Gut Guide
10 years of Mistakes in...

Your companion for tricky moments

Our brand-new book is a fresh, practical guide inspired by UEG’s popular Mistakes in... series. Filled with expert tips from leading voices in digestive health, it’s designed to help you avoid common pitfalls and refine your clinical decision-making. Whether you’re just starting or bring many years of experience, this is your go-to resource for turning lessons learned into better patient care.

An online version will be available in 2026. 



Thank you to all authors of the Gut Guide!

Find the complete list of all contributing authors and their articles below.

While not every 'Mistakes in…' article could be included in the Gut Guide, such as 'Animal models of nonalcoholic steatohepatitis' and 'Nutrition in chronic liver disease', you can discover more contributions and new additions to the collection at gutflix.eu.

Gut Guide

Acknowledgements

View our supporter of the Gut Guide.

See supporter

Gut Guide References

Chapter 1: Endoscopy

  • Endoscopy
  • Gastroscopy
  • Capsule endoscopy
  • Tissue acquisition during endoscopy
  • Colonoscopy
  • Endoscopic resection
  • Polypectomy
  • Colorectal cancer
Endoscopy

Authors: Arnaud Lemmers and Jacques Devière        
Affiliation:
Arnaud Lemmers is Head of Clinic, GI Endoscopy, Hospital Universitaire de Bruxelles (HUB), Erasme Hospital, Brussels, Belgium. 
Jacques Devière is former Head of Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.   
Correspondence:         
Link to online article: gutflix.eu/r/HJFyglfu17eA        
Conflicts of interest: None        

References:    

  1. Cameron AJ, Higgins JA. Linear gastric erosion. A lesion associated with large diaphragmatic hernia and chronic blood loss anemia. Gastroenterology. 1986; 91: 338–342. [Link]
  2. Camus M, et al. Severe upper gastrointestinal hemorrhage from linear gastric ulcers in large hiatal hernias: a large prospective case series of Cameron ulcers. Endoscopy 2013; 45: 397–400. [Link]
  3. Lara LF, et al. Dieulafoy lesions of the GI tract: localization and therapeutic outcomes. Dig Dis Sci 2010; 55: 3436–3441. [Link]
  4. Baxter M and Aly EH. Dieulafoy's lesion: current trends in diagnosis and management. Ann R Coll Surg Engl 2010; 92: 548–554. [Link]
  5. Hirano I. 2015 David Y Graham Lecture: The first two decades of eosinophilic esophagitis—from acid reflux to food allergy. Am J Gastro 2016; 111: 770–776. [Link]
  6. Vahabzadeh B, et al. Validation of the Prague C and M criteria for the endoscopic grading of Barrett’s esophagus by gastroenterology trainees: a multicenter study. Gastrointest Endosc 2012; 75: 236–241. [Link]
Gastroscopy

Authors: Jochen Weigt and Arne Kandulski    
Affiliation:
Jochen Weigt is a Professor and Section leader of Endoscopy at the Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Leipziger Str. 44 39120 Magdeburg, Germany. 
Arne Kandulski is Head of the University Endoscopy Department at the Department of Internal Medicine I, University Hospital of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. 
Correspondence:     
Link to online article: https://gutflix.eu/r/sfsGTLX3Rybn    
Conflicts of interest:
JW receives honorary for lectures and research grant from Fujifilm Europe.
AK receives speaker, consultancy and advisory board fees from Roche Pharma AG, Eisai GmbH, Abbvie Deutschland, Janssen-Cilag, Boston Scientific Corp., Micro-Tech Europe, Bayer Vital GmbH, and Bristol Myers Squibb.     

References:  

  1. Ho S-H, Uedo N, Aso A, et al. Development of Image-enhanced Endoscopy of the Gastrointestinal Tract: A Review of History and Current Evidences. Journal of clinical gastroenterology 2018; 52: 295–306. [Link]
  2. Zhao Z, Yin Z, Wang S, et al. Meta-analysis: The diagnostic efficacy of chromoendoscopy for early gastric cancer and premalignant gastric lesions. Journal of gastroenterology and hepatology 2016; 31: 1539–45. [Link]
  3. Kikuste I, Marques-Pereira R, Monteiro-Soares M, et al. Systematic review of the diagnosis of gastric premalignant conditions and neoplasia with high-resolution endoscopic technologies. Scandinavian journal of gastroenterology 2013; 48: 1108–17. [Link]
  4. Pimentel-Nunes P, Dinis-Ribeiro M, Soares JB, et al. A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions. Endoscopy 2012; 44: 236–46. [Link]
  5. Dias-Silva D, Pimentel-Nunes P, Magalhães J, et al. The learning curve for narrow-band imaging in the diagnosis of precancerous gastric lesions by using Web-based video. Gastrointestinal endoscopy 2014; 79: 910–20; quiz 983-e1, 983.e4. [Link]
  6. Esposito G, Pimentel-Nunes P, Angeletti S, et al. Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study. Endoscopy 2019; 51: 515–521. [Link]
  7. Shu X, Wu G, Zhang Y, et al. Diagnostic value of linked color imaging based on endoscopy for gastric intestinal metaplasia: a systematic review and meta-analysis. Annals of translational medicine 2021; 9: 506. [Link]
  8. Zhang G, Zheng J, Zheng L, et al. Gastric intestinal metaplasia assessment between linked color imaging based on endoscopy and pathology. Scandinavian journal of gastroenterology 2021; 56: 103–110. [Link]
  9. Subramaniam S, Kandiah K, Schoon E, et al. Development and validation of the international Blue Light Imaging for Barrett’s Neoplasia Classification. Gastrointestinal endoscopy 2020; 91: 310–320. [Link]
  10. de Groof AJ, Fockens KN, Struyvenberg MR, et al. Blue-light imaging and linked-color imaging improve visualization of Barrett’s neoplasia by nonexpert endoscopists. Gastrointestinal endoscopy 2020; 91: 1050–1057. [Link]
Capsule endoscopy

Authors: Cristina Carretero and Reena Sidhu        
Affiliation:
Cristina Carretero is a Gastroenterologist at University of Navarra Clinic, Pamplona, Spain. 
Reena Sidhu is a Consultant Gastroenterologist & Hon Sen Lecturer University of Sheffield. FRCP MD. Academic unit of Gastroenterology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.     
Correspondence:      
Link to online article: https://gutflix.eu/r/cTQrDVFIYZt2        
Conflicts of interest: None     

References:

  1. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352–386. [Link]
  2. Maiden L, Thjodleifsson B, Seigal A, et al. Long-Term Effects of Nonsteroidal Anti-Inflammatory Drugs and Cyclooxygenase-2 Selective Agents on the Small Bowel: A Cross- Sectional Capsule Enteroscopy Study. Clin Gastroenterol Hepatol 2007; 5: 1040–1045. [Link]
  3. Sidhu R, Brunt LK, Morley SR, et al. Undisclosed use of nonsteroidal anti-inflammatory drugs may underlie small-bowel injury observed by capsule endoscopy. Clin Gastroenterol Hepatol 2010; 8: 992–995. [Link]
  4. Liao Z, Gao R, Xu C, et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010; 71: 280–286. [Link]
  5. Rondonotti E, Spada C, Adler S, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423–446. [Link]
  6. Nemeth A, Kopylov U, Koulaouzidis A, et al. Use of patency capsule in patients with established Crohn’s disease. Endoscopy 2016; 48: 373–379. [Link]
Tissue acquisition during endoscopy

Authors: Richard Azevedo and Mário Dinis-Ribeiro        
Affiliation: Richard Azevedo and Mário Dinis-Ribeiro are at the Department of Gastroenterology, Portuguese Oncology Institute of Porto, Portugal.        
Correspondence:         
Link to online article: https://gutflix.eu/r/vyj1ze2vPLYZ        
Conflicts of interest: None        

References:

  1. Ono S, Fujishiro M, Kodashima S, et al. Evaluation of safety of endoscopic biopsy without cessation of antithrombotic agents in Japan. Journal of Gastroenterology 2012; 47: 770–774. [Link]
  2. Whitson MJ, Dikman AE, von Althann C, et al. Is gastroduodenal biopsy safe in patients receiving aspirin and clopidogrel?: a prospective, randomized study involving 630 biopsies. Journal of clinical gastroenterology 2011; 45: 228–33. [Link]
  3. Veitch AM, Radaelli F, Alikhan R, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut 2021; 70: 1611–1628. [Link]
  4. Acosta RD, Abraham NS, Chandrasekhara V, et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointestinal Endoscopy 2016; 83: 3–16. [Link]
  5. Sancho-Poch FJ, Balanzó J, Ocaña J, et al. An evaluation of gastric biopsy in the diagnosis of gastric cancer. Gastrointestinal Endoscopy 1978; 24: 281–282. [Link]
  6. Misumi A, Mori K, Ikeda T, et al. Evaluation of fibergastroscopic biopsy in the diagnosis of gastric cancer: a study of 339 cases. Gastroenterologia Japonica 1978; 13: 255–63. [Link]
  7. Lal N, Bhasin DK, Malik AK, et al. Optimal number of biopsy specimens in the diagnosis of carcinoma of the oesophagus. Gut 1992; 33: 724–726. [Link]
  8. Choi Y, Choi HS, Jeon WK, et al. Optimal Number of Endoscopic Biopsies in Diagnosis of Advanced Gastric and Colorectal Cancer. Journal of Korean Medical Science 2012; 27: 36–39. [Link]
  9. Pimenta-Melo AR, Monteiro-Soares M, Libânio D, et al. Missing rate for gastric cancer during upper gastrointestinal endoscopy: a systematic review and meta-analysis. European journal of gastroenterology & hepatology 2016; 28: 1041–9. [Link]
  10. Pouw RE, Barret M, Biermann K, et al. Endoscopic tissue sampling - Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 1174–1188. [Link]
  11. Pouw RE, Bisschops R, Gecse KB, et al. Endoscopic tissue sampling - Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 1261–1273. [Link]
  12. Han KS, Sohn DK, Choi DH, et al. Prolongation of the period between biopsy and EMR can influence the nonlifting sign in endoscopically resectable colorectal cancers. Gastrointestinal Endoscopy 2008; 67: 97–102. [Link]
Colonoscopy

Authors: Manmeet Matharoo, Srivathsan Ravindran and Siwan Thomas-Gibson        
Affiliation:
Manmeet Matharoo is a consultant Gastroenterologist at St Mark’s Hospital, London. 
Srivathsan Ravindran is a research fellow based at St Mark’s Hospital, Imperial College London and the Joint Advisory Group on Gastrointestinal endoscopy (JAG), London, UK.
Siwan Thomas-Gibson is a gastroenterologist and specialist endoscopist and Deputy Director of Bowel Cancer Screening at St Mark’s Hospital, London, London, UK. She was the appointed Dean of St Mark’s Hospital Academic Institute in 2019-2021.      
Correspondence:         
Link to online article: https://gutflix.eu/r/7WbNZU9z8WbQ        
Conflicts of interest: None        

References:

  1. Rees CJ, Trebble TM, Wagner CV, et al. British Society of Gastroenterology position statement on patient experience of GI endoscopy. Gut 2020; 69: 1718–1719. [Link]
  2. Maurice JB, Rochford A, Marshall S, et al. Green endoscopy: using quality improvement to develop sustainable practice. Frontline Gastroenterology 2022; 13: 342–345. [Link]
  3. British Society of Gastroenterology (BSG), Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS)  Guidance on the indications for diagnostic upper gi endoscopy, flexible sigmoidoscopy and colonoscopy. 2013. [Link]
  4. Ravindran S, Haycock A, Woolf K, et al. Development and impact of an endoscopic non-technical skills (ENTS) behavioural marker system. BMJ simulation & technology enhanced learning 2020; 7: 17–25. [Link]
  5. Hicks M MS Caitlin W. Improving Safety and Quality of Care With Enhanced Teamwork Through Operating Room Briefings. JAMA Surgery 2014; 149: 863–868. [Link]
  6. Matharoo M, Thomas-Gibson S, Haycock A, et al. Implementation of an endoscopy safety checklist. Frontline Gastroenterology 2014; 5: 260–265. [Link]
  7. Gralnek IM, Bisschops R, Matharoo M, et al. Guidance for the implementation of a safety checklist for gastrointestinal endoscopic procedures: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2022; 54: 206–210. [Link]
  8. Ching H-L, Lau MS, Azmy IA, et al. Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2022; 54: 712–722. [Link]
  9. Everett SM, Griffiths H, Nandasoma U, et al. Guideline for obtaining valid consent for gastrointestinal endoscopy procedures. Gut 2016; 65: 1585–1601. [Link]
  10. Choy MC, Matharoo M, Thomas-Gibson S. Diagnostic ileocolonoscopy: getting the basics right. Frontline Gastroenterology 2020; 11: 484–490. [Link]
  11. Gavin DR, Valori RM, Anderson JT, et al. The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut 2013; 62: 242–249. [Link]
  12. Anderson R, Burr NE, Valori R. Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis. Gastroenterology 2020; 158: 1287-1299.e2. [Link]
  13. Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. UEG Journal 2017; 5: 309–334. [Link]
  14. Kaminski MF, Wieszczy P, Rupinski M, et al. Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death. Gastroenterology 2017; 153: 98–105. [Link]
  15. Manfredi MA, Dayyeh BKA, Bhat YM, et al. Electronic chromoendoscopy. Gastrointestinal Endoscopy 2015; 81: 249–261. [Link]
  16. Repici A, Spadaccini M, Antonelli G, et al. Artificial intelligence and colonoscopy experience: lessons from two randomised trials. Gut 2022; 71: 757–765. [Link]
  17. Kröner PT, Engels MM, Glicksberg BS, et al. Artificial intelligence in gastroenterology: A state-of-the-art review. World Journal of Gastroenterology 2021; 27: 6794–6824. [Link]
  18. Siau K, Crossley J, Dunckley P, et al. Direct observation of procedural skills (DOPS) assessment in diagnostic gastroscopy: nationwide evidence of validity and competency development during training. Surgical Endoscopy 2019; 34: 105–114. [Link]
  19. Ravindran S, Matharoo M, Coleman M, et al. Teamworking in endoscopy: a human factors toolkit for the COVID-19 era. Endoscopy 2020; 52: 879–883. [Link]
  20. Ravindran S, Healey C, Coleman M, et al. Validation of the TEAM-ENTS (teamwork in endoscopy assessment module for endoscopic non-technical skills) framework. Endoscopy 2022; 54: S171 [Link]
  21. Lee TJ, Siau K, Esmaily S, et al. Development of a national automated endoscopy database: The United Kingdom National Endoscopy Database (NED). UEG Journal 2019; 7: 798–806. [Link]
  22. Rey JF, Lambert R, ESGE Quality Assurance Committee. ESGE recommendations for quality control in gastrointestinal endoscopy: guidelines for image documentation in upper and lower GI endoscopy. Endoscopy 2001; 33: 901–3. [Link]
Endoscopic resection

Authors: Francesco Auriemma and Alessandro Repici        
Affiliation:
Francesco Auriemma and Alessandro Repici are at the Digestive Endoscopy Unit, Humanitas Research Hospital, Milan, Italy. 
Alessandro Repici is also at the Humanitas University, Rozzano, MI, Italy.       
Correspondence: [email protected]    
Link to online article: ttps://gutflix.eu/r/kG0n1LlVhG2z        
Conflicts of interest: None        
Online Video 1: https://youtu.be/G2I8XTtYVqc?feature=shared

References:    

  1. Moss A, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909–1918. [Link]
  2. Rex DK, Hassan C, Bourke MJ. The colonoscopist’s guide to the vocabulary of colorectal neoplasia: histology, morphology, and management. Gastrointestinal Endoscopy 2017; 86: 253–263. [Link]
  3. Klein A and Bourke MJ. How to perform high-quality endoscopic mucosal resection during colonoscopy. Gastroenterology 2017; 152: 466–471. [Link]
  4. Fahrtash-Bahin F et al. Snare tip soft coagulation achieves effective and safe endoscopic hemostasis during wide-field endoscopic resection of large colonic lesions (with videos). Gastrointest Endosc 2013; 78: 158–163. [Link]
  5. Burgess NG et al. Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol 2014; 12: 651–661.e3. [Link]
Polypectomy

Authors: Lynn Debels and David J. Tate        
Affiliation:
Lynn Debels is a gastroenterologist and a fellow in Interventional Endoscopy at the University Hospital of Ghent, C Heymanslaan 10, Belgium. 
David J. Tate is a British Interventional Endoscopist at theUniversity Hospital of Ghent, C Heymanslaan 10, Belgium    
Correspondence:         
Link to online article: https://gutflix.eu/r/6cv1x6VUA7NL        
Conflicts of interest:
DJT consulting fees and research support from Olympus Medical.
LD no conflicts of interest.         

References:    

  1. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. The New England journal of medicine 1993; 329: 1977–81. [Link]
  2. Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. The New England journal of medicine 2012; 366: 687–96. [Link]
  3. Anderson R, Burr NE, Valori R. Causes of post-colonoscopy colorectal cancers based on World Endoscopy Organization system of analysis. Gastroenterology 2020; 158: 1287–99.e2. [Link]
  4. Pohl H, Srivastava A, Bensen SP, et al. Incomplete polyp resection during colonoscopy – results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144: 74–80.e1. [Link]
  5. Waschke KA, Anderson J, Valori RM, et al. ASGE principles of endoscopic training. Gastrointestinal endoscopy 2019; 90: 27–34. [Link]
  6. Jegadeesan R, Aziz M, Desai M, et al. Hot snare vs cold snare polypectomy for endoscopic removal of 4–10 mm colorectal polyps during colonoscopy: a systematic review and meta-analysis of randomised controlled studies. Endoscopy international open 2019; 7: E708–16. [Link]
  7. Qu J, Jian H, Li L, et al. Effectiveness and safety of cold versus hot snare polypectomy: a meta-analysis. Journal of gastroenterology and hepatology 2019; 34: 49–58. [Link]
  8. Kawamura T, Takeuchi Y, Asai S, et al. A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study). Gut 2018; 67: 1950–7. [Link]
  9. Rodríguez Sánchez J, Sánchez Alonso M, Pellisé Urquiza M. The “bubble sign”: a novel way to detect a perforation after cold snare polypectomy. Endoscopy 2019; 51: 796–7. [Link]
  10. Tate DJ, Desomer L, Heitman SJ, et al. Clinical implications of decision making in colorectal polypectomy: an international survey of Western endoscopists suggests priorities for change. Endoscopy international open 2020; 8: E445–55. [Link]
  11. Schett B, Wallner J, Weingart V, et al. Efficacy and safety of cold snare resection in preventive screening colonoscopy. Endoscopy international open 2017; 5: E580–6. [Link]
  12. Paspatis GA, Tribonias G, Konstantinidis K, et al. A prospective randomised comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps. Colorectal disease 2011; 13: e345–8. [Link]
  13. Sidhu M, Forbes N, Tate DJ, et al. A randomised controlled trial of cold snare polypectomy technique: technique matters more than snare wire diameter. The American journal of gastroenterology 2022; 117: 100. [Link]
  14. Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270–97. [Link]
  15. The Gastrointestinal Quality and Safety Foundation [Internet]. Brussels: GIEQs Online Educational Platform; c2022 [cited 2022 Aug 18]. Best practice demonstration of cold snare polypectomy; [starts at Chapter 4]. [Link]
  16. Repici A, Hassan C, Vitetta E, et al. Safety of cold polypectomy for <10 mm polyps at colonoscopy: a prospective multicentre study. Endoscopy 2012; 44: 27–31. [Link]
  17. Moss A, Bourke MJ, Williams SJ, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909–18. [Link]
  18. Moss A, Williams SJ, Hourigan LF, et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57–65. [Link]
  19. Peery AF, Cools KS, Strassle PD, et al. Increasing rates of surgery for patients with nonmalignant colorectal polyps in the United States. Gastroenterology 2018; 154: 1352–60.e3. [Link]
  20. Bahin FF, Heitman SJ, Bourke MJ. Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis. Gut 2019; 68: 1130. [Link]
  21. Adler J, Robertson DJ. Interval colorectal cancer after colonoscopy: exploring explanations and solutions. The American journal of gastroenterology 2015; 110: 1657–64. [Link]
  22. Kudo S-e, Tamura S, Nakajima T, et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointestinal endoscopy 1996; 44: 8–14. [Link]
  23. Sano Y, Tanaka S, Kudo S-e, et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Digestive endoscopy 2016; 28: 526–33. [Link]
  24. Hewett DG, Kaltenbach T, Sano Y, et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143: 599–607.e1. [Link]
  25. Debels L, Tate DJ. The accuracy of human detection of submucosal invasive cancer – analysis of 739 individual assessments of large non-pedunculated colorectal polyps using a novel clinical decision support tool. United European gastroenterology journal 2021; 9: 1197–221.  [Link]
  26. Burgess NG, Hourigan LF, Zanati SA, et al. Risk stratification for covert invasive cancer among patients referred for colonic endoscopic mucosal resection: a large multicentre cohort. Gastroenterology 2017. [Link]
  27. Tate DJ. GIEQs prediction tool for submucosal invasion [Internet]. Brussels: GIEQs Online Educational Platform; c2022 [cited 2022 Aug 18]. [Link]
  28. Bahin FF, Heitman SJ, Bourke MJ, et al. Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis. Gut 2018; 67: 1965–73. [Link]
  29. Gupta S, Miskovic D, Bhandari P, et al. A novel method for determining the difficulty of colonoscopic polypectomy. Frontline gastroenterology 2013; 4: 244–8. [Link]
  30. Sidhu M, Tate DJ, Desomer L, et al. The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon. Endoscopy 2018; 50: 684–92. [Link]
  31. Anderson J, Lockett M. Training in therapeutic endoscopy: meeting present and future challenges. Frontline gastroenterology 2019; 10: 135–40. [Link]
  32. Sidhu M, Tate DJ, Desomer L, et al. SMSA-EMR score is a novel endoscopic risk assessment tool for predicting critical endoscopic mucosal resection outcomes. Gastrointestinal endoscopy 2018; 87: AB467–8. [Link]
  33. The Gastrointestinal Quality and Safety Foundation [Internet]. Brussels: GIEQs Online Educational Platform; c2022 [cited 2022 Aug 18]. Lecture regarding competency in polypectomy covering SMSA and SMSA+ scores in practice; [starts at Chapter 17]. [Link]
  34. Tate DJ, Desomer L, Hourigan LF, et al. Two-stage endoscopic mucosal resection is a safe and effective salvage therapy after a failed single-session approach. Endoscopy 2017; 49: 888–98. [Link]
  35. Tate DJ, Bahin FF, Desomer L, et al. Cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST) is an effective and safe strategy for the management of non-lifting large laterally spreading colonic lesions. Endoscopy 2018; 50: 52–62. [Link]
  36. The Gastrointestinal Quality and Safety Foundation [Internet]. Brussels: GIEQs Online Educational Platform; c2022 [cited 2022 Aug 18]. Assessing the mucosal defect after colorectal polypectomy. [Link]
  37. Bahin FF, Naidoo M, Williams SJ, et al. Prophylactic endoscopic coagulation to prevent bleeding after wide-field endoscopic mucosal resection of large sessile colon polyps. Clinical gastroenterology and hepatology 2015; 13: 722–4. [Link]
  38. Bahin FF, Rasouli KN, Byth K, et al. Prediction of clinically significant bleeding following wide-field endoscopic resection of large sessile and laterally spreading colorectal lesions: a clinical risk score. The American journal of gastroenterology 2016; 111: 1115–22. [Link]
  39. Burgess NG, Bassan MS, McLeod D, et al. Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut 2017; 66: 1779–1789. [Link]
  40. Gupta S, Sidhu M, Shahidi N, et al. Effect of prophylactic endoscopic clip placement on clinically significant post-endoscopic mucosal resection bleeding in the right colon: a single-centre, randomised controlled trial. The Lancet gastroenterology & hepatology 2022; 7: 152–60. [Link]
  41. Pohl H, Grimm IS, Moyer MT, et al. Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomised trial. Gastroenterology 2019; 157: 977–84.e3. [Link]
Colorectal cancer

Authors: Joaquín Castillo-Iturra, Antoni Castells and Francesc Balaguer        
Affiliation:
Joaquín Castillo-Iturra, Antoni Castells and Francesc Balaguer are at the Department of Gastroenterology, Hospital Clínic de Barcelona, Spain; Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) and the Facultat de Medicina i Ciències de la Salud, Universitat de Barcelona (UB), Barcelona, Spain        
Correspondence:         
Link to online article: https://gutflix.eu/r/0zX4pUOs8f0h        
Conflicts of interest: None        

References:    

  1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209-249.  [Link]
  2. Vasen HFA, Tomlinson I, Castells A. Clinical management of hereditary colorectal cancer syndromes. Nat Rev Gastroenterol Hepatol 2015; 12: 88-97.  [Link]
  3. IJspeert JEG, Vermeulen L, Meijer GA, et al. Serrated neoplasia-role in colorectal carcinogenesis and clinical implications. Nat Rev Gastroenterol Hepatol 2015; 12: 401-409.  [Link]
  4. Baile‐Maxía S, Mangas‐Sanjuan C, Sala‐Miquel N, et al. Incidence, characteristics, and predictive factors of post‐colonoscopy colorectal cancer. United Eur Gastroenterol J 2024; 12: 309-318.  [Link]
  5. Corley DA, Jensen CD, Marks AR, et al. Adenoma Detection Rate and Risk of Colorectal Cancer and Death. N Engl J Med 2014; 370: 1298-1306.  [Link]
  6. Muto T, Bussey HJR, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975; 36: 2251-2270.  [Link]
  7. Carballal S, Balaguer F, IJspeert JEG. Serrated polyposis syndrome; epidemiology and management. Best Pract Res Clin Gastroenterol 2022; 58-59: 101791.  [Link]
  8. Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76: 182-188.  [Link]
  9. Crockett SD, Nagtegaal ID. Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia. Gastroenterology 2019; 157: 949-966.e4.  [Link]
  10. van Leerdam ME, Roos VH, van Hooft JE, et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877-895.  [Link]
  11. Dekker E, Bleijenberg A, Balaguer F. Update on the World Health Organization Criteria for Diagnosis of Serrated Polyposis Syndrome. Gastroenterology 2020; 158: 1520-1523.  [Link]
  12. Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. The Lancet 2010; 375: 1624-1633.  [Link]
  13. Mandel JS, Bond JH, Church TR, et al. Reducing Mortality from Colorectal Cancer by Screening for Fecal Occult Blood. N Engl J Med 1993; 328: 1365-1371.  [Link]
  14. Schoen RE, Pinsky PF, Weissfeld JL, et al. Colorectal-Cancer Incidence and Mortality with Screening Flexible Sigmoidoscopy. N Engl J Med 2012; 366: 2345-2357.  [Link]
  15. Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths. N Engl J Med 2012; 366: 687-696.  [Link]
  16. Van Rijn JC, Reitsma JB, Stoker J, et al. Polyp Miss Rate Determined by Tandem Colonoscopy: A Systematic Review. Am J Gastroenterol 2006; 101: 343-350.  [Link]
  17. Kaminski MF, Wieszczy P, Rupinski M, et al. Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death. Gastroenterology 2017; 153: 98-105.  [Link]
  18. Ji X. Poorly differentiated cluster grade-a vital predictor for lymph node metastasis and oncological outcomes in patients with T1 colorectal cancer: a retrospective study.  [Link]
  19. Dang H, Dekkers N, Le Cessie S, et al. Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis. Clin Gastroenterol Hepatol 2022; 20: e298-e314.  [Link]
  20. Miyachi H, Kudo S, Ichimasa K, et al. Management of T1 colorectal cancers after endoscopic treatment based on the risk stratification of lymph node metastasis. J Gastroenterol Hepatol 2016; 31: 1126-1132.  [Link]
  21. Beaton C, Twine CP, Williams GL, et al. Systematic review and meta‐analysis of histopathological factors influencing the risk of lymph node metastasis in early colorectal cancer. Colorectal Dis 2013; 15: 788-797.  [Link]
  22. Ozawa T, Kandimalla R, Gao F, et al. A MicroRNA Signature Associated With Metastasis of T1 Colorectal Cancers to Lymph Nodes. Gastroenterology 2018; 154: 844-848.e7.  [Link]
  23. Zwager LW, Bastiaansen BAJ, Montazeri NSM, et al. Deep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis. Gastroenterology 2022; 163: 174-189.  [Link]
  24. Brunori A, Daca-Alvarez M, Pellisé M. pT1 colorectal cancer: A treatment dilemma. Best Pract Res Clin Gastroenterol 2023; 66: 101854.  [Link]
  25. Rutter MD, Beintaris I, Valori R, et al. World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer. Gastroenterology 2018; 155: 909-925.e3.  [Link]
  26. Le Clercq CMC, Bouwens MWE, Rondagh EJA, et al. Postcolonoscopy colorectal cancers are preventable: a population-based study. Gut 2014; 63: 957-963.  [Link]
  27. Singh H, Nugent Z, Demers AA, et al. Rate and Predictors of Early/Missed Colorectal Cancers After Colonoscopy in Manitoba: A Population-Based Study. Am J Gastroenterol 2010; 105: 2588-2596.  [Link]
  28. Singh S, Singh PP, Murad MH, et al. Prevalence, Risk Factors, and Outcomes of Interval Colorectal Cancers: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2014; 109: 1375-1389.  [Link]
  29. Adler J, Robertson DJ. Interval Colorectal Cancer After Colonoscopy: Exploring Explanations and Solutions. Am J Gastroenterol 2015; 110: 1657-1664.  [Link]
  30. Robertson DJ, Lieberman DA, Winawer SJ, et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut 2014; 63: 949-956.  [Link]
  31. Leung LJ, Lee JK, Merchant SA, et al. Post-Colonoscopy Colorectal Cancer Etiologies in a Large Integrated US Health Care Setting. Gastroenterology 2023; 164: 470-472.e3.  [Link]
  32. Sawhney MS, Farrar WD, Gudiseva S, et al. Microsatellite Instability in Interval Colon Cancers. Gastroenterology 2006; 131: 1700-1705.  [Link]
  33. Imperiale TF, Glowinski EA, Lin-Cooper C, et al. Five-Year Risk of Colorectal Neoplasia after Negative Screening Colonoscopy. N Engl J Med 2008; 359: 1218-1224.  [Link]
  34. Laiyemo AO, Murphy G, Sansbury LB, et al. Hyperplastic polyps and the risk of adenoma recurrence in the polyp prevention trial. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2009; 7: 192-197.  [Link]
  35. Hassan C, Antonelli G, Dumonceau J-M, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy 2020; 52: 687-700.  [Link]

Chapter 2: Oesophagus and Stomach

  • Gastro-oesophageal reflux disease diagnosis
  • Eosinophilic oesophagitis
  • Endoscopic diagnosis and management of Barrett’s oesophagus
  • Endoscopic treatment of Barrett's oesophagus neoplasia
  • The management of Helicobacter pylori infection
  • The management of gastric polyps
  • The use of proton pump inhibitors
  • Gastrostomy insertion
Gastro-oesophageal reflux disease diagnosis

Authors: Sabine Roman and François Mion    
Affiliation: Sabine Roman and François Mion are at the Department of Digestive Physiology, Hospices Civils de Lyon and Lyon I University, Lyon, France.    
Correspondence:     
Link to online article: https://gutflix.eu/r/yyC37v5T8EGN    
Conflicts of interest: SR has served as consultant for Sandhill Scientific and Medtronic. FM has served as consultant for Medtronic.    

