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Topic Review
Pancreatic Neuroendocrine Tumors and Management
The growing importance of advanced endoscopy in the diagnosis and treatment of pancreatic neuroendocrine neoplasms (PanNETs) necessitates a comprehensive understanding of various biochemical markers, genetic testing methods, radiological techniques, and treatment approaches that encompass multiple disciplines within and beyond gastrointestinal oncology.
  • 495
  • 16 Aug 2023
Topic Review
Gut Microbiota and NAFLD Development
NAFLD, the most common liver disorder in the Western world, is characterized by intrahepatic lipid accumulation; is highly prevalent in the aging population; and is closely associated with obesity, insulin resistance, hypertension, and dyslipidemia.
  • 492
  • 23 Sep 2022
Topic Review
NAFLD and Reduced Bone Mineral Density
Non-alcoholic fatty liver disease (NAFLD) is reaching epidemic proportions worldwide. Moreover, the prevalence of this liver disease is expected to increase rapidly in the near future, aligning with the rise in obesity and the aging of the population. The pathogenesis of NAFLD is considered to be complex and to include the interaction between genetic, metabolic, inflammatory, and environmental factors. It is well documented that NAFLD is linked to the other conditions common to insulin resistance, such as abnormal lipid levels, metabolic syndrome, and type 2 diabetes mellitus. Additionally, it is considered that the insulin resistance may be one of the main mechanisms determining the disturbances in both bone tissue metabolism and skeletal muscles quality and functions in patients with NAFLD. 
  • 480
  • 29 May 2023
Topic Review
Estrobolome and Hepatocellular Adenomas
Hepatocellular adenoma (HCA) or hepatic adenoma is defined as a benign liver lesion, seen in patients with excessive exposure to estrogen (the higher the dose of estrogen therapy, the higher the risk of HCA), genetic and metabolic syndromes or who have undergone anabolic androgen therapy. It is known that the estrobolome plays an important role in the human endocrine system; specifically relevant in the metabolization of estrogen are bacterial species producing β-glucuronidase (GUS) enzymes.
  • 480
  • 20 Nov 2023
Topic Review
New Scenarios of Systemic Therapy for Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is the fifth neoplasm in the world and the fourth leading cause of death from cancer. Treatment options for early stage HCC include potentially curative techniques such as liver transplantation (LT), liver resection (LR) and radiofrequency ablation (RFA). The advent of immunotherapy in HCC treatment has significantly improved the rate of response to systemic therapy and could offer the rationale for adjuvant and/or neoadjuvant therapeutic schemes also in the management of liver neoplasms. 
  • 476
  • 07 Jun 2023
Topic Review
Non-Alcoholic Fatty Liver Disease Patients
Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of disorders ranging from simple steatosis to non-alcoholic steatohepatitis (NASH). Hepatic steatosis may result from the dysfunction of multiple pathways and thus multiple molecular triggers involved in the disease have been described. The development of NASH entails the activation of inflammatory and fibrotic processes. Furthermore, NAFLD is also strongly associated with several extra-hepatic comorbidities, i.e., metabolic syndrome, type 2 diabetes mellitus, obesity, hypertension, cardiovascular disease and chronic kidney disease. Due to the heterogeneity of NAFLD presentations and the multifactorial etiology of the disease, clinical trials for NAFLD treatment are testing a wide range of interventions and drugs, with little success. A review is given to the different phenotypic characteristics of NAFLD patients, whose disease may be triggered by different agents and driven along different pathophysiological pathways. Thus, correct phenotyping of NAFLD patients and personalized treatment is an innovative therapeutic approach that may lead to better therapeutic outcomes.
  • 476
  • 14 Jul 2023
Topic Review
The Role of IL-23 Inhibitors in Crohn’s Disease
Promoting a Th17 pathogenic response, the interleukin (IL)-23 pathway is crucial in the pathophysiology of inflammatory bowel disease (IBD). With a favorable safety profile, ustekinumab, a monoclonal antibody targeting the shared p40 component of IL-12/23, is currently approved for the treatment of IBD in patients with disease refractory to corticosteroids and biologic drugs. Risankizumab, mirikizumab, and guselkumab are specific IL-23p19 antagonists tested for the treatment of Crohn’s disease (CD). However, only risankizumab currently has been approved for its treatment. Trials with guselkumab and mirikizumab are currently ongoing, with promising preliminary efficacy and safety results.
  • 472
  • 11 Jan 2024
Topic Review
Artificial Intelligence in Polyp Detection
There has been an exponential rise in the availability of artificial intelligence systems in endoscopy. As a result, maintaining an informed understanding of the utility and efficacy of existing systems has become increasingly complex. 
  • 470
  • 06 Nov 2023
Topic Review
Biologic Therapy for Inflammatory Bowel Disease Patients
Many patients with inflammatory bowel disease (IBD) experience a loss of effectiveness to biologic therapy (i.e., anti-TNF therapy, etc.). Therefore, in addition to the adverse effects of the treatment, these patients also face failure to achieve and maintain remission. Immunogenicity, the process of production of antibodies to biological agents, is fundamental to the evolution of loss of response to treatment in IBD patients.
  • 470
  • 07 Mar 2024
Topic Review
Endoscopic Ultrasound-Guided Chemoablative Techniques for Pancreatic Cystic Lesions
Pancreatic cystic lesions (PCLs) are known precursors to pancreatic cancer, one of the deadliest types of cancer worldwide. Surgical removal or pancreatectomies remain the central approach to managing precancerous high-risk PCLs. Endoscopic ultrasound (EUS)-guided therapeutic management of PCLs is a novel management strategy for patients with prohibitive surgical risks. Various ablation techniques have been explored utilizing EUS-guided fine needle injection (FNI) of alcohol and chemotherapeutic agents.
