Gastroenterology Research and Practice The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Genome-Wide and Gene-Specific Epigenomic Platforms for Hepatocellular Carcinoma Biomarker Development Trials Thu, 17 Apr 2014 00:00:00 +0000 The majority of the epigenomic reports in hepatocellular carcinoma have focused on identifying novel differentially methylated drivers or passengers of the oncogenic process. Few reports have considered the technologies in place for clinical translation of newly identified biomarkers. The aim of this study was to identify epigenomic technologies that need only a small number of samples to discriminate HCC from non-HCC tissue, a basic requirement for biomarker development trials. To assess that potential, we used quantitative Methylation Specific PCR, oligonucleotide tiling arrays, and Methylation BeadChip assays. Concurrent global DNA hypomethylation, gene-specific hypermethylation, and chromatin alterations were observed as a hallmark of HCC. A global loss of promoter methylation was observed in HCC with the Illumina BeadChip assays and the Nimblegen oligonucleotide arrays. HCC samples had lower median methylation peak scores and a reduced number of significant promoter-wide methylated probes. Promoter hypermethylation of RASSF1A, SSBP2, and B4GALT1 quantified by qMSP had a sensitivity ranging from 38% to 52%, a specificity of 100%, and an AUC from 0.58 to 0.75. A panel combining these genes with HCC risk factors had a sensitivity of 87%, a specificity of 100%, and an AUC of 0.91. Christina Michailidi, Ethan Soudry, Mariana Brait, Leonel Maldonado, Andrew Jaffe, Carmen Ili-Gangas, Priscilla Brebi-Mieville, Jimena Perez, Myoung Sook Kim, Xiaoli Zhong, Quiang Yang, Blanca Valle, Stephen J. Meltzer, Michael Torbenson, Manel Esteller, David Sidransky, and Rafael Guerrero-Preston Copyright © 2014 Christina Michailidi et al. All rights reserved. Lactose Malabsorption Testing in Daily Clinical Practice: A Critical Retrospective Analysis and Comparison of the Hydrogen/Methane Breath Test and Genetic Test ( Polymorphism) Results Wed, 16 Apr 2014 12:10:07 +0000 The aim of this study was to establish a retrospective evaluation and comparison of the hydrogen/methane (H2/CH4) breath test and genetic test (C/T−13910 polymorphism) results in lactose malabsorption testing. In total 263 consecutive patients with suspected lactose malabsorption were included in this study. They underwent the H2/CH4 breath test following the ingestion of 50 g lactose and were tested for the C/T−13910 polymorphism. In total 51 patients (19.4%) had a C/C−13910 genotype, indicating primary lactose malabsorption. Only 19 patients (7.2%) also had a positive H2/CH4 breath test. All in all 136 patients (51.69%) had a C/T−13910 and 76 patients (28.91%) a T/T−13910 genotype, indicating lactase persistence. Four patients (1.5%) with the C/T−13910 genotype and one patient (0.4%) with the T/T−13910 genotype had a positive H2/CH4 breath test result, indicating secondary lactose malabsorption. Cohen's Kappa measuring agreement between the two methods was 0.44. Twenty patients (7.6%) with a positive H2/CH4 peak within 60 minutes after lactose ingestion were classified as patients with lactose-dependent small intestinal bacterial overgrowth (SIBO). In conclusion, only moderate agreement between the breath test and the genetic test was shown. Secondary lactose malabsorption as well as preanalytical limitations of the combined H2/CH4 breath test procedure can cause discrepant results. This trial is registered with K-42-13. Dietmar Enko, Erwin Rezanka, Robert Stolba, and Gabriele Halwachs-Baumann Copyright © 2014 Dietmar Enko et al. All rights reserved. Adalimumab Treatment in Biologically Naïve Crohn’s Disease: Relationship with Ectopic MUC5AC Expression and Endoscopic Improvement Wed, 16 Apr 2014 08:57:57 +0000 Background. Adalimumab (ADA) is effective for patients with Crohn’s disease (CD). However, there have been few reports on ADA therapy with respect to its relationship with pathologic findings and drug efficacy in biologically naïve CD cases. Methods. Fifteen patients with active biologically naïve CD were treated with ADA. We examined them clinically and pathologically with ectopic MUC5AC expression in the lesions before and after 12 and 52 weeks of ADA therapy, retrospectively. Results. Both mean CD activity index scores and serum C-reactive protein values were significantly lower after ADA therapy (). In the MUC5AC negative group, all cases exhibited clinical remission (CR) and endoscopic improvement at 52 weeks. In MUC5AC positive groups, loss of MUC5AC expression was detected in cases having CR and endoscopic improvement at 52 weeks, while remnant ectopic MUC5AC expression was observed in those exhibiting no endoscopic improvement and flare up after 52 weeks. Conclusions. ADA leads to CR and endoscopic improvement in biologically naïve CD cases. In addition, ectopic MUC5AC expression may be a predictive marker of flare up and endoscopic improvement in the intestines of CD patients. Tsutomu Mizoshita, Satoshi Tanida, Hironobu Tsukamoto, Keiji Ozeki, Takahito Katano, Hirotaka Nishiwaki, Masahide Ebi, Yoshinori Mori, Eiji Kubota, Hiromi Kataoka, Takeshi Kamiya, and Takashi Joh Copyright © 2014 Tsutomu Mizoshita et al. All rights reserved. Geographic Mapping of Crohn’s Disease and Its Relation to Affluence in Jiangsu Province, an Eastern Coastal Province of China Tue, 15 Apr 2014 14:11:32 +0000 Background. Geographical variation