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Efthymakis K, Bologna G, Simeone P, Pierdomenico L, Catitti G, Vespa S, Milano A, De Bellis D, Laterza F, Pandolfi A, Pipino C, Sallese M, Marchisio M, Miscia S, Neri M, Lanuti P. Circulating Extracellular Vesicles Are Increased in Newly Diagnosed Celiac Disease Patients. Nutrients 2022; 15:nu15010071. [PMID: 36615729 PMCID: PMC9824360 DOI: 10.3390/nu15010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/10/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
Extracellular vesicles (EVs) are a class of circulating entities that are involved in intercellular crosstalk mechanisms, participating in homeostasis maintenance, and diseases. Celiac disease is a gluten-triggered immune-mediated disorder, characterized by the inflammatory insult of the enteric mucosa following local lymphocytic infiltration, resulting in villous atrophy. The goal of this research was the assessment and characterization of circulating EVs in celiac disease patients, as well as in patients already on an adequate gluten-free regimen (GFD). For this purpose, a novel and validated technique based on polychromatic flow cytometry that allowed the identification and enumeration of different EV sub-phenotypes was applied. The analysis evidenced that the total, annexin V+, leukocyte (CD45+), and platelet (CD41a+) EV counts were significantly higher in both newly diagnosed celiac disease patients and patients under GFD compared with the healthy controls. Endothelial-derived (CD31+) and epithelial-derived (EpCAM+) EV counts were significantly lower in subjects under gluten exclusion than in celiac disease patients, although EpCAM+ EVs maintained higher counts than healthy subjects. The numbers of EpCAM+ EVs were a statistically significant predictor of intraepithelial leukocytes (IEL). These data demonstrate that EVs could represent novel and potentially powerful disease-specific biomarkers in the context of celiac disease.
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Affiliation(s)
- Konstantinos Efthymakis
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Digestive Endoscopy and Gastroenterology Unit, SS Annunziata Hospital, ASL2 Abruzzo, 66100 Chieti, Italy
| | - Giuseppina Bologna
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Pasquale Simeone
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Correspondence:
| | - Laura Pierdomenico
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Giulia Catitti
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Simone Vespa
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Angelo Milano
- Digestive Endoscopy and Gastroenterology Unit, SS Annunziata Hospital, ASL2 Abruzzo, 66100 Chieti, Italy
| | - Domenico De Bellis
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Laterza
- Digestive Endoscopy and Gastroenterology Unit, SS Annunziata Hospital, ASL2 Abruzzo, 66100 Chieti, Italy
| | - Assunta Pandolfi
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Caterina Pipino
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Michele Sallese
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Department of Innovative Technologies in Medicine & Dentistry, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
| | - Marco Marchisio
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Sebastiano Miscia
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Matteo Neri
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Paola Lanuti
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
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Milano A, Efthymakis K, D’Ardes D, Tana M, Mazzotta E, De Febis G, Laterza F, Tarquini P, Marini E, Porreca E, Cipollone F, Neri M. Gastrointestinal manifestations of SARS-CoV-2 infection in an Italian population of hospitalized patients. Therap Adv Gastroenterol 2022; 15:17562848221104610. [PMID: 35757382 PMCID: PMC9218448 DOI: 10.1177/17562848221104610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/03/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus enters the cells via angiotensin-converting enzyme 2 receptor; therefore, tissues expressing this receptor are potential targets for infection. Although many studies have observed gastrointestinal (GI) symptoms in coronavirus disease 2019 (COVID-19) patients, prevalence and clinical impact are still uncertain due to the heterogeneity of reports and obstacles to generalization. METHODS In this cross-sectional study, we included symptomatic patients requiring hospital admission, with a confirmed diagnosis of COVID-19 by nasopharyngeal polymerase chain reaction test, between 18 March and 30 May 2020. Demographic data, symptoms at onset, vital signs, and laboratory tests at admission were recorded. RESULTS In all, 300 patients were included (57%M, 43%F). GI symptoms were mainly diarrhea (13%), anorexia (4.3%), vomiting (3%), and abdominal pain (2.3%). Overall, males were younger (68 years versus 76 years; p = 0.01); patients with GI manifestations at disease onset required significantly faster hospital admission and showed larger GI complication rates. GI symptoms were associated with abnormal high aspartate aminotransferase and alanine aminotransferase serum titers, especially in male patients. CONCLUSION Our study on an Italian population during the outbreak of the COVID-19 pandemic shows that GI symptoms are part of the spectrum of the SARS-CoV-2 infection and could be the only manifestations at disease onset. Although patients with GI symptoms were associated with faster hospital admission and liver involvement, prognosis was not affected.
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Affiliation(s)
- Angelo Milano
- UOSD Endoscopia Digestiva e Gastroenterologia, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy
| | - Konstantinos Efthymakis
- UOSD Endoscopia Digestiva e Gastroenterologia, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy
| | - Damiano D’Ardes
- Medicina Generale 1, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy
| | - Marco Tana
- Medicina Generale 2, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy
| | - Elena Mazzotta
- Malattie Infettive, Ospedale Civile ‘Giuseppe Mazzini’, ASL Teramo, Teramo, Italy
| | - Giulia De Febis
- Medicina Interna, Ospedale ‘San Liberatore’, ASL Teramo, Atri, Italy
| | - Francesco Laterza
- UOSD Endoscopia Digestiva e Gastroenterologia, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy
| | - Pierluigi Tarquini
- Malattie Infettive, Ospedale Civile ‘Giuseppe Mazzini’, ASL Teramo, Teramo, Italy
| | - Enrico Marini
- Medicina Interna, Ospedale ‘San Liberatore’, ASL Teramo, Atri, Italy
| | - Ettore Porreca
- Medicina Generale 2, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy,Department of Innovative Technologies in Medicine and Dentistry, University ‘G. D’Annunzio’, Chieti-Pescara, Chieti, Italy
| | - Francesco Cipollone
- Medicina Generale 1, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy,Department of Medicine and Ageing Sciences, University ‘G. D’Annunzio’, Chieti-Pescara, Chieti, Italy
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Vanella G, Hassan C, De Bellis M, Giardini M, Grasso E, Laterza F, Tarantino O, Di Giulio E. IMPlementing split Regimen OVEr Single dose using a Plan-Do-Study-Act approach (IMPROVES study). Endosc Int Open 2019; 7:E1457-E1467. [PMID: 31673618 PMCID: PMC6805191 DOI: 10.1055/a-0996-8118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/09/2019] [Accepted: 06/27/2019] [Indexed: 12/17/2022] Open
Abstract
Background and aims A split-dose regimen for colonoscopy is recommended by international guidelines, but its adoption is still suboptimal. Our aim was to assess whether a Plan-Do-Study-Act approach (PDSA), a scientific method promoting quality improvement, would be able to improve adherence to a split-dose regimen, and to identify factors influencing its adoption. Methods This study consisted of three phases: Cycle 1: a cross-sectional assessment of split-dose adherence in consecutive outpatients/inpatients undergoing colonoscopies in 74 Italian centers; Educational intervention: regional meetings with literature review, analysis of Cycle 1 data, and discussion on corrective measures; local diffusion of educational material and tools for improvement; Cycle 2: reassessment of split-dose adherence after spontaneous local interventions. Demographic, clinical, and procedural variables were systematically collected. Multivariate logistic regression was used to identify predictors of split-dose adoption. Results In total, 8213 patients (mean age = 60.29 years (SD = 13.58), men = 54 %, outpatients = 88.4 %) were enrolled between 2013 and 2016 (Cycle 1 = 4189 patients and Cycle 2 = 4024 patients). Split-dose adoption rose from 29.1 % in Cycle 1 to 51.1 % in Cycle 2 ( P < 0.0001), and being enrolled in Cycle 2 independently predicted split-dose adherence (OR = 2.9; 95 %CI 2.6 - 3.3). The adoption improved in all time slots, including colonoscopies scheduled before 0930. The main corrective measures were: rescheduling of colonoscopies after 0930 (between 0930 and 1130: OR = 2.6; 95 %CI 2.3 - 3.1; after 1130: OR = 7; 95 %CI 5.9 - 8.4); the cleansing regimen communicated by the Endoscopy unit (via form: OR = 1.6; 95 %CI 1.3 - 1.9; via visit: OR = 2.1; 95 %CI 1.7 - 2.5); a decrease in the use of deep sedation (OR = 2; 95 %CI 1.7 - 2.5). Conclusions An educational intervention with observation-driven corrections through a PDSA approach was able to substantially increase the adoption of a split-dose regimen.
