Limited resection of pancreatic cancer in high-risk patients can result in a second primary
Dear Editor, We read with interest the paper by Canto and coworkers recently published in Gut that provided guidelines for the management of individuals with a high risk for pancreatic ductal adenocarcinoma (PDAC).1 Although indications for surgery are discussed, no recommendations are given regarding the extent of surgery, that is, partial pancreatectomy (PP) or total pancreatectomy (TP), in cases with a small screen-detected PDAC. This is an important issue because it seems very likely that a hereditary background increases the risk for a second primary cancer of the pancreas. Here, we describe two high-risk individuals ...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Potjer, T. P., Bartsch, D. K., Slater, E. P., Matthai, E., Bonsing, B. A., Vasen, H. F. A. Tags: PostScript Source Type: research

Randomised controlled trial of lactulose versus rifaximin for prophylaxis of hepatic encephalopathy in patients with acute variceal bleed
We read with interest the article by Peter Ferenci1 on the diagnosis of minimal hepatic encephalopathy (HE), still a challenge, and Goldbecker et al2 on the comparison of the most favoured methods for the diagnosis of HE in liver transplantation candidates. Identification and treatment of the precipitating factors are the primary therapeutic option for HE. Variceal bleed seen in 25%–30% of patients with cirrhosis is an important precipitating factor for development of HE, and associated with increased morbidity and mortality.3 4 Acute variceal bleed (AVB) is an important precipitating factor for development of HE. Th...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Maharshi, S., Sharma, B. C., Srivastava, S., Jindal, A. Tags: PostScript Source Type: research

Authors' response: Importance of defining loss of response before therapeutic drug monitoring
This study is hitherto the only published RCT of personalised antitumour necrosis factor-alpha (anti-TNFα) therapy where measurements of serum trough levels of drug and anti-drug antibodies (Abs) have been used to prospectively guide interventions according to proposed underlying immune-pharmacological basis for treatment failure. The study builds on our original hypothesis, which operates with IFX treatment failure caused by (1) drug immunogenicity with blockade of drug-mediated TNF-neutralisation by anti-IFX Abs and/or anti-IFX Ab-mediated increased drug clearance; (2) non-immune-mediated pharmacokinetic issues wit...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Steenholdt, C., Ainsworth, M. A. Tags: PostScript Source Type: research

GI highlights from the literature
Basic scienceInnate lymphoid cells, IL-22 and ID2: the essentials for a healthy gut Guo X, Liang Y, Zhang Y, et al. Innate lymphoid cells control early colonization resistance against intestinal pathogens through ID2-dependent regulation of the microbiota. Immunity 2015;42:731–743. The microbiota regulates the host immune response to mediate colonisation resistance against pathogens. However, a number of host genetic factors also play a role in an individual's susceptibility to pathogen infection. If and how these host genetic factors contribute to colonisation resistance against pathogens through shaping the microbi...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: McLean, M. H. Tags: JournalScan Source Type: research

Correction
van der Meer AJ. Association between antiviral treatment and extrahepatic outcomes in patients with hepatitis C virus infection. Gut 2015;64:364–6. The provenance and peer review statement has been corrected to ‘Commissioned; externally peer reviewed’. (Source: Gut)
Source: Gut - July 9, 2015 Category: Gastroenterology Tags: Corrections Source Type: research

Correction
Lee YA, Wallace MC, Friedman SL, et al. Pathobiology of Liver Fibrosis – A Translational Success Story. Gut 2015;64:830–41. The provenance and peer review statement has been corrected to ‘Commissioned; externally peer reviewed’. (Source: Gut)
Source: Gut - July 9, 2015 Category: Gastroenterology Tags: Corrections Source Type: research

Faecal immunochemical tests versus guaiac faecal occult blood tests: what clinicians and colorectal cancer screening programme organisers need to know
Although colorectal cancer (CRC) is a common cause of cancer-related death, it is fortunately amenable to screening with faecal tests for occult blood and endoscopic tests. Despite the evidence for the efficacy of guaiac-based faecal occult blood tests (gFOBT), they have not been popular with primary care providers in many jurisdictions, in part because of poor sensitivity for advanced colorectal neoplasms (advanced adenomas and CRC). In order to address this issue, high sensitivity gFOBT have been recommended, however, these tests are limited by a reduction in specificity compared with the traditional gFOBT. Where colonos...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Tinmouth, J., Lansdorp-Vogelaar, I., Allison, J. E. Tags: Endoscopy, GUT Recent advances in clinical practice, Colon cancer Source Type: research

