The impact of pseudomembrane formation on the outcome of Clostridium difficile-associated disease.

Purpose: Although pseudomembranes are the hallmark manifestation of Clostridium difficile-associated diarrhea (CDAD), there are scant data specifically addressing their impact on the clinical outcome. We investigated whether the formation of pseudomembranes predicts a worse CDAD outcome.

Methods: CDAD patients hospitalized during 2010 underwent sigmoidoscopy and were followed prospectively.

Diverticulitis in the young is not more aggressive than in the elderly, but it tends to recur more often: systematic review and meta-analysis.

Background And Aim: For years, the natural course of diverticulitis in the young has been debatable in terms of its severity and recurrence rate, and no consensus has been reached regarding its treatment and timing of surgery. Thus, the study aims to evaluate by meta-analysis the natural course of acute diverticulitis in the young.

Methods: Data were obtained from electronic databases and manual search of studies comparing the course of diverticulitis in young versus elderly patients.

Mucosal improvement in patients with moderate to severe postoperative endoscopic recurrence of Crohn's disease and azathioprine metabolite levels.

Background: The value of azathioprine metabolites (6-thioguanine nucleotides [6-TGN]) in monitoring clinical treatment response is still controversially discussed. Data regarding thiopurine metabolite levels and endoscopic improvement are lacking.

Methods: Data were analyzed post hoc from a 1-year, multicenter, double-blind, double-dummy, randomized trial comparing azathioprine 2.

Role of endoscopy in patients with diverticular disease.

Acute diverticulitis occurs in 10-25% of patients with diverticulosis. Colonoscopy is advised 6 weeks after an attack of acute diverticulitis in order to completely evaluate the colonic lumen and exclude a potential malignancy. We conducted several studies aimed to evaluate the feasibility and safety of early colonoscopy in patients with acute diverticulitis.

The risk of advanced histology in small-sized colonic polyps: are non-invasive colonic imaging modalities good enough?

Purpose: The study aims to evaluate the risk of advanced histology within small colonic polyps and assess whether this risk warrants different recommendation for surveillance and treatment of such polyps.

Methods: A retrospective study of all patients undergoing their first ever colonoscopy and polypectomy in a tertiary hospital for one of three indications: screening, positive family history,and positive occult blood in stool. The histological reports of all resected polyps were retrieved and stratified according to the various polyps' sizes.

Budesonide 9 mg is at least as effective as mesalamine 4.5 g in patients with mildly to moderately active Crohn's disease.

Background & Aims: Comparative data on budesonide vs mesalamine for the treatment of mild-to-moderately active Crohn's disease (CD) are sparse. We assessed the efficacy and safety of each therapy in patients with mildly to moderately active CD.

Methods: We performed a randomized, double-blind, double-dummy, 8-week, multicenter study in which 309 patients with mildly to moderately active CD received pH-modified-release oral budesonide (9 mg/day once daily or 3 mg/day 3 times daily) or Eudragit-L-coated oral mesalamine (4.

A randomised placebo-controlled multicentre trial of intravenous semapimod HCl for moderate to severe Crohn's disease.

Objective: Semapimod, a small molecule known to inhibit proinflammatory cytokine activity, was studied to determine the optimal dose necessary to achieve a response in patients with moderate to severe Crohn's disease (CD).

Methods: A randomised, double-blind, placebo-controlled trial (CD04) was carried out followed by an open-label extension study (CD05). The trial was conducted in international multicentre outpatient clinics and included patients with moderate to severe CD (Crohn's Disease Activity Index (CDAI) 250-400).

Azathioprine versus mesalazine for prevention of postoperative clinical recurrence in patients with Crohn's disease with endoscopic recurrence: efficacy and safety results of a randomised, double-blind, double-dummy, multicentre trial.

Objective: The aim of the study was to compare azathioprine versus mesalazine tablets for the prevention of clinical recurrence in patients with postoperative Crohn's disease (CD) with moderate or severe endoscopic recurrence.

Methods: This was a 1 year, double-blind, double-dummy, randomised study which took place in 21 gastroenterology centres in Austria, the Czech Republic, Germany and Israel. The study participants were 78 adults with CD who had undergone resection with ileocolonic anastomosis in the preceding 6-24 months without subsequent clinical recurrence and with a Crohn's disease activity index (CDAI) score <200, but with moderate or severe endoscopic recurrence.

The immunogenic part of infliximab is the F(ab')2, but measuring antibodies to the intact infliximab molecule is more clinically useful.

Objectives: To localise the immunogenic part of infliximab and evaluate the clinical usefulness of measuring antibodies against infliximab fragments.

Design: Observational study.

Settings: A specialised inflammatory bowel disease (IBD) centre in a tertiary hospital.

Long-term clinical outcome of patients with gastric gastrointestinal stromal tumors.

Background: About 10-30% of gastrointestinal stromal tumors prove to be malignant. Nevertheless, the natural history of gastric gastrointestinal stromal tumors has not been fully elucidated.

Aims: To determine the long-term clinical outcome of nonresected gastric gastrointestinal stromal tumors.

Double balloon enteroscopy: a 2 year experience.

