M. Novi

Efficacy of Lactobacillus GG in maintaining remission of ulcerative colitis

Aminosalicylates are the mainstay of therapy to prevent relapse of quiescent ulcerative colitis. The rationale for using probiotics is based on the evidence implicating intestinal bacteria in the pathogenesis of this disorder.

Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development.

BACKGROUND/AIMS Prognostic scores currently used in cirrhotic patients do not include thrombotic risk factors (TRFs). Predicting factors of portal vein thrombosis (PVT) development are still unknown. We wanted to describe TRFs as a function of liver disease severity using the MELD score and assess the role of local and systemic TRFs as predictors of PVT development in cirrhotic patients. METHODS One hundred consecutive patients with liver cirrhosis were included in the study. TRFs, D-dimers, MELD score, portal vein patency and flow velocity were evaluated in all subjects at baseline and every 6 months thereafter. Variables able to predict PVT development within 1 year were identified by means of multiple logistic regression. RESULTS The plasma levels of protein C and antithrombin were lower and the concentration of D-dimers was higher in patients with advanced disease. Plasma levels of antithrombin, protein C and protein S resulted significantly lower in PVT group at univariate analysis, but reduced portal vein flow velocity was the only variable independently associated with PVT development. CONCLUSIONS Lower concentrations of natural coagulation inhibitors are frequently detected in patients with liver cirrhosis. A reduced portal flow velocity seems to be the most important predictive variable for PVT development in patients with cirrhosis.

Small intestinal bacterial overgrowth recurrence after antibiotic therapy

OBJECTIVES:Current treatment for small intestinal bacterial overgrowth (SIBO) is based on courses of broad-spectrum antibiotics. No data concerning SIBO recurrence are available. The aims of the present study were to investigate SIBO recurrence as assessed by glucose breath test (GBT) after antibiotic treatment and conditions associated to SIBO recurrence.METHODS:Eighty consecutive patients affected by SIBO and decontaminated by rifaximin (1,200 mg per day for 1 wk) were enrolled. Diagnosis of SIBO was based on GBT. GBT was reassessed at 3, 6, and 9 months after evidence of GBT normalization. GBT positivity recurrence, predisposing conditions, and gastrointestinal symptoms were evaluated.RESULTS:Ten (10/80, 12.6%), 22 (22/80, 27.5%), and 35 (35/80, 43.7%) patients showed positivity to GBT at 3, 6, and 9 months after successful antibiotic treatment, respectively. At multivariate analysis, older age (OR 1.09, 95% CI 1.02–1.16), history of appendectomy (OR 5.9, 95% CI 1.45–24.19), and chronic use of proton pump inhibitors (PPIs) (OR 3.52, 95% CI 1.07–11.64) were significantly associated to GBT positivity recurrence. All gastrointestinal symptoms significantly increased at 3, 6, and 9 months in patients with evidence of GBT positivity recurrence.CONCLUSIONS:GBT positivity recurrence rate was high after antibiotic treatment. Older age, history of appendectomy, and chronic use of PPIs were associated with GBT positivity recurrence. Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence.

Stem cell-based therapy in gastroenterology and hepatology.

Protagonists of a new scientific era, stem cells are promising tools on which regenerative medicine relies for the treatment of human pathologies. Stem cells can be obtained from various sources, including embryos, fetal tissues, umbilical cord blood, and also terminally differentiated organs. Once forced to expand and differentiate into functional progenies, stem cells may become suitable for cell replacement and tissue engineering. The manipulation and/or stimulation of adult stem cells seems to be particularly promising, as it could improve the endogenous regenerative potential without risks of rejection and overcome the ethical and political issues related to embryonic stem cell research. Stem cells are already leaving the bench and reaching the bedside, despite an incomplete knowledge of the genetic control program driving their fate and plasticity. In gastroenterology and hepatology, the first attempts to translate stem cell basic research into novel therapeutic strategies have been made for the treatment of several disorders, such as inflammatory bowel diseases, diabetes mellitus, celiachy and acute or chronic hepatopaties. Nonetheless, critical aspects need to be further addressed, including the long‐term safety, tolerability and efficacy of cell‐based treatments, as well as their carcinogenic potential. Aim of this review is to summarize the state‐of‐the‐arts on gastrointestinal and hepatic stem cells and on stem cell‐based therapies in gastroenterology and hepatology, highlighting both the benefits and the potential risks of these new tools for the treatment and prevention of human diseases.

