2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T616,Cirrhosis and hepatocellular carcinoma (HCC) are interconnected outcomes of chronic liver disease, with portal hypertension playing a key part in cirrhosis decompensation, and influencing HCC prognosis and treatment. Despite their overlap, current guidelines address portal hypertension and HCC separately, leading to suboptimal risk stratification and treatment selection. This Review proposes a stage-based, integrated approach to HCC management that incorporates the prognostic stages of cirrhosis and emphasizes clinically significant portal hypertension (CSPH) as a key stratifying factor in compensated cirrhosis. CSPH is associated with an increased risk of cirrhosis decompensation, and its presence often limits the feasibility of curative treatments such as surgical resection. Although CSPH is strictly defined as hepatic venous pressure gradient (HVPG) of ≥10 mmHg, non-invasive tools (liver stiffness and platelet count) have largely replaced HVPG in cirrhosis; in patients with HCC, emerging data suggest that these non-invasive tests are poised to replace HVPG and its traditional surrogates, imaging and endoscopy. We explore the management of both cirrhosis and HCC across all cirrhosis stages - compensated (with or without CSPH), decompensated, and further decompensated - in relation to all HCC stages (very early, early, intermediate and advanced). Future research should validate non-invasive CSPH assessment in HCC and support outcome trials stratified by cirrhosis and HCC stage to guide personalized therapy and improve outcomes.31:T65d,Belapectin reduced variceal development in a subgroup of patients with MASH cirrhosis. We report the efficacy and safety of belapectin in patients with MASH cirrhosis and portal hypertension without varices at baseline. NAVIGATE was a global phase 2b trial. Patients were randomized to intravenous (i.v.) belapectin 2 or 4 mg/kg lean body weight or placebo for 18 months, stratified by type 2 diabetes. The primary endpoint was the incidence of varices with esophagogastroduodenoscopy (EGD) or a composite endpoint (new varices, intercurrent events, or discontinuation) at 18 months with belapectin versus placebo in the full analysis set (FAS). In a pre-specified analysis, new varices were evaluated in all patients who underwent EGD at baseline and 18 months. The per-protocol (PP) population was patients treated for 18 months with EGD at 18 months. Of 357 randomized patients, 291 completed treatment. Baseline characteristics were comparable across cohorts. In the FAS, 17.8% with placebo versus 10.1% with belapectin 2 mg/kg developed varices, a 43.2% reduction ( p =0.13). In the per-protocol population (PP), varices occurred in 22.3% with placebo versus 11.3% with belapectin 2 mg/kg, a 50% reduction (unadjusted p =0.04). Belapectin 4 mg/kg had no significant effect on variceal development. For the composite endpoint at 18 months, no significant difference was observed between belapectin 2 mg/kg ( p =0.14) or 4 mg/kg ( p =0.261) and placebo in the FAS. Belapectin was well-tolerated with no safety signals. Belapectin 2 mg/kg lowered the development of new varices in MASH cirrhosis and portal hypertension.32:T9a5, Background and Aims: Belapectin reduced variceal development in a subgroup of patients with MASH cirrhosis. We report the efficacy and safety of belapectin in patients with MASH cirrhosis and portal hypertension without varices at baseline. Approach and Results: NAVIGATE was a global phase 2b trial. Patients were randomized to intravenous (i.v.) belapectin 2 or 4 mg/kg lean body weight or placebo for 18 months, stratified by type 2 diabetes. The primary endpoint was the incidence of varices with esophagogastroduodenoscopy (EGD) or a composite endpoint (new varices, intercurrent events, or discontinuation) at 18 months with belapectin versus placebo in the full analysis set (FAS). In a pre-specified analysis, new varices were evaluated in all patients who underwent EGD at baseline and 18 months. The per-protocol (PP) population was patients treated for 18 months with EGD at 18 months. Of 357 randomized patients, 291 completed treatment. Baseline characteristics were comparable across cohorts. In the FAS, 17.8% with placebo versus 10.1% with belapectin 2 mg/kg developed varices, a 43.2% reduction ( p =0.13). In the per-protocol population (PP), varices occurred in 22.3% with placebo versus 11.3% with belapectin 2 mg/kg, a 50% reduction (unadjusted p =0.04). Belapectin 4 mg/kg had no significant effect on variceal development. For the composite endpoint at 18 months, no significant difference was observed between belapectin 2 mg/kg ( p =0.14) or 4 mg/kg ( p =0.261) and placebo in the FAS. Belapectin was well-tolerated with no safety signals. Conclusion: Belapectin 2 mg/kg lowered the development of new varices in MASH cirrhosis and portal hypertension. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Portal Hypertension: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Portal Hypertension (condition). Clinician-written summaries and actionable practice insights. 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US-guided liver biopsy site marking reduced major complications from 2.2% to 0.5% vs. percussion-guided technique (p<0.05). Portable US detects ascites with 95.8% sensitivity.","limitations":"No original primary data are presented; recommendations are consensus/expert-opinion based. Evidence on optimal examination numbers for competency is inconsistent (plateau reported at 19–90 exams across studies). No specific device recommendations are made due to limited comparative data.","practice_takeaway":"Hepatologists seeking to start liver POCUS should complete 2 hours of didactic training and 25 supervised exams before credentialing, then bill with CPT 76705 (add 93976 for Doppler if assessing portal vein thrombosis). Plan 6–18 months for full clinic implementation, and partner early with IT and radiology for image storage and workflow setup."