Reviews & Analysis

The use of nutritional therapy for Crohn's disease is controversial. The author of this Viewpoint article discusses the available evidence for this type of therapy, including data on therapeutic efficacy, possible mechanisms of action and groups of patients for whom this approach might be particularly beneficial. He also highlights directions for future research.

In this Case Study, Schnitzbauer et al. describe the case of a 30-year-old male who suffered multiple fractures and extensive internal injuries, including liver rupture with formation of a hematoma, because of a motorcycle accident. While in intensive care, the hepatic hematoma became infected with antibiotic-resistant bacteria and serum levels of cholestatic parameters started to increase, until retrograde cholangiography supported a diagnosis of cholangitis in a critically ill patient. Acute liver failure ensued, and liver transplantation carried out. In spite of a number of intervening complications, 50 months after transplantation the patient was in good health; therefore, the authors conclude that post-traumatic sclerosing cholangitis should probably become an indication for liver transplantation.

This Viewpoint article discusses changes in current understanding of the pathogenesis of pilonidal disease and evidence for off-midline primary closure methods as the best techniques for the surgical management of this disease. The potential role for antibiotics in the treatment of pilonidal disease is also discussed.

This Case Study considers a 51-year-old male who developed unilateral hearing loss while taking pegylated interferon and ribavirin for the treatment of chronic hepatitis C infection. The patient was treated with prednisone and continued with his antiviral therapy. Improvement in the patient's hearing was achieved within a few days, and full recovery was achieved within 2 months.

In the past 15 years there has been continuous improvement in outcome after orthotopic liver transplantation (OLT). As such, the recognition and prevention of long-term post-OLT complications—rejection episodes, recurrence of underlying liver disease and the adverse effects of immunosuppression—have become ever more important. This Review suggests guidelines for the management of OLT recipients to improve long-term survival, overall outcome and health-related quality of life.

Even after complete resection of nonmetastatic pancreatic cancer, recurrence rates are high. Combined modality therapy including radiation therapy reduces the recurrence rate and improves disease-free survival for several types of tumor of the gastrointestinal tract, but the use of adjuvant radiotherapy for pancreatic cancer is controversial. In this Review, the authors discuss the studies—prospective and retrospective—and the issues surrounding the use of adjuvant radiotherapy for pancreatic cancer.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common diseases of the Western world, and is associated with an increased risk of cardiovascular disease. The beneficial effects of moderate wine consumption on cardiovascular function are well known. This Viewpoint article discusses potential risks and benefits of alcohol consumption in patients with NAFLD.

In the past few years, newly developed technologies have improved endoscopic recognition of the duodenum, making possible the real-time recognition of the duodenal villous pattern during upper endoscopy. This Review highlights the progress made that could be helpful for the diagnosis of celiac disease, including the development of the water-immersion technique, high-resolution magnification endoscopy, chromoendoscopy, optical band imaging, optical coherence tomography and confocal endomicroscopy.

This article considers the case of a 72-year-old male who presented with epigastric pain, anorexia and progressive jaundice. Liver function tests revealed enzyme abnormalities consistent with cholestasis, while radiographic and endoscopic findings were suggestive of autoimmune pancreatitis with biliary involvement. Examinations for the presence of malignant cells were negative. A diagnosis of autoimmune pancreatitis with IgG₄-associated cholangitis was made and the patient was treated with corticosteroids.

Gastrointestinal complications are a common occurrence in patients receiving oncologic therapy. These complications can be severe or even life-threatening and, therefore, require prompt diagnosis and treatment. This Review discusses some of the most common gastrointestinal complications associated with oncologic therapy, including esophagitis, diarrhea, radiation proctitis and drug hepatotoxicity. The diagnosis and symptoms of the complications are discussed, together with current concepts relating to their treatment.

Celiac disease is a common condition and is associated with considerable morbidity and mortality. The incidence of celiac disease is increasing, and a substantial proportion of new diagnoses are in elderly individuals. This Review highlights age-related differences in the clinical presentation, investigation and management of elderly patients suspected of having celiac disease, and emphasizes the need for a greater awareness of this condition in the elderly population.

Dietary treatment for obesity can lead to reasonable weight loss, resulting in associated health benefits. The author of this Review discusses the various types of diet available for the treatment of obesity, their relative efficacies, and associated adverse effects. The author also considers alternative treatment options when dietary strategies fail and discusses the challenges associated with long-term weight maintenance.

Interferon-based therapy is the cornerstone of treatment for chronic hepatitis C; however, many patients do not respond optimally to current treatment regimens. In this Review, the author considers how interferon-based therapy might be tailored to ensure the best chance of achieving a sustained virological response while preventing over-treatment. The potential of alternative treatment options that will most likely be used in combination with interferon, at least initially, is also discussed.

The use of antibiotics in patients with active, uncomplicated IBD is controversial. Clinical studies in patients with Crohn's disease have been small and yielded uncertain results, which have discouraged clinicians from including antibiotics in the therapeutic armamentarium for this disease. The author of this Viewpoint article discusses the available evidence for the use of antibiotics in IBD, and outlines possible mechanisms of action.

IBS is a common disorder; however, the available treatment options are unsatisfactory for many patients. A considerable percentage of patients with IBS seek advice from practitioners offering complementary and alternative medical approaches. This Review discusses the literature for alternative mind-body interventions for the treatment of IBS, and addresses the potential relationship of these interventions to the biopsychosocial model and IBS.

Infectious diarrhea is a global health issue that affects billions of individuals annually. The diarrheas can be classified as noninflammatory or inflammatory based on their pathogenesis and clinical presentation. This Review presents our current understanding of the pathogenesis and clinical syndromes of infectious diarrheas, including their epidemiology and the various host factors that protect against enteric infection.

The eradication ofHelicobacter pyloriinfection is still a challenge for clinicians. Approximately 5% of patients who undergo two courses of eradication therapy remain infected. The authors of this Viewpoint article discuss the available options for salvage therapy in these patients and the role of antimicrobial susceptibility testing in this setting.

Numerous hereditary cancers involve the gastrointestinal tract, and identification of these familial cancer syndromes should improve the detection, diagnosis and management of affected patients. This Review addresses the role of gastroenterologists and genetic counselors in the recognition of hereditary cancer syndromes, and suggests how a partnership between these two professions can influence the management of the patient and their family.

This article discusses the 11-year case history of a 13-year-old girl who presented with vomiting, abdominal pain and distension with evidence of small-bowel obstruction. Over the years, numerous laparotomies were performed for recurrent abdominal symptoms, which were managed with intravenous fluids, bowel rest and nasogastric decompression of the upper gut. After a diagnosis of primary visceral myopathy was made, prokinetic agents were prescribed and a venting gastrostomy inserted for decompression. Total parenteral feeding was initially used to maintain nutrition but was ceased when her symptoms improved.

The efficacy of triple therapy forHelicobacter pyloriinfection is often unacceptably low. As a consequence, new first-line treatment alternatives have been proposed. This Viewpoint article discusses the options for improving first-line therapy cure rates either by triple therapy modifications—increasing the length of treatment and/or using high doses of PPIs—or promising new drug schedules such as 'sequential' or 'concomitant' therapies.