Lancet Gastroenterology & Hepatology最新文献

{"title":"The burden of chronic hepatitis B and C in 2022 and progress towards elimination: a global report.","authors":"Fuqiang Cui,Diana Faini,Devin Razavi-Shearer,Homie Razavi,Casimir Manzengo Mingiedi,Monica Alonso Gonzalez,Ahmed Sabry Alaama,Antons Mozalevskis,Polin Chan,Kiyohiko Izumi,Mohamed Amine Ghrabi,Meg Doherty,Lesi Olufunmilayo,Niklas Luhmann,Catherine de Martel,Mae Dirac,Timothy B Hallett,Shevanthi Nayagam,Peter Vickerman,Daniel Low-Beer","doi":"10.1016/s2468-1253(25)00375-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00375-9","url":null,"abstract":"BACKGROUNDWHO has worked closely with member states to set baseline targets, monitor progress and gaps, and develop a strategy to achieve the elimination of viral hepatitis as a public health threat by 2030. This analysis aimed to use the latest data to assess global progress, identify gaps, and provide strategic support to countries and regions to scale up prevention and treatment services to meet global, regional, and country-level targets.METHODSData on key indicators for 2022 were collated in 2023, including prevalence, incidence, mortality, and the cascade of care for chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections. WHO country offices, regional offices, related departments, and partners were involved to verify and ensure the quality and completeness of the data. Data from 2022 were compared with historical data to monitor progress, and reported data were compared with expected data and targets to identify gaps in incidence and mortality.FINDINGSAs of June 30, 2023, WHO had received verified data reports from 187 of 194 countries and territories, including data contributions from collaborative partners. We estimated that, in 2022, globally, 254 million (3·27%) of 7758 million people were living with chronic HBV infection and 50 million (0·65%) people were living with HCV infection. Overall, five countries (China [83·7 million; 27·5%], India [35·3 million; 11·6%], Indonesia [18·9 million; 6·2%], Nigeria [15·7 million; 5·2%], and Pakistan [12·6 million; 4·2%]) accounted for 55% of the combined global burden of HBV and HCV. There were more than 2·2 million (95% CI 1·8-2·7) new chronic HBV and HCV infections and more than 1·3 million (95% CI 1·1-1·6) deaths due to HBV and HCV in 2022, with the majority of deaths due to HBV (1·1 million [95% CI 0·98-1·24]); as a result, the point estimate for deaths due to hepatitis in 2022 exceeded that of deaths due to tuberculosis in 2023 (1·25 million [95% UI 1·13-1·37]). There were 1·2 million new chronic HBV infections worldwide in 2022; 62·7% (771 000) of these new infections occurred in the African Region. In 2022, 34·1 million (95% CI 30·2-38·5) individuals living with HBV were diagnosed; of these, 6·6 million (95% CI 5·9-7·5) received antiviral treatment. In 2022, 25·7 million (95% CI 19·5-28·8) individuals were diagnosed with HCV infection and 12·5 million (95% CI 9·5-14·0) were treated with direct-acting antiviral drugs in 2015-22.INTERPRETATIONViral hepatitis represents a substantial burden of infectious disease globally, comparable with that caused by tuberculosis. Progress towards global hepatitis elimination is currently insufficient to meet the 2030 targets defined in the UN Sustainable Development Goals; efforts need to be rapidly and urgently scaled up across all regions. In particular, given the rising mortality due to hepatitis B globally, expansion of hepatitis B vaccination is a priority, particularly in the African Region, where the majority of new chronic HB","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"52 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524658","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":"Transanal total mesorectal excision in the era of robotic surgery","authors":"Patricia Sylla","doi":"10.1016/s2468-1253(26)00075-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00075-0","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"14 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502049","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":"Long-term progression of steatotic liver disease: multiple drivers of the same disease?","authors":"Helena Cortez-Pinto","doi":"10.1016/s2468-1253(26)00086-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00086-5","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"57 