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The finding of a terminal ileitis after kidney transplantation can cause a diagnostic challenge. Because the development of Crohn's disease under immunosuppressive therapy is unlikely, this diagnosis should only be considered after exclusion of infectious disease and drug-related intestinal toxicity. Defining the underlying cause of terminal ileitis is often hampered by a shortage of specific diagnostic tests or their lack of sensitivity. We present three patients with terminal ileitis after kidney transplantation resulting from different etiologies. Subsequently, we describe the characteristics that can help to make the differential diagnosis.

We present a case of a 41-year-old woman with severe abdominal pain caused by two jejuno-jejunal intussusceptions. Further investigation showed coeliac disease as the underlying cause. The patient recovered rapidly on a gluten-free diet. So coeliac disease could be the underlying cause of idiopathic intussusception more often than previously thought and intussusception should be suspected in patients with known coeliac disease presenting with abdominal pain. (Acta gastro-enterol. belg., 2016, 79, 000-000).

Diverticulosis of the colon is a common disease with an increasing incidence in Western countries. Recent literature has shown some changes in the traditional approach of this disease. The theory that diverticulosis is caused by a reduced intake of dietary fibre, is doubtful. There might be some chemical and histological overlap between diverticulitis, inflammatory bowel disease and irritable bowel disease. High quality clinical study found no effect for antibiotics in acute, uncomplicated diverticulitis. Cyclic administration of mesalazine and rifaximin result in reduced symptoms of diverticular disease. For the treatment of diverticular abscesses, percutaneous drainage shows promising results. Recurrence of acute diverticulitis is rare and most serious complications are linked to the first episode. Recent evidence does not support the traditional recommendation for elective surgery after two episodes of acute diverticulitis any more. This review summarizes the last evidence in diverticular disease and diverticulitis.

Distal intestinal obstruction syndrome (DIOS) - the incomplete of complete intestinal obstruction by intestinal contents in the terminal ileum and proximal colon- is frequently seen in cystic fibrosis (CF) patients. Diagnosis is based on suggestive symptoms of abdominal pain in the right lower quadrant, a palpable mass on examination and signs of obstruction on plain radiography. Treatment consists of intensive laxative treatment with oral laxatives and enemas. Surgery only serves as the last resort for patients not responding to medical therapy, because of the well-known high rate of peri- and postoperative morbidity of surgery in CF patients. In this article we present 3 cases of DIOS, followed by a review of the relevant literature.

Reflux into the esophagus after partial or total gastrectomy is a well known problem. Even a Roux-en-Y reconstruction is not always a definitive solution. Bile reflux might occur and cause disabling symptoms, unresponsive to the classic anti-acid or anti-reflux therapy. Endoscopy and a Tc-99m-BrIDA hepatobiliary (HIDA) scan can be used to make the diagnosis. Clinical studies have shown that lanreotide (somatuline), which strongly inhibits many gastro-intestinal hormones, reduces the bile salts outputs. We present a case of a patient with bile reflux after Roux-en-Y. After administration of lanreotide he had a good clinical improvement and mucosal healing on endoscopy. Lanreotide can be a good treatment option for bile reflux when classic treatment fails, but clinical trials with more patients will have to confirm this.

Crohn's disease is often accompanied by extraintestinal inflammation. Acute pancreatitis can be a rare manifestation of Crohn's disease. The present report describes a patient who developed two episodes of pancreatitis before the diagnosis of Crohn's disease. Clinical and laboratory evaluation excluded other causes of pancreatitis, confirming a direct association of the pancreatitis with Crohn's disease. This case report supports the hypothesis that acute pancreatitis may precede the clinical manifestations and diagnosis of the underlying inflammatory bowel disease.

Acid peptic diseases such as peptic ulcer and gastrointestinal reflux disease have a high prevalence; they can have an important impact on the patient's quality of life and generate a considerable health care cost. Proton pump inhibitors are the most potent pharmacological inhibitors of gastric acid secretion currently available and are the mainstay medical therapy for acid peptic diseases. This review provides primary care clinicians with best practice guidelines for optimal use of these drugs.

