The future of hepatology Preventing liver disease together with the public, scientists and artificial intelligence

Background and Aims: The coming decades will bring important challenges for medicine, including hepatology, such as rising healthcare costs and the increasing role of artificial intelligence (AI). Addressing these challenges depends partly on how the scientific community builds public trust and support for long-term policy solutions. Here, we explore how broader societal involvement in hepatology through participatory medicine, centred on collaboration between the general public, clinicians, researchers, and intelligent systems, could contribute to research, prevention, and public engagement. Such approaches stimulate partnerships that benefit both lay contributors and researchers. Methods: Examples from other scientific domains, including astronomy (Galaxy Zoo, involving more than 200,000 volunteers classifying galaxies), molecular biology (EteRNA, a gamified platform where tens of thousands of players solve RNA-folding puzzles), meteorology (WOW, integrating data from citizen weather stations) and traffic monitoring (Telraam, where citizens deploy street-level traffic sensors) show how citizen participation and AI can form co-learning loops. Drawing inspiration from these four case studies, we developed six new participatory hepatology projects. Results: These projects fall into two categories based on participants. Four are public led: Liver Zoo (medical imaging annotation), Liver Cache (geocaching-based prevention and awareness), LiverQuest (gamified prevention and behavioural reflection) and Heporama (community-driven aflatoxin surveillance). Two are patient centric: Liver Cancer Wisdom Bank (patient knowledge repository) and Liver4Mind (neurocognitive monitoring in cirrhosis and encephalopathy). Conclusion: These proposals illustrate how participatory approaches can strengthen trust, public engagement, and innovation in hepatology, supporting societal involvement in research and prevention. Intended as catalysts for dialogue, we invite the hepatology community to shape these and related participatory initiatives, thereby strengthening communication and public education while positioning hepatology at the forefront of innovative and trust-building medicine. Impact and implications: This study sets out the case for expanding participatory medicine in hepatology beyond patient-centred research to also include the general public, addressing persistent gaps in prevention, awareness, and representative data in an era of increasing AI use. By adapting established citizen science models from other disciplines into six hepatology-specific project archetypes, the study shows how public engagement can support earlier risk awareness and prevention while providing complementary behavioural, environmental, and perceptual insights, beyond those available in clinical settings. These findings are particularly relevant for hepatologists, public health researchers, and policymakers searching for scalable ways to engage the general population, including individuals at risk but not yet medically treated. In practice, this work helps existing patient-led initiatives broaden their scope, and helps researchers design new public-facing participatory initiatives where few currently exist.