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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  [753 journals]
  • Colonic motility in ulcerative colitis
    • Authors: Bassotti, G; Antonelli, E, Villanacci, V, Baldoni, M, Dore, M. P.
      Pages: 457 - 462
      Abstract: Background Inflammatory conditions affecting the gut may cause motility disturbances, and ulcerative colitis – one of the main disorders among the inflammatory bowel diseases – may display abnormal colonic motility. Aim To review the abnormalities of the large bowel in ulcerative colitis, by considering the motility, laboratory (in vitro) and pathological studies dealing with this topic. Methods A comprehensive online search of Medline and the Science Citation Index was carried out. Results Patients with ulcerative colitis frequently display colonic motor abnormalities, including lack of contractility, an increase of propulsive contractile waves, an excessive production of nitric oxide, vasoactive intestinal polypeptide nerves, interleukin 1 beta, neurotensin, tachykinins levels and the weaker action of substance P, likely related to a neuromuscular dysfunction due to the inflammatory process. Conclusions A better understanding of the pathophysiological grounds of altered colonic motility in ulcerative colitis may lead to a more in-depth knowledge of the accompanying symptoms and to better and more targeted therapeutic approaches.
      PubDate: 2014-11-26T03:08:59-08:00
      DOI: 10.1177/2050640614548096|hwp:master-id:spueg;2050640614548096
      Issue No: Vol. 2, No. 6 (2014)
  • Assessing patient reported outcome measures: A practical guide for
    • Authors: Alrubaiy, L; Hutchings, H. A, Williams, J. G.
      Pages: 463 - 470
      Abstract: Gastrointestinal illnesses cause physical, emotional and social impact on patients. Patient reported outcome measures (PROMs) are increasingly used in clinical decision-making, clinical research and approval of new therapies. In the last decade, there has been a rapid increase in the number of PROMs in gastroenterology and, therefore, the choice between which of these PROMs to use can be difficult. Not all PROM instruments currently used in research and clinical practice in gastroenterology have gone through a rigorous development methodology. New drugs and therapies will not have access to the market if the PROMs used in their clinical trials are not validated according to the guidelines of the international agencies. Therefore, it is important to know the required properties of PROMs when choosing or evaluating a drug or a clinical intervention. This paper reviews the current literature on how to assess the validity and reliability of PROMs. It summarises the required properties into a practical guide for gastroenterologists to use in assessing an instrument for use in clinical practice or research.
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614558345|hwp:master-id:spueg;2050640614558345
      Issue No: Vol. 2, No. 6 (2014)
  • Ruling in or out a source of gastrointestinal bleeding
    • Authors: Sonnenberg A.
      Pages: 471 - 474
      Abstract: Background and aims The search for a source of gastrointestinal bleeding is associated with two distinct approaches of trying to rule in a specific diagnosis or rule out any potential source of bleeding. The study aim was to understand the conceptual differences underlying the two searches. Methods The performance of endoscopy as diagnostic test is analyzed in terms of Bayes’ formula. Results The performance of gastrointestinal endoscopy to rule in a suspected lesion is mostly influenced by its underlying specificity. Because the specificity of endoscopy is less likely to be affected by procedural exigencies, the demands on pre-procedural prep and general quality can be more relaxed. In contradistinction, the performance of endoscopy to rule out a suspected bleeding site is mostly influenced by its sensitivity, which can easily be compromised by suboptimal procedural conditions. Conclusions Paradoxically, the more urgent, focused, and important search (to rule in a bleeding site), carries less stringent criteria for its execution than the more general and aimless search (to rule out a bleeding site) that frequently ends up just empty handed.
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614557319|hwp:master-id:spueg;2050640614557319
      Issue No: Vol. 2, No. 6 (2014)
  • Accuracy of liquid cytology in the diagnosis and monitoring of
           eosinophilic oesophagitis
    • Authors: Rodriguez-Sanchez, J; Garcia Rojo, M, Lopez Viedma, B, de la Santa Belda, E, Palomar, P. O, Torrijos, E. G, Lopez, L. G, Camacho, J. O.
