Pub Date : 2015-12-15DOI: 10.33590/emjgastroenterol/10310702
Lucy Smithers
The importance of the gut microbiota to health is becoming more widely appreciated. The range of commensal microorganisms in healthy individuals and in patients with a variety of digestive diseases is under active investigation, and evidence is accumulating to suggest that both the diversity and balance of bacterial species are important for health. Disturbance of the balance of microorganisms – dysbiosis – is associated with obesity and a variety of diseases. Restoring the balance by modulating the microbiota through diet, probiotics, or drugs is now being developed as a potential treatment for digestive diseases. Rifaximin has been shown to increase levels of beneficial bacterial species without perturbing the overall composition of the microbiota in patients with a variety of digestive diseases, making it a ‘eubiotic’ rather than an antibiotic. Rifaximin has demonstrated clinical benefit in the treatment of symptomatic uncomplicated diverticular disease, where changes in the colonic microbiota contribute to the pathogenesis of this disease. Modulating the microbiota is also a promising treatment for some types of irritable bowel syndrome (IBS) that have been linked to an overgrowth of coliform and Aeromonas species in the small intestine. Rifaximin has demonstrated efficacy in relieving symptoms and reducing relapses in diarrhoeal IBS in the TARGET-1, 2, and 3 trials, without reducing microbial diversity or increasing antimicrobial resistance. While many aspects of the balance of gut microbiota in disease are not yet fully understood, the new understanding of rifaximin as a modulator of gut microbiota may open up new treatment options in digestive disease.
{"title":"Gut Microbiota: Modulate its Complexity to Restore the Balance","authors":"Lucy Smithers","doi":"10.33590/emjgastroenterol/10310702","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310702","url":null,"abstract":"The importance of the gut microbiota to health is becoming more widely appreciated. The range of commensal microorganisms in healthy individuals and in patients with a variety of digestive diseases is under active investigation, and evidence is accumulating to suggest that both the diversity and balance of bacterial species are important for health. Disturbance of the balance of microorganisms – dysbiosis – is associated with obesity and a variety of diseases. Restoring the balance by modulating the microbiota through diet, probiotics, or drugs is now being developed as a potential treatment for digestive diseases. Rifaximin has been shown to increase levels of beneficial bacterial species without perturbing the overall composition of the microbiota in patients with a variety of digestive diseases, making it a ‘eubiotic’ rather than an antibiotic. Rifaximin has demonstrated clinical benefit in the treatment of symptomatic uncomplicated diverticular disease, where changes in the colonic microbiota contribute to the pathogenesis of this disease. Modulating the microbiota is also a promising treatment for some types of irritable bowel syndrome (IBS) that have been linked to an overgrowth of coliform and Aeromonas species in the small intestine. Rifaximin has demonstrated efficacy in relieving symptoms and reducing relapses in diarrhoeal IBS in the TARGET-1, 2, and 3 trials, without reducing microbial diversity or increasing antimicrobial resistance. While many aspects of the balance of gut microbiota in disease are not yet fully understood, the new understanding of rifaximin as a modulator of gut microbiota may open up new treatment options in digestive disease.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80017583","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 : 2015-12-15DOI: 10.33590/emjgastroenterol/10314932
G. Marchegiani, S. Andrianello, G. Malleo, A. Borin, C. Bassi, R. Salvia
Pancreatic cystic neoplasms (PCNs) are no longer considered as rare entities because their prevalence in the general population ranges from 3–20%. They are usually asymptomatic, incidentally discovered, and diagnosed in the seventh decade of life. The main clinical concern with regard to PCNs is related to their risk of malignant progression, which is relevant for those PCNs that produce mucin. Since 2006, several sets of international guidelines have proposed algorithms for the management of PCNs, and these have been subsequently validated by several studies. Retrospective review of the literature shows that current treatment of PCNs remains unsatisfactory because the guidelines are based on a low level of evidence. However, the guidelines are able to correctly identify lesions that can be safely followed and, as occurs in vaccination campaigns, they are able to exercise a preventive effect in the general population.
