Lancet Gastroenterology & Hepatology最新文献

{"title":"The central role of primary care in liver health.","authors":"Rob Brierley,Hugh Thomas","doi":"10.1016/s2468-1253(26)00196-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00196-2","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"443 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365317","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":"Dupilumab versus placebo in adults and adolescents with eosinophilic gastritis (DEGAS): a double-blind, placebo-controlled, phase 2, multicentre, randomised controlled trial.","authors":"Nirmala P Gonsalves,Evan S Dellon,Kara L Kliewer,Tetsuo Shoda,Regina Yearout,Seema S Aceves,Nicoleta C Arva,John A Besse,Julie M Caldwell,Mirna Chehade,Amaziah Coleman,Margaret H Collins,Sara Anvari,Gary W Falk,Sandeep K Gupta,Girish Hiremath,David A Katzka,Paneez Khoury,John Leung,Calies Menard-Katcher,Paul Menard-Katcher,Kathryn A Peterson,Maria A Pletneva,Amanda K Rudman Spergel,Jonathan M Spergel,Tatyana Vaysman,Joshua B Wechsler,Benjamin L Wright,Guang-Yu Yang,Xue Zhang,Meijian Zhou,Ashish Bansal,Bram P Raphael,Amr Radwan,Jennifer Maloney,Antonio Martin,Yamo Deniz,Glenn T Furuta,Lisa J Martin,Marc E Rothenberg, ","doi":"10.1016/s2468-1253(26)00116-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00116-0","url":null,"abstract":"BACKGROUNDEosinophilic gastritis currently has no approved treatments and is postulated to be driven by type 2 inflammation. Dupilumab blocks type 2 cytokines IL-4 and IL-13 and has efficacy in multiple diseases characterised by type 2 inflammation, including eosinophilic oesophagitis. We aimed to assess the efficacy and safety of dupilumab in patients with eosinophilic gastritis.METHODSDEGAS was a proof-of-concept, phase 2, multicentre, randomised controlled trial consisting of a 12-week, double-blind, placebo-controlled period, followed by a 24-week open-label extension period. Patients aged 12-70 years from 11 hospitals in the USA with histologically active eosinophilic gastritis (≥30 eosinophils per high-power field [HPF] in at least five HPFs in the gastric antrum and/or body) and moderate-to-severe symptoms occurring at least 2 days per week in the 2 weeks before screening were recruited. Patients with current or recent use of any biologic or current use of systemic steroids at a dose of more than 10 mg/day (prednisone) were excluded. Eligible patients were individually randomised (1:1) to parallel groups and received six injections over 12 weeks: subcutaneous dupilumab (600 mg once followed by 300 mg every 2 weeks) or subcutaneous placebo. Randomisation was performed using a central variable block (block sizes permuted between 2 and 4), with stratification by age (12-17 years or ≥18 years) and use (yes or no) of either systemic corticosteroids, swallowed corticosteroids for eosinophilic gastritis, or non-steroidal systemic immunosuppression therapy. Throughout the duration of the study, patients were expected to maintain their treatments or diets for eosinophilic gastritis. All patients who completed the double-blind period could enter the open-label extension at week 12, during which both groups received dupilumab until week 34. The primary endpoint of relative change from baseline in mean gastric eosinophil count from the five most eosinophil-dense HPFs in the gastric antrum and/or body was analysed at week 12 using linear regression. Secondary endpoints included absolute changes from baseline in Eosinophilic Gastritis Histologic Scoring System (EoS-HSS) total score, mean gastric eosinophil count from the five most eosinophil-dense HPFs, and Eosinophilic Gastritis Endoscopic Reference System (EoG-REFS) total score. All randomly assigned patients who received at least one dose of study drug were included in the safety analysis and efficacy analyses were done in all randomly assigned patients who received at least one dose of study drug and had outcome data available at week 12 (complete case). This study is registered with ClinicalTrials.gov (NCT03678545) and is now complete.FINDINGSBetween May 14, 2021, and Nov 10, 2023, we randomly assigned 41 patients, of whom 21 (51%) received dupilumab and 20 (49%) received placebo during the double-blind period and were included in the safety analysis. Patients were aged 12-59 years (mean 30·5 years","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"28 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148313502","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":"Addition of ipilimumab to atezolizumab plus bevacizumab in advanced