Gastroenterology as a specialty can make a substantial contribution to reducing the carbon footprint of the health-care system. Concrete actions are needed to increase awareness, education and evidence-based knowledge on eco-sustainable diagnostic and therapeutic approaches to digestive diseases.

A study published in Nature elucidates the genomic landscape of colorectal cancer (CRC). Researchers performed whole-genome sequencing of CRC samples from participants in the UK 100,000 Genomes Project. Analysis of the samples (n = 2,023) identified >250 putative driver genes of CRC and characterized subgroups of CRC. For example, the researchers clustered microsatellite-stable CRC into four distinct

In a study published in Nature Medicine, researchers report an artificial intelligence (AI)-based digital pathology tool for scoring metabolic dysfunction-associated steatohepatitis (MASH; formerly known as nonalcoholic steatohepatitis (NASH)) histology. MASH clinical trial enrollment and endpoint assessment are based on histological criteria. The tool, which is termed AIM-MASH, produced predictions

New research has mapped neuroimmune interactions in the mouse gut, revealing that TRPV1-expressing nociceptor neurons (involved in visceral pain) control and suppress regulatory T (Treg) cells in the gut, increasing susceptibility to colitis in mouse models. The findings potentially link pain signalling with immunomodulatory mechanisms in the gut. In their screen, eight distinct neuronal subsets were

From 26–29 June 2024, Nature Reviews Gastroenterology & Hepatology attended the 56th meeting of the European Pancreatic Club (EPC) in Santiago de Compostela, Spain. The hybrid meeting featured sessions that traversed basic, translational and clinical science, with sessions dedicated to the latest research into acute and chronic pancreatitis, cystic pancreatic lesions and pancreatic cancer, among others

A multicenter, open-label, controlled phase IIIb clinical trial (SEQUENCE) published in the New England Journal of Medicine, compared the efficacy and safety of risankizumab (a monoclonal antibody that targets IL-23A) versus ustekinumab (a monoclonal antibody that targets IL-12 and IL-23) in patients with moderate-to-severe Crohn's disease who previously did not respond to anti-tumour necrosis factor

In June 2024, Nature Reviews Gastroenterology & Hepatology attended in person the European Association for the Study of the Liver (EASL) Congress 2024 in Milan, Italy. This was the third year the international liver conference was in person and virtual, with the session recordings available for 3 months. According to the organizers, 7,809 people attended the meeting, 7,108 onsite and 701 online. There

A recent study in Nature Medicine describes a multi-parametric profile of a pre-metastatic signature using liver biopsy samples to predict metastatic outcomes in early-stage pancreatic cancer (PaC). The investigators obtained liver biopsy samples during pancreatectomy from patients with localized PaC (n = 49) and without cancerous lesions (n = 19). The liver samples were analysed by combining imaging

Mother-to-child transmission of hepatitis B virus remains a mode of transmission in high-burden regions where there are gaps in antenatal screening, limited hepatitis B virus birth-dose vaccination and variable access to antiviral prophylaxis. Policymakers, governments and relevant stakeholders must ensure equitable access to necessary interventions to achieve elimination targets.

The countdown to the 2030 viral hepatitis elimination goal continues, but time is running out and progress is not keeping pace. Viral hepatitis remains a major public health challenge; we need to take action now to mobilize resources and focus efforts.

Two phase III trials of new drugs for eosinophilic oesophagitis (EoE) have been reported in The New England Journal of Medicine. The findings not only highlight new treatments for the condition, but also potentially shift the emphasis for future therapeutic targets and diagnostic criteria. In the first trial (EoE KIDS), Mirna Chehade and colleagues assessed dupilumab, a human monoclonal antibody that

Globally, one in six people have a disability, and individuals with disabilities often experience a narrow margin of health, less financial security and health disparities. We call for action to improve access to health care for people with disabilities and show how this plan might be achieved.

A new study published in Cell has identified a novel regenerative stem cell population in the upper crypt of the intestinal epithelium. The cells, which express Fgfbp1 and are distinct from Lgr5+ cells, were shown using time-resolved fate mapping and lineage tracing to give rise to Lgr5+ crypt base columnar cells and all other intestinal lineages — and continued to regenerate the intestinal epithelium

A multicentre phase II study (NICHE-2; NCT03026140) conducted by the Netherlands Cancer Institute has investigated the safety and efficacy of neoadjuvant immunotherapy in patients with locally advanced, mismatch repair-deficient colon cancer. Patients (n = 115 enrolled) were treated with neoadjuvant nivolumab (PD1 inhibitor) plus ipilimumab (CTLA4 inhibitor). After treatment, 113 patients (98%; 97

After decades of institutional deceit, deflection, defensiveness and delay, publication of the final report of the Infected Blood Inquiry lays bare the failings of the British state and its National Health Service. Now, it is time for justice, accountability and a change in patient safety culture.