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Affiliation(s)
- Giuseppe Vanella
- Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Mario De Bellis
- Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | | | | | | | | | - Emilio Di Giulio
- Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy,Corresponding author Emilio Di Giulio, MD Sapienza University of RomeFaculty of Medicine and PsychologySant’Andrea University HospitalVia di Grottarossa, 1035-103900189 RomeItaly+39-06-33776692
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Efthymakis K, Serio M, Milano A, Laterza F, Bonitatibus A, Di Nicola M, Neri M. Application of the Biopsy-Sparing ESPGHAN Guidelines for Celiac Disease Diagnosis in Adults: A Real-Life Study. Dig Dis Sci 2017; 62:2433-2439. [PMID: 28717844 DOI: 10.1007/s10620-017-4672-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 04/27/2017] [Accepted: 07/04/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Current adult celiac disease diagnosis requires histological confirmation. However, pediatric guidelines have proposed biopsy-sparing algorithms. AIMS To explore the applicability of the ESPGHAN criteria and assess the accuracy of serology in predicting disease in adults. METHODS We evaluated 234 consecutive adults showing elevated anti-tTG titers, EMA-positivity, and genetic susceptibility. Patients underwent upper endoscopy with duodenal biopsy. We determined optimal anti-tTG cutoff levels using ROC curves. RESULTS Mean anti-tTG levels were 71.1 ± 66.5 U/ml; mean normalized levels were 14.8 ± 14.1 × ULN (mean ± SD). Partial/total villous atrophy was present in 36%/55% of cases, respectively. Anti-tTG levels correlated with histology (r s = 0.397, p < 0.001). AUC was similar before and after normalization (0.803 vs 0.807). Applying the ESPGHAN criterion (≥10 × ULN), we calculated a 97.66% PPV. ROC curve analysis showed an optimal cutoff of ≥16 × ULN, with a PPV of 98.86%. Eleven different assays were used for anti-tTG titer determination: Two were prevalent, labeled A (n = 141) and B (n = 59). They performed differently regarding disease prediction (AUC = 0.689 vs 0.925, p < 0.01), showing distinct optimal cutoff values (14.3 × ULN vs 3.7 × ULN), even after standardization (-0.14 vs -1.2). CONCLUSION In adult symptomatic patients showing EMA-positivity and genetic susceptibility, anti-tTG titers correlated with histology. ESPGHAN criteria performed similarly to previous studies. However, a calculated 16 × ULN cutoff showed an improved PPV. Among prevalent assays, PPV peaked differently both after normalization and standardization, indicating intrinsic differences in performance, thus preventing uniform prediction of disease in a real-life setting. Assay-specific optimal cutoffs seem possible, but would complicate diagnostic criteria. However, biopsy-sparing strategies in adults could prove useful in challenging patients.
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Affiliation(s)
- Konstantinos Efthymakis
- Department of Medicine and Ageing Sciences and Center for Excellence On Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Mariaelena Serio
- Department of Medicine and Ageing Sciences and Center for Excellence On Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Angelo Milano
- Department of Medicine and Ageing Sciences and Center for Excellence On Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Francesco Laterza
- Department of Medicine and Ageing Sciences and Center for Excellence On Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Antonella Bonitatibus
- Department of Medicine and Ageing Sciences and Center for Excellence On Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences and Center for Excellence On Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy.
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Filiberti RA, Fontana V, De Ceglie A, Blanchi S, Grossi E, Della Casa D, Lacchin T, De Matthaeis M, Ignomirelli O, Cappiello R, Rosa A, Foti M, Laterza F, D'Onofrio V, Iaquinto G, Conio M. Association between coffee or tea drinking and Barrett's esophagus or esophagitis: an Italian study. Eur J Clin Nutr 2017; 71:980-986. [PMID: 28488688 DOI: 10.1038/ejcn.2017.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 02/01/2017] [Accepted: 04/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Only a few papers have treated of the relationship between Barrett's esophagus (BE) or erosive esophagitis (E) and coffee or tea intake. We evaluated the role of these beverages in BE and E occurrence. SUBJECTS/METHODS Patients with BE (339), E (462) and controls (619) were recruited. Data on coffee and tea and other individual characteristics were collected using a structured questionnaire. RESULTS BE risk was higher in former coffee drinkers, irrespective of levels of exposure (cup per day; ⩽1: OR=3.76, 95% CI 1.33-10.6; >1: OR=3.79, 95% CI 1.31-11.0; test for linear trend (TLT) P=0.006) and was higher with duration (>30 years: OR=4.18, 95% CI 1.43-12.3; TLT P=0.004) and for late quitters, respectively (⩽3 years from cessation: OR=5.95, 95% CI 2.19-16.2; TLT P<0.001). The risk of BE was also higher in subjects who started drinking coffee later (age >18 years: OR=6.10, 95% CI 2.15-17.3). No association was found in current drinkers, but for an increased risk of E in light drinkers (<1 cup per day OR =1.85, 95% CI 1.00-3.43).A discernible risk reduction of E (about 20%, not significant) and BE (about 30%, P<0.05) was observed in tea drinkers. CONCLUSIONS Our data were suggestive of a reduced risk of BE and E with tea intake. An adverse effect of coffee was found among BE patients who had stopped drinking coffee. Coffee or tea intakes could be indicative of other lifestyle habits with protective or adverse impact on esophageal mucosa.
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Affiliation(s)
- R A Filiberti
- Clinical Epidemiology, IRCCS AOU San Martino- IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - V Fontana
- Clinical Epidemiology, IRCCS AOU San Martino- IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - A De Ceglie
- Gastroenterology, General Hospital, Sanremo, Imperia, Italy
| | - S Blanchi
- Gastroenterology, General Hospital, Sanremo, Imperia, Italy
| | - E Grossi
- Medical Department, Bracco Spa, Milan, Italy
| | - D Della Casa
- Digestive Endoscopic Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - T Lacchin
- Endoscopy, Policlinico San Giorgio, Pordenone, Italy
| | - M De Matthaeis
- Gastroenterology and Digestive Endoscopy, Ospedale di Lavagna, Lavagna, Italy
| | - O Ignomirelli
- Endoscopy, IRCCS, Rionero in Vulture, Potenza, Italy
| | - R Cappiello
- Gastroenterology, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - A Rosa
- Clinical Epidemiology, IRCCS AOU San Martino- IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - M Foti
- Gastroenterology, LARC private Clinic, Torino, Italy
| | - F Laterza
- Internal Medicine and Gastroenterology, University &Foundation, Chieti, Italy
| | - V D'Onofrio
- Gastroenterology and Digestive Endoscopy, S. G. Moscati Hospital, Avellino, Italy
| | - G Iaquinto
- Gastroenterology and Digestive Endoscopy, S. G. Moscati Hospital, Avellino, Italy
| | - M Conio
- Gastroenterology, General Hospital, Sanremo, Imperia, Italy
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Efthymakis K, Milano A, Laterza F, Serio M, Neri M. Iron deficiency anemia despite effective gluten-free diet in celiac disease: Diagnostic role of small bowel capsule endoscopy. Dig Liver Dis 2017; 49:412-416. [PMID: 28065527 DOI: 10.1016/j.dld.2016.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 10/13/2016] [Revised: 12/01/2016] [Accepted: 12/05/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIM Iron deficiency anemia (IDA) is associated with celiac disease (CD). Although gluten-free diet (GFD) is an efficient treatment for CD, IDA remains an occasional finding during follow-up and correlates to inadequate gluten exclusion. Little is known regarding persistent IDA despite effective GFD. We aimed to evaluate the role of small bowel capsule endoscopy (SBCE) in this setting. METHODS We prospectively included consecutive patients undergoing GFD for ≥24 months with persistent concomitant IDA. Patients were assessed serologically and, if negative, underwent endoscopic evaluation. RESULTS Twenty-six patients underwent esophago-gastro-duodenoscopy (EGD), colonoscopy and SBCE. Altogether, 11 patients resulted positive. EGD showed mucosal lesions in 7: erosive gastritis (n=3), erosive duodenitis (n=1), active CD (n=3). Colonoscopy showed hemorrhoids in 2. SBCE was positive in 6 cases: erosive jejunitis (n=3, 1 eventually diagnosed as refractory CD, 2 as Crohn's disease), angiodysplasias (n=2), lymphangectasia (n=1). Some overlap was observed between procedures, since in 4 subjects EGD and SBCE produced significant findings. However, in 3 cases SBCE documented severe disease, not found at EGD. Hypoalbuminemia was significantly associated with a positive SBCE outcome (p<0.01). CONCLUSION SBCE yielded significant findings in 23% of celiacs with persistent IDA despite adequate GFD. These were associated to hypoalbuminemia, indicating their occurrence at more severe stages of the disease.
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Affiliation(s)
- Konstantinos Efthymakis
- Department of Medicine and Ageing Sciences and Center for Excellence on Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Angelo Milano
- Department of Medicine and Ageing Sciences and Center for Excellence on Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Francesco Laterza
- Department of Medicine and Ageing Sciences and Center for Excellence on Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Mariaelena Serio
- Department of Medicine and Ageing Sciences and Center for Excellence on Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences and Center for Excellence on Ageing and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University and Foundation, Chieti, Italy.
