Search Medical Journals & Research Articles

[Review] Current and emerging therapeutic landscape for metabolic dysfunction-associated steatohepatitis

Globally, metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common chronic liver disease, affecting up to one in three people in the general population, with an estimated increase in prevalence of more than 50% in the last three decades. The rise in prevalence of MASLD will result in substantial increases in the number patients with decompensated cirrhosis and those developing liver cancer by 2030. Despite the complex pathobiology of MASLD, two major breakthroughs in phase 3 clinical trials now herald an era of licensed therapies for MASLD.

[In Focus] The label of a diagnosis

To suddenly and unexpectedly feel unwell is not welcome in our busy day-to-day lives. For the physical symptoms to persist longer than you know they should is even worse. The desperation to feel better is palpable. To constantly feel unwell is draining. And, of course, nobody wants to admit that there may be an underlying cause. The denial that you may need to seek medical help and the fear of the unknown are real and strong. But, eventually and probably inevitably, it seems that seeking professional help is the only sensible option, the only way forward.

[News] Research in Brief

Perioperative camrelizumab plus rivoceranib shows benefit in patients with hepatocellular carcinoma at intermediate or high risk of relapse, according to the CARES-009 phase 2/3 trial. Zheng Wang and colleagues randomly assigned patients to receive either perioperative therapy comprising two cycles of neoadjuvant camrelizumab plus rivoceranib, followed by surgery and adjuvant camrelizumab plus rivoceranib (n=148), or surgery alone (n=146). At a prespecified interim analysis, with a median follow-up of 21·3 months, median EFS was 42·1 months (95% CI 23·2–not estimable [NE]) in the perioperative group versus 19·4 months (14·9–NE) in the surgery-alone group (hazard ratio [HR] 0·59, 95% CI 0·41–0·85; p=0·0040).

[Corrections] Correction to Lancet Gastroenterol Hepatol 2025; 10: 431–41

Hugova K, Mares J, Hakanson B, et al. Per-oral endoscopic myotomy versus laparoscopic Heller's myotomy plus Dor fundoplication in patients with idiopathic achalasia: 5-year follow-up of a multicentre, randomised, open-label, non-inferiority trial. Lancet Gastroenterol Hepatol 2025; 10: 431–41—In this Article, Prof Alessandro Repici's affiliations should have been “Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy” and “Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy”.

[Corrections] Correction to Lancet Gastroenterol Hepatol 2019; 4: 364–75

Hurt C, Ramaraj R, Farr A, et al. Feasibility and economic assessment of chromocolonoscopy for detection of proximal serrated neoplasia within a population-based colorectal cancer screening programme (CONSCOP): an open-label, randomised controlled non-inferiority trial. Lancet Gastroenterol Hepatol 2019; 4: 364–75—The appendix of this Article had been inadvertently switched with that of another paper; the correct appendix has now been supplied, as of Dec 2, 2025.

[Correspondence] Clinical remission in ulcerative colitis: restoring precision in trial terminology

The term remission is a fundamental descriptor of therapeutic success in clinical medicine, denoting the abatement of symptoms and a return towards normal function. In ulcerative colitis, the term clinical remission can be traced back to the first modern randomised controlled trial in gastroenterology, the landmark cortisone versus placebo study, in which remission was defined strictly by symptom resolution.1 Endoscopic disease activity was reported separately, indicating early recognition that these outcomes represent separate dimensions of disease control.

[Correspondence] Endoscopic palliation of malignant gastric outlet obstruction: harmonising outcomes

Three recent randomised controlled trials (RCTs)—two of which were published in The Lancet Gastroenterology & Hepatology—have defined endoscopic ultrasonography-guided gastroenterostomy as a transformative advance for malignant gastric outlet obstruction.1–3 Each trial represents a major technical and methodological accomplishment, collectively positioning endoscopic ultrasonography-guided gastroenterostomy as a credible and increasingly accessible alternative to surgical bypass or duodenal stent palliation.

[Correspondence] Efficacy differentiation of sterile faecal filtrates in Clostridioides difficile infection

We congratulate Dina Kao and colleagues on their elegant and methodologically rigorous non-inferiority trial comparing lyophilised sterile faecal filtrate (LSFF) with lyophilised faecal microbiota transplantation (LFMT) in patients with recurrent Clostridioides difficile infection.1 This work represents the first adequately powered attempt to test whether live microbes are indispensable for the efficacy of microbiota-based therapy in this important indication.

