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Gut microbiota and metabolic syndrome

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World Journal of Gastroenterology 2014年第43期20卷 16079-16094页

作者： Davide Festi Ramona Schiumerini Leonardo Henry Eusebi Giovanni Marasco Martina Taddia antonio colecchia Department of Digestive Diseases and Internal Medicine University of BolognaS Orsola Hospital40138 BolognaItaly

Gut microbiota exerts a significant role in the pathogenesis of the metabolic syndrome, as confirmed by studies conducted both on humans and animal models. Gut microbial composition and functions are strongly influenced by diet. This complex intestinal “superorganism” seems to affect host metabolic balance modulating energy absorption, gut motility, appetite, glucose and lipid metabolism, as well as hepatic fatty storage. An impairment of the fine balance between gut microbes and host’s immune system could culminate in the intestinal translocation of bacterial fragments and the development of “metabolic endotoxemia”, leading to systemic inflammation and insulin resistance. Diet induced weight-loss and bariatric surgery promote significant changes of gut microbial composition, that seem to affect the success, or the inefficacy, of treatment strategies. Manipulation of gut microbiota through the administration of prebiotics or probiotics could reduce intestinal low grade inflammation and improve gut barrier integrity, thus, ameliorating metabolic balance and promoting weight loss. However, further evidence is needed to better understand their clinical impact and therapeutic use.

关键词： Gut microbiota Metabolic syndrome Obesity Diabetes Non-alcoholic fatty liver disease Probiotic Prebiotic Bariatric surgery

Prognostic factors for hepatocellular carcinoma recurrence

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World Journal of Gastroenterology 2014年第20期20卷 5935-5950页

作者： antonio colecchia Ramona Schiumerini Alessandro Cucchetti Matteo Cescon Martina Taddia Giovanni Marasco Davide Festi Department of Gastrointestinal Diseases and Internal Medicine University of Bologna 40138 Bologna Italy Department of General Surgery and Transplants University of Bologna 40138 Bologna Italy

The recurrence of hepatocellular carcinoma,the sixth most common neoplasm and the third leading cause of cancer-related mortality worldwide,represents an important clinical problem,since it may occur after both surgical and medical *** recurrence rate involves 2 phases:an early phase and a late *** early phase usually occurs within 2 years after resection;it is mainly related to local invasion and intrahepatic metastases and,therefore,to the intrinsic biology of the *** the other hand,the late phase occurs more than 2 years after surgery and is mainly related to de novo tumor formation as a consequence of the carcinogenic cirrhotic *** recent studies have reported that early and late recurrences may have different risk factors,it is clinically important to recognize these factors in the individual patient as soon as *** aim of this review was,therefore,to identify predicting factors for the recurrence of hepatocellularcarcinoma,by means of invasive and non-invasive methods,according to the different therapeutic strategies *** particular the role of emerging techniques(e.g.,transient elastography)and biological features of hepatocellular carcinoma in predicting recurrence have been *** particular,invasive methods were differentiated from non-invasive ones for research purposes,taking into consideration the emerging role of the genetic signature of hepatocellular carcinoma in order to better allocate treatment strategies and surveillance follow-up in patients with this type of tumor.

关键词： Percutaneous ethanol injection Percutaneous radiofrequency ablation Transarterial chemoembolization Hepatic resection Orthotopic liver transplant Liver biopsy Liver stiffness measurement Hepatocellular carcinoma

Non-invasive tests for the prediction of primary hepatocellular carcinoma

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World Journal of Gastroenterology 2020年第24期26卷 3326-3343页

作者： Giovanni Marasco antonio colecchia Giovanni Silva Benedetta Rossini Leonardo Henry Eusebi Federico Ravaioli Elton Dajti Luigina Vanessa Alemanni Luigi colecchia Matteo Renzulli Rita Golfieri Davide Festi Department of Medical and Surgical Sciences(DIMEC) University of BolognaBologna 40138Italy Unit of Gastroenterology Borgo Trento University Hospital of VeronaVerona 37126Italy Radiology Unit Sant’Orsola Malpighi HospitalUniversity of BolognaBologna 40138Italy

