Gastroenterology Insights

11 pages, 734 KiB

Open AccessArticle

Temporal Trends in Biologic Prescriptions for Patient with Inflammatory Bowel Disease: A Retrospective Cohort Study

by Sunimal Fernando, Reeham Abu-Rgeef, Shankar Menon, Kenji So, Kannan Venugopal and Sherman Picardo

Gastroenterol. Insights 2025, 16(1), 4; https://doi.org/10.3390/gastroent16010004 - 9 Jan 2025

Abstract

Background: Biologic therapies, such antitumour necrosis factor-alpha agents (infliximab and adalimumab), as well as newer agents (ustekinumab and vedolizumab), all have well-demonstrated safety and efficacy profiles in the management of inflammatory bowel disease (IBD). The choice of an optimal first-line biologic remains unclear [...] Read more.

Background: Biologic therapies, such antitumour necrosis factor-alpha agents (infliximab and adalimumab), as well as newer agents (ustekinumab and vedolizumab), all have well-demonstrated safety and efficacy profiles in the management of inflammatory bowel disease (IBD). The choice of an optimal first-line biologic remains unclear due to a lack of comparative randomised trials and real-world studies; however, certain patient and disease characteristics may influence this choice. The aims of this study were to explore temporal trends in the choice of a first-line biologic therapy and the factors that influence this choice. Methodology: This study is a retrospective observational cohort study of all patients with IBD who commenced induction and completed at least one maintenance dose of a biologic therapy between 1 January 2015 and 31 December 2021. Relevant patient and disease-specific factors were collected, including history of malignancy and opportunistic infections at time of diagnosis, for each eligible patient. Factors affecting the choice of biologic therapy were compared using ANOVA and chi-square tests. Results: 280 patients were included in the study. Ustekinumab has overtaken infliximab and adalimumab as the first-line choice for Crohn’s disease since its introduction in 2018. Infliximab has remained the preferred first-line therapy for ulcerative colitis over adalimumab and vedolizumab. Ustekinumab has become he preferred biologic agent for older patients and those with a history of malignancy. Conclusions: Whilst an older agent such as infliximab is still preferred for the management of UC, novel agents such as ustekinumab are now more readily considered as a first-line agent for the management of CD. Full article

(This article belongs to the Section Gastrointestinal Disease)

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14 pages, 2417 KiB

Open AccessArticle

Reevaluation of an Established In Vivo Gastric Vessel Bleed Model for Hemostatic Device Safety and Efficacy Testing

by Jessica L. Grimsby, Matthew D. Szkolnicki and Kevin A. Wood

Gastroenterol. Insights 2025, 16(1), 3; https://doi.org/10.3390/gastroent16010003 - 7 Jan 2025

Abstract

Background: For over a decade, endoscopic hemostatic powders have been used to manage upper gastrointestinal bleeding (UGIB). Various preclinical benchtop and animal models have been developed to evaluate these devices. Multiple companies have released hemostatic powders to market, assessing their safety and efficacy [...] Read more.

Background: For over a decade, endoscopic hemostatic powders have been used to manage upper gastrointestinal bleeding (UGIB). Various preclinical benchtop and animal models have been developed to evaluate these devices. Multiple companies have released hemostatic powders to market, assessing their safety and efficacy using an established porcine gastric vessel bleed model. The model requires inserting an artery segment into the gastric lumen, which is then punctured to produce a bleed. This simulates an aggressive arterial bleed, allowing hemostatic prototype devices to be tested under challenging conditions. Methods: We aimed to evaluate the relationship between intragastric pressure and bleed severity by injecting the gas used to deliver hemostatic powder to the bleed site without administering the hemostatic powder. Results: Our results indicate that elevated intragastric pressures alone can cause bleed cessation. Additional findings suggest that other factors in the model can lead to false positive hemostasis. Conclusions: This study highlights limitations in the current state porcine gastric vessel bleed model. The results underscore the importance of vetting preclinical models before acquiring efficacy data and the need to develop more robust and effective bleed models for testing hemostatic devices. Full article

(This article belongs to the Section Gastrointestinal Disease)

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10 pages, 420 KiB

Open AccessArticle

Screening Colonoscopy Uptake Among Adult Stroke Survivors: Findings from the 2022 BRFSS Data

by Benjamin E. Ansa, Alaina Head, Zola Johnson, Wonder King Selassie Hatekah, Beulah Ansa and Darryl Nettles

Gastroenterol. Insights 2025, 16(1), 2; https://doi.org/10.3390/gastroent16010002 - 6 Jan 2025

Abstract

Background/Objectives: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths globally. Screening for cancer helps to prevent comorbid conditions among individuals with chronic medical conditions, such as stroke. The gold standard for CRC screening is colonoscopy. Stroke is the fifth [...] Read more.

