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Clemente G, Della Pia N, Bramanti A, Cerbara L, Russo G, De Rosa P, Marotta V, Tortora A, Riccio M, Vitale M. Role of nutritional therapy on dietary habits and glycemic control in insulin-treated kidney transplant patients with diabetes. Diabetes Res Clin Pract 2024; 211:111680. [PMID: 38657795 DOI: 10.1016/j.diabres.2024.111680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/03/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
AIMS To evaluate the effect of nutritional therapy on glycemic compensation and key cardio-renal risk markers in patients with diabetes and kidney transplant, on insulin treatment by Multiple Daily Injection (MDI) or Continuous Subcutaneous Insulin Infusion (CSII). METHODS 34 patients with diabetes on insulin treatment and kidney transplant recipients were enrolled;12 participated in the structured nutritional program (intervention group), 22 patients (control group) did not receive nutritional protocol. Both groups were then divided into subgroups according to the method of insulin administration (MDI and CSII). RESULTS Statistically significant reduction in fasting blood glucose values, glycosylated hemoglobin (HbA1c) and glycosuria were observed in both groups at the end of the study. The intervention group, significantly reduced total cholesterolemia and the glycemic index, together with reduced dietary intake of lipids, cholesterol, soluble carbohydrates and increased consumption of carbohydrates and fiber. These improvements were even more pronounced in patients treated with CSII. CONCLUSIONS A proper nutritional approach optimize glycometabolic outcomes and contribute significantly to the reduction of the major cardiovascular risk factors in renal transplant patients.
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Affiliation(s)
- G Clemente
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno); IRPPS-Institute for Research on Population and Social Policies of the Italian National Research Council, Fisciano (Salerno).
| | - N Della Pia
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno)
| | - A Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno (Salerno)
| | - L Cerbara
- IRPPS-Institute for Research on Population and Social Policies of the Italian National Research Council, Fisciano (Salerno)
| | - G Russo
- Department of Clinical and Experimental Medicine, University of Messina (Messina)
| | - P De Rosa
- General Surgery and Kidney Transplants. A.O.U San Giovanni di Dio e Ruggi D'Aragona (Salerno)
| | - V Marotta
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno)
| | - A Tortora
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno)
| | - M Riccio
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno)
| | - M Vitale
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno); Department of Medicine, Surgery and Dentistry, University of Salerno (Salerno)
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Cappello M, Barbara G, Bellini M, Consalvo D, Di Sabatino A, Marasco G, Principi M, Savarino EV, Tortora A, Obici L. Identification and management of gastrointestinal manifestations of hereditary transthyretin amyloidosis: Recommendations from an Italian group of experts. Dig Liver Dis 2023:S1590-8658(23)01063-0. [PMID: 38105149 DOI: 10.1016/j.dld.2023.11.025] [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: 10/26/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
Gastrointestinal manifestations are common across all hereditary transthyretin amyloidosis (ATTRv) genotypes. However, they are poorly specific, and their recognition as part of ATTRv is difficult, resulting in misdiagnosis with more common conditions. Moreover, delays in diagnosis occur because of fragmented knowledge, a shortage of centers of excellence and specialists dedicated to ATTRv management, and the scarce involvement of gastroenterologists in multidisciplinary teams. A group of Italian gastroenterologists with experience in the management of ATTRv took part in a project aimed at assessing the awareness of ATTRv among the community of Italian gastroenterologists through an online survey and providing education about practical aspects of ATTRv management. Survey results reported low participation, and very few patients with ATTRv were cared for by gastroenterologists. This highlights the need for greater attention to rare diseases in gastroenterology and emphasizes increasing awareness of ATTRv and diagnostic suspicion. Based on the experts' recommendations, a diagnosis of ATTRv should be suspected when at least one of the 'red flags' is detected. Subsequently, it is suggested to promptly ask for genetic testing and exclude a serum and urinary monoclonal protein, even before the detection of amyloid in biopsy samples, particularly in non-endemic areas.
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Affiliation(s)
- Maria Cappello
- Gastroenterology and Hepatology Section, ProMiSe Department, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, via Massarenti 9, 40138, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Massimo Bellini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Danilo Consalvo
- Department of Gastroenterology and Digestive Endoscopy, AORN ``Antonio Cardarelli'', Via Antonio Cardarelli 9, 80131, Napoli, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Therapeutics, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy; First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Piazzale Golgi 19, 27100 Pavia, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, via Massarenti 9, 40138, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Mariabeatrice Principi
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari, Piazza Umberto I, 70121, Bari, Italy
| | - Edoardo Vincenzo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova, via Nicolò Giustiniani 2, 35100, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, via Nicolò Giustiniani 2, 35100, Italy
| | - Annalisa Tortora
- UOC Gastroenterologia, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale L.A. Scuro, 10, 37134 Verona VR, Italy
| | - Laura Obici
- Rare Diseases Unit and Amyloidosis Research and Treatment Centre, IRCCS San Matteo Hospital Foundation, viale Camillo Golgi 19, 27100, Pavia, Italy
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3
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De Vincentis A, D'Amato D, Cristoferi L, Gerussi A, Malinverno F, Lleo A, Colapietro F, Marra F, Galli A, Fiorini C, Coco B, Brunetto M, Niro GA, Cotugno R, Saitta C, Cozzolongo R, Losito F, Giannini EG, Labanca S, Marzioni M, Marconi G, Morgando A, Pellicano R, Vanni E, Cazzagon N, Floreani A, Chessa L, Morelli O, Muratori L, Pellicelli A, Pompili M, Ponziani F, Tortora A, Rosina F, Russello M, Cannavò M, Simone L, Storato S, Viganò M, Abenavoli L, D'Antò M, De Gasperi E, Distefano M, Scifo G, Zolfino T, Calvaruso V, Cuccorese G, Palitti VP, Sacco R, Bertino G, Frazzetto E, Alvaro D, Mulinacci G, Palermo A, Scaravaglio M, Terracciani F, Galati G, Ronca V, Zuin M, Claar E, Izzi A, Picardi A, Invernizzi P, Vespasiani‐Gentilucci U, Carbone M. Predictors of serious adverse events and non-response in cirrhotic patients with primary biliary cholangitis treated with obeticholic acid. Liver Int 2022; 42:2453-2465. [PMID: 35932095 PMCID: PMC9804305 DOI: 10.1111/liv.15386] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/24/2022] [Accepted: 06/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS Obeticholic acid (OCA) has recently been restricted in patients with primary biliary cholangitis (PBC) with "advanced cirrhosis" because of its narrow therapeutic index. We aimed to better define the predicting factors of hepatic serious adverse events (SAEs) and non-response in cirrhotic patients undergoing OCA therapy. METHODS Safety and efficacy of treatment were evaluated in a cohort of consecutive PBC cirrhotic patients started with OCA. OCA response was evaluated according to the Poise criteria. Risk factors for hepatic SAEs and non-response were reported as risk ratios (RR) with 95% confidence intervals (CIs). RESULTS One hundred PBC cirrhotics were included, 97 Child-Pugh class A and 3 class B. Thirty-one had oesophageal varices and 5 had a history of ascites. Thirty-three per cent and 32% of patients achieved a biochemical response at 6 and 12 months respectively. Male sex (adjusted-RR 1.75, 95%CI 1.42-2.12), INR (1.37, 1.00-1.87), Child-Pugh score (1.79, 1.28-2.50), MELD (1.17, 1.04-1.30) and bilirubin (1.83, 1.11-3.01) were independently associated with non-response to OCA. Twenty-two patients discontinued OCA within 12 months: 10 for pruritus, 9 for hepatic SAEs (5 for jaundice and/or ascitic decompensation; 4 for upper digestive bleeding). INR (adjusted-RR 1.91, 95%CI 1.10-3.36), lower albumin levels (0.18, 0.06-0.51), Child-Pugh score (2.43, 1.50-4.04), history of ascites (3.5, 1.85-6.5) and bilirubin (1.30, 1.05-1.56), were associated with hepatic SAEs. A total bilirubin≥1.4 mg/dl at baseline was the most accurate biochemical predictor of hepatic SAEs under OCA. CONCLUSIONS An accurate baseline assessment is crucial to select cirrhotic patients who can benefit from OCA. Although OCA is effective in one third of cirrhotics, bilirubin level ≥1.4 mg/dl should discourage from its use.
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Affiliation(s)
| | - Daphne D'Amato
- Gastroenterology Unit, Città della salute e della scienzaTurinItaly
| | - Laura Cristoferi
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and SurgeryUniversity of Milano‐Bicocca, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER), San Gerardo HospitalMonzaItaly
| | - Alessio Gerussi
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and SurgeryUniversity of Milano‐Bicocca, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER), San Gerardo HospitalMonzaItaly
| | - Federica Malinverno
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and SurgeryUniversity of Milano‐Bicocca, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER), San Gerardo HospitalMonzaItaly
| | - Ana Lleo
- Internal Medicine and Hepatology, Humanitas Clinical and Research Center IRCCSHumanitas UniversityMilanItaly
| | - Francesca Colapietro
- Internal Medicine and Hepatology, Humanitas Clinical and Research Center IRCCSHumanitas UniversityMilanItaly
| | - Fabio Marra
- Internal Medicine and Hepatology Unit, Department of Experimental and Clinical MedicineUniversity of FirenzeFirenzeItaly
| | - Andrea Galli
- Department of Experimental and Clinical Biochemical SciencesUniversity of FlorenceFlorenceItaly
| | - Cecilia Fiorini
- Department of Experimental and Clinical Biochemical SciencesUniversity of FlorenceFlorenceItaly
| | - Barbara Coco
- Hepatology Unit, University Hospital of PisaPisaItaly
| | | | - Grazia Anna Niro
- Gastroenterology Unit, Fondazione Casa Sollievo Della Sofferenza IRCCSSan Giovanni RotondoItaly
| | - Rosa Cotugno
- Gastroenterology Unit, Fondazione Casa Sollievo Della Sofferenza IRCCSSan Giovanni RotondoItaly
| | - Carlo Saitta
- Division of Medicine and HepatologyUniversity Hospital of Messina “Policlinico G. Martino”MessinaItaly
| | - Raffaele Cozzolongo
- Gastroenterology UnitNational Institute of Gastroenterology “S de Bellis” Research HospitalCastellana GrotteItaly
| | - Francesco Losito
- Gastroenterology UnitNational Institute of Gastroenterology “S de Bellis” Research HospitalCastellana GrotteItaly
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal MedicineUniversity of Genova, IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Sara Labanca
- Gastroenterology Unit, Department of Internal MedicineUniversity of Genova, IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Marco Marzioni
- Clinic of Gastroenterology and HepatologyUniversità Politecnica delle MarcheAnconaItaly
| | - Giulia Marconi
- Clinic of Gastroenterology and HepatologyUniversità Politecnica delle MarcheAnconaItaly
| | - Anna Morgando
- Gastroenterology Unit, Città della salute e della scienzaTurinItaly
| | | | - Ester Vanni
- Gastroenterology Unit, Città della salute e della scienzaTurinItaly
| | - Nora Cazzagon
- Gastroenterology Unit, Department of Surgery, Oncology and GastroenterologyPadua University HospitalPaduaItaly
| | - Annarosa Floreani
- Gastroenterology Unit, Department of Surgery, Oncology and GastroenterologyPadua University HospitalPaduaItaly
| | - Luchino Chessa
- Liver Unit, University Hospital of CagliariCagliariItaly
| | - Olivia Morelli
- Clinic of Gastroenterology and Hepatology, Department of MedicineUniversità degli Studi di PerugiaPerugiaItaly
| | - Luigi Muratori
- DIMEC Università di Bologna, Policlinico di Sant'OrsolaBolognaItaly
| | | | - Maurizio Pompili
- Internal Medicine and Hepatology Unit, Policlinico GemelliSapienza UniversityRomeItaly
| | - Francesca Ponziani
- Internal Medicine and Hepatology Unit, Policlinico GemelliSapienza UniversityRomeItaly
| | - Annalisa Tortora
- Internal Medicine and Hepatology Unit, Policlinico GemelliSapienza UniversityRomeItaly
| | | | | | | | - Loredana Simone