References: 

  1. Vakil N, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900–1920.  [Link]
  2. Ronkainen J and Agreus L. Epidemiology of reflux symptoms and GORD. Best Pract Res Clin Gastroenterol 2013; 27: 325–337.  [Link]
  3. Peery AF, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012; 143: 1179–1187.e1-3.  [Link]
  4. Gatta L, et al. Meta-analysis: the efficacy of proton pump inhibitors for laryngeal symptoms attributed to gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2007; 25: 385–392.  [Link]
  5. Herregods TV, et al. Patients with refractory reflux symptoms often do not have GERD. Neurogastroenterol Motil 2015; 27: 1267–1273.  [Link]
  6. Boeckxstaens GE, Zaninotto G and Richter JE. Achalasia. Lancet 2014; 383: 83–93.  [Link]
  7. Kessing BF, Bredenoord AJ and Smout AJ. Erroneous diagnosis of gastroesophageal reflux disease in achalasia. Clin Gastroenterol Hepatol 2011; 9: 1020–1024.  [Link]
  8. Gyawali CP, Yadlapati R, Fass R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut 2024; 73: 361–371.  [Link]
  9. Absah I, et al. Rumination syndrome: pathophysiology, diagnosis, and treatment. Neurogastroenterol Motil 2017; 29: e12954  [Link]
  10. Zerbib F and Stoll D. Management of laryngopharyngeal reflux: an unmet medical need. Neurogastroenterol Motil 2010; 22: 109–112.  [Link]
  11. Bytzer P, et al. Limited ability of the proton-pump inhibitor test to identify patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2012; 10: 1360–1366.  [Link]
Eosinophilic oesophagitis

Authors: Javier Molina-Infante and Alfredo J. Lucendo
Affiliation:
Javier Molina-Infante works at the Department of Gastroenterology, Hospital Universitario de Caceres, Caceres, Spain and at Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, CIBEREHD, Madrid, Spain. 
Alfredo J. Lucendo works at the Centro de Investigación Biomédicaen Red Enfermedades Hepáticas y Digestivas, CIBEREHD, Madrid, Spain and at the Department of Gastroenterology, Hospital Generalde Tomelloso, Ciudad Real, Spain.
Correspondence:
Link to online article: https://gutflix.eu/r/DPS58F7QudeJ
Conflicts of interest: None

References: 

  1. Lucendo AJ, Molina-Infante J, Arias Á, et al. Guidelines on eosinophilic esophagitis: evidence‐based statements and recommendations for diagnosis and management in children and adults. UEG Journal 2017; 5: 335–358.  [Link]
  2. Navarro P, Arias Á, Arias-González L, Laserna-Mendieta EJ, Ruiz-Ponce M, Lucendo AJ. Systematic review with meta-analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther 2019; 49: 1116-1125.   [Link]
  3. Hahn JW, Lee K, Shin JI, Cho SH, Turner S, Shin JU, et al. Global Incidence and Prevalence of Eosinophilic Esophagitis, 1976-2022: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2023; 21: 3270-3284.e77.  [Link]
  4. Roberts SE, Morrison-Rees S, Thapar N, Williams JG. Incidence and prevalence of eosinophilic oesophagitis across Europe: A systematic review and meta-analysis. United European Gastroenterol J 2024; 12: 89-102.  [Link]
  5. Plate J, Söderbergh T, Bergqvist J, et al. Eosinophilic esophagitis prevalence, incidence, and presenting features: a 22-year population-based observational study from southwest Sweden. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 2025; 38: doae025.  [Link]
  6. Schoepfer AM, Safroneeva E, Bussmann C, et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology 2013; 145: 1230–1232.  [Link]
  7. Dellon ES, Kim HP, Sperry SL, et al. A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease. Gastrointest Endosc 2014; 79: 577–585.  [Link]
  8. Lipka S, Kumar A, Richter JE. Impact of Diagnostic Delay and Other Risk Factors on Eosinophilic Esophagitis Phenotype and Esophageal Diameter. J Clin Gastroenterol 2016; 50: 134–140.  [Link]
  9. Warners MJ, Oude Nijhuis RAB, de Wijkerslooth LRH, Smout AJPM, Bredenoord AJ. The natural course of eosinophilic esophagitis and long-term consequences of undiagnosed disease in a large cohort. Am J Gastroenterol 2018; 113: 836-844.   [Link]
  10. Shoda T, Wen T, Aceves SS, Abonia JP, Atkins D, Bonis PA, et al. Eosinophilic oesophagitis endotype classification by molecular, clinical, and histopathological analyses: a cross-sectional study. Lancet Gastroenterol Hepatol 2018; 3: 477-488.   [Link]
  11. Dunn JLM, Shoda T, Caldwell JM, Wen T, Aceves SS, Collins MH, et al. Esophageal type 2 cytokine expression heterogeneity in eosinophilic esophagitis in a multisite cohort. J Allergy Clin Immunol 2020; 145: 1629-1640.e4.  [Link]
  12. Podboy AJ, Lavey C, Mara K, Geno D, Khana S, Ravi K, et al. Eosinophilic Esophagitis Is Rarely Continually Symptomatic 10 Years After an Initial Treatment Course in Adults. Dig Dis Sci 2019; 64: 3568-3578.  [Link]
  13. Greuter T, Bussmann C, Safroneeva E, Schoepfer AM, Biedermann L, Vavricka SR, et al. Long-Term Treatment of Eosinophilic Esophagitis With Swallowed Topical Corticosteroids: Development and Evaluation of a Therapeutic Concept. Am J Gastroenterol 2017; 112: 1527-1535.  [Link]
  14. Eluri S, Runge TM, Hansen J, Kochar B, Reed CC, Robey BS, et al. Diminishing Effectiveness of Long-Term Maintenance Topical Steroid Therapy in PPI Non-Responsive Eosinophilic Esophagitis. Clin Transl Gastroenterol 2017; 8:e97.   [Link]
  15. Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 2013; 62: 489-95.  [Link]
  16. Sorge A, Coletta M, Elli L, et al. Clinical practices and adherence to guidelines for eosinophilic esophagitis: A European survey. Digestive and Liver Disease 2024; 56: 1196–1203.  [Link]
  17. Aceves SS, Alexander JA, Baron TH, Bredenoord AJ, Day L, Dellon ES, et al. Endoscopic approach to eosinophilic esophagitis: American Society for Gastrointestinal Endoscopy Consensus Conference. Gastrointest Endosc 2022; 96: 576-592.e1.  [Link]
  18. Eluri S, Corder SR, Kim E, Tappata M, Reed CC, Shaheen NJ, et al. Clinical features and time trends associated with an endoscopically normal esophagus in active eosinophilic esophagitis. Endoscopy 2021; 53: 886-892.  [Link]
  19. Rodríguez-Sánchez J, Barrio-Andrés J, Nantes Castillejo O, Valdivieso-Cortazar E, Pérez-Martínez I, Boumidi A, et al. The Endoscopic Reference Score shows modest accuracy to predict either clinical or histological activity in adult patients with eosinophilic oesophagitis. Aliment Pharmacol Ther 2017; 45: 300-309.  [Link]
  20. Safroneeva E, Straumann A, Coslovsky M, Zwahlen M, Kuehni CE, Panczak R,  et al. Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults with Eosinophilic Esophagitis. Gastroenterology 2016; 150: 581-590.  [Link]
  21. Safroneeva E, Pan Z, King E, Martin LJ, Collins MH, Yang GY, et al. Long-Lasting Dissociation of Esophageal Eosinophilia and Symptoms After Dilation in Adults With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol 2022; 20: 766-775.e4.  [Link]
  22. Hirano I, Collins MH, Assouline-Dayan Y, Evans L, Gupta S, Schoepfer AM, et al. RPC4046, a Monoclonal Antibody Against IL13, Reduces Histologic and Endoscopic Activity in Patients With Eosinophilic Esophagitis. Gastroenterology 2019; 156: 592-603.e10.   [Link]
  23. Lucendo AJ, Miehlke S, Schlag C, Vieth M, von Arnim U, Molina-Infante J, et al. Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. Gastroenterology 2019; 157: 74-86.e15.   [Link]
  24. Dellon ES, Rothenberg ME, Collins MH, Hirano I, Chehade M, Bredenoord AJ, et al. Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. N Engl J Med 2022; 387: 2317-2330.  [Link]
  25. Dellon ES, Peterson KA, Mitlyng BL, Iuga A, Bookhout CE, Cortright LM, et al. Mepolizumab for treatment of adolescents and adults with eosinophilic oesophagitis: a multicentre, randomised, double-blind, placebo-controlled clinical trial. Gut 2023; 72: 1828-1837.   [Link]
  26. Gentile N, Katzka D, Ravi K, Trenkner S, Enders F, Killian J, et al. Oesophageal narrowing is common and frequently under-appreciated at endoscopy in patients with oesophageal eosinophilia. Aliment Pharmacol Ther 2014; 40: 1333-40.   [Link]
Endoscopic diagnosis and management of Barrett’s oesophagus

Authors: Rehan Haidry and Apostolis Papaefthymiou
Affiliation: Rehan Haidry and Apostolis Papaefthymiou are both at the Digestive Diseases and Surgery Institute, Cleveland Clinic, London, UK.
Correspondence:
Link to online article: https://gutflix.eu/r/yBxGZXAicLIi
Conflicts of interest:
AP declares no conflicts of interest.
RH has received research grant support from Pentax Medical, to support research infrastructure.

References:

  1. Wani S, Holmberg D, Santoni G, Kauppila JH, Farkkila M, von Euler-Chelpin M, et al. Magnitude and time-trends of post-endoscopy esophageal adenocarcinoma and post-endoscopy esophageal neoplasia in a population-based cohort study: the Nordic Barrett’s Esophagus Study. Gastroenterology 2023; 165: 909–19.e13.  [Link]
  2. Shaheen NJ, Green B, Medapalli RK, Mitchell KL, Wei JT, Schmitz SM, et al. The perception of cancer risk in patients with prevalent Barrett’s esophagus enrolled in an endoscopic surveillance program. Gastroenterology 2005; 129: 429–36.  [Link]
  3. Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 2014; 63: 7–42.  [Link]
  4. Weusten BLAM, Bisschops R, Dinis-Ribeiro M, di Pietro M, Pech O, Spaander MCW, et al. Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2023; 55: 1124–46.  [Link]
  5. Sharma P, Dent J, Armstrong D, Bergman JJGHM, Gossner L, Hoshihara Y, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392–9.  [Link]
  6. Visrodia K, Singh S, Krishnamoorthi R, Ahlquist DA, Wang KK, Iyer PG, et al. Magnitude of missed esophageal adenocarcinoma after Barrett’s esophagus diagnosis: a systematic review and meta-analysis. Gastroenterology 2016; 150: 599–607.e7.  [Link]
  7. Gupta N, Gaddam S, Wani SB, Bansal A, Rastogi A, Sharma P. Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus. Gastrointestinal endoscopy 2012; 76: 531–8.  [Link]
  8. Enestvedt BK, Lugo R, Guarner-Argente C, Shah P, Falk GW, Furth E, et al. Location, location, location: does early cancer in Barrett’s esophagus have a preference? Gastrointestinal endoscopy 2013; 78: 462–7.  [Link]
  9. Edebo A, Vieth M, Tam W, Bruno M, Van Berkel AM, Stolte M, et al. Circumferential and axial distribution of esophageal mucosal damage in reflux disease. Diseases of the esophagus 2007; 20: 232–8.  [Link]
  10. Pech O, Gossner L, Manner H, May A, Rabenstein T, Behrens A, et al. Prospective evaluation of the macroscopic types and location of early Barrett’s neoplasia in 380 lesions. Endoscopy 2007; 39: 588–93.  [Link]
  11. Kariyawasam VC, Bourke MJ, Hourigan LF, Lim G, Moss A, Williams SJ, et al. Circumferential location predicts the risk of high-grade dysplasia and early adenocarcinoma in short-segment Barrett’s esophagus. Gastrointestinal endoscopy 2012; 75: 938–44.  [Link]
  12. Sharma P, Bergman JJGHM, Goda K, Kato M, Messmann H, Alsop BR, et al. Development and validation of a classification system to identify high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus using narrow-band imaging. Gastroenterology 2016; 150: 591–8.  [Link]
  13. Lipman G, Bisschops R, Sehgal V, Ortiz-Fernández-Sordo J, Sweis R, Esteban J, et al. Systematic assessment with I-SCAN magnification endoscopy and acetic acid improves dysplasia detection in patients with Barrett’s esophagus. Endoscopy 2017; 49: 1219–28.  [Link]
  14. Coletta M, Sami SS, Nachiappan A, Fraquelli M, Casazza G, Ragunath K. Acetic acid chromoendoscopy for the diagnosis of early neoplasia and specialised intestinal metaplasia in Barrett’s esophagus: a meta-analysis. Gastrointestinal endoscopy 2016; 83: 57–67.e1.  [Link]
  15. Kandiah K, Chedgy FJQ, Subramaniam S, Longcroft-Wheaton G, Bassett P, Repici A, et al. International development and validation of a classification system for the identification of Barrett’s neoplasia using acetic acid chromoendoscopy: the Portsmouth acetic acid classification (PREDICT). Gut 2018; 67: 2085–91.  [Link]
  16. Meinikheim M, Mendel R, Palm C, et al. Influence of artificial intelligence on the diagnostic performance of endoscopists in the assessment of Barrett’s esophagus: a tandem randomized and video trial. Endoscopy 2024; 56: 641–649.  [Link]
  17. Jukema JB, Kusters CHJ, Jong MR, et al. Computer-aided diagnosis improves characterization of Barrett’s neoplasia by general endoscopists (with video). Gastrointestinal Endoscopy 2024; 100: 616-625.e8.  [Link]
  18. Tschanz ER. Do 40% of patients resected for Barrett esophagus with high-grade dysplasia have unsuspected adenocarcinoma? Archives of pathology & laboratory medicine 2005; 129: 177–80.  [Link]
  19. Beaufort I, Akkerman E, van Munster S, Weusten B. Effect of biopsy protocol adherence vs non-adherence on dysplasia detection rates in Barrett’s esophagus surveillance endoscopies: a systematic review and meta-analysis. Endoscopy international open 2023; 11: E221–9.  [Link]
  20. Beaufort IN, Milne AN, Alderlieste YA, Baars JE, Bos PR, Burger JPW, et al. Adherence to guideline recommendations for Barrett’s esophagus (BE) surveillance endoscopies: effects of dedicated BE endoscopy lists. Endoscopy international open 2023; 11: E952–62.  [Link]
  21. Duits LC, Phoa KN, Curvers WL, ten Kate FJW, Meijer GA, Seldenrijk CA, et al. Barrett’s oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut 2015; 64: 700–6.  [Link]
  22. El-Serag HB, Naik AD, Duan Z, Shakhatreh M, Helm A, Pathak A, et al. Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett’s oesophagus. Gut 2016; 65: 1252–60.  [Link]
  23. Kastelein F, van Olphen SH, Steyerberg EW, Spaander MCW, Bruno MJ. Impact of surveillance for Barrett’s oesophagus on tumour stage and survival of patients with neoplastic progression. Gut 2016; 65: 548–54.  [Link]
Endoscopic treatment of Barrett's oesophagus neoplasia

Authors: Eva P.D. Verheij, Roos E. Pouw and Jacques J. Bergman
Affiliation:
Jacques Bergman is a Professor of Gastrointestinal Endoscopy and Head of Endoscopy in the Department of Gastroenterology and Hepatology at Amsterdam University Medical Centers, location Free University Center, Amsterdam, the Netherlands.
Roos Pouw, is Principle Investigator and Associate Professor at the same department.
Eva Verheij is a PhD fellow at the same department.
Correspondence:
Link to online article: https://gutflix.eu/r/W3MER1yasups
Conflicts of interest: None

References:

  1. Weusten B, et al. Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49: 191–198. [Link]
The management of Helicobacter pylori infection

Authors: Anthony O’Connor and Colm O’Moráin        
Affiliation: Anthony O’Connor and Colm O’Moráin are both at Tallaght Hospital/Trinity College Dublin, Belgard Road, Tallaght, Dublin, Ireland.        
Correspondence:         
Link to online article: https://gutflix.eu/r/GpuDEO5dJ8zI        
Conflicts of interest: None        

References: 

  1. van Blankenstein M, van Vuuren AJ, Looman CW, et al. The prevalence of Helicobacter pylori infection in the Netherlands. Scand J Gastroenterol 2013; 48: 794–800. [Link]
  2. Gisbert JP and Pajares JM. 13C-urea breath test in the diagnosis of Helicobacter pylori infection—a critical review. Aliment Pharmacol Ther 2004; 20: 1001–1017. [Link]
  3. Malfertheiner P, Megraud F, O'Morain CA on behalf of the European Helicobacter and Miscrobiota Study Group and Consensus panel, et al. Management of Helicobacter pylori infection—the Maastricht V/Florence consensus report. Gut 2017; 66: 6-30. [Link]
  4. O’Connor A, O’Moráin NR, Dobson M, et al. 182 Test, treat and retest. Who is best at checking for Helicobacter pylori eradication after a positive urea breath test (UBT), family physicians or gastroenterologists? Gastroenterology 2010; 138 (Suppl 1): S-33, DOI: 10.1016/S0016-5085(10)60153-9. [Link]
The management of gastric polyps

Authors: William Waddingham and David G. Graham
Affiliation:
William Waddingham and David Graham are based at University College London Hospital and University College London, London, UK.
David Graham is a Consultant Gastroenterologist and Interventional Endoscopist and Clinical Lead at University College London Hospital and an Honorary Senior Lecturer at University College London, London, UK.
William Waddingham is a Gastroenterology Specialist Registrar and MRC Clinical Research Training Fellow.
Correspondence:
Link to online article: https://gutflix.eu/r/qubUItgOL1ZI
Conflicts of interest: None

References:

  1. Goddard AF, Badreldin R, Pritchard DM, et al. The management of gastric polyps. Gut 2010; 59: 1270–1276.  [Link]
  2. Carmack SW, Genta RM, Schuler CM, et al. The current spectrum of gastric polyps: A 1-year national study of over 120,000 patients. Am J Gastroenterol 2009; 104: 1524–1532.  [Link]
  3. el-Zimaity HM, Jackson FW and Graham DY. Fundic gland polyps developing during omeprazole therapy. Am J Gastroenterol 1997; 92: 1858–1860.  [Link]
  4. Morais DJ, Yamanaka A, Zeitune JMR, et al. Gastric polyps: A retrospective analysis of 26,000 digestive endoscopies. Arq Gastroenterol 2007; 44: 14–17.  [Link]
  5. Banks M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut 2019; 68: 1545–1575.  [Link]
  6. Bisschops R, et al. Performance measures for upper gastrointestinal endoscopy: A European Society of Gastrointestinal Endoscopy quality improvement initiative. United Eur Gastroenterol J 2016; 4: 629–656.  [Link]
  7. Park JM, et al. Longer observation time increases proportion of neoplasms detected by esophagogastroduodenoscopy. Gastroenterology 2017; 153: 460–469.e1.  [Link]
  8. Rugge M, et al. Gastric epithelial dysplasia in the natural history of gastric cancer: A multicenter prospective follow-up study. Gastroenterology 1994; 107: 1288–1296.  [Link]
  9. Sung, JK. Diagnosis and management of gastric dysplasia. Korean J Intern Med 2016; 31: 201–209.  [Link]
  10. Wang L, Huang W, Du J, et al. Diagnostic yield of the light blue crest sign in gastric intestinal metaplasia: A meta-analysis. PLoS One 2014; 9: e92874.  [Link]
The use of proton pump inhibitors

Authors: Roos E. Pouw and Albert J. Bredenoord
Affiliation: Roos E. Pouw and Albert J. Bredenoord are at the Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
Correspondence:
Link to online article: https://gutflix.eu/r/Azi0tsVLd7zl
Conflicts of interest: REP declares no conflicts of interest. AJB has received speaker’s fees and research support from AstraZeneca, MMS and Medtronic.

References:

  1. Klinkenberg-Knol EC, et al. Double-blind multicentre comparison of omeprazole and ranitidine in the treatment of reflux oesophagitis. Lancet 1987; 1: 349–351.  [Link]
  2. Freedberg DE, et al. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology 2017; 152: 706–715.  [Link]
  3. Wolfe MM and Sachs G. Acid suppression: optimizing therapy for gastroduodenal ulcer healing, gastroesophageal reflux disease, and stress-related erosive syndrome. Gastroenterology 2000; 118: S9–S31.  [Link]
  4. Sachs G. Proton pump inhibitors and acid-related diseases. Pharmacotherapy 1997; 17: 22–37.  [Link]
  5. Reimer C. Safety of long-term PPI therapy. Best Pract Res Clin Gastroenterol 2013; 27: 443–454.  [Link]
  6. William JH and Danziger J. Magnesium deficiency and proton-pump inhibitor use: a clinical review. J Clin Pharmacol 2016; 56: 660–668.  [Link]
  7. Oberhuber G and Stolte M. Gastric polyps: an update of their pathology and biological significance. Virchows Arch 2000; 437: 581–590.  [Link]
  8. Jalving M, et al. Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy. Aliment Pharmacol Ther 2006; 24: 1341–1348.  [Link]
  9. Bhatt DL, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2008; 52: 1502–1517.  [Link]
  10. Reimer C, et al. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology 2009; 137: 80–87.  [Link]
Gastrostomy insertion

Author: Thomas Welbank
Affiliation: Thomas Welbank is working at Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England.
Correspondence:
Link to online article: https://gutflix.eu/r/xeBJNa4W92tC
Conflicts of interest: None

References:

  1. Westaby D, Young A, O’Toole P, et al. The provision of a percutaneously placed enteral tube feeding service. Gut 2010; 59: 1592–1605.  [Link]
  2. National Collaborating Centre for Acute Care (UK). Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. London: National Collaborating Centre for Acute Care (UK), 2006.  [Link]
  3. Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40: 4745–4761.  [Link]
  4. Boullata JI, Carrera AL, Harvey L, et al. ASPEN Safe Practices for Enteral Nutrition Therapy. J Parenter Enter Nutr 2017; 41: 15–103.  [Link]
  5. Hvas CL, Farrer K, Blackett B, et al. Reduced 30-day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study. J Hum Nutr Diet 2018; 31: 413–421.  [Link]
  6. Fugazza A, Capogreco A, Cappello A, et al. Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques. World J Gastrointest Endosc 2022; 14: 250.  [Link]
  7. McCulloch A, Roy O, Massey D, et al. Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates. Frontline Gastroenterol 2018; 9: 105–109.  [Link]
  8. Sutcliffe J, Wigham A, Mceniff N, et al. CIRSE Standards of Practice Guidelines on Gastrostomy. Cardiovasc Intervent Radiol 2016; 39: 973–987.  [Link]
  9. Serrano Aguayo P, Herguido N, Campos J, et al. New laparoscopic assisted percutaneous gastrostomy. Description and comparison with others gastrostomy types. Clin Nutr ESPEN 2016; 16: 24–29.  [Link]
  10. Welbank T, Kurien M. To PEG or not to PEG that is the question. Proc Nutr Soc 2021; 80: 1–8.  [Link]
  11. Gaspar R, Ramalho R, Coelho R, et al. Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure. GE - Port J Gastroenterol 2023; 30: 61–67.  [Link]
  12. Menni A, Tzikos G, Chatziantoniou G, et al. Buried bumper syndrome: A critical analysis of endoscopic release techniques. World J Gastrointest Endosc 2023; 15: 44–55.  [Link]
  13. Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr Edinb Scotl 2020; 39: 5–22.  [Link]
  14. Yuan Y, Zhao Y, Xie T, et al. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev 2016; 2016: CD009198.  [Link]

Chapter 3: Small Intestine and Nutrition

  • Intestinal failure and parenteral nutrition
  • Jejunal feeding
  • Coeliac disease diagnosis
  • Refractory coeliac disease
Intestinal failure and parenteral nutrition

Authors: Sarah Williams, Samreen Malik and Shameer Mehta
Affiliation:
Sarah Williams is Lead Specialist Intestinal Failure Dietitian at the Royal London Hospital, Barts Health NHS Trust, London, UK.
Samreen Malik is a Pharmacologist at the Royal London Hospital, Barts Health NHS Trust, London, UK.
Shameer Mehta is Lead Pharmacist, intestinal failure and clinical nutrition at Barts Health NHS Trust, London, UK.
Correspondence:
Link to online article: https://gutflix.eu/r/ZjUUnjjWJA9N
Conflicts of interest: None

References:

  1. Pironi L, Arends J, Bozzetti F, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016; 35: 247–307.  [Link]
  2. Naghibi M, Toskas A, Willsmore J, et al. United Kingdom artificial nutrition database: The changing landscape of adult home parenteral support. J Parenter Enter Nutr 2023; 47: 635–645.  [Link]
  3. Fuhrman MP. The Albumin-nutrition connection: separating myth from fact 1 1Editor: Eva P. Shronts, MMSc RP. Nutrition 2002; 18: 199–200.  [Link]
  4. Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc 2004; 104: 1258–1264.  [Link]
  5. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and Clinical Significance. J Parenter Enter Nutr 2019; 43: 181–193.  [Link]
  6. Levitt D, Levitt M. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med 2016; Volume 9: 229–255.  [Link]
  7. Eckart A, Struja T, Kutz A, et al. Relationship of Nutritional Status, Inflammation, and Serum Albumin Levels During Acute Illness: A Prospective Study. Am J Med 2020; 133: 713-722.e7.  [Link]
  8. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019; 38: 48–79.  [Link]
  9. Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017; 36: 49–64.  [Link]
  10. Chakraborty RK, Burns B. Systemic Inflammatory Response Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing, http://www.ncbi.nlm.nih.gov/books/NBK547669/ (2024, accessed 29 August 2024).  [Link]
  11. Duncan A, Talwar D, McMillan DC, et al. Quantitative data on the magnitude of the systemic inflammatory response and its effect on micronutrient status based on plasma measurements. Am J Clin Nutr 2012; 95: 64–71.  [Link]
  12. Galloway SP, McMillan DC, Sattar N. Effect of the inflammatory response on trace element and vitamin status. Ann Clin Biochem Int J Lab Med 2000; 37: 289–297.  [Link]
  13. Berger MM, Shenkin A, Schweinlin A, et al. ESPEN micronutrient guideline. Clin Nutr 2022; 41: 1357–1424.  [Link]
  14. Bublin M, Breiteneder H. Cross-Reactivity of Peanut Allergens. Curr Allergy Asthma Rep 2014; 14: 426.  [Link]
  15. National Institute for Health and Care Excellence (NICE). CG174 Intravenous Fluid Therapy in Adults in Hospital: guideline. NICE clinical guidelines., https://www.nice.org.uk/guidance/cg174/ (2013, accessed 6 August 2024).  [Link]
  16. Lyerly HK. The Handbook of Surgical Intensive Care: Practices of the Surgery Residents at the Duke University Medical Center. Year Book Medical Publishers, 1989.
  17. Lee HA. Parenteral Nutrition in Acute Metabolic Illness. Academic Press, 1974.  [Link]
  18. Trissel LA, Gilbert DL, Martinez JF, et al. Compatibility of Medications With 3‐in‐1 Parenteral Nutrition Admixtures. J Parenter Enter Nutr 1999; 23: 67–74.  [Link]
  19. Gilbar PJ, Groves CF. Visual Compatibility of Total Parenteral Nutrition Solution (Synthamin 17 Premix (R)) with Selected Drugs During Simulated Y-Site Injection. Aust J Hosp Pharm 1994; 24: 167–173.  [Link]
  20. Vincent J-L, Angus DC, Artigas A, et al. Effects of drotrecogin alfa (activated) on organ dysfunction in the PROWESS trial. Crit Care Med 2003; 31: 834–840.  [Link]
  21. Brun-Buisson C, Minelli C, Bertolini G, et al. Epidemiology and outcome of acute lung injury in European intensive care units. Intensive Care Med 2004; 30: 524–524.  [Link]
  22. Baker M, Nightingale J. Abnormal liver function tests and parenteral nutrition. Clin Nutr 2004; 23: 864–865.  [Link]
  23. Cazals‐Hatem D, Billiauws L, Rautou P, et al. Ultra‐short bowel is an independent risk factor for liver fibrosis in adults with home parenteral nutrition. Liver Int 2018; 38: 174–182.  [Link]
  24. Cavicchi M, Beau P, Crenn P, et al. Prevalence of Liver Disease and Contributing Factors in Patients Receiving Home Parenteral Nutrition for Permanent Intestinal Failure. Ann Intern Med 2000; 132: 525.  [Link]
  25. Gabe SM, Culkin A. Abnormal liver function tests in the parenteral nutrition fed patient. Frontline Gastroenterol 2010; 1: 98–104.  [Link]
  26. Quigley EMM, Marsh MN, Shaffer JL, et al. Hepatobiliary complications of total parenteral nutrition. Gastroenterology 1993; 104: 286–301.  [Link]
  27. Vanek VW, Seidner DL, Allen P, et al. A.S.P.E.N. Position Paper: Clinical Role for Alternative Intravenous Fat Emulsions. Nutr Clin Pract 2012; 27: 150–192.  [Link]
  28. Anez-Bustillos L, Dao DT, Fell GL, et al. Redefining essential fatty acids in the era of novel intravenous lipid emulsions. Clin Nutr 2018; 37: 784–789.  [Link]
  29. Buchman AL, Ament ME, Sohel M, et al. Choline Deficiency Causes Reversible Hepatic Abnormalities in Patients Receiving Parenteral Nutrition: Proof of a Human Choline Requirement: A Placebo‐Controlled Trial. J Parenter Enter Nutr 2001; 25: 260–268.  [Link]
  30. Farrer K, Harrison S, Baker M, et al. British Intestinal Failure Alliance (BIFA) Position Statement, https://www.bapen.org.uk/pdfs/bifa/position-statements/advice-during-a-shortage-of-iv-micronutrients-for-patients-receiving-pn-updated-08-11-21.pdf (2021, accessed 7 August 2024).  [Link]
Jejunal feeding

Authors: Ashley Bond and Simon Lal        
Affiliation:
Ashley Bond is a Consultant Gastroenterologist at Liverpool University Hospitals Foundation Trust, UK.
Simon Lal is a Consultant Gastroenterologist at Salford Royal NHS Foundation Trust and a Professor at the University of Manchester, UK.        
Correspondence:         
Link to online article: https://gutflix.eu/r/uAQvzDfUvvBO        
Conflicts of interest: None        

References:    

  1. Seres DS, Valcarcel M and Guillaume A. Advantages of enteral nutrition over parenteral nutrition. Ther Adv Gastroenterol 2013; 6: 157–167. [Link]
  2. Alkhawaja S, Martin C, Butler R, et al. Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults. Cochrane Database Syst Rev 2015; 8: CD008875. [Link]
  3. Pearce CB and Duncan HD. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgraduate Medical Journal 2002; 78: 198–204. [Link]
  4. Lynch A, Tang CS, Jeganathan LS, et al. A systematic review of the effectiveness and complications of using nasal bridles to secure nasoenteral feeding tubes. Aust J Otolaryngol 2018; 1: 8. [Link]
  5. Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr 2017; 36: 623–650. [Link]
  6. Blakely A, Ajmal S, Sargent R, et al. Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies. World J Gastrointest Surg 2017; 27: 53–60. [Link]          
Coeliac disease diagnosis

Authors: Umberto Volta, Giacomo Caio and Roberto De Giorgio
Affiliation:
Umberto Volta is at the Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 
Giacomo Caio and Roberto De Giorgio both are at the University of Ferrara, Ferrara, Italy.
Correspondence:
Link to online article: https://gutflix.eu/r/YxIRQ95gpiFy
Conflicts of interest: None

References:

  1. Al-Toma A, Volta U, Auricchio R, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J 2019; 7: 583-613.  [Link]
  2. Biagi F, Gobbi P, Marchese A, et al. Low incidence but poor prognosis of complicated coeliac disease: a retrospective multicentre study. Dig Liver Dis 2014; 46: 227–230.  [Link]
  3. Ludvigsson JF, Bai JC, Biagi F, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut 2014; 63: 1210–1228.  [Link]
  4. Villanacci V, Ceppa P, Tavani E, et al. Coeliac disease: the histology report. Dig Liver Dis 2011; 43 (Suppl 4): S385–S395.  [Link]
  5. Brown I, Mino-Kenudson M, Deshpande V, et al. Intraepithelial lymphocytosis in architecturally preserved proximal small intestinal mucosa: an increasing diagnostic problem with a wide differential diagnosis. Arch Pathol Lab Med 2006; 130: 1020–1025.  [Link]
  6. Rubio-Tapia A, Hill ID, Semrad C, et al. American College of Gastroenterology Guidelines update: Diagnosis and management of celiac disease. Am J Gastroenterol 2023; 118: 59-76.  [Link]
  7. Salmi TT, Collin P, Järvinen O, et al. Immunoglobulin A autoantibodies against transglutaminase 2 in the small intestinal mucosa predict forthcoming coeliac disease. Aliment Pharmacol Ther 2006; 24: 541–552.  [Link]
  8. Murray JA and Rubio-Tapia A. Diarrhoea due to small bowel diseases. Best Pract Res Clin Gastroenterol 2012; 26: 581–600.  [Link]
  9. Scialom S, Malamut G, Meresse B, et al. Gastrointestinal disorder associated with olmesartan mimics autoimmune enteropathy. PLoS One 2015 23; 10: e0125024.  [Link]
  10. Volta U, Caio G, Stanghellini V, et al. The changing clinical profile of celiac disease: a 15-year experience (1998-2012) in an Italian referral center. BMC Gastroenterol 2014; 14: 194.  [Link]
  11. Volta U, Rostami K, Auricchio R, et al. Diagnosis of Seronegative and Ultrashort Celiac Disease. Gastroenterology 2024; 167: 104–115.  [Link]
Refractory coeliac disease

Authors: Umberto Volta, Giacomo Caio and Roberto De Giorgio
Affiliation:
Umberto Volta is at the Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 
Giacomo Caio and Roberto De Giorgio both are at the University of Ferrara, Ferrara, Italy"
Correspondence:
Link to online article: https://gutflix.eu/r/suY982TCZB4k
Conflicts of interest: None

References:

  1. Cellier C, Delabesse E, Helmer C, et al. Refractory sprue, coeliac disease, and enteropathy associated T-cell lymphoma. French Coeliac Disease Study Group. Lancet 2000; 356: 203–208.  [Link]
  2. Al-Toma A, Verbeek WHM and Mulder CJJ. Update on the management of refractory coeliac disease. J Gastrointestin Liver Dis 2007; 16: 57–63.  [Link]
  3. Rubio-Tapia A and Murray JA. Classification and management of refractory coeliac disease. Gut 2010; 59: 547–557.  [Link]
  4. Rubio–Tapia A, Kelly DG, Lahr BD, et al. Clinical staging and survival in refractory celiac disease: a single center experience. Gastroenterology 2009; 136: 99–107.  [Link]
  5. Di Sabatino A, Brunetti L, Carnevale Maffè G, et al. Is it worth investigating splenic function in patients with celiac disease? World J Gastroenterol 2013; 19: 2313–2318.  [Link]
  6. van Wanrooij RLJ, Bouma G, Bontkes HJ, et al. Outcome of referrals for non-responsive celiac disease in a tertiary center: Low incidence of refractory celiac disease in the Netherlands. Clin Transl Gastroenterol 2017; 8: e218.  [Link]
  7. van Gils T, Nijeboer P, van Wanrooij RL, et al. Mechanisms and management of refractory coeliac disease. Nat Rev Gastroenterol Hepatol 2015; 12: 572–579.  [Link]
  8. Daum S, Cellier C and Mulder CJJ. Refractory coeliac disease. Best Pract Res Clin Gastroenterol 2005; 19: 413–424.  [Link]
  9. Malamut G, Meresse B, Cellier C, et al. Refractory celiac disease: From bench to bedside. Semin Immunopathol 2012; 34: 601–613.  [Link]
  10. Jamma S, Leffler DA, Dennis M, et al. Small intestinal release mesalamine for the treatment of refractory celiac disease type I. J Clin Gastroenterol 2011; 45: 30–33.  [Link]
  11. Al-Toma A, Visser OJ, van Roessel HM, et al. Autologous hematopoietic stem cell transplantation in refractory celiac disease with aberrant T cells. Blood 2007; 109: 2243–2249.  [Link]
  12. Cellier C, Bouma G, van Gils T et al. [AGA Abstract 616] AMG 714 (ANTI-IL-15 MAB) halts the progression of aberrant intraepithelial lymphocytes in refractory celiac disease type ii (RCD-II): A phase 2a, randomized, double-blind, placebo-controlled study evaluating AMG 714 in adult patients with RCD-II/PRE-EATL. Gastroenterology 2018; 154 (6) Suppl 1: S-129–S-130.   AGA Abstract 616 AMG 714 (ANTI-IL-15 MAB) halts the progression of aberrant intraepithelial lymphocytes in refractory celiac disease type ii (RCD-II): A phase 2a, randomized, double-blind, placebo-controlled study evaluating AMG 714 in adult patients with RCD-II/PRE-EATL. Gastroenterology 2018; 154 (6) Suppl 1: S-129–S-130.
  13. Nijeboer P, van Wanrooij R, van Gils T, et al. Lymphoma development and survival in refractory coeliac disease type II: Histological response as prognostic factor. United Eur Gastroenterol J 2017; 5: 208–217.  [Link]
  14. Al-Toma A, Volta U, Auricchio R, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United Eur Gastroenterol J 2019; 7: 583–613.  [Link]
  15. Roma E, Roubani A, Kolia E, et al. Dietary compliance and life style of children with coeliac disease. J Hum Nutr Diet. 2010; 23: 176–182.  [Link]
  16. Schuppan D, Kelly CP and Krauss N. Monitoring non-responsive patients with celiac disease. Gastrointest Endosc Clin N Am 2006; 16: 593–603.  [Link]

