Gastroenterology and Hepatology From Bed to Bench最新文献

Aim: The present study presents a new combined approach for the treatment of irritable bowel syndrome (IBS), in which the effect of Cognitive Behavioral Therapy (CBT) based on exposure to awareness and emotional expression on patients' symptoms is examined.

Background: IBS is one of the most common functional gastrointestinal diseases where psychological distress is an integral part of its presentation.

Methods: We performed a clinical trial study on 30 patients with IBS. They were divided into two groups receiving the intervention and waiting list control. All patients were evaluated by IBS quality of life scale, IBS severity score, hospital anxiety and depression scale and visceral sensitivity index in three stages: pre-test, pre-test, and one-month follow-up. Our treatment program for the intervention group (n=15) included 10 group sessions, every week for 90 minutes, based on an exposure-based cognitive behavioral therapy protocol. Also, they underwent three 90-minute sessions of an emotional expression and awareness training program.

Results: The mean age of the participants was 31.0±8.77 years old. No previous history of substance addiction, psychiatric, or neurologic diseases was seen. Twenty participants (66.7%) were single, twenty-three participants (76.7%) had a university degree, and 9 participants were unemployed. No significant difference was seen between the case and control groups regarding education, occupation, and marital status. All pairwise comparisons of pre-test, post-test, and follow-up IBS-QOL scores were significant between the two groups (p<0.001). Similarly, pre- and post-, and pre- and follow-up test differences for IBS-SSS and VSI were significantly different between the two groups.

Conclusion: Exposure-based CBT combined with emotional expression and awareness training could alleviate the IBS symptoms, reduce visceral sensitivity, and improve quality of life.

Hepatocellular carcinoma (HCC) typically presents with a primary hepatic mass. Nevertheless, on rare occasions, the initial presentation can be exclusively related to extrahepatic metastases and the most common sites of metastases are the lungs, lymph nodes, bones, and adrenal glands. While, bone metastases are generally accompanied by multiple metastatic spreads elsewhere in the body or previously diagnosed HCC, cases of solitary bone metastases with no liver lesion at imaging have been reported. Indeed, two rare entities of HCC have been reported in the literature which are the ectopic hepatocellular carcinoma and the infiltrative type of hepatocellular carcinoma with a very challenging radiologic diagnosis and poor prognosis. In this article, we present a case of extrahepatic costal metastases of hepatocellular carcinoma, which was diagnosed through a bone biopsy, with no focal lesion on liver imaging including ultrasound, multiphase MRI, and CT scan except for the presence of a portal vein thrombosis. It is important to consider the possibility of HCC metastases when evaluating rapidly growing extrahepatic lesions in patients with chronic liver disease and to consider the tumor characteristics and imaging findings as well as limitations to make accurate and timely diagnosis leading to improved patient management. Our patient had probably an infiltrating HCC because of two prominent factors: the presence of portal vein thrombosis and a markedly elevated alpha-fetoprotein (AFP). A liver biopsy was crucial in order to confirm the diagnosis but unfortunately it could not be performed because of the unexpected death of the patient due to hemorrhagic shock. It is also worth noting in this case, that the elevated level of AFP raised the suspicion on an underlying HCC and contributed to more elaborate diagnostic tests.

Aim: We aimed to perform a systematic review to gather evidence on the efficacy of somatostatin analogs (SA) in managing bleeding gastrointestinal angiodysplasias (GIADs).

Background: Some usual treatment modalities for bleeding caused by GIADs include endoscopic or surgical management. However, considering their availability and side effects, they may not be feasible for every patient. On that account, pharmacological management may become a safe and effective option.

Methods: In January 2024, a systematic review of the literature was conducted using the PubMed/Medline, Cochrane Library, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework was followed. Inclusion in this review was restricted to randomized clinical trials (RCTs) or observational studies comparing the use of SA as the main or complementary therapy in patients with GIADs. The outcomes of interest were hemoglobin levels, transfusion requirements, bleeding, and safety/adverse effects.

Results: Seven studies were included in the systematic review, two RCTs and five observational studies. There were 682 patients, of which 166 (24.3%) received any form of treatment involving SA. The studies varied greatly regarding follow-up, SA of choice, and other treatments associated with SA or as a control. Lanreotide appears to be able to significantly improve hemoglobin levels when associated with various treatments, whereas octreotide does not. One RCT found a significant reduction in blood or iron transfusion units when comparing SA to a standard of care, but other studies had mixed results. Lanreotide may be useful in reducing bleeding episodes in patients treated with argon plasma coagulation with double-balloon enteroscopy. Gastrointestinal adverse events such as diarrhea, vomiting, and abdominal pain were commonly reported across studies.

Conclusion: The majority but not all included studies suggest that SA may improve hemoglobin levels and reduce bleeding in patients with GIAD. However, the studies included small sample sizes and were not of strong statistical power. Further RCTs with larger populations are necessary to validate the effectiveness of SA in managing patients with GIAD.

