Factors Predicting Failure in Anorectal Biofeedback

Anorectal biofeedback is a method used by specialists in gastrointestinal motility to treat disorders of defecation. In the case of the anorectal biofeedback, unlike in biofeedback applications in other medical fields, the signal is represented by the pressure in the anorectal canal. The pressure is assessed by anorectal manometry. Patients are trained to become aware of this signal in an attempt to reeducate them for a correct defecation. Following the variation of the signals, patients can learn how to modulate the anal sphincter pressure and to improve their defecation disorders. Anorectal biofeedback is therefore used for fecal incontinence and for chronic terminal constipation. Despite its potential, the method is not intensively used and many patients ignore it. The specialists’ evaluation of the method is controversial: from enthusiastic to deceiving results, different data are available. The aim of this presentation is to analyze factors of success and of failure in the use of anorectal biofeedback in a single center specialized in anorectal manometry and to compare our data with results described by other authors

Inflammation as a Potential Therapeutic Target in IBS

The pathogenesis of irritable bowel syndrome (IBS) has been intensively researched, and despite a long journey for unraveling all the structures and the pathways involved, it still remains partially obscure. Inflammation was the first to be hypothesized as a potential pathway for the pathogenesis of IBS. It remains a keystone in the complex machinery of the pathogenesis that is currently considered multifactorial. Elucidating the pathogenesis of IBS is crucial for a targeted therapy of the disease. In this chapter, we review information regarding gut inflammation in IBS, underlining some of the newest data or the cornerstones. Additionally, our aim was also to review treatment currently available and future perspectives regarding anti‐inflammatory treatments for IBS. Newer techniques allow detection and research of mediators involved in inflammation, as well as their potential role to be targeted by pharmacological agents. Recent data supports not only further research of the newer agents that are currently being developed but also some of the available ones that do not have sufficient evidence. Emerging therapies that target inflammation are under evaluation, in trials. A multidrug or a multidisciplinary approach needs to be considered in some cases that fail to respond to current treatment

Acute Cholecystitis as a Complication After Colonoscopy: A Case Report and Literature Review

Acute cholecystitis after colonoscopy is a rare event, with less than 10 cases described in the literature. We report the case of a male patient with silent gallstones who underwent colonoscopy for follow-up of his Crohn’s disease. The colonoscopy revealed erosions in the terminal ileum, from which biopsies were taken. A sessile polyp 4 mm in diameter at the recto-sigmoid junction was also removed. Less than 24 h after the colonoscopy, the patient complained of upper right quadrant pain, nausea and vomiting. Based on the clinical findings, laboratory data and ultrasonography, we diagnosed acute cholecystitis and excluded any complication after the colonoscopy. Laparoscopic cholecystectomy was performed and the patient was discharged

