Gastroenterology Research and Practice The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Targeting Angiogenesis and Tumor Microenvironment in Metastatic Colorectal Cancer: Role of Aflibercept Mon, 21 Jul 2014 08:05:25 +0000 In the last decades, we have progressively observed an improvement in therapeutic options for metastatic colorectal cancer (mCRC) treatment with a progressive prolongation of survival. mCRC prognosis still remains poor with low percentage of 5-year survival. Targeted agents have improved results obtained with standard chemotherapy. Angiogenesis plays a crucial role in colorectal cancer growth, proliferation, and metastasization and it has been investigated as a potential target for mCRC treatment. Accordingly, novel antiangiogenic targeted agents bevacizumab, regorafenib, and aflibercept have been approved for mCRC treatment as the result of several phase III randomized trials. The development of a tumor permissive microenvironment via the aberrant expression by tumor cells of paracrine factors alters the tumor-stroma interactions inducing an expansion of proangiogenic signals. Recently, the VELOUR study showed that addition of aflibercept to FOLFIRI regimen as a second-line therapy for mCRC improved significantly OS, PFS, and RR. This molecule represents a valid second-line therapeutic option and its peculiar ability to interfere with placental growth factor (PlGF)/vascular endothelial growth factor receptor 1 (VEGFR1) axis makes it effective in targeting angiogenesis, inflammatory cells and in overcoming resistances to anti-angiogenic first-line treatment. Here, we discuss about Aflibercept peculiar ability to interfere with tumor microenvironment and angiogenic pathway. Guido Giordano, Antonio Febbraro, Michele Venditti, Serena Campidoglio, Nunzio Olivieri, Katia Raieta, Pietro Parcesepe, Giusy Carmen Imbriani, Andrea Remo, and Massimo Pancione Copyright © 2014 Guido Giordano et al. All rights reserved. Neoadjuvant Therapy in Pancreatic Cancer: An Emerging Strategy Tue, 01 Jul 2014 06:30:57 +0000 Pancreatic adenocarcinoma (PDAC) is the fourth leading cause of cancer deaths among men and women, being responsible for 6% of all cancer-related deaths. Surgical resection offers the only chance of cure, but only 15 to 20 percent of cases are potentially resectable at presentation. In recent years, increasing evidences support the use of neoadjuvant strategies in pancreatic cancer in patients with resectable pancreatic cancer as well as in patients with borderline resectable or locally advanced PDAC in order to allow early treatment of micrometastatic disease, tumour regression, and reduced risk of peritoneal tumour implantation during surgery. Furthermore, neoadjuvant treatment allows evaluation of tumour response and increases patient’s compliance. However, most evidences in this setting come from retrospective analysis or small case series and in many studies chemotherapy or chemoradiation therapies used were suboptimal. Currently, prospective randomized trials using the most active chemotherapy regimens available are trying to define the real benefit of neoadjuvant strategies compared to conventional adjuvant strategies. In this review, the authors examined available data on neoadjuvant treatment in patients with resectable pancreatic cancer as well as in patients with borderline resectable or locally advanced PDAC and the future directions in this peculiar setting. Alessandro Bittoni, Matteo Santoni, Andrea Lanese, Chiara Pellei, Kalliopi Andrikou, and Cascinu Stefano Copyright © 2014 Alessandro Bittoni et al. All rights reserved. The Application of Functional Magnetic Resonance Imaging in an Infant Rat Model of Irritable Bowel Syndrome Tue, 01 Jul 2014 00:00:00 +0000 The aim of this study was to use functional magnetic resonance imaging (BOLD-fMRI) to investigate the activated region associated with visceral pain in the brains of infant rats in a model of IBS. Sixteen newborn rats were randomized into an IBS model group and a control group. Those in the IBS group were separated from their mothers and were mechanically immobilized and had rectal sensitization with mustard essential oil for 1 week. The control group had no treatment. After 2 weeks, balloon catheters were inflated with 5 or 10 mL of air in the rectums of both groups. BOLD-fMRI was performed and the data analyzed by imaging software. In the IBS model group, rectal stimulation with 5 mL air distension activated the anterior cingulate cortex, insula cortex (IC), prefrontal cortex (PFC), and thalamus, while 10 mL air significantly activated the ACC, IC, PFC, and thalamus in the model, but not controls. IBS model group was hypersensitive to visceral stimulation by rectal balloon inflation. The major brain areas participating in visceral sensation included the IC, PFC, and thalamus. Xueping Zhu, Xiaoli Zhu, Weichang Chen, and Jianhua Chen Copyright © 2014 Xueping Zhu et al. All rights reserved. Endoscopic Measurement of Polyp Size Using a Novel Calibrated Hood Mon, 30 Jun 2014 08:55:18 +0000 Background. Although the size of colon polyps is an important risk factor for colorectal cancer, a standardized measurement technique has yet to be determined. In clinical practice, most endoscopists estimate polyp size by uncertain visual estimation; however, colonoscopic polypectomy is indicated for adenomatous polyps more than 5 mm in diameter. We have therefore developed a novel calibrated hood that