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1. Belgian consensus on irritable bowel syndrome

Author

Kindt, S, Louis, H, Deschepper, H, Arts, J, Caenepeel, P, De Looze, D, Gerkens, A, Holvoet, T, Latour, P, Mahler, T, Mokaddem, F, Nullens, S, Piessevaux, H, Poortmans, P, Rasschaert, G, Surmont, M, Vafa, H, Van Malderen, K, Vanuytsel, T, Wuestenberghs, Fabien, Tack, J, Kindt, S., Louis, H., De Schepper, H., Arts, J., CAENEPEEL, Philip, De Looze, D., Gerkens, A., Holvoet, T., Latour , P., Mahler, T., Mokaddem, F., Nullens, S., Piessevaux, H., Poortmans , P., Rasschaert, G., Surmont, M., Vafa, H., Van Malderen, K., Vanuytsel, T., Wuestenberghs, F., Tack, J., Clinical sciences, Gastroenterology, Pediatrics, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, and UCL - (MGD) Service de gastro-entérologie

Subjects
Diarrhea, irritable bowel syndrome, Consensus, Science & Technology, Gastroenterology & Hepatology, treatment, diagnosis, review, BILE-ACID MALABSORPTION, PLACEBO-CONTROLLED TRIAL, CHRONIC CONSTIPATION, OPEN-LABEL, CLINICAL-TRIAL, Delphi consensus, DOUBLE-BLIND, Belgium, ABDOMINAL-PAIN, FECAL MICROBIOTA TRANSPLANTATION, Humans, FUNCTIONAL GASTROINTESTINAL DISORDERS, Human medicine, Constipation, Life Sciences & Biomedicine, CELIAC GLUTEN SENSITIVITY
Abstract

BACKGROUND: Irritable bowel syndrome (IBS) is characterised by recurrent abdominal pain related to defaecation or associated with altered stool frequency or consistency. Despite its prevalence, major uncertainties in the diagnostic and therapeutic management persist in clinical practice. METHODS: A Delphi consensus was conducted by 20 experts from Belgium, and consisted of literature review and voting process on 78 statements. Grading of recommendations, assessment, development and evaluation criteria were applied to evaluate the quality of evidence. Consensus was defined as > 80 % agreement. RESULTS: Consensus was reached for 50 statements. The Belgian consensus agreed as to the multifactorial aetiology of IBS. According to the consensus abdominal discomfort also represents a cardinal symptom, while bloating and abdominal distension often coexist. IBS needs subtyping based on stool pattern. The importance of a positive diagnosis, relying on history and clinical examination is underlined, while additional testing should remain limited, except when alarm features are present. Explanation of IBS represents a crucial part of patient management. Lifestyle modification, spasmolytics and water-solube fibres are considered first-line agents. The low FODMAP diet, selected probiotics, cognitive behavioural therapy and specific treatments targeting diarrhoea and constipation are considered appropriate. There is a consensus to restrict faecal microbiota transplantation and gluten-free diet, while other treatments are strongly discouraged. CONCLUSIONS: A panel of Belgian gastroenterologists summarised the current evidence on the aetiology, symptoms, diagnosis and treatment of IBS with attention for the specificities of the Belgian healthcare system. ispartof: ACTA GASTRO-ENTEROLOGICA BELGICA vol:85 issue:2 pages:360-382 ispartof: location:Belgium status: accepted

Published
2022

2. Belgian consensus on irritable bowel syndrome.

Author

UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - (MGD) Service de gastro-entérologie, Kindt, S, Louis, H, Deschepper, H, Arts, J, Caenepeel, P, De Looze, D, Gerkens, A, Holvoet, T, Latour, P, Mahler, T, Mokaddem, F, Nullens, S, Piessevaux, H, Poortmans, P, Rasschaert, G, Surmont, M, Vafa, H, Van Malderen, K, Vanuytsel, T, Wuestenberghs, Fabien, Tack, J, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - (MGD) Service de gastro-entérologie, Kindt, S, Louis, H, Deschepper, H, Arts, J, Caenepeel, P, De Looze, D, Gerkens, A, Holvoet, T, Latour, P, Mahler, T, Mokaddem, F, Nullens, S, Piessevaux, H, Poortmans, P, Rasschaert, G, Surmont, M, Vafa, H, Van Malderen, K, Vanuytsel, T, Wuestenberghs, Fabien, and Tack, J

Abstract

Irritable bowel syndrome (IBS) is characterised by recurrent abdominal pain related to defaecation or associated with altered stool frequency or consistency. Despite its prevalence, major uncertainties in the diagnostic and therapeutic management persist in clinical practice. A Delphi consensus was conducted by 20 experts from Belgium, and consisted of literature review and voting process on 78 statements. Grading of recommendations, assessment, development and evaluation criteria were applied to evaluate the quality of evidence. Consensus was defined as > 80 % agreement. Consensus was reached for 50 statements. The Belgian consensus agreed as to the multifactorial aetiology of IBS. According to the consensus abdominal discomfort also represents a cardinal symptom, while bloating and abdominal distension often coexist. IBS needs subtyping based on stool pattern. The importance of a positive diagnosis, relying on history and clinical examination is underlined, while additional testing should remain limited, except when alarm features are present. Explanation of IBS represents a crucial part of patient management. Lifestyle modification, spasmolytics and water-solube fibres are considered first-line agents. The low FODMAP diet, selected probiotics, cognitive behavioural therapy and specific treatments targeting diarrhoea and constipation are considered appropriate. There is a consensus to restrict faecal microbiota transplantation and gluten-free diet, while other treatments are strongly discouraged. A panel of Belgian gastroenterologists summarised the current evidence on the aetiology, symptoms, diagnosis and treatment of IBS with attention for the specificities of the Belgian healthcare system.

