Cătălina Vlăduț, Mădălina Stan-Ilie, Adrian Săftoiu, R. Tutuian, Gabriel Constantinescu
Peri-pancreatic fluid collections are late complications of acute pancreatitis. Loculated peri-pancreatic fluid collections, even rare, remain the „black sheep” in terms of drainage, due to difficulty to puncture all compartments, thus prohibiting proper drainage of all compartments. Recombined tissue plasminogen activator (r-tPA) has been advocated as treatment of the loculated collections, due to its ability to dissolve the fibrinous strands and thus facilitate proper drainage. We report the case of a 58 years-old male presenting with a painful loculated peri-pancreatic fluid collection secondary to acute pancreatitis. We performed Alteplase injection, followed by successful endosonographic drainage with lumen apposing metal stent of the collection after 48 hours. Our observation suggests that r-tPA could be a new strategy for loculated collections management, ensuring better drainage and limiting the indication for surgical treatment.
{"title":"Recombinant Tissue Plasminogen Activator: The New Concept for Dissolving Septae in Loculated Peri-pancreatic Fluid Collection prior to Endoscopic Drainage. A Case Report","authors":"Cătălina Vlăduț, Mădălina Stan-Ilie, Adrian Săftoiu, R. Tutuian, Gabriel Constantinescu","doi":"10.15403/jgld-4798","DOIUrl":"https://doi.org/10.15403/jgld-4798","url":null,"abstract":"Peri-pancreatic fluid collections are late complications of acute pancreatitis. Loculated peri-pancreatic fluid collections, even rare, remain the „black sheep” in terms of drainage, due to difficulty to puncture all compartments, thus prohibiting proper drainage of all compartments. Recombined tissue plasminogen activator (r-tPA) has been advocated as treatment of the loculated collections, due to its ability to dissolve the fibrinous strands and thus facilitate proper drainage. We report the case of a 58 years-old male presenting with a painful loculated peri-pancreatic fluid collection secondary to acute pancreatitis. We performed Alteplase injection, followed by successful endosonographic drainage with lumen apposing metal stent of the collection after 48 hours. Our observation suggests that r-tPA could be a new strategy for loculated collections management, ensuring better drainage and limiting the indication for surgical treatment.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Garima Setia, A. Bhavanani, Meena Ramanathan, Nilakantan Ananthakrishnan, Vinod Vinoth, B. S. M. Prabu, Balanehru Subramanian
Functional dyspepsia (FD) is a common upper gastrointestinal disorder, characterized by bothersome epigastric pain or burning, fullness after meals or early satiety. The precise pathophysiology remains incompletely understood but may include the role of disordered gut-brain communication leading to disturbances in gastro-duodenal physiological functioning. Even if there are several pharmacological treatment options, it is a chronic and relapsing disorder with persistent symptoms that makes its management difficult. Yoga is a fast-spreading complementary and alternative medicine (CAM) specialty, that has gained attention in the medical field for its ability to address the physical, emotional, mental and social aspects of health and disease. Various other CAM therapies are being used for FD with varying efficacy. However, apart from one research study that used yoga therapy on abdominal pain related functional gastrointestinal disorders in children which included a few FD cases as well (11.6%), no other study using yoga therapy has been done in FD as per our best knowledge. Therefore, in the present review, we have summarized the current scientific understanding of the probable effects of yoga on the pathophysiological mechanisms involved in FD (gastric motility, fundic accommodation, hypersensitivity, duodenal inflammation, psychological distress and gut-brain dysfunction). The literature suggests yoga can have a beneficial role in the management of FD. However, rigorous research and clinical trials are required to confirm the same.