Towards an HBV cure: state-of-the-art and unresolved questions--report of the ANRS workshop on HBV cure
HBV infection is a major cause of liver cirrhosis and hepatocellular carcinoma. Although HBV infection can be efficiently prevented by vaccination, and treatments are available, to date there is no reliable cure for the>240 million individuals that are chronically infected worldwide. Current treatments can only achieve viral suppression, and lifelong therapy is needed in the majority of infected persons. In the framework of the French National Agency for Research on AIDS and Viral Hepatitis ‘HBV Cure’ programme, a scientific workshop was held in Paris in June 2014 to define the state-of-the-art and unanswere...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Zeisel, M. B., Lucifora, J., Mason, W. S., Sureau, C., Beck, J., Levrero, M., Kann, M., Knolle, P. A., Benkirane, M., Durantel, D., Michel, M.-L., Autran, B., Cosset, F.-L., Strick-Marchand, H., Trepo, C., Kao, J.-H., Carrat, F., Lacombe, K., Schinazi, R. Tags: GUT Recent advances in basic science, Cirrhosis, Hepatic cancer Source Type: research

Liver injury in acute hepatitis A is associated with decreased frequency of regulatory T cells caused by Fas-mediated apoptosis
Conclusions The size of the Treg pool was contracted during AHA, resulting from apoptosis of Tregs induced by a Fas-mediated mechanism. Decrease in Treg numbers led to reduced suppressive activity of the Treg pool and consequently resulted in severe liver injury during AHA. (Source: Gut)
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Choi, Y. S., Lee, J., Lee, H. W., Chang, D.-Y., Sung, P. S., Jung, M. K., Park, J. Y., Kim, J. K., Lee, J. I., Park, H., Cheong, J. Y., Suh, K.-S., Kim, H. J., Lee, J. S., Kim, K.-A., Shin, E.-C. Tags: Hepatology Source Type: research

A genomic and clinical prognostic index for hepatitis C-related early-stage cirrhosis that predicts clinical deterioration
Objective The number of patients with HCV-related cirrhosis is increasing, leading to a rising risk of complications and death. Prognostic stratification in patients with early-stage cirrhosis is still challenging. We aimed to develop and validate a clinically useful prognostic index based on genomic and clinical variables to identify patients at high risk of disease progression. Design We developed a prognostic index, comprised of a 186-gene signature validated in our previous genome-wide profiling study, bilirubin (>1 mg/dL) and platelet count (
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: King, L. Y., Canasto-Chibuque, C., Johnson, K. B., Yip, S., Chen, X., Kojima, K., Deshmukh, M., Venkatesh, A., Tan, P. S., Sun, X., Villanueva, A., Sangiovanni, A., Nair, V., Mahajan, M., Kobayashi, M., Kumada, H., Iavarone, M., Colombo, M., Fiel, M. I., Tags: Hepatic cancer Hepatology Source Type: research

Entecavir treatment does not eliminate the risk of hepatocellular carcinoma in chronic hepatitis B: limited role for risk scores in Caucasians
Background Hepatocellular carcinoma (HCC) risk-scores may predict HCC in Asian entecavir (ETV)-treated patients. We aimed to study risk factors and performance of risk scores during ETV treatment in an ethnically diverse Western population. Methods We studied all HBV monoinfected patients treated with ETV from 11 European referral centres within the VIRGIL Network. Results A total of 744 patients were included; 42% Caucasian, 29% Asian, 19% other, 10% unknown. At baseline, 164 patients (22%) had cirrhosis. During a median follow-up of 167 (IQR 82–212) weeks, 14 patients developed HCC of whom nine (64%) had cirrhosi...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Arends, P., Sonneveld, M. J., Zoutendijk, R., Carey, I., Brown, A., Fasano, M., Mutimer, D., Deterding, K., Reijnders, J. G. P., Oo, Y., Petersen, J., van Bommel, F., de Knegt, R. J., Santantonio, T., Berg, T., Welzel, T. M., Wedemeyer, H., Buti, M., Prad Tags: Hepatitis B, Hepatic cancer Hepatology Source Type: research

