Pub Date : 2022-09-21DOI: 10.3390/gastroent13040032
E. Ilieva, Vilyana Kostadinova, I. Tzotcheva, Nadezhda Rimpova, Yordanka Paskaleva, S. Lazova
(1) Background: Currently, multisystem inflammatory syndrome in children (MIS-C) is diagnosed based on clinical symptoms and laboratory findings of inflammation in the body. Once MIS-C is diagnosed, children will need to be followed over time. The imaging modalities most commonly used in the evaluation of patients with MIS-C include radiographs, ultrasound (US), and computed tomography (CT). Our study aims to summarise the literature data for the main gastrointestinal and pulmonary imaging features in children diagnosed with MIS-C and to share a single-centre experience. (2) Methods: We present the imaging findings in a cohort of 51 children diagnosed with MIS-C, admitted between December 2020 and February 2022. Imaging studies include chest and abdominal radiographs, thoracic, abdominal, and neck US and echocardiography (ECHO), and CT of the chest, abdomen, and pelvis. (3) Results: In accordance with the results in other studies, our observations show predominantly gastrointestinal involvement (GI) with ascites (33/51, 65%) and lymphadenopathy (19/51, 37%), ileitis or colitis (18/51, 35%), some cases of splenomegaly (9/51, 18%), hepatomegaly (8/51, 16%), and a few cases of renal enlargement (3/51, 6%) and gallbladder fossa oedema/wall thickening (2/51, 4%). Most common among the thoracic findings are posterior–basal consolidations (16/51, 31%), pleural effusion (14/51, 27%), and ground-glass opacities (12/51, 24%). We also register the significant involvement of the cardiovascular system with pericarditis (30/51, 58%), pericardial effusion (16/51, 31%), and myocarditis (6/51, 12%). (4) Conclusions: Radiologists should be aware of those imaging findings in order to take an important and active role not only in applying an accurate diagnosis, but also in the subsequent management of children with MIS-C. Radiological findings are not the primary diagnostic tool, but can assist in the evaluation of the affected systems and guide treatment.
{"title":"Abdominal and Thoracic Imaging Features in Children with MIS-C","authors":"E. Ilieva, Vilyana Kostadinova, I. Tzotcheva, Nadezhda Rimpova, Yordanka Paskaleva, S. Lazova","doi":"10.3390/gastroent13040032","DOIUrl":"https://doi.org/10.3390/gastroent13040032","url":null,"abstract":"(1) Background: Currently, multisystem inflammatory syndrome in children (MIS-C) is diagnosed based on clinical symptoms and laboratory findings of inflammation in the body. Once MIS-C is diagnosed, children will need to be followed over time. The imaging modalities most commonly used in the evaluation of patients with MIS-C include radiographs, ultrasound (US), and computed tomography (CT). Our study aims to summarise the literature data for the main gastrointestinal and pulmonary imaging features in children diagnosed with MIS-C and to share a single-centre experience. (2) Methods: We present the imaging findings in a cohort of 51 children diagnosed with MIS-C, admitted between December 2020 and February 2022. Imaging studies include chest and abdominal radiographs, thoracic, abdominal, and neck US and echocardiography (ECHO), and CT of the chest, abdomen, and pelvis. (3) Results: In accordance with the results in other studies, our observations show predominantly gastrointestinal involvement (GI) with ascites (33/51, 65%) and lymphadenopathy (19/51, 37%), ileitis or colitis (18/51, 35%), some cases of splenomegaly (9/51, 18%), hepatomegaly (8/51, 16%), and a few cases of renal enlargement (3/51, 6%) and gallbladder fossa oedema/wall thickening (2/51, 4%). Most common among the thoracic findings are posterior–basal consolidations (16/51, 31%), pleural effusion (14/51, 27%), and ground-glass opacities (12/51, 24%). We also register the significant involvement of the cardiovascular system with pericarditis (30/51, 58%), pericardial effusion (16/51, 31%), and myocarditis (6/51, 12%). (4) Conclusions: Radiologists should be aware of those imaging findings in order to take an important and active role not only in applying an accurate diagnosis, but also in the subsequent management of children with MIS-C. Radiological findings are not the primary diagnostic tool, but can assist in the evaluation of the affected systems and guide treatment.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47251077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-19DOI: 10.3390/gastroent13030031
