European Registry on management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients.

Objective: The best approach for management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care.

Design: International multicentre prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in management by European gastroenterologists.

Fifty years of digestive endoscopy: Successes, setbacks, solutions and the future.

Flexible endoscopes became generally available 50 years ago and created a revolution in the practice of gastroenterology. They improved diagnosis enormously, enabled quicker, less invasive, and more cost-effective surgical treatment, while endoscopic screening has prevented many cancer deaths. The new technology stimulated research leading to a better understanding of gastrointestinal pathology, identifying new diseases and clarifying the etiology of others.

Epidemiology of Helicobacter pylori infection.

The study of Helicobacter pylori genetic variability brought us interesting data on the history of mankind. Based on multilocus sequence typing and more recently on whole-genome sequencing, paleomicrobiology still attracts the attention of global researchers in relation to its ancestor roots and coexistence with humans. Three studies determining the prevalence of virulence factors illustrates the controversial results obtained since 30 years by studies trying to associate prevalence of different virulence markers and clinical outcomes of H.

Quality assurance in gastrointestinal endoscopy: An Egyptian experience.

Over the last four decades, gastrointestinal endoscopy has become of paramount importance to diagnose, treat and prevent diseases of the digestive tract. Practice variation, however, is likely to have an important effect on the effectiveness of endoscopy and can impair the delivery of high-quality endoscopic procedures. There have been increasing demands to assess the quality of service and track and improve patient outcomes.

Epidemiology of Helicobacter pylori infection.

This review of recent publications related to the epidemiology of Helicobacter pylori highlights the origin of the infection, its changing prevalence, transmission, and outcome. A number of studies have addressed the ancestor roots of the bacteria, and the first genomewide analysis of bacterial strains suggests that its coexistence with humans is more ancient than previously thought. As opposed to the generally declining prevalence of H.

Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan.

Aim: To assess the diagnostic concordance between endoscopic and histological atrophy in the United Kingdom and Japan.

Methods: Using published data, a total of 252 patients, 126 in the United Kingdom and 126 in Japan, aged 20 to 80 years, were evaluated. The extent of endoscopic atrophy was classified into five subgroups according to a modified Kimura-Takemoto classification system and was compared with histological findings of atrophy at five biopsy sites according to the updated Sydney system.

Helicobacter pylori and Nonmalignant Diseases.

Helicobacter pylori is responsible for most peptic ulcers, plays a role in functional dyspepsia and is thought by some to influence the course of gastroesophageal reflux disease. This article addresses recent studies that have been published in connection with these diseases. H.

Helicobacter pylori and public health.

Gastric cancer and peptic ulcer between them cause the death of over a million people each year. A number of articles this year have studied changes in the prevalence of the infection in a variety of countries and ethnic groups. They confirm the known risk factors for infection, principally a low standard of living, poor education, and reduced life span.

Guidelines for designing a digestive disease endoscopy unit: report of the World Endoscopy Organization.

A dedicated digestive disease endoscopy unit is structurally and functionally differentiating rapidly as a result of increasing diagnostic and therapeutic possibilities in the last 10-20 years. Publications with practical details are scarce, imposing a challenge in the construction of such a unit. The lack of authoritative information about endoscopy unit design means that architects produce their own design with or without consulting endoscopists working in such a unit.

Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report.

Management of Helicobacter pylori infection is evolving and in this 4th edition of the Maastricht consensus report aspects related to the clinical role of H pylori were looked at again in 2010. In the 4th Maastricht/Florence Consensus Conference 44 experts from 24 countries took active part and examined key clinical aspects in three subdivided workshops: (1) Indications and contraindications for diagnosis and treatment, focusing on dyspepsia, non-steroidal anti-inflammatory drugs or aspirin use, gastro-oesophageal reflux disease and extraintestinal manifestations of the infection. (2) Diagnostic tests and treatment of infection.

Effect of dyspepsia on survival: a longitudinal 10-year follow-up study.

Objectives: Most chronic and recurrent gastrointestinal (GI) symptoms in the community are caused by functional GI disorders, such as functional dyspepsia and irritable bowel syndrome (IBS). It is not known, however, whether these conditions affect mortality. We present the results of a large community-based prospective study that examines this issue.

Clinical outcome of acute upper gastrointestinal hemorrhage among patients admitted to a government hospital in Egypt.

Background/aim: Acute upper gastrointestinal hemorrhage (AUGIH) is a life-threatening emergency that results in high morbidity and mortality. The mortality rate varies between 4% and 14%. The aim of the study was to determine the clinical outcome of AUGIH among patients admitted to a government hospital in Egypt.

Prevalence of microscopic colitis in patients with chronic diarrhea in Egypt: a single-center study.

