Minerva gastroenterology最新文献

Spontaneous portosystemic shunts (SPSSs) are common among patients with liver cirrhosis. These vascular structures are collateral veins that directly connect the portal vein system with the systemic circulation. The prevalence increases as cirrhosis worsens. Published studies exist investigating the possible association between presence and extension of SPSSs and clinical manifestation of liver cirrhosis, however some issues continue to be debated. Recent research on this topic has extended knowledge and brought out interesting new aspects. The aim of this review is to provide a comprehensive and updated revision of the role of SPSSs in liver cirrhosis, from pathophysiology to clinical and therapeutic considerations, specifically addressing the most controversial and emerging findings. On this purpose PubMed and Medline were used as data sources and an extensive review of the literature, including the most recent and relevant published studies, was performed. The presence of SPSSs, especially if multiple and/or large, is associated with an increased risk of developing several complications of liver cirrhosis. Patients with higher MELD have larger SPSSs with negative impact on survival. Regarding hepatocellular carcinoma, there is evidence suggesting a potential tumorigenic effect associated with SPSSs, but further investigations on humans are needed. In the context of liver transplantation, the negative effect of SPSSs on graft function and patients' survival is a matter of debate, with no consensus on their surgical management. Currently, several interventional treatments have been proposed for SPSSs that have demonstrated excellent outcomes in selected populations.

Liver cirrhosis, marked by fibrosis and nodular regeneration, triggers a cascade of events resulting in portal hypertension (PH) and, subsequently, hepatic decompensation in its final stages. PH, arising from increased intrahepatic vascular resistance, serves as a harbinger of complications such as ascites, variceal bleeding, and hepatic encephalopathy, underscoring its clinical significance. Timely diagnosis of clinically significant portal hypertension (CSPH) is of pivotal importance, prompting the exploration of noninvasive diagnostic tools such as liver stiffness and spleen stiffness measurement. β-blockers, particularly Carvedilol, emerge as stalwart therapeutic agents in managing CSPH by inducing splanchnic vasoconstriction and reducing cardiac output. However, choosing between β-blockers and endoscopic banding ligation (EBL) for variceal bleeding prophylaxis requires careful consideration, especially in decompensated cirrhosis cases. EBL, while effective in preventing variceal bleeding, has several drawbacks, ranging from its inability to effectively treat PH to its association with upper digestive tract complications such as portal hypertensive gastropathy (PHG) and portal hypertensive polyps (PHPs). This narrative review aims to underline the appropriate diagnostic and therapeutic strategies for PH and to elucidate the relationship between PH, PHG, PHPs, and the use of EBL. This investigation emphasizes the urgency for further research aimed at devising optimal management strategies for PHG and PHPs, particularly in decompensated cirrhosis. Indeed, PH in cirrhotic patients requires a multifaceted approach encompassing early diagnosis, tailored therapeutic interventions, and ongoing research efforts aimed at refining treatment strategies and improving patient outcomes.

Gastroparesis is a chronic gastrointestinal disorder characterized by delayed gastric emptying without mechanical obstruction, leading to symptoms such as nausea, vomiting, and abdominal pain. Despite its significant impact on patient quality of life, effective management remains challenging. Current treatments, such as prokinetic agents and antiemetics, offer symptomatic relief but have limitations, necessitating the exploration of new approaches. We reviewed the most recent literature using PubMed and Medline, focusing on studies that address the etiology, pathophysiology, and management of gastroparesis, including novel pharmacological agents, endoscopic techniques, and lifestyle modifications. Emerging therapies, including gastric peroral endoscopic myotomy and ghrelin agonists, show promise in improving patient outcomes. In this review, we examine these therapeutic advancements and discuss their potential role in the future management of gastroparesis.

Background: Gastroesophageal reflux disease is a clinical condition due to the reflux of stomach contents and leading either to erosive or non-erosive disease. Repeated exposure of esophagus to hydrochloric acid, pepsin, bile salts and pancreatic enzymes in gastric contents damages esophageal mucosa, causing inflammation and increased paracellular permeability. A possible therapy for gastroesophageal reflux disease should hinder gastroesophageal reflux and provide esophageal mucosal protection against all aggressive components. The medical device (Med) tested in this study was developed for the treatment of gastroesophageal reflux disease with the aim to achieve a barrier to protect esophageal mucosa against reflux damages and neutralization of the acidic pocket in the stomach.

