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Non-celiac gluten sensitivity： questions still to be answered despite increasing awareness

Cellular & Molecular Immunology 2013年第5期10卷 383-392页

作者： Umberto Volta Giacomo Caio francesco tovoli Roberto De Giorgio Department of Medical and Surgical Sciences St. Orsola-Malpighi Hospital University of Bologna Bologna Italy

Recently, the increasing number of patients worldwide who are sensitive to dietary gluten without evidence of celiac disease or wheat allergy has contributed to the identification of a new gluten-related syndrome defined as non-celiac gluten sensitivity. Our knowledge regarding this syndrome is still lacking, and many aspects of this syndrome remain unknown. Its pathogenesis is heterogeneous, with a recognized pivotal role for innate immunity; many other factors also contribute, inctuding tow-grade intestinal inflammation, increased intestinal barrier function and changes in the intestinal microbiota. Gluten and other wheat proteins, such as amylase trypsin inhibitors, are the primary triggers of this syndrome, but it has also been hypothesized that a diet rich in fermentable monosaccharides and polyols may elicit its functional gastrointestinal symptoms. The epidemiology of this condition is far from established; its prevalence in the general population is highly variable, ranging from 0.63% to 6%. From a clinical point of view, non-celiac gluten sensitivity is characterized by a wide array of gastrointestinal and extraintestinal symptoms that occur shortly after the ingestion of gluten and improve or disappear when gluten is withdrawn from the diet. These symptoms recur when gluten is reintroduced. Because diagnostic biomarkers have not yet been identified, a double-blind placebo-controlled gluten challenge is currently the diagnostic method with the highest accuracy. Future research is needed to generate more knowledge regarding non-celiac gluten sensitivity, a condition that has global acceptance but has only a few certainties and many unresolved issues.

关键词： celiac disease epithelial barrier function gut inflammation non-celiac gluten sensitivity wheat allergy

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Hepatocellular adenoma: An unsolved diagnostic enigma

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World Journal of Gastroenterology 2019年第20期25卷 2442-2449页

作者： Matteo Renzulli Alfredo Clemente francesco tovoli Salvatore Cappabianca Luigi Bolondi Rita Golfieri Radiology Unit Department of ExperimentalDiagnostic and Speciality MedicineSant’Orsola HospitalUniversity of BolognaBologna 40138Italy Radiology and Radiotherapy Unit Department of Precision MedicineUniversity of Campania "L. Vanvitelli"Naples 80138Italy Unit of Internal Medicine Department of Medical and Surgical SciencesUniversity of BolognaBologna 40138Italy

Hepatocellular adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liver tumours, an HCA may be complicated by bleeding and malignant transformation. HCAs have been divided into four subtypes based on molecular and pathological features: hepatocyte nuclear factor 1α-mutated HCA, inflammatory HCA,β-catenin-mutated HCA, and unclassified HCA.β-cateninmutated HCA has the highest risk of haemorrhage or malignant transformation. In the latest upgrade of the guidelines regarding the management of benign liver tumours published in 2016 by the European Association for the Study of the Liver, magnetic resonance imaging (MRI) was recognized to be superior to all other imaging modalities in detecting HCAs and in being able to subtype HCAs up to 80%, with positive identification of 1α-mutated HCA or inflammatory HCA achievable with > 90% specificity. This review analyzed the imaging features of HCA using MRI with hepato-specific contrast agents, focusing on the limitations in the HCA characterization.