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Filiberti RA, Fontana V, De Ceglie A, Blanchi S, Grossi E, Della Casa D, Lacchin T, De Matthaeis M, Ignomirelli O, Cappiello R, Rosa A, Foti M, Laterza F, D'Onofrio V, Iaquinto G, Conio M. Alcohol consumption pattern and risk of Barrett's oesophagus and erosive oesophagitis: an Italian case-control study. Br J Nutr 2017; 117:1151-1161. [PMID: 28478792 DOI: 10.1017/s0007114517000940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Knowledge about the association between alcohol and Barrett's oesophagus and reflux oesophagitis is conflicting. In this case-control study we evaluated the role of specific alcoholic beverages (red and white wine, beer and liquors) in 339 Barrett's oesophagus and 462 oesophagitis patients compared with 619 endoscopic controls with other disorders, recruited in twelve Italian endoscopic units. Data on alcohol and other individual characteristics were obtained from structured questionnaires. No clear, monotonic significant dose-response relationship was pointed out for red wine. However, a generalised U-shaped trend of Barrett's oesophagus/oesophagitis risk due to red wine consumption particularly among current drinkers was found. Similar results were also found for white wine. Liquor/spirit consumption seemed to bring about a 1·14-2·30 risk excess, although statistically non-significant, for current Barrett's oesophagus/oesophagitis drinkers. Statistically significant decreasing dose-response relationships were found in Barrett's oesophagus for frequency and duration of beer consumption. Similar, but less clear downward tendencies were also found for oesophagitis patients. In conclusion, although often not statistically significant, our data suggested a reduced risk of Barrett's oesophagus and oesophagitis with a low/moderate intake of wine and beer consumption. A non-significant increased risk of Barrett's oesophagus/oesophagitis was observed with a higher intake of any type of heavy alcohol consumption, but no conclusion can be drawn owing to the high number of non-spirit drinkers and to the small number of drinkers at higher alcohol intake levels.
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Affiliation(s)
- Rosa A Filiberti
- 1Clinical Epidemiology,IRCCS AOU San Martino-IST,Largo R Benzi 10,16132 Genova,Italy
| | - Vincenzo Fontana
- 1Clinical Epidemiology,IRCCS AOU San Martino-IST,Largo R Benzi 10,16132 Genova,Italy
| | - Antonella De Ceglie
- 2Gastroenterology,General Hospital,Via G Borea 56,18038 Sanremo,Imperia,Italy
| | - Sabrina Blanchi
- 2Gastroenterology,General Hospital,Via G Borea 56,18038 Sanremo,Imperia,Italy
| | - Enzo Grossi
- 3Medical Department,Bracco Spa,Via E Folli 50,20134 Milan,Italy
| | - Domenico Della Casa
- 4Digestive Endoscopic Surgery,Spedali Civili di Brescia,Piazzale Spedali Civili 1,25123 Brescia,Italy
| | - Teresa Lacchin
- 5Endoscopy,Policlinico San Giorgio,Via Gemelli 10,33170 Pordenone,Italy
| | - Marina De Matthaeis
- 6Gastroenterology and Digestive Endoscopy,Ospedale di Lavagna,ASL 4 Chiavarese,Via Don Bobbio 25,16033 Lavagna,Italy
| | - Orazio Ignomirelli
- 7Endoscopy,IIRCCS,Centro di Riferimento Oncologico di Basilicata,Via Padre Pio 1,85028 Rionero in Vulture,Potenza,Italy
| | - Roberta Cappiello
- 8Gastroenterology,S. Maria degli Angeli Hospital,Via Piave 54,33170 Pordenone,Italy
| | - Alessandra Rosa
- 1Clinical Epidemiology,IRCCS AOU San Martino-IST,Largo R Benzi 10,16132 Genova,Italy
| | - Monica Foti
- 9Gastroenterology,LARC Private Clinic,Cso Venezia 10,10155 Torino,Italy
| | - Francesco Laterza
- 10Department of Internal Medicine,Unit of Endoscopy and Gastroenterology,University Hospital SS.Annunziata, G.D'Annunzio University,Via dei Vestini,66100 Chieti,Italy
| | - Vittorio D'Onofrio
- 11Gastroenterology and Digestive Endoscopy,S. G. Moscati Hospital,Via San Giuseppe Moscati,83100 Avellino,Italy
| | - Gaetano Iaquinto
- 11Gastroenterology and Digestive Endoscopy,S. G. Moscati Hospital,Via San Giuseppe Moscati,83100 Avellino,Italy
| | - Massimo Conio
- 2Gastroenterology,General Hospital,Via G Borea 56,18038 Sanremo,Imperia,Italy
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8
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Abstract
Gestational diabetes mellitus (GDM) is defined as a glucose intolerance that occurs for the first time or it is first identified during pregnancy. The GDM etiology is multifactorial. It has not completely been established yet and several known risk factors may contribute to its onset. To date, there are no shared guidelines on the management and follow-up, especially regarding the low-income countries. In this paper, we describe the state of art about epidemiology, physiopathology, diagnosis, and management of GDM. Moreover, we focus on the current state in low income countries trying to outline basis for further research.
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9
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Filiberti R, Fontana V, De Ceglie A, Blanchi S, Grossi E, Della Casa D, Lacchin T, De Matthaeis M, Ignomirelli O, Cappiello R, Foti M, Laterza F, Annese V, Iaquinto G, Conio M. Smoking as an independent determinant of Barrett's esophagus and, to a lesser degree, of reflux esophagitis. Cancer Causes Control 2015; 26:419-29. [PMID: 25555994 DOI: 10.1007/s10552-014-0518-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/19/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the role of smoking in Barrett's esophagus (BE) and erosive esophagitis (E) compared to endoscopic controls with no BE or E. Smoking is considered a cause of both BE and E, but results on this topic are quite controversial. METHODS Patients with BE (339), E (462) and controls (619: 280 with GERD (gastroesophageal reflux disease)-negative and 339 with GERD-positive anamnesis) were recruited in 12 Italian endoscopy units. Data were obtained from structured questionnaires. RESULTS Among former smokers, a remarkable upward linear trend was found in BE for all smoking-related predictors. In particular, having smoked for more than 32 years increased the risk more than two times (OR 2.44, 95 % CL 1.33-4.45). When the analysis was performed in the subgroup of subjects with GERD-negative anamnesis, the risk of late quitters (<9 years) passed from OR 2.11 (95 % CL 1.19-3.72) to OR 4.42 (95 % CL 1.52-12.8). A noticeably positive dose-response relationship with duration was seen also among current smokers. As regards E, no straightforward evidence of association was detected, but for an increased risk of late quitters (OR 1.84, 95 % CL 1.14-2.98) in former smokers and for early age at starting (OR 3.63, 95 % CL 1.19-11.1) in GERD-negative current smokers. CONCLUSIONS Smoking seems to be an independent determinant of BE and, to a lesser degree, of E. The elevation in risk is independent from GERD and is already present in light cigarette smokers. Smoking cessation may reduce, but not remove this risk.
