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Evidence-based guidelines from wealthy countries define optimum goals for resource-constrained countries. This Viewpoint article discusses how health-care policy in developing countries can only be influenced through local involvement in the construction and implementation of guidelines. The authors also discuss the potential yet controversial role of the biomedical industry in facilitating the development and dissemination of global guidelines.
The author of this Review considers the modalities available for the treatment of dysphagia in patients with malignant or benign esophageal strictures. State-of-the-art techniques, such as stent placement for malignant strictures and dilation therapy for benign strictures, are discussed, as are new developments, such as brachytherapy for malignant strictures. New indications, such as stent placement and incisional therapy for refractory benign strictures, are also considered.
The idiopathic inflammatory bowel diseases remain a vexing diagnostic challenge for clinicians. There have, however, been advances in the imaging modalities available for the diagnosis of IBD and the assessment of disease activity. In this Review, the authors discuss the new imaging techniques available—abdominal ultrasound, MRI, CT, capsule endoscopy and double-balloon endoscopy—and how they compare with each other and with more traditional diagnostic modalities.
Patients with diabetes often have gastrointestinal symptoms, but the extent and severity of this problem and the specificity of the symptoms experienced are not nearly as well defined as generally assumed. The authors of this Review examine the frequency and type of gastrointestinal symptoms experienced by patients with diabetes, review the underlying pathophysiology of these gastrointestinal complications and consider the therapeutic options available.
This Case Study describes a 47-year-old woman who was treated with indomethacin for osteoarthritis-related hip pain. Soon after beginning treatment she developed nausea, vomiting, abdominal pain, dark urine and jaundice. Despite discontinuing all medications, her symptoms worsened. Treatment with prednisone 40 mg/day was initially successful, but after tapering (over 18 months) and then discontinuing prednisone her liver chemistry test results worsened and a liver biopsy showed evidence of chronic hepatitis.
