Mistakes in decompensated liver cirrhosis and how to avoid them
Protecting against future decompensation episodes is key
Patients with early stages of chronic liver disease and even those with compensated cirrhosis can present without any clinical symptoms, which means that liver disease and ongoing liver damage can remain unidentified for many years. However, morbidity and mortality drastically increase once the stage of ‘decompensated cirrhosis’ has been reached.1,2 Decompensated cirrhosis describes the development of clinically overt signs of portal hypertension and/or impairment of hepatic function (e.g. variceal bleeding, ascites or overt hepatic encephalopathy). The first hepatic decompensation event significantly increases the risk that further complications of liver cirrhosis and decompensation episodes will occur.2 Moreover, individuals who have advanced stages of liver cirrhosis are four times more susceptible to infection, which is, in turn, the most frequent trigger of hepatic decompensation.3,4
Enhance your knowledge about ERCP
Gastrointestinal Neuroendocrine Tumours
Learn about NETs
What not to do at UEG Week
Most common things you should avoid when attending UEG Week, to help you get the most out of your congress participation.
Attending international conferences is important to stay up to date in the world of digestive health. For junior specialists, a big congress like UEG Week can be overwhelming. Henriette Heinrich is Gastroenterology Consultant in the Stadtspital Triemli, Zuerich, Switzerland, and incoming chair of the Young Talent Group. She has summarised the most common things you should avoid when attending UEG Week, to help you get the most out of your congress participation.
1. Not attending!
2. Not planning ahead @UEG Week
3. Not paying a visit to the Young GI Lounge (Hall 8.0)
4. Not jumping into the UEG Talent Pool
5. Not attending the Young GI Network event "Let’s meet!"
6. Not checking out the Education Booth (Hall 8.0)
7. Staying offline
- The UEG Week Mobile App (see pitfall number two)
- Online content to watch or rewatch (again, see pitfall number two)
- The UEG Week live video chats, during which surgeons and gastroenterologists battle it out and we explore the compatibility of having a job and a family. YOUR ONLINE INPUT AND QUESTIONS ARE HIGHLY APPRECIATED!
- Missing the news updates about UEG Week on Twitter, Instagram and Facebook
8. Missing out on seriously important events on research funding for scientists
- EU funded Cooperation Networks in GI: How to get involved?
- Fellowships and grants: How UEG can help your career
- EU funding opportunities and strategy in digestive health
9. Not bringing your team
Why students should attend UEG Week
3 medical students reveal how they experienced UEG Week.
Ivelina Georgieva, Giusi Sciume and Nikolay Manov study medicine in Italy and Bulgaria and attended UEG Week for the first time in 2018. In this video, they tell Radislav Nakov and Gianluca Ianiro why attending a big international congress can be helpful for undergraduate students’ careers as well and what they liked most about UEG Week.
Mistakes in chronic hepatitis B management and how to avoid them
All patients require long-term monitoring.
Hepatitis B virus (HBV) infection is the most common chronic viral infection in the world. Despite the availability of a preventative vaccine, more than 250 million people worldwide are chronically infected with HBV. The complications of chronic HBV infection—cirrhosis and hepatocellular cancer (HCC)—account for more than 850,000 deaths per year.1 HBV is transmitted haematogenously and sexually, with the majority of HBV infections being transmitted vertically (or perinatally) in high prevalence regions.2 HBV infection acquired at birth or in early childhood results in chronicity in >95% of cases, whereas only 5–10% of those who are infected in adulthood will progress to chronic infection.
Mistakes in the management of ECF and how to avoid them
Gl fistulae can be one of the most challenging complications of intestinal disease to manage
Gastrointestinal fistulae can be one of the most challenging complications of intestinal disease to manage. These abnormal tracts connect the epithelialised gut surface to either another part of the gut, another organ or tissue, or to the skin (table 1). This connection can cause enteric contents to bypass important absorptive surfaces, resulting in insidious malnutrition or overt diarrhoea, infection within other organs or the exquisitely embarrassing occurrence of having faeculant material in a woman’s vagina or on a person’s skin. Understandably, this can have a major impact on a person’s quality of life and psychological wellbeing and hamper overall prognosis in terms of general health and wellbeing. Through careful multidisciplinary management of the situation much can be done to address the fears and expectations of patients: careful stoma management, medical therapies to control output, nutritional support and consideration of the central role that surgery plays in resolving a fistula.
