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Can rifaximin for hepatic encephalopathy be discontinued during broad-spectrum antibiotic treatment?

World Journal of Hepatology 2024年第2期16卷 115-119页

作者： Chien-Hao Huang piero Amodio Division of Hepatology Department of Gastroenterology and HepatologyChang-Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan Department of Clinical and Experimental Medicine University of PaduaPadova 35122Italy

Hepatic encephalopathy(HE)is a formidable complication in patients with decompensated cirrhosis,often necessitating the administration of rifaximin(RFX)for effective ***,is a gut-restricted,poorly-absorbable oral rifamycin derived antibiotic that can be used in addition to lactulose for the secondary prophylaxis of *** has shown notable reductions in infection,hospital readmission,duration of hospital stay,and ***,limited data exist about the concurrent use of RFX with broad-spectrum antibiotics,because the patients are typically excluded from studies assessing RFX efficacy in HE.A pharmacist-driven quasi-experimental pilot study was done to address this *** argue against the necessity of RFX in HE during broad-spectrum antibiotic treatment,particularly in critically ill patients in intensive care unit(ICU).The potential for safe RFX discontinuation without adverse effects is clearly illuminated and valuable insight into the optimization of therapeutic strategies is *** findings also indicate that RFX discontinuation during broadspectrum antibiotic therapy was not associated with higher rates of delirium or coma,and this result remained robust after adjustment in multivariate ***,rates of other secondary clinical and safety outcomes,including ICU mortality and 48-hour changes in vasopressor requirements,were ***,since the activity of RFX is mainly confined to the modulation of gut microbiota,its potential utility in patients undergoing extensive systemic antibiotic therapy is debatable,given the overlapping antibiotic ***,this suggests that the action of RFX on HE is class-specific(related to its activity on gut microbiota),rather than drug-specific.A recent double-blind randomized controlled(ARiE)trial provided further evidence-based support for RFX withdrawal in critically ill cirrhotic ICU patients receiving broad-spectrum *** studies prompt further discussion about

关键词： Rifaximin discontinuation Hepatic encephalopathy Broad-spectrum antibiotics Crit-ically ill Medical intensive care unit Pharmacist-driven protocol

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Different doses of consensus interferon plus ribavirin in patients with hepatitis C virus genotype 1 relapsed after interferon monotherapy:A randomized controlled trial

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World Journal of Gastroenterology 2006年第42期12卷 6861-6864页

作者： Giuseppe Alaimo Vito Di Marco Donatella Ferraro Rosa Di Stefano Salvatore Porrovecchio Francesca D’Angelo Vincenza Calvaruso Antonio Craxì piero Luigi Almasio Cattedra di Gastroenterologia Dipartimento Biomedico di Medicina Interna e Specialistica University of Palermo Italy Cattedra di Virologia Di-partimento di Igiene e Microbiologia University of Palermo Italy

AIM： To assess the efficacy of different schedules of consensus interferon （CIFN） plus ribavirin in retreating chronic hepatitis C patients who relapsed after recombinant interferon （rIFN） monotherapy. METHODS： Forty-five patients （34 males and 11 females） with chronic hepatitis due to hepatitis C virus （HCV） genotype 1 who relapsed after a previous course of rIFN monotherapy were randomized to receive 9 μg CIFN three times per week for 52 wk （group A, n = 22） or 18 μg CIFN three times per week for 52 wk （group B, n = 23） in combination with ribavirin 800 to 1200 mg daily for 52 wk （according to body weight）. Virological response was evaluated at week 24 （ERR）, at the end of treatment （ETR） and at 76 wk （SVR）. RESULTS： By intention-to-treat analysis, subjects in group A had an EVR in 35% of cases, an ETR in 35% and a SVR in 27.3% of cases. Subjects in group B had an EVR in 32% of cases, an ETR in 35% and a SVR in 26.1% of cases. Treatment was stopped because of adverse effects （mostly intolerance） in 15 patients （6 in group A and 9 in group B）. IFN dose reduction was needed in 2 patients （1 in group A and 1 in group B）. Ribavirin dose was reduced in 2 patients in group A and 1 in group B respectively. Among the 15 subjects who received at least 80% of the intended schedule, the rate of SVR was 80% （6 in group A and 6 in group B）. CONCLUSION： CIFN in combination with ribavirin when given to HCV genotype 1 relapsers after rIFN monotherapy obtains an unsatisfactory rate of sustained viral clearance independently of dosage of the drug. This may be due to its scarce tolerability.

