Gastroenterology Insights

10 pages, 569 KiB

Open AccessArticle

A Convenience Sample Looking at Microbiome Differences Between Anxious and Non-Anxious Patients in a GI Clinic

by Sabine Hazan, Mathilda von Guttenberg, Adriana C. Vidal, Norman M. Spivak and Alexander Bystritsky

Gastroenterol. Insights 2024, 15(4), 1054-1063; https://doi.org/10.3390/gastroent15040072 - 9 Dec 2024

Abstract

Background: The gut–brain axis, significantly influenced by the gut microbiome, is a growing focus in mental health research. This study aimed to investigate gut microbiome differences between anxious and non-anxious participants. Methods: A convenience sample of 119 participants consisted of 56 [...] Read more.

Background: The gut–brain axis, significantly influenced by the gut microbiome, is a growing focus in mental health research. This study aimed to investigate gut microbiome differences between anxious and non-anxious participants. Methods: A convenience sample of 119 participants consisted of 56 participants with self-assessed low to zero levels of anxiety and 63 with self-assessed mild to severe levels of anxiety, using the self-rated Generalized Anxiety Disorder 7-item (GAD-7) test. Fresh stool samples were collected for bacterial DNA extraction. DNA library preparation was performed using shotgun methodology, sequenced with the NextSeq 500/550 High Output v2.5 300 cycle kit, and mapped using minimap2. Bioinformatics analysis was conducted using One Codex. Results: The study participants were all of white race/ethnicity and the mean age, 54 (anxious group) vs. 55 (non-anxious) yr old, was not different between groups (p = 0.75). In the anxious group, 33% were females versus 25% in the non-anxious group, p = 0.46. Six percent of the anxious group reported a prior diagnosis of depression and 8% had irritable bowel syndrome, compared to none in the non-anxious group (p = 0.02, p = 0.006, respectively). Mann–Whitney tests revealed higher relative abundances of the genera Clostridioides (p = 0.011) and Bacteroides (p = 0.002) in the anxious group. Conversely, the anxious group had lower levels of the genera Bifidobacterium (p = 2.118 × 10⁻¹⁰), Faecalibacterium (p = 0.020), and the Phylum Actinobacteria (p = 1.516 × 10⁻⁸). Conclusions: Our findings corroborate previous studies, showing significant gut microbiome differences between anxious individuals and their non-anxious counterparts. These results support further exploration of microbiome-centric anxiety research. Full article

(This article belongs to the Section Gastrointestinal Disease)

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26 pages, 948 KiB

Open AccessReview

Non-Alcoholic Fatty Liver Disease, Awareness of a Diagnostic Challenge—A Clinician’s Perspective

by Cristina Maria Marginean, Denisa Pirscoveanu, Sergiu Marian Cazacu, Marian Sorin Popescu, Iulia Cristina Marginean, George Alexandru Iacob and Mihaela Popescu

Gastroenterol. Insights 2024, 15(4), 1028-1053; https://doi.org/10.3390/gastroent15040071 - 5 Dec 2024

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease globally. NAFLD is a complex pathology, considered to be the hepatic expression of metabolic syndrome (MetS). It is supposed to become the main indication for liver transplantation in the coming [...] Read more.

Non-alcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease globally. NAFLD is a complex pathology, considered to be the hepatic expression of metabolic syndrome (MetS). It is supposed to become the main indication for liver transplantation in the coming years and is estimated to affect 57.5–74.0% of obese people, 22.5% of children and 52.8% of obese children, with 50% of individuals with type 2 diabetes being diagnosed with NAFLD. Recent research has proved that an increase in adipose tissue insulin resistance index is an important marker of liver injury in patients with NAFLD. Despite being the main underlying cause of incidental liver damage and a growing worldwide health problem, NAFLD is mostly under-appreciated. Currently, NAFLD is considered a multifactorial disease, with various factors contributing to its pathogenesis, associated with insulin resistance and diabetes mellitus, but also with cardiovascular, kidney and endocrine disorders (polycystic ovary syndrome, hypothyroidism, growth hormone deficiency). Hepatitis B and hepatitis C, sleep apnea, inflammatory bowel diseases, cystic fibrosis, viral infections, autoimmune liver diseases and malnutrition are some other conditions in which NAFLD can be found. The aim of this review is to emphasize that, from the clinician’s perspective, NAFLD is an actual and valuable key diagnosis factor for multiple conditions; thus, efforts need to be made in order to increase recognition of the disease and its consequences. Although there is no global consensus, physicians should consider screening people who are at risk of NAFLD. A large dissemination of current concepts on NAFLD and an extensive collaboration between physicians, such as gastroenterologists, internists, cardiologists, diabetologists, nutritionists and endocrinologists, is equally needed to ensure we have the knowledge and resources to address this public health challenge. Full article

