1
|
Ribolsi M, De Bortoli N, Frazzoni M, Marchetti L, Savarino E, Cicala M. Proximal esophageal impedance baseline increases the yield of impedance-pH and is associated with response to PPIs in chronic cough patients. Neurogastroenterol Motil 2024; 36:e14775. [PMID: 38424679 DOI: 10.1111/nmo.14775] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Chronic cough significantly impairs the quality of life. Although various studies focused on MNBI as assessed in the distal esophagus, scarce data are available on the clinical value of proximal measurements. AIM To investigate the role of proximal MNBI in the workup of patients with chronic cough and its ability to predict PPI response. METHODS Demographic, clinical, endoscopy findings, impedance-pH and HRM tracings from consecutive cough patients were evaluated. MNBI was calculated at proximal and distal esophagus. RESULTS One hundred and sixty four patients were included. In addition to traditional variables, when considering also the PSPW index or MNBI at 3 cm or 15 cm, the proportion of patients with pathological impedance-pH monitoring significantly increased. 70/164 patients were responders, while 94 (57.3%) were non-responder to double PPI dose (p < 0.05). Patients with pathologic MNBI at 3 cm and/or 15 cm as well as those with pathologic PSPW index were characterized by a significantly higher proportion of responders than that observed among patients with normal impedance-pH variables (p < 0.001). The proportion of responders with pathological MNBI at 15 cm was significantly higher than the proportion of responders with pathological MNBI at 3 cm (82.8% vs. 64.3%, p < 0.05). At multivariable model, pathological MNBI at both 3 cm and 15 cm as well as PSPW index were associated with PPI responsiveness. The strongest association with PPI response was observed for MNBI at 15 cm. CONCLUSIONS The assessment of MNBI at proximal esophagus increases the diagnostic yield of impedance-pH monitoring and may represent a useful predictor of PPI responsiveness in the cumbersome clinical setting of suspected reflux-related cough.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Nicola De Bortoli
- Department of New Technologies and Translational Research in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Lorenzo Marchetti
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua School of Medicine and Surgery, Padova, Italy
| | - Michele Cicala
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| |
Collapse
|
2
|
Saibeni S, Bezzio C, Bossa F, Privitera AC, Marchi S, Roselli J, Mazzuoli S, Geccherle A, Soriano A, Principi MB, Viola A, Sarpi L, Cappello M, D'Incà R, Mastronardi M, Bodini G, Guerra M, Benedetti A, Romano M, Cicala M, Di Sabatino A, Scaldaferri F, De Rosa T, Giardino AM, Germano V, Orlando A, Armuzzi A. Golimumab improves health-related quality of life of patients with moderate-to-severe ulcerative colitis: Results of the go-care study. Dig Liver Dis 2024; 56:83-91. [PMID: 37574431 DOI: 10.1016/j.dld.2023.07.031] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND In recent years, improvement of Health-Related Quality of Life (HRQoL) in Ulcerative colitis (UC) has become a relevant measure for treatment efficacy. METHODS We report results from a multicenter prospective study in Italy investigating HRQoL in adult patients with UC treated with golimumab (GLM). Patients who had shown clinical response after a 6-week induction phase (w0), were followed for an additional 48 weeks (w48) (total 54-week treatment). RESULTS Of the 159 patients enrolled 90 completed the study. Compared to values at the beginning of treatment (n = 137), significant improvements were observed for mean total Inflammatory Bowel Disease Questionnaire (IBDQ) scores at w0 (168.5) and w48 (181.7). Patients with baseline PMS above the median tended to have greater improvements in IBDQ at w0 (OR 2.037, p = 0.033) and w48 (OR 3.292, p = 0.027). Compared to beginning of GLM treatment, the mean Full Mayo Score (FMS) decreased by 5.9 points at w48, while mean Partial Mayo Score (PMS) decreased by 3.9 points at w0 and by 4.9 points at w48. CONCLUSIONS GLM improved HRQoL, disease activity and inflammatory biomarkers in UC patients with moderate-to-severely active disease. The greater the burden of disease activity at baseline, the greater the improvement of HRQoL after 24 and 48 weeks of treatment.
Collapse
Affiliation(s)
- S Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Milan, Italy
| | - C Bezzio
- IBD Unit, Gastroenterology IBD Unit, Rho Hospital, ASST Rhodense, Milan, Italy
| | - F Bossa
- Foudation Casa della Sofferenza, UOC Gastroenterology and Digestive Endoscopy, San Giovanni Rotondo, Foggia, Italy
| | | | - S Marchi
- Department of Translational Research, University of Pisa, Italy
| | - J Roselli
- Gastroenterology, Biomedical and Experimental and Clinical Sciences, "Mario Serio" University of Florence, Italy
| | - S Mazzuoli
- IBD Unit U.O.C. of Gastroenterology "Monsignor Raffaele Dimiccoli" Hospital, ASL Barletta, Italy
| | - A Geccherle
- IBD Unit IRCCS "Sacro Cuore-Don Calabria" Negrar di Valpolicella, Verona, Italy
| | - A Soriano
- Department of Internal Medicine, Gastroenterology Division and IBD Center, Azienda Unità Sanitaria Locale - IRCCS of Reggio Emilia Arcispedale S. Maria Nuova, 42121 Reggio Emilia, Italy
| | - M B Principi
- U.O.C. of Gastroenterology, "Azienda Policlinico- Universitaria", Bari, Italy
| | - A Viola
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - L Sarpi
- Gastroenterology and Digestive Endoscpy, Hospital "Media Valle del Tevere" Pantalla -Todi, Perugia, Italy
| | - M Cappello
- Gastroenterology and Hepatology Section, Promise, University of Palermo, Italy
| | - R D'Incà
- U.O.C of Gastroenterology, "University Azienda", Padua, Italy
| | - M Mastronardi
- U.O.S IBD IRCCS "S. De Bellis" Castellana Grotte, Bari Italy
| | - G Bodini
- Policlinico San Martino, University of Genoa, Italy
| | - M Guerra
- Foudation Casa della Sofferenza, UOC Gastroenterology and Digestive Endoscopy, San Giovanni Rotondo, Foggia, Italy
| | - A Benedetti
- Clinic of Gastroenterology, Hepatology and Digestive Endoscopy, Università Politecnica delle Marche-Ospedali Riuniti, Ancona, Italy
| | - M Romano
- Precision Medicine Department, University "l. Vanvitelli" Naples, Italy
| | - M Cicala
- U.O.C. of Gastroenterology and Digestive Endoscopy, "Campus Bio Medico" University, Rome, Italy
| | - A Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia Italy; First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - F Scaldaferri
- CEMAD (Digestive Disease Center) - UOS IBD UNIT, Fondazione Policlinico Universitario ‟A Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T De Rosa
- Medical Affairs MSD Italy, Rome, Italy
| | | | - V Germano
- Medical Affairs MSD Italy, Rome, Italy
| | - A Orlando
- IBD Unit A.O. Ospedali Riuniti "Villa Sofia Cervello", Palermo, Italy
| | - A Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy.
| |
Collapse
|
3
|
Ribolsi M, Marchetti L, Savarino E, Gyawali CP, Cicala M. Chicago Classification v4.0 Stratifies Acid Burden and Abnormal Impedance-pH Variables Better Than Chicago Classification v3.0 Chicago Classification v4.0 and GERD. Am J Gastroenterol 2024; 119:206-209. [PMID: 37655704 DOI: 10.14309/ajg.0000000000002491] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) severity increases with esophageal body hypomotility, but the impact of Chicago Classification (CC) v4.0 criteria on GERD diagnosis is incompletely understood. METHODS In patients with GERD evaluated with high-resolution manometry and pH-impedance monitoring, CCv3.0 and CCv4.0 diagnoses were compared. RESULTS In 247 patients, hypomotility diagnosis decreased from 45.3% (CCv3.0) to 30.0% (CCv4.0, P < 0.001). In contrast, within patients with ineffective esophageal motility, proportions with pathological acid exposure increased from 38% (CCv3.0) to 88% (CCv4.0); baseline impedance and esophageal clearance demonstrated similar findings ( P < 0.05 for each comparison). DISCUSSION CCv4.0 hypomotility criteria are more specific in supporting GERD evidence compared with CCv3.0.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Lorenzo Marchetti
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, USA
| | - Michele Cicala
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| |
Collapse
|
4
|
Balestrieri P, Ribolsi M, Cimini P, Alvaro G, Zobel BB, Tullio A, Cicala M. Wall Thickness Ratio-A New Magnetic Resonance Parameter-Is Associated With the Outcome of Biological Therapy in Patients With Ileal and Ileocolonic Crohn's Disease. J Clin Gastroenterol 2024; 58:64-70. [PMID: 36730458 DOI: 10.1097/mcg.0000000000001809] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/20/2022] [Indexed: 02/04/2023]
Abstract
GOALS The present study was aimed at identifying a new magnetic resonance enterography (MRE) parameter assessing the clinical outcome of biological therapy in patients with active ileal/ileocolonic Crohn's disease (CD). BACKGROUND Transmural healing (TH) has been associated with improved outcomes in CD. However, some patients with clinical remission and inactive disease at endoscopy do not achieve TH. MATERIALS AND METHODS Ileal/ileocolonic CD patients scheduled for biological therapy were prospectively evaluated, at baseline (T0) and after 1 year of treatment (T1), with Harvey Bradshaw Index score, blood tests, ileocolonscopy, and MRE. Clinical activity was assessed after 2 years of treatment (T2). Wall thickness ratio (WTR) was calculated in the same affected ileal segment, as the ratio between the ileum wall thickness value at T1 and the ileum wall thickness value at T0. RESULTS A total of 103 patients were included. Mean WTR at T1 in nonresponders was significantly higher than in responders. At receiver operating characteristic analysis, WTR values were significantly associated to biological therapy responsiveness. A WTR cutoff value of 0.77 mm was identified to discriminate responders from nonresponders (sensitivity: 79%; specificity: 67%). In responders, the proportion of patients with a WTR<0.77 was significantly higher than the proportion of patients achieving TH at T1. Among patients achieving endoscopic remission, 11/29 (37.9%) presented TH, while 20/29 (68.9%) presented WTR<0.77 ( P : 0.035). At multivariate logistic regression analysis, WTR<0.77 was significantly associated to biological therapy response. CONCLUSION WTR index represents an easy-to-calculate MRE parameter and seems to be a promising tool for monitoring therapeutic response in CD patients during biological therapy.
Collapse
Affiliation(s)
| | | | - Paola Cimini
- Diagnostic Imaging, Campus Bio Medico University of Rome, Roma, Italy
| | - Giuseppe Alvaro
- Diagnostic Imaging, Campus Bio Medico University of Rome, Roma, Italy
| | - Bruno B Zobel
- Diagnostic Imaging, Campus Bio Medico University of Rome, Roma, Italy
| | | | | |
Collapse
|
5
|
Peyrin-Biroulet L, Allegretti JR, Rubin DT, Bressler B, Germinaro M, Huang KHG, Shipitofsky N, Zhang H, Wilson R, Han C, Feagan BG, Sandborn WJ, Panés J, Hisamatsu T, Lichtenstein GR, Sands BE, Dignass A, Abrahamovych O, Afanasieva H, Aitova L, Altintas E, Altwegg R, Andreev P, Aomatsu K, Augustyn M, Balestrieri P, Begun J, Brunatto L, Bulgheroni D, Bunkova E, Cabello M, Cao Q, Caprioli F, Cerqueira R, Chen B, Chen CC, Chen CP, Chiu CT, Choi CH, Cicala M, Datsenko O, Dewint P, Domenech E, Dutré J, Duvall G, Fernandez J, Filip R, Fogel R, Fowler S, Fujii T, Fukata M, Furumoto Y, Gasbarrini A, Gawdis-Wojnarska B, Gilletta C, Gionchetti P, Goldin E, Golovchenko O, Gonciarz M, Gonen C, Segura GG, Gridnyev O, Gyokeres T, Hébuterne X, Hedin C, Hellström P, Hilmi IN, Horný I, Horvat G, Hoshi N, Hrdlicka L, Ishihara S, Ivanishyn O, Jang BI, Junior O, Kagaya T, Kanmura S, Karakina M, Katsuhiko N, Kierkus J, Kim HJ, Kim TO, Kim YH, Kiss GG, Klaus J, Kleczkowski D, Klopocka M, Kobayashi T, Kobielusz-Gembala I, Koo JS, Kopon A, Kravchenko T, Kudo M, Kwon KA, Lago P, Laharie D, Lawrance I, Leszczyszyn J, Li Y, Lukas M, Maaser C, Maemoto A, Marusawa H, McBride M, Mendu S, Miheller P, Miyabayashi H, Mohl W, Moore G, Motoya S, Murali N, Naem M, Nakajima K, Nakamoto Y, Nancey S, Neto J, Onizawa M, Ono Y, Ono Y, Osada T, Osipenko M, Owczarek D, Patel B, Patel K, Petrova E, Poroshina E, Portela F, Prystupa L, Rivero M, Roblin X, Romatowski J, Rydzewska G, Saibeni S, Sakuraba H, Samaan M, Schultz M, Schulze J, Sedghi S, Seidler U, Shin SJ, Stanislavchuk M, Stokesberry D, Suzuki T, Taguchi H, Tankova L, Thin L, Tkachev A, Torrealba L, Tsarynna N, Tulassay Z, Ueo T, Valuyskikh E, Vasilevskaya O, Viamonte M, Wei SC, Weisshof R, Wojcik K, Ye BD, Yen HH, Yoon H, Yoshida K, Yurkiv A, Zaha O, Zhan Q. Guselkumab in Patients With Moderately to Severely Active Ulcerative Colitis: QUASAR Phase 2b Induction Study. Gastroenterology 2023; 165:1443-1457. [PMID: 37659673 DOI: 10.1053/j.gastro.2023.08.038] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND & AIMS The QUASAR Phase 2b Induction Study evaluated the efficacy and safety of guselkumab, an interleukin-23p19 subunit antagonist, in patients with moderately to severely active ulcerative colitis (UC) with prior inadequate response and/or intolerance to corticosteroids, immunosuppressants, and/or advanced therapy. METHODS In this double-blind, placebo-controlled, dose-ranging, induction study, patients were randomized (1:1:1) to receive intravenous guselkumab 200 or 400 mg or placebo at weeks 0/4/8. The primary endpoint was clinical response (compared with baseline, modified Mayo score decrease ≥30% and ≥2 points, rectal bleeding subscore ≥1-point decrease or subscore of 0/1) at week 12. Guselkumab and placebo week-12 clinical nonresponders received subcutaneous or intravenous guselkumab 200 mg, respectively, at weeks 12/16/20 (uncontrolled study period). RESULTS The primary analysis population included patients with baseline modified Mayo scores ≥5 and ≤9 (intravenous guselkumab 200 mg, n = 101; 400 mg, n = 107; placebo, n = 105). Week-12 clinical response percentage was greater with guselkumab 200 mg (61.4%) and 400 mg (60.7%) vs placebo (27.6%; both P < .001). Greater proportions of guselkumab-treated vs placebo-treated patients achieved all major secondary endpoints (clinical remission, symptomatic remission, endoscopic improvement, histo-endoscopic mucosal improvement, and endoscopic normalization) at week 12. Among guselkumab week-12 clinical nonresponders, 54.3% and 50.0% of patients in the 200- and 400-mg groups, respectively, achieved clinical response at week 24. Safety was similar among guselkumab and placebo groups. CONCLUSIONS Guselkumab intravenous induction was effective vs placebo in patients with moderately to severely active UC. Guselkumab was safe, and efficacy and safety were similar between guselkumab dose groups. CLINICALTRIALS gov number: NCT04033445.
