Reviews & Analysis

Inflammatory bowel disease (IBD) has different manifestations and associated risk factors between the sexes. This Review explores the sex-based differences in presentation and management of IBD, as well as insights into sex-based differences in pathogenesis and underlying mechanisms inferred from basic research.

Liver biopsy sample evaluation is an essential part of clinical studies in nonalcoholic steatohepatitis (NASH) and is key in excluding confounding morbidities. Current scoring systems, which are decisive for study inclusion, rely on imprecisely defined histological features, leading to a high observer variability of disease categorization. In this News & Views, measures to overcome these limitations are discussed.

Therapeutic drug monitoring (TDM) has been suggested as a useful tool for managing patients with inflammatory bowel disease on biologic therapy. This Perspective examines evidence and guidelines related to TDM in inflammatory bowel disease management and also strategies to optimize biologic treatment where TDM is not available.

Food addiction is an eating behaviour that reflects alterations in brain–gut–microbiome (BGM) interactions and a shift towards hedonic mechanisms. This Review summarizes the physiology of food addiction in obesity as it relates to BGM interactions and provides insights into treatment targets for food addiction aimed at each level of the BGM axis.

Faecal microbiota transplantation (FMT) has emerged as a successful treatment for recurrent Clostridioides difficile infection. In this Perspective, the authors examine the pharmacology of FMT in treatment of C. difficile infection and consider FMT within a pharmacological framework using the parameters intrinsic to all therapeutics: pharmacy, pharmacokinetics, pharmacodynamics and pharmacotherapeutics.

Gut microbiota can be manipulated to benefit host health, including the use of probiotics, prebiotics and synbiotics. This Consensus Statement outlines the definition and scope of the term ‘synbiotics’ as determined by an expert panel convened by the International Scientific Association for Probiotics and Prebiotics in May 2019.

The liver has a broad range of regenerative capacities. In this Review, Michalopoulos and Bhushan describe the regenerative mechanisms employed by hepatic cells after liver injury as well as the experimental models used to investigate these mechanisms and discuss the clinical implications.

Vagus nerve stimulation has shown promise in treating inflammatory bowel disease. A new study identifies a hepatic vagal branch pathway necessary to maintain colonic immune cell homeostasis in experimental colitis, challenging the dogma that an anti-inflammatory reflex requires an intact spleen and that α7-nicotinic receptor agonists are a panacea for inflammatory conditions.

In this Review, Thomson et al. describe the immunobiology underlying liver graft tolerance and failure, and discuss therapeutic approaches for minimization or withdrawal of anti-rejection immunosuppressive drug therapy post transplantation.

Gastrointestinal dysfunction (including dysphagia and constipation) can occur in Parkinson disease (PD), with evidence that they can arise prior to diagnosis of PD. This Review describes new insights into the mechanisms and pathophysiology of the gastrointestinal involvement of PD, including clinical manifestations.

Intestinal epithelial glycosylation is influenced by host genetics, the environment and the gut microbiota. In this Review, Kudelka et al. describe the functions of epithelial glycans and discuss the role of epithelial glycosylation in Crohn’s disease and ulcerative colitis.

Viral hepatitis is a global public health problem. In this Viewpoint, we asked a selection of scientists and clinicians working in the viral hepatitis field to provide their opinions on progress and pitfalls towards the 2030 viral hepatitis elimination goals.

Modern therapies for malignant liver tumours integrate neoadjuvant and adjuvant strategies. This broad Review discusses these approaches, including advances in staged surgeries, systemic therapies, ablation therapies and liver transplantation.

Evidence points to a crucial role of necroptosis and pyroptosis as important modes of programmed cell death in the intestine in addition to apoptosis. This Review discusses advances in our understanding of apoptosis, necroptosis and pyroptosis as major cell death pathways that can result in pathophysiological outcomes.

Large-scale datasets of increasing size and complexity are being produced in the microbiome and oncology field. This Perspective discusses the potential to harness gut microbiome analysis, big data and machine learning in cancer, and the potential and limitations with this approach.

Cholangiocarcinoma (CCA) comprises heterogeneous biliary malignant tumours, and their incidence is increasing worldwide. This expert Consensus Statement, endorsed by the ENS-CCA, summarizes the latest advances in CCA, including classification, genetics and treatment, and provides recommendations for CCA management and priorities across basic, translational and clinical research.

Pancreatic cancer is notorious for its affinity for invading nerves. A new study using a systematic unbiased RNA-interference screen of neuronal chemokines in cocultures of mouse sensory neurons and pancreatic cancer cells has now identified CCL21 and CXCL10 as key mediators of neural invasion, neural remodelling and pain in pancreatic cancer.

The COVID-19 pandemic has resulted in changes to the management of patients with inflammatory bowel disease, including major disruptions to endoscopy. This Perspective provides a guide and recommendations for inflammatory bowel disease endoscopy during a global health emergency based on expert experience in Italy and France.

Most patients who undergo curative intent surgery for pancreatic cancer will still die of recurrent disease. A new study shows that pancreatic tumours that pass through the genetic bottlenecks of surgery and additional chemoradiotherapy have altered mutational signatures, driver genes and subclonal architecture.

A mountable ‘smart’ toilet system has been developed to personalize health monitoring. The system uses excretion data, including urinalysis, urodynamics, stool form and defecation timing, stored in a cloud server. This smart toilet system has the potential to provide useful information to characterize symptoms of patients with bowel dysfunction or defecatory disorders.