Digestive and Liver Disease (DIGEST LIVER DIS)

Publications in this journal

• Article: A low-volume polyethylene glycol plus ascorbate solution for bowel cleansing prior to colonoscopy: The NORMO randomised clinical trial.

  Thierry Ponchon, Christian Boustière, Denis Heresbach, Hervé Hagege, Anne-Laure Tareirias, Marc Halphen
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  ABSTRACT: BACKGROUND: Patient acceptability of the preparation is a key factor in the success of colonoscopy, yet standard polyethylene glycol solutions are poorly tolerated owing to their high volume (4L) and low palatability. This study compared the efficacy, safety and acceptability of a 2L polyethylene glycol+ascorbate solution with a standard 4-L polyethylene glycol solution. METHODS: Adults referred for colonoscopy were randomised to 2-L polyethylene glycol+ascorbate (n=202) or 4-L polyethylene glycol solution (n=198). Colon cleansing success was assessed using the Harefield Cleansing Scale(©) and the Aronchick scale. Safety and acceptability were also assessed. RESULTS: Successful cleansing was achieved in 94.1% and 90.9% of subjects with the 2-L and 4-L solutions respectively using the Harefield Cleansing Scale(©) and 94.6% and 90.0% using the Aronchick scale (non significant). Despite better acceptability and tolerability, no superiority over the standard 4-L preparation was demonstrated. Fewer treatment-related adverse events were reported with the 2-L solution (80.2% versus 89.9%, p=0.011). More subjects were willing to take the 2L PEG+ascorbate solution again (87% versus 51%, p<0.001), found it easier to drink (80% versus 70%, p=0.025), with a better taste (p=0.01). CONCLUSIONS: Two-litre polyethylene glycol+ascorbate solution, with a similar high degree of cleansing and superior acceptability and tolerability, presents an alternative to 4-L polyethylene glycol when compliance is an issue.
  Digestive and Liver Disease 06/2013;
• Article: Unexplained gastrointestinal symptoms: Think mitochondrial disease.

  Thomas P Chapman, Gina Hadley, Carl Fratter, Sue N Cullen, Bridget E Bax, Murray D Bain, Robert A Sapsford, Joanna Poulton, Simon P Travis
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  ABSTRACT: Defects in mitochondrial function are increasingly recognised as central to the pathogenesis of many diseases, both inherited and acquired. Many of these mitochondrial defects arise from abnormalities in mitochondrial DNA and can result in multisystem disease, with gastrointestinal involvement common. Moreover, mitochondrial disease may present with a range of non-specific symptoms, and thus can be easily misdiagnosed, or even considered to be non-organic. We describe the clinical, histopathological and genetic findings of six patients from three families with gastrointestinal manifestations of mitochondrial disease. In two of the patients, anorexia nervosa was considered as an initial diagnosis. These cases illustrate the challenges of both diagnosing and managing mitochondrial disease and highlight two important but poorly understood aspects, the clinical and the genetic. The pathophysiology of gastrointestinal involvement in mitochondrial disease is discussed and emerging treatments are described. Finally, we provide a checklist of investigations for the gastroenterologist when mitochondrial disease is suspected.
  Digestive and Liver Disease 06/2013;
• Article: A survey on mortality from non-variceal upper gastrointestinal bleeding: Is the emergency referral system adequate?

