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Manfredi G, Bertè R, Iiritano E, Alicante S, Londoni C, Brambilla G, Romeo S, Menozzi F, Griffanti P, Brandi G, Moreschi O, Pezzilli R, Zullo A, Buscarini E. Premedication with simethicone and N-acetylcysteine for improving mucosal visibility during upper gastrointestinal endoscopy in a Western population. Endosc Int Open 2021; 9:E190-E194. [PMID: 33532557 PMCID: PMC7834924 DOI: 10.1055/a-1315-0114] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background and study aim Pre-endoscopic use of a preparation with tensioactive and mucolytic agents improved gastric mucosa visualization in Eastern studies. Data on Western population are scanty. Patients and methods This prospective, endoscopist-blinded, randomized study enrolled patients who underwent esophagogastroduodenoscopy in a single center. Before endoscopy patients, were randomized to receive or not receive an oral preparation with simethicone and N-acetylcysteine in water. A pretested score (Crema Stomach Cleaning Score [CSCS]) for gastric mucosa cleaning evaluation was used. In detail, the stomach was divided into the antrum, body, and fundus and a score of 1 to 3 was assigned to each part (the higher the score, the better the preparation), and a total value ≤ 5 was considered as insufficient. Time between endoscope insertion and clean achievement (mouth to clean time) or the end of examination (mouth to mouth time) was recorded. Results A total of 197 patients were enrolled. The mean overall CSCS value and mucosal cleaning in all parts was better in treated patients than in controls. Prevalence total score ≤ 5 was significantly lower in patients treated before endoscopy. Need for water flush occurred less frequently in treated patients ( P < 0.0001). The mouth to clean time was lower in the treated than in the control group (2.3 ± 1.6 vs 3.8 ± 1.6 min; P < 0.001), whereas no significant difference in mouth to mouth time emerged. Conclusions Data from this study show that premedication with simethicone and N-acetylcysteine results in significantly better endoscopic visualization of gastric mucosa, and the proposed CSCS could be useful for standardizing this evaluation.
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Affiliation(s)
- Guido Manfredi
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Roberto Bertè
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy,Gastroenterology and Endoscopy Department, ‘Ca’ Granda’ Hospital, Milan, Italy
| | - Elena Iiritano
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Saverio Alicante
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Claudio Londoni
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Giancarlo Brambilla
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Samanta Romeo
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Fernanda Menozzi
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Paola Griffanti
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Giovanna Brandi
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Oliva Moreschi
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | | | - Angelo Zullo
- Gastroenterology, ‘Nuovo Regina Margherita’ Hospital, Rome, Italy
| | - Elisabetta Buscarini
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
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Massironi S, Viganò C, Dioscoridi L, Filippi E, Pagliarulo M, Manfredi G, Conti CB, Signorelli C, Redaelli AE, Bonato G, Iiritano E, Frego R, Zucchini N, Ungari M, Pedaci M, Bono F, Di Bella C, Buscarini E, Mutignani M, Penagini R, Dinelli ME, Invernizzi P. Endoscopic Findings in Patients Infected With 2019 Novel Coronavirus in Lombardy, Italy. Clin Gastroenterol Hepatol 2020; 18:2375-2377. [PMID: 32480008 PMCID: PMC7260560 DOI: 10.1016/j.cgh.2020.05.045] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a major worldwide threat caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rapidly spreading to a global pandemic. As of May 11, 2020, 4,176,346 cases have been reported worldwide, 219,814 in Italy, and of them, 81,871 occurred in the Lombardy region.1 Although the respiratory manifestations of COVID-19 have been widely described, the impact on the gastrointestinal (GI) system remains less clear. The reported prevalence of digestive symptoms ranges from 3% to 79%, depending on the setting,2-5 but data on GI endoscopic and histologic findings in COVID-19 patients are lacking. Therefore, the aim of this study is to describe the GI endoscopic and histologic findings in COVID-19 patients.
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Affiliation(s)
- Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza.
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza
| | - Lorenzo Dioscoridi
- Niguarda Hospital, Diagnostic and Interventional Digestive Endoscopy Milano, Lombardia
| | - Elisabetta Filippi
- Department of Pathophysiology and Transplantation, University of Milan,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Guido Manfredi
- Department of Gastroenterology and Endoscopy, Maggiore Hospital, ASST Crema, Crema
| | | | | | | | - Giulia Bonato
- Niguarda Hospital, Diagnostic and Interventional Digestive Endoscopy Milano, Lombardia
| | - Elena Iiritano
- Department of Gastroenterology and Endoscopy, Maggiore Hospital, ASST Crema, Crema
| | | | - Nicola Zucchini
- Division of Pathology, San Gerardo Hospital, ASST Monza, Monza
| | | | - Marianna Pedaci
- Department of Gastroenterology and Endoscopy, Maggiore Hospital, ASST Crema, Crema
| | - Francesca Bono
- Division of Pathology, San Gerardo Hospital, ASST Monza, Monza
| | | | - Elisabetta Buscarini
- Department of Gastroenterology and Endoscopy, Maggiore Hospital, ASST Crema, Crema
| | | | - Roberto Penagini
- Department of Pathophysiology and Transplantation, University of Milan
| | | | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza
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Buscarini E, Manfredi G, Brambilla G, Menozzi F, Londoni C, Alicante S, Iiritano E, Romeo S, Pedaci M, Benelli G, Canetta C, La Piana G, Merli G, Scartabellati A, Viganò G, Sfogliarini R, Melilli G, Assandri R, Cazzato D, Rossi DS, Usai S, Tramacere I, Pellegata G, Lauria G. GI symptoms as early signs of COVID-19 in hospitalised Italian patients. Gut 2020; 69:1547-1548. [PMID: 32409587 PMCID: PMC7246093 DOI: 10.1136/gutjnl-2020-321434] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/18/2022]
Affiliation(s)
| | - Guido Manfredi
- Gastroenterology Department, ASST Maggiore Hospital, Crema, Italy
| | | | - Fernanda Menozzi
- Gastroenterology Department, ASST Maggiore Hospital, Crema, Italy
| | - Claudio Londoni
- Gastroenterology Department, ASST Maggiore Hospital, Crema, Italy
| | - Saverio Alicante
- Gastroenterology Department, ASST Maggiore Hospital, Crema, Italy
| | - Elena Iiritano
- Gastroenterology Department, ASST Maggiore Hospital, Crema, Italy
| | - Samanta Romeo
- Gastroenterology Department, ASST Maggiore Hospital, Crema, Italy
| | - Marianna Pedaci
- Gastroenterology Department, ASST Maggiore Hospital, Crema, Italy
| | | | - Ciro Canetta
- Emergency Medicine Department, ASST Maggiore Hospital, Crema, Italy
| | | | - Guido Merli
- Intensive Care Department, ASST Maggiore Hospital, Crema, Italy
