this month in the scandinavian journal of gastroenterology
TRANSCRIPT
EDITORIAL
This month in the Scandinavian Journal of Gastroenterology
In this issue of the journal, Burgdorf et al. review the
current knowledge of immunotherapy in colorectal
cancer (CRC) [1]. A considerable number of clinical
trials have been published in which various immu-
notherapeutic agents have been used, the authors
focusing on the clinical efficacy and perspectives of
the different newer immunotherapeutic agents in the
treatment of cancer, particularly CRC.
There have been only a few studies comparing the
outcomes of laparoscopic Nissen and laparoscopic
Lind fundoplication. Although postoperative dys-
phagia and time taken to return to work are
significantly higher and longer in the Nissen group,
Khan et al. found no statistically significant differ-
ences between either group at 1 year [2]. They
conclude that both operations provide good quanti-
tative and qualitative control of GORD.
On comparing between wireless and catheter-
based oesophageal pH recordings, Hakanson et al.
indicate that subjective parameters are less affected
with the wireless device [3]. Acid exposure time has
been found to be significantly lower with the wireless
device, indicating underestimation of oesophageal
acid exposure compared with traditional recording.
The authors conclude that these two methods are
not immediately interchangeable for use in clinical
practice.
The effects of a high dose of oral lanzoprazole on
intragastric pH in patients with major peptic ulcer
bleeding are investigated by Høie et al. [4]. Median
pH values and percentage of time maintaining a pH
over 6 are comparable to those in previous i.v.
studies in this context. It is conceivable that high
oral doses of proton-pump inhibitors (PPIs) might
improve the cost-effectiveness of PPI treatment for
bleeding peptic ulcers, but this needs further study.
Both bacterial and host factors contribute to the
gastric inflammatory processes in Helicobacter pylori-
infected subjects. Defensins are endogenous anti-
biotic peptides that can form a chemical barrier
at the epithelial surface, their deficiency possibly
facilitating bacterial adherence and mucosal inflam-
mation. In vitro experiments and genotyping
of single nucleotide polymorphism of the beta-
defensins show that the inducible and constitutive
forms of beta-defensins may be important in the
pathogenesis of H. pylori-induced gastritis [5].
Macrophage migration inhibitory factor (MIF) is
a key pro-inflammatory mediator that is pivotal in
many inflammatory and immune diseases. Arisawa
et al. show that certain MIF polymorphisms are
associated with development of ulcerative colitis
(UC), chronicity of UC phenotype, distal colitis
phenotype and the severity of inflammation [6].
The results of a questionnaire on gastrointestinal
symptoms, completed by a random population-
based sample in the USA [7], indicate recollection
of abdominal pain as a child being specifically
associated with irritable bowel syndrome (IBS) but
not with GORD or functional dyspepsia.
In a study by Morken et al., patients with both
present and cured Giardia lamblia infection had
significantly higher subjective complaint scores than
healthy controls [8]. Somatic co-morbidity (muscu-
loskeletal pain) was similar to that in controls. The
authors conclude that post-giardiasis IBS patients
suffer little somatic co-morbidity and that this form
of post-infective IBS is predominantly biological
in origin.
Glucagon-like peptide 2 is shown by Bremholm
et al. to be an important regulator of mesenteric
blood flow in healthy volunteers [9]. Mesenteric
blood flow increased in similar fashion after a
standard meal and after subcutaneous administra-
tion. An exponential dose response was observed
after i.v. infusion.
Magnified ileoscopy during colonoscopy for ab-
dominal complaints is valuable in the diagnosis of
coeliac disease [10]. More studies evaluating this
practice are needed.
A high prevalence of parasitic and viral infections
in patients with active UC is reported from India
[11]. Prompt identification and treatment of such
infections may improve the clinical course of active
UC.
Fukumoto et al. show that one-fourth of small-
bowel tumours found by transabdominal ultrasono-
graphy (TUS) can subsequently be detected by
capsule endoscopy and by double balloon endo-
scopy [12]. With tumours larger than 20 mm, the
Scandinavian Journal of Gastroenterology, 2009; 44: 259�260
ISSN 0036-5521 print/ISSN 1502-7708 online # 2009 Informa UK Ltd.
DOI: 10.1080/00365520902783725
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detection rate with TUS is approximately 60%.
The authors conclude that TUS is the first choice
modality when examining small-bowel lesions.
H. pylori stimulates the production of interleukin
(Il)-1beta, a pro-inflammatory cytokine. Functional
genetic polymorphisms that affect production of (Il)-
1beta have been associated with an increased risk of
gastric cancer. In a large population based in
Sweden, however, Persson et al. failed to show this
relationship [13].
Kim et al. find that models for end-stage liver
disease (MELD) and MELD-Na correlate well with
survival of patients with hepatocellular cancer trea-
ted with transarterial chemoembolization [14],
although not superior to other staging systems or
Child-Pugh score in this group of patients.
A mouse model of non-alcoholic steatohepatitis is
shown by Nan et al. to be reversed by rosiglitazone, a
peroxisome proliferative activated receptor gamma
agonist [15].
In some recent studies, light to moderate alcohol
consumption has been found to decrease the risk of
non-alcoholic fatty liver disease (NAFLD). Ekstedt
et al. find that heavy episodic drinking is more
common in patients with NAFLD, and who have a
significant liver fibrosis progression during follow-up
[16]. Although the authors are to be complimented
for their thorough history of alcohol consumption, it
is not entirely clear whether some of their patients
had NAFLD or alcoholic liver disease.