C. Marginean, M. Popescu, C. Vasile, M. Stanciu, I. Popescu, V. Biciușcă, D. Ciobanu, A. Dobrescu, L. Sandulescu, S. Bondari, Marian-Sorin Popescu, P. Mitruț
Background: Chronic pancreatitis (CP) has been described as a multifactorial, ongoing inflammatory condition of the pancreas of varying intensity that produces persistent pain, leading to exocrine and endocrine insufficiency and a decreased lifespan. Currently, there are three primary forms of chronic pancreatitis: chronic autoimmune pancreatitis (steroid-sensitive pancreatitis), chronic obstructive pancreatitis, and chronic calcific pancreatitis, the latter being closely related to excessive alcohol consumption for one or even two decades before the onset of symptoms. Case report: We present the case of a 29 year old man who required medical attention for a significant unintentional weight loss and a history of upper abdominal pain. Blood tests revealed substantial abnormalities, and the patient was admitted for further investigation. CT and MRI confirmed the presence of a pancreatic pseudocyst and extensive pancreatic parenchymal calcifications and revealed multiple hepatosplenic microabscesses of fungal etiology. Conclusions: Chronic calcifying pancreatitis is a complex clinical entity that can lead to secondary diabetes due to progressive destruction of the pancreatic parenchyma. Protein malnutrition, caused by malabsorption syndrome, immune cell dysfunction, and a high glucose environment caused by diabetes mellitus, may create a state of immunodeficiency, predisposing the patient to opportunistic infections.
{"title":"Chronic Calcifying Pancreatitis Associated with Secondary Diabetes Mellitus and Hepatosplenic Abscesses in a Young Male Patient: A Case Report","authors":"C. Marginean, M. Popescu, C. Vasile, M. Stanciu, I. Popescu, V. Biciușcă, D. Ciobanu, A. Dobrescu, L. Sandulescu, S. Bondari, Marian-Sorin Popescu, P. Mitruț","doi":"10.3390/gastroent13030031","DOIUrl":"https://doi.org/10.3390/gastroent13030031","url":null,"abstract":"Background: Chronic pancreatitis (CP) has been described as a multifactorial, ongoing inflammatory condition of the pancreas of varying intensity that produces persistent pain, leading to exocrine and endocrine insufficiency and a decreased lifespan. Currently, there are three primary forms of chronic pancreatitis: chronic autoimmune pancreatitis (steroid-sensitive pancreatitis), chronic obstructive pancreatitis, and chronic calcific pancreatitis, the latter being closely related to excessive alcohol consumption for one or even two decades before the onset of symptoms. Case report: We present the case of a 29 year old man who required medical attention for a significant unintentional weight loss and a history of upper abdominal pain. Blood tests revealed substantial abnormalities, and the patient was admitted for further investigation. CT and MRI confirmed the presence of a pancreatic pseudocyst and extensive pancreatic parenchymal calcifications and revealed multiple hepatosplenic microabscesses of fungal etiology. Conclusions: Chronic calcifying pancreatitis is a complex clinical entity that can lead to secondary diabetes due to progressive destruction of the pancreatic parenchyma. Protein malnutrition, caused by malabsorption syndrome, immune cell dysfunction, and a high glucose environment caused by diabetes mellitus, may create a state of immunodeficiency, predisposing the patient to opportunistic infections.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48170939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-10DOI: 10.3390/gastroent13030030
E. Nacheva-Georgieva, D. Doykov, V. Andonov, K. Doykova, Silviya Bogdanova Tsvetkova
