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Monino L, Bachmann R, Leonard D, Remue C, Danse E, Kartheuser A, Moreels T. Endoscopic management of complex colorectal anastomotic leakage with a pelvic collection and rectovaginal fistula. Endoscopy 2023; 55:E1135-E1136. [PMID: 37940119 PMCID: PMC10632066 DOI: 10.1055/a-2178-4008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Laurent Monino
- Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Radu Bachmann
- Department of Colorectal Surgery, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Daniel Leonard
- Department of Colorectal Surgery, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Christophe Remue
- Department of Colorectal Surgery, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Etienne Danse
- Radiology Department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Alex Kartheuser
- Department of Colorectal Surgery, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Tom Moreels
- Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
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2
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Affiliation(s)
- Azdin Iabkriman
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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3
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Pennazio M, Rondonotti E, Despott EJ, Dray X, Keuchel M, Moreels T, Sanders DS, Spada C, Carretero C, Cortegoso Valdivia P, Elli L, Fuccio L, Gonzalez Suarez B, Koulaouzidis A, Kunovsky L, McNamara D, Neumann H, Perez-Cuadrado-Martinez E, Perez-Cuadrado-Robles E, Piccirelli S, Rosa B, Saurin JC, Sidhu R, Tacheci I, Vlachou E, Triantafyllou K. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy 2023; 55:58-95. [PMID: 36423618 DOI: 10.1055/a-1973-3796] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
MR1: ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence. MR2: ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence. MR3: ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence. MR4: ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence. MR5: ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence. MR6: ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence. MR7: ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn's disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence. MR8: ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence. MR9: ESGE recommends, in patients with established Crohn's disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence. MR10: ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence. MR11: ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence.
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Affiliation(s)
- Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | | | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK
| | - Xavier Dray
- Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Tom Moreels
- Division of Gastroenterology and Hepatology, University Hospital Saint-Luc, Brussels, Belgium
| | - David S Sanders
- Sheffield Teaching Hospitals NHS Foundation Trust, Gastroenterology Sheffield, Sheffield, UK
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Carretero
- Department of Gastroenterology. University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Fuccio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Begona Gonzalez Suarez
- Gastroenterology Department - ICMDiM, Hospital Clínic of Barcelona, DIBAPS, CiBERHED, Barcelona, Spain
| | - Anastasios Koulaouzidis
- Centre for Clinical Implementation of Capsule Endoscopy, Store Adenomer Tidlige Cancere Center, Svendborg, University of Southern Denmark, Denmark
| | - Lumir Kunovsky
- 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.,Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | | | | | - Stefania Piccirelli
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jean-Christophe Saurin
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Reena Sidhu
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, United Kingdom
| | - Ilja Tacheci
- 2nd Department of Internal Medicine - Gastroenterology, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| | | | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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4
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Beyna T, Moreels T, Arvanitakis M, Pioche M, Saurin JC, May A, Knabe M, Agnholt JS, Bjerregaard NC, Puustinen L, Schlag C, Aabakken L, Paulsen V, Schneider M, Neurath MF, Rath T, Devière J, Neuhaus H. Motorized spiral enteroscopy: results of an international multicenter prospective observational clinical study in patients with normal and altered gastrointestinal anatomy. Endoscopy 2022; 54:1147-1155. [PMID: 35451040 DOI: 10.1055/a-1831-6215] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND : Motorized spiral enteroscopy (MSE) has been shown to be safe and effective for deep enteroscopy in studies performed at expert centers with limited numbers of patients without previous abdominal surgery. This study aimed to investigate the safety, efficacy, and learning curve associated with MSE in a real-life scenario, with the inclusion of patients after abdominal surgery and with altered anatomy. METHODS : Patients with indications for deep enteroscopy were enrolled in a prospective observational multicenter study. The primary objective was the serious adverse event (SAE) rate; secondary objectives were the diagnostic and therapeutic yield, procedural success, time, and insertion depth. Data analysis was subdivided into training and core (post-training) study phases at centers with different levels of MSE experience. RESULTS : 298 patients (120 women; median age 68, range 19-92) were enrolled. In the post-training phase, 21.5 % (n = 54) had previous abdominal surgery, 10.0 % (n = 25) had surgically altered anatomy. Overall, SAEs occurred in 2.3 % (7/298; 95 %CI 0.9 %-4.8 %). The SAE rate was 2.0 % (5/251) in the core group and 4.3 % (2/47) in the training group, and was not increased after abdominal surgery (1.9 %). Total enteroscopy was achieved in half of the patients (n = 42) undergoing planned total enteroscopy. In 295/337 procedures (87.5 %), the anatomical region of interest could be reached. CONCLUSIONS : This prospective multicenter study showed that MSE was feasible and safe in a large cohort of patients in a real-life setting, after a short learning curve. MSE was shown to be feasible in postsurgical patients, including those with altered anatomy, without an increase in the SAE rate.
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Affiliation(s)
- Torsten Beyna
- Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Germany
| | - Tom Moreels
- Department of Gastroenterology and Hepatology, Hospital Department Clinique Universitaires Saint-Luc Université, Brussels, Belgium
| | - Marianna Arvanitakis
- Department of Gastroenterology and Hepato-Pancreatology, Université Libre des Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Mathieu Pioche
- Department of Digestive Diseases, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Jean-Christophe Saurin
- Department of Digestive Diseases, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Andrea May
- Department of Internal Medicine II, Sana Klinikum Offenbach GmbH, Offenbach, Germany.,Department of Gastroenterology, Asklepios Paulinen Klinik, Wiesbaden, Germany
| | - Mate Knabe
- Department of Internal Medicine II, Sana Klinikum Offenbach GmbH, Offenbach, Germany.,Department of Gastroenterology and Hepatology, Center of Internal Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jørgen Steen Agnholt
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lauri Puustinen
- Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
| | - Christoph Schlag
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,Department of Gastroenterology and Endoscopy, Universitätsspital Zürich, Zurich, Switzerland
| | - Lars Aabakken
- Institute of Clinical Medicine, OUS-Rikshospitalet University Hospital, Oslo, Norway
| | - Vemund Paulsen
- Institute of Clinical Medicine, OUS-Rikshospitalet University Hospital, Oslo, Norway
| | - Markus Schneider
- Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Germany
| | - Markus F Neurath
- Department of Internal Medicine I for Gastroenterology, Pulmonology and Endocrinology, University Hospital Erlangen, Erlangen, Germany
| | - Timo Rath
- Department of Internal Medicine I for Gastroenterology, Pulmonology and Endocrinology, University Hospital Erlangen, Erlangen, Germany
| | - Jacques Devière
- Department of Gastroenterology and Hepato-Pancreatology, Université Libre des Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Horst Neuhaus
- Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Germany
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5
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Navez J, Iesari S, Kourta D, Baami-Mariza K, Nadiri M, Goffette P, Baldin P, Ackenine K, Bonaccorsi-Riani E, Ciccarelli O, Coubeau L, Moreels T, Lerut J. The real incidence of biliary tract complications after adult liver transplantation: the role of the prospective routine use of cholangiography during post-transplant follow-up. Transpl Int 2020; 34:245-258. [PMID: 33188645 DOI: 10.1111/tri.13786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/13/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
Biliary tract complications (BTCs) still burden liver transplantation (LT). The wide reporting variability highlights the absence of systematic screening. From 2000 to 2009, simultaneous liver biopsy and direct biliary visualization were prospectively performed in 242 recipients at 3 and 6 months (n = 212, 87.6%) or earlier when indicated (n = 30, 12.4%). Median follow-up was 148 (107-182) months. Seven patients (2.9%) experienced postprocedural morbidity. BTCs were initially diagnosed in 76 (31.4%) patients; 32 (42.1%) had neither clinical nor biological abnormalities. Acute cellular rejection (ACR) was present in 27 (11.2%) patients and in 6 (22.2%) BTC patients. Nine (3.7%) patients with normal initial cholangiography developed BTCs after 60 (30-135) months post-LT. BTCs directly lead to 7 (2.9%) re-transplantations and 14 (5.8%) deaths resulting in 18 (7.4%) allograft losses. Bile duct proliferation at 12-month biopsy proved an independent risk factor for graft loss (P = 0.005). Systematic biliary tract and allograft evaluation allows the incidence and extent of biliary lesions to be documented more precisely and to avoid erroneous treatment of ACR. The combination 'abnormal biliary tract-canalicular proliferation' is an indicator of worse graft outcome. BTCs are responsible for important delayed allograft and patient losses. These results underline the importance of life-long follow-up and appropriate timing for re-transplantation.
