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DIAGNOSING HAEMOCHROMATOSIS: ARE CLINICIANS GETTING RUSTY?
Hereditary haemochromatosis (HH) is the commonest autosomal recessive disease in those of North European descent. Although in Ireland the homozygote frequency in the HFE gene is 1:83, this is not reflected in the number of individuals recognised to have HH. Ryan and colleagues wanted to know whether the discrepancy was because the early symptoms of HH were non-specific or because the C282Y mutation had incomplete penetrance. They studied 79 homozygous individuals and 30 HH probands, and concluded that failure to recognise this condition was more likely to be due to under-diagnosis.See page 108
ONCE NON-ULCER DYSPEPSIA; NOT ALWAYS NON-ULCER DYSPEPSIA
Hsu and colleagues report the results of a study that might cause some endoscopic distress to clinicians. Patients with endoscopy-negative dyspepsia at entry had routine follow up endoscopy. Sixteen of 209 such patients developed peptic ulceration over two years. Those good friends of the upper GI tract, Helicobacter pylori and NSAIDs, were independent risk factors predicting ulcer occurrence. Probably a good idea to lower the threshold for repeat endoscopy in “higher risk” patients. See page 15
SEVERE HEPATITIS A: ACCEPT NO SUBSTITUTES
Hepatitis A virus (HAV) infection is still a major problem in the developing world and a significant problem within industrialised nations. The reason why some patients develop severe or fulminant hepatitis A is unclear. The HAV genotype was studied in patients with hepatitis A infection of varying severity. The 5` non-translated region showed fewer nucleotide substitutions in severely ill patients. Although host factors contribute to the severity of the infection, it looks as though substitutions within the HAV genome may also influence clinical status. See page 82
UC: NO FIRE WITHOUT SMOKE
Individuals who are concerned about developing inflammatory bowel disease (IBD) need to think hard about whether to smoke. If their brother or sister has IBD, their decision might well be influenced by a report on disease phenotype in sibling pairs with genetic susceptibility to I.B.D.? A study of 339 sib pairs found 89 who were discordant for smoking. In these discordant pairs, the pattern was almost always Crohn's disease in the smoker; ulcerative colitis in the non-smoker. Maybe tobacco consumption pushes the phenotype towards Crohn's in those genetically predisposed to IBD. See page 21
THE CUT AND THRUST OF DEBATE
In its indefatigable efforts to stimulate our readers to the full, Gut has been running a series of debates on issues where controversy reigns. The task of marshalling evidence and presenting it coherently (if not impartially) is a real challenge to the debater's intellect. Although, like most really great plays, debates are better in performance than on the page, we hope readers will enjoy this month's tussle on early surgery in Crohn's disease. The participants present their respective arguments persuasively—so it's just as well that, in the real world, tricky management decisions involve real collaboration between those who might be antagonists in print.See pages 11 and 13
BENCH>PRESS—POWER TO LIFT GUT TO GREATER HEIGHTS
The publishing world loves charismatic epithets. For example, Palm Springs is the name given to the department in the BMJ Publishing Group which provides your author proofs. Gut can now announce that it has gone live with Bench>Press, a web based manuscript handling system which has already begun to radically enhance our whole editorial process. The serial steps of electronic submission, reviewing, decision making, revising, and acceptance (or otherwise) makes use of the internet's power to accelerate the editorial process at every stage. Authors can expect speedier decisions; they will join our readers in welcoming more efficient and more rapid publication. May the force be with us!
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