Gastroenterology Insights

14 pages, 3227 KiB

Open AccessArticle

A Preliminary Study Examining the Correlation between EGFRI Treatment, Clinic Dermatoscopy Features, and Serum Levels of Anti-Alpha-Galactosyl IgE in Colorectal Cancer Patients

by Cristina Maria Popa, Irina Florina Cherciu Harbiyeli, Ana Maria Ciurea, Irina Mihaela Cazacu, Simona Laura Ianosi, Michael Schenker and Adrian Saftoiu

Gastroenterol. Insights 2024, 15(2), 505-518; https://doi.org/10.3390/gastroent15020037 - 17 Jun 2024

Viewed by 1287

Abstract

The introduction of molecularly targeted therapies, particularly the epidermal growth factor receptor inhibitors (EGFRIs), has had a positive impact by increasing the life expectancy of patients with advanced colorectal cancer (CRC). The most used anti-EGFRIs monoclonal antagonist, Cetuximab, induces skin responses in most [...] Read more.

The introduction of molecularly targeted therapies, particularly the epidermal growth factor receptor inhibitors (EGFRIs), has had a positive impact by increasing the life expectancy of patients with advanced colorectal cancer (CRC). The most used anti-EGFRIs monoclonal antagonist, Cetuximab, induces skin responses in most patients, leading to a reduction of dosages or even therapy discontinuation, all with devastating effects. Our study aimed to assess the predictive role and the possible correlations of clinical features, imaging aspects (dermatoscopy), and laboratory tests (anti-alpha-galactosyl IgE levels) for early detection of Cetuximab skin toxicity in patients with metastatic CRC. The association of IgE antibodies against goat alpha-1,3-galactose serum levels with various degrees of skin toxicity encountered during the oncologic treatment resulted in higher concentrations in patients with pruritus and hair changes. Incorporating dermatoscopy into the routine dermatological consultation allowed us to perform a severity assessment, dynamically record, and identify even the erupting lesions previously invisible to classical examination. Hence, we were enabled to generate a broad report and to classify various degrees of skin toxicity severity linked to Cetuximab treatment in 19 patients with metastatic CRC. Detecting the emergent lesions and initiating dermatological treatment in the early stages decreased the severity of skin toxicity. As a result, the duration of the antibiotic treatment was much shorter, and the risk of dose reduction or interruption of the cancer treatment was diminished. In conclusion, we emphasize the need for a regular dermatological examination with dermatoscopy of CRC patients undergoing Cetuximab treatment. Skin toxicity is a significant concern for these patients, and healthcare providers should be vigilant in monitoring and managing this side effect in order to optimize patient care. The correlation between anti-alpha-Gal IgE levels and Cetuximab-induced skin toxicities is an emerging area. More extensive studies need to be published in order to establish this relationship directly. Full article

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

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7 pages, 654 KiB

Open AccessCommunication

Clip Closure and PuraStat for Prevention of Clinically Significant Delayed Bleeding after Colorectal Endoscopic Submucosal Dissection: A Prospective, Observational Study

by Mihai Ciocîrlan, Dana Bilous, Andrei Gîla, Daniel-Corneliu Leucuta, Daniela Mihailă, Adrian Tulin, Anca Gheorghiu, Elena Tianu and Cătălina Vlăduț

Gastroenterol. Insights 2024, 15(2), 498-504; https://doi.org/10.3390/gastroent15020036 - 12 Jun 2024

Viewed by 1519

Abstract

Background and aims. Clinically significant delayed bleeding (CSDB) may complicate endoscopic colorectal submucosal dissection (ESD). We aimed to assess the efficacy of preventive measures for CSDB. Methods. We assessed the results of a prospective registry of colorectal ESD for laterally spreading lesions. We [...] Read more.

Background and aims. Clinically significant delayed bleeding (CSDB) may complicate endoscopic colorectal submucosal dissection (ESD). We aimed to assess the efficacy of preventive measures for CSDB. Methods. We assessed the results of a prospective registry of colorectal ESD for laterally spreading lesions. We evaluated the effect of clip closure and PuraStat application on the prevention of CSDB. Results. A total of 40 patients with 41 colorectal ESDs were included. ESD was successful in 38 lesions (92.7%), 35 with R0 resection (92.1%) and 33 with curative resection (86.8%). CSDB occurred in 3 of 38 lesions (7.9%, 95% CI [1.7–21.4%]), exclusively after rectal ESD (3 of 22 rectal lesions vs. 0 of 16 colonic lesions, p = 0.249). Clip closure was more frequently used after colonic ESD (12 of 16 colonic lesions vs. 2 of 22 rectal lesions, p < 0.001) and was not protective for CSDB in the univariate analysis, even though no events occurred after clip closure (0 of 14 lesions with clip closure vs. 3 of 24 lesions without, p = 0.283). PuraStat was more frequently applied after ESD for rectal lesions (16 of 22 rectal lesions vs. 2 of 16 colonic lesions, p < 0.001) and was not protective for CSDB, with all three events occurring after PuraStat application (3 of 18 lesions with PuraStat application vs. 0 of 20 lesions without, p = 0.097). Conclusions. CSDB occurred exclusively after rectal ESD, and no predictive factors were identified in the univariate analysis. Clip closure and PuraStat application were not protective for CSDB. Full article

