Gastroenterology Insights

13 pages, 8300 KiB

Open AccessReview

Esophageal Food Impaction and Foreign Object Ingestion in Gastrointestinal Tract: A Review of Clinical and Endoscopic Management

by Livia Marieta Negoita, Catalin Stefan Ghenea, Gabriel Constantinescu, Vasile Sandru, Madalina Stan-Ilie, Oana-Mihaela Plotogea, Umar Shamim, Bogdan Florin Dumbrava and Mariana Mihaila

Gastroenterol. Insights 2023, 14(1), 131-143; https://doi.org/10.3390/gastroent14010010 - 17 Mar 2023

Cited by 2 | Viewed by 4706

Abstract

Foreign bodies in the digestive tract represent a frequent pathology for the emergency service. Foreign bodies are represented by impacted food bolus or voluntarily and involuntarily swallowed objects. Involuntary swallowing of objects occurs most frequently in children, especially between six months and three [...] Read more.

Foreign bodies in the digestive tract represent a frequent pathology for the emergency service. Foreign bodies are represented by impacted food bolus or voluntarily and involuntarily swallowed objects. Involuntary swallowing of objects occurs most frequently in children, especially between six months and three years of age. Food impaction is mostly encountered among adults with different pathologies. For the removal of swallowed foreign bodies, digestive endoscopy is the gold standard method, being successful in over 95% of cases without significant complications. For the endoscopic management of foreign bodies, it is crucial to be aware of the indications, devices, techniques and patient preparation in order to achieve successful and safe removal from the digestive tract. Recommendations in this article are based on a review of the literature and extensive personal experience. Full article

(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)

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10 pages, 1143 KiB

Open AccessCase Report

Cholangioscopy-Assisted Laser Lithotripsy for Treatment of Postcholecystectomy Mirizzi Syndrome: Case Series

by Bozhidar Hristov, Daniel Doykov, Vladimir Andonov, Deyan Radev, Krasimir Kraev, Petar Uchikov, Gancho Kostov, Siyana Valova, Eduard Tilkiyan and Katya Doykova

Gastroenterol. Insights 2023, 14(1), 121-130; https://doi.org/10.3390/gastroent14010009 - 06 Mar 2023

Cited by 1 | Viewed by 3967

Abstract

Introduction. Mirizzi syndrome (MS) represents a rare clinical entity caused by impaction of one or multiple stones in the infundibulum of the gall bladder or the cystic duct resulting in partial or complete obstruction of the common hepatic or common bile duct (CBD). [...] Read more.

Introduction. Mirizzi syndrome (MS) represents a rare clinical entity caused by impaction of one or multiple stones in the infundibulum of the gall bladder or the cystic duct resulting in partial or complete obstruction of the common hepatic or common bile duct (CBD). Though described more than a century ago, MS is still one of the most challenging diseases in the spectrum of biliary pathology. In recent years, endoscopic treatment has become an increasingly popular treatment modality. Patients and methods. Three consecutive patients subjected to cholangioscopy-assisted laser lithotripsy (CA-LL) for postocholecystectomy MS (pMS) were retrospectively evaluated. Case reports. Successful clearance of the cystic duct was achieved in all patients in one or two sessions. One complication in the form of mild cholangitis was observed. Clinical success was 100%. Discussion. According to current research, CA-LL achieves a high rate of ductal clearance and acceptable complication rate in patients with pMS. A 250 µm laser fiber seems to be the optimal choice for CA-LL. Our results suggest that procedure duration is closely associated to the stone size and possibly to the operator experience. In our opinion, upon obtainment of successful ductal clearance and drainage, prophylactic stenting does not improve clinical outcome. Conclusions. Our results demonstrate that CA-LL is a safe and effective treatment for pMS. Full article

(This article belongs to the Section Biliary Content)

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11 pages, 1566 KiB

Open AccessArticle

Significance of Micromorphological Characteristics and Expression of Intermediate Filament Proteins CK7 and CK20 in the Differential Diagnosis of Serrated Lesions of the Colorectum

by Ivan Ilić, Pavle Ranđelović, Žaklina Mijović, Maja Jovičić Milentijević, Biljana Radovanović Dinić and Jana Cvetković

Gastroenterol. Insights 2023, 14(1), 110-120; https://doi.org/10.3390/gastroent14010008 - 26 Feb 2023

Viewed by 1548

Abstract

Serrated lesions in the colorectum include all epithelial neoplastic lesions, which show a sawtooth-like morphology in the epithelial crypts. Classification systems nosologically divide colon serrated polyps into three different categories, primarily emphasizing their micromorphological growth pattern and cytodifferentiation: (1) hyperplastic polyps, (2) sessile [...] Read more.

