bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterozygosity for IL23R p.Arg381Gln confers a protective effect not only against Crohn’s disease but also ulcerative colitis
Authors: BÜNING C. , SCHMIDT H. H.‐J. , MOLNAR T. , DE JONG D. J , FIEDLER T. , BÜHNER S. , STURM A. , BAUMGART D. C. , NAGY F. , LONOVICS J. , DRENTH J. P. H. , LANDT O. , NICKEL R. , BÜTTNER J. , LOCHS H. , WITT H. 
Published: July 2010

SummaryBackground  A recent study reported that a non‐synonymous single nucleotide polymorphism (rs11209026, p.Arg381Gln) located in the IL23R gene is a protective marker for inflammatory bowel disease.Aim  To analyse the frequency of p.Arg381Gln in three independent European inflammatory bowel disease cohorts and to evaluate how this variant influences disease behaviour.Methods  We assessed a European cohort of 919 inflammatory bowel disease patients and compared the IL23R p.Arg381Gln genotype frequency with 845 healthy controls. Inflammatory bowel disease patients originated from Germany [Crohn’s disease (CD): n = 318; ulcerative colitis (UC): n = 178], Hungary (CD: n = 148; UC: n = 118) and the Netherlands (CD: n = 157). Ethnically matched controls were included. We performed subtyping analysis in respect to CARD15 alterations and clinical characteristics.Results  The frequency of the glutamine allele of p.Arg381Gln was significantly lower in inflammatory bowel disease patients compared with controls in a pooled analysis of all three cohorts (P < 0.000001) as well as in the individual cohorts (Germany: P = 0.001, Hungary: P = 0.02 and the Netherlands: P = 0.0002). The p.Arg381Gln genotype distribution was similar between CD and UC. We did not observe either statistical interactions between p.Arg381Gln and CARD15 variants or any significant associations between p.Arg381Gln genotype and subphenotypes.Conclusions  The p.Arg381Gln IL23R variant confers a protective effect against both CD and UC, but does not determine disease phenotype.
Review article: increasing the dose of oral mesalazine therapy for active ulcerative colitis does not improve remission rates
Authors: SAFDI A. V. , COHEN R. D. 
Published: July 2010

SummaryBackground  Oral mesalazine (mesalamine, 5‐aminosalicylic acid) formulations are effective in the treatment of active ulcerative colitis. All formulations contain the same active drug but differ with regard to mechanisms to deliver the drug to the colon. Patients who fail to respond to initial therapy are often administered higher doses of the same formulation.Aim  To review published trials of oral mesalazine formulations in treating active ulcerative colitis and to examine the effect of dose escalation on remission rates.Results  Increasing the doses of oral mesalazine formulations does not result in higher remission rates, although increasing the doses of some formulations has been effective in increasing symptomatic improvement and/or response to treatment.Conclusions  Because oral mesalazine formulations do not demonstrate a significant dose response with regard to induction of remission of active ulcerative colitis, simple dose escalation may not be the most effective course for patients who fail to respond to initial mesalazine treatment.
Review article: Helicobacter pylori eradication for the prevention of gastric cancer
Authors: DE VRIES A. C. , KUIPERS E. J. 
Published: July 2010

SummaryBackground  Gastric cancer is the fourth most common cancer and second leading cause of cancer‐related death worldwide. A clear association between Helicobacter pylori infection and gastric cancer was established years ago. H. pylori eradication may be an effective approach to decrease morbidity and mortality of gastric cancer.Aim  To discuss current evidence of H. pylori eradication for prevention of gastric cancer.Results  Recent studies have shown that the association between H. pylori and gastric cancer has probably been underestimated. This may have resulted from negative H. pylori status in subjects after loss of colonisation in the presence of atrophic gastritis and intestinal metaplasia, prior to development of gastric cancer. The recognition of the central role of H. pylori in carcinogenesis has increased expectations of gastric cancer prevention by H. pylori eradication. A primary preventive effect of eradication in subjects with H. pylori‐induced gastritis has been demonstrated. However, a secondary preventive effect in patients with pre‐malignant gastric lesions is still controversial, especially in patients with intestinal metaplasia and dysplasia.Conclusions  At this moment, H. pylori eradication seems indicated at the earliest stage of gastric carcinogenesis. This treatment policy requires confirmation; results of ongoing randomised controlled trials are therefore eagerly awaited.
Review article: multimodality treatment of liver metastases increases suitability for surgical treatment
Authors: DE JONG K. P. 
Published: July 2010

