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Zagari RM, Frazzoni L, Fuccio L, Bertani H, Crinò SF, Magarotto A, Dajti E, Tringali A, Da Massa Carrara P, Cengia G, Ciliberto E, Conigliaro R, Germanà B, Lamazza A, Pisani A, Spinzi G, Capelli M, Bazzoli F, Pasquale L. Corrigendum: Adherence to European society of gastrointestinal endoscopy quality performance measures for upper and lower gastrointestinal endoscopy: a nationwide survey from the Italian society of digestive endoscopy. Front Med (Lausanne) 2024; 11:1406746. [PMID: 38654831 PMCID: PMC11037098 DOI: 10.3389/fmed.2024.1406746] [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: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fmed.2022.868449.].
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Affiliation(s)
- Rocco Maurizio Zagari
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Leonardo Frazzoni
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Helga Bertani
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Andrea Magarotto
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elton Dajti
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Enrico Ciliberto
- Gastroenterology and Digestive Endoscopy Unit, S. Giovanni di Dio Hospital, Crotone, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Baggiovara University Hospital, Baggiovara, Italy
| | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, S. Martino Hospital, Belluno, Italy
| | - Antonietta Lamazza
- Department of Surgery “Pietro Valdoni”, University La Sapienza, Rome, Italy
| | - Antonio Pisani
- National Institute of Gastroenterology IRCCS Saverio de Bellis, Castellana Grotte, Bari, Italy
| | - Giancarlo Spinzi
- Gastroenterology and Endoscopy Department, Valduce Hospital, Como, Italy
| | - Maurizio Capelli
- Kiwa Cermet Certification Body, Statistical Department, Bologna, Italy
| | - Franco Bazzoli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luigi Pasquale
- UOC Gastroenterologia ed Endoscopia Digestiva, Ospedale Frangipane, Avellino, Italy
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Zorzi M, Battagello J, Amidei CB, Antonelli G, Germanà B, Valiante F, Benvenuti S, Tringali A, Bortoluzzi F, Cervellin E, Giacomin D, Meggiato T, Rizzotto ER, Fregonese D, Dinca M, Baldassarre G, Scalon P, Pantalena M, Milan L, Bulighin G, Di Piramo D, Azzurro M, Gabbrielli A, Repici A, Rugge M, Hassan C. Low Colorectal Cancer Risk After Resection of High-Risk Pedunculated Polyps. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00105-8. [PMID: 38325601 DOI: 10.1016/j.cgh.2024.01.027] [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: 07/18/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Post-fecal immunochemical test (FIT) colonoscopy represents a setting with an enriched prevalence of advanced adenomas. Due to an expected higher risk of colorectal cancer (CRC), postpolypectomy surveillance is recommended, generating a substantially increased load on endoscopy services. The aim of our study was to investigate postpolypectomy CRC risk in a screening population of FIT+ subjects after resection of low-risk adenomas (LRAs) or high-risk adenomas (HRAs). METHODS We retrieved data from a cohort of patients undergoing postpolypectomy surveillance within a FIT-based CRC screening program in Italy between 2002 and 2017 and followed-up to December 2021. Main outcomes were postpolypectomy CRC incidence and mortality risks according to type of adenoma (LRA/HRA) removed at colonoscopy as well as morphology, size, dysplasia, and location of the index lesion. We adopted as comparators FIT+/colonoscopy-negative and FIT- patients. The absolute risk was calculated as the number of incident CRCs per 100,000 person-years of follow-up. We used Cox multivariable regression models to identify associations between CRC risks and patient- and polyp-related variables. RESULTS Overall, we included 87,248 post-FIT+ colonoscopies (133 endoscopists). Of these, 42,899 (49.2%) were negative, 21,650 (24.8%) had an LRA, and 22,709 (26.0%) an HRA. After a median follow-up of 7.25 years, a total of 635 CRCs were observed. For patients with LRAs, CRC incidence (hazard ratio [HR], 1.18; 95% confidence interval [CI], 0.92-1.53) was not increased compared with the FIT+/colonoscopy-negative group, while for HRAs a significant increase in CRC incidence (HR, 1.53; 95% CI, 1.14-2.04) was found. The presence of 1 or more risk factors among proximal location, nonpedunculated morphology, and high-grade dysplasia explained most of this excess CRC risk in the HRA group (HR, 1.85; 95% CI, 1.36-2.52). Patients with only distal pedunculated polyps without high-grade dysplasia, representing 39.2% of HRA, did not have increased risk compared with the FIT- group (HR, 0.87; 95% CI, 0.59-1.28). CONCLUSIONS CRC incidence is significantly higher in patients with HRAs diagnosed at colonoscopy. However, such excess risk does not appear to apply to patients with only distal pedunculated polyps without high-grade dysplasia, an observation that could potentially reduce the burden of surveillance in FIT programs.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | | | | | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy; Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Italy.
| | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, San Martino Hospital, ULSS 1 Dolomiti, Belluno, Italy
| | - Flavio Valiante
- Gastroenterology and Digestive Endoscopy Unit, Santa Maria del Prato Hospital, ULSS 1 Dolomiti, Feltre, Italy
| | - Stefano Benvenuti
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Alberto Tringali
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 2 Marca Trevigiana, Conegliano, Italy
| | - Francesco Bortoluzzi
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Erica Cervellin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 3 Serenissima, Dolo, Italy
| | - Davide Giacomin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 4 Veneto Orientale, San Donà di Piave, Italy
| | - Tamara Meggiato
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 5 Rovigo, Rovigo, Italy
| | - Erik Rosa Rizzotto
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Padua, Italy
| | - Diego Fregonese
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Camposampiero, Italy
| | - Manuela Dinca
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Monselice, Italy
| | - Gianluca Baldassarre
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 7 Pedemontana, Santorso, Italy
| | - Paola Scalon
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 7 Pedemontana, Bassano del Grappa, Italy
| | - Maurizio Pantalena
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 8 Berica, Arzignano, Italy
| | - Luisa Milan
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 8 Berica, Vicenza, Italy
| | - Gianmarco Bulighin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, San Bonifacio, Italy
| | - Daniele Di Piramo
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, Villafranca, Italy
| | - Maurizio Azzurro
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, Legnago, Italy
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Repici
- Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Italy
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, Padova, Italy; Pathology and Cytopathology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Cesare Hassan
- Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Italy
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Zullo A, De Francesco V, Amato A, Bergna I, Bendia E, Giorgini G, Buscarini E, Manfredi G, Cadoni S, Cannizzaro R, Realdon S, Ciuffi M, Ignomirelli O, Da Massa Carrara P, Finucci G, Di Somma A, Frandina C, Loria M, Galeazzi F, Ferrara F, Gemme C, Bertetti NS, Gentili F, Lotito A, Germanà B, Russo N, Grande G, Conigliaro R, Cravero F, Venezia G, Marmo R, Senneca P, Milano A, Efthymakis K, Monica F, Montalto P, Lombardi M, Morelli O, Castellani D, Nigro D, Festa R, Peralta S, Grasso M, Privitera A, Distefano ME, Scaccianoce G, Loiacono M, Segato S, Balzarini M, Usai Satta P, Lai M, Manta R. Upper Gastrointestinal Endoscopy Quality in Italy: A Nationwide Study. J Gastrointestin Liver Dis 2023; 32:433-437. [PMID: 38147598 DOI: 10.15403/jgld-5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/02/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS International guidelines advise improving esophagogastroduodenoscopy (EGD) quality in Western countries, where gastric cancer is still diagnosed in advanced stages. This nationwide study investigated some indicators for the quality of EGD performed in endoscopic centers in Italy. METHODS Clinical, endoscopic, and procedural data of consecutive EGDs performed in one month in the participating centers were reviewed and collected in a specific database. Some quality indicators before and during endoscopic procedures were evaluated. RESULTS A total of 3,219 EGDs performed by 172 endoscopists in 28 centers were reviewed. Data found that some relevant information (family history for GI cancer, smoking habit, use of proton pump inhibitors) were not collected before endoscopy in 58.5-80.7% of patients. Pre-endoscopic preparation for gastric cleaning was routinely performed in only 2 (7.1%) centers. Regarding the procedure, sedation was not performed in 17.6% of patients, and virtual chromoendoscopy was frequently (>75%) used in only one (3.6%) center. An adequate sampling of the gastric mucosa (i.e., antral and gastric body specimens) was heterogeneously performed, and it was routinely performed only by 23% of endoscopists, and in 14.3% centers. CONCLUSIONS Our analysis showed that the quality of EGD performed in clinical practice in Italy deserves to be urgently improved in different aspects.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology and Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italia.
| | | | - Arnaldo Amato
- Gastroenterology Unit, A. Manzoni Hospital, Lecco, Italy..
| | - Irene Bergna
- Gastroenterology Unit, A. Manzoni Hospital, Lecco, Italy..
| | | | | | | | - Guido Manfredi
- Gastroenterology and Endoscopy Unit, Maggiore Hospital, Crema (CR), Italy..
| | - Sergio Cadoni
- Gastroenterology Unit, CTO Hospital, Iglesias, Italy..
| | - Renato Cannizzaro
- Experimental Oncological Gastroenterology Unit, CRO Hospital, Aviano (PN), Italy..
| | - Stefano Realdon
- Experimental Oncological Gastroenterology Unit, CRO Hospital, Aviano (PN), Italy..
| | - Mario Ciuffi
- Endoscopy Unit, IRCCS CROB Hospital, Rionero in Vulture (PZ), Italy..
| | | | | | - Giovanni Finucci
- Gastroenterology Unit, ASL Toscana Nord-Ovest, San Luca Hospital, Lucca, Italy.
| | | | - Chiara Frandina
- Gastroenterology Unit, S. Giovanni di Dio Hospital, Crotone, Italy.
| | | | | | | | - Carlo Gemme
- Gastroenterology Unit, SS. Antonio, Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
| | - Noemi Sara Bertetti
- Gastroenterology Unit, SS. Antonio, Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
| | | | - Antonio Lotito
- Gastroenterology Unit, Santa Maria Hospital, Terni, Italy.
| | | | - Nunzia Russo
- Gastroenterology and Endoscopy Unit, San Martino Hospital, Belluno, Italy.
| | - Giuseppe Grande
- Gastroenterology Unit, Civile Baggiovara Hospital, Modena, Italy.
| | - Rita Conigliaro
- Gastroenterology Unit, Civile Baggiovara Hospital, Modena, Italy.
| | - Federico Cravero
- Gastroenterology Unit, Santa Croce e Carle Hospital, Cuneo, Italy.
| | - Giovanna Venezia
- Gastroenterology Unit, Santa Croce e Carle Hospital, Cuneo, Italy.
| | - Riccardo Marmo
- Gastroenterology Unit, L. Curto Hospital, Polla (SA), Italy.
| | - Piera Senneca
- Gastroenterology Unit, L. Curto Hospital, Polla (SA), Italy.
| | - Angelo Milano
- Gastroenterology and Endoscopy Unit, SS. Annunziata Hospital, Hospital, Chieti, Italy.
| | | | - Fabio Monica
- Gastroenterology Unit, San Giovanni di Dio Hospital, Gorizia; Gastroenterology and Endoscopy Unit, Cattinara Hospital, Trieste, Italy..
| | - Paolo Montalto
- Gastroenterology Unit, ASL Toscana Centro, Pistoia, Italy.
| | - Mario Lombardi
- Gastroenterology Unit, ASL Toscana Centro, Pistoia, Italy.
| | - Olivia Morelli
- Gastroenterology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy.
| | - Danilo Castellani
- Gastroenterology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy.
| | - Daniela Nigro
- Gastroenterology Unit, San Carlo Hospital, Melfi (PZ), Italy.
| | - Roberto Festa
- Gastroenterology Unit, San Carlo Hospital, Melfi (PZ), Italy.
| | - Sergio Peralta
- Gastroenterology Unit, AOU Policlinico Hospital, Palermo, Italy.
| | - Maria Grasso
- Gastroenterology Unit, AOU Policlinico Hospital, Palermo, Italy.
| | | | | | | | | | - Sergio Segato
- Gastroenterology Unit, ASST dei Sette Laghi Hospital, Varese, Italy.
| | - Marco Balzarini
- Gastroenterology Unit, ASST dei Sette Laghi Hospital, Varese, Italy.
| | | | | | - Raffaele Manta
- Gastroenterology Unit, ASL Toscana Nord-Ovest, San Luca Hospital, Lucca, Italy.
