1,720,987 research outputs found
Extrahepatic cholangiocarcinoma: clinical features
No full textExtrahepatic cholangiocarcinomas (E-CCAs), are hepatobiliary cancers with features of cholangiocyte differentiations, originating from extrahepatic biliary tree at the bifurcation of the hepatic ducts and also in the distal duct. E-CCAs represent the most common type of cholangiocarcinomas (CCAs) and are characterized by poor overall survival. The principal risk factors for E-CCAs are strictly related to geographic location. Jaundice is the most common physical sign at disease presentation. Other common more non-specific symptoms include hepatomegaly, right upper qudrant mass, weight loss, vomiting, nausea, diarrhoea, malaise and fatigue. Unlike intrahepatic CCA, an incidental asymptomatic presentation occurs in a small percentage of cases. This chapter evaluates the principal clinical features of E-CCAs, briefly discussing its specific risk factors
Letter: FibroTest for staging fibrosis in non-alcoholic fatty liver disease - authors' reply.
No full textNo abstract availabl
Coeliac disease and autoimmune hepatitis: Gluten-free diet can influence liver disease outcome.
No full textno abstract availabl
Pomegranate: from the Promised Land to calm the fire in Inflammatory Bowel Disease
No full textInflammatory bowel disease (IBD) has a multifactorial aetiology and it is thought to be related to a combination of individual genetic susceptibility and environmental triggers that stimulate an inflammatory response. Although evidence indicates that dietary intake plays an important role, few studies have focused on the effect of (poly)phenol-rich food consumption on early markers of mucosal inflammation. At present only one study has investigated the anti-inflammatory effects of ellagitannins (ETs), a (poly)phenolic subclass mainly found in some fruits and nuts, related to IBD in rats [1]. Therefore, we hypothesised that treatment with a fruit juice containing ETs can significantly modulate biomarkers of mucosal inflammation compared with a control group receiving placebo.
The double-blind, randomised controlled trial will include patients with IBD, ulcerative colitis and Crohn's disease, in stable clinical remission (≥3 months). Participants will be randomly allocated to one of two groups: active treatment (125 mL pomegranate juice, naturally rich in ETs) or placebo taken twice daily for 12 weeks.
The primary outcome is to measure changes to the faecal neutrophil-derived protein calprotectin, surrogate marker of mucosal improvement, between the two groups from baseline to 12 weeks later. The secondary outcomes include systemic and mucosal changes of biochemical and molecular inflammatory response markers. The compliance of trial participants will be tested by uHPLC system coupled to mass spectrometer to quantify ET-metabolites in plasma and urine. In addition to the primary and secondary objectives, this trial will include plasma level of trimethylamine-N-oxide (TMAO) that may have potential as a biomarker to assess disease activity in IBD [2].
References. 1. Rosillo et al. 2012 Pharmacol Res. 2012; 66:235-42. 2. Wilson et al. 2015 Dig Dis Sci. 60:3620-30.
Acknowledgments. This study was funded by the Italian Ministry of Education, University and Research MIUR - SIR Programme no. RBSI14LHMB funded to F.D. All beverages will be provided by Conserve Italia (Bologna, Italy)
Polifenoli ed efficacia antinfiammatoria: lo strano caso del melograno e le malattie croniche intestinali
No full textPremesse. Il Progetto NIKE “New Insight and Knowledge on anti-inflammatory Effectiveness of dietary phenolics” è un progetto finanziato Ministero dell’Istruzione, dell’Università e della Ricerca nell’ambito del Programma SIR (Scientific Independence of young Researchers).
Obiettivi. Focus generale del progetto è studiare l’efficacia protettiva anti-infiammatoria di un alimento naturalmente ricco in ellagitannini (ET) - una sottoclasse di polifenoli - verso l’infiammazione, al fine garantire una remissione clinica più prolungata nelle malattie infiammatorie croniche intestinali (inflammatory bowel disease, IBD), quali morbo di Crohn e rettocolite ulcerosa. Inoltre, NIKE si propone di chiarire il meccanismo di azione che sottende tali effetti anti-infiammatori a livello cellulare e dell’intero organismo.
