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BackgroundTNF-like cytokine 1A (TL1A) is a key mediator of inflammation and fibrosis. The efficacy and safety of the anti-TL1A monoclonal antibody tulisokibart as induction treatment was assessed in adults with moderately to severely active Crohn's disease with a history of insufficient response, loss of response, or intolerance to conventional or approved biological therapies. MethodsIn the phase

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The Coaltion for Global Hepatitis Elimination's National Hepatitis Elimination Profiles assess the status of national data, policy, and programme development the elimination of viral hepatitis. Profiles from 33 countries and territories show progress, towards elimination of hepatitis B with 24 (73%) of them meeting the 2025 WHO interim target of 0·5% or less HBsAg prevalence in children younger than

BackgroundAlthough several PD-1 or PD-L1 inhibitors combined with antiangiogenic agents have been approved as first-line treatment of advanced hepatocellular carcinoma, treatment needs remain unmet given the high incidence and mortality of hepatocellular carcinoma and due to factors such as regional approval status, medical insurance restrictions, and cost considerations. In this phase 3 HEPATORCH

The Coalition for Global Hepatitis Elimination's National Hepatitis Elimination Profiles assess the status of national data, policy, and programme development for the elimination of viral hepatitis. To date, profiles from 33 countries and territories have been developed. These profiles reveal that 30 (91%) countries and territories have hepatitis C national action plans, 11 (33%) have systems to monitor

BackgroundEarlier diagnosis of pancreatic ductal adenocarcinoma is key to improving overall survival in patients with this hard-to-treat cancer. We independently validated two previously identified plasma-based metabolic signatures for exclusion of pancreatic ductal adenocarcinoma in cohorts with an increased annual risk. MethodsThe METAPAC study was a prospective, multicentre, investigator-masked

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BackgroundNovel treatments are needed for eosinophilic oesophagitis. Etrasimod is an oral, once-daily, selective sphingosine 1-phosphate (S1P)1,4,5 receptor modulator in development for the treatment of immune-mediated inflammatory diseases. We assessed efficacy and safety of etrasimod versus placebo in adults with eosinophilic oesophagitis. MethodsIn this double-blind, randomised, phase 2 trial, patients

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In December, 2023, The Lancet Gastroenterology & Hepatology published the results of the DRA-GOO trial,1 comparing endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) versus uncovered duodenal metal stenting for patients with unresectable malignant gastric outlet obstruction.

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Section snippets FIT screening non-inferior to colonoscopyFaecal immunochemical test (FIT) screening is more widely accepted than colonoscopy and offers non-inferior protection against colorectal cancer mortality, according to the 10-year results of the COLONPREV trial.Antoni Castells and colleagues randomly assigned participants to receive an invitation to one-time colonoscopy (n=28 708) or FIT every

BackgroundThe U-ACTIVATE long-term extension study aims to evaluate the long-term efficacy and safety of upadacitinib in patients with moderately to severely active ulcerative colitis. Here, we report interim results after 3 years of total treatment. MethodsU-ACTIVATE is an ongoing, 288-week, phase 3, long-term extension study done at 307 centres across 43 countries (active sites on Dec 31, 2021, are

BackgroundTotal neoadjuvant therapy has been shown to increase pathological complete response and disease-free survival in patients with locally advanced rectal cancer after total mesorectal excision (TME). We hypothesised that total neoadjuvant therapy could maximise the number of patients attaining a clinical complete response who could then be instead referred to organ preservation with watch and

BackgroundEndoscopic ultrasonography-guided gastroenterostomy (EUS-GE) is a novel endoscopic method to palliate malignant gastric outlet obstruction. We aimed to assess whether the use of EUS-GE with a double balloon occluder for malignant gastric outlet obstruction could reduce the need for reintervention within 6 months compared with conventional duodenal stenting. MethodsThe was an international

BackgroundHepatitis C virus (HCV) infection is a significant public health concern. Limited data have shown unusually high HCV seroprevalence among Rohingya refugees residing in camps in Cox's Bazar, Bangladesh. We aimed to assess the prevalence of HCV seropositivity and active infection and identify risk factors to inform the HCV response. MethodsA cross-sectional survey was conducted between May

Perianal fistulae can present a diagnostic challenge when distinguishing perianal Crohn's disease from idiopathic perianal fistulae. This distinction is key, as perianal Crohn's disease requires inflammatory bowel disease (IBD) therapy, whereas idiopathic perianal fistulae are primarily managed surgically. When luminal inflammation is absent, but Crohn's disease is suspected, the term isolated perianal

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Patients with irritable bowel syndrome (IBS) are often interested in dietary interventions as a means of managing their symptoms. However, the relative efficacy of available diets for the management of IBS is unclear. We aimed to examine the relative efficacy of various dietary interventions in IBS.

