Lancet Gastroenterology & Hepatology最新文献

{"title":"Prevention of colorectal cancer through screening for advanced precancerous lesions: are blood-based tests the answer?","authors":"Jean M Winter, Erin L Symonds","doi":"10.1016/S2468-1253(26)00197-4","DOIUrl":"10.1016/S2468-1253(26)00197-4","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"864-865"},"PeriodicalIF":39.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708618","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":"A blood-based test for detection of advanced adenomas and colorectal cancer (DENEB): a multicentre diagnostic accuracy study.","authors":"Alessandro Mannucci, Caiming Xu, Francesc Balaguer, Yoshinaga Okugawa, Yuji Toiyama, Miguel Pera, Jing Zhang, David L Bartlett, Ali H Zaidi, Christina Therkildsen, Giulia Martina Cavestro, Luis Bujanda, Ajay Goel","doi":"10.1016/S2468-1253(26)00180-9","DOIUrl":"10.1016/S2468-1253(26)00180-9","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer is the third most common and second deadliest cancer in the USA, but cases and deaths are preventable through appropriate screening. Blood-based screening tests hold promise for increasing participation in colorectal cancer screening; however, their preventive effect remains limited if premalignant lesions are missed. Detection of advanced adenomas is essential to reduce both colorectal cancer incidence and mortality. The DENEB study aimed to develop and evaluate a novel blood-based assay for this purpose.</p><p><strong>Methods: </strong>The DENEB study was an outcome-enriched case-controlled multicentre biomarker study, conducted according to the Early Detection Research Network phase I-III framework to discover circulating biomarkers associated with colorectal cancer and advanced adenomas (phase I) and then train (phase II) and test a blood-based assay (phase III) in non-overlapping cohorts. Discovery cohort 1 (n=274; March 16, 2010 to Dec 20, 2017; Barcelona, Spain) and discovery cohort 2 (n=307; Sept 9, 2013 to Dec 26, 2017; Tsu, Japan) and in silico cohorts (n=99, GSE39833, Japan; n=61, GSE25609, Spain; and n=107, GSE41655, China) were used for biomarker discovery; clinical cohort 1 (n=535; July 2, 2018, to Sept 27, 2023; Barcelona, Spain and Tsu, Japan) was used for training and clinical cohort 2 (n=230; July 2, 2018, to Sept 27, 2023; Barcelona, Spain and Tsu, Japan) for testing. In each cohort, data from average-risk individuals (aged 18-100 years) with colonoscopy findings from screening or diagnostic colonoscopy were included in the analyses, including data from treatment-naive patients with colorectal cancer recruited before surgery to enrich for this outcome. Individuals were classified according to their colonoscopy findings and histopathology as having colorectal cancers, advanced adenomas, low-risk adenomas, or as non-disease controls (negative colonoscopy findings). To develop the test, candidate miRNAs overexpressed in the blood of patients with colorectal cancer and adenomas were identified via small RNA sequencing in discovery cohorts 1 and 2. The in-silico cohorts were used as a biological validation and reproducibility filter. Only those biomarkers with significant overexpression in at least two of the discovery and in-silico cohorts were retained. The identified biomarkers were measured with reverse transcription quantitative PCR (RT-qPCR) in clinical cohorts 1 and 2. In clinical cohort 1, using an XGBoost machine-learning model, we built and locked two separate models (one for colorectal cancer and one for advanced adenomas) and established their diagnostic thresholds. These thresholds were then tested in clinical cohort 2. The primary outcome measures were sensitivity for colorectal cancer and advanced adenomas, and specificity for advanced neoplasia assessed in all eligible participants aged 45 years or older. This study is registered with ClinicalTrial.gov, NCT06342440.</","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"897-907"},"PeriodicalIF":39.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708597","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":"Correction to Lancet Gastroenterol Hepatol 2026; published online July 16. https://doi.org/10.1016/S2468-1253(26)00163-9.","authors":"","doi":"10.1016/S2468-1253(26)00235-9","DOIUrl":"10.1016/S2468-1253(26)00235-9","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"e11"},"PeriodicalIF":39.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650017","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":"Propelling MASLD trials into the era of non-invasive tests.","authors":"Li-You Lian, Wen-Yue Liu, Wenhao Li, Rohit Loomba, Mark D Muthiah, Frank Tacke, Jörn M Schattenberg, Naim Alkhouri, Arun J Sanyal, Ming-Hua Zheng","doi":"10.1016/S2468-1253(26)00153-6","DOIUrl":"10.1016/S2468-1253(26)00153-6","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"869-871"},"PeriodicalIF":39.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240327","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":"Launch of the Africa CDC toolkit for hepatitis B: bringing care closer to people in Africa.","authors":"Alexander J Stockdale, Gibril Ndow, Danjuma Adda, Sangwoo Tak, Asgeir Johannessen, C Wendy Spearman","doi":"10.1016/S2468-1253(26)00221-9","DOIUrl":"10.1016/S2468-1253(26)00221-9","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"867-869"},"PeriodicalIF":39.