SummaryBackground Liver metastases of colorectal cancer occur frequently, but only 10–20% are eligible for liver surgery. Recent new developments changed the concepts of treating patients with colorectal liver metastases.Aim To describe the available modalities that can result in increasing resectability rate.Methods Potentials and drawbacks of portal vein embolization, radiofrequency ablation (RFA), trans‐ablated tumour hepatectomy, neoadjuvant chemotherapy and the approach to patients with extrahepatic metastases are described.Results Portal vein embolization is a well‐established technique to increase the volume of the future liver remnant. RFA should be applied if partial liver resection alone cannot make the liver tumour‐free. Neoadjuvant chemotherapy in patients with unresectable liver metastases can result in secondary resectability rates of 15–40%. Hepatotoxicity can lead to a higher complication rate after partial liver resection. A limited number of extrahepatic tumour localizations should be resected as well.Conclusions A more aggressive approach to patients with colorectal liver metastases improves resectability rate and survival. Unfortunately, these new options have not been thoroughly evaluated in randomized controlled trials. For some of these modalities, the currently available results are so promising that it might be difficult to start such trials in the future.
Review article: surgical management of chronic pancreatitis
Authors: VAN DER GAAG N. A. , GOUMA D. J. , VAN GULIK T. M. , BUSCH O. R. C. , BOERMEESTER M. A. 
Published: July 2010

SummaryBackground  The therapeutic approach to patients with chronic pancreatitis (CP) is complicated by the fact that patients are presented to the physician at different stages of disease and in the presence of varying clinical symptoms. Generally, an expectant approach is justified for patients with asymptomatic CP. At present, patients with symptoms related to gland destruction are initially treated by endoscopic means, while surgical treatment of CP is usually reserved for intractable abdominal pain, suspicion of cancer, and complications such as persistent pseudocysts.Aim  To review the studies currently available evaluating surgical and/or endoscopic management of CP.Results  Improvements in imaging techniques, as well as a better understanding of the pathophysiology of CP and mechanisms causing pain, have led to a more conscious selection of patients for surgery. Type of surgery depends on whether the pancreatic duct is dilated, presence of an inflammatory mass and occurrence of complications (pseudocysts, gastric outlet obstruction). Eventually, after initial endoscopic treatment, a substantial number of patients still need surgery for persistent complaints.Conclusions  For patients with symptomatic CP, a multidisciplinary approach is indicated with low threshold to surgical intervention, since long‐term pain relief is accomplished more often after surgical treatment than after endoscopic treatment.
Review article: translumenal endoscopic debridement of organized pancreatic necrosis – the first step towards natural orifice translumenal endoscopic surgery
Authors: VOERMANS R. P. , BRUNO M. J. , VAN BERGE HENEGOUWEN M. I. , FOCKENS P. 
Published: July 2010

SummaryBackground  Over the last decades, gastrointestinal endoscopy has transformed from serving purely diagnostic purposes to therapeutic applications. One recent major progress is taking the endoscope beyond the gastrointestinal lumen into the peritoneal cavity for diagnostic and therapeutic procedures. The first step towards Natural Orifice Translumenal Endoscopic Surgery (NOTES) was translumenal endoscopic debridement of pancreatic necrosis.Aim  To overview current status of endoscopic debridement of organized pancreatic necrosis. Finally, we take a short look into the potential future of translumenal endoscopic procedures.Methods  Medical databases were searched for relevant publications, dealing with endoscopic debridement of pancreatic necrosis and NOTES.Results  All current published studies concerning endoscopic debridement of organized pancreatic necrosis were retrospectivally performed and relatively small (largest n = 25). Succes rates varies from 80–93% and complication rates from 7–20%. There was no procedure related mortality reported. Published NOTES experiments showed feasibilty of a variety of transgastric, transcolonic and transvaginal procedures in the porcine model.Conclusion  Endoscopic debridement seems to be an effective and relatively safe minimally invasive therapy in patients with symptomatic organized pancreatic necrosis and is the first step towards NOTES. Further comparative studies need to define its definitive role in the management of these patients.
Review article: management of diverticulitis
Authors: SZOJDA M. M. , CUESTA M. A. , MULDER C. M. , FELT‐BERSMA R. J. F. 
Published: July 2010

