388 research outputs found
Quality measures improving endoscopic screening of colorectal cancer: a review of the literature
No full textIntroduction: Colorectal cancer (CRC) is a major health-care problem all over the world and CRC screening is effective in reducing mortality and increasing the 5-year survival. Colonoscopy has a central role in CRC screening. It can be performed as a primary test, as a recall policy after a positive result of another screening test, and for surveillance. Since effectiveness of endoscopic screening depends on adequate detection and removal of colonic polyps, consistent quality measures, which are useful in enhancing the diagnostic yield of examination, are essential. Areas covered: The aim of this review is to analyze current evidence from literature supporting quality measures able to refine endoscopic screening of colorectal cancer. Expert commentary: Quality measures namely a) time slot allotted to colonoscopy, b) assessment of indication, c) bowel preparation, d) Cecal intubation, e) withdrawal time, f) adenoma detection rate, g) proper management of lesions (polypectomy technique, polyps retrieval rate and tattooing of resection sites), and h) adequate follow-up intervals play a key role in identifying malignant and at-risk lesions and improving the outcome of screening. Adherence to these quality measures is critical to maximize the effectiveness of CRC screening, as well as, a proper technique of colonoscopy and a quality report of the procedure. Among all recommended measures, adenoma detection rate is the most important and must be kept above the recommended quality threshold by all physicians practicing in the setting of screening
Longitudinal Gut Microbiome Shifts Correlate With Clinical Outcomes of Immune Checkpoint Inhibitors–Treated Melanoma: Time for Microbial Biomarkers in Oncology?
No full textNo abstract availabl
Fecal calprotectin levels are elevated in transthyretin amyloidosis patients with gastrointestinal manifestations
No full textTransthyretin amyloid (ATTR) amyloidosis is a rare systemic disorder characterized by amyloid deposits formed by misfolded monomers of the transthyretin. Gastrointestinal (GI) manifestations are common in ATTR amyloidosis; however, their pathogenesis is not fully elucidated. In the present study, we aim to evaluate the diagnostic role of fecal calprotectin (FC) in ATTR amyloidosis patients with GI manifestations.We recruited 21 consecutive ATTR amyloidosis patients and 42 sex and age-matched healthy controls. The presentation of GI symptoms and the severity of peripheral neuropathy were evaluated. Colonoscopy and FC assessment were performed in all subjects.Mean levels of FC in ATTR amyloidosis patients (184 μg/g [30-430]) were significantly higher thаn those of controls (40 μg/g [30-70]), P < .001. Receiver operating characteristic curve analysis indicated a FC cut-off level of 71 μg/g, which differentiates ATTR amyloidosis with GI manifestations from healthy subjects with 91% sensitivity, 100% specificity, 100% positive predictive value, 95% negative predictive value and 97% overall accuracy. FC values were significantly associated with the presence of neutrophilic granulocytic infiltration in the colonic mucosa (P = .002), with the presence of amyloid deposits in rectal mucosa (P = .007) and the presence of diarrhea (P = .046).FC levels are elevated in patients with ATTR amyloidosis with GI manifestations, which suggests an inflammatory component in the pathogenesis of the disease. The presence of elevated FC concentrations could help gastroenterologists to include ATTR amyloidosis in their diagnostic work-up
Young GI angle: Living through a crisis: How to manage downturns in your career
No full textDepending on its reason, a crisis can last a time and needs patience and persistence to be solved. First, you feel the shot and realize what is happening. Then, you will probably remain shocked for some time, and you will need time to manage the crisis and get back on your feet. Moreover, you must consider, that after the end of the acute crisis, that a recovery period will be necessary to adapt yourself to the new environment and stand up again. During that time frame, it could be extremely hard to go ahead with your clinical and scientific career (e.g., learning new skills or carrying on new research), and you can feel scared. Because we humans are programmed to be skeptical when it comes to change-although it is an eternal constant. Also do not be afraid of wasting or losing time: even if it will take months to solve the issue, this time will not be wasted. You will have found a new balance, and, more importantly, you will have learned important skills how to manage a difficult situation and be ready for the next one. The term "crisis" means originally "separation". This can reflect both the need of a choice and the fact that, after a crisis, you will not be the same. Despite being unpleasant, a crisis can be an opportunity for your life and your career-it can make you understand what you really want, depending on your ideas and your ambitions. A re-establishment of your environment can be fruitful for your career and your motivation-so do not hesitate to embrace change and learn from it
Letter: Disappearing Microbe, Emerging Disease? Nuancing the Protective Effects of Helicobacter pylori Against Eosinophilic Oesophagitis. Authors' Reply
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Gut barrier in health and disease: Focus on childhood
No full textThe gut barrier is a functional unit, organized as a multi-layer system, made up of two main components: a physical barrier surface, which prevents bacterial adhesion and regulates paracellular diffusion to the host tissues, and a deep functional barrier, that is able to discriminate between pathogens and commensal microorganisms, organizing the immune tolerance and the immune response to pathogens. Other mechanisms, such as gastric juice and pancreatic enzymes (which both have antibacterial properties) participate in the luminal integrity of the gut barrier. From the outer layer to the inner layer, the physical barrier is composed of gut microbiota (that competes with pathogens to gain space and energy resources, processes the molecules necessary to mucosal integrity and modulates the immunological activity of deep barrier), mucus (which separates the intraluminal content from more internal layers and contains antimicrobial products and secretory IgA), epithelial cells (which form a physical and immunological barrier) and the innate and adaptive immune cells forming the gut-associated lymphoid tissue (which is responsible for antigen sampling and immune responses). Disruption of the gut barrier has been associated with many gastrointestinal diseases, but also with extra-intestinal pathological condition, such as type 1 diabetes mellitus, allergic diseases or autism spectrum disorders. The maintenance of a healthy intestinal barrier is therefore of paramount importance in children, for both health and economic reasons. Many drugs or compounds used in the treatment of gastrointestinal disorders act through the restoration of a normal intestinal permeability. Several studies have highlighted the role of probiotics in the modulation and reduction of intestinal permeability, considering the strong influence of gut microbiota in the modulation of the function and structure of gut barrier, but also on the immune response of the host. To date, available weapons for the maintenance and repair of gut barrier are however few, even if promising. Considerable efforts, including both a better understanding of the gut barrier features and mechanisms in health and disease, and the development of new pharmacological approaches for the modulation of gut barrier components, are needed for the prevention and treatment of gastrointestinal and extraintestinal diseases associated with gut barrier impairment
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