  Paola Cesaro, Anna Kohn, Lucio Petruziello, Mario Angelico, Francesco Franceschi, Alessandro Gigliozzi, Antonietta Lamazza, Leonardo Tammaro, Sandro Boschetto, Stefano Brighi, Angelo Antoniozzi, Leonardo Baiocchi
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  ABSTRACT: BACKGROUND: Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important cause of mortality and morbidity worldwide. Little information is available on the clinical management of non-variceal upper gastrointestinal bleeding in Italy in relation to the current organization of the Italian Emergency Health Services into Level-I and Level-II Emergency Departments (ED), the latter being more complex structures with greater resources. METHODS: A retrospective survey on clinical, endoscopic, and survival data was conducted by the regional sections of the 3 main Italian gastroenterological societies, AIGO, SIED and SIGE, recording all consecutive episodes of non-variceal upper gastrointestinal bleeding referred to 7 centres (4 of which were Level-II Emergency Departments) in Rome, Italy, during a one-year period. A total of 624 consecutive patients (64% males, mean age 67.6±16.2years) were included. Thirty-day mortality was 4.6%. Main factors associated with survival at both univariate and multivariate analysis were the presence of full Rockall score <5 and the admission to a Level-II Emergency Departments (p<0.001). Level-I Emergency Departments admitted patients with a full Rockall score ≥5 (p=0.02) more frequently than patients with negative endoscopic findings (p<0.001). CONCLUSIONS: Referral of non-variceal upper gastrointestinal bleeding patients to Emergency Departments with more resources (Level-II) is associated with reduced mortality. Yet, unfortunately, high-risk patients were more often admitted to Level-I Emergency Departments, which suggests the need for a better organization of the emergency referral system.
  Digestive and Liver Disease 06/2013;
• Article: Diagnostic and therapeutic role of endoscopy in gastroenteropancreatic neuroendocrine neoplasms.

  Fabia Attili, Gabriele Capurso, Giuseppe Vanella, Lorenzo Fuccio, Gianfranco Delle Fave, Guido Costamagna, Alberto Larghi
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  ABSTRACT: Gastroenteropancreatic neuroendocrine neoplasms have substantially increased over the last decades. Because of the indolent clinical course of the disease even in advance stages and the rise in the incidental diagnosis of small asymptomatic lesions, the prevalence of gastroenteropancreatic neuroendocrine neoplasms is higher than that of pancreatic, gastric and oesophageal adenocarcinomas, making them the second most prevalent cancer type of the gastrointestinal tract. This increase in the overall prevalence of gastroenteropancreatic neuroendocrine neoplasms has been paralleled by a growth in the importance of the endoscopist in the care of these patients, who usually require a multidisciplinary approach. In this manuscript the diagnostic and therapeutic role of endoscopic for gastroenteropancreatic neuroendocrine neoplasms will be reviewed.
  Digestive and Liver Disease 05/2013;
• Article: Small bowel capsule endoscopy for management of Crohn's disease: Where do we stand?

  Roberto de Franchis
  Digestive and Liver Disease 05/2013;
• Article: Ultrasound-guided percutaneous biopsy for diagnosis of gastrointestinal lesions.

  Ilario de Sio, Annalisa Funaro, Luigi Maria Vitale, Marco Niosi, Giampiero Francica, Alessandro Federico, Dolores Sgambato, Carmelina Loguercio, Marco Romano
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  ABSTRACT: BACKGROUND AND AIMS: Endoscopical examination is not always sufficient for the diagnosis of gastrointestinal masses. This study assessed the diagnostic accuracy and safety of ultrasound-guided percutaneous biopsy of gastrointestinal lesions. METHODS: This retrospective study evaluated 114 patients who underwent ultrasound-guided biopsy of gastrointestinal masses with a 18G needle. Thirty-two of these patients underwent a 22G fine-needle biopsy for cytology. Histology was compared with a composite standard of reference for diagnosis (i.e. post-surgery histological evaluation in 73 cases and computed tomography or magnetic resonance scan findings, together with a compatible clinical follow-up for at least 24 months, in the remaining 41 cases). Safety was assessed by recording side effects for up to 4h after the procedure. RESULTS: Of the 114 lesions evaluated, 112 were malignant (98.2%) and 2 benign (1.8%). Specimens were adequate for histology in all but one case. Specimens were obtained from the stomach (n=38; 33.3%), small bowel (n=36; 31.6%) and colon (n=40; 35.1%). Diagnosis was correct in 113/114 cases (99.1%). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were 99.1%, 100%, 100%, 66%, and 99%, respectively. One of the 114 patients (0.9%) bled from a gastric GIST. CONCLUSIONS: Ultrasound-guided percutaneous biopsy of gastrointestinal lesions is a valid alternative when diagnosis of a gastrointestinal mass cannot be obtained with an endoscopical procedure.
  Digestive and Liver Disease 05/2013;
• Article: Linaclotide for treatment of irritable bowel syndrome-The view of European regulators.