(This article belongs to the Section Liver)

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14 pages, 713 KiB

Open AccessReview

The Role of Artificial Intelligence in Endoscopic Ultrasound for Pancreatic Diseases

by Ancuța Năstac, Alexandru Constantinescu, Octavian Andronic, Dan Nicolae Păduraru, Alexandra Bolocan and Bogdan Silviu Ungureanu

Gastroenterol. Insights 2024, 15(4), 1014-1027; https://doi.org/10.3390/gastroent15040070 - 27 Nov 2024

Abstract

The integration of artificial intelligence (AI) into healthcare, particularly in the field of gastroenterology, marks a significant advancement in the diagnosis and treatment of pancreatic disorders. This narrative review explores the application of AI in enhancing Endoscopic Ultrasound (EUS) imaging techniques for pancreatic [...] Read more.

The integration of artificial intelligence (AI) into healthcare, particularly in the field of gastroenterology, marks a significant advancement in the diagnosis and treatment of pancreatic disorders. This narrative review explores the application of AI in enhancing Endoscopic Ultrasound (EUS) imaging techniques for pancreatic pathologies, focusing on developments over the past decade. Through a comprehensive literature search across several scientific databases, including PubMed, Google Scholar, and Web of Science, this paper selects and analyzes 50 studies that highlight the role, benefits, precision rates, and limitations of AI in EUS. The findings suggest that AI not only improves the quality of endoscopic procedures, as acknowledged by a majority of gastroenterologists in the UK and USA, but also offers a promising future for medical diagnostics and treatment, potentially addressing the shortage of specialists and reducing morbidity and mortality rates. Despite AI’s infancy in clinical applications and the ethical concerns regarding data privacy, its integration into EUS has enhanced diagnostic accuracy and provided minimally invasive therapeutic alternatives. This review underscores the necessity for further clinical data to evaluate the applicability and reliability of AI in healthcare, advocating for a collaborative approach between physicians and AI technologies to revolutionize the traditional clinical diagnosis and expand treatment possibilities in gastroenterology. Full article

(This article belongs to the Section Gastrointestinal and Hepato-Biliary Imaging)

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16 pages, 916 KiB

Open AccessReview

The Esophageal Microbiota in Esophageal Health and Disease

by Erica Bonazzi, Greta Lorenzon, Daria Maniero, Caterina De Barba, Luisa Bertin, Brigida Barberio, Renato Salvador, Michele Valmasoni, Fabiana Zingone, Matteo Ghisa and Edoardo Vincenzo Savarino

Gastroenterol. Insights 2024, 15(4), 998-1013; https://doi.org/10.3390/gastroent15040069 - 20 Nov 2024

Abstract

The esophagus, traditionally viewed as a sterile conduit, is now recognized as a dynamic habitat for diverse microbial communities. The emerging evidence suggests that the esophageal microbiota plays an important role in maintaining esophageal health and contributing to disease. The aim of this [...] Read more.

The esophagus, traditionally viewed as a sterile conduit, is now recognized as a dynamic habitat for diverse microbial communities. The emerging evidence suggests that the esophageal microbiota plays an important role in maintaining esophageal health and contributing to disease. The aim of this systematic review was to synthesize the current knowledge on the esophageal microbiota composition, its variation between healthy individuals and those with esophageal diseases, and the potential mechanisms through which these microorganisms influence esophageal pathology. A systematic literature search was conducted using multiple databases, including PubMed, Scopus, and Web of Science, to identify relevant studies published up to July 2024. The inclusion criteria encompassed original research articles that used molecular techniques to characterize the esophageal microbiota in human subjects, comparing healthy individuals with patients affected by esophageal conditions such as gastroesophageal reflux disease (GERD), Barrett’s esophagus, eosinophilic esophagitis, and esophageal cancer. The primary outcomes were the composition and diversity of the esophageal microbiota, and the secondary outcomes included the correlations between microbial profiles and disease states. The esophageal microbiota of healthy individuals was dominated by Gram-positive bacteria, particularly Streptococcus. Conversely, the esophageal microbiota is considerably altered in disease states, with decreased microbial diversity and specific microbial signatures associated with these conditions, which may serve as biomarkers for disease progression and as targets for therapeutic intervention. However, the heterogeneous study designs, populations, and analytical methods underscore the need for standardized approaches in future research. Understanding the esophageal microbiota’s role in health and disease could guide microbiota-based diagnostics and treatments, offering novel avenues for managing esophageal conditions. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Gastrointestinal Disorders)

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22 pages, 8420 KiB

Open AccessReview

CT and MR Imaging of Hepatocellular Carcinoma and Liver Cirrhosis

by Masahiro Okada, Ryoji Aoki, Yujiro Nakazawa, Kenichiro Tago and Kazushi Numata

Gastroenterol. Insights 2024, 15(4), 976-997; https://doi.org/10.3390/gastroent15040068 - 5 Nov 2024

Abstract

Liver masses are routinely evaluated using ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). MRI may be used for further investigation in cases with atypical findings and difficult diagnoses. Hepatocellular carcinoma (HCC) is a common malignancy, and it is important to [...] Read more.