Cost-effectiveness analysis of sofosbuvir-based regimens for chronic hepatitis C
Conclusions The options that included SOF+RBV+pIFN in a 12-week course regimen fell below the efficiency threshold considered in our setting. IFN-free regimens administered for 24 weeks reached figures over the benchmark of 40 000/QALY. (Source: Gut)
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: San Miguel, R., Gimeno-Ballester, V., Blazquez, A., Mar, J. Tags: Hepatitis C Hepatology Source Type: research

Long-term lifestyle changes after colorectal cancer screening: randomised controlled trial
Objective There is uncertainty whether cancer screening affects participant incentives for favourable lifestyle. The present study investigates long-term effects of colorectal cancer (CRC) screening on lifestyle changes. Design In 1999–2001, men and women drawn from the population registry were randomised to screening for CRC by flexible sigmoidoscopy (‘invited-to-screening’ arm) or to no-screening (control arm) in the Norwegian Colorectal Cancer Prevention trial. A subgroup of 3043 individuals in the ‘invited-to-screening’ and 2819 in the control arm, aged 50–55 years, randomised ...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Berstad, P., Loberg, M., Larsen, I. K., Kalager, M., Holme, O., Botteri, E., Bretthauer, M., Hoff, G. Tags: Endoscopy, Colon cancer Source Type: research

A 52-year-old man with heartburn and weight loss
A previously fit and well 52-year-old man presented to the hospital with a 3-month history of refractory heartburn and progressive weight loss (5 kg). After an initial response to empiric treatment with 20 mg omeprazole daily, heartburn relapsed and became refractory to proton pump inhibitor. His past medical history and physical examination were unremarkable. Upper endoscopy showed a thick white membrane in the distal part of the oesophagus, crossing the gastro-oesophageal junction (figure 1A); the mucosa surrounding the distal margin was slightly depressed but not reddened. An initial diagnosis of candidosis wa...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Gizzi, G., Foschini, M. P., Fabbri, C., Fuccio, L. Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research

Definition and taxonomy of interval colorectal cancers: a proposal for standardising nomenclature
Conclusions The Working Group on interval CRC of the World Endoscopy Organization endorses adoption of this standardised nomenclature. A standardised nomenclature will facilitate benchmarking and comparison of interval CRC rates across programmes and regions. (Source: Gut)
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Sanduleanu, S., le Clercq, C. M. C., Dekker, E., Meijer, G. A., Rabeneck, L., Rutter, M. D., Valori, R., Young, G. P., Schoen, R. E., On behalf of the Expert Working Group on 'Right-sided lesions and interval cancers', Colorectal Cancer Screening Committe Tags: Colon cancer Source Type: research

Post-colonoscopy colorectal cancer (PCCRC) rates vary considerably depending on the method used to calculate them: a retrospective observational population-based study of PCCRC in the English National Health Service
Conclusions The method used to determine PCCRC rates significantly affects findings with potential to substantially underestimate rates. To enable international benchmarking there needs to be a standardised method for defining PCCRC. This study proposes a new methodology using colonoscopy as a denominator and between 2001 and 2007 this method indicated an 8.6% PCCRC rate across the English NHS. It also demonstrated PCCRC rates have fallen over time. (Source: Gut)
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Morris, E. J. A., Rutter, M. D., Finan, P. J., Thomas, J. D., Valori, R. Tags: Endoscopy, Open access, Colon cancer Source Type: research

Eosinophil-mediated signalling attenuates inflammatory responses in experimental colitis
Conclusions Eosinophils exert a protective effect in acute mouse colitis, via production of anti-inflammatory lipid mediators. (Source: Gut)
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Masterson, J. C., McNamee, E. N., Fillon, S. A., Hosford, L., Harris, R., Fernando, S. D., Jedlicka, P., Iwamoto, R., Jacobsen, E., Protheroe, C., Eltzschig, H. K., Colgan, S. P., Arita, M., Lee, J. J., Furuta, G. T. Tags: Open access Inflammatory bowel disease Source Type: research

