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Gastrointestinal Tract Disorders
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Gastrointestinal Tract Disorders

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 67296

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Dr. Marilena Durazzo

E-Mail Website
Guest Editor
Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
Interests: gastrointestinal disorders; Helicobacter pylori; microbiota; geriatrics; gastroenterology; diabetes mellitus; gastroesophageal reflux; functional gastrointestinal disorders; inflammatory bowel diseases; malabsorption syndromes

Special Issue Information

Dear Colleagues,

Gastrointestinal tract disorders are a wide group of diseases involving both the gastrointestinal tube (esophagus, stomach, small and large intestine) and related organs (liver, pancreas, and gallbladder). These dysfunctions may differ by site, etiology, and severity, going from simple malfunctions to mere diseases. Because of their variety and heterogeneity, gastrointestinal disorders can affect many people and are widespread throughout the population. Therefore, scientific research in this area is facing a great challenge. Better knowledge of gastrointestinal disorders in terms of their pathophysiology, clinical features, and possible complications is necessary for the development of new diagnostic methods and therapeutic strategies. During the last several decades, some scientific developments have already been made, giving more opportunities to these patients. However, much remains to be discovered and to be done to help physicians in their everyday work and to give patients a better prognosis.

The present Special Issue aims to highlight recent advances in gastrointestinal tract disorders, focusing on their diagnostic and therapeutic path, evolution, and complications.

Dr. Marilena Durazzo
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gastrointestinal disorders
  • diagnosis
  • treatment
  • prognosis
  • complications

Published Papers (19 papers)

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Editorial

Jump to: Research, Review

3 pages, 190 KiB  
Editorial
Trends in the Comprehension and Management of Gastrointestinal Tract Disorders
by Marilena Durazzo, Arianna Ferro, Sharmila Fagoonee and Rinaldo Pellicano
J. Clin. Med. 2022, 11(6), 1730; https://doi.org/10.3390/jcm11061730 - 21 Mar 2022
Viewed by 1516
Abstract
During the last decade, relevant advances have been made in the knowledge of the pathogenetic mechanisms of gastrointestinal (GI) tract disorders [...] Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)