Liver masses are routinely evaluated using ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). MRI may be used for further investigation in cases with atypical findings and difficult diagnoses. Hepatocellular carcinoma (HCC) is a common malignancy, and it is important to know the exact spread and number of HCCs, as there are numerous treatment options. In addition, it is important to know how the differentiations of HCCs are reflected on the images, and what the subtypes of HCCs look like on the images. Elastography with US and MRI is increasingly used to measure liver stiffness, and non-invasive assessment of liver fibrosis is also possible. This review describes the diagnosis of HCC on commonly used CT and MRI, and also touches on the frontiers of imaging diagnosis of liver parenchymal changes such as liver cirrhosis. Full article

(This article belongs to the Special Issue Novelties in Diagnostics and Therapeutics in Hepatology: 2nd Edition)

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13 pages, 1675 KiB

Open AccessArticle

Too Many Couch Potatoes Among Middle-Aged Inflammatory Bowel Disease Patients: Findings from the “BE-FIT-IBD-2” Study

by Antonietta Gerarda Gravina, Raffaele Pellegrino, Giovanna Palladino, Annalisa Zanini, Alessandro Federico and Fabiana Zingone

Gastroenterol. Insights 2024, 15(4), 963-975; https://doi.org/10.3390/gastroent15040067 - 4 Nov 2024

Abstract

Background: Regular physical activity (PA) is desirable, regardless of age, even in patients with chronic conditions such as inflammatory bowel disease (IBD). Aims: This study aims to assess PA levels and related barriers/facilitators in IBD patients, stratifying them into age groups (with a [...] Read more.

Background: Regular physical activity (PA) is desirable, regardless of age, even in patients with chronic conditions such as inflammatory bowel disease (IBD). Aims: This study aims to assess PA levels and related barriers/facilitators in IBD patients, stratifying them into age groups (with a threshold of 50 years). Methods: The International PA Questionnaire (IPAQ) assessed PA levels regarding resting metabolic rate (Met) in minutes per week (min/wk). Patient-reported outcomes 2 (PRO-2) evaluated disease activity. Results: Among the 237 enrolled patients, PA rates were found to differ significantly in terms of patients being sufficiently active (55% vs. 39.8%), inactive (39.6% vs. 59.1%), and engaging in health-enhancing PA (5.4% vs. 1.1%) between patients under and at least 50 years old, respectively (p < 0.001). Overall, PA levels followed this trend, being higher in younger patients [892 (446.5–1439) vs. 545.25 (257–1210.47) Met min/wk, p = 0.007]. Individuals aged at least 50 years tend to have lower PA at regression analysis (OR: 3.302, p = 0.018). Patients aged at least 50 years perceived IBD as more of a barrier to PA (p = 0.04). Bowel urgency is a significant barrier, especially in older patients (p = 0.022). Conclusions: Age is an unmodifiable factor impacting and influencing PA levels. Strategies to recover exercise levels in older IBD patients should be encouraged. Full article

(This article belongs to the Section Gastrointestinal Disease)

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19 pages, 1350 KiB

Open AccessReview

Understanding Why Metabolic-Dysfunction-Associated Steatohepatitis Lags Behind Hepatitis C in Therapeutic Development and Treatment Advances

by Caesar Ferrari, Bilal Ashraf, Zainab Saeed and Micheal Tadros

Gastroenterol. Insights 2024, 15(4), 944-962; https://doi.org/10.3390/gastroent15040066 - 30 Oct 2024

Abstract

Therapeutic development for metabolic-dysfunction-associated steatohepatitis (MASH) trails behind the success seen in hepatitis C virus (HCV) management. HCV, characterized by a viral etiology, benefits from direct-acting antivirals (DAAs) targeting viral proteins, achieving cure rates exceeding 90%. In contrast, MASH involves complex metabolic, genetic, [...] Read more.

