https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/issue/feed Gastroenterology and Hepatology from Bed to Bench 2021-10-14T10:27:33+00:00 Mohammad Reza Zali ghfbb.journal@sbmu.ac.ir Open Journal Systems <p>GHFBB is the official journal of <a href="http://gldrc.sbmu.ac.ir/?siteid=136&amp;pageid=16100" target="_blank" rel="noopener">Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences</a>, Tehran, Iran.</p> https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2369 Co-morbidities associated with non-coeliac gluten sensitivity 2021-10-11T06:56:59+00:00 Geoffrey K Holmes geoffreyholmes31@gmail.com 2021-08-23T04:18:22+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2401 Virus in the pathogenesis of inflammatory bowel disease: role of Toll-like receptor 7/8/3 2021-10-11T07:12:48+00:00 Hamid Asadzadeh Aghdaei hamid.assadzadeh@gmail.com Negar Jamshidi negar.jamshidi20@yahoo.com Vahid Chaleshi chaleshi@gmail.com Nazanin Jamshidi nazaninjamshidi1991@gmail.com Amir Sadeghi ghfbb.journal@gmail.com Mohammad Reza Zali nnzali@hotmail.com <p>Inflammatory bowel disease (IBD) pathogenesis is influenced by immune system malfunction, particularly innate immune receptors such toll-like receptors. Furthermore, due to the extreme close association between viruses and IBD incidence, it is critical to further investigation between the virus and IBD. TLRs 3, 5, and 7 are three members of TLRs family that are involved in antiviral immune responses. Finding a relationship between TLR related virus and IBD is important not only for disease pathogenesis but also for therapeutic effectiveness. Furthermore, it has been shown that influenza expresses severe in patients with IBD who use immune system inhibitors, and the influenza vaccine is less effective in these patients. In dendritic cells, TLR7 and TLR8 regulate the production of interferons (IFNs) and inflammatory mediators. COVID-19 causes the production of IL-6, which could be due to the induction of TLR pathways. TLR activation by SARS-CoV-2 causes inflammation and IL-1 production, which induces IL-6 to be produced. Understanding the TLR associated viruses’ molecular mechanism can greatly help improve the quality of life of people with IBD. Therefore, the present study aimed to review the role of TLR7, 8 and 3 in inflammatory bowel disease, their association with viral infections and to evaluate different antagonists for the treatment of IBD.</p> 2021-08-23T04:27:04+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2282 Adult celiac disease with persistent IBS-type symptoms: a pilot study of an adjuvant FODMAP diet 2021-10-11T07:14:21+00:00 Nick Trott nick.trott@nhs.net Dr Anupam Rej anupam.rej@nhs.net Sarah Coleman shcoleman1@sheffield.ac.uk Professor David Sanders david.sanders1@nhs.net <p>Background and Aims</p> <p>Patients with biopsy proven adult celiac disease (CD) may have on-going gastrointestinal symptoms despite adherence to the gluten-free diet (GFD). Functional gut symptoms including Irritable Bowel Syndrome (IBS) is one cause of persisting symptoms in CD patients. This pilot study assessed the benefit of an adjuvant low FODMAP diet (LFD) in adult CD patients established on GFD who had a normal remission biopsy.</p> <p>Methods</p> <p>Twenty-five adult CD patients who were adherent to the GFD were recruited. These patients had histologically normal villi on their remission biopsy. A specialist dietitian then offered an adjuvant LFD. Symptom response was assessed using the Gastrointestinal Symptom Rating Scale (GSRS) from baseline to follow up.