Non-invasive, ultrasound-based methods for visualizing and measuring tissue elasticity are becoming more and more common in routine daily practice. An accurate diagnosis of malignant and benign tumors is essential for determining the appropriate treatment. Despite the wide use of imaging techniques, the investigation for assessing the elasticity of focal liver lesions and their differentiating is still continuing. Aim: To investigate the value of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for the differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 125 adult patients were included from the Clinic of Gastroenterology of University Hospital Kaspela, Plovdiv city, Bulgaria, in the period from January 2021 to July 2022. Participants were divided into two groups—with benign (hemangiomas) and malignant focal liver lesions (hepatocellular carcinoma). The group with benign lesions included 63 patients and the group with malignant focal liver lesions (FLLs)—62 patients. Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) integrated in the same ultrasound machine (Esaote MyLab™ 9Exp) were performed for each lesion. Results: Malignant FLLs have significantly higher stiffness in both pSWE (2.52–4.32 m/s, 90% CI: 2.37 to 2.68, 90% CI: 4.19 to 4.55) and 2d-SWE (2.52–4.43 m/s, 90% CI: 2.31 to 2.65, 90% CI: 4.27 to 4.61). Conclusion: 2D-SWE and pSWE could provide complementary data about FLLs. They enable us to conveniently and easily obtain accurate stiffness information of FLLs.
{"title":"Point Shear Wave Elastography and 2-Dimensional Shear Wave Elastography as a Non-Invasive Method in Differentiating Benign from Malignant Liver Lesions","authors":"E. Nacheva-Georgieva, D. Doykov, V. Andonov, K. Doykova, Silviya Bogdanova Tsvetkova","doi":"10.3390/gastroent13030030","DOIUrl":"https://doi.org/10.3390/gastroent13030030","url":null,"abstract":"Non-invasive, ultrasound-based methods for visualizing and measuring tissue elasticity are becoming more and more common in routine daily practice. An accurate diagnosis of malignant and benign tumors is essential for determining the appropriate treatment. Despite the wide use of imaging techniques, the investigation for assessing the elasticity of focal liver lesions and their differentiating is still continuing. Aim: To investigate the value of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for the differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 125 adult patients were included from the Clinic of Gastroenterology of University Hospital Kaspela, Plovdiv city, Bulgaria, in the period from January 2021 to July 2022. Participants were divided into two groups—with benign (hemangiomas) and malignant focal liver lesions (hepatocellular carcinoma). The group with benign lesions included 63 patients and the group with malignant focal liver lesions (FLLs)—62 patients. Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) integrated in the same ultrasound machine (Esaote MyLab™ 9Exp) were performed for each lesion. Results: Malignant FLLs have significantly higher stiffness in both pSWE (2.52–4.32 m/s, 90% CI: 2.37 to 2.68, 90% CI: 4.19 to 4.55) and 2d-SWE (2.52–4.43 m/s, 90% CI: 2.31 to 2.65, 90% CI: 4.27 to 4.61). Conclusion: 2D-SWE and pSWE could provide complementary data about FLLs. They enable us to conveniently and easily obtain accurate stiffness information of FLLs.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":"1 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41371561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-09DOI: 10.3390/gastroent13030029
M. Ferronato, M. Lenzi, P. Muratori, L. Muratori
Background. Assessment of liver fibrosis is essential to guide treatment in autoimmune hepatitis (AIH), but non-invasive tests (NITs) showed poor accuracy. Our study aims to evaluate the performance of NITs among different AIH presentations. Methods. Monocentric retrospective study among 122 AIH patients. NITs were compared to histological grading of liver fibrosis. We performed an accuracy analysis among acute (jaundice and/or transaminases > 10 times upper limit of normal) and non-acute patients. Results. A significant difference in the distribution of NIT values for each Ishak stage was found for spleen-diameter-to-platelet-count ratio (SD/PC) (p < 0.001), fibrosis-4-score (FIB-4) (p = 0.002), AST-to-ALT ratio (AAR) (p = 0.002), red-blood-cell-width-distribution-to-platelet-count ratio (RDW/PC) (p = 0.008) and AST-to-platelet-count ratio (APRI) (p = 0.029). The AUC for advanced fibrosis of SD/PC, FIB-4, RDW/PC, APRI and AAR were, respectively, 0.814, 0.770, 0.768, 0.708 and 0.694. The AUC of SD/PC, FIB-4 and APRI in non-acute subgroup were 0.902, 0.834 and 0.758, while in acute patients they were 0.754, 0.724 and 0.716. RDW/PC and AAR weren’t different among the two subgroups. Conclusions. For SD/PC, FIB-4 and APRI, diagnostic accuracy is higher in patients with non-acute presentation. In this context, SD/PC and FIB-4 showed an overall performance that could be of interest in clinical practice alongside other non-invasive techniques.
