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Biomedical subjects

V Stanghellini

Publications and source records attributed to V Stanghellini.

At least 37 records · Page 2Linked to original sources
PubMed1999

Relationship between upper gastrointestinal symptoms and lifestyle, psychosocial factors and comorbidity in the general population: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST).

BACKGROUND: The Domestic/International Gastroenterology Surveillance Study (DIGEST) investigated the prevalence and economic/quality-of-life impact of upper gastrointestinal (GI) symptoms over 3 months among the general population of seven international sites (n = 5581). METHODS: Respondents were classified as having relevant or non-relevant symptoms, and were further classified as having gastro-oesophageal reflux disease (GORD)-, ulcer-, or dysmotility-like symptoms, based on their most bothersome symptom. Associations were investigated between the prevalence of relevant upper GI symptoms and these subtypes, and the following potential risk factors: psychosocial variables (income, educational level, marital status, having children, occupation, any significant life event during previous year); lifestyle variables (tobacco use, levels of alcohol and caffeine consumption); comorbidity variables (illnesses or symptoms experienced in the previous 3 months, concurrent conditions diagnosed by a doctor, prescriptions and over-the-counter (OTC) medications taken in the previous 3 months for health problems other than upper GI symptoms). RESULTS AND CONCLUSIONS: The most notable risk factors for the occurrence of upper GI symptoms, including symptoms indicative of GORD, were found to be various indicators of psychological stress (particularly recent life events) and psychiatric disease. A wide range of other non-psychiatric illnesses and their treatments was also clearly associated with the occurrence of upper GI symptoms, consistent with these symptoms occurring in many organic illnesses or as adverse effects of their treatments. Smoking was also found to be associated with GORD-like symptoms.

Adult↗
PubMed1998

Detection of substance P immunoreactivity in human peripheral leukocytes.

The neuropeptide substance P (SP) has a marked proinflammatory effect and modulates the immune response. In this study, we tested the hypothesis that human peripheral leukocytes contain SP. Resting peripheral leukocytes collected from healthy volunteers (n = 20) were studied by applying a SP rabbit polyclonal antiserum to both flow cytometry and immunohistochemistry. To identify possible changes in Sp expression, we also analyzed both activated T-lymphocytes (cell cultures; n = 5 normal subjects) and neoplastic hematologic samples of different types of leukemias. Flow cytometry showed that normal granulocytes and monocytes contained SP, whereas lymphocytes were generally negative (or weakly positive) with the exception of a few (10-20%) positive subsets. In comparison, activated T-lymphocytes were markedly immunolabeled by SP as well as samples from neoplastic patients demonstrated strong SP immunoreactivity in all cell lineages. This pattern was confirmed by immunohistochemistry on cytospins. Our results support a potential role for SP-mediated immunomodulatory mechanisms both in normal and pathological conditions.

Flow Cytometry↗
PubMed1998

Treatment of dyspepsia.

Dyspepsia is a condition that is commonly seen by family physicians and gastroenterologists in clinical practice. However, there is little consensus on how dyspepsia should be treated. Some of the issues that require consideration are: Who seeks medical help? What types of physicians do patients choose to see? Do different types of physicians see the same types of patients? Do different types of physicians treat dyspepsia differently? What causes dyspepsia? In addition, the definition of dyspepsia and the symptoms associated with it vary from region to region, creating problems when discussing these issues on an international basis. In this review, the above issues are discussed, with particular attention to the impact of Helicobacter pylori infection and gastric dysmotility. Recommendations for treatment are made, and predictions of how dyspepsia will be treated in the future are given.

Dyspepsia↗
PubMed1998

Nomenclature of dyspepsia, dyspepsia subgroups and functional dyspepsia: clarifying the concepts.