What you always wanted to know from UEG Rising Stars...
Current and previous awardees answer our questions.
The Rising Stars Award provides a durable platform for young researchers to further improve and progress in their professional career. Current and previous UEG Rising Stars told us more about their experience receiving this award and how they benefited.
Take the next step in your research career and apply to become a Rising Star!Watch video interviews with other UEG Rising Stars.
How did the Rising Star Award contribute to your career in the long run?
What meant winning the UEG Rising Star Award to you and how has your career developed since you received the award?
What is the right moment and career stage to apply for the Rising Star Award and what will increase candidates’ chances to receive it?
Do you have any tips for Rising Star Award applicants? What should they consider and what should they focus on?
Do you have any tips for researchers from countries that offer fewer scientific opportunities? How can they compete in the run for the Rising Star Award?
How did you experience receiving the Rising Star Award and presenting your research on the stage?
Has the Rising Star Award made an impact on your career so far?
What was your motivation to apply for the Rising Star Award and what are your expectations?
Women in endoscopy
Marianna Arvanitakis talks about the situation and obstacles for women in interventional endoscopy.
Marianna Arvanitakis is an Associate Clinical Professor in the Department of Gastroenterology, Hôpital Erasme, Brussels and specialises in pancreatic disease, nutrition and endoscopy.In this video, YTG member Ivana Mikolasevic talks to her about the situation and obstacles for women in endoscopy, in particular interventional endoscopy.
Ready to put your GI knowledge to the test?
Mistakes in refractory coeliac disease and how to avoid them
Assessing adherence to a GFD and the initial coeliac disease diagnosis are important
Refractory coeliac disease (RCD) is characterized by the persistence or recurrence of symptoms and signs of malabsorption associated with villous atrophy in patients with coeliac disease who have adhered to a strict gluten-free diet (GFD) for more than 12 months.1–3 Serology is usually negative or, in a small percentage of cases, positive at a low titre.4 Splenic hypofunction, a risk factor for RCD, can be indicated by Howell–Jolly bodies and pitted red cells in a peripheral blood smear. A reduced spleen size visible on ultrasound examination also provides direct evidence of hyposplenism.5
From clinical fellow to clinical lecturer – how to secure a post
Neel Sharma of the University of Birmingham shares his tips.
Post undertaking a research fellowship, the decision to remain as a clinician academic is the first one to take. If motivated and passionate enough it is a no brainer. However entering the next stage of training from fellow to lecturer is no easy feat; limited funding and posts. That in itself is a true test of your commitment.
Dr Neel Sharma, GI Registrar and Clinical Lecturer at the Institute of Immunology and Immunotherapy and Institute of Translational Medicine, University of Birmingham shares his tips that may prove useful for those hoping to secure a post.
- Reach out to potential supervisors before submitting your application. It is advisable to show interest early on. Sending out an email and arranging an informal meeting helps to demonstrate your background thus far, your research progression during your fellowship and more importantly your understanding of the field. Supervisors are keen to know how well you recognise the current gaps in the evidence and how you may choose to solve them. Of course there is no one solution but the exchange of thinking is a fundamental element in academia. By meeting potential supervisors they can gauge how well you would fit their lab or research interests and if not which other supervisors may be better suited to you.
- The application form. The application process is fairly straight forward, highlighting your degrees thus far, prizes, publications and presentations. Where you will be able to set yourself apart is highlighting your long-term plan and what you can bring to the department in terms of your skillset. And here there is no right or wrong. Collaboration is key for any successful researcher. You must demonstrate an awareness of such and potential collaborations thus far is crucial. It is now overtly outdated to think that one centre can achieve academic success without reliance on other institutions. There is now no single expert. Have you taken steps to develop a network early on? Are you culturally aware? Ensuring diversity in your research network with a willingness to embrace expertise both East and West will set you apart from the rest.
- The interview. And last but by no means least the interview. Interviews are never plain sailing. You may have to face several. But your approach should be consistent each time. It is highly likely that you will be asked to analyse a research study. This will help to highlight to panel members your ability to condense a paper in to its main findings and of more importance its potential flaws. Gain an understanding of trial methodology and data analysis, most of which you will be familiar with post fellowship but there may be some methods or stats you may not be aware of. You will be asked about your research vision and so be concrete in your beliefs. Even if some panel members disagree stick to what you believe. And what you want to add to the field, even if widely different to the panel. Remember you are not here to solve all the research gaps but to add to the understanding of the discipline over your career. Demonstrate to the interviewers your motivation and even if criticised remember the criticisms are designed simply to ensure what you aim to contribute will be more rigorous and more translatable in the future.