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610203","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":"Correction to Lancet Gastroenterol Hepatol 2026; 11: 627-44.","authors":"","doi":"10.1016/S2468-1253(26)00246-3","DOIUrl":"10.1016/S2468-1253(26)00246-3","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"11 10","pages":"e11"},"PeriodicalIF":39.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882727","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":"Pain management in chronic pancreatitis: beyond opioids.","authors":"Søren S Olesen, Louise Kuhlmann, Rupjyoti Talukdar, Sanjay Pandanaboyana, Vikesh K Singh, Asbjørn M Drewes","doi":"10.1016/S2468-1253(26)00186-X","DOIUrl":"https://doi.org/10.1016/S2468-1253(26)00186-X","url":null,"abstract":"<p><p>Chronic pancreatitis is characterised by complex, multifactorial pain affecting 80-90% of patients. Pain arises from overlapping nociceptive and neuropathic mechanisms, often accompanied by CNS sensitisation and reorganisation that amplify symptoms (nociplastic pain). Opioid use is highly prevalent in chronic pancreatitis despite its many side-effects and addictive potential, and there is a need for alternative treatment strategies. Non-opioid pharmacological treatments, including neuromodulators, target specific pain mechanisms, with gabapentinoids showing the strongest evidence. Other interventions, such as cognitive behavioural therapy, antioxidants, dietary strategies, and lifestyle modification, might provide additional benefit, but high-quality evidence remains scarce. Endoscopic and surgical interventions relieve obstructive disease; however, the evidence base has a shortage of sham-controlled trials, complicating the interpretation of treatment effect. Emerging approaches, including novel neuromodulatory and anti-inflammatory therapies and integration of pharmacological and non-pharmacological treatments, hold promise for improving pain control. Multidimensional assessment, combining patient-reported outcomes, quantitative sensory testing, imaging, and emerging biomarkers, enables pain phenotyping and could support more individualised and more effective management, guiding multimodal strategies. Future research should prioritise mechanism-based trials, refined patient phenotyping, and predictive biomarkers to guide personalised therapies.</p>","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":39.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083041","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":"Short-course prophylaxis with the Toronto HCV protocol for recipients of non-liver solid organ transplants from donors with hepatitis C viraemia: a retrospective, matched cohort study.","authors":"Wesam Aleyadeh, Marcelo Cypel, S Joseph Kim, Michael A McDonald, Jeffrey Schiff, Ana Carolina Alba, Shaf Keshavjee, Kaijo Yacht, Dipika Munyal, Rhonda Allan, June Wang, Deepali Kumar, Atul Humar, Jordan J Feld","doi":"10.1016/S2468-1253(26)00237-2","DOIUrl":"https://doi.org/10.1016/S2468-1253(26)00237-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Organs from donors positive for hepatitis C virus (HCV) nucleic acid testing (NAT-positive) expand the non-liver solid organ donor pool. Standard post-transplantation direct-acting antiviral therapy requires an 8-12-week course, which might add logistical, financial, and pharmacological complexity. We therefore aimed to evaluate long-term follow-up from an initial pilot trial and outcomes after adoption of the short-course Toronto HCV protocol as the institutional standard of care in HCV-negative recipients of organs from HCV viraemic donors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective, matched cohort study was conducted at a single transplant centre at Toronto General Hospital (Toronto, ON, Canada). Eligible patients were HCV NAT-negative recipients (aged ≥18 years) who received kidney, kidney-pancreas, pancreas, heart, or lung transplants from an HCV NAT-positive donor (aged &lt;70 years). Recipients were categorised into the initial cohort (received treatment during the initial pilot study; n=30) and standard of care cohort (received treatment after institutional adoption of the Toronto HCV protocol on Jan 9, 2020; n=86). The Toronto HCV protocol consists of oral glecaprevir 300 mg/day and pibrentasvir 120 mg/day and oral ezetimibe 10 mg/day for 8 days. The first dose is administered 6-12 h before transplantation for 8 days (one pretransplantation dose and seven post-transplantation doses). Data were abstracted from electronic medical records. Each donor-positive, recipient-negative (D+R-) recipient of kidney, lung, and heart transplants was matched with up to four donor-negative, recipient-negative (D-R-) controls based on organ type, sex, age, transplantation date, and primary disease. The primary outcome was undetectable HCV RNA at 12 weeks post-transplantation or at the latest documented assessment for recipients who died before that timepoint. Secondary outcomes were 2-year overall survival, graft function at 1 year (mean estimated glomerular filtration rate [eGFR], mean forced expiratory volume in 1 s [FEV]&lt;sub&gt;1&lt;/sub&gt;, and left ventricular ejection fraction &lt;40%), and safety. Survival was compared between D+R- recipients and matched D-R- controls separately for each organ type using a Cox proportional hazards regression model stratified by matched set.