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Portal hypertension-associated gastric pathology: role of endoscopic banding ligation.
IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-03-06 DOI: 10.23736/S2724-5985.25.03759-3
Maria L Gambardella, Carmelo Luigiano, Giuseppe LA Torre, Giuseppe G M Scarlata, Francesco Luzza, Ludovico Abenavoli

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.

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引用次数: 0
Advanced approaches in the comprehensive management of gastroparesis: from etiology to emerging therapies.
IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-27 DOI: 10.23736/S2724-5985.24.03804-X
Vishali Moond, Sahib Singh, Umar Hayat, Parth Patel, Archit Garg, Hassam Ali, Douglas G Adler

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.

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引用次数: 0
Barrier and protective effects of a newly developed medical device for the treatment of gastroesophageal reflux disease.
IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-27 DOI: 10.23736/S2724-5985.25.03755-6
Federico Benetti, Elisa Gaio, Stefano Agostini

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.

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引用次数: 0
Prophylaxis of HBV reinfection and disease in liver transplanted patients: 2024 update on the role of HBIG and cost-effectiveness evaluation.
IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-30 DOI: 10.23736/S2724-5985.24.03864-6
Stefano Fagiuoli, Alfredo Marzano, Luciano DE Carlis, Paolo DE Simone, Maria Rendina

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.

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引用次数: 0
Traditional Chinese medicine nursing strategies for regulating gut microbiome in incontinence-associated dermatitis: a prospective study. 中医药护理对尿失禁相关性皮炎患者肠道菌群调节的前瞻性研究。
IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-16 DOI: 10.23736/S2724-5985.24.03726-4
Hong Gao, Jiayan Song
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引用次数: 0
Small intestinal bacterial overgrowth: from malabsorption to misinterpretation. 小肠细菌过度生长:从吸收不良到误读。
IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-13 DOI: 10.23736/S2724-5985.24.03781-1
Eamonn M Quigley

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.

小肠细菌过度生长(SIBO)最初被描述为在肠道解剖或生理破坏有利于通常局限于结肠的细菌增殖的情况下导致消化不良和吸收不良的原因。在这种情况下,SIBO引起的症状的发病机制得到了很好的描述。最近,SIBO的概念被扩展到解释肠易激综合征患者的腹胀、排便习惯改变和不适等症状,从那时起,许多胃肠道和胃肠外疾病都被归因于SIBO。在这些最近的研究中,SIBO的诊断主要基于呼吸氢测试;一种容易被误解的方法。在这里,我们批判性地评估SIBO的“现代”(相对于“经典”)概念,并呼吁在呼气测试的应用中谨慎,特别是那些使用乳果糖作为底物的呼气测试,以诊断这种疾病。我们期待着应用现代分子微生物学技术来评估小肠微生物组和代谢组,并描绘什么是真正的正常。
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引用次数: 0
How to navigate the many direct-to-consumer microbiota analyses and why to use them. 如何浏览众多直接面向消费者的微生物群分析,以及为什么要使用它们。
IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-17 DOI: 10.23736/S2724-5985.24.03799-9
Francesco DI Pierro, Alexander Bertuccioli, Massimiliano Cazzaniga, Mariarosaria Matera, Ilaria Cavecchia, Viviana Gerardi, Stefania Piccirelli, Daniele Salvi, Cecilia L Pugliano, Paola Cesaro, Cristiano Spada, Nicola Zerbinati

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.

