Lode Van Overbeke - Academia.edu (original) (raw)

Papers by Lode Van Overbeke

Acta gastro-enterologica belgica, Dec 1, 2022

A 76-year-old lady was referred for resection of a large (50 mm) sigmoidal sessile adenoma (Paris... more A 76-year-old lady was referred for resection of a large (50 mm) sigmoidal sessile adenoma (Paris classification IIb, JNET2a, Figure A). After submucosal injection with diluted indigo carmine and adrenaline, the lesion was resected using cold snare piecemeal technique (Captivator 10 mm cold single use snare, Boston). Because of a zone with presumably residual polyp tissue, an additional resection of submucosa was performed (Figure B, arrow). This resection turned out to cut deeper than expected and reached as far as the circular muscles (Figure B, arrowhead). No preventive clips were placed. No complications occurred, there were no immediate or late bleedings. Since the beginning of endoscopy, polyps were always removed by means of coagulation (1). This habit has since persisted for decades. Thereafter cold snare resection seemed to be an equally efficient but safer technique for removing smaller polyps (2). Meanwhile, there is growing evidence that cold snare piecemeal resection is also a safe alternative to classical endoscopic mucosal resection for larger sessile lesions (3). This picture suggests that complete submucosal resection by means of cold snare technique could be achievable and deserves additional study as an alternative to the classic endoscopic submucosal dissection.

Biochemia Medica

Vitamin B12 deficiency can present with neurologic and psychiatric symptoms without macrocytic an... more Vitamin B12 deficiency can present with neurologic and psychiatric symptoms without macrocytic anaemia. We describe a case of late-onset cobalamin C deficiency which typically presents with normal serum vitamin B12 concentrations, posing an additional diagnostic challenge. A 23-year-old woman with decreased muscle strength and hallucinations was diagnosed with 'catatonic depression' and admitted to a residential mental health facility. She was referred to our hospital for further investigation 3 months later. Heteroanamnesis revealed that the symptoms had been evolving progressively over several months. Magnetic resonance imaging (MRI) of the brain showed diffuse symmetrical white matter lesions in both hemispheres. Routine laboratory tests including vitamin B12 and folic acid were normal except for a slight normocytic, normochromic anaemia. Over the next 6 weeks her symptoms deteriorated, and she became unresponsive to stimuli. A new MRI scan showed progression of the white matter lesions. The neurologist requested plasma homocysteine (Hcys) which was more than 8 times the upper limit of normal. Further testing revealed increased methylmalonic acid and the patient was diagnosed with adult-onset cobalamin C deficiency. This case illustrates that Hcys and/or methylmalonic acid should be determined in patients presenting with neuropsychiatric symptoms suggestive of vitamin B12 deficiency with a normal serum vitamin B12 to rule out a late-onset cobalamin C deficiency.

Wikijournal of Medicine, 2017

Gastrointestinal bleeding (GI bleed) is a common and potentially life-threatening reason for emer... more Gastrointestinal bleeding (GI bleed) is a common and potentially life-threatening reason for emergency room and intensive care unit admission. This article reports the case of an 83-year-old man with acute GI bleeding from an unusual cause. The clinical information is presented in a step-by-step and question-answer format for learning purposes. This paper is particularly aimed at an internal medicine readership. Case presentation In March 2011, an 83-year-old man developed paroxysmal atrial fibrillation and distal right leg ischaemia successfully treated with embolectomy. He had a remote medical history of hypersensitivity pneumonitis (from mushroom farming), coronary artery bypass grafting (CABG) surgery, chronic lymphocytic leukaemia (CLL), and Billroth type II gastrectomy for previous gastric ulcer bleeding. His medication included a β-blocker, a statin, low-dose aspirin, an angiotensin II receptor blocker and a protonpump inhibitor (PPI). Lab results were normal except for slight thrombocytopenia (141,000 platelets/µL; normal range 150,000-450,000 platelets/µL) and lymphocytosis (21,675 cells/µL, normal range 1,200-3,600 cells/µL with smudge cells, monoclonal B-lymphocytes 17,700 cells/µL). Echocardiography showed only left atrial dilatation and grade 2 mitral insufficiency, without inferior vena cava dilatation. He lived independently and was in an excellent general condition, going on regular skiing holidays.

