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Iovino P, Lavorgna M, Orlo E, Russo C, De Felice B, Campolattano N, Muscariello L, Fenti A, Chianese S, Isidori M, Musmarra D. An integrated approach for the assessment of the electrochemical oxidation of diclofenac: By-product identification, microbiological and eco-genotoxicological evaluation. Sci Total Environ 2024; 909:168511. [PMID: 37977373 DOI: 10.1016/j.scitotenv.2023.168511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
Diclofenac (DCF), a contaminant of emerging concern, is a non-steroidal anti-inflammatory drug widely detected in water bodies, which demonstrated harmful acute and chronic toxicity toward algae, zooplankton and aquatic invertebrates, therefore its removal from impacted water is necessary. DCF is recalcitrant toward traditional treatment technologies, thus, innovative approaches are required. Among them, electrochemical oxidation (EO) has shown promising results. In this research, an innovative multidisciplinary approach is proposed to assess the electrochemical oxidation (EO) of diclofenac from wastewater by integrating the investigations on the removal efficiency and by-product identification with the disinfection capacity and the assessment of the effect on environmental geno-toxicity of by-products generated through the oxidation. The electrochemical treatment successfully degraded DCF by achieving >98 % removal efficiency, operating with NaCl 0.02 M at 50 A m-2. By-product identification analyses showed the formation of five DCF parental compounds generated by decarboxylic and CN cleavage reactions. The disinfection capacity of the EO technique was evaluated by carrying out microbiological tests on pathogens generally found in aquatic environments, including two rod-shaped Gram-negative bacteria (Pseudomonas aeruginosa and Escherichia coli), one rod-shaped Gram-positive bacterium (Bacillus atrophaeus), and one Gram-positive coccus (Enterococcus hirae). Eco-toxicity was evaluated in freshwater organisms (algae, rotifers and crustaceans) belonging to two trophic levels through acute and chronic tests. Genotoxicity tests were carried out by Comet assay, and relative expression levels of catalase, manganese and copper superoxide dismutase genes in crustaceans. Results highlight the effectiveness of EO for the degradation of diclofenac and the inactivation of pathogens; however, the downstream mixture results in being harmful to the aquatic ecosystem.
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Affiliation(s)
- P Iovino
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, Caserta 81100, Italy
| | - M Lavorgna
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, Caserta 81100, Italy
| | - E Orlo
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, Caserta 81100, Italy
| | - C Russo
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, Caserta 81100, Italy.
| | - B De Felice
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, Caserta 81100, Italy
| | - N Campolattano
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, Caserta 81100, Italy
| | - L Muscariello
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, Caserta 81100, Italy
| | - A Fenti
- Department of Engineering, University of Campania "Luigi Vanvitelli", Via Roma 29, Aversa 81031, Italy.
| | - S Chianese
- Department of Engineering, University of Campania "Luigi Vanvitelli", Via Roma 29, Aversa 81031, Italy
| | - M Isidori
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Via Vivaldi 43, Caserta 81100, Italy
| | - D Musmarra
- Department of Engineering, University of Campania "Luigi Vanvitelli", Via Roma 29, Aversa 81031, Italy
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Iovino P, Daniela D'angelo DD, Ercole Vellone EV, Matteo Ruggeri MR. The cost-effectiveness of nurse-led self-care interventions in patients with heart failure. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Nurse-led self-care interventions (NLSCI) in heart failure (HF), defined as the nurse education delivered to improve the daily patient self-management, are not widely adopted by the health-care systems, even though they are effective to improve outcomes (e.g., mortality, readmission). Moreover, few studies have evaluated whether NLSCI are also cost-effective.
Purpose
To determine the cost-effectiveness of NLSCI in the context of HF care compared with standard care (care delivered by general practitioner and/or cardiologist).
Methods
We performed a cost-effectiveness analysis, with a 20-year time horizon, from the perspective of the Italian National Health Service. We developed a Markov model to simulate the progression of a cohort of 1,000 HF patients aged 70 years, who were assumed to alternatively receive a NLSCI after hospital discharge, or usual care. Effectiveness on mortality and on hospitalizations of NLSCI and usual care were extrapolated from a review of randomized control trials. Health-care costs were derived from literature and national formularies. The differences in costs and the differences in Quality Adjusted Life Years (QALY) between the NLSCI and usual care were estimated to present an incremental cost-effectiveness ratio (ICER). A willingness to pay (WTP) threshold of €40,000 per QALY was considered. Probabilistic sensitivity analyses were conducted to test the robustness of results and to estimate a cost-effectiveness acceptability curve.
Results
Over the 20-year time horizon, NLSCI implied an extra cost of € 1.3 million and a gain of 247 QALYs compared to usual care. This resulted in an ICER of € 5,490/QALY, which is far below the €40,000/QALY WTP threshold. Sensitivity analysis showed that the ICER remains below the WTP threshold in 100% of simulations. Moreover, the cost-effectiveness acceptability curve showed a probability of 80% of being under € 7,500/QALY.
Conclusions
This study demonstrated that NLSCI represent an affordable solution to support patients with HF as the related extra costs of € 1.3 million is justified by the reduction in mortality and improvement in quality of life. This finding supports the promotion of NLSCI as part of routine care, in order to pursue an optimal allocation of public health expenditures.
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Affiliation(s)
- P Iovino
- University of Rome Tor Vergata, Rome, Italy. , Rome , Italy
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Iovino P, Giulia Locatelli LG, Giulia Locatelli LG, Alvaro Rosaria RA, Alvaro Rosaria RA, Barbara Riegel BR, Barbara Riegel BR, Corinne Jurgens CJ, Corinne Jurgens CJ, Ercole Vellone EV, Ercole Vellone EV. A cluster analysis of psychological and physical symptoms in patients with heart failure. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): CECRI (Center of Excellence for Nursing Scholarship) Rome
Background
The experience of psychological and physical symptoms of heart failure can be burdensome for patients. Identification of profiles of symptom burden may lead to greater understanding of the mechanism underlying this experience and improve symptom-centered care.
Purpose
The aim of this analysis was to identify profiles of psychological and physical symptoms in heart failure patients and compare the sociodemographic and clinical characteristics of patients in each cluster.
Methods
This was a secondary analysis of baseline data from the MOTIVATE-HF trial, that enrolled 510 patients across Italy. Cluster analysis was used to identify profiles of patients based on the two scores of the Hospital Anxiety and Depression scale and the total score of the Heart Failure Somatic Perception Scale. Each profile was described in terms of sociodemographic characteristics (e.g., age, gender, severity of disease), self-care maintenance and management behaviors, and self-efficacy (Self-care of Heart Failure Index), generic quality of life (12-item Short Form Survey), health-related quality of life (Kansas City Cardiomyopathy Questionnaire), and cognitive status (Montreal Cognitive Assessment Scale). Comparisons between the characteristics of each profile were performed by analysis of variance (ANOVA) and chi square test.
Results
Patients (n = 510) were 72.37 years old on average (SD = 12.28), with a slightly higher prevalence of men (58%). Sixty per cent of the sample were symptomatic: New York Heart Association (NYHA) class 2, 31.4% in NYHA class III, and 6.5% in NYHA class IV. Three profiles were identified: (1) low distress, characterized by the youngest patients (69.76, SD = 12.17), mostly in NYHA class II, and with the highest score on self-care self-efficacy and self-care maintenance behaviors; (2) average distress, characterized by the oldest patients (74.45, SD = 11.99), who were mostly retired, with the highest level of education, and poorest (physical) health-related quality of life and low self-care behaviors; (3) high distress, characterized by an average age of 73.08 (SD = 12.29), with the lowest hemoglobin level, the worst cognitive status, and the worst generic and health-related quality of life.
Conclusions
The profiles identified in this study and their characteristics provide new insights into the burden of psychological and physical symptoms experienced by heart failure patients. This represents the first step in promoting symptom-centered care in the future.
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Affiliation(s)
- P Iovino
- University of Rome Tor Vergata, Rome, Italy. , Rome , Italy
| | | | | | | | | | | | | | - C J Corinne Jurgens
- Boston College - William F. Connell School of Nursing , Boston , United States of America
| | - C J Corinne Jurgens
- Boston College - William F. Connell School of Nursing , Boston , United States of America
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Caggianelli G, Iovino P, Rebora P, Occhino G, Zeffiro V, Locatelli G, Ausili D, Alvaro R, Riegel B, Vellone E. A motivational interviewing intervention improves the burden of physical symptoms in patients with heart failure: A secondary outcome analysis of a randomized clinical trial. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Center of Excellence for Nursing Scholarship, Rome, Italy
Background. Patients with heart failure (HF) experience a variety of physical symptoms. Symptoms are perceived by patients as burdensome and, as such, negatively affect quality of life. Besides, physical symptoms are among the first reasons for seeking emergency care and hospitalization. Findings from the MOTIVATE-HF trial show that motivational interviewing (MI) leads to better self-care. However, whether MI also reduces the burden of physical symptoms is not yet known.
Purpose. To evaluate the effectiveness of MI on the burden of physical symptoms in patients with HF.
Methods. Secondary outcome analysis of the MOTIVATE-HF trial. The study was a three-arm, multicenter randomized controlled trial with a 12-month follow-up. Patients with HF and their informal caregivers were enrolled and randomly divided into three arms: MI performed only with patients (Arm 1); MI performed both with patients and caregivers (Arm 2); usual care (Arm 3). Patients with a diagnosis of HF in NYHA functional class II-IV were recruited in three Italian centers. Participants underwent one face-to-face MI session, followed by three phone calls within two months from enrollment. Physical symptoms were measured with the Heart Failure Somatic Perception Scale (HFSPS) with the dimensions of dyspnea, chest discomfort, early and subtle, and edema. Higher scores at the HFSPS and its dimensions indicate worse physical symptom. Data were collected at baseline, and 3 (T1), 6 (T2), 9 (T3) and 12 (T4) months after enrollment. T-test was used to compare differences in HFSPS scores in Arms 1 and 2 versus Arm 3 at each follow-up. Changes over time were analyzed with mixed linear longitudinal models.
Results. A sample of 510 patients (median 74 years, 58% male) and their caregivers (median 55 years, 75.5% female) were randomized to Arm 1 (n = 155), Arm 2 (n = 177) and Arm 3 (n = 178). Chest discomfort improved in Arms 1 and 2 versus Arm 3 at T4 (mean difference(Δ): -8.13, P = .014). Dyspnea also improved in Arms 1 and 2 than Arm 3 both at T3 and T4 (Δ: -7, P = .027 and Δ: -6.78, P = .038, respectively). HFSPS total score improved in Arms 1 and 2 versus Arm 3 at T3 (Δ: -4.55, P = .048). Over the year of observation, the mixed linear longitudinal models showed a significant improvement in Chest discomfort and total HFSPS score in Arm 2 versus Arm 3 (β = -2.61, P = .002 and, β = -1.35, P = .02).
