204 results on '"Enrico Roda"'
Search Results
2. Chronic hepatitis B in 2008
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Alessandra Caponi, Andrea Lisotti, C. Grenci, and Enrico Roda
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medicine.medical_specialty ,Hepatology ,Chronic hepatitis ,Fibrosis ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,medicine.disease ,business - Published
- 2008
3. Efficacy of Esomeprazole (20 mg Once Daily) for Reducing the Risk of Gastroduodenal Ulcers Associated With Continuous Use of Low-Dose Aspirin
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Christopher J. Hawkey, Angel Lanas, Lars-Erik Svedberg, Dimitros Karamanolis, Joachim Labenz, Emma Nauclér, Christoffel van Rensburg, Konstantin Tchernev, Neville D. Yeomans, Enrico Roda, Sander Veldhuyzen van Zanten, and I. Racz
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Male ,Peptic Ulcer ,medicine.medical_specialty ,Global Health ,Placebo ,Gastroenterology ,Endoscopy, Gastrointestinal ,Esomeprazole ,Efficacy ,Double-Blind Method ,Risk Factors ,Internal medicine ,Humans ,Esomeprazole Sodium ,Medicine ,Enzyme Inhibitors ,Reflux esophagitis ,Omeprazole ,Aged ,Retrospective Studies ,Aspirin ,Dose-Response Relationship, Drug ,Hepatology ,business.industry ,Incidence ,Anti-Inflammatory Agents, Non-Steroidal ,Heartburn ,Treatment Outcome ,Female ,medicine.symptom ,business ,Follow-Up Studies ,medicine.drug - Abstract
Low-dose aspirin is standard treatment for prevention of cardiovascular events in at-risk patients. However, long-term administration of low-dose aspirin is associated with a greater risk of adverse events, including gastroduodenal ulcers. This study determined the efficacy of esomeprazole for reducing the risk of gastric and/or duodenal ulcers and dyspeptic symptoms in patients receiving continuous, low-dose aspirin therapy.Patients agedor =60 yr, without baseline gastroduodenal ulcer at endoscopy, who were receiving aspirin 75-325 mg once daily, were randomized to esomeprazole 20 mg once daily or placebo for 26 wk. The presence of endoscopic gastric and/or duodenal ulcers and esophageal lesions was assessed at weeks 8 and 26. Upper gastrointestinal symptoms were assessed at weeks 8, 16, and 26.The intention-to-treat population comprised 991 patients (esomeprazole, N = 493; placebo, N = 498). Twenty-seven patients (5.4%) in the placebo group developed a gastric or duodenal ulcer during 26 weeks' treatment compared with eight patients (1.6%) in the esomeprazole group (life-table estimates: 6.2%vs 1.8%; P= 0.0007). At 26 wk, the cumulative proportion of patients with erosive esophagitis was significantly lower for esomeprazole versus placebo (4.4% and 18.3%, respectively; P0.0001). At 26 wk, esomeprazole-treated patients were more likely to experience resolution of heartburn, acid regurgitation, and epigastric pain (P0.05).Esomeprazole 20 mg once daily reduces the risk of developing gastric and/or duodenal ulcers and symptoms associated with the continuous use of low-dose aspirin in patients agedor =60 yr without preexisting gastroduodenal ulcers.
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- 2008
4. Clinical trial: modulation of human placental multidrug resistance proteins in cholestasis of pregnancy by ursodeoxycholic acid
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James L. Boyer, V. Feletti, Francesca Lodato, E. Baglivo, Albert Mennone, Enrico Roda, Patrizia Simoni, Marco Montagnani, Giuseppe Pelusi, Nicola Rizzo, Antonio Colecchia, Domenico De Aloysio, Davide Festi, Francesco Azzaroli, and Giuseppe Mazzella
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medicine.medical_specialty ,Pregnancy ,Hepatology ,Bile acid ,business.industry ,Bilirubin ,medicine.drug_class ,Multidrug resistance-associated protein 2 ,Gastroenterology ,medicine.disease ,Ursodeoxycholic acid ,chemistry.chemical_compound ,Endocrinology ,medicine.anatomical_structure ,chemistry ,Internal medicine ,Cord blood ,Placenta ,Medicine ,Pharmacology (medical) ,business ,Cholestasis of pregnancy ,medicine.drug - Abstract
Summary Background The effects of ursodeoxycholic acid on human placental bile acids and bilirubin transporters in intrahepatic cholestasis of pregnancy are still undefined. Aim To evaluate whether ursodeoxycholic acid affects MRP2, MRP3 and MRP4 expression in the placenta. Materials and methods Forty-three pregnant women were enrolled; fourteen subjects had physiological pregnancies. Intrahepatic cholestasis of pregnancy patients were divided into two groups: (i) 13 received ursodeoxycholic acid (20 mg/kg/day) and (ii) 16 untreated. Total bile acid and bilirubin in serum and cord blood were determined in each subject. Multidrug resistance proteins expression (immunoblot, quantitative real-time PCR) was evaluated in placentas collected at delivery. anova test was used for statistical analysis of data. Results Ursodeoxycholic acid administration significantly improved maternal serum bile acid and cord blood bilirubin and bile acid levels. MRP2 protein and RNA expression was significantly increased in placentas from treated patients compared to controls (P
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- 2007
5. Eicosapentaenoic acid (EPA) reduces crypt cell proliferation and increases apoptosis in normal colonic mucosa in subjects with a history of colorectal adenomas
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Donato Di Pierro, Roger J. Leicester, S. Matthews, E. D. Courtney, J. Y. Kang, Andrea Belluzzi, Caroline Finlayson, and Enrico Roda
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Adenoma ,Male ,medicine.medical_specialty ,Colon ,Colorectal cancer ,Diet therapy ,Biopsy ,Administration, Oral ,Apoptosis ,Colorectal adenoma ,Gastroenterology ,Internal medicine ,medicine ,Humans ,Intestinal Mucosa ,Cell Proliferation ,Retrospective Studies ,chemistry.chemical_classification ,business.industry ,Cell growth ,Fatty Acids ,Fatty acid ,Colonoscopy ,Middle Aged ,medicine.disease ,Fish oil ,Immunohistochemistry ,Eicosapentaenoic acid ,Treatment Outcome ,Eicosapentaenoic Acid ,chemistry ,Female ,Colorectal Neoplasms ,business ,Follow-Up Studies - Abstract
Background and aims Omega-3 fatty acids in fish oil exert a protective effect on the development of colorectal cancer in animal models. Patients with colorectal adenomas have been shown to have increased crypt cell proliferation and decreased apoptosis in macroscopically normal appearing colonic mucosa. We investigated whether dietary supplementation with eicosapentaenoic acid (EPA) could alter crypt cell proliferation and apoptosis in such patients. Patients/methods Thirty subjects were randomised to either 3 months of highly purified EPA in free fatty acid form (2 g/day) or to no treatment. Colonic biopsies were taken at the initial colonoscopy and repeated 3 months later, and analysed for cell proliferation and apoptosis (immunohistochemistry) and mucosal fatty acid content. Results/findings Crypt cell proliferation was significantly reduced whilst apoptosis was significantly increased after EPA supplementation. Neither crypt cell proliferation nor apoptosis were altered in the control group. EPA in the mucosa increased significantly after EPA supplementation, whereas there was no significant change in controls. Conclusions Dietary supplementation with EPA significantly increases levels of this fatty acid in colonic mucosa, associated with significantly reduced proliferation and increased mucosal apoptosis. Further studies are needed to assess the potential efficacy of EPA supplementation in preventing polyps in the chemoprevention of colorectal cancer.
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- 2007
6. 13C-Urea Breath Test to Assess Helicobacter pylori Bacterial Load
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Giuseppe Martinelli, Enrico Roda, C. Martuzzi, Rocco Maurizio Zagari, Lorenzo Fuccio, Paolo Pozzato, Franco Bazzoli, Zagari R.M., Pozzato P., Martuzzi C., Fuccio L., Martinelli G., Roda E., and Bazzoli F.
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Adult ,Male ,medicine.medical_specialty ,Rapid urease test ,Chronic gastritis ,Severity of Illness Index ,Gastroenterology ,Helicobacter Infections ,13C urea breath test ,Excretion ,Internal medicine ,Gastroscopy ,medicine ,Humans ,Urea ,In patient ,Aged ,Aged, 80 and over ,Breath test ,Carbon Isotopes ,Helicobacter pylori ,medicine.diagnostic_test ,biology ,business.industry ,General Medicine ,Middle Aged ,biology.organism_classification ,medicine.disease ,Urease ,Infectious Diseases ,Breath Tests ,Gastritis ,Female ,medicine.symptom ,business - Abstract
Background. Some authors have reported, using different protocols, that 13C-urea breath test (13C-UBT) is capable of assessing the intragastric Helicobacter pylori bacterial load, whereas others have not confirmed these data. Our aim is to evaluate the correlation between 13C-UBT values and H. pylori bacterial load. Materials and Methods. One hundred ninety-two patients diagnosed H. pylori-positive by rapid urease test, histology, and 13C-UBT were enrolled. H. pylori bacterial load (H. pylori score) and gastritis activity (activity score) were evaluated according to the Updated Sydney System. 13C-UBT was performed according to the European Standard Protocol. Breath samples were obtained every 10 minutes for 60 minutes in 52 patients and at 30 minutes (T30) in 140 patients and analyzed by mass spectrometry. Results. At T30, mean ± SD excess delta 13CO2 excretion was 17.4 ± 1.1, 29.9 ± 2.2, and 48.7 ± 4.8 in patients with H. pylori scores 1, 2, and 3, respectively. This difference was statistically significant: H. pylori score 1 versus 2, p
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- 2005
7. Measuring dyspepsia: a new severity index validated in Bologna
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Paolo Pozzato, S Veldhuyzen van Zanten, L. De Luca, Luigi Ricciardiello, Franco Bazzoli, C. Martuzzi, T. Fiorini, Enrico Roda, Rocco Maurizio Zagari, De Luca L., Zagari R.M., Pozzato P., Fiorini T., Ricciardiello L., Martuzzi C., Roda E., Bazzoli F., and van Zanten S.J.
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Male ,medicine.medical_specialty ,Index (economics) ,Dyspepsia, Gastrointestinal symptoms, Helicobacter pylori, Mean global symptom index ,Population ,Gastroenterology ,Surveys and Questionnaires ,Internal medicine ,Healthy volunteers ,Humans ,Medicine ,Dyspepsia ,education ,education.field_of_study ,Hepatology ,business.industry ,Reproducibility of Results ,Mean age ,Middle Aged ,Breath Tests ,Italy ,Treatment study ,Female ,business ,After treatment - Abstract
Background. Measurement of the severity of dyspepsia symptoms before and after treatment and determining what is a significant change is a major problem in designing dyspepsia treatment studies. Objectives. To assess the reproducibility, validity and responsiveness to treatment of a dyspepsia questionnaire to be used in clinical and population-based studies. Methods. Seventy-three dyspeptic patients (35 male, 38 female; mean age 52 years) and 75 healthy volunteers (32 male, 43 female; mean age 52 years) were included. Subjects were interviewed for the presence/absence and severity/frequency of 19 gastrointestinal symptoms. Severity was measured on a 5-point scale. Frequency was also recorded on a 5-point scale. A global symptom index (severity × frequency) was calculated for the eight most severe symptoms; a mean global symptom index (8-MGSI) was considered for the evaluation of the instrument. To evaluate intra-observer variation, one author interviewed subjects (T0) and then repeated the interview 1 week later (T1). For inter-observer variation, two authors interviewed patients. Validity was measured by comparing 8-MGSI of the dyspepsia patients to those of healthy volunteers. Responsiveness was assessed by comparing mean global symptom index before and 1 month after appropriate therapy. Results. Reproducibility: The mean 8-MGSI was 4.5 at T0 and 3.7 at T1 with a correlation coefficient of 0.62. As for inter-observer variation, the average 8-MGSI was 4.8 by the first author and 3.9 by the second with a correlation coefficient of 0.60. Validity: The mean 8-MGSI was, respectively, 1.4 in healthy volunteers and 4.8 in dyspeptic patients (p = 0.001). Responsiveness: After treatment, a significant improvement in 8-MGSI was detected (p = 0.001). Conclusions. This questionnaire is a reliable, valid and responsive instrument for measuring the presence, severity and frequency of dyspepsia.
