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Gastroenterol. Insights, Volume 13, Issue 3 (September 2022) – 10 articles

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8 pages, 4309 KiB  
Case Report
Chronic Calcifying Pancreatitis Associated with Secondary Diabetes Mellitus and Hepatosplenic Abscesses in a Young Male Patient: A Case Report
by Cristina Maria Marginean, Mihaela Popescu, Corina Maria Vasile, Mihaela Stanciu, Iulian Alin Popescu, Viorel Biciusca, Daniela Ciobanu, Amelia Dobrescu, Larisa Daniela Sandulescu, Simona Bondari, Marian Sorin Popescu and Paul Mitrut
Gastroenterol. Insights 2022, 13(3), 305-312; https://doi.org/10.3390/gastroent13030031 - 19 Sep 2022
Cited by 1 | Viewed by 2589
Abstract
Background: Chronic pancreatitis (CP) has been described as a multifactorial, ongoing inflammatory condition of the pancreas of varying intensity that produces persistent pain, leading to exocrine and endocrine insufficiency and a decreased lifespan. Currently, there are three primary forms of chronic pancreatitis: chronic [...] Read more.
Background: Chronic pancreatitis (CP) has been described as a multifactorial, ongoing inflammatory condition of the pancreas of varying intensity that produces persistent pain, leading to exocrine and endocrine insufficiency and a decreased lifespan. Currently, there are three primary forms of chronic pancreatitis: chronic autoimmune pancreatitis (steroid-sensitive pancreatitis), chronic obstructive pancreatitis, and chronic calcific pancreatitis, the latter being closely related to excessive alcohol consumption for one or even two decades before the onset of symptoms. Case report: We present the case of a 29 year old man who required medical attention for a significant unintentional weight loss and a history of upper abdominal pain. Blood tests revealed substantial abnormalities, and the patient was admitted for further investigation. CT and MRI confirmed the presence of a pancreatic pseudocyst and extensive pancreatic parenchymal calcifications and revealed multiple hepatosplenic microabscesses of fungal etiology. Conclusions: Chronic calcifying pancreatitis is a complex clinical entity that can lead to secondary diabetes due to progressive destruction of the pancreatic parenchyma. Protein malnutrition, caused by malabsorption syndrome, immune cell dysfunction, and a high glucose environment caused by diabetes mellitus, may create a state of immunodeficiency, predisposing the patient to opportunistic infections. Full article
(This article belongs to the Special Issue Diagnostic and Therapeutic Challenges in Pancreatobiliary Diseases)
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9 pages, 2137 KiB  
Article
Point Shear Wave Elastography and 2-Dimensional Shear Wave Elastography as a Non-Invasive Method in Differentiating Benign from Malignant Liver Lesions
by Emiliya Lyubomirova Nacheva-Georgieva, Daniel Ilianov Doykov, Vladimir Nikolov Andonov, Katya Angelova Doykova and Silviya Bogdanova Tsvetkova
Gastroenterol. Insights 2022, 13(3), 296-304; https://doi.org/10.3390/gastroent13030030 - 10 Sep 2022
Cited by 3 | Viewed by 2380
Abstract
Non-invasive, ultrasound-based methods for visualizing and measuring tissue elasticity are becoming more and more common in routine daily practice. An accurate diagnosis of malignant and benign tumors is essential for determining the appropriate treatment. Despite the wide use of imaging techniques, the investigation [...] Read more.