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Affiliation(s)
- Rosa Filiberti
- Clinical Epidemiology, IRCCS AOU San Martino- IST-Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi, 10, 16132, Genoa, Italy,
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10
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Efthymakis K, Massacesi C, Milano A, Laterza F, Tafuri E, Cipollone F, Neri M. Acute esophageal necrosis: possible association with terlipressin. Endoscopy 2014; 46 Suppl 1 UCTN:E279-80. [PMID: 24906100 DOI: 10.1055/s-0034-1365789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Konstantinos Efthymakis
- Department of Medicine and Ageing Sciences, Section of Internal Medicine and Center for Excellence on Ageing (Ce.S.I.), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Chiara Massacesi
- Department of Medicine and Ageing Sciences, Section of Internal Medicine and Center for Excellence on Ageing (Ce.S.I.), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Angelo Milano
- Department of Medicine and Ageing Sciences, Section of Internal Medicine and Center for Excellence on Ageing (Ce.S.I.), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Francesco Laterza
- Department of Medicine and Ageing Sciences, Section of Internal Medicine and Center for Excellence on Ageing (Ce.S.I.), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Emanuele Tafuri
- Department of Medicine and Ageing Sciences, Section of Internal Medicine and Center for Excellence on Ageing (Ce.S.I.), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Ageing Sciences, Section of Internal Medicine and Center for Excellence on Ageing (Ce.S.I.), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences, Section of Internal Medicine and Center for Excellence on Ageing (Ce.S.I.), "G. D'Annunzio" University and Foundation, Chieti, Italy
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11
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Genovesi D, Mazzilli L, Trignani M, DI Tommaso M, Nuzzo A, Biondi E, Tinari N, Martino MT, Innocenti P, DI Sebastiano P, Mazzola L, Lanci C, Neri M, Laterza F, Marino M, Ferrini G, Spadaccini A, Filippone A, DI Giandomenico E, Marulli A, Palombo G, Sparvieri A, Marchetti A, Pizzicannella G, Petrini F, DI Felice M, Ottaviani F, Monteodorisio A, DI Nicola M, Cefaro GA. Developing a decision-making model based on an interdisciplinary oncological care group for the management of colorectal cancer. Anticancer Res 2014; 34:2525-2531. [PMID: 24778070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To report our experience on implementation and preliminary results of a decision-making model based on the recommendations of an Interdisciplinary Oncological Care Group developed for the management of colorectal cancer. PATIENTS AND METHODS The multidisciplinary team identified a reference guideline using appraisal of guidelines for research and evaluation (AGREE) tool based on a sequential assessment of the guideline quality. Thereafter, internal guidelines with diagnostic and therapeutic management for early, locally advanced and metastatic colonic and rectal cancer were drafted; organizational aspects, responsibility matrices, protocol actions for each area of specialty involved and indicators for performing audits were also defined. RESULTS The National Institute for Health and Care Excellence (NICE) UK guideline was the reference for drafting the internal guideline document; from February to November 2013, 125 patients with colorectal cancer were discussed by and taken under the care of the Interdisciplinary Oncological Care Group. The first audit performed in December 2013 revealed optimal adherence to the internal guideline, mainly in terms of uniformity and accuracy of perioperative staging, coordination and timing of multi-modal therapies. To date, all patients under observation are within the diagnostic and therapeutic course, no patient came out from the multidisciplinary "path" and only in 14% of cases have the first recommendations proposed been changed. The selected indicators appear effective and reliable, while at the moment, it is not yet possible to assess the impact of the multidisciplinary team on clinical outcome. CONCLUSION Although having a short observation period, our model seems capable of determining optimal uniformity of diagnostic and therapeutic management, to a high degree of patient satisfaction. A longer observation period is necessary in order to confirm these observations and for assessing the impact on clinical outcome.
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Affiliation(s)
- Domenico Genovesi
- Department of Radiotherapy SS. Annunziata Hospital, via dei Vestini, 66100 Chieti, Italy.
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12
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De Ceglie A, Filiberti R, Blanchi S, Fontana V, Fisher DA, Grossi E, Lacchin T, De Matthaeis M, Ignomirelli O, Cappiello R, Casa DD, Foti M, Laterza F, Rosati R, Annese V, Iaquinto G, Conio M. History of cancer in first degree relatives of Barrett's esophagus patients: a case-control study. Clin Res Hepatol Gastroenterol 2011; 35:831-8. [PMID: 21924696 DOI: 10.1016/j.clinre.2011.07.015] [Citation(s) in RCA: 7] [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] [Received: 06/28/2011] [Accepted: 07/26/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Familial clusters of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) have been reported. This study evaluates the history of cancer in BE patients families. METHODS In two years, patients with BE (272), esophagitis (456) and controls (517) were recruited in 12 Italian Endoscopy Units. Cancer family history in first-degree (FD) relatives was determined by a questionnaire. RESULTS Approximately 53% of BE, 51% of esophagitis, and 48% of controls had at least one relative affected by any type of malignancy. Probands with at least one esophageal or gastric (E/G) cancer-affected relative showed a BE risk which was at least eighty-five percent higher than that of probands without affected relatives. The relative risk of BE was 4.18, 95% CL=0.76-23.04 if a FD relative had early (mean age ≤ 50 years) onset E/G cancer compared to late onset E/G cancer. CONCLUSION In this sample there was no evidence that a family history of cancer was associated with the diagnosis of BE. An intriguing result was the association between the occurrence of E/G cancers at earlier ages (< 50 years) among BE relatives with respect the control group. This could suggest a genetic contribution in onset of these tumors, but the sample was too small to demonstrate a significant association. Further exploration of family history of E/G cancer and a diagnosis of BE in larger samples is warranted.
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Affiliation(s)
- Antonella De Ceglie
- Unit of Digestive Endoscopy, Cancer Institute Giovanni Paolo II, Bari, Italy
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13
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Milano A, Balatsinou C, Filippone A, Caldarella MP, Laterza F, Lapenna D, Pierdomenico SD, Pace F, Cuccurullo F, Neri M. A prospective evaluation of iron deficiency anemia in the GI endoscopy setting: role of standard endoscopy, videocapsule endoscopy, and CT-enteroclysis. Gastrointest Endosc 2011; 73:1002-8. [PMID: 21396638 DOI: 10.1016/j.gie.2011.01.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [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] [Received: 09/05/2010] [Accepted: 01/03/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Iron deficiency anemia (IDA) is a frequently encountered condition in clinical practice. After conventional endoscopy, the cause of anemia remains unknown in up to 40% of patients. OBJECTIVE To evaluate prospectively the diagnostic efficacy of a systematic endoscopic approach to IDA and to compare the diagnostic yield of videocapsule endoscopy (VCE) and CT-enteroclysis in endoscopy-negative patients. DESIGN Consecutive patients with IDA were enrolled prospectively. SETTING Open-access endoscopy within an academic hospital. PATIENTS This study involved 189 patients with IDA, including 98 women and 91 men; mean (±standard deviation) age 68 years±16.6 years. INTERVENTION Patients with IDA underwent gastroscopy and colonoscopy plus ileoscopy. Endoscopy-negative patients were further blindly evaluated by both CT-enteroclysis and VCE. MAIN OUTCOME MEASUREMENTS Diagnostic yield of conventional endoscopy; diagnostic yield of VCE versus CT-enteroclysis. RESULTS Endoscopy results were positive in 144 of 189 patients (76.2%). CT-enteroclysis and VCE allowed a diagnosis in 37 of 45 endoscopy-negative patients (82.2%). Overall, VCE was superior to CT-enteroclysis (77.8% vs 22.2%; P<.001), in particular when flat lesions were found. LIMITATIONS Single-center study. CONCLUSION A systematic approach to IDA, which includes standard endoscopy, VCE, and CT-enteroclysis allows an overall diagnostic rate of 95.7%; however, CT-enteroclysis should be limited to cases of nondiagnostic VCE.
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Affiliation(s)
- Angelo Milano
- Department of Medicine and Aging Sciences, Section of Internal Medicine and Gastroenterology and Center for Excellence on Ageing (Ce.S.I.), G.D'Annunzio University and Foundation, Chieti, Italy
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14
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Malvasi A, Tinelli A, Brizzi A, Guido M, Laterza F, De Nunzio G, Bochicchio M, Ghi T, Stark M, Benhamou D, Di Renzo GC. Intrapartum sonography head transverse and asynclitic diagnosis with and without epidural analgesia initiated early during the first stage of labor. Eur Rev Med Pharmacol Sci 2011; 15:518-523. [PMID: 21744746] [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: 05/31/2023]
Abstract
PURPOSE To investigate if early epidural analgesia can influence fetal head engagement into the pelvis and if it can increase the rate of transverse and asynclitic position during labour. MATERIALS AND METHODS 195 women with combined spinal-epidural analgesia (CSE) or without neuraxial analgesia were studied. CSE was performed using a mixture of ropivacaine 0.02% with 0.3 microg/ml of sufentanil administered in the spinal space. Maintenance of analgesia was managed with intermittent epidural administration of 10-15 ml of ropivacaine (0.07%-0.10%) mixed with 0.5 microg/ml of sufentanil, based on the stage of labour and the degree of pain. 2D transabdominal ultrasound (US) was used. Serial transabdominal US examinations were performed at 45-90 min intervals to detect transverse and asynclitic positions, using the following signs: squint sign, sunset thalamus and cerebellum signs that best details the fetal head station. After delivery, the complete set of clinical and US data obtained by each examination were recorded and compared in women with and without labour analgesia. Data were examined by independent reviewers. RESULTS There was no difference in obstetric outcome between women in whom CSE had been used and those who did not request analgesia during labour (p > 0.05). CONCLUSIONS Epidural analgesia initiated early during labour and using low doses does not increase the rate of dystocic labors. Transverse fetal head positioning with anterior or posterior asynclitism does not seem to be promoted by drug or technique-related mechanisms, but rather should be the consequence of cephalopelvic disproportion.
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Affiliation(s)
- A Malvasi
- Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy.
