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[Personal View] Overlooked determinants and unequal outcomes: rethinking metabolic dysfunction-associated steatotic liver disease beyond the biomedical model

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.

[Review] Reducing alcohol-associated liver disease burden in the general population

The prevalence of alcohol use disorder (AUD) and alcohol-associated liver disease (ALD) is rising. The National Institute on Alcohol Abuse and Alcoholism organised a multistakeholder workshop focused on reducing the burden of ALD. Decreasing ALD morbidity and mortality requires a multipronged approach, including increased population-based screening for AUD, early recognition of ALD, and multidisciplinary treatment. Recommended screening tools for alcohol use include the alcohol use disorders identification test for consumption (AUDIT-C).

[Articles] Efficacy of behavioural therapies for irritable bowel syndrome: a systematic review and network meta-analysis

Several behavioural therapies are efficacious for global symptoms in IBS, although the most evidence exists for those classed as brain–gut behaviour therapies. However, certainty in the evidence for all direct and indirect comparisons across the network were rated as either low or very low confidence, due in part to publication bias and the risk of bias of the included trials.

[Articles] Endoscopic versus surgical gastroenterostomy for palliation of malignant gastric outlet obstruction (ENDURO): a randomised controlled trial

In patients with malignant gastric outlet obstruction, palliative treatment with endoscopic gastroenterostomy was superior to surgical gastroenterostomy for time to resumption of solid oral intake and was non-inferior for the rate of persistent or recurrent obstructive symptoms requiring re-intervention. Based on these results, endoscopic gastroenterostomy should be the preferred palliative treatment for patients with malignant gastric outlet obstruction.

[News] Research in Brief

Low-dose aspirin reduces the risk of colorectal cancer recurrence in patients with resected PI3K-altered localised disease, according to the ALASCCA trial. Anna Martling and colleagues randomly assigned patients with prespecified PIK3CA hotspot mutations in exon 9 or 20 (group A) or other moderate-to-high impact variants in PIK3CA, PIK3R1, or PTEN (group B) to receive either aspirin 160 mg (157 in group A, 156 in group B) or placebo (157 in group A, 156 in group B) once daily for 3 years. 3-year cumulative incidence of recurrence in group A was 7·7% with aspirin versus 14·1% with placebo (hazard ratio [HR] 0·49, 95% CI 0·24–0·98; p=0·04).

[News] UEG Week 2025

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 patients receiving obefazimod 50 mg, and four (3%) of 158 patients receiving placebo achieved clinical remission as per the FDA definition (stool frequency subscore of 0 or 1, rectal bleeding subscore of 0, and Mayo endoscopic subscore of 0 or 1; both p<0·0001 vs placebo).

[Correspondence] Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy

The multicentre observational study by Krzysztof Budzyń and colleagues1 reports that after routine exposure to artificial intelligence (AI)-assisted polyp detection, endoscopists’ performance during non-AI colonoscopy fell by 6·0%. Some will interpret these findings as evidence that AI exposure affects doctors’ interpretation abilities and as a reason to retreat from assistance, an intuitive yet incomplete reading.

[Correspondence] Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy

The multicentre observational study by Krzysztof Budzyń and colleagues1 raises imperative evidence of artificial intelligence (AI)-induced deskilling in colonoscopy, showing a 6·0% absolute decline in adenoma detection rate among endoscopists after computer-aided detection introduction and subsequent removal. Given that academic medical centres have been early adopters of AI, we highlight the training implications for novice practitioners and broader deskilling ramifications.

[Correspondence] Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy

Krzysztof Budzyń and colleagues1 provide timely evidence that continuous exposure to computer-aided polyp detection might erode unaided performance. Adenoma detection rate fell by 6·0% for colonoscopies not assisted by artificial intelligence (AI) following the introduction of AI across four centres. This first real-world evidence of automation-induced deskilling linked to patient outcomes in medicine will attract attention beyond endoscopy alone.

[Comment] Cultural competence in the delivery of nutrition and symptom care in irritable bowel syndrome

Culture has been described as “a set of practices and behaviours defined by customs, habits, language, and geography that groups of individuals share”.1 Ethnic identity and national allegiance are key parts of culture. Food culture or the “beliefs, values, and attitudes” a community holds towards food and its traditions are also fundamentally a part of culture.2 Food culture practices imparted across generations include how food systems (the infrastructure involved in producing, acquiring, and distributing food) operate, the expression of gender roles in the context of food and diet, and related religious practices such as fasting or food offerings.

[Comment] Evidence without evolution: a call for precision behavioural therapy in irritable bowel syndrome

In The Lancet Gastroenterology & Hepatology, Elyse Thakur and colleagues1 present an update of their 2020 systematic review and network meta-analysis on the efficacy of behavioural therapies for irritable bowel syndrome (IBS).2 This new meta-analysis, evaluating 67 randomised trials including 7441 participants (of which 26 trials enrolling 3298 patients were newly available since the previous analysis), took a new approach to therapy classification using a framework for brain–gut behaviour therapies.

[Comment] Redefining palliation in malignant gastric outlet obstruction

The field of therapeutic endoscopic ultrasonography has undergone remarkable expansion over the past decade. Initially used for drainage of pancreatic fluid collections, therapeutic endoscopic ultrasonography now spans a wide array of pancreaticobiliary and gastrointestinal indications.1,2 Reflecting this growth, the European Society of Gastrointestinal Endoscopy issued its first guidelines on therapeutic endoscopic ultrasonography in 2022.3 One notable advance has been the ability to create anastomoses between luminal structures, either to access excluded segments—such as in endoscopic ultrasonography-directed transgastric and transenteric endoscopic retrograde cholangiopancreatography procedures—or to bypass obstructed segments in the setting of gastric outlet or small bowel obstruction.

[Editorial] Bridging the evidence gap in dietary approaches to gut disorders

An estimated one in ten people are living with constipation at any point in time. Chronic constipation has a substantial impact on the quality of life of those affected and is also associated with considerable economic impact, both in terms of direct costs and loss of productivity. Individuals living with disorders of gut–brain interaction such as chronic constipation often express a preference for dietary interventions as a first-line treatment approach, perhaps in recognition that food can be a trigger of symptoms, or because dietary management gives a greater sense of control and could be associated with fewer side-effects than medical therapy.

[Personal View] The psychobiological model of disorders of gut–brain interaction: introduction of a novel, integrated, and testable model

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.

[Review] Recompensation in decompensated cirrhosis

Recompensation of decompensated cirrhosis has been defined by the Baveno consensus as control or cure of the main underlying cause; resolution of clinical manifestations, including ascites and hepatic encephalopathy, without the use of prophylactic medications, and without variceal bleeding for 12 months; and restoration of hepatic function. Cure and recompensation are usually associated with regression of liver fibrosis. Recompensation can occur when hepatitis C virus is eradicated, if hepatitis B virus infection (without hepatitis D co-infection) is suppressed, and following persistent alcohol abstinence in patients with alcohol-associated cirrhosis.