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Journal Cover United European Gastroenterology Journal
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2050-6406 - ISSN (Online) 2050-6414
   Published by Sage Publications Homepage  [842 journals]
  • The role for protein tyrosine phosphatase non-receptor type 22 in
           regulating intestinal homeostasis
    • Authors: Spalinger, M. R; Scharl, M.
      Pages: 325 - 332
      Abstract: Inflammatory bowel disease represents a chronic intestinal inflammation. Recent knowledge suggests a crucial role for genetic, immunological and bacterial factors in inflammatory bowel disease pathogenesis. Variations within the gene locus encoding PTPN22 have been associated with inflammatory bowel disease. PTPN22 is critically involved in controlling immune cell activation and thereby plays an important role in maintaining intestinal homeostasis. Although in B and T cells the mechanism showing how PTPN22 affects cell signalling pathways is well studied, its role in myeloid cells remains less defined. Regulation of the innate immune system plays an essential role in the intestine, and levels of PTPN22 in myeloid cells are drastically reduced in the intestine of inflammatory bowel disease patients. Therefore, additional studies to define the role of PTPN22 in myeloid cells might clearly enhance our understanding of how PTPN22 contributes to intestinal homeostasis.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615600115
      Issue No: Vol. 4, No. 3 (2016)
  • Creating an effective clinical registry for rare diseases
    • Authors: DAgnolo, H. M; Kievit, W, Andrade, R. J, Karlsen, T. H, Wedemeyer, H, Drenth, J. P.
      Pages: 333 - 338
      Abstract: The exposure of clinicians to patients with rare gastrointestinal diseases is limited. This hurts clinical studies, which impedes accumulation of scientific knowledge on the natural disease course, treatment outcomes and prognosis in these patients. An excellent method to detect patterns on an aggregate level that would not be possible to discover in individual cases, is a registry study. This paper aims to describe a template to create a successful international registry for rare diseases. We focus mainly on rare hepatic diseases, but lessons from this paper serve other fields in medicine, as well.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615618042
      Issue No: Vol. 4, No. 3 (2016)
  • Real-time diagnosis of H. pylori infection during endoscopy: Accuracy of
           an innovative tool (EndoFaster)
    • Authors: Costamagna, G; Zullo, A, Bizzotto, A, Spada, C, Hassan, C, Riccioni, M. E, Marmo, C, Strangio, G, Di Rienzo, T. A, Cammarota, G, Gasbarrini, A, Repici, A.
      Pages: 339 - 342
      Abstract: Background EndoFaster is novel device able to perform real-time ammonium measurement in gastric juice allowing H. pylori diagnosis during endoscopy. This large study aimed to validate the accuracy of EndoFaster for real-time H. pylori detection. Methods Consecutive patients who underwent upper endoscopy in two centres were prospectively enrolled. During endoscopy, 4 ml of gastric juice were aspirated to perform automatic analysis by EndoFaster within 90 seconds, and H. pylori was considered present (>62 ppm/ml) or absent (≤62 ppm/ml). Accuracy was measured by using histology as gold standard, and 13C-urea breath test (UBT) in discordant cases. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were calculated. Results Overall, 189 patients were enrolled, but in seven (3.4%) the aspirated gastric juice amount was insufficient to perform the test. The accuracy, sensitivity, specificity, PPV, and NPV were 87.4%, 90.3%, 85.5%, 80.2%, 93.1%, respectively, and 92.6%, 97.1%, 89.7%, 85.9%, 98.0%, respectively, when H. pylori status was reclassified according to the UBT result in discordant cases. Conclusions This study found a high accuracy/feasibility of EndoFaster for real-time H. pylori diagnosis. Use of EndoFaster may allow selecting those patients in whom routine gastric biopsies could be avoided.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615610021
      Issue No: Vol. 4, No. 3 (2016)
  • Low risk of adenocarcinoma and high-grade dysplasia in patients with
           non-dysplastic Barretts esophagus: Results from a cohort from a country
           with low esophageal adenocarcinoma incidence
    • Authors: Pereira, A. D; Chaves, P.
