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<br /> GASTROENTEROLOGY<br /> ISSN 2054-6203 December 2013 • emjreviews.com<br /> INSIDE<br /> Review of<br /> UEG Week 2013<br /> Berlin, Germany<br /> CONTENTS<br /> EDITORIAL BOARD................................................................................................................................. 4<br /> CONGRESS REVIEW............................................................................................................................... 8<br /> • Review of the 21st United European Gastroenterology Congress,<br /> held in Berlin, Germany, 12th-16th October 2013<br /> SYMPOSIUM REVIEW<br /> • Treatment of Hepatic Encephalopathy: Targeting the Gut-Liver-Brain Axis.................. 20<br /> STATE-OF-THE-ART TREATMENT OF IRRITABLE BOWEL SYNDROME: RECENT ADVANCES<br /> AND EMERGING THERAPEUTIC ALTERNATIVES..............................................................<a title="EMJ - Gastroenterology page 1" href="http://viewer.zmags.com/publication/25af39a6?page=1"> GASTROENTEROLOGY ISSN 2054-6203 </a> <a title="EMJ - Gastroenterology page 2" href="http://viewer.zmags.com/publication/25af39a6?page=2"> CONTENTS EDITORIAL BOARD.......................</a> <a title="EMJ - Gastroenterology page 3" href="http://viewer.zmags.com/publication/25af39a6?page=3"> GASTROENTEROLOGY EFFECTS OF ANTIBIOTIC USE ON T</a> <a title="EMJ - Gastroenterology page 4" href="http://viewer.zmags.com/publication/25af39a6?page=4"> European Medical Journal Gastroenterology</a> <a title="EMJ - Gastroenterology page 5" href="http://viewer.zmags.com/publication/25af39a6?page=5"> Prof Chadli Dziri Head of Medical Staff, </a> <a title="EMJ - Gastroenterology page 6" href="http://viewer.zmags.com/publication/25af39a6?page=6"> Robust protection against recurrent episodes of h</a> <a title="EMJ - Gastroenterology page 7" href="http://viewer.zmags.com/publication/25af39a6?page=7"> Welcome Kelly-Ann Lazarus Editor, European Medica</a> <a title="EMJ - Gastroenterology page 8" href="http://viewer.zmags.com/publication/25af39a6?page=8"> UEG CONGRESS 2013 THE INTERNATIONALES CONGRESS CE</a> <a title="EMJ - Gastroenterology page 9" href="http://viewer.zmags.com/publication/25af39a6?page=9"> Welcome to the European Medical Journal r</a> <a title="EMJ - Gastroenterology page 10" href="http://viewer.zmags.com/publication/25af39a6?page=10"> UEG CONGRESS 2013 THE INTERNATIONALES CONGRESS CE</a> <a title="EMJ - Gastroenterology page 11" href="http://viewer.zmags.com/publication/25af39a6?page=11"> panel discussions and ‘Chat with </a> <a title="EMJ - Gastroenterology page 12" href="http://viewer.zmags.com/publication/25af39a6?page=12"> UEG CONGRESS 2013 THE INTERNATIONALES CONGRESS CE</a> <a title="EMJ - Gastroenterology page 13" href="http://viewer.zmags.com/publication/25af39a6?page=13"> Critical analysis in the diagnosis of alcoholic l</a> <a title="EMJ - Gastroenterology page 14" href="http://viewer.zmags.com/publication/25af39a6?page=14"> UEG CONGRESS 2013 THE INTERNATIONALES CONGRESS CE</a> <a title="EMJ - Gastroenterology page 15" href="http://viewer.zmags.com/publication/25af39a6?page=15"> Cell count can reduce complications after pancrea</a> <a title="EMJ - Gastroenterology page 16" href="http://viewer.zmags.com/publication/25af39a6?page=16"> UEG CONGRESS 2013 THE INTERNATIONALES CONGRESS CE</a> <a title="EMJ - Gastroenterology page 17" href="http://viewer.zmags.com/publication/25af39a6?page=17"> New syndrome non-coeliac gluten sensitivity requi</a> <a title="EMJ - Gastroenterology page 18" href="http://viewer.zmags.com/publication/25af39a6?page=18"> UEG