Achalasia: Physician versus Surgeon
Two European experts give their opposing views on the best treatment option for achalasia
Oesophageal achalasia is a rare motility disorder, in which peristalsis is impaired or absent and the lower oesophageal sphincter fails to relax. Symptoms of achalasia include dysphagia, regurgitation of undigested food, coughing and choking, chest pain and chest infections.
We invited two European experts to give their opposing viewpoints—physician versus surgeon—on the best treatment option for achalasia.
A Physician's Viewpoint—Paul FockensAlthough the title of this blog quickly attracted your attention, it is actually not a choice between physician and surgeon but a choice between peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM). From a patient's point of view, the natural orifice approach will be preferred as it diminishes complications and reduces recovery time. But are both treatments equal in their efficacy and safety profile? There are many studies that suggest the efficacy of both POEM and LHM is excellent, but POEM has not been around very long so less evidence is available. Two large randomized controlled trials presented in abstract form and awaiting full publication both demonstrate the high efficacy of POEM, which seems equal to LHM and superior to a set of two pneumatic dilations. But how about safety? POEM is significantly less invasive, and thereby safer, than LHM; complications are very rare and usually mild. Therefore, with comparable efficacy and improved safety when compared with LHM, POEM seems to have a bright future. Is there any disadvantage to POEM? Yes, there is one issue and that is reflux. POEM can currently not be combined with an endoscopic antireflux procedure, so a significant percentage of patients will have to use proton pump inhibitors after POEM. It is up to the patient, after care has been taken to inform them about all available treatment options, to come to a shared decision with their doctor. Without a doubt in my mind, I believe POEM will frequently be the patient's favourite choice! References
- Ponds FA, et al. Peroral endoscopic myotomy (POEM) versus pneumatic dilatation in therapy-naive patients with achalasia: results of a randomized controlled trial [abstract 637]. Gastroenterology 2017; 152 (suppl 1): S139.
- Werner YB, et al. Endoscopic versus surgical myotomy in patients with primary idiopathic achalasia [abstract LB08]. United European Gastroenterology Journal 2018; 6: 1590.
A Surgeon's Viewpoint—Giovanni ZaninottoSurgical treatment of oesophageal achalasia divides the muscle fibresof the distal oesophagus and cardia, leaving the underlying mucosa intact. Consequently, resistance of the lower oesophageal sphincter to the flow of the bolus is diminished. Heller myotomy, named for the German surgeon who performed it first (in 1913), has been completed laparoscopically (LHM) since 1990, with a partial wrap of the fundus added to prevent iatrogenic gastro-oesophageal reflux disease (GORD). LHM has gained vast popularity because of its efficacy in reducing dysphagia (89% and 85% of patients are asymptomatic at 5 and 10 years, respectively) while maintaining a very good safety profile (mortality <0.1%, morbidity <7%). Postoperative reflux is observed in 10–20% of patients when a partial fundoplication is added to LHM. Three randomized controltrials and three meta-analyses have compared the efficacy of LHM with that of pneumatic dilation, revealing that pneumatic dilation can achieve the same efficacy as LHM only after multiple, sequential dilations. Moreover, LHM is more effective than pneumatic dilation for treatment of type III spastic achalasia. There are no randomized control trials published in full that compare LHM with POEM, though two meta-analyses show that POEM achieves slightly (but significantly) better symptomatic control than LHM, especially for type III achalasia. However, the duration of the patient follow-up was shorter for POEM, and POEM presented a higher risk of postoperative reflux (20–40%). I believe five small abdominal scars are preferable to an increased risk of GORD, and that LHM remains the 'single-shot' better option for achalasia patients. References
- Boeckxstaens G, Zaninotto G and Richter JE. Achalasia. Lancet 2013; 383: 83–93.
- Zaninotto G, et al. The 2018 ISDE achalasia guidelines. Dis Esoph 2018; 9: 1–31.
Dealing with nutrition, diet, microbiota and IBS
Nutrition expert Heidi Staudacher speaks about advances in IBS research.