Most small gallbladder polyps are benign and do not change significantly over time. They are usually incidental findings on ultrasound. Therefore, these polyps should be checked periodically with routine percutaneous ultrasonography. In the asymptomatic patient, gallbladder polyps that are greater than 1 cm in diameter should be treated with cholecystectomy. The size of the polyp and the patient greater than 50 years are important risk factors for malignant potential. Patients who have biliary pain and small gallbladder polyps without gallstones present a difficult management decision for the clinician. If the physician is confident that the polyps are the source of the pain, patients should be referred for cholecystectomy. Endoscopic ultrasound and positron emission tomography may prove to be useful in assessing the malignant potential of large gallbladder polyps. Laparoscopic cholecystectomy is the treatment of choice for most gallbladder polyps. If a malignant polyp is suspected, patients should undergo an open cholecystectomy.

Inflammatory bowel disease is an idiopathic chronic inflammatory process of the gastrointestinal tract. The aetiology remains unknown but probably involves a combination of genetic susceptibility, environmental triggers and abnormal immune regulation. Immunomodulators are effective in treating inflammatory bowel disease. Azathioprine and 6-mercaptopurine (6MP) are the most frequently used immunomodulator agents. These agents are probably underused by many clinicians because of concerns about myelosuppression, pancreatitis, allergic reactions and hepatotoxicity, which can occur in a fraction of patients taking these drugs. Therefore, clinicians have sought ways to optimize therapeutic response and limit toxic side effects. Neutropenia, although uncommon, can occur in patients taking azathioprine or 6MP. The question of neutropenia effecting clinical response has been raised as a possible indicator of therapeutic response. In the study from Campbell and Ghosh [7] in this issue of the European Journal of Gastroenterology and Hepatology, no difference in relapse rates was noted between neutropenic and non-neutropenic patients. In fact, severe life-threatening neutropenia was seen in four patients.

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