Journal Description
Gastroenterology Insights
Gastroenterology Insights
is an international, scientific, peer-reviewed open access journal on gastrointestinal diseases published quarterly online by MDPI (from Volume 11 Issue 1 - 2020).
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, ESCI (Web of Science), Embase, and other databases.
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 32.6 days after submission; acceptance to publication is undertaken in 7.3 days (median values for papers published in this journal in the second half of 2023).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Gastroenterology Insights is a companion journal of Life.
Impact Factor:
2.9 (2022);
5-Year Impact Factor:
2.2 (2022)
Latest Articles
Assessment of Cognitive Function in Romanian Patients with Chronic Alcohol Consumption
Gastroenterol. Insights 2024, 15(2), 433-446; https://doi.org/10.3390/gastroent15020031 - 17 May 2024
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
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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.
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(This article belongs to the Special Issue Novelties in Diagnostics and Therapeutics in Hepatology: 2nd Edition)
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Open AccessReview
Pruritus, Fatigue, Osteoporosis and Dyslipoproteinemia in Pbc Patients: A Clinician’s Perspective
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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
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
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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.
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(This article belongs to the Section Liver)
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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
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
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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.
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(This article belongs to the Section Gastrointestinal Disease)
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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
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
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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.
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(This article belongs to the Section Gastrointestinal Disease)
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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
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
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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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Open AccessArticle
Endoscopic Ultrasonography-Guided Fine-Needle Biopsy for Patients with Resectable Pancreatic Malignancies
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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
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
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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.
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(This article belongs to the Section Pancreas)
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Open AccessArticle
Identification of an Objective Cut-Off Point to Define the Clinical Stage T4a in Colon Cancer
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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
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.
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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.
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(This article belongs to the Collection Advances in Gastrointestinal Cancer)
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Open AccessArticle
Oral L-Citrulline Supplementation Improves Fatty Liver and Dyslipidemia in Adolescents with Abdominal Obesity: A Parallel, Double-Blind, Randomized Clinical Trial
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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
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
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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.
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(This article belongs to the Section Liver)
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Open AccessArticle
Duodenal Adenocarcinoma: The Relationship between Type of Surgery and Site of Recurrence in a Spanish Cohort
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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
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
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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.
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(This article belongs to the Section Gastrointestinal Disease)
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Open AccessReview
The Pathogenesis of Pancreatitis and the Role of Autophagy
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Ioannis Tsomidis, Argyro Voumvouraki and Elias Kouroumalis
Gastroenterol. Insights 2024, 15(2), 303-341; https://doi.org/10.3390/gastroent15020022 - 22 Apr 2024
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
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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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Open AccessArticle
Prevention of Musculoskeletal Injuries in Gastrointestinal Endoscopists
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Tadej Durič, Ivana Cibulkova and Jan Hajer
Gastroenterol. Insights 2024, 15(2), 285-302; https://doi.org/10.3390/gastroent15020021 - 14 Apr 2024
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
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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.
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(This article belongs to the Section Gastrointestinal and Hepato-Biliary Imaging)
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Open AccessArticle
Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm?
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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
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
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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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Open AccessArticle
Increased Serum Apelin Levels in Patients with Inflammatory Bowel Disease
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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
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
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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)
Open AccessCase Report
Gastrointestinal Granular Cell Tumor: The First Report of a Multifocal and Potentially Hereditary Case
by
Riccardo Sigon, Lisa Fusaro, Fabio Monica and Michele Campigotto
Gastroenterol. Insights 2024, 15(1), 248-254; https://doi.org/10.3390/gastroent15010018 - 13 Mar 2024
Abstract
Granular cell tumors (GCTs), also known as Abrikossoff tumors, are rare tumors that originate from Schwann cells that primarily localize in the tongue, skin and submucosal tissues and involve the gastrointestinal tract in 11% of cases. We present a case of a young
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Granular cell tumors (GCTs), also known as Abrikossoff tumors, are rare tumors that originate from Schwann cells that primarily localize in the tongue, skin and submucosal tissues and involve the gastrointestinal tract in 11% of cases. We present a case of a young woman who first presented to our center in 2018 for an EGDS to assess a thickening of the esophageal wall, seen on a CT. On that occasion, a diagnosis of Abrikossoff tumor was made. She underwent endoscopic resection with subsequent yearly follow-up without evidence of recurrence. Five years later, during a routine colonoscopy, we found numerous white submucosal formations in all of the explored tracts, with a histological examination compatible with GCTs. Her daughter presented with a white nodule on her tongue, also diagnosed as a GCT. Her daughter was also diagnosed with a GCT of the tongue a few months later. Our research represents a significant contribution to the field given that it presents the first documented case of a patient with multifocal gastrointestinal GCTs and suggests a potential hereditary component.
