The Italian journal of gastroenterology最新文献

The study aimed to differentiate the factors triggering porphyria cutanea tarda, paying special attention to the presumed role of hepatitis C virus infection. In a representative Bulgarian contingent, HCV-antibodies were identified using ELISA II and immunoblot. Seropositivity was significantly higher (p < 0.01) in the sporadic form (36 out of 57 patients; 63.2%) compared with the familiar form (4 out of 20 subjects; 20%). Alcohol abuse was the most common factor preceding the expression of open porphyria both in the sporadic and the familiar forms. In 10 sporadic cases, no precipitating factors were observed, except for the fact that they were anti-HCV positive. In another 2 anti-HCV positive patients, porphyria cutanea tarda was preceded by blood transfusions. Renewed consumption of alcohol after successful treatment was a common reason for relapse, but relapses were most frequent in anti-HCV positive patients (35 relapses in 12 patients), in whom other promoting factors were absent. Analysis of triggering factors shows that most probably hepatitis C virus infection could contribute to the expression of porphyria cutanea tarda and the association of both diseases is not coincidental.

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.

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 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 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.

Improved knowledge of pathophysiology of portal hypertension and technological progress have contributed to development of new endoscopic techniques and pharmacological approaches to treatment of this condition. To put the role of endoscopy in the right perspective, it is important to consider that liver transplantation has greatly modified prognosis of cirrhosis. Because of the increase of indications for transplantation, these complications are no longer regarded as the last, but rather as an intermediate stage before a possible transplantation. We have reviewed some pathophysiologic, diagnostic and therapeutic aspects on portal hypertension, especially the role of endoscopy in diagnosis, natural history and therapeutic options for complications of cirrhosis. In addition to sclerotherapy, new endoscopic methods have been developed, with a low complication rate and possibility of being applied for treatment of gastric varices, i.e. injection of tissue adhesives and rubber band ligation. Besides oesophageal varices, gastric varices and portal hypertensive gastropathy (and portal colopathy) are important findings in cirrhosis. Further information is needed on natural history and treatment of these conditions. Digestive haemorrhage is the most important consequence of portal hypertension, so treatment should be aimed at controlling acute bleeding, rebleeding and, more important, at preventing first haemorrhagic episode. Good results will probably be obtained using a combination of drugs, a combination of endoscopic methods or a combination of both. All will need evaluation in randomised, controlled trials. These considerations renew interest in strategies for diagnosis and treatment of portal hypertension and a multidisciplinary approach may be necessary, involving gastroenterologists, endoscopists, interventionist radiologists and surgeons, ideally in a departmental environment.

Duodenal tumours is an extremely fragmentary topic since the experience of various specialists: gastroenterologists, pathologists, radiologists and surgeons is involved. At present, correct epidemiologic data is lacking whereas much progress has been made in the diagnostic field, thanks to the endoscopic, histologic and radiologic techniques. Thus a different classification scheme has been suggested in the attempt to codify the fundamental aspects of this lesion. An interdisciplinary data base has been proposed in order to provide useful data for an epidemiological evaluation.

The interdisciplinary approach to medical practice is a cultural and operational prerequisite for proper diagnostic and therapeutic activity. Its constant application contributes to the improvement of medical performances with beneficial effects on their costs. Anatomic pathology interacts with clinical and instrumental diagnostics and makes a fundamental contribution to the conclusive diagnosis of disease. Furthermore, morphological data are often crucial in the monitoring of therapeutic effects and a mandatory prerequisite for evaluating the efficacy of treatment in clinical trials both on neoplastic and non-neoplastic diseases. Such deep involvement in clinical practice and the need to keep diagnostic practice up to date with the explosive advances in scientific knowledge justify the demand for pathologists specializing in sub-specialties of their discipline. However, there is an inevitable need for these dedicated pathologists to remain within the cultural and physical environment of the Pathology Department where they have been introduced to and trained in the discipline. The present paper highlights the scientific and practical motives leading to the creation in Italy, and other European countries of a working group open to pathologists particularly dedicated to gastrointestinal disease. The group is called the Gruppo Italiano di Patologi dell'Apparato Digerente (GIPAD).--Italian Group of Digestive Tract Pathologists.

Cases of two adolescents with recurrent abdominal pain, localized in the periumbilical area, due to primary oesophageal disorders are reported. Food allergy or intolerance, as well as other paediatric causes, were not involved in the pathogenesis of recurrent abdominal pain in these two patients. Case 1 was affected by primary gastro-oesophageal reflux disease: upper endoscopy with biopsies and oesophageal 24-hour pH-monitoring showed mild oesophagitis and pathological reflux index, respectively. Case 2 was affected by "irritable oesophagus syndrome": upper endoscopy with biopsies was normal and oesophageal 24-hour pH-monitoring showed a close correlation between gastro-oesophageal reflux and recurrent abdominal pain episodes. Both patients were successfully treated with cisapride (0.2 mg/kg t.i.d.) and ranitidine (2.5 mg/KG b.i.d.). These reports suggest that primary gastro-oesophageal reflux disease and irritable oesophagus syndrome may cause recurrent abdominal pain in children.

Efficacy of one-week triple antimicrobial therapy (bismuth, tinidazole, amoxicillin) as compared to the same drug combination given for 4 weeks was assessed in children with Helicobacter pylori (H. pylori) gastritis and non-ulcer dyspepsia. Twenty-six patients (group A) and 30 (group B) had one-week and four-week schedule, respectively. Eradication (absence of organism at endoscopy at least 1 month after ending treatment) was achieved in 84.6% of group A (22) and 83.3% of group B (25), with marked reduction of histological gastritis score in both groups. Among patients with eradicated H. pylori, symptoms improved significantly in 14 and 16 patients of group A and B, respectively, but were still present in 17 (8 group A, 9 group B). The latter showed gastroparesis and abnormal gastro-oesophageal reflux at a subsequent diagnostic work-up and improved with prokinetic therapy. In 3 patients of group A and 3 of group B, symptoms improved despite persistence of bacterium into the stomach. Finally, in 3 cases (1 group A, 2 group B) both symptoms and H. pylori infection were unchanged. At 6 month follow-up, symptoms were present in 7 patients (3 group A, 4 group B): 6 of them (3 group A, 3 group B) showed H. pylori gastritis at endoscopy. We conclude that in children with dyspepsia and H. pylori gastritis one-week triple antimicrobial schedule is effective in eradicating bacterium; however, detection of H. pylori gastritis in dyspeptic children does not invariably indicate a pathogenic role of the organism in these patients.