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Albumin-bilirubin score in non-malignant liver diseases should be properly validated

World Journal of Gastroenterology 2023年第46期29卷 6089-6091页

作者： Andrea Pasta Francesco Calabrese Maria Corina Plaz Torres giorgia bodini Manuele Furnari EdoardoVincenzo Savarino Vincenzo Savarino Edoardo Giovanni Giannini Elisa Marabotto Gastroenterology Unit Department of Internal MedicineUniversity of GenoaIRCCS‐Ospedale Policlinico San MartinoGenoa 16132Italy Department of Surgery Oncology and GastroenterologyUniversity Hospital of PaduaPadua 35128Italy

The albumin-bilirubin(ALBI)score to assess the risk of decompensation in patients with initially compensated cirrhosis may improve their prognostic *** letter critically evaluates the research,which utilizes the ALBI score to forecast decompensation in cirrhosis patients over a three-year *** score was initially developed to assess liver function in hepatocellular carcinoma,its prognostic utility for non-malignant liver diseases has now been explored,recognizing decompensation as a pivotal event that significantly affects patient’s *** concerns regarding the methodology of this research may be raised,particularly the exclusive use of radiological diagnosis,potentially including patients without definite cirrhosis and thus skewing the decompensation risk *** reported predominance of variceal bleeding as a decompensating event conflicts with established literature,that often reports ascites as the initial decompensation *** letter highlights the absence of details on esophageal varices and their management,which could introduce bias in evaluating the ALBI score's predictive ***,the letter points out the small sample size of patients with high-risk ALBI grades,potentially compromising the score's validity in this *** suggest prospective future research to investigate the dynamic changes in the ALBI score over time to reinforce the validity of the ALBI score as a predictor of decompensation in non-malignant liver disease.

关键词： Albumin-bilirubin score Decompensated cirrhosis Liver disease Nonmalignant liver disease Portal hypertension

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Esophageal motility abnormalities in gastroesophageal reflux disease

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2014年第2期5卷 86-96页

作者： Irene Martinucci Nicola de Bortoli Maria Giacchino giorgia bodini Elisa Marabotto Santino Marchi Vincenzo Savarino Edoardo Savarino Division of Gastroenterology University of Pisa56124 PisaItaly Division of Gastroenterology Department of Internal MedicineUniversity of Genoa16132GenoaItaly Division of Gastroenterology Department of SurgeryOncology and GastroenterologyUniversity of Padua35128 PaduaItaly

Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophagealmotility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from nonerosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

关键词： Gastroesophageal reflux disease High-resolution manometry Ineffective esophageal motility Esophagogastric junction Transient lower esophageal sphincter relaxations

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Esophageal testing: What we have so far

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World Journal of Gastrointestinal Pathophysiology 2016年第1期7卷 72-85页

作者： Nicola de Bortoli Irene Martinucci Lorenzo Bertani Salvatore Russo Riccardo Franchi Manuele Furnari Salvatore Tolone giorgia bodini Valeria Bolognesi Massimo Bellini Vincenzo Savarino Santino Marchi Edoardo Vincenzo Savarino Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa Gastroenterology Unit Department of Internal MedicineUniversity of Genoa Surgery Unit Department of SurgerySecond University of Naples Gastroenterology Unit Department SurgeryOncology and GastroenterologyUniversity of Padua

Gastroesophageal reflux disease(GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry(HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h p H-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and p H monitoring can detect acid and non-acid reflux events. Endo FLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal p H-metry. Future studies are required of these techniques to evaluate their diagnostic accuracy and usefulness, although the available data are promising.

关键词： Gastroesophageal reflux disease Highresolution manometry Multichannel impedance and pH BRAVO EndoFLIP PEP-test Restech

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