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DE Bastiani R, Lopetuso LR, DE Bastiani M, Bacchin P, Benedetto E, Boscariolo L, Caneve R, Chesani F, Chiumeo F, Civic Z, Dainese A, DE Polo M, Disclafani G, Grattagliano I, Mana O, Mancuso M, Mastronuzzi T, Pati A, Pirrotta E, Salandini M, Sanna G, Scoglio R, Severino P, Tosetti C, Turnava L, Zamparella M, Elisei W, Gasbarrini A, Tursi A. Assessment of small intestinal bacterial overgrowth and methane production in patients on chronic proton-pump inhibitor treatment: prevalence and role of rifaximin in its management in primary care. Minerva Gastroenterol (Torino) 2023; 69:523-528. [PMID: 36943203 DOI: 10.23736/s2724-5985.21.03118-1] [Citation(s) in RCA: 1] [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: 03/23/2023]
Abstract
BACKGROUND Although proton pump inhibitor (PPI) drugs have considered able to induce small intestinal bacterial overgrowth (SIBO), no data are so far available from primary care (PC). We assessed the prevalence of SIBO and methane (CH4) production consequent to chronic PPI therapy using Lactulose Breath Test (LBT). Secondary aim was to explore the possible role of rifaximin in treating PPI-induced SIBO patients. METHODS One hundred twenty-five gastroesophageal reflux disease patients, constantly treated with PPI for at least 6 months and undergoing to LBT, were retrospectively assessed. An age-matched control population (control) of 100 patients, which had not used PPI in the last 6 months, was also enrolled. In the PPI group, SIBO positive patients and CH4 producers were treated with rifaximin 1200 mg/daily for 14 days and re-checked with LBT one month after the end of treatment. The area under the curve (AUC) before and after treatment was also calculated for both SIBO positive patients and CH4 producers. RESULTS In the PPI group, SIBO prevalence was significantly higher vs. controls (38/125 [30.4%] vs. 27/100 [27%], P<0.05). 77/125 (61.6%) PPI patients were found to be CH4 producers vs. 21/100 (21%) controls (P<0.05). Among SIBO patients in the PPI group, 34 (89.4%) were also CH4 producers vs. 17/27 (63%) controls (P<0.05). After treatment, LBT resulted negative in 15/22 SIBO patients (68.1%) (P<0.05) and in 18/34 CH4 producers (52.9%) (P<0.05). At the AUC analysis, an overall reduction of 54.2% for H2 in SIBO patients and of 47.7% for CH4 was assessed after rifaximin treatment (P<0.05). CONCLUSIONS Our data showed that chronic use of PPI could be able to increase the prevalence of SIBO and to shift the intestinal microbial composition towards a CH4-producing flora. rifaximin could represent a useful therapeutical option for PPI-induced SIBO and for modulating CH4-producing flora.
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Affiliation(s)
- Rudi DE Bastiani
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Loris R Lopetuso
- Department of Medical and Surgical Sciences, Sacred Heart Catholic University, Rome, Italy
- CEMAD Digestive Disease Center, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Medicine and Ageing Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco DE Bastiani
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Paolo Bacchin
- General Pratictioner, Azienda Sanitaria Locale Veneto 1, Santa Giustina, Belluno, Italy
| | - Edoardo Benedetto
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Laura Boscariolo
- General Pratictioner, Azienda Sanitaria Locale Veneto 1, Feltre, Belluno, Italy
| | - Rosanna Caneve
- General Pratictioner, Azienda Sanitaria Locale Veneto 1, Lamon, Belluno, Italy
| | - Fabio Chesani
- General Pratictioner, Azienda Provinciale Socio-Sanitaria Trento, Trento, Italy
| | - Francesco Chiumeo
- General Pratictioner, Azienda Provinciale Socio-Sanitaria Trento, Civezzano, Trento, Italy
| | - Zinaida Civic
- General Pratictioner, Azienda Sanitaria Locale Veneto 1, Feltre, Belluno, Italy
| | - Antonio Dainese
- General Pratictioner, Azienda Provinciale Socio-Sanitaria Trento, Stenico, Trento, Italy
| | - Manuela DE Polo
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Giuseppe Disclafani
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Ignazio Grattagliano
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Ornella Mana
- General Pratictioner, Azienda Provinciale Socio-Sanitaria Trento, Trento, Italy
| | - Maurizio Mancuso
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Tecla Mastronuzzi
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Antonino Pati
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Enzo Pirrotta
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy -
| | - Maurizio Salandini
- General Pratictioner, Azienda Provinciale Socio-Sanitaria Trento, Trento, Italy
| | - Guido Sanna
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Riccardo Scoglio
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Pietro Severino
- General Pratictioner, Azienda Provinciale Socio-Sanitaria Trento, Trento, Italy
| | - Cesare Tosetti
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Leyla Turnava
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Maria Zamparella
- GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy
| | - Walter Elisei
- Division of Gastroenterology, S. Camillo Hospital, Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Sacred Heart Catholic University, Rome, Italy
| | - Antonio Tursi