Chapter 4: Surgery and Imaging

  • Acute diverticulitis
  • Pouchitis
  • Chronic intestinal pseudo-obstruction
  • Enteral stenting
  • Bariatric surgery
  • The management of enterocutaneous fistulae
  • Managing perianal disease
  • Small bowel bleeding
  • Computed tomography performed for the acute abdomen
  • Gastrointestinal ultrasound
  • Cases on call
Acute diverticulitis

Authors: Simone J. Rottier, Anna A.W. van Geloven, W. Hermien Schreurs and Marja A. Boermeester
Affiliation:     
Simone J. Rottier is an MD working in the Department of Surgery at Amsterdam University Medical Centers, Amsterdam, The Netherlands. 
Anna A.W. van Geloven is a gastrointestinal surgeon at the Department of Surgery at Tergooi, Hilversum, The Netherlands.
W. Hermien Schreurs is a lung and gastrointestinal surgeon in the Department of Surgery, Northwest Clinics, Alkmaar/Den Helder, The Netherlands.
Marja A. Boermeester is a professor of surgery and a clinical epidemiologist in the Department of Surgery at Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Correspondence:
Link to online article: https://gutflix.eu/r/3gJO4YH5cMlO
Conflicts of interest: None

References:

  1. Burkitt DP, et al. Effect of dietary fibre on stools and the transit-times, and its role in the causation of disease. Lancet 1972; 2: 1408–1412.  [Link]
  2. Stam MA, et al. An unrestricted diet for uncomplicated diverticulitis is safe: results of a prospective diverticulitis diet study. Colorectal Dis 2017; 19: 372–377.  [Link]
  3. van de Wall BJ, et al. Dietary restrictions for acute diverticulitis: evidence-based or expert opinion? Int J Colorectal Dis 2013; 28: 1287–1293.  [Link]
  4. Rottier SJ, van Dijk ST, Ünlü Ç, et al. Complicated Disease Course in Initially Computed Tomography-Proven Uncomplicated Acute Diverticulitis. Surgical Infections 2019; 20: 453–459.  [Link]
  5. Nielsen K, et al. The limited role of ultrasound in the diagnostic process of colonic diverticulitis. World J Surg 2014; 38: 1814–1818.  [Link]
  6. Lambrichts DPV, et al. Multicentre study of non-surgical management of diverticulitis with abscess formation. Br J Surg 2019; 106: 458–466.  [Link]
  7. Lameris W, et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol 2008; 18: 2498–2511.  [Link]
  8. van Randen A, et al. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol 2011; 21: 1535–1545.  [Link]
  9. Gregersen R, et al. Treatment of patients with acute colonic diverticulitis complicated by abscess formation: A systematic review. Int J Surg 2016; 35: 201–208.  [Link]
  10. Wasvary H, et al. Same hospitalization resection for acute diverticulitis. Am Surg 1999; 65: 632–635.  [Link]
  11. Bridoux V, et al. Elective operation after acute complicated diverticulitis: is it still mandatory? World J Gastroenterol 2014; 20: 8166–8172.  [Link]
  12. Sallinen VJ, et al. Nonoperative management of perforated diverticulitis with extraluminal air is safe and effective in selected patients. Dis Colon Rectum 2014; 57: 875–881.  [Link]
  13. van Dijk ST, et al. A systematic review of pericolic extraluminal air in left-sided acute colonic diverticulitis. Surg Infect (Larchmt) 2018; 19: 362–368.  [Link]
  14. Colas PA, et al. Failure of conservative treatment of acute diverticulitis with extradigestive air. World J Surg 2017; 41: 1890–1895.  [Link]
  15. Daniels L, et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg 2017; 104: 52–61.  [Link]
  16. Chabok A, et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012; 99: 532–539.  [Link]
  17. van Dijk ST, et al. Long-term effects of omitting antibiotics in uncomplicated acute diverticulitis. Am J Gastroenterol 2018; 113: 1045–1052.  [Link]
Pouchitis

Authors: Jonathan P. Segal, Susan K. Clark and Ailsa L. Hart
Affiliation:
Jonathan Segal is a specialist gastreonterology registrar, and Susan Clark is a consultant colorectal surgeon at St Mark’s Hospital, Harrow, United Kingdom and in the Department of Surgery and Cancer, Imperial College London, UK.
Ailsa Hart is a consultant gastroenterologist at St Mark’s Hospital, Harrow, United Kingdom and in the Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK.
Correspondence:
Link to online article: https://gutflix.eu/r/Qw8r7Pe2y9lA
Conflicts of interest: None

References:

  1. Lepistö A, Luukkonen P and Järvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum 2002; 45: 1289–1294.  [Link]
  2. Sandborn WJ. Pouchitis: definition, risk factors, frequency, natural history, classification, and public health perspective. In: Sutherland LR, Mcleod RS, Noel Williams C, Martin F and Wallace JL (eds) Trends in Inflammatory Bowel Disease Therapy 1996. 1997; Springer Netherlands, 1997, p.51–63.
  3. Pardi DS and Shen B. Endoscopy in the management of patients after ileal pouch surgery for ulcerative colitis. Endoscopy 2008; 40: 529–533.  [Link]
  4. Shen B. Pouchitis: What every gastroenterologist needs to know. Clin Gastroenterol Hepatol 2013; 11: 1538–1549.  [Link]
  5. Sandborn WJ, Tremaine WJ, Batts KP, et al. Pouchitis after ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 1994; 69: 409–415.  [Link]
  6. Ben-Bassat O, Tyler AD, Xu W, et al. Ileal pouch symptoms do not correlate with inflammation of the pouch. Clin Gastroenterol Hepatol 2014; 12: 831–837.e2.  [Link]
  7. van der Ploeg V, Maeda Y, Faiz OD, et al. The prevalence of chronic peri-pouch sepsis in patients treated for antibiotic-dependent or refractory primary idiopathic pouchitis. Colorectal Dis 2017; 19: 827–831.  [Link]
  8. Navaneethan U and Shen B. Secondary pouchitis: Those with identifiable etiopathogenetic or triggering factors. Am J Gastroenterol 2010; 105: 51–64.  [Link]
  9. Segal JP, Ding NS, Worley G, et al. Systematic review with meta-analysis: the management of chronic refractory pouchitis with an evidence-based treatment algorithm. Aliment Pharmacol Ther 2017; 45: 581–592.  [Link]
  10. Segal JP, Poo SX, McLaughlin SD, et al. Long-term follow-up of the use of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis. Frontline Gastroenterol 2018; 9: 154–158.  [Link]
  11. Kim GK. The risk of fluoroquinolone-induced tendinopathy and tendon rupture: what does the clinician need to know? J Clin Aesthet Dermatol 2010; 3: 49–54.  [Link]
  12. Goolsby TA, Jakeman B and Gaynes RP. Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature. Int J Antimicrob Agents 2018; 51: 319–325.  [Link]
  13. Seril DN and Shen B. Clostridium difficile infection in patients with ileal pouches. Am J Gastroenterol 2014; 109: 941–947.  [Link]
  14. Shen B. Diagnosis and management of postoperative ileal pouch disorders. Clin Colon Rectal Surg 2010; 23: 259–268.  [Link]
  15. Shen B, Lashner BA, Bennett AE, et al. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol 2004; 99: 1527–1531.  [Link]
  16. Thompson-Fawcett MW, Mortensen NJ, Warren BF. Cuffitis and inflammatory changes in the columnar cuff, anal transitional zone, and ileal reservoir after stapled pouch-anal anastomosis. Dis Colon Rectum 1999; 42: 348–355.  [Link]
  17. Thompson JS. Cuffitis: A new cause of pouch dysfunction. Am J Gastroenterol 1999; 94: 2007.  [Link]
  18. Wu B, Lian L, Li Y, et al. Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch–anal anastomoses. Inflamm Bowel Dis 2013; 19: 404–410.  [Link]
Chronic intestinal pseudo-obstruction

Authors: Carolina Malagelada and Luis G. Alcala-Gonzalez
Affiliation:
Carolina Malagelada and Luis G. Alcalá-González are both at Digestive Motility Unit, Vall d'Hebron University Hospital, Barcelona, Spain, Department of Medicine, Universitat Autònomade Barcelona and Centro de Investigación Biomédica en Red deEnfermedades Hepáticas y Digestivas (Ciberehd), Spain.
Correspondence:
Link to online article: https://gutflix.eu/r/15hNdhAHZrsB
Conflicts of interest: CM has served as a consultant for Alfasigma. LA has no conflicts of interest.

References:

  1. Gallego D, Malagelada C, Accarino A, et al. Functional neuromuscular impairment in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13458.  [Link]
  2. Alcalá González LG, Malagelada C. Current insights on chronic intestinal dysmotility: pseudo-obstruction and enteric dysmotility. Rev Esp Enferm Dig 2024; 116: 63–67.  [Link]
  3. Di Nardo G, Zenzeri L, Guarino M, et al. Pharmacological and nutritional therapy of children and adults with chronic intestinal pseudo-obstruction. Expert Rev Gastroenterol Hepatol 2023; 17: 325–341.  [Link]
  4. Basilisco G, Marchi M, Coletta M. Chronic intestinal pseudo-obstruction in adults: A practical guide to identify patient subgroups that are suitable for more specific treatments. Neurogastroenterol Motil 2024; 36: e14715.  [Link]
  5. Rosen R, Garza JM, Tipnis N, et al. An ANMS-NASPGHAN consensus document on esophageal and antroduodenal manometry in children. Neurogastroenterol Motil 2018; 30: e13239.  [Link]
  6. Stanghellini V, Cogliandro RF, De Giorgio R, et al. Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: a single center study. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2005; 3: 449–458.  [Link]
  7. Keller J, Bassotti G, Clarke J, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 2018; 15: 291–308.  [Link]
  8. Ang D, Pannemans J, Vanuytsel T, et al. A single-center audit of the indications and clinical impact of prolonged ambulatory small intestinal manometry. Neurogastroenterol Motil 2018; 30: e13357.  [Link]
  9. Alcalá-González LG, Malagelada C, Monrroy H, et al. Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction. Neurogastroenterol Motil 2023; 35: e14462.  [Link]
  10. Alcala-Gonzalez LG, Malagelada C, Galan C, et al. Propagation patterns of jejunal motor activity measured by high-resolution water-perfused manometry. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc 2021; 33: e14240.  [Link]
  11. de Jonge CS, Smout AJPM, Nederveen AJ, et al. Evaluation of gastrointestinal motility with MRI: Advances, challenges and opportunities. Neurogastroenterol Motil 2018; 30: e13257.  [Link]
  12. Maurer AH. Enhancing Scintigraphy for Evaluation of Gastric, Small Bowel, and Colonic Motility. Gastroenterol Clin North Am 2020; 49: 499–517.  [Link]
  13. Ohkubo H, Kessoku T, Fuyuki A, et al. Assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction using cine-MRI. Am J Gastroenterol 2013; 108: 1130–1139.  [Link]
  14. Menys A, Butt S, Emmanuel A, et al. Comparative quantitative assessment of global small bowel motility using magnetic resonance imaging in chronic intestinal pseudo-obstruction and healthy controls. Neurogastroenterol Motil 2016; 28: 376–383.  [Link]
  15. Alcalá-González LG, Accarino A, Martí R, et al. Distinctive gastrointestinal motor dysfunction in patients with MNGIE. Neurogastroenterol Motil 2023; 35: e14643.  [Link]
  16. Mann SD, Debinski HS, Kamm MA. Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults. Gut 1997; 41: 675–681.  [Link]
  17. Emmanuel AV, Shand AG, Kamm MA. Erythromycin for the treatment of chronic intestinal pseudo-obstruction: description of six cases with a positive response. Aliment Pharmacol Ther 2004; 19: 687–694.  [Link]
  18. O’Dea CJ, Brookes JH, Wattchow DA. The efficacy of treatment of patients with severe constipation or recurrent pseudo-obstruction with pyridostigmine. Colorectal Dis Off J Assoc Coloproctology G B Irel 2010; 12: 540–548.  [Link]
  19. Sabbagh C, Amiot A, Maggiori L, et al. Non-transplantation surgical approach for chronic intestinal pseudo-obstruction: analysis of 63 adult consecutive cases. Neurogastroenterol Motil 2013; 25: e680-686.  [Link]
  20. Sogawa H, Costa G, Armanyous S, et al. Twenty Years of Gut Transplantation for Chronic Intestinal Pseudo-obstruction: Technical Innovation, Long-term Outcome, Quality of Life, and Disease Recurrence. Ann Surg 2021; 273: 325–333.  [Link]
Enteral stenting

Authors: Joyce V. Veld, Paul Fockens and Jeanin E. van Hooft
Affiliation:
Joyce Veld is a PhD student in the Department of Gastroenterology and Hepatology and the Department of Surgery,
Paul Fockens is Head of the Department of Gastroenterology and Hepatology,
and Jeanin van Hooft is a Gastroenterologist in the Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands."
Correspondence:
Link to online article: https://gutflix.eu/r/7Gy9CGZ1yv0B
Conflicts of interest: None

References:

  1. D’Etoilles, L. La lanacherie de l'esophagotomie. Brussels, 1845.
  2. Lew RJ and Kochman ML. A review of endoscopic methods of oesophageal dilation. J Clin Gastroenterol 2002; 35: 117–126.  [Link]
  3. Dasari BV, et al. The role of oesophageal stents in the management of oesophageal anastomotic leaks and benign oesophageal perforations. Ann Surg 2014; 259: 852–860.  [Link]
  4. Yamao K, et al. Factors predicting through-the-scope gastroduodenal stenting outcomes in patients with gastric outlet obstruction: a large multicenter retrospective study in West Japan. Gastrointest Endosc 2016; 84: 757–763.e6.  [Link]
  5. Lee JE, et al. Impact of carcinomatosis on clinical outcomes after self-expandable metallic stent placement for malignant gastric outlet obstruction. PLoS One 2015; 10: e0140648.  [Link]
  6. Hori Y, et al. Stent under expansion on the procedure day, a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction. J Gastroenterol Hepatol 2015; 30: 1246–1251.  [Link]
  7. Jullumstro E, et al. Colon cancer incidence, presentation, treatment and outcomes over 25 years. Colorectal Dis 2011; 13: 512–518.  [Link]
  8. van Hooft JE, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2014; 46: 990–1053.  [Link]
  9. Tumours NWGG. Colorectal carcinoma, Oncoline, https://www.oncoline.nl/colorectaalcarcinoom (2014, accessed January 2019; in Dutch).  [Link]
  10. Iversen LH. Aspects of survival from colorectal cancer in Denmark. Danish Med J 2012; 59: B4428.  [Link]
  11. Tanis PJ, et al. Resection of obstructive left-sided colon cancer at a national level: A prospective analysis of short-term outcomes in 1,816 patients. Dig Surg 2015; 32: 317–324.  [Link]
  12. Baron T and Law, R. Use of expandable stents in the esophagus. UpToDate, https://www.uptodate.com/contents/use-of-expandable-stents-in-the-esophagus (2017, accessed January 2019).  [Link]
  13. Baron T and Law, R. Enteral stents for the management of malignant colorectal obstruction, UpToDate, https://www.uptodate.com/contents/enteral-stents-for-the-management-of-malignant-colorectal-obstruction (2017, accessed Janaury 2019).  [Link]
  14. Geraghty J, et al. Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome. Colorectal Dis 2014; 16: 476–483.  [Link]
  15. Kim JW, et al. Comparison of clinical outcomes between endoscopic and radiologic placement of self-expandable metal stent in patients with malignant colorectal obstruction. Korean J Gastroenterol 2013; 61: 22–29.  [Link]
  16. Sebastian S, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004; 99: 2051–2057.  [Link]
  17. de Gregorio MA, et al. Ten-year retrospective study of treatment of malignant colonic obstructions with self-expandable stents. J Vascular Inerv Radiol 2011; 22: 870–878.  [Link]
  18. Lopera JE, et al. Gastroduodenal stent placement: current status. Radiographics 2004; 24: 1561–1573.  [Link]
  19. Tringali A, et al. Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study. Gastrointest Endosc 2014; 79: 66–75.  [Link]
  20. Lee H, et al. Covered metallic stents with an anti-migration design vs. uncovered stents for the palliation of malignant gastric outlet obstruction: a multicenter, randomized trial. Am J Gastroenterol 2015; 110: 1440–1449.  [Link]
  21. Costamagna G, et al. Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: an international prospective multicentre registry. Dig Liver Dis 2012; 44: 37–43.  [Link]
  22. Lillemoe KD, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 1999; 230: 322–328.  [Link]
  23. Dumonceau JM, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline — Updated October 2017. Endoscopy 2018; 50: 910–930.  [Link]
  24. May A, Hahn EG and Ell C. Self-expanding metal stents for palliation of malignant obstruction in the upper gastrointestinal tract. Comparative assessment of three stent types implemented in 96 implantations. J Clin Gastroenterol 1996; 22: 261–266.  [Link]
  25. Rozanes I, Poyanli A and Acunas B. Palliative treatment of inoperable malignant oesophageal strictures with metal stents: one center's experience with four different stents. Eur J Radiol 2002; 43: 196–203.  [Link]
  26. Lopera JE and De Gregorio MA. Fluoroscopic management of complications after colorectal stent placement. Gut Liver 2010; 4 (Suppl 1): S9–S18.  [Link]
Bariatric surgery

Author: Francesco Saverio Papadia
Affiliation: Francesco Saverio Papadia is an Associated Professor at the Department of Surgical Sciences and Integrated Diagnostics (DISC) at the University of Genoa School of Medicine, Genoa, Italy.
Correspondence:
Link to online article: https://gutflix.eu/r/bwZyTL8CvtvS
Conflicts of interest: None

References:

  1. Phelps NH, Singleton RK, Zhou B, et al. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. The Lancet 2024; 403: 1027–50.  [Link]
  2. Aronson S, Martin G, Gulur P, et al. Preoperative optimization: a continued call to action. Anesthesia and analgesia 2020; 130: 808–10.  [Link]
  3. Haskins IN, Amdur R, Vaziri K. The effect of smoking on bariatric surgical outcomes. Surgical endoscopy 2014; 28: 3074–80.  [Link]
  4. Di Palma A, Liu B, Maeda A, Anvari M, Jackson T, Okrainec A. Marginal ulceration following Roux-en-Y gastric bypass: risk factors for ulcer development, recurrence and need for revisional surgery. Surgical endoscopy 2021; 35: 2347–53.  [Link]
  5. Kim JJ, Rogers AM, Ballem N, Schirmer B. ASMBS updated position statement on insurance mandated preoperative weight loss requirements. Surgery for obesity and related diseases 2016; 12: 955–9.  [Link]
  6. Edholm D, Kullberg J, Haenni A, et al. Preoperative 4-week low calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obesity surgery 2011; 21: 345–50.  [Link]
  7. Sivakumar J, Chong L, Ward S, Sutherland TR, Read M, Hii MW. Body composition changes following a very-low-calorie pre-operative diet in patients undergoing bariatric surgery. Obesity surgery 2020; 30: 119–26.  [Link]
  8. Tashiro T, Pislaru SV, Blustin JM, et al. Perioperative risk of major non-cardiac surgery in patients with severe aortic stenosis: a reappraisal in contemporary practice. European heart journal 2014; 35: 2372–81.  [Link]
  9. Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surgery for obesity and related diseases 2016; 12: 731–49.  [Link]
  10. Kassir R, Debs T, Ben Amor I, Blanc P, et al. Complications of bariatric surgery: presentation and emergency management. International journal of surgery 2016; 27: 77–81.  [Link]
  11. Gonzalez R, Sarr MG, Smith CD, Baghai M, Kendrick M, Szomstein S, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. Journal of the American College of Surgeons 2007; 204: 47–55.  [Link]
  12. Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 2014; 270: 327–41.  [Link]
  13. Csendes A, Burgos AM, Braghetto I. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obesity surgery 2012; 22: 855–62.  [Link]
  14. Camerini G, Pretolesi F, Marinari GM, Adami G, Marini P, Papadia F, et al. Radiology of patients with vertical banded gastroplasty. Obesity surgery 2002; 12: 57–61.  [Link]
  15. Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicentre experience with 2,834 patients. Surgical endoscopy 2013; 27: 240–5.  [Link]
  16. Rosenthal RJ, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surgery for obesity and related diseases 2012; 8: 8–19.  [Link]
  17. Iannelli A, Tavana R, Martini F, Noel P, Gugenheim J. Laparoscopic Roux limb placement over a fistula defect without mucosa-to-mucosa anastomosis: a modified technique for surgical management of chronic proximal fistulas after laparoscopic sleeve gastrectomy. Obesity surgery 2014; 24: 825–8.  [Link]
  18. Nedelcu AM, Skalli M, Deneve E, Fabre JM, Nocca D. Surgical management of chronic fistula after sleeve gastrectomy. Surgery for obesity and related diseases 2013; 9: 879–84.  [Link]
  19. García Ruiz de Gordejuela A, Madrazo-González Z, Casajoana-Badia A, Muñoz-Campaña A, Cuesta-González FJ, Pujol-Gebelli J. Evaluation of bariatric surgery patients at the emergency department of a tertiary referral hospital. Revista espanola de enfermedades digestivas 2015; 107: 23–8.  [Link]
  20. Petrucciani N, Martini F, Kassir R, Juglard G, Hamid C, Boudrie H, et al. Internal hernia after one anastomosis gastric bypass (OAGB): lessons learned from a retrospective series of 3368 consecutive patients undergoing OAGB with a biliopancreatic limb of 150 cm. Obesity surgery 2021; 31: 2537–44.  [Link]
  21. Geubbels N, Lijftogt N, Fiocco M, van Leersum NJ, Wouters MW, de Brauw LM. Meta-analysis of internal herniation after gastric bypass surgery. The British journal of surgery 2015; 102: 451–60.  [Link]
  22. Spector D, Perry Z, Shah S, et al. Roux-en-Y gastric bypass: hyperamylasemia is associated with small bowel obstruction. Surgery for obesity and related diseases 2015; 11: 38–43.  [Link]
  23. Lockhart ME, Tessler FN, Canon CL, Smith JK, Larrison MC, Fineberg NS, et al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. American journal of roentgenology 2007; 188: 745–50.  [Link]
  24. Altinoz A, Maasher A, Jouhar F, Babikir A, Ibrahim M, Al Shaban T, et al. Diagnostic laparoscopy is more accurate than computerized tomography for internal hernia after Roux-en-Y gastric bypass. The American journal of surgery 2020; 220: 214–6.  [Link]
  25. Nimeri AA, Maasher A, Al Shaban T, Salim E, Gamaleldin MM. Internal hernia following laparoscopic Roux-en-Y gastric bypass: prevention and tips for intra-operative management. Obesity surgery 2016; 26: 2255–6.  [Link]
  26. Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nature reviews endocrinology 2012; 8: 544–56.  [Link]
  27. Botella-Carretero JI, Lafuente C, Montes-Nieto R, et al. Serum bioavailable vitamin D concentrations and bone mineral density in women after obesity surgery. Obesity surgery 2016; 26: 2732–7.  [Link]
  28. Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Annals of surgery 2008; 248: 714–20.  [Link]
  29. Hari T, Elsherbiny S. Bariatric surgery – what the ophthalmologist needs to know. Eye 2021; 1–7.  [Link]
  30. Oudman E, Wijnia JW, van Dam M, Biter LU, Postma A. Preventing Wernicke encephalopathy after bariatric surgery. Obesity surgery 2018; 28: 2060–8.  [Link]
  31. Chuang SC, Lee KT, Chang WT, et al. Risk factors for bile duct injury during laparoscopic cholecystectomy: a nationwide study. Annals of surgery 2012; 255: 157–62.  [Link]
  32. Sugerman HJ, Brewer WH, Shiffman ML, et al. A multicentre, placebo-controlled, randomised, double-blind trial of prophylactic ursodiol for the prevention of gallstone formation after gastric-bypass-induced rapid weight loss. The American journal of surgery 1995; 169: 91–6.  [Link]
  33. Halldestam I, Kullman E, Borch K. Incidence of gallstone disease after bariatric surgery: need for cholecystectomy. Surgery for obesity and related diseases 2004; 1: 108–12.
  34. Ferreira LE, Baron TH. Role of endoscopy in the bariatric surgery patient. Gastrointestinal endoscopy 2007; 66: 258–66.  [Link]
  35. Uy MC, Talingdan-Te MC, Espinosa WZ. Ursodeoxycholic acid for the prevention of gallstone formation after bariatric surgery: a meta-analysis. Obesity surgery 2008; 18: 1532–8.  [Link]
The management of enterocutaneous fistulae

Authors: Philip Allan, Jonathan Epstein and Simon Lal
Affiliation: 
Philip Allan is a Consultant Gastroenterologist at Oxford University Hospitals NHS Foundation Trust, UK. 
Jonathan Epstein is a General and Colorectal Surgeon at Salford Royal NHS Foundation Trust, UK
Simon Lal is a Consultant Gastroenterologist at the University of Manchester and Salford Royal NHS Foundation Trust, UK.
Correspondence:
Link to online article: https://gutflix.eu/r/Z7q2deM7Sb9z
Conflicts of interest: None

References:

  1. Lal S, et al. Review article: intestinal failure. Aliment Pharmacol Therapeut 2006; 24: 19–31. [Link]
  2. Visschers RG, et al. Treatment strategies in 135 consecutive patients with enterocutaneous fistulas. World J Surg 2008; 32: 445–453. [Link]
  3. Scripcariu V, et al. Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection. Br J Surg 1994; 81: 1475–1478. [Link]
  4. Visschers RG, et al. Guided treatment improves outcome of patients with enterocutaneous fistulas. World J Surg 2012; 36: 2341–2348. [Link]
Managing perianal disease

Authors: Phil Tozer and John T. Jenkins        
Affiliation: Phil Tozer and John T Jenkins are at St. Mark’s Hospital, London, UK.        
Correspondence:         
Link to online article: https://gutflix.eu/r/qfXqplkS8CsI        
Conflicts of interest: None        

References:    

  1. Riss S, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012; 27: 215–220. [Link]
  2. Nelson RL, et al. Non surgical therapy for anal fissure. Cochrane Database Syst Rev 2012: CD003431. [Link]
  3. Alonso-Coello P, et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev 2005: CD004649. [Link]
  4. Owen BN, et al. Prevalence and frequency of heterosexual anal intercourse among young people: a systematic review and meta-analysis. AIDS Behav 2015; 19: 1338–1360. [Link]
Small bowel bleeding

Authors: Edward J. Despott, Andrea Telese and Alberto Murino
Affiliation:
Edward J. Despott is the lead consultant gastroenterologist and interventional endoscopist, 
Andrea Telese is an endoscopy fellow and 
Alberto Murino is a consultant gastroenterologist and interventional endoscopist at the Royal Free Unit for Endoscopy, University College London (UCL) Institute for Liver and Digestive Health and The Royal Free Hospital, London, UK.
Correspondence:
Link to online article: https://gutflix.eu/r/zRweqfXpP7n4
Conflicts of interest: None

References:

  1. Lau WY, et al. Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin. Gut 1987; 28: 869–877.  [Link]
  2. Pennazio M, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352–376.  [Link]
  3. Gerson LB, et al. ACG Clinical Guideline: Diagnosis and management of small bowel bleeding. Am J Gastroenterol 2015; 110: 1265–1287.  [Link]
  4. Raju GS, et al. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology 2007; 133: 1694–1696.  [Link]
  5. Gunjan D, et al. Small bowel bleeding: a comprehensive review. Gastroenterol Rep (Oxf) 2014; 2: 262–275.  [Link]
  6. Shinozaki S, et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol 2010; 8: 151–158.  [Link]
  7. Aniwan S, et al. Urgent double balloon endoscopy provides higher yields than non-urgent double balloon endoscopy in overt obscure gastrointestinal bleeding. Endosc Int Open 2014; 02: E90–E95.  [Link]
  8. Singh A, et al. Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study. Gastrointest Endosc 2013; 77: 761–766.  [Link]
  9. Yamada A, et al. Timing of capsule endoscopy influences the diagnosis and outcome in obscure-overt gastrointestinal bleeding. Hepatogastroenterol 2012; 59: 676–679.  [Link]
  10. Monkemuller K, et al. A retrospective analysis of emergency double-balloon enteroscopy for small-bowel bleeding. Endoscopy 2009; 41: 715–717.  [Link]
  11. Rondonotti E, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423–446.  [Link]
  12. Sanaka MR, et al. Antegrade is more effective than retrograde enteroscopy for evaluation and management of suspected small-bowel disease. Clin Gastroenterol Hepatol 2012; 10: 910–916.  [Link]
Computed tomography performed for the acute abdomen

Authors: Hameed Rafiee and Stuart Taylor        
Affiliation:
Hameed Rafiee is at the Norfolk and Norwich University Hospital, UK. 
Stuart Taylor is at University College Hospital, London, UK.        
Correspondence:         
Link to online article: https://gutflix.eu/r/vx2W26hjZKne        
Conflicts of interest: None        

References:    

  1. Busireddy KK, et al. Pancreatitis—imaging approach. World J Gastrointest Pathophysiol 2014; 5: 252–270. [Link]
  2. Moschetta M, et al. Multi-detector CT features of acute intestinal ischemia and their prognostic correlations. World J Radiol 2014; 6: 130–138. [Link]
  3. Furukawa A, et al. CT diagnosis of acute mesenteric ischaemia from various causes. AJR 2009; 192: 408–416. [Link]
  4. Duran R, et al. Multidetector CT features of mesenteric vein thrombosis. Radiographics 2012; 32: 1503–1522. [Link]
  5. Lips LMJ, et al. Sigmoid cancer versus chronic diverticular disease: differentiating features at CT colonography. Radiology 2015; 275: 127–135. [Link]
Gastrointestinal ultrasound

Authors: Andreas Jessen Gjengstø, Kim Nylund, Hilde Løland von Volkmann and Odd Helge Gilja    
Affiliation:
Andreas J. Gjengstø is a Consultant at Department of Medicine, Haukeland University Hospital, Haukelandsbakken 22, 5021 Bergen, Norway and currently working on his Ph.D at the University ofBergen, Norway.
Kim Nylund is an Associate Professor at the Department of Clinical Medicine, University of Bergen and a Consultant and Clinical Researcher, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Hilde L. vonVolkmann is a Consultant gastroenterologist, Head of the IBD-group Section of Gastroenterology, Department of Medicine,Haukeland University Hospital, Norway.
Odd H. Gilja is a Professor at the Department of Clinical Medicine, University of Bergen; Senior Consultant and  Director at National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway.    
Correspondence: [email protected]    
Link to online article: https://gutflix.eu/r/CCE7C5rPps4O    
Conflicts of interest:
OHG has received speaker honoraria from the following companies: AbbVie, Bracco, Almirall, GE Healthcare, Takeda AS, Meda AS, Ferring AS, Allergan, and Janssen-Cilag. He has served as consultant for Bracco, GE Healthcare, Takeda and Samsung. KN and HLvV has received lecture fees from Takeda and Janssen. AJG has no conflict of interest.

