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Stickel F.,University of Bern | Helbling B.,Stadtspital Waid | Heim M.,University of Basel | Geier A.,University of Zürich | And 3 more authors.
Journal of Viral Hepatitis | Year: 2012

Combined pegylated interferon (PegIFN) and ribavirin represents the standard therapy for patients with chronic hepatitis C (CHC), which allows for sustained viral response (SVR) in up to 90% of patients depending on certain viral and host factors. Clinical studies have demonstrated the importance of adherence to therapy, that is, the ability of patients to tolerate and sustain a fully dosed therapy regimen. Adherence is markedly impaired by treatment-related adverse effects. In particular, haemolytic anaemia often requires dose reduction or termination of ribavirin treatment, which compromises treatment efficacy. Recent evidence points to a beneficial role of recombinant erythropoietin (EPO) in alleviating ribavirin-induced anaemia thereby improving quality of life, enabling higher ribavirin dosage and consequently improving SVR. However, no general consensus exists regarding the use of EPO for specific indications: its optimal dosing, treatment benefits and potential risks or cost efficiency. The Swiss Association for the Study of the Liver (SASL) has therefore organized an expert meeting to critically review and discuss the current evidence and to phrase recommendations for clinical practice. A consensus was reached recommending the use of EPO for patients infected with viral genotype 1 developing significant anaemia below 100 g/L haemoglobin and a haematocrit of <30% during standard therapy to improve quality of life and sustain optimal ribavirin dose. However, the evidence supporting its use in patients with pre-existing anaemia, non-1 viral genotypes, a former relapse or nonresponse, liver transplant recipients and cardiovascular or pulmonary disease is considered insufficient. © 2011 Blackwell Publishing Ltd.


Maiss J.,Gastroenterology Clinic | Maiss J.,Friedrich - Alexander - University, Erlangen - Nuremberg | Schwab D.,Martha Maria Hospital | Ludwig A.,Friedrich - Alexander - University, Erlangen - Nuremberg | And 4 more authors.
Zeitschrift fur Gastroenterologie | Year: 2010

Objective: Peptic ulcers are the leading cause of upper gastrointestinal (GI) bleeding. The aim of this study was the evaluation of the recent clinical practice in drug therapy and endoscopic treatment of ulcer bleedings in Germany and to compare the results with the medical standard. Methods: A structured questionnaire (cross-sectional study) was sent to 1371 German hospitals that provide an emergency service for upper GI bleeding. The project was designed similar to a nationwide inquiry in France in 2001. Forty-four questions concerning the following topics were asked: hospital organisation, organisation of emergency endoscopy service, endoscopic and drug therapy of ulcer bleeding, endoscopic treatment of variceal bleeding. Return of the questionnaires was closed in August 2004. Results: Response rate was 675/1371 (49%). Mean hospitals size was <200 beds, 49% (n = 325) had basic care level. 92% provided a 24-hour endoscopy service, specialized nurses were available in 75%. Fiberscopes were used only in 15%. A mean of 10 ± 12 (range: 0-160) bleeding cases/month were treated, 6 ± 6 cases per month (60%) were ulcer bleedings. Endoscopy was performed in 72% immediately after stabilization but in all cases within 24 hours. The Forrest classification was used in 99% whereas prognostic scores were applied only in 3%. Forrest Ia./Ib/IIa/IIb/IIc/III ulcers were indications for endoscopic therapy in 99%/99%/90%/58%/4%/ 2% respectively. Favoured initial treatment was injection (diluted epinephrine, mean volume 17 ± 13 mL/lesion) followed by clipping. In re-bleedings, 93% tried endoscopic treatment again. Scheduled re-endoscopy was performed in 63%. PPI were used in 99.6%, 85% administered standard dose twice daily. PPI administration was changed from intravenous to oral with the end of fasting in nearly all hospitals. PPI administra. tion schemes can be improved. Indications for Helicobacter pylori eradication followed rational principles. Conclusion: Medical and endoscopic treatment of bleeding ulcers reached a high standard, although some therapeutic strategies leave room for improvement. Bigger hospitals tend to be closer to the medical standard. © Georg Thieme Verlag KG Stuttgart.


