Euro Gastroenterology 2018

Gastrointestinal (GI) disorders are common among all people, including those affected by diabetes. At some point in any patient's life, the chances that he or she will develop a GI tract problem, be it peptic ulcer disease, gallstones, irritable bowel syndrome, food poisoning, or some other malady, are extremely high. 75% of patients visiting diabetes clinics will report significant GI symptoms. The entire GI tract can be affected by diabetes from the oral cavity and esophagus to the large bowel and anorectal region. Common complaints may include dysphagia, early satiety, reflux, constipation, abdominal pain, nausea, vomiting, and diarrhea. Many patients go undiagnosed and under-treated because the GI tract has not been traditionally associated with diabetes and its complications.

Both acute and chronic hyperglycemia can lead to specific GI complications. Diabetes is a systemic disease that may affect any organ systems, and the GI tract is no exception. As with other complications of diabetes, the duration of the disorder and poor glycemic control seem to be associated with more severe GI problems.

The human gut microbiota has become the subject of extensive research in recent years and our knowledge of the resident species and their potential functional capacity is rapidly growing. Our gut harbours a complex community of over 100 trillion microbial cells which influence human physiology, metabolism, nutrition and immune function while disruption to the gut microbiota has been linked with gastrointestinal conditions such as inflammatory bowel disease and obesity. Here, we review the many significant recent studies that have centered on further enhancing our understanding of the complexity of intestinal communities as well as their genetic and metabolic potential.

The role of diet and dietary habits including fibers, food additives and preservatives on the aetiology of gastric cancers, colorectal cancers and other G.I disorders in the tropics are herein reviewed. Carcinomas of the gut believed to be on the decline in the developed countries have plateaued and increasing cases are being reported in the tropics. Africa and Nigeria in particular, with little or no cases previously are currently experiencing patterns of incidence similar to those of the Western Hemisphere. All these developments are premeditated by the nature of diets and dietary factors contained therein. Some of these factors contain chemical carcinogens, irritants as additives or preservatives, high cholesterol, highly spiced foods, alcohol, nicotine, xanthines, caffeine, most of which provoke gastric acid secretions dyspepsia and heartburn, and they lack vegetables and dietary fibres known to protect the G.I tract against various diseases. The roles of dietary hygiene implicating certain microorganisms associated with G.I diseases like Helicobacter Pylori are also discussed.

What you eat can contribute to digestive problems. Many people eat too much processed food and sugar, and not enough fiber, fruits, and vegetables. Poor eating habits, such as eating too quickly or skipping meals, can also be part of the problem. Many digestive problems can be prevented by eating a healthy, balanced diet.

The digestive system made up of the gastrointestinal tract (GI), liver, pancreas, and gallbladder helps the body digest food. Digestion is important for breaking down food into nutrients, which your body uses for energy, growth, and cell repair.

Some digestive diseases and conditions are acute, lasting only a short time, while others are chronic, or long-lasting.

• Irritable Bowel Syndrome (IBS)
• Crohn's Disease
• Celiac Disease
• Bowel Control Problems (Fecal Incontinence)
• Gas
• Lactose Intolerance
• Diarrhea
• Diverticulosis & DiverticulitisAcid Reflux (GER & GERD)

Probiotics are currently defined by the World Health Organization as "live microorganisms which when administered in adequate amounts confer health benefits on the host." There are trillions of bacteria which live in our digestive tracts. More than 400 different species have been identified. Most of these are healthy bacteria while others have the potential to cause damage to our intestinal systems.

Bacterial microflora of the gastrointestinal (GI) tract may play an important role in the pathophysiology of some GI disorders. Probiotics have been used as a treatment modality for over a century. They may restore normal bacterial microflora and effect the functioning of the GI tract by a variety of mechanisms. Probiotics are not currently regulated and only few randomized controlled trials exist investigating their efficacy in different GI disorders. They are available in a variety of formulations and delivery systems making interpretation and comparison of studies even more difficult. The efficacy of probiotics, either as a single strain or a combination of probiotics, has been tested in antibiotic-associated diarrhea, Clostridium difficile colitis, infectious diarrhea, ulcerative colitis, Crohn’s disease, pouchitis, and irritable bowel syndrome, among other disorders. Many questions regarding use of probiotics in GI disorders remain to be answered in future studies, such as most optimal doses, duration of treatment, physiological and immunological effects, efficacy of specific probiotics in specific disease states, and safety in debilitated patients.

Recent biological and medical advances have clarified the mechanisms of chronic liver inflammation and succeeded in providing new therapies for various liver diseases. The aim of this issue is to summarize the current status of the basic and clinical findings in chronic liver inflammation and its complications. Such information will help develop better management programs for patients and can improve their prognosis.

