Contents
Contributors
1 Introduction
What is evidence-based gastroenterology and hepatology?
Clinical decision making in gastroenterology and hepatology
Application of a diagnostic test
Offering a prognosis
Recommendations concerning therapy
Are the results of this study valid?
Are the results of this valid study important?
Are these results applicable to my patient?
Are the results of this meta-analysis valid and reliable?
Are these results applicable to our patient example?
Rationale for a book on evidence-based gastroenterology and hepatology
Part I: Gastrointestinal disorders
2 Gastroesophageal reflux disease
Introduction
Epidemiology of gastroesophageal reflux disease
Pathophysiology of gastroesophageal reflux disease
Diagnostic tests for gastroesophageal reflux disease
Therapeutic trial of acid suppression as a diagnostic test for GERD
Treatment of gastroesophageal reflux disease
H2-receptor antagonists
Erosive gastroesophageal reflux disease
Treatment of non-erosive reflux disease (NERD)
Symptomatic gastroesophageal reflux disease: empirical therapy for uninvestigated patients
Treatment of esophageal peptic stricture
Endoscopic treatments
Anti-reflux surgery
3 Barrett’s esophagus
Introduction
Definition
Epidemiology
Pathogenesis
Diagnosis
Treatment
Screening and surveillance
Conclusion
4 Esophageal motility disorders: Achalasia and spastic motor disorders
Achalasia
Summary
Spastic motility disorders
Summary
5 Eosinophilic esophagitis
Introduction
Searching for the evidence
Definition
Etiology
Epidemiology
Diagnosis
Prognosis
Management
Pharmacological therapies
Dietary interventions
Endoscopic dilation
Future therapies
Acknowledgements
6 Ulcer disease and Helicobacter pylori infection: Etiology and treatment
Introduction
What is the evidence for the role of H. pylori in peptic ulcer disease?
Association of H. pylori with ulcer disease (strength, consistency and specificity)
Temporal relationship
Biological gradient
Effects of interventions: outcomes following H. pylori eradication
Coherence of the data with earlier epidemiological information
Treatment of duodenal ulcer
Summary
Treatment of gastric ulcer
H. pylori eradication therapy
Summary
7 Non-steroidal anti-inflammatory drug-induced gastro-duodenal toxicity
Introduction
Background
Risk factors for NSAID related gastrointestinal toxicity
Do endoscopic ulcers predict clinical events?
The role of Helicobacter pylori in NSAID associated ulcers
Definition of terms
Misoprostol
Clinical ulcers
H2-receptor antagonists
Proton pump inhibitors
Head-to-head comparisons
Summary
Cyclo-oxygenase-2 inhibitors
Endoscopic ulcer trials
Endoscopically detected gastro-duodenal ulcers
Clinical gastrointestinal events
Symptoms and treatment withdrawals
Summary
8 Acute non-variceal gastrointestinal hemorrhage: Treatment
Introduction
Risk assessment and resuscitation
Specific therapy
Drug therapy
Endoscopic therapy
Conclusions
Conclusion
Conclusion
9 Functional dyspepsia
Introduction
Definition of functional dyspepsia
Diagnosis of functional dyspepsia
Subgroups of dyspepsia and overlap with GERD
Diagnostic investigation: endoscopy or radiographs?
Methodological problems in trials of functional dyspepsia
Functional versus uninvestigated dyspepsia
Drug treatment
Conclusion
10 Celiac disease: Diagnosis, treatment and prognosis
Epidemiology
Clinical manifestations
Pathology
Serological testing
Therapy
Prognosis
Conclusion
11 Crohn’s disease
Introduction
Induction of remission
Treatment of therapy-resistant or steroid-dependent patients
Maintenance of remission
Summary
12 Ulcerative colitis
Introduction
Histological diagnosis
Prognosis
Cancer surveillance (see also Chapter 17)
Treatment
Azathioprine and 6-mercaptopurine
13 Pouchitis after restorative proctocolectomy
Introduction
Diagnosis and classification
Treatment with antibiotics
Treatment with probiotics
Treatment with anti-inflammatory and immune modifier agents
Treatment with nutritional agents
Treatment with allopurinol
Treatment with bismuth
Treatment algorithm for pouchitis
Response to treatment of pouchitis (natural history)
Conclusion
14 Microscopic colitis: Collagenous and lymphocytic colitis
Epidemiology
Histopathology
Etiology and pathophysiology
Clinical features and diagnosis
One or two diseases?
