Journal Description
Gastrointestinal Disorders
Gastrointestinal Disorders
is an international, open access, peer-reviewed journal on gastroenterology, published quarterly online by MDPI.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions; authors retain copyright.
- High Visibility: indexed within Scopus, ESCI (Web of Science), FSTA, and other databases.
- Journal Rank: CiteScore - Q2 (Immunology and Microbiology (miscellaneous))
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 25.5 days after submission; acceptance to publication is undertaken in 3.9 days (median values for papers published in this journal in the first half of 2024).
- 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.
- Reliable service: rigorous peer review and professional production.
Impact Factor:
0.9 (2023)
Latest Articles
Texture Analysis and Prediction of Response to Neoadjuvant Treatment in Patients with Locally Advanced Rectal Cancer
Gastrointest. Disord. 2024, 6(4), 858-870; https://doi.org/10.3390/gidisord6040060 - 28 Oct 2024
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Background: The purpose of this study is to determine the relationship between the texture analysis extracted from preoperative rectal magnetic resonance (MR) studies and the response to neoadjuvant treatment. Materials and Methods: In total, 88 patients with rectal adenocarcinoma who underwent staging MR
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Background: The purpose of this study is to determine the relationship between the texture analysis extracted from preoperative rectal magnetic resonance (MR) studies and the response to neoadjuvant treatment. Materials and Methods: In total, 88 patients with rectal adenocarcinoma who underwent staging MR between 2017 and 2022 were retrospectively enrolled. After the completion of neoadjuvant treatment, they underwent surgical resection. The tumour regression grade (TRG) was collected. Patients with TRG 1–2 were classified as responders, while patients with TRG 3 to 5 were classified as non-responders. A texture analysis was conducted using LIFEx software (v 7.6.0), where T2-weighted MR sequences on oriented axial planes were uploaded, and a region of interest (ROI) was manually drawn on a single slice. Features with a Spearman correlation index > 0.5 have been discarded, and a LASSO feature selection has been applied. Selected features were trained using bootstrapping. Results: According to the TRG classes, 49 patients (55.8%) were considered responders, while 39 (44.2) were non-responders. Two features were associated with the responder class: GLCM_Homogeneity and Discretized Histo Entropy log 2. Regarding GLCM_Homogeneity, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were 0.779 (95% CIs = 0.771–0.816), 86% (80–90), and 67% (60–71). Regarding Discretized Histo Entropy log 2, we found 0.775 AUC (0.700–0.801), 80% sensitivity (74–83), and 63% specificity (58–69). Combining both radiomics features the radiomics signature diagnostic accuracy increased (AUC = 0.844). Finally, the AUC of 1000 bootstraps were 0.810. Conclusions: Texture analysis can be considered an advanced tool for determining a possible correlation between pre-surgical MR data and the response to neoadjuvant therapy.
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Open AccessReview
Unraveling Gastric and Small Intestine Gastrointestinal Stromal Tumors: A Review of Our Current Knowledge
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Panagiotis Eskitzis, Vasiliki Michou, Rodoula Theoti, Antonia Antoniou, Drosos Tsavlis and Doxakis Anestakis
Gastrointest. Disord. 2024, 6(4), 842-857; https://doi.org/10.3390/gidisord6040059 - 18 Oct 2024
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Background: Gastrointestinal Stromal Tumors (GISTs) are characterized as round, well–defined mass lesions in the submucosal layer of the gastrointestinal (GI) tract. GISTs often present histological diversity and mutations in c-KIT and PDGFRA genes. Symptoms usually appear as abdominal pain, often accompanied by gastrointestinal
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Background: Gastrointestinal Stromal Tumors (GISTs) are characterized as round, well–defined mass lesions in the submucosal layer of the gastrointestinal (GI) tract. GISTs often present histological diversity and mutations in c-KIT and PDGFRA genes. Symptoms usually appear as abdominal pain, often accompanied by gastrointestinal bleeding or abdominal mass. The prognosis relies on tumor size, mitotic index, and different mutations, such as KIT mutations. There are a variety of diagnostic measures in the case of GISTs. However, it is important to note that ultrasound is the most common and reliable method for diagnosing gastric GISTs. The treatment methods followed vary from preoperative systemic therapy to surgical interventions. Depending on the type of GIST, professionals decide upon the best treatment plan for the patient. Objective: This review aims to inform the scientific community about the intricacies of gastric and small intestine GISTs to enhance understanding and improve patient management, with a particular focus on the importance of understanding and interpreting the unique microscopic histopathological findings of GISTs.