in the incidence of Crohn’s disease (CD) has been reported in Europe and North American. However, there are no comparable data in mainland China. Methods. We retrospectively identified incident cases of CD patients registered in Jinling hospital during 2003 to 2012. The standardized incidence ratio (SIR) was calculated for each area of Jiangsu province and a thematic map of CD was made according to the local SIR. The association between incidence and local economic status was revealed by correlation between SIR of CD and different local economic indicators. Results. A total of 653 CD patients (male-to-female ratio, 1.8 : 1) from Jiangsu province were included. A steady increase was observed in the number of CD patients over the period of observation. Disease map of SIR showed a pronounced geographic concentration of CD in the south part of Jiangsu province. Spearman correlation analysis showed a positive correlation between local SIR of CD and local economic indicators. Conclusions. There is a marked geographic variability in CD incidence across Jiangsu province. CD incidence in affluent areas seems to be higher than that in less affluent areas. Further multicenter population-based studies are needed to assess the real disease map of CD. Dong Hu, Jianan Ren, Gefei Wang, Guosheng Gu, Song Liu, Xiuwen Wu, Jun Chen, Huajian Ren, Zhiwu Hong, and Jieshou Li Copyright © 2014 Dong Hu et al. All rights reserved. Synchronized Dual Pulse Gastric Electrical Stimulation Induces Activation of Enteric Glial Cells in Rats with Diabetic Gastroparesis Thu, 10 Apr 2014 12:30:18 +0000 Objective. The aims of this study were to investigate the effects of synchronized dual pulse gastric electrical stimulation (SGES) on gastric motility in different periods for diabetic rats and try to explore the possible mechanisms of the effects. Methods. Forty-six rats were used in the study. Gastric slow waves were recorded at baseline, 7–14-day diabetes and 56–63-day diabetes before and after stimulation and the age-matched control groups. SGES-60 mins and SGES-7 days (60 mins/day) were performed to test the effects on gastric motility and to evaluate glial marker S100B expression in stomach. Results. (1) Gastric emptying was accelerated in 7–14-day diabetes and delayed in 56–63-day diabetes. (2) The S100B expression in 56–63-day diabetes decreased and the ultrastructure changed. (3) The age-associated loss of EGC was observed in 56–63-day control group. (4) SGES was able to not only accelerate gastric emptying but also normalize gastric slow waves. (5) The S100B expression increased after SGES and the ultrastructure of EGC was partially restored. The effect of SGES-7 days was superior to SGES-60 mins. Conclusions. Delayed gastric emptying due to the growth of age may be related to the EGC inactivation. The effects of the SGES on gastric motility may be associated with EGC activation. Wei Yang, Nian Wang, Xue Shi, and Jie Chen Copyright © 2014 Wei Yang et al. All rights reserved. The CIMP Phenotype in BRAF Mutant Serrated Polyps from a Prospective Colonoscopy Patient Cohort Thu, 10 Apr 2014 00:00:00 +0000 Colorectal cancers arising via the serrated pathway are often associated with BRAF V600E mutation, CpG island methylator phenotype (CIMP), and microsatellite instability. Previous studies have shown a strong association between BRAF V600E mutation and serrated polyps. This study aims to evaluate CIMP status of all the serrated polyp subtypes and its association with functionally important genes such as MLH1, p16, and IGFBP7. CIMP status and methylation were evaluated using the real-time based MethyLight assay in 154 serrated polyps and 63 conventional adenomas. Results showed that CIMP-high serrated polyps were strongly associated with BRAF mutation and proximal colon. CIMP-high was uncommon in conventional adenomas (1.59%), occurred in 8.25% of hyperplastic polyps (HPs), and became common in sessile serrated adenomas (SSAs) (51.43%). MLH1 methylation was mainly observed in the proximal colon and was significantly associated with BRAF mutation and CIMP-high. The number of samples methylated for p16 and IGFBP7 was the highest in SSAs. The methylation panel we used to detect CIMP is highly specific for CIMP-high cancers. With this panel, we demonstrate that CIMP-high is much more common in SSAs than HPs. This suggests that CIMP-high correlates with increased risk of malignant transformation which was also observed in methylation of functionally important genes. Winnie C. Fernando, Mariska S. Miranda, Daniel L. Worthley, Kazutomo Togashi, Dianne J. Watters, Barbara A. Leggett, and Kevin J. Spring Copyright © 2014 Winnie C. Fernando et al. All rights reserved. Safety of Laparoscopic Colorectal Surgery in a Low-Volume Setting: Review of Early and Late Outcome Thu, 03 Apr 2014 08:53:49 +0000 Background. There is increasing evidence suggesting that the laparoscopic technique is the treatment of choice for large bowel resection, including for malignancy. The purpose of the study was to assess whether general surgeons, with particular skills in advanced laparoscopy, can adequately provide safe laparoscopic colorectal resections in a low-volume setting. Methods. A retrospective review of prospectively collected case series of all laparoscopic colorectal resections performed under the care of a single general surgeon is presented. The primary endpoint was postoperative clinical outcome in terms of morbidity and mortality. Secondary endpoints were adequacy of