Treatment of microscopic colitis
15 Drug-induced diarrhea
Drug induced diarrhea
Watery diarrhea
Inflammatory diarrhea
Fatty diarrhea
Conclusion
16 Metabolic bone disease in gastrointestinal disorders
Introduction
Hepatic osteodystrophy
Inflammatory bowel disease
Celiac disease
Glucocorticoid-induced bone loss
Proton pump inhibitors and fracture risk
Conclusion
17 Colorectal cancer in ulcerative colitis: Surveillance
Epidemiological investigation
Axioms
Questions
Chemoprevention
Improving cancer surveillance programs in ulcerative colitis
18 Colorectal cancer: Population screening and surveillance
Rules of evidence and feasibility of evidence
What to do when ideal evidence is lacking
Colorectal cancer: an ideal target for prevention and early detection through screening
Organized vs opportunistic screening
Fecal occult blood testing
Expected sensitivity of FITs
Stool DNA
Flexible sigmoidoscopy
Radiologic screening
CT colonography (CTC) or virtual colonoscopy (VC)
Colonoscopy screening
Implementing screening
Comparing guidelines
19 Prevention and treatment of travelers’ diarrhea
Background
Epidemiology of travelers’ diarrhea
Etiology of travelers’ diarrhea
Evidence-base evaluation
Prevention of travelers’ diarrhea
Historical considerations
Immunoprophylaxis
Effectiveness of chemoprophylaxis and immunoprophylaxis in the prevention of TD
Current practice and recommendations
Future research in prevention of travelers’ diarrhea
Treatment of travelers’ diarrhea
Evidence-based review of travelers’ diarrhea treatment
Current practice and recommendations
Future research for treatment of travelers’ diarrhea
Conclusions
Acknowledgments
20 Clostridium difficile associated disease: Diagnosis and treatment
Epidemiology
Treatment for the initial episode
Treatment for recurrent CDAD
Prevention
Summary
Acknowledgement
21 Irritable bowel syndrome
Definition of irritable bowel syndrome
Prevalence and incidence of irritable bowel syndrome
Irritable bowel syndrome and health services
Pathogenesis of irritable bowel syndrome
Making a diagnosis of irritable bowel syndrome
Summary
Treatment of irritable bowel syndrome
Summary
Prognosis of irritable bowel syndrome
22 Ogilvie’s syndrome
Introduction
Pathogenesis
Clinical features
Management
Medical therapy
Clinical guidelines
Summary
23 Gallstone disease
Introduction
Elective cholecystectomy
Elective laparoscopic versus open cholecystectomy
Further issues in elective laparoscopic cholecystectomy
Acute cholecystitis
Cholecystectomy via NOTES
Gallstone pancreatitis
Choledocholithiasis
24 Acute pancreatitis
Definition of acute pancreatitis
Diagnosis
Severe acute pancreatitis
Definition of severe pancreatitis
Prediction of severity
Role of CT in acute pancreatitis
Organization of care
Initial management and resuscitation
Prophylactic antibiotics
Nutrition in acute pancreatitis patients
Management of gallstones causing pancreatitis
The role of early ERCP in severe biliary pancreatitis
Intervention for necrosis
Abdominal compartment syndrome
Acknowledgement
25 Obesity management: Considerations for the gastroenterologist
Introduction
Background
The role of the gastrointestinal tract in ingestive behavior
Gastrointestinal symptoms and disease in the obese patient
Bariatric surgery – a primer for the gastroenterologist
Considerations in endoscopy
Endoscopic treatments for obesity
Part II: Liver disease
26 Hepatitis C
Introduction
HCV genome
Prevalence and transmission
Acute hepatitis C infection
Natural history and progression of chronic infection
Diagnosis and evaluation
Treatment for chronic hepatitis C
Summary
27 Hepatitis B: Prognosis and treatment
Background
Evaluation of available evidence
Conclusions
28 Alcoholic liver disease
Screening
Treatment
29 Non-alcoholic fatty liver disease
Introduction
Epidemiology
Natural history of NAFLD
Susceptibility
Disease associations with NAFLD
Clinical presentation
Investigation
Overall management strategy for NAFLD
Treatments directed at components of the metabolic syndrome
Treatments directed at the liver
30 Hemochromatosis
Introduction
Pathogenesis of hemochromatosis
Diagnosis of hemochromatosis
Underdiagnosis of hemochromatosis
Population screening
Treatment of hemochromatosis
31 Wilson’s disease
Introduction
Physiological copper metabolism
Molecular pathogenesis
Molecular genetics
Clinical manifestations
Hepatic disease
Neurological and neuro-psychiatric disease
Other clinical changes
Diagnostic approach
Treatment
Monitoring
Prognosis
Pregnancy