The beginning of June saw the publication of four trials assessing the efficacy and safety of incretin-based drugs in steatotic liver disease and cirrhosis, coinciding with the European Association for the Study of the Liver 2024 Congress (5–8 June). In a phase II, dose-finding, multicentre, double-blind clinical trial (SYNERGY-NASH), Rohit Loomba and colleagues assessed the safety and efficacy of

New research has identified ETS2 as a central regulator of human inflammatory macrophages. An intergenic region on chr21q22 (a so-called gene desert), which has been linked to a range of inflammatory disorders including inflammatory bowel disease (IBD), ankylosing spondylitis, primary sclerosing cholangitis and Takayasu arteritis, was investigated. A series of experiments pinpointed ETS2, an ETS-family

From 18–21 May 2024, Nature Reviews Gastroenterology & Hepatology was back at Digestive Disease Week (DDW) in Washington DC, USA, alongside >14,300 attendees both in person and virtually, according to the organizers. A wide array of sessions were available, covering basic, translational and clinical science in gastroenterology and hepatology. For basic and translational sciences, talks on the gut microbiome

A recent study published in Cell Metabolism has investigated the effect of intermittent fasting on nonalcoholic steatohepatitis (NASH) and NASH-related hepatocellular carcinoma (HCC) in mice. First, the researchers demonstrated that Western diet-fed mice put on an intermittent fasting regimen (consisting of 2 non-consecutive days of fasting per week) were resistant to obesity and had significantly

In March 2024, Nature Reviews Gastroenterology & Hepatology attended in person the 33rd annual meeting of the Asian Pacific Association for the Study of the Liver (APASL) in the historic city of Kyoto, Japan. In the opening ceremony, Masao Omata talked about hepatitis B virus (HBV) and hepatitis C (HCV) elimination and the need for a cirrhosis cure, and Shuichiro Shina (president of APASL 2024) addressed

For Pride Month, we celebrate the LGBTQ+ community and take stock of the challenges they continue to experience. Gastroenterologists and hepatologists can and should advocate, improve inclusion and be effective allies for our LGBTQ+ colleagues and patients.

Two studies have reported positive phase III trials for ileal bile acid transporter inhibitors for pruritus and other cholestasis-associated clinical features. In the first study (ASSERT), the efficacy and safety of odevixibat was assessed for Alagille syndrome in a double-blind, randomized, placebo-controlled trial enrolling patients across ten countries. Patients (n = 52; median age 5.5 years) were

Real-world data on the use of nucleos(t)ide analogues (NAs) for chronic hepatitis B (CHB) are limited. A cross-sectional study within a retrospective multinational clinical consortium (2000–2021 REAL-B consortium) was examined to determine rates of CHB evaluation and treatment. Of 12,566 treatment-naive adults with CHB from 25 centres across 9 countries (mean age 47.1 years, 41.7% female patients,

The Fontan procedure is a reconstructive surgery for single-ventricle congenital heart disease. The procedure, often performed early in childhood, commonly results in multiple end-organ complications, including liver fibrosis or Fontan-associated liver disease (FALD). However, the underlying mechanisms of FALD are unknown and it is thought to be distinct from other forms of fibrotic liver disease.

Controlling for confounders in quantitative microbiome data challenges the robustness of some reported associations between the gut microbiota and colorectal cancer (CRC) stages, according to a recent study. The faecal microbiota of 589 patients at different CRC stages was analysed and compared with up to 15 published studies (totalling 4,439 patients and controls). Quantitative microbiome profiling

The kinase MKK4 is a regulator of hepatocyte regeneration. A new study published in Cell reports the development of small-molecule inhibitors of MKK4. HRX215 increased liver regeneration post-hepatectomy in mouse and pig models and increased hepatocyte proliferation in fibrotic mouse livers post-partial hepatectomy. In addition, HRX215 treatment prevented post-hepatectomy liver failure in a lethal

A prospective randomized clinical trial (NCT02933970) has compared the efficacy of hepatitis C virus infection treatment via facilitated telemedicine integrated into opioid treatment programmes (n = 290) versus standard-of-care off-site hepatitis specialist referral (n = 312). The study was conducted across opioid treatment programmes in New York, USA. In the telemedicine group, 92.4% of patients initiated

A new study published in Cell Host & Microbe has compared the development of the microbiota in breast-fed and formula-fed infants. In the trial, 210 infants were randomly assigned to be breast-fed or to receive one of four formulas containing varying supplements, such as bifidobacteria or galacto-oligosaccharides, during the first year of life. The researchers found similar faecal bacterial communities

The Framingham Heart Study is an ongoing observational cohort study to identify risk factors for cardiovascular disease. Xavier and colleagues used data from study participants to investigate links between the gut microbiome and cardiovascular disease. They generated stool metagenomic and metabolomic data from 1,429 study participants. In particular, they identified that Oscillibacter species were

A distinct Fusobacterium nucleatum clade, Fna C2, that is dominant in the human colorectal cancer (CRC) niche has been identified in a new study published in Nature. Importantly, in mice, Fna C2 treatment led to increased numbers of large intestinal adenomas and altered metabolite profiles. The findings illuminate the crucial connection between a bacterial subspecies and human colon cancer and provide

The lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) community navigates a complex social landscape marked by strides in acceptance alongside enduring discrimination. Allies — individuals outside of the LGBTQIA+ spectrum who support and advocate for this community — are paramount, with allyship playing a critical part in influencing the health and well-being of LGBTQIA+ individuals

Bile acids regulate nutrient absorption and mitochondrial function, they establish and maintain gut microbial community composition and mediate inflammation, and they serve as signalling molecules that regulate appetite and energy homeostasis. The observation that there are hundreds of bile acids, especially many amidated bile acids, necessitates a revision of many of the classical descriptions of

Magnetic resonance imaging following injection of hepatobiliary contrast agents improves the detection of hepatocellular carcinomas when contrast agent accumulations in tumours and the surrounding pathological liver differ. However, tissue accumulation is poorly investigated, and this Clinical Outlook article highlights experimental data to understand better contrast agent accumulation in human pathological

Cultural safety seeks to remediate health inequities through empowering marginalized and minoritized patient populations, minimizing implicit bias and incorporating social determinants of health into practice. Here, we propose a cultural safety framework to guide communication with patients from sexual and gender minorities.