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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

Low utility of plasma Nociceptin/orphanin FQ in the diagnosis of hepatocellular carcinoma

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World Journal of Gastroenterology 2006年第29期12卷 4716-4720页

作者： Aldo Spadaro Antonino Ajello Carmelo Luigiano Carmela Morace Maria Letizia Resta Grazia Berlinghieri Salvatore Campo Claudio Scisca Angela Alibrandi Graziella D'arrigo Nunziata Alessi Oscar Ferraù Maria Antonietta Freni Dipartimento Clinico Sperimentale di Medicina e Farmacologia Clinica Medica Pad.CAOUVia Consolare Valeria No.1Messina 98125Italy

瞄准：在肝细胞癌(HCC ) 的察觉的浆液 alpha-fetoprotein (alpha-FP ) 的用途是可疑的。nociceptin/orphanin FQ (N/OFQ ) 的很高的传播层次，为新奇 opioid 受体的 ligand，最近在 HCC 被报导了。这研究的目的是在与肝肝硬化在病人产... 详细信息

瞄准：在肝细胞癌(HCC ) 的察觉的浆液 alpha-fetoprotein (alpha-FP ) 的用途是可疑的。nociceptin/orphanin FQ (N/OFQ ) 的很高的传播层次，为新奇 opioid 受体的 ligand，最近在 HCC 被报导了。这研究的目的是在与肝肝硬化在病人产生的 HCC 的诊断估计血浆 N/OFQ 的角色。方法：血浆 N/OFQ 层次被 ELISA 在 58 个病人(28 HCC 和 30 肝肝硬化) 并且在 25 健康控制测量。价值被相关与临床并且实验室特征包括 alpha-FP。枪兵索引，寒风伊朗的银币相关系数，非参量的联合(NPC ) 测试和判别式逐步的分析被用于数据的统计评估。结果：nociceptin 的上面的正常限度是 122 pg/mL。在这上面的血浆层次截止与 HCC 在 21.4% 病人被发现，在 23.3% 那些与肝硬化并且在 8% 健康题目。200 ng/mL 与肝硬化那些与 HCC 并且在没有在 46.4% 病人被发现的 alpha-FP 浆液层次 > 。没有关联在 N/OFQ 层次和任何东西之间被发现临床并且实验室特征，包括 alpha-FP。由 NPC 测试， HCC 和肝脏硬化症的病人关于 alpha-FP 是不同的(P = 0.000 ) 然而并非以 nociceptin (P = 0.595 ) 。由点寒风伊朗的银币关联， HCC 存在断然与 alpha-FP 被相关(rpb = 0.52， P = 0.000 ) 然而并非与 N/OFQ (rpb = 0.16， P = 0.157 ) 。在判别式分析， alpha-FP 在 Wilks 测试是重要的(Y =-0.709 + 0.03 alpha-FP ) 并且适当地分类 81% 所有病人和 61% HCC。N/OFQ 比 alpha-FP 有更低的敏感，特性和预兆的价值。结论：Nociceptin 与长期的肝疾病在病人被增加，独立于 HCC 的存在，尽管内在的机制还得被澄清。我们断定它不是为 HCC 的一个有用标记。

关键词：等离子体诊断方法肝细胞癌病理机制

Follow-up of intestinal metaplasia in the stomach: When, how and why

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World Journal of Gastrointestinal Oncology 2012年第3期4卷 30-36页

作者： Angelo Zullo Cesare Hassan Adriana Romiti Michela Giusto Carmine Guerriero Roberto Lorenzetti salvatore MA campo Silverio Tomao Gastroenterology and Digestive Endoscopy Nuovo Regina Margherita Hospital Oncology Sant'Andrea Hospital Oncology Department of Experimental Medicine University of Rome "Sapienza"

Gastric cancer remains the second most frequent cause of cancer-related mortality in the world. Screening programs in some Asian countries are impractical in the majority of other countries worldwide. Therefore, follow-up of precancerous lesions is advisable for secondary gastric cancer prevention. Intestinal metaplasia (IM) is recognized as a precancerous lesion for gastric cancer, increasing the risk by 6-fold. IM is highly prevalent in the general population, being detected in nearly 1 of every 4 patients undergoing upper endoscopy. The IM prevalence rate is significantly higher in patients with Helicobacter pylori (H. pylori) infection, in first-degree relatives of gastric cancer patients, in smokers and it increases with patient age. IM is the "breaking point" in the gastric carcinogenesis cascade and does not appear to regress following H. pylori eradication, although the cure of infection may slow its progression. Gastric cancer risk is higher in patients with incomplete-type IM, in those with both antral and gastric body involvement, and the risk significantly increases with IM extension over 20% of the gastric mucosa. Scheduled endoscopic control could be cost-effective in IM patients, depending on the yearly incidence of gastric cancer in IM patients, the stage of gastric cancer at diagnosis discovered at surveillance, and the cost of endoscopy. As a pragmatic behavior, yearly endoscopic control would appear justified in all IM patients with at least one of these conditions: (1) IM extension > 20%; (2) the presence of incomplete type IM; (3) first-degree relative of gastric cancer patients; and (4) smokers. In the remaining IM patients, a less intensive (2-3 years) could be proposed.

关键词： Intestinal metaplasia Gastric cancer Follow-up Prevention Risk factors

Pseudoachalasia: A peculiar case report and review of the literature

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World Journal of Gastrointestinal Endoscopy 2013年第9期5卷 450-454页

作者： salvatore Maria Antonio campo Angelo Zullo Chiara Maria Scandavini Barbara Frezza Paola Cerro Genoveffa Balducci Gastroenterology and Digestive Endoscopy Unit Nuovo Regina Margherita Hospital Department of Surgery S. Andrea University Radiology Unit Nuovo Regina Margherita Hospital

Pseudoachalasia is a rare secondary achalasia, which accounts for only a small subgroup of patients. We describe a 77-year-old woman with recent onset of dysphagia and typical esophageal manometric findings of achalasia. Moreover, esophageal manometric findings of vascular compression at 36 cm from the nose were associated with dysphagia. An upper endoscopy showed the absence of lesions both in the esophagus and gastro-esophageal junction, whilst a 15-mm ulcer on the gastric angulus was detected. The gastric ulcer resulted in being a diffuse signet ring cell carcinoma at histology, suggesting pseudoachalasia. An abdominal computed tomography scan showed an irregular concentric thickening of the gastro-esophageal junction wall extending for 7 cm and a dilated ascending thoracic aorta with no presence of the inferior vena cava, with an enlarged azygos as the source of vascular compression of esophagus. Moreover, cardia involvement from diffuse signet ring cell carcinoma of the gastric angulus was also recognized as the cause of dysphagia. The cancer was not suitable for a surgical approach in an old patient with cardiovascular comorbidities and support therapy was started. In our ambulatory series, pseudoachalasia was eventually diagnosed in 4.7% of 234 consecutive patients with esophageal manometric finding suggestive of achalasia. We also reviewed cases in the literature and aimed to evaluate the reported causes of pseudoachalasia.

关键词： Pseudoachalasia Achalasia Esophageal vascular compression Thoracic aorta Azygos vein

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