Volume 11 Issue 7, July 2014

Increased gastro-oesophageal reflux (GER) is described as a very common problem in infants. Loots et al. investigated the effect of the left lateral position on reflux and symptoms, finding that body position affects GER but not symptoms. The data highlight the difficulties faced in investigating reflux disease in the paediatric population.

Patients with noncoeliac gluten sensitivity (NCGS) can experience a range of gastrointestinal and extraintestinal symptoms. A study has now demonstrated that gluten is independently associated with depression in patients with NCGS. NCGS-associated depression might share similar pathophysiological mechanisms to other neurological manifestations observed in gluten-related disorders, such as ataxia and encephalopathy.

Predicting outcomes in upper gastrointestinal bleeding (UGIB) is important for identifying patients at high risk of morbidity and mortality who would benefit from early intervention. Various scoring systems have been developed to this end, but could clinical judgment replace or complement these risk stratification scores?

HBV transmission remains a global health issue despite the availability of an effective and safe vaccine. Mother-to-child transmission remains an important source of incident cases of HBV. Here, Tran Tram and Heather Patton provide an overview of issues pertinent to HBV infection during pregnancy and present a proposed management algorithm.

Narcotic bowel syndrome (NBS) is characterized by incompletely controlled abdominal pain that cannot be explained by another known or previous diagnosis in patients receiving steady or increasing doses of opioids. In this Review, the authors summarize the literature on NBS including diagnosis, patient characteristics, mechanisms and treatment options.

High-quality bowel preparation is essential for effective colonoscopy. The modern colonoscopist considers efficacy, tolerability and safety when selecting bowel preparations. In this Review, Doug Rex presents his perspective in describing elements of a bowel preparation programme that enhance high-quality colon cleansing with acceptable tolerability.

Chronic diarrhoea induced by bile acids is common and the underlying mechanisms are linked to homeostatic regulation of hepatic bile acid synthesis by fibroblast growth factor 19 (FGF19). This Review first concentrates on studies that have investigated different methods to increase recognition and diagnosis of bile-acid-induced diarrhoea, before describing further evidence for a role of FGF19 and logical steps to improve treatment, related to findings with FGF19.

Portal vein thrombosis (PVT) is a fairly common complication of liver cirrhosis. In this Review, the authors discuss the evidence regarding the management of PVT in patients with liver cirrhosis and propose an exploratory and preliminary algorithm, noting the limited data and low-quality evidence available to date.

Advancing the field of therapeutics for hepatocellular carcinoma has been far more challenging than initially anticipated; sorafenib is the only approved systemic therapy in more than 5 years. Marcus-Alexander Wörns and Peter Galle elucidate the current landscape of phase III trials in advanced HCC, with a special focus on future challenges.