The burdens of digestive diseases
Stephen B. Hanauer
p377 | doi:10.1038/nrgastro.2009.104
Table of contents
July 2009 Vol 6 No 7
Editorial
Research Highlights
Liver: Simvastatin might be an effective therapy for portal hypertension in cirrhosis | PDF (181 KB)
p379 | doi:10.1038/nrgastro.2009.96
Hepatitis C: Angiotensin blockade—halting liver fibrosis | PDF (127 KB)
p380 | doi:10.1038/nrgastro.2009.91
Cirrhosis: PPI use is associated with bacterial peritonitis | PDF (69 KB)
p380 | doi:10.1038/nrgastro.2009.98
Targeted therapy proves promising | PDF (50 KB)
p381 | doi:10.1038/nrgastro.2009.76
Celiac disease: Increased celiac disease in IBS | PDF (49 KB)
p381 | doi:10.1038/nrgastro.2009.93
Surgery: Acute appendicitis—antibiotics versus appendicectomy | PDF (51 KB)
p381 | doi:10.1038/nrgastro.2009.95
Large intestine: Exercise decreases risk of diverticular complications | PDF (88 KB)
p382 | doi:10.1038/nrgastro.2009.94
Pancreas: EUS-guided celiac plexus block for pain management | PDF (98 KB)
p382 | doi:10.1038/nrgastro.2009.97
News and Views
Hepatitis: HCV variability, the immune system and resistance to antiviral drugs
Jean-Michel Pawlotsky
p383 | doi:10.1038/nrgastro.2009.102
Several novel antiviral treatments for HCV are in preclinical or clinical development, and most target viral enzymes and their functions. These new drugs all potentially select for resistant viral variants, both in vitro and in vivo; viral resistance is, therefore, likely to become an important issue in clinical practice.
Stomach: Quadruple therapy for Helicobacter pylori eradication
Javier P. Gisbert
p385 | doi:10.1038/nrgastro.2009.101
The low success rates of standard triple-therapy regimens for eradication of Helicobacter pylori infection have led to development of alternative approaches. Findings from a new meta-analysis that compared the efficacy of concomitant quadruple therapy with that of standard triple therapy revealed the concomitant approach to be superior for eradication of H. pylori.
Ulcerative colitis: Natural history—an optimistic message from Norway
Laurent Peyrin-Biroulet & Jean-Frederic Colombel
p387 | doi:10.1038/nrgastro.2009.100
Selection of an optimum treatment regimen for patients with ulcerative colitis depends on several factors, including the natural history of the disease. A new study indicates that prognosis for patients with newly diagnosed ulcerative colitis might not be as bad as typically thought—an important finding that should be taken into account when the risks and benefits of future treatment strategies are discussed.
Surgery: New indications for laparoscopic sigmoidectomy
Badma Bashankaev & Steven D. Wexner
p388 | doi:10.1038/nrgastro.2009.99
Current recommendations for the performance of laparoscopic sigmoidectomy in patients with diverticulitis reserve this procedure for individuals who have complications of the disease or have had numerous, severe disease episodes. Findings from a 2009 study challenge this dogma and suggest that patients' quality of life should also be considered.
Surgery: Laparoscopy for suspected appendicitis
Roland E. Andersson
p390 | doi:10.1038/nrgastro.2009.85
The routine use of diagnostic laparoscopy for young women who present with right iliac fossa pain reduces the rate of negative appendectomy, according to a new study. However, the implementation of laparoscopy as a routine approach for the diagnosis of suspected acute appendicitis would probably increase morbidity and mortality for these patients.
Reviews
Mucosal ablation of Barrett esophagus
Irving Waxman & Vani J. A. Konda
p393 | doi:10.1038/nrgastro.2009.90
Patients with Barrett esophagus and high-grade dysplasia or intramucosal carcinoma have traditionally been managed by esophagectomy. However, the development of endoscopic ablative therapies has changed this management approach. This Review discusses the different endoscopic ablative therapies currently available including tissue-acquiring and non-tissue-acquiring modalities. The success rates and complications of the different techniques are also addressed.
New and experimental therapies for HCV
Arema A. Pereira & Ira M. Jacobson
p403 | doi:10.1038/nrgastro.2009.92
Standard treatment with pegylated interferon and ribavirin only cures just over half of patients with HCV infection. Pereira and Jacobson review the evidence on the efficacy and promise of several specifically targeted antiviral therapies, which, most likely in combination with interferon and ribavirin, may improve the success rate of HCV therapy.
Pancreatic cancer: molecular pathogenesis and new therapeutic targets
Han H. Wong & Nicholas R. Lemoine
p412 | doi:10.1038/nrgastro.2009.89
Pancreatic cancer is lethal and notoriously difficult to treat, therefore, there is an urgent need to develop new therapeutic and diagnostic modalities. This Review discusses the agents that have been developed to target the pathways and processes involved in pancreatic tumorigenesis, and reviews the results of laboratory and clinical trials of these agents. Future therapeutic targets are also discussed.
Targeted therapy for hepatocellular carcinoma
Hans Christian Spangenberg, Robert Thimme & Hubert E. Blum
p423 | doi:10.1038/nrgastro.2009.86
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Treatment options for patients with advanced HCC are limited because of the lack of effective chemotherapeutic agents. This Review discusses the mechanisms of targeted therapies and describes clinical studies that have investigated the safety and efficacy of these therapies in patients with HCC. Perspectives for future developments are also provided.
Case Study
Hepatosplenic T-cell lymphoma in a patient with Crohn's disease
Florian Beigel, Matthias Jürgens, Cornelia Tillack, Marion Subklewe, Doris Mayr, Burkhard Göke, Stephan Brand & Thomas Ochsenkühn
p433 | doi:10.1038/nrgastro.2009.87
This article considers the case of a 58-year-old man who presented with a 35-year history of Crohn's disease, pararectal fistulas and abscess formation. He had been taking azathioprine therapy for approximately 5.5 years. He was started on infliximab; however, his fistulas persisted and the abscess recurred. He was, therefore, switched to adalimumab. After development of pancytopenia, a bone marrow biopsy and a diagnostic splenectomy were performed, leading to a diagnosis of hepatosplenic T-cell lymphoma.
