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Background: the presence of alarm symptoms (AS) such as anorexia, weight loss, signs of gastrointestinal bleeding is believed to discriminate between upper gastrointestinal (UGI) organic lesions and functional dyspepsia, but evidence in the literature is limited. Aim: To evaluate the prevalence of AS in a sample of the general population undergoing upper gastrointestinal endoscopy (OGD), in order to determine their value in predicting the presence of endoscopic lesions (EL). Methods: In the frame of the ongoing Loiano-Monghidoro project (APT 2001;15:1001-7), inhabitants of Loiano-Monghidoro commons are being re-invited to undergo OGD, and a previously validated detailed symptom questionnaire. 892 subjects have been evaluated during the period of time from January 2000 — October 2001 (442 males, 450 females, age range 18-86 years, mean age 54.4). The presence of AS was defined by at least one of the following symptoms: weigh loss, GI bleeding, anaemia, persisting vomiting, dysphagia, anorexia, pain radiating to the back. The presence of EL was defined by at least one of the following findings: oesophagitis, gastric and duodenal ulcers, erosive duodenitis, malignancies. All, but one, subjects completed the symptom questionnaire. Chi-square and Fischer exact tests were used for statistical analysis. Results: The prevalence of AS was 6.6% (59/892 subjects, 33 females, 26 males, age range 21-84 years, mean age 52.5) and the prevalence of EL was 16.7% (149/892) subjects, 60 females, 89 males, age range 19-86 years, mean age 56.7). AS were reported by 19/149 (12.8%) subjects with EL and by 40/743 (5.4%) of those without EL (OR = 2.6; 95% CI = 1.48-4.7; p < 0.001). Conclusions: In this large sample of the general population the presence of AS increased by almost three fold the risk of having major UGI endoscopic lesions. This finding might be relevant in planning management strategies for UGI disorders in the general population. [ABSTRACT FROM AUTHOR]

Background: HP infection and family history (FH) of gastric cancer (GC) seem to be risk factors for GC. Aim and methods: to study if Hp infection is associated with an increased risk of intestinal metaplasia (IM)in relatives of GC patients. In the frame of the ongoing Loiano-Monghidoro Project (APT 2001; 15:10017), inhabitants are re-invited to undergo upper gastrointestinal endoscopy with biopsies, [sup 13]C-UBT, medical interview and questionnaire. Odds ratio (OR), as an estimate of the relative risk for IM, was calculated by logistic regression analysis. Results: of 892 subjects enrolled histological evaluation is available for 672 subjects. 104 subjects had FH+ and 568 subjects had a FH-. The prevalence of IM was 32% (140/437) vs 17.4% (41/235), (p<0.0001), in HP+ and HP- subjects, respectively (OR= 2.2, 95% CI 1.5-3.3); the risk however appeared to be greater in HP+ FH+ (OR= 2.6, 95% CI 1.0-7.3) than HP+ FH- subjects (OR= 2.0, 95% CI 1.3-3.2). The prevalence of IM was 36.5% (38/104) vs. 25.2% (143/568) (p< 0.02)in FH+ and FHsubjects respectively(OR=1.7, 95% CI 1.1-2.6). The prevalence of IM was 42.1%(32/76) vs 29.9%(108/361), (p< 0.04), in HP+ FH+ and HP+FHsubjects respectively (OR= 1.7, 95% CI 1.0-2.8). Differently the prevalence of IM was similar in HP- FH+ 21.4% (6/28) and HP- FH- 16.9% (35/207) (p= ns) (OR= 1.3, 95% CI 0.5-3.5). Conclusions: The risk of developing IM associated with HP infection is increased in first-degree relatives of GC patients and a FH+ for GC is a risk factor of IM only in HP+ subjects. [ABSTRACT FROM AUTHOR]

Background: H. pylori infection is associated with peptic ulcer disease and gastric cancer and has also been implicated as a possible cause of extraintestinal disorders such as skin diseases. There are a few case reports on patients with skin diseases, such as prurigo nodularis that are associated with gastric cancer. Aims: The aim of this study was to examine the prevalence of H. pylori infection and the gastric cancer in patients with pruritic skin diseases. Methods: All patients were examined for circulating specific IgG antibodies against H. pylori in sera using ELISA. H. pylori-positive selected patients who were more than 50 years old underwent upper gastrointestinal endoscopy for confirmation of infection and screening of gastric cancer. Results: Seventy five patients with pruritic skin diseases were examined including 43 cases of pruritus cutaneous, 15 cases of nummular dermatitis, 17 cases of prurigo chronica multiforme. The prevalence of H. pylori infection was 70% in pruritus cutaneous, 73% in nummular dermatitis and 76% in pmrigo chronica multiforme. Early gastric cancer was detected in 3 of 30 patients with pruritus cutaneous, 1 of 11 with nummular dermatitis, 1 of 11 with pmrigo chronica multiforme. The prevalence of early gastric cancer was 9.6% which was much higher than the prevalence among patients having general endoscopic screening for gastric cancer. Two patients underwent endoscopic mucosal resection; the others had partial gastrectomy. Conclusions: These results suggest H. pylori -positive patients with pruritic skin diseases are a high risk group of gastric cancer and endoscopic screening is recommended. [ABSTRACT FROM AUTHOR]

Background: Data on the prevalence of endoscopic lesions of the UGI tract in asymptomatic subjects are lacking. Aim: To evaluate the prevalence of endoscopic lesions of the UGI tract and their association with dyspeptic symptoms in the general population. Methods: In the frame of the ongoing Loiano-Monghidoro project (APT 2001;15:1001-7), inhabitants of the Loiano and Monghidoro commons are being re-invited to undergo UGI endoscopy and [sup 13]C-urea breath test. During UGI endoscopy gastric biopsies are obtained for histology and rapid urease test. Dyspeptic symptoms are evaluated by a previously validated questionnaire. Results: 892 subjects (442 males, 450 females, age range 18-86 years, mean age 54.4 years) were enrolled. The prevalence of endoscopic lesions of UGI tract was 16.7%: erosive esophagitis 8.2%, gastric ulcer 1.3%, duodenal ulcer 2%, concomitant esophagitis + gastric or duodenal ulcer 0.7%, erosive duodenitis 3.6%, gastric neoplasia 0.9%. Overall, 24.8% (37/149) of subjects with endoscopic lesions was asymptomatic. In particular, no symptoms were reported by 23.2% of subjects with esophagitis (20% with esophagitis of grade I and 31.4% of grade II), 33.3% of subjects with gastric ulcer, 33.3% with duodenal ulcer, 25% with erosive duodenitis and 25% with gastric neoplasia. H. pylori infection was present in 54.8%, 83.3%, 100%, 100%, 87.5%, and 100% of the subjects with esophagitis, gastric ulcer, duodenal ulcer, concomitant esophagitis + peptic ulcer, erosive duodenitis end gastric neoplasia, respectively. Conclusions: Endoscopic lesions of UGI tract are observed in 16% of this population and their association with H. pylori infection is as one would expect. Although not supporting the need of endoscopic screening of the general population, these results do support the need of defining high risk groups of asymptomatic subjects in whom endoscopic screening might prevent the development of advanced disease or severe complications. [ABSTRACT FROM AUTHOR]