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Zorzi M, Antonelli G, Barbiellini Amidei C, Battagello J, Germanà B, Valiante F, Benvenuti S, Tringali A, Bortoluzzi F, Cervellin E, Giacomin D, Meggiato T, Rosa-Rizzotto E, Fregonese D, Dinca M, Baldassarre G, Scalon P, Pantalena M, Milan L, Bulighin G, Di Piramo D, Azzurro M, Gabbrielli A, Repici A, Rex DK, Rugge M, Hassan C, Giacomin A, Buda A, Costa D, Checchin D, Marin R, Patarnello E, Ceriani A, Guido E, Bertomoro P, Merlini N, Murer F, Ntakirutimana E, Benazzato L, Bellocchi MCC. Adenoma Detection Rate and Colorectal Cancer Risk in Fecal Immunochemical Test Screening Programs : An Observational Cohort Study. Ann Intern Med 2023; 176:303-310. [PMID: 36802754 DOI: 10.7326/m22-1008] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening programs based on fecal immunochemical tests (FITs) represent the standard of care for population-based interventions. Their benefit depends on the identification of neoplasia at colonoscopy after FIT positivity. Colonoscopy quality measured by adenoma detection rate (ADR) may affect screening program effectiveness. OBJECTIVE To examine the association between ADR and postcolonoscopy CRC (PCCRC) risk in a FIT-based screening program. DESIGN Retrospective population-based cohort study. SETTING Fecal immunochemical test-based CRC screening program between 2003 and 2021 in northeastern Italy. PATIENTS All patients with a positive FIT result who had a colonoscopy were included. MEASUREMENTS The regional cancer registry supplied information on any PCCRC diagnosed between 6 months and 10 years after colonoscopy. Endoscopists' ADR was categorized into 5 groups (20% to 39.9%, 40% to 44.9%, 45% to 49.9%, 50% to 54.9%, and 55% to 70%). To examine the association of ADR with PCCRC incidence risk, Cox regression models were fitted to estimate hazard ratios (HRs) and 95% CIs. RESULTS Of the 110 109 initial colonoscopies, 49 626 colonoscopies done by 113 endoscopists between 2012 and 2017 were included. After 328 778 person-years follow-up, 277 cases of PCCRC were diagnosed. Mean ADR was 48.3% (range, 23% and 70%). Incidence rates of PCCRC from lowest to highest ADR group were 13.13, 10.61, 7.60, 6.01, and 5.78 per 10 000 person-years. There was a significant inverse association between ADR and PCCRC incidence risk, with a 2.35-fold risk increase (95% CI, 1.63 to 3.38) in the lowest group compared with the highest. The adjusted HR for PCCRC associated with 1% increase in ADR was 0.96 (CI, 0.95 to 0.98). LIMITATION Adenoma detection rate is partly determined by FIT positivity cutoff; exact values may vary in different settings. CONCLUSION In a FIT-based screening program, ADR is inversely associated with PCCRC incidence risk, mandating appropriate colonoscopy quality monitoring in this setting. Increasing endoscopists' ADR may significantly reduce PCCRC risk. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy (M.Z., C.B.A., J.B.)
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, and Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy (G.A.)
| | | | | | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, San Martino Hospital, ULSS 1 Dolomiti, Belluno, Italy (B.G.)
| | - Flavio Valiante
- Gastroenterology and Digestive Endoscopy Unit, Santa Maria del Prato Hospital, ULSS 1 Dolomiti, Feltre (BL), Italy (F.V.)
| | - Stefano Benvenuti
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy (S.B.)
| | - Alberto Tringali
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 2 Marca Trevigiana, Conegliano (TV), Italy (A.T.)
| | - Francesco Bortoluzzi
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 3 Serenissima, Venezia, Italy (F.B.)
| | - Erica Cervellin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 3 Serenissima, Dolo (VE), Italy (E.C.)
| | - Davide Giacomin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 4 Veneto Orientale, San Donà di Piave (VE), Italy (D.G.)
| | - Tamara Meggiato
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 5 Rovigo, Italy (T.M.)
| | - Erik Rosa-Rizzotto
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Padova, Italy (E.R.-R.)
| | - Diego Fregonese
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Camposampiero, Italy (D.F.)
| | - Manuela Dinca
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Monselice, Italy (M.D.)
| | - Gianluca Baldassarre
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 7 Pedemontana, Santorso, Italy (G.B.)
| | - Paola Scalon
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 7 Pedemontana, Bassano del Grappa, Italy (P.S.)
| | - Maurizio Pantalena
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 8 Berica, Arzignano, Italy (M.P.)
| | - Luisa Milan
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 8 Berica, Vicenza, Italy (L.M.)
| | - Gianmarco Bulighin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, San Bonifacio, Italy (G.B.)
| | - Daniele Di Piramo
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, Villafranca, Italy (D. Di P.)
| | - Maurizio Azzurro
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, Legnago, Italy (M.A.)
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy (A.G.)
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy, and IRCCS Humanitas Research Hospital, Endoscopy Unit, Rozzano, Milan, Italy (A.R., C.H.)
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana (D.K.R.)
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, and Department of Medicine DIMED Pathology and Cytopathology Unit, University of Padova, Padova, Italy (M.R.)
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy, and IRCCS Humanitas Research Hospital, Endoscopy Unit, Rozzano, Milan, Italy (A.R., C.H.)
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5
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Zullo A, Germanà B, Galliani E, Iori A, de Pretis G, Manfredi G, Buscarini E, Ciuffi M, Ignomirelli O, Farinati F, Savarino E, Pallini P, Milan L, Conigliaro R, Grande G, Cannizzaro R, Maiero S, Pisani A, Marangi S, Manta R, Morelli O, Peralta S, La Mantia A, Buonocore MR, Khalaf K, Hassan C, Monica F. Real-time determination of gastric juice pH with EndoFaster® for atrophic gastritis assessment. Dig Liver Dis 2022; 54:1646-1648. [PMID: 35794064 DOI: 10.1016/j.dld.2022.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND In patients with atrophic gastritis involving gastric body mucosa the pH value of gastric juice is distinctly increased, so that pH assessment would allow predict this precancerous lesion. We tested whether EndoFaster® - a device allowing real-time pH measure and H. pylori diagnosis - may optimize the need of taking gastric biopsies. METHODS In this prospective, multicentre study, the accuracy of EndoFaster® for ruling out gastric atrophy involving corporal mucosa was assessed. Real-time pH and ammonium determination was performed by aspirating 3-6 ml gastric juice during endoscopy. Histology performed on 5 standard gastric biopsies was used as gold standard. RESULTS A total of 1008 consecutive patients were observed in 12 centres. At histology, gastric body mucosa atrophy/metaplasia was detected in 65 (6.4%) cases, and a pH value >4.5 in the gastric juice was observed in 150 patients. The values of EndoFaster® performance in predicting the presence of atrophic gastritis were as follow: 51% sensitivity, 84% specificity, 18% PPV, 96% NPV, and 82% accuracy. The NPV value was not distinctly affected by neither ongoing proton pump inhibitor therapy nor H. pylori infection. By considering also data of ammonium concentrations, the values of EndoFaster® in detecting extensive atrophy on gastric mucosa were 74% sensitivity, 84% specificity, 24% PPV, 98% NPV, and 83% accuracy. CONCLUSION The very high NPV of EndoFaster® might allow to safely rule out presence of atrophic gastritis, reducing the need of taking gastric biopsies in unselected patients managed in clinical practice.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology Unit, Gastroenterologia ed Endoscopia Digestiva, 'Nuovo Regina Margherita' Hospital, Via Emilio Morosini, 30, Rome 00153 , Italy.
| | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, 'San Martino' Hospital, Belluno, Italy
| | - Ermenegildo Galliani
- Gastroenterology and Digestive Endoscopy Unit, 'San Martino' Hospital, Belluno, Italy
| | - Andrea Iori
- Gastroenterology and Digestive Endoscopy Unit, Santa Chiara' Hospital, Trento, Italy
| | - Giovanni de Pretis
- Gastroenterology and Digestive Endoscopy Unit, Santa Chiara' Hospital, Trento, Italy
| | - Guido Manfredi
- Gastroenterology and Digestive Endoscopy Unit, 'Maggiore' Hospital, Crema, Italy
| | - Elisabetta Buscarini
- Gastroenterology and Digestive Endoscopy Unit, 'Maggiore' Hospital, Crema, Italy
| | - Mario Ciuffi
- Endoscopy Unit, IRCCS CROB, Rionero in Vulture, Italy
| | | | - Fabio Farinati
- Gastroenterology Unit, University of Padua, Padua, Italy
| | | | - Paolo Pallini
- Gastroenterology Unit, 'San Bortolo' Hospital, Vicenza, Italy
| | - Luisa Milan
- Gastroenterology Unit, 'San Bortolo' Hospital, Vicenza, Italy
| | - Rita Conigliaro
- Gastroenterology Unit, 'Ospedale Civile Baggiovara', Modena, Italy
| | - Giuseppe Grande
- Gastroenterology Unit, 'Ospedale Civile Baggiovara', Modena, Italy
| | | | - Stefania Maiero
- Experimental Oncological Gastroenterology Unit, CRO, Aviano, Italy
| | - Antonio Pisani
- Gastroenterology Unit, 'Saverio De Bellis' Research Hospital, Castellana Grotte, Italy
| | - Stefania Marangi
- Gastroenterology Unit, 'Saverio De Bellis' Research Hospital, Castellana Grotte, Italy
| | - Raffaele Manta
- Gastroenterology Unit, 'Santa Maria della Misericordia' Hospital, Perugia, Italy
| | - Olivia Morelli
- Gastroenterology Unit, 'Santa Maria della Misericordia' Hospital, Perugia, Italy
| | - Sergio Peralta
- Gastroenterology Unit, 'AOU Policlinico', Palermo, Italy
| | | | | | - Kareem Khalaf
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Cesare Hassan
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, 'Cattinara' Academic Hospital, Trieste, Italy
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6
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De Francesco V, Alicante S, Amato A, Frazzoni L, Lombardi G, Manfredi G, Monica F, Sferrazza S, Vassallo R, Germanà B, Pasquale L, Annibale B, Cadoni S. Quality performance measures in upper gastrointestinal endoscopy for lesion detection: Italian AIGO-SIED-SIGE joint position statement. Dig Liver Dis 2022; 54:1479-1485. [PMID: 35871984 DOI: 10.1016/j.dld.2022.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 12/29/2022]
Abstract
Esophagogastroduodenoscopy (EGD) plays a crucial role in the management of gastroduodenal diseases by allowing a direct and accurate evaluation of the mucosa and the execution of several operative maneuvers. Despite a constant development of new imaging tools and operative devices, the widespread use of EGD has not resulted in a significant reduction of mortality for patients affected by esophageal/gastric cancer during the last three decades in Western countries. Evidence indicates that this disheartening scenario derives from a high variability of execution of EGD which determines its quality and diagnostic yield, delaying the diagnosis of neoplastic diseases. Based on this evidence, in recent years many scientific societies have produced different position papers aimed at defining quality performance measures in EGD. Thus, the Italian Association of Gastroenterologists and Endoscopists, the Italian Society of Digestive Endoscopy and the Italian Society of Gastroenterology have produced this joint document based on the review of ASGE, ACG, BSG, ESGE and Asian Consensus EGD position papers with the aim of indicating the quality standards of EGD (pre-, intra- and post-procedure) focused on lesion detection to be adopted in the Italian context.
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Affiliation(s)
| | - Saverio Alicante
- Gastroenterology and Digestive Endoscopy Department, Maggiore Hospital, ASST Crema, Italy
| | - Arnaldo Amato
- GastroenterologyDivision, Valduce Hospital, Como, Italy
| | - Leonardo Frazzoni
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Lombardi
- Gastroenterology and Digestive Endoscopy, AORN Cardarelli, Naples, Italy
| | - Guido Manfredi
- Gastroenterology and Digestive Endoscopy Department, Maggiore Hospital, ASST Crema, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, Cattinara Academic Hospital, Trieste, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy, APSS Santa Chiara Hospital, Trento, Italy
| | - Roberto Vassallo
- Gastroenterology and Endoscopy Unit, Buccheri la Ferla Hospital, Palermo, Italy
| | | | | | - Bruno Annibale
- Medical, Surgical and Translational Medicine Department, Sant'andrea Hospital, Sapienza University, Rome, Italy
| | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
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7
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Zullo A, Germanà B, Galliani E, Iori A, de Pretis G, Manfredi G, Buscarini E, Ciuffi M, Ignomirelli O, Farinati F, Savarino E, Pallini P, Milan L, Conigliaro R, Grande G, Cannizzaro R, Maiero S, Pisani A, Marangi S, Manta R, Morelli O, Peralta S, Mantia AL, Rossano Buonocore M, Monica F. Real-time gastric juice analysis with EndoFaster for H. pylori diagnosis: a large, multicentre study. Eur J Gastroenterol Hepatol 2022; 34:1121-1124. [PMID: 36170680 DOI: 10.1097/meg.0000000000002429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Helicobacter pylori infection is the main cause of the most frequent gastroduodenal diseases. Because its prevalence is decreasing in developed countries, gastric biopsies are negative in several patients. By measuring ammonium in the gastric juice, EndoFaster allows to exclude H. pylori infection during endoscopy. This study aimed to assess the accuracy of device versions working with either 6 ml or 3 ml of gastric juice. STUDY DESIGN This prospective study involved 12 endoscopic units. During endoscopy, EndoFaster testing was performed and standard five gastric biopsies were taken. The accuracy was calculated by considering histological assessment as the gold standard for H. pylori diagnosis. RESULTS Gastric juice analysis was attempted in 1279 patients, but it failed in 131 (15.5%) and in 10 (2.3%), with the 6 ml and the 3 ml device, respectively (P < 0.001). Overall, EndoFaster detected H. pylori infection with an 86.3% sensitivity, 83.3% specificity, 52.7% positive predictive value, 96.6% negative predictive value and 83.8% accuracy. The performance was not affected either by ongoing proton pump inhibitor therapy or a previous H. pylori eradication. No significant difference in accuracy emerged between the two versions of the device. CONCLUSION The novel version of the EndoFaster device operating with 3 ml gastric juice may be performed in virtually all patients, and it allows excluding H. pylori infection with a very high accuracy. Gastric biopsies can be avoided in a definite portion of cases without endoscopic lesions or other clinical indications.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology Unit, 'Nuovo Regina Margherita' Hospital, Rome
| | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, 'San Martino' Hospital, Belluno
| | | | - Andrea Iori
- Gastroenterology and Digestive Endoscopy Unit,' Santa Chiara' Hospital, Trento
| | - Giovanni de Pretis
- Gastroenterology and Digestive Endoscopy Unit,' Santa Chiara' Hospital, Trento
| | - Guido Manfredi
- Gastroenterology and Digestive Endoscopy Unit, 'Maggiore' Hospital, Crema
| | | | | | | | | | | | - Paolo Pallini
- Gastroenterology Unit, 'San Bortolo' Hospital, Vicenza
| | - Luisa Milan
- Gastroenterology Unit, 'San Bortolo' Hospital, Vicenza
| | | | | | | | | | - Antonio Pisani
- Gastroenterology Unit, 'Saverio De Bellis' Research Hospital, Castellana Grotte
| | - Stefania Marangi
- Gastroenterology Unit, 'Saverio De Bellis' Research Hospital, Castellana Grotte
| | - Raffaele Manta
- Gastroenterology Unit, 'Santa Maria della Misericordia' Hospital, Perugia
| | - Olivia Morelli
- Gastroenterology Unit, 'Santa Maria della Misericordia' Hospital, Perugia
| | | | | | | | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, 'Cattinara' Academic Hospital, Trieste, Italy
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8
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Zagari RM, Frazzoni L, Fuccio L, Bertani H, Crinò SF, Magarotto A, Dajti E, Tringali A, Da Massa Carrara P, Cengia G, Ciliberto E, Conigliaro R, Germanà B, Lamazza A, Pisani A, Spinzi G, Capelli M, Bazzoli F, Pasquale L. Adherence to European Society of Gastrointestinal Endoscopy Quality Performance Measures for Upper and Lower Gastrointestinal Endoscopy: A Nationwide Survey From the Italian Society of Digestive Endoscopy. Front Med (Lausanne) 2022; 9:868449. [PMID: 35463020 PMCID: PMC9018975 DOI: 10.3389/fmed.2022.868449] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/08/2022] [Indexed: 12/20/2022] Open
Abstract
Background The quality of gastrointestinal (GI) endoscopy has been recently identified as a major priority being associated with many outcomes and patient's experience. Objective To assess adherence of endoscopists to the European Society of Gastrointestinal Endoscopy (ESGE) quality performance measures for upper and lower GI endoscopy in Italy. Methods All endoscopist members of the Italian Society of Digestive Endoscopy (SIED) were invited from October 2018 to December 2018 to participate to a self-administered questionnaire-based survey. The questionnaire included questions on demographics and professional characteristics, and the recent ESGE quality performance measures for upper and lower GI endoscopy. Results A total of 392 endoscopists participated in the study. Only a minority (18.2%) of participants recorded the duration of esophagogastroduodenoscopy (EGD) and 51% provided accurate photo documentation in the minimum standard of 90% of cases. Almost all endoscopists correctly used Prague and Los Angeles classifications (87.8% and 98.2%, respectively), as well as Seattle and Management of precancerous conditions and lesions in the stomach (MAPS) biopsy protocols (86.5% and 91.4%, respectively). However, only 52.8% of participants monitored complications after therapeutic EGD, and 40.8% recorded patients with a diagnosis of Barrett's esophagus (BE). With regard to colonoscopy, almost all endoscopists (93.9%) used the Boston Bowel Preparation Scale for measuring bowel preparation quality and reported a cecal intubation rate ≥90%. However, about a quarter (26.2%) of participants reported an adenoma detection rate of <25%, only 52.8% applied an appropriate polypectomy technique, 48% monitored complications after the procedure, and 12.4% measured patient's experience. Conclusion The adherence of endoscopists to ESGE performance measures for GI endoscopy is sub-optimal in Italy. There is a need to disseminate and implement performance measures and endorse educational and scientific interventions on the quality of endoscopy.
