A rare biopsy finding with many possible causes
What's causing epigastric abdominal pain and nausea in this 55-year-old man?
A 55-year-old man was referred to our general gastroenterology clinic by colleagues from the renal transplant unit for evaluation of persistent epigastric abdominal pain and nausea that had been present for the past 6 months and had started to interfere with his quality of life.The patient’s past medical history included allogeneic renal transplantation 3 years prior, secondary to progressive hypertensive kidney disease. His current immunosuppression regimen was mycophenolate mofetil, cyclosporine, everolimus and steroids, while his hypertension was being controlled with nebivolol. The only other drug taken on a regular basis was oral iron supplementation to manage mild hypochromic anaemia. His symptoms had failed to resolve with a proton pump inhibitor (PPI) trial administered by a gastroenterologist in private practice. He had also undergone noninvasive testing (urea breath test) for the presence of Helicobacter pyloriinfection, with the result being negative. He denied weight loss, vomiting, changes in bowel habit, fever or any other accompanying symptoms in the same time period as his main complaints. No significant information was elicited from his family or regarding his social history (including travels and sexual behaviour). Physical examination findings were unremarkable. The patient had recently undergone blood tests that revealed no significant changes from his previous baseline values. In view of the above symptoms and history an upper gastrointestinal endoscopy was scheduled and performed. The endoscopic findings included erythema with small erosions of the gastric mucosa. Multiple biopsy samples were obtained from areas with findings and also from macroscopically normal mucosa. Histological findings are shown in figure 1. Figure 1 | Histological findings in the stomach of the case patient. Haematoxylin and eosin (H&E) staining. Magnification x400.
Case Question 1WHAT IS THE HISTOLOGICAL DIAGNOSIS? A. MALT lymphoma B. H. pylori-associated chronic gastritis C. Granulomatous gastritis D. Gastric adenocarcinoma E. Collagenous gastritis
Case Question 2IN VIEW OF THE PAST HISTORY OF THIS PATIENT, WHAT WAS THE UNDERLYING CAUSE OF THE SYMPTOMS OBSERVED? A. Sarcoidosis B. Granulomatosis with polyangiitis C. Crohn’s disease D. Tuberculosis E. Histoplasmosis F. A drug-induced reaction G. Helicobacter pyloriinfection H. Whipple’s disease
Case Question 3HOW SHOULD WE PROCEED REGARDING THE MANAGEMENT OF THIS PATIENT? A. Acid suppression with PPIs B. Investigate other possible causes C. Stop iron supplementation and take repeat biopsy samples D. Stop iron supplementation and investigate other possible causes
Apply for a UEG Activity Grant to produce an online course
Developing an online course is not as complicated as you may think.
Mistakes in enteral stenting and how to avoid them
Indications include stenosis (oesophageal and colonic) and gastric outlet obstruction
Gastrointestinal stent placement was introduced at the end of the nineteenth century when it was performed in patients who had a malignant oesophageal obstruction.1 Nowadays, gastrointestinal stents are placed for multiple indications, such as oesophageal stenosis (Figure 1), gastric outlet obstruction (Figure 2) and colonic stenosis (Figure 3).
Tough but doable
8 Tips for passing the European Specialty Examination in Gastroenterology and Hepatology
Anthea Pisani is a gastroenterology trainee in Mater Dei Hospital in Malta. She passed the European Specialty Examination in Gastroenterology and Hepatology in April 2018 and gave a talk about “Tough but doable: A personal view on the exam” in the Young GI Lounge at the subsequent UEG Week in Vienna. Her presentation was very much appreciated, so we asked Anthea to share her top tips for passing the exam in the GI Hive.
So, you have decided to sit for the European Specialty Examination in Gastroenterology and Hepatology. Perhaps this was a voluntary decision on your behalf in order to broaden your horizons, or it may be a mandatory aspect of your training. It may be your first attempt or maybe a re-attempt and you might be at the beginning of your training or at the end of it. Either way, good luck with your preparations. Here are some points to help guide you towards becoming a European board certified Gastroenterologist.
Learn about Autoimmune Pancreatitis
From bench to the UEG floor
A personal experience from an young gastroenterologist from Egypt and how UEG helped him to achieve his goals.
Mohammed Khorshid, a young gastroenterologist, tells us his personal success story of being invited to give an oral presentation at UEG Week.
The London Neurogastroenterology Course
Learn about pathophysiology and evidence-based treatment of functional GI disorders
13th EDS Postgraduate Course
EDS aims to support young surgeons and gastroenterologists during their residency training.
UEG Classroom Courses
These educational events are perfect opportunities to increase your GI knowledge.
Radislav Nakov, member of the YTG and the Education Committee explains what’s happening at UEG’s classroom courses and who should attend them.These educational events are perfect opportunities to increase your GI knowledge but also to expand your professional network. Find out more about the courses and how to apply.
An incidental diagnosis by endoscopic ultrasound
What has been detected by follow-up EUS in a patient with a multifocal IPMN?