      Pages: 343 - 352
      Abstract: Background The risk of esophageal adenocarcinoma (EAC) in non-dysplastic Barrett’s esophagus (NDBE) is considered to be approximately 0.3% per year or even lower, according to population-based studies. Data from countries with low EAC incidence are scarce. Our principal aim was to determine the incidence of high-grade dysplasia (HGD) and EAC in NDBE. Our secondary aims were to identify the predictors of progression and to calculate the incidence of HGD/EAC, by using the calculation method for surveillance time in population-based studies. Materials and methods A cohort of NDBE patients was prospectively followed up. Cases of HGD and EAC (study end points) diagnosed during the first year of follow-up were considered as prevalent. Only cases with an endoscopic surveillance time > 1 year were included in our analysis. Results We enrolled 331 patients (251 men) in the surveillance program. Their median age was 59 years (interquartile range (IQR): 47–67 years). Their median NDBE length was 3 cm (IQR: 2–4 cm). Of these patients, 80 died during the follow-up (one from EAC) and two were lost to follow-up. After 2284 patient-years of endoscopic follow-up (median surveillance time, 5 years (IQR: 2–10 years)), we found that five cases of HGD and two cases of EAC were diagnosed. The incidence of HGD/EAC was 3.1 cases per 1000 patient-years (95% CI: 1.3–6.0) and that of EAC was 0.9 (95% CI: 0.2–2.9). The incidence of HGD/EAC in short segments (≤ 3 cm) was 0.7 cases per 1000 patient-years (95% CI: 0.3–3.4). The sole variable that we found associated with progression was NDBE length. If the total surveillance time was considered (3537 patient-years), the incidence of HGD and EAC was only slight lower. Conclusions The incidence of HGD and EAC was very low in NDBE. Therefore, current surveillance guidelines must be reassessed, at least for short-segment BE.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615612409
      Issue No: Vol. 4, No. 3 (2016)
  • Randomized double blind placebo-controlled trial of Saccharomyces
           cerevisiae CNCM I-3856 in irritable bowel syndrome: improvement in
           abdominal pain and bloating in those with predominant constipation
    • Pages: 353 - 362
      Abstract: Background Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by recurrent abdominal pain and/or discomfort. Probiotics have been reported to benefit IBS symptoms but the level of benefit remains quite unclear. Objective This study was designed to assess the benefit of Saccharomyces cerevisiae I-3856 on IBS symptoms. Methods A randomized, double blind, placebo-controlled trial has been performed in 379 subjects with diagnosed IBS. Subjects were randomly supplemented with the probiotics (1000 mg) or placebo for 12 weeks. Questionnaires (gastrointestinal symptoms, stools, wellbeing, and quality of life) were completed. Primary endpoint was percentage of responders defined as having a 50% decrease in the weekly average "intestinal pain/discomfort score" for at least 4 out of the last 8 weeks of the study. Results There was no overall benefit of S. cerevisiae I-3856 on IBS symptoms and wellbeing in the study population. Moreover, S. cerevisiae I-3856 was not statistically significant predictor of the responder status of the subjects (p > 0.05). Planned subgroup analyses showed significant effect in the IBS-C subjects: improvement of gastrointestinal symptoms was significantly higher in active group, compared to placebo, on abdominal pain/discomfort and bloating throughout the study and at the end of the supplementation. Conclusions In this study, S. cerevisiae I-3856 at the dose of 1000 mg per day does not improve intestinal pain and discomfort in general IBS patients. However, it seems to have an effect in the subgroup with constipation which needs further studies to confirm (NCT01613456 in registry).
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615602571
      Issue No: Vol. 4, No. 3 (2016)
  • Determinants of esophageal varices bleeding in patients with advanced
           hepatocellular carcinoma treated with sorafenib
    • Authors: Iavarone, M; Primignani, M, Vavassori, S, Sangiovanni, A, La Mura, V, Romeo, R, Colombo, M.