关键词： Interferon Ribavirin Hepatitis C virus Hepatitis C Relapser

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Growth differentiation factor-15 serum concentrations reflect disease severity and anemia in patients with inflammatory bowel disease

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World Journal of Gastroenterology 2024年第13期30卷 1899-1910页

作者： Ante Tonkic Marko Kumric Ivna Akrapovic Olic Doris Rusic piero Marin Zivkovic Daniela Supe Domic Zeljko Sundov Ivan Males Josko Bozic Biology of Neoplasms University of Split School of MedicineSplit 21000Croatia Department of Pathophysiology University of Split School of MedicineSplit 21000Croatia Department of Gastroenterology University Hospital of SplitSplit 21000Croatia Department of Pharmacy University of Split School of MedicineSplit 21000Croatia Department of Medical Laboratory Diagnostics University Hospital of SplitSplit 21000Croatia Department of Health Studies University of SplitSplit 21000Croatia Department of Internal Medicine University of Split School of MedicineSplit 21000Croatia Department of Surgery University Hospital of SplitSplit 21000Croatia

BACKGROUND Population of patients with inflammatory bowel disease(IBD)is burdened by various extraintestinal manifestations which substantially contribute to greater morbidity and ***-differentiation factor-15(GDF-15)is often overexpressed under stress conditions,such as inflammation,malignancies,heart failure,myocardial ischemia,and many *** To explore the association between GDF-15 and IBD as serum concentrations of GDF-15 were shown to be an independent predictor of poor outcomes in multiple *** additional aim was to determine possible associations between GDF-15 and multiple clinical,anthropometric and laboratory parameters in patients with *** This cross-sectional study included 90 adult patients diagnosed with IBD,encompassing both Crohn’s disease(CD)and ulcerative colitis(UC),and 67 healthy age-and sex-matched *** patients underwent an extensive workup,including colonoscopy with subsequent histopathological *** activity was assessed by two independent gastroenterology consultants specialized in IBD,employing well-established clinical and endoscopic scoring ***-15 serum concentrations were determined following an overnight fasting,using electrochemiluminescence *** In patients with IBD,serum GDF-15 concentrations were significantly higher in comparison to the healthy controls[800(512-1154)pg/mL vs 412(407-424)pg/mL,P<0.001],whereas no difference in GDF-15 was found between patients with CD and UC[807(554-1451)pg/mL vs 790(509-956)pg/mL,P=0.324].Moreover,multiple linear regression analysis showed that GDF-15 levels predict CD and UC severity independent of age,sex,and C-reactive protein levels(P=0.016 and P=0.049,respectively).Finally,an association between GDF-15 and indices of anemia was ***,negative correlations were found between GDF-15 and serum iron levels(r=-0.248,P=0.021),as well as GDF-15 and hemoglobin(r=-0.351,P=0.021).Accordingly,in comparison to I

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis Growth-differentiation factor-15 Anemia Extraintestinal manifestations

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Liver Research 2018年第4期2卷 186-199页

作者： Helen H.Wang piero Portincasa Min Liu Patrick Tso David Q.-H.Wang Department of Medicine Division of Gastroenterology and Liver DiseasesMarion Bessin Liver Research CenterAlbert Einstein College of MedicineBronxNYUSA Department of Biomedical Sciences and Human Oncology Clinica Medica“A.Murri”University of Bari“Aldo Moro”Medical SchoolBariItaly Department of Pathology and Laboratory Medicine University of Cincinnati College of MedicineCincinnatiOHUSA

