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| 1 | New fecal test for non-invasive Helicobacter pylori detection:A diagnostic accuracy study显示文摘AIM To assess the diagnostic accuracy of a new fecal test for detecting Helicobacter pylori(H. pylori), using ^(13)Curea breath test as the reference standard, and explore bacterial antibiotic resistance. METHODS We conducted a prospective two-center diagnostic test accuracy study. We enrolled consecutive people≥ 18 years without previous diagnosis of H. pylori infection, referred for dyspepsia between February and October 2017. At enrollment, all participants underwent 13 C-urea breath test. Participants aged over 50 years were scheduled to undergo upper endoscopy with histology. Participants collected stool samples 1-3 d after enrollment for a new fecal investigation(THD fecal test). The detection of bacterial 23 S rRNA subunit gene indicated H. pylori infection. We also used the index diagnostic test to examine mutations conferring resistance to clarithromycin and levofloxacin. Independent investigators analyzed index test and reference test standard results blinded to the other test findings. We estimated sensitivity, specificity, positive(PPV) and negative(NPV) predictive value, diagnostic accuracy, positive and negative likelihood ratio(LR), together with 95% confidence intervals(CI).RESULTS We enrolled 294 consecutive participants(age: Median 37.0 years, IQR: 29.0-46.0 years; men: 39.8%). Ninetyfive(32.3%) participants had a positive ^(13)C-urea breath test. Twenty-three(7.8%) participants underwent upper endoscopy with histology, with a full concordance between ^(13)C-urea breath test and histology in detecting H. pylori infection. Four(1.4%) out of the 294 participants withdrew from the study after the enrollment visit and did not undergo THD fecal testing. In the 290 participants who completed the study, the THD fecal test sensitivity was 90.2%(CI: 84.2%-96.3%), specificity 98.5%(CI:96.8%-100%), PPV 96.5%(CI: 92.6%-100%), NPV 95.6%(CI: 92.8%-98.4%), accuracy 95.9%(CI: 93.6%-98.2%), positive LR 59.5(CI: 19.3-183.4), negative LR 0.10(CI: 0.05-0.18). Out of 83 infected participants identified with the THD fecal test, 34(41.0%) had bacterial genotypic changes consistent with antibiotic-resistant H. pylori infection. Of these, 27(32.5%) had bacterial strains resistant to clarithromycin, 3(3.6%) to levofloxacin, and 4(4.8%) to both antibiotics. CONCLUSION The THD fecal test has high performance for the non-invasive diagnosis of H. pylori infection while additionally enabling the assessment of bacterial antibiotic resistances. | Andrea Iannone Floriana Giorgio Francesco Russo Giuseppe Riezzo Bruna Girardi Maria Pricci Suetonia C Palmer Michele Barone Mariabeatrice Principi Giovanni FM Strippoli Alfredo Di Leo Enzo Ierardi | 2018 | World Journal of Gastroenterology2018，24，27： | 5 |
| 2 | HBsAg clearance by Peg-interferon addition to a long-term nucleos(t)ide analogues therapy显示文摘The ideal endpoint of hepatitis B virus(HBV)antiviral therapy is HBsAg loss,a difficult goal to obtain,especially in HBeAg negative patients.Herein,we report the results obtained by the addition of peg-interferonα-2a to a long-lasting nucleos(t)ide analogues therapy in a HBeAg negative,genotype D patient with steadily HBV-DNA negative/HBsAg positive values.In 2002,our Caucasian 44-year-old male patient received lamivudine and,4 years later,added adefovir because of a virological breakthrough.In 2011,considering his young age,liver stiffness(4.3 kPa)and HBsAg levels(3533IU/mL),we added Peg-interferonα-2a for six months(3in combination with nucleos(t)ide analogues followed by 3 mo of Peg-interferonα-2a monotherapy).A decrease of HBsAg levels was observed after 1 mo(1.21log)of Peg-interferon and 3 mo(1.88 log)after the discontinuation of all drugs.Later,a complete clearance of HBsAg was obtained with steadily undetectable HBVDNA serum levels(<9 IU/mL).HBsAg clearance by the addition of a short course of Peg-interferonα-2a represents an important result with clinical and pharmacoeconomic implications,considering that nucleos(t)ide analogues therapy in HBeAg negative chronic hepatitis B patients is considered a long-lasting/life-long treatment. | Michele Barone Andrea Iannone Alfredo Di Leo | 2014 | World Journal of Gastroenterology2014，20，26： | 5 |
