Is routine surveillance of a pouch always necessary? This question is explored in the Advances in IBD column in this month’s issue of Gastroenterology & Hepatology. Dr Stefan D. Holubar discusses the arguments for and against routine surveillance of pouches, recommended surveillance intervals, where most cancers in this patient population develop, and the importance of the rectal cuff. Other topics of discussion include whether a hand-sewn anastomosis or a double-stapled anastomosis should be used, techniques for performing pouch surveillance, how the type of pouch impacts surveillance, and whether pouches can last forever.
One of our feature articles this month provides a comprehensive overview of the treatment of patients with chronic pancreatitis. Dr Darius J. Javidi, Mr Neechi Okwor, and Dr Timothy B. Gardner discuss numerous risk modifiers for this condition, including alcohol, cigarette smoking, and hypertriglyceridemia. Additionally, the authors outline a systematic approach for the diagnosis and medical management of common complications such as abdominal pain, exocrine pancreatic insufficiency, and endocrine insufficiency. The authors also propose endoscopic management strategies for chronic pancreatitis involving pancreatic calcifications (stones) and biliary tree strictures and abnormalities, as well as approaches for managing nonresponsive disease such as celiac plexus nerve block, surgery, and total pancreatectomy with islet autotransplantation.
Our other feature article this month explores reflux-related cough. As Dr Ofer Z. Fass and Dr Rena H. Yadlapati note, chronic cough affects approximately 10% of the global population and although gastroesophageal reflux disease is a common cause of this condition, the relationship is poorly understood. The authors review the diagnosis of reflux-related cough, including the use of patient-reported outcome measures, empiric medical treatment, endoscopy, and ambulatory reflux testing. Additionally, the authors examine various management approaches for reflux-related cough, such as lifestyle interventions, pharmacotherapeutics like proton pump inhibitors and alginates, and behavioral interventions such as laryngeal recalibration therapy. The authors also consider whether there is a role for endoscopic and surgical interventions.
The management of patients with primary sclerosing cholangitis is explored in our Advances in Hepatology column. Dr Kris V. Kowdley discusses current management of this condition and various therapeutic approaches that have been studied, including ursodeoxycholic acid, farnesoid X receptor agonists like obeticholic acid, peroxisome proliferator-activated receptor agonists such as elafibranor, fibrates such as bezafibrate, and ileal bile acid transport inhibitors, along with other important management considerations.
Finally, also involving the liver, our HCC in Focus column features an interview with Dr Jose Debes on the potential use of methylation markers for risk prediction of hepatocellular carcinoma. He discusses how methylation markers work, research on their use for hepatocellular carcinoma risk prediction, how they compare with traditional methods, their advantages and disadvantages, and their potential use in different types of hepatocellular carcinoma, among other issues.
As always, I hope these articles provide useful information and valuable clinical insights, and I wish you and your patients a happy and healthy new year.
Sincerely,
Gary R. Lichtenstein, MD, FACG, AGAF, FCCF, FACP