Conclusions. The results of this secondary analysis indicate that MI may be effective in decreasing the burden of physical symptoms in HF patients, especially if also caregivers are involved in the intervention. Since symptom burden is among the first reasons for seeking emergency care and hospitalization in HF, MI might be a viable option to improve symptom burden via self-care.
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Affiliation(s)
- G Caggianelli
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | - P Iovino
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | - P Rebora
- University of Milan-Bicocca, Department of Medicine and Surgery, Monza, Italy
| | - G Occhino
- University of Milan-Bicocca, Biostatistics and Bioimaging Centre, Monza, Italy
| | - V Zeffiro
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | - G Locatelli
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | - D Ausili
- University of Milan-Bicocca, Department of Medicine and Surgery, Monza, Italy
| | - R Alvaro
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | - B Riegel
- University of Pennsylvania, School of Nursing, Philadelphia, United States of America
| | - E Vellone
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
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Affiliation(s)
- P Iovino
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - M Bellini
- Gastrointestinal Unit-Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
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Westland H, Jaarsma T, Riegel B, Iovino P, Henry Osokpo O, Stawnychy M, Tarbi E. Self-care interventions in patients with coronary artery disease: room for improvement. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3412] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
After a coronary artery event it is vital that patients perform self-care Self-care can be defined broadly as a process of maintaining health through treatment adherence and health-promoting practices (self-care maintenance), behavior and condition monitoring (self-care monitoring), and managing signs and symptoms when they occur (self-care management). For patients with coronary artery disease (CAD) essential self-care activities include adherence to medication, risk-factor management, symptom monitoring and preventive behavior. To advance the field of self-care in CAD patients, it is important to understand which self-care elements are currently addressed in interventions studies. The purpose of this study was to describe which behaviors are emphasized in self-care interventions for patients with CAD.
Methods
We conducted a systematic review of self-care interventions in chronic diseases. Four databases were search for randomized controlled trials with allocation to an intervention or to usual care or another intervention in adults with nine major symptomatic chronic conditions, one of which was coronary artery disease. Between 2008 and 2019 there were 9309 potential articles addressing self-care in chronic disease. After duplicates were removed and titles and abstracts were reviewed, 166 full-text articles on CAD studies evaluating a self-care intervention were assessed for eligibility and 15 studies remained after further assessment.
Results
Almost all studies (80%) in CAD patients included all three components of self-care (self-care maintenance, monitoring and management) in their interventions. Self-care maintenance behaviors addressed in these studies were mainly related to physical activity (73%) diet (60%) and medication management (33%) Another 40% included a psychosocial component, but only 4 studies (26%) were specially targeted at smoking behavior. With regard to self-care monitoring, most (60%) included monitoring of their physical activity level and 26% monitoring of symptoms. Self-care management behaviours were addressed rarely, but when addressed, focused on adapting activity level (60%), adapting diet (27%), medication changes (20%) and stress reduction (20%). Goal setting (60%), problem solving (40%) and feedback (33%) were the behavioural change techniques that were used most often to promote self-care. Only 1 study mentioned the use of social support. One study used reminders.
Conclusions
Most interventions that are tested to improve outcomes in patients with CAD address self-care maintenance, monitoring, management. The behavioural change techniques used are limited. There is a large variation in which behaviours are emphasized in research studies and the focus is primarily on changing traditional lifestyle factors, but not all life-style factors are addressed adequately in the interventions.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Australian Catholic University
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Affiliation(s)
- H Westland
- University Medical Center Utrecht, Julius Center, Utrecht, Netherlands (The)
| | - T Jaarsma
- Linkoping University, Linkoping, Sweden
| | - B Riegel
- Australian Catholic University, Melbourne, Australia
| | - P Iovino
- University of Rome Tor Vergata, Rome, Italy
| | - O Henry Osokpo
- University of Pennsylvania, School of Nursing, Philadelphia, United States of America
| | - M Stawnychy
- University of Pennsylvania, School of Nursing, Philadelphia, United States of America
| | - E Tarbi
- University of Pennsylvania, School of Nursing, Philadelphia, United States of America
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Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro N. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg 2018; 28:3783-3794. [PMID: 30121858 DOI: 10.1007/s11695-018-3450-2] [Citation(s) in RCA: 598] [Impact Index Per Article: 99.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), being a Federation of 62 national societies, is the ideal network to monitor the number and type of procedures at a global level. The IFSO survey, enriched with a special section on revisional procedures, aims to report the number and types of bariatric procedures performed worldwide in 2016 and analyzes the surgical trends from 2008 to 2016. METHODS The 2016 IFSO Survey form was emailed to all IFSO societies. Each Society was requested to indicate the number and type of bariatric procedures performed in the country. Trend analyses from 2008 to 2016 were also performed. RESULTS The total number of bariatric/metabolic procedures performed in 2016 was 685,874; 634,897 (92.6%) of which were primary and 50,977 were revisional (7.4%). Among the primary interventions, 609,897 (96%) were surgical and 25,359 (4%) were endoluminal. The most performed primary surgical bariatric/metabolic procedure was sleeve gastrectomy (SG) (N = 340,550; 53.6%), followed by Roux-en-Y gastric bypass (N = 191,326; 30.1%), and one-anastomosis gastric bypass (N = 30,563; 4.8%). CONCLUSIONS In 2016, there was an increase in the total number both of surgical and endoluminal bariatric/metabolic procedures. Revisional procedures represent about 7% of the total bariatric interventions. SG remains the most performed surgical procedure in the world.
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Affiliation(s)
- Luigi Angrisani
- General and Endoscopic Surgery Unit, "S. Giovanni Bosco" Hospital, Via Filippo Maria Briganti, 255, Naples, Italy.
| | - A Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - P Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - A Vitiello
- General and Endoscopic Surgery Unit, "S. Giovanni Bosco" Hospital, Via Filippo Maria Briganti, 255, Naples, Italy
| | - K Higa
- Advanced Laparoscopy Surgery Associates, Fresno Heart and Surgical Hospital, Fresno, CA, USA
- Fresno Medical Education Program, University of California, San Francisco, San Francisco, CA, USA
| | - J Himpens
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - H Buchwald
- Departments of Surgery and Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - N Scopinaro
- Department of Surgery, University of Genoa, School of Medicine, Genoa, Italy
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Angrisani L, Santonicola A, Vitiello A, Ferraro L, Iovino P. Reply to Letter to the Editor "Left Gastric Artery Embolization for Weight Loss-a Dead-End Procedure". Obes Surg 2018; 28:3627-3628. [PMID: 30128644 DOI: 10.1007/s11695-018-3464-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Luigi Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Via Filippo Maria Briganti, 255, Naples, Italy.
| | - A Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - A Vitiello
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Via Filippo Maria Briganti, 255, Naples, Italy
| | - L Ferraro
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Via Filippo Maria Briganti, 255, Naples, Italy
| | - P Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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Angrisani L, Santonicola A, Vitiello A, Ferraro L, Iovino P. Reply to Letter to the Editor in Response to "Elipse Balloon: the Pitfalls of Excessive Simplicity". Obes Surg 2018; 28:3633. [PMID: 30121856 DOI: 10.1007/s11695-018-3461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Luigi Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Via Filippo Maria Briganti, 255, Naples, Italy.
| | - A Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - A Vitiello
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Via Filippo Maria Briganti, 255, Naples, Italy
| | - L Ferraro
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Via Filippo Maria Briganti, 255, Naples, Italy
| | - P Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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Bucci C, Amato M, Zingone F, Caggiano M, Iovino P, Ciacci C. Prevalence of Sleep Bruxism in IBD Patients and Its Correlation to Other Dental Disorders and Quality of Life. Gastroenterol Res Pract 2018; 2018:7274318. [PMID: 29721012 PMCID: PMC5867589 DOI: 10.1155/2018/7274318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/21/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel diseases could experience mouth and teeth disorders and alterations in psychological mood. Vice versa, the psychological status may influence the presence of oral diseases. AIM To evaluate in inflammatory bowel disease patients the prevalence of sleep bruxism and its correlation with the presence of oral diseases, quality of sleep, and psychological disturbances. METHODS Patients were consecutively recruited in our clinic and examined for temporomandibular disorders, dental enamel disorders, sleep bruxism, and recurrent aphthous stomatitis by two dentists. Patients also underwent Pittsburgh Sleep Quality Index and Beck Depression Inventory Scale questionnaires. RESULTS 47 patients and 46 controls were included. Sleep bruxism and enamel wear disorders were more frequent in Crohn's disease patients when compared with ulcerative colitis patients and controls (p = 0.03 and p = 0.02, resp.). Among groups, no differences were noted for enamel hypoplasia, temporomandibular disorders, recurrent aphthous stomatitis, depression, and quality of sleep. We found a positive correlation between bruxism and temporomandibular disorders (Spearman 0.6, p < 0.001) and between bruxism and pathological sleep (Pittsburgh Sleep Quality Index > 5) (Spearman 0.3, p < 0.005). CONCLUSION Bruxism and enamel wear disorders should be routinely searched in Crohn's disease patients. Moreover, the attention of healthcare givers to sleep disturbances should be addressed to all inflammatory bowel disease patients.