CONGRESS 2013 THE INTERNATIONALES CONGRESS CE</a> <a title="EMJ - Gastroenterology page 19" href="http://viewer.zmags.com/publication/25af39a6?page=19"> Do immunosuppressants increase the risk of skin c</a> <a title="EMJ - Gastroenterology page 20" href="http://viewer.zmags.com/publication/25af39a6?page=20"> TREATMENT OF HEPATIC ENCEPHALOPATHY: TARGETIN</a> <a title="EMJ - Gastroenterology page 21" href="http://viewer.zmags.com/publication/25af39a6?page=21"> Liver injury Hepatic fibrosis Gut dysbiosis Al</a> <a title="EMJ - Gastroenterology page 22" href="http://viewer.zmags.com/publication/25af39a6?page=22"> the result of damage at different levels of the i</a> <a title="EMJ - Gastroenterology page 23" href="http://viewer.zmags.com/publication/25af39a6?page=23"> Impaired bile flow/composition Impaired synth</a> <a title="EMJ - Gastroenterology page 24" href="http://viewer.zmags.com/publication/25af39a6?page=24"> other complications of cirrhosis. However, t</a> <a title="EMJ - Gastroenterology page 25" href="http://viewer.zmags.com/publication/25af39a6?page=25"> Table 1. Systemic haemodynamics, endogenous vasoa</a> <a title="EMJ - Gastroenterology page 26" href="http://viewer.zmags.com/publication/25af39a6?page=26"> Reduce portal H</a> <a title="EMJ - Gastroenterology page 27" href="http://viewer.zmags.com/publication/25af39a6?page=27"> hepatosplenomegaly, no ascites and no peripheral </a> <a title="EMJ - Gastroenterology page 28" href="http://viewer.zmags.com/publication/25af39a6?page=28"> 100 Rifaximin 80 Placebo Patients (%) 60 4</a> <a title="EMJ - Gastroenterology page 29" href="http://viewer.zmags.com/publication/25af39a6?page=29"> not be sufficient to eradicate the bacteria and o</a> <a title="EMJ - Gastroenterology page 30" href="http://viewer.zmags.com/publication/25af39a6?page=30"> STATE-OF-THE-ART TREATMENT OF IRRITABLE BOWEL </a> <a title="EMJ - Gastroenterology page 31" href="http://viewer.zmags.com/publication/25af39a6?page=31"> Table 1. ROME III diagnostic criteria and subtype</a> <a title="EMJ - Gastroenterology page 32" href="http://viewer.zmags.com/publication/25af39a6?page=32"> successfully with loperamide (see below), but has</a> <a title="EMJ - Gastroenterology page 33" href="http://viewer.zmags.com/publication/25af39a6?page=33"> has also been found to be effective for patients </a> <a title="EMJ - Gastroenterology page 34" href="http://viewer.zmags.com/publication/25af39a6?page=34"> Table 3: Primary endpoints specified by the Europe</a> <a title="EMJ - Gastroenterology page 35" href="http://viewer.zmags.com/publication/25af39a6?page=35"> is a nonabsorbable antibiotic that demonstrates n</a> <a title="EMJ - Gastroenterology page 36" href="http://viewer.zmags.com/publication/25af39a6?page=36"> acute pain attacks in patients with irritable bow</a> <a title="EMJ - Gastroenterology page 37" href="http://viewer.zmags.com/publication/25af39a6?page=37"> htm. Accessed 11 November 2011. 47. Tack J et al.</a> <a title="EMJ - Gastroenterology page 38" href="http://viewer.zmags.com/publication/25af39a6?page=38"> 85. van Nood E et al. Fecal microbiota transplant</a> <a title="EMJ - Gastroenterology page 39" href="http://viewer.zmags.com/publication/25af39a6?page=39"> CALL FOR PAPERS IF YOU ARE INTERESTED IN SUBMITT</a> <a title="EMJ - Gastroenterology page 40" href="http://viewer.zmags.com/publication/25af39a6?page=40"> UNDERSTANDING THE PATHOPHYSIOLOGY OF IBS Giovanni</a> <a title="EMJ - Gastroenterology page 41" href="http://viewer.zmags.com/publication/25af39a6?page=41"> history of emotional, physical, and sexual abuse)</a> <a title="EMJ - Gastroenterology page 42" href="http://viewer.zmags.com/publication/25af39a6?page=42"> There is no evidence that bloating is caused by a</a> <a title="EMJ - Gastroenterology page 43" href="http://viewer.zmags.com/publication/25af39a6?page=43"> compared with controls. Increased permeabilit</a> <a title="EMJ - Gastroenterology page 44" href="http://viewer.zmags.com/publication/25af39a6?page=44"> of the gastrointestinal tract acting on receptors</a> <a title="EMJ - Gastroenterology page 45" href="http://viewer.zmags.com/publication/25af39a6?page=45"> motility in irritable bowel syndrome: is IBS a mo</a> <a title="EMJ - Gastroenterology page 46" href="http://viewer.zmags.com/publication/25af39a6?page=46"> gastroenteritis. Gastroenterology. 2010</a> <a title="EMJ - Gastroenterology page 47" href="http://viewer.zmags.com/publication/25af39a6?page=47"> SUBSCRIBE TO THE EMJ NEWSLETTER www.news.emjrevie</a> <a title="EMJ - Gastroenterology page 48" href="http://viewer.zmags.com/publication/25af39a6?page=48"> PRACTICAL EVALUATION AND HANDLING OF PATIENTS </a> <a title="EMJ - Gastroenterology page 49" href="http://viewer.zmags.com/publication/25af39a6?page=49"> When patients are presenting themselves at </a> <a title="EMJ - Gastroenterology page 50" href="http://viewer.zmags.com/publication/25af39a6?page=50"> Patient ID ______________________________________</a> <a title="EMJ - Gastroenterology page 51" href="http://viewer.zmags.com/publication/25af39a6?page=51"> symptom development.24,25,29 This may be </a> <a title="EMJ - Gastroenterology page 52" href="http://viewer.zmags.com/publication/25af39a6?page=52"> facilitate this treatment, which demands a great </a> <a title="EMJ - Gastroenterology page 53" href="http://viewer.zmags.com/publication/25af39a6?page=53"> J Gastroenterol. 2013;48:27-34. 35. Halpert A, Go</a> <a title="EMJ - Gastroenterology page 54" href="http://viewer.zmags.com/publication/25af39a6?page=54"> ENDOSCOPIC OPTICAL ENHANCEMENT TE</a> <a title="EMJ - Gastroenterology page 55" href="http://viewer.zmags.com/publication/25af39a6?page=55"> Consistently, growing efforts have </a> <a title="EMJ - Gastroenterology page 56" href="http://viewer.zmags.com/publication/25af39a6?page=56"> Consistently, several studies have re</a> <a title="EMJ - Gastroenterology page 57" href="http://viewer.zmags.com/publication/25af39a6?page=57"> could detect 4.75-fold more neoplastic lesio</a> <a title="EMJ - Gastroenterology page 58" href="http://viewer.zmags.com/publication/25af39a6?page=58"> with chronic inflammation seen on CLE showed acute</a> <a title="EMJ - Gastroenterology page 59" href="http://viewer.zmags.com/publication/25af39a6?page=59"> for real-time in vivo histology during ongo</a> <a title="EMJ - Gastroenterology page 60" href="http://viewer.zmags.com/publication/25af39a6?page=60"> surveillance in ulcerative colitis. Expert Rev Ga</a> <a title="EMJ - Gastroenterology page 61" href="http://viewer.zmags.com/publication/25af39a6?page=61"> 2012;18(12):2261-9. 73. Kiesslich R et al. L</a> <a title="EMJ - Gastroenterology page 62" href="http://viewer.zmags.com/publication/25af39a6?page=62"> ADHESION MOLECULES AS A THERAPEUTIC </a> <a title="EMJ - Gastroenterology page 63" href="http://viewer.zmags.com/publication/25af39a6?page=63"> signalling molecules participate in media</a> <a title="EMJ - Gastroenterology page 64" href="http://viewer.zmags.com/publication/25af39a6?page=64"> Table 1. Integrins and their receptors. Adhesion </a> <a title="EMJ - Gastroenterology page 65" href="http://viewer.zmags.com/publication/25af39a6?page=65"> adhesion molecules, which are characterised </a> <a