| 3 | Noninvasive molecular analysis of Helicobacter pylori : Is it time for tailored first-line therapy?显示文摘The main problem of Helicobacter pylori(H. pylori) infection management is linked to antibiotic resistances. This phenomenon has grown in the last decade, inducing a dramatic decline in conventional regimen effectiveness. The causes of resistance are point mutations in bacterial DNA, which interfere with antibiotic mechanism of action, especially clarithromycin and levofloxacin. Therefore, international guidelines have recently discouraged their use in areas with a relevant resistance percentage, suggesting first-line schedules with expected high eradication rates, i.e., bismuth containing or non-bismuth quadruple therapies. These regimens require the daily assumption of a large number of tablets. Consequently, a complete adherence is expected only in subjects who may be motivated by the presence of major disorders. However, an incomplete adherence to antibiotic therapies may lead to resistance onset, since sub-inhibitory concentrations could stimulate the selection of resistant mutants. Of note, a recent meta-analysis suggests that susceptibility tests may be more useful for the choice of first than second-line or rescue treatment. Additionally, susceptibility guided therapy has been demonstrated to be highly effective and superior to empiric treatments by both meta-analyses and recent clinical studies. Conventional susceptibility test is represented by culture and antibiogram. However, the method is not available everywhere mainly for methodology-related factors and fails to detect hetero-resistances. Polymerase chain reaction(PCR)-based, culture-free techniques on gastric biopsy samples are accurate in finding even minimal traces of genotypic resistant strains and hetero-resistant status by the identification of specific point mutations. The need for an invasive endoscopic procedure has been the most important limit to their spread. A further step has, moreover, been the detection of point mutations in bacterial DNA fecal samples. Few studies on clarithromycin susceptibility have shown an overall high sensitivity and specificity when compared with culture or PCR on gastric biopsies. On these bases, two commercial tests are now available although they have shown some controversial findings. A novel PCR method showed a full concordance between tissue and stool results in a preliminary experience. In conclusion, despite poor validation, there is increasing evidence of a potential availability of noninvasive investigations able to detect H. pylori resistances to antibiotics. These kinds of analysis are currently at a very early phase of development and caution should be paid about their clinical application. Only further studies aimed to evaluate their sensitivity and specificity will afford novel data for solid considerations. Nevertheless, noninvasive molecular tests may improve patient compliance, time/cost of infection management and therapeutic outcome. Moreover, the potential risk of a future increase of resistance to quadruple regimens as a consequence of their use on large scale and incomplete patient adherence could be avoided. | Enzo Ierardi Floriana Giorgio Andrea Iannone Giuseppe Losurdo Mariabeatrice Principi Michele Barone Antonio Pisani Alfredo Di Leo | 2017 | World Journal of Gastroenterology2017，23，14： | 3 |
| 4 | Novel frontiers of agents for bowel cleansing for colonoscopy显示文摘The incidence of colorectal cancer(CRC)is characterized by rapid declines in the wake of widespread screening.Colonoscopy is the gold standard for CRC screening,but its accuracy is related to high quality of bowel preparation(BP).In this review,we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy.Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’acceptability.The role of the diet before colonoscopy was also changed,as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’tolerance and/or quality of BP.The review also described BP in special situations,as lower gastrointestinal bleeding,elderly people,patients with chronic kidney disease,patients with inflammatory bowel disease,patients with congestive heart failure,inpatient,patient with previous bowel resection,pregnant/lactating patients.The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales.Finally,the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota.Moreover,the study underlined several points needed to further investigations. | Milena Di Leo Andrea Iannone Monica Arena Giuseppe Losurdo Maria Angela Palamara Giuseppe Iabichino Pierluigi Consolo Maria Rendina Carmelo Luigiano Alfredo Di Leo | 2021 | World Journal of Gastroenterology2021，27，45： | 2 |
