It has previously been proposed that the epidemiology of inflammatory bowel disease (IBD) in a region evolves predictably across four distinct epidemiological stages determined by changes in incidence and prevalence. The four stages are emergence, acceleration in incidence, compounding prevalence and prevalence equilibrium. Now, a new study published in Nature has applied this framework to real-world

In a new study published in Nature, researchers have investigated the progression of the genetic liver disease α1-antitrypsin deficiency (AATD) in human tissue. Spatial proteomics by mass spectrometry and machine learning, via a technique termed Deep Visual Proteomics, was able to analyse the progressive proteotoxicity of AATD, a condition that causes misfolding of α1-antitrypsin in hepatocytes. A

Although the gut–brain axis has long been thought to guide mood and behaviour, it had not been thoroughly investigated at a neurocircuit level until 2018, when a key paper by Han and colleagues delineated a gut-to-brain circuit stimulating reward behaviour. By mapping and manipulating the peripheral nervous system, the investigators found that sensory neurons in the nodose ganglion of the vagus nerve

Probiotics encounter colonization resistance from native gut microbiomes, affecting their effectiveness. Genetic engineering of probiotics lacks universal applicability, as gut microbiotas are highly individualized. Here, we employed probiotic Lactiplantibacillus plantarum HNU082 (Lp082) to test whether Lp082 gut-adapted mutants can resolve colonization resistance in a new gut environment. Relying

Background Hepatocellular carcinoma (HCC) is a significant global cancer burden, with rising incidence and lacking a unified prevention strategy due to complex aetiologies. Viral exposures may shape host immunity via specific reactive viral antigens that could induce immune responses against hepatocarcinogenesis. Objective We aimed to characterise viral exposure differences between HCC patients and

Dietary gluten triggers symptoms in patients with gluten-related disorders (GRDs) including celiac disease (CeD), non-celiac gluten sensitivity (NCGS), and subsets of patients with functional dyspepsia (FD). The gastrointestinal microbiota is altered in these patients when compared to healthy individuals. As the microbiota is crucial for the hydrolysis of gluten, we hypothesized that the capacity of

Breast milk, rich in human milk oligosaccharides (HMOs), supports the early-life colonization of beneficial bacteria such as bifidobacteria and lactobacilli, potentially reducing early-life antibiotic resistance. However, antibiotic treatment may interfere with the beneficial functions of HMO-degrading bacteria. This study investigated the metabolism of HMOs by bifidobacteria and lactobacilli isolated

The Phase 2b trial of MK-3655 (NCT04583423) provides critical insights into fibroblast growth factor 21 (FGF21) pathway modulation, yet raises fundamental questions about therapeutic targeting strategies [1]. While the reported 26.1% placebo-adjusted liver fat reduction at 300 mg (p < 0.05) aligns with early-phase FGF21 analogs [2], it falls substantially below the ≥ 40% reductions seen with efruxifermin

We read with interest the study by Ye et al. [1]. The authors demonstrated that targeted next-generation sequencing (tNGS) has high sensitivity (83%) and 100% specificity for detecting Mycobacterium tuberculosis from fresh ulcer base biopsy samples, offering an alternative to conventional methods like acid-fast bacillus staining, TB-PCR, and histopathological examination. Given the diagnostic challenges

No Abstract

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.

No Abstract

No Abstract

No Abstract

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

No Abstract

Background Obesity-related cognitive decline is linked to gut microbiota dysbiosis, with emerging evidence suggesting that dietary interventions may ameliorate cognitive impairment via gut-brain axis modulation. The role of microglial cells in this process remains underexplored. Objective To investigate how diet-induced changes in gut microbiota influence cognitive function in individuals with obesity

We read with great interest the recently published study by Groen et al comparing high-definition (HD) dye-based chromoendoscopy (CE) to HD white-light endoscopy (WLE) with segmental re-inspection and single-pass HD WLE in surveillance for colorectal neoplasia (CRN) in inflammatory bowel disease (IBD) patients.1 This multicentre randomised controlled trial addresses a critical clinical question. However