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15
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Dell'Edera D, Pacella E, Epifania AA, Benedetto M, Tinelli A, Mazzone E, Laterza F, Malvasi A. Importance of molecular biology in the characterization of beta-thalassemia carriers. Eur Rev Med Pharmacol Sci 2011; 15:79-86. [PMID: 21381502] [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: 05/30/2023]
Abstract
OBJECTIVES The term beta-thalassemia includes all those hereditary disturbances of the hemoglobin (Hb), transferred trough a recessive autosomal mechanism, due to a reduced or else defective synthesis of beta globin sequences. The aim of this paper is to highlight as sometimes the only biochemical diagnosis is not exhaustive and a molecular diagnostic widening is necessary to detect the genetic deficiency that is the reason of the beta-thalassemic trait. CASE REPORT AND RESULTS To improve this theory the following clinical case is reported: a 29 years old girl that was 11 weeks pregnant addressed us to receive the prenatal screening test related to the first three-month pregnancy period. The biochemical and hematological tests highlighted that Mrs. D.F. was a carrier of the beta-thalassemic trait, (MCV 63fl decrease, MCH 30pg, HbA2: 4.4 increase, HbF:1.5 increase, red blood cells 5.92 x 10(6)/ul and Hb 12.4 g/dl), that has been confirmed trough our molecular analysis (genotype: beta+IVS1.110 G --> A in heterozigosys). More difficult to be realized was the case of Mr. B.A.: he showed an uncertain hematological picture labeled as "compatible with a alpha-thalassemia picture" (MCV 62.9fl decrease, MCH 21.4pg decrease, HbA2: 2.7, HbF: 1.0, red blood cells 5.33 x10(6)/ul, Hb 11.4 g/dl decrease). This picture revealed difficult to be understood because of the regularity of HbA2 (2.7%) that was in contrast with the value of the MCV (62.9). In situation like this only the molecular diagnosis allows correctly highlighting the specific typology of thalassemia the subject is carrier of. As a matter of fact the molecular analysis excluded the possibility that Mr. B.A. was a alpha-thalassemia carrier and pointed out that he was a healthy carrier of beta-thalassemia (genotype beta degrees 39C --> T in heterozigosys). In the light of what has been explained above, the couple has been informed about risks to beget child suffering from beta-thalassemia and together with the married couple has been decided to work out a prenatal diagnosis through a sample of chorionic villus. DISCUSSION AND CONCLUSIONS The identification of these particular cases fixes important implications about the prenatal diagnosis approach. The correct characterization of the healthy carrier is absolutely necessary with a subsequent study in depth of the partner's situation. It is important to highlight the importance of a careful study of hematological parameters and a widespread and correct information about clinical implication connected to the complications of the beta-thalassemia. As to this subject, the molecular study of the defect of the gene let to point out couples that run the risk of beta-thalassemia and to develop an exhaustive and correct information about the possibility to beget children suffering from beta-thalassemia. If two carrier partners wish to have children they can chose among the following possibilities: they can be well informed about the risk and accept the possibility to beget a child suffering from beta-thalassemia, they can give up the idea of having children or they can decide to beget children however but to avoid the possibility that the same suffers of thalassemia they can ask for a prenatal diagnosis.
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Affiliation(s)
- D Dell'Edera
- Unit of Cytogenetic and Molecular Genetics -"Madonna delle Grazie" Hospital, Matera, Italy.
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16
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Pacella E, Malvasi A, Tinelli A, Laterza F, Dell'Edera D, Pacella F, Mazzeo F, Ferraresi A, Malarska KG, Cavallotti C. Stickler syndrome in Pierre-Robin sequence prenatal ultrasonographic diagnosis and postnatal therapy: two cases report. Eur Rev Med Pharmacol Sci 2010; 14:1051-1054. [PMID: 21375138] [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: 05/30/2023]
Abstract
The Pierre-Robin Syndrome (PRS) is a rare congenital abnormality, with an approximately 1/30,000 estimated rate, characterized by the presence of the combination of mandibular hypoplasia (micrognathia or small jaw), glossoptosis (retrusion of the tongue into the pharyngeal airway) and, often, a posterior cleft of the secondary palate. It may be an isolated occurrence or part of a more complex syndrome and it is associated with long-term respiratory, nutritional, and developmental difficulties. Stickler syndrome (SS) is a rare autosomal dominant connective tissue disorder estimated to affect approximately 1/7500 newborns. It is diagnosed clinically and, at present, there is no consensus on a minimal clinical diagnostic criterion. The most frequent diagnosis in patients with syndromic Pierre Robin sequence is Stickler syndrome, which may be complicated by congenital high myopia and substantial risk of retinal detachment. However, cases of Stickler syndrome with probable visual complications are rarely identified among this group of patients by members of the cleft team. The patient had an acute unilateral hydrops, with a monolateral keratoconus. The ocular abnormalities included: severe myopia, abnormalities of the vitreous, and high risk of retinal detachment (with subsequent blindness). We report two extremely rare cases of prenatal diagnosis of PRS and SS, prematurely identified by prenatal ultrasonography and successively managed by oculists ophthalmogists.
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Affiliation(s)
- E Pacella
- Department of Ophtalmology, Sapienza University, Rome, Italy
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17
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Dell'Edera D, Malvasi A, Vitullo E, Epifania AA, Tinelli A, Laterza F, Novelli A, Pacella E, Mazzone E, Novelli G. Androgen insensitivity syndrome (or Morris syndrome) and other associated pathologies. Eur Rev Med Pharmacol Sci 2010; 14:947-957. [PMID: 21284344] [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: 05/30/2023]
Abstract
BACKGROUND The androgen insensitivity syndrome (AIS) is a disease connected with the inactivation of AR due to a mutation that inactivate male sexual differentiation, and causes a spectrum of phenotypic anomalies having as a common aspect the loss of reproductive characteristics. PATIENTS In this paper the clinical, endocrinological and molecular features of three patients are reported. The first case concerns a 17 years old patient, the second an infant suffering from inguinal hernia that has been surgically corrected when he was 3 months old and finally the third case concerns a 57 years old woman. RESULTS All the subjects had a common primary amenorrhea and a following pelvic echography highlighted the absence of internal genital organs and the presence of a dead-end vagina. All the patients are characterized by a normal male karyotype and present on the short arm of the Y chromosome the SRY gene. Moreover, FISH revealed the presence of androgen receptor gene on the X chromosome and the SRY gene on the Y one. The automatic sequencing of the genes for the androgen receptor (AR) shows that each subject has a mutation in the gene for the androgen receptor (AR). These mutations are associated with complete androgen insensivity syndrome (CAIS). All the cases of study exhibited a negative family history for CAIS. CONCLUSION This study confirms the need to perform a pelvic examination by means of echography in pre-pubertal and pubertal age to highlight the normality of the internal genitalia (uterus and ovaries). If a primary amenorrhea is checked, the karyotyping is compulsory. If a Morris's syndrome is suspected, it is of critical importance to find the rudimentary male gonads (by means of MRI, pelvic echography, laparoscopy) and surgically remove them to prevent the onset of malignancies (teratoblastoma, gonadoblastoma). Once the considered disease has been identified, a continuous psychological help can be considered useful for the patient and the family.
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Affiliation(s)
- D Dell'Edera
- Unit of Cytogenetic and Molecular Genetics, Madonna delle Grazie Hospital, Matera, Italy.
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18
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Balatsinou C, Milano A, Caldarella MP, Laterza F, Pierdomenico SD, Cuccurullo F, Neri M. Eosinophilic esophagitis is a component of the anticonvulsant hypersensitivity syndrome: description of two cases. Dig Liver Dis 2008; 40:145-8. [PMID: 17395557 DOI: 10.1016/j.dld.2007.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 09/11/2006] [Revised: 01/18/2007] [Accepted: 01/18/2007] [Indexed: 12/11/2022]
Abstract
Anticonvulsant hypersensitivity syndrome is a rare syndrome caused by a specific, severe unusual reaction to antiepileptic agents; anticonvulsant hypersensitivity syndrome develops 1 week to 3 months after the introduction of the drug and most frequently consists of a multisystemic and multiorgan involvement. Drug withdrawal usually leads to rapid improvement of symptoms. Up to now no oesophageal damage has been described. We present two cases of carbamazepine hypersensitivity syndrome with concomitant development of eosinophilic oesophagitis that resolved after drug withdrawal.
