Nature Reviews Gastroenterology &Hepatology最新文献

Cirrhosis, portal hypertension and hepatocellular carcinoma: a stage-based approach. 肝硬化、门脉高压和肝细胞癌：一种基于分期的方法。

IF 51 1区医学

Nature Reviews Gastroenterology &Hepatology Pub Date : 2026-05-06 DOI: 10.1038/s41575-026-01209-5

Manon Allaire, Tamar Taddei, Dominique Thabut, Guadalupe Garcia-Tsao

{"title":"Cirrhosis, portal hypertension and hepatocellular carcinoma: a stage-based approach.","authors":"Manon Allaire, Tamar Taddei, Dominique Thabut, Guadalupe Garcia-Tsao","doi":"10.1038/s41575-026-01209-5","DOIUrl":"https://doi.org/10.1038/s41575-026-01209-5","url":null,"abstract":"<p><p>Cirrhosis and hepatocellular carcinoma (HCC) are interconnected outcomes of chronic liver disease, with portal hypertension playing a key part in cirrhosis decompensation, and influencing HCC prognosis and treatment. Despite their overlap, current guidelines address portal hypertension and HCC separately, leading to suboptimal risk stratification and treatment selection. This Review proposes a stage-based, integrated approach to HCC management that incorporates the prognostic stages of cirrhosis and emphasizes clinically significant portal hypertension (CSPH) as a key stratifying factor in compensated cirrhosis. CSPH is associated with an increased risk of cirrhosis decompensation, and its presence often limits the feasibility of curative treatments such as surgical resection. Although CSPH is strictly defined as hepatic venous pressure gradient (HVPG) of ≥10 mmHg, non-invasive tools (liver stiffness and platelet count) have largely replaced HVPG in cirrhosis; in patients with HCC, emerging data suggest that these non-invasive tests are poised to replace HVPG and its traditional surrogates, imaging and endoscopy. We explore the management of both cirrhosis and HCC across all cirrhosis stages - compensated (with or without CSPH), decompensated, and further decompensated - in relation to all HCC stages (very early, early, intermediate and advanced). Future research should validate non-invasive CSPH assessment in HCC and support outcome trials stratified by cirrhosis and HCC stage to guide personalized therapy and improve outcomes.</p>","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":" ","pages":""},"PeriodicalIF":51.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Human deskilling in medical artificial intelligence: prohibited or permissible under the EU Artificial Intelligence Act? 医疗人工智能中的人类技能培训：欧盟人工智能法案禁止还是允许？

IF 51 1区医学

Nature Reviews Gastroenterology &Hepatology Pub Date : 2026-05-05 DOI: 10.1038/s41575-026-01210-y

Sara Gerke, Cesare Hassan, Yuichi Mori

引用次数: 0

Liver disease care amid wars and conflicts. 战争和冲突中的肝病护理。

IF 51 1区医学

Nature Reviews Gastroenterology &Hepatology Pub Date : 2026-05-01 DOI: 10.1038/s41575-026-01212-w

Yasser Fouad, Bilal Hotayt, Mohammed Eslam

引用次数: 0

γδ T cells in colorectal and liver cancer. γδ T细胞在结直肠癌和肝癌中的作用。

IF 65.1 1区医学

Nature Reviews Gastroenterology &Hepatology Pub Date : 2026-04-22 DOI: 10.1038/s41575-026-01196-7

Dieter Kabelitz,Sebastian Zeissig

{"title":"γδ T cells in colorectal and liver cancer.","authors":"Dieter Kabelitz,Sebastian Zeissig","doi":"10.1038/s41575-026-01196-7","DOIUrl":"https://doi.org/10.1038/s41575-026-01196-7","url":null,"abstract":"Among tissue-resident immune cells, γδ T cells have a unique role in local immune surveillance. Under homeostatic conditions, they control tissue integrity and maintain the epithelial barrier. In contrast to conventional αβ T cells, γδ T cells sense stress-induced cellular alterations and, therefore, can recognize transformed cells independently of MHC (HLA in humans) molecules. In colorectal cancer and hepatocellular carcinoma, γδ T cells constitute an important part of the antitumour immune response. However, there is evidence that γδ T cells can also promote tumorigenesis. In this Review, we present basic features of γδ T cells and their distribution and function in the context of the local immune response. We discuss the ligands and antigens recognized by circulating and tissue-resident human γδ T cells, as well as the functional diversity of γδ T cell subsets within tumour-infiltrating T cells in colorectal and liver cancer. Given their potent cytotoxic activity and HLA-independent mode of action, there is increasing interest in harnessing γδ T cells for application in cancer immunotherapy. We therefore discuss the current status and future challenges of using γδ T cells as an innovative immunotherapeutic strategy for gastrointestinal and liver cancer.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"25 1","pages":""},"PeriodicalIF":65.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147733823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The critical role of gut-brain signalling in eating behaviour and obesity. 肠-脑信号在饮食行为和肥胖中的关键作用。