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502050","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":"Transanal total mesorectal excision versus laparoscopic total mesorectal excision for mid and low rectal cancer (COLOR III): short-term outcomes of an international, multicentre, phase 3, randomised, controlled, non-inferiority trial","authors":"Jurriaan B Tuynman, Hongwei Yao, Laura R Moolenaar, Colin Sietses, Roel Hompes, Felix Aigner, Antonio Caycedo–Marulanda, Chien-Chih Chen, Muneer Deeb, Pascal G Doornebosch, Bo Feng, Chi-Chung Foo, Alois Fürst, Masaaki Ito, Francisco B de Lacy, Pedro Leão, Justin A Maykel, Andrea Muratore, Stefan E van Oostendorp, Sung Chan Park, Michał Pędziwiatr, MingYang Ren, Gerald Seitinger, Hein B A C Stockmann, Aaldert K Talsma, Andreas Türler, Weidong Tong, Quan Wang, Qing Xu, Hongyu Zhang, Jan-Hein T M van Waesberghe, Mahsoem Ali, Jos W R Twisk, Zhongtao Zhang, Antonio M de Lacy, George B Hanna, Hendrik J Bonjer, Muneer Deeb, Mahsoem Ali, Jaap Bonjer, Charlotte Deijen, Roel Hompes, Thomas Koedam, Wytze Lameris, Annabel van Lieshout, Linda Mol, Laura Moolenaar, Stefan van Oostendorp, Jurriaan Tuynman, Jos Twisk, Jan-Hein van Waesberghe, Bin Huang, Feifei Huang, Zhigang Ke, Fan Li, Xiaoli Ran, Yue Tian, Weidong Tong, Li Wang, Xiangfeng Wang, Guodong Xiao, Liyang Yao, Jingwang Ye, Huichao Zheng, Yongbo An, Jiale Gao, Jianning Song, Pengyu Wei, Guocong Wu, Zhengyang Yang, Hongwei Yao, Zhongtao Zhang, Pedro Leão, Maria Sousa, Marion Brunner, Arthur Heiligensetzer, Peter Sauer, Alois Fürst, Vinzenz Völkel, Matthias Biebl, Luca Dittrich, Rosa Schmuck, Robbert Bosker, Koen Talsma, Andrea Muratore, Patrizia Marsanic, Gabie de Jong, Guusje Vughs, Colin Sietses, Antonio Caycedo-Marulanda, Sanjiv Mathur, Pamela Leduc, Raquel Bravo, Marlene Caldera, Yoelimar Guzmán, Francisco Borja de Lacy, Antonio María de Lacy, Ana Otero, Miguel Pera, Pascal Doornebosch, Maarten Vermaas, Michal Pędziwiatr, Andreas Türler, Haug-Lambert Loriz, Chien-Chih Chen, Chun-Ho Chu, Felix Aigner, Gabriele Moitzi, Richard Stadler, Gerald Seitinger, Qing Guo, MingYang Ren, Qing Teng, Dongbing Zhou, Sung Chan Park, Masaaki Ito, Hiro Hasegawa, Chi Chung Foo, Abraham Man, Lei Gu, Qing Xu, Batuer Aikemu, Bo Feng, Zhenghao Cai, Haiqin Song, Minhua Zheng, Ronald Vuylsteke, Hein Stockmann, Hou-Hsuan Cheng, Jeng-Kai Jiang, Chung-Chi Lin, Hung-Hsin Lin, Yinggang Ge, Xingye Wu, Xiang Xu, Hongyu Zhang, Liang He, Yuchen Guo, Yang Gong, Quan Wang, Karim Alavi, Justin Maykel, Paul Sturrock, Jingjing He","doi":"10.1016/s2468-1253(26)00022-1","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00022-1","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"1 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502279","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":"Binge drinking, metabolic dysfunction, and the spectrum of steatotic liver disease in the USA: a cross-sectional and longitudinal analysis","authors":"Zobair M Younossi, Aleksander Krag, Shira Zelber-Sagi, Markos Kalligeros, Marco Arrese, Luis Antonio Diaz, Juan Pablo Arab, Ashwani K Singal, Mario G Pessoa, Robert J Wong, Javier Crespo, Maja Thiele, Ajay Duseja, C Wendy Spearman, Mohamed El-Kassas, Yusuf Yilmaz, Jiangao Fan, Laurent Castera, Frank Tacke, Vincent Wai-Sun Wong, Michael Betel, Andrei Racila, Ariana Nader, Gabriella Y Paik, Dana Ivancovsky Wajcman, Laura Sol Grinshpan, Linda Henry, Yuchiro Eguichi, Janus P Ong, Fatema Nader, Saleh A Alqahtani, James M Paik","doi":"10.1016/s2468-1253(25)00376-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00376-0","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"14 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502051","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":"Indocyanine green fluorescence angiography for anastomotic perfusion assessment in colorectal surgery: a systematic review with meta-analysis, meta-regression, and trial sequential analyses","authors":"Éanna J Ryan, Odhrán K Ryan, Neil Corrigan, Gemma Ainsworth, Denise E Hilling, Alexander L Vahrmeijer, Jyrki Kössi, Jun Watanabe, David Jayne, Ronan A Cahill","doi":"10.1016/s2468-1253(25)00373-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00373-5","url":null,"abstract":"<h3>Background</h3>Anastomotic leak is a serious complication in colorectal surgery. Indocyanine green fluorescence angiography (ICGFA) is an adjunctive digital method of assessing bowel perfusion intraoperatively. We assessed whether ICGFA use during surgery reduces postoperative anastomotic leak exclusively using data from randomised controlled trials (RCTs).