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Dig Liver Dis [journal]
- Ileal ulcers not responding to infliximab therapy: Think about intestinal ganglioneuromatosis. [LETTER]
- Dig Liver Dis 2014 Nov 6.
- Impact of social media on Gastroenterologists in the United States. [LETTER]
- Dig Liver Dis 2014 Nov 20.
- Probe-based confocal laser endomicroscopy in the pancreatic duct provides direct visualization of ductal structures and aids in clinical management. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Nov 13.
Confocal endomicroscopy provides real-time evaluation of various sites and has been used to provide detailed endomicroscopic imaging of the biliary tree. We aimed to evaluate the feasibility and utility of probe-based confocal laser endomicroscopy of the pancreatic duct as compared to cytologic and histologic results in patients with indeterminate pancreatic duct strictures.Retrospective data on patients with indeterminate pancreatic strictures undergoing endoscopic retrograde cholangiopancreatography (ERCP) and confocal endomicroscopy were collected from two tertiary care centres. Real-time confocal endomicroscopy images were obtained during ERCP and immediate interpretation according to the Miami Classification was performed.18 patients underwent confocal endomicroscopy for evaluation of pancreatic strictures from July 2011 to December 2012. Mean pancreatic duct size was 4.2mm (range 2.2-8mm). Eight cases were interpreted as benign, 4 as malignant, 4 suggestive of intraductal papillary mucinous neoplasms, and 2 appeared normal. Cytology/histopathology for 15/16 cases showed similar results to confocal endomicroscopy interpretation. Kappa coefficient of agreement between cyto/histopathology and confocal endomicroscopy was 0.8 (p=0.0001). Pancreatic confocal endomicroscopy changed management in four patients, changing the type of surgery from total pancreatectomy to whipple.Confocal endomicroscopy is effective in assisting with diagnosis of indeterminate pancreatic duct strictures as well as mapping of abnormal pancreatic ducts prior to surgery.
- Liver transplantation using grafts with rare metabolic disorders. [REVIEW]
- Dig Liver Dis 2014 Nov 13.
Metabolic diseases that involve the liver represent a heterogeneous group of disorders. Apart from the metabolic defect, the subject's liver functions may be normal. With the increasing need for organs, livers from donors with metabolic diseases other than familial amyloid polyneuropathy might be possibly used for transplantation. However, whether such livers qualify as grafts and how they might impact recipient outcome are still unanswered questions. This review of the literature summarizes current experience in the use of such grafts in the context of cadaveric, domino, and living-related liver transplantation.
- Prevention and treatment of postoperative Crohn's disease recurrence with anti-TNF therapy: A meta-analysis of controlled trials. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Nov 14.
The magnitude of the efficacy of anti-tumour necrosis factor (TNF) therapy in preventing and treating postoperative Crohn's disease recurrence has yet to be determined.We searched MEDLINE, the Cochrane Library, and EMBASE. The primary endpoints, and clinical and endoscopic recurrence, were analysed using the Mantel-Haenszel and DerSimonian and Laird methods.Nine controlled trials (n=362) that evaluated the efficacy of anti-TNF therapy in preventing (n=7) or treating (n=2) postoperative recurrence were included. Anti-TNF therapy was more effective at preventing (n=6) endoscopic recurrence than the control arms (odds ratio 0.05; 95% confidence interval 0.02-0.13, P<0.0001; NNT=1.9). Anti-TNF therapy was more effective at preventing (n=5) clinical recurrence than the control arms (odds ratio 0.10; 95% confidence interval 0.05-0.21, P<0.0001; NNT=2.4). Anti-TNF therapy was more effective than control arms at treating endoscopic postoperative recurrence (n=2; odds ratio 16.64; 95% confidence interval 2.51-110.27, P<0.004; NNT=2.3). Neither heterogeneity nor publication bias was observed.Anti-TNF agents may be more effective in preventing clinical and endoscopic postoperative Crohn's disease recurrence than control treatment (thiopurines or mesalamine). Efficacy in treating postoperative Crohn's disease recurrence will require further investigation. Large randomised controlled trials are awaited.
- A randomized clinical trial of Saccharomyces cerevisiae versus placebo in the irritable bowel syndrome. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Nov 13.
We aimed to evaluate clinical symptoms in subjects with irritable bowel syndrome receiving Saccharomyces cerevisiae in a randomized double-blind placebo-controlled clinical trial.Overall, 179 adults with irritable bowel syndrome (Rome III criteria) were randomized to receive once daily 500mg of Saccharomyces cerevisiae, delivered by one capsule (n=86, F: 84%, age: 42.5±12.5), or placebo (n=93, F: 88%, age: 45.4±14) for 8 weeks followed by a 3-week washout period. After a 2-week run-in period, cardinal symptoms (abdominal pain/discomfort, bloating/distension, bowel movement difficulty) and changes in stool frequency and consistency were recorded daily and assessed each week. A safety assessment was carried out throughout the study.The proportion of responders, defined by an improvement of abdominal pain/discomfort, was significantly higher (p=0.04) in the treated group than the placebo group (63% vs 47%, OR=1.88, 95%, CI: 0.99-3.57) in the last 4 weeks of treatment. A non-significant trend of improvement was observed with Saccharomyces cerevisiae for the other symptoms. Saccharomyces cerevisiae was well tolerated and did not affect stool frequency and consistency.Saccharomyces cerevisiae is well tolerated and reduces abdominal pain/discomfort scores without stool modification. Thus, Saccharomyces cerevisiae may be a new promising candidate for improving abdominal pain in subjects with irritable bowel syndrome.