Serrated lesions in the colorectum include all epithelial neoplastic lesions, which show a sawtooth-like morphology in the epithelial crypts. Classification systems nosologically divide colon serrated polyps into three different categories, primarily emphasizing their micromorphological growth pattern and cytodifferentiation: (1) hyperplastic polyps, (2) sessile serrated adenomas/polyps and (3) traditional serrated adenomas. Overall, 109 patients with serrated lesions of the colon, who underwent endoscopic or surgical polypectomy/tumorectomy during one or multiple endoscopic or surgical interventions, over a four-year period, were analyzed. The average age of patients was 62.8 ± 11.6 years. The frequency of serrated lesions of the colon in male patients was 2.4 times higher than in females (70.6% vs. 29.4%). All sessile serrated lesions without dysplasia were positive for CK7 and statistically significant compared to other serrated lesions, if this positivity was present in the complete crypt (p = 0.005). CK20 positivity, which is limited to the upper half of the crypt, is a special feature of hyperplastic polyps compared to other serrated lesions, which is statistically significant (p = 0.0078). Whereas, CK20 positivity of complete crypts is a statistically significant feature of traditional serrated adenomas (p < 0.01). Differences in the expression pattern of cytokeratin 7 and 20 in different serrated lesions may indicate different pathways of colorectal carcinogenesis, and be diagnostically and prognostically useful. Full article

(This article belongs to the Collection Advances in Gastrointestinal Cancer)

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46 pages, 5151 KiB

Open AccessArticle

Congenital Gastrointestinal Anomalies in Europe 2010–2019: A Geo-Spatiotemporal and Causal Inferential Study of Epidemiological Patterns in Relationship to Cannabis- and Substance Exposure

by Albert Stuart Reece and Gary Kenneth Hulse

Gastroenterol. Insights 2023, 14(1), 64-109; https://doi.org/10.3390/gastroent14010007 - 23 Feb 2023

Cited by 4 | Viewed by 1868

Abstract

Introduction: Congenital anomalies (CA’s) of most of the gastrointestinal tract have been linked causally with prenatal or community cannabis exposure. Therefore, we studied this relationship in Europe. Methods: CA data were from Eurocat. Drug-use data were sourced from the European Monitoring Centre for [...] Read more.

Introduction: Congenital anomalies (CA’s) of most of the gastrointestinal tract have been linked causally with prenatal or community cannabis exposure. Therefore, we studied this relationship in Europe. Methods: CA data were from Eurocat. Drug-use data were sourced from the European Monitoring Centre for Drugs and Drug Addiction. Income data were taken from the World Bank. Results: When countries with increasing rates of daily cannabis use were compared with those which were not, the overall rate of gastrointestinal CA’s (GCA’s) was higher in the former group (p = 0.0032). The five anomalies which were related to the metrics of cannabis exposure on bivariate analysis were bile duct atresia, Hirschsprungs, digestive disorders, annular pancreas and anorectal stenosis or atresia. The following sequence of GCA’s was significantly linked with cannabis metrics at inverse-probability-weighted-panel modelling, as indicated: esophageal stenosis or atresia, bile duct atresia, small intestinal stenosis or atresia, anorectal stenosis or atresia, Hirschsprungs disease: p = 1.83 × 10⁻⁵, 0.0046, 3.55 × 10⁻¹², 7.35 × 10⁻⁶ and 2.00 × 10⁻¹², respectively. When this GCA series was considered in geospatial modelling, the GCA’s were significantly cannabis-related from p = 0.0003, N.S., 0.0086, 6.652 × 10⁻⁵, 0.0002, 71.4% of 35 E-value estimates and 54.3% minimum E-values (mEVv’s) > 9 (high zone) and 100% and 97.1% > 1.25 (causality threshold). The order of cannabis sensitivity by median mEVv was Hirschsprungs > esophageal atresia > small intestinal atresia > anorectal atresia > bile duct atresia. Conclusions: Seven of eight GCA’s were related to cannabis exposure and fulfilled the quantitative criteria for epidemiologically causal relationships. Penetration of cannabinoids into the community should be carefully scrutinized and controlled to protect against exponential and multigenerational genotoxicity ensuing from multiple cannabinoids. Full article

