http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Wed, 15 May 2013 13:26:53 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/214958/ Background. Balloon-assisted enteroscopy has been recognized as a useful method for performing endoscopic retrograde cholangiopancreatography in patients with complex postsurgical anatomy. Objective. To clarify the usefulness of single-balloon enteroscopy for performing endoscopic retrograde cholangiopancreatography successfully in patients after Billroth II gastrectomy or Roux-en-Y reconstruction and compare it with that of conventional endoscopy. Patients and Methods. We analyzed 204 endoscopic retrograde cholangiopancreatography procedures performed at Kyoto Second Red Cross Hospital between 1997 and 2011 in 93 patients after Billroth II gastrectomy and Roux-en-Y reconstruction with gastrectomy and choledochojejunostomy. We compared recent results with those achieved before the advent of single-balloon enteroscopy (“pre-single-balloon enteroscopy” group versus “post-single-balloon enteroscopy” group). Results. The rate of reaching the blind end was 11/12 (91.7%) in post-single-balloon enteroscopy Roux-en-Y gastrectomy cases and 3/9 (33.3%) in pre-single-balloon enteroscopy Roux-en-Y gastrectomy cases (). The rate of accomplishing target procedures was 7/12 (58.3%) in post-single-balloon enteroscopy Roux-en-Y gastrectomy cases. No significant difference was found in the rates for Billroth II gastrectomy cases. Conclusion. The single-balloon enteroscopy system is effective in reaching the blind end in patients who have undergone Roux-en-Y reconstruction; however, further innovations are needed to accomplish endoscopic retrograde cholangiopancreatography-related procedures. Takuji Kawamura, Koichiro Mandai, Koji Uno, and Kenjiro Yasuda Copyright © 2013 Takuji Kawamura et al. All rights reserved. Wed, 24 Apr 2013 10:46:01 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/205417/ Introduction. Studied patients with oesophageal cancer do not represent normal daily presentation. Aim. A retrospective study was done in all consecutive patients in order to describe presentation, treatment, and survival. Patients. All patients in a ten-year period were included. Patients were grouped in three groups. Group 1: no metastases and potentially curable, dead, or alive at time of evaluation. Group 2: patients presenting with metastases and treated with palliative chemotherapy, and group 3: patients with or without metastases but untreatable because of low Karnofsky index or important comorbidity rendering treatment not feasible. Results. One hundred thirty one evaluable patients were included. There was no difference in histological type of the tumour. Patients in group 3 were significantly older. Survival was not different between groups 2 and 3. Survival in group 1 was significantly longer () compared with groups 2 and 3. Patients in group 1 received treatment with chemoradiation and surgery. Patients in groups 2 and 3 were more often treated with palliative chemotherapy and endoscopic stenting. Conclusion. The overall survival of oesophageal cancer in normal daily life is poor. Supportive care seems to be the best treatment option in patients with metastases or low Karnofsky index. Palliative chemotherapy does not add to overall survival. R. J. L. F. Loffeld and P. E. P. Dekkers Copyright © 2013 R. J. L. F. Loffeld and P. E. P. Dekkers. All rights reserved. Mon, 22 Apr 2013 17:06:02 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/605931/ Background/Aim. The aim of this study was to determine the effect of propofol on acid reflux as measured with the Bravo pH monitoring system. Methods. 48-hour pH tracings of 88 children were retrospectively evaluated after placement of the Bravo capsule under propofol. Comparisons between day 1 and day 2, as well as 6-hour corresponding segments from day 1 and day 2, were made. Results. The number of reflux episodes was significantly increased during the first six-hour period on day one as compared to day 2 . The fraction of time the pH was <4 was also increased during this period, though it did not reach statistical significance. When comparing full 24-hour periods, there was no difference noted in either the number of reflux episodes or the fraction of time pH < 4 between day one and day two. Conclusion. Our data suggest an increase in gastroesophageal reflux during the postanesthesia period. This could be a direct effect of propofol, or related to other factors. Regardless of the cause, monitoring of pH for the first 6 hours following propofol administration may not be reliable when assessing these patients. Monitoring pH over a prolonged 48-hour time period can overcome this obstacle. Anupama Chawla, Eugenia Girda, Grace Walker, Frances Turcotte Benedict, Mila Tempel, and Jeffrey Morganstern Copyright © 2013 Anupama Chawla et al. All rights reserved. Sun, 21 Apr 2013 09:31:44 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/862312/ Purpose. We examined current osteoporosis prevention practices in patients with inflammatory bowel disease (IBD) on chronic steroid using the 2003 American Gastroenterological Association guidelines as standard of care. Methods. We identified all IBD patients followed at the Oklahoma City VA Medical Center from January 2003 to December 2010, who had been on daily oral steroids (prednisone ≥5 mg or budesonide ≥6 mg) for ≥3 consecutive months. Associations of calcium and vitamin D (vitD) prescribing and bone mineral density (BMD) testing with patient