Pub Date : 2025-10-28DOI: 10.1016/s2468-1253(25)00258-4
Marte Lie Høivik
{"title":"Optimising treatment in Crohn's disease: is the main issue early versus late or biologic naive versus biologic experienced?","authors":"Marte Lie Høivik","doi":"10.1016/s2468-1253(25)00258-4","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00258-4","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"59 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145382774","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}
Thoracoscopic oesophagectomy, a minimally invasive treatment for oesophageal cancer, is used worldwide. However, no large-scale, multicentre, randomised controlled trial has compared long-term survival as the primary endpoint between thoracoscopic and open oesophagectomy. We aimed to confirm the non-inferiority in overall survival of thoracoscopic oesophagectomy over open oesophagectomy in patients with resectable thoracic oesophageal cancer.
Methods
This multicentre, open-label, randomised, controlled, phase 3, non-inferiority trial was conducted at 31 hospitals across Japan. Patients aged 20–80 years were eligible if they had histologically confirmed oesophageal squamous cell carcinoma, oesophageal adenosquamous carcinoma, or oesophageal basaloid squamous cell carcinoma, which was located in the thoracic oesophagus; an Eastern Cooperative Oncology Group performance status of 0 or 1; clinical stage I, II, or III (but not T4) disease; and had not received previous treatment for oesophageal cancer, except for endoscopic resection of superficial lesions and preoperative chemotherapy (doublet or triplet) per Japanese guidelines. Patients were randomly assigned (1:1) using a web-based system with adjustment factors by clinical stage (IA vs IB, II, or III), age (<76 years vs ≥76 years), and institution, to right open transthoracic oesophagectomy or right thoracoscopic oesophagectomy, both with at least D2 lymphadenectomy. The primary endpoint was investigator-assessed overall survival, analysed in the intention-to-treat population. The non-inferiority margin was 9% for 3-year overall survival (hazard ratio [HR] 1·44). Two formal interim analyses of overall survival were planned: the first after half of the expected number of patients were enrolled and the second after patients had been accrued and protocol treatment completed. The trial would be terminated for efficacy if non-inferiority and superiority in overall survival was shown for thoracoscopic oesophagectomy in the first interim analysis and if non-inferiority in overall survival was shown in the second interim analysis. This trial was registered with UMIN Clinical Trials Registry, UMIN000017628 (follow-up ongoing).
Findings
From May 20, 2015, to June 17, 2022, 300 patients were randomly assigned (150 to open oesophagectomy and 150 to thoracoscopic oesophagectomy). 247 (82%) of 300 patients were male and 53 (18%) were female. The median age was 68 years (IQR 64–72). 148 (99%) of 150 patients underwent open oesophagectomy, and all 150 patients underwent thoracoscopic oesophagectomy. In the first interim analysis at a median follow-up of 1·6 years (IQR 0·8–2·5), non-inferiority was not confirmed (HR 0·56 [99·99990046% CI 0·05–5·73]; one-sided pnon-inferiority=0·002326, greater than the prespecified non-inferiority threshold). At a median follow-up of 2·6 years (IQR 1·4–4·9) for the second interim analysis, 3-year overall survival wa
{"title":"Thoracoscopic versus open oesophagectomy for patients with oesophageal cancer (JCOG1409 MONET): a multicentre, open-label, randomised, controlled, phase 3, non-inferiority trial","authors":"Hiroya Takeuchi, Ryunosuke Machida, Masahiko Ando, Yasuhiro Tsubosa, Hirotoshi Kikuchi, Hirofumi Kawakubo, Kazuhiro Noma, Masaki Ueno, Takahiro Tsushima, Takeo Bamba, Takeo Fujita, Yoichi Hamai, Tomokazu Kakishita, Hiroyuki Daiko, Kazuo Koyanagi, Satoru Matsuda, Ken Kato, Keita Sasaki, Ryosuke Kita, Yuko Kitagawa, Ken Sasaki","doi":"10.1016/s2468-1253(25)00207-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00207-9","url":null,"abstract":"<h3>Background</h3>Thoracoscopic oesophagectomy, a minimally invasive treatment for oesophageal cancer, is used worldwide. However, no large-scale, multicentre, randomised controlled trial has compared long-term survival as the primary endpoint between thoracoscopic and open oesophagectomy. We aimed to confirm the non-inferiority in overall survival of thoracoscopic oesophagectomy over open oesophagectomy in patients with resectable thoracic oesophageal cancer.