Search Results (203)

Background: Rising incidence of inflammatory bowel disease (IBD) is an increasing concern among patients of young age worldwide and its most important complication is colitis-associated cancer (CAC). Vitamin D (VD) deficiency is common in IBD and inversely associated with disease activity; meanwhile, vitamin D receptor (VDR) signaling in the gut protects the mucosal epithelial barrier and inhibits inflammation in the colon. This study aims to investigate the connection between VDR expression and IBD in human colorectal tissues. Research design and methods: Using a cross-sectional analysis, this study investigated VDR nuclear immunohistochemistry expression in 35 subjects. The expression level was measured in patients with IBD, and compared with healthy controls (cut off 36.29%). Results: VDR nuclear expression was significantly down-regulated in colorectal tissues of patients with IBD, compared with controls (p = 0.025). Under-expression of VDR was more remarkable in colon cells of patients with UC (p = 0.023). These results confirm the protective role of VD for colonic mucosa in human colon as well, and suggest a benefit from VD supplementation in IBD patients. Conclusions: Our findings add to the body of evidence regarding the positive effect of VD in colorectal mucosal integrity. This study contributes in establishing one of the proposed markers related to disease activity, which can also predict the risk for complications. Full article

Hematological abnormalities are frequently linked to chronic liver disease of any etiology. About 75% of patients with advanced chronic liver disease experience anemia. The causes of anemia are complex and multifactorial, particularly in cirrhotic patients. Acute and long-term blood loss from the upper gastrointestinal tract, malnutrition, an enlarged spleen brought on by portal hypertension, hemolysis, and coagulation issues are the main causes of anemia. Alcohol, a common cause of chronic liver disease, determines anemia through direct toxicity on the bone marrow, with the suppression of hematopoiesis, through vitamin B6, B12, and folate deficiency due to low intake and malabsorption. In patients with chronic hepatitis C virus infection, antiviral drugs such as pegylated interferon and ribavirin can also cause significant anemia. The use of interferon has been linked to bone marrow toxicity, and hemolytic anemia brought on by ribavirin is a well-known dose-dependent side effect. Within six months of the infection with hepatitis B, hepatitis C, and Epstein–Barr viruses, aplastic anemia associated with hepatitis is seen. This anemia is characterized by pancytopenia brought on by hypocellular bone marrow. Esophageal varices, portal hypertensive gastropathy, and gastric antral vascular ectasia can all cause acute and chronic blood loss. These conditions can progress to iron deficiency anemia, microcytic anemia, and hypochromic anemia. Another common hematologic abnormality in liver cirrhosis is macrocytosis, with multifactorial causes. Vitamin B12 and folate deficiency are frequent in liver cirrhosis, especially of alcoholic etiology, due to increased intestinal permeability, dysbiosis, and malnutrition. Many chronic liver diseases, like viral and autoimmune hepatitis, have a chronic inflammatory substrate. Proinflammatory cytokines, including tumor necrosis factor and interleukin 1, 6, and 10, are the main factors that diminish iron availability in progenitor erythrocytes and subsequent erythropoiesis, leading to the development of chronic inflammatory, normochromic, normocytic anemia. Full article

The aim of the present study was to test a new oral contrast medium composed of natural components for the magnetic resonance (MR) imaging of small bowel diseases. Between January 2018 and June 2019, 35 patients affected by ileocolic Crohn’s disease (CD) were enrolled in the present study. Each patient underwent two sequential MR enterographies, first with the standard polyethylene glycol (PEG) water solution and, after 3 weeks, with the new natural beverage designed by our team. At the end of the administration of each oral contrast, a satisfaction survey was given to the patients to assess the palatability of both beverages. The intestinal distention and the quality of images were evaluated by two expert radiologists for both studies and the interreader agreement was calculated. According to the satisfaction questionnaire, 97.1% of patients expressed positive judgments regarding the natural beverage (71.4% very good and 25.7% good) whereas only 8.6% of them appreciated the PEG water solution (8.6% good) (p = 0.0001). The degree of intestinal distention was excellent and good in 97.1% of patients after the administration of PEG and in 94.3% of the patients after the administration of the natural beverage, without significant differences between the two products and with almost perfect (k = 0.821) and substantial (k = 0.754) inter-observer variability, respectively. No statistical differences were observed between the two expert radiologists regarding the evaluation of the imaging quality; in particular, they were considered good and excellent in 100% of patients after the administration of PEG water solution and in 97.2% of those who took the natural beverage, with substantial (k = 0.618) and almost perfect (k = 0.858) inter-observer variability, respectively. The new natural beverage demonstrated the same intestinal distension and excellent image quality compared to the synthetic standard oral contrast administered during MRE for small bowel diseases, proving to be a valid alternative with better palatability. Full article