{"title":"Blood-Based Non-Invasive Tests of Hepatic Fibrosis in Autoimmune Hepatitis: Application among Selected Patients Leads to Higher Accuracy","authors":"M. Ferronato, M. Lenzi, P. Muratori, L. Muratori","doi":"10.3390/gastroent13030029","DOIUrl":"https://doi.org/10.3390/gastroent13030029","url":null,"abstract":"Background. Assessment of liver fibrosis is essential to guide treatment in autoimmune hepatitis (AIH), but non-invasive tests (NITs) showed poor accuracy. Our study aims to evaluate the performance of NITs among different AIH presentations. Methods. Monocentric retrospective study among 122 AIH patients. NITs were compared to histological grading of liver fibrosis. We performed an accuracy analysis among acute (jaundice and/or transaminases > 10 times upper limit of normal) and non-acute patients. Results. A significant difference in the distribution of NIT values for each Ishak stage was found for spleen-diameter-to-platelet-count ratio (SD/PC) (p < 0.001), fibrosis-4-score (FIB-4) (p = 0.002), AST-to-ALT ratio (AAR) (p = 0.002), red-blood-cell-width-distribution-to-platelet-count ratio (RDW/PC) (p = 0.008) and AST-to-platelet-count ratio (APRI) (p = 0.029). The AUC for advanced fibrosis of SD/PC, FIB-4, RDW/PC, APRI and AAR were, respectively, 0.814, 0.770, 0.768, 0.708 and 0.694. The AUC of SD/PC, FIB-4 and APRI in non-acute subgroup were 0.902, 0.834 and 0.758, while in acute patients they were 0.754, 0.724 and 0.716. RDW/PC and AAR weren’t different among the two subgroups. Conclusions. For SD/PC, FIB-4 and APRI, diagnostic accuracy is higher in patients with non-acute presentation. In this context, SD/PC and FIB-4 showed an overall performance that could be of interest in clinical practice alongside other non-invasive techniques.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46883666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01Epub Date: 2022-07-30DOI: 10.3390/gastroent13030024
Rami A Al-Horani, Raquel Chiles
Eosinophilic esophagitis (EE) is a chronic, immune-mediated or antigen-mediated esophageal disease. Treatment for patients with EE can be challenging with no previously approved medications. Current management strategies follow the four D's paradigm of drugs, dietary elimination, dilation, and disease anxiety and hypervigilance therapy. On 20 May 2022, dupilumab was approved by FDA for EE. A dose of 300 mg dupilumab weekly significantly improved signs and symptoms of EE compared to placebo in a phase 3 trial. The approval of dupilumab will fulfill an unmet need for the increasing number of patients with EE.
