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The sustained trajectory of small bowel research.

DOI:10.1097/MOG.0000000000000044 Gastroenterologists uniformly acknowledge the 1980s as the decade of the foregut, highlighted by the discovery of what became known as Helicobacter pylori, and its role in peptic ulcer disease, gastric lymphoma and gastric cancer. Most will concede that the past decade has been the era of the large bowel with striking progress in understanding and management of various colonic disorders, particularly inflammatory bowel disease and colorectal cancer. In contrast, advances in our understanding of the pathophysiology of the small bowel, that most vital segment of the alimentary tract, have been on a different trajectory, less steep but sustained, and now at a stage in which a multitude of developments can be saluted. In celebration, the topics selected for this issue reflect recent and particularly noteworthy advances, the authors of which were invited because they are active participants in the unfolding stories portrayed. Once considered awkward or difficult to study, the small bowel is now accessible by capsule endoscopy and by imaging modalities which should be seen as complementary and are being continually refined [1–3]. One of the drivers of this has been a requirement for increased accuracy in assessing the level of activity of disorders such as Crohn’s disease, where mucosal healing has become a desired therapeutic target. No longer restricted to plain barium studies, clinicians need to familiarize themselves with the advantages of different imaging modalities in different disorders and in different phases of the same disorder. For example, computed tomography is still the most suitable modality for most patients with acute disease such as an active relapse or complication of Crohn’s disease, whereas other imaging strategies may be preferable in sub-acute phases of the disorder. Contrast-enhanced ultrasonography, newer technical modifications of magnetic resonance and low radiation protocols for computed tomography reviewed in this issue by Murphy et al. are rapidly being translated from research settings to daily practice. Celiac disease is perhaps the most remarkable condition in terms of the lessons to be learned from the changing nature of its epidemiology, diagnosis and molecular pathophysiology [4]. Much could be learned from the disparity in awareness of celiac