Ulrike Kapp-Popov


T  +43 (0) 699 1997 16 16


E  e-learning@ueg.eu

 

 

Elisabeth Sailer


T  +43 699 1997 16 20


e.sailer@ueg.eu

 

Ruby Sutton


T  +43 699 1997 16 18


r.sutton@ueg.eu

 

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

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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

Basic research training for gastroenterology researchers

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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. 

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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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Basic and translational research in motility and neurogastroenterology

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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Mistakes in acute jaundice and how to avoid them

Jaundice—one of the major signs in medicine—can result from numerous conditions

Jaundice or icterus (derived from the ancient Greek word ikteros that described the yellow-breasted oriole bird) is not a diagnosis in itself but constitutes one of the major signs in medicine. Jaundice refers to the yellowish discoloration of tissue that occurs as a consequence of the deposition of bilirubin. This discoloration is a physical manifestation of a marked increase in serum bilirubin levels. Normal serum bilirubin values are <17 μmol/L; for jaundice to be perceived visually serum bilirubin levels need to be elevated to >40 μmol/L (equivalent to 2.5 mg/dL).

Most serum bilirubin is formed from the breakdown of the haem contained in senescent red blood cells by the reticuloendothelial system. Thus, unconjugated bilirubin is released in the bloodstream, where it is bound by albumin. Through the blood circulation bilirubin is moved to liver hepatocytes, where it undergoes further processing. In brief, bilirubin becomes conjugated in the hepatocytes through glucuronidation, which allows it to be excreted from the body (unconjugated bilirubin is water insoluble and cannot pass into the urine). Conjugated bilirubin forms one of the main components of bile and most of it passes through the biliary tree to the intestine. Unconjugated and conjugated bilirubin are reported in laboratory measurements as indirect and direct bilirubin, according to their chemical properties (i.e. reaction with reagents).1 Jaundice can be caused by abnormalities in any of the steps comprising the formation, metabolism and excretion of bilirubin. In addition, these processes may be functioning properly, but jaundice can be seen because of an obstruction of the biliary tree at any point, from its intrahepatic origins to its end at the ampulla of Vater. For this reason, it is clear that numerous conditions can result in jaundice. When faced with a patient presenting with jaundice a reasonable and careful diagnostic approach is, therefore, warranted to elucidate the underlying cause of this sign. Conventional wisdom may be that “jaundice by itself never killed anyone,” but it is imperative to find the cause as soon as possible, as prompt intervention saves lives in many cases.  Here, we outline several of the mistakes made when approaching a patient presenting with acute jaundice based on our clinical experience and published data. 

Hereditary Gastrointestinal Polyposis Syndromes

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Mistakes in capsule endoscopy and how to avoid them

Wireless technology means capsule endoscopy is well tolerated, but it is also a drawback

Capsule endoscopy is a noninvasive technique intended for studying the small bowel and/or colon. The capsule endoscope consists of a small, wireless, pill-sized camera that can be swallowed and allows direct visualization of the gastrointestinal mucosa. The design of the capsule differs depending on the part of the gastrointestinal tract to be studied. The small-bowel capsule has one optical dome and is generally used in patients who have suspected bleeding or to identify evidence of active Crohn’s disease. By contrast, the colon capsule has two optical domes, a higher frame rate and can be considered as an alternative to conventional colonoscopy, especially for cases when the examination was incomplete. There is also a new capsule with two optical domes that is designed for the panendoscopic study of both the small bowel and colon. 

The main characteristic of capsule endoscopy is the wireless technology, which enables it to be very well tolerated. However, this feature is also one of its drawbacks, as the capsule cannot be directly controlled by the physician. The capsule moves through the gut depending solely on intestinal motility, and the examiner is not able to drive it back and forth or to stop it to look more carefully at any finding. Moreover, the visualization relies heavily on the adequacy of intestinal cleansing as rinsing with water and aspiration are not possible. Capsule endoscopists should be aware of these shortcomings, as they directly affect the reading and diagnosis. Here we discuss frequent errors that are made when performing capsule endoscopy, based on the published literature and more than 15 years’ experience

A not-so-black-and-white case of gastrointestinal bleeding

What's causing the black tarry stool, episode of coffee-ground emesis and epigastric pain?

