Conventional therapies for inflammatory bowel diseases(IBD) involve combinations of pharmacologic agents such as aminosalicylates, azathioprine, and corticosteroids. Recently, the therapeutic scenario has been heavily...Conventional therapies for inflammatory bowel diseases(IBD) involve combinations of pharmacologic agents such as aminosalicylates, azathioprine, and corticosteroids. Recently, the therapeutic scenario has been heavily increased by the introduction of agents including monoclonal antibodies targeted to specific proinflammatory cytokines, to adhesion molecules, and the induction of anti-inflammatory cytokines and T-cell activation. However, the use of these drugs is accompanied by a certain number of side effects, with some of them being quite severe, rising concerns about the safety profile. Furthermore, the cost of these emerging therapeutic strategies is significant, considering the increasing incidence and the chronic trend of IBD. Nutraceuticals is a broad term used to describe any product derived from food sources claiming extra health benefits beyond the intrinsic nutritional value found in foods. The beneficial effects of nutraceutical compounds in human health have been emerging in the last decades. Although few clinical trials have been performed in IBD patients, nutraceuticals, such as herbal products or vitamins, are generally accepted as safer alternative/supplementation to conventional therapy. In vitro and IBD-animal models studies have shown their involvement in several biological processes, including antioxidant defenses, cell proliferation, gene expression, which could account for a role in the maintenance of the mucosal barrier integrity, the control of the inflammatory pathways and the modulation of the immune response. These data suggest a wide spectrum of positive effects exerted by nutraceuticals, with a high potential for a therapeutic use in humans. In the present review, the beneficial effects of the most investigated nutraceutical compounds in the setting of human IBD are discussed.展开更多
AIM： To evaluate the prevalence of Giardia lamblia （G. lamblia） infection in patients with irritable bowel syndrome （IBS） and dyspepsia and to establish which is the most accurate test to diagnose the infection i...AIM： To evaluate the prevalence of Giardia lamblia （G. lamblia） infection in patients with irritable bowel syndrome （IBS） and dyspepsia and to establish which is the most accurate test to diagnose the infection in this setting. METHODS： One hundred and thirty-seven patients who consecutively attended the Outpatient Gastroenterology Clinic for the first time between January 2002 and Decernber 2003 due to symptoms of IBS and/or dyspepsia were recruited. All patients underwent clinical evaluation, first-step haematology and chemistry tests, serologic assays for celiac disease, lactose-H2 breath test, abdominal ultrasonography, and esophagogastroduodenoscopy. Helicobacterpylon status was evaluated. In patients with symptoms of IBS older than 45 years, colonoscopy was also performed. In all patients, duodenal biopsies and stool samples were examined for trophozoites and cysts of G. lamblia by several methods. RESULTS： G. lamblia was identified in 9 patients. The following diagnoses were also made： IBS （100/137, 73%）, functional dyspepsia （62/137, 45%）, organic dyspepsia （33/137, 24%）, and lactose intolerance （75/137, 55%）. A significant association was found between giardiasis and H pylori infection （x^2= 6.632, OR= 12.4, CI= 1.5-68.1）. There were no symptoms that reliably allowed the recognition of giardiasis. Direct search of the parasite in duodenal biopsy and stool sample examinations gave concordant results in all cases while histological examination of duodenal biopsies displayed a low sensitivity （e.g., 22.2%）. CONCLUSION： In this consecutive series, diagnosis of G.lamblia infection accounted for 6.5% of patients with IBS and dyspepsia. Duodenal biopsies for diagnosis of giardiasis may be unnecessary if stool sample examination is performed.展开更多
