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Azathioprine monotherapy withdrawal in inflammatory bowel diseases: A retrospective mono-centric study

World Journal of Gastroenterology 2023年第27期29卷 4334-4343页

作者： Martina Crepaldi Daria Maniero Alessandro Massano Margherita Pavanato Brigida Barberio edoardo vincenzo savarino Fabiana Zingone Department of Surgery Oncologyand GastroenterologyUniversity of PaduaPadua 35128Italy

BACKGROUND There is no consensus on the recommended duration of and optimal time to stop azathioprine(AZA)therapy in inflammatory bowel disease(IBD).Determining the optimal duration and cessation time can help to balance the risks of long-term intake with the possibility of relapse after *** To describe the events following AZA *** Retrospective analysis was performed to examine data from adult patients affected by IBD who were followed at the University of Padua and had started but then discontinued AZA between 1995 and *** on therapy duration,reasons for cessation,and type of relapse after cessation were *** regression models were used to estimate the risk of relapse in different *** A total of 133 ulcerative colitis patients and 141 Crohn’s disease patients were *** with AZA was stopped in the 1st year in approximately 34%of patients but was continued for more than 10 years in approximately 10%of *** discontinuation was due to primary failure or disease relapse in 30%of patients and due to disease remission in 25.2%of *** of the remaining cases stopped AZA therapy due to side effects(primarily clinical intolerance,cytopenia,and pancreatic disease).Patients who stopped AZA for clinical remission had an 83%lower risk of relapse during the observation time than other groups,with a relapse-free rate of 89%after 1 year and 79%after 2 *** AZA administration is effective and safe,but it requires careful monitoring for potential minor and major side *** 10%of patients who achieved remission with AZA needed a new treatment within 1 year of drug interruption.

关键词： Azathioprine Inflammatory bowel diseases Ulcerative Colitis Crohn's Disease Relapse Side effects

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Glucose transporter expression in the human colon

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World Journal of Gastroenterology 2018年第7期24卷 775-793页

作者： Flavia Merigo Alessandro Brandolese Sonia Facchin Silvia Missaggia Paolo Bernardi Federico Boschi Renata D’Incà edoardo vincenzo savarino Andrea Sbarbati Giacomo Carlo Sturniolo Department of Neuroscience Biomedicine and Movement Human Anatomy and Histology Section University of Verona Department of Medicine Gastroen-terology Section University of Verona Department of Surgery Oncology and Gastroenterology Gastroenterology Section University Hospital of Padua Department of Computer Science University of Verona

AIM To investigate by immunostaining glucose transporter expression in human colorectal mucosa in controls and patients with inflammatory bowel disease(IBD). METHODS Colorectal samples were obtained from patients undergoing lower endoscopic colonoscopy or rectosigmoidoscopy. Patients diagnosed with ulcerativecolitis(n = 18) or Crohn's disease(n = 10) and scheduled for diagnostic colonoscopy were enrolled. Patients who underwent colonoscopy for prevention screening of colorectal cancer or were followed-up after polypectomy or had a history of lower gastrointestinal symptoms were designated as the control group(CTRL, n = 16). Inflammatory status of the mucosa at the sampling site was evaluated histologically and/or endoscopically. A total of 147 biopsies of colorectal mucosa were collected and processed for immunohistochemistry analysis. The expression of GLUT2, SGLT1, and GLUT5 glucose transporters was investigated using immunoperoxidase labeling. To compare immunoreactivity of GLUT5 and LYVE-1, which is a marker for lymphatic vessel endothelium, doublelabeled confocal microscopy was used. RESULTS Immunohistochemical analysis revealed that GLUT2, SGLT1, and GLUT5 were expressed only in short epithelial portions of the large intestinal mucosa. No important differences were observed in glucose transporter expression between the samples obtained from the different portions of the colorectal tract and between the different patient groups. Unexpectedly, GLUT5 expression was also identified in vessels, mainly concentrated in specific areas where the vessels were clustered. Immunostaining with LYVE-1 and GLUT5 antibodies revealed that GLUT5-immunoreactive(-IR) clusters of vessels were concentrated in areas internal to those that were LYVE-1 positive. GLUT5 and LYVE-1 did not appear to be colocalized but rather showed a close topographical relationship on the endothelium. Based on their LYVE-1 expression, GLUT5-IR vessels were identified as lymphatic. Both inflamed and nonin