Research

Jump to: Editorial, Review

12 pages, 4016 KiB  
Article
Effect of DA-9701 on the Gastrointestinal Motility in the Streptozotocin-Induced Diabetic Mice
by Changyoon Ha, Heejin Kim, Rari Cha, Jaemin Lee, Sangsoo Lee, Jung-Hwa Ryu, Hyunjin Kim and Ok-Jae Lee
J. Clin. Med. 2021, 10(22), 5282; https://doi.org/10.3390/jcm10225282 - 13 Nov 2021
Cited by 4 | Viewed by 1697
Abstract
Background: Compared to the general population, diabetic patients experience more frequent episodes of gastrointestinal (GI) motility dysfunction, owing to the disruption of functional innervations. DA-9701 is a new prokinetic agent formulated from the extracts of Pharbitidis semen and Corydalis tuber. Aim: To investigate [...] Read more.
Background: Compared to the general population, diabetic patients experience more frequent episodes of gastrointestinal (GI) motility dysfunction, owing to the disruption of functional innervations. DA-9701 is a new prokinetic agent formulated from the extracts of Pharbitidis semen and Corydalis tuber. Aim: To investigate the effect of DA-9701 on GI motility in an animal model of streptozotocin (STZ)-induced diabetes. Methods: Diabetes was induced in mice by intraperitoneal injection of STZ (40 mg/kg of body weight in 0.1 M citrate buffer) for 3 days. Diabetic mice were divided into four groups and administered DA-9701 in different doses (1, 3, and 10 mg/kg) or placebo for 2 weeks. Intestinal transit was assessed using charcoal meal movement. GI isometric contraction was measured by applying an isometric force transducer on a circular muscle strip of the antrum, ileum, and proximal colon of sacrificed mice. Gastric emptying rate was evaluated by measuring the dye percentage remaining in the stomach relative to the total dye amount recovered in a standardization group of mice. Results: Body weight and antral and small intestinal motility were less in diabetic mice than in control mice, and colonic motility was similar in both. DA-9701 showed a dose-dependent increase in the amplitude of spontaneous phasic contractions in the antrum, ileum, and colon in diabetic mice without influencing body weight or blood glucose levels. The degree of improvement was comparable between diabetic and control mice. Intestinal transit was significantly more delayed in diabetic mice than in controls (43 ± 7% vs. 67 ± 8%, p < 0.05); however, DA-9701 restored the delayed intestinal transit more effectively compared to placebo (75% vs. 50%). The gastric emptying rate was significantly more delayed in diabetic mice than in controls (43 ± 10% vs. 62 ± 12%, p < 0.05), and was improved by DA-9701 in a dose-dependent manner (50%, 55%, and 60% in mice treated with 1, 3, and 10 mg/kg of DA-9701, respectively, vs. 43% in placebo-treated and 60% in control mice). Conclusions: DA-9701 improved GI contractility without affecting blood sugar and body weight in diabetic mice. DA-9701 could improve the decreased GI motility and clinical symptoms in progressive diabetic patients. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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11 pages, 800 KiB  
Article
Characteristics, Location, and Clinical Outcomes of Gastrointestinal Bleeding in Patients Taking New Oral Anticoagulants Compared to Vitamin K Antagonists
by A Reum Choe, Chang Mo Moon, Chung Hyun Tae, Jaeyoung Chun, Ki Bae Bang, Yoo Jin Lee, Hyun Seok Lee, Yunho Jung, Sung Chul Park and Hoon Sup Koo
J. Clin. Med. 2021, 10(12), 2693; https://doi.org/10.3390/jcm10122693 - 18 Jun 2021
Cited by 2 | Viewed by 1989
Abstract
New oral anticoagulants (NOACs) are commonly used in clinical practice as alternatives to vitamin K antagonists (VKA). However, the etiology, clinical course, and risk of gastrointestinal (GI) bleeding remain unclear. We aimed to evaluate the clinical characteristics and location of acute GI bleeding [...] Read more.
New oral anticoagulants (NOACs) are commonly used in clinical practice as alternatives to vitamin K antagonists (VKA). However, the etiology, clinical course, and risk of gastrointestinal (GI) bleeding remain unclear. We aimed to evaluate the clinical characteristics and location of acute GI bleeding associated with NOACs and its severity and outcomes compared to VKA. This retrospective multicenter study included 381 subjects on anticoagulants who underwent appropriate diagnostic examination due to GI bleeding. Regarding the characteristics of acute GI bleeding, the proportion of vascular lesions was significantly lower in the NOACs group than that in the VKA group. Small bowel bleeding occurred less commonly in the NOACs group, but the difference did not reach statistical significance. Regarding severity and clinical outcomes, patients on NOACs received significantly smaller volumes of transfused blood products and had shorter ICU stays than those on VKA. Moreover, the need for surgery and the risk of rebleeding in the NOACs group were significantly lower than those in the VKA group. Patients on NOACs have better clinical outcomes in terms of severity of acute GI bleeding or rebleeding than patients on VKA. Patients on NOACs demonstrate different characteristics and location of acute GI bleeding than those on VKA. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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8 pages, 316 KiB  
