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United European Gastroenterology Journal    Follow    
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 2050-6406 - ISSN (Online) 2050-6414
     Published by Sage Publications Homepage  [718 journals]
  • Lack of seasonal variation in the incidence of eosinophilic oesophagitis
           in adolescent and adult non-PPI-responsive oesophageal eosinophilia
           midwestern US populations
    • Authors: Frederickson, N. W; Bayman, L, Valestin, J, Redd, M, Lee, Y.-J, Soubra, M, Schey, R.
      Pages: 69 - 76
      Abstract: Background Eosinophilic oesophagitis (EoO) has been associated with allergic disorders as well as aeroallergens. The current literature has shown a possible association between seasonal variation, mainly in the spring, and the incidence of EoO. However, this data was based on small population studies that did not exclude proton-pump inhibitor (PPI)-responsive oesophageal eosinophilia (PPI-ROE) in their cohort. Aim The aim of this study was to determine if there is a seasonal variation associated with the diagnosis of EoO in patients that had been treated with high-dose PPI prior to diagnosis. Methods Oesophageal biopsies were obtained from a cohort of patients who presented with symptoms of dysphagia, odynophagia, and heartburn during a 10-year period. Symptomatic patients who had biopsies from the mid and distal oesophagus with ≥20 eosinophils per high-power field (hpf) while on high-dose PPI treatment for at least 5 weeks were diagnosed as having EoO. The monthly and seasonal incidences were determined (winter, January–March; spring, April–June; summer, July–September; Autumn, October–December). Results A total of 20,718 patients were identified and their records evaluated. From this cohort, 193 (0.93%) symptomatic patients had biopsy-proven oesophageal eosinophilia (≥20 eosinophils/hpf) and no seasonal variation was seen in this group. However, only 57 (0.28%) had been adequately treated with PPI prior to diagnosis (i.e. non-PPI-ROE biopsy-proven EoO; ≥20 eosinophils/hpf: 39 males, 18 females; age 29.5 years). The most common medical history components included asthma (12.3%) and food allergies (3.5%), and the most common presenting symptoms included dysphagia (50.9%) and heartburn (26.3%). The monthly and seasonal incidences in our cohort were with no apparent trend (p = 0.713 and 0.703, respectively). Conclusions The incidence of EoO was consistent across all 12 months as well as during the four seasons. Our data does not support a seasonal variation in relation to the incidence of EoO in the US midwestern non-PPI-ROE population.
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614525152|hwp:master-id:spueg;2050640614525152
      Issue No: Vol. 2, No. 2 (2014)
  • EndoFLIP system for the intraoperative evaluation of peroral endoscopic
    • Authors: Familiari, P; Gigante, G, Marchese, M, Boskoski, I, Bove, V, Tringali, A, Perri, V, Onder, G, Costamagna, G.
      Pages: 77 - 83
      Abstract: Background Peroral endoscopic myotomy (POEM) has been recently introduced in clinical practice for the treatment of achalasia. The endoluminal functional lumen imaging probe (EndoFLIP) system) uses impedance planimetry for the real-time measurement of the diameter of the oesophago-gastric junction. Objective The aim of this study is to prospectively evaluate the effect of POEM on the oesophago-gastric junction using EndoFLIP. Methods All the patients who underwent POEM in a single centre between April and July 2013 were enrolled in the study. EndoFLIP was used intraoperatively, immediately before and after POEM. During follow-up patients underwent oesophagogastroduodenoscopy, oesophageal pH monitoring and manometry. Clinical outcomes were compared with the diameter of the oesophago-gastric junction after POEM. Results In total, 23 patients (12 males, mean age 51.7 years) were enrolled, and 21 underwent POEM successfully. Preoperative mean basal lower oesophageal sphincter pressure was 42.1 mmHg (±17.6). Before POEM, the mean oesophago-gastric junction diameter and cross-sectional area were 6.3 mm (±1.8) and 32.9 mm2 (±23.1), respectively. After treatment, the mean diameter and cross-sectional area of the oesophago-gastric junction were 11.3 mm (±1.7 SD) and 102.38 mm2 (±28.2 SD), respectively. No complications occurred during a mean follow-up of 5 months. Median post-operative Eckardt score was 1. Three patients (14.3%) referred heartburn. Follow-up studies revealed gastro-oesophageal reflux disease (GORD) in 57.1% of patients and oesophagitis in 33.3%. No correlations were observed between the diameter of oesophago-gastric junction after POEM and symptoms relief, GORD incidence and lower oesophageal sphincter pressure. Conclusions The diameter of oesophago-gastric junction substantially increases after POEM. EndoFLIP is a reliable method for the intraoperative evaluation of oesophago-gastric junction diameter. However, the real usefulness of this technology after POEM remains controversial.
