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A rare case of epiploic appendagitis in a patient affected by ulcerative colitis on vedolizumab therapy

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Gastroenterology Report 2022年第1期10卷 661-664页

作者： Daniela Pugliese Giuseppe Privitera Luigi Larosa Valentin Calvez diana Broglia Nicoletta de Matthaeis Alessandro Armuzzi CEMAD IBD UNITUnita Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario“A.Gemelli”IRCCSRomeItaly dipartimento Universitario di Medicina e Chirurgia Traslazionale Universita Cattolica del Sacro CuoreRomeItaly Fondazione Policlinico Universitario A.Gemelli IRCCS UOC di Radiodiagnostica Presidio ColumbusDipartimento di Diagnostica per immaginiRadioterapia Oncologica ed EmatologiaLargo Francesco VitoRomeItaly Universita Cattolica del Sacro Cuore RomeItaly IBD Center IRCCS Humanitas Research HospitalRozzanoMilanItaly Department of Biomedical Sciences Humanitas UniversityPieve EmanueleMilanItaly

Introduction Epiploic appendagitis(EA)is an acute inflammation of the pedunculated mesenteric fat attached to the colonic surface,distinguished into two forms:primary EA,seemingly elicited by local ischaemic factors;and secondary EA(SEA),elicited by the inflammation of the adjacent organs,with diverticulitis being the most common trigger[1].Few case series have described the association between SEA and inflammatory bowel disease(IBD);however,information about clinical,laboratory and imaging findings,outcomes,and the impact of IBD-specific therapy were not reported.We first report the case of a woman affected by ulcerative colitis(UC)who developed a SEA during vedolizumab therapy(Figure 1A).

关键词： inflammation organs acute

Serum chromogranin-A in hepatocellular carcinoma: diagnostic utility and limits

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World Journal of Gastroenterology 2005年第13期11卷 1987-1990页

作者： Aldo Spadaro Antonino Ajello Carmela Morace Agata Zirilli Graziella D'arrigo Carmelo Luigiano Francesco Martino Anna Bene Domenico Migliorato Santi Turiano Oscar Ferraù Maria Antonietta Freni dipartimento Clinico Sperimentale di Medicina e Farmacologia dipartimento di Statistica dipartimento di Scienze Radiologiche unità operativa di gastroenterologia

AIM: The utility of serum alpha-fetoprotein (α-FP) for the detection of hepatocellular carcinoma (HCC) is questionable.High serum levels of chromogranin-A (CgA) have recently been reported in HCC. Impaired hepatic, renal, and heart functions influence circulating CgA. The aim of this study was to assess sensitivity and specificity of serum CgA as a marker of HCC in patients with liver cirrhosis (LC).METHODS: Serum CgA levels were measured by RIA in 339 patients of which 54 HCC, 132 LC, 45 chronic hepatitis (CH), 27 chronic heart failure (CHF), 36 chronic renal failure (CRF), 45 chronic inflammatory bowel disease (IBD)as disease controls and in 75 healthy controls. Patients with liver disease or IBD and concomitant renal and/or heart failure were excluded. Pearson correlation, nonparametric combination test and confidence interval analysis were used for statistical analysis.RESULTS: Serum CgA above normal values (100 ng/mL)were found in 83% of HCC patients, in 48% of LC patients,in 20% of CH patients, in 33% of IBD patients, in 92% of CRF patients, in 100% of CHF patients, and in none of the healthy controls. The mean CgA values in HCC (769±1 046), in LC (249±369), in CH (87±94), in CRF (1 390±1 401), in CHF (577±539), in IBD (146±287) were significantly higher than those in healthy controls (48±18).HCC patients had higher CgA values (P＜0.01) than LC,CH, and IBD patients but did not differ from those with CRF or CHF. The 95% CI for the mean (250-1 289 ng/mL)in HCC patients was selected as a CgA range and the lower value of such range was assumed as cut-off.Sensitivity and specificity of CgA, calculated in relation to the cut-off in patients with cirrhosis and HCC, were respectively 61% (CI 48-73%) and 82% (CI 75-88%).Serum α-FP values were ＞200 ng/mL in 21% of the HCC patients and in none of the LC patients. No significant correlation was found between α-FP and CgA in patients with HCC and in patients with cirrhosis.CONCLUSION: When HCC is suspected and α-FP is normal or ＜200 ng/mL, CgA serum values represent a co

关键词：嗜铬粒蛋白-A 血清肝细胞癌诊断方法

Orphan patients with inflammatory bowel disease-when we treat beyond evidence

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World Journal of Gastroenterology 2021年第47期27卷 8047-8057页