The terms biliary sludge and cholesterol microlithiasis(hereafter referred to as microlithiasis)were originated from different diagnostic techniques and may represent different stages of cholesterol gall-stone *** the pathogenesis of biliary sludge and microlithiasis may be similar,micro-lithiasis could be preceded by biliary sludge,followed by persistent precipitation and aggregation of solid cholesterol crystals,and eventually,gallstone *** clinical conditions are clearly associated with the formation of biliary sludge and microlithiasis,including total parenteral nutrition,rapid weight loss,pregnancy,organ transplantation,administration of certain medications,and a variety of acute and chronic *** studies have demonstrated complete resolution of biliary sludge in approximately 40%of patients,a cyclic pattern of disappearing and reappearing in about 40%,and progression to gallstones in nearly 20%.Although only a minority of patients with ultrasonographic demonstration of biliary sludge develop gallstones,it is still a matter of controversy whether micro-lithiasis could eventually evolve to cholesterol *** sludge and microlithiasis are asymp-tomatic in the vast majority of patients;however,they can cause biliary colic,acute cholecystitis,and acute *** sludge and microlithiasis are most often diagnosed ultrasonographically and bile microscopy is considered the gold standard for their *** measures to prevent the development of biliary sludge are not practical or cost-effective in the general *** cholecystectomy offers the most definitive therapy on biliary *** sphincterotomy or surgical intervention is effective for microlithiasis-induced *** acid can effectively prevent the recurrence of solid cholesterol crystals and significantly reduce the risk of recurrent pancreatitis.

关键词： Biliary sludge Cholesterol microlithiasis Acute cholecystitis Acute pancreatitis Biliary colic Cholesterol monohydrate crystals Lithogenic bile

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clinical course and prognostic factors of hepatorenal syndrome:a retrospective single-center cohort study

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World Journal of Hepatology 2013年第12期5卷 685-691页

作者： Anna Licata Marcello Maida Ambra Bonaccorso Fabio Salvatore Macaluso Maria Cappello Antonio Craxì piero Luigi Almasio Section of Gastroenterology Dipartimento Biomedicodi Medicina Interna e SpecialisticaUniversity of Palermo

AIM: To investigate clinical and biochemical features of hepatorenal syndrome(HRS), to assess short and long- term survival evaluating potential predictors of early mortality. METHODS: Sixty-two patients with liver cirrhosis and renal failure, defined as a serum creatinine value > 1.5 mg/dL on at least two measurements within 48 h, admitted to our tertiary referral Unit from 2001 to 201, were retrospectively reviewed. Among them, 33 patients(53.2%) fulfilled the revised criteria of the International Ascites Club for the diagnosis of HRS. Twenty-eight patients were treated with combinations of terlipressin and albumin, two with dopamine and al- bumin, and three with albumin alone. No patients were suitable for liver transplantation. Complete response was defined as normalization of creatinine levels to less than 1.5 mg/dL, partial response as a decrease of at least 50% but not to less than 1.5 mg/dL, no response as no reduction in creatinine or a decrease of less 50% compared to pre-treatment values. All of the patients were followed up for at least 1 year until January 2013. RESULTS: HRS type 1 was diagnosed in 15 patients(45.5%). Hepatitis C virus infection was the primary etiology(69.6%), followed by alcohol(15.2%), and cryptogenesis(15.2%). Complete response to therapy was obtained in only 3 cases(9.1%) and partial re- sponse in 7 patients(21.2%). Median survival was 30 d(range: 10-274) without significant differences be- tween type 1 and type 2 HRS. By univariate analysis, Child-Pugh class C(P = 0.009), presence of hepatocel- lular carcinoma(P = 0.04), low serum sodium(P = 0.02), high bilirubin values(P = 0.009) and high Model for End-stage Liver Disease(MELD) score(P = 0.03) were predictive factors of 30-d mortality. By multivari- ate analysis, only serum sodium 27(OR = 18.72; P = 0.01) were independently associated with a survival of less than one month. CONCLUSION: HRS still has a poor prognosis, even when va

关键词： Hepatorenal syndrome Liver cirrhosis Hepatitis C virus vasoactive drugs Mortality

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Impact of hepatitis C virus infection on lifestyle