</p> <p>Results</p> <p>Of the 25 CD patients in remission with concurrent IBS 9 patients did not wish to pursue the LFD, 1 patient had incomplete data. Fifteen patients completed a minimum of four weeks on the LFD (mean age 44 ± 17.3; median duration of follow-up 7.2 years; range 43.2 years). Global symptom relief of gut symptoms was reported by 8/15 patients (53% <em>P</em> = 0.007). Significant reductions in abdominal pain (<em>P </em>&lt;0.01) distension (<em>P</em> &lt; 0.02) and flatulence (<em>P</em> &lt;0.01) were demonstrated.</p> <p>Conclusions</p> <p>This is the first study to demonstrate an adjunct LFD is an effective dietary treatment for concurrent IBS in adult CD patients with biopsy-confirmed remission. Such patients should be seen by a specialist dietitian to ensure nutritional adequacy and appropriate reintroduction of FODMAP containing foods.</p> 2021-08-23T04:31:01+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/1947 Determination of allograft fibrosis by measurement of liver stiffness using transient elastography in children after liver transplantation at Shiraz Organ Transplant Center 2021-10-14T06:45:25+00:00 Seyed Mohsen Dehghani ghfbb.journal@gmail.com Maryam Ataollahi ghfbb.journal@gmail.com seyyed Bozorgmehr Hedayati ghfbb.journal@gmail.com Fateme Parooie ghfbb.journal@gmail.com Iraj Shahramian ghfbb.journal@gmail.com <p><strong>Introduction:</strong> Liver stiffness (LS) assessment using fibro-scanning (transient elastography-TE) is a non-invasive method for the evaluation of liver fibrosis. The aim of this study was to determine allograft fibrosis by measuring LS using TE in children after liver transplantation at Shiraz Organ Transplant Center.</p> <p><strong>Methods:</strong> All children undergoing liver transplant from 2012 to 2016 were included in the study. Demographic data, graft type, immunosuppressive drugs, as well as clinical and paraclinical data were obtained from patients’ records. TE was performed to determine LS in all patients. Liver fibrosis was also confirmed based on Metavir score.</p> <p><strong>Results:</strong> During this period more than 400 liver Tx were done in children but just 54 were available and willing to this study .54 patients including 20 (37%) girls and 34 (63%) boys who underwent liver transplantation were studied. The mean age of the patients was 12.96 ±5.32 years. Correlations between FS score (LS) and AST (P = 0.01), total bilirubin (P = 0.002), albumin (P = 0.001), PT (P = 0.03), and INR (P = 0.001) were significant. There was no significant relationship between FS score (LS) and type of allograft (P = 0.79) and underlying disease (P = 0.36). Positive and significant correlations were observed between Metavir score and AST (P = 0.01), total bilirubin (P = 0.01), INR (P = 0.004) and cholesterol (P = 0.001). The severity of fibrosis significantly and negatively correlated with albumin (P = 0.004) and glucose (P = 0.003). Also, there was no significant relationship between Metavir score and allograft type (P = 0.7).</p> <p><strong>Conclusion:</strong> Our study demonstrated that 14.9% of LT patients had a METAVIR ≥ F2. The time between LT and TE was significantly correlated with LS, and the degree of liver fibrosis based on Metavir score. However, there was no significant relationship between LS with allograft type as well as underlying liver disease</p> 2021-08-23T04:39:09+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2250 Introducing physical exercise as a potential strategy in liver cancer prevention and development 2021-10-14T10:27:33+00:00 Mona Zamanian Azodi Mona.azodi@gmail.com Sakineh khatoon Hajisayah sk_sayah@sbmu.ac.ir Mohammadreza Razzaghi ghfbb.journal@gmail.com Mostafa Rezaei Tavirani tavirany@yahoo.com <p><strong>Background. </strong>There are many evidences about benefits of physical activity which are mostly related to the metabolism regulation and body health. Deeper investigation deals with other features of physical activity such as anticancer property.