Acta gastro-enterologica Belgica最新文献

{"title":"Risk-stratified evaluation of prophylactic strategies for delayed bleeding after gastric ESD: a multicenter retrospective study on clipping efficacy in the low-risk category.","authors":"S Abiko, K Kinoshita, H Oda, K Hatanaka, Y Yamamoto, H Naruse, T Miyagishima, N Sakamoto","doi":"10.51821/89.2.15369","DOIUrl":"10.51821/89.2.15369","url":null,"abstract":"<p><strong>Background and study aims: </strong>Delayed bleeding (DB) remains a major complication after gastric endoscopic submucosal dissection (ESD), and risk-stratified preventive strategies are not well established. This study evaluated the efficacy of the modified search, coagulation, and clipping (MSCC) method and MSCC combined with polyglycolic acid sheets and fibrin glue (PMSCC) using the Bleeding after ESD Trend from Japan (BEST-J) score.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed 303 patients who underwent gastric ESD with MSCC or PMSCC between April 2018 and March 2024. DB was defined as bleeding requiring emergency endoscopic hemostasis or transfusion, or a hemoglobin decrease ≥ 2 g/dL. Observed DB rates were compared with threshold rates derived from the BEST-J score.</p><p><strong>Results: </strong>In the low-risk category (MSCC/PMSCC: 237/0), no DB occurred in the MSCC group (0%; 95% confidence interval [CI]: 0.00-1.54%), with the upper CI limit below the threshold rate (2.8%). In the intermediate-risk category, DB occurred in one patient in the MSCC group (1/29; 3.4%; 95% CI: 0.08-17.8%), and no DB was observed in the PMSCC group (0/3; 0.0%; 95% CI: 0.00-70.8%); the confidence intervals overlapped the threshold rate (6.1%). In the high-risk category, DB occurred in 1/4 (25.0%; 95% CI: 0.63-80.6%) and 5/30 (16.7%; 95% CI: 5.6-34.7%) patients in the MSCC and PMSCC groups, respectively; neither the observed rate nor its confidence interval fell below the threshold rate (11.4%).</p><p><strong>Conclusions: </strong>The MSCC method is an effective prophylactic strategy for preventing DB in the low-risk category as defined by the BEST-J score.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"89 2","pages":"333-340"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High relapse rates after budesonide in microscopic colitis: a large retrospective analysis revealing the need for advanced therapies.","authors":"T Taelman, M Lenfant, S Vermeire, M Ferrante, J Sabino, B Verstockt","doi":"10.51821/89.2.15176","DOIUrl":"10.51821/89.2.15176","url":null,"abstract":"<p><strong>Background: </strong>Microscopic colitis (MC) is a chronic inflammatory bowel disorder causing watery diarrhea despite normal endoscopic findings. Budesonide is the only approved therapy, yet long-term durability and the need for alternatives in steroid-dependent or -refractory cases remain unclear.</p><p><strong>Methods: </strong>We performed a retrospective single-center cohort study of all patients with histologically confirmed MC between 2013 and 2022, with ≥3 months of follow-up. Demographics, clinical features, treatments, and outcomes were collected. Clinical remission followed Hjortswang criteria: fewer than three stools per day or fewer than one watery stool per day on average.</p><p><strong>Results: </strong>A total of 239 idiopathic MC patients met inclusion criteria. Spontaneous remission occurred in 19.2%, more often in males (OR 2.39, p=0.02). Corticosteroids, predominantly budesonide, were prescribed in 78.7% and induced remission in 75.5% within three months. Relapse affected 54.8% of responders, typically during tapering (44.6%) or shortly after cessation (55.3%). Younger age predicted relapse (OR 0.97, p=0.003). Conventional alternatives, including 5-ASA, cholestyramine, methotrexate, and azathioprine, were largely ineffective after corticosteroid failure or dependency. Advanced therapies (anti-TNF agents, vedolizumab, JAK inhibitors) were initiated in 12.6%, more often in younger patients (OR 0.95, p=0.001) and those with a family history of IBD (OR 4.11, p=0.03). These therapies achieved post-induction remission in 70% of refractory cases. Two patients required colectomy.</p><p><strong>Conclusion: </strong>In this large cohort with long-term follow-up, budesonide remained the primary treatment, yet over half of responders relapsed during tapering or after discontinuation. Conventional alternatives showed limited benefit. Advanced therapies demonstrated meaningful effectiveness in steroid-refractory or steroid-dependent MC, underscoring the need for broader therapeutic options.