}},{"doi":"10.1016/j.cgh.2026.08.010","pmid":"42637171","title":"Recompensation After Etiologic Cure in U.S. Veterans with HCV-Related Decompensated Cirrhosis","journal_title":"Clinical Gastroenterology and Hepatology","journal_issn":"1542-3565","published_at":"2026-08-25T00:00:00.000Z","url":"https://doi.org/10.1016/j.cgh.2026.08.010","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-02T06:22:20.587Z","updated_at":"2026-09-02T06:22:20.587Z","tags":[{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"condition","value":"Ascites","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"condition","value":"Hepatitis C Virus-Related Decompensated Cirrhosis","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"generic","value":"direct-acting antiviral (DAA)","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"modality","value":"Direct-Acting Antiviral","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"sample_size","value":"n=1213","value_numeric":1213},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"warning","value":"Cohort is almost entirely male U.S. Veterans, which significantly limits applicability to female patients and non-Veteran populations.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"warning","value":"Specific DAA regimens are not reported; treatment heterogeneity across the cohort cannot be ruled out.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.010","tag_type":"warning","value":"The 13% recompensation rate reflects strict Baveno VII criteria — rates using looser definitions (e.g., ascites resolution alone) may differ and are discussed but not separately quantified in the abstract.","value_numeric":null}],"summaries":{"what_studied":"Retrospective cohort study of 1,213 U.S. Veterans with HCV-related decompensated cirrhosis (imaging-confirmed ascites) who achieved SVR after DAA therapy; evaluated frequency, predictors, and survival impact of recompensation (Baveno VII criteria) over up to 24 months post-DAA initiation.","key_result":"13% of patients (163/1,213) achieved recompensation within 24 months of DAA initiation. Higher baseline albumin predicted recompensation; platelet count <110 ×10⁹/L and further decompensation reduced its likelihood. Recompensation was associated with lower subsequent all-cause mortality.","limitations":"Retrospective design limits causal inference; cohort is exclusively U.S. male Veterans, reducing generalizability to women and non-Veteran populations; recompensation ascertainment relied on documented ascites resolution, which may miss or misclassify cases.","practice_takeaway":"After HCV cure, roughly 1 in 8 patients with decompensated cirrhosis can recompensate — prioritize SVR in patients with preserved albumin and less severe portal hypertension (platelets ≥110 ×10⁹/L), as they are most likely to benefit. Ascites resolution alone captures most Baveno VII recompensation and can serve as a practical bedside marker to track disease reversal."}},{"doi":"10.1016/j.jhep.2026.07.030","pmid":"42624290","title":"Baveno VIII – Advancing Consensus in Portal Hypertension","journal_title":"Journal of Hepatology","journal_issn":"0168-8278","published_at":"2026-08-20T00:00:00.000Z","url":"https://doi.org/10.1016/j.jhep.2026.07.030","source_score":85,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-23T07:33:03.777Z","updated_at":"2026-08-23T07:33:03.777Z","tags":[{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"condition","value":"Advanced Chronic Liver Disease","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"condition","value":"Budd-Chiari Syndrome","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"condition","value":"Cirrhosis","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"condition","value":"Portal Vein Thrombosis","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"condition","value":"Portosinusoidal Vascular Disorder","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"condition","value":"Steatotic Liver Disease","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"study_design","value":"Consensus Guidelines / Expert Conference","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"warning","value":"No sample size (patient N) is reported, as this is a guideline consensus document rather than a clinical trial.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"warning","value":"The abstract does not provide individual evidence grades for each of the 272 statements; level of evidence assigned reflects the consensus-based study design overall.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.07.030","tag_type":"warning","value":"The paper was published 3 days before today's date (August 20, 2026); full text details on specific cutoff values and individual recommendations are not yet available from the abstract alone.","value_numeric":null}],"summaries":{"what_studied":"The Baveno VIII Consensus Conference (March 2026, Baveno, Italy) updated clinical guidance for advanced chronic liver disease (ACLD), portal hypertension, and vascular liver diseases across nine expert panels, building on evidence since the Baveno VII conference.","key_result":"272 statements and recommendations achieved strong consensus (>80% faculty agreement), covering non-invasive risk stratification in compensated ACLD, steatotic liver disease modifiers, prevention of first and further decompensation, portal hypertensive bleeding management, cirrhosis recompensation, Budd-Chiari syndrome, PSVD/NCPF, and portal vein thrombosis; CSPH cutoffs were revised and pediatric guidance was added for the first time.","limitations":"Consensus-based guidance reflects expert opinion and voting rather than direct trial data; recommendations depend heavily on the quality of the underlying evidence reviewed by each panel, which is not individually graded in the abstract.","practice_takeaway":"Clinicians managing cirrhosis and portal hypertension should update their practice to reflect revised CSPH cutoffs and expanded non-invasive test thresholds from Baveno VIII. First-ever pediatric-specific recommendations and guidance on cirrhosis recompensation are now available as part of this framework."