Background and aims: Clarification of the position of the European Society of Gastrointestinal Endoscopy (ESGE) regarding the interventional options available for treating patients with chronic pancreatitis. Methods: Systematic literature search to answer explicit key questions with levels of evidence serving to determine recommendation grades. The ESGE funded development of the Guideline. Summary of selected recommendations For treating painful uncomplicated chronic pancreatitis, the ESGE recommends extracorporeal shockwave lithotripsy/endoscopic retrograde cholangiopancreatography as the first-line interventional option. The clinical response should be evaluated at 6???8 weeks; if it appears unsatisfactory, the patient?s case should be discussed again in a multidisciplinary team. Surgical options should be considered, in particular in patients with a predicted poor outcome following endoscopic therapy (Recommendation grade B). For treating chronic pancreatitis associated with radiopaque stones???5?mm that obstruct the main pancreatic duct, the ESGE recommends extracorporeal shockwave lithotripsy as a first step, combined or not with endoscopic extraction of stone fragments depending on the expertise of the center (Recommendation grade B). For treating chronic pancreatitis associated with a dominant stricture of the main pancreatic duct, the ESGE recommends inserting a single 10-Fr plastic stent, with stent exchange planned within 1 year (Recommendation grade C). In patients with ductal strictures persisting after 12 months of single plastic stenting, the ESGE recommends that available options (e.?g., endoscopic placement of multiple pancreatic stents, surgery) be discussed in a multidisciplinary team (Recommendation grade D). For treating uncomplicated chronic pancreatic pseudocysts that are within endoscopic reach, the ESGE recommends endoscopic drainage as a first-line therapy (Recommendation grade A). For treating chronic pancreatitis-related biliary strictures, the choice between endoscopic and surgical therapy should rely on local expertise, patient co-morbidities and expected patient compliance with repeat endoscopic procedures (Recommendation grade D). If endoscopy is elected, the ESGE recommends temporary placement of multiple, side-by-side, plastic biliary stents (Recommendation grade A).

Infection-related exposures seem to enhance risk for CD in children. The timing of these exposures during early childhood may be relevant to the etiology of pediatric CD.

Our study shows that serum ASCA measured close to diagnosis can determine the occurrence of early complications in pediatric CD. Preventive treatment targeted toward these susceptible patients could potentially modify the disease course.

AIM:To determine the distribution and frequencies of the genotypes and haplotypes of the genes encoding for the glucocorticoid receptor (GR), the tumor necrosis factor (TNF)-α and the interleukin (IL)-10 in childhood Crohn's disease (CD) and to assess the impact of the corresponding DNA variants on clinical and disease phenotypes. METHODS:Ten variants in GR, TNF-α and IL-10 were genotyped in 113 childhood CD cases and 95 healthy subjects, both of French-Canadian origin. RESULTS:For the GR polymorphisms (R23K and N363S) and IL-10 variants in the 5'flanking region (-1082 G > A, -819 T > C and -592 A > C), no difference was observed in allele and genotype frequencies between CD patients and controls. At the haplotype level, we found three IL-10 haplotypes previously described in Caucasians (GCC, ACC and ATA) and three novel haplotypes only present in IBD patients. When we analyzed the haplotype distribution with the anatomical location of the disease, the GCC haplotype was associated with the colonic and the ACC haplotype with the terminal ileum location, respectively. The genotyping of five polymorphisms in the promoter region of the TNF-α gene (-1031 T > C, -863 A > C, -857 T > C, -308 A > G and -238 A > G) revealed a significant overrepresentation of homozygous -1031 CC among CD patients (OR = 9.9) and an association with the colonic location. For TNF-α, eleven haplotypes were inferred, including two frequent ones, TCCGG and CACGG, which were significantly observed more frequently in controls and cases, respectively.CONCLUSION: This is one of the first studies investigating the association between haplotype structure and disease location in a CD pediatric cohort. Our results will help to increase our understanding of the genetic determinants of childhood CD.

Pacemaker location in the abdominal wall is considered a contraindication to videocapsule endoscopy (VCE). The aim of this study was to review our experience on the use of VCE in patients with a pacemaker located in the abdominal wall. VCE was carried out with monitoring of cardiac rhythm. This was a retrospective review of VCE case studies performed at two tertiary care university medical centers (pediatric and adult). The main outcome measures were adverse events and quality of VCE images. No adverse events were experienced in any of the five patients with implanted cardiac pacemakers, including the two with abdominal pacemaker. No interference with the VCE recording was observed during the studies, although the capsule was observed to be briefly inactivated by the pacemaker in one case. The present study, though small, suggests that VCE is safe in adult and pediatric patients who are fitted with cardiac pacemakers, even when implanted in the abdominal wall. The VCE exam can be carried out successfully under close supervision. Dysfunction of the capsule appears to be more likely than problems with cardiac pacing.

