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Journal Cover United European Gastroenterology Journal
  [2 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  [838 journals]
  • Crohns disease and skin
    • Authors: Gravina, A; Federico, A, Ruocco, E, Lo Schiavo, A, Romano, F, Miranda, A, Sgambato, D, Dallio, M, Ruocco, V, Loguercio, C, Romano, M.
      Pages: 165 - 171
      Abstract: Crohn’s disease is a chronic inflammatory bowel disease potentially involving any segment of the gastrointestinal tract. Extra-intestinal manifestations may occur in 6%–40% of patients, and disorders of the skin are among the most common. This manuscript will review skin manifestations associated to Crohn’s disease, with a particular focus on lesions associated to anti-tumour necrosis factor therapy.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615597835
      Issue No: Vol. 4, No. 2 (2016)
  • Reporting systems in gastrointestinal endoscopy: Requirements and
           standards facilitating quality improvement: European Society of
           Gastrointestinal Endoscopy position statement
    • Pages: 172 - 176
      Abstract: To develop standards for high quality of gastrointestinal endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all gastrointestinal endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE’s viewpoints on requirements for high-quality endoscopy reporting systems. The following recommendations are issued:
      Endoscopy reporting systems must be electronic.
      Endoscopy reporting systems should be integrated into hospital patient record systems.
      Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources.
      Endoscopy reporting systems shall restrict the use of free text entry to a minimum, and be based mainly on structured data entry.
      Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated.
      Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically.
      Endoscopy reporting systems shall enable the inclusion of information on histopathology of detected lesions; patient’s satisfaction; adverse events; surveillance recommendations.
      Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format.
      Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees.
      Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640616629079
      Issue No: Vol. 4, No. 2 (2016)
  • Influence of reflux and central obesity on intercellular space diameter of
           esophageal squamous epithelium
    • Authors: Blevins, C. H; Sharma, A. N, Johnson, M. L, Geno, D, Gupta, M, Bharucha, A. E, Katzka, D. A, Iyer, P. G.
      Pages: 177 - 183
      Abstract: Background While central obesity increases gastroesophageal reflux (GER) by mechanically disrupting the anti-reflux barrier, limited data exist on pathways by which central obesity may potentiate esophageal injury by non-mechanical means. Obesity has been associated with an impaired epithelial intestinal barrier. Objective We aimed to assess the influence of central obesity and reflux on the squamous esophageal epithelial intercellular space diameter (ICSD). Methods The ICSD was measured using electron microscopy in esophageal biopsies from individuals who underwent ambulatory pH monitoring and endoscopy. Anthropometric measurements were obtained on all participants. Participants were classified into four groups: with and without central obesity and reflux. Results Sixteen individuals were studied with four in each study group. The mean ICSD was almost three-fold greater (p < 0.001) in the group with central obesity without reflux, compared to controls without central obesity and reflux. It was also comparable to the ICSD in groups with acid reflux only and those with both reflux and central obesity. Conclusions There is evidence of esophageal squamous ICSD increase in individuals with central obesity who do not have evidence of acid and nonacid reflux on ambulatory pH monitoring. This may reflect a mechanism by which central obesity potentiates reflux-induced esophageal injury and inflammation.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615598426
      Issue No: Vol. 4, No. 2 (2016)
  • Nickel sensitization in patients with gastro-esophageal reflux disease
    • Authors: Stanghellini, V; Tosetti, C, Benedetto, E, Condoluci, M, De Bastiani, R, Cogliandro, R, Mastronuzzi, T, De Polo, M, Di Mita, F, Napoli, L, Ubaldi, E, Nebiacolombo, C, Cottone, C, Grattagliano, I, Zamparella, M, Baldi, E, Sanna, G.
      Pages: 184 - 190
      Abstract: Background Gastro-esophageal reflux disease (GERD) leads to frequent medical visits, and available therapies fail in up to 40% of patients. Food allergies may be involved in GERD pathogenesis; however, allergens other than food have received little attention. Nickel allergy is common in the general population and some high-nickel foods are associated with GERD. However, the potential relationship between nickel allergy and GERD remains unaddressed. Aim This study aimed to evaluate the prevalence of nickel sensitization in patients with and without GERD and to compare clinical and demographic features. Methods This prospective, multicenter study included 210 adult GERD patients and 140 patients without GERD who presented at the general practitioner. All GERD patients had undergone treatment with proton pump inhibitors and upper digestive endoscopy within the previous five years. Demographic and clinical data were collected by questionnaire and patients underwent a nickel patch allergy test. Results Patients with and without GERD presented similar characteristics, with the exception of nickel sensitization, which was significantly more prevalent among GERD patients than controls (39.5% vs. 16.4%; p = 0.001). Nickel-positive GERD patients were more frequently female (90.4% vs. 65.4%, p = 0.003) and asthmatic (18.1% vs. 4.7%; p = 0.038), compared to nickel-negative GERD patients. At six-month follow-up, most of the patients, with or without nickel sensitization, reported improved symptoms without differences in drug prescription. Conclusion Nickel sensitization is particularly prevalent in GERD patients seen in general practice. Whether allergies other than food allergy play a role in GERD remains to be elucidated.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615595917
      Issue No: Vol. 4, No. 2 (2016)
  • Sleep disturbance due to heartburn and regurgitation is common in patients
           with functional dyspepsia
    • Authors: Vakil, N; Wernersson, B, Wissmar, J, Dent, J.
