Opinion in 2015

Upper gastrointestinal cancer is often missed during examinations and survival outcomes are still poor among patients in the Western world. As discussed in this Perspectives, following the Japanese example, an improved gastroscopy technique, advanced training for endoscopists and optimized screening procedures for risk stratification will be necessary to elicit a change in clinical practice and improve diagnosis and treatment.

Treatment for inflammatory disorders has progressed remarkably since the introduction of highly effective biologic agents. Lessons can be learned from how other clinical specialties use immunomodulatory agents. In this article, Her and Kavanaugh introduce a rheumatology perspective to the management of inflammatory disorders to provide insights that might inform clinical practice in gastroenterology.

As understanding of the gut microbiota advances, the focus has shifted to ways to modulate the microbiota to improve health. One such strategy is the use of prebiotics. Here, Bindels and colleagues challenge the current definition of prebiotics, proposing revisions to the concept in an effort to strengthen the relevance of prebiotics as valuable therapeutic approaches.

The incidence of oesophageal adenocarcinoma has increased over the past four decades and although treatments have improved over this time, survival has not improved substantially. In this Perspectives, Vaughan and Fitzgerald suggest a five-tier strategy for prevention and control that begins with a wide population base and triages individuals into progressively higher risk strata, each with risk-appropriate prevention, screening and treatment options.