Chronic atrophic gastritis （CAG） is an inflammatory condition characterized by the loss of gastric glandular structures which are replaced by connective tissue （non-metaplastic atrophy） or by glandular structures ...Chronic atrophic gastritis （CAG） is an inflammatory condition characterized by the loss of gastric glandular structures which are replaced by connective tissue （non-metaplastic atrophy） or by glandular structures inappropriate for location （metaplastic atrophy）. Epidemiological data suggest that CAG is associated with two different types of tumors： Intestinal-type gastric cancer （GC） and type I gastric carcinoid （T I GC）. The pathophysiological mechanisms which lead to the development of these gastric tumors are different, It is accepted that a multistep process initiating from Helico- bacterpylori-related chronic inflammation of the gastric mucosa progresses to CAG, intestinal metaplasia, dysplasia and, finally, leads to the development of GC. The T I GC is a gastrin-dependent tumor and the chronic elevation of gastrin, which is associated with CAG, stimulates the growth of enterochromaffin-like cells with their hyperplasia leading to the development of T I GC. Thus, several events occur in the gastric mucosa before the development of intestinatype GC and/ or T I GC and these take several years. Knowledge ofCAG incidence from superficial gastritis, its prevalence in different clinical settings and possible risk factors as- sociated with the progression of this condition to gastric neoplasias are important issues. This editorial intends to provide a brief review of the main studies regarding incidence and prevalence of CAG and risk factors for the development of gastric neoplasias.展开更多
Helicobacter pylori(Hp) is a major human pathogen causing chronic, progressive gastric mucosal damage and is linked to gastric atrophy and cancer. Hp-positive individuals constitute the major reservoir for transmissio...Helicobacter pylori(Hp) is a major human pathogen causing chronic, progressive gastric mucosal damage and is linked to gastric atrophy and cancer. Hp-positive individuals constitute the major reservoir for transmission of infection. There is no ideal treatment for Hp. Hp infection is not cured by a single antibiotic, and sometimes, a combined treatment with three or more antibiotics is ineffective. Atrophic gastritis(AG) is a chronic disease whose main features are atrophy and/or intestinal metaplasia of the gastric glands, which arise from long-standing Hp infection. AG is reportedly linked to an increased risk for gastric cancer, particularly when extensive intestinal metaplasia is present. Active or past Hp infection may be detected by conventional methods in about two-thirds of AG patients. By immunoblotting of sera against Hp whole-cell protein lysates, a previous exposure to Hp infection is detected in all AG patients. According to guidelines, AG patients with Hp positivity should receive eradication treatment. The goals of treatment are as follows:(1) Cure of infection, resolution of inflammation and normalization of gastric functions;(2) possible reversal of atrophic and metaplastic changes of the gastric mucosa; and(3) prevention of gastric cancer. An ideal antibiotic regimen for Hp should achieve eradication rates of approximately 90%, and complex multidrug regimens are required to reach this goal. Amongst the factors associated with treatment failure are high bacterial load, high gastric acidity, Hp strain, smoking, low compliance, overweight, and increasing antibiotic resistance. AG, when involving the corporal mucosa, is linked to reduced gastric acid secretion. At a non-acidic intra-gastric p H, the efficacy of the common treatment regimens combining proton pump inhibitors with one or more antibiotics may not be the same as that observed in patients with Hp gastritis in an acid-producing stomach. Although the efficacy of these therapeutic regimens has been thoroughly tested in subjects with Hp infection, there is a paucity of evidence in the subgroupof patients with AG. Bismuth-based therapy may be an attractive treatment in the specific setting of AG, and specific studies on the efficacy of bismuth-based therapies are needed in patients with AG.展开更多
Pernicious anemia （PA） is a macrocytic anemia that is caused by vitamin B12 deficiency, as a result of intrinsic factor deficiency. PA is associated with atrophic body gastritis （ABG）, whose diagnosis is based on ...Pernicious anemia （PA） is a macrocytic anemia that is caused by vitamin B12 deficiency, as a result of intrinsic factor deficiency. PA is associated with atrophic body gastritis （ABG）, whose diagnosis is based on histological confirmation of gastric body atrophy. Serological markers that suggest oxyntic mucosa damage are increased fasting gastrin and decreased pepsinogen I. Without performing Schilling＇s test, intrinsic factor deficiency may not be proven, and intrinsic factor and parietal cell antibodies are use- ful surrogate markers of PA, with 73% sensitivity and 100% specificity. PA is mainly considered a disease of the elderly, but younger patients represent about 15% of patients. PA patients may seek medical advice due to symptoms related to anemia, such as weak-ness and asthenia. Less commonly, the disease is suspected to be caused by dyspepsia. PA is frequently associated with autoimmune thyroid disease （40%） and other autoimmune disorders, such as diabetes mellitus （10%）, as part of the autoimmune polyen-docrine syndrome. PA is the end-stage of ABG. Long- standing Helicobacter pylori infection probably plays a role in many patients with PA, in whom the active infectious process has been gradually replaced by an autoimmune disease that terminates in a burned-out infection and the irreversible destruction of the gastric body mucosa. Human leucocyte antigen-DR genotypes suggest a role for genetic susceptibility in PA. PA patients should be managed by cobalamin replacement treatment and monitoring for onset of iron deficiency. Moreover, they should be advised about possible gastrointestinal long-term consequences, such as gastric cancer and carcinoids.展开更多
