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Following the 4th International Conference on Capsule Endoscopy (ICCE, Miami 2005), the main indications for videocapsule endoscopy (VCE) were reviewed. The consensus guidelines were published in Endoscopy in 2005. These propositions for VCE were based on an analysis of evidence reported in the literature published through 2005. A small working group of experts examined each methodology and presented their report at the plenary session. The final conclusions were then published. At the ICCE 2006 held in Paris, this first version of the consensus guidelines was improved and completed.

Unlabelled: The attention given by the physician and the quality of the patient-physician relationship mainly determine the outcome of a consultation. Care seeking is a main characteristic of patients with functional bowel disorders, including irritable bowel syndrome (IBS), while patients with suspected organic disease (Org) would rather expect a precise answer about their condition. The aim of this study was thus to evaluate the outcome of the consultation with a gastroenterologist in IBS patients, as compared to a group of patients with suspected organic disease., Patients and Methods: A prospective multicenter cross-sectional study "one given week" included 158 patients consulting for the first time 18 gastroenterologists. Patients were consulting for abdominal pain and were classified as IBS or Org on the basis of the physician's clinical impression. Questionnaires including 27 common questions were distributed to the patients and the physicians at the end of the consultation and filled separately., Results: The diagnosis of IBS was done in 110 patients and that of Org in 48. Groups were comparable for the characteristics, the intensity and the frequency of attacks of abdominal pain. The index of satisfaction of the patients was not different between groups (IBS: 8.7 +/- 1.4; Org: 9.1 +/- 1.4; P=0.16). The intensity of abdominal pain was reported in the same range by the patient (IBS: 5.1 +/- 2.9; Org: 4.5 +/- 2.8) and the physician (IBS: 4.6 +/- 2.3; Org: 4.8 +/- 2.6) in both groups. Digestive and extra-digestive symptoms were quoted equally by physicians, whatever the group the patient belonged to. Information given by the physician on diagnosis and therapy were equally well perceived by patients of both groups. However, the physician tended to evaluate the efficacy of the prescribed therapy to be lower in IBS (7.1 +/- 2.0) than in Org patients (8.0 +/- 1.7; P<0.01)., Conclusion: In this study, the consultation with a gastroenterologist is equally well perceived by IBS and Org patients and it seems to meet the expectancy of the patient in most cases. However, the physician appeared less confident in the efficacy of the therapy proposed to IBS patients.

From March to October 1989, 237 French gastroenterologists included 1,301 patients referred for irritable bowel syndrome in a 9-month epidemiological survey based on questionnaires and monthly auto-evaluation. In the patient population, the high preponderance of women (sex ratio: 2.33), the high prevalence of cholecystectomy (9%), appendectomy (53%) and an association with at least one symptom of non-ulcer dyspepsia (70%) were observed. Fifty per cent of the patients completed the 9-month follow-up period; among them, 60% declared an improvement in their symptoms, but only 30% in their quality of life and independently of the clinical course. This study suggests that symptoms and quality of life in patients consulting for irritable bowel syndrome should be taken into account separately, both in daily practice and in therapeutic evaluation.

The importance of colonic motor disorders during the irritable bowel syndrome is recognized, but, paradoxically, their description has yet to be perfected. Among the fundamental questions that remain unanswered, three are of prime importance: a) are there one or more specific disturbances in basal colonic motility? b) can specific motor disorders be induced by certain situations, for instance, during stress? c) is there any real relationship between clinical symptoms and coexisting motor disorders? The answers to these questions are full of ambiguities; this may be explained by the difficulty with which methods of investigation are performed as well as the heterogeneous character of the disorders. Presently, recording colonic myoelectric activity over a 24 hour period or more might prove to be useful in increasing our knowledge on motor disorders. It is not at all certain that a specific basal abnormality exists and the results of the effects of stress vary according to the methods used. Segmental hyperactivity in painful constipation, abnormal colonic response to alimentation in the case of painful bloating, and propulsive hyperactivity with absence or decrease in the "sigmoid brake" during painless diarrhea have been noted on basal motor activity recordings during sleep and after meals. Myoelectric disorders, however, are seen in only two-thirds of patients with intestinal functional disorders. "Sensitivity", personality, or other disorders, and particularly, intestinal disorders, can contribute to explain the pathophysiology of "irritable bowels" in which the role of colonic disorders has yet to be shown.