  Michael Berntgen, Harald Enzmann, Elmer Schabel, Concepcion Prieto Yerro, Antonio Gómez-Outes, Tomas Salmonson, Joachim Musaus
  Digestive and Liver Disease 05/2013;
• Article: Impact of gluten-free diet on cardiovascular risk factors. A retrospective analysis in a large cohort of coeliac patients.

  Barbara Zanini, Elisa Mazzoncini, Francesco Lanzarotto, Chiara Ricci, Bruno M Cesana, Vincenzo Villanacci, Alberto Lanzini
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  ABSTRACT: BACKGROUND: Concerns have been raised on whether a gluten-free diet affects the cardiovascular risk profile of coeliac patients. AIMS: To assess changes of multiple cardiovascular risk factors in coeliac patients evaluated before and during a gluten-free diet. METHODS: Retrospective analysis of the effects of 1-5 years of gluten-free diet on indicators of cardiovascular risk and on distribution in cardiovascular risk categories in 715 coeliac patients. RESULTS: Compared to baseline, significant increases were found in body mass index (21.4±3.4 vs. 22.5±3.5; p<0.0001), total cholesterol (171.2±37.4mg/dL vs. 181.4±35.1mg/dL; p<0.0001), and γ-glutamyl transpeptidase (16.5±14.9 vs. 19.5±19.2U/L; p<0.0001). Significant reductions were found in serum triglycerides (87.9±49.5 vs. 80.2±42.8mg/dL; p<0.0001) and homocysteine (16.9±9.6 vs. 13.3±8.0μmol/L; p=0.018) during gluten-free diet. The proportion of patients included in an arbitrarily defined category of "lowest cardiovascular risk profile" decreased from 58% at baseline to 47% during gluten-free diet. CONCLUSIONS: A gluten-free diet significantly affects cardiovascular risk factors in coeliac patients, but changes do not consistently point towards worse or better risk profiles, thus suggesting that the diet is unlikely to be atherogenic.
  Digestive and Liver Disease 05/2013;
• Article: Prevalence of low phospholipid-associated cholelithiasis in young female patients.

  Bertrand Condat, David Zanditenas, Véronique Barbu, Marie-Pierre Hauuy, Béatrice Parfait, Ahmed El Naggar, Véronique Collot, Joélle Bonnet, Yann Ngo, Anware Maftouh, Laurent Dugué, Chant Balian, Alain Charlier, Martine Blazquez, Olivier Rosmorduc
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  ABSTRACT: BACKGROUND AND AIMS: We evaluated the prevalence of low phospholipid-associated cholelithiasis, a specific form of cholelithiasis associated with at least 2 of the 3 following criteria: first symptoms before the age of 40; intrahepatic comet tail artefacts, sludge or microlithiasis on ultrasound imaging; and recurrence of symptoms after cholecystectomy. METHODS: We prospectively studied the cases of 60 consecutive female patients under 30 with symptomatic cholelithiasis. RESULTS: A diagnosis of low phospholipid-associated cholelithiasis was made in 14/60 patients (23%). The molecular analysis showed ABCB4 (n=4) and ABCB11 (n=4) gene mutations. Low phospholipid-associated cholelithiasis was frequently observed in non-overweight patients [13/27 (48%)], was present in most patients whose biliary symptoms occurred before the age of 18 [7/10 (70%)] and was often associated with cholangitis or acute pancreatitis [9/14 (64%), p<0.05] while "common" cholelithiasis was mainly associated with cholecystitis [16/46 (35%), p<0.05]. CONCLUSION: Nearly one quarter of the female patients under the age of 30 admitted for symptomatic cholelithiasis had low phospholipid-associated cholelithiasis; particularly if body weight was normal, the symptoms began before the age of 18 or in the presence of severe biliary complications.
  Digestive and Liver Disease 05/2013;
• Article: Bowel ultrasonography as an aid for diagnosis of intestinal acute graft-versus-host-disease after allogeneic haematopoietic stem cell transplantation.

