Acta gastro-enterologica Belgica最新文献

Background: The clinical management of functional dyspepsia (FD) is challenging. This study evaluated the efficacy and safety of Aurantii Fructus Immaturus flavonoid (AFIF) tablets vs. domperidone for FD.

Methods: This multicenter, randomized, double-blind, doubledummy, positive-controlled trial recruited FD patients, who were randomized 1:1 to the AFIF (AFIF and domperidone placebo) and domperidone (domperidone and AFIF placebo) groups. The primary endpoint was the rate of disappearance of all four FD symptoms (postprandial feeling of fullness, early satiety, upper abdominal pain, and upper abdominal burning sensation) after 4 treatment weeks.

Results: Totally 120 and 119 patients were included in the AFIF and domperidone groups, respectively. The rates of disappearance of all four symptoms after 4 treatment weeks were 28.33% and 31.93% in the AFIF and domperidone groups, respectively (p=0.5748). The rate of disappearance of all four symptoms 4 weeks after treatment discontinuation was significantly higher in the AFIF (21.05%) compared with the domperidone group (4.39%, p=0.0002). The gastric emptying rates 2h after a meal were significantly increased in both AFIF (7.58%, p<0.0001) and domperidone (6.95%, p=0.0121) groups versus baseline, without a significant between-group difference (p=0.8457). Twenty-two (1 moderate) and 43 (3 moderate) adverse events occurred in the AFIF (19.17%) and domperidone (36.13%) groups, respectively.

Conclusion: The efficacy of AFIF tablets is similar to that of domperidone after 4 treatment weeks, while AFIF tablets may have a better safety profile than domperidone. Additionally, AFIF tablets have a significant advantage over domperidone in the rate of symptom disappearance 4 weeks after treatment discontinuation.

Gastroparesis is a condition with a growing incidence and few effective treatments. In recent years, GPOEM has demonstrated its superiority to other existing treatments. We report here on our experience in which 34 patients underwent GPOEM, with 23 patients assessed for symptoms and quality of life before and after the procedure. We measured an average clinical success rate of 73.92% and an excellent risk profile with only two minor complications. The procedure was very well accepted by patients as all would be willing to undergo it again. Patients for whom GPOEM was successful saw a major improvement in their quality of life, which returned to normal, and, for those suffering from reflux, a significant reduction in their PPI treatment. As for the patients for whom the procedure was not a success, we found that they were at high risk of somatization, so screening questionnaires should be considered pre-intervention to screen these patients and avoid unnecessary procedures.

Eosinophilic esophagitis (EoE) is a chronic disorder characterized by eosinophilic inflammation of the oesophagus triggered by food allergens and possibly aeroallergens. We present a boy with the diagnosis of EoE at the age of 4 years and the disease responded to topical steroids. When he turned 7 years old he had the concomitant diagnose of grass pollen allergy. A clear difference between both histological (October 2019: 0 eosinophils (Eo's)/High Power Field (HPF), April 2022: 80 Eo's/ HPF) and clinical signs (October 2019: pediatric eoe symptom score (PEESS) 3/100, April 2022: PEESS 31/100) is evident when comparing winter to spring. The boy is currently only using topical budesonide during grass pollen season. There are increasing arguments in favour of aeroallergens as a trigger for EoE. This information is important for determining the timing of endoscopic follow-up. And it may be beneficial to consider upgrading treatment during allergy season, or exclusively administering treatment during allergy season.

Colorectal cancer (CRC) is the second and third leading cause of cancer death in men and women respectively worldwide. Colonoscopy is the gold standard screening test to detect premalignant lesions with endoscopic polypectomy preventing evolution to CRC. Endoscopic polypectomy is effective with a higher safety profile and is less costly as compared to surgery. Bestpractice polypectomy technique is crucial, as 10% of polyps <2 cm are incompletely resected and may therefore play a significant role in the development of post colonoscopy colorectal cancer (PCCRC). Hot snare polypectomy (HSP) has traditionally been the technique of choice for endoscopic polypectomy but is associated with a small but appreciable risk of adverse events, primarily postpolypectomy bleeding and perforation. Recent high-quality studies have demonstrated the similar efficacy and superior safety profile of cold snare polypectomy (CSP) for polyps less than 10 mm in size. In daily clinical practice, the vast majority of colorectal polyps encountered by gastroenterologists are less than 10 mm, making CSP the technique of choice. Widespread use of CSP over HSP may therefore significantly reduce the number of adverse events associated with endoscopic polypectomy. The indication for CSP may be extended to larger lesions, including large, non-dysplastic sessile serrated lesions and small pedunculated polyps with a thin stalk. In addition, the risk-benefit ratio of CSP is favourable in patients in whom interruption of anticoagulants is a concern in terms of thromboembolic risk. In this review, the focus will be on safety of hot versus cold snare polypectomy as a technique for the resection of diminutive and small polyps.