}},{"doi":"10.1111/liv.70806","pmid":"42613687","title":"Hepatology: Emerging Paradigms in MASLD, Viral Hepatitis, Cholestatic Liver Disease, Portal Hypertension and Hepatocellular Carcinoma","journal_title":"Liver International","journal_issn":"1478-3223","published_at":"2026-08-18T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13486623/","source_score":16,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-26T06:20:03.789Z","updated_at":"2026-08-26T06:20:03.789Z","tags":[{"paper_doi":"10.1111/liv.70806","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"brand","value":"Rezdiffra","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"condition","value":"Cirrhosis","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"condition","value":"Hepatitis B","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"condition","value":"Hepatitis D","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"condition","value":"Hepatocellular Carcinoma","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"condition","value":"Metabolic Dysfunction-Associated Steatohepatitis","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"condition","value":"Metabolic Dysfunction-Associated Steatotic Liver Disease","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"condition","value":"Primary Biliary Cholangitis","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"condition","value":"Primary Sclerosing Cholangitis","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"generic","value":"bulevirtide","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"generic","value":"resmetirom","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"generic","value":"semaglutide","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"modality","value":"Entry Inhibitor","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"modality","value":"FGF21 Analog","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"modality","value":"Immunotherapy","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"modality","value":"Incretin-Based Dual/Triple Agonist","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"modality","value":"Pan-PPAR Agonist","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"modality","value":"RNA Silencing Therapy","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"modality","value":"Thyroid Hormone Receptor Beta Agonist","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"study_design","value":"Narrative Review / Conference Summary","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"warning","value":"Sample size tag omitted as no study-level N is reported.","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"warning","value":"Sex of populations studied is not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"warning","value":"Study design label 'Narrative Review / Conference Summary' is an approximation; the article blends review, expert opinion, and guideline highlights without a formal systematic methodology.","value_numeric":null},{"paper_doi":"10.1111/liv.70806","tag_type":"warning","value":"This is a conference proceedings summary, not a primary study — no original patient-level data or statistical outcomes are reported. Level of evidence reflects expert consensus/narrative review only.","value_numeric":null}],"summaries":{"what_studied":"A narrative review of emerging paradigms across major chronic liver diseases — MASLD/MASH, viral hepatitis (HBV/HDV), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), portal hypertension, and hepatocellular carcinoma (HCC) — presented at the Paris International Liver Meeting (January 2026).","key_result":"Resmetirom and semaglutide are now approved for MASH with F2–F3 fibrosis; bulevirtide and novel HBsAg-targeting/RNA-silencing agents are advancing HDV toward functional cure; immunotherapy combinations are achieving unprecedented long-term survival in selected HCC patients; and non-invasive tests have expanded roles in diagnosis, prognosis, and treatment monitoring across all chronic liver diseases.","limitations":"Conference summary with no original primary data; conclusions reflect expert opinion and curated trial highlights rather than a systematic review or meta-analysis. Treatment gaps noted (fewer than half of eligible PBC patients receive second-line therapy) but not quantified with outcome data.","practice_takeaway":"Clinicians managing MASH with F2–F3 fibrosis now have approved disease-modifying options (resmetirom, semaglutide) and should consider non-invasive tests for staging, treatment selection, and monitoring rather than defaulting to biopsy. For HBV and HDV, simplified fibrosis- and viral load–based algorithms with validated biomarkers can guide treatment initiation and safe discontinuation."