[Show abstract][Hide abstract] ABSTRACT: Helicobacter pylori is now an accepted gastroduodenal pathogen and is being investigated for possible implications in nongastroenterological conditions such as growth impairment. Subjects infected by cytotoxic Cag-A positive strains seem more likely to develop serious gastroduodenal diseases but the possible role of Cag-A positive strains in non gastroenterological diseases has not been fully investigated.
1) To evaluate the prevalence of Helicobacter pylori infection and Cag-A positivity in short children compared to auxologically normal children. All the subjects were without gastro-intestinal symptoms and were not obese or significantly underweight. 2) To verify the reliability of the ELISA assay for H. pylori.
H. pylori infection was assessed in 338 children, 182 auxologically normal and 156 short children, with and without deficiency in growth hormone, by the determination of specific IgG antibody. In 79 subjects (all seropositive and a random sample of seronegative children), 13C-urea breath test and cytotoxic Cag-A positive strains were examined.
The overall seroprevalence of H. pylori infection by IgG antibody was 18/156 (11.5%) and 13/182 (7.1%) in short and auxologically normal children respectively. The 13C-urea breath test was positive in 29 children: 17 (10.9%) short and 12 (6.6%) auxologically normal. Western blotting documented infection by cytotoxic Cag-A positive strains in 12/17 (70.6%) and 8/12 (66.6%) of short and auxologically normal children respectively. None of the differences between the two groups were significant.
1) We found a similar prevalence of H. pylori infection and Cag-A positivity in two large pediatric populations of short or auxologically normal children. Therefore: 1) Our data did not confirm a role of H. pylori infection in short stature in children. 2) We found a high reliability of ELISA assay for the detection of IgG antibodies compared to breath test.
[Show abstract][Hide abstract] ABSTRACT: To assess the relationship between skeletal integrity and lactose malabsorption, we studied bone mineral content (BMC), current milk and calcium intake and lactose absorption by hydrogen (H2) breath test in 155 post-menopausal women. A statistically significant relationship was found between age, onset of menopause and BMC, and between BMC and current milk intake. Although BMC was reduced in women with lower calcium intake, this relationship failed to reach statistical significance. There was an inverse relationship between mean H2 production and BMC in women 2–5 years after the onset of menopause.
These results may indicate that, although the loss of ovarian function is a pre-eminent factor in the development of osteoporosis, milk consumption represents a defensive factor against adult bone loss.
Journal of Human Nutrition and Dietetics 03/2008; 3(3):159 - 164. DOI:10.1111/j.1365-277X.1990.tb00232.x · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Over the last 20 years, upper gastrointestinal endoscopy has become the investigation of choice for patients with symptoms referrable to the upper gastrointestinal tract. As the increasing number of patients referred for endoscopy has led to enlarged waiting lists and medical expenses, it has been recommended that preendoscopic screening strategies might identify patients at low risk of having major pathology. These patients could avoid prompt endoscopy and might safely undergo different management. Since the recognition of the major role played by Helicobacter pylori in gastroduodenal pathology, H. pylori serological and demographical features have been proposed as part of preendoscopic screening strategies in dyspeptic patients referred to endoscopy, in an attempt to reduce endoscopic workload and medical expenses.
We evaluate data presented in the literature and aim to give interpretations possibly helpful in the clinical practice.
The analysis of the endoscopic findings showed that applying a preendoscopic strategy based on age and H. pylori status in local hospitals without a specific interest in H. pylori research would have meant missing a proportion of relevant pathology: 35 of 557 (6.3%) peptic ulcers (24 duodenal and 11 gastric ulcers) and two gastric cancers (0.3%).
Although we do understand the need to increase the cost-effectiveness of endoscopy and realize that considering age and H. pylori status could help to get to this target, we conclude that similar preendoscopic screening strategies must be refined further before being adopted on a large scale.
[Show abstract][Hide abstract] ABSTRACT: The diagnosis of Helicobacter pylori infection can be made easily by the rapid urease test during endoscopy. The mainly commercial rapid urease test available in routine practice, is in liquid phase, need to be stored at 4 degrees C and generally they are not ready to use. Recently a new rapid urease test, the Pronto Dry, has been reported to be faster in the final reading, ready to use, and it can be stored at room temperature. Aim of the study was to evaluate the diagnostic accuracy and the reaction time of Pronto Dry vs liquid phase-rapid urease test, before and after treatment of Helicobacter pylori infections.