{"title":"Yoga Therapy in Functional Dyspepsia. A Narrative Review","authors":"Garima Setia, A. Bhavanani, Meena Ramanathan, Nilakantan Ananthakrishnan, Vinod Vinoth, B. S. M. Prabu, Balanehru Subramanian","doi":"10.15403/jgld-4867","DOIUrl":"https://doi.org/10.15403/jgld-4867","url":null,"abstract":"Functional dyspepsia (FD) is a common upper gastrointestinal disorder, characterized by bothersome epigastric pain or burning, fullness after meals or early satiety. The precise pathophysiology remains incompletely understood but may include the role of disordered gut-brain communication leading to disturbances in gastro-duodenal physiological functioning. Even if there are several pharmacological treatment options, it is a chronic and relapsing disorder with persistent symptoms that makes its management difficult. Yoga is a fast-spreading complementary and alternative medicine (CAM) specialty, that has gained attention in the medical field for its ability to address the physical, emotional, mental and social aspects of health and disease. Various other CAM therapies are being used for FD with varying efficacy. However, apart from one research study that used yoga therapy on abdominal pain related functional gastrointestinal disorders in children which included a few FD cases as well (11.6%), no other study using yoga therapy has been done in FD as per our best knowledge. Therefore, in the present review, we have summarized the current scientific understanding of the probable effects of yoga on the pathophysiological mechanisms involved in FD (gastric motility, fundic accommodation, hypersensitivity, duodenal inflammation, psychological distress and gut-brain dysfunction). The literature suggests yoga can have a beneficial role in the management of FD. However, rigorous research and clinical trials are required to confirm the same.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"82 9","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138945364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashwin Patwardhan, Paul Simkin, Sourav Das, Annie Zhou, Geoff Hebbard
{"title":"The diagnostic sensitivity of unprepared abdominal-pelvic computed tomography in high-risk patients for colonoscopy, suspected of colorectal cancer","authors":"Ashwin Patwardhan, Paul Simkin, Sourav Das, Annie Zhou, Geoff Hebbard","doi":"10.15403/jgld-5076","DOIUrl":"https://doi.org/10.15403/jgld-5076","url":null,"abstract":"","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"54 50","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138946339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Akash Roy, S. Giri, Ankita Singh, Arun Vaidya, S. Angadi
Background and Aims: Lactulose is the first-line drug for both treatment and secondary prophylaxis for overt hepatic encephalopathy (HE). The use of lactulose for the primary prophylaxis of HE in patients with cirrhosis and acute upper gastrointestinal bleeding (AUGIB) has been debated. Hence, we conducted this meta-analysis to assess the role of lactulose in HE prophylaxis in patients with cirrhosis and AUGIB. Methods: A comprehensive search of literature from inception to December 2022 was performed of three databases for randomized studies comparing lactulose and placebo in patients with cirrhosis and AUGIB. Risk ratios (RR) with 95% confidence intervals were calculated for all the dichotomous outcomes. Results: A total of five studies were included in the final analysis, out of which three studies had a low risk of bias, and two had a moderate risk of bias. Lactulose therapy was associated with a significantly lower risk of OHE compared to placebo, with a RR of 0.38 (0.23-0.62) and a number needed to treat of 6. There was no difference in the risk of mortality between the groups, with a RR of 0.71 (0.29-1.76). The pooled incidence rates of overall adverse events (AEs) and diarrhea with the use of lactulose therapy were 53.2% (42.2- 64.2) and 34.7% (17.7-51.7), but a majority did not require drug discontinuation. The certainty of the evidence was moderate to low. Conclusions: Prophylactic lactulose reduces the incidence of HE after AUGIB but has no effect on mortality. Diarrhea and abdominal discomfort are common AEs but do not need drug discontinuation.
背景和目的：乳果糖是治疗和二级预防明显肝性脑病（HE）的一线药物。关于乳果糖是否可用于肝硬化和急性上消化道出血（AUGIB）患者肝性脑病的一级预防，一直存在争议。因此，我们进行了这项荟萃分析，以评估乳果糖在肝硬化合并急性上消化道出血患者的 HE 预防中的作用。方法：对三个数据库中从开始到 2022 年 12 月的文献进行了全面检索，以寻找在肝硬化和 AUGIB 患者中比较乳果糖和安慰剂的随机研究。计算了所有二分法结果的风险比 (RR) 及 95% 置信区间。结果：共有五项研究被纳入最终分析，其中三项研究存在低度偏倚风险，两项研究存在中度偏倚风险。与安慰剂相比，乳果糖疗法明显降低了OHE的风险，RR值为0.38（0.23-0.62），需要治疗的人数为6人；两组患者的死亡风险没有差异，RR值为0.71（0.29-1.76）。使用乳果糖疗法的总体不良事件（AEs）和腹泻的汇总发生率分别为53.2%（42.2-64.2）和34.7%（17.7-51.7），但大多数患者无需停药。证据的确定性为中低。结论预防性乳果糖可降低 AUGIB 后 HE 的发生率，但对死亡率没有影响。腹泻和腹部不适是常见的不良反应，但无需停药。