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(This article belongs to the Section Gastrointestinal Disease)
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Open AccessArticle
EncephalApp Stroop Test as a Screening Tool for the Detection of Minimal Hepatic Encephalopathy in Patients with Cirrhosis—Single-Center Experience
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Marko Vojnovic, Ivana Pantic, Goran Jankovic, Milos Stulic, Milica Stojkovic Lalosevic, Nina Pejic and Tamara Milovanovic
Gastroenterol. Insights 2024, 15(1), 237-247; https://doi.org/10.3390/gastroent15010017 - 12 Mar 2024
Abstract
Background: Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy. One of the neuropsychological tests that detects MHE is the Stroop test (via EncephalApp). The aim was to evaluate the Stroop test for the screening and diagnosis of MHE. Methods: This
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Background: Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy. One of the neuropsychological tests that detects MHE is the Stroop test (via EncephalApp). The aim was to evaluate the Stroop test for the screening and diagnosis of MHE. Methods: This prospective case–control study was performed at the Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, and included patients with cirrhosis and MHE and healthy controls. In all patients, the presence of MHE was confirmed using the animal naming test. The Stroop test was performed on each participant, and the results were compared between the two groups. The test has two components, the “OFF” and “ON” states. Results: A total of 111 participants were included. The median OFF time did not differ between the two groups, 106.3 and 91.4, p > 0.05. However, in patients with MHE, the median values of ON time and total time were significantly higher, with 122.3 vs. 105.3 and 228.0 vs. 195.6, respectively, p < 0.05. Statistical significance between patients and controls in examined parameters was detected in younger participants and the group with higher educational levels. Conclusions: The Stroop test displayed limited sensitivity in Serbian patients. Age and education affect time measurements and test performance.
Full article
(This article belongs to the Special Issue Novelties in Diagnostics and Therapeutics in Hepatology)
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Open AccessReview
An Updated Review on Probiotic Production and Applications
by
Guru Prasad Venkatesh, Gouthami Kuruvalli, Khajamohiddin Syed and Vaddi Damodara Reddy
Gastroenterol. Insights 2024, 15(1), 221-236; https://doi.org/10.3390/gastroent15010016 - 11 Mar 2024
Abstract
Microorganisms are ubiquitous and have been exploited for centuries to generate primary and secondary metabolites essential for human welfare and environmental sustainability. Microorganisms occupy a prominent position in the industrial sector due to their unique properties, such as the limited time and space
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Microorganisms are ubiquitous and have been exploited for centuries to generate primary and secondary metabolites essential for human welfare and environmental sustainability. Microorganisms occupy a prominent position in the industrial sector due to their unique properties, such as the limited time and space required for their growth and proliferation, as well as their easy manipulation of the genetic material. Among all the microorganisms, probiotics have grabbed the attention of researchers because of their nonpathogenic nature and immersive application in treating digestive ailments and vitamin deficiency, boosting immunity, and detoxifying harmful chemicals. Furthermore, probiotics are widely used to treat various diseases such as constipation, colon cancer, type 2 diabetes mellitus, and obesity, as well as a range of intestinal disorders, including inflammatory bowel disease, among others. The updated information on these diseases and the role of probiotics has not been updated in the past few years. The present review covers updated information on the role of probiotics in these topics. The growth of populations around the globe has attracted the attention of scientists, primarily investigating diverse technologies to meet the gap between probiotic production and demand. With the support of standardized tools and techniques, researchers have explored the potent probiotic strains feasible for industrial production and treating health ailments. In the current review, we have curated the potential information essential for the screening, strain selection, production, and application necessary for probiotic researchers.
