Life | Special Issue : Novel Diagnosis and Treatment of Gastrointestinal Disease

Research

11 pages, 1125 KiB

Open AccessArticle

Evaluating the Efficacy of Resect-and-Discard and Resect-and-Retrieve Strategies for Diminutive Colonic Polyps

by Andrei Lucian Groza, Bogdan Miutescu, Cristian Tefas, Alexandru Popa, Iulia Ratiu, Roxana Sirli, Alina Popescu, Alexandru Catalin Motofelea and Marcel Tantau

Life 2024, 14(4), 532; https://doi.org/10.3390/life14040532 - 21 Apr 2024

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Abstract

Background and Objectives: Diminutive polyps present a unique challenge in colorectal cancer (CRC) prevention strategies. This study aims to assess the characteristics and variables of diminutive polyps in a Romanian cohort, intending to develop a combined resect-and-retrieve or resect-and-discard strategy that reduces the [...] Read more.

Background and Objectives: Diminutive polyps present a unique challenge in colorectal cancer (CRC) prevention strategies. This study aims to assess the characteristics and variables of diminutive polyps in a Romanian cohort, intending to develop a combined resect-and-retrieve or resect-and-discard strategy that reduces the need for an optical diagnosis. Materials and Methods: A prospective cohort study was conducted at two endoscopy centers in Romania from July to December 2021. Adult patients undergoing colonoscopies where polyps were identified and resected were included. Endoscopic procedures employed advanced diagnostic features, including blue-light imaging (BLI) and narrow-band imaging (NBI). Logistic regression analysis was utilized to determine factors impacting the probability of adenomatous polyps with high-grade dysplasia (HGD). Results: A total of 427 patients were included, with a mean age of 59.42 years (±11.19), predominantly male (60.2%). The most common indication for a colonoscopy was lower gastrointestinal symptoms (42.6%), followed by screening (28.8%). Adequate bowel preparation was achieved in 87.8% of cases. The logistic regression analysis revealed significant predictors of HGD in adenomatous polyps: age (OR = 1.05, 95% CI: 1.01–1.08, p = 0.01) and polyp size (>5 mm vs. ≤5 mm, OR = 4.4, 95% CI: 1.94–10.06, p < 0.001). Polyps classified as Paris IIa, Ip, and Isp were significantly more likely to harbor HGD compared to the reference group (Is), with odds ratios of 6.05, 3.68, and 2.7, respectively. Conclusions: The study elucidates significant associations between the presence of HGD in adenomatous polyps and factors such as age, polyp size, and Paris classification. These findings support the feasibility of a tailored approach in the resect-and-discard and resect-and-retrieve strategies for diminutive polyps, potentially optimizing CRC prevention and intervention practices. Further research is warranted to validate these strategies in broader clinical settings. Full article

(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)

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15 pages, 300 KiB

Open AccessArticle

Comparative Analysis of Antibiotic Resistance in Acute Cholangitis Patients with Stent Placement and Sphincterotomy Interventions

by Bogdan Miutescu, Deiana Vuletici, Calin Burciu, Felix Bende, Iulia Ratiu, Tudor Moga, Eyad Gadour, Felix Bratosin, Durganjali Tummala, Vasile Sandru, Gheorghe Balan and Alina Popescu

Life 2023, 13(11), 2205; https://doi.org/10.3390/life13112205 - 13 Nov 2023

Cited by 1 | Viewed by 1012

Abstract

In response to rising concerns over multidrug resistance patterns in acute cholangitis patients, this retrospective study was conducted at the Emergency County Hospital Timisoara, Romania, encompassing patients treated between August 2020 and August 2023. The study aimed to investigate the influence of prior [...] Read more.

