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By critically analyzing the efficacy and limitations of existing niche remodeling strategies and looking forward to the future direction of precision targeting strategies (such as specific strains, phage therapy, and microbial enzyme inhibitors), this review aims to provide a theoretical basis and roadmap for constructing a new paradigm of multidimensional, personalized liver disease management based on the gutliver axis, ultimately promoting a paradigm shift in liver disease diagnosis and treatment from targeting the liver to regulating the intestinal niche (Fig