Volume 4 Issue 6, June 2007

Many clinicians approach the diagnosis of IBS as one of exclusion, even though diagnostic testing usually has a low yield and the Rome guidelines encourage diagnosis on the basis of symptoms alone. This Viewpoint discusses patterns of IBS diagnosis in practice, provides theories on why guidelines are not adhered to, and offers some practical guidance on IBS diagnosis.

Autoimmune pancreatitis—a nonalcoholic, chronic lymphoplasmacytic pancreatitis that frequently results in the stenosis of the main pancreatic duct and distal common bile duct—has been accepted as a unique clinical entity that is present predominantly in the Asian population. In this Review, the authors discuss various issues surrounding autoimmune pancreatitis, including its definition, epidemiology, pathogenesis and etiology, clinical presentation, diagnosis and treatment.

Although conventional IBD surgery can be performed using a minimally invasive approach, controversy surrounds the role of laparoscopy in the surgical management of IBD. The authors of this Review consider the current position of laparoscopy in the surgical management of IBD, the short-term and long-term results achieved using this approach, and the supposed benefits and difficulties associated with such minimally invasive surgery.

The pathogenesis of gastroparesis is complicated and poorly understood: this lack of understanding has impeded the development of effective therapies for gastroparesis. In this Review, the authors examine the data available on the pathogenesis of gastroparesis, discussing both animal and human studies, and the role of nerves, interstitial cells of Cajal and smooth muscle.