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Screening for colorectal cancer is effective in preventing a major cause of morbidity and mortality. Before implementing organized screening programs, however, policymakers must consider its value relative to other health-related and nonhealth-related needs. One way of doing so is cost-effectiveness analysis. This Viewpoint highlights some key issues surrounding such analysis and suggests areas for further research.
The ubiquity of gluten in foodstuffs, patient compliance, and variable patient susceptibility to gluten are all limiting factors of the gluten-free diet—the treatment of choice for celiac disease. New therapeutic strategies are emerging as a result of improved understanding of the molecular events underlying celiac disease; this Viewpoint considers whether a gluten-free diet is still adequate.
Until recently, the active form of vitamin D was thought to function primarily as a regulator of calcium and phosphate metabolism; discovery of the vitamin D receptor in tissues not involved in calcium and phosphate homeostasis has challenged this view. The authors of this Review discuss the immunomodulatory role of vitamin D and evidence for its involvement in the pathogenesis of inflammatory bowel disease.
Intraductal papillary mucinous neoplasia (IPMN)—a spectrum of neoplastic changes in the epithelial lining of the pancreatic duct—is being increasingly recognized. There is controversy surrounding the natural history, evaluation, surgical management and surveillance of IPMN. The authors of this Review present pooled surgical data and future directions, and propose an algorithm for the management of patients with IPMN.
This Review considers the endoscopic ablative techniques now available for use in the esophagus—photodynamic therapy, laser therapy, multi-polar electro-coagulation, argon plasma coagulation, endoscopic mucosal resection, radiofrequency ablation and cryotherapy. At present, photodynamic therapy is the only FDA-approved ablative modality for high-grade dysplasia in Barrett's esophagus, but, at this stage, it is not clear which technique will emerge as superior for the treatment of esophageal adencocarcinoma precursors.
