A novel prepless X-ray imaging capsule for colon cancer screening
Message The demand for bowel cleansing hampers participation in screening colonoscopy, while poor preparation impairs adenoma detection. A novel prepless X-ray imaging capsule for colon screening is presented; the capsule emits low dose X-rays, which are scattered by ingested contrast agent mixed with colon contents, and sensed by detectors in the capsule to generate high-resolution three-dimensional (3D) imagery of the colon without bowel cleansing. Following preliminary studies with implanted polyps in synthetic colon phantoms, bovine cadaver and live swine, and human experiments with dummy capsules (n=75), 49 patients s...
Source: Gut - February 12, 2016 Category: Gastroenterology Authors: Gluck, N., Shpak, B., Brun, R., Rösch, T., Arber, N., Moshkowitz, M. Tags: Endoscopy, Open access, Colon cancer Endoscopy news Source Type: research

Targeting TGR5 in cholangiocyte proliferation: default topic
The transmembrane G protein-coupled receptor TGR5 binds to and is activated by bile acids.1 2 TGR5 is widely distributed, in animals and humans, in the gallbladder, liver, brown adipose tissue, muscle, intestine, kidney, placenta and brain. In the liver, TGR5 appears in sinusoidal endothelial cells, bile duct epithelial cells and Kupffer cells. Interestingly, the ubiquitous TGR5 expression positions previously unsuspected tissues such as muscle, brain and adipose tissue, and cells such as macrophages and endothelial cells, as potential targets of bile acid signalling. Bile acid binding to TGR5 activates multiple signalling...
Source: Gut - February 12, 2016 Category: Gastroenterology Authors: Rodrigues, C. M. P., Moshage, H. Tags: Commentary Source Type: research

Next-generation metabolic imaging in pancreatic cancer
In pancreatic ductal adenocarcinoma (PDAC), the lack of specific symptoms or diagnostic markers, the highly aggressive nature of the disease and high intrinsic and acquired therapy resistance all result in a virtually unchanged overall 5-year survival rate of around 5%.1 Thus, early detection of PDAC is a major task for improvement of prognosis and management of this fatal disease as surgery currently presents the only option for long-term survival.2 Conventional imaging techniques, including CT, proton-based MRI and endoscopic ultrasound, differentiate tumour tissue based on morphological and physiological (eg, reduced pe...
Source: Gut - February 12, 2016 Category: Gastroenterology Authors: Braren, R. F., Siveke, J. T. Tags: Commentary Source Type: research

Real friends: Faecalibacterium prausnitzii supports mucosal immune homeostasis
IBD is commonly considered as an exaggerated immune response to the microbiota in a genetically susceptible host. This statement recognises the central role of the enteric microbiota in the pathogenesis of IBD. Consistently, in animal models of IBD, inflammation is not observed in the absence of live bacteria and distinct members of the microbiota differ in their potential to trigger disease. Patients with IBD present substantial changes of their microbiota commonly described as dysbiosis.1–4 However, intestinal bacteria not only drive disease but quite the contrary, individual commensal members also dampen inflammat...
Source: Gut - February 12, 2016 Category: Gastroenterology Authors: Hornef, M. W., Pabst, O. Tags: Commentary Source Type: research

Functional annotation of high-quality SNP biomarkers of gastric cancer susceptibility: the Yin Yang of PSCA rs2294008
Dear Editor, We read the recent article by Mocellin et al1 with great interest. Their comprehensive meta-analysis nominated 11 germline variants at nine loci with high level of cumulative evidence for genetic susceptibility to gastric cancer (GC). Evidence for five of the nine loci (PKLR at 1q22, CASP8 at 2q33.1, MUC1 at 1q22, TGFBR2 at 3p241 and GSTP1 at 11q13.2) came from hypothesis-driven studies based on biological relevance, while the remaining loci were identified through genome-wide association studies (GWAS). However, all loci await functional annotation in the relevant normal tissue to further our understanding of...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Sung, H., Yang, H. H., Hu, N., Su, H., Taylor, P. R., Hyland, P. L. Tags: PostScript Source Type: research

Prevalent low-grade dysplasia: the strongest predictor of malignant progression in Barrett's columnar-lined oesophagus
Dear Professor Emad El-Omar, We read with interest the work by Duits et al1 who find that validated low-grade dysplasia (LGD) is highly predictive of malignant progression in Barrett's oesophagus (BO). Yachimski2 stresses the need for this important finding to be validated in other centres. Our experience of prevalent LGD as a predictor of malignant progression in BO in the West of Scotland strongly reinforces the conclusions of our colleagues in the Netherlands. Patients with BO diagnosed between 1994 and 2009 at one centre (Glasgow Royal Infirmary (GRI)) all had BO visible endoscopically, with biopsy-proven metaplastic g...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Moyes, L. H., Oien, K. A., Foulis, A. K., Fullarton, G. M., Going, J. J. Tags: Open access PostScript Source Type: research

