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[Articles] Oral nicotine pouch use in Great Britain: a repeat cross-sectional study, 2020–25

Nicotine pouch use has risen in Great Britain, primarily driven by sharp increases among young people, especially young men. Most users also smoked or vaped, and a growing proportion of smokers used pouches in attempts to quit smoking. These findings underscore the importance of implementing age-of-sale legislation for nicotine pouches and conducting research on their effectiveness for smoking cessation.

[Articles] Gaming and gambling behaviours among Italian adolescents: a cross-sectional study

Like gaming, gambling is widespread among Italian adolescents, including minors. Findings indicate a convergence between these behaviours and suggest that gaming monetisation systems might engage psychological vulnerabilities similar to those involved in gambling, or even—although causal inferences cannot be drawn due to the limitations of the cross-sectional design—promote gambling participation and escalation.

[Corrections] Correction to Lancet Public Health 2024; 9: e871–85

Fletcher RA, Rockenschaub P, Neuen BL, et al. Contemporary epidemiology of hospitalised heart failure with reduced versus preserved ejection fraction in England: a retrospective, cohort study of whole-population electronic health records. Lancet Public Health 2024; 9: e871–85—In figure 1D of this Article, the annual change in incidence should have read “Reduced ejection fraction –2·6% (95% CI –9·5 to 4·8)” and “Preserved ejection fraction 2·5% (95% CI –3·7 to 9·2)”. This correction has been made as of Dec 3, 2025.

[Correspondence] Cervical cancer screening beyond traditional barriers

The PREVENT Project implementation study, published in the Lancet Public Health by Aime Powell and colleagues, showed success in cervical cancer screening for Aboriginal and Torres Strait Islander women in Western Australia.1 The study's achievement of 36% participation rates and 95% same-day colposcopy completion among women who tested positive for human papillomavirus represents a major advance in addressing screening disparities that affect marginalised populations globally.

[Comment] Contextualising an increase in the use of oral nicotine pouches

The sale of oral nicotine pouches across the world has substantially increased since 2018.1 Like snus (oral pouches containing tobacco), nicotine pouches deliver nicotine via the mouth when placed between the gum and lip or cheek. Snus is associated with lower mortality rates than combustible tobacco.2 Unlike snus, nicotine pouches contain no tobacco, so they are sometimes described as “tobacco free” or “white snus,” and are thought to be less harmful than snus.3 However, evidence is currently limited, and many existing studies have been conducted by nicotine pouch manufacturers.

[Editorial] Violence against women: preventing the preventable

840 million women and girls have experienced violence in their lifetime, according to WHO's latest prevalence estimates. In 2023, 11·4% of women experienced physical and/or sexual violence from an intimate partner. The latest Global Burden of Disease (GBD) 2023 data provide insight into the health impacts of intimate partner violence (IPV) and sexual violence. Both reports reinforce violence against women (VAW) as a global public health crisis sparing no country. As we mark the UN Women Campaign 16 days of Activism against Gender-Based Violence, too many countries have seemingly forgotten that the sustainable development goal 5·2 aims to end violence against women and girls.

[Viewpoint] Ulcerative colitis: moving beyond the mucosal dogma

Ulcerative colitis has traditionally been regarded as a non-fibrotic, solely mucosal disease, whereas Crohn's disease is characterised by transmural inflammation and fibrosis. However, more recent evidence supports the existence of disease involvement beyond the mucosa in ulcerative colitis. Intestinal ultrasound has allowed for dynamic, in-vivo characterisation of the transmural alterations that occur in ulcerative colitis, such as increased bowel wall thickness, submucosal thickening, loss of bowel wall stratification, haustral loss, and mesenteric fibrofatty proliferation.

[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.