Background/Objectives: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths globally. Screening for cancer helps to prevent comorbid conditions among individuals with chronic medical conditions, such as stroke. The gold standard for CRC screening is colonoscopy. Stroke is the fifth leading cause of death in the United States and a leading cause of long-term disability. This study examined the prevalence of screening colonoscopy among individuals who reported ever having had a stroke (stroke survivors). Methods: The 2022 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for the weighted prevalence and odds of screening colonoscopy uptake among adults aged 45 years and older, based on having had a stroke and socioeconomic status. Results: Almost 6% (n = 16,371) of the adults included in the analysis (N = 285,329) reported having had a stroke, and the weighted prevalence of screening colonoscopy for this group was 73.3% compared to 67.8% for those without stroke. Stroke survivors were 1.3 times more likely to have had a screening colonoscopy compared to those without a history of stroke. Higher odds of screening colonoscopy uptake were observed among stroke survivors that were older than 45–49 years old, with high school or greater than high school education. Stroke survivors that were multiracial and without health insurance coverage had lower odds of screening colonoscopy uptake compared to those that were white and had health insurance coverage, respectively. Conclusions: Though adult stroke survivors, compared to those without a stroke, are more likely to report having had a screening colonoscopy, differences in screening colonoscopy uptake were observed among subgroups of this population based on sociodemographic status. Tailored interventions are needed for increasing screening colonoscopy uptake among disadvantaged subgroups. Full article

(This article belongs to the Special Issue Novelties in Colorectal Surgery and Proctology)

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14 pages, 1160 KiB

Open AccessArticle

Smoking and Risk of Fatty Liver Disease: A Meta-Analysis of Cohort Studies

by Moonhyung Lee, Seung-Kwon Myung, Sang Hee Lee and Yoosoo Chang

Gastroenterol. Insights 2025, 16(1), 1; https://doi.org/10.3390/gastroent16010001 - 2 Jan 2025

Abstract

Background/Objectives: It remains inconclusive whether or not smoking is associated with an increased risk of fatty liver disease (FLD). We investigated the association between smoking and the risk of FLD by using a meta-analysis of cohort studies. Methods: PubMed and EMBASE [...] Read more.

Background/Objectives: It remains inconclusive whether or not smoking is associated with an increased risk of fatty liver disease (FLD). We investigated the association between smoking and the risk of FLD by using a meta-analysis of cohort studies. Methods: PubMed and EMBASE were searched using keywords from their inception to September 2023 to identify relevant studies. Results: Out of 806 articles searched from the databases, a total of 20 cohort studies were included in the final analysis. In the meta-analysis, smoking was significantly associated with an increased risk of FLD (odds ratio/relative risk/hazard ratio, 1.14; 95% confidence interval, 1.05–1.24; n = 20). Subgroup analyses showed a significant positive association between them in prospective cohort studies (odds ratio/relative risk/hazard ratio, 1.15; 95% confidence interval, 1.05–1.18; n = 5) but not in retrospective cohort studies and cross-sectional studies based on cohort studies. In the subgroup meta-analysis by gender in Asians, smoking significantly increased the risk of FLD in men, while there was no significant association between FLD and smoking in women. Conclusions: This meta-analysis showed that smoking increases the risk of FLD. In addition to well-known risk factors of FLD, clinicians should recommend smoking cessation for the management of FLD. Full article

(This article belongs to the Section Liver)

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13 pages, 1439 KiB

Open AccessArticle

Drug-Induced Liver Injury: Role of Circulating Liver-Specific microRNAs and Keratin-18

by Romilda Cardin, Debora Bizzaro, Francesco Paolo Russo, Francesca D’Arcangelo, Francesco Ideo, Filippo Pelizzaro, Chiara Carlotto, Milena Minotto, Fabio Farinati, Patrizia Burra and Giacomo Germani

Gastroenterol. Insights 2024, 15(4), 1093-1105; https://doi.org/10.3390/gastroent15040075 - 19 Dec 2024

Abstract

Background and Objective: Drug-induced liver injury (DILI) is increasingly becoming a cause of acute hepatitis. The study evaluated the role of liver-specific microRNAs (miRNAs) and keratin-18 (K-18) markers M30 (apoptosis) and M65 (necrosis) as biomarkers of acute hepatitis. Methods: Sixty-eight patients were [...] Read more.

