Search

The gastrointestinal tract, particularly the stomach, is the most common site of mucosa-associated lymphoid tissue lymphoma (MALToma). Many studies describe primary MALT lymphoma arising from the gastric mucosa, especially in association with Helicobacter pylori infection. On the contrary, primary MALT duodenal lymphoma is a very rare neoplasm. We report a case of a patient with gastrointestinal bleeding in whom primary gastric and duodenal MALT lymphoma were occurred simultaneously.

A 46-year-old man was referred to our Unit for hematemesis. The medical history of the patient revealed an HCV-related cirrhosis, a human immunodeficiency virus (HIV) infection and recent and persistent episodes of emesis. An urgent gastroscopy disclosed evidence of active bleeding from varices of the lower third of the esophagus and a concomitant laceration of the esophageal wall due to the emesis. These two conditions have been endoscopically diagnosed and successfully treated by sclerotherapy and endoscopic clipping.

Leptospirosis is a spirochetal zoonosis with a worldwide distribution affecting both animals and humans. These are infected only occasionally by direct contact with infected animals or through contaminated water and soil. Generally, this disease is commonly found in tropical regions. Infected patients usually present with non-specific features. In fact, the clinical manifestations of leptospirosis are variable, ranging from occult infection to Weil's disease with fatal complications. Often the disease remains underdiagnosed due to the broad spectrum of signs and symptoms. Here we are reporting a case of a woman with an ictero-haemorraghic leptospirosis complicated by acute renal failure and pulmonary involvement that received intensive care unit support including intubation and ventilation and promptly resolved with appropriate therapy.

Background and Aim: Colorectal post anastomotic benign strictures are not uncommon. The purpose of this study was to investigate the results of endoscopic balloon dilatation of anastomotic strictures., Materials and Methods: The study was on a retrospective survey. Records of 14 consecutive patients with anastomotic strictures (5 F, 9 M; median age 64 years; range: 50-87 years), attending our GI Unit from February 1st 2008 to December 31st 2009, were analyzed. All patients had been operated for colon carcinoma. All of them were treated with balloon dilatation., Results: All the patients presented symptoms of obstruction. The total number of dilatation sessions was 37 and the median number of sessions by patient was 1,5 (range: 1-7). After the procedures, all patients had an improvement of symptoms. No complications were observed., Conclusions: Our experience underlines that endoscopic ballon dilatation, in patients with post anastomotic benign strictures, is a safe technique with a low rate of complications.

Introduction: Magnetic resonance cholangio-pancreatography (MRCP) is a valuable method for the evaluation of biliary and pancreatic diseases and a valuable alternative to endoscopic retrograde cholangiopancreatography (ERCP). It is noninvasive and does not require the use of contrast material or ionizing radiation. Since its introduction in 1991, this technique has significantly improved in spatial resolution, now allowing the accurate assessment of the major bilio-pancreatic diseases., State of the Art: MRCP is commonly performed with heavily T2-weighted sequences in order to highlight static fluids, as those contained in dilated pancreatic and biliary ducts. Newest MR equipments allow to perform MRCP within 10-15 minutes, due to the availability of ultra-fast sequences. Currently, MRCP is widely performed as a primary imaging modality for the assessment of obstructive jaundice and other benign or malignant bilio-pancreatic ducts abnormalities. The primary MRCP application is the evaluation of biliary obstructions due to choledocholithiasis, iatrogenic strictures, cholangiocarcinoma or pancreatic carcinoma. Other MRCP applications include the assessment of the exocrine pancreatic function, following secretin stimulation. Whenever needed, the MRCP may be completed with a conventional contrast-enhanced magnetic resonance imaging (MRI) of the upper abdomen and functional studies as well, thus providing an all-in-one mophological and functional study of the pancreas and biliary system. More recent applications include the possibility of 3D reconstructions and the use of hepato-biliary contrast agents, that provide a higher definition of the biliary tree, both in pathologic and normal conditions. The introduction of 3Tesla magnets could provide higher anatomic detail., Conclusions: In the next years the role of MRCP will further expand, due to the availability of faster sequences, 3D imaging and functional studies.

Microscopic colitis is an increasingly common cause of chronic watery diarrhoea, and often a causes of abdominal pain of unknown origins. The increase of interest for this clinical entity is due to a misdiagnosis of any symptoms that have been frequently attributed to diarrhea-predominant irritable bowel syndrome, often for many years before diagnosis. Presumably, most estimates of incidence and prevalence understate the true frequency of microscopic colitis for this reason. The aim of this paper is to evaluate the importance of microscopic colitis as cause of chronic non bloody diarrhoea, on the basis of literature review. These kind of colitis are characterized by normal colonic mucosa at endoscopy or barium enema but with increased inflammation in colonic biopsies. Microscopic colitis consists of two main subtypes, collagenous colitis and lymphocytic colitis, distinguished by the presence of absence of a thickened subepithelial collagen band. Several models of pathogenesis has been proposed but no convincing mechanism has been identified, although is difficult to characterize this clinical entity as an independent phenomenon or a simple manifestation or related factors active to induce microscopic changing in the colonic mucosa. A rational approach to therapy does not exist and was conduct with several types of drugs after the exclusion of other causes, commonly characterized by this symptoms and the definitive histological assessment in the biopsies specimens. In the majority of cases this condition tends to follow a self-limited course but potentially can assume the characteristics of relapsing course with the necessity to a chronic therapy. Several long-term follow-up studies excluded a possible progression to neoplastic malignancies of microscopic colitis.