{"title":"Cystic Pancreatic Lesions Beyond the Guidelines: Can we Make an Evidence-Based Decision Whether to Resect or to Observe?","authors":"G. Marchegiani, S. Andrianello, G. Malleo, A. Borin, C. Bassi, R. Salvia","doi":"10.33590/emjgastroenterol/10314932","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314932","url":null,"abstract":"Pancreatic cystic neoplasms (PCNs) are no longer considered as rare entities because their prevalence in the general population ranges from 3–20%. They are usually asymptomatic, incidentally discovered, and diagnosed in the seventh decade of life. The main clinical concern with regard to PCNs is related to their risk of malignant progression, which is relevant for those PCNs that produce mucin. Since 2006, several sets of international guidelines have proposed algorithms for the management of PCNs, and these have been subsequently validated by several studies. Retrospective review of the literature shows that current treatment of PCNs remains unsatisfactory because the guidelines are based on a low level of evidence. However, the guidelines are able to correctly identify lesions that can be safely followed and, as occurs in vaccination campaigns, they are able to exercise a preventive effect in the general population.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74346722","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 : 2015-12-15DOI: 10.33590/emjgastroenterol/10311684
J. Spicak, T. Hucl
Endoscopic retrograde cholangiopancreatography (ERCP) has become an effective and safe therapeutic method, providing clinical success in more than 80% of cases. As ERCP has evolved from a diagnostic to a therapeutic procedure, technical demands have risen. Furthermore, it is an invasive procedure that can be potentially harmful when administered improperly. Quality of ERCP and procedural outcome are dependent on various factors that are related to the patient, procedure, and endoscopist. These factors are reviewed in detail and their contribution to ERCP quality is presented and discussed. Preventive therapies through procedural techniques and medical management to avoid complications are available. Proper and organised training and ERCP outcome reporting are essential for further quality improvement.
{"title":"Perfect or Failed ERCP: What Makes the Difference?","authors":"J. Spicak, T. Hucl","doi":"10.33590/emjgastroenterol/10311684","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311684","url":null,"abstract":"Endoscopic retrograde cholangiopancreatography (ERCP) has become an effective and safe therapeutic method, providing clinical success in more than 80% of cases. As ERCP has evolved from a diagnostic to a therapeutic procedure, technical demands have risen. Furthermore, it is an invasive procedure that can be potentially harmful when administered improperly. Quality of ERCP and procedural outcome are dependent on various factors that are related to the patient, procedure, and endoscopist. These factors are reviewed in detail and their contribution to ERCP quality is presented and discussed. Preventive therapies through procedural techniques and medical management to avoid complications are available. Proper and organised training and ERCP outcome reporting are essential for further quality improvement.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88198406","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 : 2015-12-15DOI: 10.33590/emjgastroenterol/10313546
D. Kelly
Advances in medical and surgical therapy mean that significant numbers of children with previously fatal liver disease are surviving into adult life. In particular, 80% of transplant recipients now survive for over 20 years. Gastroenterologists and hepatologists who treat adult patients need to be aware of the clinical management and complications of diseases originating in infancy, such as biliary atresia, progressive familial intrahepatic cholestasis, Alagille syndrome, and metabolic diseases such as hereditary tyrosinemia type 1. They need to be familiar with the long-term consequences of liver transplantation in childhood, e.g. renal failure, recurrent disease, osteoporosis, and post-transplant malignancies, especially post-transplant lymphoproliferative disease, which differs in presentation and evolution from adult transplant recipients. Survivors of childhood illness require a different approach to that for young adults presenting after 18 years of age. Adult physicians need to consider the emotional, social, and sexual health of these young people, and be aware of the high rate of non-adherence, both for clinic appointments and medication, as well as the implications for graft loss, particularly after transition to adult services. Developing adequate transitional care for these young people is based on effective collaboration at the paediatric–adult interface and is a major challenge for paediatric and adult providers alike in the 21st century.
