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Biomedical subjects

G Gasbarrini

Publications and source records attributed to G Gasbarrini.

At least 307 records · Page 17Linked to original sources
PubMed1997

Determinants of functional status in healthy Italian nonagenarians and centenarians: a comprehensive functional assessment by the instruments of geriatric practice.

OBJECTIVE: To evaluate the physical ability and psychocognitive status of a population more than 90 years of age with regard to sociodemographic, behavioral, and biomedical variables known to affect functional status in old age. DESIGN: A survey design was used. SETTING: Emilia Romagna, Northern Italy. PARTICIPANTS: Eighty-four healthy community-dwelling subjects aged 90 to 106 years. MEASUREMENTS: Sociodemographic variables, health behavior, anthropometric indices, and serum DHEAS levels were recorded. Functional assessment was performed by instruments currently used in geriatric practice: the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Activities of Daily Living (ADL) scale. A stepwise multiple regression analysis was performed. RESULTS: GDS scores correlated directly with MMSE scores and inversely with ADL severity scores. Poor education, institutionalization, sensory impairment, muscular mass loss, and lower DHEAS levels were the variables with the highest correlation to functional impairment. Smoking, alcohol consumption, and marital status were relatively unimportant. An inverse association was found between DHEAS levels and dependency scores of single ADLs (continence, mobility). CONCLUSION: Impaired cognitive and physical ability with no increase in depression prevalence was found in a sample of subjects more than 90 years of age free of major age-related disease. Muscular mass and DHEAS levels seem to play a role in maintaining physical independence. In turn, physical independence, as well as social and cultural factors, strongly affect the compliance of long-lived subjects with psychocognitive tests currently used in the clinical evaluation of younger old people, suggesting that these instruments are not reliable for screening for cognitive impairment and depression in the oldest old subjects.

Activities of Daily Living↗
PubMed1997

Spontaneous intrahepatic portosystemic venous shunt in a patient with cirrhosis: diagnosis by combined color Doppler and pulsed Doppler ultrasonography.

Large spontaneous intrahepatic portosystemic venous shunts are occasionally found and their diagnosis by Doppler sonography is rarely reported. The authors describe a case of spontaneous intrahepatic porto-systemic venous shunt in liver cirrhosis diagnosed by color Doppler and characterized by an unusual pulsed Doppler spectrum: a continuous flat portal-like pattern of flow in the portal branch, and in both the shunt and the hepatic vein.

Aged↗
PubMed1997

The growth of primary low-grade B-cell gastric lymphoma is sustained by Helicobacter pylori.

BACKGROUND: The growth of primary low-grade B-cell gastric mucosa-associated lymphoid tissue (MALT) lymphoma is an antigen-dependent process CASE: We were able to document the influence of Helicobacter pylori on the natural history of primary low-grade B-cell gastric MALT lymphoma in a case investigated by means of polymerase chain reaction for IgH rearrangement. In this case the presence or absence of the bacterium appeared to affect both clinical manifestations and histologic features of the neoplasia, with an acceleration or a slowing down of the neoplastic expansion, respectively. CONCLUSIONS: We identified H. pylori as an antigenic stimulus that supports the growth of MALT-type lymphoma. This finding enables us to make some considerations about the management of the disease.

Aged↗
PubMed1997

Gastric mucosa-associated lymphoid tissue in autoimmune thyroid diseases.

BACKGROUND: There is increasing evidence for a link between Helicobacter pylori infection and the development of lymphoid follicles in the gastric mucosa. It is not known whether other factors may also play a role. The aim of this study was to investigate the role played by the host with peculiar immunogenic disorders, in the presence or absence of a known antigenic stimulus such as H. pylori. For this, we studied patients with autoimmune thyroid diseases. METHODS: Thirty patients with autoimmune thyroid diseases and 30 dyspeptic patients without a history of thyroid disorders (as control group) underwent upper endoscopy. Lymphoid follicles and H. pylori status were assessed by histopathologic and enzymatic analysis. RESULTS: Organized mucosa-associated lymphoid tissue was found in 73.3% of the patients and in 33.3% of control group. Lymphoid follicles were found in 87.5% of the H. pylori-positive patients and in 57.1% of the H. pylori-negative patients (P = NS). In the control group these follicles were present in 50% of H. pylori-positive subjects and in 14.3% of those who were H. pylori-negative. CONCLUSIONS: lYMPHOID follicles in the gastric mucosa are common in autoimmune thyroid diseases. Besides H. pylori infection, other factors (environmental, unknown infectious agents) or mechanisms related to the underlying disease may play a causal role.

