Search

Endoscopic ultrasound guided portal pressure gradient measurement (EUS-PPGm) would provide useful clinical information in patients with liver diseases. However, there is yet scarcely data on the clinical relevance of this EUS-guided procedure.

Objectives:Treatment for celiac disease (CD) is a lifelong strict gluten-free diet (GFD). Patients should be followed-up with dietary interviews and serology as CD markers to ensure adherence to the diet. However, none of these methods offer an accurate measure of dietary compliance. Our aim was to evaluate the measurement of gluten immunogenic peptides (GIP) in stools as a marker of GFD adherence in CD patients and compare it with traditional methods of GFD monitoring.Methods:We performed a prospective, nonrandomized, multicenter study including 188 CD patients on GFD and 84 healthy controls. Subjects were given a dietary questionnaire and fecal GIP quantified by enzyme-linked immunosorbent assay (ELISA). Serological anti-tissue transglutaminase (anti-tTG) IgA and anti-deamidated gliadin peptide (anti-DGP) IgA antibodies were measured simultaneously.Results:Of the 188 celiac patients, 56 (29.8%) had detectable GIP levels in stools. There was significant association between age and GIP in stools that revealed increasing dietary transgressions with advancing age (39.2% in subjects ≥13 years old) and with gender in certain age groups (60% in men ≥13 years old). No association was found between fecal GIP and dietary questionnaire or anti-tTG antibodies. However, association was detected between GIP and anti-DGP antibodies, although 46 of the 53 GIP stool-positive patients were negative for anti-DGP.Conclusions:Detection of gluten peptides in stools reveals limitations of traditional methods for monitoring GFD in celiac patients. The GIP ELISA enables direct and quantitative assessment of gluten exposure early after ingestion and could aid in the diagnosis and clinical management of nonresponsive CD and refractory CD. Trial registration number NCT02711397.

Les tumeurs primitives de l’intestin grêle représentent seulement 50 % de toutes les tumeurs du tractus gastro-intestinal. Les manifestations cliniques de ces tumeurs ne sont pas spécifiques et leurs symptômes apparaissent tardivement. La rareté, la non spécificité des symptômes et leur inaccessibilité rend ces tumeurs de l’intestin grêle susceptibles de passer inaperçues, avec un diagnostic très souvent erroné et tardif, et d’être responsables d’un taux de mortalité élevé. Le développement de la capsule endoscopique pour l’étude de l’intestin grêle et l’utilisation de l’imatinib dans les tumeurs stromales gastro-intestinales (TSGI) ont représenté d’importantes innovations dans le diagnostic et le traitement de ces patients. Cette étude a pour objet de discuter le rôle de ces deux nouveautés dans le traitement des tumeurs de l’intestin grêle et de proposer un algorithme pour leur diagnostic et traitement. Primary small-bowel tumors are representing only 5 % of all primary tumors of the gastrointestinal tract. Clinical manifestations of these tumors are nonspecific and the neoplasmarelated symptoms occur lately. The rarity, non specific symptoms and inaccessibility make small bowel tumors liable to be overlooked, with frequent delayed or erroneous diagnosis, and are responsible for high mortality rates. The development of capsule endoscopy for small bowel examination, as well as the use of imatinib in gastrointestinal stromal tumors (GIST), supposed outstanding innovations in diagnosis and therapy of these patients. The role of these two innovations in the management of small bowel tumors is discussed in this review and a diagnostic and therapeutic algorithm is proposed. [ABSTRACT FROM AUTHOR]

This corrects the article DOI: 10.1038/ajg.2016.439

Cid: Baxalta Innovations GmbH, now part of Shire: Other: Investigator Clinical Studies.