  Emma Calabrese, Francesca Zorzi, Emanuela Visconti, Gottardo De Angelis, Raffaella Cerretti, Giovanna Del Vecchio Blanco, Alessandra Picardi, Laura Cudillo, Massimiliano Postorino, Luca Franceschini, Livia Biancone, William Arcese, Francesco Pallone
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  ABSTRACT: OBJECTIVE: Aim of our prospective study was to investigate accuracy of bowel ultrasonography in detecting gastrointestinal acute graft versus host disease (GVHD), when using clinical assessment as gold standard. In a subgroup of patients, bowel ultrasonography was compared with colonoscopy and histology in diagnosing of gastrointestinal acute GVHD. METHODS: Fifty-two patients underwent allogeneic hematopoietic stem cell transplantation and developed gastrointestinal symptoms. RESULTS: Clinical assessment lead to a diagnosis of gastrointestinal acute GVHD in 17/52 patients, no gastrointestinal acute GVHD was detected in 20/52 patients, while 15 patients were not able to complete the study. Bowel ultrasonography detected either bowel wall thickness of the ileum and the colon or dilation in 16/17 patients and showed 94% sensitivity (95% CI 0.69-0.99), 95% specificity (95% CI 0.73-0.99), and 94.5% accuracy. Colonoscopy was performed in 13/52 patients, showing gastrointestinal acute GVHD in 11/13. In these 11 patients, histology confirmed the diagnosis of gastrointestinal acute GVHD, and bowel ultrasonography detected findings compatible with gastrointestinal acute GVHD in all 11 patients, and was negative in the 2 patients with no gastrointestinal acute GVHD. CONCLUSION: Bowel ultrasonography can be considered a valuable tool to add to clinical assessment for patients with suspected gastrointestinal acute GVHD for addressing a prompt and appropriate treatment.
  Digestive and Liver Disease 05/2013;
• Article: Authors' reply to: Comment to "Variation of quality of colonoscopy in Italy over five years: A nation-wide observational study"

  Franco Radaelli, Silvia Paggi, Giorgio Minoli
  Digestive and Liver Disease 05/2013;
• Article: Author's reply to "Comment on: Predictors of clinical response of acid suppression in Chinese patients with gastrooesophageal reflux disease"

  An Jiang Wang, He Wang, Xuan Zhu
  Digestive and Liver Disease 05/2013;
• Article: Longitudinal assessment of liver stiffness in patients undergoing antiviral treatment for hepatitis C.

  Cristina Stasi, Umberto Arena, Anna Linda Zignego, Giampaolo Corti, Monica Monti, Elisa Triboli, Elena Pellegrini, Sara Renzo, Luisa Leoncini, Fabio Marra, Giacomo Laffi, Stefano Milani, Massimo Pinzani
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  ABSTRACT: BACKGROUND: Liver stiffness has been suggested as a parameter of fibrosis progression/regression in hepatitis C virus (HCV) patients. AIM: To evaluate stiffness before and after peginterferon-ribavirin treatment. METHODS: Stiffness was prospectively measured in 74 HCV patients, 32 genotypes 1/4 (43.25%) and 42 genotypes 2/3 (56.75%), before, at end of treatment, and after 3 years of follow-up (49 patients). On the same study day, 21 patients underwent liver biopsy. RESULTS: In 55 patients with sustained virological response (74.32%), liver stiffness decreased significantly at end of therapy (6.8±4.9kPa) vs. baseline (9.5±6.9kPa, p=0.04). The decrease vs. baseline was maintained in 30 sustained virological response patients after 3 years follow-up (6.8±4.6kPa vs. 10.8±8.5kPa, p=0.0141). No difference was found at end of treatment vs. baseline (10.1±4.7kPa vs. 9.7±4.2kPa, p=0.825) and after 3 years of follow-up vs. baseline (10.2±3.4kPa vs. 9.7±4.2kPa, p=0.765) in null responders. Similar results were found in relapsers at end of treatment vs. baseline (13.7±7.7kPa vs. 15.2±8.2kPa, p=0.74), and after 3 years of follow-up vs. baseline (16.9±10.0kPa vs. 15.2±8.2kPa, p=0.734). Pre-treatment stiffness >12kPa was significantly associated with no SVR (p<0.025), RR=2.44 (95%C.I. 1.17-5.07). CONCLUSION: Liver stiffness may be useful to assess long-term antiviral treatment response.
  Digestive and Liver Disease 05/2013;
• Article: Nanotechnology in diagnostics and therapeutics for gastrointestinal disorders.