| 5 | Extra-intestinal manifestations of non-celiac gluten sensitivity: an expanding paradigm显示文摘Non celiac gluten sensitivity(NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not affected by celiac disease(CD) or wheat allergy. The possibility of systemic manifestations in this condition has been suggested by some reports. In most cases they are characterized by vague symptoms such as ‘foggy mind', headache, fatigue, joint and muscle pain, leg or arm numbness even if more specific complaints have been described. NCGS has an immune-related background. Indeed there is a strong evidence that a selective activation of innate immunity may be the trigger for NCGS inflammatory response. The most commonly autoimmune disorders associated to NCGS are Hashimoto thyroiditis, dermatitis herpetiformis, psoriasis and rheumatologic diseases. The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported; it could be a characteristic feature that could help the diagnosis and be simultaneously managed. A possible neurological involvement has been underlined by NCGS association with gluten ataxia, gluten neuropathy and gluten encephalopathy. NCGS patients may show even psychiatric diseases such as depression, anxiety and psychosis. Finally, a link with functional disorders(irritable bowel syndrome and fibromyalgia) is a topic under discussion. In conclusion, the novelty of this matter has generated an expansion of literature data with the unavoidable consequence that some reports are often based on low levels of evidence. Therefore, only studies performed on large samples with the inclusion of control groups will be able to clearly establish whether the large information from the literature regarding extra-intestinal NCGS manifestations could be supported by evidence-based agreements. | Giuseppe Losurdo Mariabeatrice Principi Andrea Iannone Annacinzia Amoruso Enzo Ierardi Alfredo Di Leo Michele Barone | 2018 | World Journal of Gastroenterology2018，24，14： | 2 |
| 6 | Role of concomitant therapy for Helicobacter pylori eradication: A technical note显示文摘We read with interest the recent meta-analysis by Lin et al who evaluated the effectiveness of concomitant regimen for Helicobacter pylori(H. pylori) in Chinese regions. They found that 7-d concomitant regimen is undoubtedly superior to 7-d triple therapy(91.2% vs 77.9%, P < 0.0001). However, it is a common belief that a triple therapy lasting 7 d should be definitively removed from the clinical practice for its ineffectiveness. Only its prolongation to 14 d may give satisfactory success rate. Thus, the assessment of an old and outdated treatment versus a more recent and successful one does not seem to bring novel and useful information. Moreover, a 7-d duration has not been ascertained for concomitant regimen, as main guidelines recommend a 10-d schedule for this scheme. Therefore, only studies comparing 10-d concomitant versus 14-d triple seem to be appropriate according to current Guidelines and would clarify which regimen is the most suitable worldwide. Additionally, in this metaanalysis concomitant and sequential therapy showed similar performances, despite it is common opinion that sequential is more prone than concomitant therapy to fail when metronidazole resistance occurs, and China is characterized by high rate of resistance to this antibiotic. None of the included studies evaluated a priori antibiotic resistances, and the lack of this detail hampers the unveiling of this apparent contradiction. In conclusion, the lack of the evaluation of the quality of included trials as well as their high heterogeneity constitute a burdensome limit to draw solid conclusions in this meta-analysis. On the bases of these considerations and the low number of examined trials, we believe that further studies and the knowledge of antibiotic resistances will support with high quality evidence which is the best regimen and its optimal duration. | Giuseppe Losurdo Floriana Giorgio Andrea Iannone Mariabeatrice Principi Michele Barone Alfredo Di Leo Enzo Ierardi | 2016 | World Journal of Gastroenterology2016，22，38： | 1 |
| 7 | May the assessment of baseline mucosal molecular pattern predict the development of gluten related disorders among microscopic enteritis?显示文摘AIM To evaluate mucosal baseline m RNA expression of tissue transglutaminase 2(t TG2), interferon gamma(IFNγ), toll-like receptor 2(TLR2) and Myeloid Differentiation factor 88(MyD 88) in patients with microscopic enteritis(ME).METHODS We retrospectively enrolled 89 patients with ME of different etiology, which was defined within a 2-year mean period of follow-up. Baseline histological examination was performed on Hematoxylin-Eosin stained sections and CD3 lymphocyte immunohistochemistry was used for intraepithelial lymphocyte count(IELs). ME was defined according to the criteria of Bucharest Consensus Conference. For each patient, formalin embedded biopsy samples of the duodenum referred to the period of ME diagnosis were retrieved. Real-time polymerase chain reaction(RT-PCR) was used to detect the amount of mR NA coding