- Department of GastroenterologyUniversity Hospital Sant'AnnaFerraraItaly
| | - Silvia Storato
- IRCCS Sacro Cuore Institute Don Calabria, GastroenterologyNegrarItaly
| | - Mauro Viganò
- Hepatology Unit, San Giuseppe HospitalMilanItaly
| | - Ludovico Abenavoli
- Department of Health SciencesUniversity “Magna Graecia” of CatanzaroItaly
| | - Maria D'Antò
- Hepatology Unit, Santa Maria delle Grazie HospitalPozzuoliItaly
| | - Elisabetta De Gasperi
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico – Division of Gastroenterology and Hepatology – CRC “A.M. and A. Migliavacca” Center for Liver DiseaseMilanItaly
| | - Marco Distefano
- Department of Infectious DiseasesUmberto I HospitalSyracuseItaly
| | - Gaetano Scifo
- Department of Infectious DiseasesUmberto I HospitalSyracuseItaly
| | - Teresa Zolfino
- Department of GastroenterologyBrotzu HospitalCagliariItaly
| | | | | | | | | | - Gaetano Bertino
- Gastroenterology and Hepatology UnitUniversity Hospital Policlinico Vittorio EmanueleCataniaItaly
| | - Evelise Frazzetto
- Gastroenterology and Hepatology UnitUniversity Hospital Policlinico Vittorio EmanueleCataniaItaly
| | - Domenico Alvaro
- Department of Translational and Precision MedicineUniversity La SapienzaRomeItaly
| | - Giacomo Mulinacci
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and SurgeryUniversity of Milano‐Bicocca, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER), San Gerardo HospitalMonzaItaly
| | - Andrea Palermo
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and SurgeryUniversity of Milano‐Bicocca, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER), San Gerardo HospitalMonzaItaly
| | - Miki Scaravaglio
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and SurgeryUniversity of Milano‐Bicocca, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER), San Gerardo HospitalMonzaItaly
| | | | - Giovanni Galati
- Internal Medicine and HepatologyUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Vincenzo Ronca
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and SurgeryUniversity of Milano‐Bicocca, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER), San Gerardo HospitalMonzaItaly
| | - Massimo Zuin
- Liver and Gastroenterology Unit, Department of Health SciencesUniversita’ degli Studi di MilanoMilanItaly,ASST Santi Paolo e CarloUniversity Hospital San PaoloMilanItaly
| | | | - Antonio Izzi
- Department of Infectious DiseasesD. Cotugno HospitalNapoliItaly
| | - Antonio Picardi
- Internal Medicine and HepatologyUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Pietro Invernizzi
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and SurgeryUniversity of Milano‐Bicocca, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER), San Gerardo HospitalMonzaItaly
| | | | - Marco Carbone
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and SurgeryUniversity of Milano‐Bicocca, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER), San Gerardo HospitalMonzaItaly
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Ponziani FR, Santopaolo F, Siciliano M, De Belvis AG, Tortora A, Mora V, Fanali C, Morsella A, Balducci F, Vetrugno G, D'Alfonso ME, Cambieri A, Cauda R, Bellantone R, Sanguinetti M, Pompili M, Gasbarrini A. Missed linkage to care for patients who screened positive for Hepatitis C in a tertiary care centre: Results of the Telepass project. J Viral Hepat 2021; 28:651-656. [PMID: 33421220 DOI: 10.1111/jvh.13465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/15/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022]
Abstract
Italy is one of the countries on track with the WHO's agenda to eliminate hepatitis C virus (HCV) by 2030. Healthcare facilities play a crucial role in seeking patients who are infected but have not yet been treated. We assessed the effectiveness of a recall strategy, named 'Telepass' project, for patients exposed to HCV infection who have not yet been linked to care in a large tertiary care centre. The 'Telepass' project was structured in two phases: (a) a retrospective analysis first identified all anti-HCV-positive subjects among patients who underwent pre-operative assessment in the facility in the course of one year; (b) a following prospective phase, aimed to recall patients in need either of further diagnostic tests (ie HCV-RNA) or treatment. A total of 12246 records of patients tested for HCV antibodies were reviewed. The overall prevalence of anti-HCV-positive subjects was 1.83% (224/12246) with a male/female ratio of 2.07. Out of the 224 anti-HCV-positive patients, 123 (54.91%) did not have documented HCV-RNA tests and were therefore selected for recall. Of these, 123 were reachable and 26 (21.13%) were successfully linked to care. Ten patients (38.46%) tested HCV-RNA positive and initiated treatment with direct-acting antivirals (DAAs). The Telepass study highlights that a recall strategy starting from internal hospital databases can help identify patients with chronic HCV infection who have not yet been linked to care, and provides an epidemiological insight into the prevalence of HCV infection in Italy in the late DAAs era.
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Affiliation(s)
- Francesca Romana Ponziani
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Special Medical Pathology and Medical Semeiotics, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesco Santopaolo
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia
| | - Massimo Siciliano
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Special Medical Pathology and Medical Semeiotics, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Antonio Giulio De Belvis
- Critical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Annalisa Tortora
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia
| | - Vincenzina Mora
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Special Medical Pathology and Medical Semeiotics, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Caterina Fanali
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Special Medical Pathology and Medical Semeiotics, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Alisha Morsella
- Critical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Institute of Special Medical Pathology and Medical Semeiotics, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Fulvio Balducci
- Planning, Control and Private Activity Management, San Giovanni Calibita Fatebenefratelli Hospital, Roma, Italia
| | - Giuseppe Vetrugno
- Risk Management Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia
| | - Maria Elena D'Alfonso
- Operational Programming, Reception and Access, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia
| | - Andrea Cambieri
- Medical Management, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia
| | - Roberto Cauda
- Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Rocco Bellantone
- Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Surgical Semeiotics, Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Maurizio Sanguinetti
- Laboratory and Infectious Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Microbiology, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Maurizio Pompili
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Special Medical Pathology and Medical Semeiotics, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Antonio Gasbarrini
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Special Medical Pathology and Medical Semeiotics, Università Cattolica del Sacro Cuore, Roma, Italia
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Tortora A, Marmo C, Gasbarrini A, Costamagna G, Riccioni ME. Management of Gastrointestinal Bleeding in Rendu-Osler Disease. Rev Recent Clin Trials 2021; 15:321-327. [PMID: 32493201 DOI: 10.2174/1574887115666200603160033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hereditary hemorrhagic telangiectasia (HHT, or Rendu-Osler-Weber disease) is a rare inherited syndrome, characterized by artero-venous malformations (AVMs or telangiectasia) with autosomal dominant transmission. AVMs can occur in any organ of the body but most commonly it occurs in the nose, pulmonary, hepatic and cerebral circulations. In patients with HHT, we report teleangectasia of mucosa of the gastrointestinal tract. METHODS Research and online content related to HHT online activity is reviewed, and DOC writing excerpts are used to illustrate key themes. RESULTS Patients with HHT have a high rate of complications related to bleeding; of them gastrointestinal bleeding accounts for 10.8%. Several therapies, both medical and endoscopic, were utilized to reduce the need for transfusions and hospitalization. CONCLUSION A combination of medical and endoscopic therapy is probably the best option.
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Affiliation(s)
- Annalisa Tortora
- Department of Gastroenterological, Fondazione Policlinico Gemelli IRCCS, Endocrino-Metabolic, and Nefro-urological Science, Rome, Italy
| | - Clelia Marmo
- Department of Gastroenterological, Fondazione Policlinico Gemelli IRCCS, Endocrino-Metabolic, and Nefro-urological Science, Rome, Italy
| | - Antonio Gasbarrini
- Department of Gastroenterological, Fondazione Policlinico Gemelli IRCCS, Endocrino-Metabolic, and Nefro-urological Science, Rome, Italy
| | - Guido Costamagna
- Department of Gastroenterological, Fondazione Policlinico Gemelli IRCCS, Endocrino-Metabolic, and Nefro-urological Science, Rome, Italy
| | - Maria Elena Riccioni
- Department of Gastroenterological, Fondazione Policlinico Gemelli IRCCS, Endocrino-Metabolic, and Nefro-urological Science, Rome, Italy
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Riccioni ME, Tortora A, Costamagna G. Editorial - Video-capsule endoscopy: a test with no contraindications? Eur Rev Med Pharmacol Sci 2020; 24:13105-13106. [PMID: 33378067 DOI: 10.26355/eurrev_202012_24220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- M E Riccioni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Luigetti M, Tortora A, Romano A, Di Paolantonio A, Guglielmino V, Bisogni G, Gasbarrini A, Calabresi P, Sabatelli M. Gastrointestinal Manifestations in Hereditary Transthyretin Amyloidosis: a Single-Centre Experience. J Gastrointestin Liver Dis 2020; 29:339-343. [PMID: 32919418 DOI: 10.15403/jgld-2474] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/07/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Hereditary transthyretin (ATTRv) amyloidosis represents a diagnostic challenge considering the great variability in clinical presentation and multiorgan involvement. In this study we report the prevalence of gastrointestinal (GI) involvement of patients with hereditary ATTRv amyloidosis from one single center of Italy, a non-endemic area. METHODS We retrospectively analyzed a cohort of 39 patients with hereditary ATTRv amyloidosis followed at the Neurology Unit of Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, Italy. All patients had a documented mutation in the gene encoding the thansthyretin. Neurological, cardiological and gastrointestinal manifestations were systematically collected at every monitoring visit. RESULTS 82% reported at least one GI symptom. Unintentional weight loss was the most frequently reported. Lower GI symptoms were more frequent than upper GI symptoms (66.7% vs. 35.9%, p=0.0122). The first GI symptom was always reported within 5 years since disease onset. Gastrointestinal symptoms were almost always present in patients with Val30Met mutation (93.8%, 15/16), and in more than half of the cases with Phe64Leu mutation (66.7%, 8/12). All cases with a non-Val30Met mutation disclosed almost all GI symptoms within 5 years since disease onset; conversely, patients with Val30Met mutation continued to develop further GI manifestations during the disease course. CONCLUSIONS Prevalence of GI symptoms in our cohort was 82%, resulting in a higher prevalence than reported in the THAOS registry. Gastroenterologists, therefore, play an important role for the management of the disease, and their expertise should be valued for an effective multidisciplinary approach to this condition.
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Affiliation(s)
- Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, Roma; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Annalisa Tortora
- Università Cattolica del Sacro Cuore, Roma; Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Gastroenterologia, Roma, Italy.
| | - Angela Romano
- Università Cattolica del Sacro Cuore, Roma; Centro Clinico NEMO adulti, Roma, Italia.
| | | | - Valeria Guglielmino
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, Roma; Università Cattolica del Sacro Cuore, Roma, Italy.
| | | | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore, Roma; Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Gastroenterologia, Roma, Italy.
| | - Paolo Calabresi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, Roma; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Mario Sabatelli
- Università Cattolica del Sacro Cuore, Roma; Centro Clinico NEMO adulti, Roma, Italia.