Genetic variant PLCE1 rs2274223 and gastric cancer: more to be explored?
We read with great interest the comprehensive study by Mocellin and colleagues1 who developed a quantitative summary of candidate genetic variants for gastric cancer susceptibility. Based on different tumour sites, the authors conducted a subgroup analysis for cardia cancer (CC) and non-cardia cancer (NCC). It is well established that CC has distinctive characteristics compared with NCC, but shares some common risk factors and pathogenesis with oesophageal cancer (OSC). In addition, there are some different genetic factors such as genetic variants between patients with CC and NCC. There is an argument that CC, located at o...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: He, Y., Wang, C., Wang, Z., Zhou, Z. Tags: PostScript Source Type: research

Management of acute-on-chronic liver failure: rotational thromboelastometry may reduce substitution of coagulation factors in liver cirrhosis
With great interest we have read the manuscript by Angeli et al,1 demonstrating development of acute-on-chronic liver failure (ACLF) as an accurate predictor for mortality in hospitalised patients with decompensated liver cirrhosis. The authors show that assessment of the chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score improves prognostic accuracy and is superior to the acute kidney injury (AKI) classification, when taken at 48 h after hospitalisation. Patients with acutely decompensated cirrhosis are in a severe condition and the manuscript shows that mortality is extremely high in patient...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Bedreli, S., Sowa, J.-P., Gerken, G., Saner, F. H., Canbay, A. Tags: PostScript Source Type: research

Serum macrophage inflammatory protein 3{alpha} levels predict the severity of HBV-related acute-on-chronic liver failure
Dear Editor, We read with interest the paper by Angeli et al1 proposing the value of the acute-on-chronic liver failure (ACLF) stratification in the prediction of short-term mortality in patients with acute decompensation of cirrhosis. Other studies2 3 indicated that the dynamic changes in serological markers are associated with patients who have cirrhosis. We hypothesised that the pathological processes of HBV-related ACLF (HBV-ACLF) would result in specific changes in the levels of signalling proteins in the blood. Thus, we aimed to search detectable biomarkers to predict the outcome of HBV-ACLF. We collected serum sampl...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Xin, J., Ding, W., Hao, S., Chen, X., Zhang, J., Jiang, L., Zhou, Q., Shi, D., Zhang, L., Xu, X., Cao, H., Li, L., Li, J. Tags: PostScript Source Type: research

Prediction of oesophageal variceal bleeding by measuring spleen stiffness in patients with liver cirrhosis
This study aimed to evaluate SS determined by ARFI imaging as a predictor of OVB. We measured SS in 446 cirrhotic patients and followed them prospectively at Kurashiki Central Hospital between 2010 and 2014. We examined the diagnostic accuracy of SS for predicting OVB using Fine and Gray multivariate analysis with competing risks, and compared... (Source: Gut)
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Takuma, Y., Nouso, K., Morimoto, Y., Tomokuni, J., Sahara, A., Takabatake, H., Doi, A., Matsueda, K., Yamamoto, H. Tags: PostScript Source Type: research

ABO blood type B and fucosyltransferase 2 non-secretor status as genetic risk factors for chronic pancreatitis
Sir, We thank Kirsten et al1 for their comments on our recent study,2 in which we reported a genome-wide analysis on ~4000 volunteers from the population-based Study of Health in Pommerania (SHIP) cohort3 with replication in 1444 blood donors. We had found a significant association between higher serum lipase activities and three single nucleotide polymorphisms (SNP) as well as the fucosyltransferase-2 (FUT2) non-secretor status (homozygosity for the FUT2 p.W134X mutation) and the ABO blood type B (figure 1). In more than 1000 patients with pancreatitis, we confirmed that FUT2 non-secretor status and blood type B are also ...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Weiss, F. U., Schurmann, C., Teumer, A., Mayerle, J., Simon, P., Völzke, H., Greinacher, A., Kuehn, J.-P., Zenker, M., Völker, U., Homuth, G., Lerch, M. M. Tags: PostScript Source Type: research

GI highlights from the literature
Basic scienceNKp46+ group 3 innate lymphoid cells in intestinal inflammation  Song C, Lee JS, Gilfillan S, et al. Unique and redundant functions of NKp46+ ILC3s in models of intestinal inflammation. J Exp Med 2015;212:1869–82. Innate lymphoid cells (ILCs) are a heterogeneous population of lymphocytes that respond to changes in the tissue cytokine microenvironment by secreting effector cytokines. ILCs are divided into three major groups (ILC1–ILC3) according to the cytokines they secrete and transcription factors needed for their development. ILC3s, the focus of this article, are important for host defence ...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: McLean, M. H. Tags: JournalScan Source Type: research

Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders
Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These include the lack of a current cohesive strategy for treatment and follow-up of mothers and their babies; the uncertain risk of postpartum HBV flares; the lack of randomised trial data on the safety and efficacy of antiviral treatment in pregnancy; the lack of head-to-head studies comparing different antivirals in pregnancy; and the lack of epidemiologic information regarding infection across different populations globally. This position paper provides a comprehensive review of the management of women with HBV infection prior...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Visvanathan, K., Dusheiko, G., Giles, M., Wong, M.-L., Phung, N., Walker, S., Le, S., Lim, S. G., Gane, E., Ngu, M., Hardikar, W., Cowie, B., Bowden, S., Strasser, S., Levy, M., Sasaduesz, J. Tags: GUT Recent advances in clinical practice Source Type: research

The gut microbiota and host health: a new clinical frontier
Over the last 10–15 years, our understanding of the composition and functions of the human gut microbiota has increased exponentially. To a large extent, this has been due to new ‘omic’ technologies that have facilitated large-scale analysis of the genetic and metabolic profile of this microbial community, revealing it to be comparable in influence to a new organ in the body and offering the possibility of a new route for therapeutic intervention. Moreover, it might be more accurate to think of it like an immune system: a collection of cells that work in unison with the host and that can promote heal...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Marchesi, J. R., Adams, D. H., Fava, F., Hermes, G. D. A., Hirschfield, G. M., Hold, G., Quraishi, M. N., Kinross, J., Smidt, H., Tuohy, K. M., Thomas, L. V., Zoetendal, E. G., Hart, A. Tags: GUT Recent advances in basic science, Open access, Colon cancer Source Type: research

Stratification of hepatocellular carcinoma risk in primary biliary cirrhosis: a multicentre international study
Objective Hepatocellular carcinoma (HCC) is an infrequent yet critical event in primary biliary cirrhosis (PBC); however, predictive tools remain ill-defined. Our objective was to identify candidate risk factors for HCC development in patients with PBC. Design Risk factor analysis was performed in over 15 centres from North America and Europe spanning>40 years observation period using Cox proportional hazards assumptions, logistic regression, and Kaplan-Meier estimates. Results Of 4565 patients with PBC 123 developed HCC, yielding an incidence rate (IR) of 3.4 cases/1000 patient-years. HCC was significantly more common in men (p
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Trivedi, P. J., Lammers, W. J., van Buuren, H. R., Pares, A., Floreani, A., Janssen, H. L. A., Invernizzi, P., Battezzati, P. M., Ponsioen, C. Y., Corpechot, C., Poupon, R., Mayo, M. J., Burroughs, A. K., Nevens, F., Mason, A. L., Kowdley, K. V., Lleo, A. Tags: Pancreas and biliary tract, Hepatic cancer Hepatology Source Type: research

Baseline quantitative hepatitis B core antibody titre alone strongly predicts HBeAg seroconversion across chronic hepatitis B patients treated with peginterferon or nucleos(t)ide analogues
Objective The investigation regarding the clinical significance of quantitative hepatitis B core antibody (anti-HBc) during chronic hepatitis B (CHB) treatment is limited. The aim of this study was to determine the performance of anti-HBc as a predictor for hepatitis B e antigen (HBeAg) seroconversion in HBeAg-positive CHB patients treated with peginterferon (Peg-IFN) or nucleos(t)ide analogues (NUCs), respectively. Design This was a retrospective cohort study consisting of 231 and 560 patients enrolled in two phase IV, multicentre, randomised, controlled trials treated with Peg-IFN or NUC-based therapy for up to 2 y...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Fan, R., Sun, J., Yuan, Q., Xie, Q., Bai, X., Ning, Q., Cheng, J., Yu, Y., Niu, J., Shi, G., Wang, H., Tan, D., Wan, M., Chen, S., Xu, M., Chen, X., Tang, H., Sheng, J., Lu, F., Jia, J., Zhuang, H., Xia, N., Hou, J., Chronic Hepatitis B Study Consortium, Tags: Hepatitis B, Open access Hepatology Source Type: research

Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas)
Conclusions After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN. Trial registration number IRB 00006477. (Source: Gut)
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Jais, B., Rebours, V., Malleo, G., Salvia, R., Fontana, M., Maggino, L., Bassi, C., Manfredi, R., Moran, R., Lennon, A. M., Zaheer, A., Wolfgang, C., Hruban, R., Marchegiani, G., Fernandez Del Castillo, C., Brugge, W., Ha, Y., Kim, M. H., Oh, D., Hirai, I Tags: Pancreas and biliary tract Source Type: research

