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Gastroenterol. Insights, Volume 11, Issue 2 (December 2020) – 6 articles

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14 pages, 831 KiB  
Review
Laboratory Assessment of Disease Activity in Pediatric Patients with Inflammatory Bowel Disease: What’s New?
by Rayna Shentova-Eneva and Tsvetelina Velikova
Gastroenterol. Insights 2020, 11(2), 58-71; https://0-doi-org.brum.beds.ac.uk/10.3390/gastroent11020009 - 21 Dec 2020
Cited by 1 | Viewed by 4597
Abstract
Laboratory tests are an integral part of both the diagnostic and follow-up algorithm of patients with inflammatory bowel disease (IBD). Their advantages over other non-invasive methods for assessing disease activity are greater objectivity than clinical activity indices and imaging studies. This review aims [...] Read more.
Laboratory tests are an integral part of both the diagnostic and follow-up algorithm of patients with inflammatory bowel disease (IBD). Their advantages over other non-invasive methods for assessing disease activity are greater objectivity than clinical activity indices and imaging studies. This review aims to analyze shortly the most common laboratory tests used to assess disease activity in pediatric patients with IBD. In addition to the conventional blood and serum markers that are not specific for gut inflammation, although routinely used, we also reviewed the established fecal markers such as calprotectin, lactoferrin, M2-pyruvate kinase, osteoprotegerin, HMGB1, chitinase 3-like 1, and the promising non-coding microRNA. In conclusion, neither marker is unique to the pediatric IBD. More clinical data are required to assess biomarkers’ full potential for diagnosis, management, and follow-up of pediatric IBD patients. Full article
(This article belongs to the Section Gastrointestinal Disease)
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11 pages, 1000 KiB  
Article
Inflammatory Bowel Diseases and Coexisting Spondyloarthritis: A Neglected and too Often Under-Reported Association by Radiologists. A Multicenter Study by Italian Research Group of Imaging in Rheumatology
by Maria Antonietta Mazzei, Francesco Gentili, Susanna Guerrini, Nunzia Di Meglio, Giuseppe Lo Re, Marina Carotti, Francesca Interlicchia, Alfonso Reginelli, Antonio Barile, Giulia Sadotti, Ubaldo Plastina Romeo, Ernesto La Paglia, Nicola Maggialetti, Rita Lo Scalzo, Alessia Vinci, Giuseppe Capodieci, Giovanna Vacca, Federico Bruno, Luca Cantarini, Bruno Frediani, Antonio Marchesoni, Andrea Giovagnoni, Luca Volterrani and Luca Bruneseadd Show full author list remove Hide full author list
Gastroenterol. Insights 2020, 11(2), 47-57; https://0-doi-org.brum.beds.ac.uk/10.3390/gastroent11020008 - 15 Dec 2020
Cited by 2 | Viewed by 2395
Abstract
Purpose: The purpose of this study was to evaluate the prevalence and the underreporting rate of sacroiliitis (SI) in a large cohort of patients with biopsy-proved Crohn’s disease (CD) who underwent magnetic resonance enterography (MRE) or computed tomography enterography (CTE). Materials and Methods: [...] Read more.
Purpose: The purpose of this study was to evaluate the prevalence and the underreporting rate of sacroiliitis (SI) in a large cohort of patients with biopsy-proved Crohn’s disease (CD) who underwent magnetic resonance enterography (MRE) or computed tomography enterography (CTE). Materials and Methods: Patients with CD were recruited from eight Italian health centers in the period from January 2013 to December 2017. Disease activity was recorded according to the CD activity index (CDAI). The scans were read by two blinded readers who defined the presence of SI according to Assessment of SpondyloArthritis International Society (ASAS) classifications and European League Against Rheumatism (EULAR) recommendations. Moreover, SI was scored using a simplified Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. Results: Interobserver agreement in diagnosing SI on imaging was good (K = 0.72–0.83). SI was diagnosed in 129 (14.4%, 54 men, 75 women) out of 894 patients; however, sacroiliac joint (SIJ) abnormalities were not mentioned in the radiological reports of 112 patients (86%). Fifty (38.7%) out of 129 patients also underwent a subsequent SIJ evaluation through a dedicated MRI protocol to confirm SI. SI was found in a higher percentage of patients with “active” than “inactive” CD (18% vs. 4%). Conclusion: This study confirms the feasibility of CTE and MRE for the screening of SI in CD patients; however, it also underlines the remarkable problem concerning the underreporting of this entity in radiological practice. Full article
(This article belongs to the Section Gastrointestinal Disease)
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11 pages, 487 KiB  
Article
Prediction of Postoperative Infection for Patients Undergoing Gastrointestinal Surgery: Findings from Electronic Health Records
by Kyoko Nakazawa, Takashi Ishikawa, Akira Toyama, Toshifumi Wakai and Kohei Akazawa
Gastroenterol. Insights 2020, 11(2), 36-46; https://0-doi-org.brum.beds.ac.uk/10.3390/gastroent11020007 - 19 Nov 2020
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Abstract
Introduction: Postoperative infection is a major cause of morbidity and prolonged hospitalization in patients undergoing gastrointestinal surgery. This observational study aimed to investigate the risk factors associated with postoperative infection and to develop a prediction model for postoperative infections that occur after gastrointestinal [...] Read more.
