Review Articles in 2009

A repeat endoscopic evaluation of a bleeding lesion on subsequent follow-up is commonly called second-look endoscopy. Tsoi and colleagues review the findings from five randomized, controlled trials and consider whether second-look endoscopy can be recommended as routine practice, and which groups of patients might benefit most. The cost-effectiveness of second-look endoscopy and the use of PPIs versus second-look endoscopy are also discussed.

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.

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.

Intestinal anastomoses are frequently performed to remove tumors or diseased tissue. They have clear benefits but they can also lead to serious complications such as dehiscences and strictures. This Review discusses the surgical techniques, healing factors and perioperative and postoperative strategies to minimize complications when performing anastomoses of the lower gastrointestinal tract.

Stem cells are primitive, relatively unspecialized cells that can self-renew and are multipotent. In this Review, Quante and Wang discuss potential types of stem cells found within the gastrointestinal tract, the susceptibility of these stem cells for malignant transformation, and their potential for use in restoring tissue function to treat gastrointestinal disorders.

The etiologies of lower gastrointestinal bleeding (LGIB), defined as bleeding from a colonic or anorectal source, are numerous and varied. LGIB can be acute or chronic; for both types, colonoscopy is the diagnostic and therapeutic procedure of choice. Hemostasis, if not occurring spontaneously, can usually be promoted by embolization or modern endoscopy techniques, and surgery is only undertaken as a last resort.

Osteoporosis is a common complication of chronic liver disease. This Review describes the prevalence and risk factors associated with bone loss in patients with chronic liver disease. New insights into the role of mediators that are involved in orchestrating bone loss in these patients are also discussed.

Pancreatic cancer, although infrequent, has an extremely high mortality rate. The epidemiologic features of this rare cancer are still poorly known. In this Review Raimondi and colleagues discuss the environmental, lifestyle and genetic factors that increase or decrease the probability of developing pancreatic cancer and that may explain the different incidence rates observed in distinct subpopulations.

Patients with end-stage liver disease often experience disease progression and develop complications while waiting for a liver transplant. Prevention and management of these complications is, therefore, paramount to ensure that the patients can remain on the waiting list and have the greatest chance of a successful outcome following transplantation.

Identification and classification of dysplasia in patients with ulcerative colitis or Crohn's disease in the large intestine is a challenge. Surveillance programs in these patients aim to detect colitis-associated dysplasia at an early stage, as the risk of these patients developing colorectal cancer is considerable. Good communication and discussion between pathologists and endoscopists is essential to help reach unequivocal diagnoses and to improve the management of colitis-associated dysplasia.

The signs and symptoms of dumping syndrome, a well-established complication of gastric and esophageal surgery, result from rapid gastric emptying and the delivery of large particles of poorly digested food to the small bowel. These symptoms, which can be classed as early or late, their pathophysiological basis, and the treatment options available to patients with dumping syndrome are outlined in this article.

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.

Systemic amyloidosis is characterized by the extracellular deposition of protein in an abnormal and insoluble form. Involvement of the gastrointestinal tract is very common but is often subclinical. This Review describes the gastrointestinal manifestations of systemic amyloidosis and discusses available methods for the diagnosis and treatment of systemic amyloidosis and its gastrointestinal consequences.

Hepatic venous pressure gradient (HVPG) is the most useful parameter for the assessment of patients with cirrhosis. HVPG provides diagnostic and prognostic information in several clinical scenarios: treatment of portal hypertension, surgery for hepatocellular carcinoma, treatment of HCV-related or HBV-related cirrhosis, and outcome of recurrent HCV infection after liver transplantation.

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 gastrointestinal mucosa is an important target of many sexually transmitted infections—it is a site for HIV entry, replication and destruction of CD4⁺T cells, and provides a niche for other sexually transmitted pathogens. This Review discusses the pathogenesis and gastrointestinal complications of HIV infection and summarizes advances in our understanding of other sexually transmitted infections of the gastrointestinal system.

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.

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.

The optimal timing of endoscopy after presentation with upper gastrointestinal bleeding is a matter for debate. Tsoi and colleagues examine the findings of randomized clinical trials and retrospective cohort studies, and conclude that endoscopy within 24 h of admission to hospital aids risk stratification of patients and reduces the need for hospitalization. However, very early endoscopy shows no evidence of benefit in terms of the risk of rebleeding or improved survival.

Barrett esophagus involves the replacement of normal esophageal squamous epithelium with metaplastic columnar epithelium and is a major precursor to adenocarcinoma of the esophagus. Histological evaluation of biopsy samples from the esophagus and gastroesophageal junction for the presence of goblet cells and extent of dysplasia is the mainstay of surveillance for Barrett esophagus. This Review discusses the histological features of Barrett esophagus and its neoplastic complications.