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- 2004
8. Bioavailability of a new ketoprofen formulation for once-daily oral administration
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Enrico Roda, Laura Sabatini, Aldo Roda, Mara Mirasoli, and Mario Baraldini
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Adult ,Male ,Ketoprofen ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Biological Availability ,Pharmaceutical Science ,Pharmacology ,Dosage form ,Bioavailability ,Delayed-Action Preparations ,stomatognathic diseases ,Solubility ,Pharmacokinetics ,Oral administration ,Area Under Curve ,Blood plasma ,Humans ,Medicine ,Liberation ,business ,Chromatography, High Pressure Liquid ,medicine.drug - Abstract
A new sustained-release formulation (sustained release Ibifen) that gradually releases ketoprofen within 24 h and ensures therapeutic plasma concentration for the entire period has been developed. It consists of tableted pH-dependent barrier film-coated ketoprofen granules and was administered at a single dose of 200 mg to 12 volunteers. Ketoprofen plasma profiles were compared with: (1) administration of Orudis retard 200 capsule (200 mg); (2) two 12-h doses of prompt release Ibifen capsules (100 mg). In vitro dissolution kinetics and ketoprofen plasma levels were measured by HPLC. Sustained release Ibifen dissolution rate was constant for 10 h, whereas Orudis retard 200 dissolution profile presented one higher slope (0-6 h) and a lower one (6-12 h). Both formulations showed a delayed kinetics with respect to prompt release Ibifen. After sustained release Ibifen administration, ketoprofen plasma peak, reached within 2 h, remained practically constant for at least 12 h (average 4 microg/ml), which is higher than therapeutic levels. Differently, Orudis retard 200 produced a delayed, higher C(max) (5.91+/-0.66 vs. 4.51+/-0.65 microg/ml; P
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- 2002
9. The Loiano-Monghidoro population-based study of Helicobacter pylori infection: prevalence by 13 C-urea breath test and associated factors
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Enrico Roda, D. Panuccio, S. Fossi, Paolo Pozzato, Franco Bazzoli, Giovanna Masala, Rocco Maurizio Zagari, G. Nicolini, Domenico Palli, Davide Festi, and Luigi Ricciardiello
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Breath test ,medicine.medical_specialty ,Multivariate analysis ,Hepatology ,biology ,medicine.diagnostic_test ,Cross-sectional study ,business.industry ,Gastroenterology ,Helicobacter pylori ,biology.organism_classification ,Asymptomatic ,Serology ,Internal medicine ,Immunology ,Epidemiology ,medicine ,Pharmacology (medical) ,medicine.symptom ,Family history ,business - Abstract
Objectives: As part of a cross-sectional study on cholelithiasis, 1533 out of 1840 residents in Loiano/Monghidoro, a rural area in Northern Italy (792 men, 741 women, age range 28–80 years), agreed to be further evaluated in relation to their Helicobacter pylori status. Methods: Each participant performed a 13C-urea breath test (13C-UBT) and provided information on sociodemographic, lifestyle and clinical characteristics. Results: The 13C-UBT was positive in 1041 subjects (67.9%; men: 69%; women: 67%) and was positively associated with increasing age (P
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- 2001
10. Endoscopic ultrasonography in portal hypertension
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Giancarlo Caletti, Pietro Fusaroli, Thomas Togliani, Monica Raimondi, and Enrico Roda
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medicine.medical_specialty ,Diagnostic methods ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Magnetic resonance imaging ,Endoscopic ultrasonography ,medicine.disease ,Systemic circulation ,Endoscopy ,Rectal varices ,Angiography ,medicine ,Portal hypertension ,Radiology, Nuclear Medicine and imaging ,Radiology ,business - Abstract
In the evaluation of patients suffering from portal hypertension, a knowledge of morphofunctional characteristics of the portal tree and of the shunts with the systemic circulation is fundamental. To the methods traditionally used for this purpose such as endoscopy, transabdominal sonography, angiography, magnetic resonance, and computed tomography, endosonography has been recently added as a minimally invasive and sensitive technique. By endosonography, it is possible to visualize portal branches, esophageal-gastric and rectal varices, collateral extraparietal veins, and small ascitic effusions that other diagnostic methods may miss.
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- 2000
11. Endosonography in gastric lymphoma and large gastric folds
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Paolo Bocus, Enrico Roda, Thomas Togliani, Pietro Fusaroli, and Giancarlo Caletti
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medicine.medical_specialty ,Acoustics and Ultrasonics ,General Chemical Engineering ,Bioengineering ,Gastroenterology ,Endosonography ,Diagnosis, Differential ,Stomach Neoplasms ,Internal medicine ,Biopsy ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Neoplasm Staging ,medicine.diagnostic_test ,business.industry ,Lymphoma, Non-Hodgkin ,Stomach ,Gastric lymphoma ,Cancer ,medicine.disease ,digestive system diseases ,Lymphoma ,medicine.anatomical_structure ,Gastric Mucosa ,Differential diagnosis ,business ,Chemoradiotherapy - Abstract
To establish a correct preoperative differential diagnosis between gastric lymphoma and cancer is essential but can be difficult as endoscopic biopsies can sometimes provide a low diagnostic yield. By EUS, infiltrative carcinoma tends to show a vertical growth in the gastric wall, while lymphoma tends to show mainly a horizontal extension. EUS provides an accurate staging of gastric lymphoma, showing the exact level of infiltration and the presence of perigastric lymph nodes, thus the physician can obtain an accurate prognosis for each patient and select the best form of treatment accordingly. The response to chemoradiotherapy can also be investigated very accurately by EUS. Large gastric folds are seen in a great number of benign and malignant conditions. Diagnosis represents a clinical challenge because etiology may be extremely varied and standard biopsies are often inconclusive. Different diseases show different levels of infiltration of the gastric wall, thus a characteristic echo-pattern helps for the differential diagnosis. Endosonography, used always in combination with biopsy, allows to rule out malignancies and to select the most appropriate treatment for each patient (medical or surgical).
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- 2000
12. Severe acute gastritis associated with Helicobacter pylori infection
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Pietro Fusaroli, Enrico Roda, M. Fedrigo, Antonio Tucci, Giuliano Bettini, and Giancarlo Caletti
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medicine.medical_specialty ,medicine.drug_class ,Biopsy ,Antibiotics ,Gastroenterology ,Helicobacter Infections ,Diagnosis, Differential ,Internal medicine ,Gastroscopy ,Gastric mucosa ,Humans ,Medicine ,Helicobacter ,Omeprazole ,Helicobacter pylori ,Hepatology ,biology ,Acute Gastritis ,business.industry ,Middle Aged ,medicine.disease ,biology.organism_classification ,Antibodies, Bacterial ,Anti-Bacterial Agents ,Lymphoma ,medicine.anatomical_structure ,Gastric Mucosa ,Gastritis ,Acute Disease ,Drug Therapy, Combination ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
We describe the case of a young female referred to our unit because of acute upper abdominal symptoms. Upper gastrointestinal endoscopy showed a gastric picture resembling lymphoma or acute non-steroidal anti-inflammatory drug gastropathy (deep, large and irregular ulcers), but the clinical history and the histological examination of gastric biopsies were consistent only with acute gastritis Helicobacter pylori-correlated. The patient was treated with omeprazole and antibiotics with complete recovery. As the patient's cat had suffered from an acute gastrointestinal distress two weeks earlier, a case of zoonosis was hypothesized and an upper gastrointestinal endoscopy was performed also on the cat. Unfortunately, we were not able to detect Helicobacter pylori in the cat gastric mucosa, but only urease-producing spiral microorganisms. Possible sources of infection and pathogenetic mechanisms of the severe gastritis are discussed.
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- 2000
13. Helicobacter pylori: Optimum Diagnosis and Test of Cure
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S. Fossi, Luigi Ricciardiello, B. Gorini, S. Maltoni, C. Martuzzi, Franco Bazzoli, G. Nicolini, Paolo Pozzato, Lorenzo Fuccio, Debora Berretti, L. De Luca, Enrico Roda, and Rocco Maurizio Zagari
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medicine.medical_specialty ,Spirillaceae ,Urea breath test ,Population ,Helicobacter Infections ,Serology ,Diagnosis, Differential ,Humans ,Urea ,Medicine ,Serologic Tests ,Pharmacology (medical) ,Carbon Radioisotopes ,Helicobacter ,Intensive care medicine ,education ,Pharmacology ,Breath test ,education.field_of_study ,Helicobacter pylori ,biology ,medicine.diagnostic_test ,business.industry ,biology.organism_classification ,Infectious Diseases ,Breath Tests ,Oncology ,Immunology ,Public Health ,Differential diagnosis ,business - Abstract
The fact that about 50% of the world's population is infected with Helicobacter (H.) pylori and the important role that this bacterium plays in public health have been important incentives in the search for accurate diagnostic methods. A large number of invasive and non-invasive methods have been used to diagnose H. pylori infection. Each method has its advantages and disadvantages and each practitioner should choose the best diagnostic method according to the facilities available. Non-invasive tests for the diagnosis of H. pylori infection are largely used in clinical practice and in management of patients with gastroduodenal disease. Serology is the most widespread test but its use is not advised in the post-treatment follow-up. The Urea Breath Test is a simple, safe and highly accurate method ideal for evaluating the short-term follow-up of H. pylori eradication after therapy.
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- 1999
14. [Untitled]
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Alessandro Pezzoli, Patrizia Simoni, Davide Festi, Laura Zambonin, Giuseppe Mazzella, Costanza Mazzeo, Francesco Azzaroli, Pietro Fusaroli, and Enrico Roda
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medicine.medical_specialty ,Cirrhosis ,Physiology ,business.industry ,Cholesterol ,Biliary cirrhosis ,Deoxycholic acid ,Gastroenterology ,Cholic acid ,Hepatology ,medicine.disease ,chemistry.chemical_compound ,Endocrinology ,Primary biliary cirrhosis ,chemistry ,Methylprednisolone ,Internal medicine ,Medicine ,business ,medicine.drug - Abstract
As immunosuppressive agents, corticosteroids maybe considered an appropriate treatment for primarybiliary cirrhosis, even if bone loss and other sideeffects may occur. We studied biliary lipid metabolism in 10 nonicteric patients, with histologicallyproven primary biliary cirrhosis (stage I-IV). Weadministered methylprednisolone (24 mg daily) for 30days to ascertain its effects on biliary lipidmetabolism, which are largely still unknown. All patientsunderwent a 30-day drug-washout period before enteringthe trial. The following parameters were studied beforeand after methylprednisolone treatment: serum biochemistry; cholic acid pool size, kineticsand synthesis; biliary lipid secretion; biliary bileacid pattern; biliary lipid molar percentage; andcholesterol saturation index. Methylprednisolone induced a statistically significant (Wilcoxon ranktest) increase in cholic acid turnover (from 0.26± 0.04 to 0.50 ± 0.05 K/day, P = 0.005)and synthesis (from 0.42 ± 0.12 to 0.78 ±0.11 mmol/day, P = 0.04), and in bile deoxycholic acid molarpercentage (from 19.4 ± 2.7 to 30.6 ± 4.4%molar, P = 0.01). On the other hand, a significantdecrease in biliary cholesterol molar percentage (from7.9 ± 0.7 to 6.4 ± 0.5 % molar, P =0.005), cholesterol saturation index (from 1.11 ±0.11 to 0.95 ± 0.07, P = 0.05), and biliarycholesterol secretion (from 64.7 ± 5.4 to 53.0± 4.5 μmol/hr, P = 0.005) was observed. These findings show thatshort-term administration of methylprednisolone inpatients with primary biliary cirrhosis does not induceexpansion of the cholic acid pool but increases cholicacid synthesis and turnover, as well as intestinalproduction of deoxycholic acid. If long-term treatmentis considered, the beneficial immunosuppressive effectsof corticosteroids have to be weighed against the hepatotoxic properties of deoxycholicacid.
- Published
- 1999
15. Efficacy and safety of three 7-day Helicobacter pylori eradication regimens containing ranitidine bismuth citrate
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Paolo Pozzato, S. Fossi, Cannizzaro O, Ederle A, G. Iaquinto, A. Olivieri, Franco Bazzoli, Gerace G, D'Angelo A, Reina G, Scarpulla G, R. Tosatto, Spadaccini A, Luigi Ricciardiello, Enrico Roda, and M. Zagari
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Breath test ,medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,biology ,business.industry ,Gastroenterology ,Amoxicillin ,Helicobacter pylori ,biology.organism_classification ,Tinidazole ,Surgery ,Ranitidine ,Tolerability ,Internal medicine ,Clarithromycin ,medicine ,Pharmacology (medical) ,business ,medicine.drug ,Antibacterial agent - Abstract
Background: This multicentre, randomized study was designed to assess the clinical efficacy, safety and tolerability of three novel 7-day triple therapies containing ranitidine bismuth citrate (RBC) and two antibiotics. Methods: We studied patients with non-ulcer dyspepsia and gastritis who were randomly assigned to one of three treatment regimens given for 7 days in a b.d. dosing schedule: RBC 400 mg plus clarithromycin 250 mg and tinidazole 500 mg (RBCCT); RBC 400 mg plus clarithromycin 500 mg and amoxycillin 1 g (RBCCA); RBC 400 mg plus tinidazole 500 mg and amoxycillin 1 g (RBCTA). H. pylori status was determined by CLO-test, histology and 13C-urea breath test. A repeat breath test was performed at least 28 days after completion of therapy to assess eradication. Results: One hundred and fifty-seven patients were eligible for intention-to-treat analysis (ITT) and 140 patients completed the study and returned for assessment of eradication. Intention-to-treat cure rates were 78% with RBCCT, 71% with RBCCA and 61% with RBCTA. An all-patients-treated analysis (APT), performed on evaluable patients, demonstrated eradication rates of 85% with RBCCT, 81% with RBCCA and 70% with RBCTA. No statistically significant difference was found between treatment groups. Twenty-four patients experienced side-effects, but in only seven cases was treatment discontinued due to adverse events. Conclusions: A 7-day course of RBC, clarithromycin and either tinidazole or amoxycillin provides a good rate of H. pylori eradication. Three novel RBC-based triple therapies proved to be safe and well tolerated, with discontinuations due to side-effects occurring in less than 5% of cases.
