Volume 6 Issue 4, April 2009

The recent outbreak of Salmonella typhimurium, associated with peanut butter and products containing it in the US and Canada, highlights our ongoing susceptibility to food-borne infections despite advanced food production systems. As the globalization of food resources continues, how can we control outbreaks and minimize their effect on health?

The recurrence of hepatitis C in HCV-infected, orthotopic liver transplant recipients is a major problem that can influence the survival of both grafted tissue and patients. Yet the effects of immunosuppression strategies, in particular those of steroids, on disease recurrence remain unclear.

Antibodies against tumor necrosis factor are a highly effective treatment for Crohn's disease, as measured by disease-activity indices. But what influence does this type of therapy have on the health-related quality of life of patients with Crohn's disease?

A retrospective, comparative study that focuses on patients with already impaired kidney function adds to the body of evidence that links administration of oral sodium phosphate bowel-preparation solutions for colonoscopy with a decrease in renal function. When possible, a polyethylene glycol solution should be used instead.

A promising new scoring system has stratified mortality risk in a large group of patients with acute pancreatitis. This new model is more practical than APACHE II, but needs to be validated in patients in whom the diagnosis of acute pancreatitis can be verified from detailed clinical records.

Adolescents with celiac disease who adhere to a gluten-free diet have a better quality of life than those who do not comply with the diet, according to a new study. Adolescents who are diagnosed as having this disease at a young age also have improved quality of life.

This review discusses advances in enteral access procedures that have considerably broadened the indications for tube feeding and have led to a substantial reduction in the need for total parenteral nutrition. Enteral feeding can now be given to most patients in the intensive care, and is associated with improved outcomes.

HCV infection is a key cause of liver disease and a worldwide health problem. The authors of this Review discuss the HCV life cycle and the mechanisms that enable the virus to evade host immune mechanisms and persist within the host. Improved understanding of HCV survival strategies should facilitate the development of effective antiviral therapies.

Intestinal fibrosis is a common and potentially serious complication of IBD. The traditional view that the development of fibrosis in these patients is inevitable and irreversible is progressively changing with improved understanding of the pathogenic mechanisms of fibrosis. This Review discusses the complex general mechanisms of fibrosis and addresses specific issues related to intestinal fibrosis in the setting of IBD, including the potential implications of novel treatments.

Several endocrine disorders are thought to have a role in the etiology of chronic liver disease and the development of nonalcoholic steatohepatitis. This Review discusses the evidence that causally links hormonal disorders, including thyroid disorders, growth hormone and adrenal insufficiency and polycystic ovary syndrome with liver disease. The role of hormone replacement to normalize liver function in some patients is also discussed.

This article considers the case of a 66-year-old white man who presented with a productive cough and pleuritic chest pain on his right side 6 months after undergoing transarterial chemoembolization for hepatocellular carcinoma. The patient was diagnosed with a biliopleural fistula, and this Case Study explores the diagnosis and management of this patient.