Reviews & Analysis

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.

This Viewpoint discusses the limited effectiveness of standard medical treatments for IBS, which leave about half of patients without satisfactory symptom relief. The article argues that adjunctive psychological therapies might enhance overall IBS outcomes as evidence suggests that psychological treatments can provide long-lasting symptom improvement for the majority of patients with IBS that is refractory to medical treatment.

The authors of this Review focus on non-malignant portal vein thrombosis (PVT), the second most common cause of portal vein occlusion. Discussion includes how the two different forms of PVT—acute and chronic—are diagnosed, how they can be treated and what the outcomes are. PVT in the setting of cirrhosis and liver transplantation is also discussed.

Home parenteral nutrition (HPN) has advanced since its introduction in the late 1960s, such that patients with intestinal failure can now survive and lead productive lives outside the hospital. This Review considers the indications for HPN, the complications that can arise, and the quality of life of patients on HPN.

Celiac disease has previously been regarded as a benign intestinal disorder that can be easily treated by a gluten-free diet. This Review article discusses advances in the understanding of the genetics and immunology of celiac disease, and considers evidence for the independent existence of the adaptive and innate immune response to gluten.