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Many experts maintain that GERD is caused by dysfunction of the gastroesophageal barrier and that gastric acid secretion is not the primary underlying defect. By contrast, a recent study by Reimer and colleagues raises the possibility that increased gastric acid secretion is an important cause of GERD.
Evidence from a recent study strongly implicates innate immunity in the etiology of Crohn's disease, with particular focus on impaired secretion of cytokines and chemokines by intestinal macrophages in response to bacterial stimuli. These findings highlight the importance of acute inflammatory responses in the first stages of disease pathogenesis.
Narrow-band imaging (NBI) is a new imaging modality that may improve the effectiveness of endoscopic surveillance and screening. Two recent studies have compared NBI with white light endoscopy; one study demonstrated no difference in adenoma detection rate between the two imaging modalities, the other study demonstrated improved differentiation of lesions with NBI compared with white light endoscopy.
Chronic alcohol use has been linked to pancreatitis for over a century, but its role in the disease has only been recently elucidated. This Review focuses on what is known from animal models and association studies conducted in humans about the relationship between alcohol consumption, smoking, and chronic pancreatitis. The authors discuss the incidence, pathogenesis and etiology of pancreatitis as well as mechanisms of disease.
Eosinophils are potent innate immune cells that are numerous in the gastrointestinal tract in health and disease. This Review discusses the role of eosinophils in the pathogenesis of numerous disorders of the gastrointestinal tract, including primary eosinophilic gastrointestinal disorders, common functional conditions (such as dyspepsia), and gastrointestinal disorders in patients with allergic disease.
Although the prevalence rates of celiac disease tend to be very similar in different Western populations, mortality rates for this disease vary widely. This Review focuses on the mortality rates for the different forms of celiac disease and potential protective factors, such as adherence to a gluten-free diet, early diagnosis and severity of clinical presentation. The authors also propose a hypothesis that links mortality rates to the amount of gluten consumed not only after but also before the diagnosis of celiac disease.
IBS is thought to be caused by dysfunctions in the gut–brain axis. Low-grade inflammation and immunological alterations may underlie disease symptoms. The authors discuss evidence for a role of innate and adaptive immunity in IBS and the mechanisms by which the immune and neural systems interact in the generation of symptoms.
This article considers the case of a 17-year-old adolescent with a history of Crohn's disease who was receiving infliximab and presented with a new-onset rash. The rash did not resolve with corticosteroid treatment and worsened after further treatment with infliximab and also after subsequent administration of adalimumab. He was diagnosed as having an anti-TNF agent induced psoriasiform rash. The rash resolved after discontinuation of anti-TNF agents and his rash has not recurred during 3 years of follow-up.