肠道菌群分析,直到几年前还是一种独家研究工具,最近开始在世界各地的医生和营养学家中传播,作为一种旨在更好地了解患者疾病的手段。正如经常发生的那样,商业推动已经真正爆发,今天有许多公司提供质量可疑的微生物群分析和/或作为一种商业工具,旨在销售补充剂等。因此,对于非专家来说,很难在众多的建议中找到自己的方法。在这篇文章中,我们不仅试图列出那些可能有助于选择一种测试而不是另一种测试的特征,而且我们也试图讨论微生物群分析的目的应该是什么,以及给生态失调和生态良好的概念带来什么意义。一个小的临床经验也被引用来支持所做的假设。
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引用次数: 0
Innovative strategies for the rapid restoration of intestinal function in patients undergoing abdominal surgery: use of probiotics. Pilot study of 15 patients. 快速恢复腹部手术患者肠道功能的创新策略:使用益生菌。15例患者的初步研究。
IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-06 DOI: 10.23736/S2724-5985.24.03701-X
Elisabetta Radice, Olexii Potapov, Elisa Martello, Giorgia Meineri, Paolo Risso, Francesco DI Pierro, Francesco Olandese, Galyna Shabat

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.

背景:尽管益生菌对健康有益,但其在腹部手术,特别是结肠直肠手术患者中的临床价值仍不确定。本随机对照试验旨在评估围手术期和术后口服丁酸梭菌CBM588®和长双歧杆菌ES1两种益生菌对免疫功能、全身炎症反应、术后感染和结直肠癌术后恢复的影响。方法:15例成年患者行结肠直肠癌切除术,两组给予益生菌治疗,另一组作为对照组。采集血液和粪便样本,评估临床参数。结果:结果显示益生菌的安全性,对抗生素和胃酸的耐药性,以及减少术后感染和肠道炎症的潜在益处。结论:未来的试验应提供更多结论性证据,证明结肠直肠癌手术围手术期给予益生菌的有效性和安全性,旨在改善患者预后并降低医疗成本。
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引用次数: 0
Robuvit® supplementation reduces progression of non-alcoholic fatty liver disease in elderly subjects. 罗布维特®补充剂可减少老年人非酒精性脂肪肝疾病的进展。
IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-04 DOI: 10.23736/S2724-5985.24.03787-2
Maria R Cesarone, Gianni Belcaro, David Cox, Giuseppe Gizzi, Luciano Pellegrini, Claudia Scipione, Valeria Scipione, Francesca Coppazuccari, Mark Dugall, Shu Hu, Luciano Orsini, Marcello Corsi, Beatrice Feragalli, Roberto Cotellese
{"title":"Robuvit® supplementation reduces progression of non-alcoholic fatty liver disease in elderly subjects.","authors":"Maria R Cesarone, Gianni Belcaro, David Cox, Giuseppe Gizzi, Luciano Pellegrini, Claudia Scipione, Valeria Scipione, Francesca Coppazuccari, Mark Dugall, Shu Hu, Luciano Orsini, Marcello Corsi, Beatrice Feragalli, Roberto Cotellese","doi":"10.23736/S2724-5985.24.03787-2","DOIUrl":"https://doi.org/10.23736/S2724-5985.24.03787-2","url":null,"abstract":"","PeriodicalId":94142,"journal":{"name":"Minerva gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776063","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}
引用次数: 0
The influence of acupoint scraping combined with traditional Chinese medicine fumigation on gastrointestinal dysfunction and defecation after minimally invasive abdominal surgery. 穴位刮痧联合中药熏蒸对腹部微创手术后胃肠功能紊乱及排便的影响
IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-01 Epub Date: 2024-01-29 DOI: 10.23736/S2724-5985.23.03621-5
Min Su, Wanchen Yu, Ying Su
{"title":"The influence of acupoint scraping combined with traditional Chinese medicine fumigation on gastrointestinal dysfunction and defecation after minimally invasive abdominal surgery.","authors":"Min Su, Wanchen Yu, Ying Su","doi":"10.23736/S2724-5985.23.03621-5","DOIUrl":"10.23736/S2724-5985.23.03621-5","url":null,"abstract":"","PeriodicalId":94142,"journal":{"name":"Minerva gastroenterology","volume":" ","pages":"463-465"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576996","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}
引用次数: 0
期刊
Minerva gastroenterology
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