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Affiliation(s)
- Julie Navez
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Samuele Iesari
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Dhoha Kourta
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Kente Baami-Mariza
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Marwan Nadiri
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Goffette
- Interventional Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Pamela Baldin
- Pathology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Kevin Ackenine
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Eliano Bonaccorsi-Riani
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Olga Ciccarelli
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Laurent Coubeau
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Tom Moreels
- Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Jan Lerut
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Vandepapelière J, Siplet J, Libbrecht L, Dano H, Baurain JF, Moreels T. Auto-immune gastritis induced by pembrolizumab, an anti-PD-1, in a melanoma patient. Acta Gastroenterol Belg 2020; 83:482-484. [PMID: 33094598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report a case of a 67-years-old woman presenting a severe acute lymphocytic gastritis induced by pembrolizumab, an immune check point inhibitor (ICI). This gastritis was her third auto-immune adverse event after 5 years of treatment with pembrolizumab, it was metabolically active at the PET Scan and confirmed by analysis of the gastric biopsies. Pembrolizumab treatment cessation and high doses of corticosteroids completely normalized the stomach clinically, endoscopically and histologically. This patient was in complete remission of her metastatic melanoma. Therefore, pembrolizumab therapy was not restarted and the patient is still in remission 6 months later. This strategy is supported by recent publications describing a relapse rate inferior to 10% in patients in complete remission after 2 years of immunotherapy. Particularities of this case are: rareness of this adverse event, late onset after introduction of pembrolizumab, evocative PET scan image, specific endoscopic aspect and histology. In addition, the favorable oncologic evolution of the patient after treatment cessation confirms the prolonged remission after immunotherapy.
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Affiliation(s)
- J Vandepapelière
- Division of Oncology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - J Siplet
- Division of Gastroenterology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - L Libbrecht
- Division of Anatomopathology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - H Dano
- Division of Anatomopathology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - J F Baurain
- Division of Oncology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - T Moreels
- Division of Gastroenterology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
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7
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Sinonquel P, Aerts M, Badaoui A, Bisschops R, Blero D, Demedts I, Deprez P, Dewint P, Eisendrath P, Hindryckx P, Lemmers A, Roelandt P, Snauwaert C, Toussaint E, Moreels T. BSGIE survey on COVID-19 and gastrointestinal endoscopy in Belgium : results and recommendations. Acta Gastroenterol Belg 2020; 83:344-354. [PMID: 32603061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND AIMS With the first wave of the COVID-19 pandemic declining, activities in the gastrointestinal clinic are being recommenced after a period of stringent measures. Since a second COVID-19 wave is not entirely ruled out health care professionals might remain faced with the need to perform endoscopic procedures in patients with a confirmed positive or unknown COVID-19 status. With this report we aim to provide a practical relevant overview of preparation and protective measures for gastroenterologists based on the currently available guidelines and our local experience and results of a national Belgian survey, to guarantee a fast recall of an adequate infection prevention if COVID-19 reoccurs. METHODS From the 23rd of March 2020 and the 13th of May 2020 we performed a Pubmed, Embase and Medline search, resulting in 37 papers on COVID-19 and endoscopy. Additionally, we combined these data with data acquired from the national BSGIE survey amongst Belgian gastroenterologists. RESULTS Based on 72 completed surveys in both university and non-university hospitals, the results show (1) a dramatic (<20%) or substantial (<50%) decrease of normal daily endoscopy in 74% and 22% of the units respectively, (2) a difference in screening and protective measures between university and non-university hospitals. These findings were subsequently compared with the current guidelines. CONCLUSION Based on new data from the BSGIE survey and current guidelines we tried to realistically represent the current COVID-19 trends in protective measures, screening and indications for endoscopy and to provide a practical overview as preparation for a possible second wave.
