Viewpoint

In this Viewpoint, members of the Association of Black Gastroenterologists and Hepatologists discuss inclusivity and equity in academic medicine and give advice to Black students interested in a career in science or medicine.

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.

In this Viewpoint article, we asked a selection of scientists and clinicians in the gut microbiota field to provide their opinions on the major advances in and future directions for research, and the challenges and solutions for translating gut microbiome research to the clinic.

Five of our Advisory Board Members—international experts across different subspecialties—reflect on the progress and frustrations of the past 10 years in gastroenterology and hepatology. They also comment on where effort and money should be invested now, as well as their predictions for progress in the next 10 years.

The association ofHelicobacter pylori infection with peptic ulcers was published in 1984. Here, Kwong Ming Fock, David Y. Graham and Peter Malfertheiner provide their insights into the advances in H. pyloriresearch over the past 30 years and where research should be targeted in the future.

The optimal duration for stent placement in patients with refractory, benign esophageal strictures (RBES) is not clear. This Viewpoint article discusses the types of stent available for RBES, their benefits and limitations, and the factors that influence stenting duration. The authors provide their opinion regarding optimal stent choice and duration on the basis of available evidence and their own experience.

IBS is a major drain on health-care resources, partly because the pharmacological management of this condition is currently unsatisfactory. Cognitive behavioral therapy, psychotherapy and hypnotherapy can help by providing a global therapeutic approach for IBS. This Viewpoint article discusses the available evidence for these behavioral therapies and highlights the benefits and the difficulties of using such approaches.

The use of nutritional therapy for Crohn's disease is controversial. The author of this Viewpoint article discusses the available evidence for this type of therapy, including data on therapeutic efficacy, possible mechanisms of action and groups of patients for whom this approach might be particularly beneficial. He also highlights directions for future research.

This Viewpoint article discusses changes in current understanding of the pathogenesis of pilonidal disease and evidence for off-midline primary closure methods as the best techniques for the surgical management of this disease. The potential role for antibiotics in the treatment of pilonidal disease is also discussed.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common diseases of the Western world, and is associated with an increased risk of cardiovascular disease. The beneficial effects of moderate wine consumption on cardiovascular function are well known. This Viewpoint article discusses potential risks and benefits of alcohol consumption in patients with NAFLD.

The use of antibiotics in patients with active, uncomplicated IBD is controversial. Clinical studies in patients with Crohn's disease have been small and yielded uncertain results, which have discouraged clinicians from including antibiotics in the therapeutic armamentarium for this disease. The author of this Viewpoint article discusses the available evidence for the use of antibiotics in IBD, and outlines possible mechanisms of action.

The eradication ofHelicobacter pyloriinfection is still a challenge for clinicians. Approximately 5% of patients who undergo two courses of eradication therapy remain infected. The authors of this Viewpoint article discuss the available options for salvage therapy in these patients and the role of antimicrobial susceptibility testing in this setting.

The efficacy of triple therapy forHelicobacter pyloriinfection is often unacceptably low. As a consequence, new first-line treatment alternatives have been proposed. This Viewpoint article discusses the options for improving first-line therapy cure rates either by triple therapy modifications—increasing the length of treatment and/or using high doses of PPIs—or promising new drug schedules such as 'sequential' or 'concomitant' therapies.

Gastroenterologists in the US have been working to answer the call to demonstrate quality in medical practice. Much has been accomplished to lay the groundwork for measuring the quality of clinical performance; however, more remains to be done to improve the quality of health care and to respond to the requirements for reporting quality.

Liver fibrosis is characterized by the excessive deposition of extracellular matrix proteins, and results from chronic liver disease. The most important goal of antifibrotic therapy is to remove the fibrogenic stimulus by treating the underlying etiology of liver disease. The authors of this Viewpoint article discuss the promising targets for antifibrotic therapy that have been identified using animal models of liver fibrosis.

The improvement of symptoms alone is no longer a satisfactory outcome for patients with Crohn's disease. The authors of this Viewpoint article argue that modification of the clinical course of Crohn's disease should be the major goal of medical therapy. Preliminary data suggest that the early use of biologics could achieve this aim in a subset of patients.

Gastroparesis is a poorly defined and poorly understood chronic digestive disorder that is difficult to treat. This Viewpoint article discusses evidence for the use of gastric electrical stimulation in patients with drug-refractory gastroparesis, and highlights directions for future research.

The tissue-engineered intestine might provide a viable alternative to intestinal transplantation for patients with intestinal failure. This Viewpoint discusses the available evidence regarding the feasibility of this type of treatment, and the state-of-the-art technology involved in creating a tissue-engineered intestine in the context of its clinical and technical limitations.

Colon cancer is the fourth most common cancer worldwide causing half a million deaths each year. The author of this Viewpoint article discusses the role of Src, a protein tyrosine kinase, in the metastasis of this disease, and potentially its treatment.

Fecundity is an important issue for women with ulcerative colitis or familial adenomatous polyposis who undergo resection of the rectum and creation of a restorative pouch. This Viewpoint article discusses the available literature on fecundity and fertility in these patients, directions for future treatments and the prevention of infertility in this patient population.