Opinion

If gastrointestinal cancer diagnosis is to be both timely and affordable in the future, the roles of health-care professionals need to be reframed. In this Perspectives, the authors consider how the relationship between medical specialists and generalists can be better integrated for optimal clinical outcomes and patient experience.

Traditionally, biopsy has been a mainstay and gold standard for the diagnosis of coeliac disease, but a biopsy-sparing approach has been suggested and adopted for the assessment of children in some countries. Here, the authors outline the current diagnostic methods for coeliac disease, discussing the pros and cons of a no-biopsy approach for both adults and children.

Acute gastroenteritis precipitates post-infectious IBS in 10–30% of patients. In this Perspectives, Ghoshal and Gwee discuss evidence of overlap between post-infectious IBS, tropical sprue (which can also develop after acute gastroenteritis) and small intestinal bowel overgrowth, and argue that greater understanding of the links between these conditions will improve understanding of IBS pathogenesis.

Gut microbiota research has rapidly evolved, but has yet to translate fully to the clinic. In this Perspectives, Eamonn Quigley explores whether the gut microbiota could be used as a clinical tool in gastrointestinal disease, providing a note of caution to the hype.

Rhythmic electrical slow waves generate the contractions fundamental to gastrointestinal motility and certain disorders. In this Perspective, Sanders and colleagues discuss the application of slow-wave extracellular recording techniques to gastrointestinal organs and how mechanical artefacts might contaminate these recordings and confound interpretation.

Although IBS and IBD are regarded as distinct entities, they do share features and symptoms. This Perspective explores the overlap between the two conditions, debating whether consideration of the similarities between IBS and IBD could improve treatment and inform future research.

The many gaps in our knowledge and understanding of HBV infection hampers our ability to develop and achieve a cure on a global scale. In this Perspective, Fabien Zoulim and colleagues propose the development of an international group consisting of four working groups (virology, immunology, innovative tools and clinical trials) to tackle the big questions and make important steps towards eradicating this disease.

Upper gastrointestinal cancer is often missed during examinations and survival outcomes are still poor among patients in the Western world. As discussed in this Perspectives, following the Japanese example, an improved gastroscopy technique, advanced training for endoscopists and optimized screening procedures for risk stratification will be necessary to elicit a change in clinical practice and improve diagnosis and treatment.

Treatment for inflammatory disorders has progressed remarkably since the introduction of highly effective biologic agents. Lessons can be learned from how other clinical specialties use immunomodulatory agents. In this article, Her and Kavanaugh introduce a rheumatology perspective to the management of inflammatory disorders to provide insights that might inform clinical practice in gastroenterology.

As understanding of the gut microbiota advances, the focus has shifted to ways to modulate the microbiota to improve health. One such strategy is the use of prebiotics. Here, Bindels and colleagues challenge the current definition of prebiotics, proposing revisions to the concept in an effort to strengthen the relevance of prebiotics as valuable therapeutic approaches.

The incidence of oesophageal adenocarcinoma has increased over the past four decades and although treatments have improved over this time, survival has not improved substantially. In this Perspectives, Vaughan and Fitzgerald suggest a five-tier strategy for prevention and control that begins with a wide population base and triages individuals into progressively higher risk strata, each with risk-appropriate prevention, screening and treatment options.

The origin of Barrett oesophagus has been debated for many years, but no consensus has been reached. In this Perspectives article, Stuart McDonald and colleagues look at the Barrett lesion itself: at its phenotype, its complexity, its clonal architecture and its stem cell organization. They conclude that current evidence most strongly supports an origin from stem cells in the cardia.

Clinical research in gastroenterology has largely been based on clinical trials or case series. Now, with the accumulation of vast amounts of health-care data in electronic medical records and repositories, research is progressing towards analysis of large databases (so-called big data). In this opinion piece, the authors describe how database analysis might be applied in gastroenterology.

Advancing the field of therapeutics for hepatocellular carcinoma has been far more challenging than initially anticipated; sorafenib is the only approved systemic therapy in more than 5 years. Marcus-Alexander Wörns and Peter Galle elucidate the current landscape of phase III trials in advanced HCC, with a special focus on future challenges.

This Perspectives article evaluates the progress that has been made in the field of neural stem cells for enteric nervous system disorders and outlines the challenges that remain before such treatments can be established in the clinical arena.

Liver transplantation is the best and most common treatment for patients with end-stage liver disease; however, great disparity exists between the need for liver organ grafts and available donors. In this Perspectives article, Chao-Long Chen et al. discuss the various reasons why living donor liver transplantation flourishes in Asia.

In this Perspectives, the authors highlight the bacteria identified as potential pathobionts (that is, pathogenic bacteria) in CRC. Furthermore, possible novel therapeutic avenues for rational prevention of pathogenic inflammation are outlined, as well as potential screening methods for CRC that target the human gut microbiota.

New insights into the virology of hepatitis D are stimulating the search for novel therapeutic approaches, but their clinical return seems far away. Here, Alessia Ciancio and Mario Rizzetto discuss the current epidemiological situation and the development of new therapeutic strategies against hepatitis D virus.

The advent of CT colonography (CTC) for colorectal cancer screen-ing has generated the need for conservative policies for post-test colonoscopy referral. This Perspectives summarizes the evidence on the natural history and management of subcentimetric colorectal polyps, and suggests a patient-tailored approach when these lesions are detected by CTC in a screening setting.

Patients with IBD who are reportedly in remission, but continue to have symptoms of abdominal discomfort and bowel dysfunction, could have IBS in addition to IBD. This Perspectives article examines the relationship between IBS and IBD, and discusses how to diagnose and treat IBS in patients with co-existing IBD.