BACKGROUND & AIMS:Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) have increased in prevalence alongside the global epidemics of obesity and type 2 diabetes and now represent one of the leading causes of chronic liver disease. Patients with MASLD and significant fibrosis (≥F2) are at increased risk for adverse outcomes. With advances in noninvasive tests (NITs) and the recent approval of resmetirom and semaglutide for noncirrhotic MASH with F2-F3 fibrosis, we provide updated consensus guidance on standardized risk stratification, treatment initiation, and response monitoring. METHODS:A structured Delphi process was conducted following a systematic updated literature review (January 2025-November 2025), covering the period since publication of the initial consensus recommendations, and included iterative anonymous voting among 40 international experts representing hepatology, gastroenterology, endocrinology, internal medicine, and primary care. Consensus was predefined as ≥70% agreement. RESULTS:Forty-two statements were developed; 86% achieved consensus in the first round, and all remaining statements reached consensus after refinement and the second round. The panel endorsed a sequential risk-stratification strategy beginning with Fibrosis-4 Index (FIB-4) as the first-line assessment, followed by vibration-controlled transient elastography or Enhanced Liver Fibrosis (ELF) testing for secondary stratification. Treatment consideration with resmetirom or semaglutide was supported for noncirrhotic MASLD with liver stiffness measurement values of 10 to 20 kPa or ELF values of 9.2 to 11.3, after exclusion of cirrhosis. Upfront combination therapy with both drugs was not recommended. Selection of pharmacologic therapy was to be determined through shared decision-making between patient and provider and individualized according to the patient's cardiometabolic profile. Treatment response at 1 year was defined as a ≥30% reduction in liver stiffness or a ≥0.5-point reduction in ELF. CONCLUSIONS:This updated international consensus provides practical algorithms that integrate most commonly used noninvasive testing with recently approved pharmacologic therapies for MASLD, addressing current variability in clinical practice and supporting standardized implementation of risk-based care.

Introduction and Objectives People deprived of liberty represent a high-risk population for hepatitis C virus (HCV) infection and an important target for microelimination strategies. However, data regarding incarcerated women in Latin America remain scarce. This study aimed to determine HCV prevalence and associated risk factors among incarcerated women in Mexico within a national HCV elimination program. Materials and Methods A prospective cross-sectional study was conducted in a women’s correctional facility in Morelos, Mexico. Incarcerated women aged 18 years underwent rapid screening for HCV, HIV, and syphilis. Reactive HCV tests were confirmed by polymerase chain reaction. Substance use, mental health, and quality of life were evaluated using validated questionnaires. Univariable and multivariable logistic regression analyses were performed to identify factors associated with HCV seropositivity. Results A total of 318 women were screened. Median age was 36 years (IQR 29–43). Eleven participants tested positive for HCV, corresponding to a prevalence of 3.46%, substantially higher than estimates for the general Mexican population. HCV-positive individuals had significantly higher DAST-20 scores (p<0.001), higher depression (p=0.003) and anxiety scores (p=0.047), and lower quality-of-life scores (p<0.001). Significant behavioral risk factors included accidental needlestick injuries (OR 8.46, 95% CI 2.29–31.27), sharing personal objects (OR 20.44, 95% CI 5.5–75.26) and reuse of syringes (OR 6.0, 95% CI 1.14–31.46). In multivariable analysis, substance use severity and cumulative risk burden remained independently associated with HCV infection. Conclusions HCV prevalence among incarcerated women in Mexico was markedly higher than in the general population, supporting correctional facilities as key targets for integrated HCV microelimination strategies.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a heterogeneous and multisystemic condition in which cardiovascular disease remains the leading cause of mortality. Paradoxically, cardiovascular risk in MASLD is itself highly variable and cannot be fully explained by the degree of hepatic involvement or the presence of conventional cardiometabolic risk factors. This clinical disconnect underscores the need for novel pathophysiological models that go beyond traditional paradigms. In this review, we propose a hypothesis-generating framework in which microbial L-histidine metabolism, particularly its biotransformation into imidazole propionate (ImP) through the bacterial urdA pathway, may contribute to the gut-liver-vascular crosstalk observed in MASLD. Availabble evidence suggests a dual mechanism: depletion of bioavailable histidine, which may impair protective signaling through TAAR1, and systemic accumulation of ImP, a bioactive metabolite that has been shown in experimental models to interfere with insulin signaling in hepatocytes and activates proinflammatory and proatherogenic cascades in endothelial tissue. Based on this evidence, we introduce the ImP⁺/urdA^high profile as a putative functional biotype that may help generate testable hypotheses for microbiota-guided risk stratification in MASLD. Future studies should determine whether this profile identifies patients with residual cardiometabolic risk and whether targeted modulation of the histidine-ImP axis can improve hepatic or vascular outcomes.

