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Ursodeoxycholic acid (UDCA) is widely used for the treatment of chronic cholestatic liver diseases. However, a recent randomized, controlled trial has surprisingly shown that the use of high-dose UDCA in patients with primary sclerosing cholangitis (PSC) may be harmful; adverse events, such as death and liver transplantation, were significantly higher in patients who received UDCA compared with placebo.
Some patients who have diverticular disease develop complications or recurrent symptoms and medical therapy may be necessary. Findings from recent studies suggest that rifaximin, a poorly absorbed antibiotic, should be recommended for long-term treatment of diverticular disease; however, the anti-inflammatory drug mesalazine seems to be more promising in the long term.
The role of total pancreatectomy for pancreatic adenocarcinoma is controversial. Concerns have been raised about increased morbidity and mortality, and poorer long-term outcomes associated with total pancreatectomy compared with pancreaticoduodenectomy. Reddy and colleagues recently reported data that support the use of total pancreatectomy, when appropriate, in clinical practice.
A long-term follow-up study used sequential liver biopsy specimens to evaluate fibrosis and signs of steatohepatitis in a large number of severely obese patients undergoing bariatric surgery, and found that bariatric surgery reduces steatosis in most patients. There are some important lessons to be learnt from the findings of this study and some unanswered questions for further investigation.
Two population-based studies highlight the detrimental role of night-time GERD symptoms on sleep quality. The studies reinforce the observation that loss of sleep is associated with night-time GERD symptoms, and that sleep loss from GERD is associated with decreased work production, increased use of health-care resources, and an overall reduction in quality of life for patients.
Weight loss and, even more importantly, weight loss maintenance are required to reduce the health risks associated with obesity. Conservative treatment by lifestyle changes and pharmacotherapy is often unsuccessful in the long-term, and bariatric surgery is only indicated in the very obese. Could intragastric balloon treatment bridge the gap between pharmacotherapy and surgery in patients who fail to respond to drugs?
Variceal rebleeding frequently develops in patients with cirrhosis after an initial episode of acute variceal hemorrhage. The best prophylactic treatment for variceal rebleeding has not been clearly identified. Several studies have been performed to determine an optimal approach but no agreement exists about how best to treat these patients.