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Affiliation(s)
- Rocco Maurizio Zagari
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Leonardo Frazzoni
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Helga Bertani
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Andrea Magarotto
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elton Dajti
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Enrico Ciliberto
- Gastroenterology and Digestive Endoscopy Unit, S. Giovanni di Dio Hospital, Crotone, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Baggiovara University Hospital, Baggiovara, Italy
| | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, S. Martino Hospital, Belluno, Italy
| | - Antonietta Lamazza
- Department of Surgery “Pietro Valdoni”, University La Sapienza, Rome, Italy
| | - Antonio Pisani
- Gastroenterology and Digestive Endoscopy Unit, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, Bari, Italy
| | - Giancarlo Spinzi
- Gastroenterology and Endoscopy Department, Valduce Hospital, Como, Italy
| | - Maurizio Capelli
- Kiwa Cermet Certification Body, Statistical Department, Bologna, Italy
| | - Franco Bazzoli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luigi Pasquale
- UOC Gastroenterologia ed Endoscopia Digestiva, Ospedale Frangipane, Avellino, Italy
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9
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Zorzi M, Hassan C, Battagello J, Antonelli G, Pantalena M, Bulighin G, Alicante S, Meggiato T, Rosa-Rizzotto E, Iacopini F, Luigiano C, Monica F, Arrigoni A, Germanà B, Valiante F, Mallardi B, Senore C, Grazzini G, Mantellini P. Adenoma detection by Endocuff-assisted versus standard colonoscopy in an organized screening program: the "ItaVision" randomized controlled trial. Endoscopy 2022; 54:138-147. [PMID: 33524994 DOI: 10.1055/a-1379-6868] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Endocuff Vision device (Arc Medical Design Ltd., Leeds, UK) has been shown to increase mucosal exposure, and consequently adenoma detection rate (ADR), during colonoscopy. This nationwide multicenter study assessed possible benefits and harms of using Endocuff Vision in a fecal immunochemical test (FIT)-based screening program. METHODS Patients undergoing colonoscopy after a FIT-positive test were randomized 1:1 to undergo Endocuff-assisted colonoscopy or standard colonoscopy, stratified by sex, age, and screening history. Primary outcome was ADR. Secondary outcomes were ADR stratified by endoscopists' ADR, advanced ADR (AADR), adenomas per colonoscopy (APC), withdrawal time, and adverse events. RESULTS 1866 patients were enrolled across 13 centers. After exclusions, 1813 (mean age 60.1 years; male 53.8 %) were randomized (908 Endocuff Vision, 905 standard colonoscopy). ADR was significantly higher in the Endocuff Vision arm (47.8 % vs. 40.8 %; relative risk [RR] 1.17, 95 % confidence interval [CI] 1.06-1.30), with no differences between arms regarding size or morphology. When stratifying for endoscopists' ADR, only low detectors (ADR < 33.3 %) showed a statistically significant ADR increase (Endocuff Vision 41.1 % [95 %CI 35.7-46.7] vs. standard colonoscopy 26.0 % [95 %CI 21.3-31.4]). AADR (24.8 % vs. 20.5 %, RR 1.21, 95 %CI 1.02-1.43) and APC (0.94 vs. 0.77; P = 0.001) were higher in the Endocuff Vision arm. Withdrawal time and adverse events were similar between arms. CONCLUSION Endocuff Vision increased ADR in a FIT-based screening program by improving examination of the whole colonic mucosa. Utility was highest among endoscopists with a low ADR.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | | | - Giulio Antonelli
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy.,Department of Translational and Precision Medicine, "Sapienza" University of Rome, Italy.,Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli (N.O.C.), ASL Roma 6, Ariccia, Rome, Italy
| | - Maurizio Pantalena
- Gastroenterology Unit, Cazzavillan Hospital, ULSS 8 Berica, Arzignano, Italy
| | - Gianmarco Bulighin
- Gastroenterology and Digestive Endoscopy Unit, Fracastoro Hospital, ULSS 9 Scaligera, San Bonifacio, Italy
| | - Saverio Alicante
- Gastroenterology Department, ASST-Crema, Maggiore Hospital, Crema, Italy
| | - Tamara Meggiato
- Department of Gastroenterology, Rovigo General Hospital, ULSS 5 Polesana, Rovigo, Italy
| | - Erik Rosa-Rizzotto
- Gastroenterology Unit, St. Anthony Hospital, Azienda Ospedale-Università, Padua, Italy
| | - Federico Iacopini
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli (N.O.C.), ASL Roma 6, Ariccia, Rome, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, ASST Santi Paolo e Carlo, Milan, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy Unit, Cattinara University Hospital, Trieste, Italy
| | - Arrigo Arrigoni
- Gastroenterology Unit, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, San Martino Hospital, ULSS 1 Dolomiti, Belluno, Italy
| | - Flavio Valiante
- Gastroenterology and Digestive Endoscopy Unit, Santa Maria del Prato Hospital, ULSS 1 Dolomiti, Feltre, Italy
| | - Beatrice Mallardi
- Screening Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
| | - Carlo Senore
- Epidemiology and Screening Unit - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Grazia Grazzini
- Screening Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
| | - Paola Mantellini
- Screening Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
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10
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Zullo A, Germanà B, Galliani E, Iori A, de Pretis G, Manfredi G, Buscarini E, Buonocore MR, Monica F. Optimizing the searching for H. pylori in clinical practice with EndoFaster Ⓡ. Dig Liver Dis 2021; 53:772-775. [PMID: 33676857 DOI: 10.1016/j.dld.2021.02.004] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM H. pylori plays a major role in gastroduodenal diseases. Since its incidence is decreasing in developed countries, gastric biopsies were negative in several patients managed in clinical practice. We tested whether EndoFasterⓇ - a device allowing real-time H. pylori detection by gastric juice analysis - may optimize the need of biopsies. METHODS In this prospective, multicentre study, the accuracy of EndoFasterⓇ for H. pylori detection was computed by using histology of gastric biopsies as a gold standard. RESULTS Data of 525 consecutive patients were available, including 90 (17.1%) patients with infection. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of EndoFasterⓇ were 87%, 84%, 53%, 97% and 85%, respectively. The overall accuracy of test was not affected neither by ongoing proton pump inhibitor therapy nor by previous eradication therapy. By using EndoFasterⓇ in our series, biopsy sampling could have been eventually avoided in a total of 279 patients, accounting for a reduction of 42.3%, accepting the risk of only 8 false negative cases. CONCLUSIONS The very high NPV of EndoFasterⓇ might allow to safely halve the need of taking gastric biopsies in unselected patients managed in clinical practice, avoiding an unavailing consume of health resources.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Via Emilio Morosini, 30, Rome 00153, Italy.
| | | | | | - Andrea Iori
- Gastroenterology and Digestive Endoscopy Unit,' Santa Chiara' Hospital, Trento, Italy
| | - Giovanni de Pretis
- Gastroenterology and Digestive Endoscopy Unit,' Santa Chiara' Hospital, Trento, Italy
| | - Guido Manfredi
- Gastroenterology and Endoscopy Department, 'Maggiore' Hospital, Crema, Italy
| | | | | | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, 'Cattinara' Academic Hospital, Trieste, Italy
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11
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Zullo A, Germanà B, Galliani E, Iori A, De Pretis G, Manfredi G, Buscarini E, Guarnieri G, Cannizzaro R, Buonocore MR, Monica F. Real-time EndoFaster improves Helicobacter pylori detection in chronic active gastritis. J Clin Pathol 2021; 75:572-574. [PMID: 33975912 DOI: 10.1136/jclinpath-2021-207498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/31/2021] [Accepted: 04/28/2021] [Indexed: 11/03/2022]
Abstract
Helicobacter pylori is the most frequent cause of chronic active gastritis (CAG), namely the first step for gastric cancer development. When infection is not detected at histology, another test is advised. EndoFaster is novel device that reveal the presence of H. pylori by determining ammonium concentration in the gastric juice during endoscopy. We evaluated whether this test may improve etiological diagnosis in CAG patients. In 595 consecutive patients who underwent upper endoscopy gastric juice was analysed with EndoFaster and standard biopsies were taken. CAG with typical bacteria was detected in 102 (17.1%) patients, and CAG without H. pylori was found in 36 (6.3%) cases. EndoFaster detected the infection in 22 (61.1%) of these patients. Neither ongoing proton pump inhibitor therapy nor previous eradication therapy affect the test accuracy. By using EndoFaster, another test to search for the infection in H. pylori-negative CAG patients may be avoided in more than 60% of cases, impacting on both patients discomfort and health resources use.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology and Digestive Endoscopy, Presidio Territoriale di Prossimità Nuovo Regina Margherita, Roma, Italy
| | | | | | - Andrea Iori
- Gastroenterology and Digestive Endoscopy, Santa Chiara Hospital, Trento, Italy
| | - Giovanni De Pretis
- Gastroenterology and Digestive Endoscopy, Santa Chiara Hospital, Trento, Italy
| | - Guido Manfredi
- Gastroenterology and Digestive Endoscopy, Maggiore Hospital Crema, Crema, Italy
| | | | | | | | | | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, Ospedale di Cattinara, Trieste, Italy
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12
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Salvador R, Costantini M, Tolone S, Familiari P, Galliani E, Germanà B, Savarino E, Merigliano S, Valmasoni M. Manometric pattern progression in esophageal achalasia in the era of high-resolution manometry. Ann Transl Med 2021; 9:906. [PMID: 34164540 PMCID: PMC8184468 DOI: 10.21037/atm.2020.03.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Esophageal manometry represents the gold standard technique for the diagnosis of esophageal achalasia because it can detect both the lack of lower esophageal sphincter (LES) relaxation and abnormal peristalsis. From the manometric standpoint, cases of achalasia can be segregated on the grounds of three clinically relevant patterns according to the Chicago Classification v3.0. It is currently unclear whether they represent distinct entities or are part of a disease continuum with the possibility of transition from a pattern to another one. The four cases described in the present report could provide further insights on this topic because the manometric pattern changed from type III to type II in all patients—without any invasive treatment. The cases described here support the hypothesis that the different manometric patterns of achalasia represent different stages in the evolution of the same disease, type III being the early stage, type II an intermediate stage, and type I probably the end stage of achalasia.