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Affiliation(s)
- C Bucci
- Gastroenterology Unit, Department of Medicine and Surgery, AOU San Giovanni di Dio e Ruggi D'Aragona, University of Salerno, Salerno, Italy
| | - M Amato
- Department of Stomatology, AOU San Giovanni di Dio e Ruggi D'Aragona, University of Salerno, Salerno, Italy
| | - F Zingone
- Gastroenterology Unit, Department of Medicine and Surgery, AOU San Giovanni di Dio e Ruggi D'Aragona, University of Salerno, Salerno, Italy
| | - M Caggiano
- Department of Stomatology, AOU San Giovanni di Dio e Ruggi D'Aragona, University of Salerno, Salerno, Italy
| | - P Iovino
- Gastroenterology Unit, Department of Medicine and Surgery, AOU San Giovanni di Dio e Ruggi D'Aragona, University of Salerno, Salerno, Italy
| | - C Ciacci
- Gastroenterology Unit, Department of Medicine and Surgery, AOU San Giovanni di Dio e Ruggi D'Aragona, University of Salerno, Salerno, Italy
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Angrisani L, Santonicola A, Vitiello A, Iovino P. Reply to Letter to the Editor: Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obes Surg 2018; 28:251-252. [PMID: 29147939 DOI: 10.1007/s11695-017-2958-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- L Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy.
| | - A Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - A Vitiello
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - P Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Vanore P, Coppola E, Iovino P, Leone V, Salvestrini S, Capasso S. Sorption thermodynamics of organic pollutants onto zeolitic tuff: Isosteric and standard enthalpy. J WATER CHEM TECHNO+ 2017. [DOI: 10.3103/s1063455x17040087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Angrisani L, Santonicola A, Iovino P, Vitiello A, Zundel N, Buchwald H, Scopinaro N. Erratum to: Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obes Surg 2017; 27:2290-2292. [PMID: 28681258 PMCID: PMC6829693 DOI: 10.1007/s11695-017-2773-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- L. Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - A. Santonicola
- 0000 0004 1937 0335grid.11780.3fGastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Via S. Allende, Baronissi, Salerno, Italy
| | - P. Iovino
- 0000 0004 1937 0335grid.11780.3fGastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Via S. Allende, Baronissi, Salerno, Italy
| | - A. Vitiello
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - N. Zundel
- Minimally Invasive and Bariatric Surgery, FSFB, Bogota, Colombia
| | - H. Buchwald
- 0000000419368657grid.17635.36Department of Surgery, University of Minnesota, Minneapolis, MN 55455 USA
- 0000000419368657grid.17635.36Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455 USA
| | - N. Scopinaro
- 0000 0001 2151 3065grid.5606.5Department of Surgery, School of Medicine, University of Genoa, Genoa, Italy
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Abstract
BACKGROUND AND AIM Several bariatric surgery worldwide surveys have been previously published to illustrate the evolution of bariatric surgery in the last decades. The aim of this survey is to report an updated overview of all bariatric procedures performed in 2014.For the first time, a special section on endoluminal techniques was added. METHODS The 2014 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) survey form evaluating the number and the type of surgical and endoluminal bariatric procedures was emailed to all IFSO societies. Trend analyses from 2011 to 2014 were also performed. RESULTS There were 56/60 (93.3%) responders. The total number of bariatric/metabolic procedures performed in 2014 consisted of 579,517 (97.6%) surgical operations and 14,725 (2.4%) endoluminal procedures. The most commonly performed procedure in the world was sleeve gastrectomy (SG) that reached 45.9%, followed by Roux-en-Y gastric bypass (RYGB) (39.6%), and adjustable gastric banding (AGB) (7.4%). The annual percentage changes from 2013 revealed the increase of SG and decrease of RYGB in all the IFSO regions (USA/Canada, Europe, and Asia/Pacific) with the exception of Latin/South America, where SG decreased and RYGB represented the most frequent procedure. CONCLUSIONS There was a further increase in the total number of bariatric/metabolic procedures in 2014 and SG is currently the most frequent surgical procedure in the world. This is the first survey that describes the endoluminal procedures, but the accuracy of provided data should be hopefully improved in the next future. We encourage the creation of further national registries and their continuous updates taking into account all new bariatric procedures including the endoscopic procedures that will obtain increasing importance in the near future.
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Affiliation(s)
- L. Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - A. Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Via S. Allende. Baronissi-, Salerno, Italy
| | - P. Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Via S. Allende. Baronissi-, Salerno, Italy
| | - A. Vitiello
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - N. Zundel
- Minimally Invasive and Bariatric Surgery, FSFB, Bogata, Colombia
| | - H. Buchwald
- Departments of Surgery and Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455 USA
| | - N. Scopinaro
- Department of Surgery, School of Medicine, University of Genoa, Genoa, Italy
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15
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Angrisani L, Santonicola A, Iovino P, Vitiello A, Zundel N, Buchwald H, Scopinaro N. Erratum to: Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obes Surg 2017. [PMID: 28681258 DOI: 10.1007/s11695-017-2773-8.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Affiliation(s)
- L Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - A Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Via S. Allende, Baronissi, Salerno, Italy.
| | - P Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Via S. Allende, Baronissi, Salerno, Italy
| | - A Vitiello
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - N Zundel
- Minimally Invasive and Bariatric Surgery, FSFB, Bogota, Colombia
| | - H Buchwald
- Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA.,Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - N Scopinaro
- Department of Surgery, School of Medicine, University of Genoa, Genoa, Italy
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16
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Abstract
BACKGROUND The aim of the present study was to investigate the prevalence of urinary tract infection (UTI) and the risk of lower urinary tract symptoms (LUTS) in women with irritable bowel syndrome (IBS) (including each subtype: constipation, diarrhea, and mixed) compared to women in the general population. METHODS Between January 2014 and December 2015, consecutive adult female patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy women with regular bowel habits were enrolled in the study. At baseline, we checked for UTI with a dipstick test and questioned patients about the presence of LUTS in the previous 24 h. RESULTS We enrolled 141 IBS patients and 91 healthy controls in the study. There was no difference in the prevalence of UTI between IBS patients and healthy controls (4.9 vs 3.3%, p = 0.5). When we excluded patients with UTI, we found a 2.79 higher risk of increased urinary frequency [odds ratio (OR) 2.79, 95% confidence interval (CI) 1.37-5.68], a 2.68 higher risk of urinary urgency (OR 2.68, 95% CI 1.04-6.91), and more than three times the risk of having dysuria (OR 3.25, 95% CI 1.06-9.97) in IBS women compared to healthy controls. The risk of having at least one urinary symptom was independent of IBS subtype and IBS severity. CONCLUSIONS Our study shows that IBS women have a similar risk of UTI compared to healthy women even if they complain more of LUTS, independently of IBS subtype and severity.
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Affiliation(s)
- F Zingone
- AOU San Giovanni di Dio e Ruggi di Aragona, Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
- Gastrointestinal Unit, University of Salerno, Via San Leonardo 1, Salerno, Italy.
| | - P Iovino
- AOU San Giovanni di Dio e Ruggi di Aragona, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - A Santonicola
- AOU San Giovanni di Dio e Ruggi di Aragona, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - S Gallotta
- AOU San Giovanni di Dio e Ruggi di Aragona, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - C Ciacci
- AOU San Giovanni di Dio e Ruggi di Aragona, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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17
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Angrisani L, Santonicola A, Iovino P, Vitiello A, Zundel N, Buchwald H, Scopinaro N. Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obes Surg 2017. [PMID: 28405878 DOI: 10.1007/s11695-017-2666-x.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Several bariatric surgery worldwide surveys have been previously published to illustrate the evolution of bariatric surgery in the last decades. The aim of this survey is to report an updated overview of all bariatric procedures performed in 2014.For the first time, a special section on endoluminal techniques was added. METHODS The 2014 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) survey form evaluating the number and the type of surgical and endoluminal bariatric procedures was emailed to all IFSO societies. Trend analyses from 2011 to 2014 were also performed. RESULTS There were 56/60 (93.3%) responders. The total number of bariatric/metabolic procedures performed in 2014 consisted of 579,517 (97.6%) surgical operations and 14,725 (2.4%) endoluminal procedures. The most commonly performed procedure in the world was sleeve gastrectomy (SG) that reached 45.9%, followed by Roux-en-Y gastric bypass (RYGB) (39.6%), and adjustable gastric banding (AGB) (7.4%). The annual percentage changes from 2013 revealed the increase of SG and decrease of RYGB in all the IFSO regions (USA/Canada, Europe, and Asia/Pacific) with the exception of Latin/South America, where SG decreased and RYGB represented the most frequent procedure. CONCLUSIONS There was a further increase in the total number of bariatric/metabolic procedures in 2014 and SG is currently the most frequent surgical procedure in the world. This is the first survey that describes the endoluminal procedures, but the accuracy of provided data should be hopefully improved in the next future. We encourage the creation of further national registries and their continuous updates taking into account all new bariatric procedures including the endoscopic procedures that will obtain increasing importance in the near future.
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Affiliation(s)
- L Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - A Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Via S. Allende. Baronissi-, Salerno, Italy.
| | - P Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Via S. Allende. Baronissi-, Salerno, Italy
| | - A Vitiello
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - N Zundel
- Minimally Invasive and Bariatric Surgery, FSFB, Bogata, Colombia
| | - H Buchwald
- Departments of Surgery and Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - N Scopinaro
- Department of Surgery, School of Medicine, University of Genoa, Genoa, Italy
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18
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Neri L, Iovino P. Bloating is associated with worse quality of life, treatment satisfaction, and treatment responsiveness among patients with constipation-predominant irritable bowel syndrome and functional constipation. Neurogastroenterol Motil 2016; 28:581-91. [PMID: 26867677 DOI: 10.1111/nmo.12758] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/19/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND The management of bloating is unclear and its relationship with patients' well-being and treatment satisfaction independent of other abdominal symptoms is uncharacterized. We evaluated the association of bloating with patient-reported outcomes. METHODS Thirty-nine centers for functional gastrointestinal disorders joined the laxative inadequate relief survey. We enrolled 2203 consecutive outpatients with functional constipation (FC) or constipation-predominant irritable bowel syndrome (IBS-C) in two cross-sectional waves. Both wave 1 and 2 included the SF-12, the patient assessment of constipation-symptoms (PAC-SYM), and the treatment satisfaction questionnaire for medication (TSQM-2). Wave 2 only included a global rating of change (GRC) scale to assess patients' assessment of efficacy concerning treatment switches occurred in the 3 months prior to the interview. Bloating in the abdomen was defined on the basis of PAC-SYM item 3. KEY RESULTS The average age was 50.1 years (SD, 16.7) and 82.1% of patients were women. The prevalence of bloating was 91.6% (n = 1970). Bloating was associated with SF-12 Physical Composite Score (p < 0.01), SF-12 Mental Composite Score (p < 0.01), GRC (p < 0.01), Satisfaction with treatment effectiveness (p < 0.01), convenience of administration (p < 0.01), and side effects (p < 0.01) after adjustment for possible confounders. CONCLUSIONS & INFERENCES Our data suggest that patients regard bloating as a key element in assessing clinical changes and treatments' efficacy as this symptom exerts a strong influence on patient-reported outcomes independent of possible confounders and other symptoms of constipation. Our data provide the rationale to investigate the efficacy and tolerability of new treatments specifically addressing this important, yet disregarded, patients' complain.
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Affiliation(s)
- L Neri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - P Iovino
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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19
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Fantini L, Iovino P, Polidori C, Boriani F, Cioni S, Trombetta L, Sassoli V. CP-156 Prescribing pattern, tolerability and efficacy study (4 weeks) of the novel drug ‘xiapex’. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Reply to Letter to the Editor: Bariatric Surgery Worldwide 2013 Reveals a Rise in Mini-Gastric Bypass. Obes Surg 2015; 25:2166-8. [PMID: 26271347 DOI: 10.1007/s11695-015-1828-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- L Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy.
| | - A Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - P Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - G Formisano
- Department of General Surgery, "Misericordia" Hospital, Grosseto, Italy
| | - H Buchwald
- Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA.
