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Original articles

Delayed gastric emptying is related to cardiovascular autonomic neuropathy in Chinese patients with type 2 diabetes

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Background and study aims : Delayed gastric emptying (DGE) is the commonest gastrointestinal (GI) complication in type 2 diabetes. We aimed to evaluate the association between DGE and cardiovascular autonomic neuropathy (CAN) in type 2 diabetes. Patients and methods :A total of 71 Chinese patients (39 men and 32 women, aged 60-90 years) and 30 controls (12 men and 18 women, aged 50-79 years) were studied in Nanjing, China. The gastric emptying was assessed by 13C-octanoic acid breath test (OBT) and gastric emptying ultrasonography (GEU). Cardiovascular autonomic neuropathy (CAN) was assessed by a scoring system being validated before. Results : The diabetic patients, except for a higher plasma glucose level, had similar characteristics compared to the non-diabetic controls. Diabetic patients had higher incidence of DGE and CAN than controls (48.5% vs. 10.7%, p = 0.001). Among diabetic patients with DGE (n = 27), 18 (66.7%) had CAN and 9 (33.3%) did not. Corresponding figures for those without DGE (n = 39) were 14 (35.9%) and 25 (64.1%), respectively (p = 0.014). Diabetes was independently associated with the risk of DGE with odd ratio (95% CI) of 15.6 (1.92, 127.06) (p = 0.010). The presence of diabetes or CAN was independently associated with the half gastric emptying time after adjusting for age, gender, plasma glucose and blood pressure. Conclusions :We found a much prolonged gastric emptying time in Chinese patients with type 2 diabetes as compared to non-diabetic controls. There was a high rate of CAN in diabetic patients, and it was associated with gastric emptying. (Acta gastro enterol. belg., 2011, 74, 28-33). [Product Details...]

Fate and ultra-structural features of chicken skin mucosa around juvenile polyps

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Objective : Chicken skin mucosa (CSM) is a common finding around juvenile polyps in children. Its ultrastructural features and fate after polypectomy are not yet clear. The aim was to study ultra-structural features and outcome of this CSM compared to that of the polyps and distant endoscopically normal mucosa. Material and Methods : From 240 children with juvenile polyps, 45 needed a second colonoscopy. Thirty six patients showing CSM represented the cohort of this study. One polyp only was studied in each patient. The histologic features of the CSM were compared to normal and polyp mucosa. The fate of CSM was evaluated in the second colonoscopy. Results : The mean numbers of intraepithelial lymphocytes, as well as lamina propria inflammatory cellular infiltrates were significantly higher in polyp mucosa than in CSM. Goblet cells were significantly higher in CSM compared to normal mucosa with marked depletion in the polyp mucosa. The muscularis mucosae thickness was significantly higher in CSM compared to polyps (p [Product Details...]

High prevalence of advanced fibrosis in association with the metabolic syndrome in a Belgian prospective cohort of NAFLD patients with elevated ALT. Results of the Belgian NAFLD registry

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Introduction : Non-alcoholic Fatty Liver Disease (NAFLD) is increasingly recognised as a source of liver related morbidity and mortality. Hard data on epidemiology and natural history are scarce. Aim : To study demographic and metabolic characteristics of the NAFLD patients seen by Belgian hepatologists. Methods : Belgian hepatologists filled in a questionnaire for every newly diagnosed NAFLD patient between January 1st and December 31st 2004. Liver biopsy was advised if ALT > 1.5 × ULN and if 3/5 of the criteria for the metabolic syndrome (MS) (ATPIII) were present, but was not mandatory. Biopsy was scored using the Brunt classification. Results : 230 patients were prospectively included in 9 centres ; 54% were males ; mean age was 49.4 ± 13.9 y ; mean BMI was 30.6 ± 4.6 kg/m2. The MS was present in 53%. In 16% formerly undiagnosed diabetes was discovered. 51% had a liver biopsy : 25% met the criteria, 26% did not. Grading did not differ between patients with or without MS. Staging was significantly more severe in patients with MS (2.43 ± 1.25 vs. 1.73 ± 1.18, p 5 × ULN were significantly older (55.9 vs. 47.64 y, p = 0.02), more frequently diabetic (53% vs. 23%, p = 0.01) and had more advanced fibrosis (3.42 vs. 1.08, p = 0.008). ALT levels were variable. Conclusions : The MS is highly prevalent in Belgian NAFLD patients and is associated with more severe disease. Mild to moderate fibrosis is frequent, and the proposed criteria for liver biopsy are not accurate in selecting these patients. Patients with elevated GGT constitute a subgroup with more advanced disease. (Acta gastro enterol. belg., 2011, 74, 9-16). [Product Details...]

Trace element levels in ischemia-reperfusion injury after left colonic anastomosis in rats and effects of papaverine and pentoxiphylline on vascular endothelial growth factor in anastomosis healing

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Background and study aims : Due to their high morbidity and mortality, anastomotic leakage and disruption are still serious problems in colonic surgery. Bowel clamps applied during anastomosis in order to prevent abdominal contamination with colonic contents, may cause microcirculation and perfusion problems and subsequent ischemia-reperfusion injury. Papaverine, a myorelaxant and vasodilatator, and pentoxiphylline, a hemorrheologic agent are used for microcirculation disorders and vascular endothelial growth factor (VEGF) is a stimulator of angiogenesis. With this experimental study, we aimed to measure trace element [copper (Cu) and zinc (Zn)] levels in ischemia-reperfusion injury due to clamps after left colonic anastomosis in rats and show the effects of papaverine and pentoxiphylline on VEGF that stimulates angiogenesis in anastomotic healing. Materials and methods : 50 female Wistar albino rats were randomized in 5 groups (n : 10). Laparotomy in group 1, left colonic transsection and anastomosis in group 2, and clamp application 1 cm proximal and distal to the anastomosis (for about 20 minutes long) during left colonic transsection and anastomosis in groups 3, 4 and 5 were performed. Additionally, after the operations, pentoxi phylline (Group 4) and papaverin (Group 5) were injected intraperitoneally. On the 10th postoperative day, plasma trace element and plasma VEGF levels were measured. Results : In this study, VEGF levels in group 1 were significantly low and this was explained as being exposed to hypoxic damage less than the other groups. In group 3, VEGF levels were significantly higher showing that the hypoxic stimulus continued without any treatment and in Group 4, significantly lower than Group 3 related to the inhibition of pentoxiphylline. Lower VEGF levels in Group 1 were thought to be related to lower VEGF induction due to less hypoxic effect. Zinc, an important trace element of the antioxidant system showed significantly higher levels in Group 4 with pentoxiphylline treatment, and this was thought to be related to the antioxidant characteristics of pentoxiphylline. Conclusions : During surgical procedures, care should be taken not to cause ischemia to the intestinal tissues, and trace elements that are important in ischemia reperfusion injury should be replaced appropriately. Although the antioxidant effect of pentoxiphylline in ischemia reperfusion injury may be benefical in treatment, its inhibition of VEGF is a disadvantage in wound healing. (Acta gastro enterol. belg., 2011, 74, 22-27). [Product Details...]

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