Zakary N.Y.,Gastroenterology and Endoscopy Unit
Clinical and Experimental Gastroenterology | Year: 2015
Objectives: To study the performance of a single test using two fecal occult blood tests with colonoscopy for the detection of colorectal cancer (CRC) for the first time in Saudi Arabia to determine possible implications for the anticipated colorectal screening program. Materials and methods: We compared the performance of guaiac and immunochemical fecal occult blood tests for the detection of CRC among patients of 50-74 years old attending two hospitals in the Eastern Region of Saudi Arabia. Samples of feces were collected from 257 asymptomatic patients and 20 cases of confirmed CRC, and they were tested simultaneously by the guaiac-based occult blood test and monoclonal antibody-based immunoassay kit. Colonoscopy was performed on all participants and the results were statistically analyzed with both positive and negative occult blood tests of both methods. Results: Of the 277 subjects, 79 tested positive for occult blood with at least one method. Overall, the number of those with an occult blood-positive result by both tests was 39 (14.1%), while for 198 (71.5%), both tests were negative (P<0.0001); 40 (14.4%) samples showed a discrepant result. Colonoscopy data were obtained for all 277 patients. A total of three invasive cancers were detected among the screening group. Of the three, the guaiac test detected two cases, while the immunochemical test detected three of them. Of the 20 control cases, the guaiac test detected 13 CRC cases (P=0.03), while the immunochemical test detected 16 of them (P<0.0001). The sensitivity of guaiac and immunochemical tests for the detection of CRC in the screening group was 50.00% (95% confidence interval [CI] =6.76-93.24) and 75.00% (95% CI =19.41-99.37), respectively. For comparison, the sensitivity of the guaiac fecal occult blood test for detecting CRC among the control group was 65.00% (95% CI =40.78-84.61) while that of FIT was 80.00% (95% CI =56.34-94.27). The specificity of the guaiac and immunoassay tests was 77.87% (95% CI =72.24-82.83) and 90.12% (95% CI =85.76-93.50), respectively. The positive likelihood ratio of guaiac and immunochemical tests for the detection of CRC was 2.26 (95% CI =0.83-6.18) and 7.59 (95% CI =3.86-14.94), whereas the negative likelihood ratio was 0.64 (95% CI =0.24-1.71) and 0.28 (95% CI =0.05-1.52), respectively. The positive predictive values of guaiac and immunochemical tests were 3.45% (95% CI =0.426-11.91) and 10.71% (95% CI =2.27-28.23), respectively. There was no marked difference in the negative predictive values for both methods. The sensitivity of the fecal occult blood test by FIT was significantly higher for stages III and IV colorectal cancer than for stages I and II (P=0.01) and it was insignificant for the guaiac fecal occult blood test (P=0.07). Conclusion: In areas where other advance screening methods of CRC are not feasible, the use of FIT can be considered. © 2015 Elsafi et al.
Urgesi R.,Gastroenterology and Endoscopy Unit |
Cianci R.,Catholic University of Rome |
Riccioni M.E.,Catholic University of Rome
Clinical and Experimental Gastroenterology | Year: 2012
With the rising prevalence of antimicrobial resistance, the treatment success of standard triple therapy has recently declined to unacceptable levels (ie, 80% or less). Following the failure of conventional triple therapy, novel eradication regimens have been developed including sequential therapy, concomitant quadruple therapy, hybrid (dual-concomitant) therapy, bismuth-containing quadruple therapy, and a therapy with administration of N-acetylcysteine before a culture-guided antibiotic regimen. This article reviews the literature published on Helicobacter pylori eradication in the last year, focusing on the development of alternative strategies for first-, second-, and third-line rescue therapy for the eradication of H. pylori. © 2012 Urgesi et al.
Manta R.,Gastroenterology and Endoscopy Unit |
Manno M.,Gastroenterology and Endoscopy Unit |
Bertani H.,Gastroenterology and Endoscopy Unit |
Barbera C.,Gastroenterology and Endoscopy Unit |
And 5 more authors.