characteristics were examined by logistic regression. Results. Sixty-three of 384 consecutive patients met inclusion criteria. Among 86 steroid courses, calcium and vitD were concurrently prescribed in 46%, and BMD was tested in 30%. There was no association of demographic and clinical characteristics with calcium/vitD prescribing and BMD testing. By multivariate analysis, steroid initiation after 2006, compared to before 2006, was associated with a significant increase in calcium (OR = 3.17 and ) and vitD (OR = 2.96 and ) prescribing and BMD testing (OR = 4.63 and ). Conclusions. We observed a low, yet increasing, adherence to osteoporosis prevention guidelines in IBD since 2003, which highlights the need for continued physician education to enhance guideline awareness and implementation. Aikaterini Thanou, Tauseef Ali, Omar Haq, Sindhu Kaitha, Jordan Morton, Stavros Stavrakis, and Mary Beth Humphrey Copyright © 2013 Aikaterini Thanou et al. All rights reserved. Thu, 18 Apr 2013 13:20:57 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/352718/ Microscopic colitis is a common cause of chronic diarrhea. Over the last years the incidence and the prevalence of microscopic colitis are rising and this rise is largely attributed to a rising awareness, and concomitantly an increasing number of diagnoses are made. Patients with microscopic colitis report watery, nonbloody diarrhea of chronic, intermittent, or chronic recurrent course. Following an unremarkable physical examination the diagnosis of microscopic colitis is made by colonoscopy, which shows essentially a normal colonic mucosa. Biopsies taken during the colonoscopy procedure will then finally establish the correct diagnosis. Histological workup can then confirm a diagnosis of microscopic colitis and can distinguish the two distinct histological forms, namely, collagenous colitis and lymphocytic colitis. Presently both forms are diagnosed and treated in the same way; thus the description of the two forms is not of clinical value, though this may change in future. Depending on the patients age and gender 10–30% of patients investigated for chronic diarrhea will be diagnosed with microscopic colitis if biopsies are taken. Microscopic colitis is most common in older patients, especially in female patients and is frequently associated with autoimmune disorders and the consumption of several drugs. This review summarizes the present knowledge of the epidemiology, the pathophysiology, and the diagnosis of microscopic colitis and discusses the former and the present treatment options. Martin Alexander Storr Copyright © 2013 Martin Alexander Storr. All rights reserved. Mon, 15 Apr 2013 15:46:53 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/606258/ Aim. The aim of this study was to identify the presence of H. pylori in biopsy specimens from symptomatic patients by PCR. In addition, the rate of cagA, vacA, iceA1, and iceA2 virulence genes was determined. Materials and Methods. One hundred antral gastric biopsy specimens were collected during endoscopy from patients suffering from gastroduodenal symptoms. The samples were collected by the gastroenterologists in their own clinics in Ramallah, Palestine. DNA was extracted from the biopsies and subsequently used for PCR identification of H. pylori and the virulence genes using specific primers. Results. The rate of positive H. pylori in the collected biopsies was 44%. The rates of the virulence genes in this sample: cagA, vacA, iceA1, and iceA2 were 65.9%, 40.9%, 63.6%, and 84.1%, respectively. Conclusion. The iceA2 gene was the most frequent in this study. Much research is necessary to determine the presence of an association of this gene with gastric pathology. Variation in the rates of the iceA gene in different countries is a strong indication of its geographical distribution. This study would provide important information regarding the prevalence of virulence genes (vacA, cagA, iceA1, and iceA2) in H. pylori strains in the sample tested in this country. Tamer Essawi, Wail Hammoudeh, Israr Sabri, Walid Sweidan, and Mohammad A. Farraj Copyright © 2013 Tamer Essawi et al. All rights reserved. Tue, 09 Apr 2013 12:16:25 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/304894/ Background. Tacrolimus (FK506) is effective for patients with ulcerative colitis (UC). However, there are few reports on tacrolimus therapy (TT) with respect to the relationship with endoscopic and clinicopathologic findings. Methods. Thirty patients with moderate/severe active UC refractory to or dependent on corticosteroid were treated with oral tacrolimus. The expression of ectopic MUC5AC in the colon was pathologically analyzed before and at 12 weeks after TT, evaluating the Mayo score and steroid-sparing effects. Results. Both mean disease and endoscopic activity index scores were reduced at levels of statistical significance in 26 UC patients receiving more than one month of TT (). The dose of prednisolone was reduced by a statistically significant amount (), and 14 of the 26 patients (53.8%) had steroid-free status 12 weeks after TT. The decrease in ectopic MUC5AC expression in the mucous cells of the colon was significantly associated with endoscopic improvement of inflammation in the UC patients with TT (). Loss of ectopic MUC5AC expression was detected in all patients who had complete response. Conclusions. Tacrolimus appears to be effective for the treatment of moderate/severe UC patients. Loss of ectopic MUC5AC expression may be important for pathologic remission in the