United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on Functional Dyspepsia

BackgroundFunctional dyspepsia (FD) is one of the most common conditions in clinical practice. In spite of its prevalence, FD is associated with major uncertainties in terms of its definition, underlying pathophysiology, diagnosis, treatment, and prognosis.MethodsA Delphi consensus was initiated with 41 experts from 22 European countries who conducted a literature summary and voting process on 87 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 36 statements.ResultsThe panel agreed with the definition in terms of its cardinal symptoms (early satiation, postprandial fullness, epigastric pain, and epigastric burning), its subdivision into epigastric pain syndrome and postprandial distress syndrome, and the presence of accessory symptoms (upper abdominal bloating, nausea, belching), and overlapping conditions. Also, well accepted are the female predominance of FD, its impact on quality of life and health costs, and acute gastrointestinal infections, and anxiety as risk factors. In terms of pathophysiological mechanisms, the consensus supports a role for impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention, Helicobacter pylori infection, and altered central processing of signals from the gastroduodenal region. There is consensus that endoscopy is mandatory for establishing a firm diagnosis of FD, but that in primary care, patients without alarm symptoms or risk factors can be managed without endoscopy. There is consensus that H. pylori status should be determined in every patient with dyspeptic symptoms and H. pylori positive patients should receive eradication therapy. Also, proton pump inhibitor therapy is considered an effective therapy for FD, but no other treatment approach reached a consensus. The long‐term prognosis and life expectancy are favorable.Conclusions and InferencesA multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD

Recovery of precious metals from spent Mo-Co-Ni/Al2O3 catalyst in organic acid medium: Process optimization and kinetic studies

In present study, the leaching kinetics of the spent Mo-Co-Ni/Al2O3 catalyst was investigated in the presence of formic acid as an organic leaching agent. Firstly, the spent catalyst was roasted in different roasting temperature (200-700 degrees C) and time (15-240 min), the maximum metal extraction was achieved that at 500 degrees C with 90 min. Then, the leaching experiments were carried out to determine the influences of process parameters following; particle size, liquid/solid ratio, formic acid concentration, leaching temperature, leaching time and stirring speed. According to the experimental results, the highest dissolution rates of molybdenum (Mo, 75.82\%), cobalt (Co, 96.81\%), nickel (Ni, 93.44\%) and aluminum (Al, 19.46\%) were reached under optimum experimental conditions; particle size thorn75 degrees 30 mm; liquid/ solid ratio 10 ml/g; formic acid concentration 0.6M; leaching temperature 80 degrees C; leaching time 90 min and stirring speed 300 r/min. Moreover, the leaching kinetics clearly reveal that the leaching reaction is controlled by liquid film diffusion and that the activation energy values (Ea) of Co, Ni, Mo and Al were to be 24.49, 25.98, 32.36 and 33.47 kJ/mol, respectively. In conclusion, the leaching process can be conducted in the presence of formic acid for the various industrial wastes in similar structure and composition to Mo-Co-Ni/Al2O3 spent catalyst

United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis

Background: Gastroparesis is a condition characterized by epigastric symptoms and delayed gastric emptying (GE) rate in the absence of any mechanical obstruction. The condition is challenging in clinical practice by the lack of guidance concerning diagnosis and management of gastroparesis. Methods: A Delphi consensus was undertaken by 40 experts from 19 European countries who conducted a literature summary and voting process on 89 statements. Quality of evidence was evaluated using grading of recommendations assessment, development, and evaluation criteria. Consensus (defined as ≥80% agreement) was reached for 25 statements. Results: The European consensus defined gastroparesis as the presence of symptoms associated with delayed GE in the absence of mechanical obstruction. Nausea and vomiting were identified as cardinal symptoms, with often coexisting postprandial distress syndrome symptoms of dyspepsia. The true epidemiology of gastroparesis is not known in detail, but diabetes, gastric surgery, certain neurological and connective tissue diseases, and the use of certain drugs recognized as risk factors. While the panel agreed that severely impaired gastric motor function is present in these patients, there was no consensus on underlying pathophysiology. The panel agreed that an upper endoscopy and a GE test are required for diagnosis. Only dietary therapy, dopamine-2 antagonists and 5-HT4 receptor agonists were considered appropriate therapies, in addition to nutritional support in case of severe weight loss. No consensus was reached on the use of proton pump inhibitors, other classes of antiemetics or prokinetics, neuromodulators, complimentary, psychological, or more invasive therapies. Finally, there was consensus that gastroparesis adversely impacts on quality of life and healthcare costs and that the long-term prognosis of gastroparesis depends on the cause. Conclusions and Inferences: A multinational group of European experts summarized the current state of consensus on definition, symptom characteristics, pathophysiology, diagnosis, and management of gastroparesis. © 2021 John Wiley & Sons Lt