| | | | | | | | | | - Roberto Assandri
- Clinical Investigation Laboratory, ASST Maggiore Hospital, Crema, Italy
| | - Daniele Cazzato
- Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Davide Sebastiano Rossi
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Susanna Usai
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Irene Tramacere
- Scientific Directorate, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | | | - Giuseppe Lauria
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy,Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
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Mariani A, Segato S, Anderloni A, Cengia G, Parravicini M, Staiano T, Tontini GE, Lochis D, Cantù P, Manfredi G, Amato A, Bargiggia S, Bernasconi G, Lella F, Berni Canani M, Beretta P, Ferraris L, Signorelli S, Pantaleo G, Manes G, Testoni PA, Prada A, Iiritano E, Lesinigo E, Mezzi GS, de Nucci G. Prospective evaluation of ERCP performance in an Italian regional database study. Dig Liver Dis 2019; 51:978-984. [PMID: 30718203 DOI: 10.1016/j.dld.2018.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/21/2018] [Accepted: 12/25/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prospective studies about endoscopic retrograde cholangio-pancreatography (ERCP) in a community setting are rare. AIM To assess success and complication rates of routinely-performed ERCP in a regional setting, and the priority quality indicators for ERCP practice. METHODS Prospective region wide observational study on consecutive patients undergoing ERCP during a 6-month period. A centralized online ERCP questionnaire was built and used for data storage. Primary quality indicators provided by the American Society of Gastrointestinal Endoscopy (ASGE) were considered. RESULTS 38 endoscopists from 18 centers performed a total of 2388 ERCP. The most common indication for ERCP was choledocholitiasis (54.8%) followed by malignant jaundice (22.6%). Cannulation of the desired duct was obtained in 2293 cases (96%) and ERCP was successful in 2176 cases (91.1%). Success and ERCP difficulty were significantly related to the experience of the operator (p = 0.001 and p < 0.001, respectively). ERCP difficulty was also significantly related to volume centers (p < 0.01). The overall complication rate was 8.4%: post-ERCP pancreatitis (PEP) occurred in 4.1% of procedures, bleeding in 2.9%, infection in 0.8%, perforation in 0.4%. Mortality rate was 0.4%. All the ASGE priority quality indicators for ERCP were confirmed. CONCLUSIONS The procedural questionnaire proved to be an important tool to assess and verify the quality of routinely-performed ERCP performance in a community setting.
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Affiliation(s)
- Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Simone Segato
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | | | - Marco Parravicini
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria, Ospedale di Circolo di Varese, Varese, Italy
| | - Teresa Staiano
- Digestive Endoscopy and Gastroenterology Unit, Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato, Italy
| | | | - Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Guido Manfredi
- Gastroenterology and Digestive Endoscopy Department, Maggiore Hospital, ASST Crema, Crema, Italy
| | - Arnaldo Amato
- Department of Gastroenterology Unit, Valduce Hospital, Como, Italy
| | | | - Giordano Bernasconi
- Gastroenterology and Digestive Endoscopy Unit, Busto Arsizio Hospital, Busto Arsizio, Varese, Italy
| | - Fausto Lella
- Gastroenterology and Digestive Endoscopy Unit, Policlinico San Pietro, Bergamo, Italy
| | - Marcella Berni Canani
- Digestive Endoscopy and Gastroenterology Unit, ASST Vimercate, Monza e Brianza, Italy
| | - Paolo Beretta
- Gastroenterology and Digestive Endoscopy Unit, ICCS, Milan, Italy
| | - Luca Ferraris
- Gastroenterologia ed Endoscopia Digestiva ASST Valleolona PO, Gallarate, Varese, Italy
| | - Sergio Signorelli
- Gastroenterology and Gastrointestinal Endoscopy Unit, ASST, Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Pantaleo
- UniSR-Social.Lab [Research Methods], Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianpiero Manes
- Department of Gastroenterology and Digestive Endoscopy, ASST Rhodense Garbagnate Milanese, Milano, Italy
| | - Pier Alberto Testoni
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Prada
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato, Italy
| | - Elena Iiritano
- Gastroenterology and Digestive Endoscopy Department, Maggiore Hospital, ASST Crema, Crema, Italy
| | - Enrico Lesinigo
- Gastroenterology and Digestive Endoscopy Unit, Busto Arsizio Hospital, Busto Arsizio, Varese, Italy
| | - Gianni Santo Mezzi
- Digestive Endoscopy and Gastroenterology Unit, ASST Vimercate, Monza e Brianza, Italy
| | - Germana de Nucci
- Department of Gastroenterology and Digestive Endoscopy, ASST Rhodense Garbagnate Milanese, Milano, Italy
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Grassia R, Iiritano E, Vjero K, Cereatti F, Capone P, Buffoli F. Severe acute diverticular bleeding: successful treatment with hemostatic powder. Gastrointest Endosc 2017; 86:239-240. [PMID: 27876632 DOI: 10.1016/j.gie.2016.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 11/10/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Roberto Grassia
- Digestive Endoscopy and Gastroenterology Unit, ASST di Cremona, Cremona, Italy
| | - Elena Iiritano
- Digestive Endoscopy and Gastroenterology Unit, ASST di Cremona, Cremona, Italy
| | - Katerina Vjero
- Digestive Endoscopy and Gastroenterology Unit, ASST di Cremona, Cremona, Italy
| | - Fabrizio Cereatti
- Digestive Endoscopy and Gastroenterology Unit, ASST di Cremona, Cremona, Italy
| | - Pietro Capone
- Digestive Endoscopy and Gastroenterology Unit, ASST di Cremona, Cremona, Italy
| | - Federico Buffoli
- Digestive Endoscopy and Gastroenterology Unit, ASST di Cremona, Cremona, Italy
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6
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Pasin F, Testa S, Capone P, Iiritano E, Grassia R. Gastrointestinal bleeding during Direct Oral AntiCoagulants-anticoagulant therapy. Is there nothing so bad that is not good for something? Eur J Intern Med 2017; 39:e25-e26. [PMID: 28242185 DOI: 10.1016/j.ejim.2017.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Affiliation(s)
| | - Sophie Testa
- Haemostasis and Thrombosis Center, ASST Cremona, Italy
| | - Pietro Capone
- Digestive Endoscopy and Gastroenterology Unit, ASST Cremona, Italy
| | - Elena Iiritano
- Digestive Endoscopy and Gastroenterology Unit, ASST Cremona, Italy
| | - Roberto Grassia
- Digestive Endoscopy and Gastroenterology Unit, ASST Cremona, Italy
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Grassia R, Capone P, Iiritano E, Vjero K, Cereatti F, Martinotti M, Rozzi G, Buffoli F. Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate. World J Gastroenterol 2016; 22:10609-10616. [PMID: 28082813 PMCID: PMC5192272 DOI: 10.3748/wjg.v22.i48.10609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/13/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane (NBCA + MS)] to treat non-variceal upper gastrointestinal bleeding (NV-UGIB).
