Reviews & Analysis

Bile acids have a crucial role in the digestion of dietary lipids and as signalling molecules in a number of metabolic pathways. Bile acid receptors have become attractive therapeutic targets for liver disease and metabolic disorders. Here, the authors provide an overview of bile acid signalling in humans and highlight the therapeutic potential of compounds that target these pathways.

This Review describes how the latest advances in so-called –omics technologies have helped to provide novel insights into the development and biology of oesophageal adenocarcinoma and its precursor lesion Barrett oesophagus. The authors discuss how these molecular profiles could improve patient management in the future, including early diagnosis and monitoring of response to therapy.

A new study has reported the long-term effectiveness and cost-effectiveness of the direct-acting antivirals telaprevir and boceprevir for the treatment of chronic hepatitis C. These findings have the potential to be used to guide clinical and reimbursement decisions for treating populations with a high prevalence of HCV infection.

Here, the authors summarize new insights into the pathogenesis of NAFLD and NASH, in particular the mechanisms responsible for liver injury and fibrosis. They highlight how a complex interplay between the environment (especially diet), host genetics and the gut microflora is crucial for the development and progression of NAFLD.

The development of obesity and NAFLD is known to be determined by host genetics, diet and lack of exercise. In addition, the gut microbiota has been shown to influence the development of both of these conditions. In this Review, current understanding of the relationship between the intestinal microbiota, obesity and NAFLD is discussed, with an emphasis on causal relationships, latest advances and therapeutic opportunities.

Paediatric IBD often presents with a more severe phenotype and course than adult-onset disease. Here, the current knowledge concerning treatment options for children with IBD are reported. The effectiveness and safety of new therapeutic advances, including biologic agents, in these paediatric patients are also discussed.

Women worry that their IBD will flare during pregnancy. A prospective multicentre study from Europe has now demonstrated that although women with Crohn's disease do not have an increased risk of relapse during pregnancy, women with ulcerative colitis are at increased risk of relapse, both during pregnancy and postpartum.

In light of the high mortality rate associated with hepatocellular carcinoma (HCC), chemopreventive strategies to prevent or delay the development of this disease are attractive. This Review outlines advances in the field of HCC chemoprevention, in particular focusing on the potential of antiviral therapy against HBV and HCV, the cancer-modifying effects of statins, antidiabetic medications and aspirin, as well as dietary strategies.

Currently, a gluten-free diet is the only approved therapy for coeliac disease. Advances in the understanding of the disease pathogenesis have enabled researchers to develop new treatment strategies. This Review outlines the search for novel future treatment modes and discusses the potential pitfalls of the new research avenues.

Current therapies for chronic HBV infection are focused on adults. However, the timing of primary infection of HBV often occurs during infancy or childhood, particularly in endemic areas. Children have the potential for a long lifespan and should be treated properly and early before complications develop.

With millions of humans infected yearly with HCV, leading to cirrhosis and cancer, a vaccine is urgently needed. Cultured virus particles constitute the antigen in most antiviral vaccines. A study in mice demonstrated induction of neutralizing antibodies by immunization with cell-culture-derived HCV, providing new possibilities for vaccine development.

With expanding waistlines, the prevalence of NAFLD has burgeoned to become the leading cause of chronic liver disease in the USA. A subset of patients with NAFLD meet criteria for NASH with its inherent risk of progression to cirrhosis. Verma et al. addressed the utility of alanine aminotransferase levels for predicting NASH or advanced fibrosis to decide who would benefit from the definitive test of liver biopsy.

Golimumab, a human anti-TNF antibody, is effective in patients with ulcerative colitis, according to new findings from an international phase III double-blind trial. The addition of this drug makes a ménage à trois of available drugs—comprising infliximab, adalimumab and golimumab—for the treatment of ulcerative colitis.

IBD often affects patients during their peak reproductive years. In this Review, the authors summarize the latest information concerning the safety of medications used to treat IBD during pregnancy and lactation, as well as their effect on fertility.

Endomicroscopy and endocytoscopy not only enable prediction of histology, but actual visualization of microscopic tissue details in real time. The authors of this Review discuss these microscopic imaging devices, outlining potential indications for their use and future directions for this technology.

Pancreatic cancer remains a lethal malignancy with poor prognosis. Here, the authors summarize emerging data on the role of mucins in the development and progression of pancreatic cancer and its microenvironment and discuss the diagnostic and therapeutic contributions of mucins for patients with pancreatic cancer.

This Review summarizes advances in molecular imaging approaches and provides an overview of molecular beacons and targets, as well as endoscopic devices for imaging. Studies on detection and characterization of lesions are put in perspective along with current challenges for this innovative approach.

Genetic testing in relatives of individuals with Lynch syndrome is of utmost importance for targeted screening and prevention. A recent systematic review suggests that the uptake of testing in at-risk relatives is inadequate and therefore the cost-effectiveness of Lynch syndrome testing is questionable. The results of this study are discussed here.

The evolution in surgical technique has somewhat bridged the chasm between need and availability of liver grafts for young children. This study, using data on >2,600 liver transplantations in children <2 years of age from the United Network of Organ Sharing, shows that partial grafts from deceased donors can provide outcomes on par with whole livers.

The main therapeutic strategies for GERD are antireflux surgery and pharmacological intervention. The vast majority of patients with GERD receive or prefer medical over surgical therapy. A recent study compared minimal access surgery with medical management and provided 5-year follow up data.