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Background: The diagnosis of eosinophilic esophagitis (EoE) and differentiation from gastroesophageal reflux disease (GERD) is potentially challenging and is based upon clinical signs and endoscopic and histological features. In order to alert the endoscopist to consider EoE in patients with esophageal symptoms before performing esophagogastroduodenoscopy, we aimed to identify a set of clinical and laboratory markers for predicting EoE. Methods: The study included 43 patients with either EoE (n = 23) or GERD (n = 20). The diagnosis of EoE was based on International Consensus Criteria. Age, gender, weight loss, history of atopy, dysphagia, history of food impaction, proton pump inhibitor (PPI) refractory heartburn, odynophagia, peripheral eosinophilia, and serum IgE were analyzed. Each symptom or sign was classified as '0' (absent, normal) or '1' (present, elevated), individually analyzed and statistically evaluated among the two groups of patients. Logistic regression analysis was carried out to identify a clinically applicable marker constellation to differentiate EoE from GERD. Results: Univariate analysis identified 6 out of the 10 variables to be significant between both groups. A stepwise procedure of logistic regression led to a model in which 3 out of the initial 10 items were found to be relevant for differentiating GERD and EoE. Derived from this model, an optimal differentiation was achieved by using the following simplified equation: peripheral eosinophilia + history of food impaction + PPI refractory heartburn leading to a maximal value of 3 (1 + 1 + 1). Based on a cut-off value of ≥2, sensitivity and specificity for diagnosing EoE were 91 and 100%, respectively. Conclusion: A defined set of markers including two clinical features and one laboratory parameter is highly predictive of EoE and thus allows physicians to distinguish EoE from GERD even before upper gastrointestinal endoscopy is performed. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Dysfunction of the intestinal epithelium is believed to result in the excessive translocation of commensal bacteria into the bowel wall that drives chronic mucosal inflammation in Crohn's disease, an incurable inflammatory bowel disease in humans characterized by inflammation of the terminal ileum. In healthy individuals, the intestinal epithelium maintains a physical barrier, established by the tight contact of cells. Moreover, specialized epithelial cells such as Paneth cells and goblet cells provide innate immune defence functions by secreting mucus and antimicrobial peptides, which hamper access and survival of bacteria adjacent to the epithelium. Epithelial cell death is a hallmark of intestinal inflammation and has been discussed as a possible pathogenic mechanism driving Crohn's disease in humans. However, the regulation of epithelial cell death and its role in intestinal homeostasis remain poorly understood. Here we demonstrate a critical role for caspase-8 in regulating necroptosis of intestinal epithelial cells (IECs) and terminal ileitis. Mice with a conditional deletion of caspase-8 in the intestinal epithelium (Casp8?IEC) spontaneously developed inflammatory lesions in the terminal ileum and were highly susceptible to colitis. Casp8?IEC mice lacked Paneth cells and showed reduced numbers of goblet cells, indicating dysregulated antimicrobial immune cell functions of the intestinal epithelium. Casp8?IEC mice showed increased cell death in the Paneth cell area of small intestinal crypts. Epithelial cell death was induced by tumour necrosis factor (TNF)-?, was associated with increased expression of receptor-interacting protein 3 (Rip3; also known as Ripk3) and could be inhibited on blockade of necroptosis. Lastly, we identified high levels of RIP3 in human Paneth cells and increased necroptosis in the terminal ileum of patients with Crohn's disease, suggesting a potential role of necroptosis in the pathogenesis of this disease. Together, our data demonstrate a critical function of caspase-8 in regulating intestinal homeostasis and in protecting IECs from TNF-?-induced necroptotic cell death. [ABSTRACT FROM AUTHOR]

The following on histology and immunohistology of Barrett's esophagus (BE) includes commentaries on the various difficulties remaining in reaching a consensus on the definition of BE; the difficulties in the characterization of intestinal and cardiac mucosa, and in the role of submucosal glands in the development of BE; the importance of a new monoclonal antibody to recognize esophageal intestinal mucosa; the importance of pseudo goblet cells; the best techniques for the endoscopic detection of Barrett's epithelium; and the biomarkers for identification of patients predisposed to the development of BE. [ABSTRACT FROM AUTHOR]

The following on esophageal disease and pathology contains commentaries on the varied definitions of Barrett's esophagus (BE); the optimal biopsy strategy in BE; reliable biomarkers for progression to neoplasia in BE; and the role of bone marrow stem cells in the morphogenesis of Barrett's esophagus. [ABSTRACT FROM AUTHOR]

