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Medicina
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Evolving Concepts in Clinical Gastroenterology
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Evolving Concepts in Clinical Gastroenterology

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (1 October 2021) | Viewed by 10202

Special Issue Editor

Prof. Dr. Anca Trifan

E-Mail Website
Guest Editor
1. Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
2. Institute of Gastroenterology and Hepatology, "St. Spiridon" University Hospital, Iasi, Romania
Interests: acute and chronic liver disease; steatohepatitis; liver transplantation; inflammatory bowel disease; celiac disease; endomicroscopy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The last two decades of medical research have changed our understanding of many gastrointestinal and hepatic diseases; many therapeutic revolutions altered the treatment targets and drastically improved our patients’ outcomes. Conditions such as liver cirrhosis, considered an irreversible end stage disease, are today understood as potentially reversible in the early phase if the offensive cause is timely removed. The unbelievable rate of sustained virologic response in hepatitis C virus infection obtained with direct acting antivirals modifies the entire approach to this disease, from a patient based one to a societal approach; today we speak less about patient cure and more about hepatitis C elimination at the global level. The potent therapeutical armamentarium available for inflammatory bowel disease changed our treatment goals and strategy: “Treat to target” became the recommended approach, mucosal healing is no longer enough and histological healing is now desired. Microbiota manipulation by different methods (antibiotics, probiotics, fecal transplantation) is expected to change the natural history of many gastrointestinal disorders. Fecal transplantation aims to become a standardized method for treatment of several conditions; many efforts have been made to make the procedure safer and to change it into an anonymous “pill” or suppository administration. I can add many facts which have changed gastroenterology and hepatology in recent years. I think that all of the above could inspire you to contribute to this special issue of Medicina.

Prof. Anca Trifan
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • elimination of hepatitis C virus infection
  • reversal of liver cirrhosis
  • inflammatory bowel disease
  • treat to target
  • mucosal healing
  • histologic healing
  • fecal transplantation

Published Papers (5 papers)

