Search

Extraintestinal manifestations occur frequently in patients with inflammatory bowel disease (IBD) and remain a diagnostic and therapeutic challenge. The aim of the Endpoints for Extraintestinal Manifestations in Inflammatory Bowel Disease Trials (EXTRA) initiative was to achieve international expert consensus on how to assess these manifestations in IBD trials. A systematic literature review was done to identify methods to diagnose extraintestinal manifestations in patients with IBD and measure treatment outcomes. A consensus meeting involving a panel of 41 attendees, including gastroenterologists and referral specialists, was held on March 31, 2021, as part of an International Organization for the Study of Inflammatory Bowel Diseases initiative. The panel agreed that a specialist's expertise is needed to confirm the diagnosis of extraintestinal manifestations before the inclusion of a patient in IBD trials, except for axial spondyloarthritis, for which typical symptoms and MRI can be sufficient. Easy-to-measure endpoints were identified to assess the response of extraintestinal manifestations to treatment without needing specialist involvement. For uveitis, peripheral spondyloarthritis, and arthralgia, endpoint measurements need specialist expertise. The timing of endpoint measurements was discussed for individual extraintestinal manifestations. The EXTRA consensus proposes guidelines on how to thoroughly evaluate extraintestinal manifestations within IBD trials, and recommends that these guidelines are implemented in future trials to enable prospective assessment of these manifestations and comparison between studies.

Background & Aims Due to the poor eradication rates of standard triple therapy, the addition of bismuth salts has been proposed for first-line eradication of Helicobacter pylori. We assessed the effectiveness and safety of the combination of bismuth and the standard, clarithromycin-containing triple therapy in eradication of H pylori infection, using data from a large multi-center registry. Methods We performed an interim analysis of data from the European Registry on H pylori Management, a prospective trial registering clinical data and outcomes from infected patients from 27 countries in Europe since 2013. We extracted data on 1141 treatment-naive patients who received first-line treatment with bismuth salts (240 mg) and a proton pump inhibitor (57% received esomeprazole, 18% received omeprazole, 11% received pantoprazole, and 14% received rabeprazole), amoxicillin (1 g), and clarithromycin (500 mg), all taken twice daily. Results Intention to treat and per-protocol rates of eradication were 88% and 94%, respectively. Intention to treat eradication increased to 93% in patients who received 14-day treatments. Adverse events occurred in 36% of patients; 76% of these events were mild, with a mean duration of 6 days. In multivariate analysis, eradication was associated with treatment compliance (odds ratio [OR], 13.0), a double dose (equivalent to 40 mg omeprazole) of proton pump inhibitor (OR, 4.7), and 14-day duration of treatment (OR, 2.0). Conclusions In an analysis of data from a large multi-center registry, we found the addition of bismuth to 14-day standard triple therapy with clarithromycin and amoxicillin to eradicate H pylori infection in more than 90% of patients, based on intention to treat analysis, with an acceptable safety profile and level of adherence. ClinicalTrials.gov no: NCT02328131 .

Provision and participation in formal external continuing medical education (CME) is costly. Employer or state support of CME is the exception rather than the rule. The medical industry has supported both providers and consumers of educational activities, leading to concerns of commercial bias. Recent medical industry initiatives in Europe to improve the transparency of the relationship between industry and the profession, including the field of medical education, have had the paradoxical effect of the industry playing an increasingly direct role in the provision of physician education. Funding of medical professional society annual congresses has been directly and indirectly jeopardized. Acknowledging that there are areas of cooperation in the field of education between the medical profession and the medical industry from which both can benefit, we argue that medical education requires an objective approach that the primary fiduciary duty of medical industry companies precludes. Medical professional societies, as not-for-profit organizations whose core mission is the development and promotion of best practice, are best placed to guide and deliver medical education to their members. (C) 2019 Published by Elsevier Inc.

