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Furazolidone therapy for Helicobacter pylori:Is it effective and safe?

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World Journal of Gastroenterology 2009年第15期15卷 1914-1915页

作者： Vincenzo De Francesco Enzo Ierardi Cesare Hassan Angelo Zullo Gastroenterology Unit "Riuniti"Hospital Gastroenterology and Digestive Endoscopy Nuovo Regina Margherita Hospital

Some aspects related with the use of furazolidone as a rescue therapy for Helicobacter pylori(H pylori) infection should be remarked,especially regarding its potential oncologic risk.The inclusion of furazolidone in a... 详细信息

关键词：幽门螺杆菌呋喃唑酮治疗方案安全幽门螺旋杆菌感染

Is concomitant quadruple therapy for Helicobacter pylori eradication really needed for Japanese patients?

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2012年第6期3卷 103-104页

作者： Vincenzo De Francesco Angelo Zullo Cesare Hassan Gastroenterology Unit Department of Medical Sciences University of Foggia Ospedali Riuniti 71100Foggia Italy Gastroenterology and Digestive Endoscopy "Nuovo Regina Margherita" Hospital 00183 RomeItaly

The study found that the 7 d of concomitant therapy (lansoprazole, amoxicillin, clarithromycin and metronidazole) achieved significantly higher eradication rates compared to 7 d of triple therapy (lansoprazole, amoxicillin, clarithromycin), the intention to treat (ITT) cure rates being 94.9% and 68.3%, respectively. According to our opinion, this study is clinically relevant for Japanese physicians for at least 2 reasons: (1) the standard triple therapy (clarithromycin plus amoxicillin) achieved disappointing cure rates in Japan-in agreement with what was observed in several countries; and (2) the concomitant quadruple therapy is an effective therapeutic alternative.

关键词： Helicobacter pylori Triple therapy Japanese patients

Helicobacter pylori eradication and reflux disease onset:Did gastric acid get "crazy"?

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World Journal of Gastroenterology 2013年第6期19卷 786-789页

作者： Angelo Zullo Cesare Hassan Alessandro Repici Vincenzo Bruzzese Gastroenterology and Digestive Endoscopy Unit Nuovo Regina Margherita Hospital Digestive Endoscopy Unit IRCCS Istituto Clinico Humanitas

Gastroesophageal reflux disease (GORD) is highly prevalent in the general population.In the last decade,a potential relationship between Helicobacter pylori (H.pylori) eradication and GORD onset has been claimed.The main putative mechanism is the gastric acid hypersecretion that develops after bacterial cure in those patients with corpus-predominant gastritis.We performed a critical reappraisal of the intricate pathogenesis and clinical data available in this field.Oesophagitis onset after H.pylori eradication in duodenal ulcer patients has been ascribed to a gastric acid hypersecretion,which could develop following body gastritis healing.However,the absence of an acid hypersecretive status in these patients is documented by both pathophysiology and clinical studies.Indeed,duodenal ulcer recurrence is virtually abolished followingH.pylori eradication.In addition,intra-oesophageal pH recording studies failed to demonstrated increased acid reflux following bacterial eradication.Moreover,oesophageal manometric studies suggest that H.pylori eradication would reduce-rather than favor-acid reflux into the oesophagus.Finally,data of clinical studies would suggest that H.pylori eradication is not significantly associated with eitherreflux symptoms or erosive oesophagitis onset,some data suggesting also an advantage in curing the infection when oesophagitis is already present.Therefore,the legend of "crazy acid" remains-as all the others a fascinating,but imaginary tale.

关键词： Helicobacter pylori Oesophageal reflux Oesophagitis Eradication Pathophysiology Clinical studies

Helicobacter pylori therapy:Present and future

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2012年第4期3卷 68-73页

作者： Vincenzo De Francesco Enzo Ierardi Cesare Hassan Angelo Zullo Gastroenterology Unit Department of Medical SciencesUniversity of FoggiaOspedali Riuniti71100 FoggiaItaly Gastroenterology and Digestive Endoscopy "Nuovo Regina Margherita" Hospital00153 RomeItaly

Helicobacter pylori(H.pylori) plays a crucial role in the pathogenesis of chronic active gastritis,peptic ulcer and gastric mucosa-associated lymphoid tissue-lymphoma,and is also involved in carcinogenesis of the stomach.H.pylori treatment still remains a challenge for physicians,since no current first-line therapy is able to cure the infection in all treated patients.Several factors may help in the eradication of therapy failure.We reviewed both bacterial and host factors involved in therapeutic management of the H.pylori infection.In addition,we evaluated data on the most successful therapy regimens-sequential and concomitant therapies-currently available for H.pylori eradication.

