Volume 3, Issue 1, p1-36
Articles published in this issue are Open Access and licensed under Creative Commons Attribution License (CC BY NC) where the readers can reuse, download, distribute the article in whole or part by mentioning proper credits to the authors.
Oral Lactulose – A Safe and Effective Strategy for the Management of Constipation in Individuals with Impaired Glucose Tolerance and Diabetes
Gastrointestinal (GI) disorders are common, also in persons with diabetes mellitus (DM), and can substantially impact their quality of life. In a representative sample of adults living in the United States, 25.8% of individuals with DM also reported disordered bowel habits and 14.6% experienced chronic constipation . Others have reported an even higher prevalence of constipation of around 30% among patients with DM. While, in some patients, symptoms can be relieved with lifestyle and dietary modifications, many individuals with DM rely on the regular use of laxatives for the managementArch Gastroenterol Res, 2022, Volume 3, Issue 1, p1-8 | DOI: 10.33696/Gastroenterology.3.036
Although gastrointestinal stromal tumors, GISTs, are the most common neoplasms arising from the gastrointestinal mesenchyme, they represent less than 1% of all digestive tumors. Its incidence has increased in recent years, probably due to improved diagnostic methods. It is currently known that GIST is the most common sarcoma. It originates from interstitial cells of Cajal and depends on the transcription factor ETV-1. These are neoplasms associated with molecular alterations and some mutations.Arch Gastroenterol Res, 2022, Volume 3, Issue 1, p9-17 | DOI: 10.33696/Gastroenterology.3.037
The intestinal microbiota creates a bodily barrier for invading pathogen by using aggressive exclusion. Pathogens and immune cells can interact directly and dynamically with symbiotic bacteria, determining the pathophysiology and outcome of an infection. They can defend the host through a variety of processes, including attachment site occupancy, nutrition intake, metabolite competition, and the synthesis of antimicrobial compounds including bacteriocins that influence pathogen survival (a process referred to as colonization resistance).Arch Gastroenterol Res, 2022, Volume 3, Issue 1, p18-22 | DOI: 10.33696/Gastroenterology.3.038
Although the prevalence of gastric cancer is decreasing in many developed nations, it is the fourth most prevalent cancer and the second leading cause of cancer-related deaths globally. Around 8 percent of recently diagnosed malignant tumors are stomach cancer, more than 7,00,000 individuals die from gastric cancer yearly. Despite extensive research into new diagnostic and therapeutic methods, the prognosis for individuals with advanced stomach cancer remains dismal, and survival rates have hardly improved. In recent years, many latest innovations have improved our understanding of the molecular mechanisms and modifications that contribute to gastric cancer’s beginning and progression, including several genetic and molecular modifications and mutations.Arch Gastroenterol Res, 2022, Volume 3, Issue 1, p23-26 | DOI: 10.33696/Gastroenterology.3.039
Intraductal Tubular Adenoma: A Case Report and Diagnostic Algorithm for Intraductal Pancreatic Lesions
Intraductal lesions of the pancreas are an increasingly recognized, radiologically detectable group of entities that require a systematic diagnostic approach to best define management given their variable prognoses. A case of isolated intraductal tubular adenoma (ITA) is reported with a comprehensive literature review; comparison of ITAs with intraductal papillary mucinous neoplasms (IPMNs) and intraductal tubular carcinomas (ITCs) is made with assessment of their distinctive imaging and histological findings and discussion of the evolution of these lesions’ classifications with regards to the established literature.Arch Gastroenterol Res, 2022, Volume 3, Issue 1, p27-36 | DOI: 10.33696/Gastroenterology.3.040
The hepatitis C virus (HCV) genome was isolated during the late 1980s using molecular cloning techniques. It is recognized as the cause of most cases of percutaneously transmitted non-A, non-B hepatitis. It is estimated, that up to 200 million people worldwide are infected with the hepatitis C virus (HCV), more than 3% of the world population.
DILI, HILI, RUCAM Algorithm, and AI, the Artificial Intelligence: Provocative issues, Progress, and Proposals
Artificial Intelligence (AI) techniques represent a fascinating, provocative, and challenging discipline, are pervasive and of global importance. The European Commission summarized the current state in a White Paper on AI issues released on 19 February 2020, discussing various AI concepts that revolutionized many complex processes
Spontaneous Resolution of Infected Pancreatic Necrosis after Fistulization into Upper Gastrointestinal Tract
A 67-year-old female with a history of arterial hypertension and previous hysterectomy, was recovered, in July 2019, for moderately-severe acute biliary pancreatitis with evidence of stones in gallbladder and bile duct and pancreatic necrosis on imaging (Magnetic Resonance Cholangiopancreatography. A contrast enhanced CT, a week after the admission, showed necrotic areas in the pancreas and a large peripancreatic fluid collection (60 mm long) with air pockets within (acute necrotic collection, with signs of infection. Since she was haemodynamically stable and there was no evidence of organ failure, according to “step-up approach”, she was managed medically with antibiotics (piperacillin-tazobactam + metronidazole) and fluids.
