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Shear-wave elastography to predict hepatocellular carcinoma after hepatitis C virus eradication:A systematic review and meta-analysis

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World Journal of Gastroenterology 2024年第10期30卷 1450-1460页

作者： Giorgio Esposto Paolo Santini Linda Galasso Irene Mignini maria Elena Ainora Antonio Gasbarrini maria assunta zoc.o CEMAD Digestive Disease Center Fondazione Policlinico Universitario“A.Gemelli”IRCCSCatholic University of RomeRome 00168Italy Fondazione Policlinico Universitario Agostino Gemelli IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS-UniversitàCattolica del Sacro CuoreRome 00168Italy Medicina Interna e Gastroenterologia CEMAD Digestive Disease CenterUniversitàCattolica del Sacro CuoreFondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

BACKGRoUND Direct-acting antiviral agents(DAAs)are highly effective treatment for chronic hepatitis C(CHC)with a significant rate of sustained virologic response(SVR).The achievement of SVR is crucial to prevent additional liver damage and slow down fibrosis *** assessment of fibrosis degree can be performed with transient elastography,magnetic resonance elastography or shear-wave elastography(SWE).Liver elastography could function as a predictor for hepato-cellular carcinoma(HCC)in CHC patients treated with *** To explore the predictive value of SWE for HCC development after complete clearance of hepatitis C virus(HCV).METHoDS A comprehensive literature search of clinical studies was performed to identify the ability of SWE to predict HCC occurrence after HCV *** accordance with the study protocol,a qualitative and quantitative analysis of the evidence was *** At baseline and after 12 wk of follow-up,a trend was shown towards greater liver stiffness(LS)in those who go on to develop HCC compared to those who do not[baseline LS standardized mean difference(SMD):1.15,95%confidence interval(95%CI):020-2.50;LS SMD after 12 wk:0.83,95%CI:0.33-1.98].The absence of a statistically significant difference between the mean LS in those who developed HCC or not may be related to the inability to correct for confounding factors and the absence of raw source *** was a statist-ically significant LS SMD at 24 wk of follow-up between patients who developed HCC vs not(0.64;95%CI:0.04-1.24).CoNCLUSIoN SWE could be a promising tool for prediction of HCC occurrence in patients treated with *** studies with larger cohorts and standardized timing of elastographic evaluation are needed to confirm these data.

关键词： Shear-wave elastography Hepatocellular carcinoma Hepatitis C virus Sustained virologic response

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Quantitative assessment of self-management in patients with nonalcoholic fatty liver disease: An unmet clinical need

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World Journal of Gastroenterology 2024年第25期30卷 3143-3146页

作者： Raffaele Borriello Giorgio Esposto Irene Mignini Antonio Gasbarrini maria assunta zoc.o CEMAD Digestive Disease Center Fondazione Policlinico Universitario A.Gemelli IRCCSCatholic University of RomeRome 00168Italy

In this editorial we comment on the article titled“Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease”by Zeng et al published in a recent issue of the World Journal of ***-alcoholic fatty liver disease(NAFLD)represents one of the current challenges in hepatology and public health,due to its continuous growing prevalence and the rising incidence of NAFLD-related fibrosis,non-alcoholic steatohepatitis and *** only effective therapeutic strategy for this dis-ease is represented by encouraging patients to improve their lifestyle through the modification of dietary intake and increased physical exercise,but the effective application of such modifications is often limited by various factors such as lack of information,psychological barriers or poor social *** poor adherence to a healthy lifestyle can be decisive in determining the clinical outcome,in daily practice there is a lack of quantitative instruments aimed at identifying patients with the lowest adherence to lifestyle changes and higher risk of disease progre-ssion in the course of *** this article,Zeng et al propose a quantitative scale to assess the grade of adherence of patients with NAFLD to hea-lthy lifestyle intervention,called the Exercise and Diet Adherence Scale(EDAS).This scale,consisting of 33 items divided into 6 dimensions which relates to six subjective aspects in the self-management of NAFLD,has shown a good correlation with the identification of the sub-cohort of patients with the highest reduction in caloric intake,increase in physical exercise,probability of a reduction in liver stiffness measurement and alanine aminotransferase *** cor-relation among clinical outcomes and specific dimensions of this scale also highlights the pivotal role of a good and confidential doctor-patient relationship and of an effective *** is an urgent need for practical and e

