Reviews & Analysis

In this Review, the authors discuss the justification for living donor liver transplantation (LDLT), the introduction of LDLT for the treatment of pediatric patients and its expansion to include the treatment of adult recipients. How pediatric and adult recipients are selected, LDLT performed, and the implications for living donors affected by these decisions are also considered.

Dietary supplements are increasingly used by a large percentage of the population worldwide. The potential impact of these supplements on our health, however, is not fully understood and their regulation is not controlled as tightly as that of drugs. This viewpoint article discusses the safety concerns and regulatory issues that surround the use of dietary supplements in the US.

Although the incidence of peptic ulcer disease and ulcer complications has decreased over the past few decades, there has been an increase in ulcer bleeding, especially in elderly patients. The authors of this Review consider the current status of understanding, diagnosis and treatment of peptic ulcer disease, and management issues that remain to be solved.

Constipation is often mild and intermittent, but can be debilitating and require medical consultation. When management with first-line conservative therapy is unsuccessful, additional studies are needed to better understand the underlying pathophysiology. This Review considers the modern principles and therapies used to manage chronic constipation of varying severities.

One area of gastroenterology that lags behind other specialties in the quality of the evidence base for clinical practice is the prevention of gastrointestinal cancer. In this Review the authors assess the evidence for various cancer prevention strategies, especially chemoprevention, and highlight the obstacles to further exploitation of this knowledge base.

This Viewpoint discusses the role of combined multichannel intraluminal impedance-pH testing in the evaluation of patients with GERD symptoms that are refractory to proton-pump-inhibitor therapy. The relationship between symptoms and reflux is important as symptoms might not be due to continuing reflux, and these patients therefore might not benefit from surgery.

Bleeding from gastric varices is a life-threatening event that presents a therapeutic challenge for clinicians. This Viewpoint discusses the advance in nonsurgical treatment of gastric fundal varices, including the new radiologic technique of balloon-occluded retrograde transvenous obliteration.

In the past 20 years the management of peptic ulcer bleeding has been revolutionized by effective endoscopic hemostasis and potent acid-suppressing agents. The author of this Review considers the roles that risk stratification, pharmacologic therapy, endoscopic therapy and surgery now have to play in the management of this common and potentially fatal condition.

Optimal management of anticoagulant and antiplatelet agents during the periendoscopic period requires consideration, but limited prospective data mean that guidelines have largely relied on expert opinion. This Review summarizes the ASGE guidelines, details the relevant literature on which they are based, considers literature that has become available since their publication, and provides a framework for the management of periendoscopic anticoagulation.

This Review discusses cholangiocarcinoma, the incidence of which is increasing globally. There are several established risk factors for cholangiocarcinoma, and others are now being recognized. Diagnosis requires the integration of clinical information, imaging studies, tumor markers and histology. Surgery can be curative, but most patients have unresectable disease, in which case palliation can improve quality of life and might also improve survival.

Controversy exists as to whether ursodeoxycholic acid improves survival in patients with primary biliary cirrhosis. This is mainly because the disease is uncommon and slowly progressive, which has meant that many clinical trials lack hard endpoints such as mortality. This Viewpoint article discusses the importance of the appropriate design of clinical trials in this field.

Pyoderma gangrenosum is a rare condition of unknown etiology that was described as an extraintestinal manifestation of inflammatory bowel disease in 1930. At present, there are few well-designed published studies that help determine the optimal therapeutic strategy to use for the management of pyoderma gangrenosum. This article reviews the published treatment strategies in current use and aims to guide effective management.

This Review discusses the use of C-reactive protein as an inflammatory marker in gastrointestinal diseases. Inflammation does not produce a good C-reactive protein response in all diseases, however, and until there are more data, the use of C-reactive protein and other biomarkers should be seen only as an aid to clinical observation and physical examination and not as a replacement.

Gastroesophageal reflux disease is associated with laryngopharyngeal reflux, but the cause and effect relationship between these two clinical entities is far from established. This Review considers studies of the pathogenesis of laryngopharyngeal reflux, the value of diagnostic testing either on or off therapy, and treatment options and duration, that have increased our our understanding of this field.

Although there are many similarities among pediatric and adult Crohn's disease patients, some unique features of the pediatric population influence the therapeutic approach adopted; pediatric Crohn's disease can have a significant impact on the patient's quality of life, growth, bone health, and development. This Review focuses on the latest advances in the treatment of complicated pediatric Crohn's disease, including the use of biologic therapies such as infliximab.

In this era of critical organ shortage, how should physicians and patients decide whether to accept or decline the offer of a specific deceased-donor liver? The author of this Viewpoint article considers recent data evaluating the impact of donor characteristics and severity of recipient disease on the decision-making process.

Acute fatty liver of pregnancy is a devastating disorder that can significantly affect the morbidity and mortality of both mother and fetus. This Viewpoint discusses the prevalence and implications of this disorder and examines the role of genetic screening in helping to identify patients at risk for this disease.