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Les derniers abstracts de la revue European Journal of Gastroenterology & Hepatology - Current Issue :

    Date de mise en ligne : Jeudi 01 janvier 1970
    Robak, Katarzyna; Zambonelli, Joanna; Bilinski, Jaroslaw; Basak, Grzegorz W.
    Diarrhea after allogeneic stem cell transplantation: beyond graft-versus-host disease
    imageDiarrhea constitutes a frequent and often debilitating complication of allogeneic hematopoietic cell transplantation (alloHCT). Especially when accompanied by jaundice, skin rash, and symptoms of the upper gastrointestinal tract, diarrhea strongly suggests emergence of acute graft-versus-host disease (GvHD), which is a serious immune complication of the procedure, with possible fatal consequences. However, especially when diarrhea occurs as an isolated symptom, the other causes must be excluded before initiation of GvHD treatment with immune-suppressive drugs. In this article, a broad overview of the literature of different causes of diarrhea in the setting of alloHCT is provided, revealing causes and presentations different from those observed in the general population. We discuss gastrointestinal GvHD with a special focus on biomarkers, but also uncover underlying infectious: viral, bacterial, and parasitic as well as toxic causes of diarrhea. Finally, we suggest a practical algorithm of approach to patients with diarrhea after alloHCT, which may help to establish a proper diagnosis and initiate a causative treatment.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Thönnes, Stefanie; Friedel, Heiko; Fröhlich, Heike
    The number of patients with chronic hepatitis C in times of new therapy options: a retrospective observational study on German health insurance funds data
    imageAim/Objectives/Background: Chronic hepatitis C (CHC) virus infection is a leading cause of liver-related morbidity and mortality. In Germany, as in many other countries, there is a lack of comprehensive epidemiological data. Routine data from sickness funds can support the estimation of the true prevalence and incidence of CHC. Methods: In this article, the results of annual and quarterly analyses of prevalence and incidence for the years 2007–2013 are presented using data of several German sickness funds. Results: Overall, the prevalence rate remained relatively stable at 0.2%, which is lower than the general assumption for Germany of 0.3%. Conclusion: We found that despite the introduction of the breakthrough designated triple therapies with telaprevir or boceprevir in 2011, there was no increase of prevalence or incidence between 2010 and 2011.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Chen, Dafan; Luo, Shengzheng; Ben, Qiwen; Lu, Lungen; Wan, Xinjian; Wu, Jianjiong
    Prevalence of hepatitis B and C and factors for infection and nonimmune in inflammatory bowel disease patients in China
    imageObjective: The aims of this study were to investigate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in inflammatory bowel disease (IBD) patients and the risk factors related to the infection and nonimmune status. Methods: A retrospective study was carried out at two clinical centers. The prevalence of viral markers and risk factors related to HBV and HCV infection and nonimmune status were analyzed in IBD patients. Age-matched and sex-matched healthy individuals were recruited as the controls. Results: A total of 980 IBD patients were included in this study. Present and past HBV infection was detected in 41.21% of the IBD group, which was higher than that in the general population (P=0.003). Age older than 30 years (P=0.000), ulcerative colitis (P=0.002), and previous surgery (P=0.039) were found to be significant risk factors for HBV infection in the multivariate analysis. 36.43% of the patients in the IBD group had nonimmune status against HBV, and age less than 40 years (P=0.011) and Crohn’s disease (P=0.002) were identified as independent risk factors in the multivariate analysis. The prevalence of HCV infection was low and similar to that of the general population. Conclusion: The prevalence of HBV infection in IBD patients in China was higher than that in Europe, USA, and the general population in China, but the prevalence of HCV infection in IBD patients was similar to that in the general population in this study. The frequency of nonimmune status against HBV was high, especially in young Crohn’s disease patients, and HBV vaccination should be intensified and have a targeted coverage.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Sourianarayanane, Achuthan; Talluri, Jyothsna; Humar, Abinav; McCullough, Arthur J.