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Open AccessArticle
Evaluating the Hematological Parameter Alterations Induced by Mavyret in Chronic Hepatitis Patients
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Alina Maria Constantinescu, Ramona Nicoleta Suciu, Antal Ioan Andrei, Harrie Toms John, Anca Ferician, Nicoleta Negrut and Felicia Manole
Gastrointest. Disord. 2024, 6(4), 832-841; https://doi.org/10.3390/gidisord6040058 - 17 Oct 2024
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Background/Objectives: The hepatitis C virus (HCV) is a significant threat to people with persistent infections. In recent years, the treatment of chronic hepatitis C (CHC) has been transformed significantly with the use of Direct-Acting Antivirals (DAAs). Hematological changes are seen in patients
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Background/Objectives: The hepatitis C virus (HCV) is a significant threat to people with persistent infections. In recent years, the treatment of chronic hepatitis C (CHC) has been transformed significantly with the use of Direct-Acting Antivirals (DAAs). Hematological changes are seen in patients suffering from CHC due to both the disease and its therapy. This study aims to address the gaps in knowledge by thoroughly evaluating the hematological parameter alterations in CHC patients treated with Mavyret. Methods: This study reported that it took place over six months in 2024 on 101 patients observed at the gastroenterology department of Pitesti County Hospital in Romania, who had confirmed diagnoses of CHC and who were receiving the DAA Mavyret. Results: The values of leukocytes significantly decreased after treatment (8.69 ± 2.96 vs. 7.93 ± 1.78, p = 0.009). Similarly, neutrophils showed a statistically significant decrease after using Mavyret (5.45 ± 2.06 vs. 4.91 ± 1.29, p = 0.018). In the case of lymphocytes, the values slightly increased from 2.14 ± 0.69 before treatment to 2.20 ± 1.19 after it, but without a statistically significant difference (p = 0.320). The values of monocytes and eosinophils significantly decreased after antiviral therapy (0.81 ± 1.02 vs. 0.59 ± 0.15, p = 0.020; 0.21 ± 0.15 vs. 0.14 ± 0.09, p < 0.001). For basophils, the mean values remained almost unchanged after DAA therapy (0.09 ± 0.08 vs. 0.09 ± 0.15, p = 0.433). Conclusions: Mavyret has proven to be a safe medication for administering to patients with CHC, but its minor adverse effects on red blood cells, white blood cells, and platelets require constant monitoring, mainly when used for an extended period and in patients who are vulnerable in this regard.
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Open AccessSystematic Review
Factors Associated with Days Alive and at Home within 30 Days (DAH30) Scores Following Surgery: A Systematic Review
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Jenna Bartyn, James Morkaya, Sascha Karunaratne, Tian You Chen, Michael Solomon, Cherry Koh, Charbel Sandroussi and Daniel Steffens
Gastrointest. Disord. 2024, 6(4), 816-831; https://doi.org/10.3390/gidisord6040057 - 2 Oct 2024
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Background/Objectives: Days Alive and at Home within 30 days (DAH30) is a patient-centred measurement tool designed to assist with the decision-making and management of patients undergoing surgery. Thus, identifying factors associated with better DAH30 scores would support healthcare providers to optimise patient care
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Background/Objectives: Days Alive and at Home within 30 days (DAH30) is a patient-centred measurement tool designed to assist with the decision-making and management of patients undergoing surgery. Thus, identifying factors associated with better DAH30 scores would support healthcare providers to optimise patient care and outcomes. This systematic review aimed to determine factors associated with DAH30 scores following surgery. Methods: A sensitive electronic search was conducted in MEDLINE, Embase, Scopus, Web of Science and CINAHL databases in September 2022. Eligible studies included patients undergoing surgery and reporting the association of preoperative and/or postoperative factors and DAH30. Risk of bias was assessed using the QUIPs tool. Results: Of the 14 studies identified, the majority (n = 13, 93%) were cohort studies, presenting moderate or high (n = 8, 60%) risk of bias. This review identified a number of factors influencing DAH30 scores in patients undergoing surgery. ASA Physical Status and surgery duration were the most common factors influencing DAH30 scores. Conclusions: Optimising patients’ health prior to surgery and reducing surgical time have the potential to improve patients’ recovery.
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Open AccessReview
Impact of Probiotics and Prebiotics on Gut Microbiome and Hormonal Regulation
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Jelina Basnet, Manar A. Eissa, Licy L. Yanes Cardozo, Damian G. Romero and Samar Rezq
Gastrointest. Disord. 2024, 6(4), 801-815; https://doi.org/10.3390/gidisord6040056 - 27 Sep 2024
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The gut microbiome plays a crucial role in human health by influencing various physiological functions through complex interactions with the endocrine system. These interactions involve the production of metabolites, signaling molecules, and direct communication with endocrine cells, which modulate hormone secretion and activity.
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The gut microbiome plays a crucial role in human health by influencing various physiological functions through complex interactions with the endocrine system. These interactions involve the production of metabolites, signaling molecules, and direct communication with endocrine cells, which modulate hormone secretion and activity. As a result, the microbiome can exert neuroendocrine effects and contribute to metabolic regulation, adiposity, and appetite control. Additionally, the gut microbiome influences reproductive health by altering levels of sex hormones such as estrogen and testosterone, potentially contributing to conditions like polycystic ovary syndrome (PCOS) and hypogonadism. Given these roles, targeting the gut microbiome offers researchers and clinicians novel opportunities to improve overall health and well-being. Probiotics, such as Lactobacillus and Bifidobacterium, are live beneficial microbes that help maintain gut health by balancing the microbiota. Prebiotics, non-digestible fibers, nourish these beneficial bacteria, promoting their growth and activity. When combined, probiotics and prebiotics form synbiotics, which work synergistically to enhance the gut microbiota balance and improve metabolic, immune, and hormonal health. This integrated approach shows promising potential for managing conditions related to hormonal imbalances, though further research is needed to fully understand their specific mechanisms and therapeutic potential.