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World Journal of Gastroenterology 2007年第19期13卷 2722-2726页

作者： Paola Scognamiglio Vincenzo Galati Assunta Navarra Maria Antonella Longo Maria Stella Aloisi Maria Giulia Antonini Massimo Puoti piero Luigi Almasio Giuseppe Ippolito Enrico Girardi Istituto Nazionale per le Malattie Infettive "L. Spallanzani" IRCCS Roma Italy Cattedra di Malattie Infettive Università di Brescia Italy Cattedra di Gastroenterologia Università di Palermo Italy

AIM: To evaluate the impact of the diagnosis of hepatitis C infection on lifestyle habits such as smoking, drinking, sports activity and ***: A self-administered, anonymous question-naire was offered to out-patients with HCV infection consecutively attending three clinical centres in ***: Of the 275 respondents, 62.2% (171) were male. Mean age was 51 (range 20-80) years. Overall, after the diagnosis of hepatitis C, 74.5% of drinkers had modified (giving up or reducing) alcohol consumption, 21.3% of smokers had modifi ed their habits and 32.3% of subjects who reported sports activity had either stopped or reduced frequency of activity or chose a less fatiguing sport. Sixty-four percent of the respondents reported having modified their diet, most of them on physician's advice. CONCLUSION: After the diagnosis of hepatitis C many patients correctly modif ied their alcohol consumption and a minority their smoking habits. The reason for reported changes in diet and physical activity needs further investigations.

关键词： Hepatitis C virus Lifestyle habits Smoking Alcohol consumption Diet Physical activity

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A vaginal drain of a pelvic abscess due to colonic diverticulitis

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World Journal of Clinical Cases 2013年第2期1卷 82-83页

作者： Marco Milone Miguel Emilio Sosa Fernandez piero Venetucci Paola Maietta Loredana Maria Sosa Fernandez Caterina Taffuri Francesco Milone Department of Advanced Biomedical Science University "Federico Ⅱ" of Naples

Although well recognized for tubo-ovarian abscesses, we report, in our best knowledge, the first case of a vaginal drain of a pelvic abscess due to colonic diverticulitis. A 78-year-old patient presented with abdominal and pelvic pain, fever(39.3 ℃) and an elevated white blood cell count(18500/mL). After abdominopelvic computed tomography the patient was presumed to have a pelvic abscess, which developed as a complication of the sigmoid diverticulitis. Due to the numerous intervening structures that create obstacles to safe percutaneous access, we planned a trans-vaginal drain. A rapid recovery was obtained within 2 d from the procedure and, at present, the follow-up was uneventful after 18 mo. We believe that transvaginal drain of pelvic abscess could be a useful alternative, when percutaneous approach is not feasible.

关键词： Vaginal Drain Diverticulitis Pelvic abscess Echography

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Chronic functional constipation is strongly linked to vitamin D deficiency

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World Journal of Gastroenterology 2019年第14期25卷 1729-1740页

作者： Alba Panarese Francesco Pesce piero Porcelli Giuseppe Riezzo Palma Aurelia Iacovazzi Carla Maria Leone Massimo De Carne Caterina Mammone Rinaldi Endrit Shahini Department of Gastroenterology and Digestive Endoscopy Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital Nephrology section Department of Emergency and Organ TransplantationUniversity of Bari Department of Psychological Health and Territorial Sciences D'Annunzio University of Chieti-Pescara Department of Clinical Pathology Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital Department of Radiology Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital Department of Emergency and Organ Transplantation University of Bari

