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Introduction. Crohn's disease (CD) and ulcerative colitis (UC), can resemble similarities regarding endoscopic/histologic aspects, which carry different outcomes. The definitive diagnosis of IBD requires corroboration of multiple datas, upper and lower endoscopy playing an important role for the positive diagnostic and for excluding other causes of diarrhea. Study objective: This work is a single-center study with retrospective recruitment of patients with first diagnosis of IBD and its primary objective is to analyze whether or not there is a relationship between the macroscopic diagnosis and the histopathological one. As secondary objectives we analized epidemiological data, symptoms, macroscopic appearence of the lessions and the existence of microscopic lessions and we calculated histopathological scores (GHAS for CD and Geboes for UC). Materials and Methods. A retrospective recruitment of patients newly diagnosed with IBD has been made, within 4 years. 174 patients were eligible and were distributed into two groups: 80 patients with exclusive colonic CD and 94 patients with pancolitis. Patients with ileal involvement, fistulizing pattern, or who were already diagnosticated and treated were excluded. Results. We had a slightly male preponderance (52.9% versus 47.1%) with a mean age of disease onset of 38.0 years; we had 68.7% patients with CD inflammatory pattern, respectively 31.3% with stenosing one. Most of the patients had moderate disease (34 -CD and 57-UC). Most commonly reported macroscopic appearance was erythema and oedema in both groups: 76.4% (CD) and 87.4% (UC). In terms of histological severity, severe forms (translated by Geboes score >3.1 and GHAS > 10) are overwhelmingly found in both groups. Conclusions. The concordance between the macroscopic appearance reported by the endoscopist and the microscopic appearance concluded by the pathologist, correlated positively with the degree of chronic inflammation for patients with UC, but we did not obtain similar results for those with CD, partialy reflecting the discontinuous nature of the lessions. The results of the correlation between Mayo score and Geboes score demonstrated that any increase in the degree of chronic inflammation, architectural changes, presence of eosinophils or neutrophils in the lamina propria, or erosions/ulcerations were associated with an increase in Mayo score. Concerning a possible correlation between the severity of CD and histopathological appearance, we had a striking observation, namely that no statistically significant association between predictors and the degree of severity of CD was evident. In conclusion, we hypothesized that a possible influence of histopathological lesions on disease severity is small. [ABSTRACT FROM AUTHOR]

Background: Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-predominent irritable bowel syndrome (IBS-D). The proper differential diagnosis requires total colonoscopy with multiple biopsies from normal-appearing mucosa and a detailed histopathological exam. Specific treatment may improve symptomatology. Aim: To evaluate the prevalence of MC in patients with an initial diagnosis of IBS-D, to analyse demographic and clinical features of MC patients and to assess the efficacy of specific treatment. Material and methods: Our retrospective study analyzed patients diagnosed with microscopic colitis in clinic during a three-year period. Diagnosis was established on histological exams of the samples obtained during colonoscopy in patients previously thought to have IBS-D. We evaluated clinical manifestations, time lapsed from their onset to definitive diagnosis, the association of MC with autoimmune diseases or with prior medication and the efficacy of treatment with budesonide or mesalazine. Results: From 247 patients considered to have IBS-D, 15 patients (6.07%) had actually MC (13 lymphocytic colitis and 2 collagenous colitis). MC was associated with nonsteroidal antiinflammatory drugs (3 patients), Lansoprazole (2 patients) and autoimmune diseases (6 patients). Watery, non-bloody diarrhea was present in all patients with MC. Other frequent complaints were nocturnal diarrhea (11 patients), abdominal pain (8 patients), abdominal bloating and flatulence (8 patients) and slight weight loss (6 patients). The diagnostic samples were obtained from the right colon in 6 cases and from rectosigmoid or transverse colon in 9 patients. Treatment was initial symptomatic in all patients, but there were 5 patients that required mesalazine and/or Budesonide, with favourable outcome. Conclusions: All the patients thought to have diarrhea-irritable bowel syndrome should be evaluated for microscopic colitis. Symptomatology is almost superimposable, but a few distinct features can be noticed. The proper and early diagnosis and the specific treatment may lead to significant clinical improvement in some difficult cases of the so-called "irritable bowel syndrome". [ABSTRACT FROM AUTHOR]

Background: Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-predominent irritable bowel syndrome (IBS-D). The proper differential diagnosis requires total colonoscopy with multiple biopsies from normal-appearing mucosa and a detailed histopathological exam. Specific treatment may improve symptomatology. Aim: To evaluate the prevalence of MC in patients with an initial diagnosis of IBS-D, to analyse demographic and clinical features of MC patients and to assess the efficacy of specific treatment. Material and methods: Our retrospective study analyzed patients diagnosed with microscopic colitis in clinic during a three-year period. Diagnosis was established on histological exams of the samples obtained during colonoscopy in patients previously thought to have IBS-D. We evaluated clinical manifestations, time lapsed from their onset to definitive diagnosis, the association of MC with autoimmune diseases or with prior medication and the efficacy of treatment with budesonide or mesalazine. Results: From 247 patients considered to have IBS-D, 15 patients (6.07%) had actually MC (13 lymphocytic colitis and 2 collagenous colitis). MC was associated with nonsteroidal antiinflammatory drugs (3 patients), Lansoprazole (2 patients) and autoimmune diseases (6 patients). Watery, non-bloody diarrhea was present in all patients with MC. Other frequent complaints were nocturnal diarrhea (11 patients), abdominal pain (8 patients), abdominal bloating and flatulence (8 patients) and slight weight loss (6 patients). The diagnostic samples were obtained from the right colon in 6 cases and from rectosigmoid or transverse colon in 9 patients. Treatment was initial symptomatic in all patients, but there were 5 patients that required mesalazine and/or Budesonide, with favourable outcome. Conclusions: All the patients thought to have diarrhea-irritable bowel syndrome should be evaluated for microscopic colitis. Symptomatology is almost superimposable, but a few distinct features can be noticed. The proper and early diagnosis and the specific treatment may lead to significant clinical improvement in some difficult cases of the so-called "irritable bowel syndrome". [ABSTRACT FROM AUTHOR]

