Gastroenterology & Hepatology

June 2020 - Volume 16, Issue 6

Letter From the Editor: Fecal Incontinence

Gary R. Lichtenstein, MD, AGAF, FACP, FACG


Fecal incontinence can occur in up to 15% of the Western population. Patients with this disorder not only have significant impairment on their quality of life from the disorder itself but also from the social stigma that accompanies it. In this month’s issue of Gastroenterology & Hepatology, one of our review articles explores the epidemiology and diagnosis of this prevalent condition. Dr Amol Sharma and Dr Satish S. C. Rao note how our understanding of the epidemiology of fecal incontinence is changing, partly due to its improved recognition in men and enhanced understanding of shifting obstetric practices in women. The authors also examine the various tests that can be used in the evaluation of fecal incontinence, such as tests of sensorimotor dysfunction, peripheral neuropathy, and anatomic defects. 

Our other review article highlights emerging treatments for patients with eosinophilic esophagitis, a disease for which no pharmacologic therapy has yet been approved by the US Food and Drug Administration. Dr Claire Beveridge and Dr Gary W. Falk examine new developments to current first-line treatments, such as the changing approach to dietary therapy (eg, a step-up approach with a 2- or 4-food elimination diet) and new topical corticosteroid formulations (eg, a pre-formulated budesonide oral suspension and disintegrating budesonide and fluticasone propionate tablets). The authors also look at several new biologic agents currently under investigation for the treatment of eosinophilic esophagitis (eg, RPC4046, dupilumab, antolimab, and benralizumab).

The use of network meta-analyses in the field of inflammatory bowel disease (IBD) is the focus of our Advances in IBD column. Along with related issues, Dr Siddharth Singh discusses how a network meta-analysis differs from other types of research, the most important parts of performing such research, and why it is needed specifically in IBD. He also explains how he and his colleagues recently performed a network meta-analysis on ulcerative colitis therapeutics.

The relationship between the brain-gut-microbiome axis and irritable bowel syndrome (IBS) is highlighted in our Advances in IBS column. Dr Premysl Bercik discusses issues such as how the brain and nervous system contribute to symptoms of IBS, the relationship between the gut microbiome and IBS pathogenesis, the association between gut microbiota and psychiatric conditions, whether there is a correlation between oxidative stress and IBS, and whether manipulation of microbiota can aid in the management of IBS.

Our Advances in Hepatology column provides an update on the use of liver transplantation in patients who have alcoholic hepatitis. Among other issues, Dr Christopher O’Brien discusses the screening and evaluation of alcoholic hepatitis patients prior to liver transplantation, recommendations from the recent Dallas Consensus, the possibility of alcohol relapse following liver transplantation, the current liver transplant outcomes in this setting, and whether liver transplantation should be considered controversial in these patients.

Finally, the potential chemoprevention of hepa-to-cellular carcinoma (HCC) with statins and aspirin is explored in our HCC in Focus column. Dr Yujin Hoshida discusses the main risk factors for HCC, research on the potential chemopreventive effects of statins and aspirin and the strength of these findings, the possible mechanisms of action of these agents, whether there appears to be an ideal dose and duration of treatment, and safety issues, among other issues. 

I hope that you enjoy these articles and find them interesting and clinically useful.


Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Millennium Medical Publishing, Inc