Lancet Gastroenterology & Hepatology最新文献

{"title":"A DEF perspective on the METAPAC study – Authors' reply","authors":"Ujjwal M Mahajan, Marlies Vornhülz, Hans Christian Stubbe, Julia Mayerle","doi":"10.1016/s2468-1253(25)00261-4","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00261-4","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"14 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144987555","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":"Research in Brief","authors":"Holly Baker","doi":"10.1016/s2468-1253(25)00269-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00269-9","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2><span><span>Guselkumab for Crohn's disease</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></h2>Guselkumab shows promise for adults with moderate-to-severe Crohn's disease, according to the GALAXI-2 and GALAXI-3 phase 3 trials. Remo Panaccione and colleagues randomly assigned patients to receive intravenous guselkumab 200 mg followed by subcutaneous guselkumab either at 200 mg every 4 weeks (n=299) or 100 mg every 8 weeks (n=297); intravenous ustekinumab followed by subcutaneous ustekinumab 90 mg every 8 weeks (n=300); or intravenous placebo (n=153). Those without a clinical response to</section></section><section><section><h2><span><span>Durvalumab for gastric cancer</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></h2>Adding durvalumab to perioperative chemotherapy improves event-free survival (EFS) in patients with resectable gastric or gastro-oesophageal junction cancer, according to the MATTERHORN trial, in which Yelena Y Janjigian and colleagues randomly assigned patients to receive perioperative FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) plus durvalumab 1500 mg every 4 weeks (n=474) or FLOT plus placebo (n=474). Treatment included two preoperative and two postoperative cycles of FLOT,</section></section><section><section><h2><span><span>Robotic surgery for rectal cancer</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></h2>Robotic surgery improves long-term outcomes for middle and low rectal cancer, according to results from the REAL trial. Qingyang Feng and colleagues randomly assigned patients with cT1–T3, N0–N1, or ycT1–T3 Nx rectal adenocarcinoma and no distant metastases to undergo either robotic (n=620) or conventional laparoscopic (n=620) rectal cancer resection. At median follow-up of 43 months, 3-year locoregional recurrence was 1·6% (95% CI 0·6–2·6) in the robotic group versus 4·0% (2·4–5·6) in the</section></section><section><section><h2><span><span>Retifanlimab for anal cancer</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></h2>Retifanlimab added to first-line chemotherapy improves outcomes for patients with inoperable locally recurrent or metastatic squamous cell carcinoma of the anal canal, according to the POD1UM-303/InterAACT-2 phase 3 trial. Sheela Rao and colleagues randomly assigned patients to receive intravenous reti","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":"144987562","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":"The psychobiological model of disorders of gut–brain interaction: introduction of a novel, integrated, and testable model","authors":"Livia Guadagnoli, Lauren C Heathcote, Lukas Van Oudenhove, Sigrid Elsenbruch, Laurie Keefer","doi":"10.1016/s2468-1253(25)00205-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00205-5","url":null,"abstract":"Psychogastroenterology encompasses both basic mechanistic research, which identifies psychological mechanisms (eg, fear-learning) that contribute to disorders of gut–brain interaction (DGBIs), and clinical applied research, which evaluates the efficacy of gut–brain behavioural therapies in DGBIs. However, progress in the field is hindered by inadequate communication between these areas, such that mechanistic processes are rarely translated into clinical targets, and interventions are developed with an incomplete understanding of the potential mechanisms by which they work or for whom they work. To bridge this translational gap, we propose the psychobiological model of DGBIs—an integrated and testable model that illustrates how psychological mechanisms central to DGBIs interact with each other and with biological processes along the gut–brain axis. In this Personal View, we introduce our model, review current evidence in psychogastroenterology, and propose specific mechanisms and causal pathways that can be tested. With this model, we aim to unify research, clarify underlying mechanisms, and identify treatment targets, with the potential to transform future research in both psychogastroenterology and DGBIs.