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Overlapping approach Proton Pump Inhibitors/Nux vomica-Heel as new intervention for gastro-esophageal reflux management:Delphi consensus study

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World Journal of Gastroenterology 2024年第18期30卷 2467-2478页

作者： edda battaglia Luciano Bertolusso Marco Del Prete Marco Monzani Marco Astegiano Gastroenterology Unit ASLTO4Ivrea 10015TurinItaly General Practitioner ASL CN2Alba-Bra 12051CuneoItaly Specialist in Nephrology International Academy of Physiological Regulating Medicine Milan 20100Italy Specialist in Endocrinology Territorial Social and Health Authority of BrianzaMonza 20900Italy Gastroenterology Specialist Retired from Gastroenterology and Hepatology UnitAOU Cittàdella Salute e della ScienzaTurin 10123Italy

BACKGROUND Gastro-esophageal reflux disease(GERD)may affect the upper digestive tract;up to 20%of population in Western nations are affected by GERD.Antacids,histamine H2-receptor antagonists,and Proton Pump Inhibitors(PPIs)are considered the referring medications for GERD.Nevertheless,PPIs must be managed carefully because their use,especially chronic,could be linked with some adverse effects.An effective and safe alternative pharmacological tool for GERD is needed.After the identification of potentially new medications to flank PPIs,it is mandatory to revise and improve good clinical practices even through a consensus process.AIM To optimize diagnosis and treatment guidelines for GERD through a consensus based on Delphi method.METHODS The availability of clinical studies describing the action of the multicomponent/multitarget medication Nux vomica-Heel,subject of the consensus,is the basic prerequisite for the consensus itself.A modified Delphi process was used to reach a consensus among a panel of Italian GERD specialists on the overlapping approach PPIs/Nux vomica-Heel as a new intervention model for the management of GERD.The Voting Consensus group was composed of 49 Italian Medical Doctors with different specializations:Gastroenterology,otolaryngology,geriatrics,and general medicine.A scientific committee analyzed the literature,determined areas that required investigation(in agreement with the multiple-choice questionnaire results),and identified two topics of interest:(1)GERD disease;and(2)GERD treatment.Statements for each of these topics were then formulated and validated.The Delphi process involved two rounds of questioning submitted to the panel experts using an online platform.RESULTS According to their routinary GERD practice and current clinical evidence,the panel members provided feedback to each questionnaire statement.The experts evaluated 15 statements and reached consensus on all 15.The statements regarding the GERD disease showed high levels of agreement,with consensus ranging from 70%to 92%.

关键词： Gastro-esophageal reflux disease Proton Pump Inhibitors Consensus Nux vomica-Heel Overlapping Decalage

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Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation(Part Ⅱ:Treatment)

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World Journal of Gastroenterology 2012年第36期18卷 4994-5013页

作者： Antonio Bove Massimo Bellini edda battaglia Renato Bocchini Dario Gambaccini Vincenzo Bove Filippo Pucciani Donato Francesco Altomare Giuseppe Dodi Guido Sciaudone Ezio Falletto Vittorio Piloni Gastroenterology and Endoscopy Unit Department of GastroenterologyAORN "A.Cardarelli"80131 NaplesItaly Gastrointestinal Unit Department of GastroenterologyUniversity of Pisa56100 PisaItaly Gastroenterology and Endoscopy Unit Cardinal Massaja Hospital14100 AstiItaly Gastroenterology Unit M.Bufalini Hospital47023 CesenaItaly Department of Medical and Surgical Critical Care University of Florence50141 FlorenceItaly Department of Emergency and Organ Transplantation University of Bari70124 BariItaly Department of Oncological and Surgical Sciences University of Padua35126 PaduaItaly Division of General and Geriatric Surgery Second University of Naples80131 NaplesItaly Sixth Division of University Surgery Department of General SurgerySan Giovanni Battista Hospital10126 TurinItaly Diagnostic Imaging Centre "N.Aliotta" Villa Silvia-SenigalliaI-60100 AnconaItaly

The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation.There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation.Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre.Osmotic laxatives may be effective in patients who do not respond to fibre supplements.Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives.Controlled trials have shown that serotoninergic enterokinetic agents,such as prucalopride,and prosecretory agents,such as lubiprostone,are effective in the treatment of patients with chronic constipation.Surgery is sometimes necessary.Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders,generalised motility disorders or psychological disorders.Randomised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation.Many surgical procedures may be used to treat obstructed defecation in patients with acquired anatomical defects,but none is considered to be the gold standard.Surgery should be reserved for selected patients with an impaired quality of life.Obstructed defecation is often associated with pelvic organ prolapse.Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse,but the efficacy and safety of such procedures have not yet been established.

