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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 ***: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： Impedance pH-metry Nonerosive reflux disease Erosive esophagitis Nonacid reflux Proximal reflux

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

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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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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： Laryngopharyngeal reflux Gastroesophageal reflux Multichannel impedance and pH monitoring Extra-esophageal reflux syndromes Chronic laryngitis

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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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Outcome of nonerosive gastro-esophageal reflux disease patients with pathological acid exposure

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World Journal of Gastroenterology 2009年第45期15卷 5700-5705页

作者： Fabio Pace Stefano Pallotta Gianpiero Manes Annalisa de Leone Patrizia Zentilin Luigi Russo vincenzo savarino Matteo Neri Enzo Grossi Rosario Cuomo Division of Gastroenterology Department of Clinical Sciences "L. Sacco" University HospitalVia G. B. Grassi 74-20157 MilanoItaly Gastroenterology Unit D.I.M.I University of GenovaViale Benedetto XV 6 16132 Genova Italy Gastroenterology Unit Dip. Med. Clin e Sper. AOU Federico ⅡVia S. Pansini 5 80131 Napoli Italy Department of Medicine and Aging Sciences and Ce.S.I "G. D'Annunzio" University & FoundationVia dei Vestini 31 66013 Chieti Italy Department of Medical Bracco Imaging SpAVia XXV Aprile 4 20097 San Donato Milanese Milano Italy

AIM： To assess the management and outcome of nonerosive gastro-esophageal reflux disease （NERD） patients who were identified retrospectively, after a 5-year follow-up. METHODS： We included patients with gastro-esophageal reflux disease （GERD） symptoms who had a negative endoscopy result and pathological 24-h esophageal pH-monitoring while off therapy. We interviewed them after an average period of 5 years （range 3.5-7 years） by means of a structured questionnaire to assess presence of GERD symptoms, related therapy, updated endoscopic data and other features. We assessed predictors of esophagitis development by means of univariate and multivariate statistical analysis. RESULTS： 260 patients （137 women） were included. Predominant GERD symptoms were heartburn and regurgitation in 103/260 （40%）. 70% received a maintenance treatment, which was proton pump inhibitor （PPI） in 55% of cases. An average number of 1.5 symptomatic relapses per patient/year of follow-up were observed. A progression to erosive gastro-esophageal reflux disease （ERD） was found in 58/193 （30.0%） of patients undergoing repeat endoscopy; 72% of these were Los Angeles grade A-B. CONCLUSION： This study to ERD occurs in about 5% shows that progression of NERD cases per year, despite therapy. Only two factors consistently and independently influence progression： smoking and absence of PPI therapy.

关键词： Esophagus Nonerosive gastro-esophageal reflux disease Gastro-esophageal reflux disease Epidemiology Acidity

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Therapeutic potential of curcumin in digestive diseases

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World Journal of Gastroenterology 2013年第48期19卷 9256-9270页

作者： Pietro Dulbecco vincenzo savarino Department of Internal Medicine and Medical Specialties University of Genoa 16132 Genoa Italy

Curcumin is a low-molecular-weight hydrophobic polyphenol that is extracted from turmeric,which possesses a wide range of biological properties including anti-inflammatory,anti-oxidant,anti-proliferative and anti-microbial *** its diverse targets and substantial safety,clinical applications of this molecule for digestive disorders have been largely limited to case series or small clinical *** poor bioavailability of curcumin is likely the major hurdle for its more widespread use in ***,complexation of curcumin into phytosomes has recently helped to bypass this problem,as it has been demonstrated that this new lecithin formulation enables increased absorption to a level 29-fold higher than that of traditional curcuminoid *** allows us to achieve much greater tissue substance delivery using significantly lower doses of curcumin than have been used in past clinical *** curcumin has already been shown to provide good therapeutic results in some small studies of both inflammatory and neoplastic bowel disorders,it is reasonable to anticipate an even greater efficacy with the advent of this new technology,which remarkably improves its *** features are very promising and may represent a novel and effective therapeutic approach to both functional and organic digestive diseases.

关键词： Curcumin Curcumin-phythosome Curcumin bioavailability Digestive disorders

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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 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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Narrow-band imaging with magnifying endoscopy is accurate for detecting gastric intestinal metaplasia

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World Journal of Gastroenterology 2013年第17期19卷 2668-2675页

作者： Edoardo savarino Marina Corbo Pietro Dulbecco Lorenzo Gemignani Elisa Giambruno Luca Mastracci Federica Grillo vincenzo savarino Gastroenterology Unit Department of Surgical Oncological and Gastroenterological Sciences University of Padua Gastroenterology Unit Department of Internal Medicine University of Genoa Department of Anatomic Pathology University of Genoa

AIM:To investigate the predictive value of narrowband imaging with magnifying endoscopy (NBI-ME) for identifying gastric intestinal metaplasia (GIM) in unselected patients. METHODS:We prospectively evaluated consecutive patients undergoing upper endoscopy for various indications, such as epigastric discomfort/pain, anaemia, gastro-oesophageal reflux disease, suspicion of peptic ulcer disease, or chronic liver diseases. Patients underwent NBI-ME, which was performed by three blinded, experienced endoscopists. In addition, five biopsies (2 antrum, 1 angulus, and 2 corpus) were taken and examined by two pathologists unaware of the endoscopic findings to determine the presence or absence of GIM. The correlation between light blue crest (LBC) appearance and histology was measured. Moreover, we quantified the degree of LBC appearance as less than 20% (+), 20%-80% (++) and more than 80% (+++) of an image field, and the semiquantitative evaluation of LBC appearance was correlated with IM percentage from the histological findings. RESULTS:We enrolled 100 (58 F/42 M) patients who were mainly referred for gastro-esophageal reflux disease/dyspepsia (46%), cancer screening/anaemia (34%), chronic liver disease (9%), and suspected celiac disease (6%); the remaining patients were referred for other indications. The prevalence of Helicobacter pylori (H. pylori ) infection detected from the biopsies was 31%, while 67% of the patients used proton pump inhibitors. LBCs were found in the antrum of 33 patients (33%); 20 of the cases were classified as LBC+, 9 as LBC++, and 4 as LBC+++. LBCs were found in the gastric body of 6 patients (6%), with 5 of them also having LBCs in the antrum. The correlation between the appearance of LBCs and histological GIM was good, with a sensitivity of 80% (95%CI:67-92), a specificity of 96% (95%CI:93-99), a positive predictive value of 84% (95%CI:73-96), a negative predictive value of 95% (95%CI:92-98), and an accuracy of 93% (95%CI:90-97). The NBI-ME ex

关键词： Narrow-band imaging Magnification Gastric intestinal metaplasia Light blue crest Gastric cancer Endoscopy Precancerous conditions Gastric biopsy

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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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