Gastroenterology & Hepatology Updates

[Comment] Progress and prospects in viral hepatitis elimination https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00021-X/fulltext?rss=yes In 2016, the World Health Assembly formally recognised viral hepatitis as a global health concern and adopted the global health sector strategy on viral hepatitis.1 Targets for eliminating viral hepatitis were ambitious: a 90% reduction in the incidence of chronic hepatitis infection (95% for hepatitis B virus [HBV] and 80% for hepatitis C virus [HCV]) and a 65% reduction in mortality compared with the 2015 baseline measure.1 And although viral hepatitis remains a global health problem, the past decade has seen substantial progress in diagnostics, therapeutics, models of care delivery, and health-care policy.

[Comment] The decade that changed hepatocellular carcinoma: shaping a new treatment paradigm https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00044-0/fulltext?rss=yes A decade ago, advances in the systemic treatment of advanced hepatocellular carcinoma had been stalled for some time. Sorafenib, the first multikinase inhibitor used to treat advanced hepatocellular carcinoma, had been approved in 2007 based on a modest survival benefit compared with placebo1 and was the sole effective option for more than 10 years. However, over the past decade, systemic therapy for hepatocellular carcinoma has undergone a profound transformation, reshaping clinical practice and leading to unprecedented improvements in patient outcomes.

[Comment] Dietary management of gastrointestinal disease: progress over the last decade and opportunities for the next https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00152-4/fulltext?rss=yes Diet is a much sought-after intervention for the management of gastrointestinal disease by both patients and clinicians. The past decade has witnessed a step-change in progress in the quantity and quality of dietary research for both the risk and the treatment of gastrointestinal disease.

[Comment] A decade of transformation in MASLD: from nomenclature to novel therapies https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00087-7/fulltext?rss=yes Over the past decade, metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading cause of chronic liver disease worldwide, affecting over 1·27 billion people, with prevalence predicted to continue increasing until 2040.1 The multisystem nature of the disease is captured by the concept of the cardio–kidney–liver metabolic syndrome.2,3 Clinicians’ disdain towards the outdated term describing the disease as non-alcoholic resulted in a nomenclature shift in 2023 to defining the disease according to its pathophysiological driver.

[Comment] A decade of progress in cholestatic liver diseases: navigating a new era https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00045-2/fulltext?rss=yes In the past decade, the landscape of cholestatic liver diseases has undergone a profound transformation. Our understanding has moved from a descriptive approach with a basic understanding of pathogenesis of cholestatic liver diseases to recognising them as a complex group of disorders with distinct clinical features, prognostic trajectories, molecular heterogeneity, and innovative therapeutic opportunities. This conceptual shift has been driven by increased diagnostic resolution and a deeper understanding of disease pathogenesis.

[Comment] A decade of artificial intelligence in endoscopy: from proof of concept to clinical reality https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00049-X/fulltext?rss=yes A decade ago, artificial intelligence (AI) in gastroenterology remained largely theoretical. Convolutional neural networks had just begun to show promise in image recognition tasks, but clinical applications were limited to small proof-of-concept studies. The prospect of real-time polyp detection during colonoscopy—let alone autonomous diagnosis—seemed distant. Today, AI systems assist endoscopists in routine practice, regulatory agencies have approved multiple devices, and large language models (LLMs) are being explored across clinical workflows.

[Comment] A decade of diversity, equity, and inclusion in gastroenterology and hepatology: a US perspective https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00092-0/fulltext?rss=yes Over the past decade, the landscape of diversity, equity, and inclusion (DEI) in gastroenterology and hepatology in the USA has evolved; however, substantial gaps remain. There has been marginal movement in the number of physicians under-represented in medicine, namely Latino (or Latina or Latinx), Black (or African American), Native American (American Indian, Alaska Native, and Native Hawaiian), and Pacific Islanders. In 2023, only 4% of the US gastroenterology and hepatology workforce identified as Black, and 6% as Latino, Latina, or Latinx.

[Correspondence] Ethnicity, diversity, and inclusion in gastroenterology: from representation to system performance https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00189-5/fulltext?rss=yes In 2023, we described a paradox in gastroenterology: an increasingly ethnically diverse workforce—mostly among trainees and early-career clinicians—alongside leadership structures that did not reflect this diversity.1,2 Since then, professional societies have made some progress in reforming their governance; articulating formal equality, diversity, and inclusion (EDI) strategies; publishing workforce and leadership demographics; and committing to transparency. Therefore, we now suggest that the challenge is no longer one of awareness, but of accountability.

[Correspondence] Therapeutic drift or formulation drift: avoiding misconceptions about rifaximin and antimicrobial resistance in cirrhosis – Authors' reply https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00191-3/fulltext?rss=yes We thank Carmelo Scarpignato and Manuel Romero-Gómez for their thoughtful Correspondence, and we agree on most of the key points made. Rifaximin remains a valuable drug, its place in the secondary prevention of recurrent overt hepatic encephalopathy is secure, and antimicrobial resistance in advanced cirrhosis is multifactorial. Our argument centres on the framework that an antimicrobial therapy often taken for years by patients with the profound immune dysfunction of advanced cirrhosis warrants the same prescribing rigour and clinical oversight as any other antibiotic therapy.