Ultrasounds are acoustic vibrations that are not perceived by the human ear as their frequency is greater than 20,000 Hz. They are artificially generated by the action of the electric current, whose polarity is periodically reversed, on a quartz crystal, subjecting it, by the action of the electromagnetic field created, to successive contractions and expansions. This alternation of movements generates vibrations, which, transmitted to cellular and intercellular structures, cause collisions and generate heat.
Liver fibrosis is a reversible wound-healing response in which a variety of cells and factors are involved in and results in excessive deposition of extracellular matrix (ECM). Cirrhosis is one of the significant causes of portal hypertension and end-stage liver disease, and it is the 14th most common cause of death around the world. Approximately 1.03 million people worldwide die from liver cirrhosis every year.
There is growing body of literature to identify novel prognostic markers in hepatocellular carcinoma (HCC), including serum ferritin (SF), transferrin levels, alfa fetoprotein (AFP), and neutrophil to lymphocyte ratio (NLR). Chronic inflammation and fibrogenesis are considered quite essential in the oncogenesis of HCC. The trigger for this inflammation could range from viral hepatitis, alcoholic cirrhosis, to non-alcoholic fatty liver disease. Also, iron overload as in hereditary hemochromatosis is linked to one of the factors for HCC oncogenesis.
Endoscopic ampullectomy (or endoscopic resection of lesions associated with the ampulla of Vater) has now been performed for more than 25 years and has been supported by the literature, however, since its inception, the efficacy of this approach is still somewhat underappreciated. In our recent publication, despite its high success rate for clearance of ampullary adenomas, even with quite an extensive lateral spreading tumour component (LST-P), we wished to re-iterate and even celebrate the value of endoscopic ampullectomy, discuss our technique, highlight the risk of post procedural haemorrhage, discuss the adenoma recurrence rate and the need for a commitment to surveillance.
Gastric cancer (GC), also known as stomach cancer, is a worldwide health problem. Anatomically, it can occur from the gastroesophageal junction to distal portions of the stomach. Considering both sexes, worldwide, it is the 5th most common neoplasm (5.7%) and the 3rd cause of mortality among malignancies, leading to approximately 782,000 deaths in 2018. The incidence varies geographically but 50% of new cases are diagnosed in developed countries. High incidence is observed in Asia, Latin America, and in the central and eastern parts of Europe. There are several ways to classify GC, but the most used is Lauren’s Classification, which proposes two main histological groups: intestinal and diffuse. This classification is important because there are marked etiological, pathological, and epidemiological differences between the subgroups, guiding the clinical approach for each patient.
Cholelithiasis is a prevalent disease, affecting 7.1% of the United States population; however, the vast majority of cases are asymptomatic and without consequence. It is estimated that less than one percent of patients develop complications, the most common of which include acute/ chronic cholecystitis, cholangitis, choledocholithiasis, and pancreatitis. An exceptionally rare complication is gallstone-related luminal gastrointestinal (GI) tract obstruction, reported to occur at rates of 0.3-0.5%, and comprising no more than five percent of small bowel obstructions.
Liver biopsy continues to be the gold-standard with regards to diagnosis and staging of the majority of liver diseases. Serologic markers certainly have helped in diagnosing various autoimmune and viral-related liver diseases. Furthermore, laboratory testing and imaging studies such as liver elastography have allowed us to non-invasively assess fibrosis. Unfortunately, there are shortcomings with these forms of testing. False positives or laboratory errors will lead to misleading diagnoses. Situations can also arise during which there are diagnostic dilemmas, such as an obese patient with positive autoimmune serology and elevated liver chemistries.
Insulin resistance has been studied extensively at systemic, organ, tissue and cellular and molecular levels. Overnutrition plays an essential role in the development of chronic metabolic diseases such as obesity and type 2 diabetes. For subjects without genetic defects, the development of insulin resistance and type 2 diabetes is a graduate process. How the transition from an insulinsensitive state to an insulin-resistant state occurs, and what the roles of nutrients are in the process have not been fully understood. Here, we try to summarize the current understanding of insulin-regulate gene expression in the liver, and describe a phenomenon of hepatic insulin resistance at gene expression (HIRAGE), which may be linked to overnutrition.
High fat high cholesterol containing Western-type diet (WD)-induced obesity remains one of the major causes for the development of metabolic syndrome and associated metabolic diseases such as Type 2 Diabetes (T2DM) and atherosclerosis (that leads to cardiovascular diseases including heart disease and stroke). In addition to changes in lipid metabolism and excessive lipid accumulation, recent studies have also described direct effects of WD on gut microbiome and attributed dysbiosis of gut flora to the observed metabolic effects.