colon of UC patients. Tsutomu Mizoshita, Satoshi Tanida, Hironobu Tsukamoto, Keiji Ozeki, Takahito Katano, Masahide Ebi, Yoshinori Mori, Hiromi Kataoka, Takeshi Kamiya, and Takashi Joh Copyright © 2013 Tsutomu Mizoshita et al. All rights reserved. Thu, 04 Apr 2013 09:59:43 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/630159/ The gut immune system shares many mediators and receptors with the autonomic nervous system. Good examples thereof are the parasympathetic (vagal) and sympathetic neurotransmitters, for which many immune cell types in a gut context express receptors or enzymes required for their synthesis. For some of these the relevance for immune regulation has been recently defined. Earlier and more recent studies in neuroscience and immunology have indicated the anatomical and cellular basis for bidirectional interactions between the nervous and immune systems. Sympathetic immune modulation is well described earlier, and in the last decade the parasympathetic vagal nerve has been put forward as an integral part of an immune regulation network via its release of Ach, a system coined “the cholinergic anti-inflammatory reflex.” A prototypical example is the inflammatory reflex, comprised of an afferent arm that senses inflammation and an efferent arm: the cholinergic anti-inflammatory pathway, that inhibits innate immune responses. In this paper, the current understanding of how innate mucosal immunity can be influenced by the neuronal system is summarized, and cell types and receptors involved in this interaction will be highlighted. Focus will be given on the direct neuronal regulatory mechanisms, as well as current advances regarding the role of microbes in modulating communication in the gut-brain axis. Wouter J. de Jonge Copyright © 2013 Wouter J. de Jonge. All rights reserved. Thu, 28 Mar 2013 14:01:14 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/840690/ In Europe and the United States, the incidence of esophageal adenocarcinoma has increased 6-fold in the last 25 years and currently accounts for more than 50% of all esophageal cancers. Barrett’s esophagus is the source of Barrett’s adenocarcinoma and is characterized by the replacement of squamous epithelium with columnar epithelium in the lower esophagus due to chronic gastroesophageal reflux disease (GERD). Even though the prevalence of GERD has recently been increasing in Japan as well as in Europe and the United States, the clinical situation of Barrett’s esophagus and Barrett’s adenocarcinoma differs from that in Western countries. In this paper, we focus on specific differences in the background factors and pathophysiology of these lesions. Makoto Oryu, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Shintaro Fujihara, Mitsuyoshi Kobayashi, Mitsugu Yasuda, and Tsutomu Masaki Copyright © 2013 Makoto Oryu et al. All rights reserved. Thu, 07 Mar 2013 13:37:46 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/415450/ Background and Objective. Cisplatin-based chemotherapy is widely recognized to cause severe gastrointestinal disorders like nausea, vomiting, and appetite loss. The aim of this study was to assess whether cisplatin-based transcatheter arterial infusion (TAI) chemotherapy reduces plasma ghrelin levels and food intake in hepatocellular carcinoma (HCC) patients. Methods. Seventeen patients with HCC who underwent cisplatin-based TAI chemotherapy (80–100 mg/body) were enrolled in this study. Changes in peptide hormones, including ghrelin and leptin, as well as cytokines, were measured before and after chemotherapy. Appetite was evaluated by visual analog scale (VAS) and food intake was scored by eleven stages (0–10). Results. Appetite and food intake were significantly decreased after chemotherapy (). Plasma acylated ghrelin levels before therapy and at day 1, day 7, and day 14 after chemotherapy were 10.4 ± 7.2, 4.7 ± 4.7, 11.7 ± 8.9, and 9.3 ± 6.6 fmol/mL, respectively. The level on day 1 was decreased significantly (). In contrast, the levels of leptin, granulocyte colony-stimulating factor (G-CSF), and monocyte chemotactic protein-1 (MCP-1) on day 1 were increased significantly (). Conclusions. TAI for HCC reduced plasma acylated ghrelin levels, appetite, and food intake significantly. In addition, it increased serum leptin levels. Tomoaki Matsumura, Makoto Arai, Masaharu Yoshikawa, Kentaro Sudo, Kazuyoshi Nakamura, Tatsuro Katsuno, Fumihiko Kanai, Taketo Yamaguchi, and Osamu Yokosuka Copyright © 2013 Tomoaki Matsumura et al. All rights reserved. Tue, 05 Mar 2013 08:56:20 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/836203/ Sarcoidosis is a chronic disorder that can virtually affect any organ system in the body. Histologically, it is characterized by the presence of T lymphocytes, mononuclear phagocytes, and noncaseating granulomas. Most commonly affected are the intrathoracic structures, with 90% of the reported cases involving the lungs. Esophageal involvement in sarcoidosis is extremely rare. Dysphagia is the most common presentation in these patients and can be attributed to various mechanisms such as direct esophageal wall infiltration, extrinsic compression, cranial neuropathy, and brainstem involvement. A thorough online literature review revealed only 23 reported cases of esophageal involvement in sarcoidosis. This paper reviews these reported cases in detail along with newer diagnostic and treatment options, including direction of future therapy. Albin Abraham, Rabab Hajar, Ravi Virdi, Jaspreet Singh, and Paul Mustacchia Copyright © 2013 Albin