Hepatitis C viral (HCV) treatment has rapidly advanced with the use of direct-acting antivirals (DAA), and many patients achieve sustained virological response (SVR). Although the risk of liver tumors is greatly reduced, there are still patients who achieve SVR but will progress to hepatocellular carcinoma (HCC). HCV infection is also a known risk for cholangiocellular carcinoma (CLC), although it is considered a relative infrequent liver malignancy. We report a series of five cases of CLC in patients that achieved SVR after HCV treatment with DAA. There were three women and two males with a median age of 62 years (range 49 to 77 years). Four patients had liver cirrhosis at the time of their HCV treatment. The interval from achieving SVR until CLC diagnosis varied, ranging from 4 to 36 months (median=12). Three patients presented with advanced disease and had extrahepatic spread at the time of their diagnosis. One patient had a resectable tumor, with no recurrence 4 years later. In one case, the tumor was initially considered an atypical HCC and was treated by radiofrequency ablation. Three years later, she was diagnosed with a large tumor recurrence that was demonstrated to be a CLC on liver biopsy. The last two patients were older males with HCV compensated cirrhosis diagnosed with CLC more than two years after achieving SVR. Palliative chemotherapy was started in both. Only a handful of CLC cases have been reported in HCV patients after SVR. Clinicians should take into account the possible development of an aggressive CLC. [ABSTRACT FROM AUTHOR]

Background: Esophageal xanthoma is a very rare lesion which can be incidentally discovered during endoscopy. Only eleven cases have been reported, including ours. Case reports: We present two new cases of esophageal xanthoma localized in the lower esophagus in a 56-year-old woman and a 62-year-old man. Endoscopically, esophageal xanthoma appears as yellowish granular spots or a slightly elevated lesion. Microscopically, it consists of fat accumulation in foamy histiocytes beneath the squamous epithelium. Conclusions: The clinical and pathological importance of these lesions and what they mean in patients is discussed, along with a review of the literature. [ABSTRACT FROM AUTHOR]

The article presents a case study of 59-year-old female with dysphagia and significant weight loss. It mentions diagnosis of lymphocytic esophagitis (LE), a rare condition of the esophagus; and also mentions use of Proton-pump inhibitors and topical corticosteroids to induce histological remission for LE management.

Circulating cell-free DNA (ccfDNA) quantity correlates with the clinical characteristics and prognosis of various cancer types. We investigated whether ccfDNA levels and the neutrophil-to-lymphocyte ratio (NLR) have prognostic value in patients with pancreatic ductal adenocarcinoma (PDAC). Peripheral blood was collected from 82 patients with PDAC prior to any diagnostic procedure or the administration of chemotherapy. Plasma DNA was isolated, and ccfDNA concentration and NLR were determined. We found that ccfDNA levels were correlated with age and tumor burden. Moreover, higher values of NLR (≥3.31) were linked with worse overall survival (OS) (4 vs. 10 months; log rank p = 0.011), and an elevated ccfDNA concentration (≥25.79 ng/mL) was strongly associated with shorter OS (4 vs. 8 months; log rank p = 0.009). According to the results of the multivariable Cox regression analysis, the baseline concentration of ccfDNA was an independent prognostic factor for OS (HR 0.45, 95% CI 0.21–0.97, p = 0.041). Furthermore, the combination of ccfDNA levels with NLR greatly enhanced the prognostic accuracy of PDAC patients. Our study demonstrates that ccfDNA concentration and NLR are independent predictors of survival in PDAC. Subsequent studies should validate this combination as a prognostic indicator in PDAC patients and assess its utility for guiding therapeutic decisions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Different pattern of inflammatory and atrophic changes in the gastric mucosa of the greater and lesser curvature" by Isajevs S and colleagues.

The article presents a case study of a 76-year-old male patient who was admitted to the hospital with dark stools and anemia. Topics discussed include the upper gastrointestinal endoscopy performed on the patient, the Brunner's glands hyperplasia revealed in histologic examination, and the immunohistochemistry analysis of the patient.

In the article, the authors present a case of a 53-year-old man who was rushed to the emergency department due to severe diarrhea and altered status to discuss pembrolizumab-induced steroid resistant immune mediated colitis and concurrent Clostridioides difficile infection. The patient has non-small-cell lung cancer. Also cited is the importance of colonoscopy and multiple colonic biopsies in the diagnosis of immune-induced colitis.

Adenoma-like adenocarcinoma is a rare subtype of colorectal carcinoma recognized by WHO in 2019 that has a histological appearance similar to that of adenomatous polyps. These tumors are characterized by the presence of dysplastic glandular structures that resemble those found in adenomas. Compared to other subtypes of conventional colorectal carcinomas, patients have significantly lower rate of nodal metastasis, distant metastasis and mortality. We present the case of a 68 years old male, with complex cardio-vascular pathology associated, chronic renal failure and diabetes mellitus, who was endoscopically evaluated two years ago. At that moment, the patient was diagnosed with an apparently benign transverse polyp, having the indication for polypectomy but was therapeutically neglected. During the current year, the patient was referred to our service for colonoscopic reevaluation. We identified the prior described sesile polyp, measuring 3cm, with glandular architecture KUDO V, with a strong macroscopic malignant aspect so we didn't considered it appropriate for endoscopic resection. For this reason, we took multiple tissue samples and tattooed the lesion for surgical further management. The pathology reported high grade dysplasia adenoma so the patient received the recommendation of endoscopic resection. At the second colonoscopy in our department, efficient elevation was obtained injecting methylene blue solution with subsequent diathermic en-block resection. The final pathology report concluded adenoma like adenocarcinoma subtype of CRC with resection margins < 0.5mm from the submucosal invasion, without tumoral budding or perineural and lympho-vascular invasion. After the tumor board discussion, the patient was referred for surgical treatment. Segmentary colectomy was performed, with favorable outcome in the absence of oncological treatment necessity. In conclusion, adenoma-like adenocarcinoma is a particular subtype of colorectal carcinoma that has a challenging endoscopic and histological diagnosis, as it can mimic adenoma on biopsy in the context of a macroscopic malignant appearance, therefore influencing treatment decisions. [ABSTRACT FROM AUTHOR]