Published
2022

5. Clinical and scientific aspects related to biosimilars in Inflammatory Bowel Diseases (IBD): Position document of the Belgian IBD Research & Development Group (BIRD)

Author

Vermeire, S., Louis, E., Dewit, O., Franchimont, D., Moreels, T., Ferrante, M., Rahier, J. -F, Hootegem, P., Vos, M., Mana, F., Baert, F., Belgian Ibd Research And Development (Bird) Group, Amininejad, L., Patrick Bontems, Bossuy, T. P., Buy Dens, P., Caenepeel, P., Cajot, O., Claessens, C., Coche, J. -C, Coenegrachts, J. -L, Colard, A., Maeyer, M., Reuck, M., Suray, N., Vroey, B., Degreef, E., Delen, S., Denis, M. -A, Dewit, S., D’heygere, F., Dutre, J., Fiasse, R., Fontaine, F., Hindryckx, P., Humblet, E., Ilegems, S., Lambrecht, G., Lammens, P., Macken, E., Maisin, J. -M, Mokaddem, F., Muls, V., Ngassa, M., Noman, M., Peeters, H., Potvin, P., Reenaers, C., Schapira, M., Schoofs, N., Sermeus, A., Smets, F., Staessen, D., Strubbe, B., Terriere, L., Thienpont, C., Vafa, H., Assche, G., Biervliet, S., Mierop, F., Gossum, A., Hoo Tegem, P., Kemseke, C., Moerkerke, W., Dermeulen, L., Dervoort, J., Poucke, H., and Veereman, G.

8. Pancreatic tuberculosis diagnosed by EUS: one disease, many faces.

Author

Vafa H, Arvanitakis M, Matos C, Demetter P, Eisendrath P, Toussaint E, Hittelet AB, Deviere J, and Delhaye M

Subjects
Adolescent, Adult, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Pancreatic Cyst diagnosis, Pancreatic Diseases diagnosis, Pancreatic Neoplasms diagnosis, Tuberculosis diagnosis, Young Adult, Endoscopic Ultrasound-Guided Fine Needle Aspiration methods, Pancreas pathology, Pancreatic Diseases pathology, Tuberculosis pathology
Abstract

Context: Pancreatic/para-pancreatic tuberculosis is an extremely rare clinical entity even in endemic regions. It can present as a cystic or solid pancreatic mass mimicking pancreatic malignancy. There are no specific imaging criteria and the clinical symptoms remain vague. Therefore, most cases are diagnosed after surgical exploration for presumed pancreatic neoplasia., Case Report: We report five cases of pancreatic tuberculosis each time with a different clinical presentation, in an occidental country setting where the diagnosis was done by EUS guided FNA (EUS-FNA)., Conclusion: EUS-FNA is a safe and promising technique for the diagnosis of pancreatic/para-pancreatic tuberculosis, avoiding unnecessary surgery.

Published
2013
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9. Lessons from a 20 year experience of Home Parenteral Nutrition in adult patients.

Author

Vafa H, Ballarin A, Arvanitakis M, Vereecken S, Dutat F, Lagasse C, Lievin V, and Van Gossum A

Subjects
Adult, Female, Humans, Intestinal Diseases therapy, Male, Middle Aged, Neoplasms therapy, Parenteral Nutrition, Home adverse effects
Abstract

Background: Home Parenteral Nutrition (HPN) is a method commonly used in patients with Chronic Intestinal Failure (CII) related to benign or malignant diseases. We report the experience from a 20 year programme of HPN in a single academic centre., Methods: In this study, we have reviewed characteristics and outcome of a group of patients enrolled in a HPN program between 1987 and 2007. Focus was given to the prevalence and severity of cholestasis in these patients as well as on their oral food behaviour., Results: In 20 years, 125 patients were included in a HPN programme; 65 patients had benign diseases (BD) and 60 advanced cancer (AC). Short bowel was the most common indications in patients with BD. Almost 40% of patients with BD were weaned off HPN. Median survival was excellent in BD patients and extremely short in AC. Death related to HPN was very rare. Cholestasis has been observed in 84% of patients but it was mild to moderate in the majority of cases. Hyperphagia was observed in 50% of the patients with BD on long-term HPN., Conclusions: This study confirms that HPN is the first line therapy in CII due to BD. Patients with AC should be carefully selected. Cholestasis is frequent but mostly without clinical impact. Half of the patients with CII due to BD become hyperphagic allowing to reduction of parenteral intake. The role of a multidisciplinary nutrition support team is essential for optimizing HPN.

Published
2010

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