Chronic hepatitis C virus (HCV) infection remains a major global public health challenge. Despite the availability of highly effective therapies capable of curing the vast majority of patients, millions remain undiagnosed and often present for medical care at advanced stages of disease. This delay not only increases mortality and the burden of cirrhosis and hepatocellular carcinoma but also affects quality of life, productivity, and healthcare system costs. In this context, screening emerges as a cornerstone for achieving HCV elimination. It enables the identification of hidden cases, early treatment initiation, prevention of complications, and reduction of community transmission. At the population level, prioritizing individuals with the highest likelihood of transmitting infection produces a multiplier effect, while both universal and risk-based strategies have consistently proven cost-effective, generating medium-term savings. In Latin America, the epidemiological landscape is heterogeneous. While overall prevalence in the general population is relatively low, high endemicity persists in vulnerable groups such as people who inject drugs, incarcerated individuals, and patients undergoing hemodialysis. Major barriers include fragmented health systems, lack of clinical registries, stigma, and restricted access to diagnosis and therapy. Yet, the region also holds clear opportunities: simplified diagnostic pathways using rapid testing and reflex algorithms, micro-elimination in key populations, pooled procurement of antivirals through the Pan American Health Organization, and the integration of digital health and telemedicine. In conclusion, HCV screening constitutes both a public health necessity and an ethical obligation. Its organized and sustainable implementation is essential to translate therapeutic efficacy into collective benefit and to accelerate progress toward the elimination of hepatitis C.

Metabolic hepatic steatosis (MetHS) is a clinically heterogeneous, multisystemic, dynamic, and complex disease, whose progression is one of the main causes of cirrhosis and hepatocarcinoma. This clinical practice guideline aims to respond to its main challenges, both in terms of disease burden and complexity. To this end, recommendations have been proposed to experts through the Delphi method. The consensus was optimal in recommendations regarding type 2 diabetes as a risk factor (1.5.1, 4.5.1), in which cases early detection of MetHS should be carried out (4.5.2). Its results also emphasize the importance of the use of non-invasive tests (FIB-4, NFS, HFS) for the exclusion of significant fibrosis in patients with suspected MetHS (2.3.1, 2.3.3). Diagnosis should be carried out through the sequential combination of non-invasive indices and transient elastography by FibroScan® for its risk stratification (2.3.3). A nearly unanimous consensus was reached regarding the role of early prevention in the impact on the quality of life and survival of patients (5.1.2), as well as on the effectiveness of the Mediterranean diet and physical exercise in relation to the improvement of steatosis, steatohepatitis and fibrosis in MetHS patients (5.2.2) and on the positive results offered by resmiterom and semaglutide in promoting fibrosis regression (5.4.1). Finally, a great consensus has been reached regarding the importance of multidisciplinary management in MetHS, for which it is essential to agree on multidisciplinary protocols for referral between levels in each health area (6.2.1), as well as ensuring that referrals to Hepatology/Digestive and Endocrinology or Internal Medicine services are effective and beneficial to prevent the risk of disease progression (6.2.3, 6.3.1).