(This article belongs to the Section Gastrointestinal Disease)

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12 pages, 1866 KiB

Open AccessArticle

Urinary Hydroxyproline as an Inflammation-Independent Biomarker of Inflammatory Bowel Disease

by Muriel Huss, Tanja Elger, Johanna Loibl, Arne Kandulski, Benedicta Binder, Petra Stoeckert, Patricia Mester, Martina Müller, Christa Buechler and Hauke Christian Tews

Gastroenterol. Insights 2024, 15(2), 486-497; https://doi.org/10.3390/gastroent15020035 - 6 Jun 2024

Cited by 1 | Viewed by 1008

Abstract

Predicting responses and monitoring the severity of inflammatory bowel disease (IBD) is challenging due to a lack of specific biomarkers. This study identifies urinary hydroxyproline, a marker of collagen turnover elevated in experimental colitis, as independent of conventional biomarkers like creatinine, glomerular filtration [...] Read more.

Predicting responses and monitoring the severity of inflammatory bowel disease (IBD) is challenging due to a lack of specific biomarkers. This study identifies urinary hydroxyproline, a marker of collagen turnover elevated in experimental colitis, as independent of conventional biomarkers like creatinine, glomerular filtration rate, C-reactive protein, and fecal calprotectin. Among 71 IBD patients, urinary hydroxyproline levels were significantly higher compared with 36 controls, with an area under the receiver operating characteristic curve of 0.814, highlighting its potential as a diagnostic tool. No significant difference in hydroxyproline levels was observed between the 50 Crohn’s disease and 21 ulcerative colitis patients, nor was there a correlation with kidney function markers, gastrointestinal symptom severity, or stool consistency. Disease localization was not associated with urinary hydroxyproline levels. Interestingly, 14 patients with primary sclerosing cholangitis and IBD also exhibited elevated urinary hydroxyproline levels, comparable to IBD patients but higher than healthy controls. This underscores the role of urinary hydroxyproline as an independent biomarker for IBD diagnosis, without association with disease severity or established markers like fecal calprotectin. Full article

(This article belongs to the Section Gastrointestinal Disease)

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15 pages, 669 KiB

Open AccessReview

Cytokine Signatures in Inflamed Mucosa of IBD Patients: State-of-the-Art

by Milena Peruhova, Dimitrina Miteva, Maria Kokudeva, Sonya Banova and Tsvetelina Velikova

Gastroenterol. Insights 2024, 15(2), 471-485; https://doi.org/10.3390/gastroent15020034 - 4 Jun 2024

Viewed by 1683

Abstract

The process of development, recurrence, and exacerbation of the inflammatory process depends on the cytokine levels in IBD. For that reason, many cytokine therapies have been developed for treating IBD patients. Researchers employ various techniques and methodologies for cytokine profiling to identify cytokine [...] Read more.

The process of development, recurrence, and exacerbation of the inflammatory process depends on the cytokine levels in IBD. For that reason, many cytokine therapies have been developed for treating IBD patients. Researchers employ various techniques and methodologies for cytokine profiling to identify cytokine signatures in inflamed mucosa. These include enzyme-linked immunosorbent assays (ELISA), multiplex immunoassays, flow cytometry, and gene expression analysis techniques (i.e., microarray, RNA-seq, single-cell RNA-seq (scRNA-seq), mass cytometry (CyTOF), Luminex). Research knowledge so far can give us some insights into the cytokine milieu associated with mucosal inflammation by quantifying cytokine levels in mucosal tissues or biological fluids such as serum or stool. The review is aimed at presenting state-of-the-art techniques for cytokine profiling and the various biomarkers for follow-up and treatment. Full article

(This article belongs to the Section Gastrointestinal Disease)

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12 pages, 1308 KiB

Open AccessArticle

Pre-Procedural Predictors of Successful Endoscopic Sleeve Gastroplasty: A Retrospective Study

by Lior Charach, Noam Peleg, Ran Abuhasira and Steven Shamah

Gastroenterol. Insights 2024, 15(2), 459-470; https://doi.org/10.3390/gastroent15020033 - 4 Jun 2024

Viewed by 844

Abstract

Objective: Obesity is a major risk factor for the morbidity and mortality of cardiovascular disease and predicts the development of hypertension, diabetes mellitus and other various diseases. Methods: A retrospective study evaluated predictors for higher total body weight loss following endoscopic sleeve gastroplasty [...] Read more.

