Overlap of GERD and gastrointestinal functional disorders.

The functional gastrointestinal disorders (FGIDs) are common conditions with an overall prevalence burden estimated at approximately one-third of the population. These represent a heterogeneous group of conditions which may include both abnormal symptom perception and functional causes and seems to share similar trigger factors as food, lifestyle and psychological factor. GERD develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms, with or without mucosal involvement. Functional heartburn (FH) represents a subcategory of patients who refers with heartburn but without abnormal esophageal acid exposure, abnormal number of reflux events or any temporal correlation between symptoms and reflux events, on the same hands these patients do not report any symptom relief during antisecretory treatment with proton pump inhibitors. To date, several studies have reported a certain degree of overlap between GERD and FGIDs that it is only partially explained solely by chance. This review evaluated the overlap between GERD but especially FH and different FGIDs as: functional non-cardiac chest pain, irritable bowel syndrome, functional dyspepsia, gastric belching and supragastric belching and pharyngeal globus. A large number of mechanisms have been proposed to elucidate the connection between these numerous conditions. When pathophysiologic tests to subgroup GERD have been performed, FH seems overlap more frequently than GERD with FGIDs. From a therapeutic point of view visceral hypersensitivity, that characterize these functional disorders might be modulated by antidepressant therapy even if there are limited evidences. More studies and especially randomized controlled trials should consider these agents for future agenda researches.

Transarterial chemoembolization for the treatment of hepatocellular carcinoma: a review.

According to the current European Association for the Study of Liver guidelines, transarterial chemoembolization (TACE) is the recommended first-line therapy for patients with intermediate-stage (Barcelona Clinic Liver Cancer-B class) hepatocellular carcinoma (HCC). The efficacy of this therapy is supported by robust evidence; however, there is still a lack of standardization in treatment methodology, and TACE protocols are widely variable. Moreover, TACE can be associated with a number of contraindications. Despite these limitations, research on TACE is still ongoing with the aim of optimizing the use of this methodology in the current management of HCC. In particular, TACE represents a control in comparative studies, and it is currently being investigated in combination schemes, for example, with sorafenib. In this review, we briefly describe the current scenario and the clinical innovations regarding TACE for the treatment of HCC.

Subthreshold Psychiatric Psychopathology in Functional Gastrointestinal Disorders: Can It Be the Bridge between Gastroenterology and Psychiatry?

BACKGROUND AND AIMS: Functional gastrointestinal disorders (FGDs) are multifactorial disorders of the gut-brain interaction. This study investigated the prevalence of Axis I and spectrum disorders in patients with FGD and established the link between FGDs and psychopathological dimensions. METHODS: A total of 135 consecutive patients with FGD were enrolled. The symptoms' severity was evaluated using questionnaires, while the psychiatric evaluation by clinical interviews established the presence/absence of mental (Diagnostic and Statistical Manual-4th edition, Axis I Diagnosis) or spectrum disorders. RESULTS: Of the 135 patients, 42 (32.3%) had functional dyspepsia, 52 (40.0%) had irritable bowel syndrome, 21 (16.2%) had functional bloating, and 20 (15.4%) had functional constipation. At least one psychiatric disorder was present in 46.9% of the patients, while a suprathreshold panic spectrum was present in 26.2%. Functional constipation was associated with depressive disorders (p < 0.05), while functional dyspepsia was related to the current major depressive episode (p < 0.05). Obsessive-compulsive spectrum was correlated with the presence of functional constipation and irritable bowel syndrome (p < 0.05). CONCLUSION: The high prevalence of subthreshold psychiatric symptomatology in patients with FGD, which is likely to influence the expression of gastrointestinal symptoms, suggested the usefulness of psychological evaluation in patients with FGDs.