BackgroundConcomitant chronic hepatitis B infection (CHB) and non-alcoholic fatty liver disease (NAFLD) is common, but the implications of NAFLD on clinical outcomes of CHB, including hepatocellular carcinoma (HCC), are not well-investigated. MethodsCHB patients were recruited for transient elastography assessment for liver stiffness (LS), and controlled attenuation parameter (CAP), a non-invasive quanti cation of hepatic steatosis, and were prospectively followed up for development of HCC. Steatosis and severe steatosis were diagnosed by CAP ≥248 dB/m and ≥280 dB/m respectively, and advanced brosis/ cirrhosis was diagnosed by LS ≥9 kPa. The independent effect of hepatic steatosis on HCC was examined via propensity score matching (PSM) of LS and other signi cant clinical variables. ResultsForty-eight patients developed HCC among 2403 CHB patients (55.6% male, median age 55.6 years, 57.1% antiviral-treated, median ALT 26 U/L) during a median follow-up of 46.4 months. Multivariate Cox regression analysis showed age (HR 1.063), male (HR 2.032), Albumin-Bilirubin score (HR 2.393) and CAP (HR 0.993) were associated with HCC development. The cumulative probability of HCC was 2.88%, 1.56% and 0.71%, respectively for patients with no steatosis, mild-to-moderate steatosis, and severe steatosis, respectively (p=0.01). The risk of HCC increased from 1.56% to 8.89% in patients without severe steatosis if advanced brosis/cirrhosis were present (p<0.001). PSM yielded 957 pairs of CHB patients and hepatic steatosis was independently associated with HCC (HR 0.41). ConclusionReduced hepatic steatosis was signi cantly associated with a higher risk of incident HCC in CHB infection. Routine CAP and LS measurements are important for risk strati cation.

Background The success rate of conventional Helicobacter pylori eradication therapy is declining, due to rising antibiotic resistance. Objectives To determine the temporal effects of prior antibiotic exposure on eradication outcome. Patients and methods This is a retrospective cohort study including all H. pylori-infected patients who received their first course of clarithromycin-containing triple therapy in 2003–18. Prior antibiotic exposures before H. pylori eradication therapy (up to 180 days, 1 year or 3 years) were retrieved. A logistic regression model was used to evaluate the association between different timings of previous antibiotic exposure, recent (within 30/60 days) or distant period, and the need for retreatment for H. pylori. Results A total of 120 787 H. pylori-infected patients were included. Prior exposure to any antibiotics within 180 days was associated with a higher risk of retreatment (OR 1.18, 95% CI 1.13–1.24) and the risk progressively increased with longer duration of antibiotic use. The results were consistent for prior exposure up to 1 year (OR 1.26, 95% CI 1.20–1.31) or 3 years (OR 1.30, 95% CI 1.25–1.35). However, when compared with those without prior antibiotic exposure, recent exposure (within 30 days) did not increase the risk of retreatment, which was consistent for analysis with prior antibiotic exposure up to 3 years. Notably, recent use of cephalosporins within 30/60 days and nitroimidazole within 30 days had significantly lower risks of retreatment. Conclusions Any prior antibiotic exposure increased the risk of treatment failure of clarithromycin-containing triple therapy. Recent exposures to some classes of antibiotics may paradoxically increase treatment success.

Background Failure rates of clarithromycin‐containing triple therapy for H. pylori are rising. To determine the trend of failure rates of clarithromycin‐containing triple therapy in different age groups in Hong Kong over the past 15 years. Materials and Methods This is a population‐based retrospective age‐period‐cohort study involving all adult H. pylori‐infected patients who had received the first course of clarithromycin‐containing triple therapy in 2003–2017. Failed eradication was identified by the need of retreatment within 2 years of eradication. Logistic regression model was used to characterize the risk of retreatment. Results 113,526 H. pylori‐infected patients were included. The overall failure rate increased from 4.83% in 2003 to 10.2% in 2016 (p for linear trend <0.001). When stratified by age of eradication, patients 75 years or above had the lowest retreatment rate of 5.11%, which progressively increased in younger patients (60–74 years: OR 1.26, 95% CI 1.15–1.38; 45–59 years: OR 1.36, 95% CI 1.24–1.48; 18–44 years: OR 1.55, 95% CI 1.41–1.69). The results remained consistent when stratified by year of birth, and period of eradication. Other risk factors for retreatment included female (OR 1.24, 95% CI 1.18–1.30), triple therapy containing metronidazole (OR 2.30, 95% CI 2.12–2.50), and shorter duration of therapy (10 days: OR 0.88, 95% CI 0.79–0.97; 14 days: OR 0.67, 95% CI 0.58–0.77 vs 7 days). Conclusions While failure rates of clarithromycin‐containing triple therapy progressively increased over the past 15 years, the failure rate was particularly high among younger patients, which could undermine the potential benefits of early H. pylori eradication.