Complementary and alternative medicine soughts and encompasses a wide range of approaches; its use begun in ancient China at the time of Xia dynasty and in India during the Vedic period, but thanks to its long-lasting curative effect, easy availability, natural way of healing, and poor side-effects it is gaining importance throughout the world in clinical practice. We conducted a review describing the effects and the limits of using herbal products in chronic liver disease, focusing our attention on those most known, such as quercetin or curcumin. We tried to describe their pharmacokinetics, biological properties, and their beneficial effects (as antioxidant role) in metabolic, alcoholic, and viral hepatitis (considering that oxidative stress is the common pathway of chronic liver diseases of different etiology). The main limit of applicability of CAM comes from the lacking of randomized, placebo-controlled clinical trials giving a real proof of efficacy of those products, so that anecdotal success and personal experience are frequently the driving force for acceptance of CAM in the population.

Focus on emerging drugs for the treatment of patients with non-alcoholic fatty liver disease

Colorectal cancer (CRC) is one of the most common malignancies in the Western world and intestinal dysbiosis might contribute to its pathogenesis. The mucosal colon microbiome and C-C motif chemokine 2 (CCL2) were investigated in 20 healthy controls (HC) and 20 CRC patients using 16S rRNA sequencing and immunoluminescent assay, respectively. A total of 10 HC subjects were classified as overweight/obese (OW/OB_HC) and 10 subjects were normal weight (NW_HC); 15 CRC patients were classified as OW/OB_CRC and 5 patients were NW_CRC. Results: Fusobacterium nucleatum and Escherichia coli were more abundant in OW/OB_HC than in NW_HC microbiomes. Globally, Streptococcus intermedius, Gemella haemolysans, Fusobacterium nucleatum, Bacteroides fragilis and Escherichia coli were significantly increased in CRC patient tumor/lesioned tissue (CRC_LT) and CRC patient unlesioned tissue (CRC_ULT) microbiomes compared to HC microbiomes. CCL2 circulating levels were associated with tumor presence and with the abundance of Fusobacterium nucleatum, Bacteroides fragilis and Gemella haemolysans. Our data suggest that mucosal colon dysbiosis might contribute to CRC pathogenesis by inducing inflammation. Notably, Fusobacterium nucleatum, which was more abundant in the OW/OB_HC than in the NW_HC microbiomes, might represent a putative link between obesity and increased CRC risk.

Gastrointestinal (GI) bezoars are aggregates of indigestible material that occur mainly in patients with altered GI anatomy (i. e. bariatric surgery, partial gastrectomy) and/or motility disorders (i. e. gastroparesis, drug-induced delayed gastric emptying). Other risk factors are high fiber intake, psychiatric diseases, and severe constipation [1]. Treatment strategies for bezoar fragmentation include pharmacological, endoscopic, and surgical approaches. Endoscopic treatment of gastric bezoar consists of attempted fragmentation by using different devices such as snares, forceps, baskets, lithotripters, argon plasma coagulation, and needle-knife [2] [3]. The use of a laser-ignited mini-explosive technique with neodymium-doped yttrium aluminium garnet (Nd:YAG) laser has also been described [4]. To date, only one article from China (original language) has described the use of holmium:YAG (Ho:YAG) laser lithotripsy in this field [5]. We present two video cases of massive gastric phytobezoar, which were irresponsive to pharmacological approaches and were successfully treated with Ho:YAG laser (Lumenis Ltd., Yokneam, Israel). The first patient was a 73-year-old man with a history of Billroth I partial gastrectomy for gastric cancer, who had endoscopic evidence of a massive, hard, phytobezoar, 10 cm in diameter ([Video 1]). The phytobezoar was successfully treated with 200 micron laser fiber (Lumenis VersaPulse P20 lithotripter, frequency 4 – 8 Hz, pulse energy 2000 mJ) The procedure time was 60 minutes. The second patient was a 58-year-old woman with a gastric band for treatment of obesity, who showed a large phytobezoar (8 cm in diameter) in the proximal gastric pouch ([Video 2]). In this case, we used a 550 micron laser fiber, which allowed the diffusion of higher pulse energy (Lumenis VersaPulse PowerSuite 100 W lithotripter, 10 – 30 Hz, 3000 mJ), resulting in a shorter procedure time (24 minutes). In both procedures, complete bezoar fragmentation was achieved in a single endoscopy session. No postprocedural complications were registered in the patients and they were discharged 1 day after the endoscopic treatment. In conclusion, Ho:YAG laser fragmentation represents a safe, effective, and rapid endoscopic approach for the treatment of massive gastric bezoars. Endoscopy_UCTN_Code_TTT_1AO_2AL

Peer reviewed article authored by (Iadevaia MD, Del Prete A, Cesaro C, Gaeta L, Zulli C, Loguercio C). Read article or submit your manuscript for publishing.

Endoscopic sphincterotomy (ES) is commonly performed during endoscopic retrograde cholangiopancreatography, and bleeding is a severe adverse event. PuraStat is a peptide developed as a hemostatic agent for endoscopy. We report its use as a hemostatic strategy in post-ES bleeding refractory to combined hemostasis. A patient with choledocholithiasis underwent endoscopic retrograde cholangiopancreatography for stone removal. After the ES, severe bleeding refractory to the injection of diluted epinephrine around the bleeding source and metal stent placement occurred. Hemostasis was achieved with the application of the hemostatic gel. We reported the use of novel self-assembling hemostatic gel as an effective therapeutic tool for post-ES refractory bleeding.