References:

  1. Maconi G, Nylund K, Ripollés T, Calabrese E, Dirks K, Dietrich CF, et al. EFSUMB recommendations and clinical guidelines for intestinal ultrasound (GIUS) in inflammatory bowel diseases. Ultraschall in der Medizin 2018; 39: 304–17.  [Link]
  2. Nylund K, Maconi G, Hollerweger A, Ripollés T, Pallotta N, Higginson A, et al. EFSUMB recommendations and guidelines for gastrointestinal ultrasound. Ultraschall in der Medizin 2017; 38: 273–84.  [Link]
  3. Maconi G, Hausken T, Dietrich CF, Pallotta N, Sporea I, Nürnberg D, et al. Gastrointestinal ultrasound in functional disorders of the gastrointestinal tract – EFSUMB consensus statement. Ultrasound international open 2021; 7: E14–24.  [Link]
  4. Dirks K, Calabrese E, Dietrich CF, Gilja OH, Hausken T, Higginson A, et al. EFSUMB position paper: Recommendations for gastrointestinal ultrasound (GIUS) in acute appendicitis and diverticulitis. Ultraschall in der Medizin 2019; 40: 163–75.  [Link]
  5. Maconi G, Di Sabatino A, Ardizzone S, Greco S, Colombo E, Russo A, et al. Prevalence and clinical significance of sonographic detection of enlarged regional lymph nodes in Crohn’s disease. Scandinavian journal of gastroenterology 2005; 40: 1328–33.  [Link]
  6. Dietrich CF, Hollerweger A, Dirks K, Higginson A, Serra C, Calabrese E, et al. EFSUMB gastrointestinal ultrasound (GIUS) task force group: Celiac sprue and other rare gastrointestinal diseases ultrasound features. Medical ultrasonography 2019; 21: 299–315.  [Link]
  7. Sævik F, Eriksen R, Eide GE, Gilja OH, Nylund K. Development and validation of a simple ultrasound activity score for Crohn’s disease. Journal of Crohn’s and Colitis 2021; 15: 115–24.  [Link]
  8. Peyrin-Biroulet L, Chamaillard M, Gonzalez F, Béclin E, Decourcelle C, Antunes L, et al. Mesenteric fat in Crohn’s disease: A pathogenetic hallmark or an innocent bystander? Gut 2007; 56: 577–83.  [Link]
  9. Kucharzik T, Wittig BM, Helwig U, Börner N, Rössler A, Rath S, et al. Use of intestinal ultrasound to monitor Crohn’s disease activity. Clinical gastroenterology and hepatology 2017; 15: 535–42.e2.  [Link]
  10. Maconi G, Greco S, Duca P, Ardizzone S, Massari A, Cassinotti A, et al. Prevalence and clinical significance of sonographic evidence of mesenteric fat alterations in Crohn’s disease. Inflammatory bowel diseases 2008; 14: 1555–61.  [Link]
  11. Nylund K, Hausken T, Gilja OH. Ultrasound and inflammatory bowel disease. Ultrasound quarterly 2010; 26: 3–15.  [Link]
  12. Di Mizio R, Maconi G, Romano S, D’Amario F, Bianchi Porro G, Grassi R. Small bowel Crohn disease: Sonographic features. Abdominal imaging 2004; 29: 23–35.  [Link]
Cases on call

Authors: Xavier Dray, Nathan Grellier and Antoine Guilloux
Affiliation:
Xavier Dray is at the Centre for Digestive Endoscopy at Sorbonne University & APHP Saint-Antoine Hospital, Paris, France.
Nathan Grellier is at Sorbonne University, Department of Gastroenterology, Saint-Antoine Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
Antoine Guilloux is at the Centre for Digestive Endoscopy, Saint-Antoine Hospital, AP-HP, Sorbonne Université, Paris, France
Correspondence:
Link to online article: https://gutflix.eu/r/NJVzqhkV1vtp
Conflicts of interest: None

References:

  1. Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopicdiagnosis and management of nonvariceal uppergastrointestinal hemorrhage (NVUGIH): EuropeanSociety of Gastrointestinal Endoscopy (ESGE)Guideline - Update 2021. Endoscopy 2021;53: 300–332.  [Link]
  2. Becq A, Camus M, Dray X. Foreign body ingestion: dosand don’ts. Frontline Gastroenterol 2021; 12: 664–670.  [Link]
  3. Ali Zargar S, Kochhar R, Mehta S, et al. The role offiberoptic endoscopy in the management of corrosiveingestion and modified endoscopic classification ofburns. Gastrointest Endosc 1991; 37: 165–169.  [Link]
  4. Chirica M, Resche-Rigon M, Zagdanski AM, et al.Computed Tomography Evaluation ofEsophagogastric Necrosis After Caustic Ingestion. Ann Surg 2016; 264: 107  [Link]
  5. Assalino M, Resche-Rigon M, Corte H, et al.Emergency computed tomography evaluation ofcaustic ingestion. Dis Esophagus 2022; 35: doac032  [Link]
  6. Gajjar RA, Gupta PB. Foreign body in the rectum: Achallenge for the emergency physician. J Family MedPrim Care 2016; 5: 495.  [Link]
  7. David Laharie. Mistakes in acute severe ulcerative colitis and how to avoid them. UEG Education 2023; 23: 19-21.  [Link]
  8. European Association for the Study of the Liver. Electronic address: [email protected], Clinical practice guidelines panel, Wendon, et al. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol 2017; 66: 1047–1081.  [Link]

Chapter 5: Hepatobiliary and Pancreas

  • Interpreting liver function test abnormalities
  • Metabolic dysfunction-associated steatotic liver disease (MASLD)
  • Alcohol-related liver disease
  • Chronic hepatitis B management
  • Decompensated liver cirrhosis
  • Coagulation in liver disease
  • Acute jaundice
  • Liver transplantation
  • Imaging hepatic lesions
  • Pancreatobiliary imaging
  • Endoscopic ultrasonography
  • Endoscopic retrograde cholangiopancreatography
  • The management of acute pancreatitis
  • Pancreatic cystic neoplasms
Interpreting liver function test abnormalities

Authors: Iris Kats, Frans J.C. Cuperus and Eric T. Tjwa
Affiliation:
Iris Kats is a gastroenterology and hepatology resident at University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
Frans JC Cuperus is a gastroenterologist and hepatologist at University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
Eric T Tjwa is a gastroenterologist and hepatologist at Radboud University Medical Centre, Nijmegen, The Netherlands.
Correspondence:
Link to online article: https://gutflix.eu/r/ZVsg4KDKn6E7
Conflicts of interest: None

References:

  1. Donnan P, McLernon D, Dillon J, et al. Development of a decision support tool for primary care management of patients with abnormal liver function tests without clinically apparent liver disease: a record-linkage population cohort study and decision analysis (ALFIE). Health Technology Assessment 2009; 13: 1–156.  [Link]
  2. Whitfield JB. Gamma glutamyl transferase. Crit Rev Clin Lab Sci 2001; 38: 263–355.  [Link]
  3. Jacquemin E. Progressive familial intrahepatic cholestasis. Clin Res Hepatol Gastroenterol 2012; 36 Suppl 1: S26-35.  [Link]
  4. Rej R. Aspartate aminotransferase activity and isoenzyme proportions in human liver tissues. Clin Chem 1978; 24: 1971–9.  [Link]
  5. Ruhl CE, Everhart JE. Upper limits of normal for alanine aminotransferase activity in the United States population. Hepatology 2012; 55: 447–54.  [Link]
  6. Litin SC, O’Brien JF, Pruett S, et al. Macroenzyme as a cause of unexplained elevation of aspartate aminotransferase. Mayo Clin Proc 1987; 62: 681–7.  [Link]
  7. Han J-H, Kwak J-Y, Lee S-S, et al. Markedly Elevated Aspartate Aminotransferase from Non-Hepatic Causes. Journal of Clinical Medicine 2023; 12: 310  [Link]
  8. Rosalki SB, Tarlow D, Rau D. Plasma gamma-glutamyl transpeptidase elevation in patients receiving enzyme-inducing drugs. Lancet 1971; 2: 376–7.  [Link]
  9. Kalas MA, Chavez L, Leon M, et al. Abnormal liver enzymes: A review for clinicians. World J Hepatol 2021; 13: 1688–1698.  [Link]
  10. Bozkus F, Dikmen N, Sahin H, et al. Serum Gamma-Glutamyl Transferase Activity as a Potential Novel Cardiovascular Biomarker in COPD. Respir Care 2016; 61: 1465–1471.  [Link]
  11. Brennan PN, Dillon JF, Tapper EB. Gamma-Glutamyl Transferase (γ-GT) - an old dog with new tricks? Liver Int 2022; 42: 9–15.  [Link]
  12. Dufour DR, Lott JA, Nolte FS, et al. Diagnosis and monitoring of hepatic injury. I. Performance characteristics of laboratory tests. Clin Chem 2000; 46: 2027–49.  [Link]
  13. Lammers WJ, van Buuren HR, Hirschfield GM, et al. Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis: an international follow-up study. Gastroenterology 2014; 147: 1338–49.e5; quiz e15.  [Link]
  14. Lowe D STZM et al. Alkaline Phosphatase. StatPearls [Internet].  [Link]
  15. Van Hootegem P, Fevery J, Blanckaert N. Serum bilirubins in hepatobiliary disease: comparison with other liver function tests and changes in the postobstructive period. Hepatology 1985; 5: 112–7.  [Link]
  16. Cohen JA, Kaplan MM. The SGOT/SGPT ratio--an indicator of alcoholic liver disease. Dig Dis Sci 1979; 24: 835–8.  [Link]
  17. Allen JP, Litten RZ, Strid N, et al. The role of biomarkers in alcoholism medication trials. Alcohol Clin Exp Res 2001; 25: 1119–25.  [Link]
  18. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of cholestatic liver diseases. J Hepatol 2009; 51: 237–67.  [Link]
  19. Northup PG, Caldwell SH. Coagulation in liver disease: a guide for the clinician. Clin Gastroenterol Hepatol 2013; 11: 1064–74.  [Link]
  20. Intagliata NM, Rahimi RS, Higuera-de-la-Tijera F, et al. Procedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study. Gastroenterology 2023; 165: 717–732.  [Link]
  21. Edoardo G. Giannini, Stephen H. Caldwell. Mistakes in coagulation in liver disease and how to avoid them. UEG Mistakes In Articles.  [Link]
  22. European Association for the Study of the Liver. Electronic address: [email protected], Clinical Practice Guideline Panel: Chair:, Panel members, et al. EASL Clinical Practice Guidelines: Drug-induced liver injury. J Hepatol 2019; 70: 1222–1261.  [Link]
  23. Haanen J, Obeid M, Spain L, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33: 1217–1238.  [Link]
  24. De Martin E, Michot J-M, Papouin B, et al. Characterization of liver injury induced by cancer immunotherapy using immune checkpoint inhibitors. J Hepatol 2018; 68: 1181–1190.  [Link]
Metabolic dysfunction-associated steatotic liver disease (MASLD)

Authors: Julian G. Yeh and Philip N. Newsome
Affiliation:
Julian G. Yeh is at the Department of Liver Medicine, Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Philip N. Newsome is a Professor, Department of Immunology and Immunotherapy, Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
Correspondence:
Link to online article: https://gutflix.eu/r/IlfEjIyCGlHr
Conflicts of interest: None

References:

  1. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol 2023; 79: 1542–1556.  [Link]
  2. Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatol Baltim Md 2016; 64: 73–84.  [Link]
  3. Adam R, Karam V, Cailliez V, et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation. Transpl Int Off J Eur Soc Organ Transplant 2018; 31: 1293–1317.  [Link]
  4. Saeed N, Glass L, Sharma P, et al. Incidence and Risks for Nonalcoholic Fatty Liver Disease and Steatohepatitis Post-liver Transplant: Systematic Review and Meta-analysis. Transplantation 2019; 103: e345–e354.  [Link]
  5. Younossi ZM, Golabi P, Paik JM, et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatol Baltim Md 2023; 77: 1335–1347.  [Link]
  6. Smits MM, Ioannou GN, Boyko EJ, et al. Non-alcoholic fatty liver disease as an independent manifestation of the metabolic syndrome: results of a US national survey in three ethnic groups. J Gastroenterol Hepatol 2013; 28: 664–670.  [Link]
  7. Lekakis V, Papatheodoridis GV. Natural history of metabolic dysfunction-associated steatotic liver disease. Eur J Intern Med 2024; 122: 3–10.  [Link]
  8. Ma X, Liu S, Zhang J, et al. Proportion of NAFLD patients with normal ALT value in overall NAFLD patients: a systematic review and meta-analysis. BMC Gastroenterol 2020; 20: 10.  [Link]
  9. Mofrad P, Contos MJ, Haque M, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatol Baltim Md 2003; 37: 1286–1292.  [Link]
  10. Amarapurkar DN, Patel ND. Clinical spectrum and natural history of non-alcoholic steatohepatitis with normal alanine aminotransferase values. Trop Gastroenterol Off J Dig Dis Found 2004; 25: 130–134.  [Link]
  11. Chen Y-T, Chen T-I, Yin S-C, et al. Prevalence, proportions of elevated liver enzyme levels, and long‐term cardiometabolic mortality of patients with metabolic dysfunction‐associated steatotic liver disease. Journal of Gastroenterology and Hepatology 2024; 39: 1939–1949.  [Link]
  12. Vogel W, Kathrein H, Dietze O, et al. [Sonography of the liver in Wilson’s disease. Sonographic studies of the liver in Wilson’s disease--significance for assessing prognosis?]. Ultraschall Med Stuttg Ger 1980 1988; 9: 270–273.  [Link]
  13. Tacke F, Horn P, Wai-Sun Wong V, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol 2024; S0168827824003295.  [Link]
  14. Harrison Stephen A., Bedossa Pierre, Guy Cynthia D., et al. A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis. N Engl J Med 2024; 390: 497–509.  [Link]
  15. Francque S, Krag A, Shawcross DL, et al. A turning point in hepatology? EASL reflects on the first approved drug for MASH. Journal of Hepatology 2024; 81: 192–194.  [Link]
  16. Newsome PN, Ambery P. Incretins (GLP-1 receptor agonists and dual/triple agonists) and the liver. J Hepatol 2023; 79: 1557–1565.  [Link]
  17. Charlton MR, Burns JM, Pedersen RA, et al. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology 2011; 141: 1249–1253.  [Link]
  18. Taylor RS, Taylor RJ, Bayliss S, et al. Association Between Fibrosis Stage and Outcomes of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Gastroenterology 2020; 158: 1611-1625.e12.  [Link]
  19. Sanyal AJ, Van Natta ML, Clark J, et al. Prospective Study of Outcomes in Adults with Nonalcoholic Fatty Liver Disease. N Engl J Med 2021; 385: 1559–1569.  [Link]
  20. Parker R, Kim S-J, Gao B. Alcohol, adipose tissue and liver disease: mechanistic links and clinical considerations. Nat Rev Gastroenterol Hepatol 2018; 15: 50–59.  [Link]
  21. Tandon P, Ney M, Irwin I, et al. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 2012; 18: 1209–1216.  [Link]
  22. Haldar D, Kern B, Hodson J, et al. Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study. J Hepatol 2019; 71: 313–322.  [Link]
  23. Mantovani A, Csermely A, Petracca G, et al. Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: an updated systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2021; 6: 903–913.  [Link]
  24. Paklar N, Mijic M, Filipec-Kanizaj T. The Outcomes of Liver Transplantation in Severe Metabolic Dysfunction-Associated Steatotic Liver Disease Patients. Biomedicines 2023; 11: 3096.  [Link]
  25. Villeret F, Dharancy S, Erard D, et al. Inevitability of disease recurrence after liver transplantation for NAFLD cirrhosis. JHEP Rep 2023; 5: 100668  [Link]
  26. Newsome PN. Recurrence of nonalcoholic fatty liver disease after liver transplantation: it is common, but does it affect outcome? Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 2010; 16: 420–422.  [Link]
  27. Samji NS, Verma R, Keri KC, et al. Liver Transplantation for Nonalcoholic Steatohepatitis: Pathophysiology of Recurrence and Clinical Challenges. Dig Dis Sci 2019; 64: 3413–3430.  [Link]
  28. Shetty A, Giron F, Divatia MK, et al. Nonalcoholic Fatty Liver Disease after Liver Transplant. J Clin Transl Hepatol 2021; 9: 428.  [Link]
  29. Heimbach JK, Watt KDS, Poterucha JJ, et al. Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 2013; 13: 363–368.  [Link]
Alcohol-related liver disease

Authors: Francisco Faustino, Pedro Marques da Costa and Helena Cortez-Pinto
Affiliation: 
Francisco de Oliveira Faustino and Pedro Marques da Costa are at Serviço de Gastrenterologia e Hepatologia – Hospital de SantaMaria, Unidade Local de Saúde Santa Maria, Lisboa, Portugal.
Helena Cortez-Pinto is also at Serviço de Gastrenterologia e Hepatologia – Hospital de Santa Maria and Laboratóriode Nutrição, Faculdade de Medicina, Universidade de Lisboa, Portugal.
Correspondence:
Link to online article: https://gutflix.eu/r/gPBX3vACnr0N
Conflicts of interest: None

References:

  1. World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).  [Link]
  2. European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).  [Link]
  3. Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.  [Link]
  4. Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.  [Link]
  5. Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.  [Link]
  6. Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.  [Link]
  7. Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.  [Link]
  8. Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.  [Link]
  9. Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.  [Link]
  10. Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.  [Link]
  11. Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.  [Link]
  12. Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.  [Link]
  13. Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.  [Link]
  14. Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.  [Link]
Chronic hepatitis B management

Authors: Upkar S. Gill and Patrick T.F. Kennedy
Affiliation:     
Upkar Gill is an Academic Clinical Lecturer & Honorary Specialist Registrar in Gastroenterology & Hepatology and
Patrick Kennedy is a Reader & Honorary Consultant Hepatologist at Barts Liver Centre, Blizard Institute, Barts and The London, School of Medicine & Dentistry, Queen Mary University of London, London, UK.
Correspondence:
Link to online article: https://gutflix.eu/r/pCyDvt7EUWGl
Conflicts of interest: None

References:

  1. Stanaway JD, Flaxman AD, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet 2016; 388: 1081–1088.  [Link]
  2. Gill US and Kennedy PTF. The impact of currently licensed therapies on viral and immune responses in chronic hepatitis B: Considerations for future novel therapeutics. J Viral Hepat 2019; 26: 4–15.  [Link]
  3. Gill US and Kennedy PT. New insights in the management of chronic hepatitis B. Clin Med (Lond) 2015; 15: 191–196.  [Link]
  4. European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2017; 67: 370–398.  [Link]
  5. Invernizzi F, Vigano M, Grossi G, et al. The prognosis and management of inactive HBV carriers. Liver Int 2016; 36 (Suppl 1):100–104.  [Link]
  6. Yurdaydin C. Recent advances in managing hepatitis D. F1000Res 2017; 6: 1596.  [Link]
  7. Townsend SA and Newsome PN. Mistakes in nonalcoholic fatty liver disease and how to avoid them. UEG Education 2017; 17: 39–41.  [Link]
  8. Peleg N, Issachar A, Arbib OS, et al. Liver steatosis is a major predictor of poor outcomes in chronic hepatitis C patients with sustained virological response. Journal of Viral Hepatitis 2019; 26: 1257–1265.  [Link]
  9. Seto WK. Chronic hepatitis B and metabolic risk factors: A call for rigorous longitudinal studies. World J Gastroenterol 2019; 25: 282–286.  [Link]
Decompensated liver cirrhosis

Authors: Tammo L. Tergast, Christoph Beier and Benjamin Maasoumy
Affiliation: 
Tammo Tergast is an intern and medical scientist, and 
Christoph Beier is a resident at the Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. 
Benjamin Maasoumy is a senior attending physician, research group leaderand lecturer at the Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, and a clinician scientist affiliated to the German Centre for Infection Research (Deutsches Zentrum für Infektionsforschung DZIF), Partner-siteHannover-Braunschweig, Hannover, Germany.
Correspondence:
Link to online article: https://gutflix.eu/r/hufIVvXWAXOK
Conflicts of interest: None

References:

  1. Jalan R, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol 2014; 60: 1310–1324.  [Link]
  2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018; 69: 406–460.  [Link]
  3. Moreau R, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426–37, 1437.e1–9.  [Link]
  4. Arvaniti V, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010; 139: 1246–56, 1256.e1–5.  [Link]
  5. Forgacs I and Loganayagam A. Overprescribing proton pump inhibitors. BMJ 2008; 336: 2–3.  [Link]
  6. Attwood S, et al. Long‐term safety of proton pump inhibitor therapy assessed under controlled, randomised clinical trial conditions: data from the SOPRAN and LOTUS studies. Aliment Pharmacol Ther 2015; 41: 1162–1174.  [Link]
  7. Dam G, et al. Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites. Hepatology 2016; 64: 1265–1272.  [Link]
  8. Tsai CF, et al. Proton pump inhibitors increase risk for hepatic encephalopathy in patients with cirrhosis in a population study. Gastroenterology 2017; 152: 134–141.  [Link]
  9. Tergast TL, et al. Dose dependent impact of proton pump inhibitors on the clinical course of spontaneous bacterial peritonitis. Liver Int 2018; 38: 1602–1613.  [Link]
  10. Sturm L, et al. Treatment with proton pump inhibitors increases the risk for development of hepatic encephalopathy after implantation of transjugular intrahepatic portosystemic shunt (TIPS). United European Gastroenterol J 2018; 6: 1380–1390.  [Link]
  11. Trikudanathan G, et al. Association between proton pump inhibitors and spontaneous bacterial peritonitis in cirrhotic patients – a systematic review and meta-analysis. Int J Clin Pract 2011; 65: 674–678.  [Link]
  12. Hung T, et al. Effect of proton pump inhibitors on mortality in patients with cirrhosis and spontaneous bacterial peritonitis. Annal Hepatol 2018; 17: 933–939.  [Link]
  13. Bajaj JS, et al. Systems biology analysis of omeprazole therapy in cirrhosis demonstrates significant shifts in gut microbiota composition and function. Am J Physiol Gastrointest Liver Physiol 2014; 307: G951–G957.  [Link]
  14. Shaheen NJ, Stuart E, Schmitz SM, et al. Pantoprazole reduces the size of postbanding ulcers after variceal band ligation: a randomized, controlled trial. Hepatology 2005; 41: 588–594.  [Link]
  15. Piano S, et al. Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide. Gastroenterology 2019; 156: 1368–1380.e10.  [Link]
  16. Fernández J, et al. Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe. J Hepatol 2019; 70: 398–411.  [Link]
  17. Fernández J, et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology 2012; 55: 1551–1561.  [Link]
  18. Lin C, et al. Should bleeding tendency deter abdominal paracentesis? Dig Liv Dis 2005; 37: 946–951.  [Link]
  19. Kim JJ, et al. Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis. Am J Gastroenterol 2014; 109: 1436–1442.  [Link]
  20. D’Amico G, Zipprich A, Villanueva C, et al. Further decompensation in cirrhosis: Results of a large multicenter cohort study supporting Baveno VII statements. Hepatology 2024; 79: 869–881.  [Link]
  21. Sundaram V, Shah P, Wong RJ, et al. Patients With Acute on Chronic Liver Failure Grade 3 Have Greater 14-Day Waitlist Mortality Than Status-1a Patients. Hepatology 2019; 70: 334–345.  [Link]
  22. Goldberg D, French B, Thomasson A, et al. Waitlist survival of patients with primary sclerosing cholangitis in the model for end-stage liver disease era. Liver Transpl 2011; 17: 1355–1363.  [Link]
  23. Allgemeinen Teil der Richtlinien gemäß § 16 Abs. 1 S. 1 Nrn. 2 u. 5 TPG für die Wartelistenführung und Organvermittlung. Deutsches Ärzteblatt 2023; 120: 116. (DOI: 10.3238/arztebl.2023.RiliOrgaWlOvLeberTx20230912)  [Link]
  24. Berg T, Aehling NF, Bruns T, et al. S2k-Leitlinie Lebertransplantation der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). Zeitschrift für Gastroenterologie 2024; 62: 1397–1573.  [Link]
Coagulation in liver disease

Authors: Edoardo G. Giannini and Stephen H. Caldwell    
Affiliation: 
Edoardo G. Giannini is a Professor in the Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Stephen H. Caldwell is a Professor and Director of Clinical Research in the Division of Gastroenterology and Hepatology, at the University of Virginia, Charlottesville, Virginia, USA.  
Correspondence:     
Link to online article: https://gutflix.eu/r/jQzQTXfnzCi9    
Conflicts of interest: EGG reports acting as a consultant and serving on advisory boards for AbbVie, Bayer, EISAI, Gilead Sciences, GSK, MSD, Roche,  Shionogi and SOBI. SHC reports receiving relevant research support from DOVA, Shionogi and Daiichi    

References:

  1.    Intagliata NM, Argo CK, Stine JG, et al. Concepts and controversies in haemostasis and thrombosis associated with liver disease: Proceedings of the 7th International Coagulation in Liver Disease Conference. Thromb Haemost 2018; 118: 1491–1506.  [Link]
  2.    Botta F, Giannini E, Romagnoli P, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003; 52: 134–139.  [Link]
  3.    Giannini EG and Peck-Radosavljevic M. Platelet dysfunction: status of thrombopoietin in thrombocytopenia associated with chronic liver failure. Semin Thromb Hemost 2015; 41: 455–461.  [Link]
  4.    Tripodi A and Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med 2011; 365: 147–156.  [Link]
  5.    Intagliata NM, Davis JPE and Caldwell SH. Coagulation pathways, hemostasis, and thrombosis in liver failure. Semin Respir Crit Care Med 2018; 39: 598–608.  [Link]
  6.    Stine JG, Intagliata NM, Shah NL, et al. Clinical cirrhosis dilemmas: Survey of practice from the 7th International Coagulation in Liver Disease Conference. Dig Dis Sci 2020; 65: 1334–1339.  [Link]
  7.    Northup PG, Sundaram V, Fallon MB, et al. Hypercoagulation and thrombophilia in liver disease. J Thromb Haemost 2008; 6: 2–9.  [Link]
  8.    Søgaard KK, Horváth-Puhó E, Grønbaek H, et al. Risk of venous thromboembolism in patients with liver disease: a nationwide population-based case-control study. Am J Gastroenterol 2009; 104: 96–101.  [Link]
  9.    Stine JG, Niccum BA, Zimmet AN, et al. Increased risk of venous thromboembolism in hospitalized patients with cirrhosis due to non-alcoholic steatohepatitis. Clin Transl Gastroenterol 2018; 9: 140.  [Link]
  10. Tripodi A, Primignani M, Lemma L, et al. Evidence that low protein C contributes to the procoagulant imbalance in cirrhosis. J Hepatol 2013; 59: 265–270.  [Link]
  11. Intagliata NM, Davis JPE, Lafond J, et al. Acute kidney injury is associated with low factor XIII in decompensated cirrhosis. Dig Liver Dis 2019; 51: 1409–1415.  [Link]
  12. Zanetto A, Rinder HM, Campello E, et al. Acute kidney injury in decompensated cirrhosis is associated with both hypo- and hyper-coagulable features. Hepatology 2020; 72: 1327–1340.  [Link]
  13. Quick AJ. The prothrombin in hemophilia and in obstructive jaundice. J Biol Chem 1935; 109: 73–4.
  14. Tripodi A, Caldwell SH, Hoffman M, et al. Review article: the prothrombin time test as a measure of bleeding risk and prognosis in liver disease. Aliment Pharmacol Ther 2007; 26: 141–148.  [Link]
  15. Trotter JF, Olson J, Lefkowitz J, et al. Changes in international normalized ratio (INR) and model for endstage liver disease (MELD) based on selection of clinical laboratory. Am J Transplant 2007; 7: 1624–1628.  [Link]
  16. Cruz-Ramón V, Chinchilla-López P, Ramírez-Pérez O, et al. Thrombosis of the portal venous system in cirrhotic vs. non-cirrhotic patients. Ann Hepatol 2018; 17: 476–481.  [Link]
  17. Intagliata NM, Caldwell SH and Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology 2019; 156: 1582–1599.  [Link]
  18. Hagerty T and Rich MW. Fall risk and anticoagulation for atrial fibrillation in the elderly: A delicate balance. Cleve Clin J Med 2017; 84: 35–40.  [Link]
  19. Ghabril M, Agarwal S, Lacerda M, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation 2016; 100: 126–133.  [Link]
  20. Pettinari I, Vukotic R, Stefanescu H, et al. Clinical impact and safety of anticoagulants for portal vein thrombosis in cirrhosis. Am J Gastroenterol 2019; 114: 258–266.  [Link]
  21. Delgado MG, Seijo S, Yepes I, et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 2012; 10: 776–783.  [Link]
  22. Villa E, Cammà C, Marietta M, et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology 2012; 143: 1253–1260.  [Link]
  23. Calvaruso V, Maimone S, Gatt A, et al. Coagulation and fibrosis in chronic liver disease. Gut 2008; 57: 1722–1727.  [Link]
  24. Davis JPE and Caldwell SH. Healing gone wrong: convergence of hemostatic pathways and liver fibrosis? Clin Sci (Lond) 2020; 134: 2189–2201.  [Link]
  25. Giannini EG, Stravitz RT and Caldwell SH. Portal vein thrombosis and chronic liver disease progression: The closer you look the more you see. Hepatology 2016; 63: 342–343.  [Link]
Acute jaundice

Authors: Spyridon Siakavellas and George Papatheodoridis
Affiliation: Spyridon Siakavellas and George Papatheodoridis are both at the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital ofAthens “Laiko”, Athens, Greece.
Correspondence:
Link to online article: https://gutflix.eu/r/R4fdrrogCUh9
Conflicts of interest: None

References:

  1. Fevery J. Bilirubin in clinical practice: a review. Liver Int 2008; 28: 592–605.  [Link]
  2. Erlinger S, Arias IM and Dhumeaux D. Inherited disorders of bilirubin transport and conjugation: new insights into molecular mechanisms and consequences. Gastroenterology 2014; 146: 1625–1638.  [Link]
  3. Marchand A, Galen RS and Van Lente F. The predictive value of serum haptoglobin in hemolytic disease. JAMA 1980; 243: 1909–1911.  [Link]
  4. Vitek L, et al. Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels. Atherosclerosis 2002; 160: 449–456.  [Link]
  5. Vuppalanchi R, Liangpunsakul S and Chalasani N. Etiology of new-onset jaundice: how often is it caused by idiosyncratic drug-induced liver injury in the United States? Am J Gastroenterol 2007; 102: 558–562.  [Link]
  6. Chand N and Sanyal AJ. Sepsis-induced cholestasis. Hepatology 2007; 45: 230–241.  [Link]
  7. Giallourakis CC, Rosenberg PM and Friedman LS. The liver in heart failure. Clinics Liv Dis 2002; 6: 947–967.  [Link]
  8. van Lingen R, et al. Jaundice as a presentation of heart failure. J R Soc Med 2005; 98: 357–359.  [Link]
  9. Okwara CJ, et al. Jaundice: A thyroid problem? Dig Dis Sci 2017; 62: 1901–1905.  [Link]
  10. Saik RP, et al. Spectrum of cholangitis. Am J Surg 1975; 130: 143–150.  [Link]
  11. Miura F, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013; 20: 47–54.  [Link]
  12. Thursz MR, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. New Engl J Med 2015; 372: 1619–1628.  [Link]
  13. Crabb DW, et al. Standard definitions and common data elements for clinical trials in patients with alcoholic hepatitis: Recommendation From the NIAAA Alcoholic Hepatitis Consortia. Gastroenterology 2016; 150: 785–790.  [Link]
Liver transplantation

Authors: Patrizia Burra and Alberto Zanetto
Affiliation: Patrizia Burra and Alberto Zanetto are at the Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy.
Correspondence: 
Link to online article: https://gutflix.eu/r/8fSrobWPcSRG
Conflicts of interest: None

References:

  1. Adam R, et al. 2018 Annual report of the European Liver Transplant Registry (ELTR) – 50-year evolution of liver transplantation. Transpl Int 2018; 31: 1293–1317.  [Link]
  2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol 2016; 64: 433–485.  [Link]
  3. Martin P, et al. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology 2014; 59: 1144–1165.  [Link]
  4. Russo FP, Ferrarese A and Zanetto A. Recent advances in understanding and managing liver transplantation. F1000Res 2016; 5.  [Link]
  5. Toniutto P, et al. Current challenges and future directions for liver transplantation. Liver Int 2017; 37: 317–327.  [Link]
  6. Burra P, et al. Liver transplantation for alcoholic liver disease in Europe: a study from the ELTR (European Liver Transplant Registry). Am J Transplant 2010; 10: 138–148.  [Link]
  7. Testino G, et al. Management of end-stage alcohol-related liver disease and severe acute alcohol-related hepatitis: position paper of the Italian Society on Alcohol (SIA). Dig Liver Dis 2020; 52: 21–32.  [Link]
  8. Kotlyar DS, et al. A critical review of candidacy for orthotopic liver transplantation in alcoholic liver disease. Am J Gastroenterol 2008; 103: 734–743.  [Link]
  9. Donckier V, et al. Ethical considerations regarding early liver transplantation in patients with severe alcoholic hepatitis not responding to medical therapy. J Hepatol 2014; 60: 866–871.  [Link]
  10. Burra P and Germani G. Transplantation for acute alcoholic hepatitis. Clin Liver Dis 2017; 9: 141–143.  [Link]
  11. Donnadieu-Rigole H, et al. Integration of an Addiction Team in a Liver Transplantation Center. Liver Transpl 2019; 25: 1611–1619.  [Link]
  12. Erard-Poinsot D, et al. Natural history of recurrent alcohol-related cirrhosis after liver transplantation: fast and furious. Liver Transpl 2020; 26: 25–33.  [Link]
  13. Lucey MR, et al. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg 1997; 3: 628–637.  [Link]
  14. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.  [Link]
  15. Burra P, et al. Long-term medical and psycho-social evaluation of patients undergoing orthotopic liver transplantation for alcoholic liver disease. Transpl Int 2000; 13 (Suppl 1): S174–S178.  [Link]
  16. Tandon P, et al. A shorter duration of pre-transplant abstinence predicts problem drinking after liver transplantation. Am J Gastroenterol 2009; 104: 1700–1706.  [Link]
  17. Burra P, et al. Common issues in the management of patients in the waiting list and after liver transplantation. Dig Liver Dis 2017; 49: 241–253.  [Link]
  18. Mathurin P, et al. Early liver transplantation for severe alcoholic hepatitis. N Engl J Med 2011; 365: 1790–1800.  [Link]
  19. Germani G, et al. Role of a dedicated referral system for patients with liver disease and potential indication for liver transplantation: prospective data from a single centre experience. Dig Liver Dis 2020; 52: e46–e71  [Link]
Imaging hepatic lesions

Author: Katja De Paepe
Affiliation: Katja De Paepe, Affiliate assistant professor at Cambridge, is an abdominal radiologist with a special interest in gastrointestinal and hepato-pancreatico-biliary imaging at the Department of Radiology, Cambridge University Hospitals, Hills Rd CB20QQ Cambridge, UK.
Correspondence:
Link to online article: https://gutflix.eu/r/rbx1jXVLthrq
Conflicts of interest: None

References:

  1. Lim J, Singal AG. Surveillance and diagnosis of hepatocellular carcinoma. Clinical liver disease 2019; 13: 2–5.  [Link]
  2. Singal AG, Pillai A, Tiro J. Early detection, curative treatment, and survival rates for hepatocellular carcinoma surveillance in patients with cirrhosis: A meta-analysis. PLoS medicine 2014; 11: e1001624.  [Link]
  3. Tzartzeva K, et al. Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis: A meta-analysis. Gastroenterology 2018; 154: 1706–18.e1.  [Link]
  4. Simmons O, et al. Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis. Alimentary pharmacology and therapeutics 2017; 45: 169–77.  [Link]
  5. LI-RADS ® v2017 US Core.  [Link]
  6. Vietti Violi N, Fowler KJ, Sirlin CB, Taouli B. Abbreviated magnetic resonance imaging for HCC surveillance. Clinical liver disease 2021; 17: 133–8.  [Link]
  7. Zane KE, Cloyd JM, Mumtaz KS, Wadhwa V, Makary MS. Metastatic disease to the liver: Locoregional therapy strategies and outcomes. World journal of clinical oncology 2021; 12: 725–45.  [Link]
  8. Galle PR, et al. EASL clinical practice guidelines: Management of hepatocellular carcinoma. Journal of hepatology 2018; 69: 182–236.  [Link]
  9. Alnammi M, Wortman J, Therrien J, Afnan J. MRI features of treated hepatocellular carcinoma following locoregional therapy: A pictorial review. Abdominal radiology (New York) 2022; 47: 2299–313.  [Link]
  10. Caseiro-Alves F, et al. Liver haemangioma: Common and uncommon findings and how to improve the differential diagnosis. European radiology 2007; 17: 1544–54.  [Link]
  11. Vilgrain V, et al. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics 2000; 20: 379–97.  [Link]
  12. Chen L, et al. Meta-analysis of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging for the detection of liver metastases. PLoS one 2012; 7: e48681.  [Link]
  13. Doo KW, et al. ‘Pseudo washout’ sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumour. American journal of roentgenology 2009; 193: W490–6.  [Link]
Pancreatobiliary imaging

