Pub Date : 2025-09-10DOI: 10.1016/s2468-1253(25)00187-6
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
<h3>Background</h3>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.<h3>Methods</h3>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; <20 g [females] or <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 (<20 g [females] or <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.<h3>Findings</h3>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 (<em>r</em><sub>S</sub>=0·638 [95% CI 0·600–0·676] in the alcohol group <em>vs r</em><sub>S</sub>=0·655 [0·623–0·688] in the metabolic group), and the average preceding 3-months self-reported intake (<em>r</em><sub>S</sub>=0·628 [95% CI 0·586–0·669] <em>vs r</em><sub>S</sub>=0·725 [0·697–0·753]). 586 (39·5%) of 1482 participants in the alcohol group and 160 (11·1%) of 14
{"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":"<h3>Background</h3>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.<h3>Methods</h3>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; <20 g [females] or <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 (<20 g [females] or <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.<h3>Findings</h3>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 (<em>r</em><sub>S</sub>=0·638 [95% CI 0·600–0·676] in the alcohol group <em>vs r</em><sub>S</sub>=0·655 [0·623–0·688] in the metabolic group), and the average preceding 3-months self-reported intake (<em>r</em><sub>S</sub>=0·628 [95% CI 0·586–0·669] <em>vs r</em><sub>S</sub>=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}
Pub Date : 2025-09-10DOI: 10.1016/s2468-1253(25)00286-9
Praveena Narayanan, Michael Ronan Lucey
No Abstract
没有抽象的
{"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}
Pub Date : 2025-09-03DOI: 10.1016/s2468-1253(25)00140-2
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
Background
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.
Methods
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 ClinicalTrials.gov (NCT05500248) and is completed.
Findings
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; pnon-inferiority=0·013). No colonoscopy-related complications, including perforation and bleeding, were reported in either group.
Interpretation
The leave-in-situ strategy through optical diagnosis with computer-assisted diagnosis support does not reduce oncological safety of co
背景：指南建议在结肠镜检查中诊断的直肠乙状结肠息肉，如果内窥镜医师光学预测它们是非肿瘤性的，则保留5mm或更小的息肉。然而，尚无随机对照试验来检验该策略的有效性和安全性。方法：这项开放标签、多中心、非自卑、随机对照试验在意大利的四个中心招募了18岁或以上的成年人，他们正在接受结肠镜检查，以进行筛查、监测或临床适应症。通过中央网络系统将符合条件的患者按1:1随机分组（按患者性别、年龄和既往腺瘤切除情况分层），分为留置组（内镜医生在光学诊断后可以将非肿瘤性病变留在原位）和全切除组（无论光学诊断如何，所有检测到的息肉都被系统切除）。患者和内窥镜医师没有被掩盖分组分配，但病理学家和研究人员评估结果被掩盖。两组的所有手术均在计算机辅助检测和诊断系统的协助下完成。内窥镜医师通过结合白光、蓝光和计算机辅助检测来光学诊断病变。主要结局是腺瘤检出率（ADR），定义为至少检测到一个腺瘤的参与者的比例（每个患者分析），通过意向治疗评估，以确定留原位策略是否优于全部切除方法，绝对非劣效性为10%。该试验已在ClinicalTrials.gov注册（NCT05500248）并已完成。结果：在2022年10月1日至2024年4月30日期间，共招募了1147例患者，其中895例患者（507例[57%]女性，388例[43%]男性，平均年龄61.1岁[SD 9.8]）被随机分为离开原位组（n=441）和全部切除组（n=454）。留原位组检测到腺瘤或结直肠癌197例，全切除组211例；留置组不良反应为44.7% (95% CI 40.4 ~ 49.5)，全切除组为46.5%(41.8 ~ 51.2)（绝对差异为- 1.8个百分点，95% CI - 8.9 ~ 4.9；非劣效性= 0.013）。两组均无结肠镜相关并发症，包括穿孔和出血。通过光学诊断和计算机辅助诊断支持的离开原位策略不会降低结肠镜检查的肿瘤安全性，以不良反应来衡量。通过减少不必要的息肉切除术，该策略可以被认为是结肠镜检查实践中一个有吸引力的选择。资助欧洲胃肠内窥镜学会。
{"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<sub><em>non-inferiority</em></sub>=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}
Pub Date : 2025-09-03DOI: 10.1016/s2468-1253(25)00271-7
No Abstract
没有抽象的
{"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}
Pub Date : 2025-09-03DOI: 10.1016/s2468-1253(25)00270-5
No Abstract
没有抽象的
{"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}
Pub Date : 2025-09-03DOI: 10.1016/s2468-1253(25)00261-4
Ujjwal M Mahajan, Marlies Vornhülz, Hans Christian Stubbe, Julia Mayerle
No Abstract
没有抽象的
{"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}
Pub Date : 2025-09-03DOI: 10.1016/s2468-1253(25)00269-9
Holly Baker
<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
{"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}
Pub Date : 2025-08-28DOI: 10.1016/s2468-1253(25)00205-5
Livia Guadagnoli, Lauren C Heathcote, Lukas Van Oudenhove, Sigrid Elsenbruch, Laurie Keefer
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.
{"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}
Pub Date : 2025-08-27DOI: 10.1016/s2468-1253(25)00226-2
Paula Iruzubieta, Tomás de Vega, Javier Crespo
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.
{"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}
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