A total of 315 untreated dyspeptic patients and 323 post-treatment patients, were enrolled in this study. At endoscopy, 5 biopsy samples were obtained from the antrum and from the corpus for histology; culture and rapid urease tests (liquid phase and Dry test). Helicobacter pylori status was defined according to European guidelines. Sensitivity and specificity of both rapid urease test were assessed at 5, 15, 30 minutes, and 3 and 24 hours after the endoscopy.
One hundred and eleven out of 315 untreated dyspeptic patients were found to be positive for Helicobacter pylori infection, and 56/323 patients were found still positive after treatment. Sensitivity at 5, 15, 30 minutes, and 3 and 24 hours in untreated patients were 45%, 71.2%, 81.1%, 90.1% and 91.9% respectively for the Pronto Dry vs 6.3%, 31.5%, 51.3%, 78.4% and 90.1% for liquid phase rapid urease test. Sensitivity at the same times in not eradicated patients were 33.9%, 66.1%, 85.7%, 92.8 and 92.8% respectively for the Pronto Dry vs 3.6%, 37.5%, 55.3%73.2%, 92.8% for liquid phase rapid urease test.
Pronto Dry showed to have higher sensitivity in pre and post treatment setting compared to liquid phase-rapid urease test within 3 hours of incubation time.
Minerva gastroenterologica e dietologica 10/2005; 51(3):247-54.
[Show abstract][Hide abstract] ABSTRACT: As evidence about the relationship between Helicobacter pylori infection and peptic ulcers accumulates, accurate testing and treatment are becoming increasingly important. However, big questions remain about the best strategies for detecting and managing this infection. In this article, the authors discuss the association between H pylori and peptic ulcer disease, the available tests for detecting the infection, and the latest treatment strategies for effective eradication.
Postgraduate Medicine 07/2005; 117(6):17-22, 46. · 1.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dilation of intercellular spaces (DIS) of human esophageal epithelium, evident at transmission electron microscopy (TEM), is an early marker of damage caused by gastroesophageal reflux, but its reversibility after therapy has not been investigated.
To evaluate whether omeprazole can induce the healing of DIS.
Thirty-eight symptomatic patients, 22 with nonerosive reflux disease (NERD) and 16 with erosive esophagitis (EE), classified on the basis of 24-h pH monitoring, were enrolled. During upper gastrointestinal endoscopy, six biopsies from apparently normal mucosa were taken within the lower 5 cm of the esophagus for histological and TEM analysis. One hundred computer measurements were taken on TEM photomicrographs of the specimens in each patient. After 3 months of omeprazole 40 mg/die a further endoscopy with biopsies was performed. In patients with persistent heartburn and/or incomplete ultrastructural recovery of esophageal epithelium, a new endoscopy was performed after 3 more months of treatment.
After 3 months of therapy, 35 patients (92.1%) showed a complete recovery of DIS and resolution of heartburn. Three patients required 3 more months of therapy because of an incomplete recovery of the epithelium correlated with sporadic heartburn. Healing of the mucosa was achieved in two patients, whereas one had an incomplete recovery of DIS with persistent heartburn.
Three and six months of omeprazole therapy led to a complete recovery of DIS in 92.1% and 97.4% of cases, respectively. No significant differences of DIS between NERD and EE were noted. Complete recovery of DIS was accompanied by regression of heartburn in all cases.
The American Journal of Gastroenterology 04/2005; 100(3):537-42. DOI:10.1111/j.1572-0241.2005.40476.x · 10.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To value whether omeprazole could induce the healing of DIS and regression of symptoms in patients with DGER.
We enrolled 15 symptomatic patients with a pathological esophageal 24-h pH-metry and bilimetry. Patients underwent endoscopy and biopsies were taken from the distal esophagus. Specimens were analyzed at histology and transmission electron microscopy (TEM). Patients were treated with omeprazole 40 mg/d for 3 mo and then endoscopy with biopsies was repeated. Patients with persistent heartburn and/or with an incomplete recovery of DIS were treated for 3 more months and endoscopy with biopsies was performed.