Abraham et al. All rights reserved. Thu, 28 Feb 2013 17:11:59 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/710856/ Phytogenic compounds with antioxidant and anti-inflammatory properties are currently discussed as promising complementary agents in prevention and treatment of inflammatory bowel disease (IBD). Our study aimed to evaluate possible protective and curative effects of broccoli extract (BE) and of the essential oils of turmeric (Cuo), thyme (To), and rosemary (Ro) in a rat model with a mild dextran sulphate sodium- (DSS-) induced colitis. Therefore Wistar rats were fed a diet without an additive (Con) or diets with the addition of BE, Cuo, To, and Ro during the whole experiment. Pretreatment with Ro, Cuo, and To increased the expression of the tight junction protein Cldn3. All additives reduced mRNA of VCAM-1 which plays a crucial role in the first state of inflammatory response. Only Ro pretreatment affected the expression of the antioxidant enzymes HO1, GPx2, and of glutathione-S-transferases. All additives counteracted the DSS-induced rise in COX2 and VCAM-1 expression. Colonic IL-10 was increased by Cuo, To, and Ro. During the recovery phase DSS pretreatment increased NFκB, VCAM-1, and MCP-1: This response was counter-regulated by all additives. We conclude that the phytogenic additives tested have a promising anti-inflammatory potential in vivo and a particular role in the prevention of IBD. Kristin Mueller, Nicole Michaela Blum, and Andreas Stefan Mueller Copyright © 2013 Kristin Mueller et al. All rights reserved. Wed, 27 Feb 2013 10:31:34 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/838134/ Familial adenomatous polyposis (FAP) is the most common inherited polyposis syndrome. Almost all patients with FAP will develop colorectal cancer if their FAP is not identified and treated at an early stage. Although there are many reports about polypoid lesions and colorectal cancers in FAP patients, little information is available concerning depressed lesions in FAP patients. Several reports suggested that depressed-type lesions are characteristic of FAP and important in the light of their rapid growth and high malignancy. Here, we describe the occurrence of depressed-type lesions in FAP patients treated at our institution. Between April 2001 and March 2010, eight of 18 FAP patients had colorectal cancers. Depressed-type colorectal cancer was found in three patients. It should be kept in mind that depressed-type lesions occur even in FAP. Shin-ei Kudo, Yuusaku Sugihara, Hiroyuki Kida, Fumio Ishida, Hideyuki Miyachi, Yuichi Mori, Masashi Misawa, Tomokazu Hisayuki, Kenta Kodama, Kunihiko Wakamura, Takemasa Hayashi, Yoshiki Wada, and Shigeharu Hamatani Copyright © 2013 Shin-ei Kudo et al. All rights reserved. Tue, 26 Feb 2013 09:32:26 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/179024/ Objective. To explore fecal calprotectin levels in pediatric ulcerative colitis (UC) in relation with the validated clinical activity index PUCAI. Methods. This study included all 37 children (median age 14 years) with UC who had calprotectin measured (PhiCal ELISA Test) by the time of PUCAI assessment at the Children's Hospital of Helsinki in a total of 62 visits. Calprotectin values <100 μg/g of stool were considered as normal. The best cut-off value of each measure to predict 3-month clinical outcome was derived by maximizing sensitivity and specificity. Results. In clinically active disease (PUCAI ≥ 10), calprotectin was elevated in 29/32 patients (91% sensitivity). When in clinical remission, 26% (8/30) of the children had normal calprotectin but 7 (23%) had an exceedingly high level (>1000 μg/g). The best cut-off value for calprotectin for predicting poor outcome was 800 μg/g (sensitivity 73%, specificity 72%; area under the ROC curve being 0.71 (95%CI 0.57–0.85)) and for the PUCAI best cut-off values >10 (sensitivity 62%, specificity 64%; area under the ROC curve 0.714 (95%CI 0.58–0.85)). Conclusion. The clinical relevance of somewhat elevated calprotectin during clinical remission in pediatric UC is not known and, until further evidence accumulates, does not indicate therapy escalation. Kaija-Leena Kolho and Dan Turner Copyright © 2013 Kaija-Leena Kolho and Dan Turner. All rights reserved. Sun, 17 Feb 2013 13:13:27 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/656921/ The symptoms of distal ulcerative colitis have been related to changes in rectal sensitivity and capacity due to inflammation, altered gastrointestinal motility, and sensory perception. With the use of anorectal manometry, the function was measured in seven patients with active distal proctitis during local treatment with ropivacaine. Seven healthy subjects were studied in the same way for comparison with normal conditions. The anal resting pressure and squeezing pressure were similar in all groups. Significantly lower rectal distention volumes were required for rectal sensation, critical volume, and to induce rectal contractility in patients with active disease compared to controls. Rectal compliance was significantly reduced in patients with active and quiescent disease. The increased rectal sensitivity and contractility in patients with active colitis appear to be related to active mucosal inflammation and ulceration. The frequency and urgency of defecation and the fecal incontinence may be due to a hypersensitive, hyperactive, and poorly compliant rectum. The findings in our study indicate that the inflammatory damage to the rectal wall with poor compliance is unaffected