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"89 2","pages":"295-302"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angor abdominalis caused by a pancreatic arteriovenous malformation: a case report.","authors":"J Goos, F Kastelein, W Lammers, P van Doormaal, L Oudijk, R de Wilde, L van Driel, M Bruno, W Kwanten","doi":"10.51821/89.2.14668","DOIUrl":"10.51821/89.2.14668","url":null,"abstract":"<p><p>Pancreatic arteriovenous malformations are rare anomalies of the pancreatic vasculature. While most cases are asymptomatic, some patients develop symptoms over time. We describe a patient with angor abdominalis due to a pancreatic arteriovenous malformation. This anomaly was successfully treated with a pancreatoduodenectomy with Roux-en-Y gastrojejunal anastomosis.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"89 2","pages":"419-422"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative Management of Omental Infarction Using Only Analgesia.","authors":"A Koopmans, D Tenzin, E Brusselle","doi":"10.51821/89.2.14889","DOIUrl":"10.51821/89.2.14889","url":null,"abstract":"<p><strong>Background: </strong>Omental infarction (OI) is an uncommon and often misdiagnosed cause of acute abdominal pain. Through increasing use of computed tomography (CT) early identification has improved, avoiding unnecessary surgical intervention.</p><p><strong>Case presentation: </strong>A 49-year-old woman presented with right-sided abdominal pain radiating to the epigastrium. Laboratory tests revealed elevated inflammatory markers while abdominal ultrasound was inconclusive. CT revealed a localized area of fat stranding in the right hypochondrium, consistent with OI. The patient was managed conservatively with analgesia and intravenous fluids. She was discharged pain-free after 4 days of hospitalization. On reassessment three weeks later, she remained asymptomatic with normalized inflammatory markers.</p><p><strong>Conclusion: </strong>OI should be considered in the differential diagnosis of right-sided abdominal pain. CT is essential for establishing diagnosis, guiding management and avoiding unnecessary surgery. Conservative treatment is safe and effective in most cases, provided patients are closely monitored for clinical deterioration.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"89 2","pages":"423-425"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of autologous hematopoietic stem cell transplantation in patients with refractory Crohn's disease: a single-center retrospective case series.","authors":"G Geebelen, A Van Besien, J Van Ham, A T D'Hooghe, M Ferrante, J Sabino, B Verstockt, D Dierickx, S Vermeire","doi":"10.51821/89.2.15503","DOIUrl":"https://doi.org/10.51821/89.2.15503","url":null,"abstract":"<p><strong>Background and aims: </strong>Despite advances in biological therapies, a subset of patients with Crohn's disease (CD) remains or becomes refractory to all available treatments. Emerging evidence indicates that autologous hematopoietic stem cell transplantation (aHSCT) may offer a viable therapeutic option for carefully selected treatment-refractory CD patients.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed the outcomes of all CD patients who underwent aHSCT for treatment-refractory disease at our IBD referral center between 2011 and 2023. All included patients had severe disease, unsuitable for surgery.</p><p><strong>Results: </strong>We included 24 CD patients (15 females, median age at transplantation 31.0 [27.0-34.5] years, median disease duration 13.0 [9.8-17.3] years) who underwent mobilization, of whom 23 patients proceeded to transplantation. All patients had CD with small bowel involvement, while 10 patients (41.7%) had concomitant perianal disease. After a median follow-up of 114.6 [66.0-138.4] months, 8 patients (34.8%) were still in remission without need for advanced therapy. Persistent disease activity after aHSCT, defined as total SES-CD >3, occurred in 15 patients (65.2%) with median time to restarting advanced therapy of 7.0 [5.0-25.0] months. At last follow-up, all patients are still alive. There were a few ICU admissions because of hemodynamic instability due to neutropenic fever following mobilization and transplantation. In the follow-up period, infectious complications occurred in 12 patients (52.2%).