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The development of COX-2 inhibitors promised to achieve the benefits of NSAIDs without gastrointestinal complications. Although clinical outcome studies have demonstrated a reduction in ulcer complications with COX-2 inhibitors the magnitude of these benefits in terms of cost-effectiveness is unclear. The cardiovascular safety of these drugs also needs to be taken into account in cost-effectiveness comparisons.
A central role is proposed for the gastrointestinal tract in graft-versus-host disease (GvHD) because the occurrence ofNOD2/CARD15mutations in the gut can predict severe GvHD. These findings could influence current therapeutic strategies for GvHD and Crohn's disease and change our understanding of their pathophysiology.
During the past few years there has been renewed interest in the management of chronic anal fissure. Treatment with botulinum neurotoxin is less expensive and easier to perform than surgery and does not require anesthesia. It is also more efficacious than nitrate therapy and is not related to the patient's willingness to complete treatment.
The past decade has witnessed substantial advances in the treatment of chronic hepatitis B, and the nucleoside and nucleotide analog inhibitors lamuvidine and adefovir dipivoxil have been a major part of this. This article discusses the benefits and limitations of treatment with lamuvidine and adefovir dipivoxil, and nucleoside and nucleotide analogs being evaluated in phase II/III clinical trials.
Basic research has led to rapid progress in understanding the mechanisms underlying hepatic fibrosis. Fibrogenic hepatic cell types have been characterized, as have general and disease-specific mechanisms. Studies also indicate that hepatic fibrosis is reversible. The impact of this work on clinical practice is that treating hepatic fibrosis is now emerging as a real possibility.
Our understanding of carcinogenesis in Barrett's esophagus has markedly increased in the past decade, thanks to the close interaction of clinicians, epidemiologists and basic scientists. This review discusses how reflux of gastroduodenal contents, dietary habits, obesity, upper gastrointestinal infections and exposure to carcinogens might contribute to the development of cancer in Barrett's esophagus.
