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Alginate controls heartburn in patients with erosive and nonerosive reflux disease

World Journal of Gastroenterology 2012年第32期18卷 4371-4378页

作者： Edoardo Savarino Nicola de Bortoli Patrizia Zentilin Irene Martinucci Luca Bruzzone Manuele Furnari santino marchi Vincenzo Savarino Division of Gastroenterology Department of Internal MedicineUniversity of Genoa16126 GenoaItaly Division of Gastroenterology Department of SurgicalOncological and Gastroenterological SciencesUniversity of Padua35128 PaduaItaly Division of Gastroenterology Department of Internal MedicineUniversity of Pisa56100 PisaItaly

AIM:To evaluate the effect of a novel alginate-based compound,Faringel,in modifying reflux characteristics and controlling symptoms.METHODS:In this prospective,open-label study,40 patients reporting heartburn and regurgitation with proven reflux disease(i.e.,positive impedance-pH test/evidence of erosive esophagitis at upper endoscopy) underwent 2 h impedance-pH testing after eating a refluxogenic meal.They were studied for 1 h under basal conditions and 1 h after taking 10 mL Faringel.In both sessions,measurements were obtained in right lateral and supine decubitus positions.Patients also completed a validated questionnaire consisting of a 2-item 5-point(0-4) Likert scale and a 10-cm visual analogue scale(VAS) in order to evaluate the efficacy of Faringel in symptom relief.Tolerability of the treatment was assessed using a 6-point Likert scale ranging from very good(1) to very poor(6).RESULTS:Faringel decreased significantly(P < 0.001),in both the right lateral and supine decubitus positions,esophageal acid exposure time [median 10(25th75th percentil 6-16) vs 5.8(4-10) and 16(11-19) vs 7.5(5-11),respectively] and acid refluxes [5(3-8) vs 1(1-1) and 6(4-8) vs 2(1-2),respectively],but increased significantly(P < 0.01) the number of nonacid reflux events compared with baseline [2(1-3)vs 3(2-5) and 3(2-4) vs 6(3-8),respectively].Percentage of proximal migration decreased in both decubitus positions(60% vs 32% and 64% vs 35%,respectively;P < 0.001).Faringel was significantly effective in controlling heartburn,based on both the Likert scale [3.1(range 1-4) vs 0.9(0-2);P < 0.001] and VAS score [7.1(3-9.8) vs 2(0.1-4.8);P < 0.001],but it had less success against regurgitation,based on both the Likert scale [2.6(1-4) vs 2.2(1-4);P = not significant(NS)] and VAS score [5.6(2-9.6) vs 3.9(1-8.8);P = NS].Overall,the tolerability of Faringel was very good 5(2-6),with only two patients reporting modest adverse events(i.e.,nausea and bloating).CONCLUSION:Our findings demonstrate that Faringel is well-tolerated and effective in

关键词：反流糜烂控制海藻酸钠患者胃暴露时间 VAS

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Differential diagnosis between functional and organic intestinal disorders:Is there a role for non-invasive tests?

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World Journal of Gastroenterology 2007年第2期13卷 219-223页

作者： Francesco Costa Maria Gloria Mumolo santino marchi Massimo Bellini Section of Gastroenterology Department of Internal MedicineUniversity of Pisa Pisa Italy

Abdominal pain and bowel habits alterations are common symptoms in the general population. The investigation to differentiate organic from functional bowel disorders represents a considerable burden both for patients and public health service. The selection of patients who should undergo endoscopic and/or radiological procedures is one of the key points of the diagnostic process, which should avoid the abuse of invasive and expensive tests as well as the underestimation of potentially harmful diseases. Over the coming years, clinicians and researchers will be challenged to develop strategies to increase the patient’s compliance and to reduce the economic and social costs of the intestinal diseases.