IF 65.1 1区医学

Nature Reviews Gastroenterology &Hepatology Pub Date : 2026-04-21 DOI: 10.1038/s41575-026-01203-x

Guillaume de Lartigue,Daniel I Brierley,Hyung Jin Choi

{"title":"The critical role of gut-brain signalling in eating behaviour and obesity.","authors":"Guillaume de Lartigue,Daniel I Brierley,Hyung Jin Choi","doi":"10.1038/s41575-026-01203-x","DOIUrl":"https://doi.org/10.1038/s41575-026-01203-x","url":null,"abstract":"The process of eating can be divided into three distinct phases of behaviour: food seeking, food consumption and non-prandial activities. The durations of, and transitions between, these behavioural phases are driven by underlying interoceptive phenomena of hunger, satiation and satiety. The gut-brain axis regulates all eating phases, with the vagus nerve a primary conduit for interoceptive feedback about gut-derived mechanical and chemical cues. This Review explores the mechanisms governing each phase, focusing on how gut-derived signals are peripherally and centrally integrated to shape hunger, satiation and satiety, food preferences, and food-related learning. Chronic exposure to high-fat, high-sugar diets disrupts these mechanisms, driving a maladaptive state characterized by hyperphagia, food choice biases and habitual overeating. We examine the mechanisms underlying this maladaptive state, including vagal fibre remodelling, altered gene expression and leptin resistance, which can impair gut-brain communication, diminishing the brain's capacity to appropriately control eating behaviour and maintain energy balance. Emerging therapies, including glucagon-like peptide 1 receptor agonists, are effective in promoting weight loss but typically do not reverse the underlying causes of gut-brain axis dysfunction. By examining the mechanisms of gut-brain signalling, this Review highlights the vagus nerve as a key, yet underappreciated, target for obesity treatment.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"7 1","pages":""},"PeriodicalIF":65.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Deciphering cytochrome P450 reductase role in MASLD: molecular mechanisms and pathophysiological implications. 解读细胞色素P450还原酶在MASLD中的作用：分子机制和病理生理意义。

IF 65.1 1区医学

Nature Reviews Gastroenterology &Hepatology Pub Date : 2026-04-20 DOI: 10.1038/s41575-026-01202-y

Catarina Baptista,Francisco Esteves,Jonathan A Fallowfield,Timothy J Kendall,Leonard J Nelson,Michel Kranendonk

{"title":"Deciphering cytochrome P450 reductase role in MASLD: molecular mechanisms and pathophysiological implications.","authors":"Catarina Baptista,Francisco Esteves,Jonathan A Fallowfield,Timothy J Kendall,Leonard J Nelson,Michel Kranendonk","doi":"10.1038/s41575-026-01202-y","DOIUrl":"https://doi.org/10.1038/s41575-026-01202-y","url":null,"abstract":"Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent and rapidly growing global health concern characterized by hepatic steatosis, oxidative stress and inflammation that can progress to metabolic dysfunction-associated steatohepatitis (MASH), fibrosis and cirrhosis. NADPH:cytochrome P450 oxidoreductase (CPR, encoded by POR), the essential electron donor for microsomal cytochrome P450 enzymes and other redox partners, orchestrates xenobiotic detoxification, lipid metabolism, steroid and bile acid biosynthesis, and redox balance - processes disrupted in MASLD. This Perspective examines emerging evidence from genetic, biochemical, transcriptomic and clinical studies that implicate CPR in the pathophysiology of MASLD, including its roles in lipid accumulation, oxidative stress, mitochondrial dysfunction, iron homeostasis, ferroptosis and inflammatory signalling. We discuss how CPR dysfunction, driven by genetic polymorphisms or metabolic stress, contributes to disease heterogeneity and progression. These insights highlight CPR as a relevant and potentially actionable regulator of hepatic metabolism. The current FDA approval of resmetirom, a thyroid hormone receptor-β agonist, which increases POR transcription levels, provides translational proof that restoring CPR-dependent pathways can ameliorate MASH with fibrosis. A deeper understanding of the multifaceted role of CPR could inform precision medicine strategies for this complex and widespread liver disease.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"22 1","pages":""},"PeriodicalIF":65.1,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What do we mean by gut health? 肠道健康是什么意思？

IF 51 1区医学

Nature Reviews Gastroenterology &Hepatology Pub Date : 2026-04-15 DOI: 10.1038/s41575-026-01208-6

