Reviews & Analysis

The interval colorectal cancer rate is a robust indicator of the quality and effectiveness of a screening programme, enabling the identification of unmet requirements and development of specific strategies to resolve them. A recent study demonstrated the use of interval cancer as an indicator to target quality improvement of colonoscopy in a screening programme.

For many patients with Hirschsprung disease, the underlying pathogenic mechanisms are unknown. A new study using a novel line of transgenic mice and tissue from patients with Hirschsprung disease suggests that overproduction of collagen VI could contribute to pathogenesis and the increased incidence of Hirschsprung disease in patients with Down syndrome.

Spondyloarthritis (SpA) is the most common extraintestinal manifestation of IBD. SpA symptoms are not always recognized in patients with IBD. Subsequently, patients with symptoms of SpA can be underdiagnosed, with effective treatment delayed. Cooperation between gastroenterologists and rheumatologists is necessary and, ideally, an integrated management of these patients should be adopted.

Bariatric surgery is efficient in achieving weight loss in severe obesity, but associated anatomical or mechanical alterations might also affect oesophageal function. Each type of surgery has its own risks and benefits when it comes to pre-existing or the potential development of postoperative oesophageal disorders. Here, the three most common types of bariatric surgery and their respective influences on oesophageal function are discussed.

IBD is a chronic inflammatory disorder of the gut and major progress has been made in understanding the underlying mechanisms that mediate the disease. Here, the authors provide a comprehensive overview of the immunopathogenesis of IBD, discussing known and emerging pathogenic factors that include immune and nonimmune events.

Oropharyngeal dysphagia is a common swallowing disorder. In this Review, Rommel and Hamdy describe the most frequent manifestations of oropharyngeal dysphagia, including potential causes and complications. They also provide a comprehensive overview of the techniques available to diagnose this condition.

Colectomy is rightly viewed as a last resort in selected patients with slow-transit constipation. A new study presents US national data that raises new concerns regarding the outcome of this procedure and perhaps questions whether it should be offered at all.

Whereas the status of the liver as privileged and exempt from humoral rejection has fallen, attempts at breaching the blood group barrier during transplantation have continued. Previously restricted to paediatric patients and emergencies, advances in immunosuppression protocols have improved outcomes to the point that ABO-incompatible liver transplantation might be more widely used in adults.

What is in a name; and why does the nomenclature of one disease, primary biliary cirrhosis, cause such contention that a proposed name change by those deeply committed to the advancement of its understanding and management stimulate huge debate?

Pre-operative diagnosis of biliary strictures often presents as a challenge to clinicians. Strictures have a range of benign causes, but can also be a result of cancer and so an ability to diagnose them accurately is very important. In this Review the authors discuss the existing modalities of assessing strictures and argue that a multimodal and multidisciplinary approach is likely to be best. New biomarkers and emerging techniques are hoped to improve diagnostic capabilities in future.

Treatment failure associated with HCV resistance to newly developed direct-acting antiviral agents is not an uncommon occurrence and poses a substantial problem to clinicians trying to re-treat patients who have failed available interferon-free treatments. A new study suggests that host-targeted agents are the way forward, but is this approach really feasible?

Rationing of livers for transplantation is a difficult problem especially when creation of national policies is needed. Italy recently convened a national consensus conference to decide who should be first in line.

Despite some advances in our understanding of the molecular characteristics of pancreatic cancer, much more progress is needed. In a new study, RNA profiling of pancreatic cancers was used to identify gene signatures of tumour cells and stromal cells to help predict patient outcomes.

Hepatocellular carcinoma (HCC) is an antigenic lesion infiltrated by T cells, but factors within the tumour and its microenvironment dampen the immune response and prevent effective antitumour immunity. The stepwise elucidation of the various immunosuppressive mechanisms at play in HCC has exposed new therapeutic options. This Review gives a comprehensive overview of the different immunotherapeutic modalities applicable in HCC, including vaccines, adoptive T-cell therapy, cytokines, gene therapy and immune checkpoint inhibitors.

Traditionally, the diagnosis of hepatorenal syndrome has been based on stringent criteria that are not ideal for patients with cirrhosis and kidney injury, leading to underdiagnosis. Acute kidney injury is now proposed to characterize renal disease in patients with cirrhosis. Florence Wong describes the evolution of these criteria that have addressed this issue and improved care for these patients.

The concept that the nervous system can adapt to gastrointestinal disorders is a new concept. In this Review the authors discuss neural plasticity in pancreatic diseases such as pancreatitis and cancer. Given the translational importance of neuropathic changes in pancreatic disorders the authors look at the available mouse models we have to study the phenomenon and highlight areas of research that still need investigation.

Liver transplantation outcomes have improved substantially over the years, but patients still have to deal with a number of consequences and risks that might follow the procedure. Optimal screening and management of recurrent disease or associated pathologies, such as metabolic, renal, cardiac disease and cancer, are essential to provide the best possible care for transplant recipients.

Despite advances in hepatitis C treatment, substantial clinical hurdles remain to achieve universal cure and global control of infection. Saeed et al. identified SEC14L2 as a host factor permitting replication of clinical HCV isolates in cell culture, providing a novel system to model infection of patient-derived viruses.

Bipotential hepatic progenitor cells (HPCs) are recognized as making modest contributions to hepatocyte regeneration, though never credited with major liver repopulation. A new study in mice demonstrates HPCs can make a massive contribution to hepatocyte replacement, suggesting HPCs have the potential to be an effective cell therapy for liver failure.

Liver transplantations for patients who are co-infected with HIV and HCV have always posed a challenge and still do, according to the results of a new study. This article discusses the factors that contribute to an increased risk of poor transplantation outcomes and how new treatment options might affect patient survival.