    Stage of fibrosis and portal pressure correlation in nonalcoholic steatohepatitis
    imageBackground: Hepatic venous pressure gradient (HVPG) measurement correlates with staging of liver fibrosis. Patients with nonalcoholic steatohepatitis (NASH) have a different pattern of fibrosis compared with hepatitis C virus (HCV) with possible alterations in pressures. Aim: The aim of this study was to compare portal pressures with the stage of fibrosis in NASH in comparison with other liver diseases. Patients and methods: Records of all patients who had undergone transjugular liver biopsy with pressure measurements between January 2001 and June 2013 were reviewed. Wedge hepatic venous pressure (WHVP) and HVPG were compared with stages of fibrosis in liver diseases of different etiologies. Results: Among 142 patients included in this study, the liver disease etiology was as follows: HCV (26.6%) and NASH (24.6%), with the remaining (38.7%) grouped under other categories. The mean age of the patients was 51.2±11.5 years, with more men with HCV (73.1%) compared with NASH (51.4%) in terms of etiology (P=0.046). There were strong correlations between the stage of fibrosis with both the HVPG (r=0.64; P<0.0001) and the WHVP (r=0.63; P<0.0001) in NASH patients. Compared with HCV patients, NASH patients had a lower HVPG (3.4±2.4 vs. 7.5±11 mmHg/stage; P=0.01) with a coefficient estimate of −0.24 (P=0.017) and WHVP (9.6±5.5 vs. 14.6±15.2 mmHg/stage; P=0.03) for the stage of fibrosis. Conclusion: HVPG and WHVP measurements were strongly correlated with stages of fibrosis in NASH. Patients with NASH had lower HVPG and WHVP for each stage of fibrosis compared with HCV patients. This raises the concern of underestimation of pressures by HVPG in NASH etiology for the stage of disease or increased fibrosis despite lower pressures in them.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Pfeifer, Lukas; Adler, Werner; Zopf, Steffen; Siebler, Jürgen; Wildner, Dane; Goertz, Ruediger S.; Schellhaas, Barbara; Neurath, Markus F.; Strobel, Deike
    Acoustic radiation force impulse elastography: comparison and combination with other noninvasive tests for the diagnosis of compensated liver cirrhosis
    imageBackground and aims: The aim of this study was to compare acoustic radiation force impulse (ARFI) elastography with other noninvasive tests and to develop a new score for the assessment of liver fibrosis/cirrhosis. Materials and methods: B-mode ultrasound (including high-frequency liver surface evaluation), routine blood tests, ARFI quantification, and mini-laparoscopic liver evaluation were obtained in compensated patients scheduled for mini-laparoscopic biopsy. Our new cirrhosis score (CS) for the assessment of liver cirrhosis, based on a linear combination of ARFI, platelet (PLT), liver surface, and prothrombin index (PI), was calculated by linear discriminant analysis. Its performance was compared with ARFI-elastography, APRI, FIB-4, alanine aminotransferase (ALT)/aspartate aminotransferase (AST)-ratio, PLT, and PI. For the diagnosis of cirrhosis, a combined gold standard (cirrhosis at histology and/or at macroscopic liver evaluation) was used. Results: In total, 171 patients, of whom 38 had compensated cirrhosis, were included. The CS was significantly better for the diagnosis of cirrhosis compared with ARFI (P=0.028), APRI (P=0.012), PLTs (P=0.013), PI (P=0.025), and ALT/AST ratio (P=0.001), but not the FIB-4 score (P=0.207), with an area under the receiver operating characteristic curve of 0.92 [95% confidence interval (CI): 0.87–0.97], 0.86 (95% CI:0.79–0.93), 0.80 (95% CI: 0.72–0.87), 0.79 (95% CI: 0.7–0.87), 0.81 (95% CI: 0.73–0.89), 0.72 (95% CI:0.64–0.81), and 0.86 (95% CI: 0.8–0.93), respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for CS were 87%, 86%, 63%, and 96%, respectively. The FIB-4 score was significantly superior to the APRI score (P=0.041) and the ALT/AST ratio (P=0.011), with no significant difference from ARFI elastography (P=0.88) for the diagnosis of cirrhosis. Conclusion: Combining ARFI elastography with other noninvasive tests that are used routinely in the workup of patients with suspected liver disease can improve diagnostic accuracy for compensated liver cirrhosis as compared with ARFI elastography alone. The FIB-4 score showed an overall comparable diagnostic accuracy to ARFI-elastography for compensated cirrhosis.