Non-invasive, ultrasound-based methods for visualizing and measuring tissue elasticity are becoming more and more common in routine daily practice. An accurate diagnosis of malignant and benign tumors is essential for determining the appropriate treatment. Despite the wide use of imaging techniques, the investigation for assessing the elasticity of focal liver lesions and their differentiating is still continuing. Aim: To investigate the value of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for the differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 125 adult patients were included from the Clinic of Gastroenterology of University Hospital Kaspela, Plovdiv city, Bulgaria, in the period from January 2021 to July 2022. Participants were divided into two groups—with benign (hemangiomas) and malignant focal liver lesions (hepatocellular carcinoma). The group with benign lesions included 63 patients and the group with malignant focal liver lesions (FLLs)—62 patients. Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) integrated in the same ultrasound machine (Esaote MyLab™ 9Exp) were performed for each lesion. Results: Malignant FLLs have significantly higher stiffness in both pSWE (2.52–4.32 m/s, 90% CI: 2.37 to 2.68, 90% CI: 4.19 to 4.55) and 2d-SWE (2.52–4.43 m/s, 90% CI: 2.31 to 2.65, 90% CI: 4.27 to 4.61). Conclusion: 2D-SWE and pSWE could provide complementary data about FLLs. They enable us to conveniently and easily obtain accurate stiffness information of FLLs. Full article
(This article belongs to the Special Issue Novelties in Diagnostics and Therapeutics in Hepatology)
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10 pages, 1893 KiB  
Article
Blood-Based Non-Invasive Tests of Hepatic Fibrosis in Autoimmune Hepatitis: Application among Selected Patients Leads to Higher Accuracy
by Marco Ferronato, Marco Lenzi, Paolo Muratori and Luigi Muratori
Gastroenterol. Insights 2022, 13(3), 286-295; https://doi.org/10.3390/gastroent13030029 - 9 Sep 2022
Cited by 2 | Viewed by 1768
Abstract
Background. Assessment of liver fibrosis is essential to guide treatment in autoimmune hepatitis (AIH), but non-invasive tests (NITs) showed poor accuracy. Our study aims to evaluate the performance of NITs among different AIH presentations. Methods. Monocentric retrospective study among 122 AIH patients. NITs [...] Read more.
Background. Assessment of liver fibrosis is essential to guide treatment in autoimmune hepatitis (AIH), but non-invasive tests (NITs) showed poor accuracy. Our study aims to evaluate the performance of NITs among different AIH presentations. Methods. Monocentric retrospective study among 122 AIH patients. NITs were compared to histological grading of liver fibrosis. We performed an accuracy analysis among acute (jaundice and/or transaminases > 10 times upper limit of normal) and non-acute patients. Results. A significant difference in the distribution of NIT values for each Ishak stage was found for spleen-diameter-to-platelet-count ratio (SD/PC) (p < 0.001), fibrosis-4-score (FIB-4) (p = 0.002), AST-to-ALT ratio (AAR) (p = 0.002), red-blood-cell-width-distribution-to-platelet-count ratio (RDW/PC) (p = 0.008) and AST-to-platelet-count ratio (APRI) (p = 0.029). The AUC for advanced fibrosis of SD/PC, FIB-4, RDW/PC, APRI and AAR were, respectively, 0.814, 0.770, 0.768, 0.708 and 0.694. The AUC of SD/PC, FIB-4 and APRI in non-acute subgroup were 0.902, 0.834 and 0.758, while in acute patients they were 0.754, 0.724 and 0.716. RDW/PC and AAR weren’t different among the two subgroups. Conclusions. For SD/PC, FIB-4 and APRI, diagnostic accuracy is higher in patients with non-acute presentation. In this context, SD/PC and FIB-4 showed an overall performance that could be of interest in clinical practice alongside other non-invasive techniques. Full article
(This article belongs to the Special Issue Feature Papers in Liver Research)
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11 pages, 2710 KiB  
Article
Radiological Features of Microvascular Invasion of Hepatocellular Carcinoma in Patients with Non-Alcoholic Fatty Liver Disease
by Matteo Renzulli, Anna Pecorelli, Nicolò Brandi, Giovanni Marasco, Francesco Adduci, Francesco Tovoli, Bernardo Stefanini, Alessandro Granito and Rita Golfieri
Gastroenterol. Insights 2022, 13(3), 275-285; https://doi.org/10.3390/gastroent13030028 - 15 Aug 2022
Cited by 3 | Viewed by 2411
Abstract
Background: The aim of the present study was to evaluate the presence and the prognostic value of the radiological signs of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). Methods: Between January 2015 and December 2017, [...] Read more.