Endoscopy | Year: 2011
Gastrointestinal perforations and post-surgical fistulas are dreaded complications that dramatically increase morbidity and mortality. A new endoscopic over-the-scope clip (OTSC) system may be potentially useful for sealing visceral perforations in several clinical settings.We evaluated the advantages and clinical impact of the placement of OTSCs on the management of non-malignant gut leaks in 12 consecutive patients. OTSCs of 9.5 or 10.5mm were used, according to the diameter of the defect within thewall. The indications for treatment were mainly related to postsurgical fistulas. Healing of the fistula was assessed by endoscopic or radiological means, and failed only once. No OTSC-related complications occurred. Endoscopic closure of perforations and post-surgical fistulas with the OTSC system is asimple and minimally invasive technique. This approach, when feasible, may be less expensive and more advantageous than a surgical approach. © Georg Thieme Verlag KG Stuttgart New York.
Neri L.,University of Milan |
Conway P.M.,Copenhagen University |
Basilisco G.,Gastroenterology and Endoscopy Unit
Quality of Life Research | Year: 2015
Background and aim: PAC-SYM is widely adopted to asses constipation severity. However, it has been validated in a small sample, few items have been included based on expert opinion and not on empirical grounds, and its factor structure has never been replicated. We aimed at evaluating the psychometric properties of PAC-SYM in patients with chronic constipation. Methods: We enrolled 2,203 outpatients with chronic constipation in two waves. We used wave I sample to test the psychometric properties of the PAC-SYM and wave II sample to cross-validate its factor structure, to assess criterion validity, responsiveness to clinical change, and its minimal clinically important difference. Results: Only a minority of patients reported any rectal tearing (38 %). Deletion of such item leads to a 11-item version (M:PAC-SYM). The remaining items in the rectal domain were moderately correlated with the stool domain. Exploratory factor analysis and confirmatory factor analysis revealed a bifactor structure with two subscales (stool and abdominal symptoms) and a general severity factor. The M:PAC-SYM demonstrated excellent reliability, moderate correlation with SF-12 and treatment satisfaction (r = 0.28-0.45), discrimination across Rome III criteria for functional constipation and abdominal pain, and responsiveness to clinical change (β = -0.49; ω2 = 0.25). M:PAC-SYM minimal clinically important difference was 0.24. Conclusion: Our analysis shows that the rectal domain may not represent a relevant cluster of symptoms for patients with chronic constipation. We developed a modified version of the PAC-SYM which might better represent symptom severity of most patients seeking care in gastroenterology referral centers. © Springer International Publishing Switzerland 2014.
Iacopini F.,Gastroenterology and Endoscopy Unit |
Saito Y.,National Cancer Center Hospital |
Yamada M.,National Cancer Center Hospital |
Grossi C.,Gastroenterology and Endoscopy Unit |
And 5 more authors.
Gastrointestinal Endoscopy | Year: 2015
Background Endoscopic resection of superficial neoplasms in inflammatory bowel disease (IBD) is appropriate if a complete resection can be achieved. However, EMR is ineffective for large, nonpolypoid neoplasms in IBD due to submucosal fibrosis, and no data are available on the efficacy of endoscopic submucosal dissection (ESD). Objective To assess ESD feasibility and efficacy for large, nonpolypoid neoplasms in patients with IBD. Design Prospective case series. Setting Multicenter: Italian and Japanese centers. Patients Consecutive patients with long-standing ulcerative colitis and a superficial nonpolypoid neoplasm, >20 mm within the colitic mucosa. Intervention Neoplasm characterization and delineation by chromoscopy and narrow-band imaging. ESD performed according to the standard technique. Main Outcome Measurements Feasibility, safety, curative resection rates. Results Nine patients with 10 neoplasms were included (7 and 3 in the Italian and Japanese centers, respectively). Neoplasms were laterally spreading tumors-non-granular in 5 cases, in the left side of the colon in 7, had median size of 33 mm, and were associated with scar in 5 cases. Margin delineation was difficult in 5 cases. Submucosal fibrosis was present in 9 cases. ESD was en bloc with negative margins (R0) in 8 cases, and curative in 7. No endoscopic invisible dysplasia or cancer was found during the follow-up (median 24 months, range 6-72 months) at the resection site and elsewhere within the colitic mucosa. Limitations Small series. Conclusion ESD achieves curative resections in patients with IBD, but the procedure is difficult because of the high prevalence of submucosal fibrosis. Patients need to be accurately evaluated before resection and adhere to strict long-term follow-ups. © 2015 American Society for Gastrointestinal Endoscopy.