Collapse
Affiliation(s)
- Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France;; INSERM, NGERE, University of Lorraine, F-54000 Nancy, France;; INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France;; FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France;; Groupe Hospitalier privé Ambroise Paré-Hartmann, Paris IBD center, 92200 Neuilly sur Seine, France;; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | | | | | | | | | - Hongyan Zhang
- Janssen Research & Development, LLC, Spring House, PA, USA
| | | | - Chenglong Han
- Janssen Research & Development, LLC, Spring House, PA, USA
| | | | | | - Julian Panés
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | | | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe University, Frankfurt, Germany.
| | - Orest Abrahamovych
- Communal Nonprofit Enterprise of Lviv Regional Council 'Lviv Regional Clinical Hospital', Lviv, Ukraine
| | - Halyna Afanasieva
- Municipal Institution 'Kherson City Clinical Hospital n.a. Y.Y.Karabelesh', Kherson, Ukraine
| | - Lilia Aitova
- City Clinical Hospital # 21, Ufa, Bashkortostan, Respublika, Russian Federation
| | - Engin Altintas
- Mersin University Medical Faculty Hospital, Mersin, Turkey
| | | | - Pavel Andreev
- NUZ 'Railway Clinical Hospital on Samara station of LLC 'Russian Railways', Samara, Samarskaya oblast, Russian Federation
| | | | | | | | - Jakob Begun
- Mater Hospital, South Brisbane, Queensland, Australia
| | | | | | - Elena Bunkova
- Medical University Reaviz, Multidisciplinary clinic, Samara, Samarskaya oblast', Russian Federation
| | | | - Qian Cao
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Flavio Caprioli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Rute Cerqueira
- Centro Hospitalar de Entre o Douro e Vouga, E.P.E, Santa Maria da Feira, Aveiro, Portugal
| | - Baili Chen
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chou-Chen Chen
- Taichung Veterans General Hospital, Taichung, Taiwan, Province of China
| | - Chou-Pin Chen
- Taichung Veterans General Hospital, Taichung, Taiwan, Province of China
| | - Cheng-Tang Chiu
- Chang-Gung Memorial Hospital, LinKou Branch, Taoyuan, Taiwan, Province of China
| | - Chang Hwan Choi
- Chung-Ang University Hospital, Seoul, Dongjak-gu, Republic of Korea
| | | | - Olena Datsenko
- Communal Nonprofit Enterprise 'City Clinical Hospital # 2 N.A. Prof. O.O. Shalimov', Kharkiv, Ukraine
| | | | - Eugeni Domenech
- Hosp. Univ. Germans Trias I Pujol, Badalona, Catalonia, Spain
| | - Joris Dutré
- Algemeen Ziekenhuis Jan Palfijn Merksem, Merksem, Belgium
| | - George Duvall
- Tyler Research Institute, LLC, Tyler, Texas, United States
| | - Juan Fernandez
- Harmony Medical Research Institute, Inc., Hialeah, Florida, United States
| | | | - Ronald Fogel
- Clinical Research Institute of Michigan, LLC, Chesterfield, Michigan, United States
| | - Sharyle Fowler
- Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Toshimitsu Fujii
- Tokyo Medical and Dental University Hospital, Bunkyo-Ku, Tokyo, Japan
| | | | - Yohei Furumoto
- Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | | | | | | | | | - Eran Goldin
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Oleksandr Golovchenko
- Medical Center Ltd 'Health Clinic', Department Of General Therapy, Vinnytsya, Ukraine
| | | | - Can Gonen
- Acibadem Kozyatagi Hospital, Istanbul, Turkey
| | | | - Oleksii Gridnyev
- SI 'L.T. Maloyi National Institute of Therapy of National Academy of Medical Sciences of Ukraine', Kharkiv, Ukraine
| | - Tibor Gyokeres
- Magyar Honvedseg Egeszsegugyi Kozpont, Budapest, Hungary
| | | | | | | | | | - Ivo Horný
- Nemocnice Strakonice, a.s., Strakonice, Czechia
| | | | | | | | | | - Olha Ivanishyn
- Lviv Clinical Hospital on Railway Transport of Affiliate Healthcare center of JSC Ukrainian Railway, Lviv, Ukraine
| | - Byung Ik Jang
- Yeungnam University Hospital, Daegu, Daegu Gwang'yeogsi, Republic of Korea
| | - Odery Junior
- CDC - Centro Digestivo de Curitiba, Curitiba, Brazil
| | - Takashi Kagaya
- National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Shuji Kanmura
- Kagoshima University Hospital, Kagoshima City, Kagoshima, Japan
| | - Marina Karakina
- Medical Center Meditsinskie Tekhnologii, Ekaterinburg, Russian Federation
| | | | | | - Hyo Jong Kim
- KyungHee University Hospital, Seoul, Republic of Korea
| | - Tae-Oh Kim
- Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Young-Ho Kim
- Samsung Medical Center, Seoul, Republic of Korea
| | - Gyula G Kiss
- Vasutegeszsegugyi Nonprofit Kozhasznu Kft Debreceni Kozpont, Debrecen, Hajdú-Bihar, Hungary
| | - Jochen Klaus
- Universitaetsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | | | - Maria Klopocka
- Szpital Uniwersytecki nr 2 im. dr. Jana Biziela w Bydgoszczy, Bydgoszcz, Poland
| | - Taku Kobayashi
- Kitasato University Kitasato Institute Hospital, Minato-ku, Tôkyô, Japan
| | | | - Ja Seol Koo
- Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
| | - Adam Kopon
- GASTROMED Kopon, Zmudzinski i wspolnicy SP.j., Specjalistyczne Centrum Gastrologii i Endoskopii, Torun, Poland
| | | | | | - Kwang An Kwon
- Gachon University Gil Medical Center, Incheon, Incheon Gwang'yeogsi, Republic of Korea
| | - Paula Lago
- Centro Hospitalar do Porto, EPE, Porto, Portugal
| | | | - Ian Lawrance
- St John of God Subiaco Hospital, Subiaco, WA, Australia
| | | | - Yan Li
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | | | | | | | | | - Matthew McBride
- Digestive Disease Specialists Inc, Oklahoma City, Oklahoma, United States
| | - Shoba Mendu
- Gastroenterology Associates of Tidewater, Chesapeake, Virginia, United States
| | | | - Hideharu Miyabayashi
- National Hospital Organization Matsumoto Medical Center, Matsumoto, Nagano, Japan
| | - Wolfgang Mohl
- Zentrum für Gastroenterologie Saar MVZ GmbH, Saarbrücken, Germany
| | | | - Satoshi Motoya
- Hokkaido P.W.F.A.C. Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Narayanachar Murali
- Gastroenterology Associates of Orangeburg, Orangeburg, South Carolina, United States
| | - Mohammed Naem
- Northshore Gastroenterology Research, LLC, Westlake, Ohio, United States
| | | | | | | | - Joaquim Neto
- Sociedade Campineira de Educacao e Instrucao-Hospital e Maternidade Celso Pierro, Campinas, São Paulo, Brazil
| | | | - Yohei Ono
- Imamura General Hospital, Kagoshima, Japan
| | - Yohei Ono
- Kagoshima IBD Gastroenterology Clinic, Kagoshima, Japan
| | - Taro Osada
- Juntendo University Hospital Urayasu, Chiba, Japan
| | - Marina Osipenko
- Medical Center SibNovoMed LLC, Novosibirsk, Russian Federation
| | | | - Bhaktasharan Patel
- Peak Gastroenterology Associates, Colorado Springs, Colorado, United States
| | - Kamal Patel
- St George's Hospital, London, United Kingdom and Northern Ireland
| | - Elina Petrova
- OOO MO New Hospital, Ekaterinburg, Russian Federation
| | | | - Francisco Portela
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Lyudmyla Prystupa
- Sumy State University, Sumy Regional Clinical Hospital, Sumy, Ukraine
| | | | - Xavier Roblin
- CHU Saint-Etienne-Hôpital Nord, Saint-Priest en Jarez, France
| | - Jacek Romatowski
- Gastromed Kralisz Romatowski Stachurska Sp. j., Bialystok, Poland
| | | | - Simone Saibeni
- Azienda Ospedaliera G.Salvini Ospedale di Rho, Rho, Milan, Italy
| | | | - Mark Samaan
- Guy's and St Thomas' Hospital, London, United Kingdom and Northern Ireland
| | | | | | - Shahriar Sedghi
- Gastroenterolgy Associates of Central GA, Macon, Georgia, United States
| | - Ursula Seidler
- Medizinische Hochschule Hannover, Hannover, Niedersachsen, Germany
| | - Sung Jae Shin
- Ajou University Hospital, Suwon, Gyeonggido, Republic of Korea
| | | | - David Stokesberry
- Digestive Disease Specialists Inc, Oklahoma City, Oklahoma, United States
| | | | | | | | - Lena Thin
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | | | | | - Nataliia Tsarynna
- Medical Center 'Ok Clinic' of LLC 'International Institute of Clinical Studies', Kyiv, Ukraine
| | - Zsolt Tulassay
- Semmelweis Egyetem, Ii. Belgyogyaszati Klinika, Budapest, Hungary
| | | | | | | | - Manuel Viamonte
- Columbus Clinical Services LLC, Miami, Florida, United States
| | - Shu-Chen Wei
- National Taiwan University Hospital, Taipei, Taiwan, Province of China
| | | | | | - Byong Duk Ye
- Asan Medical Center, Seoul, Seoul Teugbyeolsi, Republic of Korea
| | - Hsu-Heng Yen
- Chang-Hua Christian Hospital, Changhua, Taiwan, Province of China
| | - Hyuk Yoon
- Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Kosuke Yoshida
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Andriy Yurkiv
- Municipal Non-profit Enterprise 'Odesa Regional Clinical Hospital' Odesa Regional Council, Odesa, Ukraine
| | | | - Qiang Zhan
- Wuxi People's Hospital, Wuxi, Jiangsu, China
| |
Collapse
|
6
|
Imperia E, Bonincontro G, Altomare A, Simonetti G, Gherardi G, Brasili E, Badiali C, Bove M, Pasqua G, De Gara L, Cicala M, Guarino MPL. Review Article title: Natural Compounds with Antimicrobial Activities in oral Candida infections during head and neck radiotherapy. Chemotherapy 2023:000534562. [PMID: 37963442 DOI: 10.1159/000534562] [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] [Received: 05/17/2023] [Accepted: 09/30/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUNDS Oral colonization and infections are frequently observed in patients during and soon after radiation therapy (RT). Infective mucositis is a common side effect associated with cancer therapy, characterized by an inflammation of the oral mucous membranes with histological mucosal and submucosal changes. Ulcerative mucositis is responsible for significant pain, impairing the patient's nutritional intake and leading to local or systemic infections promoting mycosis due to several species of the genus Candida. According to international guidelines, treatment of candidiasis depends on the infection site and patient's condition. SUMMARY Recently several studies have shown the protective role of natural compounds counteracting the activity of Candida biofilms. The aim of this review is to discuss the antimicrobial activities of natural compounds in fungal infections, especially Candida spp., during and soon after radiotherapy. Indeed new molecules are being discovered and assessed for their capacity to control Candida spp. growth and, probably in the future, will be used to treat oral candidiasis, overall, during radiotherapy. This review reports several preliminary data about preclinical and clinical evidence of their efficacy in the prevention and/or treatment of mucositis due to Radiotherapy with a brief description of the natural compounds with anti-Candida activities. KEY MESSAGES The increase in the resistance to the available antifungal drugs related to Candida spp. infections increased as well as drug interactions, urging the development of innovative and more effective agents with antifungal action. Recent preclinical and clinical studies are identifying natural substances with anti-inflammatory and antifungal activity that could be tested in the prevention of candidiasis in patients undergoing radiotherapy. Further studies are needed to confirm these preliminary data.
Collapse
|
7
|
Corazziari ES, Gasbarrini A, D'Alba L, D'Ovidio V, Riggio O, Passaretti S, Annibale B, Cicala M, Repici A, Bassotti G, Ciacci C, Di Sabatino A, Neri M, Bragazzi MC, Ribichini E, Radocchia G, Iovino P, Marazzato M, Schippa S, Badiali D. Poliprotect vs Omeprazole in the Relief of Heartburn, Epigastric Pain, and Burning in Patients Without Erosive Esophagitis and Gastroduodenal Lesions: A Randomized, Controlled Trial. Am J Gastroenterol 2023; 118:2014-2024. [PMID: 37307528 PMCID: PMC10617666 DOI: 10.14309/ajg.0000000000002360] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/09/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In the treatment of upper GI endoscopy-negative patients with heartburn and epigastric pain or burning, antacids, antireflux agents, and mucosal protective agents are widely used, alone or as add-on treatment, to increase response to proton-pump inhibitors, which are not indicated in infancy and pregnancy and account for significant cost expenditure. METHODS In this randomized, controlled, double-blind, double-dummy, multicenter trial assessing the efficacy and safety of mucosal protective agent Poliprotect (neoBianacid, Sansepolcro, Italy) vs omeprazole in the relief of heartburn and epigastric pain/burning, 275 endoscopy-negative outpatients were given a 4-week treatment with omeprazole (20 mg q.d.) or Poliprotect (5 times a day for the initial 2 weeks and on demand thereafter), followed by an open-label 4-week treatment period with Poliprotect on-demand. Gut microbiota change was assessed. RESULTS A 2-week treatment with Poliprotect proved noninferior to omeprazole for symptom relief (between-group difference in the change in visual analog scale symptom score: [mean, 95% confidence interval] -5.4, -9.9 to -0.1; -6.2, -10.8 to -1.6; intention-to-treat and per-protocol populations, respectively). Poliprotect's benefit remained unaltered after shifting to on-demand intake, with no gut microbiota variation. The initial benefit of omeprazole was maintained against significantly higher use of rescue medicine sachets (mean, 95% confidence interval: Poliprotect 3.9, 2.8-5.0; omeprazole 8.2, 4.8-11.6) and associated with an increased abundance of oral cavity genera in the intestinal microbiota. No relevant adverse events were reported in either treatment arm. DISCUSSION Poliprotect proved noninferior to standard-dose omeprazole in symptomatic patients with heartburn/epigastric burning without erosive esophagitis and gastroduodenal lesions. Gut microbiota was not affected by Poliprotect treatment. The study is registered in Clinicaltrial.gov (NCT03238534) and the EudraCT database (2015-005216-15).
Collapse
Affiliation(s)
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, CEMAD Centro Malattie Dell'Apparato Digerente, Università Cattolica Del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS. Rome, Italy
| | - Lucia D'Alba
- Department of Gastroenterology and Digestive Endoscopy, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Valeria D'Ovidio
- Unit of Gastroenterology and Digestive Endoscopy, S. Eugenio Hospital, Rome, Italy
| | - Oliviero Riggio
- Dipartimento di Medicina Traslazionale e di Precisione, Sapienza University of Rome, Rome, Italy
| | - Sandro Passaretti
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Annibale
- Dipartimento Scienze Medico-Chirurgiche e Medicina Traslazionale, Universita' Sapienza Roma, Ospedale Universitario Sant'Andrea, Rome, Italy
| | - Michele Cicala
- Department of Digestive Diseases, Campus Bio Medico University, Rome, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gabrio Bassotti
- Gastroenterology & Hepatology Section, Department of Medicine & Surgery, University of Perugia, Perugia, Italy
| | - Carolina Ciacci
- PO di Malattie Dell'Apparato Digerente, Università di Salerno, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | | | - Matteo Neri
- Department of Medicine and Ageing Sciences and Center for Advanced Studies and Technology (CAST), “G. D'Annunzio” University of Chieti-Pescara, Chieti-Pescara, Italy
| | | | - Emanuela Ribichini
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Radocchia
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paola Iovino
- PO di Malattie Dell'Apparato Digerente, Università di Salerno, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Massimiliano Marazzato
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Serena Schippa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Danilo Badiali
- Dipartimento di Medicina Traslazionale e di Precisione, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
8
|
Ribolsi M, Savarino E, Frazzoni M, Cicala M. Prospective validation of reflux monitoring by impedance-pH in predicting PPI response in typical GERD. Dig Liver Dis 2023; 55:721-726. [PMID: 36572569 DOI: 10.1016/j.dld.2022.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/14/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND The Lyon Consensus proposed a hierarchical approach to GERD diagnosis based on conventional and new impedance-pH metrics, namely acid exposure time (AET), number of reflux episodes, post-reflux swallow-induced peristaltic wave (PSPW) index, and mean nocturnal baseline impedance (MNBI). AIMS To define the value of conventional and new impedance-pH parameters as predictors of response to label-dose PPI in typical GERD. METHODS Consecutive adult patients with typical esophageal symptoms were prospectively studied with impedance-pH monitoring and treated with 8-week label-dose PPI. At the end of the PPI course, symptoms response was assessed. RESULTS Among 255 patients who entered the study, 168 (65.9%) reported symptom remission. At ROC analysis, both MNBI and PSPW index were significantly associated to PPI responsiveness with AUC of 0.783 and 0.801, respectively. Cut-off values of 1747Ω for MNBI and 50% for PSPW index were identified as discriminators between response and non-response to label-dose PPI. At multivariate analysis, MNBI, PSPW index, and AET >6% were efficient predictors of PPI responses (OR 3, 5.4 and 2.3, respectively). Number of reflux episodes did not predict PPI response. CONCLUSIONS The novel MII-pH variables together with pathological are highly predictive of response of the typical GERD syndrome to label-dose PPI.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Via Alvaro del Portillo 200 - 00128, Roma, Italy.