关键词： Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Liver cirrhosis Metabolic associated fatty liver disease Metabolic associated steatohepatitis Insulin resistance Self-management Self-management measurement Patient education

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Dynamic contrast enhanced ultrasound in differential diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis

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World Journal of Gastrointestinal oncology 2024年第6期16卷 2804-2815页

作者： Giorgio Esposto Paolo Santini Fabrizio Termite Linda Galasso Irene Mignini maria Elena Ainora Antonio Gasbarrini maria assunta zoc.o Department of CEMAD Digestive Disease Center Fondazione Policlinico Universitario A Gemelli IRCCSCatholic University of RomeRome 00168Italy Department of Fondazione Policlinico Universitario Agostino Gemelli IRCCS UniversitàCattolica del Sacro CuoreRome 00168Italy Department of Medicina Interna e Gastroenterologia CEMAD Digestive Disease CenterFondazione Policlinico Universitario A Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy

BACKGRoUND Non-invasive differential diagnosis between hepatocellular carcinoma(HCC)and other liver cancer(*** or metastasis)is highly challenging and definitive diagnosis still relies on histological *** patterns of enhancement and wash-out of liver nodules can be used to stratify the risk of malignancy only in cirrhotic patients and HCC frequently shows atypical *** contrast-enhanced ultrasound(DCEUS)with standardized software could help to overcome these obstacles,providing functional and quantitative parameters and potentially improving accuracy in the evaluation of tumor *** To explore clinical evidence regarding the application of DCEUS in the differential diagnosis of liver *** A comprehensive literature search of clinical studies was performed to identify the parameters of DCEUS that could relate to histological *** accordance with the study protocol,a qualitative and quantitative analysis of the evidence was *** Rise time was significantly higher in HCC patients with a standardized mean difference(SMD)of 0.83(95%CI:0.48-1.18).Similarly,other statistically significant parameters were mean transit time local with a SMD of 0.73(95%CI:0.20-1.27),peak enhancement with a SMD of 0.37(95%CI:0.03-0.70),area wash-in area under the curve with a SMD of 0.47(95%CI:0.13-0.81),wash-out area under the curve with a SMD of 0.55(95%CI:0.21-0.89)and wash-in and wash-out area under the curve with SMD of 0.51(95%CI:0.17-0.85).SMD resulted not significant in fall time and wash-in rate,but the latter presented a trend towards greater values in HCC compared to intrahepatic *** DCEUS could improve non-invasive diagnosis of HCC,leading to less liver biopsy and early *** quantitative analysis needs to be applied on larger cohorts to confirm these preliminary results.

关键词： Dynamic contrast enhanced ultrasound Hepatocellular carcinoma Intracellular cholangiocarcinoma Quantitative ultrasound Liver cancer Time-intensity curve

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Dynamic contrast enhanced ultrasound in gastrointestinal diseases:A current trend or an indispensable tool?

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World Journal of Gastroenterology 2023年第25期29卷 4021-4035页

作者： Mattia Paratore Matteo Garcovich maria Elena Ainora Laura Riccardi Antonio Gasbarrini maria assunta zoc.o Medicina Interna e Gastroenterologia CEMAD Digestive Disease CenterFondazione Policlinico Universitario A.Gemelli IRCCSRome 00168Italy Medicina Interna e Gastroenterologia CEMAD Digestive Disease CenterUniversità Cattolica del Sacro CuoreFondazione Policlinico Universitario A.Gemelli IRCCSRome 00168Italy

Contrast enhanced ultrasound(CEUS)has been widely implemented in clinical practice because of the enormous quantity of information it provides,along with its low cost,reproducibility,minimal invasiveness,and safety of the secondgeneration ultrasound contrast *** overcome the limitation of CEUS given by the subjective evaluation of the contrast enhancement behaviour,quantitative analysis of contrast kinetics with generation of time-intensity curves has been introduced in recent *** quantification of perfusion parameters[named as dynamic-CEUS(D-CEUS)]has several applications in gastrointestinal neoplastic and inflammatory ***,the limited availability of large studies and the heterogeneity of the technologies employed have precluded the standardisation of D-CEUS,which potentially represents a valuable tool for clinical practice in management of gastrointestinal *** this article,we reviewed the evidence exploring the application of D-CEUS in gastrointestinal diseases,with a special focus on liver,pancreas,and inflammatory bowel diseases.

