The Italian journal of gastroenterology (Ital J Gastroenterol)

Publications in this journal

• Article: Endoscopic aspects of gastroduodenal mucosa due to NSAIDs.

  M Ruina, M Caselli, S Sartori, L Trevisani, R La Corte, F Trotta, V Alvisi
  [show abstract] [hide abstract]
  ABSTRACT: The role of endoscopy in NSAID-related gastroduodenal pathologies is reviewed. If an accepted and largely used algorithm in which the role of endoscopy is exactly identified is not available, current strategy for the management of gastroduodenal toxicity gives indication for endoscopy immediately after the onset of symptoms, anaemia and evidence of bleeding, overt or occult. The endoscopic patterns of lesions in patients taking NSAID are characteristics patterns of erosive and ulcerative lesions. Endoscopy can recognize early lesions, allowing us to prevent a more advanced mucosal damage.
  The Italian journal of gastroenterology 01/1997; 28 Suppl 4:9-11.
• Article: Small bowel tumours in Tuscany.

  E Crocetti
  The Italian journal of gastroenterology 01/1997; 28(9):531.
• Article: Pilot study of a short course of ribavirin and alpha interferon in the treatment of chronic active hepatitis C not responding to alpha-interferon alone.

  G Scotto, V Fazio, G Tantimonaco
  [show abstract] [hide abstract]
  ABSTRACT: Chronic active hepatitis due to HCV represents a severe progressive disorder of the liver, At present, Interferon seems to be the most efficacious treatment available, however, only 20-25% of the patients treated achieve complete remission. The efficacy has, therefore, been evaluated of Ribavirin, a nucleoside analogue active both on DNA and RNA viruses, in the treatment of non responders to a previous course of interferon. Twenty patients were randomly assigned to two groups: A) received the association R (800 mg/day for 2 months)+interferon (9 Mu/week for 6 months); B) received IFN (9 Mu/week for 6 months). All patients completed the study without important side effects. Four patients in group A presented reduced ALT and loss of viraemia during treatment with Ribavirin. Only one patient in group B had reduced indices of cell lysis and was negative for HCV-RNA during the course of the study. However, viremia and an increase of ALT values were observed in all of these subjects once treatment was interrupted. The results emerging from this study indicate that Ribavirin therapy, at the dose and duration of treatment employed, is not sufficient to change the natural course of events of chronic active hepatitis from HCV.
  The Italian journal of gastroenterology 01/1997; 28(9):505-11.
• Article: Delayed gastric emptying in an infant with Sandifer syndrome.

  E Cardi, G Corrado, M Cavaliere, P Capocaccia, M Matrunola, P Rea, C Pacchiarotti
  [show abstract] [hide abstract]
  ABSTRACT: The case of an infant with Sandifer syndrome is reported. Real-time ultrasonography showed delayed gastric emptying time, which returned to normal when the patient was asymptomatic. The importance of gastric motility investigations in Sandifer syndrome is stressed since delayed gastric emptying could play a role in the pathogenesis of this disease.
  The Italian journal of gastroenterology 01/1997; 28(9):518-9.
• Article: NSAID gastropathy: state of the art.

  C Cervini, W Grassi, R De Angelis
  [show abstract] [hide abstract]
  ABSTRACT: Non-steroidal anti-inflammatory drugs (NSAIDs) give rise to a wide range of gastrointestinal side-effects. These are reviewed and it is stressed that some safety measures are possible only if the risk factors are considered. The relations between dyspeptic symptoms and gastrointestinal lesions are also debated. It is suggested that the ulcerogenic potential of various molecules must be carefully evaluated, especially in elderly patients.
  The Italian journal of gastroenterology 01/1997; 28 Suppl 4:1-5.
• Article: Prevention of NSAID-gastropathy.

  S Ardizzone, G Bianchi Porro
  [show abstract] [hide abstract]
  ABSTRACT: The role is reviewed of gastric antisecretory and mucosal protective drugs in the prevention of NSAID-induced gastric and duodenal mucosal lesions. The results of the randomized, double-blind, controlled trials show that misoprostol is the only antiulcer drug proven to be effective in the prevention of NSAID-induced gastric and duodenal ulcers as well as for reducing serious upper gastrointestinal complications (perforation and/or haemorrhage). However, recent data suggest that even omeprazole and high dose of H2-receptor antagonists may have a role in the prevention of NSAID-induced gastric and duodenal ulcerations.
  The Italian journal of gastroenterology 01/1997; 28 Suppl 4:33-6.
• Article: Variations in the hypervariable region 1 of the envelope region E2 of hepatitis C virus RNA appear associated with virus persistence independently of liver disease.