Article
Cost-Effectiveness, Efficacy, and Safety Analysis of Tailored Therapy in Patients with Helicobacter pylori Infection
by A Reum Choe, Ki-Nam Shim, Yehyun Park, Eun-Mi Song, Chung Hyun Tae and Sung-Ae Jung
J. Clin. Med. 2021, 10(12), 2619; https://doi.org/10.3390/jcm10122619 - 14 Jun 2021
Cited by 11 | Viewed by 2024
Abstract
Recently in Korea, where triple therapy is accepted as the first-line Helicobacter pylori (H. pylori) eradication treatment, antibiotic resistance to clarithromycin has increased considerably, resulting in eradication rates of less than 80%. We investigated the efficacy of tailored therapy after a [...] Read more.
Recently in Korea, where triple therapy is accepted as the first-line Helicobacter pylori (H. pylori) eradication treatment, antibiotic resistance to clarithromycin has increased considerably, resulting in eradication rates of less than 80%. We investigated the efficacy of tailored therapy after a clarithromycin resistance test compared with empirical therapy for H. pylori eradication. The cost-effectiveness of H. pylori eradication success was evaluated according to the average medical cost per patient. A total of 364 patients were enrolled in the study. The first-line H. pylori eradication rate was significantly higher in patients who received tailored therapy than in those who received empirical therapy. The total medical costs for the tailored and empirical groups were 46,374 Won and 53,528 Won. The total treatment period for each ultimately successful eradication in the tailored group was 79.8 ± 2.8 days, which is shorter than that of the empirical group (99.2 ± 7.4 days). The rate of eradication-related adverse events for the tailored group and empirical group was 12.9% and 14.8%, respectively. Tailored therapy could be a useful option to achieve a higher successful eradication rate, shorter treatment periods, and lower medical costs than empirical therapy in the era of increasing antibiotic resistance. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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16 pages, 1997 KiB  
Article
Endoscopic Vacuum Therapy in Patients with Transmural Defects of the Upper Gastrointestinal Tract: A Systematic Review with Meta-Analysis
by Da Hyun Jung, Hae-Ryong Yun, Se Joon Lee, Na Won Kim and Cheal Wung Huh
J. Clin. Med. 2021, 10(11), 2346; https://doi.org/10.3390/jcm10112346 - 27 May 2021
Cited by 20 | Viewed by 2961
Abstract
A transmural defect of the upper gastrointestinal (UGI) tract is a life-threatening condition associated with high morbidity and mortality. Recently, endoscopic vacuum therapy (EVT) was used for managing UGI defects and showed promising results. We conducted a systematic review and meta-analysis to synthesize [...] Read more.
A transmural defect of the upper gastrointestinal (UGI) tract is a life-threatening condition associated with high morbidity and mortality. Recently, endoscopic vacuum therapy (EVT) was used for managing UGI defects and showed promising results. We conducted a systematic review and meta-analysis to synthesize evidence on the efficacy of EVT in patients with transmural defects of the UGI tract. We searched the PubMed, Cochrane Library, and Embase databases for publications on the effect of EVT on successful closure, mortality, complications, and post-EVT strictures. Methodological quality was assessed using the Newcastle–Ottawa quality assessment scale. This meta-analysis included 29 studies involving 498 participants. The pooled estimate rate of successful closure with EVT was 0.85 (95% confidence interval [CI]: 0.81–0.88). The pooled estimate rates for mortality, complications, and post-EVT strictures were 0.11, 0.10, and 0.14, respectively. According to the etiology of the transmural defect (perforation vs. leak and fistula), no significant difference was observed in successful closure (odds ratio [OR]: 1.45, 95% CI: 0.45–4.67, p = 0.53), mortality (OR: 0.77, 95% CI: 0.24–2.46, p = 0.66), complications (OR: 0.94, 95% CI: 0.17–5.15, p = 0.94), or post-EVT stricture rates (OR: 0.70, 95% CI: 0.12–4.24, p = 0.70). The successful closure rate was significantly higher with EVT than with self-expanding metal stent (SEMS) placement (OR: 3.14, 95% CI: 1.23–7.98, p = 0.02). EVT is an effective and safe treatment for leaks and fistulae, as well as for perforations in the UGI. Moreover, EVT seems to be a better treatment option than SEMS placement for UGI defects. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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10 pages, 502 KiB  
Article
Prevalence and Clinical Characteristics of Dyssynergic Defecation and Slow Transit Constipation in Patients with Chronic Constipation
by Samuel Tanner, Ahson Chaudhry, Navneet Goraya, Rohan Badlani, Asad Jehangir, Dariush Shahsavari, Zubair Malik and Henry P. Parkman