Plasma 25-hydroxyvitamin D and colorectal cancer risk according to tumour immunity status
Conclusions High plasma 25(OH)D level is associated with lower risk of colorectal cancer with intense immune reaction, supporting a role of vitamin D in cancer immunoprevention through tumour–host interaction. (Source: Gut)
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Song, M., Nishihara, R., Wang, M., Chan, A. T., Qian, Z. R., Inamura, K., Zhang, X., Ng, K., Kim, S. A., Mima, K., Sukawa, Y., Nosho, K., Fuchs, C. S., Giovannucci, E. L., Wu, K., Ogino, S. Tags: Colon cancer Source Type: research

A challenging case of multiple splenic and pancreatic lesions in a patient with Crohn's disease
A 40-year-old woman with a history of ileocolonic Crohn's disease treated with oral mesalamine presented with fever and diffuse abdominal pain without diarrhoea. Laboratory tests were notable only for increased serum C-reactive protein (CRP) (46 mg/L) and leucocytosis (10 100 cells/μL) with neutrophilia (8700 cells/μL). Abdominal CT revealed multiple mesenteric lymph nodes (MLNs) without evidence of thickening of the bowel wall or complications such as stricture, fistula or abscess. Laparoscopic biopsy samples of some MLNs were performed; their histopathological analysis revealed a suppurative lymphadenitis...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Boschetti, G., Assaad, S., Balme, B., Boyer, S., Flourie, B., Nancey, S. Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research

An international randomised trial of celecoxib versus celecoxib plus difluoromethylornithine in patients with familial adenomatous polyposis
Conclusions CXB combined with DFMO yielded moderate synergy according to a video-based global assessment. No significant difference in adenoma count, the primary endpoint, was seen between the two study arms. No evidence of DFMO-related ototoxicity was seen. There were no adverse cardiovascular outcomes in either trial arm and no significant increase in AEs in the CXB+DFMO arm of the trial. Differences in outcomes between primary and secondary endpoints may relate to sensitivity of the endpoint measures themselves. Trial registration number ClinicalTrials.gov number N01-CN95040. (Source: Gut)
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Lynch, P. M., Burke, C. A., Phillips, R., Morris, J. S., Slack, R., Wang, X., Liu, J., Patterson, S., Sinicrope, F. A., Rodriguez-Bigas, M. A., Half, E., Bulow, S., Latchford, A., Clark, S., Ross, W. A., Malone, B., Hasson, H., Richmond, E., Hawk, E. Tags: Colon cancer Source Type: research

Small-molecule inhibitors prevent the genotoxic and protumoural effects induced by colibactin-producing bacteria
Objective Colorectal cancers (CRCs) are frequently colonised by colibactin toxin-producing Escherichia coli bacteria that induce DNA damage in host cells and exhibit protumoural activities. Our objective was to identify small molecules inhibiting the toxic effects induced by these colibactin-producing bacteria. Design A structural approach was adopted for the identification of a putative ligand for the ClbP enzyme involved in the synthesis of colibactin. Intestinal epithelial cells and a CRC mouse model were used to assess the activity of the selected compounds in vitro and in vivo. Results Docking experiments identified...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Cougnoux, A., Delmas, J., Gibold, L., Faïs, T., Romagnoli, C., Robin, F., Cuevas-Ramos, G., Oswald, E., Darfeuille-Michaud, A., Prati, F., Dalmasso, G., Bonnet, R. Tags: Colon cancer GI cancer Source Type: research

Ten-year incidence of colorectal cancer following a negative screening sigmoidoscopy: an update from the Colorectal Cancer Prevention (CoCaP) programme
Conclusions Though still below population levels, the incidence of CRC during years 6–10 following a negative sigmoiodoscopy is appreciably higher than during the first 5 years. (Source: Gut)
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Doria-Rose, V. P., Levin, T. R., Palitz, A., Conell, C., Weiss, N. S. Tags: Endoscopy, Colon cancer Source Type: research

Compartment-specific immunity in the human gut: properties and functions of dendritic cells in the colon versus the ileum
Conclusions The regulatory properties of colonic DC may represent an evolutionary adaptation to the greater bacterial load in the colon. The colon and the ileum should be regarded as separate entities, each comprising DC with distinct roles in mucosal immunity and imprinting. (Source: Gut)
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Mann, E. R., Bernardo, D., English, N. R., Landy, J., Al-Hassi, H. O., Peake, S. T., Man, R., Elliott, T. R., Spranger, H., Lee, G. H., Parian, A., Brant, S. R., Lazarev, M., Hart, A. L., Li, X., Knight, S. C. Tags: Open access Gut immunity Source Type: research