Background: A stoma poses numerous physical, social, and psychological challenges and interferes with some religious practices, thus potentially negatively affecting the quality of life. In the contemporary era of stoma care, the study sought to assess this impact in a population with distinctive sociocultural characteristics. Methods: A modified City of Hope Quality of Life ostomy questionnaire was used to survey patients with intestinal stomas. The scoring was dichotomous on a 0 to 10 scale, where 0–3 indicated severe impact, 4–6 moderate, and 7–10 minimum. Statistical analysis involved Student’s t-test, one-way ANOVA, Spearman’s correlation, and multivariate linear regression. Results: There were 108 patients, with 59 males and 49 females. The mean age was 40.8 years. The overall quality of life score was 6, for the social domain 7, the physical domain 6, the psychological domain 5, and the spiritual domain 6. The stoma’s impact on the quality of life was severe in 2%, moderate in 61%, and minimal in 37% of patients. Young patients, women, and those with benign diseases or without a job had low scores. Furthermore, 90% of patients had difficulty performing religious activities. For the regression analysis, life quality predictors were dietary, religious, pouch and stoma site issues, leak, odor, diarrhea or constipation, depression, anxiety, and future and disease concerns. Conclusions: Despite advances in stoma care, stoma patients had multiple impediments to their life quality. These were mainly psychological, but the physical and religious ones were also significant. A holistic approach to managing stoma patients is thus needed to help them have fulfilling lives. Full article

Chronic liver disease (CLD) is a growing concern worldwide. The common etiological factors include infection, alcohol abuse, exposure to hepatotoxic drugs, autoimmune disorders, and metabolic diseases. The chronic liver disease progresses to liver cirrhosis and its consequent complications. It is routinely managed by a combination of various therapies in combination with lifestyle modifications. The current literature supports the growing importance of the usage of herbal medicines in the management of CLD due to their efficacy and very low incidence of adverse effects. Liv.52 is a known polyherbal formulation and has been used for over 50 years in India and other countries. The evidence collected from preclinical and clinical studies supports the use of Liv.52 in symptomatic improvement and supportive treatment due to hepatitis (including Hepatitis B), alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD), and non-alcoholic steatohepatitis (NASH) and hepatotoxicity due to drugs used in the treatment of tuberculosis. Liv.52 has also shown some preliminary hepatoprotective effects in patients with liver cirrhosis due to its potential antioxidant and anti-inflammatory effects. Both the syrup and tablet formulations are well tolerated and have shown a good safety profile. Liv.52 may be a favorable herbal choice for the management of CLD due to various etiologies. Full article

The aim of this study was to investigate the predictive role of preoperative pancreatic density and muscular mass, assessed via CT imaging, in patients undergoing duodenocephalopancreasectomy, specifically in relation to the occurrence of postoperative pancreatic fistula (POPF). A retrospective analysis was conducted on a cohort of 57 consecutive patients who had been diagnosed with cephalo-pancreatic disease and had undergone duodenocephalopancreasectomy in the last five years. The most prevalent pathologies observed were ductal adenocarcinoma (29.2%), biliary adenocarcinoma (12.9%), and duodenal and papillary adenocarcinoma (13.9%). We collected information about age, sex, histopathological findings, type of surgery, presence or absence of pancreatic fistula, pancreatic density on preoperative CT images, and muscular area, calculated at the level of the L3 vertebra using “3D Slicer” software. Our data show that 28% of patients developed a pancreatic fistula, with an average attenuation of pancreatic density of 27 HU, which was lower than that observed in the non-fistula group (33.31 HU). However, statistical analysis did not reveal a significant association between low pancreatic density and fistula development. Therefore, our findings do not establish a significant association between pancreatic fistula and pancreatic density, aligning with the existing literature on the subject. Full article