Objective: Obesity is a major risk factor for the morbidity and mortality of cardiovascular disease and predicts the development of hypertension, diabetes mellitus and other various diseases. Methods: A retrospective study evaluated predictors for higher total body weight loss following endoscopic sleeve gastroplasty (ESG). Adults (>18 years old) with BMI > 30 kg/m² who underwent ESG from January 2019 to July 2022 were included. Patients under the age of 18 were excluded from the study. Results: This retrospective cohort included 76 patients, of whom 62 women (81.6%) and 14 were men (18.4%) with a mean age of 46.3 ± 10.4. The mean BMI baseline was 36.6 ± 4.21. Out of the included patients, 10% were lost to follow-up at 1 month, 33% at 3 months, 50% after 6 months, and only 30% met 12 months follow-up. During the follow-up period, no mortality was documented. Three major adverse events (3.9%) were documented (one mediastinal abscess, one lower gastrointestinal bleeding and one pulmonary embolism), all of them in female patients. Among the demographic clinical and laboratory data examined, smoking (N = 6, p < 0.001) was associated with successful ESG, which was determined as total body weight loss (TBWL) above 15%. The rest of the variables examined were not shown to be statistically significant to sleeve success. Overall, 65 of the 76 patients which were studied in this research had more than 5% TBWL, 42 patients had more than 10% TBWL, 21 patients had more than 15% TBWL and 7 patients lost more than 20% of their weight during 1 year of follow-up. Maximal TBWL was achieved 3 months following the procedure. During the first month following ESG, the average weight lost was 8.6% (N = 69); at 3 months, it was 12.3% (N = 48); at 6 months, it was 11.3% (N = 33); and at 12 months, it was 9.8% (N = 13). Smoking was associated with higher weight loss. Conclusions: The current study showed a positive correlation between ESG weight loss above 15% and smoking. Older patients (>50) gained weight earlier, within 3 months, and by 1 year of follow-up almost returned back to their original weight. Females sustained weight loss over 1 year of follow-up compared to males. Patients with lower BMI continued losing weight during the follow-up period (12 months). This study tries to summarize pre-procedural prediction of ESG success. Full article

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

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12 pages, 913 KiB

Open AccessReview

Herbs and Spices: Modulation of Gut Microbiota for Healthy Aging

by Samjhana Pradhan, Cynthia Blanton, Javier Ochoa-Reparaz, Nirajan Bhattarai and Kavita Sharma

Gastroenterol. Insights 2024, 15(2), 447-458; https://doi.org/10.3390/gastroent15020032 - 22 May 2024

Cited by 1 | Viewed by 2131

Abstract

The gut microbiota interacts with the host’s immune function, and evidence supports a relationship between the gut microbiota and age-related disease. Consumption of herbs and spices, which contain bioactive compounds such as polyphenols, is associated with gut microbiota characteristics that may act to [...] Read more.

The gut microbiota interacts with the host’s immune function, and evidence supports a relationship between the gut microbiota and age-related disease. Consumption of herbs and spices, which contain bioactive compounds such as polyphenols, is associated with gut microbiota characteristics that may act to prevent or manage age-related declines in health. This review evaluates the evidence describing the effect of herb/spice intake on the gut microbiota and health during aging. Commonly consumed herbs/spices, their impact on prominent gut bacteria phyla (Bacteriodetes, Firmicutes), and diseases of aging are highlighted. Studies in humans and animals are reviewed. Mechanisms of action are discussed, and future directions for research are proposed. Dietary enrichment with herbs and spices is a potential novel intervention for mitigating declines in physiological function with age. Full article

(This article belongs to the Special Issue Nutrition and Gastrointestinal Diseases: From the Basic Science to the Clinical Practice)

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14 pages, 1063 KiB

Open AccessArticle

Assessment of Cognitive Function in Romanian Patients with Chronic Alcohol Consumption

by Shandiz Morega, Claudiu-Marinel Ionele, Mihaela-Andreea Podeanu, Dan-Nicolae Florescu and Ion Rogoveanu

Gastroenterol. Insights 2024, 15(2), 433-446; https://doi.org/10.3390/gastroent15020031 - 17 May 2024

Viewed by 1328

Abstract

Alcoholism presents a significant health concern with notable socioeconomic implications. Alcohol withdrawal syndrome (AWS) can manifest when individuals cease or drastically reduce their alcohol consumption after prolonged use. Non-alcoholic fatty liver disease (NAFLD) is characterized by substantial lipid accumulation in the liver cells [...] Read more.

Alcoholism presents a significant health concern with notable socioeconomic implications. Alcohol withdrawal syndrome (AWS) can manifest when individuals cease or drastically reduce their alcohol consumption after prolonged use. Non-alcoholic fatty liver disease (NAFLD) is characterized by substantial lipid accumulation in the liver cells of individuals with no history of alcohol consumption. There is evidence suggesting an association between cognitive impairment and both conditions. This study aimed to evaluate cognitive impairment in patients with NAFLD and AWS using the Mini-Mental State Examination (MMSE). This study involved 120 patients admitted to two hospitals in Craiova, Romania. Results indicated that patients with NAFLD did not exhibit cognitive impairment as measured by MMSE (Mean = 29.27, SD = 0.785). Conversely, patients with AWS showed more pronounced cognitive dysfunction, with a mean MMSE score at admission of 16.60 ± 4.097 and 24.60 ± 2.832 after 2 weeks under treatment with Vitamins B1 and B6 and Cerebrolysin. Additionally, our findings suggested that cognitive dysfunction among alcohol consumers was correlated with the severity of clinical symptoms, as demonstrated by the severity of tremors in our study. The two-week period under treatment and alcohol withdrawal was insufficient for cognitive function to return to normal levels. Observational studies on longer periods of time are advised. Full article

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

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14 pages, 966 KiB

Open AccessReview

Pruritus, Fatigue, Osteoporosis and Dyslipoproteinemia in Pbc Patients: A Clinician’s Perspective

by Sylvia Drazilova, Tomas Koky, Marian Macej, Martin Janicko, Dagmar Simkova, Ariunzaya Tsedendamba, Slavomira Komarova and Peter Jarcuska

Gastroenterol. Insights 2024, 15(2), 419-432; https://doi.org/10.3390/gastroent15020030 - 17 May 2024

Viewed by 1360

Abstract

In this review article, we summarize the most common clinical manifestations of Primary biliary cholangitis (PBC): pruritus, fatigue, osteoporosis, and dyslipoproteinemia and discuss their impact of the patients’ quality of life. More than half of PBC patients suffer from pruritus or fatigue at [...] Read more.

