Lancet Gastroenterology & Hepatology最新文献

{"title":"Pre-emptive TIPS for gastric varices","authors":"Sagnik Biswas","doi":"10.1016/s2468-1253(25)00197-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00197-9","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"68 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247481","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":"Zubing Mei, De Zheng, Qingming Wang, Peixin Du, Ye Han","doi":"10.1016/s2468-1253(25)00232-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00232-8","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"37 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247414","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":"Lessons learned from the BOSS trial","authors":"Oliver Old, Paul Moayyedi, Janusz Jankowski, Stephen Attwood, M Sofia Massa, Alex Zimmermann, Hugh Barr","doi":"10.1016/s2468-1253(25)00264-x","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00264-x","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"114 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247416","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' reply","authors":"Andrew Y F Li Yim, Evgeni Levin, Wouter J de Jonge, Peter Henneman, Jack J Satsangi, Geert R D'Haens","doi":"10.1016/s2468-1253(25)00298-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00298-5","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"158 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247435","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":"Redefining palliation in malignant gastric outlet obstruction","authors":"Schalk W van der Merwe, Gitte Aabye Olsen, Michiel Bronswijk","doi":"10.1016/s2468-1253(25)00239-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00239-0","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"86 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226697","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":"Endoscopic versus surgical gastroenterostomy for palliation of malignant gastric outlet obstruction (ENDURO): a randomised controlled trial","authors":"Yorick L van de Pavert, Janine B Kastelijn, Marc G Besselink, Dieke C Booij, Jurjen J Boonstra, Judith Boot, Marco J Bruno, Olivier R Busch, Freek Daams, Wouter J M Derksen, Paul Fockens, Bas Groot Koerkamp, Jeroen Hagendoorn, Jeanin E van Hooft, Akin Inderson, Willem J Lammers, Daan J Lips, J Sven D Mieog, I Quintus Molenaar, Alexander A F A Veenhof, Babs M Zonderhuis","doi":"10.1016/s2468-1253(25)00209-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00209-2","url":null,"abstract":"<h3>Background</h3>In patients with malignant gastric outlet obstruction, endoscopic ultrasonography-guided gastroenterostomy might be superior to surgical gastroenterostomy, but randomised trials are scarce. We aimed to assess time to resumption of oral intake and the rate of persistent or recurrent obstructive symptoms requiring re-intervention following endoscopic ultrasonography-guided gastroenterostomy compared with surgical gastroenterostomy.<h3>Methods</h3>ENDURO was a multicentre, randomised controlled trial conducted at 12 Dutch academic and teaching hospitals. Hospitals with experience in at least 20 LAMS placements of any indication, at least ten endoscopic gastroenterostomies, and approved competence were eligible to perform endoscopic gastroenterostomy independently within the trial. Adults aged 18 years and older with symptomatic, malignant gastric outlet obstruction in a palliative setting were randomly assigned (1:1) to endoscopic or surgical gastroenterostomy. Randomisation was performed with an electronic data capture system using randomly generated permuted blocks of 2 and 4 and stratified by WHO performance status (0–1 and 2–3). The first coprimary outcome was time to resumption of solid oral intake (Gastric Outlet Obstruction Scoring System score ≥2). The second coprimary outcome was non-inferiority for persistent or recurrent obstructive symptoms requiring re-intervention. The predefined non-inferiority margin of the risk difference was 20%. All outcomes were analysed in all randomly assigned participants. This trial was registered in the International Clinical Trials Registry Platform, NL9592, and is completed.<h3>Findings</h3>Between Feb 18, 2022, and Feb 26, 2024, 250 patients were screened, 98 of whom were randomly assigned to endoscopic gastroenterostomy (n=48) or surgical gastroenterostomy (n=50). 43 (44%) patients were female and 55 (56%) were male. Endoscopic gastroenterostomy had a shorter time to solid oral intake than surgical gastroenterostomy (median 1 day [IQR 1–3] <em>vs</em> 3 days [1–6], hazard ratio 2·21 [95% CI 1·43–3·42]; p=0·0003). Endoscopic gastroenterostomy was non-inferior to surgical gastroenterostomy for persistent or recurrent obstructive symptoms requiring re-intervention (five [10%] <em>vs</em> six [12%], risk difference 1·6% [upper limit of 90% CI 8·9]). Overall adverse events were reported in 28 (58%) patients in the endoscopic gastroenterostomy group and 32 (64%) in the surgical gastroenterostomy group (relative risk 0·91 [95% CI 0·66–1·25]). One fatal event occurred in the endoscopic gastroenterostomy group and three fatal events occurred in the surgical gastroenterostomy group.