SummaryBackground and Aim  The incidence and therefore complications of (sigmoid) diverticular disease are increasing.Methods  Review of current literature.Results  From all patients, 15% will develop diverticulitis, 5% complications and 5% diverticular bleeding. Diagnosis is established with computerised tomography. Colonoscopy is needed to rule out malignancy. NSAIDs increase the risk of perforation; steroids, diabetes, collagen vascular disease and immune compromised are associated with complicated disease and death. In mild diverticulitis, antibiotics are recommended. In complicated disease with abscesses, <5 cm antibiotics are sufficient. Larger abscesses are drained under computerised tomography‐guidance. Peritonitis forms an indication for surgery. Diverticulitis recurrence rate is around 30%, most are uncomplicated. Recurrence after surgery is around 10%. Elective surgery is reserved for fistula closure and obstruction. The need for elective surgery to prevent recurrence has diminished because of new insights. Important is to identify risk groups. New issues are the possible relationship between diverticulitis and cancer, segmental colitis associated with diverticulitis, and treatment of diverticulitis with mesalazine and probiotics.Conclusions  Uncomplicated diverticulitis is treated medically. Complicated diverticulitis with small abscesses is treated with antibiotics while larger abscesses are drained with computerised tomography‐guided puncture. Emergency surgery is reserved for peritonitis, elective surgery for fistula/stenosis. Surgery to prevent recurrence is indicated only in selected cases (e.g. immune compromised).
Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance imaging for detection of hepatocellular carcinoma in patients with advanced cirrhosis
Authors: SNOWBERGER N. , CHINNAKOTLA S. , LEPE R. M. , PEATTIE J. , GOLDSTEIN R. , KLINTMALM G. B. , DAVIS G. L. 
Published: July 2010

SummaryBackground  Serum alpha fetoprotein (AFP), ultrasound, computerized tomography scanning, and magnetic resonance imaging are commonly used to screen for hepatocellular carcinoma (HCC) in patients with cirrhosis.Aim  To assess the accuracy of screening in advanced cirrhosis.Methods  The study group consisted of 239 patients with proven HCC in the explanted liver at the time of liver transplant. AFP and imaging were done at referral and serially until transplant.Results  Hepatocellular carcinoma was detected before liver transplant in 78% and discovered incidentally in 22%. The cause of cirrhosis was hepatitis C (HCV) (55%), hepatitis B (HBV) (17%), alcohol (9%), and other/unknown (19%). Although AFP was elevated 62%, the median level was 15 ng/mL. Only 26%, 15% and 13% were more than 100, 400 and 1000 ng/mL, respectively. By comparison, AFP was elevated in 20% without HCC, but exceeded 100 ng/mL in only 3%. The overall accuracy of AFP was poor regardless of the cutoff. Magnetic resonance imaging was more accurate than computerized tomography or ultrasound in detecting tumour, particularly when performed within 3 months of transplant.Conclusions  Magnetic resonance imaging is most sensitive for imaging HCC and best reflects actual tumour size. AFP is insensitive and adds little to screening strategies, but has prognostic value when extremely elevated.
Review article: the pathophysiology of thrombocytopenia in hepatitis C virus infection and chronic liver disease
Authors: WEKSLER B. B. 
Published: July 2010