<h3>Methods</h3>This multicentre, open-label, randomised, controlled, phase 3, non-inferiority trial was conducted at 31 hospitals across Japan. Patients aged 20–80 years were eligible if they had histologically confirmed oesophageal squamous cell carcinoma, oesophageal adenosquamous carcinoma, or oesophageal basaloid squamous cell carcinoma, which was located in the thoracic oesophagus; an Eastern Cooperative Oncology Group performance status of 0 or 1; clinical stage I, II, or III (but not T4) disease; and had not received previous treatment for oesophageal cancer, except for endoscopic resection of superficial lesions and preoperative chemotherapy (doublet or triplet) per Japanese guidelines. Patients were randomly assigned (1:1) using a web-based system with adjustment factors by clinical stage (IA <em>vs</em> IB, II, or III), age (<76 years <em>vs</em> ≥76 years), and institution, to right open transthoracic oesophagectomy or right thoracoscopic oesophagectomy, both with at least D2 lymphadenectomy. The primary endpoint was investigator-assessed overall survival, analysed in the intention-to-treat population. The non-inferiority margin was 9% for 3-year overall survival (hazard ratio [HR] 1·44). Two formal interim analyses of overall survival were planned: the first after half of the expected number of patients were enrolled and the second after patients had been accrued and protocol treatment completed. The trial would be terminated for efficacy if non-inferiority and superiority in overall survival was shown for thoracoscopic oesophagectomy in the first interim analysis and if non-inferiority in overall survival was shown in the second interim analysis. This trial was registered with UMIN Clinical Trials Registry, UMIN000017628 (follow-up ongoing).<h3>Findings</h3>From May 20, 2015, to June 17, 2022, 300 patients were randomly assigned (150 to open oesophagectomy and 150 to thoracoscopic oesophagectomy). 247 (82%) of 300 patients were male and 53 (18%) were female. The median age was 68 years (IQR 64–72). 148 (99%) of 150 patients underwent open oesophagectomy, and all 150 patients underwent thoracoscopic oesophagectomy. In the first interim analysis at a median follow-up of 1·6 years (IQR 0·8–2·5), non-inferiority was not confirmed (HR 0·56 [99·99990046% CI 0·05–5·73]; one-sided p<sub>non-inferiority</sub>=0·002326, greater than the prespecified non-inferiority threshold). At a median follow-up of 2·6 years (IQR 1·4–4·9) for the second interim analysis, 3-year overall survival wa","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"125 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283446","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 : 2025-10-10DOI: 10.1016/s2468-1253(25)00284-5
Sophie R Abber, Helen Burton-Murray
No Abstract
没有抽象的
{"title":"Evidence without evolution: a call for precision behavioural therapy in irritable bowel syndrome","authors":"Sophie R Abber, Helen Burton-Murray","doi":"10.1016/s2468-1253(25)00284-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00284-5","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"23 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254886","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 : 2025-10-10DOI: 10.1016/s2468-1253(25)00238-9
Elyse R Thakur, Mais Khasawneh, Paul Moayyedi, Christopher J Black, Alexander C Ford