  • 468
  • 14 Jul 2023
Topic Review
The Role of Cholangioscopy in Biliary Diseases
Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). 
  • 464
  • 25 Sep 2023
Topic Review
Low-Dose Alcohol Consumption on Chronic Liver Disease
Although alcohol is one of the most important etiologic agents in the development of chronic liver disease worldwide, also recognized as a promoter of carcinogenesis, several studies have shown a beneficial effect of moderate consumption in terms of reduced cardiovascular morbidity and mortality. Whether this benefit is also present in patients with liver disease due to other causes (viral, metabolic, and others) is still debated. Although there is no clear evidence emerging from guidelines and scientific literature, total abstention from drinking is usually prescribed in clinical practice.
  • 452
  • 06 Mar 2024
Topic Review
Role of Nutrition in Alcoholic Liver Disease
Alcoholic liver disease (ALD) has different stages as it develops, and the severity of ALD is correlated with malnutrition.
  • 450
  • 25 Apr 2023
Topic Review
Surveillance and Diagnosis of NAFLD-Related Hepatocellular Carcinoma
With the significant achievements in eradicating the hepatitis C virus by direct-acting antiviral agents and the rising epidemic of obesity, diabetes mellitus, and metabolic syndrome, there is a paradigm shift in the leading cause of liver cirrhosis and cancer to nonalcoholic fatty liver disease (NAFLD). Data highlight the rapidly rising incidence of NAFLD-related hepatocellular carcinoma (HCC) worldwide and expose the unseen part of the iceberg. NAFLD-related HCC has some characteristic features that distinguish it from other etiologies such as HBV and HCV, which makes its diagnosis and management more complicated. 
  • 449
  • 25 Sep 2023
Topic Review
Microbiota Changes in Irritable Bowel Syndrome Subtypes
Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits. It can be subclassified in different subtypes according to the main clinical manifestation: constipation, diarrhea, mixed, and unclassified. The role of gut microbiota in IBS has garnered significant attention in the scientific community. Emerging research spotlights the intricate involvement of microbiota dysbiosis in IBS pathogenesis. Studies have demonstrated reduced microbial diversity and stability and specific microbial alterations for each disease subgroup. Microbiota-targeted treatments, such as antibiotics, probiotics, prebiotics, synbiotics, fecal microbiota transplantation, and even diet, offer exciting prospects for managing IBS.
  • 444
  • 07 Oct 2023
Topic Review
Mechanistic Insights into Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease characterized by eosinophilic infiltration of the esophagus. It arises from a complex interplay of genetic predisposition (susceptibility loci), environmental triggers (allergens and dietary antigens), and a dysregulated immune response, mainly mediated by type 2 T helper cell (Th2)-released cytokines, such as interleukin (IL)-4, IL-5, and IL-13.
  • 443
  • 27 Dec 2023
Topic Review
Pancreatic Walled-off Necrosis Management
Necrotizing pancreatitis is a complex clinical condition burdened with significant morbidity and mortality. In recent years, the huge progress of interventional endoscopic ultrasound (EUS) has allowed a shift in the management of pancreatic necrotic collections from surgical/percutaneous approaches to mini-invasive endoscopic internal drainage and debridement procedures. The development of lumen-apposing metal stents (LAMSs), devices specifically dedicated to transmural EUS interventions, further prompted the diffusion of such techniques.
  • 429
  • 27 Feb 2024
Topic Review
The Liver-Centric Role in Insulin Resistance
The central mechanism involved in the pathogenesis of MAFLD is insulin resistance with hyperinsulinemia, which stimulates triglyceride synthesis and accumulation in the liver. On the other side, triglyceride and free fatty acid accumulation in hepatocytes promotes insulin resistance via oxidative stress, endoplasmic reticulum stress, lipotoxicity, and the increased secretion of hepatokines. Cytokines and adipokines cause insulin resistance, thus promoting lipolysis in adipose tissue and ectopic fat deposition in the muscles and liver. Free fatty acids along with cytokines and adipokines contribute to insulin resistance in the liver via the activation of numerous signaling pathways. The secretion of hepatokines, hormone-like proteins, primarily by hepatocytes is disturbed and impairs signaling pathways, causing metabolic dysregulation in the liver. ER stress and unfolded protein response play significant roles in insulin resistance aggravation through the activation of apoptosis, inflammatory response, and insulin signaling impairment mediated via IRE1/PERK/ATF6 signaling pathways and the upregulation of SREBP 1c. Circadian rhythm derangement and biological clock desynchronization are related to metabolic disorders, insulin resistance, and NAFLD, suggesting clock genes as a potential target for new therapeutic strategies.
  • 428
  • 22 Nov 2023
Topic Review
COVID-19 Pandemic on Psychological Status in IBD Patients
The coronavirus disease (COVID-19) pandemic has had a considerable impact on the global healthcare system and potentially the clinical course of patients with inflammatory bowel disease (IBD). Although IBD is a chronic disease, its therapy (except steroid therapy) does not increase the risk of contracting or aggravating COVID-19.
  • 425
  • 16 Oct 2023
Topic Review
Risk Factors for NAFLD-Related Hepatocellular Carcinoma
Non-alcoholic fatty liver disease (NAFLD) affects up to a quarter of the adult population in many developed and developing countries. This spectrum of liver disease ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. The incidence of NASH is projected to increase by up to 56% in the future. There is growing epidemiological evidence that NAFLD has become the fastest-growing cause of hepatocellular carcinoma (HCC) in industrialized countries. The annual incidence of HCC varies between patients with NASH cirrhosis and patients with noncirrhotic NAFLD.
  • 424
  • 23 Nov 2023
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