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. 

The World Economic Forum Gender Gap Report of November 2017 indicated that it would take 100 years to close the gender gap at a world level1. While some academics are working towards closing the education gap, the intent to parity is yet to be translated into action on the representation and voice in other professional areas.
In the medical science field, the increasing number of women has not paralleled so far by a proportionate number of women in the leading positions, nor by a modification of the man-tailored traditional working environment in one more suitable to the modern model of family. It is believed that woman leadership can accelerate the process of women empowerment, via closing the education gap, translating the good intents into action, but mainly by identifying and removing barriers for women to succeed. 
United European Gastroenterology (UEG)’s  global vision is of promoting and providing equal opportunities and to be a place free of discrimination. The vision is supported by the UEG Equality & Diversity Task Force (E&D TF). During UEG Week 2018, the Equality & Diversity Task Force and the Young Talent Group of UEG organized the Career Chat and a Facebook live interview with the aim of supporting young gastroenterologists (GIs) to reach their goals and a satisfying work-life balance. 
Both initiatives were successful, and the discussion aimed to make both senior and young GIs conscious and creative in removing inherent barriers to succeed. It was recognized that the working set in most GI and endoscopy units is still man-modelled. However, young doctors felt the need to set up systems that help them to go through the natural life stage changes while having a satisfying career. The participants (both genders, but in the vast majority woman) expressed their need to find the right track in advancing women and making the workplace more gender-inclusive. 
In the Career Chat, was highlighted that the vast majority of the “leadership” or “career” challenges women GIs are facing are neither career nor profession related. They are emotional, often linked to the sense of guilt of not being a good parent because of the time and efforts spent at work. As a result women, especially mothers, have a sense of failure in achieving good results both at home and at work. The discussion between the senior and young participants of the Career Chat showed that to become successful and fully express their strengths and creativity, professionals independent of gender should strive to have some habits but might also need to give up some of them.

Here is a list of Do's and Dont's that came out of the Career Chat: 

  1. Make a careful analysis of your potential and find out how to empower yourself, both at work and within the family.   
  2. 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! 
  3. 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. 
  4. 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. 
  5. 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.
  6. 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!)
  7. 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.   
  8. 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.
  9. 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.  
  10. 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.    
It seems that there is not a perfect recipe to achieve work-life balance. It will never be 50:50 because the amount of time and efforts to dedicate at work or at the family/social life will vary according to the personal priorities and also the times of life. In conclusion, senior and young GIs agreed with the idea that life as a physician is tough but rewarding. The recommendation is to refuse to give up being a woman and a mother. Life experience will give a woman leverage in being a physician, maybe a better one. Reference:
  1. 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

Together with the Research Committee and the YTG, Gianluca developed a new UEG grant, the UEG Research Fellowship. In 2019, UEG will award a grant of € 50,000 to a researcher so that they can spend 12 months working with a renowned European principal investigator (PI). 
The Research Fellowship is suitable for clinical or basic researchers from Europe or the Mediterranean area. Those who are in training, have completed their training or PhD within the past 3 years or already have significant research experience are eligible to apply. The Research Fellowship is highly recommended for young researchers who want the opportunity to develop their ideas in a new working environment.
Download the detailed information and criteria, and apply by no later than January 18, 2019.

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.

Mistakes in pancreatic cystic neoplasms and how to avoid them

Surveillance and therapeutic approaches need to be tailored appropriately

Pancreatic cystic neoplasms (PCN) are a frequent and clinically challenging condition. PCN prevalence increases with age and reports estimate that they may be present in 2–45% of the general population1,2. In addition, the biological behaviour of the various types of PCN differs (ranging from benign to malignant [table 1]), requiring different surveillance and therapeutic approaches. Correct management of PCN is, therefore, critical for avoiding progression to cancer, but at the same time avoiding unneeded close and long-term follow-up, unnecessary invasive diagnostic procedures and overtreatment.


In this article, we discuss some frequent and relevant mistakes that can be made in the diagnosis, surveillance and management of PCN, and propose strategies to avoid them. These strategies are mainly based on the recently published European evidence-based guidelines on PCN.3

Mistakes in... booklet 2018 out!

With more than 40,000 page visits in the first 7 months of 2018, this series is one of the highlights of our educational offering.

