Pub Date : 2020-12-01Epub Date: 2020-07-03DOI: 10.23736/S1121-421X.20.02732-4
Elena Mosso, Silvia Bonetto, Gianluigi Longobardi, Ludovico Abenavoli, Davide G Ribaldone, Giorgio M Saracco, Rinaldo Pellicano
Dyspepsia is a disorder that refers mainly to central upper abdominal pain or discomfort. When a cause of this symptom is not identified the condition is termed functional dyspepsia (FD), that affects a large part of the general population. The relevance of FD is due to its high prevalence, but also to its chronic or intermittent course. This induces a significant burden for each national healthcare system. The pathogenesis of FD is complex and multifactorial, depending on cultural, environmental, and biological factors. Although considered of main importance in the pathophysiology of several gastroduodenal diseases, in the context of FD Helicobacter pylori (H. pylori) infection plays a limited role. The diagnosis of FD requires the exclusion of organic gastroduodenal diseases as well as H. pylori infection. Thus, the diagnostic workup includes a complete anamnesis, biochemical tests, and endoscopy with biopsy (when requested), and the satisfaction of clinic criteria recommended by the Rome IV consensus. The treatment of FD is also challenging, in fact more and more studies focused on a wide range of different therapies, with a multitude of results. The aim of this literature review is to provide an update of the new evidences useful for diagnosis and management of FD.
{"title":"Management of functional dyspepsia in 2020: a clinical point of view.","authors":"Elena Mosso, Silvia Bonetto, Gianluigi Longobardi, Ludovico Abenavoli, Davide G Ribaldone, Giorgio M Saracco, Rinaldo Pellicano","doi":"10.23736/S1121-421X.20.02732-4","DOIUrl":"https://doi.org/10.23736/S1121-421X.20.02732-4","url":null,"abstract":"<p><p>Dyspepsia is a disorder that refers mainly to central upper abdominal pain or discomfort. When a cause of this symptom is not identified the condition is termed functional dyspepsia (FD), that affects a large part of the general population. The relevance of FD is due to its high prevalence, but also to its chronic or intermittent course. This induces a significant burden for each national healthcare system. The pathogenesis of FD is complex and multifactorial, depending on cultural, environmental, and biological factors. Although considered of main importance in the pathophysiology of several gastroduodenal diseases, in the context of FD Helicobacter pylori (H. pylori) infection plays a limited role. The diagnosis of FD requires the exclusion of organic gastroduodenal diseases as well as H. pylori infection. Thus, the diagnostic workup includes a complete anamnesis, biochemical tests, and endoscopy with biopsy (when requested), and the satisfaction of clinic criteria recommended by the Rome IV consensus. The treatment of FD is also challenging, in fact more and more studies focused on a wide range of different therapies, with a multitude of results. The aim of this literature review is to provide an update of the new evidences useful for diagnosis and management of FD.</p>","PeriodicalId":74201,"journal":{"name":"Minerva gastroenterologica e dietologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38123604","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 : 2020-12-01DOI: 10.23736/S1121-421X.20.02821-4
G. Mulinacci, L. Cristoferi, A. Palermo, M. Lucà, A. Gerussi, P. Invernizzi, M. Carbone
Primary Sclerosing Cholangitis (PSC) is a chronic liver disorder commonly affecting young patients and associated with uncertain prognosis and elevated risk of end-stage liver disease and hepatobiliary cancer. Rate of progression in PSC is heterogeneous and accurately predicting the disease course is of paramount importance to clinical practice and interventional trial design. So far, efforts have brought to the development of models looking at short-to-middle-term outcome using composite models including clinical, laboratory, radiological and histological parameters with limited performance. In the era of whole genome sequencing and digital innovation, the time is ripe for the development of stratified medicine in PSC. Efforts should be directed toward developing wellphenotyped cohorts of patients with longitudinal follow-up across sustained periods of time, application of novel image-processing technology, and biomarker discovery using multi-omics platforms.