A phase II study of laquinimod in Crohn's disease
Objective Laquinimod is an oral therapeutic agent under investigation for the treatment of Crohn's disease (CD), Huntington's disease, lupus nephritis and multiple sclerosis. This dose escalation study evaluated the safety and efficacy of laquinimod as induction therapy in patients with active moderate–severe CD. Design Multicentre, double-blind, sequential-cohort, randomised controlled trial with laquinimod doses of 0.5, 1, 1.5 or 2 mg/day or placebo (n=45 per cohort randomised in a 2:1 ratio) for 8 weeks with 4-week follow-up. Stable concomittant therapies and prior use of anti-tumour necrosis factor age...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: D'Haens, G., Sandborn, W. J., Colombel, J. F., Rutgeerts, P., Brown, K., Barkay, H., Sakov, A., Haviv, A., Feagan, B. G., on behalf of the Laquinimod for Crohn's Disease Investigators, on behalf of the Laquinimod for Crohn's Disease Investigators, Baert, Tags: Crohn's disease, Open access Inflammatory bowel disease Source Type: research

Causes of death in people with coeliac disease in England compared with the general population: a competing risk analysis
Conclusions Overall, people with CD have no major excess risk of cancer, digestive disease or respiratory disease related or cardiovascular mortality compared with the general population. These findings should be reassuring to patients with CD and clinicians managing their care. (Source: Gut)
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Abdul Sultan, A., Crooks, C. J., Card, T., Tata, L. J., Fleming, K. M., West, J. Tags: Open access, Coeliac disease Source Type: research

Genetic variation and gastric cancer risk: a field synopsis and meta-analysis
Conclusions We have identified several high-quality biomarkers of gastric cancer susceptibility. These data will form the backbone of an annually updated online resource that will be integral to the study of gastric carcinoma genetics and may inform future screening programmes. (Source: Gut)
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Mocellin, S., Verdi, D., Pooley, K. A., Nitti, D. Tags: Campylobacter, Salmonella, Shigella, Escherichia coli, Helicobacter pylori, Editor's choice, Stomach and duodenum, Pancreatic cancer Source Type: research

Intergenerational reduction in Helicobacter pylori prevalence is similar between different ethnic groups living in a Western city
Conclusions Although the highest H. pylori and CagA prevalence was found in children of non-Dutch ethnicities, the decreased colonisation rates were uniform across all ethnic groups, implying the importance of environmental factors in H. pylori transmission in modern cities, independent of ethnicity. (Source: Gut)
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: den Hollander, W. J., Holster, I. L., van Gilst, B., van Vuuren, A. J., Jaddoe, V. W. V., Hofman, A., Perez-Perez, G. I., Kuipers, E. J., Moll, H. A., Blaser, M. J. Tags: Helicobacter pylori Source Type: research

Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry
We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3-monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008–2010 and 2011–2013). Durability of successful treatment and progression to OAC were also evaluated. R...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Haidry, R. J., Butt, M. A., Dunn, J. M., Gupta, A., Lipman, G., Smart, H. L., Bhandari, P., Smith, L., Willert, R., Fullarton, G., Di Pietro, M., Gordon, C., Penman, I., Barr, H., Patel, P., Kapoor, N., Hoare, J., Narayanasamy, R., Ang, Y., Veitch, A., Ra Tags: Open access, Oesophageal cancer Oesophagus Source Type: research

Fair prices for new direct-acting antiviral agents (DAAs) to make treatment for all affordable
Until 2011, the combination of pegylated interferon (pINF) and ribavirin (RBV) for 24 or 48 weeks was the approved treatment for chronic hepatitis C (CHC). Telaprevir and boceprevir, licensed in 2011 for use in patients infected with HCV genotype 1, were the first direct-acting antiviral agents (DAAs). With combinations including these agents, higher sustained viral response (SVR) rates were achieved compared with pINF+RBV, but also higher side effects. In 2013, sofosbuvir (SOF) was approved for use in HCV-infected patients with genotypes 2 and 3 in combination with RBV, and in those with genotypes 1 and 4, in combina...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Deuffic-Burban, S., Yazdanpanah, Y. Tags: Commentary Source Type: research

Monitoring postcolonoscopy colorectal cancers: dangerous crossroads?
Quality indicators for colonoscopy should be designed to render the outcomes of healthcare services measurable and transparent for both patients and physicians. For example, as the goal of colonoscopy is to prevent and detect colorectal cancer (CRC), improved quality should minimise the postcolonoscopy colorectal cancer (PCCRC) rate. In fact, most other indicators of procedural quality, such as adenoma detection rate and caecal intubation rate, owe their validation to a correlation with PCCRC rate. In an ideal world, rigorous monitoring of PCCRC rates can be used for benchmarking at multiple levels (regional, national, int...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Sanduleanu, S., Dube, C. Tags: Commentary Source Type: research

