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PubMed | Gastroenterologia, Centrale Operativa Screening, Gastroenterologia ed endoscopia digestiva, Gastroenterologia ed Endoscopia Digestiva and 5 more.
Type: Comparative Study | Journal: Endoscopy | Year: 2016

The high volume and poor palatability of 4L of polyethylene glycol (PEG)-based bowel cleansing preparation required before a colonoscopy represent a major obstacle for patients. The aim of this study was to compare two low volume PEG-based preparations with standard 4L PEG in individuals with a positive fecal immunochemical test (FIT) within organized screening programs in Italy.A total of 3660 patients with a positive FIT result were randomized to receive, in a split-dose regimen, 4L PEG or 2L PEG plus ascorbate (PEG-A) or 2L PEG with citrate and simethicone plus bisacodyl (PEG-CS). The noninferiority of the low volume preparations vs. 4L PEG was tested through the difference in proportions of adequate cleansing.A total of 2802 patients were included in the study. Adequate bowel cleansing was achieved in 868 of 926 cases (93.7%) in the 4L PEG group, in 872 out of 911 cases in the PEG-A group (95.7%, difference in proportions +1.9%, 95% confidence interval [CI] -0.1 to 3.9), and in 862 out of 921 cases in the PEG-CS group (93.6%, difference in proportions -0.2%, 95%CI -2.4 to 2.0). Bowel cleansing was adequate in 95.5% of cases when the preparation-to-colonoscopy interval was between 120 and 239 minutes, whereas it dropped to 83.3% with longer intervals. Better cleansing was observed in patients with regular bowel movements (95.6%) compared with those with diarrhea (92.4%) or constipation (90.8%).Low volume PEG-based preparations administered in a split-dose regimen guarantee noninferior bowel cleansing compared with 4L PEG. Constipated patients require a personalized preparation.EudraCT 2012-003958-82.

Frazzoni M.,Fisiopatologia Digestiva | Conigliaro R.,Gastroenterologia | Mirante V.G.,Fisiopatologia Digestiva | Melotti G.,Chirurgia Generale
Neurogastroenterology and Motility | Year: 2012

Background By analysis of symptom-reflux association, endoscopy-negative refractory heartburn can be related to acid/non-acid refluxes with impedance-pH monitoring. Unfortunately, patients frequently do not report symptoms during the test. We aimed to assess the contribution of quantitative analysis of impedance-pH parameters added to symptom-reflux association in evaluating patients with endoscopy-negative heartburn refractory to high-dose proton pump inhibitor therapy. Methods The symptom association probability (SAP), the symptom index (SI), the esophageal acid exposure time and the number of distal and proximal refluxes were assessed at on-therapy impedance-pH monitoring. Relationships with hiatal hernia and manometric findings were also evaluated. Key Results Eighty patients were prospectively studied. Refractory heartburn was more frequently related to reflux by a positive SAP/SI and/or abnormal impedance-pH parameters (52/80 cases) (65%) than by a positive SAP/SI only (38/80 cases) (47%) (P=0.038). In patients with refractory non-erosive reflux disease (NERD) defined by a positive SAP/SI and/or abnormal impedance-pH parameters, the prevalence of hiatal hernia was significantly higher (56%vs 21%, P=0.007) and the mean lower esophageal sphincter tone was significantly lower (18.7 vs 25.8mmHg, P=0.005) than in those (35%) with reflux-unrelated, i.e., functional heartburn (FH). On the contrary, no significant difference was observed subdividing patients according to a positive SAP/SI only. Conclusions & Inferences Quantitative analysis of impedance-pH parameters added to symptom-reflux association allows a subdivision of refractory-heartburn patients into refractory NERD and FH which is substantiated by pathophysiological findings and which restricts the diagnosis of FH to one third of cases. © 2011 Blackwell Publishing Ltd.

Frazzoni M.,Fisiopatologia Digestiva | Conigliaro R.,Gastroenterologia | Manta R.,Gastroenterologia | Melotti G.,Chirurgia Generale
Alimentary Pharmacology and Therapeutics | Year: 2011