An asymptomatic 66-year-old male patient with a multifocal intraductal papillary mucinous neoplasm (IPMN) underwent a follow-up EUS examination with a linear array echoendoscope. His medical history included diabetes, hypertension and smoking. While advancing the echoendoscope in the oesophagus, the endoscopic ultrasound (EUS) image shown was captured.WHAT IS YOUR DIAGNOSIS? A. Oesophageal duplication cyst B. Aortic aneurism C. Mediastinal cyst D. Aortic dissection
Work-life balance: 10 tips from the UEG Week 2018 experience
A list of Dos and Dont's that came out of the Career Chat.
Carolina Ciacci is a full Professor of Gastroenterology at University of Salerno (Italy), a member of the UEG Equality & Diversity Taskforce and a mother of two adult children. At UEG Week 2018, she participated in the session “Career Chat: Women as educators” and in the Facebook live chat “How to improve work-life balance for doctors?”. Based on these discussions and her own personal experience she shares her ten tips for work life balance in this edition of the GI Hive.
Here is a list of Do's and Dont's that came out of the Career Chat:
- Make a careful analysis of your potential and find out how to empower yourself, both at work and within the family.
- Set up your priorities, short and long-term goals. Get the skills you need to succeed. Look around, find a spot for you in your working setting, fill up the empty space with expertise and knowledge. Live up to your potential!
- Choose your family partner carefully. This will help to share your family duties with him/her. Make a written list of each of your tasks. Try to set a routine for chores but know that you both need to be flexible.
- Ask for help! Outsourcing is not a shame. It is hard to be on the same day on call, a mother, and a good housekeeper. Hire all the help you can afford, even if you have to pay a fee.
- Make a careful plan of your expenses, since outsourcing is expensive. In some periods of your life, it is more important to spend less on entertaining and more on babysitting or housekeeping.
- Be efficient! Consider reducing commuting by living close to the workplace, or the kindergarten/ school. Find a gym next to your working place and go whenever you can. Check on your smartphone the time you spend on social media. You will be surprised how much time you waste scrolling the screen of your phone (yet it is sane to do that for some time!)
- Keep healthy! Eat well, train your body, and get a good night´s sleep. Don’t forget to look after your mind. Have a little quiet time alone. Enjoy small moments of harmony. It is vital to be fit for the daily challenges of your life.
- Learn to say “no”! Saying “no” is difficult; however, you need to protect yourself from unnecessary and unfair demands that will add nothing to your personal growth and career. Be firm and protect your space.
- Failure is not an option (Gene Kranz, Apollo 13). Accept the possibility that sometimes in your life your career might slow down temporarily because of family engagements. Use your time at home cleverly; you might find a way to write a review or improve your knowledge in a particular field.
- Do not mix up family and work. When you are at work, focus on what you are doing. Do not make unnecessary phone calls or waste time discussing your family life with your colleagues. Remember also that your colleagues may have supported you when you were on parental leave, so be helpful and available for them, too. On the other hand, if you are at home with your family limit checking your emails, or answering phone calls as much as possible. Multitasking will not work if you are striving for excellence in both fields.
- World Economic Forum. The Global Gender Gap Report 2017
Mistakes in chronic diarrhoea and how to avoid them
Chronic diarrhoea is a common condition with a wide variety of possible causes
Chronic diarrhoea, lasting more than 3 or 4 weeks, is a common condition with a wide variety of different possible causes. Estimates suggest 5% of the population have experienced chronic diarrhoea and sought medical advice about it. All gastroenterologists see many patients whose principal complaint is frequent, loose stools, and will be aware of investigations that are needed to diagnose serious conditions such as inflammatory bowel disease (IBD) or colorectal cancer (CRC). Most people who present with chronic diarrhoea will not have these conditions and, if less common disorders are not considered, may be given a diagnosis of diarrhoea-predominant irritable bowel syndrome (IBS-D) or perhaps functional diarrhoea.1 Many different treatments are used for IBS-D and often benefit only a small proportion of patients, leaving many with unmet needs, seeking further investigation, advice and treatment.Guidelines for the investigation of chronic diarrhoea in adults have recently been updated.2 These guidelines provide recommendations for investigating most patients who have chronic diarrhoea, and reflect the now greater availability of simple tests such as faecal calprotectin, coeliac serology, lower gastrointestinal endoscopy and tests for bile acid diarrhoea (BAD). The criteria for functional gastrointestinal disorders were revised in 2016 (Rome IV), with modifications made to the definitions of the various functional bowel disorders (FBD).1 The revised criteria recognise a continuum between functional diarrhoea and IBS-D, and the usefulness of the Bristol stool form scale (BSFS) types 6 and 7 for defining diarrhoea. Approaches to the clinical evaluation of patients are indicated in those articles,1–2 which provide much of the evidence discussed here, backed up by my clinical experience, highlighting certain mistakes that can be made in the management of chronic diarrhoea.
UEG Research Fellowship
UEG YTG Member Gianluca Ianiro talks about this revolutional UEG grant for researchers.
We spoke with Gianluca Ianiro, a gastroenterologist at Policlinico Universitario A. Gemelli in Rome, and a member of the UEG Young Talent Group (YTG) and UEG Research Committee
European Specialty Examination in Gastroenterology and Hepatology
The ESEGH is a high quality, reliable examination, based on a proven format.
Enhance your knowledge with the UEG Library!
Find new educational online content from UEG Week 2018 subtitled into Spanish.