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8
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Gaetani E, Passali GC, Riccioni ME, Tortora A, Pola R, Costamagna G, Gasbarrini A. Hereditary haemorrhagic telangiectasia: A disease not to be forgotten during the COVID-19 pandemic. J Thromb Haemost 2020; 18:1799-1801. [PMID: 32348627 PMCID: PMC9770823 DOI: 10.1111/jth.14885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Eleonora Gaetani
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Giulio Cesare Passali
- Division of Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Maria E Riccioni
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Annalisa Tortora
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Roberto Pola
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Guido Costamagna
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
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9
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Gaetani E, Agostini F, Porfidia A, Giarretta I, Feliciani D, Di Martino L, Tortora A, Gasbarrini A, Pola R. Safety of antithrombotic therapy in subjects with hereditary hemorrhagic telangiectasia: prospective data from a multidisciplinary working group. Orphanet J Rare Dis 2019; 14:298. [PMID: 31878955 PMCID: PMC6933630 DOI: 10.1186/s13023-019-1278-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/09/2019] [Indexed: 12/20/2022] Open
Abstract
Subjects with the rare autosomal dominant disease Hereditary Hemorrhagic Telangiectasia (HHT) may develop medical conditions that require antithrombotic therapy (AT). However, safety of AT is uncertain in these patients and the only data currently available derive from retrospective analyses of registries and/or databases. At the HHT Centre of the ‘Fondazione Policlinico Universitario A. Gemelli IRCCS’ (Rome, Italy), a prospective study is currently ongoing to evaluate the safety of AT in subjects affected by HHT. The study is enrolling subjects with a definite diagnosis of HHT who receive an AT prescription by one of the physicians of the HHT Centre. The primary outcome is the number of hemorrhagic events, distinguished in major, clinically relevant non-major (CRNM), and minor bleedings, according to the criteria of the International Society on Thrombosis and Hemostasis (ISTH). Another primary outcome is worsening of epistaxis upon initiation of AT, assessed using the internationally accepted Epistaxis Severity Score (ESS). Additional outcomes are changes in hemoglobin levels and changes in the need of blood transfusion after initiation of AT. Here, we present the results of an interim analysis, conducted on the 12 HHT subjects that have been enrolled so far. After a mean follow-up of 6.5 ± 0.8 months, no major bleedings, no CRNM bleedings, and no minor bleedings different from epistaxis were recorded. Worsening of epistaxis upon initiation of AT was documented only in one patient, but did not require discontinuation of AT. There were no significant changes in the mean ESS measured before and after initiation of AT. There were no significant changes in hemoglobin levels and need for blood transfusion after initiation of AT. Although preliminary, these are the first prospective data on the safety of AT in HHT patients. Our interim analysis suggests that, when prescribed by experienced physicians in a multidisciplinary setting, AT is well tolerated by HHT patients. More patients and a longer follow-up are needed to confirm these findings.
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Affiliation(s)
- Eleonora Gaetani
- Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Division of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Fabiana Agostini
- Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Division of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelo Porfidia
- Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Division of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Igor Giarretta
- Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Daniela Feliciani
- Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Division of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Di Martino
- Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annalisa Tortora
- Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Division of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Roberto Pola
- Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy. .,Division of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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10
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Tortora A, Riccioni ME, Gaetani E, Ojetti V, Holleran G, Gasbarrini A. Rendu-Osler-Weber disease: a gastroenterologist's perspective. Orphanet J Rare Dis 2019; 14:130. [PMID: 31174568 PMCID: PMC6555961 DOI: 10.1186/s13023-019-1107-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022] Open
Abstract
Hereditary hemorrhagic teleangectasia (HHT, or Rendu-Osler-Weber disease) is a rare inherited syndrome, characterized by arterio-venous malformations (AVMs or Telangiectasia). The most important and common manifestation is nose bleeds (epistaxis). The telangiectasias (small AVMs) are most evident on the lips, tongue, buccal mucosa, face, chest, and fingers, however; large arterio-venous malformations can also occur in the lungs, liver, pancreas, or brain. Telangiectasias in the upper gastrointestinal tract are known to occur, however data regarding possible small-bowel involvement is limited due to technical difficulties in visualizing the entire gastrointestinal tract. The occurrence of AVMs in the stomach and small bowel can result in chronic bleeding and anaemia. Less frequently, this may occur due to bleeding from oesophageal varices, as patients with HHT can develop hepatic parenchymal AVMs or vascular shunts which cause hepatic cirrhosis and portal hypertension. Gastroenterologists have a crucial role in the management of these patients, however difficulties remain in the detection and management of complications of HHT in the gastrointestinal tract.
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Affiliation(s)
- Annalisa Tortora
- Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy. .,Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Maria Elena Riccioni
- Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Eleonora Gaetani
- Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Veronica Ojetti
- Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Grainne Holleran
- Department of Clinical Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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11
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Cerrito L, Ponziani FR, Garcovich M, Tortora A, Annicchiarico BE, Pompili M, Siciliano M, Gasbarrini A. Regorafenib: a promising treatment for hepatocellular carcinoma. Expert Opin Pharmacother 2018; 19:1941-1948. [PMID: 30345837 DOI: 10.1080/14656566.2018.1534956] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors with 854,000 new cases per year and represents the second most frequent cause of cancer-death. Despite surveillance, the number of patients that are diagnosed at a stage in which they are eligible for curative treatments ranges from 30% to 60%. Advanced HCC (BCLC-C) is characterized by a median survival of 6 months. Sorafenib, the first systemic drug proven to be effective in prolonging survival of unresectable HCC, was approved by the FDA in 2007 but no second-line treatment was available for a decade for patients progressing on sorafenib. Finally, in 2016, the RESORCE trial demonstrated regorafenib as an effective second-line treatment. Areas covered: In this manuscript, the authors review the principal preclinical and clinical trials on regorafenib used in the treatment of unresectable HCC patients progressing on sorafenib and highlight both the advantages and the limitations of this drug. Expert opinion: Regorafenib is the only second-line treatment available for patients progressing on sorafenib. Despite its promising clinical application, many doubts still remain, necessitating further investigation to explore the tolerability of this drug in Child-Pugh B and sorafenib-intolerant patients, while its scarce cost-effectiveness must also be improved.
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Affiliation(s)
- Lucia Cerrito
- a Division of Internal Medicine, Gastroenterology and Hepatology Unit , Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Francesca R Ponziani
- a Division of Internal Medicine, Gastroenterology and Hepatology Unit , Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Matteo Garcovich
- a Division of Internal Medicine, Gastroenterology and Hepatology Unit , Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Annalisa Tortora
- a Division of Internal Medicine, Gastroenterology and Hepatology Unit , Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Brigida E Annicchiarico
- a Division of Internal Medicine, Gastroenterology and Hepatology Unit , Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Maurizio Pompili
- a Division of Internal Medicine, Gastroenterology and Hepatology Unit , Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Massimo Siciliano
- a Division of Internal Medicine, Gastroenterology and Hepatology Unit , Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Antonio Gasbarrini
- a Division of Internal Medicine, Gastroenterology and Hepatology Unit , Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italy
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12
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Holleran G, Valerii G, Tortora A, Scaldaferri F, Conti S, Amato A, Gasbarrini A, Costamagna G, Riccioni ME. The use of single balloon enteroscopy in Crohn's disease and its impact on clinical outcome. Scand J Gastroenterol 2018; 53:925-929. [PMID: 29966446 DOI: 10.1080/00365521.2018.1476914] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 02/09/2023]
Abstract
OBJECTIVES Single balloon enteroscopy (SBE) is an effective and safe modality for the diagnosis and therapeutic intervention of small bowel disorders. Its use in patients with Crohn's disease (CD) and particularly its effect on management changes in CD have not yet been determined. MATERIALS AND METHODS We performed a retrospective review of the endoscopic and clinical data available on a cohort of patients with small bowel CD who had undergone SBE to determine the diagnostic and therapeutic yield of the procedure and the initial and longer-term impact it had on clinical management. RESULTS About 52 patients have undergone SBE in our unit for the investigation of known (n = 39) or suspected (n = 13) small bowel CD with a diagnostic yield of 77% and 39%, respectively. SBE had an immediate clinical impact in 69% (n = 33) of patients, including dilatation of a stricture in 27% (n = 13), initiation or adjustment of dose of medications in 48% (n = 23), referral for surgical resection in 6% (n = 3). Moreover, the procedure permitted determining a new diagnosis of CD in 8% of the patients (n = 4), and excluding it in 8% (n = 4). Longer term follow-up was available in 34 patients (65%) which showed a significant difference in mean HBI score from 6.6 before the procedure to 4.2 after it (p < .0001). CONCLUSIONS SBE has a high diagnostic and therapeutic yield in CD and significantly impacts disease management. Careful patient selection is a key factor in optimizing its use in CD.
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Affiliation(s)
- Grainne Holleran
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy.,b Trinity College Dublin Clinical Medicine Tallaght , Dublin , Ireland
| | - Giorgio Valerii
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy
| | - Annalisa Tortora
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy
| | - Franco Scaldaferri
- c Division of Internal Medicine and Gastroenterology , Catholic University of the Sacred Heart , Rome , Italy
| | - Silvia Conti
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy
| | - Arianna Amato
- d Department of Anaesthesiology , Catholic University of the Sacred Heart , Rome , Italy
| | - Antonio Gasbarrini
- c Division of Internal Medicine and Gastroenterology , Catholic University of the Sacred Heart , Rome , Italy
| | - Guido Costamagna
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy
| | - Maria Elena Riccioni
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy
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13
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Caraceni P, Riggio O, Angeli P, Alessandria C, Neri S, Foschi FG, Levantesi F, Airoldi A, Boccia S, Svegliati-Baroni G, Fagiuoli S, Romanelli RG, Cozzolongo R, Di Marco V, Sangiovanni V, Morisco F, Toniutto P, Tortora A, De Marco R, Angelico M, Cacciola I, Elia G, Federico A, Massironi S, Guarisco R, Galioto A, Ballardini G, Rendina M, Nardelli S, Piano S, Elia C, Prestianni L, Cappa FM, Cesarini L, Simone L, Pasquale C, Cavallin M, Andrealli A, Fidone F, Ruggeri M, Roncadori A, Baldassarre M, Tufoni M, Zaccherini G, Bernardi M. Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial. Lancet 2018; 391:2417-2429. [PMID: 29861076 DOI: 10.1016/s0140-6736(18)30840-7] [Citation(s) in RCA: 283] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Evidence is scarce on the efficacy of long-term human albumin (HA) administration in patients with decompensated cirrhosis. The human Albumin for the treatmeNt of aScites in patients With hEpatic ciRrhosis (ANSWER) study was designed to clarify this issue. METHODS We did an investigator-initiated multicentre randomised, parallel, open-label, pragmatic trial in 33 academic and non-academic Italian hospitals. We randomly assigned patients with cirrhosis and uncomplicated ascites who were treated with anti-aldosteronic drugs (≥200 mg/day) and furosemide (≥25 mg/day) to receive either standard medical treatment (SMT) or SMT plus HA (40 g twice weekly for 2 weeks, and then 40 g weekly) for up to 18 months. The primary endpoint was 18-month mortality, evaluated as difference of events and analysis of survival time in patients included in the modified intention-to-treat and per-protocol populations. This study is registered with EudraCT, number 2008-000625-19, and ClinicalTrials.gov, number NCT01288794. FINDINGS From April 2, 2011, to May 27, 2015, 440 patients were randomly assigned and 431 were included in the modified intention-to-treat analysis. 38 of 218 patients died in the SMT plus HA group and 46 of 213 in the SMT group. Overall 18-month survival was significantly higher in the SMT plus HA than in the SMT group (Kaplan-Meier estimates 77% vs 66%; p=0·028), resulting in a 38% reduction in the mortality hazard ratio (0·62 [95% CI 0·40-0·95]). 46 (22%) patients in the SMT group and 49 (22%) in the SMT plus HA group had grade 3-4 non-liver related adverse events. INTERPRETATION In this trial, long-term HA administration prolongs overall survival and might act as a disease modifying treatment in patients with decompensated cirrhosis. FUNDING Italian Medicine Agency.
