News & Views

The current re-treatment options available to patients with chronic hepatitis C who fail to respond to treatment with pegylated interferon plus ribavirin are limited. Findings from a large, multicenter study suggest that re-treatment with consensus interferon plus ribavirin should now be considered for compliant, motivated nonresponders.

A recent survey of patients, primary physicians and gastroenterologists found that an overwhelming majority prefer endoscopic polypectomy for small polyps detected by screening CT colonography. These hypothetical results, however, strongly contradict results in actual clinical practice.

Among the challenges of studying the contribution of individual dietary factors to cancer risk is the interwoven nature of diet—dietary factors are often correlated and eating patterns are complex. A large, prospective epidemiological study of diet patterns used cluster analyses to demonstrate the benefit of a fruit and vegetable diet to colorectal cancer risk.

The optimal therapy for patients with metastatic and treatment-refractory colorectal cancer is controversial. Questions with regard to both the sequence and combinations of different drugs need to be answered by well-designed and adequately powered studies before the most appropriate option for second-line treatment for these patients can be defined.

Relatively little information exists on the prognosis for elderly patients with chronic hepatitis C (CHC). Moreover, the majority of randomized, clinical trials of hepatitis C treatment exclude elderly patients. Findings from a 2009 clinical study address risk of hepatocellular carcinoma, life expectancy and the influence of antiviral therapy in elderly patients with CHC.

Nonalcoholic fatty liver disease has long been neglected by health-care professionals unless affected patients develop cirrhosis; however, new research shows this disease impairs health-related quality of life. The association of nonalcoholic fatty liver disease with chronic metabolic diseases and cardiovascular complications restricts our ability to define a specific role for liver damage in the poor perceived health status of these patients.

Considerable advances in tools for the diagnosis and management of Crohn's disease have been made. Despite technological progress, a new study reports that more than one-third of patients with Crohn's disease are still diagnosed with fistulizing disease intraoperatively and that the surgical management of these patients is not well characterized.

More than 50% of patients infected with HCV genotype 1 fail respond to standard treatment with peginterferon plus ribavirin. Potent treatment strategies are urgently needed to improve outcomes for such patients. Novel interferons and specifically targeted antiviral therapy for HCV (STAT-C) represent promising strategies.

Few randomized, controlled trials have investigated the efficacy of pharmacological treatment for lymphocytic colitis. Data from a new randomized, placebo-controlled trial have demonstrated the efficacy of budesonide in inducing remission of this disease; this study is an important contribution to this field.

Diagnosis of celiac disease in children under 2 years of age at first biopsy currently requires a small-bowel biopsy to be taken after a gluten challenge. The authors of a new study question these recommendations, and suggest that gluten challenge and biopsy are not required in this group of patients.

Findings from a new, multinational, randomized, controlled trial suggest that histamine receptor 2 antagonists and PPIs are equal in their ability to control peptic ulcer rebleeding. However, several methodological issues of this study limit the conclusions that can be drawn from it.

Detection of polyps by colonoscopy is commonly performed during slow withdrawal of the colonoscope, after its rapid insertion. The authors of a new study found that considerably more polyps were identified during endoscope insertion, rather than withdrawal, and suggest that further investigation of polyp inspection during the insertion phase is warranted.

Severe infections are an established risk of immunosuppressive therapy; however, the risk of opportunistic infections in patients with IBD who receive immunosuppressive therapy has so far only been studied retrospectively. The increased incidence of herpes flares and development or worsening of viral warts in patients with IBD who receive azathioprine has now been demonstrated for the first time in a prospective study.

Two very different studies have recently been published, which indicate that use of intravenous PPIs as an adjunct to endoscopic hemostasis might effectively prevent recurrent ulcer bleeding. What do these studies add to our current knowledge, and what are their practical implications for gastroenterologists?

Two multicenter trials have evaluated the potential of capsule endoscopy as a diagnostic tool for screening and surveillance of esophageal varices in cirrhotic patients. Their results are similar and show that capsule endoscopy has good performance characteristics, although it is somewhat inferior to esophagogastroduodenoscopy.

The low success rates of standard triple-therapy regimens for eradication of Helicobacter pylori infection have led to development of alternative approaches. Findings from a new meta-analysis that compared the efficacy of concomitant quadruple therapy with that of standard triple therapy revealed the concomitant approach to be superior for eradication of H. pylori.

The routine use of diagnostic laparoscopy for young women who present with right iliac fossa pain reduces the rate of negative appendectomy, according to a new study. However, the implementation of laparoscopy as a routine approach for the diagnosis of suspected acute appendicitis would probably increase morbidity and mortality for these patients.

Selection of an optimum treatment regimen for patients with ulcerative colitis depends on several factors, including the natural history of the disease. A new study indicates that prognosis for patients with newly diagnosed ulcerative colitis might not be as bad as typically thought—an important finding that should be taken into account when the risks and benefits of future treatment strategies are discussed.

Current recommendations for the performance of laparoscopic sigmoidectomy in patients with diverticulitis reserve this procedure for individuals who have complications of the disease or have had numerous, severe disease episodes. Findings from a 2009 study challenge this dogma and suggest that patients' quality of life should also be considered.

Several novel antiviral treatments for HCV are in preclinical or clinical development, and most target viral enzymes and their functions. These new drugs all potentially select for resistant viral variants, both in vitro and in vivo; viral resistance is, therefore, likely to become an important issue in clinical practice.