enables accurate measurement of polyp size during colonoscopy. Method. We compared prepolypectomy estimates using the calibrated hood against measurements of preformalin-fixed samples immediately after polypectomy. Results. Sixty-five polyps removed from 44 patients were included in the present study. The mean size of polyps was significantly larger at prepolypectomy (6.06 ± 1.23 mm) than after polypectomy (5.48 ± 1.31 mm, ). Conclusion. Accurately measuring the size of polyps during colonoscopy is important, since polyps are shrunk by polypectomy. Attaching the calibrated hood appears useful in the measurement of polyp size to determine indications for polypectomy in patients with colon polyps. Keiichiro Kume, Tatsuyuki Watanabe, Ichiro Yoshikawa, and Masaru Harada Copyright © 2014 Keiichiro Kume et al. All rights reserved. High-Intensity Focused Ultrasound Treatment for Advanced Pancreatic Cancer Thu, 26 Jun 2014 06:39:32 +0000 Pancreatic cancer is under high mortality but has few effective treatment modalities. High-intensity focused ultrasound (HIFU) is becoming an emerging approach of noninvasively ablating solid tumor in clinics. A variety of solid tumors have been tried on thousands of patients in the last fifteen years with great success. The principle, mechanism, and clinical outcome of HIFU were introduced first. All 3022 clinical cases of HIFU treatment for the advanced pancreatic cancer alone or in combination with chemotherapy or radiotherapy in 241 published papers were reviewed and summarized for its efficacy, pain relief, clinical benefit rate, survival, Karnofsky performance scale (KPS) score, changes in tumor size, occurrence of echogenicity, serum level, diagnostic assessment of outcome, and associated complications. Immune response induced by HIFU ablation may become an effective way of cancer treatment. Comments for a better outcome and current challenges of HIFU technology are also covered. Yufeng Zhou Copyright © 2014 Yufeng Zhou. All rights reserved. A Gastrointestinal Electrical Stimulation System Based on Transcutaneous Power Transmission Technology Wed, 25 Jun 2014 08:49:18 +0000 Electrical stimulation has been suggested as a possible treatment for various functional gastrointestinal disorders (FGID). This paper presents a transcutaneous power supplied implantable electrical stimulation system. This technology solves the problem of supplying extended power to an implanted electrical stimulator. After implantation, the stimulation parameters can be reprogrammed by the external controller and then transmitted to the implanted stimulator. This would enable parametric studies to investigate the efficacy of various stimulation parameters in promoting gastrointestinal contractions. A pressure detector in the internal stimulator can provide real-time feedback about variations in the gastrointestinal tract. An optimal stimulation protocol leading to cecal contractions has been proposed: stimulation bursts of 3 ms pulse width, 10 V amplitude, 40 Hz frequency, and 20 s duration. The animal experiment demonstrated the functionality of the system and validated the effects of different stimulation parameters on cecal contractions. Bingquan Zhu, Yongbing Wang, Guozheng Yan, Pingping Jiang, and Zhiqiang Liu Copyright © 2014 Bingquan Zhu et al. All rights reserved. Prevalence and Risk Factors of Asymptomatic Colorectal Polyps in Taiwan Mon, 23 Jun 2014 08:04:07 +0000 Purpose. To investigate the prevalence and risk factors of hyperplastic and adenomatous colorectal polyps in a Taiwanese general population. Methods. From January 2009 to December 2011, consecutive asymptomatic subjects undergoing a routine health check-up were evaluated by colonoscopy. The colorectal polyps were assessed, and medical history and demographic data were obtained from each patient. Logistic regression analysis was conducted to search the independent risk factors for asymptomatic hyperplastic and adenomatous colorectal polyps. Results. Of the 1899 asymptomatic subjects, the prevalences of hyperplastic polyps and adenomatous polyps were 11.1% and 16.1%, respectively. Multivariate analysis revealed that high body mass index (: OR, 1.32, 95% CI, 1.05–1.71) and current smoking (OR, 1.87, 95% CI, 1.42–2.71) were independent predictors for hyperplastic colorectal polyps. Age over 60 years old (OR, 3.49, 95% CI, 1.86–6.51), high body mass index (: OR, 1.75, 95% CI, 1.21–2.71), heavy alcohol consumption (OR, 2.01, 95% CI, 1.02–3.99), and current smoking (OR, 1.31, 95% CI, 1.04–1.58) were independent predictors for adenomatous colorectal polyps. Conclusion. High BMI and smoking are common risk factors for both adenomatous and hyperplastic polyps. Old age and alcohol consumption are additional risk factors for the development of adenomatous polyps. Fu-Wei Wang, Ping-I Hsu, Hung-Yi Chuang, Ming-Shium Tu, Guang-Yuan Mar, Tai-Ming King, Jui-Ho Wang, Chao-Wen Hsu, Chiu-Hua Chang, and Hui-Chun Chen Copyright © 2014 Fu-Wei Wang et al. All rights reserved. Duodenal Chromogranin A Cell Density as a Biomarker for the Diagnosis of Irritable Bowel Syndrome Mon, 16 Jun 2014 13:01:34 +0000 Background and Aim. Chromogranin A (CgA) is a common marker for endocrine cells. The density of duodenal CgA cells is reduced in patients with irritable bowel syndrome (IBS). Methods. The present study was undertaken to evaluate the density of duodenal CgA as a biomarker for the diagnosis of IBS. Two hundred and three patients