1,721,159 research outputs found
Are noninvasive methods clinically useful in advanced, decompensated liver cirrhosis when "les Jeux Sont Faits"?
No full textDysbiosis in Celiac disease patients with persistent symptoms on gluten-free diet: a condition similar to that present in irritable bowel syndrome patients?
No full textComment on:
Altered duodenal microbiota composition in celiac disease patients suffering from persistent symptoms on a long-term gluten-free diet. [Am J Gastroenterol. 2014
Enlarged pancreas: not always a cancer
No full textPancreatic fat accumulation has been described with various terms including pancreatic lipomatosis, pancreatic steatosis, fatty replacement, fatty infiltration, fatty pancreas, lipomatous pseudohypertrophy and nonalcoholic fatty pancreas disease. It has been reported to be associated with type 2 diabetes mellitus, acute pancreatitis, pancreatic cancer and the formation of pancreatic fistula. The real incidence of this condition is still unknown. We report a case of pancreatic steatosis in a non-obese female patient initially diagnosed with a mass in the head of the pancreas. Magnetic resonance imaging (MRI) was carried out to define the characteristics of the pancreatic mass. MRI confirmed the diagnosis of fat pancreas. Enlarged pancreas is not always a cancer, but pancreatic steatosis is characterized by pancreatic enlargement. MRI could give a definite diagnosis of pancreatic steatosis or cancer
Dieta e microbiota intestinale: Due facce di una stessa medaglia?
No full textGut microbiota is a complex ecosystem, resident in the digestive tract, exerting multiple functions that can have a significant impact on the pathophysiology of the host organism. The composition and functions of this "superorganism" are influenced by many factors, and among them, the host's dietary habits seem to have a significant effect. Dietary changes in the evolution of human history and in the different stages of life of the human subjects are responsible for qualitative and functional modification of gut microbiota. At the same time, the different dietary models adopted in worldwide geographic areas take into account the inter-individual differences concerning composition and microbial function. This close relationship between diet, gut microbiota and host seems, in fact, to be responsible for the protection or predisposition to develop several metabolic, immunological, neoplastic and functional diseases. Thus, several studies have evaluated the impact of diet and lifestyle modification strategies on gut microbiota composition and functions which, in turn, seems to affect the effectiveness of such therapeutic measures. Gut microbiota manipulation strategies, as complementary to dietary modifications, represent a fascinating field of research, even if consolidated data are still lacking
Non invasive parameters for predicting esophageal varices in children: their sequential use provides the best accuracy.
No full textNo abstract availabl
Encefalopatia epatica
No full textL’encefalopatia epatica (EE) costituisce una frequente complicanza della malattia cronica del fegato, che si può manifestare con un ampio spettro di anomalie neurologiche/psichiatriche che vanno da alterazioni subcliniche al coma. In accordo con le più recenti linee-guida, l’EE può essere classificata in differenti tipi, a seconda della severità dell’insufficienza epatica, della presenza di shunt porto-sistemici e del numero di episodi pregressi o della persistenza del quadro clinico. Da un punto di vista clinico, i quadri di EE posso essere definiti come non alterato, nascosto (che comprende due condizioni, l’EE minima e quella di grado 1, secondo la classificazione che valuta il grado di coinvolgimento mentale) e quello manifesto (che presenta tre gradi di impegno mentale). I meccanismi patogenetici alla base delle differenti forme di EE sono complessi e numerosi, per es. il ruolo dell’ammonio, di citochine pro-infiammatorie, di composti simil-benzodiazepine e l’accumulo di manganese. Nel tempo sono state proposte e attuate differenti strategie terapeutiche per l’EE, in particolare per la forma manifesta, dal momento che la gestione dell’EE nascosta richiede una valutazione caso per caso. Momento fondamentale della gestione del paziente con EE è rappresentato dalla ricerca e dall’eventuale riconoscimento con conseguente trattamento dei fattori scatenanti. I trattamenti più efficaci, che possono essere effettuati singolarmente o in combinazione, sono rappresentati dai disaccaridi lattulosio e lattitolo e dall’antibiotico topico rifaximina. Ulteriori composti utilizzati nel trattamento della EE, in particolare nei casi non responsivi, sono rappresentati dagli aminoacidi ramificati e da composti in grado di favorire l’eliminazione dell’ammonioHepatic encephalopathy (HE) is a common complication of liver cirrhosis and it can manifest with a broad spectrum of neuropsychiatric abnormalities of varying severity, acuity and time course with important clinical implications. According to recent guidelines, HE has been classified into different types, depending on the severity of hepatic dysfunction, the presence of porto-systemic shunts and the number of previous episodes or persistent manifestations. From a clinical point of view, HE can be recognized as unimpaired, covert (that deals with minimal and grade 1 according to the grading of mental state), and overt (that is categorized from grade 2 to grade 4). Different and only partially known pathogenic mechanisms have been identified, comprising ammonia, inflammatory cytokines, benzodiazepine-like compounds and manganese deposition. Different therapeutic strategies are available for treating HE, in particular the overt HE, since covert HE needs to be managed case by case. Recognition and treatment of precipitating factors represent fundamental part of the management. The more effective treatments, which can be performed separately or combined, are represented by non-absorbable disaccharides (lactulose and lactitol) and the topic antibiotic rifaximin; other possible therapies, mainly used in patients non responders to previous treatments, are represented by branched chain amino acids and metabolic ammonia scavengers
Ruolo e significato clinico dei metodi non invasivi nella valutazione dell’ipertensione portale nel paziente affetto da epatopatia cronica
No full textSummary. Portal hypertension (PH) is the main driver of complications in patients with advanced chronic liver disease (ACLD). Correctly identifying the presence and severity of PH is crucial for the management and prognosis of compensated ACLD (cACLD) patients. Over the last 20 years, several non-invasive tests (NITs) have been proposed for PH assessment; among these, liver (LSM) and spleen (SSM) stiffness measurement by transient elastography are the most validated and accurate predictors of clinically significant PH (CSPH) and its complications, such as gas-troesophageal varices, clinical decompensation and hepatocellular carcinoma. The inclusion of NITs in the official recommendations of the Baveno VI Consensus, as valid and trustworthy tools to assess PH in cACLD patients, represents one of the major advances in hepatology of the last years. For instance, the recently proposed Baveno VI Criteria (LSM150×109/L) have proven to be a valid strategy to rule out the presence of high-risk varices (HRV) and identify patients that can safely avoid screening upper endoscopy (EGD). In conclusion, further studies are necessary to fully explore the potential of NITs and maximize their use in everyday clinical practice
- …