{"title":"Prophylactic Lactulose Therapy in Patients with Cirrhosis and Upper Gastrointestinal Bleeding: A Meta-analysis of Randomized Trials","authors":"Akash Roy, S. Giri, Ankita Singh, Arun Vaidya, S. Angadi","doi":"10.15403/jgld-4975","DOIUrl":"https://doi.org/10.15403/jgld-4975","url":null,"abstract":"Background and Aims: Lactulose is the first-line drug for both treatment and secondary prophylaxis for overt hepatic encephalopathy (HE). The use of lactulose for the primary prophylaxis of HE in patients with cirrhosis and acute upper gastrointestinal bleeding (AUGIB) has been debated. Hence, we conducted this meta-analysis to assess the role of lactulose in HE prophylaxis in patients with cirrhosis and AUGIB. \u0000Methods: A comprehensive search of literature from inception to December 2022 was performed of three databases for randomized studies comparing lactulose and placebo in patients with cirrhosis and AUGIB. Risk ratios (RR) with 95% confidence intervals were calculated for all the dichotomous outcomes. \u0000Results: A total of five studies were included in the final analysis, out of which three studies had a low risk of bias, and two had a moderate risk of bias. Lactulose therapy was associated with a significantly lower risk of OHE compared to placebo, with a RR of 0.38 (0.23-0.62) and a number needed to treat of 6. There was no difference in the risk of mortality between the groups, with a RR of 0.71 (0.29-1.76). The pooled incidence rates of overall adverse events (AEs) and diarrhea with the use of lactulose therapy were 53.2% (42.2- 64.2) and 34.7% (17.7-51.7), but a majority did not require drug discontinuation. The certainty of the evidence was moderate to low. \u0000Conclusions: Prophylactic lactulose reduces the incidence of HE after AUGIB but has no effect on mortality. Diarrhea and abdominal discomfort are common AEs but do not need drug discontinuation.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"31 48","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138946829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic ultrasound (EUS) guided biliary drainage (BD) is an accepted salvage procedure in patients with distal malignant biliary obstruction (DMBO) when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. The potential advantages of EUS-BD include gastric or duodenal biliary access, utilization of novel biliary stents and stent placement away from the area of stenosis, resulting in longer stent patency. These features make EUS-BD very appealing as a primary procedure for biliary drainage. There is a growing body of evidence supporting the utilization of EUS as a primary drainage procedure instead of ERCP, with comparable outcomes.
在内镜逆行胰胆管造影术（ERCP）不成功的情况下，内镜超声（EUS）引导胆道引流术（BD）是远端恶性胆道梗阻（DMBO）患者公认的挽救手术。EUS-BD 的潜在优势包括胃或十二指肠胆道通路、新型胆道支架的使用和远离狭窄区域的支架放置，从而延长支架的通畅时间。这些特点使得 EUS-BD 作为胆道引流的主要手术非常有吸引力。越来越多的证据支持使用 EUS 代替 ERCP 作为主要引流手术，而且效果相当。
{"title":"Endoscopic Ultrasound Biliary Drainage in Pancreatic Cancer","authors":"Kar Wai Lau, M. Rimbaș, Giulia Tripodi, A. Larghi","doi":"10.15403/jgld-4922","DOIUrl":"https://doi.org/10.15403/jgld-4922","url":null,"abstract":"Endoscopic ultrasound (EUS) guided biliary drainage (BD) is an accepted salvage procedure in patients with distal malignant biliary obstruction (DMBO) when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. The potential advantages of EUS-BD include gastric or duodenal biliary access, utilization of novel biliary stents and stent placement away from the area of stenosis, resulting in longer stent patency. These features make EUS-BD very appealing as a primary procedure for biliary drainage. There is a growing body of evidence supporting the utilization of EUS as a primary drainage procedure instead of ERCP, with comparable outcomes.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"12 9","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lea U. Krauß, S. Schmid, Patricia Mester, Kirsten Utpatel, Claudia Kunst, Martina Müller, V. Pavel
Background and Aims: Amyloidosis is a group of systemic disorders caused by extracellular deposition of misfolded serum proteins. Gastrointestinal (GI) involvement is associated with a higher risk of GI bleeding, especially if mucosal lesions are present. Our study aims to evaluate the frequency of GI manifestations in patients with amyloidosis, to clinically characterize these patients and to describe the endoscopic and histopathologic findings in GI amyloidosis. Methods: A retrospective, single-center study of all patients admitted with amyloidosis and GI manifestations was conducted at a German University Hospital between July 2003 and June 2023. Clinical, endoscopic, and histopathological data was retrieved from medical records. Results: Between July 2003 and June 2023, 63 patients with different types of amyloidosis were included into the study. Twenty-three (36,5%) were diagnosed with GI involvement of amyloidosis (60.9% male, median age 62 ± 18.28 years). The distribution of the types of amyloidosis were amyloid light chain (AL) at 52.5%, transthyretin (ATTR) at 21.7%, amyloid A (AA) at 13.0%, and unknown at 18%. Initial GI symptoms were present in 78.3% of the patients and included mainly diarrhea (34.8%), and abdominal pain (30.4%) Affected GI organs were primarily the colon (60,8%) and the stomach (39.1%). Endoscopic findings were ulcerations (47.8%), mucosal inflammation (43.5%), polyps (26.1%), erosions (13.0%), vascular malformation, polypoid protrusion, submucosal hematoma, erythema, metaplasia, and diverticulum. Histopathological findings included vascular wall thickening, (peri-)vascular and interstitial amyloid deposition. Gastrointestinal bleeding occurred in 39.1% of the patients. The mortality rate 5 years after diagnosis was 47.8%. Conclusions: Gastrointestinal amyloidosis can present with multiple symptoms and endoscopic findings, rendering diagnosis a challenge. Of clinical relevance, GI bleeding was a frequent event in our patient cohort. Therefore, clinicians must be aware of GI bleeding as a manifestation of amyloidosis and definite diagnosis should be achieved based on biopsy results.
