1
|
Sasegbon A, Luo Y, Keefer LA, Vasant DH. The consequences of limited training in disorders of gut-brain interaction: Results from a national survey of gastroenterology trainees in the United Kingdom. Neurogastroenterol Motil 2023; 35:e14649. [PMID: 37482914 DOI: 10.1111/nmo.14649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Despite their high prevalence and burden, disorders of gut-brain interaction (DGBI) are undertaught and underrepresented in medical curricula. We evaluated the exposure of UK gastroenterology trainees to DGBI and their comfort managing these conditions. METHODS An electronic survey was distributed to trainees via UK training program directors. The survey included questions on stage of training; subspecialty interest; access to DGBI training opportunities, and comfort levels with DGBI diagnosis and management. Responses were compared between junior and senior trainees, by subspecialty interest (luminal and non-luminal), by geographical region, and training program size. KEY RESULTS One hundred twelve trainees from across the UK participated (21.4% of national training post holders). Exposure to DGBI lectures (32.8% junior vs. 73.3% senior trainees, p = 0.00003) and clinics (9.0% junior vs. 42.2% senior trainees, p = 0.00003), increased with seniority. Regardless of seniority, most trainees were rarely comfortable making a DGBI diagnosis (39.5% senior vs. 33.9% junior trainees, p = 0.69), and were not comfortable initiating neuromodulators (50% senior vs. 25.8% junior trainees, p = 0.08). Trainees without a luminal subspecialty interest (50%) accessed fewer DGBI clinics (p = 0.04), had less communication skills training (p = 0.04) and were less likely to have been observed during DGBI consultations (p = 0.002). Responses were similar across UK regions and did not differ between smaller and larger programs. CONCLUSIONS & INFERENCES DGBI training opportunities are limited in UK gastroenterology training across training grades. Most trainees lack confidence with DGBI diagnosis and management. Urgent interventions need to be targeted at all stages of training to ensure DGBI competencies for future gastroenterologists and improve patient outcomes.
Collapse
Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Yuying Luo
- The Henry D. Janowitz Division of Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie A Keefer
- The Henry D. Janowitz Division of Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dipesh H Vasant
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
2
|
Patejdl R, Demir IE, Frieling T, Goebel-Stengel M, Günther L, Keller J, Niesler B, Stengel A, Neckel PH. Curricular representation of neurogastroenterology: A survey among medical students in Germany. Neurogastroenterol Motil 2023; 35:e14557. [PMID: 36893050 DOI: 10.1111/nmo.14557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Neurogastroenterological disorders (NGDs) are highly prevalent and substantially impact patients' quality of life. Effective treatment of NGDs depends on the competence and training of medical caregivers. Students' perceived competence in neurogastroenterology and its place in medical school curricula are assessed in this study. METHODS A multi-center digital survey among medical students was conducted at five universities. Self-ratings of competence regarding basic mechanisms, diagnosis, and treatment of six chronic medical conditions were assessed. These included irritable bowel syndrome (IBS), gastroesophageal reflux disease, and achalasia. Ulcerative colitis, hypertension, and migraine were included as references. KEY RESULTS Of 231 participants, 38% remembered that neurogastroenterology was covered in their curriculum. Highest competence ratings were stated for hypertension and the lowest for IBS. These findings were identical for all institutions irrespective of their curricular model and demographic parameters. Students who remembered neurogastroenterology as a part of their curriculum reported higher competence ratings. According to 72% of students, NGDs should be highlighted more prominently in the curriculum. CONCLUSIONS & INFERENCES Despite its epidemiological relevance, neurogastroenterology is only weakly represented in medical curricula. Students report low levels of subjective competence in handling NGDs. In general, assessing the learners' perspective on an empirical basis may enrichen the process of national standardization of medical school curricula.