Salvage treatment/bridge to transplantation in fulminant liver failure
Liver transplantation
Summary
32 Primary biliary cirrhosis
Introduction
Diagnosis
Natural history
Surrogate markers of outcome
Therapeutic trial design: assessment of credibility
Randomized controlled trials of treatment for primary biliary cirrhosis
The future for therapy in primary biliary cirrhosis
33 Autoimmune hepatitis
Introductions
Features of autoimmune hepatitis
Diagnosis
Prognosis
34 Primary sclerosing cholangitis
Introduction
Etiology
Diagnosis
Epidemiology, natural history and prognosis
Management of complications
Medical therapy – the prevention of disease progression
Conclusion
35 Non-histological assessment of liver fibrosis
Serum markers of liver fibrosis
Transient elastography
Is there a way to optimize the performance of the tests?
Can we expect more from non-invasive tests?
Correlation with clinical events and survival
Proposed algorithm for the prediction of liver fibrosis in HCV patients
Conclusion
36 Portal hypertensive bleeding
Introduction
Randomized controlled trials for prevention of first variceal bleeding
Outcome of acute variceal bleeding
Randomized controlled trials for the treatment of acute variceal bleeding
Randomized controlled trials of vasoactive drug treatment of acute variceal bleeding
Randomized controlled trials of emergency sclerotherapy in the management of acute variceal bleeding
Randomized controlled trials of emergency surgery in the management of acute variceal bleeding
Randomized controlled trials of other endoscopic therapies in the management of acute variceal bleeding
Gastric varices
Uncontrolled variceal bleeding
Prevention of recurrent variceal bleeding
Randomized controlled trials for the prevention of variceal re-bleeding
Randomized controlled trials of surgical therapy
Conclusion
Summary
37 Hepatic outflow syndromes and splanchnic venous thrombosis
Budd-Chiari syndrome
Portal and splanchnic vein thrombosis
Veno occlusive disease/sinusoidal obstruction syndrome
38 Ascites, hepatorenal syndrome and spontaneous bacterial peritonitis
Introduction
Ascites
Hepatorenal syndrome
Spontaneous bacterial peritonitis
Acknowledgement
39 Hepatic encephalopathy: Treatment
Design of clinical trials in hepatic encephalopathy
Natural history of HE
Methods to quantify
Evidence-based medicine and hepatic encephalopathy
Treatment of hepatic encephalopathy
Pharmacotherapy
Molecular adsorbent recirculating system (MARS)
Persistent HE type C
Minimal HE
Summary of recommended treatment of hepatic encephalopathy in clinical practice
Chronic therapy
40 Hepatocellular carcinoma
Introduction
Early diagnosis
Population to be screened
Screening tests
The recall policy
Treatment of patients with cirrhosis and HCC
Intermediate HCC
Advanced HCC
End-stage HCC
Treatment of patients with normal livers
Acknowledgement
41 Fulminant hepatic failure: Treatment
Introduction
General supportive management
Management of cerebral edema
Renal failure
Specific therapies
Liver transplantation
42 Liver transplantation: Prevention and treatment of rejection
Introduction
Acute allograft rejection
Immunosuppression in liver transplant recipients
Chronic ductopenic rejection
Acknowledgements
43 Liver transplantation: Prevention and treatment of infection
Risk factors for infection
Time of infection occurrence
Bacterial infection
Viral infections
Fungal infections
Acknowledgment
44 Management of HCV infection and liver transplantation
Introduction
Natural history of recurrent HCV
Factors associated with severe HCV recurrence
Treatment of recurrent HCV
Pre-transplant antiviral therapy
Preemptive antiviral treatment
Treatment of established disease
Risk of acute cellular rejection and alloimmune hepatitis
Retransplantation for allograft cirrhosis
Summary
45 Management of HBV infection and liver transplantation
Pre-transplant approach
Prophylactic post-transplant approach
Therapeutic post-transplant approach
Anti-HBc positive donors
46 Liver biopsy
Introduction
Liver biopsy and its histological interpretation in chronic viral hepatitis
Different approaches of liver biopsy
“Histological” assessment without liver biopsy
47 Drug induced liver disease: Mechanisms and diagnosis
Introduction
Mechanisms
Risk factors
Diagnostic approach and tools for causality assessment
Color Plates
Index
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Library of Congress Cataloging-in-Publication Data
Evidence-based gastroenterology and hepatology / edited by John W.D. McDonald . . . [et al.]. - 3rd ed.
