Reviews & Analysis

Potent nucleoside and nucleotide analogs might replace hepatitis B immunoglobulin (HBIG) to prevent HBV recurrence after liver transplantation in HBV-related liver disease. Two studies, however, suggest that viral load before transplant, and not the HBIG regimen, is the strongest risk factor for HBV recurrence.

The role of microbiological analysis of bile from patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is unclear. Although the majority of such patients have positive cultures, only a few develop postprocedural bacteremia or fever. Microbiological bile analysis might, however, have a role in patients with complications of orthotopic liver transplantation and those in whom adequate biliary drainage has not been achieved.

Assessment and uptake of hepatitis C treatment among injection drug users with HCV infection remains low, partly due to concerns regarding poor adherence and response to therapy. Findings from a large, prospective study demonstrate comparable adherence and response to hepatitis C treatment among nondrug users, former drug users and active drug users.

Nonselective β-blockers are often used in patients with cirrhosis and esophageal varices to prevent variceal bleeding. A recent study has suggested that nonselective β-blockers promote more harm than benefit in patients who have cirrhosis and refractory ascites. The authors of the study suggest that these drugs should be contraindicated in these patients.

Gastric polyps are a heterogeneous group of lesions that have differing consequences for patients, particularly in terms of malignant potential. However, there is currently no consensus for the management of patients with these polyps. The British Society of Gastroenterology has, therefore, published objective management guidelines for patients with these lesions.

Epstein–Barr virus (EBV) infection with gastrointestinal tract involvement is extremely rare in immunocompetent adults. This Case Study describes an immunocompetent 30-year-old man who presented with several months of bloody diarrhea and cramping abdominal pain, suggestive of IBD. However, viral serologic tests confirmed acute EBV infection, and EBV-associated lymphoproliferative disorder of B-cell lineage with diffuse colonic involvement was diagnosed.

Clostridium difficileis as an important health-care-associated pathogen and is linked to significant morbidity, economic burden, and even mortality. A dramatic rise in the incidence ofC. difficileinfections has occurred over the past decade and new at-risk populations are emerging. This Review discusses recent changes in the epidemiology of CDI and its risk factors, examines the evidence behind various treatment regimens and management strategies and suggests measures for infection control.

Nonalcoholic fatty liver disease (NAFLD) and/or nonalcoholic steatohepatits can take decades to evolve and progress, which limits the quality of longitudinal data. Researchers have, therefore, turned their attention to the development of suitable animal models to test the role of molecules and molecular pathways in the progression of fatty liver formation. This Review discusses the benchmark animal models that recapitulate the pathology and metabolic dysfunction associated with NALFD.

Epiploic appendagitis is a very rare condition that results from inflammation of an epiploic appendage in the colon. Gastroenterologists and all medical personnel should be aware of this condition, which mimics many other intra-abdominal acute and subacute conditions. In this Review article, Schnedl and colleagues discuss the clinical findings epiploic appendagitis, its pathophysiology, diagnosis, and treatment.

Pancreatic cancer is a highly aggressive malignancy, which is partly attributable to drug resistance. This Review summarizes the current knowledge of the biological significance of the epithelial–mesenchymal transition, cancer stem cells and microRNAs in the context of drug resistance in patients with pancreatic cancer and describes how this knowledge could be applied to overcoming chemoresistance in pancreatic cancer.

This article discusses the case of a 63-year-old woman who presented with dysphagia 27 years after she received radiation therapy for Hodgkin disease. She was diagnosed with a large tracheoesophageal fistula and poorly differentiated squamous cell carcinoma of the esophagus. The authors describe, for the first time, successful surgical management of this complex clinical condition.

The latest genome-wide association studies in large cohorts of patients with a range of liver diseases have provided new insights into the pathophysiology of these illnesses. This Review outlines the role of genetic testing in monogenic liver diseases, compiles the results of genome-wide association studies in hepatology and discusses new concepts in the genetics of liver diseases in general.

The gut microbiota is implicated in the etiology of nonalcoholic fatty liver disease (NAFLD) as well as progression to the more severe nonalcoholic steatohepatitis. Evidence supporting this role is mainly from animal models, although data from human studies are also emerging. In this Review, the authors provide an overview of the gut–liver interactions that contribute to the pathogenesis of NAFLD and propose that modification of the gut microbiota by prebiotics or probiotics could be a potentially important therapeutic strategy.

Organ allocation policies have evolved over the past 20 years, particularly with the adoption of mathematical models into clinical practice. There are three possible policies for prioritization for liver transplantation: medical urgency, utility and transplant benefit. The transplant community has still not devised the optimal allocation system for liver transplantation—this Review summarizes the advantages and limitations of the current systems.

Surgical complications are a major cause of avoidable medical mistakes, and might occur more frequently when surgery is performed at night. In a recent study, Lonze et al. found that patients who underwent liver transplantation surgery at night had a longer operative time and a greater risk of early death than those who underwent surgery during the day.

Hyperplastic polyposis syndrome is a widely accepted, but poorly understood, risk factor for colorectal cancer. A recent report has laid the foundations for improving the management of patients with this enigmatic disorder by identifying the features associated with colorectal cancer risk, as well as estimating the magnitude of this risk.

A study by Lebrec and colleagues suggests that, despite having no effect on short-term mortality, pentoxifylline, an inhibitor of tumor necrosis factor, reduces the risk of liver-related complications in patients with advanced Child–Turcotte–Pugh class C cirrhosis.

Chemokines regulate the migration of immune cells into the liver in response to acute and chronic injuries and also have roles in stellate cell activation, hepatocyte proliferation and angiogenesis. In this Review, the authors describe experimental liver disease models in which chemokines and chemokine receptors have been studied, and highlight agents that are currently under clinical investigation for use in human diseases.

A 37-year-old female was given esomeprazole to treat reflux-like dyspeptic symptoms ∼3 years after undergoing surgery for a neuroendocrine pancreatic neoplasm. During esomeprazole treatment, her serum chromogranin A level rose to around three times the upper limit of normal, but her gastrin levels remained in the normal range. Relapse of the neuroendocrine tumor was suspected; however, investigations led to a diagnosis of esomeprazole-induced hyperchromograninemia in the absence of elevated levels of fasting serum gastrin.

Helicobacter pylorihas an essential role in the development of various gastroduodenal diseases, but only a small proportion of people infected withH. pylori develop these diseases. In this Review, Yoshio Yamaoka discusses current knowledge of the H. pylorivirulence factors CagA, VacA, OipA and DupA. In particular, he considers how these virulence factors contribute to differing geographic gastric cancer disease patterns and to the development of both gastric cancer and duodenal ulcer.