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Pernicious anemia: New insights from a gastroenterological point of view

World Journal of Gastroenterology 2009年第41期15卷 5121-5128页

作者： Edith Lahner bruno annibale Department of Digestive and Liver Disease University Sapienza 2nd Medical School Ospedale Sant'Andrea Via di Grottarossa 1035 00189 Roma Italy

Pernicious anemia (PA) is a macrocytic anemia that is caused by vitamin B12 defi ciency, as a result of intrinsic factor deficiency. PA is associated with atrophic body gastritis (ABG), whose diagnosis is based on histological confirmation of gastric body atrophy. Serological markers that suggest oxyntic mucosa damage are increased fasting gastrin and decreased pepsinogen .Without performing Schilling's test,intrinsic factor deficiency may not be proven, andintrinsic factor and parietal cell antibodies are useful surrogate markers of PA, with 73% sensitivity and 100% specificity. PA is mainly considered a disease of the elderly, but younger patients represent about 15% of patients. PA patients may seek medical advice due to symptoms related to anemia, such as weakness and asthenia. Less commonly, the disease is suspected to be caused by dyspepsia. PA is frequently associated with autoimmune thyroid disease (40%) and other autoimmune disorders, such as diabetes mellitus (10%), as part of the autoimmune polyendocrine syndrome. PA is the end-stage of ABG. Longstanding Helicobacter pylori infection probably plays a role in many patients with PA, in whom the active infectious process has been gradually replaced by an autoimmune disease that terminates in a burned-out infection and the irreversible destruction of the gastricbody mucosa. Human leucocyte antigen-DR genotypes suggest a role for genetic susceptibility in PA. PA patients should be managed by cobalamin replacement treatment and monitoring for onset of iron defi ciency. Moreover, they should be advised about possible gastrointestinal long-term consequences, such as gastric cancer and carcinoids.

关键词：胃肠贫血恶性

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Risk for gastric neoplasias in patients with chronic atrophic gastritis:A critical reappraisal

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World Journal of Gastroenterology 2012年第12期18卷 1279-1285页

作者： Lucy Vannella Edith Lahner bruno annibale Dipartimento Medico-Chirurgico di Scienze Cliniche Tecnobiomediche e Medicina TraslazionaleSant'Andrea HospitalSchool of MedicineUniversity Sapienza

Chronic atrophic gastritis (CAG) is an inflammatory condition characterized by the loss of gastric glandular structures which are replaced by connective tissue (non-metaplastic atrophy) or by glandular structures inappropriate for location (metaplastic atrophy).Epidemiological data suggest that CAG is associated with two different types of tumors:Intestinal-type gastric cancer (GC) and type Ⅰ gastric carcinoid (TⅠGC).The pathophysiological mechanisms which lead to the development of these gastric tumors are different.It is accepted that a multistep process initiating from Helicobacter pylori-related chronic inflammation of the gastric mucosa progresses to CAG,intestinal metaplasia,dysplasia and,finally,leads to the development of GC.The TⅠGC is a gastrin-dependent tumor and the chronic elevation of gastrin,which is associated with CAG,stimulates the growth of enterochromaffin-like cells with their hyperplasia leading to the development of TⅠGC.Thus,several events occur in the gastric mucosa before the development of intestinal-type GC and/or TⅠGC and these take several years.Knowledge of CAG incidence from superficial gastritis,its prevalence in different clinical settings and possible risk factors associated with the progression of this condition to gastric neoplasias are important issues.This editorial intends to provide a brief review of the main studies regarding incidence and prevalence of CAG and risk factors for the development of gastric neoplasias.

关键词：慢性炎症风险因素萎缩性胃炎评估患者幽门螺杆菌 CAG

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Treatment of Helicobacter pylori infection in atrophic gastritis

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World Journal of Gastroenterology 2018年第22期24卷 2373-2380页

作者： Edith Lahner Marilia Carabotti bruno annibale Medical-Surgical Department of Clinical Sciences and Translational Medicine Sant'Andrea Hospital University Sapienza