关键词： Ulcerative colitis Colon Crohn’s disease Glucose transporter LYVE-1,Immunohistochemistry

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Esophageal testing: What we have so far

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World Journal of Gastrointestinal Pathophysiology 2016年第1期7卷 72-85页

作者： Nicola de Bortoli Irene Martinucci Lorenzo Bertani Salvatore Russo Riccardo Franchi Manuele Furnari Salvatore Tolone Giorgia Bodini Valeria Bolognesi Massimo Bellini vincenzo savarino Santino Marchi edoardo vincenzo savarino Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa Gastroenterology Unit Department of Internal MedicineUniversity of Genoa Surgery Unit Department of SurgerySecond University of Naples Gastroenterology Unit Department SurgeryOncology and GastroenterologyUniversity of Padua

Gastroesophageal reflux disease(GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry(HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h p H-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and p H monitoring can detect acid and non-acid reflux events. Endo FLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal p H-metry. Future studies are required of these techniques to evaluate their diagnostic accuracy and usefulness, although the available data are promising.

关键词： Gastroesophageal reflux disease Highresolution manometry Multichannel impedance and pH BRAVO EndoFLIP PEP-test Restech

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Albumin-bilirubin score in non-malignant liver diseases should be properly validated

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World Journal of Gastroenterology 2023年第46期29卷 6089-6091页

作者： Andrea Pasta Francesco Calabrese Maria Corina Plaz Torres Giorgia Bodini Manuele Furnari edoardovincenzo savarino vincenzo savarino edoardo Giovanni Giannini Elisa Marabotto Gastroenterology Unit Department of Internal MedicineUniversity of GenoaIRCCS‐Ospedale Policlinico San MartinoGenoa 16132Italy Department of Surgery Oncology and GastroenterologyUniversity Hospital of PaduaPadua 35128Italy

The albumin-bilirubin(ALBI)score to assess the risk of decompensation in patients with initially compensated cirrhosis may improve their prognostic *** letter critically evaluates the research,which utilizes the ALBI score to forecast decompensation in cirrhosis patients over a three-year *** score was initially developed to assess liver function in hepatocellular carcinoma,its prognostic utility for non-malignant liver diseases has now been explored,recognizing decompensation as a pivotal event that significantly affects patient’s *** concerns regarding the methodology of this research may be raised,particularly the exclusive use of radiological diagnosis,potentially including patients without definite cirrhosis and thus skewing the decompensation risk *** reported predominance of variceal bleeding as a decompensating event conflicts with established literature,that often reports ascites as the initial decompensation *** letter highlights the absence of details on esophageal varices and their management,which could introduce bias in evaluating the ALBI score's predictive ***,the letter points out the small sample size of patients with high-risk ALBI grades,potentially compromising the score's validity in this *** suggest prospective future research to investigate the dynamic changes in the ALBI score over time to reinforce the validity of the ALBI score as a predictor of decompensation in non-malignant liver disease.

关键词： Albumin-bilirubin score Decompensated cirrhosis Liver disease Nonmalignant liver disease Portal hypertension

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Alginate controls heartburn in patients with erosive and nonerosive reflux disease

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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 ***: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 *** were studied for 1 h under basal conditions and 1 h after taking 10 mL *** both sessions,measurements were obtained in right lateral and supine decubitus *** 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 *** 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 t

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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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：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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Remote sensing ***-based monitoring of agricultural terrace degradation

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International Soil and Water Conservation Research 2021年第1期9卷 1-10页