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Affiliation(s)
- Renato Salvador
- Department of Surgery, Oncology and Gastroenterology, School of Medicine, University of Padova, Padova, Italy
| | - Mario Costantini
- Department of Surgery, Oncology and Gastroenterology, School of Medicine, University of Padova, Padova, Italy
| | - Salvatore Tolone
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pietro Familiari
- Digestive Endoscopy Unit, Catholic University of Sacred Heart, Rome, Italy
| | | | | | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, School of Medicine, University of Padova, Padova, Italy
| | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, School of Medicine, University of Padova, Padova, Italy
| | - Michele Valmasoni
- Department of Surgery, Oncology and Gastroenterology, School of Medicine, University of Padova, Padova, Italy
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13
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Pasquale L, Maurano A, Cengia G, Da Massa Carrara P, Germanà B, Graziani MG, Manes G, Pisani A, Golia M, Marciano E, Rodella L, Schiffino L, Gandolfo C, Terrosi C, Cusi MG. Infection prevention in endoscopy practice: comparative evaluation of re-usable vs single-use endoscopic valves. Infect Prev Pract 2021; 3:100123. [PMID: 34368741 PMCID: PMC8336158 DOI: 10.1016/j.infpip.2021.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022] Open
Abstract
Re-usable air/water and suction valves used in endoscopes often demonstrate risk of infection. To the authors' knowledge, the safety and efficacy of re-usable and single-use valves have not been compared to date. As such, a laboratory investigation was undertaken to compare the safety and efficacy of re-usable and single-use valves at 11 Italian endoscopy sites. Safety was evaluated by analysing the rinse liquid of reprocessed re-usable valves ready for use, and efficacy was assessed based on the completion of endoscopic procedures without valve malfunction. This study found significantly lower contamination of single-use valves compared with re-usable valves (0 vs 29.1%, respectively; P=0.007) and similar efficacy (97.6 vs 98.8%, respectively; P=ns). Microbiological analysis of the rinse liquid of reprocessed re-usable valves identified various surviving micro-organisms and highlighted their potential pathogenicity. Such data suggest that sterile single-use valves may be safer than re-usable valves, and have comparable performance.
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Affiliation(s)
- L Pasquale
- Gastroenterology and General Medicine Unit, Civil Hospital 'Frangipane' di Ariano Irpino, Avellino, Italy
| | - A Maurano
- University Hospital, Mercato S. Severino, Salerno, Italy
| | - G Cengia
- Digestive Endoscopy Unit, ASST Garda, Manerbio Hospital, Manerbio, Italy
| | - P Da Massa Carrara
- Gastroenterology and Digestive Endoscopy, Azienda USL Toscana Centro, Pistoia, Italy
| | - B Germanà
- AULSS1 Dolomiti, Belluno Hospital, Belluno, Italy
| | - M G Graziani
- Gastroenterology and Digestive Endoscopy, S. Giovanni Addolorata Hospital, Rome, Italy
| | - G Manes
- Gastroenterology and Digestive Endoscopy, ASST Rhodense, Garbagnate Milanese and Rho Hospital, Garbagnate Milanese, Milan, Italy
| | - A Pisani
- IRCCS de Bellis, Castellana Grotte, Bari, Italy
| | - M Golia
- Diagnostic and Endoscopic Surgery Unit, Monza Hospital, Monza, Italy
| | - E Marciano
- Pisana University Hospital, Presidio Cisanello, Pisa, Italy
| | - L Rodella
- Surgical Unit, Borgo Trento Hospital, Piazzale Stefani, Verona, Italy
| | - L Schiffino
- Digestive Endoscopy Unit, G.B. Grassi Hospital, Ostia, Rome, Italy
| | - C Gandolfo
- Santa Maria alle Scotte University Hospital, Siena, Italy
| | - C Terrosi
- Virology Unit, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - M G Cusi
- Santa Maria alle Scotte University Hospital, Siena, Italy.,Virology Unit, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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14
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Galloro G, Pisani A, Zagari RM, Lamazza A, Cengia G, Ciliberto E, Conigliaro RL, Da Massa Carrara P, Germanà B, Pasquale L. Safety in digestive endoscopy procedures in the covid era recommendations in progres of the italian society of digestive endoscopy. Dig Liver Dis 2020; 52:800-807. [PMID: 32405285 PMCID: PMC7218383 DOI: 10.1016/j.dld.2020.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 01/08/2023]
Abstract
The new corona virus disease has started in Wuhan - China at the end of 2019 and quickly spread with a pandemic trend across the rest of the world. The scientific community is making an extraordinary effort to study and control the situation, but the results are just partial. Based on the most recent scientific literature and strong statements by the most prestigious international health institutions, the Italian Society of Digestive Endoscopy has drawn up some recommendations about the use of personal protective equipment, the correct way of dressing and undressing of endoscopists and nurses, before and after digestive endoscopy procedures. In addition, some other important indications are given to reduce the risk of contamination of healthcare providers during endoscopic activities, in the setting of a pandemic. Nevertheless, because of the very quick evolution of our knowledge on this issue, these recommendations must be considered as evolving, because they could change in a short time.
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Affiliation(s)
- Giuseppe Galloro
- Department of Clinical Medicine and Surgery. Surgical Endoscopy Unit. University Federico II of Naples. Via S. Pansini, 5 80131 Napoli Italy.
| | - Antonio Pisani
- Gastroenterology and Digestive Endoscopy Unit. S. De Bellis Hospital of Castellana Grotte. Via Turi, 27 70013 Castellana Grotte (BA) Italy
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences. Gastroenterology Unit, University Alma Mater of Bologna. Via G Masserenti, 9 40138 Bologna Italy
| | - Antonietta Lamazza
- Department of Surgery P. Valdoni. Digestive Endoscopy Unit, University La Sapienza of Rome Viale del Policlinico, 155 00161 Rome Italy
| | - Gianpaolo Cengia
- Digestive Endoscopy Unit, Manerbio Hospital, Via Lungomella Valsecchi, 2 25025 Manerbio (BS) Italy
| | - Enrico Ciliberto
- Gastroenterology Unit, S. Giovanni di Dio Hospital of Crotone, Via Bologna 88900 Crotone Italy
| | - Rita L Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Baggiovara University Hospital, Via P. Giardini, 1355 41126 Baggiovara (MO) Italy
| | - Paola Da Massa Carrara
- Gastroenterology and Digestive Endoscopy Unit, S. Jacopo Hospital of Pistoia. Via Ciliegiole, 97 51100 Pistoia Italy
| | - Bastianello Germanà
- Gastroenterology Unit, S. Martino Hospital of Belluno, Viale Europa, 22 32100 Belluno Italy
| | - Luigi Pasquale
- Gastroenterology Unit, S. O. Frangipane Hospital of A. Irpino, Via R. Maddalena 83031 A. Irpino (AV) Italy
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15
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Manta R, Mangiafico S, Zullo A, Bertani H, Caruso A, Grande G, Zito FP, Mangiavillano B, Pasquale L, Parodi A, Germanà B, Bassotti G, Monica F, Zilli M, Pisani A, Mutignani M, Conigliaro R, Galloro G. First-line endoscopic treatment with over-the-scope clips in patients with either upper or lower gastrointestinal bleeding: a multicenter study. Endosc Int Open 2018; 6:E1317-E1321. [PMID: 30410951 PMCID: PMC6221819 DOI: 10.1055/a-0746-8435] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Endoscopic treatment is the mainstay approach for gastrointestinal bleeding, in either upper (UGIB) or lower (LGIB) tract. The over-the-scope clip (OTSC) may overcome limitations of standard clips or thermocoagulation in high-risk bleeding lesions. We evaluate the main clinically relevant outcomes following endoscopic hemostasis with OTSC in high-risk lesions and/or patients. Patients and methods This was a retrospective analysis of prospectively collected databases including all patients with UGIB and LGIB who underwent OTCS placement as first-line treatment in eleven tertiary endoscopic referral centers. Technical success, primary hemostasis, rebleeding, blood transfusion, hospital stay, and hemorrhage-related mortality rates were evaluated. Results Data from 286 patients, with either UGIB (N = 214) or LGIB (N = 72) were available. Overall, 112 patients (39.2 %) were receiving antithrombotic therapy. Technical success and primary hemostasis rates were 97.9 % and 96.4 %, respectively. Early rebleeding occurred in 4.4 %, more frequently in those on antithrombotic therapy, and no late rebleeding was observed. Following a successful primary haemostasis, only 5.2 % patients needed blood transfusions, and the median hospital stay was 4 days (range: 3 - 11). Eighteen patients with either technical failure (N = 6) or rebleeding (N = 12) underwent radiological or surgical approaches. Overall, bleeding-related deaths occurred in 5 (1.7 %) patients, including 3 patients with technical procedural failure, and 2 in the rebleeding group. Conclusions Data from our large, multicenter study show that OTSC placement is an effective first-line treatment for hemostasis in high-risk patients and/or lesions both in upper and lower gastrointestinal tract.
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Affiliation(s)
- Raffaele Manta
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy,Corresponding author Raffaele Manta, MD Gastroenterologia ed Endoscopia DigestivaAzienda Ospedaliera Universitaria di ModenaOspedale S.Agostino-EstenseViale Giardini Nord 1355Baggiovara, ModenaItaly+0039 059 3961216
| | - Santi Mangiafico
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
| | - Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Helga Bertani
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
| | - Angelo Caruso
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
| | - Giuseppe Grande
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
| | | | | | - Luigi Pasquale
- Gastroenterology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Andrea Parodi
- Gastroenterology Unit, Galliera Hospital, Genova, Italy
| | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, Belluno Hospital, Belluno, Italy
| | - Gabrio Bassotti
- Gastroenterology Unit, Department of Medicine, Perugia University, Perugia, Italy
| | - Fabio Monica
- Gastroenterology Unit, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Maurizio Zilli
- Gastroenterology Unit, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Antonio Pisani
- Gastroenterology Section, Department of Emergency and Organ Transplantation, Bari University, Bari, Italy
| | | | - Rita Conigliaro
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
| | - Giuseppe Galloro
- Surgical Digestive Endoscopy, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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16
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Gargari G, Taverniti V, Gardana C, Cremon C, Canducci F, Pagano I, Barbaro MR, Bellacosa L, Castellazzi AM, Valsecchi C, Tagliacarne SC, Bellini M, Bertani L, Gambaccini D, Marchi S, Cicala M, Germanà B, Dal Pont E, Vecchi M, Ogliari C, Fiore W, Stanghellini V, Barbara G, Guglielmetti S. Fecal Clostridiales distribution and short-chain fatty acids reflect bowel habits in irritable bowel syndrome. Environ Microbiol 2018; 20:3201-3213. [PMID: 29749705 DOI: 10.1111/1462-2920.14271] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/07/2018] [Indexed: 12/16/2022]
Abstract
Irritable bowel syndrome (IBS), a common functional gastrointestinal disorder, is classified according to bowel habits as IBS with constipation (IBS-C), with diarrhea (IBS-D), with alternating constipation and diarrhea (IBS-M), and unsubtyped (IBS-U). The mechanisms leading to the different IBS forms are mostly unknown. This study aims to evaluate whether specific fecal bacterial taxa and/or short-chain fatty acids (SCFAs) can be used to distinguish IBS subtypes and are relevant for explaining the clinical differences between IBS subcategories. We characterized five fecal samples collected at 4-weeks intervals from 40 IBS patients by 16S rRNA gene profiling and SCFA quantification. Finally, we investigated the potential correlations in IBS subtypes between the fecal microbial signatures and host physiological and clinical parameters. We found significant differences in the distribution of Clostridiales OTUs among IBS subtypes and reduced levels of SCFAs in IBS-C compared to IBS-U and IBS-D patients. Correlation analyses showed that the diverse representation of Clostridiales OTUs between IBS subtypes was associated with altered levels of SCFAs; furthermore, the same OTUs and SCFAs were associated with the fecal cytokine levels and stool consistency. Our results suggest that intestinal Clostridiales and SCFAs might serve as potential mechanistic biomarkers of IBS subtypes and represent therapeutic targets.
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Affiliation(s)
- Giorgio Gargari
- Division of Food Microbiology and Bioprocesses, Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Valentina Taverniti
- Division of Food Microbiology and Bioprocesses, Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Claudio Gardana
- Division of Food Microbiology and Bioprocesses, Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Filippo Canducci
- Dipartimento di biotecnologie e scienze della vita, Università degli Studi dell'Insubria, Varese, Italy
| | - Isabella Pagano
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Maria Raffaella Barbaro
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Lara Bellacosa
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Anna Maria Castellazzi
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Valsecchi
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Carlotta Tagliacarne
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Massimo Bellini
- Gastroenterology Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Lorenzo Bertani
- Gastroenterology Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Dario Gambaccini
- Gastroenterology Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Santino Marchi
- Gastroenterology Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Michele Cicala
- Gastroenterology Unit, University Campus Bio-Medico of Rome, Rome, Italy
| | | | | | - Maurizio Vecchi
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | - Cristina Ogliari
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | | | - Vincenzo Stanghellini
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Simone Guglielmetti
- Division of Food Microbiology and Bioprocesses, Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy
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17
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Cremon C, Guglielmetti S, Gargari G, Taverniti V, Castellazzi AM, Valsecchi C, Tagliacarne C, Fiore W, Bellini M, Bertani L, Gambaccini D, Cicala M, Germanà B, Vecchi M, Pagano I, Barbaro MR, Bellacosa L, Stanghellini V, Barbara G. Effect of Lactobacillus paracasei CNCM I-1572 on symptoms, gut microbiota, short chain fatty acids, and immune activation in patients with irritable bowel syndrome: A pilot randomized clinical trial. United European Gastroenterol J 2018; 6:604-613. [PMID: 29881616 PMCID: PMC5987284 DOI: 10.1177/2050640617736478] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [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] [Received: 06/05/2017] [Accepted: 09/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Evidence suggests a role of intestinal microbiota-host interactions in the pathophysiology and symptoms of irritable bowel syndrome (IBS). OBJECTIVE The objective of this article is to assess the effects of Lactobacillus paracasei CNCM I-1572 on clinical and gut microbiota-related factors in IBS. METHODS We conducted a multicenter, randomized, double-blind, cross-over, 18-week, placebo-controlled, pilot trial assessing the effect of Lactobacillus paracasei CNCM I-1572 on symptoms, gut microbiota composition, fecal short chain fatty acid (SCFA), immunoglobulin A, and cytokines in IBS. The intestinal microbial ecosystem was characterized by 16S rRNA gene profiling. RESULTS Forty IBS patients were enrolled from five Italian centers. Lactobacillus paracasei CNCM I-1572 did not significantly improve IBS symptoms, including primary efficacy variables worst abdominal pain/discomfort and IBS degree of relief. Interestingly, Lactobacillus paracasei CNCM I-1572 induced a significant reduction in genus Ruminococcus, dominated by taxa related to Ruminococcus bromii and Ruminococcus callidus, a significant increase in the SCFAs acetate and butyrate, and a significant reduction in the pro-inflammatory cytokine interleukin-15. CONCLUSIONS This pilot study shows that Lactobacillus paracasei CNCM I-1572 is able to modulate gut microbiota structure/function and reduce immune activation in IBS. As no statistically significant effect on IBS-symptoms was found, further studies are necessary to determine the role of this probiotic in IBS. The study was registered at ClinicalTrials.gov registry under identifier NCT02371499.
