Cyclic Change of Sphincter of Oddi Motility and Its Relationship with Small Bowel Migrating Motor Complex in Humans
ConclusionsSO motility in humans showed cyclical phasic changes closely coordinated with the MMC of the SB in a fasting state; however, the proportion of phases differed between the SO and the SB. The basal pressure significantly increased during physiological high-frequency phase III contractions of the SO. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 14, 2018 Category: Gastroenterology Source Type: research

PNPLA3 Gene Polymorphisms in HCV/HIV-Coinfected Individuals
ConclusionThe HRM method is an effective, rapid technique for characterizing PNPLA3 genotype. In those with HCV/HIV infection, nearly 40% carry gene polymorphisms associated with the development of NASH or ASH. Prospective studies should focus on this group to determine whether they represent a subset of HIV-infected persons at increased risk of fibrotic progression. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 14, 2018 Category: Gastroenterology Source Type: research

Passing the “Acid Test”: Do Proton Pump Inhibitors Affect the Composition of the Microbiome?
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 14, 2018 Category: Gastroenterology Source Type: research

An Increased Chromosome 7 Copy Number in Endoscopic Bile Duct Biopsy Specimens Is Predictive of a Poor Prognosis in Cholangiocarcinoma
ConclusionsDetection by FISH assay of an increased chromosome 7 copy number in transpapillary forceps biopsy specimens is predictive of a poor prognosis in CCA patients. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 12, 2018 Category: Gastroenterology Source Type: research

Activation of PD-1 Protects Intestinal Immune Defense Through IL-10/miR-155 Pathway After Intestinal Ischemia Reperfusion
ConclusionActivation of PD-1 with PD-L1 Ig relieves intestinal immune defensive injury through IL-10/miR-155 pathway following intestinal I/R attack. PD-1, IL-10, and miR-155 may be potential targets for the damages of intestinal barrier and immunity. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 12, 2018 Category: Gastroenterology Source Type: research

3-Aminobenzamide Prevents Concanavalin A-Induced Acute Hepatitis by an Anti-inflammatory and Anti-oxidative Mechanism
ConclusionsOur results suggest that 3-AB has a therapeutic effect on concanavalin A-induced liver injury by inhibiting expression of the key pro-inflammatory cytokine TNF α, via PARP-1-independent NFκB suppression and via an NFκB-independent anti-oxidative mechanism. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 8, 2018 Category: Gastroenterology Source Type: research

Homocysteine and Folate in Inflammatory Bowel Disease: Can Reducing Sulfur Reduce Suffering?
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 6, 2018 Category: Gastroenterology Source Type: research

Silybin Alleviates Hepatic Steatosis and Fibrosis in NASH Mice by Inhibiting Oxidative Stress and Involvement with the Nf- κB Pathway
ConclusionsSilybin was effective in preventing the MCD-induced increases in hepatic steatosis, fibrosis and inflammation. The effect was related to alteration of lipid metabolism-related gene expression, activation of the Nrf2 pathway and inhibition of the NF- κB signaling pathway in the NASH liver. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 6, 2018 Category: Gastroenterology Source Type: research

Altered Metabolic Profile of Triglyceride-Rich Lipoproteins in Gut-Lymph of Rodent Models of Sepsis and Gut Ischemia-Reperfusion Injury
AbstractBackgroundTriglyceride-rich lipoproteins are important in dietary lipid absorption and subsequent energy distribution in the body. Their importance in the gut-lymph may have been overlooked in sepsis, the most common cause of critical illness, and in gut ischemia-reperfusion injury, a common feature of many critical illnesses.AimsWe aimed to undertake an exploratory study of triglyceride-rich lipoprotein fractions in gut-lymph using untargeted metabolic profiling to identify altered metabolites in sepsis or gut ischemia-reperfusion.MethodsThe gut-lymph was collected from rodent sham, sepsis, and gut ischemia-reperf...
Source: Digestive Diseases and Sciences - September 4, 2018 Category: Gastroenterology Source Type: research

Concise Commentary: Quercetin Flavonoid of the Month or IBD Therapy?
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 4, 2018 Category: Gastroenterology Source Type: research