SummaryBackground  The pathophystology of thrombocytopenia in patients with chronic liver disease resulting from hepatitis C virus (HCV) infection is complex and involves several complementary mechanisms that likely act in concert.Aim  To summarize the available data on the etiology of thrombocytopenia in patients with chronic liver disease.Results  In patients with untreated hepatitis C, both prevalence and severity of thrombocytopenia increase in parallel with the extent of disease, usually becoming clinically relevant when patients develop extensive fibrosis and/or cirrhosis. Pathogenetic mechanisms include hypersptenism secondary to portal hypertension, bone marrow suppression resulting from either HCV itself or interferon treatment, aberrations of the immune system resulting in the formation of anti‐platelet antibodies and/or immune‐complexes that bind to platelets and facilitate their premature clearance, development of immunologically‐mediated extrahepatic manifestations including mixed cryoglobulinemia with or without associated joint, renal, or cutaneous involvement, and thrombopoietin (TPO) deficiency secondary to liver dysfunction. In chronic liver disease, the natural inverse relationship between TPO and platelet levels is not maintained; therefore, blood TPO levels fail to have clinical relevance or predictive value in assessing the thrombocytopenic status of a given patient.Conclusions  The development of thrombocytopenisa in patients with chronic liver disease is complex and multifactorial.
Review article: the function and regulation of proteins involved in bile salt biosynthesis and transport
Authors: PELLICORO A. , FABER K. N. 
Published: July 2010

SummaryBackground Bile salts are produced and secreted by the liver and are required for intestinal absorption of fatty food components and excretion of endobiotics and xenobiotics. They are reabsorbed in the terminal ileum and transported back to the liver via the portal tract. Dedicated bile salt transporters in hepatocytes and enterocytes are responsible for the unidirectional transport of bile salts in the enterohepatic cycle.Aim To give an overview of the function and regulations of proteins involved in bile salt synthesis and transport.Methods Data presented are obtained from PubMed‐accessible literature combined with our own recent research.Result Hepatocytes and enterocytes contain unique bile salt importers (sodium‐taurocholate cotransporting polypeptide and apical sodium‐dependent bile acid transporter, respectively) and exporters (bile salt export pump and organic solute transporter alpha‐beta, respectively). Enzymes involved in bile salt biosynthesis reside in different subcellular locations, including the endoplasmic reticulum, mitochondria, cytosol and peroxisomes. Defective expression or function of the transporters or enzymes may lead to cholastasis. The bile salt‐activated transcription factor Farnesoid X receptor controls expression of genes involved in bile salt biosynthesis and transport.Conclusions Detailed knowledge is available about the enzymes and transporters involved in bile salt homeostasis and how their defective function is associated with cholestasis. In contrast, the process of intracellular bile salt transport is largely unexplored.
Meta analysis: cancer risk in Barrett’s oesophagus
Authors: THOMAS T. , ABRAMS K. R. , DE CAESTECKER J. S. , ROBINSON R. J. 
Published: July 2010

SummaryBackground  Risk of cancer in Barrett’s oesophagus is reported to vary between studies and also between countries, where the studies were conducted as per several systematic reviews. Cancer incidence has implications on surveillance strategies.Aim  To perform a meta‐analysis to determine the incidence of oesophageal cancer in Barrett’s oesophagus.Methods  Articles retrieved by MEDLINE search (English language, 1966–2004). Studies had to necessarily include verified Barrett’s oesophagus surveillance patients, documented follow‐up and cancer identified as the outcome measure. A random effects model of meta‐analysis was chosen and results were expressed as mean (95% CI).Results  Forty‐one articles selected for conventional Barrett’s oesophagus (length >3 cm); eight included short segment Barrett’s oesophagus (one additional article including only short segment Barrett’s oesophagus). Cancer incidence was 7/1000 (6–9) person‐years duration of follow‐up (pyd), with no detectable geographical variation [UK 7/1000 (4–12) pyd, USA 7/1000 (5–9) pyd and Europe 8/1000 (5–12) pyd]. Cancer incidence in the UK was 10/1000 (7–14), when two large studies were excluded. Cancer incidence in SSBO was 6/1000 (3–12) pyd. When short segment Barrett’s oesophagus compared to conventional Barrett’s oesophagus, there was a trend towards reduced cancer risk [OR 0.55, (95% CI: 0.19–1.6), P = 0.25].Conclusion  We found no geographical variations in Barrett’s oesophagus cancer risk, but observed a trend towards reduced cancer risk in short segment Barrett’s oesophagus. There is a time trend of decreasing cancer incidence.
The effectiveness of rifabutin triple therapy for patients with difficult‐to‐eradicate Helicobacter pylori in clinical practice
Authors: VAN DER POORTEN D. , KATELARIS P. H. 
Published: July 2010

