CINXE.COM

<!DOCTYPE html><html lang="en-US"><head><title>Just a moment...</title><meta http-equiv="Content-Type" content="text/html; charset=UTF-8"><meta http-equiv="X-UA-Compatible" content="IE=Edge"><meta name="robots" content="noindex,nofollow"><meta name="viewport" content="width=device-width,initial-scale=1"><style>*{box-sizing:border-box;margin:0;padding:0}html{line-height:1.15;-webkit-text-size-adjust:100%;color:#313131;font-family:system-ui,-apple-system,BlinkMacSystemFont,Segoe UI,Roboto,Helvetica Neue,Arial,Noto Sans,sans-serif,Apple Color Emoji,Segoe UI Emoji,Segoe UI Symbol,Noto Color Emoji}body{display:flex;flex-direction:column;height:100vh;min-height:100vh}.main-content{margin:8rem auto;max-width:60rem;padding-left:1.5rem}@media (width <= 720px){.main-content{margin-top:4rem}}.h2{font-size:1.5rem;font-weight:500;line-height:2.25rem}@media (width <= 720px){.h2{font-size:1.25rem;line-height:1.5rem}}#challenge-error-text{background-image:url(data:image/svg+xml;base64,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);background-repeat:no-repeat;background-size:contain;padding-left:34px}@media (prefers-color-scheme:dark){body{background-color:#222;color:#d9d9d9}}</style><meta http-equiv="refresh" content="390"></head><body class="no-js"><div class="main-wrapper" role="main"><div class="main-content"><noscript><div class="h2"><span id="challenge-error-text">Enable JavaScript and cookies to continue</span></div></noscript></div></div><script>(function(){window._cf_chl_opt={cvId: '3',cZone: "www.gastrojournal.org",cType: 'managed',cRay: '8e770b89ca8081b4',cH: 'vEc31xQWwpJ6OIpyE74SMoiEkPjAtzQsABX32dejiew-1732426625-1.2.1.1-y_2rssky75dajGv2Rs6GA39FTbNHPulC7psohIXyIQU.q54sTj5bLk8OGIjeKcmp',cUPMDTk: "\/article\/S0016-5085(15)01025-2\/fulltext?__cf_chl_tk=7BMFuuLC7TPF15mnCIgMA8uVuv4m2hKCsiRPWnZ5xF8-1732426625-1.0.1.1-mXwF2kN8vD1BmWsvIri1liuONiwJRtd5bOvrrl0cccQ",cFPWv: 'g',cITimeS: '1732426625',cTTimeMs: '1000',cMTimeMs: '390000',cTplC: 0,cTplV: 5,cTplB: 'cf',cK: "",fa: "\/article\/S0016-5085(15)01025-2\/fulltext?