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Affiliation(s)
- Paolo Caraceni
- Department of Medical and Surgical Sciences, and Center for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Oliviero Riggio
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padua, Padua, Italy
| | - Carlo Alessandria
- Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Sergio Neri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Francesco G Foschi
- Internal Medicine, Hospital of Faenza, Azienda Unità Sanitaria Locale of Romagna, Faenza, Italy
| | - Fabio Levantesi
- Internal Medicine, Hospital of Bentivoglio, AUSL of Bologna, Bologna, Italy
| | - Aldo Airoldi
- Liver Unit, Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - Sergio Boccia
- Gastroenterology Unit, University Hospital, Ferrara, Italy
| | | | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Roberto G Romanelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Raffaele Cozzolongo
- Division of Gastroenterology, National Institute of Gastroenterology S De Bellis, Castellana Grotte (Bari), Italy
| | - Vito Di Marco
- Unit of Gastroenterology and Hepatology, Biomedical Department of Internal and Specialistic Medicine, University of Palermo, Palermo, Italy
| | - Vincenzo Sangiovanni
- Azienda Ospedaliera di Rilievo Nazionale dei Colli, Cotugno Hospital of Naples, Naples, Italy
| | - Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Pierluigi Toniutto
- Internal Medicine, Department of Medical Area, University of Udine, Udine, Italy
| | - Annalisa Tortora
- Gastroenterology, Gemelli Foundation, Catholic University, Rome, Italy
| | | | | | - Irene Cacciola
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy
| | - Gianfranco Elia
- Infectious Diseases and Hepatology, University Hospital of Parma, Parma, Italy
| | - Alessandro Federico
- Department of Clinical and Experimental Internal Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Sara Massironi
- Gastroenterology and Endoscopy Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Guarisco
- Internal Medicine, S Sebastiano General Hospital, Frascati (Rome), Italy
| | - Alessandra Galioto
- Internal Medicine, Hospital of Dolo, Azienda Unità Locale Socio-sanitaria Serenissima, Mestre, Italy
| | | | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Silvia Nardelli
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padua, Padua, Italy
| | - Chiara Elia
- Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Loredana Prestianni
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federica Mirici Cappa
- Internal Medicine, Hospital of Faenza, Azienda Unità Sanitaria Locale of Romagna, Faenza, Italy
| | - Lucia Cesarini
- Liver Unit, Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | | | - Chiara Pasquale
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Cavallin
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padua, Padua, Italy
| | - Alida Andrealli
- Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Federica Fidone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Matteo Ruggeri
- Graduate School of Health Economics and Management, Catholic University, Rome, Italy
| | | | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, and Center for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Manuel Tufoni
- Department of Medical and Surgical Sciences, and Center for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, and Center for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, and Center for Applied Biomedical Research, University of Bologna, Bologna, Italy.
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14
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Ponziani FR, Miele L, Tortora A, Furnari M, Bodini G, Pompili M, Gasbarrini A, Giannini EG. Treatment of early stage chronic hepatitis C virus infection. Expert Rev Clin Pharmacol 2018; 11:519-524. [PMID: 29498556 DOI: 10.1080/17512433.2018.1447923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Treatment of Hepatitis C Virus (HCV) with direct acting antivirals (DAAs) is able to achieve the cure of infection in almost the totality of patients, independently of the characteristics of the individual and the virus, using short treatment schedules, and without the need of ribavirin. The high cost of DAAs is the main limiting factor for universal treatment of HCV. However, there is a strong evidence that treatment of infection at the early stage of disease may be the most rewarding approach. Areas covered: This review evaluates the aspects underlying the benefit of treating chronic HCV infection at the early stage of disease. It outlines the considerations that have to be taken into account when planning treatment in patients with HCV and minimal liver disease, assessing the positive reflex of viral eradication on several HCV-associated extra-hepatic conditions such as the risk of lymphoma, insulin-resistance and glycaemic control, and renal function. Lastly, it also covers the improvement of patients' quality of life and the pharmaco-economic aspects associated with early treatment. Expert commentary: Treatment of patients with HCV and minimal liver disease is associated with a beneficial, pleiotropic effect of viral eradication that goes beyond the simplistic consideration of the improvement in liver disease-related outcomes.
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Affiliation(s)
- Francesca Romana Ponziani
- a Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico "A. Gemelli" , Catholic University of Rome , Rome , Italy
| | - Luca Miele
- a Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico "A. Gemelli" , Catholic University of Rome , Rome , Italy
| | - Annalisa Tortora
- a Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico "A. Gemelli" , Catholic University of Rome , Rome , Italy
| | - Manuele Furnari
- b Gastroenterology Unit, Department of Internal Medicine , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Giorgia Bodini
- b Gastroenterology Unit, Department of Internal Medicine , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Maurizio Pompili
- a Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico "A. Gemelli" , Catholic University of Rome , Rome , Italy
| | - Antonio Gasbarrini
- a Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico "A. Gemelli" , Catholic University of Rome , Rome , Italy
| | - Edoardo Giovanni Giannini
- b Gastroenterology Unit, Department of Internal Medicine , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
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15
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Cianci R, Urgesi R, Tortora A, Amato A, Newton EE, Costamagna G, Riccioni ME. WITHDRAWN: The Role of capsule endoscopy and device assisted enteroscopy for small bowel lesions in hereditary hemorrhagic telangiectasia. Dig Liver Dis 2017:S1590-8658(17)30891-5. [PMID: 28619257 DOI: 10.1016/j.dld.2017.05.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/14/2017] [Accepted: 05/15/2017] [Indexed: 12/11/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Rossella Cianci
- Department of Internal Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Riccardo Urgesi
- Endoscopy Unit, S. Giovanni Addolorata Hospital, Rome, Italy
| | - Annalisa Tortora
- Endoscopy Unit, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Arianna Amato
- Department of Anaesthesiology, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | | | - Guido Costamagna
- Endoscopy Unit, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
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16
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Binda C, Tortora A, Garcovich M, Annicchiarico BE, Siciliano M. Toxicity and risks from drug-to-drug interactions of new antivirals for chronic hepatitis C. Eur Rev Med Pharmacol Sci 2017; 21:102-111. [PMID: 28379589] [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: 06/07/2023]
Abstract
The new direct acting antivirals (DAAs), defined as those drugs that are effective in combinations without interferon, have totally changed HCV treatment and probably in few years will also totally change global landscape of advanced liver diseases. The advantage of DAAs is a low-risk/high-benefit ratio. Although overall adverse events during DAAs treatment are limited in frequency and severity, some toxicity issues emerged during the first years of real-life experience with these drugs. Another peculiar characteristic of present DAAs is a high probability of interaction with other "common-use" drugs, such as anti-hypertensive, anti-platelet, antiarrhythmic and cholesterol lowering agents. Above all, special attention should be paid in older patients and in those belonging to special populations, who more frequently require the concomitant use of polytherapy.
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Affiliation(s)
- C Binda
- Gastroenterologic Area, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
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17
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Yung DE, Rondonotti E, Giannakou A, Avni T, Rosa B, Toth E, Lucendo AJ, Sidhu R, Beaumont H, Ellul P, Negreanu L, Jiménez-Garcia VA, McNamara D, Kopylov U, Elli L, Triantafyllou K, Shibli F, Riccioni ME, Bruno M, Dray X, Plevris JN, Koulaouzidis A, Argüelles-Arias F, Becq A, Branchi F, Tejero-Bustos MÁ, Cotter J, Eliakim R, Ferretti F, Gralnek IM, Herrerias-Gutierrez JM, Hussey M, Jacobs M, Johansson GW, McAlindon M, Montiero S, Nemeth A, Pennazio M, Rattehalli D, Stemate A, Tortora A, Tziatzios G. Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy. United European Gastroenterol J 2017; 5:974-981. [PMID: 29163963 DOI: 10.1177/2050640617692501] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 01/11/2017] [Indexed: 12/18/2022] Open
Abstract
Background Recent data imply young patients (age ≤50 years) undergoing small-bowel (SB) capsule endoscopy (CE) for iron deficiency anaemia (IDA) show higher diagnostic yield (DY) for sinister pathology. We aimed to investigate DY of CE in a large cohort of young IDA patients, and evaluate factors predicting significant SB pathology. Materials and methods This was a retrospective, multicentre study (2010-2015) in consecutive, young patients (≤50 years) from 18 centres/12 countries, with negative bidirectional gastrointestinal (GI) endoscopy undergoing SBCE for IDA. Exclusion criteria: previous/ongoing obscure-overt GI bleeding; age <19 or >50 years; comorbidities associated with IDA. Data retrieved: SBCE indications; prior investigations; medications; SBCE findings; final diagnosis. Clinical and laboratory data were analysed by multivariate logistic regression. Results Data on 389 young IDA patients were retrieved. In total, 169 (43.4%) were excluded due to incomplete clinical data; data from 220 (122F/98M; mean age 40.5 ± 8.6 years) patients were analysed. Some 71 patients had at least one clinically significant SBCE finding (DY: 32.3%). They were divided into two groups: neoplastic pathology (10/220; 4.5%), and non-neoplastic but clinically significant pathology (61/220; 27.7%). The most common significant but non-neoplastic pathologies were angioectasias (22/61) and Crohn's disease (15/61). On multivariate analysis, weight loss and lower mean corpuscular volume(MCV) were associated with significant SB pathology (OR: 3.87; 95%CI: 1.3-11.3; p = 0.01; and OR: 0.96; 95%CI: 0.92-0.99; p = 0.03; respectively). Our model also demonstrates association between use of antiplatelets and significant SB pathology, although due to the small number of patients, definitive conclusions cannot be drawn. Conclusion In IDA patients ≤50 years with negative bidirectional GI endoscopy, overall DY of SBCE for clinically significant findings was 32.3%. Some 5% of our cohort was diagnosed with SB neoplasia; lower MCV or weight loss were associated with higher DY for SB pathology.
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Affiliation(s)
- Diana E Yung
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Andry Giannakou
- Faculty of Economics and Management, The Open University of Cyprus, Nicosia, Cyprus
| | - Tomer Avni
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Reena Sidhu
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom
| | - Hanneke Beaumont
- Department of Gastroenterology, VU Medical Center, Amsterdam, The Netherlands
| | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Malta
| | - Lucian Negreanu
- Internal Medicine II Gastroenterology, University Hospital, Carol Davila University Bucharest
| | | | - Deidre McNamara
- Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Dept of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Fahmi Shibli
- Institute of Gastroenterology and Hepatology, Ha'Emek Medical Center, Afula, Israel
| | | | - Mauro Bruno
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Xavier Dray
- Paris 6 University and APHP Hôpital Saint-Antoine, Paris, France
| | - John N Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Koulaouzidis
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Aymeric Becq
- Paris 6 University and APHP Hôpital Saint-Antoine, Paris, France
| | - Federica Branchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | - Jose Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Francesca Ferretti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Ha'Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Mary Hussey
- Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Maarten Jacobs
- Department of Gastroenterology, VU Medical Center, Amsterdam, The Netherlands
| | | | - Mark McAlindon
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom
| | - Sara Montiero
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Artur Nemeth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Marco Pennazio
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Deepa Rattehalli
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield , United Kingdom
| | - Ana Stemate
- Internal Medicine II Gastroenterology, University Hospital, Carol Davila University Bucharest
| | | | - Georgios Tziatzios
- Hepatogastroenterology Unit, 2nd Dept of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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Pitocco D, Rizzi A, Tortora A, Manto A, Zaccardi F, Ghirlanda G, Costamagna G, Riccioni ME. Possible Radio Interference Between Video Capsule Endoscopy and Second-Generation OmniPod Patch Pump. Diabetes Technol Ther 2016; 18:444-5. [PMID: 27333334 DOI: 10.1089/dia.2016.0007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Video capsule endoscopy (VCE) is a noninvasive diagnostic tool used to observe the small intestinal mucosa. We report a case of a 57-year-old woman with T2DM, treated with continuous subcutaneous insulin infusion using second-generation OmniPod patch pump, undergoing VCE (Given M2A; VCE Ltd, Yoqneam, Israel) for melena and anemia. During VCE, an abnormal interruption of communication between video capsule and its receiver occurred. Two hours after capsule ingestion, the patient activated the insulin pump infusion through the Personal Diabetes Manager (PDM) because she drank a sugary beverage for the first time after ingestion. Due to this, we decided to repeat VCE after the removal of the insulin pump and PDM: at this time, the capsule recorded for more than 10 h without any interruption. The video capsule and second-generation OmniPod patch pump use the same radio frequency and this may cause interference between these two devices. In patients using second-generation OmniPod patch pump undergoing VCE, we suggest to switch to intravenous insulin infusion or multiple daily injection or to use a different model of VCE, as MiRoCam (Intromedic, Seoul, Korea).