Helicobacter pylori(Hp) is a major human pathogen causing chronic, progressive gastric mucosal damage and is linked to gastric atrophy and cancer. Hp-positive individuals constitute the major reservoir for transmission of infection. There is no ideal treatment for Hp. Hp infection is not cured by a single antibiotic, and sometimes, a combined treatment with three or more antibiotics is ineffective. Atrophic gastritis(AG) is a chronic disease whose main features are atrophy and/or intestinal metaplasia of the gastric glands, which arise from long-standing Hp infection. AG is reportedly linked to an increased risk for gastric cancer, particularly when extensive intestinal metaplasia is present. Active or past Hp infection may be detected by conventional methods in about two-thirds of AG patients. By immunoblotting of sera against Hp whole-cell protein lysates, a previous exposure to Hp infection is detected in all AG patients. According to guidelines, AG patients with Hp positivity should receive eradication treatment. The goals of treatment are as follows:(1) Cure of infection, resolution of inflammation and normalization of gastric functions;(2) possible reversal of atrophic and metaplastic changes of the gastric mucosa; and(3) prevention of gastric cancer. An ideal antibiotic regimen for Hp should achieve eradication rates of approximately 90%, and complex multidrug regimens are required to reach this goal. Amongst the factors associated with treatment failure are high bacterial load, high gastric acidity, Hp strain, smoking, low compliance, overweight, and increasing antibiotic resistance. AG, when involving the corporal mucosa, is linked to reduced gastric acid secretion. At a non-acidic intra-gastric p H, the efficacy of the common treatment regimens combining proton pump inhibitors with one or more antibiotics may not be the same as that observed in patients with Hp gastritis in an acid-producing stomach. Although the efficacy of these therapeutic regimens has been thoroughly tested in subjects with Hp infec

关键词： Atrophic gastritis Preneoplastic condition Intestinal metaplasia Helicobacter pylori Eradication treatment

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Pre-endoscopic screening for Helicobacter pylori and celiac disease in young anemic women

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World Journal of Gastroenterology 2009年第22期15卷 2748-2753页

作者： Lucy Vannella Debora Gianni Edith Lahner Antonio Amato Enzo Grossi Gianfranco Delle Fave bruno annibale Department of Digestive and Liver Disease Hospital Sant'AndreaII School of Medicine University Sapienza Center for Thalassemic Disease of Rome Department of Medical Affair Italian Diagnostic Center Department of Digestive and Liver Disease Hospital Sant’AndreaII School of Medicine University Sapienza

AIM:To evaluate the usefulness of pre-endoscopic serological screening for Helicobacter pylori(H pylori) infection and celiac disease in women aged<50 years affected by iron-defi ciency anemia(IDA).METHODS:One hundred and fi fteen women aged<50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies(tTG) and anti-H pylori IgG antibodies.tTG and H pylori IgG antibody were assessed using an enzyme-linked immunosorbent assay(ELISA).All women were invited to undergo upper GI endoscopy.During gastroscopy,biopsies were collected from antrum(n=3),gastric body(n=3) and duodenum(n=4) in all patients,irrespective of test results.The assessment of gastritis was performed according to the Sydney system and celiac disease was classifi ed by Marsh's System.RESULTS:45.2% women were test-positive:41 patients positive for H pylori antibodies,9 patients for tTG and 2 patients for both.The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test-negative(65.4% vs 42.8%;Fisher test P=0.0239).The serological results were confi rmed by gastroscopy in 100% of those with positive H pylori antibodies,in 50% of those with positive tTG and in 81.5% of testnegative patient.Sensitivity and specif icity were 84.8% and 100%,respectively for H pylori infection and,80% and 92.8% for tTG.Twenty-eight patients had positive H pylori antibodies and in all the patients,an active H pylori infection was found.In particular,in 23 out of 28(82%) patients with positive H pylori antibodies,a likely cause of IDA was found because of the active inflammation involving the gastric body.CONCLUSION:Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease,likely causes of IDA.

关键词：幽门螺杆菌贫血妇女疾病腹腔筛查内镜

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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

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Intestinal metaplasia surveillance:Searching for the roadmap

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World Journal of Gastroenterology 2013年第10期19卷 1523-1526页

作者： Angelo Zullo Cesare Hassan Alessandro Repici bruno annibale Gastroenterology and Digestive Endoscopy Unit Nuovo Regina Margherita Hospital00153 RomeItaly Department of Gastroenterology IRCCS Istituto Clinico Humanitas20089 MilanItaly Department of Digestive and Liver Disease Sant'Andrea HospitalII School of Medicine University Sapienza of Rome00153 RomeItaly

