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Tursi A.,Gastroenterology Service | Elisei W.,ASL Rome H | Brandimarte G.,Cristo Re Hospital | Giorgetti G.M.,Digestive Endoscopy and Nutrition Unit | And 5 more authors.
Neurogastroenterology and Motility | Year: 2012

Background Inflammation may be detected in diverticular disease (DD), and fibrosis may also develop. We assessed the mucosal expression of bFGF, SD1, and TNF-α in DD according to the severity of the disease. Moreover, we assessed the response to therapy of these cytokines in acute uncomplicated diverticulitis (AUD). Methods Fifteen patients affected by AUD and seven patients affected by symptomatic uncomplicated diverticular disease (SUDD) were enrolled. Patients with asymptomatic diverticulosis (AD), segmental colitis associated with diverticulosis (SCAD), ulcerative colitis (UC), and healthy subjects (HC) served as control groups. Key Results The expression of bFGF, SD1, and TNF-α was significantly higher in diverticulitis than in healthy controls, in diverticulosis, and in uncomplicated diverticular disease. Cytokines were significantly higher in uncomplicated diverticular disease than in healthy controls. Cytokine expression in diverticulitis did not differ significantly from that of ulcerative colitis. After treatment, TNF-α expression dropped significantly. Conclusions & Inferences Mucosal TNF-α is overexpressed only in symptomatic DD, while SD1 and bFGF are already overexpressed in AD. Finally, TNF-α but not SD1 or bFGF expression seems to be influenced by the treatment in AUD. © 2012 Blackwell Publishing Ltd. Source


Tursi A.,Gastroenterology Service | Elisei W.,ASL Rome H | Giorgetti G.M.,Digestive Endoscopy and Nutrition Unit | Inchingolo C.D.,Lorenzo Bonomo Hospital | And 3 more authors.
International Journal of Colorectal Disease | Year: 2012

Background and aims Literature data about the outcome of segmental colitis associated with diverticulosis (SCAD) are scarce. Our aim was to assess the clinical outcome of SCAD according to the type of disease. Patients/methods Twenty-seven SCAD patients underwent a 5-year follow-up (13 males, 14 females; mean age, 63.71 years; range, 50-85 years). Eleven patients were affected by type A, eight by type B, four by type C and four by type D SCAD. During the follow-up, all type B, C, and D patients were under continuous medical treatment. Five type A patients refused any maintaining treatment, but accepted to undergo the clinical, endoscopic, and histological follow-up. Results/findings Five type A patients taking therapy (83.33%), two type A not taking therapy (50%), all type C patients (100%), five type B patients (62.5%) and none of type D (0%) were under continuous remission at the end of the follow-up. All type D patients required further steroid course to obtain remission, and two patients required azathioprine to maintain remission. Interpretations/conclusions SCAD B and D patients fail to maintain long-term remission, often requiring immunosuppressive treatment. SCAD A and C patients show a more benign course; however, long-term treatment guarantees longer remission also in those patients. © 2011 Springer-Verlag. Source


Tursi A.,Gastroenterology Service | Elisei W.,ASL Rome H | Giorgetti G.M.,Digestive Endoscopy and Nutrition Unit | Inchingolo C.D.,Lorenzo Bonomo Hospital | And 3 more authors.
Journal of Gastrointestinal and Liver Diseases | Year: 2013

Background & Aims: Colonic diverticulitis shows a high recurrence rate, but the factors associated with such recurrence are still unknown. The aim of our study was to investigate the role of endoscopic and histological inflammation as predictors for the recurrence of diverticulitis. Methods: One hundred and thirty patients suffering from Acute Uncomplicated Diverticulitis (AUD) (81 males, 49 females, mean age 64.71 years, range 40-85) were prospectively assessed. All patients had AUD confirmed by computerized tomography (CT) and endoscopy. Clinical, endoscopic and histological follow-up was performed after 6, 12 and thereafter 24 months after diagnosis of AUD. Results: Sixteen patients were lost to follow-up. Diverticulitis recurred in 18 patients (13.84%): 15 (13.15%) patients showed recurrence of AUD, whilst 3 (2.63%) showed recurrence of complicated diverticulitis. At the end of the follow-up period, endoscopic inflammation was still detected in 31 (27.67%) patients, and active histological inflammation in 41 patients (36.6%). Only detection of endoscopic and of histological inflammation during the follow-up was a predictor of diverticulitis recurrence (Log rank test, p = 0.0004). Conclusions: Detection of endoscopic and histological inflammation after attack of AUD was identified as a predictor of diverticulitis recurrence. Source


