Review Articles, News & Views, Perspectives, Hypotheses, Analyses and Review in 2013

Cannabis (or marijuana) has been used in traditional medicine to treat intestinal inflammation. A survey by Ravikoff Allegretti et al. at a specialized IBD clinic shows that, in the USA, marijuana is used by a substantial number of patients with IBD to alleviate their symptoms.

Factors associated with ageing, such as comorbidities, polypharmacy and diminished physical reserve, can affect the natural history of IBD. This Review highlights how these age-associated variables can affect older patients with IBD and also illustrates the multiple gaps in our current knowledge of IBD in the elderly.

Helicobacter pyloriinfection has been associated with multiple diseases, including cardiovascular disease and hepatobiliary diseases, localized outside of the stomach, especially those characterized by a persistent and low-grade systemic inflammation. Here, the authors describe the most important studies published so far about a possible role ofH. pyloriin non-gastrointestinal diseases.

IBD is a chronic disorder with disease onset ranging from early childhood to beyond the sixth decade of life. This Review provides an overview of the differences in epidemiology, clinical characteristics, and natural history of paediatric, adult, and elderly-onset IBD. In addition, potential differences in host–gene–microbial interactions according to age are highlighted.

We are moving towards an era of disease categorization beyond Crohn's disease and ulcerative colitis to a more robust definition of a spectrum of IBD subtypes. This Review outlines some of the genetic, clinical, biochemical, serological, and microbiome data that could be used for risk stratification and treatment selection in clinically meaningful subgroups of patients.

Targeting angiogenesis has not been successful as a treatment for pancreatic cancer. Studies using monoclonal antibodies or small molecule inhibitors of the VEGFR pathway have failed to demonstrate benefit. Now, a phase II study has shown that sorafenib does not improve the efficacy of gemcitabine plus cisplatin chemotherapy in patients with locally advanced or metastatic pancreatic adenocarcinoma.

Perinatal transmission of HCV is the main route of acquisition of HCV infection in children. Few studies have explored the mechanism of perinatal transmission, but a key role in transmission has been attributed to maternal viraemia. A new study now provides insights on the biological basis of this association.

Endoscopic assessment in IBD provides direct visualization of the affected bowel mucosa. There is an important need for the meaningful measurement of these endoscopic images at the correct time point for medical decision-making and for clinical trials. European guidelines on endoscopy in IBD have recently been published.

Here, Nathalie Rommel, Jan Tack and colleagues provide an overview of the extensive literature concerning globus and discuss the quality of the evidence to date. They also put forward a potential theoretical model to support management and future research in globus.

This Review presents the emerging surgical therapies available to treat patients with faecal incontinence. These techniques include neuromodulation, neosphincter creation (muscle or artificial) and injection therapy. The need for further research and development—not only in terms of the devices and procedures, but also to identify which patients are likely to benefit most from such interventions—is also highlighted.

Cholera is a public health problem worldwide, with prevalence increasing over the past decade. A safe and affordable oral cholera vaccine is now available, and a study in Guinea has demonstrated that a cholera vaccination programme can be conducted with success in high-risk areas at the beginning of a cholera epidemic.

Patients chronically infected with HBV are at risk of HBV reactivation if immunosuppressive therapies are initiated. In this Review, Hwang and Lok describe the clinical manifestations, incidence and risk factors associated with HBV reactivation during immunosuppression. Practical insights into the management of patients with HBV who require immunosuppressive therapy are also provided.

Cardiac dysfunction has been reported in patients with cirrhosis—nearly half of whom have been shown to have abnormalities in cardiac function—and improved understanding of these changes has led to the definition of so-called cirrhotic cardiomyopathy. Here, the authors describe the underlying pathophysiology, clinical features, diagnosis and treatment of cirrhotic cardiomyopathy.

Reports from a large, prospective study in paediatric patients suggest that oesophagogastroduodenoscopy is valuable for diagnosis in children with chronic abdominal pain. Nonetheless, the vast majority of children with chronic abdominal pain will have a functional gastrointestinal disorder, and no test is needed to achieve this diagnosis.

Minimal access surgery (MAS) is widely used for colon cancer, but its use for rectal cancer remains limited owing to issues with technical feasibility and oncologic outcomes. In this Review, the current evidence in support of laparoscopic and robotic total mesorectal excision for rectal cancer resection is presented. Other MAS approaches, including transanal endoscopic microsurgery and natural orifice transluminal endoscopic surgery, are also discussed.

In this Review—intended as an introduction to the topic of hepatic autophagy for clinical scientists—the authors describe the different types of hepatic autophagy, their role in maintaining homeostasis in a healthy liver and the contribution of autophagic malfunction to liver disease.

This Review describes advances in artificial and bioartificial liver support systems and current developments. The evolving field of hepatocyte transplantation as a less invasive alternative to whole-organ transplantation is also reviewed, and a detailed overview of cutting-edge hepatic tissue engineering is included. Challenges and opportunities of the different approaches are analysed with respect to clinical relevance, as well as basic science concerns.

The standard treatment for stage III rectal cancer is chemoradiation followed by radical surgery. Recent trials have recommended a 'watch and wait' approach for patients who achieve a complete clinical response. A new study reports that 51% of patients who achieved a sustained complete clinical response did not require radical surgery.

Much understanding of IBD pathology is based on personal experience, anecdotal observations and small case studies. A paper on the histopathology of IBD provides an exhaustive literature review, and attempts to delineate guidelines for pathologists to use by providing evidence for consensus statements developed by a European contingent of gastrointestinal pathologists and clinicians.

Advances in 3D printing techniques are gathering pace. With regard to living donor liver transplantation (LDLT), 3D printing could enable accurate assessment of liver volume and accurate visualization of liver anatomy, and could be particularly helpful for paediatric LDLT.