Nine patients had a non-erosive reflux disease at endoscopy (NERD) while 6 had erosive esophagitis (ERD). At histology, of the 6 patients with erosive esophagitis, 5 had mild esophagitis and 1 moderate esophagitis. No patients with NERD showed histological signs of esophagitis. After 3 mo of therapy, 13/15 patients (86.7%, P<0.01) showed a complete recovery of DIS and disappearance of heartburn. Of the 2 patients treated for 3 more months, complete recovery of DIS and heartburn were achieved in one.
Three or 6 mo of omeprazole therapy led to a complete regression of the ultrastructural esophageal damage in 86.7% and in 93% of patients with DGER, NERD and ERD respectively. The ultrastructural recovery of the epithelium was accompanied by regression of heartburn in all cases.
World Journal of Gastroenterology 03/2005; 11(12):1876-80. DOI:10.3748/wjg.v11.i12.1876 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Helicobacter pylori (H. pylori) infection may be diagnosed by means of invasive techniques requiring endoscopy and biopsy (histological examination, rapid urease test, culture, polymerase chain reaction) and by non-invasive techniques (urea breath test, detection of specific antibodies in the serum or urine, detection of the H. pylori antigen in a stool specimen). Some non-invasive tests detect active infection e.g. the urea breath test and the stool antigen test and are called active tests. Other non-invasive tests are markers of exposure to H. pylori (e.g. serology or urine) but do not indicate whether active infection is ongoing and are called passive tests. Non-invasive tests and treatment strategies are widely recommended in primary care settings and the choice of the appropriate test depends on the pre-test probability of infection, the characteristics of the test being used and its cost-effectiveness. The available non-invasive tests are reviewed in this article.
Annali italiani di medicina interna: organo ufficiale della Societa italiana di medicina interna 01/2005; 20(1):23-7.
[Show abstract][Hide abstract] ABSTRACT: Atrophic gastritis is a precancerous condition that is commonly caused by chronic Helicobacter pylori (H. pylori) infection. This blinded, controlled study was designed to determine if serum gastrin and pepsinogens were reliable markers of atrophy in asymptomatic patients.
One hundred and forty-seven asymptomatic patients underwent endoscopy with multiple gastric biopsies obtained for histology, culture, and rapid urease test. Fasting serum gastrin (total and G-17) and serum pepsinogens (I-II) were determined by standard immunoassays. Gastric atrophy was histologically assessed in accordance with internationally accepted criteria; three main patterns of gastritis were distinguished: (a) nonatrophic gastritis, (b) atrophic antrum-restricted and antrum-predominant gastritis, and (c) corpus-restricted gastritis. Receiving operating characteristic (ROC) analysis was used to determine the best cut-off for each serum test in nonatrophic gastritis versus antrum-restricted/antrum-predominant atrophic gastritis.
No significant differences in serum gastrin and pepsinogens I-II were detected in nonatrophic gastritis versus patients with antrum-restricted/antrum-predominant atrophic gastritis. The positive likelihood ratios for an abnormal serum test to detect antrum-restricted/antrum-predominant atrophy in the gastric body were total serum gastrin 2.13 (95% CI 0.99, 4.6), gastrin-17: 1.55 (95% CI 0.75, 36.17), pepsinogen I: 2.74 (1.4, 5.4), pepsinogen II: 1.74 (1.27, 2.39), and the ratio of pepsinogen I and II: 1.8 (1.2-2.8). Negative likelihood ratios ranged from 0.20 to 0.65.
In an asymptomatic population, serum gastrin (total and G-17) and pepsinogens I-II (and their ratio) do not discriminate nonatrophic versus antrum-restricted/predominant atrophic gastritis.
The American Journal of Gastroenterology 11/2004; 99(10):1910-5. DOI:10.1111/j.1572-0241.2004.40614.x · 10.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Current guidelines recommend non-invasive testing and treatment of young dyspeptic patients without alarm symptoms.
To evaluate the accuracy of a new rapid immunochromatographic stool test to diagnose Helicobacter pylori infection before and after treatment compared with a gold standard.