AIM:To investigate risk factors for low bone mineral density(BMD) in celiac disease(CD) patients,focusing on circulating autoantibodies against osteoprotegerin(OPG).METHODS:Seventy asymptomatic CD adult patients on gl...AIM:To investigate risk factors for low bone mineral density(BMD) in celiac disease(CD) patients,focusing on circulating autoantibodies against osteoprotegerin(OPG).METHODS:Seventy asymptomatic CD adult patients on gluten-free diet(GFD) and harbouring persistent negative CD-related serology were recruited.Conventional risk factors for osteoporosis(e.g.,age,sex,menopausal status,history of fractures,smoke,and body mass index) were checked and BMD was assessed by dual energy X ray absorptiometry.Serum calcium and parathyroid hormone(PTH) levels were evaluated.Thirty-eight patients underwent repeat duodenal biopsy.Serum samples from a selected sub-group of 30 patients,who were also typed for human leukocyte antigen(HLA) DQ2 and DQ8 haplotype,were incubatedwith homodimeric recombinant human OPG and tested by western blotting with an anti-OPG antibody after immunoprecipitation.RESULTS:Despite persistent negative CD-related serology and strict adherence to GFD,49 out of the 70(74%) patients displayed low BMD.Among these patients,13(24%) showed osteoporosis and 36(76%) osteopenia.With the exception of age,conventional risk factors for osteoporosis did not differ between patients with normal and low BMD.Circulating serum calcium and PTH levels were normal in all patients.Duodenal mucosa healing was found in 31(82%) out of 38 patients who underwent repeat duodenal biopsy with 20(64%) still displaying low BMD.The remaining 7 patients had an incomplete normalization of duodenal mucosa with 6(84%) showing low BMD.No evidence of circulating antibodies against OPG was found in the serum of 30 celiac patients who were tested for,independent of BMD,duodenal histology,and HLA status.CONCLUSION:If any,the role of circulating autoantibodies against OPG in the pathogenesis of bone derangement in patients with CD is not a major one.展开更多
Non-alcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease.This term does not describe the pathogenetic mechanisms and complications associated with NAFLD.The new definition,Metabolic Dy...Non-alcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease.This term does not describe the pathogenetic mechanisms and complications associated with NAFLD.The new definition,Metabolic Dysfunction-associated Steatotic Liver disease(MASLD),emphasizes the relationship between NAFLD and cardiometabolic comorbidities.Cardiovascular disease features,such as arterial hypertension and atherosclerosis,are frequently associated with patients with MASLD.Furthermore,these patients have a high risk of developing neoplastic diseases,primarily hepatocellular carcinoma,but also extrahepatic tumors,such as esophageal,gastric,and pancreatic cancers.Moreover,several studies showed the correlation between MASLD and endocrine disease.The imbalance of the gut microbiota,systemic inflammation,obesity,and insulin resistance play a key role in the development of these complications.This narrative review aims to clarify the evolution from NAFLD to the new nomenclature MASLD and evaluate its complications.展开更多
Non-alcoholic steatohepatitis(NASH)is a clinical condition characterized by inflammation and swelling of the hepatocytes.If not adequately treated,NASH can lead to the development of fibrosis and liver cancer.Currentl...Non-alcoholic steatohepatitis(NASH)is a clinical condition characterized by inflammation and swelling of the hepatocytes.If not adequately treated,NASH can lead to the development of fibrosis and liver cancer.Currently,drug therapies used in the management of NASH patients are deficient and non-specific.Patients’adherence to a healthy lifestyle with a low-calorie diet is a crucial element in the treatment of NASH.The Mediterranean diet is a diet that,more than any other,has indicated beneficial effects in this pathology.The proposed review summarizes the evidence regarding the beneficial effects of consuming the Mediterranean diet typical foods in NASH.展开更多
Hepatocellular carcinoma (HCC) is a primary liver cancer that occurs with a frequency of 85% in patients with livercirrhosis. It is the sixth most common type of cancer globally. Asia is the continent with the highest...Hepatocellular carcinoma (HCC) is a primary liver cancer that occurs with a frequency of 85% in patients with livercirrhosis. It is the sixth most common type of cancer globally. Asia is the continent with the highest incidence(72%), followed by Europe (8%) and Africa (5%). Men are four times more likely than women to develop thiscancer, especially in the 70-80 age group. Risk factors include alcoholic liver disease, tobacco use, geneticpredisposition, dysmetabolic comorbidities such as type 2 diabetes mellitus and obesity, hepatitis B virus andhepatitis C virus infections, and non-alcoholic fatty liver disease. Unhealthy dietary regimens and gut dysbiosis areadditional risk factors that have been recently investigated. These two factors are closely related because the gutmicrobiota performs several biological functions, including nutrient metabolism, a process that promotes guthomeostasis, known as eubiosis. With regard to the correlation between diet, gut microbiota, and HCCdevelopment, there are several mechanisms that have not yet been fully elucidated. This narrative review aims toevaluate the impact of diet and gut microbiota changes in the development of HCC. Our analysis, performed onseveral clinical and pre-clinical studies, showed that a high-fat diet promotes gut dysbiosis and hepatic fataccumulation, leading to the progression from simple steatosis to HCC, while the Mediterranean diet, rich in fiberand monounsaturated fatty acids, had a protective role. For this reason, international employment of this dietaryregimen for therapeutic purposes should be encouraged.展开更多