by local anaesthetics such as ropivacaine. The symptomatic relief and reduction in clinical symptoms following treatment are not reflected in the anorectal manometric findings. Eva Arlander, Robert Löfberg, Leif Törkvist, and Ulrik Lindforss Copyright © 2013 Eva Arlander et al. All rights reserved. Thu, 07 Feb 2013 09:41:58 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/434706/ Growing worldwide obesity epidemic has prompted the development of two main treatment streams: (a) conservative approaches and (b) invasive techniques. However, only invasive surgical methods have delivered significant and sustainable benefits. Therefore, contemporary research exploration has focused on the development of minimally invasive gastric manipulation methods featuring a safe but reliable and long-term sustainable weight loss effect similar to the one delivered by bariatric surgeries. This antiobesity approach is based on placing external devices in the stomach ranging from electrodes for gastric electrical stimulation to temporary intraluminal bezoars for gastric volume displacement for a predetermined amount of time. The present paper examines the evolution of these techniques from invasively implantable units to completely noninvasive patient-controllable implements, from a functional, rather than from the traditional, parametric point of view. Comparative discussion over the available pilot and clinical studies related to gastric electrical stimulation outlines the promises and the fallacies of this concept as a reliable alternative anti-obesity strategy. Martin P. Mintchev Copyright © 2013 Martin P. Mintchev. All rights reserved. Thu, 31 Jan 2013 07:24:04 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/824320/ Gastroesophageal reflux (GER) is very common in children due to immaturity of the antireflux barrier. In critically ill patients there is also a high incidence due to a partial or complete loss of pressure of the lower esophageal sphincter though other factors, such as the use of nasogastric tubes, treatment with adrenergic agonists, bronchodilators, or opiates and mechanical ventilation, can further increase the risk of GER. Vomiting and regurgitation are the most common manifestations in infants and are considered pathological when they have repercussions on the nutritional status. In critically ill children, damage to the esophageal mucosa predisposes to digestive tract hemorrhage and nosocomial pneumonia secondary to repeated microaspiration. GER is mainly alkaline in children, as is also the case in critically ill pediatric patients. pH-metry combined with multichannel intraluminal impedance is therefore the technique of choice for diagnosis. The proton pump inhibitors are the drugs of choice for the treatment of GER because they have a greater effect, longer duration of action, and a good safety profile. Maria José Solana García, Jesús López-Herce Cid, and César Sánchez Sánchez Copyright © 2013 Maria José Solana García et al. All rights reserved. Sun, 27 Jan 2013 14:32:40 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/464053/ Aim. To compare the effectiveness of surgical procedures (selective or nonselective shunt, devascularization, and combined shunt and devascularization) in preventing recurrent variceal bleeding and other complications in patients with portal hypertension. Methods. A systematic literature search of the Medline and Cochrane Library databases was carried out, and a meta-analysis was conducted according to the guidelines of the Quality of Reporting Meta-Analyses (QUOROM) statement. Results. There were a significantly higher reduction in rebleeding, yet a significantly more common encephalopathy () in patients who underwent the shunt procedure compared with patients who had only a devascularization procedure. Further, there were no significant differences in rebleeding, late mortality, and encephalopathy between selective versus non-selective shunt. Next, the decrease of portal vein pressure, portal vein diameter, and free portal pressure in patients who underwent combined treatment with shunt and devascularization was more pronounced compared with patients who were treated with devascularization alone (). Conclusions. This meta-analysis shows clinical advantages of combined shunt and devascularization over devascularization in the prevention of recurrent variceal bleeding and other complications in patients with portal hypertension. Lanning Yin, Haipeng Liu, Youcheng Zhang, and Wen Rong Copyright © 2013 Lanning Yin et al. All rights reserved. Wed, 16 Jan 2013 09:36:49 +0000 http://www.hindawi.com/isrn/gastroenterology/2013/935295/ Various findings concerning the clinical significance of quantitative changes in hepatitis B surface antigen (HBsAg) during the acute and chronic phase of hepatitis B virus (HBV) infection have been reported. In addition to being a biomarker of HBV-replication activity, it has been reported that HBsAg could contribute to the immunopathogenesis of HBV persistent infection. Moreover, HBsAg could become an attractive target for immune therapy, since the cellular and humeral immune response against HBsAg might be able to control the HBV replication and life cycle. However, several reports have described the immune suppressive function of HBsAg. HBsAg might suppress monocytes, dendritic cells (DCs), natural killer (NK), and natural killer T (NK-T) cells by direct interaction. On the other hand, cytotoxic T lymphocytes (CTLs) and helper T (Th) cells were exhausted by high amounts of HBsAg. In this