Volume 9 Issue 6, June 2012

A lack of consensus exists on definitions of coeliac disease and related disorders. A paper published in Gut provides guidance to the scientific and clinical community on the terms to be used. However, new nomenclature and different classifications have been proposed in two other publications. Is there a way out of the confusion?

Clostridium difficile infection (CDI) is a common complication of IBD and is associated with disease flare-ups and adverse outcomes. Low levels of serum albumin and haemoglobin alongside high concentrations of serum creatinine predict the need for surgery and risk of death associated with CDI in patients with IBD.

Faecal incontinence can occur in patients who have undergone a colonoscopy. The incidence of postexamination faecal incontinence in a large Norwegian cohort has now been reported, and the risk of faecal incontinence found to be reduced if CO₂ is used instead of air to insufflate the colon.

Evidence has accumulated to show that mucosal healing can alter the course of Crohn's disease. New results from the EXTEND trial clearly demonstrate that adalimumab is able to induce and maintain mucosal healing in Crohn's disease and has the potential for disease modification.

Increased knowledge of the gut microbiota will be key to understanding its role in health and disease. This Review presents the techniques currently used to characterize the gut microbiota. The authors explain the various methods—from culture through to microbiome shotgun sequencing—suggesting when they can be most appropriately applied to human studies, and also critically reviewing their advantages and limitations as a guide to clinicians.

Around 50% of patients with ulcerative colitis who undergo ileal pouch–anal anastomosis develop at least one episode of pouchitis. In this Review, Bo Shen describes the aetiology and pathogenesis of pouchitis, particularly the role of dysbiosis andClostridium difficileinfection. Risk factors, clinical features, disease courses and prognoses of pouchitis are discussed, as well as the diagnosis and management of patients with 'conventional' pouchitis and systemic immune-mediated disorders associated with pouchitis.

Advances in understanding the biology of tumour progression and metastasis have clearly highlighted the importance of aberrant tumour metabolism. Although much progress has been made in understanding the somatic mutations and expression genomics behind these alterations in metabolism, the regulation of these processes by microRNAs (miRNAs) is only beginning to be appreciated. This Review presents a comprehensive summary of current knowledge of miRNA-mediated metabolic regulation in cancer, with a particular focus on pancreatic cancer.

Vitamin B₁₂ functions as an essential coenzyme in humans. The absorption of this molecule and its subsequent distribution in the body is mediated by a complex set of carrier proteins, receptors and transporters. This Review describes basic and clinical features of this multistep pathway with emphasis on the gastrointestinal transport of vitamin B₁₂and its importance in clinical medicine.

Liver transplantation is often used to treat patients with end-stage liver disease as a result of infection with HCV. However, the optimal choice of immunosuppressants in these patients is still undecided. In this article Luc van der Laan and colleagues explore the effect of different immunosuppressants on the complex cellular events involved in HCV infection and interferon signalling.