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Gastroenterol. Insights, Volume 13, Issue 2 (June 2022) – 7 articles

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12 pages, 662 KiB  
Review
Gastrointestinal Ischemia—Stumbling Stone in COVID-19 Patients
by Monika Peshevska-Sekulovska, Irina Boeva, Metodija Sekulovski, Miroslav Zashev and Milena Peruhova
Gastroenterol. Insights 2022, 13(2), 206-217; https://doi.org/10.3390/gastroent13020021 - 14 Jun 2022
Cited by 4 | Viewed by 2619
Abstract
The emergence of the novel SARS-CoV2 virus, proclaimed by the World Health Organization (WHO) as a culpable agent for the pandemic situation, caught the scientific and medical communities off guard. One of the most common complications following pulmonary disease is represented by gastrointestinal [...] Read more.
The emergence of the novel SARS-CoV2 virus, proclaimed by the World Health Organization (WHO) as a culpable agent for the pandemic situation, caught the scientific and medical communities off guard. One of the most common complications following pulmonary disease is represented by gastrointestinal (GI) disorders, especially ischemic damage. Inflammation, vasculopathy, immobility, endothelial dysfunction, and a hypercoagulable condition have all been proposed as pathophysiological factors for GI ischemia in these patients. Owing to the COVID-19 effect on a variety of GI conditions, especially ischemic changes, and the high mortality rate, physicians should always keep in mind this complication. They should take a deeper look at clinical and imaging modalities in this cohort of patients so that a proper and time-saving treatment strategy can be applied. Our study aimed to elucidate the thrombogenic mechanism in different GI disorders. Moreover, we analyzed the factors related to necrotic GI changes, by summarizing the already reported data of GI ischemia in COVID-19. To the best of our knowledge, this review is the first to incorporate all GI ischemia cases reported in the literature so far. Full article
(This article belongs to the Collection Gastroenterological Aspects of COVID-19 Infection)
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14 pages, 3171 KiB  
Review
The Role of Cholangioscopy and EUS in the Evaluation of Indeterminate Biliary Strictures
by Wilson Siu and Raymond S. Y. Tang
Gastroenterol. Insights 2022, 13(2), 192-205; https://doi.org/10.3390/gastroent13020020 - 14 Jun 2022
Cited by 3 | Viewed by 3063
Abstract
Bile duct stenosis continues to present a diagnostic dilemma for clinicians. It is important to establish the benign or malignant nature of the stricture early in order to avoid any unnecessary delay in medical treatment or surgery. Tissue acquisition for histological diagnosis is [...] Read more.
Bile duct stenosis continues to present a diagnostic dilemma for clinicians. It is important to establish the benign or malignant nature of the stricture early in order to avoid any unnecessary delay in medical treatment or surgery. Tissue acquisition for histological diagnosis is particularly crucial when the initial diagnostic work up is inconclusive. The diagnostic yield from the conventional endoscopic retrograde cholangiopancreatography (ERCP) with brushing and biopsy is suboptimal. Patients with indeterminate biliary strictures (IDBSs) often require a multi-disciplinary diagnostic approach and additional endoscopic evaluation, including cholangioscopy and endoscopic ultrasound, before a final diagnosis can be reached. In this article, we discuss the recent endoscopic advancements in the diagnosis of biliary stricture with a focus on the roles of cholangioscopy and endoscopic ultrasound (EUS). Full article
(This article belongs to the Special Issue Diagnostic and Therapeutic Challenges in Pancreatobiliary Diseases)
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10 pages, 295 KiB  
Article
Correlation between the Lymphocyte-To-Monocyte Ratio (LMR) and Child–Pugh and MELD/MELDNa Scores in Vietnamese Patients with Liver Cirrhosis
by Diem Thi Nguyen, Nhan Huu Kha, Nhung Thi Hong Thai, Trang Diem Kha, Phuong Kim Bo, Khoa Tran Dang Dang, Hao Yen Tran and Thang Nguyen
Gastroenterol. Insights 2022, 13(2), 182-191; https://doi.org/10.3390/gastroent13020019 - 31 May 2022
Viewed by 2321
Abstract
Objectives: This study aims to determine cirrhotic patients’ clinical and laboratory characteristics, thereby examining the correlation between lymphocyte-to-monocyte ratio and Child–Pugh and MELD/MELDNa scores. Methods: A cross-sectional study with an analysis of 153 patients admitted to the Department of Gastroenterology–Clinical Hematology at Can [...] Read more.