作者： Anton Pijl edoardo Quarella Teun A.Vogel vincenzo D'Agostino Paolo Tarolli Dept.of Land EnvironmentAgriculture and ForestryUniversity of PadovaVialedell'Università1635020LegnaroPDItaly Soil Physics and Land Management Group Wageningen UniversityDroevendaalsesteeg 46708PBWageningenthe Netherlands

The degradation of agricultural terraces is considered a major challenge to soil and water conservation in steep-slope *** terracing is a widespread conservation practice,its sustainability is threatened by adverse climatic and man-made *** studies have shown the impact of terrace designs on the formation of runoff pathways,causing degradation processes on terrace platforms(*** erosion)and walls(***,landslides,collapse).This study evaluates a remote sensing versus a field-based approach to monitor hydrological processes responsible for terrace degradation,as tested in a north-Italian *** field-based approach was based on spatially measured Soil Moisture Content(SMC)using a Time Domain Reflectometry(TDR)instrument,which clearly revealed saturation hotspots around two damaged terraces in the study ***,these zones showed a particular cross-sectional SMC profile,with the highest saturation close to the terrace platform *** remote sensing approach was based on aerial imagery acquired by an Unmanned Aerial Vehicle(UAV)and photogrammetric reconstruction of the vineyard geomorphology,allowing terrain-based analysis and physical erosion *** this approach,simulations indicated that terrace damages could be partly explained by the formation of preferential runoff pathways caused by the terrace *** parallel methodology allowed a comparison of the merits and limitations of either approach,as done in light of published *** occurrence of two SMC hotspots at terrace edges(and their non-typical cross-sectional profiles)could be better understood from simulated surface flow *** the causal relationship between heterogeneous soil saturation and terrace instability has been previously reported in literature,the novelty of the presented study is the use of topsoil SMC as an indicator of potential damages,favouring the scalability compared to fixed,local and often intrusive terrace sub-sur

关键词： Agricultural terraces Remote sensing UAV Soil moisture Land degradation

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Noncoding RNAs as drivers of the phenotypic plasticity of oesophageal mucosa

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World Journal of Gastroenterology 2017年第43期23卷 7653-7656页

作者： Matteo Fassan Sonia Facchin Giada Munari Giuseppe Nicolò Fanelli Greta Lorenzon edoardo savarino Surgical Pathology Unit Department of MedicineUniversity of Padua Gas-troenterology Unit Department of Surgical Oncology and GastroenterologyUniversity of Padua

The histological commitment of the lower oesophageal mucosa largely depends on a complex molecular landscape. After extended inflammatory insult due to gastroesophageal reflux disease,squamous oesophageal mucosa may differentiate into columnar metaplastic mucosa. In this setting,the presence of intestinal metaplasia is considered the starting point of Barrett's carcinogenetic cascade. Aside from secondary prevention strategies for Barrett's mucosa(BM) patients,there are multiple endoscopic ablative therapies available for BM eradication and for the replacement of metaplastic epithelia with a neosquamous mucosa. However,BM frequently recurs in a few years,which supports the notable phenotypic plasticity of the oesophageal mucosa. In recent years,several reports pinpointed a class of small noncoding RNAs,the micro RNAs(mi RNAs),as principal effectors and regulators of oesophageal mucosa metaplastic(and neoplastic) transformation. Because of mi RNAs notable stability in fixed archival diagnostic specimens,expression profiling of mi RNAs represent an innovative diagnostic,prognostic and predictive tool in the stratification of phenotypic alterations in the oesophageal mucosa.

关键词： Barretts mucosa Biomarkers Noncoding RNA MicroRNAs 组织变形

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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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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 ***,data establishing a solid link between FH and IBS are lacking,mainly because the clinical definition of FH has undergone substantial changes over 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 *** 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 *** of these critical issues,there is preliminary evidence supporting a significantdegree of FH-IBS *** underscores the need for studies based on updated diagnostic criteria and accurate pathophysiological classifications,particularly to distinguish FH from *** 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 *** 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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