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Background Serum gamma-glutamyltransferase (GGT) activity is a sensitive but non-specific marker of non-alcoholic fatty liver disease (NAFLD). Recently, four GGT fractions (big-, medium-, small-, free-GGT) were described in humans. Aim We aimed to investigate whether a specific GGT fraction pattern is associated with NAFLD. Methods Gamma-glutamyltransferase fractions were determined in patients with NAFLD (n = 90), and compared with those in control subjects (n = 70), and chronic hepatitis C (CHC, n = 45) age and gender matched. Results Total GGT was elevated in NAFLD as compared to controls (median, 25°–75°percentile: 39.4, 20.0–82.0 U/L vs. 18.4, 13.2–24.9 U/L respectively, P

Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry. Future studies are required of these techniques to evaluate their diagnostic accuracy and usefulness, although the available data are promising.

INTRODUCTION Although in CD mucosal healing is regarded as a major therapeutic end-point, the mere mucosal examination can underestimate disease activity in a tipically transmural disease. A reliable assessment of parietal inflammation should be part of the diagnostic work up and, if regularly performed during treatment, it could contribute to evaluate the therapeutic response and to decide if and when to stop therapy Contrast Enhaced Ultrasound (CEUS) is a promising, non invasive tool which is able to quantify the gut wall inflammation allowing a more accurate assessment of disease activity in CD patients AIMS The aim of the study was to evaluate if CEUS is a useful tool to quantify the variation of parietal inflammation in patients with small bowel CD before and after therapy PATIENTS AND METHODS Fifteen CD patients (6 males, 9 females; mean age 38 yrs) with luminal disease confined to terminal ileum (L1B1 sec. Montreal classification) on maintenance therapy with biologics underwent clinical (CDAI), biological (serology and faecal markers) and CEUS assessment before and 12 months after starting therapy. Bowel wall thickness (BWT) was measured in all patients and quantification of wall gut inflammation was obtained by applying a digital image processing software based on Sun-Java and released in public domain (Image J). The analysis of intensity light was performed within particular Region of Interest (ROI) drawn by the operator within the ileum avoiding perivisceral structures. Time-signal intensity curves were processed and maximum enhancement (ME) was analyzed. Statistical analysis was performed by using Wilcoxon's signed rank test and Spearman's rank correlation coefficient. RESULTS All patients were in clinical remission after 12 months of therapy. Overall results (mean+/-SD) are shown in table 1 A significant correlation was found between ME and CDAI (r=0.73 p=0.004), PCR (r=0.69 p=0.007), Faecal calprotectin (r= 0.54 p=0.044). CONCLUSION In small bowel CD, CEUS may be a helpful non-invasive procedure to quantify the transmural inflammation and to follow the inflammatory process during therapy Table 1

Background/Aims: Gastroesophageal reflux (GER) and subsequent aspiration events are hypothesized to be potential contributors to chronic allograft dysfunction in lung transplant recipients. There are limited data on changes in GER or esophageal motility post-transplantation. We hypothesized that patients who had undergone lung transplantation would be predisposed to increased reflux events. Methods: Prospective comparative series of 19 pretransplant patients (47% female) and 13 post-transplant patients (23% female) being evaluated for GER. All patients were on regular acid suppression. After informed consent, patients filled out a detailed GER symptom questionnaire. Thereafter, both groups underwent esophageal manometry and 24hour catheter pH monitoring. Results: Mean age was similar between groups (Pre: 55yrs, 95% CI: 49-60; Post: 53yrs, 95% CI: 47-58. p= 0.65) . Cause of lung disease was also similar between groups (interstitial lung disease: 9/19 patients pre, 4/13 post. COPD: 7/19 patients pre, 4/13 post). No differences in esophageal manometry, including baseline lower esophageal sphincter (LES) pressures (Pre-transplantation: 12.5 mmHg, 95% CI: 9.5-16.0. Post transplant: 9.0, 95% CI: 5.0-12.9. p=0.13) and percent LES relaxation (Pre-transplant: 76%, 95% CI: 63-88. Post transplant: 70%, 95% CI: 58-83, p= 0.28) were observed between the two groups. Patients post-lung transplantation had a significantly increased total time spent in reflux over the 24 hour study period, as well as a significantly increased number of reflux episodes over five minutes (Table). There was a trend towards an increase in the DeMeester score in patients post-lung transplantation. Conclusion: This hypothesis-generating study suggests that post-lung transplant patients have more prolonged reflux episodes and total time spent in reflux compared to pretransplant candidates, via a mechanism independent of altered esophageal motility.