J. Clin. Med. 2021, 10(9), 2027; https://doi.org/10.3390/jcm10092027 - 9 May 2021
Cited by 13 | Viewed by 2997
Abstract
Patients with chronic constipation who do not respond to initial treatments often need further evaluation for dyssynergic defecation (DD) and slow transit constipation (STC). The aims of this study are to characterize the prevalence of DD and STC in patients referred to a [...] Read more.
Patients with chronic constipation who do not respond to initial treatments often need further evaluation for dyssynergic defecation (DD) and slow transit constipation (STC). The aims of this study are to characterize the prevalence of DD and STC in patients referred to a motility center with chronic constipation and correlate diagnoses of DD and STC to patient demographics, medical history, and symptoms. High-resolution ARM (HR-ARM), balloon expulsion testing (BET) and whole gut transit scintigraphy (WGTS) of consecutive patients with chronic constipation were reviewed. Patients completed questionnaires describing their medical history and symptoms at the time of testing. A total of 230 patients completed HR-ARM, BET, and WGTS. Fifty (22%) patients had DD, and 127 (55%) patients had STC. Thirty patients (13%) had both DD and STC. There were no symptoms that were suggestive of STC vs. DD; however, patients with STC and DD reported more severe constipation than patients with normal transit and anorectal function. Patients with chronic constipation often need evaluation for both DD and STC to better understand their pathophysiology of symptoms and help direct treatment. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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11 pages, 274 KiB  
Article
Carotid Plaque Assessment Reclassifies Patients with Inflammatory Bowel Disease into Very-High Cardiovascular Risk
by Alejandro Hernández-Camba, Marta Carrillo-Palau, Laura Ramos, Noemi Hernández Alvarez-Buylla, Inmaculada Alonso-Abreu, Anjara Hernández-Pérez, Milagros Vela, Laura Arranz, Manuel Hernández-Guerra, Miguel Ángel González-Gay and Iván Ferraz-Amaro
J. Clin. Med. 2021, 10(8), 1671; https://doi.org/10.3390/jcm10081671 - 13 Apr 2021
Cited by 9 | Viewed by 1523
Abstract
The addition of carotid ultrasound into cardiovascular (CV) risk scores has been found to be effective in identifying patients with chronic inflammatory diseases at high-CV risk. We aimed to determine if its use would facilitate the reclassification of patients with inflammatory bowel disease [...] Read more.
The addition of carotid ultrasound into cardiovascular (CV) risk scores has been found to be effective in identifying patients with chronic inflammatory diseases at high-CV risk. We aimed to determine if its use would facilitate the reclassification of patients with inflammatory bowel disease (IBD) into the very high-CV-risk category and whether this may be related to disease features. In this cross-sectional study encompassing 186 IBD patients and 175 controls, Systematic Coronary Risk Evaluation (SCORE), disease activity measurements, and the presence of carotid plaques by ultrasonography were assessed. Reclassification was compared between patients and controls. A multivariable regression analysis was performed to evaluate if the risk of reclassification could be explained by disease-related features and to assess the influence of traditional CV risk factors on this reclassification. After evaluation of carotid ultrasound, a significantly higher frequency of reclassification was found in patients with IBD compared to controls (35% vs. 24%, p = 0.030). When this analysis was performed only on subjects included in the SCORE low-CV-risk category, 21% IBD patients compared to 11% controls (p = 0.034) were reclassified into the very high-CV-risk category. Disease-related data, including disease activity, were not associated with reclassification after fully multivariable regression analysis. Traditional CV risk factors showed a similar influence over reclassification in patients and controls. However, LDL-cholesterol disclosed a higher effect in controls compared to patients (beta coef. 1.03 (95%CI 1.02–1.04) vs. 1.01 (95%CI 1.00–1.02), interaction p = 0.035) after adjustment for confounders. In conclusion, carotid plaque assessment is useful to identify high-CV risk IBD patients. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
12 pages, 1341 KiB  
Article
Anxiety and Gastrointestinal Symptoms Related to COVID-19 during Italian Lockdown
by Ludovico Abenavoli, Pietro Cinaglia, Giuditta Lombardo, Eduardo Boffoli, Miriam Scida, Anna Caterina Procopio, Tiziana Larussa, Luigi Boccuto, Christian Zanza, Yaroslava Longhitano, Sharmila Fagoonee and Francesco Luzza
J. Clin. Med. 2021, 10(6), 1221; https://doi.org/10.3390/jcm10061221 - 16 Mar 2021
Cited by 14 | Viewed by 3193
Abstract
The first case of infection by SARS-CoV-2 (i.e., COVID-19) was officially recorded by the Italian National Health Service on 21 February 2020. Respiratory tract manifestations are the most common symptoms, such as gastrointestinal symptoms (GISs) like nausea or sickness, diarrhea, and anorexia, and [...] Read more.