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614521193|hwp:master-id:spueg;2050640614521193
      Issue No: Vol. 2, No. 2 (2014)
  • Rapid air infusion into the oesophagus: Motor response in patients with
           achalasia and nonobstructive dysphagia assessed with high-resolution
    • Authors: Elvevi, A; Mauro, A, Consonni, D, Pugliese, D, Tenca, A, Franchina, M, Conte, D, Penagini, R.
      Pages: 84 - 90
      Abstract: Background Achalasia is a neurodegenerative disorder of the oesophagus. Alteration of motor activity induced by oesophageal distension has not been explored. Objectives To investigate this function, using high-resolution Manometry. Methods This study enrolled 15 healthy subjects, 15 nonobstructive dysphagia (NOD), and 18 achalasia patients successfully treated with pneumatic dilation (six with restored peristalsis). The three groups underwent five rapid (
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614520866|hwp:master-id:spueg;2050640614520866
      Issue No: Vol. 2, No. 2 (2014)
  • Risk factors for the development of oesophageal adenocarcinoma in
           Barrett's oesophagus: a UK primary care retrospective nested case-control
    • Authors: Cooper, S; Menon, S, Nightingale, P, Trudgill, N.
      Pages: 91 - 98
      Abstract: Background Oesophageal adenocarcinoma (OAC) incidence is rising rapidly and prognosis remains poor. Endoscopic surveillance of Barrett’s oesophagus (BO) remains controversial. Objective A nested case–control study was undertaken to evaluate risk factors for progression of BO to OAC, potentially guiding surveillance efforts. Methods The Health Improvement Network database includes general practitioner consultations from 5 million UK subjects. BO subjects with 1-year minimum of follow up were followed until development of OAC or end of time on database. Demographic variables (age, gender, smoking, body mass index) and data on medication considered negatively (aspirin/nonsteroidal anti-inflammatory drugs/proton pump inhibitors) or positively associated (lower oesophageal sphincter-relaxing and asthma drugs) with OAC development were studied. Cox regression analysis-derived hazard ratios with 95% confidence intervals estimated the relative risk for OAC progression. Results A total of 3749 BO subjects were studied: 55 developed OAC during 17,743 patient years of follow up, a progression rate of 0.3% per annum. There was 96.7% of the cohort who took proton-pump inhibitors, with no association observed. Increasing age (1.03, 95% CI 1.01–1.05, p = 0.005), male gender (3.06, 95% CI 1.50–6.24, p = 0.002), and having ever smoked (2.36, 95% CI 1.13–4.93, p = 0.023) were associated with progression to OAC, (although smoking lost association on multivariate analysis). Increasing number of drugs used for asthma (2.91, 95% CI 1.10–7.68, p= 0.0314) was also associated. Conclusion In this nested case–control study of BO, male gender, increasing age, and increasing use of asthma drugs were associated with progression to OAC.
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614523596|hwp:master-id:spueg;2050640614523596
      Issue No: Vol. 2, No. 2 (2014)
  • Clinical significance of hepatitis B virion and SVP productivity:
           relationships between intrahepatic and serum markers in chronic hepatitis
           B patients
    • Authors: Lesmana, C. R. A; Jackson, K, Lim, S. G, Sulaiman, A, Pakasi, L. S, Gani, R. A, Hasan, I, Sulaiman, A. S, Lesmana, L. A, Hammond, R, Revill, P, Locarnini, S, Bowden, S. D.
