Field Of Gastroenterology Research Articles

Use of ambient lighting during colonoscopy and its effect on adenoma detection rate and eye fatigue: results of a pilot study

Background and study aims Adenoma detection rate (ADR) appears to decrease as the number of consecutive hours performing procedures increases, and eye strain may be a contributing factor. Ambient light may improve symptoms of eye strain, but its effects have yet to be explored in the field of gastroenterology. We aim to determine if using ambient lighting during screening colonoscopy will maintain ADRs and improve eye strain symptoms compared with low lighting. Methods At a single center, retrospective data were collected on colonoscopies performed under low lighting and compared to prospective data collected on colonoscopies with ambient lighting. Eye fatigue surveys were completed by gastroenterologists. Satisfaction surveys were completed by physicians and staff. Results Of 498 low light and 611 ambient light cases, 172 and 220 adenomas were detected, respectively ( P = 0.611). Under low lighting, the ADR decreased 5.6 % from first to last case of the day ( P = 0.2658). With ambient lighting, the ADR increased by 2.80 % ( P = 0.5445). The difference in the overall change in ADR between first and last cases with ambient light versus low light was statistically significant (8.40 % total unit change, P = 0.01). The average eye strain scores were 8.12 with low light, and 5.63 with ambient light ( P = 0.3341). Conclusions Performing screening colonoscopies with ambient light may improve the differential change in ADR that occurs from the beginning to the end of the day. This improvement in ADR may be related to improvement in operator fatigue. The effect of ambient light on eye strain is unclear. Further investigation is warranted on the impact of ambient light on symptoms of eye strain and ADR.

ID: 3521475 COMPARING PATIENT SATISFACTION AMONG TELEMEDICINE, DIRECT ACCESS, AND IN-PERSON CLINIC PRE-PROCEDURE VISITS FOR GASTROINTESTINAL ADVANCED ENDOSCOPIC PROCEDURES

Background and aims: With the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, healthcare providers abruptly changed their delivery of care to protect patients and staff from infection. One such change was to convert in-person advanced gastrointestinal endoscopy pre-procedure consultations to telemedicine visits. The use of telemedicine has been successfully used in the field of gastroenterology in managing symptoms and chronic conditions among established patients. However, to our knowledge, there is little literature on the utility of this modality for pre-procedure consultation visits, where patients often meet their proceduralists for the first time. The aim of this study was to compare overall patient satisfaction among those who had pre-procedure consultation visits by telemedicine, in –person, or a direct access procedure (instructions and procedure explained by a nurse practitioner or physicians assistant). Methods: Patients who had undergone an advanced endoscopic procedure at Long Island Jewish Hospital from the months of May 2020 to August 2020 were called by telephone and asked to complete a modified version of the validated patient satisfaction survey mGHAA-9. The survey was designed to assess patient satisfaction in their pre-procedure, intra-procedure, and post procedure experiences. Patients were grouped based on whether they had received an in-clinic consultation visit by the endoscopist, telemedicine consultation visit by the endoscopist, or direct access. Geographic location to the office, prior endoscopic experience, type of endoscopic procedure (diagnostic vs. therapeutic), and new gastrointestinal cancer diagnosis data were recorded. Results: Of the total 322 patients that were called, 123 agreed to participate (38%) and provided responses to the survey. There were 26 who had in person consultation visits, 32 who had telemedicine consultation visits, and 65 direct access visits. Overall mean satisfaction among the three groups did not reveal a statistically significant difference (p value= 0.983). Furthermore, sub-analysis of the preprocedure, intra procedure, and post procedure satisfaction scores did not reveal statistically significant differences (p=0.996, p=0.244, and p=0.998, respectively). However, patients with a new gastrointestinal cancer diagnosis had a statistically significant higher mean satisfaction score in those who had telemedicine visits with proceduralists compared to those who had direct access procedures (P=0.0116). Conclusion: Our study suggests that pre-procedure consultation visits by telemedicine, in-person, or direct access all have similar satisfaction scores among patients. However, telemedicine consultation visits with the endoscopist may be preferred over direct access in patients who have a clinically high suspicion for a new gastrointestinal cancer diagnosis. [Formula presented]

