Liver & Colorectal Conditions: How New Data Will Impact Care

This transcript has been edited for clarity. Hello. I’m Dr David Johnson, 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. Welcome back to highlights from Digestive Disease Week (DDW) 2026. In part 1, I covered studies related to the upper gastrointestinal tract through the pancreas. In part 2, I’ll focus on the liver and colon. There’s a lot of exciting data, so let’s get started. 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.[1] 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.[2]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.[3]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.[4]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. Blood-Based HCC Screening Outperforms Ultrasound A follow-up analysis of the ALTUS study was presented, comparing a multitarget blood test with ultrasound for HCC detection.[5]Prior results were presented as a late-breaking presentation at the AASLD meeting in November.[6] In that presentation, investigators showed that the blood test had a threefold higher early-stage sensitivity for HCC than ultrasound (66.7% vs 22.2%) in a head-to-head comparison.In this follow-up of 2293 patients, 37 cases of HCC were detected. The blood test demonstrated higher sensitivity than ultrasound in patients with BMI 2 cm of the perianal fistulas in at least two or three dimensions confirmed by MRI results. Guselkumab achieved an approximate 28% improvement in remission compared with control. This is the first randomized controlled trial to evaluate an IL-23p19 antagonist in perianal fistulizing Crohn’s disease, marking a promising step forward in this difficult-to-treat population.DDW 2026 delivered a wealth of impactful findings. I hope these highlights help inform your clinical practice and ultimately improve patient care. We look forward to seeing these studies published in full. I’m Dr David Johnson. Thanks again for listening. David A. Johnson, MD, a regular contributor to Medscape, is 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, and a past president of the American College of Gastroenterology. His primary focus is the clinical practice of gastroenterology. He has published extensively in the internal medicine/gastroenterology literature, with principal research interests in esophageal and colon disease, and more recently in sleep and microbiome effects on gastrointestinal health and disease.