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Journal Cover   United European Gastroenterology Journal
  [1 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2050-6406 - ISSN (Online) 2050-6414
   Published by Sage Publications Homepage  [819 journals]
  • UEG career highlight: Rebecca Fitzgerald, winner of the UEG Research Prize
    • Pages: 225 - 225
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640615586655
      Issue No: Vol. 3, No. 3 (2015)
  • Combining simple patient-oriented tests with state-of-the-art molecular
           diagnostics for early diagnosis of cancer
    • Authors: Fitzgerald; R. C.
      Pages: 226 - 229
      Abstract: Early diagnosis is an important strategy to improve outcomes from cancer. Oesophageal adenocarcinoma is an example of a cancer that presents late, with very poor outcomes, and for which the presence of the precursor lesion Barrett’s oesophagus provides the opportunity to intervene at an early stage. In this review, I describe the challenges in the field and the work that we have done to devise a conceptually novel approach to early diagnosis, using a cell collection device (Cytosponge), coupled with molecular assays. This is a personal perspective in which I also describe the career pathway that led me into academic gastroenterology, and the rewards and challenges of translational research in molecular diagnostics. There are fantastic opportunities for clinicians wishing to pursue academic medicine, because it is a time when massive strides are being made in a whole number of areas; for example: imaging, sequencing technology and targeted therapies. Clinicians who can straddle the laboratory and the clinic are essential, to maximise the progress that can be made for the benefit of patients.
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640615576677
      Issue No: Vol. 3, No. 3 (2015)
  • Use of probe-based confocal laser endomicroscopy (pCLE) in
           gastrointestinal applications. A consensus report based on clinical
    • Authors: Wang, K. K; Carr-Locke, D. L, Singh, S. K, Neumann, H, Bertani, H, Galmiche, J.-P, Arsenescu, R. I, Caillol, F, Chang, K. J, Chaussade, S, Coron, E, Costamagna, G, Dlugosz, A, Ian Gan, S, Giovannini, M, Gress, F. G, Haluszka, O, Ho, K. Y, Kahaleh, M, Konda, V. J, Prat, F, Shah, R. J, Sharma, P, Slivka, A, Wolfsen, H. C, Zfass, A.
      Pages: 230 - 254
      Abstract: Background Probe-based confocal laser endomicroscopy (pCLE) provides microscopic imaging during an endoscopic procedure. Its introduction as a standard modality in gastroenterology has brought significant progress in management strategies, affecting many aspects of clinical care and requiring standardisation of practice and training. Objective This study aimed to provide guidance on the standardisation of its practice and training in Barrett’s oesophagus, biliary strictures, colorectal lesions and inflammatory bowel diseases. Methods Initial statements were developed by five group leaders, based on the available clinical evidence. These statements were then voted and edited by the 26 participants, using a modified Delphi approach. After two rounds of votes, statements were validated if the threshold of agreement was higher than 75%. Results Twenty-six experts participated and, among a total of 77 statements, 61 were adopted (79%) and 16 were rejected (21%). The adoption of each statement was justified by the grade of evidence. Conclusion pCLE should be used to enhance the diagnostic arsenal in the evaluation of these indications, by providing microscopic information which improves the diagnostic performance of the physician. In order actually to implement this technology in the clinical routine, and to ensure good practice, standardised initial and continuing institutional training programmes should be established.
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640614566066
      Issue No: Vol. 3, No. 3 (2015)
  • The human gastric microbiota: Is it time to rethink the pathogenesis of
           stomach diseases'
    • Authors: Nardone, G; Compare, D.
