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Gut microbiota role in irritable bowel syndrome:Newtherapeutic strategies

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World Journal of Gastroenterology 2016年第7期22卷 2219-2241页

作者： eleonora Distrutti Lorenzo Monaldi Patrizia Ricci Stefano Fiorucci S.C.di gastroenterologia ed epatologia Azienda Ospedaliera di Perugia06100 PerugiaItaly Dipartimento di Scienze Chirurgiche e Biomediche Universitàdegli Studi di Perugia06100 PerugiaItaly

In the last decade the impressive expansion of our knowledge of the vast microbial community that resides in the human intestine, the gut microbiota, has provided support to the concept that a disturbed intestinal ecology might promote development and maintenance of symptoms in irritable bowel syndrome(IBS). As a correlate, manipulation of gut microbiota represents a new strategy for the treatment of this multifactorial disease. A number of attempts have been made to modulate the gut bacterial composition, following the idea that expansion of bacterial species considered as beneficial(Lactobacilli and Bifidobacteria) associated with the reduction of those considered harmful(Clostridium, escherichia coli, Salmonella, Shigella and Pseudomonas) should attenuate IBS symptoms. In this conceptual framework, probiotics appear an attractive option in terms of both efficacy and safety, while prebiotics, synbiotics and antibiotics still need confirmation. Fecal transplant is an old treatment translated from the cure of intestinal infective pathologies that has recently gained a new life as therapeutic option for those patients with a disturbed gut ecosystem, but data on IBS are scanty and randomized, placebo-controlled studies are required.

关键词： Irritable bowel syndrome Gut microbiota Probiotics Prebiotics Synbiotics Antibiotics Fecaltransplantation

Budd-Chiari syndrome management:Lights and shadows

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World Journal of Hepatology 2011年第10期3卷 262-264页

作者： Andrea Mancuso Epatologia e Gastroenterologia Ospedale Niguarda Ca'Granda

Budd-Chiari syndrome (BCS) is a rare disease whose management should follow a step by step strategy.Anticoagulation and medical therapy should be the first line treatment.Revascularization or TIPS are indicated in case of no response to medical therapy.OLT should be indicated as a rescue therapy and anticoagulation be started soon after OLT.However,no clear indica-tion can actually be given about the timing of different treatments.Moreover,there is some concern about treatment of some subgroup of patients,especially regarding the risk of recurrence after liver transplanta-tion.The topic of this paper is to critically review the actual knowledge of BCS management.

关键词： Budd-Chiari syndrome Management Liver transplantation

Hepatocellular Carcinoma and Liver Transplantation:State of the Art

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Journal of Clinical and Translational Hepatology 2014年第3期2卷 176-181页

作者： Andrea Mancuso Giovanni Perricone Epatologia e Gastroenterologia Ospedale Niguarda Ca'GrandaMilanoItaly Medicina Interna 1 Azienda di Rilievo Nazionale ad Alta Specializzazione Civico-Di Cristina-BenfratelliPalermoItaly

Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in chronic liver disease and cirrhosis.The incidence of HCC is growing worldwide.With respect to any other available treatment for liver cancer,liver transplantation (LT) has the highest potential to cure.LTallows for removal at once of both the tumor ("seed")and the damaged-hepatic tissue ("soil") where cancerogenesis and chronic liver disorders have progressed together.The Milan criteria (MC) have been applied worldwide to select patients with HCC for LT,yielding a 4-year survival rate of 75%.These criteria represent the benchmark for patient selection and are the basis for comparison with any other suggested criteria.However,MC are often considered to be too restrictive,and recent data show that between 25% and 50% of patients with HCC are currently transplanted beyond conventional indications.Consequently,any unrestricted expansion of selection criteria will increase the need for donor organs,lengthen waiting periods,increase drop-out rates,and impair outcomes on intention-to-treat analysis.Management of HCC recurrence after LT is challenging.There are a few reports available regarding the safety and efficacy of sorafenib for HCC recurrence after LT,but the data are heterogeneous.A multi-center prospective randomized controlled trial comparing placebo with sorafenib is advised.Alternatively,a metaanalysis of patient survival with sorafenib for HCC recurrence after LT could be helpful to characterize the therapeutic benefit and safety of sorafenib.Here,we review the use of LT for HCC,with particular emphasis on the selection criteria for transplantation in patients with HCC and management of HCC recurrence after LT.