The association of tissue anti-TNF drug levels with serological and endoscopic disease activity in inflammatory bowel disease: the ATLAS study
Objective The aim of this study was to assess the correlation between serum and intestinal anti-tumour necrosis factor (TNF) levels, and their relationship to endoscopic disease activity and levels of TNF. Design Cross-sectional study of 30 patients receiving treatment with infliximab or adalimumab for Crohn's disease or UC. For each patient, a sample of serum was matched to tissue biopsies. Endoscopic and histological disease activity was recorded for each tissue sample. Results There was a significant positive correlation between anti-TNF in serum and tissue (r=0.3920, p=0.002), especially in uninflamed tissue (r=0.50, p
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Yarur, A. J., Jain, A., Sussman, D. A., Barkin, J. S., Quintero, M. A., Princen, F., Kirkland, R., Deshpande, A. R., Singh, S., Abreu, M. T. Tags: Crohn's disease Inflammatory bowel disease Source Type: research

Geographical patterns of the standing and active human gut microbiome in health and IBD
Conclusions These analyses reveal important interactions of patients’ geographical origin and disease in the interpretation of disease-associated changes in microbial communities and highlight the added value of analysing communities on both the 16S rRNA gene (DNA) and transcript (RNA) level. (Source: Gut)
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Rehman, A., Rausch, P., Wang, J., Skieceviciene, J., Kiudelis, G., Bhagalia, K., Amarapurkar, D., Kupcinskas, L., Schreiber, S., Rosenstiel, P., Baines, J. F., Ott, S. Tags: Crohn's disease Gut microbiota Source Type: research

Dysbiotic gut microbiota causes transmissible Crohn's disease-like ileitis independent of failure in antimicrobial defence
Conclusions We provide clear experimental evidence for the causal role of gut bacterial dysbiosis in the development of chronic ileal inflammation with subsequent failure of Paneth cell function. (Source: Gut)
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Schaubeck, M., Clavel, T., Calasan, J., Lagkouvardos, I., Haange, S. B., Jehmlich, N., Basic, M., Dupont, A., Hornef, M., Bergen, M. v., Bleich, A., Haller, D. Tags: Crohn's disease, Open access, Editor's choice Gut microbiota Source Type: research

Motilin-induced gastric contractions signal hunger in man
Rationale Hunger is controlled by the brain, which receives input from signals of the GI tract (GIT). During fasting, GIT displays a cyclical motor pattern, the migrating motor complex (MMC), regulated by motilin. Objectives To study the relationship between hunger and MMC phases (I–III), focusing on spontaneous and pharmacologically induced phase III and the correlation with plasma motilin and ghrelin levels. The role of phase III was also studied in the return of hunger after a meal in healthy individuals and in patients with loss of appetite. Findings In fasting healthy volunteers, mean hunger ratings during a g...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Tack, J., Deloose, E., Ang, D., Scarpellini, E., Vanuytsel, T., Van Oudenhove, L., Depoortere, I. Tags: Gastrointestinal hormones Neurogastroenterology Source Type: research

A novel human gastric primary cell culture system for modelling Helicobacter pylori infection in vitro
Conclusions A robust and quasi-immortal 3D organoid model has been established, which is considered instrumental for future research aimed to understand the underlying mechanisms of infection, mucosal immunity and cancer of the human stomach. (Source: Gut)
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Schlaermann, P., Toelle, B., Berger, H., Schmidt, S. C., Glanemann, M., Ordemann, J., Bartfeld, S., Mollenkopf, H. J., Meyer, T. F. Tags: Open access, Stomach and duodenum, Pancreatic cancer Helicobacter pylori Source Type: research

Length of Barrett's oesophagus and cancer risk: implications from a large sample of patients with early oesophageal adenocarcinoma
Objective Although it is well understood that the risk of oesophageal adenocarcinoma increases with Barrett length, transition risks for cancer associated with different Barrett lengths are unknown. We aimed to estimate annual cancer transition rates for patients with long-segment (≥3 cm), short-segment (≥1 to
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Pohl, H., Pech, O., Arash, H., Stolte, M., Manner, H., May, A., Kraywinkel, K., Sonnenberg, A., Ell, C. Tags: Oesophageal cancer Oesophagus Source Type: research

Prospective evaluation of endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass (EPASS) for malignant gastric outlet obstruction
Message Surgical gastrojejunostomy (GJ), which has been the standard palliative treatment for malignant gastric outlet obstruction (MGOO), is associated with good functional outcome and the long-term relief of symptoms. Endoscopic placement of a metal stent for MGOO treatment has been gaining popularity as an alternative to surgical GJ because of its high technical success rates and less invasiveness. Interestingly, several investigators have attempted endoscopic GJ as ‘endoscopic bypass’ for longer efficacy while maintaining a less invasive procedure.1 We previously reported on the feasibility and safety of EU...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Itoi, T., Ishii, K., Ikeuchi, N., Sofuni, A., Gotoda, T., Moriyasu, F., Dhir, V., Teoh, A. Y. B., Binmoeller, K. F. Tags: Gastric emptying disorders, Stomach and duodenum Endoscopy news Source Type: research

