American Gastroenterological Association technical review on the management of Barrett's esophagus.

Small-bowel capsule endoscopy (SBCE)
 1 ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization. Strong recommendation, high quality evidence. However, the optimal timing for taking purgatives is yet to be established. 2 ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients. Strong recommendation, moderate quality evidence. 3 ESGE recommends that patients with pacemakers can safely undergo SBCE without special precautions. Strong recommendation, low quality evidence. 4 ESGE suggests that SBCE can also be safely performed in patients with implantable cardioverter defibrillators and left ventricular assist devices. Weak recommendation, low quality evidence. 5 ESGE recommends the acceptance of qualified nurses and trained technicians as prereaders of capsule endoscopy studies as their competency in identifying pathology is similar to that of medically qualified readers. The responsibility of establishing a diagnosis must however remain with the attending physician. Strong recommendation, moderate quality evidence. 6 ESGE recommends observation in cases of asymptomatic capsule retention. Strong recommendation, moderate quality evidence. In cases where capsule retrieval is indicated, ESGE recommends the use of device-assisted enteroscopy as the method of choice. Strong recommendation, moderate quality evidence. Device-assisted enteroscopy (DAE)
 1 ESGE recommends performing diagnostic DAE as a day-case procedure in patients without significant underlying co-morbidities; in patients with co-morbidities and/or those undergoing a therapeutic procedure, an inpatient stay is recommended. Strong recommendation, low quality evidence The choice between different settings also depends on sedation protocols. Strong recommendation, low quality evidence. 2 ESGE suggests that conscious sedation, deep sedation, and general anesthesia are all acceptable alternatives: the choice between them should be governed by procedure complexity, clinical factors, and local organizational protocols. Weak recommendation, low quality evidence. 3 ESGE recommends that the findings of previous diagnostic investigations should guide the choice of insertion route. Strong recommendation, moderate quality evidence. If the location of the small-bowel lesion is unknown or uncertain, ESGE recommends that the antegrade route should be generally preferred. Strong recommendation, low quality evidence. In the setting of massive overt bleeding, ESGE recommends an initial antegrade approach. Strong recommendation, low quality evidence. 4 ESGE recommends that, for balloon-assisted enteroscopy (i. e., single-balloon enteroscopy [SBE] and double-balloon enteroscopy [DBE]), small-bowel insertion depth should be estimated by counting net advancement of the enteroscope during the insertion phase, with confirmation of this estimate during withdrawal. Strong recommendation, low quality evidence. ESGE recommends that, for spiral enteroscopy, insertion depth should be estimated during withdrawal. Strong recommendation, moderate quality evidence. Since the calculated insertion depth is only a rough estimate, ESGE recommends placing a tattoo to mark the identified lesion and/or the deepest point of insertion. Strong recommendation, low quality evidence. 5 ESGE recommends that all endoscopic therapeutic procedures can be undertaken at the time of DAE. Strong recommendation, moderate quality evidence. Moreover, when therapeutic interventions are performed, additional specific safety measures are needed to prevent complications. Strong recommendation, high quality evidence.

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Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

Introduction: The gastrointestinal mucosa constitutes a critical barrier where millions of microbes and environmental antigens come in close contact with the host immune system. Intestinal barrier defects have been associated with a broad range of diseases and therefore denote a new therapeutic target.Areas covered: This review is based on an extensive literature search in PubMed of how the intestinal barrier contributes to health and as a trigger for disease. It discusses the anatomy of the intestinal barrier and explains the available methods to evaluate its function. Also reviewed is the importance of diet and lifestyle factors on intestinal barrier function, and three prototypes of chronic diseases (inflammatory bowel disease, celiac disease and nonalcoholic fatty liver disease) that have been linked to barrier defects are discussed.Expert commentary: The intestinal barrier has been investigated by various methods, but correlation of results across studies is difficult, representing a major sh...

/pdf/the-intestinal-barrier-a-fundamental-role-in-health-and-6v3pj2rh9c.pdf

The intestinal barrier: a fundamental role in health and disease.

Purpose Most of the esophageal squamous cell carcinomas (ESCCs) and cancers of the head and neck (HN 97% v 55%, P < .001, respectively). The sensitivity ...

Early Detection of Superficial Squamous Cell Carcinoma in the Head and Neck Region and Esophagus by Narrow Band Imaging: A Multicenter Randomized Controlled Trial

The bacterial pathogen Helicobacter pylori has co-evolved with humans and colonizes approximately 50% of the human population, but only causes overt gastric disease in a subset of infected hosts. In this Review, we discuss the pathogenesis of H. pylori and the mechanisms it uses to promote persistent colonization of the gastric mucosa, with a focus on recent insights into the role of the virulence factors vacuolating cytotoxin (VacA), cytotoxin-associated gene A (CagA) and CagL. We also describe the immunobiology of H. pylori infection and highlight how this bacterium manipulates the innate and adaptive immune systems of the host to promote its own persistence.

/pdf/life-in-the-human-stomach-persistence-strategies-of-the-4uer8kug3v.pdf

Life in the human stomach: persistence strategies of the bacterial pathogen Helicobacter pylori

W1676 NSAID-Induced Small Bowel Injury Is Reduced in Patients with Rheumatoid Arthritis Receiving Anti-Tumor Necrosis Factor-α Therapy

BACKGROUND The standard therapy for gastric cancer with peritoneal metastasis has remained unclear. PURPOSE This prospective feasibility study was aimed to investigate the efficacy and safety of S-1 plus paclitaxel for advanced/recurrent gastric cancer patients with peritoneal metastasis able to take oral feeding. PATIENTS AND METHODS Seven patients were enrolled in this study. Paclitaxel 50mg/m2 was administered on days 1 and 8. S-1 was administered orally at 40 mg/m2 bid for 14 consecutive days, followed by a 1-week rest. Overall survival, the response rate and safety were examined for efficacy and tolerability. RESULTS The median survival time was 310 days. The response rate in five patients was 80. 0%. Grade 3 toxicity was observed in two patients. Combination chemotherapy of weekly paclitaxel and S-1 demonstrated efficacy and tolerable toxicity. This regimen will be one of the initial treatment options for unresectable or metastatic gastric cancer with peritoneal metastasis.

[Combination of S-1 and paclitaxel for advanced/recurrent gastric cancer patients with peritoneal metastasis, feasibility study (OGSG0401)].

W1705 Autophagy Promotes Gastric Ulcer Healing

A 31-year-old man has visited our hospital, complaining diarrhea and leg edema. Blood test showed hypoalbuminea, but we couldn't find the reason by several examinations. Therefore, we performed double balloon enteroscopy, and intestinal lymphangiectasia was diagnosed histologically by biopsy. It's useful and effective to perform double balloon enteroscopy and histological examination for the unknown origin case of protein loosing enteropathy.

Hirohisa Machida

Papers

W1676 NSAID-Induced Small Bowel Injury Is Reduced in Patients with Rheumatoid Arthritis Receiving Anti-Tumor Necrosis Factor-α Therapy

[Combination of S-1 and paclitaxel for advanced/recurrent gastric cancer patients with peritoneal metastasis, feasibility study (OGSG0401)].

W1705 Autophagy Promotes Gastric Ulcer Healing

[Efficacy of double balloon enteroscopy for patients with intestinal lymphangiectasia, case report of primary intestinal lymphangiectasia].

The effect of food intake on pharmacokinetics of lansoprazole OD tablet