      Pages: 255 - 260
      Abstract: Introduction Although long thought to be a sterile organ, due to its acid production, the human stomach holds a core microbiome. Aim To provide an update of findings related to gastric microbiota and its link with gastric diseases. Methods We conducted a systematic review of the literature. Results The development of culture-independent methods facilitated the identification of many bacteria. Five major phyla have been detected in the stomach: Firmicutes, Bacteroidites, Actinobacteria, Fusobacteria and Proteobacteria. At the genera level, the healthy human stomach is dominated by Prevotella, Streptococcus, Veillonella, Rothia and Haemophilus; however, the composition of the gastric microbiota is dynamic and affected by such factors as diet, drugs and diseases. The interaction between the pre-existing gastric microbiota and Helicobacter pylori infection might influence an individual’s risk of gastric disease, including gastric cancer. Conclusions The maintenance of bacterial homeostasis could be essential for the stomach’s health and highlights the chance for therapeutic interventions targeting the gastric microbiota, even if gastric pH, peristalsis and the mucus layer may prevent bacteria colonization; and the definition of gastric microbiota of the healthy stomach is still an ongoing challenging task.
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640614566846
      Issue No: Vol. 3, No. 3 (2015)
  • Buspirone, a new drug for the management of patients with ineffective
           esophageal motility'
    • Authors: Scheerens, C; Tack, J, Rommel, N.
      Pages: 261 - 265
      Abstract: Ineffective esophageal motility (IEM) is the most frequently encountered esophageal motility disorder. Patients may present with a variety of symptoms, such as dysphagia, heartburn, odynophagia, and regurgitation. Over the past years, the landscape of esophageal motility testing has been revolutionized; however, our current treatment options for IEM still remain limited. Previous studies have suggested that buspirone, a serotonin receptor agonist, enhances esophageal peristalsis and lower esophageal sphincter (LES) function. Recent work provides the first evidence that buspirone may influence LES resting pressure in patients with systemic sclerosis. Future research should evaluate whether the beneficial effects of buspirone also apply to the broad clinical entity of esophageal dysphagia patients with IEM.
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640615585688
      Issue No: Vol. 3, No. 3 (2015)
  • Beneficial effect of the 5-HT1A receptor agonist buspirone on esophageal
           dysfunction associated with systemic sclerosis: A pilot study
    • Authors: Karamanolis, G. P; Panopoulos, S, Karlaftis, A, Denaxas, K, Kamberoglou, D, Sfikakis, P. P, Ladas, S. D.
      Pages: 266 - 271
      Abstract: Background Esophageal involvement in systemic sclerosis (SSc) carries significant morbidity and is empirically managed with domperidone, albeit with questionable efficacy. The oral 5-HT1A receptor agonist buspirone may enhance esophageal peristalsis and lower esophageal sphincter (LES) function in healthy volunteers. Aim We aimed to test the hypothesis that buspirone may exert a beneficial acute effect on esophageal motor dysfunction in symptomatic patients with SSc. Methods Twenty consecutive patients with SSc reporting esophageal symptoms underwent high-resolution manometry before and 30 minutes after administration of buspirone (10 mg). Ten other patients received domperidone (10 mg) and served as control group. Changes in LES resting and residual pressure, amplitude, duration, and velocity of distal esophageal body contractions were examined. Results Esophageal hypomotility and hypotensive LES was found in 63% and 67% of patients, respectively. Demographic and clinical characteristics, including baseline manometric parameters, were comparable between groups. Resting pressure of LES increased after buspirone from 9.42 ± 2.6 to 11.53 ± 3.4 mmHg (p = 0.0002 by paired t-test), but not after domperidone; a trend for increase of amplitude of contractions was also observed after buspirone (p = 0.09). Comparison of the individual changes revealed that buspirone was superior to domperidone in enhancing LES pressure ( + 2.11 ± 2.0 versus –0.45 ± 2.3 mmHg, p = 0.006). No significant effects of either drug were noted on other examined parameters of esophageal function. Conclusion The beneficial acute effect of buspirone on impaired LES function associated with SSc suggests a role of 5-HT1A receptor-mediated interactions in these patients. Prospective studies to examine whether buspirone is of long-term therapeutic value for SSc-associated esophageal disease are warranted.
