International evidence has demonstrated that early adequate anticoagulation improves survival in patients with acute mesenteric ischemia without increasing the risk of bleeding complications. Artificial intelligence-assisted automated bedside assessment of gastric motility assessment has emerged as a novel approach for individualized nutritional support in critically ill patients. Recent large-scale clinical trials have questioned the routine use of high-protein nutrition and probiotic/prebiotic supplementation in critical illness, highlighting the context-dependent efficacy of these interventions. Moreover, advances in understanding the gut-lung axis and the association between gut microbiota resistome profiles and patient prognosis have provided novel perspectives for infection prevention and management. Studies investigating stress ulcer prophylaxis, particularly through analyses of treatment-effect heterogeneity, have further advanced the concept of precision prevention. In addition, optimized transfusion strategies for thrombocytopenia-associated gastrointestinal bleeding in critically ill patients have been proposed. Although several of these findings still require further validation, collectively they provide a solid foundation for the development of individualized therapeutic strategies based on deeper pathophysiological understanding and emerging technologies. This review summarizes and critically appraises major advances in critical care gastroenterology reported in 2025.