Drug absorption represents an important factor affecting the efficacy of oral drug treatment.Gastric secretion and motility seem to be critical for drug absorption.A causal relationship between impaired absorption of ...Drug absorption represents an important factor affecting the efficacy of oral drug treatment.Gastric secretion and motility seem to be critical for drug absorption.A causal relationship between impaired absorption of orally administered drugs and Helicobacter pylori(H.pylori)infection has been proposed.Associations have been reported between poor bioavailability of l-thyroxine and l-dopa and H.pylori infection.According to the Maastricht Florence Consensus Report on the management of H.pylori infection,H.pylori treatment improves the bioavailability of both these drugs,whereas the direct clinical benefits to patients still await to be established.Less strong seems the association between H.pylori infection and other drugs malabsorption,such as delavirdine and ketoconazole.The exact mechanisms forming the basis of the relationship between H.pylori infection and impaired drugs absorption and/or bioavailability are not fully elucidated.H.pylori infection may trigger a chronic inflammation of the gastric mucosa,and impaired gastric acid secretion often follows.The reduction of acid secretion closely relates with the wideness and the severity of the damage and may affect drug absorption.This minireview focuses on the evidence of H.pylori infection associated with impaired drug absorption.展开更多
Patients with Helicobacter pylori (H. pylori) infection may complain of dyspeptic symptoms without presence of macroscopic lesions on gastroduodenal mucosa. Such a condition is usually recognized as functional dyspeps...Patients with Helicobacter pylori (H. pylori) infection may complain of dyspeptic symptoms without presence of macroscopic lesions on gastroduodenal mucosa. Such a condition is usually recognized as functional dyspepsia, and different pathogenetic mechanisms are involved. The role of H. pylori in these patients is controversial. Several trials assessed the potential role of H. pylori eradication in improving dyspeptic symptoms, and data of some meta-analyses demonstrated that cure of infection is associated with a small (10%), but significant therapeutic gain as compared to placebo. The reason for which dyspeptic symptoms regress in some patients following bacterial eradication, but persist in others remains unclear. Regrettably, trials included in the meta-analyses are somewhat different for study design, definition of symptoms, assessment of symptoms changes, and some may be flawed by potential pitfalls. Consequently, the information could be not consistent. We critically reviewed the main available trials, attempting to address future research in this field展开更多
AIM： To investigate the possible relationships between gastric autoimmune phenomena and clinical presentations of this disorder, in consecutive atrophic body gastritis patients. METHODS： A total of 140 atrophic body...AIM： To investigate the possible relationships between gastric autoimmune phenomena and clinical presentations of this disorder, in consecutive atrophic body gastritis patients. METHODS： A total of 140 atrophic body gastritis patients, diagnosed as consecutive outpatients presenting with macrocytic or iron deficiency anemia, or longstanding dyspepsia underwent gastroscopy with antral and body biopsies, assay of intrinsic factor, parietal cells and Helicobacter pylori （ H pylon） antibodies. Gastritis was assessed according to Sydney System. RESULTS： Parietal cell antibodies were equally distributed in all clinical presentations, whereas the positivity of intrinsic factor antibodies （49/140, 35%） was significantly higher in pernicious anemia patients （49.2%） than in iron deficiency （21.1%） and dyspeptic patients （27.8%）. No specific pattern of autoantibodies was related to the clinical presentations of atrophic body gastritis. A positive correlation was obtained between the body atrophy score and the intrinsic factor antibody levels （r=0.2216, P=0.0085）. Associated autoimmune diseases were present in 25/140 （17.9%） patients, but the prevalence of autoimmune diseases was comparable, irrespective of the clinical presentations. CONCLUSION： The so-called hallmarks of gastric autoimmunity, particularly in intrinsic factor antibody cannot be usefully employed in defining an autoimmune pattern in the clinical presentations of ABG.展开更多
AIM: To investigate whether ANNs and LDA could recognize patients with ABG in a database, containing only clinical and biochemical variables, of a pool of patients with and without ABG, by selecting the most predictiv...AIM: To investigate whether ANNs and LDA could recognize patients with ABG in a database, containing only clinical and biochemical variables, of a pool of patients with and without ABG, by selecting the most predictive variables and by reducing input data to the minimum.METHODS: Data was collected from 350 consecutive outpatients (263 with ABG, 87 with non-atrophic gastritis and/or celiac disease [controls]). Structured questionnaires with 22 items (anagraphic, anamnestic, clinical, and biochemical data) were filled out for each patient. All patients underwent gastroscopy with biopsies. ANNs and LDA were applied to recognize patients with ABG.Experiment 1: random selection on 37 variables, experiment 2: optimization process on 30 variables, experiment 3:input data reduction on 8 variables, experiment 4: use of only clinical input data on 5 variables, and experiment 5:use of only serological variables.RESULTS: In experiment 1, overall accuracies of ANNs and LDA were 96.6% and 94.6%, respectively, for predicting patients with ABG. In experiment 2, ANNs and LDA reached an overall accuracy of 98.8% and 96.8%,respectively. In experiment 3, overall accuracy of ANNs was 98.4%. In experiment 4, overall accuracies of ANNs and LDA were, respectively, 91.3% and 88.6%. In experiment 5, overall accuracies of ANNs and LDA were,respectively, 97.7% and 94.5%.CONCLUSION: This preliminary study suggests that advanced statistical methods, not only ANNs, but also LDA,may contribute to better address bioptic sampling during gastroscopy in a subset of patients in whom ABG may be suspected on the basis of aspecific gastrointestinal symptoms or non-digestive disorders.展开更多
AIM: To investigate the role of artifi cial neural networks in predicting the presence of thyroid disease in atrophic body gastritis patients. METHODS: A dataset of 29 input variables of 253 atrophic body gastritis pa...AIM: To investigate the role of artifi cial neural networks in predicting the presence of thyroid disease in atrophic body gastritis patients. METHODS: A dataset of 29 input variables of 253 atrophic body gastritis patients was applied to artifi cial neural networks (ANNs) using a data optimisation procedure (standard ANNs,T&T-IS protocol,TWIST protocol). The target variable was the presence of thyroid disease. RESULTS: Standard ANNs obtained a mean accuracy of 64.4% with a sensitivity of 69% and a specifi city of 59.8% in recognizing atrophic body gastritis patients with thyroid disease. The optimization procedures (T&T-IS and TWIST protocol) improved the performance of the recognition task yielding a mean accuracy,sensitivity and specifi city of 74.7% and 75.8%,78.8% and 81.8%,and 70.5% and 69.9%,respectively. The increase of sensitivity of the TWIST protocol was statistically signifi cant compared to T&T-IS. CONCLUSION: This study suggests that artificial neural networks may be taken into consideration as a potential clinical decision-support tool for identifying ABG patients at risk for harbouring an unknown thyroid disease and thus requiring diagnostic work-up of their thyroid status.展开更多
Atrophic gastritis and intestinal metaplasia(IM) of the stomach are common and are associated with an increased risk for gastric cancer.In the absence of guidelines,a pragmatic management has been performed in Western...Atrophic gastritis and intestinal metaplasia(IM) of the stomach are common and are associated with an increased risk for gastric cancer.In the absence of guidelines,a pragmatic management has been performed in Western countries in patients with these premalignant conditions.Recently,formal European guidelines have been delivered on this topic.Basically,it has been recommended that patients with extensive atrophic gastritis(AG) and/or extensive IM should be offered endoscopic surveillance every 3 years.On the contrary,no scheduled endoscopic/histological control has been advised for those patients with precancerous conditions confined to the antrum.In this commentary,we highlighted some potential weaknesses in the management formally recommended by the new guidelines.In detail,we discussed that AG and IM patients do not share the same gastric cancer risk,at least in Western countries,deserving a different approach.Some factors significantly associated with gastric cancer risk,such as IM type,first-degree family history of gastric cancer,and smoking habit have not been considered in tailoring the endoscopic follow-up.Finally,some data would suggest that a 3-year follow-up in patients with extensive gastric precancerous conditions could result in an inadequate secondary prevention.展开更多
AIM： To evaluate the usefulness of pre-endoscopic serological screening for He//cobacter py/or/ （H py/or/} infection and celiac disease in women aged 〈 50 years affected by iron-deficiency anemia （IDA）. METHODS：...AIM： To evaluate the usefulness of pre-endoscopic serological screening for He//cobacter py/or/ （H py/or/} infection and celiac disease in women aged 〈 50 years affected by iron-deficiency anemia （IDA）. METHODS： One hundred and fifteen women aged 〈 50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies （tTG） and anti-H pylori IgG antibodies, tTG and H pylori IgG antibody were assessed using an enzyme-linked immunosorbent assay （ELISA）. All women were invited to undergo upper GI endoscopy. During gastroscopy, biopsies were collected from antrum （n = 3）, gastric body （n = 3） and duodenum （n = 4） in all patients, irrespective of test results. The assessment of gastritis was performed according to the Sydney system and celiac disease was classified