Recent Advances in Gastroenterology 12 Chris Probert
INDEX
Note: Page numbers in bold or italic refer to tables or figures, respectively.
A
Ablation techniques 6566
Acamprosate 144
N-acetylcysteine, in alcoholic hepatitis 145
Acetylsalicylic acid (ASA), in upper GI bleeding 122
Adalimumab 5
in microscopic colitis 89
in ulcerative colitis 56
AFI see Autofluorescence imaging (AFI)
AIMS65 score 116, 117
AIP see Autoimmune pancreatitis (AIP)
Alcohol dehydrogenase 139
Alcoholic hepatitis 141, 141, 144
corticosteroids for 145
liver transplantation for 145146
N-acetylcysteine in 145
pentoxifylline in 145
supportive therapy for 144145
Alcohol-related liver disease 137
alcoholic fatty liver 140
alcoholic hepatitis 141
cirrhosis 141142
and detoxification/withdrawal 142143
diagnosis and investigation 140
epidemiology 137139, 138
natural history 139
pathogenesis 139140
pharmacotherapy for abstinence 143144
Alcohol Use Disorders Identification Test (AUDIT) 142
5-Aminosalicylates (5-ASA)
in Crohn's disease 15
in ulcerative colitis 3
Anti-gliadin antibodies 2627
Anti-TNF therapy
in Crohn's disease 17
withdrawal of 1718
Autofluorescence imaging (AFI) 58, 58
Autoimmune pancreatitis (AIP) 9495, 9899 see also IgG4-related disease (IgG4-RD)
HISORt criteria for diagnosis of 107
Autophagy 12
Autophagy related 16-like 1 (ATG16L1) 12
Azathioprine
in IgG4-related disease 108
in microscopic colitis 89
B
Baclofen 144
Bacterial culture, for H. pylori detection 43
Balloon tamponade, in variceal haemorrhage 121
Bariatric procedures, endoscopic 71 see also Intragastric balloon (IGB)
Barium swallow studies 47
Barrett's oesophagus, radio frequency ablation of 65, 66
Benzodiazepines, in alcohol withdrawal 142
Biliary intervention, endoscopic 6970
Bismuth subsalicylate, in microscopic colitis 88
Boceprevir 132
Boston consensus criteria, for histological diagnosis of IgG4-RD 104, 105
Budesonide, in microscopic colitis 8788
Budesonide MMX, in ulcerative colitis 6
C
Cag-encoded type IV secretion system 36
Cag pathogenicity island 36
Cap-assisted colonoscopy 63
Capsule endoscopy
contraindication to 51
indications for 5152
procedure 51
for small bowel evaluation 4951
Carbonic anhydrase (CA) II 94
Cat-scratch phenomenon 83
Chlordiazepoxide, in alcohol withdrawal 142
Cholangioscopy SpyGlass 6970, 70
Chronic sclerosing dacryoadenitis (CSD) 102
Cirrhosis 141142 see also Alcohol-related liver disease
Citrulline 25
CLE see Confocal laser endomicroscopy (CLE)
Clinical institute withdrawal assessment (CIWA) scale 142143, 143
Coeliac disease (CD) 23
atypical 23, 2425
citrulline level in 25
classical 23, 24
double balloon enteroscopy in 31
endoscopy in 30, 3031
food antibodies and 2627
histological examination in 29, 29
HLA typing test for 2526
immunological markers in 26
and inflammatory bowel disease, link between 25
latent 23
patients at high risk of 25
potential 23
prevalence 23
serology and biopsy for, investigation of 2729, 28
serology and targeted screening 29
silent 23
small bowel radiology in 26
testing for 2325
tissue reactive autoantibodies and 27
wireless capsule endoscopy in 31
Collagenous colitis (CC) 77 see also Microscopic colitis (MC)
Colon capsule endoscopy (CCE) 61
Colonoscopy 62
cap-assisted colonoscopy 63
TER colonoscopy 62, 62
water immersion colonoscopy 63
Colorectal cancer 6465
Confocal laser endomicroscopy (CLE) 31, 59, 59
Contrast agents, luminal 48
Contrast-enhanced endoscopic ultrasound (CE-EUS) 6364, 64
Crohn's disease 11, 47
adaptive immune response in, alterations in 1314
5-aminosalicylates in 15
anti-TNF therapy in 1718
diagnosis and monitoring 14, 4749
epidemiology 11
future treatment strategies 1819
genetic factors in pathogenesis of 12
innate immune response in, alterations in 13