Digestive and Liver Disease

Acta gastro-enterologica Belgica, 2015

Until now, "eosinophilic hepatitis" has not been recognized as a separate disease entit... more Until now, "eosinophilic hepatitis" has not been recognized as a separate disease entity. We report a case of a middle-aged women with an acute febrile, severe cholestatic hepatitis accompanied with rash and quincke oedema, and an elevated serum IgE level. Liver biopsy showed lymphocytic inflammation with a remarkably high number of eosinophils. She responded rapidly to methylprednisolone treatment, which could be quickly tapered off and stopped without relapse. The term 'idiopathic acute eosinophilic hepatitis' seems to be the best fitting diagnostic term.

Acta gastro-enterologica Belgica, 2005

BACKGROUND AND AIMS It is generally accepted that enteropathy-type intestinal lymphoma (EATL) ari... more BACKGROUND AND AIMS It is generally accepted that enteropathy-type intestinal lymphoma (EATL) arises against a background of gluten enteropathy. We investigate whether patients with this diagnosis had celiac disease or pre-existing celiac disease, based on gliadin and endomysium antibodies, as well as duodenal biopsies, HLA typing and response to gluten-free diet. METHODS AND RESULTS Retrospective study of patients with the diagnosis of peripheral T cell lymphoma of the intestine between January 1990 and January 2002 at the university hospital Gasthuisberg Leuven (n = 14). Patients in whom serologic testing was performed or patients known with pre-existing celiac disease (CD) were included (n = 9). Six of these nine patients were tested for endomysium antibodies (AEM), none of them were positive. Of the six patients with biopsies of mucosa uninvolved by lymphoma, all of them had villous atrophy; five had increased intraepithelial lymphocytes (IEL). In the four patients were HLA typi...

Acta gastro-enterologica Belgica, 2008

We report on two cases of acute liver injury along with the intake of Greater Celandine (Chelidon... more We report on two cases of acute liver injury along with the intake of Greater Celandine (Chelidonium majus), a well-known herbal remedy frequently used for irritable bowel syndrome. All other possible causes of acute liver damage were excluded in both patients. In one patient, cholestatic hepatitis recurred rapidly after involuntary re-exposition. Both patients fully recovered after the withdrawal of Greater Celandine. The two cases add to the existing database about the potential hepatotoxicity of drugs containing Greater Celandine and raise the question whether the approval of this drug should be reevaluated in the light of lacking evidence for a therapeutic benefit.

BACKGROUND AND AIMS Cold snare polypectomy (CSP) is an accepted technique to remove diminutive or... more BACKGROUND AND AIMS Cold snare polypectomy (CSP) is an accepted technique to remove diminutive or small (6-9 mm) polyps. Here we present a series of CSP for advanced non-pedunculated polyps (> 10 mm). PATIENTS AND METHODS This is a retrospective, single operator study. A total of 111 patients with non-pedunculated polyps (Paris classification 0-IIa, 0-IIb, 0-Is) estimated > 10 mm, underwent CSP. RESULTS A total of 129 polyps were removed (87 0-IIa, 18 0-IIb, 24 0-Is). The number of these polyps ranked according to size were as follows : 11-19 mm : 63 (49%), 20-29 mm : 44 (34%), > 30 mm : 22 (17%). Thirty-eight (29.5%) were sessile serrated adenomas, 47 (36%) were tubular adenomas, 25 (19.3%) were villous adenoma's and 18 (14%) were hyperplastic polyps. Forty-nine (38%) polyps were resected in a piecemeal fashion, submucosal injection with diluted Indigo Carmine was used in 24 (19%). Immediate oozing bleeding was frequent but in almost all patients rapid spontaneous haem...

A 48-year-old female presented with diarrhea, abdominal pain and fever of two days duration. Clin... more A 48-year-old female presented with diarrhea, abdominal pain and fever of two days duration. Clinical examination showed abdominal distension with tenderness. The patient was being treated for cerebral hemangiopericytoma with chemotherapy. Because of respiratory infection and chemotherapy induced pancytopenia antibiotic therapy had been given for seven days. CT scan of the abdomen showed a markedly distended colon, consistent with toxic megacolon (Fig. A). Two days later, protruding nodules within the air-filled distended colon were visible on plain film of the abdomen (Fig. B (detailed view of the hepatic flexure)). The inflammatory pseudopolyposis was not visible on the initial CT scan of the abdomen, not even with pulmonary window. Left coloscopy performed nine days after onset of symptoms showed findings consistent with pseudomembranous colitis and confirmed inflammatory pseudopolyposis. The patient died three weeks later from sepsis. Toxic megacolon may be seen as a complicatio...