for tT G2, IFNγ, TLR2 and My D88, and the quantity was expressed as fold change compared to controls. Control group was represented by duodenal normal specimens from 15 healthy subjects undergoing endoscopy for functional symptoms. Comparisons among continuous variables were performed by One way analysis of variance(ANOVA) and Bonferroni’s test. The χ~2 test was used for categorical variables. Pearson’s test was used to evaluate correlations. Receiver operating curves were drawn for all four markers to estimate sensitivity and specificity in discriminating the development of CD and GS.RESULTS After a period of follow up of 21.7 ± 11.7 mo, the following diagnoses were achieved: gluten related disorders in 48 subjects(31 CD; 17 GS) and non-gluten related ones in 41(29 Irritable Bowel Syndrome- IBS; 12 Others). CD patients had the highest tT G2 levels(8.3 ± 4.5). The ANOVA plus Bonferroni analysis showed that CD > Other ME > GS = IBS > negative controls. A cut off value of 2.258 was able to discriminate between CD and GS with a sensitivity of 52.94% and a specificity of 87.1%. Additionally, CD patients had the highest IFNγ levels(8.5 ± 4.1). ANOVA plus Bonferroni demonstrated CD > Other ME > GS = IBS > negative controls. A cut off of 1.853 was able to differentiate CD and GS with a sensitivity of 47.06% and a specificity of 96.77%. Patients with non gluten-related causes of ME exhibited the highest TLR2 levels(6.1 ± 1.9) as follows: Other ME > CD = GS = IBS > negative controls. TLR2 was unable to discriminate CD from GS. Patients with CD overexpressed MyD 88 levels similarly to non gluten-related causes of DL(7.8 ± 4.9 and 6.7 ± 2.9), thus CD = Other ME > GS = IBS > negative controls. A cut off of 3.722 was able to differentiate CD from GS with a sensitivity of 52.94% and a specificity of 74.19%. IELs count(15-25 and more than 25/100 enterocytes) strongly correlated with mR NA levels of all tested molecules(P < 0.0001).CONCLUSION Our results confirm that a single marker is unable to predict a discrimination among ME underlying conditions as well as between CD and GS. Mucosal high levels of t TG and IFNγ m RNA may predict the development of CD more than GS with high specificity, despite an expected low sensitivity. TLR2 does not discriminate the development of CD from GS. My D88 levels indicate that intestinal permeability is more increased when a severe intestinal damage underlies ME in both gluten related and unrelated conditions. Therefore, the results of the present paper do not seem to show a clear translational value. | Giuseppe Losurdo Floriana Giorgio Domenico Piscitelli Lucia Montenegro Claudia Covelli Maria Grazia Fiore Antonio Giangaspero Andrea Iannone Mariabeatrice Principi Annacinzia Amoruso Michele Barone Alfredo Di Leo Enzo Ierardi | 2016 | World Journal of Gastroenterology2016，22，35： | 1 |
| 8 | A prospective trial in Saudi Arabia comparing the 14-day standard triple therapy with the 10-day sequential therapy for treatment of Helicobacter pylori infection: A further confirmation of 'Geographic Weight'显示文摘 | Giuseppe Losurdo Andrea Iannone Floriana Giorgio Enzo Ierardi Alfredo Di Leo Mariabeatrice Principi | 2016 | Saudi Journal of Gastroenterology2016，，1： | 1 |
| 9 | Prevalence and associated factors of obesity in inflammatory bowel disease:A case-control study显示文摘BACKGROUND In recent years,an increasing prevalence of obesity in inflammatory bowel disease(IBD)has been observed.Obesity,moreover,has been directly correlated with a more severe clinical course and loss of response to treatment.AIM To assess the prevalence and associated factors of obesity in IBD.METHODS We collected data about IBD disease pattern and activity,drugs and laboratory investigations in our center.Anthropometric measures were retrieved and obesity defined as a body mass index(BMI)>30.Then,we compared characteristics of obese vs non obese patients,and Chi-squared test and Student’s t test were used for discrete and continuous variables,respectively,at univariate analysis.For multivariate analysis,we used binomial logistic regression and estimated odd ratios(OR)and 95%confidence intervals(CI)to ascertain factors associated with obesity.RESULTS We enrolled 807 patients with IBD,either ulcerative colitis(UC)or Crohn’s disease(CD).Four hundred seventy-four patients were male(58.7%);the average age was 46.2±13.2 years;438(54.2%)patients had CD and 369(45.8%)UC.We enrolled 378 controls,who were comparable to IBD group for age,sex,BMI,obesity,diabetes and abdominal circumference,while more smokers and more subjects with hypertension were observed among controls.The prevalence of obesity was 6.9%in IBD and 7.9%in controls(not statistically