Relief of obstructive jaundice from pancreatic cancer: the end of the plastic stent era?
Initially described by Soehendra and Reynders-Frederix1 in 1980, plastic stents have been widely used for endoscopic relief of malignant biliary obstruction. The relative ease of placement and removal of plastic stents, as well as their low cost, have made them an attractive option for the past 35 years. It has been apparent for decades, however, that self-expandable metal stents (SEMS) provide much more durable biliary drainage than plastic stents. Accumulating evidence now suggests that it may no longer be justifiable to use plastic stents when it is clear that metal stents are associated with superior outcomes, few...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Baron, T. H., Grimm, I. S. Tags: Commentary Source Type: research

Defining dysbiosis threatens Koch's postulates and current dogma on the role of Paneth cells in Crohn's disease
Whereas the intestinal epithelium self-renews every 3–5 days, it promotes a robust antimicrobial response to enteropathogens when they first breach the integrity of the mucosal barrier. Foremost, the interaction between gut commensals and the single layer of intestinal epithelial cells is involved in many common, essential physiological processes (eg, nutrient absorption, cell proliferation, cell motility and metabolic activities). In Crohn's disease, it is thought that impaired epithelial function develops into transmural inflammatory lesions at the terminal ileum, where abnormal granule formation and enhanced ...
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: Chamaillard, M., Radulovic, K. Tags: Commentary Source Type: research

Barrett's oesophagus: size does matter
For several decades, the incidence of oesophageal adenocarcinoma (OAC) has shown the highest proportional rise among all cancers in the Western world. In order to detect neoplasia at a curable stage, endoscopic surveillance of patients with its precursor lesion Barrett's oesophagus (BO) is recommended by various societal guidelines and as such has been widely implemented over the past decades. However, although surveillance endoscopy is intuitively rational, there is currently no proof from randomised trials that this strategy reduces OAC mortality, and its cost-effectiveness has been questioned. The observation that
Source: Gut - January 6, 2016 Category: Gastroenterology Authors: de Jonge, P. J. F., Hvid-Jensen, F. Tags: Commentary Source Type: research

Gastroenterology training in Europe-unmet educational needs beyond the machines: response from the European Section and Board of Gastroenterology
Ianiro and Gasbarrini suggest that the role of the European Section and Board of Gastroenterology (ESBGH) has been ‘lost in translation’.1 Data on the timeline and distribution of our recognised training centres are used to suggest that there has been a decline in training centre applications which may be a marker for problems in specialist gastroenterology training across Europe. The initial preponderance of numbers of training centres in the UK was due to the enthusiastic recruitment of UK centres by the UK National delegate in the late 1990s, and does not reflect in any way on the quality of training across ...
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Barrison, I. G., Jacques, J.-P. Tags: PostScript Source Type: research

Efficacy of mesalazine in IBS
Editor, We read the papers by Barbara et al1 and Lam et al2 with interest. The authors reported the results of two randomised controlled trials (RCTs) of mesalazine in IBS. These are the largest studies examining the efficacy of this drug in IBS, to date, and the authors are to be applauded for conducting them. The efficacy of mesalazine in UC is undisputed.3–5 However, the observation that a subset of patients with IBS, particularly those with a post-infective aetiology, may demonstrate low-grade colonic mucosal inflammatory changes has led to a renewed interest in the use of the drug for this condition.6 Unfortunat...
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Min, T., Ford, A. C. Tags: PostScript Source Type: research

Gastroenterology training in Europe: unmet educational needs beyond the machines
We read with interest the paper by Ekkelenkamp et al, who found that the early use of validated simulators during endoscopy training expedites the learning of procedural skills. Authors propose the structured employment of simulators within endoscopy training curricula.1 Endoscopic learning represents an essential component of gastroenterology training and would surely benefit from the application of virtual reality techniques. Nevertheless, beyond the necessity of high-tech gadgets, other basic educational needs of gastroenterology trainees appear to remain unmet in Europe to date. In 2002, Bisschops et al compared the tr...
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Ianiro, G., Gasbarrini, A. Tags: PostScript Source Type: research

Genetic variants of lipase activity in chronic pancreatitis
We read with great interest the article by Weiss et al1 reporting genetic associations of rs632111 (fucosyltransferase 2; FUT2), rs8176693 (ABO) and rs889512 (chymotrypsinogen B2; CTRB2) with lipase levels. Weiss et al also claimed that the variants at the FUT2 and ABO loci were associated with chronic pancreatitis (CP). No association with CP was observed for the CTRB2 locus. Elevated lipase levels are a diagnostic criterion for acute pancreatitis and might mirror subclinical pancreatic injury in patients without severe complaints. Hence, variants associated with elevated serum lipase levels might also be associated with ...
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Kirsten, H., Scholz, M., Kovacs, P., Grallert, H., Peters, A., Strauch, K., Frank, J., Rietschel, M., Nöthen, M. M., Witt, H., Rosendahl, J. Tags: PostScript Source Type: research