In response to rising concerns over multidrug resistance patterns in acute cholangitis patients, this retrospective study was conducted at the Emergency County Hospital Timisoara, Romania, encompassing patients treated between August 2020 and August 2023. The study aimed to investigate the influence of prior interventions, specifically sphincterotomy (with or without stent placement), on the current clinical and microbiological profiles of acute cholangitis patients. By differentiating between patients with a history of sphincterotomy and the endoscopic retrograde cholangiopancreatography (ERCP)-naïve, we assessed the resistance of bacterial strains to antibiotics by the Tokyo Guidelines 2018, using bile cultures from 488 patients. The study identified various multidrug-resistant organisms, with a total multidrug resistance incidence of 19.9%. Significant variations were observed in the distribution of specific microorganisms and resistance patterns across different intervention groups. Patients with previous interventions, particularly those with both sphincterotomy and stent, exhibited elevated white blood cells (WBC) and C-reactive protein (CRP) levels in comparison to their ERCP-naïve counterparts. This group also presented a striking prevalence of two bacteria in their bile cultures at 50.0%, compared to 16.1% in ERCP-naïve individuals. Regarding multidrug resistance, the prior sphincterotomy with stent placement had a prevalence of 50.0%. The presence of ESBL bacteria was also significantly higher in the same group at 28.7%, contrasting with the 8.9% in ERCP-naïve patients. Additionally, the same group had a higher burden of Klebsiella spp. infections, at 37.2%, and Enterococcus spp. at 43.6%. On the antibiotic resistance front, disparities persisted. Piperacillin/Tazobactam resistance was notably more rampant in patients with a previous sphincterotomy and stent, registering at 25.5% against 11.1% in the ERCP-naïve group. This study underscores a substantial discrepancy in multidrug resistance patterns and antibiotic resistance among acute cholangitis patients with previous manipulation of the bile ducts, without expressing significant differences by the type of stent used. Full article

(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)

14 pages, 960 KiB

Open AccessArticle

Exploring Health-Related Quality of Life in Patients with Anal Fistulas: A Comprehensive Study

by Tudor Mateescu, Lazar Fulger, Durganjali Tummala, Aditya Nelluri, Manaswini Kakarla, Lavinia Stelea, Catalin Dumitru, George Noditi, Amadeus Dobrescu, Cristian Paleru and Ana-Olivia Toma

Life 2023, 13(10), 2008; https://doi.org/10.3390/life13102008 - 03 Oct 2023

Cited by 1 | Viewed by 937

Abstract

Anal fistulas often cause significant impairment to patients’ health-related quality of life (HRQOL). This cross-sectional study aimed to compare the HRQOL between patients with anal fistulas with inflammatory bowel disease (IBD) and those without, hypothesizing significant differences in HRQOL scores between these groups. [...] Read more.

Anal fistulas often cause significant impairment to patients’ health-related quality of life (HRQOL). This cross-sectional study aimed to compare the HRQOL between patients with anal fistulas with inflammatory bowel disease (IBD) and those without, hypothesizing significant differences in HRQOL scores between these groups. The secondary objectives were to identify specific aspects of life quality most affected and explore potential variables influencing HRQOL. The study was conducted at the Clinical Emergency Hospital “Pius Brinzeu” in Timisoara, Romania, using a convenience sample of 175 adult patients diagnosed with anal fistulas, stratified into IBD and non-IBD groups. Quality of life was evaluated at initial hospital admission and three months post-treatment using four questionnaires: SF-36, GIQLI, HADS, and the WHOQOL-BREF. Initial SF-36 scores were marginally lower in the IBD group, with mean physical and mental scores of 52.0 and 54.5, respectively. Both groups showed an improvement after intervention, but the mean difference was higher in the IBD group, with an increase of 1.1 in physical score. Initial GIQLI scores were significantly lower in the IBD group (110) compared to the non-IBD group (116). Post-intervention, the mean scores increased to 116 and 121, respectively. HADS scores suggested higher anxiety levels in the non-IBD group (7.5 vs. 6.1), although depression scores were similar. Post-intervention, anxiety scores decreased more substantially in the non-IBD group (−0.9 vs. −0.3). The WHOQOL-BREF scores were lower across all domains for the IBD group at the initial test (physical health: 12.4, psychological health: 14.9, social relationships: 14.4, environment: 13.0). Post-intervention, scores increased marginally in the IBD group (physical health: 12.7, psychological health: 15.9, social relationships: 14.1, environment: 13.8) but varied in the non-IBD group. HRQOL, as measured by multiple questionnaires, is impacted differently in anal fistula patients with and without IBD. These findings highlight the importance of a tailored approach to managing this patient population to improve their quality of life post-treatment. Full article

(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)

