Pub Date : 2018-08-28DOI: 10.33590/emjgastroenterol/10313003
Chris Williams
Crohn’s disease (CD) is a chronic, progressive, relapsing-remitting disorder characterised by periods of inflammatory activity occurring most commonly in the terminal ileum and colon, resulting in worsening bowel damage and increasing disability, which in turn are associated with significant impairment in quality of life (QoL). The recognition of CD as a progressive disease has shifted the goal of treatment from symptom management towards a focus on slowing disease progression, with the aim of reducing subsequent disability and mitigating impacts on QoL. This symposium focusses on understanding the advantages and limitations of current management strategies. It addresses the full spectrum of the complexity of CD, ranging from biologic therapy for moderately-to-severely active luminal CD, to new treatment options for complex perianal fistula based on innovative stem cell approaches.
{"title":"Individualised Care for Crohn’s Disease: Evolving Approaches for a Progressive Disease","authors":"Chris Williams","doi":"10.33590/emjgastroenterol/10313003","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313003","url":null,"abstract":"Crohn’s disease (CD) is a chronic, progressive, relapsing-remitting disorder characterised by periods of inflammatory activity occurring most commonly in the terminal ileum and colon, resulting in worsening bowel damage and increasing disability, which in turn are associated with significant impairment in quality of life (QoL). The recognition of CD as a progressive disease has shifted the goal of treatment from symptom management towards a focus on slowing disease progression, with the aim of reducing subsequent disability and mitigating impacts on QoL. This symposium focusses on understanding the advantages and limitations of current management strategies. It addresses the full spectrum of the complexity of CD, ranging from biologic therapy for moderately-to-severely active luminal CD, to new treatment options for complex perianal fistula based on innovative stem cell approaches.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76318200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-12DOI: 10.33590/emjgastroenterol/10314348
T. Penfold
Inflammatory bowel disease (IBD) has a dramatic impact on patients and their families, as well as on society as a whole due to its significant economic impact around the world.1 Achieving the best outcomes for patients relies on early intervention, a treat-to-target (T2T) approach guided by a tight control (TC) strategy, and open dialogue with the patient allowing for individualisation of treatment.2 Dr Halfvarson discussed the current understanding of C-reactive protein (CRP) and faecal calprotectin (FC), both of which are useful biomarkers for the diagnosis, monitoring, adaptation of treatment, and prediction of relapse for IBD. Dr Bossuyt outlined that monitoring based on objective markers is very important in IBD because they can detect smouldering disease activity and also correlate with background inflammation.3,4 Dr Bossuyt also discussed new data emerging from the CALM study in Crohn’s disease (CD), concluding that using biomarkers as a TC strategy can be successful in IBD management because they reflect endoscopic outcomes independent of disease location and are the main drivers of treatment decisions during monitoring.5,6 Lastly, Prof Panaccione discussed the positive impact of the T2T approach on patient quality of life (QoL) and societal costs. In the CALM study, TC resulted in improved clinical outcomes, reduced CD-related hospitalisation, and improved QoL of patients.7–10 Furthermore, an extrapolated cost-effectiveness analysis of the CALM data over 2 years, taking into account indirect costs associated with improved work productivity, found that TC reduced overall societal costs and improved patient outcomes compared to clinical management (CM).11
{"title":"Keep CALM and Use Biomarkers in Inflammatory Bowel Disease","authors":"T. Penfold","doi":"10.33590/emjgastroenterol/10314348","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314348","url":null,"abstract":"Inflammatory bowel disease (IBD) has a dramatic impact on patients and their families, as well as on society as a whole due to its significant economic impact around the world.1 Achieving the best outcomes for patients relies on early intervention, a treat-to-target (T2T) approach guided by a tight control (TC) strategy, and open dialogue with the patient allowing for individualisation of treatment.2 Dr Halfvarson discussed the current understanding of C-reactive protein (CRP) and faecal calprotectin (FC), both of which are useful biomarkers for the diagnosis, monitoring, adaptation of treatment, and prediction of relapse for IBD. Dr Bossuyt outlined that monitoring based on objective markers is very important in IBD because they can detect smouldering disease activity and also correlate with background inflammation.3,4 Dr Bossuyt also discussed new data emerging from the CALM study in Crohn’s disease (CD), concluding that using biomarkers as a TC strategy can be successful in IBD management because they reflect endoscopic outcomes independent of disease location and are the main drivers of treatment decisions during monitoring.5,6 Lastly, Prof Panaccione discussed the positive impact of the T2T approach on patient quality of life (QoL) and societal costs. In the CALM study, TC resulted in improved clinical outcomes, reduced CD-related hospitalisation, and improved QoL of patients.7–10 Furthermore, an extrapolated cost-effectiveness analysis of the CALM data over 2 years, taking into account indirect costs associated with improved work productivity, found that TC reduced overall societal costs and improved patient outcomes compared to clinical management (CM).11","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"09 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86038931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-14DOI: 10.33590/emjgastroenterol/10313202