A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett ’s Esophagus
AbstractBackgroundPublished guidelines do not address what the minimum incremental diagnostic yield (IDY) for detection of dysplasia/cancer is required over the standard Seattle protocol for an advanced imaging modality (AIM) to be implemented in routine surveillance of Barrett ’s esophagus (BE) patients. We aimed to report expert practice patterns and attitudes, specifically addressing the minimum IDY in the use of AIMs in BE surveillance.MethodsAn international group of BE experts completed an anonymous electronic survey of domains relevant to surveillance practice patterns and use of AIMs. The evaluated AIMs were ...
Source: Digestive Diseases and Sciences - September 3, 2018 Category: Gastroenterology Source Type: research

Patient and Caregiver Attitudes and Practices of Exercise in Candidates Listed for Liver Transplantation
ConclusionsPatients and caregivers are willing to exercise to optimize physical fitness prior to liver transplantation. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 3, 2018 Category: Gastroenterology Source Type: research

A New Look at Familial Risk of Inflammatory Bowel Disease in the Ashkenazi Jewish Population
ConclusionsThis study reports familial risk estimates for a significant proportion of the AJ IBD population in the UK. The high rate of a positive family history in this cohort may reflect the greater genetic burden for IBD among AJs. These data are of value in predicting the likelihood of future recurrence of IBD in AJ families. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 3, 2018 Category: Gastroenterology Source Type: research

Upper Gastrointestinal Bleeding of Unusual Causation
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 3, 2018 Category: Gastroenterology Source Type: research

Overlap Between Gastric and Esophageal Motility Disorders: A Contractual Arrangement?
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - September 3, 2018 Category: Gastroenterology Source Type: research

Topical Steroids and Elimination Diets for EoE: Happier Together?
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

Tumor Necrosis Factor Ligand-Related Molecule 1A Regulates the Occurrence of Colitis-Associated Colorectal Cancer
ConclusionsTL1A can induce tumor cell proliferation and promote the occurrence of CAC by activating Wnt/ β-catenin pathway. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

Angle of His Accentuation Is a Viable Alternative to Dor Fundoplication as an Adjunct to Laparoscopic Heller Cardiomyotomy: Results of a Randomized Clinical Study
ConclusionAOH is similar to Dor as an adjunct to LHCM in safety and efficacy and can be performed in shorter time.Clinical Registration NumberCTRI: REF/2014/06/007146. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

High Expression of ABL2 Suppresses Apoptosis in Gastric Cancer
ConclusionAll the data showed that high expression of ABL2 suppresses apoptosis through Ras/Erk and PI3K/AKT signaling pathway in GC cell lines. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

Identifying Nonalcoholic Fatty Liver Disease Advanced Fibrosis in the Veterans Health Administration
ConclusionsWhile NFS and FIB-4 scores exhibit good diagnostic accuracy, FIB-4 is optimal in identifying NAFLD advanced fibrosis in the VHA. Easily implemented as a point-of-care clinical test, FIB-4 can be useful in directing patients that are most likely to have advanced fibrosis to GI/hepatology consultation and follow-up. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

G-POEM for Gastroparesis: Is There Pressure to Go with the Flow?
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

Colorectal Polyps in Childhood Cancer Survivors Treated with Radiation Therapy
ConclusionsCancer survivors treated with RT for childhood cancer have a higher prevalence of adenomatous polyps compared to the average-risk population. These findings support the early initiation of colonoscopy screening 10  years after radiation therapy, even in patients who have received RT doses below 30 Gy. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

Small-Bowel Capsule Endoscopy in Clinical Practice: Has Anything Changed Over 13  Years?
AbstractBackgroundIn Lombardia, one of the 20 Italian administrative Regions, small-bowel capsule endoscopy (SBCE) was introduced in 2001. In January 2011, the Regional Health Authorities established a reimbursement for outpatient SBCE.AimTo prospectively record data on SBCE between 2011 –2013 and compare them to similar data retrospectively collected from the same geographical area (covering the period 2001–2008) and published in 2008.MethodsConsecutive SBCEs performed between January 2011 and December 2013 in Lombardia were prospectively collected.ResultsIn 3  years, 3142 SBCEs were collected; the diagno...
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

MiR-27a/b Regulates Liver Regeneration by Posttranscriptional Modification of Tmub1
ConclusionMiR-27a/b regulates hepatocyte proliferation by controlling posttranscriptional modification of Tmub1 during liver regeneration. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

Concise Commentary: Remaining Outside the Hospital Is a Golden State in Cirrhosis —Lessons from California
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

