Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease in Bosnia and Herzegovina and a major contributor to liver- and cardiovascular-related morbidity and mortality. These national guidelines provide the first country-specific, evidence-based recommendations for the diagnosis, risk stratification, and management of MASLD, covering the full disease spectrum from steatosis to cirrhosis and its complications. MASLD management is based on a coordinated, stepwise model across primary, secondary, and tertiary healthcare levels, with primary healthcare serving as the central gatekeeper and coordinator of care. Active case-finding of clinically significant fibrosis is emphasized, particularly in high-risk populations, such as individuals with type 2 diabetes mellitus or obesity. Primary healthcare plays a key role in early risk assessment through systematic evaluation of metabolic risk factors and first-line use of simple non-invasive tools, notably the FIB-4 index. A stepwise non-invasive diagnostic algorithm is recommended, with elastography (preferably vibration-controlled transient elastography or 2D shear wave elastography where available) used for further assessment in patients with indeterminate or high-risk results. Lifestyle modification and optimal management of cardiometabolic comorbidities remain the foundations of MASLD treatment. In eligible patients with type 2 diabetes mellitus and/or overweight or obesity, glucagon-like peptide-1 receptor agonists may be considered, while bariatric surgery represents an option for selected individuals with persistent obesity. Advanced MASLD, including cirrhosis, requires multidisciplinary management, surveillance for hepatocellular carcinoma, and evaluation for liver transplantation in cases of decompensation. These guidelines aim to standardize MASLD care in Bosnia and Herzegovina and strengthen the pivotal role of primary healthcare within the national MASLD care pathway.

Background Proton pump inhibitors (PPIs) are widely used for the treatment of acid-related disorders, but inappropriate or prolonged use carries potential health risks. Physicians, due to their access to medication and clinical knowledge, may be prone to self-medicating with PPIs without appropriate oversight. Objective To assess the prevalence and patterns of personal PPI use and self-medication among practicing physicians in Bosnia and Herzegovina, and to identify demographic and professional predictors of such behavior. Methods A cross-sectional, questionnaire-based survey was conducted among 448 physicians who responded to the study invitation, out of approximately 600 invited, from various healthcare levels in Bosnia and Herzegovina between January and May 2025. The survey collected data on PPI use history, consultation behavior, awareness of adverse effects, and adherence to treatment guidelines. Multivariable logistic regression was used to identify independent predictors of self-medication. Results A total of 65.4% of respondents reported past PPI use, during their medical practice, and 31.7% were current users. Over half (52.2%) admitted using PPIs without consulting another physician, and only 17.4% referred to clinical guidelines prior to use. Occasional use was the most common pattern (59.0%), while adverse effects were rarely reported (1.8%). No demographic or professional variable was significantly associated with self-medication with PPIs (defined as PPI use without consulting another physician) in the multivariable analysis. Conclusion Self-medication with PPIs is highly prevalent among physicians and frequently occurs without clinical consultation or adherence to guidelines. This behavior appears to be widespread across age groups, sexes, and care levels, highlighting the need for institutional interventions that promote rational prescribing and raise awareness about responsible self-care within the medical profession.

In this editorial, we comment on the article published by Qiu et al. Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention. Ultrasound (US)-guided techniques - whether needle aspiration (NA) or catheter drainage - are key minimally invasive treatments, especially in patients with multiple or deep-seated abscesses where conventional surgery is often impractical. The timing and choice of evacuation method significantly influence clinical outcomes. Although catheter drainage may be necessary for larger or refractory collections, NA represents a less invasive alternative that is often sufficient for smaller abscesses - particularly multiloculated ones - and can avoid multiple catheter placements. This consideration is especially important in the early phase of the disease, when the abscess collection is poorly demarcated from surrounding tissue and more prone to bleeding during or after intervention. Traditional practice delays intervention until liquefaction occurs; however, emerging evidence supports early US-guided evacuation - even in partially liquefied or non-liquefied abscesses - as both safe and effective. Early intervention, particularly via NA when feasible, is associated with faster symptom resolution, shorter hospitalization, and fewer complications. This editorial explores the role of US-guided interventions in pyogenic liver abscess manaement, emphasizing the importance of individualized, timely approaches that optimize disease outcomes while minimizing procedural risk.

The liver is a central metabolic organ that regulates numerous physiological processes, including glucose and lipid metabolism, detoxification, and the synthesis of essential proteins and bile. Bile acids (BAs), synthesized from cholesterol in hepatocytes, not only facilitate the emulsification and absorption of dietary fats but also act as potent signaling molecules through receptors such as the farnesoid X receptor (FXR) and Takeda G-protein-coupled receptor 5. Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease globally, closely linked with obesity, insulin resistance, and other components of metabolic syndrome. In MASLD, the metabolism of BAs is markedly disrupted, resulting in alterations in their synthesis, composition, and signaling activity. These changes contribute to hepatic steatosis, inflammation, and fibrosis, thereby exacerbating metabolic dysfunction and liver damage. The altered profiles and signaling activity of BAs in MASLD patients suggest that BAs act not only as biomarkers of disease severity, but also as active mediators of its pathogenesis. Modulators of BA signaling pathways, especially FXR agonists, are the focus of intense research for their potential to beneficially influence liver steatosis and inflammation in MASLD. Recent research has yielded promising results, indicating potential therapeutic application and the introduction of novel agents aimed at modulating BA homeostasis and function. This minireview outlines the physiological roles of BAs, seeks to advance the elucidation of the mechanisms by which their dysregulation contributes to MASLD progression, and highlights current and emerging therapeutic approaches. A deeper understanding of these complex interactions is essential for improving the diagnosis, prognosis and treatment of MASLD.

Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver diseases. In some countries, its use is restricted to radiologists, limiting access for other clinicians, such as gastroenterologists. Endoscopic ultrasound, as a novel technique, plays a crucial role in diagnosis and treatment of digestive diseases. However, its use is sometimes recommended for conditions where no clear advantage over percutaneous ultrasound exists, leaving the impression that clinicians sometimes resort to an endoscopic approach due to the unavailability of percutaneous options.

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