International audience; Background and aims: Inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), are chronic and disabling disorders. Prospective disease-modification trials to prevent disease progression are eagerly awaited. However, disease progression is not clearly defined. The objective of the Selecting End PoInts foR Disease-ModIfication Trials (SPIRIT) initiative was to achieve international expert consensus on the endpoints to be used in future IBD-disease modification trials.Methods: This initiative under the auspices of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) began with a systematic literature search to evaluate the current evidence on the definition of disease progression in IBD. On October 22, 2019, a consensus meeting took place during the United European Gastroenterology Week (UEGW) Congress in Barcelona, during which predefined proposed statements were discussed in a plenary session and voted on anonymously. Agreement was defined as at least 75% of participants voting for any one statement.Results: The group agreed that the ultimate therapeutic goal in both CD and UC is to prevent disease impact on patient's life (health-related quality of life, disability, fecal incontinence), midterm complications (encompass bowel damage in CD, IBD-related surgery and hospitalizations, disease extension in UC, extraintestinal manifestations, permanent stoma, short bowel syndrome), and long-term complications (gastrointestinal and extraintestinal dysplasia or cancer, mortality).Conclusions: Recommendations on which goals to achieve in disease-modification trials for preventing disease progression in patients with IBD are proposed by the SPIRIT consensus. However, these recommendations will require validation in actual clinical studies before implementation in disease-modification trials.

The discovery of Helicobacter pylori was one of the most notable in gastroenterology – and indeed medicine. The century before Marshall and Warren's discovery is peppered with isolated accounts of spiral-shaped bacteria in the stomach. The discovery of H. pylori , and the recognition of its importance, came about as a consequence of combined clinical, pathological and microbiological work. The discovery has transformed the treatment of peptic ulcers and other related diseases.

The aim of this study was to assess whether the taking of an additional biopsy from the incisura angularis increases the chance of detecting maximal degrees of atrophy and intestinal metaplasia (IM) in patients with Helicobacter pylori gastritis and functional dyspepsia. At entry into a randomised trial, biopsies were taken from 328 patients (mean age 48 years), two from both the gastric antrum and corpus, and one from the incisura angularis, and comparative grading of gastritis variables was carried out. Biopsy material from the gastric antrum, corpus, and the incisura angularis revealed no notable differences in atrophy or an incidence of IM and mucosa-associated lymphatic tissue. However, when the incisura biopsies were classified histologically, 58% contained antral mucosa (AM), 18% corpus mucosa (CM), and 24% intermediate zone mucosa. AM at the incisura was associated with considerably more severe gastritis in both the incisura and antrum (14% atrophy, 20% IM) than in CM of incisura (2% atrophy, 6% IM). Corpus atrophy and IM were rare in the AM group and absent from the CM group. Incisura angularis biopsy in patients with H. pylori gastritis and functional dyspepsia does give additional information regarding the severity of gastritis expected in the corpus and antrum. Antral-type mucosa in the incisura angularis region seems to indicate an increased risk for the development of atrophy and/or IM. (c) 2006 Elsevier GmbH. All rights reserved.

Nutrition has an important role in the management of inflammatory bowel disease. This role includes the prevention and correction of malnutrition, the prevention of osteoporosis and in children the promotion of optimal growth and development. In active Crohn's disease nutritional therapy (in the form of enteral feeding) is an effective primary therapy for many patients. Corticosteroids, however, are more effective than enteral diet therapy in adults. Enteral diets should be considered as primary therapy in pediatric Crohn's disease, especially in children with poor nutritional status or growth impairment. Enteral nutrition does not have a proven primary therapeutic role in ulcerative colitis. There are many theories that suggest that diet may be implicated in the aetiology of inflammatory bowel disease, however, there are, as yet, no dietary approaches proven to reduce the risk of developing IBD.

