Reviews & Analysis

The authors of this Review present what is known about the pathophysiology of increased coagulation in patients with cancer and how it applies to pancreatic carcinoma. The relationship between the activation of coagulation or symptomatic thromboembolic disease and the development of pancreatic carcinoma is explored. In addition, the relationship between thromboembolic disease and prognosis, and the rationale and evidence for the use of anticoagulants in patients with pancreatic carcinoma are considered.

Inborn errors of bile acid synthesis can present as neonatal cholestasis, neurologic disease or fat-soluble-vitamin deficiencies. In this Review, the authors discuss what we now know about the mechanisms underlying these disorders thanks to the application of modern biochemical and molecular techniques, the importance of early diagnosis, and the treatment options currently available.

The improvement of symptoms alone is no longer a satisfactory outcome for patients with Crohn's disease. The authors of this Viewpoint article argue that modification of the clinical course of Crohn's disease should be the major goal of medical therapy. Preliminary data suggest that the early use of biologics could achieve this aim in a subset of patients.

Gastroparesis is a poorly defined and poorly understood chronic digestive disorder that is difficult to treat. This Viewpoint article discusses evidence for the use of gastric electrical stimulation in patients with drug-refractory gastroparesis, and highlights directions for future research.

Heartburn is a challenging clinical symptom to treat as it does not always readily respond to antisecretory therapy. The authors of this Review provide an update on the evidence available to support the mechanisms currently postulated to underlie heartburn: acid reflux, weakly acidic reflux, bile reflux, mechanical stimulation of the esophagus, esophageal hyperalgesia and psychological comorbidity.

In this Review, the author focuses on the diagnostic evaluation of dysphagia, a disorder that is common in the general population and even more so in the elderly and in the chronic-care setting. In particular, the importance of taking a good history is emphasized. Consideration is also given to interpreting the findings of radiography, endoscopy and esophageal manometry, and what to do when these three modalities fail to yield a diagnosis.

This article considers the case of a 54-year-old male with a history of coronary artery disease, diabetes mellitus and tobacco abuse who presented with right upper quadrant abdominal pain, decreased appetite and jaundice. After admission, the patient's clinical status declined rapidly, with the development of confusion, respiratory failure, hypotension, renal failure and worsening lactic acidosis. The patient developed asystole and was pronounced dead on hospital day 4.

Biofeedback is a conditioning treatment in which information about a physiologic process is converted into a simple visual or auditory signal to enable the patient to learn to control a disordered function. In this Review, the authors consider the evidence for biofeedback as a treatment for IBS, functional dyspepsia, functional anorectal pain, aerophagia, fecal incontinence and functional defecation disorders, with a particular focus on dyssynergic defecation and fecal incontinence.

The tissue-engineered intestine might provide a viable alternative to intestinal transplantation for patients with intestinal failure. This Viewpoint discusses the available evidence regarding the feasibility of this type of treatment, and the state-of-the-art technology involved in creating a tissue-engineered intestine in the context of its clinical and technical limitations.

Colon cancer is the fourth most common cancer worldwide causing half a million deaths each year. The author of this Viewpoint article discusses the role of Src, a protein tyrosine kinase, in the metastasis of this disease, and potentially its treatment.

Fecundity is an important issue for women with ulcerative colitis or familial adenomatous polyposis who undergo resection of the rectum and creation of a restorative pouch. This Viewpoint article discusses the available literature on fecundity and fertility in these patients, directions for future treatments and the prevention of infertility in this patient population.

This Case Study considers a 56-year-old female with a 2-week history of fevers, chills and right upper quadrant pain. Her medical history was significant only for hypertension. She denied high-risk sexual behavior, the use of tobacco, alcohol or illicit drugs, had no sick contacts and had not traveled recently, but she had adopted a stray cat 1 month before presentation.

This Review addresses the problem ofHelicobacter pylori resistance. The authors discuss concepts of resistance that have become part of mainstream thinking for other infectious diseases but not for H. pylori. In addition, data on the pharmacokinetics and pharmacodynamics of the drugs used in H. pyloritherapy and the effect of host cytochrome P450 genotypes are put in context with treatment outcome.

Metabonomics—the study of metabolic changes in an integrated biological system—has the potential to identify biomarkers, enhance clinical diagnostic and prognostic information, and expand hypothesis generation. This Review introduces the basic principles of NMR spectroscopy and multivariate data analytical tools, both of which are essential components of metabonomics. The applications and potential of metabonomics in basic and clinical research relevant to the field of gastroenterology are also discussed.

Universal immunization against HBV and blood-donor screening for HBV and HCV have greatly decreased the risk of transmission of these viruses; however, a significant number of children still become chronically infected with HBV and HCV. In this Review, the authors consider the epidemiology, transmission, prevention, clinical presentation and natural history, management and screening, and treatment of hepatitis B and C in children.

This Case Study describes a female with ileocolic Crohn's disease who was taking immunosuppressive therapy who presented with a 1-month history of bloody diarrhea, decreased caliber of stools, a broad indurated perianal fissure as well as a deep palmar space abscess. The patient was diagnosed with disseminated histoplasmosis. The authors of this article discuss the diagnosis and management of this patient and the importance of considering histoplasmosis in patients on immunosuppressive therapy who develop atypical symptoms.

Virtual reality simulation as a training method for surgery has been available for more than a decade. Despite investigation into this technique, the desired widespread implementation of this training strategy has not been observed in clinical practice. This Viewpoint article discusses the advantages, disadvantages, current and future applications for virtual reality simulation in modern surgery.

Tumor angiogenesis—the formation of new tumor-associated vasculature—has been recognized as an essential event in tumor progression. Vascular endothelial growth factor (VEGF), one of the most important factors involved in tumor angiogenesis, is overexpressed in several gastrointestinal cancers. In this Review, the authors consider antiangiogenic therapy for the treatment of colorectal, gastric, hepatocellular and pancreatic cancer. Emphasis is placed on the mechanism of action and application of the humanized anti-VEGF monoclonal antibody bevacizumab, but other potential antiangiogenic targets and therapies are also discussed.

Gastrointestinal hormones are known to have an important role in the regulation of appetite and energy balance in obese individuals. In this Review, the authors consider several gastrointestinal hormones that have a role in modulation of the gut–brain axis and contribute to obesity, and examine their specific effects on appetite, hunger and energy balance.

This Case Study considers a 20-year-old female with a history of Crohn's colitis, perirectal abscesses and fistulizing disease who developed painful erythematous nodules in her pretibial region. She was on no medications for her Crohn's disease because of medication side effects and intolerance. Active Crohn's disease with perianal fistula and sigmoid colitis and erythema nodosum were diagnosed and treatment with adalimumab initiated.