13^th Euro-Global Gastroenterology Conference August 20-21, 2018 Rome, Italy

The digestive system made up of the gastrointestinal tract (GI), liver, pancreas, and gallbladder helps the body digest food. Digestion is important for breaking down food into nutrients, which your body uses for energy, growth, and cell repair. Some digestive diseases and conditions are acute, lasting only a short time, while others are chronic, or long-lasting.

When you eat, your body breaks food down to a form it can use to build and nourish cells and provide energy. This process is called digestion. Your digestive system is a series of hollow organs joined in a long, twisting tube. It runs from your mouth to your anus and includes your esophagus, stomach, and small and large intestines. Your liver, gallbladder and pancreas are also involved. They produce juices to help digestion.

The esophagus is the muscular tube that carries food, and liquids from your mouth to the stomach. You may not be aware of your esophagus until you swallow something too large, too hot, or too cold. You may also notice it when something is wrong. You may feel pain or have trouble swallowing. The most common problem with the esophagus is GERD (gastro esophageal reflux disease). With GERD, a muscle at the end of your esophagus does not close properly. This allows stomach contents to leak back, or reflux, into the esophagus and irritate it. Over time, GERD can cause damage to the esophagus. Other problems include heartburn, cancer, and esophagitis. Doctors may use various tests to make a diagnosis. These include imaging tests, an upper endoscopy, and a biopsy.

The following are additional diseases and conditions that affect the esophagus:

• Achalasia
• Acute esophageal necrosis
• Barrett's esophagus
• Boerhaave syndrome
• Caustic injury to the esophagus
• Chagas disease
• Diffuse esophageal spasm
• Esophageal atresia and Tracheoesophageal fistula
• Esophageal cancer
• Esophageal dysphagia
• Esophageal varices
• Esophageal web
• Esophagitis
• Hiatus hernia
• Jackhammer esophagus (hypercontractile peristalsis)
• Killian–Jamieson diverticulum
• Mallory-Weiss syndrome
• Neurogenic dysphagia
• Nutcracker esophagus
• Schatzki's ring
• Zenker's Diverticulum

Gastroesophageal Reflux disease: is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach. Many people, including pregnant women, suffer from heartburn or acid indigestion caused by GERD. Doctors believe that some people suffer from GERD due to a condition called hiatal hernia. In most cases, GERD can be relieved through diet and lifestyle changes; however, some people may require medication or surgery.

Reflux means to flow back or return. Therefore, gastro esophageal reflux is the return of the stomach's contents back up into the esophagus. In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the LES is weak or relaxes inappropriately, allowing the stomach's contents to flow up into the esophagus.

This is divided into 7 sections: the production of acid in the stomach, the regulation of gastric acid secretion, the pharmacology of acid secretion, the biology of acid-related diseases, gastric and duodenal ulcer disease, gastro esophageal reflux disease, and Helicobacter pylori. Each of these sections is extremely well written and provides historical insights into the various areas. For example, the first section point out that Paracelsus was one of the first to relate chemistry to disease; however, he was under the mistaken assumption that acid found in the stomach was ingested.

Section 2 presents an accounting of William Beaumont’s study of the gastric fistula in Alexis Saint Martin, which was the result of a gunshot wound. Also included in this section is the accounting of Pavlov’s delineation of vagal function in relation to the GI tract. Other important milestones of gastric physiology that are recounted include Codes’ study of the relationship of histamine to gastric secretion and the work of Bayless and Starling in identifying the hormone secretin.

In Section 2, gastric acid secretion and its neural and endocrine regulation is covered in a comprehensive manner as are all aspects of parietal cell function.

The history of the therapeutic approach to acid-related diseases is detailed in Section 3 and includes the Sippy diet, antacids, sulfated polysaccharide (sulcralfate), histamine H2 receptor antagonists, and proton pump inhibitors along with surgery.

Section 4 deals with the barrier function of the upper GI tract, intragastric pH, pepsin, intrinsic factor, and regulation of the growth of gastric epithelium.