Sameh Hany Emile, H. Elfeki
Sleeve gastrectomy (SG) has been recognised as an effective procedure for the treatment of morbid obesity and associated comorbidities; however, the shortcomings of SG, such as staple line leak, haemorrhage, vomiting, and weight regain, have also been well-reported. An underestimated adverse effect of SG is nutritional deficiency (ND). While ND is a well-known complication of malabsorptive bariatric procedures, it can still occur after restrictive operations, including SG, yet its incidence and mechanism are still unclear. In an attempt to learn about the incidence and type of ND after SG we performed an organised literature search of electronic databases searching for articles that assessed the incidence and type of ND after SG. The median incidence of iron and zinc deficiency after SG was 8.8% and 18.8%, respectively. The majority of patients already had vitamin D deficiency preoperatively, with a median of 35.5% of patients still demonstrating vitamin D deficiency postoperatively. Comparing ND before and after SG, the incidence of iron and vitamin D deficiency declined postoperatively; in contrast, there was a tangible increase in the incidence of vitamin B1, B6, B12, and calcium deficiency. Vitamin B1 and B12 deficiencies were recorded in a median of 10.0% and 11.7% of patients, respectively, and were associated with neurologic manifestations in <1% of patients. Prevention of ND after SG requires proper recognition and correction of preoperative ND with immediate supplementation of trace elements and vitamins postoperatively, in addition to long follow-up.
{"title":"Nutritional Deficiency After Sleeve Gastrectomy: A Comprehensive Literature Review","authors":"Sameh Hany Emile, H. Elfeki","doi":"10.33590/emjgastroenterol/10313202","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313202","url":null,"abstract":"Sleeve gastrectomy (SG) has been recognised as an effective procedure for the treatment of morbid obesity and associated comorbidities; however, the shortcomings of SG, such as staple line leak, haemorrhage, vomiting, and weight regain, have also been well-reported. An underestimated adverse effect of SG is nutritional deficiency (ND). While ND is a well-known complication of malabsorptive bariatric procedures, it can still occur after restrictive operations, including SG, yet its incidence and mechanism are still unclear. In an attempt to learn about the incidence and type of ND after SG we performed an organised literature search of electronic databases searching for articles that assessed the incidence and type of ND after SG. The median incidence of iron and zinc deficiency after SG was 8.8% and 18.8%, respectively. The majority of patients already had vitamin D deficiency preoperatively, with a median of 35.5% of patients still demonstrating vitamin D deficiency postoperatively. Comparing ND before and after SG, the incidence of iron and vitamin D deficiency declined postoperatively; in contrast, there was a tangible increase in the incidence of vitamin B1, B6, B12, and calcium deficiency. Vitamin B1 and B12 deficiencies were recorded in a median of 10.0% and 11.7% of patients, respectively, and were associated with neurologic manifestations in <1% of patients. Prevention of ND after SG requires proper recognition and correction of preoperative ND with immediate supplementation of trace elements and vitamins postoperatively, in addition to long follow-up.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83823613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-14DOI: 10.33590/emjgastroenterol/10313857
Cosmas Rinaldi A. Lesmana, R. Gani, L. Lesmana
Fat accumulation in the pancreas, defined as fatty pancreas, is usually an incidental finding during transabdominal ultrasound examination. Fatty pancreas without any significant alcohol consumption is defined as non-alcoholic fatty pancreas disease. Even though its clinical impact is still largely unknown, hypothetically the disease progression could lead to chronic pancreatitis and possibly pancreatic cancer development. Recently, metabolic problems such as diabetes, central obesity, fatty liver, and dyslipidaemia have been considered important risk factors related to non-alcoholic fatty pancreas disease and pancreatic cancer; however, the exact mechanism is not yet fully understood. Early detection and screening for pancreatic cancer in clinical practice is troublesome because of the non-specific symptoms, anatomical location, accuracy of biomarkers in clinical practice, and high risk of radiation and contrast agent exposure from imaging study. Endoscopic ultrasound is still considered the best method for pancreas evaluation and for the screening and diagnosis of pancreatic cancer. However, there is still much debate regarding its cost, availability, and the training experience of the operator.