surgical margins and number of lymph nodes harvested for colorectal cancer cases. Results. Seventy-three patients underwent 75 laparoscopic resections between March, 2003, and May, 2011. There was no elective mortality and the overall 30-day postoperative morbidity was 9.3%. Conversion and anastomotic leakage rates were both 1.3%, respectively. None of the malignant cases had positive margins and the median number of lymph nodes retrieved was 17. Conclusions. Our results support the view that general surgeons with advanced skills in minimally invasive surgery may safely perform laparoscopic colorectal resection in a low-volume setting in carefully selected patient cases. Robert C. Gandy and Christophe R. Berney Copyright © 2014 Robert C. Gandy and Christophe R. Berney. All rights reserved. Serum Activins and Follistatin during the Treatment of Chronic Hepatitis C Genotypes 1 and 4 and Their Correlations with Viral Load and Liver Enzymes: A Preliminary Report Tue, 01 Apr 2014 12:46:35 +0000 Aims. To measure the effect of pegylated interferon-α therapy on serum activin-A, activin-B, and follistatin and their correlation with viral load and liver fibrosis in chronic hepatitis C (CHC). Methods. This study was cross-sectional and sera were collected from 165 participants classified into 7 groups: 40 healthy negative control, 33 treatment naïve patients as positive control, 19 patients at week 4, 22 at week 12, and 19 at week 24 of treatment initiation and 21 responders and 11 nonresponders at the end of 48-week treatment protocol. Serum candidate proteins were measured using ELISA and liver fibrosis was assessed by AST platelet ratio index (APRI). Results. CHC significantly increased activins and decreased follistatin compared to negative control . Activin-A and follistatin levels returned to the levels of negative control group at weeks 4, 12, and 24 following treatment initiation and were significantly different from positive control . Both proteins were significantly different between responders and nonresponders. Activin-A correlated positively and significantly with the viral load and APRI. Conclusion. CHC modulates serum activin-A and follistatin and they appear to be influenced by pegylated interferon-α therapy. Further studies are needed to explore the role of activins in CHC. Bassem Refaat, Adel Galal El-Shemi, Ahmed Mohamed Ashshi, and Adnan AlZanbagi Copyright © 2014 Bassem Refaat et al. All rights reserved. Overexpression of Testes-Specific Protease 50 (TSP50) Predicts Poor Prognosis in Patients with Gastric Cancer Sun, 30 Mar 2014 11:31:32 +0000 Purpose. To investigate the expression of TSP50 protein in human gastric cancers and its correlation with clinical/prognostic significance. Methods. Immunohistochemistry (IHC) analysis of TSP50 was performed on a tissue microarray (TMA) containing 334 primary gastric cancers. Western blot was carried out to confirm the expression of TSP50 in gastric cancers. Results. IHC analysis revealed high expression of TSP50 in 57.2% human gastric cancer samples (191 out of 334). However, it was poorly expressed in all of the 20 adjacent nontumor tissues. This was confirmed by western blot, which showed significantly higher levels of TSP50 expression in gastric cancer tissues than adjacent nontumor tissues. A significant association was found between high levels of TSP50 and clinicopathological characteristics including junior age at surgery (), later TNM stage (), and present lymph node metastases (). The survival of gastric cancer patients with high expression of TSP50 was significantly shorter than that of the patients with low levels of TSP50 (). Multivariate Cox regression analysis indicated that TSP50 overexpression was an independent prognostic factor for gastric cancer patients (). Conclusions. Our data demonstrate that elevated TSP50 protein expression could be a potential predictor of poor prognosis in gastric cancer patients. Fang Liu, Qinghua Cao, Ni Liu, Changzhao Li, Changxuan You, Chuanxin Liu, Ling Xue, and Rongcheng Luo Copyright © 2014 Fang Liu et al. All rights reserved. Inflammatory Bowel Disease in Australasian Children and Adolescents Sun, 30 Mar 2014 10:02:17 +0000 Many reports indicate increasing rates of inflammatory bowel disease, with data also showing changing patterns of this chronic disease in children and adolescents. This review focuses upon the available data of the epidemiology of inflammatory bowel disease in children and adolescents in Australia and New Zealand (collectively termed Australasia). Recent data show high incidence of IBD (especially Crohn disease) in this area and indicate rising rates of IBD in children and adolescents. A. S. Day, D. A. Lemberg, and R. B. Gearry Copyright © 2014 A. S. Day et al. All rights reserved. Association between Faecalibacterium prausnitzii Reduction and Inflammatory Bowel Disease: A Meta-Analysis and Systematic Review of the Literature Thu, 27 Mar 2014 07:15:20 +0000 Background. Laboratory data suggests a reduction of Faecalibacterium prausnitzii (F. prausnitzii) is confirmed both in fecal samples in inflammatory bowel disease (IBD) patients. Numerous observational studies have suspected dysbiosis, an imbalance between protective and harmful bacteria to be relevant to the etiology and pathogenesis of IBD. Methods. Medline, EMBASE, Pubmed, and others. were searched by 2 independent reviewers. Of 48 abstracts reviewed, 11 studies met our inclusion criteria (subject ). Meta-analysis was performed with Review