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - N Scopinaro
- Department of Surgery, University of Genoa, School of Medicine, Genoa, Italy.
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21
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Abstract
BACKGROUND The first global survey of bariatric/metabolic surgery based on data from the nations or national groupings of the International Federation for the Surgery of Obesity and Metabolic Diseases (IFSO) was published in 1998, followed by reports in 2003, 2009, 2011, and 2012. In this survey, we report a global overview of worldwide bariatric surgery in 2013. MATERIALS AND METHODS A questionnaire evaluating the number and the type of bariatric procedure performed in 2013 was emailed to all members of bariatric societies belonging to IFSO. Trend analyses from 2003 to 2013 were also performed. RESULTS There were 49/54 (90.7%) responders; 37 of the 49 with national registries. The total number of bariatric procedures performed worldwide in 2013 was 468,609, 95.7% carried out laparoscopically. The highest number (n = 154,276) was from the USA/Canada region. The most commonly performed procedure in the world was Roux-en-Y gastric bypass (RYGB), 45%; followed by sleeve gastrectomy (SG), 37%; and adjustable gastric banding (AGB), 10%. Most significant were the rise in prevalence of SG from 0 to 37% of the world total from 2003 to 2013, and the fall in AGB of 68% from its peak in 2008 to 2013. CONCLUSIONS SG is currently the most frequently performed procedure in the USA/Canada and in the Asia/Pacific regions, and second to RYGB in the Europe and Latin/South America regions. The accuracy of the IFSO-based world survey of procedures would be enhanced if each nation or national group would create a national registry.
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Affiliation(s)
- L Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Via Filippo Maria Briganti, 255, Naples, Italy,
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22
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Bucci C, Tremolaterra F, Gallotta S, Fortunato A, Cappello C, Ciacci C, Iovino P. A pilot study on the effect of a symbiotic mixture in irritable bowel syndrome: an open-label, partially controlled, 6-month extension of a previously published trial. Tech Coloproctol 2014; 18:345-53. [PMID: 23922211 DOI: 10.1007/s10151-013-1055-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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] [Received: 05/22/2013] [Accepted: 07/25/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND In recent years, the efficacy of probiotics has received considerable attention in the treatment for irritable bowel syndrome (IBS). In this regard, a symbiotic mixture (Probinul(®)) has shown beneficial effects. The aim of this study was to extend the previously published 4-week randomized, double-blinded, placebo-controlled study of this symbiotic mixture. METHODS This is an open-label prospective, partially controlled, 6-month extension period pilot study in which patients continued to receive the symbiotic mixture (Group 1) or were switched from placebo to symbiotic mixture (Group 2) using cyclic administration (last 2 weeks/month). The primary endpoints were the overall satisfactory relief of bloating and flatulence (assessed as proportions of responders). The secondary endpoints were evaluation of the symptom severity scores (bloating, flatulence, pain and urgency) and bowel function scores (frequency, consistency and incomplete evacuation). RESULTS Twenty-six IBS patients completed the 6-month extension period (13 patients in Group 1 and 13 patients in Group 2). In the per-protocol analysis, the proportions of responders across time were not significantly different in the groups but in Group 2, there was an increased percentage of responders for flatulence (p = 0.07). In addition, the score of flatulence was reduced significantly during the 6-month treatment period in Group 2 (p < 0.05), while no other significant differences were detected. CONCLUSIONS Treatment with this symbiotic mixture was associated with persistence of relief from flatulence or new reduction in flatulence in the present 6-month long extension study. These results need to be more comprehensively assessed in large, long-term, randomized, placebo-controlled studies.
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Affiliation(s)
- C Bucci
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Via S Allende, 84081, Baronissi, Salerno, Italy
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23
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Ciacci C, Russo I, Bucci C, Iovino P, Pellegrini L, Giangrieco I, Tamburrini M, Ciardiello MA. The kiwi fruit peptide kissper displays anti-inflammatory and anti-oxidant effects in in-vitro and ex-vivo human intestinal models. Clin Exp Immunol 2014; 175:476-84. [PMID: 24168016 PMCID: PMC3927908 DOI: 10.1111/cei.12229] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 02/05/2023] Open
Abstract
Literature reports describe kiwi fruit as a food with significant effects on human health, including anti-oxidant and anti-inflammatory activity. Fresh fruit or raw kiwi fruit extracts have been used so far to investigate these effects, but the molecule(s) responsible for these health-promoting activities have not yet been identified. Kissper is a kiwi fruit peptide displaying pore-forming activity in synthetic lipid bilayers, the composition of which is similar to that found in intestinal cells. The objective of this study was to investigate the kissper influence on intestinal inflammation using cultured cells and ex-vivo tissues from healthy subjects and Crohn's disease (CD) patients. The anti-oxidant and anti-inflammatory properties of kissper were tested on Caco-2 cells and on the colonic mucosa from 23 patients with CD, by challenging with the lipopolysaccharide from Escherichia coli (EC-LPS) and monitoring the appropriate markers by Western blot and immunofluorescence. EC-LPS challenge determined an increase in the intracellular concentration of calcium and reactive oxygen species (ROS). The peptide kissper was highly effective in preventing the increase of LPS-induced ROS levels in both the Caco-2 cells and CD colonic mucosa. Moreover, it controls the calcium increase, p65-nuclear factor (NF)-kB induction and transglutaminase 2 (TG2) activation inflammatory response in Caco-2 cells and CD colonic mucosa. Kissper efficiently counteracts the oxidative stress and inflammatory response in valuable model systems consisting of intestinal cells and CD colonic mucosa. This study reports the first evidence supporting a possible correlation between some beneficial effects of kiwi fruit and a specific protein molecule rather than generic nutrients.
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Affiliation(s)
- C Ciacci
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
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24
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Ciacci C, Russo I, Bucci C, Iovino P, Pellegrini L, Giangrieco I, Tamburrini M, Ciardiello MA. The kiwi fruit peptide kissper displays anti-inflammatory and anti-oxidant effects in in-vitro and ex-vivo human intestinal models. Clin Exp Immunol 2013. [PMID: 24168016 DOI: 10.1111/cei.12229.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Literature reports describe kiwi fruit as a food with significant effects on human health, including anti-oxidant and anti-inflammatory activity. Fresh fruit or raw kiwi fruit extracts have been used so far to investigate these effects, but the molecule(s) responsible for these health-promoting activities have not yet been identified. Kissper is a kiwi fruit peptide displaying pore-forming activity in synthetic lipid bilayers, the composition of which is similar to that found in intestinal cells. The objective of this study was to investigate the kissper influence on intestinal inflammation using cultured cells and ex-vivo tissues from healthy subjects and Crohn's disease (CD) patients. The anti-oxidant and anti-inflammatory properties of kissper were tested on Caco-2 cells and on the colonic mucosa from 23 patients with CD, by challenging with the lipopolysaccharide from Escherichia coli (EC-LPS) and monitoring the appropriate markers by Western blot and immunofluorescence. EC-LPS challenge determined an increase in the intracellular concentration of calcium and reactive oxygen species (ROS). The peptide kissper was highly effective in preventing the increase of LPS-induced ROS levels in both the Caco-2 cells and CD colonic mucosa. Moreover, it controls the calcium increase, p65-nuclear factor (NF)-kB induction and transglutaminase 2 (TG2) activation inflammatory response in Caco-2 cells and CD colonic mucosa. Kissper efficiently counteracts the oxidative stress and inflammatory response in valuable model systems consisting of intestinal cells and CD colonic mucosa. This study reports the first evidence supporting a possible correlation between some beneficial effects of kiwi fruit and a specific protein molecule rather than generic nutrients.
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Affiliation(s)
- C Ciacci
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
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25
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Iovino P, Mohammed I, Anggiansah A, Anggiansah R, Cherkas LF, Spector TD, Trudgill NJ. A study of pathophysiological factors associated with gastro-esophageal reflux disease in twins discordant for gastro-esophageal reflux symptoms. Neurogastroenterol Motil 2013; 25:650-6. [PMID: 23710904 DOI: 10.1111/nmo.12137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 03/15/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Differences in lower esophageal sphincter (LES) and peristaltic function and in transient LES relaxations (TLESR) have been described in patients with gastro-esophageal reflux disease (GERD). However, some of these differences may be the result of chronic GERD rather than being an underlying contributory factor. METHODS Twins discordant for GERD symptoms, i.e., only one twin had GERD symptoms, underwent standard LES and esophageal body manometry, and then using a sleeve sensor prolonged LES and pH monitoring, 30 min before and 60 min after a 250 mL 1200 kcal lipid meal. KEY RESULTS Eight monozygotic and 24 dizygotic female twins were studied. Although there was no difference in preprandial LES pressure (symptomatic 13.2 ± 7.1 mmHg vs asymptomatic 15.1 ± 6.2 mmHg, P = 0.4), LES pressure fell further postprandially in symptomatic twins (LES pressure area under the curve 465 ± 126 vs 331 ± 141 mmHg h, P < 0.01). 12/37 (32%) of acid reflux episodes in symptomatic twins occurred due to low LES pressure or deep inspiration/strain and 0/17 in asymptomatic twins (P = 0.01). There was no difference between symptomatic and asymptomatic twins in: peristaltic amplitude, ineffective esophageal body motility, hiatus hernia prevalence, or LES length. There was also no difference in TLESR frequency preprandially (symptomatic median 1(range 0-2) vs asymptomatic 0(0-2), P = 0.08) or postprandially (2.5(1-8) vs 3(1-6), P = 0.81). CONCLUSIONS & INFERENCES Twins with GERD symptoms had lower postprandial LES pressure and given the close genetic link between the twins, it is possible that such differences are caused by GERD. Acid reflux episodes associated with a hypotensive LES were seen in symptomatic, but not in asymptomatic twins.
