Roberta D’Aniello

Therapeutic options in pediatric non alcoholic fatty liver disease: current status and future directions

The epidemics of overweight and obesity has resulted in a significant increase of non alcoholic fatty liver disease (NAFLD), a potentially progressive condition. Currently, obesity related hepatopathy represents therefore the main cause of pediatric chronic liver disease. The first choice treatment at all ages is weight loss and/or lifestyle changes, however compliance is very poor and a pharmacological approach has become necessary. In the present article we present a systematic literature review focusing on established pediatric NALFD drugs (ursodeoxycholic acid, insulin sensitizers, and antioxidants) and on innovative therapeutic options as well.Regarding the former ones, a pediatric pilot study highlighted that ursodeoxycholic acid is not efficient on transaminases levels and bright liver. Similarly, a recent large scale, multicenter randomized clinical trial (TONIC study) showed that also insulin sensitizers and antioxidant vitamin E have scarce effects on serum transaminase levels. Among a large series of novel therapeutic approaches acting on recently proposed different pathomechanisms, probiotics seem hitherto the most interesting and reasonable option for their safety and tolerability. Toll-like receptors modifiers, Pentoxifylline, and Farnesoid X receptors agonists have been still poorly investigated, and will need further studies before becoming possible promising innovative therapeutic strategies.

Probiotics to Treat Visceral Obesity and Related Liver Disease

Obesity and its related complications have reached epidemic proportions that cannot be completely explained by energy imbalance between dietary calories and physical exercise. Increasing interest is therefore developing in a number of recently identified obesogenic triggering factors (e.g. endocrine disruptors, sleep deprivation, fructose intake, gut-liver axis, and intestinal microbiota). In this chapter, we will focus on recent advances in our knowledge of the gut-liver axis and gut microbiota, which suggest that: (1) age, geographical origin, breastfeeding, diet, and lifestyle may all influence microbiome composition;

Hypertransaminasemia: Is it Always Liver Disease? The Case of Subclinical Myopathies and Macroenzymes

Abstract: Aminotransferases increase in serum is generally considered indicative of liver cell injury. However, these enzymes are also present in tissues other than the liver, mainly the muscles. Therefore, after an incidental finding of hypertransaminasemia, serum creatine kinase check and an accurate physical examination -looking for subtle signs of muscular affection- are necessary to reach a correct diagnosis and avoid missing salient signs of a muscular disorder. In the case of protracted isolated AST elevation, the possibility of macro -AST should be taken into account as well. This is a generally benign condition, whose prompt recognition might avoid expensive, and occasionally invasive liver disease-related diagnostic procedures. Polyethylene glycol testing is considered a valuable screening test.