Pierrette Gast

Ultrastructural demonstration of histamine in human enterochromaffin like cell granules.

graphic brush cytology has proved negative by using a fine spring-loaded Tru-cut needle Biopty gun (Biopty TM, Radiplast, Uppsala), percutaneously under ultrasound guidance. The use of self expanding metal stents was alluded to in the leading article, and a primary indication would be those patients with nonresectable hilar cholangiocarcinoma in whom good survival might be expected. There is no evidence that the optimum route of insertion for these metal stents is via the transhepatic route, and there are many advantages in placing metal stents endoscopically.

Commentary: endoscopic dilatation for stricturing Crohn's disease

We thank de Hollander and Kuipers for their comments on our article, in which we demonstrated in a randomised clinical trial (RCT), that simvastatin as adjuvant therapy to the standard triple therapy improves the eradication rate of Helicobacter pylori infection. We agree with de Hollander and Kuipers in noting that the treatment groups were small and we did not provide clinical information, especially on gastrointestinal pathology. On the subject of whether H. pylori eradication treatment is more effective in patients with peptic ulcer disease (PUD) than in those with non-ulcer dyspepsia (NUD) or other non-ulcer gastric diseases this remains controversial. 4 Huang et al. in a systematic review including 22 studies showed that there is no convincing evidence to suggest that NUD patients respond to H. pylori eradication treatments differently from those with PUD. However, there was a trend for patients with PUD who received the classical triad of proton pump inhibitor, clarithromycin and amoxicillin for 7 days. Regarding the underlying mechanisms involved in H. pylori eradication, we proposed a number of speculative mechanisms. One of these speculative mechanisms is the anti-inflammatory effect of statins. We agree with de Hollander and Kuipers that statins, by exerting anti-inflammatory effects, may play a significant role in H. pylori eradication. In contrast, statins have not been proven to reduce the progression of gastritis to gastric cancer. More RCTs are needed to assess the efficacy of statins in H. pylori eradication focusing on the impact of 10–14 days treatment, and the role of long-term statin use in preventing or reducing the risk of progression to neoplasia in Barretts oesophagus and gastric cancer.

Apports Recents De La Genetique Dans Les Maladies Inflammatoires Intestinales

SummaryIt is clear since many years that the liability to develop inflammatory bowel disease is influenced by genetic factors. Recent progresses in the field of genetic markers and genetic models bring the concept of genetic heterogeneity. This new concept leads us to try to classify different forms of inflammatory bowel disease and could have in the future an impact on the prevention, the follow up and the treatment of these diseases