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In the latter, the pathogenesis is less clear but a high intake of alcohol over several years results in toxic effects on pancreatic acinar and stellate cells, and biochemical changes in pancreatic secretions that facilitate the formation of pancreatic plugs. Chronic pancreatitis is the end result of continuing pancreatic inflammation and is characterized by extensive fibrosis that replaces exocrine cells and, to a lesser extent, endocrine cells in pancreatic islets. 4,5 Common clinical features are chronic pain, steatorrhea, nutritional deficiencies, analgesic addiction (particularly opiods) and diabetes. An exception is the reduced frequency of pancreatitis after ERCP in patients given non-steroidal, anti-inflammatory drugs or treated with pancreatic stents. 7 After acute alcoholic pancreatitis, cessation of alcohol and smoking reduce the risk of progression to recurrent acute and chronic disease. 8,9 In patients with mild biliary pancreatitis, same-admission cholecystectomy rather than later (interval) cholecystectomy (with or without ERCP) also reduces the risk of recurrence. 10 Longer-term treatment with corticosteroids may prevent progression to chronic pancreatitis in patients with autoimmune pancreatitis, although the natural history of this disorder is highly variable. 11 In idiopathic pancreatitis presumed to be caused by sphincter dysfunction, endoscopic or operative procedures to facilitate duct drainage continue to evoke debate and may not avoid progression to chronic pancreatitis. 12 Ongoing challenges include a better understanding of the pathogenesis of idiopathic pancreatitis, effective medication to avoid severe necrotizing pancreatitis and better ways to diagnose and treat the persistent inflammation that results in chronic disease.

The association of Helicobacter pylori with chronic duodenal ulceration was a seminal observation in the short history of gastroenterology. However, H. pylori is now known to be an ancient bacterium, whereas there is persuasive evidence that the epidemic of duodenal ulceration began in the second half of the 19th century and continued into the second half of the 20th century. Possible explanations for the epidemic include genomic changes in the organism and environmental or other influences on the human host. While genomic changes resulted in the appearance of virulence factors, these seem likely to have appeared thousands of years ago with minimal effects on gastritis because of coexisting suppression of gastric immunity. In contrast, the emergence of duodenal ulceration is best explained by a change in the pattern of gastritis from inflammation involving the antrum and body in most individuals to a significant minority (10–20%) with antral gastritis but with relative sparing of the body of the stomach. In the latter group, the increase in serum gastrin (particularly G17) associated with antral gastritis had trophic effects on gastric parietal cells with an increase in the parietal cell mass and hypersecretion of gastric acid. Hypersecretion of acid is seen as the major risk factor for duodenal ulceration with significant contributions from environmental factors including smoking and use of nonsteroidal, anti‐inflammatory drugs. Host factors favoring changes in the pattern of gastritis include delayed acquisition of infection and improved nutrition; both with enhancing effects on mucosal immunity. The epidemic of chronic duodenal ulcer could be related to genomic changes in Helicobacter pylori or to environmental or other changes in the host. This article favors the latter explanation and attributes the epidemic to the emergence of gastritis largely restricted to the antrum of the stomach. This is likely to have occurred because of enhanced mucosal immunity due to delay in the acquisition of infection and improved nutrition.