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Open AccessCase Report
Squamous Cell Carcinoma of the Gallbladder Masquerading as Complicated Cholecystitis: A Case Report and Review
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Najib Bahrou, El Khalil Cherif, Salaheddine Abdennebi, Yahya Zain Al Abidine Khedid, Mohamed El Absi, El Mahjoub Echarrab, Mohamed Elounani and El Alami El Faricha El Hassan
Gastrointest. Disord. 2024, 6(3), 796-800; https://doi.org/10.3390/gidisord6030055 - 18 Sep 2024
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In summary, squamous cell carcinoma (SCC) of the gallbladder, although rare, poses significant diagnostic and therapeutic challenges. We report the case of a 51-year-old woman with no previous medical history, with SCC discovered during complicated cholecystitis with cholangitis, treated by palliative chemotherapy, underscoring
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In summary, squamous cell carcinoma (SCC) of the gallbladder, although rare, poses significant diagnostic and therapeutic challenges. We report the case of a 51-year-old woman with no previous medical history, with SCC discovered during complicated cholecystitis with cholangitis, treated by palliative chemotherapy, underscoring the difficulty in early detection and the poor prognosis associated with advanced-stage diagnosis. Treatment options are limited, with palliative chemotherapy often being the primary recourse for unresectable tumors. Gallbladder cancers, including SCC, share risk factors with adenocarcinomas, but their distinct histopathological features and clinical presentations warrant careful consideration. Despite recent advancements in treatment modalities, including adjuvant therapy, optimal management strategies remain elusive, highlighting the need for further research to improve outcomes for patients with this aggressive malignancy.
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Open AccessReview
Hepatitis B Management in the Middle East: A Narrative Review of Current Antiviral Treatments
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Hannah Beck, Nishaanth Dalavaye, Kalaikshiga Kengadaran, Mosammath Monira Khatun, Ria Hitesh Patel, Taif Al-Rubaye and Laith Alrubaiy
Gastrointest. Disord. 2024, 6(3), 784-795; https://doi.org/10.3390/gidisord6030054 - 12 Sep 2024
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Introduction: Chronic hepatitis B (CHB) is a significant public health issue worldwide, especially in the Middle East region. Around 8% to 20% of patients with CHB develop cirrhosis, which may progress to hepatocellular carcinoma. The significant morbidity and mortality associated with CHB
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Introduction: Chronic hepatitis B (CHB) is a significant public health issue worldwide, especially in the Middle East region. Around 8% to 20% of patients with CHB develop cirrhosis, which may progress to hepatocellular carcinoma. The significant morbidity and mortality associated with CHB denote the importance of high-quality treatment. Methods: We searched the PubMed, Medline, and Cochrane databases from inception to January 2024 to identify relevant studies. Search terms were generated using established treatment guidelines for CHB. We also manually searched the bibliographies of relevant literature to obtain additional papers. Results: In this narrative review, we evaluated the seven currently licensed antiviral therapies for chronic Hepatitis B treatment, including nucleos(t)ide analogs (NAs) and pegylated interferon-alpha (PEG-IFNα). NAs can be divided into two categories: high barrier to resistance and low barrier to resistance. Tenofovir disoproxil fumarate, tenofovir alafenamide, and entecavir are NAs with a high barrier to resistance. Telbivudine has shown promise in providing high efficacy with low viral resistance rates; however, it is not recommended because of insufficient evidence and lack of cost-effectiveness. Lamivudine and adefovir dipivoxil, despite being efficacious, have a low barrier to resistance, the primary reason they are no longer recommended. PEG-IFNα has high efficacy and can be completed in 48 weeks. It is not associated with resistance; however, it has been reported to have several systemic adverse effects. Conclusions: Current first-line NA treatments in the Middle East include entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide. These drugs are favored over other NAs because of their low rates of resistance. PEG-IFNα has superiority over NAs in inducing a more durable antiviral response and having a finite treatment duration. The main drawback of PEG-IFNα is an unfavorable safety profile.
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Open AccessReview
Effectiveness of Pelvic Floor Muscle Training for Treating Faecal Incontinence
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Yohei Okawa
Gastrointest. Disord. 2024, 6(3), 774-783; https://doi.org/10.3390/gidisord6030053 - 27 Aug 2024
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The purpose of this study is to examine the effect of pelvic floor muscle training on faecal incontinence. Faecal incontinence is a condition in which stool leaks from the anus involuntarily or uncontrollably. Faecal incontinence is common in elderly people and patients with
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The purpose of this study is to examine the effect of pelvic floor muscle training on faecal incontinence. Faecal incontinence is a condition in which stool leaks from the anus involuntarily or uncontrollably. Faecal incontinence is common in elderly people and patients with underlying diseases, but the pathophysiology of faecal incontinence is diverse, and treatment methods must be varied accordingly. Among the known treatment methods, in this study, we focused on pelvic floor muscle training, which can be performed in daily life. The literature was searched for papers that present existing knowledge and address current perspectives. Extracted studies included papers that report scientific consensus. After reviewing the literature, it appears that it is possible to effectively train patients to defecate twice a day, approximately 30 min after breakfast and dinner, by having them attempting to defecate, even when there is no such urge. Pelvic floor muscle training can improve urinary and faecal incontinence by strengthening the contractile force of the pelvic floor muscles such as the external anal sphincter and levator ani. However, the specific types of faecal incontinence patients that can effectively benefit from pelvic floor muscle training is unclear. It is important for patients to understand the pelvic floor muscle training program and to develop sufficient motivation to continue training at home.
