Clinical Outlook

Potassium-competitive acid blockers (P-CABs) overcome the limitations of proton pump inhibitors by providing faster, longer and stronger acid suppression without meal timing. Evidence shows that P-CABs are non-inferior for the management of mild erosive oesophagitis and superior for severe erosive oesophagitis, whereas data for non-erosive reflux disease remain conflicting.

Current treatments for Crohn’s disease prioritize early intervention with biological therapies, with several landmark trials demonstrating that starting biologic agents within the first years of diagnosis leads to superior patient outcomes. Although challenges remain, early use of biological treatments is increasingly supported in managing moderate to severe Crohn’s disease.

Probiotics might prevent some necrotizing enterocolitis, late-onset sepsis and mortality in preterm infants. However, clinical practice varies widely, and families are often excluded from shared decision making. This Clinical Outlook highlights current evidence, clinical practice guidelines and the future outlook of probiotics in the neonatal intensive care unit.

Apical sodium-dependent bile acid transporter inhibitors have revolutionized care for children with genetic cholestasis. This Clinical Outlook discusses how this new class of drugs came into clinical practice and how they might benefit transplant-free survival for a multitude of indications.

Management of anticoagulation in cirrhosis is challenging because of the concomitant risk of both thromboembolism and bleeding complications. Randomized controlled studies are lacking. Direct oral anticoagulants seem to be the most manageable option. However, for patients with Child C cirrhosis, the only safer anticoagulant strategy, currently, is low-molecular-weight heparin.

Guidelines currently recommend organ-specific management of obesity-related complications. Agents that agonize glucagon-like peptide 1 receptors, including those that co-agonize other anorexigenic hormone receptors, lead to substantial weight loss and benefits in people with varying obesity-related complications, with further trials underway. These medications enable cause-specific management of obesity complications.

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 livers.

A substantial percentage of patients with inflammatory bowel disease (IBD) exhibit biologic treatment failure or loss of response over time. This article explores the effectiveness and safety of monoclonal antibodies targeting the IL-23 pathway in treating IBD; continued research is needed to address lingering questions regarding long-term safety and efficacy.

Imaging techniques for assessing liver fibrosis are advancing. This Clinical Outlook article discusses the best practices and reviews emerging options for magnetic resonance and ultrasound-based elastography.

Recent randomized controlled trials in acute pancreatitis have provided evidence that challenges current approaches to management, including fluid resuscitation, antibiotic administration, management of infected necrosis and use of early endoscopic retrograde cholangiopancreatography. The evidence means that we need to reassess the current management guidelines.

Colon capsule endoscopy (CCE) is used for restricted indications only. Growing demand for out-of-hospital treatment combined with technical and clinical improvements in quality has made a wider use plausible. Artificial intelligence-supported footage analysis and quality assessment might further improve quality and reduce the price of CCE to a competitive level.

A careful integration of the effectiveness and safety of the therapies for inflammatory bowel disease, considering patients’ disease risks, treatment complications and preferences, is warranted to inform the positioning of therapies in clinical practice. Precision medicine might help choose the best option for an individual patient.

The feasibility of long-term organ preservation ex vivo has been reported for the first time with proof of concept in human transplantation. Here, we discuss the possible applications of this novel technology in the clinical setting.

Severe obesity in adolescents affects their health and quality of life. Currently, metabolic and bariatric surgery (MBS) is the only effective intervention, but only a limited number of individuals undergo MBS procedures. Therefore, vigorous research in MBS is a priority for the benefit of adolescents with obesity.

Antibodies targeting tumour necrosis factor have substantially advanced the treatment of paediatric inflammatory bowel disease. Understanding pharmacokinetics and therapeutic drug monitoring has led to increased efficacy and durability of response. Primary non-response is more common in ulcerative colitis than in Crohn’s disease, highlighting the need for alternative biologic agents and oral small molecules.