{"title":"Risk stratification in primary sclerosing cholangitis.","authors":"G. Mulinacci, L. Cristoferi, A. Palermo, M. Lucà, A. Gerussi, P. Invernizzi, M. Carbone","doi":"10.23736/S1121-421X.20.02821-4","DOIUrl":"https://doi.org/10.23736/S1121-421X.20.02821-4","url":null,"abstract":"Primary Sclerosing Cholangitis (PSC) is a chronic liver disorder commonly affecting young patients and associated with uncertain prognosis and elevated risk of end-stage liver disease and hepatobiliary cancer. Rate of progression in PSC is heterogeneous and accurately predicting the disease course is of paramount importance to clinical practice and interventional trial design. So far, efforts have brought to the development of models looking at short-to-middle-term outcome using composite models including clinical, laboratory, radiological and histological parameters with limited performance. In the era of whole genome sequencing and digital innovation, the time is ripe for the development of stratified medicine in PSC. Efforts should be directed toward developing wellphenotyped cohorts of patients with longitudinal follow-up across sustained periods of time, application of novel image-processing technology, and biomarker discovery using multi-omics platforms.","PeriodicalId":74201,"journal":{"name":"Minerva gastroenterologica e dietologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86244319","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}
The outbreak of Coronavirus disease 2019 (COVID-19) worldwide had evidenced the opportunity to increase the interaction between specialist and primary care physician (PCP). COVID 19, started in December 2019 in China, has been considered a public health emergency by the Department of Health and Human Services and, now, it is a pandemic disease with worldwide diffusion. The COVID-19 crisis permits to increase the role of telemedicine as a tool for the delivery of health care services at distance and to slow down the virus diffusion. This technology is cheap and easy to use but it is limited by governmental licensing restrictions, reimbursement barriers, lesser extent of infrastructure and difficulties related to the change. During COVID-19 epidemy, telemedicine is safe, low cost and-permits to treat urgent and routine specialist cases without human proximity and contact which would spread infection, particularly to the elderly and immunocompromised patients. In COVID-19 era, the goal of PCP is to reduce travels and visits in specialized center for liver disease patients. A strict collaboration between specialized hepatologist and PCP is needed.
{"title":"COVID emergency: an opportunity to increase the interaction between hepatologist and primary care physician.","authors":"Giovanni Casella, Fabio Ingravalle, Adriana Ingravalle, Claudio Monti, Fulvio Bonetti, Aurelio Limonta","doi":"10.23736/S1121-421X.20.02713-0","DOIUrl":"https://doi.org/10.23736/S1121-421X.20.02713-0","url":null,"abstract":"<p><p>The outbreak of Coronavirus disease 2019 (COVID-19) worldwide had evidenced the opportunity to increase the interaction between specialist and primary care physician (PCP). COVID 19, started in December 2019 in China, has been considered a public health emergency by the Department of Health and Human Services and, now, it is a pandemic disease with worldwide diffusion. The COVID-19 crisis permits to increase the role of telemedicine as a tool for the delivery of health care services at distance and to slow down the virus diffusion. This technology is cheap and easy to use but it is limited by governmental licensing restrictions, reimbursement barriers, lesser extent of infrastructure and difficulties related to the change. During COVID-19 epidemy, telemedicine is safe, low cost and-permits to treat urgent and routine specialist cases without human proximity and contact which would spread infection, particularly to the elderly and immunocompromised patients. In COVID-19 era, the goal of PCP is to reduce travels and visits in specialized center for liver disease patients. A strict collaboration between specialized hepatologist and PCP is needed.</p>","PeriodicalId":74201,"journal":{"name":"Minerva gastroenterologica e dietologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38009564","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 : 2020-11-19DOI: 10.23736/S1121-421X.20.02795-6
G. Germani, S. Battistella, Doina Ulinici, A. Zanetto, S. Shalaby, M. Pellone, M. Gambato, M. Senzolo, F. Russo, P. Burra
Drug induced liver injury (DILI) is a necro-inflammatory liver disease caused by several drugs commonly used in clinical practice, herbs and dietary supplements prescribed for medical purposes. Despite its rarity, it represents the major cause of acute liver failure requiring liver transplantation in USA and its frequency is increasing in Europe too. Two types of drug induced liver injury have been recognized: intrinsic and idiosyncratic. Predisposing factors may be classified in environmental, drugs- and individual- related risk factors, with the latter further distinguished in genetics and non-genetics. The liver injury can present with a hepatocellular, cholestatic or mixed pattern of disease. A definitive diagnosis of DILI is, nowadays, one of the main challenging issue in the management of these patients. Diagnosis often is based on suspicion derived from clinical history, biochemical exams and eventually on histological examination from liver biopsy. Score system may be helpful in this setting and new markers are gaining more prominence. Evaluation for liver transplantation is indicated when spontaneous resolution does not occur or in cases of ALF. Overall, the 1-year survival rate following liver transplantation is lower than that seen in patients who have been transplanted for chronic liver failure; however long-term survival is higher compared to other indications.