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Affiliation(s)
- P Iovino
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, UK
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26
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Tremolaterra F, Pascariello A, Gallotta S, Ciacci C, Iovino P. Colonic gas transit in patients with bloating: the effect of an electromechanical stimulator of the abdominal wall. Tech Coloproctol 2013. [PMID: 23207715 DOI: 10.1007/s10151-012-0951-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of our study was to evaluate gas retention, abdominal symptoms and changes in girth circumference in females with bloating using an active or sham abdominal wall mechanical stimulation. METHODS In 14 female patients, complaining of bloating (11 with irritable bowel syndrome and 3 with functional bloating according to the Rome III criteria) a gas mixture was continuously infused into the colon for 1 h (accommodation period). Abdominal perception and girth were measured. At the beginning of the 30-min period of free rectal gas evacuation (clearance period), an electromechanical device was positioned on the abdominal wall of all patients. The patients were randomly assigned to an active or a sham stimulation protocol group. Gas retention, perception and abdominal distension were measured at the end of the clearance period. RESULTS All patients tolerated the volume (1,440 ml) of gas infused into the colon. Abdominal perception and girth measurements was similar in both groups during the accommodation period. At the end of the clearance, the perception score and the girth changes in the active and sham stimulation groups were similar (2.8 ± 2.0 vs. 1.4 ± 1.2, p = 0.2 and 4.9 ± 4.5 vs. 2.8 ± 2.3 mm, p = 0.3 active vs. sham, respectively). Furthermore, the mechanical stimulation of the abdominal wall did not significantly reduce gas retention (495 ± 101 ml vs. 566 ± 55, active vs. sham, p = 0.1). CONCLUSIONS An external mechanical massage of the abdominal wall did not improve intestinal gas transit, abdominal perception and abdominal distension in our female patients complaining of functional bloating.
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Affiliation(s)
- F Tremolaterra
- IRCCS, Centro di Riferimento Oncologico di Basilicata, Rionero in Vulture, PZ, Italy
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27
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Zingone F, Capone P, Tortora R, Rispo A, Morisco F, Caporaso N, Imperatore N, De Stefano G, Iovino P, Ciacci C. Role of gluten intake at the time of hepatitis B virus vaccination in the immune response of celiac patients. Clin Vaccine Immunol 2013; 20:660-2. [PMID: 23446217 PMCID: PMC3647759 DOI: 10.1128/cvi.00729-12] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Some reports have demonstrated an inadequate response to hepatitis B vaccination in patients affected by celiac disease. The aim of our study was to evaluate hepatitis B vaccination response in relation to gluten exposure status in patients with celiac disease. To measure the gluten exposure status at the time of vaccination, we considered three groups: group A (exposed to gluten), including patients vaccinated as 12-year-old adolescents (the celiac disease diagnosis was established after vaccination); group B (not exposed to gluten), including patients vaccinated as 12-year-old adolescents on a gluten-free diet at the time of vaccination; and group C (infants), including patients vaccinated at birth. The response of celiac patients to hepatitis B vaccination was compared to that of healthy subjects, i.e., those in the control group (group D). This study included 163 celiac patients (group A, 57 patients; group B, 46 patients; and group C, 60 patients) and 48 controls (group D). An inadequate response to hepatitis B immunization was present in 43.9% of patients in group A, 34.8% of patients in group B, 58.3% of patients in group C, and 8.3% of patients in group D (group A versus group D, P < 0.001; group B versus group D, P = 0.002; group C versus group D, P = 0.001) (no significant difference for group A versus group B and group A versus group C was evident). Our data suggest that gluten exposure does not influence the response to hepatitis B immunization and that the human leukocyte antigen probably plays the main immunological role in poor responses to hepatitis B-vaccinated celiac patients.
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Affiliation(s)
- F. Zingone
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - P. Capone
- Department of Clinical and Experimental Medicine, Unit of Gastroenterology, University of Naples Federico II, Naples, Italy
| | - R. Tortora
- Department of Clinical and Experimental Medicine, Unit of Gastroenterology, University of Naples Federico II, Naples, Italy
| | - A. Rispo
- Department of Clinical and Experimental Medicine, Unit of Gastroenterology, University of Naples Federico II, Naples, Italy
| | - F. Morisco
- Department of Clinical and Experimental Medicine, Unit of Gastroenterology, University of Naples Federico II, Naples, Italy
| | - N. Caporaso
- Department of Clinical and Experimental Medicine, Unit of Gastroenterology, University of Naples Federico II, Naples, Italy
| | - N. Imperatore
- Department of Clinical and Experimental Medicine, Unit of Gastroenterology, University of Naples Federico II, Naples, Italy
| | - G. De Stefano
- Department of Clinical and Experimental Medicine, Unit of Gastroenterology, University of Naples Federico II, Naples, Italy
| | - P. Iovino
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - C. Ciacci
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Leone V, Canzano S, Iovino P, Salvestrini S, Capasso S. A novel organo-zeolite adduct for environmental applications: sorption of phenol. Chemosphere 2013; 91:415-420. [PMID: 23427860 DOI: 10.1016/j.chemosphere.2012.11.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 11/27/2012] [Accepted: 11/30/2012] [Indexed: 06/01/2023]
Abstract
A novel organo-zeolite adduct has been synthesized by sorbing humic acids (HA) onto zeolitic tuff and then heating the resulting complex at 330°C for 1.5h. Desorption tests showed that this procedure effectively immobilized HA on the tuff. The crystal structure of the zeolitic tuff and the chemical structure of HA were not altered during the preparation. Phenol sorption analysis demonstrated that the HA-zeolite adduct had good sorbing properties; moreover, the sorbed amount markedly decreased with increased ionic strength. These results point to prospective application of the HA-zeolite adduct as a low-cost and environmentally friendly sorbent for water purification from phenol and possibly other neutral organic pollutants.
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Affiliation(s)
- V Leone
- Department of Environmental Science, Second University of Naples,Via Vivaldi 43, 81100 Caserta, Italy
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Galloro G, Magno L, Ruggiero S, Iovino P, Formisano C, Cortese L, Fusco F, Meola C, Carlomagno GM. Comparison between tungsten and steel polypectomy snares: evaluation of depth of colonic thermal wall injury in a pig model. Endoscopy 2013; 45:121-6. [PMID: 23307147 DOI: 10.1055/s-0032-1325930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Thermal injury of the colonic wall during polypectomy may induce complications such as bleeding and perforation. To date, the role of the snare material in these injuries has not been examined. The aim of this study was to evaluate the depth of colonic post-polypectomy thermal wall injury induced by tungsten and steel endoscopic snares, in an effort to reduce electrosurgery-related complications. MATERIALS AND METHODS This was a single tertiary center experimental study in a porcine model. A total of 90 polypectomies where performed in three live pigs under general anesthesia, using both steel and tungsten snares by cut, coagulation, and blend current modes. The pigs were then euthanized and their colons examined histologically. RESULTS Steel snares induced significantly deeper tissue injury than tungsten snares in the pure cut mode (Pearson χ2 = 6.136, P = 0.013). The ordinal logistic regression analysis showed that the current mode and snare material were significantly associated with the ordinal score for the depth of injury. Thus, cut mode was positively associated with a lower score and coagulation mode with a higher score. In addition, tungsten was significantly associated with a lower depth of tissue injury. CONCLUSIONS Due to its inherent electrical properties, tungsten is very well suited for manufacture into electrosurgical endoscopic devices. Thus, tungsten snares may be advantageous for routine use in endoscopic polypectomy, although further studies are needed to confirm these promising findings in human patients.
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Affiliation(s)
- G Galloro
- Department of General, Geriatric, Oncological Surgery and Advanced Technology, Special Section of Surgical Digestive Endoscopy, School of Medicine, University of Naples Federico II, Naples, Italy
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Passananti V, Siniscalchi M, Zingone F, Bucci C, Tortora R, Iovino P, Ciacci C. Prevalence of eating disorders in adults with celiac disease. Gastroenterol Res Pract 2013; 2013:491657. [PMID: 24369457 PMCID: PMC3867876 DOI: 10.1155/2013/491657] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 11/03/2013] [Accepted: 11/03/2013] [Indexed: 02/07/2023] Open
Abstract
Background. Symptoms of celiac disease negatively impact social activities and emotional state. Aim was to investigate the prevalence of altered eating behaviour in celiac patients. Methods. Celiac patients and controls completed a dietary interview and the Binge Eating Staircases, Eating Disorder Inventory (EDI-2), Eating Attitudes Test, Zung Self-Rating Depression Scale, State Trait Anxiety Inventory Forma Y (STAI-Y1 and STAI-Y2), and Symptom Check List (SCL-90). Results. One hundred celiac adults and 100 controls were not statistically different for gender, age, and physical activity. STAI-Y1 and STAI-Y2, Somatization, Interpersonal, Sensitivity, and Anxiety scores of the SLC-90 were higher in CD patients than controls. EDI-2 was different in pulse thinness, social insecurity, perfectionism, inadequacy, ascetisms, and interpersonal diffidence between CD and HC women, whilst only in interceptive awareness between CD and HC men. A higher EAT-26 score was associated with the CD group dependently with gastrointestinal symptoms. The EAT26 demonstrated association between indices of diet-related disorders in both CD and the feminine gender after controlling for anxiety and depression. Conclusion. CD itself and not gastrointestinal related symptoms or psychological factors may contribute pathological eating behavior in celiac adults. Eating disorders appear to be more frequent in young celiac women than in CD men and in HC.
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Affiliation(s)
- V. Passananti
- 1Department of Clinical and Experimental Medicine, University Federico II of Naples, Via S. Pansini, 80131 Naples, Italy
| | - M. Siniscalchi
- 2Department of Medicine and Surgery, University of Salerno, Baronissi Campus, Via S. Allende, 84081 Baronissi, Salerno, Italy
| | - F. Zingone
- 2Department of Medicine and Surgery, University of Salerno, Baronissi Campus, Via S. Allende, 84081 Baronissi, Salerno, Italy
| | - C. Bucci
- 2Department of Medicine and Surgery, University of Salerno, Baronissi Campus, Via S. Allende, 84081 Baronissi, Salerno, Italy
| | - R. Tortora
- 1Department of Clinical and Experimental Medicine, University Federico II of Naples, Via S. Pansini, 80131 Naples, Italy
| | - P. Iovino
- 2Department of Medicine and Surgery, University of Salerno, Baronissi Campus, Via S. Allende, 84081 Baronissi, Salerno, Italy
| | - C. Ciacci
- 2Department of Medicine and Surgery, University of Salerno, Baronissi Campus, Via S. Allende, 84081 Baronissi, Salerno, Italy
- *C. Ciacci:
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Ciacci C, Maiuri L, Russo I, Tortora R, Bucci C, Cappello C, Santonicola A, Luciani A, Passananti V, Iovino P. Efficacy of budesonide therapy in the early phase of treatment of adult coeliac disease patients with malabsorption: an in vivo/in vitro pilot study. Clin Exp Pharmacol Physiol 2009; 36:1170-6. [PMID: 19473192 DOI: 10.1111/j.1440-1681.2009.05211.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
1. Budesonide is a glucocorticosteroid with a local anti-inflammatory effect. Coeliac disease is an immune-mediated disease caused by gluten ingestion in intolerant patients. The aim of the present study was to investigate the efficacy of budesonide in malabsorptive coeliac patients and its effect in an in vitro gliadin challenge. 2. Twenty coeliac patients with malabsorption were enrolled in the present study and were randomly assigned to one of two 4 week treatments: (i) a gluten-free diet alone; or (ii) a gluten-free diet plus 6 mg budesonide daily. At the end of 4 weeks treatment, all patients underwent clinical evaluation, laboratory tests and self-evaluation of well-being using a visual analogue scale. Intestinal biopsies from five coeliac patients (selected randomly) and four non-coeliac disease controls who underwent upper endoscopy for intestinal bleeding were challenged with gliadin (0.5 mg/mL) and budesonide (10-30 microg/mL) for 3 and 24 h. Biopsies were tested by immunohistochemistry and immunofluorescence for known markers of inflammation. 3. Treatment of patients with 6 mg budesonide daily for 4 weeks resulted in increased bodyweight, a decreased number of evacuations and decreased stool weight compared with patients on a gluten-free diet alone for 4 weeks. Well-being scores were higher in patients treated with both a gluten-free diet and budesonide compared with those receiving a gluten-free diet alone. 4. In vitro studies showed that budesonide reduced epithelial tyrosine phosphorylation and expression of histocompatibility leucocyte antigen complex DR (HLA-DR) elicited by gliadin-derived peptides. In addition, the expression of cyclo-oxygenase (COX)-2 and intercellular adhesion molecule (ICAM)-1 in the lamina propria was reduced in patients treated with both gliadin and budesonide compared with patients treated with gliadin alone. Budesonide alone decreased HLA-DR in crypt enterocytes, as well as ICAM-1 and COX-2 expression in the lamina propria of biopsy specimen of coeliac patients. Budesonide had no effect in control samples. 5. In conclusion, the results of the present study indicate that budesonide shows efficacy in the treatment of symptoms in adult coeliac patients with overt malabsorption. The mechanism underlying the effects of budesonide in reducing symptoms was elucidated by in vitro studies involving a gliadin challenge.
