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Gastrointestinal manifestations in myotonic muscular dystrophy

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World Journal of Gastroenterology 2006年第12期12卷 1821-1828页

作者： Massimo Bellini Sonia Biagi Cristina Stasi Francesco Costa maria gloria mumolo Angelo Ricchiuti Santino Marchi Gastroenterology Unit Department of Internal MedicineUniversity of PisaItaly

Myotonic dystrophy （MD） is characterized by myotonic phenomena and progressive muscular weakness. Involvement of the gastrointestinal tract is frequent and may occur at any level. The clinical manifestations have previously been attributed to motility disorders caused by smooth muscle damage, but histologic evidence of alterations has been scarce and conflicting. A neural factor has also been hypothesized. In the upper digestive tract, dysphagia, heartburn, regurgitation and dyspepsia are the most common complaints, while in the lower tract, abdominal pain, bloating and changes in bowel habits are often reported. Digestive symptoms may be the first sign of dystrophic disease and may precede the rnusculo-skeletal features. The impairment of gastrointestinal function may be sometimes so gradual that the patients adapt to it with little awareness of symptoms. In such cases routine endoscopic and ultrasonographic evaluations are not sufficient and targeted techniques （electrogastrography, manornetry, electromyography, functional ultrasonography, scintigraphy, etc.） are needed. There is a low correlation between the degree of skeletal muscle involvement and the presence and severity of gastrointestinal disturbances whereas a positive correlation with the duration of the skeletal muscle disease has been reported. The drugs recommended for treating the gastrointestinal complaints such as prokinetic, antidyspeptic drugs and laxatives, are mainly aimed at correcting the motility disorders. Gastrointestinal involvement in MD remains a complex and intriguing condition since many important problems are still unsolved. Further studies concentrating on genetic aspects, early diagnostic techniques and the development of new therapeutic strategies are needed to improve our management of the gastrointestinal manifestations of MD.

关键词： Myotonic dystrophy Digestive disorders Gastrointestinal symptoms

From bench to bedside: Fecal calprotectin in inflammatory bowel diseases clinical setting

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World Journal of Gastroenterology 2018年第33期24卷 3681-3694页

作者： maria gloria mumolo Lorenzo Bertani Linda Ceccarelli Gabriella Laino Giorgia Di Fluri Eleonora Albano Gherardo Tapete Francesco Costa Department of General Surgery and Gastroenterology Gastroenterology Unit Azienda Ospedaliero Universitaria Pisana Department of New Technologies and Translational Research in Medicine and Surgery University of Pisa

Fecal calprotectin(FC) has emerged as one of the most useful tools for clinical management of inflammatory bowel diseases(IBD). Many different methods of assessment have been developed and different cutoffs have been suggested for different clinical settings. We carried out a comprehensive literature review of the most relevant FC-related topics: the role of FC in discriminating between IBD and irritable bowel syndrome(IBS) and its use in managing IBD patients In patients with intestinal symptoms, due to the high negative predictive value a normal FC level reliably rules out active IBD. In IBD patients a correlation with both mucosal healing and histology was found, and there is increasing evidence that FC assessment can be helpful in monitoring disease activity and response to therapy as well as in predicting relapse, post-operative recurrence or pouchitis. Recently, its use in the context of a treat-to-target approach led to a better outcome than clinically-based therapy adjustment in patients with early Crohn's disease. In conclusion, FC measurement represents a cheap, safe and reliable test, easy to perform and with a good reproducibility. The main concerns are still related to the choice of the optimal cut-off, both for differentiating IBD from IBS, and for the management of IBD patients.

关键词： Fecal calprotectin Inflammatory bowel diseases Crohn's disease Ulcerative colitis Irritable

Evaluation of latent links between irritable bowel syndrome and sleep quality

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World Journal of Gastroenterology 2011年第46期17卷 5089-5096页

作者： Massimo Bellini Angelo Gemignani Dario Gambaccini Simona Toti Danilo Menicucci Cristina Stasi Francesco Costa maria gloria mumolo Angelo Ricchiuti Remo Bedini Nicola de Bortoli Santino Marchi Gastrointestinal Unit Department of GastroenterologyUniversity of Pisa Institute of Clinical Physiology National Research Council Extreme Centre Scuola Superiore S Anna Department of Physiological Science University of Pisa Italian National Institute of Statistics