  M R Brunetto, T Suzuki, H Aizaky, D Flichman, P Colombatto, M L Abate, F Oliveri, Y Matsuura, F Bonino, T Miyamura
  [show abstract] [hide abstract]
  ABSTRACT: The high genetic variability of the 5' end of the envelope protein-coding region E2 (HVR1 E2) of Hepatitis C Virus (HCV) RNA has been suggested by many authors to play an important role in both virus persistence and outcome of liver disease. We studied the relations between HVR1 E2 variability and HCV genotypes, HCV-RNA levels and liver disease in 8 chronic HCV carriers (5 males and 3 females, median age 41 years, followed-up for a mean period of 3 years). Four were healthy HCV carriers with persistently normal ALT levels and normal liver histology and 4 patients with chronic liver disease. In each patient, the HVR1 E2 variability of 2 serum HCV-RNA isolates obtained at least 12 months apart were evaluated by direct sequencing. Nucleotide and amino acid homologies ranged between 97.6%-57.1% and 92.8%-25% in healthy carriers and 95.2%-55.9% and 89.3%-32.1% in patients, respectively. We did not observe any correlation between HVR1 E2 heterogeneity and HCV genotypes, viraemia levels, presence and extent of liver necroinflammation. Our findings suggest that HVR1 E2 heterogeneity has no direct implications in hepatitis, pathogenesis but it could play a major role in virus persistence.
  The Italian journal of gastroenterology 01/1997; 28(9):499-504.
• Article: Epidemiological aspects of NSAID gastropathy.

  M Guslandi
  [show abstract] [hide abstract]
  ABSTRACT: NSAIDs are among the most frequently prescribed drugs worldwide. Unfortunately acute and especially chronic NSAID intake is accompanied by untoward side effects of the digestive system, particularly the gastroduodenal tract. Erosions and ulcers are more common in the stomach, but also the duodenal mucosa can be involved. Elderly patients are the subjects most at risk of developing gastric lesions, which are often asymptomatic. Complications such as bleeding and perforation may suddenly occur, sometimes with a fatal outcome. Epidemiological data and risk factors are reviewed and commented in detail.
  The Italian journal of gastroenterology 01/1997; 28 Suppl 4:6-8.
• Article: Ultrastructural damage of gastric epithelium in patients taking NSAIDs.

  M Caselli, M Ruina, R La Corte, L Trevisani, S Sartori, A Dentale, P Gaudenzi, F Trotta, V Alvisi
  [show abstract] [hide abstract]
  ABSTRACT: As far as concerns ultrastructural lesions in the gastric epithelium following NSAIDs, a review has been made of existing data and ideas for future research concerning the ultrastructural field are advanced. Specific ultrastructural damage of the gastric epithelial cells has been recognized in patients taking NSAIDs: this pattern of damage appears characterized by a proliferative phenomen of "desquamation" of contiguous epithelial cells. Studies in animal models indicate that the first-level of epithelial damage involves a mitochondrial derangement and an alteration of tight junctions and cytoskeletal. The length of time of local drug action on the gastric mucosa could be the reason for the characteristic morphological presentation seen in vivo. If ulcers are the result of an imbalance between cell necrosis and cell regeneration, the high progression speed of cell necrosis to contiguous cells should play a basic role in the genesis of ulcers.
  The Italian journal of gastroenterology 01/1997; 28 Suppl 4:16-8.
• Article: New NSAIDs and gastroduodenal damage.

  G C Folco
  [show abstract] [hide abstract]
  ABSTRACT: Two isoforms of cyclooxygenase (COX) are described: COX-1 is a constitutive enzyme and is widely expressed in most tissues, COX-2 is an inducible enzyme and is abundant throughout the gastrointestinal tract. Expression of COX-2 can be induced locally by inflammatory stimuli and appears coincident with local prostaglandin (PG) production. Currently available non-steroidal antiinflammatory drugs (NSAIDs) are widely used for the treatment of inflammatory diseases; however, significant side-effects due to inhibition of COX-1 limit their use. Inhibitors of COX-2 are as active as non-selective NSAIDs and inhibit PG synthesis in inflammatory cells. In contrast to other NSAIDs, selective COX-2 inhibitors do not cause ulcers in the stomach or intestine.
  The Italian journal of gastroenterology 01/1997; 28 Suppl 4:28-9.
• Article: Stimulatory effect of (R) alpha-methylhistamine on duodenal HCO3- secretion in anaesthetized rats.