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy
| | - Michele Cicala
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Via Alvaro del Portillo 200 - 00128, Roma, Italy
| |
Collapse
|
9
|
Balestrieri P, Cicala M, Ribolsi M. Psychological distress in inflammatory bowel disease. Expert Rev Gastroenterol Hepatol 2023:1-15. [PMID: 37254523 DOI: 10.1080/17474124.2023.2209723] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Mental health disorders are common in inflammatory bowel disease (IBD) and affect patients' quality of life, impacting on disease outcomes and health care-related costs. AREAS COVERED Even if psychological issues in IBD patients are highly burdened in terms of quality of life, psychiatric comorbidities still receive less attention into routine care than the physical symptoms of the disease. The present review provides an overview of recent literature, focusing on the association between perceived stress and IBD outcomes. For this purpose, the epidemiology of more common psychological comorbidities in IBD and their potential effect on the onset and disease course have been examined. Moreover, therapeutic interventions in the management of these patients have also been evaluated. EXPERT OPINION Screening of patients at high risk of psychological issues is currently an unmet, clinical need in the management of IBD. Under-diagnosed and under-treated mental health disorders in IBD patients may impact outcomes, leading to increased disability and health-care utilization and associated costs. A patient-tailored, integrated model of care in the management of IBD is required to optimize disease outcomes and improve patients' quality of life.
Collapse
Affiliation(s)
- Paola Balestrieri
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, Rome, Italy
| | - Michele Cicala
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, Rome, Italy
| | - Mentore Ribolsi
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, Rome, Italy
| |
Collapse
|
10
|
Ribolsi M, Frazzoni M, Marchetti L, Brigida M, Cicala M, Savarino E. Proximal esophageal impedance baseline increases the yield of impedance-pH monitoring for GERD diagnosis and is associated with heartburn response to PPI. Neurogastroenterol Motil 2023:e14612. [PMID: 37203462 DOI: 10.1111/nmo.14612] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Impairment of esophageal mucosal integrity as assessed by low mean nocturnal baseline impedance (MNBI) measured in the distal esophagus increases the diagnostic yield of impedance-pH in patients with inconclusive GERD diagnosis as defined by Lyon criteria. AIM To assess the diagnostic yield of MNBI measurement in the proximal esophagus, and its relationship with PPI response. METHODS Expert review of off-therapy impedance-pH tracings from consecutive patients with heartburn, 80 responders and 80 non-responders to label-dose PPI. Data were compared to those from 36 healthy controls using ROC analysis. Multivariate analysis was performed to measure the strength of association of MNBI with PPI response. RESULTS A threshold value of 2665 Ω was defined for proximal MNBI by ROC analysis, affording 91.7% sensitivity and 86.5% specificity. Proximal and distal MNBI were significantly lower in non-responder cases as compared to responders. Adding proximal MNBI positivity to pathologic (>6%) acid exposure time (AET) and positive symptom-reflux association, the proportion of patients with abnormal impedance-pH findings increased from 74/160 (46%) to 106/160 (66.3%) (p = 0.0016). Among the 12 patients with pathologic proximal MNBI as the only positive impedance-pH finding, 9 cases (75%) were PPI responders. According to multivariate analysis, AET and pathological distal and proximal MNBI were significantly associated with PPI response, the strongest association observed for proximal MNBI. CONCLUSIONS Impedance baseline assessment in the proximal esophagus may increase the diagnostic yield of impedance-pH monitoring. Heartburn response to PPI is directly related to ultrastructural mucosal damage in the distal and in the proximal esophagus as well.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy
| | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy
| | - Lorenzo Marchetti
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy
| | - Mattia Brigida
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy
| | - Michele Cicala
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| |
Collapse
|
11
|
Rosa CD, Altomare A, Terrigno V, Carbone F, Tack J, Cicala M, Guarino MPL. Constipation-Predominant Irritable Bowel Syndrome (IBS-C): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms. Nutrients 2023; 15:nu15071647. [PMID: 37049488 PMCID: PMC10096616 DOI: 10.3390/nu15071647] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 02/22/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by abdominal pain associated with defecation or a change in bowel habits. The pathogenesis of IBS is not completely clear, but it is known to be multifactorial and complex. Endogenous and exogenous factors such as abnormal GI motility, low-grade inflammation, increased epithelial permeability and visceral hypersensitivity, but diet and psychosocial aspects are also recognized as important actors. Furthermore, the interaction between diet and gut microbiota has gained interest as a potential contributor to the pathophysiology of IBS. To date, there is no specific diet for IBS with constipation (IBS-C); however, many studies show that fiber intake, especially soluble fiber such as inulin, could have a positive effect on symptoms. This review aims to evaluate the effects of some nutritional components such as fibers but also functional foods, prebiotics, probiotics and symbiotics on symptoms and microbiota in IBS-C subjects.
Collapse
Affiliation(s)
- Claudia Di Rosa
- Research Unit of Food Science and Human Nutrition, Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy; (C.D.R.)
| | - Annamaria Altomare
- Research Unit of Gastroenterology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
- Operative Research Unit of Gastroenterology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Correspondence:
| | - Vittoria Terrigno
- Research Unit of Food Science and Human Nutrition, Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy; (C.D.R.)
| | - Florencia Carbone
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Jan Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Michele Cicala
- Research Unit of Gastroenterology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
- Operative Research Unit of Gastroenterology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Michele Pier Luca Guarino
- Research Unit of Gastroenterology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
- Operative Research Unit of Gastroenterology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| |
Collapse
|
12
|
Ribolsi M, Marchetti L, Blasi V, Cicala M. Anxiety correlates with excessive air swallowing and PPI refractoriness in patients with concomitant symptoms of GERD and functional dyspepsia. Neurogastroenterol Motil 2023:e14550. [PMID: 36786093 DOI: 10.1111/nmo.14550] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Anxiety may exacerbate GERD and FD symptoms perception and reduce quality of life. As many as 50% of patients with GERD symptoms have incomplete relief with PPI therapy, and psychological factors may influence PPI responsiveness. AIM The potential relationship between anxiety, excessive air swallowing, and PPI responsiveness was evaluated. METHODS GERD patients with concomitant FD were prospectively evaluated. Validated structured questionnaires were used to evaluate anxiety, GERD, and FD symptoms. All patients were treated, within the previous year, with at least 8 weeks of standard dose PPI therapy. RESULTS One hundred sixty-one patients were included. Frequency of non-responders in patients with moderate/severe anxiety was significantly higher compared to patients with mild anxiety (62.7% vs. 37.3%, p < 0.01). Patients with moderate/severe anxiety displayed a significantly higher mean FD symptoms score value compared to patients with mild anxiety. A significantly higher mean number of air swallows were observed in patients with moderate/severe anxiety. At ROC analysis, air swallows and mixed reflux episodes were significantly associated with the presence of PPI refractoriness (AUC: 0.725, 95% CI: 0.645-0.805 and 0.768, 0.692-0.843). According to univariate analysis, an abnormal number of air swallows, mixed reflux episodes and presence of moderate/severe anxiety was significantly associated with PPI refractoriness. CONCLUSION Our results, if confirmed in in a larger, prospective clinical and therapeutic study, demonstrate the usefulness of an up-front evaluation with anxiety questionnaire and esophageal testing in patients with a broad spectrum of upper gastrointestinal symptoms who fail to respond to PPI treatment, supporting the option of alternative treatment modalities.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy
| | - Lorenzo Marchetti
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy
| | - Valentina Blasi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy
| | - Michele Cicala
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy
| |
Collapse
|
13
|
Lo Presti A, Del Chierico F, Altomare A, Zorzi F, Monteleone G, Putignani L, Angeletti S, Cicala M, Guarino MPL, Ciccozzi M. Phylogenetic analysis of Prevotella copri from fecal and mucosal microbiota of IBS and IBD patients. Therap Adv Gastroenterol 2023; 16:17562848221136328. [PMID: 36644130 PMCID: PMC9837282 DOI: 10.1177/17562848221136328] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Prevotella copri is the most abundant member of the genus Prevotella that inhabits the human large intestines. Evidences correlated the increase in Prevotella abundance to inflammatory disorders, suggesting a pathobiont role. OBJECTIVES The aim of this study was to investigate the phylogenetic dynamics of P. copri in patients with irritable bowel syndrome (IBS), inflammatory bowel diseases (IBDs) and in healthy volunteers (CTRL). DESIGN A phylogenetic approach was used to characterize 64 P. copri 16S rRNA sequences, selected from a metagenomic database of fecal and mucosal samples from 52 patients affected by IBD, 44 by IBS and 59 healthy. METHODS Phylogenetic reconstructions were carried out using the maximum likelihood (ML) and Bayesian methods. RESULTS Maximum likelihood phylogenetic tree applied onto reference and data sets, assigned all the reads to P. copri clade, in agreement with the taxonomic classification previously obtained. The longer mean genetic distances were observed for both the couples IBD and CTRL and IBD and IBS, respect to the distance between IBS and CTRL, for fecal samples. The intra-group mean genetic distance increased going from IBS to CTRLs to IBD, indicating elevated genetic variability within IBD of P. copri sequences. None clustering based on the tissue inflammation or on the disease status was evidenced, leading to infer that the variability seemed to not be influenced by concomitant diseases, disease phenotypes or tissue inflammation. Moreover, patients with IBS appeared colonized by different strains of P. copri. In IBS, a correlation between isolates and disease grading was observed. CONCLUSION The characterization of P. copri phylogeny is relevant to better understand the interactions between microbiota and pathophysiology of IBD and IBS, especially for future development of therapies based on microbes (e.g. probiotics and synbiotics), to restore the microbiota in these bowel diseases.
Collapse
Affiliation(s)
| | | | - Annamaria Altomare
- Research Unit of Gastroenterology, Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Francesca Zorzi
- Gastrointestinal Unit, Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Giovanni Monteleone
- Gastrointestinal Unit, Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Lorenza Putignani
- Department of Diagnostic and Laboratory Medicine, Unit of microbiology and diagnostic immunology, Unit of microbiomics and Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy,Unit of Clinical Laboratory Fondazione Policlinico Universitario Campus Bio Medico, Rome, Italy
| | - Michele Cicala
- Research Unit of Gastroenterology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy,Operative Research Unit of Gastroenterology, Fondazione Policlinico Universitario Campus Bio-Medico of Rome, Via Alvaro del Portillo, Roma, Italy
| | | | | |
Collapse
|
14
|
Molfino A, Emerenziani S, Tonini G, Santini D, Gigante A, Guarino MPL, Nuglio C, Imbimbo G, La Cesa A, Cicala M, Muscaritoli M. Early impairment of food intake in patients newly diagnosed with cancer. Front Nutr 2023; 9:997813. [PMID: 36687669 PMCID: PMC9849803 DOI: 10.3389/fnut.2022.997813] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Background Patients with gastrointestinal or lung cancer often suffer from a loss of appetite (anorexia), resulting in reduced food intake (hypophagia) and body weight loss. This study evaluated the prevalence of anorexia, hypophagia, pre-cachexia and cachexia in patients with cancer at time of diagnosis. Patients and methods Patients with newly diagnosed gastrointestinal or lung cancers were included. Body mass index (BMI) and weight loss over the prior 6 months were recorded. Patients were assessed for (pre-)cachexia and for anorexia using the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) and a specific anorexia questionnaire (AQ). Energy and protein intake were calculated through food diaries. Patients were considered hypophagic if intake was ≤70% of guideline-recommended levels. Results Overall, 102 patients [53 male; median age: 67 (range, 21-88) years] were enrolled. Mean BMI (± standard deviation) was 23.1 ± 3.4 kg/m2; average percentage of weight loss was 10.1 ± 7.8%. At diagnosis, 68% (69/102) of patients had cachexia, and 11% (11/102) pre-cachexia. Prevalence of anorexia was 57% (58/102) and 75% (76/102) according to FAACT and AQ, respectively. Forty-eight percent (49/102) of patients had hypophagia. Patients with anorexia had lower daily energy (p = 0.002) and protein intake (p = 0.0257), and greater percentage of weight loss (p = 0.0005). In patients with hypophagia, negative correlations were observed between percentage of weight loss and total daily calorie (r = -0.40; p = 0.01) and protein intake (r = -0.340; p = 0.018). Conclusion Anorexia, inadequate nutritional intake and cachexia are highly prevalent in patients with gastrointestinal or lung cancer at diagnosis. Negative protein and energy balance may play an important role in the pathogenesis of cachexia. Early multimodal strategies to improve food intake are urgently needed.
Collapse
Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sara Emerenziani
- Gastroenterology Unit, Campus Bio-Medico University, Rome, Italy
| | | | | | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Chiara Nuglio
- Gastroenterology Unit, Campus Bio-Medico University, Rome, Italy
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Michele Cicala
- Gastroenterology Unit, Campus Bio-Medico University, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy,*Correspondence: Maurizio Muscaritoli,
| |
Collapse
|
15
|
Ribolsi M, Frazzoni M, Cicala M, Savarino E. Association between post-reflux swallow-induced peristaltic wave index and esophageal mucosal integrity in patients with GERD symptoms. Neurogastroenterol Motil 2023; 35:e14344. [PMID: 35238440 DOI: 10.1111/nmo.14344] [Citation(s) in RCA: 4] [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: 11/02/2021] [Revised: 01/13/2022] [Accepted: 02/12/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Impedance-pH monitoring allows evaluation of esophageal chemical clearance, a response to reflux elicited by the esophago-salivary reflex, by means of the post-reflux swallow-induced peristaltic wave (PSPW) index; mucosal integrity can be evaluated by means of mean nocturnal baseline impedance (MNBI) and is regarded as a GERD marker. Currently, the relationship between PSPW index and MNBI has not yet been fully investigated and represents the aim of the present study. METHODS Impedance-pH tracings from consecutive patients were reviewed. ROC analysis and multivariate regression models were generated to evaluate the association between acid exposure time (AET), total refluxes (TRs), PSPW index, and MNBI. Patients were classified by means of AET thresholds and symptom-reflux association indexes into conclusive and inconclusive GERD, reflux hypersensitivity (RH), and functional heartburn (FH). Pathologic MNBI <2292 Ω was defined according to published outcome studies. KEY RESULTS Two hundred and thirty patients constituted the study cohort. Overall, a significant direct correlation was observed between PSPW index and MNBI (0.759, p < 0.001). At ROC analysis, a PSPW index cut-off value of 53% was the best discriminator between normal from pathologic MNBI values (sensitivity 88%, specificity 86.4%). Considering AET cut-off of 4% or 6%, a sensitivity of 80.7% and 46% and a specificity of 62.5% and 93.2% were found, respectively. According to multivariate analysis, AET >4% and PSPW index value <53% or <61% were significantly associated with pathologic MNBI values. CONCLUSIONS AND INFERENCES Esophageal chemical clearance is a major defense mechanism against reflux and its impairment represents a major determinant of reflux-associated mucosal damage.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Michele Cicala
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| |
Collapse
|
16
|
Ribolsi M, Andrisani G, Di Matteo FM, Cicala M. Achalasia, from diagnosis to treatment. Expert Rev Gastroenterol Hepatol 2023; 17:21-30. [PMID: 36588469 DOI: 10.1080/17474124.2022.2163236] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Achalasia is an uncommon esophageal motility disorder and is characterized by alterations of the motility of the esophageal body in conjunction with altered lower esophageal sphincter (LES) relaxation. The clinical presentation of patients with achalasia may be complex; however, the most frequent symptom is dysphagia. The management of patients with achalasia is often challenging, due to the heterogeneous clinical presentation. AREAS COVERED The diagnosis and management of achalasia has significantly improved in the last years due to the growing availability of high-resolution manometry (HRM) and the implementation in the therapeutic armamentarium of new therapeutic endoscopic procedures. Traditional therapeutic strategies include botulinum toxin injected to the LES and pneumatic balloon dilation. On the other hand, surgical treatments contemplate laparoscopic Heller myotomy and, less frequently, esophagectomy. Furthermore, in the last few years, per oral endoscopic myotomy (POEM) has been proposed as the main endoscopic therapeutic alternative to the laparoscopic Heller myotomy. EXPERT OPINION Diagnosis and treatment of achalasia still represent a challenging area. However, we believe that an accurate up-front evaluation is, nowadays, necessary in addressing patients with achalasia for a more accurate diagnosis as well as for the best treatment options.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, Rome, Italy
| | | | | | - Michele Cicala
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, Rome, Italy
| |
Collapse
|
17
|
Citarelli G, Locuratolo N, De Martino G, Resta M, Sassara M, Ricci G, Cicala M, Piscopo A, Sanasi M, Scicchitano P, Lisi F, Spadafina T, Grande D, Caldarola P. C57 DUAL ANTIPLATELET THERAPY DID NOT PREDICT ALL–CAUSE BLEEDING AT LONG–TERM FOLLOW–UP AFTER ACS: A SUBANALYSIS FROM THE APULIA PONTE ACS STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. Nevertheless, the risk for bleeding often impact on the long–term administration of DAPT. The aim of this study was to evaluate the determinants of bleeding risk after ACS.