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(This article belongs to the Special Issue Nutrition and Gastrointestinal Diseases: From the Basic Science to the Clinical Practice)
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Open AccessCase Report
Abdominal Pain—Beyond Colonic Lipoma Intussusception
by
Raluca-Ioana Dascalu, Gabriel Constantinescu, Alexandru Scafa, Oana-Mihaela Plotogea, Vasile Sandru, Ecaterina Mihaela Rinja, Alexandra Jichitu and Madalina Ilie
Gastroenterol. Insights 2024, 15(1), 213-220; https://doi.org/10.3390/gastroent15010015 - 6 Mar 2024
Abstract
Colonic lipomas are relatively rare benign tumors which are composed of mature fat cells and occur most frequently in the large intestine. The occurrence of colonic lipomas in the transverse colon is relatively uncommon. Generally, colonic lipomas are asymptomatic, and many individuals might
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Colonic lipomas are relatively rare benign tumors which are composed of mature fat cells and occur most frequently in the large intestine. The occurrence of colonic lipomas in the transverse colon is relatively uncommon. Generally, colonic lipomas are asymptomatic, and many individuals might not experience any noticeable symptoms. Therefore, they are usually discovered incidentally during colonoscopy or as a result of diagnostic imaging prescribed for other reasons. The size and location of the lipoma could influence the clinical presentation. If symptoms occur, they include abdominal pain, changes in bowel habits, or gastrointestinal bleeding. The prognosis for colonic lipomas is generally excellent but it requires an individualized approach based on the specific characteristics of the tumor, the patient’s symptoms, and other clinical considerations. We report a case of a colonic intussusception caused by a colonic lipoma in an adult who underwent surgery, with an uneventful recovery.
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(This article belongs to the Section Gastrointestinal Disease)
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Open AccessReview
GLP-1RA Essentials in Gastroenterology: Side Effect Management, Precautions for Endoscopy and Applications for Gastrointestinal Disease Treatment
by
Justin Wan, Caesar Ferrari and Micheal Tadros
Gastroenterol. Insights 2024, 15(1), 191-212; https://doi.org/10.3390/gastroent15010014 - 18 Feb 2024
Abstract
Amidst the obesity and type II diabetes mellitus (T2DM) epidemics, glucagon-like peptide-1 receptor agonists (GLP-1RAs) stand out as a promising therapeutic ally, achieving notable success in glycemic control and weight management. While GLP-1RAs’ positive clinical outcomes are commendable, they introduce significant gastrointestinal (GI)
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Amidst the obesity and type II diabetes mellitus (T2DM) epidemics, glucagon-like peptide-1 receptor agonists (GLP-1RAs) stand out as a promising therapeutic ally, achieving notable success in glycemic control and weight management. While GLP-1RAs’ positive clinical outcomes are commendable, they introduce significant gastrointestinal (GI) challenges, emphasizing the pivotal role of gastroenterologists in understanding and managing these implications. Physicians should be vigilant of potential complications if endoscopy is indicated and considered. A protocol coined “The Three E’s: Education, Escalation, and Effective Management” is essential as the first defense against GLP-1RA-induced dyspepsia, necessitating routine GI consultations. Awareness and intervention of potential aspiration due to GLP-1RA-induced gastroparesis are vital in clinical management. Furthermore, the evolving recognition of GLP-1RAs’ beneficial effects on non-alcoholic steatohepatitis (NASH) suggests gastroenterologists will increasingly prescribe them. Thus, a comprehensive understanding of pharmacological properties and potential GI complications, including the undetermined cancer risk landscape, becomes paramount. This review accentuates the nuances of GLP-1RA therapy from a gastroenterological lens, juxtaposing the therapeutic potential, manageable side effects, and circumstantial challenges, ensuring that GI specialists remain at the forefront of holistic care in obesity and T2DM management.