SummaryBackground Failure of first line and subsequent Helicobacter pylori eradication therapy is a significant problem and alternative treatments are few.Aims To evaluate the efficacy of a rifabutin‐based triple therapy in clinical practice and determine the optimal strategy for its use.Methods Patients referred after first or subsequent treatment failure were prescribed rifabutin triple therapy consisting of standard dose proton pump inhibitor, amoxicillin 1 g and rifabutin 150 mg each b.d. for 10 days.Results In 67 patients, the main indications for treatment were dyspepsia (55%), peptic ulcer disease (24%) and increased gastric cancer risk (18%). The median number of previous treatments was 2 (range: 1–9). Eradication of Helicobacter pylori was achieved in 76% (48/63) per protocol and 72% (48/67) on an intention‐to‐treat basis. When used as second line therapy, 95% (18/19) achieved eradication compared with 68% (30/44) when two or more previous treatments had been used (P = 0.03). Outcome was independent of age, ethnicity, gender or indication for treatment. Adverse events were reported in 10%.Conclusion Rifabutin triple therapy is a well tolerated and effective second line therapy in the treatment of persistent Helicobacter pylori; however, its efficacy decreases with increasing number of failed previous therapies.
Systematic review: endoscopic dilatation in Crohn’s disease
Authors: HASSAN C. , ZULLO A. , DE FRANCESCO V. , IERARDI E. , GIUSTINI M. , PITIDIS A. , TAGGI F. , WINN S. , MORINI S. 
Published: July 2010

SummaryBackground  Endoscopic dilatation for Crohn’s disease has been evaluated only in some small and heterogeneous studies.Aim  To evaluate any association between the main clinical variables and endoscopic variables and the efficacy and safety of endoscopic dilatation in Crohn’s disease.Methods  A Medline search regarding pneumatic dilatation in Crohn’s disease was performed. Several technical and clinical variables were extracted from each study to build up a descriptive, pool‐data analysis. Data on individual patients were extracted from suitable studies to create a simulated population upon which a multivariate statistical analysis was performed.Results  Thirteen studies enrolling 347 Crohn’s disease patients were reviewed. Endoscopic dilatation was mainly applied to postsurgical strictures, being technically successful in 86% of the cases. Long‐term clinical efficacy was achieved in 58% of the patients. Mean follow‐up was as long as 33 months, corresponding to 800 patient years of follow‐up. Major complication rate was 2%, being higher than 10% in two series. At multivariate analysis, a stricture length ≤4 cm was associated with a surgery‐free outcome (OR: 4.01; 95% CI: 1.16–13.8; P < 0.028).Conclusions  Endoscopic dilatation is an effective and safe treatment for short strictures caused by Crohn’s disease, impacting substantially on the natural history of these patients.
Cumulative incidence of chronic constipation: a population‐based study 1988–2003
Authors: CHOUNG R. S. , LOCKE III G. R. , SCHLECK C. D. , ZINSMEISTER A. R. , TALLEY N. J. 
Published: July 2010

SummaryAim  To estimate the cumulative incidence of chronic constipation and evaluate potential risk factors.Methods  In previous cross‐sectional studies in 1988, random samples of Olmsted County, MN residents were mailed valid gastrointestinal symptoms surveys. A similar survey was mailed in 2003 to all the remaining eligible subjects who had been mailed to previously. An incident case of chronic constipation was defined as no reported constipation or irritable bowel syndrome on their initial survey but reported constipation on the second survey.Results  In all, 5507 (79%) subjects responded to the initial survey and 2298 (55%) subjects responded to the second survey in which chronic constipation could be defined. Over 12 years, the cumulative incidence of chronic constipation was 17.4% (14.5, 20.5). Among those less than age 50 years at baseline, the incidence of chronic constipation differed by gender (9.2% in men vs. 18.3% in women). In those over 70 years, the incidence of chronic constipation was more similar for men and women (20.6% vs. 25.0%). The other risk factor associated with new onset chronic constipation was the presence of abdominal pain at baseline [OR = 2.0 (1.3, 3.0)].Conclusion  The cumulative incidence of chronic constipation over more than a decade was almost one in six, and more pronounced in women and the elderly.