Year in Review in 2013

In 2013, several new IBD drugs, including golimumab and vedolizumab, have been approved or completed successful programmes, showing efficacy in both Crohn's disease and ulcerative colitis. In addition, classic IBD drugs have been formulated for colonic delivery, such as budesonide MMX^®, which was recently approved for mild-to-moderate ulcerative colitis.

Advances are being made in understanding the pathogenesis, treatment outcomes and surveillance of Barrett oesophagus. Central obesity and age at onset of gastro-oesophageal reflux are being recognized as risk factors that have implications for screening. The persistent finding of nondysplastic Barrett oesophagus during surveillance is associated with low risk of malignant progression, whereas dysplastic Barrett oesophagus requires continued surveillance.

Coeliac disease comprises intolerance against dietary wheat, rye and barley gluten and is one of the most common food-related life-long disorders in Western countries. In 2013, new knowledge of the clinical diversity of coeliac disease and further details about the autoimmune aspects of this disorder have emerged.

Although the idea of faecal transplantation dates back many decades, only with advances in scientific technologies can we begin systematic development of this new class of therapeutics. The primary focus remains on treatment of Clostridium difficile infection—new applications are beginning to emerge, but a long journey remains ahead.

Successful treatment with antivirals reduces the incidence of some extrahepatic manifestations of HCV. Thus, the advent of well-tolerated and highly potent antiviral regimens might enable extension of the indication for therapy to patients at risk of developing serious extrahepatic disorders, irrespective of the severity of the underlying liver disease.

In 2012, important advances were made in understanding the pathogenesis of IBD—the Immunochip project increased the number of known IBD loci to 163, and underscored the common susceptibility to infectious diseases. With regard to management of IBD, novel non-anti-TNF agents have shown efficacy in phase II and III trials.

Knowledge of colorectal cancer (CRC) risks has been rebalanced in 2012. The 'serrated pathway' to CRC, exemplified by serrated polyposis syndrome, emphasizes the importance of serrated lesions. The dogma that patients with IBD are at high risk of CRC, however, might be overstated; optimizing CRC prevention needs to focus on patients at increased risk.

With the first HCV protease inhibitors approved in 2011, we are currently in a transition phase towards a shift in treatment paradigm. Within the next 3 years, the vast majority of patients with hepatitis C will probably be treated with completely different drugs in most Western countries.

Liver cancer remains an evolving indication for liver transplantation in the year 2012 as advances are made in patient selection, neoadjuvant treatment and living-donor liver transplantation. Patient survival is improving and, as patient selection and treatment advances, more transplantations can be conducted on patients with liver cancer.

New techniques have introduced unprecedented sensitivity to the investigation of the gut microbiota, enabling insights into the discrete contributions of select bacterial species and advancing our mechanistic appreciation of the roles of diet and host immunity in limiting or enabling metabolic and inflammatory disease.

Efforts to understand fatty liver disease have focused on the gut microbiome's stimulation of hepatic injury and fibrosis through specialized signalling complexes at the cell surface and in the cytosol of liver cells. Combined with increased hedgehog activity and progenitor cell expansion, new clues are emerging to elucidate the pathogenesis of fibrosis.