TNF-like cytokine 1A (TL1A) and its functional receptor, death-domain receptor 3 (DR3), are members of the TNF and TNFR superfamilies, respectively, with recognised roles in regulating innate and adaptive immune responses; additional existence of a decoy receptor, DcR3, indicates a tightly regulated cytokine system. The significance of TL1A:DR3 signalling in the pathogenesis of inflammatory bowel disease (IBD) is supported by several converging lines of evidence. Herein, we aim to provide a comprehensive understanding of what is currently known regarding the TL1A/DR3 system in the context of I ..read more

We have read with interest the contribution by Bedke et al,1 reporting changes in the stool microbiota associated with primary sclerosing cholangitis (PSC) in human and murine models of the disease. These changes coincide with an expansion of FoxP3+T reg cells, a response also linked with luminal butyrate concentrations and/or other goods and services arising from select commensal bacteria.2 Furthermore, the authors find patients with PSC with an associated IBD (PSC-IBD) as well as mice receiving faecal transfer from such patients experience a milder form of IBD, or attenuation of colitis, res ..read more

International guidelines recommend that primary prophylaxis of varices in patients with cirrhosis be either non-selective beta-blockers (NSBBs) or variceal band ligation (VBL). These recommendations are based on studies that include both compensated and decompensated patients. Notably, the European Association for the Study of the Liver 2018 guidelines recognise a gap in the efficacy of NSBB therapy for patients with decompensated cirrhosis.1 The Baveno guidelines recommend preventing further decompensation in patients with ascites and high-risk varices (large varices >5 mm, or with red spo ..read more

With great interest, we read the article by Lou et al,1 who reported deviated gut microbiota in children with autism spectrum disorders (ASD). Recently, increasing studies have revealed abnormalities in extraneural tissues, particularly the gastrointestinal (GI) tract.2 Besides, the important role of lipids in the gut-brain axis of ASD is highlighted by their involvement in neurodevelopmental processes disrupted in ASD3 and their susceptibility to remodelling through intestinal intervention.4 In this study, we explored disrupted lipid profiles using lipidomics combined with single-cell transcr ..read more

We would like to offer some critical observations regarding the recent article published on the environmental impact of single-use (SU) versus reusable (RU) gastroscopes.1 The study provides essential insights into the growing concerns about the environmental effects of medical procedures, but we believe there are certain areas that require further clarification and contextual analysis. Specifically, the interpretation of the results in the discussion section, particularly concerning the carbon footprint comparison between SU and RU gastroscopes, leaves some important aspects unaddressed. Whil ..read more

Recently, we were intrigued by a recent study by Montironi et al,1 in which they discovered that an inflamed subclass in hepatocellular carcinoma (HCC) patients is associated with a response to immunotherapy. The authors used a 20-gene signature to distinguish these patients and further found different immune infiltration between inflamed and non-inflamed class at the bulk level. We commend the authors for undertaking this study, which holds significant clinical implications. We also observed that Li et al2 have validated the predictive value of inflamed class in two additional RNA-seq dataset ..read more

We extend our congratulations to Tevethia et al for their recently published ‘CAVARLY trial’, which suggests the combination of variceal band ligation (VBL) and carvedilol is superior to VBL or carvedilol alone in the reduction of the first episode of oesophageal variceal bleeding (OVB) in patients with high-risk varices.1 This is the first primary prophylaxis randomised control trial to examine combination therapy and provides some interesting results which require further thought. Despite significantly lower rates of OVB and mortality in the combination therapy group, other indicators of dis ..read more

Background Natural killer/T-cell lymphoma (NKTCL) is a highly aggressive malignancy with a dismal prognosis, and gaps remain in understanding the determinants influencing disease outcomes. Objective To characterise the gut microbiota feature and identify potential probiotics that could ameliorate the development of NKTCL. Design This cross-sectional study employed shotgun metagenomic sequencing to profile the gut microbiota in two Chinese NKTCL cohorts, with validation conducted in an independent Korean cohort. Univariable and multivariable Cox proportional hazards analyses were applied to ass ..read more

Clinical presentation A 34-year-old man presented to our institution for review with recurrent abdominal pain, constipation, lethargy, fevers and episodic migratory soft tissue severe cellulitis of the limbs after minimal exercise. This was on a background of a diagnosis of eosinophilic enterocolitis at the age of 10 when due to recurrent abdominal pain, endoscopy was performed with biopsies showing eosinophilic infiltration of the oesophagus, stomach, duodenum and colon. This had been treated with steroids in the past with clinical response. A variety of disease-modifying antirheumatic drugs ..read more

Background One in three children with Crohn’s disease develop perianal fistula complications (PFCs), among the most disturbing and difficult-to-treat disease-related complications. Retrospective evidence suggests PFCs may be preventable. Objective We aimed to determine if early antitumour necrosis factor-alpha (anti-TNF) therapy prevents PFC development in a well-characterised prospective cohort of paediatric patients with Crohn’s disease who were free from PFC at enrolment. Design RISK was a multicentre inception cohort of children newly diagnosed with Crohn’s disease. We included all patient ..read more