Objectives: This study aims to determine cirrhotic patients’ clinical and laboratory characteristics, thereby examining the correlation between lymphocyte-to-monocyte ratio and Child–Pugh and MELD/MELDNa scores. Methods: A cross-sectional study with an analysis of 153 patients admitted to the Department of Gastroenterology–Clinical Hematology at Can Tho Central General Hospital. Data were collected via patient interviews and medical records. Results: The included patients were more likely to be male (66.7%) and were ≥60 years old (51.6%). Excessive alcohol consumption and hepatitis B were the dominant causes of cirrhosis (35.3% and 34.0%). The clinical and laboratory characteristics were similar to previous studies in cirrhotic patients. The mean Child score was 9.3 ± 2.1, including 9.8% of patients with Child A, 44.4% for Child B, and 45.8% for Child C. The mean MELD and MELDNa scores were 16.9 ± 7.1 and 19.4 ± 8.1, respectively. The mean lymphocyte-to-monocyte ratio (LMR) is 2.0 ± 2.2 (from 0.09 to 25.3), being negatively correlated with the other scores (Pearson correlation coefficients were −0.238; −0.211 and −0.245, respectively, all p-values < 0.01). Patients with LMR below 3.31 were more likely to be classified as Child–Pugh B and C. Conclusion: The correlation between LMR with Child–Pugh, MELD, and MELDNa scores was weak and negative. Full article
(This article belongs to the Special Issue Novelties in Diagnostics and Therapeutics in Hepatology)
9 pages, 1733 KiB  
Case Report
Hydrocolonic Sonography: Description of the Technique and Its Application in a Case of Intracolonic Lipoma: Report about a Case
by Diego Martínez García, Maria Teresa Belmonte Alcaráz, Guilda Morell Gonzalez, Javier Emilio Brugal Molina, Carlos Ballester Rosique, Francisco Jose Menarguez Pina and Miguel Ángel Morcillo Rodenas
Gastroenterol. Insights 2022, 13(2), 173-181; https://doi.org/10.3390/gastroent13020018 - 11 May 2022
Viewed by 2956
Abstract
Intracolonic lipomas are benign lesions but can cause serious complications, especially when they are large. Regarding a 3 cm intracecal lipoma, we describe an ultrasound modality called a hydrocolonic ultrasound and how this technique can be used in the long-term follow-up of these [...] Read more.
Intracolonic lipomas are benign lesions but can cause serious complications, especially when they are large. Regarding a 3 cm intracecal lipoma, we describe an ultrasound modality called a hydrocolonic ultrasound and how this technique can be used in the long-term follow-up of these lesions. Full article
(This article belongs to the Section Gastrointestinal and Hepato-Biliary Imaging)
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11 pages, 972 KiB  
Review
High-Quality Colonoscopy: A Review of Quality Indicators and Best Practices
by Mason Soeder, Alla Turshudzhyan, Lisa Rosenberg and Micheal Tadros
Gastroenterol. Insights 2022, 13(2), 162-172; https://doi.org/10.3390/gastroent13020017 - 1 May 2022
Cited by 3 | Viewed by 3785
Abstract
Colorectal cancer (CRC) continues to be the third leading cause of cancer-related deaths in the US. Colonoscopy remains the best preventative tool against the development of CRC. As a result, high-quality colonoscopy is becoming increasingly important. Specifically, recent guidelines have highlighted pre-procedural, peri-procedural, [...] Read more.
Colorectal cancer (CRC) continues to be the third leading cause of cancer-related deaths in the US. Colonoscopy remains the best preventative tool against the development of CRC. As a result, high-quality colonoscopy is becoming increasingly important. Specifically, recent guidelines have highlighted pre-procedural, peri-procedural, and post-procedural practices, which promise to improve patient outcomes and reduce the mortality and interval cancer rates in patients undergoing colonoscopies. Despite the guidelines and advances in modern endoscopy, the procedure remains provider-dependent, which results in differences in outcomes. As a result, incorporating high-quality colonoscopy approaches early in training is key to improving patient outcomes. Additionally, ensuring that high-quality colonoscopy is practiced widely by endoscopists can lead to the most cost-effective care. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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14 pages, 1502 KiB  
Review
The Role of Interferon Regulatory Factors in Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis
by Chunye Zhang, Shuai Liu and Ming Yang
Gastroenterol. Insights 2022, 13(2), 148-161; https://doi.org/10.3390/gastroent13020016 - 26 Apr 2022
Cited by 11 | Viewed by 4864
Abstract
Non-alcoholic fatty liver disease (NAFLD) is becoming the most common chronic liver disease with many metabolic comorbidities, such as obesity, diabetes, and cardiovascular diseases. Non-alcoholic steatohepatitis (NASH), an advanced form of NAFLD, accompanies the progression of hepatic steatosis, inflammation, cell death, and varying [...] Read more.
