In anticipation of the upcoming Liver Meeting, being held in Boston, Massachusetts in November, this month’s issue of Gastroenterology & Hepatology shines a spotlight on hepatology. One of our review articles examines the elimination of hepatitis C virus (HCV) in the United States. As Dr Isabelle Nguyen, Dr Karine Moussa, and Dr Julio Gutierrez note, HCV infection is a significant public health issue that now has highly effective and simple-to-take treatments. The World Health Organization has introduced a series of goals for the global elimination of this disease by 2030. The authors look at the barriers and challenges that have been encountered while trying to meet these goals, the evolution of HCV testing and prevention of transmission, and ways to enhance future care and cure of this disease in the United States.
In another review article involving hepatology, Dr Mausam Patel, Dr Charlotte Hunt, and Dr LisaVanWagner review the physiology of portal hypertension, initially focusing on its established understanding and then reviewing recent updates. The authors also highlight the paradigm shift in portal hypertension terminology and classification, as well as important diagnostic and prognostic advances. Other key issues include the role of transient elastography in the diagnosis of portal hypertension and novel medications for the prevention or treatment of this condition, such as immunomodulatory drugs, angiogenesis blockers, and vasoactive substances.
One of our columns this month also spotlights liver disease. In our MASH in Focus column, Dr Mary E. Rinella outlines why and how the nomenclature for metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis was developed. Her discussion also covers the new umbrella term of steatotic liver disease, the new liver disease category of MetALD, and the possible impact of the new nomenclature.
This month’s issue also includes a review article that explores dietary treatment of patients with eosinophilic esophagitis (EoE). Ms Bethany Doerfler, Dr Angela Y. Lam, and Dr Nirmala Gonsalves compare empiric elimination diets and allergy testing–directed diets and note the importance of using a dietary approach that patients with EoE and their families can adhere to. The authors also outline how providers can discuss dietary therapy with their EoE patients and focus on nutritional considerations that providers should take into account with dietary approaches. Also examined are failure of initial dietary therapy as well as evaluation of response to treatment.
Professor Siew C. Ng delves into the early-life microbiome and inflammatory bowel disease (IBD) risk in our Advances in IBD column. She discusses early-life events that affect the gut microbiome, the influence of the maternal microbiome on the microbiome of the infant, and how the gut microbiome’s bacterial diversity and composition compare in mothers with IBD and those without it. Other topics of discussion include how these findings may affect clinical practice as well as common myths and misconceptions in this area.
Finally, the potential relationship between gravity and irritable bowel syndrome (IBS) is explored in our Advances in IBS column with Dr Brennan Spiegel. Topics of discussion include how gravity might help determine the susceptibility of IBS and the link between IBS and associated conditions, why some individuals may carry abdominal load better than others, and how gravity strain may help us understand some of the neuropsychological features of IBS.
I hope that you enjoy these articles and find them interesting and clinically useful.
Gary R. Lichtenstein, MD, AGAF, FACP, FACG