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C Tosetti

Publications and source records attributed to C Tosetti.

33 records · Page 2Linked to original sources
PubMed1998

Management of dyspepsia in general practice. A critical assessment.

The International Gastro Primary Care Group (IGPCG) Upper Gastrointestinal Disease Management Plan is mainly characterised by the proposal that management of patients with upper gastrointestinal syndromes be based on the predominant symptom, rather than on symptom clusters. Although no study has directly tested this hypothesis in general practice, some data indirectly support the proposal. Classification based on the relevance of specific symptoms could identify distinct subgroups of patients with functional dyspepsia with at least partially different features. Data obtained from the literature are discussed and evaluated in relation to the suggested algorithm. Overall, this management plan for patients with dyspepsia seems to be both safe and effective. However, there is a need for prospective studies evaluating its actual validity.

Disease Management↗
PubMed1996

Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia.

BACKGROUND & AIMS: Although gastric dysmotility and dyspeptic symptoms are often associated, their relationship remains unclear. The aim of this study was to evaluate the relationship between gastric emptying abnormalities and clinical features in functional dyspepsia. METHODS: In 343 patients with functional dyspepsia, the gastric emptying of solids was measured by a radioisotopic technique and four dyspeptic symptoms (epigastric pain and burning, postprandial fullness, nausea, and vomiting) were measured as absent, mild, relevant, and severe, according to their influence on patients' usual activities. RESULTS: Delayed gastric emptying was detected in 33.5% of dyspeptics. Delayed gastric emptying was particularly frequent in patients characterized by female sex, low body weight, presence of relevant and severe postprandial fullness, nausea, vomiting, and absence of relevant and severe epigastric pain. Logistic regression showed that delayed gastric emptying was invariably associated with female sex and postprandial fullness (odds ratio, 2.34; 95% confidence interval, 1.45-3.75) and vomiting (odds ratio, 4.04; 95% confidence interval, 1.30-12.54) when coded as severe and only postprandial fullness (odds ratio, 3.78; 95% confidence interval, 1.78-8.01) when coded as relevant and severe. CONCLUSIONS: Female sex, relevant and severe postprandial fullness, and severe vomiting are independently associated with delayed gastric emptying of solids in patients with functional dyspepsia seen in a referral center.

Adult↗
PubMed1996

Gastric emptying of solids in morbid obesity.

OBJECTIVE: To evaluate the effect of weight loss induced by dietetic treatment, with or without an intragastric balloon, on gastric emptying of obese subjects. SUBJECTS: 20 morbidly obese subjects (21-54 years, 45.3-58.0 kg/m2) and 20 healthy controls (21-56 years, 20.3-24.8 kg/m2). DESIGN: Parallel study of a 4 month, low calorie dietetic treatment with or without a 500 ml intragastric balloon. RESULTS: In basal conditions, obese subjects had accelerated gastric emptying as compared to healthy controls. At the end of the dietetic treatment period, a significant decrease of body weight was obtained. Patients also showed a slowing of gastric emptying. Both the weight loss and the slowing of gastric emptying occurred irrespective of the presence or absence of the intragastric balloon. CONCLUSION: The present findings are compatible with the hypothesis that gastric emptying, food intake and body weight are integrated parameters in subjects with morbid obesity.

Adult↗
PubMed1996

Relevance of postprandial glycosuria in survey for diabetes mellitus.

Since the oral glucose tolerance test is not applicable in large surveys for diabetes mellitus, economic tests or clinical criteria are required to select subjects needing a complete glycometabolic assessment. This study evaluated, in a selected high risk population (110 subjects; 71 males; median age: 53 years, range 30-70), the utility of glycosuria after a meal rich in carbohydrates in the detecting of diabetes, compared to other tests for glycosuria (fasting glycosuria, glycosuria after a glucose load) and clinical criteria (diabetic family history, overweight and their combination). For each test and, retrospectively, for clinical criteria, sensitivity, sensibility, predictive value positive (PVP) and predictive value negative (PVN) were calculated. Postprandial glycosuria resulted to be an effective approach (sensitivity: 100%; specificity: 44%; PVP: 23%, PVN: 100%) in people over 50 years old, in which both clinical criteria (sensitivity: 22-78%; PVN: 81-90%) and fasting glycosuria (sensitivity 11%; PVN: 86%) proved defective. In younger subjects both the presence of fasting glycosuria (sensitivity: 100%; specificity: 96%; PVP: 33%; PVN: 100%) and of relevant diabetic family history (sensitivity: 100%; specificity: 85%; PVN: 100%) proved more adequate as screening procedures.