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Research

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10 pages, 2423 KiB  
Article
L3 Skeletal Muscle Index Dynamics in Patients with HCV-Related Compensated Cirrhosis Following Sustained Virological Response after Direct Acting Antiviral Treatment
by Florin Mihai, Anca Trifan, Carol Stanciu, Laura Huiban, Cristina Muzîca, Corina Lupașcu-Ursulescu, Dragoș Negru, Marius Lucian Savin, Irina Gîrleanu, Tudor Cuciureanu and Ana Maria Sîngeap
Medicina 2021, 57(11), 1226; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111226 - 10 Nov 2021
Cited by 4 | Viewed by 1432
Abstract
Background and Objectives: Sarcopenia is commonly associated with liver cirrhosis and predicts clinical outcome. Our aim was to identify the changes in skeletal muscle index (SMI) on computed tomography (CT) examination, as a quantitative marker of sarcopenia, in patients with HCV-related cirrhosis [...] Read more.
Background and Objectives: Sarcopenia is commonly associated with liver cirrhosis and predicts clinical outcome. Our aim was to identify the changes in skeletal muscle index (SMI) on computed tomography (CT) examination, as a quantitative marker of sarcopenia, in patients with HCV-related cirrhosis after direct acting antivirals (DAAs) treatment and to assess predictive factors for the evolution of SMI. Materials and Methods: This is a single center retrospective study in patients with HCV-related compensated cirrhosis who obtained sustained virological response (SVR) after DAAs. CT examinations were performed in 52 patients before and within 5–24 months after treatment. The total muscle area (TMA) of abdominal muscle at the level of third lumbar vertebra (L3) was measured at baseline and after SVR. The L3-SMI was calculated from TMA divided by body height squared (cm2/m2). We assessed changes in L3-SMI after SVR according to baseline body mass index (BMI) and laboratory data. Predictive factors were assessed by linear regression model. Results: Patients with L3-SMI above the gender-specific cut-off value at baseline had higher values of serum creatinine (median 0.73) compared to patients with low L3-SMI (median 0.68, p = 0.031). After SVR, 14 patients showed increase of L3-SMI, and 38 patients had a decrease of L3-SMI. BMI in the decreased L3-SMI group was significantly lower (median 26.17) than those without decreased L3-SMI (median 28.84, p = 0.021). ALT values in the decreased L3-SMI group (median 66.5) were significantly lower than those without a decrease in L3-SMI (median 88, p = 0.045). Conclusions: Low creatinine serum level correlates with sarcopenia. SMI was partially influenced by the viral clearance. Lower BMI and ALT serum levels at baseline were predictive for no benefit in terms of muscle mass dynamics. Understanding all the mechanisms involved in sarcopenia and identifying the most vulnerable patients could ensure optimal adapted care strategies. Full article
(This article belongs to the Special Issue Evolving Concepts in Clinical Gastroenterology)
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12 pages, 1220 KiB  
Article
Role of PNPLA3 in the Assessment and Monitoring of Hepatic Steatosis and Fibrosis in Patients with Chronic Hepatitis C Infection Who Achieved a Sustained Virologic Response
by Oana Irina Gavril, Lidia Iuliana Arhire, Otilia Gavrilescu, Mihaela Dranga, Oana Barboi, Radu Sebastian Gavril, Roxana Popescu, Cristina Cijevschi Prelipcean, Anca-Victorita Trifan and Catalina Mihai
Medicina 2021, 57(11), 1153; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111153 - 24 Oct 2021
Cited by 2 | Viewed by 1478
Abstract
Background and Objectives: Hepatic diseases are an important public health problem. All patients with chronic hepatitis C virus (HCV) infection receive treatment, regardless of hepatic fibrosis severity. However, evaluation of hepatic fibrosis and steatosis is still useful in assessing evolution, prognosis and [...] Read more.
Background and Objectives: Hepatic diseases are an important public health problem. All patients with chronic hepatitis C virus (HCV) infection receive treatment, regardless of hepatic fibrosis severity. However, evaluation of hepatic fibrosis and steatosis is still useful in assessing evolution, prognosis and monitoring of hepatic disease, especially after treatment with direct-acting antivirals (DAAs). The aim of this study was to assess the link between patatin-like phospholipase domain-containing 3 (PNPLA3) polymorphism and the degree of hepatic steatosis and fibrosis in patients with chronic HCV infection, as well as changes in steatosis and fibrosis three monthsafter obtaining a sustained viral response (SVR). Materials and Methods:Ourstudy included 100 patients with chronic hepatitis C (CHC) infection and compensated cirrhosis who received DAA treatment and who were evaluated using Fibromax prior to and 3 months after SVR. The influence of PNPLA3 (CC, CG, GG) genotype among these patients on the degree of post-treatment regression of steatosis and fibrosis was assessed. Results: Regression was noticed in the degree of both hepatic steatosis and hepatic fibrosis post-DAA treatment (three months after SVR). Analysis of the correlation between PNPLA3 genotype and fibrosis indicated that the average level of fibrosis (F) before DAA treatment was higher in patients with the GG genotype than in patients with the CC or CG genotype. Three months after SVR, the average level of fibrosis decreased; however, it remained significantly increased in GG subjects compared to that in CC or CG patients. The degree of hepatic steatosis before treatment was not significantly different among patients with different PNPLA3 genotypes, and no significant correlations were observed three months after SVR. Conclusions: The genetic variants of PNPLA3 influence the evolution of hepatic fibrosis. The GG subtype plays an important role in the degree of hepatic fibrosis both before and after treatment (three months after SVR)and could be a prognostic marker for assessment of post-SVR evolution. Full article
(This article belongs to the Special Issue Evolving Concepts in Clinical Gastroenterology)
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12 pages, 502 KiB  
Article
Anemia in Crohn’s Disease—The Unseen Face of Inflammatory Bowel Disease
by Mihaela Dranga, Lucian Vasile Boiculese, Iolanda Valentina Popa, Mariana Floria, Oana Irina Gavril, Oana-Bogdana Bărboi, Anca Trifan, Cristina Cijevschi Prelipcean, Cătălina Mihai and Otilia Gavrilescu
Medicina 2021, 57(10), 1046; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57101046 - 30 Sep 2021
Cited by 1 | Viewed by 1968
Abstract
Background and Objectives: Anemia is the most frequent complication of inflammatory bowel diseases. Clinically, anemia can affect important quality-of-life (QoL) components, such as exercise capacity, cognitive function, and the ability to carry out social activities. The disease activity has a significant impact [...] Read more.
Background and Objectives: Anemia is the most frequent complication of inflammatory bowel diseases. Clinically, anemia can affect important quality-of-life (QoL) components, such as exercise capacity, cognitive function, and the ability to carry out social activities. The disease activity has a significant impact on QoL, mainly due to clinical manifestations, which are more severe during the periods of disease activity. Our aim was to estimate the impact of anemia on QoL in patients with Crohn’s disease. Material and Methods. We made a prospective study on 134 patients with Crohn’s disease (CD) in a Romanian tertiary center. The CD diagnosis was established by colonoscopy and histopathological examination. In particular cases, additional examinations were required (small bowel capsule endoscopy, computed tomography enterography, and magnetic resonance enterography). Anemia was defined according to the World Health Organization’s definition, the activity of the disease was assessed by Crohn’s disease activity index (CDAI) score, and the QoL was evaluated by Inflammatory Bowel Disease Questionnaire 32 (IBDQ 32). Results: 44.8% patient had anemia, statistically related to the activity of the disease and corticoids use. We found a strong association between QoL and disease activity on all four sub-scores: patients with more severe activity had a significantly lower IBDQ (260.38 ± 116.96 vs. 163.85 ± 87.20, p = 0.001) and the presence of anemia (127.03 vs. 148.38, p = 0.001). In multiple regression analyses, both disease activity and anemia had an impact on the QoL. Conclusions: Anemia has high prevalence in the CD in northeastern region of Romania. Anemia was more common in female patients, in patients undergoing corticosteroid treatment, and in those with active disease. Both anemia and disease activity had a strong negative and independent impact on QoL. Full article
(This article belongs to the Special Issue Evolving Concepts in Clinical Gastroenterology)
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9 pages, 300 KiB  
Article
The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort
by Irina Girleanu, Anca Trifan, Laura Huiban, Cristina Muzica, Roxana Nemteanu, Andreea Teodorescu, Ana Maria Singeap, Camelia Cojocariu, Stefan Chiriac, Oana Petrea, Sebastian Zenovia, Robert Nastasa, Tudor Cuciureanu and Carol Stanciu
Medicina 2021, 57(9), 964; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57090964 - 13 Sep 2021
Cited by 3 | Viewed by 1696
Abstract
Background and Objectives: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Antibiotic prophylaxis is effective but can lead to an increased incidence of Clostridioides difficile infection (CDI). The aim of this study was to evaluate the incidence of CDI [...] Read more.
Background and Objectives: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Antibiotic prophylaxis is effective but can lead to an increased incidence of Clostridioides difficile infection (CDI). The aim of this study was to evaluate the incidence of CDI and the risk factors in cirrhotic patients with a previous episode of SBP receiving norfloxacin as secondary prophylaxis. Materials and Methods: We performed a prospective, cohort study including patients with liver cirrhosis and SBP, successfully treated over a 2-year period in a tertiary university hospital. All the patients received secondary prophylaxis for SBP with norfloxacin 400 mg/day. Results: There were 122 patients with liver cirrhosis and SBP included (mean age 57.5 ± 10.8 years, 65.5% males). Alcoholic cirrhosis was the major etiology accounting for 63.1% of cases. The mean MELD score was 19.7 ± 6.1. Twenty-three (18.8%) of all patients developed CDI during follow-up, corresponding to an incidence of 24.8 cases per 10,000 person-years. The multivariate Cox regression analysis demonstrated that alcoholic LC etiology (HR 1.40, 95% CI 1.104–2.441, p = 0.029) and Child-Pugh C class (HR 2.50, 95% CI 1.257–3.850, p = 0.034) were independent risk factors for CDI development during norfloxacin secondary prophylaxis. The development of CDI did not influence the mortality rates in cirrhotic patients with SBP receiving norfloxacin. Conclusions: Cirrhotic patients with SBP and Child-Pugh C class and alcoholic liver cirrhosis had a higher risk of developing Clostridioides difficile infection during norfloxacin secondary prophylaxis. In patients with alcoholic Child-Pugh C class liver cirrhosis, alternative prophylaxis should be evaluated as SBP secondary prophylaxis. Full article
(This article belongs to the Special Issue Evolving Concepts in Clinical Gastroenterology)