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Affiliation(s)
- P Sinonquel
- Universitair Ziekenhuis Gasthuisberg, Leuven
| | - M Aerts
- Universitair Ziekenhuis Brussel, Brussels
| | - A Badaoui
- Centre Hospitalier Universitaire de Namur, Namur
| | - R Bisschops
- Universitair Ziekenhuis Gasthuisberg, Leuven
| | | | - I Demedts
- Universitair Ziekenhuis Gasthuisberg, Leuven
| | - P Deprez
- Cliniques Universitaires Saint-Luc, Brussels
| | - P Dewint
- Algemeen Ziekenhuis Maria-Middelares, Ghent
- Universitair Ziekenhuis Antwerpen, Antwerp
| | - P Eisendrath
- Centre Hospitalier Universitaire Saint-Pierre, Brussels
- Hôpital Erasme, Brussels
| | | | | | - Ph Roelandt
- Universitair Ziekenhuis Gasthuisberg, Leuven
| | | | - E Toussaint
- Centre Hospitalier Universitaire de Charleroi, Charleroi
| | - T Moreels
- Cliniques Universitaires Saint-Luc, Brussels
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8
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Bossuyt P, Baert F, Coenegrachts JL, De Vos M, Dewit O, Ferrante M, Fontaine F, Mana F, Vandervoort J, Moreels T. Ulcerative colitis treatment : an insight into daily clinical practice. Acta Gastroenterol Belg 2019; 82:365-372. [PMID: 31566323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The natural history of ulcerative colitis (UC) is unpredictable. Factors associated with the need for different types of step-up therapy in UC patients failing on 5-aminosalicylic acid (5-ASA) or corticosteroids are understudied. AIMS Describe step-up therapy in patients with UC the first year after failing on 5-ASA or corticosteroids. METHODS A Belgian, multi-center, prospective, non-interventional observational study comprising adult UC patients failing on 5-ASA or corticosteroids and naïve to immunomodulators/ biologicals. During a 12 months follow-up, patient characteristics, demography, medical therapy, biomarkers, therapy adherence and quality of life (QoL) were assessed. RESULTS After 1 year, 35% of the patients were on biological therapy. Use of anti-TNF differed depending on baseline treatment: corticosteroid-refractory patients (55.8%), 5-ASA refractory (20.0%), and corticosteroid-dependent (16.0%) patients (p<0.001). The decision to start a line of therapy was based on the Mayo combined severity but not on biomarkers like faecal calprotectin, haemoglobin, CRP, albumin, platelets, and number of extraintestinal manifestations. At year 1, 84.2% of the patients had only mild UC or remission and a significant improvement of fatigue (p=0.004) and IBDQ scores (p<0.001) were observed implying an improved QoL. CONCLUSION Treatment step-up, based on clinical scores in immunomodulatory and anti-TNF naïve patients with UC, provides good clinical outcomes and QoL.
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Affiliation(s)
- P Bossuyt
- Department of Gastroenterology, Imelda GI Clinical Research, Imelda General Hospital, Bonheiden, Belgium
| | - F Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - J L Coenegrachts
- Department of Gastroenterology, Jessa Ziekenhuis, Hasselt, Belgium
| | - M De Vos
- Department of Gastroenterology, University Hospitals Gent, Gent, Belgium
| | - O Dewit
- Department of Gastroenterology, UCL Saint Luc, Brussel, Belgium
| | - M Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - F Fontaine
- Department of Gastroenterology, Clinique Saint Joseph, Liège, Belgium
| | - F Mana
- Department of Gastroenterology, UZ Brussel, Brussel, Belgium
| | - J Vandervoort
- Department of Gastroenterology, OLV Ziekenhuis, Aalst, Belgium
| | - T Moreels
- Department of Gastroenterology, UCL Saint Luc, Brussel, Belgium
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9
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Gys B, Haenen F, Moreels T. Re: "Laparoscopic Roux-en-Y Gastric Bypass: Surgical Technique and Tips for Success" (J Laparoendosc Adv Surg Tech A 2018;28:938-943). J Laparoendosc Adv Surg Tech A 2018; 29:76. [PMID: 30418083 DOI: 10.1089/lap.2018.0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ben Gys
- 1 Department of Abdominal Surgery, Sint-Dimpna Hospital, Geel, Belgium
| | - Filip Haenen
- 1 Department of Abdominal Surgery, Sint-Dimpna Hospital, Geel, Belgium
| | - Tom Moreels
- 2 Department of Gastroenterology and Hepatology, University Hospital Saint-Luc, Brussels, Belgium
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10
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Gys B, Haenen F, Moreels T. The importance of long-term postoperative follow-up, including low threshold for endoscopic examination of the remnant stomach after Roux-en-Y gastric bypass. J Minim Access Surg 2018; 15:279. [PMID: 30106028 PMCID: PMC6561059 DOI: 10.4103/jmas.jmas_166_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ben Gys
- Department of Surgery, AZ Sint Dimpna, Geel, Belgium
| | - Filip Haenen
- Department of Surgery, AZ Sint Dimpna, Geel, Belgium
| | - Tom Moreels
- Department of Gastroenterology and Hepatology, University Hospital Saint-Luc, Brussels, Belgium
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Miehlke S, Acosta MBD, Bouma G, Carpio D, Magro F, Moreels T, Probert C. Oral budesonide in gastrointestinal and liver disease: A practical guide for the clinician. J Gastroenterol Hepatol 2018; 33:1574-1581. [PMID: 29603368 DOI: 10.1111/jgh.14151] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/26/2018] [Accepted: 03/17/2018] [Indexed: 01/10/2023]
Abstract
Oral budesonide is a second-generation steroid that allows local, selective treatment of the gastrointestinal tract and the liver, minimizing systemic exposure. The results of randomized trials comparing budesonide versus placebo or active comparators have led to expert recommendations that budesonide be used to treat mild or moderate active ileocecal Crohn's disease, microscopic colitis (including both collagenous and lymphocytic colitis), ulcerative colitis, and non-cirrhotic autoimmune hepatitis. The mechanism of budesonide action obviates the need for dose tapering due to safety reasons after induction therapy. Where low-dose budesonide is used to maintain remission, usually in microscopic colitis, it does not appear to have adverse safety implications other than slight reductions in cortisol levels on rare occasions. As a gut-selective and liver-selective corticosteroid, budesonide offers an appealing alternative to conventional systemic glucocorticoids in diseases of these organs.