Therapeutic development for metabolic-dysfunction-associated steatohepatitis (MASH) trails behind the success seen in hepatitis C virus (HCV) management. HCV, characterized by a viral etiology, benefits from direct-acting antivirals (DAAs) targeting viral proteins, achieving cure rates exceeding 90%. In contrast, MASH involves complex metabolic, genetic, and environmental factors, presenting challenges for drug development. Non-invasive diagnostics like ultrasound, FibroScan, and serum biomarkers, while increasingly used, lack the diagnostic accuracy of liver biopsy, the current gold standard. This review evaluates therapies for MASH, including resmetirom (Rezdiffra) and combinations like pioglitazone and vitamin E, which show potential but offer modest improvements due to MASH’s heterogeneity. The limited efficacy of these treatments highlights the need for multi-targeted strategies addressing metabolic and fibrotic components. Drawing parallels to HCV’s success, this review emphasizes advancing diagnostics and therapies for MASH. Developing effective, patient-specific therapies is crucial to closing the gap between MASH and better-managed liver diseases, optimizing care for this growing health challenge. Full article

(This article belongs to the Section Liver)

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18 pages, 376 KiB

Open AccessReview

Non-Cirrhotic Ascites: Causes and Management

by Paul Carrier, Marilyne Debette-Gratien, Jérémie Jacques and Véronique Loustaud-Ratti

Gastroenterol. Insights 2024, 15(4), 926-943; https://doi.org/10.3390/gastroent15040065 - 17 Oct 2024

Abstract

Ascites is a common syndrome characterized by an excess of fluid in the peritoneum. While cirrhosis is the most common cause, a wide range of other conditions—such as cancer, right heart failure, and tuberculosis—can also lead to ascites, and multiple etiologies may be [...] Read more.

Ascites is a common syndrome characterized by an excess of fluid in the peritoneum. While cirrhosis is the most common cause, a wide range of other conditions—such as cancer, right heart failure, and tuberculosis—can also lead to ascites, and multiple etiologies may be present simultaneously. Effective diagnosis and management are essential, primarily relying on clinical examination and paracentesis, guided by specific tests. Full article

(This article belongs to the Section Liver)

14 pages, 775 KiB

Open AccessArticle

Nutritional Status, Diet, and Intestinal Permeability of Mexican Children with Autism Spectrum Disorders

by Karina Alejandra Pedroza-García, Miriam Aracely Anaya-Loyola, Dolores Ronquillo, María del Carmen Caamaño, David Masuoka, Jorge Palacios-Delgado and Jorge L. Rosado

Gastroenterol. Insights 2024, 15(4), 912-925; https://doi.org/10.3390/gastroent15040064 - 16 Oct 2024

Abstract

Introduction: Autism spectrum disorder (ASD) comprises a group of developmental disorders characterized by deficits in social interaction and behavioral patterns. Children with ASD may face nutritional challenges, primarily due to their restrictive behaviors and frequent gastrointestinal issues. Objective: The objective of the present [...] Read more.

Introduction: Autism spectrum disorder (ASD) comprises a group of developmental disorders characterized by deficits in social interaction and behavioral patterns. Children with ASD may face nutritional challenges, primarily due to their restrictive behaviors and frequent gastrointestinal issues. Objective: The objective of the present study was to assess nutritional status, dietary habits, and intestinal permeability in a sample of individuals with ASD. Methods: A cross-sectional study was conducted with 24 children and adolescents (both sexes), aged 4 to 18 years, living in two cities of Mexico (Aguascalientes and Querétaro). Weight and height were measured, and body mass index for age was calculated and compared using WHO Z-scores. Diet was assessed through three 24 h dietary recalls and a food frequency questionnaire. Intestinal permeability was evaluated using a lactulose/mannitol test by HPLC. Results: A high prevalence of malnutrition was observed; 12.5% of the participants were underweight, and 45.8% were overweight or obese. Children had a low intake of fiber, vitamin E, folate, potassium, zinc, and phosphorus and a high intake of sodium. On average, the intestinal permeability ratio was 0.09 ± 0.05, with 54.2% of the children exhibiting high intestinal permeability. Conclusions: It is advisable to develop food counseling strategies for children with ASD to prevent micronutrient deficiencies, promote healthy weight, and improve gastrointestinal integrity. Full article

(This article belongs to the Section Gastrointestinal Disease)

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8 pages, 5345 KiB

Open AccessCase Report

Laparoscopic Splenectomy for a Congenital Epidermoid Cyst in a 15-Year-Old Child—Case Report

by Denitza Kofinova, Yanko Pahnev, Edmond Rangelov, Ivan Vasilevski, Olga Bogdanova, Elena Ilieva and Hristo Shivachev

Gastroenterol. Insights 2024, 15(4), 904-911; https://doi.org/10.3390/gastroent15040063 - 13 Oct 2024

Abstract

Splenic epidermoid cysts are rare benign congenital tumors. However, if the cyst is not completely removed, it can reoccur. Laparoscopic splenectomy in children is being conducted more often, but it is a therapeutic challenge in cases of a giant cyst. We report a [...] Read more.

