Best Practice & Research Clinical Gastroenterology RSS feed: Current Issue. In practical paperback format, each 200 page topic-based issue of Best Practice & Research Clinical Gastroenterology will provide a comprehensive review of current clinical practice and thinking within the specialty of gastroenterology. All chapters are commissioned and written by an international team of practising clinicians with the Guest Editors for each issue drawn from a pool of renowned experts and opinion leaders. Reference is made to: • the latest original research • Cochrane Reviews • audits and confidential enquiries • national and international conferences • national and international guidelines • personal communications All chapters take the form of practical, evidence-based reviews that seek to address key clinical issues of diagnosis, treatment and patient management. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. Management will be described in practical terms so that it can be applied to the individual patient. Boxed and bulleted Learning Objectives and Practice Points are features within each chapter and will highlight the core and essential knowledge that will help the physician to provide the best care to their patients. The series' objective is to provide a continuous update for the busy clinician and researcher. 2010 topics Vol 24:1 February - Gastrointestinal lymphomas W. Fischbach and H. Boot Vol 24:2 April - Adverse events of GI Pharmacology C. Beglinger Vol 24:3 June - Chronic Pancreatitis M. Bruno Volume 24:4 August - New developments in colorectal cancer Screening G. Hoff and N. Segnan Vol 24:5 October - Hereditary liver disease F. Lammert Vol 24:6 December - Not yet confirmed 2009 topics Vol 23:1 February - Emerging Diseases of the Gastrointestinal Tract Ernst J. Kuipers (The Netherlands) Vol 23:2 April - Genetic Testing in Gastroenterology Hans Vasen Vol 23:3 June - Mandatory and Optional Functions Tests in Gastroenterology and Hepatology Jutta Keller, Ansgar Lohse and Peter Layer Vol 23:4 August - special issue devoted to common proctology scenarios Vol 23:5 October - Endosonography in Gastroenterology G.N.J. Tytgat Vol 23:6 December - Management of GI Diseases in the Elderly A. Pilotto 2008 topics Vol 22:3 June - Eosinophils in Healthy Gut and Gastrointestinal Diseases S. C. Bischoff (Germany) and A. Straumann (Switzerland) Vol 22:4 April - Advances in diagnostic assessment of the oesophageal mucosa J Dent (Australia), P Sharma (USA), G N Tytgat (The Netherlands) Vol 22: 5 October - Gastrointestinal Endoscopy G N Tytgat (The Netherlands) Vol 22: 6 December - Recent Developments in Hepatitis B & C S. W. Schalm and H. L. A. Janssen (The Netherlands) 2007 topics, volume 21, issues 1-6 Vol 21:1 February - Complications of cirrhosis D Lebrec (France) Vol 21:2 April - Helicobacter Pylori A Axon (UK) Vol 21:3 June - The difficult patient in gastroenterology J Tack (Belgium) and J Scholmerich (Germany) Vol 21:4 August - Severe gastrointestinal motor disorders G E Boeckxstaens (The Netherlands) Vol 21:5 October - Pregnancy-related gastroenterological and hepatological diseases and complications F Shanahan (Ireland) Vol 21:6 December - The multidisciplinary management of gastrointestinal cancer E. van Gutsem (Belgium) 2006 topics, volume 20, issues 1-6 Vol 20:1 February - Advances in imaging of the GI tract G Bianchi Porro (Italy) Vol 20:2 April - Pancreatic cancer J Neoptolemos UK) Vol 20:3 June - Novel developments in GI nutrition L Mathus-Vliegen (The Netherlands)and A Thomson (UK) Vol 20:4 August - Gastric cancer K McColl (UK) Vol 20:5 October - Oesophageal cancer J van Lanschot and G Tytgat (The Netherlands) Vol 20:6 December - Gallstone disease K van Erpecum and P Portincasa (The Netherlands) http://www.bpgastro.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Best Practice & Research Clinical Gastroenterology1521-6918241February 2010 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.bpgastro.com/article/PIIS1521691810000089/abstract?rss=yesAims & Scope/ Editorial Board10.1016/S1521-6918(10)00008-9Best Practice & Research Clinical Gastroenterology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Gastroenterology2010-02-01241S1521-6918(10)X0002-6iiiiiihttp://www.bpgastro.com/article/PIIS1521691809001620/abstract?rss=yesThe field of gastrointestinal malignancies encompasses a great variety of neoplasms, most of them having an epithelial origin. Gastrointestinal lymphomas comprise the largest group of the non-epithelial tumours. This issue is devoted to the primary gastrointestinal lymphomas which are regarded as a distinct