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Hungin AP, Yadlapati R, Anastasiou F, Bredenoord AJ, El Serag H, Fracasso P, Mendive JM, Savarino EV, Sifrim D, Udrescu M, Kahrilas PJ. Management advice for patients with reflux-like symptoms: an evidence-based consensus. Eur J Gastroenterol Hepatol 2024; 36:13-25. [PMID: 38006602 PMCID: PMC10695341 DOI: 10.1097/meg.0000000000002682] [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: 08/23/2023] [Accepted: 10/11/2023] [Indexed: 11/27/2023]
Abstract
Patients with reflux-like symptoms (heartburn and regurgitation) are often not well advised on implementing individualised strategies to help control their symptoms using dietary changes, lifestyle modifications, behavioural changes or fast-acting rescue therapies. One reason for this may be the lack of emphasis in management guidelines owing to 'low-quality' evidence and a paucity of interventional studies. Thus, a panel of 11 gastroenterologists and primary care doctors used the Delphi method to develop consolidated advice for patients based on expert consensus. A steering committee selected topics for literature searches using the PubMed database, and a modified Delphi process including two online meetings and two rounds of voting was conducted to generate consensus statements based on prespecified criteria (67% voting 'strongly agree' or 'agree with minor reservation'). After expert discussion and two rounds of voting, 21 consensus statements were generated, and assigned strength of evidence and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) rating. Eleven statements achieved the strongest (100%) agreement: five are related to diet and include identification and avoidance of dietary triggers, limiting alcohol, coffee and carbonated beverages, and advising patients troubled by postprandial symptoms not to overeat; the remaining six statements concern advice around smoking cessation, weight loss, raising the head-of-the-bed, avoiding recumbency after meals, stress reduction and alginate use. The aim of developing the consensus statements is that they may serve as a foundation for tools and advice that can routinely help patients with reflux-like symptoms better understand the causes of their symptoms and manage their individual risk factors and triggers.
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Affiliation(s)
- A. Pali Hungin
- Professor Emeritus, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Foteini Anastasiou
- 4th Local Primary Care Team, Municipality Practice and Academic Practice of Heraklion; University of Crete, Crete, Greece
| | - Albert J. Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Hashem El Serag
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Pierluigi Fracasso
- Department of Gastroenterology and Digestive Endoscopy, Ospedale Sandro Pertini, Local Health Agency Roma 2, Rome, Italy
| | - Juan M Mendive
- La Mina Primary Care Academic Centre, Catalan Health Institute, University of Barcelona, Spain
| | - Edoardo V. Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK
| | | | - Peter J Kahrilas
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Burra P, Bretthauer M, Buti Ferret M, Dugic A, Fracasso P, Leja M, Matysiak Budnik T, Michl P, Ricciardiello L, Seufferlein T, van Leerdam M, Botos A. Digestive cancer screening across Europe. United European Gastroenterol J 2022; 10:435-437. [PMID: 35474447 PMCID: PMC9103365 DOI: 10.1002/ueg2.12230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Patrizia Burra
- Department of Surgery, Oncology and GastroenterologyMultivisceral Transplant UnitPadua University HospitalPaduaItaly
| | - Michael Bretthauer
- Department of Health Management and Health EconomyInstitute of Health and SocietyUniversity of OsloOsloNorway
| | | | - Ana Dugic
- Department of GastroenterologyKlinikum Bayreuth Friedrich‐Alexander‐University Erlangen‐NürnbergBayreuthGermany
| | | | - Marcis Leja
- Institute of Clinical and Preventive MedicineUniversity of Latvia and Riga East University HospitalRigaLatvia
| | - Tamara Matysiak Budnik
- Institut des maladies de l'appareil digestifCentre Hospitalier Universitaire de NantesNantesFrance
| | - Patrick Michl
- Department of Internal Medicine IMartin‐Luther University Halle‐WittenbergHalleGermany
| | - Luigi Ricciardiello
- Department of Medical and Surgical SciencesUniversita degli Studi di BolognaBolognaItaly
| | | | | | - Andreea Botos
- United European Gastroenterology (UEG)AustriaAustria
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Peck‐Radosavljevic M, Burra P, Ferret MB, Fracasso P, Ricciardiello L, Seufferlein T, Van Hootegem P, van Leerdam M, Zelber‐Sagi S. COVID-19 and digestive health: Implications for prevention, care and the use of COVID-19 vaccines in vulnerable patients. United European Gastroenterol J 2021; 9:1091-1095. [PMID: 34716760 PMCID: PMC8598962 DOI: 10.1002/ueg2.12173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Patrizia Burra
- Department of Surgery, Oncology and GastroenterologyMultivisceral Transplant UnitPadua University HospitalItaly
| | | | | | - Luigi Ricciardiello
- Department of Medical and Surgical Sciencesrgical SciencesUniversita degli Studi di BolognaBolognaItaly
| | | | - Philippe Van Hootegem
- Department of Internal Medicine and Division of Gastroenterology and HepatologySint‐Lucas General HospitalBruggeBelgium
| | | | - Shira Zelber‐Sagi
- School of Public HealthFaculty of Social Welfare and Health SciencesUniversity of HaifaHaifaIsrael
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Fracasso P. Dyspepsia in Primary Care Medicine: A European Prospective. Dig Dis 2021; 40:266-269. [PMID: 33971660 DOI: 10.1159/000517112] [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: 03/18/2021] [Accepted: 05/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dyspepsia is a very frequent condition, affecting up to 50% of general population. Primary care is the logical setting for starting a management. In treating dyspeptic patients, it is a crucial point to distinguish between functional problems, common diseases such as reflux esophagitis or peptic ulcer, and life-threatening diseases such as upper gastrointestinal (GI) cancer. In Europe, there are different approaches to this problem. We describe the management of dyspepsia, with a particular focus on relationship between dyspepsia and gastric cancer. SUMMARY Initial treatment of dyspepsia includes empirical treatment, noninvasive testing for Helicobacter pylori, and upper GI tract endoscopy. Treatment choice is based on different variables, including alarm signs, patient preference, and possibility to perform a gastroscopy. General practitioners are not allowed in all European nations to order a gastroscopy. This may have some reflection on quality of cure. KEY MESSAGE In European countries, there are heterogeneities in terms of gastric cancer incidence, mortality, and quality of cure. Awareness of them is a first step in identifying possible solutions.
