High-Impact Papers in 2026

Why does H. pylori eradication matter in gastric cancer?

Gastric cancer is the second-most deadly cancer, but has a low-quality evidence base to support screening. This meta-analysis of RCTs and observational studies sought to determine whether H. pylori eradication reduces gastric cancer mortality. Ford et al. found a 0.87% rate of cancer in those with H. pylori treatment vs. 1.2% in those without treatment. In patients undergoing endoscopic mucosal resection (EMR), cancer rates were lower with H. pylori treatment (5.9% vs 11.4% in untreated controls). The paper strengthens the evidence for H. pylori screening and post-EMR eradication of H. pylori. Gastroenterology. 2025;169(2):261-276. doi: 10.1053/j.gastro.2024.12.033

Monitoring IBD with wearable devices.

Current IBD monitoring relies on clinic visits, blood/stool tests, or colonoscopy. Physiological signals of systemic inflammation (HR, HRV, SpO2, daily step count) have been linked to IBD flares. Hirten et al. conducted a prospective observational cohort of 309 people in 36 states who have IBD and regularly use a wearable device. The cohort was followed for 7 months. Circadian patterns in heart rate were able to predict a flare up to 7 weeks before they occurred, providing an early-warning biomarker. The data also suggests autonomic nervous system dysfunction is a key mechanism of flare. The data will need to be validated in a controlled study with a broader patient population. Gastroenterology. 2025;168(5):939-951.e5. doi: 10.1053/j.gastro.2024.12.024

Barrett’s esophagus (BE) surveillance.

Population studies have revised the risk of BE progression to adenocarcinoma downward, yet surveillance has been widely practiced for decades without evidence from randomized controlled trials. Major societies have recommended regular endoscopic surveillance for BE, which consumes significant endoscopic resources. Old et al. published results from the BOSS trial, which included 3453 patients with BE randomized 1:1 to surveillance endoscopy every 2 years or symptom-triggered endoscopy at 109 UK centers. The two groups had similar survival and cancer-specific survival rates, despite more high-grade dysplasia detected with more frequent surveillance. Endoscopy as needed may be sufficient for surveillance of patients with BE and low risk of cancer. Gastroenterology. 2025;169(6):1233-1243.e8. doi: 10.1053/j.gastro.2025.03.021

Long-term follow up after acute pancreatitis (AP) matters.

Although the survival rate after an episode of AP is approximately 98%, long-term risks include recurrent episodes and the development of chronic pancreatitis, as well as endocrine dysfunction (prediabetes and diabetes). Miko et al. conducted a large, multicenter observational study of 360 patients with at least one episode of AP who were stratified by recurrence and followed for 4 years. Among patients with only one AP episode, 35% had progressed to chronic AP and 74% developed endocrine dysfunction (compared to 40% at baseline). Disease progression was rapid during the first 2 years after the initial event. The authors recommended imaging-based follow-up and annual oral glucose tolerance testing in the first 2 years after AP. Gastroenterology. 2026;170(3):631-634. doi: 10.1053/j.gastro.2025.09.034

Real-world impact of AUD pharmacotherapy on healthcare utilization, cost, and cost-effectiveness.

AUD pharmacotherapy is related to significantly lower alcohol-related hospitalization and substantial cost savings; Nguyen et al. conducted a retrospective study of Optum’s Clinformatics Data Mart Database, including almost 1 million records of 110,000 patients who initiated AUD treatment from January 2017 to December 2023. They found that the hospitalization rate increased with severity of liver disease and was lower among those who received medications for AUD (MAUD). Cost savings with MAUD were observed across all liver disease severities and were greatest in patients with moderate-to-severe liver disease ($7000); every 3 cents spent on MAUD in patients with moderate-to-severe liver disease resulted in a $1 savings in other healthcare expenses. Off-label gabapentin and FDA-approved naltrexone were the most commonly used MAUDs, with a median 150 days of treatment. Two-thirds of patients took MAUD for more than 90 days. Twenty-six patients needed to be treated to prevent 1 any-cause hospitalization. The findings support broader implementation of MAUD in patients with advanced ALD. Hepatology. 2026. doi: 10.1097/HEP.0000000000001720

Liver Risk Score predicts long-term liver-related outcomes in those without disease.

Hernaez et al. conducted a retrospective study of 171,000 US veterans without evidence of liver disease and calculated the Liver Risk Score (LRS) based on eight routinely measured parameters: age, sex, glucose, cholesterol, AST, ALT, GGT, and platelets. They found that LRS accurately stratified risk for liver events (High LRS ≥15: HR 5.82), mortality (HR 5.25) and HCC (HR10.1). The LRC was particularly accurate for predicting liver outcomes among Hispanic individuals. The LRS outperformed other tests such as FIB-4 (age, platelets) and APRI (AST to platelet ratio) and can be integrated into EHR to trigger risk-based targeted care and improve health equity. Hepatology. 2026. doi: 10.1097/HEP.0000000000001669

Liver stiffness for HCC risk stratification in MASLD.

John et al. analyzed transient elastography data and HCC incidence among 30,000 individuals with MASLD in the VALID study cohort. The risk of HCC risk increased by 18% with every 5 kPa increase in liver stiffness. The annual HCC incidence in patients with MASLD, cardiometabolic risk factors, and LSM ≥10 kPa was 0.46 per 100 patient-years, which is higher than the threshold incidence to support screening. The authors recommended surveillance of individuals with MASLD with diabetes and LSM ≥10 kPa. Hepatology. 2025. doi: 10.1097/HEP.0000000000001498

Association between weight change and clinical outcomes in MASLD.

Shi et al. examined longitudinal weight change and obesity status for 10,000 individuals from 16 centers and the association with liver-related events over a follow-up of 12 months. A total of 123 events occurred. Weight gain of >5% significantly increased risk of liver stiffness progression and liver-related events, while weight loss >5% was associated with improvement in liver stiffness and achieving non-obese status through weight loss reduced risk to that seen in non-obese individuals. Patients should be counseled about the benefits of 5% weight loss on liver outcomes. Hepatology. 2025. doi: 10.1097/HEP.0000000000001557