The following on proton pump inhibitors and chemoprevention in Barrett's esophagus includes commentaries on normalization of esophageal refluxate; the effects of 5-HT4 agonists on EGF secretion and of lubripristone on chloride channels agents; the role of Campylobacter toxin production; the deleterious effects of unconjugated bile acids; the role of baclofen in nonacid reflux; the threshold for adequate esophageal acid exposure; the effects of proton pump inhibitor (PPI) therapy on normalization of esophageal pH and on cell proliferation; the role of the phenotype of cellular proliferation on the effects of PPI therapy; and the value of Symptom Index and Symptom Association Probability in the evaluation of potential response to treatment. [ABSTRACT FROM AUTHOR]

Endoscopic retrograde cholangiopancreatography (ERCP) is technically more challenging in patients with postsurgical anatomy. We assessed the technical success of performing ERCP with the double balloon enteroscope (DBE) in patients with Roux-en-Y anastomosis. This is a prospective evaluation of patients with Roux-en-Y anastomosis who underwent ERCP with the DBE. Diagnostic success was defined as successful duct cannulation or securing the diagnosis, and therapeutic success was defined as the ability to treat the underlying disorder. Complications of ERCP were defined according to standard criteria. ERCP using the DBE was performed on 17 occasions in 11 patients (10 men; mean age, 59.7 (range, 36–77) years) with Roux-en-Y anastomosis with or without hepaticojejunostomy. Indications for ERCP: biliary obstruction or cholestasis ( n = 11). The overall diagnostic success was 82%, and the therapeutic success was 58%. Reasons for failed biliary cannulation included: inability to reach the proximal end of the afferent loop ( n = 1), impossibility to advance the wire into the CDB despite adequate insertion of the biliary catheter into the distal CBD ( n = 2), and inability to advance the stent over an adequately placed guidewire ( n = 1). One major complication occurred (5.8%): perforation of the hepaticojejunostomy in a patient with recurrent choledocolithiasis, which was successfully resolved surgically. ERCP using the DBE is feasible in patients with complex postsurgical anatomy, permitting diagnostic and therapeutic interventions in 82% and 58% of cases, respectively. Nevertheless, due to the complex anatomy, presence of adhesions, and looping of the usually long limbs complications can occur. [ABSTRACT FROM AUTHOR]

Background/Aim: Primary gastrointestinal tract involvement occurs in one third of patients with Whipple’s disease (WD). Nevertheless, there are scant data on the endoscopic appearance of WD. The aim of this study was to provide a detailed endoscopic-pathologic assessment of patients with WD. Methods: Four patients with a diagnosis of WD who underwent endoscopic evaluation by a single endoscopist were included. Published information on WD was reviewed in detail, focusing on the endoscopic and histologic features of this disease. Results: WD had a wide range of endoscopic features, including edema, brown discoloration of the mucosa, erythematous spots, subepithelial hemorrhages, and megaduodenum. Magnification endoscopy revealed engorged and flattened villi, villi filled with white material, and white ring-like structures inside of the villi and multiple yellow spots. The histological features of WD include a coarse granular cytoplasm and foamy macrophages that stain strongly with the period acid-Schiff reagent. Conclusions: Gastrointestinal WD has a wide spectrum of endoscopic appearance. Magnification endoscopy enhances the mucosal details. Esophagogastroduodenoscopy with procurement of biopsy specimens from the duodenum was an accurate method for the diagnosis of WD in this case series. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

In this study, δ13CV- PDB and δ15NAIR values of 132 cocaine samples from a big seizure in Germany in 2002 were determined using elemental analyser isotope ratio mass spectrometry. The 1.2 tons of cocaine were packed in 1 kg packages and the cocaine bricks inside these packages showed certain logos. Twenty different logos could be identified. Results show a large variability among some samples, for δ15NAIR values ranging from-17 to -2 ‰. Furthermore, the possibility of linking samples with the same logo was checked. The results show that, in general, there is no relationship between the determined isotope ratio and a certain logo. [ABSTRACT FROM AUTHOR]

None The diagnosis and treatment of polypoid lesions located in diverticula is challenging. We report the case of a polypoid lesion originating in a diverticulum with the Aurora rings sign and intramucosal cancer which was successfully resected using an endoscopic full-thickness resection device (FTRD, Ovesco, Tübingen, Germany). [Extracted from the article]

Keywords: Hereditary diffuse gastric cancer; CDH1; Signet ring cell carcinoma EN Hereditary diffuse gastric cancer CDH1 Signet ring cell carcinoma 1 2 2 05/18/20 20200428 NES 200428 Introduction Inherited CDH1 pathogenic variants cause Hereditary Diffuse Gastric Cancer (HDGC) syndrome, a disease with very poor prognosis.[1] Carriers of such variants present an estimated lifetime risk of gastric signet ring cell carcinoma (SRCC) of 70% in men and 56% in women, by the age of 80 years old.[2] Although risk reduction gastrectomy is the indicated procedure for disease prevention in pre-symptomatic mutation carriers, some carriers opt for delaying surgery and undergo regular endoscopic surveillance. When using a strict endoscopic surveillance protocol (focal visible lesion and random biopsy sampling), SRCC detection rate yield is approximately 60% in CDH1 mutation carriers.[3] In this letter, we wish to call the attention to cervical esophageal gastric inlet patches (GIPs). [Extracted from the article]

