Volume 6 Issue 9, September 2009

Relatively little information exists on the prognosis for elderly patients with chronic hepatitis C (CHC). Moreover, the majority of randomized, clinical trials of hepatitis C treatment exclude elderly patients. Findings from a 2009 clinical study address risk of hepatocellular carcinoma, life expectancy and the influence of antiviral therapy in elderly patients with CHC.

Nonalcoholic fatty liver disease has long been neglected by health-care professionals unless affected patients develop cirrhosis; however, new research shows this disease impairs health-related quality of life. The association of nonalcoholic fatty liver disease with chronic metabolic diseases and cardiovascular complications restricts our ability to define a specific role for liver damage in the poor perceived health status of these patients.

Few randomized, controlled trials have investigated the efficacy of pharmacological treatment for lymphocytic colitis. Data from a new randomized, placebo-controlled trial have demonstrated the efficacy of budesonide in inducing remission of this disease; this study is an important contribution to this field.

The optimal therapy for patients with metastatic and treatment-refractory colorectal cancer is controversial. Questions with regard to both the sequence and combinations of different drugs need to be answered by well-designed and adequately powered studies before the most appropriate option for second-line treatment for these patients can be defined.

More than 50% of patients infected with HCV genotype 1 fail respond to standard treatment with peginterferon plus ribavirin. Potent treatment strategies are urgently needed to improve outcomes for such patients. Novel interferons and specifically targeted antiviral therapy for HCV (STAT-C) represent promising strategies.

Considerable advances in tools for the diagnosis and management of Crohn's disease have been made. Despite technological progress, a new study reports that more than one-third of patients with Crohn's disease are still diagnosed with fistulizing disease intraoperatively and that the surgical management of these patients is not well characterized.

Restoration of normal growth is a marker of success of therapy in pediatric Crohn's disease. This Review highlights current understanding of the complex pathophysiologic mechanisms that contribute to growth impairment, which clearly stems from more than simply injudicious chronic corticosteroid use and inadequate nutrition.

The development of effective acid-suppression therapy has revolutionized the treatment of acid-related diseases. This Review provides an update on the status of acid-suppression therapy and includes discussion of the efficacy and safety of available agents, novel agents in development, risks of acid suppression, and directions for future research.

Acute cholangitis is a bacterial infection of the biliary tract that occurs in an obstructed system and is characterized by fever, abdominal pain and jaundice. No universally accepted consensus for the diagnosis of acute cholangitis exists. This Review describes current recommendations for the diagnosis and management of this disease and discusses the merits and drawbacks of the most comprehensive guidelines available.

Acute liver failure is the abrupt loss of hepatocellular function in a patient with a previously normal liver. In this Review, Stravitz and Kramer discuss the intensive care management of patients with acute liver failure, the treatment of complications to prevent multi-organ-system failure, and the role of orthotopic liver transplantation in this setting.

The incidence ofClostridium difficile infection has dramatically risen, in concert with the increasing use of PPIs for gastric acid suppression. This Perspective focuses on the role that PPI use may have in C. difficileinfection, and weighs up the pros and cons of PPI therapy.