Lancet Gastroenterology & Hepatology最新文献

{"title":"Evidence without evolution: a call for precision behavioural therapy in irritable bowel syndrome","authors":"Sophie R Abber, Helen Burton-Murray","doi":"10.1016/s2468-1253(25)00284-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00284-5","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"23 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254886","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}

{"title":"Efficacy of behavioural therapies for irritable bowel syndrome: a systematic review and network meta-analysis","authors":"Elyse R Thakur, Mais Khasawneh, Paul Moayyedi, Christopher J Black, Alexander C Ford","doi":"10.1016/s2468-1253(25)00238-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00238-9","url":null,"abstract":"<h3>Background</h3>Irritable bowel syndrome (IBS) management guidelines recommend that behavioural therapies, particularly brain–gut behaviour therapies, should be considered as a treatment. Some, such as IBS-specific cognitive behavioural therapy (CBT) or gut-directed hypnotherapy, have specific techniques and, therefore, are in their own class of brain–gut behaviour therapy, while others, such as stress management or relaxation training, are common or universal techniques that are present in most classes of brain–gut behaviour therapy. In addition, there are other behavioural therapies or treatment options, including digital therapies, which are not classed as brain–gut behaviour therapies. We aimed to evaluate relative efficacy of the available behavioural therapies in IBS.<h3>Methods</h3>For this systematic review and network meta-analysis we searched MEDLINE, EMBASE, EMBASE Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials from inception to April 23, 2025, to identify randomised controlled trials (RCTs) comparing the efficacy of behavioural therapies for adults with IBS with each other, or a control intervention. We judged efficacy using dichotomous assessments of improvement in global IBS symptoms. We pooled data with a random effects model, with efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs. We ranked behavioural therapies according to their P score, which is the mean extent of certainty that one treatment is better than another, averaged over all competing behavioural therapies.<h3>Findings</h3>We identified 67 eligible RCTs, comprising 7441 participants. After completion of treatment, and compared with waiting list control, behavioural therapies with the largest numbers of trials, and patients recruited, that showed efficacy were: minimal contact CBT (RR for global IBS symptoms not improving at first point of follow-up post-treatment 0·55 [95% CI 0·39–0·76], P score 0·78; two RCTs, 511 patients), telephone disease self-management (0·57 [0·41–0·80], P score 0·75; two trials, 746 patients), dynamic psychotherapy (0·59 [0·43–0·80], P score 0·72; three RCTs, 303 patients), CBT (0·65 [0·53–0·80], P score 0·64; nine trials, 1150 patients), disease self-management (0·68 [0·50–0·92], P score 0·58; three RCTs, 375 patients), internet-based minimal contact CBT (0·77 [0·61–0·96], P score 0·43; five RCTs, 705 patients), and gut-directed hypnotherapy (0·79 [0·66–0·95], P score 0·39; 12 trials, 1507 patients). After completion of treatment, among trials recruiting only patients with refractory symptoms, telephone disease self-management and contingency management were both superior to attention placebo control (0·52 [0·28–0·94] and 0·50 [0·26–0·96], respectively) and routine care (0·46 [0·31–0·69] and 0·45 [0·24–0·85], respectively), and group CBT (0·50 [0·29–0·86]), internet-based minimal contact disease self-management (0·58 [0·40–0·86]), and dynamic psychotherapy (0·61 [0·44–0·86]) were ","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"36 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254888","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}

{"title":"Fatigue in people with primary biliary cholangitis: a position paper from the European Reference Network for Rare Liver Diseases","authors":"Ozgur M Koc, Anne-Kristin Toussaint, Aurelie Untas, Piotr Milkiewicz, Henriette Ytting, Laura Buck, David E Jones, Gideon Hirschfield, Angela Leburgue, Christoph Schramm, Frederik Nevens, Adriaan J van der Meer, Alessio Gerussi, Jef Verbeek","doi":"10.1016/s2468-1253(25)00257-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00257-2","url":null,"abstract":"Given the unmet need of fatigue in primary biliary cholangitis (PBC), the PBC working group of the European Reference Network for Rare Liver Diseases assessed and summarised the current evidence relating to fatigue in PBC to provide guidance for clinical practice and identify knowledge gaps to shape the future research agenda. Six key questions regarding PBC-related fatigue were summarised through systematic review and meta-analyses. Fatigue is highly prevalent in PBC and substantially affects health-related quality of life. Several measurement tools are available but future research should emphasise longitudinal designs to track symptoms with easy-to-apply and accurate tools. The pathophysiology of fatigue in PBC remains largely unknown and involves a complex interplay of various factors. Pilot studies suggest the effectiveness of non-pharmacological treatments, which warrant further investigation. Pending the results of clinical trials, no pharmacological treatment can be recommended for PBC-related fatigue. Finally, we introduce a practical, three-step ASK-MEASURE-TREAT algorithm that can be applied in all patients with PBC.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"204 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260716","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}