with IBS were recruited (180 females and 23 males; mean age, 36 years; range, 18–66 years). The control group comprised 86 healthy subjects without gastrointestinal complaints (77 females and 9 males; mean age, 38 years; range, 18–67 years). Biopsy samples were taken from the duodenum during gastroscopy. Sections from these biopsy samples were immunostained for CgA using the avidin-biotin complex (ABC) method. CgA cell density was quantified by computerized image analysis. Results. The CgA cell density was lower in IBS-total and in all of the IBS subgroups than in the controls. The sensitivity and specificity for a cutoff of <200 cells/mm2 were 86% and 95%, respectively. Conclusion. The duodenal CgA cell density seems to be a good biomarker for the diagnosis of IBS. It is an inexpensive, simple, and easy-to-use method that does not require sophisticated equipment or considerable experience. Magdy El-Salhy, Odd Helge Gilja, Doris Gundersen, Jan Gunnar Hatlebakk, and Trygve Hausken Copyright © 2014 Magdy El-Salhy et al. All rights reserved. A Modified Technique Reduced Operative Time of Laparoendoscopic Rendezvous Endoscopic Retrograde Cholangiopancreatography Combined with Laparoscopic Cholecystectomy for Concomitant Gallstone and Common Bile Ductal Stone Sun, 15 Jun 2014 11:44:02 +0000 Laparoendoscopic rendezvous (LERV) endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC+ERCP/LERV) are considered an optimal approach for concomitant gallstones and common bile duct stones. The rendezvous technique is essential for the success of procedure. We applied two different LERV techniques, traditional technique and modified technique, in 60 consecutive cases from January 2011 to November 2012. 32 cases who underwent modified technique (group 1) from February 2012 to November 2012 were retrospectively compared to 28 cases (group 2) who underwent traditional technique from January 2011 to January 2012. There was no significant difference between two groups with respect to preoperative demographic features. Although the difference was not statistically significant, the procedure was successfully performed in 31 cases (96.9%) in group 1 and 24 cases (86.2%) in group 2. The mean operative time and time of endoscopic part were 82.6 ± 19.6 min and 26.5 ± 5.99 min in group 1 which were significantly shorter than those in group 2 (118.0 ± 23.1 min and 58.7 ± 13.3 min, resp.). There was no postoperative pancreatitis and mortality in both groups. The mean hospital stay, blood loss, incidence of complications, and residual stone were of no difference in both groups. This study proved that this modified technique can effectively reduce the operative time and time of endoscopic part of LC+ERCP/LERV compared with traditional technique. Wei Liu, Qunwei Wang, Jing Xiao, Liying Zhao, Jiangsheng Huang, Zhaohui Tan, and Pengfei Li Copyright © 2014 Wei Liu et al. All rights reserved. The Relationship between H. pylori Infection and Osteoporosis in Japan Thu, 12 Jun 2014 10:53:24 +0000 Background and Objective. H. pylori infection causes a chronic inflammation in the gastric mucosa. However, this local inflammation may result in extra-digestive conditions. Our aim is to investigate the relationship between H. pylori infection and osteoporosis in Japan. Methods. This cross-sectional study was conducted among outpatients at the Juntendo University Hospital between 2008 and 2014. Participants for patient profile, H. pylori infection status, comorbidity, internal medical therapies, lumbar dual-energy X-ray absorptiometry (DXA), and bone turnover marker were collected and upper gastrointestinal endoscopy for reflux esophagitis, hiatal hernia, peptic ulcer disease (PUD), and endoscopic gastric mucosal atrophy (EGA) was performed. The diagnosis of osteoporosis was performed in accordance with the Japanese criteria. We investigated risk factors of osteoporosis. Results. Of the eligible 200 study subjects, 41 cases were of osteoporosis. Bivariate analysis showed that age, being female, BMI, alcohol, smoking, H. pylori, bone-specific ALP, PUD, and EGA were related to osteoporosis. Multivariate analysis showed that age (OR 1.13; 95%CI 1.07–1.20), being female (OR 4.77; 95%CI 1.78–12.77), BMI (OR 0.79; 95%CI 0.68–0.92), H. pylori (OR 5.33; 95%CI 1.73–16.42), and PUD (OR 4.98; 95%CI 1.51–16.45) were related to osteoporosis. Conclusions. H. pylori infection may be a risk factor of osteoporosis in Japan. Daisuke Asaoka, Akihito Nagahara, Mariko Hojo, Hitoshi Sasaki, Yuji Shimada, Takashi Yoshizawa, Taro Osada, and Sumio Watanabe Copyright © 2014 Daisuke Asaoka et al. All rights reserved. Gut Microbiota in HIV Infection: Implication for Disease Progression and Management Thu, 12 Jun 2014 07:02:52 +0000 Survival rates among HIV patients have significantly improved since the introduction of antiretroviral therapy (ART) in HIV management. However, persistent disease progression and clinical complications in virally suppressed individuals point to additional contributing factors other than HIV replication; microbial translocation is one such factor. The role of underlying commensal microbes and microbial products that traverse the intestinal lumen into systemic circulation in the absence of overt bacteraemia is under current investigation. This review focuses on current knowledge of the complex microbial communities and microbial markers involved in the disruption of mucosal immune T-cells in the promotion of inflammatory