Foreword
Riccardo Troncone is Full Professor of Paediatrics and Director of the European Laboratory for the Investigation of Food-Induced Diseases (ELFID) at the University Federico II in Naples. He is a member of several scientific societies of paediatrics and immunology, as well as the current President of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). His research interests are mainly focused on mucosal immunology; from a clinical point of view, they include coeliac disease, food allergies and inflammatory chronic bowel disease. He is the author of three books, 86 monographies and/or reviews, 112 original papers and 184 contributions to national and international congresses. He has been Senior Associate Editor of the Journal of Pediatric Gastroenterology and Nutrition (JPGN). He has been involved in two previous research projects on coeliac disease funded by the EU (5th and 6th Framework) and is responsible for a work package in a current project on the prevention of coeliac disease (CD Prevent, 6th EU Framework).
T
he current issue of European Gastroenterology & Hepatology Review offers contributions in some of the most relevant areas of gastroenterology and hepatology.
Inflammatory bowel disease (IBD) is the subject of three articles. The first, by Mark Löwenberg and Geert D’Haens, is a review of the most recent progresses in therapy. Conventional immunomodulators and anti-tumour necrosis factor (TNF) agents are discussed, as well as novel drugs that specifically target inflammatory mediators. TNF blockers are at the forefront, other neutralising antibodies and small molecule inhibitors having had less impact than expected. The complexity of pathogenetic mechanisms in IBD, characterised by the interplay of multiple inflammatory pathways, is likely to require a combination of different strategies. On the other hand, as emphasized in the review by Ellen Scherl and Randy Longman, serological biomarkers and immunogenotyping are refined to predict response and allow individualised therapy.
Irritable bowel syndrome (IBS) is another major topic in this issue. IBS is characterised by a high prevalence and a significant impact on patients’ quality of life. The review paper by Eamonn Quigley focuses on the use of prebiotics and probiotics in IBS management. They are here proposed as adjuvant therapy to pharmacological intervention.
Hereditary syndromes are responsible for 5–10 % of colorectal cancer. Different hereditary polyposis syndromes are reviewed in a paper by Robin Mendelsohn and Arnold Markowitz, with a special emphasis on their genetics, screening and surveillance policies as well as prophylactic procedures. Familial adenomatous polyposis, MYP-associated polyposis, Lynch syndrome, hamartomatous polyposis syndrome and familial colorectal cancer type X are among the conditions presented.
Infancy is nowadays seen as a crucial time impacting on health in adult life. The first months of life are seen as a window of opportunity during which environmental factors, such as nutrition, influence health beyond the first year – and potentially permanently. As Nitin Gupta, Andrew Stewart Day and Daniel Avi Lemberg explain in their review of recent advances in infant nutrition, breast milk represents an optimal nutrient source and also exerts a protective effect. There is a growing interest in probiotics as a tool to redirect immune response. Possible benefits are envisaged in the prevention of atopic diseases, although the evidence is still conflicting due to several confounding factors. Polyunsaturated fatty acids, particularly docosahexaenoic acid (DHA), are considered of outmost importance in infant development. DHA concentration are high in the brain and retinal photoreceptors, suggesting a role in both cognition and vision. Another area where infant nutrition may have long-lasting preventative effects is coeliac disease. Additionally, special attention is nowadays paid to the risk of later obesity. Berthold Koletzko’s group studies have suggested a protective effect from the lower protein content in breast milk, whereas high protein intake increases the concentration of insulin-releasing amino acids and the secretion of insulin-like growth factor 1, thereby inducing increased weight gain. Lowering protein content is envisaged as a strategy to reduce the risk of childhood obesity.
Contributions on liver diseases include an interesting review of hepatic encephalopathy. The pathogenetic mechanisms attribute a role to low-grade cerebral oedema. In the paper by Cihan Yurdaydin and Ramazan Idilman, the management of hepatic encephalopathy is exhaustively discussed, in particular the role of non-absorbable disaccharidases and antibiotics.
In conclusion, I am sure you will find the information contained in this issue of European Gastroenterology & Hepatology Review of great interest and impact on your daily practice. n
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© TOUCH BRIEFINGS 2011
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