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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  [743 journals]
  • Message from the editors
    • Authors: Tack, J; Greten, T, Kaser, A, Pech, O.
      Pages: 331 - 332
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614549532|hwp:resource-id:spueg;2/5/331
      Issue No: Vol. 2, No. 5 (2014)
  • Vedolizumab for inflammatory bowel disease: Changing the game, or more of
           the same'
    • Authors: Raine; T.
      Pages: 333 - 344
      Abstract: Two decades ago, the first reports of the use of monoclonal antibodies targeting tumour-necrosis factor α heralded a revolution in treatment options for moderate to severe Crohn’s disease and ulcerative colitis. Nonetheless, patients with refractory disease or loss of treatment response are all too familiar to gastroenterologists. Preventing the infiltration of the gastrointestinal mucosa by circulating cells of the immune system using antibodies targeting the adhesion molecules involved represents an attractive new treatment option. Vedolizumab has recently received European and US regulatory approval for treatment of ulcerative colitis and Crohn’s disease on the basis of encouraging results from one of the largest phase III trial programmes ever conducted in the field of inflammatory bowel diseases and promising safety data. Are we now seeing another revolution in the management of inflammatory bowel disease, and how can this new drug best be used in clinical practice'
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614550672|hwp:resource-id:spueg;2/5/333
      Issue No: Vol. 2, No. 5 (2014)
  • Epidemiology of chronic pancreatitis: burden of the disease and
    • Authors: Levy, P; Dominguez-Munoz, E, Imrie, C, Lohr, M, Maisonneuve, P.
      Pages: 345 - 354
      Abstract: The epidemiology of chronic pancreatitis (CP) is incompletely understood. A number of difficulties exist in estimating the prevalence and incidence of CP. Long-term follow-up is often problematic, especially in chronic alcoholics, and obtaining a formal and standardised diagnosis can take years. The available studies are reasonably consistent in their estimation of the incidence of CP but few studies have attempted to estimate prevalence. Although life expectancy in CP is diminished compared with control populations, median survival lies in the range of 15–20 years. Such a survival would suggest a prevalence of CP rather higher than that determined from the survey studies. A recent epidemiological study in France found an annual incidence of 7.8 per 100,000. Assuming a survival of 15–20 years, the annual prevalence should be between 120 to 143 per 100,000. Overall, our understanding of the epidemiology of CP is poor compared with other illnesses. We consider that both prevalence and the rate of pancreatic insufficiency and of CP are currently underestimated. There is a distinct need for more studies to remedy this lack of knowledge.
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614548208|hwp:master-id:spueg;2050640614548208
      Issue No: Vol. 2, No. 5 (2014)
  • Impedance as an adjunct to manometric testing to investigate symptoms of
    • Authors: Omari, T; Tack, J, Rommel, N.
      Pages: 355 - 366
      Abstract: Dysphagia is a common reason for referral for investigations of oesophageal motility. Impedance measurement has now been incorporated into commercially available diagnostic manometry systems for more than a decade. This innovation, which offered the ability to record patterns of bolus transport without the need for simultaneous radiology, has for the most part failed to live up to expectations, offering few additional diagnostic insights. This review examines the potential pitfalls related to how impedance patterns are currently analysed and introduces and discusses the new concept of pressure-flow analysis integrating pressure and impedance measurements to derive new metrics linked to the pressures occurring within and around the bolus as it is being transported.
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614549096|hwp:master-id:spueg;2050640614549096
      Issue No: Vol. 2, No. 5 (2014)
  • Sixteen-year follow-up of Barrett's esophagus, endoscopically treated with
           argon plasma coagulation
    • Authors: Milashka, M; Calomme, A, Van Laethem, J. L, Blero, D, Eisendrath, P, Le Moine, O, Deviere, J.
