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Weight loss and, even more importantly, weight loss maintenance are required to reduce the health risks associated with obesity. Conservative treatment by lifestyle changes and pharmacotherapy is often unsuccessful in the long-term, and bariatric surgery is only indicated in the very obese. Could intragastric balloon treatment bridge the gap between pharmacotherapy and surgery in patients who fail to respond to drugs?
Two population-based studies highlight the detrimental role of night-time GERD symptoms on sleep quality. The studies reinforce the observation that loss of sleep is associated with night-time GERD symptoms, and that sleep loss from GERD is associated with decreased work production, increased use of health-care resources, and an overall reduction in quality of life for patients.
Variceal rebleeding frequently develops in patients with cirrhosis after an initial episode of acute variceal hemorrhage. The best prophylactic treatment for variceal rebleeding has not been clearly identified. Several studies have been performed to determine an optimal approach but no agreement exists about how best to treat these patients.
A long-term follow-up study used sequential liver biopsy specimens to evaluate fibrosis and signs of steatohepatitis in a large number of severely obese patients undergoing bariatric surgery, and found that bariatric surgery reduces steatosis in most patients. There are some important lessons to be learnt from the findings of this study and some unanswered questions for further investigation.
Mucosal healing has emerged as an important treatment goal for patients with IBD. This Review article focuses on the definition of mucosal healing, the ability of available IBD medications to induce and maintain mucosal healing, and the influence of mucosal healing on the course of IBD. The article also discusses how best to integrate the treatment end point of mucosal healing into clinical practice for the management of patients with IBD.
Hepatitis D is considered to be the most severe form of viral hepatitis in humans and represents a major health burden in certain areas of the world. Diagnosis is challenging and treatment options are limited. This Review discusses the epidemiology, virology, pathogenesis, diagnosis and management of hepatitis D and highlights future challenges.
Therapeutic options to treat the common cancer hepatocellular carcinoma are limited and new treatments are therefore required. Radioembolization with iodine-131 or rhenium-188 labeled lipiodol, or with yttrium-90 labeled microspheres is a promising approach. Jean-Luc Raoul and coauthors discuss the different radionuclides and delivery vehicles used, the clinical trial data and the future perspectives for radioembolization.
Hereditary hemochromatosis, or primary iron overload, is one of the most frequent genetic diseases in the world. This Review describes the regulation of iron metabolism and the inherited mutations that cause hereditary hemochromatosis. The author also discusses inherited and environmental modifiers that affect the severity of the disease.
A range of treatments for hepatic fibrosis are currently in the development process. However, the single greatest limitation in bringing these therapies to the clinical setting is a lack of sufficient methodology for assessing their pharmacological effects. This Perspectives article highlights the potential for novel and existing biomarkers to act as treatment end points in clinical trials of new drugs for hepatic fibrosis.
