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M Frazzoni

Publications and source records attributed to M Frazzoni.

At least 19 recordsLinked to original sources
PubMed2006

Pathophysiological characteristics of the various forms of gastro-oesophageal reflux disease. Spectrum disease or distinct phenotypic presentations?

BACKGROUND: The traditional approach to gastro-oesophageal reflux disease as a spectrum disease has recently been criticised and the distinct phenotypic presentations model has been proposed. AIM: To evaluate the main pathophysiological characteristics of various gastro-oesophageal reflux disease presentations. METHODS: Oesophageal manometry and 24-h pH-monitoring were performed in a gastro-oesophageal reflux disease series collected in a 7-year period. RESULTS: Four hundred and twenty-one subjects were studied. Mean total percentage acid reflux time was significantly higher in long-segment Barrett's oesophagus and in ulcerative oesophagitis than in all the other gastro-oesophageal reflux disease groups, whilst in short-segment Barrett's oesophagus results were quite similar to those found in non-erosive reflux disease and in erosive reflux disease. Patients with ulcerative oesophagitis and long-segment Barrett's oesophagus were older than all the other gastro-oesophageal reflux disease groups. The mean lower oesophageal sphincter pressure was significantly reduced in non-erosive reflux disease, erosive reflux disease, ulcerative oesophagitis, short-segment Barrett's oesophagus and long-segment Barrett's oesophagus as compared with functional heartburn and hypersensitive oesophagus and with controls. CONCLUSIONS: In keeping with the spectrum model of gastro-oesophageal reflux disease, severity of acid reflux increases from non-erosive reflux disease through erosive reflux disease up to ulcerative oesophagitis and long-segment Barrett's oesophagus. Ulcerative oesophagitis and long-segment Barrett's oesophagus could represent an advanced step in the natural history of gastro-oesophageal reflux disease. Our results do not confirm the distinct phenotypic presentations hypothesis.

Adult↗
PubMed2005

Intra-oesophageal acid suppression in complicated gastro-oesophageal reflux disease: esomeprazole versus lansoprazole.

BACKGROUND: Acid suppression is the mainstay of therapy in gastro-oesophageal reflux disease. Esomeprazole 40 mg is more effective than lansoprazole 30 mg in healing mucosal lesions in severe erosive reflux oesophagitis. However, data comparing esomeprazole with lansoprazole in patients with complications of gastro-oesophageal reflux disease, such as ulcerative reflux oesophagitis and Barrett's oesophagus, are lacking. AIM: To compare the efficacy of esomeprazole and lansoprazole at their standard dosages in suppressing oesophageal acid exposure in complicated gastro-oesophageal reflux disease. METHODS: Thirty patients with complicated gastro-oesophageal reflux disease (7 with ulcerative reflux oesophagitis and 23 with Barrett's oesophagus), randomly assigned to receive 40 mg esomeprazole (n=16) or 30 mg lansoprazole (n=14) once daily, underwent oesophageal 24-h pH monitoring while on therapy. Total, upright diurnal and supine nocturnal percentage acid reflux time were assessed. RESULTS: Esomeprazole was significantly more effective than lansoprazole in decreasing oesophageal acid exposure. Normalisation of both total and supine nocturnal percentage acid reflux time was obtained in 12 of 16 (75%) patients treated with esomeprazole but only in 4 of 14 (28%) cases treated with lansoprazole (p=0.026). CONCLUSIONS: Normalisation of oesophageal acid exposure can be achieved in the majority of complicated gastro-oesophageal reflux disease cases with esomeprazole 40 mg once daily.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

Pathophysiological characteristics of patients with non-erosive reflux disease differ from those of patients with functional heartburn.