METHODS In our retrospective study we took into account 579 out of 1177 patients receiving endoscopic treatment for NV-UGIB admitted to our institution from 2008 to 2015; the remaining 598 patients were treated with other treatments. Initial hemostasis was not achieved in 45 of 579 patients; early rebleeding occurred in 12 of 579 patients. Thirty-three patients were treated with modified cyanoacrylate: 27 patients had duodenal, gastric or anastomotic ulcers, 3 had post-mucosectomy bleeding, 2 had Dieulafoy’s lesions, and 1 had duodenal diverticular bleeding.
RESULTS Of the 45 patients treated endoscopically without initial hemostasis or with early rebleeding, 33 (76.7%) were treated with modified cyanoacrylate glue, 16 (37.2%) underwent surgery, and 3 (7.0%) were treated with selective transarterial embolization. The mean age of patients treated with NBCA + MS (23 males and 10 females) was 74.5 years. Modified cyanoacrylate was used in 24 patients during the first endoscopy and in 9 patients experiencing rebleeding. Overall, hemostasis was achieved in 26 of 33 patients (78.8%): 19 out of 24 (79.2%) during the first endoscopy and in 7 out of 9 (77.8%) among early rebleeders. Two patients (22.2%) not responding to cyanoacrylate treatment were treated with surgery or transarterial embolization. One patient had early rebleeding after treatment with cyanoacrylate. No late rebleeding during the follow-up or complications related to the glue injection were recorded.
CONCLUSION Modified cyanoacrylate solved definitively NV-UGIB after failure of conventional treatment. Some reported life-threatening adverse events with other formulations, advise to use it as last option.
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8
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Mariani A, Di Leo M, Giardullo N, Giussani A, Marini M, Buffoli F, Cipolletta L, Radaelli F, Ravelli P, Lombardi G, D'Onofrio V, Macchiarelli R, Iiritano E, Le Grazie M, Pantaleo G, Testoni PA. Early precut sphincterotomy for difficult biliary access to reduce post-ERCP pancreatitis: a randomized trial. Endoscopy 2016; 48:530-5. [PMID: 26990509 DOI: 10.1055/s-0042-102250] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIM Precut sphincterotomy is a technique usually employed for difficult biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of bile duct disease. It is a validated risk factor for post-ERCP pancreatitis (PEP), but it is not clear whether the risk is related to the technique itself or to the repeated biliary cannulation attempts preceding it. The primary aim of the study was to assess the incidence of PEP in early precut compared with the standard technique in patients with difficult biliary cannulation. Secondary aims were to compare complications and cannulation success. PATIENTS AND METHODS In this prospective, multicenter, randomized, clinical trial, patients who were referred for therapeutic biliary ERCP and difficult biliary cannulation were randomized to early precut (Group A) or repeated papillary cannulation attempts followed, in cases of failure, by late precut (Group B). PEP was defined as the onset of upper abdominal pain associated with an elevation in serum pancreatic enzymes of at least three times the normal level at more than 24 hours after the procedure. No rectal indomethacin or diclofenac was used for prevention of PEP. RESULTS A total of 375 patients were enrolled. PEP developed in 10 of the 185 patients (5.4 %) in Group A and 23 of the 190 (12.1 %) in Group B (odds ratio [OR] 0.35; 95 % confidence interval [CI] 0.16 - 0.78). The incidence of PEP was significantly lower in the early precut group (10/185, 5.4 %) than in the delayed precut subgroup (19/135 [14.1 %]; OR 0.42, 95 %CI 0.17 - 1.07). There were no differences in biliary cannulation success rates, bleeding, perforation, and cholangitis. CONCLUSIONS In patients with difficult biliary cannulation, early precut is an effective technique and can significantly reduce the incidence of PEP. Repeated biliary cannulation attempts are a real risk factor for this complication.