Background: Double balloon enteroscopy is a new technique that enables deep intubation of the endoscope into the small bowel lumen. Through a channel in the endoscope, invasive procedures such as biopsy, polypectomy and hemostasis can be performed, avoiding the need for surgery.

Objectives: To prospectively analyze our results of the first 124 DBEs performed since February 2007.

Mild to moderate Crohn's disease: still room for step-up therapies?

Step-up therapy in Crohn's disease refers to the classic therapeutic approach resulting in progressive increase of therapies with the increasing severity of the disease. This approach has been recently challenged by the top-down strategy, where biologicals together with thiopurines were used as first-line therapy. Several arguments exist against the top-down therapy.

Infectious serologies and autoantibodies in inflammatory bowel disease: insinuations at a true pathogenic role.

The aim of this study was to reevaluate the role of infection in inflammatory bowel disease (IBD). Sera from 119 patients with IBD [80 with Crohn's disease (CD); 39 with ulcerative colitis] and 98 healthy controls were assessed using the Bio-Rad BioPlex 2200 for the presence of Toxoplasma gondii, cytomegalovirus, Epstein-Barr virus, Treponema pallidum, and Saccharomyces cerevisiae. Hepatitis B virus, hepatitis C virus (HCV), and anti-Helicobacter pylori antibodies were assessed by ELISA.

Fibrotest or Fibroscan for evaluation of liver fibrosis in haemophilia patients infected with hepatitis C.

Non-invasive modalities to estimate fibrosis stage are desirable in hepatitis C-infected haemophilia patients. Previous studies found a high rate of significant fibrosis both by Fibrotest (FT) and Fibroscan (FS) in these patients. To estimate liver fibrosis and to assess the concordance between FT and FS in hepatitis C-infected haemophilia patients.

A new rectal ultrasonographic method for the staging of rectal cancer.

Purpose: Radial transrectal ultrasound is the most frequently used method for preoperative staging of rectal cancer. Accuracy rates of transrectal ultrasound have fallen significantly to 64% and 70% for tumor and node staging, respectively. The use of a frontal probe may overcome the drawbacks of radial transrectal ultrasound.

Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED-ECCO consensus.

Crohn's disease and ulcerative colitis are lifelong diseases seen predominantly in the developed countries of the world. Whereas ulcerative colitis is a chronic inflammatory condition causing diffuse and continuous mucosal inflammation of the colon, Crohn's disease is a heterogeneous entity comprised of several different phenotypes, but can affect the entire gastrointestinal tract. A change in diagnosis from Crohn's disease to ulcerative colitis during the first year of illness occurs in about 10 % - 15 % of cases.

The outcome of a second preparation for colonoscopy after preparation failure in the first procedure.

Background: There are scant data regarding the outcome of consecutive repeated procedures in patients who failed to adequately clean their colon for colonoscopy.

Objective: To investigate the outcome of a second colonoscopy after preparation-associated failure of the first colonoscopy.

Design And Setting: A retrospective study in a tertiary-referral center.

Familial clustering of Crohn's disease in Israel: prevalence and association with disease severity.

Background: There is limited data addressing the severity of Crohn's disease (CD) in patients with a family history of inflammatory bowel disease (IBD) compared to sporadic cases.

Methods: We investigated the familial occurrence of IBD and its correlation with disease behavior in CD patients attending the Israeli IBD Foundation meeting using a structured questionnaire.

Results: The study group consisted of 181 CD patients with a total of 825 1(st) degree relatives.

Prevalence and predictive signs for gastrointestinal lesions in premenopausal women with iron deficiency anemia.

Introduction: The reported rates of gastrointestinal (GI) lesions among pre-menopausal women with iron deficiency anemia (IDA) vary considerably.

Aim: To assess the prevalence of significant gastrointestinal lesions among symptomatic and asymptomatic pre-menopausal women with IDA, and to shed light on potential predictors of their presence.

Methods: Clinical, endoscopic, and histological data was collected from 116 pre-menopausal women with IDA.

Role of colonoscopy in patients with persistent acute diverticulitis.

Aim: To identify patients with persistent acute diverticulitis who might benefit from an early colonoscopy during their first hospitalization.

Methods: All patients hospitalized between July 2000 and December 2006 for acute diverticulitis who underwent colonoscopy were included in the study. Patients were followed during hospitalization and after discharge.

Omega-3 free fatty acids for the maintenance of remission in Crohn disease: the EPIC Randomized Controlled Trials.

Context: Maintenance therapy for Crohn disease features the use of immunosuppressive drugs, which are associated with an increased risk of infection. Identification of safe and effective maintenance strategies is a priority.

Objective: To determine whether the oral administration of omega-3 free fatty acids is more effective than placebo for prevention of relapse of Crohn disease.

Treatment of hepatitis C in patients with haemophilia - the Israeli National Hemophilia Center experience.

Treatment with pegylated interferon (Peg-IFN) and ribavirin, now the standard of care, has been shown to achieve sustained viral response (SVR) in up to 60% of patients with hepatitis C (HCV). Studies of response to this combination in HCV-infected haemophilia patients are scarce. The aim of the study was to report the results and safety of interferon/ribavirin treatment in HCV and HCV-/HIV-infected patients at the Israeli National Hemophilia Center.