Article Text

Digest
1. Ian Forgacs, Associate Editor

## THE ENTEROCYTE AS BATTLEGROUND

At most international meetings these days, it is standing room only at the sessions on colonic microflora. Much of the current enthusiasm surrounds the interaction between bacteria and host mucosa. Yet bacteria-bacteria interactions themselves are of consuming interest. This month's Gut includes a paper on whether lactobacilli protect against cellular injury promoted by a pathogenic E coli strain. In the presence of lactobacilli there was a dose dependent decrease in E coli together with protection of brush border structure and function. Lactobacilli seem to have won the day. See page 803

## VIAGRA: REACHING THE OESOPHAGUS

Whatever else, sildenafil is an interesting drug. It blocks phosphodiesterase type 5 which degrades nitric oxide stimulated 35 cyclic GMP—resulting in smooth muscle relaxation. Studies in healthy males and patients with oesophageal motor over-reactivity showed a reduction of lower oesophageal sphincter pressure as well as diminished propulsion forces. These stimulating observations suggest a role for viagra in oesophageal dysmotility. Side effects may be an issue! See page 758

The Eurohepygast study group must win some sort of award—if only for being the most clumsily named consortium of medical researchers. Despite their dreadful name, the group has done some reasonably good research. By studying Helicobacter pylori strains in 14 countries, they have found that simultaneous presence of anti-CagA and anti-VacA antibodies increased the risk of atrophic gastritis. Their most surprising conclusion was that “diet was homogeneous in Europe”. Really? See page 779

The shaded areas reflect LOS vector volume which was decreased by sildenafil (pp 758–64).

## GOING FOR A QUICK STRETCH

Hydrostatic dilation is a good treatment for achalasia. Its success (or otherwise) is usually judged by symptomatic improvement (or lack of same) but the judge is often also the therapist. Vaezi and colleagues felt that a more objective assessment might be useful. They compared symptomatic improvement with change in length of a column of barium. In 30% of patients poor emptying was observed despite a good symptomatic response and almost all of these relapsed within one year. One cannot really object to a good objective assessment of outcome. See page 765

## FNH: ARE MEN THE SAME AS WOMEN?

A retrospective study from a specialist centre in France looked at gender differences in focal nodular hyperplasia (FNH). Eighteen men and 216 women with FNH were identified over a 9 year period. In men at presentation, mean age was greater and size of lesions smaller than in the women. The males were much more likely to be treated surgically—probably because their MRI features were more often atypical. For men with FNH, size is not everything. See page 869

## CJD AND OGD

My hunch is that it will be prions (or some other grim infectious agent) rather than a thermonuclear holocaust that will end the world. However, moving from Nostradamus to the rational evaluation of data, Bramble (from the BSG) and Ironside (from the CJD Surveillance Unit) have written an informative and useful guide to present thinking about endoscopy and transmission of CJD. Much food for thought—and it is now quite clear that is is unacceptable to re-use forceps after ileal biopsy. See page 888

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