News & Views

No approved vaccine is currently available against hepatitis E virus (HEV), which can cause acute hepatitis E. A large-scale phase III study involving more than 100,000 Chinese adults has reported that the recombinant HEV vaccine, HEV 239, prevented acute hepatitis E with a vaccine efficacy of 94–100%.

Noncardiac chest pain (NCCP) is a common condition; however, there are few treatment options for patients with NCCP. A study has recently investigated the potential benefit of using a serotonin–norepinephrine reuptake inhibitor (venlafaxine) to treat patients with functional chest pain, which is experienced by a subgroup of those with NCCP.

Potent nucleoside and nucleotide analogs might replace hepatitis B immunoglobulin (HBIG) to prevent HBV recurrence after liver transplantation in HBV-related liver disease. Two studies, however, suggest that viral load before transplant, and not the HBIG regimen, is the strongest risk factor for HBV recurrence.

The role of microbiological analysis of bile from patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is unclear. Although the majority of such patients have positive cultures, only a few develop postprocedural bacteremia or fever. Microbiological bile analysis might, however, have a role in patients with complications of orthotopic liver transplantation and those in whom adequate biliary drainage has not been achieved.

Assessment and uptake of hepatitis C treatment among injection drug users with HCV infection remains low, partly due to concerns regarding poor adherence and response to therapy. Findings from a large, prospective study demonstrate comparable adherence and response to hepatitis C treatment among nondrug users, former drug users and active drug users.

Nonselective β-blockers are often used in patients with cirrhosis and esophageal varices to prevent variceal bleeding. A recent study has suggested that nonselective β-blockers promote more harm than benefit in patients who have cirrhosis and refractory ascites. The authors of the study suggest that these drugs should be contraindicated in these patients.

Gastric polyps are a heterogeneous group of lesions that have differing consequences for patients, particularly in terms of malignant potential. However, there is currently no consensus for the management of patients with these polyps. The British Society of Gastroenterology has, therefore, published objective management guidelines for patients with these lesions.

Surgical complications are a major cause of avoidable medical mistakes, and might occur more frequently when surgery is performed at night. In a recent study, Lonze et al. found that patients who underwent liver transplantation surgery at night had a longer operative time and a greater risk of early death than those who underwent surgery during the day.

Hyperplastic polyposis syndrome is a widely accepted, but poorly understood, risk factor for colorectal cancer. A recent report has laid the foundations for improving the management of patients with this enigmatic disorder by identifying the features associated with colorectal cancer risk, as well as estimating the magnitude of this risk.

A study by Lebrec and colleagues suggests that, despite having no effect on short-term mortality, pentoxifylline, an inhibitor of tumor necrosis factor, reduces the risk of liver-related complications in patients with advanced Child–Turcotte–Pugh class C cirrhosis.

In a prospective Chinese study in which bismuth was added to standard PPI-based triple therapy, the Helicobacter pylori eradication rate was above 90%. Increased treatment duration was also crucial—a therapeutic gain of 13% was achieved if the quadruple therapy was administered for 14 days instead of 7 days. Clarithromycin resistance was also overcome by the prolonged bismuth-containing quadruple therapy.

Despite steady improvement in survival after variceal bleeding in patients with cirrhosis, bleeding-related mortality remains high. Current treatment recommendations utilize a step-up strategy, in which only patients who rebleed despite drug and endoscopic therapy undergo TIPS (transjugular intrahepatic portosystemic shunt) implantation; however, in patients who are at high risk of rebleeding, early use of TIPS might greatly reduce mortality.

Endoscopic ultrasound (EUS) is the diagnostic modality of choice for various pancreatic pathologies. A recent study has suggested that EUS evaluation during diagnostic workup is a predictor of increased survival in patients with pancreatic cancer owing to improved pancreatic cancer staging and selection of suitable candidates for surgery.

Moderate sedation is typically used during lower gastrointestinal endoscopy procedures. Deep sedation with propofol is becoming widespread but carries the risk of cardiorespiratory depression. Nitrous oxide is an inhaled sedative administered routinely in dentistry that might prove to be a safe option for sedation during lower gastrointestinal endoscopy.

Endoscopy is the mainstay for diagnosis and therapy of upper gastrointestinal bleeding. Early risk assessment is crucial for effective timing of endoscopy and determination of the need for other measures to be taken—scoring systems should be used for this purpose. A new prospective study suggests that the Blatchford score can identify patients who do not need endoscopic intervention.

Hemochromatosis associated with HFE C282Y homozygosity affects persons of western European descent, and is the most common and well-characterized primary iron overload disorder worldwide. New clinical practice guidelines summarize current knowledge of the prevalence and penetrance of C282Y homozygosity and provide evidence-based recommendations for diagnosis and management of patients with HFE hemochromatosis.

A confident and efficient diagnosis of IBS is an important aspect of clinical gastroenterology. How far to investigate a patient with typical IBS symptoms has been the subject of a number of clinical guidelines. A recent study has recommended, somewhat provocatively, that investigation for pancreatic exocrine insufficiency should be added to the tests undertaken in patients with suspected diarrhea-predominant IBS who are referred to a gastroenterologist.

Surgical repair of complex anal fistulas has to achieve a balance between optimal primary healing and best preservation of continence. As traditional surgical techniques confer a risk of continence deterioration, innovative sphincter-preserving techniques have been introduced. A new study indicates that use of bioprosthetic plugs in the surgical treatment of complex anal fistulas is associated with a long-term success rate of 81%.

An improved understanding of thiopurine metabolism has enabled individualized dosing of these agents in patients with IBD. Ansari et al. describe the use of allopurinol to deliberately manipulate thiopurine metabolism in patients who previously could not tolerate therapeutic doses of azathioprine or 6-mercaptopurine. This therapeutic maneuver potentially enables this therapy to be given to a considerable subgroup of patients otherwise unable to tolerate thiopurine therapies.

In a large, randomized, controlled trial conducted in the UK, screening flexible sigmoidsocopy led to substantial reductions in the incidence of and mortality from distal colorectal cancer. Both fecal occult blood testing and flexible sigmoidoscopy screening are now proven to reduce colorectal cancer mortality.