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Affiliation(s)
- Stephan Miehlke
- Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany
| | - Manuel Barreiro-de Acosta
- Intestinal Inflammatory Disease Unit, Department of Gastroenterology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gerd Bouma
- Department of Gastroenterology, Vrije University Medical Center, Amsterdam, The Netherlands
| | - Daniel Carpio
- Digestive System Service, University Hospital of Pontevedra Complex, Pontevedra, Spain
| | - Fernando Magro
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Tom Moreels
- Hepato-Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Chris Probert
- Department of Gastroenterology, Institute of Translational Medicine, Liverpool, UK
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Franchimont D, Ferrante M, Louis E, De Vos M, Dewit O, Van Hootegem P, Moreels T, Liefferinckx C, Bossuyt P, Baert F, Rahier JF, Vermeire S. Belgian IBD research group (BIRD) position statement 2017 on the use of biosimilars in inflammatory bowel diseases (IBD). Acta Gastroenterol Belg 2018; 81:49-53. [PMID: 29562378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- D Franchimont
- Department of Gastroenterology, Hopital Erasme Brussels, Belgium
| | - M Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - E Louis
- Department of Gastroenterology, Centre Hospitalier Universitaire de Liege, Belgium
| | - M De Vos
- Department of Gastroenterology - Ghent University Hospital - Ghent University, Belgium
| | - O Dewit
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc UCL Bruxelles, Belgium
| | - P Van Hootegem
- Department of Gastroenterology, AZ Sint Lucas Brugge, Belgium
| | - T Moreels
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc UCL Bruxelles, Belgium
| | - C Liefferinckx
- Department of Gastroenterology, Hopital Erasme Brussels, Belgium
| | - P Bossuyt
- Department of Gastroenterology, Imeldaziekenhuis, Bonheiden, Belgium
| | - F Baert
- Department of Gastroenterology, AZ Delta Roeselare, Belgium
| | - J F Rahier
- Department of Gastroenterology, CHU UCL Mont-Godinne, Belgium
| | - S Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
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13
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Peeters H, Louis E, Baert F, Dewit O, Coche JC, Ferrante M, Lambrecht G, Colard A, Van Gossum A, Bossuyt P, Moreels T, Vander Cruyssen B, Gils A, De Vos M. Efficacy of switching to infliximab in patients with Crohn's disease with loss of response to adalimumab. Acta Gastroenterol Belg 2018; 81:15-21. [PMID: 29562373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Anti-TNF monoclonal antibodies are a cornerstone in the treatment of Crohn's disease. Prospective data on switching from the subcutaneous and human adalimumab (ADM) to the intravenous and chimeric infliximab (IFX) are scarce. PATIENTS AND METHODS In this prospective, observational, multicentre cohort study we included 21 patients with loss of response to ADM despite at least 4 consecutive weekly injections. Clinical response (CDAI drop≥70 points) and remission (CDAI≤150) were assessed after switching from ADM to IFX after 10 weeks, 6 and 12 months. Predictive factors of response/remission, the need for therapy intensification, discontinuation and safety were investigated. RESULTS Short-term response and remission (10 weeks) were seen in 57% and 48% respectively. Mid- and long-term clinical response and remission were achieved in 40% and 25% after 6 months and in 45% and 20% after 12 months respectively. At 12 months, 81% still were on IFX. IFX therapy intensification was needed in half of the patients at 6 months and three quarter of patients at 12 months. Undetectable ADM trough levels (despite weekly injections) were a predictive factor for short-term response and remission to IFX. About half of the patients with response at week 10 maintained response at 6 and 12 months. CONCLUSIONS Switching from ADM to IFX can be efficacious in patients with loss of response, in particular in case of undetectable ADM trough levels. The majority of patients however will need IFX therapy intensification during their first year of treatment.
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Affiliation(s)
| | - E Louis
- University Hospital CHU, Liège, Belgium
| | - F Baert
- AZ Delta, Roeselare, Belgium
| | - O Dewit
- Hôpital Universitaire St-Luc, Bruxelles, Belgium
| | - J C Coche
- Clinique St-Pierre, Ottignies, Belgium
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Haenen FW, Gys B, Moreels T, Michielsen M, Gys T, Lafullarde T. Linitis plastica of the bypassed stomach 7 years after Roux-en-Y gastric bypass: a case report. Acta Chir Belg 2017; 117:391-393. [PMID: 27397038 DOI: 10.1080/00015458.2016.1192839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Laparoscopic Roux-en-Y gastric bypass (RYGB) is currently the preferred surgical procedure to treat morbid obesity. It has proven its effects on excess weight loss and its positive effect on comorbidities. One of the main issues, however, is the post-operative evaluation of the bypassed gastric remnant. In literature, cancer of the excluded stomach after RYGB is rare. We describe the case of a 52-year-old woman with gastric linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass, diagnosed by means of laparoscopy and Single-Balloon enteroscopy, and it is clinical importance. Linitis plastica of the excluded stomach after RYGB is a very rare entity. This case report shows the importance of long-term post-operative follow-up, and the importance of single-balloon enteroscopy for visualization of the bypassed stomach remnant, when other investigations remain without results. This case report is only the second report of a linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass.
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Affiliation(s)
- Filip Wn Haenen
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Ben Gys
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Tom Moreels
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Maartje Michielsen
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Tobie Gys
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Thierry Lafullarde
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
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Driessen A, Macken E, Moreels T, Jouret-Mourin A. Dysplasia in inflammatory bowel disease. Acta Gastroenterol Belg 2017; 80:299-308. [PMID: 29560697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ulcerative colitis and Crohn's diseases are relapsing longstanding inflammatory bowel diseases, associated with an increased risk of developing colorectal cancer. Continuous surveillance is necessary to detect the preneoplastic lesions in an early stage. New endoscopic techniques have improved the diagnostic accuracy and have resulted in a new and more simplified classification system of the dysplastic lesions in the bowel. Histopathologically these lesions are very heterogenous, consisting of adenomatous, villous and the more recently discovered serrated dysplasia. Its diagnosis may be hampered by the inflamed mucosa, resulting in a high interobserver variability in the categories of indefinite for dysplasia and low-grade dysplasia. Therefore the ECCO guidelines recommend to confirm the diagnosis of dysplasia by a pathologist with expertise in gastrointestinal pathology. In this article we give an overview of colitis-associated dysplasia from the point of view of the endoscopist and the pathologist.
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Affiliation(s)
- A Driessen
- Dept. of Pathology, University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
| | - E Macken
- Dept. of Gastroenterology, University Hospital Antwerp, Antwerp, Belgium
| | - T Moreels
- Dept. of Gastroenterology, Cliniques Universitaires St Luc, UCL, Bruxelles, Belgium
| | - A Jouret-Mourin
- Dept. of Pathology, Cliniques Universitaires St Luc, UCL, Bruxelles, Belgium
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Bisschops R, De Ruyter V, Demolin G, Baert D, Moreels T, Pattyn P, Verhelst H, Lepoutre L, Arts J, Caenepeel P, Ooghe P, Codden T, Maisonobe P, Petrens E, Tack J. Lanreotide Autogel in the Treatment of Idiopathic Refractory Diarrhea: Results of an Exploratory, Controlled, Before and After, Open-label, Multicenter, Prospective Clinical Trial. Clin Ther 2016; 38:1902-1911.e2. [PMID: 27423779 DOI: 10.1016/j.clinthera.2016.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/13/2016] [Accepted: 06/15/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Chronic idiopathic diarrhea is the passage of loose stools >3 times daily, or a stool weight >200 g/d, persisting for >4 weeks without clear clinical cause. Patients refractory to standard anti-diarrhetics have limited treatment options. Somatostatin analogues have the ability to reduce gastrointestinal secretions and motility. This study evaluated the efficacy and safety of lanreotide Autogel(*) 120 mg in chronic idiopathic diarrhea. METHODS Other anti-diarrhetics were not allowed during the study and were stopped at screening. Patients received lanreotide Autogel 120 mg at baseline and day 28. Stool frequency and consistency (Bristol Stool Scale) were recorded; quality of life (QoL) was assessed using the 36-item Short Form Health Survey and irritable bowel syndrome QoL questionnaires; adverse events were monitored. The primary outcome was the proportion of patients with a reduction of ≥50% or normalization to a mean of ≤3 stools/d at day 28. FINDINGS Thirty-three patients with >3 stools/d at baseline were included; mean (SD) age was 55.2 (16.4) years. Fourteen patients (42.4%) had a response to lanreotide Autogel at day 28 and 17 (51.5%) at day 56. Mean (SD) number of stools decreased significantly from 5.7 (2.2) at baseline to 3.7 (2.2) at day 56 overall (n = 32; P < 0.001). Significant and clinically meaningful improvements in disease-specific QoL were found in the overall populations. No new safety signals emerged. IMPLICATIONS Lanreotide Autogel 120 mg decreased symptoms in these patients with chronic idiopathic refractory diarrhea, and meaningfully improved QoL. These finding have to be confirmed in further clinical trials. ClinicalTrials.gov IDENTIFICATION NCT00891371; Eudract CT 2009-009356-20.