paper, we focused on the immunological aspects of HBsAg, since better understanding of the interaction between HBsAg and immune cells could contribute to the development of an immune therapy as well as a biomarker of the state of HBV persistent infection. Yasuteru Kondo, Masashi Ninomiya, Eiji Kakazu, Osamu Kimura, and Tooru Shimosegawa Copyright © 2013 Yasuteru Kondo et al. All rights reserved. Sun, 30 Dec 2012 10:59:23 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/824671/ Background and Aims. The optimal treatment of patients with internal rectal intussusception (IRI) is unresolved. The aim was to study the short- and long-term outcome of resection rectopexy in these patients. Methods. An observational and mainly prospective study of 48 patients (44 women) with IRI who had ligament-preserving suture rectopexy by laparoscopic or open technique. Outcome measures were morbidity, scores for constipation and anal incontinence, patients’ report, and health-related quality of life (HRQoL). Results. From preoperatively to a median of 6 months and 76 months postoperatively, constipation scores were reduced from a mean of (95% CI) 13.20 (11.41 to 15.00) to 6.91 (5.29 to 8.54) and 6.35 (4.94 to 7.76) . The number of constipated patients was reduced from 35 to eleven and eight, respectively, and none became constipated. Nine of ten symptoms of constipation improved. Corresponding scores for anal incontinence were 4.7 (2.4–7.0), 4.0 (2.4–5.7), and 4.1 (2.3–5.8), respectively. HRQoL at long-term followup compared to the general Norwegian population was reduced in four out of eight dimensions concerning physical factors. The patient-reported outcome at short- and long-term followup was improved by 85.4% and 75.0%, respectively. Conclusions. Resection rectopexy for IRI improved the outcome. HRQoL was reduced compared with the general population. Egil Johnson, Kristin Kjellevold, Hans-Olaf Johannessen, and Anders Drolsum Copyright © 2012 Egil Johnson et al. All rights reserved. Thu, 27 Dec 2012 16:10:08 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/527634/ Introduction. Endoscopy of the colon and rectum is increasingly used. Aim of the Study. All consecutive endoscopies of the colon and rectum were studied in order to assess the yearly prevalence of significant endoscopic diagnoses. Methods. All consecutive endoscopies of the colon and rectum were included. Endoscopies were done with endoscopes of Olympus. Significant endoscopic diagnoses were defined as colorectal cancer, polyps, diverticuli, large sessile polyps, and inflammatory bowel disease. Results. In 20 years a total of 24431 endoscopies were done. The yearly number of sigmoidoscopies was mean 96, range of 42–370. The number of colonoscopies was mean 1126, range of 643–1912. The number of colonoscopies significantly increased. The number of colonoscopies on request of an internist or gastroenterologist showed a slow but steady increase. Successful caecal intubation rose from 70% to 92% in 2011. Since 1996 there is a steep increase in the percentage of procedures with abnormalities. The number of cancer and polyps increased in twenty years. No great changes were seen in inflammatory bowel disease. Conclusion. Colonoscopy is a procedure with a high diagnostic yield. The number of patients with tumours rose in twenty years. R. J. L. F. Loffeld, B. Liberov, and P. E. P. Dekkers Copyright © 2012 R. J. L. F. Loffeld et al. All rights reserved. Wed, 26 Dec 2012 10:50:29 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/123826/ In patients with advanced cirrhosis, not only hepatocellular carcinoma but also bacterial infections, such as spontaneous bacterial peritonitis (SBP) or pneumonia, are frequent clinical complications in such immune-compromised patients. These pathologies often progress to renal dysfunction, especially hepatorenal syndrome (HRS). The central pathology of HRS is splanchnic arterial vasodilation and hyperpermeability followed by bacterial translocation (BT). BT induces a severe inflammatory response in the peritoneal lymphoid tissue, with the activation of the immune systems and the long-lasting production of vasoactive mediators that can impair the circulatory function and cause renal failure. Recent studies report that the plasma amino acid imbalance appeared to be related to an abnormality of the immune system in patients with decompensated cirrhosis. This paper can provide a new approach for future studies of the pathology in cirrhotic patients with renal dysfunction. Eiji Kakazu, Yasuteru Kondo, and Tooru Shimosegawa Copyright © 2012 Eiji Kakazu et al. All rights reserved. Mon, 17 Dec 2012 15:37:33 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/628317/ Background. One of the most serious gastrointestinal disorders occurring in neonates is necrotising enterocolitis (NEC). It is recognised as the most common intra-abdominal emergency and is the leading cause of short bowel syndrome. With extremely high mortality and morbidity, this enigmatic disease remains a challenge for neonatologists around the world as its definite aetiology has yet to be determined. As current medical knowledge stands, there is no single well-defined cause of NEC. Instead, there are nearly 20 risk factors that are proposed to increase the likelihood of developing NEC. Aims and Objectives. The aim of this project was to conduct a comprehensive literature review around the 20 or so well-documented and less well-documented risk factors for necrotising enterocolitis. Materials and Methods. Searches of the