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Third-line rescue therapy for Helicobacter pylori infection

World Journal of Gastroenterology 2006年第15期12卷 2313-2319页

作者： rossella cianci Massimo Montalto Franco Pandolfi Giovan Battista Gasbarrini Giovanni Cammarota Department of Internal Medicine Endoscopy Unit Catholic University of Sacred HeartRomeItaly

H pylori gastric infection is one of the most prevalent infectious diseases worldwide. The discovery that most upper gastrointestinal diseases are related to Hpylori infection and therefore can be treated with antibiotics is an important medical advance. Currently, a first-line triple therapy based on proton pump inhibitor （PPI） or ranitidine bismuth citrate （RBC） plus two antibiotics （darithromycin and amoxicillin or nitroimidazole） is recommended by all consensus conferences and guidelines. Even with the correct use of this drug combination, infection can not be eradicated in up to 23% of patients. Therefore, several second line therapies have been recommended. A 7 d quadruple therapy based on PPI, bismuth, tetracycline and metronidazole is the more frequently accepted. However, with second-line therapy, bacterial eradication may fail in up to 40% of cases. When Hpylori eradication is striclly indicated the choice of further treatment is controversial. Currently, a standard third-line therapy is lacking and various protocols have been proposed. Even after two consecutive failures, the most recent literature data have demonsbated that Hpylori eradication can be achieved in almost all patients, even when antibiotic susceptibility is not tested. Different possibilities of empirical treatment exist and the available third-line strategies are herein reviewed.

关键词： Helicobacter pylori Third-line rescue therapy Antimicrobial resistance Levofloxacin Rifabutin Furazolidone Doxycycline

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Colon capsule endoscopy: Advantages, limitations and expectations. Which novelties?

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World Journal of Gastrointestinal Endoscopy 2012年第4期4卷 99-107页

作者： Maria Elena Riccioni Riccardo Urgesi rossella cianci Alessandra Bizzotto Cristiano Spada Guido Costamagna Digestive Endoscopy Unit Catholic University 00168 Rome Italy Gastroenterology and Digestive Endoscopy Unit Catholic University of Rome 00168 Rome Italy Institute of Internal Medicine Catholic University 00168 Rome Italy

Since the first reports almost ten years ago, wireless capsule endoscopy has gained new f ields of application. Colon capsule endoscopy represents a new diagnostic technology for colonic exploration. Clinical trials have shown that colon capsule endoscopy is feasible, accurate and safe in patients suffering from colonic diseases and might be a valid alternative to conventional colonoscopy in selected cases such as patients refusing conventional colonoscopy or with contraindications to colonoscopy or when colonoscopy is incomplete. Despite the enthusiasm surrounding this new technique, few clinical and randomized controlled trials are to be found in the current literature, leading to heterogeneous or controversial results. Upcoming studies are needed to prove the substantial utility of colon capsule endoscopy for colon cancer screening, especially in a low prevalence of disease population, and for other indications such as inflammatory bowel disease. Possible perspectives are critically analysed and reported in this paper.

关键词： Colonoscopy Colorectal cancer Inflammatory bowel disease PillCam colon capsule Polyps Preparation

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Negative capsule endoscopy in patients with obscure gastrointestinal bleeding reliable: Recurrence of bleeding on long-term follow-up

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World Journal of Gastroenterology 2013年第28期19卷 4520-4525页

作者： Maria Elena Riccioni Riccardo Urgesi rossella cianci Gianluca Rizzo Luca D'Angelo Riccardo Marmo Guido Costamagna Digestive Endoscopy Unit Catholic University of Rome 00168 Rome Italy Gastroenterology and Digestive Endoscopy Unit Ospedale Belcolle 01100 Viterbo Italy Department of Internal Medicine Catholic University of Rome 00168 Rome Italy Department of Surgery Catholic University of Rome 00168 Rome Italy Department of Neurosurgery Ospedale Belcolle 01100 Viterbo Italy Gastroenterology Unit Ospedale di Polla 84035 Polla Salerno Italy