Non-alcoholic fatty liver disease(NAFLD)is one of the most common liver diseases and is related to unhealthy lifestyle habits,characterized by a diet rich in sugars and fats leading to excessive calorie intake,and lac...Non-alcoholic fatty liver disease(NAFLD)is one of the most common liver diseases and is related to unhealthy lifestyle habits,characterized by a diet rich in sugars and fats leading to excessive calorie intake,and lack of exercise.In recent years,there is a growing incidence of this pathology,raising the attention of hepatologists,endocrinologists,diabetologists,and nutritionists.In this context,the alimentary regimen adopted by patients with NAFLD has become an increasingly scrutinised parameter.Diet is now considered a crucial factor in the treatment of NAFLD since it has been observed that some functional foods play a beneficial role.These include coffeewhose health effects have already been amply demonstrated.Here we describe the beneficial effects of coffee consumption reported in the NAFLD literature.展开更多
Hepatocellular carcinoma(HCC,also known as primary liver cancer),is the fourth most frequent cancer and the third cause of deaths associated with cancer worldwide(1).HCC occurs in liver damaged tissue,due to chronic r...Hepatocellular carcinoma(HCC,also known as primary liver cancer),is the fourth most frequent cancer and the third cause of deaths associated with cancer worldwide(1).HCC occurs in liver damaged tissue,due to chronic regenerative and inflammatory processes that contribute to the initiation and progression of the tumor(2).The main environmental factors associated with HCC are hepatotropic viral infection(hepatitis B and C,particularly),excessive consumption of alcohol,and exposure to aflatoxin through the diet.However,in the last 20 years,non-alcoholic fatty liver disease(NAFLD)has become a quickly emerging cause of end-stage liver disease worldwide.Typically,its hepatic injury starts with simple steatosis,which can progress to advanced stages such as non-alcoholic steatohepatitis(NASH),fibrosis and finally cirrhosis.Epidemiology studies report that about 3-15%of the obese patients with NASH progress to cirrhosis,and about 4-27%of NASH patients with cirrhosis present HCC(1).展开更多
文摘Conventional therapies for inflammatory bowel diseases(IBD) involve combinations of pharmacologic agents such as aminosalicylates, azathioprine, and corticosteroids. Recently, the therapeutic scenario has been heavily increased by the introduction of agents including monoclonal antibodies targeted to specific proinflammatory cytokines, to adhesion molecules, and the induction of anti-inflammatory cytokines and T-cell activation. However, the use of these drugs is accompanied by a certain number of side effects, with some of them being quite severe, rising concerns about the safety profile. Furthermore, the cost of these emerging therapeutic strategies is significant, considering the increasing incidence and the chronic trend of IBD. Nutraceuticals is a broad term used to describe any product derived from food sources claiming extra health benefits beyond the intrinsic nutritional value found in foods. The beneficial effects of nutraceutical compounds in human health have been emerging in the last decades. Although few clinical trials have been performed in IBD patients, nutraceuticals, such as herbal products or vitamins, are generally accepted as safer alternative/supplementation to conventional therapy. In vitro and IBD-animal models studies have shown their involvement in several biological processes, including antioxidant defenses, cell proliferation, gene expression, which could account for a role in the maintenance of the mucosal barrier integrity, the control of the inflammatory pathways and the modulation of the immune response. These data suggest a wide spectrum of positive effects exerted by nutraceuticals, with a high potential for a therapeutic use in humans. In the present review, the beneficial effects of the most investigated nutraceutical compounds in the setting of human IBD are discussed.