{"title":"Non-Alcoholic Fatty Pancreas Disease, Pancreatic Cancer, and Impact of Endoscopic Ultrasound Examination on Screening and Surveillance","authors":"Cosmas Rinaldi A. Lesmana, R. Gani, L. Lesmana","doi":"10.33590/emjgastroenterol/10313857","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313857","url":null,"abstract":"Fat accumulation in the pancreas, defined as fatty pancreas, is usually an incidental finding during transabdominal ultrasound examination. Fatty pancreas without any significant alcohol consumption is defined as non-alcoholic fatty pancreas disease. Even though its clinical impact is still largely unknown, hypothetically the disease progression could lead to chronic pancreatitis and possibly pancreatic cancer development. Recently, metabolic problems such as diabetes, central obesity, fatty liver, and dyslipidaemia have been considered important risk factors related to non-alcoholic fatty pancreas disease and pancreatic cancer; however, the exact mechanism is not yet fully understood. Early detection and screening for pancreatic cancer in clinical practice is troublesome because of the non-specific symptoms, anatomical location, accuracy of biomarkers in clinical practice, and high risk of radiation and contrast agent exposure from imaging study. Endoscopic ultrasound is still considered the best method for pancreas evaluation and for the screening and diagnosis of pancreatic cancer. However, there is still much debate regarding its cost, availability, and the training experience of the operator.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80559258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-14DOI: 10.33590/emjgastroenterol/10314912
Muhammad Ilham Abdul Hafidz, T. Jayaraman, R. Affendi Raja Ali, Yeong Yeh Lee
Biologics are large complex molecules that are produced in living systems. They have revolutionised the treatment of patients suffering from various diseases, including inflammatory bowel disease. However, in many parts of the world, patient access to biologics has been hampered, mainly because of the high costs associated with these therapies. Since the patent expiration of several of these biologics, biosimilars have emerged, promising equal effectiveness and safety for patients but at a more affordable price. Despite this, concerns remain regarding the use of biosimilars as replacements for biologics. This review discusses the issues and controversies surrounding the development and applicability of biosimilars in the field of gastroenterology.
{"title":"Are We Ready for Biosimilars in Gastroenterology?","authors":"Muhammad Ilham Abdul Hafidz, T. Jayaraman, R. Affendi Raja Ali, Yeong Yeh Lee","doi":"10.33590/emjgastroenterol/10314912","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314912","url":null,"abstract":"Biologics are large complex molecules that are produced in living systems. They have revolutionised the treatment of patients suffering from various diseases, including inflammatory bowel disease. However, in many parts of the world, patient access to biologics has been hampered, mainly because of the high costs associated with these therapies. Since the patent expiration of several of these biologics, biosimilars have emerged, promising equal effectiveness and safety for patients but at a more affordable price. Despite this, concerns remain regarding the use of biosimilars as replacements for biologics. This review discusses the issues and controversies surrounding the development and applicability of biosimilars in the field of gastroenterology.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80357862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-14DOI: 10.33590/emjgastroenterol/10313313
A. Omodele-Lucien, I. Goren
Since it was first identified in 1982, Helicobacter pylori has continued to draw attention far beyond its role in peptic ulcer disease and is now associated with a myriad of immune-mediated diseases, both inside the gastrointestinal tract (GIT), such as mucosa-associated lymphoid tissue lymphoma, and systemic diseases, such as H. pylori-associated immune thrombocytopenia. This association has ignited research into the mechanisms of H. pylori pathogenicity, especially regarding its role within a multitude of diseases outside the GIT. Despite controversies, a growing body of evidence has begun to establish potential associations between H. pylori and extragastric GIT pathologies; H. pylori has recently been associated with luminal diseases, such as inflammatory bowel diseases and coeliac disease, as well as pancreatic, hepatobiliary, and malignant diseases of the GIT. Despite the lack of conclusive evidence regarding the mechanisms of these relationships, studies have found strong associations, like the case of H. pylori and coeliac disease, while others have not discovered such connections. In addition, while studies have established positive associations between H. pylori and various extragastric diseases, other studies have found the pathogen to play a protective role in disease development. This review comments on the latest evidence that addresses the role of H. pylori in non-gastric gastrointestinal diseases, and establishes the nature of these relationships and the implications of H. pylori eradication from a clinical perspective.
