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Journal Cover United European Gastroenterology Journal
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 2050-6406 - ISSN (Online) 2050-6414
     Published by Sage Publications Homepage  [737 journals]
  • IgG4-related disease: a new kid on the block or an old aquaintance'
    • Authors: Beyer, G; Schwaiger, T, Lerch, M. M, Mayerle, J.
      Pages: 165 - 172
      Abstract: IgG4-related systemic disease is a recently recognized systemic condition characterized by unique pathological features that can affect a variety of organs. It includes a growing number of medical conditions which have the following features in common: diffuse organ swelling or focal mass formation, sclerosing storiforme (whirl-shaped) fibrosis with a lymphoplasmacytic infiltrate rich in IgG4-bearing plasma cells, as well as elevated levels of serum IgG4. It invariably responds to steroid treatment and is mostly diagnosed in elderly men. Well-known syndromes like Mikulicz's disease of the salivary or lacrimal gland, Küttner's tumour of the submandibular gland, Riedel's thyroiditis, or retroperitoneal fibrosis, as well as novel entities such as autoimmune pancreatitis type 1, are now regarded to be manifestations of this systemic disease. This article provides an overview of the epidemiology, concepts of pathogenesis, clinical presentation, proposed diagnostic approaches, treatment options, and differential diagnosis of IgG4-related disease.
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614532457|hwp:master-id:spueg;2050640614532457
      Issue No: Vol. 2, No. 3 (2014)
  • Prevalence of gastro-oesophageal reflux disease with upper
           gastrointestinal symptoms without heartburn and regurgitation
    • Authors: Vakil, N; Wernersson, B, Ohlsson, L, Dent, J.
      Pages: 173 - 178
      Abstract: Background: Symptomatically ‘silent’ gastro-oesophageal reflux disease (GORD) may be underdiagnosed. Objective: To determine the prevalence of untreated GORD without heartburn and/or regurgitation in primary care. Methods: Patients were included if they had frequent upper gastrointestinal symptoms and had not taken a proton pump inhibitor in the previous 2 months (Diamond study: NCT00291746). GORD was diagnosed based on the presence of reflux oesophagitis, pathological oesophageal acid exposure, and/or a positive symptom–acid association probability. Patients completed the Reflux Disease Questionnaire (RDQ) and were interviewed by physicians using a prespecified symptom checklist. Results: GORD was diagnosed in 197 of 336 patients investigated. Heartburn and/or regurgitation were reported in 84.3% of patients with GORD during the physician interviews and in 93.4% of patients with GORD when using the RDQ. Of patients with heartburn and/or regurgitation not identified at physician interview, 58.1% (18/31) reported them at a ‘troublesome’ frequency and severity on the RDQ. Nine patients with GORD did not report heartburn or regurgitation either at interview or on the RDQ. Conclusions: Structured patient-completed questionnaires may help to identify patients with GORD not identified during physician interview. In a small proportion of consulting patients, heartburn and regurgitation may not be present in those with GORD.
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614532458|hwp:master-id:spueg;2050640614532458
      Issue No: Vol. 2, No. 3 (2014)
  • Challenging the dogma: a randomized trial of standard vs. half-dose
           concomitant nonbismuth quadruple therapy for Helicobacter pylori infection
    • Authors: Sharara, A. I; Sarkis, F. S, El-Halabi, M. M, Malli, A, Mansour, N. M, Azar, C, Eloubeidi, M. A, Mourad, F. H, Barada, K, Sukkarieh, I.