Metodi. Uno studio randomizzato controllato con placebo sarà condotto all’inizio del progetto presso l’Ospedale Sant’Orsola-Malpighi di Bologna al fine di valutare gli effetti della somministrazione di un succo di melagrana, naturalmente ricco in ET, su di un gruppo di soggetti con IBD in remissione ad alto rischio di recidiva. Il livello di calprotectina fecale sarà utilizzato come indice di attività dei processi flogistici intestinali. I metaboliti degli ET saranno identificati e misurati in plasma, urine e feci come marker dell’assunzione dietetica. Successivamente, i metaboliti identificati nel sangue saranno utilizzati per la supplementazione in due tipi di colture cellulari (cellule intestinali e immunitarie), a concentrazioni paragonabili a quelle misurate in vivo, per indagarne il/i meccanismo/i di azione dell’ipotizzato effetto anti-infiammatorio. I dati ottenuti in vitro saranno infine verificati ex-vivo in campioni di tessuti (biopsie intestinali e plasma) ottenuti durante lo studio di intervento.
Risultati attesi. Fino ad oggi, un solo studio ha esaminato gli effetti anti-infiammatori degli ET relativi alle IBD nell’animale da esperimento [1]. Quindi NIKE sarà il primo progetto a indagare gli effetti protettivi putativi di questi composti verso l’infiammazione e conseguente ricaduta di IBD nell’uomo. Inoltre, l’analisi integrata di tutti i risultati ottenuti nell’ambito del progetto consentirà ad aumentare le conoscenze su biodisponibilità, bioattività e meccanismo di azione degli ET.
Questo studio è finanziato dal Ministero dell’Istruzione, dell’Università e della Ricerca (MIUR) nell’ambito del Programma SIR 2014 (Progetto RBSI14LHMB, responsabile F.D.).
[1] Rosillo et al, Pharmacol Res 2012; 66:235-42
Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon
No full textColonic diverticulosis imposes a significant burden on industrialized societies. The current accepted causes of diverticula formation include low fiber content in the western diet with decreased intestinal content and size of the lumen, leading to the transmission of muscular contraction pressure to the wall of the colon, inducing the formation of diverticula usually at the weakest point of the wall where penetration of the blood vessels occurs. Approximately 20 % of the patients with colonic diverticulosis develop abdominal symptoms (i.e., abdominal pain and discomfort, bloating, constipation, and diarrhea), a condition which is defined as symptomatic uncomplicated diverticular disease (SUDD). The pathogenesis of SUDD symptoms remains uncertain and even less is known about how to adequately manage bowel symptoms. Recently, low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors leading to symptom development, thus changing and improving the therapeutic approach. In this review, a comprehensive search of the literature regarding on SUDD pathogenetic hypotheses and pharmacological strategies was carried out. The pathogenesis of SUDD, although not completely clarified, seems to be related to an interaction between colonic microbiota alterations, and immune, enteric nerve, and muscular system dysfunction (Cuomo et al. in United Eur Gastroenterol J 2:413-442, 2014). Greater understanding of the inflammatory pathways and gut microbiota composition in subjects affected by SUDD has increased therapeutic options, including the use of gut-directed antibiotics, mesalazine, and probiotics (Bianchi et al. in Aliment Pharmacol Ther 33:902-910, 2011; Comparato et al. in Dig Dis Sci 52:2934-2941, 2007; Tursi et al. in Aliment Pharmacol Ther 38:741-751, 2013); however, more research is necessary to validate the safety, effectiveness, and cost-effectiveness of these interventions
Can fecal calprotectin better stratify Crohn’s disease activity index?
Full text linkBackground. Crohn’s disease (CD) activity index (CDAI) is still widely used for monitoring
clinical activity in CD patients, but is of little value as indicator of persistent inflammation in
symptomless patients. Fecal calprotectin levels ≥150 μg/g are strongly indicative of endoscopically
and/or histologically active disease. Our aim was to study, in a large cohort of CD patients, the
relationship between CDAI and fecal calprotectin levels.
Methods. CDAI and fecal calprotectin levels were evaluated in consecutive patients from a CD
outpatient clinic.