  G Coruzzi, E Gambarelli, G Bertaccini
  [show abstract] [hide abstract]
  ABSTRACT: The effect of the histamine H3 receptor agonist (R) alpha-methylhistamine on duodenal bicarbonate secretion was investigated in the anaesthetized rat. (R) alpha-methylhistamine (3-30 mumol/kg i.v.) caused a dose-dependent increase in alkaline secretion which was completely blocked by the H3 receptor antagonist clobenpropit (3 mumol/kg i.v.). This antagonist caused a slight reduction (19%) of the secretory response to PGE2 50 micrograms/kg i.v. These data indicate that the alkaline response to (R) alpha-methylhistamine is related to the activation of histamine H3 receptors and suggest that this could be an additional mechanism involved in the previously observed gastroprotective effect of this compound.
  The Italian journal of gastroenterology 01/1997; 28(9):520-2.
• Article: Helicobacter pylori infection in families of Helicobacter pylori-positive children.

  M Bonamico, S Monti, I Luzzi, F M Magliocca, E Cipolletta, L Calvani, A Marcheggiano, R Rossi, P Paoluzi
  [show abstract] [hide abstract]
  ABSTRACT: Relatives of Helicobacter pylori positive patients show a higher incidence of Helicobacter pylori infection than the general population, probably due to relapses and/or reinfections between members of the family. Aim of this study was to evaluate the prevalence of the infection in 121 relatives of 41 children with Helicobacter pylori positive gastritis. Specific IgG antibodies (ELISA) were evaluated, and bacteria on gastric biopsy specimens were investigated by urease-rapid test, culture test and GIEMSA or acridine orange staining. Of the eighty-two relatives, 68% were antibody positive. Thirty-five agreed to undergo endoscopy. With the exception of one brother, all subjects (97%) were found to be infected by Helicobacter pylori. Two symptomatic relatives, with normal antibody titres, were submitted to endoscopy and found to be colonized by Helicobacter pylori. The present data confirm the high prevalence of infection within families and appear to demonstrate the usefulness of endoscopy for all subjects showing positive antibody titres as well as for symptomatic relatives, even if serologically negative, to confirm the presence of any pathological conditions and reduce the risk of relapses within families.
  The Italian journal of gastroenterology 01/1997; 28(9):512-7.
• Article: Activation of cytotoxic and natural killer T-cell system in patients with hepatocellular carcinoma and cirrhosis.

  C Marafin, M Rinaldi, C Angonese, G De Franchis, M Plebani, R Naccarato, F Farinati
  [show abstract] [hide abstract]
  ABSTRACT: The immune response in liver cirrhosis and hepatocellular carcinoma is receiving renewed attention in consideration of the possible treatment with biological response modifiers. The aim of this study was to evaluate whether cirrhosis and hepatocellular carcinoma induce any modification in peripheral lymphocyte subsets. Lymphocytes were evaluated (number/percentage) in 61 patients with hepatocellular carcinoma, 35 with cirrhosis and 24 healthy controls. Using flow cytometry, 10 lymphocyte subpopulations were assayed, plus the CD4/CD8 ratio. Results demonstrated no change in the number of lymphocytes; cirrhosis and hepatocellular carcinoma patients had significantly more HLA-DR+ (p = 0.001) and CD3+/HLA-DR+ (activated T) (p = 0.002) and fewer CD3+ (mature T) (p = 0.02) cell than controls; hepatocellular carcinoma patients had significantly more CD3+/CD56+/CD16- (cytotoxic non-MHC restricted T cells) and CD25+ (IL-2 receptor positive cells). If the percentages of all cells with cytotoxic-T activity were pooled, a significant increase (p = 0.03) was seen in hepatocellular carcinoma patients. In conclusion, in contrast to previous data, hepatocellular carcinoma patients reveal an increased number of cytotoxic non-MHC restricted T cells.
  The Italian journal of gastroenterology 01/1997; 28(9):493-8.
• Article: Irritable oesophagus syndrome as cause of chronic cough.