An independent validation of the mortality score for the short-term prognostic prediction in patients with chronic HCV infection and advanced liver disease
We read with great interest the article by van der Meer et al1 recently published in Gut. They found that a simple algorithm based on demographic and readily available laboratory variables is able to predict long-term prognosis of patients with chronic HCV infection and well-compensated, advanced liver disease. Indeed, in this time and age, an accurate assessment of the outcome of patients with HCV infection and advanced fibrosis is of utmost importance as prognostic subclassification may help prioritise those who are in urgent need of antiviral treatment within an homogeneous group of patients who are equally candidates t...
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Giannini, E. G., Savarino, V. Tags: PostScript Source Type: research

Comparison of the in vitro susceptibility of rifaximin versus norfloxacin against multidrug resistant bacteria in a hospital setting. A proof-of-concept study for use in advanced cirrhosis
We read with interest the recent letter to the editor from Waidmann et al1 investigating the effect of multidrug resistant (MDR) bacteria intestinal colonisation on the prognosis of patients with cirrhosis. The authors concluded that infections due to MDR bacteria and asymptomatic intestinal colonisation with MDR bacteria are a risk factor for mortality in cirrhosis. That information expands the relevance of preventing and treating infections due to MDR bacteria in patients with cirrhosis. Infections due to MDR bacteria are mostly nosocomial in origin and represent an increasing threat in decompensated cirrhosis, due to th...
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Ramos, J. M., Vidal, I., Bellot, P., Gomez-Hurtado, I., Zapater, P., Such, J. Tags: PostScript Source Type: research

GI highlights from the literature
Basic scienceGenetic classification of colorectal cancer subtypes Guinney J, Dienstmann R, Wang X, et al. The consensus molecular subtypes of colorectal cancer. Nat Med 2015;21:1350–6. Cancers display heterogeneity, and thus personalised cancer therapy has the potential to improve patient outcome. Guinney and colleagues developed a consortium with independent analysis of large-scale transcriptome data using independent groups to generate a network of gene pathways that can be ascribed to specific, hitherto unknown colorectal cancer (CRC) subtypes. Whole-genome gene-expression data were used from 18 CRC datasets and a...
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: McLean, M. H. Tags: JournalScan Source Type: research

Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction?
IBS is one of the most common types of functional bowel disorder. Increasing attention has been paid to the causative role of food in IBS. Food ingestion precipitates or exacerbates symptoms, such as abdominal pain and bloating in patients with IBS through different hypothesised mechanisms including immune and mast cell activation, mechanoreceptor stimulation and chemosensory activation. Wheat is regarded as one of the most relevant IBS triggers, although which component(s) of this cereal is/are involved remain(s) unknown. Gluten, other wheat proteins, for example, amylase-trypsin inhibitors, and fructans (the latter belon...
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: De Giorgio, R., Volta, U., Gibson, P. R. Tags: GUT Recent advances in clinical practice Source Type: research

The role of mast cells in functional GI disorders
Functional gastrointestinal disorders (FGIDs) are characterized by chronic complaints arising from disorganized brain-gut interactions leading to dysmotility and hypersensitivity. The two most prevalent FGIDs, affecting up to 16–26% of worldwide population, are functional dyspepsia and irritable bowel syndrome. Their etiopathogenic mechanisms remain unclear, however, recent observations reveal low-grade mucosal inflammation and immune activation, in association with impaired epithelial barrier function and aberrant neuronal sensitivity. These findings come to challenge the traditional view of FGIDs as pure functional...
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Wouters, M. M., Vicario, M., Santos, J. Tags: GUT Recent advances in basic science, Dyspepsia, Irritable bowel syndrome Source Type: research

Glutathione peroxidase 4 is reversibly induced by HCV to control lipid peroxidation and to increase virion infectivity
Conclusions HCV induces oxidative stress but controls it tightly by inducing ROS scavengers. Among these, GPx4 plays an essential role in the HCV life cycle. Modulating oxidative stress in CHC by specifically targeting GPx4 may lower specific infectivity of virions and prevent hepatocarcinogenesis, especially in patients who remain difficult to be treated in the new era of interferon-free regimens. (Source: Gut)
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Brault, C., Levy, P., Duponchel, S., Michelet, M., Salle, A., Pecheur, E.-I., Plissonnier, M.-L., Parent, R., Vericel, E., Ivanov, A. V., Demir, M., Steffen, H.-M., Odenthal, M., Zoulim, F., Bartosch, B. Tags: Hepatitis C, Hepatic cancer Hepatology Source Type: research