p,;cm
Includes bibliographical references and index.
ISBN 978-1-4051-8193-8 (alk. paper)
1. Gastroenterology-Textbooks. 2. Hepatology-Textbooks. 3. Gastrointestinal system-Diseases-Textbooks. 4. Liver-Diseases-Textbooks. 5. Evidence-based medicine-Textbooks. I. McDonald, John W.D.
[DNLM: . Gastrointestinal Diseases-diagnosis. 2. Gastrointestinal Diseases-therapy. 3. Evidence-based Medicine-methods. 4. Liver Diseases-diagnosis. 5. Liver Diseases-therapy.
WI 140 E928 2010]
RC801.E95 2010
616.3′3-dc22
2010011010
A catalogue record for this book is available from the British Library.
Contributors
Bincy P Abraham
Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, USA
Paul C Adams
London Health Sciences Centre, London, Ontario, Canada
Aftab Ala
Centre for Gastroenterology, Hepatology and Nutrition, Department of Medicine, Frimley Park Hospital NHS Foundation Trust, Surrey, UK
Piero Luigi Almasio
Division of Gastroenterology, Academic Department of Internal Medicine, University of Palermo, Palermo, Italy
Raúl J Andrade
Liver Unit, Gastroenterology Service, “Virgen de la Victoria” University Hospital and School of Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Málaga, Spain
Vicente Arroyo
Liver Unit and GI Unit, Hospital Clínic and University of Barcelona, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBERHED), Barcelona, Spain
Johan Bohr
Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden
Michel Boucher
HTA Development, CADTH, Ottawa, Canada
Marc Bradette
Division of Gastroenterology, Centre Hospitalier Universitaire de Québec, Québec City, Canada
Andrew K Burroughs
The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and Department of Surgery, University College London, London, UK
James R Burton, Jr
University of Colorado, Denver, Colorado, USA
Stephen Caldwell
Department of Hepatology, University of Virginia, Charlottesville, Virginia, USA
Calogero Cammà
Division of Gastroenterology, Academic Department of Internal Medicine, University of Palermo, Palermo, Italy
Andrés Cárdenas
Liver Unit and GI Unit, Hospital Clínic and University of Barcelona, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBERHED), Barcelona, Spain
Hélène Castel
Department of Hepatology, Hôpital Claude Huriez, Lille, France
Nishchay Chandra
Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
Roger W Chapman
Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
Naoki Chiba
Division of Gastroenterology, McMaster University Medical Centre, Hamilton and Guelph General Hospital, Guelph, Canada
Evangelos Cholongitas
The Royal Free Shiila Sherlock Liver Centre, Royal Free Hospital and Department of Surgery, University College London, London, UK
Nicholas Church
Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
Paul Collins
School of Clinical Sciences, University of Liverpool, Liverpool, UK
Massimo Colombo
Department of Medicine, First Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
Ann Cranney
Canadian Protective Medical Association and Clinical Epidemiology, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Canada
Antonio Craxì
Division of Gastroenterology, Academic Department of Internal Medicine, University of Palermo, Palermo, Italy
Susan N Cullen
Buckinghamshire Hospitals NHS Trust, High Wycombe, UK
Christopher P Day
Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
Amar P Dhillon
Histopathology Department, Royal Free Hospital, London, UK
Vito Di Marco
Division of Gastroenterology, Academic Department of Internal Medicine, University of Palermo, Palermo, Italy
James S Dooley
Centre for Hepatology, University College London Medical School (Royal Free Campus), University College London and the Royal Free Sheila Sherlock Liver Centre, Royal Free Hampstead NHS Trust, London, UK
Catherine Dubé
Division of Gastroenterology, University of Calgary, Calgary, Canada
Herbert L DuPont
Center for Infectious Disease, University of Texas Health Science Center at Houston, School of Public Health and Internal Medicine Service, St. Luke’s Episcopal Hospital, Department of Medicine, Baylor College of Medicine, Houston, USA
