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Volume 74 - 2011 - Fasc.1 - Expert Point of View

Upper gastrointestinal tract bleeding management : Belgian guidelines for adults and children

Upper gastrointestinal bleeding (UGIB) remains a common dis- ease affecting 100 to 170 per 100 000 adults per year and causing thereby a significant burden to healthcare resources. Despite the improvements in the management of this disorder, the associated mortality ranges from 5 to 14%. Since the general management of UGIB is not uniform, the main objective of this work is to provide guidelines for the care of adults and children presenting with bleeding caused by gastro-duodenal ulcer or variceal rupture. Methods : In the absence of evidence-based recommendations, these guidelines were proposed after expert opinions reconciliation and graded accordingly. They are based on the published literature up to September 2010 and graded according to the class of evidence. Results : The current guidelines for the management of UGIB include recommendations for the diagnostic process, general sup- portive care, pharmacological therapy aiming at bleeding control, specific and endoscopic treatment of acute bleeding and follow-up for both gastro-duodenal ulcers and portal hypertension-induced bleeding. (Acta gastroenterol. belg., 2011, 74, 45-66).


Abdominal ultrasonography by the hepato-gastroenterologist : problems, demands, solutions

This document analyzes the reasons for organizing an abdomi- nal ultrasound training for Belgian trainees in hepatogastro- enterology. The hepatogastroenterology speciality should implement, together with the radiology speciality and the national scientific and professional associations, the minimum training requirements which are proposed by the European Board of Gastroenterology and Hepatology and the European Federation of Societies for Ultrasound in Medicine and Biology. Trainees in hepatogastroenterology should acquire the same theoretical and practical training as radiologists, they should be taught and super- vised by competent instructors and have their expertise evaluated. (Acta gastroenterol. belg., 2011, 74, 67-69).


Screening for colorectal cancer in asymptomatic average risk patients : role of imaging

Early detection of colorectal cancer or advanced adenomas is a public health priority in many industrialized countries. There are various methods of screening average risk individuals for colorec- tal cancer, and their effectiveness may depend on subjective parameters like local expertise and patient's preferences. This paper reviews these tests with special emphasis regarding imaging techniques that aim to provide less-invasive alternatives to optical colonoscopy (OC) which is the standard of reference. Both Double- Contrast Barium Enema (DCBE) and Virtual Colonoscopy (VC) have >90% sensitivity compared to OC in the detection of clinical- ly relevant colonic lesions. Nevertheless, VC may have an edge over DCBE for technical and reproductivity reasons, as well as greater learning opportunities. Imaging techniques criticisms regarding diminutive and flat lesions, cost, radiation exposure and effects on gastroenterological practice are addressed. (Acta gastroenterol. belg., 2011, 74, 70-76).