by Marsh＇s System. RESULTS： 45.2% women were test-positive： 41 patients positive for H pylori antibodies, 9 patients for tTG and 2 patients for both. The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test- negative （65.4% vs 42.8%; Fisher test P = 0.0239）. The serological results were confirmed by gastroscopy in 100% of those with positive H pylori antibodies, in 50% of those with positive tTG and in 81.5% of test- negative patient. Sensitivity and specificity were 84.8% and 100%, respectively for Hpylori infection and, 80% and 92.8% for tTG. Twenty-eight patients had positive H pylori antibodies and in all the patients, an active Hpylori infection was found. In particular, in 23 out of 28 （82%） patients with positive H pylori antibodies, a likely cause of IDA was found because of the active inflammation involving the gastric body. CONCLUSION： Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease, likely causes of IDA.展开更多
AIM： To investigate in symptomatic uncomplicated di- verticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms. METHODS： This study was a multicentre, 6-too ran- domized, ...AIM： To investigate in symptomatic uncomplicated di- verticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms. METHODS： This study was a multicentre, 6-too ran- domized, controlled, parallel-group intervention with a preceding 4-wk washout period. Consecutive out- patients with symptomatic uncomplicated diverticular disease, aged 40-80 years, evaluated in 4 Gastroenterology Units, were enrolled. Symptomatic uncomplicated diverticular disease patients were randomized to two treatment arms A or B. Treatment A （n = 24 patients） received 1 symbiotic sachet Flortec~ （Lactobacillus paracasei B21060） once daily plus high-fibre diet for 6 mo. Treatment B （n = 21 patients） received high-fibre diet alone for 6 rno. The primary endpoint was regres- sion of abdominal symptoms and change of symptom severity after 3 and 6 mo of treatment. RESULTS： In group A, the proportion of patients with abdominal pain 〈 24 h decreased from 100% at base- line to 35% and 25% after 3 and 6 mo, respectively （P 〈 0.001）. In group B the proportion of patients with this symptom decreased from 90.5% at baseline to 61.9% and 38.1% after 3 and 6 mo, respectively （P = 0.001）. Symptom improvement became statistically sig- nificant at 3 and 6 mo in group A and B, respectively. The proportion of patients with abdominal pain 〉24 h decreased from 60% to 20% then 5% after 3 and 6 too, respectively in group A （P 〈 0.001） and from 33.3% to 9.5% at both 3 and 6 mo in group B （P = 0.03）. In group A the proportion of patients with ab- dominal bloating significantly decreased from 95% to 60% after 3 mo, and remained stable （65%） at 6-mo follow-up （P = 0.005） while in group B, no significant changes in abdominal bloating was observed （P = 0.11）. After 6 mo of treatment, the mean visual analogic scale （VAS） values of both short-lasting abdominal pain （VAS, mean ± SD, group A： 4.6 ± 2.1 vs 2.2 ± 0.8, P = 0.02; group B： 4.6 ± 2.9 vs 2.0 ± 1.9, P = 0.03） and abdom- inal bloating （VAS, mean ± SD, group A： 5.3 ± 2.2 vs 3.0 ± 1.7, P = 0.005; group B： 5.3 ±3.2 vs 2.3 ± 1.9, P = 0.006） decreased in both groups, whilst the VAS values of prolonged abdominal pain decreased in the Flortec group, but remained unchanged in the high-fibre diet group （VAS, mean ± SD, group A： 6.5 ± 1.5 vs 4.5 ± 2.1, P = 0.052; group B： 4.5 ± 3.8 vs 5.5 ± 3.5）. CONCLUSION： A high-fibre diet is effective in relievingabdominal symptoms in symptomatic uncomplicated di- verticular disease. This treatment may be implemented by combining the high-fibre diet with Flortec~.展开更多
AIM:To compare the site,age and gender of cases of colorectal cancer(CRC) and polyps in a single referral center in Rome,Italy,during two periods.METHODS:CRC data were collected from surgery/pathology registers,and po...AIM:To compare the site,age and gender of cases of colorectal cancer(CRC) and polyps in a single referral center in Rome,Italy,during two periods.METHODS:CRC data were collected from surgery/pathology registers,and polyp data from colonoscopy reports.Patients who met the criteria for familial adenomatous polyposis,hereditary non-polyposis colorectal cancer syndrome or inflammatory bowel disease were excluded from the study.Overlap of patients between the two groups(cancers and polyps) was carefully avoided.Theχ 2 statistical test and a regression analysis were performed.RESULTS:Data from a total of 768 patients(352 and 416 patients,respectively,in periods A and B) who underwent surgery for cancer were collected.During the same time periods,a total of 1693 polyps were analyzed from 978 patients with complete colonoscopies(428 polyps from 273 patients during period A and 1265 polyps from 705 patients during period B).A proximal shift in cancer occurred during the latter years for both sexes,but particularly in males.Proximal cancer increased > 3-fold in period B compared to period A in males [odds ratio(OR) 3.31,95%CI:2.00-5.47;P < 0.0001).A similar proximal shift was observed for polyps,particularly in males(OR 1.87,95%CI:1.23-2.87;P < 0.0038),but also in females(OR 1.62,95%CI:0.96-2.73;P < 0.07).CONCLUSION:The prevalence of proximal proliferative colonic lesions seems to have increased over the last decade,particularly in males.展开更多
