Digestive Disease Week (DDW) 2026 Highlights: Part 2
David A. Johnson, MD
Professor of medicine and chief of gastroenterology at Eastern Virginia Medical School/Macon & Joan Brock Virginia Health Sciences at Old Dominion University in Norfolk, Virginia.
Spontaneous Bacterial Peritonitis (SBP) Care Shows Gaps
In 2021, the American Association for the Study of Liver Diseases (AASLD) updated its guidelines for ascites and SBP. They provided a strong, class I recommendation to use intravenous (IV) albumin to prevent renal failure and improve survival, particularly in high-risk patients (eg, those with renal impairment or sepsis).
This study evaluated real-world adherence using the Nationwide Readmissions Database (2021-2022). Among 27,728 admissions of adults with SBP and concurrent cirrhosis, only 1.4% received albumin. Even among high-risk patients (renal failure, sepsis, or Child-Pugh class C), use was just 1.8% and declined from 1.5% in 2021 to 1.2% in 2022.
Although the analysis did not demonstrate a significant mortality benefit to albumin use, this is probably reflective of extremely low utilization and confounding. However, the key takeaway should be clear: This is a major quality gap, and adherence to guideline-based care must improve.
Cirrhosis Care Should Include Oral Health
Two studies highlighted the importance of oral health in patients with liver disease.
First, at a Veterans Affairs (VA) center in Richmond, Virginia, researchers found that over half of patients with cirrhosis had periodontal disease requiring treatment, yet only 14% received care.
Second, a national VA analysis (2005-2023) showed that patients with compensated cirrhosis who received regular dental care (at least one visit a year) had a lower risk for complications, including reductions in ascites (-11%), hepatic encephalopathy (-14%), hepatocellular carcinoma (HCC; -27%), all-cause hospitalizations (-13%), and liver-related hospitalizations (-15%) than matched patients who did not receive regular dental care.
These studies reinforce the importance of integrating oral health into cirrhosis care. As gastroenterologists and hepatologists, we may need think a bit more like dentists when managing these patients.
GLP-1s Show Broad Benefits in Cirrhosis
A study evaluating GLP-1 receptor agonists used the MarketScan database to analyze more than 400,000 patients with cirrhosis.
Investigators found that GLP-1 receptor agonist use was associated with a significantly lower risk for hepatic decompensation (-50%), liver transplantation (-56%), HCC (-52%), nonliver cancers (-50%), coronary vascular disease (-35%), and chronic kidney disease (-36%).
These findings suggest that incretin-based therapies may offer pleotropic benefits extending well beyond weight loss, particularly in patients with cirrhosis.