Hepatocellular carcinoma(HCC)is one of the most common malignancies in the world and it is one of the main complications of cirrhosis and portal *** in the presence of a well-established follow-up protocol for cirrhotic patients,to date poor data are available on predictive markers for primary HCC occurrence in the setting of compensated advanced chronic liver disease patients(cACLD).The gold standard method to evaluate the prognosis of patients with cACLD,beyond liver fibrosis assessed with histology,is the measurement of the hepatic venous pressure gradient(HVPG).An HVPG≥10 mmHg has been related to an increased risk of HCC in cACLD ***,these methods are burdened by additional costs and risks for patients and are mostly available only in referral *** the last decade increasing research has focused on the evaluation of several,simple,non-invasive tests(NITs)as predictors of HCC *** reviewed the currently available literature on biochemical and ultrasound-based scores developed for the noninvasive evaluation of liver fibrosis and portal hypertension in predicting primary *** found that the most reliable methods to assess HCC risk were the liver stiffness measurement,the aspartate aminotransferase to platelet ratio index score and the fibrosis-4 *** promising NITs need further investigations and validation for different liver disease aetiologies.

关键词： Non-invasive test Fibrosis-4 index Hepatocellular carcinoma Liver stiffness measurement Spleen stiffness measurement Albi

Post-trans-arterial chemoembolization hepatic necrosis and biliary stenosis: Clinical charateristics and endoscopic approach

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World Journal of Clinical Cases 2023年第36期11卷 8434-8439页

作者： Silvia Cocca Lorenzo Carloni Margherita Marocchi Giuseppe Grande Marcello Bianchini antonio colecchia Rita Conigliaro Helga Bertani Gastroenterology and Endoscopy Unit Azienda Ospedaliero Universitaria Policlinico di ModenaModena 41121Italy Department of Medical and Surgical Sciences IRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 00100Italy Department of Internal Medicine Azienda Ospedaliero Universitaria Policlinico di ModenaModena 41121Italy

Liver cancer is the fifth most common tumor and the second highest death-related cancer in the ***(HCC)represents 90%of liver *** to the Barcelona Clinic Liver Cancer group,different treatment options could be offered to patients in consideration of tumor burden,liver function,pa-tient performance status and biochemical marker serum concentration such as ***-arterial chemoembolization(TACE)is the treatment of choice in patients with diagnosis of unresectable HCC not eligible for liver trans-plantation,and preserved arterial *** is known to be safe and its com-plications are generally mild such as post-TACE syndrome,a self-resolving adverse event that occurs in about 90%of patients after the ***,albeit rarely,more severe adverse events such as biloma,sepsis,hepatic failure,chemoagents induced toxicities,and post-TACE liver necrosis can occur.A prompt diagnosis of these clinical conditions is fundamental to prevent further *** a result,biliary stenosis could be a rare post-TACE necrosis complication and can be difficult to *** from untreated biliary strictures include recurring infections,jaundice,chronic cholestasis,and secon-dary biliary cirrhosis.

关键词： Hepatocarcinoma Trans-arterial Chemoembolization Biliary stenosis Multistenting

New insights on portal hypertension’s screening in people with cystic fibrosis

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Hepatobiliary Surgery and Nutrition 2024年第5期13卷 894-897页

作者： Luigi colecchia Federico Ravaioli Giovanni Marasco Elton Dajti antonio colecchia Department of Medical and Surgical Sciences(DIMEC) University of BolognaBolognaItaly Department of Visceral Surgery and Medicine InselspitalBern University HospitalBernSwitzerland Gastroenterology Unit Department of Medical Specialities(CHIMOMO)University of Modena and Reggio EmiliaModenaItaly

Cystic fibrosis-associated liver disease(CFLD)is a significant cause of morbidity and mortality affecting people with cystic fibrosis(PwCF)(1).Approximately 40%of PwCF have liver involvement,defined as the existence of any hepatic manifestation,including biochemical liver abnormalities(2).In a small percentage of these patients,liver involvement may ultimately result in the development of portal hypertension(PH)and its *** presence of at least two of the following variables-abnormal liver tests,abnormal liver ultrasound(US),abnormal physical examination with hepatosplenomegaly or histologic evidence of liver disease-were historically the basis for the European criteria to define CFLD(3).Nevertheless,the emergence of a new approach for liver assessment as liver elastography has led to the proposal of its inclusion in new diagnostic criteria(4).