Tursi A.,Gastroenterology Service | Elisei W.,ASL RMH | Brandimarte G.,Cristo Re Hospital | Giorgetti G.M.,S. Eugenio Hospital | Aiello F.,University of Palermo
Journal of Clinical Gastroenterology | Year: 2010

Background: Acute uncomplicated diverticulitis (AUD) may show histologic and serologic signs of inflammation. Goals: To assess whether serologic markers of inflammation may be predictive of abnormal histology in AUD. Study: Twenty-one consecutive patients affected by AUD were studied (15 Males, 6 Females, mean age 66.19 y, range 43 to 85 y). Diagnosis of AUD was based on specific endoscopic and CT scan patterns. Several serologic markers were assessed [White blood cells (WBC), Erytro-sedimentation Rate, C-reactive protein (CRP), fibrinogen, α1-acid glycoprotein]. Neutrophilic and lymphocytic inflammatory infiltrate was also scored. Results: WBC was increased in 4/21 pts (19.4%), Erytro-sedimentation Rate in 12/21 pts (57.14%), CRP in 13/21 pts (61.9%), fibrinogen in 5/21 pts (23.8%), and α1-acid glycoprotein in 6/21 pts (28.57%). All serologic markers were related with the degree of histologic damage. In patients scoring 3 in neutrophilic infiltrate (severe active inflammation), all markers showed a statistical significant relation (ranging from P=0.004 for WBC to P=0.00001 for fibrinogen). CRP was the most sensitive marker of mild-moderate histologic damage, as it was increased in 4/10 (40%) patients scoring 0 or 1 in neutrophilic infiltrate (absence of mild active inflammation) (P=0.005). Conclusions: Serologic markers showed a strict relation with the degree of histologic damage in AUD. Moreover, CRP is the most sensitive marker of mild-moderate histologic damage. Copyright © 2010 by Lippincott Williams & Wilkins. Source


Tursi A.,Gastroenterology Service | Elisei W.,ASL Rome H | Giorgetti G.,Digestive Endoscopy and Nutrition Unit | Picchio M.,P. Colombo Hospital | Brandimarte G.,Cristo Re Hospital
Panminerva Medica | Year: 2014

Aim. The aim of the present study was to assess the efficacy of the standard triple therapy containing PPI plus amoxycillin and clarithromycin in curing Helicobacter pylori (H. pylori) infection during a long-term period. Methods. A retrospective analysis was conducted on 1497 consecutive dyspeptic patients with proven H. pylori infection and enrolled from 1996 to 2006. Patients received a standard triple therapy with proton pump inhibitor (PPI) plus amoxicillin 1 g and clarithromycin 500 mg for 7 days (all twice daily) plus PPI every day for further 4 weeks in case of active peptic ulcer or severe gastritis detected at endoscopy. One month after conclusion of therapy, endoscopy was performed in those patients for whom the examinations were clinically relevant. The remaining patients were checked by 13C-urea breath test. Results. The overall H. pylori eradication rate was 70.41% (on intention-to-treat analysis). However, it decreased significantly during the observation period, ranging from 90% (95% CI 87.14% to 93.91%) in 1996 to 51.11% (95% CI 48.14% to 55.91%) in 2006 (on i-t-t analysis) (P=0.001). No difference in eradicating the was found infection between Puglia and Lazio (1996: P=0.39; 2006: P=0.64). Conclusion. Standard triple therapy does not appear any-more a valid therapeutic strategy for the management of H. pylori infection in clinical practice. Source

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