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Undernutrition is widely prevalent in patients with cirrhosis and affects prognosis. Given the lack of data regarding the dietary intake (DI) and habits of patients with cirrhosis, the aim of the present study was to evaluate them by assessing diet's adequacy compared to the new guidelines, and the association of DI with nutritional status indicators. One hundred and eighty-seven patients (57.8% male, 59.9 ± 10.9 years old, 44.9% decompensated ones) with cirrhosis of various etiologies were enrolled. The patients' DI was assessed using three 24 h recalls, which were analyzed regarding macronutrients' intake, food groups consumption, adherence to the Mediterranean diet and meal patterns. The Goldberg cut-off limits for the ratio of energy intake to resting energy expenditure were used to evaluate dietary underreporting and patients were accordingly classified as low or adequate energy reporters (LERs and AERs). Among the AERs (n = 91, 48.7%) only 29.7% and 31.9% met current recommendations regarding energy and protein intake, accordingly. Patients reported low intake of several healthy food groups and low adherence to the Mediterranean diet. They reported a median of 4.3 eating episodes per day and they frequently omitted late evening snack. Nevertheless, no statistically significant associations were found between parameters of DI and annual and two-year survival. Low energy reporting was very frequent in this sample of patients with liver cirrhosis. Diet quality was rather poor, whereas energy and protein intakes were lower than those recommended. [ABSTRACT FROM AUTHOR]

This article compares the outcomes of endoscopic treatment for nonvariceal upper gastrointestinal hemorrhage (NVUGIH) caused by peptic ulcers (PU) and Dieulafoy's lesions (DL). The study reviewed the endoscopy database of a hospital over a 10-year period and included patients who underwent upper gastrointestinal endoscopies for hematemesis, hematochezia, and melena. The results showed that DL patients had a significantly higher need for endoscopic hemostasis compared to PU patients. Combination therapy was the preferred technique in both groups, and there was no statistically significant difference in terms of persistent or recurrent bleeding between the two groups. [Extracted from the article]

Background: Colon capsule endoscopy (CCE) could be an option to examine the colon after incomplete colonoscopy. Objective: To investigate the extent that CCE complements incomplete colonoscopy and guides further workup. Design: Prospective, follow-up study. Setting: Three tertiary-care centers. Patients: Consecutive outpatients after colonoscopy failure; 1-year study period. Intervention: Patients underwent CCE either immediately after colonoscopy or were rescheduled. Further investigations were guided by the results of CCE. Patients were followed as long as 2 years. Results: We studied 75 outpatients; 39 had a screening colonoscopy. One third of the patients underwent CCE immediately after colonoscopy. Overall, CCE reached or went beyond the colon segment at which colonoscopy stopped in 68 patients (91%). CCE technically complemented difficult colonoscopy independently of whether same-day CCE was performed (24 [96%]) or was not performed (44 [88%]). CCE detected additional significant findings in 36% of the same-day CCE cases and in 48% of the rescheduled ones. Two patients in the same-day group and 13 in the rescheduled CCE group underwent further colon examination that revealed additional significant findings in 3 of them. Ten percent of the patients reported mild adverse events (AE). If needed, 63 participants (84%) were willing to repeat CCE. Follow-up has not identified symptomatic missed colon cancers. Limitations: Selected patient population, first-generation colon capsule, old preparation scheme. Conclusion: CCE performed immediately or at a scheduled date after colonoscopy failure is feasible and safe. CCE after incomplete colonoscopy appears to yield significant findings, guide further workup, and has high patient acceptance. [Copyright &y& Elsevier]

Background: There are no data on the role of PillCam Colon capsule (PCC) endoscopy for examination of the colon in incomplete colonoscopy cases. Objective: To evaluate whether PCC endoscopy can complete colon examination after failure of conventional colonoscopy to visualize the cecum. Setting: Three tertiary centers. Study design: Retrospective case series. Patients: Patients who underwent PCC endoscopy after incomplete colonoscopy from January to June 2008. Interventions: Conventional colonoscopy and PCC endoscopy. Results: By using PCC, we studied 12 patients who had incomplete colonoscopy. Six patients had an obstructing tumor of the left side of the colon, and, in 6 cases, there were technical difficulties to complete colonoscopy. PCC endoscopy visualized the rectum in 1 case. The capsule did not reach the site where colonoscopy stopped in 6 of the 12 cases, ie, 3 left sited tumors and 3 with technical difficulties. Moreover, in 1 of the 3 cases in which the capsule passed the site where colonoscopy stopped, poor bowel preparation precluded the accurate examination of the colon. Four patients underwent a third colon examination (3 barium enemas and 1 virtual CT colonoscopy). There were no adverse events related to PCC endoscopy. Limitations: A retrospective study and a selected patient population. Data may not be applicable to other settings. Conclusion: In this retrospective case series of patients with incomplete colonoscopy, PCC endoscopy did not always satisfactorily examine the colon. [Copyright &y& Elsevier]