Splenic epidermoid cysts are rare benign congenital tumors. However, if the cyst is not completely removed, it can reoccur. Laparoscopic splenectomy in children is being conducted more often, but it is a therapeutic challenge in cases of a giant cyst. We report a case of a 15-year-old girl who presented with nausea, anorexia and abdominal pain. The ultrasound showed a giant well-defined hypoechoic cyst with diffuse internal echoes. Computed tomography revealed a cystic mass (92/124/102 mm) without contrast enhancement. Anti-Echinococcus ELISA IgG was negative, and serum tumor markers CA 19-9 79.1 U/mL (N < 34) and CA-125 39.6 U/ML (N < 35) were elevated. Before the operation, the girl was vaccinated for Haemophilus influenzae, Pneumococci and Meningococci. Laparoscopic splenectomy was performed. The patient’s postoperative course was uneventful. Histopathology indicated a cyst walled by multilayered squamous epithelium positive for cytokeratin AE1/AE3. The diagnosis epidermoid cyst was confirmed. Full article

(This article belongs to the Section Gastrointestinal Disease)

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9 pages, 258 KiB

Open AccessArticle

The Effect of Body Composition on Osteoporosis Risk in Adults with Celiac Disease

by Kinga Skoracka, Michał Michalak, Alicja Ewa Ratajczak-Pawłowska, Anna Maria Rychter, Agnieszka Zawada, Agnieszka Dobrowolska and Iwona Krela-Kaźmierczak

Gastroenterol. Insights 2024, 15(4), 895-903; https://doi.org/10.3390/gastroent15040062 - 4 Oct 2024

Abstract

Background: Celiac disease (CD) has been linked with increased susceptibility to osteoporosis; therefore, we aimed to explore whether, in a group of patients with CD, body composition parameters impact bone parameters. Methods: This study covered 56 adults—47 women and 9 men—with CD, and [...] Read more.

Background: Celiac disease (CD) has been linked with increased susceptibility to osteoporosis; therefore, we aimed to explore whether, in a group of patients with CD, body composition parameters impact bone parameters. Methods: This study covered 56 adults—47 women and 9 men—with CD, and 20 healthy controls—16 women and 4 men. Densitometry of the lumbar spine (L1–L4) and femoral neck (FN) was conducted using dual-energy X-ray absorptiometry (DXA). Body mass was measured by bioimpedance method. Furthermore, serum 25(OH)D and ionized calcium concentration were determined. Results: We found osteopenia in the FN in 19.65% of patients and in L1–L4 in 26.79% of the patients. One patient displayed evidence of osteoporosis in the L1–L4 region, while two patients (3.57%) exhibited similar findings in the FN. Significant positive correlations were observed between bone mineral density (BMD) and body mass, fat-free mass (FFM), muscle mass, and basal metabolic rate (BMR) for both L1–L4 and the FN, and body mass index (BMI) of L1–L4. Conclusions: In conclusion, people with CD are at an increased risk of decreased BMD. Patients with lower body mass, FFM, muscle mass, BMI, and BMR more often present with osteopenia and osteoporosis. Full article

(This article belongs to the Special Issue Feature Papers in Celiac Disease)

17 pages, 1053 KiB

Open AccessReview

Nutritional Consequences of Celiac Disease and Gluten-Free Diet

by Paola Ilaria Bianchi, Nicola Aronico, Giovanni Santacroce, Giacomo Broglio, Marco Vincenzo Lenti and Antonio Di Sabatino

Gastroenterol. Insights 2024, 15(4), 878-894; https://doi.org/10.3390/gastroent15040061 - 27 Sep 2024

Abstract

Celiac disease is an immune-mediated condition triggered by gluten ingestion in genetically predisposed individuals. The global prevalence of celiac disease is significant, affecting approximately 1.4% of women and 0.7% of men, with incidence rates of 17.4 and 7.8 per 100,000 person-years, respectively. The [...] Read more.

Celiac disease is an immune-mediated condition triggered by gluten ingestion in genetically predisposed individuals. The global prevalence of celiac disease is significant, affecting approximately 1.4% of women and 0.7% of men, with incidence rates of 17.4 and 7.8 per 100,000 person-years, respectively. The clinical presentation of celiac disease may range from overt diarrhea and malabsorption to more subtle features such as nutritional deficiencies and extraintestinal manifestations. It is the most common cause of global malabsorption in Western countries. A life-long gluten-free diet is the only available treatment for celiac disease. Moreover, a gluten-free diet is often adopted by individuals without celiac disease, either to address non-celiac gluten sensitivity or for other reasons. This review aims to explore the current understandings of the nutritional consequences of untreated celiac disease and the impact of the gluten-free diet itself. Physicians and dietitians specializing in celiac disease should focus on providing a well-rounded nutritional scheme to address deficiencies caused by the disease and prevent the instauration of new nutritional imbalances. Full article

(This article belongs to the Special Issue Feature Papers in Celiac Disease)

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13 pages, 1100 KiB

Open AccessArticle

Resection of the Inferior Vena Cava Due to Tumor Involvement Allows Long-Term Survival in Different Neoplasms

by Isabel Jaén-Torrejimeno, Diego López-Guerra, Adela Rojas-Holguín, Antonio Enrique Gómez-Martin and Gerardo Blanco-Fernández

Gastroenterol. Insights 2024, 15(4), 865-877; https://doi.org/10.3390/gastroent15040060 - 26 Sep 2024

Abstract

Background: The involvement of the inferior vena cava in advanced abdominal tumors is a surgical challenge, given the high postoperative morbidity and poor long-term prognosis. Our goal was to analyze our experience, perioperative management, and results. Methods: We retrospectively evaluated short and long-term [...] Read more.

