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The origin of Barrett oesophagus has been debated for many years, but no consensus has been reached. In this Perspectives article, Stuart McDonald and colleagues look at the Barrett lesion itself: at its phenotype, its complexity, its clonal architecture and its stem cell organization. They conclude that current evidence most strongly supports an origin from stem cells in the cardia.
IBD has emerged as a global disease. Ng and colleagues have identified that some environmental risk factors are shared across the world, whereas others are distinctly unique to individuals living in Asia. This work adds a new clue to the mystery of the environmental determinates of IBD.
Little progress has been made in the pharmacological management of patients with hepatic encephalopathy, partly because it is difficult to perform clinical trials in this group of patients. A new clinical trial now suggests that polyethylene glycol is more effective than the current standard first-line therapy in these patients.
Optimization of biologic therapies in IBD represents an important therapeutic strategy to improve clinical outcomes. Vaughn and colleagues have analysed the long-term benefits of proactive therapeutic concentration monitoring of infliximab in patients with IBD.
Failure to control acute variceal bleeding is a strong predictor of mortality in patients with cirrhosis. Various criteria have been proposed to define failure to control bleeding for use as end points in randomized clinical trials. However, the clinical applicability and validation of these proposed criteria remain unresolved issues.
IBD is known to be associated with an abnormal response to an unbalanced gut microbiota in genetically predisposed individuals. The therapeutic goal now is to control progression of the disease. Given the heterogeneity of IBD, the two universes of basic and clinical science must work in parallel to realize the hope of personalized therapy.
Five of our Advisory Board Members—international experts across different subspecialties—reflect on the progress and frustrations of the past 10 years in gastroenterology and hepatology. They also comment on where effort and money should be invested now, as well as their predictions for progress in the next 10 years.
Polycystic liver diseases are inherited in a dominant or recessive form and result in progressive bile duct dilatation and/or cyst development. Current therapeutic strategies are limited and the only curative option is liver transplantation. This Review discusses the molecular mechanisms that cause polycystic liver diseases and preclinical and clinical studies into new therapeutic targets. The authors also highlight future avenues of research.