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Protocol liver biopsies in long-term management of patients transplanted for hepatitis B-related liver disease

World Journal of Gastroenterology 2006年第11期12卷 1706-1712页

作者： Stefano Targhetta Federico Villamil Paolo Inturri Patrizia Pontisso Stefano fagiuoli Umberto Cillo Attilio Cecchetto Simona Gianni Remo Naccarato Patrizia Burra Gastroenterology Section Department of Surgical and Gastroenterological Sciences University of PadovaItaly Liver Unit Fundacion Favaloro Buenos AiresArgentina Gastroenterology Unit San Bonifacio Hospital VeronaItaly Clinica Medica 5 Department of Clinical and Experimental Medicine University of PadovaItaly Surgery Section Department of Surgical and Gastroenterological Sciences University of PadovaItaly Department of Pathology University of Padova Italy

AIM：To evaluate the long-term histological outcome of patients transplanted for HBV-related liver disease and given HBIg prophylaxis indefinitely after LT. METHODS： Forty-two consecutive patients transplanted for hepatitis B were prospectively studied. HBsAg, HBVDNA and liver function tests were evaluated in the serum 3, 6 and 12 mo after LT and then yearly. LB was obtained 6 and 12 mo after LT and yearly thereafter. Chronic hepatitis （CH） B after LT was classified as minimal, mild, moderate or severe. RESULTS： HBV recurred in 7/42 （16.6%） patients after 6-96 mo of follow-up. A hundred and eightyseven LB were evaluated. Four of 7 patients with graft reinfection, all with unknown HBV DNA status before LT, developed cirrhosis at 12-36 mo of follow-up. Of the 122 LB obtained from 28 HBsAg＋/HCV- recipients with no HBV recurrence after LT, all biopsies were completely normal in only 2 patients （7.1%）, minimal/non-specific changes were observed in 18 （64.2%）, and at least 1 biopsy showed CH in the remaining 8 （28.5%）. Twentynine LB obtained from 7 patients transplanted for HBVHCV cirrhosis and remaining HBsAg- after LT revealed recurrent CH-C. Actuarial survival was similar in patients with HBsAg＋ or HBsAg- liver ***： Though protocol biopsies may enable the detection of graft dysfunction at an early stage, the risk of progression and the clinical significance of these findings remains to be determined.

关键词： Liver transplantation Hepatitis B virus Liverbiopsy Anti-HBs Immunoglobulins

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Gut microbiota in autism and mood disorders

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World Journal of Gastroenterology 2016年第1期22卷 361-368页

作者： Francesca Mangiola Gianluca Ianiro Francesco Franceschi Stefano fagiuoli Giovanni Gasbarrini Antonio Gasbarrini Catholic University School of Medicine00168 RomeItaly Department of Internal Medicine Division of Internal MedicineGastroenterology and Liver Disease “A.Gemelli”University Hospital 00168 RomeItaly Gastroenterology and Transplant Hepatology Papa Giovanni XXIII Hospital24127 BergamoItaly “Ricerca in Medicina”ONLUS Foundation 40121 BolognaItaly

The hypothesis of an important role of gut microbiota in the maintenance of physiological state into the gastrointestinal(GI)system is supported by several studies that have shown a qualitative and quantitative alteration of the intestinal flora in a number of gastrointestinal and extra-gastrointestinal *** the last few years,the importance of gut microbiota impairment in the etiopathogenesis of pathology such as autism,dementia and mood disorder,has been *** evidence of the inflammatory state alteration,highlighted in disorders such as schizophrenia,major depressive disorder and bipolar disorder,strongly recalls the microbiota alteration,highly suggesting an important role of the alteration of GI system also in neuropsychiatric *** to now,available evidences display that the impairment of gut microbiota plays a key role in the development of autism and mood *** application of therapeutic modulators of gut microbiota to autism and mood disorders has been experienced only in experimental settings to date,with few but promising results.A deeper assessment of the role of gut microbiota in the development of autism spectrum disorder(ASD),as well as the advancement of the therapeutic armamentarium for the modulation of gut microbiota is warranted for a better management of ASD and mood disorders.