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Affiliation(s)
- Alberto Mariani
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Scientific Institute San Raffaele Milan, Italy
| | - Milena Di Leo
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Scientific Institute San Raffaele Milan, Italy
| | - Nicola Giardullo
- Gastroenterology and Gastrointestinal Endoscopy Unit, S.G. Moscati Hospital, Avellino, Italy
| | - Antonella Giussani
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Scientific Institute San Raffaele Milan, Italy
| | - Mario Marini
- Gastroenterology Unit, A.O.U.S. Policlinico S.Maria alle Scotte, Siena, Italy
| | - Federico Buffoli
- Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Italy
| | | | | | - Paolo Ravelli
- Digestive Endoscopy Unit, Department of Gastroenterology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Vittorio D'Onofrio
- Gastroenterology and Gastrointestinal Endoscopy Unit, S.G. Moscati Hospital, Avellino, Italy
| | | | - Elena Iiritano
- Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Italy
| | - Marco Le Grazie
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Scientific Institute San Raffaele Milan, Italy
| | - Giuseppe Pantaleo
- UniSR-Social.Lab (Research Methods), San Raffaele University of Milan, Faculty of Psychology, Milan, Italy
| | - Pier Alberto Testoni
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Scientific Institute San Raffaele Milan, Italy
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Toppo L, Tomasello G, Liguigli W, Lazzarelli S, Tanzi G, Ghidini M, Perrucci B, Brighenti M, Ratti M, Panni S, Giganti MO, Donini M, Rovatti M, Maglietta G, Ranieri V, Grassia R, Iiritano E, Iezzi ELISA, Caminiti C, Passalacqua R. Modified dose-dense taxotere cisplatin fluorouracil regimen (mTCF-dd) in a large cohort of patients (pts) with metastatic or locally advanced non-squamous gastroesophageal cancer (GEC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Laura Toppo
- SC Oncologia, Ospedale di Cremona, Cremona, Italy
| | | | | | | | - Giulia Tanzi
- SC Anatomia Patologica, Ospedale di Cremona, Cremona, Italy
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10
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Martinotti M, Ranieri V, Iiritano E, Staiano T, Dusi R, Laterza E, Buffoli F. Combined Endoscopic Transanal Vacuum-Assisted Rectal Drainage: A Novel Therapy for Colorectal Anastomotic Leak after TME for Cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ss.2014.510071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Grassia R, Staiano T, Iiritano E, Bianchi G, Dizioli P, Coppeta GP, Buffoli F. Use of cyanoacrylate glue as a rescue therapy of a duodenal diverticular rebleeding. Gastrointest Endosc 2012; 75:1288-9. [PMID: 21821249 DOI: 10.1016/j.gie.2011.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 05/26/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Roberto Grassia
- Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy
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Staiano T, Grassia R, Iiritano E, Bianchi G, Dizioli P, Buffoli F. Treatment of radiation-induced hemorrhagic gastritis with endoscopic band ligation. Gastrointest Endosc 2010; 72:452-3. [PMID: 20226458 DOI: 10.1016/j.gie.2009.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 11/12/2009] [Indexed: 12/10/2022]
Affiliation(s)
- Teresa Staiano
- Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy
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Buffoli F, Iiritano E, Grassia R, Bianchi G, Dizioli P, Staiano T. Successful removal of an ileal gallstone by endoscopic ileocecal valvulotomy (with video). Gastrointest Endosc 2010; 71:183-4; discussion 184. [PMID: 19922929 DOI: 10.1016/j.gie.2009.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 08/28/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Federico Buffoli
- Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy
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Grassia R, Bodini P, Dizioli P, Staiano T, Iiritano E, Bianchi G, Buffoli F. Neuroendocrine carcinomas arising in ulcerative colitis: Coincidences or possible correlations? World J Gastroenterol 2009; 15:4193-5. [PMID: 19725156 PMCID: PMC2738818 DOI: 10.3748/wjg.15.4193] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal malignancies. Adenocarcinoma is the commonest type of colorectal neoplasm associated with ulcerative colitis (UC) and Crohn’s disease, but other types of epithelial and non-epithelial tumors have also been described in inflamed bowel. With regards to non-epithelial malignancies, lymphomas and sarcomas represent the largest group of tumors reported in association with IBD, especially in immunosuppressed patients. Carcinoids and in particular neuroendocrine neoplasms other than carcinoids (NENs) are rare tumors and are infrequently described in the setting of IBD. Thus, this association requires further investigation. We report two cases of neoplasms arising in mild left-sided UC with immunohistochemical staining for neuroendocrine markers: a large cell and a small cell neuroendocrine carcinoma of the rectum. The two patients were different in age (35 years vs 77 years) and disease duration (11 years vs 27 years), and both had never received immunosuppressant drugs. Although the patients underwent regular endoscopic and histological follow-up, the two neoplasms were locally advanced at diagnosis. One of the two patients developed multiple liver metastases and died 15 mo after diagnosis. These findings confirm the aggressiveness and the poor prognosis of NENs compared to colorectal adenocarcinoma. While carcinoids seem to be coincidentally associated with IBD, NENs may also arise in this setting. In fact, long-standing inflammation could be directly responsible for the development of pancellular dysplasia involving epithelial, goblet, Paneth and neuroendocrine cells. It has yet to be established which IBD patients have a higher risk of developing NENs.
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Grassia R, Staiano T, Iiritano E, Bianchi G, Dizioli P, Baratta V, Buffoli F. Gastrointestinal hemorrhage caused by secondary aorto-duodenal fistula: a case report. Eur Rev Med Pharmacol Sci 2009; 13:147-150. [PMID: 19499851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Aortic graft-enteric fistula is a life-threatening complication of aortic reconstruction surgery. It is a rare condition but its frequency is rising because of an increase of patients who underwent to aortic aneurysm repairs with prosthetic implants. We report a case of a 72 years-old man with a secondary aorto-duodenal fistula. The man presented haematochezia and mild normocytic anaemia; the patient had undergone an aortic-bifemoral bypass 8 years earlier because of subrenal abdominal aortic aneurysm. An urgent upper endoscopy showed the aortic graft crossing the third segment of the eroded duodenal wall with no signs of bleeding from the prosthesis. He underwent an emergent operation to repair the graft-enteric fistula, to have the partial removal of the graft, as well as an aneurysmectomy and implantation of new endoaortic graft. The post-operative course was uneventful and the patient was discharged two weeks after the operation. He received a regular follow up. A secondary aorto-duodenal fistula is rarely diagnosed in an early phase as a herald haemorrhage. A precocious identification of this condition is thus essential to refer the patient to an urgent operation and to reduce the associated mortality.
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Affiliation(s)
- R Grassia
- Internal Medicine and Gastroenterology Division, Digestive Endoscopy Unit, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy.
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Ghiorzo P, Gargiulo S, Nasti S, Pastorino L, Battistuzzi L, Bruno W, Bonelli L, Taveggia P, Pugliese V, Borgonovo G, Mastracci L, Fornarini G, Romagnoli P, Iiritano E, Savarino V, Bianchi-Scarrà G. Predicting the risk of pancreatic cancer: on CDKN2A mutations in the melanoma-pancreatic cancer syndrome in Italy. J Clin Oncol 2007; 25:5336-7; author reply 5337-8. [PMID: 18024887 DOI: 10.1200/jco.2007.13.5624] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Giannini EG, Zentilin P, Dulbecco P, Iiritano E, Bilardi C, Savarino E, Mansi C, Savarino V. A comparison between sodium alginate and magaldrate anhydrous in the treatment of patients with gastroesophageal reflux symptoms. Dig Dis Sci 2006; 51:1904-9. [PMID: 16977507 DOI: 10.1007/s10620-006-9284-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 03/01/2006] [Indexed: 12/28/2022]
Abstract
The aims of the present study were to compare effects of sodium alginate and the antacid magaldrate anhydrous in adults with gastroesophageal reflux (GOR) symptoms. Patients with heartburn and/or acid regurgitation for at least 3 days in the week before the study started (n=203) were randomized to receive a single dose of sodium alginate or magaldrate anhydrous at the onset of symptoms during a 3-day run-in period. Patients with symptoms during the run-in (n=191) were rerandomized to receive a 14-day treatment with either drug given as four daily doses. A speed of action < or =30 min was significantly more frequent among patients in the alginate group (49.4% vs. 40.4%; P=0.0074). A trend toward a more prolonged duration of action (median: 16.5 vs. 12.7 hr) and a greater sum of the symptom intensity difference (median: 40.0 vs. 31.0) was observed in the sodium alginate group. Total disappearance of symptoms was reported in 81.6% and 73.9% of patients in the sodium alginate group and magaldrate group, respectively. We conclude that sodium alginate was faster than magaldrate in relieving GRO symptoms and showed a tendency toward a more prolonged duration of action and a higher level of efficacy.