Portal Vein Tumor Thrombosis Revascularization During Sorafenib Treatment for Hepatocellular Carcinoma

Portal Vein Tumor Thrombosis Revascularization During Sorafenib Treatment for Hepatocellular Carcinoma

CD133+ stem cell mobilization after partial hepatectomy depends on resection extent and underlying disease.

BACKGROUND Bone marrow stem cells (BMSC) can participate to liver regeneration. However, conflicting results have been reported on this topic in patients undergoing liver resection. AIMS To assess the impact of liver resection extent and presence of underlying liver disease in modulating BMSC mobilization. METHODS We enrolled 29 patients undergoing liver resection of different extents, 5 surgical controls and 10 blood donors. Circulating CD133+ BMSC were measured by flow cytometry at different time-points after surgery. The hepatic commitment of mobilized BMSC was investigated by polymerase chain reaction. Liver specimens were collected during surgery for histopathological analysis. Hepatocyte growth factor and granulocyte-colony stimulating factor serum levels were measured by enzyme-linked immunosorbent assay. RESULTS BMSC mobilization was found in patients undergoing major liver resection, especially in the presence of underlying disease. Ductular reactions were noted in patients with chronic hepatopathy and the hepatic progenitor-like cells expressed CD133, NCAM, cytokeratin-19, and alpha-fetoprotein. Hepatocyte growth factor and granulocyte-colony stimulating factor levels increased following liver resection and the contemporaneous presence of liver disease was associated with their highest raise. CONCLUSIONS Liver repair is mainly an endogenous process. BMSC become important in case of extensive resection, especially in the presence of underlying hepatopathy and hepatic progenitor-like cells activation. Hepatocyte growth factor and granulocyte-colony stimulating factor seem to be involved in the dynamics underlying hepatic regeneration and BMSC recruitment.

Essential thrombocythemia as underlying cause of malabsorption syndrome

Dear Editor, In October 2008, we observed a 31-year-old woman with 2year history of postprandial abdominal pain, diarrhea, and peripheral edema. Patient had no evidence of cardiac or renal failure; liver and spleen size were normal, and there was no palpable lymphoadenomegalies. Liver, pancreatic, and thyroid function tests and acute-phase reactants were normal, antigliadin, and antiendomysial, and anti-DNA antibodies were absent, and antibodies to HCV, HBV, and HIV were negative. Repeated controls of hematological parameters evidenced slight thrombocytosis and leukocytosis, in the presence of low serum ferritin. Moreover, low serum protein and cholesterol, marked hypoalbuminemia and hypogammaglobulinemia were present. No proteinuria was found, and it was hypothesized an enteric loss of protein. The stool specimens were negative for occult blood and parasitic contamination. A total body CT scan evidenced no lymphoadenomegalies, while a generalized thickening of ileal wall with mesenteric edema was present. Furthermore, no alterations of hepatic and portal veins were found. Gastrointestinal endoscopy showed jejunal mucosa covered by congested, stocky, and whitish villi and biopsies of duodenal and jejunal tract documented a protein-losing enteropathy. Thrombocytosis was considered secondary to the iron deficiency, and patient received 2-week intravenous supplementation of iron and folic acid with recovery of ferritin value. Because of thrombocytosis persisted, we decided to investigate the presence of myeloproliferative neoplasms (MPNs). The patient was proved negative for JAK2 and MPL mutations and for BCR/ABL rearrangement, while endogenous erythroid colonies were found. In addition, the HUMARA assay demonstrated monoclonal expansion of hematopoiesis. Bone marrow biopsy evidenced megakaryocytic hyperplasia, and the diagnosis of essential thrombocythemia) was made [1]. The high incidence of splanchnic thrombosis in patients with MPNs prompted us to a more accurate investigation of abdominal vessels [2, 3]. Actually, a CT angiography revealed a significant stenosis of the superior mesenteric artery (Fig. 1). The patient underwent selective mesenteric angiography and percutaneous endovascular angioplasty, with adequate revascularization. The presence of acquired or hereditary thrombophilic defects was ruled out, and therapy with low-dose aspirin and hydroxycarbamide was undertaken. During the following months, the nutritive state and the clinical conditions of patient progressively improved. The most relevant feature affecting the clinical course of pH-negative MPNs is the prothrombotic state causing both arterial and venous thromboses and microvessel disturbances [2, 3]. In particular, splanchnic vein thromboses (SVT), including both portal and mesenteric vein thromboses, are L. Teofili : L. Torti :G. Leone Department of Hematology, Catholic University, Rome, Italy