Sodium phosphate is found by Chen et al. to be as
well tolerated and safe as polyethylene glycol in
patients with chronic constipation preparing for
colonoscopy [17].
In a primary care setting in The Netherlands,
Velden et al. show that patients with GORD are of
similar psychological state of mind as the general
population, disproving previous suggestions of a
relationship between psychological distress and
GORD [18].
Einar Bjornsson
Editor
References
[1] Burgdorf SK, Nielsen HJ, Rosenberg J. Immunotherapy in
colorectal cancer. Scand J Gastroenterol 2009;/44:/261�8.
[2] Khan MA, Smythe A, Globe J, Stoddard CJ, Ackroyd R.
Randomized controlled trial of laparoscopic Nissen versus
Lind fundoplication for gastro-oesophageal reflux disease.
Scand J Gastroenterol 2009;/44:/269�75.
[3] Hakanson BS, Berggren P, Granqvist S, Ljungqvist O,
Thorell A. Comparison of wireless 48-h (Bravo) versus
traditional ambulatory 24-h esophageal pH monitoring.
Scand J Gastroenterol 2009;/44:/276�83.
[4] Høie O, Stallemo A, Matre J, Stokkeland M. Effect of oral
lansoprazole on intragastric pH after endoscopic treatment
for bleeding peptic ulcer. Scand J Gastroenterol 2009;/44:/
284�8.
[5] Kocsis AK, Kiss ZF, Tiszlavicz L, Tiszlavicz Z, Mandi Y.
Potential role of human beta-defensin 1 in Helicobacter
pylori-induced gastritis. Scand J Gastroenterol 2009;/44:/
289�95.
[6] Arisawa T, Tahara T, Shibata T, Nagasaka M, Nakamura M,
Kamiya Y, et al. Association between promoter polymorph-
isms of nuclear factor-erythroid 2-related factor 2 gene and
peptic ulcer diseases. Scand J Gastroenterol 2009;/44:/
296�300.
[7] Chitkara DK, Talley NJ, Schleck C, Zinsmeister AR, Shah
ND, Locke GR 3rd. Recollection of childhood abdominal
pain in adults with functional gastrointestinal disorders.
Scand J Gastroenterol 2009;/44:/301�7.
[8] Morken MH, Lind RA, Valeur J, Wilhelmsen I, Berstad A.
Subjective health complaints and quality of life in patients
with irritable bowel syndrome following Giardia lamblia
infection: a case control study. Scand J Gastroenterol 2009;/
44:/308�13.
[9] Bremholm L, Hornum M, Henriksen BM, Larsen S, Holst
JJ. Glucagon-like peptide-2 increases mesenteric blood flow
in humans. Scand J Gastroenterol 2009;/44:/314�9.
[10] Trecca A, Gaj F, Gagliardi G, Calcaterra R, Battista S,
Silano M. Role of magnified ileoscopy in the diagnosis of
cases of coeliac disease with predominant abdominal symp-
toms. Scand J Gastroenterol 2009;/44:/320�4.
[11] Banerjee D, Deb R, Dar L, Mirdha BR, Pati SK, Thareja S,
et al. High frequency of parasitic and viral stool pathogens in
patients with active ulcerative colitis: report from a tropical
country. Scand J Gastroenterol 2009;/44:/325�31.
[12] Fukumoto A, Tanaka S, Imagawa H, Shishido T, Oka S,
Yoshida S, et al. Usefulness and limitations of transabdom-
inal ultrasonography for detecting small-bowel tumors.
Scand J Gastroenterol 2009;/44:/332�8.
[13] Persson C, Engstrand L, Nyren O, Hansson LE, Enroth H,
Ekstrom AM, et al. Interleukin 1-beta gene polymorphisms
and risk of gastric cancer in Sweden. Scand J Gastroenterol
2009;/44:/339�45.
[14] Kim Hj, Kim JH, Choi JH, Yim HJ, Yeon JE, Park JJ, et al.
The value of the model for end-stage liver disease for disease
for predicting survival in hepatocellular carcinoma patients
treated with transarterial chemoembolisation. Scand J Gas-
troenterol 2009;/44:/346�57.
[15] Nan YM, Fu N, Wu WJ, Liang BL, Wang RQ, Zhao SX, et
al. Rosiglitazone prevents nutritional fibrosis and steatohe-
patitis in mice. Scand J Gastroenterol 2009;/44:/358�65.
[16] Ekstedt M, Franzen LE, Holmqvist M, Bendtsen P, Mathie-
sen UL, Bodemar G, et al. Alcohol consumption is
associated with progression of hepatic fibrosis in non-
alcoholic fatty liver disease. Scand J Gastroenterol 2009;/
44:/366�74.
[17] Chen H, Li X, Ge Z. Comparative study on two colonic
bowel preparations for patients with chronic constipation.
Scand J Gastroenterol 2009;/44:/375�9.
[18] Velden AV, Wit ND, Quartero AO, Grobbee DE, Numans
ME. GORD patients on chronic acid suppressive medica-
tion: a population-average psychological state. Scand J
Gastroenterol 2009;/44:/380�2.
260 Editorial
Scan
d J
Gas
troe
nter
ol D
ownl
oade
d fr
om in
form
ahea
lthca
re.c
om b
y X
avie
r U
nive
rsity
on
11/0
4/14
For
pers
onal
use
onl
y.