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Review

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46 pages, 1355 KiB

Open AccessReview

Short-Chain Fatty Acids and Human Health: From Metabolic Pathways to Current Therapeutic Implications

by Sonia Facchin, Luisa Bertin, Erica Bonazzi, Greta Lorenzon, Caterina De Barba, Brigida Barberio, Fabiana Zingone, Daria Maniero, Marco Scarpa, Cesare Ruffolo, Imerio Angriman and Edoardo Vincenzo Savarino

Life 2024, 14(5), 559; https://doi.org/10.3390/life14050559 - 26 Apr 2024

Viewed by 173

Abstract

The gastrointestinal tract is home to trillions of diverse microorganisms collectively known as the gut microbiota, which play a pivotal role in breaking down undigested foods, such as dietary fibers. Through the fermentation of these food components, short-chain fatty acids (SCFAs) such as [...] Read more.

The gastrointestinal tract is home to trillions of diverse microorganisms collectively known as the gut microbiota, which play a pivotal role in breaking down undigested foods, such as dietary fibers. Through the fermentation of these food components, short-chain fatty acids (SCFAs) such as acetate, propionate, and butyrate are produced, offering numerous health benefits to the host. The production and absorption of these SCFAs occur through various mechanisms within the human intestine, contingent upon the types of dietary fibers reaching the gut and the specific microorganisms engaged in fermentation. Medical literature extensively documents the supplementation of SCFAs, particularly butyrate, in the treatment of gastrointestinal, metabolic, cardiovascular, and gut-brain-related disorders. This review seeks to provide an overview of the dynamics involved in the production and absorption of acetate, propionate, and butyrate within the human gut. Additionally, it will focus on the pivotal roles these SCFAs play in promoting gastrointestinal and metabolic health, as well as their current therapeutic implications. Full article

(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)

14 pages, 3060 KiB

Open AccessReview

Interventional Radiology Locoregional Therapies for Intrahepatic Cholangiocarcinoma

by Gregory Woodhead, Sean Lee, Lucas Struycken, Daniel Goldberg, Jack Hannallah and Shamar Young

Life 2024, 14(2), 217; https://doi.org/10.3390/life14020217 - 02 Feb 2024

Viewed by 1126

Abstract

Surgical resection remains the cornerstone of curative treatment for intrahepatic cholangiocarcinoma (iCCA), but this option is only available to a small percentage of patients. For patients with unresectable iCCA, systemic therapy with gemcitabine and platinum-based agents represents the mainstay of treatment; however, the [...] Read more.

Surgical resection remains the cornerstone of curative treatment for intrahepatic cholangiocarcinoma (iCCA), but this option is only available to a small percentage of patients. For patients with unresectable iCCA, systemic therapy with gemcitabine and platinum-based agents represents the mainstay of treatment; however, the armamentarium has grown to include targeted molecular therapies (e.g., FGFR2 inhibitors), use of adjuvant therapy, liver transplantation in select cases, immunotherapy, and locoregional liver-directed therapies. Despite advances, iCCA remains a challenge due to the advanced stage of many patients at diagnosis. Furthermore, given the improving options for systemic therapy and the fact that the majority of iCCA patients succumb to disease progression in the liver, the role of locoregional therapies has increased. This review will focus on the expanding role of interventional radiology and liver-directed therapies in the treatment of iCCA. Full article

(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)

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12 pages, 1274 KiB

Open AccessReview

Advancements in Microwave Ablation Techniques for Managing Pancreatic Lesions

by Devarshi R. Ardeshna, Matthew Leupold, Zobeida Cruz-Monserrate, Timothy M. Pawlik, Jordan M. Cloyd, Aslam Ejaz, Hamza Shah, Jordan Burlen and Somashekar G. Krishna

Life 2023, 13(11), 2162; https://doi.org/10.3390/life13112162 - 04 Nov 2023

Cited by 1 | Viewed by 1390

Abstract

Thermal ablation, including microwave ablation, has become increasingly important in the management of many solid tumors, including primary and metastatic tumors of the liver, kidney, and lung. However, its adoption to treat pancreatic lesions has been slowed due to concerns about potential adverse [...] Read more.