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Open AccessArticle
Abdominal Pain and Chronic Opiate Use in Patients with Gastroparesis
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Abraham Ifrah, John Ebeid and Henry P. Parkman
Gastrointest. Disord. 2024, 6(3), 765-773; https://doi.org/10.3390/gidisord6030052 - 16 Aug 2024
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Introduction: Although opiate narcotics may worsen gastroparesis(GP), patients can take these for abdominal pain (AP) or other chronic pain syndromes. This study aims to evaluate medications patients with gastroparesis use for AP and compare patients who use opiate analgesics for AP to those
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Introduction: Although opiate narcotics may worsen gastroparesis(GP), patients can take these for abdominal pain (AP) or other chronic pain syndromes. This study aims to evaluate medications patients with gastroparesis use for AP and compare patients who use opiate analgesics for AP to those using opiate analgesics for non-abdominal pain. Methods: Patients at a tertiary academic center gastroenterology clinic completed the Patient Assessment of Gastrointestinal Disorders–Symptom Severity Index (PAGI-SYM) and Quality of Life Short-Form 8 (QOL SF-8) surveys between 10/2021 and 03/2023. Patients recorded gastroparesis treatments, pain treatments and indication, and any hospitalizations/emergency department (ED) visits within 3 months of a clinic visit. Results: A total of 53 patients were enrolled: 72% reported having AP. Patients were using the following medications for AP: 25% heating pad, ice or hot showers, 20.8% acetaminophen, 14.6% hyoscyamine, 13% opiate use, 13% marijuana use, 10.4% dicyclomine, 8.3% Nonsteroidal anti-inflammatory drugs (NSAIDs), 4% benzodiazepine, and 2.1% gabapentin. The reported reasons for using opiates were 58% AP, 16.6% chronic back pain, 16.6% Reflex Sympathetic Dystrophy (RSD) and fibromyalgia, and 8.3% osteoarthritis. All opiate users reported daily scheduled use. AP severity scores (4.1 vs. 2.8; p = 0.041), morphine equivalent usage (77 ± 44 vs. 32 ± 28; p = 0.037), and the number of ER visits (1.0 vs. 0 over 3 months) were higher in patients using opiates for AP than those using opiates for non-abdominal pain. Conclusions: In this series, 72% of patients with gastroparesis had abdominal pain, and 13% of patients were taking opiates. Patients who used opiate analgesics for abdominal pain had a higher average abdominal pain severity score and used a higher amount of opiate analgesia than patients using opiates for musculoskeletal pain. Abdominal pain in patients with gastroparesis can be harder to control with opiate analgesia compared to non-abdominal pain, supporting the concept of avoiding chronic opiate usage for abdominal pain in gastroparesis.
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(This article belongs to the Topic Advances in Gastrointestinal and Liver Disease: From Physiological Mechanisms to Clinical Practice)
Open AccessArticle
Actitan: A Natural Complex for Managing Diarrhea—Insights from Cross-Sectional Survey Research Involving Patients, Pharmacists and Physicians
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Roberto Cioeta, Paola Muti, Marta Rigoni, Andrea Cossu and Emiliano Giovagnoni
Gastrointest. Disord. 2024, 6(3), 753-764; https://doi.org/10.3390/gidisord6030051 - 8 Aug 2024
Cited by 1
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Diarrhea continues to be a global health problem as acute diarrhea carries the risk of dehydration, while both acute and chronic diarrhea can significantly affect patients’ quality of life and reduce productivity. The innovative medical device Actitan, which consists of a complex of
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Diarrhea continues to be a global health problem as acute diarrhea carries the risk of dehydration, while both acute and chronic diarrhea can significantly affect patients’ quality of life and reduce productivity. The innovative medical device Actitan, which consists of a complex of natural molecules, could be an effective option for the treatment of diarrhea from various causes. The aim of this post-market cross-sectional study was to evaluate the perceived efficacy, safety and usage pattern of the two formulations for adults (Actitan-P) and children (Actitan-F) among patients/child caregivers, physicians and pharmacists. Participants completed online questionnaires with closed multiple-choice questions that were rated on a verbal 5-point Likert scale. These surveys were conducted via the online platform Real World Data, which provides digital questionnaires for patients, doctors and pharmacists. Two separate surveys were conducted for the two formulations, with a total of 2630 participants (1488 participants for Actitan-P and 1142 participants for Actitan-F). Overall, the results indicate a high level of efficacy and safety of the product. In the case of Actitan-F, more than 96% of caregivers rated safety as good or excellent, and over 92% rated efficacy as good or excellent. Actitan-P also received positive feedback: nearly 86% of patients reported good/excellent efficacy, and more than 93% rated safety as good or excellent. These positive evaluations were confirmed by physicians and pharmacists, who also did not report adverse effects. In summary, this study confirms the role of Actitan as a safe and effective option for the treatment of diarrhea of different causes and in different patient groups, including young children.
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Open AccessBrief Report
Coil- and Plug-Assisted Transvenous Retrograde Obliteration (CARTO/PARTO) in the Treatment of Gastric Varices: A European Single Centre Experience
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Giuseppe Pelle, Flavio Andresciani, Massimo Messina, Silvia Nardelli, Lorenzo Ridola, Ermanno Notarianni, Adelchi Saltarelli, Stefania Gioia, Alessandro Tanzilli and Cesare Ambrogi
Gastrointest. Disord. 2024, 6(3), 742-752; https://doi.org/10.3390/gidisord6030050 - 7 Aug 2024
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In Europe, transjugular intrahepatic portosystemic shunt (TIPS) is considered the primary treatment for gastric varix (GV) bleeding to reduce portal hypertension. However, in Asian countries, balloon-occluded retrograde transvenous obliteration (BRTO) and its variants plug/coil assisted transvenous retrograde obliteration (PARTO/CARTO) are the preferred approaches.
