1
|
Tosetti C, Savarino E, Benedetto E, De Bastiani R. Elimination of Dietary Triggers Is Successful in Treating Symptoms of Gastroesophageal Reflux Disease. Dig Dis Sci 2021; 66:1565-1571. [PMID: 32578044 DOI: 10.1007/s10620-020-06414-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The relationship between aliments and pathophysiological abnormalities leading to gastroesophageal reflux disease (GERD) symptoms elicitation is unclear. Nevertheless, patients often report symptoms after ingestion of specific foods. AIMS To identify in primary care setting the presence of foods able to trigger GERD symptoms, and evaluate whether a consequent specific food elimination diet may result in clinical improvement. METHODS Diagnosis of GERD and quantification of reflux symptoms were done according to GERD-Q questionnaire (positive when > 8). During clinical data collection, patients were asked to report aliments associated with their symptoms. Also, a precompiled list of additional foods was administered to them. Then, patients were requested to eliminate the specific foods identified, and to come back for follow-up visit after 2 weeks when GERD-Q questionnaire and clinical data collection were repeated. RESULTS One-hundred GERD (mean GERD-Q score 11.6) patients (54 females, mean age 48.7 years) were enrolled. Eighty-five patients reported at least one triggering food, mostly spicy foods (62%), chocolate (55%), pizza (55%), tomato (52%), and fried foods (52%). At follow-up visit, the diagnosis of GERD was confirmed in only 55 patients, and the mean GERD-Q score decreased to 8.9. Heartburn reporting decreased from 93 to 44% of patients, while regurgitation decreased from 72 to 28%. About half of the patients agreed to continue with only dietary recommendations. CONCLUSIONS Most patients with GERD can identify at least one food triggering their symptoms. An approach based on abstention from identified food may be effective in the short term.
Collapse
Affiliation(s)
- Cesare Tosetti
- National Health System, Group for Primary Care Gastroenterology (GIGA-CP), Belluno, Italy
- Department of Primary Care Porretta Terme, Health Agency of Bologna, Bologna, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology - DiSCOG, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
| | - Edoardo Benedetto
- National Health System, Group for Primary Care Gastroenterology (GIGA-CP), Belluno, Italy
- Primary Care Gastroenterologist, National Health System, Cosenza, Italy
| | - Rudi De Bastiani
- National Health System, Group for Primary Care Gastroenterology (GIGA-CP), Belluno, Italy
- Department of Primary Care, Heath Agency of Belluno, Feltre, Italy
| | | |
Collapse
|
2
|
Bozzani A, Grattagliano I, Pellegatta G, Furnari M, Galeone C, Savarino V, Savarino E, De Bastiani R. Usefulness of Pep-Test for Laryngo-Pharyngeal Reflux: A Pilot Study in Primary Care. Korean J Fam Med 2020; 41:250-255. [PMID: 32460472 PMCID: PMC7385291 DOI: 10.4082/kjfm.18.0207] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background Gastroesophageal reflux disease is a digestive disorder characterized by nausea, regurgitation, and heartburn. Gastroesophageal reflux is the primary cause of laryngeal symptoms, especially chronic posterior laryngitis. The best diagnostic test for this disease is esophageal impedance-pH monitoring; however, it is poorly employed owing to its high cost and invasiveness. Salivary pepsin measured using a lateral flow device (Pep-test) has been suggested as an indirect marker of laryngopharyngeal reflux (LPR). The present study tested the reliability of Pep-test in diagnosing LPR in uninvestigated primary care attenders presenting with chronic laryngeal symptoms, and evaluated the raw pepsin concentration in patients with LPR. Methods A multicenter, non-interventional pilot study was conducted on 86 suspected patients with LPR and 59 asymptomatic subjects as controls in three Italian primary care settings. A reflux symptom index questionnaire was used to differentiate patients with LPR (score >13) from controls (score <5). Two saliva samples were collected, and comparisons between the groups were performed using two-sided statistical tests, according to variable distributions. Results There was no statistical difference in the salivary pepsin positivity between LPR patients and controls, whereas the pepsin intensity value was higher in controls than in LPR patients. Conclusion A high prevalence of pepsin positivity was observed in asymptomatic controls. Pepsin measurement should not be considered as a diagnostic test for LPR in primary care patients.