Introduction: Postoperative infection is a major cause of morbidity and prolonged hospitalization in patients undergoing gastrointestinal surgery. This observational study aimed to investigate the risk factors associated with postoperative infection and to develop a prediction model for postoperative infections that occur after gastrointestinal surgery. Methods: The study population comprised 1637 patients who underwent gastrointestinal surgery at Niigata University Medical and Dental Hospital between June 2013 and May 2017. Observational data from 1883 surgical procedures were used in the statistical analyses (including 198 patients who underwent several operations). Results: The generalized estimating equation (GEE) was used to detect significant risk factors, including older age, history of smoking, body temperature greater than 38 °C, non-endoscopic surgical procedures, surgery in the thoracic or lower gastrointestinal tract, and use of medical nutritional products during surgery. The sensitivity and specificity of the GEE model were 88.2% and 55.1%, respectively. Conclusion: This study established a predictable GEE model, incorporating the data of patients who were hospitalized several times into a prediction analysis, even though the sensitivity was not sufficiently high. The GEE model, which is considered clinically useful, can be constructed using a variety of variables, including those obtained from electronic health records. Full article
(This article belongs to the Section Gastrointestinal Disease)
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9 pages, 274 KiB  
Article
Pediatric Ulcerative Colitis in Kazakhstan: First Case Series from Central Asia and Current Clinical Management
by Dimitri Poddighe, Aigerim Telman, Ernas Tuleutayev and Aigul Ibrayeva
Gastroenterol. Insights 2020, 11(2), 27-35; https://0-doi-org.brum.beds.ac.uk/10.3390/gastroent11020006 - 14 Nov 2020
Cited by 5 | Viewed by 2214
Abstract
The diagnoses of ulcerative colitis have increased in pediatric patients in the last two decades. Whereas there are several reports from most areas of the world, no clinical studies describing the clinical management of pediatric ulcerative colitis are currently available from Central Asia. [...] Read more.
The diagnoses of ulcerative colitis have increased in pediatric patients in the last two decades. Whereas there are several reports from most areas of the world, no clinical studies describing the clinical management of pediatric ulcerative colitis are currently available from Central Asia. In this article, we first describe a case series of pediatric patients affected with ulcerative colitis in Kazakhstan. This is a retrospective study including 25 consecutive pediatric patients diagnosed with ulcerative colitis in a tertiary pediatric hospital. The available demographic, clinical, hematological and inflammatory parameters at diagnosis and at the first one-year follow-up have been provided and analyzed. Most pediatric patients diagnosed with ulcerative colitis were older than 12 years, with prevalence of male gender. The analysis of clinical, laboratory, endoscopic parameters at the diagnosis suggested a significant diagnostic delay compared to developed countries; however, most of them showed clinical, laboratory and endoscopic improvements at the one-year follow-up. Even though the therapeutic approach and outcomes resulted to be consistent with other clinical studies from developed countries, several aspects of the medical follow-up should be improved, especially in pediatric patients with extensive disease. Full article
(This article belongs to the Section Gastrointestinal Disease)
7 pages, 1297 KiB  
Communication
Diagnosis and Treatment of Acute Pancreatitis Due to Hypertriglyceridemia in Italy: A Survey among Physicians of the Italian Association for the Study of the Pancreas: A Brief Report
by Raffaele Pezzilli
Gastroenterol. Insights 2020, 11(2), 20-26; https://0-doi-org.brum.beds.ac.uk/10.3390/gastroent11020005 - 26 Oct 2020
Viewed by 2211
Abstract
Introduction: The Italian Association for the Study of the Pancreas promoted a survey on exploring the point of view of Italian pancreatologists regarding the diagnosis and the treatment of acute pancreatitis (AP) due to hypertriglyceridemia (HAP). Method: A questionnaire was administered, and it [...] Read more.
