Volume 11 Issue 6, June 2014

Serrated polyposis syndrome (SPS) is a condition characterized by multiple and/or proximal serrated polyps in the colorectum. Several features of SPS suggest there is an underlying genetic disorder that is yet to be identified. A new study provides insights on the diagnostic yield of screening colonoscopy in first-degree relatives of patients with SPS.

A staging system capable of addressing the real issues facing patients with hepatocellular carcinoma has long been overdue. The new Hong Kong Liver Cancer staging system might do just that because it deals effectively with the limitations of previous staging systems.

A new study proposes a modelling strategy to identify reactions, genes and metabolites relevant in hepatocellular carcinoma using in silico and in vivo analyses. The proposed genome-scale metabolic model integrates genomic and proteomic information, and points to statins, among others, as potential chemopreventive and anticancer drugs.

In an update on recommendations for colorectal cancer screening, an Asia–Pacific consensus group has set a good standard for presenting level of agreement to recommendation levels. However, this update also exposes how consensus groups might concentrate on the less controversial issues—leaving the tricky questions in the dark.

Advances in sequencing technologies have enabled the examination of liver cancer genomes at high resolution. The authors of this Review discuss somatic mutations, structural alterations, HBV integration, RNA editing and retrotransposon changes associated with liver cancer. Potential therapeutic targets are also highlighted.

Microvesicles—extracellular vesicles released by virtually all cells—are now implicated in key processes of liver diseases including fibrosis and complications of cirrhosis and hepatocellular carcinoma. This Review describes studies assessing circulating microvesicle levels in patients with liver diseases, together with an insight into the mechanisms that could account for these changes. The potential of microvesicles as biomarkers in liver diseases is also discussed.

HCV and HIV co-infection is associated with accelerated hepatic fibrosis progression and higher rates of liver decompensation and death compared to HCV monoinfection. However, with multiple direct acting antiviral agents in development to treat HCV, a unique opportunity exists to redefine the treatment paradigm for co-infected patients. In this Review, the authors address the epidemiology, natural history, pathogenesis and management of HIV and HCV co-infection.

The pathophysiology of IBD is complex. A number of genetic association studies and findings from research consortia have identified a large number of IBD susceptibility genes. Here, the authors describe available evidence on the genetics of IBD, and how this data can be used to inform our understanding of the disease itself, including insights into the functional consequences and how they provide novel therapeutic targets or disease biomarkers.

Clinical research in gastroenterology has largely been based on clinical trials or case series. Now, with the accumulation of vast amounts of health-care data in electronic medical records and repositories, research is progressing towards analysis of large databases (so-called big data). In this opinion piece, the authors describe how database analysis might be applied in gastroenterology.