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World Journal of Clinical Cases 2020年第6期8卷 1013-1025页

作者： Emanuele Sinagra Erika Utzeri gaetano cristian morreale Carlo Fabbri Fabio Pace Andrea Anderloni Gastroenterology and Endoscopy Unit Fondazione Istituto Giuseppe GiglioContrada Pietra Pollastra PisciottoCefalù90015Italy Euro-Mediterranean Institute of Science and Technology Palermo 90100Italy Nuova Casa di Cura di Decimomannu Cagliari 09100Italy Section of Gastroenterology S.Elia-Raimondi HospitalCaltanissetta 93100Italy Gastroenterology and Digestive Endoscopy Unit Forlì-CesenaAzienda USL RomagnaForlì47121Italy Unit of Gastroenterology Bolognini HospitalBergamo 24100Italy Digestive Endoscopy Unit Division of GastroenterologyHumanitas Research HospitalRozzano 20089Italy

Despite the bi-directional interaction between gut microbiota and the brain not being fully understood,there is increasing evidence arising from animal and human studies that show how this intricate relationship may facilitate inflammatory bowel disease(IBD)pathogenesis,with consequent important implications on the possibility to improve the clinical outcomes of the diseases themselves,by acting on the different components of this system,mainly by modifying the microbiota.With the emergence of precision medicine,strategies in which patients with IBD might be categorized other than for standard gut symptom complexes could offer the opportunity to tailor therapies to individual patients.The aim of this narrative review is to elaborate on the concept of the gutbrain-microbiota axis and its clinical significance regarding IBD on the basis of recent scientific literature,and finally to focus on pharmacological therapies that could allow us to favorably modify the function of this complex system.

关键词： Irritable bowel syndrome Inflammatory bowel disease Gut-brain axis Therapy

New therapeutic perspectives in irritable bowel syndrome: Targeting low-grade inflammation, immuno-neuroendocrine axis, motility, secretion and beyond

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World Journal of Gastroenterology 2017年第36期23卷 6593-6627页

作者： Emanuele Sinagra gaetano cristian morreale Ghazaleh Mohammadian Giorgio Fusco Valentina Guarnotta Giovanni Tomasello Francesco Cappello Francesca Rossi Georgios Amvrosiadis Dario Raimondo Gastroenterology and Endoscopy Unit Fondazione Istituto Giuseppe GiglioContrada Pietra Pollastra Pisciotto Euro-Mediterranean Institute of Science and Technology Department of Experimental Biomedicine and Clinical Neuroscience Section of Human AnatomyUniversity of Palermo Unit of Gastroenterology Ospedali Riuniti Villa Sofia-Vincenzo Cervello Department of Medicine Division of Gastroenterology and HepatologyKarolinska InstitutetKarolinska University Hospital Unit of Internal Medicine Ospedali Riuniti Villa Sofia-Vincenzo Cervello Section of Cardio-Respiratory and Endocrine-Metabolic Diseases Biomedical Department of Internal and Specialist MedicineUniversity of Palermo

Irritable bowel syndrome(IBS)is a chronic,recurring,and remitting functional disorder of the gastrointestinal tract characterized by abdominal pain,distention,and changes in bowel habits.Although there are several drugs for IBS,effective and approved treatments for one or more of the symptoms for various IBS subtypes are needed.Improved understanding of pathophysiological mechanisms such as the role of impaired bile acid metabolism,neurohormonal regulation,immune dysfunction,the epithelial barrier and the secretory properties of the gut has led to advancements in the treatment of IBS.With regards to therapies for restoring intestinal permeability,multiple studies with prebiotics and probiotics are ongoing,even if to date their efficacy has been limited.In parallel,much progress has been made in targeting low-grade inflammation,especially through the introduction of drugs such as mesalazine and rifaximin,even if a better knowledge of the mechanisms underlying the low-grade inflammation in IBS may allow the design of clinical trials that test the efficacy and safety of such drugs.This literature review aims to summarize the findings related to new and investigational therapeutic agents for IBS,most recently developed in preclinical as well as Phase 1 and Phase 2clinical studies.