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Affiliation(s)
- Pierluigi Fracasso
- Local Health Agency Roma 2, Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
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Fracasso P, Cannizzaro R. Colorectal cancer screening saves lives: The last piece of the puzzle. Dig Liver Dis 2021; 53:523-524. [PMID: 33653624 DOI: 10.1016/j.dld.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Pierluigi Fracasso
- Gastroenterology and Digestive Endoscopy, Ospedale Sandro Pertini, Via dei Monti Tiburtini 385, Rome 00157, Italy.
| | - Renato Cannizzaro
- Director S.O.C. Gastroenterologia Oncologica Sperimentale, Centro di Riferimento Oncologico Istituto Nazionale Tumori (IRCCS), via Franco Gallini 2, Aviano (PN) 33081 Italy
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Vanella G, Capurso G, Burti C, Fanti L, Ricciardiello L, Souza Lino A, Boskoski I, Bronswijk M, Tyberg A, Krishna Kumar Nair G, Angeletti S, Mauro A, Zingone F, Oppong KW, de la Iglesia-Garcia D, Pouillon L, Papanikolaou IS, Fracasso P, Ciceri F, Rovere-Querini P, Tomba C, Viale E, Eusebi LH, Riccioni ME, van der Merwe S, Shahid H, Sarkar A, Yoo JWG, Dilaghi E, Speight RA, Azzolini F, Buttitta F, Porcari S, Petrone MC, Iglesias-Garcia J, Savarino EV, Di Sabatino A, Di Giulio E, Farrell JJ, Kahaleh M, Roelandt P, Costamagna G, Artifon ELDA, Bazzoli F, Testoni PA, Greco S, Arcidiacono PG. Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study. BMJ Open Gastroenterol 2021; 8:e000578. [PMID: 33627313 PMCID: PMC7907837 DOI: 10.1136/bmjgast-2020-000578] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported. AIMS We aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19. METHODS All consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, χ2 or Fisher's exact test were used to compare patients with major abnormalities to those with negative procedures, and multivariate logistic regression to identify independent predictors. RESULTS Between February and May 2020, during the first pandemic outbreak with severely restricted endoscopy activity, 114 endoscopies on 106 patients with COVID-19 were performed in 16 institutions (men=70.8%, median age=68 (58-74); 33% admitted in intensive care unit; 44.4% reporting GI symptoms). 66.7% endoscopies were urgent, mainly for overt GI bleeding. 52 (45.6%) patients had major abnormalities, whereas 13 bled from previous conditions. The most prevalent upper GI abnormalities were ulcers (25.3%), erosive/ulcerative gastro-duodenopathy (16.1%) and petechial/haemorrhagic gastropathy (9.2%). Among lower GI endoscopies, 33.3% showed an ischaemic-like colitis.Receiver operating curve analysis identified D-dimers >1850 ng/mL as predicting major abnormalities. Only D-dimers >1850 ng/mL (OR=12.12 (1.69-86.87)) and presence of GI symptoms (OR=6.17 (1.13-33.67)) were independently associated with major abnormalities at multivariate analysis. CONCLUSION In this highly selected cohort of hospitalised patients with COVID-19 requiring endoscopy, almost half showed acute mucosal injuries and more than one-third of lower GI endoscopies had features of ischaemic colitis. Among the hospitalisation-related and patient-related variables evaluated in this study, D-dimers above 1850 ng/mL was the most useful at predicting major mucosal abnormalities at endoscopy. TRIAL REGISTRATION NUMBER ClinicalTrial.gov (ID: NCT04318366).
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Affiliation(s)
- Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Capurso
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Cesare Burti
- Digestive Endoscopy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lorella Fanti
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna and Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Andre Souza Lino
- GI Endoscopy Service, Hospital Casa de Saude de Santos, Santos, Brazil
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Amy Tyberg
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
| | - Govind Krishna Kumar Nair
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stefano Angeletti
- Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Aurelio Mauro
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Kofi W Oppong
- Department of Gastroenterology, Newcastle upon Tyne hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Daniel de la Iglesia-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela. Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Lieven Pouillon
- Imelda GI Clinical Research Center, Imeldaziekenhuis, Bonheiden, Belgium
| | - Ioannis S Papanikolaou
- National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | | | - Fabio Ciceri
- Department of Hematology and Stem Cell Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Rovere-Querini
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Carolina Tomba
- Digestive Endoscopy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Edi Viale
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Leonardo Henry Eusebi
- Department of Medical and Surgical Sciences, University of Bologna and Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Disease, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Haroon Shahid
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
| | - Jin Woo Gene Yoo
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Emanuele Dilaghi
- Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - R Alexander Speight
- Department of Gastroenterology, Newcastle upon Tyne hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Francesco Azzolini
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Buttitta
- Department of Medical and Surgical Sciences, University of Bologna and Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Serena Porcari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Chiara Petrone
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela. Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Edoardo V Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Emilio Di Giulio
- Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - James J Farrell
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michel Kahaleh
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
| | - Philip Roelandt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Disease, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna and Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Per Alberto Testoni
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Salvatore Greco
- Digestive Endoscopy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Bertario L, Aste H, Arrigoni A, Fracasso P, Rossini FP, Rossetti C, Valanzano R. Clinical Aspects and Management of Hereditary Non-Polyposis Colorectal Cancer (HNPCC). Tumori 2018; 82:117-21. [PMID: 8644373 DOI: 10.1177/030089169608200205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hereditary non-polyposis colorectal cancer (HNPCC) is an autosomical dominant trasmitted disease phenotypically defined according to the “Amsterdam criteria” as follows: at least 3 affected relatives, one of whom first degree relative of other two, at least two successive generations affected. Important cardinal features are: 1 prevalent proximal location of cancers (above splenic flexure); 2 multiple synchronous or methachronous large bowel cancers; 3 early age of onset (<50 years); 4 presence of extracolonic cancers (endometrium, stomach, urinary tract, skin). The treatment is essentially surgical and total colectomy with ileo-rectum anastomosis is already proposed as standard procedure with annual endoscopic examination of retained rectum. The screening of individuals at risk, so determined by the analysis of pedigree or the results of molecular tests, must be performed every 1-2 years by colonoscopy starting around the age of 25 years. In this review are described and analysed the spectrum of the disease with particular attention to the frequency and characteristics of extracolonic cancers. Moreover, the guidelines of the surveillance and screening are reported following the data of the literature and as proposed by the International Collaborative Group (ICG-HNPCC).