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Affiliation(s)
- Cesare Cremon
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Simone Guglielmetti
- Department of Food, Environmental and Nutritional Sciences, Division of Food Microbiology and Bioprocesses, University of Milan, Milan, Italy
| | - Giorgio Gargari
- Department of Food, Environmental and Nutritional Sciences, Division of Food Microbiology and Bioprocesses, University of Milan, Milan, Italy
| | - Valentina Taverniti
- Department of Food, Environmental and Nutritional Sciences, Division of Food Microbiology and Bioprocesses, University of Milan, Milan, Italy
| | - Anna Maria Castellazzi
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Valsecchi
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Carlotta Tagliacarne
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Massimo Bellini
- Gastroenterology Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Lorenzo Bertani
- Gastroenterology Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Dario Gambaccini
- Gastroenterology Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Michele Cicala
- Gastroenterology Unit, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Maurizio Vecchi
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Isabella Pagano
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Maria Raffaella Barbaro
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Lara Bellacosa
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Vincenzo Stanghellini
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
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18
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Cavallaro LG, Hassan C, Lecis P, Galliani E, Dal Pont E, Iuzzolino P, Roldo C, Soppelsa F, Germanà B. The impact of Endocuff-assisted colonoscopy on adenoma detection in an organized screening program. Endosc Int Open 2018; 6:E437-E442. [PMID: 29616237 PMCID: PMC5880036 DOI: 10.1055/a-0578-8515] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/02/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Colorectal cancer (CRC) screening with biennial fecal occult blood test has been shown to reduce CRC mortality. For the effectiveness of the CRC screening program is crucial that a high-quality colonoscopy with a high adenoma detection rate (ADR) be performed. To improve ADR, various endoscopic devices have been developed. Endocuff, an endoscopic cap with finger-like projections, has been shown to improve ADR. The aim of this study was to compare in an organized CRC screening program ADR, advanced adenoma detection rate (AADR) and mean number of adenomas per patient (MAP) using standard colonoscopy (SC) and Endocuff-assisted colonoscopy (EAC). PATIENTS AND METHODS We compared performance of SC (in 2014) and EAC (in 2015) in consecutive participants in an organized CRC screening program. RESULTS SC and EAC were performed in 546 (284 males) and 519 (293 males) subjects, respectively (mean age 60 years). Cecal intubation rate was 97.4 % for SC and 97.1 % for EAC and not significantly different ( P = 0.7). ADR was 47 % for SC and 52 % for EAC, P = 0.1. MAP in SC and EAC were 0.87 (range: 0 - 7) and 1.11 (range: 0 - 13) respectively, P = 0.02. AADR rate was 25 % and 23 % for SC and EAC, respectively, P = 0.5. CONCLUSION Endocuff-assisted colonoscopy does not improve the number of patients with at least one adenoma but it may increase the number of detected adenomas per procedure.
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Affiliation(s)
- Lucas G. Cavallaro
- Gastroenterology Unit, San Martino Hospital, ULSS 1, Belluno, Italy,Corresponding author Lucas G. Cavallaro Gastroenterology UnitSan Martino Hospital ULSS 1Viale Europa 2232100 BellunoItaly+390437516580
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome Italy
| | - Pierenrico Lecis
- Gastroenterology Unit, San Martino Hospital, ULSS 1, Belluno, Italy
| | | | | | | | - Claudia Roldo
- Pathology Unit, San Martino Hospital, ULSS 1, Belluno Italy
| | - Fabio Soppelsa
- Public Health Service, San Martino Hospital, ULSS 1, Belluno, Italy
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19
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Zorzi M, Valiante F, Germanà B, Baldassarre G, Coria B, Rinaldi M, Heras Salvat H, Carta A, Bortoluzzi F, Cervellin E, Polo ML, Bulighin G, Azzurro M, Di Piramo D, Turrin A, Monica F. Comparison between different colon cleansing products for screening colonoscopy. A noninferiority trial in population-based screening programs in Italy. Endoscopy 2016; 48:223-31. [PMID: 26760605 DOI: 10.1055/s-0035-1569574] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS The high volume and poor palatability of 4 L of polyethylene glycol (PEG)-based bowel cleansing preparation required before a colonoscopy represent a major obstacle for patients. The aim of this study was to compare two low volume PEG-based preparations with standard 4 L PEG in individuals with a positive fecal immunochemical test (FIT) within organized screening programs in Italy. PATIENTS AND METHODS A total of 3660 patients with a positive FIT result were randomized to receive, in a split-dose regimen, 4 L PEG or 2 L PEG plus ascorbate (PEG-A) or 2 L PEG with citrate and simethicone plus bisacodyl (PEG-CS). The noninferiority of the low volume preparations vs. 4 L PEG was tested through the difference in proportions of adequate cleansing. RESULTS A total of 2802 patients were included in the study. Adequate bowel cleansing was achieved in 868 of 926 cases (93.7 %) in the 4 L PEG group, in 872 out of 911 cases in the PEG-A group (95.7 %, difference in proportions + 1.9 %, 95 % confidence interval [CI] - 0.1 to 3.9), and in 862 out of 921 cases in the PEG-CS group (93.6 %, difference in proportions - 0.2 %, 95 %CI - 2.4 to 2.0). Bowel cleansing was adequate in 95.5 % of cases when the preparation-to-colonoscopy interval was between 120 and 239 minutes, whereas it dropped to 83.3 % with longer intervals. Better cleansing was observed in patients with regular bowel movements (95.6 %) compared with those with diarrhea (92.4 %) or constipation (90.8 %). CONCLUSION Low volume PEG-based preparations administered in a split-dose regimen guarantee noninferior bowel cleansing compared with 4 L PEG. Constipated patients require a personalized preparation. TRIAL REGISTRATION EudraCT 2012 - 003958 - 82.
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Affiliation(s)
- Manuel Zorzi
- Veneto Cancer Registry, Regione Veneto, Padua, Italy
| | - Flavio Valiante
- Gastroenterologia ed endoscopia digestiva, ULSS 2, Feltre, Italy
| | - Bastianello Germanà
- Dipartimento delle Chirurgie Specialistiche, Gastroenterologia, Ospedale S. Martino, ULSS 1, Belluno, Italy
| | | | - Bartolomea Coria
- Centrale Operativa Screening, Servizio Igiene e Sanità Pubblica, ULSS 6, Vicenza, Italy
| | - Michela Rinaldi
- Gastroenterologia, Ospedale di Conegliano, ULSS 7, Conegliano, Italy
| | - Helena Heras Salvat
- Gastroenterologia, Ospedale S. Maria di Ca' Foncello, ULSS 9, Treviso, Italy
| | - Alessandra Carta
- Endoscopia Digestiva, Chirurgia, ULSS 10, San Donà di Piave, Italy
| | | | | | | | - Gianmarco Bulighin
- Gastroenterologia ed Endoscopia Digestiva, ULSS 20, San Bonifacio, Italy
| | - Maurizio Azzurro
- Endoscopia Digestiva e Gastroenterologia, ULSS 21, Legnago, Italy
| | - Daniele Di Piramo
- Gastroenterologia ed Endoscopia Digestiva, ULSS 22, Bussolengo, Italy
| | - Anna Turrin
- Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venezia, Italy
| | - Fabio Monica
- Gastroenterologia ed Endoscopia, Azienda Ospedaliero Universitaria "Ospedali Riuniti," Trieste, Italy
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20
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Barbara G, Cremon C, Annese V, Basilisco G, Bazzoli F, Bellini M, Benedetti A, Benini L, Bossa F, Buldrini P, Cicala M, Cuomo R, Germanà B, Molteni P, Neri M, Rodi M, Saggioro A, Scribano ML, Vecchi M, Zoli G, Corinaldesi R, Stanghellini V. Randomised controlled trial of mesalazine in IBS. Gut 2016; 65:82-90. [PMID: 25533646 PMCID: PMC4717362 DOI: 10.1136/gutjnl-2014-308188] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 11/20/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Low-grade intestinal inflammation plays a role in the pathophysiology of IBS. In this trial, we aimed at evaluating the efficacy and safety of mesalazine in patients with IBS. DESIGN We conducted a phase 3, multicentre, tertiary setting, randomised, double-blind, placebo-controlled trial in patients with Rome III confirmed IBS. Patients were randomly assigned to either mesalazine, 800 mg, or placebo, three times daily for 12 weeks, and were followed for additional 12 weeks. The primary efficacy endpoint was satisfactory relief of abdominal pain/discomfort for at least half of the weeks of the treatment period. The key secondary endpoint was satisfactory relief of overall IBS symptoms. Supportive analyses were also performed classifying as responders patients with a percentage of affirmative answers of at least 75% or >75% of time. RESULTS A total of 185 patients with IBS were enrolled from 21 centres. For the primary endpoint, the responder patients were 68.6% in the mesalazine group versus 67.4% in the placebo group (p=0.870; 95% CI -12.8 to 15.1). In explorative analyses, with the 75% rule or >75% rule, the percentage of responders was greater in the mesalazine group with a difference over placebo of 11.6% (p=0.115; 95% CI -2.7% to 26.0%) and 5.9% (p=0.404; 95% CI -7.8% to 19.4%), respectively, although these differences were not significant. For the key secondary endpoint, overall symptoms improved in the mesalazine group and reached a significant difference of 15.1% versus placebo (p=0.032; 95% CI 1.5% to 28.7%) with the >75% rule. CONCLUSIONS Mesalazine treatment was not superior than placebo on the study primary endpoint. However, a subgroup of patients with IBS showed a sustained therapy response and benefits from a mesalazine therapy. TRIAL REGISTRATION NUMBER ClincialTrials.gov number, NCT00626288.
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Affiliation(s)
- Giovanni Barbara
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Vito Annese
- Division of Gastroenterology SOD2, University Hospital Careggi, Florence, Italy
| | - Guido Basilisco
- Gastroenterology Unit, Ospedale Maggiore, Policlinico, Milan, Italy
| | - Franco Bazzoli
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Massimo Bellini
- Gastroenterology Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Antonio Benedetti
- Department of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ancona, Italy
| | - Luigi Benini
- Gastroenterology Unit, University of Verona, Verona, Italy
| | - Fabrizio Bossa
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Paola Buldrini
- Gastroenterology Unit of Comacchio/Lagosanto, Ferrara, Italy
| | - Michele Cicala
- Gastroenterology Unit, University Campus Bio-Medico of Rome, Rome, Italy
| | - Rosario Cuomo
- Digestive Motility Diseases, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | | | - Paola Molteni
- Gastroenterology Unit, Department of Clinical Science, "L. Sacco" University Hospital, Milan, Italy
| | - Matteo Neri
- Department of Medicine and Aging Sciences and CESI, G. D'Annunzio University and Foundation, Chieti, Italy
| | - Marcello Rodi
- Gastroenterology Unit, St. Andrea Hospital, Vercelli, Italy
| | - Alfredo Saggioro
- Department of Digestive Diseases, Hepatology and Clinical Nutrition, Dell'Angelo Hospital, Venice, Italy
| | | | - Maurizio Vecchi
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Roberto Corinaldesi
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
| | - Vincenzo Stanghellini
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, Bologna, Italy
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Tursi A, Brandimarte G, Di Mario F, Andreoli A, Annunziata ML, Astegiano M, Bianco MA, Buri L, Cammarota G, Capezzuto E, Chilovi F, Cianci M, Conigliaro R, Del Favero G, Di Cesare L, Di Fonzo M, Elisei W, Faggiani R, Farroni F, Forti G, Germanà B, Giorgetti GM, Giovannone M, Lecca PG, Loperfido S, Marmo R, Morucci P, Occhigrossi G, Penna A, Rossi AF, Spadaccini A, Zampaletta C, Zilli M, Zullo A, Scarpignato C, Picchio M. Development and validation of an endoscopic classification of diverticular disease of the colon: the DICA classification. Dig Dis 2014; 33:68-76. [PMID: 25531499 DOI: 10.1159/000366039] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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
BACKGROUND A validated endoscopic classification of diverticular disease (DD) of the colon is lacking at present. Our aim was to develop a simple endoscopic score of DD: the Diverticular Inflammation and Complication Assessment (DICA) score. METHODS The DICA score for DD resulted in the sum of the scores for the extension of diverticulosis, the number of diverticula per region, the presence and type of inflammation, and the presence and type of complications: DICA 1 (≤ 3), DICA 2 (4-7) and DICA 3 (>7). A comparison with abdominal pain and inflammatory marker expression was also performed. A total of 50 videos of DD patients were reassessed in order to investigate the predictive role of DICA on the outcome of the disease. RESULTS Overall agreement in using DICA was 0.847 (95% confidence interval, CI, 0.812-0.893): 0.878 (95% CI 0.832-0.895) for DICA 1, 0.765 (95% CI 0.735-0.786) for DICA 2 and 0.891 (95% CI 0.845-0.7923) for DICA 3. Intra-observer agreement (kappa) was 0.91 (95% CI 0.886-0.947). A significant correlation was found between the DICA score and C-reactive protein values (p = 0.0001), as well as between the median pain score and the DICA score (p = 0.0001). With respect to the 50 patients retrospectively reassessed, occurrence/recurrence of disease complications was recorded in 29 patients (58%): 10 (34.5%) were classified as DICA 1 and 19 (65.5%) as DICA 2 (p = 0.036). CONCLUSIONS The DICA score is a simple, reproducible, validated and easy-to-use endoscopic scoring system for DD of the colon.