Manager 5.2. Results. The bacterial count of F. prausnitzii in IBD patients was significantly lower () log10 CFU/g feces than healthy controls () log10 CFU/g feces; . The Standardization Mean Difference of F. prausnitzii in IBD patients was −0.94 (95% confidence interval [CI]: −1.07–−0.80). Subgroup analyses revealed a trend toward a greater effect for CD (SMD: −1.13, 95% CI: −1.32–−0.94) when compared to UC (SMD: −0.78, 95% CI: −0.97–−0.60). Conclusions. The abundance of F. prausnitzii was decreased in IBD patients compared with healthy controls. Furthermore, the reduction of F. prausnitzii and misbalance of the intestinal microbiota are particularly higher in CD patients with ileal involvement. Yuan Cao, Jun Shen, and Zhi Hua Ran Copyright © 2014 Yuan Cao et al. All rights reserved. Erratum to “Prognostic and Predictive Value of CpG Island Methylator Phenotype in Patients with Locally Advanced Nonmetastatic Sporadic Colorectal Cancer” Wed, 26 Mar 2014 11:18:39 +0000 Yuwei Wang, Yadong Long, Ye Xu, Zuqing Guan, Peng Lian, Junjie Peng, Sanjun Cai, and Guoxiang Cai Copyright © 2014 Yuwei Wang et al. All rights reserved. Incidence and Paris Classification of Pediatric Inflammatory Bowel Disease Thu, 20 Mar 2014 12:31:48 +0000 New epidemiological data suggest that the incidence of inflammatory bowel disease (IBD) is increasing. As a result the burden of disease accounts for more strains to the health care system. The clinical variability queries whether disease characteristics are related to clinical outcome. Our aim was to delineate the latest results of incidence trends in pediatric IBD and to compare the first experiences with Paris Classification. Incidence of pediatric IBD has been increasing in Western Europe and in Eastern Europe. To better characterize IBD, Paris Classification was introduced and validated recently. Ileocolonic involvement is the most characteristic disease location in Crohn’s disease (CD) based on applying Paris Classification. The rate of perianal disease and complicated behaviour in CD was similar. It is of interest that CD patients with colonic involvement were less likely to have stricturing disease compared with patients with ileal involvement. In addition, pancolitis dominated in ulcerative colitis (UC). However, most countries lack prospective, nationwide epidemiological studies to estimate incidence trends. This review emphasizes the importance of nationwide registries that enroll all pediatric IBD cases serving reliable data for “everyday practice.” These first reports have shown that Paris Classification is a useful tool to determine the pediatric IBD phenotype. Katalin Eszter Müller, Peter Laszlo Lakatos, Maria Papp, and Gabor Veres Copyright © 2014 Katalin Eszter Müller et al. All rights reserved. Delayed Laparoscopic Cholecystectomy Is Safe and Effective for Acute Severe Calculous Cholecystitis in Patients with Advanced Cirrhosis: A Single Center Experience Wed, 19 Mar 2014 12:08:47 +0000 Acute calculous cholecystitis is a common disease in cirrhotic patients. Laparoscopic cholecystectomy can resolve this problem but is performed based on the premise that the local inflammation must been controlled. An Initial ultrasound guided percutaneous transhepatic cholecystostomy may reduce the local inflammation and provide advantages in subsequent surgery. In this paper, we detailed our experience of treating acute severe calculous cholecystitis in patients with advanced cirrhosis by delayed laparoscopic cholecystectomy plus initiated ultrasound guided percutaneous transhepatic cholecystostomy and provided the analysis of the treatment effect. We hope this paper can provided a kind of standard procedure for this special disease; however, further prospective comparative randomized trials are needed to assess this treatment in cirrhotic patients with acute cholecystitis. Zhicheng Yao, Kunpeng Hu, Pingzhu Huang, He Huang, Xingui Chen, Peisheng Yang, and Bo Liu Copyright © 2014 Zhicheng Yao et al. All rights reserved. Helicobacter pylori and Systemic Disease Wed, 19 Mar 2014 11:30:31 +0000 Chao-Hung Kuo, Yen-Hsu Chen, Khean-Lee Goh, and Lin-Li Chang Copyright © 2014 Chao-Hung Kuo et al. All rights reserved. Common Bile Duct Dilatations in Asymptomatic Neonates: Incidence and Prognosis Wed, 19 Mar 2014 09:59:03 +0000 Background. This retrospective study reviewed 213 asymptomatic neonates with common bile duct (CBD) dilatations diagnosed via ultrasound to evaluate their incidence and outcomes. Materials and Methods. From August 2001 to July 2010, 18,230 abdominal ultrasound scans were performed as newborn screening. There were 213 (1.17%) cases of CBD dilatation. Dilatation of neonatal CBD was defined when its diameter was ≥2 mm. The neonates’ birth history, CBD size, and follow-up results were analyzed. Results. In the 213 infants, four cystic dilatations (1.88%, 4/213) that were eventually diagnosed as choledochal cysts (CC). Among 209 neonates with fusiform dilatations (size 2.0–6.7 mm), 77 had ultrasound follow-up and 87% of them resolved spontaneously which were diagnosed as transient CBD dilatation (TCBDD). Eighty percent of TCBDDs resolved within 6 months. Patients with initial CBD size ≥3 mm had significantly lower resolution rate and neonates whose mothers are older than 35 years took longer time to resolve. Conclusion. The incidence of CBD dilatation in asymptomatic neonates was 1.17%. Eighty percent of TCBDDs resolved within 6 months. Regular ultrasound follow-up every 6 months may be