<h3>Background</h3>Irritable bowel syndrome (IBS) management guidelines recommend that behavioural therapies, particularly brain–gut behaviour therapies, should be considered as a treatment. Some, such as IBS-specific cognitive behavioural therapy (CBT) or gut-directed hypnotherapy, have specific techniques and, therefore, are in their own class of brain–gut behaviour therapy, while others, such as stress management or relaxation training, are common or universal techniques that are present in most classes of brain–gut behaviour therapy. In addition, there are other behavioural therapies or treatment options, including digital therapies, which are not classed as brain–gut behaviour therapies. We aimed to evaluate relative efficacy of the available behavioural therapies in IBS.<h3>Methods</h3>For this systematic review and network meta-analysis we searched MEDLINE, EMBASE, EMBASE Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials from inception to April 23, 2025, to identify randomised controlled trials (RCTs) comparing the efficacy of behavioural therapies for adults with IBS with each other, or a control intervention. We judged efficacy using dichotomous assessments of improvement in global IBS symptoms. We pooled data with a random effects model, with efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs. We ranked behavioural therapies according to their P score, which is the mean extent of certainty that one treatment is better than another, averaged over all competing behavioural therapies.<h3>Findings</h3>We identified 67 eligible RCTs, comprising 7441 participants. After completion of treatment, and compared with waiting list control, behavioural therapies with the largest numbers of trials, and patients recruited, that showed efficacy were: minimal contact CBT (RR for global IBS symptoms not improving at first point of follow-up post-treatment 0·55 [95% CI 0·39–0·76], P score 0·78; two RCTs, 511 patients), telephone disease self-management (0·57 [0·41–0·80], P score 0·75; two trials, 746 patients), dynamic psychotherapy (0·59 [0·43–0·80], P score 0·72; three RCTs, 303 patients), CBT (0·65 [0·53–0·80], P score 0·64; nine trials, 1150 patients), disease self-management (0·68 [0·50–0·92], P score 0·58; three RCTs, 375 patients), internet-based minimal contact CBT (0·77 [0·61–0·96], P score 0·43; five RCTs, 705 patients), and gut-directed hypnotherapy (0·79 [0·66–0·95], P score 0·39; 12 trials, 1507 patients). After completion of treatment, among trials recruiting only patients with refractory symptoms, telephone disease self-management and contingency management were both superior to attention placebo control (0·52 [0·28–0·94] and 0·50 [0·26–0·96], respectively) and routine care (0·46 [0·31–0·69] and 0·45 [0·24–0·85], respectively), and group CBT (0·50 [0·29–0·86]), internet-based minimal contact disease self-management (0·58 [0·40–0·86]), and dynamic psychotherapy (0·61 [0·44–0·86]) were
{"title":"Efficacy of behavioural therapies for irritable bowel syndrome: a systematic review and network meta-analysis","authors":"Elyse R Thakur, Mais Khasawneh, Paul Moayyedi, Christopher J Black, Alexander C Ford","doi":"10.1016/s2468-1253(25)00238-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00238-9","url":null,"abstract":"<h3>Background</h3>Irritable bowel syndrome (IBS) management guidelines recommend that behavioural therapies, particularly brain–gut behaviour therapies, should be considered as a treatment. Some, such as IBS-specific cognitive behavioural therapy (CBT) or gut-directed hypnotherapy, have specific techniques and, therefore, are in their own class of brain–gut behaviour therapy, while others, such as stress management or relaxation training, are common or universal techniques that are present in most classes of brain–gut behaviour therapy. In addition, there are other behavioural therapies or treatment options, including digital therapies, which are not classed as brain–gut behaviour therapies. We aimed to evaluate relative efficacy of the available behavioural therapies in IBS.<h3>Methods</h3>For this systematic review and network meta-analysis we searched MEDLINE, EMBASE, EMBASE Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials from inception to April 23, 2025, to identify randomised controlled trials (RCTs) comparing the efficacy of behavioural therapies for adults with IBS with each other, or a control intervention. We judged efficacy using dichotomous assessments of improvement in global IBS symptoms. We pooled data with a random effects model, with efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs. We ranked behavioural therapies according to their P score, which is the mean extent of certainty that one treatment is better than another, averaged over all competing behavioural therapies.