Volume 12 Issue 12, December 2015

Treatment failure associated with HCV resistance to newly developed direct-acting antiviral agents is not an uncommon occurrence and poses a substantial problem to clinicians trying to re-treat patients who have failed available interferon-free treatments. A new study suggests that host-targeted agents are the way forward, but is this approach really feasible?

Colectomy is rightly viewed as a last resort in selected patients with slow-transit constipation. A new study presents US national data that raises new concerns regarding the outcome of this procedure and perhaps questions whether it should be offered at all.

Whereas the status of the liver as privileged and exempt from humoral rejection has fallen, attempts at breaching the blood group barrier during transplantation have continued. Previously restricted to paediatric patients and emergencies, advances in immunosuppression protocols have improved outcomes to the point that ABO-incompatible liver transplantation might be more widely used in adults.

What is in a name; and why does the nomenclature of one disease, primary biliary cirrhosis, cause such contention that a proposed name change by those deeply committed to the advancement of its understanding and management stimulate huge debate?

Hepatocellular carcinoma (HCC) is an antigenic lesion infiltrated by T cells, but factors within the tumour and its microenvironment dampen the immune response and prevent effective antitumour immunity. The stepwise elucidation of the various immunosuppressive mechanisms at play in HCC has exposed new therapeutic options. This Review gives a comprehensive overview of the different immunotherapeutic modalities applicable in HCC, including vaccines, adoptive T-cell therapy, cytokines, gene therapy and immune checkpoint inhibitors.

Leaks are the most common post-operative complication of bariatric surgery; a procedure which is on the rise owing to the increased prevalence of obesity. Pierre Eisendrath and Jacques Deviere discuss the use of endoscopy as a therapeutic approach to resolving these complications, showing that it is a valid alternative to avoid additional surgical procedures.

Traditionally, the diagnosis of hepatorenal syndrome has been based on stringent criteria that are not ideal for patients with cirrhosis and kidney injury, leading to underdiagnosis. Acute kidney injury is now proposed to characterize renal disease in patients with cirrhosis. Florence Wong describes the evolution of these criteria that have addressed this issue and improved care for these patients.

IBD is a chronic, incurable disease and can be a major burden to health-care resources. Moreover, the epidemiology of IBD is changing worldwide. In this Perspectives, Gilaad Kaplan discusses the current global burden of IBD and how this might evolve over the next decade, as well as the challenges that might arise with this changing incidence.