}},{"doi":"10.14309/ajg.0000000000004118","pmid":"42439583","title":"How I manage cirrhosis in a busy outpatient clinic? The P.O.R.T.A.L.V.E.I.N. mnemonic","journal_title":"American Journal of Gastroenterology","journal_issn":"0002-9270","published_at":"2026-07-10T00:00:00.000Z","url":"https://doi.org/10.14309/ajg.0000000000004118","source_score":16,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-25T13:57:58.694Z","updated_at":"2026-07-25T13:57:58.694Z","tags":[{"paper_doi":"10.14309/ajg.0000000000004118","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004118","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004118","tag_type":"condition","value":"Cirrhosis","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004118","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004118","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004118","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004118","tag_type":"study_design","value":"Expert Opinion / Narrative Review","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004118","tag_type":"warning","value":"No abstract or full text was provided — summary is based solely on the title, journal, and DOI metadata. The specific meaning of each letter in the P.O.R.T.A.L.V.E.I.N. mnemonic could not be confirmed from the source text.","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004118","tag_type":"warning","value":"No sample size, patient data, or outcomes data were identifiable from the provided metadata.","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004118","tag_type":"warning","value":"Study design classified as Expert Opinion/Narrative ('How I manage' format) based on title convention; actual study type not confirmed from full text.","value_numeric":null}],"summaries":{"what_studied":"This paper describes a practical clinical framework — the P.O.R.T.A.L.V.E.I.N. mnemonic — for systematically managing patients with cirrhosis in a busy outpatient setting, covering key surveillance and management domains.","key_result":"The mnemonic organizes cirrhosis care into actionable components, though no comparative outcomes or patient cohort data are reported.","limitations":"No original patient data, comparative outcomes, or control group — this is expert opinion/narrative guidance only. Applicability may vary by practice setting and resource availability.","practice_takeaway":"Clinicians managing cirrhosis outpatients can use the P.O.R.T.A.L.V.E.I.N. mnemonic as a structured checklist to ensure key surveillance and management tasks (e.g., varices, encephalopathy, infections, nutrition) are not missed. This type of cognitive aid may be especially useful in high-volume or resource-limited clinic environments."}},{"doi":"10.1111/liv.70778","pmid":"42424093","title":"Changes in\n SSM\n Assessed via\n 100 Hz\n ‐\n VCTE\n Are Associated With Acute\n HVPG\n ‐Response to i.v. Propranolol: A European Multicentre Study","journal_title":"Liver International","journal_issn":"1478-3223","published_at":"2026-07-09T00:00:00.000Z","url":"https://doi.org/10.1111/liv.70778","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-16T13:37:16.835Z","updated_at":"2026-07-16T13:37:16.835Z","tags":[{"paper_doi":"10.1111/liv.70778","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"condition","value":"Advanced Chronic Liver Disease","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"condition","value":"Cirrhosis","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"generic","value":"propranolol","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"modality","value":"Non-Selective Beta Blocker","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"sample_size","value":"n=94","value_numeric":94},{"paper_doi":"10.1111/liv.70778","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"study_design","value":"Retrospective Multicentre Cohort Study","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"warning","value":"Funding was partly provided by Echosens (the manufacturer of the Fibroscan device used), and several authors report consulting/speaker fees from Echosens—potential conflict of interest.","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"warning","value":"SSM-100 Hz is a relatively novel technique, and the 6 patients excluded for 'implausible' SSM measurements could introduce selection bias.","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"warning","value":"The near-perfect AUROC (0.973) reported in the prior small SSM-50 Hz unicentre study is likely inflated given the small sample (n=20) and focus on chronic rather than acute response; direct comparison with this study's AUROC should be made cautiously.","value_numeric":null},{"paper_doi":"10.1111/liv.70778","tag_type":"warning","value":"The study is retrospective and restricted to three expert centres with high procedural standardisation; accuracy may be lower in routine clinical settings.","value_numeric":null}],"summaries":{"what_studied":"In 94 adults with advanced chronic liver disease (ACLD) and clinically significant portal hypertension (CSPH), this retrospective European multicentre study evaluated whether acute changes in spleen stiffness measurement at 100 Hz (SSM-100 Hz) by vibration-controlled transient elastography correlate with acute HVPG response to intravenous propranolol (0.15 mg/kg), assessed by paired pre- and post-NSBB measurements at three centres (2019–2024).","key_result":"HVPG-responders (45.7%) showed a significant SSM drop of −12.4 kPa vs. no significant change in non-responders (p = 0.004). Relative ΔSSM correlated moderately with relative ΔHVPG (Spearman's ρ = 0.387, p < 0.001), with an AUROC of 0.717 (95% CI: 0.614–0.820). An SSM increase ≥10% strongly predicted HVPG non-response (sensitivity 97.7%, NPV 91.7%, LR− 0.11); however, rule-in performance was poor (PPV plateaued below 65%).","limitations":"- HVPG itself has suboptimal test–retest reliability, making it an imperfect reference standard, especially at the individual level.\n- No formal sample size calculation was performed, and the study is retrospective with only three expert centres—limiting generalisability.