microbiome in, changes in 1213
principles of treatment in 15
thiopurines and anti-TNF agents, combined therapy for 17
thiopurines in 1516
vitamin D supplementation in 15
Cryotherapy 6566
CT colonography (CTC) 5254, 54
C urea hydrogen breath tests 43
Cut down, Annoyed, Guilty, Eye-opener (CAGE) questionnaire 142
Cyanoacrylate glue 122
Cyclo3 Fort, and microscopic colitis 81, 82
Cytochrome P-450 2E1 (CYP2E1) 139140
Cytotoxin associated gene A (CagA) 36
D
Dermatitis herpetiformis (DH), coeliac disease and 24, 26
Diagnostic endoscopy 57
autofluorescence imaging 58, 58
colonoscopy 6263
confocal laser endomicroscopy 59, 59
electronic endoscopic contrast enhancement techniques 58
endoscopic ultrasound 6364
high-resolution and zoom magnification 57
molecular imaging 60, 60
screening for cancer 6465
small bowel endoscopy 61, 62
video capsule endoscopy 6061, 61
Diarrhoea, in microscopic colitis 82
Directly acting antiviral agents (DAAs) 131133
Disulfiram 143144
Double balloon enteroscopy (DBE) 61
in coeliac disease 31
Duodenum, imaging modalities for 47
DupA 37
D-Xylose absorption testing 25
E
Elastography 142
Electronic endoscopic contrast enhancement techniques 58, 58
Endoscopic submucosal dissection (ESD) 66, 67
Endoscopic ultrasound (EUS) 47, 63
contrast-enhanced endoscopic ultrasound 6364, 64
EUS elastography (EUS-EG) 63, 64
EUS-guided fine-needle aspiration (EUS-FNA) 63
Endoscopy
coeliac disease 30, 3031
diagnostic (see Diagnostic endoscopy)
therapeutic (see Therapeutic endoscopy)
for upper GI bleeding 118122
Escherichia coli, in Crohn's disease 13
EUS see Endoscopic ultrasound (EUS)
EUS-guided anterograde cholangiopancreatography (EACP) 69, 69
EUS-guided cystogastrostomy 68
EUS-guided fine-needle injection (EUS-FNI) 6869
F
Faecal calprotectin, for intestinal inflammation 3, 14
Faecalibacterium prausnitzii, in Crohn's disease 13
Fine-needle aspiration (FNA) 47
Flexible spectral imaging colour enhancement (FICE) 58
G
Gastric adenocarcinoma 35, 39
Gastric cancer, H. pylori infection and 35, 3941, 40
atrophic gastritis 41
dysplasia 41
H. pylori eradication, in pre-neoplasia 4142, 42
metaplasia 41
risk factors 40
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma 4243
Gastritis, H. pylori colonisation and
acute gastritis 37
chronic superficial gastritis 38
Gastrointestinal (GI) bleeding , upper see Upper GI bleeding (UGIB)
Gastroscopy 47
Glasgow alcoholic hepatitis score (GAHS) 141, 141
Glasgow–Blatchford score (GBS), for upper gastrointestinal bleeding 115
Gliadins 26
Gluten-free diet (GFD), in coeliac disease 23 See also Coeliac disease (CD)
Gluten-sensitive enteropathy (GSE) 24
H
Haematemesis 113, 115 see also Upper GI bleeding (UGIB)
HALO360 and HALO90 system, for oesophageal RFA 65, 66
Harvey–Bradshaw index 14
Hashimoto's thyroiditis 103
Helicobacter pylori 3536, 114 see also Upper GI bleeding (UGIB)
and acute gastritis 37
chronic colonisation, outcomes of 38, 3843
and chronic superficial gastritis 3738
colonisation rates, variability in 35
faecal antigen tests 43
and humans, association between 36
non-gastric outcomes, of colonisation 43
testing and eradication 44
virulence factors 3637
Hemospray 6667, 68
Hepatitis B virus (HBV) 125
acute severe 127
chemotherapy and 127
high-risk groups 126
interferon for 126
nucleoside/nucleotide analogues for 126127
and pregnancy 127
prevalence 125
transmission 126
vaccination 126
Hepatitis C virus (HCV) 125, 128
acute infection 131
directly acting antiviral agents for 131133
interferon-free regimens trials for 133, 134
investigations and diagnosis 128129
life cycle 131
NS5a inhibitors for 133
pathophysiology and transmission 128
pegylated interferon-α and ribavirin for 129, 129131, 130
polymerase inhibitors for 133
