This month in the Scandinavian Journal of Gastroenterology

In this issue of the Journal, Vignes & Carcelain [1] focus on T-cell loss in patients with primary intestinal lymphangiectasia (PIL). They show that the counts of CD4 and CD8 subsets are significantly reduced among patients compared with healthy controls. Interestingly, the T-cells remaining in the patients are significantly activated compared with controls. They conclude that the loss is not sufficiently compensated by increased T-cell production.

Steenholdt et al. [2] evaluate Toll-like receptor-8 (TLR-8) and its naturally occurring antagonist Tollip mRNA expression in colonic epithelial cells and mononuclear cells from lamina propria of non-inflamed and inflamed human gut tissue from patients with either ulcerative colitis (UC) or Crohn's disease (CD). TLR-8 expression is shown to be up-regulated in colonic epithelium of patients with IBD, while expression of Tollip is similar to expression among healthy persons.

Mishima et al. [3] also focus on IBD and show that CD5⁺ B-cell counts are not related to either age or gender, while it could be shown by regression analyses that UC, corticosteroid therapy and total white blood cell counts in peripheral blood have a significant relation to decreased CD5⁺ B-cell counts. In addition, in vitro dexamethasone therapy shows that apoptosis is similar in CD5⁺ and CD5^– B cells.

Havemann et al. [4] offered endoscopic stenting to 45 patients with gastric outlet obstruction caused by advanced upper GI-tract malignancy. Oral intake before and after the procedure was assessed by a scoring system (GOOSS) and show that stenting significantly improves oral intake. Finally, procedure-related mortality was not observed and the researchers conclude that stenting is safe and feasible.

Mechanisms leading to sclerosing cholangitis (SC) have not yet been fully identified. Nakken et al. [5] focus on abcb4 (–/–) mice fed either cholic acid (CA) or ursodeoxycholic acid (UDCA); control animals were abcb4 (+/ + ) mice. Use of cDNA microarrays showed a 3-fold greater up-regulation of genes in CA-fed mice compared to USCA-fed mice.

In a review article, Kalaitzakis & Meenan [6] conclude that EUS is more appropriate for locoregional staging compared with other imaging modalities and that EUS-FNA improves the accuracy of EUS in staging procedures. Although EUS has limited accuracy in detecting submucosal invasion, it is still important because it can identify both T2 and N1 disease.

Møller et al. [7] examine the high mortality rates after emergency surgery for perforated peptic ulcer. They evaluate a variety of parameters in relation to 30-day mortality of 27%. Variables such as ASA score, age, shock, metabolic acidosis, increased creatinine and subnormal albumin upon admission and insufficient postoperative nutrition were independently associated with 30-day mortality.

Coeliac disease can disrupt certain stages of in vitro angiogenesis, and it is therefore believed that the disease can lead to alterations in mucosal vasculature of the patients. Myrsky et al. [8] verify how ingestion of gluten can lead to altered appearance of small-bowel microvasculature in patients with coeliac disease.

Pulmonary hypertension (PH) is a frequent complication of primary biliary cirrhosis (PBC). In a prospective, single-centre study. Shen et al. [9] show that a variety of variables known to be associated with PBC are significantly worse among patients with PBC and PH. They conclude that these patients have a poorer prognosis than do PBC patients without PH.

Over the course of 4 months, Lankisch et al. [10] prospectively determined pancreatic enzyme (amylase and lipase) levels in 1765 patients. The authors conclude that pancreatic enzyme levels might be elevated in a small proportion of patients admitted to hospital, but that pancreatic disease is rare in patients showing no symptoms of pancreatic disease.

Lluch et al. sought to determine asymmetric and symmetric dimethylarginine and nitric oxide levels in patients with chronic hepatitis C and patients treated for hepatitis C, and in healthy volunteers well. Their findings show that the concentrations are similar among all three groups of individuals tested [11].

Oh et al. [12] had the 10 patients included in their study undergo EUS-guided ethanol lavage for septated cystic tumours, resulting in complete resolution in 6 of them. Partial resolution was reached in 2 patients and 2 patients were referred to surgery, where neoplastic disease was detected. The investigators recommend that selection must be a requirement in EUS-EL of pancreatic cysts.

Recent findings indicate that bacteria may have a specific role in the development of IBD. Nishikawa et al. [13] use terminal restriction fragment length polymorphisms (T-RFLP) to determine the mucosa-associated microbiota in UC and non-UC individuals. Their findings indicate that the microbiota in UC patients is different from that in non-UC individuals. In addition, the microbial composition appears to be less diverse among the UC patients than among the non-UC individuals.

The mechanisms leading to reduced colonic contractility in colitis have not yet been fully identified. Lubbad et al. [14] use a well-known experimental model of carbachol-induced colonic contraction in their study. The investigators found that subsequent carbachol-induced colonic contraction is reduced in animals with colitis, but that curcumin prophylaxis improves colonic contraction.

Liver biopsy is the ultimate method for differentiating between simple steatosis and non-alcoholic steatohepatitis (NASH). However, non-invasive methods are preferable in preventing some of the adverse effects of biopsy. Kikuchi et al. [15] find that ^99mTC uptake is significantly reduced in patients with NASH compared with patients with simple steatosis.

Bartchewsky et al. [16] evaluate the level of tissue concentrations of IL-1, IL-8 and COX-2 in Helicobacter pylori-positive patients with chronic gastritis and patients with gastric cancer. It is shown that levels are increased in patients with gastritis compared with non-infected individuals. Bartchewsky et al. conclude that increased levels of the cytokines might be involved in the carcinogenesis of gastric cancer.

Mulder et al. [17] consider that proximal neoplasia remains undetected in some individuals offered sigmoidoscopy. In a retrospective study it is shown that 57 of 255 patients <65 years and 185 of 528 patients >65 years had proximal cancer without any distal neoplasia. These patients would have been misdiagnosed had they been offered sigmoidoscopy alone.

Although circulating immune complexes are involved in a variety of autoimmune diseases, they can also be detected in otherwise healthy persons. Eisenmann et al. [18] consider that these complexes might be associated with food antigens. Subsequently, they found that such antigens could play a role in the formation of immune complexes in circulation.