171 results on '"Lorenzo Ridola"'
Search Results
2. Dysbiosis in Inflammatory Bowel Disease and Spondyloarthritis: Still a Long Way to Go?
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Maria Consiglia Bragazzi, Federica Pianigiani, Rosanna Venere, and Lorenzo Ridola
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inflammatory bowel disease ,spondyloarthritis ,dysbiosis ,microbiota ,fecal microbiota transplantation ,tumor necrosis factor alpha inhibitor ,Medicine - Abstract
The association between Inflammatory Bowel Disease (IBD) and Spondyloarthritis (SpA) has been known for years, as has the concept that IBD is associated with an altered intestinal bacterial composition, a condition known as “dysbiosis”. Recently, a state of intestinal dysbiosis has also been found in SpA. Dysbiosis in the field of IBD has been well characterized so far, as well as in SpA. The aim of this review is to summarize what is known to date and to emphasize the similarities between the microbiota conditions in these two diseases: particularly, an altered distribution in the gut of Enterobacteriaceae, Streptococcus, Haemophilus, Clostridium, Akkermansia, Ruminococcus, Faecalibacterium Prausnitzii, Bacteroides Vulgatus, Dialister Invisus, and Bifidubacterium Adolescentis is common to both IBD and SpA. At the same time, little is known about intestinal dysbiosis in IBD-related SpA. Only a single recent study has found an increase in Escherichia and Shigella abundances and a decrease in Firmicutes, Ruminococcaceae, and Faecalibacterium abundances in an IBD-related SpA group. Based on what has been discovered so far about the altered distribution of bacteria that unite both pathologies, it is appropriate to carry out further studies aiming to improve the understanding of IBD-related SpA for the purpose of developing new therapeutic strategies.
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- 2024
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3. Use of albumin infusion for cirrhosis-related complications: An international position statement
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Zhaohui Bai, Nahum Méndez-Sánchez, Fernando Gomes Romeiro, Andrea Mancuso, Cyriac Abby Philips, Frank Tacke, Metin Basaranoglu, Massimo Primignani, Mostafa Ibrahim, Yu Jun Wong, Filipe Gaio Nery, Rolf Teschke, Carlos Noronha Ferreira, Alberto E. Muñoz, Kanokwan Pinyopornpanish, Thierry Thevenot, Shivaram Prasad Singh, Arpan Mohanty, Sanjaya K. Satapathy, Lorenzo Ridola, Hitoshi Maruyama, Evangelos Cholongitas, Giovanni Battista Levi Sandri, Li Yang, Shalimar, Yongping Yang, Erica Villa, Aleksander Krag, Florence Wong, Rajiv Jalan, Alastair O’Brien, Mauro Bernardi, and Xingshun Qi
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Decompensated ,Human albumin ,Kidney injury ,Liver failure ,Management ,Portal hypertension ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Numerous studies have evaluated the role of human albumin (HA) in managing various liver cirrhosis-related complications. However, their conclusions remain partially controversial, probably because HA was evaluated in different settings, including indications, patient characteristics, and dosage and duration of therapy. Methods: Thirty-three investigators from 19 countries with expertise in the management of liver cirrhosis-related complications were invited to organise an International Special Interest Group. A three-round Delphi consensus process was conducted to complete the international position statement on the use of HA for treatment of liver cirrhosis-related complications. Results: Twelve clinically significant position statements were proposed. Short-term infusion of HA should be recommended for the management of hepatorenal syndrome, large volume paracentesis, and spontaneous bacterial peritonitis in liver cirrhosis. Its effects on the prevention or treatment of other liver cirrhosis-related complications should be further elucidated. Long-term HA administration can be considered in specific settings. Pulmonary oedema should be closely monitored as a potential adverse effect in cirrhotic patients receiving HA infusion. Conclusions: Based on the currently available evidence, the international position statement suggests the potential benefits of HA for the management of multiple liver cirrhosis-related complications and summarises its safety profile. However, its optimal timing and infusion strategy remain to be further elucidated. Impact and implications: Thirty-three investigators from 19 countries proposed 12 position statements on the use of human albumin (HA) infusion in liver cirrhosis-related complications. Based on current evidence, short-term HA infusion should be recommended for the management of HRS, LVP, and SBP; whereas, long-term HA administration can be considered in the setting where budget and logistical issues can be resolved. However, pulmonary oedema should be closely monitored in cirrhotic patients who receive HA infusion.
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- 2023
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4. Hepatic encephalopathy increases the risk for mortality and hospital readmission in decompensated cirrhotic patients: a prospective multicenter study
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Oliviero Riggio, Ciro Celsa, Vincenza Calvaruso, Manuela Merli, Paolo Caraceni, Sara Montagnese, Vincenzina Mora, Martina Milana, Giorgio Maria Saracco, Giovanni Raimondo, Antonio Benedetti, Patrizia Burra, Rodolfo Sacco, Marcello Persico, Filippo Schepis, Erica Villa, Antonio Colecchia, Stefano Fagiuoli, Mario Pirisi, Michele Barone, Francesco Azzaroli, Giorgio Soardo, Maurizio Russello, Filomena Morisco, Sara Labanca, Anna Ludovica Fracanzani, Antonello Pietrangelo, Gabriele Di Maria, Silvia Nardelli, Lorenzo Ridola, Antonio Gasbarrini, and Calogero Cammà
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hepatic encephalopathy ,decompensated cirrhosis ,orthotopic liver transplant ,hospital readmission ,mortality ,Medicine (General) ,R5-920 - Abstract
IntroductionHepatic encephalopathy (HE) affects the survival and quality of life of patients with cirrhosis. However, longitudinal data on the clinical course after hospitalization for HE are lacking. The aim was to estimate mortality and risk for hospital readmission of cirrhotic patients hospitalized for HE.MethodsWe prospectively enrolled 112 consecutive cirrhotic patients hospitalized for HE (HE group) at 25 Italian referral centers. A cohort of 256 patients hospitalized for decompensated cirrhosis without HE served as controls (no HE group). After hospitalization for HE, patients were followed-up for 12 months until death or liver transplant (LT).ResultsDuring follow-up, 34 patients (30.4%) died and 15 patients (13.4%) underwent LT in the HE group, while 60 patients (23.4%) died and 50 patients (19.5%) underwent LT in the no HE group. In the whole cohort, age (HR 1.03, 95% CI 1.01–1.06), HE (HR 1.67, 95% CI 1.08–2.56), ascites (HR 2.56, 95% CI 1.55–4.23), and sodium levels (HR 0.94, 95% CI 0.90–0.99) were significant risk factors for mortality. In the HE group, ascites (HR 5.07, 95% CI 1.39–18.49) and BMI (HR 0.86, 95% CI 0.75–0.98) were risk factors for mortality, and HE recurrence was the first cause of hospital readmission.ConclusionIn patients hospitalized for decompensated cirrhosis, HE is an independent risk factor for mortality and the most common cause of hospital readmission compared with other decompensation events. Patients hospitalized for HE should be evaluated as candidates for LT.
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- 2023
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5. The Management of Hepatic Encephalopathy from Ward to Domiciliary Care: Current Evidence and Gray Areas
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Daniele Bellafante, Stefania Gioia, Jessica Faccioli, Oliviero Riggio, Lorenzo Ridola, and Silvia Nardelli
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overt hepatic encephalopathy ,minimal hepatic encephalopathy ,portosystemic shunts ,ammonia ,liver cirrhosis ,Medicine - Abstract
Hepatic encephalopathy (HE) is a common complication of advanced liver disease and acute liver failure. It is a condition that features several neuropsychiatric symptoms that affect mortality, morbidity and the quality of patients’ and caregivers’ lives. An HE diagnosis is generally an exclusion diagnosis. Once the patient is admitted to the hospital, clinical examination, blood tests and eventually neuroimaging should be performed with the aim of ruling out other causes of acute brain dysfunction. Moreover, HE is recognized using various precipitants that can potentially promote its onset, alone or in combination, and must be identified. Once the diagnostic process is complete, a correct treatment should be started. The anti-HE treatment is based on a combination of the correction of precipitants; non-absorbable antibiotics, such as rifaximin; and non-absorbable disaccharides. Once the patient is discharged from the hospital, specific anti-HE therapy should be maintained in order to prevent other HE episodes.
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- 2023
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6. Transjugular Intrahepatic Portosystemic Shunt Placement: Effects on Nutritional Status in Cirrhotic Patients
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Ilaria de Felice, Lorenzo Ridola, Oliviero Riggio, Jessica Faccioli, Silvia Nardelli, and Stefania Gioia
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malnutrition ,sarcopenia ,myosteatosis ,transjugular intrahepatic portosystemic shunt ,portal hypertension ,Medicine - Abstract
Malnutrition is a tangible complication of cirrhosis with portal hypertension with a prevalence of up to 50%. In particular, sarcopenia and myosteatosis, defined as the alteration in muscle quantity and quality, have a negative impact on the main complications of liver disease and are associated with higher mortality in patients with cirrhosis. Recently, alterations in adipose tissue have also been described in cirrhotic patients and they seem to influence the course of liver disease. Several pieces of evidence indicate that a transjugular intrahepatic portosystemic shunt (TIPS), placed for the treatment of refractory portal hypertension, can lead to a modification of body composition consisting in the improvement of the skeletal muscle index, myosteatosis, and an increase in subcutaneous fat. These modifications of the nutritional status, even more pronounced in sarcopenic patients before TIPS, have been associated with an amelioration of cognitive impairment after TIPS as well as with an increase in the survival rate. The aim of this paper is to provide an overview of the effects of TIPS placement on nutritional status in cirrhosis focusing on its pathophysiological mechanisms and its relationship with liver-related outcomes.
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- 2023
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7. Primary Prophylaxis of Overt Hepatic Encephalopathy: Is It Time to Consider It?