AIM:To examine the links between quality of sleep and the severity of intestinal symptoms in irritable bow-el syndrome(IBS).METHODS:One hundred and forty-two outpatients(110female,32 male)who met the Rome Ⅲ criteria for IBS with no psychiatric comorbidity were consecutively en-rolled in this *** on age,body mass index(BMI),and a set of life-habit variables were recorded,and IBS symptoms and sleep quality were evaluated using the questionnaires IBS Symptom Severity Score(IBS-SSS)and Pittsburgh Sleep Quality Index(PSQI).The associa-tion between severity of IBS and sleep disturbances was evaluated by comparing the global IBS-SSS and PSQI score(Pearson's correlation and Fisher's exact test)and then analyzing the individual items of the IBS-SSS and PSQI questionnaires by a unitary bowel-sleep model based on item response theory(IRT).RESULTS:IBS-SSS ranged from mild to severe(120-470).The global PSQI score ranged from 1 to 17(median 5),and 60 patients were found to be poor sleepers(PSQI>5).The correlation between the global IBS-SSS and PSQI score indicated a weak association(r=0.2 and 95% CI:-0.03 to 0.35,P<0.05),which becomes stronger using our unitary ***,the IBS and sleep disturbances severities,estimated as latent variables,resulted significantly high intra-subject cor-relation(posterior mean of r=0.45 and 95% CI:0.17 to 0.70,P<0.05).Moreover,the correlations between patient features(age,sex,BMI,daily coffee and alcohol intake)and IBS and sleep disturbances were also ana-lyzed through our unitary *** was a signif icant regressor,with patients≤50 years old showing more severe bowel disturbances(posterior mean=-0.38,P<0.05)and less severe sleep disturbances(posterior mean=0.49,P<0.05)than older *** daily coffee intake was correlated with a lower sever-ity of bowel disturbances(posterior mean=-0.31,P<0.05).Sex(female)and daily alcohol intake(modest)were correlated with less severe sleep ***:The unitary bowel-sleep mod

关键词： Irritable bowel syndrome Sleep disorders Item response theory model Bayesian model

How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

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World Journal of Gastroenterology 2012年第32期18卷 4363-4370页

作者： Nicola de Bortoli Andrea Nacci Edoardo Savarino Irene Martinucci Massimo Bellini Bruno Fattori Linda Ceccarelli Francesco Costa maria gloria mumolo Angelo Ricchiuti Vincenzo Savarino Stefano Berrettini Santino Marchi Division of Gastroenterology University of Pisa56124 PisaItaly Ear Nose and Throat Audiology Phoniatrics UnitUniversity of Pisa56124 PisaItaly Division of Gastroenterology University of Padua35100 PaduaItaly Division of Gastroenterology University of Genoa16100 GenoaItaly

AIM:To investigate the prevalence of gastroesophageal reflux disease(GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux(LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients with laryngopharyngeal symptoms(LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors(PPIs) for at least 8 wk,and the therapeutic outcome was assessed through validated questionnaires(GERD impact scale,GIS;visual analogue scale,VAS).LPR diagnosis was performed by ear,nose and throat specialists using the reflux finding score(RFS) and reflux symptom index(RSI).After a 16-d wash-out from PPIs,all patients underwent an upper endoscopy,stationary esophageal manometry,24-h multichannel intraluminal impedance and pH(MII-pH) esophageal monitoring.A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis(ERD),pathological acid exposure time(AET) in the absence of esophageal erosions(NERD),and a positive correlation between symptoms and refluxes(hypersensitive esophagus,HE).RESULTS:The male/female ratio was 0.52(14/27),the mean age ± SD was 51.5 ± 12.7 years,and the mean body mass index was 25.7 ± 3.4 kg/m *** subjects reported one or more ***-five out of 41 patients also had typical GERD symptoms(heartburn and/or regurgitation).The most frequent laryngoscopic findings were posterior laryngeal hyperemia(38/41),linear indentation in the medial edge of the vocal fold(31/41),vocal fold nodules(6/41) and diffuse infraglottic oedema(25/41).The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy(P < 0.05);conversely,23/41 did not report any clinical *** the same time,the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy(P < 0.001).A significant reduction in LPS *** the other hand,such result was not recorded for *** was detected in 2/41 patients,and ineffective esophageal motility