Collapse
Affiliation(s)
- Alberto Bozzani
- GIGA-CP (Italian Group for Primary Care Gastroenterology), Milan, Italy
| | | | | | | | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Rudi De Bastiani
- GIGA-CP (Italian Group for Primary Care Gastroenterology), Milan, Italy
| |
Collapse
|
3
|
Padoan A, D’Incà R, Scapellato ML, De Bastiani R, Caccaro R, Mescoli C, Moz S, Bozzato D, Zambon CF, Lorenzon G, Rugge M, Plebani M, Basso D. Improving IBD diagnosis and monitoring by understanding preanalytical, analytical and biological fecal calprotectin variability. ACTA ACUST UNITED AC 2018; 56:1926-1935. [DOI: 10.1515/cclm-2018-0134] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/03/2018] [Indexed: 12/12/2022]
Abstract
Abstract
Background:
The appropriate clinical use of fecal calprotectin (fCal) might be compromised by incomplete harmonization between assays and within- and between-subjects variability. Our aim was to investigate the analytical and biological variability of fCal in order to provide tools for interpreting fCal in the clinical setting.
Methods:
Experiments were conducted to investigate the effects of temperature and storage time on fCal. Thirty-nine controls were enrolled to verify biological variability, and a case-control study was conducted on 134 controls and 110 IBD patients to compare the clinical effectiveness of three different fCal assays: ELISA, CLIA and turbidimetry.
Results:
A 12% decline in fCal levels was observed within 24 h following stool collection irrespective of storage temperature. Samples were unstable following a longer storage time interval at room temperature. Within- and between-subjects fCal biological variability, at 31% and 72% respectively, resulted in a reference change value (RCV) in the region of 100%. fCal sensitivity in distinguishing between controls and IBD patients is satisfactory (68%), and the specificity high (93%) among young (<65 years), but not among older (≥65 years) subjects (ROC area: 0.584; 95% CI: 0.399–0.769). Among the young, assays have different optimal thresholds (120 μg/g for ELISA, 50 μg/g for CLIA and 100 μg/g for turbidimetry).
Conclusions:
We recommend a standardized preanalytical protocol for fCal, avoiding storage at room temperature for more than 24 h. Different cutoffs are recommended for different fCal assays. In monitoring, the difference between two consecutive measurements appears clinically significant when higher than 100%, the fCal biological variability-derived RCV.