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In Europe, transjugular intrahepatic portosystemic shunt (TIPS) is considered the primary treatment for gastric varix (GV) bleeding to reduce portal hypertension. However, in Asian countries, balloon-occluded retrograde transvenous obliteration (BRTO) and its variants plug/coil assisted transvenous retrograde obliteration (PARTO/CARTO) are the preferred approaches. The purpose of this study is to report a European single-center experience in the use of PARTO/CARTO techniques for the treatment of GVs in patients with portal hypertension, focusing on the effectiveness and safety of the procedure. All the procedures involving the PARTO/CARTO techniques performed from 2019 to 2023 were retrospectively evaluated. Technical success was defined as the complete obliteration of both the GVs and the gastro-renal (GR) shunt on review of the Computed Tomography (CT) scan performed 3 days after the procedure. The obliteration rate was also evaluated through performing CT scans 1 and 12 months after the procedure, and through endoscopic follow-up at 3 and 6 months. Additionally, major and minor complications were reported. The study involved seven patients, with a technical success of 100%. During follow-up, there were no episodes of variceal rebleeding or upper gastrointestinal bleeding. Two patients developed ascites, which resolved with medical therapy. One patient exhibited focal portal thrombosis, which was successfully treated with heparin. PARTO/CARTO techniques demonstrated high technical and clinical success rates, offering advantages over traditional BRTO. The use of coils and plugs simplifies the procedure, eliminates sclerosing agents, and prevents complications associated with balloon guiding catheters.
Full article
(This article belongs to the Special Issue Feature Papers in Gastrointestinal Disorders in 2023-2024)
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Open AccessArticle
Traditional Biomarkers in Patients with Pancreatic Cancer Staged by Computed Tomography and Endoscopic Ultrasound: Is There Still a Role in the Molecular Era?
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Maria Giulia Demarzo, Chiara Facchini, Giuliana Rosa Bisso, Ciro Marrone and Maria Caterina Parodi
Gastrointest. Disord. 2024, 6(3), 733-741; https://doi.org/10.3390/gidisord6030049 - 7 Aug 2024
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Serum carbohydrate antigen 19-9 (Ca19-9) is the only approved biomarker approved for the screening and diagnosis of pancreatic cancer (PC), but its value remains controversial. The aim of our study is to evaluate the role of CA 19-9 in the management of PC
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Serum carbohydrate antigen 19-9 (Ca19-9) is the only approved biomarker approved for the screening and diagnosis of pancreatic cancer (PC), but its value remains controversial. The aim of our study is to evaluate the role of CA 19-9 in the management of PC patients in jaundiced patients staged by both Computed Tomography (CT) and Endoscopic Ultrasound (EUS). Additionally, we evaluated traditional cholestasis marker behavior. Medical records of 73 patients have been retrospectively reviewed. We considered tumor size, tumor stage, CA 19-9, cytolysis, and cholestasis biomarkers. All patients underwent CT scan for staging. EUS +/− fine-needle biopsy (FNB) was performed in doubtful cases. Median alkaline phosphatase (ALP) and y-glutamyltransferase (GGT) levels were significantly lower compared to baseline after the biliary drainage (204 vs. 465 U/L, p < 0.0001, 204. U/L vs. 608.5, p < 0.0001, respectively), whilst no differences were observed for CA 19-9 levels. CA 19-9 showed significant association with the tumor stage in the pre-drainage setting. CT and EUS showed a low agreement in estimating tumor size (mean difference 4.8 mm 95% LoA −10.82–20.38). We did not find any significant correlation between CA 19-9 and bilirubin levels (r = −0.05, p = 0.7). In our cohort, survival rate was lower in patients with higher CA 19-9 levels (log rank p = 0.007). CA 19-9 has some limitations as a biomarker in the PC setting, thus it cannot address the treatment strategy alone. Nonetheless, it provides valuable information, and is not replaceable for the time being.
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Open AccessCommunication
Sex Differences and Bmal1/Acetylcholine- or Bmal1/Noradrenaline-Mediated Effects of Blue Light Irradiation on Dextran-Sodium-Sulfate-Induced Ulcerative Colitis Model Mice
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Keiichi Hiramoto, Sayaka Kubo, Keiko Tsuji, Daijiro Sugiyama and Hideo Hamano
Gastrointest. Disord. 2024, 6(3), 720-732; https://doi.org/10.3390/gidisord6030048 - 5 Aug 2024
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Humans are exposed to significant amounts of blue light from computers and smartphones. However, the effects of blue light on ulcerative colitis remain unclear. In this study, we assessed blue-light-irradiation-induced alterations in colonic symptoms using a dextran sodium sulfate (DSS)-induced ulcerative colitis model
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Humans are exposed to significant amounts of blue light from computers and smartphones. However, the effects of blue light on ulcerative colitis remain unclear. In this study, we assessed blue-light-irradiation-induced alterations in colonic symptoms using a dextran sodium sulfate (DSS)-induced ulcerative colitis model mice. Both male and female institute of cancer research (ICR) mice were administered DSS (5%) ad libitum for 5 days while irradiated with 40 kJ/m2 blue light daily. Additionally, tranexamic acid (TA) was administered daily throughout the study. Male mice treated with DSS/blue light exhibited exacerbated colitis compared to those treated with DSS alone. In contrast, female mice treated with DSS/blue light exhibited enhanced symptoms compared to those treated with DSS alone. Additionally, in male mice exposed to blue light, the clock/brain and muscle Arndt-like 1 (Bma1)/noradrenaline/macrophage or beta2-adrenergic receptor (β2-AR) pathways were activated. In female mice, the Bmal1/acetylcholine/macrophage/nicotinic acetylcholine receptor alpha 7 (α7nAChR) pathway was activated. These findings highlight sex differences in the effects of blue light on DSS-induced ulcerative colitis. Moreover, the worsening of symptoms in males was ameliorated through TA administration.
