Volume 11 Issue 2, February 2014

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.

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.

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.

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.

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.

2013 saw several advances in small bowel endoscopy: new 3D visualization software, increased battery life, side-viewing cameras and higher frame rate. Studies on prokinetics for patient preparation, safety in the elderly, rebleeding after negative capsule endoscopy and defining optimum training requirements for fellows were encouraging. Procedure time and small bowel length evaluated by double-balloon and spiral endoscopy were shown to be comparable.

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.

Paediatric IBD often presents with a more severe phenotype and course than adult-onset disease. Here, the current knowledge concerning treatment options for children with IBD are reported. The effectiveness and safety of new therapeutic advances, including biologic agents, in these paediatric patients are also discussed.

Transition of adolescents and young adults with IBD from paediatric to adult-focused health-care systems can be difficult, and care is needed to avoid breaks in continuity of care and negative effects on patient health. Here, Zeisler and Hyams provide a comprehensive overview of transitional care in paediatric IBD.

IBD often affects patients during their peak reproductive years. In this Review, the authors summarize the latest information concerning the safety of medications used to treat IBD during pregnancy and lactation, as well as their effect on fertility.

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.

IBD can develop rapidly in individuals of any age, from young children to older people in their sixties and seventies. Clinical research findings now indicate that the characteristics of the disease vary according to the age at disease onset and so specific management approaches are required depending on when IBD develops. The five Reviews in this Focus issue bring together leaders in the field to provide new insights into the protection of mothers and babies during pregnancy and/or lactation, management of paediatric patients, how best to coordinate the transition of patients from a paediatrician to a gastroenterologist during adolescence, as well as how to diagnose and manage elderly-onset IBD.