News & Views in 2015

The interval colorectal cancer rate is a robust indicator of the quality and effectiveness of a screening programme, enabling the identification of unmet requirements and development of specific strategies to resolve them. A recent study demonstrated the use of interval cancer as an indicator to target quality improvement of colonoscopy in a screening programme.

For many patients with Hirschsprung disease, the underlying pathogenic mechanisms are unknown. A new study using a novel line of transgenic mice and tissue from patients with Hirschsprung disease suggests that overproduction of collagen VI could contribute to pathogenesis and the increased incidence of Hirschsprung disease in patients with Down syndrome.

Spondyloarthritis (SpA) is the most common extraintestinal manifestation of IBD. SpA symptoms are not always recognized in patients with IBD. Subsequently, patients with symptoms of SpA can be underdiagnosed, with effective treatment delayed. Cooperation between gastroenterologists and rheumatologists is necessary and, ideally, an integrated management of these patients should be adopted.

Colectomy is rightly viewed as a last resort in selected patients with slow-transit constipation. A new study presents US national data that raises new concerns regarding the outcome of this procedure and perhaps questions whether it should be offered at all.

Whereas the status of the liver as privileged and exempt from humoral rejection has fallen, attempts at breaching the blood group barrier during transplantation have continued. Previously restricted to paediatric patients and emergencies, advances in immunosuppression protocols have improved outcomes to the point that ABO-incompatible liver transplantation might be more widely used in adults.

What is in a name; and why does the nomenclature of one disease, primary biliary cirrhosis, cause such contention that a proposed name change by those deeply committed to the advancement of its understanding and management stimulate huge debate?

Treatment failure associated with HCV resistance to newly developed direct-acting antiviral agents is not an uncommon occurrence and poses a substantial problem to clinicians trying to re-treat patients who have failed available interferon-free treatments. A new study suggests that host-targeted agents are the way forward, but is this approach really feasible?

Rationing of livers for transplantation is a difficult problem especially when creation of national policies is needed. Italy recently convened a national consensus conference to decide who should be first in line.

Despite some advances in our understanding of the molecular characteristics of pancreatic cancer, much more progress is needed. In a new study, RNA profiling of pancreatic cancers was used to identify gene signatures of tumour cells and stromal cells to help predict patient outcomes.

Despite advances in hepatitis C treatment, substantial clinical hurdles remain to achieve universal cure and global control of infection. Saeed et al. identified SEC14L2 as a host factor permitting replication of clinical HCV isolates in cell culture, providing a novel system to model infection of patient-derived viruses.

Bipotential hepatic progenitor cells (HPCs) are recognized as making modest contributions to hepatocyte regeneration, though never credited with major liver repopulation. A new study in mice demonstrates HPCs can make a massive contribution to hepatocyte replacement, suggesting HPCs have the potential to be an effective cell therapy for liver failure.

Liver transplantations for patients who are co-infected with HIV and HCV have always posed a challenge and still do, according to the results of a new study. This article discusses the factors that contribute to an increased risk of poor transplantation outcomes and how new treatment options might affect patient survival.

A global consensus report on Helicobacter pylori gastritis has been developed. Topics discussed include whether dyspepsia caused by H. pylori infection is separate from functional dyspepsia or not, the evaluation method for H. pylori-induced gastritis, eradication therapy for H. pylori gastritis to prevent gastric carcinogenesis and management after H. pylori eradication.

Early detection of colorectal lesions is the cornerstone of cancer prevention. Intravenous administration of a novel fluorescent peptide probe now enables the screening of the whole colorectal area using near-infrared fluorescence colonoscopy, an approach that was documented as safe, well-tolerated and specific in its detection of colorectal polyps.

HBV persists by depositing covalently closed circular DNA (cccDNA) into the nucleus of infected host cells. HBV X protein (HBx) is a crucial determinant for regulating HBV activity, but the molecular details have not been fully understood. A new role for HBx in regulating cccDNA transcription has now been identified.

Modulation of the gut microbiota is one of the promising tools to tackle obesity. Chang and colleagues have recently shown that an extract of the mushroom Ganoderma lucidum, a traditional remedy in Asia, can reduce obesity in mice by modulating the gut microbiota, thereby exerting a prebiotic effect.

Measurements of liver copper content are considered the gold standard for diagnosis of Wilson disease. New evidence shows that a reduction of the diagnostic threshold indicative for Wilson disease potentially improves diagnostic accuracy.

The role of the gut microbiota in brain development and behaviour is emerging. New research demonstrates that maturation and activation of microglia are regulated by the gut microbiota, providing more evidence for the link between the microbiota and brain health.

Coeliac disease is an immune-mediated enteropathy induced by gluten. Generation of gluten-specific CD4⁺ T cells is necessary but not sufficient to induce overt disease. Now, epithelial stress has been proposed as a distinct factor that synergizes with the anti-gluten adaptive immune response to induce intraepithelial lymphocyte activation and tissue damage.

Restrictive transfusion strategy saves blood and is safe in most clinical settings, including gastrointestinal bleeding. However, generalizability of a restrictive transfusion approach in acute gastrointestinal bleeding remains controversial as it often affects elderly patients with major cardiovascular comorbidity who have been excluded from existing trials.