- Published
- 1998
16. Ranitidine bismuth citrate plus clarithromycin 7-day regimen is effective in eradicating Helicobacter pylori in patients with duodenal ulcer
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Spadaccini A, Catalano Fa, Pilotto A, Franco Bazzoli, Cardelli A, A. Olivieri, M. Zagari, Paolo Pozzato, Lami F, Susi D, Enrico Roda, R. Tosatto, Scarpulla G, and Giglio A
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Breath test ,medicine.medical_specialty ,Hepatology ,biology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Helicobacter pylori ,bacterial infections and mycoses ,biology.organism_classification ,Group B ,law.invention ,Ranitidine ,Regimen ,Randomized controlled trial ,law ,Internal medicine ,Clarithromycin ,Medicine ,Pharmacology (medical) ,business ,medicine.drug ,Antibacterial agent - Abstract
Background: No clinical study has been performed to-date to evaluate the efficacy of the dual therapy of ranitidine bismuth citrate (RBC) plus clarithromycin (C) 500 mg b.d. given for 7 days for the eradication of H. pylori. Aim: To assess the eradication rates achieved by treatment with RBC 400 mg b.d. for 28 days combined with clarithromycin 500 mg b.d. for 7 days in H. pylori-positive duodenal ulcer patients. Methods: One hundred and twelve H. pylori-positive patients with endoscopically proven active duodenal ulcer were included in a multicentre, open, randomized trial. H. pylori infection was initially detected by CLO-test and histology on antral and corpus biopsies, and by 13C-urea breath test (UBT). Patients were included if at least two of the tests were positive for H. pylori infection. Patients were randomized to receive RBC 400 mg b.d. for 4 weeks combined with clarithromycin 500 mg b.d. for the first 7 days (Group A) or 14 days (Group B). A second endoscopy was performed at least 28 days after the end of therapy for the assessment of ulcer healing and H. pylori infection. Eradication was assumed if all the tests (CLO-test, histology and UBT) were negative for H. pylori. Results: Fifty patients in Group A and 55 in Group B were assessed for H. pylori eradication and ulcer healing. The eradication rates according to intention-to-treat analysis were 75% in Group A and 80% in Group B. Considering only those patients with evaluable data at least 28 days after the end of therapy, H. pylori eradication was achieved in 84% and 82% in Group A and B, respectively. No statistically significant difference in eradication was found between the two groups by Mantel–Haenszel test. Only one patient, in Group A, was withdrawn because of adverse events (epigastric pain and pruritus). Conclusions: Dual therapy with RBC plus clarithromycin for 7 days could be an effective regimen for H. pylori eradication.
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- 1998
17. [Untitled]
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Alfred Hellstern, Ulrich Leuschner, Ala Benjaminov, Hanns Ackermann, Thomas Heine, Davide Festi, Monica Orsini, Enrico Roda, Tim C. Northfield, Riadh Jazrawi, Winfried Kurtz, Hans Joachim Schmeck-Lindenau, Jochen Stumpf, Britt E. Eidsvoll, Erling Aadland, Gerd Lux, Eckhart Boehnke, Ditmar Wurbs, Myriam Delhaye, Michel Cremer, Ingolf Sinn, Erich Horing, Ulrich V. Gaisberg, Michael Neubrand, Tilmann Sauerbruch, Vladimir Salamon, Werner Swobodnik, Hasko V. Sanden, Wolfgang Schmitt, Thomas Kaser, Hans Schomerus, Johannes Georg Wechsler, Paul Janowitz, Jorn Lohmann, Heiner Porst, Adolfo Francesco Attili, Eberhard Bartels, Wolfgang Arnold Wolf, Dieter Strohm, and Fred Paul
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medicine.medical_specialty ,Percutaneous ,Physiology ,business.industry ,Gallbladder ,Gastroenterology ,Gallbladder Stone ,Hepatology ,Single Center ,Surgery ,Route of administration ,Patient satisfaction ,medicine.anatomical_structure ,Internal medicine ,medicine ,business ,Severe complication - Abstract
Since there are now several ways to treat symptomatic gallstone disease, one is able to select treatment on the basis of the patient's comfort, the practicability, effectiveness, and side effects of the technique, and the relative costs. In order to assess the present status of contact dissolution with methyl tert-butyl ether with regard to these aspects, the present enquiry reports the data of 21 European hospitals. Eight hundred three patients were selected for contact litholysis of cholesterol gallbladder stones using methyl tert-butyl ether. Percutaneous transhepatic puncture of the gallbladder was performed under x-ray or ultrasound guidance. Dissolution rate, side effects, and treatment times of 268 patients from one single center were compared to those of 535 patients from the other 20 centers. Two hundred sixty-four patients were followed for five years to assess stone recurrence. Physicians were asked how they assessed the expenditure of the method, the discomfort to the patients, and the staffing situation. Patients were asked to indicate their acceptance on an analog scale. Puncture was successful in 761 (94.8%) patients. Prophylactic administration of antibiotics was not necessary. Stones were dissolved in 724 (95.1%) patients. In 315 (43.5%) sludge remained in the gallbladder. The most severe complication was bile leakage, which led 12 (1.6%) patients to have elective cholecystectomy. Toxic injuries due to the ether were not reported. Method-related lethality amounted to 0%, 30-day-lethality to 0.4%. Stone recurrence rate was about 40% in solitary stones and about 70% in multiple stones over five years. Patients with multiple stones developed recurrent stones almost twice as often as those with solitary stones. The probability of stone recurrence in patients with sludge in the gallbladder after catheter removal was not statistically significantly different from those without sludge. Seventy to 90% of the centers found the puncture to be simple and not distressing for patients and the relation between expenditure and therapeutic success to be acceptable. The acceptance of contact litholysis by the patients was excellent. Contact litholysis when applied by an experienced team provides real advantages in the treatment of gallstone disease. The method is technically simple, well accepted by the patients, and can be easily applied in community hospitals. Contact litholysis may be of particular value in patients who are not suitable for anesthesia or surgery.
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- 1998
18. 13C labelled cholesteryl octanoate breath test for assessing pancreatic exocrine insufficiency
- Author
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Aldo Roda, GM Ubalducci, Enrico Roda, A Cipolla, and Maurizio Ventrucci
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pancreatic disease ,Gastroenterology ,Pancreatic function tests ,chemistry.chemical_compound ,Biliary and Pancreatic Disease ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Exocrine pancreatic insufficiency ,Pancreas ,Aged ,Aged, 80 and over ,Breath test ,Carbon Isotopes ,medicine.diagnostic_test ,Cholesterol ,business.industry ,Pancreatic exocrine insufficiency ,Cholesteryl octanoate ,Pancreatic Diseases ,Reproducibility of Results ,Middle Aged ,Biliopancreatic Diversion ,medicine.disease ,Fat malabsorption ,Intestinal Diseases ,Endocrinology ,Breath Tests ,chemistry ,Chronic Disease ,Female ,Cholesterol Esters ,business - Abstract
Background—A non-invasive test for assessment of fat digestion has been developed based on the intraluminal hydrolysis of cholesteryl-[1-13C]octanoate by pancreatic esterase.Aims—To determine the diagnostic performance of this breath test in the assessment of exocrine pancreatic function.Methods—The test was performed in 20 healthy controls, 22 patients with chronic pancreatic disease (CPD), four with biliopancreatic diversion (BPD), and 32 with non-pancreatic digestive diseases (NPD); results were compared with those of other tubeless tests (faecal chymotrypsin and fluorescein dilaurate test).Results—Hourly recoveries of13CO2 were significantly lower in CPD when compared with healthy controls or NPD. In patients with CPD with mild to moderate insufficiency, the curve of 13CO2recovery was similar to that of healthy controls, while in those with severe insufficiency it was flat. In three patients with CPD with severe steatorrhoea, a repeat test after pancreatic enzyme supplementation showed a significant rise in13CO2 recovery. The four BPD patients had low and delayed 13CO2 recovery. Only eight of the 32 patients with NPD had abnormal breath test results. There was a significant correlation between the results of the breath test and those of faecal chymotrypsin, the fluorescein dilaurate test, and faecal fat measurements. For the diagnosis of pancreatic disease using the three hour cumulative 13CO2 recovery test, the sensitivity was 68.2% and specificity 75.0%; values were similar to those of the other two tubeless pancreatic function tests. In seven healthy controls, nine patients with CPD, and nine with NPD a second breath test was performed using Na-[1-13C]octanoate and a pancreatic function index was calculated as the ratio of13C recovery obtained in the two tests: at three hours this index was abnormal in eight patients with CPD and in three with NPD.Conclusion—The cholesteryl-[1-13C]octanoate breath test can be useful for the diagnosis of fat malabsorption and exocrine pancreatic insufficiency.
- Published
- 1998
19. Cancer of the Esophagus - Endoscopic Ultrasound: Selection for Cure
- Author
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Giancarlo Caletti, Gregary Marhefka, Paolo Bocus, Thomas Togliani, Enrico Roda, and Pietro Fusaroli
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,Esophageal Neoplasms ,Cost-Benefit Analysis ,Treatment outcome ,Decision Making ,Endoscopic ultrasonography ,Complete resection ,Endosonography ,medicine ,Humans ,In patient ,Esophagus ,lcsh:RC799-869 ,Neoplasm Staging ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Tumour staging ,Reproducibility of Results ,General Medicine ,Esophageal cancer ,medicine.disease ,Combined Modality Therapy ,Surgery ,medicine.anatomical_structure ,lcsh:Diseases of the digestive system. Gastroenterology ,business - Abstract
Several treatment options are available to treat esophageal cancer. Ideally, treatment should be individualized, based on the projected treatment outcome for that individual. Accurate staging of the extent of the disease at the time of diagnosis offers the most rational attempt at stratifying patients into categories that can be used to affect treatment choices. Endoscopic ultrasonography (EUS) is the most accurate nonoperative technique for determining the depth of tumour infiltration and thus is accurate in predicting which patients will be able to undergo complete resection. EUS is also being used for tumour staging in order to guide treatment decisions in patients with esophageal cancer.
- Published
- 1998
20. Factors associated with gallstone disease in the MICOL experience
- Author
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Livio Capocaccia, Nicola Carulli, L. Lalloni, R. Capocaccia, Enrico Roda, Adolfo Francesco Attili, Emanuele Scafato, Lajos Okolicsanyi, Claudia Sama, S Mariotti, Davide Festi, Alessandro Menotti, G.L. Ricci, and Luigi Barbara
- Subjects
medicine.medical_specialty ,Univariate analysis ,Multivariate analysis ,Hepatology ,medicine.diagnostic_test ,business.industry ,Physical examination ,Gallstones ,medicine.disease ,Surgery ,Blood chemistry ,Internal medicine ,Epidemiology ,medicine ,Family history ,business ,Body mass index - Abstract
The epidemiological associations of gallstone disease were evaluated in a general population sample of 29,584 individuals (15,910 men and 13,674 women; age range, 30-39 years) belonging to 14 cohorts examined between December 1984 and April 1987. Subjects were screened for the presence of gallstones by gallbladder ultrasonography, completed a questionnaire, and underwent a physical examination and blood chemistry tests. Participants were considered to have gallstone disease if they had already had cholecystectomy or gallstones. Statistical associations were established by univariate analysis of the age-standardized data and by stepwise multiple logistic regression. Increasing age and body mass index and a maternal family history of gallstone disease were the most consistent associations (both at univariate and multivariate analysis and in both sexes) found in this study. Personal history of dieting was associated with gallstone disease in men, and at univariate analysis, in women. Decreasing serum total cholesterol levels and increasing serum triglycerides were associated with gallstone disease in both sexes in the multivariate analysis. In women, associations were also found with a number of pregnancies and paternal family history of gallstone disease. A slight but negative association with contraceptive pill use was identified only at multivariate analysis. Associations (investigated at univariate analysis) were also found with diabetes, cirrhosis, angina or myocardial infarction, and peptic ulcer. There was no association with smoking habits and use of aspirin or antirheumatic drugs.
- Published
- 1997
21. The risk of adenomatous polyps in asymptomatic first-degree relatives of persons with colon cancer
- Author
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Francesco Taroni, Enrico Roda, S. Fossi, Maria Cristina Morelli, S. Sottili, Franco Bazzoli, Rocco Maurizio Zagari, and Paolo Pozzato
- Subjects
medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,business.industry ,Colorectal cancer ,Gastroenterology ,Colonoscopy ,Odds ratio ,medicine.disease ,digestive system diseases ,Relative risk ,Internal medicine ,Medicine ,First-degree relatives ,Risk factor ,Family history ,business ,Mass screening - Abstract
Background & Aims: Increasing evidence indicates that inherited susceptibility is important in the pathogenesis of colorectai neoplasia. The aim of this study was to clarify whether having only one first-degree relative with colorectal cancer increases the risk of developing adenomatous polyps and whether total colonoscopy is an appropriate screening measure in these patients. Methods: The frequency of such a history was evaluated in 397 asymptomatic patients who underwent total colonoscopy. Of these patients, 155 had colorectal polyps and the remaining 242 did not have polyps. Results: Among polyp cases, 27 of 155 (17.4%) had a positive history; among those without polyps, 12 of 242 (5.0%) had a positive history. Alternatively expressed, 27 of 39 patients (69%) with family history and 128 of 358 patients (36%) without family history had adenomas. The estimated risk for polyps associated with family history was 1.9. Among polyp cases, 14 of 27 patients (51.9%) with family history and 32 of 128 patients (25.0%) without family history had only proximal polyps ( χ 2 test; P = 0.006; odds ratio, 3.2). In the same groups, frequency of high-grade dysplasia was 8 of 27 patients (29.6%) and 16 of 128 patients (12.5%), respectively ( χ 2 test; P = 0.04; odds ratio, 2.9). Conclusions: Relative to subjects with no family history, asymptomatic patients with one first-degree relative with colorectal cancer had nearly double the risk of developing adenomatous polyps, greater frequency of severely dyspiastic lesions, and significantly higher frequency of proximal polyp location. This suggests that total colonoscopy screening is indicated in these subjects.
