Minerva dietologica e gastroenterologica最新文献

Hundred-nine patients suffering from stomach cancer of 2398 oesophago-gastroduodenoscopies performed in the period 1977-1986 have been considered. The frequency of advanced stomach cancer and early stomach cancer with respect to total endoscopies was respectively 4.5% and 0.36%, which is in agreement with the literature. The results of the study show that Siena and its province present a downward trend in this condition and current rates are two cases out of 100,000 inhabitants. Meantime, careful clinical observation of patients with stomach Ca. shows the absolute lack of predictive symptoms in the early stages and the considerable importance of endoscopy in diagnosis.

In the last few years, several drugs have been proposed for the healing of peptic ulcers H2 receptor antagonists are probably the reference-drugs for their efficacy and safety. Acute treatment of peptic ulcer with cimetidine, ranitidine or famotidine gives a high healing rate: from 60% to 90%, depending on the location of the ulcer and the drug used. However, relapse after short-term treatment still remains frequent, and prophylaxis of recurrence must be decided. Long-term treatment with antisecretory drugs could be dangerous for changes of the gastric system, with nitrites and nitro-compounds occurrence, and for the risk of frequent relapses. Therefore, the role of mucus-barrier drugs and surgery must be reconsidered.

Most endoscopically treated colorectal adenomas are found in the sigmoid colon and the incidence gradually diminishes in the proximal districts until we reach a figure of 10% or so in the right colon. The present series of 356 adenomas endoscopically removed in 1980-85 differs from other reports in that 24.4% of the adenomas were located in the right colon. These 87 adenomas were mostly (79%) under 5 mm in diameter, sessile (89%) and histologically tubular with slight dysplasia (95%). Only 3 adenomas over 10 mm in diameter and tubulovillous presented severe dysplasia. This high incidence of right colonic adenomas differs significantly from findings in other endoscopic series but is in line with the findings of an autoptic study of colorectal polyps (21% of the adenomas were found in the right colon). In addition both in the autoptic study and the present endoscopic series the adenomas of the right colon were small, only slightly dysplastic, unlikely to evolve into malignancy and could have been created by the E1 factor hypothesised by Hill et al. These data confirm the low incidence of right colonic cancer and suggest that patients subjected to the removal of small adenomas of the right colon do not require close surveillance.

A case of intestinal haemorrhage due to ectopic ulcerated gastric mucosa in Meckel's diverticulum in a young male is reported. The haemorrhage was stopped 5 days after continuous infusion with ranitidine (6 fials in 500 cc of physiological solution X 2). The therapy also proved effective in cases of bleeding ectopic gastric mucosa.

Two cases of protracted hepatitis A with normalisation of the transaminases and disappearance of the anti-HAV IgM over a year after onset are described.

Non-steroidal anti-inflammatory drugs, essential for the treatment of rheumatic diseases, are frequently associated with significant adverse effects on the integrity of the gastrointestinal mucosa. Sulglicotide (S), a natural product, has been found to possess gastromucosal protective properties. Aim of the present study was to evaluate whether (S) 200 mg t.i.d prevented or reduced the severity of gastric and/or duodenal mucosal injury induced by Diclofenac. A total of 30 patients with either rheumatoid arthritis (RA) or osteoarthritis (OA) who required NSAID therapy for at least 8 weeks were enrolled into a double-blind randomized placebo-controlled study. The main criteria for entry into the trial was the absence of gastrointestinal symptoms, and gastric/duodenal lesions assessed by endoscopy. At the end of the treatment endoscopy and relative symptoms were assessed. Six out of 15 patients, in both groups of treatment developed mucosal injury, but only in the placebo group the gastric damage was important (ulcer and petechiae) while in the group (S) we observed only hyperemia of the gastric mucosa. These preliminary data indicate the usefulness of Sulglicotide in preventing or reducing mucosal injury from NSAID treatment.

The Mallory-Weiss syndrome is a more common cause of upper gastrointestinal bleeding than that previously recognised. Personal experience is reported of twelve cases of Mallory-Weiss tear, constituting 6.4% of all cases of upper gastrointestinal tract hemorrhage observed in the three year period from 1984 to 1986. History of alcoholism was present in 50% and hiatus hernia was associated in 41% of all the cases. Ten patients (84%) were managed nonoperatively, two patients underwent operation. None of the twelve patients in this series died. The literature of the last few years, is reviewed with particular reference to progress in the treatment of the syndrome.

Extraintestinal manifestations and perianal complications were examined in 69 patients with ulcerative colitis (UC) and in 29 patients with Crohn's disease (CD). 17.5% of patients with UC presented an extraintestinal manifestation or a perianal disease against 48% of patients with CD. Over all, joint disease turned out to be the most frequent manifestation, but its frequency is significantly higher in patients with CD (27%) than in those with UC (3%). In the latter the most frequent disease is cholelithiasis (7%). This percentage is the same in both groups of patients. In 1.5% of patients with UC and in 14% of patients with CD perianal complications appeared; all patients with CD showed a colonic involvement.

The pronounced antiemetic properties of Alizapride, one of the new azimidobenzamides suggested the assessment of its efficacy on 40 patients due for oesophagogastroduodenoscopy. The drug proved highly satisfactory as premedication for the examination, significantly inhibiting vomiting and stomach wall tone during the examination as was indicated by in vitro studies.

Ileal carcinoid is an infrequent pathology that may present clinically in a highly varied way. It may be completely asymptomatic and present acutely with occlusion or haemorrhage, or it may present with an unmistakable symptomatology of carcinoid syndrome. Clinical aspects are discussed together with possibilities of treating the primary lesions and metastases. Five cases observed in the past 7 years are reported.