Background: The involvement of the inferior vena cava in advanced abdominal tumors is a surgical challenge, given the high postoperative morbidity and poor long-term prognosis. Our goal was to analyze our experience, perioperative management, and results. Methods: We retrospectively evaluated short and long-term results of surgical resections of tumors with associated inferior vena cava resection performed in our facilities between 2012 and 2023. Results: A total of 25 patients were selected for our retrospective study: 3 with renal carcinoma, 5 with sarcoma, 12 with metastatic lesions, 2 with adrenal tumors, 1 pancreatic tumor, 1 extra-adrenal paraganglioma and 1 with hepatocellular carcinoma. Postoperative severe complications (Dindo-Clavien score ≥ IIIa) affected 36% of patients and the mortality rate was 8%. Partial resection with primary repair was performed in 13 patients (52%), with patch reconstruction in 6 (24%), and vascular reconstruction with prosthesis in 6 patients (24%). The mean disease-free survival was 7 months (IQR 2.5–11.5). Graft thrombosis occurred in 2 patients during follow-up. Conclusions: In selected patients, the resection of the inferior vena cava is a complex surgery with an assumable morbimortality and relative survival improvement. Full article

(This article belongs to the Collection Advances in Gastrointestinal Cancer)

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30 pages, 2307 KiB

Open AccessSystematic Review

Therapeutic Needs of Older Adults with Inflammatory Bowel Disease (IBD): A Systematic Review

by Suja P. Davis, Rachel McInerney, Stephanie Fisher and Bethany Lynn Davis

Gastroenterol. Insights 2024, 15(3), 835-864; https://doi.org/10.3390/gastroent15030059 - 23 Sep 2024

Abstract

Background/Objective: Inflammatory bowel disease (IBD) diagnosis in the elderly falls under two categories: those diagnosed at a younger age and transitioning to the elderly group (>60 years) and those diagnosed at ≥60 years of age. Although it is difficult to calculate the incidence [...] Read more.

Background/Objective: Inflammatory bowel disease (IBD) diagnosis in the elderly falls under two categories: those diagnosed at a younger age and transitioning to the elderly group (>60 years) and those diagnosed at ≥60 years of age. Although it is difficult to calculate the incidence of IBD among elderly adults precisely, it is estimated that around 10–15% of IBD in the US are diagnosed after 60 years, and approximately 13% of IBD cases are diagnosed after the age of 65 globally. The objective of this systematic review is to assess the therapeutic needs of elderly adults with IBD, focusing on quality of life (QOL), symptom presentation, mental health management, IBD medication utilization patterns, surgical outcomes, and healthcare utilization to identify gaps in IBD management. Methods: We identified 42 published articles through a database search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses from October 2023 to June 2024. We conducted the quality appraisal of the selected studies using the Joanna Briggs Institute (JBI) critical appraisal tools. Results: Our findings indicate decreased health-related QOL, more colonic and less penetrating disease in elderly Crohn’s disease patients, and comparable symptoms between elderly and younger ulcerative colitis patients. Despite an increased trend in prescribing biologics, the elderly show decreased response rates and poor remission. Higher healthcare utilization is noted among elderly IBD patients, alongside insufficient attention to their mental health concerns. Conclusions: The findings from this systematic review offer a comprehensive synthesis of the management of elderly adults with IBD and highlight several unmet needs that warrant attention in future research and clinical practice considerations. Full article

(This article belongs to the Section Alimentary Tract)

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16 pages, 4816 KiB

Open AccessArticle

Characterization of Immune Cell Populations and Acid-Sensing Receptors in the Human Esophagus

by Marina Fortea, Leen Hacour, Francesc Sancho, Carlos Boada, Cesar Sevillano-Aguilera, Ana María. González-Castro, Eloisa Salvo-Romero, Beatriz Lobo, Danila Guagnozzi, Laurens J. Ceulemans, Jacques Pirenne, Carmen Alonso-Cotoner, Javier Santos, Ricard Farré and Maria Vicario

Gastroenterol. Insights 2024, 15(3), 819-834; https://doi.org/10.3390/gastroent15030058 - 20 Sep 2024

Abstract

Introduction: Esophageal inflammatory diseases are frequent diagnoses in clinical practice and have diverse etiologies, the most common being those associated with the exposure to gastric content, drugs and allergens. In diseases, the immunological component is well identified in endoscopic biopsies, which mainly contain [...] Read more.