  G Corrado, P D'Eufemia, C Pacchiarotti, M Cavaliere, P Rea, G Frandina, O Giardini, E Cardi
  [show abstract] [hide abstract]
  ABSTRACT: Case of an infant with chronic cough is reported. The most frequent causes of chronic cough were ruled out. Twenty-four hour oesophageal pH-monitoring showed a close correlation between gastro-oesophageal reflux episodes and cough attacks. The patient was successfully treated with cisapride (0.3 mg/kg t.i.d.). These findings show that irritable oesophagus syndrome can cause chronic cough.
  The Italian journal of gastroenterology 01/1997; 28(9):526-30.
• Article: Histopathological aspects of mucosal injury related to non-steroidal anti-inflammatory drugs.

  A S Taha
  [show abstract] [hide abstract]
  ABSTRACT: As the majority of patients with chronic arthritis are treated, for many years, with non-steroidal anti-inflammatory drugs (NSAID), it is only natural to expect the long-term use of these agents to be associated with a range of oesophago-gastro-duodenal histopathological changes. We have demonstrated that oesophagitis (defined as basis of papillary length, basal cell hyperplasia and inflammatory cell infiltration) is less prevalent in patients taking NSAID. This phenomenon can be utilised in the treatment of certain conditions such as post-irradiation oesophagitis and Barrett's oesophagitis. It also implies that NSAID-related oesophageal ulceration is due to lodging of tablets in the oesophagus and is, in turn, preventable by swallowing of some fluids or solids after taking NSAID. In the stomach, long-term use of NSAID is associated with a specific entity known as chemical or reactive gastritis in about 25% of cases. This is frequently associated with ulceration. Chronic active superficial gastritis, in the presence of Helicobacter pylori, can be found in about 70% of cases. Not unlike oesophagitis, the prevalence of active duodenitis is low in chronic NSAID users. Local ulceration still takes place. This implies that duodenitis is not required in at least some cases of NSAID-related duodenal ulcers, and demonstrates the multi-factorial nature of the pathogenesis of mucosal damage in long-term users of a NSAID.
  The Italian journal of gastroenterology 01/1997; 28 Suppl 4:12-5.
• Article: Early pathogenic events in NSAID-induced gastrointestinal damage.

  I Bjarnason, J Hayllar
  [show abstract] [hide abstract]
  ABSTRACT: A number of studies show that the idea that inhibition of cyclooxygenase is the sole mechanism of NSAID-induced gastrointestinal damage is no longer tenable. We re-examined various aspects of the mechanism of small intestinal damage due to NSAIDs in rat. Subcellular organelle marker enzyme studies show selective alterations in mitochondrial and brush border marker enzymes. Electron microscopy shows changes compatible with uncoupling of mitochondrial oxidative phosphorylation. In vitro, all common acidic-NSAIDs (n = 15) were found to uncouple oxidative phosphorylation at concentrations (microM) easily achievable within intestinal epithelium. Experiments in bile duct ligated animals show that intact indomethacin within the gastrointestinal lumen is required for uncoupling. Relative importance and pathophysiological consequences of uncoupling and inhibition of cyclooxygenase were assessed following administration of R and S flurbiprofen: the former selectively uncouples whilst the latter is also an effective cyclooxygenase inhibitor. R flurbiprofen uncoupled in vitro and in vivo, increased intestinal permeability and caused mild intestinal inflammation, but had not significant effect on prostanoid levels and produced no ulcers. S flurbiprofen uncoupled and increased intestinal permeability equally but was associated with significant decreases in intestinal prostanoid levels, more inflammation and numerous ulcers. Collectively these studies suggest that uncoupling may underlie the "topical" phase of NSAID damage which leads to increased intestinal permeability and inflammation, but concomitant inhibition of cyclooxygenase is essential to drive the inflammation to ulcers.
  The Italian journal of gastroenterology 01/1997; 28 Suppl 4:19-22.
• Article: Therapy of NSAIDs-induced gastropathy.