protease inhibitors for 132133
High-resolution endoscopes 57, 58
I
Idiopathic thrombocytopaenic purpura (ITP) 43
IgA anti-endomysial antibody (AEA) 27
IgA anti-TTG, and coeliac disease 27
IgA wheat antibodies 27
IgG4 hepatopathy 100
and autoimmune hepatitis 100
IgG4 pachymeningitis 103
IgG4-related cholecystitis 100
IgG4-related disease (IgG4-RD) 93
abdominal/thoracic aortitis 103
biliary manifestations 99100, 100
breasts and 104
clinical features 97
constrictive pericarditis and 104
cutaneous manifestations 104
demographics 9697
diagnostic guidelines 107, 107, 108
epidemiology 96
future directions 109
gallbladder and 100
gastrointestinal tract and 100101
histopathological features 104107, 105, 106, 106
historical perspective 9596, 96
liver manifestations 100
lymph nodes, involvement of 103, 104
meningeal disease 103
orbital disease 102
pancreas and 9899, 99
pathogenetic mechanisms in 94, 9495
pituitary gland and 103
prostate and 104
pulmonary manifestations 101, 101
radiological features 9798, 98
renal manifestations 101, 102
retroperitoneal fibrosis 102
salivary and lacrimal gland involvement 101102
serological evaluation 97
thyroid and 103
treatment 108
IgG4-related prostatitis 104
IgG4-related sclerosing cholangitis (IRC) 99100
IgG4-related sclerosing mastitis 104
IgG4-related tubulointerstitial nephritis 101, 101
IgG4-sialoadenitis 101102
Ileocolonoscopy 14
Immune response, alterations in, in Crohn's disease 1314
Immunity-related GTPase family M protein (IRGM) 12
Immunoglobulin G4 (IgG4) 93 see also IgG4-related disease (IgG4-RD)
Inflammatory bowel disease (IBD) 12
Infliximab
and ciclosporin in acute severe colitis 45
with immunomodulators in ulcerative colitis 4
in microscopic colitis 89
in moderately to severely active ulcerative colitis 34
trough levels and antibodies to infliximab 4
Interleukin 8 (IL-8) 37
Interleukin 23 receptor (IL23R) 12
Intragastric balloon (IGB) 71, 71
Iron deficiency anaemia (IDA) 43
I-scan 58
J
Japanese comprehensive diagnostic criteria, for IgG4-RD 108
K
Kuttner's tumour 102
L
Lactoferrin (LF) 94
Lamivudine, in HBV infection 126127
Large bowel, evaluation of
CT colonography 5254, 54
MRI defaecography 55
MRI of rectum 5455
Leukocyte trafficking in gut mucosa, targeting of
in Crohn's disease 1819
in ulcerative colitis 68, 7
Lille score 141
Luminal imaging
large bowel 5255
small bowel 4752
stomach and duodenum 47
Lymphocytic colitis (LC) 77 see also Microscopic colitis (MC)
Lymphoplasmacytic inflammation 104
M
Maddrey's discriminant function 141, 141
Magnetic resonance imaging (MRI) 14 see also MR enterography (MRE)
pelvic floor 55
rectum 5455
Malaena 113 see also Upper GI bleeding (UGIB)
Marsh Classification, for gluten enteropathy 29
MC see Microscopic colitis (MC)
6-mercaptopurine, in microscopic colitis 89
Mesalazine
in microscopic colitis 88
in ulcerative colitis 3
METAVIR score 141, 142
Methotrexate
in IgG4-related disease 108
in microscopic colitis 89
Michigan alcohol screening test (MAST) 142
Microbiomes, alteration in
in Crohn's disease 1213
Microscopic colitis (MC) 77
age and 78
algorithm for treatment of 86, 87
bile acid malabsorption 81
budesonide treatment 8687
collagenous colitis 77, 84, 85
colonoscopic changes in 8384
complications related with 83
drug-induced 81, 82
empirical treatment 8889
familial and genetic risk factors 79
gender and 7778
histopathological diagnosis of 84, 8486, 85
immunopathogenesis 80, 8081
incidence 78, 78
initial management 86
lymphocytic colitis 77, 85, 86
MC not otherwise specified (NOS) 86
MC with giant cells 77, 86
mode of onset and clinical course 83
pregnancy and 83
prevalence 7879
smoking and 79
subtypes 77
surgery in 89
symptoms 8182, 82
Mikulicz's disease 102
Minnesota tube 121
