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Esophagitis and its causes:Who is “guilty” when acid is found “not guilty”?

World Journal of Gastroenterology 2017年第17期23卷 3011-3016页

作者： laurino grossi antonio francesco ciccaglione leonardo marzio g.d’annunzio university of chieti-pescara school of gastroenterology digestive sciences c/o ospedale spirito santo

Esophagitis is mainly a consequence of gastroesophageal reflux disease, one of the most common diseases affecting the upper digestive tract. However the esophageal mucosa can also be targeted by some infectious, systemic or chemical conditions. Eosinophilic esophagitis(Eo E) is an immune-mediated inflammatory disease, characterized by eosinophilic infiltration in the mucosa. Esophageal localization of Crohn's disease is not very common, but it should always be considered in patients with inflammatory bowel disease complaining of upper digestive tract symptoms. There are also forms of infectious esophagitis(e.g., Herpes simplex virus or Candida albicans) occurring in patients with a compromised immune system, either because of specific diseases or immunosuppressive therapies. Another kind of damage to esophageal mucosa is due to drug use(including oncologic chemotherapeutic regimens and radiotherapy) or caustic ingestion, usually of alkaline liquids, with colliquative necrosis and destruction of mucosa within a few seconds. Dysphagia is a predominant symptom in Eo E, while infectious, drug-induced and caustic damages usually cause chest pain and odynophagia. Endoscopy can be useful for diagnosing esophagitis, although no specific pattern can be identified. In conclusion when a patient refers upper gastrointestinal tract symptoms and the diagnosis of gastro-esophageal reflux disease is not convincing we should always carefully investigate the patient's clinical history to consider possibilities other than the gastric refluxate.

关键词： Esophagitis Gastroesophageal reflux disease Eosinophilic esophagitis Crohn’s disease Herpes simplex virus Manometry Candida Caustic Dysphagia Chest pain

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Quadruple therapy with moxifloxacin and bismuth for first-line treatment ofHelicobacter pylori

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World Journal of Gastroenterology 2012年第32期18卷 4386-4390页

作者： Antonio Francesco Ciccaglione Luigina Cellini laurino grossi Leonardo Marzio Digestive Physiopathology Unit Gabriele d'Annunzio UniversityPescara Civic Hospital65124 PescaraItaly Department of Drug Sciences Gabriele d'Annunzio University66013 ChietiItaly

AIM:To compare triple therapy vs quadruple therapy for 10 d as first-line treatment ofHelicobacter pylori(***) ***:Consecutive *** positive patients never treated in the past for this infection were randomly treated with triple therapy of pantoprazole(PAN) 20 mg bid,amoxicillin(AMO) 1 g bid and moxifloxacin(MOX) 400 mg bid for 10 d(PAM) or with quadruple therapy of PAN 20 mg bid,AMO 1 g bid,MOX 400 mg bid and bismuth subcitrate 240 mg bid for 10 d(PAMB).All patients were found positive at 13 C-Urea breath test(UBT) performed within ten days prior to the start of the study.A successful outcome was confirmed with an UBT performed 8 wk after the end of treatment.χ 2 analysis was used for statistical *** protocol(PP) and intention-to-treat(ITT) values were also ***:Fifty-seven patients were enrolled in the PAM group and 50 in the PAMB *** patient in each group did not return for further *** was higher in the PAMB group(negative:46 and positive:3) vs the PAM group(negative:44 and positive:12).The *** eradication rate was statistically significantly higher in the PAMB group vs the PAM group,both with the PP and ITT analyses(PP:PAMB 93.8%,PAM 78.5%,P < 0.02;ITT:PAMB 92%,PAM 77.1 %,P <0.03).CONCLUSION:The addition of bismuth subcitrate can be considered a valuable adjuvant to triple therapy in those areas where *** shows a high resistance to fluoroquinolones.

关键词： Helicobacter pylori infection First-line therapy Quadruple therapy Amoxicillin Moxifloxacin Bismuth subcitrate

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Typical and atypical symptoms of gastro esophageal reflux disease: Does Helicobacter pylori infection matter?