• Clinical Presentation, Disease Burden, and Resource Utilization
• Noninvasive Method for Estimating Hepatic Fibrosis
• HCV Genotype-4 Disease
• Herbal Supplements
• Hemophiliac Patients With HCV Infection
• Clinical Course in Patients Receiving Antiviral Therapy for Recurrent HCV-Related Liver Disease
• Nonalcoholic Steatohepatitis
• Potpourri
• Nonalcoholic Fatty Liver Disease
• Advances in the treatment of liver cirrhosis

Digestive, liver, and nutritional problems in children often are quite different from those seen in adults. Specialized training and experience in pediatric gastroenterology are important. Pediatric gastroenterologists treat children from the newborn period through the teen years. They choose to make pediatric care the core of their medical practice, which provides extensive experience specifically in the care of infants, children, and teens. We most commonly see children who complain of nausea, vomiting, diarrhea, constipation, soiling or stool incontinence, abdominal pain, unexplained weight loss, liver disease or elevated liver tests and congenital anomalies of the GI tract.

• Lactose intolerance
• Short bowel syndrome
• Acute or chronic abdominal pain
• Food allergies or intolerances
• Chronic constipation
• Chronic or severe diarrhea
• Pancreatic insufficiency
• Nutritional problems
• Feeding disorders
• Complicated Gastroesophageal reflux disease

Genetics and genomics are beginning to strongly influence the care of patients with GI conditions. From common disorders such as colorectal cancer, pancreatitis and multiple polyps; to rare conditions like hereditary hemorrhagic telangiectasia, knowledge of genomic developments is increasingly highly useful to doctors and their patients. And in the research realm, genomic analyses are beginning to dissect the etiology of clinically important but enigmatic conditions such as irritable bowel syndrome.

Molecular analyses have become an integral part of biomedical research as well as clinical medicine. The definition of the molecular and genetic basis of many human diseases has led to a better understanding of their pathogenesis and has in addition offered new perspectives for their diagnosis, therapy and prevention. Genetically, human diseases can be classified as monogenetic, complex genetic and acquired genetic diseases. Based on this classification, gene therapy is based on four concepts: gene substitution, gene augmentation, block of gene expression or function as well as DNA vaccination. While recent developments are promising, various delivery, targeting and safety issues need to be addressed before gene therapy will enter clinical practice.

Today, cancer is no longer solely defined by location or even by stage. We know there is no routine cancer, and there are no routine gastrointestinal cancers. Gastrointestinal cancers are complex diseases. Each patient’s cancer is different, behaving differently in the bodies they’re in and calling for a tailored, individualized treatment plans for each patient. Gastrointestinal cancer refers to malignant conditions of the gastrointestinal tract (GI tract) and accessory organs of digestion, including the esophagus, stomach, biliary system, pancreas, small intestine, large intestine, rectum and anus. The symptoms relate to the organ affected and can include obstruction (leading to difficulty swallowing or defecating), abnormal bleeding or other associated problems. The diagnosis often requires endoscopy, followed by biopsy of suspicious tissue. The treatment depends on the location of the tumor, as well as the type of cancer cell and whether it has invaded other tissues or spread elsewhere. These factors also determine the prognosis.

• Anal Cancer
• Colon Cancer
• Esophageal Cancer
• Gallbladder Cancer
• Liver Cancer
• Pancreatic Cancer
• Rectal Cancer
• Small Intestine Cancer
• Stomach (Gastric) Cancer

Neurogastroenterology encompasses the study of the brain, the gut, and their interactions with relevance to the understanding and management of gastrointestinal motility and functional gastrointestinal disorders. Specifically, Neurogastroenterology focuses on the functions, malfunctions and the malformations of the sympathetic, parasympathetic, and enteric divisions of the digestive tract. Disorders related to gastrointestinal motility (the movement of food contents through the GI tract) and gastric acid production are among the most common problems in the field of Gastroenterology and indeed, in all of medicine.

Peristalsis is a series of radially symmetrical contractions and relaxations of muscles which propagate down a muscular tube. In humans and other mammals, peristalsis is found in the smooth muscles of the digestive tract to propel contents through the digestive system.

Segmentation contractions are the contractions in intestines carried out by the smooth muscle walls. Unlike peristalsis, which involves the contraction and relaxation of muscles in one direction, segmentation occurs simultaneously in both directions as the circular muscles alternatively contract. This allows for thorough mixing of intestinal contents, known as chyme, to allow greater absorption.

The secretion of gastrointestinal enzymes, such as gastrin and secretin, is regulated through cholinergic neurons residing in the walls of the digestive tract. Hormone secretion is controlled by the vagovagal reflex, where the neurons in the digestive tract communicate through both afferent and efferent pathways with the vagus nerve.

Unlike liver disease, there are no gastrointestinal diseases specifically caused by pregnancy. However, pregnancy may complicate most gastrointestinal diseases, particularly gastroesophageal reflux and inflammatory bowel disease. In addition, gastrointestinal symptoms are extremely common in the pregnant patient. Symptoms such as nausea, vomiting, and dyspepsia occur in 50–90% of all patients.1 Most of these symptoms are a manifestation of normal altered physiology in which changes occur both functionally and anatomically. These changes may cause new symptoms, worsen preexisting disease, or mask potentially deadly disease. A lack of experience in dealing with these symptoms can have devastating effects. The physician must be able to distinguish whether these symptoms are those of normal pregnancy or a potentially life-threatening complication such as preeclampsia. The physician must also know which medications are safe in pregnancy, as well as which tests are safe to perform during pregnancy.

Some women have GI disorders that are unique to pregnancy. Other pregnant patients present with chronic GI disorders that require special consideration during pregnancy.