BACKGROUND: Patients with endoscopy-negative heartburn can be subdivided into non-erosive reflux disease and functional heartburn on the basis of abnormal and normal, respectively, oesophageal acid exposure. Different pathophysiological characteristics could explain the reportedly low efficacy of proton pump inhibitors in functional heartburn. AIM: To assess if non-erosive reflux disease and functional heartburn are pathophysiologically distinguishable. METHODS: Oesophageal manometry and pH-monitoring were performed in 145 patients with endoscopy-negative heartburn, in 72 patients with erosive reflux disease, in 58 patients with complicated reflux disease, and in 60 controls. RESULTS: Patients with non-erosive reflux disease (84 cases) and functional heartburn (61 cases) differed with regard to the prevalence of hiatal hernia (49% vs. 31%, P = 0.008), the mean lower oesophageal sphincter tone (18.5 vs. 28.4 mmHg, P < 0.05), and the number of upright diurnal acid refluxes lasting more than 5 min (3.6 vs. 0.37, P < 0.05). The results were very close in thenon-erosive reflux disease, erosive reflux disease and complicated reflux disease groups, whilst patients with functional heartburn were indistinguishable from controls. CONCLUSIONS: Pathophysiological characteristics typical of gastro-oesophageal reflux disease are found in patients with non-erosive reflux disease but not in patients with functional heartburn. This could explain the reportedly low efficacy of proton pump inhibitors in functional heartburn and suggests considering different management strategies.

Adult↗
PubMed2003

Effective intra-oesophageal acid suppression in patients with gastro-oesophageal reflux disease: lansoprazole vs. pantoprazole.

BACKGROUND: : Effective intra-oesophageal acid suppression is an important therapeutic goal in complicated and atypical gastro-oesophageal reflux disease. AIM: : To compare the efficacy of lansoprazole and pantoprazole in normalizing oesophageal acid exposure. METHODS: : Fifty patients with complicated or atypical gastro-oesophageal reflux disease were randomly assigned to receive 30 mg lansoprazole (n = 26) or 40 mg pantoprazole (n = 24) once daily. Three to four weeks after the start of treatment, patients underwent 24-h oesophageal pH monitoring whilst on therapy. If the results were improved but still abnormal, the dosage was doubled and pH monitoring was repeated. If oesophageal acid exposure was not improved, the patient was shifted to the alternative drug regimen. RESULTS: : Oesophageal acid exposure was normalized in all 26 patients treated with lansoprazole (in 35% of cases with a double daily dosage), whereas in six of the 24 (25%) patients treated with pantoprazole it was neither normalized nor lowered (P = 0.008). Accordingly, the mean percentage acid reflux time was significantly lower for the lansoprazole group (2.1) than for the pantoprazole group (5.8) (P = 0.032). CONCLUSIONS: : Effective intra-oesophageal acid suppression can be accomplished more reliably with lansoprazole than with pantoprazole in patients with complicated and atypical gastro-oesophageal reflux disease.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non-erosive reflux disease.

BACKGROUND: The reason why less than one-half of patients with gastro-oesophageal reflux disease develop complicated reflux disease (ulcerative oesophagitis, oesophageal strictures and Barrett's oesophagus) and erosive reflux oesophagitis is not fully understood. Supine nocturnal oesophageal acid reflux is considered to be critically involved in this phenomenon, but reliable data are lacking. AIM: To clarify whether high levels of supine nocturnal oesophageal acid exposure are associated with complicated reflux disease. METHODS: Ambulatory 24-h oesophageal pH monitoring was performed in 220 patients with gastro-oesophageal reflux disease (56 with complicated reflux disease, 76 with erosive reflux oesophagitis and 88 with non-erosive reflux disease). The total, supine nocturnal and upright diurnal percentage acid reflux times were calculated. RESULTS: The total percentage acid reflux time was significantly greater in complicated reflux disease than in either erosive reflux oesophagitis (P = 0.024) or non-erosive reflux disease (P = 0.000). These differences were entirely due to a greater supine nocturnal percentage acid reflux time (P = 0.038 and P = 0.000, respectively), whereas no difference was observed in the upright diurnal percentage acid reflux time. CONCLUSIONS: Complicated reflux disease is characterized by high levels of supine nocturnal percentage acid reflux time. Prospective studies would be appropriate to clarify whether the normalization of this parameter is relevant to the effective management of this subset of patients with gastro-oesophageal reflux disease.

Circadian Rhythm↗
PubMed2002

Laparoscopic fundoplication versus lansoprazole for gastro-oesophageal reflux disease. A pH-metric comparison.