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Jessica Faccioli, Silvia Nardelli, Stefania Gioia, Oliviero Riggio, and Lorenzo Ridola
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n/a ,Medicine - Abstract
Hepatic encephalopathy (HE) represents one of the most frequent complications of liver cirrhosis and one of the most debilitating clinical manifestations of liver disease due to the accumulation of toxic substances in the blood and central nervous system [...]
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- 2023
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8. Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution
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Daniele Bellafante, Stefania Gioia, Jessica Faccioli, Oliviero Riggio, Lorenzo Ridola, and Silvia Nardelli
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overt hepatic encephalopathy ,minimal hepatic encephalopathy ,sarcopenia ,portosystemic shunts ,ammonia ,liver cirrhosis ,Medicine - Abstract
Hepatic encephalopathy (HE) is a common complication in patients with advanced liver disease. It is a brain dysfunction characterized by neurological and psychiatric symptoms that significantly affects quality of life, morbidity and mortality of patients. HE has various precipitants that can potentially promote its onset, alone or in combination. Among the historically well-known precipitants, such as infections, gastrointestinal bleeding, dehydration, electrolyte disorders and constipation, recent studies have highlighted the role of malnutrition and portosystemic shunts as new precipitating factors of HE. The identification, management and correction of these factors are fundamental for effective HE treatment, in addition to pharmacological therapy with non-absorbable disaccharides and/or antibiotics.
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- 2023
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9. Minimal Hepatic Encephalopathy Affects Daily Life of Cirrhotic Patients: A Viewpoint on Clinical Consequences and Therapeutic Opportunities
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Jessica Faccioli, Silvia Nardelli, Stefania Gioia, Oliviero Riggio, and Lorenzo Ridola
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minimal hepatic encephalopathy ,cirrhosis ,quality of life ,sleep disorders ,therapy ,non-absorbable disaccharides ,Medicine - Abstract
Minimal hepatic encephalopathy (MHE) is a frequent complication of hepatic encephalopathy (HE) and can affect up to 80% of patients with liver cirrhosis. It is characterized by the lack of obvious clinical signs and the presence of alterations detectable using psychometric or electrophysiological testing focused on attention, working memory, psychomotor speed and visuospatial ability. Ideally, each patient should be tested for this condition because, despite the absence of symptoms, it has severe repercussions on daily life activities. It may be responsible for an inability to drive, sleep disturbances, risk of falls and inability to work. Some studies have highlighted its prognostically unfavorable role on mortality and risk of “overt” HE (OHE). Finally, MHE severely affects the lives of patients and caregivers, altering their quality of life and their socioeconomic status. Several treatments have been proposed for MHE treatment, including non-absorbable disaccharides, poorly absorbable antibiotics, such as rifaximin, probiotics and branched-chain amino acids, with promising results. For this reason, early diagnosis and intervention with appropriate measures is essential, with the aim of improving both performance on psychometric tests, as well as clinical aspects related to this condition.
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- 2022
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10. Nutrition Assessment and Management in Patients with Cirrhosis and Cognitive Impairment: A Comprehensive Review of Literature
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Jessica Faccioli, Silvia Nardelli, Stefania Gioia, Oliviero Riggio, and Lorenzo Ridola
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hepatic encephalopathy ,protein caloric-malnutrition ,sarcopenia ,dietary intervention ,cirrhosis ,mortality ,Medicine - Abstract
Hepatic encephalopathy (HE) represents a common complication of liver cirrhosis. Protein-calorie malnutrition is frequently encountered in the cirrhotic patient and its most obvious clinical manifestation is sarcopenia. This condition represents a risk factor for HE occurrence because skeletal muscle acts as an alternative site for ammonium detoxification. Preventive intervention through an adequate assessment of nutritional status should be carried out at early stages of the disease and in a multidisciplinary team using both non-instrumental methods (food diary, anthropometric measurements, blood chemistry tests) and instrumental methods (bioimpedance testing, DEXA, CT, indirect calorimetry, dynamometry). Dietary recommendations for patients with HE do not differ from those for cirrhotic patient without HE. Daily caloric intake in the non-obese patient should be 30–40 Kcal/Kg/day with a protein intake of 1–1.5 g/Kg/day, especially of vegetable origin, through 4–6 meals daily. In patients with HE, it is also essential to monitor electrolyte balance, supplementing any micronutrient deficiencies such as sodium and zinc, as well as vitamin deficiencies because they can cause neurological symptoms similar to those of HE. In light of the critical role of nutritional status, this aspect should not be underestimated and should be included in the diagnostic–therapeutic algorithm of patients with HE.
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- 2022
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11. Ammonia and the Muscle: An Emerging Point of View on Hepatic Encephalopathy
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Simone Di Cola, Silvia Nardelli, Lorenzo Ridola, Stefania Gioia, Oliviero Riggio, and Manuela Merli
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cirrhosis ,sarcopenia ,myosteatosis ,hepatic encephalopathy ,Medicine - Abstract
In the last years the link between the presence of muscular alterations and hepatic encephalopathy (HE), both minimal and overt, has been deeply studied. The pathophysiological background supporting the relationship between muscle depletion, and HE is characterized by an imbalance between the capacity of muscle in ammonia metabolism and trafficking and the inability of the liver in removing ammonia through urea synthesis due to liver failure and/or the presence of porto-systemic shunts. This review will focus on the clinical burden, the physio pathological mechanisms understanding the liver muscle axis and principles of management of muscular alterations in cirrhosis.
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- 2022
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12. Cognitive Impairement in Non-Cirrhotic Portal Hypertension: Highlights on Physiopathology, Diagnosis and Management
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Stefania Gioia, Silvia Nardelli, Oliviero Riggio, Jessica Faccioli, and Lorenzo Ridola
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porto-sinusoidal vascular liver disease ,idiopathic non-cirrhotic portal hypertension ,portal vein thrombosis ,hepatic encephalopathy ,porto-systemic shunt ,Medicine - Abstract
Hepatic encephalopathy (HE) is one of the most frequent complications of cirrhosis. Several studies and case reports have shown that cognitive impairment may also be a tangible complication of portal hypertension secondary to chronic portal vein thrombosis and to porto-sinusoidal vascular disease (PSVD). In these conditions, representing the main causes of non-cirrhotic portal hypertension (NCPH) in the Western world, both overt and minimal/covert HE occurs in a non-neglectable proportion of patients, even lower than in cirrhosis, and it is mainly sustained by the presence of large porto-systemic shunt. In these patients, the liver function is usually preserved or only mildly altered, and the development of porto-systemic shunt is either spontaneous or iatrogenically frequent; HE is an example of type-B HE. To date, in the absence of strong evidence and large cooperative studies, for the diagnosis and the management of HE in NCPH, the same approach used for HE occurring in cirrhosis is applied. The aim of this paper is to provide an overview of type B hepatic encephalopathy, focusing on its pathophysiology, diagnostic tools and management in patients affected by porto-sinusoidal vascular disease and chronic portal vein thrombosis.
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- 2021
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13. Emerging Therapies for Advanced Cholangiocarcinoma: An Updated Literature Review
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Anthony Vignone, Francesca Biancaniello, Marco Casadio, Ludovica Pesci, Vincenzo Cardinale, Lorenzo Ridola, and Domenico Alvaro
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cholangiocarcinoma ,targeted therapy ,immunotherapy ,Medicine - Abstract
Cholangiocarcinoma is a group of malignancies with poor prognosis. Treatments for the management of advanced-stage cholangiocarcinoma are limited, and the 5-year survival rate is estimated to be approximately 5–15%, considering all tumor stages. There is a significant unmet need for effective new treatment approaches. The present review is provided with the aim of summarizing the current evidence and future perspectives concerning new therapeutic strategies for cholangiocarcinoma. The role of targeted therapies and immunotherapies is currently investigational in cholangiocarcinoma. These therapeutic options might improve survival outcomes, as shown by the promising results of several clinical trials illustrated in the present review. The co-presence of driver mutations and markers of susceptibility to immunotherapy may lead to rational combination strategies and clinical trial development. A better understanding of immunologically based therapeutic weapons is needed, which will lead to a form of a precision medicine strategy capable of alleviating the clinical aggressiveness and to improve the prognosis of cholangiocarcinoma.
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- 2021
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14. Sex Differences in Response to TNF-Inhibiting Drugs in Patients With Spondyloarthropathies or Inflammatory Bowel Diseases
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Bruno Laganà, Angelo Zullo, Maria Lia Scribano, Maria Sole Chimenti, Alberto Migliore, Andrea Picchianti Diamanti, Roberto Lorenzetti, Palma Scolieri, Lorenzo Ridola, Elena Ortona, Marina Pierdominici, and Vincenzo Bruzzese
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spondyloarthritis ,inflammatory bowel disease ,sex differences ,adalimumab ,infliximab ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Spondyloarthritis (SpA) and inflammatory bowel diseases (IBD) are chronic inflammatory diseases characterized by an aberrant immune response and inflammation with a key role for TNF in their pathogenesis. Accordingly, TNF-inhibiting therapy (TNFi) has dramatically improved the management of these diseases. However, about 30% of patients discontinue TNFi for lack of response, loss of response, and side effects and/or adverse events. Thus, the possibility to identify in advance those patients who will have a good response to TNFi would be extremely beneficial. The aim of this study was to investigate differences between males and females with either SpA or IBD in response to TNFi molecules, i.e., infliximab (IFX) and adalimumab (ADA), considering the reasons for TNFi withdraw. Data of 594 patients, 349 with IBD (M/F: 194/155) and 245 with SpA (M/F: 123/122), previously unexposed to TNFi, were collected. In the IBD group, the rate of female patients discontinuing ADA was significantly higher than that of male patients (p = 0.03). No difference emerged according to the distribution of reason for discontinuation. Otherwise, a similar discontinuation rate between female and male patients receiving IFX therapy was observed. In the SpA group, the overall discontinuation rate was not different between males and females both for ADA and IFX. However, in patients treated with ADA, males interrupted therapy more frequently than females due to lack of response (p = 0.03). In conclusion, the assessment of sex differences in TNFi response could help physicians personalize the therapeutic approach in a sex-oriented perspective.