1 Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium 2 Faculty... more 1 Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium 2 Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium 3 Department of Gastroenterology and Hepatology, ZNA Stuyvenberg, Antwerp, Belgium 4 Department of Gastroenterology and Hepatology, Hôpitaux Iris Sud Bracops, Brussels, Belgium 5 Department of Gastroenterology and Hepatology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium 6 Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland 7 Department of Gastroenterology and Hepatology, AZ Groeninge, Kortrijk, Belgium 8 Department of Gastroenterology and Hepatology, Clinique Saint-Joseph, Clinique de l'Espérance, Liège, Belgium 9 Department of Gastroenterology and Hepatology, AZ St-Maarten, Mechelen, Belgium 10 Medisch Sociaal Opvangcentrum Limburg, Genk, Belgium 11 Center for Statistics (CenStat), Hasselt University, Belgium 12 Free Clinic, Antwerp ...

Tijdschrift Voor Geneeskunde, 2021

A link between oedema and eosinophils: eosinophilic fasciitis A 65-year-old man presented with pr... more A link between oedema and eosinophils: eosinophilic fasciitis A 65-year-old man presented with progressive swelling in his 4 limbs. The skin on his limbs was oedematous and indurated, with an orange peel skin and blistering in some places, as well as a groove sign over the tibia. Lab results showed a remarkable eosinophilia of 23% (reference ≤ 6%). A deep skin biopsy revealed fascial infiltration and fibrin deposition, consistent with eosinophilic fasciitis (EF). EF is a rare cause of fasciitis, eosinophilia and polyclonal hypergammaglobulinemia. Because of its rarity, diagnostic delay is usually significant. Corticosteroids are the mainstay of therapy, but because of an incomplete response and the need for long-term treatment, corticosteroid sparing agents are often associated.

Journal of Hepatology

Recently, concerns were raised of high rates of HCC recurrence in patients treated with direct‐ac... more Recently, concerns were raised of high rates of HCC recurrence in patients treated with direct‐acting antivirals (DAA) for hepatitis C infection. We investigated the HCC occurrence and recurrence rates within 6 months after treatment with DAA with or without pegylated interferon (PEG‐IFN) in real life. This is a retrospective, multicenter cohort trial, executed in 15 hospitals distributed across Belgium. Populations were matched based on fibrosis score (Metavir F3‐F4). Patients with a Child‐Pugh score ≥ B were excluded. In total, 567 patients were included, of whom 77 were treated with PEG‐IFN+DAA between 2008 and 2013 and 490 with DAA without PEG‐IFN between 2013 and 2015. Patients treated with PEG‐IFN+DAA (53±9y) were younger than patients treated with DAA without PEG‐IFN (59±12y) (P=.001). 47% of patients treated with PEG‐IFN+DAA were in the F4 stage vs 67% of patients treated with DAA without PEG‐IFN (P=.001). Screening was inadequate in 20% of both patient groups (P=.664). The early occurrence rate of HCC was 1.7% and 1.1% in patients treated with DAA with and without PEG‐IFN, respectively (P=.540). The early recurrence rate was 0% in patients treated with PEG‐IFN+DAA and 15.0% in patients treated with DAA without PEG‐IFN (P=.857). There is no difference in early occurrence of new HCC between patients treated with DAA with and without PEG‐IFN. We did observe a high early recurrence rate of HCC in patients treated with DAA without PEG‐IFN. However, these patients were at baseline more at risk for HCC. Finally, in 20%, screening for HCC was inadequate.

Journal of the Belgian Society of Radiology

Sarcoidosis is a multisystemic disease usually affecting the lungs and mediastinal lymph nodes. O... more Sarcoidosis is a multisystemic disease usually affecting the lungs and mediastinal lymph nodes. Other organs, such as the liver and the spleen, are less commonly involved. Patients usually present with mild nonspecific symptoms. On imaging, hepatosplenomegaly with or without multiple focal lesions within the spleen may be seen in the active disease stage. Rarely, the disease may evolve to cirrhosis and liver failure. We report such a rare case of hepatosplenic sarcoidosis complicated by acute esophageal bleeding due to portal hypertension.

Acta gastro-enterologica Belgica

Until now, "eosinophilic hepatitis" has not been recognized as a separate disease entit... more Until now, "eosinophilic hepatitis" has not been recognized as a separate disease entity. We report a case of a middle-aged women with an acute febrile, severe cholestatic hepatitis accompanied with rash and quincke oedema, and an elevated serum IgE level. Liver biopsy showed lymphocytic inflammation with a remarkably high number of eosinophils. She responded rapidly to methylprednisolone treatment, which could be quickly tapered off and stopped without relapse. The term 'idiopathic acute eosinophilic hepatitis' seems to be the best fitting diagnostic term.