{"title":"Drug induced liver injury: from pathogenesis to liver transplantation.","authors":"G. Germani, S. Battistella, Doina Ulinici, A. Zanetto, S. Shalaby, M. Pellone, M. Gambato, M. Senzolo, F. Russo, P. Burra","doi":"10.23736/S1121-421X.20.02795-6","DOIUrl":"https://doi.org/10.23736/S1121-421X.20.02795-6","url":null,"abstract":"Drug induced liver injury (DILI) is a necro-inflammatory liver disease caused by several drugs commonly used in clinical practice, herbs and dietary supplements prescribed for medical purposes. Despite its rarity, it represents the major cause of acute liver failure requiring liver transplantation in USA and its frequency is increasing in Europe too. Two types of drug induced liver injury have been recognized: intrinsic and idiosyncratic. Predisposing factors may be classified in environmental, drugs- and individual- related risk factors, with the latter further distinguished in genetics and non-genetics. The liver injury can present with a hepatocellular, cholestatic or mixed pattern of disease. A definitive diagnosis of DILI is, nowadays, one of the main challenging issue in the management of these patients. Diagnosis often is based on suspicion derived from clinical history, biochemical exams and eventually on histological examination from liver biopsy. Score system may be helpful in this setting and new markers are gaining more prominence. Evaluation for liver transplantation is indicated when spontaneous resolution does not occur or in cases of ALF. Overall, the 1-year survival rate following liver transplantation is lower than that seen in patients who have been transplanted for chronic liver failure; however long-term survival is higher compared to other indications.","PeriodicalId":74201,"journal":{"name":"Minerva gastroenterologica e dietologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83021712","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 : 2020-11-19DOI: 10.23736/S1121-421X.20.02775-0
G. Germani, S. Battistella, Doina Ulinici, A. Zanetto, S. Shalaby, M. Pellone, M. Gambato, M. Senzolo, F. Russo, P. Burra
Hepatocellular carcinoma (HCC) represents the sixth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. HCC occurs predominantly in patients with underlying chronic liver disease and cirrhosis, and it presents a poor prognosis in advanced stage. Since its approval, for the following 10 years, sorafenib remained the only systemic agent with proven clinical efficacy for patients with advanced HCC. Recently, more drugs have been studied and several advances in first‑line and second‑line treatment options should yield significant improvements in survival. Lenvatinib, another tyrosine‑kinase inhibitor, was found to be non-inferior to sorafenib in terms of overall survival (OS), with significantly better progression-free survival and objective response rate (ORR). The tyrosinekinase inhibitors, regorafenib and cabozantinib, were shown to significantly improve survival in the second‑line setting after sorafenib failure. Ramucirumab, a VEGF inhibitor, can also improve survival in the second‑line setting among patients with AFP≥400 ng/dL. Moreover, good efficacy was seen in phase I/II trials of immune checkpoint inhibitors as monotherapy. Ongoing trials are evaluating combination immune checkpoint inhibitor and tyrosine‑kinase inhibitors or VEGF inhibitors for increasing overall survival in this patient population with advanced HCC.