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Affiliation(s)
- C Balatsinou
- Department of Medicine and Aging Sciences, Section of Internal Medicine and Gastroenterology and Ce.S.I. Foundation, G. D'Annunzio University & Foundation Via dei Vestini, Chieti 66100 Italy
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19
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Caldarella MP, Giamberardino MA, Sacco F, Affaitati G, Milano A, Lerza R, Balatsinou C, Laterza F, Pierdomenico SD, Cuccurullo F, Neri M. Sensitivity disturbances in patients with irritable bowel syndrome and fibromyalgia. Am J Gastroenterol 2006; 101:2782-9. [PMID: 17227524 DOI: 10.1111/j.1572-0241.2006.00823.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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: 12/11/2022]
Abstract
BACKGROUND Although visceral hypersensitivity is a common feature among patients with irritable bowel syndrome (IBS), studies on somatic sensitivity have given controversial results. AIM To assess visceral sensitivity in response to isotonic rectal distensions and somatic sensitivity at different layers of the body wall (skin, subcutis, and muscle) in patients with IBS and fibromyalgia (FM), within and outside the area of abdominal pain referral. MATERIALS AND METHODS We studied 10 patients with IBS, 5 patients with FM, 9 patients with IBS+FM, and 9 healthy controls. Rectal distensions were performed by increasing tension at 4 g steps up to 64 g or discomfort. Pain thresholds to electrical stimulation were measured within and outside the areas of abdominal pain referral. RESULTS Patients with IBS and IBS+FM demonstrated rectal hypersensitivity in comparison to controls. The threshold of discomfort was 44 +/- 5 g in IBS and 36 +/- 5 in IBS+FM patients, while patients with FM and healthy controls tolerated all distensions without discomfort. In the areas of pain referral, pain thresholds of all three tissues of the body wall were lower than normal in all patients groups (p < 0.001). In control areas, the pain thresholds were normal in skin, and lower than normal in subcutis and muscle in IBS (p < 0.001). FM and IBS+FM demonstrated somatic hypersensitivity at all sites (p < 0.001 vs healthy). CONCLUSION Our observations seem to indicate that, although sharing a common hypersensitivity background, multiple mechanisms may modulate perceptual somatic and visceral responses in patients with IBS and FM.
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Affiliation(s)
- Maria P Caldarella
- Department of Medicine and Aging Sciences, Section of Internal Medicine and Gastroenterology, Centre for the Study of Aging, Gabriele D'Annunzio University and Foundation, Chieti, Italy
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20
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Fazii P, Neri M, Bucci E, Pistola F, Laterza F, Colagrande E, Cosentino L, Caldarella M, Clerico L, Stella M, Pelatti A, Riario Sforza G. DIAGNOSI E TERAPIA DELL’ANISAKIDOSI MEDIANTE ENDOSCOPIO. DESCRIZIONE DI TRE CASI IN ABRUZZO. Microbiol Med 2006. [DOI: 10.4081/mm.2006.3193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Balatsinou C, Milano A, Laterza F, Caldarella MP, Angelucci D, Vecchiet J, Zingariello P, Falasca K, Lapenna D, Neri M. Esophagitis and anticonvulsant hypersensitivity syndrome. Endoscopy 2006; 38:957. [PMID: 16981126 DOI: 10.1055/s-2006-925130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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] [Indexed: 12/10/2022]
Affiliation(s)
- C Balatsinou
- Department of Medicine and Science of Aging, Section of Internal Medicine and Gastroenterology and Section of Infectious Diseases, G. D'Annunzio University and Foundation, Chieti, Italy
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Brümmer U, Cappelli P, Laterza F, Di Liberato L, Sirolli V, Milano A, Mastrippolito S, D'Arezzo M, Muscianese P, Amoroso L, Neri M, Bonomini M. Wireless capsule endoscopy in the diagnostic of small intestine angiodysplasia in chronic uremic patient. MINERVA UROL NEFROL 2005; 57:61-9. [PMID: 15944523] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Gastroenteric bleeding due to angiodysplasia (AD) is a relatively common occurrence in patients with end-stage renal failure. Gastric and colon angiodysplasic lesions can be easily revealed by endoscopic procedures, whereas lesions of the small intestine are more difficult to detect. Imaging modalities used in the diagnostic imaging algorithm for the detection of small-bowel AD, include non-invasive methods like enema-helical computer tomography,(99m)Tc-labelled red blood cell scintigraphy, and angiography, and invasive methods such as intraoperative enteroscopy. We report the cases of 3 hemodialysis patients with recurrent episodes of gastrointestinal bleeding, caused by small-bowel AD diagnosed by means of wireless-capsule endoscopy. In all cases, previous gastroscopy and colonoscopy were unrevealing. Wireless-capsule endoscopy consists in swallowing a capsule endoscope (11 mmx27 mm) which contains a miniature video camera, a light source, batteries, and a radio transmitter. Video images are transmitted by means of radio telemetry to aerials taped to the body that allow images to be captured. Moving images from a period as long as 6 h are stored on a portable recorder. Wireless-capsule endoscopy may prove valuable in the assessment of gastrointestinal bleeding in uremic patients with unrevealing results at gastroscopy and colonoscopy.
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Affiliation(s)
- U Brümmer
- Institute of Nephrology, SS. Annunziata University Hospital, Chieti, Italy
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Bonomini M, Sirolli V, Milano A, Brummer U, Laterza F, Caldarella MP, Cappelli P, Neri M. [Angiodysplasia of the small bowel: a possible cause of anemia even in mild chronic renal failure]. G Ital Nefrol 2005; 22:171-6. [PMID: 15875281] [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: 05/02/2023]
Abstract
BACKGROUND Gastroenteric angiodysplasia (AD) is a vascular lesion characterized by vascular ectasias to the submucous sheath of the gastrointestinal tract. Lesions can be flat or raised, isolated or grouped and can break or ulcerate causing acute hemorrhage or, more commonly, chronic bleeding. CASE-REPORT We describe a 65-year-old patient with a 3-yr history of chronic renal failure (CRF), who gradually developed anemia (hemoglobin (Hb) 10 g/dl) without any episodes of clinically relevant bleeding or any exposure to bleeding risk factors. Blood pressure (BP) was normal and renal function was stable (serum creatinine (Cr) 1.9 mg/dl). Routine laboratory tests showed a slight reduction in serum iron and transferrin saturation and a slightly elevated absolute reticulocyte count. These findings were associated with a positive occult gastrointestinal blood test and raised the clinical suspicion of chronic gastrointestinal blood loss. Oesophagogastro-duodenoscopy and colonoscopy demonstrated an absence of significant lesions, suggesting the need to investigate for a lesion localized in the small intestine. Capsular endoscopy, a recently developed endoscopic technique, particularly suited for small bowel pathology, was performed, and demonstrated the presence of an angiodysplasic lesion, located in the jejunum. CONCLUSIONS Our case report supports the necessity for a complete clinical and laboratory evaluation of the possible causes of anemia superimposed on relative erythropoietin deficiency in CRF patients. When gastrointestinal blood loss is suspected, the entire gastroenteric tract should be examined to search for the bleeding sites. Our report also demonstrates that AD could be responsible for gastrointestinal bleeding even in mild CRF and not only, as usually reported, in end-stage renal disease (ESRD). Capsular endoscopy offers the unique possibility to determine the bleeding site in the small intestine and appears as an effective diagnostic procedure in CRF patients.
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Affiliation(s)
- M Bonomini
- Istituto di Clinica Nefrologica-Emodialisi, Universita' 'G. d'Annunzio' e Ospedale Clinicizzato 'SS. Annunziata', Chieti-Italy.
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Caldarella MP, Milano A, Laterza F, Sacco F, Balatsinou C, Lapenna D, Pierdomenico SD, Cuccurullo F, Neri M. Visceral sensitivity and symptoms in patients with constipation- or diarrhea-predominant irritable bowel syndrome (IBS): effect of a low-fat intraduodenal infusion. Am J Gastroenterol 2005; 100:383-9. [PMID: 15667496 DOI: 10.1111/j.1572-0241.2005.40100.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [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: 12/11/2022]
Abstract
BACKGROUND Visceral hypersensitivity is common in Irritable Bowel Syndrome (IBS) patients, and symptoms exacerbate postprandially. Yet the effects of nutrients on visceral sensitivity and symptoms in these patients have not been fully explored. AIMS To evaluate the differences of visceral sensitivity and symptoms in healthy subjects and IBS patients during fasting and intraduodenal lipids infusion. METHODS Graded rectal distensions at fixed tension levels were performed in 16 IBS patients (8 IBS-C and 8 IBS-D) and 6 healthy subjects before and during intraduodenal lipids infusion at 0.5 kcal/min. Tension levels were increased in 4 gr increments up to 64 gr or discomfort during both conditions. At each step, perception and symptoms were measured by means of a validated questionnaire. RESULTS In basal conditions, perception thresholds in IBS patients and health were, respectively, 8 +/- 2 gr versus 32 +/- 9 gr (p < 0.001) with no changes during lipids. Intraduodenal lipids infusion significantly lowered threshold of discomfort in IBS patients in comparison to fasting (24 +/- 6 gr vs 34 +/- 4 gr; p < 0.05), while health tolerated all distension without discomfort. No differences of compliance, perception, or discomfort were observed between the two subgroups of patients at each tension step. The predominant symptom elicited in patients with IBS-C was abdominal pain (54%), while patients with IBS-D exhibited urgency (63%, p < 0.005); this pattern was maintained during lipids. CONCLUSIONS Intraduodenal lipids increase visceral sensitivity in both IBS-C and IBS-D; symptoms specificity in response to rectal distension is maintained in the postprandial period. Lipids may be responsible for the postprandial symptoms exacerbation in IBS.