文摘AIM： To evaluate the prevalence of Giardia lamblia （G. lamblia） infection in patients with irritable bowel syndrome （IBS） and dyspepsia and to establish which is the most accurate test to diagnose the infection in this setting. METHODS： One hundred and thirty-seven patients who consecutively attended the Outpatient Gastroenterology Clinic for the first time between January 2002 and Decernber 2003 due to symptoms of IBS and/or dyspepsia were recruited. All patients underwent clinical evaluation, first-step haematology and chemistry tests, serologic assays for celiac disease, lactose-H2 breath test, abdominal ultrasonography, and esophagogastroduodenoscopy. Helicobacterpylon status was evaluated. In patients with symptoms of IBS older than 45 years, colonoscopy was also performed. In all patients, duodenal biopsies and stool samples were examined for trophozoites and cysts of G. lamblia by several methods. RESULTS： G. lamblia was identified in 9 patients. The following diagnoses were also made： IBS （100/137, 73%）, functional dyspepsia （62/137, 45%）, organic dyspepsia （33/137, 24%）, and lactose intolerance （75/137, 55%）. A significant association was found between giardiasis and H pylori infection （x^2= 6.632, OR= 12.4, CI= 1.5-68.1）. There were no symptoms that reliably allowed the recognition of giardiasis. Direct search of the parasite in duodenal biopsy and stool sample examinations gave concordant results in all cases while histological examination of duodenal biopsies displayed a low sensitivity （e.g., 22.2%）. CONCLUSION： In this consecutive series, diagnosis of G.lamblia infection accounted for 6.5% of patients with IBS and dyspepsia. Duodenal biopsies for diagnosis of giardiasis may be unnecessary if stool sample examination is performed.
文摘AIM:To investigate risk factors for low bone mineral density(BMD) in celiac disease(CD) patients,focusing on circulating autoantibodies against osteoprotegerin(OPG).METHODS:Seventy asymptomatic CD adult patients on gluten-free diet(GFD) and harbouring persistent negative CD-related serology were recruited.Conventional risk factors for osteoporosis(e.g.,age,sex,menopausal status,history of fractures,smoke,and body mass index) were checked and BMD was assessed by dual energy X ray absorptiometry.Serum calcium and parathyroid hormone(PTH) levels were evaluated.Thirty-eight patients underwent repeat duodenal biopsy.Serum samples from a selected sub-group of 30 patients,who were also typed for human leukocyte antigen(HLA) DQ2 and DQ8 haplotype,were incubatedwith homodimeric recombinant human OPG and tested by western blotting with an anti-OPG antibody after immunoprecipitation.RESULTS:Despite persistent negative CD-related serology and strict adherence to GFD,49 out of the 70(74%) patients displayed low BMD.Among these patients,13(24%) showed osteoporosis and 36(76%) osteopenia.With the exception of age,conventional risk factors for osteoporosis did not differ between patients with normal and low BMD.Circulating serum calcium and PTH levels were normal in all patients.Duodenal mucosa healing was found in 31(82%) out of 38 patients who underwent repeat duodenal biopsy with 20(64%) still displaying low BMD.The remaining 7 patients had an incomplete normalization of duodenal mucosa with 6(84%) showing low BMD.No evidence of circulating antibodies against OPG was found in the serum of 30 celiac patients who were tested for,independent of BMD,duodenal histology,and HLA status.CONCLUSION:If any,the role of circulating autoantibodies against OPG in the pathogenesis of bone derangement in patients with CD is not a major one.