      Pages: 191 - 198
      Abstract: Background Reflux symptoms (heartburn and regurgitation) are common in patients with functional dyspepsia who do not have gastroesophageal reflux disease (GERD). Objective The purpose of this study was to assess the relationship of reflux symptoms with sleep disturbances in patients with functional dyspepsia without GERD and in those with GERD. Methods This post-hoc analysis of data from the Diamond study (NCT00291746) included patients with frequent upper gastrointestinal symptoms, of whom 137 had functional dyspepsia and 193 had GERD (diagnosed by endoscopy and pH monitoring). Patients completed symptom questionnaires and were interviewed by physicians. Results During the seven nights before study entry, 46.0% of patients with functional dyspepsia and 64.8% of those with GERD reported sleep disturbances (any frequency) related to reflux symptoms. Frequent (often/every night) sleep disturbances were experienced by 12.4% of patients with functional dyspepsia and 24.9% of those with GERD (p = 0.005). Among patients with functional dyspepsia, the prevalence of sleep disturbances was highest in those whose heartburn and/or regurgitation were moderate to severe (vs mild/very mild) and frequent (4–7 vs 1–3 days/week). Conclusions Sleep disturbances due to reflux symptoms are common in patients with functional dyspepsia who do not have GERD, and become more frequent with increasing reflux symptom severity and frequency.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615599716
      Issue No: Vol. 4, No. 2 (2016)
  • A delayed onset of bowel activity after the start of conventional
           polyethylene glycol predicts inadequate colon cleansing before
           colonoscopy: A prospective observational study
    • Authors: Papastergiou, V; Papasavvas, S, Mathou, N, Giannakopoulos, A, Evgenidi, A, Karagiannis, J. A, Paraskeva, K. D.
      Pages: 199 - 206
      Abstract: Background Evaluation of factors correlating with the quality of bowel preparation (QBP) is critical to ensure high-quality colonoscopy. Objectives We sought to determine whether the time interval between the start of conventional polyethylene glycol (PEG) ingestion and the onset of bowel activity is predictive of QBP. Methods Consecutive adult outpatients attending colonoscopy were prospectively assessed. Data including demographics, medical history, time of starting/completion of PEG and time when bowel activity started were recorded. The QBP was assessed according to the Ottawa bowel preparation score (OBPS); inadequate QBP was OBPS ≥7. Results A total of 171 patients (92 males, mean age: 60.5 years) complying with preparation instructions were included. The median OBPS was 5 (range: 1–13) and 57 (33.3%) had inadequate QBP. The median interval between the initiation of PEG and the onset of bowel activity was 60 min (range: 9–300 min). Patients (n = 52, 30.4%) with a delayed (>90 min) onset of bowel activity had poorer QBP (p = 0.0001). In multivariate analysis, male gender (OR: 2.38, p = 0.03), the interval between the end of preparation and the start of colonoscopy (OR: 1.94, p = 0.02) and time to onset of bowel activity >90 min (OR: 3.38, p = 0.004) were predictive of inadequate QBP. Conclusion The time interval between the initiation of PEG ingestion and the onset of bowel activity is predictive of the QBP. Our data support "on demand" intensification of bowel preparation in patients with a delayed onset of purgative response to PEG.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615608572
      Issue No: Vol. 4, No. 2 (2016)
  • Endoscopic submucosal dissection for early Barretts neoplasia
    • Authors: Barret, M; Cao, D. T, Beuvon, F, Leblanc, S, Terris, B, Camus, M, Coriat, R, Chaussade, S, Prat, F.