Review

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8 pages, 18094 KiB  
Review
Rare Clinical Association between Clostridioides difficile Infection and Ischemic Colitis: Case Report and Literature Review
by Elena Mirela Ionescu, Ana-Maria Curte, Andrei Ovidiu Olteanu, Carmen Monica Preda, Ioana Tieranu, Artsiom Klimko and Cristian George Tieranu
Medicina 2021, 57(7), 705; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57070705 - 11 Jul 2021
Cited by 1 | Viewed by 2792
Abstract
Background and Objectives: Gut microbiota plays an important role in the wellbeing of the host through different interactions between microflora constituents. In certain instances, Clostridioides difficile may pullulate, causing infection with associated colitis that may vary in terms of severity from mild disease [...] Read more.
Background and Objectives: Gut microbiota plays an important role in the wellbeing of the host through different interactions between microflora constituents. In certain instances, Clostridioides difficile may pullulate, causing infection with associated colitis that may vary in terms of severity from mild disease to severe colitis, with increased associated mortality due to its complications. However, there are few literature data regarding the association between Clostridioides difficile and ischemic colitis. Case report: We report the case of a 30-year-old male patient, overweight, with impending dehydration, who presented with hematochezia and colicky abdominal pain, with positive fecal tests for the detection of Clostridioides difficile infection and endoscopic appearance suggesting ischemic colitis in the sigmoid and left colon, confirmed by computed tomography and histology. The patient was treated with oral Vancomycin, with resolution of symptoms, and was reevaluated through colonoscopy eight weeks after discharge, with endoscopic mucosal normalization and histological scarring process on biopsy samples. Conclusion: We report one of the few cases in the literature of ischemic colitis associated with Clostridioides difficile infection, with resolution of clinical, endoscopic, and histologic changes after specific treatment with oral Vancomycin suggesting a possible association between the two diseases. We also review the existing literature data regarding this comorbid association. Full article
(This article belongs to the Special Issue Evolving Concepts in Clinical Gastroenterology)
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