Dyspepsia is a common condition, reported to affect 40% of the adult population in the developed world annually, with an estimated incidence of 8%. Dyspepsia accounts for 2% to 3% of all general practice consultations. It has been estimated that only 10% of sufferers seek medical advice, and 22% of these are referered to a specialist. Older patients are more likely to present, probably because of concern about the possibility of significant underlying pathology. Nonulcer dyspepsia (NUD) is the underlying diagnosis in a considerable proportion of individuals with dyspepsia. The prevalence is highest in young patients (younger than 25 years old), but in patients older than age 60 with dyspepsia, 20% have a normal endoscopy. NUD comprises a symptom complex referable to the upper gastrointestinal tract that persists for longer than 4 weeks, for which neither a biochemical nor structural abnormality can be identified. Diagnostic criteria were established by the Rome Consensus Committee in 1991 59 and were updated in 1998 in Vienna. The cause of NUD appears to be multifactorial, and different mechanisms may result in different subtypes of disease, which have been subgrouped on the basis of the predominant symptom type—ulcerlike, refluxlike, and dysmotilitylike. The management of NUD is varied depending on the cause and individual response to treatment. The role of Helicobacter pylori infection in the pathogenesis and treatment of NUD is an area of ongoing avid research and remains controversial. Patients with NUD are more likely to be infected than asymptomatic individuals, and there is evidence to show benefit, in at least a subset of sufferers, after eradication of H. pylori . Dyspepsia causes considerable morbidity and has substantial socioeconomic implications, as a result of workdays lost and the expense of medical investigations and treatment. The estimated total cost of dyspepsia to the United States in 1993 was greater than $14 million.

Summary Background Helicobacter pylori is a common human pathogen implicated in certain gastrointestinal diseases. In the search for new non-invasive techniques to diagnose H pylori infection, we evaluated an EIA for H pylori antigen in stool (HpSA). Methods In a prospective multicentre study, stool specimens from 501 patients (276 men, 225 women; age range 17–88 years, mean 52) undergoing gastroscopy in 11 centres throughout Europe were tested with HpSA and the carbon-13-urea breath test. At endoscopy, four biopsy samples were taken for histology (haematoxylin and eosin) and H pylori detection (giemsa in both antrum and corpus, culture and rapid urease test). Patients were defined as positive for H pylori if histology (antrum, corpus, or both) and urease test were positive, or if culture was positive. Patients classified as having H pylori infection received an eradication regimen; 107 were reassessed 4 weeks after therapy. Findings Of 272 patients with H pylori infection by the predefined criteria, 256 were positive by HpSA (sensitivity 94·1% [95% CI 90·6–96·6]). Of 219 patients without infection, 201 were negative by HpSA (specificity 91·8% [87·3–95·1]). Interpretation The stool assay was a reliable and easy-to-use tool for diagnosis of H pylori infection. The test was accurate even shortly after treatment.

Background & Aims: The role of omeprazole in triple therapy and the impact of Helicobacter pylori resistance on treatment outcome are not established. This study investigated the role of omeprazole and influence of primary H. pylori resistance on eradication and development of secondary resistance. Methods: Patients (n = 539) with a history of duodenal ulcer and a positive H. pylori screening test result were randomized into 4 groups. OAC group received 20 mg omeprazole, 1000 mg amoxicillin, and 500 mg clarithromycin; OMC group received 20 mg omeprazole, 400 mg metronidazole, and 250 mg clarithromycin; and AC (amoxicillin, 1000 mg, and clarithromycin, 500 mg) and MC (metronidazole, 400 mg, and clarithromycin, 250 mg) groups received no omeprazole. All doses were administered twice daily for 1 week. H. pylori status was assessed before and after therapy by 13 C-urea breath test. Susceptibility testing was performed at entry and in patients with persistent infection after therapy. Results: Eradication (intention to treat [n = 514]/per protocol [n = 449]) was 94%/95% for OAC, 26%/25% for AC ( P P Conclusions: Addition of omeprazole achieves high eradication rates, reduces the impact of primary resistance, and may decrease the risk of secondary resistance compared with regimens containing only two antibiotics. GASTROENTEROLOGY 1999;116:248-253

We studied the relation between angiographically defined coronary artery disease and serologic evidence of Helicobacter pylori infection in 488 patients undergo ing elective coronary angiography. There was no association between Helicobacter pylori infection and coronary artery disease (odds ratio 1.3, 95% confidence interval 0.83 to 2.16).