Thermal ablation, including microwave ablation, has become increasingly important in the management of many solid tumors, including primary and metastatic tumors of the liver, kidney, and lung. However, its adoption to treat pancreatic lesions has been slowed due to concerns about potential adverse events. The success of radiofrequency ablation (RFA) in inoperable pancreatic cancers paved the way for its use in pancreatic neuroendocrine tumors and pancreatic cystic neoplasms (PCLs). In the last decade, other thermal ablation techniques, like microwave ablation, have emerged as alternatives to RFA. Microwaves, with frequencies ranging from 900 to 2450 MHz, generate heat by rapidly oscillating water molecules. Microwave ablation’s advantage lies in its ability to achieve higher intra-lesion temperatures and uniform heating compared with RFA. Microwave ablation’s application in pancreatic cancer and pancreatic neuroendocrine tumors has demonstrated promise with similar technical success to RFA. Yet, concern for peri-procedure complications, as well as a dearth of studies comparing RFA and microwave ablation, emphasize the need for further research. No studies have evaluated microwave ablation in PCLs. We herein review thermal ablation’s potential to treat pancreatic lesions. Full article

(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)

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23 pages, 588 KiB

Open AccessReview

The Role of Intestinal Microbiota in Celiac Disease and Further Therapeutic Perspectives

by Oana Belei, Iulius Jugănaru, Diana-Georgiana Basaca, Andrei Ioan Munteanu and Otilia Mărginean

Life 2023, 13(10), 2039; https://doi.org/10.3390/life13102039 - 11 Oct 2023

Cited by 2 | Viewed by 1585

Abstract

Celiac disease (CD) is an immune-mediated enteropathy caused by exposure to gluten and related prolamins in genetically susceptible individuals. It is a complex genetic disorder with multiple contributing genes. Linkage studies have identified several genomic regions that probably contain CD susceptibility genes. The [...] Read more.

Celiac disease (CD) is an immune-mediated enteropathy caused by exposure to gluten and related prolamins in genetically susceptible individuals. It is a complex genetic disorder with multiple contributing genes. Linkage studies have identified several genomic regions that probably contain CD susceptibility genes. The most important genetic factors are HLA-DQ2 and DQ8. Several known environmental triggers promote the onset of CD at any age after gluten introduction in individuals with a genetic background, such as viral infections and intestinal dysbiosis. Recent publications have described the interference of the intestinal microbiome in gluten metabolism, modulation of local immune reactions, and in maintaining normal gut permeability. These results have promoted further lines of research on the benefit of probiotic administration to prevent disease onset or alleviate clinical symptoms along with a gluten-free diet (GFD). The relationship between gut microbiome changes and the onset of CD is incompletely understood, still being the subject of current research. This narrative review analyzes the interplay between environmental factors, intestinal microbiome alterations, and the course of CD. Furthermore, this review sets out to discuss if modulation of intestinal microflora with pre- and probiotics along with a GFD could represent a reliable therapeutic target for celiac patients. Full article

(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)

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Other

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0 pages, 3045 KiB

Open AccessCase Report

What to Do When There Is Something Unexpected?

by Vlad Sabin Ivan, Daniel-Florin Lighezan, Melania Ardelean, Nicoleta Balteș, Alexandra Corina Faur, Paul-Gabriel Ciubotaru, Adina-Flavia Cutina-Morgovan and Roxana Buzaș

Life 2024, 14(2), 213; https://doi.org/10.3390/life14020213 - 31 Jan 2024

Viewed by 676

Abstract

Background: Myocardial infarction is currently the leading cause of death worldwide, followed by malignant neoplasms. The presence of both within the same patient obviously increases the risk of death, as many coronary events are detected in patients diagnosed with cancer. Diagnosis of an [...] Read more.

Background: Myocardial infarction is currently the leading cause of death worldwide, followed by malignant neoplasms. The presence of both within the same patient obviously increases the risk of death, as many coronary events are detected in patients diagnosed with cancer. Diagnosis of an occult digestive cancer in the acute phase of myocardial infarction is most frequently prompted by a hemorrhagic complication. Case summary: This case features an 81-year-old male patient diagnosed with acute myocardial infarction, treated with primary percutaneous intervention (PCI), who developed post-stenting hemorrhagic complications in the first 24 h due to the presence of two different concomitant malignant neoplasms. The outcome was favorable in the acute phase, even if de-escalation therapy was given immediately post-stenting, and intrastent residual thrombotic risk was high. Conclusions: The presence of bleeding complications in patients with acute myocardial infarction should mobilize resources in search of a neoplastic cause, especially a digestive one. However, other locations should be looked for, depending on the source of bleeding. Full article