Medline, Embase, and Science direct databases were conducted using the words “necrotising enterocolitis + the risk factor in question” for example, “necrotising enterocolitis + dehydration.” Search results were ordered by relevance with bias given to more recent publications. Conclusion. This literature review has demonstrated the complexity of necrotising enterocolitis and emphasised the likely multifactorial aetiology. Further research is needed to investigate the extent to which each risk factor is implicated in necrotising enterocolitis. Thomas Peter Fox and Charles Godavitarne Copyright © 2012 Thomas Peter Fox and Charles Godavitarne. All rights reserved. Tue, 11 Dec 2012 15:30:28 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/791383/ Background and Aims. Nutritional support in severe acute pancreatitis (SAP) is controversial concerning the merits of enteral or parenteral nutrition in the management of patients with severe acute pancreatitis. Here, we assess the therapeutic efficacy of gradually combined treatment of parenteral nutrition (PN) with enteral nutrition (EN) for SAP. Methods. The clinical data of 130 cases of SAP were analyzed retrospectively. Of them, 59 cases were treated by general method of nutritional support (Group I) and the other 71 cases were treated by PN gradually combined with EN (Group II). Results. The APACHE II score and the level of IL-6 in Group II were significantly lower than Group I . Complications, mortality, mean hospital stay, and the cost of hospitalization in Group II were 39.4 percent, 12.7 percent, 32 9 days, and 30869.4 12794.6 Chinese Yuan, respectively, which were significantly lower than those in Group I. The cure rate of Group II was 81.7 percent which is obviously higher than that of 59.3% in Group I . Conclusions. This study indicates that the combination of PN with EN not only can improve the natural history of pancreatitis but also can reduce the incidence of complication and mortality. Akanand Singh, Ming Chen, Tao Li, Xiao-Li Yang, Jin-Zheng Li, and Jian-Ping Gong Copyright © 2012 Akanand Singh et al. All rights reserved. Wed, 05 Dec 2012 08:59:52 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/919371/ The short-term effects of balloon-occluded retrograde transvenous obliteration (BRTO) to treat gastric varices were evaluated by using computed tomography (CT) and gastroscopy (GF). The subjects were 77 patients who underwent BRTO to treat gastric varices. The short-term effects of BRTO were investigated with regard to ascites, pleural effusion, venous thrombus, and esophageal varices by comparing the findings of CT and GF performed within one month before and after BRTO. The mean duration of followup was 960.1 days. Ascites and pleural effusion were exacerbated after BRTO in 26 (33.8%) and 31 (40.3%), respectively. A significant difference in ascites exacerbation was noted in patients with hypoalbuminemia and a high Child-Pugh score, and a significant difference in exacerbation of pleural effusion was noted in patients with hypoalbuminemia. Venous thrombus was noted in 7 patients (9.1%). Esophageal varices were exacerbated in 14 (21.2%) of the 66 patients. The 2-year survival rate was 720 days, and significant differences were noted in the Child-Pugh classification and the concomitance of hepatocellular carcinoma (HCC) on multivariate analysis of prognosis-related factors. Conclusion. The frequencies of exacerbation of ascites, pleural effusion, and esophageal varices after BRTO were high but these may not be related to survival. Manabu Watanabe, Kazue Shiozawa, Takashi Ikehara, Shigeru Nakano, Michio Kougame, Takafumi Otsuka, Yoshinori Kikuchi, Koji Ishii, Yoshinori Igarashi, and Yasukiyo Sumino Copyright © 2012 Manabu Watanabe et al. All rights reserved. Tue, 04 Dec 2012 11:58:45 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/690402/ Background. Protein supplementation has been shown to be effective for the treatment of malnourished patients with liver cirrhosis. The parameters used to assess nutritional improvement in cirrhotic patients for such treatment are important. Objective. To evaluate the parameters for assessment of nutritional status in patients with liver cirrhosis after protein supplementation. Material and Method. A cross-sectional, prospective clinical trial with 22 cirrhotic patients was performed. Data from anthropometry, bioelectrical impedance, subjective global assessment (SGA), and visceral protein were gathered and analyzed to assess nutritional improvement after protein supplementation. Results. Twenty-two cirrhotic patients (mean age years; 54.5% male; 63.6% alcoholic cirrhosis; 63.6% Child-Pugh C) were recruited. After protein supplementation, a significant improvement was demonstrated in the SGA class A from 10 patients (45.5%) to 16 (72.7%) and 18 (81.8%) at the 4th and 8th weeks, respectively. Body weight, body mass index, and lean muscle mass were significantly increased from baseline at the 8th week. No significant change in other nutritional parameters was observed. Conclusions. The SGA and lean muscle mass were significant parameters in order to assess nutritional status in cirrhotic patients after protein supplementation. Supanee Putadechakum, Theerawut Klangjareonchai, Arpussanee Soponsaritsuk, and Chulaporn Roongpisuthipong Copyright © 2012 Supanee Putadechakum et al. All rights reserved. Sun, 25 Nov 2012 09:02:56 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/607149/ Undernutrition in frail elderly people is a pathological condition that needs