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- 2019
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15. Hepatic Encephalopathy in the 21st Century: Still an Emerging Topic
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Lorenzo Ridola and Oliviero Riggio
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n/a ,Medicine - Abstract
Why write about hepatic encephalopathy (HE) in the twenty-first century [...]
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- 2021
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16. Rifaximin as treatment for hepatic encephalopathy: Some considerations
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Lorenzo Ridola, Angelo Zullo, and Cesare Hassan
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2013
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17. Hepatic encephalopathy – recent advances in treatment and diagnosis
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Silvia Nardelli, Stefania Gioia, Jessica Faccioli, Oliviero Riggio, and Lorenzo Ridola
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Hepatology ,Gastroenterology - Published
- 2023
18. Non-invasive tests for fibrosis detection: still in search for the best way
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Lorenzo Ridola, Danila Capoccia, Gloria Guarisco, Oliviero Riggio, and Frida Leonetti
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General Earth and Planetary Sciences ,Original Article ,General Environmental Science - Abstract
BACKGROUND: Vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP™) have shown reliable performance predicting fibrosis and steatosis in normal- to overweight patients but have not been validated in severe to morbid obesity. This study aimed at determining the accuracy of VCTE, CAP™ and the composite score FibroScan-AST (FAST) in patients with a body mass index (BMI) of ≥35 kg/m(2). METHODS: Patients scheduled for bariatric-metabolic surgery underwent preoperative VCTE/CAP™ measurement, and intraoperative liver biopsy. The feasibility and accuracy of VCTE, CAP™ and the composite score FAST were retrospectively analysed to evaluate fibrosis, steatosis and active fibrotic non-alcoholic steatohepatitis [NASH + non-alcoholic fatty liver disease (NAFLD) activity score ≥4 + fibrosis grade ≥2] using per protocol (PP) and intent to diagnose (ITD) calculation. RESULTS: In total, 170 patients (median BMI 44.4 kg/m(2)) were included in the study. Liver biopsy showed NASH, simple steatosis, and normal livers in 60.6% (n=103), 28.8% (n=49), and 10.6% (n=18), respectively. VCTE and CAP™ delivered reliable results in 90.6% (n=154/170) and 90.5% (n=134/148). The AUC (PP) of VCTE, CAP™, and FAST were 0.687 (≥F2), 0.786 (≥F3), 0.703 (≥S2), 0.738 (S3), and 0.780 (active fibrotic NASH). The AUC increased to 0.742 (≥F2), 0.842 (≥F3), 0.712 (≥S2), 0.780 (S3), and 0.836 (active fibrotic NASH) in patients below the median BMI of 44.4 kg/m(2). CONCLUSIONS: VCTE, CAP™ and FAST show acceptable accuracy for the detection of fibrosis, steatosis and NASH in a real-life cohort of patients with obesity. Accuracy improves in patients with a BMI
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- 2022
19. Clinical outcomes and prognostic factors in non-cirrhotic non-neoplastic patients with portal vein thrombosis: A single-centre experience
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Stefania Gioia, Oliviero Riggio, Silvia Nardelli, Lorenzo Ridola, and Chiara Marzano
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Hepatology ,Gastroenterology - Published
- 2023
20. Determinants of prognosis in cirrhosis: a new outlook
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Lorenzo, Ridola, Stefania, Gioia, Jessica, Faccioli, Silvia, Nardelli, and Oliviero, Riggio
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General Earth and Planetary Sciences ,General Environmental Science - Published
- 2022
21. Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more?
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Stefania Gioia, Alessandra Spagnoli, Michele Carlin, Antonio Cioffi, Lorenzo Ridola, Silvia Nardelli, Manuela Merli, and Oliviero Riggio
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Liver Cirrhosis ,Male ,Sarcopenia ,medicine.medical_specialty ,Cirrhosis ,Psychometrics ,Adrenergic beta-Antagonists ,minimal hepatic encephalopathy ,Timed Up and Go test ,Gastroenterology ,timed up and go test ,myosteatosis ,Internal medicine ,falls ,medicine ,Humans ,Cognitive Dysfunction ,In patient ,Risk factor ,sarcopenia ,Muscle, Skeletal ,Hepatic encephalopathy ,Hepatology ,business.industry ,Skeletal muscle ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Hepatic Encephalopathy ,Time and Motion Studies ,Accidental Falls ,Female ,Brain matter ,Tomography, X-Ray Computed ,business ,human activities ,Follow-Up Studies - Abstract
Minimal hepatic encephalopathy (MHE) is considered a risk factor for falls in patients with liver cirrhosis. However, MHE is prevalent in patients with muscle alterations (sarcopenia and myosteatosis) probably due to the role of muscle in ammonia handling.To assess the respective role of muscle alterations and MHE on the risk of falls in cirrhotic patients.Fifty cirrhotics were studied for MHE detection by using Psychometric Hepatic Encephalopathy Score (PHES) and Animal Naming Test (ANT). CT scan was used to quantify the skeletal muscle index (SMI) and muscle attenuation, as a measure of myosteatosis. The risk of falls was evaluated by the Timed UpGo test (TUG). The occurrence of falls during follow up was also detected.32 patients (64%) had an abnormal TUG (14 s). In the group with TUG ≥ 14 s, MHE (72vs31%, p0.005) and myosteatosis (94vs50%, p = 0.002) were significantly more frequent than in patients with TUG14 s. At multivariate the variables independently associated to TUG ≥ 14 s were myosteatosis, MHE and chronic beta-blockers use. During a mean follow-up of 25±16.9 months, 12 patients fell; the percentage of falls was significantly higher in patients with TUG ≥ 14 s (50%vs9%, p = 0.001) as well as in patients with myosteatosis (33%vs6%, p = 0.03), but similar in patients with or without MHE (35%vs15%, NS).In cirrhotic patients both muscle alterations and cognitive impairment, as well as chronic beta-blockers use, are associated to the risk of falls.
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- 2022
22. Albumin for cognitive impairment after TIPS: a road to be explored
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Silvia Nardelli, Stefania Gioia, Jessica Faccioli, Oliviero Riggio, and Lorenzo Ridola
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Hepatology - Published
- 2022
23. Prevention of post-tips hepatic encephalopathy: The search of the ideal candidate
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Silvia Nardelli, Daniele Bellafante, Lorenzo Ridola, Jessica Faccioli, Oliviero Riggio, and Stefania Gioia
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Cellular and Molecular Neuroscience ,Neurology (clinical) ,Biochemistry - Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) has been used since more than 25 years to treat some of the complications of portal hypertension, especially variceal bleeding and ascites refractory to conventional therapy. TIPS establishes a communication between the portal and hepatic veins, inducing the blood to shift from the splanchnic circulation into the systemic vascular bed with the aim of decompressing the portal venous system, and avoids the major complications of portal hypertension. However, the shunt of the portal blood into the systemic circulation is the cause of one of the major complications of the procedure: the post-TIPS hepatic encephalopathy (HE). To date, few pharmacological treatment has been proven effective to prevent this complication and thus, the identification of patients at high risk of post-TIPS hepatic encephalopathy and the patients' carefully selection is the only way to prevent this frequent complication.
- Published
- 2022
24. Lactulose in Liver Cirrhosis
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Jessica Faccioli, Stefania Gioia, Silvia Nardelli, Oliviero Riggio, and Lorenzo Ridola
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- 2022
25. Post TIPS hepatic encephalopathy: look at muscle and fat!
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Stefania Gioia, Silvia Nardelli, Jessica Faccioli, and Lorenzo Ridola
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Nutrition and Dietetics ,cirrhosis ,liver cirrhosis ,hepatic encephalopathy ,portasystemic shunt ,Critical Care and Intensive Care Medicine ,mortality ,sarcopenia ,TIPS ,humans ,muscles ,transjugular intrahepatic ,Portasystemic Shunt, Transjugular Intrahepatic - Published
- 2022
26. Cognitive impairement in non-cirrhotic portal hypertension: highlights on physiopathology, diagnosis and management
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Stefania Gioia, Silvia Nardelli, Oliviero Riggio, Jessica Faccioli, and Lorenzo Ridola
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porto-sinusoidal vascular liver disease ,hepatic encephalopathy ,idiopathic non-cirrhotic portal hypertension ,portal vein thrombosis ,porto-systemic shunt ,Medicine ,Review ,General Medicine - Abstract
Hepatic encephalopathy (HE) is one of the most frequent complications of cirrhosis. Several studies and case reports have shown that cognitive impairment may also be a tangible complication of portal hypertension secondary to chronic portal vein thrombosis and to porto-sinusoidal vascular disease (PSVD). In these conditions, representing the main causes of non-cirrhotic portal hypertension (NCPH) in the Western world, both overt and minimal/covert HE occurs in a non-neglectable proportion of patients, even lower than in cirrhosis, and it is mainly sustained by the presence of large porto-systemic shunt. In these patients, the liver function is usually preserved or only mildly altered, and the development of porto-systemic shunt is either spontaneous or iatrogenically frequent; HE is an example of type-B HE. To date, in the absence of strong evidence and large cooperative studies, for the diagnosis and the management of HE in NCPH, the same approach used for HE occurring in cirrhosis is applied. The aim of this paper is to provide an overview of type B hepatic encephalopathy, focusing on its pathophysiology, diagnostic tools and management in patients affected by porto-sinusoidal vascular disease and chronic portal vein thrombosis.
