Protein is an essential nutrient in the human diet. This Review explores the fate of dietary protein in the gastrointestinal tract and its influence on colonic health and disease, providing insights into dietary protein metabolism, digestion, absorption, fermentation and the implications for colonic health.

In this Review, Brown and colleagues describe the latest insights into the role of cholesterol synthesis and metabolism in the gut and liver, and implications in diseases such as metabolic dysfunction-associated steatotic liver disease, hepatocellular carcinoma and colorectal cancer.

Acute-on-chronic liver failure (ACLF) is a complex syndrome characterized by acute hepatic decompensation superimposed on pre-existing chronic liver disease or cirrhosis. This Review provides an update on definitions, pathophysiological mechanisms, clinical presentation and management of ACLF.

Metabolic dysfunction-associated steatotic liver disease is a leading cause of chronic liver disease, with rising liver transplantation rates. New therapies such as resmetirom and semaglutide mark a shift in treatment. However, identifying suitable patients remains challenging, requiring integrated approaches combining fibrosis stage, metabolic factors and non-invasive tools in real-world practice.

Dietary assessment commonly relies on asking people what they remember eating. Genomic methods can change this assessment, paralleling how DNA sequencing revolutionized microbiology. By identifying consumed foods directly from stool, these approaches offer an objective, scalable alternative that gastroenterology researchers can begin using today.

Artificial intelligence is rapidly being adopted in healthcare, but studies have shown a ‘deskilling’ phenomenon. Routine exposure to medical artificial intelligence can pose deskilling risks for physicians. We discuss these risks and whether such systems violate the European Union Artificial Intelligence Act, the world’s first comprehensive regulatory framework on artificial intelligence.

This Comment highlights the effects of war- and armed conflict-related healthcare disruptions on chronic liver conditions — a crisis that increases morbidity and mortality. Major disruption mechanisms are described, and we advocate for conflict-adapted hepatology guidelines and practical, multi-level response strategies appropriate for armed conflict-associated humanitarian situations.

A new Consensus Statement puts forward a definition of ‘gut health’ in an attempt to bring some clarity and consistency to a term that is widely used but often ill-defined and vague.