[Clostridium difficile infection and chronic inflammatory bowel disease.].

Patients with IBD are at increased risk of developing Clostridium difficile (CD) infection and have worse outcomes, including higher rates of colectomy and death, and experience higher rates of recurrence. However, it is still not clear whether CD is a cause of IBD or a consequence of the inflammatory state and of intestinal dysbiosis. The association between IBD and CD may be due to different factors, such as drugs that are used for the treatment of IBD, including repeat courses of antibiotics, that might alter the intestinal flora and promote colonization, altered immune and nutritional status, frequent hospitalizations, and even genetic predisposition.

[Probiotics for the antibiotics associated diarrhea and for Clostridium difficile infection.].

The term probiotic refers to live microorganisms that survive passage through the gastrointestinal tract and have beneficial effects on the host. Many strains of probiotic microorganisms have been shown to inhibit growth and metabolic activity as well as the adhesion to intestinal cells of enteropathogenic bacteria, to modulate the gut microbiota and to have immunostimulatory or regulatory properties. The use of probiotic microorganisms for the prevention and the treatment of Antibiotic Associated Diarrhea is an obvious measure and perhaps the most usual application of probiotics.

[Side effects of antibiotic: diarrhea and Clostridium difficile infection.].

Antibiotics are some of the most frequently prescribed medications worldwide, but antibiotic therapy may disturb the colonization resistance of gut microbiota to pathogenic bacteria, resulting in a range of symptoms that include, most notably, diarrhea that occurs between 7% and 33% of adults and 66 and 80% in pediatric patients (median of 22%) who take antibiotics. The diverse class of antibiotics may damage the metabolic homeostasis and can alter the level of intestinal metabolites including amino acids, bile acids, glucose, short chain fatty acids through alteration in abundance of metabolically active bacteria. Clostridium difficile is the main cause of antibiotics associated diarrhea: 3rd generation Cephalosporin, Clyndamicin, 2nd and 4th generation Cephalosporines, Sulfamethoxazole-trimethoprim, Quinolones, Penicillin combination show the strongest association with diarrhea.

["Probiotic medicine" and certainty of the evidence.].

These are excellent times for probiotic medicine. We have discovered more than 150,000 genomes of the microbiome, which can be aggregated into 4,930 species. However, the dream of microbiome-based medicine requires a new approach - an ecological and evolutionary understanding of host-microbe interactions, rather than a qualitative analysis of species.

[2020: Evidence-Based Medicine odyssey. The fall and rise of evidence-based medicine in the year of coronavirus.].

It was a very dark year for EBM. One of the side effects of the Covid-19 pandemic is a severe compression of the evidences. Here are some worrying events.

[Clinical outcomes and hospital costs of hepatic encephalopathy: an analysis of "real life" data from Marche Region.].

Hepatic encephalopathy (HE) describes a spectrum of potentially reversible neuropsychiatric changes observed in patients with hepatic dysfunction and/or portosystemic shunt. The aim of this study is to compare data from clinical trials and observational studies with Italian real-world (RW) data as for clinical outcomes; other aim is to evaluate economic burden of hepatic encephalopathy related to hospitalization for overt HE. The work is based on data from the Health Information Systems (SIS) of Marche Region, Italy (about 1.

[Revival of evidence-based medicine in gastroenterology.].

The evidence-based medicine (EBM) in gastroenterology is born with the XIII International Congress of Gastroenterology, the world congress of Gastroenterology, held in Rome in 1988. A clinical epidemiology manual was placed in the congress bag for each participant. The book contained an approach to biostatistics, interpretation of epidemiological data, clinical trials, meta-analysis and decision analysis.

Probiotics and Evidence-based Medicine: To All Involved: We have a Problem.

The methods used to discern the structure (anatomy) and function (physiology) of the indigenous microbiota can be divided according to which aspect of the microbiota they can interrogate and are positioned accordingly. At the most basic level, methods can simply describe the community structure of the microbiota, that is, which taxa are present and in what relative amounts. Methods that investigate functional potential generally catalog the coding potential of individual members of the microbiota or the entire community (the metagenome).

[Burden of diverticular disease: an observational analysis based on Italian real-world data.].

Introduction: Diverticular disease (DD) represent a wide variety of conditions associated with the presence of diverticula in the colon. The most serious form is an acute episode of diverticulitis which can lead to hospitalization and surgery with various types of consequences. The main aim of this study was to evaluate, from both cross-sectional and longitudinal perspective, the economic burden of diverticulitis in the real practice.

[Promoting evidence-based gastroenterology: back to the future.].

Evidence-based medicine continues to thrive thanks to the publication of a considerable amount of papers focusing on data collection and sharing. Assessment of the accuracy of diagnostic tests still remains highly deficient, often leading to inappropriate clinical decision-making. Like most other doctors, gastroenterologists as well have to face the ever-growing availability of complex and expensive exams, being charged with the task of choosing the best diagnostic option and interpreting test results.

Gut Microbiota and the Liver: A Tale of 2 Cities: A Narrative View in 2 Acts.