Hepatic encephalopathy (HE) is a serious neurological disorder characterized by brain dysfunction due to liver failure which occurs as a result of chronic or acute liver disease. HE can manifest with various neurological or psychiatric symptoms ranging from excessive sleepiness and sleep disorders to coma. HE is a serious disorder that in acute conditions can even lead to the death of the patient due to cerebral edema. Carnitine acts as a vital component in facilitating the transport of long-chain fatty acids into the mitochondria, thereby enabling their oxidation for the generation of energy. Carnitine additionally assumes a crucial role in the functionality of the brain. Carnitine deficiency is associated with various types of inherited disorders related to low levels of carnitine. A strong correlation exists between the insufficiency of carnitine and the occurrence of HE. If a deficiency of carnitine is identified through clinical symptoms or laboratory results in patients with liver dysfunction, treatment with carnitine replacement therapy is recommended. Thus, the administration of acetyl-L-carnitine in patients with HE can improve their mental and psychological conditions. In the present study, we provide an overview of the molecular and cellular mechanisms underlying HE. Our aim in this review has been genetic investigation of HE and genetic mutations to the causes of this neurological condition, which include carnitine deficiency, hyperammonemia, and etc. Finally, we discuss the genetic mutations that lead to carnitine deficiency as well as hyperammonemia and are associated with this neurological disease, together with the future treatment of this disease based on carnitine therapy. More studies soon will help early diagnosis (before poor prognosis) based on clinical observations, genetic tests, prenatal diagnosis, and new treatment strategies. Hepatic encephalopathy, Carnitine, Ammonia, Genetic, Treatment.

Aim: We evaluated the response to Trans-arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) patients according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. We determined the prognostic value of the neutrophil-to-lymphocyte ratio (NLR).

Background: TACE is the most commonly used method to treat patients with large, unresectable tumors or as bridge therapy in patients with HCC before liver transplantation.

Methods: In this cross-sectional study, patients with a diagnosis of HCC who were referred for TACE were studied. The response rate to TACE treatment was assessed based on dynamic MRI 28 days after treatment according to mRECIST criteria. The NLR value was calculated, and its prognostic value was evaluated to predict the response to treatment.

Results: Forty patients with HCC who underwent TACE were included. The response to TACE treatment included a complete response (CR) in 6 patients (15%), partial response (PR) in 16 patients (40%), and stable disease (SD) in 18 patients (45%). No progressive disease (PD) was found. Responders (CR and PR) were 22 patients (55%). The mean NLR after treatment in the non-responders was significantly higher than in the responders (4.2 vs. 2.4, P-value = 0.026). NLR values greater than 2.6 after treatment had a sensitivity of 70.6% and a specificity of 77.3% in diagnosing non-responders, with an Area Under the Curve (AUC) of 0.73 [95% confidence interval 0.58-0.89], P-value = 0.011.

Conclusion: Non-responders observed higher levels of NLR after treatment than responders. As a moderate prognostic factor, an NLR level of more than 2.6 after treatment could discriminate against non-responders.

Aim: The purpose of this retrospective single-center study was to determine the frequency of sarcopenia and its association with mortality and other morbidities in children with chronic liver disease who had undergone liver transplantation.

Background: Sarcopenia, a muscle-wasting syndrome, is common in patients with advanced liver disease and is associated with increased morbidity and mortality. While sarcopenia in adults has been extensively studied, there is little information in this regard about children and adolescents with chronic liver diseases.

Methods: The study included 108 children and adolescents who had undergone liver transplantation. Sarcopenia was measured using skeletal muscle index at the third lumbar vertebral level and assessed using abdominal computed tomography imaging.

Results: The frequency of sarcopenia in the studied population was found to be 45.7%. Patients with sarcopenia were more likely to be male (P<0.0001), older (P<0.0001), and had lower height-for-age z-scores (P=0.012). Genetic/metabolic diseases were the most common underlying cause of sarcopenia in children. Except for a higher rate of transplant rejection in the sarcopenia group (P=0.035), there was no significant difference in mortality rates (P=0.688) or post-LT complications between the two groups. One year after LT, computed tomography-derived body composition parameters revealed no significant differences between children who survived and those who did not.

Conclusion: Our findings indicated a high frequency of sarcopenia in children with chronic liver disease, implying that more research is needed to better understand its impact on clinical outcomes in this population.

Aim: This study aimed to investigate whether transdiagnostic treatment as well as acceptance and commitment therapy (ACT) could improve treatment adherence and alleviate gastrointestinal symptoms plus perceived stress in patients suffering from irritable bowel syndrome.

Background: Research has shown that people with chronic diseases often have negative attitudes toward medications, especially when they also have psychiatric disorders. This, along with the complex dosing requirements and inadequate knowledge about medication adherence among irritable bowel syndrome patients, can affect the treatment efficacy.

Methods: A randomized clinical trial was conducted using a pre-test-post-test design. The statistical population included patients with irritable bowel syndrome referring to Taleghani Hospital in Tehran between winter 2021 and spring 2022. Convenience sampling was used to select 30 individuals, with 15 people assigned to each group. Two types of psychotherapy were provided online and individually to the participants. The desired treatments were given to the transdiagnostic treatment and ACT groups in eight weekly sessions of 45-60 minutes.