Do different patients with coeliac disease have different mortality rates?
Although mortality of patients with coeliac disease has being studied for>25 years, it is not yet clear whether it is higher than in the general population. In the first years after the diagnosis of coeliac disease, some studies showed a definitely increased mortality rate that, however, decreases over time. On the other hand, other studies showed that this was not always the case (reviewed in ref 1). All these studies are difficult to compare because they differ widely from each other for epidemiological and clinical reasons. To explain these apparently contrasting results, we suggested that mortality rates were d...
Source: Gut - July 9, 2015 Category: Gastroenterology Authors: Biagi, F., Corazza, G. R. Tags: Commentary Source Type: research

Altered microbiota in microscopic colitis
Recently, Shin et al1 reported that Akkermansia spp had a beneficial effect on glucose homeostasis in obese mice. Mucin degrading Akkermansia—promoting mucin degradation and turnover—is associated with a healthy mucosa. In IBD, a deranged microbiota is reported while findings in microscopic colitis (MC) are lacking. MC is a disorder characterised by chronic non-bloody diarrhoea, predominantly affecting elderly smoking women. Despite frequent diarrhoea, laboratory anomalies are seldom seen. Since an altered microbiota is reported in several immune mediated diseases and since MC affects the gut, our hypothesis wa...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Fischer, H., Holst, E., Karlsson, F., Benoni, C., Toth, E., Olesen, M., Linden, M., Sjoberg, K. Tags: Open access PostScript Source Type: research

British Society of Gastroenterology policy and processes for the development of guidelines
We describe our BSG policy on the production of guidelines, which sets a sufficiently high quality benchmark such that we have been awarded National Institute of Health and Care Excellence (NICE) accreditation for our production process.3 The full policy and advice document are available on our website.4 Most guidelines are commissioned by the BSG clinical services and standards committee (CSSC). The formulation of guidelines are driven by a Guideline Development Group (GDG), include a writing committee, members of which are recognised authorities in the field, and others representing a range of relevant expertise, as well...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Tham, T. C., Gleeson, D., Greenfield, S. M., Harris, A., Cort, S. Tags: PostScript Source Type: research

Colonisation with multidrug-resistant bacteria is associated with increased mortality in patients with cirrhosis
We read with interest the recent paper by Angeli et al1 investigating the acute-on-chronic liver failure classification in comparison to the acute kidney injury classification as a prognostic parameter in patients with decompensated cirrhosis. Higher stages of acute-on-chronic liver failure were accompanied with mortality and more frequently bacterial infections were identified in patients with multiorgan failure in this large cohort of patients. It is well known that patients with cirrhosis are at high risk for bacterial infections and bacterial infections are common causes of hepatic decompensations.2 Infectious complica...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Waidmann, O., Kempf, V. A., Brandt, C., Zeuzem, S., Piiper, A., Kronenberger, B. Tags: PostScript Source Type: research

Aetiopathogenesis of functional dyspepsia
Dear Editor, I read the paper by Fang et al1 with interest. The authors reported risk factors for functional dyspepsia (FD), defined using the Rome III criteria, in a large referral population from Taiwan. They reported that these criteria performed poorly in distinguishing between organic pathology and FD, that those with FD were more likely to exhibit concomitant IBS and that there were distinct differences in risk factors between epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). The latter observation led them to conclude that these two FD subgroups have a distinct aetiopathogenesis. The Rome III ...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Ford, A. C. Tags: PostScript Source Type: research

An endoscopic Mayo score of 0 is associated with a lower risk of colectomy than a score of 1 in ulcerative colitis
Dear Sir, In a recent article1 we showed that correlation between histological indexes is strong for ulcerative colitis (UC). Due to the lack of intervention studies and the absence of a validated histological index, histological healing cannot be considered as a treatment goal in clinical practice for these patients. Pending these studies, we need to define the therapeutic goal for patients with UC. In the ACT 1 and 2 clinical trials,2 early mucosal healing defined by an endoscopic Mayo score (EMS) of 0–1 was associated with a lower risk of colectomy through 54 weeks of follow-up evaluation and better long-term...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Manginot, C., Baumann, C., Peyrin-Biroulet, L. Tags: PostScript Source Type: research

