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Small intestine contrast ultrasonography vs computed tomography enteroclysis for assessing ileal Crohn's disease.

AIM: To compare computed tomography enteroclysis (CTE) vs small intestine contrast ultrasonography (SICUS) for assessing small bowel lesions in Crohn's disease (CD), when using surgical pathology as gold standard. METHODS: From January 2007 to July 2008, 15 eligible patients undergoing elective resection of the distal ileum and coecum (or right colon) were prospectively enrolled. All patients were under follow-up. The study population included 6 males and 9 females, with a median age of 44 years (range: 18-80 years). INCLUSION CRITERIA: (1) certain diagnosis of small bowel requiring elective

Nutritional support teams increase percutaneous endoscopic gastrostomy uptake in motor neuron disease.

AIM: To examine factors influencing percutaneous endoscopic gastrostomy (PEG) uptake and outcomes in motor neuron disease (MND) in a tertiary care centre. METHODS: Case notes from all patients with a confirmed diagnosis of MND who had attended the clinic at the Repatriation General Hospital between January 2007 and January 2011 and who had since died, were audited. Data were extracted for demographics (age and gender), disease characteristics (date of onset, bulbar or peripheral predominance, complications), date and nature of discussion of gastrostomy insertion, nutritional status [weight me

[Video capsule endoscopy--preliminary experience in university hospital setting].

INTRODUCTION: The use of video capsule endoscopy (VCE) started in late 2001 when it was approved by the Food and Drug Administration (FDA). Since then, we are able to visualize small bowel mucosa with a minimally invasive technique, very comfortable for patients, with very few complications and without the need of hospitalization. At Dubrava University Hospital, we have been using VCE since October 2006, and by February 2008 we examined 30 patients. AIM: The aim of the study was to present our preliminary results in the use of VCE during a period of one year and five months. We also report in

AGA Clinical Practice Update on Management of Refractory Celiac Disease: Expert Review.

DESCRIPTION: The purpose of this expert review is to summarize the diagnosis and management of refractory celiac disease. It will review eva … nts with refractory celiac disease require regular follow-up by a multidisciplinary team, including gastroenterologists and dietitians, to assess clinical and histologic response to therapy. Identify local experts with expertise in celiac disease to assist with management. BEST PRACTICE ADVICE 10: Patients with refractory celiac disease without response to steroids m …

[Laparoscopic sacrocolpopexy for pelvic organ prolapse: guidelines for clinical practice].

INTRODUCTION: Open sacrocolpopexy have demonstrated its efficiency in surgical treatment of pelvic organ prolapse with an important backward … n reread and amended by an also multidisciplinary group of proofreaders (urologists, gynecologists, gastroenterologists and surgeons). The methodology follows at best the recommendations of the HAS with a scientific argument for every question (accompanied with the level of proof, NP) and the recommendations, the officers (In, B, C and agreement of experts) and valid …

Ileocaecal resection versus infliximab for ileal Crohn's disease: retrospective 10-year follow-up of the LIR!C trial.

BACKGROUND: The LIR!C trial showed that laparoscopic ileocaecal resection is an effective alternative to infliximab therapy with similar quality-of-life outcomes in patients with uncomplicated ileocaecal Crohn's disease who had not responded to conventional treatment. We aimed to assess the 10-year outcomes of participants in the trial, focusing on the long-term therapy-free and clinical remission rates of both interventions. METHODS: In this retrospective follow-up study, we included patients who participated in the LIR!C trial, a multicentre randomised controlled trial that compared ileocae

[Practical management of side effects of tyrosine kinase inhibitor therapy in chronic myeloid leukemia].

Összefoglaló. A krónikus myeloid leukaemia ritka, klonális őssejt eredetű betegség. A myeloid sejtsor kóros működését a 9-es és 22-es kromoszómák reciprok transzlokációja következtében kialakuló fúziós gén (BCR/ABL1) által kódolt patológiás (fokozott) aktivitású tirozin-kináz jelátviteli fehérje okozza. A tartós, gyakran élethosszig tartó BCR/ABL1 specifikus tirozin-kináz-gátló (TKI-) kezelés a betegek jelentős hányadában az egészséges populáció túlélését elérő teljes gyógyulást biztosít, melyhez folyamatos, a mindenkori szakmai ajánlásoknak megfelelő onkohematológiai ellenőrzés szükséges. Az

[When is it too early or too late for surgery in Crohn's disease? ].