Gender differences in gastroenterology and hepatology authorship and editorial boards

Women are numerically under-represented in the field of gastroenterology and hepatology. This study aims to characterize the gender distribution of first and senior authors and editorial board members across high impact factor journals in gastroenterology and hepatology. Publications from January 1, 2019 to December 31, 2019 were reviewed from 29 journals. Gender of editorial board leadership, editorial board members, first, and senior authors was identified using publicly available data. Spearman correlation coefficients were calculated to assess for a relationship among editorial board, first author, and senior author gender and impact factor. Of 29 journals (median impact factor 5.55) with 357 journal issues and 8036 articles, there were 3 of 39 female chief editors (7.7%), 601 of 3455 female editorial board members (17.4%), 2547 of 8036 female first authors (31.7%), and 1390 of 7335 female senior authors (19%). No statistically significant correlations existed between impact factor and chief editor gender with gender distribution of editorial boards, first authors, or senior authors. Positive correlations existed between male-dominated editorial boards and male first (+.52, P= .005) and senior authorship (+.56, P= .002), whereas negative correlations occurred between male-dominated editorial boards and female first (-.51, P= .006) and senior authorship (-.56, P= .002). Positive correlations also existed between publication of first and senior authors of the same gender (+.57, men [P= .001];+.58, women [P= .001]). Although gender distribution of female first authorship approaches current distributions in the field of gastroenterology and hepatology, editor-in-chief positions, editorial board membership, and senior authorship continue to be primarily men. Future endeavors to improve proportionate gender representation include improved journal leadership selection transparency, targeted diversity statements, and enhanced mentorship.

Gender equality in academic gastroenterology: a review of gastroenterology literature over four decades.

Historically males have dominated the physician ranks, although in recent years, there has been an increase in the proportion of female doctors to redress this imbalance. With such attention being paid to gender equality in society, this study aimed to characterise the changing prevalence of female authorship of peer-reviewed published research with in the field of gastroenterology. In order to quantitatively assess the growth of female gastroenterologists, we decided to examine the changing face of gender equality within the field of academic gastroenterology from 1971 to 2010. All research published in the January and July issues ofGastroenterologyfrom 1971 to 2010 was reviewed. The gender of the first author and last author (considered the senior author) of each study was recorded. Research was subsequently categorised by type: basic science research, clinical trials, and epidemiologic research. Data was analysed in 5-year time periods. Author gender could be identified from a total of 865 abstracts from 80 journal issues. In total, there were 120 (13.8%) female first authors and 91 (10.5%) female senior authors. Female first authorship has tripled since 1995, from 11% (1991-1995) to 32% (2006-2010). Female senior authorship has also tripled since 2000, from 7% (1996-2000) to 24% (2006-2010). Results demonstrated that there has been a significant increase in the prevalence of female authorship of published research in Gastroenterology since 1995. The increasing prevalence of females within the field of academic gastroenterology can therefore be extrapolated to demonstrate the growing numbers of female gastroenterologists in the entire field including clinical and academic gastroenterology.

Gender and Nationality Trends in Manuscripts Published in Prominent Gastroenterology Journals Between 1997 and 2017.