文摘Chronic atrophic gastritis （CAG） is an inflammatory condition characterized by the loss of gastric glandular structures which are replaced by connective tissue （non-metaplastic atrophy） or by glandular structures inappropriate for location （metaplastic atrophy）. Epidemiological data suggest that CAG is associated with two different types of tumors： Intestinal-type gastric cancer （GC） and type I gastric carcinoid （T I GC）. The pathophysiological mechanisms which lead to the development of these gastric tumors are different, It is accepted that a multistep process initiating from Helico- bacterpylori-related chronic inflammation of the gastric mucosa progresses to CAG, intestinal metaplasia, dysplasia and, finally, leads to the development of GC. The T I GC is a gastrin-dependent tumor and the chronic elevation of gastrin, which is associated with CAG, stimulates the growth of enterochromaffin-like cells with their hyperplasia leading to the development of T I GC. Thus, several events occur in the gastric mucosa before the development of intestinatype GC and/ or T I GC and these take several years. Knowledge ofCAG incidence from superficial gastritis, its prevalence in different clinical settings and possible risk factors as- sociated with the progression of this condition to gastric neoplasias are important issues. This editorial intends to provide a brief review of the main studies regarding incidence and prevalence of CAG and risk factors for the development of gastric neoplasias.
文摘Helicobacter pylori(Hp) is a major human pathogen causing chronic, progressive gastric mucosal damage and is linked to gastric atrophy and cancer. Hp-positive individuals constitute the major reservoir for transmission of infection. There is no ideal treatment for Hp. Hp infection is not cured by a single antibiotic, and sometimes, a combined treatment with three or more antibiotics is ineffective. Atrophic gastritis(AG) is a chronic disease whose main features are atrophy and/or intestinal metaplasia of the gastric glands, which arise from long-standing Hp infection. AG is reportedly linked to an increased risk for gastric cancer, particularly when extensive intestinal metaplasia is present. Active or past Hp infection may be detected by conventional methods in about two-thirds of AG patients. By immunoblotting of sera against Hp whole-cell protein lysates, a previous exposure to Hp infection is detected in all AG patients. According to guidelines, AG patients with Hp positivity should receive eradication treatment. The goals of treatment are as follows:(1) Cure of infection, resolution of inflammation and normalization of gastric functions;(2) possible reversal of atrophic and metaplastic changes of the gastric mucosa; and(3) prevention of gastric cancer. An ideal antibiotic regimen for Hp should achieve eradication rates of approximately 90%, and complex multidrug regimens are required to reach this goal. Amongst the factors associated with treatment failure are high bacterial load, high gastric acidity, Hp strain, smoking, low compliance, overweight, and increasing antibiotic resistance. AG, when involving the corporal mucosa, is linked to reduced gastric acid secretion. At a non-acidic intra-gastric p H, the efficacy of the common treatment regimens combining proton pump inhibitors with one or more antibiotics may not be the same as that observed in patients with Hp gastritis in an acid-producing stomach. Although the efficacy of these therapeutic regimens has been thoroughly tested in subjects with Hp infection, there is a paucity of evidence in the subgroupof patients with AG. Bismuth-based therapy may be an attractive treatment in the specific setting of AG, and specific studies on the efficacy of bismuth-based therapies are needed in patients with AG.
基金Supported by Funds of the Italian Ministry for University and Research (PRIN 2007) and by funds of the University "La Sapienza", Rome, Italy
文摘Pernicious anemia （PA） is a macrocytic anemia that is caused by vitamin B12 deficiency, as a result of intrinsic factor deficiency. PA is associated with atrophic body gastritis （ABG）, whose diagnosis is based on histological confirmation of gastric body atrophy. Serological markers that suggest oxyntic mucosa damage are increased fasting gastrin and decreased pepsinogen I. Without performing Schilling＇s test, intrinsic factor deficiency may not be proven, and intrinsic factor and parietal cell antibodies are use- ful surrogate markers of PA, with 73% sensitivity and 100% specificity. PA is mainly considered a disease of the elderly, but younger patients represent about 15% of patients. PA patients may seek medical advice due to symptoms related to anemia, such as weak-ness and asthenia. Less commonly, the disease is suspected to be caused by dyspepsia. PA is frequently associated with autoimmune thyroid disease （40%） and other autoimmune disorders, such as diabetes mellitus （10%）, as part of the autoimmune polyen-docrine syndrome. PA is the end-stage of ABG. Long- standing Helicobacter pylori infection probably plays a role in many patients with PA, in whom the active infectious process has been gradually replaced by an autoimmune disease that terminates in a burned-out infection and the irreversible destruction of the gastric body mucosa. Human leucocyte antigen-DR genotypes suggest a role for genetic susceptibility in PA. PA patients should be managed by cobalamin replacement treatment and monitoring for onset of iron deficiency. Moreover, they should be advised about possible gastrointestinal long-term consequences, such as gastric cancer and carcinoids.