      Pages: 179 - 188
      Abstract: Background Current treatment of Helicobacter pylori consists of three or four drugs for 7–14 days with important associated cost and adverse events. Aims This study compared efficacy and safety of standard dose vs. half-dose concomitant nonbismuth quadruple therapy (NBQT) for 7 days. The standard dose consisted of twice daily rabeprazole 20 mg, amoxicillin 1 g, metronidazole 500 mg, and clarithromycin 500 mg. Methods This was a prospective randomized trial. 14C-urea breath test was performed ≥4 weeks after treatment and ≥2 weeks off acid suppressive therapy. Compliance and adverse events were monitored during treatment. Results A total of 200 consecutive treatment-naïve patients were enrolled. Baseline characteristics were similar between groups, with 15.5% of subjects reporting prior macrolide use. Eradication occurred in 78% (95% CI 68.6–85.7%) in both groups on intention-to-treat analysis. Per-protocol rates were 82.1 vs. 83.9% for standard-dose patients vs. half-dose patients, respectively (p = NS). Adverse events (only mild) were reported in 57 vs. 41% of standard-dose patients vs. half-dose patients (p = 0.024), with metallic taste and nausea notably less frequent in the latter (36 vs. 12% and 18 vs. 7%, respectively; p < 0.05 for both). Overall, eradication failed in 38.7% of prior macrolide users vs. 18.9% without such exposure (p = 0.019). On multivariate logistic regression, prior macrolide exposure was the only factor associated with failed eradication (OR 2.60, 95% CI 1.06–6.39; p = 0.038). Treatment was cheaper with the half-dose regimen. Interpretation A 50% reduction in antibiotic dosage does not diminish efficacy of concomitant nonbismuth quadruple therapy but leads to significant reduction in cost and adverse events. Seven-day concomitant NBQT is suboptimal for H. pylori independent of prior macrolide exposure.
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614530919|hwp:master-id:spueg;2050640614530919
      Issue No: Vol. 2, No. 3 (2014)
  • Gastrointestinal polypoid lesions: a poorly known endoscopic feature of
           portal hypertension
    • Authors: Lemmers, A; Evrard, S, Demetter, P, Verset, G, Gossum, A. V, Adler, M, Deviere, J, Moine, O. L.
      Pages: 189 - 196
      Abstract: Aim To describe a poorly known endoscopic entity associated with portal hypertension, characterized by polypoid lesions either in the stomach or small intestine of patients with cirrhosis. Methods Between 2003 and 2012, patients with cirrhosis and portal hypertension underwent endoscopic workup of portal hypertension in our endoscopy unit. The clinical expression, endoscopic features of these lesions, and their pathological characteristics are described. Results A total of 1538 patients were included, among which 14 (0.9%) presented polypoid lesions; these patients had evidence of portal hypertension and had dilated capillaries in the lamina propria. Four patients presented with severe anaemia or melaena and required treatment. Propranolol was administered to three patients, and one patient needed a transjugular intrahepatic portosystemic shunt in order to control bleeding. For asymptomatic patients in whom polypoid lesions were resected, no recurrence of lesions was observed during follow-up gastroscopy (median 36 months, range 7–85 months). Conclusion Portal hypertension-associated gastric or small intestine polypoid lesions may be associated with a significant risk of bleeding and are responsive to adequate treatment of portal hypertension.
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614529108|hwp:master-id:spueg;2050640614529108
      Issue No: Vol. 2, No. 3 (2014)
  • Prediction scores or gastroenterologists' Gut Feeling for triaging
           patients that present with acute upper gastrointestinal bleeding
    • Authors: de Groot, N; van Oijen, M, Kessels, K, Hemmink, M, Weusten, B, Timmer, R, Hazen, W, van Lelyveld, N, Vermeijden, J, Curvers, W, Baak, L, Verburg, R, Bosman, J, de Wijkerslooth, L, de Rooij, J, Venneman, N, Pennings, M, van Hee, K, Scheffer, R, van Eijk, R, Meiland, R, Siersema, P, Bredenoord, A.