Authors: Marianna Arvanitakis and Martina Pezzullo
Affiliation:
Marianna Arvanitakis is a gastroenterologist in the Department of Gastroenterology, Hepato-pancreatology and Digestive Oncology.
Martina Pezzullo is a radiologist in the Department of Radiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Correspondence:
Link to online article: https://gutflix.eu/r/w2DCm2P2NJ0D
Conflicts of interest: None

References:

  1. Harrington KA, Shukla-Dave A, Paudyal R, et al. MRI of the Pancreas. Journal of Magnetic Resonance Imaging 2020; 53: 347–359.  [Link]
  2. Zamboni GA, Ambrosetti MC, Pezzullo M, et al. Optimum imaging of chronic pancreatitis. Abdom Radiol (NY) 2020; 45: 1410–1419.  [Link]
  3. Yam BL and Siegelman ES. MR imaging of the biliary system. Radiol Clin North Am 2014; 52: 725–755.  [Link]
  4. Novikov A, Kowalski TE and Loren DE. Practical management of indeterminate biliary strictures. Gastrointest Endosc Clin N Am 2019; 29: 205–214.  [Link]
  5. Seo N, Kim SY, Lee SS, et al. Sclerosing cholangitis: clinicopathologic features, imaging spectrum, and systemic approach to differential diagnosis. Korean J Radiol 2016; 17: 25–38.  [Link]
  6. Kamisawa T, Zen Y, Nakazawa T, et al. Advances in IgG4-related pancreatobiliary diseases. Lancet Gastroenterol Hepatol 2018; 3: 575–585.  [Link]
  7. Katabathina VS, Dasyam AK, Dasyam N, et al. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 2014; 34: 565–586.  [Link]
  8. Fernandez YVM and Arvanitakis M. Early diagnosis and management of malignant distal biliary obstruction: a review on current recommendations and guidelines. Clin Exp Gastroenterol 2019; 12: 415–432.  [Link]
  9. Vernuccio F, Borhani AA, Dioguardi Burgio M, et al. Common and uncommon pitfalls in pancreatic imaging: it is not always cancer. Abdom Radiol (NY) 2016; 41: 283–294.  [Link]
  10. Klauss M, Maier-Hein K, Tjaden C, et al. IVIM DW-MRI of autoimmune pancreatitis: therapy monitoring and differentiation from pancreatic cancer. Eur Radiol 2016; 26: 2099–2106.  [Link]
Endoscopic ultrasonography

Authors: Andrada Seicean and Rodica Gincul
Affiliation: 
Andrada Seicean is Professor of Gastroenterology and Internal Medicine at the University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, Romania, working in the Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania. 
Rodica Gincul works working in the Department of Gastroenterology and Endoscopy, Jean Mermoz Private Hospital, Lyon, France.
Correspondence:
Link to online article: https://gutflix.eu/r/GNVc4e81o8C5
Conflicts of interest: None

References:

  1. Ghorashi B and Rector WR. Gray scale sonographic anatomy of the pancreas. J Clin Ultrasound 1977; 5: 25–29.  [Link]
  2. Möller K, Jenssen C, Braden B, et al. Pancreatic changes with lifestyle and age: What is normal and what is concerning? Endoscopic Ultrasound 2023; 12: 213.  [Link]
  3. Choi CW, et al. Associated factors for a hyperechogenic pancreas on endoscopic ultrasound. World J Gastroenterol 2010; 16: 4329–4334.  [Link]
  4. Catalano MF, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc 2009; 69: 1251–1261.  [Link]
  5. Savides TJ, et al. Detection of embryologic ventral pancreatic parenchyma with endoscopic ultrasound. Gastrointest Endosc 1996; 43: 14–19.  [Link]
  6. Yamashita Y, Shimokawa T, Napoléon B, et al. Value of contrast-enhanced harmonic endoscopic ultrasonography with enhancement pattern for diagnosis of pancreatic cancer: A meta-analysis. Digestive Endoscopy 2019; 31: 125–133.  [Link]
  7. Palazzo L, et al. Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma. Results of a prospective study with comparison to ultrasonography and CT scan. Endoscopy 1993; 25: 143–150.  [Link]
  8. Bhutani MS, et al. The no endosonographic detection of tumor (NEST) study: a case series of pancreatic cancers missed on endoscopic ultrasonography. Endoscopy 2004; 36: 385–389.  [Link]
  9. Munigala S, et al. New diagnosis of chronic pancreatitis: risk of missing an underlying pancreatic cancer. Am J Gastroenterol 2014; 109: 1824–1830.  [Link]
  10. Gincul R, et al. Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: a prospective multicenter trial. Endoscopy 2014; 46: 373–379.  [Link]
  11. Tian G, Ye Z, Zhao Q, et al. Complication incidence of EUS-guided pancreas biopsy: A systematic review and meta-analysis of 11 thousand population from 78 cohort studies. Asian Journal of Surgery 2020; 43: 1049–1055.  [Link]
  12. Zhu H, Jiang F, Zhu J, et al. Assessment of morbidity and mortality associated with endoscopic ultrasound‐guided fine‐needle aspiration for pancreatic cystic lesions: A systematic review and meta‐analysis. Digestive Endoscopy 2017; 29: 667–675.  [Link]
  13. Gopakumar H, Puli SR. Value of Endoscopic Ultrasound-Guided Through-the-Needle Biopsy in Pancreatic cystic Lesions. A Systematic Review and Meta-Analysis. Journal of Gastrointestinal Cancer 2023; 55: 15–25.  [Link]
  14. Tarantino I, et al. Complications of endoscopic ultrasound fine needle aspiration on pancreatic cystic lesions: final results from a large prospective multicenter study. Dig Liver Dis 2014; 46: 41–44.  [Link]
  15. Zhu H, et al. Assessment of morbidity and mortality associated with endoscopic ultrasound-guided fine-needle aspiration for pancreatic cystic lesions: A systematic review and meta-analysis. Dig Endosc 2017; 29: 667–675.  [Link]
  16. Kawakubo K, et al. A Prospective Multicenter Study Evaluating Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Prescribed Antithrombotic Agents. Gut Liver 2018; 12: 353–359.  [Link]
  17. Veitch AM, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Endoscopy 2016; 48: C1.  [Link]
  18. Facciorusso A, Arvanitakis M, Crinò SF, et al. Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review. Endoscopy 2025; 57: 390–418.  [Link]
  19. Annema JT, et al. Mediastinitis caused by EUS-FNA of a bronchogenic cyst. Endoscopy 2003; 35: 791–793.  [Link]
  20. Valli PV, Gubler C and Bauerfeind P. Severe infectious complications after endoscopic ultrasound-guided fine needle aspiration of suspected mediastinal duplication cysts: a case series. Inflamm Intest Dis 2017; 1: 165–171.  [Link]
  21. Han C, et al. A case report of esophageal bronchogenic cyst and review of the literature with an emphasis on endoscopic ultrasonography appearance. Medicine (Baltimore) 2016; 95: E3111.  [Link]
  22. Grandjean JP, et al. Vestigial retrorectal cystic tumors in adults: a review of 30 cases. Gastroenterol Clin Biol 2008; 32: 769–778.  [Link]
  23. Asbun HJ, Conlon K, Fernandez-Cruz L, et al. When to perform a pancreatoduodenectomy in the absence of positive histology? A consensus statement by the International Study Group of Pancreatic Surgery. Surgery 2014; 155: 887–892.  [Link]
  24. Shimosegawa T, Chari ST, Frulloni L, et al. International Consensus Diagnostic Criteria for Autoimmune Pancreatitis. Pancreas 2011; 40: 352–358.  [Link]
  25. Möller K, Braden B, Culver EL, et al. Secondary sclerosing cholangitis and IgG4-sclerosing cholangitis – A review of cholangiographic and ultrasound imaging. Endoscopic Ultrasound 2023; 12: 181.  [Link]
  26. Yamashita Y, Shimokawa T, Napoléon B, et al. Value of contrast‐enhanced harmonic endoscopic ultrasonography with enhancement pattern for diagnosis of pancreatic cancer: A meta‐analysis. Digestive Endoscopy 2018; 31: 125–133.  [Link]
  27. Cho MK, Moon S-H, Song TJ, et al. Contrast-Enhanced Endoscopic ultrasound for differentially diagnosing autoimmune pancreatitis and pancreatic cancer. Gut And Liver 2018; 12: 591–596.  [Link]
  28. Zhang B, Zhu F, Li P, et al. Endoscopic ultrasound elastography in the diagnosis of pancreatic masses: A meta-analysis. Pancreatology 2018; 18: 833–840.  [Link]
  29. Iglesias-García J, Domínguez-Muñoz JE. Standardization of endoscopic ultrasound shear wave elastography. Clinical Endoscopy 2023; 56: 185–187.  [Link]
  30. Ohno E, et al. Feasibility and usefulness of endoscopic ultrasonography-guided shear-wave measurement for assessment of autoimmune pancreatitis activity: a prospective exploratory study. J Med Ultrason (2001) 2019; 46: 425–433.  [Link]
  31. Yoon SB, Moon S, Song TJ, et al. Endoscopic ultrasound‐guided fine needle aspiration versus biopsy for diagnosis of autoimmune pancreatitis: Systematic review and comparative meta‐analysis. Digestive Endoscopy 2020; 33: 1024–1033.  [Link]
Endoscopic retrograde cholangiopancreatography

Authors: Mathieu Pioche, Jérôme Rivory, Thierry Ponchon and Marion Schaefer
Affiliation: 
Mathieu Pioche, is a physician at the Department of Endoscopy and Gastroenterology Edouard Herriot Hospital and INSERM U1032, LabTau.
Jérôme Rivory is a physician at the Department of Endoscopy and Gastroenterology Edouard Herriot Hospital andINSERM U1032, LabTau. 
Thierry Ponchon is the Head of the Department of Endoscopy and Gastroenterology, Edouard HerriotHospital, Lyon, France, and INSERM U1032, LabTau, Lyon, France.
Marion Schaefer is a physician at the HepatogastroenterologyDepartment at Nancy Regional University Hospital, Nancy, France.
Correspondence:
Link to online article: https://gutflix.eu/r/l781po1mk7rg
Conflicts of interest: None

References:

  1. Eissa M, Okasha HH, Abbasy M, et al. Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones. WJGE 2022; 14: 564–574.  [Link]
  2. Polkowski M, et al. Endoscopic ultrasound versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones: a randomized trial comparing two management strategies. Endoscopy 2007; 39: 296–303.  [Link]
  3. Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2019; 51: 472–491.  [Link]
  4. Dumonceau JM, et al.. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020; 52: 127-149.  [Link]
  5. Dickinson RJ and Davies S. Post-ERCP pancreatitis and hyperamylasaemia: the role of operative and patient factors. Eur J Gastroenterol Hepatol 1998; 10: 423–428.  [Link]
  6. Vandervoort J, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002; 56: 652–656.  [Link]
  7. Christensen M, et al. Complications of ERCP: a prospective study. Gastrointest Endosc 2004; 60: 721–731.  [Link]
  8. Testoni PA, et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016; 48 :657-83.  [Link]
  9. Kylänpää L, et al. Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: a randomized controlled trial. Endoscopy. 2021; 53: 1011-1019.  [Link]
  10. Levenick JM, et al. Rectal indomethacin does not prevent post-ERCP pancreatitis in consecutive patients. Gastroenterology 2016; 150: 911–917.  [Link]
  11. Sethi S, et al. A meta-analysis on the role of rectal diclofenac and indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreas 2014; 43: 190–197.  [Link]
  12. Elmunzer BJ, et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med 2012; 366: 1414–1422.  [Link]
  13. Park HS, Lee JM, Choi J-Y, et al. Preoperative Evaluation of Bile Duct Cancer: MRI Combined with MR Cholangiopancreatography Versus MDCT with Direct Cholangiography. American Journal of Roentgenology 2008; 190: 396–405.  [Link]
  14. Soares KC, et al. Hilar cholangiocarcinoma: diagnosis, treatment options, and management. Hepatobiliary Surg Nutr 2014; 3: 18–34.  [Link]
  15. Dumonceau J-M, Tringali A, Papanikolaou IS, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated October 2017. Endoscopy 2018; 50: 910–930.  [Link]
  16. Draganov PV, et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc 2012; 75: 347–353.  [Link]
  17. Clinicopathologic session; biliary cirrhosis secondary to extrahepatic obstruction. Prensa Médica Mex 1950; 15: 119–122. Spanish.
  18. Warter J and Sacrez A. The problem of complicated jaundice (hepatitis-extrahepatic biliary obstruction syndrome). Strasbg Méd 1962; 13: 666–676. French.
  19. Guzmán-Calderón GE, Chirinos J, Díaz-Arocutipa C, et al. Covered Versus Uncovered Metal Stents for the Drainage of the Malignant Distal Biliary Obstruction With ERCP: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2025; 59: 276–284.  [Link]
The management of acute pancreatitis

Authors: Georg Beyer, Simon Sirtl, Elisabeth Orgler and Julia Mayerle
Affiliation: Georg Beyer, Simon Sirtl, Elisabeth Orgler and Julia Mayerle are at the Department of Medicine II, LMU University Hospital, LMU Munich, Germany.
Correspondence: 
Link to online article: https://gutflix.eu/r/sqeQO7hGlDC6
Conflicts of interest: None

References:

  1. Peery AF, Crockett SD, Murphy CC, et al. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2021. Gastroenterology 2022; 162: 621-644. 20211019.  [Link]
  2. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111.  [Link]
  3. Szatmary P, Grammatikopoulos T, Cai W, et al. Acute Pancreatitis: Diagnosis and Treatment. Drugs 2022; 82: 1251-1276.  [Link]
  4. Mayerle J, Sendler M, Hegyi E, et al. Genetics, Cell Biology, and Pathophysiology of Pancreatitis. Gastroenterology 2019; 156: 1951-1968.e1.  [Link]
  5. Beyer G, Hoffmeister A, Michl P, et al. S3-Leitlinie Pankreatitis – Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – September 2021 – AWMF Registernummer 021-003. Z Gastroenterol 2022; 60: 419-521.  [Link]
  6. Schepers NJ, Bakker OJ, Besselink MG, et al. Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis. Gut 2019; 68: 1044-1051.  [Link]
  7. Working Group IAPAPAAPG. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13: e1-15.  [Link]
  8. de-Madaria E, Banks PA, Moya-Hoyo N, et al. Early factors associated with fluid sequestration and outcomes of patients with acute pancreatitis. Clin Gastroenterol Hepatol 2014; 12: 997-1002.  [Link]
  9. Zorniak M, Beyer G and Mayerle J. Risk Stratification and Early Conservative Treatment of Acute Pancreatitis. Visceral Medicine 2019; 35: 82-89.  [Link]
  10. Gardner TB, Vege SS, Chari ST, et al. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology 2009; 9: 770-776.  [Link]
  11. Mao EQ, Fei J, Peng YB, et al. Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis. Chinese medical journal 2010; 123: 1639-1644.  [Link]
  12. Mao EQ, Tang YQ, Fei J, et al. Fluid therapy for severe acute pancreatitis in acute response stage. Chinese medical journal 2009; 122: 169-173.  [Link]
  13. Holodinsky JK, Roberts DJ, Ball CG, et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Critical Care 2013; 17: 1–15.  [Link]
  14. Kirkpatrick AW, Sugrue M, McKee JL, et al. Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017. Anaesthesiol Intensive Ther 2017; 49: 83-87.  [Link]
  15. de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. New England Journal of Medicine 2022; 387: 989-1000.  [Link]
  16. Wu BU, Hwang JQ, Gardner TH, et al. Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol 2011; 9: 710-717 e711.  [Link]
  17. Investigators P, Rowan KM, Angus DC, et al. Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis. N Engl J Med 2017; 376: 2223-2234.  [Link]
  18. Sun Y, Lu ZH, Zhang XS, et al. The effects of fluid resuscitation according to PiCCO on the early stage of severe acute pancreatitis. Pancreatology 2015; 15: 497–502.  [Link]
  19. Huber W, Umgelter A, Reindl W, et al. Volume assessment in patients with necrotizing pancreatitis: a comparison of intrathoracic blood volume index, central venous pressure, and hematocrit, and their correlation to cardiac index and extravascular lung water index. Crit Care Med 2008; 36: 2348-2354.  [Link]
  20. Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25: 17-30.  [Link]
  21. Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci 2018; 25: 31-40.  [Link]
  22. Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2019; 51: 472-491.  [Link]
  23. van Santvoort HC, Besselink MG, de Vries AC, et al. Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study. Ann Surg 2009; 250: 68-75.  [Link]
  24. Schepers NJ, Hallensleben NDL, Besselink MG, et al. Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): a multicentre randomised controlled trial. Lancet 2020; 396: 167-176.  [Link]
  25. Hallensleben ND, Stassen PMC, Schepers NJ, et al. Patient selection for urgent endoscopic retrograde cholangio-pancreatography by endoscopic ultrasound in predicted severe acute biliary pancreatitis (APEC-2): a multicentre prospective study. Gut 2023; 72: 1534–1542.  [Link]
  26. da Costa DW, Bouwense SA, Schepers NJ, et al. Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial. The Lancet 2015; 386: 1261-1268.  [Link]
  27. da Costa DW, Schepers NJ, Romkens TE, et al. Endoscopic sphincterotomy and cholecystectomy in acute biliary pancreatitis. Surgeon 2016; 14: 99-108.  [Link]
  28. Di Martino M, Ielpo B, Pata F, et al. Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis. JAMA Surg 2023; 158: e233660.  [Link]
  29. van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2018; 391: 51-58.  [Link]
  30. Bang JY, Arnoletti JP, Holt BA, et al. An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis. Gastroenterology 2019; 156: 1027-1040.e1023.  [Link]
  31. Boxhoorn L, van Dijk SM, van Grinsven J, et al. Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis. N Engl J Med 2021; 385: 1372-1381.  [Link]
  32. Bang JY, Lakhtakia S, Thakkar S, et al. Upfront endoscopic necrosectomy or step-up endoscopic approach for infected necrotising pancreatitis (DESTIN): a single-blinded, multicentre, randomised trial. Lancet Gastroenterol Hepatol 2024; 9: 22-33.  [Link]
  33. Siriwardena AK, Jegatheeswaran S and Mason JM. A procalcitonin-based algorithm to guide antibiotic use in patients with acute pancreatitis (PROCAP): a single-centre, patient-blinded, randomised controlled trial. Lancet Gastroenterol Hepatol 2022; 7: 913–921.  [Link]
  34. Bakker OJ, van Brunschot S, Farre A, et al. Timing of enteral nutrition in acute pancreatitis: meta-analysis of individuals using a single-arm of randomised trials. Pancreatology 2014; 14: 340-346.  [Link]
Pancreatic cystic neoplasms

Authors: J. Enrique Domínguez-Muñoz and Giovanni Marchegiani
Affiliation: 
J. Enrique Domínguez-Muñoz is at the Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain. 
Giovanni Marchegiani is at the Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Italy.
Correspondence:
Link to online article: https://gutflix.eu/r/0wlIPIfXq2M2
Conflicts of interest: None

References:

  1. Vilela A, Quingalahua E, Vargas A, et al. Global Prevalence of Pancreatic Cystic Lesions in the General Population on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology 2024; 22: 1798-1809.e6.  [Link]
  2. Ohtsuka T, Fernandez-del Castillo C, Furukawa T, et al. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology 2024; 24: 255–270.   [Link]
  3. The European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018; 67: 789–804.   [Link]
  4. Noia JL, Mejuto R, Oria I, et al. Rapid diagnosis of mucinous cystic pancreatic lesions by on-site cyst fluid glucometry. Surg Endosc 2022; 36: 2473–2479.   [Link]
  5. Rossi G, Petrone MC, Tacelli M, et al. Glucose and lactate levels are lower in EUS-aspirated cyst fluid of mucinous vs non-mucinous pancreatic cystic lesions. Dig Liver Dis 2024; 56: 836–840.   [Link]
  6. Khan I, Baig M, Bandepalle T, et al. Utility of Cyst Fluid Carcinoembryonic Antigen in Differentiating Mucinous and Non-mucinous Pancreatic Cysts: An Updated Meta-Analysis. Dig Dis Sci 2022; 67: 4541–4548.   [Link]
  7. McCarty TR, Garg R, Rustagi T. Pancreatic cyst fluid glucose in differentiating mucinous from nonmucinous pancreatic cysts: a systematic review and meta-analysis. Gastrointest Endosc 2021; 94: 698-712.e6.   [Link]
  8. Li S, Wang Z, Pan C, et al. Comparative Performance of Endoscopic Ultrasound-Based Techniques in Patients With Pancreatic Cystic Lesions: A Network Meta-Analysis. Am J Gastroenterol 2023; 118: 243–255.   [Link]
  9. Haeberle L, Schramm M, Goering W, et al. Molecular analysis of cyst fluids improves the diagnostic accuracy of pre-operative assessment of pancreatic cystic lesions. Sci Rep 2021; 11: 2901.   [Link]
  10. Rift CV, Melchior LC, Kovacevic B, et al. Targeted next-generation sequencing of EUS-guided through-the-needle-biopsy sampling from pancreatic cystic lesions. Gastrointest Endosc 2023; 97: 50-58.e4.   [Link]
  11. Kirschenbaum JD, Gonda TA. The Use of Integrated Molecular Testing in the Assessment and Management of Pancreatic Cysts. Curr Gastroenterol Rep 2023; 25: 182–190.   [Link]
  12. Lisotti A, Napoleon B, Facciorusso A, et al. Contrast-enhanced EUS for the characterization of mural nodules within pancreatic cystic neoplasms: systematic review and meta-analysis. Gastrointest Endosc 2021; 94: 881-889.e5.   [Link]
  13. Ohno E, Balduzzi A, Hijioka S, et al. Association of high-risk stigmata and worrisome features with advanced neoplasia in intraductal papillary mucinous neoplasms (IPMN): A systematic review. Pancreatology 2024; 24: 48–61.   [Link]
  14. Fong ZV, Hernandez-Barco YG, Castillo CF. A Clinical Guide to the Management of Intraductal Papillary Mucinous Neoplasms: the Need for a More Graded Approach in Clinical Decision-making. J Gastrointest Surg 2023; 27: 1988–1998.   [Link]

Chapter 6: Inflammatory Bowel Disease

  • The medical management of IBD
  • Therapeutic drug monitoring of biologics in IBD
  • Biomarkers for IBD
  • Nutrition in IBD
  • Malignancy surveillance in IBD
  • Opportunistic infections and vaccinations in IBD
  • Acute severe ulcerative colitis
  • The management of postoperative Crohn’s disease
  • Microscopic colitis
  • IBD and reproduction
The medical management of IBD

Authors: Tim Raine and Nik Sheng Ding
Affiliation: 
Tim Raine is at the Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK.
Nik Ding is at the Department of Gastroenterology, St Vincent’s Hospital Melbourne, University of Melbourne, Melbourne, Australia.
Correspondence:
Link to online article: https://gutflix.eu/r/thx4WixtgTtR
Conflicts of interest:
TR has received honoraria or consultation fees from Abbvie, Astellas, Dr Falk, Hospira, GSK, Janssen, MSD, Novartis, Pfizer and Takeda. 
NSD has received honoraria or consultation fees from Abbvie, Dr Falk, Pfizer and Shire.

References:

  1. Molodecky NA, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012; 142: 46–54.e42.  [Link]
  2. Akobeng AK, et al. Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn's disease. Cochrane Database Syst Rev 2016; 9: CD003715.  [Link]
  3. Gordon M, et al. Oral 5-aminosalicylic acid for maintenance of surgically-induced remission in Crohn's disease. Cochrane Database Syst Rev 2011: CD008414.  [Link]
  4. Terdiman JP, et al. American Gastroenterological Association Institute guideline on the use of thiopurines, methotrexate, and anti-TNF-alpha biologic drugs for the induction and maintenance of remission in inflammatory Crohn's disease. Gastroenterology 2013; 145: 1459–1463.  [Link]
  5. Gomollon F, et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis 2017; 11: 3–25.  [Link]
  6. Siegel CA, et al. DOP060 Real-world treatment pathway visualizations show low use of biologic therapies in Crohn's disease and ulcerative colitis in the United States. J Crohns Colitis 2017; 11 (Suppl 1) : S61–S62.  [Link]
  7. Feagan BG, Sandborn WJ, Gasink C, et al. Ustekinumab as induction and maintenance therapy for Crohn's disease. N Engl J Med 2016; 375: 1946–1960.  [Link]
  8. Steinhart AH, et al. Corticosteroids for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2003; CD000301.  [Link]
  9. Kuenzig ME, et al. Budesonide for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2014; CD002913.  [Link]
  10. Irving PM, et al. Review article: Appropriate use of corticosteroids in Crohn's disease. Aliment Pharmacol Ther 2007; 26: 313–329.  [Link]
  11. Lichtenstein GR, et al. Serious infection and mortality in patients with Crohn's disease: More than 5 years of follow-up in the TREAT registry. Am J Gastroenterol 2012; 107: 1409–1422.  [Link]
  12. Melmed GY and Siegel CA. Quality improvement in inflammatory bowel disease. Gastroenterol Hepatol 2013; 9: 286–292.  [Link]
  13. Westwood N and Travis SP. Review article: What do patients with inflammatory bowel disease want for their clinical management? Aliment Pharmacol Ther 2008; 27 (Suppl 1): 1–8.  [Link]
  14. Magro F, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: Definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis 2017; 11: 649–670.  [Link]
  15. Chhaya V, et al. Steroid dependency and trends in prescribing for inflammatory bowel disease—a 20-year national population-based study. Aliment Pharmacol Ther 2016; 44: 482–494.  [Link]
  16. Gecse KB, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease. Gut 2014; 63: 1381–1392.  [Link]
  17. Teruel C, Garrido E and Mesonero F. Diagnosis and management of functional symptoms in inflammatory bowel disease in remission. World J Gastrointest Pharmacol Ther 2016; 7: 78–90.  [Link]
  18. Mao R, et al. Fecal calprotectin in predicting relapse of inflammatory bowel diseases: a meta-analysis of prospective studies. Inflamm Bowel Dis 2012; 18: 1894–1899.  [Link]
  19. Ricanek P, et al. Evaluation of disease activity in IBD at the time of diagnosis by the use of clinical, biochemical, and fecal markers. Scand J Gastroenterol 2011; 46: 1081–1091.  [Link]
  20. Jones J, et al. Relationships between disease activity and serum and fecal biomarkers in patients with Crohn's disease. Clin Gastroenterol Hepatol 2008; 6: 1218–1224.  [Link]
  21. Peyrin-Biroulet L, et al. Defining Disease severity in inflammatory bowel diseases: Current and future directions. Clin Gastroenterol Hepatol 2016; 14: 348–354.e17.  [Link]
  22. Baert F, et al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn's disease. Gastroenterology 2010; 138: 463–468.  [Link]
  23. Neurath MF and Travis SP. Mucosal healing in inflammatory bowel diseases: A systematic review. Gut 2012; 61: 1619–1635.  [Link]
  24. Shah SC, et al. Mucosal healing is associated with improved long-term outcomes of patients with ulcerative colitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 1245–1255 e8.  [Link]
  25. Khanna R, et al. Early combined immunosuppression for the management of Crohn's disease (REACT): A cluster randomised controlled trial. Lancet 2015; 386: 1825–1834.  [Link]
  26. De Cruz P, et al. Crohn's disease management after intestinal resection: a randomised trial. Lancet 2015; 385: 1406–1417.  [Link]
  27. Colombel JF, et al. Abstract 718 Superior endoscopic and deep remission outcomes in adults with moderate to severe Crohn's disease managed with treat to target approach versus clinical symptoms: Data from CALM. Gastroenterology 2017; 152 (Suppl 1): S155.  [Link]
  28. Bernstein CN, et al. Hospitalisations and surgery in Crohn's disease. Gut 2012; 61: 622–629.  [Link]
  29. Kaplan GG, et al. Decreasing colectomy rates for ulcerative colitis: a population-based time trend study. Am J Gastroenterol 2012; 107: 1879–1887.  [Link]
  30. Yassin NA, et al. Systematic review: The combined surgical and medical treatment of fistulising perianal Crohn's disease. Aliment Pharmacol Ther 2014; 40: 741–749.  [Link]
  31. Travis SP, et al. Predicting outcome in severe ulcerative colitis. Gut 1996; 38: 905–910.  [Link]
  32. de Groof J, et al. OP015 Cost-effectiveness of laparoscopic ileocecal resection versus infliximab treatment of terminal ileitis in Crohn's disease: the LIR!C TRIAL. J Crohns Colitis 2017; 11 (Suppl 1) : S9–S10.  [Link]
Therapeutic drug monitoring of biologics in IBD

Authors: Konstantinos Papamichail and Adam S. Cheifetz    
Affiliation:
Konstantinos Papamichail is a Physician Scientist at the Center of Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center and an Assistant Professor of Medicine at Harvard Medical School, USA.
Adam S. Cheifetz is the Director of the Center of Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA and an Assistant Professor of Medicine at Harvard Medical School, USA.    
Correspondence:     
Link to online article: https://gutflix.eu/r/mrCRp4yUge5d    
Conflicts of interest:
K.P. received lecture/speaker fees from Physicians Education Resource LLC and Grifols; scientific advisory board fees from ProciseDx Inc and Scipher Medicine Corporation; and serves as a consultant for Prometheus Laboratories Inc. A.S.C. served as a consultant and or advisory board member for Janssen, Abbvie, Protagonist, Spherix, Artizan, Food is Good, Clario, Pfizer, Fresenius Kabi, Artugen, ProciseDx, Prometheus, Equillium, Samsung, Arena, Grifols, Bacainn, Bristol Myers Squibb, Takeda; unbranded speaker for BMS and Abbvie.  