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Cavallaro LG, Monica F, Germanà B, Marin R, Sturniolo GC, Saia M. Time trends and outcome of gastrointestinal bleeding in the Veneto region: a retrospective population based study from 2001 to 2010. Dig Liver Dis 2014; 46:313-7. [PMID: 24365335 DOI: 10.1016/j.dld.2013.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 06/06/2013] [Revised: 11/03/2013] [Accepted: 11/12/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastrointestinal bleeding is the most frequent emergency for gastroenterologists. Despite advances in management, an improvement in mortality is still not evident. AIM Determining time trends of gastrointestinal bleeding hospitalization and outcomes from 2001 to 2010 in the Veneto Region (Italy). PATIENTS AND METHODS Data of patients admitted with gastrointestinal bleeding from Veneto regional discharge records were retrospectively evaluated. Chi-squared and multivariate logistic regression model were used. RESULTS Overall, 44,343 patients (mean age 64.2 ± 8.6 years) with gastrointestinal bleeding were analysed: 23,450 (52.9%) had upper, 13,800 (31.1%) lower, and 7093 (16%) undefined gastrointestinal bleeding. Admission rate decreased from 108.0 per 100,000 in 2001 to 80.7 in 2010, mainly owing to a decrease in upper gastrointestinal bleeding (64.4 to 35.9 per 100,000, p<0.05). Reductions in hospital fatality rate (from 5.3% to 3%, p<0.05), length of hospital stay (from 9.3 to 8.7 days, p<0.05), and need for surgery (from 5.6% to 5%, p<0.05) were observed. Surgery (OR: 2.97, 95% CI: 2.59-3.41) and undefined gastrointestinal bleeding (OR: 2.89, 95% CI: 2.62-3.19) were found to be risk factors for mortality. CONCLUSIONS Patient admissions for gastrointestinal bleeding decreased significantly over the years, owing to a decrease in upper gastrointestinal bleeding. Improved outcomes could be related to regional dedicated clinical gastroenterological management.
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Affiliation(s)
| | - Fabio Monica
- Gastroenterology Unit, S. Bassiano Hospital, Bassano del Grappa (VI), Italy
| | | | - Renato Marin
- Gastroenterology Unit, Hospital of Dolo (VE), Italy
| | | | - Mario Saia
- Health Directorate, Veneto Region, Venezia, Italy
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23
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Zaninotto G, Minnei F, Guirroli E, Ceolin M, Battaglia G, Bellumat A, Betetto G, Bozzola L, Cassaro M, Cataudella G, Dal Bò N, Farinati F, Florea G, Furlanetto A, Galliani E, Germanà B, Guerini A, Macrì E, Marcon V, Mastropaolo G, Meggio A, Miori G, Morelli L, Murer B, Norberto L, Togni R, Valiante F, Rugge M. The Veneto Region's Barrett's Oesophagus Registry: aims, methods, preliminary results. Dig Liver Dis 2007; 39:18-25. [PMID: 17141593 DOI: 10.1016/j.dld.2006.09.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 07/18/2006] [Accepted: 09/25/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND The natural history of Barrett's Oeosphagus is not completely clarified and Barrett's Oeosphagus Registries are considered useful tools to expand our knowledge on this disease. A Barrett's Oeosphagus Registry has been therefore established in the Veneto Region and neighbouring provinces. AIMS The aims of the Registry are to assess the demographical, endoscopical and histological characteristics of Barrett's Oeosphagus patients; the prevalence of non-invasive neoplasia and Barrett's Adenocarcinoma and the timing and incidence of Barrett's Oeosphagus progression to malignancy. METHODS An interdisciplinary committee of endoscopists, pathologists and information technology experts was established in 2004 to design a website-based Barrett's Oesophagus Registry for the Veneto Region and neighbouring north-eastern Italian provinces. Protocols for endoscopies and biopsies and standard reports were carefully defined. RESULTS In the first 18 months, 397 patients with endoscopically visible and histologically proven Barrett's Oeosphagus were enrolled in the Registry; the median age of these patients was 66 years (male:female=3:1). Most patients (75%) had a Short Segment of Barrett's Oesophagus (<or=3 cm) and only 1 in 4 had a Long Segment of Barrett's Oesophagus (>3 cm). Long Segment of Barrett's Oesophagus patients were 5 years older than the Short Segment of Barrett's Oesophagus patients (p<0.05), suggesting a progression from Short Segment of Barrett's Oesophagus to Long Segment of Barrett's Oesophagus. Though no data are available on the incidence of non-invasive neoplasia or Barrett's Adenocarcinoma (i.e., progression to cancer at least 12 months after enrolment), the prevalence of neoplastic lesions (found within 12 months of enrolment) was 5% for Short Segment of Barrett's Oesophagus and 19% for Long Segment of Barrett's Oesophagus, indicating that a careful multiple-biopsy endoscopic protocol is needed, especially when Long Segment of Barrett's Oesophagus are suspected at endoscopy. The prevalence of Barrett's Adenocarcinoma among patients with non-invasive neoplasia was 1/17 cases of low-grade non-invasive neoplasia and 2/3 cases of high-grade non-invasive neoplasia, indicating that these patients require strict endoscopic and bioptic follow-up. CONCLUSION A regional Barrett's Oeosphagus Registry is feasible at a relatively low cost and enables significant data to be collected in a relatively short time. The use of a standardised endoscopic nomenclature and report form, a strict biopsy protocol, a standard report for pathologists improves the quality of endoscopic and histological diagnoses.
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Affiliation(s)
- G Zaninotto
- Department of General Surgery & Organ Transplantation, University of Padova, Padova, Italy
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Benvenuti S, Zancanella L, Piazzi L, Comberlato M, Chilovi F, Germanà B, Lecis P, Brosolo P, Ederle A. Prevention of post-ERCP pancreatitis with somatostatin versus gabexate mesylate: A randomized placebo controlled multicenter study. Dig Liver Dis 2006. [DOI: 10.1016/s1590-8658(06)80037-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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25
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Mazzon D, Germanà B, Poole D, Celato M, Bernardi L, Calleri G, Fant F, Bernard M, Lecis P, Costan Biedo F. Conscious sedation during endoscopic retrograde colangiopancreatography: implementation of SIED-SIAARTI-ANOTE guidelines in Belluno Hospital. Minerva Anestesiol 2005; 71:101-9. [PMID: 15714186] [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: 05/01/2023]
Abstract
AIM In this study we describe the results of adoption of local guidelines for conscious sedation (CS) during endoscopic-retrograde-cholangiopancreatography (ERCP) in Belluno Hospital. Local guidelines were created referring to SIED-SIAARTI-ANOTE guidelines for CS in gastrointestinal endoscopy. METHODS Between January 2002 and February 2004, 300 ERCPs to be performed under CS have been scheduled. According to local guidelines CS was performed by the gastroenterologist assisted by an anesthesia nurse. An anesthesiologist was always on call in the intensive care unit (ICU) for emergencies and could be on the site in less than 5 min. RESULTS In 278 patients the procedure was performed safely and effectively by the gastroenterologist without any anesthesiological assistance. At follow-up controls patients had either positive or no recollection of the procedure. An anesthesiologist was called in 13 cases to perform deep sedation and in 9 cases to deal with undesired effects (arterial hypertension in 5 patients, 1 episode of bradycardia, 1 of ventricular tachycardia, 1 of atrial fibrillation and 1 of hypoxia). CONCLUSION In our experience, CS during ERCP can be safely performed autonomously by a gastroenterologist in the majority of cases. Drug prescription protocol and the presence of an anesthesia nurse create ideal conditions for the operator, patient comfort and good results with a low incidence of undesired events and few calls for the anesthesiologist. To allow safe and effective performance of CS, the Department of Anesthesia should promote the in-service training and up dating of gastroenterologists and anesthesia nurses.
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Affiliation(s)
- D Mazzon
- Department of Anesthesiology and Intensive Care, San Martino Hospital, Belluno
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Biedo FC, Germanà B. [Requirements of the clinician]. Radiol Med 2003; 106:88-9. [PMID: 14710427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Franco Costan Biedo
- Divisione di Gastroenterologia ed Endoscopia Digestiva, Ospedale Civile San Martino, Belluno
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Lecis P, Germanà B, Papa N, Bertiato G, Doglioni C, Galliani E, Biedo FC. [p-ANCA and ASCA antibodies in the differential diagnosis between ulcerative rectocolitis and Crohn's disease]. Recenti Prog Med 2002; 93:308-13. [PMID: 12050913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
UNLABELLED Anti-Saccaromyces cerevisiae antibodies (ASCA) seem to be associated with Crohn's disease (CD), while anti-neutrophil cytoplasm antibodies (p-ANCA) seem to be a recognised marker for ulcerative colitis (UC). AIM Of our study was to determine whether the presence of ASCA and p-ANCA antibodies could differentiate CD from UC and IBD from aspecific chronic colitis (ACC). METHODS Serum samples were obtained from 23 patients with CD and 32 with UC, and from 13 patients with aspecific chronic colitis. Diagnosis was established on clinical findings, endoscopy and histology. Determination of ASCA and p-ANCA antibodies was performed using indirect immunofluorescence technique and ELISA, respectively. RESULTS 20% CD patients against 50% UC patients expressed p-ANCA (p < 0.05). Vice versa 61% CD patients against 16% UC patients expressed ASCA (p < 0.05). The combination of positive ASCA and negative p-ANCA determined a sensibility, specificity and positive predictive value of 45%, 91% and 75% respectively, for diagnosis of CD. The combination of positive p-ANCA and negative ASCA determined a sensibility, specificity and positive predictive value of 44%, 95% and 94% respectively, for diagnosis of UC. CONCLUSION Our results indicate that ASCA are principally expressed in patients with CD, by contrast p-ANCA seem to be strongly associated with UC. The combination of these two tests can be useful in evaluating patients with indeterminate colitis, distinguishing UC from CD.
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Affiliation(s)
- Pierenrico Lecis
- Unità Operativa Autonoma di Gastroenterologia, Ospedale San Martino, Belluno
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Zaninotto G, Avellini C, Barbazza R, Baruchello G, Battaglia G, Benedetti E, Bernardi A, Boccù C, Bonoldi E, Bottona E, Bozzola L, Canizzaro R, Canzonieri V, Caroli A, Carta A, Colonna A, Costa-Biedo F, Dal Bò N, De Bastiani R, De Bernardin M, De Bernardinis F, De Pretis G, Di Mario F, Doglioni C, Donisi PM, Franceschi M, Furlanetto A, Germanà B, Grassi SA, Macor V, Marcon V, Marin R, Meggiato T, Melina V, Menghi A, Milan R, Militello C, Molena D, Monica F, Murer B, Nisi E, Olivieri P, Orzes N, Parenti A, Paternello E, Penelli N, Pilotto A, Piscioli F, Pozzato F, Ronzani G, Rugge M, Saggioro A, Stracca-Pansa V, Togni R, Valiante F, Vianello F. Prevalence of intestinal metaplasia in the distal oesophagus, oesophagogastric junction and gastric cardia in symptomatic patients in north-east Italy: a prospective, descriptive survey. The Italian Ulcer Study Group "GISU". Dig Liver Dis 2001; 33:316-21. [PMID: 11432508 DOI: 10.1016/s1590-8658(01)80084-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Incidence of adenocarcinoma of distal oesophagus and gastric cardia, probably arising from areas of intestinal metaplasia, has been increasing rapidly. AIMS To define prevalence of intestinal metaplasia of distal oesophagus, oesophagogastric junction and gastric cardia and to evaluate potential associated factors, by means of a prospective multicentre study including University and teaching hospitals, and primary and tertiary care centres. PATIENTS Each of 24 institutions involved in study enrolled 10 consecutive patients undergoing first-time routine endoscopy for dyspeptic symptoms. METHODS Patients answered symptom questionnaires and underwent gastroscopy Three biopsies were taken from distal oesophagus, oesophago-gastric junction and gastric cardia, and were stained with haematoxylin and eosin. Specimens were also evaluated for Helicobacter pylori infection. RESULTS A total of 240 patients (124 male, 116 female; median age 56 years, range 20-90) were enrolled in study. Intestinal metaplasia affected distal oesophagus in 5, oesophago-gastric junction in 19 and gastric cardia in 10 patients. Low-grade dysplasia was found at distal oesophagus and/or oesophago-gastric junction of 3/24 patients with intestinal metaplasia vs 2/216 without intestinal metaplasia (p<0.05). A significant association was found between symptoms and presence of intestinal metaplasia, regardless of location, and between Helicobacter pylori infection and intestinal metaplasia at oesophago-gastric junction. CONCLUSIONS Intestinal metaplasia of distal oesophagus, oesophagogastric-junction and gastric cardia is found in a significant proportion of symptomatic patients undergoing gastroscopy and is associated with dysplasia in many cases. Although prevalence of dysplasia seems to decrease when specialized columnar epithelium is found in short segment, or even focally in oesophago-gastric junction, these small foci of intestinal metaplastic cells may represent source of most adenocarcinomas of cardia.
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Affiliation(s)
- G Zaninotto
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Padova, Facoltà di Medicina, Italy.
