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Original Article

An unusual cause of acute lower gastrointestinal bleeding

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A 45 year old male patient was referred to hospital after syncope during defaecation. Rapid peranal blood loss occurred shortly after admission. Gastroscopy and coloscopy performed as first line diagnostic measures failed to detect the source of haemorrhage. Ultrasound (US) revealed a hypoechoic and hypervascularized tumor mass in the right lower abdomen. A gastrointestinal stromal tumor (GIST) of the jejunum was diagnosed after laparatomy. Collectively US should be among the first line diagnostic procedures in younger patients presenting with lower gastrointestinal haemorrhage. [Product Details...]

Apoptosis and proliferation in gastric epithelium due to Helicobacter pylori : An immunohistochemical and ultrastructural study

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The effect of H. pylori infection on gastric epithelial cell apoptosis and proliferation is contradictory. Using immunohistochemistry and electron microscopy, this study sought to demonstrate gastric epithelial changes (ie, apoptosis and proliferation) due to chronic H. pylori infection. Methods : Eighteen female 6- to 8-week old Swiss Albino mice were inoculated intragastrically with 3 doses of 109 CFU/mL H. pylori prepared in a Brucella Broth in 5 days. Nine others served as a control group. At the end of 28 weeks, tissue specimens from the gastric antrum were excised and examined immunohistochemically (epithelial growth factor for regeneration and Caspase-3 for apoptosis) and electron microscopically. Immunohistochemical assessment was performed using the indirect peroxidase-antiperoxidase method. Results : In the H. pylori-infected group, EGF staining in gastric epithelium was found to be decreased significantly compared to that in control group (P < 0.001). Caspase-3 reactivity was commonly observed in surface epithelial cells and glandular epithelial cells in H. pylori-infected group and totally it was statistically significant compared to Caspase-3 staining in control group (P < 0.001). Electron micrograph images demonstrated numerous apoptotic cells with condensed chromatin. Conclusion : Chronic H. pylori infection of 28 weeks duration increases apoptosis in gastric epithelium ; however, increased apoptosis does not induce proliferation. [Product Details...]

Atypical symptoms of GORD in Belgium : Epidemiological features, current management and open label treatment with 40 mg esomeprazole for one month

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Frequency of atypical symptoms in patients suffering from gastro-oesophageal reflux disease (GORD) is not well known, and the optimal management of such symptoms has not been well established. Our aims were to set up an observatory of these atypical symptoms of GORD in Belgium and to study the efficacy of one month treatment with esomeprazole 40 mg. Patients and methods : Gastroenterologists participating in this observational survey were asked to register every new outpatient with symptoms of GORD during a period of 20 consecutive working days. All patients who reported predominant presence of atypical manifestations of GORD were documented and characterized more in detail. In patients with dominant chest pain or ENT symptoms, a treatment with esomeprazole 40 mg daily during 4 weeks was proposed. Results : 90 gastroenterologists included 2864 patients consulting for symptoms suggestive of GORD, including 776 (27.1%) with dominant atypical symptoms. Endoscopy (performed in 2800 patients) showed significantly less oesophagitis in atypical than in typical GORD patients (68% vs. 81.1% ; P < 0.0001). Management of atypical GORD patients appeared to be very heterogeneous. Overall 516/776 patients were included in the open phase of treatment with esomeprazole 40 mg, but data for analysis are only available in 228 patients. After one month, symptoms had disappeared in 57.1% and significantly improved in 26.6%. Conclusion : Atypical GORD represents a large number of consultations in gastroenterology in Belgium. It is associated with less endoscopic lesions than typical GORD. Its management is heterogeneous reflecting the lack of guidelines on this topic. Response rate after esomeprazole 40 mg for one month in this open uncontrolled trial was high. This result warrants confirmation in a placebo-controlled trial. [Product Details...]

Effect of interferon alfa and ribavirin treatment on hepatitis C virus RNA in serum and peripheral blood mononuclear cells in children with chronic hepatitis C

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The correlations between the severity of hepatic lesions, age, gender, HBV co-infection and negativisation of HCV-RNA from serum and peripheral blood mononuclear cells (PBMC) after treatment of chronic hepatitis C (CHC) were analysed. 41 children (11 F/ 30 M), aged 5-16 years (mean 10 2.8), were treated with IFN-a and ribavirin for 12 months. Sustained negativisation of HCV-RNA from serum was achieved in 25 patients (61%), in 3 (7%) it reappeared after treatment, and in 13 (32%) it was ineffective. Clearance of HCV did not correlate with age (p = 0.65), sex (p = 0.13), past HBV infection (n = 22 anti-HBc +) (p = 0.24), maximum pre-treatment ALT activity (p = 0.06), grade of inflammation (p = 0.33) or stage of fibrosis (p = 0.9) in liver biopsy. It was achieved in 6/16 children previously resistant to IFN-a monotherapy and in 19/25 nave (p = 0.017). HCV-RNA was detected in PBMC in 9/24 (37%) seronegative children and in 1/21 (5%) in comparative group of seronegative adults ; p = 0.004. Persistence of HCV-RNA in PBMC after combined treatment occurred in 5/10 (50%) patients resistant to previous IFN-a monotherapy, 6/35 (20%) of them cleared HCV from PBMC (p = 0.04). Conclusions : Age and gender, infection route, history of HBV infection or severity of histopathologic liver lesions had no influence on the efficacy of treatment with IFN-a and ribavirin. Clearance of HCV from serum and from PBMC occurs less frequently in patients previously resistant to IFN-a. Children with CHC require longitudinal observation after successful antiviral treatment as in 37% of those considered to be free from the virus by ordinary measures, HCV-RNA was found in PBMC. [Product Details...]

Effects of lexipafant (BB-882), a platelet activating factor receptor antagonist, on liver damage due to bile duct ligation in rats

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Background and study aims : Extrahepatic cholestasis is one of the main factors causing liver fibrosis. In this study, we aimed to evaluate the effects of lexipafant (BB-882), a platelet activating factor receptor antagonist, on liver damage in rats with bile duct ligation. Methods : A total of 30 male Sprague-Dawley rats weighing 160-190 g were used in this study. Group 1 (Sham-control, n = 10) rats were undergone laparotomy alone and bile duct was just dissected from the surrounding tissue. Group 2 rats (BDL/Untreated, n = 10) were subjected to bile duct ligation and no drug was applied. Group 3 rats (BDL/BB-882, n = 10) received a daily dose of BB-882 intraperitoneally for 14 days after BDL. At the end of the two-week period, biochemical and histological evaluation was processed. Results : The mean serum bilirubin and liver enzymes level significantly decreased, and Superoxide dismutase, catalase and glutathione peroxidase values were significantly increased in BDL/BB-882 group when compared to BDL/Untreated group. The histopathological score was significantly less in the BDL/BB-882 group compared to the BDL/Untreated rats. In the BDL/BB-882 group was observed less fibrosis and neutrophil infiltration Conclusions : These results suggest that BB-882 (lexipafant) may reduce the severity of the inflammatory response to liver injury produced by bile duct ligation in rats. [Product Details...]

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