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Affiliation(s)
- C Ciacci
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
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Abstract
Visceral hypersensitivity is often considered to play a major etiologic role in the pathophysiology of irritable bowel syndrome in adults, and some authors argue that this increased sensitivity is mainly due to psychological factors. In contrast, there are no data in children with irritable bowel syndrome which confirm this relationship. The aim of the study was to evaluate the relationship between psychosocial aspects and sensorymotor function in children affected by irritable bowel syndrome. Ten children fulfilling the Rome II criteria for irritable bowel syndrome and seven healthy controls were enrolled. We studied the thresholds and the perception of visceral stimuli in the rectum by means of an electronic barostat (isobaric phasic distentions, 3 mmHg/1 min, interval 1 min) and a validated questionnaire. Personality features were evaluated by means of the Big Five Questionnaire for Children. Sleep, mood disturbance, anxiety and individual performance (missed school days, school results and social activities) were also evaluated. Children with irritable bowel syndrome showed significantly lower thresholds for discomfort (14.8 +/- 3.5 vs 22.3 +/- 6.9 mmHg, P = 0.010) and a higher cumulative perception score (28.2 +/- 11.1 vs 12.3 +/- 8.0, P = 0.005) compared with healthy controls. A higher emotional instability (57.8 +/- 7.0 vs 48.7 +/- 10.1, P = 0.047), sleep disturbance (7.2 +/- 1.0 vs 9.3 +/- 0.5, P = 0.004) and anxiety (6.3 +/- 2.0 vs 2.3 +/- 1.7, P = 0.009) were observed in irritable bowel syndrome patients. Moreover, in a multivariate analysis, the cumulative perception score was significantly related to emotional instability (P = 0.042). In conclusion children with irritable bowel syndrome exhibit visceral hypersensitivity and psychosocial impairment. Emotional instability, as a personality feature in these children, seems to modulate the perception response to visceral stimulations.
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Affiliation(s)
- P Iovino
- Gastroenterology and Endoscopic Units, University Federico II, Naples, Italy.
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Ciacci C, Peluso G, Iannoni E, Siniscalchi M, Iovino P, Rispo A, Tortora R, Bucci C, Zingone F, Margarucci S, Calvani M. L-Carnitine in the treatment of fatigue in adult celiac disease patients: a pilot study. Dig Liver Dis 2007; 39:922-8. [PMID: 17693145 DOI: 10.1016/j.dld.2007.06.013] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 06/11/2007] [Accepted: 06/28/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fatigue is common in celiac disease. L-Carnitine blood levels are low in untreated celiac disease. L-Carnitine therapy was shown to improve muscular fatigue in several diseases. AIM To evaluate the effect of L-carnitine treatment in fatigue in adult celiac patients. METHODS Randomised double-blind versus placebo parallel study. Thirty celiac disease patients received 2 g daily, 180 days (L-carnitine group) and 30 were assigned to the placebo group (P group). The patients underwent clinical investigation and questionnaires (Scott-Huskisson Visual Analogue Scale for Asthenia, Verbal Scale for Asthenia, Zung Depression Scale, SF-36 Health Status Survey, EuroQoL). OCTN2 levels, the specific carnitine transporter, were detected in intestinal tissue. RESULTS Fatigue measured by Scott-Huskisson Visual Analogue Scale for Asthenia was significantly reduced in the L-carnitine group compared with the placebo group (p=0.0021). OCTN2 was decreased in celiac patients when compared to normal subjects (-134.67% in jejunum), and increased after diet in both celiac disease treatments. The other scales used did not show any significant difference between the two celiac disease treatment groups. CONCLUSION L-Carnitine therapy is safe and effective in ameliorating fatigue in celiac disease. Since L-carnitine is involved in muscle energy production its decreased absorption due to OCTN2 reduction might explain muscular symptoms in celiac disease patients. The diet-induced OCTN2 increase, improving carnitine absorption, might explain the L-carnitine treatment efficacy.
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Affiliation(s)
- C Ciacci
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy.
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Galloro G, Diamantis G, Magno L, Inzirillo M, Mignogna MC, Mignogna C, De Rosa G, Iovino P. Technical aspects in endoscopic biopsy of lesions in esophageal pemphigus vulgaris. Dig Liver Dis 2007; 39:363-7. [PMID: 17307037 DOI: 10.1016/j.dld.2006.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 12/12/2006] [Accepted: 12/12/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Aim of this study is to compare a specific kind of biopsy forceps to a traditional one in providing an adequate specimen of esophageal pemphigus vulgaris lesions that includes the basement membrane for definitive diagnosis. PATIENTS AND METHODS Prospective, randomized, blind, single-center study. We performed upper endoscopy with biopsy in 32 patients divided into two groups of 16 each: in group A with a commercially available standard biopsy forceps while in group B with a commercially available rocking biopsy forceps. Hundred-ninety-six biopsy specimens from both groups were blindly evaluated by the same pathologist. RESULTS In group A 18.8% of biopsy specimens were adequate (basement membrane included). In group B 87.5% of biopsy specimens were adequate. The presence of the entire thickness of the mucosa was significantly higher in group B compared to group A. All parameters typically taken into account by pathologist for diagnosis of esophageal pemphigus vulgaris were significantly improved in group B. CONCLUSIONS The biopsy forceps used in group B permits a rocking motion of the tip on contact with the mucosa, produces a deeper full-thickness mucosal sample up to the basement membrane and assists in the evaluation of histologic features of esophageal pemphigus vulgaris.
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Affiliation(s)
- G Galloro
- Department of General, Geriatric, Oncological Surgery and Advanced Technologies, Special Section of Surgical Digestive Endoscopy, School of Medicine, University Federico II of Naples, Via S. Pansini, 5, 80132 Naples, Italy.
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Capasso S, Colella C, Coppola E, Iovino P, Salvestrini S. Removal of humic substances from water by means of calcium-ion-enriched natural zeolites. Water Environ Res 2007; 79:305-9. [PMID: 17469662 DOI: 10.2175/106143006x111772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The ability of the natural zeolited Neapolitan Yellow Tuff (NYT) enriched with calcium ions to remove humic acids from water was evaluated by batch adsorption equilibrium tests and dynamic experiments carried out by percolating humic acid solutions through a small NYT column (breakthrough curves). Under the experimental condition explored, the sorption capacity increases with the ionic strength and has the highest value at pH 7.4. The partition coefficient for a low concentration of humic acid ([humic acid] --> 0), at pH 7.4 in 0.01 M sodium chloride, was approximately 1000 L/kg, versus the value of approximately 100 L/kg in the absence of the alkaline metal salt. Therefore, after humic acids have been adsorbed in a column filled with the calcium-ion-enriched tuff, a reduction of the salt concentration in the ongoing solution enhances the release of the adsorbed material. These findings show that NYT can be used for the removal of humic acids from water.
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Affiliation(s)
- S Capasso
- Department of Environmental Sciences, Second University of Naples, Caserta, Italy.
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Iovino P, Angrisani L, Galloro G, Consalvo D, Tremolaterra F, Pascariello A, Ciacci C. Proximal stomach function in obesity with normal or abnormal oesophageal acid exposure. Neurogastroenterol Motil 2006; 18:425-32. [PMID: 16700721 DOI: 10.1111/j.1365-2982.2006.00768.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [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] [Indexed: 02/05/2023]
Abstract
There is an increased prevalence of gastro-oesophageal reflux and symptoms in obese patients. Information about the proximal stomach in obese patients with reflux is lacking. Gastric volume and compliance are similar between obese and lean subjects. To study the proximal stomach function and perception in obese patients with normal or abnormal oesophageal acid exposure, thirty-one obese patients, with normal or abnormal oesophageal acid exposure, underwent medical evaluation of oesophageal and gastrointestinal symptoms by a questionnaire and measurement of proximal stomach function and perception by an electronic barostat and a standardized questionnaire. Nineteen obese patients had abnormal oesophageal acid exposure. The percentage of total time with pH <4 is significantly related to the presence of hiatal hernia, the oesophageal intensity-frequency symptom score and gender, i.e. higher percentage in men. The perception cumulative score was significantly different between patients with normal and abnormal oesophageal acid exposure after adjusting for covariates (gender, body mass index, age, minimal distending pressure, gastric tone and gastric compliance). Gastric tone and compliance were significantly related to the perception cumulative score. In conclusion, patients with abnormal oesophageal acid exposure have increased gastric perception. A significant relation among gastric tone, gastric compliance and upper gastrointestinal sensations was shown.
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Affiliation(s)
- P Iovino
- Dipartimento di Chirurgia Generale, Geriatria, Oncologica e Tecnologie Avanzate, University of Naples Federico II, Naples, Italy.