基金Supported by"Sapienza"University of Roma grant,No.0006345
文摘Drug absorption represents an important factor affecting the efficacy of oral drug treatment.Gastric secretion and motility seem to be critical for drug absorption.A causal relationship between impaired absorption of orally administered drugs and Helicobacter pylori(H.pylori)infection has been proposed.Associations have been reported between poor bioavailability of l-thyroxine and l-dopa and H.pylori infection.According to the Maastricht Florence Consensus Report on the management of H.pylori infection,H.pylori treatment improves the bioavailability of both these drugs,whereas the direct clinical benefits to patients still await to be established.Less strong seems the association between H.pylori infection and other drugs malabsorption,such as delavirdine and ketoconazole.The exact mechanisms forming the basis of the relationship between H.pylori infection and impaired drugs absorption and/or bioavailability are not fully elucidated.H.pylori infection may trigger a chronic inflammation of the gastric mucosa,and impaired gastric acid secretion often follows.The reduction of acid secretion closely relates with the wideness and the severity of the damage and may affect drug absorption.This minireview focuses on the evidence of H.pylori infection associated with impaired drug absorption.
文摘Patients with Helicobacter pylori (H. pylori) infection may complain of dyspeptic symptoms without presence of macroscopic lesions on gastroduodenal mucosa. Such a condition is usually recognized as functional dyspepsia, and different pathogenetic mechanisms are involved. The role of H. pylori in these patients is controversial. Several trials assessed the potential role of H. pylori eradication in improving dyspeptic symptoms, and data of some meta-analyses demonstrated that cure of infection is associated with a small (10%), but significant therapeutic gain as compared to placebo. The reason for which dyspeptic symptoms regress in some patients following bacterial eradication, but persist in others remains unclear. Regrettably, trials included in the meta-analyses are somewhat different for study design, definition of symptoms, assessment of symptoms changes, and some may be flawed by potential pitfalls. Consequently, the information could be not consistent. We critically reviewed the main available trials, attempting to address future research in this field
基金Supported by Grants From the Italian Ministry for the University (MIUR), No. 02/12/01/10 1999-2002 and No. 8.111.126.5
文摘AIM： To investigate the possible relationships between gastric autoimmune phenomena and clinical presentations of this disorder, in consecutive atrophic body gastritis patients. METHODS： A total of 140 atrophic body gastritis patients, diagnosed as consecutive outpatients presenting with macrocytic or iron deficiency anemia, or longstanding dyspepsia underwent gastroscopy with antral and body biopsies, assay of intrinsic factor, parietal cells and Helicobacter pylori （ H pylon） antibodies. Gastritis was assessed according to Sydney System. RESULTS： Parietal cell antibodies were equally distributed in all clinical presentations, whereas the positivity of intrinsic factor antibodies （49/140, 35%） was significantly higher in pernicious anemia patients （49.2%） than in iron deficiency （21.1%） and dyspeptic patients （27.8%）. No specific pattern of autoantibodies was related to the clinical presentations of atrophic body gastritis. A positive correlation was obtained between the body atrophy score and the intrinsic factor antibody levels （r=0.2216, P=0.0085）. Associated autoimmune diseases were present in 25/140 （17.9%） patients, but the prevalence of autoimmune diseases was comparable, irrespective of the clinical presentations. CONCLUSION： The so-called hallmarks of gastric autoimmunity, particularly in intrinsic factor antibody cannot be usefully employed in defining an autoimmune pattern in the clinical presentations of ABG.
