Editor-in-Chief, Deputy Editor 2017-2019

 

Editor-in-Chief:

Tom MOREELS

 

Deputy Editor:

Nicolas LANTHIER

 

Letters



Emphysematous gastritis


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Emphysematous gastritis is characterized by the presence of intramural gas produced by bacteria in situ in the gastric wall. It is an uncommon and severe form of phlegmonous gastritis, associated with a high mortality. We report two cases of emphysematous gastritis. First case : a 64-year-old alcoholic man presented with acute epigastric pain radiating to the back, distended abdomen and hematemesis. C-reactive protein level was 322 mg/l. Three hours later, the patient experienced sudden exacerbation of the pain, with abdominal guarding. CT scan showed symmetrical thickening of the gastric wall with presence of intra-parietal air bubbles and peritoneal effusion (Fig. 1). Emergency laparotomy revealed abundant peritoneal turbid fluid and a distended stomach with a thickened and congested wall covered with false membranes. A partial gastrectomy was performed. The following day, a deterioration of the general status appeared due to a disseminated Pseudomonas aeruginosa infection with shock and not reversible multi-organ failure. [Product Details...]



Endoscopic Mucosal Resection of Large Colorectal Polyps : Outcomes from a District UK Screening Centre


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We read with interest the article by Carvalho R. and colleagues on endoscopic mucosal resection of large colorectal polyps (1). We would like to share our experience. We investigated the outcomes of Endoscopic Mucosal Resection (EMR) of colorectal polyps 2 cm or larger within Lancashire bowel cancer screening centre. A retrospective review of 5190 polypectomies was performed from 2003 to 2009. A total of 61 patients (61 polyp EMRs), each with a polyp 2 cm or greater were included in the study. The mean age was 69 years, 75% (n = 46) were male. The mean size was 35 mm. The majority of the polyps were sessile (n = 40) and located in the left colon (n = 43). The endoscopist was able to lift the lesion in 95% of cases (n = 58). Tattooing was performed in 46% (n = 28) and Argon-beam photocoagulation (APC) therapy was applied in 41% of cases (n = 25). In 97%, the resections were complete (n = 59). The majority of the resections were piecemeal. Histopathology results were obtainable in 57 patients of whom 12% (n = 7/57) showed high grade dysplasia and 5% (n = 3/57) were confirmed as adenocarcinoma [Product Details...]



Is really megacolon a contraindication to infliximab in Crohn’s disease ?


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Toxic megacolon (TM) is a rare complication of severe ulcerative colitis (UC) and colonic Crohn’s disease (CD), defined as a clinical syndrome accompanied by radiographic evidence of colonic dilatation that in many cases must be treated aggressively with surgical intervention (1). We report two cases of steroid and antibiotic-refractory fulminant Crohn’s colitis, complicated by toxic megacolon, who were successfully treated with infliximab (IFX), thus avoiding surgical intervention. Although there are no well defined recommendation about the correct timing of colectomy in CD-associated TM, and despite the fact that it may be imprudent to advocate delaying surgery in favour of anti-tumor necrosis (anti-TNF) factor therapy in these cases, we think that a medical “rescue therapy” can be considered in a subset of patients with stable clinical condition during corticosteroid treatment. (Acta gastroenterol. belg., 2013, 76, 442-444). [Product Details...]



Is there any effect of sequential eradication therapy of helicobacter pylori on functional dyspepsia symptom resolution ?


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Dyspepsia is one of the most common chronic illnesses of adults and affects up to 40% of the population in the Western world (1). Similarly, dyspepsia affects 28.4% of population in Turkey and a majority of them were taking medications for dyspepsia (2). Functional dyspepsia (FD), a common functional gastrointestinal disorder, is defined by the Rome III criteria as symptoms of epigastric pain or discomfort, postprandial fullness, and early satiety within the last 3 months with symptom onset at least 6 months earlier (3). Recent data supports that Helicobacter pylori (H. pylori) eradication provides significant benefits to patients with FD. The Maastricht IV Consensus Report recommends it (4). In this regard, we aimed to clarify if sequential therapy has an effect on symptom resolution of FD patients with H. pylori using a validated health quality index. [Product Details...]



Short-term amlodipine induced liver injury : an extremely rare acute complication


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Toxic liver injury comprises an insidious and potentially devastating complication of pharmaceutical preparations. Drug-induced hepatotoxicity may virtually mimic any form of chronic or acute liver disease (1). Amlodipine is a long-acting dihydropyridine calcium antagonist used as an anti-hypertensive agent (2). Treatment with amlodipine is usually well-tolerated and overwhelming majority of adverse reactions reported during amlodipine treatment are of mild or moderate severity (3). Herein, we report of an unusual and extremely rare case with shortterm amlodipine induced hepatotoxicity (liver injury). A 46 year-old man was admitted to the cardiology clinic for refractory hypertension. He had a history of 3-year ramipril treatment to lower high blood pressure. He was then prescribed 10 mg amlodipine and stopped taking ramipril. The liver function tests were normal during this period. After 1 week of amlodipine treatment, he was controlled in an outpatient unit and referred to the gastroenterology clinic due to elevated liver enzymes. [Product Details...]


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