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Affiliation(s)
- Dario Pitocco
- 1 Diabetes Care Unit, Internal Medicine, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Alessandro Rizzi
- 1 Diabetes Care Unit, Internal Medicine, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Annalisa Tortora
- 2 Digestive Endoscopy Unit, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Andrea Manto
- 1 Diabetes Care Unit, Internal Medicine, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Francesco Zaccardi
- 1 Diabetes Care Unit, Internal Medicine, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Giovanni Ghirlanda
- 1 Diabetes Care Unit, Internal Medicine, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Guido Costamagna
- 2 Digestive Endoscopy Unit, Policlinico Agostino Gemelli Hospital , Rome, Italy
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Franceschi F, Ojetti V, Gabrielli M, Petruzziello C, Tortora A, Gasbarrini G, Lopetuso LR, Scaldaferri F, Gasbarrini A. High dose amoxicillin-based first line regimen is equivalent to sequential therapy in the eradication of H. pylori infection. Eur Rev Med Pharmacol Sci 2016; 20:297-300. [PMID: 26875899] [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: 06/05/2023]
Abstract
OBJECTIVE Helicobater (H.) pylori eradication rates with standard first-line triple therapy have declined to unacceptable levels. To date, amoxicillin-resistant H. pylori strains have rarely been detected. Whether increasing the dosage of amoxicillin in a standard 7 days eradicating regimen may enhance its efficacy is not known. The aim of this paper is to compare the efficacy of a 7 days high-dose amoxicillin based first-line regimen with sequential therapy. PATIENTS AND METHODS We have retrospectively analyzed data from 300 sex and age matched patients, who underwent 3 different therapeutic schemes: (1) standard LCA, lansoprazole 30 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg bid for 7 days; (2) high dose LCA (HD-LCA), lansoprazole 30 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg tid for 7 days; (3) sequential LACT, lansoprazole 30 mg bid plus amoxicillin 1000 mg bid for 5 days, followed by lansoprazole 30 mg bid, clarithromycin 500 mg bid and tinidazole 500 mg bid for 5 days. Eradication was confirmed by 13C-urea breath test. Compliance and occurrence of adverse effects were also assessed. RESULTS Eradication rates were: 55% for LCA, 75% for HD-LCA and 73% for LACT. Eradication rates were higher in HD-LCA group compared to LCA (p<0.01), while no significant differences were observed in HD-LCA group compared to LACT (p=ns). Compliance and occurrence of adverse effects were similar among groups. CONCLUSIONS High-dose amoxicillin based eradicating treatment is superior to standard triple therapy and equivalent to sequential therapy; compared to the latter, the shorter duration may represent an advantage.
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Affiliation(s)
- F Franceschi
- Internal Medicine Institute and Internal Medicine and Gastroenterology; Catholic University of the Scred heart, Rome, Italy.
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20
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Tito A, Bimonte M, Carola A, De Lucia A, Barbulova A, Tortora A, Colucci G, Apone F. An oil-soluble extract ofRubus idaeuscells enhances hydration and water homeostasis in skin cells. Int J Cosmet Sci 2015; 37:588-94. [DOI: 10.1111/ics.12236] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/13/2015] [Indexed: 01/24/2023]
Affiliation(s)
- A. Tito
- Arterra Bioscience srl; via B. Brin 69 Napoli Italy
| | - M. Bimonte
- Arterra Bioscience srl; via B. Brin 69 Napoli Italy
| | - A. Carola
- Arterra Bioscience srl; via B. Brin 69 Napoli Italy
| | - A. De Lucia
- Arterra Bioscience srl; via B. Brin 69 Napoli Italy
| | - A. Barbulova
- Arterra Bioscience srl; via B. Brin 69 Napoli Italy
| | - A. Tortora
- Arterra Bioscience srl; via B. Brin 69 Napoli Italy
| | - G. Colucci
- Arterra Bioscience srl; via B. Brin 69 Napoli Italy
- VitaLab srl; via B. Brin 69 Napoli Italy
| | - F. Apone
- Arterra Bioscience srl; via B. Brin 69 Napoli Italy
- VitaLab srl; via B. Brin 69 Napoli Italy
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21
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Ojetti V, Ianiro G, Tortora A, D'Angelo G, Di Rienzo TA, Bibbò S, Migneco A, Gasbarrini A. The effect of Lactobacillus reuteri supplementation in adults with chronic functional constipation: a randomized, double-blind, placebo-controlled trial. J Gastrointestin Liver Dis 2014; 23:387-91. [PMID: 25531996 DOI: 10.15403/jgld.2014.1121.234.elr] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS There is a growing interest for the use of probiotics for chronic constipation. A recent randomized controlled trial (RCT) showed a positive effect of Lactobacillus reuteri (L. reuteri) on bowel movement frequency in infants with chronic constipation. The aim of the present study was to evaluate the effects of L. reuteri in adult patients with functional constipation. METHODS A double-blind, placebo RCT was conducted in 40 adults (18M/22F, 35+/-15 years) affected by functional constipation according to the Rome III criteria. Patients were randomly assigned to receive a supplementation of L. reuteri (DSM 17938), or matching placebo for 4 weeks. The increase of bowel movements/week was the primary outcome, while the improvement of stool consistency was the secondary outcome. RESULTS At week 4, the mean increase in bowel movements/week was 2.6 (SD +/-1.14, 95% CI:1.6-3.6) in the L. reuteri group and 1.0 (SD+/-1. 95% CI:0.12-1.88) in the placebo group (p=0.046). At the end of the treatment, the mean bowel movements/week was 5.28+/-1.93 in the L. reuteri group and 3.89+/-1.79 in the placebo group. There was a not significant difference in the stool consistency between the two groups. CONCLUSIONS L. reuteri is more effective than the placebo in improving bowel movement frequency in adult patients with functional constipation as previously demonstrated in children, even if it seems to have no effect on stool consistency.
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Affiliation(s)
- Veronica Ojetti
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy.
| | - Gianluca Ianiro
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
| | - Annalisa Tortora
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
| | - Giovanna D'Angelo
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
| | | | - Stefano Bibbò
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
| | - Alessio Migneco
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
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22
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Franceschi F, Tortora A, Di Rienzo T, D’Angelo G, Ianiro G, Scaldaferri F, Gerardi V, Tesori V, Lopetuso LR, Gasbarrini A. Role of Helicobacter pylori infection on nutrition and metabolism. World J Gastroenterol 2014; 20:12809-12817. [PMID: 25278679 PMCID: PMC4177464 DOI: 10.3748/wjg.v20.i36.12809] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/12/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) is a gram-negative pathogen that is widespread all over the world, infecting more than 50% of the world’s population. It is etiologically associated with non-atrophic and atrophic gastritis, peptic ulcer and shows a deep association with primary gastric B-cell lymphoma and gastric adenocarcinoma. Recently, the medical research focused on the modification of the gastric environment induced by H. pylori infection, possibly affecting the absorption of nutrients and drugs as well as the production of hormones strongly implicated in the regulation of appetite and growth. Interestingly, the absorption of iron and vitamin B12 is impaired by H. pylori infection, while infected subjects have lower basal and fasting serum levels of ghrelin and higher concentration of leptin compared to controls. Since leptin is an anorexigenic hormone, and ghrelin stimulates powerfully the release of growth hormone in humans, H. pylori infection may finally induce growth retardation if acquired very early in the childhood and in malnourished children. This review is focused on the nutritional effects of H. pylori infection, such as the reduced bioavailability or the malabsorbption of essential nutrients, and of gastrointestinal hormones, as well as on the relationship between H. pylori and the metabolic syndrome.
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Abstract
While Helicobacter pylori infection was initially revealed to be associated only with some gastroduodenal diseases, further studies have shown its possible role in several extragastric diseases. For idiopathic thrombocytopenic purpura, sideropenic anemia, and vitamin B12 deficiency, the diagnosis of H. pylori infection is recommended, and there are many other conditions such as cardiovascular, neurological, dermatological, and respiratory diseases in which H. pylori may possibly play a role. Interestingly, a potential role has also been described for GI neoplastic diseases, including colorectal and pancreatic cancer. Different mechanisms of action have been proposed, ranging from the induction of a low grade inflammatory state to the occurrence of molecular mimicry mechanisms. This review summarizes the results of the most relevant studies published on this topic over the last year.
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Franceschi F, Scaldaferri F, Riccioni ME, Casagranda I, Forte E, Gerardi V, Cordischi C, Antonini S, Tortora A, Di Rienzo T, D'Angelo G, Merra G, Costamagna G, Zuccalà G, Gasbarrini A. Management of acute dyarrhea: current and future trends. Eur Rev Med Pharmacol Sci 2014; 18:2065-2069. [PMID: 25027348] [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: 06/03/2023]
Abstract
Acute diarrhea is a very common symptom, which may recognize different causes and is basically the expression of an altered homeostasis of the bowel, which overcame current classifications. When approaching patients with acute diarrhea, we should firstly check body temperature and vital parameters and secondly provide a general medical examination mainly focused on the abdomen, in order to exclude surgical causes of diarrhea, such as acute appendicitis, diverticulitis, intestinal occlusion and others. Another important aspect is the assessment of the level of hydration in order to provide the right amount of fluids. There is no current indication for the administration of loperamide in infectious diarrhea, but there is a strong rationale for new class of drugs, which may be defined as "mucous regenerators", such as gelatin tannate. Further studies are needed on this matter in order to test the effect of gelatin tannate in adult patients with acute diarrhea.
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Affiliation(s)
- F Franceschi
- Emergency Department; 1Internal Medicine and Gastroenterology and 2Digestive Endoscopy Department, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.
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25
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Fasano A, Bove F, Gabrielli M, Petracca M, Zocco MA, Ragazzoni E, Barbaro F, Piano C, Fortuna S, Tortora A, Di Giacopo R, Campanale M, Gigante G, Lauritano EC, Navarra P, Marconi S, Gasbarrini A, Bentivoglio AR. The role of small intestinal bacterial overgrowth in Parkinson's disease. Mov Disord 2013; 28:1241-9. [PMID: 23712625 DOI: 10.1002/mds.25522] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 03/29/2013] [Accepted: 04/09/2013] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease is associated with gastrointestinal motility abnormalities favoring the occurrence of local infections. The aim of this study was to investigate whether small intestinal bacterial overgrowth contributes to the pathophysiology of motor fluctuations. Thirty-three patients and 30 controls underwent glucose, lactulose, and urea breath tests to detect small intestinal bacterial overgrowth and Helicobacter pylori infection. Patients also underwent ultrasonography to evaluate gastric emptying. The clinical status and plasma concentration of levodopa were assessed after an acute drug challenge with a standard dose of levodopa, and motor complications were assessed by Unified Parkinson's Disease Rating Scale-IV and by 1-week diaries of motor conditions. Patients with small intestinal bacterial overgrowth were treated with rifaximin and were clinically and instrumentally reevaluated 1 and 6 months later. The prevalence of small intestinal bacterial overgrowth was significantly higher in patients than in controls (54.5% vs. 20.0%; P = .01), whereas the prevalence of Helicobacter pylori infection was not (33.3% vs. 26.7%). Compared with patients without any infection, the prevalence of unpredictable fluctuations was significantly higher in patients with both infections (8.3% vs. 87.5%; P = .008). Gastric half-emptying time was significantly longer in patients than in healthy controls but did not differ in patients based on their infective status. Compared with patients without isolated small intestinal bacterial overgrowth, patients with isolated small intestinal bacterial overgrowth had longer off time daily and more episodes of delayed-on and no-on. The eradication of small intestinal bacterial overgrowth resulted in improvement in motor fluctuations without affecting the pharmacokinetics of levodopa. The relapse rate of small intestinal bacterial overgrowth at 6 months was 43%. © 2013 Movement Disorder Society.
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Affiliation(s)
- Alfonso Fasano
- Department of Neurology, Catholic University of Sacred Heart, Gemelli University Hospital, Rome, Italy.