    Date de mise en ligne : Jeudi 01 janvier 1970
    de Oliveira, Ana C.
    Short article: Noninvasive assessment of portal hypertension and detection of esophageal varices in cirrhosis: state-of-the-art
    Portal hypertension (PHT) is a major consequence of any chronic liver disease and it is the main cause of complications in patients with cirrhosis. Measurement of hepatic vein pressure gradient is considered the gold standard for PHT assessment, together with its diagnosis and prognosis relevance. Even though hepatic vein pressure gradient measurement is a safe procedure, it is still considered an invasive technique and not widely available. There is thus a need for noninvasive methods that can predict the progression of PHT as well as the presence and the risk of complications related to esophageal varices. This review aimed to discuss the noninvasive markers used in the assessment of PHT and detection of high-risk esophageal varices in patients with liver cirrhosis. We focus on the main biomarkers, particularly those used in the routine assessment of chronic liver disease, and the physical methods that use tissue elastography as a diagnosis tool.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Kerbert, Annarein J.C.; Schaapman, Jelte J.; van der Reijden, Johan J.; Amorós Navarro, Àlex; McCormick, Aiden; van Hoek, Bart; Arroyo, Vicente; Ginès, Pere; Jalan, Rajiv; Vargas, Victor; Stauber, Rudolf; Verspaget, Hein W.; Coenraad, Minneke J.; for the CANONIC Study Investigators of the EASL-CLIF Consortium
    Short article: Impact of genetic variation in the vasopressin 1a receptor on the development of organ failure in patients admitted for acute decompensation of liver cirrhosis
    imageBackground: Vasopressin receptor-mediated vasoconstriction is considered to be involved in the pathogenesis of organ failure in acute-on-chronic liver failure (ACLF). Patients and methods: We studied the association between six single nucleotide polymorphisms (SNPs) of the vasopressin 1a receptor gene and the development of organ failure in 826 patients admitted for acute decompensation of liver cirrhosis (n=641) or ACLF (n=185). Results: No associations were found for SNPs with the presence of circulatory or renal failure. A C>T mutation in SNP rs7308855 and a T>A mutation in SNP rs7298346 showed an association with the presence of coagulation failure in the entire population (n=61, P=0.024 and 0.060, respectively) and in the subgroup of patients with ACLF (n=44, P=0.081 and 0.056, respectively). Conclusion: Genetic variation in the vasopressin 1a receptor was found not to be associated with circulatory or renal failure, but with the presence of coagulation failure in patients with acute decompensation of liver cirrhosis and ACLF.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Solbach, Philipp; Höner zu Siederdissen, Christoph; Taubert, Richard; Ziegert, Szilvia; Port, Kerstin; Schneider, Andrea; Hueper, Katja; Manns, Michael P.; Wedemeyer, Heiner; Jaeckel, Elmar
    Home-based drainage of refractory ascites by a permanent-tunneled peritoneal catheter can safely replace large-volume paracentesis
    imageBackground and aim: Refractory ascites has a poor prognosis. Recurrent large-volume paracentesis is the current standard of care; however, it results in circulatory dysfunction and renal dysfunction, and hospitalization is commonly required. Transjugular intrahepatic portosystemic shunt placement is not an option in a substantial number of patients because of contraindications. The placement of a tunneled peritoneal drainage catheter has been shown to be effective in patients with malignant ascites. However, data in patients with nonmalignant refractory ascites are rare. Patients and methods: We followed 24 consecutive patients in whom tunneled peritoneal drainage catheters were placed in the Endoscopy Unit at Hannover Medical School between June 2013 and December 2014. Results: Catheters were placed in 24 patients with refractory ascites in end-stage liver disease and with a contraindication to transjugular intrahepatic portosystemic shunt placement. Placement was technically successful in all patients. The dosage of diuretics could be reduced significantly. The number of paracentesis decreased from 2.2±1 to 0 per week, although the volume of daily ascites removal remained stable (2 l). Despite frequent drainage of ascites, kidney function, serum sodium, and serum albumin remained stable. Seven adverse events occurred in six (25%) patients. Five patients listed for liver transplantation underwent successful transplantation without a negative impact. Conclusion: The tunneled peritoneal drainage catheter placement is a viable and effective treatment alternative in patients with refractory ascites because of end-stage liver disease, reducing diuretic intake and the need for paracentesis. The procedure avoids hyponatremia, worsening kidney function, and albumin infusions without an increased risk of spontaneous bacterial peritonitis.