1,721,052 research outputs found
Editorial: Infections and hepatic encephalopathy–does the chicken or the egg come FIRST? A novel perspective at the horizon
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Physiopathology and treatment of anastomotic ulcer: An emerging pathology?
No full textAnastomotic ulcer in the upper gastrointestinal tract is a relatively infrequent lesion which generally occurs in gastrojejunal anastomosis. Different alterations have been involved in its pathogenesis, which likely remains multifactorial. Several risk factors have been identified, including NSAID use and smoking habit, while postoperative proton pump inhibitor therapy exerts a protective effect. Data on the potential role of H. pylori are still controversial, and further well-designed studies are needed. Improvement of surgical technique (absorbable suture, small pouch, reinforced stapler, etc.) could reduce the incidence of marginal ulcer. Novel therapies based on perianastomotic injection with different stimulating factors showed promising results in experimental models. The marginal ulcer may remain asymptomatic or cause different symptoms requiring a prompt upper endoscopy. Prolonged proton pump inhibitor therapy seems to be the best medical approach, and the ulcer healing need to be confirmed. Indeed, some patients may experience an ulcer complication (bleeding, perforation, and stenosis) requiring either an endoscopic or a surgical approach in selected cases
The burden of minimal hepatic encephalopathy: from diagnosis to therapeutic strategies
Full text linkMinimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy (HE). It affects the performance of psychometric tests focused on attention, working memory, psychomotor speed, and visuospatial ability, as well as electrophysiological and other functional brain measures. MHE is a frequent complication of liver disease, affecting up to 80% of tested patients. By being related to falls, an impairment in fitness to drive and the development of overt HE, MHE severely affects the lives of patients and caregivers by altering their quality of life and their socioeconomic status. MHE is detected in clinically asymptomatic patients using appropriate psychometric tests and neurophysiological methods that highlight neuropsychological alterations, such as video-spatial orientation deficits, attention disorders, memory, reaction times, electroencephalogram slowing, prolongation of latency-evoked cognitive potentials, and reduction in the critical flicker frequency. Several treatments have been proposed for MHE treatment, including non-absorbable disaccharides, poorly absorbable antibiotics such as rifaximin, probiotics and branched-chain amino acids. However, because of the multiple diagnosis methods, the various endpoints of treatment trials and the variety of agents used in trials, the treatment of MHE is not currently recommended as routine, but only on a case-by-case basis
Inflammatory and neoplastic cholangiopathies [Colangiopatie infiammatorie e neoplastiche]
No full textL’albero biliare è costituito da cellule epiteliali mature, i colangiociti, ed è suddiviso in dotti biliari intra ed extraepatici. I colangiociti facilitano la secrezione e la modificazione dei costituenti della bile e fungono da condotti di trasporto della bile nell’intestino. L’alterazione della normale funzione del colangiocita può portare allo sviluppo di molteplici patologie biliari, conosciute come colangiopatie. Esse sono generalmente croniche, con un decorso progressivamente ingravescente e spesso mancano di un trattamento efficace determinando una prognosi infausta, persino letale, per i pazienti. Queste colangiopatie hanno caratteristiche peculiari sia per quanto riguarda l’esordio sia per il decorso clinico. I processi patogenetici che interessano i colangiociti non sono ancora del tutto noti. A seconda della loro natura, queste malattie sono ulteriormente suddivise in genetiche, idiopatiche (tra cui la colangite biliare primitiva, la colangite sclerosante primitiva e la colangite associata a IgG4) e patologie neoplastiche (come il colangiocarcinoma o l’epato-colangiocarcinoma). Questa rassegna descrive le nuove conoscenze riguardo i meccanismi patofisiologici e molecolari coinvolti nella cascata del danno epatico che possono fornire la base di nuovi approcci terapeutici per queste colangiopatie.Summary. The biliary tree consists of mature epithelial cells called cholangiocytes and is subdivided in intra and extrahepatic bile ducts. They facilitate the secretion and modification of the bile constituents and act as transport ducts of bile to the intestine. The alteration of the normal function of cholangiocyte, can lead to the development of multiple biliary diseases, known as cholangiopathies, generally chronic, with a progressive course and which often are lacking of an effective treatment, determining a poor prognosis, even lethal, for the patient. These cholangiopathies have peculiar characteristics both for onset and clinical course. The pathogenetic processes affecting cholangiocytes are not yet fully known. Depending on their nature, these diseases are further subdivided into genetic, idiopathic, which include primary biliary cholangitis, primary sclerosing cholangitis and associated IgG4 cholangitis and malignant such as cholangiocarcinoma or mixed hepato-cholangiocarcinoma. This review is focused on the new insights on the pathophysiological and molecular mechanisms involved in the liver damage cascade which provide the basis of novel therapeutic approaches for these cholangiopathies
Sarcopenia and cognitive impairment in liver cirrhosis: a viewpoint on the clinical impact of minimal hepatic encephalopathy
Full text linkMinimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy (HE). MHE is considered as a preclinical stage of HE and is part of a wide spectrum of typical neurocognitive alterations characteristic of patients with liver cirrhosis, particularly involving the areas of attention, alertness, response inhibition, and executive functions. MHE can be detected by testing the patients' psychometric performance, attention, working memory, psychomotor speed, and visuospatial ability, as well as by means of electrophysiological and other functional brain measures. MHE is very frequent, affecting from 20% up to 80% of patients tested, depending of the diagnostic tools used. Although subclinical, MHE is considered to be clinically relevant. In fact, MHE has been related to the patients' falls, fitness to drive, and working ability. As a consequence, MHE affects the patients and caregivers lives by altering their quality of life and even their socioeconomic status. Recently sarcopenia, a very common condition in patients with advanced liver disease, has been shown to be strictly related to both minimal and overt HE. Aim of this review is to summarize the most recently published evidences about the emerging relationship between sarcopenia and cognitive impairment in cirrhotic patients and provide suggestions for future research
Episodic precipitant-induced hepatic encephalopathy treatment: the ideal trial is still lacking
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