[Dermatogenic enteropathy].
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Adolescent↗
Biomedical subjects
G Gasbarrini
Publications and source records attributed to G Gasbarrini.
[Effects of administration of arginine thiazolidinecarboxylate in liver pathology of various origins. Results of a multicenter study].
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Adolescent↗
The role of interleukin-8 and other cytokines in the pathogenesis of Felty's syndrome.
OBJECTIVE: Felty's syndrome (FS) is defined as rheumatoid arthritis (RA) with neutropenia and, in some cases, splenomegaly; the outcome is primarily determined by the risk of infection, which is related to the degree of neutropenia. We analysed whether the clinical manifestations of FS, especially neutropenia, could be explained by abnormalities in cytokine production. METHODS: We examined the production in FS of five cytokines involved in the maturation and activation of polymorphonuclear cells (PMNs): IL-1 beta, TNF alpha, IL-8, G-CSF and GM-CSF. Because of the role of systemic IL-8 in neutrophil migration, serum IL-8 levels were also evaluated. RESULTS: Spontaneous and anti-CD16 stimulated cytokine production was similar in FS, RA and healthy controls (NC). However, anti-CD3 stimulated IL-8 production was significantly increased compared to NC in both RA and FS. FS patients who spontaneously produced G-CSF in culture were protected from bacterial infections. Serum IL-8 levels were elevated in FS and RA compared to NC (p < 0.001 for both groups). In FS, serum IL-8 was higher in patients with a history of bacterial infections compared to those without (p < 0.01) and there was a weak inverse correlation between neutropenia and serum IL-8 levels (Kendal's tau B = -0.31, p = 0.05). CONCLUSION: The neutropenia of FS cannot be explained by changes in peripheral blood cytokine production, although changes in the bone marrow microenvironment cannot be excluded. Our data do suggest a possible role for G-CSF and IL-8 in the development of certain FS complications.
Arthritis, Rheumatoid↗
IgA endomysium antibody: a valuable tool in the screening of coeliac disease but not its follow-up.
The IgA antiendomysium antibody was found in 99 of 100 consecutive patients with adult untreated coeliac disease, whereas IgA and/or IgG antigliadin antibodies were found in 92 of the same patients. Twenty-nine of them, presenting with minimal, transient or apparently unrelated symptoms (subclinical presentation), were antiendomysium antibody positive, whereas antigliadin antibodies were present in 26. In 33 of them, we also investigated the relationship between circulating antiendomysium antibody and the persistence of jejunal lesions after the institution of a gluten-free diet. Although 24 treated coeliac patients turned out to be antiendomysium antibody negative, in 17 of them jejunal lesions persisted. The present study shows that IgA antiendomysium antibody is a highly sensitive and specific marker for both subclinical and classical coeliac disease, but that it is not a reliable test in the follow up of coeliac patients.
Adolescent↗
Intestinal malabsorption and related clinical syndromes.
The term malabsorption is used to define the defective passage of the products of normal digestion through the intestinal mucosa. The clinical consequences and expression of this phenomenon are extremely variable. This paper discusses in detail those conditions which, due to frequency, clinical polymorphism and difficulty in diagnosis or in therapeutic control represent particularly current problems in the field of Internal Medicine. At the clinical level, physicians more and more frequently find a dissociation between malabsorption, intended as a chemical-physical phenomenon, enteropathy, intended as a morbid process characterized by evident morphological alterations of the small intestine, and malabsorption syndrome, intended as a combination of symptoms consequent to malabsorption. Diseases of the small intestine are thus more frequently accompanied by minor, transitory and extra-intestinal symptoms. This explains why many such diseases still remain underdiagnosed. Since the chief clinical problem involves diagnosis, intestinal absorption should always be appropriately assessed even if the symptoms do not at first sight appear to be connected with malabsorption.
Humans↗
Distal splenorenal shunt and insulin secretion, plasma glucagon, and glucose homeostasis in cirrhosis.