Additive antitumour response to the rabbit VX2 hepatoma by combined radio frequency ablation and toll like receptor 9 stimulation
Conclusions The combination of TLR9 stimulation with RFA resulted in a potentiated antitumour T cell response and cytotoxicity in the VX2 tumour model. Only this combination prevented subsequent tumour spread and resulted in a significantly improved survival, justifying the need for further exploration of the combination of ablative therapies and TLR9 agonists in liver cancer. (Source: Gut)
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Behm, B., Di Fazio, P., Michl, P., Neureiter, D., Kemmerling, R., Hahn, E. G., Strobel, D., Gress, T., Schuppan, D., Wissniowski, T. T. Tags: Hepatic cancer Hepatology Source Type: research

STK33 promotes hepatocellular carcinoma through binding to c-Myc
Conclusions STK33 plays an essential role in hepatocellular proliferation and liver tumorigenesis. The C-terminus of STK33 could be a potential therapeutic target in the treatment of patients with STK33-overexpressed HCC. (Source: Gut)
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Yang, T., Song, B., Zhang, J., Yang, G.-S., Zhang, H., Yu, W.-F., Wu, M.-C., Lu, J.-H., Shen, F. Tags: Open access, Hepatic cancer Hepatology Source Type: research

The broad assessment of HCV genotypes 1 and 3 antigenic targets reveals limited cross-reactivity with implications for vaccine design
Conclusions HCV T cell specificity is distinct between genotypes with limited T cell cross-reactivity in resolved and chronic disease. Therefore, viral regions targeted in natural HCV infection may not serve as attractive targets for a vaccine that aims to protect against multiple HCV genotypes. (Source: Gut)
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: von Delft, A., Humphreys, I. S., Brown, A., Pfafferott, K., Lucas, M., Klenerman, P., Lauer, G. M., Cox, A. L., Gaudieri, S., Barnes, E. Tags: Open access Hepatology Source Type: research

Peripancreatic fat necrosis worsens acute pancreatitis independent of pancreatic necrosis via unsaturated fatty acids increased in human pancreatic necrosis collections
Conclusions UFAs, IL-1β and IL-8 are elevated in NCs. However, UFAs generated via peripancreatic fat lipolysis causes worse inflammation and MSOF, converting mild AP to SAP. (Source: Gut)
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Noel, P., Patel, K., Durgampudi, C., Trivedi, R. N., de Oliveira, C., Crowell, M. D., Pannala, R., Lee, K., Brand, R., Chennat, J., Slivka, A., Papachristou, G. I., Khalid, A., Whitcomb, D. C., DeLany, J. P., Cline, R. A., Acharya, C., Jaligama, D., Murad Tags: Pancreas and biliary tract, Pancreatitis Source Type: research

A mechanistic multicentre, parallel group, randomised placebo-controlled trial of mesalazine for the treatment of IBS with diarrhoea (IBS-D)
Conclusions This study does not support any clinically meaningful benefit or harm of mesalazine compared with placebo in unselected patients with IBS-D. More precise subtyping based on underlying disease mechanisms is needed to allow more effective targeting of treatment in IBS. Trial registration number NCT01316718. (Source: Gut)
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Lam, C., Tan, W., Leighton, M., Hastings, M., Lingaya, M., Falcone, Y., Zhou, X., Xu, L., Whorwell, P., Walls, A. F., Zaitoun, A., Montgomery, A., Spiller, R. Tags: Diarrhoea, Open access Neurogastroenterology Source Type: research

Randomised controlled trial of mesalazine in IBS
Conclusions Mesalazine treatment was not superior than placebo on the study primary endpoint. However, a subgroup of patients with IBS showed a sustained therapy response and benefits from a mesalazine therapy. Trial registration number ClincialTrials.gov number, NCT00626288. (Source: Gut)
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Barbara, G., Cremon, C., Annese, V., Basilisco, G., Bazzoli, F., Bellini, M., Benedetti, A., Benini, L., Bossa, F., Buldrini, P., Cicala, M., Cuomo, R., Germana, B., Molteni, P., Neri, M., Rodi, M., Saggioro, A., Scribano, M. L., Vecchi, M., Zoli, G., Cor Tags: Open access Neurogastroenterology Source Type: research

The normoglycaemic biobreeding rat: a spontaneous model for impaired gastric accommodation
Conclusions BB-DP rats of 220 days display altered fundic motor control and impaired accommodation, which is least partially explained by loss of nitrergic function. This may be related to inflammatory changes in the neuromuscular layer, suggesting that normoglycaemic BB-DP rats provide a spontaneous model for inflammation-induced impaired gastric accommodation. (Source: Gut)
Source: Gut - December 8, 2015 Category: Gastroenterology Authors: Vanormelingen, C., Vanuytsel, T., Masaoka, T., De Hertogh, G., Vanheel, H., Vanden Berghe, P., Farre, R., Tack, J. Tags: Dyspepsia Neurogastroenterology Source Type: research