基金Supported by a grant from Bracco Imaging Spa, Milan, Italy, and a grant from the Italian Ministry of University and Research (No. 2002-2003)
文摘AIM: To investigate whether ANNs and LDA could recognize patients with ABG in a database, containing only clinical and biochemical variables, of a pool of patients with and without ABG, by selecting the most predictive variables and by reducing input data to the minimum.METHODS: Data was collected from 350 consecutive outpatients (263 with ABG, 87 with non-atrophic gastritis and/or celiac disease [controls]). Structured questionnaires with 22 items (anagraphic, anamnestic, clinical, and biochemical data) were filled out for each patient. All patients underwent gastroscopy with biopsies. ANNs and LDA were applied to recognize patients with ABG.Experiment 1: random selection on 37 variables, experiment 2: optimization process on 30 variables, experiment 3:input data reduction on 8 variables, experiment 4: use of only clinical input data on 5 variables, and experiment 5:use of only serological variables.RESULTS: In experiment 1, overall accuracies of ANNs and LDA were 96.6% and 94.6%, respectively, for predicting patients with ABG. In experiment 2, ANNs and LDA reached an overall accuracy of 98.8% and 96.8%,respectively. In experiment 3, overall accuracy of ANNs was 98.4%. In experiment 4, overall accuracies of ANNs and LDA were, respectively, 91.3% and 88.6%. In experiment 5, overall accuracies of ANNs and LDA were,respectively, 97.7% and 94.5%.CONCLUSION: This preliminary study suggests that advanced statistical methods, not only ANNs, but also LDA,may contribute to better address bioptic sampling during gastroscopy in a subset of patients in whom ABG may be suspected on the basis of aspecific gastrointestinal symptoms or non-digestive disorders.
基金funds from MIUR 2005 (Italian Ministry for University and Research) and University Sapienza Roma
文摘AIM: To investigate the role of artifi cial neural networks in predicting the presence of thyroid disease in atrophic body gastritis patients. METHODS: A dataset of 29 input variables of 253 atrophic body gastritis patients was applied to artifi cial neural networks (ANNs) using a data optimisation procedure (standard ANNs,T&T-IS protocol,TWIST protocol). The target variable was the presence of thyroid disease. RESULTS: Standard ANNs obtained a mean accuracy of 64.4% with a sensitivity of 69% and a specifi city of 59.8% in recognizing atrophic body gastritis patients with thyroid disease. The optimization procedures (T&T-IS and TWIST protocol) improved the performance of the recognition task yielding a mean accuracy,sensitivity and specifi city of 74.7% and 75.8%,78.8% and 81.8%,and 70.5% and 69.9%,respectively. The increase of sensitivity of the TWIST protocol was statistically signifi cant compared to T&T-IS. CONCLUSION: This study suggests that artificial neural networks may be taken into consideration as a potential clinical decision-support tool for identifying ABG patients at risk for harbouring an unknown thyroid disease and thus requiring diagnostic work-up of their thyroid status.
文摘Atrophic gastritis and intestinal metaplasia(IM) of the stomach are common and are associated with an increased risk for gastric cancer.In the absence of guidelines,a pragmatic management has been performed in Western countries in patients with these premalignant conditions.Recently,formal European guidelines have been delivered on this topic.Basically,it has been recommended that patients with extensive atrophic gastritis(AG) and/or extensive IM should be offered endoscopic surveillance every 3 years.On the contrary,no scheduled endoscopic/histological control has been advised for those patients with precancerous conditions confined to the antrum.In this commentary,we highlighted some potential weaknesses in the management formally recommended by the new guidelines.In detail,we discussed that AG and IM patients do not share the same gastric cancer risk,at least in Western countries,deserving a different approach.Some factors significantly associated with gastric cancer risk,such as IM type,first-degree family history of gastric cancer,and smoking habit have not been considered in tailoring the endoscopic follow-up.Finally,some data would suggest that a 3-year follow-up in patients with extensive gastric precancerous conditions could result in an inadequate secondary prevention.
基金Supported by (in part) Grants from the Italian Ministry for University and Research, MIUR, COFIN 2005 No. 0011222 and University Sapienza Roma and in part by a grant from Centro Diagnostico Italiano Milano, Italy
文摘AIM： To evaluate the usefulness of pre-endoscopic serological screening for He//cobacter py/or/ （H py/or/} infection and celiac disease in women aged 〈 50 years affected by iron-deficiency anemia （IDA）. METHODS： One hundred and fifteen women aged 〈 50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies （tTG） and anti-H pylori IgG antibodies, tTG and H pylori IgG antibody were assessed using an enzyme-linked immunosorbent assay （ELISA）. All women were invited to undergo upper GI endoscopy. During gastroscopy, biopsies were collected from antrum （n = 3）, gastric body （n = 3） and duodenum （n = 4） in all patients, irrespective of test results. The assessment of gastritis was performed according to the Sydney system and celiac disease was classified by Marsh＇s System. RESULTS： 45.2% women were test-positive： 41 patients positive for H pylori antibodies, 9 patients for tTG and 2 patients for both. The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test- negative （65.4% vs 42.8%; Fisher test P = 0.0239）. The serological results were confirmed by gastroscopy in 100% of those with positive H pylori antibodies, in 50% of those with positive tTG and in 81.5% of test- negative patient. Sensitivity and specificity were 84.8% and 100%, respectively for Hpylori infection and, 80% and 92.8% for tTG. Twenty-eight patients had positive H pylori antibodies and in all the patients, an active Hpylori infection was found. In particular, in 23 out of 28 （82%） patients with positive H pylori antibodies, a likely cause of IDA was found because of the active inflammation involving the gastric body. CONCLUSION： Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease, likely causes of IDA.