{"title":"Extragastric Gastrointestinal Manifestations of Helicobacter Pylori: Friend or Foe?","authors":"A. Omodele-Lucien, I. Goren","doi":"10.33590/emjgastroenterol/10313313","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313313","url":null,"abstract":"Since it was first identified in 1982, Helicobacter pylori has continued to draw attention far beyond its role in peptic ulcer disease and is now associated with a myriad of immune-mediated diseases, both inside the gastrointestinal tract (GIT), such as mucosa-associated lymphoid tissue lymphoma, and systemic diseases, such as H. pylori-associated immune thrombocytopenia. This association has ignited research into the mechanisms of H. pylori pathogenicity, especially regarding its role within a multitude of diseases outside the GIT. Despite controversies, a growing body of evidence has begun to establish potential associations between H. pylori and extragastric GIT pathologies; H. pylori has recently been associated with luminal diseases, such as inflammatory bowel diseases and coeliac disease, as well as pancreatic, hepatobiliary, and malignant diseases of the GIT. Despite the lack of conclusive evidence regarding the mechanisms of these relationships, studies have found strong associations, like the case of H. pylori and coeliac disease, while others have not discovered such connections. In addition, while studies have established positive associations between H. pylori and various extragastric diseases, other studies have found the pathogen to play a protective role in disease development. This review comments on the latest evidence that addresses the role of H. pylori in non-gastric gastrointestinal diseases, and establishes the nature of these relationships and the implications of H. pylori eradication from a clinical perspective.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"4 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86517642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-14DOI: 10.33590/emjgastroenterol/10313415
H. Mandavdhare, Harjeet Singh, Vishal Sharma
Abdominal tuberculosis and its protean manifestations still create a diagnostic challenge for clinicians and remain an important concern in the developing world. Crohn’s disease, which is being increasingly recognised in countries where intestinal tuberculosis is prevalent, needs to be differentiated as the two diseases resemble each other in their clinical presentation, and in their radiological, endoscopic, and histological findings. New diagnostic modalities and scoring systems have facilitated the differentiation of Crohn’s disease from intestinal tuberculosis with good accuracy. Randomised trials have shown 6 months of therapy to be equivalent to longer durations of treatment for patients with abdominal tuberculosis. This review focusses on the recent advances in diagnosis and management of abdominal tuberculosis.
{"title":"Editor’s Pick: Recent Advances in the Diagnosis and Management of Abdominal Tuberculosis","authors":"H. Mandavdhare, Harjeet Singh, Vishal Sharma","doi":"10.33590/emjgastroenterol/10313415","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313415","url":null,"abstract":"Abdominal tuberculosis and its protean manifestations still create a diagnostic challenge for clinicians and remain an important concern in the developing world. Crohn’s disease, which is being increasingly recognised in countries where intestinal tuberculosis is prevalent, needs to be differentiated as the two diseases resemble each other in their clinical presentation, and in their radiological, endoscopic, and histological findings. New diagnostic modalities and scoring systems have facilitated the differentiation of Crohn’s disease from intestinal tuberculosis with good accuracy. Randomised trials have shown 6 months of therapy to be equivalent to longer durations of treatment for patients with abdominal tuberculosis. This review focusses on the recent advances in diagnosis and management of abdominal tuberculosis.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91273877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-14DOI: 10.33590/emjgastroenterol/10312003
C. Yeung, Hung-Chang Lee
Helicobacter pylori infection is the most prevalent chronic bacterial infection in the world. The prevalence of H. pylori infection ranges from approximately 10–90% and is influenced by age, country, socioeconomic status, nutritional status, urbanisation, hygiene, and diagnostic tools available. In general, chronic H. pylori infection can lead to chronic antral gastritis, peptic ulcer disease, primary gastric lymphoma, and gastric adenocarcinoma. As public hygiene and sanitation have improved, the rates of H. pylori infection and related diseases have been declining annually in developed and rapidly developing countries, although the infection is still common in some geographic areas. In Taiwan, an Asian country with a high incidence rate of gastric malignancy, there is a similar trend of declining H. pylori prevalence rates. Prevalence rate differed vastly between rural and urban areas; however, rates have fallen greatly in recent decades. Optimal treatment of H. pylori infection in children has not yet been determined and will require further collaborative studies. However, eradication failures are concerning since global rates of antibiotic resistance are increasing and therapy for H. pylori infection is increasingly prescribed. In Taiwan, the overall antimicrobial resistant rates to clarithromycin, metronidazole, and levofloxacin were 23.4%, 20.3%, and 11.8%, respectively. With the propagation of public health education, advancement of diagnostic tools, and patient-specific tailoring of therapeutic strategies, the prevalence and eradication failure rate of H. pylori infection in children should improve in the near future, both in developed and developing countries.