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Germanà B, Galliani E, Lecis P, Costan F. [Diagnosis of Helicobacter pylori infections using isotope-selective non dispersive infrared spectrometry with 13C-urea breath test]. Recenti Prog Med 2001; 92:113-6. [PMID: 11294099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE The 13C-Urea Breath Test (13C-UBT) is a non-invasive simple and reliable test for the diagnosis of Helicobacter pylori infection. Widespread use of the test is limited by the high cost of isotope-ratio mass-spectrometry that is required for analysis of the breath samples. The aim of our study was: 1) evaluate the accuracy of a simple optical method called isotope-selective non-dispersive infrared spectrometry (NDIRS), which is designed to measure 13CO2/12CO2 ratio; 2) evaluate the possibility to reduce timing of breath samples collection after 13C-urea ingestion. METHODS 13C-UBT and gastroscopy were performed in one hundred patients (mean age: 51 years; range: 18-81 years; M/F: 48/52) after overnight fasting. None had taken antibiotics, proton pump inhibitor or bismuth-containing preparations for at least four weeks. Two biopsies from the antrum and two from the body of the stomach were obtained from each patient to investigate the Helicobacter pylori status. Breath samples were collected from each patient in aluminised plastic bags with a volume of 1200 ml, before and 10, 20 and 30 minutes after ingestion of 75 mg 13C-urea dissolved in 200 ml of orange juice. A value of "Delta-Over-Baseline" higher than 4@1000 was considered positive. The operators of each device were unaware of Helicobacter pylori status. RESULTS 54/55 patients resulted positive on 13C-UBT in respect of immunohistochemistry. 44/45 patients resulted negative on 13C-UBT in respect of immunohistochemistry. The sensibility resulted 98.1%, specificity 97.7%. No significant difference between sample collection at 10, 20 or 30 minutes after ingestion of 13C-urea was found (Chi square: p: n.s.). DISCUSSION This study shows that the diagnostic accuracy of infrared spectroscopy is excellent and comparable with data of other authors about conventional isotope-ratio mass spectrometry. No significant difference between sample collection at 10, 20 or 30 minutes after ingestion of 13C-urea was found (Chi square: p: n.s.). Timing of sample collection may be reduced from 30 to 10 minutes with the purpose of cut down more the costs for this test.
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Affiliation(s)
- B Germanà
- Unità Operativa di Gastroenterologia ed Endoscopia digestiva, Ospedale San Martino, Belluno
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Pilotto A, Di Mario F, Franceschi M, Leandro G, Battaglia G, Germanà B, Marin R, Valerio G. Pantoprazole versus one-week Helicobacter pylori eradication therapy for the prevention of acute NSAID-related gastroduodenal damage in elderly subjects. Aliment Pharmacol Ther 2000; 14:1077-82. [PMID: 10930903 DOI: 10.1046/j.1365-2036.2000.00804.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [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: 12/23/2022]
Abstract
AIM To compare the efficacy of pantoprazole vs. a one-week Helicobacter pylori eradication therapy for the prevention of NSAID-related gastroduodenal damage. METHODS Patients over 60 years old with symptoms and/or a history of ulcer who needed NSAID treatment were evaluated by endoscopy. H. pylori positive subjects who had no severe gastroduodenal lesions were randomized to take, concomitantly with NSAID therapy, either: (i) pantoprazole 40 mg daily plus amoxycillin 1 g b.d. and clarithromycin 250 mg b.d. for 1 week (35 subjects, Group PAC) or (ii) pantoprazole 40 mg daily for 1 month (34 subjects, Group P). Endoscopy was repeated after 1 month. RESULTS A significantly higher incidence of severe gastroduodenal damage was found in Group PAC than in Group P (29% vs. 9%, P<0.05). The percentages of patients worsened, unchanged and improved after 1 month were, respectively: Group PAC: 46%, 46%, and 9% and Group P: 7%, 65%, and 29% (P<0.0008). The percentage of H. pylori-negative subjects was 89% in Group PAC and 52% in Group P (P=0.0009). The incidence of gastroduodenal damage was higher in Group PAC treatment failures than in cured patients (50% vs. 25.8%, P=ns). CONCLUSION One month of pantoprazole was more effective than a proton pump inhibitor-based triple therapy in the prevention of gastroduodenal damage in elderly H. pylori-positive NSAID users.
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Affiliation(s)
- A Pilotto
- Digestive Pathophysiology Center, Department of Geriatrics, Vicenza, Italy.
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Di Mario F, Battaglia F, Dal Bò N, Leandro G, Benedetti E, Bottona E, Caroli A, Costan-Biedo F, De Bastiani R, Germanà B, Andrea Grassi S, Madia D, Marcon V, Marin R, Monica F, Olivieri P, Orzes N, Pilotto A, Ronzani G, Saggioro A, Tafner G. Cure of Helicobacter pylori-positive active duodenal ulcer patients: a double-blind, multicentre, 12-month study comparing a two-week dual vs a one-week triple therapy. GISU (Interdisciplinary Group for Ulcer Study). Dig Liver Dis 2000; 32:108-15. [PMID: 10975783 DOI: 10.1016/s1590-8658(00)80395-3] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS To compare a two-week dual therapy to a one-week triple therapy for the healing of duodenal ulcer and the eradication of the Helicobacter pylori infection. PATIENTS AND METHODS A total of 165 patients with active duodenal ulcer were enrolled in the study. At entry, endoscopy, clinical examination and laboratory tests were performed. Histology and the rapid urease test were used to diagnose Helicobacter pylori infection. Patients received either lansoprazole 30 mg plus amoxycillin 1 g bid for two weeks (two-week, dual therapy) or lansoprazole 30 mg plus amoxycillin 1 g plus tinidazole 500 mg bid for one week plus lansoprazole qd for an additional week (one-week, triple therapy). Two and twelve months after cessation of therapy, endoscopy and clinical assessments were repeated. RESULTS Duodenal ulcer healing and Helicobacter pylori eradication were both significantly greater (p<0.0001) in the triple therapy group (healing: 98.6%; Helicobacter pylori cure rate: 72.6%) than in the dual therapy group (healing: 77.3%; Helicobacter pylori cure rate: 33.3%). Ulcers healed more frequently in Helicobacter pyloricured than in Helicobacter pylori-not cured patients (94.9% vs. 77.2%; p<0.0022). After one year, Helicobacter pylori eradication was re-confirmed in 46/58 patients previously treated with the triple therapy and in 10/40 patients treated with the dual therapy [p<0.0001]. Only three duodenal ulcer relapses were observed throughout follow-up: all were in Helicobacter pylori-not cured patients. CONCLUSIONS Triple therapy was more effective than dual both in curing Helicobacter pylori infection and healing active duodenal ulcers. The speed of ulcer healing obtained after only 7 days of antibiotics and 14 days of proton pump inhibitors confirmed that longer periods of anti ulcer therapy were not necessary. Helicobacter pylori -not cured patients had more slowly healing ulcers which were more apt to relapse when left untreated.
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Affiliation(s)
- F Di Mario
- Gastroenterology Unit, University of Padova, Italy
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Abstract
AIMS To verify whether the proposed new silver staining method compares favourably with other well established methods in the detection of Helicobacter pylori in gastric biopsies. METHODS One hundred and forty pairs of antral and fundic biopsies, routinely formalin fixed and paraffin wax embedded, from 70 consecutive unselected patients were stained with haematoxylin and eosin, modified Giemsa, and the proposed H pylori silver stain (HpSS). H pylori immunodetection was performed in the same material with a polyclonal antiserum against H pylori. RESULTS H pylori was detected in 89 biopsies from 48 patients with haematoxylin and eosin; in a further five biopsies (one antral and four fundic) with Giemsa stain, thereby identifying one more H pylori infected patient. The new silver staining method was positive in all the cases detected by these two methods and detected three extra infected patients (five more positive biopsies). Immunohistochemistry detected one more positive case (two positive biopsies) not identified by any of the other methods. CONCLUSIONS The HpSS method proposed is highly sensitive in detecting H pylori; it is simple and it compares well with other methods used routinely for evaluating gastric biopsies for H pylori.
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Affiliation(s)
- C Doglioni
- Department of Pathology, City Hospital, Belluno, Italy
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Di Mario F, Battaglia G, Grassi SA, Vigneri S, Scialabba A, Termini R, Dotto P, Germanà B, Feriana M, Vianello F, Favero GD. Different doses of omeprazole in the maintenance treatment of patients with peptic ulcers resistant to H2-blockers. Curr Ther Res Clin Exp 1994. [DOI: 10.1016/s0011-393x(05)80321-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Di Mario F, Battaglia G, Ferrana M, Benvenuti M, Grassi S, Dal Bò N, Pilotto A, Salandin S, Grasso G, Pasini M, Germanà B. Sucralfate gel versus ranitidine in the treatment of gastroesophageal reflux disease: A controlled study. Curr Ther Res Clin Exp 1994. [DOI: 10.1016/s0011-393x(05)80173-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Vianello F, Germanà B, Plebani M, Dotto P, Del Bianco T, Laino G, Dal Santo P, Battaglia G, Dal Bö N, Salandin S, Ferrana M, Rugge M, Di Mario F. A preliminary report on Helicobacter pylori and antral gastrin concentration in patients with duodenal ulcer. Curr Ther Res Clin Exp 1994. [DOI: 10.1016/s0011-393x(05)80071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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36
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Farinati F, Valiante F, Germanà B, Della Libera G, Baffa R, Rugge M, Plebani M, Vianello F, Di Mario F, Naccarato R. Prevalence of Helicobacter pylori infection in patients with precancerous changes and gastric cancer. Eur J Cancer Prev 1993; 2:321-6. [PMID: 8358284 DOI: 10.1097/00008469-199307000-00006] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Several papers suggested a role for H. pylori infection in gastric cancer. We evaluated the prevalence of H. pylori infection in an endoscopic population of patients with gastric precancerous conditions and lesions by studying biopsies from 252 patients and recording the presence and degree of H. pylori infection. Patients were subgrouped as follows: chronic non-atrophic gastritis (CG), chronic atrophic gastritis (CAG), intestinal metaplasia (IM), epithelial dysplasia (ED) and gastric cancer (K). As control populations, patients with duodenal ulcer (DU) and patients with no endoscopic and histologic damage (CO) were investigated. H. pylori infection rate increased with age, but became significantly lower (P < 0.001) with the progression of gastric mucosal damage: DU 85%, CG 72%, CAG 58%, particularly in the antral type (39%), IM 63% overall, ED 44% and K 35%. The density of colonization showed the same trend (P < 0.001). Of the K patients, only 36% were H. pylori positive in the adjacent mucosa. Anti-H. pylori antibodies (IgG, IgA and IgM) were also tested. A concordance in the diagnosis between histology and serology was obtained in 82% of the cases. In our experience, H. pylori infection correlates inversely with the presence of gastric precancerous changes and cancer. A cautious interpretation of the epidemiological data regarding H. pylori infection and gastric cancer is therefore, in our opinion, mandatory.
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Affiliation(s)
- F Farinati
- Cattedra Mallattie Apparato Digerente, Università di Padova, Italy
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37
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Di Mario F, Dotto P, Vianello F, Germanà B, Grassi SA, Del Favero G, Faggian D, Plebani M, Naccarato R. Effects of H2 blockers and omeprazole on peptic secretion: a prospective, randomized study in duodenal ulcer subjects. Acta Gastroenterol Belg 1993; 56:223-8. [PMID: 8103616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
UNLABELLED Aim of the present study has been to investigate the possible modifications of peptic secretion after a period with H2 blockers and omeprazole, evaluating in the same patient pepsinogen group A levels in gastric mucosa and pepsin in gastric juice. 54 active duodenal ulcer were studied: during an upper gastrointestinal endoscopy a sample of gastric juice and one fundus biopsy were taken before and after four weeks 300 mg/daily ranitidine (23 patients), 40 mg/daily famotidine (7 patients), 300 mg/daily nizatidine (12 patients) therapy and 40 mg/daily omeprazole (12 patients) therapy. RESULTS H2-blockers and omeprazole treatment determines a non statistically significant decrease of pepsin in gastric juice and in pepsinogen group A in gastric mucosa.