关键词： Therapy Low grade inflammation Motility Secretion Irritable bowel syndrome Immunoendocrine axis

Management of antiplatelet or anticoagulant therapy in endoscopy: A review of literature

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World Journal of Gastrointestinal Endoscopy 2020年第6期12卷 172-192页

作者： Marcello Maida Sandro Sferrazza Carlo Maida gaetano cristian morreale Alessandro Vitello Giovanni Longo Vincenzo Garofalo Emanuele Sinagra Gastroenterology and Endoscopy Unit S.Elia-Raimondi HospitalCaltanissetta 93100Italy Gastroenterology and Endoscopy Unit Santa Chiara HospitalTrento 38123Italy U.O.C di Medicina Interna con Stroke Care Dipartimento di Promozione della SaluteMaterno-Infantiledi Medicina Interna e Specialistica di Eccellenza“G.D’Alessandro”University of PalermoPalermo 93100Italy Cardiology Unit S.Elia-Raimondi HospitalCaltanissetta 93100Italy Gastroenterology and Endoscopy Unit Istituto San Raffaele GiglioCefalu 90015Italy

Endoscopic procedures hold a basal risk of bleeding that depends on the type of procedure and patients’comorbidities.Moreover,they are often performed in patients taking antiplatelet and anticoagulants agents,increasing the potential risk of intraprocedural and delayed bleeding.Even if the interruption of antithrombotic therapies is undoubtful effective in reducing the risk of bleeding,the thromboembolic risk that follows their suspension should not be underestimated.Therefore,it is fundamental for each endoscopist to be aware of the bleeding risk for every procedure,in order to measure the risk-benefit ratio for each patient.Moreover,knowledge of the proper management of antithrombotic agents before endoscopy,as well as the adequate timing for their resumption is essential.This review aims to analyze current evidence from literature assessing,for each procedure,the basal risk of bleeding and the risk of bleeding in patients taking antithrombotic therapy,as well as to review the recommendation of American society for gastrointestinal endoscopy,European society of gastrointestinal endoscopy,British society of gastroenterology,Asian pacific association of gastroenterology and Asian pacific society for digestive endoscopy guidelines for the management of antithrombotic agents in urgent and elective endoscopic procedures.

关键词： Antiplatelet Anticoagulant Endoscopy Management Bleeding Risk

Effectiveness of very low-volume preparation for colonoscopy:A prospective, multicenter observational study

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World Journal of Gastroenterology 2020年第16期26卷 1950-1961页

作者： Marcello Maida Emanuele Sinagra gaetano cristian morreale Sandro Sferrazza Giuseppe Scalisi Dario Schillaci Marco Ventimiglia Fabio Salvatore Macaluso Giovanni Vettori Giuseppe Conoscenti Concetta Di Bartolo Serena Garufi Domenico Catarella Michele Manganaro Clara Maria Virgilio Salvatore Camilleri Gastroenterology and Endoscopy Unit S.Elia-Raimondi HospitalCaltanissetta 93100Italy Gastroenterology and Endoscopy Unit Istituto San Raffaele GiglioCefalu 90015Italy Gastroenterology and Endoscopy Unit Santa Chiara HospitalTrento 38014Italy Gastroenterology Unit ARNAS GaribaldiCatania 95100Italy Gastroenterology Unit Basarocco HospitalNiscemi 93015CaltanissettaItaly Department of Internal Medicine Villa Sofia-Cervello HospitalPalermo 90100Italy

BACKGROUND The effectiveness of colonoscopy strictly depends on adequate bowel cleansing.Recently,a 1 L polyethylene glycol plus ascorbate(PEG-ASC)solution(Plenvu;Norgine,Harefield,United Kingdom)has been introduced on the evidence of three phase-3 randomized controlled trials,but it had never been tested in the real-life.AIM To assess the effectiveness and tolerability of the 1 L preparation compared to 4 L and 2 L-PEG solutions in a real-life setting.METHODS All patients undergoing a screening or diagnostic colonoscopy after a 4,2 or 1 L PEG preparation,were consecutively enrolled in 5 Italian centers from September 2018 to February 2019.The primary endpoints of the study were the assessment of bowel cleansing success and high-quality cleansing of the right colon.The secondary endpoints were the evaluation of tolerability,adherence and safety of the different bowel preparations.Bowel cleansing was assessed through the Boston Bowel Preparation Scale.Adherence was defined as consumption of at least 75%of each dose,while tolerability was evaluated through a semiquantitative scale.Safety was systematically monitored through adverse events reporting.RESULTS Overall,1289 met the inclusion criteria and were enrolled in the study.Of these,490 patients performed a 4 L-PEG preparation(Selgesse^■),566 a 2 L-PEG cleansing(Moviprep^■or Clensia^■)and 233 a 1 L-PEG preparation(Plenvu^■).Bowel cleansing by Boston Bowel Preparation Scale was 6.5±1.5 overall and 6.3±1.5,6.2±1.5,7.3±1.5(P<0.001)in the subgroups of 4 L,2 L and 1 L-PEG preparation,respectively.Cleansing success was achieved in 72.4%,74.1%and 90.1%(P<0.001),while a high-quality cleansing of the right colon in 15.9%,12.0%and 41.4%(P<0.001)for 4 L,2 L and 1 L-PEG preparation groups,respectively.The 1 L preparation was the most tolerated compared to the 2 and 4 L-PEG solutions in the absence of serious adverse events within any of the three groups.Multiple regression models confirmed 1 L PEG-ASC preparation as an independent predictor of overall cleansing success,high-

