Volume 6 Issue 7, July 2009

Several novel antiviral treatments for HCV are in preclinical or clinical development, and most target viral enzymes and their functions. These new drugs all potentially select for resistant viral variants, both in vitro and in vivo; viral resistance is, therefore, likely to become an important issue in clinical practice.

The low success rates of standard triple-therapy regimens for eradication of Helicobacter pylori infection have led to development of alternative approaches. Findings from a new meta-analysis that compared the efficacy of concomitant quadruple therapy with that of standard triple therapy revealed the concomitant approach to be superior for eradication of H. pylori.

Selection of an optimum treatment regimen for patients with ulcerative colitis depends on several factors, including the natural history of the disease. A new study indicates that prognosis for patients with newly diagnosed ulcerative colitis might not be as bad as typically thought—an important finding that should be taken into account when the risks and benefits of future treatment strategies are discussed.

Current recommendations for the performance of laparoscopic sigmoidectomy in patients with diverticulitis reserve this procedure for individuals who have complications of the disease or have had numerous, severe disease episodes. Findings from a 2009 study challenge this dogma and suggest that patients' quality of life should also be considered.

The routine use of diagnostic laparoscopy for young women who present with right iliac fossa pain reduces the rate of negative appendectomy, according to a new study. However, the implementation of laparoscopy as a routine approach for the diagnosis of suspected acute appendicitis would probably increase morbidity and mortality for these patients.

Patients with Barrett esophagus and high-grade dysplasia or intramucosal carcinoma have traditionally been managed by esophagectomy. However, the development of endoscopic ablative therapies has changed this management approach. This Review discusses the different endoscopic ablative therapies currently available including tissue-acquiring and non-tissue-acquiring modalities. The success rates and complications of the different techniques are also addressed.

Standard treatment with pegylated interferon and ribavirin only cures just over half of patients with HCV infection. Pereira and Jacobson review the evidence on the efficacy and promise of several specifically targeted antiviral therapies, which, most likely in combination with interferon and ribavirin, may improve the success rate of HCV therapy.

Pancreatic cancer is lethal and notoriously difficult to treat, therefore, there is an urgent need to develop new therapeutic and diagnostic modalities. This Review discusses the agents that have been developed to target the pathways and processes involved in pancreatic tumorigenesis, and reviews the results of laboratory and clinical trials of these agents. Future therapeutic targets are also discussed.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Treatment options for patients with advanced HCC are limited because of the lack of effective chemotherapeutic agents. This Review discusses the mechanisms of targeted therapies and describes clinical studies that have investigated the safety and efficacy of these therapies in patients with HCC. Perspectives for future developments are also provided.

This article considers the case of a 58-year-old man who presented with a 35-year history of Crohn's disease, pararectal fistulas and abscess formation. He had been taking azathioprine therapy for approximately 5.5 years. He was started on infliximab; however, his fistulas persisted and the abscess recurred. He was, therefore, switched to adalimumab. After development of pancytopenia, a bone marrow biopsy and a diagnostic splenectomy were performed, leading to a diagnosis of hepatosplenic T-cell lymphoma.