(This article belongs to the Collection Advances in Gastrointestinal Cancer)

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19 pages, 2250 KiB

Open AccessSystematic Review

Systematic Review of Endoscopic Management of Stricture, Fistula and Abscess in Inflammatory Bowel Disease

by Partha Pal, Swathi Kanaganti, Rupa Banerjee, Mohan Ramchandani, Zaheer Nabi, Duvvuru Nageshwar Reddy and Manu Tandan

Gastroenterol. Insights 2023, 14(1), 45-63; https://doi.org/10.3390/gastroent14010006 - 13 Feb 2023

Cited by 3 | Viewed by 3083

Abstract

Background: Interventional inflammatory bowel disease (IIBD) therapies can play a key role in inflammatory bowel disease (IBD) related stricture/fistula/abscess deferring or avoiding invasive surgery. Methods: A total of 112 studies pertaining to IIBD therapy for strictures/fistula/abscess between 2002 and December 2022 were included [...] Read more.

Background: Interventional inflammatory bowel disease (IIBD) therapies can play a key role in inflammatory bowel disease (IBD) related stricture/fistula/abscess deferring or avoiding invasive surgery. Methods: A total of 112 studies pertaining to IIBD therapy for strictures/fistula/abscess between 2002 and December 2022 were included by searching Pubmed, Medline and Embase with a focus on technical/clinical success, recurrence, re-intervention and complications. Results: IIBD therapy for strictures include endoscopic balloon dilation (EBD), endoscopic stricturotomy (ES) and self-expanding metal stent (SEMS) placement. EBD is the primary therapy for short strictures while ES and SEMS can be used for refractory strictures. ES has higher long-term efficacy than EBD. SEMS is inferior to EBD although it can be useful in long, refractory strictures. Fistula therapy includes endoscopic incision and drainage (perianal fistula)/endoscopic seton (simple, low fistula) and endoscopic ultrasound-guided drainage (pelvic abscess). Fistulotomy can be done for short, superficial, single tract, bowel-bowel fistula. Endoscopic injection of filling agents (fistula plug/glue/stem cell) is feasible although durability is unknown. Endoscopic closure therapies like over-the-scope clips (OTSC), suturing and SEMS should be avoided for de-novo/bowel to hollow organ fistulas. Conclusion: IIBD therapies have the potential to act as a bridge between medical and surgical therapy for properly selected IBD-related stricture/fistula/abscess although future controlled studies are warranted. Full article

(This article belongs to the Special Issue Basic and Translational Research in Inflammatory Bowel Disease)

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7 pages, 538 KiB

Open AccessCase Report

A Case of Advanced Hepatocellular Carcinoma with Bone Metastases Managed with Tyrosine Kinase Inhibitors and Aggressive Palliative Radiation Therapy: Role of Combination Therapy for Extending Survival

by Luca Ielasi, Bernardo Stefanini, Fabio Piscaglia, Alessandro Granito and Francesco Tovoli

Gastroenterol. Insights 2023, 14(1), 38-44; https://doi.org/10.3390/gastroent14010005 - 12 Feb 2023

Cited by 2 | Viewed by 1799

Abstract

We report the case of a 68-year-old man with advanced hepatocellular carcinoma (HCC) with multiple bone metastases (BM) treated with tyrosine kinase inhibitors. Despite an insufficient disease control on BM with a progression free survival (PFS) of 6 months, sorafenib was not discontinued [...] Read more.