关键词： Colonoscopy Bowel preparation Polyethylene glycol Polyethylene glycolplus ascorbate Effectiveness Tolerability

Emerging artificial intelligence applications in gastroenterology: A review of the literature

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Artificial Intelligence in Gastrointestinal Endoscopy 2020年第1期1卷 6-18页

作者： gaetano cristian morreale Emanuele Sinagra Alessandro Vitello Endrit Shahini Erjon Shahini Marcello Maida Gastroenterology and Endoscopy Unit S.Elia-M.Raimondi HospitalCaltanissetta 93100Italy Gastroenterology and Endoscopy Unit Fondazione Istituto G.GiglioCefalù90015Italy Gastroenterology and Endoscopy Unit Istituto di CandioloFPO-IRCCSCandiolo(Torino)93100Italy Polytechnic University of Bari Bari 70126Italy

Artificial intelligence(AI)allows machines to provide disruptive value in several industries and applications.Applications of AI techniques,specifically machine learning and more recently deep learning,are arising in gastroenterology.Computer-aided diagnosis for upper gastrointestinal endoscopy has growing attention for automated and accurate identification of dysplasia in Barrett’s esophagus,as well as for the detection of early gastric cancers(GCs),therefore preventing esophageal and gastric malignancies.Besides,convoluted neural network technology can accurately assess Helicobacter pylori(H.pylori)infection during standard endoscopy without the need for biopsies,thus,reducing gastric cancer risk.AI can potentially be applied during colonoscopy to automatically discover colorectal polyps and differentiate between neoplastic and nonneoplastic ones,with the possible ability to improve adenoma detection rate,which changes broadly among endoscopists performing screening colonoscopies.In addition,AI permits to establish the feasibility of curative endoscopic resection of large colonic lesions based on the pit pattern characteristics.The aim of this review is to analyze current evidence from the literature,supporting recent technologies of AI both in upper and lower gastrointestinal diseases,including Barrett's esophagus,GC,H.pylori infection,colonic polyps and colon cancer.

关键词： Artificial intelligence Machine learning Deep learning Computer-aided diagnosis Gastroenterology Endoscopy

Inflammation in irritable bowel syndrome:Myth or newtreatment target?

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世界胃肠病学杂志：英文版 2016年第7期22卷 2242-2255页

作者： Emanuele Sinagra Giancarlo Pompei Giovanni Tomasello Francesco Cappello gaetano cristian morreale Georgios Amvrosiadis Francesca Rossi Attilio Ignazio Lo Monte Aroldo Gabriele Rizzo Dario Raimondo Gastroenterology and Endoscopy Unit Fondazione Istituto San Raffaele GiglioContrada Pietra Pollastra Pisciotto90015 CefalùItaly PhD Course in Surgical Biotechnology and Regenerative Medicine University of Palermo90100 PalermoItaly Euro-Mediterranean Institute of Science and Technology(IEMEST) 90100 PalermoItaly Pathology Unit Fondazione Istituto San Raffaele GiglioContrada Pietra Pollastra Pisciotto90015 CefalùItaly Department of Experimental Biomedicine and Clinical Neuroscience Section of Human AnatomyUniversity of Palermo90100 PalermoItaly Unit of Gastroenterology Ospedali Riuniti Villa Sofia-Vincenzo Cervello90100 PalermoItaly DICHIRONS Department of SurgicalOncological and Stomatological DisciplinesUniversity of Palermo90100 PalermoItaly Unit of Pathology Ospedali Riuniti Villa Sofia-Vincenzo Cervello90100 PalermoItaly

Low-grade intestinal inflammation plays a key role in the pathophysiology of irritable bowel syndrome(IBS), and this role is likely to be multifactorial. The aim of this review was to summarize the evidence on the spectrum of mucosal inflammation in IBS, highlighting the relationship of this inflammation to the pathophysiology of IBS and its connection to clinical practice. We carried out a bibliographic search in Medline and the Cochrane Library for the period of January 1966 to December 2014, focusing on publications describing an interaction between inflammation and IBS. Several evidences demonstrate microscopic and molecular abnormalities in IBS patients. Understanding the mechanisms underlying low-grade inflammation in IBS may help to design clinical trials to test the efficacy and safety of drugs that target this pathophysiologic mechanism.

关键词： Inflammation Irritable bowel syndrome Mast cells Neuroendocrine cells Pathology