Hassan Elberm
Department of Surgery, Southampton University Hospitals, Southampton, UK
Elizabeth J Elliott
Discipline of Paediatrics and Child Health, University of Sydney and The Children’s Hospital of Westminster, Sydney and Centre for Evidence-Based Paediatrics, Gastroenterology and Nutrition, Sydney, Australia
Carlo A Fallone
Division of Gastroenterology, McGill University Health Center, Montreal, Canada
Brian G Feagan
Robarts Clinical Trials, Robarts Research Unit, University of Western Ontario, London, Ontario, Canada
M Brian Fennerty
Oregon Health and Science University, Division of Gastroenterology and Hepatology, Portland, Oregon, USA
Peter Ferenci
Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
Alexander C Ford
Department of Gastroenterology, St James’s University Hospital, Leeds, UK
Brett E Fortune
University of Colorado, Denver, Colorado, USA
Giacomo Germani
The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and Department of Surgery, University College London, London, UK
Pere Ginès
Liver Unit and GI Unit, Hospital Clínic and University of Barcelona, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBERHED), Barcelona, Spain
John Goulis
Fourth Department of Medicine, Aristotelian University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
Leah Gramlich
Division of Gastroenterology, Royal Alexandra Hospital University of Alberta, Edmonton, Canada
James Gregor
Department of Medicine, University of Western Ontario, London, Ontario, Canada
E Jenny Heathcote
Francis Family Liver Centre, Toronto Western Hospital, University Health Network and Department of Medicine, University of Toronto, Toronto, Canada
Gideon M Hirschfield
Francis Family Liver Centre, Toronto Western Hospital, University Health Network and Department of Medicine, University of Toronto, Toronto, Canada
Massimo Iavarone
Department of Medicine, First Division of Gastroenterology, Fondazione IRCCS Maggiore Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
Gary P Jeffrey
Western Australia Liver Transplantation Service, Sir Charles Gairdner Hospital, Nedlands, Australia
Derek P Jewell
Experimental Medicine Division, John Radcliffe Hospital, Oxford, UK
Colin D Johnson
Department of Surgery, Southampton University Hospitals, Southampton, UK
Emilie Jolicoeur
Department of Gastroenterology, Montfort Hospital, Ottawa, Canada
Bret A Lashner
Center for Inflammatory Bowel Disease, Cleveland Clinic, Cleveland, USA
Calvin HL Law
Hepatobiliary, Pancreatic and Gastrointestinal Surgery,
Department of Health Policy, Management and Evaluation, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Theodore R Levin
The Permanente Medical Group, Inc., Walnut Creek, California, USA
Robert Löfberg
IBD Unit, HMQ Sophia Hospital, Karolinska Institute, Stockholm, Sweden
M Isabel Lucena
Clinical Pharmacology Service, “Virgen de la Victoria” University Hospital and School of Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Málaga, Spain
John WD McDonald
Robarts Clinical Trials, Robarts Research Unit, University of Western Ontario, London, Ontario, Canada
Lynne V McFarland
Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Washington, USA
John G McHutchison
Division of Gastroenterology, Duke Clinical Research Institute and Duke University Medical Center, North Carolina, USA
Michael MP Manns
Department of Gastroenterology, Hepatology and Endocrinology, Medical School, Hanover, Germany
Philippe Mathurin
Department of Hepatology, Hôpital Claude Huriez, Lille, France
Paul Moayyedi
Gastroenterology Division, McMaster University Medical Centre, Hamilton, Canada
Rachid Mohamed
Division of Gastroenteology, University of Calgary, Calgary, Canada
Katherine Muir
University of Toronto, Toronto, Canada
Christian Müller
Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
Nicholas Murphy
Queen Elizabeth Hospital (Birmingham), Edgbaston, Birmingham, UK
Miquel Navasa
Liver Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, IDIBAPS, CIBEREHD, Barcelona, Spain
James O’Beirne
Royal Free Hospital, London, UK
Kelvin Palmer