Prospective, single-blind study, performed in a tertiary care hospital. A total of 303 consecutive dyspeptic patients underwent endoscopy with multiple biopsies. Infected patients were offered a treatment and invited to come back 4-6 weeks after the end of therapy to repeat the endoscopy. Patients were also asked to provide a stool sample before and after therapy.
About 149 patients were H. pylori infected. The sensitivity and specificity before treatment were 91.3 and 93.5%; after treatment 92 and 100%. The likelihood ratios were robust enough to produce significant changes from pretest to post-test probability both in pre-treatment (LR+ = 14, LR- = 0.093) and post-treatment (LR+ = 19.6, LR- = 0.095).
The novel immunochromatographic stool test is fast, easy to perform and provides good differentiation between positive and negative results. It might become a rapid near patients test easily performed in the doctor office.
[Show abstract][Hide abstract] ABSTRACT: Patients affected by familial adenomatous polyposis (FAP) are at risk of developing duodenal neoplasia. Our objective was to detect early abnormalities of the epithelial cell proliferation and ultrastructure of apparently normal duodenal mucosa of FAP patients. Biopsy specimens were taken from the duodenal mucosa. Cell proliferation was studied by immunohistochemistry with proliferating cell nuclear antigen (PCNA), and ultrastructure, by transmission electron microscopy. We found that the PCNA labeling index for duodenal mucosa of patients with FAP was higher in comparison to the case of hospital controls without cancer risk (P = 0.019). Moreover, ultrastructural changes related to an impairment of cell adhesion function were found in all biopsies of FAP patients but not in the duodenal mucosa of the controls. We conclude that alterations of cell proliferation kinetics and epithelial adherens junction structures were phenotypic characteristics of histologically normal duodenal mucosa of FAP patients. These abnormalities may be considered as intermediate biomarkers of neoplasia and potential surrogate endpoints in chemoprevention studies.
Human Pathlogy 06/2004; 35(5):622-6. DOI:10.1016/j.humpath.2004.01.018 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is uncertainty about the best method of testing patients for Helicobacter pylori (H. pylori) infection while they are taking proton pump inhibitors. The aim of this study was to determine: (i) if the decreased sensitivity of the urea breath test during proton pump inhibitor is corrected by different techniques for breath testing and (ii) if the sensitivity of stool test is decreased with the administration of proton pump inhibitors.
Prospective randomized single-blind study was performed in a tertiary care university hospital. Out of 72 H. pylori infected patients endoscoped for upper abdominal symptoms 48 were randomized to proton pump inhibitors (omeprazole 20 mg each day or esomeprazole 40 mg each day) and 24 to antacid (aluminum hydroxide 800 mg each day) for 14 days. Several breath tests (standard 75 mg (13)C-UBT with citric acid, with orange juice, a tablet breath test with 100 and 50 mg of (13)C), and a stool test were carried out. Baseline samples were collected before and after treatment.
The baseline sensitivity for all breath tests was 100% in both groups; for stool test it was 97.8% (95% CI: 88.7-96.6) and 90% (95% CI: 69.9-97.2) in the proton pump inhibitor and antacid group, respectively. After treatment, the sensitivity of tests was significantly low (UBTs range: 77.1%-85.4%; stool test: 83%; 95% CI: 63.9-91.1), while it was unchanged in the antacid group.
False negative breath and stool tests are equally common in patients taking proton pump inhibitors. Antacids do not impair the sensitivity of the breath tests or the stool test.
The American Journal of Gastroenterology 06/2004; 99(5):823-9. DOI:10.1111/j.1572-0241.2004.30162.x · 10.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the outcome of 19 patients who underwent intestinal transplantation (ITx) for intestinal failure.
The 19 patients who underwent primary ITx between December 2000 and May 2003 were prescribed three different immunosuppressive protocols that included daclizumab, alemtuzumab, and antithymocyte globulin induction, respectively. A mucosal surveillance protocol for early detection of rejection consisted of zoom video endoscopy and serial biopsies associated with orthogonal polarization spectral imaging. Retrospective review of the clinical records was performed to assess the impact of new modalities of immunosuppression and intestinal mucosal monitoring on patient outcomes.
