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Topic Review
Diagnosis and Management of Acute Liver Failure
Acute liver failure (ALF) is a rare and specific form of severe hepatic dysfunction characterized by coagulopathy and hepatic encephalopathy in a patient with no known liver disease. ALF carries a high morbidity and mortality. Careful attention should be given to hemodynamics and metabolic parameters along with the active surveillance of infections. Timely transfer and supportive management are important in an intensive care unit in a liver transplant center. Identifying patients who will and will not improve with medical management and may need emergent liver transplantation is critical.
  • 420
  • 14 Dec 2023
Topic Review
Gene Variants in Non-Alcoholic Fatty Liver Disease
Non-alcoholic fatty liver disease (NAFLD) describes a steatotic (or fatty) liver occurring as a consequence of a combination of metabolic, environmental, and genetic factors, in the absence of significant alcohol consumption and other liver diseases. Many liver disease-related gene variants have been identified from large-scale genome-wide association studies (GWAS).
  • 419
  • 26 Oct 2023
Topic Review
Role of Intestinal Microbiota in Celiac Disease Pathogenesis
The intestinal microbiota contributes to maintaining the integrity of the intestinal barrier, preventing the formation of a “leaky” intestine. On the contrary, a change in the composition of the microbiota can act as a significant link in the pathogenesis of gluten intolerance and exacerbate the course of the disease. The possibility of modulating the composition of the microbiota by prescribing probiotic preparations is being considered. The effectiveness of the use of probiotics containing Lactobacillus and Bifidobacterium bacteria in experimental and clinical studies as a preventive and therapeutic agent has been documented.
  • 419
  • 19 Jan 2024
Topic Review
Inflammatory Bowel Disease and Adverse Pregnancy Outcomes
Inflammatory Bowel Disease (IBD) presents distinct challenges during pregnancy due to its influence on maternal health and pregnancy outcomes. IBD can affect women of reproductive age aspiring for a safe pregnancy. Effective disease control before conception is vital to improve fertility and ensure a healthy pregnancy, thus reducing potential flare-ups. Continuation of IBD treatments during pregnancy and breastfeeding is generally viewed as safe, emphasizing the importance of thorough disease management for both mother and child.
  • 416
  • 05 Jan 2024
Topic Review
Gut–Brain Axis, Microbiota and Probiotics
Irritable bowel syndrome (IBS) is a relatively common digestive disorder. It is estimated that IBS has a prevalence of 10–15% in the general population in industrialized countries and is a factor with a significant impact on both the individual and society in terms of quality of life and health care costs. Depending on symptomatology, comorbidities, quality of life and healthcare needs, IBS can have a mild, moderate, or severe clinical course. Some studies have shown that the severe form occurs in 15–40% of patients with IBS.
  • 414
  • 05 Dec 2023
Topic Review
Precision Medicine in Inflammatory Bowel Disease
Ulcerative colitis and Crohn’s disease are traditionally defined as the two main subtypes of inflammatory bowel disease. However, a more recent view considers inflammatory bowel diseases (IBDs) as a spectrum of heterogeneous phenotypes with consistent differences in clinical presentation and behaviors, likely explained by differences in underlying pathogenetic mechanisms. The etiology is still elusive, and the suggested pathogenesis is a complex interplay among genetic predisposition and abnormal immune response at the mucosal intestinal level, activated by only partially identified environmental triggers leading to altered intestinal permeability and impaired handling of gut microbiota. The undeniable continuous progress of medical therapy with more frequent shifts from traditional to more advanced modalities also underlines the actual unmet needs. 
  • 413
  • 27 Oct 2023
Topic Review
Hepatocellular Carcinoma in Non-Fibrotic Liver
Hepatocellular carcinoma (HCC) in a non-fibrotic liver (F0) is considered to be rare, and there is a marked paucity of studies in the literature on this HCC type. A review of the literature shows some important clinical and tumor characteristics: (a) it occurs mainly in young female and elder male patients; (b) clinically, under normal hepatic function, alpha-fetoprotein level is often normal, and there are no risk factors; (c) associated with metabolic disease; (d) macroscopically, single large lesions are noted; and (e) microscopically, the lesions are well-differentiated and encapsulated. Radiological imaging results are straightforward, showing arterial hyperenhancement and later wash-out. The combined use of B-mode and contrast-enhanced (CE) ultrasound (US) is the most reliable and cost-effective diagnostic method. Few peri-and post-operative complications are noted and 5-year survival is not inferior to patients with HCC on fibrosis liver despite the lesion’s large size. Most clinicians believe that HCC is unlikely to occur if patients have no symptoms and normal hepatic function.