processes in HIV infections. Unanswered questions and aims for future studies are addressed. We provide perspective for discussing potential future therapeutic strategies focused on modulating the gut microbiota to abate HIV disease progression. Felix Chinweije Nwosu, Ekaterina Avershina, Robert Wilson, and Knut Rudi Copyright © 2014 Felix Chinweije Nwosu et al. All rights reserved. Stent Selection for Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: A Multicenter Study in China Wed, 11 Jun 2014 11:34:42 +0000 Aims. We attempted to establish some guidelines for the selection of transmural stents during endoscopic drainage of PFCs by retrospective review of the clinical data obtained from three tertiary hospitals. Patients and Methods. Clinical data of 93 patients with attempted endoscopic drainage of symptomatic PFCs were obtained through chart review and prospective follow-up. Results. Treatment success for acute pseudocyst (), chronic pseudocyst (), and WOPN () was 95.3%, 100%, and 88.2%, respectively (). Clinical success for single-stent drainage was 93.9% (46/49) versus 97.4% (37/38) for multiple-stent drainage (). Secondary infection for single-stent drainage was 18.4% (9/49) versus 5.3% (2/38) for multiple-stent drainage (). Secondary infection for stent diameter less than or equal to 8.5 F was 3.4% (1/29) versus 17.2% (10/58) for stent diameter larger than or equal to 10 F (). Conclusion. EUS-guided transmural drainage is an effective therapy for PFCs. Single-stent transmural drainage of PFCs is enough and does not seem to influence clinical success. The number or diameter of stents does not seem to be associated with secondary infection. Hui Lin, Xian-Bao Zhan, Si-Yu Sun, Xiu-Jiang Yang, Zhen-Dong Jin, Duo-Wu Zou, and Zhao-Shen Li Copyright © 2014 Hui Lin et al. All rights reserved. Polyethylene Glycol Electrolyte Lavage Solution versus Colonic Hydrotherapy for Bowel Preparation before Colonoscopy: A Single Center, Randomized, and Controlled Study Thu, 05 Jun 2014 12:35:02 +0000 This single center, randomized, and controlled study aimed to compare the effectiveness and safety of polyethylene glycol electrolyte lavage (PEG-EL) solution and colonic hydrotherapy (CHT) for bowel preparation before colonoscopy. A total of 196 eligible outpatients scheduled for diagnostic colonoscopy were randomly assigned to the PEG-EL () or CHT () groups. Primary outcome measures included colonic cleanliness and adverse effects. Secondary outcome measures were patient satisfaction and preference, colonoscopic findings, ileocecal arrival rate, examiner satisfaction, and cecal intubation time. The results show that PEG-EL group was associated with significantly better colonic cleanliness than CHT group, fewer adverse effects, and increased examiner satisfaction. However, the CHT group had higher patient satisfaction and higher diverticulosis detection rates. Moreover, the results showed the same ileocecal arrival rate and patient preference between the two groups (). These findings indicate that PEG-EL is the preferred option in patients who followed the preparation instructions completely. Yan Cao, Kai-Yuan Zhang, Jiao Li, Hao Lu, Wan-Ling Xie, Sheng-Tao Liao, Dong-Feng Chen, Deng-Feng Zeng, and Chun-Hui Lan Copyright © 2014 Yan Cao et al. All rights reserved. Mast Cells Density Positive to Tryptase Correlates with Angiogenesis in Pancreatic Ductal Adenocarcinoma Patients Having Undergone Surgery Wed, 04 Jun 2014 06:48:16 +0000 Background. Literature data suggest that cells such as mast cells (MCs), are involved in angiogenesis. MCs can stimulate angiogenesis by releasing of several proangiogenic cytokines stored in their cytoplasm. In particular MCs can release tryptase, a potent in vivo and in vitro proangiogenic factor. Nevertheless few data are available concerning the role of MCs positive to tryptase in primary pancreatic cancer angiogenesis. This study analyzed MCs and angiogenesis in primary tumour tissue from patients affected by pancreatic ductal adenocarcinoma (PDAC). Method. A series of 31 PDAC patients with stage (by AJCC for Pancreas Cancer Staging 7th Edition) was selected and then underwent surgery. Tumour tissue samples were evaluated by means of immunohistochemistry and image analysis methods in terms of number of MCs positive to tryptase (MCDPT), area occupied by MCs positive to tryptase (MCAPT), microvascular density (MVD), and endothelial area (EA). The above parameters were related to each other and to the main clinicopathological features. Results. A significant correlation between MCDPT, MCAPT, MVD, and EA group was found by Pearson’s -test analysis ( ranged from 0.69 to 0.81; value ranged from 0.001 to 0.003). No other significant correlation was found. Conclusion. Our pilot data suggest that MCs positive to tryptase may play a role in PDAC angiogenesis and they could be further evaluated as a novel tumour biomarker and as a target of antiangiogenic therapy. Michele Ammendola, Rosario Sacco, Giuseppe Sammarco, Giuseppe Donato, Valeria Zuccalà, Maria Luposella, Rosa Patruno, Ilaria Marech, Severino Montemurro, Nicola Zizzo, Cosmo Damiano Gadaleta, and Girolamo Ranieri Copyright © 2014 Michele Ammendola et al. All rights reserved. Daily Feeding of Fructooligosaccharide or Glucomannan Delays Onset of Senescence in SAMP8 Mice Mon, 02 Jun 2014 11:52:30 +0000 We hypothesized that daily intake of nondigestible saccharides delays senescence onset through the