Lancet Gastroenterology & Hepatology最新文献

{"title":"Prevalence of hepatitis C virus seropositivity and active infection in a Rohingya refugee population in Cox's Bazar camps, Bangladesh: a cross-sectional study","authors":"Birgit Schramm, Khondaker A Ashakin, Wasim Firuz, Md Hadiuzzaman, Jihane Ben-Farhat, Andrés Arias-Rodríguez, Anisur Rahman, Pradip Sen Gupta, Abu Toha Rezuanul Haque Bhuiyan, Marve Duka, Suna Balkan, Farah Hossain","doi":"10.1016/s2468-1253(25)00094-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00094-9","url":null,"abstract":"<h3>Background</h3>Hepatitis C virus (HCV) infection is a significant public health concern. Limited data have shown unusually high HCV seroprevalence among Rohingya refugees residing in camps in Cox's Bazar, Bangladesh. We aimed to assess the prevalence of HCV seropositivity and active infection and identify risk factors to inform the HCV response.<h3>Methods</h3>A cross-sectional survey was conducted between May 10 and June 14, 2023, in adult (≥18 years) residents of seven camps in Cox's Bazar. Households were selected by simple random geosampling and one participant per household was selected at random. Participants were screened for HCV antibodies with a rapid finger prick blood test and, if seropositive, venous samples were tested for HCV viral load. A structured questionnaire collected information about demographics, HCV knowledge, and exposure risks. Survey-adjusted prevalence estimates of HCV seropositivity and active infection were generated by applying sampling weights. Factors associated with HCV seropositivity were identified using univariable and multivariable current status analysis and those associated with active infection via logistic regression.<h3>Findings</h3>The survey included 641 participants, of whom 425 (66%) were women and for whom the median age was 34 years (IQR 28–46). 191 individuals tested positive for HCV antibodies. 187 of these individuals were tested for active infection and 124 had a detectable HCV viral load. The survey-adjusted prevalence estimate of HCV seropositivity was 30·4% (95% CI 26·5–34·5), and that of active infection 19·8% (95% CI 16·5–23·4). Current status analysis identified higher odds of HCV seropositivity among individuals reporting medical injection(s) (adjusted odds ratio 1·8 [95% CI 1·2–2·8]) or surgery (5·9 [1·9–18·4]), and among women (2·1 [1·3–3·2]). 328 (51%) of 641 participants had never heard of hepatitis C. Five (4%) of 124 participants with HCV viraemia reported previous HCV treatment.<h3>Interpretation</h3>There is a substantial burden of active HCV infection among adult Rohingya camp residents, highlighting the urgent need to scale up testing and treatment capacities. The survey had constraints in identifying risk factors and could not provide data on HCV incidence. Reassessing infection prevalence after mass interventions and prospective surveillance are recommended to monitor ongoing transmission. A well-concerted multi-stakeholder action plan is needed to prevent future large-scale burden of severe liver disease and halt ongoing transmission.<h3>Funding</h3>Médecins Sans Frontières.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"43 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893414","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":"Isolated perianal Crohn's disease: a systematic review and expert consensus proposing novel diagnostic criteria and management advice","authors":"Luke Nathan Hanna, Liesbeth Jozefien Munster, Shivani Joshi, Jarmila Dagmara Wendelien van der Bilt, Christianne Johanna Buskens, Ailsa Hart, Phil Tozer","doi":"10.1016/s2468-1253(25)00007-x","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00007-x","url":null,"abstract":"Perianal fistulae can present a diagnostic challenge when distinguishing perianal Crohn's disease from idiopathic perianal fistulae. This distinction is key, as perianal Crohn's disease requires inflammatory bowel disease (IBD) therapy, whereas idiopathic perianal fistulae are primarily managed surgically. When luminal inflammation is absent, but Crohn's disease is suspected, the term isolated perianal Crohn's disease is sometimes applied. However, no formal guidance exists for diagnosing or managing isolated perianal Crohn's disease. Furthermore, whereas fistula granuloma might provide specific evidence of Crohn's disease, they are rarely detected in perianal fistulae, so are unlikely to sensitively delineate aetiology. This project aimed to develop an opinion-based framework for isolated perianal Crohn's disease. A systematic review evaluated clinical features suggestive of isolated perianal Crohn's disease and evidence for IBD therapies in patients with perianal fistulae without luminal IBD. The findings of this systematic review informed a multidisciplinary consensus process with IBD specialists, resulting in the formulation of diagnostic criteria and management recommendations for isolated perianal Crohn's disease. We then tested this diagnostic approach in a prospective cohort of 50 patients treated as having idiopathic perianal fistulae at a proctology referral centre, identifying six (12%) individuals as meeting the diagnostic criteria. Our findings underscore the scarcity of evidence guiding isolated perianal Crohn's disease diagnosis and the need for a composite risk-based assessment. The proposed framework provides a tool for clinical practice and research but requires validation and refinement. Clear communication with patients is essential, given the diagnostic and therapeutic uncertainties. Future studies should refine these criteria, explore biological markers for isolated perianal Crohn's disease, and establish evidence-based methods to differentiate isolated perianal Crohn's disease within the perianal fistulae spectrum.