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  1. Ian Forgacs, Associate Editor

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STELLATE CELLS: A STAR PERFORMER IN PANCREATITIS

The natural history of acute pancreatitis is particularly fascinating—especially given the spectrum of the condition from mild inflammation to massive haemorrhagic necrosis. Zimmerman and colleagues have been interested in the regenerative process after necrotising pancreatitis, and studied surgical specimens to determine the key cells involved. They showed that regeneration was quite ordered. The process involved pancreatic stellate cells and their myofibroblast offspring. Although stellate cells are closely involved in pancreatic fibrosis, this study helps to clarify their role in acute severe injury.

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SLOW TRANSIT, SLICK STUDY

The general reader of this journal may not be well versed in gastrointestinal electrophysiology. One must hope that a real breakthrough in motility cannot be all that far away—after all, disturbances of motility cause so much distress to our patients and effective therapy is so limited. Lyford and colleagues highlight the importance of the interstitial cells of Cajal (JCC) as the intestinal pacemaker. An elegant study using confocal microscopy and 3D reconstructions of the colon showed that decreased ICC volume is seen throughout the colon in idiopathic slow transit constipation.

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SMOKING, TONSILS, AND BILE DUCTS

Epidemiologists have had a great time investigating ulcerative colitis (UC). The positive link with non-smoking and the negative association with appendicectomy are now well characterised. Given its high prevalence in UC, maybe it is not surprising that patients in Oxford with primary sclerosing cholangitis (PSC) show the same association with non-smoking (although this link was independent of whether or not the patient had UC). But, in this sizeable cohort, no link was found with appendicectomy although tonsillectomy seems to decrease the PSC risk. Like much epidemiology, the results are interesting, even fascinating, but the explanations are obscure.

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GORD MOVES IN MYSTERIOUS WAYS

George Bernard Shaw said that America and Britain were divided by a common language. He might have been thinking of the consequences of how the medical term for the gullet is spelled on either side of the Atlantic. The resulting abbreviations are ghastly whether your patient has GORD or GERD. Omari and colleagues have done an important study on GOR in the very young. In infant GORD, TLOSRs are abnormally common although GE is OK.

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FLAT AND DEPRESSED IN SWEDEN

Many western gastroenterologists will have been impressed by the skill with which their Japanese counterparts identify non-polypoid or non-ulcerating tumours in the stomach and colon. Flat adenomas are considered to be unusual in western countries. A study of 371 Swedish patients found that 66 (7%) of 973 colonic tumours were flat or depressed. High grade dysplasia was more likely in flat/depressed lesions than in protruding tumours. European colonoscopists should not be depressed by these findings; they must rise to meet the challenge.

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Figure1

Avoiding colitis? See page 567.

OCCULT BLOOD, NORMAL COLON...NORMAL STOMACH

There are few papers that really influence clinical practice but Gut does highlight potentially important clinical papers in our “Clinical @lert” section. This month, the result of a huge case series from Denmark carries a useful message for gastroenterologists. If occult blood screening is positive, yet colonic investigation is negative, it is not justified to investigate the upper GI tract. Robinson's highly readable commentary sets this paper in the context of data from the large screening trials. Keep your gastroscope in the cupboard.

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