tumour entity with specific properties different from those of other non-Hodgkin's lymphomas. Although being a rare disease primary gastrointestinal lymphomas were subject of intensive basic science and clinical studies during the last two decades. A secondary spread of nodal lymphomas to the gastrointestinal tract is beyond the scope of this issue.PrefaceH. Boot, W. Fischbach10.1016/j.bpg.2009.12.004Best Practice & Research Clinical Gastroenterology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Gastroenterology2010-02-01241S1521-6918(10)X0002-611http://www.bpgastro.com/article/PIIS1521691809001565/abstract?rss=yesThe diagnosis gastrointestinal lymphoma can be made on endoscopic biopsies in the vast majority of cases. Definitive subtyping of the lymphoma according to the WHO classification with the use of additional immunological and molecular markers is the cornerstone for further decision making. Several lymphomas may occur multifocally or show both small cell and large cell components. Therefore, a second endoscopy with an extensive biopsy protocol (mapping) may be mandatory.Staging procedures are required for therapeutic decision making and should include CT-scan, laboratory studies and bone marrow examination as required in other lymphomas. Additional studies must be performed depending subtype and localisation of the lymphoma. In gastric lymphoma endosonography reveals prognostic information. In marginal zone lymphoma of MALT-type attention to other MALT-sites and autoimmune diseases is necessary. In enteropathy-associated T-cell lymphoma screening for coeliac disease and enteroscopy are required. In several lymphomas (diffuse large B-cell lymphoma and mantle cell lymphoma) a PET-scan is considered as standard of care.The value of staging procedures after treatment is less well defined. At least in gastric lymphomas, histology is the gold standard after treatment and during follow-up.Diagnosis and staging in gastrointestinal lymphomaHenk Boot10.1016/j.bpg.2009.12.003Best Practice & Research Clinical Gastroenterology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Gastroenterology2010-02-01241S1521-6918(10)X0002-6312http://www.bpgastro.com/article/PIIS152169180900153X/abstract?rss=yesType of lymphoma and stage of disease are the two decisive prognostic factors and therapeutic determinants. For the locoregional staging, i.e. assessment of the gastric wall infiltration and perigastric lymphonodular involvement, endoscopic ultrasound (EUS) is highly useful. EUS has, therefore, to be integrated into the standard staging procedure of gastric lymphoma, although its impact on initial treatment decisions might be limited in the individual case. A benefit from the use of miniechoendoscopes, EUS elastography and EUS-guided biopsies has not yet been proven in gastric lymphoma. EUS also confers an important prognostic value regarding treatment responses to Helicobacter pylori eradication. On the contrary, EUS cannot be recommended as a regular part of follow-up investigations considering its limited value in predicting the response of the lymphoma to radiation or chemotherapy.Staging role of EUSW. Fischbach, O. Al-Taie10.1016/j.bpg.2009.11.003Best Practice & Research Clinical Gastroenterology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Gastroenterology2010-02-01241S1521-6918(10)X0002-61317http://www.bpgastro.com/article/PIIS1521691809001516/abstract?rss=yesPrimary gastrointestinal lymphomas are relatively common, with the large majority occurring in the stomach. In the commonest histological subtype, i.e. diffuse large B-cell lymphoma (DLCBL), chemotherapy has widely been applied in the past, either following surgery or – in more recent years – as part of conservative management in combination with radiotherapy. Relatively little data, however, exist for chemotherapy as sole treatment modality in localised gastric DLBCL, which nevertheless are highly promising and suggest that combination therapy might overtreat a substantial proportion of patients. In gastric MALT-lymphoma, the use of chemotherapy has been restricted either to patients with a priori disseminated disease or individuals judged to be at high risk or failing local treatment approaches. Only a few prospective phase II studies have been performed, and one controlled trial has shown that chemotherapy was superior in terms of event free survival at ten years when compared to radiation and surgery. These suggest that systemic treatment approaches might be highly effective both in gastric DLBCL as well as MALT-lymphoma, and the scope of this article is to briefly summarize