Evidence for the Presence of Non-Celiac Gluten Sensitivity in Patients with Functional Gastrointestinal Symptoms: Results from a Multicenter Randomized Double-Blind Placebo-Controlled Gluten Challenge
PubMed | Busto Arsizio Hospital, Medicine and Gastroenterology Unit, Santa Maria del Prato Hospital, Alphasearch and 11 more.
Type: Journal Article | Journal: Nutrients | Year: 2016
Non-celiac gluten sensitivity (NCGS) is characterized by the onset of symptoms after eating gluten-containing food. We aimed to single out NCGS subjects among subjects with functional gastrointestinal symptoms. Patients were enrolled in a multicenter double-blind placebo-controlled trial with crossover. Symptoms and quality of life were evaluated by means of 10-cm VAS and SF36. Iron parameters, transaminases and C reactive protein (CRP) were evaluated. After a three-week-long gluten-free diet (GFD), responsive patients were randomly assigned to gluten intake (5.6 g/day) or placebo for seven days, followed by crossover. The primary endpoint was the worsening of symptoms (VAS increase 3 cm) during gluten ingestion compared to placebo. One hundred and forty patients were enrolled and 134 (17 males, mean age 39.1 11.7 years, BMI 22.4 3.8) completed the first period. A total of 101 subjects (10 males, mean age 39.3 11.0 years, BMI 22.3 4.0) reported a symptomatic improvement (VAS score 2.3 1.2 vs. 6.5 2.2 before and after GFD, p = 0.001). 98 patients underwent the gluten challenge and 28 (all females, mean age 38.9 12.7 years, BMI 22.0 2.9) reported a symptomatic relapse and deterioration of quality of life. No parameters were found to be statistically associated with positivity to the challenge. However, 14 patients responded to the placebo ingestion. Taking into account this finding, about 14% of patients responding to gluten withdrawal showed a symptomatic relapse during the gluten challenge. This group is suspected to have NCGS.
PubMed | Allergology and Clinical Immunology Unit, Santa Maria del Prato Hospital, Italian National Cancer Institute, Gastroenterology Unit ASST Santi Paolo e Carlo Milan and 7 more.
Type: | Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver | Year: 2016
Gluten-related disorders is a term that encompasses different diseases induced by the ingestion of gluten-containing food. Because of their incidence the scientific community has been intensively studying them.To support gastroenterologists with a correct nomenclature and diagnostic approach to gluten-related disorders in adulthood.The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) commissioned a panel of experts to prepare a position statement clarifying the nomenclature and diagnosis of gluten-related disorders, focusing on those of gastroenterological interest. Each member was assigned a task and levels of evidence/recommendation have been proposed.The panel identified celiac disease, wheat allergy and non-celiac gluten sensitivity as the gluten-related disorders of gastroenterological interest. Celiac disease has an autoimmune nature, wheat allergy is IgE-mediated while the pathogenesis of non-celiac gluten sensitivity is still unknown as is the case of non-IgE mediated allergy. Diagnosis should start with the serological screening for celiac disease and wheat allergy. In case of normal values, the response to a gluten-free diet should be evaluated and a confirmatory blind food challenge carried out.Gluten-related disorders are clinically heterogeneous. Patients should be carefully managed and specific protocols applied for a correct differential diagnosis in gastroenterological setting.
Giglia G.,University of Palermo |
Giglia G.,Maastricht University |
Brighina F.,University of Palermo |
Rizzo S.,Fondazione Instituto San Raffaele G Giglio |
And 6 more authors.
Functional Neurology | Year: 2014
Several studies have shown that transcranial direct current stimulation (tDCS) is able to enhance performances on verbal and visual working memory (WM) tasks. Available evidence points to the right dorsolateral prefrontal cortex (DLPFC) as a critical area in visual WM, but to date direct comparisons of the effects obtained by stimulating the left versus the right DLPFC in the same subject are lacking.Our aim was to determine whether tDCS over the right DLPFC can differently affect performance as compared with left DLPFC stimulation. Ten healthy subjects performed a memory-guided visuospatial task in three conditions: baseline, during anodal stimulation applied over the right and during anodal stimulation applied over the left DLPFC. All the subjects also underwent a sham stimulation as control. Our results show that only active stimulation over the right DLPFC is able to increase performance when compared to the other conditions. Our findings confirm the crucial role played by the right DLPFC in spatial WM tasks. © 2014, CIC Edizioni Internazionali s.r.l., Inc. All rights reserved.