      Pages: 363 - 370
      Abstract: Background and aims Sorafenib is the standard of care for patients with advanced hepatocellular carcinoma (HCC), yet treatment safety may be challenged by portal hypertension. We therefore assessed the prevalence, risk factors and clinical consequences of esophageal varices (EVs) in sorafenib-treated patients with HCC. Methods Starting in 2008, all compensated patients with advanced or intermediate HCC not eligible for other therapies were consecutively enrolled in a prospective evaluation of sorafenib therapy, all with pretreatment by upper-gastrointestinal endoscopy (UGE). Results A total of 150 patients received sorafenib for 4.6 (95% CI, 3.3–5.6) months. At baseline, 61 (41%) patients were EV free (group A), 78 (52%) had EVs (61 small EVs (group B), 17 medium/large EVs (group C)) and 11 (7%) previously endoscopically treated EVs (group D). Propranolol was given to all patients with medium/large EVs and those with previous bleeding. Twelve patients (8%) bled from EVs after 36 (18–260) days of sorafenib. During sorafenib, bleeding occurred in six of 26 group B patients with neoplastic portal vein thrombosis (nPVT), three of nine group C patients with nPVT, two of five group D patients with nPVT and one of six without nPVT (p < 0.0001), nPVT being the strongest independent predictor of bleeding by multivariate analysis (HR = 15.4, 95% CI 1.84–129.6). Conclusion UGE screening is worthwhile in HCC patients allocated to sorafenib since it identifies patients with EVs at risk of bleeding during therapy, particularly those with nPVT.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615615041
      Issue No: Vol. 4, No. 3 (2016)
  • Comparison of AIMS65, Glasgow-Blatchford score, and Rockall score in a
           European series of patients with upper gastrointestinal bleeding:
           performance when predicting in-hospital and delayed mortality
    • Authors: Martinez-Cara, J. G; Jimenez-Rosales, R, Ubeda-Munoz, M, de Hierro, M. L, de Teresa, J, Redondo-Cerezo, E.
      Pages: 371 - 379
      Abstract: Objective AIMS65 is a score designed to predict in-hospital mortality, length of stay, and costs of gastrointestinal bleeding. Our aims were to revalidate AIMS65 as predictor of inpatient mortality and to compare AIMS65’s performance with that of Glasgow–Blatchford (GBS) and Rockall scores (RS) with regard to mortality, and the secondary outcomes of a composite endpoint of severity, transfusion requirements, rebleeding, delayed (6-month) mortality, and length of stay. Methods The study included 309 patients. Clinical and biochemical data, transfusion requirements, endoscopic, surgical, or radiological treatments, and outcomes for 6 months after admission were collected. Clinical outcomes were in-hospital mortality, delayed mortality, rebleeding, composite endpoint, blood transfusions, and length of stay. Results In receiver-operating characteristic curve analyses, AIMS65, GBS, and RS were similar when predicting inpatient mortality (0.76 vs. 0.78 vs. 0.78). Regarding endoscopic intervention, AIMS65 and GBS were identical (0.62 vs. 0.62). AIMS65 was useless when predicting rebleeding compared to GBS or RS (0.56 vs. 0.70 vs. 0.71). GBS was better at predicting the need for transfusions. No patient with AIMS65 = 0, GBS ≤ 6, or RS ≤ 4 died. Considering the composite endpoint, an AIMS65 of 0 did not exclude high risk patients, but a GBS ≤ 1 or RS ≤ 2 did. The three scores were similar in predicting prolonged in-hospital stay. Delayed mortality was better predicted by AIMS65. Conclusion AIMS65 is comparable to GBS and RS in essential endpoints such as inpatient mortality, the need for endoscopic intervention and length of stay. GBS is a better score predicting rebleeding and the need for transfusion, but AIMS65 shows a better performance predicting delayed mortality.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615604779
      Issue No: Vol. 4, No. 3 (2016)
  • Rifabutin-based 10-day and 14-day triple therapy as a third-line and
           fourth-line regimen for Helicobacter pylori eradication: A pilot study
    • Authors: Mori, H; Suzuki, H, Matsuzaki, J, Tsugawa, H, Fukuhara, S, Miyoshi, S, Hirata, K, Seino, T, Matsushita, M, Nishizawa, T, Masaoka, T, Kanai, T.