      Pages: 475 - 481
      Abstract: Background Oesophagoscopy with biopsy is considered the gold standard for diagnosing and monitoring eosinophilic oesophagitis (EoE). Therefore is important to discover less-invasive diagnostic methods. Methods Cytology specimens were obtained in patients with active EoE (AEoE) (≥15 eos/hpf) and EoE in remission (EoER) (
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614552315|hwp:master-id:spueg;2050640614552315
      Issue No: Vol. 2, No. 6 (2014)
  • Sexual activity does not predispose to reflux episodes in patients with
           gastroesophageal reflux disease
    • Authors: Bor, S; Valytova, E, Yapali, S, Yildirim, E, Vardar, R.
      Pages: 482 - 489
      Abstract: Background The role of sexual activity on gastroesophageal reflux disease (GERD) is an under-recognized concern of patients, and one rarely assessed by physicians. Objective The objective of this article is to determine the influence of sexual activity on the intraesophageal acid exposure and acid reflux events in GERD patients. Methods Twenty-one patients with the diagnosis of GERD were prospectively enrolled. Intraesophageal pH monitoring was recorded for 48 hours with a Bravo capsule. All patients were instructed to have sexual intercourse or abstain in a random order two hours after the same refluxogenic dinner within two consecutive nights. Patients were requested to have sex in the standard "missionary position" and women were warned to avoid abdominal compression. The patients completed a diary reporting the time of the sexual intercourse and GERD symptoms. The percentage of reflux time and acid reflux events were compared in two ways: within 30 and 60 minutes prior to and after sexual intercourse on the day of sexual intercourse and in the same time frame of the day without sexual intercourse. Results Fifteen of 21 GERD patients were analyzed. The percentage of reflux time and number of acid reflux events did not show a significant difference within the 30- and 60-minute periods prior to and after sexual intercourse on the day of sexual intercourse and on the day without sexual intercourse, as well. Conclusion Sexual activity does not predispose to increased intraesophageal acid exposure and acid reflux events. Larger studies are needed to confirm our findings in patients who define reflux symptoms during sexual intercourse.
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614550851|hwp:master-id:spueg;2050640614550851
      Issue No: Vol. 2, No. 6 (2014)
  • Emergency single-balloon enteroscopy in overt obscure gastrointestinal
           bleeding: Efficacy and safety
    • Authors: Pinto-Pais, T; Pinho, R, Rodrigues, A, Fernandes, C, Ribeiro, I, Fraga, J, Carvalho, J.
      Pages: 490 - 496
      Abstract: We aimed to evaluate the impact of emergency single-balloon enteroscopy (SBE) on the diagnosis and treatment for active overt obscure gastrointestinal bleeding (OGIB). Methods SBE procedures for OGIB were retrospectively reviewed and sub-divided according to the bleeding types: active-overt and inactive-overt bleeding. The patient’s history, laboratory results, endoscopic findings and therapeutic interventions were registered. Emergency SBE was defined as an endoscopy that was performed for active-overt OGIB, within 24 hours of clinical presentation. Results Between January 2010 and February 2013, 53 SBEs were performed in 43 patients with overt OGIB. Seventeen emergency SBEs were performed in 15 patients with active overt-OGIB procedures (group A), which diagnosed the bleeding source in 14: angiodysplasia (n = 5), ulcers/erosions (n = 3), bleeding tumors (gastrointestinal stromal tumor (GIST), n = 3; neuroendocrine tumor, n = 1), and erosioned polyps (n = 2). Endoscopic treatment was performed in nine patients, with one or multiple hemostatic therapies: argon plasma coagulation (n = 5), epinephrine submucosal injection (n = 5), hemostatic clips (n = 3), and polypectomy (n = 2). Twenty-eight patients with inactive bleeding (group B) were submitted to 36 elective SBEs, which successfully diagnosed 18 cases. The diagnostic yield in group A (93.3%) was significantly higher than in group B (64.3%)—Fisher’s exact test, p = 0.038. Conclusion This study revealed an important role of emergency SBE in the diagnosis of bleeding etiology in active overt OGIB.