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2015年第4期6卷 238-243页

作者： laurino grossi Antonio Francesco Ciccaglione Leonardo Marzio c/o Digestive Sciences Unit School of Gastroenterology G. d’Annunzio University Chieti-Pescara

AIM: To analyze whether the presence of Helicobacter pylori(H. pylori) infection could affect the quality of symptoms in gastro-esophageal reflux disease(GERD) patients. METHODS: one hundred and forty-four consecutive patients referred to our Unit for suspected GERD were recruited for the study. All patients underwent esophageal p H-metric recording. For those with a positive test, C13 urea breath test was then performed to assess the H. pylori status. GERD patients were stratified according to the quality of their symptoms and classified as typical, if affected by heartburn and regurgitation, and atypical if complaining of chest pain, respiratory and ears, nose, and throat features. H. pylori-negative patients were also asked whether they had a previous diagnosis of H. pylori infection. If a positive response was given, on the basis of the time period after successful eradication, patients were considered as "eradicated"(E) if H. pylori eradication occurred more than six months earlier or "recently eradicated" if the therapy had been administered within the last six months. Patients without history of infection were identified as "negative"(N). χ2 test was performed by combining the clinical aspects with the H. pylori ***: one hundred and twenty-nine of the 144 patients, including 44 H. pylori-positive and 85 H. pylori-negative(41 negative, 21 recently eradicated, 23 eradicated more than 6 mo before), were eligible for the analysis. No difference has been found between H. pylori status and either the number of reflux episodes(138 ± 23 vs 146 ± 36, respectively, P = 0.2, not significant) or the percentage of time with pH values < 4(6.8 ± 1.2 vs 7.4 ± 2.1, respectively, P = 0.3, not significant). The distribution of symptoms was as follows: 13 typical(30%) and 31 atypical(70%) among the 44 H. pylori-positive cases; 44 typical(52%) and 41 atypical(48%) among the 85 H. pylori-negative cases,(P = 0.017 vs H. pylori +; OR = 2.55, 95%CI: 1.17-5.55). Furthermore

关键词： Eradication Helicobacter pylori C13 urea breath te

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Clinical and economic impact of infliximab one-hour infusion protocol in patients with inflammatory bowel diseases:A multicenter study

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第2期8卷 131-136页

作者： Anna Viola Giuseppe Costantino Antonino Carlo Privitera Fabrizio Bossa Angelo Lauria laurino grossi Maria Beatrice Principi Nicola Della Valle Maria Cappello Gastroenterology and Hepatology Section Dipartimento Biomedico di Medicina Interna e Specialistica University of Palermo IBD Unit Dipartimento di Medicina Interna e Terapia Medica University of Messina IBD and PelvicF loor Unit Azienda Ospedaliera per l’Emergenza Ospedale Cannizzaro Gastroenterology Section Casa Sollievo della Sofferenza S. Giovanni Rotondo Gastroenterology and Endoscopy Unit A.O.Bianchi-Melacrino-Morelli Fisiopatologia Digestiva Ospedale Spirito Santo Gastroenterology Section Gastroenterologia

AIM To assess the impact of short infliximab(IFX) infusion on hospital resource utilization and *** All inflammatory bowel diseases(IBD) patients who received IFX 1 h infusion from March 2007 to September 2014 in eight centers from Southern Italy were included in the analysis. Demographic, clinical and infusion related data were collected. The potential benefits related to the short infusion protocol were assessed both in terms of time saving and increased infusion unit capacity. In addition, indirect patient-related cost savings were *** One hundred and twenty-five patients were recruited(64 with ulcerative colitis and 61 with Crohn's disease). Median duration of disease was of 53 mo and mean age of pts at diagnosis was of 34 years(SD: ± 13). Adverse infusion reactions were reported in less than 4% both before and after short infusion. The total number of infusions across the selected centers was of 2501(30.5% short infusions). In the analyzed cohort, 1143 h were saved(762 in the infusion and 381 in observation phases) through the rapid IFX infusion protocol. This time saving(-15% compared to the standard protocol in infusion phase) represents, from the hospital perspective, an opportunity to optimize infusion unit capacity by allocating the saved time in alternative cost-effective treatments. This is the case of opportunity cost that represents the value of forgone benefit which could be obtained from a resource in its next-best alternative use. Hence, an extra hour of infusion in the case of standard 2-h IFX represents a loss in opportunity to provide other cost effective services. The analysis showed that the short infusion increased the infusion units capacity up to 50% on days when the IFX infusions were scheduled(infusion phase). Furthermore, the analysis showed that the short IFX infusion protocol leads to time savings also in the post-infusion phase(observation) leading to a time saving of 10% on average among the analyzed centers. F

关键词： Infliximab One-hour infusion Cost savings Economic impact Multicenter study

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