      Pages: 380 - 387
      Abstract: Background and aim This prospective randomized study was designed to assess the efficacy of 10-day and 14-day rifabutin-based triple therapy as a third- or fourth-line rescue therapy. Methods Patients who failed first- and second-line eradication therapy were enrolled. H. pylori was isolated from gastric biopsy specimens and the rpoB mutation status, a factor of resistance to rifamycins, and minimum inhibitory concentrations (MICs) of rifabutin and amoxicillin were determined. Enrolled patients were randomly assigned to receive 10-day or 14-day eradication therapy with esomeprazole (20 mg, 4 times a day (q.i.d.)), amoxicillin (500 mg, q.i.d.), and rifabutin (300 mg, once a day (q.d.s.)). Poor compliance was defined as intake of
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615618043
      Issue No: Vol. 4, No. 3 (2016)
  • Co-infection with Helicobacter pylori and Epstein-Barr virus in benign
           upper digestive diseases: An endoscopic and serologic pilot study
    • Authors: Buzas, G. M; Konderak, J.
      Pages: 388 - 394
      Abstract: Background Some gastric cancers are Epstein-Barr virus associated. Aim To assess the prevalence of Helicobacter pylori and viral co-infection in benign upper digestive diseases. Methods One hundred and four outpatients were included in a prospective endoscopic–serologic study. Epstein–Barr virus immunoglobulin G (IgG), immunoglobulin M and viral capsid antigen titres were assayed with an ELISA test. Helicobacter pylori was determined by the modified Giemsa stain and by IgG-chemiluminescence. Results The overall prevalence of Helicobacter pylori was 56.7%. Duodenal ulcer patients were infected in 72.5 % of the cases, with the prevalence being 33.3% in functional dyspepsia (p = 0.0008) and 25.8% in reflux patients (p = 0.0001). Epstein–Barr virus IgG was detected in 70.1% of the whole group, 75% of duodenal ulcer patients, 51.2% of functional dyspepsia patients (p = 0.04) and 51.6% of the reflux disease cases (p = 0.04). Co-infection with both agents was detected in 60% of duodenal ulcer patients, 18.1% of functional dyspepsia (p = 0.00014) and 12.9% of reflux disease patients (p = 0.00012). Anti-viral IgG titre displayed a 31.7 ± 3.0 cut-off index in duodenal ulcer, 20.5 ± 3.5 in functional dyspepsia (p = 0.01) and 21.4 ± 3.6 in reflux cases (p = 0.03). Conclusions Both Helicobacter pylori and Epstein–Barr virus, and co-infection with these agents, were significantly more prevalent in duodenal ulcer patients than in dyspeptic/reflux patients.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615610265
      Issue No: Vol. 4, No. 3 (2016)
  • Gastric malt lymphoma: Analysis of a series of consecutive patients over
           20 years
    • Authors: Moleiro, J; Ferreira, S, Lage, P, Dias Pereira, A.
      Pages: 395 - 402
      Abstract: Introduction and aims Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is closely associated with Helicobacter pylori (HP) infection. Our aim was to evaluate demographic, clinical and endoscopic characteristics of gastric MALT lymphoma patients, as well as to analyse response to treatment and factors that affect complete remission (CR) and relapse. We also assessed the long-term prognosis. Methods The study involved a retrospective evaluation of consecutive patients admitted with gastric MALT lymphoma (1993–2013). Results A total of 144 patients (76 men; mean age 56) were included. At stage EI, 94/103 patients (92%) received HP eradication and 78 (83%) achieved CR after a mean period of 7 months (2–63 months) and 67 (86%) remained in CR after a mean follow-up time of 105 months. HP infection status (p = 0.004) and lymphoma localisation to the antrum plus body (p = 0.016) were associated with higher and lower CR rates, respectively. Relapse occurred in 11/78 (14%) patients after a mean period of 21 months. The absence of HP re-infection (p = 0.038), the need of only one eradication regimen (p = 0.009) and antrum lymphomas (p = 0.031) correlated with lower relapse rates. At stage EII, HP eradication was performed in 17/24 patients but only five experienced CR (30%). Among 16 patients diagnosed at stage EIV, nine achieved CR after chemotherapy ± surgery and 3/7 without remission died due to disease progression. The 5- and 10-year overall disease free survival rates were 90.5% and 79.1%, respectively. Conclusions Most patients were diagnosed at an early stage. Eradication therapy was highly effective in inducing complete remission. Long-term evaluation showed that the long-term prognosis was very favourable.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615612934
      Issue No: Vol. 4, No. 3 (2016)
  • Temporary placement of fully covered self-expandable metal stents for the
           treatment of benign biliary strictures
    • Authors: Chaput, U; Vienne, A, Audureau, E, Bauret, P, Bichard, P, Coumaros, D, Napoleon, B, Ponchon, T, Duchmann, J.-C, Laugier, R, Lamouliatte, H, Vedrenne, B, Gaudric, M, Chaussade, S, Robin, F, Leblanc, S, Prat, F.