Collapse
Affiliation(s)
- Andrea Padoan
- Department of Medicine – DIMED , University of Padova , Padova , Italy
| | - Renata D’Incà
- Division of Gastroenterology , University Hospital , Padova , Italy
| | - Maria Luisa Scapellato
- Department of Cardiologic, Thoracic and Vascular Sciences , Preventive Medicine and Risk Assessment Unit , University Hospital of Padova , Padova , Italy
| | - Rudi De Bastiani
- Italian Association for Gastroenterology in Primary Care (GICA-CP) , Feltre , Italy
| | - Roberta Caccaro
- Division of Gastroenterology , University Hospital , Padova , Italy
| | - Claudia Mescoli
- Department of Medicine – DIMED , University of Padova , Padova , Italy
| | - Stefania Moz
- Department of Medicine – DIMED , University of Padova , Padova , Italy
| | - Dania Bozzato
- Department of Medicine – DIMED , University of Padova , Padova , Italy
| | | | - Greta Lorenzon
- Division of Gastroenterology , University Hospital , Padova , Italy
| | - Massimo Rugge
- Department of Medicine – DIMED , University of Padova , Padova , Italy
| | - Mario Plebani
- Department of Medicine – DIMED , University of Padova , Padova , Italy
| | - Daniela Basso
- Department of Medicine – DIMED , University of Padova , Padova , Italy
| |
Collapse
|
4
|
Tursi A, Franceschi M, Allegretta L, Savarino E, De Bastiani R, Elisei W, Baldassarre G, Ferronato A, Scida S, Miraglia C, Penna A, Licci C, Rizzo GL, Pranzo G, Cassieri C, Brandimarte G, Picchio M, Di Mario F. Effectiveness and Safety of Pylera® in Patients Infected by Helicobacter Pylori: A Multicenter, Retrospective, Real Life Study. Dig Dis 2018; 36:264-268. [PMID: 29669354 DOI: 10.1159/000487391] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our aims were to assess the real life effectiveness and safety of the new bismuth-containing quadruple therapy in a large population of patients infected by Helicobacter pylori. METHODS Consecutive dyspeptic H. pylori-positive patients were enrolled, both naïve for treatment and already unsuccessfully treated. Patients were treated with Pylera® 3 capsules 4 times/daily plus omeprazole 20 mg or esomeprazole 40 mg 2 times/daily for 10 days. Eradication was confirmed using a urea-breath test (at least 30 days after the end of the treatment). Efficacy and safety were assessed. RESULTS A total of 349 patients were treated. H. pylori eradication was achieved in 316 (90.5%, 95% CIs 80.8-1.0) patients in the intention-to-treat population, and in 93.5% (95% CIs 83.5-1.0) in the per-protocol population. No difference in the eradication rate was found between naïve and previously treated patients (91.3 vs. 90.0%, p = 0.901). Adverse events occurred in 55 patients (15.8%, 95% CIs 11.9-20.1). Five patients discontinued treatment: 2 patients suffered from severe abdominal pain, one patient from headache, one patient from diarrhea, and one patient from diffuse urticarial rush. CONCLUSIONS Pylera® achieved a remarkable eradication rate in real life both as first treatment and as a rescue therapy, with a good safety profile.
Collapse
Affiliation(s)
| | | | - Leonardo Allegretta
- Division of Gastroenterology, "S. Caterina Novella" Hospital, Galatina, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Rudi De Bastiani
- Italian Association for Gastroenterology in Primary Care (GICA-CP), Feltre, Italy
| | | | | | | | - Serena Scida
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Parma, Parma, Italy
| | - Chiara Miraglia
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Parma, Parma, Italy
| | - Antonio Penna
- Division of Gastroenterology, "S. Paolo" Hospital, Bari, Italy
| | - Claudio Licci
- Private Practice Gastroenterologist, Monopoly, Italy
| | | | - Giuseppe Pranzo
- Digestive Endoscopy Service, "Valle d'Itria" Hospital, Martina Franca, Italy
| | - Claudio Cassieri
- Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, Rome, Italy
| | - Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, Rome, Italy
| | | | - Francesco Di Mario
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Parma, Parma, Italy
| |
Collapse
|
5
|