- Published
- 1995
22. Helicobacter pylori and functional dyspepsia: review of previous studies and commentary on new data
- Author
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F. Bazzoli, Rocco Maurizio Zagari, L. De Luca, Debora Berretti, S. Fossi, Paolo Pozzato, G. Nicolini, Enrico Roda, and Luigi Ricciardiello
- Subjects
Helicobacter pylori infection ,medicine.medical_specialty ,Helicobacter pylori ,biology ,business.industry ,Spirillaceae ,Gastroenterology ,bacterial infections and mycoses ,biology.organism_classification ,Helicobacter Infections ,Biological effect ,Dyspepsia Management ,Internal medicine ,Prevalence ,medicine ,Humans ,Dyspepsia ,Gastritis ,medicine.symptom ,business - Abstract
Many studies have attempted to prove a link between Helicobacter pylori infection and functional dyspepsia but the results have been conflicting. Several mechanisms have been postulated for how H pylori associated inflammation disturbs antral and duodenal function but no pathophysiological explanation of how H pylori may cause dyspeptic symptoms is presently available.
- Published
- 2002
23. Ribavirin for chronic hepatitis C: And the mystery goes on
- Author
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Giuseppe Mazzella, Enrico Roda, Stefano Brillanti, Brillanti S., Mazzella G., and Roda E.
- Subjects
Drug ,Combination therapy ,Hepatitis C virus ,media_common.quotation_subject ,viruses ,medicine.disease_cause ,Antiviral Agents ,Drug Administration Schedule ,chemistry.chemical_compound ,Pharmacotherapy ,Chronic hepatitis ,Ribavirin ,Medicine ,Humans ,TERAPIA COMBINATA ,media_common ,Hepatology ,business.industry ,Gastroenterology ,MECCANISMO D' AZIONE ,Interferon-alpha ,virus diseases ,Hepatitis C ,Off-Label Use ,Hepatitis C, Chronic ,medicine.disease ,EPATITE C ,digestive system diseases ,RIBAVIRINA ,Peg interferon ,HCV ,chemistry ,Immunology ,Drug Therapy, Combination ,business - Abstract
Twenty years ago, ribavirin was first used in the treatment for chronic hepatitis C. After few years, ribavirin, in combination with interferon-alpha, showed a dramatic synergistic efficacy against hepatitis C virus infection, leading to viral clearance in about 50% of patients. Recent discovery of potent inhibitors of hepatitis C virus proteases did not replace ribavirin as the mainstay of combination therapy for chronic hepatitis C. Despite this fundamental role of ribavirin, many aspects of the mechanism of action and of the optimal dose and duration of therapy remain to be discovered or settled. In the present review, the authors recall the milestones in the history of ribavirin and try to shed light on the more relevant features of ribavirin action and utilization, and on the clinical problems encountered in managing and optimizing treatment for chronic hepatitis C. Finally, some potential off-label use of this drug in most difficult-to-treat subjects is pointed out. In conclusion, even if a sort of mystery surrounds ribavirin, its efficacy against hepatitis C virus infection fortunately remains lasting and stable.
- Published
- 2011
24. Rifaximin in the treatment of chronic hepatic encephalopathy; results of a multicenter study of efficacy and safety
- Author
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L. Marzio, L. Grossi, Davide Festi, Paolo Parini, A. Ferrieri, S. Li Bassi, M. Falcucci, Enrico Roda, A. Sangermano, M. Orsini, S. Sottili, and Giuseppe Mazzella
- Subjects
Pharmacology ,Chemotherapy ,medicine.medical_specialty ,Cirrhosis ,business.industry ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,Encephalopathy ,medicine.disease ,Gastroenterology ,Surgery ,Rifaximin ,Lactulose ,chemistry.chemical_compound ,chemistry ,Internal medicine ,medicine ,Pharmacology (medical) ,business ,Hepatic encephalopathy ,Antibacterial agent ,medicine.drug - Abstract
Hepatic encephalopathy (HE) is a metabolic-neurophysiologic syndrome that occurs in patients with liver disease. One of the main pathogenic mechanisms is represented by circulating toxins produced from the intestinal metabolism of nitrogenous compounds. The therapeutic approach to HE includes drugs that eliminate ammoniaproducing bacteria. The aim of this study was to evaluate the efficacy and safety of rifaximin, a nonabsorbable antibacterial agent, in the treatment of chronic HE in a large population of cirrhotic patients. One hundred thirty-six cirrhotic patients (100 men, 36 women; mean age, 59.5 years) with clinical and biochemical signs of mild HE were studied under three different treatment protocols: one open study in which rifaximin (1200 mg/day) was administered for 21 days to 80 patients; and two randomized controlled studies, one in which rifaximin (1200 mg/day, 20 patients) and neomycin (3000 mg/day, 15 patients) were administered for 21 days and one in which rifaximin (1200 mg/day, 9 patients) and lactulose (40 gm/day, 12 patients) were administered for 21 days. In the open study, after 5 days of treatment, ammonia reached normal values in each patient; after 7 days, electroencephalographic abnormalities were present only in a few cases; and after 15 days, no patients showed neurologic signs of HE. In the rifaximin versus neomycin study, blood ammonia levels and neurologic signs significantly decreased during both treatments, but rifaximin induced an earlier disappearance of clinical and biochemical signs of HE. In the rifaximin versus lactulose study, both drugs were efficacious in reducing the neurologic signs of HE, but some patients treated with lactulose presented mild side effects at the beginning of the therapy, which disappeared in the course of treatment. This study confirms the usefulness of rifaximin in the management of cirrhotic patients with mild HE; the absence of significant side effects suggests its use even in more severe cases of HE, either alone or in association with other drugs.
- Published
- 1993
25. ESWL for difficult bile duct stones: a 15-year single centre experience
- Author
-
Giuseppe Mazzella, Federica Buonfiglioli, Francesco Azzaroli, Paolo Cecinato, Rosangela Muratori, Enrico Roda, F. Alessandrelli, R. Muratori, F. Azzaroli, F. Buonfiglioli, F. Alessandrelli, P. Cecinato, G. Mazzella, and E. Roda
- Subjects
Adult ,Male ,medicine.medical_specialty ,Brief Article ,Hemobilia ,medicine.medical_treatment ,Hemorrhage ,Lithotripsy ,Severity of Illness Index ,Refractory ,Severity of illness ,medicine ,Humans ,Longitudinal Studies ,Aged ,Aged, 80 and over ,business.industry ,Bile duct ,Gastroenterology ,Haemobilia ,Stent ,General Medicine ,Middle Aged ,medicine.disease ,BILE DUCTS ,Extracorporeal shock wave lithotripsy ,Surgery ,Choledocholithiasis ,Treatment Outcome ,medicine.anatomical_structure ,CHOLELITHIASIS ,Vomiting ,Female ,medicine.symptom ,business ,ESWL - Abstract
AIM: To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) for the management of refractory bile duct cholelithiasis in a third level referral centre. METHODS: The clinical records of all patients treated with a second generation electromagnetic lithotripter (Lithostar Plus, SIEMENS) from October 1990 to April 2005 were evaluated. All patients were monitored during the procedure and antibiotics were administered in case of cholangitis. The χ2 test and logistic regression analysis were performed as appropriate. RESULTS: Two hundred and fourteen patients (102 males, 112 females; mean age 74.8 ± 0.84 years - single stone 97, multiple stones 117) underwent ESWL. The mean number of sessions and shock waves were 3.5 ± 0.13 and 3477.06 ± 66.17, respectively. The maximum stone size was 5 cm. Complete stone clearance was achieved in 192 (89.7%) patients. Of the remaining patients 15 required surgery, 2 a palliative stent and in 5 patients stone fragmentation led to effective bile drainage with clinical resolution despite incomplete clearance. Age, sex and stone characteristics were not related to treatment outcome. Major complications occurred in two patients (haemobilia and rectal bleeding) and minor complications in 25 (3 vomiting, 22 arrhythmias). No procedure-related deaths occurred. CONCLUSION: ESWL is a safe and effective technique for clearance of refractory bile duct stones.
- Published
- 2010
26. Reactivation of Crohn's disease after pandemic aH1N1 and seasonal flu vaccinations
- Author
-
Andrea Lisotti, Giulia Roda, Enrico Roda, Stefano Brillanti, Lisotti A., Roda G., Brillanti S., and Roda E.
- Subjects
REACTIVATION ,Crohn's disease ,Hepatology ,biology ,business.industry ,Crohn disease ,Orthomyxoviridae ,Gastroenterology ,CROHN'S DISEASE ,biology.organism_classification ,medicine.disease ,Virology ,Flu vaccinations ,Vaccination ,INFLUENZA ,VACCINATION ,Immunology ,Pandemic ,Medicine ,Young adult ,business - Abstract
We report a case of a prompt reactivation of a quiescent Crohn's disease with pain, fever and abdominal abscess which occurred after seasonal and pandemic flu vaccinations. Based on the clinical history and the timing of the events, we could relate the relapse of CD to the double vaccinations.
- Published
- 2010
27. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study
- Author
-
Paolo Pazzi, Adolfo Francesco Attili, Maria Letizia Bacchi Reggiani, Enrico Roda, Ferdinando Romano, Antonio Colecchia, Paola Loria, Davide Festi, S. Capodicasa, Eleonora Scaioli, Festi D., Bacchi-Reggiani M.L., Attili A.F., Poria P., Pazzi P., Scaioli E., Capodicasa S., Romano F., Roda E., and Colecchia A.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Population ,Gallstones ,Risk Assessment ,Severity of Illness Index ,Asymptomatic ,Gastroenterology ,Recurrence ,Risk Factors ,Surveys and Questionnaires ,Internal medicine ,Epidemiology ,Severity of illness ,medicine ,Humans ,Cholecystectomy ,Lost to follow-up ,education ,Aged ,Ultrasonography ,education.field_of_study ,Chi-Square Distribution ,Hepatology ,business.industry ,Patient Selection ,Middle Aged ,medicine.disease ,Natural history ,biliary symptoms ,cholecystectomy ,epidemiology ,gallstones ,Cross-Sectional Studies ,Logistic Models ,Treatment Outcome ,Italy ,Population Surveillance ,Disease Progression ,gallstone disease ,Female ,medicine.symptom ,business ,Cohort study - Abstract
Background and Aims: The knowledge of natural history is essential for disease management. We evaluated the natural history (e.g. frequency and characteristics of symptoms and clinical outcome) of gallstones (GS) in a population-based cohort study. Methods: A total of 11 229 subjects (6610 men, 4619 women, age-range: 29–69 years, mean age: 48 years) were studied. At ultrasonography, GS were present in 856 subjects (338 men, 455 women) (7.1%). GS were followed by means of a questionnaire inquiring about the characteristics of specific biliary symptoms. Results: At enrolment, 580 (73.1%) patients were asymptomatic, 94 (11.8%) had mild symptoms and 119 (15.1%) had severe symptoms. GS patients were followed up for a mean period of 8.7 years; 63 subjects (7.3%) were lost to follow up. At the end of the follow up, of the asymptomatic subjects, 453 (78.1%) remained asymptomatic; 61 (10.5%) developed mild symptoms and 66 (11.4%) developed severe symptoms. In subjects with mild symptoms, the symptoms disappeared in 55 (58.5%), became severe in 23 (24.5%), remained stable in 16 (17%); in subjects with severe symptoms, the symptoms disappeared in 62 (52.1%), became mild in 20 (16.8%) and remained stable in 37 (31.1%). A total of 189 cholecystectomies were performed: 41.3% on asymptomatic patients, 17.4% on patients with mild symptoms and 41.3% on patients with severe symptoms. Conclusions: This study indicates that: (i) asymptomatic and symptomatic GS patients have a benign natural history; (ii) the majority of GS patients with severe or mild symptoms will no longer experience biliary pain; and (iii) a significant proportion of cholecystectomies are performed in asymptomatic patients. Expectant management still represents a valid therapeutic approach in the majority of patients.
- Published
- 2010
28. Pilot study: the use of sulfasalazine for the treatment of acute pouchitis
- Author
-
M. Grazia, Giampaolo Ugolini, Maria Luisa Bianchi, Giancarlo Rosati, Marta Serrani, Andrea Belluzzi, Giulia Roda, Enrico Roda, Lucia Castellani, Belluzzi A., Serrani M., Roda G., Bianchi M.L., Castellani L., Grazia M., Rosati G., Ugolini G., and Roda E.