      Pages: 403 - 412
      Abstract: Background Endoscopic treatment of benign biliary strictures (BBS) can be challenging. Objective To evaluate the efficacy of fully covered self-expandable metal stents (FCSEMS) in BBS. Methods Ninety-two consecutive patients with BBS (chronic pancreatitis (n = 42), anastomotic after liver transplantation (n = 36), and post biliary surgical procedure (n = 14)) were included. FCSEMS were placed across strictures for 6 months before endoscopic extraction. Early success rate was defined as the absence of biliary stricture or as a minimal residual anomaly on post-stent removal endoscopic retrograde cholangiopancreatography (ERCP). Secondary outcomes were the final success and stricture recurrence rates as well as procedure-related morbidity. Results Stenting was successful in all patients. Stenting associated complications were minor and occurred in 22 (23.9%) patients. Migration occurred in 23 (25%) patients. Stent extraction was successful in all but two patients with proximal stent migration. ERCP after the 6 months stenting showed an early success in 84.9% patients (chronic pancreatitis patients: 94.7%, liver transplant: 87.9%, post-surgical: 61.5%) (p = 0.01). Final success was observed in 57/73 (78.1%) patients with a median follow-up of 12 ± 3.56 months. Recurrence of biliary stricture occurred in 16/73 (21.9%) patients. Conclusions FCSEMS placement is efficient for patients with BBS, in particular for chronic pancreatitis patients. Stent extraction after 6 months indwelling, although generally feasible, may fail in a few cases.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615606550
      Issue No: Vol. 4, No. 3 (2016)
  • Symptom burden and consulting behavior in patients with overlapping
           functional disorders in the US population
    • Authors: Vakil, N; Stelwagon, M, Shea, E. P, Miller, S.
      Pages: 413 - 422
      Abstract: Background Regulatory and treatment guidelines focus on individual conditions, yet clinicians often see patients with overlapping conditions. Objective This cross-sectional survey study assesses the impact of overlapping functional dyspepsia (FD), gastroesophageal reflux disease (GERD), irritable bowel syndrome with constipation (IBS-C), and chronic idiopathic constipation (CIC) on symptom burden and consulting behavior. Methods Survey participants met Rome III criteria for FD, IBS-C, and/or CIC, and/or reported GERD; participants answered questions about symptom frequency and bothersomeness, work and productivity, and consulting behavior. Results Of 2641 respondents, 1592 (60.3%) had one condition; 832 (31.5%) had two; and 217 (8.2%) had three; 57.3% of 1690 FD, 54.6% of 1337 GERD, 82.6% of 328 IBS-C, and 62.5% of 552 CIC respondents had condition overlap. Overall GI symptoms were very/extremely bothersome in 28.6% of single-condition respondents, 50.7% of two-condition, and 69.6% of three-condition respondents (p < 0.001, chi square). Symptom frequency and productivity losses both increased with condition overlap. Over 12 months, 43.7% of single-condition, 49.9% of two-condition, and 66.5% of three-condition respondents consulted a physician about GI symptoms (p < 0.001, chi square). Conclusion Functional GI disorders frequently overlap with each other and with GERD. Condition overlap is associated with greater symptom burden and increased physician consultations.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615600114
      Issue No: Vol. 4, No. 3 (2016)
  • Randomized controlled study of endoscopic band ligation and argon plasma
           coagulation in the treatment of gastric antral and fundal vascular ectasia
    • Authors: Elhendawy, M; Mosaad, S, Alkhalawany, W, Abo-Ali, L, Enaba, M, Elsaka, A, Elfert, A. A.
