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Firenze, Italy

Stasi C.,University of Florence | Stasi C.,Health Agency of Tuscany | Bellini M.,University of Pisa | Bassotti G.,University of Perugia | And 2 more authors.
Techniques in Coloproctology | Year: 2014

Background: Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract characterized by abdominal discomfort, pain and changes in bowel habits, often associated with psychological/psychiatric disorders. It has been suggested that the development of IBS may be related to the body's response to stress, which is one of the main factors that can modulate motility and visceral perception through the interaction between brain and gut (brain-gut axis). The present review will examine and discuss the role of serotonin (5-hydroxytryptamine, 5-HT) receptor subtypes in the pathophysiology and therapy of IBS. Methods: Search of the literature published in English using the PubMed database. Results: Several lines of evidence indicate that 5-HT and its receptor subtypes are likely to have a central role in the pathophysiology of IBS. 5-HT released from enterochromaffin cells regulates sensory, motor and secretory functions of the digestive system through the interaction with different receptor subtypes. It has been suggested that pain signals originate in intrinsic primary afferent neurons and are transmitted by extrinsic primary afferent neurons. Moreover, IBS is associated with abnormal activation of central stress circuits, which results in altered perception during visceral stimulation. Conclusions: Altered 5-HT signaling in the central nervous system and in the gut contributes to hypersensitivity in IBS. The therapeutic effects of 5-HT agonists/antagonists in IBS are likely to be due also to the ability to modulate visceral nociception in the central stress circuits. Further studies are needed in order to develop an optimal treatment. © 2013 Springer-Verlag.

Stasi C.,Health Agency of Tuscany | Stasi C.,University of Florence | Silvestri C.,Health Agency of Tuscany | Voller F.,Health Agency of Tuscany | Cipriani F.,Health Agency of Tuscany
Journal of Infection and Public Health | Year: 2016

The World Health Organization (WHO) resolution adopted in 2010 recognized viral hepatitis as a global health problem. In April 2014, for the first time, the WHO produced guidelines for the screening, care and treatment of persons with hepatitis C infections. In May 2014, a follow-up resolution urged WHO Member States to develop and implement a national strategy for the prevention, diagnosis and treatment of viral hepatitis based on the local epidemiological context. Although blood donor screening, which began in the early 1990s, has reduced the spread of the virus in the population, the WHO estimates that 150 million people are chronically infected with hepatitis C virus (HCV) and are at an increased risk of developing liver cirrhosis and hepatocellular carcinoma. In addition, 3-4 million people are infected each year. HCV treatment is currently evolving rapidly, and several drugs are in various stages of development.With regard to the hepatitis B virus (HBV), in March 2015, the WHO published the first guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection, which were designed to complement the recent guidelines on HCV. Although the introduction of an effective vaccine against the hepatitis B virus has reduced the prevalence and health and economic impact of hepatitis in industrialized countries, the WHO estimates that more than 2 billion people are HBV-infected and 350 million people are chronic carriers. © 2015 King Saud Bin Abdulaziz University for Health Sciences.

Bellini M.,University of Pisa | Gambaccini D.,University of Pisa | Stasi C.,University of Florence | Stasi C.,Health Agency of Tuscany | And 3 more authors.
World Journal of Gastroenterology | Year: 2014

Irritable bowel syndrome (IBS) is the most frequently diagnosed functional gastrointestinal disorder in primary and secondary care. It is characterised by abdominal discomfort, pain and changes in bowel habits that can have a serious impact on the patient's quality of life. The pathophysiology of IBS is not yet completely clear. Genetic, immune, environmental, inflammatory, neurological and psychological factors, in addition to visceral hypersensitivity, can all play an important role, one that most likely involves the complex interactions between the gut and the brain (gut-brain axis). The diagnosis of IBS can only be made on the basis of the symptoms of the Rome ? criteria. Because the probability of organic disease in patients fulfilling the IBS criteria is very low, a careful medical history is critical and should pay particular attention to the possible comorbidities. Nevertheless, the severity of the patient's symptoms or concerns sometimes compels the physician to perform useless and/or expensive diagnostic tests, transforming IBS into a diagnosis of exclusion. The presence of alarming symptoms (fever, weight loss, rectal bleeding, significant changes in blood chemistry), the presence of palpable abdominal masses, any recent onset of symptoms in patient aged over 50 years, the presence of symptoms at night, and a familial history of celiac disease, colorectal cancer and/or inflammatory bowel diseases all warrant investigation. Treatment strategies are based on the nature and severity of the symptoms, the degree of functional impairment of the bowel habits, and the presence of psychosocial disorders. This review examines and discusses the pathophysiological aspects and the diagnostic and therapeutic approaches available for patients with symptoms possibly related to IBS, pointing out controversial issues and the strengths and weaknesses of the current knowledge. © 2014 Baishideng Publishing Group Inc. All rights reserved.