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614554850|hwp:master-id:spueg;2050640614554850
      Issue No: Vol. 2, No. 6 (2014)
  • Endoscopic mucosal resection of large rectal adenomas in the era of
           centralization: Results of a multicenter collaboration
    • Authors: Barendse, R; Musters, G, Fockens, P, Bemelman, W, de Graaf, E, van den Broek, F, van der Linde, K, Schwartz, M, Houben, M, van Milligen de Wit, A, Witteman, B, Winograd, R, Dekker, E, on behalf of the TREND study group
      Pages: 497 - 504
      Abstract: Background and objective Endoscopic mucosal resection (EMR) of large rectal adenomas is largely being centralized. We assessed the safety and effectiveness of EMR in the rectum in a collaboration of 15 Dutch hospitals. Methods Prospective, observational study of patients with rectal adenomas >3 cm, resected by piecemeal EMR. Endoscopic treatment of adenoma remnants at 3 months was considered part of the intervention strategy. Outcomes included recurrence after 6, 12 and 24 months and morbidity. Results Sixty-four patients (50% male, age 69 ± 11, 96% ASA 1/2) presented with 65 adenomas (diameter 46 ± 17 mm, distance ab ano 4.5 cm (IQR 1–8), 6% recurrent lesion). Sixty-two procedures (97%) were technically successful. Histopathology revealed invasive carcinoma in three patients (5%), who were excluded from effectiveness analyses. At 3 months’ follow-up, 10 patients showed adenoma remnants. Recurrence was diagnosed in 16 patients during follow-up (recurrence rate 25%). Fifteen of 64 patients (23%) experienced 17 postprocedural complications. Conclusion In a multicenter collaboration, EMR was feasible in 97% of patients. Recurrence and postprocedural morbidity rates were 25% and 23%. Our results demonstrate the outcomes of EMR in the absence of tertiary referral centers.
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614554218|hwp:master-id:spueg;2050640614554218
      Issue No: Vol. 2, No. 6 (2014)
  • Are IBD patients more likely to have a prior diagnosis of irritable bowel
           syndrome? Report of a case-control study in the General Practice
           Research Database
    • Authors: Card, T. R; Siffledeen, J, Fleming, K. M.
      Pages: 505 - 512
      Abstract: Background Inflammatory bowel disease (IBD) patients are sometimes first diagnosed with irritable bowel syndrome (IBS), which may be construed as a misdiagnosis. Objective The objective of this article is to determine if this occurs more than expected by chance. Methods We conducted a case-control study nested in the General Practice Research Database. We selected incident cases of IBD and up to 10 matched controls for each. We assessed the proportions with IBS recorded prior to the IBD diagnosis and variation by age, sex, and calendar time. We compared proportions affected in fixed time periods and conducted conditional logistic regression to derive odds ratios. Results The 20, 193 cases were three times as likely as controls to have a prior record of IBS. Fifteen per cent of IBD cases and 5% of controls had IBS coded before diagnosis with 11% having a code for IBS over one year before IBD (cf. 5% of controls) and 6% over five years earlier (cf. 3%). These figures roughly doubled if typical antispasmodic therapies were assumed to represent IBS diagnoses. Conclusion If excess IBS diagnoses represent misdiagnoses of IBD, our results suggest that about 10% of IBD patients are misdiagnosed and in 3% of cases this may persist for five or more years.
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614554217|hwp:master-id:spueg;2050640614554217
      Issue No: Vol. 2, No. 6 (2014)
  • High prevalence of symptoms in a severely abused "non-patient" women
    • Authors: Pallotta, N; Piacentino, D, Ciccantelli, B, Rivera, M, Golini, N, Spagnoli, A, Vincoli, G, Farchi, S, Corazziari, E.
