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Clinical understanding of IBS has been advanced considerably by studying a small subgroup of patients who develop IBS acutely after an episode of infectious gastroenteritis. This Viewpoint article discusses post-infective IBS and how psychosocial and gut-specific factors (including activation of the gut mucosal immune system) interact to produce IBS symptoms.
Medical therapy for GERD has improved remarkably since the introduction of PPIs; however, despite twice-daily dosing of PPIs, reflux symptoms can persist, new symptoms can occur or be unmasked, and esophagitis can fail to heal. Management of such 'refractory' GERD can be a challenge. The author of this Review considers the diagnostic approach to refractory GERD and the diagnoses that are possible.
The local staging and management of rectal cancer has evolved in the past decade. Imaging modalities used for staging rectal cancer include computed tomography, endoscopic ultrasound, magnetic resonance imaging, and positron emission tomography. In this Review, the author discusses the strengths and limitation of these modalities, along with the management of rectal cancer.
Minimal hepatic encephalopathy (MHE)—the mild cognitive impairment commonly seen in patients who have cirrhosis—has a significant impact on quality of life. Current understanding is that MHE forms part of the spectrum of hepatic encephalopathy, although this remains to be proven. This Review focuses on the pathogenesis and neuropsychological findings of MHE, the effect of MHE on quality of life and survival, and treatment options.
Improved knowledge of the complex pharmacology, metabolism, mechanism of action, and toxicity profile of thiopurines has guided the development of strategies to improve pharmacotherapy in patients with IBD. This Review discusses the clinical implications of these developments, such as reducing the risk of adverse events (e.g. myelodepression and hepatotoxicity) by genetic screening, metabolite level characterization, and dose reductions.
This Case Study describes a 17-year-old boy who presented with sudden onset of visual impairment, identified as bilateral anterior uveitis by an ophthalmologist. The patient was diagnosed with multifocal Crohn's disease, involving the terminal ileum, cecum, stomach and duodenum. The authors discuss the importance of rapid evaluation of extraintestinal manifestations of Crohn's disease.
