News & Views in 2011

Autoimmune pancreatitis (AIP) is becoming increasingly recognized as a unique form of chronic pancreatitis. Its diagnosis, based on clinical and pathological parameters, is challenging. AIP is currently divided clinicopathologically into type 1 and type 2. Histological diagnostic criteria for type 1 and type 2 AIP have now been proposed by an international consensus study.

As a result of its multifactorial nature, IBS poses a major therapeutic challenge in relation to what factors are best targeted. Hypnotherapy offers a unique solution to this problem by virtue of its ability to modify a wide range of pathophysiological processes to bring about symptomatic improvement.

Algorithms can predict the risk of rebleeding and mortality in patients with upper gastrointestinal bleeding, but not the risk of rebleeding following endoscopic treatment in patients with ulcers. A recent meta-analysis has addressed this issue, and could facilitate the development of methods to predict rebleeding and endoscopic treatments to reduce rebleeding.

Endoscopic palliation of malignant biliary obstruction or gastric outlet obstruction can be technically challenging and might require other interventions in some patients. Results from two recent studies suggest that nitinol self-expanding metal stents are safe and effective for both indications and might decrease the need for other interventions in these patients.

For colorectal cancer screening, the issue is no longer whether the fecal immunochemical test (FIT) is preferable to the guaiac fecal occult blood test, but how best to use the FIT. Using the OC-Sensor^™ FIT with a hemoglobin cut-off level of 50 ng/ml could offer the best cost-effectiveness ratio compared with nonscreening settings.

Accurate estimation of standard liver volume (SLV) is one of the key factors for successful liver transplantation. Contrary to some misconceptions, SLV was developed for the sake of the recipient and not for the donor in living donor liver transplantation. A recent study evaluated the accuracy of five formulas for estimation of SLV, and investigated the effect of liver steatosis on errors in estimation.

Crohn's disease is a life-long illness, with patients increasingly being exposed to diagnostic medical radiation. Diagnostic strategies are being re-evaluated after concerns were raised over the long-term effects of medical radiation. A recent study explored the cost-effectiveness of a magnetic resonance enterography program in patients with Crohn's disease, which could reduce the risk of radiation-induced neoplasia.

Pediatric liver transplantation is a major surgical challenge, especially in very small patients (≤5 kg), and existing literature on low-body-weight transplant recipients is limited. Two new studies discuss the possibilities and limitations of liver transplantation in very young infants and demonstrate encouraging results for liver transplantation in infancy.

An ideal diagnostic test should be quick, reliable and noninvasive. Fecal calprotectin is considered a marker of intestinal inflammation and has proven to be an effective test for IBD, but is fecal calprotectin a useful diagnostic tool when assessing patients with cirrhosis?

The multiple indications for liver transplantation make prioritization for organ allocation a hotly debated topic. Evidence is building that the current allocation system favors patients with hepatocellular carcinoma and should be replaced with one based on transplant benefit and not just survival.

Smoking is known to be a risk factor for chronic pancreatitis. However, to date, few studies have investigated the association between smoking and the risk of acute pancreatitis. A recent prospective, population-based study provides strong evidence that smoking should be considered a risk factor for acute pancreatitis.

Detecting and characterizing colonic polyps using high-definition imaging and narrow-band imaging (NBI) has yielded modest results. Now, two randomized studies have substantiated the role of NBI in reducing polyp miss rates in patients with hyperplastic polyposis syndrome, and in differentiating adenomas from hyperplastic polyps, although with no improvement in adenoma detection rates.

As the clinical use of multidetector CT has increased, concerns have grown as to whether its benefits are commensurate with cost and risk of radiation exposure. Now, multidetector CT has been shown to be useful in the diagnosis of appendicitis, with a substantial influence on both clinical management and patient outcomes.

Aspirin is widely used for cardiovascular disease prevention, but is associated with adverse gastrointestinal effects, which reduce the likelihood of treatment compliance. A new study shows that PPI co-therapy reduces gastrointestinal and cardiovascular events, and is cost-effective at generic price for treating patients who take aspirin for secondary cardiovascular disease prevention.

Fast-track colonic surgery can be successfully implemented in community hospitals. Two recent studies provide further evidence of the benefits of this fast-track surgical approach on postoperative gastrointestinal recovery after laparoscopic and open procedures. The issue is no longer whether fast-track colonic surgery is better than standard care, but how to improve the approach and its implementation.

A new study explores the use of liver biopsy to differentiate drug-induced liver injury (DILI) from autoimmune hepatitis. However, not all that glitters is necessarily the gold standard—disagreement among experts on the histological features of DILI could create uncertainty over the accuracy of this diagnostic approach.

A novel disability index tool has been developed that assesses measures of physical, psychological and social functioning in individuals with IBD. Could this tool potentially aid the assessment of such individuals in routine clinical practice?

The conclusions of clinical trials in patients with nonalcoholic steatohepatitis (NASH) can be influenced by the study design. A group of experts has published recommendations for the design of studies in NASH; these recommendations represent a step towards a standardized methodology for clinical trials in this setting.

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.

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.