News & Views in 2012

As pregnancies frequently occur in patients with IBD, and given that TNF inhibitors are increasingly being used for treatment of this chronic intestinal disease, the discontinuation of biologic agents during the third trimester in patients with quiescent disease has been advocated owing to safety concerns.

Ciclosporin and infliximab are used as rescue therapies for the treatment of severe steroid-refractory ulcerative colitis. Now, an open-label, head-to-head randomized controlled trial has demonstrated that these drugs are well-tolerated and have equivalent efficacy in inducing short-term clinical response, mucosal healing and decreasing colectomy rates at 3 months.

Treatment of recurrent Clostridium difficile infection is challenging. New research now replicates human disease in a mouse model, shedding light on why antibiotics often fail to prevent further recurrences and demonstrating that targeted manipulation of the gut microbiota could be a feasible treatment option.

The risk of venous thromboembolism (VTE) is known to be increased in patients with IBD. However, no specific consensus statements exist regarding the prevention of postoperative VTE in patients with this disease. The results of a large retrospective cohort study quantifying the risk of postoperative VTE in patients with IBD are discussed.

Treatment success for Helicobacter pylori, a major human pathogen, with popular drug regimens has generally declined to unacceptably low levels. As part of the worldwide effort to identify novel drug regimens that will reliably achieve high levels of success, Tay, Marshall and colleagues report their results with novel multidrug-tailored therapies.

Novel findings draw attention to the adverse effect that neoplastic transformation of epithelial cells has on intestinal barrier function and cancer progression. An impaired intestinal barrier facilitated the translocation of microbial products, which promoted cytokine production and subsequent tumour progression in mice. The findings could open new therapeutic avenues for patients with early stage colorectal cancer.

Hepatocellular carcinoma (HCC) is a heterogeneous cancer with variable outcomes after treatment. Prognosis of HCC cannot be accurately predicted by current clinical staging systems. Development of prognostic biomarkers is critical to improve treatment outcome. Recent studies indicate that inflammatory and immunological markers might provide reliable prognostic classification in HCC.

In an attempt to better characterize mucosal healing in ulcerative colitis, various endoscopic scoring systems have been introduced. However, most have limited interobserver agreement. A recent study has validated the ulcerative colitis colonoscopic index of severity and found that this new scoring system provides reproducible results among gastroenterologists.

Elastography has been shown to increase the accuracy of endoscopic ultrasonography for the differential diagnosis of pancreatic masses. Recent data have led to questions about the validity of its use in a routine clinical setting, outside controlled studies. Further improvements of the technique are needed to increase the reproducibility of its results and make it a useful clinical tool.

A retrospective analysis of adjuvant and neoadjuvant therapy in patients with resectable biliary tract adenocarcinoma shows they confer no survival advantage in the treated groups, leading the authors to conclude they have no benefit. However, the study design does not allow definitive conclusions to be drawn about these treatments.

Impaired growth is common in children and adolescents with Crohn's disease, but it can be difficult to interpret growth status accurately. Bone age is a useful measure of skeletal maturity, but should serial bone-age estimation be part of the routine care of children with Crohn's disease?

Metagenomic and metabonomic analysis suggests that age-associated stability of the intestinal ecosystem is strongly influenced by an individual's social and dietary status. The process of immunosenescence might serve as a causal link to explain the association between a perturbed distal gut microbiota and frailty in the elderly.

As new therapeutics are emerging for the treatment of patients with HCV, the nomenclature for defining virologic response is becoming outdated, leading to inconsistencies and confusion. A recent paper has attempted to devise a new nomenclature that will be able to respond to future advances in HCV therapy.

New findings demonstrate novel interactions between diet, bacteria, genetic susceptibility and immune responses in IBD. Milk fat increases production of taurocholine-conjugated bile acids, which promotes growth of sulphate-reducing bacteria that cause immune-mediated colitis in susceptible mice. These observations will guide human studies that might improve dietary advice for patients with IBD.

Given the early onset of ulcerative colitis in children, it is desirable to identify young patients with this disease who are at risk of adverse outcomes. Identification of these patients would enable the introduction of disease-modifying therapies early in the disease course and thus prevent the need for surgical therapy.

Immunization against HBV has now been integrated into the WHO Expanded Programme on Immunization throughout the world. The reduction in chronic carriage rates in children from 10% to 0.9% over 25 years in Taiwan raises the exciting possibility that HBV could be targeted for eradication, but is vaccination alone sufficient to eliminate the infection?

Transjugular liver biopsy (TJLB) has an advantage over percutaneous liver biopsy (PLB) in that Glisson's capsule is not penetrated, enabling multiple passes without increasing the risk of complications. A new prospective study shows that TJLB is a safe alternative to PLB for obtaining samples of adequate size and quality to assess liver histology.

Various methods screen for alcohol consumption in patients with alcoholic liver disease. However, each test has its own limitations. The feasibility of the methanol test for identifying recent alcohol consumption in liver transplant candidates has been investigated. New studies are required to optimize the best strategy in these patients.

Hepatitis E virus (HEV) infection is the most common cause of hepatitis worldwide. In the developing world, HEV infection is also a common cause of decompensation in patients with chronic liver disease and has a very high mortality. Could the same be true in the UK? A recent paper examines this issue.

Acute pancreatitis is the most common and feared complication following endoscopic retrograde cholangiopancreatography (ERCP). Pharmacological prevention of post-ERCP pancreatitis has been disappointing, especially in high-risk patients. However, a prospective multicentre trial has demonstrated the efficacy of rectal administration of indomethacin for preventing post-ERCP pancreatitis in high-risk cases.