title="EMJ - Gastroenterology page 66" href="http://viewer.zmags.com/publication/25af39a6?page=66"> Table 2. Clinical trials involving drugs targetin</a> <a title="EMJ - Gastroenterology page 67" href="http://viewer.zmags.com/publication/25af39a6?page=67"> NCT number; status Completed Completed NC</a> <a title="EMJ - Gastroenterology page 68" href="http://viewer.zmags.com/publication/25af39a6?page=68"> Table 3. Clinical trials involving drugs targetin</a> <a title="EMJ - Gastroenterology page 69" href="http://viewer.zmags.com/publication/25af39a6?page=69"> Completed Completed Completed NCT009286</a> <a title="EMJ - Gastroenterology page 70" href="http://viewer.zmags.com/publication/25af39a6?page=70"> Natalizumab Several placebo-controlled stud</a> <a title="EMJ - Gastroenterology page 71" href="http://viewer.zmags.com/publication/25af39a6?page=71"> a more favourable safety profile; e.g. a blockade </a> <a title="EMJ - Gastroenterology page 72" href="http://viewer.zmags.com/publication/25af39a6?page=72"> 1, ISIS 3082, has been shown to be active</a> <a title="EMJ - Gastroenterology page 73" href="http://viewer.zmags.com/publication/25af39a6?page=73"> 11. Cellier C et al. In-situ endothelial cell adh</a> <a title="EMJ - Gastroenterology page 74" href="http://viewer.zmags.com/publication/25af39a6?page=74"> EFFECTS OF ANTIBIOTIC USE ON THE MICROBIOTA OF </a> <a title="EMJ - Gastroenterology page 75" href="http://viewer.zmags.com/publication/25af39a6?page=75"> composition of the gut microbiota. These studies </a> <a title="EMJ - Gastroenterology page 76" href="http://viewer.zmags.com/publication/25af39a6?page=76"> Importantly, C. difficile can cause a varyi</a> <a title="EMJ - Gastroenterology page 77" href="http://viewer.zmags.com/publication/25af39a6?page=77"> allergies.40,44-46 Furthermore, some relations</a> <a title="EMJ - Gastroenterology page 78" href="http://viewer.zmags.com/publication/25af39a6?page=78"> EFFECTS ON METABOLIC HEALTH The gut microbiota</a> <a title="EMJ - Gastroenterology page 79" href="http://viewer.zmags.com/publication/25af39a6?page=79"> Acknowledgements This work was supported the Span</a> <a title="EMJ - Gastroenterology page 80" href="http://viewer.zmags.com/publication/25af39a6?page=80"> 38. Kuvaeva IB et al. Microecology of the </a> <a title="EMJ - Gastroenterology page 81" href="http://viewer.zmags.com/publication/25af39a6?page=81"> From a host of fourteen therapeutical areas, EURO</a> <a title="EMJ - Gastroenterology page 82" href="http://viewer.zmags.com/publication/25af39a6?page=82"> MANAGING ULCERATIVE COLITIS: THE GUIDELINES AND</a> <a title="EMJ - Gastroenterology page 83" href="http://viewer.zmags.com/publication/25af39a6?page=83"> Left-Sided Disease A combination of oral and </a> <a title="EMJ - Gastroenterology page 84" href="http://viewer.zmags.com/publication/25af39a6?page=84"> Specific treatment New diagnosis Infection? CMV;</a> <a title="EMJ - Gastroenterology page 85" href="http://viewer.zmags.com/publication/25af39a6?page=85"> regarding infliximab contain only a few subjects w</a> <a title="EMJ - Gastroenterology page 86" href="http://viewer.zmags.com/publication/25af39a6?page=86"> However there is little published data that study</a> <a title="EMJ - Gastroenterology page 87" href="http://viewer.zmags.com/publication/25af39a6?page=87"> We strongly recommend that all the above drug tre</a> <a title="EMJ - Gastroenterology page 88" href="http://viewer.zmags.com/publication/25af39a6?page=88"> failed previous glucocorticoid, immunosuppressive</a> <a title="EMJ - Gastroenterology page 89" href="http://viewer.zmags.com/publication/25af39a6?page=89"> 