Pan-European Registry on H. pylori Management (HP-EuReg): Bacterial Resistance Adrian G. McNicholl, Antonio Gasbarrini, Bojan Tepes, Dmitry S. Bordin, Frode Lerang, Marcis Leja, Theodore Rokkas, Dino Vaira, Oleg Shvets, Limas Kupcinskas, Angeles Perez Aisa, Anthony T. Axon, Gyorgy M. Buzas, Ilkay Simsek, Miroslava Katicic, Jose C. Machado, Vincent Lamy, Krzysztof Przytulski, Lyudmila Boyanova, Peter Bytzer, Christoph Beglinger, Lisette Capelle, Adrian Goldis, Lea Veijola, Miroslav Vujasinovic, Alain Huerta, Jorge Perez-Lasala, Maria Caldas, Mercedes Ramas, Francis Megraud, Colm A. O'Morain, Javier P. Gisbert

Pan-European Registry on H. pylori Management (HP-EuReg): Bacterial Resistance Adrian G. McNicholl, Antonio Gasbarrini, Bojan Tepes, Dmitry S. Bordin, Frode Lerang, Marcis Leja, Theodore Rokkas, Dino Vaira, Oleg Shvets, Limas Kupcinskas, Angeles Perez Aisa, Anthony T. Axon, Gyorgy M. Buzas, Ilkay Simsek, Miroslava Katicic, Jose C. Machado, Vincent Lamy, Krzysztof Przytulski, Lyudmila Boyanova, Peter Bytzer, Christoph Beglinger, Lisette Capelle, Adrian Goldis, Lea Veijola, Miroslav Vujasinovic, Alain Huerta, Jorge Perez-Lasala, Maria Caldas, Mercedes Ramas, Francis Megraud, Colm A. O'Morain, Javier P. Gisbert

Purpose: Diagnosing and treating H. Pylori infection is important for the management of peptic ulcer disease and gastric cancer. The purpose of this study is to compare the sensitivity and effects of H. Pylori detection by pathology and by HP MPCR. Methods: Between March 2011 and Oct 2014 in a clinical practice in New Jersey, 6943 patients suspected of having an H. Pylori infection underwent gastroscopy with biopsies.When the pathology was negative for H. Pylori, the specimen was tested for H. Pylori by HP MPCR from TZAM Diagnostics. The positive results recorded during the specified time period were grouped into the following categories: Pathology (the positive results determined only by pathology), HP MPCR (the positive results determined only by HP MPCR), and Total Positive (the total number of positive results determined by both methods). Results: Out of the 6943 patients, 2456 (35%) total patients tested positive for H. Pylori: 14% (1001) by pathology and 21% (1455) by HP MPCR. Furthermore, all three result categories Pathology, HP MPCR, and Total Positive reveal a decline in the incidence of H. Pylori infection from 2011 to 2014. The incidence of H. Pylori by pathology decreased from 15.8% in 2011 to 13.5% in 2014 (r = -0.891) at a rate of -0.89% per year. The incidence of H. Pylori by HP MPCR decreased from 30.3% in 2011 to 14.0% in 2014 (r = -0.978) at a rate of -5.4% per year. The total incidence of infection (taking both pathology and HP MPCR results into account) decreased from 46.1% in 2011 to 27.6% in 2014 (r= -0.975) at a rate of -6.3% per year (Figure 1). Conclusion: The data demonstrates that HP MPCR is useful in tandem with pathological detection, capturing an additional 21% of the study's population. Assuming a fixed patient population, the incidence of H. Pylori appears to be declining in this clinical practice. However, detection by HP MPCR indicates a much sharper decline in the incidence of H. Pylori infection (-5.4% per year) than detection by pathology (-0.89%). This trend can potentially be explained by the accuracy of HP MPCR detection. Because HP MPCR captures infected patients in addition to those captured by pathological examination, more patients can be treated for the infection, contributing to a general decline in positive H. Pylori cases. The data analysis of this population suggests that utilizing HP MPCR is a potential step toward the eradication of H. Pylori infection.