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Affiliation(s)
- Edoardo G Giannini
- Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università degli Studi di Genova, Viale Benedetto XV, no. 6, 16132, Genoa, Italy
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Zentilin P, Iiritano E, Dulbecco P, Bilardi C, Savarino E, De Conca S, Parodi A, Reglioni S, Vigneri S, Savarino V. Normal values of 24-h ambulatory intraluminal impedance combined with pH-metry in subjects eating a Mediterranean diet. Dig Liver Dis 2006; 38:226-32. [PMID: 16480938 DOI: 10.1016/j.dld.2005.12.011] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 12/16/2005] [Accepted: 12/21/2005] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Multichannel intraluminal impedance combined with pH-metry is a novel technique for studying gastro-oesophageal reflux. As refluxes are particularly frequent after meals, we carried out this study in order to assess the impact of a Mediterranean diet on normal values of impedancemetry. METHODS Twenty-five Italian healthy subjects (13 men, median age 29 years, range 22-67 years) without reflux symptoms were recruited for this study. They underwent oesophageal 24-h impedance + pH-metry. A Mediterranean diet was given to all subjects on the day of examination and its total energy intake was 9668.5 kJ (2300 kcal). RESULTS A total of 1518 refluxes were recorded during 24 h with more upright than recumbent episodes (median 15 versus 0; p<0.01). The median total acid exposure time was 0.5% (range 0-4.2%). Acid and weakly acidic refluxes were equally reported (49% versus 51%). Weakly acidic episodes were more frequent than acid ones during 1-h postprandial periods (68% versus 32%; p<0.0001). Liquid-only and mixed refluxes reached the proximal oesophagus (15 cm above lower oesophageal sphincter) in 42.6% of cases. Median acid clearing time was longer than median bolus clearing time (28 s versus 12 s; p<0.01). CONCLUSIONS This study provides normal values of pH-impedancemetry in Italian people eating a Mediterranean diet and are suitable for comparative pathophysiological investigations on reflux patients who have dietary habits similar to those of our country.
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Affiliation(s)
- P Zentilin
- Department of Internal Medicine and Medical Speciality, University of the Studies of Genoa, Viale Benedetto XV, n. 6, 16132 Genoa, Italy
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Zentilin P, Dulbecco P, Savarino E, Parodi A, Iiritano E, Bilardi C, Reglioni S, Vigneri S, Savarino V. An evaluation of the antireflux properties of sodium alginate by means of combined multichannel intraluminal impedance and pH-metry. Aliment Pharmacol Ther 2005; 21:29-34. [PMID: 15644042 DOI: 10.1111/j.1365-2036.2004.02298.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Alginate-based preparations act as mechanical antireflux barrier, which can reduce both acid and non-acid reflux events and limit the proximal migration of oesophageal refluxate. AIM To evaluate all the above features with a novel technique, multichannel electrical impedance and pH-metry. METHODS Ten reflux patients underwent stationary impedancemetry and pH-metry after eating a refluxogenic meal. They were studied 1 h in basal conditions and 1 h after taking 10 mL of Gaviscon Advance. In both sessions, measurements were obtained in right lateral and supine decubitus. RESULTS Alginate preparation was able to decrease significantly (P < 0.05) the number of acid reflux events and the percentage time pH < 4.0 compared with baseline. There was no effect of the drug on non-acid refluxes. Gaviscon Advance was also significantly effective (P < 0.05) in reducing the height of proximal migration of reflux events compared with baseline in both decubitus positions. CONCLUSIONS Our findings explain how Gaviscon Advance controls acid reflux episodes, limits the proximal migration of refluxed material and thereby decreases symptoms in clinical practice.
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Affiliation(s)
- P Zentilin
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Genoa, Genoa, Italy
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21
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Bilardi C, Dulbecco P, Zentilin P, Reglioni S, Iiritano E, Parodi A, Accornero L, Savarino E, Mansi C, Mamone M, Vigneri S, Savarino V. A 10-day levofloxacin-based therapy in patients with resistant Helicobacter pylori infection: a controlled trial. Clin Gastroenterol Hepatol 2004; 2:997-1002. [PMID: 15551252 DOI: 10.1016/s1542-3565(04)00458-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Antibiotic resistance is a major issue in anti- Helicobacter pylori treatment. This study was aimed at assessing the efficacy of 2 therapies in patients with resistant H pylori infection. METHODS Patients who had failed 1 or more eradication regimens underwent upper gastrointestinal endoscopy and 2 antral and 2 corpus biopsy specimens were taken for histology and culture. Metronidazole, clarithromycin, and amoxicillin resistance were determined by E-test. Patients were randomly assigned to 2 therapies: 1 group received pantoprazole 40 mg, amoxicillin 1 g, levofloxacin 250 mg, all twice daily for 10 days, and the other group was treated with omeprazole 20 mg twice daily for the first week and omeprazole 20 mg twice daily, tetracycline 250 mg 4 times daily, metronidazole 500 mg twice daily, and bismuth subcitrate 240 mg twice daily for the second week. Therapeutic success was evaluated by 13C urea breath test after 4 weeks of treatment. RESULTS We enrolled 44 patients in the levofloxacin-based regimen and 46 patients in the quadruple therapy. The former was successful in 31 of 44 (70%; 95% confidence interval: 53-87) and the latter in 17 of 46 (37%; 95% confidence interval: 23-47) patients, using intention-to-treat (ITT) analysis (P < .001). The rates of H pylori resistance to metronidazole, clarithromycin, and amoxicillin were 46%, 12%, and 0%, respectively. Resistance to both metronidazole and clarithromycin was found in 10% of cases. CONCLUSIONS Triple therapy containing levofloxacin was better than quadruple therapy. The 70% success rate observed indicates that 10 days of pantoprazole, amoxicillin, and levofloxacin should be considered in patients who had failed 1 or more eradication regimens.