Nowadays ultrasound-based non-invasive techniques for the evaluation of tissue elasticity are becoming increasingly popular. A key determinant for the adequate treatment of focal liver lesions is on establishment of accurate diagnosis. Contemporary imaging modalities, particularly ultrasonographic, are widely accepted for assessing the elasticity of focal liver lesions but the investigation of their accuracy and differentiation potential is still ongoing. Aim: To compare the values of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for liver metastases from colorectal cancer. Materials and Methods: A total of 31 adult patients with liver metastases from colorectal cancer (CRC) were included from the Department of Gastroenterology of University Hospital Kaspela, Plovdiv, Bulgaria, in the period June 2022 to November 2022. The men/women ratio of the participants was respectively 11 women and 20 men. For all of them point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) were performed to evaluate the stiffness of liver metastases, by measuring the shear wave velocity (SWV) in a region of interest (ROI). Prior histological confirmation of colorectal cancer through diagnostic lower endoscopy was a prerequisite for inclusion in the study. Contrast-enhanced computer tomography (CECT) was used as a reference imaging modality to confirm the presence of lesions in the liver. All the images were evaluated by a radiologist with long-standing experience in liver imaging. Results: For point shear wave elastography (pSWE), the lower limit was found to be 1.80 m/s (90% CI: 1.39 to 2.32) and the upper limit was 4.21 m/s (90% CI: 3.69 to 4.60). For two-dimensional shear wave elastography (2D-SWE), the lower limit was determined to be 1.87 m/s (90% CI: 1.54 to 2.25) and the upper limit was 3.65 m/s (90% CI: 3.26 to 3.97). Conclusions: Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) could bring additional information about the stiffness of liver metastases from colorectal cancer but they are not to be considered a method to substitute biopsy of colorectal cancer during lower endoscopy. Full article

Hepatitis C infection is a leading etiology of hepatic dysfunction and a major indication for liver transplantation due to the development of fibrosis, cirrhosis, and hepatocellular carcinoma. Nonalcoholic fatty liver disease (NAFLD) and, specifically, its subtype nonalcoholic steatohepatitis (NASH) is a rising cause of liver disease. It is predicted to surpass hepatitis C as a leading indication for transplant. The introduction of direct-acting antivirals (DAAs) decreased the prevalence of chronic hepatitis C infections, but the obesity epidemic and metabolic syndrome have increased the prevalence of NASH. Weight loss and dietary modifications are recommended NASH therapies, but unlike for hepatitis C, federally approved agents are lacking and currently under investigation. Clinical trials face many barriers in NASH treatment because of the difficulty of diagnosis and a lack of standardized and accurate clinical and histologic responses. Mortality and morbidity in NASH are heightened because of the presence of multiple comorbidities including cardiovascular disease, diabetes, and renal dysfunction. A liver transplant may be indicated, but a thorough screening of candidates, including a comprehensive cardiovascular assessment, is essential to ensuring successful outcomes pre- and post-transplant. Therapeutic agents for NASH are warranted before it becomes a significant and leading cause of morbidity and mortality worldwide. Full article

Background: Digestive symptoms and gastrointestinal issues in children with coronavirus 2019 disease (COVID-19) and Multisystem Inflammatory Syndrome in Children (MIS-C) are commonly reported in pediatric studies from different countries. Our retrospective observational study aimed to summarize the main digestive symptoms and objective data on gastrointestinal involvement in children with MIS-C. Methods: We present the clinical, laboratory, and imaging data of 51 children with MIS-C hospitalized in a single center from 25 November 2020 to 24 April 2021, focusing on gastrointestinal involvement. Results: A total of 46/51 children (90.2%) reported at least one abdominal symptom (abdominal pain (86%, N = 44), vomiting, nausea, diarrhea), predominantly at presentation. Most children were older than 5 years (N = 40, 78%), predominated by the male sex (N = 37, 72.5%), and with a mean age of 8.82 ± 4.16 years. We found a tendency for lymphopenia, neutrophilia, and higher levels of CRP, d-dimer, and ferritin in MIS-C patients with abdominal pain (R-squared 0.188, F-statistic vs. constant model: 11.9, p-value = 0.00122, 20% explanation of variation with p = 0.001). We found a statistically significant linear relationship (regression) between neutrophile percentage (NEU%) and hospital stay and a tendency for elevated transaminases to be more frequent in older children (27.3% under 5 years and 65% over 5 years; p = 0.0583). We found no significant associations between digestive symptoms and age or the predominant SARS-CoV-2 variant. Conclusions: Most of our MIS-C patients presented with abdominal pain, usually along with other GI symptoms, which could be applied in clinical practice to MIS-C in children visiting the emergency room with abdominal pain and evidence of recent COVID-19 contact or infection. Further information from larger cohorts of MIS-C patients is needed to better understand the epidemiology of gastrointestinal involvement in these patients. Full article

