News & Views

Crohn's disease is a life-long illness, with patients increasingly being exposed to diagnostic medical radiation. Diagnostic strategies are being re-evaluated after concerns were raised over the long-term effects of medical radiation. A recent study explored the cost-effectiveness of a magnetic resonance enterography program in patients with Crohn's disease, which could reduce the risk of radiation-induced neoplasia.

Pediatric liver transplantation is a major surgical challenge, especially in very small patients (≤5 kg), and existing literature on low-body-weight transplant recipients is limited. Two new studies discuss the possibilities and limitations of liver transplantation in very young infants and demonstrate encouraging results for liver transplantation in infancy.

An ideal diagnostic test should be quick, reliable and noninvasive. Fecal calprotectin is considered a marker of intestinal inflammation and has proven to be an effective test for IBD, but is fecal calprotectin a useful diagnostic tool when assessing patients with cirrhosis?

The multiple indications for liver transplantation make prioritization for organ allocation a hotly debated topic. Evidence is building that the current allocation system favors patients with hepatocellular carcinoma and should be replaced with one based on transplant benefit and not just survival.

Smoking is known to be a risk factor for chronic pancreatitis. However, to date, few studies have investigated the association between smoking and the risk of acute pancreatitis. A recent prospective, population-based study provides strong evidence that smoking should be considered a risk factor for acute pancreatitis.

Detecting and characterizing colonic polyps using high-definition imaging and narrow-band imaging (NBI) has yielded modest results. Now, two randomized studies have substantiated the role of NBI in reducing polyp miss rates in patients with hyperplastic polyposis syndrome, and in differentiating adenomas from hyperplastic polyps, although with no improvement in adenoma detection rates.

As the clinical use of multidetector CT has increased, concerns have grown as to whether its benefits are commensurate with cost and risk of radiation exposure. Now, multidetector CT has been shown to be useful in the diagnosis of appendicitis, with a substantial influence on both clinical management and patient outcomes.

Aspirin is widely used for cardiovascular disease prevention, but is associated with adverse gastrointestinal effects, which reduce the likelihood of treatment compliance. A new study shows that PPI co-therapy reduces gastrointestinal and cardiovascular events, and is cost-effective at generic price for treating patients who take aspirin for secondary cardiovascular disease prevention.

Fast-track colonic surgery can be successfully implemented in community hospitals. Two recent studies provide further evidence of the benefits of this fast-track surgical approach on postoperative gastrointestinal recovery after laparoscopic and open procedures. The issue is no longer whether fast-track colonic surgery is better than standard care, but how to improve the approach and its implementation.

A new study explores the use of liver biopsy to differentiate drug-induced liver injury (DILI) from autoimmune hepatitis. However, not all that glitters is necessarily the gold standard—disagreement among experts on the histological features of DILI could create uncertainty over the accuracy of this diagnostic approach.

A novel disability index tool has been developed that assesses measures of physical, psychological and social functioning in individuals with IBD. Could this tool potentially aid the assessment of such individuals in routine clinical practice?

The conclusions of clinical trials in patients with nonalcoholic steatohepatitis (NASH) can be influenced by the study design. A group of experts has published recommendations for the design of studies in NASH; these recommendations represent a step towards a standardized methodology for clinical trials in this setting.

Iron deficiency anemia can occur secondary to IBD. A new clinical trial demonstrates that ferric carboxymaltose is more cost-effective, convenient and efficacious than iron sucrose for treating iron deficiency anemia in patients with IBD, an innovation that could make anemia treatment easier for clinicians, patients and health-care providers alike.

Novel interventions aimed at increasing colorectal cancer screening are needed to reduce mortality from this preventable disease. Two randomized controlled trials have found that a multicomponent outreach program increased screening rates by ∼6% among patients with an expired colonoscopy order, while personalized electronic messages had no sustainable effect on screening rates.

Despite numerous trials, the question of whether to use ciclosporin or tacrolimus treatment following liver transplantation in patients with HCV infection is still unresolved. A large retrospective analysis now indicates that tacrolimus is preferable; however, several limitations of this study must be considered.

The incidence of nonalcoholic fatty liver disease (NAFLD) in children is growing in parallel with that of obesity; however, to date, no drugs have been approved for its treatment. Results from a 5-year clinical trial show that neither metformin nor vitamin E are effective for the treatment of pediatric NAFLD.

Conservative treatment of high-output postoperative pancreatic fistulas (POPFs) includes prolonged fasting with nutritional support. However, the choice between enteral and parenteral nutrition is arbitrary. A randomized clinical trial that compared these two types of nutritional support has demonstrated that enteral feeding is associated with a substantially higher closure rate and a shorter time to closure of POPFs.

A recent position paper by the American Gastroenterological Association has made a range of excellent recommendations for the management of patients with Barrett esophagus. However, the guidelines have several important limitations, including the omission of endoscopic therapy for patients who have T1 Barrett adenocarcinoma.

The failure of antiviral therapy for chronic hepatitis B can involve both virological breakthrough and genotypic resistance. A study of the failure of nucleoside analogue therapy suggests that drug-resistant mutants are not solely responsible for treatment failure. Suboptimal treatment adherence might also have an important role.

Despite major advances in understanding its prevention and treatment, diarrhea remains a leading cause of global child deaths and a potentially important cause of lifelong morbidity. A new study asks the question: how many lives would be saved by universal scaling up of best practices for diarrhea prevention and control?