Volume 2 Issue 10, October 2005

Global differences in drug regulation might influence the availability of drugs for the treatment of irritable bowel syndrome in Europe. The author of this Viewpoint explores the role of drug regulation in the context of the difficulties faced in achieving therapeutic success in this challenging area.

The authors of this Review discuss the common causes and pathophysiology of gastroparesis—delayed gastric emptying in the absence of mechanical obstruction. The diagnostic approach to gastroparesis is also considered, along with evidence to support medical and surgical therapies, including currently available prokinetic drugs, novel medical therapies, and the promising technique of gastric electrical stimulation.

This Review considers the optimal approach to assessing the common medical problem of noncardiac chest pain, for which the appropriate application of investigations is controversial. In addition to musculoskeletal and psychiatric investigations, gastroesophageal investigations include esophagogastroduodenoscopy, radiological assessment, ambulatory esophageal pH monitoring, esophageal manometry, provocative tests, and a proton pump inhibitor test.

The authors consider the use of prognostic and diagnostic markers as an addition to initial clinical assessment for the identification of patients who are likely to develop severe acute pancreatitis. They also discuss antibiotic prophylaxis, fluid resuscitation and rehydration, enteral versus parenteral nutrition, pain management and the timing of surgical or interventional necrosectomy.

The availability of new, less-invasive diagnostic tools means that pathological diagnoses are increasingly required to be made from smaller biopsy specimens. The author of this Review addresses the diagnostic terminology used in the reporting of nongynecologic aspiration cytology results, makes recommendations of how clinicians should interpret these results and discusses additional tests that are required for certain diagnostic categories.