关键词： Laryngopharyngeal reflux Gastroesophageal reflux Multichannel impedance and pH monitoring Extra-esophageal reflux syndromes Chronic laryngitis

Intestinal pseudo-obstruction in inactive systemic lupus erythematosus: An unusual finding

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2010年第6期1卷 135-136页

作者： Giulia Leonardi Nicola de Bortoli Massimo Bellini maria gloria mumolo Francesco Costa Angelo Ricchiuti Stefano Bombardieri Santino Marchi Gastroenterology Unit Cisanello Hospital University of Pisa Reumatology Unit Hospital of Santa Chiara University of Pisa

Chronic intestinal pseudo-obstruction (CIP) is an infre-quent complication of an active systemic lupus erythema-tosus (SLE). We illustrate a case of SLE inactive-related CIP. A 51-year old female with inactive SLE (ECLAM score 2) was hospitalized with postprandial fullness, vomiting, abdominal bloating and abdominal pain. She had had no bowel movements for five days. Plain abdominal X-ray revealed multiple fluid levels and dilated small and large bowel loops with air-fluid levels. Intestinal contrast radiology detected dilated loops. CIP was diagnosed. The patient was treated with prokinetics, octreotide, claritromycin, rifaximin, azathioprine and tegaserod without any clinical improvement. Then methylprednisolone (500 mg iv daily) was started. After the first administration, the patient showed peristaltic movements. A bowel movement was reported after the second administration. A plain abdominal X-ray revealed no air-fluid levels. Steroid therapy was slowly reduced with complete resolution of the symptoms. The patient is still in a good clinical condition. SLE-related CIP is generally reported as a complication of an active disease. In our case, CIP was the only clinical demonstration of the SLE.

关键词： Chronic intestinal pseudo-obstruction Systemic lupus erythematosus

GIS-based soil maps as tools to evaluate land capability and suitability in a coastal reclaimed area(Ravenna,northern Italy)

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International Soil and Water Conservation Research 2021年第2期9卷 167-179页

作者： Mauro De Feudis gloria Falsone Massimo Gherardi maria Speranza Gilmo Vianello Livia Vittori Antisari Department of Agricultural and Food Sciences Alma Mater Studiorum-University of BolognaVia Fanin4040127BolognaItaly Boreal Mapping Via Casella23/a40030Grizzana MorandiItaly Centro Sperimentale per lo Studio e l’Analisi Del Suolo(CSSAS) Alma Mater Studiorum-University of BolognaBolognaItaly

Land capability and suitability maps are useful tools for soil resource *** study aimed to build land capability and suitability maps using a multi-thematic approach by GIS in a salt-affected coastal area of ***,morphological,geological,pedological delineations and land cover maps,remote sensing image and climate data were acquired and the main physical and chemical properties,including electrical conductivity(EC)and available water capacity,were analysed on the soil samples collected in the study *** acquired information were elaborated through QGIS software to obtain the land capability and suitability *** suitability map showed that most of the area(80%)is suitable for cultivation and,therefore,can be addressed for agricultural purposes without risk of *** fact,the land capability map showed that 42%of the investigated area belongs to class I and II indicating that they can be used for a wide range of *** 44%of the investigated area clustered in class III and *** these latter the cultivation should be allowed to a limited range of crops due to the high sand content,which does not allow a good water retention,and due to a strong intrusion of sea water with consequent increase of the soil *** our study area,where agricultural productivity and environmental impact are in conflict,to classify the lands on base the land capability and suitability could help to define the best agricultural practices to apply in order to preserve soil functions.

