Reviews & Analysis

In this Review, the authors discuss gene therapy involving the use of recombinant adeno-associated virus vectors for the treatment of inherited liver diseases, including ongoing clinical trials that are producing promising results.

Key studies published in 2022 highlight the emergence of several novel drugs for inflammatory bowel disease. Head-to-head trials and network meta-analyses have also been conducted to identify the sequencing of these treatments, but we still have a long way to go to achieve personalized medicine.

There is an increasing burden of gastrointestinal cancers in East Asia. This Review provides an updated summary of the epidemiology of gastrointestinal cancers in this region and discusses risk factors and implications for prevention.

In this Review, the authors consider various paths to functional cure of chronic hepatitis B (CHB) and the need to individualize therapy of this heterogeneous infection until a therapeutic avenue for all patients with CHB is available.

The gut microbiome field is shifting from association to modulation. Microbiota-based treatments come in many shapes and sizes, ranging from dietary intervention to live bacterial products. Recent methodological advances are instrumental to developing innovative new treatment strategies in microbiome-linked pathologies.

New data suggest that moderate fluid resuscitation is safer in acute pancreatitis than the standard aggressive fluid resuscitation. The findings suggest that an approach that includes safety and goal-directed checkpoints could enable treatment to be individualized and highlight the importance of clinical evidence in challenging dogma and improving evidence-based medicine.

The year 2022 was notable for substantial research progress related to pancreatic ductal adenocarcinoma (PDAC). The first single-cell and spatial transcriptomic atlases of PDAC were reported, a mechanism for how Schwann cells promote perineural invasion was explored, and, finally, the role of exercise in abrogating immunosuppression was shown.

In this Review, Cowardin, Moore and colleagues discuss advances in our understanding of environmental enteric dysfunction in the context of intestinal adaptation and the gut microbiome during pregnancy, lactation and early childhood.

Various pathways enable communication between the gut and brain, and this communication influences physiology and behaviour. Studies published in 2022 demonstrate how our understanding of several of these pathways is advancing rapidly.

Health care contributes to the climate change burden, and measures should be taken to mitigate these effects. This Perspective discusses the carbon footprint of surgery in gastroenterology and hepatology and offers an overview of sustainable strategies.

In 2022, we witnessed advances in the field of alcohol-related liver disease. Key developments included the discovery of novel proteomics-based biomarkers and potential therapeutic targets that regulate the recognition of molecules derived from gut microbiota to modulate liver injury. Additionally, there have been significant advances in refining selection for liver transplantation in severe alcohol-associated hepatitis.

2022 was a proficuous year in both the nonalcoholic fatty liver disease (NAFLD) and obesity fields. Pharmacological treatment for obesity and NAFLD is moving forward, with the possibility of replacing bariatric surgery, artificial intelligence might help us access the histological effects of new drugs, and there were advances in personalized hepatocellular carcinoma screening in patients with NAFLD.

Intestinal gluconeogenesis (IGN) is a conserved mechanism documented in all vertebrates and it has a crucial role in energy homeostasis and metabolic processes. This Perspective provides an overview of IGN and discusses its importance in natural selection.

Key studies published in 2022 further established the importance of alterations in the gut microenvironment and interactions with the enteric and central nervous systems in symptom generation in irritable bowel syndrome and suggested novel and clinically accessible therapeutic approaches for this large group of patients.

This Review discusses the current and emerging therapeutic landscape for treatment of advanced hepatocellular carcinoma, including molecular-targeted monotherapies, immuno-oncology monotherapies, combination therapies and novel therapeutic approaches.

Advances in artificial intelligence (AI) are changing endoscopy and gastrointestinal surgery, including computer-assisted detection and diagnosis, computer-aided navigation, robot-assisted intervention and automated reporting. This Perspective introduces the role of AI in computer-assisted interventions in gastroenterology with insights on regulatory aspects and the challenges ahead.

Primary sclerosing cholangitis (PSC) is closely associated with inflammatory bowel disease (IBD) and potentially provides unique insights into the gut–liver axis. This Review explores these links and provides an overview of the gut microbiome in PSC, including PSC–IBD, exploring related hypotheses of disease mechanisms.

Gastric and gastro-oesophageal cancer is a leading cause of cancer-related death worldwide with a poor prognosis. This Review provides a comprehensive overview of current treatment strategies set on a molecular basis, and discusses future therapeutic avenues.

Pruritus in cholestatic liver diseases is a frequent symptom that impairs quality of life. This Review describes the mechanisms underlying cholestasis-associated itch, discusses potential pruritogens, and highlights therapeutic approaches to manage pruritus in various conditions, including primary biliary cholangitis, primary sclerosing cholangitis and intrahepatic cholestasis of pregnancy.

The gastrointestinal tract is involved in COVID-19, gastrointestinal symptoms can occur and marked changes in the gut microbiota have been observed. This Perspective highlights interactions between the gut microbiota and SARS-CoV-2 infection and increasing interest in the gut–lung axis.