Journal of medical virology, Jan 29, 2015

No data have been reported yet on treatment outcome in persons who inject drugs (PWID) infected w... more No data have been reported yet on treatment outcome in persons who inject drugs (PWID) infected with hepatitis C virus treated with boceprevir or telaprevir in combination with peginterferon (Peg IFN) and ribavirin (RBV). Additionally, there are concerns about the safety of boceprevir and telaprevir in some subgroups of patients with hepatitis C (HCV). In a cohort of HCV patients infected with genotype 1 in Belgium, treatment outcome of patients infected due to IV drug use was analyzed and compared with patients who have no history of substance use. The study population consisted of 179 patients: 78 PWID and 101 controls treated with boceprevir (n = 79) or telaprevir (n = 100) additional to Peg IFN and RBV; 53 (30%) had advanced disease (F3, F4) and 79 (44%) had an antiviral therapy previously. There were no significant differences in the baseline characteristics between both groups, except that PWID patients were more frequently infected with genotype 1a (67% vs 21%), were younger ...

JBR-BTR : organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR)

We report a case of intestinal ileal lipomatosis in a 56-year-old Caucasian male complicated with... more We report a case of intestinal ileal lipomatosis in a 56-year-old Caucasian male complicated with small bowel obstruction due to ileocolic intussusception with a lipoma serving as lead point. This rare disease is often only discovered incidentally as a consequence of mechanical complications and not well reported in the international literature, compared to intussusception due to an isolated lipoma. Computed tomography is the imaging modality of choice to depict complications of this distinct clinicopathological entity. Density measurements can confirm the fatty content and homogeneity analysis of the lesions can guide the radiologist in the differential diagnosis.

JBR-BTR : organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR), 2001

A 48-year-old female presented with diarrhea, abdominal pain and fever of two days duration. Clin... more A 48-year-old female presented with diarrhea, abdominal pain and fever of two days duration. Clinical examination showed abdominal distension with tenderness. The patient was being treated for cerebral hemangiopericytoma with chemotherapy. Because of respiratory infection and chemotherapy induced pancytopenia antibiotic therapy had been given for seven days. CT scan of the abdomen showed a markedly distended colon, consistent with toxic megacolon (Fig. A). Two days later, protruding nodules within the air-filled distended colon were visible on plain film of the abdomen (Fig. B (detailed view of the hepatic flexure)). The inflammatory pseudopolyposis was not visible on the initial CT scan of the abdomen, not even with pulmonary window. Left coloscopy performed nine days after onset of symptoms showed findings consistent with pseudomembranous colitis and confirmed inflammatory pseudopolyposis. The patient died three weeks later from sepsis. Toxic megacolon may be seen as a complication of inflammatory bowel disease, mostly ulcerative colitis. Infrequently, it complicates other ulcerating diseases of the colon such as ischemic colitis, Behcet’s syndrome, infectious colitis due to amebiasis, shigellosis, salmonellosis, cholera, strongyloidiasis, or Campylobacter and pseudomembranous colitis. In our patient toxic megacolon resulted from pseudomembranous colitis following antibiotic therapy. IMAGES IN CLINICAL RADIOLOGY

Gastroenterology, 1999

The hepatotoxic potential of conventional drugs is well known, but herbal medicines are often ass... more The hepatotoxic potential of conventional drugs is well known, but herbal medicines are often assumed to be harmless. In the last 2 years, we have observed 10 cases of acute hepatitis induced by preparations of greater celandine (Chelidonium majus), which are frequently ...

Acta gastro-enterologica Belgica

During the last 5 years we identified 7 patients with a history of episodic acute abdominal pain ... more During the last 5 years we identified 7 patients with a history of episodic acute abdominal pain and subobstruction due to intestinal angioedema secondary to the use of Angiotensin Converting Enzyme (ACE) inhibitors. These cases were all diagnosed in one gastroenterology department. This is thereby the largest single centre case series of ACE inhibitor-induced angioedema that has been published until now. Our findings suggest that this syndrome is far more frequent than international literature would let us believe. We also describe one of the first male cases diagnosed with this entity for which there is a significant female predominance. In the presence of an appropriate history and suggestive findings on CT scan, this diagnosis can relatively easily be made if one is sufficiently intent on it. An appropriate diagnosis can save these patients a lot of unnecessary diagnostic procedures and discomfort.

