Clinical Review

Recent advances: Gastroenterology

BMJ 1998; 316 doi: (Published 10 January 1998) Cite this as: BMJ 1998;316:125
  1. G O Barbezat, Mary Glendining professor of medicine (
  1. a Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand
  • Accepted 28 August 1997

Gastroenterology has developed rapidly as a scientific and clinical discipline. Advances have resulted from simple, painstaking clinical observations on one hand and highly sophisticated scientific methods on the other. Some of the important developments in gastroenterology are reviewed here.

Topics were selected after formal discussion with colleagues, and priority was given to areas of current interest. Reference material was chosen after a literature search in the medical library and included abstracts from proceedings of recent conferences. Attendance at conferences allowed discussions with some experts; communication in writing was made with others.

Haemochromatosis usually becomes symptomatic between the ages of 40 and 70 years, by which time the liver, pancreas, heart, joints, skin, and endocrine systems may have been damaged severely and often irreversibly. Deposition of iron in vital organs may be prevented by depleting the body of iron. Venesection, common in the 18th century, remains an effective treatment for haemochromatosis today.

Hereditary haemochromatosis is a recessive single gene disorder that occurs in at least l in 400 white people, reflecting a very high carrier frequency of 1 in 10.1 The problem has been to establish the diagnosis at an early stage in this common disease. A genetic key to this would not only prevent complications but allow patients to enjoy a normal life expectancy.

Summary points

  • Genetic screening for hereditary haemochromatosis is now a reality

  • New treatments for Barrett's oesophagus can remove gastric and intestinal metaplasia

  • Helicobacter pylori can be eradicated effectively in 1 week by a regimen of drugs given twice daily

  • Progress is being made in developing an oral vaccine against H pylori

  • Endoscopic screening reduces mortality from colon cancer, but issues of social cost need further evaluation

  • Although the cause of Crohn's disease remains elusive, response to some antibiotic regimens suggests an infective link involving intestinal bacteria in …

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