Objective This study investigated the diameter of internal iliac artery (IIA) aneurysms (IIAAs) at the time of rupture to evaluate whether the current threshold diameter for elective repair of 3 cm is reasonable. The prevalence of concomitant aneurysms and results of surgical treatment were also investigated. Methods This was a retrospective analysis of patients with ruptured IIAA from seven countries. The patients were collected from vascular registries and patient records of 28 vascular centers. Computed tomography images taken at the time of rupture were analyzed, and maximal diameters of the ruptured IIA and other aortoiliac arteries were measured. Data on the type of surgical treatment, mortality at 30 days, and follow-up were collected. Results Sixty-three patients (55 men and 8 women) were identified, operated on from 2002 to 2015. The patients were a mean age of 76.6 years (standard deviation, 9.0; range 48-93 years). A concomitant common iliac artery aneurysm was present in 65.0%, 41.7% had a concomitant abdominal aortic aneurysm, and 36.7% had both. IIAA was isolated in 30.0%. The mean maximal diameter of the ruptured artery was 68.4 mm (standard deviation, 20.5 mm; median, 67.0 mm; range, 25-116 mm). One rupture occurred at <3 cm and four at <4 cm (6.3% of all ruptures). All patients were treated, 73.0% by open repair and 27.0% by endovascular repair. The 30-day mortality was 12.7%. Median follow-up was 18.3 months (interquartile range, 2.0-48.3 months). The 1-year Kaplan-Meier estimate for survival was 74.5% (standard error, 5.7%). Conclusions IIAA is an uncommon condition and mostly coexists with other aortoiliac aneurysms. Follow-up until a diameter of 4 cm seems justified, at least in elderly men, although lack of surveillance data precludes firm conclusions. The mortality was low compared with previously published figures and lower than mortality in patients with ruptured abdominal aortic aneurysm. Abdominal aortic aneurysm (AAA) is the most common and studied aneurysm. Aneurysms of the iliac arteries are found considerably less often, and epidemiologic data on these do not exist. In many cases iliac artery aneurysms coexist with aortic aneurysms: ∼10% to 20% of patients with AAA also have a concomitant aneurysm in the iliac arteries. 1 The artery most often affected is the common iliac artery (CIA), followed by the internal iliac artery (IIA), also called the hypogastric artery. In the case of isolated aneurysms in the iliac arteries, without involvement of the aorta, the most common location is the IIA. 2 Aneurysms of the external iliac artery are extremely rare, possibly because these arteries originate later in development from a different cell population than the distal aorta and the CIA and IIA. Studies on IIA aneurysms (IIAAs) are scarce owing to the rarity of the condition. The existing literature consists primarily of case reports and small patient series. No prospective studies on IAAs exist. According to the literature, IAAs have a high rupture and mortality rate even in elective cases, possibly because of their deep location in the pelvis. 3 The etiology and risk factors of IAA seem to be the same as AAA. 4 Iliac aneurysms are mostly degenerative but can also be mycotic or caused by genetic disorders such as Marfan or Ehlers-Danlos syndromes. Traumatic aneurysms in the iliac arteries have also been described; for example, caused by iatrogenic trauma from hip, lumbar, or gynecologic operations. A mainly historical subpopulation of young women with IIAA caused by trauma from pregnancy and delivery has been described. 5 and 6 IAAs cause symptoms more often than AAA because of compression of pelvic structures such as ureters, bladder, veins, or lumbar nerves. Wilhelm et al 7 reported that 53% of published isolated IIAA cases were symptomatic, not including the ruptured ones (31%). The high proportion of symptomatic patients in these older reports may partly be explained, however, by the fact that most of these cases were from time before widespread use of modern imaging. IIAA are not easily discovered with clinical examination because of their location 8 but are detected increasingly often as a result of imaging and screening programs. Because the studies on IIAAs are scarce, the natural history is virtually unknown. A widely used threshold for elective repair is 3 cm, originally suggested by McCready et al 9 because their series did not include any ruptures under that diameter. However, only seven ruptures were included in that report. The reference list of this article illustrates that most of the papers on this subject were published when open repair was the only treatment option. Nowadays endovascular treatment is the first option in many centers. 10 The aim of this study was to investigate at what diameter IIAAs tend to rupture and whether the current operative threshold of 3 cm is rational. Secondary aims were to assess the prevalence of concomitant aortoiliac aneurysms, treatment patterns, and the results of treatment.

Telemedicine may also serve to refocus attention on the importance of medical history as a triage to more extensive investigations such as endoscopic procedures. Both journals are jointly owned by Wiley, an experienced and highly respected publisher, and the Journal of Gastroenterology and Hepatology Foundation [JGHF], a charitable foundation that supports conferences, educational and clinical activities in the Asia-Pacific region. [...]a special thank you to our authors and readers who choose JGH Open from a variety of other scientific and educational options.

On one hand, some have argued that few, if any, interactions are appropriate as the major responsibility of pharmaceutical companies is to maximize profits for shareholders, while the major responsibility for medical practitioners is to provide the best possible care for patients. 1 In contrast, others have conceded that medical practitioners and various companies do have the shared goal of improving human health and that the introduction of new products is normally preceded by clinical trials supervised by clinicians. 2 Furthermore, we do need new and improved products to treat human disease, and the reality is that most of these will need development and promotion by larger companies. Several publications have documented inappropriate or unethical behavior, not only by pharmaceutical companies but also by medical organizations and individual medical practitioners. 5–7 Although many of us feel competent to assess and compare new products, the evidence is that our preference can be influenced by promotional activity, particularly sponsorship of local meetings, individual visits by company representatives, free drug samples, and small gifts, often of an advertising nature. In many countries (but not in the United States or New Zealand), direct‐to‐consumer advertising using newspapers, television, or social media is restricted to nonprescription or “over‐the‐counter” medication. 3 In this issue of JGH Open, Dr Gangireddy and others have analyzed industry payments to gastroenterologists and hepatologists in 2017 from data available on the Open Payments website of the Centers for Medicare and Medicaid Services (CMS) in the United States. 8 Legislation requiring pharmaceutical companies to publicly disclose all payments to physicians above $10 was passed in 2010, and data have been available online since 2014.