We report the case of a 68-year-old man with advanced hepatocellular carcinoma (HCC) with multiple bone metastases (BM) treated with tyrosine kinase inhibitors. Despite an insufficient disease control on BM with a progression free survival (PFS) of 6 months, sorafenib was not discontinued and multiple radiation therapy (RT) sessions with a palliative purpose were performed. Thanks to this aggressive radiotherapy approach in order to control the bone tumor burden, the patient has continued sorafenib for 34.6 months achieving an overall survival (OS) of 41.3 months. This result highlights the importance of a tailored management of patients with advanced HCC and the role of the RT for BM control, even if at lower cumulative radiation dose, for extending patient survival. Full article

(This article belongs to the Special Issue Feature Papers in Liver Research)

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1 pages, 191 KiB

Open AccessEditorial

Acknowledgment to the Reviewers of Gastroenterology Insights in 2022

by Gastroenterology Insights Editorial Office

Gastroenterol. Insights 2023, 14(1), 37; https://doi.org/10.3390/gastroent14010004 - 17 Jan 2023

Viewed by 1259

Abstract

High-quality academic publishing is built on rigorous peer review [...] Full article

10 pages, 710 KiB

Open AccessArticle

Relationship between Undernutrition and Anemia in Patients with Ulcerative Colitis

by Yury P. Uspenskiy, Sergei V. Ivanov, Alexander S. Krasichkov, Michael M. Galagudza and Yulia A. Fominykh

Gastroenterol. Insights 2023, 14(1), 27-36; https://doi.org/10.3390/gastroent14010003 - 29 Dec 2022

Viewed by 2118

Abstract

This study aimed to assess the relationship between malnutrition and anemia in patients with ulcerative colitis (UC). The cross-sectional retrospective study included 80 patients with UC. Body mass index and total body fat mass were derived retrospectively from bioimpedance measurements. Anemia was diagnosed [...] Read more.

This study aimed to assess the relationship between malnutrition and anemia in patients with ulcerative colitis (UC). The cross-sectional retrospective study included 80 patients with UC. Body mass index and total body fat mass were derived retrospectively from bioimpedance measurements. Anemia was diagnosed retrospectively according to WHO criteria. A binary logistic regression was performed to study the relationship between nutritional status parameters and anemia, and adjusted for demographic and disease-associated characteristics. The prevalence of anemia in the study population was 40.0%. Among all included patients, 86.3% had acute disease corresponding to S1–S3 disease behavior. In the adjusted binary logistic model, total serum protein level below 64 g/L and low body fat percentage were associated with high odds for the of development of anemia, with odds ratios of 5.1 (95% CI 1.5; 17.8; p = 0.01) and 8.5 (95% CI 1.1; 63.6; p = 0.037), respectively. The adjusted model included sex, age, disease activity, extent of gut involvement, quantity of relapses from disease onset, and treatment with immunosuppressive drugs as confounders. Hypoproteinemia and low body fat percentage were associated with anemia in patients with UC. These results suggested that undernutrition may be involved as one of the causative factors of anemia in UC. Full article

(This article belongs to the Special Issue Basic and Translational Research in Inflammatory Bowel Disease)

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Graphical abstract

14 pages, 371 KiB

Open AccessReview

Hepatobiliary Impairments in Patients with Inflammatory Bowel Diseases: The Current Approach

by Vlad Alexandru Ionescu, Gina Gheorghe, Valentin Nicolae Varlas, Ana Maria Alexandra Stanescu and Camelia Cristina Diaconu

Gastroenterol. Insights 2023, 14(1), 13-26; https://doi.org/10.3390/gastroent14010002 - 27 Dec 2022

Cited by 1 | Viewed by 2392

Abstract

Inflammatory bowel disease (IBD) refers to chronic conditions with a low mortality but high disability. The multisystemic nature of these diseases can explain the appearance of some extraintestinal manifestations, including liver damage. Abnormal liver biochemical tests can be identified in approximately one third [...] Read more.