National young GI sections and the ECYG

Ivana Mikolasevic talks about the European Conference of Young Gastroenterologists

The GI Hive is a brand-new blog from the UEG Young Talent Group (YTG) that covers the most up-to-date information about life, career development, education and opportunities for young gastroenterologist in Europe. Interviews, infographics, WhatsApp conversations and videos with both junior and renowned gastroenterologists will all be published in the GI Hive on a regular basis.

Our latest guest in the GI Hive is Ivana Mikolasevic, a member of the UEG YTG and an associate professor in Rijeka, Croatia. In December 2018, Ivana and a group of young gastroenterologists from the Croatian Young GI section (Tomislav Bokun, Maja Mijić, Sanja Stojsavljević, Nadija Skenderević, Ana Ostojić, Viktor Domislović, Ivan Jakopčić, Petra Puž) are holding the first European Conference of Young Gastroenterologists in Zagreb, Croatia. Ivana is president of the organizing committee and shared a few words with us about the conference and the Croatian Young GI Section.

There are still countries in Europe without a young GI section and the YTG has published a paper on how to start one. Could you tell us how everything started in your country and about the organisation of the Croatian Young GI section and its activities?

We revived the inactive youth section of our national society of gastroenterology in 2013. We first started having meetings during national society meetings/congresses, following the organisation of dedicated sessions for young gastroenterologists when they presented their best scientific work. Then we took over the administration of our society's webpage and gradually the idea of having our own meeting grew. At the beginning of 2017 we organised the first three-day symposium dedicated to members of the youth section: it was a great success and was repeated early this year. To be honest, as we are a rather small community, we were sceptical about having our own meeting, but it eventually appeared to become almost like a necessity and the occasion all young members eagerly awaited—to meet each other and be able to discuss common interests and problems. Our senior colleagues have been extremely supportive of all our activities, so we would suggest that young gastroenterologists start activities for themselves in their own countries without fear, and that they ask for support of any kind from senior colleagues.

How did you decide to organise the first European Conference of Young Gastroenterologists (ECYG)?

So, I talked in front of our small ECYG team—Tomislav Bokun, Maja Mijić, Sanja Stojsavljević, Nadija Skenderević, Ana Ostojić, Viktor Domislović, Ivan Jakopčić, Petra Puž and me. The idea for the conference organisation was born within the Youth Section of the Croatian Society of Gastroenterology, with a desire to stimulate and strengthen international cooperation.  We already have annual meetings of the youth section when we discuss how to improve our education; we hold lectures about specific topics in digestive health and so on. We wanted to do the same thing with this conference but on a European level, because we have all had such good experiences making contact with colleagues from other countries who we met on courses and congresses we have attended during our education. Therefore, we wanted to create something that would be focused on young gastroenterologists and their networking, under the supervision of senior experts established in specific fields of gastroenterology. The idea of gathering together as many young GIs as possible so that we can make new contacts and share experiences made us enthusiastic, although, at first, none of us were probably aware of exactly what we were getting ourselves into. Then, once we put down all the assignments on paper, we rolled up our sleeves and started working.

What can young GIs learn by attending the ECYC?

This is the first conference targeting young gastroenterologist from all over Europe with the purpose of exchanging experience, knowledge and ideas with eminent professors and researchers. The main idea of the conference is for us, young gastroenterologists, to have a chance to present our most challenging clinical cases and discuss them with our peers and acknowledged experts in the field. Furthermore, ECYG gives us the opportunity to present our clinical and scientific work in a poster presentation form. Not only that, during hands-on sessions young delegates will be able to improve their manual skills in abdominal ultrasound, Colour Doppler, elastography and endoscopy. Moreover, this conference will enable us to initiate constructive and productive dialogues and to create a network for future collaboration with colleagues all over Europe. Finally, to enable us to achieve this goal, interaction will be encouraged and stimulated throughout the conference.

What are the most important messages from the conference?

