Colonic diverticular bleeding: An update on pathogenesis and management.

Colonic diverticular bleeding is the most common cause of lower gastrointestinal (GI) bleeding, which can be life-threatening and frequently recurrent. In recent years, the prevalence of diverticulosis has increased in developed countries, with a documented incidence of 50% in patients older than 60 years. Based on the evidence, the use of anticoagulants and/or antiplatelets in the elderly population has resulted in an increased incidence of acute diverticular bleeding. According to the literature, about 50% of patients with diverticular bleeding require a blood transfusion, and 18% - 53% need emergency surgery. Although endoscopic identification of the culprit diverticula and appropriate intervention is a challenge, the newer treatment modality, over-the-scope clip method (OTSC) has been demonstrated to be an effective endoscopic hemostatic method in severe diverticular bleeding, especially in cases of rebleeding after first-line conventional endoscopic procedures. In this review, we summarize the pathophysiology of colonic diverticulosis and diverticular bleeding, recent evidence in its management, and existing theories on various preventive strategies to control diverticular bleeding. We also discuss the efficacy and treatment outcome of the OTSC technique in controlling diverticular bleeding.

Gastrointestinal Microbiota and Breast Cancer Chemotherapy Interactions: A Systematic Review.

Breast cancer is the most common type of cancer in women besides basal cell and squamous cell skin cancer. The current systemic therapy guidelines for this heterogeneous disease are mainly based on the molecular subtypes. However, more research is required to improve rates of therapy resistance and prevent side effects. Previous studies have shown that the human gut microbiota may have an important role in carcinogenesis as well as therapy outcomes, but this factor has not yet been integrated into therapy protocols. This systematic review aims to analyze how response rates and side effect profiles of breast cancer systemic therapies may be affected by the gastrointestinal microbiota. A literature search was performed using multiple databases and keywords related to gastrointestinal microbiota, breast cancer, and anticancer drugs. Studies were excluded if they primarily focused on diseases other than breast cancer. Abstracts, reviews, meta-analyses, and animal experiments were also excluded. After screening, nine studies met all selection criteria and included a total of 566 participants. Most studies described the impact of the gut microbiota on therapy response, but a few additionally discussed chemotherapy side effects, probiotics, or antibiotics. In general, diversity and specific microbiota were linked to chemotherapy response as well as prognosis. Microbiota diversity was also predictive of side effects such as neurological symptoms, weight gain, and constipation. The diversity and composition of gastrointestinal microbiota may serve as biomarkers and provide pathways for the optimization of chemotherapy in breast cancer patients.