Reviews & Analysis

After endoscopic resection of Barrett neoplasia, complete ablation of the remaining Barrett segment is thought to reduce the risk of relapse. Little is known about the long-term outcome of radiofrequency ablation (RFA) after prior endoscopic resection of Barrett neoplasia. The use of RFA in nondysplastic Barrett oesophagus is receiving increasing levels of criticism.

The leading clinical investigators from the European community, the so-called “Mallorca group”, have recently published revised guidelines for the clinical management of Lynch syndrome. Their paper provides an important update on the identification, education and management of Lynch syndrome, but further investigation is still warranted.

Acute-on-chronic liver failure (ACLF) is a unique clinical entity that causes confusion amongst clinicians because no clear definition or standardized clinical features have been agreed worldwide. A recent comprehensive study provided an evidence-based definition and addressed its clinical features in patients with ACLF who have cirrhosis with acute decompensation.

The risk of severe complications during colonoscopy is very low. This risk should be kept low when changing strategies to reduce discomfort during the examination. The increased use of deep sedation from <10% in 2000 to 35% in 2009 might have its downsides in years to come if the trend continues.

Although numerous studies have reported the safety and efficacy of laparoscopic surgery for rectal cancer, the results of large multicentre randomized controlled trials have been lacking. A study including 1,103 patients has now shown that laparoscopic surgery for rectal cancer can result in similar safety, resection margins and completeness of resection with improved recovery compared with laparotomy.

Nys et al. discuss the emerging role of autophagy as a regula-tor of immune and/or inflammatory responses and as a stress adaptive mechanism, and analyze its value as a diagnostic and/or therapeutic target in Crohn's disease. Moreover, they highlight how several drugs used in the treatment of Crohn's disease have already been shown to affect autophagy induction as part of their mode of action.

Various factors are reported to affect the risk of local recurrence after resection of colorectal liver metastases. This article discusses the findings of a recent study that investigated the effect of fatty liver disease on the risk of recurrence.

Compelling evidence indicates that liver regeneration after portal vein occlusion and liver resection promotes tumour progression in patients with colorectal liver metastases. Here, the authors present clinical and experimental data from animal models of colorectal liver metastases pertaining to whether liver regeneration causes proliferation of tumour cells.

Patients with elderly-onset IBD are more likely to have marked comorbidities and polypharmacy than those diagnosed at a younger age, which might affect therapeutic decision-making. Increased knowledge of this higher-risk group might guide patient management. Data from a large population-based study evaluating the clinical presentation and course of elderly-onset IBD are discussed.

Variceal bleeding is a life-threatening condition. Here the au-thors summarize recent clinical findings and present the most updated advances on the management of gastro-oesophageal varices and variceal bleeding.

The authors present the emerging evidence that pancreatic cancer causes diabetes and associated weight loss. The emerging concepts in the pathogenesis of these metabolic changes are also discussed as well as the potential for the discovery of biomarkers for the early diagnosis of pancreatic cancer.

This Review presents current knowledge on the complex popu-lation usually included under the umbrella term of nonerosive reflux disease. The authors outline the need to clearly separate the subsets of patients with real reflux disease from the sub-group with functional heartburn, which does not pertain to GERD.

Functional gastrointestinal disorders (FGIDs) have traditionally been diagnosed on the basis of characteristic symptom patterns in the absence of organic disease that explains the symptoms. Evidence is now emerging that structural abnormalities in the brain might have a role in the pathophysiology of FGIDs.

Severe acute malnutrition is a life-threatening disease affecting millions of children. A recent study has now identified an immature gut microbiome as an important contributing factor in children with kwashiorkor. The condition was transmissible into gnotobiotic mice by combining stool transplantation and region-specific diet. In addition, antibiotics reduce mortality in children with kwashiorkor.

NAFLD is becoming much more common, and will soon be the major underlying aetiology for liver transplantation. This article discusses the evidence that NAFLD is a multisystem disease and outlines the factors that determine interindividual variation in the development and progression of NAFLD.

The acinar cell of the exocrine pancreas produces, stores and secretes enzymes necessary for the digestion and absorption of food. Here, Logsdon and Ji describe two major stressors of the acinar cell, endoplasmic reticulum and digestive enzyme stress, which are major drivers of pancreatic pathology, as well as outlining the coping mechanisms that have evolved to compensate for these two key stressors.

Post hoc analysis of treatment responses from a European achalasia trial confirms that subtyping of patients with achalasia does help direct therapy. The high success rates for types I and II achalasia with either pneumatic dilatation or laparoscopic Heller myotomy support the recommendation that available local expertise should be a major consideration in treatment choice.

Better tools for early detection and accurate staging of pancreatic cancer are needed. The role of ¹⁸F-fluorodeoxyglucose (FDG)-PET in this setting is controversial. The results of a large retrospective study analyzing the value of FDG-PET in the diagnosis of pancreatic ductal adenocarcinoma are discussed here.

Gastrointestinal mucus is the first line of defence against bac-teria; the organization of this protective system varies markedly along the digestive tract. In this Review, the authors provide an overview of the mucus system and discuss the role of mucus in health and disease.

Therapy for Crohn's disease has traditionally been based on a step-up approach, with treatment with the powerful TNF antagonists reserved as a last resort before surgery. In this Review, the authors discuss the use of anti-TNF agents as first-line therapy to achieve disease modification and the challenges in selecting appropriate patients for this approach.