Viewpoint

Leptin is involved in many biological processes that implicate it in the development of colorectal cancer. This Viewpoint discusses the biological plausibility of a relationship between leptin and colorectal cancer, and the evidence available to support such a relationship.

The treatment of chronic hepatitis C is rapidly evolving. Current treatment modalities are being refined, and entirely new, specifically targeted, antiviral therapies (known as STAT-C) that inhibit the various steps of viral replication are being developed. This Viewpoint discusses the status of agents in development and their implications for the future treatment of hepatitis C.

Although alcohol consumption and tobacco use are the major risk factors for esophageal cancer in developed countries, nutrition and diet are also important. This Viewpoint discusses evidence for a link between diet and esophageal cancer and the influence it might have with regard to the prevention of esophageal cancer.

This Viewpoint makes a plea for more uniform, careful and complete endoscopic diagnosis and grading of Barrett's esophagus in both clinical practice and research. Incorporation of the initiatives proposed into adequately powered, multicenter, prospective studies should provide much needed authoritative guidance on the management of Barrett's esophagus.

This Viewpoint discusses the role of stool DNA testing as a new diagnostic tool for detecting colorectal cancer. Preliminary data show it to have better performance characteristics than fecal occult blood testing, however, in its current form sensitivity remains low. Stool DNA testing needs to be studied in larger cohorts of asymptomatic patients, and new markers need to be developed before its role in colorectal cancer screening can be fully established.

Endoscopy is an established tool for the diagnosis and treatment of patients with upper gastrointestinal bleeding. The timing of endoscopy is, however, a matter of controversy. This Viewpoint article argues that endoscopy has the greatest potential for therapeutic benefit and reductions in costs and resource use when it is performed urgently, before a patient is admitted to hospital.

This Viewpoint discusses the limited effectiveness of standard medical treatments for IBS, which leave about half of patients without satisfactory symptom relief. The article argues that adjunctive psychological therapies might enhance overall IBS outcomes as evidence suggests that psychological treatments can provide long-lasting symptom improvement for the majority of patients with IBS that is refractory to medical treatment.

The role of psychological distress in provoking and exacerbating IBD is controversial. This Viewpoint discusses the role of psychological factors in the pathogenesis of IBD and focuses on the need for including psychological care in the clinical management of patients with IBD.

The treatment of idiopathic acute pancreatitis is challenging owing to its varied etiology. This Viewpoint discusses the use of empiric cholecystectomy as a definitive treatment option for idiopathic acute pancreatitis caused by occult gallstone disease, and compares cholecystectomy with other treatment options including biliary sphincterotomy and medical therapy with ursodeoxycholic acid.

Intestinal detoxification and defense systems are important for maintaining normal gut physiology. This Viewpoint presents the concept that inflammatory bowel disease might be caused by a defective mucosal detoxification system. Polymorphisms in detoxification genes and related endobiotic plasma biomarkers might both support diagnosis, stratification and therapy in patients with inflammatory bowel disease.

Colorectal cancer claims more than 50,000 lives annually in the US. Screening for colorectal cancer, with the removal of any identified polyps, significantly impacts the death rate from this largely preventable cancer. This Viewpoint discusses the relative merits and pitfalls of colonoscopy and CT colonography as screening modalities in the setting of colorectal cancer.

This Viewpoint looks at the possible reasons why the publication of medical errors in the scientific literature is so infrequent, not only when compared with the number and variety of medical errors that occur, but also in view of the didactic importance of debating mistakes and possible ways to avoid them.

Pancreatic cancer has an extremely poor natural course, and early diagnosis is difficult owing to its location and the lack of early markers for the disease. This Viewpoint discusses whether it is possible to survive pancreatic carcinoma in light of these features, in addition to examining current and potential future therapies.

A wide range of expert opinions exist on the ideal case definition for hemochromatosis, and much of the debate centers on its phenotypic or genotypic diagnosis. The author of this Viewpoint discusses the controversy involved in establishing a diagnosis for the disease and provides recommendations for an appropriate case definition.

The number of patients using alternative and complementary therapies is increasing worldwide, and a large percentage have inflammatory bowel disease. This Viewpoint considers evidence for the safety and efficacy of these therapies for the treatment of inflammatory bowel disease, and the reasons why patients choose to seek alternatives to conventional medicine.

The pathogenesis of hepatic encephalopathy and cerebral edema in patients with acute liver failure has yet to be fully elucidated. This Viewpoint considers whether infection and inflammation have a role to play, and discusses emerging data on the molecular pathways that could link ammonia to infection and inflammation in this setting.

Dietary supplements are increasingly used by a large percentage of the population worldwide. The potential impact of these supplements on our health, however, is not fully understood and their regulation is not controlled as tightly as that of drugs. This viewpoint article discusses the safety concerns and regulatory issues that surround the use of dietary supplements in the US.

This Viewpoint discusses the role of combined multichannel intraluminal impedance-pH testing in the evaluation of patients with GERD symptoms that are refractory to proton-pump-inhibitor therapy. The relationship between symptoms and reflux is important as symptoms might not be due to continuing reflux, and these patients therefore might not benefit from surgery.

Bleeding from gastric varices is a life-threatening event that presents a therapeutic challenge for clinicians. This Viewpoint discusses the advance in nonsurgical treatment of gastric fundal varices, including the new radiologic technique of balloon-occluded retrograde transvenous obliteration.

Controversy exists as to whether ursodeoxycholic acid improves survival in patients with primary biliary cirrhosis. This is mainly because the disease is uncommon and slowly progressive, which has meant that many clinical trials lack hard endpoints such as mortality. This Viewpoint article discusses the importance of the appropriate design of clinical trials in this field.