{"title":"Current and future perspective on targeted agents and immunotherapies in hepatocellular carcinoma.","authors":"G. Germani, S. Battistella, Doina Ulinici, A. Zanetto, S. Shalaby, M. Pellone, M. Gambato, M. Senzolo, F. Russo, P. Burra","doi":"10.23736/S1121-421X.20.02775-0","DOIUrl":"https://doi.org/10.23736/S1121-421X.20.02775-0","url":null,"abstract":"Hepatocellular carcinoma (HCC) represents the sixth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. HCC occurs predominantly in patients with underlying chronic liver disease and cirrhosis, and it presents a poor prognosis in advanced stage. Since its approval, for the following 10 years, sorafenib remained the only systemic agent with proven clinical efficacy for patients with advanced HCC. Recently, more drugs have been studied and several advances in first‑line and second‑line treatment options should yield significant improvements in survival. Lenvatinib, another tyrosine‑kinase inhibitor, was found to be non-inferior to sorafenib in terms of overall survival (OS), with significantly better progression-free survival and objective response rate (ORR). The tyrosinekinase inhibitors, regorafenib and cabozantinib, were shown to significantly improve survival in the second‑line setting after sorafenib failure. Ramucirumab, a VEGF inhibitor, can also improve survival in the second‑line setting among patients with AFP≥400 ng/dL. Moreover, good efficacy was seen in phase I/II trials of immune checkpoint inhibitors as monotherapy. Ongoing trials are evaluating combination immune checkpoint inhibitor and tyrosine‑kinase inhibitors or VEGF inhibitors for increasing overall survival in this patient population with advanced HCC.","PeriodicalId":74201,"journal":{"name":"Minerva gastroenterologica e dietologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86849373","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 : 2020-11-19DOI: 10.23736/S1121-421X.20.02791-9
S. Battistella, E. Lynch, M. Gambato, A. Zanetto, M. Pellone, S. Shalaby, S. Sciarrone, A. Ferrarese, G. Germani, M. Senzolo, P. Burra, F. Russo
Hepatitis B virus is a major health problem worldwide, with approximatively 240 million people living with a chronic HBV infection. HBV chronic infection remains the major cause of hepatocellular carcinoma worldwide, with more than half of HCC patients being chronic HBV carriers, even if underlying mechanisms of tumourigenesis are not totally understood. HBV-related HCC can be prevented by reducing the exposure to HBV by vaccination or by treatment of CHB infection. Current treatment of CHB are Peg-IFN alpha and oral NUCs. Treating HBV infection, either with IFN or NUCs, substantially reduces the risk of HCC development, even if anti-viral therapy fails to completely eliminate HCC risk. Among treated patients, cirrhosis, HBeAg negative at baseline, and failure to remain in virological remission were associated with an increased risk of HCC. The reduction of the risk of developing HCC during anti-viral therapy is largely dependent upon the maintenance of virological remission, since viral load is found to be the most important factor leading to cirrhosis and its complications, including liver cancer development. The question whether Peg-IFN-alpha is superior to NUCs and whether there is a superior agent among NUCs is still controversial. Several studies demonstrated that anti-viral therapy with NUCs could reduce the risk of HCC recurrence after curative treatment of HBV-related HCC.