{"title":"UEG Week 2025","authors":"Rob Brierley","doi":"10.1016/s2468-1253(25)00321-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00321-8","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>ABTECT 1 &amp; 2</h2>Data from two randomised trials indicate that the microRNA upregulator obefazimod resulted in significantly higher rates of clinical remission at week 8 than did placebo in patients with moderately-to-severely active ulcerative colitis. Both trials, presented by Bruce E Sands (New York City, NY, USA), randomly assigned participants to receive obefazimod 25 mg, obefazimod 50 mg, or placebo. At week 8, in the ABTECT 1 trial, 38 (24%) of 160 patients receiving obefazimod 25 mg, 69 (22%) of 318</section></section><section><section><h2>TRIASSIC trial</h2>For en-bloc resection of large, non-pedunculated rectal lesions, endoscopic submucosal dissection (ESD) is non-inferior to transanal minimally invasive surgery (TAMIS) in terms of local recurrence at 12 months, according to data presented by Nik Dekkers (Leiden, the Netherlands). In the multicentre, randomised TRIASSIC trial, patients with non-pedunculated rectal lesions larger than 2 cm that were located at most 15 cm from the anal verge were randomly assigned to undergo either ESD (n=100) or</section></section><section><section><h2>WATERLAND trial</h2>Fluid resuscitation with lactated Ringer's solution in patients with acute pancreatitis did not improve key clinical outcomes compared with normal saline, according to the results of the WATERLAND trial. In this randomised controlled trial presented by Enrique de-Madaria (Alicante, Spain), patients with acute pancreatitis were randomly assigned to receive fluid resuscitation with either lactated Ringer's (n=399) or normal saline (n=393) for at least 48 h. Although there was evidence that</section></section><section><section><h2>The Mediterranean diet in irritable bowel syndrome</h2>The Mediterranean diet could be a new first-line dietary option for patients with irritable bowel syndrome (IBS), according to data presented by Imran Aziz (Sheffield, UK). In a randomised non-inferiority trial, individuals with IBS were randomly assigned to follow the Mediterranean diet (n=68) or traditional dietary advice (n=71) for 6 weeks. The primary endpoint was the proportion of participants achieving clinical response (defined as a 50-point or greater reduction in the IBS Symptom</section></section>","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"1 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260715","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}

{"title":"Foodborne pathogen surveillance cut by the CDC","authors":"","doi":"10.1016/s2468-1253(25)00305-x","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00305-x","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"16 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247411","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}

{"title":"Childhood obesity tops underweight, says UNICEF","authors":"","doi":"10.1016/s2468-1253(25)00304-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00304-8","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"24 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247412","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}

{"title":"Age-related changes of the gastrointestinal tract","authors":"Alberto Pilotto, Carlo Custodero, Lucilla Crudele, Wanda Morganti, Nicola Veronese, Marilisa Franceschi","doi":"10.1016/s2468-1253(25)00235-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00235-3","url":null,"abstract":"Disorders of the gastrointestinal tract are common in those aged 65 years or older, impairing their quality of life and potentially increasing morbidity and mortality risk. Unlike many organ systems, the luminal gastrointestinal tract does not undergo much natural degeneration. However, age-related anatomical and functional changes of the gastrointestinal tract might promote pathophysiology and explain some atypical presentations of gastrointestinal disorders in older adults. This Review summarises current knowledge of major anatomical and functional changes that occur in the gastrointestinal tract during ageing. These changes are often more evident in older adults who are frail or multimorbid, and frailty in older age might also influence the presentation, prognosis, and management of older patients with gastrointestinal disorders.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"116 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247410","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}

{"title":"Refining the faecal incontinence core outcome set – Authors' reply","authors":"Sadé L Assmann, Daniel Keszthelyi, Merel L Kimman, Stéphanie O Breukink","doi":"10.1016/s2468-1253(25)00292-4","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00292-4","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"19 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247415","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}

{"title":"Pre-emptive TIPS for gastric varices – Authors' reply","authors":"Christophe Bureau, Jean-Paul Cervoni, Hélène Larrue, Maxime Desmarets","doi":"10.1016/s2468-1253(25)00285-7","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00285-7","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"26 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247413","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}

{"title":"Peripheral blood DNA methylation signatures to predict treatment response in Crohn's disease","authors":"Hui Li, Jingni Zeng, Lu Zhang, Qin Guo, Chengshan Guo","doi":"10.1016/s2468-1253(25)00259-6","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00259-6","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"7 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247419","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}