关键词： Porto-sinusoidal vascular disease(PSVD) portal hypertension cystic fibrosis liver stiffness spleen stiffness

Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice

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World Journal of Hepatology 2021年第8期13卷 840-852页

作者： Alberto Ferrarese Nicola Passigato Caterina Cusumano Stefano Gemini Angelo Tonon Elton Dajti Giovanni Marasco Federico Ravaioli antonio colecchia Department of Gastroenterology Verona University HospitalVerona 37124Italy Department of Medical and Surgical Sciences University of BolognaBologna 40138Italy

Patients with cirrhosis show an increased susceptibility to infection due to disease-related *** infection therefore represents a common,often detrimental event in patients with advanced liver disease,since it can worsen portal hypertension and impair the function of hepatic and extrahepatic *** pharmacological strategies to prevent infection,antibiotic prophylaxis remains the first-choice,especially in high-risk groups,such as patients with acute variceal bleeding,low ascitic fluid proteins,and prior episodes of spontaneous bacterial ***,antibiotic prophylaxis has to deal with the changing bacterial epidemiology in cirrhosis,with increased rates of gram-positive bacteria and multidrug resistant rods,warnings about quinolonesrelated side effects,and low prescription ***-term antibiotic prophylaxis is applied in many other settings during hospitalization,such as before interventional or surgical procedures,but often without knowledge of local bacterial epidemiology and without strict adherence to antimicrobial *** paper offers a detailed overview on the application of antibiotic prophylaxis in cirrhosis,according to the current evidence.

关键词： Cirrhosis Quinolones Spontaneous bacterial peritonitis Liver transplantation Trans-jugular intrahepatic portosystemic shunt Variceal bleeding

Long-term leukocyte natural α-interferon and ribavirin treatment in hepatitis C virus recurrence after liver transplantation

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World Journal of Gastroenterology 2013年第32期19卷 5278-5285页

作者： Mariarosa Tamè Federica Buonfiglioli Massimo Del Gaudio Andrea Lisotti Paolo Cecinato antonio colecchia Francesco Azzaroli Antonietta D’Errico Rosario Arena Claudio Calvanese Chiara Quarneti Giorgio Ballardini antonio Daniele Pinna Giuseppe Mazzella Department of Digestive Diseases and Internal Medicine S. Orsola-Malpighi HospitalUniversity of Bologna Department of Liver and Multiorgan Transplant Unit S. Orsola-Malpighi HospitalUniversity of Bologna Department of Hematology Oncology and Laboratory MedicineS. Orsola-Malpighi HospitalUniversity of Bologna

AIM:To evaluate the effect of long-term treatment with leukocyte natural-interferon(ln-α-IFN)plus ribavirin(RBV).METHODS:Forty-six patients with hepatitis C virus(HCV)recurrence received 3 MU three times a week of ln-α-IFN plus RBV for 1 mo;then,patients with good tolerability(n=30)were switched to daily IFN administration,while the remaining were treated with the same *** have been treated for 12 mo after viral clearance while non-responders(NR)entered in the longterm treatment *** biopsies were planned at baseline,1 year after sustained virological response(SVR)and at 36 mo after start of therapy in *** software package was used for statistical ***:About 16.7%of genotype 1-4 and 70%of genotype 2-3 patients achieved *** patients withdrew therapy because of non-tolerance or noncompliance.A significant improvement in serum biochemistry and histological activity was observed in all SVR patients and long-term treated;100%of patients with SVR achieved a histological response(fibrosis stabilization or improvement)with a significant reduction in mean staging value(from 2.1 to 1.0;P=0.0031);histological response was observed in 84%of long-term treated patients compared to 57%of *** patients died during the entire study period(follow-up 40.6±7.7 mo);of them,5 presented with severe HCV recurrence on ***(OR=0.38,95%CI:0.08-0.59,P=0.01),leukopenia(OR=0.54,95%CI:0.03-0.57,P=0.03)and severe HCV recurrence(OR=0.51,95%CI:0.25-0.69,P=0.0003)were variables associated to ***-term treatment was well tolerated;no patients developed rejection or autoimmune ***:Long-term treatment improves histology in SVR patients and slows disease progression also in NR,leading to a reduction in liver decompensation,graft failure and liver-related death.

