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Giant fibrovascular polyps of the esophagus are rare benign tumors that originate at the hypopharynx or the upper third of the esophagus. Because of the indolent and benign nature they are mostly discovered when very large with symptoms like dysphagia or regurgitation of the polyp into the mouth which can cause asphyxia and dead. The removal of these polyps is obligatory. Although more than 100 cases of giant fibrovascular esophageal polyps have been described in literature so far, the approach for removal is not yet standard and needs a customized use of medical technology from different disciplines. We present the case of a 42 year old man in whom a giant polyp was removed transorally by a combination of instruments and materials from different disciplines (gastroenterological, surgical and laryngological).

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In this case report we describe the evolution of Cheilitis granulomatosa (GC) in a young patient with Crohn's disease during treatment with anti-TNF-alfa therapy.

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The finding of a terminal ileitis after kidney transplantation can cause a diagnostic challenge. Because the development of Crohn's disease under immunosuppressive therapy is unlikely, this diagnosis should only be considered after exclusion of infectious disease and drug-related intestinal toxicity. Defining the underlying cause of terminal ileitis is often hampered by a shortage of specific diagnostic tests or their lack of sensitivity. We present three patients with terminal ileitis after kidney transplantation resulting from different etiologies. Subsequently, we describe the characteristics that can help to make the differential diagnosis.

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We present a case of a 41-year-old woman with severe abdominal pain caused by two jejuno-jejunal intussusceptions. Further investigation showed coeliac disease as the underlying cause. The patient recovered rapidly on a gluten-free diet. So coeliac disease could be the underlying cause of idiopathic intussusception more often than previously thought and intussusception should be suspected in patients with known coeliac disease presenting with abdominal pain. (Acta gastro-enterol. belg., 2016, 79, 000-000).

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Diverticulosis of the colon is a common disease with an increasing incidence in Western countries. Recent literature has shown some changes in the traditional approach of this disease. The theory that diverticulosis is caused by a reduced intake of dietary fibre, is doubtful. There might be some chemical and histological overlap between diverticulitis, inflammatory bowel disease and irritable bowel disease. High quality clinical study found no effect for antibiotics in acute, uncomplicated diverticulitis. Cyclic administration of mesalazine and rifaximin result in reduced symptoms of diverticular disease. For the treatment of diverticular abscesses, percutaneous drainage shows promising results. Recurrence of acute diverticulitis is rare and most serious complications are linked to the first episode. Recent evidence does not support the traditional recommendation for elective surgery after two episodes of acute diverticulitis any more. This review summarizes the last evidence in diverticular disease and diverticulitis.

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Distal intestinal obstruction syndrome (DIOS) - the incomplete of complete intestinal obstruction by intestinal contents in the terminal ileum and proximal colon- is frequently seen in cystic fibrosis (CF) patients. Diagnosis is based on suggestive symptoms of abdominal pain in the right lower quadrant, a palpable mass on examination and signs of obstruction on plain radiography. Treatment consists of intensive laxative treatment with oral laxatives and enemas. Surgery only serves as the last resort for patients not responding to medical therapy, because of the well-known high rate of peri- and postoperative morbidity of surgery in CF patients. In this article we present 3 cases of DIOS, followed by a review of the relevant literature.

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Crohn's disease is often accompanied by extraintestinal inflammation. Acute pancreatitis can be a rare manifestation of Crohn's disease. The present report describes a patient who developed two episodes of pancreatitis before the diagnosis of Crohn's disease. Clinical and laboratory evaluation excluded other causes of pancreatitis, confirming a direct association of the pancreatitis with Crohn's disease. This case report supports the hypothesis that acute pancreatitis may precede the clinical manifestations and diagnosis of the underlying inflammatory bowel disease.

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Acid peptic diseases such as peptic ulcer and gastrointestinal reflux disease have a high prevalence; they can have an important impact on the patient's quality of life and generate a considerable health care cost. Proton pump inhibitors are the most potent pharmacological inhibitors of gastric acid secretion currently available and are the mainstay medical therapy for acid peptic diseases. This review provides primary care clinicians with best practice guidelines for optimal use of these drugs.

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Reflux into the esophagus after partial or total gastrectomy is a well known problem. Even a Roux-en-Y reconstruction is not always a definitive solution. Bile reflux might occur and cause disabling symptoms, unresponsive to the classic anti-acid or anti-reflux therapy. Endoscopy and a Tc-99m-BrIDA hepatobiliary (HIDA) scan can be used to make the diagnosis. Clinical studies have shown that lanreotide (somatuline), which strongly inhibits many gastro-intestinal hormones, reduces the bile salts outputs. We present a case of a patient with bile reflux after Roux-en-Y. After administration of lanreotide he had a good clinical improvement and mucosal healing on endoscopy. Lanreotide can be a good treatment option for bile reflux when classic treatment fails, but clinical trials with more patients will have to confirm this.