{"title":"Clinical, Endoscopic, and Histopathologic Observations in Gastrointestinal Amyloidosis","authors":"Lea U. Krauß, S. Schmid, Patricia Mester, Kirsten Utpatel, Claudia Kunst, Martina Müller, V. Pavel","doi":"10.15403/jgld-5107","DOIUrl":"https://doi.org/10.15403/jgld-5107","url":null,"abstract":"Background and Aims: Amyloidosis is a group of systemic disorders caused by extracellular deposition of misfolded serum proteins. Gastrointestinal (GI) involvement is associated with a higher risk of GI bleeding, especially if mucosal lesions are present. Our study aims to evaluate the frequency of GI manifestations in patients with amyloidosis, to clinically characterize these patients and to describe the endoscopic and histopathologic findings in GI amyloidosis. \u0000Methods: A retrospective, single-center study of all patients admitted with amyloidosis and GI manifestations was conducted at a German University Hospital between July 2003 and June 2023. Clinical, endoscopic, and histopathological data was retrieved from medical records. \u0000Results: Between July 2003 and June 2023, 63 patients with different types of amyloidosis were included into the study. Twenty-three (36,5%) were diagnosed with GI involvement of amyloidosis (60.9% male, median age 62 ± 18.28 years). The distribution of the types of amyloidosis were amyloid light chain (AL) at 52.5%, transthyretin (ATTR) at 21.7%, amyloid A (AA) at 13.0%, and unknown at 18%. Initial GI symptoms were present in 78.3% of the patients and included mainly diarrhea (34.8%), and abdominal pain (30.4%) Affected GI organs were primarily the colon (60,8%) and the stomach (39.1%). Endoscopic findings were ulcerations (47.8%), mucosal inflammation (43.5%), polyps (26.1%), erosions (13.0%), vascular malformation, polypoid protrusion, submucosal hematoma, erythema, metaplasia, and diverticulum. Histopathological findings included vascular wall thickening, (peri-)vascular and interstitial amyloid deposition. Gastrointestinal bleeding occurred in 39.1% of the patients. The mortality rate 5 years after diagnosis was 47.8%. \u0000Conclusions: Gastrointestinal amyloidosis can present with multiple symptoms and endoscopic findings, rendering diagnosis a challenge. Of clinical relevance, GI bleeding was a frequent event in our patient cohort. Therefore, clinicians must be aware of GI bleeding as a manifestation of amyloidosis and definite diagnosis should be achieved based on biopsy results.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"87 23","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138945426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Bodini, Andrea Ghezzi, A. Pasta, E. Marabotto, F. Calabrese, C. Facchini, M. Demarzo, Edoardo G Giannini
Background and Aims: Fecal calprotectin (FC) is a biomarker of gut inflammation, and Escherichia coli Nissle 1917 (EcN) is a probiotic strain able to reduce gut inflammation and maintain disease remission in patients with inflammatory bowel disease (IBD). The aim is to assess the effects of EcN administration in patients with IBD in clinical remission and altered FC values. Methods: We prospectively included 82 patients with ulcerative colitis (UC) (n=49) and Crohn’s disease (CD) (n=33) in clinical remission and with FC values above 250 mcg/g (T0) who were treated with EcN alone for 2 months. FC values were assessed at the end of EcN treatment (T1) and clinical disease activity at 3 months (T2). Results: At T1 median FC values were significantly lower compared to T0 both in patients with CD (312 mcg/g vs 626 mcg/g, p<0.0001) and UC (100 mcg/g vs 584 mcg/g; p<0.0001). Patients with UC who experienced disease relapse at T2 had lesser reduction in median FC values at T1 (-229 mcg/g, vs -397 mcg/g, p=0.049), while in patients with CD we observed no statistically significant difference (-358 mcg/g, vs -427; p=0.568). In patients with UC, a reduction of at least 532 mcg/g in FC had an accuracy of 69.7% and a positive predictive value of 65.7% in predicting maintenance of remission. Conclusions: A short course of EcN was associated with a reduction of FC values in patients with IBD in clinical remission and baseline altered FC values, and in patients with UC this decrease was associated with maintenance of clinical remission.