Tursi A, Di Mario F, Franceschi M, De Bastiani R, Elisei W, Baldassarre G, Ferronato A, Grillo S, Landi S, Zamparella M, De Polo M, Boscariolo L, Picchio M. New bismuth-containing quadruple therapy in patients infected with Helicobacter pylori: A first Italian experience in clinical practice. Helicobacter 2017; 22. [PMID: 28125857 DOI: 10.1111/hel.12371] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rising antibiotic resistance requires the evaluation of new and effective therapies. AIMS To test the efficacy and safety of the new bismuth-containing quadruple therapy in patients infected with Helicobacter pylori. MATERIAL AND METHODS Consecutive H. pylori-positive dyspeptic patients were enrolled, either naïve or with previous failure treatment. Patients were treated with Pylera® (three-in-one capsules containing bismuth subcitrate potassium 140 mg, metronidazole 125 mg, and tetracycline 125 mg) three capsules q.i.d. plus omeprazole 20 mg or esomeprazole 40 mg b.i.d. for 10 days. Eradication was confirmed using an urea breath test (at least 30 days after the end of treatment). Efficacy was assessed by UBT and safety by means of treatment-emergent adverse events. RESULTS One hundred and thirty-one patients were included in the study: 42% of patients were naïve, and 58%, with previous failure treatment. H. pylori eradication was achieved in 124 patients (94.7%, 95% confidence intervals (CIs) 89.3-97.8) in ITT population. In the PP population, the percentage was 97.6% (95%, CIs 93.3-99.2). No difference in eradication rate was found either between naïve and previously treated patients (92.7% vs 96.0%, P=.383), or smoking and nonsmoking ones, or in patients taking omeprazole or esomeprazole. Treatment-emergent adverse events occurred in 35 patients (26.7%, 95% CIs 19.9-34.9). They were mild in all cases except in four, who discontinued the study due to diarrhea (three patients) and diffuse urticarial rush (one patient). CONCLUSIONS Pylera® achieved a remarkable eradication rate in clinical practice, irrespective if it was used as first treatment or as a rescue therapy. Treatment-emergent adverse events were uncommon generally mild.
Collapse
Affiliation(s)
- Antonio Tursi
- Gastroenterology Service, ASL BAT, Andria (BT), Italy
| | - Francesco Di Mario
- Department of Clinical & Experimental Medicine, Gastroenterology Unit, University of Parma, Parma, Italy
| | | | - Rudi De Bastiani
- Italian Association for Gastroenterology in Primary Care (GICA-CP), Feltre (BL), Italy
| | - Walter Elisei
- Division of Gastroenterology, ASL RM6, Albano Laziale (Roma), Italy
| | | | - Antonio Ferronato
- Digestive Endoscopy Unit, ULSS4 Alto Vicentino, Santorso, Schio (VI), Italy
| | - Simone Grillo
- Department of Clinical & Experimental Medicine, Gastroenterology Unit, University of Parma, Parma, Italy
| | - Stefano Landi
- Department of Clinical & Experimental Medicine, Gastroenterology Unit, University of Parma, Parma, Italy
| | - Maria Zamparella
- Italian Association for Gastroenterology in Primary Care (GICA-CP), Feltre (BL), Italy
| | - Manuela De Polo
- Italian Association for Gastroenterology in Primary Care (GICA-CP), Feltre (BL), Italy
| | - Laura Boscariolo
- Italian Association for Gastroenterology in Primary Care (GICA-CP), Feltre (BL), Italy
| | - Marcello Picchio
- Division of Surgery, "P. Colombo" Hospital, ASL RM6, Velletri (Rome), Italy
| |
Collapse
|
6
|
Tursi A, De Bastiani R, Franceschi M, Goni E, Riccò M, Venerito M, Rugge M, Scarpignato C, Picchio M, Di Mario F, Collaborative group TPC. Non-invasive assessment of gastric secretory function in centenarians. Geriatr Care 2017. [DOI: 10.4081/gc.2017.6682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Gastric acid secretion is believed to decrease in the aging stomach, but the number of elderly patients on proton pump inhibitor (PPI) therapy is increasing. The aim was to assess gastric function by means of serology (PGI, PGII, G17 and IgG antibodies against <em>Helicobacter pylori</em>) in centenarians. Twenty-five centenarians (2 males, 23 females, mean age 101.3 years, range 100- 106 years) underwent to serological gastric markers assessment by means of Gastropanel<sup>®</sup>. Patients with laboratory signs of severe oxyntic gastric atrophy (OGA) underwent gastroscopy with biopsy samples. Twelve patients (48.0%) had serological values according to normal gastric secretion; 3 patients (12%) had serological values according to severe OGA, confirmed by histology; 21 patients (84.0%) had serological values according to <em>H. pylori</em> infection. Acid secretion seems to be preserved in a large part of centenarians. Serological markers may be helpful to identify patients affected by OGA, in whom the administration of PPI is inappropriate.