different;P=0.38).In the comparison of obese IBD patients and obese controls,we did not find any difference regarding diabetes and hypertension prevalence,nor in sex or smoking habits.Obese IBD patients were younger than obese controls(51.2±14.9 years vs 60.7±12.1 years,P=0.03).At univariate analysis,obese IBD were older than normal weight ones(51.2±14.9 vs 44.5±15.8,P=0.002).IBD onset age was earlier in obese population(44.8±13.6 vs 35.6±15.6,P=0.004).We did not detect any difference in disease extension.Obese subjects had consumed more frequently long course of systemic steroids(66.6%vs 12.5%,P=0.02)as well as antibiotics such as metronidazole or ciprofloxacin(71.4%vs 54.7%,P=0.05).No difference about other drugs(biologics,mesalazine or thiopurines)was observed.Disease activity was similar between obese and non obese subjects both for UC and CD.Obese IBD patients suffered more frequently from arterial hypertension,type 2 diabetes,non-alcoholic fatty liver disease.Regarding laboratory investigations,obese IBD patients had higher levels of triglyceridemia,fasting blood glucose,gamma-glutamyl-transpeptidase.On multivariate analysis,however,the only factor that appeared to be independently linked to obesity in IBD was the high abdominal circumference(OR=16.3,95%CI:1.03-250,P=0.04).CONCLUSION Obese IBD patients seem to have features similar to general obese population,and there is no disease-specific factor(disease activity,extension or therapy)that may foster obesity in IBD. | Giuseppe Losurdo Rosa Federica La Fortezza Andrea Iannone Antonella Contaldo Michele Barone Enzo Ierardi Alfredo Di Leo Mariabeatrice Principi | 2020 | World Journal of Gastroenterology2020，26，47： | 1 |
| 10 | Hydradenitis suppurativa and inflammatory bowel disease: An unusual, but existing association显示文摘Inflammatory bowel disease(IBD) could be associated with several extra-intestinal manifestations(EIMs) involving musculoskeletal, hepatopancreatobiliary, ocular, renal, and pulmonary systems, as well as the skin. In the last years, hidradenitis suppurativa(HS) is acquiring an increasing interest. IBD, especially Crohn's disease(CD), is among the most reported associated diseases in HS patients. The aim of this paper is to give a brief overview of data showing a possible epidemiologic and pathogenetic association between IBD and HS. We performed a pooled-data analysis of four studies and pooled prevalence of HS in IBD patients was 12.8%, with a 95%CI of 11.7%-13.9%. HS was present in 17.3% of subjects with CD(95%CI: 15.5%-19.1%) and in 8.5% of UC patients(95%CI: 7.0%-9.9%). Some items, especially altered immune imbalance, are generally involved in IBD pathogenesis as well as invoked by HS. Smoking is one of the most relevant risk factors for both disorders, representing a predictor of their severity, despite, actually, there being a lack of studies analyzing a possible shared pathway. A role for inheritance in HS and CD pathogenesis has been supposed. Despite a genetic susceptibility having been demonstrated for both diseases, further studies are needed to investigate a genetic mutual route. Although the pathogenesis of IBD and HS is generally linked to alterations of the immune response, recent findings suggest a role for intestinal and skin microbiota, respectively. In detail, the frequent finding of Staphylococcus aureus and coagulase-negative staphylococci on HS cutaneous lesions suggests abacterial involvement in disease pathogenesis. Moreover, microflora varies in the different cutaneous regions of the body and, consequently, two different profiles of HS patients have been identified on these bases. On the other hand, it is well-known that intestinal microbiota may be considered as 'the explosive mixture' at the origin of IBD despite the exact relationship having not been completely clarified yet. A better comprehension of the role that some bacterial species play in the IBD pathogenesis may be essential to develop appropriate management strategies in the near future. A final point is represented by some similarities in the therapeutic management of HS and IBD, since they may be controlled by immunomodulatory drugs. In conclusion, an unregulated inflammation may cause the lesions typical of both HS and IBD, particularly when they coexist. However, this is still a largely unexplored field. | Mariabeatrice Principi Nicoletta Cassano Antonella Contaldo Andrea Iannone Giuseppe Losurdo Michele Barone Mario Mastrolonardo Gino Antonio Vena Enzo Ierardi Alfredo Di Leo | 2016 | World Journal of Gastroenterology2016，22，20： | 1 |