Methods
This was a subanalysis of the PONTE ACS study. The PONTE ACS study is a prospective, longitudinal, cohort study which enrolled patients who were discharged from HUB centres of ASL BARI after coronary revascularization and/or ACS. They underwent clinical evaluation at 30 days, 3, 6 and 1 year–follow–up. The data were collected after including the data in the electronic medical record of the PONTE ACS study. Anthropometric, clinical and pharmacological parameters, instrumental and laboratory examinations were included. Data were computed in order to evaluate the major determinants of all–cause bleeding at one–year follow–up.
Results
We finally enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 years). Pharmacological treatments were optimized during the follow–up visits. According to anti–thrombotic therapies, 92.1% of patients persisted on DAPT at one–year follow–up. The number of patients on DAPT+anticoagulant were: 4.4%. All–cause bleeding occurred in 2.2% of patients. Anthropometric characteristics (height [β: –0.04594 ± 0.01610, p = 0.0044] and weight [β: –0.03043 ± 0.01035, p = 0.033]), male gender [β: –0.7008 ± 0.2818, p = 0.0129], and age [β: 0.02535 ± 0.01219, p = 0.0376] were the major determinants of all–cause bleeding at univariate regression analysis but they were not confirmed at multivariate regression analysis (p=ns). Kaplan Meier curve points out the impact of age on all–cause bleeding (Figure 1). Nor DAPT or triple therapy remained associated with all–cause bleeding at one year follow–up.
Conclusions
Long–term DAPT is not a predictor of all–cause bleeding in patients who suffered ACS and/or coronary revascularization.
Collapse
Affiliation(s)
- G Citarelli
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - N Locuratolo
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - G De Martino
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - M Resta
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - M Sassara
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - G Ricci
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - M Cicala
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - A Piscopo
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - M Sanasi
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - P Scicchitano
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - F Lisi
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - T Spadafina
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - D Grande
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| | - P Caldarola
- UOC CARDIOLOGIA – P.O. “SAN PAOLO” BARI (BA) ASL BARI, BARI; DISTRETTO SOCIO SANITARIO N. 5, GRUMO APPULA (BA), ASL BARI, GRUMO APPULA; UOC CARDIOLOGIA – P.O. “DI VENERE” BARI (BA) ASL BARI, BARI; UOC CARDIOLOGIA – P.O. “F. PERINEI” ALTAMURA (BA) ASL BARI, ALTAMURA; UO CARDIOLOGIA – P.O. “DON TONINO BELLO” MOLFETTA (BA) ASL BARI, MOLFETTA; UO CARDIOLOGIA P.O. “SARCONE” TERLIZZI (BA) ASL BARI, TER
| |
Collapse
|
18
|
Ribolsi M, Frazzoni M, De Bortoli N, Tolone S, Arsiè E, Mariani L, De Carlo G, Maniero D, Penagini R, Cicala M, Savarino E. Reflux characteristics triggering post-reflux swallow-induced peristaltic wave (PSPW) in patients with GERD symptoms. Neurogastroenterol Motil 2022; 34:e14183. [PMID: 34051123 PMCID: PMC9285402 DOI: 10.1111/nmo.14183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/16/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Esophageal chemical clearance has been evaluated with the post-reflux swallow-induced peristaltic wave (PSPW) index. The factors triggering PSPW in Gastro-esophageal reflux disease (GERD) have not yet been investigated. This multicenter study was aimed at evaluating the characteristics of reflux episodes associated with PSPW occurrence in patients with typical GERD symptoms. METHODS Impedance-pH tracings from patients with typical reflux symptoms were analyzed. Sixteen healthy subjects were included for comparison. Multivariate analysis was performed to determine predictors of PSPW events. KEY RESULTS Impedance-pH tracings from 60 patients and 16 healthy subjects were evaluated. A total of 3454 refluxes were recorded. In patients, comparing reflux episodes followed with those not followed by a PSPW, significantly higher proportions of acid (79% vs. 74%, p: 0.02), mixed (47% vs. 32%, p: 0.0001) and proximal refluxes (34% vs. 20%, p: 0.0001) were observed. A multivariate analysis, acid (OR: 1.3, 95% CI: 1.05-1.6), mixed (OR: 2, 95% CI: 1.6-2.3), and proximal (OR: 2.1, 95% CI: 1.7-2.5) refluxes were independently associated with PSPWs. Reflux episodes followed by a PSPW were characterized by a significantly higher bolus clearing time [(mean ± SD) 41 s ± 6 s vs. 30 s ± 5 s, p < 0.05] whereas nadir pH value of reflux events preceding PSPWs was tangentially but not significantly lower [(mean ± SD) 2.61 ± 1.22 vs. 2.74 ± 1.26, p: 0.057]. CONCLUSIONS AND INFERENCES Acid, mixed and proximal refluxes, and their duration are key factors in eliciting PSPWs. PSPW represents a response to reflux directly related to the potential harmfulness of reflux contents.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Department of Digestive DiseasesCampus Bio Medico University of RomeRomaItaly
| | - Marzio Frazzoni
- Digestive Pathophysiology UnitBaggiovara HospitalModenaItaly
| | - Nicola De Bortoli
- Department of Translational Research and New Technology in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Salvatore Tolone
- General and Bariatric Surgery UnitDepartment of Surgery2nd University of NaplesNapoliItaly
| | - Elena Arsiè
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly,Fondazione IRCCS Ospedale Maggiore PoliclinicoMilanItaly
| | - Lucia Mariani
- Department of Translational Research and New Technology in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Giovanni De Carlo
- Department of Digestive DiseasesCampus Bio Medico University of RomeRomaItaly
| | - Daria Maniero
- Gastroenterology UnitDepartment of Surgery, Oncology and GastroenterologyUniversity of PaduaPadovaItaly
| | - Roberto Penagini
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly,Fondazione IRCCS Ospedale Maggiore PoliclinicoMilanItaly
| | - Michele Cicala
- Department of Digestive DiseasesCampus Bio Medico University of RomeRomaItaly
| | - Edoardo Savarino
- Gastroenterology UnitDepartment of Surgery, Oncology and GastroenterologyUniversity of PaduaPadovaItaly
| |
Collapse
|
19
|
Ribolsi M, Frazzoni M, Marabotto E, De Carlo G, Ziola S, Maniero D, Balestrieri P, Cicala M, Savarino E. Novel impedance-pH parameters are associated with proton pump inhibitor response in patients with inconclusive diagnosis of gastro-oesophageal reflux disease according to Lyon Consensus. Aliment Pharmacol Ther 2021; 54:412-418. [PMID: 34181753 PMCID: PMC8361916 DOI: 10.1111/apt.16481] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 05/01/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Lyon Consensus delineates impedance-pH parameters that can demonstrate/exclude gastro-oesophageal reflux disease (GERD). In patients with acid exposure time between 4% and 6%, GERD diagnosis has been considered inconclusive. In these cases, mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index may either confirm or refute GERD diagnosis and represent predictors of proton pump inhibitor (PPI) response. AIMS To investigate the diagnostic yield of MNBI and PSPW index and their relationship with PPI response in patients with inconclusive GERD diagnosis. METHODS Review of impedance-pH tracings from PPI responder/non-responder patients with typical reflux symptoms. Multivariate regression analysis was performed to determine the association of MNBI and PSPW index to PPI response. RESULTS Among 233 patients evaluated, 145/233 (62.2%) were PPI responders; 62 had conclusive and 65 inconclusive evidence of GERD, 46 had reflux hypersensitivity, and 60 functional heartburn. Abnormal MNBI and PSPW index were significantly more frequent in inconclusive GERD as compared to the functional heartburn group (P < 0.001). Within the inconclusive GERD group, 35/65 (54%) patients were PPI responders and displayed a significantly higher proportion of cases with pathological MNBI or PSPW index as compared to non-responders (32/35 [91.4%] and 30/35 [85.7%] vs 9/30 [30%] and 7/30 [23.3%], P < 0.001). By multivariate analysis, pathological PSPW index and/or MNBI values were significantly associated with PPI response in all groups. CONCLUSIONS The present study highlights the value of MNBI and PSPW index as adjunctive metrics in characterising patients with inconclusive evidence of GERD and identifying those responsive to PPI treatment.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Department of Digestive DiseasesCampus Bio Medico University of RomeRomaItaly
| | - Marzio Frazzoni
- Digestive Pathophysiology UnitBaggiovara HospitalModenaItaly
| | | | - Giovanni De Carlo
- Department of Digestive DiseasesCampus Bio Medico University of RomeRomaItaly
| | | | - Daria Maniero
- Gastroenterology UnitDepartment of Surgery, Oncology and GastroenterologyUniversity of PaduaPadovaItaly
| | - Paola Balestrieri
- Department of Digestive DiseasesCampus Bio Medico University of RomeRomaItaly
| | - Michele Cicala
- Department of Digestive DiseasesCampus Bio Medico University of RomeRomaItaly
| | - Edoardo Savarino
- Gastroenterology UnitDepartment of Surgery, Oncology and GastroenterologyUniversity of PaduaPadovaItaly
| |
Collapse
|
20
|
Ribolsi M, Frazzoni M, Marabotto E, Cicala M, Savarino E. Editorial: inconclusive diagnosis of GERD: are new parameters in impedance-pHmetry ready for clinical use? Authors' reply. Aliment Pharmacol Ther 2021; 54:498-499. [PMID: 34331808 DOI: 10.1111/apt.16529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/13/2022]
Affiliation(s)
| | - Marzio Frazzoni
- Fisiopatologia Digestiva, Nuovo Ospedale S.Agostino, Modena, Italy
| | - Elisa Marabotto
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Michele Cicala
- Malattie Apparato Digerente, Campus Bio Medico, Rome, Italy
| | | |
Collapse
|
21
|
De Vincentis A, Santonico M, Del Chierico F, Altomare A, Marigliano B, Laudisio A, Reddel S, Grasso S, Zompanti A, Pennazza G, Putignani L, Guarino MPL, Cicala M, Antonelli Incalzi R. Gut Microbiota and Related Electronic Multisensorial System Changes in Subjects With Symptomatic Uncomplicated Diverticular Disease Undergoing Rifaximin Therapy. Front Med (Lausanne) 2021; 8:655474. [PMID: 34350192 PMCID: PMC8326398 DOI: 10.3389/fmed.2021.655474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/11/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Intestinal dysbiosis might play a pathogenetic role in subjects with symptomatic uncomplicated diverticular disease (SUDD), but the effect of rifaximin therapy has been scantly explored with regard to gut microbiota variations in patients with SUDD. Aims: To verify to which extent rifaximin treatment affects the gut microbiota and whether an electronic multisensorial assessment of stools and breath has the potential for detecting these changes. Methods: Breath and stool samples were collected from consecutive patients with SUDD before and after a 7 days' therapy with rifaximin. Stool microbiota was assessed, and the electronic multisensorial assessment was carried out by means of the BIONOTE electronic (e-)tongue in stools and (e-)nose in breath. Results: Forty-three subjects (female 60%, median age 66 years) were included, and 20 (47%) reported clinical improvement after rifaximin therapy. Alpha and beta diversity of stool microbiota did not significantly change after treatment, while a significant variation of selected taxa was shown (i.e., Citrobacter, Coprococcus, Anaerotruncus, Blautia, Eggerthella lenta, Dehalobacterium, SMB53, and Haemophilus parainfluenzae). Overall, the electronic multisensorial system suboptimally mirrored microbiota changes, but it was able to efficiently predict patients' clinical improvement after rifaximin with accuracies ranging from 0.81 to 0.98. Conclusions: In patients with SUDD, rifaximin administration is associated with significant variation of selected taxa. While inaccurate in predicting gut microbiota change, an electronic multisensorial system, made up of e-tongue and e-nose, was able to predict clinical improvement, thus potentially qualifying as an easy and cheap tool to forecast subjects taking most likely benefit from rifaximin therapy.
Collapse
Affiliation(s)
| | - Marco Santonico
- Unit of Electronics for Sensor Systems, Department of Science and Technology for Humans and the Environment, University Campus Bio-Medico di Roma, Rome, Italy
| | - Federica Del Chierico
- Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Annamaria Altomare
- Unit of Gastroenterology, University Campus Bio Medico of Rome, Rome, Italy
| | | | - Alice Laudisio
- Unit of Geriatrics, University Campus Bio Medico of Rome, Rome, Italy
| | - Sofia Reddel
- Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Simone Grasso
- Unit of Electronics for Sensor Systems, Department of Science and Technology for Humans and the Environment, University Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandro Zompanti
- Unit of Electronics for Sensor Systems, Department of Engineering, University Campus Bio-Medico di Roma, Rome, Italy
| | - Giorgio Pennazza
- Unit of Electronics for Sensor Systems, Department of Engineering, University Campus Bio-Medico di Roma, Rome, Italy
| | - Lorenza Putignani
- Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Unit of Parasitology and Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | - Michele Cicala
- Unit of Gastroenterology, University Campus Bio Medico of Rome, Rome, Italy
| | | |
Collapse
|
22
|
Frazzoni M, Frazzoni L, Ribolsi M, De Bortoli N, Tolone S, Conigliaro R, Arsiè E, Penagini R, Cicala M, Savarino E. Esophageal pH increments associated with post-reflux swallow-induced peristaltic waves show the occurrence and relevance of esophago-salivary reflex in clinical setting. Neurogastroenterol Motil 2021; 33:e14085. [PMID: 33471424 DOI: 10.1111/nmo.14085] [Citation(s) in RCA: 12] [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: 11/03/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Following acid perfusion, esophageal pH is restored by swallowed bicarbonate-containing saliva secreted in response to a vagal esophago-salivary reflex. At impedance-pH monitoring, the post-reflux swallow-induced peristaltic wave (PSPW) index puts into relationship timely post-reflux swallows with the number of reflux events: Low values typify reflux-related heartburn (RRH) and lack of on-therapy improvement characterizes proton pump inhibitor (PPI) failure. Considerable esophageal pH increments associated with PSPWs could demonstrate the occurrence of esophago-salivary reflex in clinical setting, while its relevance could be shown by lower esophageal pH increments in PPI-refractory RRH. METHODS Prospective multicenter study in patients with PPI-refractory or PPI-responsive RRH evaluated with off-PPI impedance-pH monitoring. Increments in pH associated with PSPWs were measured and the mean calculated to obtain the PSPW-associated ∆pH. KEY RESULTS The mean PSPW-associated ∆pH in 294 RRH patients was 1.2 ± 0.7 and was lower in 137 PPI-refractory (1.0 ± 0.6) than in 157 PPI-responsive (1.5 ± 0.6) cases (p < 0.0001). Lower PSPW-associated ∆pH was independently related to PPI failure at multivariable logistic regression analysis (OR 0.16, 95% CI 0.09-0.26). At ROC analysis, comparing PPI-refractory to PPI-responsive cases the AUC for PSPW-associated ∆pH was 0.76 (95% CI 0.71-0.82), the best cutoff value being 1.2. CONCLUSIONS AND INFERENCES Considerable PSPW-associated pH increments demonstrate the occurrence of esophago-salivary reflex in clinical setting. Lower increments in PPI-refractory RRH cases show the clinical relevance of esophago-salivary reflex, confirming that PSPW represents a defense mechanism against reflux. PSPW-associated ∆pH can efficiently predict PPI response in patients undergoing off-therapy impedance-pH monitoring.