hepatocellular carcinoma (PRODIGE 81-FFCD 2101-TRIPLET HCC): phase 2 results from a randomised, multicentre, open-label, phase 2-3 trial.","authors":"Philippe Merle,Jean-Frederic Blanc,Karine Le Malicot,Jean-Marie Peron,Vincent Bourgeois,Mohamed Bouattour,Yann Touchefeu,Carole Vitellius,Faiza Khemissa Akouz,Alexandra Heurgué,Paul Girot,Eric Assenat,Eric Nguyen-Khac,Jean-Pierre Bronowicki,Juliette Viaud,Meher Ben Abdelghani,Sylvain Manfredi,Julien Edeline,Jean-Marc Phelip, ","doi":"10.1016/s2468-1253(26)00115-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00115-9","url":null,"abstract":"BACKGROUNDPatients with unresectable hepatocellular carcinoma have a poor prognosis and treatments with long-term benefits are needed. Anti-PD-L1 or anti-PD-1 plus anti-VEGF or anti-CTLA-4 double combinations are validated, first-line, systemic immunotherapies. We report the preplanned phase 2 results of the phase 2-3 PRODIGE 81-FFCD 2101-TRIPLET-HCC trial investigating the survival outcomes and safety profile of a triple combination of atezolizumab, bevacizumab, and ipilimumab in a first-line setting.METHODSThis randomised, open-label, phase 2-3 trial enrolled patients aged 18 years or older with unresectable hepatocellular carcinoma without previous systemic therapy at 36 hospitals in France. Patients had at least one measurable untreated lesion per Response Evaluation Criteria in Solid Tumours version 1.1 (RECIST v1.1), Child-Pugh class A disease, and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Patients were randomly assigned (1:1) to receive intravenous treatment every 3 weeks for up to 2 years with atezolizumab 1200 mg plus bevacizumab 15 mg/kg (plus ipilimumab 1 mg/kg for up to four doses), or atezolizumab plus bevacizumab alone. Subsequent follow-up was for a further 2 years. Randomisation was done centrally by the study funder, via an electronic case report form, using the minimisation method, and stratified by centre, ECOG performance status, macrovascular invasion or extrahepatic spread (or both), and baseline α-fetoprotein. We report the non-comparative phase 2 results with a primary endpoint of objective response (complete or partial) within the first 24 weeks of treatment, assessed per investigator by RECIST v1.1, in patients who received at least the first dose of study medication (modified intention-to-treat population); 35 patients in the experimental group needed to have had an objective response at week 24 for the trial to progress to phase 3. Missing data were not replaced. The trial is registered with ClinicalTrials.gov (NCT05665348) and is complete.FINDINGSBetween March 9, 2023, and Sept 20, 2024, 229 patients were randomly assigned to treatment and 226 received at least one dose of study medication; 113 patients received atezolizumab plus bevacizumab plus ipilimumab and 113 received atezolizumab plus bevacizumab. 206 (91%) patients were male and 20 (9%) were female. At 24 weeks, 34 (30% [80% CI 24-36]) patients in the atezolizumab plus bevacizumab plus ipilimumab group had an objective response as had 31 (27% [22-34]) patients in the atezolizumab plus bevacizumab group. The trial was therefore stopped and did not progress to phase 3. The most common (>2% of patients) investigator-assessed treatment-related, grade 3-4 adverse events in the atezolizumab plus bevacizumab plus ipilimumab group were colitis (four [4%] patients), confusional syndrome (three [3%]), arterial hypertension (11 [10%]), and asthenia (six [5%]); the most common in the atezolizumab plus bevacizumab group were acute renal fai","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"29 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298911","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":"EASL Congress 2026.","authors":"Rob Brierley","doi":"10.1016/S2468-1253(26)00184-6","DOIUrl":"https://doi.org/10.1016/S2468-1253(26)00184-6","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":38.6,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220866","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":"Digestive Disease Week 2026","authors":"Bethany Gomersall","doi":"10.1016/s2468-1253(26)00158-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00158-5","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"46 25 1","pages":"555"},"PeriodicalIF":35.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148286397","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: 314-22.","authors":"","doi":"10.1016/S2468-1253(26)00111-1","DOIUrl":"10.1016/S2468-1253(26)00111-1","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"11 6","pages":"e8"},"PeriodicalIF":38.