Reviews & Analysis

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  • Pancreatic stellate cells are the main mediator of fibrogenesis during chronic pancreatitis, and chronic pancreatitis is a consistent risk factor for pancreatic ductal adenocarcinoma. In this Review, the authors discuss the idea that pancreatic stellate cells have a linking role in the development of pancreatic ductal adenocarcinoma via their ability to communicate with inflammatory cells, acinar cells and pancreatic cancer cells.

    • Hana Algül
    • Matthias Treiber
    • Roland M Schmid
    Review Article
  • This Review summarizes current understanding of nonalcoholic fatty liver disease, which is now accepted as the hepatic manifestation of metabolic syndrome. The authors consider the evaluation of patients at risk of developing nonalcoholic fatty liver disease, including the assessment of risk factors, the application of imaging modalities and the role of liver biopsy, as well as potential treatment approaches.

    • Clare Nugent
    • Zobair M Younossi
    Review Article
  • Numerous drugs can damage the gastrointestinal tract, and improved recognition of drug-induced gastrointestinal tract pathology is needed to improve patient care. The authors of this Review discuss the most common and well-described drug-related clinicopathological conditions of the gastrointestinal tract. Much discussion is dedicated to NSAIDs—the most commonly prescribed drugs and consequently the drugs most commonly associated with gastrointestinal tract toxicity.

    • Marc P Pusztaszeri
    • Robert M Genta
    • Byron L Cryer
    Review Article
  • The rising incidence of esophageal adenocarcinoma has stimulated interest in screening for Barrett's esophagus, but there is no proof that screening decreases esophageal cancer mortality. This Viewpoint argues that, on the basis of the available evidence, screening is beneficial, and that it is better to err on the side of caution and perform unnecessary screening rather than miss curable cancers.

    • Stuart J Spechler
    Viewpoint
  • With the advent of natural orifice translumimal endoscopic surgery (NOTES), a new dimension has been added to minimally invasive surgery. The authors of this Review examine the current status of NOTES, analyze the associated hazards and potential benefits of the technique, and consider the implications of NOTES for future surgical endoscopy.

    • Mihir S Wagh
    • Christopher C Thompson
    Review Article
  • Our understanding of how proteases function and interact within the gastrointestinal tract has been largely restricted to their role in nutrient digestion; however, it has become clear that proteases are involved in regulating signaling processes that are important for intestinal epithelial cell function. In this Review, the authors discuss how proteases impact gastrointestinal pathophysiology, specifically mucosal permeability, immune defense mechanisms and pathogenic challenges.

    • Toni M Antalis
    • Terez Shea-Donohue
    • Alessio Fasano
    Review Article
  • The large-scale study of protein expression and protein function by using molecular technologies—proteomics—has become increasingly attractive, because the proteome reflects the intrinsic genetic program of the cell and the impact of its immediate environment. This Review describes conventional proteomic technologies currently being used and their limitations, and demonstrates their clinical applicability, with specific reference to published data of relevance to the gastroenterology field.

    • Shahida Din
    • Anne Marie Lennon
    • Jack Satsangi
    Review Article
  • Disrupted sleep is reported by many patients with IBS, yet the role of sleep in IBS is not defined. This Viewpoint article discusses the subjective and objective evidence for disrupted sleep in patients with IBS, examines the relationship between gastrointestinal symptoms and sleep disturbance, and highlights areas for future research.

    • Ami D Sperber
    • Ariel Tarasiuk
    Viewpoint
  • Many clinicians approach the diagnosis of IBS as one of exclusion, even though diagnostic testing usually has a low yield and the Rome guidelines encourage diagnosis on the basis of symptoms alone. This Viewpoint discusses patterns of IBS diagnosis in practice, provides theories on why guidelines are not adhered to, and offers some practical guidance on IBS diagnosis.

    • Brennan MR Spiegel
    Viewpoint
  • Autoimmune pancreatitis—a nonalcoholic, chronic lymphoplasmacytic pancreatitis that frequently results in the stenosis of the main pancreatic duct and distal common bile duct—has been accepted as a unique clinical entity that is present predominantly in the Asian population. In this Review, the authors discuss various issues surrounding autoimmune pancreatitis, including its definition, epidemiology, pathogenesis and etiology, clinical presentation, diagnosis and treatment.

    • Tilman Pickartz
    • Julia Mayerle
    • Markus M Lerch
    Review Article
  • Although conventional IBD surgery can be performed using a minimally invasive approach, controversy surrounds the role of laparoscopy in the surgical management of IBD. The authors of this Review consider the current position of laparoscopy in the surgical management of IBD, the short-term and long-term results achieved using this approach, and the supposed benefits and difficulties associated with such minimally invasive surgery.

    • Sebastiaan W Polle
    • Willem A Bemelman
    Review Article
  • The pathogenesis of gastroparesis is complicated and poorly understood: this lack of understanding has impeded the development of effective therapies for gastroparesis. In this Review, the authors examine the data available on the pathogenesis of gastroparesis, discussing both animal and human studies, and the role of nerves, interstitial cells of Cajal and smooth muscle.

    • Harsha Vittal
    • Gianrico Farrugia
    • Pankaj J Pasricha
    Review Article
  • The cause of irritable bowel syndrome (IBS) remains a mystery and treatment continues to pose a real challenge. This Viewpoint examines the role of dietary, pharmaceutical and psychological therapies in IBS and the value of taking an integrated treatment approach to the management of patients with this condition.

    • Roger Jones
    Viewpoint
  • Advances in our understanding of hepatic fibrosis have provoked great excitement over the prospect of effective antifibrotic therapy. This Viewpoint looks at how far the field has advanced, what the remaining obstacles are, and whether antifibrotic therapy might soon become a clinical reality for patients with chronic liver disease.

    • Scott L Friedman
    Viewpoint
  • Nutritional support is an established and routine part of patient management. Conventionally, enteral nutrition is preferred to parenteral nutrition, because studies have indicated that enteral nutrition causes fewer complications. In this Review, the author critically analyzes the available data that compare these administration routes, and suggests that the effect of hyperglycemia, energy intake and obesity are perhaps more important than the route of nutrition in determining outcome.

    • Khursheed N Jeejeebhoy
    Review Article
  • The authors of this Review discuss the increased risk of morbidity and mortality associated with surgery in patients with underlying liver disease, and describe the essential role that preoperative assessment has in these patients. The nature and severity of the underlying liver disease and the type of surgery being undertaken are all considered and guidelines for preoperative assessment provided.

    • A James Hanje
    • Tushar Patel
    Review Article
  • Although the introduction of parenteral nutrition revolutionized the care of premature babies, long-term parenteral nutrition incurs the risk of life-threatening hepatic complications. The authors of this Review discuss the fundamentals of parenteral nutrition associated cholestasis, animal models of the disease, transporters crucial for bile acid homeostasis, and the molecular pathogenesis of this life-threatening condition.

    • Beth A Carter
    • Robert J Shulman
    Review Article