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Open AccessReview
Nursing Interventions Targeting Fatigue in Inflammatory Bowel Disease: A Systematic Review
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Matteo Martinato, Elena Boffo, Greta Lorenzon, Eleonora Monaco, Clara Iervolino, Rosanna Irene Comoretto, Edoardo Vincenzo Savarino and Dario Gregori
Gastrointest. Disord. 2024, 6(3), 706-719; https://doi.org/10.3390/gidisord6030047 - 5 Aug 2024
Abstract
A prevalent symptom among Inflammatory Bowel Disease (IBD) patients is fatigue, characterized by a persistent sense of energy depletion that affects all aspects of daily life. This review aims to evaluate nursing interventions reported in the literature to alleviate fatigue in IBD patients.
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A prevalent symptom among Inflammatory Bowel Disease (IBD) patients is fatigue, characterized by a persistent sense of energy depletion that affects all aspects of daily life. This review aims to evaluate nursing interventions reported in the literature to alleviate fatigue in IBD patients. A comprehensive search was conducted across four electronic databases—PubMed, CINAHL, Cochrane, and Scopus—and four scientific journals: “Gastroenterology”, “Inflammatory Bowel Disease”, “Journal of Crohn’s and Colitis”, and “United European Gastroenterology Journal”. Inclusion criteria were clinical trials involving adult IBD patients in remission or mild disease activity. Out of 234 studies, 2 were selected for review. These studies assess the effectiveness of Solution-Focused Therapy (SFT) that emphasizes solving problems and developing strategies for improvement, and Problem-Solving Therapy (PST) that focuses on identifying problems and coping strategies. SFT showed a positive impact on fatigue with a significant improvement in the Checklist Individual Strength after three months: 45.5% in the control group, 85.7% in the SFT group, and 60% in the PST group, but its impact declined over time. Additionally, SFT demonstrated potential for reducing healthcare costs compared to standard of care and PST. Further research is needed to provide nurses interventions for managing fatigue in IBD patients. The review protocol has been registered at OSF.io.
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(This article belongs to the Special Issue Factors Affecting Disease Activity in Children and Adults with Inflammatory Bowel Disease: An Exploration of Pro-Inflammatory and Anti-Inflammatory Elements)
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Open AccessArticle
Metabolic Compartmentalization in Colorectal Cancer Hepatic Metastases and Correlation with Tumor Aggressiveness
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Nuno Castro, Mariana Fernandes, Ana Pereira, Mariana Costa, Nuno Machado, Cláudio Branco, Carlos Veiga, Adhemar Longatto-Filho and Sandra F. Martins
Gastrointest. Disord. 2024, 6(3), 692-705; https://doi.org/10.3390/gidisord6030046 - 29 Jul 2024
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At the time of colorectal cancer (CRC) diagnosis, approximately 25% of patients present with liver metastases, and 70% develop them during follow-up. This is the primary cause of therapeutic failure and most associated deaths, making it imperative to understand the molecular mechanisms involved
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At the time of colorectal cancer (CRC) diagnosis, approximately 25% of patients present with liver metastases, and 70% develop them during follow-up. This is the primary cause of therapeutic failure and most associated deaths, making it imperative to understand the molecular mechanisms involved in this process and the biological components involved. In the process of anaerobic glycolysis occurring in these cells, to maintain cellular homeostasis, excess lactate is removed via monocarboxylate transporters (MCTs). This study aimed to characterize monocarboxylate transporter 4 (MCT4), human glucose transporter protein isoform 1(GLUT1), cluster of differentiation 147 (CD147), and the acidic cell surface adhesion protein (CD44) in various cellular and histological compartments of liver metastases from CRC in 45 patients diagnosed with metastatic CRC. The characterization revealed significant correlations between the compartmentalization of these markers and the patients’ clinicopathological data. The findings for MCT4, GLUT1, CD147, and CD44 obtained in this study are very promising in relation to considering these markers as therapeutic targets in further investigations.
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Open AccessReview
The Impact of a Gluten-Free Diet on Pregnant Women with Celiac Disease: Do We Need a Guideline to Manage Their Health?
by
Yeliz Serin, Camilla Manini, Pasqualino Amato and Anil K. Verma
Gastrointest. Disord. 2024, 6(3), 675-691; https://doi.org/10.3390/gidisord6030045 - 17 Jul 2024
Abstract
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A healthy and balanced diet is a critical requirement for pregnant women as it directly influences both the mother’s and infant’s health. Poor maternal nutrition can lead to pregnancy-related complications with undesirable effects on the fetus. This requirement is equally important for pregnant
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A healthy and balanced diet is a critical requirement for pregnant women as it directly influences both the mother’s and infant’s health. Poor maternal nutrition can lead to pregnancy-related complications with undesirable effects on the fetus. This requirement is equally important for pregnant women with celiac disease (CD) who are already on a gluten-free diet (GFD). Although the GFD is the sole treatment option for CD, it still presents some challenges and confusion for celiac women who wish to conceive. Poorly managed CD has been linked to miscarriages, preterm labor, low birth weight, and stillbirths. Current CD guidelines primarily focus on screening, diagnosis, treatment, and management but lack an evidence-based approach to determine appropriate energy requirements, recommended weight gain during pregnancy, target macronutrient distribution from the diet, the recommended intake of vitamins and minerals from diet and/or supplementation, timing for starting supplementation, and advised portions of gluten-free foods during pregnancy. We recommend and call for the development of such guidelines and/or authoritative papers in the future.