In this review article, we summarize the most common clinical manifestations of Primary biliary cholangitis (PBC): pruritus, fatigue, osteoporosis, and dyslipoproteinemia and discuss their impact of the patients’ quality of life. More than half of PBC patients suffer from pruritus or fatigue at the time of diagnosis. We discuss the pathophysiological aspects of the PBC clinical manifestations and treatment options. The pathophysiology of pruritus and fatigue is not adequately elucidated, but IL-31 is associated with the severity of pruritus and could be used to objectify the subjective reporting by questionnaires. Although PBC patients suffer from atherogenic dyslipidemia, they do not seem to have a higher cardiovascular risk; however, this observation needs to be clarified by further clinical studies. The second-line of PBC treatment affects pruritus severity: Obeticholic acid (OCA) worsens pruritus while fibrates improve it. Itching can be alleviated by both non-pharmacological and pharmacological approach, however the are multiple barriers to pharmacological treatment. There is no adequate treatment for fatigue today. Treatment of osteoporosis and dyslipidemia is similar for non-PBC patients; stage of liver disease should be considered in treatment. Further research to clarify the pathophysiology and to eventually discover an effective treatment to improve survival and quality of life (especially pruritus and fatigue) in PBC patients is needed. Full article

(This article belongs to the Section Liver)

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10 pages, 812 KiB

Open AccessReview

p16 Expression in Multinucleated Stromal Cells of Fibroepithelial Polyps of the Anus (FEPA): A Comprehensive Review and Our Experience

by Milena Gulinac, Tsvetelina Velikova, Latchezar Tomov and Dorian Dikov

Gastroenterol. Insights 2024, 15(2), 409-418; https://doi.org/10.3390/gastroent15020029 - 17 May 2024

Viewed by 937

Abstract

Fibroepithelial polyps of the anus (FEPA) are a common benign polypoid proliferation of the stroma covered by squamous epithelium. They are also an often-overlooked part of pathological practice. Currently, immunohistochemistry (IHC) for p16 is the only recommended test for anal intraepithelial neoplasia, but [...] Read more.

Fibroepithelial polyps of the anus (FEPA) are a common benign polypoid proliferation of the stroma covered by squamous epithelium. They are also an often-overlooked part of pathological practice. Currently, immunohistochemistry (IHC) for p16 is the only recommended test for anal intraepithelial neoplasia, but the expression of p16 in stromal multinucleated atypical cells in FEPA has not been described. We aimed to evaluate the expression of p16 in stromal multinucleated atypical cells in FEPA and its role as a diagnostic biomarker to determine the origin of the atypical multinucleated cells in the stroma of FEPA and to rule out the possibility of a neoplastic process. Therefore, we researched a series of 15 FEPA in middle-aged patients histologically and by IHC. Examination of the subepithelial connective tissue from the FEPA showed bizarre, multinucleated cells, while their causal relationship with human papillomavirus (HPV) infection was rejected. In all cases, these cells showed mild to moderate atypical nuclear features and positive expression for p16, while the overlying squamous epithelium was negative. We concluded that FEPA are benign lesions in the stroma where mononuclear and multinucleated (sometimes atypical) cells showing fibroblastic and myofibroblastic differentiation can be found. Nevertheless, we believe that these cells have a practical diagnostic significance, although sometimes the presence of giant cells is difficult to establish, especially in the inflammatory context. The histological similarity between FEPA and normal anal mucosa supports the hypothesis that FEPA may represent the reactive hyperplasia of subepithelial fibrous connective tissue of the anal mucosa. Full article

(This article belongs to the Section Gastrointestinal Disease)

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13 pages, 1690 KiB

Open AccessSystematic Review

Octreotide versus Terlipressin as Adjuvant to Endoscopic Variceal Band Ligation in Bleeding Oesophageal Varices: A Systematic Review and Meta-Analysis

by Ahmed A. Sadeq, Noha Abou Khater, Farah Ahmed Issa and Ahmed Al-Rifai

Gastroenterol. Insights 2024, 15(2), 396-408; https://doi.org/10.3390/gastroent15020028 - 15 May 2024

Viewed by 2255

Abstract

Background: Acute variceal bleeding (AVB) is a critical complication of portal hypertension, contributing significantly to mortality worldwide. Pharmacological interventions, including terlipressin and octreotide, have evolved to manage AVB, yet consensus on their comparative effectiveness remains elusive. This study conducts a comprehensive systematic review [...] Read more.

