Volume 7 Issue 8, August 2010

Surgical repair of complex anal fistulas has to achieve a balance between optimal primary healing and best preservation of continence. As traditional surgical techniques confer a risk of continence deterioration, innovative sphincter-preserving techniques have been introduced. A new study indicates that use of bioprosthetic plugs in the surgical treatment of complex anal fistulas is associated with a long-term success rate of 81%.

An improved understanding of thiopurine metabolism has enabled individualized dosing of these agents in patients with IBD. Ansari et al. describe the use of allopurinol to deliberately manipulate thiopurine metabolism in patients who previously could not tolerate therapeutic doses of azathioprine or 6-mercaptopurine. This therapeutic maneuver potentially enables this therapy to be given to a considerable subgroup of patients otherwise unable to tolerate thiopurine therapies.

The modern colonoscopist faces two problems: identifying all relevant lesions and then making an appropriate risk assessment of the detected lesions. The latter is crucial for determining patient outcome. A feasibility study suggests that a new endomicroscopy technology could greatly improve the detection and assessment of neoplastic colorectal lesions.

In a large, randomized, controlled trial conducted in the UK, screening flexible sigmoidsocopy led to substantial reductions in the incidence of and mortality from distal colorectal cancer. Both fecal occult blood testing and flexible sigmoidoscopy screening are now proven to reduce colorectal cancer mortality.

The field of hepatic fibrosis enjoys remarkable vitality. As a result, we now have a comprehensive and nuanced portrait of fibrosis progression and regression. In this Review, Scott Friedman provides an update on recent advances in our understanding of the pathways of hepatic fibrosis before considering the key challenges that lie ahead when translating these discoveries into new treatments.

The prognosis for locally advanced pancreatic carcinoma remains dismal despite advances in chemotherapy and radiotherapy over the past few decades. The use of radiotherapy for pancreatic carcinoma is often disputed because of the hypothesis that patients with pancreatic cancer die from distant metastases. This Review discusses the data from prospective and retrospective studies evaluating radiotherapy and other treatment options for locally advanced pancreatic carcinoma.

Hepatocellular carcinoma is a global health problem, although developing countries are disproportionally affected. About three-quarters of hepatocellular carcinomas are attributed to chronic HBV and HCV infections. This Review provides an overview of the global variation in hepatocellular carcinoma incidence and etiology, as well as the prevention, screening, diagnosis and treatment of this cancer.

A 72-year-old man was evaluated for dysgeusia, diarrhea and ano-rexia. 3 months earlier he began to experience taste changes, a de-cline in appetite and 3–7 loose, non-bloody stools per day, followed by nausea, lower abdominal cramping and weight loss of 22.68 kg. Cronkhite–Canada syndrome was diagnosed and treatment started with prednisone, a histamine-2-receptor blocker and oral micronutrient supplementation. All visible polyps were removed and subtotal colectomy with end-to-side ileorectostomy per-formed.

The pathophysiology of IBS is poorly understood. Epidemiological studies point to risk factors such as familial clustering, sexual abuse and other forms of childhood trauma, low birth weight and gastrointestinal infection. Epigenetics focuses on the interaction between DNA sequence, DNA modifications and environmental factors to produce a phenotype. In this Perspective, Dinan and colleagues present an epigenetic model of IBS. Applying epigenetic methodology to IBS may help unravel its pathophysiology and lead to more effective treatments.