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Open AccessArticle
Reliability of Kudo’s Glandular Pit Pattern in Predicting Colorectal Lesion Histology at Routine Colonoscopy with Digital Chromoendoscopy
by
Sabrina Gloria Giulia Testoni, Pier Alberto Testoni, Chiara Notaristefano, Edi Viale and Giulia Martina Cavestro
Gastrointest. Disord. 2024, 6(3), 661-674; https://doi.org/10.3390/gidisord6030044 - 10 Jul 2024
Abstract
Background. The large number of lesions detected via high-definition (HD) imaging during colonoscopy calls for the reliable real-time histological characterization of polyps, especially diminutive and small ones, to permit tailored management based on the neoplastic risk, such as a “resect-and-discard” or a
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Background. The large number of lesions detected via high-definition (HD) imaging during colonoscopy calls for the reliable real-time histological characterization of polyps, especially diminutive and small ones, to permit tailored management based on the neoplastic risk, such as a “resect-and-discard” or a “diagnose-and-leave” strategy for low-risk adenomas and hyperplastic polyps (HPs). The Kudo classification of glandular pit pattern is currently used for predicting polyp histology. Aim. The aim in this study was to assess whether Kudo’s glandular pit pattern, assessed via HD digital chromoendoscopy (i-Scan) without magnification and optical enhancement, reliably predicts polyp histology and differentiates neoplastic lesions (NLs) from non-neoplastic lesions (non-NLs) during routine colonoscopy. Methods. Consecutive colorectal lesions recorded in a database over 12 months, with Kudo’s glandular pit pattern classification, were retrospectively compared with histology. The diagnostic accuracy and negative predictive value (NPV) for adenomatous histology of Kudo’s pit patterns were assessed separately for diminutive (≤5 mm) and small (6–9 mm) polyps, accordingly to the American Society for Gastrointestinal Endoscopy (ASGE) Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI), and in large (≥10 mm) lesions. Results. A total of 2230 lesions were recorded: 898 diminutive, 704 small, and 628 large. Kudo’s type II pit pattern was prevalent in diminutive polyps and recognized mostly in HPs (83.27%); it was also found in 38.8% of adenomas. In the right colon, Kudo’s type II pit pattern was prevalent in adenomas (70.04% vs. 20.74% in HPs); among the serrated lesions, it was evenly distributed between HPs and adenomas. Kudo’s type IIIL/IIIs/IV pit pattern was prevalent in NLs (61% vs. 8.37% of non-NLs) in diminutive polyps, evenly distributed between non-NLs and NLs in small polyps, and found only in NLs in large polyps. Kudo’s type Vi/Vn pit pattern correctly identified all but one adenocarcinoma. The NPV for adenomatous histology did not reach the recommended 90% PIVI threshold for differentiation between NLs and non-NLs in diminutive polyps showing Kudo’s type II pit pattern and in small polyps showing type IIIL/IIIs/IV pit pattern. Conclusions. Kudo’s pit pattern classification carried out with digital chromoendoscopy (i-Scan) during routine colonoscopy does not allow the reliable differentiation between non-NLs and NLs in diminutive and small polyps, so a “diagnose-and-leave” strategy for diminutive polyps may leave undetected adenomas, while a “resect-and-discard” strategy could miss lesions requiring closer follow-up.
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(This article belongs to the Special Issue Colorectal Cancer Screening (CRC) in the EU)
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Open AccessReview
Biologics in Focus: A Comprehensive Review of Current Biological and Small Molecules Therapies for Crohn’s Disease in the United Arab Emirates (UAE)
by
Laith Alrubaiy, Louise Christine Pitsillides, Thomas O’Connor, Matilda Woodhill, Harry Higgins, Thaer Khaleel Swaid, Doa’a Alkhader and Zaher Koutoubi
Gastrointest. Disord. 2024, 6(3), 644-660; https://doi.org/10.3390/gidisord6030043 - 7 Jul 2024
Abstract
Introduction: The management of Crohn’s disease (CD) in the Middle East, like in other parts of the world, is rapidly evolving with the introduction of novel advanced medical and biological therapies. In the United Arab Emirates (UAE), several biological therapies are used
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Introduction: The management of Crohn’s disease (CD) in the Middle East, like in other parts of the world, is rapidly evolving with the introduction of novel advanced medical and biological therapies. In the United Arab Emirates (UAE), several biological therapies are used to achieve remission in severe and resistant cases of CD. We carried out a literature search to analyze the effectiveness and safety of biologic treatments currently licensed in the UAE. Methods: We searched the PubMed, Embase and Cochrane library databases from inception to January 2020 to identify relevant studies. Search terms were generated using established treatment guidelines for CD. We also manually searched the bibliographies of relevant literature to obtain additional papers. Results: Biologic and small molecule agents for CD include four core drug classes: anti-tumor necrosis factor-α agents (TNF-α), integrin receptor antagonists, Janus kinase (JAK) inhibitors and IL-12/IL-23 antagonists. All drug classes showed good efficacy and safety in managing patients with CD. Some drug classes had distinguishable side effect profiles. This included an increased lymphoma and tuberculous risk for TNF-α and integrin receptor antagonists. Many trials supported the effectiveness of these licensed drugs. Biologic agent intolerance was common; one-third of patients receiving TNF-α treatment will develop intolerance to that specific drug. Conclusions: Advanced medical therapies licensed in the UAE have proven to be safe and efficacious. Additional research is required to evaluate the safety and efficacy of newer biologics and biosimilars.
