Editor-in-Chief & Deputy Editor 2019-2021





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Acta Gastroenterologica Belgica is supported by grants from its major sponsors


Acta Gastroenterologica Belgica is supported by grants

from its major sponsors

Dr Falk Pharma







Acta Gastro-Enterologica Belgica is published in

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Acute mesenteric ischemia : Classification, evaluation and therapy

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Mortality rates of acute mesenteric ischemia still range between 60 and 100%. Unfortunately, retrospective series have not shown any significant improvement in mortality in the past decades. With approximately 50%, superior mesenteric artery (SMA) embolism is the most common form of acute mesenteric ischemia, followed by SMA thrombosis (~25%), nonocclusive mesenteric ischemia (~20%) and mesenteric venous thrombosis (~5%). Clinical presentation may be unspecific, but is often characterised by an initial discrepancy between severe subjective pain and relatively unspectacular findings on physical examination. The key to a better outcome (and the main problem in clinical practice) is early diagnosis. Up to now, helas, there are no simple and noninvasive diagnostic tests of sufficient sensitivity and specificity. Thus, angiography remains the cornerstone of diagnosis and should be performed early in all patients with a risk profile and a clinical presentation suspicious of AMI. The initial therapeutic step in all patients with AMI is resuscitation and a stabilization of circulation. If an advanced stage of ischemia is suspected, broad spectrum antibiotics have to be given. Nonocclusive mesenteric ischemia without signs of peritoneal infarction may be managed by pharmacological vasodilation, and vasodilators are also considered as a valuable supportive treatment option in patients with obstructive mesenteric ischemia. Patients with mesenteric venous thrombosis have to be treated by immediate anticoagulation, followed by laparotomy if peritoneal signs are present. Standard treatment for patients with obstructive mesenteric arterial syndromes is a laparotomy with embolectomy or revascularization and, if indicated, resection of infarcted bowel. – . This review will give an overview on the different forms of mesenteric ischemia and then focus on the diagnosis and on generally recommended forms of treatment. [Product Details...]

Economic evaluation of chronic hepatitis C treatment by interferon-ribavirin combination therapy in Belgium

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With present treatments for chronic hepatitis C by the combination of interferon alpha and ribarivin, it is possible to obtain sustained viral response in a large number of patients. This viral response is associated with long-term disappearance of the virus, improvement of histology, improvement in quality of life and, most than likely, a reduction in the risk of premature death or infection-linked complications. This therapy is, however, expensive and the number of potentially treatable patients is high view of the relatively high prevalence of the disease in the population. An economic evaluation is thus indispensable in order, on the one hand, to assess the cost-effectiveness ratio of the treatment (i. the extra cost to be paid for obtaining the greater effectiveness provided by the therapeutic combination in comparison with absence of treatment or treatment by interferon alone), and, on the other hand, to estimate practically the global cost of treatment for Belgium (i.e. the annual expense for society according to the number of patients treated per year). [Product Details...]

NASH/NAFLD management

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Management of a disease must be informed by understanding of its natural history and prognosis, diagnostic criteria and methods, and by our knowledge of treatments available and their efficacy. It is the purpose of this contribution to draw aspects of all three areas together so that we propose the best management guidelines and strategy in the light of present knowledge towards the end of 2002. Non-alcoholic fatty liver disease (NAFLD) is largely encountered in office and outpatient practice (1) most patients have either no relevant symptoms or these are ill defined at presentation ¨C these facts inform our management decisions. Natural history We believe that almost all individuals who have simple fat alone on liver biopsy ¨C no steatohepatitis or necrosis, no fibrosis, have an excellent prognosis with only 2 out of 99 reported cases developing significant liver disease over about 10 years of follow up (2,3). There is a consensus emerging from the increasing number of studies of natural history that increasing age over perhaps 45 years, presence of overt Type 2 diabetes, and greater degrees of obesity are all associated with increased likelihood of development... [Product Details...]

Pregnancy and inflammatory bowel disease

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Overall, around 25% of women with inflammatory bowel disease will conceive during their disease. Most of the women with inflammatory bowel disease will have a normal pregnancy and healthy children. However, specific problems may arise related to these pregancies. This paper reviews what is known on fertility, risk of disease transmission, effect of the disease on the pregnancy and the reverse, delivery, medical follow up and treatment as well as breastfeeding in the setting of inflammatory bowel disease. [Product Details...]

