Reviews & Analysis

Over the past decade, inflammation-induced alterations at the hepatocellular, bile ductular and ductal level have been linked to different clinical presentations of cholestasis in sepsis. In this Review, the authors give a comprehensive overview of the molecular and cellular mechanisms that underlie sepsis-associated cholestasis and the potential clinical and therapeutic implications that these mechanisms have for critically ill patients.

The author of this Review considers who is at risk of developing NSAID-related gastrointestinal complications, what treatment options are available for patients with a high gastrointestinal risk, the cardiovascular risk of COX-2 inhibitors, and how to assess the risk. Recommendations for prescribing NSAIDs according to both gastrointestinal and cardiovascular risk are provided.

This Viewpoint discusses the limited effectiveness of standard medical treatments for IBS, which leave about half of patients without satisfactory symptom relief. The article argues that adjunctive psychological therapies might enhance overall IBS outcomes as evidence suggests that psychological treatments can provide long-lasting symptom improvement for the majority of patients with IBS that is refractory to medical treatment.

The authors of this Review focus on non-malignant portal vein thrombosis (PVT), the second most common cause of portal vein occlusion. Discussion includes how the two different forms of PVT—acute and chronic—are diagnosed, how they can be treated and what the outcomes are. PVT in the setting of cirrhosis and liver transplantation is also discussed.

Home parenteral nutrition (HPN) has advanced since its introduction in the late 1960s, such that patients with intestinal failure can now survive and lead productive lives outside the hospital. This Review considers the indications for HPN, the complications that can arise, and the quality of life of patients on HPN.

Celiac disease has previously been regarded as a benign intestinal disorder that can be easily treated by a gluten-free diet. This Review article discusses advances in the understanding of the genetics and immunology of celiac disease, and considers evidence for the independent existence of the adaptive and innate immune response to gluten.

The role of psychological distress in provoking and exacerbating IBD is controversial. This Viewpoint discusses the role of psychological factors in the pathogenesis of IBD and focuses on the need for including psychological care in the clinical management of patients with IBD.

Cholangiocarcinoma is, in most cases, rapidly fatal, having an inadequate response to the treatment strategies currently available. The authors of this Review describe the mechanism of action, efficacy and complications of photodynamic therapy—a relatively new local, minimally invasive treatment for cholangiocarcinoma that uses the photo-physical properties of photosensitizers to destroy tumors.

Pathogenic intestinal protozoa are responsible for clinically important infections in both the developed and developing world. Treatments have been available for several decades for giardiasis, isosporiasis and amoebiasis, but until recently there were no effective remedies for the intestinal coccidia—cyptosporidium, microsporidium and cyclospora. In this Review, the author discusses the various pathogenic intestinal protozoa and the treatment options available.

The treatment of chronic hepatitis B has improved substantially in recent years. FDA-approved therapies now include interferon α, pegylated interferon α2a, lamivudine, adefovir dipivoxil, and entecavir. Other antiviral agents and combination regimens are in various stages of development. This Review summarizes the results obtained for approved therapies and highlights emerging antiviral agents for the treatment of chronic hepatitis B.

The treatment of idiopathic acute pancreatitis is challenging owing to its varied etiology. This Viewpoint discusses the use of empiric cholecystectomy as a definitive treatment option for idiopathic acute pancreatitis caused by occult gallstone disease, and compares cholecystectomy with other treatment options including biliary sphincterotomy and medical therapy with ursodeoxycholic acid.

Intestinal detoxification and defense systems are important for maintaining normal gut physiology. This Viewpoint presents the concept that inflammatory bowel disease might be caused by a defective mucosal detoxification system. Polymorphisms in detoxification genes and related endobiotic plasma biomarkers might both support diagnosis, stratification and therapy in patients with inflammatory bowel disease.

In the past few years, data obtained from work in animal models, human genetics, basic science and clinical trials, has provided new insights into the mechanisms underlying Crohn's disease and ulcerative colitis. In this review, the author discusses the evidence underlying the disparate theories on the pathogenesis of these diseases and attempts to reconcile them into a coherent hypothesis based on the experimental data.

This Review considers the pathophysiologic basis for transjugular intrahepatic portosystemic shunt (TIPS) placement in cirrhotic patients with refractory ascites. The effect of TIPS placement on hemodynamics and sodium retention is discussed, along with how TIPS placement compares with large-volume paracentesis–the standard therapy for refractory ascites. Disadvantages of the procedure, predicting mortality after TIPS placement, candidate selection and monitoring after TIPS placement are also covered.

Colorectal cancer claims more than 50,000 lives annually in the US. Screening for colorectal cancer, with the removal of any identified polyps, significantly impacts the death rate from this largely preventable cancer. This Viewpoint discusses the relative merits and pitfalls of colonoscopy and CT colonography as screening modalities in the setting of colorectal cancer.

A constellation of cardiac abnormalities, including blunted contractile responses to stress and repolarization abnormalities, can be found in patients with cirrhosis. So-called cirrhotic cardiomyopathy is now recognized as a significant contributor to morbidity and mortality. In this Review, the authors discuss the clinical features of cirrhotic cardiomyopathy, pathogenic mechanisms underlying the condition, and general diagnostic criteria and treatment measures for cirrhotic cardiomyopathy.