Background: Acute variceal bleeding (AVB) is a critical complication of portal hypertension, contributing significantly to mortality worldwide. Pharmacological interventions, including terlipressin and octreotide, have evolved to manage AVB, yet consensus on their comparative effectiveness remains elusive. This study conducts a comprehensive systematic review and meta-analysis of randomized control trials (RCTs) comparing terlipressin and octreotide in the management of AVB, aiming to provide insights into their relative benefits. Methods: This study included RCTs with head-to-head comparisons of terlipressin and octreotide. The search strategy covered PubMed, Scopus, and Cinahl databases, and the included studies involved adult patients with confirmed AVB undergoing endoscopic variceal band ligation (EVBL). Results: Seven RCTs meeting inclusion criteria were included in the meta-analysis. The assessed outcomes were: achieving haemostasis within 24 h, rebleeding rate, and mortality rate. The pooled analysis revealed no statistically significant differences between terlipressin and octreotide in achieving haemostasis (OR: 1.30, p = 0.23), rebleeding rates at 5 days (OR: 0.7, p = 0.23), and mortality at 42 days (OR: 0.9, p > 0.5). Conclusion: This meta-analysis suggests that terlipressin and octreotide exhibit similar efficacy in reducing bleeding, rebleeding rates, and mortality when used as adjuvants to EVBL in AVB. Clinicians are encouraged to consider individual patient characteristics and the broader clinical context when choosing between these agents. Future research should focus on addressing existing evidence gaps and enhancing understanding of variables influencing EVBL outcomes. Full article

(This article belongs to the Section Gastrointestinal Disease)

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10 pages, 621 KiB

Open AccessArticle

Effect of Concomitant Use of Polaprezinc and Vonoprazan-Based Triple Therapy for Helicobacter pylori Eradication

by Yuto Suzuki, Yasumi Katayama, Yo Fujimoto, Koji Toyoda, Morio Takahashi and Masaya Tamano

Gastroenterol. Insights 2024, 15(2), 386-395; https://doi.org/10.3390/gastroent15020027 - 11 May 2024

Viewed by 1337

Abstract

Background: Vonoprazan-based triple therapy has recently been reported as being more effective than proton pump inhibitors for the eradication of Helicobacter pylori (H. pylori), but it is apparent that the eradication rate could be further improved. Methods: We investigated the effect [...] Read more.

Background: Vonoprazan-based triple therapy has recently been reported as being more effective than proton pump inhibitors for the eradication of Helicobacter pylori (H. pylori), but it is apparent that the eradication rate could be further improved. Methods: We investigated the effect of the concomitant use of polaprezinc, a therapeutic agent for gastric ulcers, and vonoprazan-based seven-day triple therapy in patients with gastric ulcers compared to standard vonoprazan-based seven-day triple therapy in patients with atrophic gastritis. The regimen for the treatment of atrophic gastritis contained vonoprazan 20 mg, amoxicillin 750 mg, and clarithromycin 200 mg b.d. (VAC group) for seven days; and that for gastric ulcers contained VAC and polaprezinc 75 mg b.d. (VACP group) for seven days. Results: Between October 2021 and January 2023, 201 subjects were examined (VAC group, n = 165; VACP group, n = 36). In per-protocol (PP) analysis, the eradication rate was significantly higher in the VACP group (100%) than in the VAC group (88.2%) (p = 0.025). In patients with severe atrophic gastritis, eradication rates were significantly higher in the VACP group (100%) than in the VAC group (84.4%) in PP analysis. (p = 0.024). Conclusions: The concomitant use of polaprezinc and standard vonoprazan-based first-line eradication therapy is effective for H. pylori. Full article

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

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11 pages, 1413 KiB

Open AccessArticle

Endoscopic Ultrasonography-Guided Fine-Needle Biopsy for Patients with Resectable Pancreatic Malignancies

by Ming-Sheng Chien, Ching-Chung Lin and Jian-Han Lai

Gastroenterol. Insights 2024, 15(2), 375-385; https://doi.org/10.3390/gastroent15020026 - 7 May 2024

Viewed by 1116

Abstract

Clinicians often use endoscopic ultrasonography to survey pancreatic tumors. When endoscopists conduct this examination and find the tumor to be unresectable, a fine-needle biopsy is subsequently performed for tissue confirmation. However, if the tumor is deemed resectable, the necessity of a pre-operative fine-needle [...] Read more.

Clinicians often use endoscopic ultrasonography to survey pancreatic tumors. When endoscopists conduct this examination and find the tumor to be unresectable, a fine-needle biopsy is subsequently performed for tissue confirmation. However, if the tumor is deemed resectable, the necessity of a pre-operative fine-needle biopsy remains debatable. Therefore, we performed a retrospective analysis of a single-center cohort of patients with pancreatic tumors who underwent an endoscopic ultrasound-guided fine-needle biopsy or aspiration (EUS-FNB or FNA) between 2020 and 2022. This study focused on patients diagnosed with resectable malignant pancreatic tumors. The exclusion criteria included individuals diagnosed with benign pancreatic lesions and those with unresectable tumors. A total of 68 patients were enrolled in this study. Histological examination revealed that pancreatic adenocarcinoma was the predominant type of tumor (n = 42, 61.8%), followed by neuroendocrine tumors (n = 22, 32.3%), and metastasis (n = 4, 5.9%). Notably, 17 patients had a history of other cancers, with 23.5% being diagnosed with a metastatic tumor rather than primary pancreatic cancer. Therefore, EUS-FNA/FNB is crucial in patients with a resectable pancreatic tumor and a history of cancer to differentiate between a primary and a metastatic tumor. Full article

