Antonio Continisio

Fecal microbiota transplantation (FMT) is a therapeutic strategy designed to modify and enrich the recipient’s gut microbiota by administering processed donor stool, with the goal of treating dysbiosis and related conditions. In 2013, the United States Food and Drug Administration (FDA) approved FMT for recurrent Clostridioides difficile infection (rCDI). Since then, its use has been proposed and investigated in several other disorders characterized by gut microbiota imbalance and altered host–microbiota interactions, including inflammatory bowel disease (IBD), immune checkpoint inhibitor-induced colitis (ICI-iC), and gastrointestinal graft-versus-host disease (GI-GVHD). This review aims to highlight the commonalities among these conditions, the pathophysiological mechanisms that support the rationale for FMT, and emerging evidence from clinical studies. Although available studies are heterogeneous, FMT is a rapidly evolving field of research with promising potential to treat IBD and improve outcomes following oncological immunotherapy and allogenic stem cell transplantation. With further validation, FMT could become an important approach in managing immune-mediated gastrointestinal diseases.

Background: Transient elastography (TE), using Fibroscan^® and point shear wave elastography (pSWE), are two techniques used to estimate liver fibrosis. The aim of our study was to compare, for the first time, these two techniques in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), stratifying the analysis on the basis of the grades of steatosis. Methods: We recruited 85 consecutive MAFLD patients who underwent liver stiffness (LS) measurement performed by Fibroscan^® and pSWE on the same day. Severity of steatosis was estimated by Fibroscan^® and expressed as controlled attenuation parameter (CAP), ranging from S0 to S3. Spearman’s “r” coefficient was used to calculate the correlation and Bland–Altman graphs was used to evaluate the agreement. Results: In general, the correlation and agreement between Fibroscan^® and pSWE were substantial (r = 0.66, p < 0.001 and bias= −0.64 ± 2.48, respectively). When data were analyzed according to the grade of steatosis, an increasing significant correlation was observed going from S0 to S2 (r = 0.79, r = 0.81, and r = 0.85, respectively), whereas a low correlation and agreement were observed for S3 patients (r = 0.48, p = 0.003, bias= −0.95 ± 2.51). Conclusions: Fibroscan^® and pSWE are equivalent techniques to estimate liver fibrosis in patients with mild to moderate steatosis, while in presence of severe steatosis their agreement is low.

Background/Objectives. Nutrition therapy for diseased patients should satisfy patients’ nutritional needs and address the specific disease-related requirements. This study evaluated the prevalence and appropriateness of artificial nutrition (AN) prescriptions at University Hospital. Methods. On a single day, a multidisciplinary team of physicians and dietitians with specialized training in clinical nutrition assessed patients receiving AN. Except for ICU patients, caloric requirements calculations were performed using BMI-specific predictive formulas adjusted with a metabolic stress factor ac-cording to clinical condition. Results. Among 578 hospitalized patients from 36 different wards, 9.7% (30/26 males/females; mean age 67.1 ± 11.6 years) were receiving AN (39 total parenteral nutrition [TPN], 16 enteral nutrition [EN], and 1 enteral plus supportive parenteral nutrition [SPN]). The most common primary diagnoses were cancer (21.4%) and respiratory failure (17.8%). Only four patients were hospitalized for primary malnutrition. The median time to initiate AN after the hospital admission was 3 days (IQR 0-13.5 days). Only 10 patients with a peripheral implanted central catheter (PICC) met the proper caloric intake, and only 5 of them received an adequate protein intake (≥1 g/kg body weight). Among patients receiving EN, 11 were allocated to ICU, and their caloric intake was 6-12 kcal/kg b.w., while protein intake was 0.44 ± 0.16 g/kg b.w. Conclu-sions. The findings highlight significant gaps in the clinical application of nutrition support, in-cluding delayed initiation, underdosing, and variability across patient groups. These issues demonstrate the necessity of improved nutritional screening, earlier intervention, and greater in-volvement of trained nutrition professionals in hospital care pathways.