      Pages: 99 - 107
      Abstract: Background Clinical use of hepatitis B viral (HBV) quantitative seromarker\s remains questionable since it is not precisely known whether they represent intrahepatic viral replication. Covalently closed circular DNA (cccDNA), relaxed circular DNA (rcDNA), and pregenomic RNA (pgRNA) are more likely to represent active HBV replication and their measurement can be used to derive virion productivity (VP; rcDNA/cccDNA), subviral particle (SVP) productivity (quantitative HBsAg/cccDNA), and replicative activity (RA; pgRNA/cccDNA). These can be used to compare relative HBV replication between HBeAg-negative and -positive patients. Objective To study the clinical significance of intrahepatic HBV replication phenomenon between HBeAg-negative and -positive patients and its correlation with quantitative HBV seromarkers. Method This was a prospective study between January 2010 and December 2011. Study subjects were naive chronic hepatitis B patients from Cipto Mangunkusumo and Medistra Hospitals. All patient samples underwent liver biochemistry and HBV seromarkers testing (HBeAg, quantitative HBsAg and HBV DNA levels), and patients underwent liver biopsy. Stored liver specimens were analysed for intrahepatic rcDNA, cccDNA, and pgRNA with quantification performed by real-time PCR. Comparison of HBV markers between HBsAg-positive and -negative patients was carried out using the Mann–Whitney U-test. Pearson’s correlation test was performed among HBV intrahepatic and seromarkers using their log-transformed values. Results A total of 104 patients were enrolled in this study; 54 (51.9%) were male. Patients’ mean age was 41.9 ± 11.63 years (range 19–70 years). Sixty-one patients (58.7%) were HBeAg-negative. All HBV markers were significantly higher in HBeAg-positive than HBeAg-negative patients, except for SVP productivity and RA. Serum HBV DNA was strongly correlated with intrahepatic total HBV DNA (r = 0.771), cccDNA (r = 0.774), and rcDNA (r = 0.780) while serum quantitative HBsAg showed only moderate correlation with intrahepatic total DNA (r = 0.671), cccDNA (r = 0.632), rcDNA (r = 0.675), and SVP productivity (r = 0.557). Conclusions Serum HBV DNA concentration and quantitative HBsAg might not accurately predict intrahepatic viral activity. Virion and SVP production do not occur in parallel with replicative activity.
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614525151|hwp:master-id:spueg;2050640614525151
      Issue No: Vol. 2, No. 2 (2014)
  • Long-term outcome of cyclosporin rescue therapy in acute,
           steroid-refractory severe ulcerative colitis
    • Authors: Molnar, T; Farkas, K, Szepes, Z, Nagy, F, Szűcs, M, Nyari, T, Balint, A, Wittmann, T.
      Pages: 108 - 112
      Abstract: Background Although cyclosporin is effective in severe ulcerative colitis (UC), long-term colectomy rate varies between 60 and 88% among patients in whom cyclosporin initially induced remission. The aim of our study was to evaluate the long-term outcome and the optimal duration of cyclosporin therapy in acute, severe UC. Methods A total of 73 patients underwent i.v. cyclosporin therapy for a steroid refractory flare up of UC between 1998 and 2009. All patients were treated with 1 mg/kg i.v. methylprednisolone for 3–7 days before the administration of cyclosporin. Patients received i.v. cyclosporin of 4–5 mg/kg for 5 days following oral treatment. Results The mean follow up after the initiation of cyclosporin was 4.2 years. There were 20 patients who underwent early colectomy. Cyclosporin had to be discontinued due to side effects in 22 patients. Cyclosporin failed and late colectomy was performed in 14 of the 53 responders. Duration of cyclosporin treatment was significantly longer in those who avoided colectomy. The probability of avoiding colectomy proved to be 66% in case of 1-year treatment period with cyclosporin. The longer treatment period resulted in longer colectomy-free disease course. Conclusions Cyclosporin is effective in acute, severe UC during long-term follow up. Our data suggest that the longer cyclosporin is used, the more it is possible to avoid colectomy in the future.
