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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.