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Iino, Chikara; Shimoyama, Tadashi; Igarashi, Takasato; Aihara, Tomoyuki; Ishii, Kentaro; Sakamoto, Jyuichi; Tono, Hiroshi; Fukuda, Shinsaku
    Usefulness of the Glasgow–Blatchford score to predict 1-week mortality in patients with esophageal variceal bleeding
    imageObjectives: Esophageal variceal bleeding is one of the most severe complications of liver cirrhosis, with high mortality. However, there is no established scoring system for short-term mortality in patients with esophageal variceal bleeding. The aim of this study was to evaluate the usefulness of the Glasgow–Blatchford score (GBS), the Model for End-Stage Liver Disease (MELD) score, and the Child–Pugh score for predicting short-term and hospital mortality in patients with esophageal variceal bleeding. Methods: A total of 47 patients with esophageal variceal bleeding were studied between September 2009 and March 2015. The GBS, the MELD score, and the Child–Pugh score were assessed for their ability to predict 1- and 6-week mortality rates using a receiver operating characteristic curve. Results: The 1- and 6-week mortality rates were 17.0 and 31.9%, respectively. The median GBS, MELD, and Child–Pugh scores were 13 (range: 4–19), 10 (range: 0–34), and 9 (range: 5–13), respectively. The GBS was superior to both the MELD and the Child–Pugh scores for prediction of 1-week mortality [area under the curve=0.82 (95% confidence interval: 0.66–0.98) vs. 0.71 (0.47–0.96) and 0.72 (0.53–0.91)]. The MELD score was superior to both the Child–Pugh score and the GBS for prediction of 6-week mortality [area under the curve=0.83 (95% confidence interval: 0.69–0.97) vs. 0.69 (0.52–0.85) and 0.67 (0.50–0.83)]. Conclusion: For 1-week mortality, the GBS was superior to the Child–Pugh and the MELD scores in patients with esophageal variceal bleeding. However, for 6-week mortality, the MELD score was superior in patients with esophageal variceal bleeding.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Smith, Sinead; Boyle, Breida; Brennan, Denise; Buckley, Martin; Crotty, Paul; Doyle, Maeve; Farrell, Richard; Hussey, Mary; Kevans, David; Malfertheiner, Peter; Megraud, Francis; Nugent, Sean; O’Connor, Anthony; O’Morain, Colm; Weston, Shiobhan; McNamara, Deirdre
    The Irish Helicobacter pylori Working Group consensus for the diagnosis and treatment of H. pylori infection in adult patients in Ireland
    imageBackground: Irish eradication rates for Helicobacter pylori are decreasing and there is an increase in the prevalence of antibiotic-resistant bacteria. These trends call into question current management strategies. Objective: To establish an Irish Helicobacter pylori Working Group (IHPWG) to assess, revise and tailor current available recommendations. Methods: Experts in the areas of gastroenterology and microbiology were invited to join the IHPWG. Questions of relevance to diagnosis, first-line and rescue therapy were developed using the PICO system. A literature search was performed. The ‘Grading of Recommendations Assessment, Development and Evaluation’ approach was then used to rate the quality of available evidence and grade the resulting recommendations. Results: Key resultant IHPWG statements (S), the strength of recommendation and quality of evidence include S8: standard triple therapy for 7 days’ duration can no longer be recommended (strong and moderate). S9: 14 days of clarithromycin-based triple therapy with a high-dose proton pump inhibitor (PPI) is recommended as first-line therapy. Bismuth quadruple therapy for 14 days is an alternative if available (strong and moderate). S12: second-line therapy depends on the first-line treatment and should not be the same treatment. The options are (a) 14 days of levofloxacin-based therapy with high-dose PPI, (b) 14 days of clarithromycin-based triple therapy with high-dose PPI or (c) bismuth quadruple therapy for 14 days (strong and moderate). S13: culture and antimicrobial susceptibility testing should be performed following two treatment failures (weak and low/very low). Conclusion: These recommendations are intended to provide the most relevant current best-practice guidelines for the management of H. pylori infection in adults in Ireland.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Deding, Ulrik; Torp-Pedersen, Christian; Bøggild, Henrik