关键词： Hepatitis C virus Hepatitis C recurrence Interferon Ribavirin Liver transplantation

Predictive factors for hepatocellular carcinoma recurrence after curative treatments

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Hepatoma Research 2020年第6期6卷 58-76页

作者： Giovanni Marasco Federico Ravaioli Amanda Vestito Benedetta Rossini Elton Dajti Luigicolecchia Kamela Gjini Matteo Renzulli Rita Golfieri Davide Festi antonio colecchia Department of Medical and Surgical Sciences(DIMEC) University of BolognaBologna 40138Italy Radiology Unit Sant’Orsola Malpighi HospitalBologna 40138Italy Unit of Gastroenterology Borgo Trento University Hospital of VeronaVerona 37126Italy

Hepatocellular carcinoma(HCC)is the fifth most common neoplasm *** of HCC after resection or loco-regional therapies represents an important clinical issue as it affects up to 70%of *** can be divided into early or late,if it occurs within or after 24 months after treatment,*** the predictive factors for early recurrence are mainly related to tumour biology(local invasion and intrahepatic metastases),late recurrences are mainly related to de novo tumour ***,it is important to recognize these factors prior to any treatment in each patient,in order to optimize the treatment strategy and follow-up after *** aim of this review is to summarize the current evidence available regarding predictive factors for the recurrence of HCC,according to the different therapeutic strategies *** particular,we will discuss the role of new ultrasound-based techniques and biological features,such as tumor-related and circulating biomarkers,in predicting HCC *** advances in imaging-related parameters in computed-tomography scans and magnetic resonance imaging will also be discussed.

关键词： Liver resection trans-arterial chemoembolization radiofrequency ablation liver stiffness measurement indocyanine green retention test

Non-invasive tests for the prediction of post-hepatectomy liver failure in the elderly

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Hepatoma Research 2020年第6期6卷 41-57页

作者： Giovanni Marasco antonio colecchia Matteo Milandri Benedetta Rossini Luigina Vanessa Alemanni Elton Dajti Federico Ravaioli Matteo Renzulli Rita Golfieri Davide Festi Department of Medical and Surgical Sciences(DIMEC) University of BolognaBologna 40138Italy Unit of Gastroenterology Borgo Trento University Hospital of VeronaP.le Aristide Stefani 1Verona 37126Italy Radiology Unit Sant’Orsola Malpighi HospitalBologna 40138Italy

Post-hepatectomy liver failure(PHLF)is associated with great morbidity and mortality after resection of hepatocellular *** studies have underlined that advanced age could be a potential factor influencing post-operative complications and long-term *** the past,candidates for resection were based on the Child-Pugh classification,the predictive value of which was rather *** selection of patients undergoing resection in Western countries is based on the assessment of portal hypertension(PH),which is clinically assessed by measurement of the hepatic venous pressure gradient,an invasive and costly ***,there have been several attempts to identify the best non-invasive test(NIT)to accurately predict *** biochemical NITs for the prediction of PHLF are focused on evaluation of underlying liver cirrhosis and *** them,FIB-4,which also includes the patient's age,seems to have more robust supporting *** Europe and the USA.,the most tested and reliable NIT for predicting PHLF is the evaluation of liver stiffness measurement,which is also influenced by *** parameters are promising tools which are used only in specialized centers however,and when *** volume parameters,as well as contrast-enhanced data,demonstrate good accuracy in predicting *** this scenario,the evaluation of sarcopenia and bone mineral density through contextual imaging allows the delineation of PHLF in at-risk elderly *** studies focused on parameters for the evaluation of PHLF in elderly patients are needed.

关键词： Post-hepatectomy liver failure liver resection elderly liver stiffness measurement indocyanine green retention test