Environmental exposures may influence other established genetic risk loci for IBD and identifying the epigenetic modifications and characterising the pathways involved represent important goals for future research. Some smoking associated variants may act through behavioural alterations such as differences in reward pathways and impulsivity, and future work could look for interactions between these SNPs and IBD mediated by factors such as diet and treatment compliance.The drive for personalised care is central to much current research, and investigations into IBD and smoking are producing promising results such as demonstrating a varying treatment response between smokers and nonsmokers. 8 and clinical phenotype will be equally important.
ACKNOWLEDGEMENTSDeclaration of personal interests: None.
FUN DING INF ORMATIONJS has served as a speaker for Falk, Ferring UK, and Takeda, and has received research funding from AbbVie.
O R C I DA. Adams http://orcid.org/0000-0001-9364-8540 Our goal has been to shed light on potential variant-environment modulations that could be used to identify patient sub-populations with differential risk for severe disease. Our study focused on smoking, and smoking prevalence unfortunately remains high in IBD patients. 7 However, further such relationships will likely exist but may be less obvious to detect. The proposal in the editorial by Adams, Kalla, and Satsangi of diet and treatment compliance are welcome suggestions, though much harder to assess in patients. The hard work, however, will begin when it comes to the validation of these associations and the subsequent application of these findings to patients.
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ACKNOWLEDGEMENTSThe authors' declarations of personal and financial interests are unchanged from those in the original article. Editorial: hepatocellular carcinoma risk in the era of direct-acting anti-virals-is the case closed?Reig et al first reported a high HCC recurrence rate of 28% among a retrospective cohort of 58 direct-acting-antiviral (DAA)-treated HCCcured patients, 1 with a similar finding from Italy. 2 Does DAA therapy increase HCC recurrence in those "cured" of HCC is the key question rather than development of de novo HCC after HCV SVR. The approach to this question is 3-fold.The first is to standardise the reporting method (use of hazard ratios and Kaplan-Meier graphs). Camma et al re-analysed the Reig data and found that the recurrence rate was actually 13% at 1 year.
3When imaging studies show no evidence of HCC, subclinical HCC cannot be discounted, and in the Reig paper, 7/16 of those with HCC recurrence had abnormal AFP levels at the time of starting