Acta gastro-enterologica belgica, Dec 1, 2022

A 76-year-old lady was referred for resection of a large (50 mm) sigmoidal sessile adenoma (Paris... more A 76-year-old lady was referred for resection of a large (50 mm) sigmoidal sessile adenoma (Paris classification IIb, JNET2a, Figure A). After submucosal injection with diluted indigo carmine and adrenaline, the lesion was resected using cold snare piecemeal technique (Captivator 10 mm cold single use snare, Boston). Because of a zone with presumably residual polyp tissue, an additional resection of submucosa was performed (Figure B, arrow). This resection turned out to cut deeper than expected and reached as far as the circular muscles (Figure B, arrowhead). No preventive clips were placed. No complications occurred, there were no immediate or late bleedings. Since the beginning of endoscopy, polyps were always removed by means of coagulation (1). This habit has since persisted for decades. Thereafter cold snare resection seemed to be an equally efficient but safer technique for removing smaller polyps (2). Meanwhile, there is growing evidence that cold snare piecemeal resection is also a safe alternative to classical endoscopic mucosal resection for larger sessile lesions (3). This picture suggests that complete submucosal resection by means of cold snare technique could be achievable and deserves additional study as an alternative to the classic endoscopic submucosal dissection.

Biochemia Medica

Vitamin B12 deficiency can present with neurologic and psychiatric symptoms without macrocytic an... more Vitamin B12 deficiency can present with neurologic and psychiatric symptoms without macrocytic anaemia. We describe a case of late-onset cobalamin C deficiency which typically presents with normal serum vitamin B12 concentrations, posing an additional diagnostic challenge. A 23-year-old woman with decreased muscle strength and hallucinations was diagnosed with 'catatonic depression' and admitted to a residential mental health facility. She was referred to our hospital for further investigation 3 months later. Heteroanamnesis revealed that the symptoms had been evolving progressively over several months. Magnetic resonance imaging (MRI) of the brain showed diffuse symmetrical white matter lesions in both hemispheres. Routine laboratory tests including vitamin B12 and folic acid were normal except for a slight normocytic, normochromic anaemia. Over the next 6 weeks her symptoms deteriorated, and she became unresponsive to stimuli. A new MRI scan showed progression of the white matter lesions. The neurologist requested plasma homocysteine (Hcys) which was more than 8 times the upper limit of normal. Further testing revealed increased methylmalonic acid and the patient was diagnosed with adult-onset cobalamin C deficiency. This case illustrates that Hcys and/or methylmalonic acid should be determined in patients presenting with neuropsychiatric symptoms suggestive of vitamin B12 deficiency with a normal serum vitamin B12 to rule out a late-onset cobalamin C deficiency.

Wikijournal of Medicine, 2017

Gastrointestinal bleeding (GI bleed) is a common and potentially life-threatening reason for emer... more Gastrointestinal bleeding (GI bleed) is a common and potentially life-threatening reason for emergency room and intensive care unit admission. This article reports the case of an 83-year-old man with acute GI bleeding from an unusual cause. The clinical information is presented in a step-by-step and question-answer format for learning purposes. This paper is particularly aimed at an internal medicine readership. Case presentation In March 2011, an 83-year-old man developed paroxysmal atrial fibrillation and distal right leg ischaemia successfully treated with embolectomy. He had a remote medical history of hypersensitivity pneumonitis (from mushroom farming), coronary artery bypass grafting (CABG) surgery, chronic lymphocytic leukaemia (CLL), and Billroth type II gastrectomy for previous gastric ulcer bleeding. His medication included a β-blocker, a statin, low-dose aspirin, an angiotensin II receptor blocker and a protonpump inhibitor (PPI). Lab results were normal except for slight thrombocytopenia (141,000 platelets/µL; normal range 150,000-450,000 platelets/µL) and lymphocytosis (21,675 cells/µL, normal range 1,200-3,600 cells/µL with smudge cells, monoclonal B-lymphocytes 17,700 cells/µL). Echocardiography showed only left atrial dilatation and grade 2 mitral insufficiency, without inferior vena cava dilatation. He lived independently and was in an excellent general condition, going on regular skiing holidays.