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Affiliation(s)
- Maria Pia Caldarella
- Department of Medicine and Ageing Sciences, Section of Internal Medicine and Gastroenterology, Gabriele D'Annunzio University and Foundation, 66100 Chieti, Italy
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25
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Neri M, Milano A, Laterza F, Di Bonaventura G, Piccolomini R, Caldarella MP, Balatsinou C, Lapenna D, Cuccurullo F. Role of antibiotic sensitivity testing before first-line Helicobacter pylori eradication treatments. Aliment Pharmacol Ther 2003; 18:821-7. [PMID: 14535876 DOI: 10.1046/j.1365-2036.2003.01757.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [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: 01/06/2023]
Abstract
BACKGROUND The resistance of Helicobacter pylori to antibiotics has been advocated as a major cause of treatment failure, and antimicrobial sensitivity testing has been proposed to improve efficacy; however, its role before first-line therapy has not been investigated in detail. AIM To assess whether antimicrobial sensitivity testing improves the eradication rate of first-line anti-Helicobacter treatments and to compare the effectiveness of ranitidine bismuth citrate and omeprazole in the presence of H. pylori resistance to antibiotics. METHODS Two hundred and forty-two patients were assigned to either empirical or antimicrobial sensitivity testing-based treatment; within each group, subjects were further randomized to receive ranitidine bismuth citrate, 400 mg b.d., tinidazole, 500 mg b.d., and clarithromycin, 500 mg b.d., or omeprazole, 20 mg b.d., clarithromycin, 500 mg b.d., and amoxicillin, 1 g b.d., for 1 week, with substitution of the resistant antibiotic in the antimicrobial sensitivity testing-based treatment group. RESULTS Eradication rates were 67% [confidence interval (CI), 55-79%] in the empirical treatment group and 76% (CI, 65-87%) in the antimicrobial sensitivity testing-based group (P=N.S.). The overall success rate was 60% (CI, 51-69%) with omeprazole and 82% (CI, 73-91%) with ranitidine bismuth citrate (P<0.03); the latter overcame antibiotic resistance in 12 of 15 strains vs. zero of eight strains by omeprazole. CONCLUSIONS Antimicrobial sensitivity testing before first-line treatment does not improve the eradication rate, which is greater when ranitidine bismuth citrate is included in the treatment.
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Affiliation(s)
- M Neri
- Department of Medicine and Ageing Sciences, Section of Internal Medicine and Gastroenterology, Centre of Excellence on Ageing, Università Gabriele D'Annunzio, Chieti, Italy.
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Caldarella MP, Balatsinou C, Milano A, Laterza F, Neri M. There is a relationship between celiac disease and patients with symptoms of irritable bowel syndrome. Gastroenterology 2002; 123:1408-9; author reply 1409. [PMID: 12360510 DOI: 10.1053/gast.2002.36390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Piccolomini R, Di Bonaventura G, Picciani C, Laterza F, Vecchiet J, Neri M. In vitro activity of clarithromycin against intracellular Helicobacter pylori. Antimicrob Agents Chemother 2001; 45:1568-71. [PMID: 11302831 PMCID: PMC90509 DOI: 10.1128/aac.45.5.1568-1571.2001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The in vitro intracellular effect of clarithromycin, amoxicillin, metronidazole, lansoprazole, and rifabutin, tested at concentrations corresponding to one times the MIC, two times the MIC, and four times the MIC, was evaluated against an invasive Helicobacter pylori strain. At four times the MIC, clarithromycin showed an early bactericidal effect within 4 h of incubation and, in determining the complete killing within a 16 h-incubation period, lansoprazole and rifabutin showed comparable activity, yielding bactericidal activities within 4 and 8 h of incubation, respectively. Amoxicillin and metronidazole showed bacteriostatic activity only.
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Affiliation(s)
- R Piccolomini
- Department of Biomedical Sciences, Clinical Microbiology Laboratory, G. D'Annunzio University, Chieti, Italy.
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Neri M, Laterza F, Howell S, Di Gioacchino M, Festi D, Ballone E, Cuccurullo F, Talley NJ. Symptoms discriminate irritable bowel syndrome from organic gastrointestinal diseases and food allergy. Eur J Gastroenterol Hepatol 2000; 12:981-8. [PMID: 11007133 DOI: 10.1097/00042737-200012090-00003] [Citation(s) in RCA: 21] [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: 12/10/2022]
Abstract
BACKGROUND The value of specific gastrointestinal symptoms in discriminating irritable bowel syndrome (IBS) from organic disease has been documented. In contrast, there have been few attempts to identify symptoms that discriminate irritable bowel syndrome from food allergy, despite similarities in their respective symptom complexes. We aimed to investigate the value of symptoms in discriminating irritable bowel syndrome from organic disease and food allergy. METHODS Subjects (n = 288) were recruited from consecutive patients presenting to the Internal Medicine, Gastroenterology and Allergy Units in Chieti. Patients completed the validated Bowel Disease Questionnaire (BDQ) prior to an independent diagnostic evaluation, which included endoscopy when appropriate. Food allergy was diagnosed using a 2-week elimination diet, followed by a placebo-controlled food challenge test, a skin prick test and serum RAST for specific IgE for suspected foods or additives. The results of the BDQ were not considered in formulating a diagnosis. In total, 99 patients were diagnosed with the IBS, 79 patients were diagnosed with organic disease and 22 patients were diagnosed with food allergy. A further 88 patients with extraintestinal allergies were included as a control group. RESULTS Based on logistic regression analysis, six symptom items discriminated IBS from organic disease, while five symptoms discriminated patients with IBS from control subjects. A diagnosis of IBS compared to organic disease was positively associated with straining on defaecation (P=0.0001), diarrhoea (P=0.001) and abdominal bloating (P=0.01), but was negatively associated with pain in the upper abdomen (P=0.0004), reflux (P=0.0001) and appetite loss (P=0.004). A diagnosis of IBS compared to extraintestinal allergy was positively associated with pain relieved by bowel movement (P=0.0001), pain in the lower abdomen (P=0.0006), pain in both the upper and lower abdomen (P=0.003), frequent pain (P=0.001) and abdominal bloating (P=0.0009). In comparison between IBS and food allergy patients, a diagnosis of IBS was positively associated with pain in the lower abdomen (P=0.001), pain relieved by bowel movements (P=0.001), frequent pain (P=0.02) and abdominal bloating (P=0.03). CONCLUSION Symptoms appear to be useful for discriminating IBS from organic gastrointestinal disease and food allergy.
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Affiliation(s)
- M Neri
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Sezione di Medicina Interna e Gastroenterologia, Università G. D'Annunzio, Chieti, Italy
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Piccolomini R, Di Bonaventura G, Festi D, Catamo G, Laterza F, Neri M. Optimal combination of media for primary isolation of Helicobacter pylori from gastric biopsy specimens. J Clin Microbiol 1997; 35:1541-4. [PMID: 9163478 PMCID: PMC229783 DOI: 10.1128/jcm.35.6.1541-1544.1997] [Citation(s) in RCA: 25] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The aim of the present study was to compare eight media, four nonselective and four selective media, to determine the best combination of media for the primary isolation of Helicobacter pylori. Over a period of 5 months, mucosal antral biopsy specimens were obtained from 222 consecutive dyspeptic patients undergoing endoscopy. Biopsy samples were plated in parallel on all eight media. Egg yolk emulsion agar (EYE), Skirrow's medium, Dent's medium, and modified Thayer-Martin medium were used as selective media; modified chocolate agar (MCHOC), Triptycase soy agar (TSA), brucella agar, and brain heart infusion agar were used as nonselective media. Overall, by using these eight media, H. pylori was recovered from biopsy specimens from 114 of 222 patients, yielding an isolation rate of 51%. Comparison of all possible combinations of the eight media showed that the highest rate of isolation of H. pylori was 100% (114 of 114) with EYE-MCHOC, followed by 96.5% (110 of 114) when EYE-TSA was used. Conversely, it was found that none of the media used alone yielded a 100% rate of recovery (the maximum recovery rate was 95%, which was achieved with EYE). These results indicate that the association of EYE and MCHOC yielded the maximum recovery of H. pylori from gastric biopsy specimens. Therefore, the use of selective and nonselective media in parallel offers optimal recovery rates with only a slight increase in costs.