Microbes are mostly important for the digestion of food, the absorption of some micronutrients, and the production of vitamins. The microbiota stimulates lymphoid structures in the gastrointestinal mucosa and decrease pathogens by competing for nutrients and space. Bacterial translocation is defined as the escape of gut bacteria and their products through the intestinal mucosa to the outside of the intestine as portovenous or systemic circulation.

[Epatology towards 2020].

Research in hepatology is booming. The spectrum of liver disease is very extensive. The recent advances in antiviral therapy have dramatically changed the clinical course of the diseases.

[Diverticular disease: towards 2020. An evidence-based approach].

Diverticular disease (DD) of the colon has an increasing burden on health service resources, in terms of hospital admissions, mortality and surgery rate. We present an overview of the clinical history of DD, and of the ways that gastroenterologists have to modify it. Prevalence of the disease increases with aging.

[Gastroenterology towards 2020].

Research in gastroenterology and hepatology is booming. The spectrum of digestive diseases is very extensive, and growing. This issue of the journal focuses on the near future of gastreonterology, and announces what changes should we expect between now and 2020.

[Environmental factors and clinical course of inflammatory bowel disease: which evidences?].

Identify environmental factors that can influence the course of inflammatory bowel disease (IBD) is of great interest since managing on these factors might improve the prognosis of patients. No environmental factor has been shown to have a linear cause-and-effect link with the relapse of the disease, but many environmental factors (smoking, diet, medications, stress, etc.) seem to play a plausible role in influencing the clinical course of IBD.

Pegylated interferon α plus ribavirin for the treatment of chronic hepatitis C: a multicentre independent study supported by the Italian Drug Agency.

Background: Data on the efficacy of Peg-interferon/ribavirin therapy for chronic hepatitis C are mostly derived from treatment of selected patients enrolled in clinical trials. This study aimed to assess the effectiveness of Peg-interferon/ribavirin therapy in "real world" chronic hepatitis C patients in Italy.

Methods: Independent observational multicentre study including consecutive patients receiving Peg-interferon/ribavirin in the 18 months before (retrospective phase) and after (prospective phase) the start of the study.

Predictors of favourable outcome in non-variceal upper gastrointestinal bleeding: implications for early discharge?

Background: There is a lack of validated predictors on which to decide the timing of discharge in patients already hospitalized for upper nonvariceal bleeding.

Aims: Identify factors that appear to protect nonvariceal bleeders from the development of negative outcome (rebleeding, surgery, death).

Methods: Secondary analysis of two prospective multicenter studies.

Predicting mortality in patients with in-hospital nonvariceal upper GI bleeding: a prospective, multicenter database study.

Background: Nonvariceal upper GI bleeding (NVUGIB) that occurs in patients already hospitalized for another condition is associated with increased mortality, but outcome predictors have not been consistently identified.

Objective: To assess clinical outcomes of NVUGIB and identify predictors of mortality from NVUGIB in patients with in-hospital bleeding compared with outpatients.

Design: Secondary analysis of prospectively collected data from 2 nationwide multicenter databases.

Neoadjuvant chemo-radiotherapy for patients with borderline resectable pancreatic cancer: a meta-analytical evaluation of prospective studies.

Context: For patients with borderline resectable pancreatic cancer, the benefit of neoadjuvant therapy remains to be defined.

Objective: We did a systematic search of the literature on this topic.

Methods: Prospective studies where chemotherapy with or without radiotherapy was given before surgery to patients with borderline resectable cancer, were analyzed by a meta-analytical approach.

[Prevention of post-operative recurrence in Crohn's disease: a critical review of randomized controlled trials and meta-analyses of different therapeutic strategies].

Surgery is an almost inevitable event in Crohn's disease but is not curative; post-operative recurrence follows a sequential and predictable course. Prevention of post-operative recurrence in Crohn's disease is therefore a relevant problem in the management of the disease. Several drugs have been evaluated to decrease the risk of recurrence: these include mesalazine, antibiotics, probiotics, budesonide, thiopurines and biologic agents.

Platelet count/spleen diameter ratio for non-invasive diagnosis of oesophageal varices: is it useful in compensated cirrhosis?

Aim: To assess the diagnostic accuracy of the platelet count/spleen diameter ratio for identification of oesophageal varices and/or hypertensive gastropathy in patients with compensated cirrhosis.

Methods: Platelet count/spleen diameter ratio was calculated in 87 consecutive patients with compensated cirrhosis. A new cut-off with the highest sensitivity and specificity for the presence/absence of oesophageal varices and/or hypertensive gastropathy was identified.

Neoadjuvant/preoperative gemcitabine for patients with localized pancreatic cancer: a meta-analysis of prospective studies.

Background: Long-term prognosis for localized pancreatic cancer remains poor. We sought to assess the benefit of neoadjuvant/preoperative chemotherapy with or without radiotherapy.

Methods: Prospective studies where gemcitabine with or without radiotherapy was provided before surgery in patients with initially resectable or unresectable disease were reviewed by meta-analysis.