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Original Article

Bile duct cannulation : success rates for various ERCP techniques and devices at a single institution

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Background and study aims : Deep bile duct cannulation is the first step in carrying out ERCP biliary interventions. Although many special techniques have been described, there is a lack of reports that describe all methods employed to cannulate in a single series. This is a prospective study about the way in which cannulation was achieved in an ordinary ERCP workload. Patients and methods : From January 2002 to June 2004, all patients who underwent ERCP with accessible and intact papilla and no gastroduodenal surgical alterations were included. Cannulation either with a 5.5 french tapered, triple lumen sphincterotome (5.5 Fr-S), loaded with a 0.035 inch hydrophilic tip guidewire, or with a 3 french tapered, double lumen sphincterotome (3 Fr-S), plus a 0.025 inch guidewire, was considered standard cannulation (SC). Other methods and devices were considered to be alternative methods. Results : Of the 199 patients, SC succeeded in 150 (75.4%). Initial cannulation was achieved in 78/100 with the 3 Fr-S, and in 59/96 (61.4%) with the 5.5 Fr-S, (p = 0.01). Alternative methods used to reach a final 98% success rate were any type of precut (23 patients, 11.5%), cannulation above a pancreatic placed guidewire (11, 5.5%), above a pancreatic stent (7, 3.5%), utilization of two devices at the same time (3, 1.5%), and papillectomy (1, 0.5%). In 4 (2%) patients, cannulation failed. Conclusions : In almost a quarter of the patients (45, 22.6%) in this series, cannulation had to be performed by alternative methods. A 3 Fr-S is a very useful tool for gaining access to the bile duct [Product Details...]

Pulmonary function tests, high-resolution computed tomography findings and inflammatory bowel disease

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Aim : The association between inflammatory bowel disease and pulmonary involvement has not been clearly established. The aim of this prospective study was to define the features of pulmonary function tests and high resolution computed tomography in inflammatory bowel disease patients and the relation between these and disease activity. Method : Fifty-two patients with inflammatory bowel disease (20 with Crohns disease and 32 with ulcerative colitis) were enrolled. The standard pulmonary function tests and thorax high resolution computed tomography findings were investigated with respect to inflammatory bowel disease activity. Crohns disease activity index and the Rachmilewitz endoscopic activity index for ulcerative colitis were used to assess disease activity. Medications used and smoking status were also documented. Results : Among the patients with ulcerative colitis, 6.25% had an obstructive and/or restrictive ventilatory defect compared with 25% of the patients with Crohns disease. Fifty percent of the patients with ulcerative colitis and 60% of the patients with Crohns disease showed abnormal findings in high resolution computed tomography. Pulmonary function tests and high resolution computed tomography abnormalities did not differ significantly between Crohns disease and ulcerative colitis. No significant difference related to inflammatory bowel disease activity was found (P > 0.05). Conclusion : Findings of high resolution computed tomography and the pulmonary function tests did not differ between ulcerative colitis and Crohns disease. Bowel disease activity did not seem to affect these measurements. [Product Details...]

The effects of Gingko biloba, vitamin E and melatonin on bacterial translocation in thioacetamide-induced fulminant hepatic failure in rats

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Background and study aims : Bacterial translocation (BT) has been implicated in the development of infectious complications in many serious clinical conditions such as fulminant hepatic failure (FHF). We aimed to investigate the effects of Gingko biloba (GB), vitamin E (Vit E) and melatonin on intestinal oxidative damage and BT in thioacetamide (TAA)-induced FHF in rats. Materials and methods : A total of 42 rats were divided into five groups. Group 1 (n = 8) was the control group. Group 2 (n = 10) was the TAA group, in which rats received 350 mg/kg TAA daily by the intraperitoneal (ip) route for 3 days. Oral 100 mg/kg GB per day was administered to group 3 (n = 8), oral 200 mg/kg Vit E per day to group 4 (n = 8) and ip 3 mg/kg melatonin per day to group 5 (n = 8) 48 h prior to the first TAA injection and was continued for 5 consecutive days. Results : When compared with the control group, serious hepatic and intestinal oxidative damage, increased Escherichia coli counts in ileal aspirates and high BT frequencies were observed in the TAA group (all p < 0.0001). Only GB treatment attenuated hepatic oxidative damage (p < 0.0001). There was no difference in intestinal oxidative damage, E. coli counts in ileal aspirates and BT frequency between TAA and the other antioxidant treatment groups (p > 0.05). Conclusion : Our results suggest that intestinal oxidative damage plays a major role in the development of BT by disrupting the barrier function of intestinal mucosa. [Product Details...]

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