(This article belongs to the Section Pancreas)

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9 pages, 1237 KiB

Open AccessArticle

Identification of an Objective Cut-Off Point to Define the Clinical Stage T4a in Colon Cancer

by Carolina Bautista-Saiz, Luisa F. Rivera-Moncada, Leonardo S. Lino-Silva, Guillermo A. Pérez-Correa and Pedro Frías-Fernández

Gastroenterol. Insights 2024, 15(2), 366-374; https://doi.org/10.3390/gastroent15020025 - 30 Apr 2024

Viewed by 1042

Abstract

Introduction: The current state of pathology practice and the variability in diagnosing pT4a colon cancer have been underexplored in existing studies. Our objective was to establish a specific cutoff point to distinguish between the pathological stages of pT3 and pT4a in colon cancer. [...] Read more.

Introduction: The current state of pathology practice and the variability in diagnosing pT4a colon cancer have been underexplored in existing studies. Our objective was to establish a specific cutoff point to distinguish between the pathological stages of pT3 and pT4a in colon cancer. Methods: We conducted a cross-sectional study involving pT3 and pT4 (pN0-2, cM0) colon cancers, measuring the distance to the serosa. Patients were categorized and analyzed based on this distance and the peritoneal reaction, with the aim being to ascertain their prognostic implications. Results: A total of 384 patients were analyzed. Patients with a distance between the invading front of cancer and the serosa ≥ 1 mm without a peritoneal reaction exhibited a median survival of 118 months, contrasting the amount of 70 months for those with <1 mm plus peritoneal reaction. Only lengths <1 mm with peritoneal reaction showed a significant correlation with mortality (p < 0.001). Conclusion: Our study revealed that patients in whom neoplastic cells were less than 1 mm from the serosal surface, accompanied by a peritoneal reaction (hemorrhage, inflammation, neovascularization, fibrin), had significantly lower survival rates compared to those with more than 1 mm distance and without peritoneal response (70 vs. 118 months, p < 0.001). Hence, such cases should be considered within the pT4a stage. Full article

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

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12 pages, 1936 KiB

Open AccessArticle

Oral L-Citrulline Supplementation Improves Fatty Liver and Dyslipidemia in Adolescents with Abdominal Obesity: A Parallel, Double-Blind, Randomized Clinical Trial

by Verónica Ivette Tovar-Villegas, Yejin Kang, Lorena del Rocío Ibarra-Reynoso, Montserrat Olvera-Juárez, Armando Gomez-Ojeda, Víctor Manuel Bosquez-Mendoza, Miriam Lizette Maldonado-Ríos, Ma. Eugenia Garay-Sevilla and Arturo Figueroa

Gastroenterol. Insights 2024, 15(2), 354-365; https://doi.org/10.3390/gastroent15020024 - 25 Apr 2024

Viewed by 3216

Abstract

Obesity in adolescents is associated with non-communicable risk factors and diseases like metabolic-associated fatty liver disease (MAFLD), which is the liver manifestation of metabolic syndrome. L-citrulline is a non-protein amino acid that has shown positive effects on the degree of steatosis in animals [...] Read more.

Obesity in adolescents is associated with non-communicable risk factors and diseases like metabolic-associated fatty liver disease (MAFLD), which is the liver manifestation of metabolic syndrome. L-citrulline is a non-protein amino acid that has shown positive effects on the degree of steatosis in animals with non-alcoholic fatty liver disease (NAFLD). The aim of the study was to evaluate the effect of oral L-citrulline supplementation on liver function and cardiovascular risk factors in adolescents with abdominal obesity and MAFLD. A prospective, double-blind clinical trial in adolescents with abdominal obesity was randomized into two groups: forty-two adolescents were supplemented with L-citrulline (6 g of L-citrulline/day) (n = 22) and placebo (n = 20) for eight weeks. The variables evaluated were anthropometry, blood pressure, glucose, insulin, HOMA-IR, L-citrulline, L-arginine, malondialdehyde, lipid profile, liver profile, urea, uric acid, and hepatic steatosis by ultrasound. After supplementation, the L-citrulline group had a decrease in liver fat accumulation (p = 0.0007); increases in body weight (p = 0.02), glucose (p = 0.03), and HOMA-IR (p = 0.03); and decreases in BMI (p = 0.002), total cholesterol (p = 0.001), HDL-C (p = 0.01), LDL-C (p = 0.002), and alkaline phosphatase (p = 0.05). L-citrulline for eight weeks decreases hepatic fat accumulation and LDL-C levels in adolescents with abdominal obesity and MAFLD. Full article

(This article belongs to the Section Liver)

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12 pages, 547 KiB

Open AccessArticle

Duodenal Adenocarcinoma: The Relationship between Type of Surgery and Site of Recurrence in a Spanish Cohort

by Gerardo Blanco-Fernández, Daniel Aparicio-López, Celia Villodre, Isabel Jaén-Torrejimeno, Cándido F Alcázar López, Diego López-Guerra, Mario Serradilla-Martín and José M. Ramia

Gastroenterol. Insights 2024, 15(2), 342-353; https://doi.org/10.3390/gastroent15020023 - 24 Apr 2024

Viewed by 1027

Abstract

We present a multicenter retrospective study of patients undergoing surgery for duodenal adenocarcinoma, from January 2010 to August 2020, in order to determine the epidemiological characteristics and the oncological results after surgical resection obtained in this rare tumor. Variables: demographics; tumor location; surgical [...] Read more.