Gastroenterology Unit, Western General Hospital, Edinburgh, UK
George V Papatheodoridis
Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital, Athens, Greece
Darrell S Pardi
Inflammatory Bowel Disease Clinic, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
David Patch
The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and Department of Surgery, University College London, London, UK
Keyur Patel
Division of Gastroenterology, Duke Clinical Research Institute and Duke University Medical Center, North Carolina, USA
Maria Pleguezuelo
The Royal Free Shiila Sherlock Liver Centre, Royal Free Hospital and Department of Surgery, University College London, London, UK
Linda Rabeneck
University of Toronto, Toronto, Canada
Joel E Richter
Department of Medicine, Temple University School of Medicine, Philadelphia, USA
Antoni Rimola
Liver Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, IDIBAPS, CIBEREHD, Barcelona, Spain
Jason R Roberts
Division of Gastroenterology and Hepatology, Medical University of South Carolina, South Carolina, USA
Juan Rodés
Liver Unit and GI Unit, Hospital Clínic and University of Barcelona, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBERHED), Barcelona, Spain
Hugo R Rosen
University of Colorado, Denver, Colorado, USA
Alaa Rostom
Forzani & MacPhail Colon Cancer Screening Centre University of Calgary, Calgary, Canada
Michael Sai Lai Sey
Department of Medicine, University of Western Ontario, London, Ontario, Canada
William J Sandborn
Inflammatory Bowel Disease Clinic, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
Michael D Saunders
Digestive Diseases Center, University of Washington School of Medicine, Washington, USA
Joseph H Sellin
Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, USA
Neeral Shah
Department of Hepatology, University of Virginia, Charlottesville Virginia, USA
Arya M Sharma
Division of Endocrinology, University of Alberta, Edmonton, Canada
Marco Senzolo
Department of Surgical and Gastroenterological Sciences, University-Hospital of Padua, Padua, Italy
Marika Simon-Rudler
UPMC Service d’Hépato-Gastroentérologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
Constantine A Soulellis
Division of Gastroenterology, McGill University Health Center, Montreal, Canada
Christina M Surawicz
Department of Gastroenterology, Harborview Medical Center, Washington, USA
Lloyd R Sutherland
Department of Community Health Sciences, University of Calgary, Health Sciences Centre, Calgary, Canada
Nicholas J Talley
Department of Medicine, The Mayo Clinic Jacksonville, USA
Véd R Tandan
Department of Surgery, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
Dominique Thabut
UPMC Service d’Hépato-Gastroentérologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
Hans L Tillmann
Division of Gastroenterology, Duke Clinical Research Institute and Duke University Medical Center, North Carolina, USA
Christos Trianto
Division of Gastroenterology, Department of Internal Medicine, University Hospital, Patras, Greece and The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and Department of Surgery, University College London, London, UK
Peter Tug well
Department of Epidemiology and Community Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
Curt Tysk
Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden
Laura VanderBeek
McMaster University, Hamilton, Ontario, Canada
Sander Veldhuyzen van Zanten
Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
Marcelo F Vela
Gastroenterology Section, Baylor College of Medicine, Houston, Texas, USA
Arndt Vogel
Department of Gastroenterology, Hepatology and Endocrinology, Medical School, Hanover, Germany
Alastair JM Watson
School of Clinical Sciences, University of Liverpool, Liverpool, UK
George Wells
Department of Epidemiology and Community Medicine and Cardiovascular Research Methods Centre, University of Ottawa, Ottawa, Canada
Julia Wendon
King’s College London School of Medicine and King’s College Hospital, London, UK
Marilyn Zeman
Division of Gastroenterology, Royal Alexandra Hospital University of Alberta, Edmonton, Canada