7. Sninsky CA et al. Oral mesalamine (Asaco</a> <a title="EMJ - Gastroenterology page 90" href="http://viewer.zmags.com/publication/25af39a6?page=90"> long-term follow-up of a single-centre cohort. </a> <a title="EMJ - Gastroenterology page 91" href="http://viewer.zmags.com/publication/25af39a6?page=91"> ranging study. Inflamm Bowel Dis. Bowel</a> <a title="EMJ - Gastroenterology page 92" href="http://viewer.zmags.com/publication/25af39a6?page=92"> NON-SURGICAL THERAPY FOR UNRESECTABLE HILAR CHOLA</a> <a title="EMJ - Gastroenterology page 93" href="http://viewer.zmags.com/publication/25af39a6?page=93"> Table 1. The Bismuth-Corlette classification for m</a> <a title="EMJ - Gastroenterology page 94" href="http://viewer.zmags.com/publication/25af39a6?page=94"> PERCUTANEOUS TRANSHEPATIC DRAINAGE VERSUS ENDOTHE</a> <a title="EMJ - Gastroenterology page 95" href="http://viewer.zmags.com/publication/25af39a6?page=95"> mm theoretically offer the optimal condition</a> <a title="EMJ - Gastroenterology page 96" href="http://viewer.zmags.com/publication/25af39a6?page=96"> was not available. Furthermore, patient subgroup </a> <a title="EMJ - Gastroenterology page 97" href="http://viewer.zmags.com/publication/25af39a6?page=97"> Figure 2. Bilateral stenting in a side by </a> <a title="EMJ - Gastroenterology page 98" href="http://viewer.zmags.com/publication/25af39a6?page=98"> Table 3. Studies comparing unilateral placement v</a> <a title="EMJ - Gastroenterology page 99" href="http://viewer.zmags.com/publication/25af39a6?page=99"> REFERENCES 1. Larghi A et al. Management of hila</a> <a title="EMJ - Gastroenterology page 100" href="http://viewer.zmags.com/publication/25af39a6?page=100"> of malignant hilar strictures: the role of liver </a> <a title="EMJ - Gastroenterology page 101" href="http://viewer.zmags.com/publication/25af39a6?page=101"> CALL FOR PAPERS IF YOU ARE INTERESTED IN SUBMITT</a> <a title="EMJ - Gastroenterology page 102" href="http://viewer.zmags.com/publication/25af39a6?page=102"> ENDOSCOPIC NECROSECTOMY AS TREATMENT FOR </a> <a title="EMJ - Gastroenterology page 103" href="http://viewer.zmags.com/publication/25af39a6?page=103"> ENDOSCOPIC NECROSECTOMY Growing Acceptance The i</a> <a title="EMJ - Gastroenterology page 104" href="http://viewer.zmags.com/publication/25af39a6?page=104"> Figure 3. Internal endoscopic aspect of the cavit</a> <a title="EMJ - Gastroenterology page 105" href="http://viewer.zmags.com/publication/25af39a6?page=105"> • cholecystectomy after biliary pancreati</a> <a title="EMJ - Gastroenterology page 106" href="http://viewer.zmags.com/publication/25af39a6?page=106"> THE VERSATILE ROLE OF THE VAGUS NERVE IN THE </a> <a title="EMJ - Gastroenterology page 107" href="http://viewer.zmags.com/publication/25af39a6?page=107"> vagus, respectively.1,5,6 However, one has to kee</a> <a title="EMJ - Gastroenterology page 108" href="http://viewer.zmags.com/publication/25af39a6?page=108"> Electrophysiological studies have confirm</a> <a title="EMJ - Gastroenterology page 109" href="http://viewer.zmags.com/publication/25af39a6?page=109"> Indeed, the administration of specific CCK-A </a> <a title="EMJ - Gastroenterology page 110" href="http://viewer.zmags.com/publication/25af39a6?page=110"> circumventricular organs [CVO]) that are devoid o</a> <a title="EMJ - Gastroenterology page 111" href="http://viewer.zmags.com/publication/25af39a6?page=111"> REFERENCES 1. Drake RL et al. Gray’s atlas of an</a> <a title="EMJ - Gastroenterology page 112" href="http://viewer.zmags.com/publication/25af39a6?page=112"> 46. Berthoud HR et al. Vagal afferent innervation</a> <a title="EMJ - Gastroenterology page 113" href="http://viewer.zmags.com/publication/25af39a6?page=113"> Trauma. 