背景与目的：粪便钙蛋白（FC）是肠道炎症的生物标志物，而大肠杆菌 Nissle 1917（EcN）是一种益生菌株，能够减轻肠道炎症并维持炎症性肠病（IBD）患者的病情缓解。我们的目的是评估在临床缓解期和 FC 值改变的 IBD 患者中服用 EcN 的效果。研究方法我们前瞻性地纳入了82名临床缓解期、FC值高于250微克/克（T0）的溃疡性结肠炎（UC）（49人）和克罗恩病（CD）（33人）患者，他们均接受了为期2个月的单独EcN治疗。在 EcN 治疗结束时（T1）评估 FC 值，在 3 个月时（T2）评估临床疾病活动性。结果：与T0相比，CD（312 mcg/g vs 626 mcg/g，p<0.0001）和UC（100 mcg/g vs 584 mcg/g，p<0.0001）患者在T1时的FC中位值明显降低。在 T2 期疾病复发的 UC 患者在 T1 期的 FC 中位值减少较少（-229 mcg/g vs -397 mcg/g，p=0.049），而在 CD 患者中，我们没有观察到有统计学意义的差异（-358 mcg/g vs -427; p=0.568）。在 UC 患者中，FC 至少降低 532 毫微克/克的准确率为 69.7%，预测病情缓解的阳性预测值为 65.7%。结论在临床缓解期和基线 FC 值改变的 IBD 患者中，EcN 的短期疗程与 FC 值的降低有关，而在 UC 患者中，FC 值的降低与临床缓解的维持有关。
{"title":"Reduction of Fecal Calprotectin Levels Induced by a Short Course of Escherichia Coli Nissle is Associated with a Lower Likelihood of Disease Flares in Patients with Ulcerative Colitis in Clinical Remission","authors":"G. Bodini, Andrea Ghezzi, A. Pasta, E. Marabotto, F. Calabrese, C. Facchini, M. Demarzo, Edoardo G Giannini","doi":"10.15403/jgld-4932","DOIUrl":"https://doi.org/10.15403/jgld-4932","url":null,"abstract":"Background and Aims: Fecal calprotectin (FC) is a biomarker of gut inflammation, and Escherichia coli Nissle 1917 (EcN) is a probiotic strain able to reduce gut inflammation and maintain disease remission in patients with inflammatory bowel disease (IBD). The aim is to assess the effects of EcN administration in patients with IBD in clinical remission and altered FC values. \u0000Methods: We prospectively included 82 patients with ulcerative colitis (UC) (n=49) and Crohn’s disease (CD) (n=33) in clinical remission and with FC values above 250 mcg/g (T0) who were treated with EcN alone for 2 months. FC values were assessed at the end of EcN treatment (T1) and clinical disease activity at 3 months (T2). \u0000Results: At T1 median FC values were significantly lower compared to T0 both in patients with CD (312 mcg/g vs 626 mcg/g, p<0.0001) and UC (100 mcg/g vs 584 mcg/g; p<0.0001). Patients with UC who experienced disease relapse at T2 had lesser reduction in median FC values at T1 (-229 mcg/g, vs -397 mcg/g, p=0.049), while in patients with CD we observed no statistically significant difference (-358 mcg/g, vs -427; p=0.568). In patients with UC, a reduction of at least 532 mcg/g in FC had an accuracy of 69.7% and a positive predictive value of 65.7% in predicting maintenance of remission. \u0000Conclusions: A short course of EcN was associated with a reduction of FC values in patients with IBD in clinical remission and baseline altered FC values, and in patients with UC this decrease was associated with maintenance of clinical remission.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"6 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138946104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Parisio, C. Settanni, S. Varca, L. Laterza, L. Lopetuso, D. Napolitano, E. Schiavoni, L. Turchini, C. Fanali, Norma Alfieri, M. Pizzoferrato, Alfredo Papa, P. Pafundi, A. Armuzzi, A. Gasbarrini, D. Pugliese, Franco Scaldaferri
Background and Aims: Subcutaneous vedolizumab formulation has been shown to be as effective and safe as the intravenous one in randomized control trials. Real-life data are limited especially for patients receiving long-term intravenous therapy. This study aimed to evaluate the safety and effectiveness of switching from intravenous to subcutaneous vedolizumab in a large cohort of patients with stable clinical remission. Methods: In this prospective cohort study, we enrolled consecutive patients attending our center between September 2021 and April 2022. The baseline demographic characteristics, 12- and 24-weeks follow-up clinical activity, C-reactive protein levels, and adverse events were recorded. The primary endpoint was to assess combined steroid-free clinical remission plus biochemical remission 24-week after the switch. Results: 93 patients (43 Crohn’s disease, 50 ulcerative colitis), switched to subcutaneous vedolizumab after a median duration of intravenous treatment of 36 months [IQR 16-52]. At baseline, 80 patients (86%) had a combined remission. At 24-week, 89.2% (n=74) maintained combined steroid-free clinical remission plus biochemical remission. 25 adverse events were reported, mostly SARS-CoV-2 infections and injection site reactions, with a further four recurrence episodes. Twelve patients (12.9%) discontinued subcutaneous administration and restarted intravenous vedolizumab. Conclusions: Switching from intravenous to subcutaneous vedolizumab can be considered effective and safe for maintaining remission in patients with inflammatory bowel disease. In addition, this might reduce healthcare costs. However, large-scale real-life studies with long-term follow-up are necessary.