作者： Giuseppe Privitera Daniela Pugliese Loris Riccardo Lopetuso Franco Scaldaferri Alfredo Papa GianLodovico Rapaccini Antonio Gasbarrini Alessandro Armuzzi dipartimento Universitario di Medicina e Chirurgia Traslazionale UniversitàCattolica del Sacro CuoreRome 00168Italy CEMAD–IBD unit-unitàoperativa Complessa di Medicina Interna e gastroenterologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario"A.Gemelli"IRCCSRome 00168Italy CEMAD–IBD unit-unitàoperativa Complessa di Medicina Interna e gastroenterologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario“A.Gemelli”IRCCSRome 00168Italy Department of Medicine and Ageing Sciences “G.d’Annunzio”University of Chieti-PescaraChieti 66100Italy Center for Advanced Studies and Technology(CAST) “G.d’Annunzio”University of Chieti-PescaraChieti 66100Italy

Inflammatory bowel disease(IBD)is a chronic condition that requires continuous medical treatment.To date,the medical management of patients with moderatelyto-severely active IBD who develop dependence or resistance to corticosteroids is based on immunomodulator drugs.Such therapies are licenced after passing through three phases of randomized controlled trials(RCTs),and are subsequently adopted in clinical practice.However,the real-life population of IBD patients who require these therapies can significantly differ from those included in RCTs.As a matter of fact,there is a number of exclusion criteria–nearly ubiquitous in all RCTs–that prevent the enrolment of specific patients:Chronic refractory pouchitis or isolated proctitis in ulcerative colitis,short-bowel syndrome and stomas in Crohn’s disease,ileorectal anastomosis in both ulcerative colitis and Crohn’s disease,and elderly age are some representative examples.In this frontier article,we aim to give an overview of current literature on this topic,in order to address the main knowledge gaps that need to be filled in the upcoming years.

关键词： Pouchitis Proctitis Stoma Short-bowel Ileo-rectal anastomosis Biologics

COVID-19 as a trigger of irritable bowel syndrome:A review of potential mechanisms

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World Journal of Gastroenterology 2021年第43期27卷 7433-7445页

作者： Carlo Romano Settanni Gianluca Ianiro Francesca Romana Ponziani Stefano Bibbò Jonathan Philip Segal Giovanni Cammarota Antonio Gasbarrini unitàoperativa Complessa Medicina Interna e gastroenterologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario"A.Gemelli"IRCCSRome 00168Italy Istituto di Patologia Speciale Medica UniversitàCattolica del Sacro CuoreRome 00168Italy Department of Gastroenterology and Hepatology Hillingdon HospitalUxbridge HA13UJUnited Kingdom

In December 2019 a novel coronavirus disease 2019(COVID-19),caused by the severe acute respiratory syndrome coronavirus-2(SARS-CoV-2),started spreading from Wuhan city of Chinese Hubei province and rapidly became a global pandemic.Clinical symptoms of the disease range from paucisymptomatic disease to a much more severe disease.Typical symptoms of the initial phase include fever and cough,with possible progression to acute respiratory distress syndrome.Gastrointestinal manifestations such as diarrhoea,vomiting and abdominal pain are reported in a considerable number of affected individuals and may be due to the SARS-CoV-2 tropism for the peptidase angiotensin receptor 2.The intestinal homeostasis and microenvironment appear to play a major role in the pathogenesis of COVID-19 and in the enhancement of the systemic inflammatory responses.Long-term consequences of COVID-19 include respiratory disturbances and other disabling manifestations,such as fatigue and psychological impairment.To date,there is a paucity of data on the gastrointestinal sequelae of SARS-CoV-2 infection.Since COVID-19 can directly or indirectly affect the gut physiology in different ways,it is plausible that functional bowel diseases may occur after the recovery because of potential pathophysiological alterations(dysbiosis,disruption of the intestinal barrier,mucosal microinflammation,post-infectious states,immune dysregulation and psychological stress).In this review we speculate that COVID-19 can trigger irritable bowel syndrome and we discuss the potential mechanisms.

关键词： SARS-CoV-2 COVID-19 Irritable bowel syndrome Microbiota Dysbiosis Gut-brain axis

Role of endoscopy in the conservative management of biliary complications after deceased donor liver transplantation

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World Journal of Hepatology 2015年第30期7卷 2927-2932页

作者： Andrea Lisotti Pietro Fusaroli Giancarlo Caletti unità operativa di gastroenterologia Ospedale Nuovo di Imola Department of Medical and Surgical Sciences University of Bologna Gastroen- terology unit Hospital of Imola

The clinical outcome of patients receiving liver trans-plantation could be significantly affected by biliary complications, including strictures, leaks, stones and bilomas; early diagnosis and treatment of these con-ditions lead to markedly reduction in morbidity and mortality. Therapeutic gold standard is represented by conservative approaches, both endoscopic and percutaneous, based on the type of biliary reconstruction, the local availability of the procedures and specific expertise. In patients with previous transplantation, the difficult biliary access and the possible presence of concomitant complications(mainly strictures) further restrict the efficacy of the endoscopic and percutaneous treatments; on the other hand, surgery should generally be avoided because of the even increased morbidity and mortality due to technical and clinical issues. Here we review the most common biliary complications occurring after liver transplantation and discuss available treatment options including future perspectives such as endoscopic ultrasound-guided biliary access in patients with Roux-en-Y choledocho-jejunostomy or extracorporeal shock wave lithotripsy for difficult stones.