  • 413
  • 15 Nov 2023
Topic Review
Influence of Ultra-Processed Food on Colorectal Cancer
Colorectal cancer (CRC) is a disease characterised by the development of malignant tumours in the colon or rectum; it is considered the most common cancer in women, and up to 50% of cases can be prevented with a healthy lifestyle. Nutritional habits are related to its appearance, and the trend of an increased consumption of ultra-processed foods (UPFs) has led to a surge in the incidence of CRC.
  • 408
  • 28 Feb 2024
Topic Review
Genetic Changes of NF-κB Signaling in Colorectal Cancer
Colorectal cancer (CRC) is the third leading cause of cancer mortality in the United States, with an estimated 52,000 deaths in 2023. Though significant progress has been made in both diagnosis and treatment of CRC in recent years, genetic heterogeneity of CRC—the culprit for possible CRC relapse and drug resistance, is still an insurmountable challenge. Thus, developing more effective therapeutics to overcome this challenge in new CRC treatment strategies is imperative. Genetic and epigenetic changes are well recognized to be responsible for the stepwise development of CRC malignancy. 
  • 407
  • 02 Jan 2024
Topic Review
Microbiome Influences Neurodevelopment in the Central Nervous System
The brain is traditionally viewed as an immunologically privileged site; however, there are known to be multiple resident immune cells that influence the central nervous system (CNS) environment and are reactive to extra-CNS signaling. Microglia are an important component of this system, which influences early neurodevelopment in addition to modulating inflammation and regenerative responses to injury and infection. Microglia are influenced by gut microbiome-derived metabolites, both as part of their normal function and potentially in pathological patterns that may induce neurodevelopmental disabilities or behavioral changes. 
  • 397
  • 17 Nov 2023
Topic Review
Gastroesophageal Reflux Disease following Sleeve Gastrectomy
Obesity is associated with serious comorbidities and economic implications. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, are effective options for weight loss and the improvement of obesity-related comorbidities. With the growing obesity epidemic, there has been a concomitant rise in bariatric surgeries, particularly in sleeve gastrectomy. Gastroesophageal reflux disease (GERD) is highly prevalent in obese individuals, can significantly impact quality of life and may lead to serious complications. Obesity and GERD both improve with weight loss.
  • 395
  • 07 Mar 2024
Topic Review
The Effect of COVID-19 on Gut Microbiota
The COVID-19 pandemic caused by the SARS-CoV-2 virus has led to significant global health implications. Although the respiratory manifestations of COVID-19 are widely recognized, emerging evidence suggests that the disease may also significantly affect the gut microbiota, the intricate community of bacteria that lives within the gastrointestinal system.
  • 393
  • 22 Aug 2023
Topic Review
Non-Alcoholic Steatohepatitis-Driven Hepatocarcinogenesis
Non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (NASH) are chronic hepatic conditions leading to hepatocellular carcinoma (HCC) development. According to the recent “multiple-parallel-hits hypothesis”, NASH could be caused by abnormal metabolism, accumulation of lipids, mitochondrial dysfunction, and oxidative and endoplasmic reticulum stresses and is found in obese and non-obese patients.
  • 380
  • 27 Sep 2023
Topic Review
B-Blockers in Liver Cirrhosis
In cirrhotic patients, non-selective b-blockers (NSBBs) constitute the reference treatment of choice as monotherapy or combined with band ligation for the prevention of first variceal bleeding and rebleeding, respectively. Furthermore, the last Baveno VII guidelines recommended carvedilol, a b-blocker with additional anti-a1 receptor activity, in all compensated cirrhotics with clinically significant portal hypertension, to prevent liver decompensation. Interestingly enough, NSBBs have been reported to have a potentially positive impact on the short-term mortality of patients with acute-on-chronic liver failure. 