      Pages: 197 - 205
      Abstract: Introduction Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added value of prediction scores to gastroenterologists’ Gut Feeling in patients with a suspected upper GI bleeding. Methods We prospectively evaluated Gut Feeling of senior gastroenterologists and asked them to estimate: (1) the risk that a clinical intervention is needed; (2) the risk of rebleeding; and (3) the risk of mortality in patients presenting with suspected upper GI bleeding, subdivided into low, medium, or high risk. The predictive value of the gastroenterologists’ Gut Feeling was compared to the Blatchford and Rockall scores for various outcomes. Results We included 974 patients, of which 667 patients (68.8%) underwent a clinical intervention. During the 30-day follow up, 140 patients (14.4%) developed recurrent bleeding and 44 patients (4.5%) died. Gut Feeling was independently associated with all studied outcomes, except for the predicted mortality after endoscopy. Predictive power, based on the AUC of the Blatchford and Rockall prediction scores, was higher than the Gut Feeling of the gastroenterologists. However, combining both the Blatchford and Rockall scores and the Gut Feeling yielded the highest predictive power for the need of an intervention (AUC 0.88), rebleeding (AUC 0.73), and mortality (AUC 0.71 predicted before and 0.77 predicted after endoscopy, respectively). Conclusions Gut Feeling is an independent predictor for the need of a clinical intervention, rebleeding, and mortality in patients presenting with upper GI bleeding; however, the Blatchford and Rockall scores are stronger predictors for these outcomes. Combining Gut Feeling with the Blatchford and Rockall scores resulted in the most optimal prediction.
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614531574|hwp:master-id:spueg;2050640614531574
      Issue No: Vol. 2, No. 3 (2014)
  • Early detection of acute graft-versus-host disease by wireless capsule
           endoscopy and probe-based confocal laser endomicroscopy: results of a
           pilot study
    • Authors: Coron, E; Laurent, V, Malard, F, Le Rhun, M, Chevallier, P, Guillaume, T, Mosnier, J.-F, Galmiche, J.-P, Mohty, M.
      Pages: 206 - 215
      Abstract: Objective Acute gastrointestinal graft-versus-host disease (GI-GVHD) is usually diagnosed using endoscopic examinations and biopsies for conventional histology. The aim of this pilot study was to determine whether mini-invasive techniques such as probe-based confocal laser endomicroscopy (pCLE) combined with wireless capsule endoscopy (WCE) could detect early lesions of GI-GVHD prior to symptoms. Design Fifteen patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) were prospectively examined with a small bowel WCE, duodenal and colorectal pCLE, and standard biopsies. Per study protocol, all these examinations were scheduled between day 21 and day 28 after allo-HSCT, independently of the presence or absence of digestive symptoms. Results During follow up, eight patients developed acute GI-GVHD. Sensitivity of WCE, pCLE, and histology were 50, 87.5, and 50%, respectively. Specificity of WCE, pCLE, and histology were 80, 71.5, and 80%, respectively. We showed a positive correlation between the Glücksberg scoring system and WCE (rho = 0.543, p = 0.036) and pCLE (rho = 0.727, p = 0.002) but not with standard histology (rho = 0.481, p = 0.069). Conclusions The results from this pilot study suggest that novel methods such as pCLE and WCE could be part of a mini-invasive algorithm for early detection of GI-GVHD.
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614529283|hwp:master-id:spueg;2050640614529283
      Issue No: Vol. 2, No. 3 (2014)
  • Upregulation of hepatic bile acid synthesis via fibroblast growth factor
           19 is defective in gallstone disease but functional in overweight
    • Authors: Renner, O; Harsch, S, Matysik, S, Lutjohann, D, Schmitz, G, Stange, E. F.
      Pages: 216 - 225
      Abstract: Background: Fibroblast growth factor 19 (FGF19) is an enteric hormone regulating bile acid de novo synthesis by sensing ileal bile acid flux. However, the role of FGF19 in cholelithiasis has not yet been elucidated and therefore is investigated in the present study. Methods: Total mRNA and protein were isolated from ileal biopsies and used for tissue expression analysis. FGF19, 7α-hydroxycholesterol (7α-OH-Chol), 27-hydroxycholesterol (27-OH-Chol), and different bile acids were determined in the blood samples. Results: FGF19 serum levels did not differ between gallstone carriers and controls but were significantly decreased in the overweight individuals (–32%, p = 0.0002), irrespective of gallstone status (normalweight to overweight controls –29%, p = 0.0017; normalweight to overweight gallstone carriers –44%, p = 0.0338), and correlated inversely with bodyweight (p < 0.0001, = –0.3317). Compared to non-overweight controls, apical sodium-dependent bile acid transporter expression was significantly diminished in the non-overweight gallstone carriers (–42%, P mRNA = 0.0393; –52%, p protein = 0.0169) as well as in the overweight controls (–24%, P mRNA = 0.0148; –43%, p protein = 0.0017). FGF19 expression varied widely and was similar in all groups. A significant negative correlation was noted between 7α-OH-Chol, 27-OH-Chol, and FGF19 serum levels (p < 0.01; 7α-OH-Chol = –0.2155; 27-OH-Chol = –0.2144) in obesity. Conclusion: Upregulation of hepatic bile acid synthesis via FGF 19 is defective in gallstone disease but functional in overweight individuals.
