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Liver fibrosis is characterized by the excessive deposition of extracellular matrix proteins, and results from chronic liver disease. The most important goal of antifibrotic therapy is to remove the fibrogenic stimulus by treating the underlying etiology of liver disease. The authors of this Viewpoint article discuss the promising targets for antifibrotic therapy that have been identified using animal models of liver fibrosis.
Functional bowel disorders (FBDs) are common disorders that are characterized by various combinations of abdominal pain and/or discomfort, bloating and changes in bowel habits. In this Review, the authors consider the existing literature regarding appropriate diagnostic evaluation of patients with a suspected FBD. The main focus of the Review is on IBS, as this is the FBD for which most information is available.
Leukocytapheresis is a controversial nonpharmacologic treatment for IBD, in which white blood cells—the effector cells of the inflammatory process—are mechanically removed from the circulation. The authors of this Review discuss the rationale behind using leukocytapheresis, how it works in practice, its efficacy in patients with IBD and its current standing within guidelines for the treatment of IBD.
The incidence and mortality of esophageal cancer have increased over the past two decades. Research into risk factors plus the ability to identify precursor lesions has permitted studies of chemoprevention for esophageal cancer to be performed; however, esophageal cancer continues to have a poor prognosis. In this Review, the authors focus on the epidemiology, risk factors, pathogenesis and prevention of both esophageal squamous cell carcinoma and esophageal adenocarcinoma.
This article considers the case of a 19-year-old white woman who presented with a 6-month history of progressively worsening dysphagia. Eosinophilic esophagitis was diagnosed and a PPI and fluticasone propionate prescribed; fluticasone propionate was tapered, but the PPI maintained. When dysphagia returned, fluticasone propionate was restarted, but rapidly progressive dysphagia with severe chest pain and odynophagia developed. A diagnosis of herpes esophagitis with concurrent eosinophilic esophagitis was made, fluticasone propionate treatment immediately discontinued and fluconazole and valaciclovir prescribed.
