Scandinavian journal of gastroenterology. Supplement最新文献

{"title":"Novel approaches in the outpatient care of patients with chronic inflammatory bowel disease.","authors":"H M van Dullemen,&nbsp;J H Kleibeuker","doi":"10.1080/00365520600664268","DOIUrl":"https://doi.org/10.1080/00365520600664268","url":null,"abstract":"<p><p>Treatment strategies for Crohn's disease are targeted toward lifelong management. Optimization of outpatient care is mandatory, because of many clinics facing capacity issues, and, along with routine follow-up of patients with inflammatory bowel disease, is putting increasing pressure on outpatient clinics. Recent studies demonstrate clearly that alternative management strategies are feasible and effective with a high rate of patient satisfaction. It is recommended that future research evaluates the way in which medical care is provided and explores the long-term effects of novel management strategies in IBD. This approach can then be extrapolated to other chronic conditions.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 243","pages":"55-8"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00365520600664268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26188146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Milestone in gastrointestinal endoscopy: double-balloon enteroscopy of the small bowel.","authors":"G D Heine,&nbsp;A Al-Toma,&nbsp;C J J Mulder,&nbsp;M A J M Jacobs","doi":"10.1080/00365520600727792","DOIUrl":"https://doi.org/10.1080/00365520600727792","url":null,"abstract":"<p><p>The small bowel (SB) has been largely bypassed by flexible endoscopy because of inaccessibility. Push enteroscopy is now in the past, with recent innovations now making visualization of the SB possible. Wireless capsule endoscopy (CE) and double-balloon endoscopy (DBE) have been introduced. In this review, we focus on the diagnostic and therapeutic modalities of DBE, which may be a suitable replacement for push enteroscopy, preoperative endoscopy and to some extent of SB fall-through and CT scan. DBE is a new method of endoscopy developed and described by Yamamoto et al. in Jichi, Japan, in cooperation with Fujinon. Introduced to the market in 2003, it is possible with this endoscope to observe the entire SB in steps of 20-40 cm. Measuring the depth of insertion is also possible. Obscure gastrointestinal bleeding can be explained and treated in the majority of cases. Biopsy sampling, hemostasis, polypectomy, dilatation and tattoo are possible in the SB. Guidelines for FAB and Peutz-Jeghers syndrome will probably be reviewed in the next few years. The safety and efficacy of DBE have been demonstrated. DBE improves SB disease management and can substitute for more complex investigations. Additional data will come to light in years to come. Combining DBE with CE, CT/MRI enteroclysis in a new era for SB work-up and treatment is the likely future.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 243","pages":"32-8"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00365520600727792","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26095424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skeletal morbidity in inflammatory bowel disease.","authors":"R A van Hogezand,&nbsp;N A T Hamdy","doi":"10.1080/00365520600664276","DOIUrl":"https://doi.org/10.1080/00365520600664276","url":null,"abstract":"<p><p>Patients with Crohn's disease are at increased risk of developing disturbances in bone and mineral metabolism because of several factors, including the cytokine-mediated nature of the inflammatory bowel disease, the intestinal malabsorption resulting from disease activity or from extensive intestinal resection and the use of glucucorticoids to control disease activity. Inability to achieve peak bone mass when the disease starts in childhood, malnutrition, immobilization, low BMI, smoking and hypogonadism may also play a contributing role in the pathogenesis of bone loss. The relationship between long-term use of glucocorticoids for any disease indication and increased risk for osteoporosis and fractures is well established. However, the relationship between Crohn's disease and ulcerative colitis and bone loss remains controversial. Depending on the population studied the prevalence of osteoporosis has thus been variably reported to range from 12 to 42% in patients with inflammatory bowel disease (IBD). In IBD most studies demonstrate a negative correlation between bone mineral density (BMD) and glucocorticoid use, but not all authors agree on the relationship between long-term glucocorticoid use and continuing bone loss. Whereas prospective studies do suggest sustained bone loss at both trabecular and cortical sites in long-term glucocorticoid users with inflammatory bowel disease, a decrease in bone mass is also observed in patients with active Crohn's disease not using glucocorticoids, and bone loss is not universally observed in patients with Crohn's disease using orally or rectally administered glucocorticoids. Data on vertebral fractures are scarce and there is no agreement about the risk of non-vertebral fractures in patients with Crohn's disease, although it