__cf_chl_f_tk=7BMFuuLC7TPF15mnCIgMA8uVuv4m2hKCsiRPWnZ5xF8-1732426625-1.0.1.1-mXwF2kN8vD1BmWsvIri1liuONiwJRtd5bOvrrl0cccQ",md: "ygCH1WzCXlfpTYp3Vj4FzfDYhNguVPyFjZ.ei3.vWBM-1732426625-1.2.1.1-bPvx7yh0CvwTqhkIEUfT.XLVOTSksjJpTjhvQZpZYs_S2J7QVoJ5W41jj5Z.onlmMjV207KpWlQw0mXLA4_x9lXfXtN6l3TeWFAKels8gNa8CA3NDwvdoU4ReJxRYfpQR2yhQzaTJE3LRiAtoLZekp7DZ3OfrrKwXzYWJLhdZJorTAL.OOR_XRXmwP5RPZwkk1nAvzcxSZYKMqvju1uVipv5xZNE43GXN9IWJaRs0lC2KaOfF8wkvmrD7Xt2Kma7CojMH3JgRVmGegpkodon0X_1nAgXHWSyxYgLI3wlA8Fj.wtSBsXLUELGtXaUCTqKyyRxlqQ_NDhUANZJ5iw3jkYAVsWK3cSqXToRJDiGvYWzeb0vCzhZdHyG4Lpqb34qcQ.XmIMRrJncNuRQQgm5XIeIm6Uv8KrVCbN0M0C1T13l8bX0SEOw..qrPtpvG3Fdx8jIWDZJJxvgDWXs0Kj5KPtMAMpCKgbBieELt.syB5.FZXtvUtRaeDkstpOBPt1_8mY.1be0xYtT7HTNy7NWHHLZAbXIIF.qDUjTQcRz0TK3O90FFFaxAJ8OuL1vvyZAcQMKNz6gh3IPOC_EMQHsAPbD1oYFqgwyWB6RE0CEAdIUPZ6yhWm69xOtL1yNszX5VVJ4YDL19ASXc61wUsV.YmB.Hyp9HKzoVBLVrpSrV7SbWReb.tDjkMJP40LdNifEpvjwCgzXf_pgDK_4rUN_OkH0FDLvFAPXWJ5_20zRII.8T4GpIPoJibB_ydYEq1viuArxr_zxvfNogx6GJICDd2wvRq_AEQrHofUidMfqVXh4QJYEnEA7oMErznp1wsKqQkUhCy25goAfE8FtPYSF05VqcGVYeNAA0uGUIosC0qcI0prrhMwvt46Su3a9U2kPNut72IMK.GqzbRUWzvPPau6wBqfwIjz2TvDOrBomOn9qBq4JJwCV7vZ_v8OhUiEFanRSdv69xa3K5WoAI1zYdFHvMCcTR4Z8G422b6o8.j2q.GTAKGkE7aD5HDznEp6FSqR_yWxKNmfMul6AwpnqPJFbni6G.7LE3HgLNxmnscl6SOTfvrww7o6HtFbinecZ3qGkPio3gf1PikuD5fl_lIkZsFCJ1wqvcLavXBXQoL7EEQpLkSakGrBj6nAd94jqzmCTm6oWRtpbZ.f6Clsadv_4M7L5slN27pmN8o7O1IGdPjt0vRBFtxvM2cfo3iw9Gh0cKOa9auUL43kYW77sAU12CCymHytOcM7TDbe9ghVVCOvge._83e.Kha0TdrDa93N4JzOp4DDFRg36DdB3zrpDseX9S3BmvNrBbKfx9jjN_TfI4_okhZoxXzC34O5gD5yIKVCdcT5IcyqHe.8buUzrMPUHhFEhG11s_WGv0vLE2q44vfZfa1TemnJpshuAt7QP6g3aE1DG6hTTksTlWibtR7WXswX5WGhOx1PQFQkJergCXwogKhC8SGMFBEFMA3YcO7lgc6TGDdawYmQWXysdr09NChfpxlBd4XygzTOhCmERL.2_gbcRz8fXRWaWODuhU9kD5IaO9F9bCsfj9VxIyR35hX7iJ4cninsp9rHqMiDfl0SL017epjWpuPtq0VsY5RoheOSKYoiYUQ8oaGCs4o4PV6yaxHoBoqwtKg0hUqNhVLvG6w3M9G1Ie5mwk9XJ677jBJzRytWopE_wqLHIRArcA87i6pj8Seqti9zes3DWV5VJ73ANbkCcAUXgz4l_ItW7yRIwF9TziTaliXypJhGSptnbL58F2puHeu7iBOXNiZKJzbk4Pi.QKaIxeS3t.U2MtPfDX3NVUjod.1GSDa7dG9h0bZmMfmOu4KH0PXUZrPl4YsFTaLY2H0UoM9vGnqYcuVGrduStmmkQrwbbVkED3vs8Cvim9YT6huTDe_tu0l