The first case of infection by SARS-CoV-2 (i.e., COVID-19) was officially recorded by the Italian National Health Service on 21 February 2020. Respiratory tract manifestations are the most common symptoms, such as gastrointestinal symptoms (GISs) like nausea or sickness, diarrhea, and anorexia, and psychological effects may be reported in affected individuals. However, similar symptoms may be observed in healthy people as a consequence of an anxiety state. Methods: We analyzed GISs and anxiety state during the COVID-19 lockdown period; from 9 March 2020 to 4 May 2020. A web-based survey consisting of 131 items was administered to 354 students affiliated with the School of Medicine of the University “Magna Graecia” of Catanzaro; Italy. A set of statistical analyses was performed to analyze the relationships among the answers to assess a correlation between the topics of interest. Results: The statistical analysis showed that 54.0% of interviewed reported at least one GISs, 36.16% of which reported a positive history for familial GISs (FGISs). The 354 subjects included in our cohort may be stratified as follows: 25.99% GISs and FGISs, 27.97% GISs and no-FGISs, 10.17% no-GISs and FGISs, 35.87% no-GISs and no-FGISs. Results indicated an anxiety state for 48.9% of respondents, of which 64.74% also presented GISs. In addition, considered dietary habits, we detect the increased consumption of hypercaloric food, sweetened drinks, and alcoholic beverages. Conclusions: The increase of GISs during the lockdown period in a population of medical students, may be correlated to both dietary habits and anxiety state due to a concern for one’s health. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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7 pages, 908 KiB  
Article
Short-Term Outcomes of Polycarbophil and Propionibacterium acnes Lysate Gel after Open Hemorrhoidectomy: A Prospective Cohort Study
by Gaetano Gallo, Ugo Grossi, Gian Luca Di Tanna, Giulio Aniello Santoro, Gilda De Paola, Giuseppe Clerico, Alberto Realis Luc, Mario Trompetto and Giuseppe Sammarco
J. Clin. Med. 2020, 9(12), 3996; https://doi.org/10.3390/jcm9123996 - 10 Dec 2020
Cited by 2 | Viewed by 2173
Abstract
Background: Pain is the most common complication after open excisional hemorrhoidectomy (OEH). We assessed the effectiveness of polycarbophil and Propionibacterium acnes lysate gel (Emorsan®Gel) on pain control after OEH. Research design and methods: Fifty consecutive patients undergoing OEH were included. All [...] Read more.
Background: Pain is the most common complication after open excisional hemorrhoidectomy (OEH). We assessed the effectiveness of polycarbophil and Propionibacterium acnes lysate gel (Emorsan®Gel) on pain control after OEH. Research design and methods: Fifty consecutive patients undergoing OEH were included. All patients received stool softeners and oral analgesia in the post-operative period. Emorsan®Gel was also used topically by the last 25 patients (Emorsan®Gel group (EG)) until Post-Operative Day 20 (POD 20). The primary outcome was the effectiveness of Emorsan®Gel on pain relief using an 11-point visual analogue scale (VAS). Morbidity, wound healing (WH), and time to work were documented at POD 1, POD 10, POD 20, and POD 40. Results: Of the 50 patients enrolled, twenty-eight (56%) were males; median age, 49 (range, 28–73) years. The VAS score decreased over time in all patients, with significantly lower scores at POD 20 in the EG (1.44 (SD, 1.16) vs. 2.12 (0.93) in the control group (CG); p = 0.045). All patients in the EG achieved complete WH at last follow-up, compared to only 17 (68%) in the CG (p = 0.004). The likelihood of WH was 66% higher in the EG (OR, 1.66 [95%CI, 0.80–3.44; p = 0.172). Conclusions: Emorsan®Gel is safe and effective at reducing pain after EOH, promoting earlier WH compared to standard care treatment. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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10 pages, 1829 KiB  
Article
Eosinophil-Derived Neurotoxin, Tumor Necrosis Factor Alpha, and Calprotectin as Non-Invasive Biomarkers of Food Protein-Induced Allergic Proctocolitis in Infants
by Artur Rycyk, Beata Cudowska and Dariusz M. Lebensztejn
J. Clin. Med. 2020, 9(10), 3147; https://doi.org/10.3390/jcm9103147 - 29 Sep 2020
Cited by 9 | Viewed by 2566
Abstract
Diagnosis of non-IgE mediated food allergy presents a special challenge due to lack of a single, non-invasive diagnostic method. We selected three fecal biomarkers of allergic inflammation of gastrointestinal origin in order to improve the diagnostic process. Twenty-seven infants with symptoms of hematochezia [...] Read more.