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Affiliation(s)
- Raf Bisschops
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | | | - Gauthier Demolin
- Department of Gastroenterology, CHC Clinique Saint-Joseph, Liège, Belgium
| | - Didier Baert
- Department of Gastroenterology, Maria Middelares Medical Centre, Ghent, Belgium
| | - Tom Moreels
- Department of Gastroenterology, Antwerp University Hospital, Edegem, Belgium
| | - Piet Pattyn
- Department of Abdominal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Hans Verhelst
- Department of Abdominal Surgery, Oost-Limburg Hospital, Genk, Belgium
| | - Luc Lepoutre
- Department of Gastroenterology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Joris Arts
- Department of Gastroenterology, University Hospital Sint-Lucas, Brugge, Belgium
| | - Philip Caenepeel
- Department of Gastroenterology, Oost-Limburg Hospital, Genk, Belgium
| | - Patrick Ooghe
- Department of Gastroenterology, Charleroi University Hospital, Charleroi, Belgium
| | - Thierry Codden
- Department of Gastroenterology, Health Centre des Fagnes, Chimay, Belgium
| | | | | | - Jan Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
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17
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Alexandre B, Vandermeeren Y, Dewit O, Moreels T, de Boer N, Dhar A, Ziady C, Shitrit ABG, Steinwurz F, Jojic N, Costantino G, Bihin B, Rahier JF, Katsanos KH. Optic Neuritis Associated or Not with TNF Antagonists in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2016; 10:541-8. [PMID: 26759360 PMCID: PMC4957451 DOI: 10.1093/ecco-jcc/jjw003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 12/08/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Acute optic neuritis [ON] is an inflammatory condition affecting the optic nerve. Clinicians should suspect optic neuritis in cases of painful and rapidly progressive loss of central visual field. This condition may be associated with a multitude of diseases, and mostly with multiple sclerosis [MS] where it may present as an initial symptom. The literature reports that optic neuritis and MS occur in patients with inflammatory bowel disease [IBD] before and after the era of anti-tumour necrosis factor-α [TNFα] drugs. At the present moment, there is little consensus for managing this complication, currently treated with corticosteroids and discontinuation of the causative agents. METHODS We collected cases through a retrospective multicentre European Crohn's and Colitis Organisation CONFER [COllaborative Network For Exceptionally Rare case reports] project. We also performed a comprehensive retrospective search of the available literature on this topic. RESULTS We report herein 12 new cases of ON, including 10 under anti-TNF therapy, collected through the CONFER project. We also compare characteristics of ON associated or not with anti-TNFα agents. CONCLUSIONS The exceptional and current observation of distant family history of MS in 17% of our patients who developed ON, despite the small number and the lack of a control arm, might be an important signal that should be taken into account in our therapeutic strategies in the future.
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Affiliation(s)
- Benjamin Alexandre
- Department of Internal Medicine and Hepato-gastroenterology Unit, Notre-Dame de Grâce Hospital, Gosselies, Belgium,*Corresponding author. Benjamin Alexandre, MD, Department of Internal Medecine and Hepato-gastroenterology Unit, Notre-Dame de Grâce Hospital, 212 Chaussée de Nivelles, 6041 Gosselies, Belgium. Tel: +32 71 37 91 27;
| | - Yves Vandermeeren
- Department of Neurology, Université Catholique de Louvain, Yvoir, Belgium
| | - Olivier Dewit
- Department of Gastroenterology, Université Catholique de Louvain, St-Luc Hospital, Brussels, Belgium
| | - Tom Moreels
- Department of Gastroenterology, Université Catholique de Louvain, St-Luc Hospital, Brussels, Belgium
| | - Nanne de Boer
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Anjan Dhar
- Darlington Memorial and Bishop Auckland Hospitals, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Chris Ziady
- Department of Gastroenterology, Kloof Hospital, Pretoria, South Africa
| | | | - Flavio Steinwurz
- Department of Gastroenterology, Hospital Israelita Albert Einstein, Sao Paolo, Brazil
| | - Njegica Jojic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia
| | - Giuseppe Costantino
- Department of Internal Medicine and Medical Therapy University of Messina, Messina, Italy
| | - Benoit Bihin
- Scientific Support Unit, Université Catholique de Louvain, Yvoir, Belgium
| | - Jean-François Rahier
- Department of Gastroenterology, Université Catholique de Louvain, Yvoir, Belgium
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18
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Vandenbulcke H, Borgies P, Dubois A, Patris A, Gallez JF, El Nawar A, Rahier JF, Moreels T, Tennstedt D, Nakad A. Crohn's Disease treated with azathioprine and basal cell carcinoma : three cases and literature review. Acta Gastroenterol Belg 2015; 78:436-438. [PMID: 26712057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Three cases of basal cell carcinoma in Crohn's disease patients treated with azathioprine are described. A review of the literature is conducted concerning this association between the occurrence of basal cell carcinoma and the use of azathioprine. Recently, practical advice on screening and follow-up of these situations have been proposed but there are no validated dermatological recommendations.