      Pages: 207 - 215
      Abstract: Introduction The possible benefit of endoscopic submucosal dissection (ESD) for early neoplasia arising in Barrett’s esophagus remains controversial. We aimed to assess the efficacy and safety of ESD for the treatment of early Barrett’s neoplasia. Methods All consecutive patients undergoing ESD for the resection of a visible lesion in a Barrett’s esophagus, either suspicious of submucosal infiltration or exceeding 10 mm in size, between February 2012 and January 2015 were prospectively included. The primary endpoint was the rate of curative resection of carcinoma, defined as histologically complete resection of adenocarcinomas without poor histoprognostic factors. Results Thirty-five patients (36 lesions) with a mean age of 66.2 ± 12 years, a mean ASA score of 2.1 ± 0.7, and a mean C4M6 Barrett’s segment were included. The mean procedure time was 191 ± 79 mn, and the mean size of the resected specimen was 51.3 ± 23 mm. En bloc resection rate was 89%. Lesions were 12 ± 15 mm in size, and 81% (29/36) were invasive adenocarcinomas, six of which with submucosal invasion. Although R0 resection of carcinoma was 72.4%, the curative resection rate was 66% (19/29). After a mean follow-up of 12.9 ± 9 months, 16 (45.7%) patients had required additional treatment, among whom nine underwent surgical resection, and seven further endoscopic treatments. Metachronous lesions or recurrence of cancer developed during the follow-up period in 17.2% of the patients. The overall complication rate was 16.7%, including 8.3% perforations, all conservatively managed, and no bleeding. The 30-day mortality was 0%. Conclusion In this early experience, ESD yielded a moderate curative resection rate in Barrett’s neoplasia. At present, improvements are needed if ESD is to replace piecemeal endoscopic mucosal resection in the management of Barrett’s neoplasia.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615608748
      Issue No: Vol. 4, No. 2 (2016)
  • Lack of interference between small bowel capsule endoscopy and implantable
           cardiac defibrillators: an 'in vivo electrophysiological study
    • Authors: Moneghini, D; Lipari, A, Missale, G, Minelli, L, Cengia, G, Bontempi, L, Curnis, A, Cestari, R.
      Pages: 216 - 220
      Abstract: Background Capsule endoscopy is a widely performed procedure for small bowel investigation. Once swallowed by the patient, the capsule transmits images to an external recorder over a digital radiofrequency communication channel. Potential electromagnetic interferences with implantable cardiac devices have been postulated. Clinical studies on the safety of capsule endoscopy in patients with cardiac defibrillators are lacking. Objective The aim of this study was to assess potential mutual electromagnetic interferences between capsule and defibrillators. Methods This study used the Given M2A video capsule system. Ten different types of defibrillators were tested in a clinical setting. Before capsule ingestion, defibrillator electrical therapies were switched off. During capsule endoscopy patients were monitored with cardiac telemetry. At the end of capsule endoscopy the following defibrillator’s parameters were analysed: change in device settings; inappropriate shocks; inappropriate anti-tachycardia therapy; inappropriate sensing or pacing; noise detection; device reset; programming changes; permanent electrical damages. Any technical problem related to capsule image transmission was recorded. Results Neither defibrillator malfunction nor interference in sensing or pacing was recorded; conversely, no capsule malfunction potentially caused by defibrillators was registered. Conclusion Our results suggest that capsule endoscopy can be safely performed in patients with cardiac defibrillators.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615608570
      Issue No: Vol. 4, No. 2 (2016)
  • In vitro fertilization-induced pregnancies predispose to gastroesophageal
           reflux disease
    • Authors: Turan, I; Kitapcioglu, G, Tavmergen Goker, E, Sahin, G, Bor, S, for the Ege Reflux Study Group
      Pages: 221 - 228
      Abstract: Background Women conceiving following in vitro fertilization (IVF) likely have a variety of risk factors that predispose them to gastroesophageal reflux disease (GERD) in the future. Objective We aimed to investigate whether pregnancy through IVF may predispose to subsequent GERD compared with pregnancies without IVF. We also evaluate whether twin IVF pregnancies lead to additional risk for having GERD compared with singleton IVF pregnancies. Methods A validated reflux questionnaire was administered to 156 women with singleton (n = 102) or twin (n = 54) IVF birth (IVF group) and 111 women with a naturally conceived singleton birth (control group). All women included in the study were primiparas who had given birth at least 1 year prior to data collection. The diagnosis of GERD was based on the occurrence of typical symptoms (heartburn, regurgitation, or both) at least once a week. Results The prevalence of GERD was 13.5% and 4.5% in IVF and control groups (p = 0.015); in the IVF group, this was slightly higher, but not statistically significant, in women with twin compared with singleton pregnancies (14.8% vs. 12.7%, p = 0.749). Logistic regression analysis showed that IVF was strongly associated with subsequent GERD (OR, 3.30; 95% CI 1.20–9.04; p = 0.02). Conclusion The risk of developing GERD at least 1 year after delivery increased following IVF. Long-term follow-up studies are required to determine whether therapy during pregnancy can prevent this risk.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615597836