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"22 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916214","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":"Overlooked determinants and unequal outcomes: rethinking metabolic dysfunction-associated steatotic liver disease beyond the biomedical model","authors":"Paula Iruzubieta, Tomás de Vega, Javier Crespo","doi":"10.1016/s2468-1253(25)00226-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00226-2","url":null,"abstract":"Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a public health priority due to its high prevalence, silent clinical course, and liver and systemic outcomes. With an estimated prevalence of 30% in the general population, MASLD is the most common chronic liver disease worldwide. Apart from the underlying metabolic factors, MASLD development and progression are strongly influenced by social and commercial determinants of health, and an associated stigma, which perpetuate inequities and hinder access to high-quality clinical management. In this Personal View, we explore how social and commercial determinants of health shape environments that promote the development and progression of MASLD. We also examine how stigma acts as an underestimated barrier, contributing to diagnostic delays and impaired quality of life in people with MASLD. Based on an integrative perspective, we propose a comprehensive and multisectoral approach for the sustainable management of MASLD.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"42 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911191","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":"Service delivery models and care cascade outcomes for people living with chronic hepatitis B: a global systematic review and meta-analysis","authors":"Alexander J Stockdale, Bethany Holt, Ajeet Singh Bhadoria, Abhishek Sadasivan, Daniel Ikeda, Todd Pollack, Janus P Ong, Thuy Pham, David B Duong, Vy Nguyen, Gibril Ndow, Roger Chou, Philippa Easterbrook","doi":"10.1016/s2468-1253(25)00163-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00163-3","url":null,"abstract":"<h3>Background</h3>Chronic hepatitis B is a leading cause of cirrhosis and hepatocellular carcinoma globally. In 2022, only 13% of the 254 million people with chronic hepatitis B were diagnosed and 3% were treated, highlighting a major gap in care provision. We aimed to comprehensively review service delivery models and their outcomes across the hepatitis B care cascade.<h3>Methods</h3>For this systematic review and meta-analysis, we searched PubMed, Embase, and Scopus for observational and interventional studies of chronic hepatitis B service delivery models that reported care outcomes, published between May 1, 2013, and July 15, 2024, with no language restrictions. Care cascade outcomes were the proportion of people diagnosed with hepatitis B who were assessed for treatment eligibility; the proportion of eligible people who started antiviral therapy; the proportion retained in care; and the proportion on therapy who had HBV DNA viral suppression. We evaluated pooled outcomes across hospital-based specialist care; co-managed care between primary and specialist care; community screening with linkage to specialist care; community screening with passive linkage to care; community test and treat clinics; primary care; and integrated care with antenatal, non-communicable disease, HIV, prison health, and substance misuse services and clinics, using a generalised linear mixed model with logit link and study random effects. For within-study comparisons of different models, we used inverse variance weighting to estimate the pooled risk ratio (RR). Heterogeneity was assessed with <em>I</em><sup>2</sup>. This study is registered with PROSPERO (CRD42023410009).<h3>Findings</h3>Of 4883 studies identified in the search, we included 106 studies comprising 110 cohorts from 50 countries in our meta-analysis. 45 (41%) of 110 cohorts were from low-income and middle-income countries and 65 (59%) were from high-income countries. 76 (72%) of 106 studies were observational, 23 (22%) were non-randomised interventional studies, and seven (7%) were randomised trials. Treatment eligibility assessment occurred in 73·9% (95% CI 65·8–80·6; <em>I</em><sup>2</sup>=98·5%) of patients for hospital-based specialist care (20 cohorts), 63·1% (53·0–72·2; <em>I</em><sup>2</sup>=99·9%) for co-managed care (23 cohorts), 50·4% (25·9–74·8; <em>I</em><sup>2</sup>=99·7%) for primary care (four cohorts), 82·3% (58·7–93·8; <em>I</em><sup>2</sup>=96·1%) for community screening with linkage to specialist care (ten cohorts), 33·2% (23·1–45·1; <em>I</em><sup>2</sup>=98·6%) for community screening with passive linkage to care (three cohorts), 56·9% (40·2–72·1; <em>I</em><sup>2</sup>=98·8%) for diagnosis in antenatal clinics and post-delivery linkage to specialist care (five cohorts), 75·0% (37·7–93·7; <em>I</em><sup>2</sup>=0·0%) for