Aliment Pharmacol Ther 2011; 34: 67-75 Summary Background EsophyX is a novel transoral incisionless fundoplication device developed to mimic surgical fundoplication. EsophyX fundoplication improves acid reflux parameters in proton pump inhibitor (PPI)-responsive GERD patients but its efficacy in refractory GERD has been scarcely studied. Aim To assess reflux parameters before and after EsophyX or laparoscopic fundoplication and their relationship with symptoms in refractory GERD. Methods In an open-label study, we enrolled prospectively patients with heartburn/regurgitation persisting despite high-dose PPI therapy. Impedance-pH monitoring was performed on PPI therapy before intervention and off PPI therapy 3 months after intervention. Results Ten patients chose to undergo EsophyX (EndoGastric Solutions, Redmond, WA, USA) fundoplication while ten chose laparoscopic fundoplication, and the baseline characteristics were comparable. Distal and proximal refluxes were significantly reduced post-operatively in the surgical but not in the endoscopic group and the median values were significantly lower in the former than in the latter. The oesophageal acid exposure time was normal in 50% of cases after EsophyX and in 100% of cases after surgery (P = 0.033); the number of distal refluxes was normal in 20% and 90% of cases (P = 0.005) and the number of proximal refluxes was normal in 40% and 100% of cases (P = 0.011), respectively. A positive persisting symptom-reflux association was found post-operatively in 6/10 patients in the EsophyX group and in 0/10 patients in the surgical group (P = 0.011). Conclusions In patients with refractory GERD, EsophyX fundoplication is significantly less effective than laparoscopic fundoplication in improving reflux parameters and accordingly, in inducing symptom remission. © 2011 Blackwell Publishing Ltd.

Bianco M.A.,Gastroenterologia | Cipolletta L.,Gastroenterologia | Rotondano G.,Gastroenterologia | Buffoli F.,Gastroenterologia | And 2 more authors.
Endoscopy | Year: 2010

Background and study aim: The aim of this study was to assess the prevalence of nonpolypoid lesions (NPLs) in Italy and their risk of containing neoplasia or advanced histology. Patients and methods: This was a multicenter cross-sectional observational study on consecutive patients undergoing total colonoscopy over a 3-month period in 80 Italian centers. Results: In all, 27400 total colonoscopies were analyzed. Cancer was diagnosed in 801 patients (2.9%). A total of 6553 precancerous lesions were detected in 5609 patients. Of these, 4154 patients (74.1%) had polypoid lesions and 1455 patients (25.9%) had NPLs. Therefore, the prevalence of NPLs was 5.3% (95%CI 5.05.6). NPLs larger than 10mm were detected in 254 patients (17.5%). NPLs were more predominant in the proximal colon (OR 2.92, 95%CI 2.563.43; P<0.0001 vs. polypoid lesions). Neoplastic tissue was diagnosed in 79.0% and advanced histology (high-grade intraepithelial neoplasia or more) in 20.9% of resected lesions. The risk of advanced histology was similar for polypoid and nonpolypoid lesions when adjusted for size. Depressed lesions had the highest risk of advanced histology (OR 10.56, 95%CI 6.0218.55; P<0.0000 vs. flat-elevated). Age was an independent predictor of both neoplasia and advanced histology (P=0.0001). Conclusions: NPLs are relatively common in the Italian population, with a prevalence similar to that in other Western series. NPLs are not more aggressive than polypoid lesions, except for those with depressed morphology. © Georg Thieme Verlag KG Stuttgart · New York.

Tomba C.,University of Milan | Baldassarri A.,Gastroenterologia | Coletta M.,University of Milan | Cesana B.M.,University of Brescia | Basilisco G.,Gastroenterologia
Alimentary Pharmacology and Therapeutics | Year: 2012

Background Symptoms of lactose intolerance are often attributed to lactose malabsorption but, as this relationship has not been demonstrated when a small dose of lactose similar to that contained in one cup of milk is ingested by intolerant patients, psychological factors may play a role in altered symptom perception. Aim To assess the hypothesis that the psychological profile influences the symptoms of lactose intolerance. Methods One hundred and two consecutive patients underwent a 15 g lactose hydrogen breath test to assess lactose malabsorption. The patients recorded the presence and severity of symptoms of lactose intolerance during the breath test using visual analogue scales. The psychological profile was assessed using a psychological symptom checklist, and health-related quality of life by means of the short-form health survey. Results Lactose malabsorption and intolerance were diagnosed in, respectively, 18% and 29% of the patients. The two conditions were not associated, and the severity of intolerance was even less in the patients with malabsorption. Multivariate logistic analysis showed that a high somatisation t-score was significantly associated with lactose intolerance (odds ratio 4.184; 1.704-10.309); the effects of the other psychological variables and of lactose malabsorption were not statistically significant. Health-related quality of life was significantly reduced in the patients with somatisation, but not in those with lactose malabsorption. Conclusions The symptoms of lactose intolerance during hydrogen breath testing at a low physiological lactose load, are unrelated to lactose malabsorption, but may reveal a tendency towards somatisation that could impair the quality of life. © 2012 Blackwell Publishing Ltd.