      Issue No: Vol. 4, No. 2 (2016)
  • Prevalence of severe esophagitis in Spain. Results of the PRESS study
           (Prevalence and Risk factors for Esophagitis in Spain: A cross-sectional
    • Authors: Pique, N; Ponce, M, Garrigues, V, Rodrigo, L, Calvo, F, de Argila, C. M, Borda, F, Naranjo, A, Alcedo, J, Jose Soria, M, Rey, E, Bujanda, L, Gisbert, J. P, Suarez, D, Calvet, X, Ponce, J, on behalf of the PRESS Study Group
      Pages: 229 - 235
      Abstract: Background The current prevalence of esophagitis in southern Europe is unknown. In addition, the risk factors for reflux esophagitis are not fully understood. Objective The objective of this article is to assess the prevalence and risk factors for esophagitis in Spain. Methods A prospective, observational, cross-sectional, multicenter study (PRESS study) was conducted among 31 gastrointestinal endoscopy units throughout Spain. A total of 1361 patients undergoing upper gastrointestinal endoscopy were enrolled. Sociodemographic, clinical and treatment data were recorded. Results A total of 95% of patients were Caucasian and 52% were male (mean age: 53 ± 17 years). The most frequent symptoms prompting endoscopy were heartburn (40%), regurgitation (26%) and dysphagia (15%). Fifty-four percent of patients undergoing endoscopy were receiving proton pump inhibitor (PPI) treatment. Esophagitis (mainly mild-moderate) was present in 154 (12.4%) patients. The severe form was recorded in only 11 (0.8%) patients. Multivariate analysis results indicated that the likelihood of esophagitis was higher in men (OR = 1.91, 95% CI = 1.31–2.78), in patients with high GERD-Q scores (OR = 1.256, 95% CI = 1.176–1.343), weight increase (OR = 1.014, 95% CI = 1.003–1.025) and high alcohol consumption (OR = 2.49, 95% CI = 1.16–5.36). Conclusion Severe esophagitis is a rare finding in the Spanish population. Male gender, high GERD-Q score, weight increase and high alcohol consumption are main risk factors for its appearance.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615595916
      Issue No: Vol. 4, No. 2 (2016)
  • Effectiveness of focal vs. balloon radiofrequency ablation devices in the
           treatment of Barretts esophagus
    • Authors: Brown, J; Alsop, B, Gupta, N, Buckles, D. C, Olyaee, M. S, Vennalaganti, P, Kanakadandi, V. N, Saligram, S, Sharma, P.
      Pages: 236 - 241
      Abstract: Background and aims The safety and efficacy of radiofrequency ablation (RFA) in treatment of Barrett’s esophagus (BE)-associated dysplasia has been well established. The effectiveness of focal and balloon RFA devices has not been compared. Therefore, the aim of our study was to assess the effectiveness of focal and balloon RFA devices in the treatment of BE by calculating absolute and percentage change in BE length with RFA therapy by comparing pre- and post-treatment BE length. Patients and methods This is a retrospective cross-sectional study of patients who underwent at least one treatment with either focal and/or balloon RFA devices who were identified from two tertiary centers. Patients’ demographics, hiatal hernia, pre- and post-treatment BE length, prior use of endoscopic therapies and number of sessions were recorded. Results Sixty-one patients who had undergone 161 RFA treatment sessions met inclusion criteria. There was no significant difference in percentage change in BE length with greater number of RFA sessions. RFA with a focal device resulted in greater percentage reduction in BE length compared to the balloon system (73% vs. 39%, p < 0.01). After adjusting for initial BE length, pre-treatment BE length, hernia status, prior endoscopic mucosal resection (EMR), prior RFA, and prior EMR/RFA sessions, RFA with a focal device at each session remained an independent predictor for a significant reduction in BE extent as compared to the balloon system. Conclusion The focal RFA device alone was more effective in treatment of BE compared to the balloon system, with a greater reduction in extent of BE. The focal RFA device for endoscopic eradication therapy of BE should be considered the preferred technique.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615594549
      Issue No: Vol. 4, No. 2 (2016)
  • Efficacy and safety of endoscopic submucosal dissection for elderly
           patients with superficial squamous esophageal neoplasms
    • Authors: Peng, C; Shen, S, Xu, G, Lv, Y, Zhang, X, Ling, T, Wang, L, Ding, X, Zou, X.