| 11 | Quinolone-based first, second and third-line therapies for Helicobacter pylori显示文摘Helicobacter pylori(H. pylori) is a very common bacterium that infects about 50% of the world population in urban areas and over 90% of people living in rural and developing countries. Fluoroquinolones, a class of antimicrobials, have been extensively used in eradication regimens for H. pylori. Levofloxacin is the most commonly used, and in second-line regimens, is one of the most effective options. However, an increasing resistance rate of H. pylori to fluoroquinolones is being observed, that will likely affect their effectiveness in the near future. Other novel fluoroquinolone molecules, such as moxifloxacin, sitafloxacin, gatifloxacin and gemifloxacin, have been proposed and showed encouraging results in vitro, although data on their clinical use are still limited. Further studies in large sample trials are needed to confirm their safety and efficacy profile in clinical practice. | Enzo Ierardi Giuseppe Losurdo Floriana Giorgio Andrea Iannone Mariabeatrice Principi Alfredo Di Leo | 2015 | World Journal of Pharmacology2015，4，4： | 1 |
| 12 | Silymarin,boswellic acid and curcumin enriched dietetic formulation reduces the growth of inherited intestinal polyps in an animal model显示文摘BACKGROUND Some substances of plant origin have been reported to exert an effect in reducing intestinal neoplasm development,especially in animal models.Adenomatous polyposis coli multiple intestinal neoplasia-ApcMin/+is the most studied murine model of genetic intestinal carcinogenesis.AIM To assess whether an enriched nutritional formulation(silymarin,boswellic acid and curcumin)with proven“in vitro”and“in vivo”anti-carcinogenetic properties may prevent inherited intestinal cancer in animal model.METHODS Forty adenomatous polyposis coli multiple intestinal neoplasia-ApcMin/+mice were used for the study of cancer prevention.They were divided into two groups:20 assumed standard and 20 enriched diet.At the 110th d animals were sacrificed.In each group,four subgroups received intraperitoneal bromodeoxyuridine injection at different times(24,48,72 and 96 h before the sacrifice)in order to assess epithelial turnover.Moreover,we evaluated the following parameters:Intestinal polypoid lesion number and size on autoptic tissue,dysplasia and neoplasia areas by histological examination of the whole small intestine,inflammation by histology and cytokine mRNA expression by real-time polymerase chain reaction,bromodeoxyuridine and TUNEL immunofluorescence for epithelial turnover and apoptosis,respectively.Additionally,we performed western blotting analysis for the expression of estrogen alpha and beta receptors,cyclin D1 and cleaved caspase 3 in normal and polypoid tissues.RESULTS Compared to standard,enriched diet reduced the total number(203 vs 416)and the mean±SD/animal(12.6±5.0 vs 26.0±8.8;P<0.001)of polypoid lesions.In enriched diet group a reduction in polyp size was observed(P<0.001).Histological inflammation and pro-inflammatory cytokine expression were similar in both groups.Areas of low-grade dysplasia(P<0.001)and intestinal carcinoma(IC;P<0.001)were significantly decreased in enriched diet group.IC was observed in 100%in standard and 85%in enriched formulation assuming animals.Enriched diet showed a faster epithelial migration and an increased apoptosis in normal mucosa and low-grade dysplasia areas(P<0.001).At western blotting,estrogen receptor beta protein was well expressed in normal mucosa of enriched and standard groups,with a more marked trend associated to the first one.Estrogen receptor alpha was similarly expressed in normal and polypoid mucosa of standard and enriched diet group.Cleaved caspase 3 showed in normal mucosa a stronger signal in enriched than in standard diet.Cyclin D1 was more expressed in standard than enriched diet group of both normal and polypoid tissue.CONCLUSION Our results are suggestive of a chemo-preventive synergic effect of the components(silymarin,boswellic acid and curcumin)of an enriched formulation in inherited IC.This effect may be mediated by the reduction of epithelial proliferation,the increase of apoptosis and the acceleration of villous cell renewal due to dietary formulation intake. | Bruna Girardi Maria Pricci Floriana Giorgio Mariano Piazzolla Andrea Iannone Giuseppe Losurdo Mariabeatrice Principi Michele Barone Enzo Ierardi Alfredo Di Leo | 2020 | World Journal of Gastroenterology2020，26，14： | 1 |