Results: There was no significant difference between the transdiagnostic treatment pre-test and ACT regarding perceived stress, medication adherence, and gastrointestinal symptoms (P>0.05). There was no significant difference either between the transdiagnostic treatment and ACT post-test. However, there was a significant difference between the pre-test and post-test phases of ACT regarding adherence, gastrointestinal symptoms, plus perceived stress (P<0.05) and transdiagnostic treatment regarding gastrointestinal symptoms (P<0.05).

Conclusion: Specialists may use transdiagnostic treatment and ACT as effective psychological treatments to alleviate gastrointestinal symptoms and perceived stress, thereby increasing treatment adherence in patients with irritable bowel syndrome.

Aim: The current study aimed to introduce the key proteins involved in liver ischemia/reperfusion (I/R) injury through protein-protein interaction (PPI) analysis.

Background: Liver transplantation (LT) is a well-known treatment for liver diseases that threaten patients with mortality. LT is a complex operation, and several risks, including liver I/R injury, affect its success. Improving LT requires detection of its molecular mechanism. Experiments have revealed that high throughput methods such as proteomics in combination with bioinformatics are useful tools for analyzing the molecular mechanism of disease.

Methods: The differentially expressed proteins (DEPs) involved in liver I/R injury were extracted from the literature. The queried DEPs plus the first 100 neighbors were included in a network through STRING database using Cytoscape software. Degree, betweenness centrality, closeness centrality, and stress were considered to determine the central nodes. The queried DEPs were assessed by action map analysis using the CluePedia application of Cytoscape software. The key proteins were identified by comparing network analysis and action map evaluation results.

Results: Six proteins, namely ALB, INS, GAPDH, CAT, IL6, and TNF, among the added first neighbors were determined as the central first neighbors. MPO, CRP, MMP9, and HMOX1 were selected as central DEPs among the queried proteins. Action map analysis confirmed the PPI findings. The final evaluation revealed that MMP9 in combination with CRP and HMOX1 plays a critical role in liver I/R injury.

Conclusion: The significant role of MMP9 in liver I/R injury was detected in this study. Two central proteins (CRP and HMOX1) were shown to have a regulatory effect on MMP9; CRP activated MMP9, while HMXO1 downregulated it.

Aim: Clomipramine (tricyclic antidepressant), Risperidone (a non-typical antidepressant), and Escitalopram (selective serotonin reuptake inhibitor antidepressant) might be good candidates for investigating the anti-colitis activity.

Background: The incidence of depression with ulcerative colitis in patients has led to the use of antidepressants in their treatment. In addition to the antidepressant effect of these drugs, anti-inflammatory effects have also been reported.

Methods: In this study, 36 rats were used 2 ml of 3% acetic acid solution rectally to show the colitis. Then, Clomipramine (25 mg/kg), Escitalopram (10 mg/kg), Prednisolone (5 mg/kg), Risperidone (2 mg/kg), and normal saline as the control was administered orally for six days. The levels of Tumor Necrosis factor-alpha (TNF-α), Interleukin-6 (IL-6), and myeloperoxidase (MPO) were measured by Enzyme-linked immune sorbent assay (ELISA), and changes in the tissue pathology were investigated.

Results: IL-6 level was significantly reduced after the administration of clomipramine and Prednisolone (p=0.025). Risperidone has significantly reduced MPO activity in colonic tissue (P=0.006). We did find no statistical decrease in MPO activity and TNF-α and IL-6 levels after consumption of Escitalopram (p>0.05).

Conclusion: Clomipramine showed the best anti-inflammatory effect compared to Escitalopram and Risperidone. Therefore, clomipramine showed the best relieving effect on inflammation of ulcerative colitis in rats.

Aim: We performed a systematic review and meta-analysis to identify the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with gastroparesis.

Background: Several studies have suggested an association between SIBO and gastroparesis, which is characterized by delayed gastric emptying in the absence of mechanical obstruction.

Methods: A comprehensive search was performed using MEDLINE, EMBASE, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) through January, 2022 for randomized controlled trials and observational studies reporting the prevalence of SIBO in gastroparesis. Pooled prevalence was estimated using a random effects model. Heterogeneity was assessed by using the inconsistency index (I2).

Results: Among the 976 articles identified, 43 studies were selected for full text review. Six studies, with 385 patients, were deemed eligible for inclusion, with a perfect agreement between investigators (kappa=1.0). Overall, 379 patients were diagnosed with gastroparesis by gastric emptying scintigraphy and six were diagnosed with a wireless motility capsule. The pooled prevalence of SIBO was 41% (95% confidence interval 0.23-0.58). SIBO was diagnosed using jejunal aspirate cultures (N=15, 8.4%), lactulose breath test (N=80, 44.7%), glucose breath test (N=30, 16.8%), D-xylose breath test (N=52, 29.1%), and hydrogen breath test (N=2, 1.1%). Heterogeneity was significant and noted to be high at 91%. Only one study reported SIBO diagnosis in controls, therefore no pooled odds ratio was calculated.

Conclusion: SIBO was present in almost half of the patients with gastroparesis. Future studies should examine and identify the association between SIBO and gastroparesis.