      Pages: 423 - 428
      Abstract: Background Gastric antral vascular ectasia (GAVE) is characterized by mucosal and submucosal vascular ectasia causing recurrent hemorrhage and thus, chronic anemia, in patients with cirrhosis. Treatment with argon plasma coagulation (APC) is an effective and safe method, but requires multiple sessions of endoscopic therapy. Endoscopic band ligation (EBL) was found to be a good alternative for APC as a treatment for GAVE, especially in refractory cases. The aim of this prospective randomized controlled study was to evaluate the safety and efficacy of EBL, as compared to APC, in the treatment of GAVE and gastric fundal vascular ectasia (GFVE). Patients and methods A total of 88 cirrhotic patients with GAVE were prospectively randomized to endoscopic treatment with either EBL or APC, every 2 weeks until complete obliteration was accomplished; then they were followed up endoscopically after 6 months, plus they had monthly measurement of hemoglobin levels during that period. Results We describe the presence of mucosal and submucosal lesions in the gastric fundal area that were similar to those found in GAVE in 13 patients (29.5%) of the EBL group and 9 patients (20.5%) of the APC group; we named this GFVE. In these cases, we treated the fundal lesions with the same techniques we had used for treating GAVE, according to the randomization. We found that EBL significantly decreased the number of sessions required for complete obliteration of the lesions (2.98 sessions compared to 3.48 sessions in the APC group (p < 0.05)). Hemoglobin levels increased significantly after obliteration of the lesions in both groups, compared to pretreatment values (p < 0.05), but with no significant difference between the two groups (p > 0.05); however, the EBL group of patients required a significantly smaller number of units of blood transfusion than the APC group of patients (p < 0.05). There were no significant differences in adverse events nor complications between the two groups (p > 0.05). Conclusions This study described and histologically proved the presence of GFVE occurring comcomitantly with GAVE in cirrhotic patients. We showed that GFVE can be successfully managed by EBL or APC. Our study revealed that EBL is more effective and is comparable in safety to APC, in the treatment of GAVE and GFVE in cirrhotic patients.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615619837
      Issue No: Vol. 4, No. 3 (2016)
  • Prevalence of constipation in the German population - a representative
           survey (GECCO)
    • Pages: 429 - 437
      Abstract: Background Variable prevalence rates between 2.4 and 35% have been reported for chronic constipation across different countries worldwide, with a low 5% for Germany. Objectives and methods We conducted a computer-assisted telephone interview among 15,002 representative individuals in Germany, asking about health-related problems, including constipation. Those who acknowledged the presence of constipation symptoms during the preceding 12 months were questioned concerning constipation features and sociographic variables. Results Of 15,002 individuals interviewed, 2,239 (14.9%) acknowledged having experienced constipation during the last 12 months, 864 (5.8%) reported constipation during the last 4 weeks, and 380 (2.5%) had current constipation symptoms; 4.4% had taken medication because of their constipation, and 2.6% had consulted a doctor for constipation. In comparison to non-constipated volunteers, those constipated had a lower health quality of life and poorer health, and lower income and social status. Conclusion Up to 15% of the general (German) population report symptoms of constipation depending on the definition. This matches pooled constipation rates across 18 countries (14%).
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615603009
      Issue No: Vol. 4, No. 3 (2016)
  • Distribution, size and shape of colorectal adenomas as determined by a
           colonoscopist with a high lesion detection rate: Influence of age, sex and
           colonoscopy indication
    • Authors: Klein, J. L; Okcu, M, Preisegger, K. H, Hammer, H. F.