A 60-year-old woman presents at the Emergency Department complaining that she has been passing black, tarry stool since yesterday and had an episode of coffee-ground emesis some hours ago. It is the first time she has noticed these kinds of symptoms. Moreover, she reports episodes of epigastric pain on and off during the past week.

The patient has never undergone endoscopy. Her medical history includes diabetes mellitus, hypertension, hyperlipidaemia, gastro-oesophageal reflux disease (GORD), osteoarthritis and alcohol abuse. She admits that she occasionally uses nonsteroidal anti-inflammatory drugs (NSAIDs) to cope with episodes of pain caused by her osteoarthritis and that she took some in the past week. On physical examination she is tachycardic (92 beats per minute) and hypotensive (82/57 mm Hg), but afebrile and her oxygen saturation level is normal. Her abdomen is mildly distended, with some tenderness during deep palpation and increased bowel sounds. Her blood test results at presentation are shown in Table 1. A variceal bleed was suspected, and an emergency upper gastrointestinal endoscopy was performed (see video).   Case Question 1  WHAT IS YOUR CLINICAL DIAGNOSIS? A. Oesophageal melanoma
B. Oesophageal infection (e.g. CMV, HSV, Candidiasis)
C. Acanthosis nigricans
D. Acute oesophageal necrosis (AEN) Case Question 2    WHICH OF THE CONDITIONS FROM THE PATIENT’S MEDICAL HISTORY IS NOT ASSOCIATED WITH THEIR DIAGNOSIS?
A. Diabetes mellitus
B. NSAID use
C. Alcohol abuse 
D. Hypoalbuminemia
E. Hypertension
Case Question 3  WHICH OF THE FOLLOWING MEASURES IS NOT RECOMMENDED FOR THE MANAGEMENT OF THIS PATIENT?
A. Nil per os
B. Aggressive fluid resuscitation
C. Antibiotics 
D. IV acid suppression with PPIs
E. Glycaemic control

Personalised nutrition - food for thought

Developing tailored eating advice based on individual nutritional needs

‘Personalised nutrition’ represents any attempt to provide tailor-made healthy eating advice based on the nutritional needs of an individual, as dictated by their behaviour, phenotype and/or genotype and their interactions. Increasing evidence has shown the potential for integrating lifestyle habits, physiology, nutraceuticals, the gut microbiome and genetics into nutritional solutions, specific to the needs of each individual, for maintaining health and preventing disease. 