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Affiliation(s)
- L Bertario
- Divisione Chirurgia Apparato Digerente, Istituto Nazionale dei Tumori, Milano, Italy
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Hungin APS, Mitchell CR, Whorwell P, Mulligan C, Cole O, Agréus L, Fracasso P, Lionis C, Mendive J, Philippart de Foy J, Seifert B, Wensaas K, Winchester C, de Wit N. Systematic review: probiotics in the management of lower gastrointestinal symptoms - an updated evidence-based international consensus. Aliment Pharmacol Ther 2018; 47:1054-1070. [PMID: 29460487 PMCID: PMC5900870 DOI: 10.1111/apt.14539] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/15/2017] [Accepted: 01/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND In 2013, a systematic review and Delphi consensus reported that specific probiotics can benefit adult patients with irritable bowel syndrome (IBS) and other gastrointestinal (GI) problems. AIM To update the consensus with new evidence. METHODS A systematic review identified randomised, placebo-controlled trials published between January 2012 and June 2017. Evidence was graded, previously developed statements were reassessed by an 8-expert panel, and agreement was reached via Delphi consensus. RESULTS A total of 70 studies were included (IBS, 34; diarrhoea associated with antibiotics, 13; diarrhoea associated with Helicobacter pylori eradication therapy, 7; other conditions, 16). Of 15 studies that examined global IBS symptoms as a primary endpoint, 8 reported significant benefits of probiotics vs placebo. Consensus statements with 100% agreement and "high" evidence level indicated that specific probiotics help reduce overall symptom burden and abdominal pain in some patients with IBS and duration/intensity of diarrhoea in patients prescribed antibiotics or H. pylori eradication therapy, and have favourable safety. Statements with 70%-100% agreement and "moderate" evidence indicated that, in some patients with IBS, specific probiotics help reduce bloating/distension and improve bowel movement frequency/consistency. CONCLUSIONS This updated review indicates that specific probiotics are beneficial in certain lower GI problems, although many of the new publications did not report benefits of probiotics, possibly due to inclusion of new, less efficacious preparations. Specific probiotics can relieve lower GI symptoms in IBS, prevent diarrhoea associated with antibiotics and H. pylori eradication therapy, and show favourable safety. This study will help clinicians recommend/prescribe probiotics for specific symptoms.
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Hungin APS, Mulligan C, Pot B, Whorwell P, Agréus L, Fracasso P, Lionis C, Mendive J, Philippart de Foy JM, Rubin G, Winchester C, Wit N. Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice -- an evidence-based international guide. Aliment Pharmacol Ther 2013; 38:864-86. [PMID: 23981066 PMCID: PMC3925990 DOI: 10.1111/apt.12460] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 07/18/2013] [Accepted: 07/31/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Evidence suggests that the gut microbiota play an important role in gastrointestinal problems. AIM To give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus. METHODS Systematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement. RESULTS Thirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18-80% (specific probiotics), 5-50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and 'high' evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70-100% agreement and 'moderate' evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life. CONCLUSIONS Specified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem.
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Affiliation(s)
- A P S Hungin
- School of Medicine, Pharmacy and Health, Durham UniversityStockton-on-Tees, UK
| | - C Mulligan
- School of Medicine, Pharmacy and Health, Durham UniversityStockton-on-Tees, UK,Research Evaluation Unit, Oxford PharmaGenesis™ LtdOxford, UK
| | - B Pot
- Institut Pasteur de Lille, Centre for Infection and Immunity of LilleLille, France,Université Lille Nord de FranceLille, France,CNRS UMR 8204Lille, France,INSERM U1019Lille, France
| | - P Whorwell
- Centre for Gastrointestinal Sciences, University of Manchester, Wythenshawe HospitalManchester, UK
| | - L Agréus
- Centre for Family Medicine, Karolinska InstituteStockholm, Sweden
| | - P Fracasso
- Gastroenterology Unit, Don Bosco Outpatient ClinicRome, Italy
| | - C Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of CreteHeraklion, Greece
| | - J Mendive
- La Mina Primary Care CentreBarcelona, Spain
| | - J-M Philippart de Foy
- Nutrition Committee of the Scientific Society of General Practice (SSMG, Belgium)Brussels, Belgium
| | - G Rubin
- School of Medicine, Pharmacy and Health, Durham UniversityStockton-on-Tees, UK
| | - C Winchester
- Research Evaluation Unit, Oxford PharmaGenesis™ LtdOxford, UK
| | - N Wit
- Nutrition Committee of the Scientific Society of General Practice (SSMG, Belgium)Brussels, Belgium
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Ardizzoia A, Parente F, Marino B, Ilardo A, Perna F, Saracino I, Zullo A, Hassan C, Fracasso P, Moretti RA, Cremaschini M, Vaira D, Ucci G. A combination of fecal tests for the detection of colon cancer: A new strategy for appropriate prioritization of referrals to colonscopy—A prospective Italian study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tiersten A, Sill M, Muggia F, Elera C, Garcia A, Fracasso P, Swensen R, Warshal D, Mannel R. Phase I/feasibility trial of dose-dense carboplatin (C) and paclitaxel (P) in patients (pts) with ovarian cancer: A Gynecologic Oncology Group study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5544] [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: 11/20/2022] Open
Abstract
5544 Background: Dose-dense regimens improve outcome for women with breast cancer. We investigated the feasibility of dose-dense CP for women with ovarian cancer. Methods: Pts with untreated stage III/IV ovarian cancer received C AUC 5 and P 175 mg/m2 day 1, pegfilgrastim 6 mg day 2 every 2 weeks for 6 cycles. Dose-limiting toxicity (DLT) was defined as: febrile neutropenia, grade 4 neutropenia ≥7 days, grade 4 thrombocytopenia (tcp), grade 3 tcp with bleeding, dose delay >2 weeks, grade 3/4 non-hematologic toxicity (excluding fatigue, hypersensitivity, nausea/vomiting, alopecia, constipation, diarrhea or bone pain), and any treatment related death. The study utilized a 2-stage sequential design (20 pts/stage) with DLTs in 6 cycles determining regimen feasibility. Results: Between September 2006 and September 2008, 43 pts enrolled. Twenty and 17 patients were evaluable for toxicity over 6 cycles in stages 1 and 2 respectively. Six DLT's were observed for both stages. Thirty pts completed treatment and 12 did not [DLTs (6), paclitaxel hypersensitivity reactions (2), progression (1), patient choice (1), infection (1) and death unrelated to treatment (1)]. One pt remains on treatment. The 6 DLTs resulting in treatment discontinuation included grade 3 neuropathy (2), grade 4 neuropathy (1), grade 4 tcp (1), grade 4 tcp/grade 3 febrile neutropenia (1), and grade 4 SVT (1). Six other DLTs not preventing treatment completion included grade 3 infection (1), grade 3 AST/ALT elevation (1), grade 3 confusion (1), grade 3 dehydration (1), grade 3 neuropathy (1) and grade 4 tcp (1). Other toxicities resulting in treatment delays included grade 3 tcp (1), grade 3 fatigue (1) and grade 2 neuropathy (2). There were 5 P dose reductions and 4 C dose reductions. Conclusions: Seventy-two percent pts completed 6 cycles of dose-dense CP. Based on DLTs (at least 12 in 37 evaluable pts), this regimen is not feasible. Given the neuropathy and tcp, we do not recommend further investigation in a phase III trial. No significant financial relationships to disclose.
