Pub Date : 2026-01-14DOI: 10.1016/s2468-1253(25)00295-x
John A Damianos,Xiao Jing Wang,Michael Camilleri
Small intestinal microbial dysbiosis (SIMD) describes clinical syndromes attributed to overabundance of microbes within the small intestine. Usually attributed to bacteria (but also less commonly to archaea and fungi), SIMD arises as a secondary condition, when there is disruption of one or more key physiological mechanisms. We provide a comprehensive review of the current understanding of SIMD pathophysiology. We highlight the key physiological factors including gastric acid, pancreatic enzymes, bile acids, small intestinal dysmotility and obstruction, colonic motility, and intestinal mucosal immunity. We then describe the disease states associated with failure of these mechanisms, providing SIMD prevalence estimates for each. Finally, we address some of the controversies regarding SIMD including testing modalities, significance of intestinal methanogen overgrowth, and the role of SIMD in irritable bowel syndrome.
{"title":"Mechanisms and pathophysiology leading to development of small intestinal microbial dysbiosis.","authors":"John A Damianos,Xiao Jing Wang,Michael Camilleri","doi":"10.1016/s2468-1253(25)00295-x","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00295-x","url":null,"abstract":"Small intestinal microbial dysbiosis (SIMD) describes clinical syndromes attributed to overabundance of microbes within the small intestine. Usually attributed to bacteria (but also less commonly to archaea and fungi), SIMD arises as a secondary condition, when there is disruption of one or more key physiological mechanisms. We provide a comprehensive review of the current understanding of SIMD pathophysiology. We highlight the key physiological factors including gastric acid, pancreatic enzymes, bile acids, small intestinal dysmotility and obstruction, colonic motility, and intestinal mucosal immunity. We then describe the disease states associated with failure of these mechanisms, providing SIMD prevalence estimates for each. Finally, we address some of the controversies regarding SIMD including testing modalities, significance of intestinal methanogen overgrowth, and the role of SIMD in irritable bowel syndrome.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"1 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993042","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 : 2026-01-14DOI: 10.1016/s2468-1253(26)00003-8
Jairath V, Danese S, D'Haens GR, et al. Safety and pharmacokinetics of SOR102, an oral bispecific inhibitor of TNF and interleukin-23 in healthy participants and patients with ulcerative colitis: a first-in-human, double-blind, randomised, placebo-controlled, phase 1 trial. Lancet Gastroenterol Hepatol 2026; 11: 34–45—In this Article, the definition of endoscopic improvement should read “defined as a Mayo endoscopic subscore ≤1”; the definition of the modified Mayo score clinical response should read “defined as a decrease from baseline in the modified Mayo score of ≥2 points and ≥30%, plus a decrease in the rectal bleeding subscore of ≥1 point or an absolute rectal bleeding subscore of 0 or 1”; the definition of Mayo score clinical remission should read “defined as Mayo score ≤2, with no individual subscore >1”; and the definition of modified Mayo score clinical remission should read “defined as a stool frequency subscore of 0 or 1 without worsening, rectal bleeding subscore of 0, and Mayo endoscopic subscore ≤1”. These corrections have been made as of Jan 14, 2026.
{"title":"Correction to Lancet Gastroenterol Hepatol 2026; 11: 34–45","authors":"","doi":"10.1016/s2468-1253(26)00003-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00003-8","url":null,"abstract":"<em>Jairath V, Danese S, D'Haens GR, et al. Safety and pharmacokinetics of SOR102, an oral bispecific inhibitor of TNF and interleukin-23 in healthy participants and patients with ulcerative colitis: a first-in-human, double-blind, randomised, placebo-controlled, phase 1 trial.</em> Lancet Gastroenterol Hepatol <em>2026;</em> 11: <em>34–45</em>—In this Article, the definition of endoscopic improvement should read “defined as a Mayo endoscopic subscore ≤1”; the definition of the modified Mayo score clinical response should read “defined as a decrease from baseline in the modified Mayo score of ≥2 points and ≥30%, plus a decrease in the rectal bleeding subscore of ≥1 point or an absolute rectal bleeding subscore of 0 or 1”; the definition of Mayo score clinical remission should read “defined as Mayo score ≤2, with no individual subscore >1”; and the definition of modified Mayo score clinical remission should read “defined as a stool frequency subscore of 0 or 1 without worsening, rectal bleeding subscore of 0, and Mayo endoscopic subscore ≤1”. These corrections have been made as of Jan 14, 2026.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"36 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972532","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 : 2026-01-13DOI: 10.1016/s2468-1253(25)00287-0
Thanh N Nguyen, Whitney E Jackson, Nitzan C Roth, Felice Cinque, Monika Sarkar, Niharika Samala, Rita S Lee, Alexandra T Strauss, Jessica Wisocky, Keyur Patel, Giada Sebastiani, Carl G Streed, Jordan E Lake, Tzu-Hao Lee
{"title":"Chronic liver disease and hepatology care in transgender and gender diverse populations","authors":"Thanh N Nguyen, Whitney E Jackson, Nitzan C Roth, Felice Cinque, Monika Sarkar, Niharika Samala, Rita S Lee, Alexandra T Strauss, Jessica Wisocky, Keyur Patel, Giada Sebastiani, Carl G Streed, Jordan E Lake, Tzu-Hao Lee","doi":"10.1016/s2468-1253(25)00287-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00287-0","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"82 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145962458","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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