Stasi C.,University of Florence | Stasi C.,Health Agency of Tuscany | Piluso A.,University of Florence | Arena U.,University of Florence | And 9 more authors.
World Journal of Gastroenterology | Year: 2015

AIM: To evaluate the association between liver stiffness (LS) prior to the initiation of dual/triple therapy and viral response. METHODS: LS was measured in all patients before treatment was administered. The therapeutic approach was based on hepatic, virological, and immunological evaluations and considered the fact that patients with severe fibrosis (F3) or compensated cirrhosis (F4) in Child-Pugh class A are the primary candidates for triple therapy. In total, 65 hepatitis C virus (HCV) patients were treated with Peg-interferon/ribavirin (Peg-IFN/RBV); 24 patients were classified as genotypes 1/4 (36.92%), and 41 patients were classified as genotypes 2/3 (63.08%) (dual therapy). In addition, 20 HCV treatment-experienced genotype 1 patients were treated with PegIFN-RBV and boceprevir (triple therapy). Wilcoxon rank-sum tests were used to compare the groups. RESULTS: LS significantly differed between dual therapy and triple therapy (P = 0.002). The mean LS value before dual therapy treatment was 8.61 ± 5.79 kPa and was significantly different between patients achieving a sustained virologic response (SVR) 24 weeks after therapy and those who did not (7.23 ± 5.18 kPa vs 11.72 ± 5.99 kPa, respectively, P = 0.0003). The relative risk of non-response to therapy was 4.45 (95%CI: 2.32-8.55). The attributable risk of non-response to therapy was 49%. The mean LS value before triple therapy treatment was 13.29 ± 8.57 kPa and was significantly different between patients achieving and not achieving SVR24 (9.41 ± 5.05 vs 19.11 ± 9.74, respectively; P = 0.008). The relative risk of non-response to therapy was 5.57% (95%CI: 1.50-20.65). The attributable risk of non-response to therapy (70%) was increased compared with dual therapy patients. Pre-treatment stiffness > 12 kPa was significantly associated with non-SVR (P < 0.025) in both groups. CONCLUSION: Pre-treatment liver stiffness may be useful for predicting the response to treatment in patients treated with either dual or triple anti-HCV therapy. © The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.

Stasi C.,Health Agency of Tuscany | Stasi C.,University of Florence | Silvestri C.,Health Agency of Tuscany | Bravi S.,University of Florence | And 2 more authors.
Wulfenia | Year: 2015

Few data exist about the aetiology of liver cirrhosis deaths. Therefore, the aim was to evaluate the aetiology of liver cirrhosis in Tuscany. We analyzed the database using the International Classification of Diseases, 9th Revision, Clinical Modification and 10th revision. 3,951 patients (2,156 M and 1,795 F; mean age 70.4) died of cirrhosis between 2003 and 2010. When these were divided into 4 age groups, cirrhosis death was detected in 0.05% of people aged 15-30 years; in 5.57% of people aged 31-45; in 17.86% of people aged 46-60; in 78.65% of people aged over 61. Out of 3,951 deaths due to cirrhosis, 1,811 deaths (45.84%) were due to viral hepatitis. We identified 74 hepatitis B and 47 hepatitis C. In 1,690 patients it was not possible to distinguish between B and C hepatitis. Eighty-five (2.15%) deaths were due to primary biliary cirrhosis, 1 (0.03%) to secondary biliary cirrhosis, 337 (8.5%) to alcoholic hepatitis. Out of 3,951, 1,718 remain unknown. In conclusion, it was shown the importance of viral aetiology on the incidence of cirrhosis, whereas it tended to decrease mortality for alcoholic cirrhosis. Future amendments of the international classification should take the viral aetiology in consideration as subclassification.

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