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19
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Karmiris K, Bossuyt P, Sorrentino D, Moreels T, Scarcelli A, Legido J, Dotan I, Naismith GD, Jussila A, Preiss JC, Kruis W, Li ACY, Bouguen G, Yanai H, Steinwurz F, Katsanos KH, Subramaniam K, Tarabar D, Zaganas IV, Ben-Horin S. Cerebrovascular events in inflammatory bowel disease patients treated with anti-tumour necrosis factor alpha agents. J Crohns Colitis 2015; 9:382-9. [PMID: 25740813 DOI: 10.1093/ecco-jcc/jjv042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Cerebrovascular accidents [CVA] have rarely been reported in inflammatory bowel disease [IBD] patients treated with anti-tumour necrosis alpha [anti-TNF alpha] agents. Our aim here was to describe the clinical course of CVA in these patients. METHODS This was a European Crohn's and Colitis Organisation [ECCO] retrospective observational study, performed as part of the CONFER [COllaborative Network For Exceptionally Rare case reports] project. A call to all ECCO members was made to report on IBD patients afflicted with CVA during treatment with anti-TNF alpha agents. Clinical data were recorded in a standardised case report form and analysed for event association with anti-TNF alpha treatment. RESULTS A total of 19 patients were identified from 16 centres: 14 had Crohn's disease, four ulcerative colitis and one IBD colitis unclassified [median age at diagnosis: 38.0 years, range: 18.6-62.5]. Patients received anti-TNF alpha for a median duration of 11.8 months [range: 0-62] at CVA onset; seven had previously been treated with at least one other anti-TNF alpha agent. Complete neurological recovery was observed in 16 patients. Anti-TNF alpha was discontinued in 16/19 patients. However, recurrent CVA or neurological deterioration was not observed in any of the 11 patients who received anti-TNF alpha after CVA [eight resumed after temporary cessation, three continued without interruption] for a median follow-up of 39.8 months [range: 5.6-98.2]. CONCLUSION These preliminary findings do not unequivocally indicate a causal role of anti-TNF alpha in CVA complicating IBD. Resuming or continuing anti-TNF alpha in IBD patients with CVA may be feasible and safe in selected cases, but careful weighing of IBD activity versus neurological status is prudent.
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Affiliation(s)
- Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Peter Bossuyt
- Imelda GI Clinical Research Center, Bonheiden, Belgium
| | - Dario Sorrentino
- IBD Center, Virginia Tech-Carilion School of Medicine, Roanoke, VA, USA and Department of Clinical and Experimental Medical Sciences, University of Udine School of Medicine, Udine, Italy
| | - Tom Moreels
- Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Antonella Scarcelli
- Department of Gastroenterology, Azienda University Hospital, Policlinico di Modena, Italy
| | - Jesus Legido
- Gastroenterology Unit, Segovia General Hospital, Segovia, Spain
| | - Iris Dotan
- IBD Center, Department of Gastroenterology and Liver Diseases and the Sackler School of Medicine, Sourasky Medical Center, Tel Aviv, Israel
| | | | - Airi Jussila
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | | | | | - Andy C Y Li
- Department of Gastroenterology, Western Sussex Hospitals NHSFT, Worthing, UK
| | - Guillaume Bouguen
- Department of Gastroenterology, University Hospital Pontchaillou, Rennes, France
| | - Henit Yanai
- Gastroenterology Unit, Segovia General Hospital, Segovia, Spain
| | | | | | - Kavitha Subramaniam
- Gastroenterology and Hepatology Unit, Canberra Hospital, Canberra, Australia
| | - Dino Tarabar
- Department of Gastroenterology, MMA Belgrade, Serbia
| | - Ioannis V Zaganas
- Department of Neurology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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Macken E, Vannoote J, Moreels T, Peeters M, Wouters K. Quality assessment of colonoscopy in Flanders: a voluntary survey among Flemish gastroenterologist. Acta Gastroenterol Belg 2015; 78:18-25. [PMID: 26118574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Colonoscopy is an important endoscopic examination for the diagnosis and treatment of pathological conditions of the colon, like polyps and colorectal cancer. However, several factors determine the quality of colonoscopy and thus the quality of polyp and colorectal cancer detection. The Flemish Society of Gastroenterology (VVGE) performed a voluntary on-line registry among its members to identify quality of colonoscopy in Flanders, Belgium. 64 gastroenterologists voluntarily registered 4276 consecutive colonoscopies performed during a 3 month study period. Colonoscopy quality indicators were prospectively collected and analysed. Results showed a low voluntary participation rate (17%), acceptable overall adenoma detection rate of 20,5% and colorectal cancer interval rate of 5,4%. Complications were low (perforation 0,1% and major bleeding 1,5%). The current study showed that in Flanders, Belgium on-line registration of colonoscopy quality indicators is feasible and that quality of colonoscopy in daily practice meets the expectations of (inter)national guidelines. However, further improvement of the registry and an open debate on the quality control of colonoscopy in Flanders is warranted (Belgian Registry B30020096548).
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Vermeire S, Louis E, Dewit O, Franchimont D, Moreels T, Ferrante M, Rahier JF, Van Hootegem P, De Vos M, Mana F, Baert F. Clinical and scientific aspects related to biosimilars in inflammatory bowel diseases (IBD): position document of the Belgian IBD Research & Development Group (BIRD). Acta Gastroenterol Belg 2015; 78:26-29. [PMID: 26118575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Rahier JF, Magro F, Abreu C, Armuzzi A, Ben-Horin S, Chowers Y, Cottone M, de Ridder L, Doherty G, Ehehalt R, Esteve M, Katsanos K, Lees CW, Macmahon E, Moreels T, Reinisch W, Tilg H, Tremblay L, Veereman-Wauters G, Viget N, Yazdanpanah Y, Eliakim R, Colombel JF. Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2014; 8:443-68. [PMID: 24613021 DOI: 10.1016/j.crohns.2013.12.013] [Citation(s) in RCA: 688] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/18/2013] [Indexed: 02/06/2023]
Affiliation(s)
- J F Rahier
- Department of Gastroenterology, CHU Dinant-Godinne, Avenue G. Therasse 1, 5530 Yvoir, Belgium.