      Pages: 367 - 373
      Abstract: Objective The thermal destruction of non-dysplastic Barrett’s esophagus (BE) and its replacement by squamous epithelium is an attractive, but unproven strategy to avoid further development of dysplasia or cancer. The goal of this study was to estimate the persistence of restoration of squamous epithelium and the risk of cancer in BE that was eradicated using argon plasma coagulation (APC) in the absence of high-grade dysplasia, 16 years after its application. Design We followed 32 patients with BE who underwent eradication of metaplastic epithelium using APC, up to 16 years later. Results At the end of the initial treatment, 25 of 32 patients (78%) had complete endoscopic eradication, there was partial squamous re-epithelialization in four patients (13%) and it was absent in three patients (9%). We observed buried metaplastic glands under new squamous epithelium in 6 of the 25 patients who had complete endoscopic eradication. At follow-up, sustained complete endoscopic eradication was observed in 16 of 32 patients (50%), partial eradication in 11 of 32 patients (35%); there were two patients (6%) lost to follow-up and three patients (9%) developed esophageal adenocarcinoma. Two of the latest cases arose from the buried glands under neosquamous epithelium after complete eradication and one arose from a small remaining Barrett’s segment. Conclusions We observed long-term re-epithelialization in the majority of patients who had previously had complete eradication of Barrett’s esophagus. This did not provide protection against cancer development, as the incidence of cancers arising from buried glands or from residual Barrett’s esophagus was similar to that observed in patients undergoing no specific treatment.
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614549095|hwp:resource-id:spueg;2/5/367
      Issue No: Vol. 2, No. 5 (2014)
  • Is hormone replacement therapy in post-menopausal women associated with a
           reduced risk of oesophageal cancer'
    • Authors: Menon, S; Nightingale, P, Trudgill, N.
      Pages: 374 - 382
      Abstract: Purpose The rise in oesophageal adenocarcinoma incidence in women with age is delayed compared with men until the post-menopausal period. A matched cohort study was therefore undertaken of post-menopausal women on hormone replacement therapy (HRT) to examine the association between HRT, oesophageal cancer and the potentially associated conditions, reflux oesophagitis and Barrett’s oesophagus. Methods Women aged over 50 years within the UK General Practice Research Database with a history of HRT exposure were matched by age and general practice with controls without HRT exposure (1:1). Matched Cox-regression analysis was performed to estimate adjusted hazard ratios. Results 51,851 HRT users and controls were studied. Prolonged HRT use for 5–10 years (hazard ratio 0.25 (95% CI 0.07–0.95)) and time-dependent covariates for increasing duration of HRT use (0.06 (0.01–0.43)) were associated with a reduced oesophageal cancer risk. HRT use was associated with reflux oesophagitis (1.27 (1.12–1.43)), but when analysis was confined to women with codes for both reflux oesophagitis and endoscopy there was no association (1.1 (0.81–1.44)), suggesting increased reporting of reflux symptoms among HRT users rather than an association with endoscopic reflux oesophagitis. Conclusion Long-term post-menopausal HRT may be associated with a reduced risk of oesophageal cancer.
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614543736|hwp:master-id:spueg;2050640614543736
      Issue No: Vol. 2, No. 5 (2014)
  • The tissue effect of argon-plasma coagulation with prior submucosal
           injection (Hybrid-APC) versus standard APC: A randomized ex-vivo study
    • Authors: Manner, H; Neugebauer, A, Scharpf, M, Braun, K, May, A, Ell, C, Fend, F, Enderle, M. D.