  Hamed Laroui, Poonam Rakhya, Bo Xiao, Emilie Viennois, Didier Merlin
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  ABSTRACT: This review describes the state of art in nanoparticle and nanodevice applications for medical diagnosis and disease treatment. Nanodevices, such as cantilevers, have been integrated into high-sensitivity disease marker diagnostic detectors and devices, are stable over long periods of time, and display reliable performance properties. Nanotechnology strategies have been applied to therapeutic purposes as well. For example, nanoparticle-based delivery systems have been developed to protect drugs from degradation, thereby reducing the required dose and dose frequency, improving patient comfort and convenience during treatment, and reducing treatment expenses. The main objectives for integrating nanotechnologies into diagnostic and therapeutic applications in the context of intestinal diseases are reviewed.
  Digestive and Liver Disease 05/2013;
• Article: Liver resection is a therapeutic option for highly selected BCLC C patients in the context of an expert multidisciplinary setting.

  Umberto Cillo
  Digestive and Liver Disease 05/2013;
• Article: Adverse events of computed tomography colonography: An Italian National Survey.

  Franco Iafrate, Gabriella Iussich, Loredana Correale, Cesare Hassan, Daniele Regge, Emanuele Neri, Paolo Baldassari, Maria Ciolina, Alessandro Pichi, Marcella Iannitti, Davide Diacinti, Andrea Laghi
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  ABSTRACT: AIM: To retrospectively study the frequency and magnitude of complications associated with computed tomography (CT) colonography in clinical practice. METHODS: A questionnaire on complications of CT colonography was sent to Italian public radiology departments identified as practicing CT colonography with a reasonable level of training. The frequency of complications and possible risk factors were retrospectively determined. Responses were collated and row frequencies determined. A multivariate analysis of the factors causing adverse events was also performed. RESULTS: 40,121 examinations were performed in13 centers during the study period. No deaths were reported. Bowel perforations occurred in 0.02% (7 exams). All perforations were asymptomatic and occurred in patients undergoing manual insufflation. Five perforations (71%) occurred in procedures performed following a recent colonoscopy. There was no significant difference between perforations associated with rectal balloon (0.017%) and those that were not (0.02%). Complications related to vasovagal reaction (either with or without spasmolytic) occurred in 0.16% (63 exams). All vasovagal reactions resolved in less than 3h, without any sequelae. CONCLUSIONS: Perforation rate at CT colonography in Italy is comparable with elsewhere in the world, occurring regardless of the experience of radiology centers. Although the risk is very small, it may not be negligible when compared with the risk of diagnostic colonoscopy.
  Digestive and Liver Disease 05/2013;
• Article: In vitro differentiation into insulin-producing β-cells of stem cells isolated from human amniotic fluid and dental pulp.

