Minerva gastroenterology最新文献

Introduction: Celiac disease (CD), an autoimmune disorder, has been linked to chronic kidney disease but results are inconsistent. This meta-analysis investigates the association between CD and the risk of kidney disease.

Evidence acquisition: A systematic literature search was conducted using PubMed, Embase, and Google Scholar up to March 31, 2024. Studies included observational reports on CD and kidney diseases. Random-effects models estimated pooled odds ratios (ORs) and 95% confidence intervals (CIs) to report the overall effect size, with significance set at P<0.05. Study quality was assessed using the Newcastle-Ottawa Scale (NCOS). Publication bias was evaluated using Egger's regression and Begg's rank correlation tests.

Evidence synthesis: Nine studies with 2022,686 patients were included. The pooled prevalence of overall kidney disease, glomerulonephritis, and end-stage renal disease (ESRD) in CD patients was 2.29% (95% CI 1.34-3.49), 1.31% (95% CI 0.52-2.47), and 1.55% (95% CI 0.11-4.59), respectively. CD was significantly associated with a higher risk of overall kidney disease (OR=1.98, 95% CI 1.48-2.65), glomerulonephritis (OR=2.68, 95% CI 1.54-4.66), and ESRD (OR=2.58, 95% CI 1.32-5.03). Most studies were of high or moderate quality according to NCOS, and no publication bias was detected.

Conclusions: CD patients have an elevated risk of various kidney diseases, including glomerulonephritis and ESRD. Monitoring renal function and managing CD are crucial to mitigating potential kidney damage. Future research should investigate the mechanisms underlying this association and explore targeted interventions to prevent or delay renal complications in CD patients.

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.

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.

Small bowel strictures secondary to either benign or malignant causes are associated with significant morbidity and impaired quality of life. Symptoms and their severity are dependent on the location and the degree of stenosis which, in addition to the etiology, dictate the approach to treatment. Endoscopic management of small bowel strictures include endoscopic balloon dilation, enteral stenting, endoscopic ultrasound-guided gastroenterostomy (EUS-GE), and stricturotomy. The introduction of the cautery-enhanced lumen-apposing metal stent has streamlined EUS-GE and has brought it to the forefront especially for select patients with malignant gastric outlet obstruction (GOO) with acceptable survival. This review will summarize the literature regarding the aforementioned interventions and will focus on EUS-GE and how it compares with traditional use of enteral stents and surgical gastrojejunostomy in the management of malignant GOO.

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.

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.