BACKGROUND: Treatment strategies that abolish abnormal reflux could prevent long-term complications of gastro-oesophageal reflux disease. AIMS: To compare the efficacy of laparoscopic fundoplication and lansoprazole in abolishing abnormal reflux in patients with gastro-oesophageal reflux disease. PATIENTS: Study population comprised 130 patients referred for possible antireflux surgery and with heartburn as the dominant symptom. METHODS: After oesophageal manometric and pH-metric evaluation and detailed information 55 patients asked to undergo laparoscopic antireflux surgery while 75 chose a medical treatment regimen based on lansoprazole. Treatment efficacy was assessed by ambulatory oesophageal pH-monitoring. RESULTS: All 55 patients who underwent fundoplication became free of heartburn: oesophageal pH-monitoring gave normal results in 85%. In patients treated with lansoprazole, at individualized daily dosages titrated to abolish both heartburn and abnormal acid reflux, normal pH-metric results were obtained in 96% of cases (p<0.05 vs surgically treated patients). CONCLUSIONS: Lansoprazole at individualized dosages was significantly more effective than laparoscopic fundoplication, in the short-term, in abolishing abnormal reflux in gastro-oesophageal reflux disease patients.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2002

Lansoprazole vs. omeprazole for gastro-oesophageal reflux disease: a pH-metric comparison.

BACKGROUND: Lansoprazole and omeprazole are widely used proton pump inhibitors for the management of gastro-oesophageal reflux. Normalization of oesophageal acid exposure is an important goal in the management of complicated and atypical gastro-oesophageal reflux disease. AIM: To compare the efficacy of lansoprazole and omeprazole in the abolition of abnormal reflux as assessed by oesophageal pH monitoring. METHODS: Seventy patients with complicated or atypical gastro-oesophageal reflux disease were randomly assigned to receive 30 mg lansoprazole or 20 mg omeprazole once daily. Three to four weeks after the start of treatment, patients underwent oesophageal pH monitoring while on therapy. If the results were still abnormal, the proton pump inhibitor dosage was doubled and 24-h pH-metry was repeated after 20-30 days. RESULTS: Thirty-six patients were randomized to receive lansoprazole and 34 patients to receive omeprazole. Ten of the 36 (29%) patients treated with 30 mg lansoprazole once daily and 23 of the 34 (68%) patients treated with 20 mg omeprazole once daily had persistently abnormal reflux at oesophageal pH monitoring (P < 0.001). In all such cases, repeat pH monitoring after doubling the proton pump inhibitor dosage gave normal results. CONCLUSIONS: At the currently marketed dosages of lansoprazole and omeprazole, normalization of oesophageal acid exposure in patients is accomplished more easily with lansoprazole.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2002

Hiatal hernia is the key factor determining the lansoprazole dosage required for effective intra-oesophageal acid suppression.

BACKGROUND: Effective intra-oesophageal acid suppression can be achieved with lansoprazole. The daily dosage could be influenced by the presence of hiatal hernia. AIM: To assess the lansoprazole daily dosage required to normalize oesophageal acid exposure in patients with and without hiatal hernia. METHODS: Fifty patients with complications or atypical manifestations of gastro-oesophageal reflux disease were given lansoprazole, 30 mg once daily. Three to four weeks after the start of treatment, patients underwent oesophageal pH monitoring while on therapy. If the results were still abnormal, the lansoprazole dosage was doubled and 24-h pH-metry was repeated 20-30 days thereafter. RESULTS: A 30-mg daily dosage of lansoprazole normalized oesophageal acid exposure in 70% of cases, whilst a 60-mg daily dosage was necessary in the remainder: the two groups differed only in the presence of hiatal hernia (28% vs. 100%, respectively; P=0.000). Effective intra-oesophageal acid suppression was obtained in all 25 patients without hiatal hernia with the 30-mg daily dosage of lansoprazole. CONCLUSIONS: Hiatal hernia is the key factor determining the lansoprazole dosage required for effective intra-oesophageal acid suppression in complicated and atypical gastro-oesophageal reflux disease. High efficacy of a 30-mg daily dosage of lansoprazole can be predicted in the absence of hiatal hernia.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1994

Combined endoscopic and surgical management of Dieulafoy vascular malformation.

