specificity.
BACKGROUND: Patients with cirrhosis who are at high risk for hepatocellular carcinoma (HCC) are recommended to undergo biannual abdominal ultrasound surveillance. However, ultrasound has limited sensitivity for small HCC lesions, and adherence to surveillance can be poor. A multianalyte cell-free DNA (cfDNA)-based blood test, HelioLiver Dx, was developed to facilitate HCC detection in this high-risk population.
DETAILS: This cross-sectional, prospective, blinded, multicenter validation study evaluated HelioLiver Dx and abdominal ultrasound in adults with cirrhosis. Participants underwent both tests, while multiphasic magnetic resonance imaging (MRI) served as the reference standard for determining HCC status. The study included 1,268 evaluable participants from 42 clinical sites in the United States.
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HelioLiver Dx combines cfDNA methylation features with patient age and sex and serum concentrations of alpha-fetoprotein (AFP), AFP-L3, and des-gamma-carboxy prothrombin (DCP). The test provides a qualitative positive or negative result, with its algorithm and cutoffs established before testing of the validation cohort.
The co-primary endpoints compared HelioLiver Dx with ultrasound for sensitivity and specificity in detecting HCC. Superiority required the lower bound of the 95% confidence interval for the sensitivity difference to exceed a prespecified 5% margin, while noninferiority for specificity required the lower bound to remain above −10%.
Of the 1,268 evaluable participants, 46 (3.6%) had HCC identified by MRI. Among these, 46% had small HCC lesions ≤2 cm in diameter. HelioLiver Dx detected HCC with a sensitivity of 47.8% (95% CI 32.9-63.1), compared with 28.3% (95% CI 16.0-43.5) for ultrasound.
For HCC lesions ≤2 cm, HelioLiver Dx had a sensitivity of 28.6% (95% CI 11.3-52.2), whereas ultrasound detected 0% (95% CI 0.0-16.1). Specificity was 87.6% (95% CI 85.6-89.4) for HelioLiver Dx and 93.9% (95% CI 92.5-95.2) for ultrasound.
The HelioLiver Dx test met the prespecified co-primary endpoints for superior sensitivity and non-inferior specificity compared with ultrasound. The study also found that the blood test identified more HCC lesions overall and more early lesions than ultrasound.
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Source: Taggart, D. J., Mahajan, S., Gallant, M. A., et al. A Multi-Analyte cfDNA-Based Blood Test for Early Detection of Hepatocellular Carcinoma. Journal of Hepatology. 2026; 85(3): 528-536. Published: September, 2026. DOI: 10.1016/j.jhep.2026.04.012.
US Measles Cases Rise in 2026 as Outbreaks Continue Amid Declining MMR Coverage
US measles activity has increased substantially in 2026, with 2,465 confirmed cases and 38 new outbreaks reported as of August 6. Declining MMR coverage may increase community vulnerability to transmission. Maintaining high vaccination coverage remains central to preventing measles outbreaks and sustaining elimination.
KEY FINDINGS: As of August 6, 2026, the US had reported 2,465 confirmed measles cases and 38 new outbreaks, with 94% of cases outbreak-associated. The increase occurs alongside a decline in kindergarten MMR coverage to 92.5% in 2024-2025 from 95.2% in 2019-2020. CDC emphasizes that measles can spread rapidly in communities with lower vaccination coverage, while 2 doses of MMR vaccine provide 97% protection against measles.
BACKGROUND: Measles was officially eliminated in the United States in 2000 following widespread use of the measles, mumps, and rubella (MMR) vaccine. However, declining vaccination coverage and increasing global measles activity have increased opportunities for measles transmission following importation into the United States.
DETAILS: As of August 6, 2026, the Centers for Disease Control and Prevention (CDC) reported 2,465 confirmed measles cases in the United States in 2026. Of these, 2,449 cases were reported by 47 jurisdictions, while 16 cases occurred among international visitors to the United States. Thirty-eight new outbreaks had been reported during 2026.
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Overall, 94% of confirmed cases in 2026 (2,309 of 2,465) were associated with outbreaks, including 936 cases from outbreaks beginning in 2026 and 1,373 from outbreaks that began in 2025. For comparison, 2,289 confirmed cases and 48 outbreaks were reported during the full year of 2025; 90% of cases (2,066 of 2,289) were outbreak-associated.