Results. We enrolled 193 CD patients, of whom 38% with CDAI <150 had a calprotectin value
≥150 μg/g, suggestive of active disease. A logistic regression model showed that for CDAI levels between
100 and 150, the estimated logistic probability of calprotectin ≥150 μg/g increased progressively to
76%, reaching 94% where disease activity was localized in the colon. With a CDAI cut-off >120, we
found a high diagnostic accuracy of 72%, with 88% specificity and 50% sensitivity (positive predictive
value: 76%, negative predictive value: 71%) to identify a calprotectin value ≥150 μg/g.
Conclusion. CDAI scores between 100 and 150 display an acceptable ability to quantify the risk of
persistent inflammation as expressed by the high calprotectin level
Retention Rate, Persistence and Safety of Adalimumab in Inflammatory Bowel Disease: A Real-Life, 9-Year, Single-Center Experience in Italy
No full textBackground: "Real-life" data of retention rate and persistence of adalimumab in inflammatory bowel disease are still limited.
AIMS:
To analyze retention rate, persistence, and safety of adalimumab in a 9-year real-life cohort of inflammatory bowel disease patients.
METHODS:
In this observational, retrospective single-center study, all adult patients treated with adalimumab as the first- and second-line biological treatment for steroid-dependent or refractory inflammatory bowel disease between March 2008 and March 2017 were included. Primary outcomes were persistence, retention rate, and adverse events; the secondary outcome was the identification of predictors of withdrawal.
RESULTS:
Ninety-six out of 181 patients (53%) withdrew their first course of adalimumab. The retention rate was 47% and 46.9% in Crohn's disease and ulcerative colitis patients, respectively; median persistence was 26 and 24 months in CD and UC patients, respectively. The cumulative probability of treatment persistence was 80.2%, 54.5%, and 29.6% and 69.6%, 40.4%, and 21.5% in CD and UC patients, respectively. The incidence rate of any adverse event was 12.5/100 patients-year; severe adverse events were 1.7/100 patients-year. The Cox regression revealed that CD patients with baseline disease duration > 72 months have a higher likelihood for withdrawal due to failure and/or adverse events (HR 1.62, 95% CI 1-2.62, p = 0.04); no predictors of discontinuation were found in UC.
CONCLUSIONS:
Adalimumab showed a great persistence in the first 12 months of therapy and excellent safety profile. Early treatment of CD patients could increase efficacy and reduce the adverse event rate
Percutaneous liver biopsy in the clinical management of hepatocellular carcinoma:back to the future
No full textno abstract availabl
Clinical application of faecal calprotectin in ulcerative colitis patients
No full textFaecal calprotectin (FC) is the most relevant noninvasive biomarker for monitoring inflammatory status, response to treatment and for predicting clinical relapse in ulcerative colitis (UC). The aim of this study was to evaluate the role of FC in predicting both clinical/endoscopic activity and clinical relapse in a large UC patient cohort.Objective Faecal calprotectin (FC) is the most relevant noninvasive biomarker for monitoring inflammatory status, response to treatment and for predicting clinical relapse in ulcerative colitis (UC). The aim of this study was to evaluate the role of FC in predicting both clinical/endoscopic activity and clinical relapse in a large UC patient cohort. Patients and methods A two-phase prospective study was carried out. In the first phase, the relationship between FC and clinical/endoscopic activity was evaluated. In the second phase, a cohort of asymptomatic patients with endoscopic mucosal healing was followed up using clinical and FC level determinations. Results One hundred and twenty-one UC patients were enrolled. The FC concentrations were directly correlated with both clinical and endoscopic activity (r= 0.76 and 0.87, respectively, P>0.05) and were capable of differentiating between different degrees of endoscopic severity (P> 0.01). An FC cut-off value of 110 ìg/g was highly predictive (95%) of endoscopic activity. Seventy-four patients in clinical remission with mucosal healing were followed up for a year or until relapse and 27% developed a clinical relapse. The FC concentration of nonrelapsed patients (48 μg/g) versus relapsed patients (218 μg/g) was significantly different (P> 0.01). An FC cut-off value of 193 μg/g had an accuracy of 89% in predicting clinical relapse. High FC levels were associated with clinical relapse using survival analysis and multivariate analysis. Conclusion Our data strongly support the use of FC for staging the activity of disease, predicting relapse and leading decisionmaking in a UC setting
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