Volume 9 Issue 9, September 2012

Transjugular liver biopsy (TJLB) has an advantage over percutaneous liver biopsy (PLB) in that Glisson's capsule is not penetrated, enabling multiple passes without increasing the risk of complications. A new prospective study shows that TJLB is a safe alternative to PLB for obtaining samples of adequate size and quality to assess liver histology.

Immunization against HBV has now been integrated into the WHO Expanded Programme on Immunization throughout the world. The reduction in chronic carriage rates in children from 10% to 0.9% over 25 years in Taiwan raises the exciting possibility that HBV could be targeted for eradication, but is vaccination alone sufficient to eliminate the infection?

Given the early onset of ulcerative colitis in children, it is desirable to identify young patients with this disease who are at risk of adverse outcomes. Identification of these patients would enable the introduction of disease-modifying therapies early in the disease course and thus prevent the need for surgical therapy.

Anti-TNF antibodies have acquired a prominent place in the management of IBD. However, with increasing use of these agents, paradoxical adverse effects involving the skin, joints and lungs have been reported. The authors review the paradoxical inflammation induced by anti-TNF agents in patients with IBD, provide hypotheses for the occurrence of this paradoxical inflammation and give practical advice on how to manage these patients.

Colonic gases are integral to digestion, with changes in the volume and composition of these gases linked to bowel disorders. In this Review, the authors provide a comprehensive discussion of the clinical importance of colonic gases in health and disease, describing the microbes involved in production and utilization of these gases and the types of gastrointestinal diseases linked to them.

Endoscopic submucosal dissection (ESD) enables en bloc complete resection of superficial gastrointestinal neoplasms regardless of the size and location of the lesions. Although a high level of skill is required, oesophageal and gastric ESD are recognized as established therapeutic procedures in Japan, and colorectal ESD is also becoming popular. With the development of suitable devices for improvement of techniques, ESD should become an established procedure in many other countries as well.

Hepatocellular carcinoma (HCC) is the fifth most commonly occurring cancer and the third most common cause of cancer-related deaths, and the incidence of this cancer is increasing. A substantial portion of HCCs are thought to arise from hepatic stem cells. In this Review, Lopa Mishra and colleagues describe TGF-β signalling in liver stem cell niches, and examine the roles of this cytokine including those in tumour progression and suppression. Important translational studies that are needed to develop novel therapies are discussed.

Hepatopulmonary syndrome (HPS), characterized by dyspnoea and hypoxaemia, is a serious condition that commonly occurs in patients with cirrhosis and, as outlined in this Review, can influence survival and candidacy for liver transplantation. Here, Zhang and Fallon provide an update on the clinical features of HPS, describing the pathophysiology and pathogenesis, diagnosis and management of this condition.

Some studies have cast doubt on the effectiveness of colonoscopy at reducing the incidence and mortality of proximal colorectal cancer (CRC), as relatively high incidence rates of these cancers are found after colonoscopy—referred to as interval cancers. In this article, the current literature regarding the incidence of, and potential explanations for, interval CRCs is outlined. Piecing together the most common technical and biological explanations could provide important feedback for the medical community.