has been suggested that non-vertebral fracture risk may be increased by up to 60% in patients with IBD. A recent publication reports an increased risk of hip fractures in Crohn's disease related to current and cumulative corticosteroid use and use of opiates, although these fractures could not be related to the severity of osteoporosis. The issue of the magnitude of the problem of osteoporosis has become particularly relevant in Crohn's disease, since the ability of therapeutic interventions to beneficially influence skeletal morbidity has been clearly established in patients with osteoporosis, whether post-menopausal women, men or glucocorticoid users. The main question that arises is whether all patients with Crohn's disease should be treated with bone protective agents on the assumption that they all have the potential to develop osteoporosis or whether the use of these agents should be restricted to patients clearly at risk of osteoporosis and fractures, providing these can be identified. We recommend, based on the available literature and our own experience, that all patients with Crohn's disease should be screened for osteoporosis by means of a bone mineral density measurem","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 243","pages":"59-64"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00365520600664276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26095427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biliary complications after liver transplantation: a review.","authors":"Robert C Verdonk,&nbsp;Carlijn I Buis,&nbsp;Robert J Porte,&nbsp;Elizabeth B Haagsma","doi":"10.1080/00365520600664375","DOIUrl":"https://doi.org/10.1080/00365520600664375","url":null,"abstract":"<p><p>After liver transplantation, the prevalence of complications related to the biliary system is 6-35%. In recent years, the diagnosis and treatment of biliary problems has changed markedly. The two standard methods of biliary reconstruction in liver transplant recipients are the duct-to-duct choledochocholedochostomy and the Roux-en-Y-hepaticojejunostomy. Biliary leakage occurs in approximately 5-7% of transplant cases. Leakage from the site of anastomosis, the T-tube exit site and donor or recipient remnant cystic duct is well described. Symptomatic bile leakage should be treated by stenting of the duct by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTCD). Biliary strictures can occur at the site of the anastomosis (anastomotic stricture; AS) or at other locations in the biliary tree (non-anastomotic strictures; NAS). AS occur in 5-10% of cases and are due to fibrotic healing. Treatment by ERCP or PTCD with dilatation and progressive stenting is successful in the majority of cases. NAS can occur in the context of a hepatic artery thrombosis, or with an open hepatic artery (ischaemic type biliary lesions or ITBL). The incidence is 5-10%. NAS has been associated with various types of injury, e.g. macrovascular, microvascular, immunological and cytotoxic injury by bile salts. Treatment can be attempted with multiple sessions of dilatation and stenting of stenotic areas by ERCP or PTCD. In cases of localized diseased and good graft function, biliary reconstructive surgery is useful. However, a significant number of patients will need a re-transplant. When biliary strictures or ischaemia of the graft are present, stones, casts and sludge can develop.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 243","pages":"89-101"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00365520600664375","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26096419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of the XXXVII Nordic Meeting of Gastroenterology, 3-5 May 2006, Vasteras, Sweden.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 242","pages":"15-50"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26192823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Argon plasma coagulation for radiation proctitis.","authors":"Jan Dees,&nbsp;Maarten A C Meijssen,&nbsp;Ernst J Kuipers","doi":"10.1080/00365520600664300","DOIUrl":"https://doi.org/10.1080/00365520600664300","url":null,"abstract":"<p><strong>Background: </strong>Rectal blood loss is a common late sequel of radiation proctitis. Teleangiectasias appear in the mucosa in 2-5% of patients after radiotherapy of the pelvis. Since pharmacotherapy is usually not beneficial, local treatment modalities with formalin irrigation, Nd:YAG laser and argon plasma coagulation (APC) have been advocated, but experience is still limited.</p><p><strong>Methods: </strong>Between January 1997 and August 2001, 50 consecutive patients with rectal bleeding due to radiation proctitis were included for treatment with APC. Thirteen patients suffered from anaemia, six of whom required blood transfusion. Nine patients were receiving anticoagulant therapy and 10 patients used low-dose aspirin. APC was performed, applying the no-touch spotting technique at an electrical power of 50 Watt and an argon gas flow of 2.0 l/min. Pulse duration was less than 0.5 s. Treatment sessions were carried out at intervals of 3 weeks.