Gender disparities remain in the field of gastroenterology (GI) despite the decreasing gender gap in the medical field overall. We sought to examine primary and last female authorship as a marker of academic opportunity and advancement to assess the proportion of women publishing in GI over 20 years (1997-2017). In this observational study, we assessed the gender and nationality of primary and last authors of original research manuscripts in three GI journals (Gastroenterology, Gut, and American Journal of Gastroenterology) across a 20-year period in 5-year intervals (in 1997, 2002, 2007, and 2012). We used a validated gender-determining algorithm, genderize.io, to classify gender. Our primary outcome was the proportion of female primary and last authors, with secondary measures assessing trends in gender and nationality. Through the Genderize.io gender database, we were able to identify the gender for 3,673 (95.9%) of primary author names and 3,504 (95.4%) of last author names in the 3,615 manuscripts evaluated. Overall, there was a significant increase in female primary authors over time, from 18.1% in 1997 to 42.6% in 2017, a 6.0% increase per 5-year period (95% CI 4.8-7.2%). A similar trend was found for female last authors, however, at a slower rate, from 8.3% in 1997 to 24.7% in 2017, a 3.5% increase per 5 years (95% CI 2.5-4.4%). These trends were noted cumulatively, and in each journal individually. Manuscripts with a female last author were more likely to demonstrate a female primary author. Female authorship in high-impact gastroenterology journals has increased over time. Last authorship has lagged primary authorship in female representation and has increased more slowly over time. Interventions to reduce gender disparity in GI research should focus on the transition from first to last authorship.

Advancing health equity: The Association of Black Gastroenterologists and Hepatologists.

The Association of Black Gastroenterologists and Hepatologists is a new organization that aims to improve gastrointestinal health outcomes in Black communities, foster networking and scholarship among its members, develop the pipeline of Black gastroenterologists and hepatologists, and promote health equity in the fields of gastroenterology and hepatology.

Artificial intelligence in gastroenterology and hepatology: Status and challenges.

Originally proposed by John McCarthy in 1955, artificial intelligence (AI) has achieved a breakthrough and revolutionized the processing methods of clinical medicine with the increasing workloads of medical records and digital images. Doctors are paying attention to AI technologies for various diseases in the fields of gastroenterology and hepatology. This review will illustrate AI technology procedures for medical image analysis, including data processing, model establishment, and model validation. Furthermore, we will summarize AI applications in endoscopy, radiology, and pathology, such as detecting and evaluating lesions, facilitating treatment, and predicting treatment response and prognosis with excellent model performance. The current challenges for AI in clinical application include potential inherent bias in retrospective studies that requires larger samples for validation, ethics and legal concerns, and the incomprehensibility of the output results. Therefore, doctors and researchers should cooperate to address the current challenges and carry out further investigations to develop more accurate AI tools for improved clinical applications.

The new era of endoscopic ultrasound in biliary disorders.

Biliary obstruction is one of challenging biliary disorders in gastroenterology field, where this long-standing condition can also lead to portal hypertension and multi-disciplinary teamwork is usually needed to manage this problem. Biliary drainage is the primary management to prevent prolonged cholestasis. Biliary system with its thin-walled and tubular structure sometimes makes the diagnosis and therapeutic not easy to approach. Over the past 3 decades, numerous new and modern diagnostic and therapeutic modalities have been developed to manage the complex biliary problems. It is well known that endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic biliary drainage (PTBD), and surgical procedure are common procedures in managing biliary disorders. However, surgical therapy and ERCP are not always easy to perform due to several contraindications. Because of difficulty in performing these procedures or unavailability of these procedures in the facility, PTBD, as the primary non-surgical procedure of choice, has been popular due to its easy technique. Endoscopic ultrasound (EUS) has evolved significantly not only as a diagnostic tool for identification and staging, but also for interventional approaches, especially in management of biliary malignancy. Recently, EUS-guided biliary drainage (EUS-BD) and EUS-guided gallbladder drainage (EUS-GBD) are developed for managing biliary disorders. Whether EUS can be useful for managing biliary obstruction as a primary procedure is still controversial. Hence, a large number of further studies are required to validate.