CDC reports confirmed measles cases notified by jurisdictions as of noon on Thursdays. An outbreak is defined as 3 or more related cases. State and CDC counts may differ because jurisdictions update and publicly report their data on different schedules.
MMR vaccination coverage among US kindergartners declined from 95.2% during the 2019-2020 school year to 92.5% during the 2024-2025 school year, leaving approximately 286,000 kindergartners at risk during the 2024-2025 school year. CDC notes that communities with vaccination coverage below the 95% level are more vulnerable to measles outbreaks. The 2026 measles case count reported by CDC as of August 6, 2026, had already exceeded the total number of confirmed cases reported during all of 2025 (2,465 vs 2,289). The high proportion of outbreak-associated cases indicates sustained transmission within affected communities.
The burden of measles remains closely associated with vaccination status. CDC reports that 2 doses of MMR vaccine are 97% effective at preventing measles, while 1 dose is 93% effective. Breakthrough infections can occur, particularly during outbreaks with high levels of circulating measles virus, and account for approximately 10% of all measles infections.
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Source: CDC: Measles Cases and Outbreaks. Centers for Disease Control and Prevention (CDC). 2026; Published: August 7, 2026.
Gut Microbiome Dysbiosis Promotes Breast Cancer Dissemination Through Altered Bile Acid Signaling
Gut microbiome dysbiosis increases primary bile acids, triggering mammary inflammation and promoting HR+ breast tumor dissemination through PGE2 signaling. Bile acid, insulin resistance, and PGE2 gene signatures were associated with reduced survival, while bile acid sequestrant use correlated with longer restricted mean survival time in metastatic disease.
KEY FINDINGS: This study demonstrates that gut microbiome imbalance may contribute to HR+ breast cancer progression through systemic metabolic and inflammatory mechanisms. Dysbiosis-associated elevation of primary bile acids was shown to promote mammary inflammation and tumor dissemination through PGE2 signaling. Clinical database analyses further suggested that bile acid pathway modulation, including bile acid sequestrant use, may be associated with improved survival outcomes in metastatic disease. These findings highlight the potential importance of microbiome-derived metabolites in cancer biology and future precision oncology strategies.
BACKGROUND: Breast cancer metastasis remains a major clinical challenge, particularly in hormone receptor-positive (HR+) tumors, which represent the most common metastatic breast cancer subtype. Emerging evidence suggests that alterations in the gut microbiome may influence systemic inflammation and cancer progression. This study investigated whether commensal dysbiosis alters bile acid metabolism and contributes to mammary gland inflammation and HR+ breast tumor dissemination.
DETAILS: Researchers evaluated the relationship between gut microbiome alterations, bile acid signaling, inflammation, and breast cancer progression using experimental models and human genomic and clinical datasets. Metabolomic profiling demonstrated increased primary bile acids in dysbiotic microbiomes. Additional mechanistic studies using bile acid sequestration and supplementation approaches examined how altered bile acid levels influenced mammary inflammation and tumor dissemination.
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The investigators further analyzed The Cancer Genome Atlas (TCGA) data to evaluate associations between bile acid-related signatures, insulin resistance, prostaglandin E2 (PGE2) signaling, and survival outcomes in patients with HR+ breast tumors. Electronic health record data from the Epic Cosmos database were also examined to assess associations between bile acid sequestrant use and outcomes among patients with metastatic disease.
Commensal dysbiosis increased primary bile acid levels by disrupting microbial bile acid metabolism. Elevated primary bile acids promoted mammary gland inflammation and enhanced HR+ breast tumor dissemination through a prostaglandin E2 (PGE2)-dependent pathway.
TCGA analysis demonstrated that gene signatures related to bile acids, insulin resistance, and PGE2 signaling were associated with reduced survival in patients with HR+ tumors. In complementary clinical data analysis, bile acid sequestrant use was associated with longer restricted mean survival time among patients with metastatic disease.
These findings identify gut microbiome–bile acid signaling as a potential biological pathway linking intestinal dysbiosis with breast cancer progression and suggest that modulation of bile acid pathways may represent an area for future therapeutic investigation.