Villanacci V.,Spedali Civili |
Annese V.,Gastroenterology and Endoscopy Unit |
Cuttitta A.,Casa Sollievo della Sofferenza Hospital |
Fisogni S.,Spedali Civili |
And 4 more authors.
Journal of Clinical Gastroenterology | Year: 2010
Background: Achalasia is a primary esophageal motor disorder characterized by degenerative changes of the myenteric plexus. The pathophysiologic abnormalities may be the final result of several intermeshing mechanisms, and more than one single factor may cause the motor abnormalities. AIMS: To report our experience in investigating the myenteric plexus of achalasia patients undergoing esophagomyotomy. PATIENTS and Methods: Tissue samples from 12 patients undergoing Heller myotomy for achalasia were evaluated and compared with esophageal tissue specimens from 7 controls. Enteric neurons and interstitial cells of Cajal (ICC) were assessed by immunohistochemical methods, and the presence of vasoactive intestinal polypeptide ergic fibers and of CD3 lymphocytes. The possible presence of herpesvirus was also assessed by immunohistochemistry, whereas that of papillomavirus was assessed by in-situ hybridization. Results: Compared with controls, achalasia patients displayed a significant decrease of both enteric neurons and ICC. Immunoreactivity for vasoactive intestinal polypeptide was completely absent in each patient. CD3 staining disclosed myenteric plexitis in 5 (42%) patients; no control patient had plexitis. All patients were completely negative for the presence of both herpes simplex virus and human papillomavirus. Conclusions: The enteric nervous system of the lower esophageal sphincter area is impaired in patients with "idiopathic achalasia," and the abnormalities involve ICC and neurons in many patients. The triggering factors for these abnormalities are, however, still unknown. Copyright © 2010 by Lippincott Williams & Wilkins.
Orlando G.,University of Catanzaro |
Luppino I.,Gastroenterology and Endoscopy Unit |
Lerose M.,University of Catanzaro |
Gervasi R.,University of Catanzaro |
And 3 more authors.
BMC Surgery | Year: 2012
Background: Anemia is the most common hematologic abnormality in older populations. Furthermore, iron deficiency anemia is common and merits investigation and treatment, as it usually results from chronic occult bleeding from the gastrointestinal tract. In view of a wide use of capsule endoscopy as a diagnostic procedure for occult gastrointestinal bleeding and of the growth of aging population, we performed a literature review about the feasibility of capsule endoscopy in the elderly. Methods. We conducted a literature search in the PubMed database in July 2012, and all English-language publications on capsule endoscopy in elderly patients since 2005 were retrieved. The potential original articles mainly focused on obscure gastrointestinal bleeding were all identified and full texts were obtained and reviewed for further hand data retrieving. Results: We retrieved only six papers based on different primary end-points. Four were retrospective non randomized studies and two were prospective non randomized studies. In the end 65, 70, 80 and 85 years were used as an age cut-off. All studies evaluate the diagnostic yield of capsule endoscopy in iron deficiency anemia. Only three studies assess the feasibility of capsule examination of the elderly. Conclusions: Iron deficiency anemia in the elderly with or without obscure gastrointestinal bleeding is the major indication for capsule endoscopy after a negative esophago-gastro-duodenoscopy and colonoscopy. It is safe and effective to identify a small bowel pathology without a great discomfort for the elderly. Inability to swallow the capsule, battery failure before capsule reaches the cecum, and capsule retention are some of the important problems associated with capsule endoscopy in elderly as well as in younger patients. © 2012 Orlando et al; licensee BioMed Central Ltd.