to be recognized and addressed early. Neurological dysphagia is among the most frequent causes of this condition in the elderly but should be considered a terminal event in Alzheimer-type dementias. Tube feeding is an important resource for facilitating metabolic recovery in cachectic patients and is particularly successful in “bridging” and stabilizing therapies prior to major treatment able to cure the patient. Clinical management of tube feeding in “incurable” conditions is complex and becomes part of the palliative care and comfort provided in the terminal stages of illness. Non-specialized physicians are often unfamiliar with the theory and practice of end-of-life interventions, and the resulting decisions are in many cases actually contrary to patient comfort. These problems deserve to be more carefully addressed when the patient is unable to cooperate or express his/her preferences and needs. The success of percutaneous endoscopic gastrostomy has led to increasingly frequent referrals for placement in critically ill elderly patients. Endoscopists therefore become a key figure in stimulating rational, correct treatment of these patients. Fabrizio Cardin Copyright © 2012 Fabrizio Cardin. All rights reserved. Mon, 19 Nov 2012 10:58:45 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/285475/ Determining the diagnosis of Crohn’s disease has been highly difficult mainly during the first years of this study carried out at the Pontificia Universidad Catolica (PUC) Clinical Hospital. For instance, it has been frequently confused with Irritable bowel syndrome and sometimes misdiagnosed as ulcerative colitis, infectious colitis or enterocolitis, intestinal lymphoma, or coeliac disease. Consequently, it seems advisable to characterize what the most relevant clinical features are, in order to establish a clear concept of Crohn's disease. This difficulty may still be a problem at other medical centers in developing countries. Thus, sharing this information may contribute to a better understanding of this disease. Based on the clinical experience gained between 1963 and 2004 and reported herein, the main clinical characteristics of the disease are long-lasting day and night abdominal pain, which becomes more intense after eating and diarrhoea, sometimes associated to a mass in the abdomen, anal lesions, and other additional digestive and nondigestive clinical features. Nevertheless, the main aim of this work has been the following: is it possible to make, in an early stage, the diagnosis of Crohn's disease with a high degree of certainty exclusively with clinical data? C. Quintana, L. Galleguillos, E. Benavides, J. C. Quintana, A. Zúñiga, I. Duarte, J. Klaassen, M. Kolbach, R. M. Soto, S. Iacobelli, M. Álvarez, and A. O'Brien Copyright © 2012 C. Quintana et al. All rights reserved. Wed, 14 Nov 2012 10:14:15 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/706937/ Objectives. The aim of this study is to investigate the effects of coeliac disease on cardiac function in children using conventional transthoracic echocardiography (TTE) and tissue Doppler echocardiography (TDE). Methods. Coeliac disease patients were evaluated in two different groups based on serum endomysial antibody (EmA) titers (EmA (+) and EmA (−)), and the data obtained by conventional and TDE studies were compared between the patient groups and healthy controls. Results. There was no significant difference between EmA (+) and EmA (−) groups in terms of the conventional TTE parameters, including ejection fraction (EF), fractional shortening (FS), and left ventricle end diastolic diameter (LVEDD), that show the left ventricular systolic function (, , ). TDE showed a significant difference in left ventricle (LV) isovolumic relaxation time (LV IVRT) and LV myocardial performance index (LV MPI) parameters between EmA (+) and EmA (−) patient groups (). Conclusion. The measurement of LV MPI and LV IVRT parameters by TDE would be beneficial in early determination of the cardiac involvement and establishing appropriate treatment and followup of patients with coeliac disease as well as in making distinction between EmA (+) and EmA (−) patients. Berna Saylan, Ayhan Cevik, Ceyda Tuna Kirsaclioglu, Filiz Ekici, Ozgur Tosun, and Gonca Ustundag Copyright © 2012 Berna Saylan et al. All rights reserved. Wed, 24 Oct 2012 16:12:40 +0000 http://www.hindawi.com/isrn/gastroenterology/2012/903240/ Multichannel intraluminal impedance (MII) for the evaluation of esophageal diseases was created in 1991 trying to solve previous limitations of esophageal function test. MII-pH is able to determine the physical characteristics of the refluxate (liquid, gas, or mixed) and nonacidic GER. MII-manometry can determine the presence of bolus and its relation with peristalsis. This paper makes a critical analysis of the clinical applications of MII 20 years after its creation. Literature review shows that MII made great contributions for the understanding of esophageal physiology; however, direct clinical applications are few. MII-pH was expected to identify patients with normal acid reflux and abnormal nonacidic reflux. These patients are rarely found off therapy, that is, nonacidic reflux parallels acid reflux. Furthermore, the significance of isolated nonacidic reflux is unclear. Contradictory MII-manometry and conventional manometry findings lack better understanding and clinical implication as well as the real significance of bolus transit. Fernando A. M. Herbella Copyright © 2012 Fernando A. M. Herbella. All rights reserved.