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Affiliation(s)
- Claudio Bilardi
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Italy
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22
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Zentilin P, Mastracci L, Dulbecco P, Gambaro C, Bilardi C, Ceppa P, Spaggiari P, Iiritano E, Mansi C, Vigneri S, Fiocca R, Savarino V. Carditis in patients with gastro-oesophageal reflux disease: results of a controlled study based on both endoscopy and 24-h oesophageal pH monitoring. Aliment Pharmacol Ther 2004; 19:1285-92. [PMID: 15191510 DOI: 10.1111/j.1365-2036.2004.02000.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There are conflicting reports on the role of gastro-oesophageal reflux disease (GERD) and Helicobacter pylori infection in the aetiology of carditis. AIM The role of reflux and H. pylori infection in causing carditis was assessed in 113 consecutive patients with GERD and in 25 controls. METHODS All subjects underwent endoscopy and pH test and carditis was diagnosed on biopsies taken across the squamocolumnar junction. Helicobacter pylori was assessed by histology and rapid urease test. GERD was diagnosed by endoscopic oesophagitis or abnormal pH test. RESULTS Carditis was detected in 53 of 71 GERD patients and in 15 of 20 controls. Among patients, 18 showed absent, 39 mild and 14 marked cardia inflammation and their H. pylori infection rates were 17, 23 and 57%, respectively (P < 0.025). Most patients with carditis (68%) lacked H. pylori infection. pH-metry was abnormal in 15 of 18 patients with normal cardia, 33 of 39 with mild carditis and 12 of 14 with marked inflammation. CONCLUSIONS Carditis is a frequent finding in GERD and controls. Mild, non-active carditis is frequent in GERD patients. Marked inflammation is associated with both H. pylori and abnormal pH testing. Thus, both GERD and H. pylori infection may play a role in inducing carditis.
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Affiliation(s)
- P Zentilin
- Dipartimento di Medicina Interna e Specialita Mediche, University of Genoa, Genoa, Italy
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Gambaro C, Bilardi C, Dulbecco P, Iiritano E, Zentilin P, Mansia C, Usai P, Vigneri S, Savarino V. Comparable Helicobacter pylori eradication rates obtained with 4- and 7-day rabeprazole-based triple therapy: a preliminary study. Dig Liver Dis 2003; 35:763-7. [PMID: 14674665 DOI: 10.1016/s1590-8658(03)00458-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Rabeprazole is a new proton pump inhibitor, which has been reported to induce a faster acid suppression than other drugs of the same category. This might be useful to reduce the duration of anti-Helicobacter therapies. AIMS The aim of this study was to assess whether there is the possibility of shortening a rabeprazole-based triple therapy from 7 to 4 days without compromising its efficacy in the eradication of Helicobacter pylori infection. PATIENTS A total of 128 consecutive dyspeptic patients with H. pylori infection were recruited for this controlled, randomized, open and parallel-group trial comparing the efficacy of two durations of the same rabeprazole-based triple therapy. METHODS All patients were subdivided to receive a combination of rabeprazole 20 mg twice daily, clarithromycin 250 mg twice daily and metronidazole 500 mg twice daily (RCM) for 4 days (n = 63) and for 7 days (n = 65). At baseline, they underwent breath 13C-urea test and endoscopy with biopsies for rapid urease testing and histology to confirm infection with H. pylori. Eradication was determined by a negative 13C-urea breath test within 28-32 days after the end of therapy. RESULTS Overall eradication rates were similar for patients treated with the 4- and the 7-day periods (intention-to-treat and per-protocol analyses showed a success rate of 81% versus 78% and 88% versus 85%, respectively; P = NS). Tolerance was similar in both groups. Most adverse events were mild to moderate, and only two patients were withdrawn because of them. CONCLUSIONS The eradication rate of the 4-day regimen was equivalent to that of the same 7-day regimen based on rabeprazole plus clarithromycin and metronidazole. Therefore, the 4-day regimen of RCM seems to give us the possibility of adopting a shorter-than-usual duration of therapy against H. pylori.
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Affiliation(s)
- C Gambaro
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, n. 6, Genoa 16132, Italy
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Zentilin P, Iiritano E, Vignale C, Bilardi C, Mele MR, Spaggiari P, Gambaro C, Dulbecco P, Tessieri L, Reglioni S, Mansi C, Mastracci L, Vigneri S, Fiocca R, Savarino V. Helicobacter pylori infection is not involved in the pathogenesis of either erosive or non-erosive gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2003; 17:1057-64. [PMID: 12694088 DOI: 10.1046/j.1365-2036.2003.01547.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The majority of reflux patients have non-erosive reflux disease. AIM To evaluate the influence of Helicobacter pylori on oesophageal acid exposure in patients with both non-erosive and erosive reflux disease and in a group of controls. The pattern and distribution of chronic gastritis were also assessed. METHODS One hundred and twelve consecutive patients with symptoms of gastro-oesophageal reflux disease agreed to undergo both upper gastrointestinal endoscopy and 24-h oesophageal pH-metry. Patients were grouped as H. pylori-positive or H. pylori-negative on the basis of both CLO-test and histology, and as cases with or without oesophagitis on the basis of endoscopy. The controls consisted of 19 subjects without reflux symptoms and with normal endoscopy and oesophageal pH-metry. RESULTS H. pylori was positive in 35 patients (31%) and in six controls (31%); oesophagitis was found in 44 patients (39%) and non-erosive reflux disease in 68 (61%). The prevalence of chronic gastritis in the antrum and corpus was higher in H. pylori-positive than in H. pylori-negative patients (P < 0.001), but was more frequently mild (P < 0.001) than moderate or severe. The percentage total time the oesophageal pH < 4.0 was higher in patients than in controls (P < 0.008-0.001), but there was no difference between H. pylori-positive and H. pylori-negative patients (12.3% vs. 12%, P = 0.43) or H. pylori-positive and H. pylori-negative controls (1.07% vs. 1.47%, P = 0.19). CONCLUSIONS H. pylori infection had the same prevalence in reflux patients and in controls. It did not affect oesophageal acid exposure, as there was no difference between H. pylori-positive and H. pylori-negative individuals. The high prevalence of mild body gastritis in H. pylori-positive patients suggests that H. pylori eradication is unlikely to lead to gastric functional recovery, which might precipitate or worsen symptoms and lesions in patients with gastro-oesophageal reflux disease.