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"58 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889627","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":"Breaking the cycle: time to invest in IBS","authors":"","doi":"10.1016/s2468-1253(25)00130-x","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00130-x","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"34 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849397","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":"Gut–brain neuromodulators for IBS: what's in a name?","authors":"Adrian A M Masclee, Gwen M C Masclee","doi":"10.1016/s2468-1253(25)00100-1","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00100-1","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"23 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849396","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 dietary interventions in irritable bowel syndrome: a systematic review and network meta-analysis","authors":"Melanie S Cuffe, Heidi M Staudacher, Imran Aziz, Enrique Coss Adame, Claudia Krieger-Grubel, Ana Maria Madrid, Bodil Ohlsson, Christopher J Black, Alexander C Ford","doi":"10.1016/s2468-1253(25)00054-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00054-8","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Patients with irritable bowel syndrome (IBS) are often interested in dietary interventions as a means of managing their symptoms. However, the relative efficacy of available diets for the management of IBS is unclear. We aimed to examine the relative efficacy of various dietary interventions in IBS.&lt;h3&gt;Methods&lt;/h3&gt;For this systematic review and network meta-analysis we searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane Central Register of Controlled Trials from database inception to Feb 7, 2025, to identify randomised controlled trials comparing an active dietary intervention requiring changes to the intake of more than one food in IBS with either a control intervention, such as a habitual diet, sham diet, a high fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, or alternative miscellaneous dietary advice, or any other active dietary intervention requiring changes to the intake of more than one food. We assessed efficacy using dichotomous assessments of improvement in global IBS symptoms or improvement in individual IBS symptoms, including abdominal pain, abdominal bloating or distension, and bowel habit. We pooled data using a random-effects model, with the efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs. We ranked interventions according to their P-score, which measures the mean extent of certainty that one intervention is better than another, averaged over all competing interventions.&lt;h3&gt;Findings&lt;/h3&gt;We identified 28 eligible randomised controlled trials (comprising 2338 patients) of 11 different dietary interventions compared with four control interventions, of which six (low FODMAP diet, British Dietetic Association/National Institute for Health and Care Excellence [BDA/NICE] diet, lactose-reduced diet, starch-reduced and sucrose-reduced diet, a personalised diet, and a Mediterranean diet) were studied in more than one trial. For global IBS symptoms, assessed in 28 randomised controlled trials and when considering only the dietary interventions studied in more than one trial, a starch-reduced and sucrose-reduced diet ranked first (RR of global IBS symptoms not improving 0·41 [95% CI 0·26–0·67]; P-score 0·84; two trials), a low FODMAP diet ranked fourth (0·51 [0·37–0·70]; P-score 0·71; 24 trials), and a BDA/NICE diet ranked tenth (0·62 [0·43–0·90]; P-score 0·44; eight trials), versus a habitual diet. For abdominal pain, assessed in 26 trials and when considering only the dietary interventions studied in more than one randomised controlled trial, a starch-reduced and sucrose-reduced diet ranked second (RR of abdominal pain not improving 0·54 [95% CI 0·33–0·90]; P-score 0·73; two trials), and a low FODMAP diet ranked fifth (0·61 [0·42–0·89]; P-score 0·64; 23 trials), versus a habitual diet. For abdominal bloating or distension, assessed in 26 trials and when considering only the dietary interventions studied in more than one randomised trial, on","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"68 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849398","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":"Expanding the menu of dietary therapies in irritable bowel syndrome","authors":"Andrea Shin","doi":"10.1016/s2468-1253(25)00070-6","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00070-6","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"22 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849395","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 gut–brain neuromodulators in irritable bowel syndrome: an updated systematic review and meta-analysis","authors":"Mais Khasawneh, Marjan Mokhtare, Paul Moayyedi, Christopher J Black, Alexander C Ford","doi":"10.1016/s2468-1253(25)00051-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00051-2","url":null,"abstract":"<h3>Background</h3>Gut–brain neuromodulators might be efficacious for irritable bowel syndrome (IBS), but there has been no synthesis of evidence from randomised controlled trials (RCTs) of some drug classes, and whether they have pain-modifying properties in IBS is unclear. We updated a previous systematic review and meta-analysis of RCTs examining these questions.<h3>Methods</h3>We searched MEDLINE (from Jan 1, 1946, to Jan 1, 2025), Embase and Embase Classic (from Jan 1, 1947, to Jan 1, 2025), and the Cochrane Central Register of Controlled Trials (from database inception to Jan 1, 2025). Trials recruiting adults with IBS and that compared gut–brain neuromodulators versus placebo over at least 4 weeks of treatment were eligible. Dichotomous symptom data were pooled using a random effects model to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% CI.<h3>Findings</h3>The search strategy identified 3625 citations. 