Knowledge Discovery Using Clustering Methods in Medical Database: A Case Study for Reflux Disease

Digitalization spreads day by day around the world; thus, the amount of data collected is on the rise. An increasing amount of data leads us to use the data and get the advantage of it by using methods like Data mining. Data mining is used in several industries. Especially as medical data is essential to be understood, it is crucial to work on it. Reflux disease is a painful illness spreading around the world. Reflux is more common compared to formerly known numbers of patients. Even though reflux is not as fatal as cancer, it decreases the quality of life and makes many people suffer in their daily life. So, reflux is affecting mental health directly. If we can ease the process of diagnosis of reflux, we may provide a better quality of life for people. In this study, various data mining algorithms are applied, and it is seen from results that medical care can be improved by changing. Nowadays, artificial intelligence applications in the field of gastroenterology stand out in various sources in the literature. However, a large database required that is specific for Reflux disease to implement these applications is available only at the Reflux Research Center in Ege University in Turkey. By benefiting the Short Form36 and Quadrad12 questionnaire data in this database, 3,909 patients and many artificial intelligence algorithms were used to discover the hidden associations among responses in the quality of life of these patients. The algorithms used in the tests are Apriori, Frequent Pattern Growth, Density-Based Spatial Clustering of Applications with Noise, Self-Organizing Map, and KMeans. In the tests, it was observed that the most successful algorithm in terms of the structure of the data was KMeans, and a set of remarkable 27 rules according to the optimal Sum of Square Error value was obtained.

Psychosocio-economic impacts of COVID-19 on gastroenterology and endoscopy practice.

Beyond posing a major health crisis, the COVID-19 pandemic has inflicted profound psychological, social, and economic impacts on populations worldwide. Mass quarantines and social isolation have affected the mental health of the wider population, exacerbating other stressors, including fear of the virus and its repercussions, general uncertainty, and financial insecurity. The pandemic has challenged the broader delivery of healthcare––ranging from the need to triage limited hospital resources to balancing risk mitigation with maintaining medical care. Specific to gastroenterology, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not only been associated with complicating extant medical conditions of the gastrointestinal (GI) tract, but has also forced a shift in the practice of gastroenterology by patients, families, and healthcare providers alike. The gastroenterology field has been required to adapt its practices to minimize the possibility of viral spread while still upholding patient care. Healthcare practitioners in GI have helped to treat COVID-19 patients, stratified inpatient and outpatient visits and procedures, and shifted to telemedicine. Still, as is the case with much of the general population, healthcare providers working in GI practice or endoscopy have faced personal and professional stressors, mental health difficulties, social isolation, financial pressures, and familial burdens––all of which can take a toll on practitioners and, by extension, the provision of GI care overall. This article will highlight how the COVID-19 pandemic has affected the psychological wellbeing, social engagement, and economic conditions of the public, healthcare providers, and GI professionals specifically. Recommendations for strategies that can continue GI services while maintaining safety for both caregivers and patients are put forth to help uphold critical GI care during this worldwide crisis.

An Impetus for Change: How COVID-19 Will Transform the Delivery of GI Health Care

An Impetus for Change: How COVID-19 Will Transform the Delivery of GI Health Care

Research Trends in General Medicine Departments of University Hospitals in Japan

PurposeThe training of generalist physicians in university hospitals needs to emphasize development of their research role in order to continue improving their research capacity and their standing in academic hospitals in Japan. This cross-sectional descriptive study aimed to survey departments of general medicine (GM) in university hospitals in Japan to identify the research areas and themes pursued by academic generalist physicians.Patients and MethodsThe heads of the departments of GM from 71 university hospitals in Japan were enrolled. The main outcomes studied were the identification of the main research areas and themes in academic departments of GM, based on the classification of the National Grants-in-Aid for Scientific Research (KAKENHI): clinical research, public health, preventive medicine, medical education, basic science, health services and safety and quality.ResultsWe received 47 of 71 replies (66.2% response rate). Clinical research was the most common area of research (62%), followed by public health and preventive medicine (14%), medical education (11%), and basic sciences (9%). Only one department identified health services and safety and quality as a research area (2%). There was marked variability in research areas across the different departments, with 23% of the research targeting the highest specialties, particularly organ-specific research in the fields of gastroenterology, cardiology, immunology, neurology, metabolic endocrinology, and hematology-oncology.ConclusionThe training of generalist physicians in university hospitals needs to emphasize development of their research role in order to continue improving the research capacity and the standing generalist physicians in academic hospitals in Japan.

