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The treatment of idiopathic acute pancreatitis is challenging owing to its varied etiology. This Viewpoint discusses the use of empiric cholecystectomy as a definitive treatment option for idiopathic acute pancreatitis caused by occult gallstone disease, and compares cholecystectomy with other treatment options including biliary sphincterotomy and medical therapy with ursodeoxycholic acid.
Intestinal detoxification and defense systems are important for maintaining normal gut physiology. This Viewpoint presents the concept that inflammatory bowel disease might be caused by a defective mucosal detoxification system. Polymorphisms in detoxification genes and related endobiotic plasma biomarkers might both support diagnosis, stratification and therapy in patients with inflammatory bowel disease.
This Review considers the pathophysiologic basis for transjugular intrahepatic portosystemic shunt (TIPS) placement in cirrhotic patients with refractory ascites. The effect of TIPS placement on hemodynamics and sodium retention is discussed, along with how TIPS placement compares with large-volume paracentesis–the standard therapy for refractory ascites. Disadvantages of the procedure, predicting mortality after TIPS placement, candidate selection and monitoring after TIPS placement are also covered.
In the past few years, data obtained from work in animal models, human genetics, basic science and clinical trials, has provided new insights into the mechanisms underlying Crohn's disease and ulcerative colitis. In this review, the author discusses the evidence underlying the disparate theories on the pathogenesis of these diseases and attempts to reconcile them into a coherent hypothesis based on the experimental data.