Digestive and Liver Disease

Acta gastro-enterologica Belgica, 2015

Until now, "eosinophilic hepatitis" has not been recognized as a separate disease entit... more Until now, "eosinophilic hepatitis" has not been recognized as a separate disease entity. We report a case of a middle-aged women with an acute febrile, severe cholestatic hepatitis accompanied with rash and quincke oedema, and an elevated serum IgE level. Liver biopsy showed lymphocytic inflammation with a remarkably high number of eosinophils. She responded rapidly to methylprednisolone treatment, which could be quickly tapered off and stopped without relapse. The term 'idiopathic acute eosinophilic hepatitis' seems to be the best fitting diagnostic term.

Acta gastro-enterologica Belgica, 2005

BACKGROUND AND AIMS It is generally accepted that enteropathy-type intestinal lymphoma (EATL) ari... more BACKGROUND AND AIMS It is generally accepted that enteropathy-type intestinal lymphoma (EATL) arises against a background of gluten enteropathy. We investigate whether patients with this diagnosis had celiac disease or pre-existing celiac disease, based on gliadin and endomysium antibodies, as well as duodenal biopsies, HLA typing and response to gluten-free diet. METHODS AND RESULTS Retrospective study of patients with the diagnosis of peripheral T cell lymphoma of the intestine between January 1990 and January 2002 at the university hospital Gasthuisberg Leuven (n = 14). Patients in whom serologic testing was performed or patients known with pre-existing celiac disease (CD) were included (n = 9). Six of these nine patients were tested for endomysium antibodies (AEM), none of them were positive. Of the six patients with biopsies of mucosa uninvolved by lymphoma, all of them had villous atrophy; five had increased intraepithelial lymphocytes (IEL). In the four patients were HLA typi...

Acta gastro-enterologica Belgica, 2008

We report on two cases of acute liver injury along with the intake of Greater Celandine (Chelidon... more We report on two cases of acute liver injury along with the intake of Greater Celandine (Chelidonium majus), a well-known herbal remedy frequently used for irritable bowel syndrome. All other possible causes of acute liver damage were excluded in both patients. In one patient, cholestatic hepatitis recurred rapidly after involuntary re-exposition. Both patients fully recovered after the withdrawal of Greater Celandine. The two cases add to the existing database about the potential hepatotoxicity of drugs containing Greater Celandine and raise the question whether the approval of this drug should be reevaluated in the light of lacking evidence for a therapeutic benefit.

BACKGROUND AND AIMS Cold snare polypectomy (CSP) is an accepted technique to remove diminutive or... more BACKGROUND AND AIMS Cold snare polypectomy (CSP) is an accepted technique to remove diminutive or small (6-9 mm) polyps. Here we present a series of CSP for advanced non-pedunculated polyps (> 10 mm). PATIENTS AND METHODS This is a retrospective, single operator study. A total of 111 patients with non-pedunculated polyps (Paris classification 0-IIa, 0-IIb, 0-Is) estimated > 10 mm, underwent CSP. RESULTS A total of 129 polyps were removed (87 0-IIa, 18 0-IIb, 24 0-Is). The number of these polyps ranked according to size were as follows : 11-19 mm : 63 (49%), 20-29 mm : 44 (34%), > 30 mm : 22 (17%). Thirty-eight (29.5%) were sessile serrated adenomas, 47 (36%) were tubular adenomas, 25 (19.3%) were villous adenoma's and 18 (14%) were hyperplastic polyps. Forty-nine (38%) polyps were resected in a piecemeal fashion, submucosal injection with diluted Indigo Carmine was used in 24 (19%). Immediate oozing bleeding was frequent but in almost all patients rapid spontaneous haem...

A 48-year-old female presented with diarrhea, abdominal pain and fever of two days duration. Clin... more A 48-year-old female presented with diarrhea, abdominal pain and fever of two days duration. Clinical examination showed abdominal distension with tenderness. The patient was being treated for cerebral hemangiopericytoma with chemotherapy. Because of respiratory infection and chemotherapy induced pancytopenia antibiotic therapy had been given for seven days. CT scan of the abdomen showed a markedly distended colon, consistent with toxic megacolon (Fig. A). Two days later, protruding nodules within the air-filled distended colon were visible on plain film of the abdomen (Fig. B (detailed view of the hepatic flexure)). The inflammatory pseudopolyposis was not visible on the initial CT scan of the abdomen, not even with pulmonary window. Left coloscopy performed nine days after onset of symptoms showed findings consistent with pseudomembranous colitis and confirmed inflammatory pseudopolyposis. The patient died three weeks later from sepsis. Toxic megacolon may be seen as a complicatio...

