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The bond between blood brothers is extremely strong. Yet, rarely is the strength of the fraternal relationship tested to the limit of making a life saving sacrifice. A 13 year old Swiss boy donated 160 cm of ileum to his identical twin brother whose distal duodenum had been anastomosed to his transverse colon after massive resectional surgery for volvulus. Post- operative progress is very clearly documented and, by the observed standards, the outcome was generally successful. Doubtless the lack of need for immunosuppression was a great advantage. Plenty of data on physiology and chemistry. Hopefully the lack of data on psychological outcomes means there weren’t any adverse experiences in that department
See page 659
BARRETT’S—A FISH DISH
Curiously, the greater the research effort in Barrett’s oesophagus, the less we seem to understand. Truly an area in which the accumulation of knowledge ends up raising more questions than seem to be answered. Readers are invited to judge for themselves whether a ray of light emerges from a study by Doak and colleagues of genetic markers in Barrett’s mucosa. They used FISH (fluorescent in-situ hybridisation) to extend their earlier observations on chromosomal analysis in pre-neoplastic tissue. Chromosome 4 hyperploidy was found in 90% of patients with Barrett’s oesophagus irrespective of whether they had simple metaplasia, low grade or high grade dysplasia. Such data are very open to interpretation. Do you agree with the authors’ conclusions?
See page 623
PANCREATIC STELLATE CELLS—A SHINING STAR
Abbreviations can be a pain. For most gastroenterologists, PSC means a disease of the biliary tree. For pancreatologists, PSC means stellate cells in their favourite organ. A number of observations suggest that PSCs have a key role to play in the development of pancreatic fibrosis. It is not clear, however, if they increase in number as a result of local proliferation or whether they migrate from adjacent areas. Phillips and colleagues studied whether rat PSCs might migrate in vitro and, if so, what factors might influence migration to occur. PSC migration was indeed observed and was stimulated by platelet derived growth factor. Understanding fibrogenesis and the factors which might control it does offer the prospect of pharmacological intervention in an area where it is so badly needed.
See page 677
OF MICE AND MEN (IN THE LIVER)
To non-hepatologists, who presumably take such things for granted, the liver’s capacity to regenerate is indeed remarkable. However, it is not always thus. The impaired capacity of the cirrhotic liver to regenerate presents a problem after hepatic resection. Liver regeneration after partial hepatectomy is a complicated process and many growth factors regulate the process of cell cycle progression. A Japanese group employed a strategy of gene transfer of hepatocyte growth factor (HGF) in cirrhotic mice and were able to show that the active treatment group exhibited effective liver regeneration with increased HGF levels in plasma. The potential application of their findings to man did not escape the authors—yet the extrapolation is not, one feels, just around the corner.
See page 694
IBS—WHEN IN ROME, DO AS THE ASIANS DO
5-HT is obviously the molecule of the month. Tegaserod is a partial selective agonist at the 5-HT4 receptor. It seems to normalise altered g-i motility, accelerates gut transit and reduces sensory response to gut distension. Great in the lab; how about in humans with IBS? Patients with IBS who met the Rome II criteria were recruited from a number of centres in the Asia-Pacific region. Those with diarrhoea-predominant IBS were excluded but the remainder were randomised to receive tegaserod 6 mg twice daily or placebo for 12 weeks. A third of placebo-treated patients and just over half the tegaserod treated patients had satisfactory relief of symptoms after a month. The effect persisted through the study period. Side effects were mostly minor. The results are certainly not sensational but there is a dearth of evidence based treatments for IBS and the present report is most welcome (as a glance at Thompson’s commentary will reveal).
BOLTING HORSES AND SEROTONIN PEAKS
Most clinical gastroenterologists will spend a substantial part of their professional lives listening to patients with functional gut symptoms. But it is not necessary to spend much time in clinic to recognise that some symptom patterns are very common. Houghton and colleagues were interested in those patients who report exacerbation of symptoms by meals. They speculated that 5-hydroxytriptamine (5-HT) might play a role in prolonged or exaggerated colonic motor responses to food. Post-prandial plasma 5-HT levels were increased in women with diarrhoea-predominant irritable bowel syndrome, and those women who noted worsening of symptoms after food had high levels of 5-HT compared to baseline. The p values for some associations bear a close look. Do also read Cremonini and Camilleri’s commentary which suggests to me that journal club in their unit is probably rather stimulating (bolting horses included).
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