<h3>Findings</h3>We identified 67 eligible RCTs, comprising 7441 participants. After completion of treatment, and compared with waiting list control, behavioural therapies with the largest numbers of trials, and patients recruited, that showed efficacy were: minimal contact CBT (RR for global IBS symptoms not improving at first point of follow-up post-treatment 0·55 [95% CI 0·39–0·76], P score 0·78; two RCTs, 511 patients), telephone disease self-management (0·57 [0·41–0·80], P score 0·75; two trials, 746 patients), dynamic psychotherapy (0·59 [0·43–0·80], P score 0·72; three RCTs, 303 patients), CBT (0·65 [0·53–0·80], P score 0·64; nine trials, 1150 patients), disease self-management (0·68 [0·50–0·92], P score 0·58; three RCTs, 375 patients), internet-based minimal contact CBT (0·77 [0·61–0·96], P score 0·43; five RCTs, 705 patients), and gut-directed hypnotherapy (0·79 [0·66–0·95], P score 0·39; 12 trials, 1507 patients). After completion of treatment, among trials recruiting only patients with refractory symptoms, telephone disease self-management and contingency management were both superior to attention placebo control (0·52 [0·28–0·94] and 0·50 [0·26–0·96], respectively) and routine care (0·46 [0·31–0·69] and 0·45 [0·24–0·85], respectively), and group CBT (0·50 [0·29–0·86]), internet-based minimal contact disease self-management (0·58 [0·40–0·86]), and dynamic psychotherapy (0·61 [0·44–0·86]) were ","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"36 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254888","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 : 2025-10-10DOI: 10.1016/s2468-1253(25)00257-2
Ozgur M Koc, Anne-Kristin Toussaint, Aurelie Untas, Piotr Milkiewicz, Henriette Ytting, Laura Buck, David E Jones, Gideon Hirschfield, Angela Leburgue, Christoph Schramm, Frederik Nevens, Adriaan J van der Meer, Alessio Gerussi, Jef Verbeek
Given the unmet need of fatigue in primary biliary cholangitis (PBC), the PBC working group of the European Reference Network for Rare Liver Diseases assessed and summarised the current evidence relating to fatigue in PBC to provide guidance for clinical practice and identify knowledge gaps to shape the future research agenda. Six key questions regarding PBC-related fatigue were summarised through systematic review and meta-analyses. Fatigue is highly prevalent in PBC and substantially affects health-related quality of life. Several measurement tools are available but future research should emphasise longitudinal designs to track symptoms with easy-to-apply and accurate tools. The pathophysiology of fatigue in PBC remains largely unknown and involves a complex interplay of various factors. Pilot studies suggest the effectiveness of non-pharmacological treatments, which warrant further investigation. Pending the results of clinical trials, no pharmacological treatment can be recommended for PBC-related fatigue. Finally, we introduce a practical, three-step ASK-MEASURE-TREAT algorithm that can be applied in all patients with PBC.
{"title":"Fatigue in people with primary biliary cholangitis: a position paper from the European Reference Network for Rare Liver Diseases","authors":"Ozgur M Koc, Anne-Kristin Toussaint, Aurelie Untas, Piotr Milkiewicz, Henriette Ytting, Laura Buck, David E Jones, Gideon Hirschfield, Angela Leburgue, Christoph Schramm, Frederik Nevens, Adriaan J van der Meer, Alessio Gerussi, Jef Verbeek","doi":"10.1016/s2468-1253(25)00257-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00257-2","url":null,"abstract":"Given the unmet need of fatigue in primary biliary cholangitis (PBC), the PBC working group of the European Reference Network for Rare Liver Diseases assessed and summarised the current evidence relating to fatigue in PBC to provide guidance for clinical practice and identify knowledge gaps to shape the future research agenda. Six key questions regarding PBC-related fatigue were summarised through systematic review and meta-analyses. Fatigue is highly prevalent in PBC and substantially affects health-related quality of life. Several measurement tools are available but future research should emphasise longitudinal designs to track symptoms with easy-to-apply and accurate tools. The pathophysiology of fatigue in PBC remains largely unknown and involves a complex interplay of various factors. Pilot studies suggest the effectiveness of non-pharmacological treatments, which warrant further investigation. Pending the results of clinical trials, no pharmacological treatment can be recommended for PBC-related fatigue. Finally, we introduce a practical, three-step ASK-MEASURE-TREAT algorithm that can be applied in all patients with PBC.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"204 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260716","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 : 2025-10-10DOI: 10.1016/s2468-1253(25)00321-8