Methods: The efficacy of Med in forming a protective barrier was performed in vitro using a cellular model of reconstructed human oral epithelium, monitoring its ability to reduce the passage of substances once the formulation was applied, as well as the subsequent reduction in inflammation and toxic effects after exposure to the Triton X-100 stimulus.

Results: The medical device is able of creating an effective barrier at the level of epithelial cells. Its protective action is demonstrated by the ability in reducing toxicity and inflammation induced by an irritant agent.

Conclusions: This work shows the promising effects of Med as a therapeutic solution for managing signs and symptoms associated with gastroesophageal reflux, capable of exerting its function through a physical action without compromising the physiological balance of epithelial cells.

Hepatitis B virus (HBV) infection is a major global health concern, with liver transplantation (LT) serving as a critical treatment for end-stage liver disease caused by HBV. However, the risk of HBV reinfection after LT remains significant, necessitating effective prophylaxis. Today, the combination of hepatitis B immune globulin (HBIG) and high-barrier nucleos(t)ide analogues (NUCs) is the standard of care for preventing HBV recurrence post-LT but concerns about the cost of HBIG and access to high-barrier NUCs have led to a reduction in the use, dose, and duration of HBIG in recent years. This review provides an updated analysis of the role of HBIG in preventing HBV recurrence post-LT, alongside a detailed evaluation of its cost-effectiveness, leveraging recent pharmacoeconomic data from Italy. The cost analysis showed that HBIG contributes approximately 12.4% (€ 49,000) to the total lifetime cost of LT-related healthcare (€395,986). Short-term HBIG prophylaxis reduced costs by 11.1%, while lifetime usage increased total costs by only 6.6%. However, the primary cost drivers were renal failure and immunosuppressive therapy. In conclusion, despite advancements in NUCs therapy, HBIG remains a cornerstone of HBV prophylaxis post-LT, particularly in high-risk patients, and discontinuation of HBIG in favor of alternative prophylaxis strategies lacks robust supporting evidence. Tailoring prophylaxis to individual patient needs and risk factors allows for personalized treatment while maintaining efficacy.

Small intestinal bacterial overgrowth (SIBO) was originally described as a cause of maldigestion and malabsorption in situations where disruptions of intestinal anatomy or physiology favored the proliferation of bacteria normally confined to the colon. In this context, the pathogenesis of symptoms resulting from SIBO was well described. More recently, the concept of SIBO was extended to explain symptoms such as bloating, altered bowel habit and discomfort among individuals with irritable bowel syndrome and since then a whole host of gastrointestinal and extragastrointestinal disorders have been attributed to SIBO. In these more recent studies, the diagnosis of SIBO has been largely based on breath hydrogen testing; an approach that is subjected to misinterpretation. Here we critically assess the "modern" (as against the "classical") concept of SIBO and plead for caution in the application of breath tests, and those that employ lactulose as the substrate, in particular, to the diagnosis of this disorder. We look forward to the application of modern molecular microbiological techniques to the assessment of the small intestinal microbiome and metabolome and the delineation of what is truly normal.

Gut microbiota analysis, until a few years ago an exclusive research tool, has recently begun to spread among doctors and nutritionists around the world as a means aimed at better understanding patient disorders. As often happens, the commercial push has literally exploded and today there are numerous companies that offer microbiota analysis of dubious quality and/or as a business appliance aimed at selling supplements and the like. For non-experts it can therefore be difficult to find one's way among the numerous proposals. In this article we try not only to list those characteristics that could perhaps help choose one test rather than another, but we also try to discuss what the purpose of a microbiota analysis should be and what meaning to give to the concepts of dysbiosis and eubiosis. A small clinical experience is also cited to support the hypotheses made.

Background: The clinical value of probiotics in patients undergoing abdominal surgery, particularly colorectal surgery, remains uncertain despite their well-documented health benefits. This pilot randomized controlled trial aimed to assess the effects of perioperative and postoperative oral administration of two probiotics, Clostridium butyricum CBM588^® and Bifidobacterium longum ES1, on immune function, systemic inflammatory response, postoperative infections, and recovery after colorectal surgery.

Methods: Fifteen adult patients underwent colorectal resection, with two groups receiving probiotics and one acting as a control. Blood and fecal samples were collected, and clinical parameters were assessed.

Results: Results showed the safety of probiotics, resistance to antibiotics and gastric acid, and potential benefits in reducing postoperative infections and intestinal inflammation.

Conclusions: Future trials should provide more conclusive evidence on the efficacy and safety of perioperative probiotic administration in colorectal surgery, aiming for improved patient outcomes and reduced healthcare costs.