From liver to gut: the hidden gastrointestinal impact of pediatric metabolic dysfunction-associated steatotic liver disease.
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INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disorder in children and is increasingly recognized as a multisystem condition. Among its extrahepatic manifestations, gastrointestinal (GI) comorbidities significantly influence disease progression and long-term outcomes. A deeper understanding of the liver - gut pathophysiological interplay is essential for developing integrated, multidisciplinary management strategies. AREAS COVERED: This narrative review summarizes current evidence on hepatic and GI comorbidities in pediatric MASLD. A comprehensive literature search was conducted across PubMed, EMBASE, and Google Scholar to identify relevant studies published to date. Beyond disease progression, the review highlights the wide spectrum of GI comorbidities, potential malignancy risks, and emerging pathophysiological insights that may inform the development of targeted therapeutic strategies. EXPERT OPINION: MASLD is a significant early-life risk factor for various GI comorbidities, highlighting the need for thorough GI assessment in pediatric MASLD management. Early detection, prevention, and comprehensive management are essential to reduce long-term complications and slow disease progression. Developing pediatric-specific guidelines and validated noninvasive biomarkers is crucial to enable standardized screening, risk stratification, and monitoring. Continued research - especially incorporating omics technologies - is vital for improving risk prediction, enabling earlier diagnosis, and advancing personalized therapies, ultimately enhancing outcomes and reducing disease burden.