Highlights include the discovery of Helicobacter pylori; reductions in the prevalence of peptic ulceration; vaccination for hepatitis B; treatment for hepatitis C; living‐donor liver transplantation; programs for the early detection of gastric, colorectal, and liver cancer; and the identification of new diseases such as autoimmune pancreatitis. Public health measures such as improved nutrition and cleaner and safer water supplies have also been important, along with the exploration of dietary therapy for a range of gastrointestinal disorders. In the short term, JGHF will continue to support both APDW and a variety of other regional organizations that promote gastrointestinal health and improvements in the management of gastrointestinal and liver disease.

High mating success in animals is often dependent on males signalling attractively with high effort. Since males should be selected to maximize their reproductive success, female preferences for these traits should result in minimal signal variation persisting in the population. However, extensive signal variation persists. The genic capture hypothesis proposes genetic variation persists because fitness-conferring traits depend on an individual's basic processes, including underlying physiological, morphological, and biochemical traits, which are themselves genetically variable. To explore the traits underlying signal variation, we quantified among-male differences in signalling, morphology, energy stores, and the activities of key enzymes associated with signalling muscle metabolism in two species of crickets, Gryllus assimilis (chirper: <20 pulses/chirp) and G. texensis (triller: >20 pulses/chirp). Chirping G. assimilis primarily fuelled signalling with carbohydrate metabolism: smaller individuals and individuals with increased thoracic glycogen stores signalled for mates with greater effort; individuals with greater glycogen phosphorylase activity produced more attractive mating signals. Conversely, the more energetic trilling G. texensis fuelled signalling with both lipid and carbohydrate metabolism: individuals with increased β-hydroxyacyl-CoA dehydrogenase activity and increased thoracic free carbohydrate content signalled for mates with greater effort; individuals with higher thoracic and abdominal carbohydrate content and higher abdominal lipid stores produced more attractive signals. Our findings suggest variation in male reproductive success may be driven by hidden physiological trade-offs that affect the ability to uptake, retain, and use essential nutrients, although the results remain correlational in nature. Our findings indicate that a physiological perspective may help us to understand some of the causes of variation in behaviour.

Phenotypic plasticity can be adaptive when phenotypes are closely matched to changes in the environment. In crickets, rhythmic fluctuations in the biotic and abiotic environment regularly result in diel rhythms in density of sexually active individuals. Given that density strongly influences the intensity of sexual selection, we asked whether crickets exhibit plasticity in signaling behavior that aligns with these rhythmic fluctuations in the socio-sexual environment. We quantified the acoustic mate signaling behavior of wild-caught males of two cricket species, Gryllus veletis and G. pennsylvanicus. Crickets exhibited phenotypically plastic mate signaling behavior, with most males signaling more often and more attractively during the times of day when mating activity is highest in the wild. Most male G. pennsylvanicus chirped more often and louder, with shorter interpulse durations, pulse periods, chirp durations, and interchirp durations, and at slightly higher carrier frequencies during the time of the day that mating activity is highest in the wild. Similarly, most male G. veletis chirped more often, with more pulses per chirp, longer interpulse durations, pulse periods, and chirp durations, shorter interchirp durations, and at lower carrier frequencies during the time of peak mating activity in the wild. Among-male variation in signaling plasticity was high, with some males signaling in an apparently maladaptive manner. Body size explained some of the among-male variation in G. pennsylvanicus plasticity but not G. veletis plasticity. Overall, our findings suggest that crickets exhibit phenotypically plastic mate attraction signals that closely match the fluctuating socio-sexual context they experience.

Theoretically, sexual signals should provide honest information about mating benefits and many sexually reproducing species use honest signals when signalling to potential mates. Male crickets produce two types of acoustic mating signals: a long-distance mate attraction call and a short-range courtship call. We tested whether wild-caught fall field cricket (Gryllus pennsylvanicus) males in high condition (high residual mass or large body size) produce higher effort calls (in support of the honest signalling hypothesis). We also tested an alternative hypothesis, whether low condition males produce higher effort calls (in support of the terminal investment hypothesis). Several components of long-distance mate attraction calls honestly reflected male body size, with larger males producing louder mate attraction calls at lower carrier frequencies. Long-distance mate attraction chirp rate dishonestly signalled body size, with small males producing faster chirp rates. Short-range courtship calls dishonestly reflected male residual mass, as chirp rate and pulse rate were best explained by a curvilinear function of residual mass. By producing long-distance mate attraction calls and courtship calls with similar or higher effort compared to high condition males, low condition males (low residual mass or small body size) may increase their effort in current reproductive success at the expense of their future reproductive success, suggesting that not all sexual signals are honest.