The International Journal of Gastroenterology and Hepatology Diseases - Current Issue

Background: Video capsule endoscopy (VCE) is a safe and effective way of investigating obscure gastrointestinal bleeding. One of the main limitations of VCE is suboptimal visualisation due to prolonged gastric transit time (GTT) or rapid small intestinal transit time (SITT). The role of metabolic risk factors, diabetes, and medications on transit times remains unclear.

Aim: The aim of this study was to assess the impact of diabetes, obesity, medications, and metabolic syndrome on transit times at VCE.

Methods: The study performed was a single centre, observational study.

Results: Significant predictors of decreased GTT were increasing age and use of beta blocker medication. No predictive factors for increased GTT were identified. Significant predictors of decreased SITT on univariate analysis were increased GTT, serum glucose >5mmol/L, obesity, and diabetes. On multivariate analysis, increased GTT and glucose remained significant.

Conclusion: Beta-blocker therapy reduces GTT. Hyperglycaemia at the time of VCE reduces SITT. These allow for possible therapeutic strategies to improve the diagnostic yield at VCE.

Objective: Immunity-related issues are the main concerns of patients undergoing inflammatory bowel disease (IBD) treatment. The treatment of IBD during the last decade has evolved due to the ever-increasing utilization of immunomodulators, which has caused the potential of contracting opportunistic infections to become the main immunity concern for patients affected by IBD.

Methods: Studies on opportunistic infections in patients with IBD identified in databases such as Google Scholar, PubMed, and Scopus were reviewed and included.

Results: IBD patients are a high-risk population for opportunistic infections, with age being a significant factor. The primary therapy for IBD patients includes the suppression of the immunity system, together with immunodeficiency and biological treatments, which, first of all, must be standardized. Since treatment with suppressive medicine, which is the original method for curing IBD, causes viral infections and the growth of various bacteria, factors suppressing the body's immunity system must be temporarily suspended, or the consumption dosage of sensitive antibiotics should be reduced. Biological treatment and anti-integrin antibodies will lead to the danger of being affected by opportunistic infections in patients with IBD.

Conclusion: Worldwide research society must conduct further research into a therapeutic strategy for IBD patients to reduce susceptibility and the risk of opportunistic infection. Information about how these individuals and the medicines they were given reacted to different infections and more detailed clinical observations are required.

Budd-Chiari Syndrome (BCS) is characterized by significant clinical and pathophysiological aspects that seem to allow a sharp differentiation between a variant in the West from one in the East.

The aim of this paper is to focus on the main issues and controversies about the management of BCS in the West. The study discusses different treatment options and how research is trying to solve controversies about debated topics, such as the timing of treatment. In fact, guidelines regarding management of BCS suggest a step-wise strategy starting with medical therapy, arriving at revascularization or TIPS as the second step, and culminating to liver transplant as rescue therapy.

However, long-term outcome is frequently dismal on sole medical therapy. In fact, it is a matter of debate whether further intervention should be suggested only when hemodynamic consequences of portal hypertension are evident. However, as recently hypothesized, chronic micro-vascular ischemia due to impaired venous hepatic outflow could trigger liver fibrosis, resulting in portal hypertension and progressive liver failure. Consequently, liver congestion relief through treatment might be useful as a preventive tool. Recently, early TIPS proved to improve BCS outcome. A direct comparison of early intervention versus step-wise strategy would seem advisable. Furthermore, further studies should address whether non-invasive tools could predict which patients benefit from early intervention.

Background: Hemolymphangioma is rarely found in the small intestine. There have only been eight reports of hemolymphangiomas arising in the small intestine to date. The first patient was reported by Fang et al. in 2012. A small intestinal hemolymphangioma may lead to anemia and gastrointestinal bleeding.

Case Presentation: We report a case of jejunal hemolymphangioma in a 49-year-old man. The patient presented with melena and anemia. He underwent double balloon enteroscopy (DBE) the antegrade approach, which demonstrated a 3.0 cm segment of jejunum with nearly 75% of the circumferential lesion with blood remnant. The raised soft lesion was in the middle of the jejunum with white patches on the surface of the mucosa. Endoscopic biopsy was not performed to avoid secondary bleeding. The patient underwent laparotomy, and partial small intestine resection was performed. A 5.0cm segment of jejunum was resected with primary anastomosis. The patient had an uneventful postoperative recovery. Macroscopic pathological examination showed a cavernous, soft and compressible tumor. Microscopic examination showed a tumor which was composed of blood and lymphatic vessels mainly located in the submucosa. The definitive histological diagnosis was jejunal hemolymphangioma. During a follow-up of 2 years, there was no further gastrointestinal bleeding.

Conclusion: Small intestinal hemolymphangioma is a rare benign tumor of which clinical manifestations are nonspecific and accurate preoperative diagnosis is challenging. Endoscopic biopsy is not recommended for hemolymphangioma of the gastrointestinal tract due to the risk of severe bleeding. Complete surgical resection of the hemolymphangioma is considered the most effective treatment for small intestinal hemolymphangioma.

Obesity is one of the major health problems of the modern era. Obesity has been associated with rapidly rising growth rates that affect every age group of the population indiscriminately, particularly the younger ones. Undoubtedly, it is necessary to identify increasingly effective therapies in order to avoid the possible complications of the syndrome. In this context, the microbiota can represent one of the therapeutic targets for the prevention and treatment of obesity. We highlight the role of the microbiota as a therapeutic target in obesity.

Background: Drug-induced liver injury (DILI) and the causative drug in patients under polypharmacy medication represent a challenging diagnosis.

Case Report: A 73 years old multimorbid man receiving polypharmacy, including rosuvastatin among other drugs, presented with high values of alanine aminotransferase (950 U/L) and aspartate aminotransferase (702 U/L), associated with a normal value of alkaline phosphatase (46 U/L), which turned out as DILI due to the hepatocellular injury type with an R-value of 29.8 as calculated from liver test values. Causality for each drug was assessed using the updated RUCAM (Roussel Uclaf Causality Assessment Method) prospectively. Causality for rosuvastatin and diltiazem was highly probable based on a RUCAM score of 9, but no reports of DILI caused by diltiazem were found. In addition, the causality grade for other drugs included in the patient’s medication was “probable” based on a RUCAM score of 6 to 8. The patient experienced a favorable outcome after discontinuation of all medication.

Discussion: The medication history, as well as the prospective and proactive causality evaluation by the updated RUCAM, helped establish the diagnosis of severe DILI by two highly suspected causative drugs, considering also several drugs with a “probable” causality grade in this case. Statins may cause direct damage to the liver, interact with other drugs, and enhance the susceptibility to DILI caused by commonly safe drugs.

Conclusion: In this case, the DILI was caused by rosuvastatin as evidenced by a high score in the updated RUCAM, but a large number of comedications may have a co-triggering effect.