Introduction. Celiac disease (CD) malabsorption may provoke various extraintestinal features like neurological disorders with a powerful impact on the patient's life. Gluten enteropathy diagnosis may be delayed and therewith the cancer risk may increase. Case presentation. A 35-year old epileptic male patient was admitted with newly onset abdominal pain, vomiting, jaundice and weight loss. The abdominal ultrasonography (US) showed ductal criteria for chronic pancreatitis (CP): irregular duct contour, visible side branches, hyperechoic duct margins and dilated main duct. Besides hepatic cholestasis and cytolysis, the blood tests showed significant lipase elevation, suggesting acute pancreatitis (AP). The upper digestive endoscopy using the side-viewing endoscope revealed the loss of duodenal folds with scalloping appearance. Advancing towards the second part of the duodenum this aspect became more irregular with an infiltrative and stenosing appearance. The biopsies showed poorly differentiated duodenal adenocarcinoma with diffuse areas of signet ring cells, respectively marked villous atrophy: Corazza-Villanacci grade B2. The tTGA were positive at high titer, same as HLA DQ2. Cephalic pancreaticoduodenectomy was performed, with clear resection margins - G3, pT3N0M0. Following surgery, besides the jaundice remission, the patient's neurological status considerably improved under optimized treatment and gluten free diet (GFD). At 6 months follow-up there were no signs of tumor residue, the patient gained weight, US revealed no signs of pancreatitis and the seizures bouts were less frequent. Discussions. There is a 60-to 80-fold increased risk of small bowel carcinoma in patients with celiac disease (CD), a long-standing or refractory disease increasing even more the risk of malignancy. In this case the morbidity was higher due to development of acute pancreatitis episodes on CP, caused by the ampular obstruction. Patients with CD have an increased risk of CP and AP, but the strength of these associations as well as the implied mechanisms are not very well clarified. A Swedish retrospective study found that patients with CD had a 3-fold increased risk of developing pancreatitis, with a lower hazard ratio for gallstone related AP comparative with nongallstone related AP. We consider that the association with the neurological disorder might be only incidental since the imaging found no occipital calcifications specific to a seizure syndrome associated with CD. Conclusions. Gluten enteropathy is a complex disease associating multiple extraintestinal symptoms. An early diagnosis with early GFD reduce the risk of small bowel carcinoma and definitely can prevent other extraintestinal manifestations. [ABSTRACT FROM AUTHOR]

Background. Endoscopic ultrasound (EUS) in association with fine needle aspiration (FNA) it is considered to be the standard of pancreatic mass lesions diagnosis. Our aim was to determine which ultrasound features, including a particular hypoechoic rim aspect can predict a pancreatic neuroendocrine tumor (pNET) diagnosis. Methods. The EUS examinations performed for solid pancreatic lesions from 2015 to 2019 in a Tertiary Gastroenterology Center were evaluated in a prospective study. There were 175 cases analyzed, out of which pNET diagnosis was established by FNA in n= 19 (10.8%). Mean age of patients with pNETs was 56.1 ± 10.3 years, significantly lower than all cases in the study group and 52.7% of which were females. We studied the following EUS characteristics by univariate and multivariate analysis: well defined margins, hypoechoic EUS aspect, homogeneous pattern, the presence of internal vascularization, stiff elastographic appearance, the presence of multiple lesions, the internalization of large vessels, Wirsung duct dilation and the presence of a hypoechoic rim delimiting the interior margin of the lesion. Results. The following EUS features were significantly associated with EUS diagnosis of pNET: well defined margins (63.1% vs 35.7% p=0.02), homogeneous pattern (36.8% vs 16.9%, p=0.03), the presence of internal vascularisation (63.1% vs 24.3%, p=0.0004), blue on elastography (89.4% vs 64.2%, p=0.03) and the presence of a hypoechoic rim (47.3% vs 2.5%, P< 0.0001). In the multivariate logistic regression analysis only the presence of a hypoechoic rim was independently associated with the pNET diagnosis (p< 0.0001). Conclusions. EUS appearance can suggest the diagnosis of a pNET. The presence of a hypoechoic rim delimiting the interior margin of the lesion is an independent predictor of pNET diagnosis. [ABSTRACT FROM AUTHOR]

Appendiceal endometriosis is a rare entity and, when accompanied by intestinal metaplasia, represents a challenging differential diagnosis with low-grade appendiceal mucinous neoplasm (LAMN). We present the case of a 47 years-old woman, with multiple surgical interventions for endometriosis, with persistent symptoms despite chronic hormonal treatment, with imaging showing stage IV endometriosis. Hence, en bloc low rectum resection with total hysterectomy and bilateral adnexectomy was performed, followed by appendectomy. Unexpectedly, despite the gross normal macroscopic appearance of the appendix, microscopy showed multiple endometriosis foci, consisting of endometrial glands embedded in varying amounts of endometrial stroma. As some of these glands were bordered by mucinous-type epithelium containing intestinal cells, Goblet cells, Paneth cells in addition to the presence of mucus-filled microcysts, immunohistochemistry (IHC) was performed in order to differentiate between intestinal-metaplasia and LAMN. IHC showed positivity of the endometrial epithelium for KRT7, estrogen receptor (ER) and progesterone receptor (PR). Both the appendiceal mucosa and the intestinal-type metaplastic epithelium of the glandular structures were positive for KRT20. Additionally, the endometrial stroma enclosing endometrial glands, as well as the stroma surrounding mucinous-type metaplastic epithelium, were positive for CD10, ER and PR. This patient's case draws attention to the rare occurrence of appendiceal endometriosis and the uncommon intestinal metaplasia, which can easily mimic LAMN, emphasizing the paramount importance of the differential diagnosis with this type of neoplasia. [ABSTRACT FROM AUTHOR]

The diagnosis of celiac disease relies on the assessment of serological data and the presence of histological alterations in the duodenal mucosa. The duodenal biopsy is pivotal in adults, and in some circumstances in children, to confirm the clinical suspicion of celiac disease. The correct interpretation of duodenal biopsies is influenced by numerous variables. The aim of this overview is to describe the correct methodological approach including the procedures of biopsy sampling, orientation, processing, staining and histopathological classification in order to avoid or minimize the errors and the variability in duodenal biopsy interpretation. Multiple biopsies taken from different sites of the duodenum during endoscopy maximize the diagnostic yield of duodenal histological sampling. Proper orientation of the biopsy samples is of the utmost importance to assess histological features of pathological duodenal mucosa and to avoid artifacts that may lead even an experienced pathologist to a wrong histological interpretation with subsequent misdiagnosis of celiac disease. An immunohistochemical stain for CD3 can be invaluable to aid the pathologist in obtaining a more accurate intra-epithelial T lymphocytes count. A simplified histological classification facilitates the clinician's work and improves the communication between pathologist and clinician. An integrated clinical and pathological approach is required for a correct diagnosis of celiac disease since a relatively large number of conditions may cause duodenal damage with a histological appearance similar to that of celiac disease. [ABSTRACT FROM AUTHOR]

The article describes the case of a 56-year old woman who was diagnosed with alpha fetoprotein (AFP)-producing colon cancer. The patient underwent blood tests, upper endoscopy, colonoscopy, computed tomography scan of the thorax, abdomen and pelvis, liver and colon biopsy. Blood test results revealed increased liver enzymes, mild cholestasis and inflammatory syndrome, while immunohistochemistry results included tubulo-papillary pattern, liver metastasis and synaptophysin positive cells.