{"title":"Bridging Paediatric Liver Diseases to Adult Care: What Does the Gastroenterologist Need to Know?","authors":"D. Kelly","doi":"10.33590/emjgastroenterol/10313546","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313546","url":null,"abstract":"Advances in medical and surgical therapy mean that significant numbers of children with previously fatal liver disease are surviving into adult life. In particular, 80% of transplant recipients now survive for over 20 years. Gastroenterologists and hepatologists who treat adult patients need to be aware of the clinical management and complications of diseases originating in infancy, such as biliary atresia, progressive familial intrahepatic cholestasis, Alagille syndrome, and metabolic diseases such as hereditary tyrosinemia type 1. They need to be familiar with the long-term consequences of liver transplantation in childhood, e.g. renal failure, recurrent disease, osteoporosis, and post-transplant malignancies, especially post-transplant lymphoproliferative disease, which differs in presentation and evolution from adult transplant recipients. Survivors of childhood illness require a different approach to that for young adults presenting after 18 years of age. Adult physicians need to consider the emotional, social, and sexual health of these young people, and be aware of the high rate of non-adherence, both for clinic appointments and medication, as well as the implications for graft loss, particularly after transition to adult services. Developing adequate transitional care for these young people is based on effective collaboration at the paediatric–adult interface and is a major challenge for paediatric and adult providers alike in the 21st century.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73170465","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 : 2015-12-15DOI: 10.33590/emjgastroenterol/10311701
V. Lane
This symposium provided an opportunity for global experts to discuss the challenges posed by the introduction of biosimilars. The impact of the manufacturing process on clinical outcomes, maintaining treatment responses over the long term, and issues surrounding patient management in a changing environment were addressed. The symposium was opened by Prof Panaccione describing the evolution of inflammatory bowel disease (IBD) treatment in the last 20 years and how biologics have improved outcomes. Prof D’Haens provided an explanation of the complexity surrounding biologic drug development and the hurdles facing drug manufacturers when ensuring high quality and consistently performing products over time. Prof Panaccione discussed the clinical challenges in balancing the transition from induction to maintenance therapy in order to provide a clinically relevant and sustained response to therapy. He also discussed the evidence for long-term outcomes with adalimumab for IBD. Prof Feagan highlighted the issues faced by clinicians treating patients with biologics, including the ability to switch between biologics without loss of efficacy or impact on safety, and the need to consider interchangeability between biologic therapies and the potential risk and impact of immunogenicity.
{"title":"Biologic Therapies: From Complexity to Clinical Practice in a Changing Environment","authors":"V. Lane","doi":"10.33590/emjgastroenterol/10311701","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311701","url":null,"abstract":"This symposium provided an opportunity for global experts to discuss the challenges posed by the introduction of biosimilars. The impact of the manufacturing process on clinical outcomes, maintaining treatment responses over the long term, and issues surrounding patient management in a changing environment were addressed.\u0000\u0000The symposium was opened by Prof Panaccione describing the evolution of inflammatory bowel disease (IBD) treatment in the last 20 years and how biologics have improved outcomes. Prof D’Haens provided an explanation of the complexity surrounding biologic drug development and the hurdles facing drug manufacturers when ensuring high quality and consistently performing products over time. Prof Panaccione discussed the clinical challenges in balancing the transition from induction to maintenance therapy in order to provide a clinically relevant and sustained response to therapy. He also discussed the evidence for long-term outcomes with adalimumab for IBD. Prof Feagan highlighted the issues faced by clinicians treating patients with biologics, including the ability to switch between biologics without loss of efficacy or impact on safety, and the need to consider interchangeability between biologic therapies and the potential risk and impact of immunogenicity.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81239242","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 : 2015-12-15DOI: 10.33590/emjgastroenterol/10311149
Lauri Arnstein
Despite major advances in the inflammatory bowel disease (IBD) treatment landscape, the management of ulcerative colitis (UC) and Crohn’s disease (CD) continues to pose challenges. There is significant scope to optimise treatment of IBD, and conventional therapies may fail to meet evolving treatment goals. Induction of remission with clinical control of symptoms and maintenance of remission with long-term prevention of disease progression are important considerations for healthcare professionals. The concept of complete remission integrates clinical remission, patient-reported outcomes, and mucosal healing, a key therapeutic goal for disease modification. The anti-integrin vedolizumab has been proven to be effective in inducing and maintaining clinical remission in IBD, both first-line and in tumour necrosis factor α (TNFα)-experienced patients, and has demonstrated mucosal healing benefits in UC patients. Safety remains critical for all therapies and vedolizumab is generally well-tolerated across all age groups, including the elderly. Real-world experience with vedolizumab has shown broadly comparable outcomes to the pivotal clinical trials.