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Scarpellini E, Giorgio V, Gabrielli M, Filoni S, Vitale G, Tortora A, Ojetti V, Gigante G, Fundarò C, Gasbarrini A. Rifaximin treatment for small intestinal bacterial overgrowth in children with irritable bowel syndrome. Eur Rev Med Pharmacol Sci 2013; 17:1314-1320. [PMID: 23740443] [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: 06/02/2023]
Abstract
OBJECTIVES Aims of the study were to assess the effects of rifaximin treatment on small intestinal bacterial overgrowth (SIBO) prevalence and gastrointestinal symptoms. STUDY DESIGN Fifty (50) irritable bowel syndrome (IBS) children were consecutively enrolled. All subjects underwent lactulose hydrogen/methane breath test (LBT) to assess SIBO before and one month after the treatment with rifaximin 600 mg daily for one week. All IBS patients filled out a Visual Analogic Scale (VAS) to assess and score gastrointestinal symptoms (abdominal pain, constipation, diarrhoea, bloating, flatulence) at baseline and one month after treatment. RESULTS The prevalence of abnormal LBT in patients with IBS was 66% (33/50). LBT normalization rate was 64% (21/33). Compliance was excellent, and no relevant side-effects were observed during treatment. VAS score was significantly higher in IBS patients with abnormal LBT than SIBO negatives, and strongly improved after successful treatment. CONCLUSIONS Rifaximin was effective and safe in SIBO treatment and IBS symptoms improvement in childhood. Double blind placebo-controlled interventional studies are warranted to verify the real impact of SIBO on gastrointestinal symptoms in children with IBS.
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Affiliation(s)
- E Scarpellini
- Internal Medicine Department and Pediatric Department, School of Medicine, Catholic University of the Sacred Heart, Gemelli Hospital, Rome, Italy
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Abstract
Symbiosis is the result of the relationship between gut microbiota and human surfaces; in fact, it regulates many functions such as metabolic and protective ones. It is widely known that any changes in the microbes in gut microbiota (dysbiosis) and the regulation of mucosal and systemic host's immunity have been linked to different diseases such as metabolic syndromes and associated disorders. Recent studies report an aberrant gut microbiota and an alteration of gut microbial metabolic activities in obese subjects, with an important influence of a number of human physiological functions. Most studies suggest that diet, especially the high-fat low-fiber western-style diet, dramatically impacts on gut microbiota composition and functions in those patients with metabolic syndrome. A deeper knowledge of a specific microbiota profile associated with increased risk of metabolic disease and its subsequent modification induced by prebiotics, probiotics or targeted antibiotics will be necessary for the development of new therapeutic approaches in the treatment of metabolic disease.
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Affiliation(s)
- Francesca D'Aversa
- UOC Internal Medicine and Gastroenterology, Policlinico A. Gemelli, Catholic University of Rome, Rome, Italy.
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Purchiaroni F, Tortora A, Gabrielli M, Bertucci F, Gigante G, Ianiro G, Ojetti V, Scarpellini E, Gasbarrini A. The role of intestinal microbiota and the immune system. Eur Rev Med Pharmacol Sci 2013; 17:323-333. [PMID: 23426535] [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: 06/01/2023]
Abstract
BACKGROUND The human gut is an ecosystem consisting of a great number of commensal bacteria living in symbiosis with the host. Several data confirm that gut microbiota is engaged in a dynamic interaction with the intestinal innate and adaptive immune system, affecting different aspects of its development and function. AIM To review the immunological functions of gut microbiota and improve knowledge of its therapeutic implications for several intestinal and extra-intestinal diseases associated to dysregulation of the immune system. METHODS Significant articles were identified by literature search and selected based on content, including atopic diseases, inflammatory bowel diseases and treatment of these conditions with probiotics. RESULTS Accumulating evidence indicates that intestinal microflora has protective, metabolic, trophic and immunological functions and is able to establish a "cross-talk" with the immune component of mucosal immunity, comprising cellular and soluble elements. When one or more steps in this fine interaction fail, autoimmune or auto-inflammatory diseases may occur. Furthermore, it results from the data that probiotics, used for the treatment of the diseases caused by the dysregulation of the immune system, can have a beneficial effect by different mechanisms. CONCLUSIONS Gut microbiota interacts with both innate and adaptive immune system, playing a pivotal role in maintenance and disruption of gut immune quiescence. A cross talk between the mucosal immune system and endogenous microflora favours a mutual growth, survival and inflammatory control of the intestinal ecosystem. Based on these evidences, probiotics can be used as an ecological therapy in the treatment of immune diseases.
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Affiliation(s)
- F Purchiaroni
- Department of Internal Medicine, School of Medicine, Catholic University of the Sacred Heart, Gemelli Hospital, Rome, Italy.
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Di Rienzo TA, D'Angelo G, Ojetti V, Campanale MC, Tortora A, Cesario V, Zuccalà G, Franceschi F. 13C-Urea breath test for the diagnosis of Helicobacter pylori infection. Eur Rev Med Pharmacol Sci 2013; 17 Suppl 2:51-58. [PMID: 24443069] [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: 06/03/2023]
Abstract
Helicobacter pylori (H. pylori) is a Gram-negative bacterium able to colonize the gastric mucosa as well as gastric metaplastic areas of the duodenum, producing inflammation. The clinical outcome depends on sophisticated interactions between bacterial factors, such as the expression of determinants of virulence and pathogenicity, and host characteristics. The severity of inflammation, may then vary among different subjects, leading to the occurrence of different gastroduodenal diseases, ranging from chronic gastritis to gastric cancer and MALT-lymphoma, to some defined extragastric manifestations. Many diagnostic tests are available for the detection of H. pylori infection including noninvasive methods, such as serology, (13)C-urea breath test (UBT), and fecal antigen tests and invasive techniques, including a combined use of endoscopic biopsy-based methods, such as rapid urease testing, histology, culture, and molecular methods. UBT is a highly sensitive and specific and allows to diagnose the presence or absence of infection of H. pylori, through the oral administration of a solution containing urea labelled with the non-radioactive natural carbon 13. This review article analyzes microbiological and clinical features of H. pylori as well as the different diagnostic tests able to detect this bacterium with a special focus on UBT.
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Affiliation(s)
- T A Di Rienzo
- Internal Medicine and Gastroenterology, Catholic University of the Sacred Heart, Rome, Italy.
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30
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Scarpellini E, Cafarotti S, Cesario A, Lococo F, Margaritora S, Gabrielli M, Tortora A, Gasbarrini A, Granone P. A case of vomiting in an anorexic achalasic patient. Eur Rev Med Pharmacol Sci 2012; 16 Suppl 4:44-47. [PMID: 23090806] [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: 06/01/2023]
Abstract
Wernicke's encephalopathy is a neurological disorder caused by thiamine (vitamin B1) deficiency characterized by vertigo, ataxia, and mental confusion. Wernicke's encephalopathy has a causative association with alcoholism but recently there has been an increased prevalence also in other clinical conditions. In literature potentially fatal Wernicke's encephalopathy onset in an advanced achalasia has been previously reported only once. We describe for the first time an improvement of achalasic symptoms in a young patient affected by end-stage achalasia and anorexia nervosa (coming from ineffective Heller-Dor myotomy) after vitamin B1 supplementation. This case report suggest a potential positive impact of B1 supplementation on end-stage achalasic patients and requires systematic studies to confirm this observation.
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Affiliation(s)
- E Scarpellini
- Internal Medicine Department, Catholic University of the Sacred Heart, Rome, Italy
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31
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Rinninella E, Zocco MA, De Gaetano A, Iezzi R, Campanale M, Cesario V, Barbaro F, Ponziani FR, Caracciolo G, Triarico S, Tortora A, Ianiro G, Gasbarrini A. From small nodule to overt HCC: a multistep process of carcinogenesis as seen during surveillance. Eur Rev Med Pharmacol Sci 2012; 16:1292-1294. [PMID: 23047515] [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: 06/01/2023]
Abstract
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death in the world. Despite many diagnostic and therapeutic tools are now available to improve survival and reduce its recurrence, prognosis is closely conditioned by the time of diagnosis. Surveillance and early diagnosis are crucial for a successful therapy. We report a clinical case from the HCC archive of the Hepatocatt meetings held in Ge-melli Hospital (Catholic University of Rome). The case describes a tumor progression in a multistep process from a small liver nodule to overt HCC and its management by a multidisciplinary team.
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Affiliation(s)
- E Rinninella
- Department of Internal Medicine and Gastroenterology, Catholic University of the Sacred Heart, Rome, Italy.
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Gigante G, Tortora A, Ianiro G, Ojetti V, Purchiaroni F, Campanale M, Cesario V, Scarpellini E, Gasbarrini A. Role of gut microbiota in food tolerance and allergies. Dig Dis 2011; 29:540-9. [PMID: 22179209 DOI: 10.1159/000332977] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Alterations of commensal flora may cause various gastrointestinal and extraintestinal diseases, including food intolerances and food allergies. According to the 'microflora hypothesis', alterations in the composition of gut microbiota in industrialized countries have disturbed the mechanisms of mucosal immune tolerance. Over the past few years several studies have looked for a role for probiotics in the treatment of food allergies with promising results.
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Affiliation(s)
- Giovanni Gigante
- Internal Medicine Department, Catholic University of Sacred Heart, Gemelli Hospital, Rome, Italy
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Ponziani F, Ojetti V, Tortora A, Di Maurizio L, Purchiaroni F, Gasbarrini A. The metabolic and toxicological considerations for mTOR inhibitors in the treatment of hepatocarcinoma. Expert Opin Drug Metab Toxicol 2011; 7:1535-46. [PMID: 22032293 DOI: 10.1517/17425255.2011.631911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is a major health problem worldwide. Several molecular pathways involved in HCC growth and progression have recently been identified. Rapamycin analogs are able to inhibit one of the most active oncogenic molecular pathways in HCC cells: the mammalian target of rapamycin (mTOR) pathway. AREAS COVERED In this review, the authors analyze the principal molecular features of the mTOR pathway and the use of rapamycin analogs in the treatment of hepatocarcinoma. The article also looks at the reoccurrence of HCC following liver transplantation as well as after the treatment of de novo neoplasms. Finally, the authors discuss the advantage of using a combined HCC pharmacological therapy to obtain a synergistic effect on tumor mass. EXPERT OPINION Among the available options for the treatment of advanced-stage HCC, mTOR pathway inhibitors show great promise. Once these agents have their safety and efficacy confirmed, in the treatment of liver disease, their use should be considered in patients affected by HCC. This should especially be the case for those who have had liver transplants or suffered with de novo tumors. Moreover, the authors believe that mTOR inhibitors could be used in a combined pharmacological approach to improve HCC molecular-targeted therapy by producing a multiple-level block of tumor intracellular signaling.
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Affiliation(s)
- Francesca Ponziani
- Catholic University of Sacred Heart, Gemelli Hospital, Largo A. Gemelli, 8 Rome 00168, Italy
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Ponziani FR, Zocco MA, Tortora A, Gasbarrini G, Gasbarrini A. Anticoagulants in cirrhotic patients: controversies and certainties in PVT management. Cardiovasc Hematol Agents Med Chem 2011; 9:183-189. [PMID: 21827387 DOI: 10.2174/187152511797037448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 05/25/2011] [Accepted: 07/07/2011] [Indexed: 05/31/2023]
Abstract
Portal vein thrombosis (PVT) is a relatively common event in patients with advanced-stage liver cirrhosis, even in patients with a compensated disease. Because of the protean clinical manifestation of PVT, ranging from massive variceal bleeding and mesenteric infarction to the complete absence of any symptom, it is mandatory to provide an early diagnosis and a prompt management. However, even if various treatments have been tested in clinical studies, most of them can be suitable only for a limited number of patients and anticoagulants are recognized as the gold standard, even if the debate about their use in PVT management in cirrhotic patients is still opened. In particular, "old" and "new" generations of anticoagulants have always been used carefully and, sometimes, with skepticism or diffidence in cirrhotic patients. In this review, we report the rationale of anticoagulants use in PVT cirrhotic patients management, analyzing the most accepted controversies and certainties, with a particular attention to their possible role as preemptive therapy.
