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

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.

Identification and classification of dysplasia in patients with ulcerative colitis or Crohn's disease in the large intestine is a challenge. Surveillance programs in these patients aim to detect colitis-associated dysplasia at an early stage, as the risk of these patients developing colorectal cancer is considerable. Good communication and discussion between pathologists and endoscopists is essential to help reach unequivocal diagnoses and to improve the management of colitis-associated dysplasia.

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.

The signs and symptoms of dumping syndrome, a well-established complication of gastric and esophageal surgery, result from rapid gastric emptying and the delivery of large particles of poorly digested food to the small bowel. These symptoms, which can be classed as early or late, their pathophysiological basis, and the treatment options available to patients with dumping syndrome are outlined in this article.

The development of effective acid-suppression therapy has revolutionized the treatment of acid-related diseases. This Review provides an update on the status of acid-suppression therapy and includes discussion of the efficacy and safety of available agents, novel agents in development, risks of acid suppression, and directions for future research.

Systemic amyloidosis is characterized by the extracellular deposition of protein in an abnormal and insoluble form. Involvement of the gastrointestinal tract is very common but is often subclinical. This Review describes the gastrointestinal manifestations of systemic amyloidosis and discusses available methods for the diagnosis and treatment of systemic amyloidosis and its gastrointestinal consequences.

Hepatic venous pressure gradient (HVPG) is the most useful parameter for the assessment of patients with cirrhosis. HVPG provides diagnostic and prognostic information in several clinical scenarios: treatment of portal hypertension, surgery for hepatocellular carcinoma, treatment of HCV-related or HBV-related cirrhosis, and outcome of recurrent HCV infection after liver transplantation.

Restoration of normal growth is a marker of success of therapy in pediatric Crohn's disease. This Review highlights current understanding of the complex pathophysiologic mechanisms that contribute to growth impairment, which clearly stems from more than simply injudicious chronic corticosteroid use and inadequate nutrition.

The gastrointestinal mucosa is an important target of many sexually transmitted infections—it is a site for HIV entry, replication and destruction of CD4⁺T cells, and provides a niche for other sexually transmitted pathogens. This Review discusses the pathogenesis and gastrointestinal complications of HIV infection and summarizes advances in our understanding of other sexually transmitted infections of the gastrointestinal system.

Acute liver failure is the abrupt loss of hepatocellular function in a patient with a previously normal liver. In this Review, Stravitz and Kramer discuss the intensive care management of patients with acute liver failure, the treatment of complications to prevent multi-organ-system failure, and the role of orthotopic liver transplantation in this setting.

Acute cholangitis is a bacterial infection of the biliary tract that occurs in an obstructed system and is characterized by fever, abdominal pain and jaundice. No universally accepted consensus for the diagnosis of acute cholangitis exists. This Review describes current recommendations for the diagnosis and management of this disease and discusses the merits and drawbacks of the most comprehensive guidelines available.

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.