BACKGROUND: Dieulafoy's disease (exulceratio simplex) is an uncommon cause of gastric hemorrhage as a result of an abnormally large, submucosal, eroded gastric artery, often located in the upper part of the stomach. It represents a clinical challenge because of the intermittent nature of massive bleeding accounting for a constantly fatal course in conservatively (nonsurgically or nonendoscopically) treated patients. Published therapeutic options include techniques of endoscopic hemostasis or operative procedures. STUDY DESIGN: Herein we report two patients in whom a combined endoscopic and operative approach was performed to obtain a definitive prevention of rebleeding and an undoubted anatomopathologic diagnosis. RESULTS: Our innovative combined endoscopic and operative approach has offered three significant advantages: endoscopic preoperative diagnosis and control of the bleeding; valid aid in the intraoperative localization of hemorrhagic lesions, which is erratic intraoperatively, requires gastrotomy, and prolongs the duration of operation; and endoscopy-guided limited wedge resection as opposed to standard techniques involving gastrotomy for simple ligation or oversewing of the involved vessel, local excision, or wide wedge resections that used to be recommended until the recent past. CONCLUSIONS: We confirm that seemingly obscure origins of massive recurring hemorrhage of the upper part of the gastrointestinal tract should increase the suspicion of Dieulafoy's disease, prompting careful examination of the gastric fundic area and greater curvature. Endoscopic hemostasis is the first choice; whenever operative treatment is indicated (because of the endoscopic or clinical situation), it should be as conservative as possible because of intraoperative endoscopic localization of the bleeding source.

Aged↗
PubMed1993

Are routine duodenal and antral biopsies useful in the management of "functional" dyspepsia? A diagnostic and therapeutic study.

Fifty-three patients with previously uninvestigated chronic dyspepsia symptoms in the absence of gastrointestinal or extra-gastrointestinal disease (functional dyspepsia) underwent antral and duodenal mucosal biopsies to detect the role of such samplings in the presence of normal endoscopic findings. Patients were enrolled in a randomized, placebo-controlled, double-blind trial, receiving either eradicating treatment (colloidal bismuth subcitrate plus metronidazole) or placebo if they had Helicobacter pylori-associated gastritis (20 patients), or cisapride or placebo if they had normal antral mucosa (28 cases). Unsuspected celiac sprue was found in one patient. Eradicating treatment ameliorated histological gastritis (p = 0.01). However, owing to great placebo efficacy, symptom remission rates following a 1-month wash-out period in both treatment groups were no higher than that in controls. Independent of the initial randomization, an extremely low symptom recurrence rate was observed during a drug-free follow-up study equivalent to the mean duration of symptoms before enrollment. We conclude that in functional dyspepsia, bulbar and antral biopsies are not useful in clinical management, equivalent symptom relief can be achieved in patients randomly assigned to both drugs and placebos, and such improvement can be long lasting in the absence of any maintenance treatment. We believe the prevalence of unsuspected villous atrophy and the therapeutic role of investigation-based reassurance deserve further assessment.

Adult↗
PubMed1991

Hemoductal pancreatitis secondary to gastroduodenal artery-ruptured pseudoaneurysm: a rare cause of hematemesis.

A 65-yr-old alcoholic man with a history of calcific pancreatitis presented with massive hematemesis complicated by lipothymia. Physical examination disclosed stigmata of chronic liver disease. The laboratory picture was predominantly of cholestatic type with impaired liver protein synthetic activity. Emergency esophagogastroduodenoscopy was unable to provide definitive diagnosis, but reendoscopy with a side-viewing duodenoscope revealed active bleeding through the ampulla of Vater. An ultrasound examination showed a large, complex pancreatic lesion that computed tomography showed to be a pancreatic pseudocyst with an inside pseudoaneurysm. A visceral angiography revealed an anomalous arising of the common hepatic artery from the superior mesenteric artery and a pseudoaneurysm of the gastroduodenal artery at its origin. A second massive hemorrhage required an emergency operation, and surgical liver biopsy revealed focal steatosis. In conclusion, bleeding of a pancreatic pseudoaneurysm may be massive but intermittent, and side-viewing duodenoscopy, even prolonged, is essential in the diagnosis.

Aged↗
PubMed1986

Ageing and small-bowel mucosa: a morphometric study.