Learn. Connect. Grow. It doesn’t matter if you come from a big or small country, region or hospital—if you try to give the best of yourself, as we, people from a small country, are trying to do by organising this conference, you can succeed in anything. Finally, our wish is that this project stimulates the awareness of young people about the need for teamwork, co-operation and education, both within their own centre and among other centres. Our small team wants to stress the importance of teamwork and collaboration needed in everyday practice to succeed.  Another important point is the apparent need for organising events and programs dedicated to young GIs. This conference is another 'proof of concept' for gathering young GIs in youth GI sections and organising events for them. We believe that every nation should have their own young GI section and all their own meetings, and we also call for close collaboration in organising hopefully future ECYGs. We invite you to view the YTG section of the UEG webpage for more information on activities for young GIs within UEG and to get into contact with the YTG and also Friends of YTG countries around Europe. We also invite you to share your experience about organizing events for young GIs as this could help us to improve the quality of ECYG. Fresh ideas are also warmly welcomed! To improve our knowledge, we have to work together and exchange our ideas, so we can approach complex medical problems from every angle. The future of the field lies with young gastroenterologists, but the knowledge lies with those who are less young. We want to transfer knowledge into the future.

What are your insights for the future of the conference?

Well, we want to do it all over again! Call us crazy, but so far this has been such a great experience and we are sure it will continue this way until and during the conference.  We hope that we will get good feedback and reviews, so we can show that a small country like Croatia can do something big as this when people work together.

Interviewer: Radislav Nakov

GORD Diagnosis

Enhance your knowledge of GORD Diagnosis

GORD Pathophysiology

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Mistakes in mouse models of NASH and how to avoid them

Several animal models attempt to mirror each stage of human NAFLD

Nonalcoholic fatty liver disease (NAFLD) is a growing cause of chronic liver disease worldwide that can manifest as nonalcoholic fatty liver (NAFL) or nonalcoholic steatohepatitis (NASH). Compared with NAFL, NASH poses a substantially higher risk of progression to advanced liver disease, cirrhosis and hepatocellular carcinoma (HCC). Given the lack of directed pharmacological therapies and the complex, multifactorial disease aetiology and pathology, NAFLD is expected to become the leading cause of end-stage liver disease in the coming decades.
 

Preclinical research aimed at elucidating the molecular mechanisms driving disease and identifying reliable biomarkers and potential treatments is critical and has gained significant attention in recent years. Several animal models attempt to mirror the histopathology and pathophysiology of each stage of human NAFLD, including the development of NASH and fibrosis, up to HCC development. Most in vivo studies use mouse models owing to their relatively low cost, short lifespan and ease of genetic manipulation, which allow for a level of experimental control that is not possible with human studies. Independent of each model’s inherent advantages and disadvantages, making a mistake when choosing, performing, or even analyzing results for a particular animal NASH model may jeopardize our ability to obtain accurate results or draw firm conclusions. 
Here, we discuss some mistakes commonly made in NASH preclinical research. We also consider the challenges and opportunities when selecting animal models for the study of NAFLD.

GI Hive, a brand new blog by the UEG Young Talent Group

Yasmijn van Herwaarden reveals more about the activities of young GIs within UEG. 

GI Hive is a brand new blog edited by UEG Young Talent Group that combines the most up-to-date information about life, career development, education and opportunities for young GI specialists in Europe. Interviews, infographics, WhatsApp conversations and videos with both junior and renowned specialists will be regularly published in GI Hive.

The first bee in the GI Hive is Yasmijn van Herwaarden – UEG Young Talent Group (YTG) chair. Yasmijn is a resident at the Rijnstate hospital in Arnhem, the Netherlands and tries to finish her PhD thesis at the Radboud university hospital in Nijmegen. She is a 30-year old Sagittarius and loves painting, pilates and plants. 


Yasmijn, could you explain what is exactly Young Talent Group? What are the activities of the young GIs within UEG?

The Young Talent Group (YTG) was formed under the umbrella of the National Societies Committee to make the UEG and especially UEG Week more accessible and attractive for young specialists, residents, PhD students and post-docs working in digestive diseases. 
Within the YTG we are a group of nine from all over Europe who meet twice a year to plan our activities. We have a young representative in all other UEG committees to give the young perspective on all UEG activities. Next to the YTG we try to have a “friend of the YTG” in each national society connected to UEG. These Friends are our ambassadors and inform us on issues and activities from their country and they spread the word about our activities in each country. 
An important part of our activities take place during the UEG Week. We try to help guide first time visitors to the congress with for example the Young GI track in the congress app and the popular mentoring program. 
We try to facilitate informal networking in the young GI lounge were everyone under 40 is welcome for coffee and power outlets during the whole week and by organizing the Let’s Meet event on Sunday night each year. We also organize special sessions for young GI’s, for example this years “How to prepare a presentation” and the “Check your CV” informal meeting in the lounge. 

