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In 2012, important advances were made in understanding the pathogenesis of IBD—the Immunochip project increased the number of known IBD loci to 163, and underscored the common susceptibility to infectious diseases. With regard to management of IBD, novel non-anti-TNF agents have shown efficacy in phase II and III trials.
Knowledge of colorectal cancer (CRC) risks has been rebalanced in 2012. The 'serrated pathway' to CRC, exemplified by serrated polyposis syndrome, emphasizes the importance of serrated lesions. The dogma that patients with IBD are at high risk of CRC, however, might be overstated; optimizing CRC prevention needs to focus on patients at increased risk.
Efforts to understand fatty liver disease have focused on the gut microbiome's stimulation of hepatic injury and fibrosis through specialized signalling complexes at the cell surface and in the cytosol of liver cells. Combined with increased hedgehog activity and progenitor cell expansion, new clues are emerging to elucidate the pathogenesis of fibrosis.
New techniques have introduced unprecedented sensitivity to the investigation of the gut microbiota, enabling insights into the discrete contributions of select bacterial species and advancing our mechanistic appreciation of the roles of diet and host immunity in limiting or enabling metabolic and inflammatory disease.
Liver cancer remains an evolving indication for liver transplantation in the year 2012 as advances are made in patient selection, neoadjuvant treatment and living-donor liver transplantation. Patient survival is improving and, as patient selection and treatment advances, more transplantations can be conducted on patients with liver cancer.
With the first HCV protease inhibitors approved in 2011, we are currently in a transition phase towards a shift in treatment paradigm. Within the next 3 years, the vast majority of patients with hepatitis C will probably be treated with completely different drugs in most Western countries.
Ischaemia–reperfusion injury (IRI) in the liver is a major complication of transplantation. This Review outlines our current understanding of the cellular and molecular mechanisms that underlie liver IRI and summarizes the latest progress in large animal models and clinical trials of liver IRI.
The permeability of the intestinal epithelial barrier has a central role in the regulation of fluid and nutrient intake as well as in the control of the passage of pathogens. In this Review, Michel Neunlist and colleagues summarize current studies characterizing neuronal and glial effects on the intestinal epithelial barrier and outline the novel concept of a digestive neuronal–glial–epithelial unit.
Although polycystic liver disease is usually a benign disease, the symptoms can be debilitating in some patients, for whom surgery is an option. This Review discusses the latest advances in the diagnosis and management of polycystic liver disease.
Upper gastrointestinal tract cancers (UGICs) pose a major health risk around the world, and therapeutic improvements have been very slow and small. Increased understanding of the role of microRNAs in UGICs could lead to novel prevention strategies, early detection and improved therapeutics for these cancers.
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.