关键词： Hepatocellular adenoma Magnetic resonance imaging Hepato-specific contrast media Liver neoplasm Gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid

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Current guidelines for the management of non-alcoholic fatty liver disease:A systematic review with comparative analysis

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World Journal of Gastroenterology 2018年第30期24卷 3361-3373页

作者： Simona Leoni francesco tovoli Lucia Napoli Ilaria Serio Silvia Ferri Luigi Bolondi Department of Medical and Surgical Sciences (DIMEC) Division of Internal MedicineUniversity of Bologna

The current epidemic of non-alcoholic fatty liver disease(NAFLD) is reshaping the field of hepatology all around the *** widespread diffusion of metabolic risk factors such as obesity,type2-diabetes mellitus,and dyslipidemia has led to a worldwide diffusion of *** parallel to the increased availability of effective anti-viral agents,NAFLD is rapidly becoming the most common cause of chronic liver disease in Western Countries,and a similar trend is expected in Eastern Countries in the next *** epidemic and its consequences have prompted experts from all over the word in identifying effective strategies for the diagnosis,management,and treatment of *** scientific societies from Europe,America,and Asia-Pacific regions have proposed guidelines based on the most recent evidence about *** guidelines are consistent with the key elements in the management of NAFLD,but still,show significant difference about some critical *** reviewed the current literature in English language to identify the most recent scientific guidelines about NAFLD with the aim to find and critically analyse the main *** distinguished guidelines from 5 different scientific societies whose reputation is worldwide recognised and who are representative of the clinical practice in different geographical *** were noted in: the definition of NAFLD,the opportunity of NAFLD screening in high-risk patients,the noninvasive test proposed for the diagnosis of NAFLD and the identification of NAFLD patients with advanced fibrosis,in the follow-up protocols and,finally,in the treatment strategy(especially in the proposed pharmacological management).These difference have been discussed in the light of the possible evolution of the scenario ofNAFLD in the next years.

关键词： Non-alcoholic fatty liver disease Metformin Liver steatosis Liver biopsy Non-invasive diagnosis Pioglitazone Clinical guidelines

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Current guidelines for the management of celiac disease:A systematic review with comparative analysis

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World Journal of Gastroenterology 2022年第1期28卷 154-175页

作者： Alberto Raiteri Alessandro Granito Alice Giamperoli Teresa Catenaro Giulia Negrini francesco tovoli Division of Internal Medicine Hepatobiliary and Immunoallergic DiseasesIRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy

BACKGROUND Wheat and other gluten-containing grains are widely consumed,providing approximately 50%of the caloric intake in both industrialised and developing *** widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease *** condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global ***,in recent years,the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease(CD)from obscurity to global *** modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of *** scientific societies,mainly from Europe and America,have proposed guidelines based on CD's most recent *** To identify the most recent scientific guidelines on CD,aiming to find and critically analyse the main *** We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English *** was lastly accessed on 1 March *** We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical *** were noted in the possibility of a no-biopsy diagnosis,HLA testing,follow-up protocols,and *** We found a relatively high concordance between the guidelines for *** modifications have occurred in the last years,especially about the possibility of a no-biopsy diagnosis in *** modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.

关键词： Celiac disease Gluten Gluten-free diet Gluten sensitivity Clinical guidelines Non-invasive diagnosis Histopathological findings Serological markers Genetics

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Telomerase reactivation is associated with hepatobiliary and pancreatic cancers

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Hepatobiliary & Pancreatic Diseases International 2020年第5期19卷 420-428页

作者： Vito Sansone Marco Le Grazie Jenny Roselli Simone Polvani Andrea Galli francesco tovoli Mirko Tarocchi Department of Medical and Surgical Sciences University of BolognaBolognaItaly Department of Experimental and Clinical Biomedical Sciences"Mario Serio" University of Florence50139 FirenzeItaly

Background:Human telomerase reverse transcriptase(hTERT)and its components play a significant role in cancer progression,but recent data demonstrated that telomeres and telomerase alterations could be found in other diseases;increasing evidence suggests a key role of this enzyme in the fields of hepatobiliary and pancreatic *** sources:We performed a PubMed search with the following keywords:telomerase,hepatocellular carcinoma,cholangiocarcinoma,pancreatic adenocarcinoma by December *** reviewed the relevant publications that analyzed the correlation between telomerase activity and hepatobiliary and pancreatic ***:Telomerase reactivation plays a significant role in the development and progression of hepatobiliary and pancreatic tumors and could be used as a diagnostic biomarker for hepatobiliary and pancreatic cancers,as a predictor for prognosis and a promising therapeutic ***:Our review summarized the evidence about the critical role of hTERT in cancerous and precancerous lesions of the alteration and its activity in hepatobiliary and pancreatic diseases.