Collapse
|
7
|
Stanghellini V, Tosetti C, Benedetto E, Condoluci M, De Bastiani R, Cogliandro R, Mastronuzzi T, De Polo M, Di Mita F, Napoli L, Ubaldi E, Nebiacolombo C, Cottone C, Grattagliano I, Zamparella M, Baldi E, Sanna G. Nickel sensitization in patients with gastro-esophageal reflux disease. United European Gastroenterol J 2016; 4:184-90. [PMID: 27087945 PMCID: PMC4804365 DOI: 10.1177/2050640615595917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 05/03/2015] [Accepted: 06/21/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastro-esophageal reflux disease (GERD) leads to frequent medical visits, and available therapies fail in up to 40% of patients. Food allergies may be involved in GERD pathogenesis; however, allergens other than food have received little attention. Nickel allergy is common in the general population and some high-nickel foods are associated with GERD. However, the potential relationship between nickel allergy and GERD remains unaddressed. AIM This study aimed to evaluate the prevalence of nickel sensitization in patients with and without GERD and to compare clinical and demographic features. METHODS This prospective, multicenter study included 210 adult GERD patients and 140 patients without GERD who presented at the general practitioner. All GERD patients had undergone treatment with proton pump inhibitors and upper digestive endoscopy within the previous five years. Demographic and clinical data were collected by questionnaire and patients underwent a nickel patch allergy test. RESULTS Patients with and without GERD presented similar characteristics, with the exception of nickel sensitization, which was significantly more prevalent among GERD patients than controls (39.5% vs. 16.4%; p = 0.001). Nickel-positive GERD patients were more frequently female (90.4% vs. 65.4%, p = 0.003) and asthmatic (18.1% vs. 4.7%; p = 0.038), compared to nickel-negative GERD patients. At six-month follow-up, most of the patients, with or without nickel sensitization, reported improved symptoms without differences in drug prescription. CONCLUSION Nickel sensitization is particularly prevalent in GERD patients seen in general practice. Whether allergies other than food allergy play a role in GERD remains to be elucidated.
Collapse
Affiliation(s)
- Vincenzo Stanghellini
- Department of Digestive Diseases and Internal Medicine, University of Bologna, Italy
- Vincenzo Stanghellini University of Bologna Department of Digestive Diseases and Internal Medicine Policlinico S. Orsola-Malpighi Via Massarenti 9 – I-40138, Bologna, Italy.
| | - Cesare Tosetti
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Edoardo Benedetto
- Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Rende, Italy
| | | | - Rudi De Bastiani
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Rosanna Cogliandro
- Department of Digestive Diseases and Internal Medicine, University of Bologna, Italy
| | - Tecla Mastronuzzi
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Manuela De Polo
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Francesco Di Mita
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Luigi Napoli
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Enzo Ubaldi
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Cristina Nebiacolombo
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Carmelo Cottone
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Ignazio Grattagliano
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Maria Zamparella
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Elisabetta Baldi
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Guido Sanna
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| |
Collapse
|
8
|