Non-alcoholic fatty liver disease (NAFLD) is becoming the most common chronic liver disease with many metabolic comorbidities, such as obesity, diabetes, and cardiovascular diseases. Non-alcoholic steatohepatitis (NASH), an advanced form of NAFLD, accompanies the progression of hepatic steatosis, inflammation, cell death, and varying degree of liver fibrosis. Interferons (IFNs) have been shown to play important roles in the pathogenesis of NAFLD and NASH. Their regulating transcriptional factors such as interferon regulatory factors (IRFs) can regulate IFN expression, as well as genes involved in macrophage polarization, which are implicated in the pathogenesis of NAFLD and advanced liver disease. In this review, the roles of IRF-involved signaling pathways in hepatic inflammation, insulin resistance, and immune cell activation are reviewed. IRFs such as IRF1 and IRF4 are also involved in the polarization of macrophages that contribute to critical roles in NAFLD or NASH pathogenesis. In addition, IRFs have been shown to be regulated by treatments including microRNAs, PPAR modulators, anti-inflammatory agents, and TLR agonists or antagonists. Modulating IRF-mediated factors through these treatments in chronic liver disease can ameliorate the progression of NAFLD to NASH. Furthermore, adenoviruses and CRISPR activation plasmids can also be applied to regulate IRF-mediated effects in chronic liver disease. Pre-clinical and clinical trials for evaluating IRF regulators in NAFLD treatment are essential in the future direction. Full article
(This article belongs to the Section Liver)
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9 pages, 490 KiB  
Article
Value of Acute Kidney Injury in Predicting Mortality in Vietnamese Patients with Decompensated Cirrhosis
by Nghia N. Nguyen, Tan H. N. Mai, Nghia H. Vo, Cuong T. Vo, Nhi T. Y. Ngo, Mai T. Vi and Thang Nguyen
Gastroenterol. Insights 2022, 13(2), 139-147; https://doi.org/10.3390/gastroent13020015 - 22 Mar 2022
Cited by 2 | Viewed by 2823
Abstract
Background: Acute kidney injury remains a common complication with a poor prognosis, and is a significant predictor of mortality in cirrhosis patients. We aimed to determine the percentage of acute kidney injury in decompensated cirrhosis patients and evaluate the treatment results of acute [...] Read more.
Background: Acute kidney injury remains a common complication with a poor prognosis, and is a significant predictor of mortality in cirrhosis patients. We aimed to determine the percentage of acute kidney injury in decompensated cirrhosis patients and evaluate the treatment results of acute kidney injury as well as several factors related to the mortality of decompensated cirrhosis patients. Methods: A prospective study was conducted on decompensated cirrhosis patients in Can Tho City, Vietnam, from 2019 to 2020. Decompensated cirrhosis patients were found to have acute kidney injury on admission by a blood creatinine test. They were treated according to ICA 2015 standards, after which they were monitored and evaluated for treatment outcomes during hospitalization. Results: Of 250 decompensated cirrhosis patients, 64 (25.6%) had acute kidney injury and 37.5% died. Several factors were associated with mortality in decompensated cirrhosis patients, such as Child–Pugh C (p = 0.02; OR = 3, 95% CI 1.5–6.3), acute kidney injury (p < 0.0001; OR = 9.5, 95% CI 4.3–21.1), hyponatremia (p = 0.01; OR = 2.5, 95% CI 1.2–5.1), elevated total bilirubin > 51 µmol/L (p = 0.03; OR = 2.2, 95% CI 1.1–4.6), and prothrombin < 70% (p = 0.03; OR = 6.8, 95% CI 1–51.6). Hypoalbuminemia was unrelated to mortality in these patients (p = 0.8; OR = 1.2, 95% CI 0.5–2.7), but gastrointestinal bleeding significantly increased mortality in these patients up to 2.3 times (p = 0.03; OR = 2.3, 95% CI 1.1–4.9). Three independent factors regarding mortality in decompensated cirrhosis patients included acute kidney injury, hepatic encephalopathy, and gastrointestinal bleeding. The rate of acute kidney injury in patients with decompensated cirrhosis was 25.6%; the mortality rate was 37.5%. Conclusions: Acute kidney injury was a valuable predictor of mortality in Vietnamese patients with decompensated cirrhosis. Full article
(This article belongs to the Section Liver)
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