{"title":"Achieving Treatment Goals in Inflammatory Bowel Disease: The Role of Gut-Selective Therapy","authors":"Lauri Arnstein","doi":"10.33590/emjgastroenterol/10311149","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311149","url":null,"abstract":"Despite major advances in the inflammatory bowel disease (IBD) treatment landscape, the management of ulcerative colitis (UC) and Crohn’s disease (CD) continues to pose challenges. There is significant scope to optimise treatment of IBD, and conventional therapies may fail to meet evolving treatment goals. Induction of remission with clinical control of symptoms and maintenance of remission with long-term prevention of disease progression are important considerations for healthcare professionals. The concept of complete remission integrates clinical remission, patient-reported outcomes, and mucosal healing, a key therapeutic goal for disease modification. The anti-integrin vedolizumab has been proven to be effective in inducing and maintaining clinical remission in IBD, both first-line and in tumour necrosis factor α (TNFα)-experienced patients, and has demonstrated mucosal healing benefits in UC patients. Safety remains critical for all therapies and vedolizumab is generally well-tolerated across all age groups, including the elderly. Real-world experience with vedolizumab has shown broadly comparable outcomes to the pivotal clinical trials.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73066935","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 : 2015-12-15DOI: 10.33590/emjgastroenterol/10310813
S. Smith
Helicobacter pylori treatment is becoming a challenge in light of increasing antimicrobial resistance and falling eradication rates. This is a cause for concern based on the complications of H. pylori infection, which include gastric and peptic ulcers, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. This review discusses recent data assessing the current treatment options for H. pylori infection and the importance of considering the prevalence of antibiotic resistance at a regional level when choosing an appropriate therapy. Alternatives to the standard first-line treatment, such as bismuth and non-bismuth quadruple therapies, are outlined and rescue therapies involving levofloxacin and rifabutin are also reviewed.
{"title":"An Update on the Treatment of Helicobacter Pylori Infection","authors":"S. Smith","doi":"10.33590/emjgastroenterol/10310813","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310813","url":null,"abstract":"Helicobacter pylori treatment is becoming a challenge in light of increasing antimicrobial resistance and falling eradication rates. This is a cause for concern based on the complications of H. pylori infection, which include gastric and peptic ulcers, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. This review discusses recent data assessing the current treatment options for H. pylori infection and the importance of considering the prevalence of antibiotic resistance at a regional level when choosing an appropriate therapy. Alternatives to the standard first-line treatment, such as bismuth and non-bismuth quadruple therapies, are outlined and rescue therapies involving levofloxacin and rifabutin are also reviewed.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81840445","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 : 2015-12-01DOI: 10.33590/emjgastroenterol/10314782
P. Andreozzi, F. Zito, G. Sarnelli, R. Cuomo
Acute diverticulitis is an acute inflammation of colonic diverticulae that is associated with an episode of severe, prolonged, lower abdominal pain (usually on the left side), changes in bowel movements, low-grade fever, and leukocytosis. Acute diverticulitis is a significant burden in industrialised societies, accounting for 313,000 hospitalisations in the USA alone, and a trend of rising incidence has been observed. Despite the high prevalence, the management of diverticulitis and post-diverticulitis is largely based on consensus more than evidence derived from randomised clinical trials. In this review we will focus on the diagnosis and management strategies for diverticulitis and post-diverticulitis.