    Perceived stress as a risk factor for dyspepsia: a register-based cohort study
    imageObjective: Dyspepsia is a common condition and has a huge impact on quality of life and working capacity, but its causes are not well understood. An association between stress and dyspepsia has been debated for decades, but the issue has not been resolved. We examined the 3-year risk of redeeming a proton-pump inhibitor or an H2-receptor antagonist as a proxy of dyspepsia according to the level of perceived stress. Participants and methods: Perceived stress was measured in a general health survey of 16 124 Danes aged older than 16 years of age in 2010 using Cohen’s Perceived Stress Scale. Data were linked individually to national registries, including the Danish National Prescription Registry. The risk of redeeming a proton-pump inhibitor or an H2-receptor antagonist for quintiles of stress level was estimated using Cox proportional hazard regression. Results: In total, 2703 redeemed one of these drugs during the 33 months of follow-up. The cumulative incidence proportion of dyspepsia increased gradually, from 11.6 to 24.9%, with quintiles of stress. After full model adjustment, the four highest stress quintiles had a statistically significantly increased risk of redeeming a drug compared with the lowest stress quintile. The hazard ratios were 1.16 [95% confidence interval (CI): 1.00–1.34] for the second quintile, 1.21 (95% CI: 1.06–1.39) for the third quintile, 1.20 (95% CI: 1.05–1.38) for the fourth quintile, and 1.30 (95% CI: 1.12–1.50) for the fifth quintile. Conclusion: Higher levels of self-reported perceived everyday life stress increased the risk of redeeming a drug for dyspepsia significantly during 33 months of follow-up.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Dore, Maria P.; Pes, Giovanni M.; Murino, Alberto; Quarta Colosso, Bianca; Pennazio, Marco
    Short article: Small intestinal mucosal injury in patients taking chemotherapeutic agents for solid cancers
    imageObjective: Chemotherapy for cancer is a systemic treatment often associated with side effects than can be debilitating and, in some cases, life-threatening. Few data are available on intestinal enterotoxicity. Wireless video capsule endoscopy (VCE) is a noninvasive method of imaging the small intestine. This study presents the results of VCE in patients with solid tumors undergoing antineoplastic regimens with agents, notably for toxicity for the gastrointestinal mucosa (i.e. carboplatin, cyclophosphamide, 5-fluorouracil, methotrexate, and cisplatin). Materials and methods: The capsule endoscopy procedure was performed 4–13 days after the end of the antineoplastic course. Each patient received a polyethylene-glycol solution (1000 mg×2 in 2 l of water) for bowel preparation and fasted for 10 h before ingestion of the capsule. Videos were evaluated by one operator, supervised by a second operator, and conclusions were drawn by an expert reader. Results: Twenty (age range: 38–77 years) patients were evaluated. The cecum was reached in 70% before exhaustion of the battery. The video capsule showed small widespread intestinal ulcerations in 25% and erosions in only one patient. The villus architecture appeared normal in all. VCE detected metastases in one patient with a melanoma. Few patients had more than one lesion. All capsules were passed in the stool. Conclusion: Our results suggest that chemotherapy in patients with solid cancers is associated with minimal visual small bowel injury. Factors other than damage of the intestinal mucosa causing loss of epithelium are likely involved in gastrointestinal toxicity and related symptoms.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Schiepatti, Annalisa; Biagi, Federico; Fraternale, Giacomo; Vattiato, Claudia; Balduzzi, Davide; Agazzi, Simona; Alpini, Claudia; Klersy, Catherine; Corazza, Gino R.