The Consideration of Endometriosis in Women with Persistent Gastrointestinal Symptoms and a Novel Neuromusculoskeletal Treatment Approach
Endometriosis is a chronic, hormone-dependent, inflammatory disease, characterized by the presence and growth of endometrial tissue outside the uterine cavity and it is associated with chronic pelvic pain and infertility. Worldwide, approximately 176 million women between the ages of 15 and 49 are affected by endometriosis. Endometriosis is a complex disease that induces a chronic inflammatory process and can be challenging to treat. Chronic pelvic pain syndrome (CPPS) is defined as pelvic pain lasting greater than three to six months that is not solely related to menstruation, sexual activity or bowel movements.
The term paraduodenal pancreatitis and groove pancreatitis are today used interchangeably, with all conditions having similar manifestations; they refer to an uncommon and still under-recognized form of recurrent or chronic pancreatitis that affects the so-called groove. The groove represents the potential space between the head of the pancreas, medially and the second part of the duodenum, laterally. It is bordered by the duodenal bulb and the third part of the duodenum in the superior and posteroinferior aspects, respectively. The inferior vena cava also forms the posterior aspect. Distal common bile duct (CBD), ampulla, major and minor papilla, superior pancreaticoduodenal vessels and lymphatics, as well as some lymph nodes, are anatomically present in the groove.
In pharmacologic doses niacin (nicotinic acid) has been used clinically for over six decades for atherogenic dyslipidemia and reduction of cardiovascular event risk. In combination with statin therapy, it effects regression of coronary atherosclerosis. Emerging evidence indicates a new potential use for niacin for the treatment of NAFLD and its complications. Despite this enormous amount of data on niacin, there is confusion and misconceptions about its use of a drug rather than as a vitamin, its formulations, and how it can be used in clinical practice. The purpose of this invited brief communication is to update and summarize this emerging evidence. We comment on how it may be valuable in the context of other drugs-in-development for NAFLD, especially for combination therapy for synergistic efficacy.
Hepatitis B virus (HBV) chronically infects more than 250 million individuals worldwide and is responsible for more than 800,000 deaths per year by promoting end-stage liver diseases, among which decompensated cirrhosis and hepatocellular carcinoma (HCC) (WHO, July 2020) are prominent. Studies performed in chimpanzees or in animalversion of HBV (woodchuck HBV: WHBV) highlighted the lack of immune responses against the virus upon primary infection. Thus, HBV has been described as a “stealth” virus (i.e. a virus that does not modify/induce immune response in the cell). However, a growing number of studies describe that HBV is able to rapidly and efficiently counteract the innate immune response in a large variety of cells (hepatocytes, macrophages, Natural Killer cell…). Hereby, we focus on the role of macrophages (Mφ) during HBV infection.
Refractory Gastro-oesophageal Reflux Disease and Laryngopharyngeal Reflux - Use the Bottom up Approach
The pathophysiology of typical gastro-oesophageal reflux disease (GORD) symptoms and reflux oesophagitis is associated with excess acid reflux, but both refractory GORD and laryngopharyngeal reflux (LPR) have strong links with functional gut disorders. Oesophageal pH impedance monitoring, our accepted gold standard for diagnosing GORD, has significant shortcomings when assessing proximal oesophageal and in particular pharyngeal reflux. In addition, identifying potential contamination of other parts of the respiratory tract such as lungs or sinuses is not possible. The association between irritable bowel syndrome (IBS) and both refractory GORD and LPR suggests a common pathogenesis.
Are We Close to Achieving a HBV Cure? Risk for Hepatocellular Carcinoma Persists Despite Long-term HBV Suppression: An Update on Our Experience
Since the discovery of the hepatitis B virus (HBV) by Blumberg et al., great progress has been made in understanding the pathogenesis of the virus and its role in hepatocellular carcinoma (HCC). It is estimated that hepatitis B is responsible for about 50% of the HCC cases worldwide. Because of geographic variations in HBV incidence, the burden of HBV-related HCC (HBV-HCC) is highest in endemic areas such as Asian-Pacific and sub- Saharan Africa and lowest in the United States and the West. The hepatitis B vaccines, developed in the 1980s, transformed the evolution of hepatitis B in the modern era. This was followed by high effective anti-viral that reduced HBV infections and HBV-HCC.
Fatty liver (FL) is the most common wide-world liver disease that is nowadays demonstrating an increasing prevalence trend. In sharp contrast, the most common causes of liver diseases, such as viral causes, are decreasing thanks to advances in antiviral therapies. Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic fat accumulation, often associated with insulin resistance (IR), and defined by the presence of steatosis in at least 5% of hepatocytes in absence of relevant alcohol intake.
Multidisciplinary treatment is widely applied for hepatocellular carcinoma (HCC) using liver resection/ transplantation, local ablation therapy, transarterial chemoembolization (TACE), and systemic therapy. Systemic therapy is recommended and can provide a modest prognosis for HCC in Barcelona Clinic Liver Cancer (BCLC) staging C.