{"title":"Hepatocellular carcinoma risk in patients with HBV-related liver disease receiving anti-viral therapy.","authors":"S. Battistella, E. Lynch, M. Gambato, A. Zanetto, M. Pellone, S. Shalaby, S. Sciarrone, A. Ferrarese, G. Germani, M. Senzolo, P. Burra, F. Russo","doi":"10.23736/S1121-421X.20.02791-9","DOIUrl":"https://doi.org/10.23736/S1121-421X.20.02791-9","url":null,"abstract":"Hepatitis B virus is a major health problem worldwide, with approximatively 240 million people living with a chronic HBV infection. HBV chronic infection remains the major cause of hepatocellular carcinoma worldwide, with more than half of HCC patients being chronic HBV carriers, even if underlying mechanisms of tumourigenesis are not totally understood. HBV-related HCC can be prevented by reducing the exposure to HBV by vaccination or by treatment of CHB infection. Current treatment of CHB are Peg-IFN alpha and oral NUCs. Treating HBV infection, either with IFN or NUCs, substantially reduces the risk of HCC development, even if anti-viral therapy fails to completely eliminate HCC risk. Among treated patients, cirrhosis, HBeAg negative at baseline, and failure to remain in virological remission were associated with an increased risk of HCC. The reduction of the risk of developing HCC during anti-viral therapy is largely dependent upon the maintenance of virological remission, since viral load is found to be the most important factor leading to cirrhosis and its complications, including liver cancer development. The question whether Peg-IFN-alpha is superior to NUCs and whether there is a superior agent among NUCs is still controversial. Several studies demonstrated that anti-viral therapy with NUCs could reduce the risk of HCC recurrence after curative treatment of HBV-related HCC.","PeriodicalId":74201,"journal":{"name":"Minerva gastroenterologica e dietologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77696694","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 : 2020-11-19DOI: 10.23736/S1121-421X.20.02777-4
M. Giuffré, M. Campigotto, A. Colombo, A. Visintin, M. Budel, A. Aversano, L. Navarria, A. Piccin, C. Cavalli, R. Sigon, Fabio Tiné, C. Abazia, F. Masutti, L. Crocè
INTRODUCTION Alcohol-related liver disease (ALD) was estimated to have a prevalence of 2% among the United States population. Since severe fibrosis in compensated patients is the main predictor of long-term survival, it is of utmost importance to early detect patients with severe fibrosis before decompensation occurs. Liver elastography has been used to stage liver fibrosis. However, there is a widespread lack in guidelines for the correct use of liver stiffness (LS) in ALD. EVIDENCE ACQUISITION A structured search was carried out on MEDLINE/PubMed database. From the original 225 research articles identified, only 12 studies met the inclusion criteria, with 10 studies being eventually included. EVIDENCE SYNTHESIS According to reported data, patients with aspartate aminotransferase (AST) > 100 IU/L and 50 IU/L showed significantly higher values of LS if compared to patients with the same fibrosis stage. Also, excessive alcohol consumption greatly influences elastography, leading to false fibrosis staging. When LS values > 5-6 kPa are detected, several aspects should be taken into account. First of all, the patient should be asked about the current alcohol consumption (i.e., active vs. abstinence, determination of abstinence period, and quantification of alcohol intake), and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. Secondly, clinicians should check liver transaminases level, and if AST are above 100 IU/L, they should be aware of a possible overestimation of fibrosis. However, whether transaminases-adapted cut-off values should be used for ad hoc decisions in patients with no time or option to withdraw from alcohol consumption is still a matter of debate. CONCLUSIONS We hope that our review article may serve as a reference point in the prospect of futures guidelines.
{"title":"The role of elastography in alcoholic liver disease: fibrosis staging and confounding factors. A review of the current literature.","authors":"M. Giuffré, M. Campigotto, A. Colombo, A. Visintin, M. Budel, A. Aversano, L. Navarria, A. Piccin, C. Cavalli, R. Sigon, Fabio Tiné, C. Abazia, F. Masutti, L. Crocè","doi":"10.23736/S1121-421X.20.02777-4","DOIUrl":"https://doi.org/10.23736/S1121-421X.20.02777-4","url":null,"abstract":"INTRODUCTION\u0000Alcohol-related liver disease (ALD) was estimated to have a prevalence of 2% among the United States population. Since severe fibrosis in compensated patients is the main predictor of long-term survival, it is of utmost importance to early detect patients with severe fibrosis before decompensation occurs. Liver elastography has been used to stage liver fibrosis. However, there is a widespread lack in guidelines for the correct use of liver stiffness (LS) in ALD.