appropriate for asymptomatic neonates with fusiform CBD dilatations to ensure resolution or progression. Shun-Feng Lin, Hung-Chang Lee, Chun-Yan Yeung, Chuen-Bin Jiang, and Wai-Tao Chan Copyright © 2014 Shun-Feng Lin et al. All rights reserved. The Prevalence, Risk Factors, and Clinical Correlates of Erosive Esophagitis and Barrett’s Esophagus in Iranian Patients with Reflux Symptoms Mon, 17 Mar 2014 06:29:52 +0000 Background. Erosive esophagitis (EE) and Barrett’s esophagus (BE) are the two important complications of gastroesophageal reflux disease. We aimed to investigate the prevalence of and the risk factors for EE and BE in an Iranian group of patients with reflux symptoms. We also examined the relationship between reflux symptoms and endoscopic findings. Methods. A total of 736 patients with gastroesophageal reflux disease (GERD) symptoms were enrolled and all underwent upper gastrointestinal endoscopy. Diagnosis of Barrett’s esophagus was confirmed by pathologic examination and Helicobacter pylori (H. pylori) infection was demonstrated by rapid urease test. Results. Two hundred eighty-three and 34 patients were found to have EE and BE, respectively. Multivariate analysis showed that hiatal hernia () and H. pylori infection () were the two significantly related risk factors for esophagitis. Only age was related to BE, with BE patients being more likely to be older () than others. Conclusions. Prevalence of EE and BE in Iranian reflux patients is similar to that seen in western countries. H. pylori infection and the presence of hiatal hernia may be strong risk factors for esophagitis as does older age for Barrett’s esophagus. Finally, reflux symptoms have no significant relationship with endoscopic findings. Alireza Sharifi, Shahab Dowlatshahi, Hedieh Moradi Tabriz, Fatemeh Salamat, and Omid Sanaei Copyright © 2014 Alireza Sharifi et al. All rights reserved. Functional Outcomes and Quality of Life after Restorative Proctocolectomy in Paediatric Patients: A Case-Control Study Sun, 16 Mar 2014 14:33:25 +0000 Background. Restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) has some peculiarities in paediatric ulcerative colitis (UC). Aims. The primary aim was to compare the bowel function of patients undergoing IPAA between those operated on in childhood and adulthood. The secondary aim was to compare the quality of life (QoL) and outcomes for children between medical and surgical therapies. Method. Children undergoing IPAA were compared with adult patients undergoing IPAA between 2007 and 2012. Function was assessed 1 year after ileostomy closure. Function and QoL of medically managed paediatric patients were compared with their surgical counterparts. Results. Twelve paediatric IPAA patients were compared with 24 adult ones. Acute presentation was common in the former, usually after failed biological treatment. Recurrent pouchitis was more frequent in children. Younger patients exhibited a trend toward better discrimination and continence. QoL was excellent in both groups. Twelve medically treated children were enrolled for secondary aim. Functioning was similar in IPAA- and medically managed children, but the former had a better QoL, confirmed by parents’ perception. Conclusions. Similar function is achieved by IPAA in childhood or adulthood. IPAA may offer a better QoL compared to prolonged medical management. The beneficial effects of IPAA experienced by children were similarly observed by their parents. Gianluca Pellino, Guido Sciaudone, Erasmo Miele, Giuseppe Candilio, Gilda Serena De Fatico, Gabriele Riegler, Annamaria Staiano, Silvestro Canonico, and Francesco Selvaggi Copyright © 2014 Gianluca Pellino et al. All rights reserved. Frequent Abdominal Pain in Childhood and Youth: A Systematic Review of Psychophysiological Characteristics Thu, 13 Mar 2014 11:12:37 +0000 Background. Frequent abdominal pain (AP) in children and adolescents is often designated as functional gastrointestinal disorder. In contrast to research on psychological and social influences on the experience of AP in this population, psychophysiological features such as function of the autonomic nervous system, the central nervous system, or the endocrine system have rarely been studied. Methods. We conducted a systematic literature search for peer-reviewed journal articles referring to children with AP between 4 and 18 years. Studies on experimental baseline characteristics or reactivity of psychophysiological outcome parameters (autonomous nervous system, central nervous system, and endocrine parameters) were included. Key Results. Twelve of 18 included studies found psychophysiological differences between children with AP and healthy ones. These studies indicate a possible autonomic dysregulation and hypersensitivity of the central nervous system in children with AP following stimulation with stress or other intense stimuli. Mainly conflicting results were found regarding baseline comparisons of autonomic and endocrine parameters. Conclusions and Inferences. Frequent AP in children may be associated with an altered psychophysiological reaction on intense stimuli. It has to be considered that the current literature on psychophysiological characteristics of childhood AP is small and heterogeneous. In particular, multiparameter studies using validated experimental paradigms are lacking. Marco Daniel Gulewitsch, Judith Müller, Paul Enck, Katja Weimer, Juliane Schwille-Kiuntke, and Angelika Anita Schlarb Copyright © 2014 Marco Daniel Gulewitsch