The surgical boarding of Crohn's disease (CD) admitted as a last effort of treatment against behavior in those the therapy prescribes it has failed, it supposes a loss on perspective that can postpone the delay in the recovery of patients and it retracts them of a better quality of life when it is considered that 50% of patients maintain inactive illness during years after selected surgical procedures; some rate no reached by the most effective treatments. The risk to specify surgical procedure in the course of CD rises to 75% of payees, more than 50% in the first year from the diagnosis, and

AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review.

DESCRIPTION: The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update is to review the availabl … ngs of the quality of evidence or strength of the presented considerations. BEST PRACTICE ADVICE 1: Gastroenterologists should be aware of potential extraesophageal manifestations of gastroesophageal reflux disease (GERD) and should inquire about such disorders including laryngitis, chronic cough, asthma, and dental erosions in GERD patients to determine whether GERD …

Covered versus bare-metal stenting of the mesenteric arteries in patients with chronic mesenteric ischaemia (CoBaGI): a multicentre, patient-blinded and investigator-blinded, randomised controlled trial.

BACKGROUND: Mesenteric artery stenting with a bare-metal stent is the current treatment for atherosclerotic chronic mesenteric ischaemia. Lo … d and a consensus diagnosis of chronic mesenteric ischaemia was made by a multidisciplinary team of gastroenterologists, interventional radiologists, and vascular surgeons. Exclusion criteria were stenosis length of 25 mm or greater, stenosis caused by median arcuate ligament syndrome or vasculitis, contraindication for CT angiography, or previous target vessel revas …

Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children.

OBJECTIVE: Gastric acidity (GA) inhibitors, including histamine-2 receptor antagonists (H2 blockers) and proton pump inhibitors (PPIs), are … e conducted a multicenter, prospective study. METHODS: The study was performed by expert pediatric gastroenterologists from 4 pediatric gastroenterology centers. Children (aged 4-36 months) consecutively referred for common GERD-related symptoms (for example, regurgitation and vomiting, feeding problems, effortless vomiting, choking), from December 2003 to March 200 …

Persistent Increase in Serum Alkaline Phosphatase in a Patient with Monoclonal Gammopathy of Undefined Significance.

We report the finding of alkaline phosphatase-immunoglobulin complex (macro-alkaline phosphatase (macro-ALP)) in a patient with persistently increased ALP activity. The identification of macro-ALP is important to rule out pathological causes of increased ALP activity and to avoid unnecessary diagnostic investigation. The patient was subsequently diagnosed with vitamin D deficiency, gallstone pancreatitis, and monoclonal gammopathy of undefined significance (MGUS). Macro-ALP can coexist with disease that can increase serum ALP activity. We report, for the first time, a case of macro-ALP in a pa

Short-term anti-TNF therapy with surgical closure versus anti-TNF therapy alone for Crohn's perianal fistulas (PISA-II): long-term outcomes of an international, multicentre patient preference, randomised controlled trial.

BACKGROUND: The PISA-II trial showed that short-term anti-tumour necrosis factor (anti-TNF) therapy followed by surgical closure induces radiological healing of perianal fistulas in patients with Crohn's disease more frequently than anti-TNF therapy alone after 18 months. This study aimed to compare long-term outcomes of both treatment arms. METHODS: Follow-up data were collected from patients who participated in the PISA-II trial, an international patient preference randomised controlled trial. This multicentre trial was performed in nine hospitals in the Netherlands and one hospital in Ital

A comprehensive review and update on Crohn's disease.

The term inflammatory bowel disease (IBD) refers principally to two major categories of chronic relapsing inflammatory intestinal disorders: Crohn's disease (CD) and ulcerative colitis (UC). In the United States, it is currently estimated that about 1.5 million people suffer from IBD, causing considerable suffering, mortality and economic loss every year. Yet the cause of IBD is unknown, and until we understand more, prevention or cure will not be possible. There is a lot of variation in the incidence and prevalence of CD based on geographic region, environment, immigrant population, and ethni

Light Chain Amyloidosis: Patient Experience Survey from the Amyloidosis Research Consortium.