      Pages: 438 - 448
      Abstract: Background Increasing attention is focused on polyp-related features that may contribute to the operator-dependent nature of colonoscopy. Few data on polyps are available from high-yield colonoscopies, which may serve as a benchmark for quality control. Objectives Describe regional distribution, histology, size and shape of polyps, and the influence of patient age and gender, in colonoscopies performed by a colonoscopist with high lesion detection rate. Methods Analysis of 698 consecutive patients with diagnostic, screening or surveillance colonoscopies. Results In 704 colonoscopies, 1908 polyps were removed (360 were protruded and 1548 flat; 1313 were hyperplastic, 562 adenomas, 5 serrated adenomas and 8 mixed). There were 232 adenomas in female patients and 343 in male patients; 39% of the adenomas were protruded and 61% were flat. The peak adenoma detection rate (ADR) was 51% in patients beyond age 79 years. Men older than 49 years had a higher ADR than women. In men and women, respectively: 40% and 32% of adenomas were in the right colon, 31% and 22% were in the transverse colon, and 30% and 47% were in the left colon. Beyond age 59 years, the majority of adenomas were in the proximal colon. Conclusions An excess of adenomas in the proximal colon started at age 60 and this was more pronounced in men than in women. In all colonic regions, the majority of adenomas had a shape that was flat and smaller than 6 mm.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615610266
      Issue No: Vol. 4, No. 3 (2016)
  • Characteristics of chronic megacolon among patients diagnosed with
           multiple endocrine neoplasia type 2B
    • Authors: Gibbons, D; Camilleri, M, Nelson, A. D, Eckert, D.
      Pages: 449 - 454
      Abstract: Background Gastrointestinal symptoms are frequent in multiple endocrine neoplasia (MEN) 2B and may be related to megacolon. Objective The objective of this article is to review the clinical features of patients with MEN 2B, particularly megacolon. Methods We used natural language processing of electronic medical records of Mayo Clinic patients over 20 years: Eight patients with definite MEN 2B were identified; of these, four had megacolon. From these patients’ records, three others with paper medical records were identified through familial association. We used a standard data sheet to identify features of the disease with particular emphasis on megacolon. Results Of the 11 patients identified with MEN 2B, seven (63%) had megacolon, typically presenting with constipation in infancy or megacolon in childhood. In addition, three patients had esophageal manifestations (two achalasia and one Zenker’s diverticulum). Megacolon often required surgical intervention for intractable constipation, abdominal distension and discomfort. Histopathological features of resected colon revealed enteric and extrinsic nerve hyperplasia and ganglioneuromas of the submucosal and myenteric plexuses. Conclusions Among patients with MEN 2B, 63% had megacolon. Significant esophageal motor disorders in MEN 2B may affect ~25% of patients. Any presentation with megacolon should trigger a search for MEN 2B in order to identify the potentially fatal endocrine tumors.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615611630
      Issue No: Vol. 4, No. 3 (2016)
  • The combination of oligo- and polysaccharides and reticulated protein for
           the control of symptoms in patients with irritable bowel syndrome: Results
           of a randomised, placebo-controlled, double-blind, parallel group,
           multicentre clinical trial
    • Authors: Alexea, O; Bacarea, V, Pique, N.
      Pages: 455 - 465
      Abstract: Background A medical device containing the film-forming agent reticulated protein and a prebiotic mixture of vegetable oligo- and polysaccharides has been developed, recently receiving European approval as MED class III for the treatment of chronic/functional or recidivant diarrhoea due to different causes including irritable bowel syndrome (IBS). In the present paper, we evaluate a protein preparation containing these components in comparison with placebo in adult patients with diarrhoea-predominant IBS. Methods In a randomised, placebo-controlled, double-blind, parallel group, multicentre clinical trial, patients were randomly assigned to receive the combination of oligo- and polysaccharides and reticulated protein and placebo (four oral tablets/day for 56 days). Demographic, clinical and quality of life characteristics and presence and intensity of abdominal pain and flatulence (seven-point Likert scale) were assessed at three study visits (baseline and at 28 and 56 days). Stool emissions were recorded on the diary card using the seven-point Bristol Stool Scale. Results A total of 128 patients were randomised to receive either tablets containing the combination (n = 63) or placebo (n = 65). Treatment with oligo- and polysaccharides and reticulated protein was safe and well tolerated. A significant improvement in symptoms across the study was observed in patients treated with oligo- and polysaccharides and reticulated protein between visit 2 and visit 3 in abdominal pain (p = 0.0167) and flatulence (p = 0.0373). We also detected a statistically significant increase in the quality of life of patients receiving the active treatment from baseline to visit 3 (p < 0.0001). Conclusions Treatment with oligo- and polysaccharides and reticulated protein is safe, improving IBS symptoms and quality of life of patients with diarrhoea-predominant IBS.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615615050
      Issue No: Vol. 4, No. 3 (2016)
  • Knife-assisted snare resection (KAR) of large and refractory colonic
           polyps at a Western centre: Feasibility, safety and efficacy study to
           guide future practice
    • Authors: Bhattacharyya, R; Chedgy, F. J, Kandiah, K, Longcroft-Wheaton, G, Bhandari, P.