Adult↗
PubMed1997

The smaller size of the 'coeliac iceberg' in adults.

BACKGROUND: Since it has been ascertained that the prevalence of coeliac disease in the general paediatric population is 3.3 per 1000, we decided to evaluate this prevalence in the general adult population. METHODS: Two thousand two hundred and thirty-seven adult subjects aged 20-87 years, representative of a population with sociodemographic characteristics typical of Western European countries with regard to sex and age, were studied. In all serum IgA antiendomysial antibodies (EMA) were searched for, and all patients who turned out to be positive underwent intestinal biopsy. RESULTS: Four symptomless subjects aged between 20 and 39 years proved positive at the IgA EMA screening. This intestinal biopsy confirmed coeliac disease in all of them. The prevalence in our study group was, therefore, 1.8 per 1000. CONCLUSIONS: This study shows that the size of the submerged part of the 'coeliac iceberg' is perhaps smaller in the adult population and suggests a linear trend towards a lower coeliac disease prevalence as age increases.

Adult↗
PubMed1997

Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status.

BACKGROUND: The etiology of inflammatory bowel disease is unclear, and the role played by anxiety and depression is highly controversial. Anxiety and depression in patients with inflammatory bowel disease could be secondary to disabling symptoms, but the interaction between physical morbidity and psychologic illness in these subjects has not been sufficiently investigated. Patients with inflammatory bowel disease are nevertheless frequently undernourished, but there are no studies on the association between anxiety and depression and malnutrition. This study was designed to characterize anxiety and depression in subjects affected by inflammatory bowel disease and to establish the influence of physical morbidity and/or nutritional status on psychologic disorders. METHODS: Seventy-nine consecutive patients, 43 with Crohn's disease (CD) and 36 with ulcerative colitis (UC), were enrolled in the study. An index of the disease activity and physical morbidity was obtained by the simplified Crohn's Disease Activity Index and Truelove-Witts criteria and using the Clinical Rating Scale. Thirty-six healthy volunteers were studied as controls. All the subjects were given the State and Trait Anxiety Inventory (STAI) test and the Zung self-rating Depression Scale. RESULTS: The percentage of subjects with state anxiety was significantly higher in the CD (P < 0.001) and UC (P < 0.001) groups than in control subjects. There was no significant difference in trait anxiety among groups. The percentage of subjects with depression was significantly higher in the CD (P < 0.05) and UC (P < 0.05) groups than in control subjects. State anxiety and depression were significantly associated with physical morbidity and correlated with malnutrition in CD and UC patients. CONCLUSION: Anxiety and depression in patients with inflammatory bowel disease could be reactive to the disabling symptoms and to malnutrition. As measured with the STAI, personality trait of anxiety does not seem to play an important role in inflammatory bowel disease.

Adult↗
PubMed1997

Differences in metabolic variables between adult coeliac patients at diagnosis and patients on a gluten-free diet.

BACKGROUND: Coeliac patients often have nutrient malabsorption with nutritional status impairment, but no report on their energy requirements is available. In this study body composition, dietary habits, basal energy expenditure, and substrate oxidation were investigated in patients with the classic form of coeliac disease. METHODS: Sixteen untreated and 18 adult coeliac patients on a gluten-free diet participated in the study. Body composition was assessed by anthropometry and bioimpedance. Energy expenditure was measured by indirect calorimetry. A food diary over 7 days was collected. RESULTS: Coeliac patients showed reduced body weight components but not a different fat-free mass percentage compared with age- and sex-matched healthy volunteers. Basal metabolic rate normalized by fat-free mass (BMR/FFM) was higher in coeliac patients than in controls. Untreated patients showed a significantly higher non-protein respiratory quotient with regard to both treated patients (P < 0.01) and controls (P < 0.05), an increased percentage of carbohydrate intake, and a good correlation between lipid faecal loss and carbohydrate oxidation (Spearman R = 0.74; P < 0.01). CONCLUSIONS: Both groups of patients had lower fat mass and FFM content than controls. The preferential carbohydrate oxidation in untreated patients might be a result of both lipid malabsorption and high carbohydrate intake.

Adolescent↗
PubMed1997

Doppler ultrasonographic evaluation of blood flow in the superior mesenteric artery in celiac patients and in healthy controls in fasting conditions and after saccharose ingestion.