Correction to: Antenatal Management for Women with Inflammatory Bowel Disease: Experience from Our ‘IBD MOM’ Clinic
The original version of the article unfortunately contained tagging error in first and family name of authors Ariella Bar-Gil Shitrit and Ami Ben Ya ’acov. This has been corrected with this erratum. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 16, 2018 Category: Gastroenterology Source Type: research

A Simple Pre-endoscopy Score for Predicting Risk of Malignancy in Patients with Dyspepsia: A 5-Year Prospective Study
ConclusionThis simple clinical-cum-laboratory test-based model performed very well in identifying dyspeptic patients at risk of UGIM. This can serve as a useful decision-making tool for referral for endoscopy. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 14, 2018 Category: Gastroenterology Source Type: research

Survival Disparities by Race and Ethnicity in Early Esophageal Cancer
AbstractBackgroundSurvival outcome disparities among esophageal cancer patients exist, but are not fully understood.AimsWe used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether survival differences among racial/ethnic patient populations persist after adjusting for demographic and clinical characteristics.MethodsOur study included T1-3N0M0 adenocarcinoma and squamous cell cancer patients diagnosed between 2003 and 2011. We compared survival among two racial/ethnic patient subgroups using Cox proportional hazards methods, adjusting for age, sex, histology, marital status, ...
Source: Digestive Diseases and Sciences - August 14, 2018 Category: Gastroenterology Source Type: research

Prior Diagnosis of Barrett ’s Esophagus Is Infrequent, but Associated with Improved Esophageal Adenocarcinoma Survival
ConclusionsPrior diagnosis of BE was associated with better survival, largely due to earlier EA stage at diagnosis. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 14, 2018 Category: Gastroenterology Source Type: research

Effects of Probiotics on Inflammation and Uremic Toxins Among Patients on Dialysis: A Systematic Review and Meta-Analysis
ConclusionOur study demonstrates potential beneficial effects of probiotics on inflammation, uremic toxins, and GI Symptoms in ESRD patients. Future large-scale clinical studies are required to assess its benefits on other important clinical outcomes including patient mortality. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 11, 2018 Category: Gastroenterology Source Type: research

IL-17A Promotes Initiation and Development of Intestinal Fibrosis Through EMT
ConclusionsOur study confirmed the involvement of IL-17A in the development of intestinal fibrosis through inducing EMT. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 10, 2018 Category: Gastroenterology Source Type: research

Medical Prophylaxis of Post-Surgical Crohn ’s Disease Recurrence: Towards Timely Anti-TNF Therapy
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 10, 2018 Category: Gastroenterology Source Type: research

The Runs: Sudden Copious Ostomy Output in an Acolonic Hirschsprung Disease Patient with Short Gut Syndrome
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 10, 2018 Category: Gastroenterology Source Type: research

Optimal Omeprazole Dosing and Symptom Control: A Randomized Controlled Trial (OSCAR Trial)
The objective of this study was to determine whether patients with persistent GERD s ymptoms on suboptimal omeprazole dosing experience symptomatic improvement when randomized to commonly recommended dosing regimen and to evaluate the economic impact of suboptimal PPI dosing in GERD patients.MethodsPatients with persistent heartburn symptoms  ≥ 3 times per week treated with omeprazole 20 mg daily were enrolled and randomized to commonly recommended dosing or continued suboptimal dosing of omeprazole. The primary outcomes were changes in symptom, frequency, and severity, as determined using the Gastroe...
Source: Digestive Diseases and Sciences - August 9, 2018 Category: Gastroenterology Source Type: research

Plasma mtDNA Analysis Aids in Predicting Pancreatic Necrosis in Acute Pancreatitis Patients: A Pilot Study
AbstractBackgroundSpecific plasma biomarkers in predicting pancreatic necrosis (PNec) are needed in treating acute pancreatitis (AP).AimsTo investigate the prognostic value of plasma mitochondrial DNA fragments (mtDNA) in patient with AP for PNec.MethodsAP patients with symptoms onset within 72  h were prospectively enrolled from June 2015 through June 2017 and were assessed for PNec using contrast-enhanced CT scan. Plasma mtDNA concentration (specific mitochondrial gene ND1) was measured using qRT-PCR.ResultsOf the 74 AP patients included, significant higher median level of plasma mtDNA was found in severe AP patient...
Source: Digestive Diseases and Sciences - August 9, 2018 Category: Gastroenterology Source Type: research