Background: The aim of the present study was to evaluate the presence and the prognostic value of the radiological signs of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). Methods: Between January 2015 and December 2017, all patients (91 patients) with de novo HCC or HCC recurrence occurring at least 2 years after the last treatment in NAFLD (36 patients) or with hepatitis C virus (HCV) liver disease (55 patients) were included. Each HCC was treated with liver resection and transplantation to obtain the anatomopathological confirmation of MVI. All patients had at least one available computed tomography (CT) scan or magnetic resonance imaging (MRI) performed no more than one month prior to the treatment. The clinical data of each patient, tumor burden (diameter, margins, two-trait predictor of venous invasion (TTPVI), and peritumoral enhancement), the recurrence rate (RR) after a 1-year follow-up, and the time to recurrence (TTR) were collected. Results: The NAFLD–HCC nodules were larger as compared to HCV–HCC (51 mm vs. 36 mm, p = 0.004) and showed a higher prevalence of TTPVI (38.9 vs. 20.0%, p = 0.058). At multivariate analysis, nodule diameter >50 mm was found to be the only independent prognostic factor of TTPVI (hazard ratio: 21.3, 95% confidence interval: 4.2–107.7, p < 0.001), and the presence of TTPVI was confirmed to be the only independent prognostic factors of recurrence (hazard ratio: 2.349, 95% confidence interval: 1.369–4.032, p = 0.002). No correlations were found between TTR and irregular tumor margins or peritumoral enhancement. Conclusion: The NAFLD–HCC patients had larger tumors at diagnosis and showed a more frequent presence of radiological signs of MVI as compared to the HCV–HCC patients. The MVI was related to a more rapid recurrence after curative treatments, demonstrating the prognostic value of this radiological diagnosis. Full article
(This article belongs to the Special Issue Novelties in Diagnostics and Therapeutics in Hepatology)
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11 pages, 1699 KiB  
Article
UPolySeg: A U-Net-Based Polyp Segmentation Network Using Colonoscopy Images
by Subhashree Mohapatra, Girish Kumar Pati, Manohar Mishra and Tripti Swarnkar
Gastroenterol. Insights 2022, 13(3), 264-274; https://doi.org/10.3390/gastroent13030027 - 10 Aug 2022
Cited by 6 | Viewed by 2252
Abstract
Colonoscopy is a gold standard procedure for tracking the lower gastrointestinal region. A colorectal polyp is one such condition that is detected through colonoscopy. Even though technical advancements have improved the early detection of colorectal polyps, there is still a high percentage of [...] Read more.
Colonoscopy is a gold standard procedure for tracking the lower gastrointestinal region. A colorectal polyp is one such condition that is detected through colonoscopy. Even though technical advancements have improved the early detection of colorectal polyps, there is still a high percentage of misses due to various factors. Polyp segmentation can play a significant role in the detection of polyps at the early stage and can thus help reduce the severity of the disease. In this work, the authors implemented several image pre-processing techniques such as coherence transport and contrast limited adaptive histogram equalization (CLAHE) to handle different challenges in colonoscopy images. The processed image was then segmented into a polyp and normal pixel using a U-Net-based deep learning segmentation model named UPolySeg. The main framework of UPolySeg has an encoder–decoder section with feature concatenation in the same layer as the encoder–decoder along with the use of dilated convolution. The model was experimentally verified using the publicly available Kvasir-SEG dataset, which gives a global accuracy of 96.77%, a dice coefficient of 96.86%, an IoU of 87.91%, a recall of 95.57%, and a precision of 92.29%. The new framework for the polyp segmentation implementing UPolySeg improved the performance by 1.93% compared with prior work. Full article
(This article belongs to the Collection Advances in Gastrointestinal Cancer)
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6 pages, 921 KiB  
Case Report
Hepatosplenic T-Cell Lymphoma Mimicking Acute Onset of Cholestatic Hepatitis in a Young Immunocompetent Man: A Case Report
by Flavio Metelli, Riccardo Solimando, Luigina Vanessa Alemanni, Roberta Gafà and Giovanni Marasco
Gastroenterol. Insights 2022, 13(3), 258-263; https://doi.org/10.3390/gastroent13030026 - 9 Aug 2022
Cited by 1 | Viewed by 2356
Abstract
We herein report a case of hepatosplenic T-cell lymphoma (HSTCL) incidentally found in a 30-year-old man who came to the emergency department after an ankle trauma. At admission, laboratory tests revealed abnormal liver enzymes and pancytopenia, and imaging showed mild hepatosplenomegaly. During hospitalization, [...] Read more.