      Pages: 513 - 521
      Abstract: Objective The objective of this article is to assess the prevalence of somatic symptoms and of gastrointestinal (GI) syndromes in abused "non-patient" women and the association with the time of perpetration, type, and severity of abuse. Methods Sixty-seven women, 18–58 years, receiving shelter in anti-violence associations were invited to fill out an anonymous questionnaire with a medical and an abuse section. The severity of abuse was expressed as the 0–6 Abuse Severity Measure (ASM). The association between abuse characteristics and the number of symptoms, and GI syndromes was assessed by Poisson regression model. Results Most women suffered from childhood and adulthood sexual and physical abuse. They reported a mean of 5.1 GI symptoms (range 0–13; median 5; IQR 6) and of 1.3 extra-GI symptoms (range 0–6; median 1; IQR 2); 30% of women matched the Rome II Criteria for one, 36% for two, and 4.4% for three or more syndromes, respectively. Women with an ASM of 5–6, having suffered from both sexual and physical abuse, reported significantly (p = 0.02) more GI symptoms, but not extra-GI ones (p = 0.07), and met criteria for more GI syndromes than women with an ASM ≤4 and those reporting only one type of abuse. No association was found between the time of perpetration of the abuse and the number of GI and extra-GI symptoms. Conclusions Symptoms in abused "non-patient" women mainly concern the abdomen and the GI tract. A history of severe, combined physical and sexual abuse is associated with a higher number of GI symptoms.
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614552010|hwp:master-id:spueg;2050640614552010
      Issue No: Vol. 2, No. 6 (2014)
  • Diagnostic accuracy of fecal immunochemical test in average- and
           familial-risk colorectal cancer screening
    • Authors: Cubiella, J; Castro, I, Hernandez, V, Gonzalez-Mao, C, Rivera, C, Iglesias, F, Alves, M. T, Cid, L, Soto, S, De-Castro, L, Vega, P, Hermo, J. A, Macenlle, R, Martinez, A, Estevez, P, Cid, E, Herreros-Villanueva, M, Portillo, I, Bujanda, L, Fernandez-Seara, J, on behalf of the COLONPREV study investigators
      Pages: 522 - 529
      Abstract: Background There is little information about the fecal immunochemical test (FIT) in familial-risk colorectal cancer (CRC) screening. Objectives The objective of this article is to investigate whether FIT diagnostic accuracy for advanced neoplasia (AN) differs between average and familial-risk (first-degree relative) patients. Methods A total of 1317 consecutive participants (595 familial) who collected one stool sample before performing a colonoscopy as a CRC screening test were included. FIT diagnostic accuracy for AN was evaluated with Chi-square test at a 20 µg hemoglobin/g of feces cut-off value. Finally, we determined which variables were independently related to AN. Results An AN was found in 151 (11.5%) patients. The overall accuracy was not statistically different between both cohorts for AN (88.4%, 91.7%; p = 0.051). At the cut-off stablished, differences in FIT sensitivity (31.1%, 40.6%; p = 0.2) or specificity (96.5%, 97.3%; p = 0.1) were not statistically significant. Finally, independent variables such as sex (male) (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.4–3.1), age (50–65, >65 years) (OR 2.1, 95% CI 1.1–4.3; OR 2.7, 95% CI 1.2–6.1), previous colonoscopy (OR 0.4, 95% CI 0.2–0.9) and FIT ≥20 µg/g feces (OR 17.7, 95% CI 10.8–29.1) were associated with AN diagnosis. Conclusions FIT accuracy for AN detection is equivalent in average and familial-risk CRC screening cohorts.
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614553285|hwp:master-id:spueg;2050640614553285
      Issue No: Vol. 2, No. 6 (2014)
  • Whole-liver CT texture analysis in colorectal cancer: Does the presence of
           liver metastases affect the texture of the remaining liver?
    • Authors: Rao, S.-X; Lambregts, D. M, Schnerr, R. S, van Ommen, W, van Nijnatten, T. J, Martens, M. H, Heijnen, L. A, Backes, W. H, Verhoef, C, Zeng, M.-S, Beets, G. L, Beets-Tan, R. G.