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Gasbarrini A, Scarpellini E, Gabrielli M, Tortora A, Purchiaroni F, Ojetti V. Clinical predictors of small intestinal bacterial overgrowth by duodenal aspirate culture. Aliment Pharmacol Ther 2011; 33:1378-9; author reply 1379-80. [PMID: 21569063 DOI: 10.1111/j.1365-2036.2011.04657.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 12/24/2022]
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Zocco MA, Piscaglia AC, Giuliante F, Arena V, Novi M, Rinninella E, Tortora A, Rumi C, Nuzzo G, Vecchio FM, Bombardieri G, Gasbarrini A. CD133+ stem cell mobilization after partial hepatectomy depends on resection extent and underlying disease. Dig Liver Dis 2011; 43:147-54. [PMID: 20688587 DOI: 10.1016/j.dld.2010.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 06/06/2010] [Accepted: 06/20/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bone marrow stem cells (BMSC) can participate to liver regeneration. However, conflicting results have been reported on this topic in patients undergoing liver resection. AIMS To assess the impact of liver resection extent and presence of underlying liver disease in modulating BMSC mobilization. METHODS We enrolled 29 patients undergoing liver resection of different extents, 5 surgical controls and 10 blood donors. Circulating CD133+ BMSC were measured by flow cytometry at different time-points after surgery. The hepatic commitment of mobilized BMSC was investigated by polymerase chain reaction. Liver specimens were collected during surgery for histopathological analysis. Hepatocyte growth factor and granulocyte-colony stimulating factor serum levels were measured by enzyme-linked immunosorbent assay. RESULTS BMSC mobilization was found in patients undergoing major liver resection, especially in the presence of underlying disease. Ductular reactions were noted in patients with chronic hepatopathy and the hepatic progenitor-like cells expressed CD133, NCAM, cytokeratin-19, and alpha-fetoprotein. Hepatocyte growth factor and granulocyte-colony stimulating factor levels increased following liver resection and the contemporaneous presence of liver disease was associated with their highest raise. CONCLUSIONS Liver repair is mainly an endogenous process. BMSC become important in case of extensive resection, especially in the presence of underlying hepatopathy and hepatic progenitor-like cells activation. Hepatocyte growth factor and granulocyte-colony stimulating factor seem to be involved in the dynamics underlying hepatic regeneration and BMSC recruitment.
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Consolo P, Luigiano C, Pellicano R, Ferrara F, Giacobbe G, Morace C, Pallio S, Tortora A, Melita G, Bassi M, D'Imperio N, Alibrandi A, Familiari L. Endoscopic resection as a safe and effective technique for treatment of pedunculated and non-pedunculated benign-appearing colorectal neoplasms measuring 40 mm or more in size. Minerva Med 2010; 101:311-318. [PMID: 21048553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The aim of this paper was to evaluate the outcome of endoscopic resection (ER) for pedunculated and non-pedunculated colorectal neoplasms exceeding 4 cm in size. METHODS All patients with a colorectal neoplasms measuring 4 cm or more, who underwent ER at our institution between January 1996 and December 2008 were included in the study. RESULTS In the study period, 67 ERs were carried out in 67 patients with a mean (±SD) age of 72±11 years. The mean neoplasms size was 48.2±12.5 mm. There were 32 sessile, 26 flat and 9 pedunculated neoplasms. The most frequent location (49.3%) was rectum. No perforation occurred, there were 4 procedural and 2 delayed bleeding, treated endoscopically, and 3 cases of transmural burn syndrome, managed conservatively. Pathologic examination showed 18 low-grade dysplasia, 43 high-grade dysplasia, 3 intramucosal and 3 invasive cancer. The most frequent type of neoplasm was villous adenoma (76.1%). The presence of malignancy was related to villous histology (P=0.005) and to age ≥ 80 of patients (P=0.04). RESULTS During endoscopic follow-up (49.4± 26.3 months) recurrence was found in 25.8% of lesions (11 sessile and 4 flat), always treated endoscopically. Recurrence was more likely in patients with lesions larger than 60 mm (P=0.04). The three patients with invasive cancer did not undergo surgery, because of advanced age and/or severe extracolonic diseases. During follow-up no local recurrence or metastasis was found. CONCLUSION ER is a safe and effective procedure for removing benign appearing very large colorectal neoplasms.
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Affiliation(s)
- P Consolo
- Department of Medicine and Pharmacology, University of Messina, Messina, Italy
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Ponziani FR, Zocco MA, Tortora A, Gasbarrini A. Is there a role for anticoagulants in portal vein thrombosis management in cirrhotic patients? Expert Opin Pharmacother 2010; 11:1479-87. [PMID: 20446862 DOI: 10.1517/14656561003749264] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE OF THE FIELD Portal vein thrombosis (PVT) is one of the principal complications of liver cirrhosis. The estimated prevalence is < 1% in patients with a compensated disease; this increases to 8 - 25% in candidates for liver transplantation. Many determinants may influence PVT clinical presentation and its outcome. AREAS COVERED IN THIS REVIEW We report the actual knowledge regarding management of PVT and analyze the different therapeutic approaches, focusing particularly on the use of anticoagulants and their implications in the complex clinical setting of liver cirrhosis. We also describe the possible available preemptive strategies, as an early prophylactic management based on clinical, biochemical or radiological parameters may in the future reduce PVT incidence and complications, ameliorating patients' outcome. WHAT THE READER WILL GAIN The importance of an accurate PVT diagnosis and its implications in PVT management; a description of the different available therapeutic tools, their efficacy and their possible risks in different typologies of patients; the principal elements to choose a correct individualized therapy for PVT patients. TAKE HOME MESSAGE The challenge for clinicians is the early identification of PVT, in order to prevent frightening complications, such as variceal bleeding or mesenteric infarction, and to provide the best therapeutic management.
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Affiliation(s)
- Francesca Romana Ponziani
- Catholic University of Rome, Department of Internal Medicine, Largo A. Gemelli 8, 00168 Rome, Italy.
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Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Maurizio LD, Bombardieri G, Cristofaro RD, Gaetano AMD, Landolfi R, Gasbarrini A. Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment. World J Gastroenterol 2010; 16:143-55. [PMID: 20066733 PMCID: PMC2806552 DOI: 10.3748/wjg.v16.i2.143] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but might also occur in absence of an overt liver disease. Several causes, either local or systemic, might play an important role in PVT pathogenesis. Frequently, more than one risk factor could be identified; however, occasionally no single factor is discernable. Clinical examination, laboratory investigations, and imaging are helpful to provide a quick diagnosis, as prompt treatment might greatly affect a patient’s outcome. In this review, we analyze the physiopathological mechanisms of PVT development, together with the hemodynamic and functional alterations related to this condition. Moreover, we describe the principal factors most frequently involved in PVT development and the recent knowledge concerning diagnostic and therapeutic procedures. Finally, we analyze the implications of PVT in the setting of liver transplantation and its possible influence on patients’ future prognoses.
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Lanciotti S, Tortora A, Bertini L, Casciani E, Polettini E, Gualdi GF. [Role of imaging in the evaluation and characterization of adrenal masses]. Clin Ter 2010; 161:e129-e135. [PMID: 20589346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The primary role of imaging in identification as well as in characterization adrenal lesions has been demonstrated by several studies. The recent technologic progress has allowed to identify adrenal lesions even when they are very small, with a consequent conspicuous increase of the frequency of incidentalomas. Computed Tomography, Magnetic Resonance and Nuclear Medicine are routinely used to evaluate adrenal glands and their pathologic conditions. The aim of this article is to show how the imaging is employed to assess adrenal masses, with special regard to the contribution given by Computed Tomography (CT) and Magnetic Resonance (MR) imaging to the differential diagnosis between benignant and malignant lesions.
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Affiliation(s)
- S Lanciotti
- Radiologia DEA, Az. Policlinico Umberto I, Università La Sapienza di Roma, Italia
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Dobosz S, Stabile H, Tortora A, Monot P, Réau F, Bougeard M, Merdji H, Carré B, Martin P, Joyeux D, Phalippou D, Delmotte F, Gautier J, Mercier R. Internal frequency conversion extreme ultraviolet interferometer using mutual coherence properties of two high-order-harmonic sources. Rev Sci Instrum 2009; 80:113102. [PMID: 19947712 DOI: 10.1063/1.3257676] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report on an innovative two-dimensional imaging extreme ultraviolet (XUV) interferometer operating at 32 nm based on the mutual coherence of two laser high order harmonics (HOH) sources, separately generated in gas. We give the first evidence that the two mutually coherent HOH sources can be produced in two independent spatially separated gas jets, allowing for probing centimeter-sized objects. A magnification factor of 10 leads to a micron resolution associated with a subpicosecond temporal resolution. Single shot interferograms with a fringe visibility better than 30% are routinely produced. As a test of the XUV interferometer, we measure a maximum electronic density of 3x10(20) cm(-3) 1.1 ns after the creation of a plasma on aluminum target.
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Affiliation(s)
- S Dobosz
- CEA, IRAMIS, Service des Photons Atomes et Molécules, F-91191 Gif- sur-Yvette, France.
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42
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Luigiano C, Consolo P, Scaffidi MG, Strangio G, Giacobbe G, Alibrandi A, Pallio S, Tortora A, Melita G, Familiari L. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy 2009; 41:829-35. [PMID: 19750448 DOI: 10.1055/s-0029-1215091] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS This study examines efficacy, outcome, and complications of endoscopic mucosal resection (EMR) for large (> or = 20 mm) and giant (> or = 40 mm) sessile and flat colorectal polyps. PATIENTS AND METHODS All EMRs carried out at our institution over a 9-year period, for large and giant sessile and flat colorectal polyps with an intensive and regular follow-up were evaluated. The rate of en bloc and piecemeal resection, complications, and recurrence were analyzed. RESULTS A total of 148 polyps were resected in 148 patients. There were 113 large polyps (76.3 %) with a mean size of 25 +/- 4.7 mm (range 20 - 39 mm) and 35 giant polyps (23.7 %) with a mean size of 48.8 +/- 12.5 mm (range 40 - 100 mm). The most frequent location was the rectum, occurring in 43.2 %. All lesions were removed in a single session. En bloc resection was performed in 65 cases (43.9 %) and piecemeal in 83 (56.1 %). Procedural bleeding occurred in 13 EMRs (8.8 %), and one case of early and one case of delayed bleeding also occurred. There were two cases of postpolypectomy syndrome and one case of perforation. Malignancy (intramucosal and invasive cancer) was mostly present in polyps with sessile shape ( P = 0.0013). Follow-up colonoscopy was performed in 142 patients for a mean of 29.8 months. Recurrence was observed in 6/142 (4.2 %) patients and was found more in patients with giant polyps ( P = 0.014). CONCLUSIONS In our experience EMR is a simple and safe procedure for removing large and giant sessile and flat colorectal polyps, and is associated with a very low risk of complication and local recurrence.
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Affiliation(s)
- C Luigiano
- Department of Medicine and Pharmacology, University Hospital G. Martino, Messina 98100, Italy.
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Colaiacomo MC, Tortora A, Di Biasi C, Polettini E, Casciani E, Gualdi GF. [Intervertebral instability]. Clin Ter 2009; 160:e75-e82. [PMID: 20198280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The clinic diagnosis of degenerative lumbar intervertebral instability is a controversial topic and have not yet been clarified clinical criteria for to define this condition with accuracy. Although the lumbar pain is the most common symptom in patients who have lumbar intervertebral instability its clinical presentation is not specific; moreover in patients with lumbar pain there are no agreed signs and symptoms that can be truly attributable to instability. Despite better imaging techniques of testing spinal instability there is not a clear relations between radiologic signs of instability and clinical symptoms. It is, however, still far from unanimous definition of degenerative lumbar intervertebral instability accepted from all specialists involved in diagnosis and treatment of this condition; however, seem there is most agree about suspected vertebral instability. Nevertheless this unresolved topic, it is possible to state that imaging play an increasing role in diagnosis and management of patients with suspected instability. The aim of this study is to investigate the different imaging modalities most indicated in diagnosis if vertebral instability and whether degenerative change can be associated with lower back pain.