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,ACUTE POUCHITIS ,Colonic Pouches ,Pilot Projects ,Pouchitis ,Severity of Illness Index ,Gastroenterology ,Young Adult ,Sulfasalazine ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Intestinal Mucosa ,Mesalamine ,Adverse effect ,Hepatology ,medicine.diagnostic_test ,Proctocolectomy ,business.industry ,Proctocolectomy, Restorative ,MEDICAL TREATMENT ,Middle Aged ,medicine.disease ,Ulcerative colitis ,Surgery ,Endoscopy ,Treatment Outcome ,ULCERATIVE COLITIS ,Female ,Pouch ,Complication ,business ,medicine.drug - Abstract
Summary Background Acute pouchitis, an idiopathic inflammatory condition of the ileal pouch anal anastomosis, is the most frequent complication after proctocolectomy for ulcerative colitis. Aim To test the hypothesis that sulfasalazine (SASP) might have a synergistic beneficial effect in acute pouchitis, by combining the anti-inflammatory activity of 5-aminosalicylic Acid and the bacteriostatic effect of sulphapyridine. Methods Twenty two patients were investigated for acute pouchitis; the Pouchitis Disease Activity Index (PDAI) was calculated and 11 patients with acute pouchitis (PDAI >7) were included in an open study, after obtaining their informed consent. Patients were treated with SASP 500 mg tablets, two tablets three times per day (3000 mg daily), for 2 months. Pouch endoscopy with biopsies was performed at the entry and at the end of the study. Results According to the PDAI score, 8/11 patients (73%) improved their clinical condition and 7/11 (63%) were in remission at the end of the treatment. At 8 weeks, the median PDAI index decreased from 11.2 ± 2.3 to 6.6 ± 4.7 P
- Published
- 2010
29. Effect of rifaximin and paromomycin in the treatment of portal-systemic encephalopathy
- Author
-
Antonio Salzetta, Enrico Roda, Paolo Parini, Giuseppe Mazzella, A Cipolla, and Ronchi M
- Subjects
Pharmacology ,medicine.medical_specialty ,Cirrhosis ,medicine.drug_class ,business.industry ,Antibiotics ,Encephalopathy ,Hyperammonemia ,Paromomycin ,medicine.disease ,Gastroenterology ,Surgery ,Rifaximin ,chemistry.chemical_compound ,chemistry ,Internal medicine ,medicine ,Pharmacology (medical) ,business ,Hepatic encephalopathy ,Antibacterial agent ,medicine.drug - Abstract
Portal-systemic encephalopathy, a condition caused by liver failure, often complicates hepatic cirrhosis. Its pathogenesis is unknown, although hyperammonemia is thought to play an important role. Non-absorbable antibiotics have been used to treat hepatic encephalopathy because of their ability to reduce intestinal flora and thereby decrease the intestinal production of ammonia. We compared the effectiveness of rifaximin, a new non-absorbable antibiotic, with that of paromomycin. Thirty cirrhotic patients (20 men and 10 women, aged 39 to 75 years) suffering from portal-systemic encephalopathy with hyperammonemia were selected by Conn's grading. Fifteen patients were randomly assigned to treatment with paromomycin (1,500 mg/day), and the other 15 received rifaximin (1,200 mg/day) for 10 days. Before, after 5 days, and after 10 days of treatment, we evaluated blood ammonia levels and each patient's signs and symptoms according to Conn's grading. Baseline ammonia levels and the degree of hepatic encephalopathy were positively correlated ( r = .65; P P P
- Published
- 1992
30. Pathophysiology and pharmacotherapy of cholelithiasis
- Author
-
Enrico Roda, Aldo Roda, Giuseppe Mazzella, Franco Bazzoli, Rita Aldini, and Davide Festi
- Subjects
medicine.medical_specialty ,medicine.drug_class ,education ,Chenodeoxycholic Acid ,Gastroenterology ,Bile Acids and Salts ,Pharmacotherapy ,Cholelithiasis ,Lithotripsy ,Internal medicine ,Humans ,Medicine ,Pharmacology (medical) ,Pharmacology ,Bile acid ,business.industry ,Gallbladder ,Ursodeoxycholic Acid ,Cholesterol crystals ,Cholesterol gallstone ,Pathophysiology ,medicine.anatomical_structure ,Biliary stone ,Solubility ,Safety ,business - Abstract
Several factors are involved in the development of gallstone formation: formation of supersaturated bile; nucleation; formation, retention and adhesion of cholesterol crystals and eventually stone growth. The dynamics of the gallbladder may play a key role in the overall process. The pathophysiologic theory of cholesterol gallstone formation and the knowledge of their physico-chemical properties support the modern concept of gallstone therapy. Chenodeoxycholic and ursodeoxycholic have been widely used as cholesterol gallstone dissolving agents and evaluated in terms of efficacy and safety.
- Published
- 1992
31. Review: low caloric intake and gall-bladder motor function
- Author
-
A. Larocca, Maria Letizia Petroni, Giuseppe Mazzella, Enrico Roda, Antonio Colecchia, Davide Festi, Nicola Villanova, and Ferdinando Romano
- Subjects
medicine.medical_specialty ,Motility ,Stimulation ,digestive system ,chemistry.chemical_compound ,Weight loss ,Internal medicine ,medicine ,Pharmacology (medical) ,Hepatology ,business.industry ,Cholesterol ,Gallbladder ,digestive, oral, and skin physiology ,Gastroenterology ,Gallstones ,medicine.disease ,Obesity ,digestive system diseases ,Ursodeoxycholic acid ,Endocrinology ,medicine.anatomical_structure ,chemistry ,medicine.symptom ,business ,medicine.drug - Abstract
Cholelithiasis is the primary expression of obesity in the hepatobiliary system. In obese subjects the risk of developing gallstones is increased due to a higher cholesterol saturation of gall-bladder bile. During weight reduction with very low calorie diets (VLCD) the incidence of gallstones increases, but the mechanism for gallstone formation is not completely understood and several pathogenetic mechanisms have been suggested: increased saturation of bile, increased gall-bladder secretion of mucin and calcium, increased presence of prostaglandins and arachidonic acid. Alterations in gall-bladder motility may contribute to gallstone formation, but few studies have addressed the issue of gall-bladder motility during rapid weight loss and its possible role in gallstone formation. VLCD have been associated with a gall-bladder stasis, as a consequence of reduced gall-bladder stimulation by low fat content of the diets. A threshold quantity of fat (10 g) has been documented to obtain efficient gall-bladder emptying. Ursodeoxycholic acid administered during VLCD seems to have a protective role in developing a biliary cholesterol crystals. Gall-bladder emptying was lower in response to low fat meals with respect to relative higher fat meals, before as well as during the VLCD. This may account the possibility of an adaptative response of the gall-bladder motility to a given diet regimen. Adequate fat content of the VLCD may prevent gallstone formation, maintaining adequate gall-bladder motility and may be more economic and physiologically acceptable than administration of a pharmacological agent.
- Published
- 2000
32. G-CSF in Peg-IFN induced neutropenia in liver transplanted patients with HCV recurrence
- Author
-
Maria Rosa Tamè, Federica Buonfiglioli, Francesca Lodato, Francesco Azzaroli, Enrico Roda, Maria Di Girolamo, Paolo Cecinato, Giuseppe Mazzella, Natalia Mazzella, Lodato F, Azzaroli F, Tamè MR, Di Girolamo M, Buonfiglioli F, Mazzella N, Cecinato P, Roda E, and Mazzella G
- Subjects
Adult ,Male ,medicine.medical_specialty ,Neutropenia ,Brief Article ,Neutrophils ,Hepacivirus ,medicine.medical_treatment ,Autoimmune hepatitis ,OLT ,Interferon alpha-2 ,Liver transplantation ,G-CSF ,Antiviral Agents ,Gastroenterology ,Polyethylene Glycols ,Postoperative Complications ,Recurrence ,Internal medicine ,Granulocyte Colony-Stimulating Factor ,Humans ,Medicine ,Aged ,PEGIFN ,biology ,business.industry ,Interferon-alpha ,General Medicine ,Hepatitis C ,Middle Aged ,biology.organism_classification ,medicine.disease ,Recombinant Proteins ,Liver Transplantation ,Granulocyte colony-stimulating factor ,Transplantation ,Immunology ,Absolute neutrophil count ,Female ,business ,RIBAVIRIN ,HEPATITIS C RECURRENCE - Abstract
AIM: To evaluate the efficacy of granulocyte colony stimulating factors (G-CSF) in liver transplanted patients with hepatitis C (HCV) recurrence and Pegylated-IFN α-2b induced neutropenia, and to evaluate the impact of G-CSF administration on virological response. METHODS: Sixty-eight patients undergoing antiviral treatment for post-liver transplantation (OLT) HCV recurrence were enrolled. All patients developing neutropenia received G-CSF. RESULTS: Twenty three (34%) received G-CSF. Mean neutrophil count at the onset of neutropenia was 700/mmc (range 400-750/mmc); after 1 mo of G-CSF it increased to 1210/mmc (range 300-5590/mmc) (P < 0.0001). Three patients did not respond to G-CSF. Treatment duration was similar in neutropenic and non-neutropenic patients. No differences in the rate of discontinuation, infections or virological response were observed between the two groups. G-CSF was protective for the onset of de novo autoimmune hepatitis (P < 0.003). CONCLUSION: G-CSF administration is effective in the case of Peg-IFN induced neutropenia increasing neutrophil count, prolonging treatment and leading to sustained virological response (SVR) rates comparable to non-neutropenic patients. It prevents the occurrence of de novo autoimmune hepatitis.
- Published
- 2009
33. Comparative evaluation of chenodeoxycholic and ursodeoxycholic acids in obese patients
- Author
-
Patrizia Simoni, Franco Bazzoli, Brunella Grigolo, Enrico Roda, Rita Aldini, Giuseppe Mazzella, Davide Festi, Aldo Roda, Ronchi M, and Nicola Villanova
- Subjects
medicine.medical_specialty ,Lithocholic acid ,Hepatology ,Bile acid ,business.industry ,Cholesterol ,medicine.drug_class ,Deoxycholic acid ,Gastroenterology ,Cholic acid ,Metabolism ,Ursodeoxycholic acid ,chemistry.chemical_compound ,Endocrinology ,chemistry ,Chenodeoxycholic acid ,Internal medicine ,Medicine ,business ,medicine.drug - Abstract
Obesity is a condition associated with an increased frequency of gallstone disease. This study attempted to evaluate the comparative effects of two gallstone-dissolving agents, chenodeoxycholic acid and ursodeoxycholic acid, on bile acid metabolism and biliary lipid secretion in obese subjects in order to identify the bile acid of choice in preventing and treating gallstone disease in obesity. Twenty obese subjects (greater than 120% ideal body wt) were randomly treated with ursodeoxycholic acid (10 mg.kg-1.day-1.1 mo-1) and then with chenodeoxycholic acid (15 mg.kg-1.day-1.1 mo-1) or with chenodeoxycholic acid first and then with ursodeoxycholic acid. Patients 1-10 were studied while eating an unrestricted weight-maintenance diet, whereas patients 11-20 were eating a 1080-kcal/d hypocaloric diet. Biliary lipid composition, cholesterol saturation index, and biliary bile acid pattern were evaluated in all subjects before and after each treatment period; in subjects 6-10 and 16-20, biliary lipid secretion rates and bile acid pool size were also evaluated. Both ursodeoxycholic acid and chenodeoxycholic acid decreased cholesterol outputs and cholesterol saturation index. However, during the weight-maintenance period the decrease induced by chenodeoxycholic acid was not significant. Biliary cholesterol outputs and cholesterol saturation index were always lower during ursodeoxycholic acid administration than during chenodeoxycholic acid therapy. Ursodeoxycholic acid levels during ursodeoxycholic acid administration and chenodeoxycholic acid levels during chenodeoxycholic acid administration increased in bile to 50% and 77%, respectively, of total bile acid levels. Bile acid pool size remained unchanged during chenodeoxycholic acid administration and was significantly reduced by ursodeoxycholic acid administration during the weight-reduction period. In conclusion, ursodeoxycholic acid in obese subjects seems more effective than chenodeoxycholic acid, at least during weight maintenance, in reducing cholesterol saturation of bile. This effect is related to a significant decrease of biliary cholesterol output.
- Published
- 1991
34. Proton pump inhibitors in cirrhosis: Tradition or evidence based practice?
- Author
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Francesca Lodato, Paolo Cecinato, V. Feletti, Maria Di Girolamo, Giuseppe Mazzella, Francesco Azzaroli, Andrea Lisotti, Davide Festi, Enrico Roda, Lodato F, Azzaroli F, Di Girolamo M, Feletti V, Cecinato P, Lisotti A, Festi D, Roda E, and Mazzella G.
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Liver Cirrhosis ,medicine.medical_specialty ,Peptic Ulcer ,Cirrhosis ,medicine.medical_treatment ,Peptic ,Disease ,Review ,Achlorhydria ,Esophageal and Gastric Varices ,Gastroenterology ,Gastric Acid ,Internal medicine ,medicine ,Sclerotherapy ,Humans ,CIRRHOSIS ,Evidence-Based Medicine ,biology ,Helicobacter pylori ,business.industry ,HELICOBACTER P ,Proton Pump Inhibitors ,General Medicine ,medicine.disease ,biology.organism_classification ,Treatment Outcome ,Practice Guidelines as Topic ,Gastroesophageal Reflux ,Gastric acid ,ACID GASTRIC SECRETION ,business ,Varices - Abstract
Proton pump inhibitors (PPI) are very effective in inhibiting acid secretion and are extensively used in many acid related diseases. They are also often used in patients with cirrhosis sometimes in the absence of a specific acid related disease, with the aim of preventing peptic complications in patients with variceal or hypertensive gastropathic bleeding receiving multidrug treatment. Contradicting reports support their use in cirrhosis and evidence of their efficacy in this condition is poor. Moreover there are convincing papers suggesting that acid secretion is reduced in patients with liver cirrhosis. With regard to Helicobacter pylori (H pylori) infection, its prevalence in patients with cirrhosis is largely variable among different studies, and it seems that H pylori eradication does not prevent gastro-duodenal ulcer formation and bleeding. With regard to the prevention and treatment of oesophageal complications after banding or sclerotherapy of oesophageal varices, there is little evidence for a protective role of PPI. Moreover, due to liver metabolism of PPI, the dose of most available PPIs should be reduced in cirrhotics. In conclusion, the use of this class of drugs seems more habit related than evidence-based eventually leading to an increase in health costs.