MSI tumours and also think that we should spare no efforts in trying to understand the molecular basis of the response to chemotherapy in that kind of tumour. The importance of DNA methylation in prognosis and chemotherapy response is not completely known, and, in our opinion, research in that area is scarce and inconclusive. In our own and other published studies, most of the tumours that show a lack of efficacy of 5-FU in MMR-deficient tumours are sporadic (and therefore with MSI caused by hypermethylation of the promoter region of MLH1), suggesting that the lack of efficacy of adjuvant 5-FU on MSI tumours could happen in both hereditary and sporadic MSI tumours. Further studies on the role of hypermethylation in prognosis and chemotherapy response in colorectal cancer are under way in our series. Soon, we will be able to report the 5-year follow-up analysis in these series, which will bring forth new and interesting data on this topic. Paraoxonase 1, 2 and 3 DNA variants and susceptibility to childhood inflammatory bowel disease R JoverInflammatory bowel disease (IBD) is characterised by an imbalance between prooxidant and anti-oxidant mechanisms. Cellular detoxification systems in IBD seem unable to adequately control the amplified generation of reactive oxygen species, put a stop to free radical injury and repair damaged cellular elements, suggesting that an increase in oxidative stress might be involved in the pathogenesis of IBD, 1 2 although the underlying molecular mechanisms remain largely undefined. Human paraoxonase family members (PON1, PON2, PON3) possess antioxidant and anti-inflammatory properties. 3-5Despite the large impact of genetic variation on PON activity, its important role in controlling oxidative stress and inflammation, [5][6][7][8] as well as its association with several pathophysiological conditions, 4 no information is available on the relationship between PON genetic variants and IBD.Here, we wanted to assess whether the genotype or haplotype distribution of PON polymorphisms was different in patients with IBD during childhood compared with healthy controls. Eight common variants in PON1, PON2 and PON3 were genotyped by polymerase chain reaction allele-specific oligonucleotide hybridisation assays in 192 incident cases of childhood IBD (mean SD age of onset 11.03 (3.9) years) diagnosed and treated at Ste-Justine Hospital (Montreal, Ontario, Canada) and in 92 controls, all of French-Canadian origin. In PON1, three promoter polymorphisms (-107 CRT, -824 ARG and -907 CRG) and two coding polymorphisms (L55M and Q192R) were genotyped. Although their distribution did not differ significantly between patients with IBD and controls, overall the frequency of the 192R (ex6 +78G) allele that seems to alter the structure of PON1 and influence enzyme activity in a substrate-dependent manner 9 was consistently higher in patients with Crohn's disease (table 1). The structures of 11 haplotypes in French-Canadians, including seven with a frequency .7%, were inferred from the genotypic frequencies o...

BackgroundCeliac disease can present in children and adults with a variety of manifestations including a rare complication known as ulcerative jejunitis. The latter has been associated with refractory celiac disease in adult onset patients. The objective of this case report is to describe the first pediatric case of ulcerative jejunitis in celiac disease, diagnosed by capsule endoscopy, which was not associated with refractory celiac disease.Case presentationThe 9 year old girl presented with a history of abdominal pain and vomiting. Laboratory investigations revealed a slightly elevated IgA tissue transglutaminase antibody level in the setting of serum IgA deficiency. Initial upper endoscopy with biopsies was not conclusive for celiac disease. Further investigations included positive IgA anti-endomysium antibody, and positive HLA DQ2 typing. Video capsule endoscopy showed delayed appearance of villi until the proximal to mid jejunum and jejunal mucosal ulcerations. Push enteroscopy with biopsies subsequently confirmed the diagnosis of celiac disease and ulcerative jejunitis. Immunohistochemical studies of the intraepithelial lymphocytes and PCR amplification revealed surface expression of CD3 and CD8 and oligoclonal T cell populations. A repeat capsule study and upper endoscopy, 1 year and 4 years following a strict gluten free diet showed endoscopic and histological normalization of the small bowel.ConclusionUlcerative jejunitis in association with celiac disease has never previously been described in children. Capsule endoscopy was essential to both the diagnosis of celiac disease and its associated ulcerative jejunitis. The repeat capsule endoscopy findings, one year following institution of a gluten free diet, also suggest that ulcerative jejunitis is not always associated with refractory celiac disease and does not necessarily dictate a poor outcome.

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