Perspectives

Autoimmune diseases share patterns of gut microbiome perturbation and immune dysregulation linked to intestinal barrier dysfunction. In this Perspective, the authors examine dietary tools for precise engineering of the gut microbiome and discuss the potential for diet-based therapies to modulate host–microbiome interaction in the treatment of autoimmune diseases.

This Perspective highlights an accumulating body of literature that outlines a direct role for oral-associated bacteria in inflammatory bowel disease pathogenesis. The authors propose a model by which oral-associated species might expand in the inflamed intestinal environment to exacerbate inflammation.

The efficacy of faecal microbiota transplantation for the treatment of a range of diseases varies. In this Perspective, Sokol and colleagues discuss the relevance of various recipient factors that influence faecal microbiota transplantation success such as inflammation, immunity and genetics.

Although COVID-19 is a respiratory disease and its causative agent, SARS-CoV-2, principally infects the respiratory tract, extrapulmonary manifestations are observed. This Perspective explores the gastrointestinal symptoms associated with COVID-19 and the putative underlying mechanisms, discussing experimental evidence on SARS-COV-2 gastrointestinal infection and the potential for faecal–oral transmission.

Population screening and endoscopic surveillance are widely used for colorectal cancer (CRC) prevention and early diagnosis. This Perspective explores the rationale for and approach to risk stratification for CRC prevention and diagnosis, including the limitations, advantages and future challenges for this approach.

The global burden of inflammatory bowel disease (IBD) is evolving. This Perspective summarizes the global epidemiology of IBD and its changing burden of disease, postulating that the disease is evolving into four epidemiological stages: Emergence, Acceleration in Incidence, Compounding Prevalence and Prevalence Equilibrium.

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.

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.

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.

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.

As the number of novel drugs for inflammatory bowel disease (IBD) increases, comparison of therapeutic options has become a key challenge in IBD trials. Here, the authors provide an overview of IBD trial design with a focus on comparative research and the head-to-head trials format.

The evidence base for robotic gastrointestinal surgery does not yet support its widespread adoption. Here, Kinross et al. discuss this evidence base and the principles on which future gastrointestinal surgical trials should be based, as well as emerging technologies.

This Perspective discusses the use of antidepressants in disorders of gut–brain interaction (DGBI) and IBD, focusing on how what we have learnt about the role of antidepressants in DGBI could help optimize the management of IBD.

An area of research suggests a role for microbiota in the pathogenesis of pancreatic diseases, such as pancreatitis, pancreatic cancer and type 1 diabetes mellitus. In this Perspectives, the authors examine the literature implicating microorganisms in diseases of the pancreas as well as the evidence of an inherent pancreatic microbiota.

Nonalcoholic fatty liver disease (NAFLD) was first described four decades ago, but it is increasingly important owing to its high prevalence in the general population. This Perspective provides an overview on the development of knowledge related to NAFLD, focusing on landmark findings.

Rapid urbanization in the developing world has been associated with an increasing incidence of several autoimmune diseases. This Perspective discusses the effect of urbanization and its surrogates on the gut microbiome in both human health and IBD and how such changes might be associated with the development of IBD.

Psychosocial risk factors (often linked to the gut–brain axis) are prevalent across different gastrointestinal disorders. Here, Keefer discusses the emerging field of psychogastroenterology and how behavioural medicine and the promise of positive psychology (resilience, optimism and self-regulation) could improve patient management.