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Iovino P, Salvestrini S, Capasso S. Background atmospheric levels of BTEX in a medium-sized city and surrounding area in Southern Italy. ACTA ACUST UNITED AC 2006. [DOI: 10.2495/air06060] [Citation(s) in RCA: 1] [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: 11/09/2022]
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Abstract
BACKGROUND Fatigue is reported by many adults at the moment of diagnosis of coeliac disease and during follow-up. AIM To evaluate the prevalence, characteristics and associations of fatigue in adult coeliac disease patients. METHODS The investigated sample comprised adults from Campania, Italy. A total of 130 coeliac disease patients were consecutively recruited in both treated (59 on gluten-free diet) and untreated conditions (71 on normal diet). The control group was made up of 80 healthy controls. Coeliac disease patients and healthy controls underwent laboratory tests, a set of questionnaires for studying fatigue: visual analogue scale for fatigue, chronic fatigue syndrome questionnaire, fatigue severity scale and a modified version of the Zung self-rating depression scale. RESULTS Coeliac disease patients showed a significantly lower body mass index than controls (P = 0.0001), lower serum iron (P = 0.04). The entire cohort of coeliac disease patients reported greater modified version of the Zung self-rating depression scale score (P = 0.001), greater visual analogue scale for fatigue score (P = 0.0001) and greater chronic fatigue syndrome questionnaire score (P = 0.0001) compared with healthy controls. Coeliac disease patients on a gluten-free diet had a significantly higher modified version of the Zung self-rating depression scale score than coeliacs on a normal diet (P = 0.001). The prevalence of pathological modified version of the Zung self-rating depression scale score was 17% in all coeliac disease patients and 0% in healthy controls. A significant correlation was found between modified version of the Zung self-rating depression scale score and fatigue scale scores in coeliacs on a normal diet. Presence/absence of gastrointestinal symptoms did not show any significant correlation with modified version of the Zung self-rating depression scale score and fatigue scale scores. In coeliacs on a gluten-free diet, modified version of the Zung self-rating depression scale and fatigue scales scores did not significantly differ from coeliacs on a normal diet and were not related to dietetic compliance. CONCLUSION In coeliacs, fatigue is a common finding, which ameliorates with the gluten-free diet and is strictly correlated to depression although coeliacs on a gluten-free diet showed more frequent and more severe depression symptoms than coeliacs on a normal diet.
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Affiliation(s)
- M Siniscalchi
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, Federico II University of Naples, Italy
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Galloro G, Mignogna M, de Werra C, Magno L, Diamantis G, Ruoppo E, Iovino P. The role of upper endoscopy in identifying oesophageal involvement in patients with oral pemphigus vulgaris. Dig Liver Dis 2005; 37:195-9. [PMID: 15888285 DOI: 10.1016/j.dld.2004.10.005] [Citation(s) in RCA: 24] [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: 04/02/2004] [Accepted: 10/14/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The involvement of oesophagus in pemphigus vulgaris is still debated. The aims of this study were to evaluate the prevalence of oesophageal involvement and the gastro-duodenal mucosa appearance before and after high-dose corticosteroid therapy in a group of patients with oral pemphigus vulgaris. METHODS We prospectively studied 28 consecutive patients with oral pemphigus by oesophageal symptom standardised questionnaire, upper gastro-intestinal endoscopy, exfoliative cytology and histological biopsy. After clinical remission, all patients underwent new endoscopy. RESULTS The prevalence of oesophageal symptoms was 57.1%. Endoscopic examination revealed oesophageal involvement with different degrees of severity in 67.8% of patients. After corticosteroid therapy, endoscopy showed normal oesophageal-gastro-duodenal mucosa. No examination-related exacerbations of the oesophageal lesions were seen. CONCLUSIONS The upper gastro-intestinal endoscopic examination, in oral pemphigus vulgaris patients with oesophageal symptoms, is safe in skilled hands technique and a useful diagnostic tool prior to starting therapy.
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Affiliation(s)
- G Galloro
- Department of General, Geriatric, Oncological Surgery and Advanced Technologies, Special Section of Surgical Digestive Endoscopy, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80132 Naples, Italy.
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Ciacci C, Iovino P, Amoruso D, Siniscalchi M, Tortora R, Di Gilio A, Fusco M, Mazzacca G. Grown-up coeliac children: the effects of only a few years on a gluten-free diet in childhood. Aliment Pharmacol Ther 2005; 21:421-9. [PMID: 15709993 DOI: 10.1111/j.1365-2036.2005.02345.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 02/05/2023]
Abstract
AIM To evaluate clinical and psychological status of adults with childhood diagnosis of coeliac disease who were re-exposed to gluten after only a few years and now on a gluten-containing diet, compared with adults with recent diagnosis of coeliac disease, and adults who remained on gluten-free diet after childhood diagnosis. METHODS A total of 195 adults with a biopsy suggestive of coeliac disease in childhood, who either had adhered to a gluten-free diet for at least 1 year after diagnosis and now are either on gluten-free diet (n = 110) or on gluten-containing diet (n = 85), and adults with newly diagnosed coeliac disease (n = 165) underwent a medical check-up. RESULTS Body mass index and main laboratory indices were statistically different among groups (lowest in never on gluten-free diet, highest in gluten-free diet). The lowest average levels of bone mineral density were found among never on gluten-free diet patients. Prevalence of autoimmune disorders was increased in never on gluten-free diet when compared with the transient gluten-free diet and gluten-free diet groups. Histology revealed villous subatrophy in all patients of never on gluten-free diet group, in 39 of 110 patients of gluten-free diet and in 84 of 85 of transient gluten-free diet groups. Herpetiform dermatitis was found in three patients of gluten-free diet, three of transient gluten-free diet and three of never on gluten-free diet. Dental enamel defects were found in 15 patients of transient gluten-free diet, 43 of never on gluten-free diet and in zero of the gluten-free diet group. Pregnancy outcome was not significantly different between the two groups, but neonatal weight was lower and breast feeding was shorter in the never on gluten-free diet group. Sexual habits, alcohol intake and cigarette smoking were significantly different in the never on gluten-free diet group when compared with the other two groups. CONCLUSION Gluten withdrawal in childhood partly protects coeliac adults from clinical and behavioural effects of gluten sensitivity.
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Affiliation(s)
- C Ciacci
- Gastrointestinal Unit, Federico II University of Napoli, Naples, Italy.
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41
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Ciacci C, Sabbatini F, Cavallaro R, Castiglione F, Di Bella S, Iovino P, Palumbo A, Tortora R, Amoruso D, Mazzacca G. Helicobacter pylori impairs iron absorption in infected individuals. Dig Liver Dis 2004; 36:455-60. [PMID: 15285524 DOI: 10.1016/j.dld.2004.02.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Infection with Helicobacter pylori is recognised as a major risk factor for chronic gastritis, peptic ulcer disease and gastric cancer. The association between H. pylori infection and iron deficiency anaemia has been established. Multiple mechanisms have been advocated to explain the relationship between H. pylori and iron status and their association might reduce iron deposit. AIM Aim of this study was to investigate whether H. pylori infection affects iron absorption. METHODS The study was designed on a prospective basis. Fifty-five subjects underwent upper gastrointestinal endoscopy and biopsy to investigate the presence of H. pylori and, when this was positive, also search of serum anti-CagA was performed. Tests included an oral iron absorption test with the administration of 1 mg/kg of Fe2+. Iron levels were measured before and 2 h after iron administration (delta iron). H. pylori-positive subjects were administered antibiotic therapy for 1 week and, 2 months later, the oral iron absorption test was repeated and urea-breath test was first performed. RESULTS H. pylori-positive subjects had lower serum level of ferritin and lower delta iron compared to H. pylori-negative subjects. That difference is significant in anaemic women and is independent of the presence of serum anti-CagA antibodies. After H. pylori eradication iron absorption test was similar to those of non-infected subjects. CONCLUSION H. pylori infection impairs iron uptake. That mechanism, together with others, may contribute to the depletion of iron in infected patients.
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Affiliation(s)
- C Ciacci
- Department of Clinical and Experimental Medicine, Gastrointestinal Unit, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy.
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42
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Iovino P, Angrisani L, Tremolaterra F, Nirchio E, Ciannella M, Borrelli V, Sabbatini F, Mazzacca G, Ciacci C. Abnormal esophageal acid exposure is common in morbidly obese patients and improves after a successful Lap-band system implantation. Surg Endosc 2002; 16:1631-5. [PMID: 12073000 DOI: 10.1007/s00464-001-9225-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2001] [Accepted: 04/01/2002] [Indexed: 02/07/2023]
Abstract
BACKGROUND The relation between gastro-esophageal reflux disease (GERD) and obesity is controversial. The laparoscopic adjustable gastric band (LAGB) procedure is effective for morbid obesity. Its indication in the presence of GERD, however, is still debated. This study aimed to investigate esophageal symptoms, motility patterns, and acid exposure in morbidly obese patients before and after LAGB placement. METHOD For this study, 43 consecutive obese patients were investigated by a standardized symptoms questionnaire, stationary manometry and 24-h ambulatory pH-metry, and 16 patients with abnormal esophageal acid exposure were reevaluated 18 months after LAGB placement. RESULTS Symptom scores and abnormal esophageal acid exposure were found to be significantly higher, Lower Esophageal Sphincter (LOS) pressure was significantly lower in obese patients than in control subjects. After LAGB, esophageal acid exposure was significantly reduced in all but two patients, who presented with proximal of gastric pouch dilation. CONCLUSIONS There is a high prevalence of GERD in the obese population. Uncomplicated LAGB placement reduces the amount of acid in these patients with abnormal esophageal acid exposure.
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Affiliation(s)
- P Iovino
- Dipartimento di Chirurgia Generale, Geriatrica, Oncologica e Tecnologic Avanzate e, Università Federico II, Napoli, Italy.
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43
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Lubrano E, Iovino P, Tremolaterra F, Parsons WJ, Ciacci C, Mazzacca G. Fibromyalgia in patients with irritable bowel syndrome. An association with the severity of the intestinal disorder. Int J Colorectal Dis 2001; 16:211-5. [PMID: 11515679 DOI: 10.1007/s003840100299] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fibromyalgia (FM) syndrome and irritable bowel syndrome (IBS) are functional disorders in which altered somatic and or visceral perception thresholds have been found. The aim of this study was to evaluate the prevalence of FM in a group of patients with IBS and the possible association of FM with patterns and severity of the intestinal disorder. One hundred thirty consecutive IBS patients were studied. The IBS was divided into four different patterns according to the predominant bowel symptom and into three levels of severity using a functional severity index. All patients underwent rheumatological evaluation for number of positive tender points, number of tender and swollen joints, markers of inflammation, and presence of headache and weakness. Moreover, patients' assessments of diffuse pain, mood and sleep disturbance, anxiety, and fatigue were also measured on a visual analogue scale. The diagnosis of FM was made based on American College of Rheumatology classification criteria. Nonparametric tests were used for statistical analysis. Fibromyalgia was found in 20% of IBS patients. No statistical association was found between the presence of FM and the type of IBS but a significant association was found between the presence of FM and severity of the intestinal disorder. The presence of FM in IBS patients seems to be associated only with the severity of IBS. This result confirms previous studies on the association between the two syndromes.