Ondansetron and irritable bowel syndrome
We read the paper by Garsed et al,1 which revives interest in 5-hydroxytryptamine (5-HT) receptor antagonists as treatment for diarrhoea-predominant irritable bowel syndrome (IBS-D). As a highly prevalent functional gastrointestinal (GI) disorder,2 without a known organic pathology to target, IBS continues to be challenging to treat. Interest in agents acting on 5-HT receptors selectively is not novel, with alosetron, the most well-studied 5-HT3 antagonist, demonstrating efficacy in treating IBS-D.3 However, cases of severe constipation and ischaemic colitis led to the withdrawal of the drug. Ondansetron first demonstrated...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Luthra, P., Ford, A. C. Tags: PostScript Source Type: research

GI highlights from the literature
Basic scienceDietary emulsifiers: impact on host microbiota and metabolic dysregulation Chassaing B, Koren O, Goodrich JK, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature 2015;519:92–6. There has been a steady rise in our consumption of food additives over the past 50 years, with many of these constituents having limited effective testing for their impact on human health. It has been suggested that emulsifiers, detergent-like molecules, added to processed foods, can promote increased bacterial translocation across epithelia and be a plausible cause for ...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: McLean, M. H. Tags: JournalScan Source Type: research

Optimising colorectal cancer screening acceptance: a review
The study aims to review available evidence concerning effective interventions to increase colorectal cancer (CRC) screening acceptance. We performed a literature search of randomised trials designed to increase individuals' use of CRC screening on PubMed, Embase, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects. Small (≤100 subjects per arm) studies and those reporting results of interventions implemented before publication of the large faecal occult blood test trials were excluded. Interventions were categorised following the Continuum of Cancer Care and the PRECEDE–PROCEED...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Senore, C., Inadomi, J., Segnan, N., Bellisario, C., Hassan, C. Tags: GUT Recent advances in clinical practice, Colon cancer Source Type: research

Reduced lipoapoptosis, hedgehog pathway activation and fibrosis in caspase-2 deficient mice with non-alcoholic steatohepatitis
Conclusions These data point to a critical role for caspase-2 in lipid-induced hepatocyte apoptosis in vivo for the production of apoptosis-associated fibrogenic factors and in the progression of lipid-induced liver fibrosis. This raises the intriguing possibility that caspase-2 may be a promising therapeutic target to prevent progression to NASH. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Machado, M. V., Michelotti, G. A., Pereira, T. d. A., Boursier, J., Kruger, L., Swiderska-Syn, M., Karaca, G., Xie, G., Guy, C. D., Bohinc, B., Lindblom, K. R., Johnson, E., Kornbluth, S., Diehl, A. M. Tags: Cirrhosis, Nonalcoholic steatosis Hepatology Source Type: research

Endothelial progenitors promote hepatocarcinoma intrahepatic metastasis through monocyte chemotactic protein-1 induction of microRNA-21
Conclusions Our results provide new insights into the complexity of EPC-HCC interactions and indicate that anticancer therapies targeting either the MCP-1 released from angiogenic EPCs or the miR-21 biogenesis in HCC cells may prevent the malignant progression of primary tumours. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Shih, Y.-T., Wang, M.-C., Zhou, J., Peng, H.-H., Lee, D.-Y., Chiu, J.-J. Tags: Hepatic cancer Hepatology Source Type: research

Osteopontin neutralisation abrogates the liver progenitor cell response and fibrogenesis in mice
Conclusions OPN upregulation during liver injury is a conserved repair response, and influences liver progenitor cell function. OPN-neutralisation abrogates the liver progenitor cell response and fibrogenesis in mouse models of liver fibrosis. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Coombes, J. D., Swiderska-Syn, M., Dolle, L., Reid, D., Eksteen, B., Claridge, L., Briones-Orta, M. A., Shetty, S., Oo, Y. H., Riva, A., Chokshi, S., Papa, S., Mi, Z., Kuo, P. C., Williams, R., Canbay, A., Adams, D. H., Diehl, A. M., van Grunsven, L. A., Tags: Cirrhosis Hepatology Source Type: research

Looking beyond the scope: recurrent rectal bleeding in a young woman
Clinical presentation A 27-year-old woman presented with 1 week of bright red rectal bleeding with generalised abdominal pain and loose stools. She had experienced three similar episodes that settled spontaneously in the year prior. Relevant past history included subcutaneous masses on left shoulder, left elbow and right paravertebral region since childhood and migraine. There was no history of inflammatory bowel disease or previous infective colitis. On clinical examination, she was haemodynamically stable. There was a cutaneous vascular lesion present on her left lower limb that was thought to represent a port-wine ...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Janko, N., Nguyen, T. C., Lubel, J. Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research