关键词： Quantitative perfusion analysis Gastrointestinal diseases Time-intensity curve Multiparametric ultrasound

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Carbon monoxide contributes to the constipating effects of granisetron in rat colon

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World Journal of Gastroenterology 2016年第42期22卷 9333-9345页

作者： Carmela Nacci Margherita Fanelli maria assunta Potenza Valentina Leo Monica Montagnani maria Antonietta De Salvia Department of Biomedical Sciences and Human oncology - Pharmacology Section Medical School University of Bari "Aldo Moro" Department of Interdisciplinary Medicine Medical School University of Bari "Aldo Moro"

AIM To investigate the mechanisms underlying the potential contribution of the heme oxygenase/carbon monoxide(Ho/Co) pathway in the constipating effects of granisetron. METHoDS For in vivo studies, gastrointestinal motility was evaluated in male rats acutely treated with granisetron [25, 50, 75 μg/kg/subcutaneous(sc)], zinc protoporphyrin IX [Zn PPIX, 50 μg/kg/intraperitoneal(ip)] and hemin(50 μmol/L/kg/ip), alone or in combination. For in vitro studies, the contractile neurogenic response to electrical field stimulation(EFS, 3, 5, 10 Hz, 14 V, 1 ms, pulse trains lasting 10 s), as well as the contractile myogenic response to acetylcholine(ACh, 0.1-100 μmol/L) were evaluated on colon specimens incubated with granisetron(3 μmol/L, 15 min), Zn PPIX(10 μmol/L, 60 min) or Co-releasing molecule-3(CoRM-3, 100, 200, 400 μmol/L) alone or in combination. These experiments were performed under co-treatment withor without atropine(3 μmol/L, a muscarinic receptor antagonist) or NG-nitro-L-Arginine(L-NNA, 100 μmol/L, a nitric oxide synthase inhibitor).RESULTS Administration of granisetron(50, 75 μg/kg) in vivo significantly increased the time to first defecation(P = 0.045 vs vehicle-treated rats), clearly suggesting a constipating effect of this drug. Although administration of Zn PPIX or hemin alone had no effect on this gastrointestinal motility parameter, Zn PPIX co-administered with granisetron abolished the granisetron-induced constipation. on the other hand, co-administration of hemin and granisetron did not modify the increased constipation observed under granisetron alone. When administered in vitro, granisetron alone(3 μmol/L) did not significantly modify the colon's contractile response to either EFS or ACh. Incubation with Zn PPIX alone(10 μmol/L) significantly reduced the colon's contractile response to EFS(P = 0.016) but had no effect on contractile response to ACh. Co-administration of Zn PPIX and atropine(3 μmol/L) abolished the Zn PPIX-mediated decrease in contrac

关键词： Granisetron Carbon monoxide Heme oxygenase Colon Contraction Neurogenic response Myogenic response

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Eubiotic properties of rifaximin: Disruption of the traditional concepts in gut microbiota modulation

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World Journal of Gastroenterology 2017年第25期23卷 4491-4499页

作者： Francesca Romana Ponziani maria assunta zoc.o Francesca D’Aversa Maurizio Pompili Antonio Gasbarrini Internal Medicine Gastroenterology and Hepatology Division Agostino Gemelli Hospital