All patients were adults (mean age 35.8 years). Etiology of intestinal failure included chronic intestinal pseudo-obstruction (n = 6), intestinal angiomatosis (n = 1), Gardner syndrome (n = 2), intestinal infarction (n = 8), radiation enteritis (n = 1), and intestinal atresia (n = 1). All patients experienced complications from total parenteral nutrition (TPN). Thirteen patients (68.4%) received isolated small bowel, whereas six (31.6%) received multivisceral grafts with or without the liver. Thirteen of 19 patients experienced at least one episode of rejection (68.4%). Most ACR episodes were treated with steroid boluses and resolved completely within 5 days. The overall 1-year patient survival was 82%. All living patients are in good health with functioning grafts having been weaned off TPN after a mean of 23.7 days post-ITx.
Advances in immunosuppressive therapy with early detection and prompt treatment of rejection episodes make ITx a valuable treatment option for patients with intestinal failure and TPN-related life-threatening complications.
[Show abstract][Hide abstract] ABSTRACT: In 2002, the Italian guidelines for eligibility of patients for intestinal transplantation (ITx) were defined as: life-threatening complications of home parenteral nutrition (HPN), lack of venous access for HPN, locally invasive tumors of the abdomen, Chronic intestinal failure (CIF) with a high risk of mortality, primary disease-related poor quality of life (QoL) despite optimal HPN. Our aim was to identify potential candidates for ITx according to these national guidelines among patients managed by a medical referral center for CIF. Records of patients who received HPN were reviewed. CIF was considered reversible or irreversible (energy by HPN <50% or >50% basal energy expenditure). Patients with irreversible CIF were considered eligible for ITx in the absence of a contraindication, as are used for solid organs Tx. From 1986 to 2003 among 64 patients who met the entry criteria 23 showed reversible and 41 irreversible, CIF. Twenty-one patients with irreversible CIF had an indication for ITx, but eight had also contraindications; thus 13 were eligible, including intestinal pseudo-obstruction (n = 6), mesenteric ischemia (n = 3), Crohn's (n = 2), radiation enteritis (n = 1), and desmoid (n = 1). Indications for ITx included HPN liver failure (n = 2), lack of venous access (n = 2), CIF with high risk of mortality (n = 3), very poor QoL (n = 6 including 5 with pseudo-obstruction). According to the Italian guidelines for ITx, 31% of patients with irreversible CIF managed by a medical referral center were eligible for ITx. Primary disease-related poor QoL was the indication in half of them. Studies on the QoL after ITx are required to allow patients to make an educated decision.
[Show abstract][Hide abstract] ABSTRACT: The non-disease-specific SF-36 instrument was applied to detect changes in quality of life among patients at a single center who were receiving home parenteral nutrition (HPN) for intestinal failure.
All HPN patients completed the questionnaire during routine visits. The SF-36 examines eight domains (scores: 0% to 100%): physical functioning (PF), role-functioning physical (RP), body pain (BP), general health (GH), vitality (VT), social functioning (SF), as well as role-functioning emotional (RE) and mental health (MH). Patient responses were standardized for the sex- and age-matched group scores of the healthy population by calculating the Z-score: (healthy population mean score - patient raw score)/healthy population standard deviation (reduced value: Z-score < -1). A difference in a domain score was considered significant in the individual patient if it was greater than the 90% confidence interval for healthy subjects and if it produced a change in Z-score category. General, sociodemographic, underlying disease and HPN-related factors were collected.
For 31 enrolled adult patients, the baseline mean Z-score was reduced in five domains: PF, RP, BP, GH and SF. Twenty patients underwent a second SF-36 assessment 10 +/- 2 months later: the HRQOL worsened in eight and improved in 10 (no. worsened domains > no. improved or vice versa). The worsened subgroup showed a decrease in body mass index (P =.104), an increase in the number of HPN infusions per week (P =.065), and a greater incidence of intestinal motility disorders (P =.161), of liquid oral diet (P =.027), and of nycturia (P =.028).
The SF-36 instrument reflecting the generic HRQOL assessment may be a suitable tool for patients on HPN.