Gut–brain neuromodulators might be efficacious for irritable bowel syndrome (IBS), but there has been no synthesis of evidence from randomised controlled trials (RCTs) of some drug classes, and whether they have pain-modifying properties in IBS is unclear. We updated a previous systematic review and meta-analysis of RCTs examining these questions.

The appendix might have an immunomodulatory role in ulcerative colitis. Appendicectomy has been suggested as a potentially therapeutic intervention to maintain remission in ulcerative colitis. We aimed to evaluate the clinical effectiveness of laparoscopic appendicectomy in maintaining remission in patients with ulcerative colitis.

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Section snippets Duvakitug in Crohn's disease and ulcerative colitisDuvakitug—an anti-TL1A antibody—was safe and efficacious for induction in patients with Crohn's disease and in those with ulcerative colitis, according to data from the double-blind, phase 2b RELIEVE UCCD basket trial. In the first presentation by Vipul Jairath (London, ON, Canada), 138 adults with moderately to severely active Crohn's

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Therapeutic progress in inflammatory bowel disease (IBD) has hitherto focused on reducing inflammation to minimise long-term complications. However, strategies aimed at preventing IBD and attenuating its disease course are particularly appealing. This concept is derived from accumulating evidence for an “at-risk” preclinical state and the associations linking genetic background and numerous environmental

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In this trial, we previously showed per-oral endoscopic myotomy (POEM) to be non-inferior to laparoscopic Heller's myotomy (LHM) plus Dor fundoplication in managing symptoms in patients with idiopathic achalasia 2 years post-procedure. However, post-procedural gastro-oesophageal reflux was more common after POEM at 2 years. Here we report 5-year follow-up data.

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Kang Y-K, Terashima M, Kim Y-W, et al. Adjuvant nivolumab plus chemotherapy versus placebo plus chemotherapy for stage III gastric or gastro-oesophageal junction cancer after gastrectomy with D2 or more extensive lymph-node dissection (ATTRACTION-5): a randomised, multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Gastroenterol Hepatol 2024; 9: 705–17—In this Article, the penultimate

Section snippets Simvastatin plus rifaximin for decompensated cirrhosisThe addition of simvastatin plus rifaximin to standard therapy does not improve outcomes in patients with decompensated liver cirrhosis, according to the LIVERHOPE phase 3 trial.Elisa Pose and colleagues randomly assigned patients with decompensated cirrhosis to receive simvastatin plus rifaximin (n=117) or placebo (n=120) for 12

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Tumour coverage with an optimal minimal ablative margin is crucial for improving local control of liver tumours following thermal ablation. The minimal ablative margin has traditionally been assessed through visual inspection of co-registered CT images. However, rates of local tumour control after thermal ablation are highly variable with visual assessment. We aimed to assess the use of a novel software-based

Timely administration of the hepatitis B virus (HBV) birth dose vaccine, along with identifying high-risk pregnant individuals for antiviral prophylaxis, is essential for the global elimination of vertical transmission of HBV. However, in resource-limited settings, access to HBV DNA testing is scarce, and accurate rapid tests for HBeAg are lacking. We aimed to assess the diagnostic performance of a

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The intestinal barrier serves as a boundary between the mucosal immune system in the lamina propria and the external environment of the intestinal lumen, which contains a diverse array of microorganisms and ingested environmental factors, including pathogens, food antigens, toxins, and other foreign substances. This barrier has a central role in regulating the controlled interaction between luminal

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Acute kidney injury (AKI) is a serious complication of cirrhosis. A systematic, global characterisation of AKI occurring in patients with cirrhosis is lacking. We therefore aimed to assess global differences in the characteristics, management, and outcomes of AKI in hospitalised patients with cirrhosis.

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Locoregional therapies play a fundamental role in the treatment of patients with early and intermediate and locally advanced hepatocellular carcinomas. With encouraging recent advances in immunotherapy-based systemic therapies, locoregional therapies are being both promoted and challenged by new systemic therapy options. Combined locoregional and systemic therapies might enhance treatment outcomes

Measuring progress towards the WHO 2030 target for hepatitis C virus (HCV) elimination among people who inject drugs (PWID)—an incidence of two or fewer infections per 100 person-years—has been challenging due to insufficient data. We aimed to estimate HCV incidence among PWID before and since 2015, progress towards the 2030 target, and the number of new annual HCV infections attributable to injecting

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