Microbioma intestinal y peso corporal – revisión

The link between gut microbiota and insulin resistance has an important clinical impact, people affected by dysbiosis having a predisposition for developing: obesity, type 2 diabetes mellitus, nonalcoholic fatty liver disease, cancers, cardiovascular, neurodegenerative and psychiatric diseases. Dysbiosis may lead through chronic inflammation to obesity and metabolic syndrome. We carried out a systematic review of the studies dedicated to the role of gut microbiota in weight gain and obesity. A systematic literature search of recent data published in electronic databases, was performed, using as search phrase: "gut microbiome and body weight and obesity". Studies that contained no data about the influence of gut microbiota changes on obesity were excluded. Western diet, antibiotic use in childhood, excessive maternal pre-pregnancy weight, Cesarean delivery, and testosterone deficiency are triggers of the alteration of microbiota and subsequently the appearance of obesity. Predominance of Firmicutes and anaerobic genera, changes in the mycobiome and viral intestinal population are implied in the etiology of obesity. Prebiotics, polyphenols, different herbs, medication (antidiabetics, calcium), physical exercise, rich fibre intake and bariatric surgery are the most important therapeutic options. Personalized dietary treatments, antiviral agents and mycobiome manipulation would represent the new target in treating obesity. Any change of the quantitative and qualitative composition of microbiota has influence on the components of metabolic syndrome, so any management strategy for the treatment or prevention of obesity in children and adulthood should have the microbiome as target.La relación entre la microbioma intestinal y la resistencia a la insulina tiene un impacto clínico importante dado que la gente afectada por disbiosis tiene predisposiciones para desarrollar la obesidad, la diabetes mellitus tipo 2, la enfermedad de hígado graso no alcohólico, cánceres, enfermedades cardiovasculares, neurodegenerativas y psiquiátricas. La disbiosis puede convertirse en una inflamación crónica, obesidad o síndrome metabólico. Hemos hecho una revisión sistemática de los estudios dedicados al papel de la microbioma intestinal para el aumento de peso y la obesidad. Una búsqueda sistemática de datos recientes publicados en las bases de datos electrónicas se ha llevado a cabo usando la frase “gut microbiome and body weight and obesity”. Se ha excluido a los estudios que no contenían informaciones sobre la influencia de los cambios de la microbioma intestinal en la obesidad. La dieta occidental, uso de los antibióticos en la niñez, peso excesivo antes del embarazo, parto por cesárea y deficiencia de testosterona provocan la alteración de la microbioma y por consiguiente la apariencia de la obesidad. El predominio de firmicutes y géneros anaeróbicos, cambios en el microbioma y populación intestinal viral están implícitos en la etiología de la obesidad. Prebióticos, polifenoles, diferentes hierbas, medicamentos (antidiabéticos, calcio), ejercicio físico, consumo de fibras y cirugía bariátrica son las opciones terapéuticas más importantes. Tratamientos dietéticos personalizados, agentes antivirales y manipulación de la microbioma representarían nuevas metas en el tratamiento de la obesidad. Cada cambio en la composición cuantitativa o cualitativa de la microbioma influye en los componentes del síndrome metabólico, así que todas las estrategias para el tratamiento o prevención de la obesidad en niños o adultos deberían tener microbioma como su meta

Exclusion Diets in Functional Dyspepsia

Functional dyspepsia represents one of the most common and prevalent disorders of the brain–gut interaction, with a large number of widespread risk factors being identified. With an intricate pathogenesis and symptomatology, it heavily impacts the quality of life and, due to the limited efficacy of traditional pharmacological agents, patients are likely to seek other medical and non-medical solutions to their problem. Over the last few years, significant research in this domain has emphasized the importance of various psychological therapies and nutritional recommendations. Nevertheless, a correlation has been established between functional dyspepsia and food intolerances, with more and more patients adopting different kinds of exclusion diets, leading to weight loss, restrictive eating behaviour and an imbalanced nutritional state, further negatively impacting their quality of life. Thus, in this systematic review, we aimed at analysing the impact and efficiency of certain exclusion diets undertook by patients, more precisely, the gluten-free diet and the low-FODMAP diet

Giant gastric polyp mimicking a duodenal tumor

Inflammatory fibroid polyps are very rare gastrointestinal tumors. We present the case of a 66-year-old woman with severe anemia and a giant gastric polyp which had intermittent duodenal intussusception. Ultrasonography showed increased gastric wall thickness and suspected an ampulloma, as revealed also by endoscopy and computed tomography. Ultrasonography reassessment showed later the intragastric mass, which was confirmed by endosonography: giant pediculated hypervascular polyp suggesting malignancy. Challenging phenomena at different investigation methods were due to intermittent protrusion into the first duodenal segment mimicking an ampulloma, but without gastric outlet syndrome or a malignant component, despite the severe anemia. Abnormal US aspect of the stomach in clinical context of anemic syndrome, requires EUS with biopsies in order to confirm underlying lesions. The particularities of this case are the: discordance between imaging aspects and the protrusion into the first duodenal segments with consecutive cholestasis mimicking an ampulloma and the lack of gastric outlet syndrome

How Can the EU Beating Cancer Plan Help in Tackling Lung Cancer, Colorectal Cancer, Breast Cancer and Melanoma?

