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FEATURE
"Efforts to eliminate viral hepatitis have stalled and we are not on track to meet the 2030 targets. But...there remains a short window of opportunity in which to act."
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Clinical significance of combined tumour-infiltrating lymphocytes and microsatellite instability status in colorectal cancer: a systematic review and network meta-analysis
The findings from this network meta-analysis suggest that better survival was only observed among patients with TIL-H colorectal cancer, regardless of MSI or MSS status. The integrated MSI-TIL classification should be further explored as a predictive tool for clinical decision-making in early-stage colorectal cancer. -
Rethinking colorectal cancer prognosis: beyond microsatellite status
Colorectal cancer is one of the most prevalent malignancies worldwide, imposing a substantial public health burden. Research suggests that colorectal cancer comprises molecular subtypes shaped by complex interactions of genetic and epigenetic changes that affect prognosis.1 -
Maralixibat in progressive familial intrahepatic cholestasis (MARCH-PFIC): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial
Maralixibat improved pruritus and predictors of native liver survival in PFIC (eg, serum bile acids). Maralixibat represents a non-surgical, pharmacological option to interrupt the enterohepatic circulation and improve the standard of care in patients with PFIC. -
Targeting the EGFR signalling pathway in metastatic colorectal cancer
Epidermal growth factor receptor (EGFR) and its activated downstream signalling pathways play a crucial role in colorectal cancer development and progression. After four decades of preclinical, translational, and clinical research, it has been shown that blocking the EGFR signalling pathway at different molecular levels represents a fundamental therapeutic strategy for patients with metastatic colorectal cancer. Nevertheless, the efficacy of molecularly targeted therapies is inescapably limited by the insurgence of mechanisms of acquired cancer cell resistance.
Microbiome-based therapeutics
The Lancet Gastroenterology & Hepatology
Published: April 8, 2024
The gut microbiome plays an important part in a number of gastrointestinal conditions, including Clostridioides difficile infection and inflammatory bowel disease. Interest in modulating the gut microbiome, through prebiotics, probiotics, and natural or artificial microbiota therapeutics, has increased markedly in the past decade. Although the field has developed rapidly, it has faced reproducibility issues and encountered safety and regulatory hurdles. This two-part Series explores the development and promise of artificial microbiome therapeutics, and the current and future perspectives for microbiota therapies for treating inflammatory bowel disease.
Hepatocellular carcinoma in sub-Saharan Africa
The Lancet Gastroenterology & Hepatology
Published: July 8, 2022
Hepatocellular carcinoma is the second leading cancer in men and the third in women in sub-Saharan Africa, with an estimated 38 629 incident cases and 36 592 hepatocellular carcinoma-related deaths in 2020 for both sexes. In high-income countries, approximately 40% of hepatocellular carcinomas are diagnosed at very early, early, or intermediate stages, when interventions with curative intent or life-prolonging palliative interventions (eg, transarterial chemoembolisation) are possible. By contrast, 95% of patients in sub-Saharan Africa present with advanced or terminal disease. This two-part Series discusses the challenges faced in the region, including treatment and prevention, and the means by which the outlook for hepatocellular carcinoma in sub-Saharan Africa can be improved.
Progress towards elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission update
The Lancet Gastroenterology & Hepatology
Published: February 14, 2024
Globally, more than 300 million individuals are living with hepatitis B or C. Deaths and disability caused by the long-term complications of these chronic infections—cirrhosis, liver failure, and hepatocellular carcinoma—represent a major public health challenge, comparable in scale to other major communicable diseases such as tuberculosis and malaria. In 2016, WHO set ambitious goals to eliminate viral hepatitis as a public health threat by 2030.
The cost of inflammatory bowel disease in high-income settings: a Lancet Gastroenterology & Hepatology Commission
The Lancet Gastroenterology & Hepatology
Published: March 3, 2023
The cost of caring for patients with inflammatory bowel disease (IBD) continues to increase as a result of a steady increase in prevalence, the chronic nature of IBD (and thus the need for long-term, often expensive treatments), the use of more intensive disease monitoring strategies, and the effects of IBD on economic productivity. The aim of this Lancet Gastroenterology & Hepatology Commission was to examine the current costs of IBD care and the drivers involved in increasing economic burden, and to explore means to deliver affordable, equitable care for patients with IBD in the future.
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Missed the global launch of our new Commission on viral hepatitis? Watch the free webinar on demand here.
Thank you to The Lancet Gastroenterology & Hepatology’s statistical and peer reviewers in 2023.
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A biomarker-stratified comparison of top-down versus accelerated step-up treatment strategies for patients with newly diagnosed Crohn's disease (PROFILE): a multicentre, open-label randomised controlled trial
Top-down treatment with combination infliximab plus immunomodulator achieved substantially better outcomes at 1 year than accelerated step-up treatment. The biomarker did not show clinical utility. Top-down treatment should be considered standard of care for patients with newly diagnosed active Crohn's disease. -
Mechanisms and management of loss of response to anti-TNF therapy for patients with Crohn's disease: 3-year data from the prospective, multicentre PANTS cohort study
Only around a third of patients with active luminal Crohn's disease treated with an anti-TNF drug were in remission at the end of 3 years of treatment. Low drug concentrations at the end of the induction period predict loss of response by year 3 of treatment, suggesting higher drug concentrations during the first year of treatment, particularly during induction, might lead to better long-term outcomes. Anti-drug antibodies associated with undetectable drug concentrations of infliximab, but not adalimumab, can be predicted by carriage of HLA-DQA1*05 and mitigated by concomitant immunomodulator use for both drugs. -
The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years. Our findings can be useful for policy makers developing strategies to tackle IBD, including the education of specialised personnel to address the burden of this complex disease. -
Semaglutide 2·4 mg once weekly in patients with non-alcoholic steatohepatitis-related cirrhosis: a randomised, placebo-controlled phase 2 trial
In patients with NASH and compensated cirrhosis, semaglutide did not significantly improve fibrosis or achievement of NASH resolution versus placebo. No new safety concerns were raised.