关键词： Gut microbiota Mood disorders Autism Depression Gut microbiota modulation Fecal microbiotatransplantation

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Management of hepatitis C infection before and after liver transplantation

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World Journal of Gastroenterology 2015年第15期21卷 4447-4456页

作者： Stefano fagiuoli Roberto Ravasio Maria Grazia Lucà Anna Baldan Silvia Pecere Alessandro Vitale Luisa Pasulo Gastroenterology and Transplant Hepatology Papa Giovanni XXIII Hospital PHarm ES Milano Liver Transplantation and Hepatobiliary Surgical Unit Padua University Hospital

Chronic hepatitis C(CHC) is the most common indication for liver transplantation(LT). Aggressive treatment of hepatitis C virus(HCV) infection before cirrhosis development or decompensation may reduce LT need and risk of HCV recurrence post-LT. Factors associated with increased HCV risk or severity of recurrence include older age, immunosuppression, HCV genotype 1 and high viral load at LT. HCV recurrence post-LT leads to accelerated liver disease and cirrhosis development with reduced graft and patient survival. Currently, interferon(IFN)-based regimens can be used in dualagent regimens with ribavirin, in triple-agent antiviral strategies with direct-acting antivirals(e.g., protease inhibitors telaprevir or boceprevir), or before transplant in compensated patients to reduce HCV viral load to prevent or reduce the risk of post-LT recurrence and complications; they cannot be used in patients with decompensated cirrhosis. IFN-based regimens are used in less than half of HCV-infected patients waiting for LT due to extremely low efficacy and poor tolerability. However, antiviral therapy is indicated after LT in patients with histologically confirmed CHC despite tolerability issues. Improvements in side effect management have increased survival in patients achieving therapeutic targets. HCV treatment pre- and post-LT results in significant health care costs especially when lack of efficacy leads to disease worsening, although studies have shown sofosbuvir treatment before LT vs conventional post-LT dual antiviral is cost effective. The suboptimal efficacy and tolerability of IFN-based therapies, plus the significant economic burden, means the need for effective and well tolerated IFN-free antiHCV therapy for pre- and post-LT remains high.

关键词： Hepatitis C virus Orthotopic liver trans plantation Interferon-free treatment Decompensated cirrhosis Chronic hepatitis C

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Management of hepatitis C infection before and after livertransplantation

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World Journal of Gastroenterology 2015年第15期21卷 4457-4465页

作者： Stefano fagiuoli Roberto Ravasio Maria Grazia Luca Gastroenterology and Transplant Hepatology Papa Giovanni XXIII Hospital PHarmES Milano

Healthcare systems throughout the world continueto face emerging challenges associated with chronicdisease management. Due to the likely increase inchronic conditions in the future it is now vital thatcooperation and support between specialists, generalistsand primary health care physicians is *** bowel disease （IBD） is one such chronicdisease. Despite specialist care being essential, muchIBD care could and probably should be delivered inprimary care with continued collaboration betweenall stakeholders. Whilst most primary care physiciansonly have few patients currently affected by IBD intheir caseload, the proportion of patients with IBDrelatedhealthcare issues cared for in the primarycare setting appears to be widespread. Data suggestshowever, that primary care physician＇s IBD knowledgeand comfort in management is suboptimal. Currenttreatment guidelines for IBD are helpful but they arenot designed for the primary care setting. Few nonexpertIBD management tools or guidelines existcompared with those used for other chronic diseasessuch as asthma and scant data have been publishedregarding the usefulness of such tools including IBDaction plans and associated supportive literature. Thepurpose of this review is to investigate what nonspecialisttools, action plans or guidelines for IBD arepublished in readily searchable medical literature andcompare these to those which exist for other chronicconditions.

关键词： Inflammatory bowel disease Ulcerativecolitis Crohn's disease Guidelines Management tools

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