This month in Scandinavian Journal Gastroenterology

In the current issue of the journal there are as usual a wide variety of interesting papers on inflammatory bowel disorder (IBD) (n = 3), gastrointestinal (GI) malignancy (n = 3), acid related disorders/Helicobacter pylori (HP) (n = 3), liver fibrosis in animal models (n = 2), GI bleeding, irritable bowel syndrome( IBS), acute pancreatitis, gastrointestinal (GI) motility and hemochromatosis, as well as a case report and comment on a previously published paper. An important paper from Denmark, deals with the possible reasons for therapeutic failure and loss of response to Infliximab in patients with IBD [1]. Infliximab levels were significantly lower and antiInfliximab levels significantly higher in in Crohn’s (CD) disease patients with loss of response compared to patients with maintained response [1]. The serum levels of the drug have not been widely used in clinical practice but this study is the first to provide cutoff levels for clincally relevant combined levels for this use. Bilateral stenting has been used for palliative draining of malignant hilar biliary strictures. An uncontrolled study in 30 patients demonstrated that Y-shaped endoscopic bilateral stentning using Y-stent appears to be a feasible method with high technical success and at least in these experienced hands low stent-related complications in this diffcult to treat patients [2]. An interesting paper on the long-term outcome of gastric acid hypersecreters with ZollingerEllison like syndrome is presented [3]. The senior author of the paper is the father of the flexible endoscope (Basil Hirschowitz). The patients were enrolled in an open lable prospective trial evaluating the effects of lansoprazole on complicated ulcers. All patients responded to a high dose of the drug (median dose 90 mg/day) and mucosal relapse was infrequent and no major complications occurred on therapy. Liver transplantation for cholangiocarcinoma (CCA) is controversial and a contraindication for transplantation in some centers. Friman et al. [4] reported the experience of the Scandia transplant of patients with CCA transplanted 1984-2005. The overall 5-year patient survival was 25% but patients with less advanced tumor (<TNM stage 2) was 36% whereas TNM stage > 2 was only 10%. Patients with TNM stage < 2 and CA 19–9 < 100 had a 5-year survival of 58%. Thus strict selection of patients is essential for acceptable results. From Austria, an important contribution dealt with the gastric phenotype in children with HP infection undergoing upper endoscopy [5]. HP is still going strong in Austria as 36% of these patients were HP positive, with 46% having pangastritis and 50% had antrum-predominant gastritis. Mucosal atrophy was found in one patient but intestinal metaplasia in none. A study from Sweden and Denmark, showed that anemia was present in 20% of IBD patients and iron deficiency in every third IBD patient [6]. The cohort was from tertiary referral centers with focus on these matters and would therefore rather be an under-than overestimation of this problem. A retrospective review of capsule endoscopies for suspected small bowel bleeding demonstrated that combination of low-dose aspirin and thienopyridine drugs (ticlopidine and clopidogrel) may exacerbate small bowel injury [7]. Inadequate supply of long-chain fatty acids was found in subjects with IBS [8]. Organic disease had been ruled out and intestinal malabsorption was suggested by the authors although no mechanism behind this is clear at the present time. Antibiotic prophylaxis in severe acute pancreatitis (SAP) is controversial. In a metaanalysis, of antibiotic prohylaxis in these patients, showed no mortality advantage and no significant decrease in infectious complications of SAP [9]. Thus, no evidence supports routine use of antibiotic prophylaxis in these patients. Irsogladine and famotidine were comparable after HP eradication in gastric ulcer patients, but the former drug was more beneficial in smokers and drinkers [10]. Automated computer analysis was found to be helpful to identify reflux episiodes and to identify the relationship between reflux episodes