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The “Changing Landscapes” Special Edition

Lacy, Brian E. MD, PhD, FACG1; Spiegel, Brennan MD, MSHS, FACG2

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The American Journal of Gastroenterology: October 2021 - Volume 116 - Issue 10 - p 1969
doi: 10.14309/ajg.0000000000001512
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“The only constant in life is change”—Heraclitus, 540 BCE–480 BCE

The field of medicine, and especially that of gastroenterology and hepatology, is constantly evolving. A few examples of some of the revolutionary achievements over the past few decades highlight groundbreaking techniques and treatments that are now considered routine. Colonoscopy, an experimental procedure when first reported in 1969, is now performed approximately 19 million times each year in the United States. Large colon polyps, which previously required surgical intervention, are now readily removed endoscopically in the outpatient setting. Superficial cancers of the gastrointestinal tract no longer require invasive surgery but can be safely resected endoscopically. Hepatitis C, previously diagnosed by exclusion as non-A, non-B hepatitis, and originally considered a chronic, incurable disease, was identified just over 30 years ago but is now easily treated and cured. Multiple biologic agents are now available to effectively treat even the most complicated inflammatory bowel disease patients. Digital technologies that were nonexistent or in primitive form at the turn of the century, such as smartphones, wearable biosensors, artificial intelligence, virtual reality, and social media platforms, are now routinely leveraged to support patients across a wide range of digestive disorders. In short, we have witnessed striking advances in our field that are improving quality of life and prolonging survival among patients with digestive disorders. Although some of these innovations might have been envisioned when we were clinical trainees, many were nearly inconceivable at the time.

These types of massive advances were an impetus for designing this special edition of The American Journal of Gastroenterology, which focuses on the changing landscape of gastroenterology and hepatology. The advent of new techniques, new therapies, and even new disorders (e.g., COVID-19–associated gastrointestinal and liver pathology) that are changing the everyday landscape of daily practice warrant dissemination to the scientific community. In this special edition, Kamboj et al. takes a look at survey results on transitioning to virtual interviewing for GI fellowships. This is a shift in how we assess candidates in the new landscape of the COVID-19 era. Two articles report on the changing landscape of chronic liver disease and cirrhosis in the United States and the economic impact of these debilitating diseases. Evaluation of esophageal function has changed dramatically in the past decade with the advent of new techniques, and Carlson et al. highlight 2 of these new technologies in an article evaluating esophageal retention. The Brief Communication article provides key information about disseminating clinical research on social media platforms and changes in health care utilization after the publication of high-impact gastroenterology publications. The Correspondence section features letters on the social determinants of health for inflammatory bowel disease and anal cancer. Finally, this issue presents the American College of Gastroenterology Clinical Guidelines Management of Benign Anorectal Disorders by Wald et al., updated from the previous 2014 guideline.

We enjoyed assembling these remarkable, cutting-edge articles for this special edition on changing landscapes in gastroenterology and hepatology. We sincerely hope that you find them as interesting and educational as we have. We can only imagine what innovations are to come.


Guarantor of the article: Brian E. Lacy, MD, PhD, FACG.

Specific author contributions: The authors contributed equally to the writing and editing of this manuscript.

Financial support: None to report.

Potential competing interests: The authors are the co-Editors-in-Chief of The American Journal of Gastroenterology.

© 2021 by The American College of Gastroenterology