Opinion in 2011

Pelvic floor dysfunction encompasses a range of symptoms that are presented to specialists across multiple disciplines. In this Perspectives Hans Peter Dietz provides an interdisciplinary overview of imaging pelvic floor dysfunction. Modern pelvic floor imaging techniques, including MRI, defecation proctography and ultrasound are discussed as well as their potential application to improving management of pelvic floor disorders.

Mucins have an important role in protecting the esophagus from the effects of acids, pepsins and other noxious materials. Mucins are altered in patients with GERD, which could be key to the development of new therapeutics. This Perspectives will cover studies about mucin secretion in the esophagus in health and disease states, and its potential role as a protective substance.

Chemoprevention of colorectal cancer (CRC) has been the focus of intensive research for more than two decades. Here, Ricciardiello, Bazzoli and Fogliano discuss the association between fruit and vegetable intake and CRC risk, and the chemopreventive activities of dietary phytochemicals. They argue that a single-agent 'magic' pill for CRC chemoprevention doesn't exist and that consuming a complex mixture of phytochemicals may be the answer.

In this Perspectives, the authors contemplate the identity of the cell of origin for pancreatic ductal adenocarcinoma. They hypothesize that a subset of cells that renew the adult organ physiologically or regenerate it upon severe tissue damage would be more susceptible to oncogenic transformation than mature, differentiated cells. They contend that such a cellular compartment could consist of putative pancreatic stem cells, progenitor cells, facultative stem cells or transdifferentiated bone marrow cells.

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a relatively new, clinically distinct entity, which is being increasingly diagnosed. The publication of international consensus guidelines for the management of IPMN helped to increase the awareness and improve the management of patients with this disease; however, a number of issues still need to be addressed. This Perspectives discusses several of these issues, including the classification of mixed-type IPMNs, criteria for the resection of branch duct IPMNs and surveillance.