Case –Control Study of Inflammatory Bowel Disease Patients with and without Clostridium difficile Infection and Poor Outcomes in Patients Coinfected with C. difficile and Cytomegalovirus
AbstractBackground and AimsClostridium difficile infection (CDI) incidence and risk factors in patients with inflammatory bowel disease (IBD) have been extensively studied. However, data describing CDI in Chinese patients with IBD are limited. We investigated the cumulative incidence, risk factors, and outcomes of CDI in Chinese IBD patients.MethodsWe conducted a retrospective, case –control study of patients hospitalized with IBD and CDI at Peking Union Medical College Hospital from January 2010 to December 2015. CDI was diagnosed based on the presence of active symptoms and positive enzyme immunoassay-based stool t...
Source: Digestive Diseases and Sciences - August 9, 2018 Category: Gastroenterology Source Type: research

Similar Sustained Virologic Response in Real-World and Clinical Trial Studies of Hepatitis C/Human Immunodeficiency Virus Coinfection
ConclusionSVR among real-world HCV/HIV coinfected populations treated with DAA regimens is similar to SVR of patients studied in clinical trials. Historically negative predictors of achieving SVR during the era of interferon-based treatments, such as those with cirrhosis, prior HCV treatment failure, GT1 infection, and African-American race, are not associated with a significantly lower SVR in real-world populations treated with various DAA regimens. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 9, 2018 Category: Gastroenterology Source Type: research

Sleep Disturbances Are Commonly Reported Among Patients Presenting to a Gastroenterology Clinic
ConclusionsPatients presenting to a tertiary care GI clinic report poorer sleep than healthy controls. In general, patients with IBS report the highest rates of sleep difficulties compared to patients with other diagnoses. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 9, 2018 Category: Gastroenterology Source Type: research

Influence of Ambulatory Triglyceride Levels on Risk of Recurrence in Patients with Hypertriglyceridemic Pancreatitis
AbstractBackground and AimsTo evaluate impact of ambulatory triglyceride levels on risk of recurrent pancreatitis in patients with hypertriglyceridemic pancreatitis.MethodsWe conducted a longitudinal retrospective cohort study of patients with serum triglyceride level ≥ 500 mg/dL during index hospitalization for acute pancreatitis within a regional integrated healthcare system between 2006 and 2013 (follow-up through 2015). Cases were identified based on combination of diagnosis codes and serum amylase/lipase. We used multivariable robust Poisson regression to determine independent effect of baseline (first ...
Source: Digestive Diseases and Sciences - August 9, 2018 Category: Gastroenterology Source Type: research

Influence of Obesity and Metabolic Abnormalities on the Risk of Developing Colorectal Neoplasia
ConclusionsPoor metabolic health, regardless of obesity, is an independent risk factor for CRN in men. Our results suggest that men with metabolic abnormalities should be considered as a high-risk group for colorectal cancer, even if they are not obese. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 9, 2018 Category: Gastroenterology Source Type: research

Effect of Helicobacter pylori Infection on GATA - 5 and TFF1 Regulation, Comparison Between Pediatric and Adult Patients
ConclusionsOur results suggest that the upregulation ofGATA-5 andTFF1 observed in vitro and in vivo may be correlated with a protective effect of the mucosa in response to infection. The epigenetic inactivation ofGATA-5 observed in human biopsies from infected patients may suggest that this alteration is an early event occurring in association withH. pylori infection. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 6, 2018 Category: Gastroenterology Source Type: research

SpyCatcher: Use of a Novel Cholangioscopic Snare for Capture and Retrieval of a Proximally Migrated Biliary Stent
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 4, 2018 Category: Gastroenterology Source Type: research

Intensive Pharmacy Care Improves Outcomes of Hepatitis C Treatment in a Vulnerable Patient Population at a Safety-Net Hospital
ConclusionsHCV treatment with DAA was well tolerated, but the rate of SVR was low (71%) compared to trials. This was due to loss to follow-up, as the per-protocol rate of SVR was much higher (95%). Use of ON-ISP was associated with an increase in SVR and may be valuable for improving care for vulnerable populations. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 4, 2018 Category: Gastroenterology Source Type: research