</p><p><strong>Conclusions: </strong>Autologous hematopoietic stem cell transplantation is a safe and effective therapy for inducing and maintaining remission in carefully selected therapy-refractory CD patients after extensive multidisciplinary discussion. Although many patients didn't achieve remission, most regained response to previously ineffective therapies.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"89 2","pages":"325-332"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Helicobacter pylori prevalence and antibiotic resistance in patients undergoing bariatric surgery in Luxembourg: Impact and implications.","authors":"J Collot, S Sofos, P Feiereisen, P Deprez, R Garcés-Durán, C Tsobo Blistain, J Santiago Azagra, M Goergen, G Berchem, M Felten","doi":"10.51821/89.2.15228","DOIUrl":"10.51821/89.2.15228","url":null,"abstract":"<p><strong>Background: </strong>Helicobacter pylori (H. pylori) infection is a global health concern and may be relevant in candidates for bariatric surgery, yet data on prevalence and antimicrobial resistance in Luxembourg are limited.</p><p><strong>Materials and methods: </strong>We conducted a retrospective, single-center cohort study including 1,110 patients with obesity evaluated for bariatric surgery at the Centre Hospitalier de Luxembourg between 2010 and 2020. H. pylori status was determined on gastric biopsy and antimicrobial resistance by susceptibility testing. Collected variables included demographics, BMI, eradication outcomes, and postoperative results (BMI loss and complications). A comparative group of 125 patients without obesity with biopsy-proven H. pylori infection was included for descriptive comparison.</p><p><strong>Results: </strong>H. pylori prevalence among bariatric candidates was 29.3%. Among infected patients, 23.3% had strains resistant to at least one antibiotic, and first-line eradication was successful in 86.3%. Infection prevalence differed by nationality, being higher among Portuguese nationals than Luxembourgish patients or those from neighboring countries and was slightly higher in women than in men. Postoperatively, mean BMI reduction was 13.7 kg/m² after sleeve gastrectomy and 14.9 kg/m² after bypass surgery. H. pylori status was not associated with weight-loss outcomes or postoperative complications after adjustment.</p><p><strong>Conclusion: </strong>Approximately one-third of bariatric surgery candidates in Luxembourg have H. pylori infection, with notable antibiotic resistance and variation by nationality and sex. After eradication and adjustment for confounders, H. pylori status was not linked to postoperative weight loss or complication rates.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"89 2","pages":"303-314"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-stakeholder Delphi consensus on future care for inflammatory bowel disease in Belgium.","authors":"T Taelman, N Deprez, J King, F Baert, A Cremer, M Ferrante, J Sabino, C Reenaers, I Arijs, P Bossuyt","doi":"10.51821/89.2.14962","DOIUrl":"10.51821/89.2.14962","url":null,"abstract":"<p><strong>Background: </strong>Care for patients with IBD has changed over the last decades with increased prevalence and subsequent financial and organizational burden on the health care system. The aim of this work was to develop a nationwide consensus on how to organize care for patients with IBD.</p><p><strong>Methods: </strong>We developed a consensus document through a modified Delphi process including different Belgian stakeholders involved in the care for patients with IBD. Through two voting rounds and a consensus meeting statements were developed.</p><p><strong>Results: </strong>Thirty-three statements reached consensus through the Delphi process. The statements can be classified in six major domains: IBD registry and data utilization, Patient reported data, Multidisciplinary care, IBD nurse role and financial support, Access to diagnostic and monitoring tools and Treatment and medication reimbursement.</p><p><strong>Conclusion: </strong>We developed a broadly supported consensus on how to organize care for patients with IBD in the Belgian healthcare environment. Selection of focus area should seek for balance between optimization of clinical outcomes, securing quality of care and maintaining financial sustainability.