{"title":"First Therapeutic Approval for Eosinophilic Esophagitis.","authors":"Rami A Al-Horani, Raquel Chiles","doi":"10.3390/gastroent13030024","DOIUrl":"https://doi.org/10.3390/gastroent13030024","url":null,"abstract":"<p><p>Eosinophilic esophagitis (EE) is a chronic, immune-mediated or antigen-mediated esophageal disease. Treatment for patients with EE can be challenging with no previously approved medications. Current management strategies follow the four D's paradigm of drugs, dietary elimination, dilation, and disease anxiety and hypervigilance therapy. On 20 May 2022, dupilumab was approved by FDA for EE. A dose of 300 mg dupilumab weekly significantly improved signs and symptoms of EE compared to placebo in a phase 3 trial. The approval of dupilumab will fulfill an unmet need for the increasing number of patients with EE.</p>","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":"13 3","pages":"238-244"},"PeriodicalIF":2.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9364827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40697978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-15DOI: 10.3390/gastroent13030028
M. Renzulli, A. Pecorelli, N. Brandi, G. Marasco, Francesco Adduci, F. Tovoli, B. Stefanini, A. Granito, R. Golfieri
Background: The aim of the present study was to evaluate the presence and the prognostic value of the radiological signs of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). Methods: Between January 2015 and December 2017, all patients (91 patients) with de novo HCC or HCC recurrence occurring at least 2 years after the last treatment in NAFLD (36 patients) or with hepatitis C virus (HCV) liver disease (55 patients) were included. Each HCC was treated with liver resection and transplantation to obtain the anatomopathological confirmation of MVI. All patients had at least one available computed tomography (CT) scan or magnetic resonance imaging (MRI) performed no more than one month prior to the treatment. The clinical data of each patient, tumor burden (diameter, margins, two-trait predictor of venous invasion (TTPVI), and peritumoral enhancement), the recurrence rate (RR) after a 1-year follow-up, and the time to recurrence (TTR) were collected. Results: The NAFLD–HCC nodules were larger as compared to HCV–HCC (51 mm vs. 36 mm, p = 0.004) and showed a higher prevalence of TTPVI (38.9 vs. 20.0%, p = 0.058). At multivariate analysis, nodule diameter >50 mm was found to be the only independent prognostic factor of TTPVI (hazard ratio: 21.3, 95% confidence interval: 4.2–107.7, p < 0.001), and the presence of TTPVI was confirmed to be the only independent prognostic factors of recurrence (hazard ratio: 2.349, 95% confidence interval: 1.369–4.032, p = 0.002). No correlations were found between TTR and irregular tumor margins or peritumoral enhancement. Conclusion: The NAFLD–HCC patients had larger tumors at diagnosis and showed a more frequent presence of radiological signs of MVI as compared to the HCV–HCC patients. The MVI was related to a more rapid recurrence after curative treatments, demonstrating the prognostic value of this radiological diagnosis.
背景:本研究的目的是评估非酒精性脂肪性肝病(NAFLD)患者肝细胞癌(HCC)微血管侵犯(MVI)的影像学征象的存在及其预后价值。方法:在2015年1月至2017年12月期间，纳入所有NAFLD(36例)或丙型肝炎病毒(HCV)肝病(55例)中复发的HCC或HCC复发至少2年的患者(91例)。每例HCC均行肝切除和肝移植治疗，以获得MVI的解剖病理证实。所有患者在治疗前不超过一个月至少进行了一次可用的计算机断层扫描(CT)或磁共振成像(MRI)。收集每位患者的临床资料、肿瘤负荷(直径、切缘、静脉浸润双特征预测因子(TTPVI)、瘤周强化)、随访1年后的复发率(RR)、复发时间(TTR)。结果:NAFLD-HCC结节比HCV-HCC更大(51 mm比36 mm, p = 0.004)， TTPVI患病率更高(38.9%比20.0%，p = 0.058)。多因素分析发现，结节直径bbb50 mm是TTPVI的唯一独立预后因素(风险比:21.3,95%可信区间:4.2 ~ 107.7,p < 0.001)， TTPVI的存在是复发的唯一独立预后因素(风险比:2.349,95%可信区间:1.369 ~ 4.032,p = 0.002)。TTR与不规则肿瘤边缘或肿瘤周围强化无相关性。结论:与HCV-HCC患者相比，NAFLD-HCC患者在诊断时肿瘤更大，MVI影像学征象更频繁。MVI与根治性治疗后的快速复发有关，证明了这种放射诊断的预后价值。