  R La Corte, M Caselli, M Ruina, G Bajocchi, V Alvisi, F Trotta
  [show abstract] [hide abstract]
  ABSTRACT: NSAID-induced gastropathy is the most frequent side effect due to NSAID use. The resulting clinical event is usually of little significance and only in a small percentage of cases results in serious side effects. Nevertheless, the large worldwide use of NSAIDs makes, even a rare side effect, numerically consistent. The pathogenesis of NSAID-induced gastropathy is related to two main mechanisms: an initial topical effect which is pH dependent and a systemic effect which is, more slowly developing, and mainly correlated to the inhibition of prostaglandin synthesis. The therapy of NSAID-gastropathy is almost completely identified with the therapy of NSAID ulceration because of its frequent relation to the development of potentially serious complications. In the case of symptomatic ulcer development the first therapeutic step is NSAID suspension and, in such a case all "antiulcer" drugs are efficient. When the NSAID can not be discontinued, omeprazole seems to be the most efficient drug; H2 blockers can promote ulcer healing but at a slower rate; sucralfate shows an efficacy similar to H2 blockers; misoprostol is useful in the prevention of NSAID-gastropathy. However, it is not so efficient in the treatment of established lesions and shows poor efficacy in the reduction of dyspeptic symptoms. For each one of these drugs it is necessary to obtain further data.
  The Italian journal of gastroenterology 01/1997; 28 Suppl 4:37-41.
• Article: New directions in cyclooxygenase research and their implications for NSAID-gastropathy.

  R J Flower
  [show abstract] [hide abstract]
  ABSTRACT: The observations reported in this paper have led to the formulation of a new hypothesis concerning the action of NSAIDs updating the concept first put forward in the early 70's. The new paradigm is that COX 1, a constitutive enzyme is thought to be a housekeeping protein, and to be important in generating prostaglandins necessary for physiological purposes, amongst which may be suppression of gastric acid secretion. In contrast, the induced COX 2 enzyme appears mainly after cell injury and inflammation and is responsible for generating the prostaglandins which mediate inflammatory episodes. In this model, inhibition of COX 1 is thought to produce the undesirable side effects of NSAID therapy, whereas inhibition of COX 2 is thought to be responsible for the anti-inflammatory effects. COX 2, therefore, appears to be the enzyme that should be targeted in anti-inflammatory drug therapy. By designing or screening for specific COX 2 inhibitors, it should be possible to develop drugs which are at least as effective anti-inflammatory agents as the current NSAIDs, but that are much safer in terms of gastrointestinal and other side effects. Early preclinical experience with highly selective inhibitors of COX 2, indeed, suggests that these compounds are anti-inflammatory, but have an ulcer sparing effect. Clinical data with meloxicam also suggest that this theoretical effect is also translated into patient benefit. The selective inhibition of COX 2 is a very attractive new concept that has revitalised NSAID research and promises future hope for the treatment of inflammatory disease without gastric side effects.
  The Italian journal of gastroenterology 01/1997; 28 Suppl 4:23-7.
• Article: Age affects glutathione content and glutathione-transferase activity in human gastric mucosa.

  C Loguercio, D Taranto, F Beneduce, L M Vitale, M Delle Cave
  [show abstract] [hide abstract]
  ABSTRACT: This study was undertaken to evaluate the influence of age on the content of glutathione, and its amino-acid precursor cysteine and on the activity of glutathione-S-transferase of gastric mucosa in man. We examined 44 gastric mucosal samples taken from the body and the antrum of the stomach of 22 healthy subjects, aged between 19 and 65 years. The results were examined in relationship to their distribution in the stomach, to the sex and to the age of the subjects. Glutathione and glutathione-S-transferase were higher in the gastric body than in the antrum, without differences between males and females. The activity of glutathione-S-transferase was directly related to glutathione content and both decreased with age. Cysteine was not influenced by any of the factors considered. These data indicate that the antioxidative and detoxifying capability of gastric mucosa decreases with age in man.
  The Italian journal of gastroenterology 01/1997; 28(9):477-81.
• Article: Immune mechanisms in the pathogenesis of inflammatory gastrointestinal disorders.

  S Romagnani, P Parronchi, M D'Elios, P Romagnani, F Annunziato, M Menghetti, E Maggi, G Del Prete
  [show abstract] [hide abstract]
  ABSTRACT: The cytokine secretion profile of T cells present in the gastric antrum of Helicobacter pylori-infected patients with peptic ulcer and in the gut of patients with Crohn's disease was investigated. A type 1 T helper (Th1)-dominated response was detected in the gastric antrum of Helicobacter pylori-infected subjects with peptic ulcer by both reverse transcriptase-PCR and immunohistochemistry. By using a T-cell cloning technique, it was shown that the majority of Th 1 cells were specific for Hp antigens. A Th1 predominance, which associated with high IL-12 expression, was also found, at both clonal and immunohistochemical level, in the gut of patients with Crohn's disease. These findings suggest that the Th1/Th2 paradigm may be useful to explain the inflammatory reactions involved in the pathogenesis of some gastrointestinal disorders.
  The Italian journal of gastroenterology 12/1996; 28 Suppl 2:11-7.