Background/aim: Microscopic colitis (MC) is diagnosed when a patient with chronic watery non-bloody diarrhea (CWND) has an endoscopically normal colon, but colonic biopsies show unique inflammatory changes characteristic of lymphocytic or collagenous colitis. MC is a disorder of unknown etiology. Studies comparing the prevalence of the disease in developing countries as compared to developed countries may shed more light on the possibility of a post-infectious etiology.

Improving the Yield of Histological Sampling in Patients With Suspected Colorectal Cancer During Colonoscopy by Introducing a Colonoscopy Quality Assurance Program.

Background: Masses discovered by clinical examination, imaging or endoscopic studies that are suspicious for malignancy typically require biopsy confirmation before treatment is initiated. Biopsy specimens may fail to yield a definitive diagnosis if the lesion is extensively ulcerated or otherwise necrotic and viable tumor tissue is not obtained on sampling. The diagnostic yield is improved when multiple biopsy samples (BSs) are taken.

Epidemiology of Helicobacter pylori infection and public health implications.

This article summarizes the published literature concerning the epidemiology and public health implications of Helicobacter pylori infection published from April 2009 through March 2010. Prevalence of infection varied between 7 and 87% and was lower in European studies. All retrieved studies examining transmission of infection concluded that spread is from person-to-person.

A study of indefinite for dysplasia in Barrett's oesophagus: reproducibility of diagnosis, clinical outcomes and predicting progression with AMACR (alpha-methylacyl-CoA-racemase).

Aims: To assess interobserver variation in the diagnosis of dysplasia in Barrett's oesophagus, especially indefinite dysplasia (IND) using the revised Vienna classification. A secondary aim was to study clinical outcome of IND cases and to evaluate expression of alpha-methyl-CoA racemase (AMACR) as a marker predictive of progression.

Methods And Results: Cases of Barrett's oesophagus and dysplasia over a 20 year period were assessed.

Throat spray, sedation or anaesthetic?

Digestive endoscopy covers a wide variety of procedures; the need for sedation is governed by the invasiveness and length of the procedure, the wishes of the patient, the desire of the operator for a compliant patient, and safety. Many patients are prepared to undergo upper digestive endoscopy using throat spray without sedation, while fewer accept unsedated colonoscopy. There are clinical advantages as well as disadvantages in employing sedation and sometimes general anaesthesia is the preferred option.

The Calcium Carbonate Breath Test, a noninvasive test of stimulated gastric acid secretion: preliminary communication.

Background: Gastric acid secretion is subject to complex control mechanisms, and varies widely between individuals and populations. Its measurement has previously required intubation of the stomach with ingestion of a test meal or injection of a secretion stimulant.

Aim: We describe a novel method of measuring gastric acid secretion noninvasively - the Calcium Carbonate Breath Test.

Is diagnostic and therapeutic endoscopy currently appropriate?: suggestions for improvement.

Endoscopy is the driving force in gastroenterology today, and recent exciting advances in technology have extended its frontiers at an unprecedented rate. We have a wider range of diagnostic and therapeutic possibilities at our disposal with more detailed methods available to analyse what we see on our video screens. We can access the small bowel lumen with consistency and intra-abdominal operations have been performed through the mouth and anus so where are the current limitations of the procedure? In spite of these remarkable advances many challenges remain for both the endoscopist and for industry, they are mainly ones associated with human weakness.

Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior.

Objective: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. The natural history of the condition has been studied extensively, but few studies have examined factors that predict its new onset or health care-seeking behavior.

Methods: Individuals, now aged 50-59 yr, originally enrolled in a population-screening program for Helicobacter pylori (H.

Ethical and legal implications in seeking and providing a second medical opinion.

Ethical and legal implications arise both when seeking a second medical opinion and when providing one. There has been debate as to whether a second opinion for a patient is a right or a concession and whilst today most would consider it to be a patient's right, there are nevertheless some disadvantages associated with seeking a second opinion. This article addresses the reasons why patients seek second opinions, it considers when physicians themselves should refer patients and it covers the issues involved in providing a second opinion particularly in cases where there is the potential for an allegation of malpractice.

How to influence health providers.

In spite of the recognition that Helicobacter pylori is responsible for most duodenal ulcer and peptic ulcer and that it is the underlying cause of most gastric cancer, little or no attention has been paid to its effect upon public health and in particular no measures have been put in place to address them. For over 20 years relatively inexpensive and noninvasive testing and treatment have been available, but no country has introduced a "screen-and-treat" policy, and relatively little research has been devoted to the identification of a vaccine for the disease. Health-care providers and doctors themselves are amenable to persuasion but in order to achieve appropriate investment in this area media pressure is required to publicize the arguments of health economics and equality of health that support the introduction of appropriate measures.

Effect of sibling number in the household and birth order on prevalence of Helicobacter pylori: a cross-sectional study.

Background: Infection with Helicobacter pylori (H. pylori) is acquired mainly in childhood, with studies demonstrating this is related to living conditions. Effects of sibling number and birth order on prevalence of infection have not been extensively studied.