Review Articles, News & Views, Perspectives, Hypotheses, Analyses and Review in 2009

The treatment of primary sclerosing cholangitis is a major challenge. Complications such as dominant bile duct stenoses and biliary infections are associated with poor outcomes. Data from a new prospective study with a follow-up of 20 years now show that dominant stenosis and fungal, but not bacterial infections reduce survival free of liver transplantation.

The management of chronic anal fissure has received renewed interest and has been re-evaluated over the past 20 years. The use of botulinum toxin seems to be a promising and safe approach, particularly in patients at high risk for incontinence. A recent meta-analysis investigated the efficacy of botulinum toxin injection compared with lateral internal sphincterotomy for the management of this condition.

The Bordeaux group has made major progress in the genotyping and phenotyping of hepatocellular adenomas. Their efforts have allowed the classification of hepatocellular adenomas into subtypes, which enhances our understanding of this benign liver lesion. The clinical relevance of their findings is open to debate.

A Markov model using data from a randomized, controlled trial has demonstrated that laparoscopic fundoplication is a cost-effective intervention for the management of chronic GERD. However, there are some limitations of the model, discussed below, which suggest that the results should be viewed cautiously until longer follow-up is reported.

Endoscopic band ligation (EBL) and nonselective β-blockade are two effective strategies in the primary prevention of variceal bleeding. Meta-analyses have shown an advantage of EBL over propranolol with regard to bleeding rates but not mortality. By contrast, a recent randomized, controlled trial shows less bleeding associated with the use of carvedilol compared with EBL.

A repeat endoscopic evaluation of a bleeding lesion on subsequent follow-up is commonly called second-look endoscopy. Tsoi and colleagues review the findings from five randomized, controlled trials and consider whether second-look endoscopy can be recommended as routine practice, and which groups of patients might benefit most. The cost-effectiveness of second-look endoscopy and the use of PPIs versus second-look endoscopy are also discussed.

Mucosal healing has emerged as an important treatment goal for patients with IBD. This Review article focuses on the definition of mucosal healing, the ability of available IBD medications to induce and maintain mucosal healing, and the influence of mucosal healing on the course of IBD. The article also discusses how best to integrate the treatment end point of mucosal healing into clinical practice for the management of patients with IBD.

Hereditary hemochromatosis, or primary iron overload, is one of the most frequent genetic diseases in the world. This Review describes the regulation of iron metabolism and the inherited mutations that cause hereditary hemochromatosis. The author also discusses inherited and environmental modifiers that affect the severity of the disease.

Intestinal anastomoses are frequently performed to remove tumors or diseased tissue. They have clear benefits but they can also lead to serious complications such as dehiscences and strictures. This Review discusses the surgical techniques, healing factors and perioperative and postoperative strategies to minimize complications when performing anastomoses of the lower gastrointestinal tract.

Stem cells are primitive, relatively unspecialized cells that can self-renew and are multipotent. In this Review, Quante and Wang discuss potential types of stem cells found within the gastrointestinal tract, the susceptibility of these stem cells for malignant transformation, and their potential for use in restoring tissue function to treat gastrointestinal disorders.

Autoimmune hepatitis is an inflammatory liver disease of unknown etiology that predominantly affects females, and requires immunosuppressive treatment. A new study investigates the role of mycophenolate mofetil as a rescue treatment for children with the disease.

IFN-α therapy for hepatitis C is associated with a high prevalence of thyroid dysfunction, which is often irreversible. Two studies have recently investigated the role of HCV, PEG-IFN-α and ribavirin in the development of autoimmune thyroid disorders in patients with hepatitis C on antiviral treatment.

When all state-of-the-art reflux monitoring technologies are available, which should be used for patients who have persistent reflux symptoms despite acid suppressive therapy? A single-center study has investigated this clinical dilemma and provides guidance on the best diagnostic strategy.

Advances in gastroenterology, including the introduction of PPIs, effective therapies for Helicobacter pylori infection, and endoscopic intervention, have promised to improve the incidence and outcomes of gastrointestinal bleeding and perforation. However, have these improvements been borne out in clinical practice?

The etiologies of lower gastrointestinal bleeding (LGIB), defined as bleeding from a colonic or anorectal source, are numerous and varied. LGIB can be acute or chronic; for both types, colonoscopy is the diagnostic and therapeutic procedure of choice. Hemostasis, if not occurring spontaneously, can usually be promoted by embolization or modern endoscopy techniques, and surgery is only undertaken as a last resort.

Osteoporosis is a common complication of chronic liver disease. This Review describes the prevalence and risk factors associated with bone loss in patients with chronic liver disease. New insights into the role of mediators that are involved in orchestrating bone loss in these patients are also discussed.

Pancreatic cancer, although infrequent, has an extremely high mortality rate. The epidemiologic features of this rare cancer are still poorly known. In this Review Raimondi and colleagues discuss the environmental, lifestyle and genetic factors that increase or decrease the probability of developing pancreatic cancer and that may explain the different incidence rates observed in distinct subpopulations.

Patients with end-stage liver disease often experience disease progression and develop complications while waiting for a liver transplant. Prevention and management of these complications is, therefore, paramount to ensure that the patients can remain on the waiting list and have the greatest chance of a successful outcome following transplantation.

Whether a midline or transverse incision is used in abdominal surgery depends mainly on the disease, anatomy and potential effects on wound healing, pain and postoperative complications. Decisions can, however, be based on a surgeon's experience and preference, as the procedures' respective benefits remain to be clearly delineated.

A new study has found undetectable serum levels of HBV DNA at week 24 of treatment to be the strongest predictor of optimal outcomes for patients with chronic HBV infection. Although this finding is not surprising, it has important implications for those patients on antiviral therapy who do not achieve a favorable response.