Reviews & Analysis

Over the past 15 years, intestinal transplantation for the treatment of intestinal failure has changed from a desperate last-ditch effort into a standard therapy for which a good outcome is expected. In this Review, the author considers several issues surrounding intestinal transplantation, including patient selection, allograft type, outcomes, complications, post-transplant monitoring and cost.

The authors of this Review discuss the diagnosis, clinical features and genetics of the hamartomatous polyposis syndromes, as well as the risk of malignancy associated with each syndrome and appropriate surveillance recommendations. Other disorders associated with the presence of hamartomatous polyps are briefly discussed, along with the potential for targeted therapy of hamartomatous polyposis syndromes.

This Review considers the role of endoscopic submucosal dissection as a treatment for early-stage gastrointestinal neoplasms. The author focuses on what is required for endoscopic submucosal dissection to be successful, safe and reliable—early detection, accurate preoperative diagnosis, a thorough knowledge of appropriate indications and techniques, and appropriate training.

Chronic pancreatitis is a difficult disease to diagnose, particularly in its early stages. EUS has been increasingly used as a method for diagnosing chronic pancreatitis because of its ability to generate high-resolution images of the pancreas. This Viewpoint examines the practical role of EUS as screening tool for chronic pancreatitis, and compares it with other diagnostic modalities.

Partial liver resection alone is not able to cure a substantial number of patients who have liver tumors. Thermoablation expands the therapeutic modalities available to these patients by using heat (radiofrequency ablation) or cold (cryoablation) to achieve tumor necrosis. This Viewpoint discusses the evidence for using these two ablative modalities in clinical practice and suggests that radiofrequency ablation is the superior approach.

Pancreatic stellate cells are the main mediator of fibrogenesis during chronic pancreatitis, and chronic pancreatitis is a consistent risk factor for pancreatic ductal adenocarcinoma. In this Review, the authors discuss the idea that pancreatic stellate cells have a linking role in the development of pancreatic ductal adenocarcinoma via their ability to communicate with inflammatory cells, acinar cells and pancreatic cancer cells.

This Review summarizes current understanding of nonalcoholic fatty liver disease, which is now accepted as the hepatic manifestation of metabolic syndrome. The authors consider the evaluation of patients at risk of developing nonalcoholic fatty liver disease, including the assessment of risk factors, the application of imaging modalities and the role of liver biopsy, as well as potential treatment approaches.

Numerous drugs can damage the gastrointestinal tract, and improved recognition of drug-induced gastrointestinal tract pathology is needed to improve patient care. The authors of this Review discuss the most common and well-described drug-related clinicopathological conditions of the gastrointestinal tract. Much discussion is dedicated to NSAIDs—the most commonly prescribed drugs and consequently the drugs most commonly associated with gastrointestinal tract toxicity.

The rising incidence of esophageal adenocarcinoma has stimulated interest in screening for Barrett's esophagus, but there is no proof that screening decreases esophageal cancer mortality. This Viewpoint argues that, on the basis of the available evidence, screening is beneficial, and that it is better to err on the side of caution and perform unnecessary screening rather than miss curable cancers.

With the advent of natural orifice translumimal endoscopic surgery (NOTES), a new dimension has been added to minimally invasive surgery. The authors of this Review examine the current status of NOTES, analyze the associated hazards and potential benefits of the technique, and consider the implications of NOTES for future surgical endoscopy.

Our understanding of how proteases function and interact within the gastrointestinal tract has been largely restricted to their role in nutrient digestion; however, it has become clear that proteases are involved in regulating signaling processes that are important for intestinal epithelial cell function. In this Review, the authors discuss how proteases impact gastrointestinal pathophysiology, specifically mucosal permeability, immune defense mechanisms and pathogenic challenges.

The large-scale study of protein expression and protein function by using molecular technologies—proteomics—has become increasingly attractive, because the proteome reflects the intrinsic genetic program of the cell and the impact of its immediate environment. This Review describes conventional proteomic technologies currently being used and their limitations, and demonstrates their clinical applicability, with specific reference to published data of relevance to the gastroenterology field.

Disrupted sleep is reported by many patients with IBS, yet the role of sleep in IBS is not defined. This Viewpoint article discusses the subjective and objective evidence for disrupted sleep in patients with IBS, examines the relationship between gastrointestinal symptoms and sleep disturbance, and highlights areas for future research.

Many clinicians approach the diagnosis of IBS as one of exclusion, even though diagnostic testing usually has a low yield and the Rome guidelines encourage diagnosis on the basis of symptoms alone. This Viewpoint discusses patterns of IBS diagnosis in practice, provides theories on why guidelines are not adhered to, and offers some practical guidance on IBS diagnosis.

Autoimmune pancreatitis—a nonalcoholic, chronic lymphoplasmacytic pancreatitis that frequently results in the stenosis of the main pancreatic duct and distal common bile duct—has been accepted as a unique clinical entity that is present predominantly in the Asian population. In this Review, the authors discuss various issues surrounding autoimmune pancreatitis, including its definition, epidemiology, pathogenesis and etiology, clinical presentation, diagnosis and treatment.

Although conventional IBD surgery can be performed using a minimally invasive approach, controversy surrounds the role of laparoscopy in the surgical management of IBD. The authors of this Review consider the current position of laparoscopy in the surgical management of IBD, the short-term and long-term results achieved using this approach, and the supposed benefits and difficulties associated with such minimally invasive surgery.