关键词： Hepatocellular carcinoma Liver transplantation Selection criteria Milan criteria Recurrence Sorafenib

Management of hepatocellular carcinoma: enlightening the gray zones

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World Journal of Hepatology 2013年第6期5卷 302-310页

作者： Andrea Mancuso Epatologia e Gastroenterologia Ospedale Niguarda Cà Granda20162 Milano Italy Medicina Interna 1 Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedale Civico90127 Palermo Italy

Management of hepatocellular carcinoma (HCC) has been continuously evolving during recent years. HCC is a worldwide clinical and social issue and typically a complicates cirrhosis. The incidence of HCC is increasing, not only in the general population of patients with cirrhosis, but particularly in some subgroups of patients, like those with human immunodeficiency virus infection or thalassemia. Since a 3% annual HCC incidence has been estimated in cirrhosis, a biannual screening is generally suggested. The diagnostic criteria of HCC has recently had a dramatic evolution during recent years. HCC diagnosis is now made only on radiological criteria in the majority of the cases. In the context of cirrhosis, the universally accepted criteria for HCC diagnosis is contrast enhancement in arterial phase and washout in venous/late phase at imaging, the so called "typical pattern". However, recently up- dated guidelines slightly differ in diagnostic criteria. Apart from liver transplantation, the only cure of both HCC and underlying liver cirrhosis, all the other treatments have to match with higher rate of HCC recurrence. The latter can be classified into curative (resection and percutaneous ablation) and palliative treatments. The aim of this paper was to review the currentknowledge on management of HCC and to enlighten the areas of uncertainty.

关键词： Hepatocellular carcinoma Management Trans-arterial chemoembolization Orthotopic liver transplantation Surgery

Management of portopulmonary hypertension:New perspectives

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World Journal of Gastroenterology 2013年第45期19卷 8252-8257页

作者： Luigi Mancuso Francesca Scordato Michela Pieri eliana Valerio Andrea Mancuso Department of Cardiologia Ospedale Cervello90100 Palermo Italy Cardiologia Clinica Candela 90100 Palermo Italy Epatologia e Gastroenterologia Ospedale Niguarda Cà Granda Milano 20162 Milano Italy Medicina Interna 1 ARNAS Civico 90100 Palermo Italy

Portopulmonary hypertension(PPHTN)is a known complication of cirrhosis.Moderate-to-severe PPHTN implies an extremely poor prognosis.It occurs in 5%-10%of patients referred for liver transplantation(LT),and probably with an higher incidence in patients with large portosystemic shunts.Patients with moderate-tosevere pulmonary hypertension have been previously excluded from LT because of the extremely high surgical risk and since the post-transplant outcome reported was poor.Recently,new perspectives in the management of patients with portopulmonary hypertension are emerging.In fact,some pulmonary vasoactive drugs have become routine in the treatment of patients with idiopathic pulmonary hypertension.These drugs,particularly epoprostenol,have been recently introduced in the treatment of patients with PPHTN,and have been shown to be effective in reducing pulmonary artery pressure as well as pulmonary vascular resistances.Furthermore,recent studies seem to demonstrate that treatment with pulmonary vasoactive drugs could allow liver transplantation with acceptable surgical risks and excellent survival.Although there are not large series nor prospective studies addressing this topic,the clinical scenario of patients with PPHTN seems to be positively changing.

关键词： Portopulmonary hypertension Cirrhosis Liver transplantation Management epoprostenol

Non-surgical treatment of esophageal achalasia

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World Journal of Gastroenterology 2006年第36期12卷 5763-5766页

作者： Vito Annese Gabrio Bassotti Dipartimento di Medicina Generale e Specialistica Unità Operativa di Gastroenterologia ed Endoscopia Ospedale "Casa Sollievo della Sofferenza"-I.R.C.C.S. San Giovanni Rotondo Italy Dipartimento di Medicina Clinica e Speri-mentale Sezione di Gastroenterologia ed Epatologia Università di Perugia Italy

esophageal achalasia is an infrequent motility disorder characterized by a progressive stasis and dilation of the oesophagus; with subsequent risk of aspiration, weight loss, and malnutrition. Although the treatment of achalasia has been traditionally based on a surgical approach, especially with the introduction of laparoscopic techniques, there is still some space for a medical approach. The present article reviews the non-surgical therapeutic options for achalasia.

关键词：手术治疗食管疾病弛缓不能病理机制

Immunological alterations in hepatitis C virus infection

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World Journal of Gastroenterology 2013年第47期19卷 8916-8923页

作者： Vincenza Calvaruso Antonio Craxì gastroenterologia and epatologia DIBIMISUniversità di Palermo90127 PalermoItaly

A higher prevalence of immunological processes has recently been reported in patients with hepatitis C virus(HCV)infection,focusing the attention of physicians and researchers on the close association between HCV and immune disorders.HCV lymphotropism represents the most important step in the pathogenesis of virusrelated immunological diseases and experimental,virologic,and clinical evidence has demonstrated a trigger role for HCV both in systemic autoimmune diseases,such as rheumatoid arthritis,Sj?gren syndrome,hemolytic anemia and severe thrombocytopenia,and in organ-specific autoimmune diseases,such as autoimmune hepatitis,thyroid disorders and diabetes.This review will outline the principal aspects of such HCVinduced immunological alterations,focusing on the prevalence of these less characterized HCV extrahepatic manifestations.