关键词：肠病炎症排泄物内窥镜检查

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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 study.Data 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 model.Indeed,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 model.Age 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 patients.Higher 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 disturbances.CONCLUSION:The unitary bowel-sleep model based on IRT revealed a strong positive corre

关键词：睡眠质量肠道 Fisher精确检验综合症睡眠障碍严重程度评价项目反应理论

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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 2.All subjects reported one or more LPS.Twenty-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 improvement.At 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 symptoms.On the other hand,such result was not recorded for LPS.Esophagitis was detected in 2/41 patients,and ineffective esophageal motility was found in 3/41 patients.The MII-pH analysis

关键词：食管反流咽喉症状缓解气体回流胃质子泵抑制剂地理信息系统

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Role of abdominal ultrasound for the surveillance follow-up of pancreatic cystic neoplasms: a cost-effective safe alternative to the routine use of magnetic resonance imaging

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World Journal of Gastroenterology 2019年第18期25卷 2217-2228页

作者： Luca Morelli Simone Guadagni Valerio Borrelli Roberta Pisano Gregorio Di Franco Matteo Palmeri Niccolò Furbetta Dario Gambaccini santino marchi Piero Boraschi Luca Bastiani Alessandro Campatelli Franco Mosca Giulio Di Candio General Surgery Unit Department of Surgery Translational and New Technologies in Medicine University of Pisa EndoCAS (Center for Computer Assisted Surgery) University of Pisa Diagnostic and Interventional Ultrasound in Transplants Unit Azienda Ospedaliero-Universitaria Pisana Gastroenterology Unit University of Pisa 2~(nd) Radiology Unit Department of Diagnostic Imaging Azienda Ospedaliero-Universitaria Pisana Institute of Clinical Physiology National Council of Research

BACKGROUND Patients with pancreatic cystic neoplasms(PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime imagebased surveillance follow-up. In these patients, the current European evidencedbased guidelines advise magnetic resonance imaging(MRI) scanning every 6 mo in the first year, then annually for the next five years, without reference to any role for trans-abdominal ultrasound(US). In this study, we report on our clinical experience of a follow-up strategy of image-based surveillance with US, and restricted use of MRI every two years and for urgent evaluation whenever suspicious changes are detected by US.AIM To report the results and cost-efficacy of a US-based surveillance follow-up for known PCNs, with restricted use of MRI.METHODS We retrospectively evaluated the records of all the patients treated in our institution with non-surgical PCN who received follow-up abdominal US and restricted MRI from the time of diagnosis, between January 2012 and January 2017. After US diagnosis and MRI confirmation, all patients underwent US surveillance every 6 mo for the first year, and then annually. A MRI scan was routinely performed every 2 years, or at any stage for all suspicious US findings.In this communication, we reported the clinical results of this alternative followup, and the results of a comparative cost-analysis between our surveillance protocol(abdominal US and restricted MRI) and the same patient cohort that has been followed-up in strict accordance with the European guidelines recommended for an exclusive MRI-based surveillance protocol.RESULTS In the 5-year period, 200 patients entered the prescribed US-restricted MRI surveillance follow-up. Mean follow-up period was 25.1 ± 18.2 mo. Surgery was required in two patients(1%) because of the appearance of suspicious features at imaging(with complete concordance between the US scan and the on-demand MRI). During the follow-up, US revealed changes in PCN appearance in 28 patients(14%). These comprised

关键词： Ultrasound Pancreatic cystic neoplasms Magnetic resonance imaging Surveillance

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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 (MD ) 被肌强直的现象和进步肌肉发达的软弱描绘。胃肠道的参与是经常的并且可以发生在任何水平。临床的表明以前被归因于改变的平滑肌损坏，而是 histologic 证据引起的活动性混乱少见、冲突。一个神经因素也被假设了。，在... 详细信息