Battaglia G.,Veneto Institute of Oncology IOV |
Antonello A.,Veneto Institute of Oncology IOV |
Realdon S.,Veneto Institute of Oncology IOV |
Cesarotto M.,Veneto Institute of Oncology IOV |
And 3 more authors.
Digestive Endoscopy | Year: 2015
Background and Aim Flexible endoscopic septum division is becoming a prominent treatment option for Zenker's diverticulum (ZD). Over the years, various techniques have been developed and many cutting tools have been tested with varying results. We report our experience with a recently designed, monopolar, rotating, scissor-shaped device (SB Knife). Methods Data on 31 consecutive patients that underwent flexible endoscopic treatment for ZD with the use of the SB Knife were retrieved. Dysphagia, regurgitation, and respiratory symptom severity before the procedure were graded. Procedure duration, rate of complications, symptom changes after the procedure and rate of relapsing patients during follow up were recorded. Results The procedure was carried out successfully in all patients. Median procedure time was 14 min. One case of late-onset bleeding developed 1 week after the procedure, and was managed endoscopically. A significant symptom improvement was achieved (dysphagia: median score <3, median score >0, P < 0.001; regurgitation: median score <2, median score >0, P < 0.001; respiratory symptoms: median score <2, median score >0, P = 0.009). Two patients had mild relapsing symptoms, respectively, after 4 and 9 months from the procedure but refused further treatment. Conclusions Endoscopic treatment of ZD using this new device is safe and efficient at short term follow up. No perforations were observed and there was a substantial reduction of symptoms after the treatment. Larger studies are needed to fully assess advantages of this new device for endoscopic treatment of ZD. © 2015 The Authors. Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.
Valiante F.,Santa Maria del Prato Hospital |
Pontone S.,University of Rome La Sapienza |
Hassan C.,Nuovo Regina Margherita Hospital |
Bellumat A.,Santa Maria del Prato Hospital |
And 4 more authors.
Digestive and Liver Disease | Year: 2012
Background: Bowel preparation is critical for the efficacy and safety of colonoscopy. Poor patient tolerance to bowel preparation has been associated with the high amount of fluid administered. A 2-L polyethylene glycol (PEG) solution containing ascorbic acid has been recently developed. Aims: To compare the efficacy, safety and acceptability of 2-L PEG + ascorbic acid vs 4-L PEG for colonoscopy. Methods: We designed a single blind randomized non-inferiority study in order to compare the two bowel preparations. A blinded assessment of cleansing was made by the endoscopist according to the Aronchick scale. Acceptability was assessed by questionnaire. Intention-to-treat (ITT) and per-protocol (PP) analysis were reported. Results: Overall, 169 patients (PP: 166) were selected for the 2-L PEG + ascorbic acid and 170 (PP: 166) for the 4-L PEG. When rating global bowel cleansing at ITT, an excellent-good level was reported in 84.6% (PP: 86.2%) of patients who received 2-L PEG + ascorbic acid and 75.3% (PP: 77%) of patients who received 4-L PEG (p=0.04). Acceptability rate favoured 2-L PEG + ascorbic acid vs 4-L PEG (83% vs 76%; p=0.02). Conclusions: 2-L PEG + ascorbic acid, completed with an additional L of clear fluids, provided bowel cleansing which appeared to be more effective and acceptable than 4-L PEG. © 2011 Editrice Gastroenterologica Italiana S.r.l.