We present a multicenter retrospective study of patients undergoing surgery for duodenal adenocarcinoma, from January 2010 to August 2020, in order to determine the epidemiological characteristics and the oncological results after surgical resection obtained in this rare tumor. Variables: demographics; tumor location; surgical intervention and immediate postoperative period; and post-surgical follow-up information, such as recurrence, overall survival (OS), and disease-free survival (DFS). A total of 32 patients underwent surgery. The median age was 69.74 years (IQR 60.47–79.09) and the male/female distribution was 3:1. The surgeries performed were: pancreaticoduodenectomy (PD) in 16 (50%) patients, segmental resection in 13 (40.6%), and the local excision of the lesion in three (9.4%). The R0 rate was higher in PD (86.7% vs. 42.9%; p = 0.013). The OS and DFS rate at one, three and five years was 95%, 70%, and 60% and 86%, 55%, and 48%, respectively. There was a greater trend towards recurrence in patients who did not undergo PD (53.8% vs. 25%; p = 0.14) and conservative surgery seemed to be associated with more local recurrence than PD (57.1% vs. 33.3%; p = 0.49). PD and limited resection are both valid options in the cases of non-ampullary duodenal adenocarcinoma, although PD presented lower rates of loco-regional recurrence. Full article

(This article belongs to the Section Gastrointestinal Disease)

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39 pages, 916 KiB

Open AccessReview

The Pathogenesis of Pancreatitis and the Role of Autophagy

by Ioannis Tsomidis, Argyro Voumvouraki and Elias Kouroumalis

Gastroenterol. Insights 2024, 15(2), 303-341; https://doi.org/10.3390/gastroent15020022 - 22 Apr 2024

Cited by 1 | Viewed by 3197

Abstract

The pathogenesis of acute and chronic pancreatitis has recently evolved as new findings demonstrate a complex mechanism operating through various pathways. In this review, the current evidence indicating that several mechanisms act in concert to induce and perpetuate pancreatitis were presented. As autophagy [...] Read more.

The pathogenesis of acute and chronic pancreatitis has recently evolved as new findings demonstrate a complex mechanism operating through various pathways. In this review, the current evidence indicating that several mechanisms act in concert to induce and perpetuate pancreatitis were presented. As autophagy is now considered a fundamental mechanism in the pathophysiology of both acute and chronic pancreatitis, the fundamentals of the autophagy pathway were discussed to allow for a better understanding of the pathophysiological mechanisms of pancreatitis. The various aspects of pathogenesis, including trypsinogen activation, ER stress and mitochondrial dysfunction, the implications of inflammation, and macrophage involvement in innate immunity, as well as the significance of pancreatic stellate cells in the development of fibrosis, were also analyzed. Recent findings on exosomes and the miRNA regulatory role were also presented. Finally, the role of autophagy in the protection and aggravation of pancreatitis and possible therapeutic implications were reviewed. Full article

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

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18 pages, 6561 KiB

Open AccessArticle

Prevention of Musculoskeletal Injuries in Gastrointestinal Endoscopists

by Tadej Durič, Ivana Cibulkova and Jan Hajer

Gastroenterol. Insights 2024, 15(2), 285-302; https://doi.org/10.3390/gastroent15020021 - 14 Apr 2024

Cited by 1 | Viewed by 1326

Abstract

Gastroenterologists are exposed daily to musculoskeletal (MSK) stress during upper and lower gastrointestinal endoscopy, both during routine endoscopies and during long, demanding therapeutic procedures. There is evidence that endoscopy-related MSK injuries are becoming more common, particularly in the back, neck, shoulders, elbows, and [...] Read more.

Gastroenterologists are exposed daily to musculoskeletal (MSK) stress during upper and lower gastrointestinal endoscopy, both during routine endoscopies and during long, demanding therapeutic procedures. There is evidence that endoscopy-related MSK injuries are becoming more common, particularly in the back, neck, shoulders, elbows, and hands. The aims of this study were to identify the most stressed muscle groups during endoscopy; to measure their activity using surface electromyographical (EMG) sensors; to detect areas of muscle overload; and to identify the number of microbreaks taken in specific muscles. Furthermore, we measured differences in the loading of these muscle groups with and without the use of special support systems such as a belt-like holder. Measurements were performed on 15 subjects (7 experienced endoscopists and 8 non-endoscopists). Due to this small sample size, inside each group, we achieved inconclusive results regarding statistically significant differences in different muscle groups. We increased the sample size by comparing all participants with and without the belt support system, disregarding their endoscopic background. There was a statistically significant difference (p < 0.05) in muscle tension and in levels of microbreaks in the muscles of the left forearm, biceps, and trapezius muscles. No statistically significant difference was observed in the muscle tension and level of microbreaks in the left deltoid muscle (p > 0.05). We hypothesize that the increased level of muscle loading and decreased level of microbreaks in the deltoid muscle are due to different muscle activity and different shoulder movements. Additionally, the deltoid muscle is not connected to the kinetic chain of body posture and stabilization. It is our belief that MSK injuries in gastrointestinal (GI) endoscopy can be prevented with the use of a belt-like support system. Full article