[Comment] Colorectal cancer screening in LGBTQIA+ people: an urgent call for equity

Worldwide, colorectal cancer is the second leading cause of cancer-related mortality and the third most common cancer, with incidence rates increasing among individuals younger than 50 years.1 Although there are multiple effective colorectal cancer screening modalities, uptake is variable. Disparities in screening participation are driven, in part, by social determinants of health, including educational attainment, income, and living environment. For example, in the USA, screening rates are lowest among non-White individuals, the uninsured, those with low income, and individuals without a high school degree.

[Comment] Closing the Middle East and north Africa representation gap in clinical trials in inflammatory bowel disease

Inflammatory bowel disease (IBD) has expanded beyond its initial confines of early industrialised countries in North America, Europe, and Oceania and now constitutes a global illness. Once rare in the Middle East and north Africa region, analyses using the Global Burden of Disease 2019 Study database showed a 30% increase in age-standardised IBD incidence from 1990 to 2019, with prevalence estimates at 48·3 per 100 000 people;1 a study by Hracs and colleagues analysing the global epidemiological evolution of IBD indicates that the Middle East and north Africa region is currently at stage 2, with growing incidence and rising prevalence.

[Comment] Expanding the therapeutic arsenal for paediatric ulcerative colitis

Interleukin-23 (IL-23) plays a pivotal role in the complex pathogenesis of both ulcerative colitis and Crohn's disease, making it a promising therapeutic target.1 Mirikizumab is a humanised IgG4 monoclonal antibody that selectively inhibits IL-23 by binding to its p19 subunit. The drug has been approved for moderate-to-severe adult ulcerative colitis; however, clinical trials in the paediatric population are still in earlier stages of development. In The Lancet Gastroenterology & Hepatology, Jess L Kaplan and colleagues report data from SHINE-1, the first phase 2 trial of mirikizumab in children with moderate-to-severe ulcerative colitis.

[Editorial] ACIP's HBV birth-dose vaccine recommendations: a fiasco

The Advisory Committee on Immunization Practices (ACIP), a panel that advises the US Centers for Disease Control and Prevention (CDC) on national vaccine policy, voted on Dec 5, 2025, to abandon recommendations for universal hepatitis B vaccination in newborns, revoking guidance that had seen the number of childhood cases of hepatitis B virus (HBV) infection in the USA fall by 99% since being adopted in 1991.

[Viewpoint] Management of transfusion-dependent β-thalassaemia in the era of novel therapies: a prioritisation-based matrix for settings with limited resources

β-thalassaemia is an inherited haemoglobinopathy characterised by ineffective erythropoiesis and chronic anaemia of varying severity, which is predominant in the region extending from the Mediterranean basin and Middle East towards southeast Asia. Patients with severe phenotypes require lifelong transfusions, iron overload monitoring, and chelation. Suboptimal management due to access challenges continues to be directly linked to increased morbidity and mortality in many regions. In the past few decades, an improved understanding of the underlying pathogenesis of β-thalassaemia has led to the development of several disease-modifying therapies and curative gene manipulation techniques.

[Articles] Predictors of clinically relevant bleeding during extended anticoagulation for cancer-associated venous thromboembolism (API-CAT): a post-hoc analysis of a randomised, non-inferiority trial

During extended treatment for cancer-associated VTE, four predictors of clinically relevant bleeding were identified in the overall population, with no evidence of interaction with the dosing regimen. Although the API-CAT study was not designed to specifically address anticoagulation discontinuation, our findings might help clinicians to more effectively balance the benefits and risks of extended anticoagulant therapy.

[Articles] Epcoritamab monotherapy for Richter transformation (EPCORE CLL-1): findings from a single-arm, multicentre, open-label, phase 1b/2 trial

In patients with Richter transformation, epcoritamab monotherapy showed clinically meaningful antitumour activity, although the investigator-assessed overall response rate was below the alternative hypothesis of 50%, with a safety profile consistent with previous studies. These findings support further investigation of epcoritamab as a potential treatment option for patients with Richter transformation.