- Published
- 2022
27. Hepatitis C virus eradication with directly acting antivirals improves health-related quality of life and psychological symptoms
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Silvia Nardelli, Oliviero Riggio, Alessio Farcomeni, Lorenzo Ridola, Stefania Gioia, and Davide Rosati
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Alexithymia ,Male ,Hepacivirus ,Anxiety ,Severity of Illness Index ,0302 clinical medicine ,Quality of life ,Medicine ,Neuropsychological assessment ,Depression (differential diagnoses) ,medicine.diagnostic_test ,Hepatitis C virus ,Depression ,Gastroenterology ,Directly acting antivirals ,General Medicine ,Neuropsychological test ,Middle Aged ,Hepatitis C ,humanities ,Treatment Outcome ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,Settore SECS-S/01 - Statistica ,Uridine Monophosphate ,medicine.medical_specialty ,Observational Study ,Antiviral Agents ,03 medical and health sciences ,Rating scale ,Internal medicine ,Humans ,Psychological testing ,Health related quality of life ,Aged ,Fluorenes ,Psychological Tests ,business.industry ,State and trait anxiety ,medicine.disease ,alexithymia ,depression ,directly acting antivirals ,health related quality of life ,hepatitis C virus ,state and trait anxiety ,Quality of Life ,Benzimidazoles ,Self Report ,Sofosbuvir ,business - Abstract
Background Alterations in health-related quality of life (HRQoL) and neuropsychological disorders were described in the hepatitis C virus (HCV) patients. Although several studies investigated the modifications of HRQoL after HCV eradication, no data exists on the modifications of neuropsychological symptoms. Aim To investigate the effect of directly acting antivirals (DAAs) treatment on HRQoL and neuropsychological symptoms. Methods Thirty nine patients with HCV infection underwent a neuropsychological assessment, including Zung-Self Depression-Rating-Scale, Spielberg State-Trait Anxiety Inventory Y1-Y2 and the Toronto-Alexithymia Scale-20 items before and after DAAs treatment. HRQoL was detected by Short-Form-36 (SF-36). Results All HRQoL domains, but role limitation physical and bodily pain, significantly improved after treatment. Interestingly, after DAAs treatment, all domains of HRQoL returned similar to those of controls. Each neuropsychological test significantly improved after HCV eradication. A significant correlation was observed among each psychological test and the summary components of SF-36. At multiple linear regression analysis including each psychological test as possible covariates, Zung-Self Depression Rating Scale (Zung-SDS) score was independently and significantly related to summary components of the SF-36 in the basal state and the difference between Zung-SDS score before and after treatment was the only variable significantly and independently related to the modification of HRQoL induced by the treatment. Conclusion Neuropsychological symptoms strongly influenced HRQoL in HCV patients and there was a significant improvement of neuropsychological tests and HRQoL after DAAs treatment.
- Published
- 2019
28. Gut liver muscle brain axis: A comprehensive viewpoint on prognosis in cirrhosis
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Lorenzo Ridola, Stefania Gioia, Jessica Faccioli, Oliviero Riggio, and Silvia Nardelli
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Liver Cirrhosis ,Hepatology ,Liver ,Muscles ,Brain ,Humans ,Prognosis - Published
- 2021
29. Letter to the editor: Episodic-precipitant-induced hepatic encephalopathy treatment: Look at new and old precipitants!
- Author
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Lorenzo Ridola, Silvia Nardelli, Stefania Gioia, Jessica Faccioli, and Oliviero Riggio
- Subjects
Liver Cirrhosis ,Ornithine ,Aspartic Acid ,Hepatology ,Double-Blind Method ,Hepatic Encephalopathy ,Humans - Published
- 2021
30. Risk factors for hepatic encephalopathy and mortality in cirrhosis: The role of cognitive impairment, muscle alterations and shunts
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Silvia Nardelli, Oliviero Riggio, Stefania Gioia, Manuela Merli, Alessandra Spagnoli, Michele di Martino, Giuseppe Pelle, and Lorenzo Ridola
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Liver Cirrhosis ,Sarcopenia ,Hepatology ,Psychometrics ,Risk Factors ,Hepatic Encephalopathy ,Gastroenterology ,Humans ,Cognitive Dysfunction ,Muscle, Skeletal - Abstract
Muscle alterations, portosystemic shunts (SPSS) and minimal hepatic encephalopathy (MHE) are related to hepatic encephalopathy (HE), however no studies have investigated the relative role of all these risk factors detected in the same patients. The aim of the study was to assess the prognostic impact of muscle alterations, MHE and SPSS on hepatic encephalopathy and transplant free survival.114 cirrhotics were submitted to Psychometric Hepatic Encephalopathy Score (PHES) and Animal Naming Test (ANT) to detect MHE. CT scan was used to analyze the skeletal muscle index (SMI), muscle attenuation and SPSS. The incidence of the first episode of HE and survival were estimated.Previous HE was present in 47 patients (41%). The variables independently associated to previous HE were: sarcopenia, MHE and SPSS. 44 patients (39%) developed overt HE during 14±11 months; MHE and SPSS were the only variables significantly asociated to overt HE. During the same follow-up, 42 patients died (37%); MELD and sarcopenia were the only variables significantly asociated to transplant free survival.MHE, sarcopenia and SPSS are clinically relevant and should be sought for in cirrhotics. In particular, MHE and SPSS are the only risk factors significantly associated to the development of HE while MELD and sarcopenia are independently associated to overall mortality.
- Published
- 2021
31. Editorial: infections and hepatic encephalopathy–does the chicken or the egg come FIRST? A novel perspective at the horizon
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Oliviero Riggio and Lorenzo Ridola
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precipitants ,Hepatology ,cirrhosis ,Hepatic Encephalopathy ,Gastroenterology ,acute on chronic liver failure ,Humans ,Pharmacology (medical) ,hepatic encephalopathy ,infection ,mortality ,rifaximin ,Lactulose ,Rifaximin - Published
- 2022
32. Small hepatic veins Budd-Chiari syndrome and paroxysmal nocturnal hemoglobinuria - The association of two rare entities: a case report
- Author
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Oliviero Riggio, Silvia Nardelli, Stefania Gioia, Giulia d'Amati, Emanuela De Santis, Bruna Cerbelli, Lorenzo Ridola, and Adriano De Santis
- Subjects
Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Case Report ,medicine.disease ,Pathology and Forensic Medicine ,Liver biopsy ,Budd-chiari syndrome ,Ascites ,Hepatic veins ,cardiovascular system ,Paroxysmal nocturnal hemoglobinuria ,medicine ,Budd–Chiari syndrome ,Etiology ,In patient ,Normal appearance ,medicine.symptom ,business - Abstract
Summary Small hepatic veins Budd-Chiari syndrome is a rare disorder characterized by hepatic venous outflow obstruction limited to the small intrahepatic veins, with normal appearance of the large hepatic veins at imaging. In this case only a liver biopsy can demonstrate the presence of a small vessels outflow block. Paroxysmal nocturnal haemoglobinuria (PNH) is one of the most severe acquired thrombophilic state and represents one of the main aetiological factors of Budd-Chiari syndrome. In patient affected by PNH with liver impairment and/or ascites, Budd-Chiari syndrome must be always taken into consideration and, if necessary, a liver biopsy performed to exclude the small hepatic veins involvement. We report a case of small hepatic veins Budd–Chiari syndrome secondary to paroxysmal nocturnal haemoglobinuria.
- Published
- 2020
33. Sarcopenia and cognitive impairment in liver cirrhosis: A viewpoint on the clinical impact of minimal hepatic encephalopathy
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Lorenzo Ridola, Stefania Gioia, Oliviero Riggio, Silvia Nardelli, and Jessica Faccioli
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Liver Cirrhosis ,Male ,Sarcopenia ,Pediatrics ,medicine.medical_specialty ,Cirrhosis ,Minimal hepatic encephalopathy ,Neuropsychological Tests ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,medicine ,Humans ,Cognitive Dysfunction ,Muscle alterations ,Hepatic encephalopathy ,Subclinical infection ,Psychomotor learning ,business.industry ,cirrhosis ,cognitive impairment ,minimal hepatic encephalopathy ,muscle alterations ,sarcopenia ,Gastroenterology ,Brain ,Minireviews ,General Medicine ,Middle Aged ,medicine.disease ,Executive functions ,Cognitive impairment ,Social Class ,Hepatic Encephalopathy ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,030211 gastroenterology & hepatology ,business ,human activities ,Neurocognitive - Abstract
Minimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy (HE). MHE is considered as a preclinical stage of HE and is part of a wide spectrum of typical neurocognitive alterations characteristic of patients with liver cirrhosis, particularly involving the areas of attention, alertness, response inhibition, and executive functions. MHE can be detected by testing the patients’ psychometric performance, attention, working memory, psychomotor speed, and visuospatial ability, as well as by means of electrophysiological and other functional brain measures. MHE is very frequent, affecting from 20% up to 80% of patients tested, depending of the diagnostic tools used. Although subclinical, MHE is considered to be clinically relevant. In fact, MHE has been related to the patients’ falls, fitness to drive, and working ability. As a consequence, MHE affects the patients and caregivers lives by altering their quality of life and even their socioeconomic status. Recently sarcopenia, a very common condition in patients with advanced liver disease, has been shown to be strictly related to both minimal and overt HE. Aim of this review is to summarize the most recently published evidences about the emerging relationship between sarcopenia and cognitive impairment in cirrhotic patients and provide suggestions for future research.