There is international agreement that dyspepsia refers to pain or discomfort centered in the upper abdomen. However, the term 'discomfort' has been variably defined. While other symptoms may often be simultaneously present, gastro-oesophageal reflux disease can usually be clearly distinguished by the presence of predominant heartburn. Dyspepsia is a frequent reason for consultation in primary care and in gastrointestinal practice. With the widespread availability and utilization of endoscopy, it has become evident that a structural (or organic) explanation is found in only a minority of patients presenting with dyspepsia. Operationally, functional dyspepsia is defined as persistent or recurrent dyspepsia for 3 or more months in the absence of a clinically identifiable structural disease causing the symptoms. It has been proposed, based on symptoms, that functional dyspepsia be subdivided into symptom subgroups to promote patient homogeneity. The initially proposed 'clustering' of symptoms into ulcer-like and dysmotility-like functional dyspepsia has proved a dismal failure because of the considerable overlap observed, the lack of stability over time and the failure to identify robust pathophysiological abnormalities or responses to therapy. A subcategorization based upon the most bothersome symptom is theoretically more attractive but needs to be prospectively and rigorously tested.

Dyspepsia↗
PubMed1998

Relevance of gastrointestinal motor disturbances in functional dyspepsia.

Gastrointestinal motor abnormalities are frequent findings in patients with functional dyspepsia. However, these abnormalities are rather non-specific and seem to be restricted to a proportion of patients. Furthermore, they are not necessarily time-linked to symptom perception. The relationship of digestive motor derangements and symptoms in functional dyspepsia remains, therefore, unsettled. A variety of methodological and conceptual shortcomings characterize many of the studies investigating the relationship between gastrointestinal motility disorders and dyspeptic symptoms, and this obviously contributes to a higher level of uncertainty in the field. Recent reports suggest that gastrointestinal dysmotility is associated with perception of some dyspeptic symptoms, at least in a subset of patients. Well-conducted studies using appropriate methodology are needed to verify whether gastrointestinal motor disorders play a causal role in functional dyspepsia and whether this is of clinical relevance.

Dyspepsia↗
PubMed1998

Reproducibility of a solid and of a liquid caloric meal for gastric emptying studies.

Simple meals are required for routine scintigraphic gastric emptying studies. We evaluated the reproducibility of a caloric liquid meal (520 kcal) compared to that of a solid meal (638 kcal) in 8 and 11 healthy volunteers, respectively. Gastric emptying rates and half-times were similar in two tests using the same meal, while the methods used to express lag times were not highly reproducible. The emptying rates and half-times of the liquid meal were delayed after the intake of bellafoline. In conclusion, this study demonstrates that: (a) gastric emptying rates and half-times are reproducible parameters for the expression of scintigraphic gastric emptying studies; (b) mathematical methods to express lag times are not highly reproducible; (c) a 500 kcal liquid meal is sensitive to the effects of bellafoline, a drug able to delay gastric emptying. Further clinical evaluation is required to test its applicability in routine studies.

Adult↗
PubMed1998

Reversal of fundic atrophy after eradication of Helicobacter pylori.

OBJECTIVES: We sought to evaluate the effect of Helicobacter pylori eradication in patients with fundic atrophic gastritis. METHODS: Acid secretion, gastric emptying, and histology were evaluated in 20 patients with fundic atrophic gastritis and H. pylori infection. After investigation, 10 patients (Group 1) received an eradicating treatment and 10 (Group 2) did not receive any treatment. One year later, the baseline investigations were repeated. Subsequently, patients in Group 2 received the same treatment given to patients in Group 1 and were reevaluated 12 months later. A further follow-up was performed in both groups 36 months after the treatment. RESULTS: At 1-yr follow-up, all the patients in Group 1 were H. pylori negative whereas all the patients in Group 2 were still infected. In Group 1, there was a significant improvement of both fundic atrophy and acid secretion, compared with baseline (p < 0.01). In Group 2, no substantial modification of either histological or functional parameters was observed at the first follow-up; conversely, a significant (p < 0.01) improvement of fundic atrophy and acid secretion was detected in these patients 12 months after eradication of the bacterium. Histological pattern remained unchanged at 36 months of follow-up in both groups. Gastric emptying remained, on the average, unaffected by the treatment; however, three patients with delayed gastric emptying at entry had normal gastric emptying after eradication of H. pylori. CONCLUSIONS: Our data suggest that mucosal atrophy can be reduced or even reversed by the eradication of H. pylori, and this is associated with a recovery of gastric function.

Amoxicillin↗
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↗
PubMed1998

Constipation: a common problem in patients with neurological abnormalities.