Collapse
Affiliation(s)
- Marzio Frazzoni
- Digestive Pathophysiology Unit and Digestive Endoscopy Unit, Baggiovara Hospital, Modena, Italy
| | - Leonardo Frazzoni
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Nicola De Bortoli
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Salvatore Tolone
- General and Bariatric Surgery Unit, Department of Surgery, 2nd University of Naples, Napoli, Italy
| | - Rita Conigliaro
- Digestive Pathophysiology Unit and Digestive Endoscopy Unit, Baggiovara Hospital, Modena, Italy
| | - Elena Arsiè
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Roberto Penagini
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Michele Cicala
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| |
Collapse
|
23
|
Ribolsi M, Savarino E, Rogers B, Rengarajan A, Coletta MD, Ghisa M, Cicala M, Gyawali CP. Patients With Definite and Inconclusive Evidence of Reflux According to Lyon Consensus Display Similar Motility and Esophagogastric Junction Characteristics. J Neurogastroenterol Motil 2021; 27:565-573. [PMID: 34045366 PMCID: PMC8521480 DOI: 10.5056/jnm20158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/13/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022] Open
Abstract
Background/Aims The role of esophageal high-resolution manometry (HRM) within Lyon consensus phenotypes, especially patients with inconclusive gastroesophageal reflux disease (GERD) evidence, has not been fully investigated. In this multicenter, observational study we aim to compare HRM parameters in patients with GERD stratified according to the Lyon consensus. Methods Clinical and endoscopic data, HRM and multichannel intraluminal impedance-pH (MII-pH) studies performed off proton pump inhibitor therapy in patients with esophageal GERD symptoms were reviewed. Lyon consensus criteria identified pathological GERD, reflux hypersensitivity, functional heartburn, and inconclusive GERD. Patients, with inconclusive GERD were further subdivided into 2 groups based on total reflux numbers (≤ 80 or > 80 reflux episodes) during the MII-pH recording time. Results A total of 264 patients formed the study cohort. Pathological GERD and inconclusive GERD patients were associated with higher numbers of reflux episodes, lower mean nocturnal baseline impedance (MNBI) values, and a higher proportion of patients with pathologic MNBI compared to functional heartburn (P < 0.05 for each comparison). On multivariate analysis, pathological GERD and inconclusive GERD patients, both with ≤ 80 or > 80 reflux episodes, were significantly associated with pathologic esophagogastric junction contractile integral values and with presence of hiatus hernia (type 2/3 esophagogastric junction). Patients with inconclusive GERD and > 80 reflux episodes were significantly associated with fragmented peristalsis and ineffective esophageal motility whilst inconclusive GERD with ≤ 80 reflux episodes were significantly associated with fragmented peristalsis. Conclusion Esophageal motor parameters on HRM are similar between pathologic and inconclusive GERD according to the Lyon consensus.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Benjamin Rogers
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Arvind Rengarajan
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Marco Della Coletta
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Matteo Ghisa
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Michele Cicala
- Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy
| | - Chandra Prakash Gyawali
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
24
|
Palombo G, Merone M, Altomare A, Gori M, Terradura C, Bacco L, Del Chierico F, Putignani L, Cicala M, Guarino MPL, Piemonte V. The impact of the intestinal microbiota and the mucosal permeability on three different antibiotic drugs. Eur J Pharm Sci 2021; 164:105869. [PMID: 34020000 DOI: 10.1016/j.ejps.2021.105869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/19/2021] [Accepted: 04/25/2021] [Indexed: 01/15/2023]
Abstract
BackgroundThe totality of bacteria, protozoa, viruses and fungi that lives in the human body is called microbiota. Human microbiota specifically colonizes the skin, the respiratory and urinary tract, the urogenital tract and the gastrointestinal system. This study focuses on the intestinal microbiota to explore the drug-microbiota relationship and, therefore, how the drug bioavailability changes in relation to the microbiota biodiversity to identify more personalized therapies, with the minimum risk of side effects. MethodsTo achieve this goal, we developed a new mathematical model with two compartments, the intestine and the blood, which takes into account the colonic mucosal permeability variation - measured by Ussing chamber system on human colonic mucosal biopsies - and the fecal microbiota composition, determined through microbiota 16S rRNA sequencing analysis. Both of the clinical parameters were evaluated in a group of Irritable Bowel Syndrome patients compared to a group of healthy controls. Key ResultsThe results show that plasma drug concentration increases as bacterial concentration decreases, while it decreases as intestinal length decreases too. ConclusionsThe study provides interesting data since in literature there are not yet mathematical models with these features, in which the importance of intestinal microbiota, the "forgotten organ", is considered both for the subject health state and in the nutrients and drugs metabolism.
Collapse
Affiliation(s)
- Giovanni Palombo
- Istituto di Analisi dei Sistemi ed Informatica "A. Ruberti", IASI-CNR (National Research Council of Italy), Rome, Italy; SYSBIO/ISBE.IT, Centre of System Biology, Rome, Italy
| | - Mario Merone
- Computer Systems and Bioinformatics Laboratory, Department of Engineering, University Campus Bio-Medico of Rome, Italy.
| | | | - Manuele Gori
- Unit of Gastroenterology Campus Bio-Medico University, Rome, Italy; Institute of Biochemistry and Cell Biology (IBBC) - National Research Council (CNR), Monterotondo Scalo, Rome, Italy
| | - Carlotta Terradura
- Unit of Chemical-physics Fundamentals in Chemical Engineering, Department of Engineering, University Campus Bio-Medico of Rome, Italy
| | - Luca Bacco
- Computer Systems and Bioinformatics Laboratory, Department of Engineering, University Campus Bio-Medico of Rome, Italy; Istituto di Linguistica Computazionale "Antonio Zampolli" (IL-CNR), ItaliaNLP Lab, Pisa, Italy
| | - Federica Del Chierico
- Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesú Children's Hospital, IRCCS, Rome, Italy
| | - Lorenza Putignani
- Department of Diagnostic and Laboratory Medicine, Unit of Parasitology and Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesú Children's Hospital, IRCCS, Rome, Italy
| | - Michele Cicala
- Unit of Gastroenterology Campus Bio-Medico University, Rome, Italy
| | | | - Vincenzo Piemonte
- Unit of Chemical-physics Fundamentals in Chemical Engineering, Department of Engineering, University Campus Bio-Medico of Rome, Italy
| |
Collapse
|
25
|
Altomare A, Gori M, Cocca S, Carotti S, Francesconi M, Ribolsi M, Emerenziani S, Perrone G, Morini S, Cicala M, Guarino MPL. Impaired Colonic Contractility and Intestinal Permeability in Symptomatic Uncomplicated Diverticular Disease. J Neurogastroenterol Motil 2021; 27:292-301. [PMID: 33594008 PMCID: PMC8026365 DOI: 10.5056/jnm20110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/31/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background/Aims Impaired intestinal motility seems to play a crucial role in symptomatic uncomplicated diverticular disease (SUDD), although the mechanism is not clear. The aim of the present study is to explore the contractility patterns of colonic smooth muscle strips (MS) and smooth muscle cells (SMCs) and to assess mucosal integrity in SUDD patients. Methods MS or SMCs were isolated from specimens of human distal colon of 18 patients undergoing surgery for non-obstructive colonic cancer, among them 9 with SUDD. Spontaneous phasic contractions on strips and morpho-functional parameters on cells were evaluated in basal conditions and in response to acetylcholine (ACh). Mucosal integrity of SUDD colonic biopsies was evaluated by the Ussing Chamber system. Immunohistochemical staining for tight junction protein complex and for Toll-like receptor 4 (TLR4) was performed. Results Colonic MS of SUDD group showed a significant reduced basal tone and ACh-elicited contraction, compared to the control group (9.5 g and 47.0% in the SUDD group; 14.16 g and 69.0% in the control group; P < 0.05). SMCs of SUDD group showed a maximal contractile response to ACh significantly reduced compared to control group (8.8% vs 16.5%, P < 0.05). SUDD patients displayed lower transepithelial electrical resistance and increased paracellular permeability compared to control group. Immunohistochemical expression of TLR4 was not different in both groups, while tight junction protein complex expression was lower in SUDD patients compared to control group patients. Conclusion It could be hypothesized that in SUDD, in absence of severe inflammation, an increased intestinal mucosal permeability is related to altered colonic motility probably responsible for symptoms genesis.
Collapse
Affiliation(s)
- Annamaria Altomare
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Manuele Gori
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.,Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), Monterotondo Scalo, Rome, Italy
| | - Silvia Cocca
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Simone Carotti
- Microscopic and Ultrastructural Anatomy Unit, Università Campus Bio-Medico di Roma, Rome, Italy.,Predictive Molecular Diagnostic Division, Department of Pathology, Campus Bio-Medico University Hospital, Rome, Italy
| | - Maria Francesconi
- Microscopic and Ultrastructural Anatomy Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mentore Ribolsi
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sara Emerenziani
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Perrone
- Predictive Molecular Diagnostic Division, Department of Pathology, Campus Bio-Medico University Hospital, Rome, Italy
| | - Sergio Morini
- Microscopic and Ultrastructural Anatomy Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Michele Cicala
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Michele P L Guarino
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| |
Collapse
|
26
|
Altomare A, Di Rosa C, Imperia E, Emerenziani S, Cicala M, Guarino MPL. Diarrhea Predominant-Irritable Bowel Syndrome (IBS-D): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms. Nutrients 2021; 13:1506. [PMID: 33946961 PMCID: PMC8146452 DOI: 10.3390/nu13051506] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by abdominal pain associated with defecation or a change in bowel habits. Gut microbiota, which acts as a real organ with well-defined functions, is in a mutualistic relationship with the host, harvesting additional energy and nutrients from the diet and protecting the host from pathogens; specific alterations in its composition seem to play a crucial role in IBS pathophysiology. It is well known that diet can significantly modulate the intestinal microbiota profile but it is less known how different nutritional approach effective in IBS patients, such as the low-FODMAP diet, could be responsible of intestinal microbiota changes, thus influencing the presence of gastrointestinal (GI) symptoms. The aim of this review was to explore the effects of different nutritional protocols (e.g., traditional nutritional advice, low-FODMAP diet, gluten-free diet, etc.) on IBS-D symptoms and on intestinal microbiota variations in both IBS-D patients and healthy subjects. To date, an ideal nutritional protocol does not exist for IBS-D patients but it seems crucial to consider the effect of the different nutritional approaches on the intestinal microbiota composition to better define an efficient strategy to manage this functional disorder.
Collapse
Affiliation(s)
- Annamaria Altomare
- Gastroenterology Unit, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.E.); (M.C.); (M.P.L.G.)
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy;
| | - Claudia Di Rosa
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy;
| | - Elena Imperia
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy;
| | - Sara Emerenziani
- Gastroenterology Unit, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.E.); (M.C.); (M.P.L.G.)
| | - Michele Cicala
- Gastroenterology Unit, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.E.); (M.C.); (M.P.L.G.)
| | - Michele Pier Luca Guarino
- Gastroenterology Unit, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.E.); (M.C.); (M.P.L.G.)
| |
Collapse
|
27
|
Rogers BD, Rengarajan A, Ribolsi M, Ghisa M, Quader F, Penagini R, de Bortoli N, Mauro A, Cicala M, Savarino E, Gyawali CP. Postreflux swallow-induced peristaltic wave index from pH-impedance monitoring associates with esophageal body motility and esophageal acid burden. Neurogastroenterol Motil 2021; 33:e13973. [PMID: 33249687 DOI: 10.1111/nmo.13973] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/29/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postreflux swallow-induced peristaltic wave (PSPW) on pH-impedance monitoring and contraction vigor on high-resolution manometry (HRM) both assess esophageal peristaltic response. We aimed to evaluate relationships between PSPW and esophageal peristalsis on HRM in the context of reflux disease in this multicenter cohort study. METHODS pH-impedance and HRM studies performed on patients with persisting reflux symptoms were reviewed from 6 centers (5 in Europe and 1 in US). Total, upright and supine acid exposure time (AET) were evaluated from pH-impedance studies; PSPW index (PSPWI) and mean nocturnal baseline impedance (MNBI) were calculated using standard methodology. Esophageal body contraction vigor was analyzed using distal contractile integral (DCI), and DCI ratio > 1 between single swallows and multiple rapid swallows (MRS) defined presence of contraction reserve. Student's t test, ANOVA, and linear regression were utilized to investigate relationships between PSPW, contraction vigor, and contraction reserve. KEY RESULTS Of 296 patients (52.8 ± 0.8 yr, 63% F), median PSPWI was 0.475. Only 24.0% had intact DCI; the remainder had varying degrees of hypomotility. As hypomotility increased, PSPWI and MNBI decreased significantly, while total AET and reflux episodes had an inverse response (P ≤ .002 for each). MRS data were available in 167 (56.4%), 72.5% had contraction reserve. MRS cohorts with normal PSPWI had significantly lower reflux burden compared to low PSPWI, regardless of presence or absence of contraction reserve (P ≤ .001). CONCLUSIONS AND INFERENCES PSPWI correlates with esophageal hypomotility and reflux burden, and complements clinical reflux evaluation. Intact PSPW is more relevant to esophageal reflux clearance than contraction reserve.
Collapse
Affiliation(s)
- Benjamin D Rogers
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - Arvind Rengarajan
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - Mentore Ribolsi
- Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy
| | - Matteo Ghisa
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Farhan Quader
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - Roberto Penagini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Nicola de Bortoli
- Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Aurelio Mauro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Michele Cicala
- Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| |
Collapse
|
28
|
Conforti C, Dianzani C, Zalaudek I, Cicala M, Persichetti P, Giuffrida R, Morariu SH, Neagu N. Spotlight on the treatment armamentarium of concomitant psoriasis and inflammatory bowel disease: a systematic review. J DERMATOL TREAT 2020; 33:1279-1286. [PMID: 33074781 DOI: 10.1080/09546634.2020.1836313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Caterina Dianzani
- Dermatology Section, Plastic and Reconstructive Surgery Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Michele Cicala
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, Rome, Italy
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | | | - Nicoleta Neagu
- Dermatology Clinic, Mureș County Hospital, Tîrgu Mureș, Romania
| |
Collapse
|
29
|
Sifrim D, Roman S, Savarino E, Bor S, Bredenoord AJ, Castell D, Cicala M, de Bortoli N, Frazzoni M, Gonlachanvit S, Iwakiri K, Kawamura O, Krarup A, Lee YY, Soon Ngiu C, Ndebia E, Patcharatraku T, Pauwels A, Pérez de la Serna J, Ramos R, Remes-Troche JM, Ribolsi M, Sammon A, Simren M, Tack J, Tutuian R, Valdovinos M, Xiao Y, Zerbib F, Gyawali CP. Normal values and regional differences in oesophageal impedance-pH metrics: a consensus analysis of impedance-pH studies from around the world. Gut 2020; 70:gutjnl-2020-322627. [PMID: 33037054 DOI: 10.1136/gutjnl-2020-322627] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 07/23/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Limitations of existing impedance-pH thresholds include small sample size of normative studies, inclusion of artefactual pH drops and incorrect identification of impedance reflux events. We aimed to obtain new impedance-pH thresholds from expert consensus analysis of tracings from a large number of healthy subjects. DESIGN Of 541 studies performed worldwide using two different systems (Diversatek, USA, and Laborie, Netherlands), 150 tracings with oesophageal diagnoses, behavioural disorders and study-related artefacts were excluded. The remainder studies were subject to two reviewer consensus analysis, in-person or through video conference, consisting of editing meals and pH drops, identification of impedance reflux and postreflux swallow-induced peristaltic wave (PSPW) using strict pre-established criteria and measurement of distal mean nocturnal baseline impedance (MNBI). RESULTS Consensus analysis was performed in 391 tracings (age 32.7 years, range 18-71, 54.2% female). Normative thresholds were significantly different between Diversatek and Laborie (total acid exposure time: 2.8% and 5%; reflux episodes: 55 and 78; MNBI at 3 cm: 1400 and 1500 ohms, at 5 cm: 1400 and 1800 ohms). Males had higher acid exposure, more reflux episodes and lower MNBI. Significant regional differences were identified, including higher PSPW scores in Western countries, and higher MNBI in Asia using Diversatek, and higher acid exposure in the Netherlands, higher MNBI in Asia and South Africa, and lower MNBI in Turkey using Laborie. CONCLUSION Normal impedance-pH monitoring thresholds have regional and system-related differences. Clinical interpretation needs to use normal thresholds valid for the system used and world region, following careful editing of the tracings.