integrated care with harm reduction services (two cohorts), and 85·4% (78·0–90·6; <em>I</em><sup>2</sup>=0·0%) for integrated care with prison health services (two c","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"12 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851314","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":"Cultural competence in the delivery of nutrition and symptom care in irritable bowel syndrome","authors":"Neha D Shah, Heidi M Staudacher","doi":"10.1016/s2468-1253(25)00236-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00236-5","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"9 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144840040","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":"Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study","authors":"Krzysztof Budzyń, Marcin Romańczyk, Diana Kitala, Paweł Kołodziej, Marek Bugajski, Hans O Adami, Johannes Blom, Marek Buszkiewicz, Natalie Halvorsen, Cesare Hassan, Tomasz Romańczyk, Øyvind Holme, Krzysztof Jarus, Shona Fielding, Melina Kunar, Maria Pellise, Nastazja Pilonis, Michał Filip Kamiński, Mette Kalager, Michael Bretthauer, Yuichi Mori","doi":"10.1016/s2468-1253(25)00133-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00133-5","url":null,"abstract":"<h3>Background</h3>It is not known if continuous exposure to artificial intelligence (AI) changes endoscopists' behaviour when conducting colonoscopy. We assessed how endoscopists who regularly used AI performed colonoscopy when AI was not in use.<h3>Methods</h3>We conducted a retrospective, observational study at four endoscopy centres in Poland taking part in the ACCEPT (Artificial Intelligence in Colonoscopy for Cancer Prevention) trial. These centres introduced AI tools for polyp detection at the end of 2021, after which colonoscopies had been randomly assigned to be conducted with or without AI assistance according to the date of examination. We evaluated the quality of colonoscopy by comparing two different phases: 3 months before and 3 months after AI implementation. We included all diagnostic colonoscopies, excluding those involving intensive anticoagulant use, pregnancy, or a history of colorectal resection or inflammatory bowel disease. The primary outcome was change in adenoma detection rate (ADR) of standard, non-AI assisted colonoscopy before and after AI exposure. Multivariable logistic regression was done to identify independent factors affecting ADR.<h3>Findings</h3>Between Sept 8, 2021, and March 9, 2022, 1443 patients underwent non-AI assisted colonoscopy before (n=795) and after (n=648) the introduction of AI (median age 61 years [IQR 45–70], 847 [58·7%] female, 596 [41·3%] male). The ADR of standard colonoscopy decreased significantly from 28·4% (226 of 795) before to 22·4% (145 of 648) after exposure to AI, corresponding with an absolute difference of –6·0% (95% CI –10·5 to –1·6; p=0·0089). In multivariable logistic regression analysis, exposure to AI (odds ratio 0·69 [95% CI 0·53–0·89]), male versus female patient sex (1·78 [1·38–2·30]), and patient age ≥60 years versus &lt;60 years (3·60 [2·74–4·72]) were the independent factors significantly associated with ADR.<h3>Interpretation</h3>Continuous exposure to AI might reduce the ADR of standard non-AI assisted colonoscopy, suggesting a negative effect on endoscopist behaviour.<h3>Funding</h3>European Commission and Japan Society for the Promotion of Science.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"65 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825306","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":"Endoscopist deskilling: an unintended consequence of AI-assisted colonoscopy?","authors":"Omer F Ahmad","doi":"10.1016/s2468-1253(25)00164-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00164-5","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"26 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825307","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 for ulcerative colitis","authors":"Sérgio Bronze, Manasi Agrawal, Iago Rodriguez-Lago, Jean-Frédéric Colombel","doi":"10.1016/s2468-1253(25)00157-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00157-8","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"1 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792243","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 for ulcerative colitis","authors":"Melania Scarpa, Ignazio Castagliuolo, Andromachi Kotsafti, Imerio Angriman, Marco Scarpa","doi":"10.1016/s2468-1253(25)00151-7","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00151-7","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"27 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792242","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}