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Affiliation(s)
- M C Colaiacomo
- Radiologia DEA, Az. Policlinico Umberto I, Università Sapienza, Roma, Italia
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Vitiello M, D'Isanto M, Galdiero M, Raieta K, Tortora A, Rotondo P, Peluso L, Galdiero M. Interleukin-8 production by THP-1 cells stimulated by Salmonella enterica serovar Typhimurium porins is mediated by AP-1, NF-κB and MAPK pathways. Cytokine 2004; 27:15-24. [PMID: 15207247 DOI: 10.1016/j.cyto.2004.03.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2003] [Revised: 02/16/2004] [Accepted: 03/16/2004] [Indexed: 11/30/2022]
Abstract
Interleukin-8 (IL-8) is released in response to inflammatory stimuli, such as bacterial products. Either porins or lipopolysaccharide (LPS) stimulated THP-1 cells to release IL-8 after 24 h. We have previously reported that stimulation of monocytic cells with Salmonella enterica serovar Typhimurium porins led to the activation of mitogen-activated protein kinase cascades and of protein tyrosine kinases (PTKs). In this report, we demonstrate, using two potent and selective inhibitors of MEK activation by Raf-1 (PD-098059) and p38 (SB-203580), that both ERK1/2 and p38 pathways play a key role in the production of IL-8 by porins and LPS. Porin-stimulated expression of activating protein 1 (AP-1) and correlated IL-8 release is also inhibited by PD-098059 or SB-203580 indicating that the Raf-1/MEK1-MEK2/MAPK cascade is required for their activation. Also PTKs modulate the pathway that control IL-8 gene expression, in fact its expression is abolished by tyrphostin. By using N-acetyl-leucinyl-leucinyl-norleucinal-H (ALLN) an inhibitor of nuclear factor-kappaB (NF-kappaB) activity, we also observed IL-8 release modulation. Our results elucidate some of the molecular mechanisms by which AP-1 and NF-kappaB regulate IL-8 release and open new strategies for the design of specific molecules that will modulate IL-8 effects in various infectious diseases.
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Affiliation(s)
- M Vitiello
- Dipartimento di Patologia Generale, Facoltà di Medicina e Chirurgia, Seconda Università di Napoli, 80138 Naples, Italy
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Galdiero M, Tortora A, Damiano N, Vitiello M, Longanella A, Galdiero E. Induction of cytokine mRNA expression in U937 cells by Salmonella typhimurium porins is regulated by different phosphorylation pathways. Med Microbiol Immunol 2003; 194:13-23. [PMID: 14628144 DOI: 10.1007/s00430-003-0209-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lipopolysaccharide (LPS) and porins of Gram-negative outer membranes are the main pathogenic factors implicated in the clinical syndrome of septic shock. The biological activity of porins and LPS are similar, but they occur by different mechanisms. It seems that porins act through different intracellular pathways with respect to LPS. In this study we analyzed the role of several inhibitors of the MEK/ERK signal pathway on the induction of proinflammatory and immunological cytokines in U937 cell line stimulated by Salmonella typhimurium porins and compared it to the cytokine induction after LPS stimulation. We investigated the effects of p38 MAP kinase inhibitor SB-203580, MEK/ERK kinase inhibitor PD-098059 and Raf-1 inhibitor forskolin, and demonstrated that they modulate cytokine mRNA expression in a different manner as a consequence of the use of porins or LPS as stimuli. TNF-alpha and IL-1beta mRNA expression is decreased by PD-098059 after stimulation with LPS but not with porins in differentiated U937 cells. IL-10 mRNA expression is inhibited by SB-203580 and PD-098059 after stimulation with porins in U937 cells. IL-6 and IL-8 mRNA expression is not changed by PD-098059 or SB-203580, after stimulation either with porins or LPS. Furthermore, mRNA expression of the studied cytokines, except for GM-CSF, is not changed using forskolin.
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Affiliation(s)
- Marilena Galdiero
- Dipartimento di Medicina Sperimentale, Facoltà di Medicina e Chirurgia, Seconda Università degli Studi di Napoli, via De Crecchio, Napoli, Italy.
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Barbuscia M, Dattola P, Di Pietro N, Pallio S, Tortora A, Melita G, Romeo C, Iannacci A, Punturieri L. [Preoperative staging of colorectal neoplasms: importance of the echo-endoscopy]. Chir Ital 2003; 49:43-8. [PMID: 12743875] [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: 03/02/2023]
Abstract
The A. A., after having confirmed how the timely diagnosis of cancer of the Sigma-Rectum section is the result a complicated and articulate diagnostic iter, describe the advantages of using the ultrasonography-endoscopy. Therefore they relate their experience, comparing the outcome of this research with that of the TC images and above all with the histo-pathological surveys on the removed sechions. They conclude affirming that a higher percentage of the diagnostic care is a clear evolution in the correct pre-operating stage of these neoplasias.
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Affiliation(s)
- M Barbuscia
- Cattedra di Chirurgia dell'Apparato Digerente, Università degli Studi di Messina
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Ingordo V, D'Andria G, D'Andria C, Tortora A. Results of atopy patch tests with house dust mites in adults with 'intrinsic' and'extrinsic' atopic dermatitis. J Eur Acad Dermatol Venereol 2002; 16:450-4. [PMID: 12428836 DOI: 10.1046/j.1468-3083.2002.00525.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [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]
Abstract
BACKGROUND The most frequently employed diagnostic criteria of atopic dermatitis (AD) can be fulfilled in the absence of elevated total circulating IgE or specific IgE to food allergens or environmental aeroallergens and/or in the absence of personal or familial history of atopy as well. Therefore a distinction between 'extrinsic' or 'allergic' and 'intrinsic' or 'non-allergic' AD has been suggested. Recently, a patch test with environmental aeroallergens, named atopy patch test (APT), has been proposed for use in the study of AD. OBJECTIVE The aim of this study was to investigate the reactivity to APT in patients with 'extrinsic' and 'intrinsic' AD. PATIENTS, MATERIALS AND METHODS Two groups of adult male subjects with AD were examined consecutively in our department (Department of Dermatology, Italian Navy Main Hospital, Taranto, Italy) andpatch tested with whole bodies of house dust mites (HDM) at a concentration of 20% in petrolatum (Dermatophagoides pteronyssinus 50%, D. farinae 50%). The groups included: (i) 95 patients affected by the adult clinical form of 'extrinsic' AD; (ii) 12 patients affected by the adult clinical form of 'intrinsic' AD; and (iii) a control group of 49 adult healthy male subjects with a negative anamnesis for eczema and atopy and negative skin prick test to aeroallergens/food allergens and/or normal level of total circulating IgE, also patch tested with the same allergen. The statistical differences were calculated by chi2 test and 95% confidence intervals (CI) were provided. RESULTS The APT was positive in 47.4% (CI: 37-57%) of'extrinsic'AD, in 66.6% (CI: 41-93%) of'intrinsic' AD and in 12.2% (CI: 3-21%) of healthy subjects. The differences between the two AD subgroups and the control group were statistically significant (P < 0.001). CONCLUSIONS APT positivity is more frequent in both 'extrinsic' and 'intrinsic' AD than in unaffected subjects. Other studies are needed to confirm our data and to explain why the APT is positive in the 'intrinsic' form.
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Affiliation(s)
- V Ingordo
- Department of Dermatology, Italian Navy Main Hospital M.O. Giulio Venticinque Taranto.
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Wang X, Amoruso S, Bruzzese R, Spinelli N, Tortora A, Velotta R, Ferdeghini C, Grassano G, Ramadan W. Optical spectroscopy diagnostics and thin film deposition of laser ablated rare earth–Ni2B2C plasma plumes. Chem Phys Lett 2002. [DOI: 10.1016/s0009-2614(01)01482-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Galdiero M, Vitiello M, Sanzari E, D'Isanto M, Tortora A, Longanella A, Galdiero S. Porins from Salmonella enterica serovar Typhimurium activate the transcription factors activating protein 1 and NF-kappaB through the Raf-1-mitogen-activated protein kinase cascade. Infect Immun 2002; 70:558-68. [PMID: 11796583 PMCID: PMC127694 DOI: 10.1128/iai.70.2.558-568.2002] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [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
In this study we examined the ability of Salmonella enterica serovar Typhimurium porins to activate activating protein 1 (AP-1) and nuclear factor kappaB (NF-kappaB) through the mitogen-activated protein kinase (MAPK) cascade, and we identified the AP-1-induced protein subunits. Our results demonstrate that these enzymes may participate in cell signaling pathways leading to AP-1 and NF-kappaB activation following porin stimulation of cells. Raf-1 was phosphorylated in response to the treatment of U937 cells with porins; moreover, the porin-mediated increase in Raf-1 phosphorylation is accompanied by the phosphorylation of MAPK kinase 1/2 (MEK1/2), p38, extracellular-signal-regulated kinase 1/2, and c-Jun N-terminal kinase. We used three different inhibitors of phosphorylation pathways: 2'-amino-3'-methoxyflavone (PD-098059), a selective inhibitor of MEK1 activator and the MAPK cascade; 4-(4-fluorophenyl)-2-(4-methylsulfinylphenyl)-5-(4-pyridyl)1H-imidazole (SB203580), a specific inhibitor of the p38 pathway; and 7beta-acetoxy-1alpha,6beta,9alpha-trihydroxy-8,13-epoxy-labd-14-en-11-one (forskolin), an inhibitor at the level of Raf-1 kinase. PD-098059 pretreatment of cells decreases AP-1 and NF-kappaB activation by lipopolysaccharide (LPS) but not by porins, and SB203580 pretreatment of cells decreases mainly AP-1 and NF-kappaB activation by porins; in contrast, forskolin pretreatment of cells does not affect AP-1 and NF-kappaB activation following either porin or LPS stimulation. Our data suggest that the p38 signaling pathway mainly regulates AP-1 and NF-kappaB activation in cells treated with S. enterica serovar Typhimurium porins. Antibody electrophoretic mobility shift assays showed that JunD and c-Fos binding is found in cells treated with porins, in cells treated with LPS, and in unstimulated cells. However, by 30 to 60 min of stimulation, a different complex including c-Jun appears in cells treated with porins or LPS, while the Fra-2 subunit is present only after porin stimulation. These data suggest different molecular mechanisms of activation induced by porins or by LPS.
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Affiliation(s)
- Massimiliano Galdiero
- Istituto di Microbiologia, Facoltà di Medicina e Chirurgia, Seconda Università degli Studi di Napoli, 80138 Naples, Italy.
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Catanoso M, Lo Gullo R, Giofré MR, Pallio S, Tortora A, Lo Presti M, Frisina N, Bagnato G, Fries W. Gastro-intestinal permeability is increased in patients with limited systemic sclerosis. Scand J Rheumatol 2001; 30:77-81. [PMID: 11324793 DOI: 10.1080/03009740151095303] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 12/28/2022]
Abstract
OBJECTIVE to evaluate gastro-intestinal (GI) permeability in patients with limited systemic sclerosis (LSS) at baseline and after oral acetylsalicylic acid (ASA). METHODS 13 patients with LSS and 10 controls were studied. Baseline GI permeability was assessed with orally administered sucrose, mannitol, and lactulose. Gastric lesions and Helicobacter status were investigated by endoscopy. In 5 patients and 6 controls (with normal baseline permeability) the GI permeability response was assessed after oral ASA. RESULTS compared with controls, gastric (p<0.05) and intestinal (p<0.02) permeability was higher in LSS patients, at baseline. After oral ASA gastric permeability (sucrose) increased in both groups (controls: 186%, LSS: 265%), whereas the lactulose/mannitol ratio raised significantly only in LSS (+31% and +148%; p<0.05 vs controls). CONCLUSIONS baseline permeability is altered in LSS; the exaggerated response of the small intestine to ASA may represent a genetically determined or a disease-related dysfunction of the mucosal barrier.
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Affiliation(s)
- M Catanoso
- Dipartimento di Medicina Interna e Terapia Medica, Policlinico Universitario, Università di Messina, Italy
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