      Pages: 466 - 473
      Abstract: Objective Endoscopic mucosal resection (EMR) is widely practiced in western countries. Endoscopic submucosal dissection (ESD) is very effective for treating complex polyps but colonic ESD in the western setting remains challenging. We have developed a novel technique of knife-assisted snare resection (KAR) for the resection of these complex lesions. Here we aim to describe the technique, evaluate its outcomes, identify outcome predictors and define its learning curve. Methods We conducted a prospective cohort study of patients who had large and refractory polyps resected by KAR at our institution from 2007 to 2013. Polyp characteristics and procedure details were recorded. Endoscopic follow-up was performed to identify recurrence. Results A total of 170 patients with polyps 20–170 mm in size were treated by KAR and followed up for a mean of 31.5 months (range 12–84 months). 29% of the polyps were >50 mm, 22% had fibrosis from previous unsuccessful interventions and 25% were in the right colon. The perforation rate (1.2%) and bleeding rate (4.7%) were acceptable and managed conservatively in most patients. Recurrence rate after the first attempt was 13.1%. Recurrence was significantly increased by polyp size >50 mm (p = 0.008; OR 5.03, 95% CI 1.54–16.48), presence of fibrosis (p = 0.002; OR 6.59, 95% CI 1.97–22.07) and piecemeal resection (p < 0.001; OR 0.31, CI 0.078–1.12). Cure rates were 87% after the first attempt, improving to 95.6% with further attempts. En bloc resection rate showed a linear increase and reached almost 80% as the endoscopist’s cumulative experience approached 100 cases. Conclusion This is the largest reported Western series on KAR in the colon. We have demonstrated the feasibility, efficacy and safety of this technique in the treatment of complex polyps, with or without fibrosis and at all sites. KAR has shown better outcomes than either EMR or ESD. We have also managed to identify significant outcome predictors and define the learning curve.
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615615301
      Issue No: Vol. 4, No. 3 (2016)
  • Rifabutin-based 10-day and 14-day triple therapy as a third-line and
           fourth-line regimen for Helicobacter pylori eradication: how should
           rifabutin be managed in rescue regimens'
    • Authors: Losurdo, G; Iannone, A, Giorgio, F, Principi, M, Di Leo, A, Ierardi, E.
      Pages: 474 - 475
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640615623697
      Issue No: Vol. 4, No. 3 (2016)
  • Reply to letter to the editor: "The dosage of rifabutin in H. pylori
           eradication regimen should be appropriately determined in each area of the
    • Authors: Mori, H; Suzuki, H.
      Pages: 476 - 477
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640616631477
      Issue No: Vol. 4, No. 3 (2016)
  • Cross-border scientific projects run by UEG national member societies
           reduce health inequalities across Europe
    • Authors: Munch, A; Verhaegh, B.
      Pages: 478 - 478
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640616651200
      Issue No: Vol. 4, No. 3 (2016)
  • PhDs in academic gastroenterology: key to a successful career
    • Authors: Fichna; J.
      Pages: 479 - 480
      PubDate: 2016-05-27T03:50:44-07:00
      DOI: 10.1177/2050640616651199
      Issue No: Vol. 4, No. 3 (2016)
School of Mathematical and Computer Sciences
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