      Pages: 242 - 249
      Abstract: Background Little is known about the outcomes of endoscopic submucosal dissection in elderly patients with superficial squamous esophageal neoplasms. Objective To assess the efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasms in elderly patients (≥65 years) compared with non-elderly patients. Methods All patients with superficial squamous esophageal neoplasms receiving endoscopic submucosal dissection were retrospectively analyzed. Among them, 130 were aged 65 or older (group A), and 201 were aged younger than 65 years (group B). Therapeutic efficacy, adverse events, and follow-up data were evaluated. Results Group A had a higher prevalence of concomitant diseases than group B (52.3% vs. 14.9%, respectively). R0 resection rate was 82.3% in group A and 84.6 % in group B (P = 0.717). The curative resection rate was 80.8% in group A and 83.6% in group B (P = 0.653). The rate of procedure-related non-cardiopulmonary adverse events was 20.8% in group A and 16.9% in group B (P = 0.377). The incidence of cardiopulmonary adverse events during or after the procedure was 6.2% in group A and 2.5% in group B (P = 0.094). No procedure-related mortality was reported in either group. Conclusion Endoscopic submucosal dissection is effective and safe for treating superficial squamous esophageal neoplasms in elderly patients.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615604780
      Issue No: Vol. 4, No. 2 (2016)
  • Efficiency and safety of endoscopic resection in the management of
           subepithelial lesions of the stomach
    • Authors: Godat, S; Robert, M, Caillol, F, Bories, E, Pesenti, C, De Cassan, C, Ratone, J. P, Poizat, F, Giovannini, M.
      Pages: 250 - 256
      Abstract: Background Gastric subepithelial tumors represent a diagnostic and therapeutic challenge, given their histologic heterogeneity and potential malignant behavior. Objective The objective of this article is to evaluate the interest, efficiency and safety of endoscopic resection for subepithelial gastric lesions of size
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615604774
      Issue No: Vol. 4, No. 2 (2016)
  • CT texture analysis in colorectal liver metastases: A better way than size
           and volume measurements to assess response to chemotherapy'
    • Authors: Rao, S.-X; Lambregts, D. M, Schnerr, R. S, Beckers, R. C, Maas, M, Albarello, F, Riedl, R. G, Dejong, C. H, Martens, M. H, Heijnen, L. A, Backes, W. H, Beets, G. L, Zeng, M.-S, Beets-Tan, R. G.
      Pages: 257 - 263
      Abstract: Background Response Evaluation Criteria In Solid Tumors (RECIST) are known to have limitations in assessing the response of colorectal liver metastases (CRLMs) to chemotherapy. Objective The objective of this article is to compare CT texture analysis to RECIST-based size measurements and tumor volumetry for response assessment of CRLMs to chemotherapy. Methods Twenty-one patients with CRLMs underwent CT pre- and post-chemotherapy. Texture parameters mean intensity (M), entropy (E) and uniformity (U) were assessed for the largest metastatic lesion using different filter values (0.0 = no/0.5 = fine/1.5 = medium/2.5 = coarse filtration). Total volume (cm3) of all metastatic lesions and the largest size of one to two lesions (according to RECIST 1.1) were determined. Potential predictive parameters to differentiate good responders (n = 9; histological TRG 1–2) from poor responders (n = 12; TRG 3–5) were identified by univariable logistic regression analysis and subsequently tested in multivariable logistic regression analysis. Diagnostic odds ratios were recorded. Results The best predictive texture parameters were uniformity and entropy (without filtration). Odds ratios for uniformity and entropy in the multivariable analyses were 0.95 and 1.34, respectively. Pre- and post-treatment texture parameters, as well as the various size and volume measures, were not significant predictors. Odds ratios for size and volume in the univariable logistic regression were 1.08 and 1.05, respectively. Conclusions Relative differences in CT texture occurring after treatment hold promise to assess the pathologic response to chemotherapy in patients with CRLMs and may be better predictors of response than changes in lesion size or volume.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615601603
      Issue No: Vol. 4, No. 2 (2016)
  • Multicenter survey on the use of device-assisted enteroscopy in Portugal
    • Authors: Pinho, R; Mascarenhas-Saraiva, M, Mao-de-Ferro, S, Ferreira, S, Almeida, N, Figueiredo, P, Rodrigues, A, Cardoso, H, Marques, M, Rosa, B, Cotter, J, Vilas-Boas, G, Cardoso, C, Salgado, M, Marcos-Pinto, R.