PubMed | University of Padua, Santa Maria Del Prato Hospital, Veneto Institute Of Oncology Iov Ircss and Birmingham City University
Type: Journal Article | Journal: Surgical endoscopy | Year: 2016
Currently there are three main treatment options for Zenkers diverticulum (ZD): surgery, rigid endoscopy and flexible endoscopy. After primary success, recurrence can be as high as 19% for surgery, 12.8% for rigid endoscopy and 20% for flexible endoscopy. Flexible endoscopy may represent an ideal treatment option for recurring ZD. The aims of this paper are to evaluate the efficacy and safety of flexible endotherapy for recurring ZD after surgery and/or endoscopic stapling and to compare the treatment outcome between naive and recurring patients.Data on patients that underwent flexible endotherapy for ZD between January 2010 and January 2015 were collected. Patients were divided into those with recurrences after surgery and/or endoscopic stapling and those who did not have previous treatments. Dysphagia, regurgitation, and respiratory symptom severity before the procedure were graded. The outcome parameters were: complications, symptom improvement after the first treatment, number of treatment sessions, rate of complete remission and relapses. These parameters were then compared between patients groups.Twenty-five recurring patients were included. Treatment was carried out successfully in all patients. Two adverse events occurred; they were successfully managed conservatively. After the first treatment, there was a significant reduction in dysphagia, regurgitation and respiratory symptoms scores. The median number of treatments was 1 (IQR 0.25, range 1-3): symptom remission was achieved in 84% patients and partial improvement in 16%. Relapsing symptoms occurred in 20% patients; they were successfully managed with an additional treatment session. Results were compared with data on 34 consecutive naive patients treated within the same time span; no differences of the outcome parameters were revealed.Flexible endotherapy for ZD recurrences after surgery and endoscopic stapling appears to be safe and effective, and its efficacy and safety profile seems to be comparable between recurring and naive patients.
Geraci A.,Santa Maria del Prato Hospital |
Sanfilippo A.,University of Palermo |
D'Arienzo M.,University of Palermo
Ortopedia Traumatologia Rehabilitacja | Year: 2011
Background. Fractures of the distal extremity of the radius are the most common bone lesions of the superior extremity of the body, representing 17% of the fractures treated in First Aid facilities. The restoration of anatomical relationships in the radiocarpal joint is considered to be a prerequisite for good functional recovery. There are numerous methods of treatment of these fractures. The Epibloc system is a percutaneous endomedullary synthesis alternative to the plaster cast in wrist fracture treatment. Material and methods. The authors describe their experience with 81 fractures (63 type A2-3 fractures and 18 type C1) of the wrist treated with the Epibloc System (ES). The results were evaluated clinically, functionally and radiographically on the 7th, 14th, 35th, 90th day. The Gartland and Werley score modified by Sarmiento was used for the functional assessment of the wrist injuries. Results. Twenty-nine patients (35.8%) had excellent results, 43 (53.1%) had good results. Forty-seven of the patients (58%) had a ROM of 100% of normal, with a dorsiflexion-palmar flexion (DF-PF) arc of 120 degrees or more. Seven (8.6 %) of the patients developed Sudeck's osteodystrophy. A "very moderate" or "moderate" malunion was observed in 19 cases (23.4%) Conclusions. 1.The ES is a surgical technique for the treatment of numerous wrist fractures. These fractures can result in excellent mobility as well as a low rate of complications and secondary loss of reduction. 2. This method enables early functional recovery with low incidence of rigidity and algodystrophy. 3. This technique is best indicated for AO type A2-3 and type C1. 4. The ES is inadequate for patients with severe osteopaenia and markedly comminuted intra-articular fractures. © MEDSPORTPRESS, 2011.