Diagnosis of non-IgE mediated food allergy presents a special challenge due to lack of a single, non-invasive diagnostic method. We selected three fecal biomarkers of allergic inflammation of gastrointestinal origin in order to improve the diagnostic process. Twenty-seven infants with symptoms of hematochezia were prospectively enrolled into this study. All patients underwent a complete differential diagnosis of rectal bleeding. Non-IgE mediated food allergy was confirmed by an open, oral food challenge. The control group included twenty-five infants with functional gastrointestinal disorders. Eosinophil-derived neurotoxin (EDN), tumor necrosis factor alpha (TNFα), and calprotectin concentration were measured in stools of all children by enzyme-linked immunosorbent assays (ELISA) using commercial kits. Median eosinophil-derived neurotoxin and calprotectin fecal levels were significantly higher in the study group than in the control group (p < 0.05). The difference of fecal tumor necrosis factor alpha concentration between both groups was not statistically significant (p > 0.05). The best diagnostic performance was reached in a combination of fecal calprotectin (fCal) and EDN i.e., 88.9% and 84%, respectively. Fecal EDN and fCAl are reliable tools in differentiating between food protein-induced allergic proctocolitis and gastrointestinal functional disorders in infants. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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9 pages, 232 KiB  
Article
Abdominal Symptoms and Colonic Diverticula in Marfan’s Syndrome: A Clinical and Ultrasonographic Case Control Study
by Giovanni Maconi, Alessandro Pini, Elia Pasqualone, Sandro Ardizzone and Gabrio Bassotti
J. Clin. Med. 2020, 9(10), 3141; https://doi.org/10.3390/jcm9103141 - 28 Sep 2020
Cited by 2 | Viewed by 2352
Abstract
Background: Marfan’s syndrome (MFS) seems to be frequently associated with colonic diverticulosis, but the prevalence of diverticula and symptoms evocative of diverticular disease in this population are still unknown. Methods: This prospective case control study included 90 consecutive patients with MFS, 90 unselected [...] Read more.
Background: Marfan’s syndrome (MFS) seems to be frequently associated with colonic diverticulosis, but the prevalence of diverticula and symptoms evocative of diverticular disease in this population are still unknown. Methods: This prospective case control study included 90 consecutive patients with MFS, 90 unselected controls, and 90 asymptomatic subjects. The clinical characteristics, including lower gastrointestinal symptoms, and ultrasonographic features of the bowel, including diverticula and thickening of the muscularis propria of the sigmoid colon, were investigated. In addition, the genotype of MFS patients was assessed. The characteristics of patients and controls were compared using parametric tests. Results: Complaints of abdominal symptoms were made by 23 (25.6%) patients with MFS and 48 (53%) control subjects (p < 0.01). Constipation and bloating were reported less frequently by MFS patients than controls (constipation: 13.3% vs. 26.6%, p = 0.039; bloating: 3.3% vs. 41.1%, p < 0.0001), while other symptoms were not significantly different. Sigmoid diverticulosis was detected in 12 (12.3%) patients with MFS, as well as in 3 (3.3%) asymptomatic healthy subjects and 4 (4.4%) random controls (p = 0.0310). The genetic variants of MFS were not correlated with symptoms or diverticula. Conclusion: Patients with MFS have a greater prevalence of diverticula, although less abdominal symptoms, compared to the general population. Symptoms and diverticula in MFS are not correlated with any genetic variant. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
10 pages, 221 KiB  
Article
Proton Pump Inhibitor Use May Increase the Risk of Diverticulitis but Not It’s Severity among Patients with Colonic Diverticulosis: A Multicenter Study
by Wisam Sbeit, Tawfik Khoury, Anas Kadah, Waseem Asadi, Amir Shahin, Ahmad Lubany, Mohammed Safadi, Haya Haddad, Ruba Abu Ahmad, Sami Abu El Hija, Rand Abboud, Mahmud Mahamid, Rinaldo Pellicano and Amir Mari
J. Clin. Med. 2020, 9(9), 2966; https://doi.org/10.3390/jcm9092966 - 14 Sep 2020
Cited by 5 | Viewed by 2629
Abstract
Colonic diverticular disease, especially diverticulitis constitutes a major cause of hospitalization and an economic burden in developed countries. Proton pump inhibitors (PPIs) are among the commonest drugs used to treat several diseases affecting the upper gastrointestinal tract. A few studies have reported that [...] Read more.
