Lancet Gastroenterology & Hepatology最新文献

{"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}

{"title":"Correction to Lancet Gastroenterol Hepatol 2025; published online Sept 10. https://doi.org/10.1016/S2468-1253(25)00187-6","authors":"","doi":"10.1016/s2468-1253(25)00297-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00297-3","url":null,"abstract":"<em>Torp N, Bech KT, Schnefeld HL, et al Phosphatidylethanol and self-reported alcohol intake to subclassify individuals at risk of steatotic liver disease: an analysis of data from a prospective cohort study.</em> Lancet Gastroenterol Hepatol <em>2025; published online Sept 10. https://doi.org/10.1016/S2468-1253(25)00187-6—</em>The title of this Article has been corrected. This correction has been made as of Sept 16, 2025.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"78 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072249","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":"Risk of hepatic and extrahepatic outcomes associated with metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-associated steatotic liver disease: a systematic review and meta-analysis","authors":"Ciro Celsa, Grazia Pennisi, Adele Tulone, Giacinta Ciancimino, Marco Vaccaro, Fabiana Pecorella, Gabriele Di Maria, Marco Enea, Federico Midiri, Alessandro Mantovani, Giovanni Targher, Aleksander Krag, Mary E Rinella, Calogero Cammà, Salvatore Petta","doi":"10.1016/s2468-1253(25)00188-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00188-8","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction and alcohol-associated steatotic liver disease (MetALD) are two separate entities within the spectrum of steatotic liver disease. We aimed to compare the risks of hepatic and extrahepatic outcomes between individuals with MASLD and MetALD in a comprehensive meta-analysis.&lt;h3&gt;Methods&lt;/h3&gt;In this systematic review and meta-analysis, we systematically searched PubMed, Scopus, and the Cochrane Central Register of Controlled Trials for observational cohort studies published up to March 1, 2025, and written in English. We included studies comparing clinical outcomes between adults (&gt;18 years) with MASLD and MetALD, if the studies incorporated appropriate statistical adjustments for known risk factors and potential confounding factors. We excluded studies that did not differentiate between MASLD and MetALD, case reports, case series, commentaries, cross-sectional or case-control studies. We evaluated each study to assess its eligibility and extracted the data. The primary outcome was liver-related events; secondary outcomes included hepatocellular carcinoma, liver-related mortality, cardiovascular events, extrahepatic cancers, and all-cause mortality. We used random-effect models to calculate pooled hazard ratios (HRs) with 95% CIs. The study was registered with PROSPERO (CRD420251003928).&lt;h3&gt;Findings&lt;/h3&gt;Of 5579 records identified, we included 24 cohort studies involving 11 575 558 individuals in the analysis. 9 801 312 individuals had MASLD (mean age 57·0 years [SD 4·55], ~62% male, and ~38% female) and 1 774 246 had MetALD (mean age 48·6 years [SD 4·91], ~82% male, and ~18% female). Individuals with MetALD had significantly higher risks of liver-related events (HR 1·62, 95% CI 1·16–2·25; p=0·0086), hepatocellular carcinoma (1·33, 1·00–1·77; p=0·048), and extrahepatic cancers (1·03, 1·01–1·06; p&lt;0·0001) compared with those with MASLD. The rates of cardiovascular events (HR 0·96, 95% CI 0·85–1·09; p=0·48), extrahepatic cancer-related mortality (1·44, 0·97–2·15; p=0·065), and all-cause mortality (1·08, 0·97–1·19; p=0·14) did not differ between the two liver conditions. Substantial heterogeneity was observed across most analyses (&lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=76–93%), with only extrahepatic cancer incidence showing low heterogeneity (&lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=0%). Egger's regression tests suggested that publication bias was unlikely for all outcomes except extrahepatic cancer-related mortality.&lt;h3&gt;Interpretation&lt;/h3&gt;MetALD might be associated with a higher risk of liver-related events, hepatocellular carcinoma, and extrahepatic cancers than MASLD, whereas all-cause mortality, extrahepatic cancer-related mortality, and cardiovascular events seem similar between the two conditions. These findings emphasise the need for distinct clinical strategies for these related yet different entities within the steatotic liver disease spectrum and highlight the imp","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"124 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043285","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 2025; 10: 896–903","authors":"","doi":"10.1016/s2468-1253(25)00294-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00294-8","url":null,"abstract":"<em>Budzyń K, Romańczyk M, Kitala D, et al. Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study.</em> Lancet Gastroenterol Hepatol <em>2025;</em> 10: <em>896–903</em>—A covariate (indication for colonoscopy) had been mistakenly omitted from the multivariable analysis presented in supplementary table 6 in the appendix of this Article. The appendix has been updated with the corrected analysis; the only affected findings are for the variables “After AI introduction (using AI in colonoscopy)” and “Age &gt;60 years”. These changes do not affect the interpretation of the data. This correction has been made as of Sept 11, 2025.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"35 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043096","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":"Phosphatidylethanol and self-reported alcohol intake to subclassify in individuals at risk of steatotic liver disease: an analysis of data from a prospective cohort study","authors":"Nikolaj Torp, Katrine Tholstrup Bech, Helle Lindholm Schnefeld, Stine Johansen, Camilla Dalby Hansen, Georg Semmler, Javier Vega Benjumea, Katrine Prier Lindvig, Katrine Holtz Thorhauge, Ellen Lyngbeck Jensen, Ellen Elise Petersen, Johanne Kragh Hansen, Ida Falk Villesen, Peter Andersen, Marianne Lerbæk Bergmann, Aleksander Krag, Mads Israelsen, Maja Thiele","doi":"10.1016/s2468-1253(25)00187-6","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00187-6","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Phosphatidylethanol is a direct biomarker of alcohol consumption within the past 1–4 weeks, making it a potential tool in the subclassification of patients with steatotic liver disease. However, the clinical utility of phosphatidylethanol among individuals at risk of steatotic liver disease remains to be established. We aimed to investigate the correlation between phosphatidylethanol and self-reported alcohol intake among individuals at risk of steatotic liver disease due to excessive alcohol consumption or metabolic dysfunction.&lt;h3&gt;Methods&lt;/h3&gt;We used data from a single-centre, prospective study that was conducted at Odense University Hospital (Odense, Denmark), designed to investigate use of non-invasive markers for screening for fibrosis. We analysed data for at-risk participants aged 30–75 years from the general population with a history of ongoing or previous excessive alcohol use (alcohol group) or metabolic dysfunction without excessive alcohol use (metabolic group). Participants self-reported past 1-week and 3-month average alcohol intake, and completed the Alcohol Use Disorders Identification-Consumption (AUDIT-C) questionnaire. The presence of hepatic steatosis (controlled attenuation parameter ≥248 dB/m), cardiometabolic risk factors and past 3-month alcohol intake were used to classify participants as having metabolic dysfunction-associated steatotic liver disease (MASLD; &lt;20 g [females] or &lt;30 g [males] per day), metabolic and alcohol-related liver disease (MetALD; 20–49 g or 30–59 g per day), or alcohol-related liver disease (ALD; ≥50 g or ≥60 g per day). Phosphatidylethanol was quantified with liquid chromatography-mass spectrometry according to standard procedures. We assessed correlations and concordance between phosphatidylethanol and self-reported alcohol intake. Underestimation of alcohol intake was defined as a low self-reported intake (&lt;20 g [females] or &lt;30 g [males] per day) but phosphatidylethanol of at least 80 ng/mL or a moderate–high self-reported intake (20–49 g or 30–59 g per day) but phosphatidylethanol 200 ng/mL or higher. We also developed a decision tree to guide clinical use of phosphatidylethanol testing on the basis of self-reported intake and AUDIT-C.&lt;h3&gt;Findings&lt;/h3&gt;1482 individuals in the alcohol group and 1442 in the metabolic group recruited between Oct 9, 2017, and Dec 9, 2022, were included in this analysis. Median phosphatidylethanol concentration was 172 ng/mL (IQR 45–434) in the alcohol group and 11 ng/mL (5–37) in the metabolic group. Phosphatidylethanol correlated with past 1-week self-reported intake (&lt;em&gt;r&lt;/em&gt;&lt;sub&gt;S&lt;/sub&gt;=0·638 [95% CI 0·600–0·676] in the alcohol group &lt;em&gt;vs r&lt;/em&gt;&lt;sub&gt;S&lt;/sub&gt;=0·655 [0·623–0·688] in the metabolic group), and the average preceding 3-months self-reported intake (&lt;em&gt;r&lt;/em&gt;&lt;sub&gt;S&lt;/sub&gt;=0·628 [95% CI 0·586–0·669] &lt;em&gt;vs r&lt;/em&gt;&lt;sub&gt;S&lt;/sub&gt;=0·725 [0·697–0·753]). 