      Pages: 383 - 390
      Abstract: Background Thermal ablation for Barrett’s oesophagus has widely been established in gastrointestinal endoscopy during the last decade. The mainly used methods of radiofrequency ablation (RFA) and argon-plasma coagulation (APC) carry a relevant risk of stricture formation of up to 5–15%. Newer ablation techniques that are able to overcome this disadvantage would therefore be desirable. The aim of the present study was to compare the depth of tissue injury of the new method of Hybrid-APC versus standard APC within a randomized study in a porcine oesophagus model. Methods Using a total of eight explanted pig oesophagi, 48 oesophageal areas were ablated either by standard or Hybrid-APC (APC with prior submucosal fluid injection) using power settings of 50 and 70 W. The depth of tissue injury to the oesophageal wall was analysed macroscopically and histopathologically. Results Using 50 W, mean coagulation depth was 937 ± 469 µm during standard APC, and 477 ± 271 µm during Hybrid-APC (p = 0.064). Using 70 W, coagulation depth was 1096 ± 320 µm (standard APC) and 468 ± 136 µm (Hybrid-APC; p = 0.003). During all settings, damage to the muscularis mucosae was observed. Using standard APC, damage to the submucosal layer was observed in 4/6 (50 W) and 6/6 cases (70 W). During Hybrid-APC, coagulation of the submucosal layer occurred in 2/6 (50 W) and 1/6 cases (70 W). The proper muscle layer was only damaged during conventional APC (50 W: 1/6; 70 W: 3/6). Limitations Ex-vivo animal study with limited number of cases. Conclusions Hybrid-APC reduces coagulation depth by half in comparison with standard APC, with no thermal injury to the proper muscle layer. It may therefore lead to a lower rate of stricture formation during clinical application.
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614544315|hwp:master-id:spueg;2050640614544315
      Issue No: Vol. 2, No. 5 (2014)
  • Outcomes of single-dose peri-procedural antibiotic prophylaxis for
           endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic
    • Authors: Marinos, E; Lee, S, Jones, B, Corte, C, Kwok, A, Leong, R. W.
      Pages: 391 - 396
      Abstract: Background Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a technique frequently used to diagnose solid and cystic lesions of the pancreas. Antibiotic prophylaxis has been recommended for EUS-FNA of pancreatic cystic lesions but is not universally observed. The most effective antibiotic and the most efficacious route and regimen of administration are also unknown. Objective This cohort study was undertaken to evaluate whether single-dose piperacillin/tazobactam or ciprofloxacin given at the time of the procedure effectively prevents major adverse events and to audit the adherence to this protocol in the setting of EUS-FNA of pancreatic cystic lesions. Design Consecutive EUS-FNA procedures of pancreatic cystic lesions were performed at Concord Hospital and significant variables regarding the procedure and adverse events were recorded. Patients were also contacted by telephone to follow-up any subacute adverse events they may have experienced. Patients Over a 30 month period (January 2010–July 2012), a total of 85 EUS-FNAs of pancreatic cysts were performed on 80 different patients. The mean age was 63.2 years (range 17–89 years; 58% females). Interventions Single-dose piperacillin/tazobactam IVs was administered to 87% of patients, while 12% of patients received ciprofloxacin IVs. Results No patients developed cyst infection, fever, or sepsis (0%) and one patient (1.2%) was hospitalised for self-limited nausea without adverse sequelae. Conclusions Single-dose piperacillin/tazobactam at the time of EUS-FNA of pancreatic cysts is an effective prophylaxis of cyst infection or sepsis and can be conveniently given as a single-dose peri-procedurally without further oral antibiotics.
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614544191|hwp:master-id:spueg;2050640614544191
      Issue No: Vol. 2, No. 5 (2014)
  • Faecal calprotectin levels differentiate intestinal from pulmonary
           tuberculosis: An observational study from Southern India
    • Authors: Larsson, G; Shenoy, K. T, Ramasubramanian, R, Thayumanavan, L, Balakumaran, L. K, Bjune, G. A, Moum, B. A.