      Pages: 264 - 274
      Abstract: Background Device-assisted enteroscopies (DAEs) are recent endoscopic techniques that enable direct endoscopic small-bowel evaluation. Objective The objective of this article is to evaluate the implementation of DAEs in Portugal and assess the main indications, diagnoses, diagnostic yield, therapeutic yield and complication rate. Methods We conducted a multicenter retrospective series using a national Web-based survey on behalf of the Portuguese Small-Bowel Study Group. Participants were asked to fill out two online databases regarding procedural data, indications, diagnoses, endoscopic therapy and complications using prospectively collected institutional data records. Results A total of eight centers were enrolled in the survey, corresponding to 1411 DAEs. The most frequent indications were obscure gastrointestinal bleeding (OGIB), inflammatory bowel disease and small-bowel tumors. The pooled diagnostic yield was 63%. A relation between the diagnostic yield and the indications was clear, with a diagnostic yield for OGIB of 69% (p = 0.02) with a 52% therapeutic yield. Complications occurred in 1.2%, with a major complication rate of 0.57%. Perforations occurred in four patients (0.28%). Conclusion DAEs are safe and effective procedures, with complication rates of 1.2%, the most serious of which is perforation. Most procedures are performed in the setting of OGIB. Diagnostic and therapeutic yields are dependent on the indication, hence appropriate patient selection is crucial.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615604775
      Issue No: Vol. 4, No. 2 (2016)
  • Short-term prognosis of potential celiac disease in Indian patients
    • Authors: Kondala, R; Puri, A. S, Banka, A. K, Sachdeva, S, Sakhuja, P.
      Pages: 275 - 280
      Abstract: Background Progression of potential celiac disease (PCD) to overt celiac disease (CD) has been described in some studies from the Western Hemisphere. There are no Asian data on this aspect of CD. Objective We aimed to study the short-term histological course of PCD in Indian patients. Methods Patients with PCD were prospectively identified by screening relatives of patients with CD, the diarrheal subtype of irritable bowel syndrome (IBS-D) and patients with iron deficiency anemia (IDA). Patients with serology that was positive for immunoglobulin A antibodies against tissue transglutaminase (IgA anti-tTG) were subjected to endoscopy with duodenal biopsy. PCD was defined as a Marsh-0 to Marsh-II lesion on duodenal biopsy, along with positive IgA tTG serology. Retesting for serology and histology was done at 6-month intervals, for 12 months. Results: We diagnosed 57 patients (23 male) of mean age 28.7 years (range: 4–73 yrs) as having PCD. Of these 57 patients, 28 were identified by screening 192 first-degree relatives of 55 index cases of CD, while the remaining 29 had either IBS-D or IDA. Duodenal biopsy showed Marsh-0, Marsh-I and Marsh-II changes in 28, 27 and 2 patients, respectively. At 6 months, 12 patients became seronegative. The remaining 45 patients continued to be seropositive at the 12-month time point. Histological progression to Marsh-III occurred in only four patients, while progression from Marsh-0 to either Marsh-I or Marsh-II occurred in six patients and one patient, respectively; but 14 patients with Marsh-I did show regression to Marsh-0. Of the two patients who were initially Marsh-II, one remained so upon follow up and one showed regression to Marsh-0. Conclusions Our data suggested that despite the fact that nearly 80% of the patients diagnosed to have PCD continue to remain seropositive for tTG 12 months later, histological progression to Marsh-III occurred in only 7% of patients over the same time period. These observations do not justify starting a gluten-free diet in all patients with PCD, in India.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615594935
      Issue No: Vol. 4, No. 2 (2016)
  • Risk factors for complications in patients with ulcerative colitis
    • Authors: Manser, C. N; Borovicka, J, Seibold, F, Vavricka, S. R, Lakatos, P. L, Fried, M, Rogler, G, the investigators of the Swiss Inflammatory Bowel Disease Cohort Study
      Pages: 281 - 287
      Abstract: Background Patients with ulcerative colitis may develop extraintestinal manifestations like erythema nodosum or primary sclerosing cholangitis or extraintestinal complications like anaemia, malabsorption or they may have to undergo surgery. Objective The aim of this study was to investigate potential risk factors for complications like anaemia, malabsorption or surgery in ulcerative colitis. Methods Data on 179 patients with ulcerative colitis were retrieved from our cross-sectional and prospective Swiss Inflammatory Bowel Disease Cohort Study data base for a median observational time of 4.2 years. Data were compared between patients with (n = 140) or without (n = 39) complications. Gender, age at diagnosis, smoking status, disease extent, delay of diagnosis or therapy, mesalamine (5-ASA) systemic and topical therapy, as well as other medication were analysed as potential impact factors. Results In the multivariate regression analysis a delay of 5-ASA treatment by at least two months (odds ratio (OR) 6.21 (95% confidence interval (CI) 2.13–18.14), p = 0.001) as well as a delay with other medication with thiopurines (OR 6.48 (95% CI 2.01–20.91), p = 0.002) were associated with a higher risk for complications. This significant impact of a delay of 5-ASA therapy was demonstrated for extraintestinal manifestations (EIMs) as well as extraintestinal complications (EICs). Extensive disease as well as therapy with methotrexate showed a significantly increased risk for surgery (extensive disease: OR 2.62 (1.02–6.73), p = 0.05, methotrexate: OR 5.36 (1.64–17.58), p = 0.006). Conclusions A delay of 5-ASA therapy of more than two months in the early stage of ulcerative colitis (UC) constitutes a risk for complications during disease course. Extensive disease is associated with a higher risk for surgery.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615627533
      Issue No: Vol. 4, No. 2 (2016)
  • Sporadic colorectal cancer: Studying ways to an end
    • Authors: Rosa, I; Fidalgo, P, Filipe, B, Albuquerque, C, Fonseca, R, Chaves, P, Pereira, A. D.