  Gianluca Carnevale, Massimo Riccio, Alessandra Pisciotta, Francesca Beretti, Tullia Maraldi, Manuela Zavatti, Gian Maria Cavallini, Giovanni Battista La Sala, Adriano Ferrari, Anto De Pol
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  ABSTRACT: AIM: To investigate the ability of human amniotic fluid stem cells and human dental pulp stem cells to differentiate into insulin-producing cells. METHODS: Human amniotic fluid stem cells and human dental pulp stem cells were induced to differentiate into pancreatic β-cells by a multistep protocol. Islet-like structures were assessed in differentiated human amniotic fluid stem cells and human dental pulp stem cells after 21 days of culture by dithizone staining. Pancreatic and duodenal homebox-1, insulin and Glut-2 expression were detected by immunofluorescence and confocal microscopy. Insulin secreted from differentiated cells was tested with SELDI-TOF MS and by enzyme-linked immunosorbent assay. RESULTS: Human amniotic fluid stem cells and human dental pulp stem cells, after 7 days of differentiation started to form islet-like structures that became evident after 14 days of induction. SELDI-TOF MS analysis, revealed the presence of insulin in the media of differentiated cells at day 14, further confirmed by enzyme-linked immunosorbent assay after 7, 14 and 21 days. Both stem cell types expressed, after differentiation, pancreatic and duodenal homebox-1, insulin and Glut-2 and were positively stained by dithizone. Either the cytosol to nucleus translocation of pancreatic and duodenal homebox-1, either the expression of insulin, are regulated by glucose concentration changes. Day 21 islet-like structures derived from both human amniotic fluid stem cells and human dental pulp stem cell release insulin in a glucose-dependent manner. CONCLUSION: The present study demonstrates the ability of human amniotic fluid stem cells and human dental pulp stem cell to differentiate into insulin-producing cells, offering a non-pancreatic, low-invasive source of cells for islet regeneration.
  Digestive and Liver Disease 05/2013;
• Article: "Primum Non Nocere": Are we getting carried away?

  Victoria Gomez, Massimo Raimondo
  Digestive and Liver Disease 05/2013;
• Article: Chronic constipation: A critical review.

  Guido Basilisco, Marina Coletta
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  ABSTRACT: Chronic constipation is a very common symptom that is rarely associated with life-threatening diseases, but has a substantial impact on patient quality of life and consumption of healthcare resources. Despite the large number of affected patients and the social relevance of the condition, no cost-effectiveness analysis has been made of any diagnostic or therapeutic algorithm, and there are few data comparing different diagnostic and therapeutic approaches in the long term. In this scenario, increasing emphasis has been placed on demonstrating that a number of older and new therapeutic options are effective in treating chronic constipation in well-performed randomised controlled trials, but there is still debate as to when these therapeutic options should be included in diagnostic and therapeutic algorithms. The aim of this review is to perform a critical evaluation of the current diagnostic and therapeutic options available for adult patients with chronic constipation in order to identify a rational patient approach; furthermore we attempt to clarify some of the more controversial points to aid clinicians in managing this symptom in a more efficacious and cost-effective manner.
  Digestive and Liver Disease 04/2013;
• Article: Endoscopic repair of post-surgical gastrointestinal complications.

  Raffaele Manta, Luca Magno, Rita Conigliaro, Angelo Caruso, Helga Bertani, Mauro Manno, Angelo Zullo, Marzio Frazzoni, Gabrio Bassotti, Giuseppe Galloro
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  ABSTRACT: Complications following gastrointestinal surgery may require re-intervention, can lead to prolonged hospitalization, and significantly increase health costs. Some complications, such as anastomotic leakage, fistula, and stricture require a multidisciplinary approach. Therapeutic endoscopy may play a pivotal role in these conditions, allowing minimally invasive treatment. Different endoscopic approaches, including fibrin glue injection, endoclips, self-expanding stents, and endoscopic vacuum-assisted devices have been introduced for both anastomotic leakage and fistula treatment. Similarly endoscopic treatments, such as endoscopic dilation, incisional therapy, and self-expanding stents have been used for anastomotic strictures. All these techniques can be safely performed by skilled endoscopists, and may achieve a high technical success rate in both the upper and lower gastrointestinal tract. Here we will review the endoscopic management of post-surgical complications; these techniques should be considered as first-line approach in selected patients, allowing to avoid re-operation, reduce hospital stay, and decrease costs.
  Digestive and Liver Disease 04/2013;