Collapse
Affiliation(s)
- Robert Patejdl
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Frieling
- Department of Gastroenterology, Helios Hospital Krefeld, Krefeld, Germany
| | - Miriam Goebel-Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Lydia Günther
- Division of Medical Biology, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jutta Keller
- Department of Internal Medicine, Israelite Hospital, Hamburg, Germany
| | - Beate Niesler
- Department of Human Molecular Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Peter H Neckel
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| |
Collapse
|
3
|
Goodoory VC, Guthrie EA, Ng CE, Black CJ, Ford AC. Editorial: definition of factors associated with poor quality of life in patients with IBS-but where to from here? Authors' reply. Aliment Pharmacol Ther 2023; 57:725-726. [PMID: 36821754 DOI: 10.1111/apt.17404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Vivek C Goodoory
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | | | - Cho Ee Ng
- County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Christopher J Black
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Alexander C Ford
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| |
Collapse
|
4
|
Drenth JPH, Pawlak KM. UEG journal's editorial team. United European Gastroenterol J 2022; 10:1041-1043. [PMID: 36424368 PMCID: PMC9752279 DOI: 10.1002/ueg2.12340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - Katarzyna M Pawlak
- Endoscopy Unit, Department of Gastroenterology, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| |
Collapse
|
5
|
Luo Y, Dixon RE, Shah BJ, Keefer LA. Gastroenterology Trainees' Attitudes and Knowledge towards Patients with Disorders of Gut-Brain Interaction. Neurogastroenterol Motil 2022; 34:e14410. [PMID: 35608084 DOI: 10.1111/nmo.14410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/28/2022] [Accepted: 05/09/2022] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Disorders of gut-brain interaction (DGBI) are highly prevalent, estimated to affect about 40% of the global population. Patients with DGBI are still inadequately treated and face stigma which adversely impacts their disease course. METHODS A 12-question multiple-choice anonymous survey was distributed electronically to all adult gastroenterology fellowship program directors across the United States. Data were collected on demographics, training, attitudes, and knowledge in managing patients with DGBI. RESULTS 9.8% and 15.9% of all trainees reported that their attendings and peers often demonstrated a dismissive attitude towards patients with DGBI, respectively. 21.4% of all trainees often felt frustrated or burned out when seeing patients with DGBI with increasing odds of burnout by years of training (OR 4.4 for F3 trainees, trainees in their third year of training). Significantly, more female trainees reported frustration and burnout when seeing patients with DGBI (p = 0.005). 28.6% of all trainees report they often do not want to see patients with DGBI in their outpatient GI practice, including 39.6% of F3 trainees. 27.1% of F3 trainees reported that they were uncomfortable with titrating neuromodulators and only 31.6% of all trainees were comfortable knowing when to refer to a gastropsychologist. DISCUSSION Many trainees expressed some unwillingness and discomfort in managing patients with DGBI. Potential interventions will require a multi-pronged and longitudinal approach with education and training initiatives at the trainee level and beyond and exploring systemic healthcare delivery innovations to remove barriers.
Collapse
Affiliation(s)
- Yuying Luo
- The Henry D. Janowitz Division of Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebekah E Dixon
- The Henry D. Janowitz Division of Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brijen J Shah
- The Henry D. Janowitz Division of Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie A Keefer
- The Henry D. Janowitz Division of Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
6
|
Simons J, Shajee U, Palsson O, Simren M, Sperber AD, Törnblom H, Whitehead W, Aziz I. Disorders of gut-brain interaction: Highly prevalent and burdensome yet under-taught within medical education. United European Gastroenterol J 2022; 10:736-744. [PMID: 35781806 PMCID: PMC9486486 DOI: 10.1002/ueg2.12271] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/15/2022] [Indexed: 11/09/2022] Open
Abstract
Background and Objective To determine the population prevalence and associated health impairment of disorders of gut‐brain interaction (DGBI) across Great Britain, and the emphasis placed upon them within medical education. Methods An Internet‐based cross‐sectional health survey was completed by 1906 general population adults across Great Britain without self‐reported organic GI disease. The survey enquired for demographics, symptom‐based criteria for Rome IV DGBI, healthcare use, non‐GI somatic symptoms, and quality of life. As a separate analysis, we evaluated which DGBI are considered core knowledge at undergraduate medical school level and post‐graduate specialization level for Gastroenterologists and General Practitioners. Results The overall prevalence of DGBI across Great Britain was 37%, being similar for England (37%), Scotland (33%), and Wales (36%); p = 0.66. There was no difference between English regions (range 33%–43%, p = 0.26). The prevalence of DGBI was highest in those aged 18–40 years (40%), then 40–64 years (37%), and least amongst those ≥65 years (29%); p < 0.001. The most common DGBI were bowel disorders (30%), followed by gastroduodenal (10.5%), anorectal (8.1%) and oesophageal disorders (6.2%). Individuals with DGBI were significantly more likely than those without DGBI to have increased GI‐related healthcare visits, medication use, surgical interventions, non‐GI somatic symptoms, and reduced quality of life. One‐in‐three people with DGBI had multiple GI organ regions involved and this correlated with increased health impairment (p < 0.001). The only DGBI mentioned across all medical training curricula is irritable bowel syndrome, while the General Practitioner and Gastroenterology Curricula also recognise the outdated term non‐ulcer dyspepsia (as opposed to functional dyspepsia). The 2010 Gastroenterology Curriculum also includes functional constipation and disordered defecation, with the incoming 2022 iteration adding in functional upper GI syndromes, functional abdominal pain, and opioid‐induced GI disturbances. Conclusion Disorders of gut‐brain interaction are common across Great Britain and incur substantial health impairment. However, they are generally under‐taught within the British medical education system. Increasing awareness and education of disorders of gut‐brain interaction might improve patient outcomes.