We present the case of a previously healthy 62 year old man who developed primary non-Hodgkin lymphoma of the liver. Biopsy confirmed that it was a diffuse large anaplastic T-cell lymphoma of an extremely rare type. The diagnosis of this type of lesions is suggested by the presence of a hepatic mass without lymphadenopathy, splenomegaly or bone marrow involvement associated with normal tumor markers (carcinoembryonic antigen, alpha-fetoprotein and CA 19-9 levels). Histological examination of tissue is essential to confirm the diagnosis. Treatment options are surgical resection and/or chemotherapy but the rate of response to treatment varies widely. Some patients can achieve prolonged remission. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) develops by accumulation of multiple genetic damages leading to genetic instability that can be evaluated by cytogenetic methods. In the current study we used Cytokinesis-Blocked Micronucleus Assay (CBMN) technique to assess the behavior of Nuclear Division Index(NDI) in peripheral lymphocytes of patients with CRC and polyps versus patients with normal colonoscopy. Methods: Blood samples were collected from patients after informed consent. By CBMN technique we assessed the proportion of mono-nucleated, bi-nucleated, tri-nucleated and tetra-nucleated cells/500 cells, to calculate NDI. Data were statistically analyzed using the SPSS 11.0 package. Results: 45 patients were available for analysis, 23 men and 22 women, with a mean age of 58.7±13.5. 17 had normal colonoscopy, 17 colonic polyps and 11 CRC. The mean NDI values were significantly smaller for patients with CRC or polyps than in patients with normal colonoscopy (1.57 vs 1.73, p=0.013). The difference persisted for patients with neoplastic lesions (adenomas and carcinomas) when compared with patients with normal colonoscopy or non neoplastic (hyperplastic) polyps (1.56 vs.1.71, p=0.018). The NDI cut-off value to predict the presence of adenomas or carcinomas was equal to 1.55 with a 54.2% sensitivity and 81% specificity of lower values (p=0.019). The NDI cut off value to predict the presence of advanced adenomas or cancer was 1.525 for a sensitivity of 56.3% and a specificity of 82.8% (p=0.048). Conclusion: NDI may be useful in screening strategies for colorectal cancer as simple, noninvasive, inexpensive cytogenetic biomarker. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) develops by accumulation of multiple genetic damages leading to genetic instability that can be evaluated by cytogenetic methods. In the current study we used Cytokinesis-Blocked Micronucleus Assay (CBMN) technique to assess the behavior of Nuclear Division Index(NDI) in peripheral lymphocytes of patients with CRC and polyps versus patients with normal colonoscopy. Methods: Blood samples were collected from patients after informed consent. By CBMN technique we assessed the proportion of mono-nucleated, bi-nucleated, tri-nucleated and tetra-nucleated cells/500 cells, to calculate NDI. Data were statistically analyzed using the SPSS 11.0 package. Results: 45 patients were available for analysis, 23 men and 22 women, with a mean age of 58.7±13.5. 17 had normal colonoscopy, 17 colonic polyps and 11 CRC. The mean NDI values were significantly smaller for patients with CRC or polyps than in patients with normal colonoscopy (1.57 vs 1.73, p=0.013). The difference persisted for patients with neoplastic lesions (adenomas and carcinomas) when compared with patients with normal colonoscopy or non neoplastic (hyperplastic) polyps (1.56 vs.1.71, p=0.018). The NDI cut-off value to predict the presence of adenomas or carcinomas was equal to 1.55 with a 54.2% sensitivity and 81% specificity of lower values (p=0.019). The NDI cut off value to predict the presence of advanced adenomas or cancer was 1.525 for a sensitivity of 56.3% and a specificity of 82.8% (p=0.048). Conclusion: NDI may be useful in screening strategies for colorectal cancer as simple, noninvasive, inexpensive cytogenetic biomarker. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old epileptic male with abdominal pain, vomiting, jaundice, and weight loss. Examinations showed ductal criteria for chronic pancreatitis, cholestasis, loss of duodenal folds, and poorly differentiated duodenal adenocarcinoma. The patient had celiac disease (CD) with high risk of morbidity due to acute pancreatitis (AP), but after surgery, his neurological status improved with no tumor residue at 6 months follow-up.

The article presents a case study of a 79 year old female with a prior cholecystectomy experiencing jaundice due to a common bile duct obstruction. It is reported that biopsies revealed pancreatic heterotopia in the choledochus, a rare condition where pancreatic tissue is anatomically separate from the main gland. It is further reported that pancreatic heterotopia in the bile duct may present symptoms mimicking malignancy.

Anorectal adenocarcinoma is a very rare complication which can occur during the long-lasting evolution of perianal fistulas (PAF), chronic inflammation being the main predisposing factor incriminated for malignant evolution. Moreover, in rare cases (only 28 being published until now), adenocarcinoma developing at the level of a perianal fistula may occur by migration of tumoral cells originating from a rectal cancer into the granulation tissue of the fistula. We present the case of a patient with a rectal adenocarcinoma that has metastasized to a perianal fistula, in evolution for 7 years. Clinical suspicion of malignant seeding at the site of the fistula has been confirmed by immunohistochemical studies. [ABSTRACT FROM AUTHOR]

microRNAs (miRNAs) have been proposed as promising molecular biomarkers for diagnosis, prognosis, and responsive therapeutic targets in different types of cancer, including colorectal cancer (CRC). In this study, we evaluated the expression levels of 84 cancer-associated miRNAs in a cohort of 39 human samples comprising 13 peritumoral and 26 tumoral tissues from surgical specimens of CRC patients. KRAS mutations were detected in 11 tumoral samples. In a first analysis, we found 5 miRNAs (miR-215-5p, miR-9-5p, miR-138-5p, miR378a-3p, and miR-150-5p) that were significantly downregulated and one upregulated (miR-135b-5p) in tumoral tissues compared with the peritumoral tissues. Furthermore, by comparing miRNA profile between KRAS mutated CRC tissues respect to wild type CRC tissues, we found 7 miRNA (miR-27b-3p, miR-191-5p, miR-let7d-5p, miR-15b-5p, miR-98-5p, miR-10a-5p, and miR-149-5p) downregulated in KRAS mutated condition. In conclusion, we have identified a panel of miRNAs that specifically distinguish CRC tissues from peritumoral tissue and a different set of miRNAs specific for CRC with KRAS mutations. These findings may contribute to the discovering of new molecular biomarkers with clinic relevance and might shed light on novel molecular aspects of CRC. [ABSTRACT FROM AUTHOR]

