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Colorectal cancer represents the second leading cause of cancer deaths in western countries with elevated costs for health service. It's very important to develop screening and surveillance programs for cancer prevention with "cost-effective" means. We present a surveillance program with colonoscopy focused on first degree relatives of CRC patients. Colonoscopy is a "cost-effective" mean of screening for high risk subjects.

Background: Endoscopic hemostasis is the method of choice for the treatment of bleeding peptic ulcers. This retrospective study was carried out to evaluate its effectiveness in routine endoscopic practice., Methods: The records of all patients with gastrointestinal bleeding undergoing esophagogastroduodenoscopy (EGDS) at the Endoscopy Center of Ferrara in the last year were retrospectively evaluated. For each patient with peptic lesions, the following data were recorded: demographic characteristics, use of NSAIDs, co-morbidity, hemodynamic conditions, blood transfusions before EGDS, time between onset of symptoms and EGDS, endoscopic findings, method of endoscopic haemostasis carried out, Rockall score and outcome. If re-bleeding occurred, the data concerning the second therapeutic intervention were recorded as well., Results: Seventy-six males and 45 females (age 34-92 years) entered the study. In 22% of cases no co-morbidity was present. Active bleeding was observed in 38% of cases, features consistent with recent bleeding in 54% of cases, and no sign of bleeding in 6.6% of cases. Peptic ulcer was observed in 89% of cases. Hemostasis was carried out in 81 patients (76 had adrenalin infiltration, 2 had argon plasma coagulator [APC], and 3 had both treatments); 26 patients had re-bleeding. The probability of re-bleeding was related to female gender (p<0.05; OR: 3.74), time between onset of symptoms and EGDS >24 hours (p<0.01; OR: 8.67), and presence of non-ulcer peptic pathology (p<0.05; OR: 0.15). Seven re-bleeding patients underwent surgery, 19 had endoscopic treatment. In 11 of these patients second hemostasis was resolutive, 8 bled again., Conclusions: Endoscopic hemostasis of bleeding peptic lesions is effective also in routine clinical practice. Adrenalin infiltration is safe, easy to perform, cheap and repeatable, and in our opinion it should be considered the technique of first choice in endoscopic hemostasis.

Dyspepsia is a major public problem. It occurs in 25-40% of the general population negatively affecting the quality of life. 2-3% of the patients visited by the GP and up to 30% of those visited by the gastroenterologist have dyspepsia. Both diagnostic procedure and therapy are expensive. Definition, aetiology and pathogenesis of the disorder are not clear cut. The aim of this review is to outline the main trends in the relevant area of the clinical practice. The authors choose the most comprehensive definition among the thirty of the medical literature. To rule out, the most commonly and frequently wrong opinions risk factors have been examined. The authors distinguished between symptoms of function and organic dyspepsia and those of Irritable Bowel Syndrome and Gastro-Esophageal Reflux Disease, which often overlap and make difficult the management of the patient. The aetiology and pathogenesis have also been discussed, with particular emphasis on Hp. Advantages and drawbacks of different diagnostic approaches have been investigated. An age and symptoms related approach of the cases with dyspepsia is proposed, which allows to manage the patient without the necessity of invasive procedures. It is finally suggested that are cases which can be managed by the GP and others for whom the gastroenterologist intervention is mandatory.

The aim of this study was to establish if the discontinuous assumption of omeprazole was effective to reduce the recurrence of duodenal ulcer disease as the cyclic periodical assumptions of the same drug. Consequently two different posologies, after duodenal ulcer recovery, were compared, both based on omeprazole. In the first trial 20 mg/die were administrated for the first 15 days of every month, for 1 year. In the second, the same dose were administrated for 15 days only when symptoms occurred. It was not utilised a comparison with placebo or other drugs. Symptomatic score and recurrence rate were evaluated by means of EGDS after 6 months and 1 year. In some patients were also controlled the gastrinemia. Both trials were effective in the prevention of duodenal ulcer relapse, without increasing gastrinemia. Nevertheless patients assuming omeprazole only when symptomatic, showed a greater symptomatic score. Concluding, the assumption of omeprazole only when symptoms occur is effective in the prevention of relapse but require a close relation between patients and the medical team.

355 patients suffering from dyspepsia with an endoscopic pathological picture were examined. Campylobacter pylori was sought histologically and by culture. Histological and cultural results were compared. There were no bacteria on the gastric mucosa of 46 patients who had no histopathological evidence of lesions. Cultural studies were performed in 40 cases on endoscopic instruments used during the examination, before and after standard sterilization. Campylobacter pylori was found on the gastric mucosa of 224 patients (63.09%); 91.93% with duodenal ulcer; 71.87% with gastric ulcer; 54.23% with erosive duodenitis; 56.71% with erosive gastritis and 54.81% with chronic gastropathy. The agreement between the two techniques was 75.39%, with a male prevalence (p = 0.05). Campylobacter pylori was present on the gastric mucosa of 10.86% of patients without histopathological evidence of lesions. Standard sterilization with alkyl-dimethyl-benzyl ammonium eliminated the campylobacter in 100% of cases.