Constipation is a frequent complaint among patients with different neurological diseases. This review provides a brief account of the numerous conditions affecting the central, peripheral and intrinsic (enteric) nervous systems in which constipation can be the only clinical manifestation or a component of a complex syndrome. Recent neuropathophysiological acquisitions show that any structural or functional impairment of the intrinsic innervation of the gut, including both developmental (i.e., Hirschsprung's disease and intestinal neuronal dysplasia) and acquired (i.e., either degenerative or inflammatory neuropathies) disorders, can be associated with constipation. Constipation may also arise from derangements of the peripheral nervous system, including diabetes and primary chronic autonomic failure (pandysautonomias). Finally, in the central nervous system, a wide array of disorders (post-traumatic, degenerative, ischaemic or neoplastic) are recognized to determine bowel dysfunction, ultimately leading to constipation. Further understanding of the fine pathophysiological mechanisms through which the intrinsic and extrinsic nerve supplies to the digestive system are involved in idiopathic constipation or in diseases generating this symptom will hopefully lead to a better treatment of this frequent pathological condition.

Central Nervous System Diseases↗
PubMed1997

Prospective screening of dyspeptic patients by Helicobacter pylori serology: a safe policy? The Italian Helicobacter pylori Study Group.

BACKGROUND AND STUDY AIMS: Endoscopic screening of all dyspeptic patients is not cost-effective, nor is it feasible in many health-care delivery systems. To select the most appropriate candidates, various preendoscopic screening strategies have been proposed, some of which include Helicobacter pylori serology and patient age. We assessed the value of these two criteria in preendoscopic screening of a large series of dyspeptic patients, and compared the results obtained in a referral hospital (university center with an extensive H. pylori research program) with those in nonreferral hospital (participating centers that did not have such a program). PATIENTS AND METHODS: Blood samples for determination of anti-H. pylori IgG antibody were collected from patients with uninvestigated dyspepsia undergoing endoscopy at one referral hospital and in 93 nonreferral hospitals throughout Italy. For IgG antibody assay, an in-house enzyme-linked immunosorbent assay (ELISA) technique was used in the referral hospital, while a commercial kit was used in the nonreferral hospitals. RESULTS: A total of 1638 patients were evaluated at the referral hospital (845 men and 793 women, mean age 46.1 years, range 18-89), and 3281 at the nonreferral hospitals (1718 men and 1563 women, mean age 48.8, range 18-96), respectively. If endoscopy had not been performed in patients who were seronegative for H. pylori and younger than 45 years, 19% versus 17.5% of the tests would have been avoided in the referral and nonreferral hospitals, respectively, while six of 304 ulcers (2%) and no cancers would have been missed versus 35 of 557 ulcers (6.3%) and two of 557 cancers (0.3%). CONCLUSIONS: A screening strategy based on age and H. pylori serology is a valid means of selecting dyspeptic patients for endoscopy; however, the policy needs further refinement for use in nonreferral hospitals.

Adolescent↗
PubMed1997

Widespread eradication of Helicobacter pylori: a debate.

BACKGROUND: Helicobacter pylori eradication is recommended currently only in peptic ulcer patients. The accumulating evidence of a possible pathogenetic role of the germ in other pathological conditions, such as mucosa-associated lymphoid tissue lymphomas and (possibly) also functional dyspepsia and gastric cancer, creates increasing pressure in favor of an expansion of such indication. However, at present, cultural and practical considerations should discourage widespread screening and eradication programs. METHODS: The basis for our study is a critical review of the literature. RESULTS: The lack of a sound pathophysiological basis linking H. pylori infection to both dyspeptic symptom perception and gastric cancer risk sharply contrasts with the numerical and clinical relevance of these pathological conditions. Screening tests are not sufficiently cheap, easy, and reliable to be applicable on a large scale. Also, eradication therapies may provide suboptimal therapeutic effects and excessive side effects if applied by physicians who are not prepared culturally. CONCLUSIONS: Improvement of pathophysiological, diagnostic, and therapeutic knowledge must be achieved before eradication programs can be proposed on a large scale.

Helicobacter Infections↗