Isadora Zanotelli Bombassaro

Background and Aims: Acute-on-chronic liver failure (ACLF) has been extensively studied in hospitalised patients, but its incidence and risk factors in outpatients remain poorly defined. This study evaluated the incidence and independent risk factors for ACLF in an outpatient cohort of individuals with cirrhosis. Methods: This is a prospective, multicenter cohort study, in which baseline data were collected at the first outpatient visit of individuals with cirrhosis, who were then followed until the development of ACLF or the competing outcomes (liver transplant or death). ACLF was defined according to the Chronic Liver Failure Consortium (CLIF-C) criteria. Cumulative incidence functions (CIFs) for ACLF were calculated, and multivariate analyses were performed using the Fine–Gray competing risk model to estimate subdistribution hazard ratios (HRs) and their 95% confidence intervals (CIs). Results: A total of 881 patients were included (78.1% - Child-Pugh A, 19.9% - Child-Pugh B, 2.0% - Child-Pugh C). Eight hundred and seven patients were actually followed, among which the cumulative incidence of ACLF in 12 months was 4.5% (n=36). Independent risk factors for ACLF at 12 months included lower levels of haemoglobin (HR=0.80; 95% CI=0.69–0.93, p=0.003) and albumin (HR=0.45; 95% CI=0.26–0.76, p=0.003), higher levels of creatinine (HR=1.44; 95% CI=1.08–1.91, p=0.013), and the presence of ascites (HR=2.12; 95% CI=1.03–4.33, p=0.040). Conclusions: The cumulative incidence of ACLF was low, likely reflecting the predominance of compensated cirrhosis at study entry. Baseline markers of anaemia and liver and kidney dysfunction were independently associated with the development of ACLF.

Gut microbiota dysbiosis has a critical role in the pathogenesis of inflammatory bowel diseases, prompting the exploration of novel therapeutic approaches like fecal microbiota transplantation, which involves the transfer of fecal microbiota from a healthy donor to a recipient with the aim of restoring a balanced microbial community and attenuating inflammation. Fecal microbiota transplantation may exert beneficial effects in inflammatory bowel disease through modulation of immune responses, restoration of mucosal barrier integrity, and alteration of microbial metabolites. It could alter disease course and prevent flares, although long-term durability and safety data are lacking. This review provides a summary of current evidence on fecal microbiota transplantation in inflammatory bowel disease management, focusing on its challenges, such as variability in donor selection criteria, standardization of transplant protocols, and long-term outcomes post-transplantation.

Background: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is recognized as a risk factor for interval cancer. Objective: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. Methods: We prospectively evaluated 479 polyps 30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. Conclusion: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.