(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)

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10 pages, 10595 KiB

Open AccessCase Report

Collision Tumors of the Colon and Peritoneum: Signet-Ring Cell Carcinoma and Granular Cell Tumor

by Dorela-Codruta Lazureanu, Denisa Anderco, Sorin Dema, Aura Jurescu, Remus Cornea, Octavia Vita, Bogdan Tunescu and Sorina Taban

Life 2023, 13(12), 2263; https://doi.org/10.3390/life13122263 - 27 Nov 2023

Viewed by 828

Abstract

Collision tumors, although rare, characterized by two distinctive (morphological, as well immunohistochemical) and spatially independent tumor components at the same location, are always puzzling for clinicians, pathologists, and patients because they do not fit into the usual approaches, being neither diagnostic nor therapeutic. [...] Read more.

Collision tumors, although rare, characterized by two distinctive (morphological, as well immunohistochemical) and spatially independent tumor components at the same location, are always puzzling for clinicians, pathologists, and patients because they do not fit into the usual approaches, being neither diagnostic nor therapeutic. Reviewing the specialized literature, to date, collision tumors have been reported in multiple locations such as the skin, esophagus, stomach, intestine, liver, kidney, bladder, adrenal gland, or thyroid. We report a case of coexistence at the same site of a malignant tumor of the ascending colon and a benign tumor emerging from the peritoneal lining, initially thought by the surgeon to be right-sided serosal carcinomatosis. But histopathological examination reveals that those multiple serosal nodules were benign granular cell tumors that have collided with highly aggressive transparietal signet-ring colon carcinoma. These results put the patient’s prognosis and therapeutic strategy in a different light than the clinical and intraoperative evaluation. Full article

(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)

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13 pages, 2247 KiB

Open AccessCase Report

Chronic Diarrhea Caused by Vasoactive Intestinal Peptide-Secreting Tumor

by Oana Belei, Diana-Georgiana Basaca, Elena Rodica Heredea, Emil Radu Iacob, Laura Olariu, Roxana Folescu, Andrei Gheorghe Marius Motoc, Anda-Maria Nanu and Otilia Mărginean

Life 2023, 13(10), 1974; https://doi.org/10.3390/life13101974 - 27 Sep 2023

Viewed by 1042

Abstract

VIPomas are a type of neuroendocrine tumor that independently produces vasoactive intestinal peptide (VIP). VIPomas causing watery diarrhea, hypokalemia, and achlorhydria (WDHA) syndrome are not frequently observed in adult patients without pancreatic ailments. However, in children, the occurrence of a VIPoma originating in [...] Read more.

VIPomas are a type of neuroendocrine tumor that independently produces vasoactive intestinal peptide (VIP). VIPomas causing watery diarrhea, hypokalemia, and achlorhydria (WDHA) syndrome are not frequently observed in adult patients without pancreatic ailments. However, in children, the occurrence of a VIPoma originating in the pancreas is exceedingly uncommon. Instead, WDHA syndrome is more commonly associated with neurogenic tumors that secrete VIP, often located in the retroperitoneum or mediastinum. Among infants, chronic diarrhea is a prevalent issue that often necessitates the attention of pediatric gastroenterologists. The underlying causes are diverse, and delays in arriving at a definitive diagnosis can give rise to complications affecting the overall well-being of the child. The authors present the case of an infant with chronic watery diarrhea, subocclusion manifestations, mild hypokalemia, and metabolic hyperchloremic acidosis secondary to a VIPoma in the retroperitoneum that was diagnosed via abdominal ultrasound and tomography. The laboratory results revealed lowered potassium levels and an excessive secretion of VIP. Following the surgical removal of the tumor, the diarrhea resolved, and both electrolyte levels and the imbalanced hormone levels returned to normal. Immunohistochemical examination confirmed the diagnosis of ganglioneuroblastoma, with N-MYC negative on molecular biology tests. We present the clinical and histo-genetic aspects of this rare clinical entity, with a literature review. Full article

(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)

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