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Affiliation(s)
- A. Tiersten
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - M. Sill
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - F. Muggia
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - C. Elera
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - A. Garcia
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - P. Fracasso
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - R. Swensen
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - D. Warshal
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - R. Mannel
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
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Kannarkat GJ, Harris T, Kelly K, Fracasso P, Moskaluk C. Evaluation of plectin-1 immunohistochemical expression in human colon cancer tumor progression. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22132 Background: Plectin-1 (PLEC1), a known scaffolding protein, was recently discovered to be upregulated and redistributed to the cell membrane in multiple cancers, thereby providing a molecular imaging biomarker for disease detection. The purpose of this study was to examine PLEC1 staining in the tumor progression of human colorectal carcinoma. Methods: A tissue microarray of colonic neoplastic progression was stained with antibody to PLEC1. A total PLEC1 immunohistochemical (IHC) staining score was obtained by multiplying the intensity of PLEC1 membrane staining, scored 1 to 3, by the percent of target cells stained, scored 1 (<25%), 2 ( 25%-75%) and 3 (>75%). Each specimen was grouped into low (0–2), intermediate (3–5) or high (6–9) expression. The mean IHC score and group distribution were obtained for each tissue type. Results: Normal colonic tissue showed the lowest membrane expression of PLEC1 with a mean IHC score of 2.24. Approximately 80% of cases were in the low group. Colonic adenomas had a slightly higher mean IHC score, 2.57, with more cases falling in the intermediate group. Invasive colorectal cancer as a whole had a mean IHC score of 3.96 with a third of cases falling into the high expression group. Inflamed colonic tissue (ulcerative colitis) stained the highest with a mean IHC score of 4.83 and all cases falling in the intermediate or high group. Conclusions: There is increasing membrane expression of PLEC1 in colonic epithelium through tumor progression. The observation of a difference in IHC staining of normal and malignant tissue requires larger confirmatory studies, but the redistribution of PLEC1 to the cell surface is a potential biomarker for molecular imaging of cancer and potential target for novel therapeutic agents. However, our finding of increased PLEC1 membrane staining in actively inflamed tissue may indicate an important caveat in the use and implementation of this biomarker in certain clinical situations. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- G. J. Kannarkat
- University of Virginia Healthsystem, Charlottesville, VA; University of Virginia, Charlottesville, VA
| | - T. Harris
- University of Virginia Healthsystem, Charlottesville, VA; University of Virginia, Charlottesville, VA
| | - K. Kelly
- University of Virginia Healthsystem, Charlottesville, VA; University of Virginia, Charlottesville, VA
| | - P. Fracasso
- University of Virginia Healthsystem, Charlottesville, VA; University of Virginia, Charlottesville, VA
| | - C. Moskaluk
- University of Virginia Healthsystem, Charlottesville, VA; University of Virginia, Charlottesville, VA
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13
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Pillot GA, Wildi J, Tan B, Suresh R, Fracasso P, Govindan R. Phase I study of pegylated liposomal doxorubicin (PLD) and irinotecan (I) in patients with solid tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.12023] [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: 11/20/2022] Open
Abstract
12023 Background: Irinotecan (I) and doxorubicin are cytotoxic agents that interact with topoisomerase I and II respectively, and display some evidence of preclinical synergy. Pegylated liposomal doxorubicin (PLD) is a novel formulation of doxorubicin that may be more tolerable than doxorubicin. We sought to define the maximum tolerated dose (MTD) of PLD and I when given in combination. Methods: Patients (pts) with good performance status (PS 0–2) and adequate cardiac, renal, liver, and bone marrow function who had received any number of prior therapies for advanced solid tumors were eligible. Pts in the first cohort received PLD at a dose of 20 mg/m2 IV on day 1 and I 100 mg/m2 on days 1 and 8 of a 21 day cycle to a maximum of 6 cycles. Growth factor support was not permitted. Results: Eleven pts were enrolled, 6 male, 5 female. Median age of the pts was 63 years (range 19–73). There were 2 cases each of non-small cell lung cancer, renal cell carcinoma, and biliary carcinoma, and one case each of breast, pancreatic, ovarian, colon, and bladder carcinoma. Three pts were initially enrolled without dose-limiting toxicity (DLT) in cohort 1, and six pts were subsequently enrolled in cohort 2 (20 mg/m2 PLD and 125 mg/m2 I), with 2 patients experiencing DLT (neutropenia, diarrhea, and fatigue). Two additional pts have been enrolled in cohort 1 (5 pts total) without DLT, and the 6th patient will be enrolled soon to define the MTD. Grade 3 neutropenia was noted in 1 pt and grade 4 neutropenia in 2 pts. Other non-hematologic toxicities across all cycles have included grade 3 anorexia, diarrhea, nausea, and fatigue in 2 pts each, and 1 pt each with grade 3 dehydration, emesis, pneumonitis, and DVT. No cardiac toxicity has been observed. Of 6 evaluable pts, 4 experienced stable disease (1 each of NSCLC, breast, pancreas, and renal cell carcinoma). Conclusions: The combination of pegylated liposomal doxorubicin and irinotecan is feasible and well- tolerated. The maximal tolerated dose is likely to be PLD 20 mg/m2 d1 and I 100 mg/m2 d1 and 8 IV q 21 days (pending enrollment of the last patient). This study was supported by Tibotec Therapeutics, Division of Ortho Biotech. [Table: see text]
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Affiliation(s)
| | - J. Wildi
- Washington University, St. Louis, MO
| | - B. Tan
- Washington University, St. Louis, MO
| | - R. Suresh
- Washington University, St. Louis, MO
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14
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Fracasso P, Scanni S, Di Iorio L, Paoluzi OA. Failure to diagnose colorectal carcinoma at colonoscopy. Endoscopy 2004; 36:1126; author reply 1126-7. [PMID: 15578310 DOI: 10.1055/s-2004-825972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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15
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Bailey H, Mahoney M, Okuno S, Ettinger D, Maples W, Fracasso P, Erlichman C. 377 Tolerability and limited activity of perifosine in patients with advanced soft tissue sarcoma (STS): a multi-center phase 2 consortium (P2C) study. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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16
