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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 *** date,the medical management of patients with moderatelyto-severely active IBD who develop dependence or resistance to corticosteroids is based on immunomodulator *** therapies are licenced after passing through three phases of randomized controlled trials(RCTs),and are subsequently adopted in clinical ***,the real-life population of IBD patients who require these therapies can significantly differ from those included in *** 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 *** 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

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World Journal of Gastroenterology 2021年第42期27卷 7299-7310页

作者： Sinan Sadalla Andrea Lisotti Lorenzo Fuccio Pietro Fusaroli unitàoperativa complessa di gastroenterologia e endoscopia Digestiva Universitàdi Bologna/Ospedale di ImolaImola(BO)40024Italy unitàoperativa complessa di gastroenterologia e endoscopia Digestiva Universitàdi Bologna/Ospedale di ImolaImola(BO)40026Italy Divisione di gastroenterologia Dipartimento di Scienze Medico-Chirurgiche(DIMEC)IRCSS-Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy

Colonoscopy is a risk factor for colon *** colon is susceptible to ischemia due to its minor blood flow compared to other abdominal organs;the etiology of colon ischemia after colonoscopy is *** causative mechanisms include splanchnic circulation impairment,bowel preparation,drugs used for sedation,bowel wall ischemia due to insufflation/barotrauma,and introduction of the *** must be aware of this condition and its risk factors for risk minimization,early diagnosis,and proper treatment.

关键词： endoscopy Colon ischemia Colonoscopy Bowel preparation Mesenteric circulation Ischemic colitis

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 *** symptoms of the disease range from paucisymptomatic disease to a much more severe *** symptoms of the initial phase include fever and cough,with possible progression to acute respiratory distress *** 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 *** intestinal homeostasis and microenvironment appear to play a major role in the pathogenesis of COVID-19 and in the enhancement of the systemic inflammatory ***-term consequences of COVID-19 include respiratory disturbances and other disabling manifestations,such as fatigue and psychological *** date,there is a paucity of data on the gastrointestinal sequelae of SARS-CoV-2 *** 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

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 Zocco 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

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 ***: 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 ***:The average defecatory frequency was once per day (range of 0.25-3.25) and was similar between males and ***, 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 ***: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： Defecation Health Behavior Adult Age Distribution Constipation Female Humans Male Middle Aged Prospective Studies Sex Distribution

Different doses of consensus interferon plus ribavirin in patients with hepatitis C virus genotype 1 relapsed after interferon monotherapy:A randomized controlled trial

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World Journal of Gastroenterology 2006年第42期12卷 6861-6864页

作者： Giuseppe Alaimo Vito Di Marco Donatella Ferraro Rosa Di Stefano Salvatore Porrovecchio Francesca D’Angelo Vincenza Calvaruso Antonio Craxì Piero Luigi Almasio Cattedra di gastroenterologia Dipartimento Biomedico di Medicina Interna e Specialistica University of Palermo Italy Cattedra di Virologia Di-partimento di Igiene e Microbiologia University of Palermo Italy

AIM： To assess the efficacy of different schedules of consensus interferon （CIFN） plus ribavirin in retreating chronic hepatitis C patients who relapsed after recombinant interferon （rIFN） monotherapy. MeTHODS： Forty-five patients （34 males and 11 females） with chronic hepatitis due to hepatitis C virus （HCV） genotype 1 who relapsed after a previous course of rIFN monotherapy were randomized to receive 9 μg CIFN three times per week for 52 wk （group A, n = 22） or 18 μg CIFN three times per week for 52 wk （group B, n = 23） in combination with ribavirin 800 to 1200 mg daily for 52 wk （according to body weight）. Virological response was evaluated at week 24 （eRR）, at the end of treatment （eTR） and at 76 wk （SVR）. ReSULTS： By intention-to-treat analysis, subjects in group A had an eVR in 35% of cases, an eTR in 35% and a SVR in 27.3% of cases. Subjects in group B had an eVR in 32% of cases, an eTR in 35% and a SVR in 26.1% of cases. Treatment was stopped because of adverse effects （mostly intolerance） in 15 patients （6 in group A and 9 in group B）. IFN dose reduction was needed in 2 patients （1 in group A and 1 in group B）. Ribavirin dose was reduced in 2 patients in group A and 1 in group B respectively. Among the 15 subjects who received at least 80% of the intended schedule, the rate of SVR was 80% （6 in group A and 6 in group B）. CONCLUSION： CIFN in combination with ribavirin when given to HCV genotype 1 relapsers after rIFN monotherapy obtains an unsatisfactory rate of sustained viral clearance independently of dosage of the drug. This may be due to its scarce tolerability.

关键词： Interferon Ribavirin Hepatitis C virus Hepatitis C Relapser

Chlamydia pneumoniae replicates in Kupffer cells in mouse model of liver infection

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World Journal of Gastroenterology 2006年第40期12卷 6453-6457页

作者： Antonella Marangoni Manuela Donati Francesca Cavrini Rita Aldini Silvia Accardo Vittorio Sambri Marco Montagnani Roberto Cevenini Sezione di Microbiologia DMCSS University of Bologna Bologna Italy Dipartimento SMeTC University of Bologna Bologna Italy Dipartimento di medicina interna e gastroenterologia University of Bologna Bologna Italy

AIM: To develop an animal model of liver infection with Chlamydia pneumoniae (C. pneumoniae) in intraperito-neally infected mice for studying the presence of chlamy-diae in Kupffer cells and ***: A total of 80 BALB/c mice were inoculated intraperitoneally with C. pneumoniae and sacrificed at various time points after infection. Chlamydiae were looked for in liver homogenates as well as in Kupffer cells and hepatocytes separated by liver perfusion with collagenase. C. pneumoniae was detected by both isola-tion in LLC-MK2 cells and fluorescence in situ hybridiza-tion (FISH). The releasing of TNFA-α by C. pneumoniae in vitro stimulated Kupffer cells was studied by enzyme-linked immunosorbent ***: C. pneumoniae isolation from liver homoge-nates reached a plateau on d 7 after infection when 6 of 10 animals were positive, then decreased, and became negative by d 20. C. pneumoniae isolation from sepa-rated Kupffer cells reached a plateau on d 7 when 5 of 10 animals were positive, and became negative by d 20. The detection of C. pneumoniae in separated Kupffer cells by FISH, confirmed the results obtained by culture. Isolated hepatocytes were always negative. Stimula-tion of Kupffer cells by alive C. pneumoniae elicited high TNF-α levels. CONCLUSION: A productive infection by C. pneumo-niae may take place in Kupffer cells and C. pneumoniae induces a local pro-inflammatory activity. C. pneumoniae is therefore, able to act as antigenic stimulus when local-ized in the liver. One could speculate that C. pneumoniaeinfection, involving cells of the innate immunity such as Kupffer cells, could also trigger pathological immune re-actions involving the liver, as observed in human patients with primary biliary cirrhosis.

关键词： Chlamydia pneumoniae Liver infection Kupffer cells Hepatocytes Culture-isolation Fluorescence in situ hybridization TNF-α Primary biliary cirrhosis

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 *** 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

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 *** incidence of HCC is growing *** respect to any other available treatment for liver cancer,liver transplantation (LT) has the highest potential to *** for removal at once of both the tumor ("seed")and the damaged-hepatic tissue ("soil") where cancerogenesis and chronic liver disorders have progressed *** 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 ***,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 ***,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 *** of HCC recurrence after LT is *** 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 ***,a metaanalysis of patient survival with sorafenib for HCC recurrence after LT could be helpful to characterize the therapeutic benefit and safety of ***,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