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between Feb 4, 2019, and Dec 31, 2024, 116 D+R- non-liver solid organ transplantations were performed using organs from 72 unique HCV NAT-positive donors: 56 (48%) kidney, 34 (29%) lung, 16 (14%) heart, six (5%) kidney-pancreas, and four (3%) pancreas transplants. The mean recipient age was 54·6 years (SD 14·4). 79 (68%) recipients were male and 37 (32%) were female. The matched D-R- cohort consisted of 168 kidney, 103 lung, and 16 heart transplant recipients (matching was not done for other organs due to small numbers). All 116 (100%) D+R- recipients met the primary endpoint; 114 (98%) recipients had documented undetect","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":39.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083130","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":"Aspirin after curative-intent treatment of colorectal cancer liver metastases (ASAC): a multicentre, phase 3, randomised, double-blind, placebo-controlled trial.","authors":"Sheraz Yaqub, Morten Valberg, Bjørn Atle Bjørnbeth, Jon-Helge Angelsen, Kristoffer Watten Brudvik, Ina Andrassy Eilertsen, Richard Fristedt, Claus Wilki Fristrup, Stefan Gilg, Oskar Hemmingsson, Bengt Isaksson, Ingebjørg Soterud Juel, Anders Riegels Knudsen, Peter Nørgaard Larsen, Kim Erlend Mortensen, Inge Christoffer Olsen, Per Sandström, Oddvar Mathias Sandvik, Ernesto Sparrelid, Helena Taflin, Ragnhild A Lothe, Kjetil Taskén","doi":"10.1016/S2468-1253(26)00260-8","DOIUrl":"https://doi.org/10.1016/S2468-1253(26)00260-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Colorectal cancer frequently metastasises to the liver. Recurrence after curative-intent treatment of colorectal cancer liver metastases is common. Aspirin has shown preventive and antitumour effects in colorectal cancer, but its role after treatment of metastatic disease is uncertain. We aimed to establish whether adjuvant aspirin improves disease-free survival after curative-intent treatment of colorectal cancer liver metastases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this phase 3, randomised, double-blind, placebo-controlled trial conducted at 14 centres in Norway, Sweden, and Denmark, patients who had undergone curative-intent treatment for colorectal cancer liver metastases were randomly assigned (1:1), stratified by study site using a centrally generated computerised sequence with variable block sizes, to aspirin 160 mg per day or matching placebo for up to 3 years or until recurrence, death, or treatment discontinuation. The primary outcome was disease-free survival in the full analysis set, comprising all patients who initiated study treatment. The trial is completed and this is the final analysis. This trial is registered with ClinicalTrials.gov, NCT03326791, and EudraCT, 2014-003601-15.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between Dec 15, 2017, and Jan 27, 2022, 466 patients were randomly assigned, of whom 428 initiated study treatment and were included in the full analysis set (217 assigned aspirin and 211 assigned placebo); 272 (64%) were male, 156 (36%) were female, and the mean age was 62·2 years. 269 disease-free survival events occurred (138 in the aspirin group and 131 in the placebo group). Aspirin did not improve disease-free survival (hazard ratio [HR] for recurrence or death 1·08 [95·44% CI 0·85-1·38]; p=0·58). Median disease-free survival was 1·13 years (95·44% CI 0·92-1·44) with aspirin and 1·40 years (1·11-1·69) with placebo. Overall survival at 36 months was 76% (95% CI 69·4-82·7) with aspirin and 85% (79·5-90·8) with placebo (HR for death 1·64 [95% CI 1·01-2·65]; p=0·045). Time to recurrence did not differ between groups (adjusted cause-specific HR 1·06 [95% CI 0·83-1·35]; p=0·64). 24 serious adverse events occurred in 17 (8%) of 217 patients in the aspirin group and five serious adverse events occurred in four (2%) of 211 patients in the placebo group. Clinically relevant adverse events and serious adverse events that occurred more commonly in the aspirin group than in the placebo group were myocardial infarction (two vs 0), epistaxis (four vs 0), duodenal ulcer (two vs 0), and cerebral haemorrhage (two vs 0). There were no treatment-related deaths.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Adjuvant aspirin did not improve disease-free survival and was associated with lower overall survival and more serious adverse events. These findings do not support routine use of aspirin after curative-intent treatment of colorectal cancer liver metastases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;Research Council of Nor","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":39.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032121","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":"Decompensation unmasks renal susceptibility in cirrhosis.","authors":"Callie J Zaborenko, Tae-Hwi Schwantes-An","doi":"10.1016/S2468-1253(26)00262-1","DOIUrl":"https://doi.org/10.1016/S2468-1253(26)00262-1","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":39.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002922","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}