Among the most popular opportunities provided by YTG are the clinical and research fellowship programmes. Could you share with us a little bit more about them?

These fellowships were started to give young clinicians and researchers an opportunity to visit another European centre. We award € 1250 to spend at least two weeks in one of the participating centers. 
When rating the applications for this fellowship we are looking for young people with a specific plan of what they want to learn from the centre they will be visiting. So if you want to apply please make a good plan of what you want to learn and carefully pick the center you want to visit to match your plan. 
This year we completely changed the research fellowship compared to the previous years. We will be awarding more money, € 50.000, to spend 12 months with a European principal investigator to work on a research project. We want to support new and longer lasting research collaborations with this fellowship. 
You have to propose a plan of what you want to do and choose the principal investigator you want to visit. Of course you can draw inspiration from the list of centers participating in the clinical fellowships.

The YTG published a paper on the needs of young GI sections in UEG Journal. Can you explain what are the needs of young sections belonging to UEG National Societies?

We circulated a questionnaire among our Friends of the Young Talent Group to make an overview of the situation of young GI’s in each country. We learned that in many countries the young GI’s/residents are not organized and represented at a national level. We believe that it is important for young professionals to be represented and actually have a say in decisions that are made about their daily work and their future workplace. 
We are trying to help the young GI’s in different countries to get organized and have a young representative in the National Society. We already have some success stories, for example the newly formed young GI sections in Bulgaria and Spain. 

Why it is important for a young GI to send an abstract to UEG Week? 

For me submitting an abstract as a young researcher was always important because it was the opportunity to visit a conference and travel. I was fortunate that if the abstract was accepted for poster or oral presentation my department would pay for the travel costs and the conference fee. 
I always get new inspiration and also motivation to continue my research after a conference. Even during a poster presentation I have gotten tips from the audience that would make it into the final manuscript. But it is also just a lot of fun to visit another country with colleagues and make new friends. 

How can a young GI get involved with Young Talent Group and what is Young GI Network?

An easy way to stay in touch and hear about all our offers is to like the Young GI Network Facebook page. You can also subscribe to our mailing list and visit the UEG website to hear about the open calls we post. All the calls for the fellowships, other awards and grants and open calls for new positions in the YTG will be posted there. 
Very soon we will start offering a new way to get involved in the UEG: it will become possible to actively apply for our new UEG Talent Pool. From this pool we will actively promote young talents to all the UEG committees. 
The last two years we did a pilot for the talent pool with the Scientific Committee where young researchers could volunteer to chair a UEG Week session together with a senior chair. The reactions from both the junior chairs and the Scientific Committee were very positive seeing this as an excellent opportunity. We will post more information shortly and open the application on the UEG website.

Interviewer: Radislav Nakov

Interdisciplinary cases combined with questions of diagnosis and therapy

The Evidence Based Medicine Course takes place during UEG Week 2019 in Barcelona.
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Mistakes in small bowel bleeding and how to avoid them

Definitive management of small bowel bleeding can pose formidable challenges

Over the past 17 years, the disruptive impact of technologies including small bowel capsule endoscopy (SBCE), device-assisted enteroscopy (DAE) and dedicated cross-sectional imaging has transformed the investigation and management of small bowel pathology. Although a small bowel source only accounts for 5–10% of all cases of gastrointestinal bleeding,1–2 definitive management of small bowel bleeding even in the current era of advanced imaging, can still pose formidable challenges.  

In this brief article, we highlight frequent mistakes made in the investigation and management of small bowel bleeding and discuss strategies for their avoidance. 

Check out our repository 

Guidance for your daily practice including consensus, position papers and standard protocols.

Basic and translational research in epithelial ion transport in the GI tract

A course for young PhDs and basic science oriented MDs with state-of-the-art lectures and hands-on lab training.
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Summer School in Prague 

This intense, clinically-oriented course is an educational concept for gastroenterology trainees, combining state-of-the-art lectures with practical skills training.
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