Non-selective {beta}-blockers are associated with improved survival in patients with ascites listed for liver transplantation
Conclusions NSBB in patients with ascites and refractory ascites listed for liver transplantation are not detrimental, and instead are associated with reduced waitlist death. Our findings argue that NSBB are safe and may confer benefit in patients with ascites complicating end-stage liver disease. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Leithead, J. A., Rajoriya, N., Tehami, N., Hodson, J., Gunson, B. K., Tripathi, D., Ferguson, J. W. Tags: Hepatic cancer Hepatology Source Type: research

Preoperative endoscopic ultrasound-guided fine needle aspiration does not impair survival of patients with resected pancreatic cancer
Conclusions Preoperative EUS-FNA was not associated with increased risk of mortality. These data suggest that EUS-FNA can be safely performed for the work-up of suspicious pancreatic lesions. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Ngamruengphong, S., Swanson, K. M., Shah, N. D., Wallace, M. B. Tags: Pancreas and biliary tract, Pancreatic cancer Source Type: research

Neurotensin--regulated miR-133{alpha} is involved in proinflammatory signalling in human colonic epithelial cells and in experimental colitis
Conclusions NT-associated colitis and inflammatory signalling are regulated by miR-133α-AFTPH interactions. Targeting of miR-133α or AFTPH may represent a novel therapeutic approach in inflammatory bowel disease. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Law, I. K. M., Bakirtzi, K., Polytarchou, C., Oikonomopoulos, A., Hommes, D., Iliopoulos, D., Pothoulakis, C. Tags: Ulcerative colitis, Open access, Gastrointestinal hormones Inflammatory bowel disease Source Type: research

Intestinal epithelial vitamin D receptor deletion leads to defective autophagy in colitis
Conclusions Our study demonstrates fundamental relationship between VDR, autophagy and gut microbial assemblage that is essential for maintaining intestinal homeostasis, but also in contributing to the pathophysiology of IBD. These insights can be leveraged to define therapeutic targets for restoring VDR expression and function. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Wu, S., Zhang, Y.-g., Lu, R., Xia, Y., Zhou, D., Petrof, E. O., Claud, E. C., Chen, D., Chang, E. B., Carmeliet, G., Sun, J. Tags: Inflammatory bowel disease Source Type: research

Bone marrow Th17 TNF{alpha} cells induce osteoclast differentiation, and link bone destruction to IBD
Conclusions Our results highlight the osteoclastogenic function of the Th17 TNF-α+ cells that contribute to bone loss in vivo in IBD. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Ciucci, T., Ibanez, L., Boucoiran, A., Birgy-Barelli, E., Pene, J., Abou-Ezzi, G., Arab, N., Rouleau, M., Hebuterne, X., Yssel, H., Blin-Wakkach, C., Wakkach, A. Tags: Crohn's disease Inflammatory bowel disease Source Type: research

Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific
Conclusions This first population-based study of IBD risk factors in Asia-Pacific supports the importance of childhood immunological, hygiene and dietary factors in the development of IBD, suggesting that markers of altered intestinal microbiota may modulate risk of IBD later in life. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Ng, S. C., Tang, W., Leong, R. W., Chen, M., Ko, Y., Studd, C., Niewiadomski, O., Bell, S., Kamm, M. A., de Silva, H. J., Kasturiratne, A., Senanayake, Y. U., Ooi, C. J., Ling, K.-L., Ong, D., Goh, K. L., Hilmi, I., Ouyang, Q., Wang, Y.-F., Hu, P., Zhu, Z Tags: Crohn's disease, Editor's choice Inflammatory bowel disease Source Type: research