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Aft R, Ylagan L, Sadeghi S, Eberlein T, Herrmann V, Dietz J, Fracasso P, Naughton M, Weilbaecher K. Effect of neoadjuvant chemotherapy on bone marrow micrometastases in women with locally advanced breast cance. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Aft
- Washington University, Saint Louis, MO
| | - L. Ylagan
- Washington University, Saint Louis, MO
| | | | | | | | - J. Dietz
- Washington University, Saint Louis, MO
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17
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Stigliano V, Fracasso P, Grassi A, Lapenta R, Citarda F, Tomaselli G, Giannarelli D, Casale V. [Utility of endoscopic follow-up after resection of colorectal cancer]. Clin Ter 2002; 153:323-6. [PMID: 12510416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
PURPOSE Patients resected for colorectal cancer are at increased risk for an anastomotic recurrence, for adenomatous polyps and for a metachronous cancer. A regular colonoscopic surveillance in these patients is justified for early detection and potential resection of anastomotic recurrences, new primary cancer and adenomatous polyps. PATIENTS AND METHODS 322 patients were observed and resected for colorectal cancer between 1970 and 1988, with complete staging agreed to be included in a follow-up program (median follow-up: 105 months). To December 1993 all the patients were submitted to colonoscopy once yearly for the first 5 years and then every 2 years. RESULTS Anastomotic recurrence was observed in 22 of the 253 patients who underwent resection for rectal or sigmoid adenocarcinoma (8.7%). Sixteen of these patients were submitted to a second curative resection with a median survival of 35 months; the median survival was 6 months in the 6 patients who could not undergo this operation (p = 0.0018). Metachronous adenomas of the residual colon were found in 24 patients (7.4%) and metachronous cancers in 5 (1.5%) at Stage A, according to Dukes' classification. CONCLUSIONS In patients resected for rectal or sigmoid carcinoma, a sigmoidoscopy should be performed every 6 months for the first 2 years for the early detection of anastomotic recurrences. In all cases, a colonoscopy should be performed every 5 years after surgery to detect metachronous lesions at early stage. Before surgery, a "clean colon" should always be established to detect possible synchronous lesions.
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Affiliation(s)
- V Stigliano
- Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, Polo Oncologico Istituto Regina Elena, Roma, Italia
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18
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Stigliano V, Fracasso P, Grassi A, Lapenta R, Citarda F, Tomaselli G, Giannarelli D, Casale V. Endoscopic follow-up in resected colorectal cancer patients. J Exp Clin Cancer Res 2000; 19:145-8. [PMID: 10965809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Patients resected for colorectal cancer are at risk for anastomotic recurrence, for adenomatous polyps and for metachronous cancer. The present retrospective study was conducted to evaluate the incidence of neoplasms of the colon, both metachronous or recurrent, in 322 patients. They were observed and resected for colorectal cancer between 1970 and 1988, with complete staging, and all agreed to be included in a follow-up program (median followup: 105 months). All the patients were submitted to colonoscopy once yearly for the first 5 years and then every 2 years. Anastomotic recurrence was observed in 22 of the 253 patients who underwent resection for rectal or sigmoid adenocarcinoma (8.7%). Sixteen of these patients were submitted to a second curative resection with a median survival of 35 months; the median survival was 6 months in the 6 patients who could not undergo this operation (p=0.0018). Metachronous adenomas of the residual colon were found in 24 patients and metachronous cancers in 5 at Stage A, according to Dukes' classification. In conclusion, a regular colonoscopic surveillance in patients resected for colorectal cancer is justified for early detection and potential resection of anastomotic recurrences, new primary cancer and adenomatous polyps. In patients resected for rectal or sigmoid carcinoma, a sigmoidoscopy should be performed every 6 months for the first 2 years for the early detection of anastomotic recurrences. In all cases, a colonoscopy should be performed every 5 years after surgery to detect metachronous lesions. Before surgery, a "clean colon" should always be established to detect possible synchronous lesions.
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Affiliation(s)
- V Stigliano
- Section of Gastroenterology, Service of Environmental Oncogenesis, Epidemiology and Prevention, Regina Elena Cancer Institute, Rome, Italy
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19
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Stigliano V, Assisi D, Fracasso P, Grassi A, Lapenta R, Casale V. Endoscopic follow-up in oncological diseases of the gastrointestinal tract: the experience of the Regina Elena Cancer Institute. J Exp Clin Cancer Res 1999; 18:463-7. [PMID: 10746971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
In oncology, follow-up refers to the medical procedures aimed to control, over time, both patients at risk of developing cancer, or those already submitted to surgical treatments for neoplastic lesions. The usefulness of an endoscopic follow-up in oncological diseases of the gastrointestinal tract is still being debated and, in some cases, a variety of different protocols are often employed for the same disease. At Regina Elena Cancer Institute, after a critical review of our data and literature, we established and followed guidelines of endoscopic follow-up for patients both at risk and submitted to curative surgery for cancer.
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20
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Fracasso P, Assisi D, Stigliano V, Casale V. [The Lynch syndrome]. Clin Ter 1999; 150:373-8. [PMID: 10687268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Lynch syndrome is a peculiar disease, accounting for 5% of the total burden of colon cancer. Characteristics of this disease are autosomal dominant transmission, early onset, and frequent right colon localization. Diagnostic criteria, aimed to collaborative studies, are based on these features (so called Amsterdam criteria). Lynch syndrome has specific biomolecular features (microsatellite instability); mismatch repair genes have been identified as responsible of this syndrome. Lynch syndrome causes high risk for extracolonic malignancies, particularly for endometrial cancer, supposed to be related to mutation of hMSH2 gene. Another feature of Lynch syndrome tumours is better survival with respect to sporadic counterpart. Genetic test allows identifying the state of mutation carriers and selects the patients to submit to screening. Endoscopic screening has been demonstrated to reduce incidence of colorectal malignancies in this syndrome.