current data on chemotherapy in gastric and GI-lymphomas according to histologic subtypes.Role of chemotherapy in gastric MALT lymphoma, diffuse large B-cell lymphoma and other lymphomasMarkus Raderer, Jan Paul de Boer10.1016/j.bpg.2009.11.001Best Practice & Research Clinical Gastroenterology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Gastroenterology2010-02-01241S1521-6918(10)X0002-61926http://www.bpgastro.com/article/PIIS1521691809001553/abstract?rss=yesIn patients with gastrointestinal lymphoma the most frequently involved site is the stomach (60%–75% of cases), followed by the small bowel, ileum, cecum, colon and rectum. The most common histological subtypes are extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) and diffuse large B-cell lymphoma (DLBCL). The role of radiotherapy is most definite in early stage gastric lymphoma.The therapeutic approach for patients with gastric Non Hodgkin lymphoma (NHL) has changed significantly over the last decades. The primary treatment of limited gastric MALT lymphoma consists of Helicobacter pylori eradication. In case of insufficient response to H. pylori eradication or in case H. pylori is absent, irradiation of the stomach and perigastric lymph nodes to a dose of 30–40Gy in 15–20 fractions is indicated. In patients with gastric DLBCL conservative treatment with anthracycline-based chemotherapy alone or in combination with involved-field radiotherapy has become the therapy of choice.Role of radiotherapy in the treatment of lymphomas of the gastrointestinal tractBerthe M.P. Aleman, Rick L.M. Haas, Richard W.M. van der Maazen10.1016/j.bpg.2009.12.002Best Practice & Research Clinical Gastroenterology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Gastroenterology2010-02-01241S1521-6918(10)X0002-62734http://www.bpgastro.com/article/PIIS1521691809001541/abstract?rss=yesPrimary gastrointestinal involvement of mantle cell lymphoma (MCL) is rare with a frequency reported between 4 and 9% of all gastrointestinal B-cell non-Hodgkin lymphomas. It was first described and so-called as multiple lymphomatous polyposis (MLP). Its clinical presentation is usually characteristic, with multiple lymphomatous polyps involving several digestive tract segments and a marked tendency towards extra-intestinal spread. The constant and typical phenotypic features of the small cleaved tumour cells, characterised as CD20+, CD5+ CD23− with a t(11;14) (q13;q32) and cyclin D1 overexpression on immunochemistry, allow MLP to be considered as the gastrointestinal counterpart of peripheral nodal MCL. They both share a very poor outcome. Response to intensive chemotherapy regimens usually results in regression of macroscopic and sometimes microscopic lesions but remissions are short and median survival from 3 to 4 years. Prognosis has been significantly improved since in younger patients, intensive front-line immunochemotherapy with autologous stem cell transplantation has been proposed. Earlier diagnosis with further studies integrating novel agents are still required to determine the optimal treatment with less toxicity.Primary gastrointestinal tract mantle cell lymphoma as multiple lymphomatous polyposisAgnes Ruskoné-Fourmestraux, Josée Audouin10.1016/j.bpg.2009.12.001Best Practice & Research Clinical Gastroenterology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Gastroenterology2010-02-01241S1521-6918(10)X0002-63542http://www.bpgastro.com/article/PIIS1521691809001528/abstract?rss=yesEnteropathy Associated T-cell Lymphoma (EATL) is an intestinal tumour of intra-epithelial lymphocytes. Based on morphology, immunohistochemistry and genetic profile EATL can be divided into two groups. EATL type I is a large cell lymphoma which is highly associated with Coeliac Disease (CD) and mostly presents with malabsorption, weight loss and CD-related symptoms. EATL type II consists of small to medium-sized cells and presents often with obstruction or perforation of the small bowel. This type of EATL has no known association with CD.When EATL has been diagnosed a thorough diagnostic work-up is needed. This work-up preferably includes video capsule enteroscopy (VCE), double-balloon enteroscopy (DBE), computed tomography (CT) combined with 18F-fluorodeoxyglucose positron emission tomography scan (18F-FDG-PET scan) if possible and magnetic resonance enteroclysis (MRE).Nowadays, most EATL patients are treated with chemotherapy mostly preceded by resection of the tumour and followed by stem cell transplantation. Despite these therapies outcome of EATL remains very poor with a 5-year survival of 8–20%. In order to improve survival