- Published
- 2019
34. Is porto sinusoidal vascular disease to be actively searched in patients with portal vein thrombosis?
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Stefania Gioia, Lorenzo Ridola, Oliviero Riggio, Silvia Nardelli, and Giulia d'Amati
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anticoagulant therapy ,obliterative portal venopathy ,portal vein thrombosis ,porto sinusoidal vascular liver disease ,Opinion Review ,medicine.medical_specialty ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Liver stiffness ,Internal medicine ,Biopsy ,medicine ,In patient ,Anticoagulant therapy ,Obliterative portal venopathy ,Hepatology ,medicine.diagnostic_test ,Vascular disease ,business.industry ,Porto sinusoidal vascular liver disease ,medicine.disease ,Portal vein thrombosis ,030220 oncology & carcinogenesis ,Liver biopsy ,Cardiology ,030211 gastroenterology & hepatology ,Complication ,business - Abstract
Porto sinusoidal vascular liver disease (PSVD) and portal vein thrombosis (PVT) are distinct vascular liver diseases characterized, respectively, by an intrahepatic and a prehepatic obstacle to the flow in the liver portal system. PVT may also occur as a complication of the natural history of PSVD, especially if a prothrombotic condition coexists. In other cases, it is associated to local and systemic pro-thrombotic conditions, even if its cause remains unknown in up to 25% despite an active search. In our opinion, the presence of PSVD should be suspected in patients with PVT especially in those with PVT “sine causa” and the active search of this condition should be included in their diagnostic work-out. However, sometimes the diagnosis of pre-existing PSVD is very hard. Biopsy cannot be fully discriminant as similar histological data have been described in both conditions. Liver stiffness may help as it has been shown to be higher in PSVD than in “pure” PVT, due to the presence of sclerosis in the portal venous radicles observable in PSVD patients. Nevertheless, comparing liver stiffness between PVT and PSVD has until now been restricted to very limited series of patients. In conclusion, even if it is still totally hypothetical, our point of view may have clinical consequences, especially when deciding to perform a liver biopsy in patients with a higher liver stiffness and suspending the anticoagulation in patients with PVT and no detectable prothrombotic factors.
- Published
- 2019
35. Muscle Alterations Are Associated With Minimal and Overt Hepatic Encephalopathy in Patients With Liver Cirrhosis
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Lorenzo Ridola, Silvia Nardelli, Barbara Lattanzi, Oliviero Riggio, Stefania Gioia, Alessio Farcomeni, and Manuela Merli
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Liver Cirrhosis ,Male ,0301 basic medicine ,Sarcopenia ,medicine.medical_specialty ,Cirrhosis ,Adipose tissue ,ammonia ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Muscular Diseases ,myosteatosis ,Internal medicine ,medicine ,Humans ,In patient ,Hepatic encephalopathy ,Aged ,First episode ,Hepatology ,business.industry ,Incidence (epidemiology) ,psychometric evaluation ,Skeletal muscle ,Middle Aged ,medicine.disease ,030104 developmental biology ,medicine.anatomical_structure ,Adipose Tissue ,Hepatic Encephalopathy ,hepatic encephalopathy ,sarcopenia ,Female ,030211 gastroenterology & hepatology ,Settore SECS-S/01 - Statistica ,business ,human activities - Abstract
Muscle alterations (myosteatosis and sarcopenia) are frequent in cirrhosis and related to some complications including overt hepatic encephalopathy (HE). The aim of our study was to investigate the relationship between muscle alterations and minimal HE (MHE) and their role in the risk of overt HE. Sixty-four patients with cirrhosis were administered the Psychometric Hepatic Encephalopathy Score and animal naming test to detect MHE. Computed tomography was used to analyze the skeletal muscle index and attenuation. The incidence of the first episode of HE, taking into account the competing risk nature of the data, was estimated. Myosteatosis was observed in 24 patients (37.5%), sarcopenia in 37 (58%), and MHE in 32 (50%). Both myosteatosis (62.5% versus 12.5%, P < 0.001) and sarcopenia (84% versus 31%, P < 0.001) were more frequent in patients with MHE. The variables independently associated with the presence of MHE were sarcopenia, previous overt HE, and myosteatosis. Thirty-one (48%) patients developed overt HE over 16.1 ± 13 months; myosteatosis was detected in 68% and sarcopenia in 84% of them. Sarcopenia and myosteatosis were also independently associated with the development of overt HE. Venous ammonia was significantly higher in patients with sarcopenia (62.6 ± 17.7 versus 41.4 ± 16.1 μg/dL, P < 0.001) and in patients with myosteatosis (65.2 ± 19.2 versus 46.7 ± 17.1 μg/dL, P < 0.001) and inversely correlated to both parameters. Survival was significantly lower in malnourished patients compared to patients without myosteatosis or sarcopenia (P < 0.001). Conclusion: Myosteatosis and sarcopenia, probably by reducing the handling of ammonia in the muscle, are independently associated with MHE and the risk of overt HE in patients with cirrhosis; in malnourished patients, the amelioration of nutritional status may be a goal to decrease both the prevalence of MHE and the incidence of overt HE.
- Published
- 2019
36. Episodic Precipitant–induced Hepatic Encephalopathy Treatment
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Lorenzo Ridola, Stefania Gioia, Jessica Faccioli, Silvia Nardelli, and Oliviero Riggio
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Gastroenterology - Published
- 2021
37. [Evidence-based management of primary liver cancers: cholangiocarcinoma.]
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Domenico, Alvaro, Maria Consiglia, Bragazzi, Rosanna, Venere, and Lorenzo, Ridola
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Cholangiocarcinoma ,Bile Ducts, Intrahepatic ,Bile Duct Neoplasms ,Incidence ,Liver Neoplasms ,Humans - Abstract
Cholangiocarcinoma (CCA) includes a cluster of highly heterogeneous biliary malignant tumours that may develop at any point of the biliary tree. Their incidence is rising worldwide, currently accounting for ~15% of all primary liver cancers and ~3% of gastrointestinal malignancies. The silent nature of these tumours combined with their high aggressiveness and refractory nature contribute to their alarming mortality rates, representing nowadays ~2% of all cancer-related deaths yearly. In the past decade, increasing efforts have been made in order to understand the complexity of these tumours and to develop new diagnostic tools and therapies that might help to increase patient's welfare.
- Published
- 2021
38. [FXR modulators and cholestatic diseases.]
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Domenico, Alvaro, Maria Consiglia, Bragazzi, Rosanna, Venere, and Lorenzo, Ridola
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Bile Acids and Salts ,Cholestasis ,Liver ,Humans ,Receptors, Cytoplasmic and Nuclear - Abstract
The Farnesoid X nuclear receptor (FXR) is a nuclear receptor of bile acids whose activation suppresses the synthesis of bile acids stimulates their excretion in the bile and inhibits its uptake in hepatocytes. FXR is also involved in the regulation of over 250 genes including those responsible for the control of lipid and carbohydrate metabolism. The activation of FXR also induces anti-inflammatory effects and antifibrotics. Over the past 10 years they have been synthesized and studied various FXR agonists which have demonstrated beneficial effects in the treatment of the main pathologies cholestatic diseases including primary biliary cholangitis, cholangitis primary sclerosing and cholangiocarcinoma.
- Published
- 2021
39. Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology
- Author
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Roberto Miraglia, Matteo Garcovich, Giulia Tosetti, Nicola Caporaso, Agostino Colli, Antonio Rampoldi, Ioannis Petridis, Stella De Nicola, Angelo Andriulli, Marcello Dallio, Giovanni Perricone, G. Gobbo, Filomena Morisco, Antonio Gasbarrini, Pietro Pozzoni, Giuseppe Malizia, Angelo Vanzulli, Gennaro D'Amico, Gianluca Svegliati Baroni, Angelo Luca, Francesco Salerno, Mario D'Amico, Manuela Merli, Luca S. Belli, Vincenzo La Mura, Luchino Chessa, A. Iacobellis, Giuseppe Tarantino, Marco Solcia, Cristiano Sgrazzutti, Lorenzo Ridola, Luigi Maruzzelli, Alessandro Federico, Aldo Airoldi, Luigi Addario, Riccardo Volpes, Massimo Primignani, D'Amico, G., Maruzzelli, L., Airoldi, A., Petridis, I., Tosetti, G., Rampoldi, A., D'Amico, M., Miraglia, R., De Nicola, S., La Mura, V., Solcia, M., Volpes, R., Perricone, G., Sgrazzutti, C., Vanzulli, A., Primignani, M., Luca, A., Malizia, G., Federico, A., Dallio, M., Andriulli, A., Iacobellis, A., Addario, L., Garcovich, M., Gasbarrini, A., Chessa, L., Salerno, F., Gobbo, G., Merli, M., Ridola, L., Baroni, G. S., Tarantino, G., Caporaso, N., Morisco, F., Pozzoni, P., Colli, A., Belli, L. S., D'Amico, Gennaro, Maruzzelli, Luigi, Airoldi, Aldo, Petridis, Ioanni, Tosetti, Giulia, Rampoldi, Antonio, D'Amico, Mario, Miraglia, Roberto, De Nicola, Stella, La Mura, Vincenzo, Solcia, Marco, Volpes, Riccardo, Perricone, Giovanni, Sgrazzutti, Cristiano, Vanzulli, Angelo, Primignani, Massimo, D'Angelo, Luca, Malizia, Giuseppe, Federico, Alessandro, Dallio, Marcello, Andriulli, Angelo, Iacobellis, Angelo, Addario, Luigi, Garcovich, Matteo, Gasbarrini, Antonio, Chessa, Luchino, Salerno, Francesco, Gobbo, Giulia, Merli, Manuela, Ridola, Lorenzo, Baroni, Gianluca Svegliati, Tarantino, Giuseppe, Caporaso, Nicola, Morisco, Filomena, Pozzoni, Pietro, Colli, Agostino, Belli, Luca Saverio, D'Amico, G, Maruzzelli, L, Airoldi, A, Petridis, I, Tosetti, G, Rampoldi, A, D'Amico, M, Miraglia, R, De Nicola, S, La Mura, V, Solcia, M, Volpes, R, Perricone, G, Sgrazzutti, C, Vanzulli, A, Primignani, M, Luca, A, Malizia, G, Federico, A, Dallio, M, Andriulli, A, Iacobellis, A, Addario, L, Garcovich, M, Gasbarrini, A, Chessa, L, Salerno, F, Gobbo, G, Merli, M, Ridola, L, Baroni, G, Tarantino, G, Caporaso, N, Morisco, F, Pozzoni, P, Colli, A, and Belli, L
- Subjects
Adult ,medicine.medical_specialty ,Cirrhosis ,Time Factors ,medicine.medical_treatment ,Validation Studies as Topic ,Models, Biological ,Severity of Illness Index ,Cohort Studies ,End Stage Liver Disease ,Liver disease ,Model for End-Stage Liver Disease ,clinical prediction rule ,Internal medicine ,Post-hoc analysis ,Medicine ,Humans ,Mortality ,Aged ,Hepatology ,business.industry ,cirrhosis ,Middle Aged ,medicine.disease ,Prognosis ,MELD ,body regions ,Italy ,Cohort ,Etiology ,TIPS ,Steatohepatitis ,business ,Transjugular intrahepatic portosystemic shunt ,cirrhosi ,Follow-Up Studies - Abstract
Background & Aims Although the discriminative ability of the model for end-stage liver disease (MELD) score is generally considered acceptable, its calibration is still unclear. In a validation study, we assessed the discriminative performance and calibration of 3 versions of the model: original MELD-TIPS, used to predict survival after transjugular intrahepatic portosystemic shunt (TIPS); classic MELD-Mayo; and MELD-UNOS, used by the United Network for Organ Sharing (UNOS). We also explored recalibrating and updating the model. Methods In total, 776 patients who underwent elective TIPS (TIPS cohort) and 445 unselected patients (non-TIPS cohort) were included. Three, 6 and 12-month mortality predictions were calculated by the 3 MELD versions: discrimination was assessed by c-statistics and calibration by comparing deciles of predicted and observed risks. Cox and Fine and Grey models were used for recalibration and prognostic analyses. Results In the TIPS/non-TIPS cohorts, the etiology of liver disease was viral in 402/188, alcoholic in 185/130, and non-alcoholic steatohepatitis in 65/33; mean follow-up±SD was 25±9/19±21 months; and the number of deaths at 3-6-12 months was 57-102-142/31-47-99, respectively. C-statistics ranged from 0.66 to 0.72 in TIPS and 0.66 to 0.76 in non-TIPS cohorts across prediction times and scores. A post hoc analysis revealed worse c-statistics in non-viral cirrhosis with more pronounced and significant worsening in the non-TIPS cohort. Calibration was acceptable with MELD-TIPS but largely unsatisfactory with MELD-Mayo and -UNOS whose performance improved much after recalibration. A prognostic analysis showed that age, albumin, and TIPS indication might be used to update the MELD. Conclusions In this validation study, the performance of the MELD score was largely unsatisfactory, particularly in non-viral cirrhosis. MELD recalibration and candidate variables for an update to the MELD score are proposed. Lay summary While the discriminative performance of the model for end-stage liver disease (MELD) score is credited to be fair to good, its calibration, the correspondence of observed to predicted mortality, is still unsettled. We found that application of 3 different versions of the MELD in 2 independent cirrhosis cohorts yielded largely imprecise mortality predictions particularly in non-viral cirrhosis. Thus, we propose a recalibration and suggest candidate variables for an update to the model.
