Acta gastro-enterologica Belgica (ACTA GASTRO-ENT BELG )

Publisher: Societé Royale Belge de Gastro-Entérologie


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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Crohn's disease is often accompanied by extraintestinal inflammation. Acute pancreatitis can be a rare manifestation of Crohn's disease. The present report describes a patient who developed two episodes of pancreatitis before the diagnosis of Crohn's disease. Clinical and laboratory evaluation excluded other causes of pancreatitis, confirming a direct association of the pancreatitis with Crohn's disease. This case report supports the hypothesis that acute pancreatitis may precede the clinical manifestations and diagnosis of the underlying inflammatory bowel disease.
    Acta gastro-enterologica Belgica 09/2014; 77(3):357-8.
  • Acta gastro-enterologica Belgica 09/2014; 77(3):345-6.
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    ABSTRACT: Calprotectin is a cytoplasmatic protein of neutrophilic granulocytes and it is an established marker for the assessment of localized intestinal inflammation. To explore correlation between values of fecal calprotectin and degree of liver cirrhosis and hepatic encephalopathy. We included 60 patients with liver cirrhosis and 37 healthy patients as controls. Patients revealing other causes of abnormal calprotectin results (gastrointestinal bleeding or inflammatory bowel disease) were excluded. The degree of liver insufficiency was assessed according to the Child-Pugh classification and Model of End Stage Liver Disease (MELD), and degree of hepatic enceph- alopathy by West-Haven criteria, serum concentration of ammonium ion and the number connection test. The mean value of fecal calprotectin in patients with liver cirrhosis was 189.1 ± 168.0 μg/g, and 35.0 ± 26.0 μg/g in the control group, respectively. We have confirmed significantly higher fecal calprotectin in patients with cirrhosis (p < 0.001). There were no significant differences in values of fecal calprotectin between the patients with different stages of liver cirrhosis according to Child-Pugh classification and MELD score (p > 0.05). We observed statistically significant difference comparing fecal calprotectin by West-Haven criteria of hepatic encephalopathy (p < 0.001), while there were no correlation with the number connection test and serum concentration of ammonium ion (p > 0.05). We confirmed significantly higher values of fecal calprotectin in patients with liver cirrhosis, especially in hepatic encephalopathy according to West-Haven criteria.
    Acta gastro-enterologica Belgica 09/2014; 77(3):302-5.
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    ABSTRACT: Mushroom poisoning by Amanita phalloides is a rare but potentially fatal disease. The initial symptoms of nausea, vomiting, abdominal pain and diarrhea, which are typical for the intoxication, can be interpreted as a common gastro-enteritis. The intoxication can progress to acute liver and renal failure and eventually death. Recognizing the clinical syndrome is extremely important. In this case report, 4 patients with amatoxin intoxication who showed the typical clinical syndrome are described. The current therapy of amatoxin intoxication is based on small case series, and no ran- domised controlled trials are available. The therapy of amatoxin intoxication consists of supportive care and medical therapy with silibinin and N-acetylcysteine. Patients who develop acute liver failure should be considered for liver transplantation.
    Acta gastro-enterologica Belgica 09/2014; 77(3):353-6.
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    ABSTRACT: Primary hepatic vascular neoplasms constitute a heterogeneous group of neoplasms with characteristic histology and variable tumour biology. To provide an updated overview on clinicopathological features, treatment and outcome of primary hepatic vascular tumours. In our retrospective study, we reviewed 10 cases of primary hepatic vascular tumours that were diagnosed at the pathology department of Mongi Slim hospital over a thirteen-year period (2000-2012). Relevant clinical information and microscopic slides were available in all cases and were retrospec- tively reviewed. Our study group included 4 men and 6 women (sex ra- tio M/F = 0.66) aged between 23 and 78 years (mean = 55.5 years). Based on imaging studies, preoperative diagnosis of hemangioma was accurately made in only three cases. Three cases were misdiagnosed preoperatively as having hydatid cyst and four cases of hemangiomas were misdiagnosed preoperatively as liver metastases. All our patients underwent surgical resection of the tumour. Histopathological examination of the surgical specimen established the diagnosis of angiosarcoma in one case, cavernous hemangioma in 8 cases and sclerosing hemangioma in one case. Hepatic tumours are increasingly detected incidentally due to widespread use of modern abdominal imaging techniques. Therefore, reliable noninvasive characterization and differentiation of such liver tumours is of major importance for clinical practice. Definitive diagnosis is based on histopathologic examination.