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614520865|hwp:master-id:spueg;2050640614520865
      Issue No: Vol. 2, No. 2 (2014)
  • Gelatin tannate ameliorates acute colitis in mice by reinforcing mucus
           layer and modulating gut microbiota composition: Emerging role for 'gut
           barrier protectors' in IBD'
    • Authors: Scaldaferri, F; Lopetuso, L. R, Petito, V, Cufino, V, Bilotta, M, Arena, V, Stigliano, E, Maulucci, G, Papi, M, Emiliana, C. M, Poscia, A, Franceschi, F, Delogu, G, Sanguinetti, M, Spirito, M. D, Sgambato, A, Gasbarrini, A.
      Pages: 113 - 122
      Abstract: Background Gelatin tannate, a gelatin powder containing tannic acids, is commonly employed as an intestinal astringent. Neither information nor animal model exist to confirm its efficacy or unravel mechanisms of action. Objective To evaluate the action of gelatin tannate in murine dextran sodium sulphate (DSS)-induced acute colitis. Methods Mice were exposed to DSS and received gelatin tannate by gavage. At sacrifice, colon histological degree of inflammation was assessed. Stool samples were cultured for microbiological analysis. Colon samples were analysed by two-photon confocal microscopy and atomic force microscopy. Elisa was performed on murine serum to assess lipopolysaccharide and peptidoglycan levels. Results Gelatin tannate treatment reduced disease activity, bodyweight loss, and preserved colonic length. It produced a decrease in the amount of enterobacteria and enterococci. At confocal microscopy, intestinal samples from healthy and treated mice displayed similar structure in mucus layer thickness and composition; samples from placebo group had no mucus layer or a thinner stratus. Atomic force microscopy confirmed these findings. Treated mice showed lower blood LPS levels vs. control. Conclusions Gelatin tannate decreased the severity of colitis. Acting as a gut barrier enhancer, it re-establishes gut homeostasis by recovering intestinal permeability and mucus layer integrity in gut mucosa and by modulating microbiota composition.
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614520867|hwp:master-id:spueg;2050640614520867
      Issue No: Vol. 2, No. 2 (2014)
  • Postpolypectomy haemorrhage following removal of large polyps using
           mechanical haemostasis or epinephrine: a meta-analysis
    • Authors: Corte, C. J; Burger, D. C, Horgan, G, Bailey, A. A, East, J. E.
      Pages: 123 - 130
      Abstract: Background and aim Postpolypectomy haemorrhage (PPH) is a known adverse event that can occur following polypectomy, occurring in 0.3–6.1% of cases. Previous meta-analysis has included small polyps, which are less likely to bleed, and less amenable to some methods of mechanical haemostasis. No comprehensive cost–benefit analysis of this topic is available. The aim of this study was to perform a meta-analysis of randomized trials and a cost–benefit analysis of prophylactic haemostasis in PPH. Methods A total of 3092 abstracts from prospective trials conducted in human colonoscopic polypectomy were screened. Outpatients undergoing polypectomy in seven suitable studies (1426 episodes), without polyposis syndromes or bleeding diathesis, were identified. The interventions of prophylactic haemostatic measures (clips, loops, and/or adrenaline injection) to prevent PPH were assessed. The main outcome measurements were PPH measured by haematochezia or drop in haematocrit >10% or haemoglobin >1 g/dl. Risk ratio and number needed to treat (NNT) were generated using meta-analysis. Results Comparing any prophylactic haemostasis to none, the pooled risk ratio for PPH was 0.35 (0.21–0.57; p < 0.0001), NNT was 13.6, and cost to prevent one PPH was USD652. Using adrenaline alone vs. no prophylactic haemostasis revealed a pooled risk ratio of 0.37 (0.20–0.66; p = 0.001), NNT 14.0, cost to prevent one PPH USD382. Any prophylactic mechanical haemostasis compared to adrenaline produced a RR for PPH of 0.28 (0.14–0.57; p < 0.0001), NNT 12.3, and cost to prevent one PPH USD1368. Conclusions Adrenaline injection or mechanical haemostasis reduces the risk of PPH. Routine prophylactic measures to reduce PPH for polyps larger than 10 mm are potentially cost effective, although more thorough cost–benefit modelling is required.
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614522619|hwp:master-id:spueg;2050640614522619
      Issue No: Vol. 2, No. 2 (2014)
  • Symptomatic fructose malabsorption in irritable bowel syndrome: A
           prospective study
    • Authors: Melchior, C; Gourcerol, G, Dechelotte, P, Leroi, A.-M, Ducrotte, P.