We herein report a case of hepatosplenic T-cell lymphoma (HSTCL) incidentally found in a 30-year-old man who came to the emergency department after an ankle trauma. At admission, laboratory tests revealed abnormal liver enzymes and pancytopenia, and imaging showed mild hepatosplenomegaly. During hospitalization, the patient’s clinical condition worsened rapidly, with a concomitant increase in cholestatic enzymes, severe jaundice, and the worsening of pancytopenia. Causes of liver injury, including many infectious diseases, were explored until the diagnosis of HSTCL was made by liver and bone marrow biopsies. Subsequently, the patient underwent six cycles of chemotherapy with a CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone or prednisolone) regimen and one with Hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone) but, despite this aggressive treatment, died due to disease progression 2 months after diagnosis. This rare disease should be considered in the diagnostic workup of acute cholestatic hepatitis presenting with concomitant hepatosplenomegaly and cytopenia. Full article
(This article belongs to the Special Issue Novelties in Diagnostics and Therapeutics in Hepatology)
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13 pages, 1238 KiB  
Review
The Outcomes of Nutritional Support Techniques in Patients with Gastrointestinal Cancers
by Vlad-Alexandru Ionescu, Gina Gheorghe, Ruxandra Oprita, Madalina Stan-Ilie, Raluca-Ioana Dascalu, Ondin Zaharia, Viorel Jinga, Camelia Cristina Diaconu and Gabriel Constantinescu
Gastroenterol. Insights 2022, 13(3), 245-257; https://doi.org/10.3390/gastroent13030025 - 5 Aug 2022
Cited by 2 | Viewed by 2411
Abstract
Gastrointestinal cancers represent a major cause of morbidity and mortality worldwide. A significant issue regarding the therapeutic management of these patients consists of metabolic disturbances and malnutrition. Nutritional deficiencies have a negative impact on both the death rates of these patients and the [...] Read more.
Gastrointestinal cancers represent a major cause of morbidity and mortality worldwide. A significant issue regarding the therapeutic management of these patients consists of metabolic disturbances and malnutrition. Nutritional deficiencies have a negative impact on both the death rates of these patients and the results of surgical or oncological treatments. Thus, current guidelines recommend the inclusion of a nutritional profile in the therapeutic management of patients with gastrointestinal cancers. The development of digestive endoscopy techniques has led to the possibility of ensuring the enteral nutrition of cancer patients without oral feeding through minimally invasive techniques and the avoidance of surgeries, which involve more risks. The enteral nutrition modalities consist of endoscopy-guided nasoenteric tube (ENET), percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic gastrostomy with jejunal tube extension (PEG-J), direct percutaneous endoscopic jejunostomy (DPEJ) or endoscopic ultrasound (EUS)-guided gastroenterostomy. Full article
(This article belongs to the Collection Advances in Gastrointestinal Cancer)
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7 pages, 488 KiB  
Perspective
First Therapeutic Approval for Eosinophilic Esophagitis
by Rami A. Al-Horani and Raquel Chiles
Gastroenterol. Insights 2022, 13(3), 238-244; https://doi.org/10.3390/gastroent13030024 - 30 Jul 2022
Cited by 14 | Viewed by 3427
Abstract
Eosinophilic esophagitis (EE) is a chronic, immune-mediated or antigen-mediated esophageal disease. Treatment for patients with EE can be challenging with no previously approved medications. Current management strategies follow the four D’s paradigm of drugs, dietary elimination, dilation, and disease anxiety and hypervigilance therapy. [...] Read more.
