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Treatment of patients with Crohn's disease to delay the natural evolution of the disease and avoid the development of complicated disease as well as the need for hospitalization and surgery is desirable. Gert Van Assche and colleagues discuss the disease-modifying potential of immunosuppressive and anti-tumor necrosis factor therapies, especially when given as early, aggressive therapy.
IBD treatment has evolved towards biologic therapy, which seeks to target specific immune and biochemical abnormalities at the molecular and cellular level. Improved understanding of the pathogenesis of IBD has suggested future drug biologic targets, which are currently being investigated. This Review article discusses the potentials and pitfalls of biologic therapy for IBD as this field advances at a rapid pace.
Early treatment of Crohn's disease with immunomodulators and anti-TNF agents is associated with better clinical outcomes than standard therapy, but these drugs may have serious adverse effects and are not suitable for all patients. The author reviews current clinical evidence and proposes a strategy for adequate selection of patients for top-down therapy of IBD.
IBD is associated with a young age at onset and normal life expectancy, which results in a lifetime accrual of disease-related costs. This Review discusses the economic impact of biologic therapy on direct costs of IBD, such as hospitalizations and surgeries, and indirect costs, such as those related to disability and loss of productivity.
IBS is thought to be caused by dysfunctions in the gut–brain axis. Low-grade inflammation and immunological alterations may underlie disease symptoms. The authors discuss evidence for a role of innate and adaptive immunity in IBS and the mechanisms by which the immune and neural systems interact in the generation of symptoms.
Hepatitis D is considered to be the most severe form of viral hepatitis in humans and represents a major health burden in certain areas of the world. Diagnosis is challenging and treatment options are limited. This Review discusses the epidemiology, virology, pathogenesis, diagnosis and management of hepatitis D and highlights future challenges.
Therapeutic options to treat the common cancer hepatocellular carcinoma are limited and new treatments are therefore required. Radioembolization with iodine-131 or rhenium-188 labeled lipiodol, or with yttrium-90 labeled microspheres is a promising approach. Jean-Luc Raoul and coauthors discuss the different radionuclides and delivery vehicles used, the clinical trial data and the future perspectives for radioembolization.