| 13 | Rifabutin as salvage therapy for Helicobacter pylori eradication:Cornerstones and novelties显示文摘When several Helicobacter pylori eradication treatments fail,guidelines recommend a cultured guided approach;however,culture is not widely available.Therefore,a rifabutin based regimen could be the best solution.Rifabutin indeed shows a low rate of antibiotic resistance.Rifabutin is generally used in combination with amoxicillin in a triple therapy,with eradication rates about 80%in third-line regimens.The ideal duration of this therapy should range between 10 and 12 d.Combinations with antibiotics other than amoxicillin have demonstrated even better results,such as vonoprazan,which is a type of novel acid suppressor drug.Finally,a new formulation of triple therapy in a single capsule is under investigation,which is a field that deserves further investigation.Some notes of caution about rifabutin should be mentioned.This drug is used to treat tuberculosis or atypical mycobacteria;therefore,before starting a rifabutin-based eradication regimen,Mycobacterium tuberculosis infection should be thoroughly tested,since its use could promote the development of antibiotic resistance,thus affecting its effectiveness against Koch’s bacillus.Additionally,some serious side effects must be evaluated before starting any rifabutin-based therapy.Adverse effects include fever,nausea,vomiting and bone marrow suppression.For this reason,full blood count surveillance is required. | Antonia Valeria Borraccino Francesca Celiberto Maria Pricci Bruna Girardi Andrea Iannone Maria Rendina Enzo Ierardi Alfredo Di Leo Giuseppe Losurdo | 2022 | World Journal of Gastroenterology2022，28，45： | 0 |
| 14 | The outcomes and safety of patients undergoing endoscopic retrograde cholangiopancreatography combining a single-use cholangioscope and a single-use duodenoscope:A multicenter retrospective international study显示文摘Background: Duodenoscope-related multidrug-resistant organism(MDRO) infections raise concerns. Disposable duodenoscopes have been recently introduced in the market and approved by regulatory agencies with the aim to reduce the risk of endoscopic retrograde cholangiopancreatography(ERCP) associated infections. The aim of this study was to evaluate the outcome of procedures performed with single-use duodenoscopes in patients with clinical indications to single-operator cholangiopancreatoscopy. Methods: This is a multicenter international, retrospective study combining all patients who underwent complex biliopancreatic interventions using the combination of a single-use duodenoscope and a single-use cholangioscope. The primary outcome was technical success defined as ERCP completion for the intended clinical indication. Secondary outcomes were procedural duration, rate of cross-over to reusable duodenoscope, operator-reported satisfaction score(1 to 10) on performance rating of the single-use duodenoscope, and adverse event(AE) rate. Results: A total of 66 patients(26, 39.4% female) were included in the study. ERCP was categorized according to ASGE ERCP grading system as 47(71.2%) grade 3 and 19(28.8%) grade 4. The technical success rate was 98.5%(65/66). Procedural duration was 64(interquartile range 15-189) min, cross-over rate to reusable duodenoscope was 1/66(1.5%). The satisfaction score of the single-use duodenoscope classified by the operators was 8.6 ± 1.3 points. Four patients(6.1%) experienced AEs not directly related to the single-use duodenoscope, namely 2 post-ERCP pancreatitis(PEP), 1 cholangitis and 1 bleeding.Conclusions: Single-use duodenoscope is effective, reliable and safe even in technically challenging procedures with a non-inferiority to reusable duodenoscope, making these devices a viable alternative to standard reusable equipment. | Alessandro Fugazza Matteo Colombo Michel Kahaleh V.Raman Muthusamy Bick Benjamin Wim Laleman Carmelo Barbera Carlo Fabbri Jose Nieto Abed Al-Lehibi Mohan Ramchandani Amy Tyberg Haroon Shahid Avik Sarkar Dean Ehrlich Stuart Shermand Cecilia Binda Marco Spadaccini Andrea Iannone Kareem Khalaf Nageshwar Reddy Andrea Anderloni Alessandro Repici | 2024 | Hepatobiliary & Pancreatic Diseases International2024，23，1： | 0 |
| 15 | Epithelial turnover in duodenal familial adenomatous polyposis: A possible role for estrogen receptors?显示文摘AIM: To investigate estrogen receptors expression in duodenal familial adenomatous polyposis(FAP) and any relationship with epithelial proliferation/apoptosis markers.METHODS: Twenty-two patients affected by FAP undergoing duodenal resection for malignancies were recruited. Controls were 15 healthy subjects undergoing endoscopy for dyspeptic symptoms. ER-α, ER-α, Ki-67, TUNEL and caspase 3 expression(labeling index: percentage of positive cells) were evaluated by immunohistochemistry or immunofluorescence and examined by light or confocal microscopy. Samples were assigned to four groups: normal tissue, low(LGD)and high-grade dysplasia(HGD), adenocarcinoma(AC). One-way analysis of variance, corrected by Bonferroni's test, and Pearson's correlation