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864846","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":"Pharmacotherapy for metabolic dysfunction-associated steatohepatitis: heart-liver co-management.","authors":"Xiao-Dong Zhou, Jeffrey V Lazarus, Chayakrit Krittanawong, Giovanni Targher, Christopher D Byrne, Zobair M Younossi, Frank Tacke, Qin-Fen Chen, Christos S Mantzoros, Herbert Tilg, Wajahat Z Mehal, Laurence S Sperling, Gregory Y H Lip, Norbert Stefan, Ming-Hua Zheng","doi":"10.1016/S2468-1253(25)00323-1","DOIUrl":"10.1016/S2468-1253(25)00323-1","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 30% of adults, with about 30% of cases progressing to metabolic dysfunction-associated steatohepatitis (MASH), which can lead to cirrhosis and hepatocellular carcinoma. Cardiovascular disease is the leading cause of death in patients with MASH, highlighting the need for integrated heart-liver co-management. MASLD and cardiovascular disease share common pathophysiological mechanisms, including insulin resistance, low-grade inflammation, atherogenic dyslipidaemia, and oxidative stress, creating a bidirectional interplay that drives disease progression. Effective management of MASLD requires addressing not only hepatic steatosis, inflammation, and fibrosis, but also managing cardiovascular risk. Current clinical practice and trials face several challenges, including the underdiagnosis of MASLD, poor collaboration between hepatologists and cardiologists, and a paucity of pharmacological options that safely target both the liver and heart. This Review covers three main pharmacological approaches: metabolic-targeted therapies, which improve the upstream metabolic milieu; liver-targeted therapies, which focus on MASH and fibrosis, but require further evaluation for cardiovascular safety; and cardiovascular therapies, which might provide hepatoprotective effects, but need further study. This Review discusses the benefits and limitations of these pharmacotherapies, emphasising the importance of an integrated heart-liver co-management approach to improve clinical outcomes for patients living with MASLD.</p>","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"521-537"},"PeriodicalIF":39.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208384","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":"Rifaximin in cirrhosis: when therapeutic drift meets antimicrobial stewardship.","authors":"Rajiv Jalan,Vishal C Patel,Saeed Shoaie","doi":"10.1016/s2468-1253(26)00076-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00076-2","url":null,"abstract":"This Viewpoint examines the evolving role of rifaximin in cirrhosis, arguing that therapeutic drift has outpaced evidence and antimicrobial stewardship. While rifaximin is effective for secondary prevention of recurrent overt hepatic encephalopathy, randomised trials have failed to demonstrate benefit for primary prevention of hepatic encephalopathy, prevention of acute-on-chronic liver failure, or broader disease modification. Concurrently, emerging microbiological and epidemiological data challenge the perception of rifaximin as a benign gut modulator. Prolonged exposure is associated with selection of antimicrobial resistance genes, rifaximin-resistant Enterobacter spp, and cross-resistance in Enterococcus faecium to last-line agents such as daptomycin. In a population already highly susceptible to multidrug-resistant infections and adverse transplant outcomes, this association with antimicrobial resistance raises important public health concerns. We argue for a recalibration of rifaximin use to evidence-based indications and for embedding antimicrobial stewardship principles within hepatology guidelines and policy.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"8 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719558","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 2022; 7: 202–03","authors":"","doi":"10.1016/s2468-1253(26)00094-4","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00094-4","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"279 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147681105","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":"André is an Idiot","authors":"Joe Moody","doi":"10.1016/s2468-1253(26)00093-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00093-2","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"52 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147681106","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}