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The increasing antimicrobial resistance of Helicobacter pylori jeopardizes the efficiency of the classical eradication triple therapy. In this article we assessed the primary resistance rates of Helicobacter pylori to the commonly used antibiotics for eradication in the area of Brussels and determined prospectively, through a questionnaire, the possible risk factors for resistance. Gastric biopsies were taken for histology and culture in all adult patients in whom Helicobacter pylori was searched from February 2009 to April 2010 at the UZBrussel hospital. Clinical and demographic data were collected through a questionnaire. Histology was positive in 222 out of 507 patients tested (43.7%). Culture was successful in 189 patients with a positive histology (85.1%), 4 patients had a positive culture with a negative histology. Resistance to clarithromycin, metronidazole, ciprofloxacin, and amoxicillin was tested. Primary resistance rates were 13.3% for clarithromycin, 26.1% for metronidazole, 23.9% for ciprofloxacin, 0.8% for amoxicillin. Dual resistance to claritromycin and metronidazole was seen in 3.9%, triple resistance (claritromycin, metronidazole and ciprofloxacin) in 1.7% and resistance to the 4 antibiotics in 0.6% of patients. We conclude that there is a decreasing resistance for clarithromycin, metronidazole resistance is stable and rapidly increasing ciprofloxacin resistance. Resistance to any of the tested antibiotics was not associated with origin, age, gender, number of siblings, level of education or status (p > 0.05).

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OBJECTIVE: Estimation of prevalence and risk factors for Helicobacter pylori (H. pylori) infection in children and young adults in Belgium. STUDY DESIGN: Five hundred and sixteen schoolchildren between 12 and 25 years old were tested for H. pylori infection using 13C-UBT in different regions in Belgium. A questionnaire was used to evaluate risk factors. RESULTS: Fifty six (11%) tested positive. In children born in Belgium, with parents from Belgium, 13 (3,2%) tested positive. In children born in a foreign country, 20 (60%) tested positive; if born in Belgium but 1 or 2 parents were from a foreign country, 15 (30%) tested positive. Differences were significant (p <0.001). In the multivariate analyses, significant risk factors were staying in a day nursery, a birthplace of child or father outside Belgium, and lower education levels of mother. CONCLUSION: In this cohort of Belgian asymptomatic children and young adults, the prevalence of H. pylori infection is 11%, ranging from 3,2% in Belgian born children with Belgian parents to 60% in children born in high prevalence countries from foreign parents. The most significant risk factor found in this study was origin.

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Heartburn, reflux and epigastric pain are frequently encountered symptoms in primary care medicine. Acid peptic diseases such as peptic ulcer and gastrointestinal reflux disease have a high prevalence, can have important impact on patient quality of life and represent a considerable health care cost. Proton pump inhibitors (PPIs) are the most potent pharmacological inhibitors of gastric acid secretion currently available and are the mainstay medical therapy for acid peptic diseases. This review summarizes current evidence on treatment of acid-peptic diseases with proton pump inhibitors and provides primary care clinicians with best practice guidelines for optimal use of these drugs.

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Finding small bowel metastases of melanoma can be important because surgical removal of unique small bowel metastasis of melanoma could improve survival. In this study, we evaluated if capsule endoscopy provides additional information after Pet CT has been performed. In this series of 9 patients collected from 3 university centers, capsule endoscopy influenced the therapeutic decision (to perform or not a surgical segmental resection) in 2/9 patients. All metastatic lesions were found in the proximal bowel. Capsule identified jejunum metastases in one case while Pet CT was negative, and identified metastases while Pet CT result was not conclusive. In one case PET CT identified mesenteric metastases while capsule was negative. SBCE influenced therapeutic decision in 2/9 patients concerning the decision of performing small bowel resection or not. In 1 patient SBCE changed the stage of the disease without affecting medical therapeutic strategy. The prognosis of patients with positive PET and/or capsule findings is very limited (2/3 died within the year). In selected patients, capsule endoscopy can provide complementary information once PET CT has been performed.

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A 33-year-old man presented with recurrent episodes of hyperemesis with symptom-free intervals since eight years. The diagnosis of cyclic vomiting syndrome due to longstanding and daily cannabis use was retained, after exclusion of any organic cause of vomiting. Although the patient was informed that the clinical response after cessation of smoking is proven to be spectacular, he continued the use of cannabis and kept on presenting with cyclic symptoms of hyperemesis.

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Obscure bleeding remains the most important indication for small bowel capsule endoscopy, but some other small bowel diseases have also been studied. The aim of this paper is to provide an overview of the recent literature concerning atypical or rare indications for the small bowel capsule endoscopy.

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