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Affiliation(s)
- F Di Mario
- Istituto di medicina interna, Cattedra malattie apparato digerente, Università degli studi di Padova
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38
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Aruin LI, Sarkisov DS, Lisenco OA, O’Connor H, Cunnane K, Queiroz DMM, Mendes EN, Rocha GA, Moura SB, Resende LMH, Cunha-Melo JR, Carvalho AST, Coelho LGV, Passos MCG, Castro LP, Oliveira CA, Lima GF, Barbosa AJA, Passos MCF, Castro P, Testino G, Perasso A, Boixeda D, de Argila CM, Vila T, Redondo C, Cantón R, Avila C, Alvarez-Baleriola I, de Rafael L, Witteman EM, Becx MCJM, De Koning RW, Silva JCP, Nogueira AMMF, Paulino E, Miranda CR, Rudelli A, Vialette G, Sevestre H, Capron D, Ducroix JP, Smail A, Baillet J, Zerbib F, Seurat PL, Sauvet P, Bechade D, Rapp N, Peacock JS, Marchildon P, Zamaniyan F, Bond-Green J, Liu P, Ciota L, Lee A, Coltro N, Chen M, Alhomsi M, Adeyemi E, Goodwin CS, Rizzi C, Maieron R, Desinan L, Avellini C, Da Broi GL, Beltrami CA, Proto G, Grimaldi F, Proietti A, Scott CA, Takasashi S, Igarshi H, Ishiyama N, Nakamura K, Masubuchi N, Ozaki M, Saito S, Aoyagi T, Itoh T, Hirata I, Matysiak-Budnik T, Poniewierka E, Gasciniak G, Jelen M, Knapik Z, Gosciniak G, Neri WM, Susi D, Bovani I, Laterza F, Cuccurullo F, Amorosi A, Bechi P, Dei R, Mazzanti R, Lynch DAF, Sobala GM, Gledhill A, Jackson P, Crabtree JE, Foster PN, Axon ATR, Dixon MF, Maaroos HI, Sipponen P, Kekki M, Di Bello MG, Raspanti S, Vardar T, Sancho FJ, Olivia E, Saiz S, Mones JP, Hood C, Lesna M, Alcolado R, Knitht T, Greaves S, Wilson A, Corlett M, Webb P, Wyatt J, Newell D, Hengels K, Forman D, Elder JB, Farinati F, Cardin R, Valiante F, Libera GD, Plebani M, Rugge M, Baffa R, Guido M, Mario FD, Naccarato R, Gilvarry J, Leen E, Sant S, Sweeney E, Morain CO, Schönlebe J, Riedel H, Prinz M, Hahn L, Porst H, Lohmann H, Orsini E, Guerre J, Tulliez M, Chaussade S, Gaudric M, Canton R, Sampedro J, García-Plaza A, Cognein P, Parodi MC, Tucci A, Gasperoni S, Stanghellini V, Tosetti C, Paparo GF, Varoli O, Siringo S, Santucci R, Monetti N, Barbara G, Corinaldesi R, Di Mario F, Dotto P, Vianello F, M. F, Grasso GA, Bianco TD, Laino G, Germanà B, Battaglia G, Axelson CK, Andersen LP, Szecsi PB, Olsen KN, Lundborg CJ, Andre C, Descos L, Martin A, Cavagna S, Brassens-Rabbé MP, Wu S, Wadström T, Mégraud F, Perdichizzi G, Muratori L, Pallio S, Bottair M, T. Fera M, Quattrocchi E, Caruso V, Karttunen T, Kerola T, Kartttunen R, Niemelä S, Kosunen TU, Bonchviam F, Pretolani S, Baraldine M, Cilla D, Baldinelli S, Gasparrini G. Pathology. Ir J Med Sci 1992. [DOI: 10.1007/bf02942888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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39
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Xu SG, Zotz RB, Recklinghausen GV, Meusers P, Goebell H, Khandekar MAK, Lesseis AM, Eastwood MA, Palmer KR, Rizzi C, Avellini C, Scott CA, Floretti G, Desinan L, Beltrami CA, Igarashi H, Takahashi S, Ishiyama N, Nakamura K, Masubuchi N, Saito S, Aoyagi T, Itoh T, Hirata I, Miglio F, Miglioli M, Mazzeo V, Holton J, Mulè P, Menegatti M, Maiolo P, Grazia E, Bini A, Gusmaroli R, Casadei A, Valpiani D, Gaudio M, Bazzocchi R, Barbara L, Webb P, Forman D, Ierardi E, Monno RA, Ingrosso M, Panza P, Lorenzis AD, Rizzi S, Pisani A, Valenza M, Francavilla A, Fukuda Y, Inoue H, Yamamoto I, Tonokatsu Y, Tamura T, Hori S, Shimoyama T, Little CL, Corbett-Feeney G, O’Callaghan J, McCarthy CF, Testoni PA, Colombo E, Bagnolo F, Jonghi-Lavarini E, Scelsi R, Fiocca R, Farinati F, Valiante F, Delia Libera G, Germanà B, Baffa R, Rugge M, Vianello F, Mario FD, Fox JG, Blanco M, Murphy JC, Kabok Z, Pappo J. Gastric cancer. Ir J Med Sci 1992. [DOI: 10.1007/bf02942892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Di Mario F, Battaglia G, Pasqualetti P, Grassi SA, Leandro G, Vio A, Germanà B, Vianello F, Dotto P, Naccarato R. Individualized treatment of duodenal ulcer disease. A pilot study. Hepatogastroenterology 1992; 39:273-6. [PMID: 1354634] [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: 03/25/2023]
Abstract
UNLABELLED A substantial number of duodenal ulcer (DU) patients relapse despite maintenance treatment with antisecretory drugs. The influence of certain risk factors and the heterogeneity of the disease could explain such behavior. The present prospective, open study compares the one-year clinical outcome (with upper GI endoscopy at the beginning of the study, at 6 and 12 months, and at every symptomatic relapse) of four groups of DU subjects, consecutively recruited from December 1987 to December 1988, separated in accordance with whether or not a bleeding DU episode had previously occurred, and whether or not an evaluation of gastric acid secretion had been made. Thus, Group I (17 patients; 12 males, 5 females) included heavy smokers and/or gastric acid hypersecretors; Group II (13 patients; 12 males, 1 female) non- or light smokers non-hypersecretors; Group III (34 patients; 22 males, 12 females) subjects with unknown gastric acid secretion; Group IV (33 patients; 30 males, 3 females) previously bleeding DU patients. All patients, except those in Group II (who were left untreated), were given ranitidine 150 mg at bedtime. The outcome of Groups I+II was compared with that of Group III (considered as "standard therapy") and Group IV patients, the latter presumably with a low risk of relapse because of the low prevalence of smokers. STATISTICS Chi-square test, Fisher's exact test, analysis of variance and the logrank test. During the year of follow-up, 27/97 patients withdrew from the study, while 18 had a DU relapse (remission rates 82.1% +/- 7.4% in Groups I+II, 70.5% +/- 8.4% in Group III, 87.5% +/- 5.9% in Group IV).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Di Mario
- Divisione di Gastroenterologia R. Farini, Padova, Italy
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41
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Di Mario F, Gottardello L, Germanà B, Dotto P, Grassi SA, Vianello F, Battaglia G, Leandro G, Burra P, Salvagnini M. Peptic ulcer in cirrhotic patients: a short- and long-term study with antisecretory drugs. Ital J Gastroenterol 1992; 24:122-5. [PMID: 1348650] [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: 03/25/2023]
Abstract
The clinical course of gastric and duodenal ulcer and the efficacy of H2 blockers in ulcer healing and the prevention of relapse in cirrhotic liver patients were studied. Seventy-four cirrhotic patients with endoscopically proven acute gastric ulcer (30), duodenal ulcer (34) or a combination of both gastric and duodenal ulcers (10) were treated for six weeks with either Cimetidine 800 mg/daily (27) or Ranitidine 300 mg/daily (47). Of the 77 patients 49 (66.2%) were healed after therapy, 11 cases (14.8%) remained unhealed even after two additional cycles of the same treatment and four were lost to follow-up. After an endoscopically proven healing of the active ulcer, 51 patients took part in the long-term study over a mean period of 24 months: 21.5% of the 27 patients were treated with a maintenance dosage of H2 blockers and 29.1% of the 24 patients left without therapy relapsed during the first year. We conclude that the ulcer healing rate with H2 blockers is lower and the relapse rate higher in cirrhotic patients than in the general ulcer population.
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Affiliation(s)
- F Di Mario
- Divisione di Gastroenterologia R Farini, Padova, Italy
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43
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Zaninotto G, Di Mario F, Costantini M, Baffa R, Germanà B, Dal Santo PL, Rugge M, Bolzan M, Naccarato R, Ancona E. Oesophagitis and pH of refluxate: an experimental and clinical study. Br J Surg 1992; 79:161-4. [PMID: 1555066 DOI: 10.1002/bjs.1800790222] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This experimental and clinical study examined the relationship between oesophageal damage and optimal pH of refluxate, and whether 24-h pH monitoring at optimal pH could discriminate the severity of oesophagitis. The rabbit oesophagus was perfused in vivo with pepsin and hydrochloric acid solutions of differing pH for 60 min. Maximal oesophageal damage coincided with peptic solutions at pH 1.5-2.5. Fifty-nine patients with proven gastro-oesophageal reflux disorders were tested for manometric features of the lower oesophageal sphincter (pressure, overall length and abdominal length) and oesophageal exposure to different pH levels. They were classified into four groups according to the endoscopically demonstrated severity of oesophagitis. Supine exposure at the optimal pH level for pepsin activity (pH 1.5-2.5) and overall sphincter length were found to discriminate the severity of oesophagitis reliably in 75 per cent of cases.
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Affiliation(s)
- G Zaninotto
- Department of Surgery, University of Padua, Italy
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44
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Vigneri S, Scialabba A, Termini R, Germanà B, Vianello F, Grassi SA, Plebani M, Di Mario F. Pathophysiology of the gastric microcirculation. Ital J Gastroenterol 1992; 24:22-30. [PMID: 1571576] [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: 12/27/2022]
Abstract
Mucosal blood flow performs an extremely important role in microcirculation wherein alterations necessarily lead to severe gastric and duodenal mucosal lesions. The removal of back-diffused H+ ions through the adaptation of microcirculatory flow represents a valid defence mechanism. The blood flow's inability to contain H+ back-diffusion lies at the bottom of rapid-onset acute mucosal lesions; moreover, it probably contributes to the onset of chronic ulcer in certain areas already precariously supplied, because of the breakdown of the mucosal barrier or a further reduction in blood supply. Portal hypertension leads to altered blood flow in the gastric microcirculation. This haemo-dynamic condition brings about a series of endoscopically evident changes which are probably a consequence of the conspicuous increase in mucosal and submucosal vascular area. This haemodynamic situation may be an aetiopatho-genetic factor in the cirrhotic subject's marked sensitivity to gastric mucosal damage.
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Affiliation(s)
- S Vigneri
- Istituto di Medicina Interna e Geriatria, Università di Palermo, Italy
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45
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Dal Santo PL, Vianello F, Germanà B, Plebani M, Di Mario F. Smoking habit on gastric bicarbonate secretion in patients with duodenal ulcer. J Clin Gastroenterol 1991; 13:590. [PMID: 1744404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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46
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Plebani M, Di Mario F, Germanà B, Vianello F, Dotto P, Naccarato R, Burlina A. Effect of storage time on peptic activity in gastric biopsies. Clin Chem 1991; 37:1658-1659. [PMID: 1893606 DOI: 10.1093/clinchem/37.9.1658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
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47
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Gottardello L, Di Mario F, Pagano R, Germanà B, Vianello F, Pasqualetti P, Battaglia G, Faggian D, Plebani M, Naccarato R. [Basal and postprandial blood gastrin in peptic ulcer. The physiopathological aspects in relation to different sites of the lesion]. Minerva Med 1991; 82:163-9. [PMID: 2017311] [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: 12/29/2022]
Abstract
A different pathophysiological mechanism is widely accepted for gastric and duodenal ulcer. In particular, the exact role of gastrin in the determinism of non hormono-dependent peptic ulcer disease is not completely clarified. Therefore, the aim of present study was to analyse fasting and post-prandial serum gastrin levels in 99 duodenal ulcer patients, 17 gastric ulcer patients and 11 subjects presenting an association of gastric and duodenal ulcer. The possible correlation between post-prandial gastrin concentrations and basal and maximal acid output in the 3 fasting serum gastrin levels appear not different among the 3 classes of patients, while post-prandial gastrin concentrations are statistically higher at 15 minutes in duodenal ulcer patients and in subjects with the association of gastric and duodenal ulcer as compared to gastric ulcer patients. Mean fasting and stimulated gastrin levels are higher in gastric ulcer females than in males during the entire test and with statistically difference at 30 minutes. The concentrations of the hormone are not different in males of the 3 groups of patients at basal time, while are statistically lower at 15 and 30 minutes in gastric ulcer males compared to the males with duodenal ulcer and the association of the localization. Finally, positive correlation has been observed between BAO and MAO and post-prandial gastric concentrations in the 3 groups of patients, while there is an inverse correlation between the previous parameters as regards sex, both in gastric and duodenal ulcer.
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Affiliation(s)
- L Gottardello
- Cattedra di Malattie dell'Apparato Digerente, Università degli Studi di Padova, Ospedale Civile, Padova
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48
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49
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Germanà B, Di Mario F, Vianello F, Dotto P, Faggian D, Plebani M, Saggioro A, Naccarato R. [Cigarette smoking and group I pepsinogen levels. Study in a normal population]. G Clin Med 1990; 71:493-495. [PMID: 2279624] [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: 09/13/2023]
Abstract
Several studies have shown an influence of cigarette smoking on serum pepsinogen group I (PGI) levels in duodenal ulcer patients and in control subjects. The elevation of PGI in smokers has just been interpreted as reflecting some degree of smoking-induced inflammation of the gastric mucosa. We have determined fasting serum PGI by radioimmunoassay in 163 healthy subjects investigated by a survey conducted on a sample population of an urban area in the North-East of Italy by means of a random selection based on the public registers of home addresses. The data reported confirmed that PGI levels are increased by smoking in a healthy population. The main contribution of this study consists in demonstrating in a non-selected population an increase of the only parameter up to date claimed to be a possible serological predictive index for ulcer disease.
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Affiliation(s)
- B Germanà
- Cattedra di Malattie dell'Apparato Digerente, Università di Padova
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50
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Germanà B, Dal Santo P, Vianello F, Faggian D, Plebani M, Gottardello L, Leandro G, Di Mario F, Naccarato R. [Gastrin tissue levels in patients with peptic ulcer: a different methodological approach]. Medicina (Firenze) 1990; 10:292-294. [PMID: 2079883] [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: 09/13/2023]
Abstract
The function of G cells has been mainly evaluated by serum gastrin. A different analytical approach considers the direct determination of gastrin levels (ng/g of wet tissue) in perendoscopic biopsies, but, up to now, the results are contradictory. In the present study we evaluated, by means of a RIA method, the concentration of gastrin (ng/g of protein nitrogen) in homogenized gastroduodenal biopsies in 127 patients with peptic ulcer and in 12 dyspeptic patients. The results demonstrated: 1) a significant gradient of gastrin concentrations among the different anatomical sites, according to the distribution of the G cells; 2) a correlation with serum gastrin levels; 3) a good equivalence of gastrin content in adjacent biopsy specimens. This preliminary report indicates that it is possible directly quantitate tissue levels of gastrin by means of an accurate and simple method.
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Affiliation(s)
- B Germanà
- Istituto di Medicina Interna, Cattedra delle Malattie dell'Apparato Digerente, Università di Padova
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