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Background and Aims Defining and assessing the reproducibility of Crohn's disease [CD] endoscopic lesions is essential in assessing endoscopic healing. Methods Twelve endoscopic CD experts from the GETAID defined aphthoid erosions [AE], superficial ulcerations [SU], deep ulcerations [DU], stenosis, and fistulas according to a Delphi-like method. Thirty different GETAID physicians declared if they found acceptable each definition. Intra- and inter-observer agreements were investigated using 100 videos with one tagged specific lesion [AE, SU, DU, or sham lesion] read by 15 independent endoscopists at baseline and 1 month later in a randomised order. Video quality was determined by an external reader. According to kappa estimate [κ ±standard error], intra or inter-observer agreement was qualified as 'moderate' [0.4–0.6], 'substantial' [0.6–0.8], or 'almost perfect' [0.8–1.0]. Results Among 30 different experts, 83% to 97% found acceptable the definitions retrieved from the Delphi-like method. Intra-observer κ was 0.717 [±0.019] for SU, 0.681 [±0.027] for AE, 0.856 [±0.014] for DU, showing 'substantial' agreement. It was 0.801 [±0.016] for any ulceration [DU or SU]. There was a high variability across readers from 'moderate' to 'almost perfect' agreement. Inter-observer κ was 0.548 [±0.042] for SU, 0.554 [±0.028] for AE 0.694 [±0.041] for DU, and 0.705 [±0.042] for any ulceration. Inter-observer agreement increased when reading the 53 high-quality videos: 0.787 [±0.064] [ p  = 0.001], 0.607 [±0.043] [ p  = 0.001], and 0.782 [±0.064][ p  = 0.001] for DU, AE, and any ulceration, respectively. Conclusions Despite variable intra-agreement level across readers, the GETAID definitions for CD endoscopic lesions provided 'substantial' inter-observer agreements, especially in case of high-quality videos. [ABSTRACT FROM AUTHOR]

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Background and Aims: Crohn's disease [CD] is associated with an increased risk of small bowel adenocarcinoma [SBA]. There are no recommendations on endoscopic screening of SBA in CD patients. The aim of this study was to evaluate the feasibility and value of endoscopic screening for SBA in CD patients at high-risk of SBA. Methods: We performed an exploratory multi-centre study in a prospective cohort of CD patients at high-risk of SBA deined as long-term small bowel disease without bowel resection for the past 10 years. Depending on the location of the disease, baseline upper and/or lower enteroscopies were performed. Random and targeted biopsies using chromoendoscopy were taken. Patients were followed-up for at least 1 year after inclusion. Results: In total, 101 patients [62 men; median age: 48 years; median duration of disease: 19 years] were recruited in ten centres. The endoscopic procedure was incomplete in 47 cases because of impassable strictures and dilation was performed in four patients. Indeterminate small bowel dysplasia was identiied in two patients at endoscopic screening; SBA was conirmed in one after surgical resection. With an at least 1-year follow-up duration, two additional cases of SBA were identiied in patients who underwent surgery for obstruction, resulting in a 33% sensitivity rate for SBA endoscopic screening. Conclusion: In a cohort of high-risk patients, the prevalence of dysplasia and SBA on CD was 4%. Because of its low sensitivity, endoscopic screening cannot be recommended for surveillance in CD patients at high-risk of SBA. [ABSTRACT FROM AUTHOR]

• Acute esophageal necrosis is an unknown entity because it is a rare disease. • Management including different specialties. • Time is necessary and surgery is not the only therapy. Acute Esophageal Necrosis Syndrome (AENS) is a rare and unknown clinical entity, defined as a diffuse circumferential black-appearing friable esophageal mucosa going from the distal esophageal mucosa to the gastroesophageal (GE) junction. Esophagogastroduodenoscopy (EGD) remains the gold standard in making diagnosis. We report here the case of a 45-year-old man with necrosis of the esophagus treated conservatively. Regression of the lesion but persistence of ulcerations were seen on the endoscopic follow-up. Distal esophageal stenosis was then diagnosed and treated by endoscopic dilation. Diagnosis of AENS must be considered when an old patient, with multiple comorbidities, presents an upper digestive hemorrhage. Upper endoscopy is mandatory. Treatment is in most of the cases conservative. Esophageal stenosis is a frequent complication. Although AENS is a rare clinical entity, it should not be dismissed by doctors, avoiding useless surgical management. This pathology remains nevertheless associated with a considerable mortality rate. [ABSTRACT FROM AUTHOR]

Background and Aims: Long-term benefits of combination therapy (combotherapy) with infliximab (IFX) and azathioprine (AZA) have been less studied in ulcerative colitis (UC) than in Crohn's disease. The aim of the present study was to determine UC disease activity in patients who received at least 6 months of combotherapy, and whether cotreatment for more than 6 months was useful in these patients. Methods: A retrospective multicenter study was conducted in seven French academic centers from January 2010 to September 2012, including all UC patients having received at least 6 months of combotherapy in prolonged remission off steroids. During the follow-up period, which was divided into trimesters, scheduled IFX was continued as maintenance and AZA could be withdrawn. Assessment of UC activity by trimester was based on the following events: disease relapse defined by clinical relapse requiring a change of treatment, IFX failure, and colectomy. Results: Eighty-two patients were included (mean age 38 years; male:female ratio 1:1) and followed up for a median of 22.3 ± 14.0 months. Comparing 393 trimesters of combotherapy with 282 trimesters of IFX alone, fewer clinical relapses were observed with combotherapy (p = 0.049). Similar results were observed for IFX failure (p = 0.048). No difference was observed for colectomy. Duration of combotherapy longer than 9 months was inversely associated with clinical relapse (hazard ratio = 0.32 [95% confidence interval 0.15-0.70]). Conclusions: UC patients treated with combotherapy should maintain IFX and AZA for at least 9 months. Further studies are required to determine the optimal duration of combotherapy before stopping AZA in this situation. [ABSTRACT FROM AUTHOR]

The selective production of chemicals from renewable resources with contemporaneous release of energy is perhaps one of the most desired targets of sustainable chemistry. Here, we report an overview of our recent research efforts, where we have demonstrated that this can be achieved using renewable alcohols, by means of two electrochemical devices: direct fuel cells and electrolyzers. In either case, an aqueous solution of the fuel in the anode compartment is oxidized on a nanostructured electrocatalyst that promotes selectively the partial oxidation of the anolyte with high stability and fast kinetics. We have found that anode electrocatalysts based on nanosized Pd particles, alone or promoted by Ni-Zn phases as well as by CeO2 or TiO2, are able to accomplish this goal in alkaline environment when used in conjunction with commercially available cathode electrocatalysts and solid or liquid electrolytes. In an electrolyzer, containing an anode electrocatalyst similar to that employable in a DAFC, the electrolyte may be either an anion exchange-membrane or a solution of an alkali metal hydroxide (NaOH or KOH, for example) and the alcohol is converted to the corresponding alkali metal carboxylate, while hydrogen gas is produced at the cathode upon water reduction. [ABSTRACT FROM AUTHOR]