<h3>Interpretation</h3>In patients with malignant gastric outlet obstruction, palliative treatment with endoscopic gastroenterostomy was superior to surgical gastroenterostomy for time to resumption of solid oral intake and was non-inferior for the rate of persistent or recurrent obstructive symptoms requiring re-inte","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"8 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226704","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":"Etrasimod as induction and maintenance treatment for patients with moderately to severely active ulcerative colitis in East Asia (ENLIGHT UC): a randomised, double-blind, placebo-controlled, multicentre, phase 3 study","authors":"Kaichun Wu, Changqing Zheng, Qian Cao, Yijuan Ding, Xiang Gao, Jie Zhong, Cheng-Tang Chiu, Hu Zhang, Xin Wang, Bangmao Wang, Jie Liang, Xiaowei Liu, Yongjian Zhou, Baohong Xu, Tae-Oh Kim, Xizhong Shen, Dongfeng Chen, Weichang Chen, Yulan Liu, Jun Shen, Tien-Yu Huang","doi":"10.1016/s2468-1253(25)00198-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00198-0","url":null,"abstract":"<h3>Background</h3>Etrasimod is an oral, once-daily sphingosine 1-phosphate (S1P) receptor modulator for the treatment of active ulcerative colitis. In the randomised, placebo-controlled, double-blind phase 3 ENLIGHT UC study, also known as the ES101002 study, we aimed to evaluate the efficacy and safety of etrasimod in patients with moderately to severely active ulcerative colitis in East Asia.<h3>Methods</h3>Using a central interactive web response system, in the 12-week induction period, adults (aged 18–75 years, inclusive) with moderately to severely active ulcerative colitis (modified Mayo score [MMS] 4–9 with an endoscopic subscore ≥2 and a rectal bleeding subscore ≥1) and an inadequate response, loss of response, or intolerance to at least one ulcerative colitis treatment were randomly assigned (2:1) to once-daily oral etrasimod 2 mg or placebo. Patients and study staff were masked to treatment assignment. Patients were enrolled from 52 hospitals across China, Taiwan, and Souh Korea. Randomisation was stratified by previous treatment status and baseline disease activity. Patients who had an MMS clinical response at induction period week 12 were re-randomly assigned (1:1) to once-daily oral etrasimod 2 mg or placebo for the 40-week maintenance period. Randomisation was stratified by induction period treatment, previous exposure to biologicals or JAK inhibitors, and concomitant use of oral corticosteroids at induction period baseline. The primary efficacy outcome was MMS clinical remission (stool frequency subscore=0 [or stool frequency subscore=1 with a ≥1 point decrease from induction period baseline], rectal bleeding subscore=0, and endoscopic subscore ≤1 [excluding friability]), assessed in the induction and maintenance periods separately (at induction period week 12 and maintenance period week 40). The primary efficacy analyses used the full analysis set (FAS), which included all patients who were randomly assigned and received at least one dose of study treatment for the induction period, and all re-randomly assigned patients who showed clinical response at induction period week 12 and received at least one dose of study treatment for the maintenance period. The safety analyses for each treatment period used the safety analysis set (SAF), which included all patients who received any amount of study drug in the corresponding treatment period. ENLIGHT UC is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT04176588</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>) and the study is complete.<h3>Findings</h3>606 patients were screened between Sept 25, 2019, a","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"23 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194958","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":"Effects of lyophilised faecal filtrate compared with lyophilised donor stool on Clostridioides difficile recurrence: a multicentre, randomised, double-blinded, non-inferiority trial","authors":"Dina Kao, Karen Wong, Christine Lee, Theodor Steiner, Rose Franz, Chelsea McDougall, Marisela Silva, Thomas S B Schmidt, Jens Walter, Raimar Loebenberg, Tanya M Monaghan, Ryland T Giebelhaus, James J Harynuk, Huiping Xu, Maryna Yaskina, Karen V MacDonald, Deborah A Marshall, Thomas Louie","doi":"10.1016/s2468-1253(25)00190-6","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00190-6","url":null,"abstract":"<h3>Background</h3>Faecal microbiota transplantation (FMT) is highly effective in preventing recurrent <em>Clostridioides difficile</em> infection. However, it is not known whether live microbes are necessary in mediating FMT efficacy. This study aims to determine whether lyophilised sterile faecal filtrate (LSFF), free of live bacteria, is non-inferior to lyophilised donor stool (LFMT) in efficacy.