It has been 6 years since we became Co-Editors-in-Chief of The American Journal of Gastroenterology when Drs. Bill Chey and Paul Moayyedi passed us the torch after their highly successful editorship of the Journal (1). Now, as our own term ends over a half decade and a pandemic later, we can reflect on our time overseeing the American College of Gastroenterology flagship Journal and consider what is yet to come.
When we first took the reins of AJG in 2015, we recognized the Journal was already in top shape and did not require meddling from the likes of 2 new editors. In fact, we took care not to shake up the Journal, which had already evolved into a venerable source of peer-reviewed science for the international gastrointestinal (GI) and liver communities. Instead, we made incremental changes throughout our 6 years of oversight. Perhaps most notable was updating the “Red Section” to reflect a broad range of opinions, expertise, and perspectives (2). We introduced a set of new columns, including the popular “How I Approach It” series where sages from the GI community shared their tips and tricks garnered over years of studied experience (3–9). In the “Quality Matters” column, we published examples of original approaches to quality improvement in digestive diseases (10–14). This was our effort to expand the Journal beyond traditional peer-reviewed clinical trials to include quality improvement efforts from the frontlines of healthcare delivery. We also introduced the “In My Own Voice” column, which offered an opportunity to share viewpoints from stakeholders typically absent from peer-reviewed journals. For example, we invited patients to describe their personal experiences living with chronic digestive diseases (15–18), learned from a dietician who self-experimented with a prolonged enteral diet (19), and even published a column by Katie Couric about her life as a cancer advocate in the wake of tragically losing her husband to colon cancer (20). The “Digital Dialogue” column focused on emerging digital technologies and ecosystems impacting digestive diseases, including the role of social media (21–23), wearable biosensors (24), electronic health records (25), and other innovations. We are proud of the Red Section and its editors, Drs. Hetal Karsan and Sameer Saini, who brought to life an incredible array of perspectives, opinions, and dynamic trends within our ever-evolving field.
In thinking about the megatrends that have shaped our time as editors, a few come to mind. The most obvious is the coronavirus 2019 (COVID-19) pandemic. It is hard to imagine how these remarks will be read 30 years from now, but the pandemic will likely resonate with future generations for years to come. As editors of the Journal during the pandemic, we were confronted early and often with waves of novel observations, discoveries, and editorials about the impact of COVID-19 on the practice of gastroenterology and hepatology. Our editorial team worked tirelessly to review hundreds of articles and select, to the best of our ability, the most salient work for our readers. We published many of the earliest observations that COVID-19 affects the GI tract and liver (26–30). These seminal papers raised awareness that COVID-19 is not “just a cough,” but a broad disease that can dramatically affect extrapulmonary systems inducing the liver and digestive tract. It will be fascinating to track how the story of GI COVID-19 evolves in the years to come.
Beyond COVID-19, there are other megatrends reflected in the recent pages of AJG. Four come to mind. First, there has been a tremendous growth in the capabilities of artificial intelligence within gastroenterology and liver diseases. We published a variety of articles on these topics, some of which are cited here (31–35). Second, the opioid epidemic remains the epidemic within the pandemic. Opioid use is pervasive across all medical specialties; digestive diseases are not immune to this trend. The Journal featured many insightful studies casting light on the problem of opioid overuse and related consequences among patients with GI and liver diseases (36–40). We hope in years to come that researchers continue to identify ways to minimize opioid use among our patients while also maintaining compassion and understanding that some people do need these medications; this is a delicate conversation that must continue in the pages of AJG. Third, the gut microbiome remains an exciting and impactful area of research for both GI and liver diseases. During our editorship, we committed to being a leading voice for microbiome research. In addition to releasing high-impact guidelines on bacterial overgrowth and breath testing (41,42), we published a wide range of primary studies examining the interaction between the microbiome and gut health and dedicated an entire special issue of the Journal to the gut microbiome (43). Fourth, there is a growing realization that sex-related disparities in gastroenterology and hepatology have been understudied and underreported. To help address this shortcoming, we dedicated the March 2021 issue to women's health and published a collection of high-impact essays and original investigations exploring the differential impact of digestive diseases on women. In their accompanying editorial to the special issue, Associate Editors Aasma Shaukat and Amy Oxentenko concluded that “what we hope to see in our lifetime is the recognition, attention, transparency, inclusivity, and solutions to address many issues faced by women who are our patients in gastroenterology, but as importantly, for women who will serve and lead in the profession of gastroenterology” (44).