关键词：外科治疗排便便秘慢性 AIGO 随机对照试验诊断手术治疗

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Appropriateness of colonoscopy: Diagnostic yield and safety in guidelines

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World Journal of Gastroenterology 2007年第12期13卷 1816-1819页

作者： Mario Grassini Carlo Verna Paolo Niola Monica Navino edda battaglia Gabrio Bassotti Gastroenterology and Endoscopy Unit Cardinal Massaja Hospital Asti Italy Gastroenterology and Hepatology Section Department of Clinical and Experimental Medicine University of Perugia Perugia Italy

AIM: To evaluate if the guidelines for the appro-priateness of performing colonoscopy by American Society for Gastrointestinal Endoscopy (AGSE) and Italian Society of Digestive Endoscopy (SIED) yield a good diagnostic efficacy and do not present risks of missing important colonic pathologies in an Italian population sample.METHODS: A total of 1017 consecutive patients (560 men and 457 women; mean age 64.4 ± 16 years) referred to an open-access endoscopy unit for colonoscopy from July 2004 to May 2006 were evaluated according to ASGE and SIED guidelines for appropriateness of performing the procedure. Diagnostic yield was defined as the percentage of relevant colonic pathologies of the total number of colonoscopies performed.RESULTS: About 85.2% patients underwent colono-scopy that was considered appropriate based on at least one ASGE or SIED criterion, while it was considered inappropriate for 14.8% of patients. The diagnostic yield of colonoscopy was significantly higher for appropriate colonoscopies (26.94% vs 10.6%, P < 0.001) than for inappropriate colonoscopies (5.3%). There was no missed colorectal cancer following the ASGE/SIED criteria.CONCLUSION: ASGE/SIED guidelines have shown a good diagnostic yield and the rate of missing relevant colonic pathologies seems very low. Unfortunately, the percentage of inappropriate referrals for colonoscopy in an open-access endoscopy system is still high, despite the number of papers published on the issue and the definition of international guidelines. Further steps are required to update and standardize the guidelines to increase their diffusion and to promote educational programs for general practitioners.

关键词：结肠镜检查指南适用性诊断结果安全性

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An extended assessment of bowel habits in a general population

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World Journal of Gastroenterology 2004年第5期10卷 713-716页

作者： Gabrio Bassotti Massimo Bellini Filippo Pucciani Renato Bocchini Antonio Bove Pietro Alduini edda battaglia Paolo Bruzzi Sezione di Gastroenterologia ed Epatologia Dipartimento di Medicina Clinica e SperimentaleUniversità di Perugia Sezione di Gastroenterologia Dipartimento di Medicina InternaUniversità di Pisa Clinica Chirurgica Generale e Discipline Chirurgiche Università di Firenze UO di Medicina Polispecialistica Azienda Sanitaria LocaleCesena UO di Gastroenterologia ed Endoscopia Digestiva Azienda Ospedaliera"A.Cardarelli"Napoli Dipartimento di Fisiopatologia Clinica Università di Torino Struttura Complessa di Epidemiologia Clinica IST GenovaItaly

AIM:Bowel habits are difficult to study, and most data on defecatory behaviour in the general population have been obtained on the basis of recalled interview. The objective assessment of this physiological function and its pathological aspects continues to pose a difficult challenge. The aim of this prospective study was to objectively assess the bowel habits and related aspects in a large sample drawn from thegeneral population.METHODS: Over a two-month period 488 subjects were prospectively recruited from the general population and asked to compile a daily diary on their bowel habits and associated signs and symptoms (the latter according to Rome Ⅱ criteria). A total of 298 (61%) participants returned a correctly compiled record, so that data for more than 8000 patient-days were available for statistical analysis.RESULTS:The average defecatory frequency was once per day (range of 0.25-3.25) and was similar between males and females.However, higher frequencies of straining at stool (P=0.001), a feeling of incomplete emptying and/or difficult evacuation (P=0.0001), and manual manoeuvres to facilitate defecation (P=0.046) were reported by females as compared to males.CONCLUSION:This study represents one of the first attempts to objectively and prospectively assess bowel habits in a sample of the general population over a relatively long period of time. The variables we analyzed are coherent with the criteria commonly used for the clinical assessment of functional constipation, and can provide a useful adjunt for a better evaluation of constipated patients.