5qmMqypQfXFpazf2ziTMyureOWAMgk.VEm9JxTFDOHHCOZEWrxKXkUVcTQD_oSdCz1mSQ7F8NCsGk8UYxOJdLSEGXpP_ZJ7KR7IbAkviE4O9Ziht6tU9DBuFnEqNKHT_gOTtK2F_b1zIgkU_lRiy8uW4P3BkIgBYIY3OHA2_y5cdrRq12cin_LsBUCMZvMz012gquFnSJwx87uvgtvJHI9ZyAv5pWrhrdQFJAFRDljcJd_wB068UX7GFFOEkzPuFnCOHAOuP_A52dNroiV6yrNLOvXt3lTGQBWF0gll6xu4Yiy6T9DBsFD9d1Dn0dsN2bft9ElB6zRmd.yLlDfGaxRPXvWuXdexT8JWUHcFEaxkC4LgvvckFJuupmeQlHzU7p1Z26w82BxK68xxgm2P3psldSOLMXTipLYinuIoBqI3ncNsgjZfO7NwJWteRyGkI1zU2Jf9BRhZiegADskNVXnSGOaSovlRJ6dOyrAWJjn.fISe8yyNugTR4I1PzxIJJE6crqAKd4.CG5lGBLNGChFO2Jq2Y7XO4rWDg9RTMO4Ucz43tMa3HduL5ueDGFz.FIxHEMhGx4g_wYEQvJ5Ji.29FOv0mo_e5E9y5qdhXAqTw_FtEhRBPyJRb8YvwVukdG4Yd2.2AbJcpULG794x0ndqP4GlMP_k9gn4j44zC.LR9aBistwUav4sDlCLetBR7Tu2s7E69Xjpx4vcYz87zkOGhXFnIKwYGCgujk7kztF1W6GGF1fQxe7UdnpniJWZLOmlyWaooLOwsglFcd1yAVoorI.dcLTdznwXGEcZTMEj0sZIB6sumFk_6Sv7m8csyaHkv06v0XbwLg_ZO_GML7zNwnereFvAZhMLzbMup7OEnh2XGTE5ajVb.5WRqb_sroR0c97_Iz7m1EDlERRd9FoPcLccQ_3cGncjbHVt.FkrpC0C69ABnMarHztEHS_TepcKFVCriGMvlECnrTPzMOOLLh041qouPl.0IMwg7zcE.jCTobgSBP14ZbdooGJVCvg2tb.y_rVFI0neugOvqQ.JBBNGOdCbMq_kWaudEkyEGFm1iOKe3yimlQh48Jx5CQmn59ZDX7Wkxc2VM_cOA9MbpEpSuDMscyiFA",mdrd: "5XldbWc3uBYq7By.J.tbFo5KqQ4IwpWBO7ByScfNHBs-1732426625-1.2.1.1-hBe6Bn5U5AgqqCkSf.mnfsIOimEbbjMYNu0xyPT08qThpyQjwvd8CgxpFJMvC3mZT9C_UjB6pLz30FS3L7Y6gXN414O0PiESu25njm0S5ndEXoMCJ6s_08sS9lxSaURRrhZsBy0wKnElFO5rPIftfnK1xJ1vCZ_xTgJfdJws.Y_vTjblwSH5NHZfnELJ53pQoYvu6tQiJXI02TlfFpO3nxszNgMjTeebgzU7_iHvCEXwIJUiI58kUE9biVL_aXKnfq.2y4PURQxlucdeMniavnoJXssLGMGUqQvZMWsVFkaLXJdv8wCOt6VRbr2Qcm_gc8GZjtPKmFD2S.uAVfXVlxVFcoQI3ULKG05UNXw74HC3u7r6VV0cU8D0Qqxr5.fklXfvbA6GlgDODCJXXPL6XSGekBiDWKxfLbw3fFw5FRKqrUYxT2jDNK9HGKPacDuv2TJR0meV7d5fk3Z2WH.0iXxAk4dbfthBe71xfWF1Xo6XBPmxWF1pyYG7Dtmsc37yuCvenfzFIFXVUvbT8JCK.2JsaBdwSM9dm5z6D08rFdxrDq666GW8JFlejfrvRB7D6u3IxvIPlH.L1NbXKJPfEKKunjSF9RtlFrzocVknVT0HBahQyAQYuWh.0YiiNhfr2Zmrac98El0vcMTrHgtlEAgXtYERp5.PwgVqWqq80TmvvZ0mtg6AL2z9pQJaIRFWOC2KK_urjHwpqrUgreue653bpv9Fj3O6OnP5yKIv.CD5e_he_YehyA3CJ.X689Ea4ux6SM6Dv2Hj9qNzONXCS99BzQrDw7rULHlBu3.thd6BgvMavqc7IlIOfWIXgUbo68MIVRhY3u6WAmxzRdvV1rs1Ylu7SEjwdy6beH.wmS.LNcZG2