{"title":"Radiological Features of Microvascular Invasion of Hepatocellular Carcinoma in Patients with Non-Alcoholic Fatty Liver Disease","authors":"M. Renzulli, A. Pecorelli, N. Brandi, G. Marasco, Francesco Adduci, F. Tovoli, B. Stefanini, A. Granito, R. Golfieri","doi":"10.3390/gastroent13030028","DOIUrl":"https://doi.org/10.3390/gastroent13030028","url":null,"abstract":"Background: The aim of the present study was to evaluate the presence and the prognostic value of the radiological signs of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). Methods: Between January 2015 and December 2017, all patients (91 patients) with de novo HCC or HCC recurrence occurring at least 2 years after the last treatment in NAFLD (36 patients) or with hepatitis C virus (HCV) liver disease (55 patients) were included. Each HCC was treated with liver resection and transplantation to obtain the anatomopathological confirmation of MVI. All patients had at least one available computed tomography (CT) scan or magnetic resonance imaging (MRI) performed no more than one month prior to the treatment. The clinical data of each patient, tumor burden (diameter, margins, two-trait predictor of venous invasion (TTPVI), and peritumoral enhancement), the recurrence rate (RR) after a 1-year follow-up, and the time to recurrence (TTR) were collected. Results: The NAFLD–HCC nodules were larger as compared to HCV–HCC (51 mm vs. 36 mm, p = 0.004) and showed a higher prevalence of TTPVI (38.9 vs. 20.0%, p = 0.058). At multivariate analysis, nodule diameter >50 mm was found to be the only independent prognostic factor of TTPVI (hazard ratio: 21.3, 95% confidence interval: 4.2–107.7, p < 0.001), and the presence of TTPVI was confirmed to be the only independent prognostic factors of recurrence (hazard ratio: 2.349, 95% confidence interval: 1.369–4.032, p = 0.002). No correlations were found between TTR and irregular tumor margins or peritumoral enhancement. Conclusion: The NAFLD–HCC patients had larger tumors at diagnosis and showed a more frequent presence of radiological signs of MVI as compared to the HCV–HCC patients. The MVI was related to a more rapid recurrence after curative treatments, demonstrating the prognostic value of this radiological diagnosis.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44292311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-10DOI: 10.3390/gastroent13030027
Subhashree Mohapatra, G. Pati, Manohar Mishra, T. Swarnkar
Colonoscopy is a gold standard procedure for tracking the lower gastrointestinal region. A colorectal polyp is one such condition that is detected through colonoscopy. Even though technical advancements have improved the early detection of colorectal polyps, there is still a high percentage of misses due to various factors. Polyp segmentation can play a significant role in the detection of polyps at the early stage and can thus help reduce the severity of the disease. In this work, the authors implemented several image pre-processing techniques such as coherence transport and contrast limited adaptive histogram equalization (CLAHE) to handle different challenges in colonoscopy images. The processed image was then segmented into a polyp and normal pixel using a U-Net-based deep learning segmentation model named UPolySeg. The main framework of UPolySeg has an encoder–decoder section with feature concatenation in the same layer as the encoder–decoder along with the use of dilated convolution. The model was experimentally verified using the publicly available Kvasir-SEG dataset, which gives a global accuracy of 96.77%, a dice coefficient of 96.86%, an IoU of 87.91%, a recall of 95.57%, and a precision of 92.29%. The new framework for the polyp segmentation implementing UPolySeg improved the performance by 1.93% compared with prior work.