</p> <p><strong>Aim. </strong>In this study, anticancer property of physical activity investigates via network analysis in the trained rats.</p> <p><strong>Methods. </strong>To investigate proteome profile of rats’ liver subjected to physical activity via bioinformatics, protein-protein interaction network analysis was applied. For this reason, a number of 12 differentially expressed proteins were searched and analyzed by Cytoscape 3.7.2 and its plug-ins. The network was analyzed to identify hub-bottleneck nodes. The action map was constructed for the central proteins.</p> <p><strong>Results. </strong>The findings indicate that among the queried proteins, Eno1 and Pgm1 were only assigned as hubs by Network Analzyer. &nbsp;Gpi, Pkm, Aldoa, and Aldoart2 also were identified ad central nodes among the first neighbors of network elements. Furthermore, glycolytic process, carbohydrate catabolic process, and glucose metabolic process are the enrichment of key elements that could be imperative in the mechanism of exercise in liver function. Anticancer property of the central nodes was highlighted.</p> <p><strong>Conclusion. </strong>Our network findings point out the anticancer properties of physical activity, which was also supported by the previous investigations. &nbsp;&nbsp;</p> 2021-08-23T04:49:49+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2179 Effects of trichostatin A on the intrinsic and extrinsic apoptotic pathway, cell viability, and apoptosis induction in hepatocellular carcinoma cell lines 2021-10-11T07:39:14+00:00 Masumeh Sanaei msanaei86@gmail.com Fraidoon Kavoosi kavoosifraidoon@gmail.com <p><strong>Background: </strong>Modulation of the acetylation status of histones, histones modification, plays an important role in regulating gene transcription and expression. Histone deacetylation controlled by histone deacetylases (HDACs) leads to gene downregulation. Histone deacetylase inhibitors (HDACIs) are an emerging class of therapeutics with potential anticancer effects. They can induce apoptosis through the activation of both extrinsic and intrinsic apoptotic pathways. The current study was assigned to investigate the effect of trichostatin A (TSA) on mitochondrial/intrinsic [pro- (Bax, Bak, and Bim) and anti- (Bcl-2, Bcl-xL, and Mcl-1) apoptotic genes] and cytoplasmic/extrinsic (DR4, DR5, FAS, FAS-L, and TRAIL genes) pathways, histone deacetylase 1, 2, and 3, p53, p73, cell viability, and apoptosis in hepatocellular carcinoma (HCC) HCCLM3, MHCC97H, and MHCC97L cell lines. <strong>Methods:</strong> The HCCLM3, MHCC97H, and MHCC97L cells were cultured and treated with TSA. To determine viability, apoptosis, and the relative expression level of the mentioned genes, MTT assay, cell apoptosis assay, and qRT-PCR were done respectively. <strong>Results:</strong> TSA up-regulated the Bax, Bak, Bim, DR4, DR5, FAS, FAS-L, TRAIL, p53, and p73 and down-regulated Bcl-2, Bcl-xL, Mcl-1, histone deacetylases 1, 2, and 3 significantly resulting in apoptosis induction. Maximal and minimal apoptosis was seen in MHCC97H and HCCLM3 cell line (93.94 and 39.68 %) respectively after 24 and 48 h. Therefore, the MHCC97H cell line was more sensitive to TSA. <strong>Conclusion: </strong>Our findings demonstrated that HDAC inhibitor TSA can induce apoptosis and inhibit cell growth through both mitochondrial/intrinsic and cytoplasmic/extrinsic apoptotic pathways in hepatocellular carcinoma HCCLM3, MHCC97H, and MHCC97L cell lines.</p> 2021-08-23T04:53:36+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2269 Side effects of Omeprazole: a System Biology study 2021-10-14T06:54:37+00:00 Maryam Hamzeloo-Moghadam ghfbb.journal@gmail.com Mostafa Rezaei –Tavirani Tavirany@yahoo.com Somayeh Jahani-Sherafat ghfbb.journal@gmail.com Sina Rezaei Tavirani ghfbb.journal@gmail.com Somayeh Esmaeili ghfbb.journal@gmail.com Mojtaba Ansari ghfbb.journal@gmail.com Alireza Ahmadzadeh ghfbb.journal@gmail.com <p><strong>Background: </strong>Omeprazole as a proton pump inhibitor has a widespread consumption to inhibit gastric acid secretion. Assessment of omeprazole effects on human cardiovascular system is the main aim of this study.