{"title":"Paediatric Helicobacter Pylori Infection in Taiwan: Current Status and Perspectives","authors":"C. Yeung, Hung-Chang Lee","doi":"10.33590/emjgastroenterol/10312003","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10312003","url":null,"abstract":"Helicobacter pylori infection is the most prevalent chronic bacterial infection in the world. The prevalence of H. pylori infection ranges from approximately 10–90% and is influenced by age, country, socioeconomic status, nutritional status, urbanisation, hygiene, and diagnostic tools available. In general, chronic H. pylori infection can lead to chronic antral gastritis, peptic ulcer disease, primary gastric lymphoma, and gastric adenocarcinoma. As public hygiene and sanitation have improved, the rates of H. pylori infection and related diseases have been declining annually in developed and rapidly developing countries, although the infection is still common in some geographic areas. In Taiwan, an Asian country with a high incidence rate of gastric malignancy, there is a similar trend of declining H. pylori prevalence rates. Prevalence rate differed vastly between rural and urban areas; however, rates have fallen greatly in recent decades. Optimal treatment of H. pylori infection in children has not yet been determined and will require further collaborative studies. However, eradication failures are concerning since global rates of antibiotic resistance are increasing and therapy for H. pylori infection is increasingly prescribed. In Taiwan, the overall antimicrobial resistant rates to clarithromycin, metronidazole, and levofloxacin were 23.4%, 20.3%, and 11.8%, respectively. With the propagation of public health education, advancement of diagnostic tools, and patient-specific tailoring of therapeutic strategies, the prevalence and eradication failure rate of H. pylori infection in children should improve in the near future, both in developed and developing countries.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91003867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-14DOI: 10.33590/emjgastroenterol/10314623
E. Lahner, M. Carabotti, B. Annibale
Atrophic body gastritis is a chronic disorder characterised by atrophy of the oxyntic glands leading to reduced gastric acid and intrinsic factor secretion. Serological studies reported yearly prevalence and incidence rates between 3–9% and 0–11%, respectively. In atrophic body gastritis, the presence of parietal cells and/or intrinsic factor autoantibodies, and autoimmune diseases, such as autoimmune thyroid disease or Type 1 diabetes mellitus, are often observed. These cases are often diagnosed as autoimmune gastritis. This association has been included as part of the autoimmune polyendocrine syndrome. A frequent clinical presentation of atrophic body gastritis is pernicious anaemia, considered an autoimmune condition, arising from vitamin B12 malabsorption as a consequence of intrinsic factor deficiency. Another presentation may be an otherwise unexplained iron deficiency anaemia, as a result of iron malabsorption and consequence of reduced gastric acid secretion. To date, no universally accepted criteria are available to define autoimmune gastritis and to distinguish this clinical entity from chronic, Helicobacter pylori-driven, multifocal atrophic gastritis. In contrast with the classical perception of a silent condition, patients with atrophic body gastritis may complain of a spectrum of gastrointestinal symptoms, ranging from dyspepsia as early satiety, postprandial fullness, and epigastric pain, to gastro-oesophageal reflux symptoms such as regurgitation and heartburn. The timely diagnosis of atrophic body gastritis is important, as this condition puts patients at an increased risk of gastric cancer and other Type 1 carcinoids that may lead to micronutrient deficiencies crucial for erythropoiesis. The present review provides an update on epidemiological and clinical aspects as well as diagnosis and outcome of the disease.