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Affiliation(s)
- P Zentilin
- Dipartimento di Medicina Interna, Università di Genova, Genova, Italy
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Zentilin P, Dulbecco P, Bilardi C, Gambaro C, Iiritano E, Biagini R, Mela GS, Tessieri L, Mele MR, Mansi C, Pandolfo N, Vigneri S, Savarino V. Circadian pattern of intragastric acidity in patients with non-erosive reflux disease (NERD). Aliment Pharmacol Ther 2003; 17:353-9. [PMID: 12562447 DOI: 10.1046/j.1365-2036.2003.01422.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Most patients with gastro-oesophageal reflux disease have non-erosive reflux disease. Proton pump inhibitors are less effective than expected in these patients, but no previous study has measured their 24-h gastric pH values. AIMS To evaluate whether there are differences in 24-h intragastric acidity between reflux patients with and without oesophagitis and controls. The influence of Helicobacter pylori on the gastric pH of reflux patients was also assessed. METHODS Sixty-three consecutive patients with gastro-oesophageal reflux disease symptoms who agreed to undergo endoscopy and 24-h pH-metry were recruited. Twenty-five (39%) had erosive oesophagitis and 38 (61%) did not. H. pylori was diagnosed by CLO test, histology and 13C-urea breath test. Gastric pH was also measured in 30 controls without digestive symptoms. RESULTS H. pylori was found in seven of the 25 (28%) patients with oesophagitis and 14 of the 38 (37%) patients with non-erosive reflux disease. Oesophageal pH-metry was abnormal in 21 of the 25 (84%) patients with oesophagitis and in 32 of the 38 (84%) patients with non-erosive reflux disease. The median gastric pH did not differ between patients with and without oesophagitis or between them and controls during the 24 h (P = 0.8) and other time intervals (P = 0.2-0.4). The gastric pH did not differ between infected and non-infected patients with oesophagitis (P = 0.2-0.4) or non-erosive reflux disease (P = 0.3-0.8). CONCLUSIONS The circadian pattern of intragastric acidity does not differ between patients with non-erosive reflux disease and oesophagitis. Moreover, the study confirms that H. pylori infection does not affect the gastric pH in either group of reflux patients.
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Affiliation(s)
- P Zentilin
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Italy
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Dulbecco P, Gambaro C, Bilardi C, Zentilin P, Mele MR, Mansi C, Biagini R, Tessieri L, Iiritano E, Usai P, Vigneri S, Savarino V. Impact of long-term ranitidine and pantoprazole on accuracy of [13C]urea breath test. Dig Dis Sci 2003; 48:315-21. [PMID: 12643609 DOI: 10.1023/a:1021931627698] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
No previous study has analyzed the impact of long-term antisecretory drugs on the precision of [13C]urea breath test (UBT). We assessed the rate of UBT conversion from positive to negative results during 60-day therapy with standard doses of ranitidine and pantoprazole. For this purpose, we recruited 60 dyspeptic patients with H. pylori infection ascertained on the basis of the concomitant results of CLO-test, histology, and UBT. Our patients were randomly assigned to receive ranitidine 300 mg at night or pantoprazole 40 mg in the morning for 60 days. UBT was performed at baseline and on days 14, 30, and 60, while patients were still taking antisecretory drugs. Patients with false-negative UBT on day 60 repeated the test every 3 days until conversion. After overnight fasting, duplicate breath test samples were taken from each patient before and 30 min after ingestion of 75 mg [13C]urea dissolved in 150 ml of 0.033 mol/liter citric acid. Four patients dropped out of the study. Both drugs induced similar false-negative UBTs on day 14 of dosing (P = 0.5). Afterwards, the three false-negative UBTs in the ranitidine group again became positive during therapy and particularly on day 30 of dosing. Of the four false-negative UBTs in the pantoprazole group at day 60, one became positive after 3 and three after 9 days of therapy cessation. Our findings show that the long-term use of ranitidine and pantoprazole at standard doses has different effects on the results of UBT. In the pantoprazole group patients again became positive within 3-9 days after stopping 60-day therapy, whereas in the ranitidine group patients reverted to positive on day 30 of dosing while they were still on treatment and this was likely due to development of tolerance. Therefore, patients taking pantoprazole need at least a 10-day withdrawal before UBT testing, while those taking ranitidine for at least 30 days can undergo UBT without the necessity of a wash-out period.
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Affiliation(s)
- Pietro Dulbecco
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Italy
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Bilardi C, Biagini R, Dulbecco P, Iiritano E, Gambaro C, Mele MR, Borro P, Tessieri L, Zentilin P, Mansi C, Vigneri S, Savarino V. Stool antigen assay (HpSA) is less reliable than urea breath test for post-treatment diagnosis of Helicobacter pylori infection. Aliment Pharmacol Ther 2002; 16:1733-8. [PMID: 12269965 DOI: 10.1046/j.1365-2036.2002.01345.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The diagnostic yield of the stool antigen test (HpSA) in evaluating the results of Helicobacter pylori eradication therapy is controversial, but many studies have used only the 13C-urea breath test (13C-UBT) as a gold standard which has greatly reduced their relevance. AIM To compare the reliability of HpSA and 13C-UBT in patients post-treatment using biopsy-based methods as reference tests. METHODS A total of 100 consecutive dyspeptic patients (42 male and 58 female; mean age, 56 +/- 18 years) were enrolled in our study. All patients were H. pylori positive on the basis of at least two biopsy-based methods, and underwent 1 week of treatment with various triple therapies. They were again endoscoped 4 weeks after completing therapy and six biopsy specimens were taken from the gastric antrum and corpus for rapid urease test, histology and culture. HpSA and 13C-UBT were also performed within 3 days of the second endoscopy. RESULTS On the basis of biopsy-based tests, infection was eradicated in 77 patients but continued in 23. Three false negatives were observed with HpSA and two with 13C-UBT. In contrast, the number of false positives was significantly higher (P < 0.01) with HpSA than with 13C-UBT (nine vs. one), confirming the lower specificity of the former test. The overall accuracy of HpSA was 88% vs. 97% for 13C-UBT (P < 0.02). CONCLUSIONS HpSA has lower diagnostic value than 13C-UBT in the evaluation of the outcome of anti-H. pylori therapy. 13C-UBT remains the first-line diagnostic method to monitor eradication results. The use of HpSA should be reserved for those settings in which 13C-UBT is not available.