Comparison of colonoscopic performance between medical and nurse endoscopists: a non-inferiority randomised controlled study in Asia
Objective To test the hypothesis that trained nurse endoscopists are not inferior to medical endoscopists in finding adenomas during colonoscopy. Design This is a prospective, randomised, single-blind, non-inferiority study comparing nurses with medical endoscopists in performing screening colonoscopy. The nurse endoscopists had been trained according to the British Joint Advisory Group on GI Endoscopy curriculum and had completed at least 140 colonoscopic procedures prior to the study. The primary endpoint was the adenoma detection rate. Secondary endpoints included the caecal intubation rate, intubation time, complicati...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Hui, A. J., Lau, J. Y., Lam, P. P. Y., Chui, A. O. M., Fan, A. S. H., Lam, T. Y. T., Tse, Y.-k., Tang, R. S. Y., Ng, S. C., Wu, J. C. Y., Ching, J. Y. L., Wong, M. C. S., Chan, F. K. L., Sung, J. Tags: Endoscopy, Colon cancer Source Type: research

Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis
Conclusions The overall pooled prevalence of uninvestigated dyspepsia was 21%, but varied among countries and according to the criteria used to define its presence. Prevalence is significantly higher in women, smokers, NSAID users and H. pylori-positive individuals, although these associations were modest. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Ford, A. C., Marwaha, A., Sood, R., Moayyedi, P. Tags: Dyspepsia Neurogastroenterology Source Type: research

Bacterial CagA protein induces degradation of p53 protein in a p14ARF-dependent manner
Conclusions Our results provide novel evidence that tumorigenicity associated with H. pylori infection is linked to inhibition of p53 protein by CagA. We propose a model in which CagA-induced degradation of p53 protein is determined by a relative level of p14ARF. In cells in which p14ARF levels were decreased due to hypermethylation or deletion of the p14ARF gene, H. pylori efficiently degraded p53, whereas p53 is protected in cells expressing high levels of p14ARF. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Wei, J., Noto, J. M., Zaika, E., Romero-Gallo, J., Piazuelo, M. B., Schneider, B., El-Rifai, W., Correa, P., Peek, R. M., Zaika, A. I. Tags: Stomach and duodenum, Pancreatic cancer Helicobacter pylori Source Type: research

Activation of {beta}-catenin signalling by TFF1 loss promotes cell proliferation and gastric tumorigenesis
Conclusions Our data indicate that loss of TFF1 promotes β-catenin activation and gastric tumorigenesis through regulation of PP2A, a major regulator of AKT-GSK3β signalling. (Source: Gut)
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Soutto, M., Peng, D., Katsha, A., Chen, Z., Piazuelo, M. B., Washington, M. K., Belkhiri, A., Correa, P., El-Rifai, W. Tags: Pancreatic cancer Stomach Source Type: research

Reliability and agreement studies: a guide for clinical investigators
Setting the framework: the difference between reliability and agreement On a daily basis, clinicians and researchers face the challenge of measuring multiple outcomes. From responses to therapies and assessments of disease activity, to certainty of diagnoses and innovation of cutting-edge diagnostic tools, it is essential within every field that outcome measurement be valid, reproducible and reliable.1 At first glance, validity, reproducibility, reliability and agreement may seem similar; however, there are fundamental differences among these concepts that are important for study design and execution, and for methodology a...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Hernaez, R. Tags: Leading article Source Type: research

To block, or not to block in advanced cirrhosis and ascites: that is the question
; Whether 'tis nobler in the mind to suffer the slings and arrows of outrageous non-selective β-blockers (NSBB), or to take arms against a sea of criticism. These words rephrase Prince Hamlet's contemplation of death and suicide in William Shakespeare's tragedy Hamlet. He bemoans the pains and unfairness of life but acknowledges that the alternative may still be worse. NSBBs have been studied since the early 1960s and have been a cornerstone in clinical hepatology where they have benefitted more patients and saved more lives than any other drug in this field over the past three decades (table 1).1 2 In addition, NSBBs...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Krag, A., Madsen, B. S. Tags: Commentary Source Type: research

Time for epithelial sensing of vitamin D to step into the limelight
It is becoming increasingly clear that the ‘one microbe-one disease’ paradigm must be reconsidered, because it fails to account for the pathogenesis of several common human illnesses with ever-increasing socioeconomic impacts (such as IBD). Notably, instability within the gut's microbial communities (referred to as dysbiosis) has been linked to loss of gut barrier function in IBD. In particular, IBDs are associated with a greater preponderance of certain Bacteroidetes and a lower abundance of Firmicutes.1 2 Likewise, several targeted approaches in mice have revealed that the major Crohn's disease-predisposing N...
Source: Gut - June 9, 2015 Category: Gastroenterology Authors: Waldschmitt, N., Chamaillard, M. Tags: Commentary Source Type: research