|Year : 2011 | Volume
| Issue : 3 | Page : 355-357
Clinical update on inflammatory disorders of gastrointestinal tract (Frontiers of gastrointestinal research)
Department of Gastroenterology, Govind Ballabh Pant Hospital, New Delhi 110 002, India
|Date of Web Publication||6-Apr-2011|
B C Sharma
Department of Gastroenterology, Govind Ballabh Pant Hospital, New Delhi 110 002
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma B C. Clinical update on inflammatory disorders of gastrointestinal tract (Frontiers of gastrointestinal research). Indian J Med Res 2011;133:355-7
|How to cite this URL:|
Sharma B C. Clinical update on inflammatory disorders of gastrointestinal tract (Frontiers of gastrointestinal research). Indian J Med Res [serial online] 2011 [cited 2020 Feb 22];133:355-7. Available from: http://www.ijmr.org.in/text.asp?2011/133/3/355/78397
Clinical update on inflammatory disorders of gastrointestinal tract (Frontiers of gastrointestinal research, vol. 26 ), Mayerle J, Tilg H, editors (S. Karger, Switzerland). 2010. 216 pages. Price: US$ 182.00
This publication provides the latest data on inflammatory disorders of the gastrointestinal tract, liver and pancreas. This book written in a lucid readable manner by 51 contributors in 18 chapters brings home, yet again, the fact that the inflammatory disorders of the digestive tract and the liver affect a large proportion of the patients and impose a significant economic and health burden on society. The book has an attractive presentation containing 25 figures which make understanding of the facts, especially the pathogenesis and diagnostic work up, more clearly. The 18 tables included in the book are valuable for easy and quick reference of the treatment options for the various disorders discussed.
Inflammatory diseases of the gastrointestinal tract no longer include only infectious disorders which have long established anti-infective treatments available, but also encompass a number of complex immunological disorders which are currently attracting scientific attention. This volume covers emerging diseases such as microscopic colitis or NAFLD (non alcoholic fatty liver disease) that have only recently moved into the focus of scientific inquiry but may have an unappreciated socio-economic impact.
The recently introduced NAFLD fibrosis score has been discussed which has an accuracy of >90 per cent in identifying different stages in NAFLD. Plasma levels of caspase-generated cytokeratin-18 fragments, a marker of hepatocyte apoptosis, have also been used to identify NASH (non alcoholic steatohepatitis). Role of transient elastography as a non-invasive procedure to detect fibrosis and cirrhosis has been highlighted. Cognitive behavioural therapy, bariatric surgery and cytoprotective agents as treatment options of NAFLD have been discussed. The pathogenesis of fibrosis in various tissues has been elegantly displayed and provides a logical framework to define sites of intervention.
The REVEAL-HBV study which provides the most comprehensive data so far on HBV DNA viral load and liver diseases has been quoted. The treatment algorithm provided for treatment of hepatitis B is very useful for practical purposes. The several specifically targeted antiviral therapy for HCV (STAT-C) agents as new treatment strategies could hopefully spare the use of pegylated interferon ribavirin which are currently the backbone for the treatment of chronic hepatitis C. The update on liver transplantation for inflammatory disorders of the gastrointestinal tract is very systematic and comprehensive.
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide. The current form of the Borcelona Clinic Liver Cancer (BCLC) staging and treatment algorithm provided is invaluable. Transarterial Chemo-embolozation (TACE) is the standard palliative treatment for patients with BCLC stage B. Significant advances in the management of HCC have been discussed which appear promising and will improve outcome in the near future in all patients except BCLC stage D.
The research into CD (celiac disease) has made tremendous progress in the last two years. CD serves as a model gastrointestinal disease of immune dysregulation and makes the preclinical and clinical validation of targeted therapies feasible. Therefore, advances in CD will spur translational research in other immune-mediated disorders as well. The novel therapies for CD have been discussed in details.
The available data on efficacy, safety and indications of anti-TNF therapy in IBD (inflammatory bowel disease) are summarized and the future directions regarding the use of these biological agents for lifelong, incurable diseases have been emphasized. Probiotics are an appealing concept and the current data on their use in gastrointestinal diseases have been reviewed. These may provide a simple and attractive way of preventing or treating IBD, and patients have good compliance as these are safe, nontoxic, and natural.
Microscopic colitis is a common cause of chronic diarrhoea, particularly in the elderly. Its two subtypes, collagenous and lymphocytic colitis, are similar clinically, and seem to respond similarly to various medical therapies. The treatment algorithm has been outlined in a very concise manner.
Several traditional clinical scores of severity of AP (acute pancreatitis) have been proposed. However, the complexity of these scales has prompted some authors to evaluate inflammatory proteins as prognostic markers in AP, including C-reactive protein, cytokines and chemokines. Data covering the field combining prediction of pancreatitis severity and inflammatory proteins have been reviewed. The literature review on the prophylactic treatment strategies to prevent infected necrosis in AP has been done. Current evidence does not support the use of prophylactic antibiotics or probiotics in patients with severe AP. Enteral nutrition should be preferred over parenteral nutrition but the optimal timing of commencement of enteral nutrition should be investigated with further studies.
The therapeutic potential and benefit of targeting NFκB in pancreatic disorders and the possible complications and pitfalls of such an approach have been vividly explored. Patients with carcinoma of the exocrine pancreas have poor prognosis. They suffer from systemic disease that is insensitive to radiotherapy and often to chemotherapy as well. One promising treatment strategy is immunotherapy. This article describes the idea behind chemo-immunotherapy and highlights three clinical trials dealing with antibody approaches based on antibody dependent cellular toxicity, direct cytotoxicity or immunostimulation.
The present status of Helicobacter pylori and its role in gastroduodenal pathologies has been dealt with. The introduction of novel targeted agents is a promising strategy which will improve the prognosis of patients with advanced tumour stages. The recent second-line trials in advanced GC (gastric cancer) have been discussed. The phase II studies assessing the role of novel targeted agents, such as sunitinib, sorafenib, HDAC inhibitors and others, as second line treatment of advanced GC have been outlined.
The primary success of this project has been in its ability to collect and portray the latest information about the various gastrointestinal inflammatory disorders, especially the exact pathogenesis at molecular and cellular levels, which can help us understand the exact hit point where our prescribed drug will target and thus block the chain of disease progression. The book has provided up-to-date information about the treatment strategies. The treatment algorithms illustrated are very useful for day-to-day practice.
The book is very handy for daily use, yet contains loads of information contributed by some of the world-leading experts in several fields who have shared their knowledge, expertise and hard work. It is a fascinating and instructive work and serves as an inspiration for clinicians and scientists to enter the rapidly developing field of inflammatory diseases in gastroenterology. It is recommended for all those who are dedicated to the area of gastroenterology.