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Our understanding of carcinogenesis in Barrett's esophagus has markedly increased in the past decade, thanks to the close interaction of clinicians, epidemiologists and basic scientists. This review discusses how reflux of gastroduodenal contents, dietary habits, obesity, upper gastrointestinal infections and exposure to carcinogens might contribute to the development of cancer in Barrett's esophagus.
During the past few years there has been renewed interest in the management of chronic anal fissure. Treatment with botulinum neurotoxin is less expensive and easier to perform than surgery and does not require anesthesia. It is also more efficacious than nitrate therapy and is not related to the patient's willingness to complete treatment.
Hepcidin is the iron-regulatory hormone that links innate immunity and iron metabolism. Normally, a regulatory feedback loop with circulatory iron controls hepatic hepcidin production. Inflammatory stimuli upregulate hepcidin production, which can lead to anemia. Anemia downregulates hepcidin production. Human disorders associated with inappropriate hepcidin levels include anemia of inflammation and hereditary hemochromatosis.
At present there is no cure for chronic pancreatitis—a progressive condition that culminates in the destruction of the pancreas. Recent advances in genetic and immunologic research have spawned new insights into the mechanisms underlying chronic pancreatitis, and new models are helping us understand associated risk factors and etiologies.
The etiology and pathogenesis of ulcerative colitis remain unclear, but evidence is accumulating that both genetics and the environment are important. Although diagnosis remains based on well-established clinical, endoscopic and histologic criteria, recent advances in the detection of fecal and serologic markers and the use of wireless capsule endoscopy promise to aid diagnosis.
At present, there is no uniformly effective treatment for recurrentClostridium difficile-associated disease. Tapering and pulsing antibiotics after a 10-day standard course can decrease the recurrence of disease, as can adjunct use of the probiotic Saccharomyces boulardii. Restoration of normal colonic flora might be another treatment option, and new treatment approaches being developed include a vaccine.
