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Celiac disease (CD) is an immune-mediated enteropathy, triggered by dietary wheat gluten and similar proteins of barley and rye in genetically susceptible individuals. This is a complex disorder involving both environmental and immune-genetic factors. The major genetic risk factor for CD is determined by HLA-DQ genes. Dysfunction of the innate and adaptive immune systems can conceivably cause impairment of mucosal barrier function and development of localized or systemic inflammatory and autoimmune processes. Exposure to gluten is the main environmental trigger responsible for the signs and symptoms of the disease, but exposure to gluten does not fully explain the manifestation of CD. Thus, both genetic determination and environmental exposure to gluten are necessary for the full manifestation of CD; neither of them is sufficient alone. Epidemiological and clinical data suggest that other environmental factors, including infections, alterations in the intestinal microbiota composition, and early feeding practices, might also play a role in disease development. Thus, this interaction is the condicio sine qua non celiac disease can develop. The breakdown of the interaction among microbiota, innate immunity, and genetic and dietary factors leads to disruption of homeostasis and inflammation; and tissue damage occurs. Focusing attention on this interaction and its breakdown may allow a better understanding of the CD pathogenesis and lead to novel translational avenues for preventing and treating this widespread disease. [ABSTRACT FROM AUTHOR]

Background: The last decade has seen significant advances in the evaluation of the small bowel. Several endoscopic techniques have been developed in recent years: capsule endoscopy (CE), double-balloon enteroscopy (DBE), and, more recently, the single-balloon enteroscopy (SBE). The aim of this study was to evaluate diagnostic and therapeutic impact, safety, and feasibility of the SBE procedure after a 3-year experience. Methods: A total of 73 SBE procedures were performed from July 2006 to July 2009. The starting insertion route (oral or anal) of SBE was chosen according to the estimated location of the suspected lesions based on the clinical presentation and, in 48 patients, on the findings of CE. A total of 70 patients with obscure gastrointestinal bleeding (31), suspected malabsorption syndrome (12), polyposis syndromes (11), suspected Crohn's disease (9), and suspected gastrointestinal tumors (7) were recruited. Results: The SBE was not carried out in four patients because of technical problems. Multiple angiodysplasias were found and treated in 9 patients; Peutz-Jeghers syndrome, familial adenomatous polyposis (FAP), and multiple polypectomies were carried out in 8 patients; endoscopic tattoos were performed in 2 patients due to the large diameter of the polyps; and multiple biopsies was performed in only one patient. SBE diagnosed Crohn's disease in four patients, malabsorption syndromes in two, lymphangiectasia in two, eosinophilic enteritis in one, melanoma in one, and nonspecific inflammation in eight. A total of seven small-bowel tumors were diagnosed (all were tattooed). In 23/70 patients the exam was negative. No major complications occurred. Conclusion: Single-balloon enteroscopy seems to be safe, useful, and highly effective in the diagnosis and therapy of several small-bowel diseases. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is an immune-mediated enteropathy, triggered by dietary wheat gluten and similar proteins of barley and rye in genetically susceptible individuals. This is a complex disorder involving both environmental and immune-genetic factors. The major genetic risk factor for CD is determined by HLA-DQ genes. Dysfunction of the innate and adaptive immune systems can conceivably cause impairment of mucosal barrier function and development of localized or systemic inflammatory and autoimmune processes. Exposure to gluten is the main environmental trigger responsible for the signs and symptoms of the disease, but exposure to gluten does not fully explain the manifestation of CD. Thus, both genetic determination and environmental exposure to gluten are necessary for the full manifestation of CD; neither of them is sufficient alone. Epidemiological and clinical data suggest that other environmental factors, including infections, alterations in the intestinal microbiota composition, and early feeding practices, might also play a role in disease development. Thus, this interaction is the condicio sine qua non celiac disease can develop. The breakdown of the interaction among microbiota, innate immunity, and genetic and dietary factors leads to disruption of homeostasis and inflammation; and tissue damage occurs. Focusing attention on this interaction and its breakdown may allow a better understanding of the CD pathogenesis and lead to novel translational avenues for preventing and treating this widespread disease. [ABSTRACT FROM AUTHOR]

Background: The past decade has seen significant advances in the evaluation of the small bowel, long considered as the 'black box' in gastroenterology. The development of several endoscopic techniques, including capsule endoscopy (CE) and double (DBE)- and single (SBE)-balloon enteroscopy, has improved the evaluation of this part of the gut and led to reach a more precise preoperative diagnosis of small-bowel tumors. These rare tumors were previously diagnosed only after laparotomy, although laparoscopic advanced surgery can be used for minimally invasive therapeutic approach in these patients. This study was designed to evaluate the diagnostic and therapeutic impact of endoscopic procedures on small-bowel tumors. Methods: During October 2010, 148 SBE procedures were performed; in 14 patients (7 males and 7 females, mean age 58.8 years; range 37-82 years) who suffered from obscure gastrointestinal bleeding, with previous negative upper and lower GI endoscopy, a diagnosis of small-bowel tumor was suspected according to CT scan (7 cases) and/or CE (11 patients). Then, an enteroscopy was performed. Results: Multiple biopsies were taken in 9 cases; endoscopic tattoos were performed in 11 cases. After endoscopic procedures, histological examination showed melanoma in one case, adenocarcinoma in seven, and adenoma in one case. In 11 of 14 patients, a laparoscopic partial resection of small bowel involved was possible due to endoscopic tattoos. In one patient, the involvement of colic segment precluded a laparoscopic resection. In two patients, the laparoscopic resection was not possible for technical problems. Histological findings on resected specimens were indicative for melanoma in one case, gastrointestinal stromal tumor (GIST) in four cases, gastrointestinal autonomic nerve tumor (GANT) in one case, adenoma in one, and adenocarcinoma in seven cases. Conclusions: New development of different endoscopic approaches to the small bowel has led to reach an earlier diagnosis of small-bowel tumors and a preoperative diagnosis with consequent minimally invasive surgical approach. [ABSTRACT FROM AUTHOR]

The article describes the case of a 75-year-old female patient who underwent a noninvasive treatment for pneumoperitoneum following gastric mucosectomy microperforation.