prospective multicentre trials, studying new therapies are needed. The combination of chemotherapy, monoclonal antibodies and/or apoptosis inducing small molecules might be a potential treatment for EATL in the (nearby) future.Enteropathy associated T-cell lymphoma and its precursor lesionsJolanda M.W. van de Water, Saskia A.G.M. Cillessen, Otto J. Visser, Wieke H.M. Verbeek, Chris J.L.M. Meijer, Chris J.J. Mulder10.1016/j.bpg.2009.11.002Best Practice & Research Clinical Gastroenterology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Gastroenterology2010-02-01241S1521-6918(10)X0002-64356http://www.bpgastro.com/article/PIIS1521691810000028/abstract?rss=yesGastrointestinal lymphoma plays a major role complicating different diseases presenting with immunosuppression, both primary and acquired immunodeficiency (incl. HIV, transplantation, immunosuppression following chemotherapy, or inflammatory bowel disease). Lymphoma in diseases with immunosuppression are clinically and pathologically heterogeneous, but share some features such as frequent involvement of extranodal sites, diffuse aggressive histology, B-cell lineage derivation, viral association with EBV and clinically aggressive courses. While gastrointestinal lymphoma in congenital immunodeficiency disorders seems to be a rare event inspite of higher prevalences, in post-transplant lymphoproliferative disorders (PTLD) the gastrointestinal tract is one of the most important organs of lymphoma.In HIV-associated non-Hodgkin's lymphoma, gastrointestinal lesions as the most frequent extranodal localisation occur in 30–50% of lymphoma patients, are late events of HIV infection with severe immunosuppression and are mainly diagnosed with advanced disease stages Ann Arbour III or IV. They are characterised by unusual, often multifocal localisation in the gastrontestinal tract, high rates of life-threatening complications (bleeding, perforation or obstruction) and high-grade B-cell histology. With the introduction of highly active antiretroviral therapy (HAART) in the therapeutic concept in AIDS, a decrease of AIDS-related GI lymphoma was noted with improved survival rates and prognosis of lymphoma. Therapy strategies including chemotherapy, immunotherapy and HAART will show promising results in response and survival rates.GI-lymphomas in immunosuppressed patients (organ transplantation; HIV)Walter Heise10.1016/j.bpg.2010.01.001Best Practice & Research Clinical Gastroenterology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Gastroenterology2010-02-01241S1521-6918(10)X0002-65769http://www.bpgastro.com/article/PIIS1521691809001632/abstract?rss=yesThe therapeutic strategy in gastric lymphoma has completely changed over the last two decades. This change is mainly characterised by the abandonnement of surgery in favour of conservative therapies and the introduction of Helicobacter pylori eradication therapy. It became evident that conservative treatment with radiation and/or chemotherapy is at least as effective as surgical resection and additionally offers the advantage of stomach preservation and better quality of life. The therapeutic goal is undoubtedly complete remission of the lymphoma as a necessary basis for cure of the disease. Both radiotherapy and chemotherapy have a high curative potential in gastric MALT lymphoma and diffuse large B-cell lymphoma (DLBCL), respectively. An open question is the additional benefit of radiation following Rituximab–CHOP chemotherapy in DLBCL. In patients with gastric MALT lymphoma of stage I H. pylori eradication offers complete remission rates of up to 80% with excellent long-term prognosis and a real chance of cure. Patients with MALT lymphoma of stage II and those with DLBCL of stage I may also respond to eradication therapy in the individual case. It also emerged recently that there is no need for any oncological therapy in patients revealing minimal histological residuals after successful H. pylori eradication. A watch-and-wait strategy is the adequate management of this condition.In summary, therapy of gastric lymphoma is nowadays individualised with lymphoma type, stage, and H. pylori status as the determinants of the choice of treatment. Efficacy and quality of life are strong arguments for a definite conservative approach encompassing H. pylori eradication, radiation and chemotherapy.Long-term follow-up of gastric lymphoma after stomach conserving treatmentW. Fischbach10.1016/j.bpg.2009.12.005Best Practice & Research Clinical Gastroenterology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Gastroenterology2010-02-01241S1521-6918(10)X0002-67177