The final section deals with Helicobacter pylori and covers its well-known history and the consequences of gastric colonization along, with the pathogenesis and treatment options

Most people with H. pylori infection will never have any signs or symptoms. It's not clear why this is, but some people may be born with more resistance to the harmful effects of H. pylori.

When signs or symptoms do occur with H. pylori infection, they may include:

• An ache or burning pain in your abdomen
• Abdominal pain that's worse when your stomach is empty
• Nausea
• Loss of appetite
• Frequent burping
• Bloating
• Unintentional weight loss

H. pylori infections are usually treated with at least two different antibiotics at once, together with another drug that reduces your stomach acid to help prevent the bacteria from developing a resistance to one particular antibiotic. Lowering stomach acid helps the antibiotics work more effectively. This treatment is sometimes referred to as triple therapy.

Gastrointestinal disorders include such conditions as constipation, irritable bowel syndrome, hemorrhoids, anal fissures, perianal abscesses, anal fistulas, perianal infections, diverticular diseases, colitis, colon polyps and cancer. Many of these can be prevented or minimized by maintaining a healthy lifestyle, practicing good bowel habits, and submitting to cancer screening.

Functional GI disorders are disorders of gut–brain interaction. It is a group of disorders classified by GI symptoms related to any combination of the following: motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut Microbiota, and altered central nervous system (CNS) processing. Gastrointestinal (GI) disorders, including functional bowel diseases such as irritable bowel syndrome (IBS) and inflammatory bowel diseases such as Crohn's disease (CD) and colitis, afflict more than one in five Americans, particularly women. While some GI disorders may be controlled by diet and pharmaceutical medications, others are poorly moderated by conventional treatments. Symptoms of GI disorders often include cramping, abdominal pain, inflammation of the lining of the large and/or small intestine, chronic diarrhea, rectal bleeding and weight loss.

Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.

Bleeding is typically divided into two main types: upper gastrointestinal bleeding and lower gastrointestinal bleeding. Causes of upper GI bleeds include: peptic ulcer disease, esophageal varices due to liver cirrhosis and cancer, among others. Causes of lower GI bleeds include: hemorrhoids, cancer, and inflammatory bowel disease among others.

Possible causes of GI bleeding:

• Angiodysplasia: Angiodysplasia is when you have abnormal or enlarged blood vessels in your GI tract. These blood vessels can become fragile and bleed.
• Benign tumors and cancer: Benign tumors  and cancer  in the esophagus, stomach, colon, or rectum may cause bleeding when they weaken the lining of the GI tract. A benign tumor is an abnormal tissue growth that is not cancerous.
• Colitis: Ulcers in the large intestine are a complication of colitis. Ulcerative colitis is an inflammatory bowel disease that can cause GI bleeding.
• Colon polyps: Colon polyps can cause GI bleeding. You can have more than one colon polyp at a time. Some types of polyps may be cancerous or can become cancerous.
• Diverticular disease: Diverticular disease can cause GI bleeding when small pouches, or sacs, form and push outward through weak spots in your colon wall.
• Esophageal varices: Esophageal varices can cause GI bleeding. Esophageal varices are usually related to a chronic liver condition called cirrhosis.
• Esophagitis: The most common cause of esophagitis is gastro esophageal reflux (GER). GER happens when your lower esophageal sphincter is weak or relaxes when it should not. Stomach acid can damage your esophagus and cause sores and bleeding.
• Gastritis: the use of non-steroidal anti-inflammatory drugs, infections, Crohn’s disease, serious illnesses, serious illnesses. If untreated, gastritis can lead to ulcers or worn-away areas of the stomach lining that can bleed in your GI tract.

Gastrointestinal pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the digestive tract and accessory organs, such as the pancreas and liver.

The main purpose of the gastrointestinal tract is the transport of food and the absorption of nutrients. Many pathologic conditions of the gastrointestinal tract impair either or both of these functions. The gastrointestinal tract, and especially the colon, is a common site of malignancy. The two main symptoms related to pathology of the gastrointestinal tract are abdominal pain and gastrointestinal hemorrhage.