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Affiliation(s)
- E Lubrano
- Physical Medicine and Rehabilitation Department, University Federico II, Naples, Italy
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De Palma GD, Galloro G, Siciliano S, Iovino P, Catanzano C. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc 2001; 53:547-53. [PMID: 11323577 DOI: 10.1067/mge.2001.113381] [Citation(s) in RCA: 262] [Impact Index Per Article: 11.4] [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: 02/05/2023]
Abstract
BACKGROUND The necessity for drainage of both liver lobes in tumors arising at the biliary bifurcation is controversial. The aim of this study was to compare the outcome of unilateral versus bilateral drainage in patients with biliary obstruction at the hilum. METHODS One hundred fifty-seven consecutive patients with primary cholangiocarcinoma, gallbladder cancer, or periportal lymph node metastases were randomly allocated to unilateral (group A) or bilateral (group B) hepatic duct drainage. RESULTS In intention-to treat analysis, group A had a significantly higher rate of successful endoscopic stent insertion than group B (88.6% vs. 76.9%, p = 0.041). Group B had a significantly higher rate of complications than group A (26.9% vs. 18.9%, p = 0.026) because of the higher rate of early cholangitis (16.6% vs. 8.8%, p = 0.013). In per-protocol analysis the rate of successful drainage, complications, and mortality did not differ between the two groups. Median survival did not differ between the two groups but was significantly different for patients with cholangiocarcinoma and those with gallbladder cancer versus patients with metastatic tumors (p = 0.0247). CONCLUSION The insertion of more than one stent would not appear justified as a routine procedure in patients with biliary bifurcation tumors.
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Affiliation(s)
- G D De Palma
- Department of Surgery and Advanced Technologies, Service of Digestive Endoscopy, University of Naples Federico II, School of Medicine, Naples, Italy
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Angrisani L, Borrelli V, Lorenzo M, Santoro T, Cimmino G, Ciannella M, Iovino P, Persico G, Tesauro B. Conversion of Lap-Band to gastric bypass for dilated gastric pouch. Obes Surg 2001; 11:232-4. [PMID: 11355033 DOI: 10.1381/096089201321577965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 02/05/2023]
Abstract
An 18-year-old female who had undergone a laparoscopic adjustable gastic banding developed several episodes of gastric pouch dilatation (GPD), treated conservatively. The last GPD (31 months after Lap-Band placement) involved the lesser curvature of the stomach and was refractory to medical treatment. Conversion to an open gastric bypass was performed. Gastric bypass is an option in the case of Lap-Band failure.
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Affiliation(s)
- L Angrisani
- S-Giovanni Bosco Hospital, Department of Surgery, Naples, Italy.
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46
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Iovino P, Valentini G, Ciacci C, De Luca A, Tremolaterra F, Sabbatini F, Tirri E, Mazzacca G. Proximal stomach function in systemic sclerosis: relationship with autonomic nerve function. Dig Dis Sci 2001; 46:723-30. [PMID: 11330404 DOI: 10.1023/a:1010779729184] [Citation(s) in RCA: 22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gastrointestinal involvement is frequent in patients with systemic sclerosis (SSc); however, studies on the proximal stomach and its regulation are lacking. It has been hypothesized that the primary event in the pathogenesis of gastrointestinal involvement in SSc is an early neural lesion. This study investigates proximal stomach function and its relation to autonomic nerve function in SSc. Twenty SSc patients classified in to clinical subsets, underwent measurement of proximal stomach function with and without glucagon by electronic barostat and an assessment of autonomic nerve function. SSc patients were not significantly different from 11 controls for gastric compliance (59.5+/-5.0 vs 47.7+/-4.2 ml/mm Hg, P = 0.1). The pressure-volume curves in each participant with and without glucagon were significantly different (P < 0.001). A significant positive association was found between gastric compliance and autonomic nerve function (P < 0.05). The change in gastric compliance during glucagon administration was significant-associated with autonomic function (P < 0.05). The perception cumulative scores did not differ between SSc patients and control subjects (P = 0.2). In conclusion, proximal stomach function is associated with autonomic nerve function in SSc patients. This confirms the frequent association of motility disorders with autonomic dysfunction in SSc.
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Affiliation(s)
- P Iovino
- Department of Medical and Surgery of Digestive Disease, Medical School, Federico 11 University, Naples Italy
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Abstract
BACKGROUND Extraction of a migrated esophageal stent may be extremely difficult with a substantial risk of complications including esophageal perforation and hemorrhage. METHODS Retrospectively 242 patients were evaluated who underwent implantation of self-expanding metal stents (SEMS) and 13 (5.4%) were identified with distal stent migration. In all cases of stent dislocation into the stomach, extraction of the stent was not attempted and a new stent was inserted. RESULTS Twelve patients had dysphagia. One patient underwent surgery because of stent impaction in the colon, 3 had unrecognized passage of the stent per rectum, and 9 had evidence of the stent into the stomach. Further severe complications were not observed in any patient and all stents remained into the stomach. CONCLUSION Complications arising from migrated esophageal stents are uncommon. Further studies are warranted to determine which patients with migrated SEMS warrant stent retrieval.
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Affiliation(s)
- G D De Palma
- Department of Surgery and Advanced Technologies, Service of Digestive Endoscopy, University of Naples Federico II, School of Medicine, Naples, Italy
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Abstract
BACKGROUND/AIMS Tissue transglutaminase has been reported to be involved in the healing of experimental gastric ulcer; nevertheless, other type(s) of transglutaminase could be involved. The present experiments aimed at examining whether plasma transglutaminase (factor XIIIa) contributes to such healing and at evaluating whether factor XIII supplementation improves gastric mucosal lesions. METHODS The healing effect of 200 U/kg of factor XIII administered intravenously was examined using a water immersion restraint rat model of stress gastric damage. The rats were sacrified 0, 2, 4, and 12 h after stress. The gastric mucosa was examined macroscopically and microscopically, and the transglutaminase activities were assayed in serum and gastric mucosa. Factor XIIIa and tissue transglutaminase protein levels in the gastric mucosa were analyzed by immunoblot. Immunohistochemistry was used to identify the location of tissue transglutaminase, factor XIIIa, and fibronectin in the gastric mucosa. RESULTS The transglutaminase activity, reduced by stress in the gastric mucosa, increased up to 12 h after stress, peaking at 4 h, when the ulcer index significantly decreased. The serum transglutaminase level was low at all time points. Exogenous administration of factor XIII allowed a faster reduction of the ulcer index that was coincident with an increased transglutaminase activity in the mucosa. Both tissue transglutaminase and factor XIIIa protein levels were reduced by 6 h of stress and increased after factor XIII administration. Immunohistochemistry showed a colocalization of both factor XIIIa and tissue transglutaminase with fibronectin in the extracellular matrix of the damaged area. CONCLUSIONS Two forms of transglutaminase are involved in the healing of stress-induced gastric erosions, and factor XIII administration allows faster gastric mucosa healing.
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Affiliation(s)
- G D'Argenio
- Gastrointestinal Unit, School of Medicine, Federico II University, Naples, Italy.
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Angrisani L, Iovino P, Lorenzo M, Santoro T, Sabbatini F, Claar E, Nicodemi O, Persico G, Tesauro B. Treatment of morbid obesity and gastroesophageal reflux with hiatal hernia by Lap-Band. Obes Surg 1999; 9:396-8. [PMID: 10484300 DOI: 10.1381/096089299765553007] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Esophageal reflux is common in obese patients. Hiatal hernia is considered a potential contraindication to placement of a Lap-Band. METHODS Esophageal investigation in patients who were candidates for a Lap-Band included clinical evaluation of symptoms (scoring system), endoscopic and radiologic evaluation, 24-h pH test, and stationary manometry. Patients with gastroesophageal reflux (GER) with or without hiatal hernia underwent the Lap-Band procedure. RESULTS GER was diagnosed in 12/40 morbidly obese patients, 11 of whom received a standard Lap-Band (3 patients were radiologically diagnosed with transient hiatal hernia). One patient with a large hiatal hernia underwent closure of the diaphragmatic esophageal hiatus, and the Lap-Band was positioned similarly to an Angelchik prosthesis. All but 1 patient who was lost at follow-up were symptom-free (range 1-24 months). CONCLUSION GER with or without hiatal hernia is not a contraindication for obese patients undergoing a Lap-Band procedure. It accomplishes by a single operation satisfactory treatment of these two disturbing diseases.
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Affiliation(s)
- L Angrisani
- 1st Department of Surgery, University Federico II, Medical School, Naples, Italy.
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50
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Ciacci C, De Rosa A, de Michele G, Savino G, Squillante A, Iovino P, Sabbatini F, Mazzacca G. Sexual behaviour in untreated and treated coeliac patients. Eur J Gastroenterol Hepatol 1998; 10:649-51. [PMID: 9744692 DOI: pmid/9744692] [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: 02/07/2023]
Abstract
BACKGROUND Sexual behaviour is often altered in chronic illness. AIM To evaluate sexual behaviour in coeliac patients before and after treatment with a gluten-free diet. PATIENTS Fifty-five adults with coeliac disease and 51 age- and sex-matched healthy controls. METHODS Routine clinical and laboratory work-up was used for diagnosis of coeliac disease. Age of first sexual intercourse, prevalence of individuals who were sexually active, frequency of intercourse, reduction in sexual desire, difficulty in attaining orgasm, pain during intercourse, and prevalence of individuals defining themselves as satisfied with their sexual life were investigated by an anonymous, self-administered questionnaire administered before and after one year's treatment with a gluten-free diet in coeliac patients, and only once in controls. Analyses included clinical conditions, demographic and socio-economic data. RESULTS Compared with controls, untreated coeliac patients had a significantly lower frequency of intercourse and a lower prevalence of individuals satisfied with their sexual life. Patients with overt and subclinical coeliac disease did not show significant differences for any indices of sexual behaviour. Compared with untreated conditions, coeliac patients after one year of treatment had improved values for all indices of sexual behaviour: differences were significant for frequency of intercourse and prevalence of individuals satisfied with their sexual life. CONCLUSION Untreated coeliac disease, even in its subclinical presentation, is associated with disorders in sexual behaviour which are improved by the dietary treatment.
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Affiliation(s)
- C Ciacci
- Department of Gastroenterology, Federico II University, Naples, Italy
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