Background & Aims: Therapeutic targets in ulcerative colitis (UC) have evolved over time from clinical remission to biological and endoscopic remission. Histologic remission remains a debatable outcome due to lack of data regarding its impact on long-term evolution. The development of histologic activity scores has brought standardization. We aimed to identify mucosal markers differentiating histological inflammation from histological remission in UC patients. Methods: The gene expression levels of 84 genes associated with inflammatory bowel diseases have been analyzed in 43 colonic mucosa samples from 30 patients with UC. The gene expression levels have been correlated with histological inflammation score of Geboes. Patients with endoscopic remission were divided by histological activity into two groups and molecular results were compared in order to identify differences in the mucosal gene expression. Results: We found a significant Pearson correlation (p<0.001 and r>0.5) between the Geboes score and the expression of 29 genes, whereas negative correlation (p<0.001 and r<-0.50) was observed with two genes in the entire UC cohort. In the subgroup of patients with endoscopic remission three transcripts: formyl-peptide receptor 1 (FPR1), matrix metalloproteinases 1 (MMP1) and mucine 1 (MUC1) were significantly up-regulated in patients with histological inflammation compared to patients with histologic remission. Conclusion: Our study further emphasizes the importance of histological assessment when endoscopic mucosal healing is present, as FPR1, MMP-1 and MUC1 were all significantly upregulated in patients with histological alterations. [ABSTRACT FROM AUTHOR]

In the last two decades anti‐tumor necrosis factor (anti‐TNF) therapy for inflammatory bowel disease (IBD) has been widely used to induce and maintain clinical and endoscopical remission, completely changing management of the disease. In this study, we aimed to identify gene expression changes in inflamed mucosa from Crohn's disease and ulcerative colitis patients treated with 5‐aminosalicylic acid (5‐ASA) (N = 25) or anti‐TNF agents (N = 12) compared to drug‐free IBD patients (N = 12) and non‐IBD control subjects (N = 18). The mucosal expression of 84 genes previously associated with IBD was evaluated by qPCR. We found that both therapeutic regimens induce a decrease in LCN2, NOS2, and TFF1, the levels of which are overexpressed in drug‐free patients compared to non‐IBD control subjects. Interestingly, a stronger effect of anti‐TNF drugs was observed on LCN2 and TFF1 levels. However, 5‐ASA seems to induce a more robust reduction of NOS2 expression. Moreover, we found that anti‐TNF treatment significantly increased ABCB1, leading to levels similar to those found in non‐IBD control subjects. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 66 year-old male patient who had a history of orthotopic liver transplantation for hepatitis C virus (HCV) liver cirrhosis. Topics discussed include the early detection of advanced pancreatic cancer in the patient, the abdominal computed tomography (CT) scan performed on the patient, and the recurrence of HCV in the patient.

Genetic research has shaped the inflammatory bowel disease (IBD) landscape identifying nearly two hundred risk loci. Nonetheless, the identified variants rendered only a partial success in providing criteria for the differential diagnosis between ulcerative colitis (UC) and Crohn's disease (CD). Transcript levels from affected intestinal mucosa may serve as tentative biomarkers for improving classification and diagnosis of IBD. The aim of our study was to identify gene expression profiles specific for UC and CD, in endoscopically affected and normal intestinal colonic mucosa from IBD patients. We evaluated a panel of 84 genes related to the IBD-inflammatory pathway on 21 UC and 22 CD paired inflamed and not inflamed mucosa and on age-matched normal mucosa from 21 non-IBD controls. Two genes in UC (CCL11 and MMP10) and two in CD (C4BPB and IL1RN) showed an upregulation trend in both noninflamed and inflamed mucosa compared to controls. Our results suggest that the transcript levels of CCL11, MMP10, C4BPB, and IL1RN are candidate biomarkers that could help in clinical practice for the differential diagnosis between UC and CD and could guide new research on future therapeutic targets. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 76-year-old female who was taken to the hospital because of acute inferior dysphagia. Topics mention including performing the upper endoscopy test which reveals a food bolus impaction in the middle third of the esophagus, intestinal metaplasia in the stomach and detection of a protozoan parasite known as Giardia duodenalis.

Background & Aims: Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects with a high risk for gastric cancer. The inter-observer agreement for the assessment of gastric atrophy is reported to be low. The aim of the study was to evaluate the inter-observer agreement for the assessment of severity and extension of gastric atrophy using oriented and unoriented gastric biopsy samples. Furthermore, the quality of biopsy specimens in oriented and unoriented samples was analyzed. Methods: A total of 35 subjects with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study were prospectively enrolled. The OLGA/OLGIM gastric biopsies protocol was used. From each subject two sets of biopsies were obtained (four from the antrum, two oriented and two unoriented, two from the gastric incisure, one oriented and one unoriented, four from the gastric body, two oriented and two unoriented). The orientation of the biopsy samples was completed using nitrocellulose filters (Endokit®, BioOptica, Milan, Italy). The samples were blindly examined by two experienced pathologists. Inter-observer agreement was evaluated using kappa statistic for inter-rater agreement. The quality of histopathology specimens taking into account the identification of lamina propria was analyzed in oriented vs. unoriented samples. The samples with detectable lamina propria mucosae were defined as good quality specimens. Categorical data was analyzed using chi-square test and a two-sided p value <0.05 was considered statistically significant. Results: A total of 350 biopsy samples were analyzed (175 oriented / 175 unoriented). The kappa index values for oriented/unoriented OLGA 0/I/II/III and IV stages have been 0.62/0.13, 0.70/0.20, 0.61/0.06, 0.62/0.46, and 0.77/0.50, respectively. For OLGIM 0/I/II/III stages the kappa index values for oriented/unoriented samples were 0.83/0.83, 0.88/0.89, 0.70/0.88 and 0.83/1, respectively. No case of OLGIM IV stage was found in the present case series. Good quality histopathology specimens were described in 95.43% of the oriented biopsy samples, and in 89.14% of the unoriented biopsy samples, respectively (p=0.0275). Conclusion: The orientation of gastric biopsies specimens improves the inter-observer agreement for the assessment of gastric atrophy. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 76-year-old female patient who was diagnosed with rectal tumour that feature a solid pseudopapillary neoplasm (SPN) after being admitted to a hospital for constipation and bloody stools. It discusses SPNs which were encountered especially by young women wherein the disease's frequency increases based on the patient's age.