Colonic diverticular disease, especially diverticulitis constitutes a major cause of hospitalization and an economic burden in developed countries. Proton pump inhibitors (PPIs) are among the commonest drugs used to treat several diseases affecting the upper gastrointestinal tract. A few studies have reported that the use of Proton Pump Inhibitors PPIs caused dysbiosis. In this study, we searched for a relationship between PPI use and the onset and severity of diverticulitis in patients with colonic diverticulosis. In a retrospective study, patients who were hospitalized for documented diverticulitis were enrolled as cases and compared with a control group of patients with uncomplicated diverticulosis. Overall, 613 patients who had a diagnosis of diverticulosis were included in the study, 217 of whom had diverticulitis. After multivariate analysis, the non-modifiable risk factors associated with diverticulitis included: age (p < 0.0001), hypertension (p < 0.0001), chronic renal failure (p = 0.007), diabetes mellitus (p < 0.0001), and left colon location (p = 0.02). However, among the modifiable factors, only PPI use (p < 0.0001) showed a significant association. Advanced disease severity (according to Hinchey classification of diverticulitis stages II–IV) was associated with aspirin use (p = 0.0004) and pan-colonic location (p = 0.02). PPI use was the only modifiable factor significantly associated with diverticulitis, but not with its severity, among patients with diverticulosis. This observation should be confirmed in future multicenter prospective studies. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
10 pages, 237 KiB  
Article
Determinants of Sleep Quality in Inflammatory Bowel Diseases
by Marcin Sochal, Ewa Małecka-Panas, Agata Gabryelska, Renata Talar-Wojnarowska, Bartosz Szmyd, Monika Krzywdzińska and Piotr Białasiewicz
J. Clin. Med. 2020, 9(9), 2921; https://doi.org/10.3390/jcm9092921 - 10 Sep 2020
Cited by 31 | Viewed by 2981
Abstract
The causes of disordered sleep, frequently reported by patients with inflammatory bowel diseases (IBD), are poorly understood. The study aimed to evaluate sleep quality in IBD patients and to identify factors affecting their sleep. IBD patients (n = 133) and healthy controls (HC; [...] Read more.
The causes of disordered sleep, frequently reported by patients with inflammatory bowel diseases (IBD), are poorly understood. The study aimed to evaluate sleep quality in IBD patients and to identify factors affecting their sleep. IBD patients (n = 133) and healthy controls (HC; n = 57) were included in the study and completed sleep questionnaires (Pittsburgh Sleep Quality Index (PSQI), Athens insomnia scale (AIS), and Epworth sleepiness scale (ESS)), Beck Depression Inventory (BDI), and pain scales (Visual Analogue Scale and Laitinen Pain Scale). IBD patients attained higher scores in all sleep questionnaires compared to HC: PSQI, AIS, and ESS (all p < 0.001). They also had prolonged sleep latency (p < 0.001) with reduced sleep efficiency (p < 0.001). Patients in exacerbation of IBD had higher scores in PSQI (p = 0.008), ESS (p = 0.009), but not in AIS, compared to those in remission. Participants with comorbid chronic diseases had higher scores in PSQI and AIS, but not in ESS, compared to others. Multiple regression revealed that the sleep questionnaire results were significantly affected by mood level (BDI), but not by the aforementioned pain scales. Sleep impairment in IBD patients is a common problem that deserves attention in everyday clinical practice and mood level seems to be the main factor affecting the quality of sleep in IBD patients. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
10 pages, 510 KiB  
Article
Effect of Vedolizumab on Anemia of Chronic Disease in Patients with Inflammatory Bowel Diseases
by Patrizio Scarozza, Elena De Cristofaro, Ludovica Scucchi, Irene Rocchetti, Irene Marafini, Benedetto Neri, Silvia Salvatori, Livia Biancone, Emma Calabrese and Giovanni Monteleone
J. Clin. Med. 2020, 9(7), 2126; https://doi.org/10.3390/jcm9072126 - 6 Jul 2020
Cited by 3 | Viewed by 1974
Abstract
Background: Anemia of Chronic Disease (ACD) can negatively influence the clinical course of Inflammatory Bowel Disease (IBD) patients. The aim of this study was to evaluate the effect of Vedolizumab on ACD in IBD. Methods: Clinical data of 75 IBD patients (25 Crohn’s [...] Read more.
Background: Anemia of Chronic Disease (ACD) can negatively influence the clinical course of Inflammatory Bowel Disease (IBD) patients. The aim of this study was to evaluate the effect of Vedolizumab on ACD in IBD. Methods: Clinical data of 75 IBD patients (25 Crohn’s disease (CD) and 50 Ulcerative Colitis (UC)) receiving Vedolizumab in a tertiary referral IBD center were retrospectively evaluated and the effect of the drug on ACD was ascertained at weeks 14 and 24. Results: ACD was diagnosed in 35 (11 CD and 24 UC) out of 75 (47%) IBD patients. At both week 14 and week 24, improvements and resolutions of ACD were achieved by 13/35 (37%) and 11/35 (31%) patients, respectively. Baseline demographic/clinical characteristics did not differ between patients with ACD improvements/resolutions and those with persistent ACD. Clinical response occurred more frequently in patients who achieved ACD resolution (10/11, 91%) than in those without ACD improvement (5/11, 45%, p = 0.022). When analysis was restricted to anemic patients, ACD resolution was documented in 10/22 patients (45%) achieving clinical response and 1/13 of non-responders (8%; p = 0.02). Conclusions: ACD occurs in half of the IBD patients and, in nearly two thirds of them, Vedolizumab treatment associates with ACD resolution/improvement. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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Review