Liver diseases remain clinically challenging and exhibit complex cellular interactions, including liver cell–immune cell communications that can shape disease progression.1 During portal injury, biliary epithelial cells (BECs, also known as cholangiocytes) expand excessively, a process termed ‘ductular reaction (DR)’ which promotes fibrogenesis, tumourigenesis and consecutive liver disease progression

The emergence of new viral pathogens necessitates innovative antiviral therapies and vaccines. Traditional approaches, such as monoclonal antibodies and vaccines, are often hindered by resistance, limited effectiveness, and high costs. Here, we develop an engineered probiotic-based antiviral platform using Escherichia coli Nissle 1917 (EcN), capable of providing both mucosal and systemic immunity via

Colorectal cancer (CRC) is one of the most prevalent cancers worldwide, with high incidence and mortality rates. An increasing body of research suggests that obesity is a significant risk factor for the development of CRC. Moreover, recent findings have highlighted the close association between the gut microbiota and both obesity and CRC. Despite this, the specific mechanisms by which the gut microbiota

We appreciate the opportunity to respond to the comments submitted by Mao et al. [1] relating to our article [2]. They provided thoughtful commentary about the strengths and weaknesses of our study, and we agree with several concerns and recommendations that they shared. For example, they highlighted the potential limitations of relying upon ICD-10 codes to assess the abdominal pain status of each

We appreciate the systematic evaluation of the effects of antispasmodics in patients with IBD by Dr. Khunsriraksakul and colleagues [1]. This addressed an important gap in our understanding of the effectiveness of antispasmodics in patients with IBD and has raised critical concerns for clinical practice. However, some aspects could be further refined to enhance clinical relevance. First, the definition

The role of the human microbiome in GI disease is an area of significant clinical and academic interest. The microbiome may well influence a number of GI diseases ranging from cancer,1 2 to IBD,3 4 to liver disease.5 6 One of the current challenges faced by microbiome researchers is the variance in terminology, methodological approaches and lack of consistency regarding outcomes. This is an issue that

Cholangiocarcinoma (CCA) is a highly aggressive adenocarcinoma of the biliary tract system with unsatisfactory therapeutic options.1 Standard frontline treatment for unresectable or metastatic CCA consisting of cisplatin and gemcitabine combined with checkpoint inhibitors targeting programmed cell death ligand 1 or programmed cell death 1 offers objective response rates of less than 30% and a median

Computer-aided detection (CADe) has increased adenoma detection in randomised trials. However, unlike other detection adjuncts, CADe is lesion specific, that is, it is trained on a specific set of lesions. If the training does not include sufficient examples of precancerous lesion subsets, CADe may not perform adequately for lesions in that subset. In a prospective assessment of a second-generation

Background and objective Gastric cancer (GC) remains a prevalent and preventable disease, yet accurate early diagnostic methods are lacking. Exosome non-coding RNAs (ncRNAs), a type of liquid biopsy, have emerged as promising diagnostic biomarkers for various tumours. This study aimed to identify a serum exosome ncRNA feature for enhancing GC diagnosis. Designs Serum exosomes from patients with GC

Background Treatment strategies for Crohn’s disease (CD) suppress diverse inflammatory pathways but many patients remain refractory to treatment. Autologous haematopoietic stem cell transplantation (SCT) is an emerging therapy for medically refractory CD though the mechanisms through which it circumvents refractory pathophysiology are unknown. Objective The objective of this study is to understand

Background Oat ingestion in coeliac disease (CD) is generally regarded as safe but can trigger enteropathy and T cells specific for oat avenin in the gut and blood of some individuals. Objective To correlate immune and clinical outcomes to oats, purified avenin and oat feeding studies were performed to examine symptoms, T-cell immunity and intestinal histology in CD. Design 33 treated HLA-DQ2.5+ adult CD

Background A large proportion of individuals with coeliac disease (CeD) remain undiagnosed. Objective The aim of this study was to assess serological screening for CeD in the adult general population. Design The study was based on the fourth Trøndelag Health Study, a population-based study performed 2017–2019 in Nord-Trøndelag County, Norway, including 56 042 participants >20 years of age (54% participation

Background Given the imperative to combat climate change, reducing the healthcare sector’s implications on the environment is crucial. Objective This study aims to offer a comprehensive assessment of the environmental impact of gastrointestinal endoscopy (GIE) procedures, specifically focusing on greenhouse gas (GHG) emissions and waste generation. Design A prospective study was conducted at the Asian