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Affiliation(s)
- C Bilardi
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Italy
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Zentilin P, Seriolo B, Dulbecco P, Caratto E, Iiritano E, Fasciolo D, Bilardi C, Mansi C, Testa E, Savarino V. Eradication of Helicobacter pylori may reduce disease severity in rheumatoid arthritis. Aliment Pharmacol Ther 2002; 16:1291-9. [PMID: 12144579 DOI: 10.1046/j.1365-2036.2002.01284.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A triggering infectious agent has long been postulated in rheumatoid arthritis. Data on the possible role of Helicobacter pylori infection are lacking. AIM To assess the effect of H. pylori eradication in patients with rheumatoid arthritis. METHODS Fifty-eight adult patients with established rheumatoid arthritis and dyspeptic symptoms were recruited - 28 were H. pylori-positive and 30 were H. pylori-negative on the basis of invasive tests. All infected patients were treated successfully. We evaluated the disease activity using clinical and laboratory parameters at baseline and every 4 months during 2 years, and compared the variations in the two subgroups. RESULTS H. pylori-eradicated rheumatoid arthritis patients showed progressive improvement over time (P < 0.0001) of all clinical indices compared with baseline, whereas H. pylori-negative rheumatoid arthritis patients remained substantially unchanged. After 2 years, H. pylori-eradicated rheumatoid arthritis patients differed significantly (P < 0.04-0.0001) from patients without H. pylori infection in terms of improvement of all clinical parameters. At the same time point, several laboratory indices (erythrocyte sedimentation rate, fibrinogen, alpha2-globulins and antinuclear antibody) showed significantly lower values (P < 0.02-0.0003) in the H. pylori-eradicated subgroup compared to the H. pylori-negative subgroup. CONCLUSIONS Our data suggest that H. pylori infection is implicated in the pathogenesis of rheumatoid arthritis, in that its eradication may induce a significant improvement of disease activity over 24 months. H. pylori eradication seems to be advantageous in infected rheumatoid arthritis patients, but controlled studies are needed.
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Affiliation(s)
- P Zentilin
- Dipartimento di Medicina Interna e Specialità Mediche, Cattedra di Gastroenterologia, Università di Genova, Genoa, Italy
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Zentilin P, Conio M, Mele MR, Mansi C, Pandolfo N, Dulbecco P, Gambaro C, Tessieri L, Iiritano E, Bilardi C, Biagini R, Vigneri S, Savarino V. Comparison of the main oesophageal pathophysiological characteristics between short- and long-segment Barrett's oesophagus. Aliment Pharmacol Ther 2002; 16:893-8. [PMID: 11966497 DOI: 10.1046/j.1365-2036.2002.01237.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM To assess the oesophageal manometric characteristics and 24-h pH profiles of patients with both short-segment and long-segment Barrett's oesophagus and compare them with those of patients with reflux oesophagitis and controls. METHODS Seventy-nine patients who had undergone upper digestive endoscopy were recruited: 16 had short-segment Barrett's oesophagus, 13 had long-segment Barrett's oesophagus, 25 had grade III oesophagitis according to the Savary-Miller classification and 25 were used as controls. The diagnosis of Barrett's oesophagus was based on the histological detection of specialized intestinal metaplasia, which extended < 3 cm into the oesophagus in patients with short-segment disease and > 3 cm in patients with long-segment disease. All subjects underwent oesophageal manometry and basal 24-h oesophageal pH monitoring. RESULTS The lower oesophageal sphincter pressure was significantly lower in patients with reflux oesophagitis and short-segment and long-segment Barrett's oesophagus than in controls (P=0.0004-0.0001), but there was no difference among the three reflux groups. The peristaltic wave amplitude of patients with long-segment Barrett's oesophagus was significantly lower than that of controls (P=0.002) and patients with short-segment Barrett's oesophagus (P=0.02), but was no different from that of patients with reflux oesophagitis. The percentage of non-propagated wet swallows was significantly higher in patients with reflux oesophagitis and short-segment and long-segment Barrett's oesophagus when compared with that of controls (P=0.0004-0.0001). The total percentage of time the oesophagus was exposed to pH < 4.0 was significantly higher in patients with reflux oesophagitis and short-segment and long-segment Barrett's oesophagus (P=0.0001) than in controls, and was higher in patients with long-segment disease than in those with short-segment disease (P=0.01). CONCLUSIONS Long-segment Barrett's oesophagus is characterized by a greater impairment of peristaltic wave amplitude and a higher oesophageal acid exposure than is short-segment Barrett's oesophagus. However, both forms are linked to increased acid reflux.
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Affiliation(s)
- P Zentilin
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Genova, Italy
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Abstract
The aim of the study was to evaluate the seroprevalence of HEV antibodies in blood donors and in healthy persons in Calabria (Italy). An age-stratified sample of blood from donors was drawn at a regional transfusion service. Sixty persons were enrolled for each of the following age-groups: 18-20, 21-30, 41-50, 51-60, > 60 years, whereas 61 persons were enrolled in the 31-40 age-group. In the oldest age-group 38 subjects were enrolled among healthy subjects attending an outpatient clinic. Participants were invited to fill in a questionnaire, including questions on demographics, such as sex, date and place of birth, place of residence, number of people in household, and occupation; exposure to specific risk factors, such as travel in hepatitis E endemic areas; history of jaundice and/or hepatitis; drug addiction and transfusion. Results of routine serological tests for blood donation (HBsAg, HCV, HIV, ALT) were also recorded. Serum samples of subjects were stored at -80 degrees C until tested. The seroprevalence of hepatitis E antibodies was studied using in parallel two commercial ELISA tests consisting of recombinant antigens and synthetic HEV polypeptides. Three hundred sixty-one persons were recruited and six of them were positive to HEV antibodies (1.7%) by the recombinant test, whereas four were positive by the synthetic peptides test (1.1%). Overall, three subjects were positive to both tests, with a prevalence of 0.8%. Of these two (0.7%) were men and one (1.3%) a woman. As to age, two (3.3%) were in the 51-60, and one (1.7%) in the > 60 age-group. None of the positive participants had travelled to highly endemic areas, and none were positive for HBsAg or HCV. The study confirms a low circulation of the HEV virus also in southern Italy, with a prevalence of infection more similar to that of northern European countries than to that of countries of the Mediterranean basin.
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Affiliation(s)
- M Pavia
- Dept. of Hygiene, Medical School, University of Reggio Calabria, Italy
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Galiano L, Veratti A, Iiritano E, Colicigno G, Senatore C. A case of Am, a rare variant in the ABO blood group system. Haematologica 1986; 71:317-9. [PMID: 3096826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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