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614527938|hwp:master-id:spueg;2050640614527938
      Issue No: Vol. 2, No. 3 (2014)
  • Correlation of aspartate aminotransferase/platelet ratio index with
           hepatic venous pressure gradient in cirrhosis
    • Authors: Verma, V; Sarin, S. K, Sharma, P, Kumar, A.
      Pages: 226 - 231
      Abstract: Background Hepatic venous pressure gradient (HVPG) is a prognostic marker in cirrhosis, but is invasive. There is a need to validate a noninvasive marker to measure portal hypertension. Aspartate aminotransferase/platelet ratio index (APRI) is proposed as a good noninvasive estimator of hepatic fibrosis. Whether APRI could be used as noninvasive tool to measure portal hypertension has not been studied. Aim To correlate APRI with HVPG in patients with cirrhosis and to determine the diagnostic usefulness of the APRI in detection of high portal pressure. Methods APRI and HVPG were measured in consecutive patients of cirrhosis aged 18–75 years, with serum bilirubin 12 mmHg) had area under curve 0.716 (95% CI 0.574–0.858). An APRI of ≥1.09 had a sensitivity 66%, specificity 73%, positive predictive value 85%, negative predictive value 47%, and diagnostic accuracy 68% for predicting HVPG >12 mmHg. Conclusions APRI correlates fairly with HVPG in patients of cirrhosis. An APRI score of ≥1.09 seems to have an acceptable accuracy for prediction of high portal pressure. APRI is a fair, bedside, cost-effective parameter for diagnosis of high portal pressure in patients with cirrhosis.
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614527084|hwp:master-id:spueg;2050640614527084
      Issue No: Vol. 2, No. 3 (2014)
  • Clinical features of constipation in general practice in Italy
    • Authors: Cottone, C; Tosetti, C, Disclafani, G, Ubaldi, E, Cogliandro, R, Stanghellini, V.
      Pages: 232 - 238
      Abstract: Background Definition and diagnosis of constipation remain challenging, partly due to different perceptions of the disease by doctors and patients. Aim To evaluate prevalence and features of constipation among individuals seen in general practice, by comparing different diagnostic instruments. Methods Standardized questionnaires and the Bristol stool form scale were distributed to all subjects attending 10 general practitioners for any reason in a 2-week period. The questionnaires investigated constipation defined according to: (1) self-perception (yes/no); (2) a visual analogue scale; (3) Rome III Criteria. Results The prevalence of constipation in 1306 subjects (790 female, 516 male) resulted: (1) 34% self-reported; (2) 28% by visual analogue scale; (3) 24% by Rome Criteria. Constipation was more frequent in females. A high frequency of symptoms of obstructed defecations was observed with differences among patients with self-reported constipation with or without Bristol stool type 1–2. Conclusions Prevalence of constipation among individuals attending their GP ranges between 24 and 34%, according to the different definitions adopted. Symptoms of obstructed defecations are frequent. The combination of self-evaluation and the Bristol stool type scale is potentially useful to identify subgroups of patients with different clinical features in general practice.
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614527283|hwp:master-id:spueg;2050640614527283
      Issue No: Vol. 2, No. 3 (2014)
  • United European Gastroenterology joins the Biomedical Alliance for Health
    • Authors: O'Morain; C.
      Pages: 240 - 241
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614536816|hwp:resource-id:spueg;2/3/240
      Issue No: Vol. 2, No. 3 (2014)
  • UEG Scientific Committee Insights: More reasons than ever to attend UEG
    • Pages: 242 - 243
      PubDate: 2014-05-23T04:58:43-07:00
      DOI: 10.1177/2050640614536357|hwp:resource-id:spueg;2/3/242
      Issue No: Vol. 2, No. 3 (2014)
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