Senzolo M.,University of Padua |
Riggio O.,University of Rome La Sapienza |
Primignani M.,Gastroenterology and Endoscopy Unit
Digestive and Liver Disease | Year: 2011
This review summarizes the document elaborated by the Italian Association for the Study of the Liver (AISF) ad hoc committee " Vascular disorders of the liver" on the primary circulatory liver diseases, which include Budd-Chiari syndrome, obstruction of the hepatic portion of the inferior vena cava, portal vein thrombosis, sinusoidal obstruction syndrome (veno-occlusive disease) and hereditary hemorrhagic telangiectasia. A characteristic of the primary circulatory liver diseases is that portal hypertension usually precedes liver dysfunction. Significant overlap exists amongst the diseases and risk factors that predispose patients to the primary circulatory liver diseases, though the pathogenesis of individual diseases varies. Management of the different vascular disorders is very peculiar and often multidisciplinary and patients should be referred to a tertiary referral centre for optimal care. © 2010 Editrice Gastroenterologica Italiana S.r.l.
PubMed | Gastroenterology and Endoscopy Unit, CNR Institute of Molecular Genetics and University of Milan
Type: Journal Article | Journal: Clinical and translational gastroenterology | Year: 2016
To provide a functional and phenotypic characterization of immune cells infiltrating small intestinal mucosa during non-IPEX autoimmune enteropathy (AIE), as to gain insights on the pathogenesis of this clinical condition.Duodenal biopsies from a patient with AIE at baseline and following drug-induced remission were analyzed by immunohistochemistry, immunofluorescence, and flow cytometry, and results were compared with those obtained from patients with active celiac disease, ileal Crohns disease and healthy controls. Lamina propria (LP) and intraepithelial (IELs) lymphocytes from AIE and controls were analyzed for mechanisms regulating cytokine production. Foxp3 expression and suppressive functions of LP regulatory T cells (Tregs) were analyzed.The quantitative deficit of Foxp3 expression in Tregs in AIE associates with unrestrained IL-17 production by IELs. Interleukin (IL)-17-producing IELs were rare in the uninflamed duodenum and in the ileum of Crohns disease patients, and disappeared upon drug-induced AIE remission. IL-17 upregulation in CD4(+)IELs and CD4(+)LP T cells had different requirements for pro-inflammatory cytokines. Moreover, transforming growth factor- (TGF-) selectively enhanced IL-17 production by CD8(+)IELs. Intriguingly, although Foxp3(low)Tregs in AIE were poorly suppressive, they could upregulate GARP-LAP/TGF- surface expression and enhanced IL-17 production selectively by CD8(+)IELs. Finally, phosphorylated Smad2/3 was detectable in duodenal CD8(+) lymphocytes in active AIE in situ, indicating that they received signals from the TGF- receptor in vivo.AIE is characterized by the appearance of unconventional IL-17-producing IELs, which could be generated locally by pro-inflammatory cytokines and TGF-. These results suggest that Foxp3(+)Tregs and Treg-derived TGF- regulate IL-17 production by IELs in the small intestine and in AIE.
PubMed | Gastroenterology and Endoscopy Unit
Type: Editorial | Journal: World journal of gastroenterology | Year: 2016
Elastographic techniques are new ultrasound-based imaging techniques developed to estimate tissue deformability/stiffness. Several ultrasound elastographic approaches have been developed, such as static elastography, transient elastography and acoustic radiation force imaging methods, which include point shear wave and shear wave imaging elastography. The application of these methods in clinical practice aims at estimating the mechanical tissues properties. One of the main settings for the application of these tools has been liver stiffness assessment in chronic liver disease, which has been studied mainly using transient elastography. Another field of application for these techniques is the assessment of focal lesions, detected by ultrasound in organs such as pancreas, prostate, breast, thyroid, lymph nodes. Considering the frequency and importance of the detection of focal liver lesions through routine ultrasound, some studies have also aimed to assess the role that elestography can play in studying the stiffness of different types of liver lesions, in order to predict their nature and thus offer valuable non-invasive methods for the diagnosis of liver masses.