Review Articles in 2008

In the past 15 years there has been continuous improvement in outcome after orthotopic liver transplantation (OLT). As such, the recognition and prevention of long-term post-OLT complications—rejection episodes, recurrence of underlying liver disease and the adverse effects of immunosuppression—have become ever more important. This Review suggests guidelines for the management of OLT recipients to improve long-term survival, overall outcome and health-related quality of life.

Even after complete resection of nonmetastatic pancreatic cancer, recurrence rates are high. Combined modality therapy including radiation therapy reduces the recurrence rate and improves disease-free survival for several types of tumor of the gastrointestinal tract, but the use of adjuvant radiotherapy for pancreatic cancer is controversial. In this Review, the authors discuss the studies—prospective and retrospective—and the issues surrounding the use of adjuvant radiotherapy for pancreatic cancer.

In the past few years, newly developed technologies have improved endoscopic recognition of the duodenum, making possible the real-time recognition of the duodenal villous pattern during upper endoscopy. This Review highlights the progress made that could be helpful for the diagnosis of celiac disease, including the development of the water-immersion technique, high-resolution magnification endoscopy, chromoendoscopy, optical band imaging, optical coherence tomography and confocal endomicroscopy.

Gastrointestinal complications are a common occurrence in patients receiving oncologic therapy. These complications can be severe or even life-threatening and, therefore, require prompt diagnosis and treatment. This Review discusses some of the most common gastrointestinal complications associated with oncologic therapy, including esophagitis, diarrhea, radiation proctitis and drug hepatotoxicity. The diagnosis and symptoms of the complications are discussed, together with current concepts relating to their treatment.

Celiac disease is a common condition and is associated with considerable morbidity and mortality. The incidence of celiac disease is increasing, and a substantial proportion of new diagnoses are in elderly individuals. This Review highlights age-related differences in the clinical presentation, investigation and management of elderly patients suspected of having celiac disease, and emphasizes the need for a greater awareness of this condition in the elderly population.

Dietary treatment for obesity can lead to reasonable weight loss, resulting in associated health benefits. The author of this Review discusses the various types of diet available for the treatment of obesity, their relative efficacies, and associated adverse effects. The author also considers alternative treatment options when dietary strategies fail and discusses the challenges associated with long-term weight maintenance.

Interferon-based therapy is the cornerstone of treatment for chronic hepatitis C; however, many patients do not respond optimally to current treatment regimens. In this Review, the author considers how interferon-based therapy might be tailored to ensure the best chance of achieving a sustained virological response while preventing over-treatment. The potential of alternative treatment options that will most likely be used in combination with interferon, at least initially, is also discussed.

IBS is a common disorder; however, the available treatment options are unsatisfactory for many patients. A considerable percentage of patients with IBS seek advice from practitioners offering complementary and alternative medical approaches. This Review discusses the literature for alternative mind-body interventions for the treatment of IBS, and addresses the potential relationship of these interventions to the biopsychosocial model and IBS.

Infectious diarrhea is a global health issue that affects billions of individuals annually. The diarrheas can be classified as noninflammatory or inflammatory based on their pathogenesis and clinical presentation. This Review presents our current understanding of the pathogenesis and clinical syndromes of infectious diarrheas, including their epidemiology and the various host factors that protect against enteric infection.

Numerous hereditary cancers involve the gastrointestinal tract, and identification of these familial cancer syndromes should improve the detection, diagnosis and management of affected patients. This Review addresses the role of gastroenterologists and genetic counselors in the recognition of hereditary cancer syndromes, and suggests how a partnership between these two professions can influence the management of the patient and their family.

Laparoscopic liver resection (LLR) is a natural extension of minimally invasive surgery. The authors of this Review consider the surgical technique used for LLR, as well as the indications for LLR, before evaluating the short-term and long-term outcomes of LLR by comparing the results of case-matched studies of LLR and open resection for both benign and malignant tumors.

Endoscopic clipping is a safe and effective technique for the treatment of various bleeding gastrointestinal lesions. This Review provides an overview of endoscopic clipping, discussing available clipping devices, basic clipping techniques, applications and efficacy, safety and future prospects. The authors stress that endoscopic identification of lesions that are amenable to clipping and proficiency in clip application are key determinants of a successful outcome.

Postoperative ileus is an undesirable stress response to major abdominal surgery that can cause abdominal pain, postoperative nausea and vomiting, distention, delayed passage of stool and the inability to take in sufficient fluids and solids. In this Review, the author considers the techniques currently available to prevent or reduce the duration of postoperative ileus, including the concept of multimodal postoperative rehabilitation (fast-track surgery).

The incidence and mortality of esophageal cancer have increased over the past two decades. Research into risk factors plus the ability to identify precursor lesions has permitted studies of chemoprevention for esophageal cancer to be performed; however, esophageal cancer continues to have a poor prognosis. In this Review, the authors focus on the epidemiology, risk factors, pathogenesis and prevention of both esophageal squamous cell carcinoma and esophageal adenocarcinoma.

Functional bowel disorders (FBDs) are common disorders that are characterized by various combinations of abdominal pain and/or discomfort, bloating and changes in bowel habits. In this Review, the authors consider the existing literature regarding appropriate diagnostic evaluation of patients with a suspected FBD. The main focus of the Review is on IBS, as this is the FBD for which most information is available.

Gastrointestinal symptoms are extremely common during pregnancy. If symptoms do not respond adequately to lifestyle and dietary changes, drug therapy is often warranted to improve quality of life and prevent complications. Moreover, chronic gastrointestinal diseases can deteriorate during pregnancy and diagnostic and therapeutic approaches need to be adapted. This Review provides an overview of the spectrum and therapy of motility disturbances during pregnancy, and discusses specific aspects of IBD and liver disease.

Leukocytapheresis is a controversial nonpharmacologic treatment for IBD, in which white blood cells—the effector cells of the inflammatory process—are mechanically removed from the circulation. The authors of this Review discuss the rationale behind using leukocytapheresis, how it works in practice, its efficacy in patients with IBD and its current standing within guidelines for the treatment of IBD.

The authors of this Review present what is known about the pathophysiology of increased coagulation in patients with cancer and how it applies to pancreatic carcinoma. The relationship between the activation of coagulation or symptomatic thromboembolic disease and the development of pancreatic carcinoma is explored. In addition, the relationship between thromboembolic disease and prognosis, and the rationale and evidence for the use of anticoagulants in patients with pancreatic carcinoma are considered.

Inborn errors of bile acid synthesis can present as neonatal cholestasis, neurologic disease or fat-soluble-vitamin deficiencies. In this Review, the authors discuss what we now know about the mechanisms underlying these disorders thanks to the application of modern biochemical and molecular techniques, the importance of early diagnosis, and the treatment options currently available.

Heartburn is a challenging clinical symptom to treat as it does not always readily respond to antisecretory therapy. The authors of this Review provide an update on the evidence available to support the mechanisms currently postulated to underlie heartburn: acid reflux, weakly acidic reflux, bile reflux, mechanical stimulation of the esophagus, esophageal hyperalgesia and psychological comorbidity.