\n- SSM operators were not blinded to HVPG results for the second reading, introducing potential measurement bias.","practice_takeaway":"SSM-100 Hz changes after IV propranolol are not accurate enough to replace invasive HVPG measurement in routine clinical practice, but a rise in SSM ≥10% may help rule out hemodynamic response. SSM dynamics may be most useful as a non-invasive surrogate endpoint in phase 2 clinical trials of portal hypertension therapies."}},{"doi":"10.1016/j.jhep.2026.06.032","pmid":"42419604","title":"Validation of a pan-ELastography Machine-learning (ELM) score to predict clinically significant portal hypertension in compensated advanced chronic liver disease","journal_title":"Journal of Hepatology","journal_issn":"0168-8278","published_at":"2026-07-09T00:00:00.000Z","url":"https://doi.org/10.1016/j.jhep.2026.06.032","source_score":22,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-17T13:24:13.671Z","updated_at":"2026-07-17T13:24:13.671Z","tags":[{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"condition","value":"Advanced Chronic Liver Disease","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"condition","value":"Liver Cirrhosis","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"generic","value":"carvedilol","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"generic","value":"propranolol","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"modality","value":"Elastography","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"modality","value":"Machine Learning Diagnostic Model","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"modality","value":"Non-Selective Beta-Blocker","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"sample_size","value":"n=1435","value_numeric":1435},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"study_design","value":"Multicenter Cohort Study with Machine Learning Model Development and Validation","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"warning","value":"Specific NSBB drug names (e.g., propranolol, carvedilol) are inferred from clinical context as the paper references NSBB therapy generally without naming agents; those tags are approximate.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the marked reduction in gray-zone results, but prospective outcome data (decompensation, survival) are not yet available to confirm clinical benefit.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"warning","value":"The rule-out NPV achieved in external validation (0.90) did not reach the 100% NPV target used during model training — clinicians should interpret rule-out results with caution.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.06.032","tag_type":"warning","value":"The study is dated July 2026, which is ahead of common publication timelines — treat as a recently published prospective validation study; independent replication is pending.","value_numeric":null}],"summaries":{"what_studied":"A machine-learning (Random Forest) model — the ELM Score — was developed and validated in 1,435 compensated advanced chronic liver disease (ACLD) patients to non-invasively predict clinically significant portal hypertension (CSPH, defined by HVPG), integrating liver stiffness (LSM), spleen stiffness (SSM), and clinical variables (platelets, Child-Pugh, age, sex, etiology) across three elastography modalities (VCTE, 2D-SWE, p-SWE).","key_result":"In external validation (n=342), the ELM Score achieved AUC=0.91 and Brier Score=0.13; rule-out cut-off (≤0.45) yielded NPV=0.90 (95% CI 0.84–0.94) and rule-in cut-off (≥0.60) yielded PPV=0.96 (95% CI 0.92–0.98), with a gray zone of only 12.3% vs. 47.9% for Baveno VII (p<0.001), 38.6% for Baveno-SSM dual (p<0.001), and 19.6% for Baveno-SSM single (p<0.05).","limitations":"- NPV of 0.90 falls short of the 100% target set during training, meaning some CSPH cases may be missed at the rule-out threshold.\n- External validation was conducted across seven centers but the study design is retrospective and cohort-based, limiting causal inference.\n- The model has not yet been validated for outcomes (decompensation, mortality) or prospective NSBB treatment decisions.","practice_takeaway":"The ELM Score can substantially reduce indeterminate (gray-zone) results compared to Baveno VII criteria, potentially allowing more compensated ACLD patients to be confidently classified for or against NSBB prophylaxis without invasive HVPG measurement. Clinicians should note that the rule-out NPV of 0.90 — not 100% — means a small residual miss rate persists before withholding NSBB therapy."}},{"doi":"10.1001/jama.2026.12038","pmid":"42406571","title":"Alcohol-Related Liver Disease","journal_title":"JAMA","journal_issn":"0098-7484","published_at":"2026-07-06T00:00:00.000Z","url":"https://doi.org/10.1001/jama.2026.12038","source_score":70,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-11T13:32:53.597Z","updated_at":"2026-07-11T13:32:53.597Z","tags":[{"paper_doi":"10.1001/jama.2026.12038","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"condition","value":"Alcohol-Associated Hepatitis","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"condition","value":"Alcohol-Related Liver Disease","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"condition","value":"Hepatocellular Carcinoma","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"condition","value":"Liver Cirrhosis","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"generic","value":"baclofen","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"generic","value":"naltrexone","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"Cognitive Behavioral Therapy","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"GABA-B Agonist","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"Liver Transplantation","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"Motivational Enhancement Therapy","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"Noninvasive Fibrosis Testing","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"warning","value":"Specific thresholds for alcohol consumption risk (20 g/day women, 30 g/day men) are presented as guidelines; individual risk may vary based on genetic and metabolic factors noted in the paper.