Introduction. The aetiology for the recent increase in pancreatic cancer incidence (PCI) in the US is unknown. This paper provides an epidemiological investigation of the exponential increase in PCI in young people aged 15–34 years, particularly amongst females, with a focus on the exponential rise amongst African American females, and its relationship to substance use. Methods. National pancreatic cancer data from recent reports. Tobacco, alcohol and daily cannabis use data taken from the annual nationally representative National Survey of Drug Use and Health, response rate = 74%. Results. Amongst the 15–34-year-aged cohort, PCI was found to be significantly more common in females (females: β-est. = 0.1749 p = 0.0005). African American females are noted to have the highest rates of daily cannabis use amongst females in the 26–34 and 35–49-year groups. The relationship between PCI and daily cannabis use was strongly positive across all ethnicities and in both sexes. In African American females, the Pearson correlation between daily cannabis use and PCI was R = 0.8539, p = 0.0051. In an additive multivariable model for each sex and race, cannabis was the only significant term remaining in the final model in the 15–34-year-aged cohort and thus out-performed alcohol as a risk factor. The most significant term in multivariate models was the alcohol:cannabis interaction which was highly significant in all ethnicities from p = 2.50 × 10⁻⁷ for Caucasian American females and the highest E-value pair was for Hispanic American females (E-value estimate = 1.26 × 10¹⁰² and E-value lower bound 2.20 × 10⁷⁴). Conclusion. These data show that cannabis fulfills quantitative criteria of causality in all age, sex and ethnicity cohorts, and thus explains both the recent surge in PCI and its ethnocentric predominance. Cannabis interacts powerfully genotoxically and cancerogenically with alcohol, with increases in cannabis use driving the current PCI surge. These results raise the important question as to how much cannabis might be responsible for the modern renaissance in cancer rates amongst younger people. Full article

Background and Objectives: Glucose metabolism alterations are very common in solid pancreatic lesions, particularly in pancreatic cancer. Similarly, diabetes and especially new-onset diabetes (NOD) have been associated with the malignant transformation of pancreatic cysts. We aimed to assess the prevalence and relevant associations of glycemic abnormalities in pancreatic cystic lesions (PCLs) in a retrospective analysis. Materials and Methods: We retrospectively recruited all patients who underwent endoscopic ultrasound for a PCL over a period of 36 months (January 2018 to December 2021). Final diagnosis was set by means of tissue acquisition, surgery, follow-up, or board decision. Demographic and clinical data, laboratory workup, and imaging features were extracted from the patients’ charts according to a predefined protocol. We considered fasting blood glucose (FBG) and HbA1c values and stratified the patients as nondiabetic (FBG ≤ 99 mg/dL, HbA1c ≤ 5.6%, no history of glycemic abnormalities), prediabetic (FBG 100–125 mg/dL, HbA1c 5.7–6.4%), or diabetic (long-lasting diabetes or NOD). Results: Altogether, 81 patients were included, with a median age of 66 years, and 54.3% of them were male. The overall prevalence of fasting hyperglycemia was 54.3%, comprising 34.6% prediabetes and 22.2% diabetes, of which 16.7% had NOD. The mean FBG and HbA1c levels were higher in malignant and premalignant PCLs (intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), cystadenocarcinoma, and cystic neuroendocrine tumor) compared to the benign lesions (pseudocysts, walled-off necrosis, and serous cystadenoma): 117.0 mg/dL vs. 108.3 mg/dL and 6.1% vs. 5.5%, respectively. Conclusions: Hyperglycemia and diabetes are common in PCLs, with a high prevalence in premalignant and malignant cysts. Screening and follow-up for glycemic abnormalities should be routinely conducted for PCLs, as they can contribute to a tailored risk assessment of cysts. Full article

Despite the fact that gastric syphilis is considered rare, it is reported as a type of organic involvement that is present in a large proportion of secondary syphilis cases, even though gastritis presenting with symptoms is extremely rare. Clinical, radiological, and endoscopic findings are non-specific and frequently mimic the symptoms of gastric adenocarcinoma or lymphoma, making diagnosis difficult. Immunostaining is required for this diagnosis. We would like to emphasize the importance of being suspicious of GS when a gastric mass exhibits the histologic features of an inflammatory pseudotumor (IPT), as previously reported for nodal IPT caused by luetic infection. We described a 56-year-old man who presented to the oncology department with a 3-month history of anorexia, epigastric pain, nausea, vomiting, and weight loss, as well as an initial radiological and endoscopic suspicion of gastric adenocarcinoma, in which immune staining allowed us to diagnose GS. In addition, we conducted an updated scoping review of the scientific literature to show the clinical, laboratory, and therapeutic findings in GS patients over the last 65 years. Full article