{"title":"Effectiveness and Safety of Switching from Intravenous to Subcutaneous Vedolizumab Formulation in Inflammatory Bowel Disease Patients in Clinical Remission","authors":"L. Parisio, C. Settanni, S. Varca, L. Laterza, L. Lopetuso, D. Napolitano, E. Schiavoni, L. Turchini, C. Fanali, Norma Alfieri, M. Pizzoferrato, Alfredo Papa, P. Pafundi, A. Armuzzi, A. Gasbarrini, D. Pugliese, Franco Scaldaferri","doi":"10.15403/jgld-5084","DOIUrl":"https://doi.org/10.15403/jgld-5084","url":null,"abstract":"Background and Aims: Subcutaneous vedolizumab formulation has been shown to be as effective and safe as the intravenous one in randomized control trials. Real-life data are limited especially for patients receiving long-term intravenous therapy. This study aimed to evaluate the safety and effectiveness of switching from intravenous to subcutaneous vedolizumab in a large cohort of patients with stable clinical remission. \u0000Methods: In this prospective cohort study, we enrolled consecutive patients attending our center between September 2021 and April 2022. The baseline demographic characteristics, 12- and 24-weeks follow-up clinical activity, C-reactive protein levels, and adverse events were recorded. The primary endpoint was to assess combined steroid-free clinical remission plus biochemical remission 24-week after the switch. \u0000Results: 93 patients (43 Crohn’s disease, 50 ulcerative colitis), switched to subcutaneous vedolizumab after a median duration of intravenous treatment of 36 months [IQR 16-52]. At baseline, 80 patients (86%) had a combined remission. At 24-week, 89.2% (n=74) maintained combined steroid-free clinical remission plus biochemical remission. 25 adverse events were reported, mostly SARS-CoV-2 infections and injection site reactions, with a further four recurrence episodes. Twelve patients (12.9%) discontinued subcutaneous administration and restarted intravenous vedolizumab. \u0000Conclusions: Switching from intravenous to subcutaneous vedolizumab can be considered effective and safe for maintaining remission in patients with inflammatory bowel disease. In addition, this might reduce healthcare costs. However, large-scale real-life studies with long-term follow-up are necessary.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"20 9","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Rusu, Roxana Luiza Caragut, Mocanu Camelia Lorena, Daniel Corneliu Leucuta, D. Dumitrascu
Background and Aims: Irritable Bowel Syndrome (IBS) is one of the most frequently diagnosed gastrointestinal disease with a prevalence of 4.1% in the general population. It is diagnosed using the Rome IV criteria. Microscopic colitis (MC), collagenous/lymphocytic colitis is a cause of chronic, watery, non-bloody diarrhea. It is a real challenge to diagnose MC in patients with IBS. The aims of the study were to determine the prevalence of MC in patients initially diagnosed with IBS, as well as to correlate fecal calprotectin levels with the endoscopic findings and microscopic inflammation in MC. Methods: This is a retrospective study conducted in a single tertiary center with over 89 IBS patients for a period of 4 years. The patients included were patients diagnosed with IBS predominant diarrhea (IBS-D) and mixed IBS (IBS-M) using the Rome IV criteria. Total colonoscopy was performed in these patients, multiple biopsies being taken and calprotectin levels were measured. Results: Out of a total of 89 IBS-D patients, 58 patients (65.2%) had no microscopic lesions, 12 patients (13.5%) had diverticular disease, 9 patients (10.1%) had non-specific chronic inflammation of the colon mucosa and 10 patients (11.2%) were diagnosed with MC. The calprotectin levels ranged from 49 μg/g to 213 μg/g. Of a total of 10 patients diagnosed with MC, 6 (60%) of them had calprotectin levels <100 μg/g and 4 (40%) had calprotectin levels >100 μg/g. The fecal calprotectin levels were higher in patients diagnosed with MC compared to those who had no microscopic lesions at the histological exam and it was also correlated with the grade of colonic microscopic inflammation. Conclusions: Microscopic colitis is less familiar to physicians and can be clinically misdiagnosed as IBS-D. An early and correct diagnosis is important for an accurate therapy.