Emerging wearable technology applications in gastroenterology: A review of the literature.

The field of gastroenterology has recently seen a surge in wearable technology to monitor physical activity, sleep quality, pain, and even gut activity. The past decade has seen the emergence of wearable devices including Fitbit, Apple Watch, AbStats, and ingestible sensors. In this review, we discuss current and future devices designed to measure sweat biomarkers, steps taken, sleep efficiency, gastric electrical activity, stomach pH, and intestinal contents. We also summarize several clinical studies to better understand wearable devices so that we may assess their potential benefit in improving healthcare while also weighing the challenges that must be addressed.

A96 GENDER DIFFERENCES IN GASTROENTEROLOGY AND HEPATOLOGY AUTHORSHIP AND EDITORIAL BOARDS

Abstract Background Women are numerically under-represented in the field of gastroenterology and hepatology. Aims To characterize the gender distribution of first and senior authors and editorial board members of the highest impact factor journals in gastroenterology and hepatology. Methods Using Clarivate Journal Citation Report 2019, the 28 highest ranked journals within gastroenterology and hepatology were selected for review, along with the Journal of the Canadian Association of Gastroenterology. Publications between January 1 to December 31, 2019 were included. Gender of board members and authors was identified using publicly available data. Spearman correlation coefficients were calculated using SPSS to assess for a relationship between editorial board, first author, and senior author gender as well as impact factor. Results Of 29 journals assessed with a median impact factor of 5.55 (IQR 3.72–9.10), 357 journal issues and 8036 articles were reviewed. Three journals were headed by female chief editors, constituting 7.7% of all editors-in-chief (3/39). In total, females made up 17.1% of editorial board members (n=584). Of 8036 first authors, 2547 (31.7%) were female. Of 7335 senior authors, 1390 (19.3%) were female. There were no statistically significant correlations between impact factor and gender. Chief editor gender did not significantly correlate with gender distribution of editorial boards, first or senior authors. There was a significant positive correlation between male-dominated editorial boards and male first and senior authorship, versus a significant negative correlation between male-dominated editorial boards and female first and senior authorship. A positive correlation exists for the same gender between first and senior authors. Conclusions Although gender distribution of female first and senior authorship approaches current distributions in the field of gastroenterology and hepatology, editor-in-chief positions and editorial board membership on journals continue to be occupied by men in higher proportions. Future endeavors such as diversity statements and mentorship may help to balance these distributions in the future. Funding Agencies None

A practical approach to the evaluation and management of gastrointestinal symptoms in patients with systemic sclerosis.

The gastrointestinal (GI) tract is the most commonly affected internal organ system in systemic sclerosis (SSc). SSc may lead to impaired function in any region of the GI tract, from the esophagus to the anorectum, which causes significant morbidity as well as mortality in patient subsets. Given the low prevalence of SSc in the community, many rheumatologists may not have a systematic framework for diagnosing or treating the GI complaints in this disease. These practice recommendations aim to summarize and consolidate the current guidelines from the fields of gastroenterology and rheumatology and establish a symptom-based framework for diagnosis and management based on available evidence in the literature. Subject areas that are in need of additional research are also identified.

