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Gut microbiota represent an interesting worldwide research area. Several studies confirm that microbiota has a key role in human diseases, both intestinal (such as inflammatory bowel disease, celiac disease, intestinal infectious diseases, irritable bowel syndrome) and extra intestinal disorders (such as autism, multiple sclerosis, rheumatologic diseases). Nowadays, it is possible to manipulate microbiota by administering prebiotics, probiotics or synbiotics, through fecal microbiota transplantation in selected cases. In this scenario, pancreatic disorders might be influenced by gut microbiota and this relationship could be an innovative and inspiring field of research. However, data are still scarce and controversial. Microbiota manipulation could represent an important therapeutic strategy in the pancreatic diseases, in addition to standard therapies. In this review, we analyze current knowledge about correlation between gut microbiota and pancreatic diseases, by discussing on the one hand existing data and on the other hand future possible perspectives.

Diabetes mellitus is a widespread disease, and represents an important public health burden worldwide. Together with cardiovascular, renal and neurological complications, many patients with diabetes present with gastrointestinal symptoms, which configure the so-called diabetic enteropathy. In this review, we will focus on upper gastrointestinal symptoms in patients with diabetes, with particular attention to dyspepsia and diabetic gastroparesis (DG). These two clinical entities share similar pathogenetic mechanisms, which include autonomic neuropathy, alterations in enteric nervous system and histological abnormalities, such as interstitial cells of Cajal depletion. Moreover, the differential diagnosis may be challenging because of overlapping clinical features. Delayed gastric emptying should be documented to differentiate between DG and dyspepsia and it can be assessed through radioactive or non-radioactive methods. The clinical management of dyspepsia includes a wide range of different approaches, above all Helicobacter pylori test and treat. As regards DG treatment, a central role is played by dietary modification and glucose control and the first-line pharmacological therapy is represented by the use of prokinetics. A minority of patients with DG refractory to medical treatment may require more invasive therapeutic approaches, including supplemental nutrition, gastric electric stimulation, pyloromyotomy and gastrectomy.

Renal dysfunction is frequent in cirrhotic patients and is associated with a worse prognosis. 1 Cirrhotic patients share with the general population common aetiologies of kidney dysfunction, including pre-renal, intrinsic and post-renal causes of acute kidney injury (AKI), as well as all the known causes of chronic kidney disease (CKD), such as diabetic or hypertensive nephropathy. 2 Additionally, they may suffer from a specific kind of renal dysfunction, hepatorenal syndrome (HRS). 3,4 Among patients hospitalized for acutely decompensated cirrhosis, about 50% present AKI (definition in Table 1) 5 ; in one-third of them, renal impairment occurs after admission. 6,7 Episodes of AKI can also occur during the follow-up in up to 50% of outpatients with decompensated cirrhosis. 8 As regards CKD (definition in Table 2), 9 this is a highly common comorbidity among patients with liver diseases, and particularly among those with decompensated cirrhosis, in whom the prevalence of CKD stage 3 or higher is reported to range from 20% to 40%. [10][11][12][13]