Fifty-two non-surgical patients presenting rectal carcinoma were treated initially with palliative laser Nd-YAG. Their mean age was 79 years (49-92). Thirty patients had a severe diarrheic syndrome, associated with tenesmus in 27 cases; 20 patients had repeated hematochezia (5 presenting diarrhea as well); 6 had obstructive signs and one was symptom-free. Thirty lesions were less than 6 cm in size, 12 were between 7 and 10 cm and 10 were greater than 10 cm. Twenty-two lesions were circumferential. During the study period, 444 laser sessions were performed (mean 8.5/patient). Bleeding was stopped in all cases during the first session. Improvement of the diarrheic syndrome, obtained in 24 of the 30 patients, was correlated with the reduction of tumor volume. Tenesmus disappeared after 1 or 2 sessions, regardless of whether the tumor was destroyed or not. Failure was observed in 6 patients with lesions larger than 10 cm. Colostomy was avoided in 4 of the 6 obstructed patients. Negative biopsies were repeatedly obtained after mucosal repair in 9 patients with small lesions (less than 6 cm). Mean follow-up is now 8.2 months for the patients still alive. Complications were: 2 cicatricial stenosis and 3 hemorrhages (one required blood transfusion). Laser Nd-YAG allows palliative but conservative and effective treatment for rectal cancers. Although complete destruction is possible for small lesions, indications with curative intent are currently limited to patients with major contraindications to surgery.

The purpose of this randomized study was to compare the effects of two methods of hemostasis--photocoagulation using YAG Neodyme laser and liquid monopolar electrocoagulation--on acute experimental bleeding ulcers created in the dog stomach with an ulcer-maker. One hundred and fifty-three lesions were made and randomized into 3 groups; 51 lesions were treated with photocoagulation and complete hemostasis was achieved in all cases. Hemostasis was obtained in 80 p. 100 of 51 ulcers treated with liquid electrocoagulation. Control untreated ulcers remained hemorrhagic after 45 min of observation. The mean external muscle injury on day 7 was 55 p. 100 after photocoagulation and 65 p. 100 after liquid electrocoagulation. On day 14, mean external injury was 60 p. 100 after photocoagulation and 75 p. 100 after liquid electrocoagulation (non-significant difference). On day 7, the mean re-epithelization index, expressed as the percentage of the original ulcer diameter, ranged from 8 to 10 p. 100 in each trial group. On day 14, reepithelization covered 78 p. 100 of control ulcers and 72 p. 100 of photocoagulated ulcers (NS). This percentage falls to 47 p. 100 in ulcers treated with liquid electrocoagulation (p less than 0.01 when compared with ulcers treated with photocoagulation). Photocoagulation seemed to be more efficient in ensuring hemostasis and external muscle injury was correlated with the energy delivered. External muscle injury could not be controlled by liquid electrocoagulation. However the difference in the percentages of mean external muscle injury between the two methods was not significant. Therefore, in man, the risk of perforation is certainly slight and not very different whatever the method of hemostasis considered.

This multicentric, double-blind and prospective study, which involved 41 French Gastroenterology Units, was designed to evaluate the efficacy and safety of famotidine, 40 mg at bedtime, compared to single dose ranitidine, 300 mg, in promoting the healing of duodenal ulcer. Two hundred and ninety-six patients with endoscopically proven duodenal ulcer were randomly allocated to 2 treatment groups: 148 were treated with famotidine, and 148 with ranitidine. Patients were treated during 4 weeks and then controlled by endoscopy. Unhealed patients at 4 weeks were treated again by the same drug for 2 weeks and then endoscopically controlled. One hundred and nine patients were evaluable in the famotidine group and 111 in the ranitidine group. Groups were well-matched for age, sex, alcohol and smoking habits, and duration of ulcer disease. At 4 weeks of treatment, 86 of the 109 patients treated with famotidine had healed (79 percent) and 74 of the 111 patients treated with ranitidine healed (67 percent). At 6 weeks of treatment, 104 patients had healed in the famotidine group (95 percent) and 101 in the ranitidine group (91 percent). Results were significantly different between the 2 groups at 4 weeks of treatment only (p = 0.039). Among smoking patients, no statistical difference was observed between the 2 groups at 4 and 6 weeks of treatment. By contrast, in non smoking patients, famotidine appeared more effective (83 percent healed) than ranitidine (67 percent) (p = 0.014) at 4 weeks. Both treatments were well tolerated and severe adverse effects were scarcely observed.(ABSTRACT TRUNCATED AT 250 WORDS)