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000A structured search was carried out on MEDLINE/PubMed database. From the original 225 research articles identified, only 12 studies met the inclusion criteria, with 10 studies being eventually included.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000According to reported data, patients with aspartate aminotransferase (AST) > 100 IU/L and 50 IU/L showed significantly higher values of LS if compared to patients with the same fibrosis stage. Also, excessive alcohol consumption greatly influences elastography, leading to false fibrosis staging. When LS values > 5-6 kPa are detected, several aspects should be taken into account. First of all, the patient should be asked about the current alcohol consumption (i.e., active vs. abstinence, determination of abstinence period, and quantification of alcohol intake), and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. Secondly, clinicians should check liver transaminases level, and if AST are above 100 IU/L, they should be aware of a possible overestimation of fibrosis. However, whether transaminases-adapted cut-off values should be used for ad hoc decisions in patients with no time or option to withdraw from alcohol consumption is still a matter of debate.\u0000\u0000\u0000CONCLUSIONS\u0000We hope that our review article may serve as a reference point in the prospect of futures guidelines.","PeriodicalId":74201,"journal":{"name":"Minerva gastroenterologica e dietologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80265530","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 : 2020-11-03DOI: 10.23736/S1121-421X.20.02784-1
A. Zanetto, G. Barbiero, M. Battistel, S. Sciarrone, S. Shalaby, M. Pellone, S. Battistella, M. Gambato, G. Germani, F. Russo, P. Burra, M. Senzolo
Portal hypertension is a clinical syndrome characterized by an increase in the portal pressure gradient, defined as the gradient between the portal vein at the site downstream of the site of obstruction and the inferior vena cava. The most frequent cause of portal hypertension is cirrhosis. In patients with cirrhosis, portal hypertension is the main driver of cirrhosis progression and development of hepatic decompensation (ascites, variceal hemorrhage, and hepatic encephalopathy), which defines the transition from compensated to decompensated stage. In decompensated patients, treatments aim at lowering the risk of death by preventing further decompensation and/or development of acute-on-chronic liver failure. Decompensated patients often pose a complex challenge which typically requires a multidisciplinary approach. The aims of the present review are to discuss the current knowledge regarding interventional treatments for patients with portal hypertension complications as well as to highlight useful information to aid hepatologists in their clinical practice. Specifically, we discuss indications and contraindications of transjugular intra-hepatic portosystemic shunt (TIPS) and balloon-occluded transvenous retrograde obliteration (BRTO) for the treatment of gastro-esophageal variceal hemorrhage in patients with decompensated cirrhosis (first section), we review the use of interventional treatments in patients with hepatic vein obstruction (Budd-Chiari syndrome) and in those with portal vein thrombosis (second section), and we briefly comment on the most frequent applications of selective splenic embolization in patients with and without underlying cirrhosis (third section).
{"title":"Management of portal hypertension severe complications.","authors":"A. Zanetto, G. Barbiero, M. Battistel, S. Sciarrone, S. Shalaby, M. Pellone, S. Battistella, M. Gambato, G. Germani, F. Russo, P. Burra, M. Senzolo","doi":"10.23736/S1121-421X.20.02784-1","DOIUrl":"https://doi.org/10.23736/S1121-421X.20.02784-1","url":null,"abstract":"Portal hypertension is a clinical syndrome characterized by an increase in the portal pressure gradient, defined as the gradient between the portal vein at the site downstream of the site of obstruction and the inferior vena cava. The most frequent cause of portal hypertension is cirrhosis. In patients with cirrhosis, portal hypertension is the main driver of cirrhosis progression and development of hepatic decompensation (ascites, variceal hemorrhage, and hepatic encephalopathy), which defines the transition from compensated to decompensated stage. In decompensated patients, treatments aim at lowering the risk of death by preventing further decompensation and/or development of acute-on-chronic liver failure. Decompensated patients often pose a complex challenge which typically requires a multidisciplinary approach. The aims of the present review are to discuss the current knowledge regarding interventional treatments for patients with portal hypertension complications as well as to highlight useful information to aid hepatologists in their clinical practice. Specifically, we discuss indications and contraindications of transjugular intra-hepatic portosystemic shunt (TIPS) and balloon-occluded transvenous retrograde obliteration (BRTO) for the treatment of gastro-esophageal variceal hemorrhage in patients with decompensated cirrhosis (first section), we review the use of interventional treatments in patients with hepatic vein obstruction (Budd-Chiari syndrome) and in those with portal vein thrombosis (second section), and we briefly comment on the most frequent applications of selective splenic embolization in patients with and without underlying cirrhosis (third section).","PeriodicalId":74201,"journal":{"name":"Minerva gastroenterologica e dietologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75635456","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 : 2020-11-03DOI: 10.23736/S1121-421X.20.02778-6
