Lancet Gastroenterology & Hepatology最新文献

{"title":"Screening for advanced liver fibrosis due to metabolic dysfunction-associated steatotic liver disease alongside retina scanning in people with type 2 diabetes: a cross-sectional study","authors":"Andrea Lindfors, Rickard Strandberg, Hannes Hagström","doi":"10.1016/s2468-1253(24)00313-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00313-3","url":null,"abstract":"<h3>Background</h3>International guidelines suggest screening for advanced fibrosis due to metabolic dysfunction-associated steatotic liver disease in people with type 2 diabetes, but how to implement these guidelines in clinical care remains unclear. We hypothesise that examination with VCTE could be implemented simultaneously with retina scanning with a high acceptance rate in people with type 2 diabetes.<h3>Methods</h3>In this cross-sectional study, we offered VCTE to people with type 2 diabetes referred to routine retina scanning in a large retina scanning facility in Stockholm, Sweden. We excluded people with type 1 diabetes, currently pregnant, with known liver disease, reporting high alcohol consumption, who did not speak Swedish, or younger than 18 years. Between Nov 6, 2020, and June 20, 2023, we conducted surveys with included participants and collected data from medical records on diabetes retinopathy, sex, and VCTE measurements. Increased liver stiffness was defined as at least 8·0 kPa, and possible advanced fibrosis as more than 12·0 kPa. Presence of metabolic dysfunction-associated steatotic liver disease was defined as a controlled attenuation parameter (CAP) value of 280 dB/m or higher. Participants with a liver stiffness measurement of at least 8·0 kPa or those with unreliable measurements were subsequently referred for a secondary evaluation at a liver specialist, including a follow-up liver stiffness measurement with VCTE. The primary outcome was the proportion of eligible people approached for screening who accepted. Secondary outcomes were the prevalence of elevated liver stiffness (≥8·0 kPa or >12·0 kPa), presence of metabolic dysfunction-associated steatotic liver disease, and the proportion of elevated liver stiffness readings at the first VCTE examination that were not elevated in the secondary evaluation with a liver specialist. Secondary outcomes were assessed in all participants who accepted screening, except false positives, which were assessed only in participants who had a second examination.<h3>Findings</h3>1301 participants were eligible to undergo assessment with VCTE, which was accepted by 1005 (77·2%). 973 (96·8%) participants had complete measurements, of whom 504 (51·8%) had CAP values of 280 dB/m or higher, indicating metabolic dysfunction-associated steatotic liver disease. Of 977 participants with reliable liver stiffness measurements, 154 (15·8%) had values of at least 8·0 kPa, suggestive of liver fibrosis, and 49 (5·0%) had values higher than 12·0 kPa, indicating possible advanced fibrosis. However, upon reassessment with a second VCTE after referral, 56 (45·2%) of 124 individuals had values less than 8·0 kPa. 74 (7·4%) of 1005 participants had a final liver stiffness of at least 8·0 kPa; 29 (2·9%) had values greater than 12·0 kPa.<h3>Interpretation</h3>Simultaneous examination with VCTE alongside retina scanning had a high acceptance rate among people with type 2 diabetes and could be a strategy for ","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"10 26 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816266","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(24)00403-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00403-5","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Mirikizumab for Crohn's disease</h2>Mirikizumab, a monoclonal antibody targeting IL-23p19, shows promise for patients with moderately-to-severely active Crohn's disease, according to the <span><span>VIVID-1 phase 3 trial</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>. Marc Ferrante and colleagues randomly assigned patients who had a previous inadequate response, loss of response, or intolerance to one or more therapies to receive either mirikizumab (n=579), ustekinumab (n=287), or placebo (n=199). The coprimary composite endpoints (mirikizumab <em>vs</em> placebo) were the proportion of patients</section></section><section><section><h2>Endoscopic sphincterotomy for post-ERCP pancreatitis</h2>Endoscopic sphincterotomy does not reduce the risk of pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) in patients undergoing biliary drainage for distal malignant biliary obstruction, according to the <span><span>SPHINX trial</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>. Anke M Onnekink and colleagues randomly assigned patients to receive either endoscopic sphincterotomy (n=156) or no sphincterotomy (control group; n=141) before ERCP with fully