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Dig Liver Dis [journal]
- Capsule endoscopy followed by single balloon enteroscopy in children with obscure gastrointestinal bleeding: A combined approach. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Sep 26.
This prospective single-centre study aims to evaluate a new diagnostic algorithm using capsule endoscopy, colon capsule endoscopy and single-balloon enteroscopy in the work-up of obscure gastrointestinal bleeding in children.The usefulness of a new diagnostic algorithm was assessed comparing the clinically relevant findings revealed by each technique, and evaluating the clinical outcomes during the follow-up.A total of 22 paediatric patients were evaluated (14 male; mean age 12.5 years±3.9). Capsule endoscopies were positive in 14 (63.6%), suspicious in 5 (22.7%) and negative in 3 (13.6%). A second look with colon capsule identified new lesions in 2/3 (67%) of previous negative cases. Enteroscopies were able to reach the positive and suspicious findings in all but 2, in which an intraoperative enteroscopy was needed. This combined approach showed positive findings in 21/22 of cases with a diagnostic yield of 95%. Eighteen patients (82%) had a complete resolution after therapy. One patient resolved his symptoms spontaneously. Despite diagnosis, in three patients (13.6%) the gastrointestinal bleeding was not resolved after therapy.This algorithm achieves optimal levels of diagnostic yield (95%) and therapeutic outcome (82%). This approach deserves to be studied in a larger multicentre cohort of patients and for a longer follow-up period.
- Management of inoperable malignant oesophageal strictures with fully covered WallFlex(®) stent: A multicentre prospective study. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Sep 24.
The majority of currently available oesophageal metal stents are partially covered to reduce migration risk. Preliminary experiences with fully covered stents seem to indicate an increased risk of migration in patients treated for malignant dysphagia. The aim of our study was to determine, in this setting, the safety and efficacy of a new, recently introduced stent with anti-migration proprieties.We designed a prospective, multicentre, non-randomized, follow-up study in nine tertiary referral centres. Eighty-two patients with dysphagia due to inoperable or metastatic oesophageal cancer were included. In all of them the fully covered WallFlex(®) stent was placed. Main outcome measurements included functional outcome, recurrent dysphagia, complications, and mortality.Dysphagia score improved from a median of 3, before stenting, to 1 at 4 weeks after stent placement (P<0.001). Perforation occurred in 1 patient after 39 days, while bleeding was reported in 3. In total, 19 patients (23.1%) developed recurrent dysphagia because of stent migration (N=10, 12.2%), tissue overgrowth (N=7; 8.5%), and food impaction (N=2; 2.4%).Placement of the fully covered WallFlex(®) stent resulted in safe and effective palliation of malignant dysphagia, with migration and tissue overgrowth rates comparable to previously reported data on partially covered stents.
- Successful pregnancy in Alagille Syndrome. [LETTER]
- Dig Liver Dis 2014 Sep 23.
- Pancreatic tuberculosis: Look at the kidney! [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Sep 20.
- What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Sep 19.
Digital rectal examination is an essential tool in the evaluation of the rectum. The aim of this trial was to determine the best position for performing a digital rectal examination.A total of 321 patients were randomized into "dorsal" or "lateral" groups in this multicentre randomized controlled trial performed in an outpatient setting. The primary endpoint was the proportion of patients with a complete digital rectal examination, defined as the examination of the rectum (upper border of the prostate), the entire circumference, and the assessment of the sphincter tone.The dorsal group included a total of 161 patients (mean age: 62.3±13.04 years), while the lateral group included 160 patients (mean age: 62.7±14.4 years). The proportion of patients with a complete digital rectal examination was 44% (n=71) in the dorsal group and 49% (n=79) in the lateral group (p=0.3). The entire circumference of the rectum could be examined in 66% of the patients (n=106) in the dorsal group and in 79.5% of the patients (n=128) in the lateral group (p=0.007).The intergroup difference in terms of digital rectal examination completion rate was not significant. In the lateral position, however, the entire circumference of the rectum could be examined more thoroughly.
- Long-term effect of faecal occult blood screening on incidence and mortality from colorectal cancer. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Sep 15.
Several randomized trials have shown a reduction of colorectal cancer mortality by screening using guaiac-based faecal occult blood tests. However, little is known on the long-term effect of screening at the population level in everyday practice.Small-sized geographic areas including a total of 91,199 individuals were allocated to either biennal screening using the Hemoccult-II test or no screening. The expected mortality and incidence in the cohort invited to screening was determined using mortality and incidence in the non-screened population.Colorectal cancer mortality was significantly lower in the population invited to screening than in the non-screened population after 11 screening rounds (standardized mortality ratio: 0.87; 0.80-0.94). The standardized mortality ratio remained significant whatever the duration of follow-up. This reduction in colorectal cancer mortality was more pronounced in those who participated in the first screening campaign, who were regular participants in screening rounds (standardized mortality ratio: 0.67; 0.59-0.76). In contrast, colorectal cancer incidence was not different between the screened and non-screened populations (standardized incidence ratio: 1.01; 0.96-1.06).Our findings confirm, in the long term, that screening with Hemoccult can reduce colorectal cancer mortality. The data also highlight the benefit of regular participation in screening and the absence of effect of screening on colorectal cancer incidence.
- Weight loss outcomes after liver biopsy in patients with nonalcoholic fatty liver disease. [LETTER]
- Dig Liver Dis 2014 Sep 15.
- The efficacy and safety of statins for the treatment of non-alcoholic fatty liver disease. [REVIEW]
- Dig Liver Dis 2014 Sep 12.
Non-alcoholic fatty liver disease is an emerging liver disease in Western countries and the most frequent cause of incidental elevation of serum liver enzymes. Dyslipidaemia is frequently observed in patients with non-alcoholic fatty liver disease, and treatment of dyslipidaemia plays a critical role in the overall management of these patients. Moreover, coronary artery disease remains the most common cause of death. Statins are effective lipid-lowering agents, associated with a lowering the risk of cardiovascular events in several interventional randomized clinical trials. However, statins are often underused in patients with non-alcoholic fatty liver disease and many physicians are concerned about the prescription of statins to patients with unexplained persistent elevation of liver enzymes or active liver disease. Based on currently available data, statin therapy, at low-to-moderate doses, seems to be safe and has low liver toxicity. Treatment of dyslipidaemia in patients with non-alcoholic fatty liver disease is recommended and may also improve liver function tests. In these patients, the risks of not taking statins could outweigh the risks of taking the drug. Conversely, the usefulness of statins for the treatment of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis is still a matter of debate and randomized clinical trials of adequate size and duration are required.