Over the 1st postoperative yr, distal splenorenal shunt (DSRS) in cirrhotic patients is followed by a reduction in portal perfusion resulting from a spontaneous opening of portal-systemic collaterals. This can influence plasma levels of insulin and glucagon. Fasting plasma glucose, insulin, C-peptide, and glucagon and their 5-h responses to a protein meal (which directly stimulates the hormone secretions) were measured before and 3 and 12 mo after DSRS in 10 cirrhotic patients. Hormone effectiveness and pancreatic alpha- and beta-cell sensitivities to ammonia (NH3), amino acids, and glucose were also calculated. Liver function and portal vein diameter were assessed before each study. Seven cirrhotic patients treated with injection sclerotherapy of esophageal varices served as a control group. Liver function did not deteriorate in either patient group. An increase in fasting glucagon (from 181 +/- 22 to 242 +/- 22 and 255 +/- 22 pg/ml, p = 0.02) and NH3 (from 57 +/- 8 to 84 +/- 11 and 97 +/- 14 micrograms/dl, p = 0.04) and a decrease in glucagon effectiveness (from 0.56 +/- 0.06 to 0.39 +/- 0.05 and 0.035 +/- 0.03, p = 0.047) and portal vein diameter (from 16.0 +/- 1.1 to 11.3 +/- 0.8 and 9.4 +/- 0.6 mm, p < 0.001) was found only in DSRS patients. The elevation in glucagon was correlated with that of NH3 at 3 mo (r = 0.83, p = 0.003) and with the reduction of portal vein diameter at 1 yr (r = -0.81, p = 0.005). In cirrhosis, DSRS does not influence insulin secretion or its plasma level and effectiveness.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Hormonal changes in male subjects over-ninety.
The physiology of aging in very old people is still poorly understood. A wide variety of age-related factors confuse the interpretation of existing data, especially as regards the modifications of the endocrine system. The effect of age on the gonad-hypophyseal function was studied in 26 over ninety-year-old males and compared with a control aged between 27 and 88, subdivided into age groups. The serum levels of total testosterone were stable up to the ninth decade while they were lower in the over ninety-year-olds; free testosterone and its peripheral metabolites (estrogens and dehydrotestosterone) were also lower in the over ninety-year-olds with respect to the others, although the decrease had started more gradually at about the fourth decade. Sex-hormone-binding-globulin, the main serum carrier of testosterone, increased gradually with age. The levels of hypophyseal gonadotropins were constant up to the ninth decade where a significant and abrupt increase was observed. The data suggest the presence of marked alterations of the testicular-hypophyseal axis in the later decades of life, with important repercussions on the pattern of circulating sex steroids.
Adult↗
[Intestinal malabsorption, celiac disease and associated lymphoma: from symptoms to diagnosis].
The clinical consequences of intestinal malabsorption are extremely variable and a dissociation between malabsorption, malabsorption syndrome and enteropathy is often noted. Enteropathy does not always results in malabsorption and in an alteration of the tests exploring the absorptive function. The following have particular relevance in clinical practice: coeliac disease, malabsorption induced by microbiologic agent (including Whipple's disease), post-surgical malabsorption and selective carbohydrate malabsorption. In particular, coeliac disease has been analyzed in its various aspects, from studies with organ cultures to immunological hypotheses, from the classical variety to subclinical forms and to serious complications, such as enteropathy-associated T cell lymphoma. Malabsorption syndromes are dramatically underdiagnosed: in the typical case of coeliac disease, enteropathy represents a clinical iceberg, and the discovery of the submerged portion, represented by the polymorphous subclinical varieties, has just started. As far as intestinal malabsorption is concerned, the main clinical problem regards diagnosis.
Adult↗
Medium-chain triglycerides for parenteral nutrition: kinetic profile in humans.