Myotonic (MD ) 被肌强直的现象和进步肌肉发达的软弱描绘。胃肠道的参与是经常的并且可以发生在任何水平。临床的表明以前被归因于改变的平滑肌损坏，而是 histologic 证据引起的活动性混乱少见、冲突。一个神经因素也被假设了。，在更低的道在上面的消化道，咽下困难，心痛，流回和消化不良是最普通的抱怨，腹的疼痛，膨胀并且在肠习惯的变化经常被报导。消化症状可以是营养不良的疾病的第一症状并且可以先于肌与骨的特征。胃肠的功能的缺陷可能有时是那么渐渐的病人与症状的很少了解适应它。不在内视镜的如此的情况常规和 ultrasonographic 评估是足够、指向的技术(胃电描记法，测压法，肌电描记法，功能的 ultrasonography， scintigraphy，等等) 被需要。而与骨胳的肌肉疾病的持续时间的积极关联被报导了，在胃肠的骚乱的骨胳的肌肉参与和存在和严厉的度之间有低关联。这些药为对待象专业版那样的胃肠的抱怨推荐了运动的、反消化不良的药和 laxatives，主要针对改正活动性混乱。自从许多重要问题仍然是未解决的，在 MD 的胃肠的参与仍然是一个复杂、吸引人的条件。专注于基因方面，早诊断的技术和新治疗学的策略的发展的进一步的研究被需要改进我们 MD 的胃肠的表明的管理。

关键词：肌肉营养不良胃肠疾病强直肌肉临床表现

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Irritable bowel syndrome: a disease still searching for pathogenesis, diagnosis and therapy

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World Journal of Gastroenterology 2014年第27期20卷 8807-8820页

作者： Massimo Bellini Dario Gambaccini Cristina Stasi Maria Teresa Urbano santino marchi Paolo Usai-Satta Gastrointestinal Unit Department of Gastroenterology University of Pisa 56124 Pisa Italy Department of Experimental and Clinical Medicine University of Florence 50134 Florence Italy Epidemiological Observatory Health Agency of Tuscany 50141 Florence Italy Gastrointestinal Unit P. Brotzu Hospital09124 Cagliari Italy

Irritable bowel syndrome(IBS) is the most frequently diagnosed functional gastrointestinal disorder in primary and secondary care. It is characterised by abdominal discomfort, pain and changes in bowel habits that can have a serious impact on the patient's quality of life. The pathophysiology of IBS is not yet completely clear. Genetic, immune, environmental, inflammatory, neurological and psychological factors, in addition to visceral hypersensitivity, can all play an important role, one that most likely involves the complex interactions between the gut and the brain(gut-brain axis). The diagnosis of IBS can only be made on the basis of the symptoms of the Rome Ⅲ criteria. Because the probability of organic disease in patients fulfilling the IBS criteria is very low, a careful medical history is critical and should pay particular attention to the possible comorbidities.Nevertheless, the severity of the patient's symptoms or concerns sometimes compels the physician to perform useless and/or expensive diagnostic tests, transforming IBS into a diagnosis of exclusion. The presence of alarming symptoms(fever, weight loss, rectal bleeding, significant changes in blood chemistry), the presence of palpable abdominal masses, any recent onset of symptoms in patient aged over 50 years, the presence of symptoms at night, and a familial history of celiac disease, colorectal cancer and/or inflammatory bowel diseases all warrant investigation. Treatment strategies are based on the nature and severity of the symptoms, the degree of functional impairment of the bowel habits, and the presence of psychosocial disorders. This review examines and discusses the pathophysiological aspects and the diagnostic and therapeutic approaches available for patients with symptoms possibly related to IBS, pointing out controversial issues and the strengths and weaknesses of the current knowledge.