| | - F Magro
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal; Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - C Abreu
- Department of Infectious Diseases, Hospital São João, Porto, Portugal
| | - A Armuzzi
- IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - S Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel-hashomer, 52961 Ramat-Gan, Israel
| | - Y Chowers
- Department of Gastroenterology, Rambam Health Care Campus, Haalia, 31096 Haifa, Israel
| | - M Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Italy
| | - L de Ridder
- Pediatric gastroenterologist, Sophia Children's Hospital, 3000 CB Rotterdam, The Netherlands
| | - G Doherty
- Centre for Colorectal Disease, St. Vincent's University Hospital and School of Medicine and Medical Science, University College Dublin, Ireland
| | - R Ehehalt
- Gastroenterology Outpatient Clinic, 69121 Heidelberg, Germany
| | - M Esteve
- Hospital Universitari Mutua de Terrassa, University of Barcelona, Catalonia, Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas, Spain
| | - K Katsanos
- Division of Gastroenterology, University Hospital of Ioannina, Medical School of Ioannina, Greece
| | - C W Lees
- Gastrointestinal Unit, Western General Hospital, EH4 2XU Edinburgh, United Kingdom
| | - E Macmahon
- Department of Infectious Diseases, Guy's & St. Thomas' NHS, Foundation Trust, London SE1 7EH, United Kingdom
| | - T Moreels
- Department of Gastroenterology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - W Reinisch
- Division Internal Medicine III, Dept. Gastroenterology and Hepatology Medical University Vienna, A-1090 Vienna, Austria; Department of Internal Medicine, McMaster University, Ontario, Canada
| | - H Tilg
- Department of Internal Medicine I, Division of Gastroenterology, Endocrinology and Metabolism, Medical University Innsbruck, Austria
| | - L Tremblay
- Department of Pharmacy, Centre Hospitalier de l'Université de Montréal, H2X 3J4 Montreal, Canada
| | - G Veereman-Wauters
- Pediatric Gastroenterology and Nutrition UZBrussels, Free University Brussels, Belgium
| | - N Viget
- Service Universitaire des Maladies infectieuses et du voyageur Centre hospitalier de Tourcoing, 59208 Tourcoing cedex, France
| | - Y Yazdanpanah
- Service des Maladies Infectieuses et tropicales, Hopital Bichat Claude Bernard, 75877 Paris, France
| | - R Eliakim
- Department of Gastroenterology and Hepatology, Sheba Medical Center, 52621 Tel Hashomer, Israel
| | - J F Colombel
- Henry D. Janowitz Division of Gastroenterology, Icahn Medical School at Mount Sinai, New York 10029, USA
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23
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De Schepper H, Macken E, Van Marck V, Spinhoven M, Pelckmans P, Moreels T. Infliximab induces remission in cryptogenic multifocal ulcerous stenosing enteritis: First case. World J Gastroenterol 2013; 19:1661-1664. [PMID: 23539523 PMCID: PMC3602486 DOI: 10.3748/wjg.v19.i10.1661] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 11/26/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
We present the case of a 29-year-old patient with a history of abdominal pain and vomiting. Based on wireless video capsule findings he was previously diagnosed with ileal Crohn’s disease at a different institution, although the clinical and radiological picture was not typical and the response to corticosteroids was poor. We performed a single-balloon enteroscopy showing a short, ulcerous stenosis 50 cm proximal from Bauhin’s valve. The endoscopic and clinical histopathological findings were compatible with cryptogenic multifocal ulcerous stenosing enteritis (CMUSE). High dose corticosteroids were again started, without effect. The monoclonal tumor necrosis factor-α (TNF-α) antibody infliximab was added to the medical therapy. After induction therapy, both clinical and endoscopic amelioration was obtained. Larger case studies are needed to confirm the efficacy of TNF-α inhibition in steroid refractory CMUSE.
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24
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De Vos M, Dewit O, D'Haens G, Baert F, Fontaine F, Vermeire S, Franchimont D, Moreels T, Staessen D, Terriere L, Vander Cruyssen B, Louis E. Fast and sharp decrease in calprotectin predicts remission by infliximab in anti-TNF naïve patients with ulcerative colitis. J Crohns Colitis 2012; 6:557-62. [PMID: 22398050 DOI: 10.1016/j.crohns.2011.11.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 09/22/2011] [Accepted: 11/02/2011] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the effect of infliximab induction therapy on calprotectin levels in patients with ulcerative colitis (UC). PATIENTS AND METHODS In this prospective study 53 patients with active UC from 17 centers were treated with infliximab therapy (5 mg/kg) at baseline, week 2, and week 6. Faecal calprotectin was measured every week. Sigmoidoscopies were performed at baseline, week 6 and week 10. RESULTS Median calprotectin levels decreased from 1260 (IQR 278.5- 3418) at baseline to 72.5 (IQR 18.5 - 463) at week 10 (p<0.001). After 10 weeks, infliximab therapy induced endoscopic remission and a decrease in calprotectin to<50 mg/kg or at least a 80% decrease from baseline level in 58% of patients. A significant and steep decrease of calprotectin levels was seen at week 2 for patients with an endoscopic remission at week 10 as compared to patients who did not show a remission. (p<0.001). At week 10 an excellent correlation was found between endoscopic remission and clinical Mayo score reflected by an AUC of ROC analyses of 0.94 (0.87-1) and with calprotectin measurements (AUC 0.91 (0.81-1)) : all patients with calprotectin levels <50 mg/kg, and a normal clinical Mayo score (=0) were in endoscopic remission. CONCLUSIONS Infliximab induces a fast and significant decrease of faecal calprotectin levels in anti-TNF naïve patients with ulcerative colitis predictive for remission of disease.
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Affiliation(s)
- M De Vos
- Ghent University Hospital, Gent, Belgium.
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25
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Küçükaycan M, Van Den Eede F, Moreels T, Sabbe BGC. [Antidepressants and the risk of bleeding]. Tijdschr Psychiatr 2012; 54:225-234. [PMID: 22422415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND By blocking the serotonin transporter system antidepressants can, in theory, result in bleedings. However, we do not yet know how great the risk of bleeding is and what the clinical implications are. AIM To assess how great the risk of bleeding is and what the clinical implications are. METHOD Using keywords 'antidepressants' and 'bleeding' we searched the relevant literature up to March 2011 to find out what the risk of bleeding were for users of antidepressants. RESULTS 34 studies met our selection criteria. Most studies reported upper gastrointestinal bleeding and hemorrhagic cerebrovascular accidents (CVA). Antidepressants with high serotonin affinity can slightly increase the risk of upper gastrointestinal bleeding. Antidepressants do not increase the risk for hemorrhagic CVA. Very little information is available about other types of bleeding. CONCLUSION Our systematic review of the literature shows that antidepressants are relatively safe as far as bleeding is concerned. Precautions can be taken in the case of high risk patients.
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Affiliation(s)
- M Küçükaycan
- Ziekenhuis Sint-Norbertus, Stationsstraat 22C, 2570 Duffel, België.
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26
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Vermorken JB, Schrijvers DLAL, Weyler JJJ, Moreels T, Carp LWG, Barentsz J, Heijmink SWTPJ. Diagnostiek in de oncologie. ONCOLOGIE 2011. [DOI: 10.1007/978-90-313-8476-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Macken E, Moreels T, Vannoote J, Siersema PD, Van Cutsem E. Quality assurance in colonoscopy for colorectal cancer diagnosis. Eur J Surg Oncol 2010; 37:10-5. [PMID: 20951537 DOI: 10.1016/j.ejso.2010.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 09/20/2010] [Indexed: 12/19/2022] Open
Abstract
Colonoscopy can prevent colorectal cancer, but its effectiveness is diminished by operator-dependent factors. Therefore, quality assurance programs should be implemented in all colonoscopy practices. Adherence to quality performance measures varies among different countries, and physicians seem reluctant to adopt them. We provide an overview of the existing guidelines for colonoscopy quality assurance, and a summary of the quality control initiatives in Belgium and the surrounding countries.
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Affiliation(s)
- E Macken
- Antwerp University Hospital, Division of Gastroenterology & Hepatology, UZ Antwerp, Wilrijkstraat 10, Antwerp, Belgium.
