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.

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.

Primary sclerosing cholangitis (PSC) is a rare liver disorder characterized by biliary ducts inflammation, fibrosis and consequently chronic cholestasis, which progressively lead to liver cirrhosis. The main feature of PSC is the frequent association with inflammatory bowel disease (IBD), with an estimated prevalence of around 70% of the cases. This strong relationship seems due to the presence of shared pathogenetic mechanisms, which seem to involve the intestinal barrier function, the human gut microbiota and the immune innated and adaptative response to antigens derived from the bowel. Of relevance, PSC-IBD have specific clinical and pathological features that differ from PSC and IBD as separate entities, explaining the diversity in outcomes among these categories, and therefore the distinct clinical management that is required. The aim of this review is to present recent data regarding the epidemiology, pathobiology and clinical features of PSC-IBD.

Background: It is known that the subcutaneous (SC) route administration of biologic drugs has several potential benefits for patient and the healthcare system. Since few real-world data are available yet about the rate of transition from intravenous (IV) to SC Vedolizumab (VDZ) in the Italian population, we assessed this rate in a large cohort of inflammatory bowel disease (IBD) patients under remission receiving IV VDZ as standard of care in a real-world setting.

Methods: Searching who was asked to switch from IV VDZ To SC VDZ, and assessing the rate of acceptance. The Mayo score in Ulcerative colitis (UC) and the Harvey-Bradshaw Index (HBI) in Crohn's Disease (CD) scored the clinical activity. Achievement and maintenance of clinical remission during the follow-up, and safety were the primary endpoints.

Results: Overall, 238 patients (145 with UC and 93 with CD) having remission ≥1 year with VDZ were asked to switch to VDZ SC, but only nine patients (four with UC and five with CD, 3.78% of the total population to which the switch was proposed) agreed to switch. No difference were found between patients accepting and patients refusing switching about the reasons of the choice. All patients accepting switch maintained clinical remission during the follow-up, and no adverse events were recorded.

Conclusions: Switching to SC route is a safe and effective choice for IBD patients under remission using VDZ. However, this choice is not preferred by the majority of patients on stable remission under IV VDZ.

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.

Acute pancreatitis (AP) is a commonly encountered GI diagnosis, accounting for 275,000 hospital admissions annually in the United States alone. Pancreatic necrosis (PN) is the most common complication of AP, and the development of PN is associated with significant morbidity and increased mortality. This expert review evaluates the evidence-based management of symptomatic PN from the era of maximal open pancreatic necrosectomy in the late 1990s though the modern paradigm of minimally invasive and endoscopic interventions. The authors present the retrospective and controlled data behind the "step-up approach" to PN treatment and discuss the application of current society guidance. Evidence based management of PN is characterized by early supportive care, and treatment by minimally invasive intervention when a patient is critically ill or persistently symptomatic. Appropriate choices when intervention is required include percutaneous drainage, minimally invasive surgery, and/or endoscopic treatment. The transition from open maximal necrosectomy to minimally invasive intervention has resulted in improved outcomes for patients, including gains in mortality, significant morbidity, and cost. The ideal precision management strategy for an individual patient remains an area of increasing understanding.