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Original articles

Can computed tomography aid in diagnosis of intramural hematomas of the intestinal wall ?

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Background : We sought to use computed tomography (CT) data to support the correct differential diagnosis of patients with spontaneous intramural hematomas of the gastrointestinal tract, to aid in the clinical management of those using oral anticoagulants. Methods : Patient data were retrospectively analyzed and patients were divided into two groups. The first group contained 10 patients (5 females, 5 males, median age 65 years [range 35- 79 years]) who had been diagnosed with spontaneous intramural hematomas of the gastrointestinal tract. The second group contained nine patients (5 females, 4 males, median age 41 years [range 24-56 years]) who exhibited intestinal wall thickening on CT, and who had been diagnosed with ulcerative colitis, Crohn’s disease, ameboma, and lymphoma. The enhancement patterns in the CT images of the two groups were compared by an experienced and inexperienced radiologist. The differences in values were subjected to ROC analysis. Results : Inter-observer variability was excellent (0.84) when post-contrast CT images were evaluated, as were the subtraction values (0.89). The subtracted values differed significantly between the two groups (p = 0.0001). A cutoff of +31.5 HU was optimal in determining whether a hematoma was or was not present. Conclusions : Contrast enhancement of an intestinal wall hematoma is less than that of other intestinal wall pathologies associated with increased wall thickness. If the post-contrast enhancement of a thickened intestinal wall is less than +31.5 HU, a wall hematoma is possible. (Acta gastroenterol. belg., 2015, 78, 399-405). [Product Details...]

Colonoscopy in patients with liver cirrhosis : success and safety issues

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Background : Patients with liver cirrhosis undergo screening colonoscopy before liver transplantation. Screening colonoscopy is subject to specific quality criteria, among which caecal intubation rate. Several factors associated with failed caecal intubation have been identified. Aims : We investigated whether liver cirrhosis influenced success and safety of screening colonoscopy. Methods : Caecal intubation and complication rate of 93 candidates for liver transplantation due to liver cirrhosis were compared with the control rates of our endoscopy unit. Several patient and colonoscopy variables were taken into account. Results : In patients with liver cirrhosis caecal intubation rate was only 83%, whereas in the control group it was 94% (P [Product Details...]

Comparison of newly found polyps after removal of small colorectal polyps with cold or hot snare polypectomy

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Background and study aims : There are limited data regarding polyp recurrence following cold or hot snare polypectomy for small colorectal polyps. The aim of this study was to evaluate the prevalence of newly found polyp after cold or hot snare polypectomy and the predictive factors. Patients and methods : This was a retrospective case-control study at a single municipal hospital. Patients undergoing cold or hot snare polypectomy for colorectal polyps ≤ 8 mm included in a previous study (Digestion 2011 ; 84 :78) were enrolled. Newly found polyps were defined as polyps detected at follow-up colonoscopy within 3 years. Predictive factors for new polyps were assessed by multivariate analysis using logistic regression. Results : A total of 72 patients (female 22, mean age 68) with 184 polyps were enrolled. Eighty-nine polyps (mean size ± SD, 5.3 ± 2 mm) were resected with cold snare while 95 polyps (mean size 5.5 ± 6 mm) were resected with hot snare polypectomy. Twenty- four new polyps ( [Product Details...]

Ethnic epidemiological profiles and antiviral therapy among patients infected with hepatitis C virus genotype 4 : a multicenter study from Belgium

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Background : Hepatitis C virus genotype 4 (HCV-4) is the most prevalent genotype in Central Africa. Aim : To compare epidemiology, clinical characteristics and any differences in access to HCV therapy in two populations of HCV-4 patients residing in Belgium. Methods : This multicenter study selected 473 HCV-4 patients from seven hospital databases and compared them according to ethnic origin, i.e., Black African (n = 331) or not (n = 142), for epidemiological, clinical, biological and histological characteristics. Interleukin 28B polymorphism (CC-genotype) was evaluated in a second cohort of 69 Black African and 30 non-Black African patients. Results : Compared to other patients, the Black African patients were more likely to be female and were older, commonly overweight, frequently had abnormal glucose metabolism and arterial hypertension ; they were less likely to have dyslipidemia, a history of alcohol consumption or ALT elevation. The route of infection was more frequently unknown in Black African than in other patients. Black African patients had more HCV-4 subtypes, were less frequently of IL28B CC-genotype and had less severe liver fibrosis. The proportion of patients who received antiviral treatment was similar in the two groups. Conclusion : In this Belgian cohort, patients with HCV-4 infection were more frequently of Black African origin than of other origin. Infected Black African patients were more commonly female, older at diagnosis, and had more co-morbidities than other patients ; they also had less advanced liver fibrosis than infected non-Black African patients and fewer had a CC genotype. (Acta gastroenterol. belg., 2015, 78, 365-372). [Product Details...]