{"title":"UPolySeg: A U-Net-Based Polyp Segmentation Network Using Colonoscopy Images","authors":"Subhashree Mohapatra, G. Pati, Manohar Mishra, T. Swarnkar","doi":"10.3390/gastroent13030027","DOIUrl":"https://doi.org/10.3390/gastroent13030027","url":null,"abstract":"Colonoscopy is a gold standard procedure for tracking the lower gastrointestinal region. A colorectal polyp is one such condition that is detected through colonoscopy. Even though technical advancements have improved the early detection of colorectal polyps, there is still a high percentage of misses due to various factors. Polyp segmentation can play a significant role in the detection of polyps at the early stage and can thus help reduce the severity of the disease. In this work, the authors implemented several image pre-processing techniques such as coherence transport and contrast limited adaptive histogram equalization (CLAHE) to handle different challenges in colonoscopy images. The processed image was then segmented into a polyp and normal pixel using a U-Net-based deep learning segmentation model named UPolySeg. The main framework of UPolySeg has an encoder–decoder section with feature concatenation in the same layer as the encoder–decoder along with the use of dilated convolution. The model was experimentally verified using the publicly available Kvasir-SEG dataset, which gives a global accuracy of 96.77%, a dice coefficient of 96.86%, an IoU of 87.91%, a recall of 95.57%, and a precision of 92.29%. The new framework for the polyp segmentation implementing UPolySeg improved the performance by 1.93% compared with prior work.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2022-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46005761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-09DOI: 10.3390/gastroent13030026
F. Metelli, R. Solimando, L. Alemanni, R. Gafà, G. Marasco
We herein report a case of hepatosplenic T-cell lymphoma (HSTCL) incidentally found in a 30-year-old man who came to the emergency department after an ankle trauma. At admission, laboratory tests revealed abnormal liver enzymes and pancytopenia, and imaging showed mild hepatosplenomegaly. During hospitalization, the patient’s clinical condition worsened rapidly, with a concomitant increase in cholestatic enzymes, severe jaundice, and the worsening of pancytopenia. Causes of liver injury, including many infectious diseases, were explored until the diagnosis of HSTCL was made by liver and bone marrow biopsies. Subsequently, the patient underwent six cycles of chemotherapy with a CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone or prednisolone) regimen and one with Hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone) but, despite this aggressive treatment, died due to disease progression 2 months after diagnosis. This rare disease should be considered in the diagnostic workup of acute cholestatic hepatitis presenting with concomitant hepatosplenomegaly and cytopenia.
{"title":"Hepatosplenic T-Cell Lymphoma Mimicking Acute Onset of Cholestatic Hepatitis in a Young Immunocompetent Man: A Case Report","authors":"F. Metelli, R. Solimando, L. Alemanni, R. Gafà, G. Marasco","doi":"10.3390/gastroent13030026","DOIUrl":"https://doi.org/10.3390/gastroent13030026","url":null,"abstract":"We herein report a case of hepatosplenic T-cell lymphoma (HSTCL) incidentally found in a 30-year-old man who came to the emergency department after an ankle trauma. At admission, laboratory tests revealed abnormal liver enzymes and pancytopenia, and imaging showed mild hepatosplenomegaly. During hospitalization, the patient’s clinical condition worsened rapidly, with a concomitant increase in cholestatic enzymes, severe jaundice, and the worsening of pancytopenia. Causes of liver injury, including many infectious diseases, were explored until the diagnosis of HSTCL was made by liver and bone marrow biopsies. Subsequently, the patient underwent six cycles of chemotherapy with a CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone or prednisolone) regimen and one with Hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone) but, despite this aggressive treatment, died due to disease progression 2 months after diagnosis. This rare disease should be considered in the diagnostic workup of acute cholestatic hepatitis presenting with concomitant hepatosplenomegaly and cytopenia.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2022-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44823742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-05DOI: 10.3390/gastroent13030025
V. Ionescu, G. Gheorghe, R. Opriță, Mădălina Stan-Ilie, R. Dascălu, Ondin Zaharia, V. Jinga, C. Diaconu, G. Constantinescu
Gastrointestinal cancers represent a major cause of morbidity and mortality worldwide. A significant issue regarding the therapeutic management of these patients consists of metabolic disturbances and malnutrition. Nutritional deficiencies have a negative impact on both the death rates of these patients and the results of surgical or oncological treatments. Thus, current guidelines recommend the inclusion of a nutritional profile in the therapeutic management of patients with gastrointestinal cancers. The development of digestive endoscopy techniques has led to the possibility of ensuring the enteral nutrition of cancer patients without oral feeding through minimally invasive techniques and the avoidance of surgeries, which involve more risks. The enteral nutrition modalities consist of endoscopy-guided nasoenteric tube (ENET), percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic gastrostomy with jejunal tube extension (PEG-J), direct percutaneous endoscopic jejunostomy (DPEJ) or endoscopic ultrasound (EUS)-guided gastroenterostomy.