Frazzoni M.,Fisiopatologia Digestiva | Conigliaro R.,Gastroenterologia | Melotti G.,Chirurgia Generale
Digestive Diseases and Sciences | Year: 2011

Background: Patients with typical reflux symptoms (heartburn/regurgitation) persisting despite proton pump inhibitor (PPI) therapy are not uncommon. Impedance-pH monitoring detects gastroesophageal reflux at all pH levels and may establish if ongoing symptoms on PPI therapy are associated with acid/nonacid reflux. Laparoscopic fundoplication is a therapeutic option in such patients but reflux parameters on PPI therapy and after intervention and their relationship with symptom persistence/remission have been scarcely studied. Aims: The aim of this study was to assess reflux parameters and their relationship with symptoms before and after laparoscopic fundoplication, on and off PPI therapy, respectively, in patients with PPI-unresponsive heartburn/regurgitation and with a positive symptom-reflux association and/or abnormal reflux parameters detected on PPI therapy. Methods: Impedance-pH monitoring was performed on high-dose PPI therapy and 3 months after laparoscopic fundoplication, off PPI therapy, in 40 patients with PPI-unresponsive heartburn/regurgitation. Symptoms were scored by a validated questionnaire. Results: Esophageal acid exposure time as well as the number of total and proximal reflux events and of acid and weakly acidic refluxes decreased significantly after surgery: normal values were found in 100, 77, 95, 92 and 65% of cases, respectively. Weakly alkaline refluxes increased significantly postoperatively but neither before nor after intervention were associated with symptoms. All patients reported total/subtotal remission of heartburn/regurgitation 3 months after surgery. Conclusions: Laparoscopic fundoplication improves acid and weakly acidic reflux parameters when compared with PPI therapy. This improvement justifies the very high post-surgical symptom remission rate that we observed. Prolonged follow-up is warranted but our findings strongly support the surgical option in PPI failures. © 2010 Springer Science+Business Media, LLC.

Frazzoni M.,Fisiopatologia Digestiva | Conigliaro R.,Gastroenterologia | Melotti G.,Chirurgia Generale
Alimentary Pharmacology and Therapeutics | Year: 2011

Background In patients with heartburn that persists despite proton pump inhibitor (PPI) therapy, reflux oesophagitis is found rarely, and its pathogenesis has been scarcely studied. Aim To assess reflux parameters by impedance-pH monitoring in PPI-resistant reflux oesophagitis. Methods Impedance-pH monitoring was performed on PPI therapy in patients with symptomatic reflux oesophagitis detected despite standard or high-dose PPI therapy of at least 8-week duration. Results Twenty patients, ten on once daily and ten on twice daily PPI regimens, were studied. The gastric acid exposure time (per cent time pH <4) ranged from 10% to 81% and was >30% in 70% of cases, but the oesophageal acid exposure time (per cent time pH <4) was abnormal in 20% of patients only. The number of acid, weakly acidic and weakly alkaline refluxes was abnormal in 25%, 100% and 15% of patients, respectively. Conclusions Weakly acidic refluxes were above the normal range in all cases, whereas acid reflux parameters and weakly alkaline refluxes were normal in the vast majority of cases. Gastric acid secretion, with consequent intra-gastric pepsins activation, persists despite ongoing PPI therapy and activated pepsins may well be present in weakly acidic refluxes. As activated pepsins maintain their proteolytic activity in a weakly acidic environment, they may be responsible for mucosal damage. We conclude that weakly acidic refluxes have a major role in the pathogenesis of PPI-resistant reflux oesophagitis. Therapeutic interventions in patients with PPI-resistant reflux oesophagitis should be tailored on the basis of impedance-pH-monitoring results. © 2010 Blackwell Publishing Ltd.

PubMed | Instituto Valenciano Of Oncolgia, Instituto Valenciano Of Oncologia and Gastroenterologia
Type: Journal Article | Journal: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva | Year: 2016

We describe a new case of enteropathy with villous atrophy in a patient suffering from arterial hypertension treated with olmesartan. The molecular and serological studies showed anti-nuclear antibodies (ANA) and haplotype HLA-DQ2 positive, as well as negative results for anti-transglutaminase, anti-endomysium and anti-enterocytes antibodies. A duodenal villous atrophy was suspected by upper gastrointestinal endoscopy, which was confirmed by histopathology. The morphological picture was suggestive of sprue-like enteropathy with severe lymphoid infiltration and predominant T lymphoid cells.

PubMed | Medicina Interna, Gastroenterologia, Radiologia e Imagen and Patologia
Type: | Journal: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva | Year: 2017

Schwannomas (or neurilemmomas) are slow-growing mesenchymal neoplasms of the peripheral nerve sheath that may arise at almost any anatomical site. Mesentery schwannoma is extremely rare, with less than ten previously described cases. We present the case of a 38-year-old woman with arterial hypertension and chronic kidney disease with an abdominal painless mass of two years duration and an inconclusive pre-operative clinical diagnosis; she was successfully treated by complete surgical resection of the mass. The aim of this report is to recognize the possibility of schwannomas in the differential diagnosis of abdominal slowly growing tumors.

News Article | November 1, 2016

NORWALK, Connecticut, 1 de novembro de 2016 /PRNewswire/ -- A Mederi Therapeutics hoje anunciou que novos dados de um acompanhamento de 10 anos de pacientes da terapia Stretta foram apresentados na Semana Europeia Unida de Gastroenterologia (United European Gastroenterology Week, UEGW,...

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