关键词： Helicobacter pylori Antibiotic resistance Virulence factors Therapy Eradication

Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy

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World Journal of Gastroenterology 2008年第32期14卷 5046-5050页

作者： Leonardo Tammaro Maria Carla Di Paolo Angelo Zullo Cesare Hassan Sergio Morini SebastianoCaliendo Lorella Pallotta Gastroenterology and DigestiveEndoscopy Ⅱ "San Giovanni Addolorata" Hospital Gastroentero-logy and Digestive Endoscopy "Nuovo Regina Margherita"Hospital

AIM: To investigate in a prospective study whether a simplifi ed clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy. METHODS: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were strati- fied according to a simple clinical score (T-score), including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis. RESULTS: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2, and 175 (40%) T3. Overall, stigmata of recent haem-orrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in T1 patients than in T2/T3 cases (85% vs 3.2%; χ2 = 304.5309, P < 0.001). Older age (t=3.311; P < 0.01) and presence of comor-bidities (χ2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients. CONCLUSION: Our simplifi ed clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further,randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients.

关键词：内窥镜检查胃肠出血食管血管曲张胃溃疡

High-fibre diet and Lactobacillus paracasei B21060 in symptomatic uncomplicated diverticular disease

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World Journal of Gastroenterology 2012年第41期18卷 5918-5924页

作者： Edith Lahner Gianluca Esposito Angelo Zullo Cesare Hassan Claudio Cannaviello Maria Carla Di Paolo Lorella Pallotta Nicoletta Garbagna Enzo Grossi Bruno Annibale Department of Digestive and Liver Disease University SapienzaRome 2nd Medical SchoolSant'Andrea Hospital00189 RomeItaly Ospedale Nuovo Regina Margherita 00189 RomeItaly Gastroenterology Unit Ospedale Israelitico00148 RomeItaly Gastroenterology Unit Ospedale San Giovanni00184 RomeItaly Medical Department Bracco Spa 20134 MilanItaly

AIM:To investigate in symptomatic uncomplicated diverticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms.METHODS:This study was a multicentre,6-mo randomized,controlled,parallel-group intervention with a preceding 4-wk washout period.Consecutive outpatients with symptomatic uncomplicated diverticular disease,aged 40-80 years,evaluated in 4 Gastroenter-ology 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 mo.The primary endpoint was regression 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 60% to 20% then 5% after 3 and 6 mo,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 abdominal 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 abdominal 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 b

关键词：饮食治疗疾病症状干酪乳杆菌高纤维并发症 VAS 胃肠病学随机分配

Rifaximin therapy and hepatic encephalopathy:Pros and cons

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2012年第4期3卷 62-67页

作者： Angelo Zullo Cesare Hassan Lorenzo Ridola Roberto Lorenzetti Salvatore MA Campo Oliviero Riggio Gastroenterology and Digestive Endoscopy Nuovo Regina Margherita Hospital00153 RomeItaly Department of Clinical Medicine Centre for the Diagnosis and Treatment of Portal Hypertension"Sapienza" University of Rome00185 RomeItaly