improvement of intestinal microflora. Here, we raised senescence accelerated mice prone 8 (SAMP8) on the AIN93 diet (CONT), with sucrose being substituted for 5% of fructooligosaccharide (FOS) or 5% of glucomannan (GM), 15 mice per group. Ten SAMR1 were raised as reference of normal aging with control diet. Grading of senescence was conducted using the method developed by Hosokawa, and body weight, dietary intake, and drinking water intake were measured on alternate days. Following 38 weeks of these diets we evaluated learning and memory abilities using a passive avoidance apparatus and investigated effects on the intestinal microflora, measured oxidative stress markers, and inflammatory cytokines. Continuous intake of FOS and GM significantly enhanced learning and memory ability and decelerated senescence development when compared with the CONT group. Bifidobacterium levels were significantly increased in FOS and GM-fed mice. Urinary 8OHdG, 15-isoprostane, serum TNF-α, and IL-6 were also lower in FOS-fed mice, while IL-10 in FOS and GM groups was higher than in CONT group. These findings suggest that daily intake of nondigestible saccharides delays the onset of senescence via improvement of intestinal microflora. Sadako Nakamura, Naoyuki Kondo, Yoshitake Yamaguchi, Michiru Hashiguchi, Kenichi Tanabe, Chihiro Ushiroda, Miho Kawahashi-Tokuhisa, Katsuyuki Yui, Mana Miyakoda, and Tsuneyuki Oku Copyright © 2014 Sadako Nakamura et al. All rights reserved. Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis Mon, 02 Jun 2014 11:45:46 +0000 Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included “open abdomen,” “abdominal compartment syndrome,” “laparostomy,” “celiotomy,” “abdominal closure,” “primary,” “delayed,” “permanent,” “fascial closure,” and “definitive closure.” Open abdomen was defined as “fail to close abdominal fascia after a laparotomy.” Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62%) patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53, ) and complication incidence (RR, 0.68, ). The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen. Yu Chen, Jinning Ye, Wu Song, Jianhui Chen, Yujie Yuan, and Jianan Ren Copyright © 2014 Yu Chen et al. All rights reserved. Identification of Aberrantly Expressed miRNAs in Gastric Cancer Sun, 01 Jun 2014 11:49:29 +0000 The noncoding components of the genome, including miRNA, can contribute to pathogenesis of gastric cancer. Their expression has been profiled in many human cancers, but there are a few published studies in gastric cancer. It is necessary to identify novel aberrantly expressed miRNAs in gastric cancer. In this study, the expression profile of 1891 miRNAs was analyzed using a miRCURY array LNA miRNA chip from three gastric cancer tissues and three normal tissues. The expression levels of 4 miRNAs were compared by real-time PCR between cancerous and normal tissues. We found that 31 miRNAs are upregulated in gastric cancer and 10 miRNAs have never been reported by other studies; 30 miRNA are downregulated in gastric cancer tissues. Gene ontology analysis revealed that those dysregulated miRNAs mainly take part in regulating cell proliferation. The levels of has-miR-105, -213, -514b, and -548n were tested by real-time PCR and have high levels in cancerous tissues. Here, we report a miRNA profile of gastric cancer and provide new perspective to understand this malignant disease. This novel information suggests the potential roles of these miRNAs in the diagnosis, prognosis biomarkers, or therapy targets of gastric cancer. Dan Liu, Xiaowei Hu, Hongfeng Zhou, Guangyue Shi, and Jin Wu Copyright © 2014 Dan Liu et al. All rights reserved. Feasibility and Safety of Single-Incision Laparoscopic Surgery in Gastric Benign and Malignant Diseases Wed, 28 May 2014 11:00:39 +0000 We systematically searched Medline and Cochrane Library and the related references occurred in the citations until February 2013 and included all the cases who suffered from gastric benign and malignant diseases where single incision laparoscopic surgery was performed. A total of 69 cases with gastric diseases undergoing SILS surgery were reviewed to evaluate the feasibility, safety, and potential benefits of SILS for the gastric diseases. Demographic data, morphologic characterisation of the lesion, and perioperative parameters were analyzed retrospectively. The initial experience with SILS for benign gastric diseases and early gastric cancer showed that it is feasible and safe when performed by experienced laparoscopic surgeons. Despite the limited number and technical difficulties it can be proposed in selected patients. Kong Jing, Wu Shuo-dong, Fan Ying, and Wang Yu Copyright © 2014 Kong Jing et al. All rights reserved. Epidemiology and Natural History of IBD in the Paediatric Age Wed, 28 May 2014 07:14:31 +0000 Graziella Guariso, Marco Gasparetto, Andrew S. Day, and Paul Henderson Copyright © 2014 Graziella Guariso et al. All rights reserved. Evaluation of the Effectiveness of Endoscopic Retrograde Cholangiopancreatography in Patients with Perihilar Cholangiocarcinoma and Its Effect on Development of Cholangitis Tue, 27 May 2014 08:54:31 +0000 Objective. We aimed to determine the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in patients with inoperable perihilar cholangiocarcinoma and establish the incidence of cholangitis development following ERCP. Material and Method. This retrospective study enrolled patients diagnosed with