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28
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Rahier JF, Moreels T, De Munter P, D'Haens G. Prevention of opportunistic infections in patients with inflammatory bowel disease and implications of the ECCO consensus in Belgium. Acta Gastroenterol Belg 2010; 73:41-45. [PMID: 20458849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In an era of increasing use of immunomodulator (IM) therapy, opportunistic infections have emerged as a pivotal safety issue in patients with inflammatory bowel disease (IBD). Today's challenge to the physician is not only to manage IBD, but also to recognise, prevent and treat common and uncommon infections. The recent European ECCO guidelines on the management and prevention of opportunistic infections in patients with IBD provide clinicians with guidance on the prevention, detection and management of opportunistic infections in patients with IBD. Proposals may appear radical, potentially changing current practice, but we believe that the recommendations will help optimise patient outcomes by reducing morbidity and mortality related to opportunistic infections in patients with IBD. In this ongoing process, prevention is far the first and most important step. Prevention of opportunistic infections relies on recognition of risk factors for infection, the use of primary or secondary chemoprophylaxis, careful monitoring (clinical and laboratory work-up) before and during the use of immunomodulators, vaccination and education of the patient. Special recommendations should also be given to patients before travel. Additionally, this paper discusses how the ECCO guidelines can be implemented in Belgium according to reimbursement legislation.
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Affiliation(s)
- J F Rahier
- Department of Gastroenterology and Hepatology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Belgium.
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29
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Rahier JF, Ben-Horin S, Chowers Y, Conlon C, De Munter P, D'Haens G, Domènech E, Eliakim R, Eser A, Frater J, Gassull M, Giladi M, Kaser A, Lémann M, Moreels T, Moschen A, Pollok R, Reinisch W, Schunter M, Stange EF, Tilg H, Van Assche G, Viget N, Vucelic B, Walsh A, Weiss G, Yazdanpanah Y, Zabana Y, Travis SPL, Colombel JF. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2009; 3:47-91. [PMID: 21172250 DOI: 10.1016/j.crohns.2009.02.010] [Citation(s) in RCA: 366] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 02/24/2009] [Accepted: 02/25/2009] [Indexed: 02/08/2023]
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30
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Affiliation(s)
- Bruno Hauser
- Universitair Ziekenhuis Brussel Kinderen, Brussels, Belgium
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31
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Macken E, Moreels T, Pelckmans P, Peeters M, Baert D, Reynaert H, Delooze D, Vannoote J, Hiele M, Coenegrachts JL, Hoste P, Van Cutsem E, D'Haens G. Quality assurance and recommendations for quality assessment of screening colonoscopy in Belgium. Acta Gastroenterol Belg 2009; 72:17-25. [PMID: 19402366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
As population-wide screening for colorectal cancer is adopted by many western countries for all individuals aged 50-75. The success of screening colonoscopy programs is highly dependent on the quality of the procedures. High-quality complete endoscopy with excellent patient preparation and adequate withdrawal time is necessary for effectively reducing colon cancer risk. In Belgium formal quality assurance programs and principles of credentialing do not exist. The current reimbursement system for colonoscopy does not reward a careful performed examination but rapidly performed examinations at unnecessarily short intervals. There is a clear need for evidence-based quality measures to ensure the quality of screening colonoscopy. In this guideline review we present an overview of the literature concerning criteria for best practice and important quality indicators for colonoscopy. A summary of the latest guidelines is given. Our goal of this update is to provide practical guidelines for endoscopists performing screening colonoscopy. We hope to provide a broad consensus and an increasing adherence to these recommendations.
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Affiliation(s)
- E Macken
- Department of Gastroenterology, UZ Antwerp, Belgium.
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32
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Geerts L, Pertile G, van de Sompel W, Moreels T, Claes C. Vitrectomy for epiretinal membranes: visual outcome and prognostic criteria. Bull Soc Belge Ophtalmol 2004:7-15. [PMID: 15510718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The treatment of choice for epiretinal membranes (ERM) causing marked retinal distortion and substantial visual impairment remains vitreoretinal surgery. The purpose of this study was to evaluate the results of surgery performed in our department and to investigate the prognostic value of different factors such as preoperative best-corrected visual acuity (BCVA), pre-existing cystoid macular edema (CME), intra-operative peeling of the internal limiting membrane (ILM), age and duration of symptoms. Eighty-eight consecutive eyes of 88 patients were operated on for ERM from July 1998 to June 2000. Both idiopathic and secondary cases were included. In all cases the ERM was successfully removed from the fovea. Mean BCVA after surgery increased from Snellen 0.2 (hand motion (HM) - 0.6) to Snellen 0.5 (HM - 1.0) (p<0.0001). Our results confirm the efficacy of surgical removal of the ERM in improving the visual acuity. Although not statistically significant, mean postoperative BCVA was slightly better in the group without pre-existing CME (p>0.05) and in the group where peeling of the ILM was performed (p>0.05). The data suggest that early surgery is likely to decrease the risk of developing irreversible macular damage (p<0.05). Because accelerated nuclear sclerosis with visual impairment is a common phenomenon after vitrectomy, one might consider performing a phaco-emulsification at the same time, especially in the elderly.
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Affiliation(s)
- L Geerts
- Dept. Ophthalmology, Middelheim Hospital, Lindendreef 1, B-2020 Antwerpen, Belgium.
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33
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Bogers J, Moreels T, De Man J, Vrolix G, Jacobs W, Pelckmans P, van Marck E. Schistosoma mansoni infection causing diffuse enteric inflammation and damage of the enteric nervous system in the mouse small intestine. Neurogastroenterol Motil 2000; 12:431-40. [PMID: 11012943 DOI: 10.1046/j.1365-2982.2000.00219.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Schistosomiasis mansoni is a major health problem, mainly occurring in developing countries. A large proportion of infected individuals suffers from motility-related gastrointestinal problems. In the present study, the diffuse inflammatory response in the small bowel wall, as compared to the egg-induced granulomatous inflammation, was investigated. For this purpose, OF1 mice infected with Schistosoma mansoni 8-16 weeks prior to the experiment, and uninfected control mice were studied. The ileum showed both a diffuse mucosal inflammation as well as a granulomatous reaction. The diffuse mucosal inflammation caused an increase in the thickness of the mucosa, with blunting of the villi. A significant, transient increase of thickness of the muscularis propria after 12 weeks of infection was noted. There was an infection-related mast cell infiltrate in the muscularis propria, consisting of formalin fixation-insensitive connective tissue mast cells. Ganglionitis of the myenteric plexus was noted. Rarely, ganglia of the myenteric plexus contained apoptotic cells. A general pharmacological set of experiments showed a significant increase in intestinal contractility, both to exogenously administered, as well as to endogenously released neurotransmitters. Our results demonstrate that S. mansoni infection in the mouse ileum leads to diffuse specific enteric inflammation that is associated with an enhanced response to contractile agents.
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Affiliation(s)
- J Bogers
- Laboratory of Pathology, University of Antwerp (UIA), Universiteitsplein 1, B-2610 Antwerp (Wilrijk), Belgium
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