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As an essential metabolic organ, the liver is intimately coupled to the intestinal microbial environment via the portal venous system. Our understanding of the gut\u2013liver axis comes almost exclusively from studies of adults; the gut\u2013liver axis in children, who have unique physiology and differing gut microbial communities, remains poorly understood. Here, we provide a comprehensive overview of common pediatric hepatobiliary conditions and recent studies exploring the contributions of the gut microbiota to these conditions or changes of the gut microbiota due to these conditions. We examine the current literature regarding the microbial alterations that take place in biliary atresia, pediatric non-alcoholic fatty liver disease, Wilson\u2019s disease, cystic fibrosis, inflammatory bowel disease, and viral hepatitis. Finally, we propose potential therapeutic approaches involving modulation of the gut microbiota and the gut\u2013liver axis to mitigate the progression of pediatric liver disease.<\/jats:p>","DOI":"10.3390\/microorganisms11030597","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T04:05:40Z","timestamp":1677470740000},"page":"597","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["The Gut\u2013Liver Axis in Pediatric Liver Health and Disease"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1016-6138","authenticated-orcid":false,"given":"Stephanie L.","family":"Rager","sequence":"first","affiliation":[{"name":"Gale and Ira Drukier Institute for Children\u2019s Health, Weill Cornell Medicine, New York, NY 10021, USA"},{"name":"Department of Pediatrics, Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melody Y.","family":"Zeng","sequence":"additional","affiliation":[{"name":"Gale and Ira Drukier Institute for Children\u2019s Health, Weill Cornell Medicine, New York, NY 10021, USA"},{"name":"Department of Pediatrics, Weill Cornell Medicine, New York, NY 10021, USA"},{"name":"Immunology and Microbial Pathogenesis Graduate Program, Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1038\/s41422-020-0332-7","article-title":"Interaction between microbiota and immunity in health and disease","volume":"30","author":"Zheng","year":"2020","journal-title":"Cell Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1080\/19490976.2015.1134082","article-title":"Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism","volume":"7","author":"Morrison","year":"2016","journal-title":"Gut Microbes"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"428","DOI":"10.3389\/fphys.2019.00428","article-title":"The Influence of the Gut Microbiome on Host Metabolism Through the Regulation of Gut Hormone Release","volume":"10","author":"Martin","year":"2019","journal-title":"Front. 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