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640614560453
      Issue No: Vol. 3, No. 3 (2015)
  • Utility of Basophil Activation Test for monitoring the acquisition of
           clinical tolerance after oral desensitization to cow's milk: Pilot study
    • Authors: Nucera, E; Pecora, V, Buonomo, A, Rizzi, A, Aruanno, A, Pascolini, L, Ricci, A. G, Di Rienzo, A, Mezzacappa, S, Ferraironi, M, Patriarca, G, Gasbarrini, G, Schiavino, D.
      Pages: 272 - 276
      Abstract: Objective The quantification of basophil activation by flow cytometry is a useful tool for the assessment of immediate-type responses to food allergens and the prediction of clinical tolerance in food allergy patients. The aim of this study is to investigate how the analysis of allergen-induced CD63 up-regulation by flow cytometry can be effective in monitoring the acquisition of clinical tolerance by specific oral desensitization in food allergy. To our knowledge, this is the first study to examine this topic. Materials and methods Three male patients affected by cow’s milk allergy underwent successful oral desensitization to cow’s milk. In order to monitor the acquired clinical tolerance that occurred after treatment, we performed laboratory tests for total and specific IgE, specific IgG4 and the Basophil Activation Test (BAT) both at baseline and at the end of the desensitization protocol. Results Using a fluorescent enzyme immunoassay, the comparison of specific cow’s milk antibodies before and after treatment showed a decrease of specific IgE levels, without reaching normal values, and an increase of specific IgG4 levels. A complete suppression of cow’s milk proteins (α-lactoalbumin, β-lactoglobulin and casein) induced CD63 regulation was observed in all three reported cases. Conclusions Using flow cytometry, food allergen-specific basophil responses could be monitored in order to identify an acquired tolerance induced by desensitization treatment. Although further studies are needed to develop this important new topic, it was interesting to note that the BAT seemed to be more sensitive and characterized by a close correlation with clinical tolerance.
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640615570694
      Issue No: Vol. 3, No. 3 (2015)
  • Management of acute variceal bleeding using hemostatic powder
    • Authors: Ibrahim, M; El-Mikkawy, A, Abdalla, H, Mostafa, I, Deviere, J.
      Pages: 277 - 283
      Abstract: Background and objectives This study aimed to test the safety and efficacy of Hemospray® for emergency control of acute variceal bleeding (AVB) due to portal hypertension in cirrhotic patients. Patients and methods This single-arm, prospective trial, conducted at two hospitals in Belgium and Egypt, included patients admitted to the emergency room with hematemesis and/or melena and known or suspected liver cirrhosis. All patients received urgent hemodynamic stabilization, octreotide (50 mcg bolus then 25 mcg/hour for 24 hours) and intravenous ceftriaxone (1 g/hour). Endoscopy to confirm AVB and Hemospray® application (if indicated) was performed within six hours of admission. Patients were kept under observation for 24 hours and underwent second endoscopy and definitive therapy (band ligation and/or cyanoacrylate injection in cases of gastric varices) the next day. Results Thirty-eight patients were admitted for suspected AVB, and 30 of these had confirmed AVB (70% male; mean age 59.5 years (range, 32.0–73 years)). Child-Pugh class C liver disease was present in 53.4%. Esophageal varices were observed in 83.4% of patients, gastric varices in 10%, and duodenal varices in 6.6%. Spurting bleeding at the time of endoscopy was observed in 43.4%. One patient developed hematemesis six hours after Hemospray® application and underwent emergency endoscopic band ligation. No major adverse events or mortalities were observed during 15-day follow-up. Conclusion Hemospray® application was safe and effective at short-term follow-up for emergency treatment of AVB in cirrhotic patients.
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640615570148
      Issue No: Vol. 3, No. 3 (2015)
  • Application of the Barcelona Clinic Liver Cancer therapeutic strategy and
           impact on survival
    • Authors: Hernandez-Guerra, M; Hernandez-Camba, A, Turnes, J, Ramos, L. M, Arranz, L, Mera, J, Crespo, J, Quintero, E.
