Comment in 2025

Despite more women entering medicine, women in gastroenterology continue to experience disparities in training, research and career opportunities. United European Gastroenterology calls to ensure that everyone has equal access to opportunities, mentoring and supportive workplaces that will benefit both professionals and patients.

Patients with pancreatic exocrine insufficiency are treated with pancreatic enzyme replacement therapy. However, there are several challenges facing the future of this treatment, including infectious agents and the presence of microplastics and nanoplastics.

After the regulatory rejection of obeticholic acid, peroxisome proliferator-activated receptor (PPAR) agonists have emerged as the leading second-line candidates for primary biliary cholangitis, pending definitive approval. Of these, only bezafibrate — a low-cost, widely available generic — has demonstrated long-term efficacy, a fact largely disregarded.

Submucosal endoscopy creates a new space to implant bioelectronics in a ‘scarless’ way, establishing a reliable interface between device and tissue that remains stable for months in the gastrointestinal tract. Submucosal bioelectronics, combining diagnostic and therapeutic functions, hold great promise as powerful tools to advance both fundamental understanding and clinical management of gastrointestinal disease.

Diet modulates not only gastrointestinal cancer risk but also survivorship, providing an opportunity to improve cancer-related outcomes and quality of life through suitable dietary and lifestyle interventions in survivors of cancer. This Comment summarizes the evidence and ongoing trials investigating diet in gastrointestinal cancer survival, including potential underlying mechanisms and future research directions.

Pathology is a fast-changing discipline, owing to developments in high-throughput molecular technologies and artificial intelligence. In this Comment, I discuss how these advances will shape the future of gastrointestinal and liver pathology.

Gastric cancer is often overlooked in the United States, yet East Asian and other immigrant communities face a markedly increased burden. A community-based, migration-informed approach is needed to strengthen prevention and reduce disparities.

Liver xenotransplantation and genetically engineered pig livers have potential to save human lives. Liver xenotransplants can either act as a bridge to allotransplantation or support the recovery and regeneration of a whole or reduced native liver in acute liver failure and in major hepatectomies through ex vivo perfusion or auxiliary liver xenotransplantation.

Liver transplantation is challenged by organ scarcity and ageing donors. Machine perfusion is a promising technique to enhance organ preservation and assessment, improving liver utilization and patient outcomes. Here, we discuss current practices in machine perfusion using the IDEAL framework and outline the steps needed to advance this technology clinically.

Onco-gastroenterology is defined as a collaborative subspecialty of Gastroenterology that is dedicated to the unique needs of individuals with or at risk of cancer, with a focus on maintaining and managing their digestive and liver health throughout their clinical course.

Despite the Middle East and North Africa having the highest global burden of metabolic dysfunction-associated steatotic liver disease, patients from this region remain markedly under-represented in the disease clinical drug trials. Addressing this gap is essential for ensuring equitable access to novel therapies and enhancing global liver health.

The European–Latin American Research Consortium towards Eradication of Preventable Gallbladder Cancer (EULAT Eradicate GBC) is identifying geographical, environmental, lifestyle, genetic and molecular risk factors for gallbladder cancer. Collaborative research is essential to improve prevention of this aggressive tumour, especially in high-incidence, low-income and middle-income regions.

There is emerging interest in adaptive platform trials for inflammatory bowel disease. In this Comment, we present the results of a workshop that was convened to consider the opportunities and challenges of developing a platform trial in Crohn’s disease.

The AI-driven ‘endo-histo-omics’ approach integrates clinical, endoscopic, histological and molecular data to improve management of inflammatory bowel disease. This strategy enables precise patient stratification and outcome prediction, paving the way for advanced intestinal barrier assessment and restoration, thereby driving progress in personalized care.

With several drugs in use that inhibit the hepatitis B virus polymerases (nucleos(t)ide analogues (or NUCs)), some argue that new direct-acting antiviral drugs, and new NUCs in particular, are not necessary. Here, we make the counter-argument that additional direct-acting antiviral drugs that can potently suppress hepatitis B virus replication, ideally via distinct mechanisms, are still needed and can provide additional therapeutic benefits.

Non-communicable diseases represent the primary cause of mortality and morbidity globally, accounting for 74% of all deaths and more than three-quarters of years lived with disability. Here, we argue that metabolic dysfunction-associated steatotic liver disease should be considered a non-communicable disease.