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"89 2","pages":"373-383"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiological Assessment of Acute Pancreatitis: A Comprehensive Review.","authors":"G Buragina, F Di Capua, F Metelli, S Grecuccio, L Bottoni, F Baronchelli, E Chizzoli, L Di Mare, N Pagano, F Sala, E Armellini","doi":"10.51821/89.2.14779","DOIUrl":"10.51821/89.2.14779","url":null,"abstract":"<p><p>Acute pancreatitis (AP) is one of the leading causes of emergency department visits and hospital admissions in Western countries. Although numerous aetiologies have been described, up to 90% of cases are attributable to gallstones and chronic alcohol abuse. The clinical presentation of AP is highly variable, ranging from mild, self-limiting disease to severe forms characterised by infected necrotising pancreatitis, systemic complications, and organ failure. Severe cases frequently require prolonged hospitalisation and are associated with increased mortality. Early identification of disease severity and accurate determination of the underlying aetiology are therefore essential to guide appropriate treatment, reduce the risk of complications, and improve patient outcomes. This review discusses the pivotal role of diagnostic radiology in the evaluation and staging of AP, with the aim of optimising patient management, treatment planning, and follow-up. Particular emphasis is placed on transabdominal ultrasound (TA-US), computed tomography (CT), and magnetic resonance imaging (MRI), as well as recent advances in artificial intelligence (AI) and its emerging applications in pancreatic imaging.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"89 2","pages":"355-366"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute oesophageal necrosis following ethyl-induced emesis: A Case Report.","authors":"V Van Lint, S Van Gool, G Van Roey","doi":"10.51821/89.2.14874","DOIUrl":"10.51821/89.2.14874","url":null,"abstract":"<p><p>Acute oesophageal necrosis, also known as black oesophagus or Gurvits syndrome, is a rare condition characterized by black discoloration of the distal oesophageal mucosa due to mucosal necrosis, typically with an abrupt transition at the gastroesophageal junction. We report a case of Gurvits syndrome in a 73-year-old man with poorly controlled type 2 diabetes mellitus and recent alcohol-induced vomiting, without ingestion of caustic substances. The patient experienced epigastric pain while remaining hemodynamically stable without significant biochemical abnormalities. Following supportive therapy with bowel rest, intravenous fluids, acid suppression, glycemic control and empiric antibiotics followed by enteral feeding via jejunostomy, patient recovered completely without complications. We observed progressive mucosal healing on follow-up endoscopy. This case highlights the importance of early recognition and supportive management of acute oesophageal necrosis, especially in patients with predisposing factors such as diabetes mellitus, vomiting, to achieve full recovery and avoid adverse outcomes.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"89 2","pages":"427-429"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent Fungus, Sudden Crisis: Gastrointestinal Bleeding due to Disseminated Histoplasmosis.","authors":"S D'Haens, G De Hertogh, L Wauters","doi":"10.51821/89.2.15081","DOIUrl":"10.51821/89.2.15081","url":null,"abstract":"<p><p>Histoplasmosis is typically a self-limiting infection in immunocompetent individuals, but may present as a life-threatening disseminated disease in immunocompromised hosts. Gastrointestinal (GI) symptoms, radiological abnormalities and endoscopic findings are non-specific. We report a case of disseminated histoplasmosis in a kidney transplant recipient presenting with hemorrhagic shock due to severe colonic ulcerations. This case highlights the importance of maintaining a high index of suspicion for GI histoplasmosis in patients originating from endemic regions and underscores the need for careful endoscopic evaluation with adequate tissue sampling.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"89 2","pages":"431-433"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}