No abstract

These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia. PURPOSE AND METHODSThe purpose of this guideline is to provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. This document is therefore aimed at gastroenterologists, physicians and nurse practitioners, as well as members of multidisciplinary teams (MDTs; surgeons, radiologists, pathologists), who take decisions on the management of such patients. The population covered by these guidelines includes: patients with gastrooesophageal reflux disease or other risk factors for Barrett's (obesity, family history for Barrett's and oesophageal adenocarcinoma (OAC)); every patient with incident or prevalent Barrett's oesophagus regardless of their age, sex or comorbidities; patients with early OAC and patients with intestinal metaplasia (IM) at the gastro-oesophageal junction (GOJ) with no endoscopic evidence of Barrett's oesophagus. The previous British Society of Gastroenterology (BSG) development of the guidelines and to aid assessment of the quality of the guidelines. Three appraisers in the author list assessed the compliance of the guidelines to the AGREE II domains. As part of the AGREE II criteria, external review of this manuscript was also performed by two internationally renowne...

No abstract

A new multiplex PCR assay was developed to separate the four major Listeria monocytogenes serovars isolated from food and patients (1/2a, 1/2b, 1/2c, and 4b) into distinct groups. The PCR test, which constitutes a rapid and practical alternative to laborious classical serotyping, was successfully evaluated with 222 Listeria strains.Listeria monocytogenes is a facultative intracellular pathogen that can cause serious illness in susceptible individuals. Persons with specific immunocompromising conditions, pregnant women, newborns, and the elderly are particularly at risk for listeriosis (9, 23). Although rare, listeriosis remains of great public health concern due to its high mortality rate (20 to 30%) (16). Ingestion of contaminated foods is considered to be the primary source of infection for both sporadic and epidemic human listeriosis cases (19). Because of the importance of L. monocytogenes strain characterizations for epidemiological investigations, a number of discriminatory subtyping methods have been described for this organism (2,4,5,18,20,24,25). Pulsed-field gel electrophoresis (PFGE) typing, which has provided the most sensitive strain discrimination up to now, has rapidly become the standard subtyping method to detect listeriosis outbreaks (4, 11). However, this method is labor-intensive and time-consuming and thus for practical purposes is often preceded by serotyping. Since all major outbreaks of the invasive form of listeriosis are due to serovar 4b strains, an infrequent serovar in foods compared to 1/2a strains (6, 9), the procedure adopted for outbreak investigations relies upon serovar characterization to provide valuable information for rapid screening of groups of strains. Indeed, the serovar information allows discrimination between isolates probably belonging to an outbreak and those that are not part of the outbreak and thus decreases the number of strains which need to be characterized by PFGE in order to improve discrimination beyond the serovar level. Moreover, serotyping is widely used for long-term microbiological surveillance of human listeriosis. For the food industry, where the presence of L. monocytogenes is a big concern, tracing contaminating strains within the food chain and the plant environment is of primary importance. Again serotyping is often used as a first-line typing method. Although 13 serovars are described for the species L. monocytogenes, at least 95% of the strains isolated from foods and patients are of serovars 1/2a, 1/2b, 1/2c, and 4b (12,21,22). Routine analysis of L. monocytogenes by serotyping with traditional agglutination methods is limited by cost, availability, and the need for technical expertise to perform the assay. Furthermore, the reproducibility of serotyping is not always satisfactory. Schonberg et al. (20) concluded in a multicenter study that a critical need exists for high-quality antisera. A new enzyme-linked immunosorbent assay serotyping format used in conjunction with a commercially available kit to make serotyping more efficient and more ...