A94 BARRIERS TO ADVANCEMENT ALONG THE GASTROENTEROLOGY CAREER PATHWAY: A RESIDENT PERSPECTIVE

Abstract Background GI residency training programs in Canada are comprised of approximately 30% females. Survey data from procedural specialities reveal gender related differences relating to work-life balance, parental obligations, access to role models, and workplace gender discrimination. Aims To determine gender specific differences affecting the choice of GI as a sub-specialty and the experience of GI as a career during residency and fellowship. Methods A 91-question mixed methods survey was electronically disseminated in two recruitment waves to PGY4-6 gastroenterology residents and fellows across Canada between May 7th-July 1st, 2020. The survey consisted of nine groups of questions aimed at understanding personal, professional, financial, and training characteristics. Comparisons were made between self-identified male and female genders. Wilcoxon (Mann Whitney U test) was used for continuous variables while chi-squared test and fisher’s exact test was applied for categorical variables using SAS software. Qualitative thematic analysis was applied for short answer responses with two independent reviewers. Results A total of 122 residents were surveyed with a response rate of 36% (44/122).There were 17 PGY4s, 15 PGY5s, and 12 PGY6s. Females comprised 41% (18/44) of respondents. Women were statistically more likely to take on a predominant caregiver role for children (p=0.012) and state that having children would slow their career advancement (p=0.046). Men were more likely to state that it is preferable to have children during residency (p=0.036) and that their partner’s preference factored into their subspecialty training choice (p=0.009) than women. Male PGY4/5 trainees were more likely to select therapeutic endoscopy for advanced training (p=0.033). No statistical difference was found regarding aspirations for administrative/leadership positions, desired future income, practice setting, academic pursuits, and perspectives on compromising marriage for career. Qualitative analysis suggests non-gender specific challenges related to achieving work-life balance, securing a desired location of practice, and obtaining financial stability are common resident and fellow concerns. Conclusions Our study is the first of its kind within the field of gastroenterology to focus on GI residents and fellows’ experiences within Canadian training programs. Our results show that there exist gender related differences in relation to work-life balance and career advancement. Women may benefit from supports to cope with increased caregiver demands in order to allow them to meet career goals which are similar to their male peers. Funding Agencies None

Phenotypic switch of smooth muscle cells in paediatric chronic intestinal pseudo-obstruction syndrome.

Smooth Muscle Cells (SMC) are unique amongst all muscle cells in their capacity to modulate their phenotype. Indeed, SMCs do not terminally differentiate but instead harbour a remarkable capacity to dedifferentiate, switching between a quiescent contractile state and a highly proliferative and migratory phenotype, a quality often associated to SMC dysfunction. However, phenotypic plasticity remains poorly examined in the field of gastroenterology in particular in pathologies in which gut motor activity is impaired. Here, we assessed SMC status in biopsies of infants with chronic intestinal pseudo‐obstruction (CIPO) syndrome, a life‐threatening intestinal motility disorder. We showed that CIPO‐SMCs harbour a decreased level of contractile markers. This phenotype is accompanied by an increase in Platelet‐Derived Growth Factor Receptor‐alpha (PDGFRA) expression. We showed that this modulation occurs without origin‐related differences in CIPO circular and longitudinal‐derived SMCs. As we characterized PDGFRA as a marker of digestive mesenchymal progenitors during embryogenesis, our results suggest a phenotypic switch of the CIPO‐SMC towards an undifferentiated stage. The development of CIPO‐SMC culture and the characterization of SMC phenotypic switch should enable us to design therapeutic approaches to promote SMC differentiation in CIPO.

Editorial introductions.

