It is well known that cigarette smoking has potential deleterious effects on the heart and on the lungs, but its effects on the liver have not been as well-defined. This month’s issue of Gastroenterology & Hepatology includes an interesting review article on cigarette smoking and different liver diseases. Dr Stephanie M. Rutledge and Dr Amon Asgharpour examine the toxic, immunologic, and oncogenic effects of cigarette smoking on the liver, as well as its effects on, and possible associations with, hepatitis B and C virus infections, hepatocellular carcinoma, nonalcoholic fatty liver disease, primary biliary cholangitis, hepatopulmonary syndrome, and liver transplant outcomes. In addition, the authors describe how coronavirus disease 2019 infection highlights the intricate interplay between the liver and the lungs.
Our other review article provides an overview of abdominal migraine, which is likely underdiagnosed in pediatric patients. Ms Demiana J. Azmy and Dr Cary M. Qualia trace the definition of this condition over time; examine its epidemiology, clinical presentation, and possible pathophysiology; and compare its diagnosis using the Rome IV criteria and the International Classification of Headache Disorders III criteria. The authors also explore the association between abdominal migraine and migraine headache and discuss how to differentiate abdominal migraine from similar conditions. In addition, they review pharmacologic and nonpharmacologic therapeutic approaches, including the STRESS mnemonic, which stands for stress management, travel tips, rest, emergency symptoms, sparkling lights, and snacks to avoid.
The importance of ergonomics as it relates to endoscopy is highlighted in our Advances in Endoscopy column. Dr Amandeep Shergill discusses the prevalence and risk factors of endoscopy-related injuries, the limitations of the current endoscope design, and how the design of endoscopes and endoscopy suites can be improved to incorporate endoscopists’ safety. She also relates the strategies that endoscopists and practices can employ to minimize the risk of injury, among other issues.
Our Advances in IBD column explores the use of ultrasound in patients with inflammatory bowel disease. Dr Stephanie R. Wilson discusses the different uses of ultrasound in this disease setting, the correlation of ultrasound with endoscopy and histology, the comparison of ultrasound with computed tomography and magnetic resonance enterography, ideal candidates, the use of a contrast agent, and new techniques, among other issues. She also provides several helpful accompanying images.
Our NASH in Focus column is authored by Dr Arun Sanyal. He examines issues involved with the genetics of nonalcoholic steatohepatitis such as whether genetic mutations can promote progression of the disease, whether genetics and demographics can help identify who has a greater risk of progression, and whether certain genetic mutations will likely prevent or, conversely, enhance therapeutic response.
Finally, Dr Brian E. Lacy provides an update on society guidelines for the management of irritable bowel syndrome in our Advances in IBS column. His discussion includes the current status of various diagnostic tests, the current recommendations for dietary and pharmacologic therapy, the possible use of fecal microbiota transplantation, changes in the management of irritable bowel syndrome, and future research in the field.
May this issue provide you with helpful information that you can put to good use in your clinical practice.
Sincerely,
Gary R. Lichtenstein, MD, AGAF, FACP, FACG