Transoral Outlet Reduction (TORe) for the Treatment of Weight Regain and Dumping Syndrome after Roux-en-Y Gastric Bypass.

Obesity is a chronic relapsing disease of global pandemic proportions. In this context, an increasing number of patients are undergoing bariatric surgery, which is considered the most effective weight loss treatment for long-term improvement in obesity-related comorbidities. One of the most popular bariatric surgeries is the Roux-en-Y gastric bypass (RYGB). Despite its proven short- and long-term efficacy, progressive weight regain and dumping symptoms remain a challenge. Revisional bariatric surgery is indicated when dietary and lifestyle modification, pharmaceutical agents and/or psychological therapy fail to arrest weight regain or control dumping. However, these re-interventions present greater technical difficulty and are accompanied by an increased risk of peri- and postoperative complications with substantial morbidity and mortality. The endoscopic approach to gastrojejunal anastomotic revision, transoral outlet reduction (TORe), is used as a minimally invasive treatment that aims to reduce the diameter of the gastrojejunal anastomosis, delaying gastric emptying and increasing satiety. With substantial published data supporting its use, TORe is an effective and safe bariatric endoscopic technique for addressing weight regain and dumping syndrome after RYGB.

[Eosinophilic gastrointestinal disorders]. / Gastroentérite à éosinophiles.

The term « eosinophilic gastrointestinal disorders ¼ describes a group of diseases that comprises eosinophilic esophagitis, gastritis, enteritis, and colitis. Eosinophilic esophagitis is the most prevalent form while eosinophilic gastritis, enteritis, and colitis are rare. Food antigens have increasingly been found to trigger the inflammatory response. This review will highlight the epidemiology, clinical manifestations, diagnostic modalities and therapeutic options of eosinophilic gastritis, enteritis, and colitis.

L'œsophagite à éosinophiles, la gastrite, l'entérite, et la colite à éosinophiles représentent un ensemble de pathologies appartenant au groupe des « eosinophilic gastrointestinal disorders ¼. Contrairement à l'œsophagite à éosinophiles, qui présente une incidence en nette augmentation, la gastrite, l'entérite et la colite à éosinophiles, rassemblées sous le nom de gastroentérite à éosinophiles (GEE), sont des entités rares. Dans de nombreux cas, l'inflammation est déclenchée par des allergènes ingérés. Cet article fait le point sur les dernières connaissances concernant l'épidémiologie, les manifestations cliniques, les modalités diagnostiques et les options thérapeutiques de la GEE.

[Acute diarrhea]. / Akute Diarrhoe.

Diarrhea, defined as three or more loose or watery stools per day, represents a frequent problem in outpatients as well as inpatients. As most of the patients with acute diarrhea show a self-limiting disease course, the main challenge for the physician is to discriminate patients for whom symptomatic therapy is sufficient from those with severe disease course and threatening complications. This review aims to provide a practical guidance for such decisions.

[Microscopic colitis: update 2014]. / Colites microscopiques--quoi de neuf?

Microscopic colitis, which includes lymphocytic colitis and collagenous colitis, represents a frequent cause of chronic watery diarrhea especially in the elderly population. Several medications, such as nonsteroidal antiinflammatory drugs, proton pump inhibitors or antidepressants, as well as cigarette smoking have been recognized as risk factors for microscopic colitis. The diagnosis of microscopic colitis is based on a macroscopically normal ileo-colonoscopy and several biopsies from the entire colon, which demonstrate the pathognomonic histopathologic findings. Therapy is mainly based on the use of budesonide. Other medications, such as mesalazine, cholestyramine and bismuth, have been evaluated as well but the evidence is less solid.

[Highlights in gastroenterology and hepatology 2013]. / Actualités en gastroentérologie et hépatologie.