Introduction: Esophageal inflammatory diseases are frequent diagnoses in clinical practice and have diverse etiologies, the most common being those associated with the exposure to gastric content, drugs and allergens. In diseases, the immunological component is well identified in endoscopic biopsies, which mainly contain the epithelium and the lamina propria; however, deeper layers are less studied. Moreover, the esophageal capacity of sensing luminal compounds is poorly understood. Methods: In transmural sections from proximal, middle and distal esophagus obtained from deceased patients, we performed a phenotypic analysis of the main immune cell populations and acid-sensing receptors by immunohistochemistry and immunofluorescence methods. Results: A total of nine donors were studied (absence of pathology, optimal tissue preservation and orientation). We found the following: (1) the vascular papillae and the lamina propria are the most infiltrated layers by the lymphoid lineage (T and B lymphocytes), followed by the epithelium, while the smooth muscular layers are mainly populated by the myeloid lineage (macrophages and mast cells); (2) intraepithelial macrophages are consistently found along the esophagus; and (3) eosinophils are absent in all the esophageal layers. The acid-sensing receptors ASIC-1, ASIC-2 and δENAC are expressed in the esophageal epithelium and in the lamina propria, yet only ASIC-2 is expressed in the muscularis mucosae. Conclusions: The human esophagus contains a differential distribution of immune cells and acid-sensing receptors across its layers. This study extends the esophageal histological knowledge previously described and reinforces its role as a defensive and sensing organ. Full article

(This article belongs to the Section Alimentary Tract)

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9 pages, 2103 KiB

Open AccessReview

Pathognomonic Signs in Pancreatic Cystic Lesions: What Gastroenterologists and Involved Clinicians Need to Know

by Alberto Martino, Luca Barresi, Francesco Paolo Zito, Michele Amata, Roberto Fiorentino, Severo Campione, Alessandro Iacobelli, Enrico Crolla, Roberto Di Mitri, Carlo Molino, Marco Di Serafino and Giovanni Lombardi

Gastroenterol. Insights 2024, 15(3), 810-818; https://doi.org/10.3390/gastroent15030057 - 12 Sep 2024

Abstract

Pancreatic cystic lesions (PCLs) have been increasingly identified in recent years, encompassing a wide spectrum ranging from benign non-evolutive to malignant invasive lesions. Despite various clinical, laboratory, imaging, endoscopic ultrasound, and cytohistological features that may aid clinicians in the complex differential diagnosis of [...] Read more.

Pancreatic cystic lesions (PCLs) have been increasingly identified in recent years, encompassing a wide spectrum ranging from benign non-evolutive to malignant invasive lesions. Despite various clinical, laboratory, imaging, endoscopic ultrasound, and cytohistological features that may aid clinicians in the complex differential diagnosis of PCLs, only a few pathognomic signs distinctive to specific PCLs have been identified. Although rarely encountered, their proper recognition is crucial for the appropriate management of PCLs. The aim of our review is to extensively discuss and illustrate pathognomic signs in the setting of PCLs. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Gastrointestinal Disorders)

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24 pages, 783 KiB

Open AccessReview

Irritable Bowel Syndrome: Current Landscape of Diagnostic Guidelines and Therapeutic Strategies

by Dareen S. Chuy, Ryan S. Wi and Micheal Tadros

Gastroenterol. Insights 2024, 15(3), 786-809; https://doi.org/10.3390/gastroent15030056 - 9 Sep 2024

Abstract

Irritable bowel syndrome (IBS) is a disorder of the gut–brain axis with pronounced adverse effects on physical health, psychological health, and overall quality of life. Diagnostic strategies can vary, highlighting a need to synthesize best-practice guidelines. Particularly, the American College of Gastroenterology and [...] Read more.

Irritable bowel syndrome (IBS) is a disorder of the gut–brain axis with pronounced adverse effects on physical health, psychological health, and overall quality of life. Diagnostic strategies can vary, highlighting a need to synthesize best-practice guidelines. Particularly, the American College of Gastroenterology and the British Society of Gastroenterology both support a positive diagnostic strategy; evaluation with C-reactive protein, fecal calprotectin, and fecal lactoferrin; and evaluation with celiac disease serology. Both guidelines do not support routine colonoscopy, and both differ in recommendations for anorectal physiology testing. Given there is currently no curative treatment available, IBS management focuses on symptomatic relief, and challenges exist in achieving and maintaining this relief. Many treatments, both pharmacologic and nonpharmacologic, exist to alleviate the uncomfortable, painful symptoms of the disorder; however, stratifying the quality of evidence behind each option is critical for application to clinical management and for tailoring this management to each patient. Lifestyle adjustments, especially in relation to diet, can be effective first-line therapies and supplements to pharmacologic therapy. Pharmacologic treatment is broadly categorized in accordance with the subtypes of IBS, with indications for different populations and mechanisms that work to target components of IBS pathophysiology. The aim of this article is to comprehensively compare updated diagnostic guidelines, review standard treatments, and outline recent pharmacologic advancements. Full article