Fibrolamellar carcinoma versus scirrhous hepatocellular carcinoma : diagnostic usefulness of CD68

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Background : Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare variant of hepatocellular carcinoma that commonly affects young individuals without a prior history of liver disease. The principal differential diagnosis is conventional hepatocellular carcinoma especially the scirrhous variant. Despite their distinctive appearance, recent studies have demonstrated a lack of consistency in how FL-HCC are diagnosed by pathologists. Aim : To investigate the diagnostic utility of CD68 in differentiating between FL-HCC and scirrhous hepatocellular carcinoma. Patients and Methods : In our retrospective study, we reviewed four cases of FL-HCC that were diagnosed at the pathology department of Mongi Slim hospital over a thirteen-year period (2002- 2014). Relevant clinical information and microscopic slides were available in all cases and were retrospectively reviewed. Immunohistochemical analysis was performed using the avidin-biotin complex technique with antibodies against CD68 and CK7. Results : Our study group included one man and three women (sex ratio M/F = 0.33) aged between 23 and 34 years (mean = 28 years). All cases arose in non-cirrhotic liver. Immunohistochemically, all cases were positive for CK7 and for CD68 (n = 4). Conclusions : CD68 immunostaining is a sensitive marker for FL-HCC that may be of use in routine diagnostic surgical pathology. Lack of CD68 staining should suggest caution in making a diagnosis of FL-HCC. (Acta gastroenterol. belg., 2015, 78, 393-398). [Product Details...]

Has patient knowledge of Inflammatory Bowel Disease improved since 1999 ?

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Background : In the UK Inflammatory Bowel Disease (IBD) Standards have highlighted the importance of patient education and support [1]. Little literature exists however regarding the impact of these standards on patient’s understanding of their disease. Aim : To utilise the Crohn’s and Colitis Knowledge Score (CCKNOW) to assess patient knowledge and make a comparison with results achieved in 1999. To assess whether disease CCKNOW scores differ between white and Asian populations in Leicestershire. Methodology : 100 outpatients with CD or UC were prospectively enrolled to complete the CCKNOW questionnaire between May and September 2013 at two Leicestershire Hospitals. Results : Mean and median scores for IBD patients were 10.15 (95% C.I. 9.2-11.1) and 9 (95% CI 8-11) respectively. CD (38) patients achieved a significantly higher score than UC (61), median scores of 10.5 and 9 respectively, p = 0.007. CCKNOW scores achieved were significantly lower with increasing age, p = 0.0006. Patient ethnicity, gender, disease duration or perceived disease activity had no significant effect upon CCKNOW score. Conclusion : Patient understanding of inflammatory bowel disease is no better now than when assessed in 1999, median scores being 9 and 10 respectively. There are persisting knowledge deficits regarding the subjects of fertility and the complications of IBD. CCKNOW scores achieved were significantly lower with increasing age, elderly patients may therefore benefit the most from increased access to appropriate educational programmes and support. (Acta gastroenterol. belg., 2015, 78, 381-385). [Product Details...]

Neutrophil to lymphocyte ratio as a reliable marker to predict insulin resistance and fibrosis stage in chronic hepatitis C virus infection

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Background : Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ratio (NLR) integrates information on the inflammatory milieu and physiological stress. Aim : We aimed to investigate the clinical utility of NLR to predict the presence of IR and fibrosis in CHCvirus infection. Methods : The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR > 3 and CHC with HOMA-IR ≤ 3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Proinflammatory cytokines [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] were measured by an enzyme-linked immunosorbent assay. Results : Patients with HOMA-IR > 3 had a higher NLR compared with patients with HOMA-IR ≤ 3 [2.61 ± 0.95 and 1.92 ± 0.86, respectively, P [Product Details...]

Validation of APRI and FIB-4 score in an Antwerp cohort of chronic hepatitis C patients

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Background and aims : Evaluation of liver fibrosis in chronic hepatitis C patients guides clinical decision-making. The aim of this study is to validate APRI and FIB-4, two easily calculated noninvasive tests to predict fibrosis, in chronic HCV patients using biopsy as a gold standard and to compare accuracy between HCV monoinfected and HIV/HCV coinfected patients. Patients and methods : We retrospectively studied HCV patients of two centres who underwent liver biopsy. Liver fibrosis was staged according to METAVIR. Results : 136 patients were included. The AUROC of FIB-4 (0.896) to discriminate F0-F2 vs. F3-F4 was significantly higher (p = 0.0186) than the AUROC of APRI (0.842). The difference in AUROC between HIV-negative and positive patients was not significant for APRI (p = 0.471), nor for FIB-4 (p = 0.495). Performance status was lower in HIV-positive patients with 46.7% and 69.0% of patients correctly classified using APRI and FIB-4, compared to 56.6% and 73.6% in HIV-negative patients, respectively. Conversion of transaminase values from one hospital to the other did not significantly change the AUROC of FIB-4 (p = 0.928). Conclusions : APRI and FIB-4 have a better performance status in HCV monoinfected patients compared to HIV/HCV coinfected patients. FIB-4 has a better AUROC compared to APRI and is the preferred noninvasive fibrosis score to discriminate between F0-F2 and F3-F4. Different hospitals should use their local absolute serum transaminase values without conversion. (Acta gastroenterol. belg., 2015, 78, 373-380). [Product Details...]

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