et al. All rights reserved. Capsule Endoscopy in the Small Bowel Crohn’s Disease Tue, 11 Mar 2014 16:32:16 +0000 CD is a chronic inflammatory disorder associated to mucosal and transmural inflammation of the bowel wall. It is well known that CD can affect the entire gastrointestinal. Therefore, ileocolonoscopy and biopsies of the terminal ileum as well as of each colonic segment to look for microscopic evidence of CD are the first-line procedures to establish the diagnosis. However, it has been observed that up to 30% of the patients have only small bowel involvement. Evaluation of the small bowel has been made with radiological procedures, barium radiography, and abdominal computed tomography or by ileocolonoscopy or enteroscopy, but they have many recognized limitations. CE is undoubtedly a very useful diagnostic tool proposed to observe small-bowel lesions undetectable by conventional endoscopy or radiologic studies. We review different studies that have been published reporting the use of CE in suspected and evaluation of the extension or the recurrence in CD and also its use in pediatric population and its complications. Federico Argüelles-Arias, Juan Rodríguez-Oballe, Calixto Duarte-Chang, Luisa Castro-Laria, Josefa María García-Montes, Ángel Caunedo-Álvarez, and Juan Manuel Herrerías-Gutiérrez Copyright © 2014 Federico Argüelles-Arias et al. All rights reserved. Efficacy of i-Scan Imaging for the Detection and Diagnosis of Early Gastric Carcinomas Sun, 09 Mar 2014 09:53:35 +0000 We determined comparative efficacy of i-Scan for detection and diagnosis of gastric cancer. Ten patients diagnosed with early gastric cancer based on histopathological findings were analyzed. White light and i-Scan moving images recorded from these patients in twin mode were separated into white light and i-Scan. Twelve endoscopists (three different skill levels) blinded to patient information evaluated the images. Correlation between demarcation accuracy and lesion brightness on still images was investigated. No significant differences were found in diagnostic accuracy between white light and i-Scan moving images for tumor detection rate (91.7% versus 90.8%, ). Diagnostic accuracy of tumor size was comparable between novice and experienced endoscopists for i-Scan moving images (65.7% versus 71.1%, ), whereas it was significantly lower for white light moving images (41.2% versus 79.5%, ). Tumor demarcation accuracy was significantly better with white light than i-Scan still images (71.0% versus 65.8%, ). Correlations between demarcation accuracy and brightness reached highs of 0.75 for white light and 0.89 for i-Scan imaging. Efficacy of i-Scan over that of white light imaging for detecting and diagnosing gastric cancer was not shown; however, the diagnostic capability of i-Scan can be improved if imaging conditions are optimized. Junichi Nishimura, Jun Nishikawa, Munetaka Nakamura, Atsushi Goto, Kouichi Hamabe, Shinichi Hashimoto, Takeshi Okamoto, Masato Suenaga, Yusuke Fujita, Yoshihiko Hamamoto, and Isao Sakaida Copyright © 2014 Junichi Nishimura et al. All rights reserved. Physician Perceptions on Colonoscopy Quality: Results of a National Survey of Gastroenterologists Thu, 06 Mar 2014 11:12:17 +0000 Background. Quality indicators for colonoscopy have been developed, but the uptake of these metrics into practice is uncertain. Our aims were to assess physician perceptions regarding colonoscopy quality measurement and to quantify the perceived impact of quality measurement on clinical practice. Methods. We conducted in-person interviews with 15 gastroenterologists about their perceptions regarding colonoscopy quality. Results from these interviews informed the development of a 34-question web-based survey that was emailed to 1,500 randomlyselected members of the American College of Gastroenterology. Results. 160 invitations were undeliverable, and 167 out of 1340 invited physicians (12.5%) participated in the survey. Respondents and nonrespondents did not differ in age, sex, practice setting, or years since training. 38.8% of respondents receive feedback on their colonoscopy quality. The majority of respondents agreed with the use of completion rate (90%) and adenoma detection rate (83%) as quality indicators but there was less enthusiasm for withdrawal time (61%). 24% of respondents reported usually or always removing diminutive polyps solely to increase their adenoma detection rate, and 20% reported prolonging their procedure time to meet withdrawal time standards. Conclusions. A minority of respondents receives feedback on the quality of their colonoscopy. Interventions to increase continuous quality improvement in colonoscopy screening are needed. Ziad F. Gellad, Corrine I. Voils, Li Lin, and Dawn Provenzale Copyright © 2014 Ziad F. Gellad et al. All rights reserved. Chronic Kidney Disease and Nonalcoholic Fatty Liver Disease—Is There a Link? Thu, 06 Mar 2014 07:34:21 +0000 Research in recent years has led to the recognition of the importance of nonalcoholic fatty liver disease (NAFLD) and its relationship to the metabolic syndrome (MS). This has led to a growing interest in the potential prognostic value of NAFLD for adverse cardiovascular disease (CVD) outcome. On the other hand, searching for new risk factors for chronic kidney disease (CKD) development and progression is very important. Growing evidence suggests that the MS is an important factor in the pathogenesis of CKD. The best confirmation of this pathogenic link is