This review highlights recent advances in gastroenterology and hepatology, including new insights into the diagnosis, pathogenesis and the treatment of ulcerative colitis, of achalasia, of irritable bowel syndrome, of chronic hepatitis B and of eosinophilic esophagitis. These new developments will be summarized and discussed critically, with a particular emphasis on their potential implications for current and future clinical practice. The recent advances on treatment of chronic hepatitis C will be published in another summary this year.

Cohort Profile: The Swiss Eosinophilic Esophagitis Cohort Study (SEECS).

BACKGROUND AND AIMS: The prospective, observational Swiss Eosinophilic Esophagitis Cohort Study (SEECS) was set up in 2015 with the following goals in mind: (1) to provide up-to-date epidemiologic data; (2) to assess the appropriateness of care; (3) to evaluate the psychosocial impact; and (4) to foster translational research projects. Data capture relies on validated instruments to assess disease activity and focuses on epidemiologic variables and biosamples (esophageal biopsies and blood specimens). An annual inclusion of 70 new patients with eosinophilic esophagitis (EoE) or proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is intended. We herein describe the SEECS cohort profile. METHODS: The SEECS includes adult patients (age ≥18 years) with EoE or PPI-REE diagnosed according to published criteria. After inclusion, the patients are typically seen once a year for a clinical and endoscopic/histologic follow-up examination. Data are captured using validated questionnaires. Biosamples from patients with gastroesophageal reflux disease (GERD) and controls with a healthy esophagus are collected as well. RESULTS: From January 2016 to July 2017, a total of 111 patients with EoE and 10 patients with PPI-REE were recruited. In addition, esophageal biopsies and blood samples from 11 patients with GERD and 20 controls with a healthy esophagus were collected. The mean age of the patients with EoE and those with PPI-REE was 39.6 ± 12.9 and 44.6 ± 15.6 years, respectively. A male predominance was found among both the patients with EoE (77.5%) and those with PPI-REE (70%). Concomitant allergic disorders were found in 79.3% of the patients with EoE and 90% of the patients with PPI-REE. At inclusion, the EoE patients were treated with the following therapeutic regimens: no therapy (0.9%), PPI (36%), swallowed topical corticosteroids (82.9%), elimination diets (15.3%), and esophageal dilation (19.8%). CONCLUSIONS: The SEECS is the first national cohort study of patients with EoE or PPI-REE. The SEECS will provide up-to-date epidemiologic data and foster translational research projects.

Medical care of type 2 diabetes mellitus in light of international and national recommendations: a retrospective analysis.

QUESTION UNDER STUDY: Type 2 diabetes mellitus (T2Dm) is a chronic disease with great economic impact. In 2009, the Swiss Society for Endocrinology and Diabetes (SSED) published recommendations for treatment of T2Dm. In Switzerland, few data are currently available on metabolic control and physician compliance with treatment guidelines. We aimed to investigate clinical care in T2Dm in the year after the publication of SSED recommendations. METHODS: We retrospectively studied the charts of all patients with T2Dm admitted to our general internal medicine clinic during 2009. Metabolic control was judged from glycated haemoglobin A1c (HbA1c) levels. Antidiabetic therapy was analysed, and frequencies of screening for end-organ damage were investigated. A group with newly diagnosed T2Dm was analysed separately from patients with known T2Dm upon admission. RESULTS: In patients with known T2Dm, the mean (± standard deviation) HbA1c level was 7.66% ± 1.73%. Only 44% of patients showed HbA1c levels at the target of ≤7%. Prior to admission and at discharge, 56% and 55% of patients, respectively, were treated with metformin. Among patients with HbA1c >8.5%, the proportion of those treated with insulin increased from 49% upon admission to 76% at discharge. Only half the patients received a lifestyle intervention in the year prior to admission or during hospital stay. Screening for diabetic retinopathy and nephropathy was performed in approximately one-third and two-thirds of patients, respectively. CONCLUSIONS: In the majority of unselected T2Dm patients admitted to our hospital, metabolic control was suboptimal. Implementation of treatment recommendations by both general practitioners and hospitals should be improved.