Basa N.,Victor Babes University of Medicine and Pharmacy Timisoara | Lazar D.,Gastroenterology Clinic
Studia Universitatis Vasile Goldis Arad, Seria Stiintele Vietii | Year: 2011

The liver represents the most common localization of primary and metastatic hepatic tumors. This paper aims to review hepatic premalignant lesions and the histopathological classification of malignant tumors of the liver, describing the main growth patterns, citoarchitectural features and immunohistochemical profile of epithelial and mesenchymal hepatic tumors. Clinical aspects, differential diagnosis criteria and developmental-prognostic behavior are discussed. © 2011 Vasile Goldis University Press.


PubMed | Pathology Unit, Nihon University, National Cancer Center Hospital, Gastroenterology and Endoscopy Unit and 2 more.
Type: Journal Article | Journal: Gastroenterology report | Year: 2016

Heterotopic gastric mucosa (HGM) is the most reported epithelial heterotopia, but it is very rare in the rectum and anus.The first case of an asymptomatic adult male with a large nonpolypoid HGM in the low rectum underwent complete resection by endoscopic submucosal dissection (ESD) is reported. The systematic review was based on a comprehensive search of MEDLINE, EMBASE and Google Scholar. Studies on humans were identified with the term heterotopic gastric mucosa in the rectum and /or anus.The search identified 79 citations, and 72 cases were evaluated comprising the present report. Congenital malformations were observed in 17 (24%) patients; rectal duplication accounted for most of the cases. The HGM was located in the anus and perineal rectum in 25 cases (41%) and low, middle and proximal pelvic rectum in 20 (33%), five (8%) and 11 cases (18%), respectively. Morphology was nonpolypoid in 37 cases (51%), polypoid in 26 cases (36%) and ulcerated in nine cases (13%). Specific anorectal symptoms were reported by 50 (69%) patients of the whole study population, and by 33 (97%) of 34 patients 18 years. Complications were observed in 23 cases (32%). The HGM was excised in 50 cases (83%). Endoscopic resection was performed in 17 cases (34%); resection was piecemeal in five of 12 lesions 15mm, required argon plasma coagulation in two cases and was associated with residual tissue in two (17%). Intestinal metaplasia and an adenoma with low-grade dysplasia were described in three adults (4%).This systematic review shows that the HGM in the rectum and anus may be associated with specific rectal symptoms and serious complications, mainly in the pediatric population, and a risk of malignancy in adults. Its complete excision should be recommended, and the ESD can overcome the technical limits of conventional endoscopic snare resection and avoid unnecessary surgery.


Cohen H.,Gastroenterology Clinic | Saenz R.,University for Development | de Almeida Troncon L.E.,University of Sao Paulo | Lizarzabal M.,University of Zulia | Olano C.,Gastroenterology Clinic
World Journal of Gastroenterology | Year: 2011

Latin America is characterized by ethnic, geographical, cultural, and economic diversity; therefore, training in gastroenterology in the region must be considered in this context. The continent's medical education is characterized by a lack of standards and the volume of research continues to be relatively small. There is a multiplicity ofevents in general gastroenterology and in sub-disciplines, both at regional and local levels, which ensure that many colleagues have access to information. Medical education programs must be based on a clinical vision and be considered in close contact with the patients. The programs should be properly supervised, appropriately defined, and evaluated on a regular basis. The disparity between the patients' needs, the scarce resources available, and the pressures exerted by the health systems on doctors are frequent cited by those complaining of poor professionalism. Teaching development can play a critical role in ensuring the quality of teaching and learning in universities. Continuing professional development programs activities must be planned on the basis of the doctors' needs, with clearly defined objectives and using proper learning methodologies designed for adults. They must be evaluated and accredited by a competent body, so that they may become the basis of a professional regulatory system. The specialty has made progress in the last decades, offering doctors various possibilities for professional development. The world gastroenterology organization has contributed to the speciality through three distinctive, but closely inter-related, programs: Training Centers, Train-the-Trainers, and Global Guidelines, in which Latin America is deeply involved. © 2011 Baishideng. All rights reserved.