      Pages: 288 - 296
      Abstract: Introduction Although colorectal cancer (CRC) has often been regarded as a single entity, different pathways may lead to macroscopically similar cancers. These pathways may evolve into a patchy colonic field defect that we aimed to study in consecutive CRC patients. Methods In a single-center, observational, prospective study, consecutive CRC patients were included if surgery and a perioperative colonoscopy were planned. Personal and familial history data were collected. Tumors were studied for microsatellite instability (MSI) status, DNA repair protein expression (DRPE) and presence of BRAF and/or APC mutations. Macroscopically normal mucosa samples were tested for APC mutations. Presence and location of synchronous and metachronous adenomas and patient follow-up were analyzed. The association of two categorical variables was tested through the Fisher’s exact test (SPSS 19). Results Twenty-four patients (12 male, mean age 69 years) were studied. High-grade MSI (MSI-H) was found in eight tumors—these were significantly more common in the right colon (p = 0.047) and more likely to have an altered DRPE (p = 0.007). BRAF mutation was found in two of six tested MSI-H tumors. APC gene mutations were found in nine of 16 non-MSI-H tumors and absent in normal mucosa samples. There was a nonsignificant co-localization of CRC and synchronous adenomas and a significant co-localization (p = 0.05) of synchronous and metachronous adenomas. Discussion Sporadic CRCs evolve through distinct pathways, evidenced only by pathological and molecular analysis, but clinically relevant both for patients and their families. In non-MSI-H tumors, the expected APC gene mutations were not detected by the most commonly used techniques in a high number of cases. More studies are needed to fully characterize these tumors and to search for common early events in normal mucosa patches, which might explain the indirect evidence found here for a field defect in the colon.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615599329
      Issue No: Vol. 4, No. 2 (2016)
  • Acute abdominal pain in the emergency department of a university hospital
           in Italy
    • Authors: Caporale, N; Morselli-Labate, A. M, Nardi, E, Cogliandro, R, Cavazza, M, Stanghellini, V.
      Pages: 297 - 304
      Abstract: Background Acute abdominal pain (AAP) is one of the most common causes of referral to an emergency department (ED), but information about its impact is limited. Objectives The objectives of this article are to define the prevalence of AAP among ED visits in a large university hospital and analyze its main clinical features. Methods All patients admitted at the Sant’Orsola, Malpighi University Hospital of Bologna ED on 12 a priori selected sample days in 2013 were included. General data were recorded for each patient. A total of 192 clinical variables were recorded for each patient with abdominal pain. Results During the observation period the ED assisted 2623 patients with a daily admission rate of 219 ± 20 (mean ± SD). Of these, 239 patients complained of AAP as their chief complaint at entry (prevalence = 9.1%). AAP prevalence was significantly higher in females than in males (10.4% vs. 7.8%; OR = 1.37; p = 0.021) as well as in foreign over Italian patients (13.2% vs. 8.5%; OR = 1.64; p = 0.007). The most frequent ED operative diagnoses were non-specific abdominal pain (n = 86, 36.0%) and gastrointestinal (GI) tract-related pain (n = 79, 33.1%; n = 19 upper GI, n = 60 lower GI). Conclusions AAP is a common cause of referral at EDs. Despite technological advances, non-specific abdominal pain is still the main operative diagnosis.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615606012
      Issue No: Vol. 4, No. 2 (2016)
  • Type 1 serrated polyposis represents a predominantly female disease with a
           high prevalence of dysplastic serrated adenomas, without germline mutation
           in MUTYH, APC, and PTEN genes
    • Authors: Petronio, M; Pinson, S, Walter, T, Joly, M.-O, Hervieu, V, Forestier, J, Saurin, J.-C.
