News & Views in 2014

Portal vein thrombosis occurs frequently in patients with cirrhosis, but it is unclear whether it is a cause or consequence of decompensation in cirrhosis. The heterogeneity of data on the influence of portal vein thrombosis on the natural history of cirrhosis has been added to in a new study.

Evidence is mounting that molecular mechanisms underlie gut dysfunction and symptom generation in IBS. Although it is still an uphill struggle, this mounting evidence is a good starting point for the discovery of one or more IBS biomarkers.

The best time point to determine cure of chronic hepatitis C was explored in a retrospective analysis of five published trials of sofosbuvir–ribavirin with or without PEG-IFN. The authors conclude that SVR12 can be used effectively to determine 'cure' rates in trials and in clinical practice.

IBD has emerged as a global disease. Ng and colleagues have identified that some environmental risk factors are shared across the world, whereas others are distinctly unique to individuals living in Asia. This work adds a new clue to the mystery of the environmental determinates of IBD.

Little progress has been made in the pharmacological management of patients with hepatic encephalopathy, partly because it is difficult to perform clinical trials in this group of patients. A new clinical trial now suggests that polyethylene glycol is more effective than the current standard first-line therapy in these patients.

Optimization of biologic therapies in IBD represents an important therapeutic strategy to improve clinical outcomes. Vaughn and colleagues have analysed the long-term benefits of proactive therapeutic concentration monitoring of infliximab in patients with IBD.

Failure to control acute variceal bleeding is a strong predictor of mortality in patients with cirrhosis. Various criteria have been proposed to define failure to control bleeding for use as end points in randomized clinical trials. However, the clinical applicability and validation of these proposed criteria remain unresolved issues.

IBD is known to be associated with an abnormal response to an unbalanced gut microbiota in genetically predisposed individuals. The therapeutic goal now is to control progression of the disease. Given the heterogeneity of IBD, the two universes of basic and clinical science must work in parallel to realize the hope of personalized therapy.

The past 10 years have represented a whirlwind of activity with regard to information on the risk factors, aetiopathogenesis, diagnosis and treatment of hepatocellular carcinoma. I will describe what I consider to be the major advances from both a tumour biology perspective and a clinical perspective over the past 10 years.

In the past decade we have witnessed an explosion in the quantity and quality of research in the functional gastrointestinal disorders. I discuss 10 top original research papers that, unless recent, have been highly cited, published in a high-impact journal and have probably shifted thinking in the field.

Clinical and basic science discoveries over the past decade have led to considerable improvements in our understanding and care of pancreatic diseases. Findings reported in 10 key papers highlight results that have already substantially altered the care of patients with acute pancreatitis, chronic pancreatitis and pancreatic cancer (or soon will).

The past 10 years have witnessed incredible developments in the treatment of hepatitis C. From an era in which the standard of care was PEG-IFN and ribavirin back in 2004, various interferon-free regimens with direct-acting antivirals are now available or will be soon. Here, major milestones in the hepatitis C treatment revolution are outlined.

Although clinicians instinctively recognise acute-on-chronic liver failure (ACLF), heretofore we have had no way of accurately studying the syndrome, as no definition of this entity existed. A consortium of European centres has finally offered a definition of ACLF and proposed a prognostic index based upon easily obtained features of patients with decompensated cirrhosis.

Measurement of faecal calprotectin concentration is increasingly used to assess disease activity in patients with IBD. Lasson et al. have now demonstrated that calprotectin concentrations in faeces of patients with mild or moderate left-sided or extensive ulcerative colitis vary considerably and have questioned the long-term stability of calprotectin when stored at room temperature.

Research on the gut microbial communities harboured in the human gut is progressing rapidly owing to the availability of novel and reliable tools for analysis. Dysfunction of the gut microbiota affects human biological fitness at multiple levels, and understanding of these effects needs to be improved to benefit human health.

Improved methods are needed to dynamically image gut behaviour to assess whether neuromuscular degenerative disease is present. So-called nanonaps (soluble nanoformulated naphthalocyanines) have been developed for oral administration to pass through the intestines and provide high contrast for visualizing bowel motion on photoacoustic imaging. Moreover, radiotracer labelling of these nanoparticles facilitates multimodal detection using PET.

Colorectal cancer (CRC) screening, the decade's most promising cancer-related public health development, is evolving. Faecal immunochemical tests (FIT) will be the primary population-based CRC screening biomarker for the next 10–15 years. Will the international community exploit the full potential of FIT and other CRC risk indicators to enable a revolution in the effectiveness of screening?

An international consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease has recently been published. The statement is an important starting point to address the many problems we still have with the clinical classification and treatment of fistulising Crohn's disease.

NSAIDs provide improved pain control and reduce the use of opioids—both important components of enhanced recovery programs after colorectal surgery. However, the possible association between NSAID use and anastomotic leaks is greatly debated. Anastomotic leak remains an important concern due to the substantial associated morbidity.

There is increasing interest in the role that diabetes has in liver-related outcomes in patients with chronic HCV. Elkrief and colleagues have furthered this discussion by indicating that diabetes may be considered a prognostic factor for major liver-related outcomes in patients with chronic HCV infection, including death and transplantation.