(This article belongs to the Section Gastrointestinal Disease)

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Open AccessArticle

The Role of Macrophage Polarization-Associated Gene Expression in the Oncological Prognosis of Hepatocellular Carcinoma

by Dong Liu, Yankun Li, Guanwu Wang, Edgar Dahl, Tom Luedde, Ulf Peter Neumann and Jan Bednarsch

Gastroenterol. Insights 2024, 15(3), 764-785; https://doi.org/10.3390/gastroent15030055 - 6 Sep 2024

Abstract

Background: The induced repolarization of tumor growth-promoting M2 macrophages into tumor growth-inhibiting M1 macrophages is a matter of intensive research and is expected to lead towards a novel targetable approach in HCC therapy. Methods: Differentially expressed M2 macrophage-related genes between normal and tumor [...] Read more.

Background: The induced repolarization of tumor growth-promoting M2 macrophages into tumor growth-inhibiting M1 macrophages is a matter of intensive research and is expected to lead towards a novel targetable approach in HCC therapy. Methods: Differentially expressed M2 macrophage-related genes between normal and tumor samples with high and low M2 macrophage infiltration in the Gene Expression Omnibus (GEO) and TCGA datasets were identified. A risk score was constructed based on univariate Cox analysis and LASSO-penalized Cox regression analysis. The relationship between the different risk score groups and clinical pathological characteristics as well as immune infiltration characteristics was studied. Subsequently, a nomogram was constructed to predict patients’ prognosis. Western blot and RT-qPCR were carried out to validate the results in human HCC samples. Results: Increased M2 macrophage infiltration was associated with a shorter overall survival (OS). Four important M2 macrophage-related genes (SLC22A1, CPS1, SLC10A1, CYP2C9) were discovered to be strongly correlated with OS and M2 macrophage infiltration. A nomogram incorporating the signature and tumor stage was developed for final clinical translation. Conclusions: SLC22A1, CPS1, SLC10A1 and CYP2C9 genes are associated with tumor-promoting M2 macrophage infiltration and might be potential targets for macrophage-related immunotherapy in HCC patients. Further, this four-gene signature is a potential tool for predicting prognosis in these patients. Full article

(This article belongs to the Section Liver)

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10 pages, 278 KiB

Open AccessArticle

A Practical Approach to Identify Non-Adherence to Mesalamine Therapy in Inflammatory Bowel Disease

by Filippo Vernia, Giorgia Burrelli Scotti, Raffaele Borghini, Mario Muselli, Stefano Necozione, Giovanni Moretta, Lorenza Scurti and Giuseppe Donato

Gastroenterol. Insights 2024, 15(3), 754-763; https://doi.org/10.3390/gastroent15030054 - 30 Aug 2024

Abstract

Introduction: Adherence to mesalamine therapy in ulcerative colitis is often inadequate. This affects long-term remission and to some extent the risk of colon cancer. Means for assessing non-adherent behavior are cumbersome, expensive, and/or time consuming. Unless multiple tools are used in association, a [...] Read more.

Introduction: Adherence to mesalamine therapy in ulcerative colitis is often inadequate. This affects long-term remission and to some extent the risk of colon cancer. Means for assessing non-adherent behavior are cumbersome, expensive, and/or time consuming. Unless multiple tools are used in association, a proportion of patients with volitional and non-volitional non-adherence is nonetheless undetected. The study was aimed at evaluating to which extent rephrasing a single question on adherence to mesalamine therapy may help identifying patients who are not compliant with medication prescription. Methods: One-hundred and seventy-four inflammatory bowel disease outpatients were asked in two consecutive visits, in random order, if they “regularly assumed the prescribed dose of mesalamine” (adherence-centered question—AQ) or “how often they skipped mesalamine pills” (non-adherence centered question—NQ). Answer concordance was evaluated in relation to clinical and demographic variables. Results: The concordance between AQ and NQ was low (K = 0.22). Lower compliance to therapy was admitted in 37.4% more patients following NQ than AQ. The reported adherence to AQ was invariably higher than that of NQ, irrespective of the variable taken into consideration. The likelihood of non-concordant answers was non-significantly higher in CD patients than in UC and in patients with shorter disease duration than in those with longstanding disease, but the logistic regression model did not identify individual variables responsible for the different answers. Conclusions: Being simple and not requiring additional time expense, centering the question on medication non-adherence identifies a large proportion of patients who would not admit non-adherence or underestimate the number of skipped doses of medication, when directly asked if they are compliant to therapy. Full article

(This article belongs to the Section Gastrointestinal Disease)

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