- Published
- 2008
35. Gastro-oesophageal reflux symptoms, oesophagitis and Barrett's oesophagus in the general population: the Loiano-Monghidoro study
- Author
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Christopher C Winchester, Franco Bazzoli, Saga Johansson, Enrico Roda, Bahman Farahmand, Rocco Maurizio Zagari, Lorenzo Fuccio, Mari-Ann Wallander, S. Casanova, Roberto Fiocca, Zagari RM, Fuccio L, Wallander MA, Johansson S, Fiocca R, Casanova S, Farahmand BY, Winchester CC, Roda E, and Bazzoli F.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Esophageal Neoplasms ,Population ,Prevalence ,Gastroenterology ,digestive system ,Endoscopy, Gastrointestinal ,GORD ,Barrett Esophagus ,Risk Factors ,Internal medicine ,Medicine ,Esophagitis ,Humans ,education ,Aged ,education.field_of_study ,business.industry ,Esophageal disease ,Patient Selection ,digestive, oral, and skin physiology ,Reflux ,Middle Aged ,medicine.disease ,digestive system diseases ,Italy ,Relative risk ,Barrett's esophagus ,Gastroesophageal Reflux ,Female ,business ,Epidemiologic Methods ,Body mass index ,BARRETT - Abstract
OBJECTIVE: Existing endoscopy-based data on gastro-oesophageal reflux disease (GORD) in the general population are scarce. This study aimed to evaluate typical symptoms and complications of GORD, and their associated risk factors, in a representative sample of the Italian population. METHODS: 1533 adults from two Italian villages were approached to undergo symptom assessment using a validated questionnaire and upper gastrointestinal endoscopy. Data were obtained from 1033 individuals (67.4% response rate). RESULTS: The prevalence of reflux symptoms was 44.3%; 23.7% of the population experienced such symptoms on at least 2 days per week (frequent symptoms). The prevalence rates of oesophagitis and Barrett's oesophagus in the population were 11.8% and 1.3%, respectively. Both frequent (relative risk (RR) 2.6; 95% confidence interval (CI) 1.7 to 3.9) and infrequent (RR 1.9; 95% CI 1.2 to 3.0) reflux symptoms were associated with the presence of oesophagitis. No reflux symptoms were reported by 32.8% of individuals with oesophagitis and 46.2% of those with Barrett's oesophagus. Hiatus hernia was associated with frequent reflux symptoms and oesophagitis, and was present in 76.9% of those with Barrett's oesophagus. We found no association between body mass index and reflux symptoms or oesophagitis. CONCLUSIONS: GORD is common in Italy, but the prevalence of Barrett's oesophagus in the community is lower than has been reported in selected populations. Both frequent and infrequent reflux symptoms are associated with an increased risk of oesophagitis. Individuals with oesophagitis and Barrett's oesophagus often have no reflux symptoms.
- Published
- 2008
36. Incidence of gallstone disease in Italy: Results from a multicenter, population-based Italian study (the MICOL project)
- Author
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Claudia Sama, Adolfo Francesco Attili, Ada Dormi, Paolo Pazzi, Paola Loria, Davide Festi, Antonio Colecchia, Enrico Roda, Tommaso Staniscia, Giuseppe Mazzella, S. Capodicasa, Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P, Pazzi P, Mazzella G, Sama C, Roda E, and Colecchia A.
- Subjects
Adult ,Male ,Abdominal pain ,medicine.medical_specialty ,Epidemiology ,Cross-sectional study ,Population ,Pain ,Disease ,Population based ,Gallstones ,Body Mass Index ,abdominal pain ,body mass index ,cholecystectomy ,epidemiology ,gallstone disease ,incidence ,prevalence ,ultrasonography ,Clinical Research ,Risk Factors ,Gallstone disease ,Prevalence ,Medicine ,Humans ,Cholecystectomy ,education ,Ultrasonography ,Incidence ,Body mass index ,Aged ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,INCIDENCE OF GALLSTONE ITALY ,CHOLESTEROL GALLSTONE ,Gastroenterology ,Age Factors ,General Medicine ,RISK FACTOR FOR GALLSTONE ,Middle Aged ,medicine.disease ,Surgery ,Cross-Sectional Studies ,Multicenter study ,Italy ,Female ,business ,Demography - Abstract
AIM: To evaluate gallstone incidence and risk factors in a large population-based study. METHODS: Gallstone incidence and risk factors, were evaluated by structured questionnaire and physical examination, respectively, in 9611 of 11 109 (86.5%) subjects who were gallstone-free at the cross-sectional study. RESULTS: Six centers throughout Italy enrolled 9611 subjects (5477 males, 4134 females, aged 30-79 years), 9517 of whom were included into analysis: 424 subjects (4.4%) had gallstones and 61 (0.6%) had been cholecystectomized yielding a cumulative incidence of 0.67% per year (0.66% in males, 0.81% in females). Increasing age, a high body mass index (BMI), a history of diabetes, peptic ulcer and angina, and low cholesterol and high triglyceride levels were identified as risk factors in men while, in females, the only risk factors were increasing age and a high BMI. Increasing age and pain in the right hypocondrium in men and increasing age in females were identified as predictors of gallstones. Pain in the epigastrium/right hypocondrium was the only symptom related to gallstones; furthermore, some characteristics of pain (forcing to rest, not relieved by bowel movements) were significantly associated with gallstones. No correlation was found between gallstone characteristics and clinical manifestations, while increasing age in men and increasing age and BMI in females were predictors of pain. CONCLUSION: Increasing age and BMI represent true risk factors for gallstone disease (GD); pain in the right hypocondrium and/or epigastrium is confirmed as the only symptom related to gallstones.
- Published
- 2008
37. Inflammatory bowel disease: Moving toward a stem cell-based therapy
- Author
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Giacomo Lanzoni, Gian Paolo Bagnara, Enrico Roda, Andrea Belluzzi, Giulia Roda, LANZONI G., RODA G, BELLUZZI A, RODA E, and BAGNARA GP.
- Subjects
business.industry ,medicine.medical_treatment ,Mesenchymal stem cell ,Gastroenterology ,Hematopoietic Stem Cell Transplantation ,General Medicine ,Disease ,Hematopoietic stem cell transplantation ,Review ,medicine.disease ,Inflammatory Bowel Diseases ,Mesenchymal Stem Cell Transplantation ,Inflammatory bowel disease ,Ulcerative colitis ,digestive system diseases ,Haematopoiesis ,Immune system ,Immunology ,medicine ,Humans ,Stem cell ,business ,Stem Cell Transplantation - Abstract
The incidence and prevalence of Crohn's disease (CD) and ulcerative colitis (UC), the two major forms of inflammatory bowel diseases (IBD), are rising in western countries. The modern hygienic lifestyle is probably at the root of a disease where, in genetically susceptible hosts, the intestinal commensal flora triggers dysregulated immune and inflammatory responses. Current therapies ranging from anti-inflammatory drugs to immunosuppressive regimens, remain inadequate. Advances in our understanding of the cell populations involved in the pathogenetic processes and recent findings on the regenerative, trophic and immunoregulatory potential of stem cells open new paths in IBD therapy. Hematopoietic and mesenchymal stem cells are catalyzing the attention of IBD investigators. This review highlights the pivotal findings for stem cell-based approaches to IBD therapy and collects the encouraging results coming in from clinical trials.
- Published
- 2008
38. Gallbladder motility in cholesterol gallstone disease
- Author
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Laura Rossi, Paolo Parini, R. Frabboni, Anna M.M. Primerano, Aldo Sangermano, Ronchi M, Enrico Roda, Davide Festi, M. Orsini, Franco Bazzoli, Giuseppe Mazzella, and Rita Aldini
- Subjects
medicine.medical_specialty ,Chemotherapy ,Hepatology ,Bile acid ,Cholesterol ,business.industry ,medicine.drug_class ,Gallbladder ,medicine.medical_treatment ,Gastroenterology ,Motility ,Gallstones ,medicine.disease ,Ursodeoxycholic acid ,chemistry.chemical_compound ,medicine.anatomical_structure ,chemistry ,Oral administration ,Internal medicine ,medicine ,business ,medicine.drug - Abstract
Gallbladder motility was evaluated by ultrasonography in 75 cholesterol gallstone patients and in 77 matched control subjects. All 75 gallstone patients were candidates for oral bile acid therapy (radiolucent gallstones
- Published
- 1990
39. A new oral formulation for the release of sodium butyrate in the ileo-cecal region and colon
- Author
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Aldo Roda, Paolo Nanni, Enrico Roda, Mario Baraldini, Maria Magliulo, Giulia Roda, Patrizia Simoni, Roda A., Simoni P., Magliulo M., Nanni P., Baraldini M., Roda G., and Roda E.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Colon ,Sodium ,Chemistry, Pharmaceutical ,chemistry.chemical_element ,Administration, Oral ,Ileum ,Butyrate ,Absorption (skin) ,Gastroenterology ,Taurochenodeoxycholic Acid ,chemistry.chemical_compound ,Cecum ,Crohn Disease ,Internal medicine ,medicine ,Humans ,Aged ,Breath test ,Carbon Isotopes ,medicine.diagnostic_test ,business.industry ,digestive, oral, and skin physiology ,Sodium butyrate ,Tauroursodeoxycholic acid ,General Medicine ,Carbon Dioxide ,Middle Aged ,Butyrates ,medicine.anatomical_structure ,chemistry ,Female ,Tablets, Enteric-Coated ,business ,Rapid Communication - Abstract
To develop a new formulation with hydroxy propyl methyl cellulose and Shellac coating for extended and selective delivery of butyrate in the ileo-caecal region and colon.One-gram sodium butyrate coated tablets containing 13C-butyrate were orally administered to 12 healthy subjects and 12 Crohn's disease patients and the rate of 13C-butyrate absorption was evaluated by 13CO2 breath test analysis for eight hours. Tauroursodeoxycholic acid (500 mg) was co-administered as a biomarker of oro-ileal transit time to determine also the site of release and absorption of butyrate by the time of its serum maximum concentration.The coated formulation delayed the 13C-butyrate release by 2-3 h with respect to the uncoated tablets. Sodium butyrate was delivered in the intestine of all subjects and a more variable transit time was found in Crohn's disease patients than in healthy subjects. The variability of the peak 13CO2 in the kinetic release of butyrate was explained by the inter-subject variability in transit time. However, the coating chosen ensured an efficient release of the active compound even in patients with a short transit time.Simultaneous evaluation of breath 13CO2 and tauroursodeoxycholic acid concentration-time curves has shown that the new oral formulation consistently releases sodium butyrate in the ileo-cecal region and colon both in healthy subjects and Crohn's disease patients with variable intestinal transit time. This formulation may be of therapeutic value in inflammatory bowel disease patients due to the appropriate release of the active compound.
- Published
- 2007
40. Efficacy of long term cyclic administration of the poorly absorbed antibiotic Rifaximin in symptomatic, uncomplicated colonic diverticular disease
- Author
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Giovanni Brandimarte, Francesca Pasqui, Enrico Roda, Francesca Pistoia, Antonio Colecchia, Davide Festi, Giuseppe Mazzella, Amanda Vestito, Colecchia A, Vestito A, Pasqui F, Mazzella G, Roda E, Pistoia F, Brandimarte G, and Festi D
- Subjects
Adult ,Male ,medicine.medical_specialty ,DIETARY FIBER ,ANTIBIOTICS ,ABDOMINAL SYMPTOMS ,DIVERTICULITIS ,Physical examination ,Gastroenterology ,Rifaximin ,law.invention ,chemistry.chemical_compound ,Pharmacotherapy ,Randomized controlled trial ,Anti-Infective Agents ,law ,Clinical Research ,Internal medicine ,Diverticulosis, Colonic ,Medicine ,Humans ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,digestive, oral, and skin physiology ,General Medicine ,Diverticulitis ,Middle Aged ,medicine.disease ,Rifamycins ,Diverticulosis ,Surgery ,Treatment Outcome ,chemistry ,Diverticular disease ,Drug Therapy, Combination ,Female ,business ,Complication - Abstract
AIM: To comparatively evaluate the long term efficacy of Rifaximin and dietary fibers in reducing symptoms and/or complication frequency in symptomatic, uncomplicated diverticular disease. METHODS: 307 patients (118 males, 189 females, age range: 40-80 years) were enrolled in the study and randomly assigned to: Rifaximin (400 mg bid for 7 d every month) plus dietary fiber supplementation (at least 20 gr/d) or dietary fiber supplementation alone. The study duration was 24 mo; both clinical examination and symptoms’ questionnaire were performed every two months. RESULTS: Both treatments reduced symptom frequency, but Rifaximin at a greater extent, when compared to basal values. Symptomatic score declined during both treatments, but a greater reduction was evident in the Rifaximin group (6.4 ± 2.8 and 6.2 ± 2.6 at enrollment, p = NS, 1.0 ± 0.7 and 2.4 ± 1.7 after 24 mo, p < 0.001, respectively). Probability of symptom reduction was higher and complication frequency lower (Kaplan-Meyer method) in the Rifaximin group (p < 0.0001 and 0.028, respectively). CONCLUSION: In patients with symptomatic, uncomplicated diverticular disease, cyclic administration of Rifaximin plus dietary fiber supplementation is more effective in reducing both symptom and complication frequency than simple dietary fiber supplementation. Long term administration of the poorly absorbed antibiotic Rifaximin is safe and well tolerated by the patients, confirming the usefulness of this therapeutic strategy in the overall management of diverticular disease.