Pan-European Registry on H. pylori Management (HP-EuReg): Bacterial Resistance Adrian G. McNicholl, Antonio Gasbarrini, Bojan Tepes, Dmitry S. Bordin, Frode Lerang, Marcis Leja, Theodore Rokkas, Dino Vaira, Oleg Shvets, Limas Kupcinskas, Angeles Perez Aisa, Anthony T. Axon, Gyorgy M. Buzas, Ilkay Simsek, Miroslava Katicic, Jose C. Machado, Vincent Lamy, Krzysztof Przytulski, Lyudmila Boyanova, Peter Bytzer, Christoph Beglinger, Lisette Capelle, Adrian Goldis, Lea Veijola, Miroslav Vujasinovic, Alain Huerta, Jorge Perez-Lasala, Maria Caldas, Mercedes Ramas, Francis Megraud, Colm A. O'Morain, Javier P. Gisbert

Pan-European Registry on H. pylori Management (HP-EuReg): Bacterial Resistance Adrian G. McNicholl, Antonio Gasbarrini, Bojan Tepes, Dmitry S. Bordin, Frode Lerang, Marcis Leja, Theodore Rokkas, Dino Vaira, Oleg Shvets, Limas Kupcinskas, Angeles Perez Aisa, Anthony T. Axon, Gyorgy M. Buzas, Ilkay Simsek, Miroslava Katicic, Jose C. Machado, Vincent Lamy, Krzysztof Przytulski, Lyudmila Boyanova, Peter Bytzer, Christoph Beglinger, Lisette Capelle, Adrian Goldis, Lea Veijola, Miroslav Vujasinovic, Alain Huerta, Jorge Perez-Lasala, Maria Caldas, Mercedes Ramas, Francis Megraud, Colm A. O'Morain, Javier P. Gisbert

Estimation Of A Markov Chain For Crohn's Disease And Classification Of Patients Into Disease Phenotypes, In Eight Countries Using Individual Longitudinal Data Aggregated Over Time

Background: Colorectal cancer (CRC) is the second commonest malignancy in developed countries. The efficacy of CRC screening is well recognised, with many countries adopting a two stage approach with either gFOBT or FIT. Age is a recognised risk factor for CRC, yet the upper age limit for screening can vary substantially. Aim: To identify patterns of anatomical distribution and histological types of screening detected colorectal polyps in differnt age groups. Methods: A retrospective database review from Ireland's first FIT based pilot CRC screening programme over a two year period. In all, 9993 people between 5074 were invited, 51% (n=5063) participated and 10% (n=514) of FIT kits were positive and referred for colonoscopy. Subjects were excluded if they had a history of IBD, CRC or had undergone a colonoscopy within five years. Patient demographics, colonoscopy reports and histology results were recorded. Patients were divided into five age groups, 50-54, 55-59, 60-64, 65-69, and 70-74. Polyps were classified as either left sided (rectal,sigmoid,descending colon) or right sided (transverse colon, descending colon, caecum). Results: A total of 419 colonoscopies were performed, 409 (98%) were complete and 53% (n=216) had either a polyp or malignancy. There were 442 polyps diagnosed in 216 people, 32% (n=70) of people had more than one polyp. In all, 167 people had 318 adenomas. Of the adenomas, 59% (n=188) were tubular adenomas and 41% (n=130) were tubulovillous and 10% (n= 32) had areas of high grade dysplasia. Sixty seven (40%) of patients with adenomas were female and 38 (23%) were over 70 years of age. The incidence and distribution of adenomas according to age was n=6 (25%) and n=1 (14%) right sided for 50-54 years, n=30 (30%) and n=15 (29%) right sided for 55-59 age group, n=41 (41%) with n=29 (35%) right sided in the 60-64 age group, n=52 (49.5%) with n=31 (35%) right sided in the 65-69 age group and n=38 (47.5%) with n=29 (38%) right sided in the 70-74 age group. Conclusion: this study shows an increased incidence and preponderance of proximal adenomas with increasing age, highlighting that evaluation of the proximal colon is particularly important in elderly people. As 23% (n=38) of people with adenomaswere between 70-74, it would be appropriate to include this age group in future screening programmes.

Institutions Institutions are listed at the end of article.submitted 10. March 2011accepted after revision:27. July 2011BibliographyDOI http://dx.doi.org/10.1055/s-0031-1291385Endoscopy 2011; 43: 1–6© Georg Thieme Verlag KGStuttgart · New YorkISSN 0013-726XCorresponding authorY. Niv, MDDepartment ofGastroenterologyRabin Medical CenterBeilinson Hospital35 Jabotinski StreetPetach Tikva 49100IsraelFax: +972-3-9210313yniv@clalit.org.il