The article presents the case study of the 26-year-old male patient who was presented to the clinic due to abdominal pain, weight loss, palor, faeces incontinence, bloody stool due to ulcerative colitis caused by severe cytomegalovirus.

Introduction: Neuroendocrine tumors are derived from cells that have the unique ability to synthesize, store and secrete a variety of metabolically active substances, peptides and amines, characteristic of the tissue of origin, which can cause distinct clinical syndromes. Material and methods: We present the case of a 58-year-old patient diagnosed and surgically treated in January 1996 for stage III inferior rectal cancer, who was readmitted after 18 years presenting persistent diarrheic syndrome and asthenia. Investigations performed (abdominal CT) showed multiple liver metastases, initially suspected as being related to the rectal cancer. Biopsy of liver metastases and pathological and immunohistochemical analysis demonstrated the neuroendocrine origin (moderately differentiated neuroendocrine tumor). Seven months after the identification of liver metastases and after initiation of oncological therapy with Interferon and Somatostatin, the patient presented severe hypoglycemia (serum glucose 13-70 mg/dl) proved to be due to insulin-like factors (serum insulin level 64.9 μU/ml) secreted by metastases. Due to the aggressive evolution of neuroendocrine tumor, with multiple episodes of severe hypoglycemia, resistant to treatment, the patient died approximately one month after the occurrence of hypoglycemic episodes. Conclusions: Despite comprehensive tests (abdominal CT scan, colonoscopy, bone scintigraphy and PET/CT), the primary site of the neuroendocrine tumors remained unknown. [ABSTRACT FROM AUTHOR]

Microscopic colitis has emerged as a major cause of chronic watery non-bloody diarrhoea, particularly in elderly females. The term is used as an umbrella term to categorize a subgroup of colitides with distinct clinicopathological phenotypes and no significant endoscopic abnormalities. Lymphocytic colitis is defined by an increased number of surface intraepithelial lymphocytes, and collagenous colitis by a thickened collagen band underneath the surface epithelium. There is increased inflammation in the lamina propria, but only little or no crypt architectural distortion. Incomplete and variant forms showing less characteristic features have been reported under different names. The differential diagnosis mainly includes resolving infectious colitis and changes related to the intake of drugs such as non-steroidal anti-inflammatory drugs. Substantial clinical and histological overlap between lymphocytic and collagenous colitis has been described, raising the suspicion that the conditions are two histological manifestations of the same entity, possibly representing different manifestations during the disease course or different stages of disease development. In this review, we provide a practical approach for pathologists, with a focus on diagnostic criteria and differential diagnosis, and discuss recent insights into the pathogenesis of disease and the relationship with classic chronic inflammatory bowel disease, i.e. Crohn's disease and ulcerative colitis. [ABSTRACT FROM AUTHOR]

Intestinal strictures are an important complication of Crohn's disease (CD), with ~40% of patients developing symptomatic obstruction within 10 years of diagnosis. However, there is a paucity of research examining the mechanisms driving the development of fibrotic strictures in CD. The present study aimed to identify the mucosal markers associated with stricturing complications by examining the differences in the gene expression profiles of two patient cohorts: Patients diagnosed with inflammatory CD (n=12) and patients with stricturing CD (n=9). For each patient, a paired sample of inflamed and uninflamed mucosa was isolated and assessed by quantitative PCR using a large panel of genes associated with inflammatory bowel disease. The presents study revealed a significantly increased level of four genes in the mucosa of patients with strictures compared with the inflammatory pattern of the disease: Formyl-peptide receptor 1 [P=0.019; fold change (FC)=11.6], C-C chemokine receptor type 1 (P=0.035; FC=5.44), IFN-γ-inducible protein 10 (P=0.037; FC=3.8) and C-C chemokine ligand 25 (P=0.048; FC=3.56). The augmented expression of these four genes in the CD stricturing phenotype, if confirmed in larger cohorts of patients, could help elucidate the mechanisms leading to disease-associated complications. [ABSTRACT FROM AUTHOR]

Aim: We evaluated the influence of the type of needle and the operator's experience on the quality of the specimen obtained at liver biopsy (LB). Material and method: We performed a multicentre, prospective study in four university hospitals, including LBs performed using either 'cutting' (TruCut) or 'suction' (Menghini) needles. According to their experience, we considered the operators as 'junior' (<100 LBs) or 'senior' (>100 LBs). Results: A total number of 745 LBs were evaluated, 413 performed with suction needles and 332 with cutting needles. Of all LBs, 473 where performed by 'senior' and 272 by 'junior' operators. The mean length of the fragment obtained was larger in LBs performed by senior (23.5±11.6 mm) vs. junior operators (15.9±9.8 mm, p<0.001) and also if modified Menghini needles were used (23.7±12.1 mm) vs. TruCut (13.0±5.2 mm, p<0.001). The number of portal tracts (PT) was higher in LBs performed by 'senior' (14.3±8.8 PT) vs. 'junior' operators (8.8±6.8 PT, p<0.001); and with Menghini needles (17.2±9.7 PT) vs. TruCut (8.6±5.0 PT, p<0.001). Conclusion: Our study demonstrates that optimal biopsy samples are obtained by two intrahepatic passages with Menghini needles and that 'senior' operators obtain better tissue samples than 'junior' ones. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is a leading cause of death from cancer all over the world, and its incidence is expected to rise further in coming years. In this study we aimed to measure the degree of epidemiological association by determining the frequency of risk factors in the test group and control group, and by determining the strength of the epidemiological association between risk factors studied and presence of HCC. Hepatitis B and C virus (HBV, HCV), alcohol and tobacco are major risk factors involved in the pathogenesis of hepatocellular carcinoma. The risk of developing hepatocellular carcinoma increases with the amount of alcohol and tobacco consumed daily. The prevention of transmission of viral hepatitis is the most important strategy to reduce the risk of developing HCC, but also the health education regarding risk factors such as smoking or alcohol consumption. [ABSTRACT FROM AUTHOR]