Medium-chain triglycerides (MCTs) have been introduced as lipid substrates in parenteral nutrition because of their rapid and complete oxidation. Although there are many clinical studies on the use of MCTs in parenteral nutrition there are only a few studies on their kinetics; most of these studies used indirect methods (such as light scattering) to determine MCT concentrations in plasma. We determined the hydrolysis rate of MCTs to medium-chain fatty acids (MCFAs) and the disposition rate of MCFAs in nine healthy volunteers who received an intravenous bolus of MCTs as 10% MCT + 10% long-chain triglyceride solution. MCTs and MCFAs were analyzed by gas-liquid chromatography. One linear compartment model was used and its parameters were numerically estimated. The first-order transformation constant of the hydrolysis step from MCT to MCFA was 0.0964 +/- 0.0152 min-1(for 8- and 10-carbon pooled together); the rate constant for tissue MCFA uptake from plasma was 0.0725 +/- 0.0230 min-1. The apparent volumes of distribution were about 4.5 L for MCT and 19 L for MCFA in a typical 70-kg subject. The plasma half-life of MCT was 11 min and that of MCFA was 17 min. The limiting step in the clinical use of MCTs seems to be tissue uptake of MCFAs.
Adult↗
Is there a link between nutritional status, immune response and phosphinositide fatty acid composition of peripheral blood lymphocytes in alcoholics?
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Alcoholism↗
One-week low-dose triple therapy vs. two-week medium-dose double therapy for H.pylori infection.
BACKGROUND/AIMS: Our study is to compare a short-term low-dose triple therapy with a long-term medium-dose double therapy for H.pylori eradication. MATERIALS AND METHODS: One hundred and ten consecutive patients, suffering from dyspeptic symptoms, with H.pylori infection, were randomly allocated to one of the following 2 groups with different therapeutic regimens: A) omeprazole 20 mg/day for 7 days, tinidazole 500 mg bid for 7 days, clarithromycin 250 mg bid for 7 days (55 pts, 20 with peptic ulcer); B) omeprazole 20 mg bid for 14 days, amoxycillin 1000 mg bid for 14 days (55 pts, 28 with peptic ulcer). The "H.pylori status" was evaluated by means of histology, culture and urease test, at entry and 8 weeks after treatment. RESULTS: Two group A and one group B pts didn't complete the treatment. The H.pylori eradication was obtained in 38 pts of group A (71.69%) (C.I.95%: 55.19176-80.86293), in 31 of group B (58.49%) (C.I.95%: 42.32777-69.7017); on Intention-to-Treat analysis, the rate of eradication gave similar results. Side effects occurred in 9 pts of group A (16.98%), in 8 of group B (14.81%). CONCLUSIONS: Short-term low-dose triple therapy with omeprazole/tinidazole/clarithromycin has a better cost/benefit ratio than long-term dual therapy with omeprazole/amoxycillin in the H.pylori eradication, but it causes more side-effects.
Amoxicillin↗
Levosulpiride in functional dyspepsia: a multicentric, double-blind, controlled trial.
Abnormalities in gastrointestinal motility have been reported in a substantial proportion of patients with functional dyspepsia, supporting the use of prokinetic drugs for treatment of dyspeptic symptoms. To evaluate efficacy and safety of levosulpiride in short-term treatment, 1298 patients were enrolled in a double-blind multicentric study carried out in 45 Italian Gastroenterology Departments. Patients were randomly assigned to either levosulpiride (25 mg tid), domperidone (10 mg tid), metoclopramide (10 mg tid) or placebo (1 tablet tid) for 4 weeks. Patients were selected on the basis of: a) occurrence in the last 4 weeks of at least 5/10 selected symptoms (anorexia, nausea, vomiting, upper abdominal pain, postprandial bloating, abdominal fullness, early satiety, belching, heartburn, regurgitation), severity of which should reach/exceed a total score of 8, as assessed by a specific scale ranging from 0 (absent) to 3 (severe); b) normal results of routine biochemical, ultrasound and endoscopic examinations. In addition, each patient subjectively evaluated efficacy of treatment by a visual analogue scale. Significant improvement was recorded for all symptoms at days 10 and 28 in all groups (p < 0.001), but levosulpiride was significantly (p < 0.01) superior to domperidone, metoclopramide and placebo both in the overall clinical improvement scale as well as in a subgroup of symptoms (postprandial bloating, epigastric pain, heartburn). Active treatments and placebo were comparable as far as concerns occurrence of side-effects (12-20%) including galactorrhoea, breast tenderness and menstrual changes.