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(This article belongs to the Special Issue Recent Advances in the Management of Gastrointestinal Disorders)
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The Relationship between Serum Zonulin and Innate Immunity in Patients with Inflammatory Bowel Disease
by
Gusel Khusainova, Vadim Genkel, Alla Kuznetsova, Karina Nikushkina, Anna Saenko, Olga Abramovskikh and Anastasiya Dolgushina
Gastroenterol. Insights 2024, 15(1), 179-190; https://doi.org/10.3390/gastroent15010013 - 10 Feb 2024
Abstract
The aim of the study was to investigate the relationship between the serum zonulin and the cellular immunity in patients with ulcerative colitis (UC) and Crohn’s disease (CD). The study included 97 patients, 13 (13.4%) patients with CD and 84 (86.6%) patients with
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The aim of the study was to investigate the relationship between the serum zonulin and the cellular immunity in patients with ulcerative colitis (UC) and Crohn’s disease (CD). The study included 97 patients, 13 (13.4%) patients with CD and 84 (86.6%) patients with UC. The concentration of zonulin in the serum was studied using the ELISA kits. The investigation of the circulated leukocyte subpopulation was carried out through flow cytometry. The functional activity of the circulating neutrophils was studied using the absorption capacity of the monodisperse polystyrene latex particles and indicators of oxygen-dependent metabolism in the nitroblue tetrazolium test. The serum zonulin concentration in CD patients was significantly higher compared with UC patients (p = 0.003). The zonulin concentration directly correlated with the functional activity of the circulating neutrophils. Patients with a zonulin concentration > 472.4 pg/mL had a significantly higher number of band neutrophils (p = 0.0104), CD3+CD8+ cells (p = 0.0212), NK cells (p = 0.0161), and lower–CD19+ cells (p = 0.0034). Among the IBD patients, zonulin was associated with IBD severity. An increase in the serum concentration of zonulin was associated with an increase in the functional activity of circulating neutrophils and an increase in the number of CD3+CD8+ cells, NK cells, and a decrease in the number of CD19+ cells.
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(This article belongs to the Section Gastrointestinal Disease)
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Origin and Clinical Impact of Early Multidrug-Resistant (MDR) Contamination in Patients Undergoing Pancreaticoduodenectomy
by
Martina Sorrentino, Giovanni Capretti, Gennaro Nappo, Francesca Gavazzi, Cristina Ridolfi, Michele Pagnanelli, Martina Nebbia, Paola Morelli and Alessandro Zerbi
Gastroenterol. Insights 2024, 15(1), 168-178; https://doi.org/10.3390/gastroent15010012 - 8 Feb 2024
Abstract
Introduction: Infections caused by multidrug-resistant bacteria (MDR) occur more frequently after pancreaticoduodenectomy (PD) compared to other abdominal surgeries, and infective complications represent a major determinant of postoperative morbidity following PD. Preoperative biliary stent (PBS) placement often leads to biliary contamination, which plays a
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Introduction: Infections caused by multidrug-resistant bacteria (MDR) occur more frequently after pancreaticoduodenectomy (PD) compared to other abdominal surgeries, and infective complications represent a major determinant of postoperative morbidity following PD. Preoperative biliary stent (PBS) placement often leads to biliary contamination, which plays a significant role in postoperative infections. The aim of this study is to evaluate the impact of MDR contamination on short-term postoperative outcomes in patients undergoing PD and to evaluate the relationship between MDR bacteria, PBS, and bile contamination. Methods: This is a retrospective study based on a prospectively maintained database including 825 consecutive patients who underwent pancreaticoduodenectomies (PDs). All procedures were performed by experienced pancreatic surgeons at a high-volume center and the patients were managed according to the same perioperative enhanced recovery protocol. Results: MDR bacteria were present in 17.5% of bile cultures, exclusively within the stented group. At the multivariate analysis, the development of major postoperative complications (MPC) was correlated with the presence of MDR bacteria in the bile (OR 1.66, 95% CI: 1.1–2.52; p = 0.02). MDR bacteria were detected early in the surgical drainage in 144 out of 825 patients (12.1%), with 72.2% having a previous biliary stent placement and 27.8% without stents (p < 0.001). Moreover, the development of an MPC was associated with the presence of MDR bacteria in the drainage (OR = 1.81, 95% CI: 1.21–2.73, p = 0.0042). Conclusions: We demonstrated that MDR contamination worsens the short-term outcomes of patients undergoing PDs. Specifically, when MDR bacteria are present in both the bile and drainage, there is a statistically significant increase in the incidence of major postoperative complications (MPC). Our data suggest that the majority of MDR surgical site infections stem from biliary contamination resulting from the placement of a preoperative biliary stent (PBS).
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(This article belongs to the Section Biliary Content)
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