关键词： Endoscopic ultrasonography Endoscopicultrasound Percutaneous trans-hepatic drainage Endoscopicretrograde cholangiopancreatography Biliarydrainage

Small bowel capsule endoscopy in 2007:Indications,risks and limitations

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World Journal of Gastroenterology 2007年第46期13卷 6140-6149页

作者： Emanuele Rondonotti Federica Villa Chris JJ Mulder Maarten AJM Jacobs Roberto de Franchis Università degli Studi di Milano IRCCS Fondazione PoliclinicoMangiagalliRegina Elena.UnitàOperativa di Gastroenterologia 3 via Pace 9Milano 20122Italy VU University Medical Centre Department of Gastroenterology and HepatologyBoelelaan 11171081 HV AmsterdamThe Nederlands Universitàdegli Studi di Milano IRCCS Fondazione PoliclinicoMangiagalliRegina Elena.UnitàOperativa di Gastroenterologia 3 via Pace 9Milano 20122Italy

囊内视镜检查法有 revoluzionized 由提供一个可靠方法评估的小肠的学习，内视镜的联盟者，全部小肠。在最后六年里，几份报纸被出版了处于不同临床的条件探索这考试的可能的角色。在现在的时间囊，内视镜检查法通常被推荐为第三考试，... 详细信息

囊内视镜检查法有 revoluzionized 由提供一个可靠方法评估的小肠的学习，内视镜的联盟者，全部小肠。在最后六年里，几份报纸被出版了处于不同临床的条件探索这考试的可能的角色。在现在的时间囊，内视镜检查法通常被推荐为第三考试，在否定双向内视镜检查法以后，在有阴暗胃肠的流血的病人。证据的成长身体也处于象 Crohn 的疾病，乳糜泻，小肠息肉病症候群或小肠肿瘤那样的另外的临床的条件为这考试建议一个重要角色。这考试的主要复杂并发症是在以前未知的小肠苛评的地点的设备的保留。然而，也由于这个工具的技术限制主要有一些另外的开的问题(它没从遥控被驾驶，是不能的拿活体检视到 insufflate 空气，正确地缩放并且定位损害到 suck 液体或碎片并且到有时) 。最近发达的双汽球肠脓毒病，尽管侵略、耗时，由于它的能力指向了活体检视探索小肠的大部分并且拿，能克服囊内视镜检查法的一些限制。在现在预定，在临床的条件的多数(即阴暗官方补给的流血)，赢的策略似乎是联合这二种技术探索小肠在一无痛苦，安全、完全的方法(与囊内视镜检查法)并且识别了定义并且对待损害(与两倍汽球肠寄生物)。

关键词：内窥镜检查小肠肠膜诊断临床医学

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

diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy

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World Journal of Gastroenterology 2014年第37期20卷 13382-13401页

作者： Renato Costi Alessandro Gnocchi Francesco di Mario Leopoldo Sarli dipartimento di Scienze Chirurgiche Università di ParmaAzienda Ospedaliero-Universitaria di Parma dipartimento Materno Infantile Unità Operativa di Gastroenterologia ed Endoscopia DigestivaAzienda Ospedaliero-Universitaria di Parma dipartimento di Medicina Clinica e Sperimentale Università di ParmaAzienda Ospedaliero-Universitaria di Parma

Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones(CBDS), which are asymptomatic in up to one half of cases. Despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound(EUS) and magnetic resonance cholangiography(MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and costeffectiveness of imaging techniques used to identifyCBDS increase together in a parallel way, the concept of "risk of carrying CBDS" has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of "under-studying" by poor diagnostic work up or "over-studying" by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. "Low risk" patients do not require further examination before laparoscopic cholecystectomy. Two main "philosophical approaches" face each other for patients with an "intermediate to high risk" of carrying CBDS: on one hand, the "laparoscopy-first" approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the "endoscopy-first" attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative cholangiography, EUS and MRC are reported to have similar results. Regarding management, the recent literature seems to show better short and long term outcome of surgery in terms of re

关键词： Biliary lithiasis Choledocholithiasis Laparoscopy