test were applied for statistical analysis.RESULTS: ER-beta showed a progressive decline: normal tissue(23.5 ± 4.9), LGD(21.1 ± 4.8), HGD(9.3 ± 3.5), AC(7.1 ± 3.1). The normal tissue of FAP subjects expressed ER-beta like the controls(23.9 ± 6.2). Conversely, ER-α showed a progressive increase from normal tissue(24.8 ± 5.6) to AC(52.0 ± 8.2); the expression in normal tissue was similar to controls(22.5 ± 5.3). Ki67 demonstrated a statistically significant progressive increase at each disease stage up to AC. TUNEL did not reveal differences between controls and normal tissue of FAP subjects, but progressive decreases were observed in LGD, through HGD to AC. Pearson's correlation test showed a direct relationship between ER-b and TUNEL LI(r = 0.8088, P < 0.0001). Conversely, ER-α was inversely correlated with TUNEL LI(r =- 0.7257, P < 0.0001). The co-expression of ER-b and caspase 3 declined progressively from normal to neoplastic tissue.CONCLUSION: This study confirmed that ER-b is strongly decreased in duodenal FAP carcinomas, declining in a multiple step fashion, thereby suggesting a putative anti-carcinogenic effect. ER-α showed the opposite trend. ER-b/caspase 3 co-expression suggests this hormone's possible involvement in apoptosis. Hormonal influences in FAP duodenal tumorigenesis, and modulation of these as a possible chemoprevention strategy, may be a promising approach. | Alfredo Di Leo Gabriella Nesi Mariabeatrice Principi Domenico Piscitelli Bruna Girardi Maria Pricci Giuseppe Losurdo Andrea Iannone Enzo Ierardi Francesco Tonelli | 2016 | World Journal of Gastroenterology2016，22，11： | 0 |
| 16 | Reversal of IgM deficiency following a gluten-free diet in seronegative celiac disease显示文摘Selective Ig M deficiency(s IGMD)is very rare;it may be associated with celiac disease(CD).We present the case of an 18-year-old man with s IGMD masking seronegative CD.Symptoms included abdominal pain,diarrhea and weight loss.Laboratory tests showed reduced Ig M,DQ2-HLA and negative anti-transglutaminase.Villous atrophy and diffuse immature lymphocytes were observed at histology.Tissue transglutaminase m RNA mucosal levels showed a 6-fold increase.The patient was treated with a gluten-free diet(GFD)and six months later the symptoms had disappeared,the villous architecture was restored and mucosal tissue transglutaminase m RNA was comparable to that of healthy subjects.After 1 year of GFD,a complete restoration of normal Ig M values was observed and duodenal biopsy showed a reduction of immature lymphocytes and normal appearance of mature immune cells. | Lucia Montenegro Domenico Piscitelli Floriana Giorgio Claudia Covelli Maria Grazia Fiore Giuseppe Losurdo Andrea Iannone Enzo Ierardi Alfredo Di Leo Mariabeatrice Principi | 2014 | World Journal of Gastroenterology2014，20，46： | 0 |
| 17 | Endoscopic ultrasound-guided ablation of solid pancreatic lesions:A systematic review of early outcomes with pooled analysis显示文摘BACKGROUND Endoscopic ultrasound-guided radiofrequency ablation(EUS-RFA)is emerging as a complementary therapeutic approach for pancreatic solid masses.However,results of published data are difficult to interpret because of a retrospective design and small sample size.AIM To systematically review data on EUS-RFA for solid lesions and to pool the results of the different experiences in order to provide more consistent evidence in terms of safety and efficacy.METHODS A comprehensive systematic literature search on the main databases was performed to identify articles in which patients with pancreatic solid lesions underwent EUS-RFA.The primary outcomes were procedure-related adverse events(AEs)and mortality.Secondary outcomes were the technical success rate and the effects on primary tumor growth.Statistical analyses were performed using Stata version 14.0.RESULTS In total,14 studies were included,with 120 patients undergoing 153 ablations of 129 solid pancreatic lesions.The STARmed technology was used in seven studies,the Habib system in six studies,and the HybridTherm probe in one study.The pooled technical success rate was 99.0%(I2:25.82%).The pooled overall AE rate was 8.0%(I2:11.46%).Excluding mild AEs,the pooled rates of serious AEs was 1.0%(I2:0%).No mortality related to the procedure was reported.CONCLUSION The present pooled analysis confirms the safety and feasibility of EUS-RFA. | Marco Spadaccini Milena Di Leo Andrea Iannone Daan von den Hoff Alessandro Fugazza Piera Alessia Galtieri Gaia Pellegatta Roberta Maselli Andrea Anderloni Matteo Colombo Peter D Siersema Silvia Carrara Alessandro Repici | 2022 | World Journal of Gastrointestinal Oncology2022，14，2： | 0 |
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