<h3>Methods</h3>This multicentre, randomised, double-blinded, non-inferiority trial was done at four academic centres in Canada. Eligible patients were adults aged 18 years or older with recurrent <em>C difficile</em> infection (at least two recurrences). Eligible patients were randomly assigned (1:1 using a prespecified computer-generated randomisation list with permutation blocks of 2 and 4, stratified by age >65 years or <65 years) to receive oral LSFF or LFMT. Each treatment dose consisted of 15 capsules that appeared identical. Participants and investigators were masked to treatment allocation. The primary outcome was the proportion of participants without recurrent <em>C difficile</em> infection (absence of more than three Bristol type 6 or 7 bowel movements per 24 h persisting more than 2 consecutive days) at 8 weeks. Analysis was done in the per protocol population, in which participants with unknown outcome status at 8 weeks due to death or loss to follow-up were excluded. Non-inferiority was established if the lower bound of the one-sided 95% CI for the difference in proportions of participants without recurrent <em>C difficile</em> between the LSFF and LFMT groups was above the non-inferiority margin of –10%. This trial was registered at <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT03806803</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and is complete.<h3>Findings</h3>Between March 27, 2019, and Nov 6, 2023, we assessed 409 patients for eligibility. 271 were excluded and the remaining 138 were enrolled and randomly assigned to receive LSFF (n=72) or LFMT (n=66). Participants' mean age was 61·2 years (SD 18·6); 91 (66%) of 138 patients were women and 47 (34%) were male. 127 participants (92%) were White. 130 (94%) of 138 participants completed the trial. At the planned interim analysis, 47 (65%) of 72 participants in the LSFF group and 57 (88%) of 65 participants in the LFMT group did not have <em>C difficile</em> recurrence at 8 weeks (difference –23%, one-sided 95% CI –33·8% to infinity; p=0·96). Given the pre-specified non-inferiority margin of –10%, non-inferiority of LSFF to LFMT could not be established and the study was terminated at the recommendation of ","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"21 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116484","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":"Filtered hopes and full-spectrum realities","authors":"Maria J G T Vehreschild","doi":"10.1016/s2468-1253(25)00195-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00195-5","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"39 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116485","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":"Reducing alcohol-associated liver disease burden in the general population","authors":"Sumeet K Asrani, Jessica Mellinger, Stacy Sterling, Michael R Lucey, Katharine A Bradley, Neeraj Bhala, Jeremy Bray, Po-Hung Chen, Andrea DiMartini, Anne Fernandez, Murtuza Ghadiali, Lamia Y Haque, Mandana Khalili, Brian Lee, Lewei Allison Lin, Anjana A Pillai, Derek D Satre, Shreya Sengupta, Marina Serper, Doug Simonetto, Vijay H Shah","doi":"10.1016/s2468-1253(25)00193-1","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00193-1","url":null,"abstract":"The prevalence of alcohol use disorder (AUD) and alcohol-associated liver disease (ALD) is rising. The National Institute on Alcohol Abuse and Alcoholism organised a multistakeholder workshop focused on reducing the burden of ALD. Decreasing ALD morbidity and mortality requires a multipronged approach, including increased population-based screening for AUD, early recognition of ALD, and multidisciplinary treatment. Recommended screening tools for alcohol use include the alcohol use disorders identification test for consumption (AUDIT-C). In patients with elevated AUDIT-C scores (AUDIT-C score of ≥3 points in women, ≥4 points in men), screening for fibrosis is recommended using non-invasive blood-based tests, such as the Fibrosis-4 index. Sequential testing using blood-based and imaging-based non-invasive liver disease assessment is preferred to blood-based tests alone to increase the positive predictive value of referral pathways. Screening, brief intervention, and referral to treatment are effective for reducing unhealthy alcohol use among adults who are not alcohol dependent. Integrated care models that incorporate mental health treatment into general medical settings are crucial for AUD and ALD. Emerging care models, such as multidisciplinary ALD clinics and substance use navigators, can improve patient engagement and outcomes. Markers of success include a reduction in per capita alcohol consumption, declines in morbidity and mortality related to AUD and ALD, and a decrease in health-care costs.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"67 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083711","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}