关键词：肠道习性肠道疾病卫生统计影响因子

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Loss of interstitial cells of Cajal network in severe idiopathic gastroparesis

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World Journal of Gastroenterology 2006年第38期12卷 6172-6177页

作者： edda battaglia Gabrio Bassotti Graziella Bellone Luca Dughera Anna Maria Serra Luigi Chiusa Alessandro Repici Pierroberto Mioli Giorgio Emanuelli Department of Gastroenterology and Clinical Nutrition University of Torino Italy Gastroenterology Section Department of Clinical and Experimental Medicine University of Perugia Italy Department of Biomedical Sciences and Human Oncology University of Torino Italy Department of Emergency Surgical Unit San Giovanni Battista Hospital Torino Italy

AIM: To report a case of severe idiopathic gastroparesis in complete absence of Kit-positive gastric interstitial cells of Cajal (ICC). METHODS: Gastric tissue from a patient with severe idiopathic gastroparesis unresponsive to medical treatment and requiring surgery was analyzed by conventional histology and immunohistochemistry. RESULTS: Gastric pacemaker cells expressing Kit receptor had completely disappeared while the local level of stem cell factor, the essential ligand for its development and maintenance, was increased. No signs of cell death were observed in the pacemaker region. CONCLUSION: These results are consistent with the hypothesis that a lack of Kit expression may lead to impaired functioning of ICC. Total gastrectomy proves to be curative.

关键词：先天性疾病胃瘫治疗临床

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Immunomodulation by probiotics and prebiotics in hepatocellular carcinoma

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World Journal of Hepatology 2022年第2期14卷 372-385页

作者： edda Russo Camila Fiorindi Francesco Giudici Amedeo Amedei Department of Experimental and Clinical Medicine University of FlorenceFlorence 50134TuscanyItaly Department of Health Professions Dietary Production Line and NutritionUniversity Hospital of CareggiFlorence 50134Italy

Hepatocellular carcinoma(HCC)is the most prevalent primary malignancy in patients suffering from chronic liver diseases and cirrhosis.Recent attention has been paid to the involvement of the gut-liver axis(GLA)in HCC pathogenesis.This axis results from a bidirectional,anatomical and functional relationship between the gastrointestinal system and the liver.Moreover,the complex network of interactions between the intestinal microbiome and the liver plays a crucial role in modulation of the HCC-tumor microenvironment,contributing to the pathogenesis of HCC by exposing the liver to pathogen-associated molecular patterns,such as bacterial lipopolysaccharides,DNA,peptidoglycans and flagellin.Indeed,the alteration of gut microflora may disturb the intestinal barrier,bringing several toll-like receptor ligands to the liver thus activating the inflammatory response.This review explores the new therapeutic opportunities that may arise from novel insights into the mechanisms by which microbiota immunomodulation,represented by probiotics,and prebiotics,affects HCC through the GLA.

关键词： Hepatocellular carcinoma Gut microbiota Probiotics Prebiotics Gut-liver axis Immunomodulation

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GLOBAL EXISTENCE OF SOLUTIONS FOR A MULTI-PHASE FLOW: A BUBBLE IN A LIQUID TUBE AND RELATED CASES

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Acta Mathematica Scientia 2015年第4期35卷 832-854页

作者： Debora AMADORI Paolo BAITI Andrea CORLI edda DAL SANTO Department of Engineering and Computer Science and Mathematics University of L'Aquila Department of Mathematics and Computer Science University of Udine Department of Mathematics and Computer Science University of Ferrara

In this paper we study the problem of the global existence （in time） of weak entropic solutions to a system of three hyperbolic conservation laws, in one space dimension, for large initial data. The system models the dynamics of phase transitions in an isothermal fluid; in Lagrangian coordinates, the phase interfaces are represented as stationary contact discontinuities. We focus on the persistence of solutions consisting in three bulk phases separated by two interfaces. Under some stability conditions on the phase configuration and by a suitable front tracking algorithm we show that, if the BV-norm of the initial data is less than an explicit （large） threshold, then the Cauchy problem has global solutions.