关键词： Agricultural lands Salt affected soils Geographic information system Land capability map Land suitability map

Pseudomelanosis duodeni associated with chronic renal failure

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World Journal of Gastroenterology 2012年第12期18卷 1414-1416页

作者： Marcia Henriques de Magalhes Costa maria da gloria Fernandes Pegado Cleber Vargas maria Elizabeth C Castro Kalil Madi Tiago Nunes Cyrla Zaltman Gastroenterology Section Department of Internal MedicineClementino Fraga Filho University HospitalUniversidade Federal do Rio de JaneiroRio de Janeiro 21941-913Brazil Department of Pathology Clementino Fraga Filho University HospitalUniversidade Federal do Rio de JaneiroRio de Janeiro 21941-913Brazil Hospital Clínic i Provincial/IDIBAPS Barcelona 08036Spain

Pseudomelanosis duodeni (PD) is a rare dark speckled appearance of the duodenum associated with gastrointestinal bleeding,hypertension,chronic heart failure,chronic renal failure and consumption of different *** report four cases of PD associated with chronic renal failure admitted to the gastroenterology outpatient unit due to epigastric pain,nausea,melena and progressive reduction of hemoglobin *** endoscopy revealed erosions in the esophagus and stomach,with no active bleeding at the *** addition,the duodenal mucosa presented marked signs of melanosis;later confirmed by histopathological *** though PD is usually regarded as a benign condition,its pathogenesis and clinical significance is yet to be defined.

关键词： Pseudomelanosis duodeni Chronic renal fail-ure Diabetes mellitus Anti hypertensive drugs Gastro-duodenal endoscopy

Comparison between Liver Cancer Mortality Rates in China and Spain

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Journal of Clinical and Translational Hepatology 2024年第10期12卷 831-833页

作者： Javier Guinea-Castanares Jesus maria Iturralde Iriso Irune Natalia Elizondo Pinillos gloria Martinez Iniesta Osakidetza Basque Health Service Ringgold Standard Institution(16651) Vitoria-GasteizSpain

Dear Editors,We have read with interest the article by Liu H et al.1 published in your journal regarding liver cancer mortality in China and would like to compare it with that of our country,Spain,which is a European ... 详细信息

关键词： mortality Cancer

Decrease of serum carnitine levels in patients with or without gastrointestinal cancer cachexia

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World Journal of Gastroenterology 2006年第28期12卷 4541-4545页

作者： mariano Malaguarnera Corrado Risino maria Pia Gargante Giovanni Oreste gloria Barone Anna Veronica Tomasello Mario Costanzo Matteo Angelo Cannizzaro Department of Senescence Urological and Neurological SciencesUniversity of CataniaCannizzaro HospitalCataniaItaly Department of Surgical Sciences University of CataniaItaly

AIM： To evaluate the levels of serum carnitine in patients with cancer in digestive organs and to compare them with other cancers in order to provide new insights into the mechanisms of cachexia. METHODS： Fifthy-five cachectic patients with or without gastrointestinal cancer were enrolled in the present study. They underwent routine laboratory investigations, including examination of the levels of various forms of carnitine present in serum （i.e., long-chain acylcarnitine, short-chain acylcarnitine, free carnitine, and total carnitine）. These values were compared with those found in 60 cancer patients in good nutritional status as well as with those of 30 healthy control subjects. RESULTS： When the cachectic patients with gastrointestinal cancer were compared with the cachectic patients without gastrointestinal cancer, the difference was -6.8 μmol/L in free carnitine （P 〈 0.005）, 0.04 μmol/ L in long chain acylcarnitine （P 〈 0.05）, 8.7 μmol/L in total carnitine （P 〈 0.001）. In the cachectic patients with or without gastrointestinal cancer, the difference was 12.2 μmol/L in free carnitine （P 〈 0.001）, 4.60 μmol/L in short chain acylcarnitine （P 〈 0.001）, and 0.60 μmol/L in long-chain acylcarnitine （P 〈 0.005） and 17.4 μmol/L in total carnitine （P 〈 0.001）. In the cachectic patients with gastrointestinal cancer and the healthy control subjects, the difference was 15.5 μmol/L in free carnitine （P 〈 0.001）, 5.2 μmol /L in short-chain acylcarnitine （P 〈 0.001）, 1.0 μmol/L in long chain acylcarnitine （P 〈 0.001）, and 21.8 μmol/L in total carnitine （P 〈 0.001）. CONCLUSION： Low serum levels of carnitine in terminal neoplastic patients are decreased greatly due to the decreased dietary intake and impaired endogenous synthesis of this substance. These low serum carnitine levels also contribute to the progression of cachexia in cancer patients.

关键词： Acetyl carnitine Nutritional status Anorexia Malnutrition Fatigue