hypertensive and diabetic nephropathy as the main causes of CKD. Furthermore, the possible link between NAFLD and CKD has also attracted research interest and recent data suggest an association between these two conditions. These findings have fuelled concerns that NAFLD may be a new and added risk factor for the development and progression of CKD. NAFLD and CKD share some important cardiometabolic risk factors and possible common pathophysiological mechanisms, and both are linked to an increased risk of incident CVD events. Therefore, common factors underlying the pathogenesis of NAFLD and CKD may be insulin resistance, oxidative stress, activation of rennin-angiotensin system, and inappropriate secretion of inflammatory cytokines by steatotic and inflamed liver. L. Orlić, I. Mikolasevic, Z. Bagic, S. Racki, D. Stimac, and S. Milic Copyright © 2014 L. Orlić et al. All rights reserved. Absence of Autophagy-Related Proteins Expression Is Associated with Poor Prognosis in Patients with Colorectal Adenocarcinoma Wed, 05 Mar 2014 00:00:00 +0000 Background/Aim. Autophagy, a cellular degradation process, has paradoxical roles in tumorigenesis and the progression of human cancers. The aim of this study was to investigate the expression levels of autophagy-related proteins in colorectal cancer (CRC) and to evaluate their prognostic significance. Methods. This study is a retrospective review of immunohistochemical and clinicopathological data. All specimens evaluated were obtained from 263 patients with colorectal cancer who had undergone surgery between November 1996 and August 2007. The primary outcomes measured were the expression levels of three autophagy-related proteins (ATG5, BECN1/Beclin 1, and Microtubule-associated protein 1 light chain 3B (LC3B)) by immunohistochemistry and its association in clinicopathological parameters and patient survival. Results. The autophagy-related protein expression frequencies were 65.1% (151/232) for ATG5, 71.3% (174/244) for BECN1, and 74.7% (186/249) for LC3B for the 263 patients. Correlation between the expression of autophagy-related proteins was significant for all protein pairs. Multivariate analysis showed that negative LC3B expression and absence of autophagy-related proteins expression were independently associated with poor prognosis. Conclusion. Absence of autophagy-related proteins expression is associated with poor clinical outcome in CRC, suggesting that these proteins have potential uses as novel prognostic markers. Ji Hye Choi, Young-Seok Cho, Yoon Ho Ko, Soon Uk Hong, Jin Hee Park, and Myung Ah Lee Copyright © 2014 Ji Hye Choi et al. All rights reserved. Clinical Characteristics and Surgical Prognosis of Hepatocellular Carcinoma with Bile Duct Invasion Sun, 02 Mar 2014 12:19:10 +0000 Objectives. Bile duct invasion (BDI) is a rare event in hepatocellular carcinoma (HCC). The present study aimed at investigating clinical characteristics and surgical outcome of HCC patients with bile duct invasion. Methods. 413 patients with HCC undergoing curative surgery were divided into two groups with (B+) and without BDI (B−). BDI was further classified as central type (B1) and peripheral type (B2). Survival was compared, and risk factors affecting prognosis were identified. Results. 35 (8.5%) patients were diagnosed BDI. Total bilirubin was significantly higher in B+ group than in B− group (). Multiple lesions and large nodules (>5 cm) were predominantly identified in B+ group (, resp.). Portal vein invasion was more frequently observed in B+ than in B− group (). Univariate and multivariate analyses identified central BDI as a significant factor affecting prognosis of HCC patients (risk 1.3, 95% CI 1.1–2.2, ). The gross overall survival of patients in B+ was significantly worse than in B− (), which, however, was not different between B2 and B− (). Conclusions. Central but not peripheral BDI was associated with poorer prognosis of HCC patients. Curative surgical resection of tumors and invaded bile duct supplies the only hope for long-term survival of patients. Ke-Wei Meng, Mei Dong, Wei-Guo Zhang, and Qing-Xian Huang Copyright © 2014 Ke-Wei Meng et al. All rights reserved. Fistuloclysis Improves Liver Function and Nutritional Status in Patients with High-Output Upper Enteric Fistula Wed, 26 Feb 2014 09:30:39 +0000 Background. We aimed to determine the efficacy of fistuloclysis in patients with high-output upper enteric fistula (EF). Methods. Patients were assigned into the fistuloclysis group (, receiving fistuloclysis plus total enteral nutrition (TEN)) and the control group (, receiving TEN). Laboratory variables were measured during the four-week treatment. Results. At baseline, variables were similar between the two groups. Delta value was defined as the changes from baseline to day 28. Compared with the control group, the fistuloclysis group showed greater improvements in liver function (Delta total bilirubin (TB): in the fistuloclysis group versus in the control group, ; Delta direct bilirubin (DB): versus , ; Delta alkaline phosphatase (ALP): versus , ); nutritional status (Delta total protein: versus , ; Delta albumin: versus , ). In the fistuloclysis subgroups, biliary fistula patients had the maximum number of variables with the greatest improvements. Conclusions. Fistuloclysis improved hepatic and nutritional parameters in patients with high-output upper EF, particularly in biliary fistula patients. Yin Wu, Jianan Ren, Gefei Wang, Bo Zhou, Chao Ding, Guosheng Gu, Jun