<h3>Methods</h3>In this systematic review and meta-analysis, we searched PubMed, ScienceDirect, Scopus, Web of Science, Embase, and the Cochrane Collaboration databases from inception to July 19, 2025, for English-language RCTs comparing additive intraoperative ICGFA with standard surgeon perfusion assessment alone in patients undergoing colorectal resection with primary anastomosis according to prespecified criteria and PRISMA guidelines. Summary-level data were extracted by two reviewers. The primary outcome was overall anastomotic leak rate. The Jadad scale (Oxford quality scoring system) was used to assess trial quality, the Cochrane Risk of Bias (RoB 2) tool for RCTs was used to assess risk of bias, and GRADE was used to assess strength of evidence. Meta-regression and trial sequential analyses were performed. This study is registered with PROSPERO, CRD420250652639.<h3>Findings</h3>719 records were initially identified, with 387 remaining after screening and 184 sought for full eligibility screening, of which nine were eligible RCTs (with 4754 patients) for analysis. ICGFA significantly reduced overall anastomotic leak (risk ratio 0·66 [95% CI 0·56–0·78], p<0·0001; number needed to treat [NNT]=24), with trial sequential analysis showing that the required information size (2183) was exceeded overall. ICGFA reduced both anastomotic leak requiring intervention (risk ratio 0·73 [95% CI 0·60–0·89], p=0·0020; NNT=39) and anastomotic leak not requiring intervention (0·48 [0·31–0·72], p=0·0004, NNT=35). Significant benefit was observed for left-sided resections (risk ratio 0·62 [95% CI 0·51–0·74], p<0·0001; NNT=19), rectal resections (0·62 [0·51–0·76], p<0·0001; NNT=19), and low anterior resections (0·62 [0·48–0·79], p<0·0001; NNT=13), in which the required information size was also exceeded, but not for right-sided resections. In the meta-regression analysis, among all tested covariates, only patient BMI significantly modified the ICGFA treatment effect, with an increasing protective effect with increasing BMI (coefficient –0·0153 [95% CI –0·0251 to –0·0056], p=0·0020). Evidence was graded as high certainty for overall, left-sided, rectal, asymptomatic, and 30-day anastomotic leaks, and moderate certainty for clinically significant anastomotic leak.<h3>Interpretation</h3>Intraoperative use of ICGFA reduces anastomotic leak rates in left-sided and rectal colorectal resections. Given the evidence available now, further general efficacy trials are no longer required and research should shift to implementation and defined targeted subgroup ICGFA role definition (ie, in non-rectal left","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"22 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495304","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":"Indocyanine green works: redefining research priorities in colorectal surgery","authors":"Zoe Garoufalia","doi":"10.1016/s2468-1253(26)00009-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00009-9","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"16 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495303","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":"How to test for hepatitis D virus infection: evidence and rationale to inform policy recommendations and future directions","authors":"Emi E Okamoto, Robia Islam, Sahar Bajis, Niklas Luhmann, Ashley Kallarakal, Frédéric Le Gal, Philippa Easterbrook","doi":"10.1016/s2468-1253(25)00265-1","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00265-1","url":null,"abstract":"Chronic hepatitis D virus (HDV) coinfection in people with chronic hepatitis B is associated with rapid progression to liver cirrhosis and high mortality. In 2020, the estimated global HDV burden among people with chronic hepatitis B was 12 million people, with a seroprevalence of 4·5%. Treatment options are now evolving with the introduction of bulevirtide; however, testing for HDV remains very low. In 2024, WHO published comprehensive guidelines on the management of people with chronic hepatitis B, including recommendations for the first time on who to test and