The following represent additions to UpToDate since the last version that were considered by the authors and editors to be of particular interest. The new material described below represents a small subset of the updating that has been performed, since approximately 40 percent of the topic reviews are updated during each four-month cycle.

BUDD-CHIARI SYNDROME

A series of 163 patients with Budd-Chiari syndrome underscored the improved prognosis with contemporary management approaches that include use of anticoagulation and diuretics, and invasive techniques (transjugular intrahepatic portosystemic shunts, stents, and liver transplantation) in selected patients [1]. (See "Clinical manifestations, diagnosis, and treatment of the Budd-Chiari syndrome".)

CELIAC DISEASE AND MORTALITY

A large database study found a small increase in all-cause mortality (mainly from cardiovascular disease and cancer) in patients with untreated celiac disease compared to the general population [2]. (See "Pathogenesis, epidemiology, and clinical manifestations of celiac disease in adults", section on 'Risk of malignancy and mortality'.)

COLONIC POLYPS

A study of 564 patients with colonic adenomas found that patients with a history of an advanced (≥1 cm or advanced histology) adenoma or multiple (≥3) adenomas were at increased risk for recurrent advanced or multiple adenomas during surveillance colonoscopies even if no adenomas were detected on the first follow-up study [3]. Thus, delaying the second follow-up colonoscopy because of a negative first follow-up study is not warranted, but extending surveillance intervals could be considered in patients with a low risk adenoma and a subsequent negative surveillance colonoscopy. (See "Approach to the patient with colonic polyps", section on 'Surveillance'.)

DYSPEPSIA

A study of 2741 patients with dyspepsia without alarm symptoms who underwent upper endoscopy found that the risk of finding a cancer varied by age [4]. Although the American Gastroenterological Association 2005 guidelines suggest endoscopy be performed in patients with dyspepsia with or without alarm symptoms who are ≥55 years of age, performing an upper endoscopy only in patients older than 55 (554 patients) would have missed three cancers (0.5 percent) while performing an upper endoscopy in those older than 50 (829 patients) would have missed only one (0.1 percent). (See "Approach to the patient with dyspepsia".)

ENDOSCOPIC ULTRASOUND FOR RECTAL CANCER

A meta-analysis of 35 studies (2732 patients) found that endoscopic ultrasound (EUS) was moderately useful in the diagnosis of nodal involvement by rectal cancer [5]. Sensitivity and specificity for detecting nodal involvement were 73 and 76 percent, respectively. (See "Endoscopic ultrasound in rectal cancer".)

GASTRIC CANCER AND HELICOBACTER PYLORI ERADICATION

A meta-analysis of seven controlled trials in populations at high risk for gastric cancer found a significantly lower rate of gastric cancer following H. pylori eradication (1.1 versus 1.7 percent) [6]. (See "Association between Helicobacter pylori infection and gastrointestinal malignancy", section on 'Does treatment reduce risk of gastric cancer?'.)

HELICOBACTER PYLORI-NEGATIVE ULCERS

A prospective study involving 120 patients with bleeding peptic ulcers who were H. pylori negative found significantly higher rates of recurrent bleeding compared with 213 patients with bleeding ulcers who were H. pylori positive (41 versus 11 percent) [7]. (See "Helicobacter pylori-negative peptic ulcer disease", section on 'Characteristics of H. pylori-negative ulcer disease'.)

HEPATIC ENCEPHALOPATHY

A randomized controlled trial demonstrated that maintenance lactulose after an episode of hepatic encephalopathy significantly reduced the incidence of recurrent episodes of hepatic encephalopathy (20 versus 47 percent) during 14 months of follow-up [8]. The study helps confirm a preventive approach in such patients. (See "Treatment of hepatic encephalopathy".)

HEPATITIS B

The American Association for the Study of Liver Diseases updated its hepatitis B guideline. The new guideline contains multiple new recommendations regarding treatment [9]. (See "Overview of the management of chronic hepatitis B and case examples".) It also re-emphasized that screening for hepatocellular carcinoma should be performed by obtaining an ultrasound every six months rather than by measuring serum alpha-fetoprotein. (See "Surveillance for hepatocellular carcinoma in adults with chronic liver disease".)

HEPATITIS C

Several studies found that polymorphisms in the IL28 gene correlated with virologic outcome in patients with chronic hepatitis C undergoing treatment with pegylated interferon plus ribavirin [10-12]. Certain genetic variants were much more likely to respond to treatment while others may account for the lower response rates observed among African Americans. (See "Pegylated interferon in the treatment of chronic hepatitis C virus infection".) IL28 polymorphisms also appear to predict the likelihood of developing chronic infection in patients with acute HCV [13]. (See "Clinical features and natural history of hepatitis C virus infection".)

INTRACTABLE NAUSEA AND VOMITING

An uncontrolled study of 33 patients with unexplained, intractable nausea and vomiting who had normal gastric emptying found a benefit from gastric electrical stimulation [14]. (See "Approach to the adult with nausea and vomiting", section on 'Gastric electrical stimulation'.)

PANCREATIC CANCER DIAGNOSIS

In a retrospective study of 624 patients with pancreatic cancer, the sensitivity of endoscopic ultrasound (EUS) for detecting pancreatic malignancy was significantly decreased in patients with underlying chronic pancreatitis compared to patients without pancreatitis (62 versus 96 percent) [15]. (See "The role of endoscopic ultrasound in the staging of pancreatic adenocarcinoma".)

POSTOPERATIVE CROHN'S DISEASE

In a meta-analysis of four controlled trials involving 433 patients who had undergone surgery for Crohn's disease, azathioprine and 6-mercaptopurine were significantly more effective than placebo in preventing both clinical and severe endoscopic postoperative recurrences [16]. (See "Medical prophylaxis of postoperative Crohn's disease", section on 'Azathioprine and 6-MP'.)

PRIMARY BILIARY CIRRHOSIS

The American Association for the Study of Liver Diseases issued a guideline on primary biliary cirrhosis [17]. Among the recommendations are suggestions for treatment of dry mucus membranes and follow-up intervals for testing. (See "Overview of the treatment of primary biliary cirrhosis".)

REFRACTORY ASCITES

A randomized controlled trial found a benefit from infusion of small volume hypertonic saline plus furosemide in patients with refractory ascites [18]. More studies are needed before such therapy should be considered. (See "Treatment of diuretic-resistant ascites in patients with cirrhosis".)

SPONTANEOUS BACTERIAL PERITONITIS

Another study demonstrated poor sensitivity (10 percent) of a Gram stain of peritoneal fluid for diagnosis of spontaneous bacterial peritonitis [19]. Nevertheless, a Gram stain can be helpful when positive and help exclude alternative diagnoses such as free perforation. (See "Diagnosis and evaluation of patients with ascites".)