Chen, Song Liu, and Jieshou Li Copyright © 2014 Yin Wu et al. All rights reserved. Endoscopic Optical Coherence Tomography (OCT): Advances in Gastrointestinal Imaging Wed, 26 Feb 2014 06:46:36 +0000 In the rapidly evolving field of endoscopic gastrointestinal imaging, Optical Coherence Tomography (OCT) has found many diverse applications. We present the current status of OCT and its practical applications in imaging normal and abnormal mucosa in the esophagus, stomach, small and large intestines, and biliary and pancreatic ducts. We highlight technical aspects and principles of imaging, assess published data, and suggest future directions for OCT-guided evaluation and therapy. Tejas S. Kirtane and Mihir S. Wagh Copyright © 2014 Tejas S. Kirtane and Mihir S. Wagh. All rights reserved. Comparison of Therapeutic Effects of Laparoscopic and Open Operation for Congenital Choledochal Cysts in Adults Tue, 25 Feb 2014 09:21:01 +0000 Background. Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for treating congenital choledochal cysts (CCCs) have proved to be efficacious in children. Its safety and efficacy in adult patients remain unknown. The purpose of this study was to determine whether the laparoscopic procedure was feasible and safe in adult patients. Methods. We reviewed 35 patients who underwent laparoscopic operation (laparoscopic group) and 39 patients who underwent an open procedure (open group). The operative time, intraoperative blood loss, time until bowel motion recovery, duration of drainage, postoperative stay, time until resumption of diet, postoperative complications, and perioperative laboratory values were recorded and analyzed in both groups. Results. The operative time was longer in the laparoscopic group and decreased significantly with accumulating surgical experience (). The mean intraoperative blood loss was significantly lower in the laparoscopic group (). The time until bowel peristalsis recovery, time until resumption of diet, abdominal drainage, and postoperative stay were significantly shorter in the laparoscopic group (). The postoperative complication rate was not higher in the laparoscopic group than in the open group (). Conclusions. Laparoscopic cyst excision and hepaticojejunostomy are a feasible, effective, and safe method for treating CCCs in adult patients. Yuan Liu, Xu Yao, Shuqiang Li, Wenhan Liu, Lei Liu, and Jingang Liu Copyright © 2014 Yuan Liu et al. All rights reserved. Prevalence and Associated Metabolic Factors of Gallstone Disease in the Elderly Agricultural and Fishing Population of Taiwan Sun, 23 Feb 2014 07:22:40 +0000 Purpose. To evaluate sex-related differences in the prevalence of and cardiovascular risk factors related to gallstone disease (GSD) in an elderly agricultural and fishing population of Taipei, Taiwan. Methods. The study sample consisted of 6511 healthy elderly participants (3971 men and 2540 women) who were voluntarily admitted to a teaching hospital for a physical checkup in 2010. The participants’ blood samples and real-time ultrasound fatty liver results were collected. Results. The prevalence of GSD in the study population was 13.2%, which increased significantly with population age (). Women were associated with significantly higher GSD prevalence than men (14.8% versus 12.2%; for the chi-square test, ). In a multiple logistic regression analysis, female sex, older age, and metabolic syndrome (MetS) were significantly associated with GSD. Multiple logistic regression analysis also revealed that obesity (odds ratio , 95% confidence interval (CI): 1.09–1.44) and metabolic factors (one or 2 versus none, , 95% CI: 1.08–1.76) were significantly associated with GSD in women but not in men. Conclusion. In the study population, female sex, older age, and MetS were associated with higher GSD prevalence. The population exhibited other sex-related differences. Hsi-Che Shen, Yi-Chun Hu, Yu-Fen Chen, and Tao-Hsin Tung Copyright © 2014 Hsi-Che Shen et al. All rights reserved. Clinical Outcomes of Colonic Stent in a Tertiary Care Center Tue, 18 Feb 2014 16:24:25 +0000 Introduction. Colonic obstruction is one of the manifestations of colon cancer for which self-expanding metal stents (SEMS) have been effectively used, to restore the luminal patency either for palliative care or as a bridge to resective surgery. The aim of our study is to evaluate the efficacy and safety of large diameter SEMS in patients with malignant colorectal obstruction. Methods and Results. A four-year retrospective review of the Medical Archival System was performed and identified 16 patients. The average age was 70.8 years, of which 56% were females. The most common cause of obstruction was colon cancer (9/16, 56%). Rectosigmoid was the main site of obstruction (9/16) and complete obstruction occurred in 31% of cases. The overall technical and clinical success rates were 100% and 87%, respectively. There were no immediate complications (<24 hours), but stent stenosis due to kinking occurred within one week of stent placement in 2 patients. Stent migration occurred in 2 patients at 34 and 91 days, respectively. There were no perforations or bleeding complications. Conclusion. Large diameter SEMS provide a safe method for palliation or as a bridge to therapy in patients with malignant colonic obstruction with high technical success and very low complication rates. Mahesh Gajendran, Chandraprakash Umapathy, John Nasr, and Andres Gelrud Copyright © 2014 Mahesh Gajendran et al. All rights reserved.