Review Articles, News & Views, Perspectives, Hypotheses, Analyses and Review in 2011

Constipation is a common functional gastrointestinal disorder in children, characterized by withholding of stools, infrequent and painful passage of hard stools, and episodes of fecal incontinence. In this Review, the authors describe the prevalence and pathophysiology of childhood constipation as well as discuss the latest available knowledge on the diagnosis, treatment and follow-up of these pediatric patients.

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.

Gastroparesis is a prevalent condition that produces symptoms of delayed gastric emptying in the absence of physical blockage. Over the past 5 years, considerable advances have been made in understanding gastroparesis, and the number of treatment options has expanded. William Hasler thus provides a timely Review of the pathogenesis, diagnosis and management of this condition.

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.

The aim of sedation in endoscopic procedures is to increase the patient's comfort and to improve endoscopic performance, especially in therapeutic procedures. This Review focuses on standard and new methods of procedural sedation and their complications. It provides an approach to choose the best sedation strategy for each patient, tailored according to the clinical risk assessment and the anxiety level of the patient, as well as to the type of planned endoscopic procedure.

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.

Bariatric surgery is emerging as an important and broadly available treatment for people with severe and complex obesity that has not responded adequately to other therapy. Gastroenterologists need to be aware of the risks and benefits of current and emerging procedures as they are likely to be increasingly involved in the integrated care of patients. This Review summarizes the evidence for the safety, efficacy and cost-effectiveness of bariatric surgery, as well as discussing mechanisms of action and future directions for surgery.

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?

Owing to the shortage of donor organs, improved selection criteria are needed for allocating patients with hepatocellular carcinoma (HCC) to receive orthotopic liver transplantation (OLT). A study has found that the neutrophil:lymphocyte ratio independently predicts tumor recurrence after OLT for HCC and, therefore, might constitute a simple entry criterion that measures host inflammation status.

The early identification of patients with ulcerative colitis who have an increased risk of colorectal cancer would be useful for clinicians. In this Review, the authors discuss the most promising preneoplastic biomarkers, including p53 mutations, chromosomal instability and senescence, in ulcerative colitis. They also present the available knowledge regarding the pathogenesis of ulcerative colitis-associated colorectal cancer.

Despite some advances, the search for effective treatment modalities for advanced gastric and gastro-esophageal junction cancer (GEJC) is far from over. However, using biologic agents to target key molecular pathways, such as those regulated by human epidermal growth factor receptor (HER) family members, may be an effective approach. This Review briefly describes HER biology, summarizes available data regarding the clinical activity of anti-HER agents and their use in gastric cancer and GEJC, and provides insight into treatment personalization strategies.

Aspirin is one of the most prescribed drugs worldwide, as it can prevent cardiovascular morbidity and mortality. However, aspirin can cause gastrointestinal complications. In this Review, Angel Lanas and Carlos Sostres discuss the gastrointestinal effects of aspirin and suggest that physicians need to consider the advantages and risks for individual patients to maximize the benefits of aspirin.

Currently, there is no satisfactory treatment for patients coinfected with hepatitis B virus and hepatitis D virus, which causes hepatitis D—the most severe form of hepatitis. A recent study has assessed the safety and efficacy of PEG-IFN-α2a and adefovir alone and in combination in these patients.

Constipation is a very common condition that is frequently managed suboptimally. A recent single-blind, randomized, crossover study has reported the superior effects of dried plums (prunes) over the stool-bulking fiber supplement psyllium in the treatment of mild to moderate symptoms of constipation.

Increasing clarithromycin resistance is dramatically reducing the efficacy of standard triple therapy for Helicobacter pylori eradication. Quadruple therapy is associated with high cure rates, yet its complex administration protocol hampers its acceptability for general use. A recent study has assessed the efficacy and safety of a novel, single-capsule bismuth-containing quadruple therapy.

Up to 30% of patients with refractory ulcerative colitis have steroid-resistant disease and, if cured with restorative proctocolectomy, could develop pouchitis. Ciclosporin and infliximab monotherapy have been used experimentally to tackle this problem. A recent study has assessed ciclosporin and infliximab as second-line therapies when one has failed.