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- 2021
40. Relevance of Spontaneous Portosystemic Shunts Detected with CT in Patients with Cirrhosis
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Giuseppe Pelle, Francesca Aprile, Guido Marzocchi, Filippo Schepis, Laura Turco, Michele Di Martino, Cristian Caporali, Alessandra Spagnoli, Marta Puzzono, Silvia Nardelli, Oliviero Riggio, Stefania Gioia, Arianna Di Rocco, Stefano Gitto, Lorenzo Ridola, and Marcello Bianchini
- Subjects
Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,hepatic encephalopathy ,gastrointestinal bleeding ,030218 nuclear medicine & medical imaging ,Female ,Humans ,Hypertension, Portal ,Italy ,Middle Aged ,Portasystemic Shunt, Surgical ,Retrospective Studies ,Venous Thrombosis ,Tomography, X-Ray Computed ,03 medical and health sciences ,0302 clinical medicine ,X ray computed ,Surgical ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Portasystemic Shunt ,Hepatic encephalopathy ,Tomography ,spontaneous portosystemic shunts ,cirrhosis ,portal hypertension ,mortality ,business.industry ,Retrospective cohort study ,medicine.disease ,Portal vein thrombosis ,X-Ray Computed ,Multicenter study ,030220 oncology & carcinogenesis ,Hypertension ,Portal ,Radiology ,business - Abstract
Background Cirrhosis leads to portal hypertension and to the consequent formation of spontaneous portosystemic shunts (SPSSs), leading to complications related to the diversion of portal blood into the systemic circulation, which is called portosystemic shunt syndrome. Purpose To investigate the characteristics of patients with cirrhosis and an SPSS and secondarily to assess the prognostic impact of SPSSs on portal hypertension-related complications and transplant-free survival. Materials and Methods A retrospective database review of patients with cirrhosis (observed from March 2015 to July 2019) was performed to identify patients with CT imaging and outcomes data. For each patient, clinical and biochemical data were collected, and the presence, types, and sizes of SPSSs were investigated with CT. Patients were followed for a mean of 27.5 months ± 22.8. Multivariable logistic analysis was used to identify the clinical characteristics associated with the presence of SPSSs (any size) and presence of SPSSs 1 cm or larger. Competitive risk analysis (Fine and Gray model) was used to identify the association between SPSSs and complications and mortality. Results Two hundred twenty-two patients with cirrhosis (157 male, 65 female; mean age, 62 years ± 12 [standard deviation]) were evaluated. An SPSS was found in 141 of 222 patients (63.5%), and 40 of 222 (18%) had a shunt diameter of at least 1 cm. At presentation, variables independently associated with the presence of SPSSs (any size) were portal vein thrombosis (odds ratio, 5.5
- Published
- 2021
41. Neurological and psychiatric effects of hepatitis C virus infection
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Stefania Gioia, Lorenzo Ridola, Oliviero Riggio, Silvia Nardelli, and Jessica Faccioli
- Subjects
Quality of life ,medicine.medical_specialty ,Cirrhosis ,Hepatitis C virus ,Encephalopathy ,Hepacivirus ,Antiviral therapy ,medicine.disease_cause ,Verbal learning ,Antiviral Agents ,Medicine ,Humans ,Cognitive decline ,Psychiatry ,Hepatic encephalopathy ,antiviral therapy ,hepatic encephalopathy ,hepatitis c virus ,neurological disorders ,psychiatric disorders ,quality of life ,business.industry ,Liver Neoplasms ,Gastroenterology ,Minireviews ,General Medicine ,Hepatitis C, Chronic ,medicine.disease ,Cryoglobulinemia ,Hepatitis C ,business ,Psychiatric disorders ,Polyneuropathy ,Neurological disorders - Abstract
Hepatitis C virus (HCV) infection is widespread and affects 71 million people worldwide. Although hepatic manifestations are the most frequent, ranging from chronic hepatitis to cirrhosis and hepatocellular carcinoma, it is also associated with several extrahepatic manifestations. Infected patients may present non-specific neurological symptoms, regardless of the presence of liver cirrhosis. Several pathogenetic mechanisms underlying neurological symptoms have been hypothesized: neuroinvasion, immune-mediated damage, neurotransmitter alterations and cryoglobulinemia. Alterations of the central nervous system include cerebral vasculopathy, acute or subacute encephalopathy and inflammatory disorders. HCV infection may be responsible for neuropathies, of which the most frequent form is symmetrical axonal sensory or sensory-motor polyneuropathy which causes loss of leg sensitivity and weakness. Up to 50% of patients with HCV infection may experience cognitive decline and psychological disorders, such as depression and fatigue. HCV associated neurocognitive disorder is independent of the presence of liver cirrhosis and affects different domains than in patients with hepatic encephalopathy. It can be studied using specific tests that mainly explore executive functions, verbal learning and verbal recall. These disorders significantly reduce the quality of life. The new antiviral therapies improve the extrahepatic symptoms of HCV infection and their success depends on the achievement of sustained virological response. However, the effect of therapy may differ depending on the type of organ involved; neurological symptoms can be irreversible if there is organic liver damage. The aim of this review is to provide a critical overview of physiopathological mechanisms, diagnostic and therapeutic strategies of the neurological and psychiatric effects of HCV infection.
- Published
- 2021
42. Hepatic Encephalopathy: Diagnosis and Management
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Oliviero Riggio, Stefania Gioia, Silvia Nardelli, Jessica Faccioli, and Lorenzo Ridola
- Subjects
Gastrointestinal bleeding ,medicine.medical_specialty ,Cirrhosis ,spontaneous portal-systemic shunts ,cirrhosis ,hepatic encephalopathy ,minimal hepatic encephalopathy ,rifaximin, non-absorbable disaccharides ,transjugular intrahepatic portosystemic shunt ,Physical examination ,Gastroenterology ,Spontaneous Portal-systemic Shunts ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,medicine ,Hepatic encephalopathy ,Review Articles ,Subclinical infection ,Coma ,medicine.diagnostic_test ,business.industry ,Stupor ,non-absorbable disaccharides ,medicine.disease ,Rifaximin ,rifaximin ,chemistry ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
Type C hepatic encephalopathy (HE) is a brain dysfunction caused by severe hepatocellular failure or presence of portal-systemic shunts in patients with liver cirrhosis. In its subclinical form, called “minimal hepatic encephalopathy (MHE), only psychometric tests or electrophysiological evaluation can reveal alterations in attention, working memory, psychomotor speed and visuospatial ability, while clinical neurological signs are lacking. The term “covert” (CHE) has been recently used to unify MHE and Grade I HE in order to refer to a condition that is not unapparent but also non overt. “Overt” HE (OHE) is characterized by personality changes, progressive disorientation in time and space, acute confusional state, stupor and coma. Based on its time course, OHE can be divided in Episodic, Recurrent or Persistent. Episodic HE is generally triggered by one or more precipitant factors that should be found and treated. Unlike MHE, clinical examination and clinical decision are crucial for OHE diagnosis and West Haven criteria are widely used to assess the severity of neurological dysfunction. Primary prophylaxis of OHE is indicated only in the patient with gastrointestinal bleeding using non-absorbable antibiotics (Rifaximin) or non-absorbable disaccharides (Lactulose). Treatment of OHE is based on the identification and correction of precipitating factors and starting empirical ammonia-lowering treatment with Rifaximin and Lactulose (per os and enemas). The latter should be used for secondary prophylaxis, adding Rifaximin if HE becomes recurrent. In recurrent/persistent HE, the treatment options include fecal transplantation, TIPS revision and closure of eventual splenorenal shunts. Treatment of MHE should be individualized on a case-by-case basis.