Villa E.,University of Modena and Reggio Emilia | Fattovich G.,Gastroenterology Clinic
Journal of Hepatology | Year: 2010

COMMENTARY ON:. Clearance of Hepatitis B Surface Antigen and Risk of Hepatocellular Carcinoma in a cohort Chronically Infected with Hepatitis B Virus. Simonetti J, Bulkow L, McMahon BJ, Homan C, Snowball M, Negus S, Williams J, Livingston SE. Hepatology. 2009 Nov 30. [Epub ahead of print]. Copyright 2009. Reprinted with permission of John Wiley and Sons, Inc. Abstract: Some individuals who are chronically infected with hepatitis B virus (HBV) eventually lose hepatitis B surface antigen (HBsAg). Hepatocellular carcinoma (HCC) has been demonstrated to occur in a few patients after loss of HBsAg. Neither factors associated with loss of HBsAg nor the incidence of HCC thereafter have been clearly elucidated. We performed a prospective population-based cohort study in 1271 Alaska native persons with chronic HBV infection followed for an average of 19.6 years to determine factors associated with loss of HBsAg and risk of developing HCC thereafter. HBsAg loss occurred in 158 persons for a rate of HBsAg clearance of 0.7%/year. Older age, but not sex, was associated with clearance of HBsAg, and loss of HBsAg was not associated with any particular HBV genotypes (A-D, and F) found in this population. Participants were followed for an average of 108.9 months after HBsAg loss. Six patients, two with cirrhosis and four without, developed HCC a mean of 7.3 years after HBsAg clearance (range, 2.0-15.5 years). The incidence of HCC after clearance of HBsAg was 36.8 per 100,000 per year (95% CI 13.5-80.0) which was significantly lower than the rate in those who remained HBsAg-positive (195.7 cases per 100,000 person-years of follow-up [95% CI 141.1-264.5; P < 0.001). After loss of HBsAg, HBV DNA was detected in the sera of 28 (18%) of those who cleared a median of 3.6 years after clearance. Conclusion: HCC can occur in persons with chronic hepatitis B who have lost HBsAg, even in the absence of cirrhosis. These persons should still be followed with periodic liver ultrasound to detect HCC early. © 2010 European Association for the Study of the Liver.


Dabritz J.,University of Munster | Dabritz J.,The Interdisciplinary Center | Dabritz J.,Murdoch Childrens Research Institute | Langhorst J.,Internal and Integrative Medicine | And 7 more authors.
Inflammatory Bowel Diseases | Year: 2013

Background: Prediction of inflammatory bowel disease relapse has important implications for therapeutic strategies. Fecal S100A12 has been reported as a novel marker of intestinal inflammation. The objective was to investigate the utility of S100A12 as a marker for the confirmation of stable remission and prediction of relapses. Methods: We consecutively included 147 adults and 34 children with Crohn's disease (n = 61) or ulcerative colitis (n = 120). Over a 3-year period, we collected 686 stool samples and 861 serum samples during regular follow-up visits. S100A12 and calprotectin levels were measured by an enzyme-linked immunoassay. Results: Fecal S100A12 correlated with S100A12 serum levels, other laboratory markers, as well as disease activity, location, and behavior. Fecal S100A12 levels in the relapse group differed significantly from those of the nonrelapse group. A baseline fecal S100A12 level of >0.5 mg/kg was significantly associated with disease relapse within 18 months. Time course analysis of fecal S100A12 before and after relapse showed a clear increase of S100A12 concentrations up to 6 months before clinical relapse. At 0.43 mg/kg, the sensitivity and specificity of S100A12 for predicting relapse already 8 to 12 weeks earlier were 70% and 83%, respectively. Conclusions: Regular measurements of fecal S100A12 levels reliably detect inflammatory bowel disease relapse at an early stage, which makes the test a promising noninvasive tool for monitoring and optimizing therapy, and may reduce the need for invasive investigations during disease follow-up. Copyright ©; 2013 Crohn's & Colitis Foundation of America, Inc.