Aim: This is a retrospective study of patients with advanced biliary tract carcinoma (BTC), who were treated with different regimens of chemotherapy. Methods: We studied patients with advanced BTC registered at the Department of Oncology at the Fundeni Clinical Institute between 2004 and 2008. The following data were analyzed: rate of response, progression free survival (PFS) to first and second line of chemotherapy, overall survival (OS) and drug toxicity. Ninety-six patients were eligible having either advanced intra or extrahepatic cholangiocarcinoma, or gallbladder cancer with no prior chemotherapy. Results: Out of 96 patients, 57 (59.4%) received fluoropyrimidines (FP)+cisplatin and 39 (40.6%) gemcitabine (Gem)+/-cisplatin. The median PFS for FP+cisplatin was 5.9 months (95%CI 5-6.9) and for Gem+/-cisplatin 6.3 months (95%CI 5.4-7.1), p=0.661. Median OS for FP+cisplatin was 10.3 months (95%CI 7.5-13.1) and for Gem+/-cisplatin 9.1 months (95%CI 7.0-11.2), p=0.098. On disease progression, 46 patients received second line CT (Gem or FP+/-platinum compounds). Median OS for patients with FP based first line and Gem+/-cisplatin in second line was 19 months (95%CI 8.9-29) higher than for the reverse sequence: 13.2 months (95%CI 12-14.4), but not statistically significant (p=0.830). All patients were evaluated for toxicities. Most patients (75.5%) reported at least one adverse event. Conclusion: Our results through direct comparison of FP+cisplatin with Gem+/-cisplatin as first line treatment did not show any statistical differences in terms of rate of response, PFS and OS. However, our study showed that FP+cisplatin as first line and Gem based second line therapy gave a better OS rate. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is a leading cause of death from cancer all over the world, and its incidence is expected to rise further in coming years. In this study we aimed to measure the degree of epidemiological association by determining the frequency of risk factors in the test group and control group, and by determining the strength of the epidemiological association between risk factors studied and presence of HCC. Hepatitis B and C virus (HBV, HCV), alcohol and tobacco are major risk factors involved in the pathogenesis of hepatocellular carcinoma. The risk of developing hepatocellular carcinoma increases with the amount of alcohol and tobacco consumed daily. The prevention of transmission of viral hepatitis is the most important strategy to reduce the risk of developing HCC, but also the health education regarding risk factors such as smoking or alcohol consumption. [ABSTRACT FROM AUTHOR]

The assessment of tissue healing has emerged as an important treatment goal in patients with inflammatory bowel disease. In patients with ulcerative colitis (UC), mucosal healing may represent the ultimate therapeutic goal due to the fact that the inflammation is limited to the mucosal layer. Mucosal and histological healing may indicate a subset of UC patients in long-term clinical, endoscopic and histological remission in whom immunomodulators, biologics, and even aminosalicylates may be withdrawn. Confocal laser endomicroscopy allows the assessment of residual cellular inflammation, crypt and vessel architecture distortion during ongoing endoscopy, and therefore permits a real-time evaluation of histological healing in patients with ulcerative proctitis. Images of conventional optical microscopy and confocal laser endomicroscopy in patients with ulcerative proctitis in remission are presented. [ABSTRACT FROM AUTHOR]

Background: Loss of genomic stability appears as a key step in colorectal carcinogenesis. Micronucleus (MN) designates a chromosome fragment or an entire chromosme which lags behind mitosis. MN may be noticed as an additional nucleus within the cytoplasm cell during the intermediate mitosis phases. We tested the hypothesis that MN and its related anomalies may be associated with the presence of neoplastic colorectal lesions. Method: Peripheral blood lymphocytes were cultured and microscopically examined. The frequency of micronuclei (FMN) and the presence of nucleoplasmic bridges (NPB) in binucleated cells were compared in patients with of without colorectal neoplastic lesions. Results: We included 45 patients undergoing colonoscopy, 23 males and 22 females, with a median age of 59. 17 patients had polyps, 11 colorectal cancer (CRC) and 17 had a normal colonoscopy. The FMN was significantly higher in women than in men (8.14 vs 4.17, p=0.008); NPB were significantly less frequent in patients with advanced adenomas (>10mm or vilous) or CRC (p=0.044) when compared with patients with normal colonoscopy, hiperplastic polyps or non-advanced adenomas. Conclusion: Micronuclei are more frequent in women, but its frequency was not significantly different in patients with advanced adenomas or CRC. Null or low frequency values for nucleoplasmic bridges presence in peripheral lymphocyte may be predictive for advanced adenomas and colorectal cancer. [ABSTRACT FROM AUTHOR]

Background: Small nodules (<3 cm) detected on ultrasound (US) in cirrhotics represent the most challenging category for noninvasive diagnosis of hepatocellular carcinoma (HCC). Aim: To evaluate real-time sonoelastography as a noninvasive tool for the diagnosis of small HCC nodules in cirrhotic patients. Methods: 42 cirrhotic patients with 58 nodules (1-3 cm) were evaluated with real-time elastography (Hitachi EUB-6500); the mean intensity of colors red, blue, green were measured using a semi-quantitative method. Analysis of histograms for each color of the sonoelastography images was performed for quantifying the elasticity of nodule tissue in comparison with the cirrhotic liver tissue. AUROC curves were constructed to define the best cut-off points to distinguish malignant features of the nodules. Univariate and multivariate logistic regression analysis was performed. Results: 595 sonoelastography images from 42 patients (25 men; 17 women) were analyzed. The mean age was 56.4±10.7 years and 69% patients were in Child-Pugh class A, 19% class B, 11% class C. For the mean intensity of green color AUROC=0.81, a cut-off value of <108.7 being diagnostic for HCC with a Sp=91.1%, Se=50%, PPV=92.1%, NPV=47.1%. Mean intensity of blue color proved to be an excellent diagnostic tool for HCC (AUROC=0.94); for a cut-off value>128.9, Sp=92.2%, Se=78.9%, PPV=95.4%, NPV=68%. Independent predictive factors of HCC for a small nodule in cirrhotic patients were: blue color>128.9 at sonoelastography and hypervascular appearance at Doppler US. Conclusions: US elastography is a promising method for the non-invasive diagnosis of early HCC. Blue color at elastography and hypervascular aspects are independent predictors of HCC. [ABSTRACT FROM AUTHOR]