covered self-expandable metal stent placement. The primary endpoint of</section></section><section><section><h2><span><span>FMT in 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>Faecal microbiota transplantation (FMT) was not efficacious at inducing remission in patients with Crohn's disease, according to a results from a new study. Dina Kao and colleagues randomly assigned patients with mild-to-moderate Crohn's disease to receive either FMT, delivered initially via colonoscopy followed by weekly capsules, or placebo for 7 weeks. The trial was halted early due to futility—at week 8, none (0%) of 15 patients in the FMT group had achieved the primary endpoint of combined</section></section><section><section><h2>Switch maintenance therapy for gastric cancer</h2>Paclitaxel plus ramucirumab as switch maintenance could be a promising treatment strategy for patients with advanced gastric cancer, according to the <span><span>ARMANI phase 3 trial</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>. Giovanni Randon and colleagues randomly assigned patients with advanced gastric or gastro-oe","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"15 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809533","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":"ACG 2024","authors":"Bethany Gomersall","doi":"10.1016/s2468-1253(24)00402-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00402-3","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Subcutaneous guselkumab for Crohn's disease</h2>Induction with subcutaneous guselkumab—a dual acting IL-23p19 subunit inhibitor—was safe and efficacious in patients with Crohn's disease according to the phase 3 GRAVITI study presented by Remo Panaccione (Calgary, AB, Canada). 347 patients with moderate-to-severe Crohn's disease with an inadequate response or intolerance to oral corticosteroids and advanced therapies were randomly assigned to subcutaneous guselkumab 400 mg at weeks 0, 4, and 8, then 200 mg every 4 weeks (n=115); subcutaneous</section></section><section><section><h2>Auxora in acute pancreatitis and SIRS</h2>In the phase 2b CARPO trial presented by Robert Sutton (Liverpool, UK), 216 patients with acute pancreatitis and at least two criteria for systemic inflammatory response syndrome (SIRS) were randomly assigned to receive, with standard of care, intravenous auxora (zegocractin)—a calcium release-activated calcium channel inhibitor—at a dose of 2 mg/kg (n=54), 1 mg/kg (n=54), or 0·5 mg/kg (n=54), or placebo (n=54), over 4 h for 3 days. Median time to solid food tolerance (the primary endpoint) in</section></section><section><section><h2>Biofeedback <em>vs</em> dextranomer–hyaluronate acid injection for faecal incontinence</h2>There was no difference in the efficacy of biofeedback therapy versus dextranomer–hyaluronate acid anal injection for the treatment of faecal incontinence, according to a trial presented by Adil Bharucha (Rochester, MN, USA). Adults with faecal incontinence who had not responded at 4 or 12 weeks of enhanced medical management, including bowel agents and pelvic floor exercises, were randomly assigned to receive biofeedback therapy (n=99) or injection (n=101). There was no difference in the</section></section><section><section><h2>Bezlotoxumab plus FMT for <em>Clostridiodes difficile</em> in IBD</h2>According to data presented by Jessica R Allegretti (Boston, MA, USA), the addition of bezlotoxumab did not enhance the efficacy of faecal microbiota transplantation (FMT) for the treatment of recurrent <em>Clostridioides difficile</em> infection in patients with inflammatory bowel disease (IBD). 61 patients with IBD who had had at least two episodes of <em>C difficile</em> infection were randomly assigned to receive a single bezlotoxumab infusion (n=30) or placebo (n=31) before receiving a single colonoscopic</section></section>","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"41 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809966","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":"Rome Foundation and international neurogastroenterology and motility societies’ consensus on idiopathic gastroparesis","authors":"Jolien Schol, I-Hsuan Huang, Florencia Carbone, Luis Maria Bustos Fernandez, Guillaume Gourcerol, Vincent Ho, Geoffrey Kohn, Brian E Lacy, Aurelio Lopez Colombo, Hiroto Miwa, Baha Moshiree, Linda Nguyen, Greg O’Grady, Kewin T H Siah, Vincenzo Stanghellini, Jan Tack","doi":"10.1016/s2468-1253(24)00284-x","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00284-x","url":null,"abstract":"To establish a consensus on the definition and management of idiopathic gastroparesis, international experts (selected by neurogastroenterology and motility societies and initiated by the Rome Foundation) devised 144 statements using the Delphi method, with at least 80% agreement required. This consensus defined idiopathic