BACKGROUND Few studies have examined intestinal motility disorders, which are disabling conditions associated with chronic functional constipation, whose pathogenesis is actually not *** To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility *** We performed a prospective case-control study, from May-June to November2017. Glucose/lactulose breath tests, radiopaque markers(multiple capsule techniques) and wireless motility capsule analysis were used to assess colonicand oro-cecal transit time, after excluding small-intestinal bacterial overgrowth condition. Then, we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires, the Irritable Bowel Syndrome Quality of life(IBS-QOL), the Short Form Health Survey 12, and the Hospital Anxiety and Depression Scale 14(HADS-14 A and HADS-14 D).RESULTS We enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects. Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels(P < 0.001), and they showed a significant impairment of all health-related quality of life and psychological tests(IBS-QOL, Short Form Health Survey 12-Physical Component Summary, Short Form Health Survey 12-Mental Component Summary, HADS-14 A and HADS-14 D), as compared to the control group(P < 0.001), which significantly correlated with low vitamin D levels(r =-0.57, P < 0.001; r = 0.21, P = 0.01; r =-0.48, P < 0.001; r =-0.57, P < 0.001; r =-0.29, P < 0.001, respectively). At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder(odds ratio = 1.19; 95% confidence interval: 1.14-1.26, P < 0.001).CONC

关键词： Chronic constipation Intestinal motility Vitamin D Quality of life Anxiety Depression

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An 81-year-old gentleman with symptomatic Bochdalek hernia

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World Journal of Gastrointestinal Surgery 2013年第7期5卷 222-223页

作者： Mohammed Zak Rajput piero Marco Fisichella Swallowing Center Department of Surgery Loyola University Medical Center Maywood IL 60153 United States

An 81-year-old gentleman with congenital polycystic kidney disease presented to his primary care physician with dysphagia, gastroesophageal reflux refractory to medical management, and 11.25 kg weight loss in a 6 mo-period. A barium swallow misdiagnosed a paraesophageal hernia for a Bochdalek hernia. Herein, we highlight how a Bochdalek hernia may be disregarded in the differential diagnosis and how providers can resort to a more common diagnosis, a paraesophageal hernia, which is more frequently encountered in old age and whose radiologic appearance might mimic a Bochdalek hernia.

关键词： Polycystic kidney disease Paraesophageal hernia Bochdalek hernia Diaphragmatic hernia Diaphragmatic hernia repair

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Over-the-scope-clip closure of long lasting gastrocutaneous fistula after percutaneous endoscopic gastrostomy tube removal in immunocompromised patients:A single center case series

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World Journal of Gastrointestinal Endoscopy 2017年第2期9卷 85-90页

作者： Henriette Heinrich Christoph Gubler piero V Valli Division of Gastroenterology and Hepatology University Hospital ZurichCH-8091 ZurichSwitzerland

Over-the-scope-clips (OTSC®) have been shown to be an effective and safe endoscopic treatment option for the closure of gastrointestinal perforations, leakages and fistulae. Indications for endoscopic OTSC® treatment have grown in number and also include gastro cutaneous fistula (GCF) after percutaneous endoscopic gastrostomy (PEG) tube removal. Non-healing GCF is a rare complication after removal of PEG tubes and may especially develop in immunosuppressed patients with multiple comorbidities. There is growing evidence in the literature that OTSC® closure of GCF after PEG tube removal is emerging as an effective, simple and safe endoscopic treatment option. However current evidence is limited to the geriatric population and short standing GCF, while information on closure of long standing GCF after PEG tube removal in a younger population with significant comorbidities is lacking. In this retrospective single-center case-series we report on five patients undergoing OTSC® closure of chronic GCF after PEG tube removal. Four out of five patients were afflicted with long lasting, symptomatic fistulae. All five patients suffered from chronic disease associated with a catabolic metabolism (cystic fibrosis, chemotherapy for neoplasia, liver cirrhosis). The mean patient age was 43 years. The mean dwell time of PEG tubes in all five patients was 808 d. PEG tube dwell time was shortest in patient 5 (21 d). The mean duration from PEG tube removal to fistula closure in patients 1-4 was 360 d (range 144-850 d). The intervention was well tolerated by all patients and no adverse events occured. Successful immediate and long-term fistula closure was accomplished in all five patients. This single center case series is the first to show successful endoscopic OTSC® closure of long lasting GCF in five consecutive middle-aged patients with significant comorbidities. Endoscopic closure of chronic persistent GCF after PEG tube removal

关键词： Gastro cutaneous fistula Endoscopic fistula closure Over-the-scope-clips Percutaneous endoscopic gastrostomy Fistula in immmunosuppressed patients

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