inoperable perihilar cholangiocarcinoma who underwent endoscopic drainage (stenting) with ERCP. Patients were evaluated for development of cholangitis and the effectiveness of ERCP. The procedure was considered successful if bilirubin level fell more than 50% within 7 days after ERCP. Results. Post-ERCP cholangitis developed in 40.7% of patients. Cholangitis development was observed among 39.4% of patients with effective ERCP and in 60.6% of patients with ineffective ERCP. Development of cholangitis was significantly more common in the group with ineffective ERCP compared to the effective ERCP group (). The average number of ERCP procedures was 2.33 ± 0.89 among patients developing cholangitis and 1.79 ± 0.97 in patients without cholangitis. The number of ERCP procedures was found to be significantly higher among patients developing cholangitis compared to those without cholangitis (). Conclusion. ERCP may not provide adequate biliary drainage in some of the patients with perihilar cholangiocarcinoma and also it is a procedure associated an increased risk of cholangitis. Serkan İpek, Emrah Alper, Cem Cekic, Serkan Cerrah, Mahmut Arabul, Fatih Aslan, and Belkis Unsal Copyright © 2014 Serkan İpek et al. All rights reserved. Influence of Life Style Factors on Barrett’s Oesophagus Mon, 26 May 2014 00:00:00 +0000 Background. Since the incidence of adenocarcinoma of the oesophagus is rising, the prognosis is poor, and surveillance programs are expensive and mostly cost ineffective, there is a need to increase the knowledge of risk factors in Barrett’s oesophagus and oesophageal cancer in order to be able to give attention to medical prevention and/or surveillance programs. Aim. To study if there is a correlation between the development of Barrett’s oesophagus and GOR (gastro oesophageal reflux), family history of GOR, and life style factors, such as alcohol, smoking habits, and mental stress. Methods. Fifty-five consecutively selected patients with Barrett’s oesophagus (BO) examined at Linköping University Hospital’s Oesophageal Laboratory were matched by sex, age, and duration of reflux symptoms with 55 GOR patients without Barrett’s oesophagus at the Oesophageal Laboratory. The medical charts in respective groups were examined for comparison of life style factors, mental stress, medication, duration of gastroesophageal acid reflux at 24 hr-pH-metry, and incidence of antireflux surgery and of adenocarcinoma of the oesophagus (ACO). Also, potential gender differences and diagnosis of ACO were studied. Results. Mean percentage reflux time on 24 hr-pH-metry was higher for the Barrett’s oesophagus group, 18% for women and 17% for men compared to 4% for women and 4% for men in the control group (). Family history of GOR was more frequent in Barrett’s oesophagus patients (62%) than in the control group (35%) (). Male patients with Barrett’s oesophagus had medical therapy for their GOR symptoms to a higher extent (38%) than male controls (65%) (). No difference was found in the number of tobacco users or former tobacco users between Barrett’s oesophagus patients and controls. Barrett’s oesophagus patients had the same level of alcohol consumption and the same average BMI as the control subjects. Female patients with Barrett’s oesophagus rated themselves as more mentally stressed (67%) than the female controls (38%) (). In the five-year medical chart follow-up, five of 55 patients developed adenocarcinoma among the Barrett’s oesophagus patients, none in the control group. Conclusions. Long reflux time and family clustering of GOR seem to influence the development of Barrett’s oesophagus. Smoking habits, alcohol consumption and BMI do not seem to have any impact on the development of Barrett’s oesophagus. A. Horna Strand and T. Franzén Copyright © 2014 A. Horna Strand and T. Franzén. All rights reserved. Brief Education on Microvasculature and Pit Pattern for Trainees Significantly Improves Estimation of the Invasion Depth of Colorectal Tumors Sun, 25 May 2014 10:57:16 +0000 Objectives. This study was performed to evaluate the effectiveness of education for trainees on the gross findings identified by conventional white-light endoscopy (CWE), the microvascular patterns identified by magnifying narrow-band imaging endoscopy (MNE), and the pit patterns identified by magnifying chromoendoscopy (MCE) in estimation of the invasion depth of colorectal tumors. Methods. A total of 420 endoscopic images of 35 colorectal tumors were used. Five trainees estimated the invasion depth of the tumors by reviewing the CWE images before education. Afterwards, the trainees estimated the invasion depth of the same tumors after brief education on CWE, MNE and MCE images, respectively. Results. The initial diagnostic accuracy for deep submucosal invasion before education and after education on CWE, MNE, and MCE findings was 54.3%, 55.4%, 67.4%, and 76.6%, respectively. The diagnostic accuracy increased significantly after MNE education (). The specificity for deep submucosal invasion before education and after education on CWE, MNE, and MCE findings was 47.9%, 45.7%, 65.0%, and 80.7%, respectively. The specificity increased significantly after MNE () and MCE () education. Conclusion. Brief education on microvascular pattern identification by MNE and pit pattern identification by MCE significantly improves trainees’ estimations of the invasion depth of colorectal tumors. Joon Sung Kim, Bo-In Lee, Hwang Choi, Bong Koo Kang, Jong In Kim, Hae Mi Lee, Eun-Joo Im, Byung-Wook Kim, Sang-Woo Kim, Myung-Gyu Choi, and Kyu Yong Choi Copyright © 2014 Joon Sung Kim et al. All rights reserved. Efficacy of Adding Bevacizumab in the First-Line Chemotherapy of Metastatic Colorectal Cancer: Evidence from Seven Randomized Clinical Trials Sun, 25 May 2014 06:52:54 +0000 Background. Efficacy of adding bevacizumab in first-line chemotherapy of metastatic colorectal cancer (mCRC) has been controversial. The aim of this study is to gather current data to analyze efficacy of adding bevacizumab to the most used combination first-line chemotherapy in mCRC, based on the 2012 meta-analysis reported by Macedo et al.  