</p> <p><strong>Methods: </strong>Gene expression profiles of “human coronary artery endothelial cells” in the absence and presence of omeprazole is downloaded from gene expression omnibus (GEO). The differentially expressed genes (DEGs) are interacted as an interactome and the hub nodes are determined. The DEGs are enriched via gene ontology (GO) analysis. The critical hubs are identified based on GO finding.</p> <p><strong>Results:</strong> Among 103 queried DEGs 61 individuals were included in the main connected component. CTNNB1, HNRNPA1, SRSF4, TRA2A, SFPQ, and RBM5 genes are identified as critical hub genes. Six clusters of biological terms were introduced as deregulated elements in the presence of omeprazole.</p> <p><strong>Conclusion: </strong>In conclusion, long time consumption of omeprazole may be accompanied with undesirable effects, however more evidences are required.</p> 2021-08-23T05:00:45+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2256 Efficacy of levofloxacin, omeprazole, nitazoxanide, and doxycycline (LOAD) regimen compared with standard triple therapy to eradicate Helicobacter pylori infection: a prospective randomized study from a tertiary hospital in India 2021-10-11T07:49:56+00:00 HAMEED RAINA hameedraina49@gmail.com Rajesh Sainani rajesh45@gmail.com Arshed Parray arshid@gmail.com Abdul Haseeb Wani haseebwani21@gmail.com Umaymah Ashraf umaymah482@gmail.com Manzoor Ahmad Raina ghfbb.journal@gmail.com <p><strong>Introduction/Aim</strong>&nbsp; :&nbsp;</p> <p><em>Helicobacter pylorus</em> is a widespread infection in India. Resistance to commonly used antibiotics against <em>Helicobacter pylori</em> increases rapidly, leading to traditional triple therapy's lower success. So, a search for a new regimen is needed.</p> <p>In this study, we compared the efficacy of&nbsp; 14-day triple therapy with a novel ten-day LOAD regimen to eradicate <em>Helicobacter pylori</em> infection in India .</p> <p><strong>Methods:</strong></p> <p>&nbsp;In this randomized trial, patients with <em>Helicobacter pylori</em> infection were randomized to LOAD therapy (levofloxacin 250 mg OD, omeprazole 40 mg BD,&nbsp; nitazoxanide 500mg BD, and doxycycline&nbsp; 100 mg OD) for ten days and standard triple therapy ( pantoprazole 80 mg, amoxicillin 2000 mg, and clarithromycin 1000 mg daily in divided doses for 14 days ). Gastric biopsy/RUT&nbsp; was done 10–12 weeks after completing therapy to confirm <em>Helicobacter pylori</em> eradication.</p> <p><strong>Resul</strong>t :</p> <p>The eradication rates with LOAD regimen&nbsp; were significantly greater than with standard triple therapy on both intention-to-treat analysis (82.75 % vs. 60.26 %, p = 0.001; difference, 22.49 % [95 % CI, 8.5-18 %] and per-protocol analysis (83.3 % vs. 62.75 %, p = 0.002; difference, 20.55 % [95 % CI, 7.1-22.5 %]). Both the treatment regimens were well tolerated.</p> <p><strong>Conclusion </strong>:</p> <p>Although the rate of eradication of H. pylori infection with the LOAD regimen was significantly higher than that with triple therapy, the efficacy was still suboptimal. It may be due to fluoroquinolone resistance or a short course of treatment.