- The phosphodiesterase-5-inhibitor udenafil lowers portal pressure in compensated preascitic liver cirrhosis. A dose-finding phase-II-study. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Nov 15.
Phosphodiesterase-5-inhibitors may lower portal pressure.To investigate the effect of the phosphodiesterase-5-inhibitor udenafil on hepatic and systemic haemodynamics in liver cirrhosis.In an open-label phase-II-study, patients with liver cirrhosis Child A/B and hepatic venous pressure-gradient ≥12mmHg received 12.5mg/day, 25mg/day, 50mg/day, 75mg/day (n=5, each), or 100mg/day (n=10) udenafil p.o. for one week. On days 0 and 6, hepatic venous pressure-gradient was measured prior to and one hour after drug ingestion. Endpoints were reduction of hepatic venous pressure-gradient from day 0 pre to day 6 post intake and reduction in the acute setting. Pharmacokinetics were measured in the two lowest dosage groups.Combining the 75 and 100mg/day groups hepatic venous pressure-gradient reduction after drug intake was 19.9% (p=0.0006) on day 0. From day 0 pre-dose to day 6 post-dose hepatic venous pressure-gradient decreased by 15.7% (p=0.040) and in 5/15 patients by ≥20% or to <12mmHg. In the 100mg/day group, mean arterial pressure decreased from 98.9mmHg by 6.2mmHg (p=0.037) from day 0 pre-dose to day 6 post-dose. Heart rates or electrocardiograms were unchanged. Udenafil was eliminated with t1/2=25h.Oral application of 75-100mg of the phosphodiesterase-5-inhibitor udenafil lowers portal pressure in the acute setting by about 20% without relevant systemic cardiovascular side effects.
- Prospective, observational real-life study on eligibility for and outcomes of antiviral treatment with peginterferon α plus ribavirin in chronic hepatitis C. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Nov 13.
We aimed to investigate eligibility, reasons for treatment discontinuation and characteristics of chronic hepatitis C patients with treatment failure to peginterferon/ribavirin in clinical practice.1128 chronic hepatitis C patients, from 45 Italian Hepatology centres, were enrolled in this phase-4, prospective, observational study from January 2009 to February 2010.687/1118 patients (61.4%) were eligible for antiviral treatment, of which 598 (87.0%) agreed with the physician's decision. Outcome information was available in 500/598 patients, among whom 348 (69.6%) completed treatment. Treatment was discontinued in 152 patients due to: lack of response (28.9%), personal reasons (29.6%), adverse events (38.2%), and decompensation (1.3%). Sustained virological response was obtained in 263/500 (52.6%), 71 (14.2%) relapsed and 61 (12.2%) were non-responders. Treatment outcome was not available in 105 (21%): lost while receiving treatment (33.3%), lost during follow-up (25.7%), withdrawn for adverse events (19.1%) or for administrative reasons (21.9%).In clinical practice, only 61% of chronic hepatitis C patients are considered eligible for peginterferon/ribavirin. Of these, 13% refuse treatment. Approximately 30% do not complete the scheduled treatment and, despite this, the sustained virological response rate is similar to that of randomized-controlled trials. In the era of new antiviral combinations, these findings have important implications for assessing eligibility and estimating drop-out rates.
- A single-centre prospective, cohort study of the natural history of acute pancreatitis. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Nov 11.
The natural history of acute pancreatitis is based on clinical studies that aim to elucidate the course of disease on the basis of predicted risk factors.To evaluate the long-term occurrence of recurrent acute pancreatitis and chronic pancreatitis in a cohort of patients following an initial episode of acute pancreatitis.196 patients were enrolled consecutively and studied prospectively. Clinical characteristics, exogenously/endogenously-associated factors, and evolution to recurrent acute pancreatitis and chronic pancreatitis were analyzed.40 patients developed recurrent acute pancreatitis 13 of whom developed chronic pancreatitis. In a univariate analysis, recurrent acute pancreatitis was associated with an idiopathic aetiology (p<0.001), pancreas divisum (p=0.001), and higher usage of cigarettes and alcohol (p<0.001; p=0.023). Chronic pancreatitis was associated with a severe first episode of acute pancreatitis (p=0.048), PD (p=0.03), and cigarette smoking (p=0.038). By multivariate analysis, pancreas divisum was an independent risk factor for recurrent acute pancreatitis (OR 11.5, 95% CI 1.6-83.3). A severe first-episode of acute pancreatitis increased the risk of progressing to chronic pancreatitis by nine-fold.Special attention should be given to patients who experience a severe first attack of acute pancreatitis as there appears to be an increased risk of developing chronic pancreatitis over the long term.
- Pancreatic neuroendocrine tumour simulating an intraductal papillary mucinous neoplasm. [LETTER]
- Dig Liver Dis 2014 Nov 18.