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Affiliation(s)
- R Piccolomini
- Department of Biomedical Sciences, G. D'Annunzio University, Chieti, Italy
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Abstract
BACKGROUND Although a number of patient and bacterial factors have been identified as predictors of treatment failure in Helicobacter pylori-associated gastritis, the causes of lack of response to treatment have not been fully elucidated. We hypothesized that bacterial infiltration of the gastric mucosa might be one of the factors responsible for treatment failure in patients harbouring the bacterium. METHODS We studied 182 patients with gastritis who underwent anti-H. pylori treatment with different drugs. Gastric biopsies obtained at endoscopy, were examined for electron microscopic features of infiltration and damage. Patients were assigned to different treatment groups, and endoscopy, evaluation of H. pylori status and electron microscopy were repeated at least 4 weeks after the end of treatment. RESULTS The overall H. pylori eradication rate was 65%. Eradication was achieved more frequently in patients without electron microscopic features of infiltration (85%), than in those patients with the bacteria deeply embedded into the gastric mucosa (45%; P < 0.0001). No treatment appeared to be clearly superior for patients with the highest degree of mucosal infiltration. CONCLUSIONS Bacterial mucosal infiltration may facilitate the survival of H. pylori during antibacterial treatment; moreover, electron microscopy may be helpful to identify patients potentially unresponsive to anti-H. pylori treatment.
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Affiliation(s)
- M Neri
- Department of Gastroenterology, S. Timoteo Hospital, Termoli, Italy
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Neri M, Susi D, Bovani I, Laterza F, Mezzetti A, Cuccurullo F. Bacterial mucosal infiltration in Helicobacter pylori-associated gastritis: histological and clinical consequences. Am J Gastroenterol 1994; 89:1801-5. [PMID: 7942671] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We wished to demonstrate that gastric epithelial cells infiltration by HP is associated with the active inflammatory response and the severity of gastritis in the gastric antrum of patients harboring the bacterium. METHODS We studied 129 patients with HP-associated gastritis and 60 HP-negative controls with gastritis of different origin. Gastric mucosal biopsies were obtained from all subjects at endoscopy and were examined for histological features of active inflammation and type of gastritis, as well as for electronmicroscopical features of invasion and damage, according to a four-degree classification (range 0-3). RESULTS At entry, the presence of acute inflammatory activity, defined according to the presence of a polymorphonuclear cell infiltrate, was significantly greater in HP-positive patients than in controls (p < 0.00001) and was well related to the depth of mucosal invasion (p < 0.001). Accordingly, the prevalence of chronic atrophic gastritis was higher in HP-positive patients (p < 0.02 vs. controls) and at grade 3 of invasion (p < 0.04 vs. grade 1 and 2). Peptic ulcers were more frequent in grade 3 patients (p < 0.04). CONCLUSION Gastric epithelial cell infiltration and damage by HP, as assessed by electron microscopy, is an important feature of HP-associated gastritis due to its histological and clinical correlates.
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Affiliation(s)
- M Neri
- Department of Gastroenterology, S. Timoteo Hospital, Termoli, Italy
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Neri M, Susi D, Laterza F, Di Iorio P, Seccia G, Mezzetti A, Cuccurullo F. Omeprazole, bismuth and clarithromycin in the sequential treatment of Helicobacter pylori infection. Aliment Pharmacol Ther 1994; 8:469-71. [PMID: 7986974 DOI: 10.1111/j.1365-2036.1994.tb00317.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 01/28/2023]
Abstract
AIMS To assess the therapeutic potential of clarithromycin, a new macrolide with high anti-Helicobacter pylori activity, given with bismuth salts and omeprazole in different regimens aimed at simplifying the treatment of H. pylori-related gastritis. METHODS Eighty-eight patients with proven H. pylori infection and gastritis were treated with one of the following four regimens: omeprazole 40 mg/day for one week (group A, n = 14); omeprazole 40 mg/day for one week followed by clarithromycin 1 g/day for 2 weeks (group B, n = 26); omeprazole 40 mg/day for one week followed by tripotassium dicitrato bismuthate 480 mg/day and clarithromycin 1 g/day, both for two weeks (group C, n = 26); and tripotassium dicitrato bismuthate 480 mg/day and clarithromycin 1 g/day for two weeks (group D, n = 22). Presence of H. pylori, histology and electron microscopy were assessed at entry and four weeks after the end of each treatment. RESULTS Omeprazole alone had no effect on H. pylori status. The highest eradication rate was obtained in group C patients (81%), a proportion significantly greater than that observed in group B (50%, P < 0.03) or group D patients (55%, P < 0.05). CONCLUSION Sequential treatment may be a useful option in the treatment of H. pylori-related gastritis.
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Affiliation(s)
- M Neri
- Servizio di Endoscopia, Ospedale S. Timoteo, Termoli, Italy
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Aruin LI, Sarkisov DS, Lisenco OA, O’Connor H, Cunnane K, Queiroz DMM, Mendes EN, Rocha GA, Moura SB, Resende LMH, Cunha-Melo JR, Carvalho AST, Coelho LGV, Passos MCG, Castro LP, Oliveira CA, Lima GF, Barbosa AJA, Passos MCF, Castro P, Testino G, Perasso A, Boixeda D, de Argila CM, Vila T, Redondo C, Cantón R, Avila C, Alvarez-Baleriola I, de Rafael L, Witteman EM, Becx MCJM, De Koning RW, Silva JCP, Nogueira AMMF, Paulino E, Miranda CR, Rudelli A, Vialette G, Sevestre H, Capron D, Ducroix JP, Smail A, Baillet J, Zerbib F, Seurat PL, Sauvet P, Bechade D, Rapp N, Peacock JS, Marchildon P, Zamaniyan F, Bond-Green J, Liu P, Ciota L, Lee A, Coltro N, Chen M, Alhomsi M, Adeyemi E, Goodwin CS, Rizzi C, Maieron R, Desinan L, Avellini C, Da Broi GL, Beltrami CA, Proto G, Grimaldi F, Proietti A, Scott CA, Takasashi S, Igarshi H, Ishiyama N, Nakamura K, Masubuchi N, Ozaki M, Saito S, Aoyagi T, Itoh T, Hirata I, Matysiak-Budnik T, Poniewierka E, Gasciniak G, Jelen M, Knapik Z, Gosciniak G, Neri WM, Susi D, Bovani I, Laterza F, Cuccurullo F, Amorosi A, Bechi P, Dei R, Mazzanti R, Lynch DAF, Sobala GM, Gledhill A, Jackson P, Crabtree JE, Foster PN, Axon ATR, Dixon MF, Maaroos HI, Sipponen P, Kekki M, Di Bello MG, Raspanti S, Vardar T, Sancho FJ, Olivia E, Saiz S, Mones JP, Hood C, Lesna M, Alcolado R, Knitht T, Greaves S, Wilson A, Corlett M, Webb P, Wyatt J, Newell D, Hengels K, Forman D, Elder JB, Farinati F, Cardin R, Valiante F, Libera GD, Plebani M, Rugge M, Baffa R, Guido M, Mario FD, Naccarato R, Gilvarry J, Leen E, Sant S, Sweeney E, Morain CO, Schönlebe J, Riedel H, Prinz M, Hahn L, Porst H, Lohmann H, Orsini E, Guerre J, Tulliez M, Chaussade S, Gaudric M, Canton R, Sampedro J, García-Plaza A, Cognein P, Parodi MC, Tucci A, Gasperoni S, Stanghellini V, Tosetti C, Paparo GF, Varoli O, Siringo S, Santucci R, Monetti N, Barbara G, Corinaldesi R, Di Mario F, Dotto P, Vianello F, M. F, Grasso GA, Bianco TD, Laino G, Germanà B, Battaglia G, Axelson CK, Andersen LP, Szecsi PB, Olsen KN, Lundborg CJ, Andre C, Descos L, Martin A, Cavagna S, Brassens-Rabbé MP, Wu S, Wadström T, Mégraud F, Perdichizzi G, Muratori L, Pallio S, Bottair M, T. Fera M, Quattrocchi E, Caruso V, Karttunen T, Kerola T, Kartttunen R, Niemelä S, Kosunen TU, Bonchviam F, Pretolani S, Baraldine M, Cilla D, Baldinelli S, Gasparrini G. Pathology. Ir J Med Sci 1992. [DOI: 10.1007/bf02942888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Morsiani E, Laterza F, Ricci D, Mazzoni M, Santini A. [Intestinal mechanisms of compensation and morphologic and functional adaptation after resection of bypass]. Minerva Med 1982; 73:1675-80. [PMID: 7088385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The intestine's ability to adapt following extensive resection is well known, and includes augmentation in calibre and the thickness of the wall, increased villus height, changes in motility, and qualitative and quantitative alterations in the flora. Positive identification of the mechanisms through which this morphological and functional adaptation takes place still forms the subject of research. An account is given of the latest views concerning the way in which compensation of the intestine takes place after resection and by-pass surgery.
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