1 Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium 2 Faculty... more 1 Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium 2 Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium 3 Department of Gastroenterology and Hepatology, ZNA Stuyvenberg, Antwerp, Belgium 4 Department of Gastroenterology and Hepatology, Hôpitaux Iris Sud Bracops, Brussels, Belgium 5 Department of Gastroenterology and Hepatology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium 6 Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland 7 Department of Gastroenterology and Hepatology, AZ Groeninge, Kortrijk, Belgium 8 Department of Gastroenterology and Hepatology, Clinique Saint-Joseph, Clinique de l'Espérance, Liège, Belgium 9 Department of Gastroenterology and Hepatology, AZ St-Maarten, Mechelen, Belgium 10 Medisch Sociaal Opvangcentrum Limburg, Genk, Belgium 11 Center for Statistics (CenStat), Hasselt University, Belgium 12 Free Clinic, Antwerp ...

Tijdschrift Voor Geneeskunde, 2021

A link between oedema and eosinophils: eosinophilic fasciitis A 65-year-old man presented with pr... more A link between oedema and eosinophils: eosinophilic fasciitis A 65-year-old man presented with progressive swelling in his 4 limbs. The skin on his limbs was oedematous and indurated, with an orange peel skin and blistering in some places, as well as a groove sign over the tibia. Lab results showed a remarkable eosinophilia of 23% (reference ≤ 6%). A deep skin biopsy revealed fascial infiltration and fibrin deposition, consistent with eosinophilic fasciitis (EF). EF is a rare cause of fasciitis, eosinophilia and polyclonal hypergammaglobulinemia. Because of its rarity, diagnostic delay is usually significant. Corticosteroids are the mainstay of therapy, but because of an incomplete response and the need for long-term treatment, corticosteroid sparing agents are often associated.

Journal of Hepatology

Recently, concerns were raised of high rates of HCC recurrence in patients treated with direct‐ac... more Recently, concerns were raised of high rates of HCC recurrence in patients treated with direct‐acting antivirals (DAA) for hepatitis C infection. We investigated the HCC occurrence and recurrence rates within 6 months after treatment with DAA with or without pegylated interferon (PEG‐IFN) in real life. This is a retrospective, multicenter cohort trial, executed in 15 hospitals distributed across Belgium. Populations were matched based on fibrosis score (Metavir F3‐F4). Patients with a Child‐Pugh score ≥ B were excluded. In total, 567 patients were included, of whom 77 were treated with PEG‐IFN+DAA between 2008 and 2013 and 490 with DAA without PEG‐IFN between 2013 and 2015. Patients treated with PEG‐IFN+DAA (53±9y) were younger than patients treated with DAA without PEG‐IFN (59±12y) (P=.001). 47% of patients treated with PEG‐IFN+DAA were in the F4 stage vs 67% of patients treated with DAA without PEG‐IFN (P=.001). Screening was inadequate in 20% of both patient groups (P=.664). The early occurrence rate of HCC was 1.7% and 1.1% in patients treated with DAA with and without PEG‐IFN, respectively (P=.540). The early recurrence rate was 0% in patients treated with PEG‐IFN+DAA and 15.0% in patients treated with DAA without PEG‐IFN (P=.857). There is no difference in early occurrence of new HCC between patients treated with DAA with and without PEG‐IFN. We did observe a high early recurrence rate of HCC in patients treated with DAA without PEG‐IFN. However, these patients were at baseline more at risk for HCC. Finally, in 20%, screening for HCC was inadequate.

Journal of the Belgian Society of Radiology

Sarcoidosis is a multisystemic disease usually affecting the lungs and mediastinal lymph nodes. O... more Sarcoidosis is a multisystemic disease usually affecting the lungs and mediastinal lymph nodes. Other organs, such as the liver and the spleen, are less commonly involved. Patients usually present with mild nonspecific symptoms. On imaging, hepatosplenomegaly with or without multiple focal lesions within the spleen may be seen in the active disease stage. Rarely, the disease may evolve to cirrhosis and liver failure. We report such a rare case of hepatosplenic sarcoidosis complicated by acute esophageal bleeding due to portal hypertension.

Acta gastro-enterologica Belgica

Until now, "eosinophilic hepatitis" has not been recognized as a separate disease entit... more Until now, "eosinophilic hepatitis" has not been recognized as a separate disease entity. We report a case of a middle-aged women with an acute febrile, severe cholestatic hepatitis accompanied with rash and quincke oedema, and an elevated serum IgE level. Liver biopsy showed lymphocytic inflammation with a remarkably high number of eosinophils. She responded rapidly to methylprednisolone treatment, which could be quickly tapered off and stopped without relapse. The term 'idiopathic acute eosinophilic hepatitis' seems to be the best fitting diagnostic term.