how to test for HDV infection. WHO recommends an anti-HDV serological assay for those with chronic hepatitis B, and if reactive, an HDV RNA test to confirm active infection and, where available, reflex laboratory-based testing for anti-HDV in those who are HBsAg positive and an HDV RNA test in those who are anti-HDV positive. WHO also recommended universal anti-HDV testing among all individuals who are HBsAg positive, or a risk-based approach among populations at high risk when this is not feasible. We present two complementary Reviews—one on who to test and one on how to test for HDV infection. This Review on how to test provides a comprehensive landscape and performance review of available serological and molecular diagnostic assays, as well as the evidence and rationale for the adoption of reflex testing both for anti-HDV in individuals who are HBsAg positive, and HDV RNA testing in those who are anti-HDV positive. Key implementation considerations and research priorities include the need for countries to incorporate HDV testing into their national policies and guidelines for chronic hepatitis B, expand laboratory capacity and training that leverages existing networks and infrastructure, promote access to quality diagnostics, including anti-HDV rapid diagnostic tests, and conduct evaluations of quality-assured assays using all HDV genotypes.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"130 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471124","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":"Who to test and reflex testing for hepatitis D virus infection: evidence and rationale to inform policy recommendations and future directions","authors":"Sahar Bajis, Niklas Luhmann, Emi Okamoto, Robia Islam, Olufunmilayo Lesi, Philippa Easterbrook","doi":"10.1016/s2468-1253(25)00266-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00266-3","url":null,"abstract":"Chronic hepatitis D coinfection affects an estimated 12 million people globally, with higher prevalence in low-income and middle-income countries, especially the African and Western Pacific regions. It leads to accelerated progression to liver cirrhosis, hepatocellular carcinoma, and increased mortality. The treatment landscape is evolving with the introduction of bulevirtide, but hepatitis D virus (HDV) testing uptake and case-finding remain low. The 2024 WHO guidelines on the management of chronic hepatitis B provide recommendations for the first time on who to test and how to test for HDV infection. WHO recommends universal anti-HDV testing among all HBsAg-positive individuals, and where this is not feasible, a complementary focused (risk-based) testing approach among higher-risk populations. We present two complementary Reviews—one on who to test and one on how to test for HDV infection. This Review on who to test summarises the evidence base and rationale for the two recommendations regarding the universal and risk-based testing approaches, as well as the recommendation for the laboratory-based reflex HDV testing both for anti-HDV and HDR RNA. Key implementation considerations include the need for countries to incorporate HDV testing into their national policies and guidelines, education and training of health-care providers in counselling and linkage to care, community awareness raising and demand creation, and the establishment of clinical care pathways for HDV infection. Research priorities include the development of HDV rapid diagnostic tests to facilitate decentralisation of HDV testing, the generation of improved epidemiological data across different populations and settings to inform testing approaches, and evaluating the cost-effectiveness and feasibility of both universal and risk-based HDV testing approaches, alongside reflex HDV serology and HDV RNA testing.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"197 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478758","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":"Africa must not be left out of the hepatitis B cure era","authors":"Mohamed El-Kassas, Hend Shousha, Asgeir Johannessen","doi":"10.1016/s2468-1253(26)00024-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00024-5","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"12 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478759","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}