基金Supported by The study was in part supported by Bracco Spa(Milan,Italy)
文摘AIM： To investigate in symptomatic uncomplicated di- verticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms. METHODS： This study was a multicentre, 6-too ran- domized, controlled, parallel-group intervention with a preceding 4-wk washout period. Consecutive out- patients with symptomatic uncomplicated diverticular disease, aged 40-80 years, evaluated in 4 Gastroenterology Units, were enrolled. Symptomatic uncomplicated diverticular disease patients were randomized to two treatment arms A or B. Treatment A （n = 24 patients） received 1 symbiotic sachet Flortec~ （Lactobacillus paracasei B21060） once daily plus high-fibre diet for 6 mo. Treatment B （n = 21 patients） received high-fibre diet alone for 6 rno. The primary endpoint was regres- sion of abdominal symptoms and change of symptom severity after 3 and 6 mo of treatment. RESULTS： In group A, the proportion of patients with abdominal pain 〈 24 h decreased from 100% at base- line to 35% and 25% after 3 and 6 mo, respectively （P 〈 0.001）. In group B the proportion of patients with this symptom decreased from 90.5% at baseline to 61.9% and 38.1% after 3 and 6 mo, respectively （P = 0.001）. Symptom improvement became statistically sig- nificant at 3 and 6 mo in group A and B, respectively. The proportion of patients with abdominal pain 〉24 h decreased from 60% to 20% then 5% after 3 and 6 too, respectively in group A （P 〈 0.001） and from 33.3% to 9.5% at both 3 and 6 mo in group B （P = 0.03）. In group A the proportion of patients with ab- dominal bloating significantly decreased from 95% to 60% after 3 mo, and remained stable （65%） at 6-mo follow-up （P = 0.005） while in group B, no significant changes in abdominal bloating was observed （P = 0.11）. After 6 mo of treatment, the mean visual analogic scale （VAS） values of both short-lasting abdominal pain （VAS, mean ± SD, group A： 4.6 ± 2.1 vs 2.2 ± 0.8, P = 0.02; group B： 4.6 ± 2.9 vs 2.0 ± 1.9, P = 0.03） and abdom- inal bloating （VAS, mean ± SD, group A： 5.3 ± 2.2 vs 3.0 ± 1.7, P = 0.005; group B： 5.3 ±3.2 vs 2.3 ± 1.9, P = 0.006） decreased in both groups, whilst the VAS values of prolonged abdominal pain decreased in the Flortec group, but remained unchanged in the high-fibre diet group （VAS, mean ± SD, group A： 6.5 ± 1.5 vs 4.5 ± 2.1, P = 0.052; group B： 4.5 ± 3.8 vs 5.5 ± 3.5）. CONCLUSION： A high-fibre diet is effective in relievingabdominal symptoms in symptomatic uncomplicated di- verticular disease. This treatment may be implemented by combining the high-fibre diet with Flortec~.
基金Supported by Grants from "Ateneo Federato" University "La Sapienza" Rome,Italy,Year 2009-Protocol C26F098MZM
文摘AIM:To compare the site,age and gender of cases of colorectal cancer(CRC) and polyps in a single referral center in Rome,Italy,during two periods.METHODS:CRC data were collected from surgery/pathology registers,and polyp data from colonoscopy reports.Patients who met the criteria for familial adenomatous polyposis,hereditary non-polyposis colorectal cancer syndrome or inflammatory bowel disease were excluded from the study.Overlap of patients between the two groups(cancers and polyps) was carefully avoided.Theχ 2 statistical test and a regression analysis were performed.RESULTS:Data from a total of 768 patients(352 and 416 patients,respectively,in periods A and B) who underwent surgery for cancer were collected.During the same time periods,a total of 1693 polyps were analyzed from 978 patients with complete colonoscopies(428 polyps from 273 patients during period A and 1265 polyps from 705 patients during period B).A proximal shift in cancer occurred during the latter years for both sexes,but particularly in males.Proximal cancer increased > 3-fold in period B compared to period A in males [odds ratio(OR) 3.31,95%CI:2.00-5.47;P < 0.0001).A similar proximal shift was observed for polyps,particularly in males(OR 1.87,95%CI:1.23-2.87;P < 0.0038),but also in females(OR 1.62,95%CI:0.96-2.73;P < 0.07).CONCLUSION:The prevalence of proximal proliferative colonic lesions seems to have increased over the last decade,particularly in males.