{"title":"Atrophic Body Gastritis: Clinical Presentation, Diagnosis, and Outcome","authors":"E. Lahner, M. Carabotti, B. Annibale","doi":"10.33590/emjgastroenterol/10314623","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314623","url":null,"abstract":"Atrophic body gastritis is a chronic disorder characterised by atrophy of the oxyntic glands leading to reduced gastric acid and intrinsic factor secretion. Serological studies reported yearly prevalence and incidence rates between 3–9% and 0–11%, respectively. In atrophic body gastritis, the presence of parietal cells and/or intrinsic factor autoantibodies, and autoimmune diseases, such as autoimmune thyroid disease or Type 1 diabetes mellitus, are often observed. These cases are often diagnosed as autoimmune gastritis. This association has been included as part of the autoimmune polyendocrine syndrome. A frequent clinical presentation of atrophic body gastritis is pernicious anaemia, considered an autoimmune condition, arising from vitamin B12 malabsorption as a consequence of intrinsic factor deficiency. Another presentation may be an otherwise unexplained iron deficiency anaemia, as a result of iron malabsorption and consequence of reduced gastric acid secretion. To date, no universally accepted criteria are available to define autoimmune gastritis and to distinguish this clinical entity from chronic, Helicobacter pylori-driven, multifocal atrophic gastritis. In contrast with the classical perception of a silent condition, patients with atrophic body gastritis may complain of a spectrum of gastrointestinal symptoms, ranging from dyspepsia as early satiety, postprandial fullness, and epigastric pain, to gastro-oesophageal reflux symptoms such as regurgitation and heartburn. The timely diagnosis of atrophic body gastritis is important, as this condition puts patients at an increased risk of gastric cancer and other Type 1 carcinoids that may lead to micronutrient deficiencies crucial for erythropoiesis. The present review provides an update on epidemiological and clinical aspects as well as diagnosis and outcome of the disease.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81559755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-14DOI: 10.33590/emjgastroenterol/10311358
J. Fricker
The goal of this symposium was to highlight the importance of early diagnosis, assessing prognostic factors, and treating to target in inflammatory bowel disease (IBD). In the introduction, Prof Colombel outlined the treat to target (T2T) and tight control (TC) approach, which involves predefining treatment targets in consultation with patients, continuously monitoring disease activity, and modifying treatments until targets are achieved. Dr Pariente presented regarding the progressiveness of Crohn’s disease (CD) and described the Lémann index (LI), which assesses cumulative structural damage in CD.1 He outlined the ‘window of opportunity’ in early disease, within which disease progression could be stopped. Dr Pariente said the T2T approach presents the opportunity for a personalised method of treatment; if targets are not achieved, treatment is intensified or switched. Prof Colombel presented the results of the CALM study,2 in which CD patients were randomised 1:1 to clinical management (CM) or TC, meaning treatment was escalated based on clinical symptoms in combination with biomarkers. The primary endpoint of mucosal healing and no deep ulceration was achieved by 45.9% of patients in the TC arm versus 30.3% in the CM arm (p=0.010). Lastly, Prof D’Haens presented a cost-effectiveness analysis using data from CALM. The calculated total direct medical costs for the TC arm were £13,296 versus £12,627 for the CM arm (a direct medical cost difference of £669).3 The quality-adjusted life years (QALY) were 0.684 for the TC arm versus 0.652 for the CM arm (giving a QALY difference of 0.032). The incremental cost-effectiveness ratio showed a cost of £20,913 per QALY gained, which falls within the threshold of The National Institute for Health and Care Excellence (NICE) guidance for cost-effectiveness.
{"title":"Keep Calm and Treat to Target in Inflammatory Bowel Disease","authors":"J. Fricker","doi":"10.33590/emjgastroenterol/10311358","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311358","url":null,"abstract":"The goal of this symposium was to highlight the importance of early diagnosis, assessing prognostic factors, and treating to target in inflammatory bowel disease (IBD). In the introduction, Prof Colombel outlined the treat to target (T2T) and tight control (TC) approach, which involves predefining treatment targets in consultation with patients, continuously monitoring disease activity, and modifying treatments until targets are achieved. Dr Pariente presented regarding the progressiveness of Crohn’s disease (CD) and described the Lémann index (LI), which assesses cumulative structural damage in CD.1 He outlined the ‘window of opportunity’ in early disease, within which disease progression could be stopped. Dr Pariente said the T2T approach presents the opportunity for a personalised method of treatment; if targets are not achieved, treatment is intensified or switched. Prof Colombel presented the results of the CALM study,2 in which CD patients were randomised 1:1 to clinical management (CM) or TC, meaning treatment was escalated based on clinical symptoms in combination with biomarkers. The primary endpoint of mucosal healing and no deep ulceration was achieved by 45.9% of patients in the TC arm versus 30.3% in the CM arm (p=0.010). Lastly, Prof D’Haens presented a cost-effectiveness analysis using data from CALM. The calculated total direct medical costs for the TC arm were £13,296 versus £12,627 for the CM arm (a direct medical cost difference of £669).3 The quality-adjusted life years (QALY) were 0.684 for the TC arm versus 0.652 for the CM arm (giving a QALY difference of 0.032). The incremental cost-effectiveness ratio showed a cost of £20,913 per QALY gained, which falls within the threshold of The National Institute for Health and Care Excellence (NICE) guidance for cost-effectiveness.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"184 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83039825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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