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

Despite advances in laparoscopic surgery for colorectal cancer, the role of laparoscopic approaches for rectal cancer remains controversial. A large, single-center study has now demonstrated the safety and feasibility of laparoscopy for rectal cancer, which provides new incentives for prospective clinical trials to rigorously test this surgical approach.

The management of alcoholic pancreatitis is mostly reactive; little is done to prevent disease progression. It is time for physicians to pay attention to the root cause of the condition—that is, alcohol—rather than just responding to its effects. This article discusses an important paper that describes the first prospective, randomized, controlled, clinical trial to investigate the effect of brief interventions for alcohol abuse on the progression of alcoholic pancreatitis.

Advances in complementary metal oxide semiconductor technology have enabled the development of capsule endoscopy, a diagnostic technique that involves ingestion of a pill-sized camera that collects and relays still images of the tissues lining the gastrointestinal tract. Moglia and colleagues review the literature on the use of different capsule endoscopy devices for the inspection of the small bowel, esophagus and colon, and discuss the potential future applications and developments of this technology.

Ghrelin is an orexigenic hormone that acts to increase food intake and fat deposition, and at high doses, can modulate gastric motility. This Review addresses the actions of ghrelin in gastrointestinal systems. Studies that have investigated the role of ghrelin receptor agonists and antagonists for the treatment of gastrointestinal motility disorders and obesity are also discussed.

Appropriate clinical and pathological evaluation is crucial for the diagnosis and management of gastric polyps and polypoid lesions. This Review discusses the endoscopic characteristics, histopathology, pathogenesis and management of polyps and common polypoid lesions in the stomach, and provides a practical guide for gastroenterologists.

Children and adolescents with untreated celiac disease display disease-related, histological alterations in the duodenal bulb, according to a new study. In 16 of the 665 patients enrolled in the study, lesions were confined to the duodenal bulb.

The selective, chloride channel 2 activator, lubiprostone, facilitates intestinal-fluid secretion and stimulates gastrointestinal motility. These effects increase stool frequency and improve abdominal discomfort for patients with constipation-predominant IBS, which makes lubiprostone the newest addition to the treatment armamentarium for these patients. Findings from a new, pivotal, phase III study by Drossman and colleagues support the use of lubiprostone in such patients.

In a study carried out in India, antioxidant therapy for chronic pancreatitis offered short-term benefits and was associated with few adverse events. Although the etiology and characteristics of this condition vary between countries, antioxidant therapy could be implemented as an adjunct treatment in the early inflammatory phase of chronic pancreatitis.

Extensive research has addressed the effectiveness of various endoscopic treatments for bleeding peptic ulcers. These studies are often heterogeneous in their methodology, definitions, end points and combinations of modalities used. Evidence-based recommendations that address clinically relevant questions are now available, and will be a valuable resource for practicing endoscopists.

Effective cleansing of the colon is pivotal to achieve an accurate colonoscopy evaluation and affords many benefits, including improved visualization, reduced procedure times and reduced complication rates. This Review discusses the colonoscopy preparations available, with an emphasis on the efficacy, tolerability and safety of each method. Knowledge of the different approaches will enable physicians to choose the best preparation for their patients.

Increased risk of colorectal cancer in patients with IBD may be due to genomic instability caused by chronic colonic inflammation. This Review evaluates the alterations to gene expression and the genetic mutations associated with colitis-associated colorectal cancer and the clinical conditions that precede it. Feagins et al. identify potential molecular targets for colorectal cancer therapy that deserve further investigation.

Secondary sclerosing cholangitis is a chronic cholestatic biliary disease, which unlike primary sclerosing cholangitis, is thought to develop as a consequence of known injuries. The presence of sclerosing cholangitis in critically ill patients is a new entity that is increasingly recognized. This Review discusses the features, diagnosis, pathogenesis and treatment options for secondary sclerosing cholangitis and sclerosing cholangitis in critically ill patients.

In this article, Rhee and colleagues review the ample preclinical evidence suggesting that the commensal bacterial flora physiologically present in the gut modulates and influences bidirectional communication between the host's gut and central nervous system. The authors propose possible mechanisms by which these three-way mutual interactions may occur and may affect the host's healthy and diseased states.

Eosinophilic esophagitis is a chronic esophageal inflammatory disease of undetermined pathophysiology resulting in dense mucosal eosinophilia and esophageal dysfunction. This Review discusses the disease in terms of its clinical presentation in children and adults, pathogenesis, diagnosis and treatment.

Gastrointestinal stromal cell tumors (GISTs) always have a degree of malignant potential, and, increasingly, they are diagnosed only on routine endoscopy. Sepe and Brugge provide a gastroenterologist's guide for GIST diagnosis and assessment of malignant potential. The authors of this Review also propose an algorithm for the treatment of localized GISTs that is especially useful for the management of incidentally diagnosed tumors.

A promising new scoring system has stratified mortality risk in a large group of patients with acute pancreatitis. This new model is more practical than APACHE II, but needs to be validated in patients in whom the diagnosis of acute pancreatitis can be verified from detailed clinical records.

The recent outbreak of Salmonella typhimurium, associated with peanut butter and products containing it in the US and Canada, highlights our ongoing susceptibility to food-borne infections despite advanced food production systems. As the globalization of food resources continues, how can we control outbreaks and minimize their effect on health?

The recurrence of hepatitis C in HCV-infected, orthotopic liver transplant recipients is a major problem that can influence the survival of both grafted tissue and patients. Yet the effects of immunosuppression strategies, in particular those of steroids, on disease recurrence remain unclear.

Adolescents with celiac disease who adhere to a gluten-free diet have a better quality of life than those who do not comply with the diet, according to a new study. Adolescents who are diagnosed as having this disease at a young age also have improved quality of life.

A retrospective, comparative study that focuses on patients with already impaired kidney function adds to the body of evidence that links administration of oral sodium phosphate bowel-preparation solutions for colonoscopy with a decrease in renal function. When possible, a polyethylene glycol solution should be used instead.