Adolescent↗
Liver transplantation in Italy: preliminary 10-year report. The Monotematica Aisf-Olt Study Group.
Experience in liver transplantation (OLT) in Italy over a ten-year period is reported. Data were obtained using a multiple-items form collected from Italian liver transplant centres (reference centres) and other Italian institutions actively involved both in the processes of evaluation of the candidates and the follow-up of liver transplant recipients (afference centres). During this period, a total of 1046 liver transplants were performed on 954 patients, with a cumulative proportional survival of 71%. The most common indication for liver transplantation was post-hepatitic cirrhosis due to either hepatitis B virus (+/-hepatitis Delta virus) or hepatitis C virus infection. Good survival rates were observed, particularly in controversial indications, such as alcoholic cirrhosis, post-hepatitic hepatitis B virus-related cirrhosis and hepatocellular carcinoma, most likely due to proper and careful selection of the patients. Cirrhosis, secondary to an autoimmunity-based liver disease, showed the highest rate of rejection episodes. Infections, in our study population, were the most common cause of death after transplantation.
Adolescent↗
Anxiety and depression in adult untreated celiac subjects and in patients affected by inflammatory bowel disease: a personality "trait" or a reactive illness?
BACKGROUND/AIMS: Psychiatric illness and psychological behavioral pathologies may be present in celiac disease and in IBD patients. In these subjects anxiety and depression could be a main cause in the reduction of the compliance to the treatment. Aim of our study was to carry out a psychometric evaluation using appropriate means to determine the level of anxiety and depression and to distinguish between "state" and "trait" forms. The correction of such disturbances would improve the quality of life and the patients' compliance to treatment. MATERIAL AND METHODS: Sixteen adult celiac patients, 16 subjects affected by IBD and 16 healthy control subjects matched for sex, residence and marital status were studied by psychological assessment. All the subjects were given the State and Trait Anxiety Inventory and the Ipat Depression Scale Questionnaire. RESULTS: State anxiety was present in a higher percentage of celiac subjects and in the patients affected by IBD with respect to the healthy controls. Anxiety as a trait was present in a similar percentage in all the subjects evaluated. Depressive syndrome was present in a percentage of celiac patients statistically superior versus the healthy control group (p < 0.01). CONCLUSION: Our results shown that anxiety is present as a "reactive" form and personality trait anxiety has no effect in celiac and IBD patients. As regard depression, our data confirm a possible linkage between brain functions and malabsorption.
Adjustment Disorders↗
Antineutrophil cytoplasmic antibodies in inflammatory bowel disease: diagnostic tool or research procedure?.
Antineutrophil cytoplasmic antibodies, initially detected in the sera of patients with Wegener's granulomatosis and other forms of systemic vasculitides, have also been observed in patients with inflammatory bowel disease, with a higher prevalence in ulcerative colitis. In this study, we investigated the prevalence of these antibodies in the sera of 42 patients with ulcerative colitis and 48 patients with Crohn's disease, and the possible correlations with disease activity and extent, extraintestinal complications, and therapy. Antineutrophil cytoplasmic antibodies were found in 30 out of the 42 patients with ulcerative colitis (71.4%); only 16 out of the 48 patients (33.3%) with Crohn's disease were positive (p < 0.001), and the prevalent pattern was perinuclear. No correlations with disease activity and extent, extraintestinal complications, or surgical or medical treatment were found. Our data indicate that in the case of inflammatory bowel disease, the search for antineutrophil cytoplasmic antibodies still remains a research procedure and cannot be used for clinical diagnosis.
Adult↗
Effects of propylthiouracil on intestinal transit time and symptoms in hyperthyroid patients.