References:

  1. Fine S, Papamichael K, Cheifetz AS, et al. Etiology and management of lack or loss of response to anti-tumor necrosis factor therapy in patients with inflammatory bowel disease. Gastroenterol Hepatol (N Y) 2019;15: 656-665.  [Link]
  2. Roblin X, Rinaudo M, Tedesco E, et al. Development of an algorithm incorporating pharmacokinetics of adalimumab in inflammatory bowel diseases. Am J Gastroenterol 2014; 109: 1250-1256.  [Link]
  3. Yanai H, Lichtenstein L, Assa A, et al. Levels of drug and antidrug antibodies are associated with outcome of interventions after loss of response to infliximab or adalimumab. Clin Gastroenterol Hepatol 2015;13: 522-530.  [Link]
  4. Kelly OB, Donnell SO, Stempak JM, et al. Therapeutic drug monitoring to guide infliximab dose adjustment is associated with better endoscopic outcomes than clinical decision making alone in active inflammatory bowel disease. Inflamm Bowel Dis 2017; 23:1202–1209.  [Link]
  5. Marquez-Megias S, Nalda-Molina R, Sanz-Valero J, et al. Cost-effectiveness of therapeutic drug monitoring of anti-tnf therapy in inflammatory bowel disease: a systematic review. Pharmaceutics 2022; 14: 1009.  [Link]
  6. Cheifetz AS, Abreu MT, Afif W, et al. A Comprehensive Literature Review and Expert Consensus Statement on Therapeutic Drug Monitoring of Biologics in Inflammatory Bowel Disease. Am J Gastroenterol 2021; 116: 2014-2025.  [Link]
  7. Sethi S, Dias S, Kumar A, et al. Meta‐analysis: The efficacy of therapeutic drug monitoring of anti‐TNF‐therapy in inflammatory bowel disease. Alimentary Pharmacology & Therapeutics 2022; 57: 1362–1374.  [Link]
  8. Spencer EA, Stachelski J, Dervieux T, et al. Failure to Achieve Target Drug Concentrations During Induction and Not HLA-DQA1∗05 Carriage Is Associated With Antidrug Antibody Formation in Patients With Inflammatory Bowel Disease. Gastroenterology 2022; 162: 1746-1748.e3.  [Link]
  9. Lega S, Phan BL, Rosenthal CJ, et al. Proactively Optimized Infliximab Monotherapy Is as Effective as Combination Therapy in IBD. Inflammatory Bowel Diseases 2018; 25: 134–141.  [Link]
  10. Drobne D, Kurent T, Golob S, et al. Optimised infliximab monotherapy is as effective as optimised combination therapy, but is associated with higher drug consumption in inflammatory bowel disease. Alimentary Pharmacology & Therapeutics 2019; 49: 880–889.  [Link]
  11. Colombel J-F, Adedokun OJ, Gasink C, et al. Combination Therapy With Infliximab and Azathioprine Improves Infliximab Pharmacokinetic Features and Efficacy: A Post Hoc Analysis. Clin Gastroenterol Hepatol 2019; 17: 1525–1532.  [Link]
  12. Solitano V, Facciorusso A, McGovern DPB, et al. HLA-DQA1∗05 Genotype and Immunogenicity to Tumor Necrosis Factor-α Antagonists: A Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology 2023; 21: 3019-3029.e5.  [Link]
  13. Louis E, Mary J-Y, Vernier-Massouille G, et al. Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped. Gastroenterology 2012; 142: 63-70.  [Link]
  14. Papamichael K, Casteele NV, Ann Gils A, et al. Long-term outcome of patients with Crohn's disease who discontinued infliximab therapy upon clinical remission Clin Gastroenterol Hepatol 2015; 13: 1103–1110.  [Link]
  15. Ben-horin S, Chowers SY, Ungar B, et al. Undetectable anti-TNF drug levels in patients with long-term remission predict successful drug withdrawal. Aliment Pharmacol Ther 2015; 42: 356–564.  [Link]
  16. Bots SJ, Kuin S, Ponsioen CY, et al. Relapse rates and predictors for relapse in a real-life cohort of IBD patients after discontinuation of anti-TNF therapy. Scand J Gastroenterol 2019; 54 281–288.  [Link]
  17. Kang B, Choi SY, Choi YO, et al. Subtherapeutic Infliximab Trough Levels and Complete Mucosal Healing Are Associated With Sustained Clinical Remission After Infliximab Cessation in Paediatric-onset Crohn's Disease Patients Treated With Combined Immunosuppressive Therapy. J Crohns Colitis 2018; 12: 644-652.  [Link]
  18. Baert F, Drobne D, Gils A, et al. Early trough levels and antibodies to infliximab predict safety and success of reinitiation of infliximab therapy. Clin Gastroenterol Hepatol. 2014; 12: 1474-81.  [Link]
  19. Boschetti G, Nachury M, Laharie D, et al. Efficacy and Safety of Infliximab Retreatment in Crohn's Disease: A Multicentre, Prospective, Observational Cohort (REGAIN) Study from the GETAID. Am J Gastroenterol 2022; 117: 1482–1490.  [Link]
  20. Normatov I, Fluxa D, Wang JD, et al. Real-World Experience With Proactive Therapeutic Drug Monitoring During Infliximab Reintroduction. Crohns Colitis 360 2021; 3: otab048.  [Link]
  21. Noor NM, Sousa P, Bettenworth D, et al. ECCO Topical Review on Biological Treatment Cycles in Crohn’s Disease. Journal of Crohn’s and Colitis 2023; 17: 1031–1045.  [Link]
  22. Drobne D, Bossuyt P, Breynaert C, et al. Withdrawal of immunomodulators after co-treatment does not reduce trough level of infliximab in patients with Crohn's disease. Clin Gastoenterol Hepatol 2015; 13: 514–521.  [Link]
  23. Vande Casteele NV, Ferrante M, Van Assche G, et al. Trough concentrations of infliximab guide dosing for patients with inflammatory bowel disease. Gastroenterology 2015; 148: 1320-1329.  [Link]
  24. Amiot A, Hulin A, Belhassan M, et al. Therapeutic drug monitoring is predictive of loss of response after de-escalation of infliximab therapy in patients with inflammatory bowel disease in clinical remission. Clin Res Hepatol Gastoenterol 2016; 40: 90-98.  [Link]
  25. Aguas Peris M, Bosó V, Navarro B, et al. Serum Adalimumab Levels Predict Successful Remission and Safe Deintensification in Inflammatory Bowel Disease Patients in Clinical Practice. Inflamm Bowel Dis 2017; 23: 1454-1460  [Link]
  26. Lucidarme C, Petitcollin A, Brochard C, et al. Predictors of relapse following infliximab de-escalation in patients with inflammatory bowel disease: the value of a strategy based on therapeutic drug monitoring. Alimet Pharmacol Ther 2019;49: 147-154.  [Link]
  27. Petitcollin A, Brochard C, Siproudhis L, et al. Pharmacokinetic Parameters of Infliximab Influence the Rate of Relapse After De-Escalation in Adults With Inflammatory Bowel Diseases. Clin Pharmacol Ther 2019; 106: 605-615.  [Link]
  28. Allegretti JR, Canakis A, McClure E, et al. Infliximab De-escalation in Patients With Crohn's Disease in Clinical Remission Is Safe and Well-tolerated Inflamm Bowel Dis 2021; 27: 2031–2033.  [Link]
  29. Santacana Juncosa E, Rodríguez-Alonso L, Padullés Zamora A, et al. Bayes-based dosing of infliximab in inflammatory bowel diseases: Short-term efficacy. Br J Clin Pharmacol 2021; 87: 494–505  [Link]
  30. Vande Casteele N, Ferrante M, Van Assche G, et al. Trough concentrations of infliximab guide dosing for patients with inflammatory bowel disease. Gastroenterology 2015; 148: 1320-9.  [Link]
  31. Drobne D, Bossuyt P, Breynaert C, et al. Withdrawal of immunomodulators after co-treatment does not reduce trough level of infliximab in patients with Crohn’s disease. Clin Gastroenterol Hepatol 2015;13: 514–521.  [Link]
  32. Aguas Peris M, Bosó V, Navarro B, et al. Serum Adalimumab Levels Predict Successful Remission and Safe Deintensification in Inflammatory Bowel Disease Patients in Clinical Practice. Inflamm Bowel Dis 2017; 23: 1454-1460.  [Link]
  33. Yarur AJ, Kanagala V, Stein DJ, et al. Higher infliximab trough levels are associated with perianal fistula healing in patients with Crohn’s disease. Aliment Pharmacol Ther 2017; 45: 933-940.  [Link]
  34. Bergqvist V, Holmgren J, Klintman D, Marsal J. Real-world data on switching from intravenous to subcutaneous vedolizumab treatment in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2022; 55: 1389–1401.  [Link]
  35. Little RD, Ward MG, Wright E, et al. Therapeutic drug monitoring of subcutaneous infliximab in inflammatory bowel disease-understanding pharmacokinetics and exposure response relationships in a new era of subcutaneous biologics. J Clin Med 2022; 11: 6173.  [Link]
  36. Berger AE, Duru G, de Vries A, et al. Comparison of immunoassays for measuring serum levels of golimumab and antibodies against golimumab in ulcerative colitis: a retrospective observational Study. Ther Drug Monit 2019; 41: 459–66.  [Link]
  37. Papamichael K, Clarke WT, Vande Casteele N, et al. Comparison of assays for therapeutic monitoring of infliximab and adalimumab in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2021; 19: 839–841.  [Link]
  38. Verdon C, Vande Casteele N, Heron V, Germain P, Afif W. Comparison of serum concentrations of ustekinumab obtained by three commercial assays in patients with Crohn’s disease. J Can Assoc Gastroenterol 2020; 4: 73–77.  [Link]
  39. Cherry M, Dutzer D, Nasser Y, et al. Point-of-care assays could be useful for therapeutic drug monitoring of IBD patients in a proactive strategy with adalimumab. J Clin Med 2020; 9: 2739  [Link]
  40. Schmitz EMH, van de Kerkhof D, Hamann D, et al. Therapeutic drug monitoring of infliximab: performance evaluation of three commercial ELISA kits. Clin Chem Lab Med 2016;54: 1211-9.  [Link]
  41. Papamichael K, Afif W, Drobne D, et al. Therapeutic drug monitoring of biologics in inflammatory bowel disease: unmet needs and future perspectives. Lancet Gastroenterol Hepatol 2022; 7: 171-185.  [Link]
  42. Dreesen E, Van Stappen T, Ballet V, et al. Anti-infliximab antibody concentrations can guide treatment intensification in patients with Crohn's disease who lose clinical response. Aliment Pharmacol Ther 2018; 47: 346–355.  [Link]
  43. Van Stappen T, Vande Casteele N, Van Assche G, et al. Clinical relevance of detecting anti-infliximab antibodies with a drug-tolerant assay: post hoc analysis of the TAXIT trial. Gut 2018; 67: 818–826.  [Link]
  44. Paul S, Del Tedesco E, Marotte H, et al. Therapeutic drug monitoring of infliximab and mucosal healing in inflammatory bowel disease: a prospective study. Inflamm Bowel Dis 2013; 19: 2568–2576.  [Link]
  45. Tun GSZ, Robinson K, Marshall L, et al. The effect of infliximab dose escalation in inflammatory bowel disease patients with antibodies to infliximab. Eur J Gastroenterol Hepatol 2022; 34: 295–301  [Link]
  46. Kim ES, Kwon Y, Choe YH, Kim MJ. Free antibodies-to-infliximab are biomarker for predicting the effect of dose intensification in pediatric Crohn’s disease patients with secondary loss of response. Therap Adv Gastroenterol 2023; 16: 17562848231170948.  [Link]
  47. Baert F, Noman M, Vermeire S, et al. Influence of immunogenicity on the long-term efficacy of infliximab in Crohn's disease. N Engl J Med 2003; 348: 601–608.  [Link]
  48. Koga A, Matsui T, Takatsu N, et al. Trough level of infliximab is useful for assessing mucosal healing in Crohn’s disease: a prospective cohort study. Intest Res 2018; 16: 223-232.  [Link]
  49. Tournier Q, Paul S, Williet N, et al. Early detection of anti-drug antibodies during initiation of anti-tumour necrosis factor therapy predicts treatment discontinuation in inflammatory bowel disease. Aliment Pharmacol Ther 2021; 53: 1190–1200.  [Link]
  50. Yanai H, Lichtenstein L, Assa A, et L. Levels of drug and antidrug antibodies are associated with outcome of interventions after loss of response to infliximab or adalimumab. Clin Gastroenterol Hepatol 2015; 13: 522–530.e2.  [Link]
  51. Bar-Yoseph H, Levhar N, Selinger L, et al. Early drug and anti-infliximab antibody levels for prediction of primary nonresponse to infliximab therapy. Aliment Pharmacol Ther 2018; 47: 212– 218.  [Link]
  52. Vande Casteele N, Khanna R, Levesque BG, et al. The relationship between infliximab concentrations, antibodies to infliximab and disease activity in Crohn's disease. Gut 2015; 64: 1539–1545.  [Link]
  53. Vande Casteele N, Sandborn WJ, Feagan, BG, et al. Real-world multicentre observational study including population pharmacokinetic modelling to evaluate the exposure–response relationship of vedolizumab in inflammatory bowel disease: ERELATE Study. Aliment Pharmacol Ther 2022; 56: 463–476.  [Link]
  54. Papamichael K, Vajravelu RK, Osterman MT, and Cheifetz, AS. Long-Term Outcome of Infliximab Optimization for Overcoming Immunogenicity in Patients with Inflammatory Bowel Disease. Digest Dis Sci 2018; 63: 761–767.  [Link]
  55. Vande Casteele N, Gils A, Singh S, et al. Antibody response to infliximab and its impact on pharmacokinetics can be transient. Am J Gastroenterol 2013; 108: 962–971.  [Link]
  56. Zitomersky NL, Atkinson BJ, Fournier K, et al. Antibodies to infliximab are associated with lower infliximab levels and increased likelihood of surgery in pediatric IBD. Inflamm Bowel Dis 2015; 21:307-314.  [Link]
  57. Kelly OB, Donnell SO, Stempak JM, et al. Therapeutic Drug Monitoring to Guide Infliximab Dose Adjustment is Associated with Better Endoscopic Outcomes than Clinical Decision Making Alone in Active Inflammatory Bowel Disease. Inflamm Bowel Dis 2017; 23: 1202–1209.  [Link]
  58. Battat R, Lukin D, Scherl EJ, et al. Immunogenicity of Tumor Necrosis Factor Antagonists and Effect of Dose Escalation on Anti-Drug Antibodies and Serum Drug Concentrations in Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27: 1443–1451.  [Link]
  59. Cohen RZ, Schoen BT, Kugathasan S, and Sauer CG. Management of Anti-drug Antibodies to Biologic Medications in Children With Inflammatory Bowel Disease. J Ped Gastroenterol Nutr 2019; 69: 551–556.  [Link]
  60. Colman RJ, Mizuno T, Fukushima K, et al. Real world population pharmacokinetic study in children and young adults with inflammatory bowel disease discovers novel blood and stool microbial predictors of vedolizumab clearance. Aliment Pharmacol Ther 2023; 57: 524–539.  [Link]
Biomarkers for IBD

Authors: Christopher Palmer-Jones and James C. Lee    
Affiliation: 
Christopher Palmer-Jones is a Senior Fellow in Gastroenterology and IBD at the Royal Free Hospital, Pond St, London, UK.
James Lee is a Clinician Scientist Group Leader at the Francis Crick Institute, 1 Midland Rd, London, UK, where he leads the Genetic Mechanisms of Disease laboratory, and an Honorary Consultant Gastroenterologist at the Royal Free Hospital, London, UK.   
Correspondence:     
Link to online article: https://gutflix.eu/r/TPFTARtXD0qf    
Conflicts of interest: 
CPJ has no conflicts of interest. JCL reports financial support for research from GSK, consultancy fees from Abbvie, AgPlus Diagnostics, PredictImmune and C4X Discovery, and is a co-inventor on a patent, “Biomarkers for inflammatory bowel disease”.    

References:

  1. Verstockt B, Parkes M, Lee JC. How Do We Predict a Patient’s Disease Course and Whether They Will Respond to Specific Treatments? Gastroenterology 2022; 162: 1383–1395.  [Link]
  2. Colombel J-F, D’haens G, Lee W-J, et al. Outcomes and Strategies to Support a Treat-to-target Approach in Inflammatory Bowel Disease: A Systematic Review. Journal of Crohn’s & colitis 2020; 14: 254–266.  [Link]
  3. Hart AL, Lomer M, Verjee A, et al. What Are the Top 10 Research Questions in the Treatment of Inflammatory Bowel Disease? A Priority Setting Partnership with the James Lind Alliance. Journal of Crohn’s & colitis 2017; 11: 204–211.  [Link]
  4. Noor NM, Verstockt B, Parkes M, et al. Personalised medicine in Crohn’s disease. The lancet Gastroenterology & hepatology 2020; 5: 80–92.  [Link]
  5. Wolters FL, Russel MG, Sijbrandij J, et al. Phenotype at diagnosis predicts recurrence rates in Crohn’s disease. Gut 2006; 55: 1124–30.  [Link]
  6. Beaugerie L, Seksik P, Nion-Larmurier I, et al. Predictors of Crohn’s disease. Gastroenterology 2006; 130: 650–6.  [Link]
  7. Loly C, Belaiche J, Louis E. Predictors of severe Crohn’s disease. Scandinavian journal of gastroenterology 2008; 43: 948–54.  [Link]
  8. Torres J, Caprioli F, Katsanos KH, et al. Predicting Outcomes to Optimize Disease Management in Inflammatory Bowel Diseases. Journal of Crohn’s & colitis 2016; 10: 1385–1394.  [Link]
  9. Cosnes J, Bourrier A, Nion-Larmurier I, et al. Factors affecting outcomes in Crohn’s disease over 15 years. Gut 2012; 61: 1140–5.  [Link]
  10. Solberg, I. C. et al. Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study). Scand J Gastroenterol 44, 431-440  [Link]
  11. Ananthakrishnan AN, Issa M, Beaulieu DB, et al. History of medical hospitalization predicts future need for colectomy in patients with ulcerative colitis. Inflammatory bowel diseases 2009; 15: 176–81.  [Link]
  12. Targownik LE, Singh H, Nugent Z, et al. The epidemiology of colectomy in ulcerative colitis: results from a population-based cohort. The American journal of gastroenterology 2012; 107: 1228–35.  [Link]
  13. Gibson G. Going to the negative: genomics for optimized medical prescription. Nature Reviews Genetics 2018; 20: 1–2.  [Link]
  14. Lee JC, Biasci D, Roberts R, et al. Genome-wide association study identifies distinct genetic contributions to prognosis and susceptibility in Crohn’s disease. Nature genetics 2017; 49: 262–268.  [Link]
  15. Biasci D, Lee JC, Noor NM, et al. A blood-based prognostic biomarker in IBD. Gut 2019; 68: 1386–1395.  [Link]
  16. Kugathasan S, Denson LA, Walters TD, et al. Prediction of complicated disease course for children newly diagnosed with Crohn’s disease: a multicentre inception cohort study. Lancet (London, England) 2017; 389: 1710–1718.  [Link]
  17. Ferrante M, Henckaerts L, Joossens M, et al. New serological markers in inflammatory bowel disease are associated with complicated disease behaviour. Gut 2007; 56: 1394–403.  [Link]
  18. Amre DK, Lu S-E, Costea F, et al. Utility of serological markers in predicting the early occurrence of complications and surgery in pediatric Crohn’s disease patients. The American journal of gastroenterology 2006; 101: 645–52.  [Link]
  19. Seow CH, Stempak JM, Xu W, et al. Novel anti-glycan antibodies related to inflammatory bowel disease diagnosis and phenotype. The American journal of gastroenterology 2009; 104: 1426–34.  [Link]
  20. Israeli E, Grotto I, Gilburd B, et al. Anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies as predictors of inflammatory bowel disease. Gut 2005; 54: 1232–6.  [Link]
  21. Bodecker-Zingmark L, Widbom L, Hultdin J, et al. Anti-Saccharomyces cerevisiae Antibodies Are Only Modestly More Common in Subjects Later Developing Crohn’s Disease. Digestive diseases and sciences 2023; 68: 608–615.  [Link]
  22. Arnott IDR, Landers CJ, Nimmo EJ, et al. Sero-reactivity to microbial components in Crohn’s disease is associated with disease severity and progression, but not NOD2/CARD15 genotype. The American journal of gastroenterology 2004; 99: 2376–84.  [Link]
  23. Choung RS, Princen F, Stockfisch TP, et al. Serologic microbial associated markers can predict Crohn’s disease behaviour years before disease diagnosis. Alimentary pharmacology & therapeutics 2016; 43: 1300–10.  [Link]
  24. Subramanian J, Simon R. Overfitting in prediction models - is it a problem only in high dimensions? Contemporary clinical trials 2013; 36: 636–41.  [Link]
  25. Ransohoff DF. Rules of evidence for cancer molecular-marker discovery and validation. Nature reviews Cancer 2004; 4: 309–14.  [Link]
  26. Argmann C, Hou R, Ungaro RC, et al. Biopsy and blood-based molecular biomarker of inflammation in IBD. Gut 2023; 72: 1271–1287.  [Link]
  27. Fagerlin A, Zikmund-Fisher BJ, Ubel PA. Helping patients decide: ten steps to better risk communication. Journal of the National Cancer Institute 2011; 103: 1436–43.  [Link]
  28. Paling J. Strategies to help patients understand risks. BMJ (Clinical research ed) 2003; 327: 745–8.  [Link]
Nutrition in IBD

Authors: Joseph Meredith, Konstantinos Gerasimidis and Richard K. Russell
Affiliation: 
Joseph Meredith is a paediatric gastroenterologist, and Richard K Russell is a consultant paediatric gastroenterologist and professor of paediatric gastroenterology and nutrition in the Department of Paediatric Gastroenterology, The Royal Hospital for Sick Children, Edinburgh, UK.
Konstantinos Gerasimidis is a professor of clinical nutrition at the School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
Correspondence:
Link to online article: https://gutflix.eu/r/m23gANb0qo9Q
Conflicts of interest: None

References:

  1. Ruemmele F, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohns Colitis 2014; 8: 1179–1207.  [Link]
  2. Swaminath A, et al. Systematic review with meta‐analysis: enteral nutrition therapy for the induction of remission in paediatric Crohn's disease. Aliment Pharmacol Ther 2017; 46: 645–656.  [Link]
  3. Matstui T, Sakurai T and Yao T. Nutritional therapy for Crohn’s disease in Japan. J Gastroenterol 2005; 4016: 25–31.  [Link]
  4. Narula N, et al. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database Syst Revs 2018; 4: CD000542.  [Link]
  5. Pigneur B, et al. Mucosal healing and bacterial composition in response to enteral nutrition vs steroid-based induction therapy—A randomised prospective clinical trial in children with Crohn’s disease. J Crohns Colitis 2019; 13: 846–855.  [Link]
  6. Borrelli O, et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn’s disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol 2006; 4: 744–753.  [Link]
  7. Grover Z, Muir R and Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn’s disease. J Gastroenterol 2014; 49: 638–645.  [Link]
  8. Day A, et al. Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease. JGH Open 2020; 4: 260–266.  [Link]
  9. Johnson T, et al. Treatment of active Crohn’s disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut 2006; 55: 356–361.  [Link]
  10. Levine A, et al. Crohn’s disease exclusion diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial. Gastroenterology 2019; 157: 440–450.  [Link]
  11. Lewis JD, et al. Inflammation, antibiotics, and diet as environmental stressors of the gut microbiome in pediatric Crohn’s disease. Cell Host Microbe 2015; 18: 489–500.  [Link]
  12. Svolos V, et al. Treatment of active Crohn’s disease with an ordinary food-based diet that replicates exclusive enteral nutrition. Gastroenterology 2019; 156: 1354–1367.  [Link]
  13. Yang Q, et al. Efficacy of exclusive enteral nutrition in complicated Crohn’s disease. Scandinavian J Gastroenterol 2017; 52: 995–1001.  [Link]
  14. Grass F, et al. Preoperative nutritional conditioning of Crohn’s patients—systematic review of current evidence and practice. Nutrients 2017; 9: 562.  [Link]
  15. Rocha A, et al. Preoperative enteral nutrition and surgical outcomes in adults with Crohn’s disease: a systematic review. GE Port J Gastroenterol 2019; 26: 184–195.  [Link]
  16. Heerasing N, et al. Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn's disease. Aliment Pharmacol Ther 2017; 45: 660–669.  [Link]
Malignancy surveillance in IBD

Authors: Matthew D. Rutter, Edyta Tulewicz-Marti and Axel Dignass
Affiliation: 
Edyta Tulewicz-Marti is at the Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, National Medical Institute of the Ministry of Interior Affairs and Administration-Warsaw, Warsaw, Poland.
Axel Dignass is at the Department of Medicine I, Agaplesion Markus Hospital, Frankfurt/Main, Germany.
Matthew Rutter is Professor of Gastroenterology at Newcastle University and the University Hospital of North Tees, UK.
Correspondence:
Link to online article: https://gutflix.eu/r/mzdUeeTpmX3z, https://gutflix.eu/r/dRGlg7cb2wni
Conflicts of interest: None

References:

  1. Soderlund S, Granath F, Brostrom O, et al. Inflammatory bowel disease confers a lower risk of colorectal cancer to females than to males. Gastroenterology 2010; 138: 1697–1703.  [Link]
  2. Jess T, Rungoe C and Peyrin-Biroulet L. Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies. Clin Gastroenterol Hepatol 2012; 638: 639–645.  [Link]
  3. Lutgens MW, van Oijen MG, van der Heijden GJ, et al. Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies. Inflamm Bowel Dis 2013; 19: 789–799.  [Link]
  4. Herrinton LJ, Liu L, Levin TR, et al. Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. Gastroenterology 2012; 143: 382–389.  [Link]
  5. Burr NE, Derbyshire E, Taylor J, et al. Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study. BMJ 2019; 367: l6090.  [Link]
  6. Shah SC, ten Hove JR, Castaneda D, et al. High risk of advanced colorectal neoplasia in patients with primary sclerosing cholangitis associated with inflammatory bowel disease. Clin Gastroenterol Hepatol 2018; 16: 1106–1113.e3.  [Link]
  7. Jess T, Simonsen J, Jorgensen KT, et al. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology 2012; 143: 375–381.e1.  [Link]
  8. Rutter M, Saunders B, Wilkinson K, et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 2004; 126: 451–459.  [Link]
  9. Rutter MD, Saunders BP, Wilkinson KH, et al. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut 2004; 53: 1813–1816.  [Link]
  10. Ekbom A, Helmick C, Zack M, et al. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med 1990; 323: 1228–1233.  [Link]
  11. Annese V, Daperno M, Rutter MD, et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7: 982–1018.  [Link]
  12. Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666–689.  [Link]
  13. Hassan C, East J, Radaelli F, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 775–794.  [Link]
  14. Elford AT, Hirsch R, McKay OM, et al. Identifying the real‐world challenges of dysplasia surveillance in inflammatory bowel disease: a retrospective cohort study in a tertiary health network. Intern Med J 2024; 54: 96–103.  [Link]
  15. McMillan C, Li DK, Mohamed G, et al. Longer Colonoscopy Withdrawal Time Is Associated With the Detection of Visible Dysplasia in Patients With Inflammatory Bowel Disease. Crohns Colitis 360 2024; 6: otae020.  [Link]
  16. Eder P, Łodyga M, Gawron-Kiszka M, et al. Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology. Gastroenterol Rev 2023; 18: 1–42.  [Link]
  17. Laukoetter MG, Mennigen R, Hannig CM, et al. Intestinal Cancer Risk in Crohn’s Disease: A Meta-Analysis. J Gastrointest Surg 2011; 15: 576–583.  [Link]
  18. Adamina M, Feakins R, Iacucci M, et al. ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology. J Crohns Colitis 2021; 15: 1089–1105.  [Link]
  19. Gordon H, Biancone L, Fiorino G, et al. ECCO Guidelines on Inflammatory Bowel Disease and Malignancies. J Crohns Colitis 2023; 17: 827–854.  [Link]
  20. Baars JE, Kuipers EJ, Dijkstra G, et al. Malignant transformation of perianal and enterocutaneous fistulas is rare: results of 17 years of follow-up from The Netherlands. Scand J Gastroenterol 2011; 46: 319–325.  [Link]
  21. Trivedi PJ, Crothers H, Mytton J, et al. Effects of Primary Sclerosing Cholangitis on Risks of Cancer and Death in People With Inflammatory Bowel Disease, Based on Sex, Race, and Age. Gastroenterology 2020; 159: 915–928.  [Link]
  22. Catanzaro E, Gringeri E, Burra P, et al. Primary Sclerosing Cholangitis-Associated Cholangiocarcinoma: From Pathogenesis to Diagnostic and Surveillance Strategies. Cancers 2023; 15: 4947.  [Link]
  23. Aparicio T, Zaanan A, Mary F, et al. Small Bowel Adenocarcinoma. Gastroenterol Clin North Am 2016; 45: 447–457.  [Link]
  24. Beaugerie L, Brousse N, Bouvier AM, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. The Lancet 2009; 374: 1617–1625.  [Link]
  25. Afif W, Sandborn WJ, Faubion WA, et al. Risk Factors for Lymphoma in Patients with Inflammatory Bowel Disease: A Case-control Study. Inflamm Bowel Dis 2013; 19: 1384–1389.  [Link]
  26. Pedersen N, Duricova D, Elkjaer M, et al. Risk of Extra-Intestinal Cancer in Inflammatory Bowel Disease: Meta-Analysis of Population-Based Cohort Studies. Am J Gastroenterol 2010; 105: 1480–1487.  [Link]
  27. Yu J, Refsum E, Wieszczy P, et al. Risk of malignant lymphomas in patients with inflammatory bowel disease: a population-based cohort study. BMJ Open Gastroenterol 2023; 10: e001037.  [Link]
  28. Tulewicz-Marti E, Stępień-Wrochna B, Maciejewska K, et al. Awareness and Compliance with the Recommendations of Primary and Secondary Prevention of Cancer in Patients with Inflammatory Bowel Disease. J Pers Med 2023; 13: 913.  [Link]
  29. Huang S, Liu Z, Liao W, et al. Risk of skin cancers in thiopurines‐treated and thiopurines‐untreated patients with inflammatory bowel disease: A systematic review and meta‐analysis. J Gastroenterol Hepatol 2019; 34: 507–516.  [Link]
  30. Ariyaratnam J, Subramanian V. Association Between Thiopurine Use and Nonmelanoma Skin Cancers in Patients With Inflammatory Bowel Disease: A Meta-Analysis. Am J Gastroenterol 2014; 109: 163–169.  [Link]
  31. Al-Bawardy B, Alfadley AF, Almousallam M, et al. Epstein-Barr virus seroprevalence among inflammatory bowel disease patients in Saudi Arabia. Saudi J Gastroenterol 2024; 30: 168–172.  [Link]
  32. Calafat M, Mañosa M, Cañete F, et al. Increased risk of thiopurine‐related adverse events in elderly patients with IBD. Aliment Pharmacol Ther 2019; 50: 780–788.  [Link]
  33. Sturm A, Maaser C, Mendall M, et al. European Crohn’s and Colitis Organisation Topical Review on IBD in the Elderly: Table 1. J Crohns Colitis 2016; jjw188.  [Link]
  34. Beaugerie L, Rahier J-F, Kirchgesner J. Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2020; 18: 1324-1335.e2.  [Link]
  35. Dahmus J, Rosario M, Clarke K. Risk of Lymphoma Associated with Anti-TNF Therapy in Patients with Inflammatory Bowel Disease: Implications for Therapy. Clin Exp Gastroenterol 2020; Volume 13: 339–350.  [Link]
Opportunistic infections and vaccinations in IBD

Authors: Paul McLellan and Julien Kirchgesner
Affiliation:
Julien Kirchgesner is Associate Professor at the Department of Gastroenterology, Saint Antoine Hospital, AP-HP, Paris, France.
Paul McLellan is Assistant Professor at the Department of Gastroenterology, Saint Antoine Hospital, AP-HP, Paris, France.
Correspondence:
Link to online article: https://gutflix.eu/r/gvWIoKA9ROH4
Conflicts of interest: JK acknowledges receiving lectures fees from Gilead, Roche and Pfizer. PM declares no conflicts of interest.  

References:

  1. Jiang HY, Wang SY, Deng M, et al. Immune response to hepatitis B vaccination among people with inflammatory bowel diseases: a systematic review and meta-analysis. Vaccine 2017; 35: 2633–41.  [Link]
  2. Taxonera C, Ponferrada Á, Bermejo F, et al. Early tuberculin skin test for the diagnosis of latent tuberculosis infection in patients with inflammatory bowel disease. J Crohns Colitis 2017; 11: 792–800.  [Link]
  3. Annese V, Beaugerie L, Egan L, et al. European evidence-based consensus: inflammatory bowel disease and malignancies. J Crohns Colitis 2015; 9: 945–65.  [Link]
  4. Griffin G, Shenoi S and Hughes GC. Hemophagocytic lymphohistiocytosis: an update on pathogenesis, diagnosis, and therapy. Best Pract Res Clin Rheumatol 2020; 34: 101515.  [Link]
  5. Beaugerie L, Rahier JF and Kirchgesner J. Predicting, preventing, and managing treatment-related complications in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2020; 18: 1324–1335.e2.  [Link]
  6. Winthrop KL, Melmed GY, Vermeire S, et al. Herpes zoster infection in patients with ulcerative colitis receiving tofacitinib. Inflamm Bowel Dis 2018; 24: 2258–65.  [Link]
  7. Kucharzik T, Ellul P, Greuter T, et al. ECCO guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease. J Crohns Colitis 2021; 15: 879–913.  [Link]
Acute severe ulcerative colitis

Author: David Laharie    
Affiliation: David Laharie is an academic researcher and a gastroenterologist at the University Hospital Bordeaux, F-33000 Bordeaux, France.    
Correspondence:     
Link to online article: https://gutflix.eu/r/k7ktwcMk0RHZ    
Conflicts of interest: DL declares conflicts of interest with Abbvie, Amgen, Biogen, Celgene, Celltrion, Ferring, Galapagos, Gilead, Janssen, Lilly, MSD, Pfizer, Takeda, Theradiag, Tillots    

References:

  1. Dinesen LC, Walsh AJ, Protic MN, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis 2010; 4: 431-7.  [Link]
  2. Adams A, Gupta V, Mohsen W, et al. Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response. Gut 2023; 72: 433-442.  [Link]
  3. Spinelli A, Bonovas S, Burisch J, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis 2022; 16: 179–89.  [Link]
  4. Dong C, Metzger M, Holsbø E, et al. Systematic review with meta-analysis: mortality in acute severe ulcerative colitis. Aliment Pharmacol Ther. 2020; 51: 8-33.   [Link]
  5. Lynch RW, Lowe D, Protheroe A, et al. Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit. Aliment Pharmacol Ther. 2013; 38: 935-45.   [Link]
  6. Justiniano CF, Aquina CT, Becerra AZ, et al. Postoperative Mortality After Nonelective Surgery for Inflammatory Bowel Disease Patients in the Era of Biologics. Ann Surg 2019; 269: 686–91.  [Link]
  7. Lee H-S, Park SH, Kim S-H, et al. Risk Factors and Clinical Outcomes Associated with Cytomegalovirus Colitis in Patients with Acute Severe Ulcerative Colitis: Inflamm Bowel Dis 2016; 22: 912–8.  [Link]
  8. Nguyen GC, Kaplan GG, Harris ML, Brant SR. A National Survey of the Prevalence and Impact of Clostridium difficile Infection Among Hospitalized Inflammatory Bowel Disease Patients. Am J Gastroenterol 2008; 103: 1443–50  [Link]
  9. Negrón ME, Rezaie A, Barkema HW, et al. Ulcerative Colitis Patients With Clostridium difficile are at Increased Risk of Death, Colectomy and Postoperative Complications: A Population-Based Inception Cohort Study. AmJ Gastroenterol 2016; 111: 691–704.  [Link]
  10. Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010 20; 375: 657-63.   [Link]
  11. Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to Corticosteroids in Severe Ulcerative Colitis: A Systematic Review of the Literature and a Meta-Regression. Clin Gastroenterol Hepatol 2007; 5: 103–10.  [Link]
  12. Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994; 330: 1841-5.  [Link]
  13. Travis SP, Farrant JM, Ricketts C, et al. Predicting outcome in severe ulcerative colitis. Gut 1996; 38: 905–10.  [Link]
  14. Jarnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 2005; 128: 1805-11.  [Link]
  15. Laharie D, Bourreille A, Branche J, et al. Ciclosporine versus infliximab in acute severe colitis refractory to intravenous steroids: a randomized study. Lancet 2012; 380: 1909-15.  [Link]
  16. Hanauer S, Panaccione R, Danese S, et al. Tofacitinib Induction Therapy Reduces Symptoms Within 3 Days for Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol. 2019; 17: 139-47.   [Link]
  17. Gisbert JP, García MJ, Chaparro M. Rescue Therapies for Steroid-refractory Acute Severe Ulcerative Colitis: A Review. Journal of Crohn’s and Colitis 2023; 17: 972–994.  [Link]
  18. Berinstein JA, Sheehan JL, Dias M, et al. Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study. Clin Gastroenterol Hepatol 2021; 19: 2112-20  [Link]
  19. Kaplan GG, McCarthy EP, Ayanian JZ, et al. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 2008; 134: 680-7.  [Link]
  20. Parc Y, Reboul-Marty J, Lefevre JH, et al. Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. Ann Surg. 2015; 262: 849-53.  [Link]
The management of postoperative Crohn’s disease

Authors: Eugeni Domènech and Míriam Mañosa    
Affiliation: 
Eugeni Domènech is Head of the Gastroenterology and Hepatology Department, and 
Míriam Mañosa is Head of the Gastroenterology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.    
Correspondence:     
Link to online article: https://gutflix.eu/r/8Zr8IOOT5dP9    
Conflicts of interest:
ED has served as a speaker for, or has received research or education funding or advisory fees from, AbbVie, Adacyte Therapeutics, Biogen, Celltrion, Gilead, Janssen, Kern Pharma, MSD, Pfizer, Roche, Samsung, Takeda, and Tillots. MM has served as a speaker, consultant and advisory member for, or has received research funding from, AbbVie, Gilead, Janssen, MSD, Pfizer, Shire Pharmaceuticals, Faes, Takeda and Tillots.    