Collapse
Affiliation(s)
- Daniel Sifrim
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sabine Roman
- Digestive Physiology, Hopital E Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Serhat Bor
- Ege University School of Medicine, Izmir, Turkey
| | - Albert J Bredenoord
- Department of Gastroenterology & Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Donald Castell
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michele Cicala
- Digestive Disease, Universita Campus Bio Medico, Roma, Italy
| | | | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy
| | - Sutep Gonlachanvit
- Department of Medicine, Chlalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | - Katsuhiko Iwakiri
- Department of Gaastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | | | - Anne Krarup
- Section of Gastroenterology and Hepatology, Department of Medicine and Department of Neurogastroenterology Research, The North Danish Regional Hospital, Hjørring, Denmark
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Chai Soon Ngiu
- Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Eugene Ndebia
- Division of Medical Physiology, Walter Sisulu University, Mthatha, South Africa
| | - Tanisa Patcharatraku
- Gastropenterology, Center of Excellence in Neurogastroenterology and Motility, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ans Pauwels
- Translational Research Center for Gastrointestinal Disorders, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Julio Pérez de la Serna
- Immunology and Gastroenterology Departments, Instituto de Investigacion Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Rosa Ramos
- Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina
| | | | - Mentore Ribolsi
- Digestive Disease, Universita Campus Bio Medico, Roma, Italy
| | - Alastair Sammon
- Division of Medical Physiology, Walter Sisulu University, Mthatha, South Africa
| | - Magnus Simren
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Tack
- Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium
| | - Radu Tutuian
- University Clinics for Visceral Surgery and Medcine, Bern University Hospital, Bern, Switzerland
| | - Miguel Valdovinos
- Experimental Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Yinglian Xiao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Frank Zerbib
- Department of Gastroenterology, Bordeaux University Hospital, Bordeaux, France
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
30
|
Ribolsi M, de Carlo G, Balestrieri P, Guarino MPL, Cicala M. Understanding the relationship between esophageal motor disorders and reflux disease. Expert Rev Gastroenterol Hepatol 2020; 14:933-940. [PMID: 32658587 DOI: 10.1080/17474124.2020.1791703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The management of gastro-esophageal reflux disease (GERD) patients is often complex as the clinical presentation is heterogeneous and the mechanisms underlying symptoms are multifactorial. In the past decades, investigations conducted with conventional manometry and, above all, the more accurate high resolution manometry (HRM), helped us in exploring the field of esophageal motility and in understanding the link between motor features and GERD pathogenesis. AREAS COVERED Several studies carried out with conventional manometry and HRM have confirmed a relevant role of esophageal motor function in GERD pathogenesis. In particular, HRM studies have shown a direct correlation between impaired esophageal body motility, disruption of the esophagogastric junction and reflux burden. These findings impact the clinical and therapeutical management of GERD patients. Moreover, HRM findings might be helpful in evaluating patients with proton pump inhibitor (PPI) resistance and inconclusive evidences of GERD. EXPERT OPINION The relationship between esophageal motility and GERD pathogenesis needs to be further evaluated by multicenter outcome studies involving a large number of GERD patients and healthy controls. However, other more promising areas could be progressed.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University , Rome, Italy
| | - Giovanni de Carlo
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University , Rome, Italy
| | - Paola Balestrieri
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University , Rome, Italy
| | | | - Michele Cicala
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University , Rome, Italy
| |
Collapse
|
31
|
Ribolsi M, Savarino E, Rogers B, Rengarajan A, Coletta MD, Ghisa M, Cicala M, Gyawali CP. High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to Proton Pump Inhibitor Therapy. J Neurogastroenterol Motil 2020; 26:447-454. [PMID: 32122112 PMCID: PMC7547194 DOI: 10.5056/jnm19153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 08/12/2019] [Revised: 10/11/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Impaired esophageal motility and disrupted esophagogastric junction (EGJ) on high-resolution manometry (HRM) have been associated with increased reflux severity in gastroesophageal reflux disease (GERD) patients. However, there are limited data evaluating HRM parameters in proton pump inhibitors (PPI) non-responders. Methods Clinical and endoscopic data, HRM and multichannel intraluminal impedance-pH studies performed of PPI therapy in patients with typical GERD symptoms were reviewed from 3 international centers. Frequency of GERD symptoms was assessed on and off PPI therapy in both non-responders (< 50% symptom improvement on PPI therapy) and responders. Rome IV definitions identified non-erosive reflux disease, reflux hypersensitivity, and functional heartburn. Univariate and multivariate analyses were performed to determine predictors of non-response. Results Of 204 patients, 105 were PPI non-responders and 99 were responders. Non-responders showed higher EGJ contractile integral values, and a lower frequency of type II and III EGJ morphology (P ≤ 0.03 for each comparison). Esophageal body diagnoses on HRM (fragmented peristalsis, ineffective esophageal motility, or absent peristalsis) did not predict non-response. On multivariate analysis, non-pathological acid exposure time (OR, 2.5; 95% CI, 1.2-5.0; P < 0.001), normal mean nocturnal baseline impedance values (OR, 2.7-2.4; 95% CI, 1.0-6.1; P < 0.05), normal EGJ contractile integral values (OR, 3; 95% CI, 1.3-7.4; P = 0.012), and presence of type I EGJ morphology (OR, 1.9; 95% CI, 1.0-3.4; P = 0.044) were associated with an unfavorable response to PPIs. Conclusions Intact EGJ metrics on HRM complement normal reflux burden in predicting non-response to PPI therapy. HRM has value in the evaluation of PPI non-responders.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Benjamin Rogers
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Arvind Rengarajan
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Marco Della Coletta
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Matteo Ghisa
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Michele Cicala
- Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy
| | - C Prakash Gyawali
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
32
|
Savarino E, Frazzoni M, Marabotto E, Zentilin P, Iovino P, Costantini M, Tolone S, Battaglia E, Cicala M, Usai-Satta P, de Bortoli N, Penagini R, Savarino V. A SIGE-SINGEM-AIGO technical review on the clinical use of esophageal reflux monitoring. Dig Liver Dis 2020; 52:966-980. [PMID: 32513632 DOI: 10.1016/j.dld.2020.04.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023]
Abstract
Patients with esophageal symptoms potentially associated with gastroesophageal reflux disease such as heartburn, regurgitation, chest pain, or cough represent one of the most frequent reasons for referral to gastroenterological evaluation. The utility of esophageal reflux monitoring in clinical practice is: (1) to accurately define reflux burden, (2) to segregate patients according to reflux monitoring results as true GERD, reflux hypersensitivity and functional heartburn, and (3) to establish a treatment plan. With this in mind, in the last decade, investigations and technical advances, with the introduction of impedance-pH monitoring and wireless pH capsule, have enhanced our understanding and management of GERD. The following recommendations were discussed and approved after a comprehensive review of the medical literature pertaining to reflux testing techniques and their recent application. This review created under the auspices of the Società Italiana di Gastroenterologia ed Endoscopia Digestiva (SIGE), Società Italiana di Neuro-Gastro-Enterologia e Motilità (SINGEM) and Associazione Italiana Gastroenterologi ed Endoscopisti Digestivi Ospedalieri (AIGO) is intended to help clinicians in applying reflux studies in the most fruitful manner within the context of their patients with esophageal symptoms.
Collapse
Affiliation(s)
- Edoardo Savarino
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
| | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy
| | - Elisa Marabotto
- Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Patrizia Zentilin
- Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paola Iovino
- Gastroenterology Unit, University of Salerno, Salerno, Italy
| | - Mario Costantini
- Clinica Chirurgica III, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | | | - Edda Battaglia
- Gastroenterology and Endoscopy Unit, Cardinal Massaja Hospital, Asti, Italy
| | - Michele Cicala
- Unit of Digestive Diseases, Campus Bio Medico University, Rome, Italy
| | | | - Nicola de Bortoli
- Gastrointestinal Unit-Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit - Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Vincenzo Savarino
- Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| |
Collapse
|
33
|
Bonelli A, Menna P, Minotti G, Angeletti S, Comandini A, Picollo R, Quarchioni E, Russo V, Salvatori E, Ferravante F, Emerenziani S, Cicala M, Muscaritoli M. Safety and tolerability of a novel oral nutritional supplement in healthy volunteers. Clin Nutr 2020; 40:946-955. [PMID: 32675020 DOI: 10.1016/j.clnu.2020.06.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Foods for Special Medical Purposes (FSMPs) are formulated to support the nutritional needs of subjects with impaired capacity to ingest, digest or absorb ordinary food or nutrients. Polglumyt® is a proprietary highly purified, high quality glycogen obtained from mussels. Here we report the results of a single-center, single dose, open label, single arm study carried out to investigate acceptance (i.e. gastrointestinal tolerance and palatability), metabolic profile and safety of a low osmolarity, high-density energy Polglumyt®-based drink (the investigational product, IP) as a novel FSMP. METHODS Twelve healthy subjects received a single oral administration of the IP under fasting conditions. The study endpoints were: changes in gastrointestinal system tolerability at 3 h, 6 h and 24 h after IP intake; IP palatability evaluation; metabolic evaluation through the kinetic profile of circulating glucose, insulin and C-peptide from 0 h to 6 h after IP intake and changes from baseline in circulating triglycerides at 3 h and 6 h after IP intake. RESULTS The IP showed a good gastrointestinal tolerability and an acceptable palatability. The IP did not affect the physiological glycemic profile and the triglycerides levels 6 h after the intake. The IP was well tolerated by study subjects, with no or minor adverse events. CONCLUSIONS The study results encourage additional clinical investigations on the IP as a novel FSMP in patients with impaired digestion or gastrointestinal absorption, unable to assume an ordinary diet, e.g. patients undergoing invasive gastrointestinal surgery, elderly or oncological patients, even with certain metabolic disorders.
Collapse
Affiliation(s)
- Annalisa Bonelli
- Angelini RR&D (Research, Regulatory & Development) - Angelini S.p.A., S.Palomba-Pomezia, Rome, Italy
| | - Pierantonio Menna
- Clinical Pharmacology Unit, University Campus Bio-Medico Rome, Italy
| | - Giorgio Minotti
- Clinical Pharmacology Unit, University Campus Bio-Medico Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Alessandro Comandini
- Angelini RR&D (Research, Regulatory & Development) - Angelini S.p.A., S.Palomba-Pomezia, Rome, Italy
| | - Rossella Picollo
- Angelini RR&D (Research, Regulatory & Development) - Angelini S.p.A., S.Palomba-Pomezia, Rome, Italy
| | - Elisa Quarchioni
- Angelini RR&D (Research, Regulatory & Development) - Angelini S.p.A., S.Palomba-Pomezia, Rome, Italy
| | - Vincenzo Russo
- Angelini RR&D (Research, Regulatory & Development) - Angelini S.p.A., S.Palomba-Pomezia, Rome, Italy
| | - Enrica Salvatori
- Angelini RR&D (Research, Regulatory & Development) - Angelini S.p.A., S.Palomba-Pomezia, Rome, Italy
| | | | - Sara Emerenziani
- Gastroenterology Unit, University Campus Bio-Medico, Rome, Italy
| | - Michele Cicala
- Gastroenterology Unit, University Campus Bio-Medico, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.
| |
Collapse
|
34
|
Ribolsi M, Cicala M. Clinical impact of proton pump inhibitor response and dependence. Neurogastroenterol Motil 2020; 32:e13846. [PMID: 32426919 DOI: 10.1111/nmo.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/17/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Mentore Ribolsi
- Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy
| | - Michele Cicala
- Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy
| |
Collapse
|
35
|
Gori M, Altomare A, Cocca S, Solida E, Ribolsi M, Carotti S, Rainer A, Francesconi M, Morini S, Cicala M, Pier Luca Guarino M. Palmitic Acid Affects Intestinal Epithelial Barrier Integrity and Permeability In Vitro. Antioxidants (Basel) 2020; 9:antiox9050417. [PMID: 32414055 PMCID: PMC7278681 DOI: 10.3390/antiox9050417] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 12/15/2022] Open
Abstract
Palmitic acid (PA), a long-chain saturated fatty acid, might activate innate immune cells. PA plays a role in chronic liver disease, diabetes and Crohn’s disease, all of which are associated with impaired intestinal permeability. We investigated the effect of PA, at physiological postprandial intestinal concentrations, on gut epithelium as compared to lipopolysaccharide (LPS) and ethanol, using an in vitro gut model, the human intestinal epithelial cell line Caco-2 grown on transwell inserts. Cytotoxicity and oxidative stress were evaluated; epithelial barrier integrity was investigated by measuring the paracellular flux of fluorescein, and through RT-qPCR and immunofluorescence of tight junction (TJ) and adherens junction (AJ) mRNAs and proteins, respectively. In PA-exposed Caco-2 monolayers, cytotoxicity and oxidative stress were not detected. A significant increase in fluorescein flux was observed in PA-treated monolayers, after 90 min and up to 360 min, whereas with LPS and ethanol, this was only observed at later time-points. Gene expression and immunofluorescence analysis showed TJ and AJ alterations only in PA-exposed monolayers. In conclusion, PA affected intestinal permeability without inducing cytotoxicity or oxidative stress. This effect seemed to be faster and stronger than those with LPS and ethanol. Thus, we hypothesized that PA, besides having an immunomodulatory effect, might play a role in inflammatory and functional intestinal disorders in which the intestinal permeability is altered.
Collapse
Affiliation(s)
- Manuele Gori
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.C.); (E.S.); (M.R.); (M.C.); (M.P.L.G.)
- Correspondence: ; Tel: +39-062-2541-9108
| | - Annamaria Altomare
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.C.); (E.S.); (M.R.); (M.C.); (M.P.L.G.)
| | - Silvia Cocca
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.C.); (E.S.); (M.R.); (M.C.); (M.P.L.G.)
| | - Eleonora Solida
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.C.); (E.S.); (M.R.); (M.C.); (M.P.L.G.)
| | - Mentore Ribolsi
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.C.); (E.S.); (M.R.); (M.C.); (M.P.L.G.)
| | - Simone Carotti
- Microscopic and Ultrastructural Anatomy Unit, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128 Rome, Italy; (S.C.); (M.F.); (S.M.)
| | - Alberto Rainer
- Tissue Engineering Laboratory, Department of Engineering, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128 Rome, Italy;
| | - Maria Francesconi
- Microscopic and Ultrastructural Anatomy Unit, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128 Rome, Italy; (S.C.); (M.F.); (S.M.)
| | - Sergio Morini
- Microscopic and Ultrastructural Anatomy Unit, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128 Rome, Italy; (S.C.); (M.F.); (S.M.)
| | - Michele Cicala
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.C.); (E.S.); (M.R.); (M.C.); (M.P.L.G.)
| | - Michele Pier Luca Guarino
- Gastroenterology Unit, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.C.); (E.S.); (M.R.); (M.C.); (M.P.L.G.)
| |
Collapse
|
36
|
Guarino MPL, Altomare A, Emerenziani S, Di Rosa C, Ribolsi M, Balestrieri P, Iovino P, Rocchi G, Cicala M. Mechanisms of Action of Prebiotics and Their Effects on Gastro-Intestinal Disorders in Adults. Nutrients 2020; 12:nu12041037. [PMID: 32283802 PMCID: PMC7231265 DOI: 10.3390/nu12041037] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023] Open
Abstract
In recent years, research has focused on the use of dietary fibers and prebiotics, since many of these polysaccharides can be metabolized by intestinal microbiota, leading to the production of short-chain fatty acids. The metabolites of prebiotic fermentation also show anti-inflammatory and immunomodulatory capabilities, suggesting an interesting role in the treatment of several pathological conditions. Galacto-oligosaccharide and short- and long-chain fructans (Fructo-oligosaccharides and inulin) are the most studied prebiotics, even if other dietary compounds seem to show the same features. There is an increasing interest in dietary strategies to modulate microbiota. The aim of this review is to explore the mechanisms of action of prebiotics and their effects on the principal gastro-intestinal disorders in adults, with a special focus on Galacto-oligosaccharides, Fructo-oligosaccharides, lactulose and new emerging substances which currently have evidence of prebiotics effects, such as xilooligosaccharides, soybean oligosaccharides, isomaltooligosaccharides, lactobionic acid, resistant starch and polyphenols.
Collapse
Affiliation(s)
- Michele Pier Luca Guarino
- Gastroenterology Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.P.L.G.); (S.E.); (M.R.); (P.B.); (G.R.); (M.C.)
| | - Annamaria Altomare
- Gastroenterology Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.P.L.G.); (S.E.); (M.R.); (P.B.); (G.R.); (M.C.)
- Correspondence: ; Tel.: +39-06-22541-606; Fax: +39-06-22541-456
| | - Sara Emerenziani
- Gastroenterology Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.P.L.G.); (S.E.); (M.R.); (P.B.); (G.R.); (M.C.)
| | - Claudia Di Rosa
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy;
| | - Mentore Ribolsi
- Gastroenterology Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.P.L.G.); (S.E.); (M.R.); (P.B.); (G.R.); (M.C.)
| | - Paola Balestrieri
- Gastroenterology Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.P.L.G.); (S.E.); (M.R.); (P.B.); (G.R.); (M.C.)
