Endoscopic trimodal imaging versus standard video endoscopy for detection of early Barrett's neoplasia: a multicenter, randomized, crossover study in general practice.

Background: Endoscopic trimodal imaging (ETMI) may improve detection of early neoplasia in Barrett's esophagus (BE). Studies with ETMI so far have been performed in tertiary referral settings only.

Objective: To compare ETMI with standard video endoscopy (SVE) for the detection of neoplasia in BE patients with an intermediate-risk profile.

Narrow-band imaging versus high-definition endoscopy for the diagnosis of neoplasia in ulcerative colitis.

Background And Study Aims: Controversy exists about which colonoscopic technique is most sensitive for the diagnosis of neoplasia in patients with ulcerative colitis. We compared new-generation narrow-band imaging (NBI) to high-definition endoscopy (HDE) for the detection of neoplasia and evaluated NBI for the differentiation of neoplastic from non-neoplastic mucosa.

Patients And Methods: Randomized crossover trial in which patients with ulcerative colitis underwent both NBI and HDE colonoscopy in random order with at least 3 weeks between the two procedures, which were performed by different endoscopists.

Pilot study of probe-based confocal laser endomicroscopy during colonoscopic surveillance of patients with longstanding ulcerative colitis.

Background And Aims: Surveillance of patients with ulcerative colitis consists of taking targeted and random biopsies, which is time-consuming and of doubtful efficiency. The use of probe-based confocal laser endomicroscopy (pCLE) may increase efficiency. This prospective pilot study aimed to evaluate the feasibility and diagnostic accuracy of pCLE in ulcerative colitis surveillance.

European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy.

Propofol sedation by non-anesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial.

European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anaesthesiologist administration of propofol for GI endoscopy.

Propofol sedation by non-anaesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial.

Mutational characterization of the bile acid receptor TGR5 in primary sclerosing cholangitis.

Background: TGR5, the G protein-coupled bile acid receptor 1 (GPBAR1), has been linked to inflammatory pathways as well as bile homeostasis, and could therefore be involved in primary sclerosing cholangitis (PSC) a chronic inflammatory bile duct disease. We aimed to extensively investigate TGR5 sequence variation in PSC, as well as functionally characterize detected variants.

Methodology/principal Findings: Complete resequencing of TGR5 was performed in 267 PSC patients and 274 healthy controls.

Validation of a cholangiographic prognostic model in primary sclerosing cholangitis.

Background And Study Aims: We previously developed a prognostic model for primary sclerosing cholangitis (PSC), which was primarily based on a cholangiographic classification of the intra- and extrahepatic biliary tree lesions. The aim of the present study was to validate the performance of this model in an external cohort.

Patients And Methods: The validation dataset consisted of patients with PSC from a single referral center in Oslo, Norway.

[Primary sclerosing cholangitis].

Primary sclerosing cholangitis (PSC) is a cholestatic liver disease of unknown cause, with genetic predisposition in combination with environmental factors possibly playing a role. The diagnosis is made on the basis of a liver enzyme profile indicating cholestasis and characteristic bile duct abnormalities in cholangiography or the liver biopsy after excluding other causes. Approximately 80% of patients have concurrent inflammatory bowel disease (IBD), specifically ulcerative colitis in most patients.

Is there a role for Crohn's disease-associated autophagy genes ATG16L1 and IRGM in formation of granulomas?

Objective: Autophagy-related 16-like 1 gene (ATG16L1) and immunity-related guanosine triphosphatase gene (IRGM) are associated with Crohn's disease susceptibility and autophagy. Elimination of invading pathogens is a function of autophagy. Formation of granulomas can be attributed to impaired recognition of bacterial components by the innate immune system.

Genome-wide association analysis in primary sclerosing cholangitis.

Background & Aims: We aimed to characterize the genetic susceptibility to primary sclerosing cholangitis (PSC) by means of a genome-wide association analysis of single nucleotide polymorphism (SNP) markers.

Methods: A total of 443,816 SNPs on the Affymetrix SNP Array 5.0 (Affymetrix, Santa Clara, CA) were genotyped in 285 Norwegian PSC patients and 298 healthy controls.

Mucosal morphology in Barrett's esophagus: interobserver agreement and role of narrow band imaging.

Background And Study Aims: We have recently proposed a classification of mucosal morphology in Barrett's esophagus based on three criteria: regularity of mucosal pattern, regularity of vascular pattern, and presence of abnormal blood vessels. We aimed to evaluate the interobserver agreement with the proposed mucosal morphology classification and to assess the additional value of narrow band imaging (NBI) over high resolution white light endoscopy (HR-WLE).