Adult↗
PubMed1995

[Acute hepatotoxicity from amiodarone].

The functional and histological liver alterations induced by amiodarone treatment have been well known for some time and often consist in isolated increases in transaminase levels during long-term treatment. Secondary phospholipidosis was observed in these cases, an alteration which suggests the presence of toxic damage. Reports in the literature also indicate acute liver intoxication, including a number of fatal cases. This paper reports the finding of acute alterations of laboratory parameters indicative of hepatocytonecrosis with alterations of protein synthesis capacity following the first dose of the drug and which regressed after its suspension. On the basis of a review of the literature the authors propose that, in addition to a dose-dependent toxic mechanism, immunogenic or idiosyncratic mechanisms may also play a role in the onset and manifestation of acute liver intoxication by amiodarone.

Acute Disease↗
PubMed1993

The effect of different dosage schedules of cisapride on gastric emptying in idiopathic gastroparesis.

The aim of this study was to determine the optimal dosage regimen of cisapride for the treatment of idiopathic gastroparesis. We studied 17 patients with documented idiopathic gastroparesis in a three-way, cross-over, double-blind study with three 4-day treatment periods separated by at least 3 days without treatment. In each period, the patients were preloaded with cisapride (10 mg tid) for three days. On the fourth day (the test day) they took either 10 mg or 20 mg before breakfast and placebo before lunch (1 x 10 mg), (1 x 20 mg), or 10 mg before breakfast and 10 mg before lunch (2 x 10 mg). The medications were taken 30 min before meals. Gastric emptying of solids (99mTc-sulphur colloid) was measured at lunch time under basal conditions and during each treatment period. Plasma concentrations of cisapride were determined before the breakfast dose, before the lunch dose, and at 1, 2, 3, 4 and 5 h after. The greatest acceleration in gastric emptying occurred with the 2 x 10 mg regimen. Although the single morning dose of 20 mg also significantly accelerated gastric emptying (P = 0.05), the reduction was not as substantial. Plasma concentrations of cisapride were significantly higher after 2 x 10 mg than after 1 x 20 mg or 1 x 10 mg. There was a significant relation between cisapride plasma concentrations and changes in gastric emptying. Peak concentrations of cisapride greater than 60 ng.ml-1 were invariably associated with acceleration of gastric emptying. We conclude that cisapride 10 mg tid before meals is the optimal dose for the treatment of idiopathic gastroparesis.

Adult↗
PubMed1993

Fat-induced ileal brake in humans: a dose-dependent phenomenon correlated to the plasma levels of peptide YY.

BACKGROUND: Upper gastrointestinal motility is regulated by the presence of nutrients in the distal gut. The present study evaluated whether lipid-induced ileal brake on gastric emptying (1) can be elicited by low fat concentrations; (2) is a dose-dependent phenomenon; and (3) is related to gastrointestinal peptide release. METHODS: Seven patients were studied in the defunctionalized stage of total colectomy, on three separate occasions. On each study day, patients ate a meal labeled in the solid component; 30 minutes later, one of the following solutions was randomly infused into the ileal pouch: 0.9% saline, 2% oleic acid, and 20% oleic acid. Plasma concentrations of peptide YY (PYY), enteroglucagon, neurotensin, and motilin were measured. RESULTS: Both oleic acid solutions slowed gastric emptying compared with saline (P < 0.001), the effect being dose dependent (P < 0.001). Ileal infusions did not modify neurotensin and enteroglucagon levels but induced a dose-dependent increase of PYY (P < 0.01) and a borderline decrease of motilin (P = 0.05) levels. Slower rates of gastric emptying were related to increased plasma concentrations of PYY (r = 0.615; P < 0.05). CONCLUSIONS: This study shows that (1) the ileal brake on gastric emptying can be evoked by low doses of lipids in the distal ileum; (2) the delay of gastric emptying is related to the release of PYY; and (3) both phenomena are dose dependent.