References:

  1. Bossuyt P, et al. The operative risk and natural history after the diagnosis of ileal penetrating Crohn's disease. Eur J Gastroenterol Hepatol 2018; 30: 539–545.  [Link]
  2. Domènech E, Mañosa M and Cabré E. An overview of the natural history of inflammatory bowel disease. Dig Dis 2014; 32: 320–327.  [Link]
  3. Rutgeerts P, et al. Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990; 99: 956–963.  [Link]
  4. Domènech E, et al. Recommendations of the Spanish Working Group on Crohn’s disease and ulcerative colitis (GETECCU) on the monitoring, prevention and treatment of postoperative recurrence in Crohn’s disease. Gastroenterol Hepatol 2017; 40: 472–483.  [Link]
  5. Nguyen GC, et al. American Gastroenterological Association Institute guideline on the management of Crohn’s disease after surgical resection. Gastroenterology 2017; 152: 271–275.  [Link]
  6. Mañosa M, et al. Addition of metronidazole to azathioprine for the prevention of postoperative recurrence of Crohn’s disease: a randomized, double-blind, placebo-controlled trial. Inflamm Bowel Dis 2013; 19: 1889–1895.  [Link]
  7. Ferrante M, et al. Systematic versus endoscopy-driven treatment with azathioprine to prevent postoperative ileal Crohn's disease recurrence. J Crohns Colitis 2015; 9: 617–624.  [Link]
  8. De Cruz P, et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet 2015; 385: 1406–1417.  [Link]
  9. Rivière P, et al. Rates of postoperative recurrence of Crohn's disease and effects of immunosuppressive and biologic therapies. Clin Gastroenterol Hepatol 2021; 19: 713–720.  [Link]
Microscopic colitis

Author: Andreas Münch        
Affiliation: Andreas Münch is a senior consultant gastroenterologist in the Department of Health, Medicine, and Caring Sciences at Linköping University, Linköping, Sweden, and President of the European Microscopic Colitis Group (EMCG).  
Correspondence:         
Link to online articlehttps://gutflix.eu/r/X1bddxmZdO8d        
Conflicts of interest: AM has received consulting fees from Ferring, Vifor, Falk Pharma and Tillotts; lecture fees from Ferring, Vifor, Janssen and Tillotts, and has received an unrestricted grant from Ferring and Tillotts.        

References:    

  1. Miehlke S, Guagnozzi D, Zabana Y, et al. European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations. United European Gastroenterology Journal 2021; 9: 13–37. [Link]
  2. Guagnozzi D, Arias A and Lucendo AJ. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]
  3. Langner C, Aust D, Ensari A, et al. Histology of microscopic colitis — review with a practical approach for pathologists. Histopathology 2015; 66: 613–626. [Link]
  4. Hjortswang H, Tysk C, Bohr J, et al. Defining clinical criteria for clinical remission and disease activity in collagenous colitis. Inflamm Bowel Dis 2009; 15: 1875–1881. [Link]
  5. Münch A, Mihaly E, Nagy F, et al. Budesonide as induction therapy for incomplete microscopic colitis: A randomised, placebo‐controlled multicentre trial. United European Gastroenterology Journal 2021; 9: 837–847. [Link]
IBD and reproduction

Authors: Ilse Molendijk, Shannon L. Kanis and C. Janneke van der Woude
Affiliation: Ilse Molendijk, Janneke van der Woude and Shannon Kanis are at the Erasmus University Medical Centre, Rotterdam, the Netherlands.
Correspondence: 
Link to online article: https://gutflix.eu/r/drYxWtLZnlup
Conflicts of interest: None

References:

  1. Baird DD, Narendranathan M and Sandler RS. Increased risk of preterm birth for women with inflammatory bowel disease. Gastroenterology 1990; 99: 987–994.  [Link]
  2. Hudson M, et al. Fertility and pregnancy in inflammatory bowel disease. Int J Gynaecol Obstet 1997; 58: 229–237.  [Link]
  3. Riis L, et al. Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease. Am J Gastroenterol 2006; 101: 1539–1545.  [Link]
  4. Kane SV. Inflammatory bowel disease, women, and pregnancy. Gastroenterol Hepatol (NY) 2013; 9: 741–743.  [Link]
  5. Torres J, et al. European Crohn’s and colitis guidelines on sexuality, fertility, pregnancy and lactation. J Crohns Colitis 2023; 17: 1–27.  [Link]
  6. Toth, A. Reversible toxic effect of salicylazosulfapyridine on semen quality. Fertil Steril 1979; 31: 538–540.  [Link]
  7. Birnie GG, McLeod TI and Watkinson G. Incidence of sulphasalazine-induced male infertility. Gut 1981; 22: 452–455.  [Link]
  8. Heetun ZS, et al. Review article: Reproduction in the patient with inflammatory bowel disease. Aliment Pharmacol Ther 2007; 26: 513–533.  [Link]
  9. Narendranathan M, et al. Male infertility in inflammatory bowel disease. J Clin Gastroenterol 1989; 11: 403–406.  [Link]
  10. Sussman A and Leonard JM. Psoriasis, methotrexate, and oligospermia. Arch Dermatol 1980; 116: 215–217.  [Link]
  11. Food and Drug Administration access data. Methotrexate injection, USP. Lake Forest (IL): Hospira Inc; 2011. http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/011719s117lbl.pdf (accessed May 13, 2024).  [Link]
  12. Mahadevan U and Matro R. Care of the pregnant patient with inflammatory bowel disease. Obstet Gynecol 2015; 126: 401–412.  [Link]
  13. Grosen A, et al. The influence of methotrexate treatment on male fertility and pregnancy outcome after paternal exposure. Inflamm Bowel Dis. 2017; 23: 561-569.  [Link]
  14. Dejaco C, et al. Azathioprine treatment and male fertility in inflammatory bowel disease. Gastroenterology 2001; 121: 1048–1053.  [Link]
  15. Hoeltzenbein M, et al. Pregnancy outcome after paternal exposure to azathioprine/6-mercaptopurine. Reprod Toxicol 2012; 34: 364–369.  [Link]
  16. Akbari M, et al. Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease. Inflamm Bowel Dis 2013; 19: 15–22.  [Link]
  17. Mahadevan, U. et al. Infliximab and semen quality in men with inflammatory bowel disease. Inflamm Bowel Dis 2005; 14: 395-399.  [Link]
  18. Villiger M, et al. Effects of TNF antagonists on sperm characteristics in patients with spondyloarthritis. Ann Rheum Dis 2010; 69: 1842–1844.  [Link]
  19. Paschou S, et al. Fertility and reproduction in male patients with ankylosing spondylitis treated with infliximab. J Rheumatol 2009; 36: 351–354.  [Link]
  20. Puchner R, et al. Impact of TNF-blocking agents on male sperm characteristics and pregnancy outcomes in fathers exposed to TNF-blocking agents at time of conception. Clin Exp Rheumatol 2012; 30: 765–767.  [Link]
  21. Sands K, et al. Review article: the safety of therapeutic drugs in male inflammatory bowel disease patients wishing to conceive. Aliment Pharmacol Ther 2015; 41: 821–834.  [Link]
  22. Grosen A, et al. Vedolizumab does not impair sperm DNA integrity in men with inflammatory bowel disease. Gastroenterology. 2019; 156: 2342-2344.  [Link]
  23. Mahadevan U, et al. Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease. Aliment Pharmacol Ther. 2017; 45: 941-950.  [Link]
  24. Mitrova K, et al. Safety of ustekinumab and vedolizumab during pregnancy – pregnancy, neonatal, and infant outcome: a prospective multicentre study. J Crohns Colitis. 2022; 16: 1808-1815.  [Link]
  25. Grosen A, et al. Normal sperm DNA integrity in patients with inflammatory bowel disease on ustekinumab maintenance therapy. Inflamm Bowel Dis. 2022; 28: 1603-1606.  [Link]
  26. Meserve J, et al. Paternal exposure to immunosuppressive and/or biologic agents and birth outcomes in patients with immune-mediated inflammatory diseases. Gastroenterology. 2021; 161: 107-115.  [Link]
  27. XELJANZ / XELJANZ XR (tofacitinib) Nonclinical Toxicology | Pfizer Medical Information - US, https://www.pfizermedicalinformation.com/xeljanz/nonclinical-toxicology#S13.1 (accessed April 26, 2024).  [Link]
  28. Rinvoq | European Medicines Agency, https://www.ema.europa.eu/en/documents/product-information/rinvoq-epar-product-information_en.pdf (accessed April 26, 2024)  [Link]
  29. Reinisch W, et al. Effects of filgotinib on semen parameters and sex hormones in male patients with inflammatory diseases: results from the phase 2, randomized, double-blind, placebo-controlled MANTA and MANTA-RAy studies. Ann Rheum Dis. 2023; 0: 1-10.  [Link]
  30. Zeposia, European Medicines Agency, https://www.ema.europa.eu/en/documents/product-information/zeposia-epar-product-information_en.pdf (accessed April 26, 2024).  [Link]
  31. Kane SV and Acquah LA, Placental transport of immunoglobulins: a clinical review for gastroenterologists who prescribe therapeutic monoclonal antibodies to women during conception and pregnancy. Am J Gastroenterol 2009; 104: 228–233.  [Link]
  32. Zelinkova Z, et al. High intra-uterine exposure to infliximab following maternal anti-TNF treatment during pregnancy. Aliment Pharmacol Ther 2011; 33: 1053–1058.  [Link]
  33. Zelinkova Z, et al. Effects of discontinuing anti-tumor necrosis factor therapy during pregnancy on the course of inflammatory bowel disease and neonatal exposure. Clin Gastroenterol Hepatol 2013; 11: 318–321.  [Link]
  34. Lima A de, Zelinkova Z, Ent C van der, et al. Tailored anti-TNF therapy during pregnancy in patients with IBD: maternal and fetal safety. Gut 2016; 65: 1261–1268.  [Link]
  35. Narula N, et al. Anti-TNFalpha Therapies Are Safe During Pregnancy in Women with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2014; 20: 1862–1869.  [Link]
  36. Mahadevan U, et al. Pregnancy and neonatal outcomes after fetal exposure to biologics and thiopurines among women with inflammatory bowel disease. Gastroenterology 2021; 160: 1131-1139.  [Link]
  37. Kanis S, et al. Health outcomes of 1000 children born to mothers with inflammatory bowel disease in their first 5 years of life. Gut 2021; 70: 1266-1274.  [Link]
  38. De Lima, et al. Tailored anti-TNF therapy during pregnancy in patients with IBD: maternal and fetal safety. Gut 2016; 65: 1261-1268.  [Link]
  39. Malhi G, et al. Risk factors for postpartum disease activity in women with inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis 2022; 28: 1090-1099.  [Link]
  40. Luu M, et al. Continuous anti-TNFalpha use throughout pregnancy: possible complications for the mother but not for the fetus. A retrospective cohort on the French National Health Insurance Database (EVASION). Am J Gastroenterol 2018; 113: 1669-1677.  [Link]
  41. Clowse ME, et al. Pregnancy outcomes in subjects exposed to certolizumab pegol. J Rheumatol 2015; 42: 2270–2278.  [Link]
  42. McConnell RA and Mahadevan U. Use of Immunomodulators and Biologics Before, During, and After Pregnancy. Inflamm Bowel Dis 2016; 22: 213–223.  [Link]
  43. Moens A, et al. Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: results of the European CONCEIVE study. Aliment Pharmacol Ther 2020; 51: 129-138.  [Link]
  44. Avni-Biron I, et al. Ustekinumab during pregnancy in patients with inflammatory bowel disease: a prospective multicentre cohort study. Aliment Pharmacol Ther 2022; 56: 1361-1369.  [Link]
  45. Chugh R, Long MD, Jiang Y, et al. Maternal and Neonatal Outcomes in Vedolizumab- and Ustekinumab-Exposed Pregnancies: Results From the PIANO Registry. Official journal of the American College of Gastroenterology | ACG 2024; 119: 468.  [Link]
  46. Wils P, et al. Safety of ustekinumab or vedolizumab in pregnant inflammatory bowel disease: a multicentre cohort study. Aliment Pharmacol Ther 2021; 53: 460-470.  [Link]
  47. Aratari A, et al. Intentional infliximab use during pregnancy for severe steroid-refractory ulcerative colitis. J Crohns Colitis 2011; 5: 262.  [Link]
  48. Schnitzler F, et al. Outcome of pregnancy in women with inflammatory bowel disease treated with antitumor necrosis factor therapy. Inflamm Bowel Dis 2011; 17: 1846–1854.  [Link]

Chapter 7: Neurogasteroenteroloy and Motility

  • Clinical investigation of gastrointestinal motility
  • Dyspepsia
  • Gastroparesis
  • The management of diarrhoea
  • Irritable bowel syndrome
  • Dietary management of irritable bowel syndrome
  • Constipation
  • Faecal incontinence management
Clinical investigation of gastrointestinal motility

Author: Mark Fox    
Affiliation: Mark Fox is at the Abdominal Center: Gastroenterology,St. Claraspital, CH-4016 Basel, Switzerland, and is Professor at theUniversity of Zürich, Zürich, Switzerland    
Correspondence:     
Link to online article: https://gutflix.eu/r/PHEM5K6DtcU1    
Conflicts of interest: MF has received funding for research and/orsupport of educational projects by Given Imaging/Medtronic,Sandhill Scientific Instruments and Medical MeasurementSystems, Mui Scientific, Reckitt Benckiser, Astra Zeneca andNestlé.    

References:

  1. Farthing M, et al. Survey of digestive health across Europe: Final report. Part 1: The burden of gastrointestinal diseases and the organisation and delivery of gastroenterology services across Europe. United European Gastroenterol J 2014; 2: 539–543.  [Link]
  2. Ford AC, et al. What is the prevalence of clinically significant endoscopic findings in subjects with dyspepsia? Systematic review and meta-analysis. Clin Gastroenterol Hepatol 2010; 8: 830–837, 837 e1–2.  [Link]
  3. Patel P, et al. Prevalence of organic disease at colonoscopy in patients with symptoms compatible with irritable bowel syndrome: cross-sectional survey. Scand J Gastroenterol 2015; 50: 816–823.  [Link]
  4. Spiegel BM, et al. Is a negative colonoscopy associated with reassurance or improved health-related quality of life in irritable bowel syndrome? Gastrointest Endosc 2005; 62: 892–899.  [Link]
  5. Locke GR, 3rd, et al. Overlap of gastrointestinal symptom complexes in a US community. Neurogastroenterol Motil 2005; 17: 29–34.  [Link]
  6. Hungin AP, Hill C and Raghunath A. Systematic review: Frequency and reasons for consultation for gastro-oesophageal reflux disease and dyspepsia. Aliment Pharmacol Ther 2009; 30: 331–342.  [Link]
  7. Kahrilas PJ, et al. Expert consensus document: Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes. Nat Rev Gastroenterol Hepatol 2017; 14: 677–688.  [Link]
  8. Savarino E, et al. Expert consensus document: Advances in the physiological assessment and diagnosis of GERD. Nat Rev Gastroenterol Hepatol 2017; 14: 665–676.  [Link]
  9. Keller J, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 2018; 15: 291–308.  [Link]
  10. Carrington EV, et al. Expert consensus document: Advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol 2018; 15: 309–323.  [Link]
Dyspepsia

Author: Mark Fox
Affiliation: Mark Fox is at the Abdominal Center: Gastroenterology,St. Claraspital, CH-4016 Basel, Switzerland, and is Professor at theUniversity of Zürich, Zürich, Switzerland
Correspondence: 
Link to online article: https://gutflix.eu/r/kC7hUop6A4tM
Conflicts of interest: None

References:

  1. Tack J, Talley NJ. Functional dyspepsia—symptoms, definitions and validity of the Rome III criteria. Nat Rev Gastroenterol Hepatol 2013; 10: 134–141.  [Link]
  2. Ford AC, Marwaha A, Lim A, et al. What Is the Prevalence of Clinically Significant Endoscopic Findings in Subjects With Dyspepsia? Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology 2010; 8: 830-837.e2.  [Link]
  3. National Institute for Health and Care Excellence NICE. Clinical Guideline 184. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management, https://www.nice.org.uk/guidance/cg184 (2014, accessed 22 February 2024).  [Link]
  4. Talley NJ, Vakil N, the Practice Parameters Committee of the American College of Gastroenterology. Guidelines for the Management of Dyspepsia. Am J Gastroenterology 2005; 100: 2324–2337.  [Link]
  5. Farré R, Vanheel H, Vanuytsel T, et al. In Functional Dyspepsia, Hypersensitivity to Postprandial Distention Correlates With Meal-Related Symptom Severity. Gastroenterology 2013; 145: 566–573.  [Link]
  6. Vanheel H, Vanuytsel T, Van Oudenhove L, et al. Postprandial symptoms originating from the stomach in functional dyspepsia. Neurogastroenterology Motil 2013; 25: 911.  [Link]
  7. Ford AC, Marwaha A, Lim A, et al. Systematic Review and Meta-analysis of the Prevalence of Irritable Bowel Syndrome in Individuals With Dyspepsia. Clinical Gastroenterology and Hepatology 2010; 8: 401–409.  [Link]
  8. Hungin APS, Hill C, Raghunath A. Systematic review: frequency and reasons for consultation for gastro‐oesophageal reflux disease and dyspepsia. Aliment Pharmacol Ther 2009; 30: 331–342.  [Link]
  9. Ford AC, Forman D, Bailey AG, et al. Initial poor quality of life and new onset of dyspepsia: results from a longitudinal 10-year follow-up study. Gut 2007; 56: 321–327.  [Link]
  10. Rich G, Shah A, Koloski N, et al. A randomized placebo‐controlled trial on the effects of Menthacarin, a proprietary peppermint‐ and caraway‐oil‐preparation, on symptoms and quality of life in patients with functional dyspepsia. Neurogastroenterology Motil 2017; 29: e13132.  [Link]
  11. Melzer J, Rösch W, Reichling J, et al. Meta‐analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004; 20: 1279–1287.  [Link]
  12. Thomas E, Wade A, Crawford G, et al. Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pocket‐targeting alginate–antacid (Gaviscon Double Action) – a double‐blind, placebo‐controlled, pilot study in gastro‐oesophageal reflux disease. Aliment Pharmacol Ther 2014; 39: 595–602.  [Link]
  13. Pinto-Sanchez MI, Yuan Y, Bercik P, et al. Proton pump inhibitors for functional dyspepsia. The Cochrane database of systematic reviews 2017; 3: CD011194.  [Link]
  14. Pittayanon R, Yuan Y, Bollegala NP, et al. Prokinetics for functional dyspepsia. The Cochrane database of systematic reviews 2018; 10: CD009431.  [Link]
  15. Horowitz N, Moshkowitz M, Leshno M, et al. Clinical trial: evaluation of a clinical decision‐support model for upper abdominal complaints in primary‐care practice. Aliment Pharmacol Ther 2007; 26: 1277–1283.  [Link]
  16. Heikkinen M, Pikkarainen P, Takala J, et al. Etiology of Dyspepsia: Four Hundred Unselected Consecutive Patients in General Practice. Scandinavian Journal of Gastroenterology 1995; 30: 519–523.  [Link]
  17. Spiegel BMR, Gralnek IM, Bolus R, et al. Is a negative colonoscopy associated with reassurance or improved health-related quality of life in irritable bowel syndrome? Gastrointestinal Endoscopy 2005; 62: 892–899.  [Link]
  18. Soo S, Forman D, Delaney BC, et al. A Systematic Review of Psychological Therapies for Nonulcer Dyspepsia. Am J Gastroenterol 2004; 99: 1817–1822.  [Link]
  19. Drossman DA, Whitehead WE, Toner BB, et al. What determines severity among patients with painful functional bowel disorders? Am J Gastroenterology 2000; 95: 974–980.  [Link]
  20. Santonicola A. Prevalence of functional dyspepsia and its subgroups in patients with eating disorders. WJG 2012; 18: 4379.  [Link]
  21. Hay P, Mitchison D, Collado AEL, et al. Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. J Eat Disord 2017; 5: 21.  [Link]
  22. Delaney B, Ford AC, Forman D, et al. Initial management strategies for dyspepsia. In: The Cochrane Collaboration (ed) Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd, p. CD001961.pub2.  [Link]
  23. Delaney BC, Qume M, Moayyedi P, et al. Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trial (MRC-CUBE trial). BMJ 2008; 336: 651–654.  [Link]
  24. Wang WH, Huang JQ, Zheng GF, et al. Effects of Proton-Pump Inhibitors on Functional Dyspepsia: A Meta-analysis of Randomized Placebo-Controlled Trials. Clinical Gastroenterology and Hepatology 2007; 5: 178–185.  [Link]
  25. Reimer C, Søndergaard B, Hilsted L, et al. Proton-Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy. Gastroenterology 2009; 137: 80-87.e1.  [Link]
  26. Schwizer W, Menne D, Schütze K, et al. The effect of Helicobacter pylori infection and eradication in patients with gastro‐oesophageal reflux disease: A parallel‐group, double‐blind, placebo‐controlled multicentre study. UEG Journal 2013; 1: 226–235.  [Link]
  27. Fox M, Forgacs I. Gastro-oesophageal reflux disease. BMJ 2006; 332: 88–93.  [Link]
Gastroparesis

Author: Asma Fikree
Affiliation: Asma Fikree is a consultant gastroenterologist at the Royal London Hospital in London, UK, and an honorary senior lecturer at Barts and the London School of Medicine and Dentistry, Queen Mary University London, UK.
Correspondence: 
Link to online article: https://gutflix.eu/r/kJ06tMLIQwMi
Conflicts of interest: None

References:

  1. Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J Nucl Med Technol 2008; 36: 44–54.  [Link]
  2. Parkman HP, Yates K, Hasler WL, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology 2011; 140: 101–115.  [Link]
  3. Wuestenberghs F, Juge M, Melchior C, et al. Association between symptoms, quality of life, and gastric emptying in dyspeptic patients. J Neurogastroenterol Motil 2019; 25: 534–543.  [Link]
  4. Parkman HP, Wilson LA, Hasler WL, et al. Abdominal pain in patients with gastroparesis: associations with gastroparesis symptoms, etiology of gastroparesis, gastric emptying, somatization, and quality of life. Dig Dis Sci 2019; 64: 2242–2255.  [Link]
  5. Olausson EA, Störsrud S, Grundin H, et al. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Am J Gastroenterol 2014; 109: 375–385.  [Link]
  6. Paine P, McMahon M, Farrer K, et al. Jejunal feeding: when is it the right thing to do? Frontline Gastroenterol 2019; 11: 397–403.  [Link]
  7. Melchior C, Desprez C, Wuestenberghs F, et al. Impact of Opioid Consumption in Patients With Functional Gastrointestinal Disorders. Front Pharmacol 2020; 11: 596467.  [Link]
  8. Calles-Escandón J, Koch KL, Hasler WL, et al. Glucose sensor-augmented continuous subcutaneous insulin infusion in patients with diabetic gastroparesis: an open-label pilot prospective study. PLoS One 2018; 13: e0194759.  [Link]
The management of diarrhoea

Authors: Julian R.F. Walters, Hans Törnblom and Magnus Simrén
Affiliation: 
Julian RF Walters is a Professor of Gastroenterology at Imperial College London and Consultant Gastroenterologist at Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
Hans Törnblom is Associate Professor of Gastroenterology at the Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Magnus Simrén is Professor of Gastroenterology at the Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Correspondence:
Link to online article: https://gutflix.eu/r/3alzxkVyRKpC, https://gutflix.eu/r/L7LgEkEswSDs
Conflicts of interest:
JRFW has acted as a consultant, speaker or advisory board member for, or his institution has received research funding from, Dr Falk, Enyo, GEHealthcare, Intercept, Metacrine, Novartis, Pendopharm and Prometheus.
HT has served as an advisory board member/consultant and/or speaker for Takeda, Tillotts, Biocodex, Dr Falk Pharma GmbH. 
MS has received unrestricted research grants from Glycom, and served as an advisory board member/consultant and/or speaker for Danone Nutricia Research, Ironwood, Menarini, Biocodex, Genetic Analysis AS, DSM, Tillotts, Takeda, Arena, Kyowa Kirin, Adnovate, Atnahs Pharma, Takeda, AlfaSigma, Sanofi, Janssen Immunology, Pfizer, Ferrer, and Falk Foundation.

References:

  1. Lacy BE, et al. Bowel Disorders. Gastroenterology 2016; 150: 1393–1407.e5.  [Link]
  2. Arasaradnam RP, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut 2018; 67: 1380–1399.  [Link]
  3. Drossman DA, Hasler WL. Rome IV—Functional GI Disorders: Disorders of Gut-Brain interaction. Gastroenterology 2016; 150: 1257–1261.  [Link]
  4. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study. Gastroenterology 2020; 160: 99-114.e3.  [Link]
  5. Camilleri M, Nurko S. Bile Acid Diarrhea in Adults and Adolescents. Neurogastroenterology & Motility 2022; 34: e14287.  [Link]
  6. Miehlke S, Verhaegh B, Tontini GE, et al. Microscopic colitis: pathophysiology and clinical management. The Lancet Gastroenterology & Hepatology 2019; 4: 305–314.  [Link]
  7. Stotzer PO, et al. Are the definitions for chronic diarrhoea adequate? Evaluation of two different definitions in patients with chronic diarrhoea. United European Gastroenterol J 2015; 3: 381–386.  [Link]
  8. Bannaga A, et al. How bad is bile acid diarrhoea: an online survey of patient–reported symptoms and outcomes. BMJ Open Gastroenterol 2017; 4: e000116.  [Link]
  9. Valentin N, et al. Biomarkers for bile acid diarrhoea in functional bowel disorder with diarrhoea: a systematic review and meta–analysis. Gut 2016; 65: 1951–1959.  [Link]
  10. Guagnozzi D, et al. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862.  [Link]
  11. Patel SG and Ahnen DJ. Colorectal Cancer in the Young. Curr Gastroenterol Rep 2018; 20: 15.  [Link]
  12. Vijayvargiya P, et al. Performance characteristics of serum C4 and FGF19 measurements to exclude the diagnosis of bile acid diarrhoea in IBS-diarrhoea and functional diarrhoea. Aliment Pharmacol Ther 2017; 46: 581–588.  [Link]
  13. Garsed K, Chernova J, Hastings M, et al. A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut 2013; 63: 1617–1625.  [Link]
  14. Marth T, Moos V, Müller C, et al. Tropheryma whipplei infection and Whipple’s disease. The Lancet Infectious Diseases 2016; 16: e13–e22.  [Link]
  15. Richard N, Desprez C, Wuestenberghs F, et al. The effectiveness of rotating versus single course antibiotics for small intestinal bacterial overgrowth. United European Gastroenterology Journal 2021; 9: 645–654.  [Link]
  16. Staudacher HM and Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut 2017; 66: 1517–1527.  [Link]
  17. De Georgio R, et al. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut 2016; 65: 169–178.  [Link]
  18. Watson L, et al. Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome? Clin Med (Lond) 2015; 15: 536–540.  [Link]
Irritable bowel syndrome

Author: Robin Spiller
Affiliation: Robin Spiller is at NIHR Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and the University of Nottingham in the Nottingham Digestive Diseases Centre, Schoolof Medicine, University of Nottingham, Nottingham, UK
Correspondence: 
Link to online article: https://gutflix.eu/r/lpdpj6t56o8x
Conflicts of interest: None

References:

  1. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology 2021; 160: 99-114 e113.  [Link]
  2. Mearin F, Lacy BE, Chang L, et al. Bowel Disorders. Gastroenterology 2016; 150: 1393-1407.e1395.  [Link]
  3. Oka P, Parr H, Barberio B, et al. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5: 908-917.  [Link]
  4. van Lanen AS, de Bree A and Greyling A. Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis. Eur J Nutr 2021; 60: 3505-3522.  [Link]
  5. Staudacher HM, Rossi M, Kaminski T, et al. Long-term personalized low FODMAP diet improves symptoms and maintains luminal Bifidobacteria abundance in irritable bowel syndrome. Neurogastroenterol Motil 2022; 34: e14241.  [Link]
  6. Hill LS, Reid F, Morgan JF, et al. SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord 2010; 43: 344-351.  [Link]
  7. Mari A, Hosadurg D, Martin L, et al. Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link? Eur J Gastroenterol Hepatol 2019; 31: 178-182.  [Link]
  8. Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013; 145: 320-328 e321-323.  [Link]
  9. Kennedy TM and Jones RH. Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population. Br J Surg 2000; 87: 1658-1663.  [Link]
  10. Kirk G, Kennedy R, McKie L, et al. Preoperative symptoms of irritable bowel syndrome predict poor outcome after laparoscopic cholecystectomy. Surg Endosc 2011; 25: 3379-3384.  [Link]
  11. Longstreth GF and Yao JF. Irritable bowel syndrome and surgery: a multivariable analysis. Gastroenterology 2004; 126: 1665-1673.  [Link]
Dietary management of irritable bowel syndrome

Authors: Zlatan Mujagic, Jenny Brouns, Daniel Keszthelyi and Jean W.M. Muris    
Affiliation:
Zlatan Mujagic is a gastroenterologist, and Daniel Keszthelyi is a gastroenterologist and Head of the Department of Gastroenterology-Hepatology at Maastricht University Medical Center+, Maastricht, The Netherlands. In addition, they both work as clinical researchers at the NUTRIM School for Nutrition, and Translational Research in Metabolism at Maastricht University. 
Jenny Brouns is a dietitian in the Department of Dietetics, Maastricht University Medical Centre, Maastricht, The Netherlands. 
Jean Muris is a general practitioner and Chair of the Department of Family Medicine at the Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.    
Correspondence:     
Link to online article: https://gutflix.eu/r/QFSYpEgzGl1Z    
Conflicts of interest:
ZM, JB and JWMM declare they have no conflicts of interest in relation to this article. 
DK has received research funding from Will Pharma, Allergan, Grunenthal, ZonMw, MLDS, UEG, ESCP and the Rome Foundation.    

References:

  1. Van den Houte K, et al. Prevalence and impact of self-reported irritable bowel symptoms in the general population. United European Gastroenterol J 2019; 7: 307–315.  [Link]
  2. Tornkvist NT, et al. Health care utilization of individuals with Rome IV irritable bowel syndrome in the general population. United European Gastroenterol J, 2021; 9: 1178–1188.  [Link]
  3. Bohn L, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634–641.  [Link]
  4. Sayuk GS, Wolf R and Chang L. Comparison of symptoms, healthcare utilization, and treatment in diagnosed and undiagnosed individuals with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol 2017; 112: 892–899.  [Link]
  5. Bijkerk CJ, et al. Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management. Can J Gastroenterol 2003; 17: 363–368.  [Link]
  6. Lacy BE, et al. ACG Clinical Guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021; 116: 17–44.  [Link]
  7. Vasant DH, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70: 1214–1240.  [Link]
  8. McKenzie YA, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 2016; 29: 549–575.  [Link]
  9. Spiller R. Impact of diet on symptoms of the irritable bowel syndrome. Nutrients 2021; 13: 575.  [Link]
  10. Moayyedi P, et al. Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterol J 2017; 5: 773–788.  [Link]
  11. Tigchelaar EF, et al. Habitual diet and diet quality in irritable bowel syndrome: a case-control study. Neurogastroenterol Motil 2017; 29: e13151.  [Link]
  12. Zamani M, Alizadeh-Tabari S and Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2019; 50: 132–143.  [Link]
  13. Simons M, et al. Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome. Neurogastroenterol Motil 2021; 34: e14188.  [Link]
  14. Lea R and Whorwell PJ. The role of food intolerance in irritable bowel syndrome. Gastroenterol Clin North Am 2005; 34: 247–255.  [Link]
  15. Onyimba F, et al. Food allergies and intolerances: a clinical approach to the diagnosis and management of adverse reactions to food. Clin Gastroenterol Hepatol 2021; 19: 2230–2240.e1.  [Link]
  16. Aguilera-Lizarraga J, et al. Local immune response to food antigens drives meal-induced abdominal pain. Nature 2021; 590: 151–156.  [Link]
  17. Barbara G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 2007; 132: 26–37.  [Link]
  18. Fabisiak A, et al. Targeting histamine receptors in irritable bowel syndrome: a critical appraisal. J Neurogastroenterol Motil 2017; 23: 341–348.  [Link]
  19. Klooker TK, et al. The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut 2010; 59: 1213–1221.  [Link]
Constipation

Authors: Claudia Barber and Jordi Serra
Affiliation: 
Claudia Barber is a pre-doc specialist in Gastroenterology at Digestive System Research Unit, University Hospital Valld’Hebron, 08035-Barcelona, Spain. 
Jordi Serra is the Head of the GI Motility Section of the University Hospital Vall d’Hebron in Barcelona, Spain.
Correspondence:
Link to online article: https://gutflix.eu/r/mOf6PZXuv9d6
Conflicts of interest: 
CB declares no conflicts of interest. 
JS acted as consultant/speaker or received research support from Allergan, Bayer, Salvat, Norgine, Cassen-Recordati and Reckitt Benkiser"

References:

  1. Mearin et al. Clinical practice guidelines: irritable bowel syndrome with constipation and functional constipation in adults: Concept, diagnosis, and healthcare continuity. (Part 1 of 2). Aten Primaria 2017; 49: 42-55.  [Link]
  2. Serra J, Pohl D, Azpiroz F, et al. European society of neurogastroenterology and motility guidelines on functional constipation in adults. Neurogastroenterology and motility 2020; 32: e13762.  [Link]
  3. Lacy BE, Mearin F, Chang L, et al. Bowel Disorders. Gastroenterology 2016; 150: 1393-1407.e5.  [Link]
  4. Bharucha et al. American gastroenterological association technical review on constipation. Gastroenterology. 2013; 144: 218‐238.  [Link]
  5. Rao SSC. Constipation: evaluation and treatment of colonic and anorectal motility disorders. Gastroenterol Clin North Am. 2007; 36: 687‐711.  [Link]
  6. Mearin et al. Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult. Rev Esp Enferm Dig 2016; 108: 332-363.  [Link]
  7. Lam et al. Clinical examination remains more important than anorectal function tests to identify treatable conditions in women with constipation. Int Urogynecol J. 2013; 24: 67‐72.  [Link]
  8. Talley NJ. How to do and interpret a rectal examination in gastroenterology. Am J Gastroenterol. 2008; 103: 820‐822.  [Link]
  9. Soh JS, Lee HJ, Jung KW, et al. The diagnostic value of a digital rectal examination compared with high‐resolution anorectal manometry in patients with chronic constipation and fecal incontinence. Am J Gastroenterol. 2015; 110: 1197‐1204.  [Link]
  10. Bove A. Consensus statement AIGO/SICCR: Diagnosis and treatment of chronic constipation and obstructed defecation (part I: Diagnosis). World J Gastroenterol. 2012; 18: 1555.  [Link]
Faecal incontinence management

Authors: Sadé L. Assmann, Stephanie O. Breukink, Daniel Keszthelyi
Affiliation: 
Daniel Keszthelyi is a professor in gastroenterology and Head of the Division of Gastroenterology-Hepatology at Maastricht University Medical Centre, Maastricht, The Netherlands.
Stephanie Breukink is an associate professor and colorectal surgeon at Maastricht University Medical Centre, P. Debyelaan 256229 HX Maastricht, The Netherlands.
Sadé Assmann is a PhD candidate at NUTRIM, Maastricht University, The Netherlands.
Correspondence:
Link to online article: https://gutflix.eu/r/ZvZkwHQYnWgU
Conflicts of interest: 
LA declares no conflicts of interest in relation to this article. 
SOB has received research funding from Zonmw, ESCP and UEG. 
DK has received research funding from Will Pharma, Allergan, Grunenthal, ZonMw, MLDS, UEG, ESCP, Horizon 2020 and the Rome Foundation."