Somatostatinomas are rare neuroendocrine tumors (NET) that arise in the gastrointestinal (GI) tract. Because of their insidious growth, they are usually asymptomatic until late stages, presenting as malignant disease. We report the case of a 50-year-old woman who presented with epigastric abdominal pain, diarrhea and significant weight loss in the last two years. On clinical examination the patient met the criteria for neurofibromatosis type 1 (NF1). Abdominal CT and MRI revealed an infiltrative duodenal mass, with pancreatic invasion, locoregional enlarged lymph nodes and disseminated hepatic nodules. Microscopy and immunohistochemistry uncovered a neuroendocrine tumor, staining positive for chromogranin A (CgA), synaptophysin and somatostatin, with a Ki67 = 1%. Somatostatin receptors (SSTRs) type 2 were negative and SSTRs type 5 were positive in less than 50% of tumoral cells. Our patient was classified as a T3N1M1 stage IV metastatic duodenal grade 1 somatostatinoma and treatment with somatostatin analogues and chemotherapy with capecitabine and temozolomide was started, with so far abdominal imaging follow-up showing stable disease. When a patient is diagnosed with a rare NET, such as a somatostatinoma, it is of utmost importance to determine if it is a sporadic tumor or just a feature of a genetic disorder. [ABSTRACT FROM AUTHOR]

A quiz concerning gastroentrology is presented.

Pegylated interferon-alpha in combination with ribavirin currently represents the therapeutic standard for the hepatitis C virus infection. Interferon based therapy may be responsible for many cutaneous side effects. We report a case of drug-induced Sweet's syndrome secondary to hepatitis C antiviral therapy. To our knowledge, this is the first reported case of Sweet's syndrome in association with pegylated interferon-alpha therapy. [ABSTRACT FROM AUTHOR]

Background. Bevacizumab (Bev) is approved in Europe and USA in combination with chemotherapy (CTH) based on fluoropirimidine (FP) in the treatment of adult patients with metastatic colorectal cancer (mCRC) in the first line of therapy, as maintenance treatment, postprogression, and in the second line of therapy. It was performed a retrospective analysis on mCRC patients treated with CTH + Bev in succesive lines in the Medical Oncology Department of the Fundeni Clinical Institute, Bucharest. Method. We collected demografic and clinical data: the disease stage at diagnosis, histopathology data, duration and CTH line, grade 3/4 adverse events, response rate (RR), progression-free survival (PFS), and overall survival (OS). Between August 2007 and December 2018 there had been treated with Bev 516 patients. At 3-6 months from the diagnosis, 384 patients (67.4%) presented synchronous metastases and 168 patients (32.6%) presented metachronous metastases. Results. A total of 358 patients (69.2%) received Bev in the first line of the treatment, of which 260 patients (72.6%) received FP + oxaliplatin (OX): FOLFOX/CAPOX, and 86 patients (24%) received FP + irinotecan(IRI): FOLFIRI/ CAPIRI. Four patients received FOLFOXIRI in the first line, and eight patients received only FP. As maintenance therapy, it was administered Bev/Bev+FP in 88 patients (79.3%) in the OX group and in 20 patients (18%) in the IRI group. A total of 128 patients (35.8%) received Bev beyond progression, of which 99 patients (79.8%) in the OX group and 22 patients (17.7%) in the IRI group; 137 patients (38.3%) received subsequent therapy lines after Bev failure. The medium chemotherapy duration for patients who received OX was 9.9 months (95% CI; 8.67-11.18), and 9.2 months (95% CI; 6.72-11.62) for those who received IRI. A total of 219 patients presented a therapy response, with a RR of 75.34% on OX, and a RR of 24.65% on IRI. The median PFS was 8.12 months (95% CI; 6.89-9.35) for OX and 8.35 months (95% CI; 6.6-10.1) for IRI, with p=0.034. The median OS was 17.03 months (95% CI; 14.66-19.40) for OX and 18.87 months (95% CI; 15.28-22.46) for IRI, with p=0.900. Conclusions. In our experience, Bev-OX had a similar efficacy as Bev-IRI regarding both PFS and OS, but with a higher response rate for those treated with OX. [ABSTRACT FROM AUTHOR]

Primary sclerosing cholangitis is a progressive liver disease characterized by chronic inflammation leading to liver fibrosis and cirrhosis. Even though the exact pathogenesis is still unclear, a combination of autoimmune, environmental, and ischemic factors could explain certain aspects of the disease. The most important diagnostic step is cholangiography, which can be obtained either by endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiography (MRCP as the gold standard), or percutaneous transhepatic cholangiography. It shows multifocal short biliary duct strictures leading to the "beaded" aspect. Cholangiocarcinoma and colorectal adenocarcinoma are the most feared complications in patients with Primary sclerosing cholangitis (PSC). Continuous screening consists of annual clinical, biochemical, and ultrasound assessments in asymptomatic patients and annual colonoscopy in patients with PSC and inflammatory bowel disease. In newly diagnosed patients with PSC, colonoscopy is mandatory and, if negative, then, a repeat colonoscopy should be performed in 3–5 years. The lack of efficient curative medical treatment makes invasive treatments such as liver transplant and endoscopy the mainstream for managing PSC and its complications. Until now, even though only ursodeoxycholic acid has shown a moderate clinical, biochemical, and even histological improvement, it has no significant influence on the risk of cholangiocarcinoma, liver transplant need, or death risk and it is no longer recommended in treating early PSC. Further studies are in progress to establish the effect of molecular-targeted therapies in PSC. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 19-year-old male who was diagnosed with Ménétrier's disease. Topics discussed include the correlation of helicobacter pylori (HP) or cytomegalovirus (CMV) infection to the disease, epidermal growth factor receptor (EGFR), and administration of transforming growth factor-α (TGF). Information regarding the efficacy of cetuximab monoclonal antibody to the disease.