      Pages: 284 - 293
      Abstract: Background The Barcelona Clinic Liver Cancer (BCLC) classification of hepatocellular carcinoma (HCC) has proved useful in the management of HCC patients. However, BCLC-recommended first-line treatment is not always applicable in clinical practice. Objective We performed a multicentre retrospective analysis of reasons for deviation from first-line treatment in 2008–2012. Methods One to three-year survival data were analysed using Kaplan-Meier method. Results A total of 407 consecutive HCC patients (66.6 ± 3 years, 83% male) with cirrhosis were included. Tumours were detected during surveillance in 53% of patients, grouped as Child-Pugh A (67%), B (25%) and C (8%); and BCLC A (including stage 0, 44%), B (26%), C (15%) and D (15%). In 31% of patients, first-line treatment was not feasible (51% in early stages) due to: technical reasons (74%); patient non-conformity (20%); medical decision (3%); and disease progression (3%). One to three-year survival of patients not receiving the recommended first-line treatment was similar to that of patients treated according to BCLC recommendations (log-rank, p = 0.229). Conclusion In real-life practice one-third of HCC patients could not receive first-line BCLC treatment. In our cohort of patients, similar short and medium-term survival was observed. Long-term prospective studies are required to determine the best alternative treatment option when BCLC first-line treatment is not feasible.
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640615575971
      Issue No: Vol. 3, No. 3 (2015)
  • Effects of vitamin D supplementation on intestinal permeability,
           cathelicidin and disease markers in Crohn's disease: Results from a
           randomised double-blind placebo-controlled study
    • Authors: Raftery, T; Martineau, A. R, Greiller, C. L, Ghosh, S, McNamara, D, Bennett, K, Meddings, J, O'Sullivan, M.
      Pages: 294 - 302
      Abstract: Background Vitamin D (vitD) supplementation may prolong remission in Crohn’s disease (CD); however, the clinical efficacy and mechanisms are unclear. Aim To determine changes in intestinal permeability (IP), antimicrobial peptide (AMP) concentrations and disease markers in CD, in response to vitD supplementation. Methods In a double-blind randomised placebo-controlled study, we assigned 27 CD patients in remission to 2000 IU/day vitD or placebo for 3 mos. We determined IP, plasma cathelicidin (LL-37 in ng/mL), human-beta-defensin-2 (hBD2 in pg/mL), disease activity (Crohn’s Disease Activity Index (CDAI)), C-reactive protein (CRP in mg/L), fecal calprotectin (µg/g), Quality of Life (QoL) and serum 25-hydroxyvitamin D (25(OH)D in nmol/L) at 0 and 3 mos. Results At 3 mos., 25(OH)D concentrations were significantly higher in those whom were treated (p < 0.001). Intra-group analysis showed increased LL-37 concentrations (p = 0.050) and maintenance of IP measures in the treated group. In contrast, in the placebo group, the small bowel (p = 0.018) and gastro-duodenal permeability (p = 0.030) increased from baseline. At 3 mos., patients with 25(OH)D ≥ 75 nmol/L had significantly lower CRP (p = 0.019), higher QoL (p = 0.037), higher LL-37 concentrations (p < 0.001) and non-significantly lower CDAI scores (p = 0.082), compared to those with levels
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640615572176
      Issue No: Vol. 3, No. 3 (2015)
  • Scientific highlights at UEG Week 2015 in Barcelona
    • Pages: 303 - 304
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640615587998
      Issue No: Vol. 3, No. 3 (2015)
  • My experience with UEG classroom courses - a personal account from a
    • Pages: 307 - 307
      PubDate: 2015-06-09T03:49:41-07:00
      DOI: 10.1177/2050640615588001
      Issue No: Vol. 3, No. 3 (2015)
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