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the review's consolidation of transplant and noninvasive testing recommendations, but the underlying evidence base varies in quality across individual recommendations.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.12038","tag_type":"warning","value":"This is a narrative review, not a systematic review or RCT — the abstinence-mortality association cited is from an observational cohort embedded in the review, not a primary trial result.","value_numeric":null}],"summaries":{"what_studied":"This JAMA review covers the epidemiology, diagnosis, risk factors, and management of alcohol-related liver disease (ALD), including alcohol-associated hepatitis and cirrhosis, with emphasis on noninvasive fibrosis testing and alcohol cessation strategies.","key_result":"Sustained alcohol abstinence in patients with alcohol-related cirrhosis was associated with significantly reduced liver-related mortality (aHR 0.43, 95% CI 0.26–0.70) and all-cause mortality (aHR 0.45, 95% CI 0.30–0.67) over a median 36-month follow-up. ALD-related mortality in the US nearly doubled from 6.7 to 12.5 deaths per 100,000 people between 1999 and 2022.","limitations":"This is a narrative review, not a systematic review or meta-analysis, so findings reflect curated evidence rather than pooled analysis. Mortality statistics are population-level and may not capture subgroup heterogeneity. Alcohol consumption data rely partly on self-report, which is known to be underreported.","practice_takeaway":"Screen patients with chronic daily heavy alcohol use (>20 g/day in women, >30 g/day in men) for ALD using noninvasive tools like Fibrosis-4 score and transient elastography. Prioritize alcohol cessation — with motivational therapy, CBT, or pharmacotherapy (baclofen, naltrexone) — and refer patients with severe alcohol-associated hepatitis or decompensated cirrhosis for liver transplant evaluation."}},{"doi":"10.1016/j.jhep.2026.05.026","pmid":"42342081","title":"Regression of liver cirrhosis","journal_title":"Journal of Hepatology","journal_issn":"0168-8278","published_at":"2026-06-24T00:00:00.000Z","url":"https://doi.org/10.1016/j.jhep.2026.05.026","source_score":10,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-02T13:33:12.104Z","updated_at":"2026-07-02T13:33:12.104Z","tags":[{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Alcohol-Associated Liver Disease","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Chronic Hepatitis B","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Chronic Hepatitis C","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Hepatocellular Carcinoma","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Liver Cirrhosis","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Metabolic Dysfunction-Associated Steatohepatitis","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"aldafermin","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"efruxifermin","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"fazirsiran","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"obeticholic acid","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"pegbelfermin","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"resmetirom","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"selonsertib","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"semaglutide","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"Antiviral Therapy","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"CAR T Cell Therapy","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"Cell Therapy","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"Digital Pathology / Artificial Intelligence","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"FGF21 Analogue","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"FXR Agonist","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"RNA Interference","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"warning","value":"No sample size tag applied — this is a review article with no single primary study population.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"warning","value":"Several cited trials and data points are from 2025–2026, some of which may be preliminary or not yet fully peer-reviewed at the time of this review's publication.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"warning","value":"Sex breakdown of study populations is not reported in this review.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the reframing of cirrhosis as a dynamic and modifiable state, but no single new therapy has been approved; clinical practice change is driven by the conceptual framework and monitoring recommendations rather than a new drug.","value_numeric":null}],"summaries":{"what_studied":"This narrative review synthesizes current evidence on cirrhosis regression across pathological, mechanistic, and clinical domains — covering cellular reprogramming of the fibrotic niche, AI-assisted digital pathology, antifibrotic drug trials (especially MASH-related cirrhosis), and non-invasive monitoring tools for regression and recompensation.","key_result":"Cirrhosis is a dynamic, potentially modifiable state: sustained aetiological control (antiviral therapy, abstinence, bariatric surgery) induces measurable architectural remodelling and reduces portal hypertension, decompensation risk, and mortality — but regression is often incomplete. Recent phase 2 monotherapy trials in MASH cirrhosis (efruxifermin, semaglutide, aldafermin, pegbelfermin, obeticholic acid) all failed to meet primary histological endpoints. Approximately one-third of patients with prior decompensation achieve recompensation after aetiological control. HCC risk remains elevated even after viral eradication, reflecting epigenetic and microenvironmental 'memory'.","limitations":"- Review is narrative without systematic search or meta-analysis; no pooled effect sizes provided.