Inflammatory bowel disease (IBD) refers to chronic conditions with a low mortality but high disability. The multisystemic nature of these diseases can explain the appearance of some extraintestinal manifestations, including liver damage. Abnormal liver biochemical tests can be identified in approximately one third of patients with IBD and chronic liver disease in 5% of them. Among the liver diseases associated with IBD are primary sclerosing cholangitis, cholelithiasis, fatty liver disease, hepatic amyloidosis, granulomatous hepatitis, drug-induced liver injury, venous thromboembolism, primary biliary cholangitis, IgG4-related cholangiopathy, autoimmune hepatitis, liver abscesses or the reactivation of viral hepatitis. The most common disease is primary sclerosing cholangitis, a condition diagnosed especially in patients with ulcerative colitis. The progress registered in recent years in the therapeutic management of IBD has not eliminated the risk of drug-induced liver disease. Additionally, the immunosuppression encountered in these patients increases the risk of opportunistic infections, including the reactivation of viral hepatitis. Currently, one of the concerns consists of establishing an efficiency and safety profile of the use of direct-acting antiviral agents (DAA) among patients with hepatitis C and IBD. Early diagnosis and optimal treatment of liver complications can improve the prognoses of these patients. Full article

(This article belongs to the Special Issue Chronic Liver Disease and Comorbidities)

12 pages, 1627 KiB

Open AccessArticle

Evaluation of Therapeutic Effect of Buspirone in Improving Dysphagia in Patients with GERD and Ineffective Esophageal Motility: A Randomized Clinical Trial

by Foroogh Alborzi Avanaki, Elham Baghereslami, Hesam Aldin Varpaei, Narges Farhadi, Najmeh Aletaha, Farshad Allameh and Mohammad Taher

Gastroenterol. Insights 2023, 14(1), 1-12; https://doi.org/10.3390/gastroent14010001 - 21 Dec 2022

Viewed by 2580

Abstract

Background: Ineffective esophageal motility (IEM) is the most common esophageal motility disorder associated with low-to-moderate amplitude contractions in the distal esophagus in manometric evaluations. Despite recent new conceptions regarding the pathophysiology of esophageal motility and IEM, there are still no effective therapeutic interventions [...] Read more.

Background: Ineffective esophageal motility (IEM) is the most common esophageal motility disorder associated with low-to-moderate amplitude contractions in the distal esophagus in manometric evaluations. Despite recent new conceptions regarding the pathophysiology of esophageal motility and IEM, there are still no effective therapeutic interventions for the treatment of this disorder. This study aimed to investigate the effect of buspirone in the treatment of concomitant IEM and GERD. Methods and Materials: The present study was a randomized clinical trial conducted at the Imam Khomeini Hospital, Tehran. Patients with a history of gastroesophageal reflux disease and dysphagia underwent upper endoscopy to rule out any mechanical obstruction and were diagnosed with an ineffective esophageal motility disorder based on high-resolution manometry. They were given a package containing the desired medication(s); half of the packets contained 10 mg (for 30 days) of buspirone and 40 mg (for 30 days) of pantoprazole, and the other half contained only 40 mg (for 30 days) of pantoprazole. Dysphagia was scored based on the Mayo score, as well as a table of dysphagia severity. Manometric variables were recorded before and after the treatment. Results: Thirty patients (15 pantoprazole and 15 pantoprazole plus buspirone) were included. Females comprised 63.3% of the population, with a mean age of 46.33 ± 11.15. The MAYO score and resting LES pressure significantly changed after treatment. The MAYO and Swallowing Disorder Questionnaire scores significantly decreased after treatment in both groups of patients. Our results revealed that the post-intervention values of manometric variables differed significantly between the two groups after controlling for the baseline values of the variables. This analysis did not demonstrate the superiority of buspirone. Conclusion: Buspirone seems to have no superiority over PPI. Treatment with concomitant IEM and GERD using proton pump inhibitors improves the patient’s clinical condition and quality of life. However, adding buspirone to the treatment regimen did not appear to make a significant difference in patient treatment. Full article

(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)

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Gastroenterol. Insights, Volume 14, Issue 1 (March 2023) – 10 articles

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