Adult↗
PubMed1992

Helicobacter pylori infection and gastric function in patients with chronic idiopathic dyspepsia.

Helicobacter pylori infection, histological features of the gastric mucosa, and gastric motor and secretory functions were evaluated in 45 consecutive patients with chronic idiopathic dyspepsia. H. pylori infection was found in 60% of dyspeptic patients, compared with 33% of 15 healthy controls (P = 0.1). No difference was detected in basal or stimulated gastric acid secretion between dyspeptic patients and healthy controls. Gastric emptying was significantly (P less than 0.01) delayed in dyspeptic patients compared with healthy controls when standardized for age and sex. Delayed gastric emptying was associated with a low frequency of H. pylori infection, female gender, and young age. Epigastric pain or burning and postprandial fullness were, respectively, more severe in patients with H. pylori infection (P less than 0.02) and in those with delayed gastric emptying (P less than 0.01). These findings support the existence of separate subsets of patients with chronic idiopathic dyspepsia. Despite the presence of overlaps, there appear to be partially different functional derangements and clinical features in different subgroups of dyspeptic patients.

Adult↗
PubMed1991

[Comparison of methods: gastro-duodenal manometry and study of gastric emptying].

Traditionally, the stomach is regarded as two functional unit regions: 1) a proximal portion mainly involved in receptive relaxation and emptying of liquids; and 2) a distal portion that grinds, mixes and empties solids. Manometric and radioisotopic studies have been employed to construct such a physiological model. More recently, ad hoc designed studies have led to the identification of other factors that contribute to the regulation of gastric emptying. Antral, intestinal and pyloric motility, fundic tone and antropyloroduodenal coordination appear to be all involved in the regulation of gastric emptying. Nowadays, no single technique can simultaneously measure those parameters. Gastroduodenal manometry can be regarded as the most advanced technique, in studying gastrointestinal motility. Nevertheless, fundic tone, which is an important determinant of gastric emptying, cannot be concurrently recorded.

Duodenum↗
PubMed1991

Patients with duodenitis have gastric secretory and motor functions like those of duodenal ulcer patients: results of a short-term treatment with ranitidine.

Gastric acid secretion, gastric emptying of solids, and the effects of short-term treatment with 300 mg ranitidine at bedtime were evaluated in symptomatic patients with endoscopically and histologically proven duodenitis. The patients investigated had basal and pentagastrin-stimulated gastric acid hypersecretion, but normal gastric emptying times. Ranitidine brought about a significant improvement of endoscopic and histological features compared with the pretreatment findings. Endoscopic but not histological improvement was significantly better than with placebo. Furthermore, ranitidine brought about a significant reduction of weekly antacid consumption compared with placebo. Both ranitidine and placebo induced significant symptomatic improvement over basal conditions, but the difference between the two treatments did not reach statistical significance. Gastric secretory and motor functions, as well as the response to therapy, were similar in duodenitis patients with and without previous history of duodenal ulcer; the only exception was in antacid consumption, which was higher in the placebo group in those with past evidence of ulcer disease. Our results suggest that duodenitis patients have secretory and motor functions similar to those of duodenal ulcer patients. Therefore, further trials on large populations of duodenitis patients with antisecretory drugs are justified.

Adult↗
PubMedDate not supplied

Standards for non-invasive methods for gastrointestinal motility: scintigraphy. A position statement from the Gruppo Italiano di Studio Motilità Apparato Digerente (GISMAD).

Scintigraphic techniques are well established methods to assess gastrointestinal transit patterns. The main advantages are represented by the possibility to evaluate, in a relatively non-invasive manner, the transit time of specific components of physiological meals as well as of some digestive secretions. These techniques are generally well accepted by the patients and results are largely not operator dependent. Their main limitation is the use of a radioisotope, that prevents repeated applications in all subjects and immediate exclusion of women of childbearing potential. Due to the high costs of these tests and the limited availability of Nuclear Medicine Departments, scintigraphic techniques should be reserved for well-selected patients. A review is made of the technical requirements and indications for scintigraphic tests currently available for clinical purposes (gastric emptying study, oesophageal transit time, evaluation of gastro-oesophageal reflux, intestinal and colonic transit time, evaluation of biliary motility and of duodenogastric reflux).

Colon↗