Spontaneous bacterial peritonitis (SBP) is a potentially fatal complication in patients with liver cirrhosis. Early diagnosis and prompt treatment of SBP are vital to shorten hospital stays and reduce mortality. According to society guidelines, patients with cirrhosis and ascites who are admitted to the hospital should have diagnostic paracentesis. However, for various reasons, paracentesis may be delayed or not performed. Therefore, recent research has focused on identifying non-invasive parameters useful in SBP prediction which require urgent antibiotic therapy if rapid and secure paracentesis is not possible or there is insufficient experience with this method. In this review, we discuss the non-invasive methods available to predict SBP. Full article

The outbreak of the coronavirus pandemic in March 2020 has caused unprecedented pressure on public health and healthcare. The spectrum of COVID-19 onset is large, from mild cases with minor symptoms to severe forms with multi-organ dysfunction and death. In COVID-19, multiple organ damage has been described, including lung damage, acute kidney injury, liver damage, stroke, cardiovascular and digestive tract disorders. The aspects of liver injury are different, sometimes presenting with only a slight increase in liver enzymes, but sometimes with severe liver injury, leading to acute liver failure requiring liver transplantation. In patients with chronic liver disease, especially liver cirrhosis, immune dysfunction can increase the risk of infection. Immune dysfunction has a multifactorial physiopathological mechanism, implying a complement system and macrophage activation, lymphocyte and neutrophil activity dysfunction, and intestinal dysbiosis. This review aims to evaluate the most relevant studies published in the last years related to the etiopathogenetic, biochemical, and histological aspects of liver injury in patients diagnosed with COVID-19. Liver damage is more evident in patients with underlying chronic liver disease, with a significantly higher risk of developing severe outcomes of COVID-19 and death. Systemic inflammation, coagulation disorders, endothelial damage, and immune dysfunction explain the pathogenic mechanisms involved in impaired liver function. Although various mechanisms of action of SARS-CoV-2 on the liver cell have been studied, the impact of the direct viral effect on hepatocytes is not yet established. Full article

Background: Upper gastrointestinal (GI) hemorrhage, caused by acute esophageal variceal bleeding, is a common complication and a leading cause of death in patients with cirrhosis. Therefore, predicting the risk in order to employ an active management to prevent rebleeding and death is crucial. Currently, there are many prognostic scoring systems that have been proposed, but research is needed to find a valid score which can be applied in clinical practice in each country and population. Aims: To compare the value of ALBI (Albumin-Bilirubin), PALBI (Platelet Albumin-Bilirubin), AIMS65, model for end-stage liver disease (MELD), and Child–Pugh scores (CPS) approaches in predicting early rebleeding and in-hospital mortality of acute variceal bleeding in patients with cirrhosis. Subjects and methods: We performed a cross-sectional descriptive study on cirrhotic patients with acute variceal bleeding who were being treated at the Department of Gastroenterology, Intensive care unit—Military Hospital 103 and the Institute for Treatment of Digestive Diseases—108 Military Central Hospital from September 2020 to May 2022. We calculated ALBI, PALBI, AIMS65, MELD, Child–Pugh values and compared them with the rates of early rebleeding and in-hospital mortality. Then, determined and compared the prognostic value through an analysis of the area under the curve (AUC). Results: 222 patients with acute esophageal variceal bleeding were eligible for inclusion in the study. The rates of rebleeding and in-hospital mortality were 9.0% and 6.8%, respectively. Regarding the prognosis of early rebleeding, the ALBI and PALBI scores have good prognostic value (AUROC 0.74; 95% CI: 0.63–0.85 and AUROC 0.7; 95% CI: 0.59–0.81; p = 0.004, respectively), while the Child–Pugh, MELD, AIMS65 scores have little prognostic value, with AUROC < 0.70. Regarding prognosis of in-hospital mortality: the ALBI, PALBI, MELD and AIMS65 all have good value in predicting in-hospital mortality, with AUROC of 0.81 (95% CI: 0.68–0.93, respectively; p < 0.001); 0.8 (95% CI: 0.69–0.91; p <0.001); 0.83 (95% CI: 0.72–0.93; p < 0.001); and 0.82 (95% CI: 0.76–0.87, p < 0.001), respectively. While Child–Pugh score only has medium prognostic value, with AUROC 0.79 (95% CI: 0.66–0.92; p < 0.05). However, there was no significant difference between these prognostic scoring systems. Conclusion: the ALBI, PALBI, MELD and AIMS65 scores all had similar good value in predicting in-hospital mortality, but with early rebleeding prognosis, only ALBI and PALBI had good value. CPS does not show prognostic value like other scores, both in predicting early rebleeding and in-hospital mortality. Full article