A direct effect of ageing in reducing mucosal surface area of the small intestine is still disputed. The aim of this study was to morphometrically evaluate a panel of jejunal biopsy specimens obtained from 16 elderly patients and 22 younger controls, all complaining of abdominal symptoms but without evidence of malabsorption and/or malnutrition in either group. Quantitative histology was performed by calculating the surface area to volume ratio of jejunal mucosa and the mean enterocyte height. The mean of surface to volume ratios in geriatric patients (97.6 +/- 18), although slightly reduced, did not significantly differ from that of younger controls (107.6 +/- 26) and no significant correlation was found between surface to volume ratio and age in years. The mean enterocyte height in the elderly group (30.1 +/- 1.2 microns) did not significantly differ from that of younger controls (31.3 +/- 2.3 microns). In conclusion, the frequent finding of malnutrition due to malabsorption in the elderly should not be attributed to a reduction of jejunal surface area as a mere consequence of age.

Adolescent↗
PubMed1985

Quantitative assessment of the mucosal architecture of jejunal biopsy specimens: a comparison between linear measurement, stereology, and computer aided microscopy.

Fifty jejunal biopsy specimens obtained from normal subjects and from untreated and treated patients with coeliac disease were assessed blindly by three independent observers, each of them using different morphometric techniques-namely, linear measurement, stereology, and computer aided microscopy. In two of 26 control biopsy specimens linear measurement was not possible because of distortion of villi. Highly significant (p less than 0.001) correlation coefficients were found between the different techniques. With all methods significant differences between controls and patients with coeliac disease and between treated and untreated coeliac patients were found. Only by stereology, however, was there no overlap between results for patients and those for controls. In view of the limitations of linear measurement and the high cost and complexity of computer aided microscopy, we propose that a simple stereological technique using an eyepiece graticule is the method of choice in the quantitative assessment of mucosal architecture in jejunal biopsy specimens.

Biopsy↗
PubMed1984

Jejunal intraepithelial lymphocytes in coeliac disease: are they increased or decreased?

We have quantified intraepithelial lymphocytes in the same biopsy series (21 healthy controls, 14 untreated coeliacs, 15 treated coeliacs, five non-coeliac patients with an abnormal jejunal mucosa) both as counts/100 epithelial cells and using as reference value a fixed area of muscularis mucosae. As expected, the number of intraepithelial lymphocytes/100 epithelial cells was significantly higher in untreated and treated coeliacs than in healthy controls, as well as in untreated when compared with treated coeliac patients. Otherwise, the number of intraepithelial lymphocytes lying in the area of mucosal surface overlying a fixed area of muscularis mucosae was significantly lower in treated and untreated coeliacs, than in healthy controls, as well as in untreated when compared with treated coeliacs. A highly significant inverse correlation was found between the number of intraepithelial lymphocytes/100 epithelial cells and the mucosal surface area measured as surface to volume ratio. When the number of intraepithelial lymphocytes/100 epithelial cells was corrected for differences in surface to volume ratio, the results were very similar to those obtained by a muscularis mucosae related count. In five coeliacs both intraepithelial lymphocyte and enterocyte muscularis mucosae related counts rose after a period of gluten free diet but the mean per cent increase of enterocytes was significantly higher than that of lymphocytes. Our results are compatible with a decrease in the total number of intraepithelial lymphocytes in the entire small bowel in coeliac disease. In untreated coeliac mucosae, however, a derangement in the usual proportions of intraepithelial lymphocytes and enterocytes is evident and may be important in the pathogenesis of coeliac disease.

Adult↗
PubMed1982

Observer variation in assessment of jejunal biopsy specimens. A comparison between subjective criteria and morphometric measurement.

in an observer variation study, the agreement rate reached by a pair of observers who measured 85 jejunal biopsy specimens using surface/volume ratio was compared with that reached by a pair of observers who subjectively assessed the same biopsy series. Both the agreement reached between the subjective observers and that reached between the objective observers proved significant by kappa statistics. However, both total and partial kappa values were greater for the pair of objective observers in every diagnostic category. Moreover, the percentage of agreement on the grading of all biopsy specimens, independent of the diagnostic categories, proved significantly higher for the objective observers. In the pair who made a qualitative assessment, interobserver variation was particularly evident in the grading of partial villous atrophy. Contrastingly, in the pair who made a quantitative assessment, agreement was present in all but one slide. The kappa values for the observers examining the same biopsy specimens on two separate occasions indicated closer agreement rates for the two objective observers. It is concluded that morphometric measurement is more reliable than subjective criteria in the assessment of jejunal biopsy specimens and that qualitative assessment of biopsy specimens should be coupled with quantitative histology.

Atrophy↗