Rob Brierley
Section snippets
ABTECT 1 & 2
Data from two randomised trials indicate that the microRNA upregulator obefazimod resulted in significantly higher rates of clinical remission at week 8 than did placebo in patients with moderately-to-severely active ulcerative colitis. Both trials, presented by Bruce E Sands (New York City, NY, USA), randomly assigned participants to receive obefazimod 25 mg, obefazimod 50 mg, or placebo. At week 8, in the ABTECT 1 trial, 38 (24%) of 160 patients receiving obefazimod 25 mg, 69 (22%) of 318
TRIASSIC trial
For en-bloc resection of large, non-pedunculated rectal lesions, endoscopic submucosal dissection (ESD) is non-inferior to transanal minimally invasive surgery (TAMIS) in terms of local recurrence at 12 months, according to data presented by Nik Dekkers (Leiden, the Netherlands). In the multicentre, randomised TRIASSIC trial, patients with non-pedunculated rectal lesions larger than 2 cm that were located at most 15 cm from the anal verge were randomly assigned to undergo either ESD (n=100) or
WATERLAND trial
Fluid resuscitation with lactated Ringer's solution in patients with acute pancreatitis did not improve key clinical outcomes compared with normal saline, according to the results of the WATERLAND trial. In this randomised controlled trial presented by Enrique de-Madaria (Alicante, Spain), patients with acute pancreatitis were randomly assigned to receive fluid resuscitation with either lactated Ringer's (n=399) or normal saline (n=393) for at least 48 h. Although there was evidence that
The Mediterranean diet in irritable bowel syndrome
The Mediterranean diet could be a new first-line dietary option for patients with irritable bowel syndrome (IBS), according to data presented by Imran Aziz (Sheffield, UK). In a randomised non-inferiority trial, individuals with IBS were randomly assigned to follow the Mediterranean diet (n=68) or traditional dietary advice (n=71) for 6 weeks. The primary endpoint was the proportion of participants achieving clinical response (defined as a 50-point or greater reduction in the IBS Symptom
来自两项随机试验的数据表明，在中度至重度活动性溃疡性结肠炎患者中，microRNA上调剂obefazimod在第8周的临床缓解率显著高于安慰剂。这两项试验均由Bruce E Sands （New York City， NY， USA）提出，随机分配受试者接受奥贝法齐mod 25 mg、奥贝法齐mod 50 mg或安慰剂。第8周，在ABTECT 1试验中，160例患者中有38例（24%）接受了奥贝法莫25 mg， 318TRIASSIC试验中有69例（22%）。根据Nik Dekkers （Leiden, Netherlands）提供的数据，在12个月的局部复发率方面，内镜下粘膜下解剖（ESD）不低于经肛门微创手术（TAMIS）。在多中心随机TRIASSIC试验中，非带蒂直肠病变大于2 cm且位于肛门边缘最多15 cm的患者被随机分配进行ESD （n=100）或WATERLAND试验。根据WATERLAND试验的结果，与生理盐水相比，急性胰腺炎患者使用乳酸林格氏液进行液体复苏并没有改善关键临床结果。在这项由Enrique de-Madaria （Alicante, Spain）提出的随机对照试验中，急性胰腺炎患者被随机分配接受至少48小时的乳酸林格氏液（n=399）或生理盐水（n=393）液体复苏。尽管有证据表明，地中海饮食对肠易激综合征（IBS）患者可能是一种新的一线饮食选择。根据Imran Aziz （Sheffield， UK）提供的数据。在一项随机非劣效性试验中，肠易激综合征患者被随机分配到遵循地中海饮食（n=68）或传统饮食建议（n=71） 6周。主要终点是达到临床缓解的参与者比例（定义为IBS症状减少50分或以上）
{"title":"UEG Week 2025","authors":"Rob Brierley","doi":"10.1016/s2468-1253(25)00321-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00321-8","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>ABTECT 1 & 2</h2>Data from two randomised trials indicate that the microRNA upregulator obefazimod resulted in significantly higher rates of clinical remission at week 8 than did placebo in patients with moderately-to-severely active ulcerative colitis. Both trials, presented by Bruce E Sands (New York City, NY, USA), randomly assigned participants to receive obefazimod 25 mg, obefazimod 50 mg, or placebo. At week 8, in the ABTECT 1 trial, 38 (24%) of 160 patients receiving obefazimod 25 mg, 69 (22%) of 318</section></section><section><section><h2>TRIASSIC trial</h2>For en-bloc resection of large, non-pedunculated rectal lesions, endoscopic