BACKGROUND: The role of capsule endoscopy (CE) in the diagnosis of active mild-to-moderate GI bleeding (GIB) immediately after a negative EGD and ileocolonoscopy has not been prospectively evaluated. OBJECTIVE: To estimate the diagnostic yield and clinical significance of CE in patients with acute, obscure, overt, mild-to-moderate GIB. DESIGN: A single-center prospective study. PATIENTS: During a 3-year period, 573 patients admitted to the hospital with acute mild-to-moderate GIB were included in this study. Among them, 37 patients (6.5%) with negative endoscopic findings, after urgent upper- and lower-GI endoscopies, underwent CE within the first 48 hours to identify the source of bleeding. RESULTS: CE revealed active bleeding in 34 patients and a diagnostic yield of 91.9%, including angiodysplasias in 18 patients, ulcers in 3 patients, and tumors in 2 patients. In the remaining 11 patients (32%), CE revealed the site of bleeding: distal duodenum in 1 case (9%), jejunum in 6 cases (54%), ileum in 2 cases (18%), and cecum in 2 cases (18%). From the 37 bleeders, 16 were managed conservatively, 14 endoscopically, and 7 surgically. During a 12-month follow-up period, bleeding recurrence was observed in 5 of 32 (15.6%). LIMITATIONS: This study had a limited number of patients. CONCLUSIONS: CE appeared to have a high diagnostic yield in patients with acute, mild-to-moderate, active hemorrhage of obscure origin when performed in the hospital after a negative standard endoscopic evaluation and has important clinical value in guiding medical management. [ABSTRACT FROM AUTHOR]

Although H. pylori(HP) eradication in patients with peptic ulceration is mandatory, its need in patients with concurrent Barrett oesophagus(BO) has never been discussed. Aim of the Study: To define the consequences of HP eradication in BO patients. Patients and Methods: The records of all patients identified between 1996 and 2001 in Blackpool area with histologically verified BO (n = 382, mean age 68±13 years, 235 men) and oesophageal adenocarcinoma (Ca) on BO (n = 114, mean age 73±11 years, 68 men) were reviewed. Validated questionnaires were completed by all patients to verify recorded data. Stat: X2, t-test. Results: 48/382 (13%) BO, 5/114 (4%) Ca patients presented a duodenal ulcer(DU) HP(+) (p = 0.01). 22/382 (6%) BO, 0/114 Ca patients presented a gastric ulcer (GU) HP(+) (p = 0.02). 2/48 (4%) DU and 0/22 GU patients with BO presented low grade dysplasia (LGD). All patients received HP eradication treatment. Follow-up > 3 months was available in 29/48 (60%) DU and 11/22 (50%) of GU patients with BO (p = 0.58). 5/29 (17%) DU and 0/11 GU patients developed LGD during follow-up (p = 0.35). 5/9 (56%) DU and 0/2 GU patients with follow-up > 90 months developed LGD (p = 0.52). 25/154 (16%) HP(-) and 1/12(8%) HP(+) nonulcer patients with a follow-up > 3 months developed LGD. 9/37 (24%) HP(-) and 0/2 HP(+) non-ulcer patients with a follow-up > 90 months developed LGD. Except of a trend of more frequent LGD in DU than HP(-) non-ulcer BO patients (p = 0.08), there was no difference between the other ulcer and non-ulcer groups. Conclusions: 1) Peptic ulcers HP(+) are more frequent in BO than Ca patients. 2) More than 50% of BO patients with DU but none of those with GU develop LGD after > 90 months of follow-up. More data are needed to define if HP eradication is safe in BO patients with DU. [ABSTRACT FROM AUTHOR]