Background Chronic restraint stress (CRS) is a tumour-promoting factor. However, the underlying mechanism is unknown. Objective We aimed to investigate whether CRS promotes head and neck squamous cell carcinoma (HNSCC) by altering the oral microbiota and related metabolites and whether kynurenine (Kyn) promotes HNSCC by modulating CD8+ T cells. Design 4-nitroquinoline-1-oxide (4NQO)-treated mice were

Background GI cancers pose an increasing global health burden, with their impact on the working-age population (WAP) aged 15–64 years remaining largely unexplored despite the crucial role of this group in societal and economic well-being. Objective To assess trends and cross-country inequality in the global burden of six GI cancers from 1990 to 2021 among individuals in the WAP. Design The 2021 Global

Background Early detection of colorectal cancer (CRC) is crucial for improving the survival rates of patients. Objective We aimed to develop a novel strategy for early CRC detection using the fragmentomic features of circulating cell-free mitochondrial DNA (ccf-mtDNA). Design Here, a total of 1147 participants, including 478 healthy controls (HCs), 112 patients with advanced adenomas (AAs) and 557

Background Cyst size, its growth rate, and diameter of the main pancreatic duct (MPD) are all associated with pancreatic carcinoma prevalence in intraductal papillary mucinous neoplasms (IPMNs). Objective To examine the above factors in relation to future risk of incident pancreatic carcinoma in individuals with IPMNs harbouring no high-risk stigmata. Design In a prospective longitudinal cohort, we

Background Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. The combination of tremelimumab and durvalumab is now a standard treatment option for advanced HCC. Objective To study immune responses in HCC patients treated with tremelimumab and durvalumab. Design We treated 28 HCC patients with durvalumab, tremelimumab and locoregional therapies. We performed a high-dimensional

Eosinophilic oesophagitis (EoE) is a chronic, immune-mediated condition characterised by eosinophilic infiltration of the oesophagus, leading to significant morbidity due to oesophageal dysfunction. The pathogenic course of EoE begins with tissue injury, marked by the intricate interplay of oesophageal barrier dysfunction and T helper 2-mediated inflammation. In response to tissue damage, a subsequent

Chronic liver disease is a cluster of disorders associated with complex haemodynamic alterations, which is characterised by structural and functional disruptions of the intrahepatic and extrahepatic vasculature. ‘Vasomics’ is an emerging omics discipline that comprehensively analyses and models the vascular system by integrating pathophysiology of disease, biomechanics, medical imaging, computational

We read with interest the recently published randomised controlled trial (RCT) ‘SPHINX’,1 addressing the role of endoscopic sphincterotomy (ES) with fully covered s metal stent (FCSEMS) placement in preventing post-ERCP pancreatitis (PEP). Although this is the largest RCT on the topic, several concerns warrant discussion. Published data report variable rates of PEP after SEMS ranging from 0% to 26

We recently read with great interest the article by Devin Abrahami et al .1 We would like to raise some concerns that warrant further discussion. The association between proton pump inhibitors (PPIs) and the risk of inflammatory bowel disease (IBD) remains a debate, the authors mostly focus on the protopathic bias introduced by study design. However, in this study, the authors used histamine-2 receptor

We read with great interest the recent article by Antonelli et al 1 on the quality assessment for artificial intelligence in digestive endoscopy (QUAIDE) framework, which enhances the quality and reproducibility of artificial intelligence (AI)-based gastrointestinal endoscopy research. While QUAIDE provides a solid foundation for pre-clinical research design, we see opportunities for further improvement

I read with interest the recent article of Wilkinson-Smith and colleagues on the assessment of colonic motility by means of MRI and high-resolution colonic manometry (HRCM),1 showing that patients with constipation and irritable bowel syndrome (IBS) may display some abnormalities when such investigated. I would like to make some observations on this study. Since HRCM probes were positioned 35 cm from

We thank Ramchandani et al for their letter on the SPHINX trial and appreciate the opportunity to address their points.1 2 The SPHINX trial aimed to assess whether endoscopic sphincterotomy (ES) could reduce post-ERCP pancreatitis (PEP). However, quantifying this effect proved difficult due to conflicting results from previous, heterogeneous randomised controlled trials (RCTs), which differed in sample

