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Low‐dose aspirin is commonly used for primary or secondary prophylaxis against cardiovascular disease in older people. However, the potential risk of upper gastrointestinal (UGI) ulceration and bleeding associated with low‐dose aspirin use is often not appreciated by prescribers and older consumers. Among 133 serial patients with UGI bleeding, aspirin‐users aged ≥70 years had a ninefold increased likelihood of overt UGI bleeding compared with non‐users, reducing by 90% in regular proton‐pump inhibitor users (adjusted odds ratio 0.10). We recommend risk‐versus‐benefit discussions when recommending aspirin to older people. [ABSTRACT FROM AUTHOR]

Background: Early and accurate non‐invasive diagnosis of liver fibrosis is important for reducing the burden of cirrhosis and related complications. Aim: This cross‐sectional study compares shear wave elastography (SWE), transient elastography (TE) and clinical markers of chronic liver disease in patients with various liver disorders. Methods: Liver ultrasound with SWE was performed on 421 adult patients, 227 of whom also had TE. Patient age, gender, body mass index (BMI), liver disease aetiology and laboratory results were recorded. Associations between SWE, TE and other tests for liver fibrosis and chronic liver disease severity were sought. Advanced liver fibrosis was defined as liver stiffness measurement (LSM) equivalent to ≥F3 using Metavir staging. Results: Patients were predominantly male (68%), with mean (standard deviation) age 54 (13) years, BMI 28 (6) kg/m2 and serum alanine aminotransferase (ALT) 39 (27) U/L. Liver disorders were predominantly non‐alcoholic fatty liver disease (NAFLD), chronic hepatitis B (CHB), chronic hepatitis C (CHC) and alcohol‐related liver disease. The median (interquartile range) LSM was 10 (6–20) kPa with SWE and 9.2 (6–21) kPa with TE. Advanced liver fibrosis was associated with older age, higher BMI, model for end‐stage liver disease score, aspartate aminotransferase (AST), AST/ALT ratio, AST to platelet ratio index, fibrosis‐4 index and Hepascore. SWE and TE LSM were positively correlated, particularly for NAFLD and CHC. SWE LSM predicted ultrasound and endoscopy‐diagnosed portal hypertension and oesophageal varices. Conclusions: Across various liver diseases, SWE is at least comparable with TE and other non‐invasive tests of liver fibrosis. SWE is accurate for predicting liver‐related portal hypertension. [ABSTRACT FROM AUTHOR]

The article talks about Non-variceal upper gastrointestinal bleeding (UGIB) resulting from gastro duodenal ulcer haemorrhage, which is a common cause of hospitalisation in middle-aged and older Australians. Mentions aspirin is the most common antiplatelet agent used at low dose for the prevention of cardiovascular events; however, low-dose enteric-coated aspirin has not fulfilled the expectation of reducing gastroduodenal ulceration and bleeding.

LINKED CONTENT: This article is linked to Lazarus et al papers. To view these articles, visit https://doi.org/10.1111/apt.16720 and https://doi.org/10.1111/apt.16768 [ABSTRACT FROM AUTHOR]

