Perspectives

Health care contributes to the climate change burden, and measures should be taken to mitigate these effects. This Perspective discusses the carbon footprint of surgery in gastroenterology and hepatology and offers an overview of sustainable strategies.

Intestinal gluconeogenesis (IGN) is a conserved mechanism documented in all vertebrates and it has a crucial role in energy homeostasis and metabolic processes. This Perspective provides an overview of IGN and discusses its importance in natural selection.

Advances in artificial intelligence (AI) are changing endoscopy and gastrointestinal surgery, including computer-assisted detection and diagnosis, computer-aided navigation, robot-assisted intervention and automated reporting. This Perspective introduces the role of AI in computer-assisted interventions in gastroenterology with insights on regulatory aspects and the challenges ahead.

The gastrointestinal tract is involved in COVID-19, gastrointestinal symptoms can occur and marked changes in the gut microbiota have been observed. This Perspective highlights interactions between the gut microbiota and SARS-CoV-2 infection and increasing interest in the gut–lung axis.

Secretory antibodies regulate intestinal bacteria, but their specificity and dependence on T cells have been matters of debate. This Perspective argues that bacteria-reactive antibodies are highly specific and that their production is under the control of T cells.

Archaea are an overlooked member of the human gut microbiota. This Perspective discusses key characteristics of archaea, their role in human health and physiology, and the clinical relevance of methanogenic archaea in the human gastrointestinal tract.

The history of hepatitis C virus (HCV) is a role model for successful basic, translational and clinical research. In this Perspective, the authors chart a timeline of breakthroughs in hepatitis C research, from discovery to cure.

Multiomics advance our understanding of disease progression and can facilitate drug discovery. In this Perspective, current knowledge and applications of omics platforms in inflammatory bowel disease diagnosis and in identifying risk factors are discussed.

Ceresa et al. discuss machine perfusion technologies for liver preservation and transplantation, including the potential of hypothermic and normothermic machine perfusion to improve preservation time and organ quality, as well as the future applications of perfusion technologies.

In this Perspective, Duan, Young and Schnabl explore the effects of bacteriophages on the gut microbiota and the potential applications of phage therapy for treatment of gastrointestinal diseases. Limitations and challenges of phage therapy for gastrointestinal diseases are also discussed.

Humans and their microbiota are intrinsically linked. Owing to dynamic interactions within the gut, nutritional science needs to incorporate the microbiome. This Perspective re-examines the history, rationale and future prospects of chemically defined diets (enteral or parenteral) in relation to the burgeoning understanding of the human microbiota.

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.