We herein present several relevant developments in the hepato-gastroenterology field during the year 2020. An expert consensus has resulted in a clearer nomenclature for “non-alcoholic” fatty liver disease, which is now referred to as "metabolic" liver disease and clearly defined using positive criteria. In fibrosing steatohepatitis, lanifibranor, which is a triple agonist of the three isoforms of the peroxisome proliferator-activated receptor (PPAR α, δ, γ), has demonstrated clear superiority over placebo in terms of disease resolution, fibrosis regression, and metabolic profile improvement. For patients with advanced hepatocellular carcinoma, the combined approach of atezolizumab (anti-programmed death-ligand 1 [anti-PD-L1]) and bevacizumab (anti–vascular endothelial growth factor [anti-VEGF) is a huge improvement and sets a new standard treatment in first-line. In cholestatic pruritus cases, fibrates are deemed to exert beneficial effects on the symptoms. Rifaximin, a broad-spectrum and, poorly absorbed antibiotic, has been demonstrated to be effective for preventing hepatic encephalopathy. This agent is now reimbursed when given in combination with lactulose. For inflammatory bowel diseases, ustekinumab (anti-interleukin [IL]12-IL23) is also now reimbursed in ulcerative colitis cases, and infliximab (anti-tumor necrosis factor [TNF]) as well as vedolizumab (anti-integrin) can be administered subcutaneously. Lastly, inflammatory bowel disease patients were proven not to exhibit any increased risk of coronavirus infection or developing severe COVID-19. In spite of their immunosuppressive therapy, these patients can (and should) benefit from the currently available vaccines.

Overall, 30% and 3% of the Belgian population suffer from fatty liver and its severe form, non-alcoholic steatohepatitis (NASH), respectively. To date, there is no pharmacological treatment in the NASH field. Nevertheless, encouraging results have been described with obeticholic acid in a Phase 3 study. As a consequence, obeticholic acid is considered a promising therapeutic strategy. In the area of chronic inflammatory bowel disease, tofacitinib (Xeljanz®) is reimbursed since September 2019 in case of first-line treatment failure in ulcerative colitis patients, providing new perspectives to patients affected by this disease. Poorly known 10 years ago, the hepatitis E virus has recently gained interest. In Europe and more particularly in Belgium, genotype 3 is responsible for the majority of cases. Hepatitis E virus infection should be checked for in each acute hepatitis case. The disease can be more severe in two sub-populations, namely patients suffering from chronic liver disease that can decompensate in this context and immunocompromised patients in whom the infection can become chronic. Great advances in the field of enteroscopy were also confirmed in 2019, due to the techniques enabling the biliopancreatic system to be accessed in patients with an altered anatomy of the upper digestive tract (gastric bypass,etc.) or through the use of motorized spiral enteroscopy. All of these techniques are employed at the Cliniques universitaires Saint-Luc. Finally, the last part of this review will be devoted to liver transplantation and the UCL-ALDAPT clinical study, whose objective is to assess the validity of a 2-stage total hepatectomy surgical procedure associated with a left-liver transplantation, so as to minimize risks in adult-to-adult living donor liver transplantation.