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

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19 pages, 6812 KiB

Open AccessArticle

Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm?

by Bozhidar Hristov, Daniel Doykov, Vladimir Andonov, Mladen Doykov, Krasimir Kraev, Petar Uchikov, Rosen Dimov, Gancho Kostov, Siyana Valova, Katya Doykova, Dzhevdet Chakarov and Milena Sandeva

Gastroenterol. Insights 2024, 15(2), 266-284; https://doi.org/10.3390/gastroent15020020 - 8 Apr 2024

Cited by 1 | Viewed by 1206

Abstract

Introduction. Biliary obstruction is a common manifestation of biliopancreatic malignancies, and its relief is an essential part of the treatment algorithm. Currently, there are three techniques to manage malignant biliary obstruction—endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic biliary drainage (PTBD), and endoscopic ultrasound-guided biliary [...] Read more.

Introduction. Biliary obstruction is a common manifestation of biliopancreatic malignancies, and its relief is an essential part of the treatment algorithm. Currently, there are three techniques to manage malignant biliary obstruction—endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic biliary drainage (PTBD), and endoscopic ultrasound-guided biliary drainage (EUS-BD). ERCP has been adopted as a first-line treatment modality but EUS-BD is gradually emerging as a viable alternative. The aim of the current article is to assess the clinical outcomes of the three nonsurgical biliary drainage procedures. Materials and methods. A total of 102 consecutive patients with unresectable biliopancreatic malignancy inducing biliary obstruction and subjected to palliative treatment by means of ERCP, EUS-BD, or PTBD were retrospectively included in the study. Results. No difference in clinical and technical success of the procedures was found: ERCP—97.2% technical; 88.9% clinical; PTBD—94.4% technical, 72.2% clinical; EUS-BD—90% technical; 83.3% clinical. Adverse events (AEs) and reinterventions were significantly more common in PTBD (38.9% and 52.8%) and ERCP (27.9% and 25%) compared to EUS-BD (10% and 3.3%). Total duration of hospital stay and number of hospitalizations were lower in the EUS-BD compared to PTBD and ERCP groups. Conclusions. In the presence of adequate expertise, EUS-BD may be superior to PTBD and ERCP in achieving and sustaining biliary drainage in the setting of unresectable malignancy. Full article

(This article belongs to the Section Biliary Content)

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11 pages, 304 KiB

Open AccessArticle

Increased Serum Apelin Levels in Patients with Inflammatory Bowel Disease

by Aikaterini Mantaka, Konstantina Kalyvianaki, Olga Kastritsi, Marilena Kampa and Ioannis E. Koutroubakis

Gastroenterol. Insights 2024, 15(2), 255-265; https://doi.org/10.3390/gastroent15020019 - 8 Apr 2024

Cited by 2 | Viewed by 1158

Abstract

Apelin has been implicated in the pathogenesis of several chronic inflammatory diseases through mechanisms related to endothelial cells dysfunction. There is evidence of increased apelin levels in mesenteric adipose tissue and colonic epithelium in patients with inflammatory bowel disease (IBD), but their significance [...] Read more.

Apelin has been implicated in the pathogenesis of several chronic inflammatory diseases through mechanisms related to endothelial cells dysfunction. There is evidence of increased apelin levels in mesenteric adipose tissue and colonic epithelium in patients with inflammatory bowel disease (IBD), but their significance remains unclear. We aimed to measure serum apelin (SA) levels in patients with IBD and to evaluate an association with disease characteristics. SA levels of 104 IBD patients and age and sex matched healthy controls (HCs) in a 1:1 ratio were compared. SA-13 levels were measured using an enzyme-linked immunosorbent assay (ELISA). Mean SA levels were increased in IBD patients compared to HCs (1996.29 ± 1592.96 pg/mL vs. 1552.99 ± 809.64 pg/mL, p = 0.012). Both patients without and with cardiovascular disease (CVD) had increased SA levels (2076.44 ± 1714.74 pg/mL vs. 1525.75 ± 818.74 pg/mL, p = 0.011 and 1743.01 ± 1116.26 pg/mL vs. 1283.92 ± 726.85 pg/mL, p = 0.035, respectively). An inverse association between mean SA levels and a history of musculoskeletal extraintestinal manifestations in the subgroup of IBD patients without CVD was found (p = 0.043). The present study—the first to evaluate SA levels in patients with IBD—showed that IBD patients have higher levels of SA compared to HCs. The potential role of SA in IBD merits further investigation in larger studies. Full article

(This article belongs to the Section Gastrointestinal Disease)

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Gastroenterol. Insights, Volume 15, Issue 2 (June 2024) – 19 articles

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