引用次数: 0

Lifespan approaches for the prevention and management of steatotic liver disease. 脂肪变性肝病的预防和治疗的寿命方法。

IF 65.1 1区医学

Nature Reviews Gastroenterology &Hepatology Pub Date : 2026-04-15 DOI: 10.1038/s41575-026-01198-5

Shira Zelber-Sagi,Dana Ivancovsky-Wajcman,Carina Kugelmas,Ali A Weinstein,Vincent Wai-Sun Wong,Laurent Castera,J Bernadette Moore,Marialena Mouzaki,Kate Hallsworth,James M Paik,Jeffrey B Schwimmer,Lynn H Gerber,Zobair M Younossi

{"title":"Lifespan approaches for the prevention and management of steatotic liver disease.","authors":"Shira Zelber-Sagi,Dana Ivancovsky-Wajcman,Carina Kugelmas,Ali A Weinstein,Vincent Wai-Sun Wong,Laurent Castera,J Bernadette Moore,Marialena Mouzaki,Kate Hallsworth,James M Paik,Jeffrey B Schwimmer,Lynn H Gerber,Zobair M Younossi","doi":"10.1038/s41575-026-01198-5","DOIUrl":"https://doi.org/10.1038/s41575-026-01198-5","url":null,"abstract":"Metabolic dysfunction-associated steatotic liver disease, and the broader spectrum of steatotic liver disease (SLD), require tailored lifestyle interventions across different age groups, considering genetics, family involvement, and psychological, environmental and social factors. Clinical practice guidelines for adults typically recommend a uniform treatment approach, regardless of age-related considerations. However, different emphases might be needed for pregnant women, adults and the older age group (≥65 years of age). Moreover, metabolic health, and therefore liver health, are determined at a very early age and even in utero and infancy. Thus, the prevention and treatment of SLD should not be overlooked at these early life stages and should be specific for each stage of life. The life course approach is a comprehensive strategy that considers health needs across all stages of life, from infancy to older age. This Review puts the spotlight on these topics, creating a comprehensive age-chronological order overview of the literature, addressing gaps in knowledge, providing practical advice and highlighting age-related considerations, in contrast to a one-size-fits-all (ages) approach.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"5 1","pages":""},"PeriodicalIF":65.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147684902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Global position statement supporting a World Health Assembly resolution on steatotic liver disease. 支持世界卫生大会关于脂肪变性肝病的决议的全球立场声明。

IF 65.1 1区医学

Nature Reviews Gastroenterology &Hepatology Pub Date : 2026-04-15 DOI: 10.1038/s41575-026-01201-z

Jeffrey V Lazarus,Bruno Halpern,Peter E H Schwarz,Delfina Boudou,Harriette G C Van Spall,Veronica Miller,Ajay Duseja

引用次数: 0

Autoimmune gastritis: emerging insights and clinical management. 自身免疫性胃炎：新见解和临床管理。

IF 65.1 1区医学

Nature Reviews Gastroenterology &Hepatology Pub Date : 2026-04-13 DOI: 10.1038/s41575-026-01200-0

Marco Vincenzo Lenti,Emanuela Miceli,Alessandro Vanoli,Antonio Di Sabatino

{"title":"Autoimmune gastritis: emerging insights and clinical management.","authors":"Marco Vincenzo Lenti,Emanuela Miceli,Alessandro Vanoli,Antonio Di Sabatino","doi":"10.1038/s41575-026-01200-0","DOIUrl":"https://doi.org/10.1038/s41575-026-01200-0","url":null,"abstract":"Autoimmune gastritis (AIG) is an immune-mediated condition that affects the oxyntic mucosa of the stomach, leading to progressive atrophy and deficiencies in vitamin B12, iron and other micronutrients. Our understanding of the pathogenesis, clinical manifestations and management of AIG has improved in the past 20 years. Initially thought to be associated mainly with pernicious anaemia and limited to certain geographical areas, AIG is now recognized as a global disorder with a broad clinical spectrum, ranging from asymptomatic cases to gastrointestinal, haematological, neurological and gynaecological manifestations. The role of Helicobacter pylori in the development of AIG has been debated, with evidence suggesting that AIG might arise through distinct pathogenic pathways both related and unrelated to H. pylori infection. The risk of gastric adenocarcinoma in AIG has also been reassessed on the basis of studies exploring its natural history. Finally, novel insights have emerged regarding the characterization of 'potential AIG' and 'seronegative AIG', two distinct conditions that were previously overlooked. In this Review, we discuss the latest advances in the field of AIG.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"134 1","pages":""},"PeriodicalIF":65.1,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0