The four categories of the causes of acute abdominal pain are (1) inflammation, including appendicitis, cholecystitis, pancreatitis, and diverticulitis; (2) perforation; (3) obstruction; and (4) vascular disease, including acute ischemia and ruptured abdominal aortic aneurysm. The five categories of causes of chronic abdominal pain are (1) inflammation, including peptic ulcer disease, esophagitis, inflammatory bowel disease, and chronic pancreatitis; (2) vascular disease, including chronic ischemia; (3) metabolic disease, including porphyria; (4) abdominal wall pain; and (5) functional causes, including irritable bowel syndrome. The most frequent causes of chronic abdominal pain are functional.

The liver is an organ about the size of a football that sits just under your rib cage on the right side of your abdomen. The liver is essential for digesting food and ridding your body of toxic substances.

Liver disease can be inherited (genetic) or caused by a variety of factors that damage the liver, such as viruses and alcohol use. Obesity is also associated with liver damage. Over time, damage to the liver results in scarring (cirrhosis), this can lead to liver failure, a life-threatening condition.

• cirrhosis
• alcohol abuse
• hepatitis A, B, C, D, and E
• Epstein Barr virus (infectious mononucleosis)
• non-alcoholic fatty liver disease
• Iron overload (hemochromatosis)

The pancreas is a gland behind your stomach and in front of your spine. It produces juices that help break down food and hormones that help control blood sugar levels. The pancreas also plays a role in diabetes. In type 1 diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked them. In type 2 diabetes, the pancreas loses the ability to secrete enough insulin in response to meals.

There are a variety of disorders of the pancreas including

• Pancreatitis
• Diabetes mellitus
• Exocrine pancreatic insufficiency
• Cystic fibrosis
• Pseudocysts
• Pancreas divisum
• Zollinger-Ellison syndrome
• Hemosuccus pancreaticus

Gallbladder diseases considered here include gallstones, tumors, and acute acalculous cholecystitis. Gallbladder stones are an extremely common disorder and are usually asymptomatic. Some patients experience biliary colic, an intermittent and often severe pain in the epigastrium or right upper quadrant, and at times between the scapula because of temporary obstruction of the cystic duct with a gallstone. If the cystic duct obstruction persists, the gallbladder becomes inflamed and the patient develops cholecystitis, an acute inflammation and infection of the gallbladder.

Biliary tract diseases considered one of the most common causes of extra hepatic biliary obstruction is choledocholithiasis, with one or more stones in the common bile duct or common hepatic duct causing biliary obstruction. Cholangiocarcinoma is an adenocarcinoma of the intrahepatic or extra hepatic bile duct.

Current research in gastrointestinal therapeutics and recent advancement targets pioneering efforts and innovative studies across all areas of gastroenterology. There have been incredible advancements in the gastrointestinal and Hepatology space. These include innovations in colorectal cancer screening, capsule endoscopy, cures for hepatitis C and new biologic therapies, among many others. We welcome your abstracts for both oral and poster presentation on Recent Advances in Gastroenterology.

High-definition and magnification endoscopes with electronic chromo endoscopy capability make it easier to visualize subtle lesions, such as small and flat polyps and patches of dysplastic gastrointestinal mucosa. They allow accurate characterization of polyps, which may in the future allow us to selectively resect only precancerous colonic polyps, while ignoring small benign hyperplastic polyps, which in turn will result in significant healthcare savings.  New digital choledochoscopes have vastly improved diagnostic and therapeutic capabilities within the bile and pancreatic duct. Confocal endomicroscopy now allows us to perform microscopic evaluation of living tissues, improving targeted biopsies in Barrett's esophagus and aiding in the evaluation of bile duct strictures and pancreatic cysts. Similarly, technological advances in endoscopic ultrasound, optical coherence tomography and spectroscopy hold great promise for improving diagnostic and therapeutic capabilities for gastrointestinal disease.