Quercetin Attenuates Adhesion Molecule Expression in Intestinal Microvascular Endothelial Cells by Modulating Multiple Pathways
ConclusionsThese results indicate that quercetin may have an anti-inflammatory effect by inhibiting expression of ICAM-1 and VCAM-1 in RIMVECs by suppressing TLR4, NF- κB, ERK, JNK and STAT but not the p38 signaling pathway. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 4, 2018 Category: Gastroenterology Source Type: research

Impaired Quality of Life, Work, and Activities Among Adults with Clostridium difficile Infection: A Multinational Survey
AbstractBackgroundEvidence of humanistic detriments ofClostridium difficile infection (CDI) remains limited.AimsTo assess humanistic burden associated with CDI.MethodsSelf-reported National Health and Wellness Survey data between 2013 and 2016 were analyzed for the USA, five European countries, China, and Brazil. Outcome measures included SF-36v2® for health-related quality of life (HRQoL) and Work Productivity and Activity Impairment questionnaire. Respondents ( ≥ 18 years old) were classified as (1) currently treated doctor-diagnosed CDI (C-CDI), (2) doctor-diagnosed prior CDI (P-CDI), or (3) never exp...
Source: Digestive Diseases and Sciences - August 3, 2018 Category: Gastroenterology Source Type: research

Colitis and Pancreatitis in a Patient with Systemic Lupus Erythematosus: Due to Disease or to Drug?
(Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - August 1, 2018 Category: Gastroenterology Source Type: research

Biomarkers of Barrett ’s Esophagus: From the Laboratory to Clinical Practice
AbstractThe currently recommended approach to managing cancer risk for patients with Barrett ’s esophagus is endoscopic surveillance including a biopsy protocol to sample the esophageal tissue randomly to detect dysplasia. However, there are numerous limitations in this practice that rely on the histopathological grading of dysplasia alone to make clinical decisions. The availability of i n silico models demonstrating the potential cost-effectiveness of biomarker-based stratification has increased interest in finding a clinically relevant “Barrett’s biomarker.” The success of endoscopic eradication ...
Source: Digestive Diseases and Sciences - July 20, 2018 Category: Gastroenterology Source Type: research

Origins of Metaplasia in Barrett ’s Esophagus: Is this an Esophageal Stem or Progenitor Cell Disease?
AbstractThe incidence of esophageal adenocarcinoma has been increasing in Western countries over the past several decades. Though Barrett ’s esophagus, in which the normal esophageal squamous epithelium is replaced with metaplastic intestinalized columnar cells due to chronic damage from gastroesophageal reflux, is accepted as the requisite precursor lesion for esophageal adenocarcinoma, the Barrett’s esophagus cell of origin a nd the molecular mechanism underlying esophageal epithelial metaplasia remain controversial. Much effort has been dedicated towards identifying the Barrett’s esophag...
Source: Digestive Diseases and Sciences - July 20, 2018 Category: Gastroenterology Source Type: research

Natural History of the Post-ablation Esophagus
AbstractEndoscopic ablative therapy including radiofrequency ablation (RFA) represents the preferred management strategy for dysplastic Barrett ’s esophagus (BE) and appears to diminish the risk of developing esophageal adenocarcinoma (EAC). Limited data describe the natural history of the post-ablation esophagus. Recent findings demonstrate that recurrent intestinal metaplasia (IM) following RFA is relatively frequent. However, dysplasti c BE and EAC subsequent to the complete eradication of intestinal metaplasia (CEIM) are uncommon. Moreover, data suggest that the risk of recurrent disease is probably highest in th...
Source: Digestive Diseases and Sciences - July 20, 2018 Category: Gastroenterology Source Type: research

Point –Counterpoint: Screening and Surveillance for Barrett’s Esophagus, Is It Worthwhile?
AbstractThe exponential rise in incidence of esophageal adenocarcinoma (EAC), paired with persistently poor survival, continues to drive efforts to improve and optimize screening and surveillance practices. While advancements in endoscopic therapy have generated a shift in management and significantly improved the outcomes of patients with early-stage EAC, the majority of prevalent EAC continues to be diagnosed at advanced stages, remaining ineligible for curative therapy. Barrett ’s esophagus (BE) screening, when applied to high-yield target populations, using minimally or noninvasive accurate tests, followed by end...
Source: Digestive Diseases and Sciences - July 20, 2018 Category: Gastroenterology Source Type: research