28 RCTs were eligible containing 2475 patients. Ten RCTs were identified since our previous meta-analysis, containing 1348 patients. The RR of global IBS symptoms not improving with gut–brain neuromodulators versus placebo in 22 RCTs (2222 patients) was 0·77 (95% CI 0·69–0·87). The best evidence in terms of persistence of global IBS symptoms was for tricyclic antidepressants (TCAs) in 11 trials (1144 patients; RR 0·70, 0·62–0·80). The RR of abdominal pain not improving with gut–brain neuromodulators versus placebo in 19 RCTs (1792 patients) was 0·72 (95% CI 0·62–0·83). The best evidence was for TCAs in seven trials (708 patients; RR 0·69, 0·54–0·87), but there was also a benefit of selective serotonin reuptake inhibitors in seven RCTs (324 patients; RR 0·74, 0·56–0·99), and serotonin and norepinephrine reuptake inhibitors in two trials (94 patients; RR 0·22, 0·08–0·59). Adverse events were not significantly more common with gut–brain neuromodulators, although rates of withdrawal due to adverse events were significantly higher. The certainty in the evidence for tricyclic antidepressants for global IBS symptoms was moderate, but it was low to very low for all other endpoints and drug classes studied.<h3>Interpretation</h3>Some gut–brain neuromodulators are efficacious in reducing global symptoms and abdominal pain in IBS. The findings support guidelines that recommend use of tricyclic antidepressants for ongoing global symptoms or abdominal pain but also highlight a potential for SSRIs to be modestly effective for abdominal pain. More data for SNRIs, azapirones, and tetracyclic antidepressants in IBS are required.<h3>Funding</h3>None.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"10 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849445","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":"Appendicectomy: a novel treatment for ulcerative colitis?","authors":"Offir Ukashi, Shomron Ben-Horin","doi":"10.1016/s2468-1253(25)00065-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00065-2","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"60 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823114","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":"Appendicectomy plus standard medical therapy versus standard medical therapy alone for maintenance of remission in ulcerative colitis (ACCURE): a pragmatic, open-label, international, randomised trial","authors":"","doi":"10.1016/s2468-1253(25)00026-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00026-3","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;The appendix might have an immunomodulatory role in ulcerative colitis. Appendicectomy has been suggested as a potentially therapeutic intervention to maintain remission in ulcerative colitis. We aimed to evaluate the clinical effectiveness of laparoscopic appendicectomy in maintaining remission in patients with ulcerative colitis.&lt;h3&gt;Methods&lt;/h3&gt;We did a pragmatic, open-label, international, randomised controlled superiority trial in 22 centres across the Netherlands, Ireland, and the UK. Patients with established ulcerative colitis who were in remission but had been treated for disease relapse within the preceding 12 months were randomly assigned (1:1) to undergo appendicectomy plus continued maintenance medical therapy (intervention group) or to continue maintenance medical therapy alone (control group). Randomisation was done with a central, computer-generated allocation concealment, stratified by disease extent. Patients and treating physicians were unmasked to group allocation. The prespecified primary outcome was the proportion of patients with a disease relapse within 1 year, predefined as a total Mayo score of 5 or higher with an endoscopic subscore of 2 or 3, or, in absence of endoscopy, based on a centrally independent masked review by a critical event committee as an exacerbation of abdominal symptoms (eg, elevated stool frequency subscore of ≥1 point from baseline) with a rectal bleeding subscore of ≥1 or faecal calprotectin level above 150 μg/g or necessitating treatment intensification other than mesalazine. Analyses were done on an intention-to-treat principle. This trial is complete and was registered with the Netherlands Trial Register (NTR2883) and ISRCTN (ISRCTN60945764).&lt;h3&gt;Findings&lt;/h3&gt;Between Sept 20, 2012, and Sept 21, 2022, 1386 patients were screened. 201 patients were randomly assigned to the appendicectomy group (n=101) or the control group (n=100). After exclusion of four patients due to eligibility violations (three had active disease and one received biological agents at time of randomisation), 99 patients in the appendicectomy group and 98 patients in the control group were included in the intention-to-treat analyses. The 1-year relapse rate was significantly lower in the appendicectomy group than in the control group (36 [36%] of 99 patients &lt;em&gt;vs&lt;/em&gt; 55 [56%] of 98 patients; relative risk 0·65 [95% CI 0·47–0·89]; p=0·005; adjusted p=0·002). Adverse events occurred in 11 (11%) of 96 patients in the appendicectomy group and 10 (10%) of 101 patients in the control group. The most frequently reported adverse events were postoperative temporary self-limiting abdominal pain in the appendicectomy group (three [3%] patients) and skin rash in the control group (three [3%] patients). Two cases (2%) of low-grade appendiceal mucinous neoplasm were incidentally found in resected appendix specimens in the appendicectomy group. Serious adverse events occurred in two (2%) of 96 patients who underwent appendi","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"75 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823113","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":"Retina and liver fibrosis screening for patients with type 2 diabetes","authors":"Yun-Chu Chen, Chun-Jen Liu, Tung-Hung Su","doi":"10.1016/s2468-1253(25)00092-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00092-5","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"37 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143814047","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}