Atrophic gastritis and intestinal metaplasia(IM) of the stomach are common and are associated with an increased risk for gastric cancer.In the absence of guidelines,a pragmatic management has been performed in Western countries in patients with these premalignant conditions.Recently,formal European guidelines have been delivered on this topic.Basically,it has been recommended that patients with extensive atrophic gastritis(AG) and/or extensive IM should be offered endoscopic surveillance every 3 years.On the contrary,no scheduled endoscopic/histological control has been advised for those patients with precancerous conditions confined to the antrum.In this commentary,we highlighted some potential weaknesses in the management formally recommended by the new guidelines.In detail,we discussed that AG and IM patients do not share the same gastric cancer risk,at least in Western countries,deserving a different approach.Some factors significantly associated with gastric cancer risk,such as IM type,first-degree family history of gastric cancer,and smoking habit have not been considered in tailoring the endoscopic follow-up.Finally,some data would suggest that a 3-year follow-up in patients with extensive gastric precancerous conditions could result in an inadequate secondary prevention.

关键词： Intestinal metaplasia Guidelines Atrophic gastritis Gastric cancer Follow-up

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Lack of specific association between gastric autoimmunity hallmarks and clinical presentations of atrophic body gastritis

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World Journal of Gastroenterology 2005年第34期11卷 5351-5357页

作者： bruno annibale Edith Lahner Riccardo Negrini Flavia Baccini Cesare Bordi bruno Monarca Gianfranco Delle Fave Department of Digestive and Liver Disease II School of Medicine University "La Sapienza" Sant'Andrea Hospital Rome Italy Microbiology Department Spedali Civili Brescia Italy Pathology Department University of Parma Parma Italy Hematology Department University "La Sapienza" Sant'Andrea Hospital Rome Italy

AIM: To investigate the possible relationships between gastric autoimmune phenomena and clinical presentations of this disorder, in consecutive atrophic body gastritis patients.METHODS: A total of 140 atrophic body gastritis patients,diagnosed as consecutive outpatients presenting with macrocytic or iron deficiency anemia, or longstanding dyspepsia underwent gastroscopy with antral and body biopsies, assay of intrinsic factor, parietal cells and Helicobacter pylori(H pylori) antibodies. Gastritis was assessed according to Sydney System.RESULTS: Parietal cell antibodies were equally distributed in all clinical presentations, whereas the positivity of intrinsic factor antibodies (49/140, 35%) was significantly higher in pernicious anemia patients (49.2%) than in iron deficiency (21.1%) and dyspeptic patients (27.8%). No specific pattern of autoantibodies was related to the clinical presentations of atrophic body gastritis. A positive correlation was obtained between the body atrophy score and the intrinsic factor antibody levels (r = 0.2216,P = 0.0085). Associated autoimmune diseases were present in 25/140 (17.9%) patients, but the prevalence of autoimmune diseases was comparable, irrespective of the clinical presentations.CONCLUSION: The so-called hallmarks of gastric autoimmunity, particularly in intrinsic factor antibody cannot be usefully employed in defining an autoimmune pattern in the clinical presentations of ABG.

关键词：胃疾病自身免疫性疾病萎缩性胃炎临床分析

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Helicobacter pylori infection and drugs malabsorption

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World Journal of Gastroenterology 2014年第30期20卷 10331-10337页

作者： Edith Lahner Camilla Virili Maria Giulia Santaguida bruno annibale Marco Centanni Gastrointestinal Unit Department of Digestive and Liver Disease"Sapienza" University of Roma00189 RomaItaly Endocrinology Unit Department of Medico-Surgical Sciences and Biotechnologies"Sapienza" University of Roma04100 LatinaItaly

Drug absorption represents an important factor affecting the efficacy of oral drug treatment.Gastric secretion and motility seem to be critical for drug absorption.A causal relationship between impaired absorption of orally administered drugs and Helicobacter pylori(H.pylori)infection has been proposed.Associations have been reported between poor bioavailability of l-thyroxine and l-dopa and H.pylori infection.According to the Maastricht Florence Consensus Report on the management of H.pylori infection,H.pylori treatment improves the bioavailability of both these drugs,whereas the direct clinical benefits to patients still await to be established.Less strong seems the association between H.pylori infection and other drugs malabsorption,such as delavirdine and ketoconazole.The exact mechanisms forming the basis of the relationship between H.pylori infection and impaired drugs absorption and/or bioavailability are not fully elucidated.H.pylori infection may trigger a chronic inflammation of the gastric mucosa,and impaired gastric acid secretion often follows.The reduction of acid secretion closely relates with the wideness and the severity of the damage and may affect drug absorption.This minireview focuses on the evidence of H.pylori infection associated with impaired drug absorption.

