Twenty years since the launch of Nature Reviews Gastroenterology & Hepatology, developments in research and clinical practice continue apace. In our anniversary issue, we focus on the past, present and future of gastroenterology and hepatology.

November 2024 marks the 20th anniversary of the first issue of Nature Reviews Gastroenterology & Hepatology (initially titled Nature Clinical Practice Gastroenterology & Hepatology). Since 2004, we have been committed to providing accessible, timely, authoritative articles encompassing basic, translational and clinical research across the fields.

To mark the occasion, we commissioned Viewpoint articles exploring the past, present and future of two topics that are central to the modern landscape of gastroenterology and hepatology: the gut microbiome and metabolic dysfunction-associated steatotic liver disease (MASLD). Our understanding of the pathophysiology of MASLD, as well as its clinical management, is rapidly evolving — represented not least by its recent renaming from nonalcoholic fatty liver disease (NAFLD)1. A Viewpoint by Alina Allen, Juan Pablo Arab and Vincent Wai-Sun Wong in this issue discusses the developments in MASLD research and clinical practice in the past two decades and also looks ahead to the future of our approach to this highly prevalent disease. In addition, since the launch of our journal, research on the gut microbiome has revolutionized our understanding of intestinal biology. In a second Viewpoint2, written by Maria Carmen Collado, Suzanne Devkota and Tarini Shankar Ghosh, these experts reflect on how the microbiome has transformed our understanding of biology, as well as how the next 20 years of microbiome research and clinical applications might progress.

Credit: Pat Morgan/Springer Nature Limited

Also in this issue, three Comment articles each focus on topical, forward-looking subjects. First, Giovanni Cammarota and Gianluca Ianiro highlight how healthcare systems contribute to pollution and greenhouse gas emissions and discuss how gastroenterology can become greener and the importance of considering an eco-sustainable approach to healthcare to safeguard future generations and align with environmental sustainability goals. Next, as microbiome research in Africa advances, opportunities and challenges arise. In their Comment, Soumaya Kouidhi and Ovokeraye Oduaran provide recommendations to standardize data collection for African microbiome research to maximize potential in this area. Finally, Brian Johnson and Kit Curtius have written an introduction to the use of ‘digital twins’ in medical practice. Medicine and clinical care need to evolve and harness data science, an area that is rapidly advancing, and gastroenterology and hepatology needs to take advantage of such digital medicine applications to improve and personalize patient care.

“gastroenterology and hepatology needs to take advantage of ... digital medicine applications to improve and personalize patient care”

We hope that taken together, these and other articles in this issue provide a wide range of perspectives on emerging topics and future directions in gastroenterology and hepatology. As we look to the future, we also reaffirm our commitment to foster and improve diversity and inclusion in our articles and journal practices, as well as to raise awareness and advance equitable health. Our recently launched series entitled ‘JEDI in gastroenterology & hepatology’ demonstrates our efforts to cover topics that encompass justice, equity, diversity and inclusion3. We would like to thank all staff, readers, authors, referees and other friends of the journal for their continued support — and as Nature Reviews Gastroenterology & Hepatology enters our third decade, we aim to continue to help clinicians and researchers keep up to date on scientific and clinical research4.