Eosinophilic esophagitis (EE) is a chronic, immune-mediated or antigen-mediated esophageal disease. Treatment for patients with EE can be challenging with no previously approved medications. Current management strategies follow the four D’s paradigm of drugs, dietary elimination, dilation, and disease anxiety and hypervigilance therapy. On 20 May 2022, dupilumab was approved by FDA for EE. A dose of 300 mg dupilumab weekly significantly improved signs and symptoms of EE compared to placebo in a phase 3 trial. The approval of dupilumab will fulfill an unmet need for the increasing number of patients with EE. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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10 pages, 932 KiB  
Review
Exploring Treatment Options for Eosinophilic Esophagitis
by Nicole Strossman, Katherine Donovan, Alexa Trovato, Nihita Manem, Nicole Nudelman, Micheal Tadros and Christopher Ashley
Gastroenterol. Insights 2022, 13(3), 228-237; https://doi.org/10.3390/gastroent13030023 - 14 Jul 2022
Cited by 3 | Viewed by 2716
Abstract
Eosinophilic esophagitis (EoE), a chronic inflammatory disease of the esophagus, has been increasing in incidence over the past several years. Mainstays of treatment include dietary modifications, steroids, proton pump inhibitors (PPIs), and endoscopic dilation, with the goal being to control disease progression, promote [...] Read more.
Eosinophilic esophagitis (EoE), a chronic inflammatory disease of the esophagus, has been increasing in incidence over the past several years. Mainstays of treatment include dietary modifications, steroids, proton pump inhibitors (PPIs), and endoscopic dilation, with the goal being to control disease progression, promote remission, and alleviate symptoms, such as dysphagia and food impaction. In addition to these well-known treatment options, preliminary studies on new medications that target specific inflammatory mediators involved in the pathogenesis of EoE have shown promise in improving symptoms. This review article summarizes and discusses the application and efficacy of long-standing and promising new treatment options for EoE. Full article
(This article belongs to the Section Gastrointestinal Disease)
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10 pages, 552 KiB  
Review
Applications of Artificial Intelligence to Eosinophilic Esophagitis
by Eric Reuben Smith and Jay Shah
Gastroenterol. Insights 2022, 13(3), 218-227; https://doi.org/10.3390/gastroent13030022 - 8 Jul 2022
Cited by 2 | Viewed by 3311
Abstract
Eosinophilic Esophagitis (EoE) is a chronic immune-related inflammation, and challenges to its diagnosis and treatment evaluation persist. This literature review evaluates all AI applications to EOE, including 15 studies using AI algorithms for counting eosinophils in biopsies, as well as newer diagnostics using [...] Read more.
Eosinophilic Esophagitis (EoE) is a chronic immune-related inflammation, and challenges to its diagnosis and treatment evaluation persist. This literature review evaluates all AI applications to EOE, including 15 studies using AI algorithms for counting eosinophils in biopsies, as well as newer diagnostics using mRNA transcripts in biopsies, endoscopic photos, blood and urine biomarkers, and an improved scoring system for disease classification. We also discuss the clinical impact of these models, challenges faced in applying AI to EoE, and future applications. In conclusion, AI has the potential to improve diagnostics and clinical evaluation in EoE, improving patient outcomes. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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