    Short article: Mortality and differential diagnoses of villous atrophy without coeliac antibodies
    imageObjective: Villous atrophy (VA) of the small bowel is mainly related to coeliac disease (CD), whose diagnosis is made on the basis of positive endomysial/tissue transglutaminase antibodies while on a gluten-containing diet in the vast majority of patients. However, VA can also occur in other conditions whose epidemiology is little known. Our aim was to study the epidemiology and clinical features of these rare enteropathies. Patients and methods: Clinical and laboratory data of all the patients with VA directly diagnosed in our centre in the last 15 years were collected and statistically analysed. Results: Between September 1999 and June 2015, 274 patients were diagnosed with VA. A total of 260 patients were also positive to coeliac antibodies; the other 14 had VA, but no IgA endomysial antibodies: five had common variable immunodeficiency, three had dermatitis herpetiformis, two had IgA deficiency associated with CD, one had abdominal lymphoma, one had unclassified sprue, one had olmesartan-associated enteropathy and one had seronegative CD. Mortality was 6.0 deaths per 100 person years (95% confidence interval: 2.2–16) in patients with VA but negative coeliac antibodies, whereas only 0.2 deaths per 100 person years (95% confidence interval: 0.1–0.6) occurred in coeliac patients. Conclusion: Patients with VA and negative endomysial antibodies are rare. However, these forms of VA identify specific causes that can be diagnosed. These patients are affected by a very high mortality.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Slonim-Nevo, Vered; Sarid, Orly; Friger, Michael; Schwartz, Doron; Sergienko, Ruslan; Pereg, Avihu; Vardi, Hillel; Singer, Terri; Chernin, Elena; Greenberg, Dan; Odes, Shmuel; on behalf of the Israeli IBD Research Nucleus (IIRN)
    Effect of threatening life experiences and adverse family relations in ulcerative colitis: analysis using structural equation modeling and comparison with Crohn’s disease
    imageBackground and aims: We published that threatening life experiences and adverse family relations impact Crohn’s disease (CD) adversely. In this study, we examine the influence of these stressors in ulcerative colitis (UC). Patients and methods: Patients completed demography, economic status (ES), the Patient-Simple Clinical Colitis Activity Index (P-SCCAI), the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), the Short-Form Health Survey (SF-36), the Brief Symptom Inventory (BSI), the Family Assessment Device (FAD), and the List of Threatening Life Experiences (LTE). Analysis included multiple linear and quantile regressions and structural equation modeling, comparing CD. Results: UC patients (N=148, age 47.55±16.04 years, 50.6% women) had scores [median (interquartile range)] as follows: SCAAI, 2 (0.3–4.8); FAD, 1.8 (1.3–2.2); LTE, 1.0 (0–2.0); SF-36 Physical Health, 49.4 (36.8–55.1); SF-36 Mental Health, 45 (33.6–54.5); Brief Symptom Inventory-Global Severity Index (GSI), 0.5 (0.2–1.0). SIBDQ was 49.76±14.91. There were significant positive associations for LTE and SCAAI (25, 50, 75% quantiles), FAD and SF-36 Mental Health, FAD and LTE with GSI (50, 75, 90% quantiles), and ES with SF-36 and SIBDQ. The negative associations were as follows: LTE with SF-36 Physical/Mental Health, SIBDQ with FAD and LTE, ES with GSI (all quantiles), and P-SCCAI (75, 90% quantiles). In structural equation modeling analysis, LTE impacted ES negatively and ES impacted GSI negatively; LTE impacted GSI positively and GSI impacted P-SCCAI positively. In a split model, ES had a greater effect on GSI in UC than CD, whereas other path magnitudes were similar. Conclusion: Threatening life experiences, adverse family relations, and poor ES make UC patients less healthy both physically and mentally. The impact of ES is worse in UC than CD.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Wickbom, Anna; Nyhlin, Nils; Montgomery, Scott M.; Bohr, Johan; Tysk, Curt
    Family history, comorbidity, smoking and other risk factors in microscopic colitis: a case–control study