There are so many other trends that evolved during our time as editors; more than we can possibly highlight here. In July 2020, our editorial team assembled to think about the major trends in GI and hepatology from the previous decade. We sought to highlight the most important advances throughout the entirety of digestive disease. The resulting document, cited here (45), offers a comprehensive guide to scientific and clinical advances as selected by our Editorial Board. We hope the document serves as an accurate portrayal of digestive disease science between 2010 and 2019 and as a helpful reference for years to come.
We are also proud of introducing our biennial tradition of publishing the “Negative Issue” of AJG. What started as an experiment to capture interesting negative studies evolved into an impactful tradition that is now a calling card of AJG. It started in 2016 when we distributed a request soliciting clinically relevant articles that report on “what medicines do not work, what diets miss the mark, what risk factors are irrelevant, what supplements are no better than placebo, what diagnostic tests are unrevealing, unhelpful, or even harmful, and anything else that may be terrifically noncontributory in gastroenterology and liver disease” (46). The result was an outpouring of submissions that lead to an incredible collection of negative studies. Since then, we published a second Negative Issue and hope the tradition continues as we pass the torch to the next team of editors. We also hope that publishing these special issues has sent a larger message to the GI and hepatology communities that negative is positive and that academicians and editors should not eschew—and should even celebrate—clinically meaningful negative studies.
As our final editorial project, we conceived and published a special issue of AJG dedicated to “The Changing Landscape of GI Practice” (47). After witnessing massive advances in health technology, fundamental changes in the way health care is delivered, a metamorphosis in how our patients access and share information online, and even the emergence of new disorders (e.g., COVID-19 GI and liver disease), our Editorial Board recognized the importance of dedicating an issue to evolving trends that are likely to transform the practice of GI and hepatology. In the October 2021 issue, our last special issue as editors, we published a collection of changing landscape articles covering everything from the use of virtual interviews for fellowships in the wake of COVID-19 (48) to rethinking the milestones for modern training curricula (49), to trends in the economic burden of liver diseases (50), and to the evolving role of social media as a platform for disseminating research (51). We are eager to track how these emerging trends will affect the practice of GI and hepatology and look forward to reading future changing landscape issues of AJG in the years and decades to come.
Overseeing AJG has been the academic honor of our professional careers. We could not be more grateful to the ACG Board of Trustees for entrusting us with the crown jewel of the College. Our parting hope is that we at least kept the jewel safe and sound through a period of tumultuous change. Moreover, we are deeply indebted to our entire team of Associate Editors, without whom the Journal could not have flourished. Sometimes it felt like we had collected a group of GI superheroes, each with their own special powers and expertise. The weekly editorial calls were reminiscent of the DC Comics “Hall of Justice” where superheroes convene to discuss challenging decisions and make tough calls. Week-in and week-out, for 6 years, this talented team of editors did their level best to pick the top science and editorials for the pages of AJG. We could not have asked for a more qualified group of colleagues with whom to shepherd the Journal through this era of change. We are also indebted to our home institutions—Mayo Jacksonville and Cedars-Sinai—for their unwavering support of our editorship and for creating academically vibrant environments that continue to forge our commitment to excellence in patient care and research. Finally, we thank the talented editorial and production teams who have supported us from behind the scenes; without their expert help, we could never have delivered the Journal into the hands of our readers.
We wish our successors the very best because they will undoubtedly navigate the Journal to even greater heights through its next unchartered era.
CONFLICTS OF INTEREST
Guarantor of the article: Brennan Spiegel, MD, MSHS, FACG.
Specific author contributions: Both authors contributed equally.
Financial support: None to report.
Potential competing interests: None to report.
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37. Patel D, Callaway J, Vaezi M. Opioid-induced foregut dysfunction. Am J Gastroenterol 2019;114:1716–25.
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