Tursi A, Brandimarte G, Di Mario F, Annunziata ML, Bafutto M, Bianco MA, Colucci R, Conigliaro R, Danese S, De Bastiani R, Elisei W, Escalante R, Faggiani R, Ferrini L, Forti G, Latella G, Graziani MG, Oliveira EC, Papa A, Penna A, Portincasa P, Søreide K, Spadaccini A, Usai P, Bonovas S, Scarpignato C, Picchio M, Lecca PG, Zampaletta C, Cassieri C, Damiani A, Desserud KF, Fiorella S, Landi R, Goni E, Lai MA, Pigò F, Rotondano G, Schiaccianoce G. Predictive value of the Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the outcome of diverticular disease of the colon: An international study. United European Gastroenterol J 2015; 4:604-13. [PMID: 27536372 DOI: 10.1177/2050640615617636] [Citation(s) in RCA: 27] [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: 09/13/2015] [Accepted: 10/22/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification has been recently developed for patients suffering from diverticulosis and diverticular disease. AIMS We assessed retrospectively the predictive value of DICA in patients for whom endoscopic data and clinical follow-up were available. METHODS For each patient, we recorded: age, severity of DICA, presence of abdominal pain, C-reactive protein and faecal calprotectin test (if available) at the time of diagnosis; months of follow-up; therapy taken during the follow-up to maintain remission (if any); occurrence/recurrence of diverticulitis; need of surgery. RESULTS We enrolled 1651 patients (793 M, 858 F, mean age 66.6 ± 11.1 years): 939 (56.9%) patients were classified as DICA 1, 501 (30.3%) patients as DICA 2 and 211 (12.8%) patients as DICA 3. The median follow-up was 24 (9-38) months. Acute diverticulitis (AD) occurred/recurred in 263 (15.9%) patients; surgery was necessary in 57 (21.7%) cases. DICA was the only factor significantly associated to the occurrence/recurrence of diverticulitis and surgery either at univariate (χ(2 )= 405.029; p < 0.0001) or multivariate analysis (hazard ratio = 4.319, 95% confidence interval (CI) 3.639-5.126; p < 0.0001). Only in DICA 2 patients was therapy effective for prevention of AD occurrence/recurrence with a hazard ratio (95% CI) of 0.598 (0.391-0.914) (p = 0.006, log rank test). Mesalazine-based therapies reduced the risk of AD occurrence/recurrence and needs of surgery with a hazard ratio (95% CI) of 0.2103 (0.122-0.364) and 0.459 (0.258-0.818), respectively. CONCLUSIONS DICA classification is a valid parameter to predict the risk of diverticulitis occurrence/recurrence in patients suffering from diverticular disease of the colon.
Collapse
Affiliation(s)
- Antonio Tursi
- Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, Andria, Italy
| | - Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Francesco Di Mario
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Maria L Annunziata
- Division of Gastroenterology, Istituto di Rocovero e Cura a Carattere Scientifico San Donato, San Donato Milanese, Italy
| | - Mauro Bafutto
- Instituto Goiano de Gastroenterologia e Endoscopia digestiva, Faculdade de Medicina da Universidade Federal de Goiás, Goiânia, Brasil
| | - Maria A Bianco
- Division of Gastroenterology, T. Maresca Hospital, Torre del Greco, Italy
| | - Raffaele Colucci
- Digestive Endoscopy Unit, San Matteo degli Infermi Hospital, Spoleto, Italy
| | - Rita Conigliaro
- Division of Digestive Endoscopy, Sant'Agostino Estense Hospital, Baggiovara, Italy
| | - Silvio Danese
- Humanitas University, IBD Center, Humanitas Clinical and Research Hospital, Via Manzoni, Rozzano, Milan, Italy
| | | | - Walter Elisei
- Division of Gastroenterology, Azienda Sanitaria Locale Azienda Sanitaria Locale Roma H., Rome, Italy
| | - Ricardo Escalante
- Loira Medical Center, Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Luciano Ferrini
- Service of Gastroenterology and Digestive Endoscopy, Villa dei Pini Home Care, Civitanova, Marche, Italy
| | - Giacomo Forti
- Division of Digestive Endoscopy, S. Maria Goretti Hospital, Latina, Italy
| | - Giovanni Latella
- Division of Gastroenterology, S. Salvatore Hospital, L'Aquila, Italy
| | - Maria G Graziani
- Service of Digestive Endoscopy, S. Camillo Hospital, Rome, Italy