OBJECTIVE: Estimation of prevalence and risk factors for Helicobacter pylori (H. pylori) infection in children and young adults in Belgium. STUDY DESIGN: Five hundred and sixteen schoolchildren between 12 and 25 years old were tested for H. pylori infection using 13C-UBT in different regions in Belgium. A questionnaire was used to evaluate risk factors. RESULTS: Fifty six (11%) tested positive. In children born in Belgium, with parents from Belgium, 13 (3,2%) tested positive. In children born in a foreign country, 20 (60%) tested positive; if born in Belgium but 1 or 2 parents were from a foreign country, 15 (30%) tested positive. Differences were significant (p

Heartburn, reflux and epigastric pain are frequently encountered symptoms in primary care medicine. Acid peptic diseases such as peptic ulcer and gastrointestinal reflux disease have a high prevalence, can have important impact on patient quality of life and represent a considerable health care cost. Proton pump inhibitors (PPIs) are the most potent pharmacological inhibitors of gastric acid secretion currently available and are the mainstay medical therapy for acid peptic diseases. This review summarizes current evidence on treatment of acid-peptic diseases with proton pump inhibitors and provides primary care clinicians with best practice guidelines for optimal use of these drugs.

L'intensification et la diversification des systèmes de culture rizicole et maraîchère dans les bas-fonds contribuent à la sécurité alimentaire et à la génération de revenus substantiels. Les principaux problèmes de l'utilisation durable des bas-fonds sont liés à la dégradation des ressources naturelles et à la pollution accrue associée à la croissance démographique, aux parasites et aux maladies des végétaux, ainsi qu'au faible accès au marché des intrants et des produits pour l'intensification. L'intensification des systèmes d'exploitation agricole dans les bas-fonds nécessitera la promotion d'un système de chaînes de produits à forte valeur, comprenant notamment le riz et les cultures maraîchères, à productivité accrue et à faible coût unitaire de production et des ressources naturelles. Le Projet du Centre du riz pour l'Afrique mentionné ici s'inscrit parfaitement dans le présent cadre de promotion des chaînes de valeur rizicole et maraîchère, tout en assurant la protection des ressources naturelles. La présente étude a identifié des systèmes de production, évalué leurs limites et analysé la rentabilité des meilleurs systèmes de culture du riz et des cultures maraîchères. Un échantillon de 235 producteurs a été sélectionné au Bénin et au Mali, en fonction de l'utilisation d'intrants et de l'accès aux marchés des produits. Quatre principaux acteurs de la chaîne des valeurs interviennent dans les bas-fonds : les producteurs, les transformateurs, les commerçants et les consommateurs. La présente étude met l'accent sur les producteurs. Les principales contraintes signalées par les planteurs sont des attaques d'insectes et d'oiseaux, le faible accès aux marchés des produits et la non disponibilité des principaux facteurs de production (semences, pesticides, petit matériel) dans les deux pays. D'autres contraintes sont liées aux coûts élevés du transport, aux pertes post-récolte et à la mauvaise conservation des cultures maraîchères et des tubercules frais. Les systèmes les plus rentables dans les bas-fonds sont ceux basés sur le riz et une culture maraîchère (gboma, une espèce du Solanum) utilisant des semences améliorées, suivis du système comportant le riz et le gboma utilisant des variétés améliorées de riz telles que le NERICA, plus des engrais chimiques et des herbicides. Le riz associé à des variétés améliorées de pommes de terre et des engrais chimiques était plus rentable au Mali. La monoculture du riz n'est pas rentable au Bénin, surtout à Vovokanmey. Les femmes pratiquent davantage la monoculture du riz au Mali..

Wireless video-endoscopy of the small bowel is a relatively new diagnostic tool with only limited paediatric experience. We report our observations in 2 children. The capsule was easily swallowed and passed uneventful through the digestive tract of a child with unexplained anaemia not older than 5 years, although the literature mentions 10 years as minimal age. In a second child, 8 years old, with recurrent episodes of acute abdominal pain, the capsule confirmed an ileo-ileal intussusception. The absence of any exposure to radiation and the non-invasive character of this technique render it of extreme interest for paediatric use. Unfortunately, the Belgian social security does not yet reimburse it. Further investigations will be needed to evaluate if video-endoscopy may replace contrast radiological examinations in children with unexplained small bowel disease.

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BACKGROUND: A new type of saline-filled, spherical-shaped balloon, which moves freely within the stomach, has been increasingly used as a tool to assist weight reduction. Balloon intolerance is an infrequent complication, characterized by continuous nausea and vomiting or abdominal pain, uncontrollable by medical therapy. This has usually been followed by puncture, deflation and extraction of the balloon. METHODS AND RESULTS: We present 4 patients in whom intolerance was treated by endoscopic volume adjustment of the device. After partial defilling of the balloon, epigastric symptoms disappeared rapidly, while the patients respectively lost 5.2, 14.4, 5.9 and 15.8 kg of body weight at the end of the treatment. Practical recommendations are provided to ensure a successful endoscopic reintubation of the balloon's valve. CONCLUSION: Early intolerance to an intragastric balloon can be successfully treated by endoscopic volume adjustment of the device.