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Affiliation(s)
- P Fracasso
- Istituto Regina Elena per lo Studio e la Cura dei Tumori, Roma, Italia.
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21
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Curia MC, Palmirotta R, Aceto G, Messerini L, Verì MC, Crognale S, Valanzano R, Ficari F, Fracasso P, Stigliano V, Tonelli F, Casale V, Guadagni F, Battista P, Mariani-Costantini R, Cama A. Unbalanced germ-line expression of hMLH1 and hMSH2 alleles in hereditary nonpolyposis colorectal cancer. Cancer Res 1999; 59:3570-5. [PMID: 10446963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
We analyzed the hMLH1 and hMSH2 genes in 30 unrelated hereditary nonpolyposis colorectal cancer (HNPCC) patients using mutational and immunohistochemical analyses combined whenever possible with primer extension assays, designed to estimate hMLH1 and hMSH2 transcript expression in peripheral blood lymphocytes. Single-strand conformational polymorphism screening and PCR-direct sequencing revealed seven hMLH1 and five hMSH2 sequence variants in 14 unrelated HNPCC patients, including three definite pathogenic mutations, four amino acid substitutions of uncertain pathogenic significance, and five polymorphisms. Immunohistochemistry indicated the lack of either hMLH1 or hMSH2 protein expression in tumors from 13 patients, and the absence of both hMLH1 and hMSH2 immunostaining was observed in the tumor from one additional case. The lack of hMLH1 or hMSH2 immunostaining was associated with the presence of microsatellite instability in the corresponding tumor and was also observed in tumors from patients negative for pathogenic mutations by mutational screening. There was a marked unbalance in the allelic expression of either hMLH1 or hMSH2 transcripts in three of eight unrelated HNPCC patients that could be analyzed, although a less marked unbalance was detected in two additional patients. Tumors from patients with germ-line unbalance in hMLH1 or hMSH2 transcript expression did not express the corresponding mismatch repair protein and displayed microsatellite instability. Our results indicate that constitutional alterations in hMLH1 and hMSH2 transcript expression may represent genetic markers for HNPCC carrier status also in cases in which mutational analysis did not detect a definite pathogenic variant. This suggests that transcript deregulation may represent a relevant mode of germ-line inactivation for mismatch repair genes.
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Affiliation(s)
- M C Curia
- Department of Oncology and Neurosciences, University Gabriele D'Annunzio, Chieti, Italy
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22
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Adkins D, Brown R, Trinkaus K, Maziarz R, Luedke S, Freytes C, Needles B, Wienski D, Fracasso P, Pluard T, Moriconi W, Ryan T, Hoelzer K, Safdar S, Rearden T, Rodriguez G, Khoury H, Vij R, DiPersio J. Outcomes of high-dose chemotherapy and autologous stem-cell transplantation in stage IIIB inflammatory breast cancer. J Clin Oncol 1999; 17:2006-14. [PMID: 10561251 DOI: 10.1200/jco.1999.17.7.2006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the disease-free survival (DFS) and overall survival (OS), prognostic factors, and treatment-related mortality of women with stage IIIB inflammatory breast cancer (IBC) treated with combined modality therapy (CMT) and high-dose chemotherapy (HDCT) with autologous stem-cell transplantation. PATIENTS AND METHODS Between 1989 and 1997, 47 consecutive patients with stage IIIB IBC were treated with CMT and HDCT and were the subject of this retrospective analysis. Chemotherapy was administered to all patients before and/or after definitive surgery. Neoadjuvant and adjuvant chemotherapy was administered to 33 and 34 patients, respectively, and 20 patients received both. All patients received HDCT with autologous stem-cell transplantation, and 41 patients received locoregional radiation therapy. Tamoxifen was prescribed to patients with estrogen receptor (ER)-positive cancer. RESULTS The mean duration of follow-up from diagnosis was 30 months (range, 6 to 91 months) and from HDCT was 22 months (range, 0.5 to 82 months). At 30 months, the Kaplan-Meier estimates of DFS and OS from diagnosis were 57.7% and 59.1%, respectively. At 4 years, the Kaplan-Meier estimates of DFS and OS from diagnosis were 51.3% and 51.7%, respectively. In a multivariate analysis, the only factors associated with better survival were favorable response to neoadjuvant chemotherapy (P =.04) and receipt of tamoxifen (P =.06); however, the benefit of tamoxifen was only demonstrated in patients with ER-positive breast cancer. At last follow-up, 28 patients (59. 6%) were alive and disease-free. Seventeen patients (36.2%) developed recurrent breast cancer. Seventeen patients died: 15 from disease recurrence and two (4.2%) from treatment-related mortality due to HDCT. CONCLUSION In this analysis, the early results of treatment with CMT and HDCT compare favorably with other series of patients with stage IIIB IBC treated with CMT alone. These outcomes must be confirmed with longer follow-up and controlled studies.
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Affiliation(s)
- D Adkins
- Division of Bone Marrow Transplantation, Washington University School of Medicine, St Louis, MO 63110-1093, USA.
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23
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Fracasso P, Assisi D, Stigliano V, Casale V. Colorectal cancer complicating ulcerative colitis: an institutional series. J Exp Clin Cancer Res 1999; 18:29-32. [PMID: 10374673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Ulcerative colitis predisposes to colorectal cancer: the risk increases along with disease duration and extension. Also some subsets of patients are at increased risk, namely patients with early onset of colitis, and patients with primary sclerosing cholangitis. Cancer complicating ulcerative colitis affects evenly all the colon, and is not located more frequently in the rectum and in the sigmoid colon, as well as the sporadic counterpart. Multiple cancers and cancers associated with high grade dysplasia are not infrequent in ulcerative colitis; for this reason, and for controlling the colitis, the treatment of choice is total colectomy, with or without colostomy. The prognosis of cancer complicating ulcerative colitis is similar to the sporadic counterpart. The Authors present a colon cancers series as a complication of colitis occurred at Regina Elena Cancer Institute of Rome, Italy, over the period 1975-1998.
