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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.
  • 161
  • 27 Dec 2023
Topic Review
Medical Treatment of Gastroesophageal Reflux Disease
Gastroesophageal reflux disease has a high incidence and prevalence in the general population. Clinical manifestations are heterogenous, and so is the response to medical treatment. Proton pump inhibitors are still the most common agents used to control reflux symptoms and for healing esophagitis, but they are not a one-size-fits-all solution for the disease. Patients with persistent troublesome symptoms despite medical therapy, those experiencing some adverse drug reaction, or those unwilling to take lifelong medications deserve valid alternatives.
  • 374
  • 04 Jul 2023
Topic Review
Melatonin and Liver Cancer
Melatonin (N-acetyl-5-methoxytryptamine) is an indoleamine with beneficial effects in a broad number of tumors, including the primary liver cancers hepatocarcinoma (HCC) and cholangiocarcinoma (CCA). Among them, melatonin has shown to modulate different cancer-associated processes and enhance drug efficacy against HCC and CCA. Therefore, melatonin has a potential role in improving the current therapeutic landscape in these liver tumors.
  • 1.5K
  • 12 Oct 2021
Topic Review
Mesenteric Fibrosis
Authors: Anna Koumarianou, Krystallenia I. Alexandraki, Göran Wallin, Gregory Kaltsas and Kosmas Daskalakis. Objective: Mesenteric fibrosis (MF) constitutes an underrecognized sequela in patients with small intestinal neuroendocrine neoplasms (SI-NENs), often complicating the disease clinical course. The aim of the present systematic review was to provide an update in evolving aspects of MF pathogenesis and its clinical management in SI-NENs. Search strategy: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Results: Complex and dynamic interactions are present in the microenvironment of tumor deposits in the mesentery. Serotonin, as well as the signaling pathways of certain growth factors play a pivotal, yet not fully elucidated role in the pathogenesis of MF. Clinically, MF often results in significant morbidity by causing either acute complications, such as intestinal obstruction and/or acute ischemia or more chronic conditions involving abdominal pain, venous stasis, malabsorption and malnutrition. Conclusions: Surgical resection in patients with locoregional disease only or symptomatic distant stage disease, as well as palliative minimally invasive interventions in advanced inoperable cases seem clinically meaningful, whereas currently available systemic and/or targeted treatments do not unequivocally affect the development of MF in SI-NENs. Increased awareness and improved understanding of the molecular pathogenesis of MF in SI-NENs may provide better diagnostic and predictive tools for its timely recognition and intervention and also facilitates the development of agents targeting MF.
  • 1.2K
  • 22 Jul 2020
Topic Review
Mesenteric Ischemia
Mesenteric ischemia is a medical condition in which injury to the small intestine occurs due to not enough blood supply. It can come on suddenly, known as acute mesenteric ischemia, or gradually, known as chronic mesenteric ischemia. The acute form of the disease often presents with sudden severe abdominal pain and is associated with a high risk of death. The chronic form typically presents more gradually with abdominal pain after eating, unintentional weight loss, vomiting, and fear of eating. Risk factors for acute mesenteric ischemia include atrial fibrillation, heart failure, chronic kidney failure, being prone to forming blood clots, and previous myocardial infarction. There are four mechanisms by which poor blood flow occurs: a blood clot from elsewhere getting lodged in an artery, a new blood clot forming in an artery, a blood clot forming in the superior mesenteric vein, and insufficient blood flow due to low blood pressure or spasms of arteries. Chronic disease is a risk factor for acute disease. The best method of diagnosis is angiography, with computed tomography (CT) being used when that is not available. Treatment of acute ischemia may include stenting or medications to break down the clot provided at the site of obstruction by interventional radiology. Open surgery may also be used to remove or bypass the obstruction and may be required to remove any intestines that may have died. If not rapidly treated outcomes are often poor. Among those affected even with treatment the risk of death is 70% to 90%. In those with chronic disease bypass surgery is the treatment of choice. Those who have thrombosis of the vein may be treated with anticoagulation such as heparin and warfarin, with surgery used if they do not improve. Acute mesenteric ischemia affects about five per hundred thousand people per year in the developed world. Chronic mesenteric ischemia affects about one per hundred thousand people. Most people affected are over 60 years old. Rates are about equal in males and females of the same age. Mesenteric ischemia was first described in 1895.
  • 237
  • 07 Nov 2022
Topic Review
Metabolic-Dysfunction-Associated Steatotic Liver Disease
Metabolic-dysfunction-associated steatotic liver disease (MASLD) is a chronic liver disease that affects more than a quarter of the global population and whose prevalence is increasing worldwide due to the pandemic of obesity. Obesity, impaired glucose metabolism, high blood pressure and atherogenic dyslipidemia are risk factors for MASLD.
  • 300
  • 01 Nov 2023
Topic Review
Metabolism-Associated Epigenetic and Immunoepigenetic Re-programming in Liver Cancer
Metabolic reprogramming and epigenetic changes have been characterized as hallmarks of liver cancer. Metabolic intermediates serve as crucial substrates for various epigenetic modulations, from post-translational modification of histones to DNA methylation. In turn, epigenetic changes can alter the expression of metabolic genes supporting on the one hand, the increased energetic demand of cancer cells and, on the other hand, influence the activity of tumor-associated immune cell populations. In this review, we will illustrate the most recent findings about metabolic reprogramming in liver cancer. We will focus on the metabolic changes characterizing the tumor microenvironment and on how these alterations impact on epigenetic mechanisms involved in the malignant progression. Furthermore, we will report our current knowledge about the influence of cancer-specific metabolites on epigenetic reprogramming of immune cells. Finally, we will review the current strategies to target metabolic and epigenetic pathways and their therapeutic potential in liver cancer, alone or in combinatorial approaches.
  • 518
  • 13 Dec 2021
Topic Review
Metformin in Esophageal Cancer
Esophageal cancer (EC), ranking sixth in global cancer mortality, comprises two distinct diseases: esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). EAC is linked to Barrett’s esophagus (BE), influenced by factors like gastroesophageal reflux disease (GERD) and obesity, while ESSC arises from squamous cells, with tobacco and alcohol as notable risks.
  • 262
  • 14 Mar 2024
Topic Review
Metformin Protects Livers against NASH-related-HCC
Nonalcoholic fatty liver disease (NAFLD) is strongly linked to the global epidemic of obesity and type 2 diabetes mellitus (T2DM). Notably, NAFLD can progress from the mildest form of simple steatosis to nonalcoholic steatohepatitis (NASH) that increases the risk for hepatocellular carcinoma (HCC), which is a malignancy with a dismal prognosis and rising incidence in the United States and other developed counties, possibly due to the epidemic of NAFLD. Metformin, the first-line drug for T2DM, has been suggested to reduce risks for several types of cancers including HCC and protect against NASH-related HCC, as revealed by epidemical studies on humans and preclinical studies on animal models.
  • 718
  • 12 Oct 2021
Topic Review
Methods of Measuring Pancreatic Cystic Lesion Size
The incidence of pancreatic cystic lesions (PCLs) has been rising due to improvements in imaging. Of these, intraductal papillary mucinous neoplasms (IPMNs) are the most common and are thought to contribute to almost 20% of pancreatic adenocarcinomas. All major society guidelines for the management of IPMNs use size defined by maximum diameter as the primary determinant of whether surveillance or surgical resection is recommended. However, there is no consensus on how these measurements should be obtained or whether a single imaging modality is superior. Furthermore, the largest diameter may fail to capture the complexity of PCLs, as most are not perfectly spherical.
  • 271
  • 14 Sep 2023
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