Background and Objective: Drug-induced liver injury (DILI) is increasingly becoming a cause of acute hepatitis. The study evaluated the role of liver-specific microRNAs (miRNAs) and keratin-18 (K-18) markers M30 (apoptosis) and M65 (necrosis) as biomarkers of acute hepatitis. Methods: Sixty-eight patients were sub-grouped as DILI, HBV- and alcohol-related acute hepatitis. Five healthy controls were included. The expression of plasma miR-21-5p, miR-34a-5p and miR-122-5p was evaluated by RT-qPCR analysis using healthy volunteers as reference. M30 and M65 were determined with ELISA kits. Results: All markers were significantly higher in the acute liver disease patients compared to controls. In DILI, miRNA levels positively correlated with M30, M65 and ALT. miR-122-5p had the highest AUC of 0.73, sensitivity of 76.2 and specificity of 72.2 in identifying DILI from other groups. Patients with hepatocellular-pattern DILI showed higher miR-122-5p and miR-21-5p compared to patients with cholestatic or mixed pattern. A new score to discriminate DILI versus other causes of acute hepatitis was developed using the identified risk factors as follows: 0.012 × miR-34a-5p + 0.012 × miR-122-5p − 0.001 × M30 + 2.642 × 1 (if mixed pattern) + 0.014 × 1 (if hepatocellular pattern) + 1.887. The AUC of the score was 0.86, with a sensitivity and specificity of 81%, better than the values of the single markers. Conclusions: Liver-specific miRNAs and K-18 could be promising serum biomarkers of DILI, especially when used in combination. Full article

(This article belongs to the Section Liver)

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18 pages, 718 KiB

Open AccessArticle

Risk Factors and Postoperative Outcomes in Pouchitis Following Restorative Proctocolectomy: An 18-Year Single-Center Study

by Luisa Bertin, Mohamad Nasrallah, Carlo Redavid, Erica Bonazzi, Daria Maniero, Greta Lorenzon, Caterina De Barba, Sonia Facchin, Marco Scarpa, Cesare Ruffolo, Imerio Angriman, Andrea Buda, Matteo Fassan, Carmelo Lacognata, Brigida Barberio, Fabiana Zingone and Edoardo Vincenzo Savarino

Gastroenterol. Insights 2024, 15(4), 1075-1092; https://doi.org/10.3390/gastroent15040074 - 17 Dec 2024

Abstract

Background/Objectives: Restorative proctocolectomy with ileo-anal pouch anastomosis (IPAA) remains the preferred surgical treatment for ulcerative colitis (UC). However, complications like pouchitis can occur. This study aimed to describe patients who underwent IPAA for inflammatory bowel disease (IBD) at Padua Hospital from 2005 to [...] Read more.

Background/Objectives: Restorative proctocolectomy with ileo-anal pouch anastomosis (IPAA) remains the preferred surgical treatment for ulcerative colitis (UC). However, complications like pouchitis can occur. This study aimed to describe patients who underwent IPAA for inflammatory bowel disease (IBD) at Padua Hospital from 2005 to 2023 and identify risk factors for pouchitis. Secondary objectives included evaluating the effectiveness of biological therapy in chronic antibiotic-refractory pouchitis (CARP), Crohn’s disease of the pouch (CDP), and Crohn’s-like inflammation of the pouch (CDLPI), and assessing risk factors for pouch failure. Methods: This retrospective, observational study included 109 patients whose data were collected from medical records. Univariate logistic regression was used to analyze associations between preoperative and postoperative factors and outcomes such as acute pouchitis and pouch failure. The effectiveness of biological therapy was assessed by measuring changes in the Pouchitis Disease Activity Index (PDAI) and the Modified Pouchitis Disease Activity Index (mPDAI) over a 12-month treatment period. Results: Univariate logistic regression revealed significant associations between preoperative extraintestinal manifestations (OR 3.569, 95% CI 1.240–10.720), previous diagnosis of Crohn’s disease (OR 10.675, 95% CI 1.265–90.089), and transmural inflammation at cross-sectional imaging before surgery (OR 3.453, 95% CI 1.193–9.991) with an acute pouchitis risk. Pouch failure was significantly associated with a previous diagnosis of Crohn’s disease (OR 9.500, 95% CI 1.821–49.571) and post-surgical fistulas (OR 41.597, 95% CI 4.022–430.172). Biological therapy led to a significant reduction in the PDAI score in patients with CARP, decreasing from a median of 10 to 4 (p = 0.006). Similarly, in patients with CDP or CDLPI, the mPDAI score was significantly reduced from a median of 9 to 1 (p = 0.034), with remission achieved in 5/6 (83.3%) of these patients. Conclusions: This study provides valuable insights into the management of IPAA patients and highlights the importance of early identification and treatment of risk factors for pouchitis and failure. Biological therapy demonstrated significant effectiveness in reducing disease activity in patients with CARP, CDP, and CDLPI, suggesting its role as a crucial component in managing these complications. Full article