submucosal dissection (ESD) is non-inferior to transanal minimally invasive surgery (TAMIS) in terms of local recurrence at 12 months, according to data presented by Nik Dekkers (Leiden, the Netherlands). In the multicentre, randomised TRIASSIC trial, patients with non-pedunculated rectal lesions larger than 2 cm that were located at most 15 cm from the anal verge were randomly assigned to undergo either ESD (n=100) or</section></section><section><section><h2>WATERLAND trial</h2>Fluid resuscitation with lactated Ringer's solution in patients with acute pancreatitis did not improve key clinical outcomes compared with normal saline, according to the results of the WATERLAND trial. In this randomised controlled trial presented by Enrique de-Madaria (Alicante, Spain), patients with acute pancreatitis were randomly assigned to receive fluid resuscitation with either lactated Ringer's (n=399) or normal saline (n=393) for at least 48 h. Although there was evidence that</section></section><section><section><h2>The Mediterranean diet in irritable bowel syndrome</h2>The Mediterranean diet could be a new first-line dietary option for patients with irritable bowel syndrome (IBS), according to data presented by Imran Aziz (Sheffield, UK). In a randomised non-inferiority trial, individuals with IBS were randomly assigned to follow the Mediterranean diet (n=68) or traditional dietary advice (n=71) for 6 weeks. The primary endpoint was the proportion of participants achieving clinical response (defined as a 50-point or greater reduction in the IBS Symptom</section></section>","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"1 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260715","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 : 2025-10-08DOI: 10.1016/s2468-1253(25)00235-3
Alberto Pilotto, Carlo Custodero, Lucilla Crudele, Wanda Morganti, Nicola Veronese, Marilisa Franceschi
Disorders of the gastrointestinal tract are common in those aged 65 years or older, impairing their quality of life and potentially increasing morbidity and mortality risk. Unlike many organ systems, the luminal gastrointestinal tract does not undergo much natural degeneration. However, age-related anatomical and functional changes of the gastrointestinal tract might promote pathophysiology and explain some atypical presentations of gastrointestinal disorders in older adults. This Review summarises current knowledge of major anatomical and functional changes that occur in the gastrointestinal tract during ageing. These changes are often more evident in older adults who are frail or multimorbid, and frailty in older age might also influence the presentation, prognosis, and management of older patients with gastrointestinal disorders.
{"title":"Age-related changes of the gastrointestinal tract","authors":"Alberto Pilotto, Carlo Custodero, Lucilla Crudele, Wanda Morganti, Nicola Veronese, Marilisa Franceschi","doi":"10.1016/s2468-1253(25)00235-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00235-3","url":null,"abstract":"Disorders of the gastrointestinal tract are common in those aged 65 years or older, impairing their quality of life and potentially increasing morbidity and mortality risk. Unlike many organ systems, the luminal gastrointestinal tract does not undergo much natural degeneration. However, age-related anatomical and functional changes of the gastrointestinal tract might promote pathophysiology and explain some atypical presentations of gastrointestinal disorders in older adults. This Review summarises current knowledge of major anatomical and functional changes that occur in the gastrointestinal tract during ageing. These changes are often more evident in older adults who are frail or multimorbid, and frailty in older age might also influence the presentation, prognosis, and management of older patients with gastrointestinal disorders.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"116 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247410","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 : 2025-10-08DOI: 10.1016/s2468-1253(25)00292-4
Sadé L Assmann, Daniel Keszthelyi, Merel L Kimman, Stéphanie O Breukink
No Abstract
没有抽象的
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