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The advent of CT colonography (CTC) for colorectal cancer screen-ing has generated the need for conservative policies for post-test colonoscopy referral. This Perspectives summarizes the evidence on the natural history and management of subcentimetric colorectal polyps, and suggests a patient-tailored approach when these lesions are detected by CTC in a screening setting.
Patients with IBD who are reportedly in remission, but continue to have symptoms of abdominal discomfort and bowel dysfunction, could have IBS in addition to IBD. This Perspectives article examines the relationship between IBS and IBD, and discusses how to diagnose and treat IBS in patients with co-existing IBD.
Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world, yet consensus is lacking on whether to treat patients with resection or transplantation. In this Perspectives, Sheung Tat Fan discusses the treatment outcome of HCC by transplantation or resection and the future development of surgical treatment of HCC.
The changing composition of the human microbiota is linked with alterations in human behaviour and the rising prevalence of immunoallergic and metabolic disorders. In this article, Fergus Shanahan discusses the clinical implications of advances in human microbial ecology; the lessons learned extend beyond the gut and are germane to all clinical specialities.
Whole-organ tissue engineering could help address the shortage of donor livers by using damaged organs that would otherwise be rejected for transplantation. In this Perspectives article, Uygun and colleagues outline progress in the decellularization and recellularization of damaged livers and describe the next steps needed for whole-organ tissue engineering to be applied in a clinical setting.
Personalized medicine is a new framework for medical care that involves modelling and simulation of a disease on the basis of underlying mechanisms. In this article, David Whitcomb uses chronic pancreatitis and an example to outline the limitations of the 20thcentury framework for medical care and examines the advantages of personalized medicine.
Liver transplantation is often used to treat patients with end-stage liver disease as a result of infection with HCV. However, the optimal choice of immunosuppressants in these patients is still undecided. In this article Luc van der Laan and colleagues explore the effect of different immunosuppressants on the complex cellular events involved in HCV infection and interferon signalling.
Gluten sensitivity is an emerging entity that is becoming increasingly common; however, little is known about its pathogenesis. Here, Umberto Volta and Roberto De Giorgio discuss the current knowledge of gluten sensitivity and define its pathogenetic, clinical and diagnostic criteria. They aim to provide a practical appraisal of gluten sensitivity that is useful for doctors and researchers in the diagnosis and appropriate management of patients with gluten sensitivity.
This Perspectives describes the characteristics of stem and progenitor cells in the liver, biliary tree and pancreas. A hypothetical model of maturational cell lineages is presented, highlighting the common embryological origin of these organs. The potential of these stem and progenitor cells in regenerative medicine is discussed, along with their role in the pathophysiology and oncogenesis of midgut organs.