      Pages: 131 - 137
      Abstract: Introduction Fructose can trigger or worsen symptoms in irritable bowel syndrome (IBS) patients. The aim of this study was to determine the prevalence of symptomatic fructose malabsorption in IBS patients and to test whether the patient's characteristics can help to detect a fructose malabsorption. Materials and methods Ninety Rome III IBS patients (predominant diarrhoea (IBS-D): 31%, predominant constipation (IBS-C): 18%, mixed type (IBS-M): 51%) were included prospectively. After exclusion of a small intestinal bacterial overgrowth by a glucose breath test, fructose malabsorption was assessed by a five-hour breath test, with symptom monitoring, after a 25 g load of fructose. An increase of more than 20 ppm of hydrogen (H2) or methane (CH4) levels in the exhaled air led to the diagnosis of malabsorption. Results Fructose test was abnormal in 20/90 patients among whom only 35% were intolerant, with a simultaneous rise of H2/CH4 levels and the onset of abdominal discomfort or diarrhoea. IBS characteristics were not predictive even if young (p = 0.031) and male IBS patients (p = 0.029) were at higher risk of malabsorption. At variance, 18 additional patients experienced intestinal symptoms during the test despite normal fructose absorption. Discussion After a 25 g fructose load, symptomatic fructose malabsorption and intolerance without malabsorption were detected in 22% and 28% of IBS patients respectively.
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614521124|hwp:master-id:spueg;2050640614521124
      Issue No: Vol. 2, No. 2 (2014)
  • Constipation severity is associated with productivity losses and
           healthcare utilization in patients with chronic constipation
    • Authors: Neri, L; Basilisco, G, Corazziari, E, Stanghellini, V, Bassotti, G, Bellini, M, Perelli, I, Cuomo, R, LIRS Study Group
      Pages: 138 - 147
      Abstract: Objective We sought to evaluate the association between constipation severity, productivity losses and healthcare utilization in a national sample of Italian patients with chronic non-organic constipation (CC) Methods We enrolled 878 outpatients with CC. Clinical and demographic data were collected by physicians during clinical examinations. Patients completed a self-administered questionnaire (Patient Assessment of Constipation-Symptoms, PAC-SYM; Work Productivity and Activity Impairment; healthcare utilization, and Symptoms Checklist 90 Revised – Somatization Scale, SCL-90 R). Results Mean PAC-SYM score was 1.62 ± 0.69. Mean weekly sick time due to constipation was 2.7 ± 8.6 h and productivity losses due to presenteeism was 19.7% ± 22.3%. Adjusted productivity losses in patients with severe CC (PAC-SYM score 2.3–4.0) compared to patients with mild symptoms (PAC-SYM score 0.0–1.0) was Italian Purchase Power Parity US$ 6160. Constipation severity (PAC-SYM quintiles) was associated with higher healthcare utilization (RRPAC-SYM 4/01.84; p-value for linear trend
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614528175|hwp:resource-id:spueg;2/2/138
      Issue No: Vol. 2, No. 2 (2014)
  • UEG Week Vienna 2014 cutting edge symposium: Today's Science, Tomorrow's
           Medicine session features the immune system - a driving force in digestive
           health and disease
    • Authors: Tilg, H; Wedemeyer, H.
      Pages: 149 - 150
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614528146|hwp:resource-id:spueg;2/2/149
      Issue No: Vol. 2, No. 2 (2014)
  • UEG Training Support - a good option to finance your high quality
           postgraduate teaching!
    • Authors: Regula, J; Sklodowska-Curie, M.
      Pages: 151 - 152
      PubDate: 2014-03-28T04:22:02-07:00
      DOI: 10.1177/2050640614528145|hwp:resource-id:spueg;2/2/151
      Issue No: Vol. 2, No. 2 (2014)
  • Representation of national matters in UEG
    • Authors: Drenth; J. P.
      Pages: 153 - 154
      PubDate: 2014-03-28T04:22:03-07:00
      DOI: 10.1177/2050640614528143|hwp:resource-id:spueg;2/2/153
      Issue No: Vol. 2, No. 2 (2014)
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