Patients And Methods: Five international experts in the field of Barrett's imaging and seven community endoscopists with no expertise in this field independently evaluated magnified still images from 50 areas, obtained with HR-WLE and NBI, in Barrett's esophagus patients.

A double-blind, placebo-controlled, randomized study of infliximab in primary sclerosing cholangitis.

Goals: To evaluate the safety and efficacy of infliximab in patients with primary sclerosing cholangitis.

Study: In this double-blind, placebo-controlled study, 24 patients with primary sclerosing cholangitis were screened and randomly assigned in a 2:1 ratio to receive infliximab (5 mg/kg) or placebo at weeks 0, 2, 6, 12, 18, and 24; patients were followed through week 52. The primary efficacy end point was a decrease of at least 50% in the serum alkaline phosphatase level from baseline to week 18.

Geographic pathology of Helicobacter pylori gastritis.

Background And Aim: Helicobacter pylori is etiologically associated with gastritis and gastric cancer. There are significant geographical differences between the clinical manifestation of H. pylori infections.

[Outbreak of amoebiasis in a Dutch family; tropics unexpectedly nearby].

An amoebic liver abscess, amoebic dysentery and asymptomatic cyst passage were diagnosed in a father, a mother and one of their three children, respectively. One of the other children had been in the tropics, but only after the father's symptoms had begun. All three family members were infected with the same strain of Entamoeba histolytica as determined by polymerase chain reaction (PCR)-based DNA typing.

Natural history of primary sclerosing cholangitis and prognostic value of cholangiography in a Dutch population.

Background: Median survival of patients with primary sclerosing cholangitis (PSC) has been estimated to be 12 years. Cholangiography is the gold standard for diagnosis but is rarely used in estimating prognosis.

Aims: To assess the natural history of Dutch PSC patients and to evaluate the prognostic value of a cholangiographic classification system.

A survey of infectious agents as risk factors for primary sclerosing cholangitis: are Chlamydia species involved?

Objectives: The aetiology of primary sclerosing cholangitis (PSC) is unknown, and the role of micro-organisms has been studied only to a limited extent. We tested the hypothesis that past or persisting infection with common viruses or atypical bacteria might play a role in genetically susceptible hosts.

Design: Case-control study.

A patient with hereditary hemochromatosis, ulcerative colitis, and primary sclerosing cholangitis: genetic aspects.

This report describes a family in which the rare combination of hereditary hemochromatosis, ulcerative colitis and primary sclerosing cholangitis was found. Subsequent to the index patient, who had all three diseases, a screening was done in his parents and siblings that included HLA-DR, HLA-DQ and HFE typing, ANCAs, liver tests and sigmoidoscopy with histology. On the basis of HLA and HFE typing, three probable haplotypes could be distinguished.

Evaluation of a modified cholangiographic classification system for primary sclerosing cholangitis.

Background: There is no uniformly accepted classification system for the range of cholangiographic abnormalities encountered in primary sclerosing cholangitis (PSC). The aims of this study were to evaluate a previously developed classification system and to test the hypothesis that the pancreatic duct can be involved in PSC.

Methods: Two observers scored 132 endoscopic retrograde cholangiopancreatographies (ERCPs) from established PSC patients.

Expression and activation of NF-kappa B in the antrum of the human stomach.

Both in vitro studies and experiments in mice suggest a key role for transcription factor NF-kappa B as a mediator of mucosal inflammation. Experiments in vitro show that NF-kappa B activation may be a critical event in the production of proinflammatory molecules in Helicobacter pylori-associated gastritis. This study examines the expression and activity of NF-kappa B in situ in antral biopsies of 69 consecutive patients with immunohistochemical techniques.

Four years experience with short term stenting in primary sclerosing cholangitis.

Objective: Symptomatic dominant strictures in primary sclerosing cholangitis are often treated with endoscopic stent therapy, but the optimal treatment duration is not well established. After a promising pilot study, we now report our 4 yr experience with short term endoscopic stent therapy for relief of dominant strictures.

Methods: Between January 1994 and October 1997, 32 patients with symptomatic primary sclerosing cholangitis with a dominant stricture at endoscopic retrograde cholangiopancreatography were treated with insertion of a 7- or 10-Fr polyethylene endoprosthesis, which was extracted after a mean of 11 days (range 1-23 days).

Immunohistochemical analysis of inflammation in primary sclerosing cholangitis.

Objectives: There are only limited data about the nature of the mononuclear infiltrate surrounding the affected biliary canaliculi in primary sclerosing cholangitis (PSC). The aim of this study was to characterize the composition of the mononuclear infiltrate and to detect signs of activation/ proliferation among the various subpopulations involved. Furthermore the putative role of the biliary epithelium as antigen presenting cells (APC) was assessed.