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This Case Study describes a 17-year-old boy who presented with sudden onset of visual impairment, identified as bilateral anterior uveitis by an ophthalmologist. The patient was diagnosed with multifocal Crohn's disease, involving the terminal ileum, cecum, stomach and duodenum. The authors discuss the importance of rapid evaluation of extraintestinal manifestations of Crohn's disease.
Medical therapy for GERD has improved remarkably since the introduction of PPIs; however, despite twice-daily dosing of PPIs, reflux symptoms can persist, new symptoms can occur or be unmasked, and esophagitis can fail to heal. Management of such 'refractory' GERD can be a challenge. The author of this Review considers the diagnostic approach to refractory GERD and the diagnoses that are possible.
Minimal hepatic encephalopathy (MHE)—the mild cognitive impairment commonly seen in patients who have cirrhosis—has a significant impact on quality of life. Current understanding is that MHE forms part of the spectrum of hepatic encephalopathy, although this remains to be proven. This Review focuses on the pathogenesis and neuropsychological findings of MHE, the effect of MHE on quality of life and survival, and treatment options.