{"title":"Management of Diverticulitis and Prevention of Recurrence","authors":"P. Andreozzi, F. Zito, G. Sarnelli, R. Cuomo","doi":"10.33590/emjgastroenterol/10314782","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314782","url":null,"abstract":"Acute diverticulitis is an acute inflammation of colonic diverticulae that is associated with an episode of severe, prolonged, lower abdominal pain (usually on the left side), changes in bowel movements, low-grade fever, and leukocytosis. Acute diverticulitis is a significant burden in industrialised societies, accounting for 313,000 hospitalisations in the USA alone, and a trend of rising incidence has been observed. Despite the high prevalence, the management of diverticulitis and post-diverticulitis is largely based on consensus more than evidence derived from randomised clinical trials. In this review we will focus on the diagnosis and management strategies for diverticulitis and post-diverticulitis.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85755661","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 : 2014-12-03DOI: 10.33590/emjgastroenterol/10310651
Ayse Nilüfer Özaydın
The discovery of Helicobacter pylori was hopeful as this agent was included in the list of ‘preventable- infectious carcinogens’, and many non-treatable gastroduodenal disorders with uncertain causes became treatable infectious diseases. Nevertheless, nowadays frequent antibiotic resistance is observed among H. pylori infections, sometimes as high as 95%. H. pylori is a bacteria that existed for a very long time, which was only recognised in the last 30 years. It can cause a variety of symptoms leading to gastroduodenal disorders from chronic inflammation in the gastrointestinal system to non-cardia gastric cancer. It is acquired in the early years of life and infection is commonly lifelong. The accepted primary route of transmission is person-to-person contact because humans are the only known significant reservoir of H. pylori. The target cell of H. pylori is the gastric mucus secreting cell. The prevalence in Europe shows a huge variety with almost all studies showing a decreasing trend. During childhood the highest prevalence was from Turkey (56.6%) and the lowest was from Czech Republic (4.8%). Among adults, the overall prevalence was found to be between 18.3% (Denmark) and 82.5% (Turkey), with substantial country-to-country variations. The prevalence rate differs by socioeconomic lifestyle characteristics and also genomic structure; it is also higher in less developed countries/populations. While the more commonly used test to determine H. pylori infection is serology, immunoglobulin G by enzyme-linked immunosorbent assay, the urea breath test (UBT), and stool antigen testing are non- invasive tests which are also recommended.
{"title":"The Geographic Variance of Helicobacter Pylori Infection in Europe and its Impact on the Incidence of Gastric Cancer","authors":"Ayse Nilüfer Özaydın","doi":"10.33590/emjgastroenterol/10310651","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310651","url":null,"abstract":"The discovery of Helicobacter pylori was hopeful as this agent was included in the list of ‘preventable- infectious carcinogens’, and many non-treatable gastroduodenal disorders with uncertain causes became treatable infectious diseases. Nevertheless, nowadays frequent antibiotic resistance is observed among H. pylori infections, sometimes as high as 95%. H. pylori is a bacteria that existed for a very long time, which was only recognised in the last 30 years. It can cause a variety of symptoms leading to gastroduodenal disorders from chronic inflammation in the gastrointestinal system to non-cardia gastric cancer. It is acquired in the early years of life and infection is commonly lifelong. The accepted primary route of transmission is person-to-person contact because humans are the only known significant reservoir of H. pylori. The target cell of H. pylori is the gastric mucus secreting cell. The prevalence in Europe shows a huge variety with almost all studies showing a decreasing trend. During childhood the highest prevalence was from Turkey (56.6%) and the lowest was from Czech Republic (4.8%). Among adults, the overall prevalence was found to be between 18.3% (Denmark) and 82.5% (Turkey), with substantial country-to-country variations. The prevalence rate differs by socioeconomic lifestyle characteristics and also genomic structure; it is also higher in less developed countries/populations. While the more commonly used test to determine H. pylori infection is serology, immunoglobulin G by enzyme-linked immunosorbent assay, the urea breath test (UBT), and stool antigen testing are non- invasive tests which are also recommended.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88716616","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 : 2014-12-03DOI: 10.33590/emjgastroenterol/10313663
M. Soltes, D. Popa, A. Fingerhut, C. Dziri
Complicated diverticular disease refers to patients who present with abscess, peritonitis, bleeding, fistula, or bowel obstruction. Management paradigms for these complications have changed enormously in the last 20 years. Surgical options include primary resection with or without anastomosis, exteriorisation of the perforation as the site of diversion, and more and more in recent years, simple lavage and drainage. The different classifications, the indications and techniques of interventional radiology, and endoscopy, as well as other minimally invasive or traditional surgical treatment of these complications are covered in this review.
{"title":"Managing Complicated Diverticular Disease in 2014","authors":"M. Soltes, D. Popa, A. Fingerhut, C. Dziri","doi":"10.33590/emjgastroenterol/10313663","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313663","url":null,"abstract":"Complicated diverticular disease refers to patients who present with abscess, peritonitis, bleeding, fistula, or bowel obstruction. Management paradigms for these complications have changed enormously in the last 20 years. Surgical options include primary resection with or without anastomosis, exteriorisation of the perforation as the site of diversion, and more and more in recent years, simple lavage and drainage. The different classifications, the indications and techniques of interventional radiology, and endoscopy, as well as other minimally invasive or traditional surgical treatment of these complications are covered in this review.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84747993","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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