Volume 11 Issue 2, February 2014

Volume 11 Issue 2

Cover image supplied by M. J. Gora, V. J. Madden and G. J. Tearney, Wellman Center for Photomedicine at Massachusetts General Hospital and Harvard Medical School, USA. A 3D image of the oesophagus created by rendering data obtained from an unsedated human subject using a swallowable tethered capsule endomicroscopy device. The capsule employs optical coherence tomography: optics within the capsule spin a focused beam around its circumference, acquiring cross-sectional images as it traverses the organ via peristalsis. A flexible tether containing an optical fibre is attached to the capsule and can be used to control its position and to remove it from the mouth so that it can be disinfected and reused.

Research Highlights

Year in Review

  • Year in Review |

    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.

    • Francesco Negro
  • Year in Review |

    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.

    • Katri Kaukinen
    •  & Markku Mäki
  • Year in Review |

    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.

    • Emmanuel C. Gorospe
    •  & Kenneth K. Wang
  • Year in Review |

    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.

    • Silvio Danese
    •  & Laurent Peyrin-Biroulet
  • Year in Review |

    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.

    • Uday C. Ghoshal

Reviews

  • Review Article |

    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.

    • Joannie Ruel
    • , Darren Ruane
    • , Saurabh Mehandru
    • , Corinne Gower-Rousseau
    •  & Jean-Frédéric Colombel
  • Review Article |

    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.

    • Marina Aloi
    • , Federica Nuti
    • , Laura Stronati
    •  & Salvatore Cucchiara
  • Review Article |

    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.

    • Bella Zeisler
    •  & Jeffrey S. Hyams
  • Review Article |

    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.

    • Ole Haagen Nielsen
    • , Cynthia Maxwell
    •  & Jakob Hendel
  • Review Article |

    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.

    • Christina Y. Ha
    •  & Seymour Katz

Focus

  • Focus |

    IBD through the ages

    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.