gastroparesis as the presence of symptoms associated with delayed gastric emptying in the absence of mechanical obstruction. Nausea and vomiting were identified as cardinal symptoms. Frequently co-existing symptoms are early satiation and postprandial fullness. Diagnosis requires the presence of these symptoms alongside delayed gastric emptying, measured by a 4 h scintigraphy or gastric emptying breath test of a mixed composition meal in the absence of mechanical obstruction. Therapeutic options with proven efficacy were sparse. Dietary adjustments, nutritional support (per guidelines from the European Society for Clinical Nutrition and Metabolism for substantial weight loss or intractable vomiting), and opioid cessation were recommended by a consensus opinion. Antiemetic and prokinetic agents were also considered potentially beneficial. This consensus offers a global perspective on idiopathic gastroparesis.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"24 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809535","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":"Interdisciplinary perspectives on the co-management of metabolic dysfunction-associated steatotic liver disease and coronary artery disease","authors":"Jacob J Gries, Jeffrey V Lazarus, Paul N Brennan, Mohammad S Siddiqui, Giovanni Targher, Chim C Lang, Salim S Virani, Carl J Lavie, Scott Isaacs, Juan Pablo Arab, Kenneth Cusi, Chayakrit Krittanawong","doi":"10.1016/s2468-1253(24)00310-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00310-8","url":null,"abstract":"Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a public health threat as it affects approximately 38% of the adult population worldwide, with its prevalence rising in step with that of obesity and type 2 diabetes. Beyond the implications of MASLD for liver health, it is also associated with cardiovascular and vascular dysfunction. Although the many shared risk factors and common metabolic milieu might indicate that cardiovascular disease and MASLD are discrete outcomes from common systemic pathogeneses, a growing body of evidence has identified a potential causal relationship between MASLD and coronary artery disease, which is the leading cause of morbidity and mortality in people with MASLD and all-cause mortality worldwide. This Review takes an interdisciplinary approach, drawing on hepatology, cardiology, endocrinology, and metabolic and internal medicine specialists to help to delineate the intricate interplay between MASLD and coronary artery disease. It sheds light on novel opportunities for targeted interventions and personalised management strategies.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"15 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809974","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":"Intensified infliximab induction therapy for steroid-refractory acute severe ulcerative colitis","authors":"Diana Coman, Robert Battat","doi":"10.1016/s2468-1253(24)00348-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00348-0","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"129 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809526","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":"Shitbag: the story of a diagnosis","authors":"Cahal McQuillan","doi":"10.1016/s2468-1253(24)00395-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00395-9","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"118 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809536","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 promise of automated liver disease risk stratification in primary care","authors":"Fredrik Åberg, Ville Männistö","doi":"10.1016/s2468-1253(24)00316-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00316-9","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"117 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809518","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":"Unifying the approach to tackling inequalities in liver health: learning from working with underserved populations","authors":"Kate Glyn-Owen, Ryan M Buchanan, Ahmed M Elsharkawy, Leah Avery, Stuart Flanagan, Heather Parsons, Ashwin Dhanda","doi":"10.1016/s2468-1253(24)00309-1","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00309-1","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"28 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809519","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":"Primary care diagnostic pathways for lower gastrointestinal symptoms","authors":"Shahida Din, Astor Rodrigues, Pearl Avery, Neal Tucker, Debra Attwood","doi":"10.1016/s2468-1253(24)00350-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00350-9","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"40 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809520","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}