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13 pages, 650 KiB  
Review
Autoimmune Diseases of Digestive Organs—A Multidisciplinary Challenge: A Focus on Hepatopancreatobiliary Manifestation
by Lumir Kunovsky, Petr Dite, Petr Jabandziev, Zdenek Kala, Jitka Vaculova, Tomas Andrasina, Matej Hrunka, Martina Bojkova and Jan Trna
J. Clin. Med. 2021, 10(24), 5796; https://doi.org/10.3390/jcm10245796 - 11 Dec 2021
Cited by 3 | Viewed by 3828
Abstract
It is well known that some pathological conditions, especially of autoimmune etiology, are associated with the HLA (human leukocyte antigen) phenotype. Among these diseases, we include celiac disease, inflammatory bowel disease, autoimmune enteropathy, autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cholangitis. Immunoglobulin [...] Read more.
It is well known that some pathological conditions, especially of autoimmune etiology, are associated with the HLA (human leukocyte antigen) phenotype. Among these diseases, we include celiac disease, inflammatory bowel disease, autoimmune enteropathy, autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cholangitis. Immunoglobulin G4-related diseases (IgG4-related diseases) constitute a second group of autoimmune gastrointestinal, hepatobiliary and pancreatic illnesses. IgG4-related diseases are systemic and rare autoimmune illnesses. They often are connected with chronic inflammation and fibrotic reaction that can occur in any organ of the body. The most typical feature of these diseases is a mononuclear infiltrate with IgG4-positive plasma cells and self-sustaining inflammatory response. In this review, we focus especially upon the hepatopancreatobiliary system, autoimmune pancreatitis and IgG4-related sclerosing cholangitis. The cooperation of the gastroenterologist, radiologist, surgeon and histopathologist is crucial for establishing correct diagnoses and appropriate treatment, especially in IgG4 hepatopancreatobiliary diseases. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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11 pages, 265 KiB  
Review
Clinical Relevance of Helicobacter pylori Infection
by Irena Mladenova
J. Clin. Med. 2021, 10(16), 3473; https://doi.org/10.3390/jcm10163473 - 6 Aug 2021
Cited by 39 | Viewed by 7242
Abstract
Helicobacter pylori (H. pylori) is a Gram-negative helical, microaerophilic bacterium which colonizes the antrum and body of the stomach, surviving in its harsh environment through mechanisms of acid resistance and colonization factors. It infects approximately 50% of the world population. Although the prevalence [...] Read more.
Helicobacter pylori (H. pylori) is a Gram-negative helical, microaerophilic bacterium which colonizes the antrum and body of the stomach, surviving in its harsh environment through mechanisms of acid resistance and colonization factors. It infects approximately 50% of the world population. Although the prevalence of this infection varies from country to country, as well as between different ethnic, social or age groups, it is estimated that about 50% of the human population only carries this microorganism. While H. pylori has been found to play a major etiological and pathogenic role in chronic gastritis, peptic ulcer disease and gastric cancer, its importance for many types of extra-gastric disease needs to be further investigated. The choice of tests to diagnose H. pylori infection, defined as invasive or non-invasive, depends on the clinical indication as to whether to perform upper gastrointestinal endoscopy. Focusing on bacterial eradication, the treatment should be decided locally based on the use of antibiotics and documented antibiotic resistance. The author provides an overview of the current state of knowledge about the clinical aspects of H. pylori infection, especially its diagnostic and therapeutic management. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
13 pages, 710 KiB  
Review
Management of Dyspepsia and Gastroparesis in Patients with Diabetes. A Clinical Point of View in the Year 2021
by Silvia Bonetto, Gabriella Gruden, Guglielmo Beccuti, Arianna Ferro, Giorgio Maria Saracco and Rinaldo Pellicano
J. Clin. Med. 2021, 10(6), 1313; https://doi.org/10.3390/jcm10061313 - 23 Mar 2021
Cited by 10 | Viewed by 4676
Abstract
Diabetes mellitus is a widespread disease, and represents an important public health burden worldwide. Together with cardiovascular, renal and neurological complications, many patients with diabetes present with gastrointestinal symptoms, which configure the so-called diabetic enteropathy. In this review, we will focus on upper [...] Read more.
Diabetes mellitus is a widespread disease, and represents an important public health burden worldwide. Together with cardiovascular, renal and neurological complications, many patients with diabetes present with gastrointestinal symptoms, which configure the so-called diabetic enteropathy. In this review, we will focus on upper gastrointestinal symptoms in patients with diabetes, with particular attention to dyspepsia and diabetic gastroparesis (DG). These two clinical entities share similar pathogenetic mechanisms, which include autonomic neuropathy, alterations in enteric nervous system and histological abnormalities, such as interstitial cells of Cajal depletion. Moreover, the differential diagnosis may be challenging because of overlapping clinical features. Delayed gastric emptying should be documented to differentiate between DG and dyspepsia and it can be assessed through radioactive or non-radioactive methods. The clinical management of dyspepsia includes a wide range of different approaches, above all Helicobacter pylori test and treat. As regards DG treatment, a central role is played by dietary modification and glucose control and the first-line pharmacological therapy is represented by the use of prokinetics. A minority of patients with DG refractory to medical treatment may require more invasive therapeutic approaches, including supplemental nutrition, gastric electric stimulation, pyloromyotomy and gastrectomy. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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15 pages, 2548 KiB  
Review
Diagnosing Constipation Spectrum Disorders in a Primary Care Setting
by Joel Heidelbaugh, Nicole Martinez de Andino, David Pineles and David M. Poppers
J. Clin. Med. 2021, 10(5), 1092; https://doi.org/10.3390/jcm10051092 - 5 Mar 2021
Cited by 5 | Viewed by 6156
Abstract
Understanding pathophysiological causes of constipation is worthwhile in directing therapy and improving symptoms. This review aims to identify and fill gaps in the understanding of the pathophysiology of constipation, understand its prevalence, review diagnostic tools available to primary care physicians (PCPs), and highlight [...] Read more.
Understanding pathophysiological causes of constipation is worthwhile in directing therapy and improving symptoms. This review aims to identify and fill gaps in the understanding of the pathophysiology of constipation, understand its prevalence, review diagnostic tools available to primary care physicians (PCPs), and highlight patients’ expectations for the management of this common spectrum of disorders. Literature searches conducted via PubMed included terms related to constipation, diagnosis, and patient perceptions. Case studies were developed to highlight the differences between patients who may be appropriately managed in the primary care setting and those requiring specialty consultation. Myriad pathophysiological factors may contribute to constipation, including stool consistency, altered intestinal motility, gut microbiome, anorectal abnormalities, as well as behavioral and psychological factors. Common diagnoses of “primary constipation” include slow-transit constipation, defecation disorders, irritable bowel syndrome with constipation, and chronic idiopathic constipation. A detailed medical history should be conducted to exclude alarm features and PCPs should be familiar with pathophysiological factors that cause constipation, available diagnostic tools, alarm signs, and the various classification criteria for constipation subtypes in order to diagnose and treat patients accordingly. PCPs should understand when a referral to a gastroenterologist, anorectal specialist, pelvic floor physical therapist, and/or mental health specialist is appropriate. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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21 pages, 633 KiB  
Review
Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update
by Marilena Durazzo, Giulia Lupi, Francesca Cicerchia, Arianna Ferro, Federica Barutta, Guglielmo Beccuti, Gabriella Gruden and Rinaldo Pellicano
J. Clin. Med. 2020, 9(8), 2559; https://doi.org/10.3390/jcm9082559 - 7 Aug 2020
Cited by 50 | Viewed by 10161
Abstract
Gastroesophageal reflux disease (GERD) is defined by the presence of symptoms induced by the reflux of the stomach contents into the esophagus. Although clinical manifestations of GERD typically involve the esophagus, extra-esophageal manifestations are widespread and less known. In this review, we discuss [...] Read more.
Gastroesophageal reflux disease (GERD) is defined by the presence of symptoms induced by the reflux of the stomach contents into the esophagus. Although clinical manifestations of GERD typically involve the esophagus, extra-esophageal manifestations are widespread and less known. In this review, we discuss extra-esophageal manifestations of GERD, focusing on clinical presentations, diagnosis, and treatment. Common extra-esophageal manifestations of GERD include chronic cough, asthma, laryngitis, dental erosions, and gingivitis. Extra-esophageal involvement can be present also when classic GERD symptoms are absent, making the diagnosis more challenging. Although available clinical studies are heterogeneous and frequently of low quality, a trial with proton pump inhibitors can be suggested as a first-line diagnostic strategy in case of suspected extra-esophageal manifestations of GERD. Full article
(This article belongs to the Special Issue Gastrointestinal Tract Disorders)
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