Q3DS55_lf1t7WOR4KUVjxyOOgsLB_qBFvC0wG4VSA5o27wk.w3P6c110eREaNycvuBYZMu3KcvHI0mgJ67d6NgT0Oacn1Y.zGOEdCkv4cuPys1ywhh4ECjkd1c3_TDIlqAaLVYUzpvzXRl1YvXRh197FXzaOsDFQ2lIDay1I_D7YaUOuz7HpaEyuFBjzO3QtrJHESZI792lZZUXsHAD063SKyOzTEHH1BjwTg1z4wnr25hKjMpiqAnZdp9MHaSt1xLYA43yixkjQKl5zUtYhb8HvHOBOEteovXKrWzyTj3N0VxjHgiSpgRDTUCVr.lxbnc_mxRbryziK6vaPTRdLPE5NmWOqhdCIvi4_rTvo_ZEX_4I9tL6A2hg3mYwcSm8FDurF6cQhM2UuX6Y6tlhHzETKBxDrMwY6N4_Pef38zeQUr8d.lBw74ALg1wL2BLjnNllo18j30fZpmjR9Z10.R3fxGVWvsYYjU_6.7Tc5fVEf9uX5KqZGCYg.zlfaonm3fWf7tKGd9l2cyffIt3MW3ui2HF0XrNw.IsInuqbZz1cfdxqGGIoODv1ODuNweuAjxplGPN9CsftgcnzvVu2ZUeMyMltTKJMDJPvdSfkeGEezh8.lf9vE7.8c3d2lkY6CNCgKalXE0KtbJ_swQCPZEW.QhbAnqYNfUHdeJfLKWPcfZrA13Kw9s8uN_JzC4MHRtvb_WHSLeC_o1POSFr2.342ric0WyWzBPhRtTHn2xuuIbSTEvx1exj7E5ZeG99yF_3FhTr92yzW5g2ZYUYC9D9ad3sGCs_5lAbVDhXrLPYy5UDESHQMSpdL.pSbpZyJp2P_sFJoMEKDIoD9PaPLEWtPf6Y.w8xQFWV3gAqa3H35S2KpyErfROkXGWWvDYOH8V0EjllduAxMgTAAiGc4MtGVai7c5341dYY2U9qfQL7NegPkpnS14hERsLnebQR7k7d.KMdLukZNI5trUVTI__utdEOyMk46sf3DvADTGKRv_8J.YyyQSEJLFs6QlH7MzsF4j75e7UAEgltzBWqJsenkshmB1LHlO8BOUT2TqwKlqLCJjc7mQzA4QDUnmpEAQteM8RcO6iHSW3Nvgsxuh4oL9N0MaRa4waVwrw"};var cpo = document.createElement('script');cpo.src = '/cdn-cgi/challenge-platform/h/g/orchestrate/chl_page/v1?ray=8e770b89ca8081b4';window._cf_chl_opt.cOgUHash = location.hash === '' && location.href.indexOf('#') !== -1 ? '#' : location.hash;window._cf_chl_opt.cOgUQuery = location.search === '' && location.href.slice(0, location.href.length - window._cf_chl_opt.cOgUHash.length).indexOf('?') !== -1 ? '?' : location.search;if (window.history && window.history.replaceState) {var ogU = location.pathname + window._cf_chl_opt.cOgUQuery + window._cf_chl_opt.cOgUHash;history.replaceState(null, null, "\/article\/S0016-5085(15)01025-2\/fulltext?__cf_chl_rt_tk=7BMFuuLC7TPF15mnCIgMA8uVuv4m2hKCsiRPWnZ5xF8-1732426625-1.0.1.1-mXwF2kN8vD1BmWsvIri1liuONiwJRtd5bOvrrl0cccQ" + window._cf_chl_opt.cOgUHash);cpo.onload = function() {history.replaceState(null, null, ogU);}}document.getElementsByTagName('head')[0].appendChild(cpo);}());</script></body></html>