Reviews & Analysis

Although alcohol consumption and tobacco use are the major risk factors for esophageal cancer in developed countries, nutrition and diet are also important. This Viewpoint discusses evidence for a link between diet and esophageal cancer and the influence it might have with regard to the prevention of esophageal cancer.

Dyspepsia is remarkably common. Of those individuals with dyspepsia who present for care, perhaps 10% are referred because their symptoms remain refractory and troublesome. Many gastroenterologists seem to feel somewhat at a loss in this situation; however, there are sensible management options to consider. This Review considers the testing and treatment alternatives, and discusses what can be done for the difficult-to treat dyspeptic patient.

Chronic consumption of alcohol can cause a spectrum of liver abnormalities, ranging from simple steatosis to steatohepatitis, cirrhosis and hepatocellular carcinoma. Alcoholic liver disease is still the most common cause of liver cirrhosis in the Western world. This Review focuses on the current management of patients with alcoholic liver disease, with emphasis on alcoholic steatohepatitis and cirrhosis.

The main physiologic function of albumin is to maintain colloid osmotic pressure. The recognition of many other physiologic functions, however, means that the clinical application of albumin has expanded. This Review discusses the physiologic actions of albumin, the clinical settings in which albumin has been used in patients with cirrhosis, and the potential benefits and pitfalls associated with the use of albumin.

This Viewpoint makes a plea for more uniform, careful and complete endoscopic diagnosis and grading of Barrett's esophagus in both clinical practice and research. Incorporation of the initiatives proposed into adequately powered, multicenter, prospective studies should provide much needed authoritative guidance on the management of Barrett's esophagus.

In this Review, the authors consider the most common severe complication of endoscopic retrograde cholangiopancreatography (ERCP)—post-ERCP pancreatitis—for which there is no definitive means of prevention. The risk factors for post-ERCP pancreatitis and pharmacologic and procedural ways of reducing its incidence are discussed, including proper patient selection, minimally traumatic cannulation techniques and pancreatic duct stenting.

Vitamin D deficiency is common in patients with cirrhosis and is associated with bone density changes. It is generally recommended that patients with cirrhosis and low bone density receive calcium and vitamin D supplementation, despite a lack of evidence for a role of vitamin D in the pathogenesis or treatment of osteoporosis in cirrhotic patients. This Review revisits the controversy surrounding the role of vitamin D in hepatic bone disease and discusses vitamin D therapy in this setting.

In the US, up to 30% of colon cancers exhibit familial clustering and 3–5% are associated with high-risk, inherited colon cancer syndromes. The authors of this Review discuss the clinical presentation and genetics of the major inherited colon cancer syndromes. Particular attention is paid to genetic testing, including when it is indicated, methods used and potential pitfalls. The role of the genetic counselor is also explored.

This Viewpoint discusses the role of stool DNA testing as a new diagnostic tool for detecting colorectal cancer. Preliminary data show it to have better performance characteristics than fecal occult blood testing, however, in its current form sensitivity remains low. Stool DNA testing needs to be studied in larger cohorts of asymptomatic patients, and new markers need to be developed before its role in colorectal cancer screening can be fully established.

This Review considers the bacterial virulence factors and host inflammatory responses involved in the development of gastric cancer afterHelicobacter pylori infection, as well as the signaling pathways affected and possible molecular targets for intervention. The effect of H. pylori eradication and the modification of environmental conditions on the progression of the gastric carcinogenic process triggered by H. pyloriare also discussed.

Advances in our understanding of the molecular events underlying the activation of the immune system have led to the development of a new generation of small molecules with immunosuppressive properties and that serve as immunomodulators. In this Review, the authors report on the progress that has been made in the development of small molecules in the field of gastroenterology.

Endoscopy is an established tool for the diagnosis and treatment of patients with upper gastrointestinal bleeding. The timing of endoscopy is, however, a matter of controversy. This Viewpoint article argues that endoscopy has the greatest potential for therapeutic benefit and reductions in costs and resource use when it is performed urgently, before a patient is admitted to hospital.

Few celiac disease patients now present with the classic symptoms and signs of overt malabsorption. As upper gastrointestinal symptoms are common in celiac disease patients, esophagogastroduodenoscopy might be part of their initial workup, often without celiac disease being considered within the differential diagnosis. This Review describes the endoscopic markers associated with celiac disease and their role in its diagnosis.

Basic research has provided evidence for a role for statins in cancer treatment and prevention; however, clinical research has both supported and refuted the role of statins in this setting. In this Review, the authors critically evaluate the current body of literature on the role of statins in the treatment and prevention of gastrointestinal cancers, with a particular focus on clinical and observational studies.

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.