AIM: To assess the rate of recurrent bleeding of the small bowel in patients with obscure bleeding already undergone capsule endoscopy (CE) with negative results. METHODS: We reviewed the medical records related to 696 consecutive CE performed from December 2002 to January 2011, focusing our attention on patients with recurrence of obscure bleeding and negative CE. Evaluating the patient follow-up, we analyzed the recurrence rate of obscure bleeding in patient with a negative CE. Actuarial rates of rebleeding during follow-up were calculated, and factors associated with rebleeding were assessed through an univariate and multivariate analysis. A P value of less than 0.05 was regarded as statistically significant. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of negative CE were calculated. RESULTS: Two hundred and seven out of 696 (29.7%) CE studies resulted negative in patient with obscure/overt gastrointestinal bleeding. Overall, 489 CE (70.2%) were positive studies. The median follow-up was 24 mo (range 12-36 mo). During follow-up, recurrence of obscure bleeding was observed only in 34 out of 207 negative CE patients (16.4%); 26 out of 34 with obscure overt bleeding and 8 out of 34 with obscure occult bleeding. The younger age (< 65 years) and the onset of bleeding such as melena are independent risk factors of rebleeding after a negative CE (OR = 2.6703, 95%CI: 1.1651-6.1202, P = 0.0203; OR 4.7718, 95%CI: 1.9739-11.5350, P = 0.0005). The rebleeding rate (CE+ vs CE-) was 16.4% vs 45.1% (χ 2 test, P = 0.00001). The sensitivity, specificity, and PPV and NPV were 93.8%, 100%, 100%, 80.1%, respectively. CONCLUSION: Patients with obscure gastrointestinal bleeding and negative CE had a significantly lower rebleeding rate, and further invasive investigations can be deferred.

关键词： Capsule endoscopy Enteroscopy Anemia Obscure gastrointestinal bleeding Rebleeding

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Current status of device-assisted enteroscopy: Technical matters, indication, limits and complications

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World Journal of Gastrointestinal Endoscopy 2012年第10期4卷 453-461页

作者： Riccioni Maria Elena Urgesi Riccardo cianci rossella Alessandra Bizzotto Galasso Domenico Costamagna Guido Unit of Digestive Endoscopy Catholic University of Rome Largo A Gemelli 00168 Rome Italy Unit of Gastroenterology and Digestive Endoscopy Belcolle Hospital 01100 Viterbo Italy Unit of Internal Medicine Catholic University of Rome Largo A Gemelli 00168 Rome Italy Unit of Digestive Endoscopy Catholic University of RomeLargo A Gemelli 00168 Rome Italy

Enteroscopy, defined as direct visualization of the smallbowel with the use of a fiberoptic or capsule endoscopy, has progressed considerably over the past severalyears. The need for endoscopic access to improvediagnosis and treatment of small bowel disease hasled to the development of novel technologies one ofwhich is noninvasive, the video capsule, and a type of invasive technique, the deviceassisted *** particular, the device-assisted enteroscopy consiststhen of three different types of instruments all able toallow, in skilled hands, to display partially or throug-hout its extension (if necessary) the small *** devices, double balloon, single balloon and spiral endoscopy, are just entering clinical use. The aim of this article is to review recent advances in small bowelenteroscopy, focusing on indications, modifications toimprove imaging and techniques, pitfalls, and clinical applications of the new instruments. With new technologies, the trials and tribulations of learning new endo-scopic skills and determining their role in the diagnosisand treatment of small bowel disease come. Identification of small bowel lesions has dramatically *** are underway to determine the best strategy toapply new enteroscopy technologies for the diagnosisand management of small bowel disease, particularly obscure bleeding. Vascular malformations such as angiectasis and small bowel neoplasms as adenocar cinomaor gas trointestinal stromal tumors. Complete entero-scopy of the small bowel is now possible. However, because of the length of the small bowel, endoscopic examination and the rapeutic maneuvers require significant skill, radiological assistance, the use of deep sedation with the assistance of the anesthetist. Prospective ran-domized studies are needed to guide diagnostic testing and the rapy with these new endoscopic techniques.

关键词： Device-assisted enteroscopy Double balloon Single balloon Spiral endoscopy

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