One area that has been gaining attention among both health professionals and the general public is nutrigenomics - the role of nutrients in gene expression. On a molecular level, nutrients work as messengers, transmitting signals that can be translated into changes in gene, protein, and metabolite expression and function, which may ultimately affect health outcomes. By employing molecular tools, nutrigenomics research identifies how nutrients and bioactive food compounds may alter gene expression, ultimately helping us to understand why people respond differently to the same diet and how genes and diet interact and predispose us to disease. 
Advances in nutrigenetics - how genes impact nutrient metabolism - and nutrigenomics do seem to encourage more personalised advice when it comes to food intake and nutritional supplements.1 
We are used to receiving generalized dietary guidelines and specific recommendations on food intake and nutrient supplements, based on age, gender and other requirements (e.g. during pregnancy or times of illness). For instance, many people will - at least intuitively - be familiar with some of the following daily nutritional recommendations for adults2:
  • 200 µg folic acid
  • 40 mg vitamin C
  • No more than 6 g salt
  • At least five portions of a variety of fruit and vegetables
  • No more than 11% of energy from saturated fat
Deficiencies in calcium, potassium, dietary fibre and vitamin D are also generally considered a public health concern.3 Some supplementation can be recommended. For example, folic acid taken during pregnancy to reduce the risk of malformations developing in the brain and spinal cord of the unborn child.  
By using information obtained from whole genome analysis, an individual’s genome can be scanned for polymorphisms (usually referred to as single nucleotide polymorphisms [SNPs]) in genes related to nutrient metabolism and disease development. For example, the methylenetetrahydrofolate reductase gene is associated with folate metabolism. If the common 677C-->T mutation (also known as the A222V mutation) is present in the methylenetetrahydrofolate reductase gene, it can result in an enzyme that has reduced activity. Should a person’s diet be low in folate, the presence of the 677C-->T mutation may lead to an increased risk of elevated homocysteine levels and a further moderate risk of cardiovascular disease.4,5 On a similar note, genetic variation may, at least in part, explain interindividual differences in plasma triacylglycerol concentrations on administration of polyunsatuared fatty acids, such as those found in fish oil,6 and it may also help explain why vitamin D might confer an increased risk of cancer development in some, while decreasing the risk in others.7 
So, is the future of gut (and general) health in personalised nutrition? How can we test it? Evidence-based medicine (EBM) relies on findings from randomized controlled trials to identify whether or not a given treatment or behaviour leads to a certain outcome. We have become used to EBM being critical to medical decision-making. A one-size-fits-all approach may appear inherently incompatible with the concept of personalised nutrition, and challenges arise when agreeing on the extent, quality and interpretation of evidence and consequent implications for dietary recommendations, particularly within the nutrigenomics arena. 
When will nutritional research be ready to be translated into public health action? Will personalized nutrition produce greater behaviour change and gains in health and wellbeing than can be achieved by conventional dietary advice?6 Although lowering the levels of dietary salt and saturated fats has had a positive effect on hypertension and lipid profiles, as demonstrated in clinical trials in healthy populations, limited trial data exist that prove a cause–effect relationship and a consequent reduction in disease by these dietary interventions.6 We also need to keep in mind that genes work together and not in isolation. This means that the presence of one SNP needs to be interpreted in the context of a person’s overall biochemistry, nutrition, and other lifestyle factors, such as activity, sleep and stress.
With advances in genetic testing, public awareness of personal genome testing and its potential is increasing. Companies are now offering affordable genetic testing options directly to the public. While there may be benefits to having your genetic information available, including the potential for personalised nutrition, there are also many risks and limitations that need to be highlighted and considered. These include, but are not limited to, whether there are sufficient regulations imposed on companies who perform genetic testing, interpretation and delivery of genetic information (via guidance of a health professional), ethical and social concerns, and privacy in terms of how DNA information is stored and used. 
Nutrigenomics and nutrigenetics, albeit an exciting area, is still relatively young and has not advanced enough to allow us to develop a diet based on a person’s entire genome–much more work is required before this can happen. Nonetheless, these tools have developed enough to highlight some nutrient–gene (and environment) interactions. So, for now, our advice is to watch this space as the field of personalised nutrition research continues to develop - who knows where we will find ourselves in the years to come!
Before you go, we would also like to guide your attention to the nutrition guidelines that are available in the UEG Standards & Guidelines Repository, including many from ESPEN and ESPGHAN! 
References 
  1. Fenech M, El-Sohemy A, Cahill L, et al. Nutrigenetics and nutrigenomics: Viewpoints on the current status and applications in nutrition research and practice. J Nutrigenet Nutrigenom 2011; 4: 69–89.
  2. Food Standards Agency. Nutrient and food based guidelines for UK institutions. https://www.ptdirect.com/training-design/nutrition/national-nutrition-guidelines-united-kingdom. (2007, revised October 2007, accessed 11 May 2018).
  3. Blumeberg JF, Bailey RL, Sesso HD, et al. The evolving role of multivitamin/multimineral supplement use among adults in the age of personalized nutrition. Nutrients 2018; 10: 248. 
  4. Kohlmeier M, De Caterina R, Ferguson LR, et al. Guide and position of the International Society of Nutrigenetics/Nutrigenomics on personalized nutrition: Part 2 – Ethics, challenges and endeavors of Precision Nutrition. J Nutrigenet Nutrigenom 2016; 9: 28–46.
  5. Liew SC and Gupta ED. Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism: Epidemiology, metabolism and the associated diseases. Eur J Med Genet 2015; 58: 1–10.
  6. Görman U, Mathers JC, Grimaldi KA, et al. Do we know enough? A scientific and ethical analysis of the basis for genetic-based personalized nutrition. Genes Nutr 2013; 8: 373–381.
  7. Davis CD and Milner JA. Nutrigenomics, vitamin D and cancer prevention. J Nutrigenet Nutrigenom 2011; 4: 1–11.
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