</p><p><strong>Results: </strong>In 47 out of 48 patients (98%) in whom the effect could be assessed, APC led to persistent clinical and endoscopic remission of rectal bleeding after a median of three sessions. One patient developed recurrent blood loss after resuming anticoagulant therapy for his aortic valve prosthesis. No adverse effects were encountered after initial treatment. One serious complication occurred in a patient with recurrent blood loss when he was prescribed aspirin for a transient ischaemic attack 2 years after the initial APC. Re-treatment resulted in a major rectal bleeding from a small ulcer with a visible vessel.</p><p><strong>Conclusions: </strong>APC is a safe, effective and well-tolerated treatment for blood loss due to radiation proctitis. The use of anticoagulants and aspirin seems to be a co-factors that induces bleeding.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 243","pages":"175-8"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00365520600664300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26094145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing the detection of hereditary non-polyposis colorectal cancer: an update.","authors":"J H F M De Bruin,&nbsp;M J L Ligtenberg,&nbsp;F M Nagengast,&nbsp;E M M Adang,&nbsp;J H J M Van Krieken,&nbsp;N Hoogerbrugge","doi":"10.1080/00365520600664508","DOIUrl":"https://doi.org/10.1080/00365520600664508","url":null,"abstract":"<p><p>Hereditary non-polyposis colorectal cancer (HNPCC) is a dominant inherited disease and accounts for up to 5% of all colorectal cancer (CRC) patients. Despite the optimization of selection criteria and enhancements in molecular techniques for identifying more families with HNPCC, most cases are not recognized. Poor patient recollection of family history and inadequate family history-taking are main causative factors. We propose a new strategy for detecting HNPCC, one in which the pathologist selects patients for microsatellite instability (MSI) testing. Criteria for MSI analysis are: (1) CRC before the age of 50 years, (2) second CRC before 70 years, (3) CRC and HNPCC-associated cancer before 70 years, or (4) adenoma before 40 years. Additionally, patients with a positive MSI test and patients with a positive family history are offered referral for genetic counselling. With this strategy, at least twice the number of HNPCC patients will be identified among a population of CRC patients, and in a cost-effective, efficient and feasible way. The identification of patients with HNPCC is important because intensive surveillance can prevent death from CRC.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 243","pages":"146-52"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00365520600664508","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26094141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of positron emission tomography in the (re-)staging of oesophageal cancer.","authors":"Marinke Westerterp,&nbsp;Henderik L Van Westreenen,&nbsp;Gerrit W Sloof,&nbsp;John Th M Plukker,&nbsp;J Jan B Van Lanschot","doi":"10.1080/00365520600664409","DOIUrl":"https://doi.org/10.1080/00365520600664409","url":null,"abstract":"<p><strong>Background: </strong>Various studies have demonstrated that 18F-Fluorodeoxyglucose-positron emission tomography (FDG-PET), measuring altered tissue glucose metabolism, is a promising non-invasive method for detecting both distant nodal and haematogenous metastases in patients with oesophageal carcinoma (OC) and might thus prevent futile esophagectomy. Moreover, FDG-PET is a promising tool in assessing response to non-surgical treatment, and might therefore be used for an early decision on whether treatment should be stopped or continued.</p><p><strong>Material and methods: </strong>Review of the recent literature regarding the diagnostic performance of FDG-PET in the preoperative staging of patients with OC and regarding diagnostic accuracy of FDG-PET in assessing response to neoadjuvant therapy in patients with OC compared to conventional techniques (especially computed tomography (CT) and endoscopic ultrasonography (EUS)).</p><p><strong>Results: </strong>A search of the literature resulted in the inclusion of 16 studies on the diagnostic value of FDG-PET. Sensitivity and specificity for the detection of locoregional metastases were moderate. Sensitivity and specificity were reasonable for distant metastases. The diagnostic accuracy of FDG-PET in assessing response to treatment was similar to the accuracy of EUS, but significantly higher than that of CT.</p><p><strong>Conclusions: </strong>The staging value of FDG-PET in OC patients is limited in the detection of locoregional metastases; however; its value is higher in the detection of distant lymphatic and haematogenous metastases. Moreover, FDG-PET is a valuable tool for the non-invasive assessment of histopathologic tumour response after neoadjuvant therapy..