Gastroenterology and Hepatology
Summary
Gastroenterology and hepatology together address the function and disorders of the digestive tract and the liver, biliary system and pancreas. Gastroenterology encompasses a spectrum from functional gut disorders and inflammatory diseases such as ulcerative colitis and Crohn’s disease, to malignancies of the oesophagus, stomach and colon. Hepatology examines acute and chronic liver conditions, including non-alcoholic fatty liver disease (NAFLD), viral hepatitis, cirrhosis and complications such as portal hypertension. Both disciplines share common themes of mucosal immunity, microbial interactions, metabolic regulation and fibrogenesis. Recent advances in endoscopic and imaging techniques have improved diagnostics and minimally invasive therapies. At the same time, an expanding body of research has illuminated molecular pathways driving inflammation, fibrotic remodelling and carcinogenesis, offering new targets for precision medicine. Integrated multidisciplinary care—including nutritional support, immunomodulation and endoscopic intervention—has become the cornerstone of management, yielding better outcomes in both common and rare conditions.
Research from Nature Portfolio
First-line treatment of advanced oesophageal squamous cell carcinoma has been transformed by the addition of anti-PD-1 antibodies to standard platinum-fluoropyrimidine chemotherapy. In a double-blind phase III trial, patients whose tumours expressed PD-L1 achieved significant improvements in progression-free and overall survival when serplulimab was combined with cisplatin and 5-fluorouracil, with an acceptable safety profile. These findings established immunochemotherapy as a new standard of care in PD-L1-positive disease.
In the salvage setting, a randomised phase II study compared the PD-1 inhibitor sintilimab with investigator-chosen chemotherapy in previously treated metastatic oesophageal squamous cell carcinoma. Sintilimab conferred a meaningful survival advantage and reduced high-grade adverse events. Exploratory biomarker analyses identified high T-cell receptor clonality and low molecular tumor burden index as predictors of durable response, while on-treatment neutrophil-to-lymphocyte ratios further refined prognostic stratification. Together, these studies underscore the critical role of immune checkpoint blockade across treatment lines and the importance of biomarker-guided patient selection.
Gastroenterology and Hepatology publication trend
The graph below shows the total number of articles in gastroenterology and hepatology across all publications each year (not limited to Nature Index journals).
Technical terms
Non-alcoholic fatty liver disease (NAFLD): accumulation of triglycerides within hepatocytes not due to significant alcohol intake.
Portal hypertension: elevated pressure in the portal venous system, often consequent to cirrhosis, leading to varices and ascites.
Fibrogenesis: activation of hepatic stellate cells to myofibroblasts that deposit extracellular matrix, resulting in liver scarring.
Epigenetic modification: heritable changes in gene expression without alterations in DNA sequence, commonly via histone acetylation or methylation.
Exosome: nano-sized extracellular vesicle released by cells that carries proteins, lipids and nucleic acids to mediate intercellular communication.
PD-1 inhibitor: monoclonal antibody that blocks the programmed death-1 receptor on T cells, enhancing anti-tumour immunity.
Enhancer: regulatory DNA element that increases transcription of target genes in a tissue- and stimulus-specific manner.
miR-146a-5p: a microRNA that modulates inflammatory and fibrogenic pathways by post-transcriptional repression of specific mRNAs.
References
- First-line serplulimab or placebo plus chemotherapy in PD-L1-positive esophageal squamous cell carcinoma: a randomized, double-blind phase 3 trial. Nature Medicine (2023).
- Clinical and biomarker analyses of sintilimab versus chemotherapy as second-line therapy for advanced or metastatic esophageal squamous cell carcinoma: a randomized, open-label phase 2 study (ORIENT-2). Nature Communications (2022).
- Genome‐Wide Profiling of H3K27ac Identifies TDO2 as a Pivotal Therapeutic Target in Metabolic Associated Steatohepatitis Liver Disease. Advanced Science (2024).
- Hepatocyte-derived exosomal miR-146a-5p inhibits hepatic stellate cell EMT process: a crosstalk between hepatocytes and hepatic stellate cells. Cell Death Discovery (2023).
- Puerarin ameliorates nonalcoholic fatty liver in rats by regulating hepatic lipid accumulation, oxidative stress, and inflammation. Frontiers in Immunology (2022).
About these summaries
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