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Open AccessReview
Risk of Hemorrhoidal Bleeding in Patients Treated with Direct Oral Anticoagulants (DOACs)
by
Carmine Petruzziello, Angela Saviano, Mattia Brigida, Alessio Migneco, Luca Luigi Manetti, Marcello Candelli and Veronica Ojetti
Gastrointest. Disord. 2024, 6(3), 634-643; https://doi.org/10.3390/gidisord6030042 - 7 Jul 2024
Abstract
(1) Background: Lower gastrointestinal bleeding (LGIB) accounts for 20% of all gastrointestinal bleeds. LGBI originates in the colon, rectum, and anus, mainly in patients who are receiving antiaggregant or anticoagulant treatment. The major causes are diverticular disease, colitis, hemorrhoids, and angiodysplasia. The literature
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(1) Background: Lower gastrointestinal bleeding (LGIB) accounts for 20% of all gastrointestinal bleeds. LGBI originates in the colon, rectum, and anus, mainly in patients who are receiving antiaggregant or anticoagulant treatment. The major causes are diverticular disease, colitis, hemorrhoids, and angiodysplasia. The literature studies underline that Direct Oral Anticoagulants (DOACs) are effective in reducing the risk of thromboembolic events but are associated with a higher risk of lower gastrointestinal bleeding (LGIB), particularly lower hemorrhoid bleeding. (2) Methods: The aim of our review is to revise the risk of hemorrhoid bleeding, pathophysiology, and management in patients taking DOACs in light of the most modern evidence. (3) Conclusions: central to the management of hemorrhoid bleeding in patients receiving DOAC therapy is the consideration of a tailored approach that respects the delicate equilibrium between the need for thromboembolic prophylaxis and the potential for bleeding complications. Cessation of anticoagulation, if clinically feasible, constitutes a fundamental cornerstone in the control of hemorrhage. This pause in therapy aims to mitigate the exacerbation of bleeding risk while offering a window for the implementation of local measures to manage hemorrhoid bleeding.
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(This article belongs to the Topic Advances in Gastrointestinal and Liver Disease: From Physiological Mechanisms to Clinical Practice)
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Open AccessArticle
Exploring the Dietary, Lifestyle, and Demographic Factors Associated with Risk for Colorectal Cancer and Colorectal Abnormalities in a Fecal Immunochemical Test-Positive Population: A Cross-Sectional Study in the Kingdom of Bahrain
by
Omar Sharif, Afnan Freije, Salwa Al-Thawadi, Dalal Alromaihi, Fida Alsaffar, Essam Juma, Faisal Abubaker, Abdulrahman Barakat, Mariam Alhammadi, Zeyad Mahmood, Suha Hejres, Hanan Matar, Alice Trezza, Mariangela Rondanelli and Simone Perna
Gastrointest. Disord. 2024, 6(3), 622-633; https://doi.org/10.3390/gidisord6030041 - 4 Jul 2024
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Background/Objectives: Colorectal cancer incidence in Bahrain occurs at a ratio of 13.4–18.8 per 100,000 persons after age standardization. This study aims to explore the relationship between colorectal cancer/abnormalities and different lifestyle factors. Secondly, it aims to explore the association between f-Hb levels, colonoscopy
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Background/Objectives: Colorectal cancer incidence in Bahrain occurs at a ratio of 13.4–18.8 per 100,000 persons after age standardization. This study aims to explore the relationship between colorectal cancer/abnormalities and different lifestyle factors. Secondly, it aims to explore the association between f-Hb levels, colonoscopy findings, and lifestyle factors in a FIT-positive population in Bahrain. Method: A retrospective cross-sectional study was performed for patients positive for FIT and who had a colonoscopy. Different dietary and demographic factors as well as f-Hb levels were assessed. Results: A total of 559 (M: 330; F: 229) subjects were enrolled in this study. Subjects with CRC had significantly higher f-Hb concentrations (median: 1269 μg/mg) when compared with subjects of other groups. Higher percentages of CRC as well as large and small polyps were recorded in males. However, there was no significant difference in f-Hb concentration between males and females (p = 0.90). Higher median levels were found for f-Hb in patients with Q3 (higher red meat consumption) compared to Q1 and Q2 in the category with CRC, despite there being no statistically significant differences among the groups (p = 0.742). Similar results for coffee consumption and f-Hb concentrations in the different groups have been recorded (p = 0.697). A higher quartile of red meat consumption was associated with an increase in CRC risk of 79.9%. Coffee consumption reflected a lower risk of CRC by −47% moving from Q1 to Q2, while BMI was found to be a risk factor (+44%) for CRC. Conclusion: This study highlighted that high f-Hb concentration can be used as a predictive biomarker of CRC.
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