Reference:

  1. Rao SS, Bharucha AE, Chiarioni G, et al. Anorectal disorders. Gastroenterology 2016; 150: 1430-42.e4.  [Link]
  2. Olsson F and Berterö C. Living with faecal incontinence: trying to control the daily life that is out of control. J Clin Nurs 2015; 24: 141-50.  [Link]
  3. Bartlett L, Nowak M and Ho YH. Impact of fecal incontinence on quality of life. World J Gastroenterol 2009; 15: 3276-82.  [Link]
  4. Deutekom M, Terra M, Dobben A, et al. Impact of faecal incontinence severity on health domains. Colorectal Dis 2005; 7: 263-9.  [Link]
  5. Wilson M. The impact of faecal incontinence on the quality of life. Br J Nurs 2007; 16: 204-7.  [Link]
  6. Assmann SL, Keszthelyi D, Kleijnen J, et al. Guideline for the diagnosis and treatment of faecal incontinence—a UEG/ESCP/ESNM/ESPCG collaboration. United European Gastroenterol J 2022; 10: 251-86.  [Link]
  7. Bharucha AE, Zinsmeister AR, Locke GR, et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology 2005; 129: 42-9.  [Link]
  8. Madoff RD, Parker SC, Varma MG, et al. Faecal incontinence in adults. Lancet 2004; 364: 621-32.  [Link]
  9. Mowatt G, Glazener CM and Jarrett M. Sacral nerve stimulation for faecal incontinence and constipation in adults. Cochrane Database Syst Rev 2007; 3: CD004464.  [Link]
  10. Brochard C, Chambaz M, Ropert A, et al. Quality of life in 1870 patients with constipation and/or fecal incontinence: constipation should not be underestimated. Clin Res Hepatol Gastroenterol 2019; 43: 682-7.  [Link]
  11. Ng KS, Nassar N, Hamd K, et al. Prevalence of functional bowel disorders and faecal incontinence: an Australian primary care survey. Colorectal Dis 2015; 17: 150-9.  [Link]
  12. Cotterill N, Norton C, Avery KN, et al. A patient-centred approach to developing a comprehensive symptom and quality of life assessment of anal incontinence. Dis Colon Rectum 2008; 51: 82-7.  [Link]
  13. Maeda Y, Vaizey C, Hollington P, et al. Physiological, psychological and behavioural characteristics of men and women with faecal incontinence. Colorectal Dis 2009; 11: 927-32.  [Link]
  14. Bharucha AE, Zinsmeister AR, Locke GR, et al. Risk factors for fecal incontinence: a population-based study in women. Am J Gastroenterol 2006; 101: 1305-12.  [Link]
  15. Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009; 137: 512-7.e2.  [Link]
  16. Rey E, Schleck CD, Zinsmeister AR, et al. Onset and risk factors for fecal incontinence in a US community. Am J Gastroenterol 2010; 105: 412-9.  [Link]

Chapter 8: Paediatric Gastroenterology

  • Paediatric foreign body ingestion
  • Paediatric IBD
  • Paediatric functional constipation diagnosis and treatment
  • Transitional care for children and young adults
  • Gastrostomy insertion in children and adolescents
Paediatric foreign body ingestion

Authors: Raoul I. Furlano, Jorge Amil-Dias, Lissy de Ridder and Christos Tzivinikos
Affiliation: 
Raoul I Furlano is Head of Pediatric Gastroenterology & Nutrition, University Children’s Hospital Basel, Switzerland.
Jorge Amil-Dias is a Pediatric Gastroenterologist at Hospital Lusiadas, Porto; Retired from Centro Hospitalar Universitário.S. João, Porto, Portugal. 
Lissy de Ridder is at the Department ofPaediatric Gastroenterology, Erasmus MC/Sophia Children’sHospital, Rotterdam, The Netherlands. 
Christos Tzivinikos is Headof Paediatric Gastroenterology Department Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates.
Correspondence:
Link to online article: https://gutflix.eu/r/upfT9xh0FIzI
Conflicts of interest: None

References:

  1. Ikenberry SO, Jue TL, Anderson MA, et al. Management of ingested foreign bodies and food impactions. Gastrointestinal Endoscopy 2011; 73: 1085–1091.  [Link]
  2. Cheng W, Tam PKH. Foreign-body ingestion in children: Experience with 1,265 cases. Journal of Pediatric Surgery 1999; 34: 1472–1476.  [Link]
  3. Thomson M, Tringali A, Dumonceau J, et al. Paediatric gastrointestinal endoscopy. Journal of Pediatric Gastroenterology and Nutrition 2016; 64: 133–153.  [Link]
  4. Ingraham CR, Mannelli L, Robinson JD, et al. Radiology of foreign bodies: how do we image them? Emergency Radiology 2015; 22: 425–430.  [Link]
  5. Lerner DG, Brumbaugh D, Lightdale JR, et al. Mitigating risks of swallowed button batteries. Journal of Pediatric Gastroenterology and Nutrition 2020; 70: 542–546.  [Link]
  6. Sethia R, Gibbs H, Jacobs IN, et al. Current management of button battery injuries. Laryngoscope Investigative Otolaryngology 2021; 6: 549–563.  [Link]
  7. Anfang RR, Jatana KR, Linn RL, et al. pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. The Laryngoscope 2018; 129: 49–57.  [Link]
  8. Wright K, Parkins K, Jahn H, et al. Catastrophic haemorrhage from button battery ingestion in children: a growing problem. Acta Paediatrica 2017; 106: 1391–1393.  [Link]
  9. Mubarak A, Benninga MA, Broekaert I, et al. Diagnosis, management, and prevention of button battery ingestion in childhood. Journal of Pediatric Gastroenterology and Nutrition 2021; 73: 129–136.  [Link]
  10. Spiers A, Jamil S, Whan E, et al. Survival of patient after aorto‐oesophageal fistula following button battery ingestion. ANZ Journal of Surgery 2012; 82: 186–187.  [Link]
  11. Leinwand K, Brumbaugh DE, Kramer RE. Button battery ingestion in children. Gastrointestinal Endoscopy Clinics of North America 2016; 26: 99–118.  [Link]
  12. Mubarak A, Benninga MA, Broekaert I, et al. Diagnosis, management, and prevention of button battery ingestion in childhood. Journal of Pediatric Gastroenterology and Nutrition 2021; 73: 129–136.  [Link]
  13. Bendig DW, Mackie GG. Management of Smooth-Blunt gastric foreign bodies in asymptomatic patients. Clinical Pediatrics 1990; 29: 642–645.  [Link]
  14. Hachimi-Idrissi S, Corne L, Vandenplas Y. Management of ingested foreign bodies in childhood: our experience and review of the literature. European Journal of Emergency Medicine 1998; 5: 319.  [Link]
  15. Piñero Madrona A, Hernández JAF, Prats MC, et al. Intestinal perforation by foreign bodies. Eur J Surg 2000; 166: 307–309.  [Link]
  16. Palta R, Sahota A, Bemarki A, et al. Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion. Gastrointestinal Endoscopy 2009; 69: 426–433.  [Link]
  17. Hameed K, Hassan MK, Rehman S, et al. Management of foreign bodies in the upper gastrointestinal tract with flexible endoscope. J Postgrad Med Inst 2011; 25: 29-34.  [Link]
  18. Tokar B, Cevik AA, Ilhan H. Ingested gastrointestinal foreign bodies: predisposing factors for complications in children having surgical or endoscopic removal. Pediatric Surgery International 2007; 23: 135–139.  [Link]
  19. Nugud AA, Tzivinikos C, Assa A, et al. Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper. Journal of Pediatric Gastroenterology and Nutrition 2023; 76: 523–532.  [Link]
  20. Kodituwakku R, Palmer S, Paul SP. Management of foreign body ingestions in children: button batteries and magnets. British Journal of Nursing 2017; 26: 456–461.  [Link]
  21. Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children. Journal of Pediatric Gastroenterology and Nutrition 2015; 60: 562–574.  [Link]
  22. Caré W, Dufayet L, Paret N, et al. Bowel obstruction following ingestion of superabsorbent polymers beads: literature review. Clinical Toxicology 2022; 60: 159–167.  [Link]
Paediatric IBD

Authors: Neil Chanchlani and Richard K. Russell
Affiliation: Neil Chanchlani is at Royal Free London Hospital NHS Foundation Trust, London, UK. Richard K.Russell is at The Royal Hospital for Children Glasgow, Glasgow, UK
Correspondence: 
Link to online article: https://gutflix.eu/r/MscMs42VP3lZ
Conflicts of interest: 
NC declares no conflicts of interest. 
RKR has received consultation fees, research grants, or honorarium, from Nestlé, AbbVie, Takeda, Napp, Mead Johnson, Nutricia and Janssen.

References:

  1. Ghione S, Sarter H, Fumery M, et al. Dramatic Increase in Incidence of Ulcerative Colitis and Crohn’s Disease (1988–2011): A Population-Based Study of French Adolescents. Am J Gastroenterol 2018; 113: 265–272.  [Link]
  2. Pigneur B, Seksik P, Viola S, et al. Natural history of Crohnʼs disease: Comparison between childhood- and adult-onset disease. Inflamm Bowel Dis 2010; 16: 953–961.  [Link]
  3. Atia O, Lujan R, Buchuk R, et al. Predictors of Complicated Disease Course in Adults and Children With Crohn’s Disease: A Nationwide Study from the epi-IIRN. Inflamm Bowel Dis 2024; 30: 2370–2379.  [Link]
  4. Kuenzig ME, Fung SG, Marderfeld L, et al. Twenty-first Century Trends in the Global Epidemiology of Pediatric-Onset Inflammatory Bowel Disease: Systematic Review. Gastroenterology 2022; 162: 1147-1159.e4.  [Link]
  5. Roberts SE, Thorne K, Thapar N, et al. A Systematic Review and Meta-analysis of Paediatric Inflammatory Bowel Disease Incidence and Prevalence Across Europe. J Crohns Colitis 2020; 14: 1119–1148.  [Link]
  6. Dotson JL, Hyams JS, Markowitz J, et al. Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease and Their Relation to Disease Type and Severity. J Pediatr Gastroenterol Nutr 2010; 51: 140–145.  [Link]
  7. Greuter T, Bertoldo F, Rechner R, et al. Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease: Prevalence, Presentation, and Anti‐TNF Treatment. J Pediatr Gastroenterol Nutr 2017; 65: 200–206.  [Link]
  8. Uhlig HH, Schwerd T, Koletzko S, et al. The Diagnostic Approach to Monogenic Very Early Onset Inflammatory Bowel Disease. Gastroenterology 2014; 147: 990-1007.e3.  [Link]
  9. Uhlig HH, Charbit‐Henrion F, Kotlarz D, et al. Clinical Genomics for the Diagnosis of Monogenic Forms of Inflammatory Bowel Disease: A Position Paper From the Paediatric IBD Porto Group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2021; 72: 456–473.  [Link]
  10. Kammermeier J, Lamb CA, Jones KDJ, et al. Genomic diagnosis and care co-ordination for monogenic inflammatory bowel disease in children and adults: consensus guideline on behalf of the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition. Lancet Gastroenterol Hepatol 2023; 8: 271–286.  [Link]
  11. D’Arcangelo G, Distante M, Veraldi S, et al. Natural History of Anemia and Efficacy and Safety of Oral Iron Therapy in Children Newly Diagnosed With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2023; 76: 771–775.  [Link]
  12. Aljomah G, Baker SS, Schmidt K, et al. Anemia in Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2018; 67: 351–355.  [Link]
  13. Gordon H, Burisch J, Ellul P, et al. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis 2024; 18: 1–37.  [Link]
  14. Broekaert IJ, Assa A, Borrelli O, et al. Approach to anaemia in gastrointestinal disease: A position paper by the ESPGHAN Gastroenterology Committee. J Pediatr Gastroenterol Nutr 2025; 80: 510–532.  [Link]
  15. Wine E, Aloi M, Van Biervliet S, et al. Management of paediatric ulcerative colitis, part 1: Ambulatory care—An updated evidence‐based consensus guideline from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn’s and Colitis Organisation. Journal of Pediatric Gastroenterology and Nutrition. Epub ahead of print July 18, 2025. DOI: 10.1002/jpn3.70097.  [Link]
  16. Henderson P, Anderson NH, Wilson DC. The Diagnostic Accuracy of Fecal Calprotectin During the Investigation of Suspected Pediatric Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2014; 109: 637–645.  [Link]
  17. Dignass AU, Gasche C, Bettenworth D, et al. European Consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. Journal of Crohn S and Colitis 2014; 9: 211–222.  [Link]
  18. Swaminath A, Feathers A, Ananthakrishnan AN, et al. Systematic review with meta‐analysis: enteral nutrition therapy for the induction of remission in paediatric Crohn’s disease. Aliment Pharmacol Ther 2017; 46: 645–656.  [Link]
  19. Russell RK, Fagbemi A, Benyacoub J, et al. Specialized and standard nutritional formulas for the dietary management of pediatric patients with Crohn’s disease: a systematic literature review. Expert Rev Gastroenterol Hepatol 2025; 19: 455–465.  [Link]
  20. Narula N, Dhillon A, Zhang D, et al. Enteral nutritional therapy for induction of remission in Crohn’s disease. The Cochrane database of systematic reviews 2018; 4: CD000542.  [Link]
  21. Day AS, Whitten KE, Sidler M, et al. Systematic review: nutritional therapy in paediatric Crohn’s disease. Aliment Pharmacol Ther 2008; 27: 293–307.  [Link]
  22. Van Rheenen PF, Aloi M, Assa A, et al. The Medical Management of Paediatric Crohn’s Disease: an ECCO-ESPGHAN Guideline Update. J Crohns Colitis 2021; 15: 171–194.  [Link]
  23. Jatkowska A, White B, Gkikas K, et al. Partial Enteral Nutrition in the Management of Crohn’s Disease: A Systematic Review and Meta-Analysis. J Crohns Colitis 2025; 19: jjae177.  [Link]
  24. Schulman JM, Pritzker L, Shaoul R. Maintenance of Remission with Partial Enteral Nutrition Therapy in Pediatric Crohn’s Disease: A Retrospective Study. Can J Gastroenterol Hepatol 2017; 2017: 1–7.  [Link]
  25. Levine A, Wine E, Assa A, et al. Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology 2019; 157: 440-450.e8.  [Link]
  26. Boneh RS, Navas-López VM, Hussey S, et al. Modified Crohn’s disease exclusion diet maintains remission in pediatric Crohn’s disease; randomized controlled trial. Clinical Gastroenterology and Hepatology. Epub ahead of print December 1, 2024. DOI: 10.1016/j.cgh.2024.12.006.  [Link]
  27. Balestrieri P, Ribolsi M, Guarino MPL, et al. Nutritional Aspects in Inflammatory Bowel Diseases. Nutrients 2020; 12: 372.  [Link]
  28. Logan M, Gkikas K, Svolos V, et al. Analysis of 61 exclusive enteral nutrition formulas used in the management of active Crohn’s disease—new insights into dietary disease triggers. Aliment Pharmacol Ther 2020; 51: 935–947.  [Link]
  29. Chanchlani N, Lin S, Bewshea C, et al. Mechanisms and management of loss of response to anti-TNF therapy for patients with Crohn’s disease: 3-year data from the prospective, multicentre PANTS cohort study. Lancet Gastroenterol Hepatol 2024; 9: 521–538.  [Link]
  30. Murray A, Nguyen TM, Parker CE, et al. Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. The Cochrane database of systematic reviews 2020; 8: CD000544.  [Link]
  31. Croft NM, Korczowski B, Kierkuś J, et al. Safety and efficacy of multimatrix mesalamine in paediatric patients with mild-to-moderate ulcerative colitis: a phase 3, randomised, double-blind study. eClinicalMedicine 2023; 65: 102232.  [Link]
  32. Turner D, Yerushalmi B, Kori M, et al. Once- Versus Twice-daily Mesalazine to Induce Remission in Paediatric Ulcerative Colitis: A Randomised Controlled Trial. J Crohns Colitis 2016; jjw180.  [Link]
  33. Levine A, Yerushalmi B, Kori M, et al. Mesalamine Enemas for Induction of Remission in Oral Mesalamine-refractory Pediatric Ulcerative Colitis: A Prospective Cohort Study. J Crohns Colitis 2017; 11: 970–974.  [Link]
  34. Murray A, Nguyen TM, Parker CE, et al. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. The Cochrane database of systematic reviews 2020; 8: CD000543.  [Link]
  35. Fell JM, Muhammed R, Spray C, et al. Management of ulcerative colitis. Arch Dis Child 2016; 101: 469–474.  [Link]
Paediatric functional constipation diagnosis and treatment

Authors: Michelle N. Bloem, Ilan J.N. Koppen, Fleur de Lorijn, Max Nieuwdorp and Marc A. Benninga    
Affiliation: 
Michelle N. Bloem, Ilan J.N. Koppen, Fleur de Lorijn, and Marc A.Benninga work at Emma Children's Hospital, Amsterdam University Medical Centre (UMC), Paediatric Gastroenterology and Nutrition, University of Amsterdam, Amsterdam, The Netherlands.
Max Nieuwdorp is at the Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC and the Department of Internal and Vascular Medicine and Experimental Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands. 
Michelle N. Bloem is also working at the Amsterdam Gastroenterology Endocrinology Metabolism Research Institute.  
Correspondence:     
Link to online article: https://gutflix.eu/r/djvxDALwivge    
Conflicts of interest: 
MAB is a consultant for Mallinckrodt, Shire, Danone, FrieslandCampina, HIPP, Norgine, Coloplast, United Pharmaceuticals, and Wellspect. All honoraria were paid to the hospital (Amsterdam UMC). IJNK received research funding from Wellspect Healthcare and The EuroQol Research Foundation. All other authors declare no conflict of interest.    

References:

  1. Koppen IJN, Vriesman MH, Saps M, et al. Prevalence of functional defecation disorders in children: A systematic review and meta-analysis. The Journal of Pediatrics 2018; 198: 121-30.e6.  [Link]
  2. Hasosah M, Alsahafi F, Alghiribi A, et al. Prevalence, characterization and risk factors of chronic constipation among saudi children: A cross-sectional study International Journal of Advanced Research 2018; 6: 1319-24.  [Link]
  3. Ip KS, Lee WT, Chan JS, et al. A community-based study of the prevalence of constipation in young children and the role of dietary fibre. Hong Kong Med J 2005; 11: 431-6.  [Link]
  4. Wu TC, Chen LK, Pan WH, et al. Constipation in taiwan elementary school students: A nationwide survey. J Chin Med Assoc 2011; 74: 57-61.  [Link]
  5. Udoh EE, Rajindrajith S, Devanarayana NM, et al. Prevalence and risk factors for functional constipation in adolescent nigerians. Arch Dis Child 2017; 102: 841-4.  [Link]
  6. Lu PL, Velasco-Benítez CA and Saps M. Sex, age, and prevalence of pediatric irritable bowel syndrome and constipation in colombia: A population-based study. J Pediatr Gastroenterol Nutr 2017; 64: e137-e41.  [Link]
  7. Chogle A, Velasco-Benitez CA, Koppen IJ, et al. A population-based study on the epidemiology of functional gastrointestinal disorders in young children. J Pediatr 2016; 179: 139-43.e1.  [Link]
  8. Rajindrajith S, Devanarayana NM, Thapar N, et al. Myths and misconceptions about childhood constipation. Eur J Pediatr 2023; 182: 1447-58.  [Link]
  9. Berger MY, Tabbers MM, Kurver MJ, et al. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: A systematic review. J Pediatr 2012; 161: 44-50.e1-2.  [Link]
  10. Benninga MA, Tabbers MM and van Rijn RR. How to use a plain abdominal radiograph in children with functional defecation disorders. Arch Dis Child Educ Pract Ed 2016; 101: 187-93.  [Link]
  11. Tabbers MM, Di Lorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from espghan and naspghan. Journal of pediatric gastroenterology and nutrition 2014; 58: 258-74.  [Link]
  12. Yallanki N, Small-Harary L, Morganstern J, et al. Inter and intraobserver variation in interpretation of fecal loading on abdominal radiographs. J Pediatr Gastroenterol Nutr 2023; 76: 295-9.  [Link]
  13. Hyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: Children and adolescents. Gastroenterology 2016; 150: 1456-68.  [Link]
  14. Benninga MA, Nurko S, Faure C, et al. Childhood functional gastrointestinal disorders: Neonate/Toddler. Gastroenterology 2016; 150: 1443-1455.e2.  [Link]
  15. Pradhan S and Jagadisan B. Yield and examiner dependence of digital rectal examination in detecting impaction in pediatric functional constipation. Journal of Pediatric Gastroenterology and Nutrition 2018; 67: 570-5.  [Link]
  16. Morais MB, Vítolo MR, Aguirre AN, et al. Measurement of low dietary fiber intake as a risk factor for chronic constipation in children. J Pediatr Gastroenterol Nutr 1999; 29: 132-5.  [Link]
  17. Roma E, Adamidis D, Nikolara R, et al. Diet and chronic constipation in children: The role of fiber. J Pediatr Gastroenterol Nutr 1999; 28: 169-74.  [Link]
  18. Lee WT, Ip KS, Chan JS, et al. Increased prevalence of constipation in pre‐school children is attributable to under‐consumption of plant foods: A community‐based study. Journal of Paediatrics and Child Health 2007; 44: 170–175.  [Link]
  19. Korczak R, Kamil A, Fleige L, et al. Dietary fiber and digestive health in children. Nutr Rev 2017; 75: 241-59.  [Link]
  20. Hojsak I, Benninga MA, Hauser B, et al. Benefits of dietary fibre for children in health and disease. Archives of Disease in Childhood 2022; 107: 973–979.  [Link]
  21. Todhunter-Brown A, Booth L, Campbell P, et al. Strategies used for childhood chronic functional constipation: The success evidence synthesis. Health Technol Assess 2024; 28: 1-266.  [Link]
  22. Koppen IJN, De Meij TGJ, Benninga MA. Investigating Probiotics in the Management of Childhood Functional Constipation: A Never-Ending Story? Indian Pediatrics 2023; 60: 429–430.  [Link]
  23. Kwiatkowska M and Krogulska A. The significance of the gut microbiome in children with functional constipation. Adv Clin Exp Med 2021; 30: 471-80.  [Link]
  24. De Geus A, Koppen IJN, Flint RB, et al. An Update of Pharmacological Management in Children with Functional Constipation. Pediatric Drugs 2023; 25: 343–358.  [Link]
  25. Felt B, Wise CG, Olson A, et al. Guideline for the management of pediatric idiopathic constipation and soiling. Multidisciplinary team from the university of michigan medical center in ann arbor. Arch Pediatr Adolesc Med 1999; 153: 380-5.  [Link]
  26. Bekkali NLH, Hoekman DR, Liem O, et al. Polyethylene glycol 3350 with electrolytes versus polyethylene glycol 4000 for constipation: A randomized, controlled trial. J Pediatr Gastroenterol Nutr 2018; 66: 10-5.  [Link]
  27. Rachel H, Griffith AF, Teague WJ, et al. Polyethylene glycol dosing for constipation in children younger than 24 months: A systematic review. J Pediatr Gastroenterol Nutr 2020; 71: 171-5.  [Link]
  28. Roy D, Akriche F, Amlani B, et al. Utilisation and safety of polyethylene glycol 3350 with electrolytes in children under 2 years: A retrospective cohort. J Pediatr Gastroenterol Nutr 2021; 72: 683-9.  [Link]
  29. Strisciuglio C, Coppola V, Russo M, et al. Promelaxin Microenemas Are Non-inferior to Oral Polyethylene Glycol for the Treatment of Functional Constipation in Young Children: A Randomized Clinical Trial. Front Pediatr 2021; 9: 753938.  [Link]
  30. Bonilla S, Nurko S and Rodriguez L. Long-term use of bisacodyl in pediatric functional constipation refractory to conventional therapy. J Pediatr Gastroenterol Nutr 2020; 71: 288-91.  [Link]
  31. Santos-Jasso KA, Arredondo-García JL, Maza-Vallejos J, et al. Effectiveness of senna vs polyethylene glycol as laxative therapy in children with constipation related to anorectal malformation. Journal of Pediatric Surgery 2017; 52: 84–88.  [Link]
  32. Vilanova-Sanchez A, Gasior AC, Toocheck N, et al. Are Senna based laxatives safe when used as long term treatment for constipation in children? Journal of Pediatric Surgery 2018; 53: 722–727.  [Link]
  33. DiMatteo MR. Variations in patients' adherence to medical recommendations: A quantitative review of 50 years of research. Med Care 2004; 42: 200-9.  [Link]
  34. Reeves PT, Jack BO, Rogers PL, et al. The Uniformed Services Constipation Action Plan: An Effective Tool for the Management of Children with Functional Constipation. The Journal of Pediatrics 2023; 253: 46-54.e1.  [Link]
  35. Koppen IJN, Van Wassenaer EA, Barendsen RW, et al. Adherence to Polyethylene Glycol Treatment in Children with Functional Constipation Is Associated with Parental Illness Perceptions, Satisfaction with Treatment, and Perceived Treatment Convenience. The Journal of Pediatrics 2018; 199: 132-139.e1.  [Link]
  36. Steiner SA, Torres MR, Penna FJ, et al. Chronic functional constipation in children: Adherence and factors associated with drug treatment. J Pediatr Gastroenterol Nutr 2014; 58: 598-602.  [Link]
  37. Krassas G, Cranswick N, Katelaris P, et al. Polyethylene glycols with or without electrolytes for constipation in children: A network meta-analysis. Pediatrics & Therapeutics 2018; 8: 1-10.  [Link]
  38. Santucci NR, Rein LE, Van Tilburg MA, et al. Self-Efficacy in Children with Functional Constipation Is Associated with Treatment Success. The Journal of Pediatrics 2020; 216: 19–24.  [Link]
  39. Koppen IJ, Lammers LA, Benninga MA, et al. Management of functional constipation in children: Therapy in practice. Paediatr Drugs 2015; 17: 349-60.  [Link]
  40. Mosiello G, Marshall D, Rolle U, et al. Consensus review of best practice of transanal irrigation in children. J Pediatr Gastroenterol Nutr 2017; 64: 343-52.  [Link]
  41. Bokova E, Svetanoff WJ, Rosen JM, et al. State of the art bowel management for pediatric colorectal problems: functional constipation. Children 2023; 10: 1078.  [Link]
  42. Baaleman DF, Wegh C a. M, Hoogveld MTA, et al. Transanal irrigation in children: treatment success, quality of life, adherence, patient experience, and independence. Journal of Pediatric Gastroenterology and Nutrition 2022; 75: 166–172.  [Link]
  43. Koppen IJN, Kuizenga‐Wessel S, Voogt HW, et al. Transanal irrigation in the treatment of children with intractable functional constipation. Journal of Pediatric Gastroenterology and Nutrition 2017; 64: 225–229.  [Link]
Transitional care for children and young adults

Authors: Jorge Amil-Dias, Hans Törnblom, Moriam Mustapha and Patrizia Burra
Affiliation: 
Jorge Amil-Dias is a pediatrician and pediatric gastroenterologist and consultant at the Hospital Lusíadas, Porto, Portugal.
Hans Törnblom is an associate professor of gastroenterology at the Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Moriam Mustapha is a registered dietician at Evelina London, Guy’s and St Thomas’ NHS Foundation Trust, UK.
Patrizia Burra is a professor of gastroenterology and Head of the Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy.
Correspondence:
Link to online article: https://gutflix.eu/r/QHRmCXVg9kFU
Conflicts of interest:
JA-D Served as member of advisory board: Adacolumn, Danone. Receipt of payment/honorarium for lectures: Danone. Receipt of payment/honorarium for consultation: Bristol-Meyers Squibb. 
HT has served as an advisory board member/consultant and/or speaker for Biocodex, Cinclus Pharma, Dr Falk Pharma GmbH, Medifactia, Takeda, Tillotts, VIPUN Medical. 
PB has served as an advisory board member/consultant and/or speaker for Biotest; Kedrion; Astellas; Gilead; Sandoz; Chiesi Farmaceutici. MM has no conflict of interest.

References:

  1. Blum RWm, Garell D, Hodgman CH, et al. Transition from child-centered to adult health-care systems for adolescents with chronic conditions. Journal of Adolescent Health 1993; 14: 570–576.  [Link]
  2. Davidson LF, Doyle MH. Health-care transition: a vital part of care, growth, and change for pediatric patients. Pediatrics in Review 2021; 42: 684–693.  [Link]
  3. Leung Y, Heyman MB, Mahadevan U. Transitioning the adolescent inflammatory bowel disease patient: Guidelines for the adult and pediatric gastroenterologist. Inflammatory Bowel Diseases 2010; 17: 2169–2173.  [Link]
  4. Ludvigsson JF, Agreus L, Ciacci C, et al. Transition from childhood to adulthood in coeliac disease: the Prague consensus report. Gut 2016; 65: 1242–1251.  [Link]
  5. Gray WN, Holbrook E, Dykes D, et al. Improving IBD transition, self‐management, and disease outcomes with an in‐clinic transition coordinator. Journal of Pediatric Gastroenterology and Nutrition 2019; 69: 194–199.  [Link]
  6. Ferrarese A, Germani G, Lazzaro S, et al. Short‐term outcomes of paediatric liver transplant recipients after transition to Adult Healthcare Service. Liver International 2017; 38: 1316–1321.  [Link]
  7. Hames A, Matcham F, Joshi D, et al. Liver transplantation and adolescence: The role of mental health. Liver Transplantation 2016; 22: 1544–1553.  [Link]
  8. Benchimol EI, Walters TD, Kaufman M, et al. Assessment of knowledge in adolescents with inflammatory bowel disease using a novel transition tool. Inflammatory Bowel Diseases 2010; 17: 1131–1137.  [Link]
  9. Kinberg S, Verma T, Kaura D, et al. Optimizing transition from pediatric to adult care in short bowel syndrome and intestinal failure. Journal of Parenteral and Enteral Nutrition 2023; 47: 718–728.  [Link]
  10. Van Rheenen PF, Aloi M, Biron IA, et al. European Crohn’s and Colitis Organisation Topical Review on Transitional Care in Inflammatory Bowel Disease. Journal of Crohn S and Colitis 2017; 11: 1032–1038.  [Link]
Gastrostomy insertion in children and adolescents

Authors: Ilse Julia Broekaert, Jorge Amil Dias, Matjaž Homan and Christos Tzivinikos
Affiliation: 
Ilse Julia Broekaert Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Jorge Amil Dias Paediatric Gastroenterology consultant at Hospital Lusíadas, Porto, Portugal. 
Matjaž Homan Department of Gastroenterology Hepatology and Nutrition, University Children’s Hospital, Faculty of Medicine, University of Ljubljana, Slovenia. 
Christos Tzivinikos Paediatric Gastroenterology Consultant at Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates and Clinical Associate Professor at Mohammed Bin Rashid University of Medicine and Health Sciences.
Correspondence: 
Link to online article: https://gutflix.eu/r/uDnojhKpYwYr
Conflicts of interest: None

References:

  1. Homan M, Hauser B, Romano C, et al. Percutaneous Endoscopic Gastrostomy in Children: An Update to the ESPGHAN Position Paper. J Pediatr Gastroenterol Nutr 2021; 73: 415-426.  [Link]
  2. Braegger C, Decsi T, Dias JA, et al. Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr 2010; 51: 110-122.  [Link]
  3. Heuschkel RB, Gottrand F, Devarajan K, et al. ESPGHAN position paper on management of percutaneous endoscopic gastrostomy in children and adolescents. J Pediatr Gastroenterol Nutr 2015; 60: 131-141.  [Link]
  4. Kim JS, Park YW, Kim HK, et al. Is percutaneous endoscopic gastrostomy tube placement safe in patients with ventriculoperitoneal shunts? World J Gastroenterol 2009; 15: 3148-3152.  [Link]
  5. Yap BK, Nah SA, Chen Y, et al. Fundoplication with gastrostomy vs gastrostomy alone: a systematic review and meta-analysis of outcomes and complications. Pediatr Surg Int 2017; 33: 217-228.  [Link]
  6. Alessandri F, Strisciuglio C, Borrazzo C, et al. Antibiotic Prophylaxis for Percutaneous Endoscopic Gastrostomy in Children: A Randomised Controlled Trial. J Pediatr Gastroenterol Nutr 2021; 72: 366-371  [Link]
  7. Jean-Bart CC, Aumar M, Ley D, et al. Complications of one-step button percutaneous endoscopic gastrostomy in children. Eur J Pediatr 2023; 182: 1665-1672.  [Link]
  8. Lucendo AJ and Friginal-Ruiz AB. Percutaneous endoscopic gastrostomy: An update on its indications, management, complications, and care. Rev Esp Enferm Dig 2014; 106: 529-539.  [Link]
  9. Sandberg F, Viktorsdottir MB, Salo M, et al. Comparison of major complications in children after laparoscopy-assisted gastrostomy and percutaneous endoscopic gastrostomy placement: a meta-analysis.Pediatr Surg Int 2018; 34: 1321-1327.  [Link]
  10. Schrag SP, Sharma R, Jaik NP, et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis 2007; 16: 407-418.  [Link]
  11. Richter-Schrag HJ and Fischer A. [Buried bumper syndrome: A new classification and therapy algorithm]. Chirurg 2015; 86: 963-969.  [Link]
  12. Figueiredo AA, Lomazi EA, Montenegro MA, et al. Quality of Life in Caregivers of Pediatric Patients with Cerebral Palsy and Gastrostomy Tube Feeding. Arq Gastroenterol 2020; 57: 3-7.  [Link]