Molecular imaging 60, 60
MR enterography (MRE)
Crohn's disease 14
small bowel 4749, 4951
MRI defaecography 55
Mucosal addressin cell adhesion molecule 1 (MAdCAM-1) 7
Mucosal healing
in Crohn's disease 18
in ulcerative colitis 23
Multi Matrix System (MMX) 6
Mycobacterium avium subspp paratuberculosis (MAP), in Crohn's disease 13
Mycophenolate mofetil, in IgG4-related disease 108
N
Nalmefene 144
Naltrexone 144
Nanopowder spray, for non-variceal UGIB 120
Narrow band imaging (NBI) 58, 58
Natalizumab, in Crohn's disease and multiple sclerosis 7
Natural orifice transluminal endoscopic surgery (NOTES) 72
NF-κB signalling 36
Non-coeliac gluten sensitivity 25
Non-nucleoside inhibitors (NNI) 133
NS5a protein 133
Nucleotide-binding oligomerization domain-containing protein 2 (NOD2) 12
O
Obliterative phlebitis 104
OCE see Oesophageal capsule endoscopy (OCE)
Octreotide, for variceal haemorrhage 121
Oesophageal capsule endoscopy (OCE) 6061
Oesophagus, ablation techniques in 6566
Orbital inflammatory pseudotumours 102
Oxyntic glands 41
P
Pancreatic cancer 65
Pancreatic collections, EUS-guided drainage of 6768
Pegylated interferon-α
in HBV infection 126
in HEV infection 134
Pentoxifylline, in alcoholic hepatitis 145
Peptic ulcer disease, H. pylori infection and 35, 3839
Percutaneous endoscopic colostomy (PEC) 7071
Per-oral endoscopic myotomy (POEM) 72, 73
POEM see Per-oral endoscopic myotomy (POEM)
Polymerase inhibitors 133
Probiotics treatment, in microscopic colitis 88
Protease inhibitors (PIs) 132133
Proton pump inhibitors (PPI), in upper GI bleeding 118, 122
R
Radio frequency ablation (RFA) 65
Rapid urease testing 43
Ras-mitogen activated protein kinase (Ras-MAPK) pathway 36
Renal IgG4 disease 101
Retroperitoneal fibrosis (RF) 102
Ribavirin, in HEV infection 134
Riedel's thyroiditis 103
Rituximab, in IgG4-related disease 108
Rockall score, for upper gastrointestinal bleeding 116
S
Sclerotherapy 121
Self-expandable metal stent (SEMS) technology 70, 72
biodegradable stents 72
drug-eluting stents 72
Sengstaken–Blakemore tube 121
Single balloon enteroscopy (SBE) 61
Small bowel, evaluation of
capsule endoscopy 4951
MR enterography 4749, 4951
ultrasound 51
Somatostatin, for variceal haemorrhage 121
Spiral enteroscopy (SE) 61, 62
SpyGlass direct visualisation system 6970, 70
Stem cell transplantation, in Crohn's disease 19
Steroids
in alcoholic hepatitis 145
in IgG4-related disease 108
Stomach, imaging modalities for 47
Storiform fibrosis 104
T
TC-325 120
Telaprevir 132
Terlipressin, for variceal haemorrhage 120121
Therapeutic endoscopy 57, 65
bariatric therapies 71, 71
cholangioscopy 6970
colonic stenting 70
cryotherapy 6566
endoscopic haemostasis 6667
EUS-guided anterograde cholangiopancreatography 69, 69
EUS-guided drainage of pancreatic collections 6768
EUS-guided fine-needle injection therapy 6869
natural orifice transluminal endoscopic surgery 7273
percutaneous endoscopic colostomy 7071
radio frequency ablation 65, 66
resection techniques 66, 67
self-expandable metal stent (SEMS) technology 72
Thiopurines
with allopurinol 16, 16
and anti-TNF agents 17
in Crohn's disease 1516
metabolism 16, 16
Third Eye Retroscope (TER) 62, 62
Ticlopidine, and microscopic colitis 81, 82
Tissue reactive autoantibodies 27
Tissue transglutaminase (TT) 26
Tofacitinib, in ulcerative colitis 8
Transfusion, in upper GI bleeding 116118
Transjugular intra-hepatic portosystemic shunting (TIPS) 121122
Trimodal imaging 58
Type 2 helper (Th2) cytokines 93
U
UGIB see Upper GI bleeding (UGIB)
Ulcerative colitis 1
adalimumab in 56
budesonide MMX in 6
and Crohn's disease, pathways of pathogenesis in 12
future treatment strategies 68
genetic factors in pathogenesis of 12
HLA locus association in 2
infliximab in 35