Hepatic encephalopathy(HE) is the second most common major complication in cirrhotics and it significantly impacts quality of life.Therapeutic approaches for HE treatment and prevention mainly continue to rely on ammonia-lowering strategies and non-absorbable disaccharides are currently considered the cornerstone therapy.Non-absorbable antibiotics,such as neomycin and paramomycin,are effective in treatment of acute HE episodes but their prolonged use for recurrence prevention is hampered by possible side-effects.To overcome these limitations,rifaximin use has been proposed.Rifaximin has been shown to be not superior to non-absorbable disaccharides for either HE treatment or prevention,with a similar incidence of side-effects.Cirrhosis significantly increases rifaximin absorption and this could be a cause for concern.Following long-term rifaximin therapy,Clostridium difficile colitis has been observed and Candida albicans has been isolated from 20% of patients.In addition,selection of resistant mutants of both Gram-negative and-positive bacteria in the gastrointestinal tract cannot be definitely ruled out.Electrolyte alterations(sodium and potassium) have been reported during rifaximin therapy,a warning for its long-term use in cirrhotics.Moreover,a potential interference with vitamin K production should be considered which could further impair the already altered clotting status of these patients.The therapeutic cost of rifaximin is markedly higher than non-absorbable disaccharides.While waiting for further safety data,caution should be used to limit the use of rifaximin therapy for a very short-term period in selected HE cirrhotics not responding to nonabsorbable disaccharides.

关键词： Hepatic encephalopathy Rifaximin Therapy Side-effects Cirrhosis

Gastric low-grade mucosal-associated lymphoid tissue-lymphoma: Helicobacter pylori and beyond

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World Journal of Gastrointestinal Oncology 2010年第4期2卷 181-186页

作者： Angelo Zullo Cesare Hassan Francesca Cristofari Francesco Perri Sergio Morini Gastroenterology and Digestive Endoscopy "Nuovo Regina Margherita"Hospital00153 RomaItaly Francesco PerriGastroenterology and Digestive Endoscopy"Casa Sollievo della Sofferenza"HospitalIRCCS71013 San Giovanni Rotondo(FG)Italy

The stomach is the most frequently involved site for extranodal lymphomas,accounting for nearly two-thirds of all gastrointestinal cases.It is widely accepted that gastric B-cell,low-grade mucosal-associated lymphoid tissue(MALT)-lymphoma is caused by Helicobacter pylori(H.pylori)infection.MALT-lymphomas may engender different clinical and endoscopic patterns.Often,diagnosis is confirmed in patients with only vague dyspeptic symptoms and without macroscopic lesions on gastric mucosa.H.pylori eradication leads to lymphoma remission in a large number of patients when treatment occurs at an early stage(Ⅰ-Ⅱ1).Neoplasia confined to the submucosa,localized in the antral region of the stomach,and without API2-MALT1 translocation,shows a high probability of remission following H.pylori eradication.When both bacterial infection and lymphoma recur,further eradication therapy is generally effective.Radiotherapy,chemotherapy and,in selected cases,surgery are the available therapeutic options with a high success rate for those patients who fail to achieve remission,while data on immunotherapy with monoclonal antibodies (rituximab)are still scarce.The 5-year survival rate is higher than 90%,but careful,long-term follow-up is required in these patients since lymphoma recurrence has been reported in some cases.

关键词： Mucosal-associated lymphoid tissue Therapy Helicobacter pylori Gastric lymphoma Predictive factors Endoscopy Clinical presentation

Mechanisms of Helicobacter pylori antibiotic resistance:An updated appraisal

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World Journal of Gastrointestinal Pathophysiology 2011年第3期2卷 35-41页

作者： Vincenzo De Francesco Angelo Zullo Cesare Hassan Floriana Giorgio Rosa Rosania Enzo Ierardi Section of Gastroenterology Department of Medical SciencesUniversity of Foggia Gastroenterology and Digestive Endoscopy 'Nuovo Regina Margherita' Hospital

Helicobacter pylori(H. pylori) antibiotic resistance is the main factor affecting the efficacy of the current eradicating therapies. The aim of this editorial is to report on the recent information about the mechanisms accounting for the resistance to the different antibiotics currently utilized in H. pylori eradicating treatments. Different mechanisms of resistance to clarithromycin,metronidazole,quinolones,amoxicillin and tetracycline are accurately detailed(point mutations,redox intracellular potential,pump efflux systems,membrane permeability) on the basis of the most recent data available from the literature. The next hope for the future is that by improving the knowledge of resistance mechanisms,the elaboration of rational and efficacious associations for the treatment of the infection will be possible. Another auspicious progress might be the possibility of a cheap,feasible and reliable laboratory test to predict the outcome of a therapeutic scheme.

关键词： Helicobacter pylori Clarithromycin Metronidazole Levofloxacin Amoxicillin Tetracycline Resistance Antibiotic Point mutation