关键词： hyperbolic systems of conservation laws phase transitions wave-front trackingalgorithm

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Exploring the food-gut axis in immunotherapy response of cancer patients

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World Journal of Gastroenterology 2020年第33期26卷 4919-4932页

作者： edda Russo Giulia Nannini Monica Dinu Giuditta Pagliai Francesco Sofi Amedeo Amedei Department of Clinical and Experimental Medicine University of FlorenceFlorence 50134Italy Unit of Clinical Nutrition Careggi University HospitalFlorence 50139Italy SOD of Interdisciplinary Internal Medicine Azienda Ospedaliera Universitaria CareggiFlorence 50134Italy

Nowadays,immunotherapy is widely used to treat different cancer types as it boosts the body's natural defenses against the malignancy,with lower risk of adverse events compared to the traditional treatments.The immune system is able to control cancer growth but,unfortunately,many cancers take advantage of immune checkpoints pathways for the immune evasion.An intricate network of factors including tumor,host and environmental variables influence the individual response to immune checkpoints’inhibitors.Between them,the gut microbiota(GM)has recently gained increasing attention because of its emerging role as a modulator of the immune response.Several studies analyzed the diversities between immunotherapy-sensitive and immunotherapy-resistant cohorts,evidencing that particular GM profiles were closely associated to treatment effect.In addition,other data documented that interventional GM modulation could effectively enhance efficacy and relieve resistance during immunotherapy treatment.Diet represents one of the major GM determinants,and ongoing studies are examining the role of the food-gut axis in immunotherapy treatment.Here,we review recent studies that described how variations of the GM affects patient’s responsivity to anti-cancer immunotherapy and how diet-related factors impact on the GM modulation in cancer,outlining potential future clinical directions of these recent findings.

关键词： Immune response Immunotherapy Programmed cell death protein 1 PD-L1 Cancer Gut microbiota High fiber diet

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Effects of viremia and CD4 recovery on gut“microbiome-immunity”axis in treatment-na?ve HIV-1-infected patients undergoing antiretroviral therapy

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World Journal of Gastroenterology 2022年第6期28卷 635-652页

作者： edda Russo Giulia Nannini Gaetana Sterrantino Seble Tekle Kiros Vincenzo Di Pilato Marco Coppi Simone Baldi Elena Niccolai Federica Ricci Matteo Ramazzotti Marco Pallecchi Filippo Lagi Gian Maria Rossolini Alessandro Bartoloni Gianluca Bartolucci Amedeo Amedei Department of Clinical and Experimental Medicine University of FlorenceFlorence 50134Italy Department of Surgical Sciences and Integrated Diagnostics University of GenoaGenoa 16126Italy Department of Biomedical Experimental and Clinical"Mario Serio"University of FlorenceFlorence 50134Italy Microbiology and Virology Unit Florence Careggi University HospitalUniversity of FlorenceFlorence 50134Italy Department of Neurosciences PsychologyDrug Research and Child HealthUniversity of FlorenceFlorence 50019Italy

BACKGROUND Human immunodeficiency virus type 1(HIV-1)infection is characterized by persistent systemic inflammation and immune activation,even in patients receiving effective antiretroviral therapy(ART).Converging data from many cross-sectional studies suggest that gut microbiota(GM)changes can occur throughout including human immunodeficiency virus(HIV)infection,treated by ART;however,the results are contrasting.For the first time,we compared the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression,after 24 wk of ART therapy.In addition,we compared the microbiota composition,microbial metabolites,and cytokine profile of patients with CD4/CD8 ratio1(immunological responders[IRs]),after 24 wk of ART therapy.AIM To compare for the first time the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression(HIV RNA<50 copies/m L)after 24 wk of ART.METHODS We enrolled 12 treatment-na?ve HIV-infected patients receiving ART(mainly based on integrase inhibitors).Fecal microbiota composition was assessed through next generation sequencing.In addition,a comprehensive analysis of a blood broad-spectrum cytokine panel was performed through a multiplex approach.At the same time,serum free fatty acid(FFA)and fecal short chain fatty acid levels were obtained through gas chromatography-mass spectrometry.RESULTS We first compared microbiota signatures,FFA levels,and cytokine profile before starting ART and after reaching virological suppression.Modest alterations were observed in microbiota composition,in particular in the viral suppression condition,we detected an increase of Ruminococcus and Succinivibrio and a decrease of Intestinibacter.Moreover,in the same condition,we also observed augmented levels of serum propionic and buty