    Acta gastro-enterologica Belgica 09/2014; 77(3):347-52.
  • Acta gastro-enterologica Belgica 09/2014; 77(3):366-7.
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    ABSTRACT: Five percent of pancreatic neoplasms are non- adenocarcinoma tumors. Clinical presentation and imaging characteristics of these tumors are similar to adenocarcinoma. This study aims at evaluating the results and efficacy of Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in diagnosing the pancreatic non-adenocarcinoma tumor in patients with solid pancreatic mass. The present study which is of a descriptive, prospective and case series nature, has been studying the diagnostic value of EUS-FNA in pancreatic non-adenocarcinoma tumor in 60 patients with pancreatic solid neoplasm. Cytopathologic diagnosis founded on EUS-FNA accepted as final diagnosis in unresectable ones. But the reference standard for the final diagnosis in patients with resectable tumor was surgical pathology. In patients with non diagnostic EUS-FNA specimen, final diagnosis achieved by re-FNA, Computerized Tomography (CT) guided biopsy, or surgery. Ten patients (17%) found to have non-adenocarcinoma tumor. Half of them were male. EUS-FNA was diagnostic in 8 cases (80%) including the 4 neuroendocrine tumors, one gastrointestinal stromal tumor, one mucinous neoplasm, one pseudopapillary tumor, and one geant cell tumor. Surgical pathology confirmed the EUS-FNA diagnosis in five patients that had resectable tumor. However EUS-FNA recognition accepted as final diagnosis in three patients that had unresectable tumor. EUS-FNA was non-diagnostic in one patient with pancreatic lymphoma and another patient with colon cancer metastasis. EUS FNA is a safe and effective for diagnosing the solid non-adenocarcinoma tumors as well as adenocarcinomas of pancreas.
    Acta gastro-enterologica Belgica 09/2014; 77(3):312-7.
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    ABSTRACT: Although laparoscopic cholecystectomy is advocated for acute cholecystitis, debate still exists about its optimal timing. This retrospective study compares the outcome of laparoscopic cholecystectomy within versus later than 5 days of onset of symptoms in patients with acute cholecystitis. One hundred thirty six patients with acute cholecystitis grade I or II were included in the study and divided in two groups. Group 1 received surgery within 5 days of symptoms and group 2 received conservative therapy and delayed surgery after 6 weeks. Group 1 and 2 consisted of 100 and 36 patients respec- tively. Because of failure of conservative therapy 5 patients of group 2 had surgery before 6 weeks. The remaining 31 patients underwent surgery after 6 weeks. Preoperative ERCP was indicated in 2 and 11 patients in groups 1 and 2 respectively (p < 0.001). The median total hospital stay was 3.0 days for group 1 and 11.0 days for group 2 (p < 0.001). In terms of operation time, conversion rates, intraoperative cholangiography, postoperative ERCP, morbidity or mortality both groups were comparable (p > 0.05). Laparoscopic cholecystectomy can be performed safely within 5 days after the onset of symptoms in patients with acute cholecystitis. Because of shortened total hospital stay and risk of failure of conservative therapy, early laparoscopic cholecystectomy should be favored.
    Acta gastro-enterologica Belgica 09/2014; 77(3):306-11.
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    ABSTRACT: Anemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD) which, in most cases, results from an absolute or functional iron deficiency. Although anemia and iron deficiency may have a dramatic impact on the quality of life of IBD patients, they are underdiagnosed and undertreated. This paper provides evidence-based consensus guidelines and practical treatment algorithms that are directly applicable to the Belgian situation. In this way, the Belgian IBD research and development Group (BIRD) aims to increase awareness and knowledge among gastroenterologists in order to improve the management of anemia and iron deficiency in their IBD patients.
    Acta gastro-enterologica Belgica 09/2014; 77(3):333-44.
  • Acta gastro-enterologica Belgica 09/2014; 77(3):365.