关键词： Hepatitis C virus Immune disorders Cytopenia extrahepatic manifestation Autoantibody

An extended assessment of bowel habits in a general population

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World Journal of Gastroenterology 2004年第5期10卷 713-716页

作者： Gabrio Bassotti Massimo Bellini Filippo Pucciani Renato Bocchini Antonio Bove Pietro Alduini edda Battaglia Paolo Bruzzi Sezione di gastroenterologia ed epatologia Dipartimento di Medicina Clinica e SperimentaleUniversità di Perugia Sezione di gastroenterologia Dipartimento di Medicina InternaUniversità di Pisa Clinica Chirurgica Generale e Discipline Chirurgiche Università di Firenze UO di Medicina Polispecialistica Azienda Sanitaria LocaleCesena UO di gastroenterologia ed endoscopia Digestiva Azienda Ospedaliera"A.Cardarelli"Napoli Dipartimento di Fisiopatologia Clinica Università di Torino Struttura Complessa di epidemiologia Clinica IST GenovaItaly

AIM:Bowel habits are difficult to study, and most data on defecatory behaviour in the general population have been obtained on the basis of recalled interview. The objective assessment of this physiological function and its pathological aspects continues to pose a difficult challenge. The aim of this prospective study was to objectively assess the bowel habits and related aspects in a large sample drawn from thegeneral population.MeTHODS: Over a two-month period 488 subjects were prospectively recruited from the general population and asked to compile a daily diary on their bowel habits and associated signs and symptoms (the latter according to Rome Ⅱ criteria). A total of 298 (61%) participants returned a correctly compiled record, so that data for more than 8000 patient-days were available for statistical analysis.ReSULTS:The average defecatory frequency was once per day (range of 0.25-3.25) and was similar between males and females.However, higher frequencies of straining at stool (P=0.001), a feeling of incomplete emptying and/or difficult evacuation (P=0.0001), and manual manoeuvres to facilitate defecation (P=0.046) were reported by females as compared to males.CONCLUSION:This study represents one of the first attempts to objectively and prospectively assess bowel habits in a sample of the general population over a relatively long period of time. The variables we analyzed are coherent with the criteria commonly used for the clinical assessment of functional constipation, and can provide a useful adjunt for a better evaluation of constipated patients.

关键词：肠道习性肠道疾病卫生统计影响因子

Protective benefit of minimally invasive liver surgery for hepatocellular carcinoma prior to transplant

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Hepatoma Research 2022年第1期8卷 179-187页

作者： Simone Khouzam Duilio Pagano Marco Barbara Vito Di Marco Giada Pietrosi Marco Maringhini Marco Canzonieri Sergio Calamia Salvatore Gruttadauria Sidney Kimmel Medical College Thomas Jefferson UniversityPhiladelphiaPA 19107USA Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation IRCCS-ISMETT(Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per I Trapianti e Terapie ad Alta Specializzazione)UPMC(University of Pittsburgh Medical Center)via E.Tricomi 5Palermo 90127Italy Sezione di gastroenterologia e epatologia Dipartimento Biomedico di Medicina Interna e SpecialisticaUniversity of PalermoPalermo 90128Italy Medicina Interna Universitàdi Palermo/ISMETTVia del Vespro 129Palermo 90127Italy Department of Surgery and Medical and Surgical Specialties University of CataniaCatania 95124Italy

Aim:The purpose of this study is to assess the benefit of laparoscopic liver resection(LLR)for hepatocellular carcinoma(HCC)given recurrence and future need for liver transplantation(LT).Methods:Data on liver resections were gathered from the Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione(IRCCS-ISMeTT)from 2003-2021.A retrospective analysis of 1408 consecutive adult patients who had a liver resection was performed with categorization based on the underlying disease process.A sub-analysis studied the 291 patients who had an LLR with an intention to transplant approach after LLR.Results:From 2012 to 2020,ISMeTT’s mean annual LLR rate was 45%.Data suggests that a laparoscopic approach to iterative surgical treatment for HCC has demonstrated protective benefits.Compared to open surgery or LT,LLR is protective against the risk of de-listing,post-transplant patient death,tumor recurrence,adhesions,and bleeding in a cirrhotic patient.Kaplan Meier’s analysis showed no difference between post-LT survival curves for those with prior open abdominal surgery or LLR(P=0.658).Conclusion:Laparoscopic surgery has important protective advantages over laparotomy surgery for the surgical treatment of HCC,particularly since treatment is not always curative.LLR can be considered a bridge therapy for transplantation,ensuring less crowding of waiting lists,a desirable condition in areas of donor storage.

关键词： Laparoscopic liver resection hepatocellular carcinoma minimally invasive liver surgery