</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 243","pages":"116-22"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00365520600664409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26096421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photodynamic therapy and Klatskin tumour: an overview.","authors":"E A J Rauws","doi":"10.1080/00365520600664441","DOIUrl":"https://doi.org/10.1080/00365520600664441","url":null,"abstract":"<p><p>The prognosis of patients with an unresectable bile duct cancer is poor. In 60-70% of patients, cholangiocarcinoma is located in the hepatic duct bifurcation and known as Klatskin tumour. Surgical resection offers the only chance for 5-year survival, but less than 20% are surgical candidates. Patients with unresectable cholangiocarcinoma are treated with biliary drains, but commonly die of liver failure or cholangitis due to biliary obstruction within 6 to 12 months. Chemotherapy and/or radiotherapy have not been evaluated in randomized, controlled trials. Photodynamic therapy (PDT) is a new and promising locoregional treatment, the aim of which is to destroy tumour cells selectively. PDT involves the injection of a photosensitizer followed by percutaneous or endoscopic direct illumination of the tumour with light of a specific wavelength. In recent non-randomized studies of small numbers of patients with unresectable cholangiocarcinoma, PDT induced a decrease in serum bilirubin levels, improved quality of life and a slightly better survival. Other non-randomized trials failed to show clinical benefits. Recently, the first prospective, randomized controlled study with PDT in a selected group of non-resectable cholangiocarcinoma patients was stopped prematurely. The improvement in survival in the PDT-randomized patients was so impressive that it was considered to be unethical to continue randomization. However, further studies are awaited in unselected patients with unresectable cholangiocarcinoma before PDT can be considered as the standard adjuvant therapy.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 243","pages":"135-8"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00365520600664441","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26096423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endosonography in anorectal disease: an overview.","authors":"R J F Felt-Bersma,&nbsp;M Cazemier","doi":"10.1080/00365520600664292","DOIUrl":"https://doi.org/10.1080/00365520600664292","url":null,"abstract":"<p><p>Anorectal endosonography (AE), which was introduced 20 years ago, derives from the study of urology. It was first used to evaluate rectal tumours and later also to investigate benign disorders of the anal sphincters and pelvic floor. The technique is easy to perform, it has a short learning curve and causes no more discomfort than a routine digital examination. A rotating probe with a 360 degrees radius and a frequency between 5 and 16 MHz is introduced to the rectum and then slowly withdrawn so that the pelvic floor and subsequently the sphincter complex are seen. Recently, it has become possible to reconstruct three-dimensional images. AE has been used for almost every possible disorder in the anal region and has increased our insight into anal pathology. The clinical indications for AE are: 1. Faecal incontinence in patients when surgery is an option. AE can show sphincter defects with excellent precision. There is a perfect correlation with surgical findings. Studies comparing AE with endoanal magnetic resonance imaging (MRI) have shown that both methods are equally good for demonstrating defects in the external anal sphincter; the internal anal sphincter is better visualized with AE. After sphincter repair, the effect is directly related to the decrease in the sphincter defect. 2. Perianal fistulae. AE has been shown to be accurate in staging perianal cryptoglandular fistulae and fistulae in Crohn's disease. When there is an external fistula opening, H2O2 can be introduced with a plastic infusion catheter. The tract then becomes visible as a hyperechoic lesion (\"white\"). It has been shown that this corresponds well with surgical findings. It is equally sensitive as endoanal MRI. Since recurrent cryptoglandular fistulae are complex in 50% and Crohn's fistula in 75%, it is mandatory to perform AE preoperatively in these patients to avoid missed tracts during surgery and subsequent recurrences. 3. Rectal tumors. In low tubulovillous adenomas or malignant polyps considered removable locally, confirming the local resectability (T0 or T1) is mandatory. Although larger rectal and more advanced tumours can be evaluated with AE, MRI is more sensitive in staging nodal involvement. 4. Anal carcinoma for staging. AE has been shown to stage better than the classical TNM classification for both local extension and prognosis. In conclusion, AE images the internal and external anal sphincter with high accuracy. It is easy to perform and is of particular value in the diagnosis of anal incontinence and perianal fistulae. It is excellent in staging anal carcinoma and can also be used in staging rectal carcinoma, especially very low large malignant polyps.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 243","pages":"165-74"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00365520600664292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26094144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}