Introduction: The Italian Association for the Study of the Pancreas promoted a survey on exploring the point of view of Italian pancreatologists regarding the diagnosis and the treatment of acute pancreatitis (AP) due to hypertriglyceridemia (HAP). Method: A questionnaire was administered, and it contained four sections regarding epidemiological characteristics of the participants, how the participants arrived at a diagnosis of the disease, how they treated familial hypertriglyceridemia, and whether they knew of the new drugs developed for the treatment of this disease. Definition of AP and HAP: In this survey, all participants followed this definition of AP: The diagnosis of AP requires two of the following three features: abdominal pain consistent with acute pancreatitis (acute onset of a persistent and severe epigastric pain, often radiating to the back); serum pancreatic enzymes at least three times greater than the upper limit of normal; and characteristic findings of acute pancreatitis using imaging techniques. On the other hand, HAP is characterized by serum triglyceride concentration of >1000 mg/dL as the diagnostic cut-off, even though a value of >500 mg/dL has been used for a more inclusive definition, since moderately elevated triglyceride levels have also been suggested as a risk factor for AP. Results. Nine percent of all managed patients with AP had HAP; 5.0 ± 7.7 patients per year had a recurrence of HAP, and the number of recurrences was about one. A diagnosis of hypertriglyceridemia was made by the majority of Italian physicians due to the presence of elevated serum triglycerides at a level of ≥880 mg/dL. Twenty-five physicians treated their patients with fibrates, 23 with statins, 11 with omega-3, one with medium-chain triglycerides, and six with plasmapheresis. Finally, fewer than 50% of the physicians knew of the new drugs to treat dyslipidemia. Conclusions: The results of this survey show that an educational program is important, and we also need an Italian National Registry both for improving knowledge regarding this disease and for identifying the causal factors in our country. Full article
(This article belongs to the Section Pancreas)
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9 pages, 14909 KiB  
Article
Extracapsular Extension Does Not Decrease Overall Survival in Rectal Cancer Patients with Lymph Node Metastasis Following Neoadjuvant Chemoradiotherapy
by Leonardo S. Lino-Silva, Carmen I. Sánchez-Acosta, Rosa A. Salcedo-Hernández and César Zepeda-Najar
Gastroenterol. Insights 2020, 11(2), 11-19; https://0-doi-org.brum.beds.ac.uk/10.3390/gastroent11020004 - 22 Oct 2020
Cited by 3 | Viewed by 2184
Abstract
Background. The Tumor-Node-Metastasis system does not include additional prognostic factors present in the Lymph Node Metastasis (LNM) such as extra-capsular extension (ECE), which is associated with decreased survival. There are not studies addressing this topic in rectal cancer patients with preoperative chemoradiotherapy [...] Read more.
Background. The Tumor-Node-Metastasis system does not include additional prognostic factors present in the Lymph Node Metastasis (LNM) such as extra-capsular extension (ECE), which is associated with decreased survival. There are not studies addressing this topic in rectal cancer patients with preoperative chemoradiotherapy (nCRT) and total mesorectal excision (TME). Aim. We aimed to examine the survival influence of ECE in patients with stage III rectal cancer who received nCRT followed by surgery. Methods. A retrospective study of 126 patients prospectively collected with rectal cancer in clinical stage III rated with nCRT and TME from 2010 to 2015 was performed. Results. In total, 71.6% of cases had 1 to 3 lymph node metastases, most tumors were grade 2 (52.4%), 25.4% had good pathologic response, 77.8% had a good quality TME, and the median tumor budding count was 4/0.785 mm2. Forty-four (34.9%) patients had ECE+, which was associated with a higher nodal stage (pN2), perineural invasion and a higher lymph node retrieval. The factors associated with the survival were a higher pathologic T stage, higher pathological N stage, high-grade tumors, and perineural invasion. The ECE did not decrease the 5–year survival with a similar median survival (86.5 months for the ECE+ group vs. 84.1 for the ECE–). Conclusion. Our results demonstrate that ECE has no impact on overall survival in rectal cancer patients who received nCRT and this was independent of nodal stage or number of lymph nodes examined. Full article
(This article belongs to the Section Gastrointestinal Disease)
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