Small intestinal neuroendocrine tumors (SI-NETs) typically follow an indolent disease course and are often accompanied by mesenteric lymph node metastases upon diagnosis. These tumors can incite a fibroblastic reaction within the mesenteric root. Here, we present two cases of patients with symptomatic small bowel obstruction due to such mesenteric involvement. These patients underwent peptide receptor radionuclide therapy (PRRT), resulting in the stabilization of the mesenteric mass and remarkable improvements in obstructive symptoms. They experienced a return to oral intake and were able to discontinue parenteral nutrition. Despite some controversies, PRRT emerges as a promising tool in managing the mesenteric mass and achieving a reversal of debilitating complications such as obstruction and mesenteric ischemia.

Background: Pancreatic ductal adenocarcinoma (PDAC) has a known poor prognosis. For a select group, those with BRCA mutations, frontline platinum-based therapy and poly (ADPribose) polymerase inhibitors are options that can potentially lead to survival benefit.

Patients and methods: We present 2 cases of patients with BRCAmutated pancreatic cancer with liver metastases that achieved a remarkable long-term complete remission on platinum-based chemotherapy.

Conclusion: Germline testing for BRCA is important in PDAC because it influences treatment choices that impact survival. Complete responses with chemotherapy alone are rarely observed in metastatic PDAC, but may be seen upon treatment with platinum-based therapy.

Background and study aims: The COVID-19 pandemic substantially impacted the healthcare system and society in 2020. This study assessed its possible impact on occurrence and stage of colorectal cancer diagnoses in Belgium.

Methods: Population-based data from the Belgian Cancer Registry were used to extrapolate 2017-2019 trends in incidence and stage distribution to expected counts for 2020 that were subsequently compared to the observed values. Stage-specific predictions were corrected to account for the overall decline in diagnoses.

Results: In 2020, 705 fewer than expected invasive and 255 fewer in situ colorectal cancers were diagnosed. For colon cancer, significant declines were observed in all genders and regions, mainly in the screening age group and in age 75+. For rectal cancers, there was only a significant decline in the latter two groups. Colon cancer pStage distribution did not change significantly. In situ rectal tumors showed a relative decline in Flanders and in the screening age group. In the latter group, more than expected cStage III rectal cancers were observed in women.

Conclusions: The excess decline in in situ rectal cancers is likely attributable to the temporary suspension of the colorectal screening program during the first pandemic wave. The overall decline in colon and rectal cancer incidence in Belgium in 2020 was not accompanied by a stage shift. Longer-term effects or impact on clinically relevant outcomes cannot be excluded.

Background and study aims: Monitoring the symptoms of inflammatory bowel diseases (IBD) patients is now frequently made in the form of patient reported outcomes (PRO), rather than historical clinical activity scores. Unlike several chronic diseases, the role of telemonitoring in IBD has not yet been defined, particularly in terms of patient compliance with remote monitoring; the aim of our study was to assess patient compliance with digital monitoring of PRO as part of routine medical follow-up.

Patients and methods: we performed a monocentric prospective study in the Gastroenterology Unit of Liège's University Hospital between May 2023 and February 2024. Adherence was considered optimal if 50% of the recordings planned for the duration of the follow-up were carried out.

Results: 31% of the patients included achieved at least 50% total encoding of their PRO over the 9 months of follow-up. The main cause of failure cited by patients was technical difficulties, well ahead of poor motivation. The overall satisfaction of practitioners and patients was generally good. Male gender was the only factor associated with adherence.

Conclusion: Overall adherence to PRO telemonitoring in IBD was around 40% and was mainly impaired by technical difficulties. Despite this, both patients and healthcare professionals found this type of monitoring relevant.

Budd-Chiari syndrome (BCS) is a rare, potentially lifethreatening condition characterised by obstruction of the hepatic venous outflow tract due to thrombosis. Treatment typically involves lifelong anticoagulation and relieving the obstruction. This case report introduces hepatic venous thromboaspiration as an additional endovascular technique to achieve recanalisation.