Comment

Deep learning can mine clinically useful information from histology. In gastrointestinal and liver cancer, such algorithms can predict survival and molecular alterations. Once pathology workflows are widely digitized, these methods could be used as inexpensive biomarkers. However, clinical translation requires training interdisciplinary researchers in both programming and clinical applications.

The gastrointestinal tract represents a target organ for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), warranting a thorough discussion on the consequences, particularly regarding inflammatory bowel diseases. Here, aspects of gastrointestinal involvement with SARS-CoV-2, the role of viruses as modulators of mucosal immunity and as treatment-related safety hazards, and the current clinical evidence will be discussed.

Greater than the coronavirus disease 2019 (COVID-19) crisis, systemic inequity in social determinants of health is the pandemic that has long fostered vulnerability to disease and poor health outcomes in the USA. Our response has major implications for the health of our nations.

Coronavirus disease 2019 (COVID-19) itself and/or the use of hepatotoxic drugs might negatively affect the course and management of patients with pre-existing chronic liver diseases. However, the greatest effect of COVID-19 on liver diseases will be indirect and delayed, resulting from the impending global economic crisis.

On ‘International NASH Day’, we launch a call for the global health community to collaboratively shape and deliver a comprehensive, long-term public health agenda for NAFLD. A global multidisciplinary coalition is needed to guide our response to this increasingly prevalent, yet underaddressed disease.

The outbreak of coronavirus disease 2019 has undeniably affected modalities of medical and gastroenterology training in all endemic areas. Indeed, the adoption of various distance-learning techniques has been mandatory to facilitate education and enhance skills such as problem-solving, self-directed learning, open communication and also holistic non-cognitive attributes such as adaptability and collaboration.

During the coronavirus disease 2019 (COVID-19) pandemic, inflammatory bowel disease (IBD) practices have been disrupted. This Comment summarizes the key strategies that should be implemented for both patients and IBD specialists to provide optimal care while avoiding new outbreaks for the first 6–12 months after the peak of the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is affecting and changing the daily practice of gastrointestinal endoscopy worldwide. To protect patients and endoscopy unit personnel, endoscopy units have had to postpone a large proportion of endoscopic procedures. These delays might have an effect on the screening for and surveillance of digestive cancers.

The coronavirus disease (COVID-19) worldwide outbreak has led to a dramatic challenge for all healthcare systems, including inflammatory bowel disease (IBD) centres. Here, we describe the fast changes and clinical issues that IBD specialists could face during this SARS-CoV-2 infection pandemic, highlighting the potential rearrangements of care and resetting of clinical priorities.

Patients are exposed to and actively seeking health information on social media. Greater attention to and engagement with social media communication could improve health literacy and counteract misinformation as well as promote innovation. However, effective and responsible social media use is nuanced and requires guidance.

Women physicians in gastroenterology and hepatology face unique challenges during their early careers, including implicit biases borne of ingrained gender stereotypes and the imposter syndrome. Addressing perceived biases and promoting leadership at the trainee level is crucial to improving female representation in gastroenterology and hepatology.

In ulcerative colitis, treating beyond endoscopic healing has shown a reduction of relapse and hospitalization, pushing for histological remission to be embraced in clinical practice and clinical trials. Here, we propose the concept of disease clearance (symptomatic, endoscopic and histological remission) as the ultimate goal in the treatment of ulcerative colitis.

Late presentation to hepatitis B virus and hepatitis C virus care is common, hindering global efforts to reduce the morbidity and mortality associated with liver disease. Models of care promoting and simplifying early testing of viral hepatitis are needed if we are to eliminate viral hepatitis as a major public health threat by 2030.

The diagnostic reach of nonalcoholic fatty liver disease (NAFLD) is broad, stretching from simple steatosis to cirrhosis. Expanded disease definitions are an important cause of waste in health care. Now is the time to revise the definition of NAFLD to include only those who have developed advanced fibrosis.

To deliver precision therapeutics, microbiome-based medicine will require precision of language, logic and numerical accuracy. Epidemiological lessons of the past suggest that attempts to link almost everything in modern life with the microbiome as a risk factor for disease, without rapprochement with plausible mechanisms, will generate controversy rather than consensus.

Studies show that gut microbial dysbiosis induced by chronic opioid use is linked to central opioid tolerance. Here, we suggest that a persistent decrease in gastrointestinal motility by opioids is a primary cause of gut microbial dysbiosis and that improving gastrointestinal transit might be a strategy in preventing opioid analgesic tolerance.

Cell-based therapies for the treatment of perianal Crohn’s disease have well-established safety profiles and improved efficacy compared with conventional therapy. However, stem cells are not a homogeneous product and questions remain before we can optimize clinical trials of these treatments and achieve best patient outcomes.

Work during the past two decades has highlighted how HIV contributes to hepatic inflammation and fibrosis, leading to changes in the timing of antiretroviral therapy initiation and to improved diagnosis and management of liver disease in patients with HIV. As this population ages, clinician vigilance with early detection of emerging liver disease will be critical.

Obesity is an established risk factor for gastrointestinal cancers. Interventions that reduce the burden of obesity at both the societal and individual level and targeted interventions among those at higher risk of cancer should be developed, supported by advances in understanding of the biology that underpins the obesity–cancer link.

Bariatric surgery-induced weight loss is associated with reduced overall cancer incidence; however, some data suggest that risk of colorectal cancer (CRC) actually increases. Here, we suggest a need to fully characterise CRC (and colorectal adenoma) risk after bariatric surgery given that preventive measures (early diagnosis and polypectomy) can mitigate risk.