Geraci A.,Santa Maria del Prato Hospital |
Tomasello G.,University of Palermo |
Sabetta S.P.,Santa Maria del Prato Hospital
Ortopedia Traumatologia Rehabilitacja | Year: 2010
Background. Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the gastrointestinal tract. The major types of IBD are Lesniowski-Crohn's disease (L-CD) and ulcerative colitis (UC). Inflammatory bowel disease (IBD) sometimes presents with arthritic manifestations. The peripheral arthritis is a problem for the orthopaedist and the physiatrist Material and methods. The authors retrospectively reviewed 65 Sicilian patients with IBD (38 with UC, 27 with L-CD) over a period of 5 years. All patients underwent clinical examinations, laboratory and imaging studies, and were screened for the presence of the rheumatoid factor. All patients also attended eight to ten 50- minute sessions of physiotherapy over a six-week period. Results. 38 patients had UC (mean age 42.1 years, range: 19-75) and 27 patients had L-CD (mean age 37.2 years, range: 17-64 years). Arthritis occurred in 11 patients (17%): 7 with UC (18.4%) and 4 with L-CD (14.8%). The mean age of patients with arthritis was 35 and mean duration of pain and functional limitation was 28 months. In 9 patients, arthritis appeared after the onset of bowel symptoms with a mean duration of 20 months in UC and 24 months in L-CD; in two patients, arthritis preceded the onset of bowel symptoms for several months. Exercise and manual therapy did not bring about good symptomatic improvement in patients with shoulder pain; good short-term results were only noted for patients with knee and hip arthritis. Conclusions. 1. The association between IBD and arthritis has been reported in the literature and confirmed in our study. 2. The role of the orthopaedist is to eliminate pain and dysfunction. 3. Physical therapy is an optimal initial approach. 4. Prosthetic surgery should be chosen as a final option when medical and manual therapies are no longer able to improve the quality of life of the patient. © MEDSPORTPRESS, 2010.
Geraci A.,Santa Maria del Prato Hospital |
Martorana U.,University of Palermo
Ortopedia Traumatologia Rehabilitacja | Year: 2011
Background. The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly persons with osteoporosis. The imperative goals of treatment are early mobilization by means of stable fixation using as minimally invasive a procedure as possible. Nowadays, there is an increasing interest in intra - medullary nailing, especially for unstable intertrochanteric fractures. The aim of the present paper is to assess the efficacy of closed intramedullary osteosynthesis with the proximal femoral nail (Endovis®) in the treatment of peritrochanteric fractures to solve the problems associated with the use of intramedullary fixation devices. Material and methods. The authors describe their experience with 87 stable and unstable proximal extracapsular femoral fractures treated with the Endovis femoral nail from July 2007 to March 2009. The results were evaluated clinically, functionally and radiographically during the 1st, 3th, 6th and 12th months post-op. Pre-injury activity and functional levels were recorded using the modified Harris hip score and V.A.S. score. Results. Postoperative radiographs showed a near-anatomical fracture reduction in 85% of patients. Three were the cases of cut-out, one case of valgus and two cases of shortening of the operated leg (<1 cm). The Harris Hip Score increased between the thirtieth and ninetieth postoperative day, accompanied by a significant decrease in pain symptoms and functional limitation. Conclusions. 1. The application of an intramedullary nail provides primary stability of the fracture. 2. The Endovis nail constitutes a powerful synthesis for stable and unstable fractures of the trochanteric region, in which is difficult to reconstruct appropriate continuity between the medial and posterior cortical layers. 3.The good mechanical stability of the nail allows rapid mobilization and early functional recovery. 4. The presence of an additional anti-rotational screw and the free sliding mechanism of the lag screw may increase rotational stability of cervico-cephalic fragments and decrease overload on the femoral head. © MEDSPORTPRESS, 2011.
Geraci A.,Santa Maria del Prato Hospital |
Mazzoccato G.,Santa Maria del Prato Hospital |
Gasparo M.,Santa Maria del Prato Hospital
Timisoara Medical Journal | Year: 2011
Greater trochanteric pain syndrome (GTPS) is a common cause of lower extremity pain. This is frequently attributed to trochanteric bursitis and distension of the subgluteal bursae. Patients are suffering from pain radiating to the posterolateral aspect of the thigh, paraesthesiae in the legs, and tenderness over the iliotibial tract. Often the symptoms are mild, with the patient treating himself successfully through activity modification and other conservative measures, including relative rest, ice, compression, elevation, anti-inflammatory medication and treatment modalities such as ultrasound and electrical stimulation, combined with a structured rehabilitation program. Patients whose symptoms persist despite conservative therapy are likely to benefit from an injection of corticosteroid and anaesthetic into the inflamed bursa. More invasive surgical interventions have anecdotally been reported to provide pain relief when previous treatment modalities fail. In this article, we review the pathogenesis, common initial symptoms, diagnostic approach, and treatment options for trochanteric bursitis.