Volume 10 Issue 11, November 2013

A new 'intelligent knife' provides near-real-time intraoperative tissue analysis and enables accurate differentiation between malignant and benign tissue. This ability to 'smell' cancer could be applicable to a variety of oncological operations in gastroenterology, but some questions and limitations remain as this interesting new technology is explored.

Much understanding of IBD pathology is based on personal experience, anecdotal observations and small case studies. A paper on the histopathology of IBD provides an exhaustive literature review, and attempts to delineate guidelines for pathologists to use by providing evidence for consensus statements developed by a European contingent of gastrointestinal pathologists and clinicians.

Here, the authors summarize new insights into the pathogenesis of NAFLD and NASH, in particular the mechanisms responsible for liver injury and fibrosis. They highlight how a complex interplay between the environment (especially diet), host genetics and the gut microflora is crucial for the development and progression of NAFLD.

The development of obesity and NAFLD is known to be determined by host genetics, diet and lack of exercise. In addition, the gut microbiota has been shown to influence the development of both of these conditions. In this Review, current understanding of the relationship between the intestinal microbiota, obesity and NAFLD is discussed, with an emphasis on causal relationships, latest advances and therapeutic opportunities.

NAFLD is a complex disease. Considerable variability exists in the severity and risk of morbidity and mortality among individuals with NAFLD, which could be influenced by genetic and environmental factors. Here, the authors discuss the latest knowledge on the genetics of NAFLD and how this genetic variation might determine disease phenotype and progression.

The incidence of NAFLD, which increases the risk of liver cancer, is increasing to epidemic proportions. This Review outlines the correlations between liver cancer and NAFLD-related cirrhosis, and the role of the metabolic syndrome in the development of liver cancer. Advances in understanding the progression of NAFLD to hepatocellular carcinoma from preclinical models will also be discussed.

Accurate diagnosis and staging of NAFLD is of utmost prognostic importance. The gold standard for diagnosis is histological examination, but growing interest exists in novel noninvasive methods to evaluate NAFLD. This Review describes the advantages and limitations of noninvasive methods for the diagnosis and quantification of steatosis, diagnosis of NASH and staging of hepatic fibrosis in NAFLD.

Optimal management of NASH is required because the condition can progress to cirrhosis and end-stage liver failure. Once first-line therapy with diet and lifestyle changes has failed, pharmacological intervention is indicated. This Review discusses the available evidence from clinical trials on pharmacological agents for NASH.

Global differences in the prevalence and presentation of NAFLD are presented in this Perspectives article. The authors also convey how scientific advances in our understanding and management of NAFLD now need to be translated to improve awareness at the level of society, influence global health policy and research priorities and ensure a better future for our coming generations.

Dramatic changes in the lifestyle and diet of the global population are fuelling the worldwide epidemic of obesity and the increasing prevalence of NAFLD. Experts now predict that the next epidemic of chronic liver disease worldwide will be a direct result of obesity and the development of NAFLD, with NAFLD replacing viral hepatitis as the primary cause of end-stage liver disease and liver transplantation. These six specially commissioned Reviews and one Perspectives articles, written by key opinion leaders in the field, highlight new understanding of the pathogenesis and genetics of NAFLD, provide practical insights into noninvasive diagnosis and pharmacological agents available to treat the disease, and discuss the global NAFLD epidemic.