Collapse
Affiliation(s)
- Julia Simons
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Umair Shajee
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Olafur Palsson
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Magnus Simren
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - William Whitehead
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Imran Aziz
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| |
Collapse
|
7
|
de-Madaria E, Mira JJ, Carrillo I, Afif W, Ang D, Antelo M, Bollipo S, Castells A, Chahal P, Heinrich H, Law JK, van Leerdam ME, Lens S, Pannala R, Park SH, Rabiee A, Savarino EV, Singh VK, Vargo J, Charabaty A, Drenth JPH. The present and future of gastroenterology and hepatology: an international SWOT analysis (the GASTROSWOT project). Lancet Gastroenterol Hepatol 2022; 7:485-494. [PMID: 35247318 DOI: 10.1016/s2468-1253(21)00442-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
GASTROSWOT is a strategic analysis of the current and projected states of the different subspecialties in gastroenterology that aims to provide guidance for research, clinical, and financial planning in gastroenterology. We executed a consensus-based international strengths, weaknesses, opportunities, and threats (SWOT) analysis. Four general coordinators, six field coordinators, and 12 experts participated in the study. SWOTs were provided for the following fields: neurogastroenterology, functional gastrointestinal disorders, and upper gastrointestinal diseases; inflammatory bowel disease; pancreatology and biliary diseases; endoscopy; gastrointestinal oncology; and hepatology. The GASTROSWOT analysis highlights the following in the current state of the field of gastroenterology: the incidence and complexity of several gastrointestinal diseases, including malignancies, are increasing; the COVID-19 pandemic has affected patient care on several levels; and with the advent of technical innovations in gastroenterology, a well trained workforce and strategic planning are required to optimise health-care utilisation. The analysis calls attention to the following in the future of gastroenterology: artificial intelligence and the use of big data will speed up discovery and smarter health-care provision in the field; the growth and diversification of gastroenterological specialties will improve specialised care for patients, but could promote fragmentation of care and health system inefficiencies; and furthermore, thoughtful planning is needed to reach an effective balance between the need for subspecialists and the value of general gastroenterology services.
Collapse
Affiliation(s)
- Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - José J Mira
- Atenena Research Group, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABAO, Sant Joan d'Alacant, Spain; Department of Health Psychology, Miguel Hernández University of Elche, Elche, Spain
| | - Irene Carrillo
- Atenena Research Group, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABAO, Sant Joan d'Alacant, Spain; Department of Health Psychology, Miguel Hernández University of Elche, Elche, Spain
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - Daphne Ang
- Department of Gastroenterology, Changi General Hospital, Singapore, Singapore
| | - Marina Antelo
- Oncology Section, Dr C Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Antoni Castells
- Gastroenterology Department, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain; Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Prabhleen Chahal
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Henriette Heinrich
- Stadtspital Waid und Triemli Abteilung für Gastroenterologie, University of Zurich, Zurich, Switzerland
| | | | - Monique E van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Sabela Lens
- Liver Unit, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - San Hyoung Park
- Department of Gastroenterology, and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Atoosa Rabiee
- Division of Gastroenterology and Hepatology, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Edoardo V Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Vikesh K Singh
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Vargo
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aline Charabaty
- Division of Gastroenterology, Sibley Memorial Hospital, Johns Hopkins University, Washington, DC, USA
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands.
| |
Collapse
|
8
|
Melchior C, Zorniak M. Young GI angle: UEG Research Fellowship - Two fellows' experiences. United European Gastroenterol J 2022; 10:240-242. [PMID: 35262256 PMCID: PMC8911531 DOI: 10.1002/ueg2.12208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chloé Melchior
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy UniversityRouenFrance
- Rouen University HospitalGastroenterology Department and INSERM CIC‐CRB 1404RouenFrance
| | - Michal Zorniak
- Department of Oncological GastroenterologyMaria Skłodowska‐Curie Memorial Cancer Centre and Institute of OncologyWarsawPoland
- Department of Gastroenterology, Hepatology and Clinical OncologyCenter of Postgraduate Medical EducationWarsawPoland
- Department of Medicine IIUniversity Hospital, LMU MunichMunichGermany
| |
Collapse
|
9
|
Upadhyaya A, d'Afflitto M, Yassa B. Letter to the Editor: How to raise the interest for neurogastroenterology among young gastroenterologists? United European Gastroenterol J 2022; 10:126-127. [PMID: 34981671 PMCID: PMC8830287 DOI: 10.1002/ueg2.12191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Advait Upadhyaya
- Wingate Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Manfredi d'Afflitto
- Wingate Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bishoy Yassa
- Wingate Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
10
|
Relevancia y necesidades del Síndrome del Intestino Irritable (SII): comparación con la Enfermedad Inflamatoria Intestinal (EII).(Por favor, si no te interesa el SII léelo). GASTROENTEROLOGIA Y HEPATOLOGIA 2022; 45:789-798. [DOI: 10.1016/j.gastrohep.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 12/07/2022]
|
11
|
Melchior C, Nuzzo A, Keszthelyi D. Raising interest for neurogastroenterology: Bottom-up from the undergraduate medical curriculum? United European Gastroenterol J 2021; 10:128-129. [PMID: 34962702 PMCID: PMC8830268 DOI: 10.1002/ueg2.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chloé Melchior
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy University, Rouen, France.,Gastroenterology Department and INSERM CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Alexandre Nuzzo
- APHP. Nord, Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Université de Paris, Paris, France
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|