Antibiotics are usually prescribed to cure infections but they also have significant modulatory effects on the gut microbiota. Several alterations of the intestinal bacterial community have been reported during antibiotic treatment, including the reduction of beneficial bacteria as well as of microbial alpha-diversity. Although after the discontinuation of antibiotic therapies it has been observed a trend towards the restoration of the original condition, the new steady state is different from the previous one, as if antibiotics induced some kind of irreversible perturbation of the gut microbial community. The poorly absorbed antibiotic rifaximin seem to be different from the other antibiotics, because it exerts non-traditional effects additional to the bactericidal/bacteriostatic activity on the gut microbiota. Rifaximin is able to reduce bacterial virulence and translocation, has anti-inflammatory properties and has been demonstrated to positively modulate the gut microbial composition. Animal models, culture studies and metagenomic analyses have demonstrated an increase in Bifidobacterium, Faecalibacterium prausnitzii and Lactobacillus abundance after rifaximin treatment, probably consequent to the induction of bacterial resistance, with no major change in the overall gut microbiota composition. Antibiotics are therefore modulators of the symbiotic relationship between the host and the gut microbiota. Specific antibiotics, such as rifaximin, can also induce eubiotic changes in the intestinal ecosystem; this additional property may represent a therapeutic advantage in specific clinical settings.

关键词： Intestinal bacteria Antibiotic Rifaximin Gut microbiota Eubiosis Dysbiosis Gut microbiota modulation

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Portal vein thrombosis in cirrhosis: Why a well-known complication is still matter of debate

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World Journal of Gastroenterology 2019年第31期25卷 4437-4451页

作者： Mariella Faccia maria Elena Ainora Francesca Romana Ponziani Laura Riccardi Matteo Garcovich Antonio Gasbarrini Maurizio Pompili maria assunta zoc.o Department of Internal Medicine and Gastroenterology Fondazione Policlinico Universitario A.Gemelli IRCCSCatholic University

Portal vein thrombosis(PVT)represents a well-known complication during the natural course of liver cirrhosis(LC),ranging from asymptomatic cases to lifethreating conditions related to portal hypertension and hepatic *** flow stasis,complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT ***,PVT occurrence remains unpredictable and many issues regarding its natural history,prognostic significance and treatment are still *** particular although spontaneous resolution or disease stability occur in most cases of PVT,factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as ***,PVT impact on LC outcome is still debated,as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction *** and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases,even if the safer therapeutic option and the optimal therapy duration are still ***,their impact on mortality rates should be addressed more *** this review we present the most debated questions regarding PVT,whose answers should come from prospective cohort studies and large sample-size randomized trials.

关键词： Portal vein thrombosis Liver cirrhosis Hypercoagulability Anticoagulation Direct oral anticoagulants

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Subclinical atherosclerosis is linked to small intestinal bacterial overgrowth via vitamin K2-dependent mechanisms

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World Journal of Gastroenterology 2017年第7期23卷 1241-1249页

作者： Francesca Romana Ponziani Maurizio Pompili Enrico Di Stasio maria assunta zoc.o Antonio Gasbarrini Roberto Flore Internal Medicine Gastroenterology and HepatologyAgostino Gemelli Hospital Biochemistry Agostino Gemelli Hospital Internal Medicine and Vascular Medicine Agostino Gemelli Hospital

To assess the rate of matrix Gla-protein carboxylation in patients with small intestinal bacterial overgrowth (SIBo) and to decipher its association with subclinical *** with suspected SIBo who presented with a low risk for cardiovascular disease and showed no evidence of atherosclerotic plaques were included in the study. A glucose breath test was performed in order to confirm the diagnosis of SIBo and vascular assessment was carried out by ultrasound examination. Plasma levels of the inactive form of MGP (dephosphorylated-uncarboxylated matrix Gla-protein) were quantified by ELISA and vitamin K2 intake was estimated using a food frequency ***-nine patients were included in the study. SIBo was confirmed in 12/39 (30.8%) patients who also presented with a higher concentration of dephosphorylated-uncarboxylated matrix Gla-protein (9.5 μg/L vs 4.2 μg/L; P = 0.004). Arterial stiffness was elevated in the SIBo group (pulse-wave velocity 10.25 m/s vs 7.68 m/s; P = 0.002) and this phenomenon was observed to correlate linearly with the levels of dephosphorylated-uncarboxylated matrix Gla-protein (β = 0.220, R2 = 0.366, P = 0.03). Carotid intima-media thickness and arterial calcifications were not observed to be significantly elevated as compared to *** is associated with reduced matrix Gla-protein activation as well as arterial stiffening. Both these observations are regarded as important indicators of subclinical atherosclerosis. Hence, screening for SIBo, intestinal decontamination and supplementation with vitamin K2 has the potential to be incorporated into clinical practice as additional preventive measures.