背景和目的：肠易激综合征（IBS）是最常见的胃肠道疾病之一，在普通人群中的发病率为 4.1%。肠易激综合征是根据罗马IV标准诊断的。显微结肠炎（MC）、胶原性/淋巴细胞性结肠炎是慢性、水样、非血性腹泻的病因。在肠易激综合征患者中诊断 MC 确实是一项挑战。本研究的目的是确定初步诊断为肠易激综合征的患者中 MC 的患病率，并将粪便钙蛋白水平与 MC 的内镜检查结果和显微炎症相关联。研究方法这是一项回顾性研究，在一家三级医疗中心进行，共有超过 89 名 IBS 患者参加，历时 4 年。研究对象是根据罗马IV标准诊断为以腹泻为主的肠易激综合征（IBS-D）和混合型肠易激综合征（IBS-M）的患者。对这些患者进行了全结肠镜检查，采集了多处活组织切片，并测量了钙黏蛋白水平。研究结果在总共 89 名 IBS-D 患者中，58 名患者（65.2%）没有显微病变，12 名患者（13.5%）患有憩室疾病，9 名患者（10.1%）患有非特异性结肠粘膜慢性炎症，10 名患者（11.2%）被诊断为 MC。钙蛋白水平从 49 微克/克到 213 微克/克不等。在 10 名确诊为 MC 的患者中，有 6 人（60%）的钙蛋白水平达到 100 微克/克。与组织学检查未发现微小病变的患者相比，确诊为 MC 的患者的粪便钙蛋白水平较高，且与结肠微小炎症的等级相关。结论显微镜下结肠炎不太为医生所熟悉，临床上可能会被误诊为肠易激综合征-D。早期正确诊断对于准确治疗非常重要。
{"title":"Microscopic Colitis: A Diagnostic Challenge in Patients with Irritable Bowel Syndrome","authors":"F. Rusu, Roxana Luiza Caragut, Mocanu Camelia Lorena, Daniel Corneliu Leucuta, D. Dumitrascu","doi":"10.15403/jgld-5025","DOIUrl":"https://doi.org/10.15403/jgld-5025","url":null,"abstract":"Background and Aims: Irritable Bowel Syndrome (IBS) is one of the most frequently diagnosed gastrointestinal disease with a prevalence of 4.1% in the general population. It is diagnosed using the Rome IV criteria. Microscopic colitis (MC), collagenous/lymphocytic colitis is a cause of chronic, watery, non-bloody diarrhea. It is a real challenge to diagnose MC in patients with IBS. The aims of the study were to determine the prevalence of MC in patients initially diagnosed with IBS, as well as to correlate fecal calprotectin levels with the endoscopic findings and microscopic inflammation in MC. \u0000Methods: This is a retrospective study conducted in a single tertiary center with over 89 IBS patients for a period of 4 years. The patients included were patients diagnosed with IBS predominant diarrhea (IBS-D) and mixed IBS (IBS-M) using the Rome IV criteria. Total colonoscopy was performed in these patients, multiple biopsies being taken and calprotectin levels were measured. \u0000Results: Out of a total of 89 IBS-D patients, 58 patients (65.2%) had no microscopic lesions, 12 patients (13.5%) had diverticular disease, 9 patients (10.1%) had non-specific chronic inflammation of the colon mucosa and 10 patients (11.2%) were diagnosed with MC. The calprotectin levels ranged from 49 μg/g to 213 μg/g. Of a total of 10 patients diagnosed with MC, 6 (60%) of them had calprotectin levels <100 μg/g and 4 (40%) had calprotectin levels >100 μg/g. The fecal calprotectin levels were higher in patients diagnosed with MC compared to those who had no microscopic lesions at the histological exam and it was also correlated with the grade of colonic microscopic inflammation. \u0000Conclusions: Microscopic colitis is less familiar to physicians and can be clinically misdiagnosed as IBS-D. An early and correct diagnosis is important for an accurate therapy.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"39 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138946774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radu Ion Seicean, D. Pușcașu, Andrei Gheorghiu, C. Pojoga, A. Seicean, George Dindelegan
