Reviews & Analysis

Cannabis (or marijuana) has been used in traditional medicine to treat intestinal inflammation. A survey by Ravikoff Allegretti et al. at a specialized IBD clinic shows that, in the USA, marijuana is used by a substantial number of patients with IBD to alleviate their symptoms.

In 2013, several new IBD drugs, including golimumab and vedolizumab, have been approved or completed successful programmes, showing efficacy in both Crohn's disease and ulcerative colitis. In addition, classic IBD drugs have been formulated for colonic delivery, such as budesonide MMX^®, which was recently approved for mild-to-moderate ulcerative colitis.

Factors associated with ageing, such as comorbidities, polypharmacy and diminished physical reserve, can affect the natural history of IBD. This Review highlights how these age-associated variables can affect older patients with IBD and also illustrates the multiple gaps in our current knowledge of IBD in the elderly.

Helicobacter pyloriinfection has been associated with multiple diseases, including cardiovascular disease and hepatobiliary diseases, localized outside of the stomach, especially those characterized by a persistent and low-grade systemic inflammation. Here, the authors describe the most important studies published so far about a possible role ofH. pyloriin non-gastrointestinal diseases.

IBD is a chronic disorder with disease onset ranging from early childhood to beyond the sixth decade of life. This Review provides an overview of the differences in epidemiology, clinical characteristics, and natural history of paediatric, adult, and elderly-onset IBD. In addition, potential differences in host–gene–microbial interactions according to age are highlighted.

We are moving towards an era of disease categorization beyond Crohn's disease and ulcerative colitis to a more robust definition of a spectrum of IBD subtypes. This Review outlines some of the genetic, clinical, biochemical, serological, and microbiome data that could be used for risk stratification and treatment selection in clinically meaningful subgroups of patients.

Advances are being made in understanding the pathogenesis, treatment outcomes and surveillance of Barrett oesophagus. Central obesity and age at onset of gastro-oesophageal reflux are being recognized as risk factors that have implications for screening. The persistent finding of nondysplastic Barrett oesophagus during surveillance is associated with low risk of malignant progression, whereas dysplastic Barrett oesophagus requires continued surveillance.

Coeliac disease comprises intolerance against dietary wheat, rye and barley gluten and is one of the most common food-related life-long disorders in Western countries. In 2013, new knowledge of the clinical diversity of coeliac disease and further details about the autoimmune aspects of this disorder have emerged.

Targeting angiogenesis has not been successful as a treatment for pancreatic cancer. Studies using monoclonal antibodies or small molecule inhibitors of the VEGFR pathway have failed to demonstrate benefit. Now, a phase II study has shown that sorafenib does not improve the efficacy of gemcitabine plus cisplatin chemotherapy in patients with locally advanced or metastatic pancreatic adenocarcinoma.

This Perspectives article evaluates the progress that has been made in the field of neural stem cells for enteric nervous system disorders and outlines the challenges that remain before such treatments can be established in the clinical arena.

Perinatal transmission of HCV is the main route of acquisition of HCV infection in children. Few studies have explored the mechanism of perinatal transmission, but a key role in transmission has been attributed to maternal viraemia. A new study now provides insights on the biological basis of this association.

Although the idea of faecal transplantation dates back many decades, only with advances in scientific technologies can we begin systematic development of this new class of therapeutics. The primary focus remains on treatment of Clostridium difficile infection—new applications are beginning to emerge, but a long journey remains ahead.

Endoscopic assessment in IBD provides direct visualization of the affected bowel mucosa. There is an important need for the meaningful measurement of these endoscopic images at the correct time point for medical decision-making and for clinical trials. European guidelines on endoscopy in IBD have recently been published.

Here, Nathalie Rommel, Jan Tack and colleagues provide an overview of the extensive literature concerning globus and discuss the quality of the evidence to date. They also put forward a potential theoretical model to support management and future research in globus.

Successful treatment with antivirals reduces the incidence of some extrahepatic manifestations of HCV. Thus, the advent of well-tolerated and highly potent antiviral regimens might enable extension of the indication for therapy to patients at risk of developing serious extrahepatic disorders, irrespective of the severity of the underlying liver disease.

This Review presents the emerging surgical therapies available to treat patients with faecal incontinence. These techniques include neuromodulation, neosphincter creation (muscle or artificial) and injection therapy. The need for further research and development—not only in terms of the devices and procedures, but also to identify which patients are likely to benefit most from such interventions—is also highlighted.

Cholera is a public health problem worldwide, with prevalence increasing over the past decade. A safe and affordable oral cholera vaccine is now available, and a study in Guinea has demonstrated that a cholera vaccination programme can be conducted with success in high-risk areas at the beginning of a cholera epidemic.

Patients chronically infected with HBV are at risk of HBV reactivation if immunosuppressive therapies are initiated. In this Review, Hwang and Lok describe the clinical manifestations, incidence and risk factors associated with HBV reactivation during immunosuppression. Practical insights into the management of patients with HBV who require immunosuppressive therapy are also provided.

Cardiac dysfunction has been reported in patients with cirrhosis—nearly half of whom have been shown to have abnormalities in cardiac function—and improved understanding of these changes has led to the definition of so-called cirrhotic cardiomyopathy. Here, the authors describe the underlying pathophysiology, clinical features, diagnosis and treatment of cirrhotic cardiomyopathy.

Reports from a large, prospective study in paediatric patients suggest that oesophagogastroduodenoscopy is valuable for diagnosis in children with chronic abdominal pain. Nonetheless, the vast majority of children with chronic abdominal pain will have a functional gastrointestinal disorder, and no test is needed to achieve this diagnosis.