[Correspondence] Therapeutic drift or formulation drift: avoiding misconceptions about rifaximin and antimicrobial resistance in cirrhosis https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00156-1/fulltext?rss=yes We read with great interest the Viewpoint by Rajiv Jalan and colleagues discussing rifaximin, therapeutic drift, and antimicrobial stewardship in cirrhosis.1 The topic is undoubtedly of major clinical relevance because rifaximin remains the standard of care for secondary prevention of recurrent overt hepatic encephalopathy according to international guidelines.2

[Comment] A decade in inflammatory bowel disease: progress, plateaus, and perspectives https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00023-3/fulltext?rss=yes Reflecting on the past decade of progress in inflammatory bowel disease (IBD) feels like observing a thunderstorm of scientific and clinical advances. Yet despite this intensity, a definitive cure remains elusive. To appreciate the current state of the field, it is useful to remember where the field stood a decade ago.

[Correspondence] The spectrum of steatotic liver disease in the USA https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00122-6/fulltext?rss=yes We read the recent analysis of the spectrum of steatotic liver disease in the USA by Zobair Younossi and colleagues1 with great interest. The study addresses an important question about the impact of alcohol under-reporting; however, we believe that the central premise—correction of self-reported alcohol intake—requires more cautious interpretation, as it underpins all subsequent conclusions.

[Correspondence] COLOR III: widespread TaTME dissemination demands a LAPCO-equivalent framework https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00112-3/fulltext?rss=yes We read with great interest the short-term outcomes of transanal total mesorectal excision (TaTME) for mid and low rectal cancer in Jurriaan B Tuynman and colleagues’ COLOR III trial,1 and the accompanying Comment by Patricia Sylla.2 The reduction in conversion rates versus laparoscopic TME (1% vs 17%) is striking, and the similar operating times compared with robotic-assisted TME, alongside substantially lower capital and consumable costs, are noteworthy. We agree that TaTME represents a valuable technique for specialists.

[News] Research in Brief https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00190-1/fulltext?rss=yes Daraxonrasib—an oral RAS(ON) multiselective inhibitor—significantly improves survival compared with standard chemotherapy in patients with previously treated metastatic pancreatic ductal adenocarcinoma, according to the phase 3 RASolute 302 trial. Eileen M O’Reilly and colleagues randomly assigned patients to receive either daraxonrasib (n=248) or investigator's choice of chemotherapy (n=252). Overall, 91·8% of patients had RAS G12 mutations.

[Corrections] Correction to Lancet Gastroenterol Hepatol 2026; 11: 546–49 https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00194-9/fulltext?rss=yes Quraishi MN, Al-Bawardy B, Banerjee R, et al. Breaking the cycle: from documenting data scarcity to enabling global IBD research. Lancet Gastroenterol Hepatol 2026; 11: 546–49—In this Comment, the corresponding author should have been Mohammed Nabil Quraishi. This correction has been made to the online version as of July 8, 2026.

Your patient develops diarrhoea after antibiotics. What’s your next step? Full AGA Guidelines on C difficile Infection in Adults

Evidence. Education. Better Care. Latest medical research, guideline updates, and news—all in one place. https://whatsapp.com/channel/0029VagObEL3rZZbSTrZSU03

[Correspondence] Cyclic exclusive enteral nutrition in paediatric Crohn's disease – Authors’ reply https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00150-0/fulltext?rss=yes We thank Aaron S Bancil and colleagues for the points raised concerning our CD-HOPE study.1

[Correspondence] Upfront medical or surgical treatment in Crohn's disease https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00078-6/fulltext?rss=yes We read with interest the Article by Lotte Oldenburg and colleagues reporting 10-year long-term outcomes from the LIR!C trial in ileocaecal Crohn's disease.1 Long-term outcome data have historically been scarce in Crohn's disease trials; therefore, the authors should be congratulated on these findings, which might help improve shared decision making by patients and their clinicians.

[Correspondence] Cyclic exclusive enteral nutrition in paediatric Crohn's disease https://www.thelancet.com/journals/langas/article/PIIS2468-1253(26)00083-X/fulltext?rss=yes Exclusive enteral nutrition (EEN) in inflammatory bowel disease is used in the paediatric population and is now recommended in the current European Crohn's and Colitis Organisation consensus statements for the induction of remission in adult Crohn's disease.1 We read the CD-HOPE trial2 with great interest, suggesting that cyclical EEN (C-EEN) is superior to partial enteral nutrition (PEN) at maintaining clinical remission in paediatric patients with active Crohn's disease who reach remission on induction EEN.