Background : Patients with inflammatory bowel disease have an increased risk of thrombotic complications; moreover, mesenteric microvascular thrombosis has been hypothesized as a contributing factor in the pathogenesis of inflammatory bowel disease. Aim : To assess the extent of subclinical atherosclerosis in inflammatory bowel disease by measuring the intima–media thickness of the common carotid artery. Methods : Fifty-two patients were enrolled in the study. Patients aged >45 years, with a history of cardiovascular disease and known risk factors for atherosclerosis were excluded from the study. Twenty healthy subjects were studied as controls. Carotid ultrasonography was performed in all patients and controls. intima–media thickness was measured proximal to the carotid bifurcation over both right and left common carotid arteries. The clinical characteristics and the laboratory parameters relevant to disease activity were recorded for all inflammatory bowel disease patients. In particular, plasma homocysteine, a well-known risk factor for thrombosis, was assessed. Results : Common carotid artery intima–media thickness was significantly higher in inflammatory bowel disease patients (0.63 ± 0.15 mm) compared with controls (0.53 ± 0.08 mm). Multiple regression analysis revealed a significant association of carotid intima–media thickness with homocysteine levels and age. Conclusions : Inflammatory bowel disease patients have an increased risk of early atherosclerosis than healthy controls as showed by greater values of carotid intima–media thickness. Homocysteine levels and age resulted independently associated with the increased arterial wall thickness. [ABSTRACT FROM AUTHOR]

Background: One-week low-dose rabeprazole/levofloxacin-based triple therapies have recently proved to be effective treatments for Helicobacter pylori infection. Aim: To compare the eradication efficacy, safety profile and patient compliance of two different 1-week levofloxacin-based Helicobacter pylori eradication regimens Methods: We prospectively recruited in a prospective, open-label study, 100 consecutive H. pylori-positive out-patients complaining of dyspeptic symptoms, referred to us for gastroscopy. They were assigned consecutively and randomly (one to one) to one of the following treatment regimens, both given for 7 days: (a) rabeprazole 20 mg o.d. (after breakfast) plus levofloxacin 500 mg o.d. (after breakfast) and clarithromycin 500 mg o.d. (after dinner) (RLC1 group); or (b) rabeprazole 20 mg o.d. (after breakfast) plus levofloxacin 500 mg o.d. (after breakfast) and clarithromycin 500 mg b.d. (after breakfast and dinner) (RLC2 group). Their H. pylori status was assessed by means of histology and rapid urease test at entry, and by [sup 13]C-urea breath test 8 weeks after the end of treatment. Results: 99/100 enrolled patients completed the study. 42/50 patients in the RLC1 group became H. pylori negative (both PP and ITT analysis: 84%) and 47/50 patients in the RLC2 group became H. pylori negative (both PP and ITT analysis: 94%). Slight or mild side-effects occurred in 4 (8%) patients of the RLC1 group and in 5 (10%) patients. Conclusions: This study demonstrates the efficacy of high-dose clarithromycin in one-week rabeprazole/levofloxacin-based triple therapies to eradicate Helicobacter pylori. This regimen prove to be safe, welltolerated and achieved the best eradication rates in alternative to amoxicillin in rabeprazole/levofloxacin therapy regimens. [ABSTRACT FROM AUTHOR]

BACKGROUND. Hepatitis C virus (HCV) has been localized in several extra-hepatic sites. Recent evidence suggest that also the stomach can harbor HCV. AIMS. We evaluated the prevalence of gastric localisation of HCV and its possible relationship with the chronic inflammatory response to H. pylori infection. Patients: Sixty patients with HCV infection (group A) and 60 subjects without HCV infection (control group), who underwent upper endoscopy for dyspeptic symptoms, were consecutively enrolled. Methods: Biopsy specimens of gastric mucosa obtained from each patient were assessed for H. pylori and chronic inflammatory infiltrates (classified as mild, moderate or marked). Furthermore, polymerase chain reaction (PCR) analyses were performed on the gastric biopsies to detect HCV and immunoglobulin heavy-chain (IgH) gene rearrangements of mucosal B cells. RESULTS. In group A, 24 of 36 patients with H. pylori infection and 6 of 24 without H. pylori harbored HCV in their stomach (P=0.0017). In these subjects both the presence of HCV in the gastric mucosa and H. pylori were significantly associated with marked or moderate inflammatory infiltrates. Oligoclonal IgH gene rearrangements were detected in three of group A patients who harbored both H. pylori and HCV in their stomach, in the control group, PCR analyses failed to find HCV in the gastric mucosa, and polyclonal patterns were detected in all the individuals. Conclusions: HCV is frequently localized in the stomach and is associated to the chronic lymphocytic inflammatory response to H. pylori. H. pylori and HCV, when both present, may favor the selection of clonal B cells. [ABSTRACT FROM AUTHOR]