News & Views in 2014

Treatment of patients with steroid-refractory ulcerative colitis is still a challenge for physicians. A recent study has evaluated the effectiveness and safety of sequential rescue therapies in this subgroup of patients.

The presence of ductal abnormalities after an unexplained acute attack of acute pancreatitis or in patients with recurrent acute pancreatitis might lead to a misdiagnosis of chronic pancreatitis or complications of acute pancreatitis. A new study suggests secretin administered during magnetic resonance cholangiopancreatography (MRCP) leads to a better diagnostic yield than MRCP alone.

A new study suggests that co-prescription of low-dose aspirin and PPIs increases the incidence of small-bowel mucosal breaks. Should we be concerned about the potential negative interactions of these drugs? Or is the balance of evidence still substantially tipped towards the need for PPIs to protect against aspirin-induced upper gastrointestinal damage?

Placebo analgesia is increasingly appreciated in many difficult to treat chronic functional gastrointestinal disorders such as IBS. However, investigations of interactions between psychological and biological placebo factors are still in early stages. Now, technologies have been developed that enable neural mechanisms of placebo analgesia to be studied more directly in humans.

The majority of patients with coeliac disease are undiagnosed, leading to debate about the utility of screening. The heterogeneous clinical presentation, which includes asymptomatic forms, can partially explain the difficulties faced when identifying coeliac disease. Now, Kurppa and colleagues add another element to the debate by strengthening the arguments for general screening.

Patients with noncoeliac gluten sensitivity (NCGS) can experience a range of gastrointestinal and extraintestinal symptoms. A study has now demonstrated that gluten is independently associated with depression in patients with NCGS. NCGS-associated depression might share similar pathophysiological mechanisms to other neurological manifestations observed in gluten-related disorders, such as ataxia and encephalopathy.

Predicting outcomes in upper gastrointestinal bleeding (UGIB) is important for identifying patients at high risk of morbidity and mortality who would benefit from early intervention. Various scoring systems have been developed to this end, but could clinical judgment replace or complement these risk stratification scores?

Increased gastro-oesophageal reflux (GER) is described as a very common problem in infants. Loots et al. investigated the effect of the left lateral position on reflux and symptoms, finding that body position affects GER but not symptoms. The data highlight the difficulties faced in investigating reflux disease in the paediatric population.

A new study proposes a modelling strategy to identify reactions, genes and metabolites relevant in hepatocellular carcinoma using in silico and in vivo analyses. The proposed genome-scale metabolic model integrates genomic and proteomic information, and points to statins, among others, as potential chemopreventive and anticancer drugs.

In an update on recommendations for colorectal cancer screening, an Asia–Pacific consensus group has set a good standard for presenting level of agreement to recommendation levels. However, this update also exposes how consensus groups might concentrate on the less controversial issues—leaving the tricky questions in the dark.

A staging system capable of addressing the real issues facing patients with hepatocellular carcinoma has long been overdue. The new Hong Kong Liver Cancer staging system might do just that because it deals effectively with the limitations of previous staging systems.

Serrated polyposis syndrome (SPS) is a condition characterized by multiple and/or proximal serrated polyps in the colorectum. Several features of SPS suggest there is an underlying genetic disorder that is yet to be identified. A new study provides insights on the diagnostic yield of screening colonoscopy in first-degree relatives of patients with SPS.

Designing clinical trials for the treatment of NASH is challenging. The pathogenesis of this disease is poorly understood and is probably multifactorial. A trial of a phosphodiesterase-4 inhibitor produced negative results, despite promising preclinical data. Examining why this trial failed might help us design better trials of treatments for NASH in the future.

Are some patients with hepatocellular carcinoma just too old to be treated? More specifically, should the age of a patient influence the way sorafenib is prescribed? A new study has tried to address these questions, providing helpful information to guide clinicians making these decisions.

Primary sclerosing cholangitis (PSC) is understood to be associated with an increased risk of malignancy in the bile ducts, gallbladder and colon. The risk of hepatocellular carcinoma in the setting of PSC, however, is not well defined. Zenouzi et al. provide an analysis of their experience in a recent article

With the ongoing shortage of livers available for transplantation, attention has turned to cell-based approaches to support liver function and enable liver regeneration. However, hepatocyte transplantation is beset with problems and a clinically adoptable strategy is lacking. How can a plentiful supply of hepatocyte-like cells with long-term proliferation be generated?

Quality of life and disability have been compared in patients with ulcerative colitis who were undergoing one of the two current major treatments of choice, proctocolectomy or anti-TNF therapy. The only significant differences between the two groups were increased use of antidiarrhoeal medication and stool frequency in those who underwent surgery.

NAFLD is regarded unquestionably as one of the components of the metabolic syndrome. Hence, metabolic perturbations occurring in the fatty liver become a systemic metabolic derangement. The phenotypic switching from fatty liver to NASH entails a reprogramming of liver metabolism to fit a stressful metabolic environment.

Epidemiology studies have shown an ∼1% prevalence of coeliac disease in Europe, North America, the Middle East and South America, but the prevalence in the Asia–Pacific region remains relatively unknown. Now, Makharia et al. have proposed much needed recommendations to help tackle the problem of coeliac disease in this region.

Functional dyspepsia has been defined in various ways, but the diagnostic yield of these definitions has not been well validated. Ford et al. have now reported the diagnostic yield of the Rome III criteria, which was not superior to previous definitions. The study also indicates the difficulty of excluding organic diseases using these criteria.