The development of capsule endoscopy (CE) in 2001 has given gastroenterologists the opportunity to investigate the small bowel in a non-invasive way. CE is most commonly performed for obscure gastrointestinal bleeding, but other indications include diagnosis or follow-up of Crohn’s disease, suspicion of a small bowel tumor, diagnosis and surveillance of hereditary polyposis syndromes, Nonsteroidal anti-inflammatory drug-induced small bowel lesions and celiac disease. Almost fifteen years have passed since the release of the small bowel capsule. The purpose of this review is to offer the reader a brief but complete overview on small bowel CE anno 2014, including the technical and procedural aspects, the possible complications and the most important indications. We will end with some future perspectives of CE.

Artificial intelligence (AI) has shown promising results in digestive endoscopy, especially in capsule endoscopy (CE). However, some physicians still have some difficulties and fear the advent of this technology. We aimed to evaluate the perceptions and current sentiments toward the use of AI in CE. An online survey questionnaire was sent to an audience of gastroenterologists. In addition, several European national leaders of the International CApsule endoscopy REsearch (I CARE) Group were asked to disseminate an online survey among their national communities of CE readers (CER). The survey included 32 questions regarding general information, perceptions of AI, and its use in daily life, medicine, endoscopy, and CE. Among 380 European gastroenterologists who answered this survey, 333 (88%) were CERs. The mean average time length of experience in CE reading was 9.9 years (0.5–22). A majority of CERs agreed that AI would positively impact CE, shorten CE reading time, and help standardize reporting in CE and characterize lesions seen in CE. Nevertheless, in the foreseeable future, a majority of CERs disagreed with the complete replacement all CE reading by AI. Most CERs believed in the high potential of AI for becoming a valuable tool for automated diagnosis and for shortening the reading time. Currently, the perception is that AI will not replace CE reading.

Background Contrast-induced acute kidney injury (CI-AKI) is a potential complication of radio-contrast investigations. Many organisations have published guidance documents on the prevention of CI-AKI. Our aim is to explore the scope, content, consistency, practicality in clinical practice and reasons for eventual underlying discrepancies of these documents. Methods We searched the literature for guidance documents developed to guide prevention of CI-AKI up to 09/2014. Four reviewers appraised guideline quality using the 23-item AGREE-II instrument, which rates reporting of the guidance development process across six domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence. Total scores were calculated as standardised averages by domain. Results Twenty-four guidance documents were evaluated. The guidance documents were produced by radiologists (N = 7), intensivists (N = 2), nephrologists (N = 6) or multidisciplinary teams (N = 9). One document did not mention the background of the authors. Only guidance documents (N = 15) that were not mere adaptations of existing guidelines were evaluated more in depth, using the AGREE tool. Overall, quality was mixed: only one clinical practice guidance document obtained an average score of >50% for all domains. The evidence was rated in a systematic way in only 11, and only 7 graded the strength of the recommendations. The Kidney Diseases Improving Global Outcomes guideline was the only one recommended without adaptions by all assessors. The guidance documents agreed in recommending pre-hydration as the main preventive measure, but there was difference in recommended total volumes, composition, rate and duration of the infused solutions. There was no consensus on the use of NaHCO₃, with eight recommending it, six considering it and one not. Five guidance documents mentioned oral pre-hydration as a possibility, and none recommended N-acetylcysteine as solitary preventive measure. More recent guidance documents recommend avoiding hypertonic contrast media, but did not recommend preference of iso-osmolar over low-osmolar contrast media. Most guidance documents recognised pre-existing chronic kidney disease, diabetes, age and cardiovascular comorbidity as risk factors. Conclusions There seems to be a relative consensus on the need for adequate pre-hydration to avoid CI-AKI, but recommendations to define at-risk populations for whom these measures should be applied and how they should be implemented differ substantially. Based on accumulating evidence, more recent guidelines do not recommend iso-osmolar over low-osmolar contrast media, whereas all recommend avoiding hypertonic agents.

INTRODUCTION: Functional dyspepsia (FD), a disorder of gut-brain interaction defined by Rome IV criteria, overlaps frequently with irritable bowel syndrome (IBS) and reflux symptoms. Overlapping gastrointestinal (GI) disorders are associated with more psychological comorbidities and decreased quality of life, but data on physiological parameters in overlapping syndromes are scarce. The aim of this study was to evaluate the impact of overlapping disorders and FD subtypes on psychological and GI symptoms, as well as relevant physiological outcomes. METHODS: In total, 202 patients with predominant Rome IV FD symptoms and overlapping IBS and/or reflux were pooled from 7 studies conducted at University Hospitals Leuven. GI and psychological symptoms, as well as GI-related quality of life were recorded. Physiological measurements included salivary cortisol, gastric emptying, systemic and duodenal immune activation, and duodenal permeability. RESULTS: GI (Patient Assessment of Upper GI Symptom Severity and Leuven Postprandial Distress Scale [ P < 0.0001]) and psychological (anxiety [ P = 0.0014], depression [ P = 0.0017] and extraintestinal somatic symptoms [ P < 0.0001]) were more pronounced in FD with overlapping disorders, whereas all physiological parameters were similar. Patients with epigastric pain syndrome reported a milder symptom pattern compared with other FD subtypes, with similar physiological alterations. Duodenal eosinophils were associated with anxiety in FD, independent of overlapping GI disorders or subtype ( P = 0.043). DISCUSSION: The common overlap between FD, IBS, and reflux is characterized by a high GI-specific, psychological, and somatic symptom burden. By contrast, key pathophysiological parameters were not different between FD with and without overlapping disorders or between FD subtypes. Central integration of multiple GI manifestations rather than more severely impaired peripheral alterations is more likely to explain the high symptom burden in overlapping disorders.

INTRODUCTION: The diagnostic Rome criteria, classify disorders of gut-brain interaction (DGBI) according to the anatomical region of the gastrointestinal (GI) tract from which the predominant symptom are perceived to originate. A study in Asian DGBI patients using an Enhanced Asian Rome questionnaire (EAR3Q) identified symptom clusters involving multiple anatomical section. Our aim was to investigate if DGBI symptom groupings involving more than 1 anatomical region can be found in both Eastern and Western DGBI patients. METHODS: Physician-diagnosed DGBI patients, recruited from 5 Eastern and 6 Western, completed the EAR4Q. We performed an exploratory and confirmatory factor analysis on questionnaire data to identify symptom groupings, describing distinct DGBI diagnostic entities. RESULTS: In total, 1,074 DGBI patients (66.8% women, 42.6 ± 14.6 years) were recruited. We identified 10 distinct symptom groupings: (i) irritable bowel syndrome predominant diarrhea triggered by a meal and relieved by bowel movement or passing of flatus; (ii) constipation; (iii) upper GI symptoms with predominant regurgitation, nausea and vomiting; (iv) upper and lower GI symptoms relieved by bowel movement or flatus; (v) epigastric pain or burning related to bowel movement or passing flatus; (vi) lower GI symptoms triggered or worsened by bowel movement or passing flatus; (vii) meal-related pain and gas symptoms; (viii) globus and dysphagia; (ix) functional chest pain and heartburn; (x) constipation and belching relieved by bowel movement or passing flatus. Although some symptom groupings aligned with the Rome IV diagnostics, several clearly include multiple anatomical regions, surpassing the scope of the Rome regional subdivision approach. CONCLUSION: Our study revealed 10 distinct symptom clusters. Some aligned with Rome criteria but other extended beyond its strict anatomical divisions, challenging a key assumption of the Rome classification framework. These results provide novel insight on a multicontinental scale about the complexity of symptom patterns in DGBI and their anatomical relationships.