We studied, by means of Doppler ultrasonography, the blood flow in the superior mesenteric artery in 12 untreated patients with celiac disease (nontropical sprue) and in 15 healthy controls; peak systolic velocity, end diastolic velocity, mean velocity, flow volume, and resistive index were measured in the fasting state and at regular intervals after ingestion of 0.5 liter of water containing 50 g of saccharose. Under fasting conditions, celiac patients showed peak systolic velocity, end diastolic velocity, mean velocity, and flow volume values significantly higher than those of normal subjects, whereas resistive index was significantly lower. After saccharose ingestion these parameters showed greater variations in normal subjects than in celiac patients. Fasting end diastolic velocity turned out to be the best parameter to distinguish celiac patients from healthy subjects. Doppler ultrasonography of the superior mesenteric artery could discriminate between normal subjects and celiac patients with overt disease. However, these data need further confirmation given the limited sample that we studied; moreover, the capability of this technique in distinguishing nontropical sprue from other gastrointestinal diseases that cause increasing splanchnic flow remains to be ascertained.

Adult↗
PubMed1997

Splenic function and alcohol addiction.

Severe hyposplenism has been recently documented in alcoholic liver disease, and it has been suggested that alcohol itself is important in the derangement of splenic function, despite a lack of evidence of a direct toxic effect of alcohol on the spleen. The aim of the present study was to assess splenic function in alcoholic patients without severe liver disease and to correlate these data with the degree and duration of alcohol intake. Fifty-two alcoholics, 31 subjects with current alcohol abuse (group A)-13 abstinent from alcohol for 1 to 6 months (group B) and B abstinent from alcohol for 6 months to several years (group C)- and 26 healthy social drinkers were studied. Splenic function was assessed by counting the percentage of pitted red cells. An in vitro experiment was performed to verify whether the presence of pitted red cells could be due to an effect of alcohol on red cell morphology. The percentage of pitted red cells in subjects from group A was significantly higher than in subjects from group B (p < 0.01), from group C (p < 0.005), and from controls (p < 0.001). There was no significant difference between group B, group C, and controls. Ten subjects from group A and 1 from group B and no subject from group C had evidence of splenic hypofunction. There was no significant correlation between the percentage of pitted red cells and daily alcohol intake or years of alcohol addiction. In conclusion, our study shows that, in patients with alcoholism but without any severe liver damage, a significant but slight increase in pitted red cells is present. Further studies are needed to clarify whether this is due to a mild form of splenic hypofunction or merely indicates erythrocyte membrane alterations.

Adult↗
PubMed1997

[Intestinal permeability].

Intestinal mucosa has an absorptive function and acts also as a selective barrier against potential antigenic, toxic and carcinogenic substances. Intestinal permeability can be defined as the capacity of mucosal surface to be penetrate by specific substances through unmediated diffusion. There are two theories about molecular permeation routes: the first one hypothesizes a transcellular (through small pores), a paracellular (through big channels) and a lipophilic pathways; the second one gives a key role only to paracellular tight-junctions. In many diseases we can find changes in intestinal permeability evaluable by simple and non invasive tests, administering "per os" probe molecules. These substances cross the epithelium in different way and amount according to their physicochemical features and mucosal integrity; then they reach circulation and are eliminated in urines where they can be detected. The most frequently molecules used are mono/disaccharides, 51Cr-labelled ethylenediaminetetraacetate (51Cr-EDTA) and polyethylene glycol (PEG). This simple method has become more and more used for diagnostic and speculative aims. These intestinal permeability tests have a low specificity so they cannot be used for a definitive diagnosis of intestinal disease; nevertheless, the high sensitivity for intestinal mucosal damage could make them a necessary method to evaluate mucosal integrity after therapy, to select patients with a specific symptoms and to support, particularly in pediatric populations, more specific and invasive diagnostic tests.

Humans↗
PubMed1997

[The modes of transmission of Helicobacter pylori infection].