关键词： Small intestinal bacterial overgrowth Vitamin K Dysbiosis Atherosclerosis Cardiovascular disease risk

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Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding:A case report and review of literature

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World Journal of Gastroenterology 2020年第22期26卷 3110-3117页

作者： Francesco Panzera Riccardo Inchingolo Marina Rizzi assunta Biscaglia maria Grazia Schievenin Emilia Tallarico Giancarlo Pacifico Beatrice Di Venere Division of Gastroenterology Department of SurgeryMadonna delle Grazie HospitalMatera 75100Italy Division of Interventional Radiology Department of RadiologyMadonna delle Grazie HospitalMatera 75100Italy Department of Intensive Care Madonna delle Grazie HospitalMatera 75100Italy Department of Pathology Madonna delle Grazie HospitalMatera 75100Italy Division of General Surgery Department of SurgeryMadonna delle Grazie HospitalMatera 75100Italy

BACKGRoUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s *** is often symptomatic and secondary to pancreatitis or *** SAA is the most common aneurysm of visceral *** contrast to pseudoaneurysm,SAA is usually asymptomatic until the rupture,with high mortality *** clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability,usually into the free peritoneal space and more rarely into the gastrointestinal *** SUMMARY We describe the case of a 35-year-old male patient,with negative past medical history,who presented to the emergency department for massive upper gastrointestinal bleeding,severe anemia and *** esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface,with a visible vessel,but no active *** injection therapy with cyanoacrylate glue was *** contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect:The radiological examination showed a giant SAA which was adherent to posterior stomach wall,and some smaller aneurysms of the left gastric and ileocolic *** of the high risk of a two-stage rupture of the giant SAA with dramatic outcome,the patient underwent immediate open surgery with aneurysmectomy,splenectomy and distal pancreatectomy with a good postoperative *** The management of a ruptured giant SAA into the stomach can be successful with surgical approach.

关键词： Splenic artery aneurysm Upper gastrointestinal bleeding Hemorrhagic shock Computed tomography Endoscopy Case report

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Elastography as a predictor of liver cirrhosis complications after hepatitis C virus eradication in the era of direct-acting antivirals

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World Journal of Hepatology 2021年第11期13卷 1663-1676页

作者： Lucia Cerrito maria Elena Ainora Alberto Nicoletti Matteo Garcovich Laura Riccardi Maurizio Pompili Antonio Gasbarrini maria assunta zoc.o CEMAD Digestive Disease Center Fondazione Policlinico Universitario"A.Gemelli"IRCCSCatholic University of Rome(Italy)Rome 00168Italy

Chronic inflammation due to hepatitis C virus(HCV)infection leads to liver fibrosis and rearrangement of liver tissue,which is responsible for the development of portal hypertension(PH)and hepatocellular carcinoma(HCC).The advent of direct-acting antiviral drugs has revolutionized the natural history of HCV infection,providing an overall eradication rate of over 90%.Despite a significant decrease after sustained virological response(SVR),the rate of HCC and liver-related complications is not completely eliminated in patients with advanced liver *** the reasons are still unclear,cirrhosis itself has a residual risk for the development of HCC and other PH-related *** elastography is a recently developed non-invasive technique for the assessment of liver *** the achievement of SVR,liver stiffness(LS)usually decreases,as a consequence of reduced inflammation and,possibly,*** studies emphasized the application of LS assessment in the management of patients with SVR in order to define the risk for developing the complications of chronic liver disease(functional decompensation,gastrointestinal bleeding,HCC)and to optimize long-term prognostic outcomes in clinical practice.

关键词： Direct-acting antiviral agents Liver stiffness Portal hypertension Hepatocellular carcinoma

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