IntroductionInformation detailing the experience of patients with light chain (AL) amyloidosis is lacking. The primary aim of this study was to gather data on the patient experience to understand the challenges in diagnosis and to gain insight into barriers to accessing appropriate care.MethodsPatients with amyloidosis, family members, and caregivers were invited to participate in an online 16-question survey (available from January 29 to February 5, 2015). Participants with AL amyloidosis were sent an eight-question follow-up survey.ResultsThe initial survey was completed by 533 participants

Endoscopic and Histological Diagnosis of Gastrointestinal Amyloidosis: A Narrative Review.

Amyloidosis encompasses a diverse group of systemic and localised disorders defined by the extracellular accumulation of misfolded proteins, leading to progressive tissue damage and multiorgan dysfunction. Gastrointestinal (GI) involvement is common, yet diagnosis is frequently delayed because symptoms are non-specific and endoscopic findings are equivocal. Recent advances in endoscopic technique, biopsy site selection and advancements in processing of pathological specimens have substantially improved the diagnosis of this condition. Targeted gastrointestinal biopsy, performed during endoscop

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… Gastroenterologists and endoscopists play a central role in identifying suspicious endoscopic findings, obtaining standardised biopsies and communicating critical clinical information to pathologists and other specialists [ 41 ]. … Ultimately, the management of these patients necessitates a multidisciplinary approach between gastroenterologists, surgeons, pathologists, haematologists, cardiologists and radiologists. …

AGA Clinical Practice Update on Esophageal Dysfunction Due to Disordered Immunity and Infection: Expert Review.

METHODS: This expert review was commissioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice … ith dysphagia, heartburn, and odynophagia. Best Practice Advice Statements: BEST PRACTICE ADVICE 1: Gastroenterologists should be aware of the esophageal manifestations of systemic immunologic and infectious diseases to reduce diagnostic delay. Clinicians should identify if there are risks for inflammatory or infectious possibilities for a patient's esophageal sympto …

Treatment of chronic hepatitis B virus infection - Dutch national guidelines.

The development of this guideline was initiated and coordinated by the Netherlands Association of Gastroenterologists and Hepatologists (Nederlandse Vereniging van Maag-Darm-Leverartsen). The aim is the establishment of national standards in the evaluation and antiviral treatment of patients with chronic hepatitis B virus (HBV) infection. This includes recommendations on the initial evaluation of patients, choice and duration of antiviral therapy, follow-up after antiviral therapy and monitoring of patients not currently requiring antiviral therapy. The initial evaluation of chronic HBV-infect…

Recommendations for Optimal Endoscopic Localization of Colorectal Neoplasms: A Delphi Consensus of National Experts.

BACKGROUND: Colonoscopy is the standard of care for diagnosis and evaluation of colorectal cancers before surgery. However, varied practices … stablish consensus recommendations based on a literature review. PATIENTS: Colorectal surgeons and gastroenterologists from across Canada who had previously demonstrated leadership in endoscopy, managed large endoscopy programs, produced high-impact publications in the field of endoscopy, or participated in the development of endoscopy guidelines were selected to pa …

Inconsistent approaches of the G-BA regarding acceptance of primary study endpoints as being relevant to patients - an analysis of three disease areas: oncological, metabolic, and infectious diseases.

BackgroundPrevious evaluations of oncological medicines in the German early benefit assessment (EBA) procedure have demonstrated inconsistent acceptance of endpoints by regulatory authorities and the Federal Joint Committee (G-BA). Accepted standard endpoints for regulatory purposes are frequently not considered as patient-relevant in the German EBA system. In this study the acceptance of clinically acknowledged primary endpoints (PEPs) from regulatory trials in EBAs conducted by the G-BA was evaluated across three therapeutic areas.MethodsMedicines for oncological, metabolic and infectious di

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… test, ADO Working Group on Dermatological Oncology, AGO Working Group on Gynaecologic Oncology, AIO Working Group on Internal Oncology, ASIM Working Group on Congenital Metabolic Disorders in Internal Medicine, BDU Professional Association of German Urologists, bng Federal Association of Registered Gastroenterologists … test, ADO Working Group on Dermatological Oncology, AGO Working Group on Gynaecologic Oncology, AIO Working Group on Internal Oncology, ASIM Working Group on Congenital Metabolic Disorders in Internal Medicine, BDU Professional Association of German Urologists, bng Federal Association of Registered Gastroenterologists …