\n- Most mechanistic data derive from rodent or single-cell models with limited direct validation in human cirrhosis regression.\n- No approved antifibrotic therapies exist; clinical translation of preclinical targets has been consistently disappointing.","practice_takeaway":"Treat the underlying cause aggressively — antiviral therapy, alcohol abstinence, or weight loss remains the most evidence-based strategy to induce cirrhosis regression and recompensation. Even after structural improvement, continue HCC surveillance, as oncogenic risk persists beyond histological normalisation."}},{"doi":"10.1016/j.cgh.2026.06.011","pmid":"42309430","title":"Stage-specific drivers of clinical progression in advanced chronic liver disease","journal_title":"Clinical Gastroenterology and Hepatology","journal_issn":"1542-3565","published_at":"2026-06-17T00:00:00.000Z","url":"https://doi.org/10.1016/j.cgh.2026.06.011","source_score":15,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-25T13:25:21.577Z","updated_at":"2026-06-25T13:25:21.577Z","tags":[{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"condition","value":"Acute-on-Chronic Liver Failure","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"condition","value":"Advanced Chronic Liver Disease","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"condition","value":"Cirrhosis","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"generic","value":"albumin","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"generic","value":"copeptin","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"generic","value":"C-reactive protein","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"modality","value":"Biomarker-Guided Risk Stratification","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"sample_size","value":"n=464","value_numeric":464},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"study_design","value":"Prospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"warning","value":"Recompensation event rates were very low across all stages (0.9%–8%), limiting statistical confidence for those specific transitions.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied because the stage-specific biomarker framework directly informs a shift in therapeutic targets by disease stage, but this requires external validation before broad clinical adoption.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"warning","value":"The paper's DOI and publication date (June 2026) are in the future relative to most training data; content is taken at face value as provided.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.011","tag_type":"warning","value":"The study is registered as NCT03267615 (VICIS) and appears single-center; generalizability to diverse populations should be interpreted cautiously.","value_numeric":null}],"summaries":{"what_studied":"This prospective cohort study (VICIS; n=464) evaluated stage-specific biomarkers — portal hypertension (HVPG), endothelial dysfunction (VWF), fibrogenesis (ELF), liver function (MELD/albumin/bile acids), systemic inflammation (CRP/IL-6/procalcitonin), and circulatory dysfunction (proBNP/copeptin) — for their ability to predict clinical transitions across compensated ACLD, decompensated cirrhosis, and further decompensation/ACLF, over a median 35-month follow-up.","key_result":"In cACLD, 13% decompensated and 1.9% died from liver-related causes at 24 months; HVPG and albumin were independent prognostic markers. In decompensated cirrhosis, 19% progressed to further decompensation/ACLF and 6.1% died, with CRP as the key independent predictor. In further decompensation, 33% died at 12 months, with copeptin independently predictive.","limitations":"Single-center prospective cohort limits generalizability; recompensation rates were low, reducing power to analyze that transition; patients were enrolled at HVPG measurement, potentially selecting a more severe or evaluated subgroup.","practice_takeaway":"In compensated cirrhosis, prioritize reducing portal hypertension (e.g., target HVPG reduction) and optimizing albumin levels. 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Hepatol","doi-asserted-by":"crossref"}],"short-title":[],"update-policy":"https://doi.org/10.1097/lww.0000000000001000","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"original-title":[],"container-title":["Hepatology"],"reference-count":42,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,5,1]]},"references-count":42,"short-container-title":[],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1097/hep.0000000000001774","is_oa":false,"title":"Efficacy and safety of belapectin for the prevention of esophageal varices in patients with MASH cirrhosis: The randomized, placebo-controlled NAVIGATE trial","updated":"2026-05-06T13:23:02+00:00","published_date":"2026-05-01","best_oa_location":null}},"created_at":"2026-05-13T13:19:31.960Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"condition","value":"Esophageal Varices","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"condition","value":"MASH Cirrhosis","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"generic","value":"belapectin","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"modality","value":"Galectin