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- 2021
43. Hepatitis B (HBV) reactivation in patients receiving biologic therapy for chronic inflammatory diseases in clinical practice
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Lorenzo, Ridola, Angelo, Zullo, Bruno, Laganà, Roberto, Lorenzetti, Alberto, Migliore, Roberta, Pica, Andrea, Picchianti Diamanti, Gianfranco, Gigliucci, Palma, Scolieri, and Vincenzo, Bruzzese
- Subjects
Male ,rheumatoid arthritis ,Hepatitis B virus ,hepatitis virus b reactivation ,crohn disease ,spondyloarthritis ,Hepatitis B ,Biological Therapy ,ulcerative colitis ,biologic therapy ,Humans ,Tumor Necrosis Factor Inhibitors ,Virus Activation - Abstract
Biologic treatment - particularly with the anti-TNF molecules - is frequently used in clinical practice to treat the severe form for both chronic rheumatic diseases and inflammatory bowel diseases. The immunosuppression induced by biologic therapies increases the risk of infections, including tuberculosis, as well as hepatitis B virus (HBV) reactivation may occur in inactive carriers or occult HBV infection (OBI) subjects during biologic therapy. This study aimed to update data on HBV prevalence and reactivation in patients receiving biologic therapy for either chronic rheumatic diseases or IBD, and to describe their management in clinical practice.This study was performed in 6 Italian centers (3 Rheumatology Units and 3 Gastroenterology Units). Clinical, biochemical and virological data, as well as follow up information, were recorded and analyzed.984 patients were considered, including 817 with rheumatic disease and 167 with IBD. A total of 43 showed HBV infection (38 OBI and 5 carriers) accounting for a prevalence of 4%. Among OBI patients, 1 (2.6%) case of HBV reactivation occurred in a male patient with Crohn disease. Among the 5 HBV carriers, two patients (1 with spondyloarthritis and 1 with rheumatoid arthritis) did not received HBV antiviral therapy, and both experienced flare of hepatitis at 47 and 49 months following biologic therapy starting.Data of our study highlight that guidelines on management of HBV patients treated with biologic therapies should be still implemented in clinical practice when considering that, although infrequent, HBV reactivation could be potentially life-threatening.
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- 2021
44. The improvement in body composition including subcutaneous and visceral fat reduces ammonia and hepatic encephalopathy after transjugular intrahepatic portosystemic shunt
- Author
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Lorenzo Ridola, Stefania Gioia, Oliviero Riggio, Manuela Merli, Ludovica Cristofaro, Silvia Nardelli, and Jessica Faccioli
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Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,hepatic encephalopathy ,Adipose tissue ,TIPS ,adipose tissue ,ammonia ,sarcopenia ,Intra-Abdominal Fat ,Gastroenterology ,Internal medicine ,medicine ,Humans ,Hepatic encephalopathy ,Retrospective Studies ,Hepatology ,business.industry ,Incidence (epidemiology) ,Skeletal muscle ,medicine.disease ,medicine.anatomical_structure ,Sarcopenia ,Body Composition ,Liver function ,Portasystemic Shunt, Transjugular Intrahepatic ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
Background Sarcopenia and myosteatosis have been associated to a poor prognosis of cirrhosis and to a higher incidence of hepatic encephalopathy (HE). The prognostic implications of visceral and subcutaneous adiposity are less known. Aim to evaluate the modifications of visceral and subcutaneous adipose tissue after TIPS and to investigate their relationships with the modification of muscle mass and with the incidence of post-TIPS HE. Patients and methods 35 cirrhotic patients submitted to TIPS were retrospectively studied. The modification of skeletal muscle index (SMI), muscle attenuation (myosteatosis), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), assessed by CT-scan and plasma ammonia were evaluated before and after a mean follow-up of 19 ± 15 months after TIPS. The number of episodes of overt HE was also recorded. Results During the follow-up, the mean SMI and muscle attenuation increased significantly; SATI significantly increased while VATI significantly decreased, although not uniformly in all patients. By comparing the patients with or without improvement in their nutritional status after TIPS, MELD remained stable while the number of episodes of overt HE was significantly lower in the patients with improved SMI and in the patients with improved SATI. Finally, inverse correlation was observed between the variation of ammonia and SATI (r= -0.40; p Conclusion In addition to muscle mass, adipose tissue is modified after TIPS. The improvement of subcutaneous adipose tissue as well as of sarcopenia and myosteatosis is associated to the amelioration of cognitive impairment independently of liver function. The correlation between adipose tissue and ammonia modification may suggest an active role of the adipose tissue in the inter-organ ammonia trafficking.
- Published
- 2021
45. Causes and Management of Non-cirrhotic Portal Hypertension
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Lorenzo Ridola, Silvia Nardelli, Oliviero Riggio, and Stefania Gioia
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Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Liver transplantation ,Liver (Scott C and E Kallwitz, Section Editors) ,03 medical and health sciences ,0302 clinical medicine ,Hypertension, Portal ,Ascites ,medicine ,Humans ,Vascular Diseases ,Portal hypertension ,Intensive care medicine ,Porto-sinusoidal vascular liver disease ,Portal Vein ,Vascular disease ,business.industry ,Liver Diseases ,Gastroenterology ,General Medicine ,medicine.disease ,Portal vein thrombosis ,Thrombosis ,Natural history ,Liver ,030220 oncology & carcinogenesis ,Chronic Disease ,Disease Progression ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
Purpose of the Review Non-cirrhotic portal hypertension (NCPH) includes a heterogeneous group of conditions. The aim of this paper is to make an overview on the denominations, diagnostical features and management of porto-sinusoidal vascular disease (PSVD) and chronic portal vein thrombosis (PVT) being the main causes of NCPH in the Western world. Recent Findings The management of NCPH consists in the treatment of associated diseases and of portal hypertension (PH). PH due to PSVD or PVT is managed similarly to PH due to cirrhosis. TIPS placement and liver transplantation are considerable options in patients with refractory variceal bleeding/ascites and with progressive liver failure. Anticoagulation is a cornerstone both in the treatment of thrombosis in PSVD and in the prevention of thrombosis recurrence in patients with portal cavernoma. Summary Physicians should be aware of the existence of PSVD and chronic PVT and actively search them in particular settings. To now, the management of portal hypertension-related complications in NCPH is the same of those of cirrhosis. Large cooperative studies on the natural history of NCPH are necessary to better define its management.
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- 2020
46. Neck circumference as reliable predictor of mechanical ventilation support in adult inpatients with COVID‐19: A multicentric prospective evaluation
- Author
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Elisabetta Macchini, Gianfranco Sanson, Paolo De Cristofaro, Renato Masala, Francesco Quintavalle, Eugenia Dal Bo, Frida Leonetti, Giuseppe Campagna, Roberto Cesareo, Giorgio Berlot, Andrea Palermo, Lorenzo Ridola, Erik Roman-Pognuz, Donatella Giacomazzi, Verena Zerbato, Silvia Manfrini, Luigi Ottaviani, Roberto Luzzati, Cosmo Del Borgo, Stefano Di Bella, Gianluca Sambataro, Di Bella, Stefano, Cesareo, Roberto, De Cristofaro, Paolo, Palermo, Andrea, Sanson, Gianfranco, Roman-Pognuz, Erik, Zerbato, Verena, Manfrini, Silvia, Giacomazzi, Donatella, Dal Bo, Eugenia, Sambataro, Gianluca, Macchini, Elisabetta, Quintavalle, Francesco, Campagna, Giuseppe, Masala, Renato, Ottaviani, Luigi, Del Borgo, Cosmo, Ridola, Lorenzo, Leonetti, Frida, Berlot, Giorgio, and Luzzati, Roberto
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Adult ,Male ,invasive mechanical ventilation ,obesity ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,Logistic regression ,BMI ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,COVID‐19 ,Predictive Value of Tests ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Prospective Studies ,Respiratory system ,Prospective cohort study ,Research Articles ,Aged ,Mechanical ventilation ,COPD ,SARS-CoV-2 ,business.industry ,COVID-19 ,neck circumference ,Middle Aged ,medicine.disease ,Respiration, Artificial ,Obesity ,Survival Rate ,Italy ,Female ,business ,Body mass index ,Neck ,Research Article - Abstract
Aims: COVID-19 is especially severe for elderly subjects with cardio-metabolic and respiratory comorbidities. Neck circumference (NC) has been shown to be strongly related to cardiometabolic and respiratory illnesses even after adjustment for body mass index (BMI). We performed a prospective study to investigate the potential of NC to predict the need for invasive mechanical ventilation (IMV) in adult COVID-19 inpatients. Materials and methods: we prospectively and consecutively enrolled COVID-19 adult patients admitted to dedicated medical wards of two Italian hospitals from March 25th to April seventh 2020. On admission, clinical, biochemical and anthropometric data, including BMI and NC were collected. As primary outcome measure, the maximum respiratory support received was evaluated. Follow-up time was 30 days from hospital admission. Results: we enrolled 132 subjects (55.0-75.8 years, 32% female). During the study period, 26 (19.7%) patients underwent IMV. In multivariable logistic regression analyses, after adjusting for age, sex, diabetes, hypertension and COPD, NC resulted independently and significantly associated with IMV risk (adjusted OR 1.260 - per 1 cm increase 95% CI:1.120-1.417; P < 0.001), with a stronger association in the subgroup with BMI ≤30 Kg/m2 (adjusted OR 1.526; 95% CI:1.243-1.874; P < 0.001). NC showed a good discrimination power in predicting patients requiring IMV (AUC 0.783; 95% CI:0.684-0.882; P < 0.001). In particular, NC > 40.5 cm (>37.5 for females and > 42.5 for males) showed a higher and earlier IMV risk compared to subjects with lower NC (Log-rank test:P < 0.001). Conclusions: NC is an easy to measure parameter able to predict the need for IMV in adult COVID-19 inpatients.