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Chantal HoussetChantal HoussetChantal Housset was trained as a Hepatologist in Université Paris 5 René Descartes, France. She was NIH Visiting Scientist at University of California San Francisco, in 1992. She obtained a PhD degree from Université Paris 07, France, in 1993 and Research Direction Habilitation from Université Paris 06, France, in 1998. She was appointed fulltime Researcher at INSERM (National Institute of Health and Medical Research) in 1994, and full-time Professor in Cell Biology at Université Paris 06, in 2000. She is Course Director of molecular and cellular biology at Sorbonne Université Medical School & Life Science Department. She is a member of the Reference Center for Inflammatory Biliary Diseases and Auto-immune Hepatitis, in Saint-Antoine Hospital, and of the Rare Liver Disease National Network (FILFOIE). She is Director of an INSERM-Sorbonne Université Laboratory of translational reasearch in Saint-Antoine Research Center (CRSA). The expertise of the Laboratory relates to the mechanisms responsible for metabolic and biliary diseases of the liver and their progression towards fibrosis. Dr Housset is member of the University National Council (CNU) in Cell Biology. She published 170 articles. Her main scientific contributions relate to the mechanisms of bile secretion, the pathobiology of biliary diseases, the origins and functions of liver myofibroblasts. Eamonn M.M. QuigleyEamonn M.M. QuigleyEamonn M.M. Quigley is Chief of Gastroenterology and Hepatology at Houston Methodist Hospital in Houston, Texas, USA, Professor of Medicine at Weill Cornell Medical College and David M Underwood Chair of Medicine in Digestive Disorders. A graduate of University College Cork, Ireland, Dr Quigley trained in internal medicine in Glasgow and Manchester, and in gastroenterology in Glasgow, the Mayo Clinic, Rochester, Minnesota, USA, and Manchester. In 1986, he joined the faculty at the University of Nebraska Medical Center in Omaha, Nebraska, USA, where he ultimately served as Chief of Gastroenterology and Hepatology. Returning to Cork in 1998, he served as Dean of the Medical School at UCC for seven years and was a principal investigator at its Alimentary Pharmabiotic Center from its inception. He served as president of both the American College of Gastroenterology and the World Gastroenterology Organization and is a past editor-in-chief of the American Journal of Gastroenterology. Clinical and research interests include irritable bowel syndrome, gastrointestinal motility and the role of the gut microbiota and probiotics in health and in gastrointestinal and metabolic disorders.

The gut-joint axis in spondyloarthritis: immunological, microbial, and clinical insights.

The strong genetic and clinical overlaps between spondyloarthritis (SpA) and inflammatory bowel disease (IBD) have placed much needed focus on the gut-joint axis of inflammation in SpA, leading to three key hypotheses that attempt to unravel this complex relationship. The arthritogenic peptide hypothesis and the aberrant cellular trafficking hypothesis have been put forth to rationalize the manner by which the innate and adaptive immune systems cooperate and converge during SpA pathogenesis. The bacterial dysbiosis hypothesis discusses how changes in the microbiome lead to architectural and immunological consequences in SpA. These theories are not mutually exclusive, but can provide an explanation as to why subclinical gut inflammation may sometimes precede joint inflammation in SpA patients, thereby implying a causal relationship. Such investigations will be important in informing therapeutic decisions which may be common to both SpA and IBD. However, these hypotheses can also offer insights for a coincident inflammatory relationship between the gut and the joint, particularly when assessing the immunological players involved. Insights from understanding how these systems might affect the gut and joint differently will be equally imperative to address where the therapeutic differences lie between the two diseases. Collectively, this knowledge has practical implications in predicting the likelihood of IBD development in SpA or presence of coincident SpA-IBD, uncovering novel therapeutic targets, and redesigning currently approved treatments. It is evident that a multidisciplinary approach between the rheumatology and gastroenterology fields cannot be ignored, when it comes to the care of SpA patients at risk of IBD or vice versa.

The "Fonds Georges Brohée": a longstanding Belgian national initiative to stimulate research in hepatogastroenterology.

The Fonds Brohée/Brohée fund was created in 1964 at the initiative of 16 Belgian physicians, in the memory of Georges Brohée, the founder of the Belgian Society of Gastroenterology in 1928 and of its Journal in 1933, first published under the name "Le Journal Belge de Gastro-entérologie", then until today as "Acta Gastro-Enterologica Belgica". The goal of the Fonds is to stimulate research in the field of gastroenterology in Belgium, by awarding a young researcher (< 40 years) for an outstanding work in the clinical, translational or fundamental setting. Since 1966, 26 remarkable works have been awarded in various areas of interest in gastrointestinal diseases, whether in IBD, functional disorders, digestive oncology and, last but not least, hepatology. Since the recognition of their work, many of the awardees have become recognized for their expertise well beyond Belgium. Hopefully, the Foundation will continue to thrive and flourish after 55 years, as the members of its board and its healthy finances will allow to continue to promote and encourage high-quality research by young hepato-gastroenterologists in Belgium.