</p> 2021-08-23T05:43:41+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2178 Candida colonization of the esophagus and gastric mucosa; a comparison of patients taking proton pump inhibitors and those taking histamine receptor antagonist drugs 2021-10-11T07:53:29+00:00 Batoul Mottaghi ghfbb.journal@gmail.com Mohammad Hassan Emami mh_emami@med.mui.ac.ir Padideh Riahi padid_r@yahoo.com Alireza Fahim fahimalireza@yahoo.com Hojjatolah Rahimi hrahimi1390@gmail.com Rasoul Mohammadi dr.rasoul_mohammadi@yahoo.com <p><strong>Aim: </strong>Investigation of <em>Candida</em> colonization of the esophagus and gastric mucosa in patients taking proton pump inhibitors in comparison to those taking histamine-2 receptor antagonists.</p> <p><strong>Background: </strong><em>Candida</em> species are normal flora of alimentary tract can cause infection of the esophagus and gastro-intestinal tract in immunocompromised patients. Consumption of proton pump inhibitors, and histamine-2 receptor antagonists have shown to alter the gastric pH which may predispose to floral transmission and colonization of the esophagus and stomach.</p> <p><strong>Patients and methods: </strong>Two hundred and forty-five clinical specimens were obtained from 91 patients underwent endoscopy from September 2019 to February 2020. Direct microscopy with KOH 10% and subculture on sabouraud dextrose agar containing chloramphenicol used as primary screening. PCR with ITS primers was performed to amplify ITS1-5.8SrDNA-ITS2 region and <em>Msp</em>I restriction enzyme used for RFLP to identify clinical isolates.</p> <p><strong>Results: </strong>Seventy cultures out of 245 specimens were positive for <em>Candida</em> colonization (28.5%). Colonization of <em>Candida</em> species in gastric acid and gastric tissue biopsies of patients who took PPIs and H2 blockers was significantly higher than those were in control group (<em>p = 0.001</em>). The use of ranitidine, pantoprazole and omeprazole increased the risk of gastric candidiasis by 10.60, 9.20, and 12.99 times, respectively (<em>p &lt; 0.05</em>).</p> <p><strong>Conclusion: </strong>The use of PPIs and H2 blockers, ageing, and consumption of vegetables were main risk factors for gastric infection in the present survey, and some other variables such as <em>Candida</em> species, cigarette smoking, drinking alcohol, etc. were not implicated in the development of gastroesophageal lesions. We need further investigations to know how these predisposing factors change the host defenses mechanisms and increase colonization of fungi at mucosal surfaces.</p> 2021-08-23T05:52:48+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/1915 Delayed dysphagia following foreign body swallowing: case report 2021-10-11T08:09:00+00:00 Gholam Reza Mohajeri ghfbb.journal@gmail.com Hamid Talebzadeh Talebzadeh.h@med.mui.ac.ir <p><strong>Background</strong></p> <p>The prevalence of foreign body swallowing is high in both children and adults. Different types of objects can be ingested. In older individuals denture ingestion is common. They may be left in the esophagus after being swallowed and then repelled.</p> <p><strong>&nbsp; Materials and methods</strong></p> <p>&nbsp;&nbsp;We present a case of a 62-year-old man who attended clinic due to dysphagia lasting for 5 years with an endoscopy report of a foreign body in his esophagus.&nbsp;&nbsp;</p> <p><strong>Results</strong></p> <p>There are a few reports of the presence of these objects in the esophagus for a long time.</p> <p><strong>Conclusion</strong></p> <p>Chronic remaining foreign bodies may be associated with complications, so extraction of the foreign body, especially in elderly, should be made promptly following diagnosis.</p> 2021-08-23T06:03:36+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2168 Melatonin effect on platelet count in patients with liver disease 2021-10-11T08:06:40+00:00 Ayda Esmaeili ph.a.esmaeili@gmail.com Mohssen Nassiri Toosi mohsen_nasiri@yahoo.com Mohammad Taher tahermdir@gmail.com jaleh bayani jalehbayani@yahoo.com Soha Namazi namazisoha@yahoo.com <p>Aim:</p> <p>Thrombocytopenia occurs by exacerbating severity of liver disease. Reduction in the secretion of <em>thrombopoetin</em>, as an intrinsic hormone mainly produced by liver, plays an important role in this complication induced by liver disease. A positive effect of melatonin on platelet count in the patients with chronic liver disease was reported in the current study.