关键词： HIV Antiretroviral therapy Microbiome-immunity axis Microbiota Cytokines Short chain fatty acid Inflammation Immunological responders Viremia

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Effect of ancient Khorasan wheat on gut microbiota,inflammation,and short-chain fatty acid production in patients with fibromyalgia

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World Journal of Gastroenterology 2022年第18期28卷 1965-1980页

作者： Simone Baldi Giuditta Pagliai Monica Dinu Leandro Di Gloria Giulia Nannini Lavinia Curini Marco Pallecchi edda Russo Elena Niccolai Giovanna Danza Stefano Benedettelli Giovanna Ballerini Barbara Colombini Gianluca Bartolucci Matteo Ramazzotti Francesco Sofi Amedeo Amedei Department of Experimental and Clinical Medicine University of FlorenceFlorence 50134Italy Unit of Clinical Nutrition Careggi University HospitalFlorence 50134Italy Department of Neurosciences PsychologyDrug Research and Child HealthSection of Pharmaceutical and Nutraceutical SciencesUniversity of FlorenceSesto Fiorentino 50019Italy Department of Biomedical Experimental and Clinical Sciences“Mario Serio”University of FlorenceFlorence 50134Italy Department of Agriculture FoodEnvironment and ForestryUniversity of FlorenceFlorence 50144Italy Multidisciplinary Center for Pain Therapy Reference Center for FibromyalgiaPiero Palagi HospitalUSL Toscana CentroFlorence 50122Italy SOD of Interdisciplinary Internal Medicine Careggi University HospitalFlorence 50134Italy

BACKGROUND Fibromyalgia(FM)syndrome is mainly characterized by widespread pain,sleeping disorders,fatigue,and cognitive dysfunction.In many cases,gastrointestinal distress is also reported,suggesting the potential pathogenic role of the gut microbiota(GM).The GM is deeply influenced by several environmental factors,especially the diet,and recent findings highlighted significant symptom improvement in FM patients following various nutritional interventions such as vegetarian diet,low-fermentable oligosaccharides,disaccharides,monosaccharides,and polyols based diets,gluten-free diet,and especially an ancient grain supplementation.In particular,a recent study reported that a replacement diet with ancient Khorasan wheat led to an overall improvement in symptom severity of FM patients.AIM To examine the effects of ancient Khorasan wheat on the GM,inflammation,and short-chain fatty acid production in FM patients.METHODS After a 2-wk run-in period,20 FM patients were enrolled in this randomized,double-blind crossover trial.In detail,they were assigned to consume either Khorasan or control wheat products for 8 wk and then,following an 8-wk washout period,crossed.Before and after treatments,GM characterization was performed by 16S rRNA sequencing while the fecal molecular inflammatory response and the short-chain fatty acids(SCFAs)were respectively determined with the Luminex MAGPIX detection system and a mass chromatography-mass spectrometry method.RESULTS The Khorasan wheat replacement diet,in comparison with the control wheat diet,had more positive effects on intestinal microbiota composition and on both the fecal immune and SCFAs profiles such as the significant increase of butyric acid levels(P=0.054),candidatus Saccharibacteria(P=9.95e-06)and Actinobacteria,and the reduction of Enterococcaceae(P=4.97e-04).Moreover,the improvement of various FM symptoms along with the variation of some gut bacteria after the Khorasan wheat diet have been documented;in fact we reported positive correlations between Actinobacteria and

关键词： Fibromialgya Gut microbiota Khorasan wheat Fibromialgya symptoms Ancient wheat

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