Volume 9 Issue 4, April 2012

The early stages of chronic pancreatitis are characterized by frequent painful episodes, which usually disappear over time. Currently, endoscopy is a bridge to surgery for patients who are in a critical condition and cannot immediately undergo surgery. Surgery in carefully selected patients remains the best approach to treating chronic pancreatitis.

Predicting outcome in acute liver failure (ALF) of any kind is difficult and frustrating. To date, no clinical or biochemical combination of markers has proved to be of much value, owing primarily to lack of sensitivity when measured against the actual outcomes observed. Cholongitas et al. investigated four readily available prognostic scores in the setting of acetaminophen-induced ALF.

The management of localized gastric cancer has evolved globally to region-specific approaches with little convergence. The unifying theme, however, is that surgery alone is insufficient for best outcomes, and adjunctive therapy must be offered. Multidisciplinary evaluation before therapy is highly recommended, but postoperative approaches are not conducive to this scenario.

A recent study demonstrates that concurrent flexible sigmoidoscopy in conjunction with CT colonography (CTC) does not improve the diagnostic yield for left-sided colorectal neoplasia compared with CTC alone. This study provides further evidence that CTC is not only more sensitive than the double contrast barium enema, but could be superior to endoscopy for initial evaluation.

Falls in cirrhosis may result from decreased muscle strength, unsuspected subcortical pathologies or psychoactive medications. Results of a prospective study reveal that cognitive dysfunction assessed by psychometric testing predicts the risk of falls in patients with cirrhosis. Early screening and effective preventive measures are required to limit the costs of falls in this population of patients.

Although pancreatic neuroendocrine tumors (PanNETs) have long been considered benign tumors, they in fact have considerable malignant potential. This Review outlines the clinicopathological features of PanNETs and the latest advances in our knowledge of the biology of these tumors. The authors also outline how mutational analysis will affect personalized therapy and discuss the approved new targeted agents tailored specifically towards PanNETs.

Microscopic colitis—characterized by watery diarrhea, normal findings on endoscopy and characteristic findings on microscopy—is being increasingly diagnosed. An accurate pathological diagnosis of this disease is important to differentiate microscopic colitis from disease mimics. In this Review, Chetty and Govender provide an overview of the key features of microscopic colitis, describing the different subtypes, etiopathogenesis, pathology and treatment.

The gastrointestinal microbiota has come to the fore in the search for the causes of IBD. Microbial diversity studies have continually demonstrated an expansion of the Proteobacteria phylum in patients with IBD. In this Review, the authors comprehensively describe the various associations of Proteobacteria and IBD. They postulate that Proteobacteria with adherent and invasive properties might exploit host defenses, drive proinflammatory change, alter the intestinal microbiota in favor of dysbiosis and ultimately lead to the development of IBD.

This Perspectives describes the characteristics of stem and progenitor cells in the liver, biliary tree and pancreas. A hypothetical model of maturational cell lineages is presented, highlighting the common embryological origin of these organs. The potential of these stem and progenitor cells in regenerative medicine is discussed, along with their role in the pathophysiology and oncogenesis of midgut organs.