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Affiliation(s)
- P Fracasso
- Servizio di Endoscopia Digestiva, Istituto Regina Elena per lo Studio e la Cura dei Tumori, Rome, Italy
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24
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Fracasso P, Caviglia R, Grassi A, Lapenta R, Stigliano V, Franco D, Casale V. Turcot syndrome: case report and nosological aspects. J Exp Clin Cancer Res 1997; 16:433-5. [PMID: 9505220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Turcot syndrome has been defined as the simultaneous presence of multiple polyposis of the colon and a malignant brain tumor. This association is supposed to be genetically transmitted, even though we still do not exactly know whether this occurs in a dominant or recessive way. The case of a 47-year-old man submitted to a right hemicolectomy for cancer and polyposis, following a series of endoscopic polypectomies and, finally, removal of left temporal glioma is here presented.
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Affiliation(s)
- P Fracasso
- Service of Digestive Endoscopy, Istituto Regina Elena, Rome, Italy
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25
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Bertario L, Arrigoni A, Aste H, Fracasso P, Ponz de Leon M, Tonelli F, Heonaine A. Recommendations for Clinical Management of Familial Adenomatous Polyposis. Tumori 1997; 83:800-3. [PMID: 9428910 DOI: 10.1177/030089169708300504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- L Bertario
- Department of Surgery of the Digestive Tract, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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26
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Grassi A, Casale V, Fracasso P, Lapenta R, Stigliano V, Giannarelli D, Bigotti G, Crespi M. Medium-large polyps of the colon: a contribution for their clinical profile and a proper surveillance. J Exp Clin Cancer Res 1997; 16:313-9. [PMID: 9387907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A retrospective analysis of polypoid lesions of the colon larger than 1 cm was performed with the aim to study their characteristics and a proper surveillance schedule. We reviewed all colon polypoid lesions larger than 1 cm found and treated during the period January 1984- December 1993 that were not considered cancer macroscopically. The records of 361 patients with 391 polyps are the object of this report. The polyps were divided into subgroups according to size: A) less than 20 mm, B) between 21 and 30 mm, and C) larger than 30 mm. Out of 391 polypoid lesions 373 were adenomas: 60% were found in males. The age group distribution showed no differences among the subgroups. The pedunculated type showed a decrease from 69.1% to 43.3% with the increasing of size: inverse figures were observed for sessile polyps. The lesions were mainly located in left colon. Synchronous adenomas were found in 25.4% patients, and metachronous and previous adenomas respectively in 24.8% and 5.2%: no significant difference was present in the subgroups. Synchronous malignancy in the colon was found in 2% of the patients. Histological characteristics demonstrated a decrease of tubular adenoma from 46.5% to 22.6% from subgroup A to C, while villous adenomas increased inversely from 6.6% to 15.1%. The presence of severe dysplasia ranged from 20.9% to 56.1% in subgroups A and C, respectively, and adenomas with invasive cancer showed a significant increase from the subgroup A to C, respectively from 4.3% to 10.5%. During an average 36-month follow-up we observed 2 metachronous colon cancers, surgically treated in Dukes stage B, 84 metachronous adenomas, all less than 10 mm and without malignant alterations. Our data confirm other literature reports regarding the profile of colon adenomas with an increasing risk of malignancy with the increase of size and the presence of villous structure. In our opinion the assessment of a "clean colon" status is important when an adenoma is found in the colon. The proper follow-up for adenomas must be tailored for any individual patient when risk factors such as size, villous structure, personal and family history of neoplastic lesions of the colon are present. The follow-up schedule, presently recommended for colon adenomas, must be flexible according to these parameters.
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Affiliation(s)
- A Grassi
- Digestive Endoscopy Service, Regina Elena Cancer Institute, Rome, Italy.
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Palmirotta R, Veri M, Curia M, Casale V, Fracasso P, Stigliano V, Guadagni F, MarianiCostantini R, Battista P, Cama A. Novel allele of the hMLH1 gene bearing a TTC deletion in the 3' untranslated region. Int J Oncol 1996; 9:701-3. [DOI: 10.3892/ijo.9.4.701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- R Palmirotta
- UNIV GABRIELE DANNUNZIO,INST PATOL UMANA & MED SOCIALE,I-66013 CHIETI,ITALY. REGINA ELENA INST CANC RES,I-00164 ROME,ITALY
| | - M Veri
- UNIV GABRIELE DANNUNZIO,INST PATOL UMANA & MED SOCIALE,I-66013 CHIETI,ITALY. REGINA ELENA INST CANC RES,I-00164 ROME,ITALY
| | - M Curia
- UNIV GABRIELE DANNUNZIO,INST PATOL UMANA & MED SOCIALE,I-66013 CHIETI,ITALY. REGINA ELENA INST CANC RES,I-00164 ROME,ITALY
| | - V Casale
- UNIV GABRIELE DANNUNZIO,INST PATOL UMANA & MED SOCIALE,I-66013 CHIETI,ITALY. REGINA ELENA INST CANC RES,I-00164 ROME,ITALY
| | - P Fracasso
- UNIV GABRIELE DANNUNZIO,INST PATOL UMANA & MED SOCIALE,I-66013 CHIETI,ITALY. REGINA ELENA INST CANC RES,I-00164 ROME,ITALY
| | - V Stigliano
- UNIV GABRIELE DANNUNZIO,INST PATOL UMANA & MED SOCIALE,I-66013 CHIETI,ITALY. REGINA ELENA INST CANC RES,I-00164 ROME,ITALY
| | - F Guadagni
- UNIV GABRIELE DANNUNZIO,INST PATOL UMANA & MED SOCIALE,I-66013 CHIETI,ITALY. REGINA ELENA INST CANC RES,I-00164 ROME,ITALY
| | - R MarianiCostantini
- UNIV GABRIELE DANNUNZIO,INST PATOL UMANA & MED SOCIALE,I-66013 CHIETI,ITALY. REGINA ELENA INST CANC RES,I-00164 ROME,ITALY
| | - P Battista
- UNIV GABRIELE DANNUNZIO,INST PATOL UMANA & MED SOCIALE,I-66013 CHIETI,ITALY. REGINA ELENA INST CANC RES,I-00164 ROME,ITALY
| | - A Cama
- UNIV GABRIELE DANNUNZIO,INST PATOL UMANA & MED SOCIALE,I-66013 CHIETI,ITALY. REGINA ELENA INST CANC RES,I-00164 ROME,ITALY