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Source: Putelo, A. M., Bajgai, S., Poblete, M. K., et al. Commensal Dysbiosis Alters Primary Bile Acid Signaling to Drive Mammary Gland Inflammation and Breast Tumor Dissemination. Cancer Research. 2026; Published: June 2, 2026. DOI: 10.1158/0008-5472.CAN-25-4466
Hepatic Venous Pressure Gradient Predicts Anticoagulation Response and Prognosis in PA-HSOS
In 76 patients with PA-HSOS, HVPG independently predicted nonresponse to initial anticoagulation. An HVPG cutoff of 20.165 mmHg yielded an AUC of 0.741, increasing to 0.881 when combined with serum total bilirubin, heart rate, and blood urea nitrogen. Higher HVPG was associated with poorer survival and greater sinusoidal injury.
KEY FINDINGS: In patients with PA-HSOS, HVPG may help identify individuals at increased risk of nonresponse to initial anticoagulation and poorer survival. An HVPG threshold of 20.165 mmHg demonstrated moderate predictive performance, while a model incorporating HVPG, serum total bilirubin, heart rate, and blood urea nitrogen showed improved discrimination. The prognostic and disease-severity associations of HVPG were stronger when measurement was performed within 1 month of disease onset. These findings suggest that early HVPG assessment may support risk stratification and treatment planning, although the results require validation in larger prospective studies.
BACKGROUND: Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is a drug-induced liver injury characterized by rapidly progressive portal hypertension. Although hepatic venous pressure gradient (HVPG) is an established measure of sinusoidal portal hypertension, its utility in assessing disease severity, predicting response to anticoagulation, and determining prognosis in PA-HSOS remains uncertain. This retrospective study evaluated the clinical value of HVPG in patients with PA-HSOS.
DETAILS: This single-center retrospective study included 76 patients diagnosed with PA-HSOS according to the Nanjing criteria who underwent HVPG measurement between January 2016 and April 2020. All patients received anticoagulation-transjugular intrahepatic portosystemic shunt (TIPS) stepwise treatment. The investigators assessed the association of HVPG with nonresponse to initial anticoagulation, prognostic survival, Drum Tower Severity Scoring (DTSS), and histopathological findings.
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Among the 76 patients, 33 responded to initial anticoagulation, whereas 43 did not respond and subsequently underwent TIPS. The median follow-up duration was 35.42 (0.53-54.47) months. HVPG was evaluated using multivariable logistic regression and receiver operating characteristic analysis. A subgroup analysis was performed after excluding patients with disease onset more than 1 month before assessment.
HVPG was independently associated with nonresponse to initial anticoagulation (95% CI: 1.006-1.413, P=0.043). An HVPG cutoff of 20.165 mmHg predicted nonresponse with a sensitivity of 0.744, specificity of 0.697, and AUC of 0.741 (95% CI: 0.626-0.857, P<0.001). Combining HVPG >20.165 mmHg with serum total bilirubin, heart rate, and blood urea nitrogen increased the AUC to 0.881 (95% CI: 0.804-0.958, P<0.001).
Patients with HVPG >20.165 mmHg had significantly poorer survival than those with HVPG <=20.165 mmHg (P=0.022, χ2=5.285). Overall mortality was 13.16% (10/76), with 9 deaths among 42 patients in the high-HVPG group and 1 death among 34 patients in the low-HVPG group.
HVPG was positively correlated with the area of sinusoidal bleeding (P=0.008, R=0.343). After excluding patients with disease onset of more than 1 month, the predictive performance of HVPG improved, with an AUC of 0.789 (95% CI: 0.654-0.924, P=0.001). In this subgroup, HVPG also showed significant linear relationships with DTSS (P0.001, R=0.522) and sinusoidal bleeding area (P=0.001, R=0.499).
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Source: Cai, Z., Li, R., Zhang, H., et al. The Value of Hepatic Venous Pressure Gradient in Patients With Pyrrolidine Alkaloid-Induced Hepatic Sinusoidal Obstruction Syndrome. Journal of Gastrointestinal Surgery. 2026; 30(8)): 102376. Published: August, 2026. DOI: 10.1016/j.gassur.2026.102376.
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