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

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11 pages, 290 KiB

Open AccessReview

The Association Between Crohn’s Disease and Patient Response to Yeast: A Review of the Literature

by Xavier Zonna, Conor Banta and Nariman Hossein-Javaheri

Gastroenterol. Insights 2024, 15(4), 1064-1074; https://doi.org/10.3390/gastroent15040073 - 10 Dec 2024

Abstract

Inflammatory bowel disease represents a wide range of pathologies and disease states including Crohn’s Disease (CD) and Ulcerative colitis (UC). Despite extensive research, the exact immunopathogenesis of Crohn’s disease remains unclear, but a variety of studies over the years have pointed to yeast [...] Read more.

Inflammatory bowel disease represents a wide range of pathologies and disease states including Crohn’s Disease (CD) and Ulcerative colitis (UC). Despite extensive research, the exact immunopathogenesis of Crohn’s disease remains unclear, but a variety of studies over the years have pointed to yeast as a potential source antigen of uncertain significance. The aim of this review is to summarize the current literature investigating the association between Crohn’s disease patients and their responses to yeast. To do this, we performed a literature review by looking at clinical and translational research regarding the immunopathogenesis of Crohn’s disease, yeast and its associated biomarkers, and overall patient response to dietary yeast published between 1 January 1990 and 1 October 2024 that were indexed on PubMed and Google Scholar with the majority written in English. It was found that antibodies against Saccharomyces cerevisiae (ASCA) have proven to be highly specific for CD during the workup of IBD and may have diagnostic value for the purpose of excluding ulcerative colitis. For CD patients, there appears to be a dysregulated immune response to antigens like yeast that results in abnormal mucosal permeability and thus increases antigen presentation to the immune system. In addition, ASCA and its immunoglobulin modifications have been shown to have significant potential in the prediction of CD onset and disease course. Interestingly, although other abnormally structured antibodies can be found in CD patients’ serum for years preceding diagnosis, there appears to be no relation between ASCA and dietary yeast sensitivity by CD patients. In conclusion, significant research efforts have been made in recent years to explore the role of diet in the disease course and management of patients with Crohn’s disease. The immunological role of antigens including yeast in CD is complex and may represent an important pathogenetic factor in addition to influencing the specific phenotype of the disease. Unfortunately, no single specific diet is superior for the management of IBD, and individualized patient treatment by experts in the field is best for adjunctive therapy. New studies characterizing the microbiome of CD patients and also using immune markers/gene modifications to predict disease outcomes have shown to be quite promising. However, further research is required to investigate the CD yeast response and its role in the pathogenesis, diagnosis and treatment of CD. Full article

(This article belongs to the Special Issue Immunological Aspects of Gastrointestinal Diseases)

10 pages, 569 KiB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Gastrointestinal Disease)

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26 pages, 948 KiB

Open AccessReview

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

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

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

Abstract

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

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

(This article belongs to the Section Liver)

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14 pages, 713 KiB

Open AccessReview

The Role of Artificial Intelligence in Endoscopic Ultrasound for Pancreatic Diseases

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

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

Abstract

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

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

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

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16 pages, 916 KiB

Open AccessReview

The Esophageal Microbiota in Esophageal Health and Disease

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

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

Abstract

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

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

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

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22 pages, 8420 KiB

Open AccessReview

CT and MR Imaging of Hepatocellular Carcinoma and Liver Cirrhosis

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

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

Abstract

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

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

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

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13 pages, 1675 KiB

Open AccessArticle

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

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

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

Cited by 1

Abstract

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

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

(This article belongs to the Section Gastrointestinal Disease)

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19 pages, 1350 KiB

Open AccessReview

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

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

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

Abstract

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

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

(This article belongs to the Section Liver)

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18 pages, 376 KiB

Open AccessReview

Non-Cirrhotic Ascites: Causes and Management

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

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

Abstract

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

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

(This article belongs to the Section Liver)

14 pages, 775 KiB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Gastrointestinal Disease)

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8 pages, 5345 KiB

Open AccessCase Report

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

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

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

Abstract

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

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

(This article belongs to the Section Gastrointestinal Disease)

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9 pages, 258 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

17 pages, 1053 KiB

Open AccessReview

Nutritional Consequences of Celiac Disease and Gluten-Free Diet

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

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

Abstract

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

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

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

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