- Territorial Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, Andria, Barletta-Andria-Trani, Italy
- Post-graduate School of Digestive Diseases, Department of Medical and Surgical Sciences, Sacred Heart Catholic University, Rome, Italy
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Chiumeo F, Folloni S. Chronic obstructive pulmonary disease and heart failure: research and clinical practice in primary care. Ital J Med 2015. [DOI: 10.4081/itjm.2015.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The treatment of chronic obstructive pulmonary disease (COPD) and comorbidities, increasing with age, is the challenge that nowadays health care systems are facing to better care treat these patients. For this reason a clinical trial was conducted in the province of Trento by a group of 30 volunteer general practitioners members of SNAMID (Scientific Society for Continuing Medical Education of General Practitioners). The objectives were to identify: i) prevalence of COPD in patients (65-98 years) in the province of Trento; ii) presence and incidence of heart failure (HF) in COPD patients; iii) early detection of other chronic diseases; and iv) improving electronic medical records (EMR) as an innovation way of professional care management. From May 2011 to October 2013, 17 doctors completed the two-year work using the EMR. The studied patients were men and women (65-98 years), suffering from COPD; the considered data included: anthropometric information, smoking status, International Classification of Diseases (ICD)-9 diagnosis of COPD, HF and chronic diseases, specific blood and instrumental tests. The extracted results were then linked with data of <em>sentinel</em> therapies, collected by the EMR. The database obtained identified patients with COPD or HF not previously recognized with ICD-9 diagnosis. The study identified the <em>sentinel</em> drugs chosen for COPD and HF, excluding other drugs not selective for the study or confusing for a proper statistical evaluation.
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Petrazzuoli F, Palmqvist S, Thulesius H, Buono N, Pirrotta E, Cuffari A, Cambielli M, D'Urso M, Farinaro C, Chiumeo F, Marsala V, Wiig EH. A Quick Test of Cognitive Speed: norm-referenced criteria for 121 Italian adults aged 45 to 90 years. Int Psychogeriatr 2014; 26:1-8. [PMID: 24810919 DOI: 10.1017/s1041610214000787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 11/07/2022]
Abstract
ABSTRACT Background: A Quick Test of Cognitive Speed (AQT) is a brief test that can identify cognitive impairment. AQT has been validated in Arabic, English, Greek, Japanese, Norwegian, Spanish, and Swedish. The aim of this study was to develop Italian criterion-referenced norms for AQT. Methods: AQT consists of three test plates where the patient shall rapidly name (1) the color of 40 blue, red, yellow, or black squares (AQT color), (2) the form of 40 black figures (circles, squares, triangles, or rectangles; AQT form), (3) the color and form of 40 figures (consisting of previous colors and forms; AQT color-form). The AQT test was administered to 121 Italian cognitively healthy primary care patients (age range: 45-90 years). Their mean Mini-Mental State Examination (MMSE) score was 28.8 ± 0.9 points (range 26-30 points). AQT naming times in seconds were used for developing preliminary criterion cut-off times for different age groups. Results: Age was found to have a significant moderate positive correlation with AQT naming times color (r = 0.65, p < 0.001), form (r = 0.53, p < 0.001), color-form (r = 0.63, p < 0.001) and a moderate negative correlation with MMSE score (r = -0.44, p < 0.001) and AQT naming times differed significantly between younger (45-55 years old), older (56-70 years old), and the oldest (71-90 years old) participants. Years of education correlated positively but weakly with MMSE score (r = 0.27, p = 0.003) and negatively but weakly with AQT color (r = -0.16, p = ns), form (r = -0.24, p = 0.007), and color-form (r = -0.19, p = 0.005). We established preliminary cut-off times for the AQT test based on +1 and +2 standard deviations according to the approach in other languages and settings. Conclusions: This is the first Italian normative AQT study. Future studies of AQT - a test useful for dementia screening in primary care - will eventually refine cut-off times for normality balancing sensitivity and specificity in cognitive diagnostics.
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Affiliation(s)
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Hans Thulesius
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Nicola Buono
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Enzo Pirrotta
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Alfredo Cuffari
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Marco Cambielli
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Maurizio D'Urso
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Carmine Farinaro
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Francesco Chiumeo
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Valerio Marsala
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Elisabeth H Wiig
- Department of Communication Disorders, Boston University, Boston, Massachusetts, USA
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