Cancer is the second leading cause of mortality in EU countries, and the needs to tackle cancer are obvious. New scientific understanding, techniques and methodologies are opening up horizons for significant improvements in diagnosis and care. However, take-up is uneven, research needs and potential outstrip currently available resources, manifestly beneficial practices—such as population-level screening for lung cancer—are still not generalised, and the quality of life of patients and survivors is only beginning to be given attention it merits. This paper, mainly based on a series of multistakeholder expert workshops organised by the European Alliance for Personalised Medicine (EAPM), looks at some of those specifics in the interest of planning a way forward. Part of this exercise also involves taking account of the specific nature of Europe and its constituent countries, where the complexities of planning a way forward are redoubled by the wide variations in national and regional approaches to cancer, local epidemiology and the wide disparities in health systems. Despite all the differences between cancers and national and regional resources and approaches to cancer care, there is a common objective in pursuing broader and more equal access to the best available care for all European citizens

How Can the EU Beating Cancer Plan Help in Tackling Lung Cancer, Colorectal Cancer, Breast Cancer and Melanoma?

Cancer is the second leading cause of mortality in EU countries, and the needs to tackle cancer are obvious. New scientific understanding, techniques and methodologies are opening up horizons for significant improvements in diagnosis and care. However, take-up is uneven, research needs and potential outstrip currently available resources, manifestly beneficial practices—such as population-level screening for lung cancer—are still not generalised, and the quality of life of patients and survivors is only beginning to be given attention it merits. This paper, mainly based on a series of multistakeholder expert workshops organised by the European Alliance for Personalised Medicine (EAPM), looks at some of those specifics in the interest of planning a way forward. Part of this exercise also involves taking account of the specific nature of Europe and its constituent countries, where the complexities of planning a way forward are redoubled by the wide variations in national and regional approaches to cancer, local epidemiology and the wide disparities in health systems. Despite all the differences between cancers and national and regional resources and approaches to cancer care, there is a common objective in pursuing broader and more equal access to the best available care for all European citizens

Update on the role of Rifaximin in digestive diseases

© Journal of Gastrointestinal and Liver Diseases. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.Various environmental factors affecting the human microbiota may lead to gut microbial imbalance and to the development of pathologies. Alterations of gut microbiota have been firmly implicated in digestive diseases such as hepatic encephalopathy, irritable bowel syndrome and diverticular disease. However, while these three conditions may all be related to dysfunction of the gut-liver-brain axis, the precise pathophysiology appears to differ somewhat for each. Herein, current knowledge on the pathophysiology of hepatic encephalopathy, irritable bowel syndrome, and diverticular disease are reviewed, with a special focus on the gut microbiota modulation associated with these disorders during therapy with rifaximin. In general, the evidence for the efficacy of rifaximin in hepatic encephalopathy appears to be well consolidated, although it is less supported for irritable bowel syndrome and diverticular disease. We reviewed current clinical practice for the management of these clinical conditions and underlined the desirability of more real-world studies to fully understand the potential of rifaximin in these clinical situations and obtain even more precise indications for the use of the drug.info:eu-repo/semantics/publishedVersio

How Can the EU Beating Cancer Plan Help in Tackling Lung Cancer, Colorectal Cancer, Breast Cancer and Melanoma?

Cancer is the second leading cause of mortality in EU countries, and the needs to tackle cancer are obvious. New scientific understanding, techniques and methodologies are opening up horizons for significant improvements in diagnosis and care. However, take-up is uneven, research needs and potential outstrip currently available resources, manifestly beneficial practices—such as population-level screening for lung cancer—are still not generalised, and the quality of life of patients and survivors is only beginning to be given attention it merits. This paper, mainly based on a series of multistakeholder expert workshops organised by the European Alliance for Personalised Medicine (EAPM), looks at some of those specifics in the interest of planning a way forward. Part of this exercise also involves taking account of the specific nature of Europe and its constituent countries, where the complexities of planning a way forward are redoubled by the wide variations in national and regional approaches to cancer, local epidemiology and the wide disparities in health systems. Despite all the differences between cancers and national and regional resources and approaches to cancer care, there is a common objective in pursuing broader and more equal access to the best available care for all European citizens.publishedVersionPeer reviewe