Minerva gastroenterology最新文献

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.

Background: Irritable bowel syndrome (IBS) is a chronic disorder with an important impact on patients' quality of life. Although several data indicate that psychological symptoms are frequently reported by patients with IBS, few therapies have been evaluated regarding these issues.

Methods: A retrospective observational study was conducted to evaluate the effectiveness of a probiotic-based dietary supplement (Colicron^®) in a group of patients with diarrhea-predominant IBS (IBS-D). We included patients treated with Colicron^® (1 cps/day for 8 weeks). Primary endpoint was the gastrointestinal symptoms' remission evaluated by Visual Analogue Scale (VAS); secondary endpoint was the impact of the treatment on physical and mental health evaluated by Hospital Anxiety and Depression Score (HADS) and Short Form Health Survey 36 (SF-36). VAS was assessed at week 4 (T4), week 8 (T8) and week 12 (T12), whereas HADS and SF-36 were performed even at the start of the Colicron^® treatment (T0).

Results: An improvement of VAS Score was observed at T8 (P<0.001) and T12 (P<0.05) compared to T4. Lower HADS-A (anxiety subdomain) score was obtained at each time point versus T0 (P<0.01), and higher scores of all SF-36 domains were observed during the treatment (0.05

Conclusions: Colicron^® could be useful in improving both gastrointestinal and psychological symptoms in IBS-D patients. Further prospective clinical trials are needed to confirm these preliminary data.

Background: I-scan is an image enhancing technology that utilizes contrast, surface, and tone enhancement to examine the microvascular and microsurface structures of mucosa. Its ability to diagnosis GC is of growing interest due to its ability to make an optical diagnosis; however, only a handful of studies have explored its role in this setting. We aimed to investigate the diagnostic capability of i-scan for GC detection.

Methods: Multiple databases were searched for studies utilizing i-scan for GC detection until February 2024. Primary outcomes included the pooled sensitivity, specificity, and accuracy.

Results: Seven studies were included (371 patients, 220 GC lesions). The pooled sensitivity was 84% (four studies, 95% CI: 0.65; 0.93), specificity was 83% (three studies, 95% CI: 0.68; 0.92) and accuracy was 84% studies (N.=3, 95% CI: 0.69; 0.93).

Conclusions: I-scan appears to be an effective diagnostic tool for GC. However, the functional capabilities related to brightness detection may limits use. Further prospective, comparative studies are needed to determine its role in clinical practice compared to white light endoscopy, narrow band imaging and chromoendoscopy.

Small molecule therapy in inflammatory bowel disease has recently gained momentum. One such agent that was recently approved for use in Crohn's disease is upadacitinib. Even though clinical trials support the use of this agent and efficacy is impressive, real-world data remains limited and scattered in the current literature. This article aims to summarize the real-world data published so far about using upadacitinib in Crohn's disease.