The prevalence of irritable bowel syndrome (IBS) symptoms in patients with inflammatory bowel disease (IBD) can vary greatly—from 11% to 64%, depending on the study population—and patients who are afflicted with this diagnosis may have psychological comorbidity, impaired quality of life, and increased health care utilization. In a feature article in this month’s issue of Gastroenterology & Hepatology, Dr David J.
Gracie and Professor Alexander C. Ford examine the possible etiology of IBS-type symptoms in IBD patients as well as disease outcomes in such patients. The authors also discuss the management of these patients using different approaches, including conventional pharmacologic therapies, intestinal microbiome manipulation, dietary interventions, gut-brain neuromodulators, and brain-gut behavioral treatments.
Our other feature article this month centers on organ allocation for liver transplant. As Dr Sunny Sandhu and Dr David Goldberg note, liver transplant can save the lives of patients with end-stage liver disease, but the demand for livers greatly surpasses the supply. The authors discuss ethical principles that guide scarce resource allocation and regulatory agencies in the United States that manage the organ and transplant system. Additionally, the authors trace the history of liver allocation systems such as the Model for End-Stage Liver Disease scoring system, recent changes in allocation and distribution such as acuity circle allocation, and future directions such as continuous distribution.
Fecal microbiota transplantation (FMT) is the focus of our Advances in IBD column. Dr Jessica R. Allegretti examines the research conducted thus far on FMT in ulcerative colitis and Crohn’s disease patients and discusses issues such as different routes of administration, donor selection and screening, and the main challenges of studying this therapeutic approach.
Our Advances in Endoscopy column presents tips
and tricks for using endoscopic clips. Dr Klaus Mönkemüller reviews different types of endoscopic clips and indications for their use. He also discusses his strategy for selecting clips, technical advice for their deployment, best practices for clip placement and positioning, and how to approach challenging locations, along with other tips.
Checkpoint inhibitor combinations for patients with hepatocellular carcinoma (HCC) are explored in our HCC in Focus column, which is authored by Dr Laura M. Kulik. Topics of discussion include recent research on different combinations, how they impact hepatitis B or C as well as timing of liver transplant, and whether there is a role for them in Child-Pugh class B patients.
Our Advances in Hepatology column features an interview with Dr Sumeet Asrani on the treatment of refractory ascites. Among other issues, he discusses the first steps of ascites management, the diagnosis of refractory ascites, the use of large-volume paracentesis and intravenous albumin, and consideration of a transjugular intrahepatic portosystemic shunt and liver transplant.
Finally, this month’s issue includes a Patient Perspective column featuring a conversation between a patient with irritable bowel syndrome with constipation (IBS-C) and Ms Christina Hanson. The discussion includes the patient’s symptoms, impact of IBS-C on relationships and activities, response to treatment with tenapanor, and effects on quality of life.
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