leukocyte trafficking in, targeting of 68, 7
mucosal healing in 23
mesalazine in 3
PF-00547,659 in, role of 8
tofacitinib in treatment of 8
vedolizumab in, efficacy of 78
vidofludimus in, efficacy of 8
Ultrasound
Crohn's disease 14
endoscopic (see Endoscopic ultrasound (EUS))
small bowel 51
Upper GI bleeding (UGIB) 113114
AIMS 65 score and 116, 117
anti-coagulated patients 118
endoscopy for 118122
epidemiology 114
frequency and source of 113
gastric variceal haemorrhage 122
Glasgow–Blatchford score for 115
initial evaluation in 114115, 115, 116
low-risk patients 116
medium-to-high-risk patients 116, 117
non-variceal 119120
post-endoscopy management 122
proton pump inhibitors in, use of 118
rebleeding in 114
resuscitation in, initial 116118
Rockall score for 116
TIPS placement 121122
variceal haemorrhage 120121
Ustekinumab, in Crohn's disease 18
V
VacA 37
Variceal band ligation 121
Variceal haemorrhage see also Upper GI bleeding (UGIB)
endoscopic control 121
gastric 122
prophylactic antibiotics in 120
rebleeding after 121122
vasopressin and analogues in 120121
Vascular cell adhesion molecule 1 (VCAM-1) 7
Vasopressin, in variceal haemorrhage management 120
Vedolizumab
in Crohn's disease 1819
in ulcerative colitis 78
Video capsule endoscopy 60
colon capsule endoscopy 61, 61
oesophageal capsule endoscopy 6061
Vidofludimus 8
in ulcerative colitis 8
Viral hepatitis 125
hepatitis B 125127
hepatitis C 128134
hepatitis D 127128
hepatitis E 134
W
Water immersion colonoscopy 63
Wernicke–Korsakoff syndrome (WKS) 143
Wheat gluten-related antibodies, in coeliac disease 2627
Wireless capsule endoscopy (WCE), in coeliac disease 31
×
Chapter Notes

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1Recent Advances in Gastroenterology 12
2
3Recent Advances in Gastroenterology 12
Chris Probert MD FRCP FHEA Professor of Gastroenterology, Institute of Translational Medicine, Liverpool, UK
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5Preface
It is a privilege to be invited to edit Recent Advances in Gastroenterology for a second time.
In this edition, I aim to provide a further series of updates for gastroenterologists, and others, on key topics in gastroenterology and hepatology. The book has been written primarily for gastroenterologists in training, general medical trainees and general practitioners with a special interest in gastroenterology. Its reach is international, but it takes a broadly British approach to the diseases under discussion.
It is 7 years since gastroenterology and hepatology were last covered by this series. When choosing topics, I have selected some old friends, such as Crohn's disease and ulcerative colitis, which have seen significant developments. However, most topics have not previously been reviewed, such as IgG4 syndrome and small intestinal imaging. Much has changed in our understanding of microscopic colitis and coeliac disease, both disorders being more common than previously realised. Other disorders such as Helicobacter infection, alcoholic liver disease and viral hepatitis are of global interest. There have also been exciting advances in the management of upper gastointestinal bleeding and endoscopy.
Recent Advances in Gastroenterology 12 provides timely coverage of all these important developments.
Chris Probert
September 2013
9Acknowledgements
I am grateful to the authors for their hard work and timely delivery of their chapters. Their contributions were of a high standard, making these both informative and a pleasure to edit.
I am also grateful to JP Medical, who recently acquired the Recent Advances series, for inviting me to lead this edition.
Finally, I thank my wife, Fiona, for her help and tolerance during its realisation.