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The management of alcoholic pancreatitis is mostly reactive; little is done to prevent disease progression. It is time for physicians to pay attention to the root cause of the condition—that is, alcohol—rather than just responding to its effects. This article discusses an important paper that describes the first prospective, randomized, controlled, clinical trial to investigate the effect of brief interventions for alcohol abuse on the progression of alcoholic pancreatitis.
Despite advances in laparoscopic surgery for colorectal cancer, the role of laparoscopic approaches for rectal cancer remains controversial. A large, single-center study has now demonstrated the safety and feasibility of laparoscopy for rectal cancer, which provides new incentives for prospective clinical trials to rigorously test this surgical approach.
Many patients with chronic constipation have a poor quality of life and are dissatisfied with laxative treatment. Findings from a multicenter, randomized, placebo-controlled, phase III study have demonstrated the beneficial effects of the 5-hydroxytryptamine 4 receptor agonist, prucalopride, for chronic constipation and associated symptoms. This drug represents the newest addition to the medical armamentarium for this disorder.
Approximately 50% of patients with chronic hepatitis C fail to achieve a sustained virological response to standard therapy with pegylated interferon and ribavirin. Progression to advanced liver disease (which may lead to hepatic decompensation, hepatocellular carcinoma, and death) is common in these patients, but can low-dose pegylated interferon maintenance therapy improve outcomes?
The benefit of preoperative combined chemotherapy and radiotherapy to perform sphincter-preserving surgery for patients with locally advanced distal rectal cancer is not supported by findings from randomized, controlled trials. These findings have, however, now been questioned by a study that supports the prospect of a tailored surgical approach to rectal-cancer treatment on the basis of tumor behavior after neoadjuvant treatment.
Appropriate clinical and pathological evaluation is crucial for the diagnosis and management of gastric polyps and polypoid lesions. This Review discusses the endoscopic characteristics, histopathology, pathogenesis and management of polyps and common polypoid lesions in the stomach, and provides a practical guide for gastroenterologists.
Ghrelin is an orexigenic hormone that acts to increase food intake and fat deposition, and at high doses, can modulate gastric motility. This Review addresses the actions of ghrelin in gastrointestinal systems. Studies that have investigated the role of ghrelin receptor agonists and antagonists for the treatment of gastrointestinal motility disorders and obesity are also discussed.
Advances in complementary metal oxide semiconductor technology have enabled the development of capsule endoscopy, a diagnostic technique that involves ingestion of a pill-sized camera that collects and relays still images of the tissues lining the gastrointestinal tract. Moglia and colleagues review the literature on the use of different capsule endoscopy devices for the inspection of the small bowel, esophagus and colon, and discuss the potential future applications and developments of this technology.
Gastrointestinal stromal cell tumors (GISTs) always have a degree of malignant potential, and, increasingly, they are diagnosed only on routine endoscopy. Sepe and Brugge provide a gastroenterologist's guide for GIST diagnosis and assessment of malignant potential. The authors of this Review also propose an algorithm for the treatment of localized GISTs that is especially useful for the management of incidentally diagnosed tumors.
This article considers the case of a 49-year-old man who presented with fatigue and poor concentration. He was diagnosed with HCV genotype 1 infection and started on a 48-week course of pegylated interferon α2b plus ribavirin. Despite initial reductions in his serum HCV-RNA levels, HCV-RNA remained detectable at week 12; however, it was undetectable by week 24. The patient was classified as a slow responder and therapy was extended to 72 weeks.