关键词： Irritable bowel syndrome Pathogenesis Diagnosis Th

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Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome

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World Journal of Gastroenterology 2013年第35期19卷 5787-5797页

作者： Nicola de Bortoli Irene Martinucci Massimo Bellini Edoardo Savarino Vincenzo Savarino Corrado Blandizzi santino marchi Division of Gastroenterology University of Pisa Division of Gastroenterology University of Padua Division of Gastroenterology University of Genoa Division of Pharmacology and Chemotherapy University of Pisa

Several studies indicate a significant degree of overlap between irritable bowel syndrome(IBS)and gastroesophageal reflux disease(GERD).Likewise,both functional heartburn(FH)and IBS are functional digestive disorders that may occur in the same patients.However,data establishing a solid link between FH and IBS are lacking,mainly because the clinical definition of FH has undergone substantial changes over the years.The available literature on the overlap between GERD or FH and IBS highlights considerable heterogeneity in terms of the criteria and diagnostic procedures used to assess heartburn and IBS.In particular,several epidemiological studies included patients with concomitant IBS and GERD without any attempt to distinguish FH(as defined by the RomeⅢcriteria)from GERD via pathophysiological investigations.Independent of these critical issues,there is preliminary evidence supporting a significantdegree of FH-IBS overlap.This underscores the need for studies based on updated diagnostic criteria and accurate pathophysiological classifications,particularly to distinguish FH from GERD.This distinction would represent an essential starting point to achieving a better understanding of pathophysiology in the subclasses of patients with GERD and FH and properly assessing the different degrees of overlap between IBS and the subcategories of heartburn.The present review article intends to appraise and critically discuss current evidence supporting a possible concomitance of GERD or FH with IBS in the same patients and to highlight the pathophysiological relationships between these disorders.

关键词： Functional gastrointestinal disorders Gastroesophageal reflux disease/Gastro-oesophageal reflux disease Irritable bowel syndrome Acidity(esophageal) Hypersensitivity

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Esophageal motility abnormalities in gastroesophageal reflux disease

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2014年第2期5卷 86-96页

作者： Irene Martinucci Nicola de Bortoli Maria Giacchino Giorgia Bodini Elisa Marabotto santino marchi Vincenzo Savarino Edoardo Savarino Division of Gastroenterology University of Pisa56124 PisaItaly Division of Gastroenterology Department of Internal MedicineUniversity of Genoa16132GenoaItaly Division of Gastroenterology Department of SurgeryOncology and GastroenterologyUniversity of Padua35128 PaduaItaly

Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophagealmotility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from nonerosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

关键词： Gastroesophageal reflux disease High-resolution manometry Ineffective esophageal motility Esophagogastric junction Transient lower esophageal sphincter relaxations

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Irritable bowel syndrome and chronic constipation: Fact and fiction

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World Journal of Gastroenterology 2015年第40期21卷 11362-11370页

作者： Massimo Bellini Dario Gambaccini Paolo Usai-Satta Nicola De Bortoli Lorenzo Bertani santino marchi Cristina Stasi Gastrointestinal Unit Department of GastroenterologyUniversity of Pisa Gastrointestinal Unit P. Brotzu Hospital Department of Experimental and Clinical Medicine University of Florence Epidemiological Observatory Regional Health Agency of Tuscany

Irritable bowel syndrome(IBS) and functional constipation(FC) are the most common functional gastrointestinal disorders. According to the Rome ⅢCriteria these two disorders should be theoretically separated mainly by the presence of abdominal pain or discomfort relieved by defecation(typical of IBS) and they should be mutually exclusive. However,many gastroenterologists have serious doubts as regards a clear separation. Both IBS-C and FC,often associated with many other functional digestive and non digestive disorders,are responsible for a low quality of life. The impact of the media on patients' perception of these topics is sometimes disruptive,often suggesting a distorted view of pathophysiology,diagnosis and therapy. These messages frequently overlap with previous subjective opinions and are further processed on the basis of the different culture and the previous experience of the constipated patients,often producing odd,useless or even dangerous behaviors. The aim of this review was to analyze the most common patients' beliefs about IBS-C and CC,helping physicians to understand where they should focus their attention when communicating with patients,detecting false opinions and misconceptions and correcting them on the basis of scientific evidence.

关键词： Irritable bowel syndrome Chronic constipation Func

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