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    ABSTRACT: Impaired gastric accommodation has been proposed as an im- portant mechanism in the generation of functional dyspepsia. There is an interest in methods that allow recording and quantifica- tion of the gastric accommodation reflex. Drinking tests, with water or nutrients, have been developed as a noninvasive, inexpensive method to assess gastric perception and accommodation. These tests are easily performed, do not need any special equipment and are well tolerated by patients. Drink test results are reported as the maximum tolerated volume, individual and cumulative symptom scores. Patients with functional dyspepsia have showed lower max- imum tolerated volumes than healthy volunteers. In these patients the maximum tolerated volume reflects the severity of early satiety and predicts impaired gastric accommodation, but it remains un- clear what physiologic processes are assessed by the drinking tests. Results of drinking tests may be influenced by physiologic factors, thus these results do not guide therapy. Given these facts, drinking tests are best reserved for clinical research purposes evaluating functional dyspeptic patients or patients with gastroparesis.
    Acta gastro-enterologica Belgica 09/2014; 77(3):328-32.
  • Acta gastro-enterologica Belgica 09/2014; 77(3):364.
  • Acta gastro-enterologica Belgica 09/2014; 77(3):362-3.
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    ABSTRACT: Endoscopic retrograde cholangio- pancreatography with stone retrieval following endoscopic sphinc- terotomy (ES) is the standard method for the management of cho- ledocholithiasis. However, biliary stenting is used to treat patients with endoscopically irretrievable bile duct stones, especially elderly and high-risk patients. The aim of this study was to evaluate the benefits and risks of biliary stenting versus stone clearance follow- ing ES in the management of choledocholithiasis. Between January 2010 and December 2012, 165 patients with common bile duct stones who underwent biliary stenting or stone clearance following ES were enrolled. One 7 Fr. double-pigtail plastic stent was placed without ES or stone extraction. The procedure time, hospitalization period, adverse events, additional endoscopic interventions required and one-year mortality were evaluated retrospectively. Ninety-nine and 66 patients were included in stenting group and in stone clearance group, respectively. Except for age, number of stones, and use of antithrombotic agents in the stent group, there were no statistically significant difference between groups. The average procedure time and hospitalization period in the stenting group were significantly shorter than those in stone clearance group (mean 21 min vs. 43.9 min, P < 0.0001; 3.8 days vs. 6.5 days, P < 0.0001). No significant differences were seen in ad- verse events and additional endoscopic interventions required be- tween both groups for at least a 1.5-year follow-up. No one-year mortality occurred. Biliary stenting using a double-pigtail stent proved to be a useful alternative therapy to stone clearance following ES in the management of choledocholithiasis in elderly patients.
    Acta gastro-enterologica Belgica 09/2014; 77(3):297-301.
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    ABSTRACT: Fulminant herpes simplex virus (HSV) hepatitis is a rare condition, which is usually identified only after orthotopic liver transplantation (OLT) or at autopsy. The most commonly affected individuals are immunosuppressed patients, although HSV hepatitis can occur in immunocompetent patients as well. A high degree of suspicion combined with early diagnostic modalities may improve survival. We present a case report of fulminant herpetic hepatitis, requiring OLT. In addition, a review of the literature was performed.
    Acta gastro-enterologica Belgica 09/2014; 77(3):359-61.
  • Acta gastro-enterologica Belgica 06/2014; 77(2):274-6.
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    ABSTRACT: Pancreas ductal adenocarcinoma (PDAC) is among tumors with unfavorable prognosis. The aim of this study was to determine potential prognostic factors in PDAC.
    Acta gastro-enterologica Belgica 06/2014; 77(2):229-34.
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    ABSTRACT: We report on a fatal case of disseminated strongyloidiasis during corticosteroid treatment presenting with abdominal pain, diarrhoea and lower gastrointestinal bleeding. The patient emigrated from Thailand 16 years before the current hospitalisation. Complicated strongyloidiasis is a relatively unrecognized complication of corticosteroid therapy in non-endemic areas. In individuals who have resided in endemic areas, even decades before treatment, strongyloidiasis should be excluded before initiation of immunosuppressants.
    Acta gastro-enterologica Belgica 06/2014; 77(2):259-61.