Anastomotic leakage (AL) constitutes a prominent cause of significant morbidity following gastrectomy for gastric cancer. The manifestation of AL typically occurs within 7 to 10 days post-surgery, with reported incidence rates of 5.8-6.7% for open gastrectomy and 3.3-4.1% for laparoscopic gastrectomy. Various predisposing risk factors have been identified, including the individual nutritional status (excluding obesity) and preoperative corticotherapy. Interestingly, the administration of neoadjuvant therapies appears to reduce the AL occurrence. In the context of distal gastrectomies, the rates of AL are comparable between laparoscopic, robotic, and open approaches. The total gastrectomies have higher AL rate compared to distal gastrectomies, which are considered the preferred approach. Prophylactic drainage measures have not demonstrated efficacy in preventing AL. As for postoperative management, conservative treatment is indicated for patients presenting with mild clinical symptoms and increased inflammatory blood tests. This approach involves fasting, enteral or parenteral nutrition, administration of antibiotics, and percutaneous drainage. For small AL, endoscopic therapies such as stents, vacuum therapy, clips, suturing devices, and injections are appropriate treatment options. In cases of high-volume fistulas, severe sepsis or failure of previous therapies, surgical reoperation becomes the ultimate solution.
吻合口漏（AL）是胃癌胃切除术后严重发病的主要原因。AL的表现通常发生在术后7至10天内，据报道，开腹胃切除术的发生率为5.8-6.7%，腹腔镜胃切除术的发生率为3.3-4.1%。已确定的易发风险因素包括个人营养状况（不包括肥胖）和术前皮质激素治疗。有趣的是，采用新辅助疗法似乎可以减少 AL 的发生。就远端胃切除术而言，腹腔镜、机器人和开腹手术的AL发生率相当。与远端胃切除术相比，全胃切除术的AL率更高，而远端胃切除术被认为是首选方法。预防性引流措施在预防AL方面并未显示出效果。至于术后处理，保守治疗适用于临床症状轻微、血液化验炎症反应加重的患者。这种方法包括禁食、肠内或肠外营养、服用抗生素和经皮引流。对于小的 AL，支架、真空疗法、夹子、缝合装置和注射等内窥镜疗法是适当的治疗选择。对于大容量瘘管、严重脓毒症或之前的疗法失败的病例，再次手术是最终的解决方案。
{"title":"Anastomotic Leakage after Gastrectomy for Gastric Cancer","authors":"Radu Ion Seicean, D. Pușcașu, Andrei Gheorghiu, C. Pojoga, A. Seicean, George Dindelegan","doi":"10.15403/jgld-5238","DOIUrl":"https://doi.org/10.15403/jgld-5238","url":null,"abstract":"Anastomotic leakage (AL) constitutes a prominent cause of significant morbidity following gastrectomy for gastric cancer. The manifestation of AL typically occurs within 7 to 10 days post-surgery, with reported incidence rates of 5.8-6.7% for open gastrectomy and 3.3-4.1% for laparoscopic gastrectomy. Various predisposing risk factors have been identified, including the individual nutritional status (excluding obesity) and preoperative corticotherapy. Interestingly, the administration of neoadjuvant therapies appears to reduce the AL occurrence. In the context of distal gastrectomies, the rates of AL are comparable between laparoscopic, robotic, and open approaches. The total gastrectomies have higher AL rate compared to distal gastrectomies, which are considered the preferred approach. Prophylactic drainage measures have not demonstrated efficacy in preventing AL. As for postoperative management, conservative treatment is indicated for patients presenting with mild clinical symptoms and increased inflammatory blood tests. This approach involves fasting, enteral or parenteral nutrition, administration of antibiotics, and percutaneous drainage. For small AL, endoscopic therapies such as stents, vacuum therapy, clips, suturing devices, and injections are appropriate treatment options. In cases of high-volume fistulas, severe sepsis or failure of previous therapies, surgical reoperation becomes the ultimate solution.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"2 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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