      Pages: 397 - 405
      Abstract: Background Current methods to establish the diagnosis of intestinal tuberculosis are inadequate. Objectives We aimed to determine the clinical features of intestinal tuberculosis and evaluate inflammatory biomarkers in intestinal as well as pulmonary tuberculosis. Methods We recruited 38 intestinal tuberculosis patients, 119 pulmonary tuberculosis patients and 91 controls with functional gastrointestinal disorders between October 2009 and July 2012 for the investigation of clinical features, C-reactive protein (CRP), faecal and serum calprotectin. Faecal calprotectin ≥200 µg/g was used as a cut-off to determine intestinal inflammation of clinical significance. Three patient categories were established: (a) pulmonary tuberculosis and faecal calprotectin
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614546947|hwp:master-id:spueg;2050640614546947
      Issue No: Vol. 2, No. 5 (2014)
  • Serial intralesional injections of infliximab in small bowel Crohn's
           strictures are feasible and might lower inflammation
    • Authors: Hendel, J; Karstensen, J. G, Vilmann, P.
      Pages: 406 - 412
      Abstract: Background Crohn’s disease can cause strictures throughout the gastrointestinal tract. Endoscopic balloon dilatation is a well-established treatment, but recurrence is seen in up to three out of four cases. Infliximab is playing an increasingly important role in the modern systemic treatment of severe Crohn’s disease. Combining the anti-inflammatory effects of infliximab with the proven effect of endoscopic balloon dilatation could possibly improve outcome. In small studies, intralesional injections in perianal fistulas have been effective and endoscopic injection therapy in colonic strictures is feasible. Objective We wanted to assess whether serial intralesional injection of infliximab in small bowel strictures is feasible and reduces local inflammation. Methods We included six patients with Crohn’s disease and inflammatory small bowel strictures. They were treated with endoscopic serial balloon dilatation. Subsequent to each dilatation, 40 mg infliximab was injected submucosally. A modified simplified endoscopic score for Crohn’s disease was used for the involved area before the initial treatment and at the final follow-up after six months. Complications and development of symptoms were registered. Results Balloon dilatation and serial injection of infliximab were accomplished in five out of six patients. One patient completed the serial balloon dilatations and follow-up but received only one infliximab injection. The modified simplified endoscopic score for Crohn’s disease decreased in all patients. There were no adverse events registered and all patients described themselves as feeling well. Conclusions Combining balloon dilatation of strictures with serial intralesional injection of infliximab in Crohn’s disease of the small bowel is feasible and seems successful in reducing inflammation.
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614547805|hwp:master-id:spueg;2050640614547805
      Issue No: Vol. 2, No. 5 (2014)
  • Italian consensus conference for colonic diverticulosis and diverticular
    • Authors: Cuomo, R; Barbara, G, Pace, F, Annese, V, Bassotti, G, Binda, G. A, Casetti, T, Colecchia, A, Festi, D, Fiocca, R, Laghi, A, Maconi, G, Nascimbeni, R, Scarpignato, C, Villanacci, V, Annibale, B.
      Pages: 413 - 442
      Abstract: The statements produced by the Consensus Conference on Diverticular Disease promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease (DD) in patients with uncomplicated and complicated DD were reviewed by a scientific board of experts who proposed 55 statements graded according to level of evidence and strength of recommendation, and approved by an independent jury. Each topic was explored focusing on the more relevant clinical questions. Comparison and discussion of expert opinions, pertinent statements and replies to specific questions, were presented and approved based on a systematic literature search of the available evidence. Comments were added explaining the basis for grading the evidence, particularly for controversial areas.
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614547068|hwp:master-id:spueg;2050640614547068
      Issue No: Vol. 2, No. 5 (2014)
  • UEG Education: time to shape the future
    • Authors: Murray; C.
      Pages: 445 - 445
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614550964|hwp:resource-id:spueg;2/5/445
      Issue No: Vol. 2, No. 5 (2014)
  • UEG Week Barcelona - the place to be for gastroenterologists in 2015!
    • Pages: 447 - 448
      PubDate: 2014-09-22T01:53:22-07:00
      DOI: 10.1177/2050640614550965|hwp:resource-id:spueg;2/5/447
      Issue No: Vol. 2, No. 5 (2014)
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