- Published
- 2007
41. Is it possible to predict the clinical course of gallstone disease? Usefulness of gallbladder motility evaluation in a clinical setting
- Author
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Enrico Roda, Maria Letizia Bacchi-Reggiani, Giuseppe Mazzella, L. Sandri, Piero Portincasa, Davide Festi, Antonio Colecchia, Giuseppe Palasciano, Colecchia A, Sandri L, Bacchi-Reggiani ML, Portincasa P, Palasciano G, Mazzella G, Roda E, and Festi D.
- Subjects
Male ,medicine.medical_specialty ,Movement ,Motility ,Pain ,Disease ,Gallstones ,Gastroenterology ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Ultrasonography ,Hepatology ,business.industry ,Gallbladder ,Clinical course ,Organ Size ,Middle Aged ,GALLBLADDER MOTILITY ,Gallbladder motility ,medicine.anatomical_structure ,Female ,business ,Biliary tract disease - Abstract
A knowledge of the predictive factors of the development and persistence of symptoms in gallstone patients (GS) plays a key role in clinical decision making. The aim of this study was to evaluate the presence of predictive factors for biliary pain development in GS, stressing the role of gallbladder motility.A total of 153 (104 women, 49 men) consecutive GS were enrolled. Gallbladder motility (%Emptying [%E], residual volume [RV]) was evaluated by ultrasonography and biliary symptoms were evaluated using a specific questionnaire in all GS at baseline and after 4 yr of follow-up.At enrolment, 61 GS reported recent (GSr) and 31 GS remote (GSo) (2 yr before) episodes of biliary pain, and 61 were asymptomatic (GSa). At baseline, GSr showed a greater %E and a smaller RV than both GSo and GSa (p0.001). After follow-up, biliary pain developed more frequently in GSr (33.3%) than in GSo (16%) and GSa (15%) (p= 0.04). The search for predictive factors of biliary pain development (by univariate and multivariate analyses) revealed a high %E, a small RV, and a history of biliary pain as risk factors.Efficient gallbladder motility is present in symptomatic GS and it represents a risk factor for biliary pain development while sluggish motility seems to play a protective role. Thus, gallbladder motility evaluation is a useful diagnostic tool in clinical decision making for GS; in symptomatic GS, a progressive reduction of gallbladder motility could suggest a "wait and see" management policy instead of an immediate surgical approach.
- Published
- 2006
42. Comparison of 1 and 2 weeks of omeprazole, amoxicillin and clarithromycin treatment for Helicobacter pylori eradication: the HYPER Study
- Author
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Giovanni Gasbarrini, Franco Bazzoli, Roberto Fiocca, Rocco Maurizio Zagari, Gabriele Bianchi-Porro, Enrico Roda, Zagari RM, Bianchi-Porro G, Fiocca R, Gasbarrini G, Roda E, and Bazzoli F.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Urea breath test ,Proton-pump inhibitor ,Gastroenterology ,Drug Administration Schedule ,Helicobacter Infections ,Double-Blind Method ,Clarithromycin ,Internal medicine ,medicine ,Humans ,Omeprazole ,Aged ,Antibacterial agent ,Breath test ,medicine.diagnostic_test ,biology ,business.industry ,Amoxicillin ,Middle Aged ,Helicobacter pylori ,biology.organism_classification ,Helicobacter Pylori ,Anti-Bacterial Agents ,Treatment Outcome ,Breath Tests ,Duodenal Ulcer ,Patient Compliance ,Drug Therapy, Combination ,Female ,business ,medicine.drug - Abstract
BACKGROUND: Triple therapy is recommended for Helicobacter pylori eradication, yet consensus on the duration of treatment is lacking. AIM: To compare the efficacy and safety of 1- and 2-week regimens of omeprazole, amoxicillin and clarithromycin in a large, multicentre, double-blind and randomised study. METHODS: A total of 909 H pylori-positive patients with duodenal ulcer, enrolled in 81 endoscopy units in Italy, were randomised to receive omeprazole, amoxicillin and clarithromycin for either 1 week (OAC1W) or 2 weeks (OAC2W) or omeprazole and amoxicillin for 2 weeks. H pylori eradication was assessed by histological examination and carbon-13 urea breath test 4 weeks after treatment. RESULTS: Both the intention-to-treat (ITT; n = 907) and per protocol (PP; n = 661) analyses showed no significant differences between the eradication rates of OAC1W (ITT 79.7%; PP 83.6%) and OAC2W (ITT 81.7%; PP 84.9%; ITT p = 0.53; PP p = 0.71). Both triple omeprazole, amoxicillin and clarithromycin regimens gave significantly higher eradication rates compared with omeprazole and amoxicillin treatment (ITT 44.6%; PP 42.8%; p
- Published
- 2006
43. Management of hepatic encephalopathy: focus on antibiotic therapy
- Author
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Davide Festi, Giuseppe Mazzella, Amanda Vestito, Enrico Roda, Antonio Colecchia, C.SCARPIGNATO, A.LANAS, SCARPIGNATO C., LANAS A., Festi D, Vestito A, Mazzella G, Roda E, and Colecchia A.
- Subjects
Pediatrics ,medicine.medical_specialty ,medicine.drug_class ,liver cirrhosis ,Antibiotics ,hepatic encephalopathy ,ammonia ,antibiotics ,Rifaximin ,chemistry.chemical_compound ,Anti-Infective Agents ,Antibiotic therapy ,Chronic liver failure ,antibiotic ,medicine ,Humans ,Attention deficits ,Hepatic encephalopathy ,business.industry ,liver cirrhosi ,Gastroenterology ,non-absorbable disaccharides ,medicine.disease ,Rifamycins ,Surgery ,Sleep patterns ,rifaximin ,Treatment Outcome ,chemistry ,Hepatic Encephalopathy ,benzodiazepine ,Complication ,business - Abstract
Altered gut microecology is considered a key pathogenetic factor in the development of both inteststinal (irritable bowel disease, inflammatory bowel disease, ecc.)and systemic (hepatic encephalophaty, steatohepatitis, ecc.) diseases. Hepatic encephalopathy (HE) is a major neuropsychiatric complication of both acute and chronic liver failure. Symptoms of HE include attention deficits, alterations of sleep patterns and muscular incoordination progressing to stupor and coma. The pathogenesis of HE is still unknown, although ammonia-induced alterations of cerebral neurotransmitter balance, especially at the astrocyte-neurone interface, may play a major role. Treatment of HE is therefore directed at reducing the production and absorption of gut-derived neurotoxic substances, especially ammonia. The non-absorbable disaccharides lactulose and lactitol were long considered as a first-line pharmacological treatment of HE, but a recent systematic review questioned their efficacy, pointing out that there is insufficient high-quality evidence to support their use. Oral antibiotics are regarded as a suitable therapeutic alternative. However, the prolonged use of antimicrobials is precluded by the possible occurrence of adverse events. Rifaximin, a synthetic antibiotic structurally related to rifamycin, displays a wide spectrum of antibacterial activity against Gram-negative and Grampositive bacteria, both aerobic and anaerobic, and a very low rate of systemic absorption. Available evidence suggests that rifaximin - thanks to its efficacy and remarkable safety - has the highest benefit-risk ratio in the overall treatment of HE.
- Published
- 2006
44. Cost-effectiveness of different diagnostic strategies to assess gastro-oesophageal reflux disease in patients with unexplained chronic persistent cough in Italy
- Author
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C. Cavoli, Lorenzo G. Mantovani, F. Torresan, Fabio Baldi, S. Ghersi, Enrico Roda, Baldi, F, Cavoli, C, Ghersi, S, Mantovani, L, Torresan, F, Roda, E, F., Baldi, C., Cavoli, S., Ghersi, Mantovani, LORENZO GIOVANNI, F., Torresan, and E., Roda
- Subjects
Male ,medicine.medical_specialty ,Cost effectiveness ,Cost-Benefit Analysis ,Disease ,Gastroenterology ,Sensitivity and Specificity ,GORD ,Indirect costs ,Gastro ,Internal medicine ,Chronic cough ,medicine ,Humans ,PPI-test ,Asthma ,Hepatology ,business.industry ,Reflux ,Middle Aged ,medicine.disease ,Cough ,Italy ,24-h oesophageal pH-metry ,Cost-effectivene ,Chronic Disease ,Gastroesophageal Reflux ,Observational study ,Female ,medicine.symptom ,business - Abstract
Background. Chronic persistent cough is a common and disabling disorder and gastro-oesophageal reflux disease is considered to be the third leading cause, after asthma and postnasal drip. Therefore, patients with unexplained chronic persistent cough usually undergo a stepwise evaluation to establish the existence of a reflux disease. Aim. To identify the most cost-effective diagnostic approach to assess gastro-oesophageal reflux disease in patients with unexplained chronic persistent cough. Methods. Direct and indirect costs associated with six diagnostic strategies using 24-h oesophageal pH-metry, oesophago-gastroduodenoscopy and the proton pump inhibitors test in different sequences, were evaluated using a decision tree model. If the first test was positive, the diagnostic work-up was stopped, if negative the patient proceeded to the second test, and so on. Clinical data from an observational prospective trial conducted in 51 patients with unexplained chronic persistent cough were used in the economic model. Results. All six strategies had the same clinical effectiveness (78.4%). The diagnostic work-up with the lowest cost was the proton pump inhibitors test followed by pH-metry and then oesophago-gastroduodenoscopy with a total cost of EURO211.08 (direct EURO142.93, indirect EURO68.15). Conclusions. This study shows that the lowest cost is the strategy where proton pump inhibitors test is performed as first investigation. Implementation of this diagnostic work-up may lead to cost savings in the management of patients with chronic persistent cough. (c) 2006 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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- 2006
45. Hepatocellular carcinoma prevention: a worldwide emergence between the opulence of developed countries and the economic constraints of developing nations
- Author
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Davide Festi, Giuseppe Mazzella, Enrico Roda, Francesco Azzaroli, Antonio Colecchia, Francesca Lodato, Lodato F, Mazzella G, Festi D, Azzaroli F, Colecchia A, and Roda E
- Subjects
medicine.medical_specialty ,Alcoholic liver disease ,Carcinoma, Hepatocellular ,Disease ,Antiviral Agents ,Liver disease ,LIVER TUMORS ,medicine ,Humans ,Intensive care medicine ,Developing Countries ,Hepatitis ,Geography ,business.industry ,Developed Countries ,CHRONIC LIVER DISEASE ,ANTIVIRAL TERAPHY ,Liver Neoplasms ,Gastroenterology ,General Medicine ,Hepatitis C ,Hepatitis B ,medicine.disease ,digestive system diseases ,Editorial ,Hepatocellular carcinoma ,Immunology ,Public Health ,business ,Viral hepatitis - Abstract
Hepatocellular carcinoma (HCC) is the fifth most common neoplasm, the major cause of death in patients with liver cirrhosis, and the third most common cause of cancer-related death in the world. The geographic distribution of HCC varies significantly and 80% of cases occur in developing countries (Far East and South Asia) where the prevalence of viral hepatitis is higher. The treatment of HCC is difficult because most patients are diagnosed when the tumour is in an advanced stage and is not amenable to potential curative therapy, thus prevention is the key to reducing HCC and its related morbidity and mortality. HCC is unique among cancers, occurring mostly in patients with a known risk factor. Ninety percent of HCCs develop in the context of chronic liver diseases and mainly in patients with cirrhosis. Viral hepatitis is the most common cause of HCC worldwide, followed by alcoholic liver disease (ALD) and other causes such as non-alcoholic fatty liver disease (NAFLD), genetic haemocromatosis (GH) and primary biliary cirrhosis in an advanced stage (III-V). In certain areas of the People's Republic of China, exposure to aflatoxin and HBV infection are thought to be responsible for the extraordinary high risk of HCC. Substantial progresses in the prevention of virusl-related hepatitis (screening of blood units, use of disposable sanitary tools, HBV vaccination) have been achieved in developed countries, but in the same areas, alcohol- and dysmetabolism-related HCCs are emerging problems which require specific interventions in terms of public health measures. In developing countries, economic constraints limit the development of any program for the prevention of viral hepatitis transmission (including health education campaigns, healthcare politics, primary prevention and the improvement of hygienic and sanitary conditions). When viral liver disease is established, only a minority of patients are treated worldwide and benefit a possible preventive effect of medical treatment on HCC development. Thus the real contribution of medical treatment to HCC prevention in patients with chronic viral hepatitis is small. Great efforts are needed to identify more effective medical measures for primary and secondary prevention of HCC.