</p> <p>&nbsp;</p> <p>Method:</p> <p>&nbsp;Design of this study was a double-blind, cross-over, placebo-controlled pilot study. The patients with liver disease were given two 5 mg pearls of melatonin or placebo for two weeks and after 2 weeks wash out period, we switched their groups. The liver function test and platelets count were assessed once at the beginning and once at the end of each phase of the study.</p> <p>Result:</p> <p>In the current study, 40 patients with eligible criteria were included. The average platelet count has significantly increased by melatonin in comparison with placebo (from 175.67±92.84 to 191.10±98.82 vs from 185.22±98.39 to 176.45±91.45) (p-value &lt;0.001). Also, melatonin significantly reduced ALT, AST, total bilirubin, and direct and MELD scores in the patients with liver disease (p-value&lt;0.05).</p> <p>Conclusion</p> <p>Melatonin may increase platelet count and inhibit thrombocytopenia in the patients with liver disease; however, more investigations are needed to confirm the obtained result.</p> 2021-08-23T00:00:00+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2239 Non-celiac gluten sensitivity as a rare cause of growth retardation in children: a case series study 2021-10-14T07:00:18+00:00 Hedyeh Saneifard h.saneifard@sbmu.ac.ir Ali Sheikhy a-sheikhy@sbmu.ac.ir Fereshteh Karbasian Karbasian.md@gmail.com Golnaz Eslamian Dr_g.eslamian@yahoo.com Marjan Shakiba shakibamarjan@sbmu.ac.ir Delara Babaie Babaie.delara@gmail.com <p><em>Background:</em> non-celiac gluten sensitivity (NCGS) is a condition characterized by gastrointestinal and extra-intestinal symptoms which triggered by ingestion of Gluten contained compounds i.e., wheat, rye, and barley, in subjects without celiac disease or wheat allergy.</p> <p><em>Case presentation:</em> hereby we present five children and adolescents with final diagnosis of NCGS. All patients had failure to thrive and abdominal pain. Following gluten free diet, clinical symptoms reduced and we detected significant weight and height gain after 1 month of diet.</p> <p><em>Conclusion:</em> relationship between failure to thrive and NCGS is still unknown, hence according to mentioned cases, NCGS may be one of the main causes of FTT, which can be prevented by gluten free diets.</p> 2021-08-23T06:09:08+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2273 An uncommon cause of intermittent dysphagia 2021-10-11T08:10:32+00:00 Saeed Abdi saeedabdi75@yahoo.com Mehran Mahdavi Roshan mehreanmahdavi@gmail.com Naghmeh Salarieh ronas67@yahoo.com <p>A 42 year old woman admitted to the gastrointestinal department of Taleghani hospital; a teaching referral hospital in Tehran; Iran with epigastric pain; fever and dysphagia. She complained of intermittent dysphagia; regurgitation and epigastric pain( without any benefit from PPI treatment)&nbsp; one month in each year from five years before admission.</p> 2021-08-23T05:59:23+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench https://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2191 Giant mass in a 15 years old girl 2021-10-11T08:16:02+00:00 Fatemeh Majidirad f-majidirad@razi.tums.ac.ir Hossein Asl Soleimani soleimani@tums.ac.ir Anahita Sadeghi anahita825@gmai.com Mohammad Reza Hadian hadianrs@sina.tums.ac.ir <p>Giant mass in a 15 years old girl</p> <p>Because this is a photo quiz, so, it has not abstract.</p> 2021-08-23T06:00:38+00:00 Copyright (c) 2021 Gastroenterology and Hepatology from Bed to Bench