Background: Up to 3% of methotrexate (MTX)‐treated rheumatoid arthritis (RA) patients might develop liver fibrosis or cirrhosis, requiring effective screening algorithms. Aims: To assess the utility of non‐invasive liver fibrosis assessment in RA patients on MTX. Methods: Fifty‐six patients were recruited from rheumatology outpatient clinics in a public tertiary centre from July 2017 to October 2018. Clinical data was collected. Screening for hepatic fibrosis was performed using transient elastography (TE), aminoaspartate transaminase to platelet ratio index (APRI), Hepascore and Fibrosis‐4 index (FIB‐4). Those with suspected significant liver fibrosis based on these screening tests were assessed by a hepatologist. Results: Twenty‐seven patients were suspected to have liver fibrosis on screening, including 10/56 (18%) by TE, 20/56 (36%) by Hepascore, 2/56 by APRI (4%) and 1/56 by FIB‐4 (2%). Of these 27 patients, 11 were reviewed by a hepatologist and one diagnosed with significant liver fibrosis. TE, but not APRI, Hepascore or FIB‐4, was found to have 100% sensitivity and 84% specificity (P = 0.029) for hepatologist‐diagnosed liver fibrosis. Conclusion: Liver fibrosis develops in a minority of MTX‐treated RA patients. The present study suggests that TE is a more sensitive screening test than APRI, FIB‐4 or Hepascore in the identification of people with RA at risk of hepatic fibrosis. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Globally, B‐mode ultrasound is the most common modality used for the diagnosis of hepatic steatosis. We aimed to assess the correlation between qualitative liver ultrasound parameters, attenuation imaging (ATI) and histopathology‐diagnosed steatosis grade obtained from liver biopsy. Our secondary aim was to examine the interobserver variability of qualitative ultrasound features.A retrospective cohort study was performed which included adult patients (age ≥ 18 years) who had same‐day liver ultrasound, ATI and liver biopsy for grading hepatic steatosis severity between 2018 and 2022. The qualitative US features for hepatic steatosis were independently scored by three radiologists and interobserver variability was examined. Histologic steatosis grade, ATI and qualitative ultrasound parameters were compared.Ninety patients were included; 67% female with a median age of 54 (IQR 39–65) years. The radiologist's overall impression had the highest correlation (very strongly correlated) with histologic steatosis grade (r = 0.82, P < 0.001). ATI coefficient and all qualitative ultrasound B‐mode features except for liver echotexture and focal fat sparing were strongly correlated with histologic steatosis grade (r ≥ 0.70, P < 0.001). Most qualitative ultrasound features had good agreement between observers (Kappa statistic 0.61–1.0, P < 0.001), (Kendall coefficient 0.92, P < 0.001).The examined qualitative ultrasound parameters and ATI had good‐excellent performance for diagnosing clinically significant hepatic steatosis; however, the radiologist's overall impression had the best correlation with histologic steatosis grade. Our findings suggest an ongoing role for qualitative liver ultrasound assessment of hepatic steatosis despite the emergence of newer quantitative measures. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic steatosis duration and severity are risk factors for liver fibrosis and cardiometabolic disease. We assessed the diagnostic accuracy of attenuation imaging (ATI), compared with histologic hepatosteatosis grading in adults with varied suspected liver pathologies. Methods: Liver biopsy was performed on 76 patients (51 women, 25 men) with non‐malignant diffuse parenchymal liver disease, within 4 weeks of multiparametric liver ultrasound including attenuation imaging (ATI). Skin‐liver capsule distance (SCD) and body mass index (BMI) were measured. Histologic steatosis was graded none (S0), mild (S1), moderate (S2) or severe (S3). We compared histology and sonographic parameters. Results: The median patient age was 50.5 (range 18–83) years and BMI 28.9 kg/m2 (interquartile range 24.0–33.3). The distribution of histologic steatosis grade was S0 (44%), S1(17%), S2(30%) and S3(9%). Median ATI value for each biopsy steatosis grade was 0.60 (IQR: 0.52–0.65), 0.65 (IQR: 0.6–0.71), 0.83 (IQR: 0.74–0.90) and 0.90 (IQR: 0.82–1.01) dB/cm/MHz for S0, S1, S2 and S3, respectively. The AUC of ATI for detection of any steatosis (S1‐S3) and moderate to severe steatosis (S2‐S3) was 0.85 (95% CI: 0.75–0.91) and 0.91 (95% CI: 0.83–0.99) with cut‐offs of 0.55 and 0.62 dB/cm/MHz. ATI threshold of 0.74 dB/cm/MHz was able to discriminate between S0‐S1 and S2‐3 with accuracy, CI and kappa statistic of 0.8889, 0.65–0.98 and 0.7534. Conclusion: We found a good correlation between ATI and steatosis grade. The most accurate discrimination was between none to mild (S0‐1) and moderate to severe (S2‐3) steatosis. [ABSTRACT FROM AUTHOR]

Background: Cannabis is one of the most common non‐prescribed psychoactive substances used in pregnancy. The prevalence of gestational cannabis use is increasing. Aim: The aim was to examine the prevalence of gestational cannabis use and associated pregnancy and neonate outcomes. Materials and Methods: A retrospective observational study involving pregnant women delivering in 2019 was conducted at a tertiary hospital in Perth, Western Australia. Gestational cannabis and other substance use records were based on maternal self‐report. Pregnancy outcomes included neonatal gestational age, birthweight, birth length, head circumference, resuscitation measures, special care nursery admission, 5‐min Apgar score and initial neonatal feeding method. Results: Among 3104 pregnant women (mean age: 31 years), gestational cannabis use was reported by 1.6% (n = 50). Cannabis users were younger, more likely to use other substances and experience mental illness or domestic violence compared with non‐users. Neonates born to cannabis users had a lower mean gestational age, birthweight and birth length compared to those born to non‐cannabis users. Gestational cannabis use (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.6–6.7) and tobacco smoking (OR 2.2, 95% CI 1.5–3.6) were associated with increased odds of a low‐birthweight neonate. Combined cannabis and tobacco use during pregnancy further increased the likelihood of low birthweight (LBW, adjusted OR 3.9, 95% CI 1.6–9.3). Multivariate logistic regression analysis adjusted for maternal sociodemographical characteristics, mental illness, alcohol, tobacco and other substance use demonstrated gestational cannabis use to be independently associated with LBW (OR 2.3, 95% CI 1.1–5.2). Conclusion: Gestational cannabis use was independently associated with low birthweight, synergistically affected by tobacco smoking. [ABSTRACT FROM AUTHOR]