Reviews & Analysis

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  • The development of COX-2 inhibitors promised to achieve the benefits of NSAIDs without gastrointestinal complications. Although clinical outcome studies have demonstrated a reduction in ulcer complications with COX-2 inhibitors the magnitude of these benefits in terms of cost-effectiveness is unclear. The cardiovascular safety of these drugs also needs to be taken into account in cost-effectiveness comparisons.

    • David Y Graham
    • Francis KL Chan
    Viewpoint
  • The past decade has witnessed substantial advances in the treatment of chronic hepatitis B, and the nucleoside and nucleotide analog inhibitors lamuvidine and adefovir dipivoxil have been a major part of this. This article discusses the benefits and limitations of treatment with lamuvidine and adefovir dipivoxil, and nucleoside and nucleotide analogs being evaluated in phase II/III clinical trials.

    • Scott K Fung
    • Anna SF Lok
    Review Article
  • Basic research has led to rapid progress in understanding the mechanisms underlying hepatic fibrosis. Fibrogenic hepatic cell types have been characterized, as have general and disease-specific mechanisms. Studies also indicate that hepatic fibrosis is reversible. The impact of this work on clinical practice is that treating hepatic fibrosis is now emerging as a real possibility.

    • Scott L Friedman
    Review Article
  • Our understanding of carcinogenesis in Barrett's esophagus has markedly increased in the past decade, thanks to the close interaction of clinicians, epidemiologists and basic scientists. This review discusses how reflux of gastroduodenal contents, dietary habits, obesity, upper gastrointestinal infections and exposure to carcinogens might contribute to the development of cancer in Barrett's esophagus.

    • Navtej S Buttar
    • Kenneth K Wang
    Review Article
  • During the past few years there has been renewed interest in the management of chronic anal fissure. Treatment with botulinum neurotoxin is less expensive and easier to perform than surgery and does not require anesthesia. It is also more efficacious than nitrate therapy and is not related to the patient's willingness to complete treatment.

    • Giuseppe Brisinda
    • Federica Cadeddu
    • Giorgio Maria
    Review Article
  • Gallstone disease continues to be a significant problem. The recent identification of mouse genes may help determine susceptibility to the disease. An infectious etiology hypothesis has also been proposed to explain the development of gallstones. Could these discoveries lead to more effective strategies for the prevention and treatment of gallstones?

    • Sum Lee
    Viewpoint
  • At present, there is no standard treatment for cholangiocarcinoma, a fatal cancer of the biliary tree. New therapies for cholangiocarcinoma are difficult to evaluate because treatment endpoints are ill-defined. This viewpoint explains why the current endpoints are problematic and proposes a new quantitative system for assessing disease progression.

    • Gregory J Gores
    • Edwina S Baskin-Bey
    • Steven R Alberts
    Viewpoint
  • Hepcidin is the iron-regulatory hormone that links innate immunity and iron metabolism. Normally, a regulatory feedback loop with circulatory iron controls hepatic hepcidin production. Inflammatory stimuli upregulate hepcidin production, which can lead to anemia. Anemia downregulates hepcidin production. Human disorders associated with inappropriate hepcidin levels include anemia of inflammation and hereditary hemochromatosis.

    • Antonello Pietrangelo
    • Christian Trautwein
    Review Article
  • At present there is no cure for chronic pancreatitis—a progressive condition that culminates in the destruction of the pancreas. Recent advances in genetic and immunologic research have spawned new insights into the mechanisms underlying chronic pancreatitis, and new models are helping us understand associated risk factors and etiologies.

    • David C Whitcomb
    Review Article
  • The etiology and pathogenesis of ulcerative colitis remain unclear, but evidence is accumulating that both genetics and the environment are important. Although diagnosis remains based on well-established clinical, endoscopic and histologic criteria, recent advances in the detection of fecal and serologic markers and the use of wireless capsule endoscopy promise to aid diagnosis.

    • Stephen B Hanauer
    Review Article
  • At present, there is no uniformly effective treatment for recurrentClostridium difficile-associated disease. Tapering and pulsing antibiotics after a 10-day standard course can decrease the recurrence of disease, as can adjunct use of the probiotic Saccharomyces boulardii. Restoration of normal colonic flora might be another treatment option, and new treatment approaches being developed include a vaccine.

    • Christina M Surawicz
    Review Article
  • This article highlights the case of a 74-year-old Caucasian female who presented with jaundice, clay-colored stools, diarrhea, and fatigue of 3 months' duration, accompanied by a weight loss of 6.8 kg. The results of initial investigations were interpreted as primary sclerosing cholangitis, but futher investigation revealed lytic and and blastic bone lesions. A sacral bone biopsy established the diagnosis of systemic mastocytosis.

    • Georgios I Papachristou
    • Anthony J Demetris
    • Mordechai Rabinovitz
    Case Study