    imageObjectives: Data on heredity, risk factors and comorbidity in microscopic colitis, encompassing collagenous colitis (CC) and lymphocytic colitis (LC), are limited. Aim: The aim was to carry out a case–control study of family history, childhood circumstances, educational level, marital status, smoking and comorbidity in microscopic colitis. Methods: A postal questionnaire was sent in 2008–2009 to microscopic colitis patients resident in Sweden and three population-based controls per patient, matched for age, sex and municipality. Results: Some 212 patients and 627 controls participated in the study. There was an association with a family history of microscopic colitis in both CC [odds ratio (OR): 10.3; 95% confidence interval (CI): 2.1–50.4, P=0.004] and LC (OR not estimated, P=0.008). Current smoking was associated with CC [OR: 4.7; 95% CI: 2.4–9.2, P<0.001) and LC (OR: 3.2; 95% CI: 1.6–6.7, P=0.002). The median age at diagnosis was around 10 years earlier in ever-smokers compared with never-smokers. CC was associated with a history of ulcerative colitis (UC) (OR: 8.7, 95% CI: 2.2–33.7, P=0.002), thyroid disease (OR: 2.3; 95% CI: 1.1–4.5, P=0.02), coeliac disease (OR: 13.1; 95% CI: 2.7–62.7, P=0.001), rheumatic disease (OR 1.9; 95% CI: 1.0–3.5, P=0.042) and previous appendicectomy (OR: 2.2; 95% CI: 1.3–3.8, P=0.003), and LC with UC (OR: 6.8; 95% CI: 1.7–28.0, P=0.008), thyroid disease (OR: 2.4; 95% CI: 1.1–5.4, P=0.037) and coeliac disease (OR: 8.7; 95% CI: 2.8–26.7, P<0.001). Conclusion: Association with a family history of microscopic colitis indicates that familial factors may be important. The association with a history of UC should be studied further as it may present new insights into the pathogenesis of microscopic colitis and UC.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Göttgens, Kevin W.A.; Jeuring, Steven F.G.; Sturkenboom, Rosel; Romberg-Camps, Mariëlle J.L.; Oostenbrug, Liekele E.; Jonkers, Daisy M.A.E.; Stassen, Laurents P.S.; Masclee, Ad A.M.; Pierik, Marieke J.; Breukink, Stéphanie O.
    Time trends in the epidemiology and outcome of perianal fistulizing Crohn’s disease in a population-based cohort
    imageObjective: Perianal disease is a debilitating condition that frequently occurs in Crohn’s disease (CD) patients. It is currently unknown whether its incidence has changed in the era of frequent immunomodulator use and biological availability. We studied the incidence and outcome of perianal and rectovaginal fistulas over the past two decades in our population-based Inflammatory Bowel Disease South-Limburg cohort. Patients and methods: All 1162 CD patients registered in the Inflammatory Bowel Disease South-Limburg registry were included. The cumulative probabilities of developing a perianal and rectovaginal fistula were compared between three eras distinguished by the year of CD diagnosis: 1991–1998, 1999–2005 and 2006–2011. Second, clinical risk factors and the risk of fistula recurrence were determined. Results: The cumulative 5-year perianal fistula rate was 14.1% in the 1991–1998 era, 10.4% in the 1999–2005 era and 10.3% in the 2006–2011 era, P=0.70. Colonic disease was associated with an increased risk of developing perianal disease, whereas older age was associated with a decreased risk (both P<0.01). Over time, more patients were exposed to immunomodulators or biologicals before fistula diagnosis (18.5 vs. 32.1 vs. 52.1%, respectively, P=0.02) and started biological therapy thereafter (18.6 vs. 34.1 vs. 54.0%, respectively, P<0.01). The cumulative 5-year perianal fistula recurrence rate was not significantly different between eras (19.5 vs. 25.5 vs. 33.1%, P=0.28). In contrast, the cumulative 5-year rectovaginal rate attenuated from 5.7% (the 1991–2005 era) to 1.7% (the 2006–2011 era), P=0.01. Conclusion: Over the past two decades, the risk of developing a perianal fistula was stable, as well as its recurrence rate, underlining the lasting need for improving treatment strategies for this invalidating condition.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Abu-Freha, Naim; Lior, Yotam; Shoher, Shira; Novack, Victor; Fich, Alexander; Rosenthal, Alexander; Etzion, Ohad
    The yield of endoscopic investigation for unintentional weight loss
