Frontline Gastroenterology 

About: Frontline Gastroenterology is an academic journal published by BMJ. The journal publishes majorly in the area(s): Medicine & Internal medicine. It has an ISSN identifier of 2041-4137. Over the lifetime, 961 publications have been published receiving 8127 citations. The journal is also known as: FG.

The molecular genetics of colorectal cancer

Abstract: Colorectal cancer is a common but heterogeneous disease, which arises through the accumulation of genetic mutations Knowledge of the molecular basis of colorectal cancer has advanced at a rapid pace in recent years, reflecting progress made in the field of genomic medicine Targeted therapies have come into mainstream use, and the exciting prospect of treatment regimens tailored to the mutation profile of individual tumours is beginning to emerge In order to understand the development and application of the next generation of colorectal cancer treatments, it is important that gastroenterologists have a working knowledge of the pathological mechanisms that drive the disease This review examines our current understanding of the molecular genetics of colorectal carcinogenesis

Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging

Abstract: Non-alcoholic fatty liver disease (NAFLD) is now the commonest cause of abnormal liver function tests (LFTs) in the UK with approximately a third of the population being affected. The exact prevalence is not known, but population studies from the USA and China using magnetic resonance spectroscopy estimate that approximately 30% of the general population have steatosis. It is a spectrum of disease ranging from simple steatosis, to non-alcoholic steatohepatitis (NASH), through to advanced fibrosis and cirrhosis. The majority have simple steatosis, but approximately 10–30% develop NASH and the development of NASH cirrhosis is associated with a poor long-term prognosis. Patients with NASH have increased liver-related and cardiovascular mortality. Many patients with NAFLD remain undiagnosed, and recognising those at risk is the first step. Clinicians overly rely on abnormal liver enzymes to identify patients with NAFLD, so patients with significant liver disease can be overlooked, potentially missing opportunities for intervention. Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, the majority of patients can be effectively diagnosed non-invasively with tests that are routinely available in the clinic today. This review discusses a pragmatic approach to diagnosis and staging of NAFLD so that patients at the highest risk of liver-related complications can be identified.

Hepatitis B in pregnancy

Abstract: Objective Vertical transmission of the hepatitis B virus (HBV) is the commonest mode of infection and can be prevented with immunoprophylaxis of the infant and antiviral therapy in the mother. Our aim was to review a cohort of subjects with HBV in pregnancy to determine the prevalence of active disease or high HBV-DNA levels that required treatment to prevent transmission, and to review the management of mothers and infants. Methods A retrospective case-note review was conducted of all the HBV-infected pregnant women and their infants who attended the Newcastle obstetric services from 2007 to 2011. Results There were 113 pregnancies in 81 women (median age 28 years; 15% hepatitis B e antigen (HBeAg) positive) during 2007–11. 71% of mothers were first diagnosed with HBV during pregnancy. The mothers were born in 28 different countries. 69% of mothers had an HBV-DNA level less than 2000 IU/mL and 13% had HBV-DNA levels greater than 1.0×10 7 IU/mL so would be eligible for antiviral therapy to prevent transmission to the infant. 9% had active eAg-positive HBV and 3% had active eAg-negative HBV requiring treatment. All infants born to HBeAg-positive mothers received hepatitis B immunoglobulin (HBIG) appropriately and 76% of infants received a full HBV vaccination course. One infant born to an HBeAg-negative mother was hepatitis B surface antigen positive 1 year post-delivery. Conclusions One in six women had active HBV requiring treatment or high HBV-DNA levels that would benefit from antiviral treatment to reduce the transmission risk. HBIG was administered appropriately but completion of the vaccination course was suboptimal.

Non-alcoholic fatty liver disease: a practical approach to treatment

Abstract: Non-alcoholic fatty liver disease (NAFLD) affects up to a third of the population in many developed countries. Between 10% and 30% of patients with NAFLD have non-alcoholic steatohepatitis (NASH) that can progress to cirrhosis. There are metabolic risk factors common to both NAFLD and cardiovascular disease, so patients with NASH have an increased risk of liver-related and cardiovascular death. Management of patients with NAFLD depends largely on the stage of disease, emphasising the importance of careful risk stratification. There are four main areas to focus on when thinking about management strategies in NAFLD: lifestyle modification, targeting the components of the metabolic syndrome, liver-directed pharmacotherapy for high risk patients and managing the complications of cirrhosis.

Non-alcoholic fatty liver disease is associated with higher levels of objectively measured sedentary behaviour and lower levels of physical activity than matched healthy controls

Abstract: Background and aims Physical activity is a key determinant of metabolic control and is recommended for people with non-alcoholic fatty liver disease (NAFLD), usually alongside weight loss and dietary change. To date, no studies have reported the relationship between objectively measured sedentary behaviour and physical activity, liver fat and metabolic control in people with NAFLD, limiting the potential to target sedentary behaviour in clinical practice. This study determined the level of sedentary behaviour and physical activity in people with NAFLD, and investigated links between physical activity, liver fat and glucose control. Methods Sedentary behaviour, physical activity and energy expenditure were assessed in 37 adults with NAFLD using a validated multisensor array over 7 days. Liver fat and glucose control were assessed, respectively, by 1 H-MRS and fasting blood samples. Patterns of sedentary behaviour were assessed by power law analyses of the lengths of sedentary bouts fitted from raw sedentary data. An age and sex-matched healthy control group wore the activity monitor for the same time period. Results People with NAFLD spent approximately half an hour extra a day being sedentary (1318±68 vs1289±60 mins/day; p<0.05) and walked 18% fewer steps (8483±2926 vs 10377±3529 steps/ day; p<0.01). As a consequence, active energy expenditure was reduced by 40% (432±258 vs 732±345 kcal/day; p<0.01) and total energy expenditure was lower in NAFLD (2690±440 vs 2901±511 kcal/day; p<0.01). Power law analyses of the lengths of sedentary bouts demonstrated that patients with NAFLD also have a lower number of transitions from being sedentary to active compared with controls (13±0.03 vs15 ±0.03%; p<0.05). Conclusions People with NAFLD spend more time sedentary and undertake less physical activity on a daily basis than healthy controls. High levels of sedentary behaviour and low levels of physical activity represent a therapeutic target that may prevent progression of metabolic conditions and weight gain in people with NAFLD and should be considered in clinical care.