Should your patients go gluten-free? Over the past few decades, the consumption of gluten-free foods has significantly increased in the United States, accounting for billions of dollars in retail sales. It is well known that a gluten-free diet improves the health of individuals with gluten-related diseases such as celiac disease. However, does this type of diet have value in patients who do not have a gluten-related disease? This question is explored in a feature article in this issue of Gastroenterology & Hepatology. Dr Benjamin Niland and Dr Brooks D. Cash examine the epidemiology and economics of a gluten-free diet, the concept of nonceliac gluten sensitivity, the effects of a gluten-free diet in different groups of patients (including those with irritable bowel syndrome, schizophrenia, atopy, and fibromyalgia), as well as the possible drawbacks of a gluten-free diet.
Gastric intestinal metaplasia and gastric cancer are the focus of our other feature article this month, written by senior authors Dr David S. Jencks and Dr Jason D. Adam, Dr Marie L. Borum, Dr Joyce M. Koh, Dr Sindu Stephen, and Dr David B. Doman. This article provides an overview of these conditions, including the epidemiology, pathogenesis, molecular patterns, risk factors, diagnosis, screening, surveillance, chemoprevention, and treatment.
In our Advances in Hepatology column, Dr Saul J. Karpen discusses novel bile acid therapies for the management of liver disease. He examines the research currently available on obeticholic acid, norursodeoxycholic acid, and ileal bile acid transporter inhibitors in the setting of primary biliary cholangitis, primary sclerosing cholangitis, nonalcoholic steatohepatitis, or pediatric liver disease, and discusses why there has been a recent revival in this area.
Intestinal fibrosis in the setting of inflammatory bowel disease (IBD) is the focus of this month’s Advances in IBD column. Dr Florian Rieder discusses how often intestinal fibrosis occurs in IBD patients, the risk factors for its development, whether the condition is reversible, how to detect it, and various treatment options (including intravenous corticosteroids, immunosuppressive therapies, endoscopic balloon dilation, strictureplasty, and surgical resection), among other issues.
Our Advances in Endoscopy column, authored by Dr Kenneth F. Binmoeller, examines the use of endoscopic ultrasound (EUS)-guided coil and glue injection to treat bleeding from gastric varices. Among other issues, he describes different types of gastric varices, the current options for treating variceal bleeding, and the role of EUS-guided coil and glue injection in this setting (including adverse events of this treatment and data on short- and long-term outcomes).
Finally, elastography, or the measurement of liver stiffness, and the risk of hepatocellular carcinoma (HCC) are featured in our HCC in Focus column. Dr James F. Trotter discusses how elastography can be performed and which patients are appropriate candidates, risk factors for HCC, and the current understanding of the relationship between liver stiffness and HCC risk, among other issues.
I hope that you enjoy these articles and find them interesting and clinically useful.
Sincerely,
Gary R. Lichtenstein, MD, AGAF, FACP, FACG