文摘Non-alcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease.This term does not describe the pathogenetic mechanisms and complications associated with NAFLD.The new definition,Metabolic Dysfunction-associated Steatotic Liver disease(MASLD),emphasizes the relationship between NAFLD and cardiometabolic comorbidities.Cardiovascular disease features,such as arterial hypertension and atherosclerosis,are frequently associated with patients with MASLD.Furthermore,these patients have a high risk of developing neoplastic diseases,primarily hepatocellular carcinoma,but also extrahepatic tumors,such as esophageal,gastric,and pancreatic cancers.Moreover,several studies showed the correlation between MASLD and endocrine disease.The imbalance of the gut microbiota,systemic inflammation,obesity,and insulin resistance play a key role in the development of these complications.This narrative review aims to clarify the evolution from NAFLD to the new nomenclature MASLD and evaluate its complications.
文摘Non-alcoholic steatohepatitis(NASH)is a clinical condition characterized by inflammation and swelling of the hepatocytes.If not adequately treated,NASH can lead to the development of fibrosis and liver cancer.Currently,drug therapies used in the management of NASH patients are deficient and non-specific.Patients’adherence to a healthy lifestyle with a low-calorie diet is a crucial element in the treatment of NASH.The Mediterranean diet is a diet that,more than any other,has indicated beneficial effects in this pathology.The proposed review summarizes the evidence regarding the beneficial effects of consuming the Mediterranean diet typical foods in NASH.
文摘Hepatocellular carcinoma (HCC) is a primary liver cancer that occurs with a frequency of 85% in patients with livercirrhosis. It is the sixth most common type of cancer globally. Asia is the continent with the highest incidence(72%), followed by Europe (8%) and Africa (5%). Men are four times more likely than women to develop thiscancer, especially in the 70-80 age group. Risk factors include alcoholic liver disease, tobacco use, geneticpredisposition, dysmetabolic comorbidities such as type 2 diabetes mellitus and obesity, hepatitis B virus andhepatitis C virus infections, and non-alcoholic fatty liver disease. Unhealthy dietary regimens and gut dysbiosis areadditional risk factors that have been recently investigated. These two factors are closely related because the gutmicrobiota performs several biological functions, including nutrient metabolism, a process that promotes guthomeostasis, known as eubiosis. With regard to the correlation between diet, gut microbiota, and HCCdevelopment, there are several mechanisms that have not yet been fully elucidated. This narrative review aims toevaluate the impact of diet and gut microbiota changes in the development of HCC. Our analysis, performed onseveral clinical and pre-clinical studies, showed that a high-fat diet promotes gut dysbiosis and hepatic fataccumulation, leading to the progression from simple steatosis to HCC, while the Mediterranean diet, rich in fiberand monounsaturated fatty acids, had a protective role. For this reason, international employment of this dietaryregimen for therapeutic purposes should be encouraged.
文摘Non-alcoholic fatty liver disease(NAFLD)is one of the most common liver diseases and is related to unhealthy lifestyle habits,characterized by a diet rich in sugars and fats leading to excessive calorie intake,and lack of exercise.In recent years,there is a growing incidence of this pathology,raising the attention of hepatologists,endocrinologists,diabetologists,and nutritionists.In this context,the alimentary regimen adopted by patients with NAFLD has become an increasingly scrutinised parameter.Diet is now considered a crucial factor in the treatment of NAFLD since it has been observed that some functional foods play a beneficial role.These include coffeewhose health effects have already been amply demonstrated.Here we describe the beneficial effects of coffee consumption reported in the NAFLD literature.
文摘Hepatocellular carcinoma(HCC,also known as primary liver cancer),is the fourth most frequent cancer and the third cause of deaths associated with cancer worldwide(1).HCC occurs in liver damaged tissue,due to chronic regenerative and inflammatory processes that contribute to the initiation and progression of the tumor(2).The main environmental factors associated with HCC are hepatotropic viral infection(hepatitis B and C,particularly),excessive consumption of alcohol,and exposure to aflatoxin through the diet.However,in the last 20 years,non-alcoholic fatty liver disease(NAFLD)has become a quickly emerging cause of end-stage liver disease worldwide.Typically,its hepatic injury starts with simple steatosis,which can progress to advanced stages such as non-alcoholic steatohepatitis(NASH),fibrosis and finally cirrhosis.Epidemiology studies report that about 3-15%of the obese patients with NASH progress to cirrhosis,and about 4-27%of NASH patients with cirrhosis present HCC(1).