| | - Enio C Oliveira
- Department of Surgery, Federal University of Goiás, Goiânia, Brasil
| | - Alfredo Papa
- Division of Internal Medicine and Gastroenterology, C.I. Columbus Catholic University, Rome, Italy
| | - Antonio Penna
- Division of Gastroenterology, S. Paolo Hospital, Bari, Italy
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Antonio Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Padre Pio Hospital, Vasto, Italy
| | - Paolo Usai
- Division of Gastroenterology, Monserrato University Hospital, University of Cagliari, Cagliari, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | - Piera G Lecca
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | | | - Claudio Cassieri
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Alberto Damiani
- Service of Gastroenterology and Digestive Endoscopy, Villa dei Pini Home Care, Civitanova, Marche, Italy
| | - Kari F Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Serafina Fiorella
- Division of Gastroenterology and Digestive Endoscopy, Padre Pio Hospital, Vasto, Italy
| | - Rosario Landi
- Division of Internal Medicine and Gastroenterology, C.I. Columbus Catholic University, Rome, Italy
| | - Elisabetta Goni
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Maria A Lai
- Division of Gastroenterology, Monserrato University Hospital, University of Cagliari, Cagliari, Italy
| | - Flavia Pigò
- Division of Digestive Endoscopy, Sant'Agostino Estense Hospital, Baggiovara, Italy
| | - Gianluca Rotondano
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Giuseppe Schiaccianoce
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| |
Collapse
|
9
|
De Bastiani R, Gabrielli M, Lora L, Napoli L, Tosetti C, Pirrotta E, Ubaldi E, Bertolusso L, Zamparella M, De Polo M, Nebiacolombo C, Bortot M, Mancuso M, Bacchin P, Marsala V, Pinna R, Tursi A, Benedetto E, Cuffari A, Pati A, Di Caro S, Perenzin G, Sala R, Calzavara Pinton G, Gasbarrini A. Association between coeliac disease and psoriasis: Italian primary care multicentre study. Dermatology 2015; 230:156-60. [PMID: 25662711 DOI: 10.1159/000369615] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 01/29/2014] [Accepted: 10/17/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies assessing the association between coeliac disease (CD) and psoriasis show conflicting results. OBJECTIVE To assess in the primary care setting the prevalence of CD in patients with psoriasis and the response to a gluten-free diet (GFD) in subjects with psoriasis and CD. METHODS We enrolled 218 patients with psoriasis and 264 controls. Coeliac screening was carried out in all subjects (Eurospital, Trieste, Italy). In subjects with a positive serology, the diagnosis of CD was confirmed histologically. RESULTS Nine (4.1%) psoriatic patients had positive anti-tissue transglutaminase antibodies compared to only 1 among controls (0.4%, p < 0.05; OR 2.03, 95% CI 1.42-90.11). The diagnosis of CD was confirmed histologically in all 10 subjects. At 6 months GFD was associated with a great improvement of skin lesions in 7 out of 8 patients with psoriasis. CONCLUSION Our multicentre primary care study showed an high prevalence of CD in psoriasis and an improvement of skin lesions in CD under GFD.
Collapse
Affiliation(s)
- Rudi De Bastiani
- GIGA-CP (Italian Group for Primary Care Gastroenterology), Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Tursi A, Grattagliano I, De Polo M, Pirrotta E, Bacchin P, Picchio M, De Bastiani R. Noninvasive prediction of chronic atrophic gastritis in autoimmune thyroid disease in primary care. Scand J Gastroenterol 2014; 49:1394-6. [PMID: 25211191 DOI: 10.3109/00365521.2014.958097] [Citation(s) in RCA: 3] [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: 02/04/2023]
Affiliation(s)
- Antonio Tursi
- GIGA-CP (Italian Group for Primary Care Gastroenterology) , Feltre (BL) , Italy
| | | | | | | | | | | | | |
Collapse
|