2011;70(5):1168-75; discussion 75- 6. 91.</a> <a title="EMJ - Gastroenterology page 114" href="http://viewer.zmags.com/publication/25af39a6?page=114"> J Clin Invest. 2008;118(6):2209-18. 133. Rosas-B</a> <a title="EMJ - Gastroenterology page 115" href="http://viewer.zmags.com/publication/25af39a6?page=115"> SUBSCRIBE TO THE EMJ NEWSLETTER www.news.emjrevie</a> <a title="EMJ - Gastroenterology page 116" href="http://viewer.zmags.com/publication/25af39a6?page=116"> A REVIEW OF CROHN’S DISEASE Phi</a> <a title="EMJ - Gastroenterology page 117" href="http://viewer.zmags.com/publication/25af39a6?page=117"> of their Crohn’s disease.3,4 Rates in the </a> <a title="EMJ - Gastroenterology page 118" href="http://viewer.zmags.com/publication/25af39a6?page=118"> Microbiome The microbiome consists of </a> <a title="EMJ - Gastroenterology page 119" href="http://viewer.zmags.com/publication/25af39a6?page=119"> (azathioprine is known to increase the risk</a> <a title="EMJ - Gastroenterology page 120" href="http://viewer.zmags.com/publication/25af39a6?page=120"> Standard abdominal radiography is useful for</a> <a title="EMJ - Gastroenterology page 121" href="http://viewer.zmags.com/publication/25af39a6?page=121"> Table 2. Clinical, endoscopic, and laboratory pre</a> <a title="EMJ - Gastroenterology page 122" href="http://viewer.zmags.com/publication/25af39a6?page=122"> an anti-metabolite, is used in Crohn’s dise</a> <a title="EMJ - Gastroenterology page 123" href="http://viewer.zmags.com/publication/25af39a6?page=123"> 5. Ahuja V, Tandon RK. Inflammatory bowel dis</a> <a title="EMJ - Gastroenterology page 124" href="http://viewer.zmags.com/publication/25af39a6?page=124"> WHAT’S NEW EUROPEAN CHMP SUPPORTS APPROVAL OF GIL</a> <a title="EMJ - Gastroenterology page 125" href="http://viewer.zmags.com/publication/25af39a6?page=125"> GASTROENTEROLOGY based on t</a> <a title="EMJ - Gastroenterology page 126" href="http://viewer.zmags.com/publication/25af39a6?page=126"> WHAT’S NEW A coffee a day keeps liver cancer away</a> <a title="EMJ - Gastroenterology page 127" href="http://viewer.zmags.com/publication/25af39a6?page=127"> GASTROENTEROLOGY Surgery not always the solution</a> <a title="EMJ - Gastroenterology page 128" href="http://viewer.zmags.com/publication/25af39a6?page=128"> WHAT’S NEW The key to intestinal health - HDAC3 </a> <a title="EMJ - Gastroenterology page 129" href="http://viewer.zmags.com/publication/25af39a6?page=129"> GASTROENTEROLOGY Butyrate: a positive influence f</a> <a title="EMJ - Gastroenterology page 130" href="http://viewer.zmags.com/publication/25af39a6?page=130"> WHAT’S NEW Specialists could save the lives of bo</a> <a title="EMJ - Gastroenterology page 131" href="http://viewer.zmags.com/publication/25af39a6?page=131"> GASTROENTEROLOGY Is there a link between autism a</a> <a title="EMJ - Gastroenterology page 132" href="http://viewer.zmags.com/publication/25af39a6?page=132"> WHAT’S NEW Is screening to detect coeliac disease</a> <a title="EMJ - Gastroenterology page 133" href="http://viewer.zmags.com/publication/25af39a6?page=133"> GASTROENTEROLOGY Colon cancer linked with gut ba</a> <a title="EMJ - Gastroenterology page 134" href="http://viewer.zmags.com/publication/25af39a6?page=134"> Abbott Products Operations AG Abbvie ACTIAL FARMA</a> <a title="EMJ - Gastroenterology page 135" href="http://viewer.zmags.com/publication/25af39a6?page=135"> Leufen Medical GmbH Life Partners Europe M.I. 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