Review Articles in 2006

In this Review, the authors consider the most common severe complication of endoscopic retrograde cholangiopancreatography (ERCP)—post-ERCP pancreatitis—for which there is no definitive means of prevention. The risk factors for post-ERCP pancreatitis and pharmacologic and procedural ways of reducing its incidence are discussed, including proper patient selection, minimally traumatic cannulation techniques and pancreatic duct stenting.

Vitamin D deficiency is common in patients with cirrhosis and is associated with bone density changes. It is generally recommended that patients with cirrhosis and low bone density receive calcium and vitamin D supplementation, despite a lack of evidence for a role of vitamin D in the pathogenesis or treatment of osteoporosis in cirrhotic patients. This Review revisits the controversy surrounding the role of vitamin D in hepatic bone disease and discusses vitamin D therapy in this setting.

In the US, up to 30% of colon cancers exhibit familial clustering and 3–5% are associated with high-risk, inherited colon cancer syndromes. The authors of this Review discuss the clinical presentation and genetics of the major inherited colon cancer syndromes. Particular attention is paid to genetic testing, including when it is indicated, methods used and potential pitfalls. The role of the genetic counselor is also explored.

This Review considers the bacterial virulence factors and host inflammatory responses involved in the development of gastric cancer afterHelicobacter pylori infection, as well as the signaling pathways affected and possible molecular targets for intervention. The effect of H. pylori eradication and the modification of environmental conditions on the progression of the gastric carcinogenic process triggered by H. pyloriare also discussed.

Advances in our understanding of the molecular events underlying the activation of the immune system have led to the development of a new generation of small molecules with immunosuppressive properties and that serve as immunomodulators. In this Review, the authors report on the progress that has been made in the development of small molecules in the field of gastroenterology.

Few celiac disease patients now present with the classic symptoms and signs of overt malabsorption. As upper gastrointestinal symptoms are common in celiac disease patients, esophagogastroduodenoscopy might be part of their initial workup, often without celiac disease being considered within the differential diagnosis. This Review describes the endoscopic markers associated with celiac disease and their role in its diagnosis.

Basic research has provided evidence for a role for statins in cancer treatment and prevention; however, clinical research has both supported and refuted the role of statins in this setting. In this Review, the authors critically evaluate the current body of literature on the role of statins in the treatment and prevention of gastrointestinal cancers, with a particular focus on clinical and observational studies.

Over the past decade, inflammation-induced alterations at the hepatocellular, bile ductular and ductal level have been linked to different clinical presentations of cholestasis in sepsis. In this Review, the authors give a comprehensive overview of the molecular and cellular mechanisms that underlie sepsis-associated cholestasis and the potential clinical and therapeutic implications that these mechanisms have for critically ill patients.

The author of this Review considers who is at risk of developing NSAID-related gastrointestinal complications, what treatment options are available for patients with a high gastrointestinal risk, the cardiovascular risk of COX-2 inhibitors, and how to assess the risk. Recommendations for prescribing NSAIDs according to both gastrointestinal and cardiovascular risk are provided.

The authors of this Review focus on non-malignant portal vein thrombosis (PVT), the second most common cause of portal vein occlusion. Discussion includes how the two different forms of PVT—acute and chronic—are diagnosed, how they can be treated and what the outcomes are. PVT in the setting of cirrhosis and liver transplantation is also discussed.

Home parenteral nutrition (HPN) has advanced since its introduction in the late 1960s, such that patients with intestinal failure can now survive and lead productive lives outside the hospital. This Review considers the indications for HPN, the complications that can arise, and the quality of life of patients on HPN.

Celiac disease has previously been regarded as a benign intestinal disorder that can be easily treated by a gluten-free diet. This Review article discusses advances in the understanding of the genetics and immunology of celiac disease, and considers evidence for the independent existence of the adaptive and innate immune response to gluten.

Cholangiocarcinoma is, in most cases, rapidly fatal, having an inadequate response to the treatment strategies currently available. The authors of this Review describe the mechanism of action, efficacy and complications of photodynamic therapy—a relatively new local, minimally invasive treatment for cholangiocarcinoma that uses the photo-physical properties of photosensitizers to destroy tumors.

Pathogenic intestinal protozoa are responsible for clinically important infections in both the developed and developing world. Treatments have been available for several decades for giardiasis, isosporiasis and amoebiasis, but until recently there were no effective remedies for the intestinal coccidia—cyptosporidium, microsporidium and cyclospora. In this Review, the author discusses the various pathogenic intestinal protozoa and the treatment options available.

The treatment of chronic hepatitis B has improved substantially in recent years. FDA-approved therapies now include interferon α, pegylated interferon α2a, lamivudine, adefovir dipivoxil, and entecavir. Other antiviral agents and combination regimens are in various stages of development. This Review summarizes the results obtained for approved therapies and highlights emerging antiviral agents for the treatment of chronic hepatitis B.

In the past few years, data obtained from work in animal models, human genetics, basic science and clinical trials, has provided new insights into the mechanisms underlying Crohn's disease and ulcerative colitis. In this review, the author discusses the evidence underlying the disparate theories on the pathogenesis of these diseases and attempts to reconcile them into a coherent hypothesis based on the experimental data.

This Review considers the pathophysiologic basis for transjugular intrahepatic portosystemic shunt (TIPS) placement in cirrhotic patients with refractory ascites. The effect of TIPS placement on hemodynamics and sodium retention is discussed, along with how TIPS placement compares with large-volume paracentesis–the standard therapy for refractory ascites. Disadvantages of the procedure, predicting mortality after TIPS placement, candidate selection and monitoring after TIPS placement are also covered.

A constellation of cardiac abnormalities, including blunted contractile responses to stress and repolarization abnormalities, can be found in patients with cirrhosis. So-called cirrhotic cardiomyopathy is now recognized as a significant contributor to morbidity and mortality. In this Review, the authors discuss the clinical features of cirrhotic cardiomyopathy, pathogenic mechanisms underlying the condition, and general diagnostic criteria and treatment measures for cirrhotic cardiomyopathy.

Hepatorenal syndrome, which is characterized by functional renal failure secondary to renal vasoconstriction in the absence of underlying kidney pathology, is a feared complication of cirrhosis. This Review focuses on the pathogenesis, clinical features, and diagnosis of hepatorenal syndrome. The authors also consider current management options, which include liver transplantation, pharmacologic therapies, transjugular intrahepatic portosystemic shunt placement and albumin dialysis.

Ursodeoxycholic acid has been administered as a remedy for liver diseases since the time of the Tang dynasty. Today, it is used to treat cholestatic liver diseases, such as primary biliary cirrhosis, primary sclerosing cholangitis and intrahepatic cholestasis of pregnancy. This Review considers what is currently known about the potential mechanisms and sites of action underlying the anticholestatic effect of ursodeoxycholic acid.