Vascular lesions of the gastrointestinal tract

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Vascular lesions of the gastrointestinal (GI) tract include arterio- venous malformations as angiodysplasia and Dieulafoy’s lesion, venous ectasias (multiple phlebectasias and haemorroids), teleangiectasias which can be associated with hereditary hemorrhagic teleangiectasia (HHT), Turner’s syndrome and systemic sclerosis, haemangioma’ s, angiosarcoma’ s and disorders of connective tissue affecting blood vessels as pseudoxanthoma elasticum and Ehlers-Danlos’s disease. As a group, they are relatively rare lesions that however may be a major source of upper and lower gastrointestinal bleeding. Clinical presentation is variable, ranging from asymptomatic cases over iron deficiency anaemia to acute or recurrent bleeding that may be life-threatening. Furthermore, patients may present with other symptoms, e.g. pain, dysphagia, odynophagia, the presence of a palpable mass, intussusception, obstruction, haemodynamic problems resulting from high cardiac output, lymphatic abnormalities with protein loosing enteropathy and ascites, or dermatological and somatic features in syndromal cases. Diagnosis can usually be made using endoscopy , sometimes with additional biopsy. Barium radiography, angiography, intraoperative enteroscopy, tagged red blood cell scan, CT-scan and MRI-scan may offer additional information. Treatment can be symptomatic, including iron supplements and transfusion therapy or causal, including therapeutic endoscopy (laser, electrocautery, heater probe or injection sclerotherapy), therapeutic angiography and surgery. The mode of treatment is of course depending on the mode of presentation and other factors such as associated disorders. If endoscopic or angiographic therapy is impossible and surgical intervention not indicated, pharmacological therapy may be warranted. Good results have been reported with different drugs, albeit most of them have not been tested in large trials. [Product Details...]

Vascular lesions of the liver and gastrointestinal tract

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In the liver, imaging can show lesions of large and medium-sized vessels, perfusion disorders related to vascular lesions, and parenchymal lesions including infarcts, regenerative nodules, and focal nodular hyperplasia. In the gastrointestinal tract, vascular lesions often result in bowel ischemia. Imaging can be used to show the vascular lesions and bowel wall abnormalities, including mural thickening, lack of perfusion, and pneumatosis. Doppler sonography, multislice helical computed tomography (CT), magnetic resonance (MR) imaging, and angiography are useful to demonstrate vascular lesions. Doppler sonography offers high spatial and temporal resolution. Information about blood flow and velocity can be obtained. However, the visualization of retroperitoneal vessels is often limited because of intestinal gas. A global view of the abdominal vasculature can be observed by using helical CT. High spatial and temporal resolution are obtained, especially when new multislice CT scanners are used. MR imaging has a better contrast resolution than CT, but its spatial resolution is lower. MR imaging can also be used to measure flow with phase contrast methods. The role of arteriography in the diagnosis of vascular lesions is decreasing. However, its role remains important to definitively demonstrate obstruction of the hepatic artery and to show arterial lesions in acute mesenteric ischemia. In addition, it is used as a problem-solving method to detect lesions in medium-sized vessels and to guide intravascular treatment. [Product Details...]

Vasculitis and the gastrointestinal tract

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Vasculitis, defined as a non-infectious inflammatory disorder of blood vessels, can affect vessels of any type in any organ. The gastrointestinal (GI) tract may thus also be involved. In systemic disorders as mixed connective tissue disease (MCTD) and systemic lupus erythematodes (SLE), patients may present with symptoms of gastrointestinal disfunction such as motility disorders, caused by alterations in the connective tissue. True vasculitis however also occurs in the GI tract. Severe, occlusive damage often leads to ischemia that may result in ulceration and perforation. Non-occlusive vascular disease may lead to vascular leakage resulting in oedema and haemorrhage. Those patients often present with diarrhoea or symptoms of bleeding. GI involvement is frequent in Henoch-Schönlein purpura and also often noted in polyarteritis nodosa (PAN), microscopic polyangiitis, Wegener’s syndrome and Churg-Strauss syndrome. Furthermore, GI vasculitis has also been described in giant cell arteritis, Takayasu’s disease, Buerger’s disease and leucocytoclastic vasculitides as essential mixed cryoglubulinemia, lupus vasculitis, rheumatoid disease, MCTD, drug-induced vasculitis and Behçet’s disease. The diagnosis and classification of vasculitis relies upon a combination of clinical, serological, haematological, radiological and histological findings. Establishing a precise diagnosis can be difficult but is important because treatment and prognosis can be highly variable. [Product Details...]

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