Helicobacter pylori plays an essential role in the development of several both acid-related and neoplastic gastroduodenal pathologies. There are still uncertainties about the transmission routes and the sources of H. pylori infection. Man is the only well established "reservoir" of H. pylori, while the role of other mammalians (cat, pig, primates), as sources of infection, is still controversy. Literature data suggest four different modalities of transmission of the infection: faeco-oral, oro-oral, gastro-oral, gastro-gastric. By faeco-oral route, the bacterium, excreted with faeces, might colonize water sources, becoming so available to be transmitted to man and other mammalians. By oro-oral route, H. pylori, which colonizes dental plaque and saliva, may be transmitted by saliva to other individuals. The gastro-oral route is the typical modality of transmission in the childhood, when H. pylori uses the mucous achlorhydric vomitus of the children to infect a new host. Finally, by gastro-gastric route the bacterium might be transmitted by endoscopic procedures. In conclusion, we believe the different modalities of transmission may be contemporaneously involved, since none per se is able to explain the widespread occurrence of H. pylori infection.

Disease Susceptibility↗
PubMed1997

Energy expenditure, substrate oxidation, and body composition in subjects with chronic alcoholism: new findings from metabolic assessment.

There is some controversy as to the effect of ethanol on body weight and alcohol energy contribution to body mass. The aim of this study was to evaluate the effect of alcohol addiction on resting energy expenditure (REE) and body composition. Twelve patients with current alcoholism (A) without severe liver disease or lipid and carbohydrate malabsorption were compared with a group of healthy social drinkers (B) matched for sex, age, and height. Their caloric intake was computed on the basis of a food diary. REE was measured with indirect calorimetry, and body composition was assessed by both anthropometry and bioimpedance. A significant decrease in fat mass in A compared with B was found (14.8 +/- 5.39 vs. 19.0 +/- 3.50 kg; p < 0.05). No significant differences were observed in fat-free mass (FFM) or in total body water between the two groups. A showed higher REE values normalized by FFM than B (35.5 +/- 2.97 vs. 33.0 +/- 2.95 kcal/kgFFM; p < 0.05). The nonprotein respiratory quotient was significantly lower in A than in B (0.76 +/- 0.03 vs. 0.86 +/- 0.03; p < 0.001), and A showed significantly higher lipid oxidation and lower carbohydrate oxidation than B (p < 0.05). The daily caloric intake provided only by food ingestion was found to be significantly higher in controls, but because the percentage of alcohol calories of total energy intake was 46.3 +/- 6.80 in alcoholics and 13.6 +/- 3.59 in controls (p < 0.0001), the total caloric intake, computed as food intake plus alcohol intake, was higher in alcoholics than in control subjects. No statistical differences were found in urinary nitrogen excretion and fecal loss between groups. Patients with alcoholism showed an increased REE over predicted values and a preferential lipid oxidation with respect to controls; these findings could be related to induction of microsomal ethanol oxidizing system and to mitochondrial function adaptation secondary to chronic alcohol abuse. In either case, the effects of such changes in energy metabolism may contribute to alcohol associated hepatic injury.

Adult↗
PubMed1997

Long-term follow-up of disappearance of gastric mucosa-associated lymphoid tissue after anti-Helicobacter pylori therapy.

OBJECTIVES: Mucosa-associated lymphoid tissue (MALT) can develop in gastric mucosa after Helicobacter pylori infection, but not all H. pylori-positive patients develop acquired MALT, probably because of different levels of individual susceptibility against H. pylori-antigens. Our aim was to conduct long-term follow-up in MALT-positive and MALT-negative patients after H. pylori had been eradicated to determine what happens after H. pylori reinfection. METHODS: We studied 30 H. pylori-positive patients, 15 MALT-positive patients (group A), and 15 MALT-negative patients (group B). After the eradication of H. pylori and disappearance of acquired MALT in group A, follow-up was conducted by repeated endoscopic biopsies every 4-6 months for a mean period of 30.6 months (31.6 months for group A, 29.4 for group B). RESULTS: During follow-up, three group A patients were reinfected by H. pylori, and MALT recurred. Moreover, in each patient, it was the same grade of acquired MALT that had previously been diagnosed (grade 2 in two patients and grade 3 in one). A second course of anti-H. pylori treatment resulted both in eradication of H. pylori and the disappearance of MALT. Conversely, none of the group B patients with H. pylori reinfection developed MALT. However, in those patients, too, a second course of treatment eradicated the H. pylori. CONCLUSIONS: Our study shows that acquired MALT appears after reinfection with H. pylori only in patients who previously had that condition. Moreover, the grade of acquired MALT that reappears is the same as previously diagnosed. These findings demonstrate that not only H. pylori infection but also individual susceptibility may be important in determining both the presence of acquired MALT and its grade. However, strict follow-up is not advisable in MALT-positive patients, because no patient developed MALT-lymphoma during follow-up.

Adult↗