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Mortimer JE, Dehdashti F, Siegel BA, Katzenellenbogen JA, Fracasso P, Welch MJ. Positron emission tomography with 2-[18F]Fluoro-2-deoxy-D-glucose and 16alpha-[18F]fluoro-17beta-estradiol in breast cancer: correlation with estrogen receptor status and response to systemic therapy. Clin Cancer Res 1996; 2:933-9. [PMID: 9816253] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We assessed the value of positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (FDG) and 16alpha-[18F]fluoro-17beta-estradiol (FES) in women with breast cancer for predicting response to systemic therapy. Results of FES-PET were correlated with estrogen receptor (ER) status. Forty-three women with locally advanced or metastatic breast cancer underwent FDG-PET and FES-PET prior to institution of systemic therapy. All patients had measurable disease and had tumors submitted for ER determination. Cancers were considered functionally hormone sensitive if the standardized uptake value of the lesion on FES-PET was >/=1.0 (FES+) and hormone resistant if the standardized uptake value was <1.0 (FES-). Information obtained by FES-PET was compared with the results of ER assays. The tumor response to chemotherapy and hormonal therapy was correlated with intensity of uptake by both FDG-PET and FES-PET. The ER status of the breast cancers was negative (ER-) in 20 patients, positive (ER+) in 21 patients, and unknown in 2 patients. All 20 of the ER- tumors were also FES-. However, of the 21 ER+ tumors, 16 were FES+ and 5 were FES-. Thirty patients were treated initially with chemotherapy, and 21 (70%) demonstrated objective responses. We were unable to correlate the response to chemotherapy with information obtained by FDG-PET or FES-PET. Thirteen patients were treated with hormone therapy, and 8 (61%) responded to that therapy. Only 1 of the 5 patients whose tumors were ER+ but FES- received hormone therapy, and this treatment resulted in disease stabilization only. Multiple sites of disease were assessed by FES-PET in 17 patients with metastatic breast cancer. Functional hormone sensitivity, defined by FES-PET, was concordant with multiple lesions in 13 (76%). Ten patients with locally advanced breast cancer developed recurrent disease. The initial site of recurrence was the breast in 5 patients. Of the 5 patients with systemic recurrence, 4 had disease detected at the site of recurrence on the pretreatment FDG-PET study but not detected on pretreatment computed tomography. In our experience, FDG-PET imaging is more sensitive than conventional imaging methods, including computed tomography, in staging women with breast cancer. When compared with the in vitro assay of ER status, FES-PET has an apparent sensitivity of 76% and specificity of 100%. Our finding of a subset of patients who have tumors that are ER+ and FES- suggests that the functional assessment of hormone sensitivity by PET imaging can identify patients with ER+ disease whose tumors are likely to be hormone refractory.
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Affiliation(s)
- J E Mortimer
- Divisions of Nuclear Medicine and Radiation Sciences, Edward Mallinckrodt Institute of Radiology, St. Louis, Missouri 63110, USA
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Stigliano V, Fracasso P, Citarda F, Grassi A, Lapenta R, Casale V. Endoscopic dilation of a benign postoperative colonic stenosis with a Sengstaken-Blakemore tube. Gastrointest Endosc 1996; 43:70-2. [PMID: 8903825 DOI: 10.1016/s0016-5107(96)70267-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- V Stigliano
- Regina Elena National Cancer Institute, Rome, Italy
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Dreyer RN, Bausch KM, Fracasso P, Hammond LJ, Wunderlich D, Wirak DO, Davis G, Brini CM, Buckholz TM, König G. Processing of the pre-beta-amyloid protein by cathepsin D is enhanced by a familial Alzheimer's disease mutation. Eur J Biochem 1994; 224:265-71. [PMID: 7523115 DOI: 10.1111/j.1432-1033.1994.00265.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A major pre-beta-amyloid protein695 (APP695) processing activity from Alzheimer's disease brain extracts was identified and found to be indistinguishable from the activity of cathepsin D.APP695 processing activity cleaved APP695 into a series of fragments that reacted on immunoblots to a monoclonal antibody (C286.8a) against beta-amyloid-(1-7)-peptide and cleaved N-dansyl-APP-(591-601)-amide at the Glu-Val and Met-Asp bonds. Fragments of 5.5 kDa and 10-12 kDa were formed from the cleavage of APP695 by cathepsin D at the Glu593-Val594 bond, and had the same N-terminus as a minor form of beta-amyloid released by cells. The Lys595-->Asn and Met596-->Leu substitutions found in a pedigree of familial Alzheimer's disease, increased the cathepsin D-catalyzed rate of accumulation of 5.5 kDa and 10-12 kDa C286.8a-reactive fragments 5-10fold. This substitution also increased the rate of N-dansyl-APP-(591-601)-amide cleavage at the Xaa-Asp bond by up to 41-fold. These observations suggest a role of cathepsin D in beta-amyloid formation under certain circumstances.
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Affiliation(s)
- R N Dreyer
- Institute for Molecular Biologicals, Miles Inc., Pharmaceuticals Division, West Haven, Connecticut 06516
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Fracasso P, Caviglia R, Grassi A, Lapenta R, Stigliano V, Casole P, Casale V. [Colonic varices secondary to recurrent acute pancreatitis]. MINERVA GASTROENTERO 1993; 39:191-3. [PMID: 8161618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Colonic varices are a rare finding, with variable clinical features. The authors describe the first case of colonic varices secondary to acute recurrent pancreatitis, and associated with colon cancer. There are about 70 reports of colonic varices; none of them is related to acute recurrent pancreatitis, whereas 52 are related to portal hypertension, and 9 are on a familial basis. Association with colon cancer is reported in one case, and seems to be occasional.
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Affiliation(s)
- P Fracasso
- Servizio di Endoscopia Digestiva, Istituto Regina Elena per lo Studio e la Cura dei Tumori, Roma
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Tarquini M, Sannino L, Bazuro G, Palomba M, Ricci C, Koch M, Fracasso P, Capurso L. [Irritable colon syndrome: therapeutic activity of otilonium bromide alone or in combination with benzodiazepine. Controlled double-blind study]. Clin Ter 1984; 109:525-31. [PMID: 6236943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Capurso L, Tarquini M, Luzietti L, Palomba M, Bazuro G, Papi C, Fracasso P, Koch M. [Tripotassium dicitrato bismuthate in the therapy of peptic ulcer: comparison with ranitidine in short-term treatment]. Clin Ter 1984; 109:335-44. [PMID: 6088161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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