Piperine: A Savor Inducer and a Cancer Reducer

Spices have been used for many decades, and although new and improved culinary spices have been developed, black pepper (<em>Piper nigrum</em>) continues to retain its distinguished title as the <em>“King of spices”</em> due to its particular pungent taste. An alkaloid called piperine is the main component in black pepper that, besides generating the well-known taste, imparts well-documented immunomodulatory, anti-inflammatory, antimicrobial, antioxidant, and even anti-cancer properties; these properties have led to rigorous research on black pepper. Studies conducted on cancer cell lines and in animal models with tumors revealed that piperine might influence tumor development and metastasis via various pathways, some of which are quite common for most types of malignant processes, while others are associated with a specific type of cancer. In this review, we summarized the effect of piperine on various types of cancer and the mechanism by which it acts as a carcinopreventive agent.

Non-Celiac Gluten Sensitivity in Children: Controversial Role of Gluten and Diagnostic Enigma

Non-celiac gluten sensitivity (NCGS) is a debatable condition that affects less than 6% of children. The absence of specific diagnostic markers and standardized diagnostic procedures make the diagnosis of NCGS challenging, covering patients with different and varied symptoms. Generally, the parents of small and younger children introduce a gluten-free diet (GFD) based on their personal experiences and expectations. Additionally, a “fad component” exists, contributing to the recent rise in the popularity of GFD. Thus, celiac disease (CD) and wheat allergy (WA) must be excluded as these also appear in individuals experiencing symptoms similar to those of NCGS, improving and worsening with gluten withdrawal and consumption, respectively. The role of gluten inducing gastrointestinal symptoms in individuals with self-reported NCGS has been skeptically assessed based on evidence in recent years. However, currently, it is unknown whether a strict GFD is necessary for patients with NCGS. Thus, the placebo-controlled gluten challenge remains the gold standard for a challenging diagnosis like NCGS. The present review evaluates the published studies based largely on the adult population and describes the key elements in diagnosing NCGS and differential diagnosis with CD and WA.

Gastro-Esophageal Reflux in the Newborn: Pathologic Event or Does Spit Happen?

Infants admitted to Neonatal Intensive Care Units (NICUs) are among the most vulnerable patients in medicine and are at risk for a variety of morbidities, many of which require pharmacologic therapy. Gastroesophageal Reflux Disease (GERD) is a common diagnosis in the NICU patient population and may or may not represent a truly pathologic process. Regardless, pharmacologic therapy is provided to many infants, who are already exposed to an inordinate number of pharmacologic agents, of which most are off label and have an inadequate evidence base to establish either efficacy or safety. Furthermore, as infancy represents a time of dramatic growth and development, many conditions resolve over time, making treatment unnecessary and potentially dangerous. Infants with GERD, especially those born prematurely, exemplify the complexity of attempting pharmacologic therapy with unproven consistent benefit versus “watching and waiting.” The following will present physiology of GERD, gastrointestinal tract anatomy and development as well as options for pharmacologic and non-pharmacologic therapies.

Varicella-Zoster Gastritis in a Liver Transplant Patient: A Call to Attention

The reactivation of the Varicella-zoster virus (VZV) is a rare cause of acute gastritis in adults. About 30 cases have been reported in the literature, mostly with immunocompromised patients and mainly after bone marrow transplantation or during the development of malignant hematological diseases. Clinically, it is usually accompanied by cutaneous manifestations. Here, we studied a case of VZV gastritis in a liver transplant (LT) patient. We described the main symptoms, endoscopic findings, histologic changes, and treatment of VZV gastritis. Till now, no case of acute gastritis due to the reactivation of VZV after solid organ transplantation had been reported [2–5]. This was the first reported case of acute gastritis by the reactivation of VZV after LT without cutaneous vesicular eruption. Gastrointestinal symptoms usually develop a week before the onset of fever and cutaneous manifestations. However, in some cases, like this one, vesicular rashes may be absent, making the diagnosis quite challenging. In conclusion, through this case, we suggest including VZV gastritis in the differential diagnosis of gastrointestinal symptoms after transplantation and informing about the response of VZV gastritis to treatment with oral acyclovir.

The Timing of Endoscopic Evaluation of Anti-TNFα Therapy Patients with Ulcerative Colitis

Anti-TNFα Therapy are used to induce remission and as maintenance therapy in refractory ulcerative colitis (UC) to achieve mucosal healing (MH). However, the time at which mucosal healing should be assessed is unclear. We retrospectively examined the optimal timing for colonoscopy and the criteria to determine the need for the continuation of treatment. We evaluated 44 UC patients that were treated with anti-TNFα Therapy and categorized them into the following groups according to the degree of MH within 12 months: MH and non-MH/NMH, early-MH (EMH, healing within three months), and slow MH/SMH (healing between 4-12 months). We compared the Mayo Endoscopic Subscore (MES) between the MH vs. NMH and SMH vs. NMH groups. The Lichtiger index and blood test results were investigated as predictive factors of MH. MH was defined as an MES of ≤ 1. The MES was significantly lower in the MH group at 3, 6, and 12 months, compared to the NMH group. Significant changes were observed in the platelet counts, the Lichtiger index, the levels of C-reactive protein (lower), and hemoglobin (higher) in the MH group at 3- and 6-months following treatment. However, the only significant difference between the SMH and NMH groups was in the endoscopic findings at 6- or 12-months post-treatment. Colonoscopy should be performed three months after treatment with anti-TNFα Therapy. The treatment should be continued in patients who do not achieve mucosal healing at 3-months, and colonoscopy should be repeated at 6- or 12-months to assess the outcomes.