Cornianu M.,U.M.F | Dema A.,U.M.F | Taban S.,U.M.F | Lazar D.,Gastroenterology Clinic | And 7 more authors.
Studia Universitatis Vasile Goldis Arad, Seria Stiintele Vietii | Year: 2011

Introduction: Hepatic bile duct lesions (BDL), lymphoid aggregates or lymphoid follicles (LA/LF) and hepatic steatosis (HS) are common histological features, often observed in patients with chronic hepatitis C (VHC). The pathogenesis and clinical significance of hepatic BDL remain unclear. Material and method: We evaluated the prevalence and clinical significance of BDL on a group of 189 liver biopsies from patients with chronic viral hepatitis (125 patients with VHC and 64 with VHB), trying therewith to compare clinical, biochemical and morphologic data in patients with and without BDL. Results: The mean age of patients with BDL was 50.5 years, slightly higher than the one of patients without BDL (48.61 years). Analyzing the frequency and pathological significance of BDL and portal lymphocyte infiltrate in patients with VHC we noted: a higher frequency of BDL in patients with VHC than in those with VHB (55/125; 44% vs.14/64; 21.8%); a high level of serum alanin-aminotransferase (ALT) (93.83 U/l), alkaline phosphatase (AP) (175.83 U/l) and gamma-glutamil-transpeptidase (gGTP) (99.76 U/l) in patients with BDL vs. 71.73 U/l, 146.76U/l and 71.24 U/l, respectively, in those without these kind of lesions; serum triglyceride (TG), cholinesterase (CHE) and total bilirubin (TB) levels were found to be significantly higher in patients without BDL. We did not observe a relationship between the sex of the patients and the presence of blood transfusions in their history, between the two groups of patients. For the group of patients with VHC and BDL we observed a higher score of necroinflammation (9.87 vs. 7.38), portal inflammation (3.01 vs. 2.44) and fibrosis (1.65 vs. 0.97) and a higher frequency of LA/LF (49 vs. 36), as compared to patients without BDL. HS was found in 96 from the 125 (76.8%) patients with VHC, in 44 from 55 (80%) patients with BDL and in 52 from 70 (74.3%) of those without BDL. Conclusion: The incidence of hepatic BDL is highly related to the severity of the histopathological lesions, being higher in patients with advanced liver disease and cholestasis. The implication and molecular role of hepatitis C virus in the pathogenesis of BDL requires further studies. © 2011 Vasile Goldis University Press.


Papamichael K.,Gastroenterology Clinic | Archavlis E.,Gastroenterology Clinic | Lariou C.,Evangelismos Hospital | Tsigka A.,Evangelismos Hospital | Mantzaris G.J.,Gastroenterology Clinic
European Journal of Gastroenterology and Hepatology | Year: 2012

Granular cell tumour (or Abrikossoff's tumour) was first described by Abrikossoff in 1926. This is a rare benign neoplasm of unclear histogenesis that is generally believed to be of nerve sheath origin. Usually, it presents as a solitary lesion, located mainly in the subcutaneous tissue of the head, or the neck, or in the oral cavity, such as a tongue lesion, although it may develop anywhere in the body. Approximately 1-2% of granular cell tumours are malignant. Granular cell tumours are extremely rare in patients with inflammatory bowel disease. To the best of our knowledge, granular cell tumours have never been reported in association either with Crohn's disease or scheduled infliximab treatment. Herein, we report a case of a granular cell tumour that presented as a subcutaneous skin nodule of the right lumbar area without any associated local or systemic symptoms in a 41-year-old woman with Crohn's disease who was receiving scheduled treatment with infliximab (5 mg/kg every 8 weeks) for 7 years. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


PubMed | Gastroenterology Clinic
Type: Case Reports | Journal: European journal of gastroenterology & hepatology | Year: 2012

Granular cell tumour (or Abrikossoffs tumour) was first described by Abrikossoff in 1926. This is a rare benign neoplasm of unclear histogenesis that is generally believed to be of nerve sheath origin. Usually, it presents as a solitary lesion, located mainly in the subcutaneous tissue of the head, or the neck, or in the oral cavity, such as a tongue lesion, although it may develop anywhere in the body. Approximately 1-2% of granular cell tumours are malignant. Granular cell tumours are extremely rare in patients with inflammatory bowel disease. To the best of our knowledge, granular cell tumours have never been reported in association either with Crohns disease or scheduled infliximab treatment. Herein, we report a case of a granular cell tumour that presented as a subcutaneous skin nodule of the right lumbar area without any associated local or systemic symptoms in a 41-year-old woman with Crohns disease who was receiving scheduled treatment with infliximab (5 mg/kg every 8 weeks) for 7 years.

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