This Week in Gastroenterology — May 28, 2026

Welcome to This Week in Gastroenterology. This week we're covering 10 notable papers spanning major advances in hepatology, new strategies for managing inflammatory bowel disease, and key updates in GI oncology and procedural safety. Let's dive in.

We begin in hepatology, where a potential new therapy for chronic hepatitis B leads our coverage, followed by a series of landmark consensus statements aimed at standardizing diagnosis and research across the field.

The Study In the New England Journal of Medicine, two replicate Phase 3 trials, B-Well 1 and B-Well 2, evaluated the antisense oligonucleotide bepirovirsen for chronic hepatitis B [1]. The trials enrolled adults with noncirrhotic chronic HBV infection who were on stable nucleoside or nucleotide analogue therapy. Patients were randomized to receive 24 weeks of bepirovirsen or placebo, with the goal of achieving a functional cure, defined as sustained HBsAg loss and undetectable HBV DNA 24 weeks after stopping all therapy.

Results At 72 weeks, a functional cure was achieved in roughly 20 percent of patients treated with bepirovirsen across both trials. In contrast, zero patients in the placebo groups achieved this endpoint. This represents a significant, though modest, success in the quest for a functional cure. However, the treatment was associated with more adverse events, reported in 91 percent of bepirovirsen patients compared to 73 percent in the placebo groups. Serious adverse events occurred in 7 percent versus 4 percent, respectively. The most common grade 3 or higher adverse event with bepirovirsen was an increase in alanine aminotransferase levels, seen in 6 percent of patients.

Beyond this new drug, a major theme this week is the push to harmonize how we define and study liver diseases. Published simultaneously in the Journal of Hepatology and Hepatology, a landmark multisociety consensus statement introduces a new common definition for porto-sinusoidal vascular disorder, or PSVD, and non-cirrhotic portal fibrosis, or NCPF [5, 8]. For years, varied terminology like idiopathic portal hypertension has hampered research. This new framework establishes that PSVD or NCPF can be used interchangeably, diagnosed through an integrated clinicopathological assessment. Core principles include requiring a high-quality liver biopsy of at least 10 millimeters and the mandatory exclusion of cirrhosis.

Furthering this theme of standardization, the Journal of Hepatology also brings us two other important documents. First, an EASL-AASLD Delphi consensus statement tackles the challenge of using surrogate endpoints and real-world evidence for drug approval in primary biliary cholangitis, aiming to create a framework that aligns with regulatory expectations [7]. Second, an EASL position paper critically reviews and classifies preclinical models of steatotic liver disease, providing guidance to improve the translational relevance of research in MASLD and MASH [6].

Finally in hepatology, a nationwide cohort study from Sweden, published in Alimentary Pharmacology and Therapeutics, serves as a sobering reminder that even with robust systems, health equity remains a challenge [4]. The study examined outcomes for patients with hepatocellular carcinoma detected through surveillance. Even in this group with early detection, individuals with low socioeconomic status had less than half the odds of receiving curative-intent treatment compared to those with high socioeconomic status. Furthermore, among those who did receive treatment, low socioeconomic status was associated with a 50 percent higher risk of death. This underscores that surveillance alone is insufficient to ensure equitable outcomes in HCC care.

Shifting to inflammatory bowel disease, two papers highlight strategies to improve patient care through technology and better communication.

First, a multicenter randomized trial from Spain published in Clinical Gastroenterology and Hepatology evaluated a telemonitoring platform called TECCU for IBD patients starting immunosuppressants or biologics [9].

The Study Patients were assigned to telemonitoring via a smartphone app or to standard care. The analysis focused on cost-effectiveness and cost-utility over one year.

Results The telemonitoring group achieved similar time in remission as the standard care group, but at a lower cost. The TECCU app significantly reduced the need for in-person visits, healthcare costs, and patient-incurred costs like travel and time off work. The analysis showed a 90 percent probability of the telemonitoring strategy being cost-effective. This provides strong evidence that digital health tools can be integrated into IBD care to reduce costs and patient burden without compromising clinical outcomes.

Complementing this, a review in The American Journal of Gastroenterology provides a practical guide for communicating the risks and safety of IBD therapies [3]. The authors synthesize evidence on malignancy, infection, venous thromboembolism, and major adverse cardiovascular events. They emphasize that while therapies like anti-TNFs, JAK inhibitors, and S1P modulators carry specific risks, these are often low in absolute terms. The review correctly identifies chronic inflammation itself as a risk factor for several cancers and points to corticosteroid use as the major driver of serious infections and VTE. The paper offers pictorial tools and a framework for discussing absolute risk, helping clinicians engage in more effective shared decision-making.

Our final section covers a key trial in rectal cancer and an important safety finding in pediatric endoscopy.

In The Lancet Gastroenterology & Hepatology, we have the results of the TESAR trial [2]. This study aimed to see if an organ-preserving strategy could be a non-inferior alternative to radical surgery for early rectal cancer.

The Study After local excision of a high-risk T1 or low-risk T2 rectal cancer, patients were randomized to either adjuvant chemoradiotherapy or the standard of care, which is completion total mesorectal excision, or cTME.

Results The primary endpoint was 3-year locoregional recurrence. Adjuvant chemoradiotherapy did not meet the pre-specified non-inferiority margin. The recurrence rate was 5 percent in the chemoradiotherapy group versus just 1.1 percent in the cTME group. This result supports cTME as the standard of care to minimize recurrence. However, it is important to note that most of these recurrences were successfully salvaged with surgery. The rate of unsalvageable locoregional recurrence at 3 years was very low and similar between the groups, at 1.3 percent for chemoradiotherapy versus zero for cTME.

Lastly, a study in The American Journal of Gastroenterology highlights a significant risk in pediatric procedural practice [10]. Investigators performed a retrospective analysis of pre-procedure glucose levels in over 5,000 children and young adults undergoing colonoscopy. They found that 8 percent of patients were hypoglycemic before their procedure, with 3 percent moderately hypoglycemic and 1 percent severely hypoglycemic. The risk was significantly higher in younger patients, especially those under 3 years old, those with lower weight percentiles, and those scheduled for afternoon procedures. The authors conclude that routine pre-procedure screening for hypoglycemia may be beneficial in at-risk pediatric populations.

If you only have time for one paper this week, make it the B-Well trials in the New England Journal of Medicine [1]. This is the first time we're seeing Phase 3 data for an antisense oligonucleotide showing a meaningful rate of functional cure in chronic hepatitis B, which could represent a significant step forward in our treatment goals for this disease.

Here are the key takeaways from this week in Gastroenterology.

First, for select chronic hepatitis B patients on nucleoside analogue therapy, 24 weeks of bepirovirsen can lead to a functional cure in about one in five patients, but requires close monitoring for adverse events, particularly liver enzyme elevations.

Second, in patients with suspected non-cirrhotic portal hypertension, clinicians should now adopt the newly harmonized PSVD or NCPF diagnostic criteria, which rely on an integrated clinicopathological assessment and a high-quality liver biopsy.

Third, for high-risk early rectal cancer after local excision, completion TME remains the standard of care. The TESAR trial showed that an organ-preserving strategy with adjuvant chemoradiotherapy resulted in a higher rate of locoregional recurrence.

Fourth, telemonitoring for IBD patients starting advanced therapies appears to be a cost-effective strategy that reduces healthcare utilization and patient burden without compromising disease control.

And finally, be aware of the significant risk of hypoglycemia in children and young adults undergoing bowel preparation for colonoscopy, especially in those who are younger or have a lower body weight. Consider pre-procedure glucose screening in this population.

That's your roundup for This Week in Gastroenterology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.