Methods. Medline, EMBASE and Cochrane library, meeting presentations and abstracts were searched. Eligible studies were randomized controlled trials (RCTs) which evaluated first-line chemotherapy with or without bevacizumab in mCRC. The extracting data were included and examined in the meta-analysis according to the type of chemotherapy regimen. Results. Seven trials, totaling 3436 patients, were analyzed. Compared with first-line chemothery alone, the adding of bevacizumab did not show clinical benefit for OS both in first-line therapy and the most used combination chemotherapy (HR = 0.89; 95% CI = 0.78–1.02; ; HR = 0.93; 95% CI = 0.83–1.05; ). In contrast with OS, the addition of bevacizumab resulted in significant improvement for PFS (HR = 0.68; 95% CI = 0.59–0.78; ). Moreover, it also demonstrated statistical benefit for PFS in the most used combination first-line chemotherapy (HR = 0.84; 95% CI = 0.75–0.94; ). And the subgroup analysis indicated only capacitabine-based regimens were beneficial. Conclusions. This meta-analysis shows that the addition of bevacizumab to FOLFOX/FOLFIRI/XELOX regimens might not be beneficial in terms of OS. Benefit has been seen when PFS has been taken into account. In subgroup analysis, benefit adding bevacizumab has been seen when capecitabine-based regimens are used. Further studies are warranted to explore the combination with bevacizumab. Yan-xian Chen, Qiong Yang, Jun-jie Kuang, Shi-yu Chen, Ying Wei, Zhi-min Jiang, and De-rong Xie Copyright © 2014 Yan-xian Chen et al. All rights reserved. Durability of Stretta Radiofrequency Treatment for GERD: Results of an 8-Year Follow-Up Sun, 18 May 2014 13:15:54 +0000 From June 2002 to March 2013 26 patients that underwent Stretta procedure (16 females, 10 males) reached to date an eight-year follow-up. Primary end point of the study was to verify the durability of the procedure at this time. All patients underwent clinical evaluation by upper endoscopy, oesophageal pressure, and pH studies. For each patient 8-year data were compared to those recorded at baseline and at 4 years. There was a significant decrease in both heartburn and GERD HRQL scores at 4 years () and at 8 years () as well as a significant increase of QoL scores at each control time (mental SF-36 and physical SF-36, ). After 4 and 8 years, 21 patients (80.7%, ) and 20 patients (76.9%, ) were completely off PPIs. Median LES pressure did not show significant amelioration at 4 and 8 years and mean oesophageal acid exposure significantly improved at 4 years () but returned to baseline values after 8 years. This further follow-up study of ours from four to eight years confirms that RF energy delivery for GERD provides durable improvement in symptoms and in quality of life and reduces antireflux drugs consumption. Luca Dughera, Gianluca Rotondano, Maria De Cento, Paola Cassolino, and Fabio Cisarò Copyright © 2014 Luca Dughera et al. All rights reserved. The Safety and Efficiency of Surgery with Colonic Stents in Left-Sided Malignant Colonic Obstruction: A Meta-Analysis Wed, 14 May 2014 00:00:00 +0000 Objective. This meta-analysis is aimed at assessing the safety and efficiency of colonic self-expanding metallic stents (SEMS) used as a bridge to surgery in the management of left-sided malignant colonic obstruction (LMCO). Methods. A systematic search was conducted in PubMed, Web of Knowledge, OVID, Google Scholar, CNKI, and WANGFANG for relevant randomized trials comparing colonic stenting used as a bridge in semielective surgery versus emergency surgery from January 2001 to September 2013. Result. Five published studies were included in this systematic review, including 273 patients (140 male/133 female). 136 patients received semielective surgery after SEMS installation while 137 patients underwent emergency surgery without SEMS. SEMS intervention resulted in significantly lower overall colostomy rate (41.9% versus 56.2%, ), surgical site infection rate (10.2% versus 19.7%, ), and overall complication rate (29.2% versus 60.5%, ). There was no statistic difference for the rate of primary anastomosis, anastomotic leak and operation-related mortality between two groups. Conclusions. semielective surgery with SEMS as a bridge for proper patients of LMCO can lower the overall rate for colostomy, surgical site infection, and complications. Xiang Zhao, Bo Liu, Ende Zhao, Jiliang Wang, Ming Cai, Zefeng Xia, Qinghua Xia, Xiaoming Shuai, Kaixiong Tao, Guobin Wang, and Kailin Cai Copyright © 2014 Xiang Zhao et al. All rights reserved. Association between Helicobacter pylori Infection and Risk of Osteoporosis in Elderly Taiwanese Women with Upper Gastrointestinal Diseases: A Retrospective Patient Record Review Tue, 13 May 2014 13:01:28 +0000 Introduction. Helicobacter pylori (H. pylori) infection could lead to chronic local and systemic immune response. The resulting increase in proinflammatory cytokines could affect bone resorption and might increase the risk of osteoporosis. This study aimed to investigate the association between H. pylori infection and osteoporosis in elderly female patients with upper gastrointestinal diseases. Methods. A retrospective patient record review study was conducted in a regional teaching hospital in south Taiwan. Relevant information on female patients aged 65 and over who were diagnosed with diseases of esophagus, gastric ulcer, or duodenal ulcer during January 2008 to December 2010 were abstracted. Association between H. pylori infection and osteoporosis was evaluated using multivariate logistic regression analysis. Results. Of the 365 patients with a mean age of 77.3 years, 77 (21.1%) had H. pylori infection and 101 (27.7%) had been diagnosed with osteoporosis. Multivariate logistic regression analysis revealed that osteoporosis was significantly associated with H. pylori infection (adjusted odds ratio = 2.03, 95% confidence interval = 1.14–3.62) after adjusting for age group, body mass index group, and use of proton pump inhibitor. Conclusion. Osteoporosis was found to be associated with H. pylori infection in Taiwanese female patients with upper gastrointestinal diseases. Further studies with information on potential confounders are needed to confirm the association. Shih-Chun Lin, Malcolm Koo, and Kun-Wei Tsai Copyright © 2014 Shih-Chun Lin et al. All rights reserved. Imaging in Gastroenterology Sun, 11 May 2014 07:39:30 +0000 Radu Badea, Iwona Sudoł-Szopińska, Sebastian Mueller, Horia Ştefănescu, and Monica Lupsor Platon Copyright © 2014 Radu Badea et al. All rights reserved. A Cross-Sectional Study of Risk Factors for Irritable Bowel Syndrome in Children 8–13 Years of Age in Suzhou, China Sun, 11 May 2014 00:00:00 +0000 To determine the prevalence and risk factors of IBS in children 8–13 years of age in Suzhou city, a cross-sectional study was conducted on children in grades 1 through 6 in public elementary schools in three districts of Suzhou. A multistage stratified random-sampling survey was conducted in a primary investigation using standardized questionnaires. Rome II criteria were used to confirm IBS and their risk factors were analyzed. Of 8,000 questionnaires 7,472 responded satisfactorily for a response rate of 93.4%. IBS was diagnosed in 10.81%. A decrease in the prevalence of IBS was significantly associated with advancing age and grade in school (trend test, ). The prevalence of IBS in females was higher but not significantly different than males. The significant risk factors for IBS included young age (OR = 0.94), food allergy (OR = 1.53), gastroenteritis during childhood (OR = 1.29), eating fried food (OR = 1.62), anxiety (OR = 1.49), psychological insults in early childhood (OR = 1.47), and parental history of constipation (OR = 1.81; all ). IBS prevalence of 10.81% in study population warrants preventive measures such as encouraging dietary changes, preventing gastroenteritis and childhood psychological insults. Xueping Zhu, Weichang Chen, Xiaoli Zhu, and Yueping Shen Copyright © 2014 Xueping Zhu et al. All rights reserved. Aberrant MicroRNAs in Pancreatic Cancer: Researches and Clinical Implications Thu, 08 May 2014 12:48:53 +0000 Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with a high rate of mortality and poor prognosis. Numerous studies have proved that microRNA (miRNA) may play a vital role in a wide range of malignancies, including PDAC, and dysregulated miRNAs, including circulating miRNAs, are associated with PDAC proliferation, invasion, chemosensitivity, and radiosensitivity, as well as prognosis. Greater understanding of the roles of miRNAs in PDAC could provide insights into this disease and identify potential diagnostic markers and therapeutic targets. The current review focuses on recent advances with respect to the roles of miRNAs in PDAC and their practical value. Tao Sun, Xiangyu Kong, Yiqi Du, and Zhaoshen Li Copyright © 2014 Tao Sun et al. All rights reserved. MDCT of Small Bowel Obstruction: How Reliable Are Oblique Reformatted Images in Localizing Point of Transition? Tue, 06 May 2014 00:00:00 +0000 The goal of this study is to prospectively assess the additional value of oblique reformatted images for localizing POT, having surgery as a reference standard. Materials and Methods. 102 consecutive patients with suspected small bowel obstruction (SBO) underwent 64-slice multidetector row CT (MDCT) using surgical findings as reference standard. Two independent GI radiologists reviewed the CT scans to localize the exact POT by evaluating axial images (data set A) followed by axial, coronal, and oblique MPR images. CT findings were compared to surgical findings in terms of diagnostic performance. McNemar’s test was used to detect any statistical difference in POT evaluation between datasets A and B. Kappa statistics were applied for measuring agreement between two readers. Results. There was a diagnostic improvement of 9.9% in the case of the less experienced radiologist in localizing POT by using oblique reformatted images. The more experienced radiologist showed diagnostic improvement by 12.9%. Wasim Memon, Yasir Jamil Khattak, Tariq Alam, Luca Maria Sconfienza, Muhammad Awais, and Shayan Sirat Maheen Anwar Copyright © 2014 Wasim Memon et al. All rights reserved.