  • 364
  • 15 Jan 2024
Topic Review
Exceptional Liver Transplant Indications
Liver transplantation represents the definitive intervention for various etiologies of liver failure and encompasses a spectrum of rare indications crucial to understanding the diverse landscape of end-stage liver disease, with significantly improved survival rates over the past three decades.
  • 363
  • 31 Jan 2024
Topic Review
Cystic Fibrosis Gastroenterologist's Transition from Pediatrics to Adult
Cystic Fibrosis is a chronic disease affecting multiple systems, including the GI tract. Clinical manifestation in patients can start as early as infancy and vary across different age groups. With the advent of new, highly effective modulators, the life expectancy of people with CF (PwCF) has improved significantly. Various GI aspects of CF care, such as nutrition, are linked to an overall improvement in morbidity, lung function and the quality of life of PwCF. The variable clinical presentations and management of GI diseases in pediatrics and adults with CF should be recognized. Therefore, it is necessary to ensure efficient transfer of information between pediatric and adult providers for proper continuity of management and coordination of care at the time of transition. 
  • 354
  • 17 Nov 2023
Topic Review
Acute Pancreatitis Management
Acute pancreatitis (AP) is diagnosed when at least two of the following criteria are met: abdominal pain characteristic of the disease, serum lipase or amylase levels greater than three times the upper limit of normal, and findings consistent with AP on imaging. Serum lipase is the preferred diagnostic marker due to its superior sensitivity and specificity. Routine CT imaging at admission is not recommended unless the diagnosis is unclear or the patient fails to improve clinically within 48–72 hours. Imaging, including contrast-enhanced CT or MRI, is reserved for evaluating complications such as necrosis or pseudocysts in patients with persistent or worsening symptoms. Identifying the etiology of AP is essential for effective management. For biliary pancreatitis, transabdominal ultrasound is the first-line imaging modality, with repeat studies recommended if the initial results are inconclusive. For idiopathic AP (IAP), additional evaluation with MRI or endoscopic ultrasound (EUS) is suggested. In patients without gallstones or a history of significant alcohol use, serum triglycerides should be measured, and levels exceeding 1,000 mg/dL suggest hypertriglyceridemia as the cause. For patients over 40 years of age with no established etiology, pancreatic cancer should be considered and further evaluated. Initial management of AP focuses on supportive care. Fluid resuscitation with lactated Ringer’s solution is recommended, with frequent reassessments to avoid volume overload, especially in patients with cardiovascular or renal comorbidities. Nutrition should be initiated early, preferably within 24–48 hours, with a low-fat solid diet in mild cases. In severe cases, enteral nutrition is preferred over parenteral nutrition, with nasogastric feeding being the optimal route due to its comparable safety and efficacy. Interventions should be tailored to clinical need. Antibiotics are not indicated for sterile necrosis but should be used in cases of infected necrosis to delay or potentially avoid invasive drainage. Endoscopic retrograde cholangiopancreatography (ERCP) is indicated within 24 hours for AP complicated by cholangitis but should not be routinely performed for biliary AP without cholangitis. Prevention of post-ERCP pancreatitis includes rectal indomethacin and, in high-risk cases, pancreatic duct stenting. To reduce recurrence risk, patients with idiopathic AP should undergo a cholecystectomy after a second episode if they are fit for surgery. Overall, these guidelines emphasize the importance of a stepwise diagnostic and therapeutic approach to manage AP effectively and minimize complications.
  • 350
  • 22 Nov 2024
Topic Review Peer Reviewed
Non-Operative Management (NOM) in Rectal Cancer: Current Evidence and Future Directions
Rectal cancer has become a significant health concern in current years, but there are very effective current neo-adjuvant treatment modalities which can result in the complete disappearance of the disease without surgery, which is often associated with severe post-surgical sequelae. Therefore, a significant effort has been made to identify the subset of patients who can avoid surgery and to investigate the long-term oncologic and functional results associated with the Non-Operative Management of such a disease.
  • 78
  • 15 Oct 2025
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