Inflammatory bowel disease (IBD) represents a group of idiopathic, chronic, inflammatory intestinal conditions. Its two main disease categories are: Crohn's disease (CD) and ulcerative colitis (UC), which feature both overlapping and distinct clinical and pathological features. While these diseases have, in the past, been most evident in the developed world, their prevalence in the developing world has been gradually increasing in recent decades. This poses unique issues in diagnosis and management which have been scarcely addressed in the literature or in extant guidelines. Depending on the nature of the complaints, investigations to diagnose either form of IBD or to assess disease activity will vary and will also be influenced by geographic variations in other conditions that might mimic IBD. Similarly, therapy varies depending on the phenotype of the disease being treated and available resources. The World Gastroenterology Organization has, accordingly, developed guidelines for diagnosing and treating IBD using a cascade approach to account for variability in resources in countries around the world.

The purpose of introducing optical electronics into video endoscopes is to improve the accuracy of diagnosis through image processing and digital technology. Narrow-band imaging (NBI), one of the most recent techniques, involves the use of interference filters to illuminate the target in narrowed red, green and blue (R/G/B) bands of the spectrum. This results in different images at distinct levels of the mucosa and increases the contrast between the epithelial surface and the subjacent vascular network. NBI can be combined with magnifying endoscopy with an optical zoom. The aim of this new technique is to characterize the surface of the distinct types of gastrointestinal epithelia - e. g., intestinal metaplasia in Barrett's esophagus. The technique may also make it possible to demonstrate disorganization of the vascular pattern in inflammatory disorders of the gastrointestinal mucosa and in superficial neoplastic lesions in the esophagus, stomach, and large bowel.

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Forecast: Turbulence in the AirThe secondary prevention of cancer of the digestive system relies on the logical assumption that early detection benefits the patient. Endoscopy is the gold standard procedure in early detection of neoplasia (either confirmed cancer or high-grade and low-grade dysplasia), particularly when the morphology is not polypoid. Furthermore, diagnosis is often accompanied by treatment in the same endoscopy session.The endoscopic standard has been supported, since the 1970s, by continuous technological progress, under Japanese leadership. The mechanical characteristics of the fiberscope have improved, as has the image obtained. A major step has been the shift from the fiber bundle to the charge-coupled device (CCD). High-resolution fiberscopes, now routinely available, detect mucosal areas to be explored by chromoscopy through minimal changes in colour and relief. The quality of the digital image depends on the multistep processing of the data collected by a CCD with a large number of pixels, and an improved optical construction (larger endoscopic field of view, wider angle of view), as far as the analogue display on the monitor. Recently structure enhancement processing has improved the contrast of flat mucosal defects, facilitating the detection of depressed lesions.Endoscopists have willingly followed this smooth progress, and one may speculate that an experienced operator using an instrument in the early 1980s would not miss many details when compared with the operator in the year 2000. Indeed the features of flat neoplastic lesions have been described extensively over more than 20 years in Japan. However we are now entering a turbulent period, as a consequence of the raising of endoscopic standards. The potential excess in the number of detected lesions raises the first question: are we able to predict, without the aid of histology, which lesions should be treated and which should be neglected? Are we confident with a negative endoscopic exploration when screening asymptomatic persons, either as individuals or as part of a mass program? What level of reassurance can we communicate to the patient?In this issue of Endoscopy, three separate papers from Japan [1 ± 3] focus on the endoscopic detection of early cancer in the digestive tract. These papers indicate limiting factors in spite of the new technology, and show that although the potential for diagnosis is high, it is still not at its maximum. The Japanese school of digestive endoscopy leads the field in the description of the early stages of neoplastic lesions in the esophagus, stomach, and intestine. Japan is also a leader in national screening programs for stomach cancer, and more recently for colorectal cancer. In Japan, 7 million people are screened annually for stomach cancer [4]. Histology: At the Tip of My FiberscopeMost manufacturers are now offering instruments with magnification (up to 100 power), either on the market or as prototypes. In contrast to the electronic zoom, the optical zoom increases the yield of information o...

Inflammatory bowel disease, ulcerative rectocolitis and Crohn's disease are a major public health problem. The incidence of ul− cerative rectocolitis (UC), which has remained stable since the early eighties, is around 10 per 100 000 inhabitants [1]. Crohn's disease (CD) appears to be on the increase, with a global inci− dence of 5.6 / 100 000 [1]. These diseases are associated with a risk of digestive cancer, which justifies regular endoscopic sur− veillance. Unfortunately, there is no properly−defined code for such surveillance, which is performed on an empirical basis. Risk and Risk Factors for Digestive Cancer Ulcerative rectocolitisThe first studies based on essentially hospital cases reported a risk of colorectal cancer which was probably overestimated of 5 to 21 % after a period of 20 years [2]. The risk appeared lower, at 3.1 % and 5 % after 20 years in two more recent studies [2]. A re− cent meta−analysis evaluated the risk of cancer at 2 % after 10 years, 8 % after 20 years and 18 % after 30 years [3]. Corresponding AuthorMarc Barthet´Department of Gastroenterology´Hôpital Nord, Chemin des Bourrely1 3915 Marseille cedex 20´Phone: 04 91 96 87 37´Fax: 04 91 96 13 11´E−