Keywords: Hereditary diffuse gastric cancer; CDH1; Signet ring cell carcinoma EN Hereditary diffuse gastric cancer CDH1 Signet ring cell carcinoma 1 2 2 01/06/21 20200101 NES 200101 Introduction Inherited CDH1 pathogenic variants cause Hereditary Diffuse Gastric Cancer (HDGC) syndrome, a disease with very poor prognosis.[1] Carriers of such variants present an estimated lifetime risk of gastric signet ring cell carcinoma (SRCC) of 70% in men and 56% in women, by the age of 80 years old.[2] Although risk reduction gastrectomy is the indicated procedure for disease prevention in pre-symptomatic mutation carriers, some carriers opt for delaying surgery and undergo regular endoscopic surveillance. When using a strict endoscopic surveillance protocol (focal visible lesion and random biopsy sampling), SRCC detection rate yield is approximately 60% in CDH1 mutation carriers.[3] In this letter, we wish to call the attention to cervical esophageal gastric inlet patches (GIPs). [Extracted from the article]

Despite the promising data, we eagerly await the longer term safety and efficacy data before considering Z-POEM as the mainstream approach, even in recurrent ZD. The authors declare that they have no conflict of interest. letter We congratulate Sanaei et al. for publishing their data on Z-POEM in 32 patients with recurrent Zenker diverticulum (ZD) [1]. [Extracted from the article]

The article discusses the case of large-bowel inflammatory lesions called langerhans cell histiocytosis which observed in systemic illness with poor prognosis and high morbidity.

B Endoscopic management of gastrointestinal motility disorders - part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline b Weusten BLA.M., Barret M, Bredenoord AJ et al. Endoscopy 2020; 52: 600-614 In the above-mentioned article, the institution of Daniel Pohl has been corrected. [Extracted from the article]

A correction is presented for the article "Development and Validation of the SIMPLE Endoscopic Classification of Diminutive and Small Colorectal Polyps" by M. Iacucci, C. Trovato, M. Daperno, et al. which appears in the same issue of the journal.

The article presents a case study of 55-year-old woman who was referred to a hospital for screening colonoscopy which reveals the presence of rectal polyps. The patient then underwent an endoscopic submucosal dissection (ESD) using an endoscopic full-thickness resection device (FTRD) and therapy. The article also discusses the effectiveness and safety of FTRD as an equipment for ESD.

The article presents a case study of a 64-year-oldman presented with abdominal pain, anemia and positive hemocult. The patient was diagnosed with small-bowel diverticulosis using On Demand Enteroscopy (ODE) technique. The topics discussed include endoscopic imagining methods, mucosal atrophy and anemia.

A quiz concerning gastrointestinal microscopy and confocal endomicroscopy of an HIV-infected patient with diarrhea and massive duodenal round cell infiltration is presented.

Background: Inadequate response to proton pump inhibitor (PPI) therapy in patients with gastroesophageal reflux disease (GERD) is reported in up to 40%. Patients with non erosive reflux disease (NERD) have lower response rates compared to patients with erosive reflux disease (ERD); pH metry contributes to GERD diagnosis and is critical for proper diagnosis of NERD. Aim of the study was to assess the need for doubling esomeprazole standard dose (40 mg) for 4 weeks in PPI naive patients with typical reflux symptoms and diagnosis of GERD based on endoscopy and 48 hours, wireless pH metry.Methods: All patients underwent upper GI endoscopy. Symptoms were recorded with a structured questionnaire (RDQ) and acid exposure was determined by 48 hours, wireless pH monitoring (BRAVO). In case of abnormal acid exposure, patients received a short term treatment with esomeprazole 40 mg q.d. for 4 weeks. If symptoms persisted, patients underwent a second pH metry on PPI and the dose was increased to 40 mg b.i.d.Results: 31 consecutive patients with typical reflux symptoms underwent 48 hours pH monitoring. 22 patients (71%) had abnormal acid exposure, 9 patients had normal pH metry (29%). Of the 9 patients with normal pH metry, 2 were found with erosive esophagitis and 7 without endoscopic abnormalities. 24 patients with documented GERD received esomeprazole treatment. 21 patients achieved complete symptom resolution with 40 mg q.d. after 4 weeks (88%). Only 2 patients required doubling the dose of esomeprazole for complete symptom resolution, 1 patient remained with symptoms.Conclusions: Patients with typical reflux symptoms and abnormal acid exposure have a high response rate to standard dose esomeprazole regardless of whether they have ERD or NERD. [ABSTRACT FROM AUTHOR]