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- 2006
46. Systemic lupus erythematosus following virological response to peginterferon alfa-2b in a transplanted patient with chronic hepatitis C recurrence
- Author
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S. Casanova, Francesca Lodato, Antonio Colecchia, Giuseppe Mazzella, Enrico Roda, Antonia D'Errico, Maria Rosa Tamè, Antonio Daniele Pinna, Francesco Azzaroli, Chiara Racchini, F. Lodato, M.R. Tame, A. Colecchia, C. Racchini, F. Azzaroli, A. D'Errico, S. Casanova, A. Pinna, E. Roda, and G. Mazzella
- Subjects
Liver Cirrhosis ,Male ,INTERFERON ,LIVER ,Hepatitis C virus ,Alpha interferon ,Case Report ,Hepacivirus ,Interferon alpha-2 ,medicine.disease_cause ,Antiviral Agents ,Autoimmune Diseases ,Polyethylene Glycols ,Postoperative Complications ,Recurrence ,Pegylated interferon ,Interferon ,Humans ,Lupus Erythematosus, Systemic ,Medicine ,Lupus erythematosus ,SYSTEMIC LUPUS ERYTHEMATOSUS ,HEPATITIS C ,TRANSPLANTATION ,business.industry ,Gastroenterology ,Autoantibody ,Interferon-alpha ,General Medicine ,Hepatitis C ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,Recombinant Proteins ,Liver Transplantation ,Immunology ,Peginterferon alfa-2b ,business ,medicine.drug - Abstract
Autoimmune manifestations are common both in patients chronically infected by hepatitis C virus, and in patients transplanted for non-autoimmune diseases. A correlation between interferon based treatment and autoimmune diseases or the development of autoantibodies is well established in non-transplanted patients, but few data are available about transplanted patients. It is unclear whether interferon may increase the incidence of acute cellular rejection and there are few reports on the development of atypical autoimmune manifestations during post-liver transplantation interferon or pegylated interferon treatment. We describe a case of systemic lupus erythematosus following treatment with pegylated interferon alfa-2b in a transplanted patient with recurrence of chronic hepatitis C. Our experience suggest that pegylated interferon may induce autoimmune diseases in the immunosuppressed host, different from acute cellular rejection and call for a great attention to possible autoimmune disorders development during interferon based treatments in liver transplanted patients.
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- 2006
47. Systemic fungemia and hepatic localizations of Fusarium solani in a liver transplanted patient: An emerging fungal agent
- Author
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Vittorio Sambri, P. Costigliola, Francesca Lodato, Giuseppe Mazzella, Francesco Azzaroli, Gian Luca Grazi, Enrico Roda, Giovanna Liguori, Marco Montagnani, Maria Rosa Tamè, Lodato F, Tame MR, Montagnani M, Sambri V, Liguori G, Azzaroli F, Costigliola P, Grazi GL, Roda E, and Mazzella G
- Subjects
Fusarium ,Adult ,Male ,Antifungal Agents ,medicine.medical_treatment ,POSTOEPRATIVE INFECTION ,liver transplantation, Fusarium solani, postoperative infection ,Context (language use) ,Liver transplantation ,Neutropenia ,NO ,Amphotericin B ,Medicine ,Humans ,Fungemia ,Fusarium solani ,Transplantation ,Hepatology ,biology ,business.industry ,food and beverages ,postoperative infection ,LIVER TRANSPLANTATION ,FURÌSARIUM SOLANI ,biology.organism_classification ,medicine.disease ,surgical procedures, operative ,Bone marrow suppression ,Liver ,Immunology ,Surgery ,business - Abstract
The incidence of invasive fungal infection is increasing especially in the field of transplantation, affecting as many as 50% of bone marrow transplant (BMT) patients with neutropenia and 5-20% of solid-organ transplant (SOT) recipients. Fusarium species are soil saprophytes and plant pathogens. They may cause superficial mycoses or important opportunistic infections in patients with bone marrow suppression and neutropenia, they have been rarely described in solid organ recipients, and up to now there have been no reports of such infection in isolated liver transplanted patients. We describe a case of disseminated Fusarium solani infection with hepatic localization in a liver transplanted patient that resolved with the administration of amphotericin B. Our observation confirms that Fusarium spp. are emerging pathogens that may most frequently affect not only BMT patients and patients with hematological malignancies, but also SOT patients. They may cause both localized and disseminated infection. In conclusion, Fusarium spp. etiology should be considered in the context of infectious diseases following liver transplantation.
- Published
- 2006
48. Ursodeoxycholic acid improves gastrointestinal motility defects in gallstone patients
- Author
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Patrizia Simoni, Davide Festi, M. Magliuolo, Enrico Roda, Francesco Azzaroli, Antonio Colecchia, Maria Letizia Bacchi-Reggiani, Giuseppe Mazzella, L. Sandri, Colecchia A, Mazzella G, Sandri L, Azzaroli F, Magliulo M, Simoni P, Bacchi-Reggiani ML, Roda E, and Festi D
- Subjects
Adult ,Male ,Cholagogues and Choleretics ,medicine.medical_specialty ,BILE ACIDS ,DEOXYCHOLIC ACID ,Gastric emptying ,Gallstones ,Gastroenterology ,Body Mass Index ,Bile Acids and Salts ,Immunoenzyme Techniques ,Placebos ,chemistry.chemical_compound ,Clinical Research ,Internal medicine ,medicine ,Humans ,Gastrointestinal Transit ,Chromatography, High Pressure Liquid ,Cholesterol ,business.industry ,Gallbladder ,Ursodeoxycholic Acid ,Deoxycholic acid ,digestive, oral, and skin physiology ,Tauroursodeoxycholic acid ,General Medicine ,Middle Aged ,medicine.disease ,Ursodeoxycholic acid ,Gastrointestinal Tract ,medicine.anatomical_structure ,chemistry ,Case-Control Studies ,Female ,Gallbladder Emptying ,Gastrointestinal Motility ,business ,medicine.drug - Abstract
AIM: To simultaneously evaluate the presence of defects in gallbladder and gastric emptying, as well as in intestinal transit in gallstone patients (GS) and the effect of chronic ursodeoxycholic acid (UDCA) administration on these parameters and on serum bile acids and clinical outcome in GS and controls (CTR). METHODS: After a standard liquid test meal, gallbla-dder and gastric emptying (by ultrasound), oroileal transit time (OITT) (by an immunoenzymatic technique) and serum bile acids (by HPLC) were evaluated before and after 3 mo of UDCA (12 mg/kg bw/d) or placebo administration in 10 symptomatic GS and 10 matched healthy CTR. RESULTS: OITT was longer in GS than in CTR (P < 0.0001); UDCA significantly reduced OITT in GS (P < 0.0001), but not in CTR. GS had longer gastric half-emptying time (t1/2) than CTR (P < 0.0044) at baseline; after UDCA, t1/2 significantly decreased (P < 0.006) in GS but not in CTR. Placebo administration had no effect on gastric emptying and intestinal transit in both GS and CTR. CONCLUSION: The gallstone patient has simultaneous multiple impairments of gallbladder and gastric emptying, as well as of intestinal transit. UDCA administration restores these defects in GS, without any effect in CTR. These results confirm the pathogenetic role of gastrointestinal motility in gallstone disease and suggest an additional mechanism of action for UDCA in reducing bile cholesterol supersaturation.
- Published
- 2006
49. Hepatic steatosis in obese patients: clinical aspects and prognostic significance
- Author
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Davide Festi, M. Bondi, Antonio Colecchia, T. Sacco, Enrico Roda, Giulio Marchesini, FESTI D., COLECCHIA A, SACCO T, BONDI M, RODA E, and MARCHESINI G.
- Subjects
medicine.medical_specialty ,Pathology ,Cirrhosis ,Endocrinology, Diabetes and Metabolism ,Biopsy ,Hyperlipidemias ,Gastroenterology ,Liver disease ,Fibrosis ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Obesity ,business.industry ,Fatty liver ,Public Health, Environmental and Occupational Health ,medicine.disease ,Prognosis ,Fatty Liver ,Liver ,Hepatic stellate cell ,Insulin resistance ,Metabolic syndrome ,Non-alcoholic steatohepatitis ,Type 2 diabetes ,Steatohepatitis ,Steatosis ,Insulin Resistance ,business - Abstract
Summary Non-alcoholic fatty liver disease is a new clinicopathological condition of emerging importance, now recognized as the most common cause of abnormal liver tests. It is characterized by a wide spectrum of liver damage: simple steatosis may progress to advanced fibrosis and to cryptogenic cirrhosis through steatohepatitis, and ultimately to hepatocellular carcinoma. Obesity is the most significant single risk factor for the development of fatty liver, both in children and in adults; obesity is also predictive of the presence of fibrosis, potentially progressing to advanced liver disease. From a pathogenic point of view, insulin resistance plays a central role in the accumulation of triglycerides within the hepatocytes and in the initiation of the inflammatory cascade. Chronic hepatocellular injury, necroinflammation, stellate cell activation, progressive fibrosis and ultimately, cirrhosis may be initiated by peroxidation of hepatic lipids and injury-related cytokine release. In the last few years, several pilot studies have shown that treatment with insulin-sensitizing agents, anti-oxidants or cytoprotective drugs may be useful, but there is no evidence-based support from randomized clinical trials. Modifications in lifestyle (e.g. diet and exercise) to reduce obesity remain the mainstay of prevention and treatment of a disease, which puts a large number of individuals at risk of advanced liver disease in the near future.
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- 2005
50. Higher doses of peginterferon alpha-2b administered twice weekly improve sustained virological response in difficult-to-treat patients with chronic hepatitis C: results of a pilot randomized study
- Author
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Silvia Giovanelli, Giuseppe Mazzella, V. Feletti, Mariarosa Tamè, Rosangela Muratori, Francesco Azzaroli, Enrico Roda, M.L. Bacchi Reggiani, Marco Montagnani, Francesca Lodato, Antonio Colecchia, Stefano Brillanti, Lodato F., Azzaroli F., Brillanti S., Colecchia A., Tame M.R., Montagnani M., Muratori R., Giovanelli S., Feletti V., Bacchi Reggiani M.L., Roda E., and Mazzella G.
- Subjects
Adult ,Male ,medicine.medical_specialty ,VIRAL HEPATITIS ,PEGINTERFERON 12KD ALFA-2A ,Pilot Projects ,Interferon alpha-2 ,Antiviral Agents ,Gastroenterology ,Drug Administration Schedule ,Polyethylene Glycols ,law.invention ,chemistry.chemical_compound ,Randomized controlled trial ,law ,Pegylated interferon ,Virology ,Internal medicine ,medicine ,Humans ,Drug Interactions ,Dose-Response Relationship, Drug ,Hepatology ,business.industry ,Ribavirin ,GENOTYPE 1 ,Interferon-alpha ,virus diseases ,Hepatitis C ,Hepatitis C, Chronic ,Middle Aged ,Viral Load ,medicine.disease ,HCV ,RIBAVIRIN ,Recombinant Proteins ,Discontinuation ,Treatment Outcome ,Infectious Diseases ,Tolerability ,chemistry ,Immunology ,Drug Therapy, Combination ,Female ,business ,Viral hepatitis ,Viral load ,medicine.drug - Abstract
SUMMARY: Beside substantial progress in treatment of chronic hepatitis C (CHC) particular patients (genotype 1/4, high viral load, previous nonresponse, cirrhosis) remain difficult to treat. The aim of our pilot randomized study was to compare efficacy and tolerability of standard doses of Peginterferon alpha-2b + ribavirin with higher doses of Peginterferon alpha-2b administered twice weekly + ribavirin. Sixty-five outpatients with CHC were subsequently enrolled. Group A (n = 22) received recommended doses of Peginterferon alpha-2b and group B (n = 43), received high doses twice weekly. Groups were comparable for baseline characteristics. All genotype 1/4 patients had high baseline viraemia. Sustained virological response (SVR) was significantly higher in group B among naïve patients (72%vs 25%, P = 0.024). A significantly higher rate of SVR was observed in group B both considering only genotype 1/4 patients, (46%vs 13%, P = 0.03) and grouping together genotype 1/4 naive and relapsers (57%vs 11%, P = 0.039). Discontinuation rate was 32% (7 of 22) in group A and 21% (9 [corrected] of 43) in group B. Our response rates are the highest reported for genotype 1/4 with high viraemia. Our pilot study supports the need of randomized studies to evaluate both viral kinetics and efficacy of high dose and twice weekly administration of Peginterferon alpha-2b in genotype 1/4 patients with high viraemia who may need personalized treatment schedules. SUMMARY: Beside substantial progress in treatment of chronic hepatitis C (CHC) particular patients (genotype 1/4, high viral load, previous nonresponse, cirrhosis) remain difficult to treat. The aim of our pilot randomized study was to compare efficacy and tolerability of standard doses of Peginterferon alpha-2b + ribavirin with higher doses of Peginterferon alpha-2b administered twice weekly + ribavirin. Sixty-five outpatients with CHC were subsequently enrolled. Group A (n = 22) received recommended doses of Peginterferon alpha-2b and group B (n = 43), received high doses twice weekly. Groups were comparable for baseline characteristics. All genotype 1/4 patients had high baseline viraemia. Sustained virological response (SVR) was significantly higher in group B among naive patients (72%vs 25%, P = 0.024). A significantly higher rate of SVR was observed in group B both considering only genotype 1/4 patients, (46%vs 13%, P = 0.03) and grouping together genotype 1/4 naive and relapsers (57%vs 11%, P = 0.039). Discontinuation rate was 32% (7 of 22) in group A and 19% (8 of 43) in group B. Our response rates are the highest reported for genotype 1/4 with high viraemia. Our pilot study supports the need of randomized studies to evaluate both viral kinetics and efficacy of high dose and twice weekly administration of Peginterferon alpha-2b in genotype 1/4 patients with high viraemia who may need personalized treatment schedules.
- Published
- 2005
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