Browse Articles

In gastroenterology, ChatGPT and large language models (LLMs) can assist clinicians in various tasks but also have several shortcomings. Although LLMs have great potential to assist clinicians in health care, they should be used as a tool to support, rather than replace, human expertise.

Recent clinical trials have demonstrated efficacy and safety of etrasimod, a new sphingosine-1-phosphate receptor modulator, in the treatment of patients with moderately-to-severely active ulcerative colitis. Etrasimod is a promising new oral treatment option for ulcerative colitis, although long-term efficacy and safety data should be accumulated.

Advances in single-cell technologies and lineage tracing have improved our understanding of liver development. In this Review, Hoodless and colleagues discuss the formation of liver parenchymal and non-parenchymal cell types, and describe emerging parallels between early liver development and the pathogenesis of liver injury.

A new study has found that a strain of the gut bacterium Lactiplantibacillus plantarum activates a NOD2–type I interferon–insulin-like growth factor 1 pathway in young mice to partially protect against the deleterious growth effects of a diet deficient in protein and fat. Could live biotherapeutic products or their derivatives unlock the full potential of nutritional interventions against childhood stunting?

The health-care sector produces significant amounts of waste and greenhouse gas emissions. In turn, environmental damage can have a negative effect on health, including gastrointestinal health. Two articles in this month’s issue prompt us to reflect upon the connections between gastrointestinal health, the health-care sector and the environment.

Colon capsule endoscopy (CCE) is used for restricted indications only. Growing demand for out-of-hospital treatment combined with technical and clinical improvements in quality has made a wider use plausible. Artificial intelligence-supported footage analysis and quality assessment might further improve quality and reduce the price of CCE to a competitive level.

Increased intestinal permeability owing to tight junction barrier loss could be targeted in gastrointestinal diseases associated with increased permeability. In this Review, the authors discuss the molecular components and regulation of the tight junction, and consider the relevance to gut diseases and therapeutic opportunities.

In this Review, Pabst and colleagues discuss the gut–liver axis, with an emphasis on the establishment and regulation of structural and functional barriers, dynamics within the axis (immune responses and microbiome) and clinical implications.

The appendix is thought to have a role in the pathogenesis of ulcerative colitis but the association remains unclear. In this Perspective, the authors consider the biology of the appendix with respect to its immunological function and the microbiome, and how this relates to its possible involvement in ulcerative colitis.

A prospective study suggests that the risk of liver fibrosis with methotrexate treatment has been overestimated. The findings suggest the need to reconsider the intensive strategies and the screening tools that are recommended for monitoring liver fibrosis in patients receiving methotrexate.

IL-12 and IL-23 have been implicated in inflammatory bowel disease. In this Review, Vande Casteele and colleagues summarize the mechanistic role of IL-12 and IL-23 in inflammatory bowel disease, and discuss the clinical development of drugs targeting IL-12 and/or IL-23.

Macrophages are critical for maintaining intestinal homeostasis, yet are implicated in chronic intestinal inflammation. This Review provides detailed insights into the biology of macrophages in the context of inflammatory bowel disease and discusses future perspectives.

In a study published in Nature, new data have highlighted the bacterial strain-level sharing rates of mother–offspring pairs, twins, families, cohabiting individuals and individuals within a population, as well as those between different populations, providing a comprehensive view of the transmission landscape of the intestinal and oral microbiome in humans. These findings highlight the need to reassess diseases currently considered to be non-communicable and underscore the importance of considering social structure and transmissibility in the design of microbial studies.

Barrett oesophagus is not detected before its progression to oesophageal adenocarcinoma in over one-half of patients, and improvements in screening for Barrett oesophagus in primary care could substantially reduce mortality associated with this cancer. Advances in screening technology will help, but collaboration of gastroenterologists with primary care providers is essential.