BACKGROUND/AIMS: Gastrointestinal disturbances such as diarrhea and malabsorption with steatorrhea may show up in hyperthyroid patients. The aim of our study was to evaluate oro-caecal transit time (OCTT) and gastrointestinal symptoms in hyperthyroid patients before and after propylthiouracil administration. MATERIALS AND METHODS: Twenty hyperthyroid patients (15 Females and 5 Males, mean age 47 years) were studied. Eight of them had diarrhea and 10 steatorrhea. The control group was composed of 20 healthy volunteers (13 F and 7 M, mean age 49 yrs). OCTT and fecal fat excretion were measured before and after propylthiouracil administration (300 mg/day for 10 day and then 200 mg/day for 30 days). RESULTS: Before the treatment in hyperthyroid patients had began the mean OCTT was significantly lower than in the control group (64 min. versus 107 min; p < 0.0001). After treatment mean OCTT became similar to the controls (p = ns); diarrhea disappeared in all affected patients and mean fecal fat excretion was reduced from 7.9 gr/24h to 3.4 gr/24h, with a statistically significantly difference (p < 0.0001). CONCLUSIONS: The treatment with propylthiouracil induces the normalization of thyroid hormone status and consequently of OCTT with the disappearance of gastrointestinal symptoms, such as diarrhea and steatorrhea, with a better efficacy if compared to other drugs utilized in the treatment of hyperthyroidism.
Administration, Oral↗
Influence of alcohol on gastrointestinal motility: lactulose breath hydrogen testing in orocecal transit time in chronic alcoholics, social drinkers and teetotaler subjects.
BACKGROUND/AIMS: The gastrointestinal tract is directly affected by the ingestion of alcohol. While the effect of acute ingestion of alcohol on the motility of the small intestine is well known, the influence of chronic intake of moderate amounts of alcohol and chronic alcoholism on gastrointestinal motility remains poorly understood. The aim of this study was to examine the orocecal transit (OCt) times in patients with chronic alcoholism and in "social drinkers" and compare them with a group of healthy teetotaler subjects, to assess the effects of chronic aleohol consumption on gastrointestinal transit through the application of a non-invasive technique: the hydrogen breath test. METHODOLOGY: Thirty-one alcoholics were enrolled in the study. The control groups consisted of 31 healthy social drinkers and 24 healthy teetotaler subjects. OCt time was assessed using the hydrogen breath test after the administration of 10 g of lactulose. RESULTS: The OCt time in patients with alcoholism was significantly delayed as compared with the social drinkers (p < 0.001) and healthy teetotaler subjects (p < 0.001); the OCt time in social drinkers was significantly longer than in healthy teetotaler subjects (p < 0.05). In the alcoholic group, there was no significant correlation between the OCt time and daily alcohol intake or years of alcohol addiction. CONCLUSION: Our results show a significant prolongation of the OCt time, both in patients with alcoholism and in social drinkers, as compared to teetotaler subjects. Our findings of an increased OCt time related to the consumption of alcohol could support the hypothesis of the toxic effect of ethanol on smooth muscle contractile proteins of the small intestine and on vagal function.
Adult↗
Orthotopic liver transplantation for alcoholic liver disease: rates of survival, complications and relapse.
BACKGROUND/AIMS: Liver transplantation for alcoholic end-stage liver disease remains controversial at many transplant centers. The aim of the present study was to evaluate the outcome of patients with alcoholic liver disease who underwent liver transplantation at Centro Trapianti, Policlinico S. Orsola, Bologna. METHODOLOGY: We describe the outcomes of 18 alcoholic patients with end-stage liver disease who received orthotopic liver transplants at our center from April, 1986 to February, 1996. The data obtained was compared with that of 114 patients with virus-related cirrhosis selected as transplant controls. An absolute period of abstinence from alcohol consumption for at least six months was required. RESULTS: Regarding the actuarial survival rate and non-fatal post-transplant complications, no significant differences were noted in comparing the non-alcoholic with the alcoholic recipients, except for a higher incidence of Cytomegalovirus infection in the alcoholic group followed-up for more than four months. The alcoholic relapse rate was 27.2%, but only one patient returned to harmful drinking. Seventy-three percent of subjects who were followed-up for at least six months were occupied in gainful employment. Alcoholic relapse did not affect employment status. CONCLUSION: This data demonstrates that liver transplantation for selected patients with end-stage alcohol-related cirrhosis achieves good results in survival, complications and employment status, and it appears difficult to defend an inflexible claim to have demonstrated an absolute long-term abstinence before transplantation when a severe deterioration of liver function is present.
Actuarial Analysis↗