    imageAim: The aim of this study was to assess the yield of endoscopic evaluation in isolated unintentional weight loss (UWL) patients compared with patients with weight loss and additional symptoms or signs. Patients and methods: A retrospective review of all patients who underwent an endoscopic evaluation for the investigation of UWL at Soroka University Medical Center between 2006 and 2012. Data on clinical indication, endoscopic, and laboratory finding were retrieved. Severe inflammation, ulcers, achalasia, and neoplasias were considered clinically significant endoscopic findings (CSEF) that could explain weight loss. Detection rates of CSEF were compared between endoscopic studies for which UWL was the sole indication (group 1) and those performed for UWL and at least one other indication (group 2). Results: During the study period, 1843 patients with UWL were evaluated with 2098 endoscopic procedures. Of these, 1540 underwent esophagogastroduodenoscopy (EGD) and 558 underwent colonoscopy. EGD was performed in 229 (14.8%) patients in group 1 (mean age: 60.9±16.4, 43.3% men), and in 1311 (85.2%) patients in group 2 (mean age: 60.5±18.5, 45% men). Pathological endoscopic findings were identified in 712 (46%) EGDs. Of these, 155 (10%) studies detected significant outcomes: six (3.9%) in group 1 and 149 (96.1%) in group 2. Of the 558 colonoscopies performed, 105 (18.8%) were performed in group 1 (mean age: 61.7±17.5, 43% men) and 453 (82.2%) in group 2 patients (mean age: 62.9±14.6, 49% men). Abnormal findings were found in 190 (33.8%) of the procedures. CSEF were found in 34 (6%) patients: two in group 1 and 32 in group 2. Conclusion: The diagnostic yield of endoscopy for investigation of patients with UWL is non-negligible, and should be considered as part of its baseline evaluation, especially in older individuals and those who present with other gastrointestinal manifestations.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Parker, Helen L.; Curcic, Jelena; Heinrich, Henriette; Sauter, Matthias; Hollenstein, Michael; Schwizer, Werner; Savarino, Edoardo; Fox, Mark
    What to eat and drink in the festive season: a pan-European, observational, cross-sectional study
    imageBackground: Digestive discomfort after meals is common in the community, especially during the festive season. It is uncertain whether this is related to intake of either high-calorie or high-fat foods or, alternatively, intake of specific foods. This prospective, cross-sectional study tested the hypothesis that the risk of reflux or dyspepsia is associated with the fat content of the meal independent of caloric load in a ‘real-life’ setting. Materials and methods: Four festive meals were served to delegates attending a conference on four consecutive days. Test meals had the same volume, but varied in calorie and fat content. Study procedures and symptoms were monitored using a mobile application (SymTrack). The effect of alcoholic compared with nonalcoholic drinks was also assessed. Primary outcome was the occurrence of reflux or dyspeptic symptoms. Fullness was documented by a visual analogue scale. Results: A total of 84/120 (70%) delegates aged 22–69 years consented to participate. At screening, 22 (31%) participants reported at least mild symptoms on the Leuven Dyspepsia Questionnaire. Specific ingredients did not appear to impact on postprandial symptoms. All high-calorie dinners [British, German, Italian (with alcohol)] induced more symptoms than the low-fat, low-calorie Czech dinner [odds ratio: 2.6, 95% confidence interval (CI): 0.97–6.9 (P=0.058), 1.5 (0.3–3.8), and 2.8 (0.7–10.5), respectively]. Self-reported fullness after the high-fat, high-calorie British dinner was higher by 23/100 (95% CI: 4–42, P=0.016) with respect to low-fat, low-calorie Czech and German dinners. Conclusion: Study participants tolerated a range of food and drink well. Reflux or dyspeptic symptoms were least likely after the low-fat, low-calorie meal. Fullness was increased after the high-fat, high-calorie dinner, but not low-fat meals. These results will help the public to make evidence-based dietary choices during the carnival season!

    Date de mise en ligne : Jeudi 01 janvier 1970
    Hjorthøj, Carsten; Østergaard, Marie L.D.; Benros, Michael E.; Toftdahl, Nanna G.; Andersen, Jon T.; Nordentoft, Merete
    Letter to the Editor
    No abstract available

    Date de mise en ligne : Jeudi 01 janvier 1970
    Goyal, Hemant; Singla, Umesh; May, Elizabeth
    Reply to Hjorthøj et al.
    No abstract available

    Date de mise en ligne : Jeudi 01 janvier 1970
    Paper alert
    No abstract available