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, Università di Salerno, Via Allende, 84081 Salerno, Italy;
| | - Giulia Rocchi
- Gastroenterology Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.P.L.G.); (S.E.); (M.R.); (P.B.); (G.R.); (M.C.)
| | - Michele Cicala
- Gastroenterology Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy; (M.P.L.G.); (S.E.); (M.R.); (P.B.); (G.R.); (M.C.)
| |
Collapse
|
37
|
Ribolsi M, Gyawali CP, Savarino E, Rogers B, Rengarajan A, Della Coletta M, Ghisa M, Cicala M. Correlation between reflux burden, peristaltic function, and mucosal integrity in GERD patients. Neurogastroenterol Motil 2020; 32:e13752. [PMID: 31670453 DOI: 10.1111/nmo.13752] [Citation(s) in RCA: 16] [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: 08/17/2019] [Revised: 09/14/2019] [Accepted: 10/07/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mean nocturnal baseline impedance (MNBI) augments the diagnostic yield of multichannel intraluminal impedance-pH (MII-pH) monitoring. While acid exposure time (AET) correlates with MNBI, it remains unclear whether esophageal motility affects MNBI values. The present study was aimed at evaluating the respective roles of esophageal motor function and AET on MNBI. METHODS High-resolution manometry (HRM) studies and ambulatory 24-hour MII-pH monitoring tracings were retrospectively analyzed from consecutive endoscopy-negative GERD patients with typical symptoms responsive to previous acid-suppressive therapy from three tertiary care centers. Univariate and multivariate analyses were performed to determine predictors of pathologic MNBI values at 3 cm and 5 cm above the lower esophageal sphincter (LES). KEY RESULTS Patients with pathological AET displayed lower MNBI values at 3 cm and 5 cm (P < .01) compared to patients with non-pathological AET. Similarly, significantly lower MNBI values were also noted at both sites with type 3 EGJ compared to type 1 EGJ (P ≤ .02 for each comparison), and with absent contractility compared to normal peristalsis (P ≤ .02 for each comparison). On multivariate analysis, the presence of type 2 or 3 EGJ and absent contractility were associated with a significantly higher probability of pathological MNBI values at 3 cm and 5 cm above the LES. CONCLUSIONS AND INFERENCES Disruption of the EGJ and absent contractility on HRM are both associated with lower MNBI values. HRM findings complement reflux testing using MII-pH monitoring.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy
| | - Chandra Prakash Gyawali
- Department of Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Benjamin Rogers
- Department of Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Arvind Rengarajan
- Department of Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Marco Della Coletta
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Matteo Ghisa
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Michele Cicala
- Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy
| |
Collapse
|
38
|
Rogers BD, Rengarajan A, Mauro A, Ghisa M, De Bortoli N, Cicala M, Ribolsi M, Penagini R, Savarino E, Gyawali CP. Fragmented and failed swallows on esophageal high-resolution manometry associate with abnormal reflux burden better than weak swallows. Neurogastroenterol Motil 2020; 32:e13736. [PMID: 31574208 DOI: 10.1111/nmo.13736] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 07/01/2019] [Revised: 08/29/2019] [Accepted: 09/16/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Association between proportions of hypomotile swallows on esophageal high-resolution manometry (HRM) and esophageal reflux burden remains incompletely understood. We investigated relationships between hypomotility, acid exposure time (AET), and mean nocturnal baseline impedance (MNBI) on ambulatory reflux monitoring. METHODS Clinical data, HRM, and ambulatory pH-impedance studies (performed off acid suppression) from patients with persisting reflux symptoms were reviewed from five international centers. AET (abnormal > 6%) and MNBI (abnormal < 2292 ohms) were extracted from pH-impedance studies. Distal contractile integral (DCI) designated esophageal peristalsis into normal (DCI > 450 mmHg.cm.s), fragmented (DCI > 450 mmHg.cm.s with breaks > 5 cm), weak (DCI 100-450 mmHg.cm.s), and failed (DCI < 100 mm mmHg.cm.s) sequences. Univariate and multivariate analyses were performed to identify motor associations of abnormal reflux burden. KEY RESULTS Of 351 patients (52.1 ± 0.8 years, 67%F), 29.3% had AET > 6% and 61.8% had MNBI < 2292 ohms. On univariate analysis, both fragmented peristalsis and IEM associated with abnormal AET (P ≤ .01) and MNBI (P ≤ .03); reflux burden was more profound with >70% fragmented as well as ineffective sequences compared to ≤70% for each (P < .05 for each comparison). When weak and failed sequences within IEM were separately analyzed, ≥50% failed sequences predicted abnormal AET (P ≤ .009), and ≥50% weak sequences did not (P = .14). On multivariate regression, ≥50% failed sequences predicted abnormal AET (P = .02), and >70% ineffective sequences trended strongly (P = .069); >70% ineffective sequences predicted abnormal MNBI (P = .046), and >70% fragmented sequences trended strongly (P = .076). CONCLUSIONS AND INFERENCES Breaks in esophageal peristaltic integrity seen with fragmented and failed sequences are more relevant to abnormal esophageal acid burden than weak sequences.
Collapse
Affiliation(s)
- Benjamin D Rogers
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - Arvind Rengarajan
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - Aurelio Mauro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Ghisa
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Nicola De Bortoli
- Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Michele Cicala
- Division of Gastroenterology, Universita' Campus Bio-Medico Di Roma, Rome, Italy
| | - Mentore Ribolsi
- Division of Gastroenterology, Universita' Campus Bio-Medico Di Roma, Rome, Italy
| | - Roberto Penagini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
39
|
Ribolsi M, Guarino MPL, Tullio A, Cicala M. Post-reflux swallow-induced peristaltic wave index and mean nocturnal baseline impedance predict PPI response in GERD patients with extra esophageal symptoms. Dig Liver Dis 2020; 52:173-177. [PMID: 31623954 DOI: 10.1016/j.dld.2019.09.011] [Citation(s) in RCA: 16] [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: 05/16/2019] [Revised: 07/31/2019] [Accepted: 09/11/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index are able to increase the diagnostic yield of impedance-pH and are associated to proton pump inhibitor (PPI) response. Few data concerning these variables in patients with extra-esophageal symptoms (EES) are available. AIMS To evaluate, in EES patients, the role of the conventional and new impedance-pH variables in diagnosing GERD and the predictive value of impedance-pH variables for PPI response. METHODS Consecutive patients presenting suspected GERD-related EES underwent impedance-pH. Patients treated in the last six months with double dose PPI therapy were enrolled. The presence of concomitant typical symptoms was assessed. RESULTS 239 EES patients were studied; 102 responders and 137 non-responders. Eighty-one (34%) were affected by non-erosive reflux disease (NERD), 61 (26%) presented reflux hypersensitivity (RH) and 97 (40%) were non-GERD. In NERD and RH groups, a significantly higher proportion of patients with pathological PSPW index or MNBI values compared to non-GERD group was observed. 24 (25%) non-GERD patients presented a pathological PSPW index and/or MNBI. Pathological PSPW index, MNBI and presence of typical symptoms were associated to PPI response. CONCLUSIONS MNBI and PSPW index measurement increases the diagnostic yield of impedance-pH; abnormal values are associated with a satisfactory response to acid-suppressive therapy in EES patients.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Department of digestive diseases, Campus Bio Medico University, Rome, Italy.
| | | | - Alessandro Tullio
- Department of digestive diseases, Campus Bio Medico University, Rome, Italy
| | - Michele Cicala
- Department of digestive diseases, Campus Bio Medico University, Rome, Italy
| |
Collapse
|
40
|
Balestrieri P, Ribolsi M, Guarino MPL, Emerenziani S, Altomare A, Cicala M. Nutritional Aspects in Inflammatory Bowel Diseases. Nutrients 2020; 12:nu12020372. [PMID: 32023881 PMCID: PMC7071234 DOI: 10.3390/nu12020372] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 12/16/2022] Open
Abstract
Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, relapsing, inflammatory disorders of the digestive tract that characteristically develop in adolescence and early adulthood. The reported prevalence of malnutrition in inflammatory bowel disease (IBD) patients ranges between 20% and 85%. Several factors, including reduced oral food intake, malabsorption, chronic blood and proteins loss, and intestinal bacterial overgrowth, contribute to malnutrition in IBD patients. Poor nutritional status, as well as selective malnutrition or sarcopenia, is associated with poor clinical outcomes, response to therapy and, therefore, quality of life. The nutritional assessment should include a dietetic evaluation with the assessment of daily caloric intake and energy expenditure, radiological assessment, and measurement of functional capacity.
Collapse
|
41
|
Emerenziani S, Pier Luca Guarino M, Trillo Asensio LM, Altomare A, Ribolsi M, Balestrieri P, Cicala M. Role of Overweight and Obesity in Gastrointestinal Disease. Nutrients 2019; 12:nu12010111. [PMID: 31906216 PMCID: PMC7019431 DOI: 10.3390/nu12010111] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/28/2019] [Accepted: 12/20/2019] [Indexed: 02/07/2023] Open
Abstract
The prevalence of obesity is increasing worldwide, leading to a severe impairment of overall health. Actually, obesity has been associated with several pathological conditions, causing an excess overall mortality. In particular, overweight and obesity are well known risk factors for a variety of gastrointestinal (GI) disorders i.e., functional GI disorders as well as, inflammatory bowel disease (IBD), pancreatitis, and GI cancer. The aim of the present review is to summarize the potential role of overweight and obesity in GI disease with particular focus on plausible biological mechanisms that could explain the association between obesity and GI disease based on the most recent evidence in the literature.
Collapse
Affiliation(s)
- Sara Emerenziani
- Correspondence: (S.E.); (L.M.T.A.); Tel.: +39-06225411690 (S.E. & L.M.T.A.)
| | | | | | | | | | | | | |
Collapse
|
42
|
Lo Presti A, Del Chierico F, Altomare A, Zorzi F, Cella E, Putignani L, Guarino MPL, Monteleone G, Cicala M, Angeletti S, Ciccozzi M. Exploring the genetic diversity of the 16S rRNA gene of Akkermansia muciniphila in IBD and IBS. Future Microbiol 2019; 14:1497-1509. [PMID: 31850811 DOI: 10.2217/fmb-2019-0175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: The human gastrointestinal tract harbors diverse, abundant microbiota and Akkermansia muciniphila is involved in this community. The aim of this study is to characterize 16 new A. muciniphila 16S ribosomal RNA sequences selected from a metagenomic database from stools of patients with irritable bowel syndrome (IBS), inflammatory bowel diseases and control (CTRLs) subjects by a phylogenetic approach. Materials & methods: A phylogenetic approach was used to study the genetic diversity and SNPs in 16 A. muciniphila 16S ribosomal RNA sequences from stools of 107 individuals, 36 of which were patients affected by IBS, 30 by inflammatory bowel disease and 41 were CTRLs. Results: Phylogenetic analysis confirmed the subdivision into different supported clusters. An increase of variability in IBS has been identified. Conclusion: The genetic variation combined to the relative abundance, contribute to the protective role of A. muciniphila. Phylogenesis represent an additional approach to investigate genetic variability.
Collapse
Affiliation(s)
| | | | | | - Francesca Zorzi
- Gastrointestinal Unit, Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Eleonora Cella
- Unit of Medical Statistics & Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | - Lorenza Putignani
- Unit of Parasitology and Unit of Human Microbiome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Giovanni Monteleone
- Gastrointestinal Unit, Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Michele Cicala
- Unit of Digestive Disease, Campus Bio-Medico University, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics & Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| |
Collapse
|
43
|
Pauwels A, Boecxstaens V, Andrews CN, Attwood SE, Berrisford R, Bisschops R, Boeckxstaens GE, Bor S, Bredenoord AJ, Cicala M, Corsetti M, Fornari F, Gyawali CP, Hatlebakk J, Johnson SB, Lerut T, Lundell L, Mattioli S, Miwa H, Nafteux P, Omari T, Pandolfino J, Penagini R, Rice TW, Roelandt P, Rommel N, Savarino V, Sifrim D, Suzuki H, Tutuian R, Vanuytsel T, Vela MF, Watson DI, Zerbib F, Tack J. How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery). Gut 2019; 68:1928-1941. [PMID: 31375601 DOI: 10.1136/gutjnl-2019-318260] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [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: 01/13/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Antireflux surgery can be proposed in patients with GORD, especially when proton pump inhibitor (PPI) use leads to incomplete symptom improvement. However, to date, international consensus guidelines on the clinical criteria and additional technical examinations used in patient selection for antireflux surgery are lacking. We aimed at generating key recommendations in the selection of patients for antireflux surgery. DESIGN We included 35 international experts (gastroenterologists, surgeons and physiologists) in a Delphi process and developed 37 statements that were revised by the Consensus Group, to start the Delphi process. Three voting rounds followed where each statement was presented with the evidence summary. The panel indicated the degree of agreement for the statement. When 80% of the Consensus Group agreed (A+/A) with a statement, this was defined as consensus. All votes were mutually anonymous. RESULTS Patients with heartburn with a satisfactory response to PPIs, patients with a hiatal hernia (HH), patients with oesophagitis Los Angeles (LA) grade B or higher and patients with Barrett's oesophagus are good candidates for antireflux surgery. An endoscopy prior to antireflux surgery is mandatory and a barium swallow should be performed in patients with suspicion of a HH or short oesophagus. Oesophageal manometry is mandatory to rule out major motility disorders. Finally, oesophageal pH (±impedance) monitoring of PPI is mandatory to select patients for antireflux surgery, if endoscopy is negative for unequivocal reflux oesophagitis. CONCLUSION With the ICARUS guidelines, we generated key recommendations for selection of patients for antireflux surgery.
Collapse
Affiliation(s)
- Ans Pauwels
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Veerle Boecxstaens
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Department of Surgical Oncology, Oncological and Vascular Access Surgery, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | | | | | - Richard Berrisford
- Peninsula Oesophago-gastric Surgery Unit, Derriford Hospital, Plymouth, Plymouth, UK
| | - Raf Bisschops
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Guy E Boeckxstaens
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Serhat Bor
- Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Albert J Bredenoord
- Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, Netherlands
| | - Michele Cicala
- Digestive Diseases, Universita Campus Bio Medico, Roma, Italy
| | - Maura Corsetti
- Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Fernando Fornari
- Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Chandra Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jan Hatlebakk
- Gastroenterology, Haukeland Sykehus, University of Bergen, Bergen, Norway
| | - Scott B Johnson
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, USA
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lars Lundell
- Department of Surgery, Karolinska, Stockholm, Sweden
| | - Sandro Mattioli
- Department of Medical and Surgical Sciences, Universita degli Studi di Bologna, Bologna, Emilia-Romagna, Italy
| | - Hiroto Miwa
- Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Taher Omari
- Department of Gastroenterology, Flinders University, Adelaide, Australia
| | - John Pandolfino
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Roberto Penagini
- Department of Pathophysiology and Transplantation, Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
| | - Thomas W Rice
- Thoracic Surgery, Emeritus Staff Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA
| | - Philip Roelandt
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Nathalie Rommel
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Neurosciences, KU Leuven, Leuven, Belgium
| | - Vincenzo Savarino
- Internal Medicine and Medical Specialties, Universita di Genoa, Genoa, Italy
| | - Daniel Sifrim
- Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Hidekazu Suzuki
- Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Radu Tutuian
- Gastroenteroloy, Tiefenauspital Bern, Bern, Switzerland
| | - Tim Vanuytsel
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - David I Watson
- Department of Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Frank Zerbib
- Department of Gastroenterology, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France
| | - Jan Tack
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
| |
Collapse
|
44
|
Ribolsi M, Giordano A, Guarino MPL, Tullio A, Cicala M. New classifications of gastroesophageal reflux disease: an improvement for patient management? Expert Rev Gastroenterol Hepatol 2019; 13:761-769. [PMID: 31327288 DOI: 10.1080/17474124.2019.1645596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 12/18/2022]
Abstract
Introduction: Gastroesophageal reflux disease (GERD) is a very common and often debilitating disease. In the broad spectrum of GERD phenotypes, three main groups may be traditionally distinguished: 1) patients only affected by esophageal and/or extra-esophageal symptoms; 2) patients with erosive esophagitis and 3) patients with further complications. Areas covered: This review provides an overview on the current classifications of GERD patients, and their impact on their management. Expert opinion: In 2017, the GERD Consensus Working Group focused the attention on patients unresponsive to PPIs. In this scenario, a diagnosis of GERD might be confirmed by evident signs of erosive esophagitis and the finding of pH or multichannel intraluminal impedance-pH tests, such as more than 6%. The 'Lyon Consensus' panel of experts confirmed that positive indices of reflux-symptom association, without other altered parameters, represent reflux hypersensitivity. GERD requires a customized management; it is crucial to assess frequency and severity of symptoms and their response to an optimal course of therapy as well as to explore the endoscopic alterations and consider other diagnoses responsible for persistent symptoms.