Journal of medical virology, Jan 29, 2015

No data have been reported yet on treatment outcome in persons who inject drugs (PWID) infected w... more No data have been reported yet on treatment outcome in persons who inject drugs (PWID) infected with hepatitis C virus treated with boceprevir or telaprevir in combination with peginterferon (Peg IFN) and ribavirin (RBV). Additionally, there are concerns about the safety of boceprevir and telaprevir in some subgroups of patients with hepatitis C (HCV). In a cohort of HCV patients infected with genotype 1 in Belgium, treatment outcome of patients infected due to IV drug use was analyzed and compared with patients who have no history of substance use. The study population consisted of 179 patients: 78 PWID and 101 controls treated with boceprevir (n = 79) or telaprevir (n = 100) additional to Peg IFN and RBV; 53 (30%) had advanced disease (F3, F4) and 79 (44%) had an antiviral therapy previously. There were no significant differences in the baseline characteristics between both groups, except that PWID patients were more frequently infected with genotype 1a (67% vs 21%), were younger ...

JBR-BTR : organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR)

We report a case of intestinal ileal lipomatosis in a 56-year-old Caucasian male complicated with... more We report a case of intestinal ileal lipomatosis in a 56-year-old Caucasian male complicated with small bowel obstruction due to ileocolic intussusception with a lipoma serving as lead point. This rare disease is often only discovered incidentally as a consequence of mechanical complications and not well reported in the international literature, compared to intussusception due to an isolated lipoma. Computed tomography is the imaging modality of choice to depict complications of this distinct clinicopathological entity. Density measurements can confirm the fatty content and homogeneity analysis of the lesions can guide the radiologist in the differential diagnosis.

JBR-BTR : organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR), 2001

A 48-year-old female presented with diarrhea, abdominal pain and fever of two days duration. Clin... more A 48-year-old female presented with diarrhea, abdominal pain and fever of two days duration. Clinical examination showed abdominal distension with tenderness. The patient was being treated for cerebral hemangiopericytoma with chemotherapy. Because of respiratory infection and chemotherapy induced pancytopenia antibiotic therapy had been given for seven days. CT scan of the abdomen showed a markedly distended colon, consistent with toxic megacolon (Fig. A). Two days later, protruding nodules within the air-filled distended colon were visible on plain film of the abdomen (Fig. B (detailed view of the hepatic flexure)). The inflammatory pseudopolyposis was not visible on the initial CT scan of the abdomen, not even with pulmonary window. Left coloscopy performed nine days after onset of symptoms showed findings consistent with pseudomembranous colitis and confirmed inflammatory pseudopolyposis. The patient died three weeks later from sepsis. Toxic megacolon may be seen as a complication of inflammatory bowel disease, mostly ulcerative colitis. Infrequently, it complicates other ulcerating diseases of the colon such as ischemic colitis, Behcet’s syndrome, infectious colitis due to amebiasis, shigellosis, salmonellosis, cholera, strongyloidiasis, or Campylobacter and pseudomembranous colitis. In our patient toxic megacolon resulted from pseudomembranous colitis following antibiotic therapy. IMAGES IN CLINICAL RADIOLOGY

Gastroenterology, 1999

The hepatotoxic potential of conventional drugs is well known, but herbal medicines are often ass... more The hepatotoxic potential of conventional drugs is well known, but herbal medicines are often assumed to be harmless. In the last 2 years, we have observed 10 cases of acute hepatitis induced by preparations of greater celandine (Chelidonium majus), which are frequently ...

Acta gastro-enterologica Belgica

During the last 5 years we identified 7 patients with a history of episodic acute abdominal pain ... more During the last 5 years we identified 7 patients with a history of episodic acute abdominal pain and subobstruction due to intestinal angioedema secondary to the use of Angiotensin Converting Enzyme (ACE) inhibitors. These cases were all diagnosed in one gastroenterology department. This is thereby the largest single centre case series of ACE inhibitor-induced angioedema that has been published until now. Our findings suggest that this syndrome is far more frequent than international literature would let us believe. We also describe one of the first male cases diagnosed with this entity for which there is a significant female predominance. In the presence of an appropriate history and suggestive findings on CT scan, this diagnosis can relatively easily be made if one is sufficiently intent on it. An appropriate diagnosis can save these patients a lot of unnecessary diagnostic procedures and discomfort.