586 (39·5%) of 1482 participants in the alcohol group and 160 (11·1%) of 14","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"83 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043098","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":"Prioritising phosphatidylethanol to aid classification and treatment of steatotic liver disease","authors":"Praveena Narayanan, Michael Ronan Lucey","doi":"10.1016/s2468-1253(25)00286-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00286-9","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"17 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043097","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":"Safety of artificial intelligence-assisted optical diagnosis for leaving colorectal polyps in situ during colonoscopy (PRACTICE): a non-inferiority, randomised controlled trial","authors":"Giulio Antonelli, Federico Desideri, Patrizio Scarozza, Gianluca Andrisani, Giulia Zerboni, Manuele Furnari, Nicolò Bevilacqua, Marta Cossignani, Michela Di Fonzo, Fabrizio Cereatti, Giulia Navazzotti, Claudia Antenucci, Francesco Maria Di Matteo, Gerolamo Bevivino, Anna Caruso, Marco Spadaccini, Sara Schiavone, Cristina Grossi, Tommy Rizkala, Michele Comberlato, Cesare Hassan","doi":"10.1016/s2468-1253(25)00140-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00140-2","url":null,"abstract":"<h3>Background</h3>Guidelines recommend leaving in situ rectosigmoid polyps diagnosed during colonoscopy that are 5 mm or smaller if the endoscopist optically predicts them to be non-neoplastic. However, no randomised controlled trial has been done to examine the efficacy and safety of this strategy.<h3>Methods</h3>This open-label, multicentre, non-inferiority, randomised controlled trial enrolled adults age 18 years or older undergoing colonoscopy for screening, surveillance, or clinical indications across four Italian centres. Eligible patients were randomised 1:1 (with stratification by patient sex, age, and previous adenoma removal) via a central web-based system, to either the leave-in-situ group, in which endoscopists could leave non-neoplastic lesions in place after optical diagnosis, or the resect-all group, in which all detected polyps were systematically removed, regardless of optical diagnosis. Patients and endoscopists were not masked to group allocation but pathologists and investigators assessing outcomes were masked. All procedures in both groups were done with the assistance of a computer-aided detection and diagnosis system. Endoscopists optically diagnosed lesions through a combination of white light, blue light, and computer-aided detection. The primary outcome was the adenoma detection rate (ADR), defined as the proportion of participants with at least one adenoma detected (per-patient analysis), assessed by intention-to-treat, to determine whether the leave-in-situ strategy was non-inferior to the resect-all approach, with an absolute 10% non-inferiority margin. This trial was 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>NCT05500248</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 completed.<h3>Findings</h3>Between Oct 1, 2022, and April 30, 2024, 1147 patients were recruited and 895 patients (507 [57%] females, 388 [43%] males, mean age 61·1 years [SD 9·8]) were randomly assigned to either the leave-in-situ group (n=441) or resect-all group (n=454). 197 adenomas or colorectal cancers were detected in the leave-in-situ group and 211 in the resect-all group; the ADR was 44·7% (95% CI 40·4 to 49·5) in the leave-in-situ group and 46·5% (41·8 to 51·2) in the resect-all group (absolute difference –1·8 percentage points, 95% CI –8·9 to 4·9; p_{<em>non-inferiority</em>}=0·013). No colonoscopy-related complications, including perforation and bleeding, were reported in either group.<h3>Interpretation</h3>The leave-in-situ strategy through optical diagnosis with computer-assisted diagnosis support does not reduce oncological safety of co","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"27 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144987690","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 DEF perspective on the METAPAC study","authors":"Alessandro Mannucci, Giulia Martina Cavestro, Ajay Goel","doi":"10.1016/s2468-1253(25)00191-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00191-8","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"15 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144987554","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":"Making AI work for patients in gastroenterology","authors":"","doi":"10.1016/s2468-1253(25)00271-7","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00271-7","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"29 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144987688","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":"Weighing the benefits of screening for early-onset colorectal cancer","authors":"","doi":"10.1016/s2468-1253(25)00270-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00270-5","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"21 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144987689","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}