BACKGROUND & AIMS:Noninvasive tests (NITs) are widely used to risk-stratify patients with metabolic dysfunction-associated steatotic liver disease (MASLD); however, their performance may vary according to patient characteristics. We evaluated the accuracy of NITs in a large, multinational MASLD cohort across select subpopulations. METHODS:We analyzed 18,759 adults with biopsy-confirmed MASLD from 41 countries. NITs included FIB-4, liver stiffness measurement (LSM), and Agile-3+. Diagnostic performance for advanced fibrosis (F3-F4) was measured using areas under the curve (AUCs) across subgroups defined by age, sex, type 2 diabetes (T2D), obesity, and alcohol use. Subgroup-specific cutoffs were derived. RESULTS:Advanced fibrosis was present in 37% of patients. Pooled AUCs were 0.79 for FIB-4, 0.83 for LSM, and 0.86 for Agile-3+. FIB-4 accuracy declined with age (AUC 0.70 in ≥65 years vs 0.79 in <65 years, P < .0001) and in middle-aged patients with T2D. The LSM performance remained stable across T2D status but was moderately reduced in patients with obesity and, more profoundly, morbid obesity (body mass index [BMI] >35 kg/m2). Sex and alcohol use had minimal impact on AUCs. Age- and T2D-specific FIB-4 cutoffs varied substantially to maintain predefined accuracy (sensitivity or specificity). The cutoffs for LSM also differed based on patients' BMI, with lower diagnostic cutoffs for advanced fibrosis required in nonobese MASLD (sensitivity 80%: 8.8 kPa in lean, 9.0 kPa overweight, 9.6 kPa in obesity, 11.0 kPa in morbid obesity). CONCLUSIONS:Accuracy of NITs for advanced fibrosis in MASLD is influenced by age, T2D, and obesity. Age-adjusted FIB-4 thresholds may enhance risk stratification. Imaging-based and composite NITs (LSM and Agile-3+) provide more consistent performance across MASLD subpopulations.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide, distinguished by pronounced clinical heterogeneity and a frequent dissociation between metabolic risk factors and the degree of hepatic injury. These observations, together with the limited contribution of genetic heritability, have prompted a re-evaluation of the traditional conceptual framework of the disease. In this context, the question has emerged as to whether MASLD could be, at least in part, a transmissible condition. While there is no evidence to suggest that MASLD is contagious in humans, as no data support person-to-person transmission, gnotobiotic animal studies demonstrate that human gut microbiota can transfer susceptibility to steatosis, inflammation, and systemic metabolic disturbances through immunometabolic mechanisms, independent of host genetics. In parallel, human studies involving microbiota-targeted interventions support the concept that the gut ecosystem is a modifiable determinant of metabolic and hepatic phenotypes. Crucially, these findings do not imply natural transmission of disease, but rather underscore the functional plasticity of microbiota-host interactions. This narrative review integrates epidemiological, experimental, and clinical data to explore the hypothesis that MASLD may be functionally transmissible. MASLD is increasingly recognized as an eco-biological disease, where liver disease risk is not only shaped by host genetics and environment, but also by the ecological configuration and functional outputs of the gut microbiome. This perspective redefines disease susceptibility as, in part, context-dependent and microbiota-mediated, without implying infectiousness in the traditional sense.

The Spanish Society of Gastroenterology (SEPD) has developed a position paper on the strategic analysis of the gastroenterology specialty in relation to the current situation and future outlook of the Spanish healthcare system. The analysis and its proposals were based on the consensus of a group of experts with recognized expertise in the specialty, selected by the ESG, who conducted an external and internal analysis and developed the SWOT and CAME matrices to identify strategic lines and general objectives for the gastroenterology specialty. As a result of this analysis, six strategic lines were defined: 1. to develop the concept of "comprehensive digestive health"; 2. to contribute to the transformation of the healthcare system towards a model of care that more effectively achieves the "quintuple aim"; 3. to adapt the training of gastroenterology specialists to current needs, both in specialty training and in continuing professional development; 4. improve the quality of digestive healthcare; and 5. ensure an adequate level of quality across all centres and regions, promote research and innovation, and 6. To position the gastroenterology specialty as a reference for healthcare policy decision-making and for the society. These strategic priorities should help position the specialty of Gastroenterology as a key area for public health, technological innovation, quality of care, and the sustainability of the Spanish National Health System.