关键词： Drug malabsorption Helicobacter pylori gastritis G

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Artifi cial neural networks in the recognition of the presence of thyroid disease in patients with atrophic body gastritis

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World Journal of Gastroenterology 2008年第4期14卷 563-568页

作者： Edith Lahner Marco Intraligi Massimo Buscema Marco Centanni Lucy Vannella Enzo Grossi bruno annibale Department of Digestive and Liver Disease University "La Sapienza"2nd Medical SchoolOspedale Sant'AndreaRomeItaly Semeion Research Center Rome Italy Endocrinology Unit Department of Experimental Medicine and PathologyUniversity "La Sapienza"Polo PontinoLatinaItaly Bracco Imaging Spa MilanItaly

AIM: To investigate the role of artifi cial neural networks in predicting the presence of thyroid disease in atrophic body gastritis patients. METHODS: A dataset of 29 input variables of 253 atrophic body gastritis patients was applied to artifi cial neural networks (ANNs) using a data optimisation procedure (standard ANNs,T&T-IS protocol,TWIST protocol). The target variable was the presence of thyroid disease. RESULTS: Standard ANNs obtained a mean accuracy of 64.4% with a sensitivity of 69% and a specifi city of 59.8% in recognizing atrophic body gastritis patients with thyroid disease. The optimization procedures (T&T-IS and TWIST protocol) improved the performance of the recognition task yielding a mean accuracy,sensitivity and specifi city of 74.7% and 75.8%,78.8% and 81.8%,and 70.5% and 69.9%,respectively. The increase of sensitivity of the TWIST protocol was statistically signifi cant compared to T&T-IS. CONCLUSION: This study suggests that artificial neural networks may be taken into consideration as a potential clinical decision-support tool for identifying ABG patients at risk for harbouring an unknown thyroid disease and thus requiring diagnostic work-up of their thyroid status.

关键词：萎缩性胃炎甲状腺疾病人造神经网络症状

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Is proliferative colonic disease presentation changing?

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World Journal of Gastroenterology 2012年第45期18卷 6614-6619页

作者： Vito D Corleto Cristiano Pagnini Maria Sofia Cattaruzza Ermira Zykaj Emilio Di Giulio Giovanna Margagnoni Emanuela Pilozzi Giancarlo D'Ambra Antonietta Lamazza Enrico Fiori Mario Ferri Luigi Masoni Vincenzo Ziparo bruno annibale Gianfranco Delle Fave Department of Medical and Surgical Sciences and Translational Medicine Faculty of Medicine and PsychologySant'Andrea Hospital"Sapienza" University00189 RomeItaly Department of Public Health and Inf.Diseases Faculty of MedicinePoliclinico Umberto I"Sapienza" University00189 RomeItaly Department of Pathology Faculty of Medicine and PsychologySant'Andrea Hospital"Sapienza" University00189 RomeItaly Department of Surgery Faculty of MedicinePoliclinico Umberto I"Sapienza" University00189 RomeItaly

AIM:To compare the site,age and gender of cases of colorectal cancer(CRC) and polyps in a single referral center in Rome,Italy,during two periods.METHODS:CRC data were collected from surgery/pathology registers,and polyp data from colonoscopy reports.Patients who met the criteria for familial adenomatous polyposis,hereditary non-polyposis colorectal cancer syndrome or inflammatory bowel disease were excluded from the study.Overlap of patients between the two groups(cancers and polyps) was carefully avoided.Theχ 2 statistical test and a regression analysis were performed.RESULTS:Data from a total of 768 patients(352 and 416 patients,respectively,in periods A and B) who underwent surgery for cancer were collected.During the same time periods,a total of 1693 polyps were analyzed from 978 patients with complete colonoscopies(428 polyps from 273 patients during period A and 1265 polyps from 705 patients during period B).A proximal shift in cancer occurred during the latter years for both sexes,but particularly in males.Proximal cancer increased > 3-fold in period B compared to period A in males [odds ratio(OR) 3.31,95%CI:2.00-5.47;P < 0.0001).A similar proximal shift was observed for polyps,particularly in males(OR 1.87,95%CI:1.23-2.87;P < 0.0038),but also in females(OR 1.62,95%CI:0.96-2.73;P < 0.07).CONCLUSION:The prevalence of proximal proliferative colonic lesions seems to have increased over the last decade,particularly in males.

关键词：结肠疾病增生性癌症患者结直肠癌数据收集肠道疾病统计检验回归分析

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