      Pages: 305 - 313
      Abstract: Aim The aim of this article is to clarify the epidemiologic, clinical, endoscopic, biological and genetic characteristics of type 1 serrated polyposis patients. Patients and methods Consecutive patients responding to the WHO definition of type 1 serrated polyposis in one reference center for polyposis patients accepted genetic counseling. Detailed data on previous endoscopies, histology, and life habits were recorded, after informed consent, germline analysis of MUTYH, APC, and PTEN germline mutations. Molecular biology was tested on available fixed tissue from different lesion types. Results We included 29 patients (mean age 53.5 years, 21 women (72.4%)), four with a personal history of colorectal cancer (CRC), with a mean of 11.6 SSAs, with associated hyperplastic polyps in 93.1% and adenomas in 82.8%. SSAs showed no dysplasia in 46.9% of lesions (three of 29 patients), LGD in 51.9% (22/29 patients), and HGD in 1.2% (four of 29 patients). Dysplasia was more frequent in proximal SSAs and in women. Colectomy 15 patients (51.7%), upper digestive neoplasms: eight patients (27.5%); smokers: 24 patients (82.8%); family history of CRC: 16 patients (55.2%). Biology: MSI-H phenotype in one SSA, V600E BRAF mutation in 95% of SSAs; MGMT hypermethylation in three of 17 SSAs. No germline mutation was detected in MYH, APC or PTEN genes. Conclusion Type 1 serrated polyposis corresponds to a majority of women, with a high prevalence of smokers, a high prevalence of dysplastic serrated adenomas, particularly in females, without identified germline mutation in targeted predisposing genes.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615594939
      Issue No: Vol. 4, No. 2 (2016)
  • The burden of bowel preparations in patients undergoing elective
    • Authors: Sharara, A. I; El Reda, Z. D, Harb, A. H, Abou Fadel, C. G, Sarkis, F. S, Chalhoub, J. M, Abou Mrad, R.
      Pages: 314 - 318
      Abstract: Background An adequate bowel preparation is an important quality measure for optimal colonoscopy. Aims The aim of this article is to study the burden of bowel preparations by examining seven specific variables (hunger, taste, volume, sleep, social, work, and adverse events (AEs)). Methods Ambulatory patients undergoing elective colonoscopy completed a questionnaire regarding their experience with the prescribed preparation. The seven study variables were graded using a numerical scale of 0–10 (best to worst). A score >6 was considered to indicate a significant impact and used as primary outcome. Patients were also asked to grade in descending order what they perceived as the worst aspect of the preparation. Results A total of 216 patients completed the survey. Preparations consisted of split-dose sodium picosulfate (SPS) (n = 49), split-dose 4 l PEG ± menthol (n = 49), full-dose PEG (n = 68), and 2 l split-dose PEG + ascorbic acid (n = 50). Except for work and AEs, all variables were considered to have a negative impact by >20% of patients (range 20.4–34.2). SPS was superior to PEG regimens in taste (4.1% vs. 35.9%) and volume (0% vs. 44.9%) (p < 0.05 for both) but inferior for hunger (30.6% vs. 19.2%; p = 0.09). The addition of menthol to PEG significantly improved taste (22.4% vs. 41.5%; p = 0.02). Sleep disturbances were most common with SPS and least with split-dose PEG (30.6% vs. 17.4%; p < 0.05). Overall, patients ranked volume, taste, and hunger as most burdensome. Conclusions The burden of bowel preparation is substantial. An informed personalized choice of preparation may improve adherence, tolerability and colon cleansing.
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640615594550
      Issue No: Vol. 4, No. 2 (2016)
  • UEG E-learning: Education at your fingertips!
    • Authors: Wood; N.
      Pages: 319 - 319
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640616639519
      Issue No: Vol. 4, No. 2 (2016)
  • Young GI Angle: What makes for a good mentor'
    • Authors: Dotan, I; Burisch, J.
      Pages: 320 - 320
      PubDate: 2016-03-22T04:19:01-07:00
      DOI: 10.1177/2050640616639520
      Issue No: Vol. 4, No. 2 (2016)
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