This month in Scandinavian Journal of Gastroenterology

The intention of Scandinavian Journal of Gastroenterology is to cover all aspects of gastroenterology from basic sciences to therapy. The present issue reflects this policy. In a review, Pezzilli et al. cover autoimmune pancreatitis. This disease is subdivided into two types, where one of the diagnostic criteria is a favorable response to steroid therapy [1]. Endoscopy represented a major breakthrough in diagnostic gastroenterology when it was introduced in the late 1960s, and was also used in the therapy of gastrointestinal diseases. Endoscopy in the broader sense is continuously being developed as described by Imagawa et al. [2], showing that capsule endoscopy with color enhancement improves the detection of angioectasias. In a Finnish study, capsule endoscopy is also shown to be feasible for children [3]. endoskopic retrograde cholangio-pancreatography (ERCP) is the endoscopic procedure with the highest mortality and complication rate, which is reflected by the fact that it is now a daysmainly used as a therapeuticmethod. In a study from Norway, Glomsaker et al. [4] describe the present results with respect to indications, procedures, morbidity, andmortality. The results seem to be in line with the best international centers. Helicobacter pylori (HP) infection is involved in the pathogenesis of most diseases in the upper gastrointestinal tract. In the present issue, Dall et al. [5] show that HP infection increases the risk of upper gastrointestinal bleeding among users of selective serotonin reuptake inhibitors. It is well known that the incidence of gastric cancer is high in East-Asia compared with other countries, even where the prevalence of HP infection is comparable. In a study from Japan/Brazil, Takamura et al. [6] studied polymorphism of cagA, and found differences that they speculate could be of importance for the high incidence of gastric cancer in East-Asia and particularly Japan. An Indian study suggests that sequential treatment could be of benefit in eradicating HP [7]. It is well known that it may be difficult to differentiate mild forms of celiac disease from normality. The histological diagnosis is problematic since it is a continuum from normal small bowel mucosa to virtual atrophy. Moreover, since the changes may be patchy, it is not surprising that there may be differences in the assessment between pathologists as demonstrated by Mubarak et al. [8]. It is to be expected that there will be a grey zone in the diagnosis of celiac disease until more is understood about the pathogenesis of the disease. Inflammatory bowel diseases still represent a therapeutic challenge. Ricanek et al. [9] from Norway related disease activity to biochemical and fecal markers. They found that in ulcerative colitis, both biochemical and fecal markers reflected severity of the disease, whereas in Crohn’s disease fecal calprotectin was only related to mucosal affection. Eosinophilic gastroenteritis is an entity without known etiology where the diagnosis is based upon infiltration of eosinophils in biopsies. Zhang et al. [10] concluded their study on this entity that it is probably more prevalent than hitherto recognized and advocated that multiple biopsies should be taken from the second part of the duodenum. Detection of cancers at an early stage, still amendable by surgery, is the cornerstone of gastroenterology. It is therefore surprising that only a third of patients with iron deficiency anemia in general practice are examined by endoscopy of the gastrointestinal tract, thus delaying the diagnosis particularly of colonic cancer [11]. In East-Asia, early gastric cancer is often treated by endoscopic resection. Han et al. [12] from Korea followed these patients and found that 5% developed metachronous cancer during a follow-up from 18 to 42 months. Von Hahn et al. [13] studied the incidence and mortality of hepatobiliary cancers in Germany. There the most spectacular finding was that intrahepatic cholangiocarcinoma showed a marked increase. The factors behind this rise are not known. Functional gastrointestinal conditions may be defined as gastrointestinal symptoms without detectable structural or biochemical cause. These complaints are frequent and not easy to treat. Nevertheless, dysfunction in motility is believed to play an important role in the generation of symptoms, and during the recent years, the role of the gut microorganisms in the pathogenesis has been focused. Waller et al. [14] therefore treated such patients with the probiotic Bifidobacterium lactis and showed that this treatment reduced whole gut transit time and reduced the symptoms.