{"title":"The Outcomes of Nutritional Support Techniques in Patients with Gastrointestinal Cancers","authors":"V. Ionescu, G. Gheorghe, R. Opriță, Mădălina Stan-Ilie, R. Dascălu, Ondin Zaharia, V. Jinga, C. Diaconu, G. Constantinescu","doi":"10.3390/gastroent13030025","DOIUrl":"https://doi.org/10.3390/gastroent13030025","url":null,"abstract":"Gastrointestinal cancers represent a major cause of morbidity and mortality worldwide. A significant issue regarding the therapeutic management of these patients consists of metabolic disturbances and malnutrition. Nutritional deficiencies have a negative impact on both the death rates of these patients and the results of surgical or oncological treatments. Thus, current guidelines recommend the inclusion of a nutritional profile in the therapeutic management of patients with gastrointestinal cancers. The development of digestive endoscopy techniques has led to the possibility of ensuring the enteral nutrition of cancer patients without oral feeding through minimally invasive techniques and the avoidance of surgeries, which involve more risks. The enteral nutrition modalities consist of endoscopy-guided nasoenteric tube (ENET), percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic gastrostomy with jejunal tube extension (PEG-J), direct percutaneous endoscopic jejunostomy (DPEJ) or endoscopic ultrasound (EUS)-guided gastroenterostomy.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48114009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-14DOI: 10.3390/gastroent13030023
N. Strossman, K. Donovan, Alex Trovato, Nihita Manem, Nicole Nudelman, Micheal Tadros, C. Ashley
Eosinophilic esophagitis (EoE), a chronic inflammatory disease of the esophagus, has been increasing in incidence over the past several years. Mainstays of treatment include dietary modifications, steroids, proton pump inhibitors (PPIs), and endoscopic dilation, with the goal being to control disease progression, promote remission, and alleviate symptoms, such as dysphagia and food impaction. In addition to these well-known treatment options, preliminary studies on new medications that target specific inflammatory mediators involved in the pathogenesis of EoE have shown promise in improving symptoms. This review article summarizes and discusses the application and efficacy of long-standing and promising new treatment options for EoE.
{"title":"Exploring Treatment Options for Eosinophilic Esophagitis","authors":"N. Strossman, K. Donovan, Alex Trovato, Nihita Manem, Nicole Nudelman, Micheal Tadros, C. Ashley","doi":"10.3390/gastroent13030023","DOIUrl":"https://doi.org/10.3390/gastroent13030023","url":null,"abstract":"Eosinophilic esophagitis (EoE), a chronic inflammatory disease of the esophagus, has been increasing in incidence over the past several years. Mainstays of treatment include dietary modifications, steroids, proton pump inhibitors (PPIs), and endoscopic dilation, with the goal being to control disease progression, promote remission, and alleviate symptoms, such as dysphagia and food impaction. In addition to these well-known treatment options, preliminary studies on new medications that target specific inflammatory mediators involved in the pathogenesis of EoE have shown promise in improving symptoms. This review article summarizes and discusses the application and efficacy of long-standing and promising new treatment options for EoE.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47466510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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