Volume 11 Issue 8, August 2014

The majority of patients with coeliac disease are undiagnosed, leading to debate about the utility of screening. The heterogeneous clinical presentation, which includes asymptomatic forms, can partially explain the difficulties faced when identifying coeliac disease. Now, Kurppa and colleagues add another element to the debate by strengthening the arguments for general screening.

A new study suggests that co-prescription of low-dose aspirin and PPIs increases the incidence of small-bowel mucosal breaks. Should we be concerned about the potential negative interactions of these drugs? Or is the balance of evidence still substantially tipped towards the need for PPIs to protect against aspirin-induced upper gastrointestinal damage?

Placebo analgesia is increasingly appreciated in many difficult to treat chronic functional gastrointestinal disorders such as IBS. However, investigations of interactions between psychological and biological placebo factors are still in early stages. Now, technologies have been developed that enable neural mechanisms of placebo analgesia to be studied more directly in humans.

Several important changes in disease classification and improvements in the management of patients with acute pancreatitis have been achieved in the past few years. This Review provides an overview of these changes, the effect on patient management and outcome, and outlines their scientific basis.

Radiation enteropathy remains an important obstacle to uncomplicated cancer cures after radiation therapy of pelvic and abdominal malignancies. Moreover, the prevalence of radiation enteropathy in the population exceeds that of IBD. This Review introduces the clinical problem of radiation enteropathy, discusses contemporary concepts in pathogenesis, current therapeutic options and strategies for development of new radioprotective agents.

In this Review, the authors highlight the strengths and weaknesses of MRI for response assessment after chemoradiotherapy in patients with rectal cancer, and on its ability to predict tumour response at the time of primary diagnosis. New functional magnetic resonance technology is also outlined.

In this Review, various aspects of pretransplant donor liver management are discussed, including donor preconditioning, conventional and dynamic preservation techniques and ex vivo organ viability monitoring and graft pretreatment. The technique and clinical outcomes of split-liver transplantation are evaluated. Furthermore, the literature on rare liver donor conditions with non-standard ethical or technical issues is assessed with respect to clinical relevance.

The gut microbiota is now acknowledged to have a profound effect on human health and disease. Here, Stephen Collins explores the role of the gut microbiota in the development of IBS, describing experimental evidence and clinical observational and trial data that implicates the gut microbiota in the manifestation of IBS.

Probiotics are widely regarded as live microorganisms that, when administered in sufficient amounts, confer a health benefit, but guidance is needed on the most appropriate use of the term. This Consensus Statement outlines recommendations for the scope and definition of the term 'probiotic' as determined by an expert panel convened by the International Scientific Association for Probiotics and Prebiotics in October 2013.