      Pages: 530 - 538
      Abstract: Background Liver metastases limit survival in colorectal cancer. Earlier detection of (occult) metastatic disease may benefit treatment and survival. Objective The objective of this article is to evaluate the potential of whole-liver CT texture analysis of apparently disease-free liver parenchyma for discriminating between colorectal cancer (CRC) patients with and without hepatic metastases. Methods The primary staging CT examinations of 29 CRC patients were retrospectively analysed. Patients were divided into three groups: patients without liver metastases (n = 15), with synchronous liver metastases (n = 10) and metachronous liver metastases within 18 months following primary staging (n = 4). Whole-liver texture analysis was performed by delineation of the apparently non-diseased liver parenchyma (excluding metastases or other focal liver lesions) on portal phase images. Mean grey-level intensity (M), entropy (E) and uniformity (U) were derived with no filtration and different filter widths (0.5 = fine, 1.5 = medium, 2.5 = coarse). Results Mean E1.5 and E2.5 for the whole liver in patients with synchronous metastases were significantly higher compared with the non-metastatic patients (p = 0.02 and p = 0.01). Mean U1.5 and U2.5 were significantly lower in the synchronous metastases group compared with the non-metastatic group (p = 0.04 and p = 0.02). Texture parameters for the metachronous metastases group were not significantly different from the non-metastatic group or synchronous metastases group (p > 0.05), although – similar to the synchronous metastases group – there was a subtle trend towards increased E1.5, E2.5 and decreased U1.5, U2.5 values. Areas under the ROC curve for the diagnosis of synchronous metastatic disease based on the texture parameters E1.5,2.5 and U1.5,2.5 ranged between 0.73 and 0.78. Conclusion Texture analysis of the apparently non-diseased liver holds promise to differentiate between CRC patients with and without metastatic liver disease. Further research is required to determine whether these findings may be used to benefit the prediction of metachronous liver disease.
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614552463|hwp:master-id:spueg;2050640614552463
      Issue No: Vol. 2, No. 6 (2014)
  • Survey of digestive health across Europe: Final report. Part 1: The burden
           of gastrointestinal diseases and the organisation and delivery of
           gastroenterology services across Europe
    • Authors: Farthing, M; Roberts, S. E, Samuel, D. G, Williams, J. G, Thorne, K, Morrison-Rees, S, John, A, Akbari, A, Williams, J. C.
      Pages: 539 - 543
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614554154|hwp:master-id:spueg;2050640614554154
      Issue No: Vol. 2, No. 6 (2014)
  • Survey of digestive health across Europe: Final report. Part 2: The
           economic impact and burden of digestive disorders
    • Authors: Anderson, P; Dalziel, K, Davies, E, Fitzsimmons, D, Hale, J, Hughes, A, Isaac, J, Onishchenko, K, Phillips, C, Pockett, R.
      Pages: 544 - 546
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614554155|hwp:master-id:spueg;2050640614554155
      Issue No: Vol. 2, No. 6 (2014)
  • UEG Week Vienna 2014 award winners
    • Pages: 547 - 548
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614561651|hwp:resource-id:spueg;2/6/547
      Issue No: Vol. 2, No. 6 (2014)
  • Erratum
    • Pages: 550 - 550
      Abstract: Tetramer-visualized gluten-specific CD4+ T cells in blood as a potential diagnostic marker for coeliac disease without oral gluten challenge by Christophersen et al., United European Gastroenterology Journal August 2014; 2: 268–278, doi:10.1177/2050640614540154. Figure 1b. Figure 1b and Figure 4b were printed incorrectly in the above paper. The correct versions of these figures are published below. Figure 4b.
      PubDate: 2014-11-26T03:09:00-08:00
      DOI: 10.1177/2050640614553383|hwp:resource-id:spueg;2/6/550
      Issue No: Vol. 2, No. 6 (2014)
  • Corrigendum
    • Pages: 551 - 551
      Abstract: Vedolizumab for inflammatory bowel disease: Changing the game, or more of the same? By Tim Raine, United European Gastroenterology Journal October 2014 2: 333–344,
      DOI : 10.1177/2050640614550672. In the above paper Figure 1 was labelled incorrectly. In the figure, the integrin target of vedolizumab appeared as α4β1 when this should have been α4β7, as correctly referred to in the figure legend and throughout the text. We apologise to readers for the error. The correct version of the figure is below:
      PubDate: 2014-11-26T03:09:00-08:00
      Issue No: Vol. 2, No. 6 (2014)
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