P. Burra, D. Bizzaro, G. Forza, A. Feltrin, Biancarosa Volpe, Andrea Ronzan, G. Feltrin, G. Carretta, F. D’Amico, U. Cillo, G. Germani
Alcohol-related liver disease is one of the most prevalent liver disease worldwide and is the second most common indication for liver transplantation. The majority of transplant programs require 6 months of abstinence prior to transplantation; commonly referred to as the "six-month rule". According to this rule, the patients admitted for severe acute alcoholic hepatitis are not eligible for liver transplantation in most transplant centers. However, there is increasing evidence that if liver transplantation is performed in selected patients after the first episode of severe decompensation with no response to steroid therapy, it represents an effective treatment. In such selected patients, the post-transplant outcomes are good with survival rates that are significantly higher when compared with patients not responding to medical therapy and not transplanted. A multidisciplinary assessment, involving several stakeholders such as a transplant hepatologist, transplant surgeon, psychologist and psychiatrist is becoming mandatory to properly evaluate the candidate to liver transplantation for alcoholic liver diseases and severe acute alcoholic hepatitis. In the clinical setting of severe acute alcoholic hepatitis, further studies are needed for the identification of accepted selection clinical and psychosocial criteria that can provide the best longterm results. The early liver transplantation option should therefore be explored within strict criteria for this setting.
{"title":"Severe acute alcoholic hepatitis: can we offer early liver transplantation?","authors":"P. Burra, D. Bizzaro, G. Forza, A. Feltrin, Biancarosa Volpe, Andrea Ronzan, G. Feltrin, G. Carretta, F. D’Amico, U. Cillo, G. Germani","doi":"10.23736/S1121-421X.20.02778-6","DOIUrl":"https://doi.org/10.23736/S1121-421X.20.02778-6","url":null,"abstract":"Alcohol-related liver disease is one of the most prevalent liver disease worldwide and is the second most common indication for liver transplantation. The majority of transplant programs require 6 months of abstinence prior to transplantation; commonly referred to as the \"six-month rule\". According to this rule, the patients admitted for severe acute alcoholic hepatitis are not eligible for liver transplantation in most transplant centers. However, there is increasing evidence that if liver transplantation is performed in selected patients after the first episode of severe decompensation with no response to steroid therapy, it represents an effective treatment. In such selected patients, the post-transplant outcomes are good with survival rates that are significantly higher when compared with patients not responding to medical therapy and not transplanted. A multidisciplinary assessment, involving several stakeholders such as a transplant hepatologist, transplant surgeon, psychologist and psychiatrist is becoming mandatory to properly evaluate the candidate to liver transplantation for alcoholic liver diseases and severe acute alcoholic hepatitis. In the clinical setting of severe acute alcoholic hepatitis, further studies are needed for the identification of accepted selection clinical and psychosocial criteria that can provide the best longterm results. The early liver transplantation option should therefore be explored within strict criteria for this setting.","PeriodicalId":74201,"journal":{"name":"Minerva gastroenterologica e dietologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86501638","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 : 2020-11-03DOI: 10.23736/S1121-421X.20.02796-8
T. Khoury, W. Sbeit, R. Pellicano, A. Mari
{"title":"Gastric per-oral endoscopic myotomy for gastroparesis: a spark of hope.","authors":"T. Khoury, W. Sbeit, R. Pellicano, A. Mari","doi":"10.23736/S1121-421X.20.02796-8","DOIUrl":"https://doi.org/10.23736/S1121-421X.20.02796-8","url":null,"abstract":"","PeriodicalId":74201,"journal":{"name":"Minerva gastroenterologica e dietologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85474806","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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