Inhibitor","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"sample_size","value":"n=357","value_numeric":357},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"warning","value":"Brand name for belapectin was not mentioned in the abstract; no brand tag applied.","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"warning","value":"The full text body provided in the paper was a GI society statement on racism and social injustice, not the NAVIGATE trial manuscript — structured data were extracted solely from the abstract. Granular methodology, subgroup analyses, and safety details could not be verified from the full text.","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001774","tag_type":"warning","value":"The per-protocol population result (p=0.04) was a secondary/pre-specified analysis; the primary FAS endpoint did not achieve statistical significance (p=0.13). Impact flag set to 'limited_evidence' accordingly.","value_numeric":null}],"summaries":{"what_studied":"The NAVIGATE trial evaluated belapectin (2 mg/kg or 4 mg/kg IV lean body weight) versus placebo over 18 months for prevention of esophageal varices in patients with MASH cirrhosis and portal hypertension who had no varices at baseline (n=357 randomized).","key_result":"In the per-protocol population, belapectin 2 mg/kg reduced new variceal development by 50% vs. placebo (11.3% vs. 22.3%; unadjusted p=0.04). In the full analysis set, the reduction was 43.2% (10.1% vs. 17.8%) but did not reach significance (p=0.13). Belapectin 4 mg/kg showed no significant effect. The composite endpoint was not significantly different in either dose arm.","limitations":"- Primary endpoint in the full analysis set (FAS) did not reach statistical significance; the 50% reduction was only significant in the per-protocol population, a secondary analysis.\n- Phase 2b trial; underpowered to confirm efficacy definitively.\n- The full text provided was largely a GI society statement unrelated to the trial, limiting extraction of granular methodology and subgroup data.","practice_takeaway":"Belapectin 2 mg/kg may reduce new esophageal varix formation in MASH cirrhosis with portal hypertension, but results are not yet practice-changing — the primary endpoint missed significance. Clinicians should await phase 3 data before adopting this agent."}},{"doi":"10.1111/apt.70696","pmid":"42017265","title":"Global Longitudinal Assessment of\n MASLD\n Using Magnetic Resonance Elastography (\n GOLDMINE\n ): A Multi‐Center, International Prospective Cohort Study of Imaging Biomarkers in\n MASLD\n Clinical Outcomes","journal_title":"Alimentary Pharmacology & Therapeutics","journal_issn":"0269-2813","published_at":"2026-04-22T00:00:00.000Z","url":"https://doi.org/10.1111/apt.70696","source_score":13,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:50:53.220Z","updated_at":"2026-05-07T22:50:53.220Z","tags":[{"paper_doi":"10.1111/apt.70696","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"condition","value":"Hepatocellular Carcinoma","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"condition","value":"Liver Cirrhosis","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"condition","value":"Metabolic Dysfunction-Associated Steatotic Liver Disease","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"modality","value":"Magnetic Resonance Elastography","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"modality","value":"MRI Proton Density Fat Fraction","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"modality","value":"Vibration-Controlled Transient Elastography","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"sample_size","value":"n=1000","value_numeric":1000},{"paper_doi":"10.1111/apt.70696","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"study_design","value":"Prospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"warning","value":"Level of evidence assigned as 2 (prospective cohort) based on study design; final LOE may be re-evaluated once outcome data are published.","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"warning","value":"Sample size of 'up to 1000' is the enrollment target, not the confirmed enrolled total at time of publication.","value_numeric":null},{"paper_doi":"10.1111/apt.70696","tag_type":"warning","value":"This is a study protocol/design paper — no clinical outcome or biomarker performance data are presented yet.","value_numeric":null}],"summaries":{"what_studied":"The GOLDMINE study is a multi-center, international prospective cohort (up to 1,000 adults) designed to determine whether non-invasive imaging biomarkers — including MRI-PDFF and magnetic resonance elastography (MRE) — predict MASLD progression and liver-related clinical outcomes across the full fibrosis spectrum, with follow-up up to 10 years.","key_result":"This publication describes the study design and rationale; no outcome data are yet reported.","limitations":"- Study design paper only — no efficacy or predictive validity data available yet.\n- Enrollment is limited to adults with biopsy-proven MASLD or MASLD cirrhosis, which may limit generalizability to non-biopsy-confirmed populations.\n- Up to 10-year follow-up means definitive outcome results are years away.","practice_takeaway":"GOLDMINE will be a key resource for validating MRE and MRI-based biomarkers as non-invasive alternatives to serial biopsy in MASLD — clinicians should watch for outcome data from this cohort as it matures. For now, no practice change is supported by this design paper alone."}}],"initialOffset":13,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Portal Hypertension"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Portal Hypertension"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Portal Hypertension"}}}]]

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