We read with great interest the recent publication by Lou et al ,1 which addressed the challenge of false positives in next-generation sequencing (NGS) due to highly homologous PRSS1 paralogs.2 3 PRSS1 was the first gene linked to chronic pancreatitis,4 with p.Arg122His (c.365G>A) and p.Asn29Ile (c.86A>T) being the most common mutations associated with the Mendelian form of the disease. Accurate identification

We read with great interest the study by Danpanichkul et al ,1 which assessed the global burden of gastrointestinal cancers, including oesophagus, gastric, colorectal, liver, pancreas and biliary tract cancers, from 2000 to 2021. The study revealed that the burden of all types of cancers varies across geographical and socioeconomic levels. The incidence rates of some types of gastrointestinal cancer

We read with great interest the article by Coté et al titled ‘Sphincterotomy for biliary sphincter of Oddi disorder and idiopathic acute recurrent pancreatitis: the RESPOnD longitudinal cohort’ published in Gut.1 The study aimed to measure the benefit of sphincterotomy for suspected sphincter of Oddi disorder (SOD) and provided valuable insights into the management of this contentious condition. While

Thanks to Dr Zeng for his insightful comments1 about our recent publication on 12-month outcomes of endoscopic retrograde cholangiopancreatography (ERCP) for sphincterotomy for sphincter of Oddi disorders (SOD).2 Many of the comments were addressed in the discussion of the paper, especially the significance of the unmeasured placebo response and greater importance of patient characteristics such as

A 71-year-old man presented with a 2-months history of arrhythmia of undetermined cause, dysphagia, vomiting and 10 kg weight loss. The patient’s history was unremarkable except for multinodular goitre and hypertension. Laboratory exams did not demonstrate significant alterations, white cell count was 7.8×109/L (ref range: 4.0–10.0), haemoglobin 16.2 g/L (ref range: 12.0–15.0), platelet 281×109/L (ref

Insulin resistance (IR) is an early marker of cardiometabolic deterioration which may develop heterogeneously in key metabolic organs, including the liver (LIR) and skeletal muscle (MIR). This tissue-specific IR is characterized by distinct metabolic signatures, but the role of the gut microbiota in its etiology remains unclear. Here, we profiled the gut microbiota, its metabolites and the plasma metabolome

Tryptophan-derived indoles produced by the gut microbiota, particularly indole-3-propionate (IPA), are key compounds associated with gastrointestinal balance and overall health. Reduced levels of IPA have been associated with inflammatory bowel disease, type 2 diabetes, and colorectal cancer. Since fiber-rich diets have been shown to promote IPA, we aimed to decipher fiber-specific effects and identify

Pathogenic Escherichia coli are a major cause of infections in both humans and animals, leading to conditions such as severe diarrheal diseases, urinary tract infections, enteritis, and septicemia. To combat bacterial infections, antibiotics are widely utilized. However, the extensive and inappropriate use of antibiotics has fueled the development and spread of antibiotic resistance, posing a significant

We appreciate the interest and comments of Dr. Green and colleagues on our article about antroduodenal motility in patients with hypermobility spectrum disorders/hypermobile Ehlers–Danlos syndrome (HSD/hEDS) [1, 2]. They commented on the high frequency of food intolerance in the HSD/hEDS population resulting in a high prevalence of enteral and parenteral feeding, and the possible role of enteric dysmotility

We commend Sweerts et al. for their largest-to-date investigation using antroduodenal manometry (ADM) in 50 patients with hypermobility spectrum disorders (HSD) and hypermobile Ehler-Danlos Syndrome (hEDS) compared to 189 non-HSD/hEDS patients [1]. ADM, a labour-intensive and technically challenging procedure, comes the closest to the gold standard of histopathological evaluation of full-thickness

Enteric bacterial pathogens pose significant threats to human health; however, the mechanisms by which they infect the mammalian gut in the face of daunting host defenses remain to be fully defined. For the attaching and effacing (A/E) bacterial family member and murine pathogen Citrobacter rodentium, its virulence strategy appears to involve penetration of the colonic mucus barrier to reach the underlying