关键词： Telomerase Telomere Cancer Hepatobiliary and pancreatic disease

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Clinical and diagnostic aspects of gluten related disorders

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World Journal of Clinical Cases 2015年第3期3卷 275-284页

作者： francesco tovoli Chiara Masi Elena Guidetti Giulia Negrini Paola Paterini Luigi Bolondi Department of Medical and Surgical Sciences University of Bologna

Gluten is one of the most abundant and widely distributed components of food in many areas. It can be included in wheat, barley, rye, and grains such as oats, barley, spelt, kamut, and triticale. Gluten-containinggrains are widely consumed; in particular, wheat is one of the world's primary sources of food, providing up to 50% of the caloric intake in both industrialized and developing countries. Until two decades ago, celiac disease(CD) and other gluten-related disorders were believed to be exceedingly rare outside of Europe and were relatively ignored by health professionals and the global media. In recent years, however, the discovery of important diagnostic and pathogenic milestones led CD from obscurity to global prominence. In addition, interestingly, people feeding themselves with glutenfree products greatly outnumber patients affected by CD, fuelling a global consumption of gluten-free foods with approximately $2.5 billion in United States sales each year. The acknowledgment of other medical conditions related to gluten that has arisen as health problems, providing a wide spectrum of gluten-related disorders. In February 2011, a new nomenclature for gluten-related disorders was created at a consensus conference in London. In this review, we analyse innovations in the field of research that emerged after the creation of the new classification, with particular attention to the new European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for CD and the most recent research about non-celiac gluten sensitivity.

关键词： Celiac disease Wheat allergy Gluten sensitivity Non-celiac gluten sensitivity Gluten-free diet Gluten Anti-gliadin antibodies

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The duration of the conventional chemoembolization for hepatocellular carcinoma:factors affecting the procedural time

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Hepatoma Research 2022年第1期8卷 313-326页

作者： Matteo Renzulli Mattia Gentilini Giovanni Marasco Nicolo Brandi Alessandro Granito Silvia Lo Monaco Anna Maria Ierardi Antonio De Cinque francesco tovoli Laura Bartalena Daniele Spinelli Fabio Piscaglia Rita Golfieri Department of Radiology IRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy Internal Medicine and Digestive Physiopathology Unit IRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy Division of Internal Medicine IRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy Diagnostic and Interventional Radiology Department Fondazione IRCCS CàGranda Ospedale Maggiore PoliclinicoUniversitàdegli Studi di Milano MilanMilan 20122Italy

Aim:The present study evaluated the duration of chemoembolization in patients with hepatocellular carcinoma,analyzing possible factors affecting the procedural ***:In total,175 patients who underwent chemoembolization have been prospectively *** procedural length was considered the time between the insertion and the removal of the angiographic *** features related to the tumor burden and angiographic procedures,which could be related to the procedural time,were ***:The chemoembolization time resulted in a mean of 58.1 *** longer procedural time was associated with a number of nodules treated per patient≥2(P<0.001),a number of segments with nodules≥2(P<0.001),the presence of more than 1 nodule in the same segment(P<0.001),the location of the tumor in the left lobe(P=0.001),the exclusion from the Milan criteria(P<0.001),and a number of segments treated≥2(P<0.001).Only the number of nodules treated per patient resulted significantly in multivariate analysis(OR 2.927,95%CI:2.015-4.251,P<0.001).Conclusion:The factors related to longer procedural time are the number of nodules treated≥2,the number of segments with nodules≥2,the involvement of the left lobe,the tumor burden outside the Milan criteria,and the number of segments treated≥*** these characteristics,known in the pre-procedural phase,represent useful tools for a correct planning of the angiographic room’s workflow during the pandemic era as well as in the future to reduce downtime and increase productivity.

关键词： Chemoembolization hepatocellular carcinoma procedural time angiographic room management

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