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- 2020
47. Minimal hepatic encephalopathy and sleep disorders in patients with cirrhosis: Which comes first?
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Silvia Nardelli, Oliviero Riggio, Lorenzo Ridola, and Stefania Gioia
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Liver Cirrhosis ,Sleep Wake Disorders ,medicine.medical_specialty ,Cirrhosis ,business.industry ,Gastroenterology ,MEDLINE ,medicine.disease ,Sleep in non-human animals ,Editorial ,Internal medicine ,Hepatic Encephalopathy ,medicine ,Humans ,In patient ,business ,hepatic encephalopathy, sleep disorders, cognitive impairment ,Hepatic encephalopathy - Published
- 2020
48. Spontaneous porto-systemic shunts in liver cirrhosis: Clinical and therapeutical aspects
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Oliviero Riggio, Silvia Nardelli, Stefania Gioia, Giuseppe Pelle, Marta Puzzono, and Lorenzo Ridola
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Liver Cirrhosis ,medicine.medical_specialty ,Hepatic encephalopathy ,Liver cirrhosis ,Portal vein thrombosis ,Porto-systemic shunt syndrome ,Porto-systemic shunts ,Variceal bleeding ,Collateral Circulation ,Esophageal and Gastric Varices ,Gastrointestinal Hemorrhage ,Hepatic Encephalopathy ,Humans ,Incidence ,Liver ,Liver Function Tests ,Portal System ,Syndrome ,Treatment Outcome ,Venous Thrombosis ,Cirrhosis ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,business.industry ,Minireviews ,General Medicine ,Gastric varices ,medicine.disease ,030220 oncology & carcinogenesis ,Portal hypertension ,030211 gastroenterology & hepatology ,Liver function ,Portosystemic shunt ,business ,Shunt (electrical) - Abstract
Spontaneous porto-systemic shunts (SPSS) are frequent in liver cirrhosis and their prevalence increases as liver function deteriorates, probably as a consequence of worsening portal hypertension, but without achieving an effective protection against cirrhosis' complications. Several types of SPSS have been described in the literature, each one associated with different clinical manifestations. In particular, recurrent or persistent hepatic encephalopathy is more frequent in patients with splenorenal shunt, while the presence of gastric varices and consequently the incidence of variceal bleeding is more common in gastrorenal shunt. In the advanced stage, the presence of large SPSS can lead to the so called "portosystemic shunt syndrome", characterized by a progressive deterioration of hepatic function, hepatic encephalopathy and, sometimes, portal vein thrombosis. The detection of SPSS in patients with liver cirrhosis is recommended in order to prevent or treat recurrent hepatic encephalopathy or variceal bleeding.
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- 2020
49. Enteropathic spondyloarthritis: Results from a large nationwide database analysis
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Maria Sole Chimenti, Angelo Zullo, Paola Conigliaro, Roberto Perricone, Francesco Caso, Palma Scolieri, Claudia Canofari, Livia Baincone, Lorenzo Ridola, Antonella Afeltra, Fischetti Fabio, Antonio Tursi, Devis Benfaremo, Andrea Picchianti-Diamanti, Flavia Baccini, Bruno Laganà, Cristiano Pagnini, Roberto Faggiani, Paola Tomietto, Raffaele Scarpa, Maria Lia Scribano, Giammarco Mocci, Marino Paroli, Elisa Cuccagna, Luca Navarini, Michele Maria Luchetti, Armando Gabrielli, Mauro Demurtas, Roberta Pica, Luis Severino Martin-Martin, Roberto Lorenzetti, Giulia Zerboni, Luisa Costa, Vincenzo Bruzzese, Stefano Festa, Picchianti-Diamanti, A., Lorenzetti, R., Chimenti, M. S., Luchetti, M. M., Conigliaro, P., Canofari, C., Benfaremo, D., Bruzzese, V., Lagana, B., Perricone, R., Zullo, A., Caso, F., Costa, L., Tomietto, P., Fabio, F., Scolieri, P., Navarini, L., Cuccagna, E., Severino Martin-Martin, L., Lia Scribano, M., Faggiani, R., Pagnini, C., Mocci, G., Demurtas, M., Tursi, A., Festa, S., Zerboni, G., Pica, R., Ridola, L., Paroli, M., Baccini, F., Baincone, L., Gabrielli, A., Afeltra, A., Scarpa, R., Picchianti-Diamanti, Andrea, Lorenzetti, Roberto, Chimenti, Maria Sole, Luchetti, Michele Maria, Conigliaro, Paola, Canofari, Claudia, Benfaremo, Devi, Bruzzese, Vincenzo, Laganà, Bruno, Perricone, Roberto, and Fischetti, Fabio
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0301 basic medicine ,Male ,Databases, Factual ,Disease ,Comorbidity ,0302 clinical medicine ,Crohn Disease ,Immunology and Allergy ,Medicine ,Disease activity ,e spondyloarthritis ,Crohn's disease ,Peripheral SpA ,Nationwide database ,Inflammatory Bowel Diseases ,Middle Aged ,Ulcerative colitis ,Axial SpA ,Enteropathic spondyloarthritis ,Italy ,Cohort ,Female ,Human ,medicine.medical_specialty ,Immunology ,Inflammatory bowel diseases ,Anti-TNF-alpha ,Cross-Sectional Studies ,Humans ,Internet ,Spondylarthritis ,Enteropathic spondyloarthriti ,Databases ,03 medical and health sciences ,Internal medicine ,Factual ,030203 arthritis & rheumatology ,Cross-Sectional Studie ,Ulcerative coliti ,business.industry ,Inflammatory Bowel Disease ,Spondylarthriti ,medicine.disease ,Rheumatology ,anti-TNF-alpha ,axial spa ,crohn's disease ,disease activity ,inflammatory bowel diseases ,peripheral spa ,ulcerative colitis ,Settore MED/16 - Reumatologia ,030104 developmental biology ,business - Abstract
Introduction Spondyloarthrits (SpA) share clinical, genetic and immunological features with Inflammatory Bowel Diseases (IBD), and enteropathic SpA (eSpA) represent the clinical evidence of the association between gut and joint diseases. This cross-sectional study aimed to report data of eSpA patients collected from the first Italian database. Patients and methods A specific web-based interface has been created to insert and collect the main clinical, serologic and imaging data from patients with eSpA, as well as disease activity, comorbidities and treatment, in a real-life scenario. Results Data were collected in 14 Italian centers (7 rheumatology and 7 gastroenterology units). A total of 347 eSpA patients were enrolled in the study. Type 1 peripheral eSpA was the most frequent form. Crohn’ Disease (CD) was the most represented IBD. CD activity was similar among eSpA, whereas UC activity was slightly higher in the axial and mixed form than in the peripheral eSpA. The disease was active in less than half of axial eSpA patients and in only 18% of patients with peripheral eSpA. Furthermore, most of the patients had an inactive IBD. Nineteen percent of the total eSpA patients were free of therapy at the time of the enrollment and 61% of the patients were receiving biotechnological agents. Conclusions The multidisciplinary management of eSpA patients, favored by this ad hoc created web-based platform, allowed to obtain data from the largest eSpA cohort. The information coming of this database might advance knowledge of eSpA and improve their standard of care.
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- 2020
50. Clinical management of type C hepatic encephalopathy
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Silvia Nardelli, Jessica Faccioli, Oliviero Riggio, Lorenzo Ridola, and Stefania Gioia
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Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Psychometrics ,medicine.medical_treatment ,Administration, Oral ,Enema ,Hepatic Veins ,Gastroenterology ,Severity of Illness Index ,Rifaximin ,03 medical and health sciences ,Liver disease ,Therapeutic approach ,chemistry.chemical_compound ,0302 clinical medicine ,Imaging, Three-Dimensional ,Non-alcoholic Fatty Liver Disease ,Internal medicine ,medicine ,Neurological syndrome ,Prevalence ,Humans ,Hepatic encephalopathy ,Review Articles ,Subclinical infection ,business.industry ,Portal Vein ,cirrhosis ,minimal hepatic encephalopathy ,non-absorbable disaccharides ,rifaximin ,spontaneous portal-systemic shunts ,transjugular intrahepatic portosystemic shunt ,Endovascular Procedures ,Middle Aged ,medicine.disease ,Lactulose ,Anti-Bacterial Agents ,Oncology ,chemistry ,030220 oncology & carcinogenesis ,Hepatic Encephalopathy ,Urinary Tract Infections ,030211 gastroenterology & hepatology ,Drug Therapy, Combination ,Stents ,business ,Tomography, X-Ray Computed ,Transjugular intrahepatic portosystemic shunt - Abstract
Type-C hepatic encephalopathy is a complex neurological syndrome, characteristic of patients with liver disease, causing a wide and complex spectrum of nonspecific neurological and psychiatric manifestations, ranging from a subclinical entity, minimal hepatic encephalopathy, to a deep form in which a complete alteration of consciousness can be observed: overt hepatic encephalopathy. Overt hepatic encephalopathy occurs in 30-40% of patients. According to the time course, hepatic encephalopathy is subdivided into episodic, recurrent and persistent. Diagnostic strategies range from simple clinical scales to more complex psychometric and neurophysiological tools. Therapeutic options may vary between episodic hepatic encephalopathy, in which it is important to define and treat the precipitating factor and hepatic encephalopathy and secondary prophylaxis, where the standard of care is non-absorbable disaccharides and rifaximin. Grey areas and future needs remain the therapeutic approach to minimal hepatic encephalopathy and issues in the design of therapeutic studies for hepatic encephalopathy.
- Published
- 2020
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