Collapse
Affiliation(s)
- Mentore Ribolsi
- a Unit of Gastroenterology and Digestive Endoscopy, University Campus Bio Medico , Rome , Italy
| | - Antonio Giordano
- a Unit of Gastroenterology and Digestive Endoscopy, University Campus Bio Medico , Rome , Italy
| | | | - Alessandro Tullio
- a Unit of Gastroenterology and Digestive Endoscopy, University Campus Bio Medico , Rome , Italy
| | - Michele Cicala
- a Unit of Gastroenterology and Digestive Endoscopy, University Campus Bio Medico , Rome , Italy
| |
Collapse
|
45
|
Lo Presti A, Zorzi F, Del Chierico F, Altomare A, Cocca S, Avola A, De Biasio F, Russo A, Cella E, Reddel S, Calabrese E, Biancone L, Monteleone G, Cicala M, Angeletti S, Ciccozzi M, Putignani L, Guarino MPL. Fecal and Mucosal Microbiota Profiling in Irritable Bowel Syndrome and Inflammatory Bowel Disease. Front Microbiol 2019; 10:1655. [PMID: 31379797 PMCID: PMC6650632 DOI: 10.3389/fmicb.2019.01655] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
An imbalance in the bacterial species resulting in the loss of intestinal homeostasis has been described in inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS). In this prospective study, we investigated whether IBD and IBS patients exhibit specific changes in richness and distribution of fecal and mucosal-associated microbiota. Additionally, we assessed potential 16S rRNA gene amplicons biomarkers for IBD, IBS, and controls (CTRLs) by comparison of taxonomic composition. The relative abundance of bacteria, at phylum and genus/species levels, and the bacterial diversity were determined through 16S rRNA sequence-based fecal and mucosal microbiota analysis. Linear discriminant analysis effect size (LEfSe) was used for biomarker discovery associated to IBD and IBS as compared to CTRLs. In fecal and mucosal samples, the microbiota richness was characterized by a microbial diversity reduction, going from CTRLs to IBS to IBD. β-diversity analysis showed a clear separation between IBD and CTRLs and between IBD and IBS with no significant separation between IBS and CTRLs. β-diversity showed a clear separation between mucosa and stool samples in all the groups. In IBD, there was no difference between inflamed and not inflamed mucosa. Based upon the LEfSe data, the Anaerostipes and Ruminococcaceae were identified as the most differentially abundant bacterial taxa in CTRLs. Erysipelotrichi was identified as potential biomarker for IBS, while Gammaproteobacteria, Enterococcus, and Enterococcaceae for IBD. This study provides an overview of the alterations of microbiota and may aid in identifying potential 16S rRNA gene amplicons mucosal biomarkers for IBD and IBS.
Collapse
Affiliation(s)
| | - Francesca Zorzi
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Silvia Cocca
- Unit of Digestive Disease, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Avola
- Unit of Digestive Disease, Campus Bio-Medico University, Rome, Italy
| | - Fabiola De Biasio
- Unit of Digestive Disease, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Russo
- Human Microbiome Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Eleonora Cella
- Unit of Medical Statistics and Molecular Epidemiology, Campus Bio-Medico University, Rome, Italy
| | - Sofia Reddel
- Human Microbiome Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Emma Calabrese
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Livia Biancone
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Monteleone
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Michele Cicala
- Unit of Digestive Disease, Campus Bio-Medico University, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Campus Bio-Medico University, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, Campus Bio-Medico University, Rome, Italy
| | - Lorenza Putignani
- Human Microbiome Unit and Parasitology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | |
Collapse
|
46
|
Cantoro L, Lenti MV, Monterubbianesi R, Cicala M, Giannarelli D, Papi C, Kohn A, Di Sabatino A. Early-onset versus late-onset Crohn's disease: An Italian cohort study. United European Gastroenterol J 2019; 8:52-58. [PMID: 32213053 DOI: 10.1177/2050640619860661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Disease heterogeneity, according to the age at onset, has been reported in Crohn's disease (CD). OBJECTIVE This study aimed to compare natural history in CD patients diagnosed ≤17 (early onset (EO)) versus ≥60 (late onset (LO)) years old. METHODS EO CD and LO CD patients referred to two Italian inflammatory bowel disease (IBD) centres were included. Relevant data comprised sex, current smoking, disease location and behaviour, IBD family history, extra-intestinal manifestations and use of medical/surgical therapy during the follow-up period. RESULTS Among 2321 CD patients, 160 met the inclusion criteria: 92 in the EO and 68 in the LO group (mean follow-up 11.7 ± 7.7 years). Family history of IBD was more frequent in EO compared to LO CD (26% vs. 4%; p < 0.0001). Ileocolonic, upper gastrointestinal and perianal involvement occurred more frequently in EO compared to LO CD (56% vs. 21%, p < 0.0001; 17% vs. 3%, p < 0.01; and 38% vs. 19%, p < 0.01, respectively). Progression to complicated disease occurred more frequently in EO CD (40% vs. 10% p < 0.005), with an increased use of corticosteroids and anti-tumour necrosis factor alpha agents within 10 years since diagnosis (81% vs. 58%, p = 0.004, and 36% vs. 16%, p = 0.01, respectively), while the cumulative probability of surgery did not differ between the two groups. CONCLUSIONS Patients with EO CD are more likely to develop a more aggressive disease with perianal involvement and a greater use of drug treatment compared to those with LO CD, without carrying an increased need for surgery.
Collapse
Affiliation(s)
- Laura Cantoro
- IBD Unit, San Camillo-Forlanini Hospital, Rome, Italy.,Gastroenterologia Aziendale, USL Umbria 1, Perugia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Michele Cicala
- Gastroenterology Unit, University Campus Bio-Medico, Rome, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | - Anna Kohn
- IBD Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| |
Collapse
|
47
|
Fiorino G, Caprioli F, Daperno M, Mocciaro F, Principi M, Viscido A, Fantini MC, Orlando A, Papi C, Annese V, Danese S, Vecchi M, Rizzello F, Armuzzi A, Previtali E, Aloi M, Alvisi P, Antonelli E, Ardizzone S, Astegiano M, Baldoni M, Beltrami M, Biancone L, Bodini G, Buda A, Bossa F, Bracci F, Calabrese E, Cappello M, Castiglione F, Ciacci C, Cicala M, Ciccocioppo R, Comberlato M, Cortelezzi CC, Cosintino R, Costa F, Costantino G, Cucchiara S, Cuomo A, D’Incà R, Di Paolo MC, Di Sabatino A, Di Sario A, Frieri G, Fries W, Gasbarrini A, Geccherle A, Gionchetti P, Graziani MG, Grossi L, Guidi L, Imperiali G, Latella G, Lionetti P, Inserra G, Maconi G, Manguso F, Marino M, Mastronardi M, Mazzuoli S, Meucci G, Mendolaro M, Milla M, Mocci G, Monteleone G, Bortoluzzi FN, Pagnini C, Pastorelli L, Pica R, Piergallini S, Privitera A, Renna S, Ribaldone DG, Ricci C, Rispo A, Rocca R, Romano C, Romano M, Russo G, Sablich R, Saibeni S, Savarino E, Scribano ML, Spagnuolo R, Stasi E, Terpin MM, Testa A, Valpiani D, Variola A, Vernia P, Vitale G, Zoli G. Use of biosimilars in inflammatory bowel disease: a position update of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Dig Liver Dis 2019; 51:632-639. [PMID: 30872085 DOI: 10.1016/j.dld.2019.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 01/16/2019] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
The first infliximab biosimilar for the treatment of inflammatory bowel disease (IBD) was introduced in 2013, and today eight anti-TNF alpha biosimilars (three for infliximab and five for adalimumab) have been approved and licensed by the European Medicines Agency. Biosimilars present great potential in terms of cost saving and possible consequential reinvestment in the health care system. The increasing knowledge about the process of biosimilar development and use in IBD and the publication of many prospective clinical studies and real-life clinical experiences have progressively changed the point of view of IBD physicians. In the present position paper, the Italian Group for the Study of Inflammatory Bowel Disease present and discuss their updated statements and positions on this topic, with emphasis on the concepts of biosimilarity and extrapolation across indications, safety and immunogenicity, interchangeability and switching, automatic substitution, and, finally, patient education about biosimilars.
Collapse
Affiliation(s)
- Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | - Marco Daperno
- Division of Gastroenterology, Ospedale Ordine Mauriziano di Torino, Turin, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Mariabeatrice Principi
- Gastroenterology Unit, Department of Organ Transplantation (DETO), Policlinico Universitario, Bari, Italy
| | - Angelo Viscido
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Ambrogio Orlando
- IBD Unit, A.O. Osp. Riuniti "Villa Sofia-Cervello", Palermo, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | | | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | | | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Altomare A, Putignani L, Del Chierico F, Cocca S, Angeletti S, Ciccozzi M, Tripiciano C, Dalla Piccola B, Cicala M, Guarino MPL. Gut mucosal-associated microbiota better discloses inflammatory bowel disease differential patterns than faecal microbiota. Dig Liver Dis 2019; 51:648-656. [PMID: 30573380 DOI: 10.1016/j.dld.2018.11.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 02/17/2018] [Revised: 08/07/2018] [Accepted: 11/22/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Growing evidence supports the potential role of intestinal microbiota in the pathophysiology of inflammatory bowel diseases (IBD) even if the literature does not reveal uniform alterations. The aim of the study was to evaluate the mucosal (MM) and faecal microbiota (FM) composition in a cohort of IBD patients compared to healthy controls (CTRLs). METHODS Faecal and mucosal samples were collected from 14 IBD patients and 11 CTRLs. The V1-V3 region of 16S rRNA locus was amplified on a 454-Junior Genome Sequencer. Reads were grouped into operational taxonomic units (OTUs) at a sequence similarity level of 97% for taxonomic assignment, and aligned for OTUs matching against Greengenes database. RESULTS Irrespective of disease localization and activity, in the MM of IBD patients a statistically significant increase of Proteobacteria (especially Enterobacteriaceae, Acidaminococcus, Veillonella dispar) and decrease of Firmicutes (especially Roseburia and Faecalibacterium prausnitzii) and Actinobacteria was found compared to CTRLs. In the colon district some specific bacterial biomarkers were identified: Enterobacteriaceae for IBD stools, Bacteroides for IBD biopsies, Mogibacteriaceae, Ruminococcaceae and Prevotella for CTRL stools, Ruminococcaceae for CTRL biopsies. CONCLUSIONS The profiles of FM were more similar to CTRLs, suggesting that microbiota adhering to the gut mucosa better discriminates patients from controls, with the identification of some interesting biomarkers.
Collapse
Affiliation(s)
- Annamaria Altomare
- Gastroenterology Unit, University Campus Bio-Medico of Rome, Rome, Italy.
| | - Lorenza Putignani
- Human Microbiome Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy; Parasitology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Federica Del Chierico
- Human Microbiome Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Silvia Cocca
- Gastroenterology Unit, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Angeletti
- Clinical Pathology and Microbiology Unit, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Bruno Dalla Piccola
- Scientific Directorate, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Michele Cicala
- Gastroenterology Unit, University Campus Bio-Medico of Rome, Rome, Italy
| | | |
Collapse
|
49
|
Ribolsi M, Biasutto D, Giordano A, Balestrieri P, Cicala M. High-resolution Manometry Findings During Solid Swallows Correlate With Delayed Reflux Clearance and Acid Exposure Time in Non-erosive Reflux Disease Patients. J Neurogastroenterol Motil 2019; 25:68-74. [PMID: 30646477 PMCID: PMC6326212 DOI: 10.5056/jnm18054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/13/2018] [Revised: 06/28/2018] [Accepted: 09/13/2018] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The role of esophageal motility in determining gastroesophageal reflux disease (GERD) severity has not been completely evaluated. A few studies have investigated high-resolution manometry (HRM) patterns during solid swallows. The present study evaluates the HRM patterns of non-erosive reflux disease (NERD) patients during both liquid and solid swallows and their correlation with the severity of GERD. Methods In 23 NERD patients and 15 healthy volunteers (HVs) HRM was performed during a standard solid meal in a seated position, followed by 24-hour impedance-pH monitoring. Results Of the 31 patients, 10 showed a pathological acid exposure time (AET; NERD patients), 13 a normal pH profile with positive symptom association probability (SAP; reflux hypersensitivity patients), and 8 normal AET and SAP (functional heartburn patients). Mean distal contractile integral and distal latency values, in all patient groups and HVs, were significantly higher during solid swallows. In the group of 10 NERD patients, the number of large breaks of the esophageal peristalsis was 16 out of 100 liquid swallows (16%) and 31 out of 171 solid swallows (18%). Fourteen out of 100 liquid swallows (14%) and 25 out of 171 solid swallows (15%) resulted ineffective. Mean reflux clearing time at multichannel intraluminal impedance-pH was 17.6 ± 3.7 seconds. NERD patients presented, during solid swallows, a significantly higher proportion of large peristaltic breaks and of ineffective swallows than reflux hypersensitivity and functional heartburn patients. Conclusion HRM during solid swallows reveals motor abnormalities, undetected during liquid swallows, which might be involved in delaying reflux and acid clearance in patients with GERD.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Unit of Digestive Disease, Campus Bio Medico University of Rome, Italy
| | - Dario Biasutto
- Unit of Digestive Disease, Campus Bio Medico University of Rome, Italy
| | - Antonio Giordano
- Unit of Digestive Disease, Campus Bio Medico University of Rome, Italy
| | - Paola Balestrieri
- Unit of Digestive Disease, Campus Bio Medico University of Rome, Italy
| | - Michele Cicala
- Unit of Digestive Disease, Campus Bio Medico University of Rome, Italy
| |
Collapse
|
50
|
Ribolsi M, Cicala M, Zentilin P, Neri M, Mauro A, Efthymakis K, Petitti T, Savarino V, Penagini R. Prevalence and clinical characteristics of refractoriness to optimal proton pump inhibitor therapy in non-erosive reflux disease. Aliment Pharmacol Ther 2018; 48:1074-1081. [PMID: 30294924 DOI: 10.1111/apt.14986] [Citation(s) in RCA: 20] [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: 05/24/2018] [Revised: 06/18/2018] [Accepted: 08/22/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The real size of the gastro-oesophageal reflux disease (GERD) population not responding to proton pump inhibitor (PPI) therapy has still not been fully elucidated. Causes of PPI refractoriness include incorrect diagnosis and lack of adherence to therapy, in terms of incorrect dosage and timing. AIMS To evaluate the prevalence of refractoriness to optimal PPI therapy and the contribution of non-erosive reflux disease (NERD), reflux hypersensitivity, and functional heartburn, to PPI refractoriness. The association of functional GI symptoms in non-responders was evaluated. METHODS Frequency and severity of GERD symptoms (heartburn, regurgitation, chest pain), dysphagia, belching, epigastric pain, postprandial distress, irritable bowel syndrome (IBS), globus, and ear nose and throat (ENT) symptoms were evaluated in patients previously classified as non-responders. Patients with at least one of the oesophageal symptoms with a frequency ≥3 /week were treated with esomeprazole 40 mg once daily for 8 weeks and then re-evaluated. Non-responders (patients with oesophageal symptoms ≥3 times per week) underwent 24 hour multichannel intraluminal impedance-pH monitoring. RESULTS Of 573 consecutive patients, 92 with oesophageal symptoms and classified as PPI-refractory underwent the esomeprazole trial; 60 did not respond. IBS, epigastric pain, and post-prandial distress episodes were associated with a poor response on multivariate analysis. NERD, reflux hypersensitivity, and functional heartburn patients constituted 32%, 42%, and 26%, respectively of the PPI-refractory group. CONCLUSIONS True refractoriness in patients with GERD symptoms attending a secondary care setting is lower than previously reported. Following a careful history and optimal PPI dosing, the rate of refractoriness was 20%. True NERD constitutes only a third of the PPI-refractory group.
Collapse
Affiliation(s)
- Mentore Ribolsi
- Digestive Disease Unit, Campus Bio Medico University, Rome, Italy
| | - Michele Cicala
- Digestive Disease Unit, Campus Bio Medico University, Rome, Italy
| | | | - Matteo Neri
- Section of Internal Medicine, Department of Medicine and Aging Sciences and Center for Excellence on Ageing (Ce.S.I.Met), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | - Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - Konstantinos Efthymakis
- Section of Internal Medicine, Department of Medicine and Aging Sciences and Center for Excellence on Ageing (Ce.S.I.Met), "G. D'Annunzio" University and Foundation, Chieti, Italy
| | | | | | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| |
Collapse
|