Background: Calprotectin, a major cytosolic protein of neutrophils, is increased in inflammatory bowel disease (IBD) and may be considered a suitable marker of intestinal inflammation. Abdominal MRI is becoming more frequently used for the evaluation of IBD patients. Aim of this study was to investigate the role of MRI in IBD for the assessment of disease activity in comparison with faecal calprotectin levels., Patients and Methods: Twenty-four consecutive hospitalized pts (12 F, 12 M, median age: 56; range: 22-77) with a proven diagnosis of CD were studied. At the time of the MRI examination, pts provided a single stool sample for calprotectin measurement. Calprotectin was measured by ELISA (Calprest(R)). Pathological values were considered more than 50 microg/g. All pts underwent MRI, performed at 1.5 T, with HASTE T2w with and without fat-saturation, FLASH T1w fat-saturated sequences pre and post iv injection of 0.1 ml/kg of Gadolinium. Presence, degree and length of wall inflammation were evaluated. The MRI degree of wall inflammation was graded with a 0-3 scoring system (0=absent 1=light 2=moderate 3=severe) by considering findings observed on T1 post Gd and T2 fat-suppressed images, as well as the degree of wall thickness. The length of extension was considered as less than 15 cm, between 15 cm and 30 cm, or more than 30 cm. Spearman's correlation coefficient was used to evaluated differences in calprotectin levels among the groups obtained by MRI findings., Results: Grade 0 MRI was found in 1 pt with a faecal calprotectin measurement of 206.25 microg/g; Grade 1 MRI was found in 4 pts with a median faecal calprotectin of 100 microg/g (5-325); Grade 2 MRI was found in 10 pts with a median faecal calprotectin of 243.75 microg/g (7.5-606.25); Grade 3 MRI was found in 9 pts with a median faecal calprotectin of 1012.5 microg/g (30-1268.8). A trend of positive correlation was therefore found between MRI scores of activity and calprotectin levels (p less than 0.0001) and between MRI scores of thickening of intestinal involvement and calprotectin levels (p = 0.005). No apparent correlation was observed between faecal calprotectin concentration and length., Conclusions: Data presenting show that faecal calprotectin levels well correlate with the degree of mucosal inflammation are in agreement with previous studies. Considering the correlation obtained between calprotectin level and MRI findings, we believe that MRI is helpful in assessing and monitoring the degree of disease in Crohn's disease.

Background and Aim: Multi Detector Computed Tomography (MDCT) is widely used in the preoperative staging of gastric cancer. MRI has an emerging role in the evaluation of intestinal diseases, although its role in the staging of gastric cancers is still to be defined. The aim of our study was to compare the diagnostic accuracy of MDCT and Magnetic Resonance Imaging (MRI) in the diagnosis and preoperative staging of gastric cancer, in comparison with histopathology., Materials and Methods: Twenty-five patients with an endoscopic diagnosis of gastric cancer underwent preoperative contrast-enhanced MDCT and MRI, blind to the results of endoscopy. MDCT (64 slices) was performed after oral administration of 800-1000 mL of tap water and scopolamine injection five minutes before the examination. The scan was performed in the axial plane before and after intravenous injection of iodinate contrast medium. Multiplanar reconstruction images were obtained on coronal and sagittal planes. MRI was performed with a 1.5 T Magnet, using the same patient's preparation, by acquiring T2-weighted HASTE sequences, with or without fat saturation (FS), True FISP (True fast imaging with steady state precession) and T1-weighted VIBE (Volumetric interpolated breath-hold examination) sequences, with and without FS, before and after contrast agent (gadolinium) i.v. injection. Gold standards (GS) were surgical and histopathological findings. Two groups of radiologists, blind each other, analyzed MRI images and MDCT findings, and related to GS results., Results: Detection rate of gastric lesions and T staging for gastric cancer were similar for MRI and MDCT (92%); MRI imaging was superior than MDCT in staging the T parameter (60% versus 48%); the accuracy of MRI imaging and 64-MDCT did not differ significantly in the evaluation of N staging (68% versus 72%)., Conclusions: Both MRI and MDCT were comparable in staging gastric cancer. MRI was more accurate in evaluation of T stage than MDCT, although both imaging modalities showed low accuracy in detection of early gastric cancer and in differentiation of T2 from T3 stage.

Bouveret's syndrome is a rare condition usually caused by a single large stone impacted in the duodenum. This is a cause of gastric outlet. Even if endoscopy is the mainstay of diagnosis, the radiographic examinations are also important too. Generally, the stones are too large to be removed endoscopically. Conservative endoscopic treatment should be attempted initially, and if it fails, surgical approach should be performed.

Background and Aim: Patients with severe brain injures and severe neurological diseases frequently require prolonged nutritional support during their hospitalization as well as during their rehabilitation period. Since 1980, the percutaneous endoscopic gastrostomy (PEG) has become the method of choice for long term feeding. The aim of the present study was to present our experience concerning the placement of PEG in critically ill patients, recovered in Intensive Care Unit (ICU)., Materials and Methods: From 3-05-2001 to 28-09-2005, 36 patients (13 female, 23 male) with a median age of 63 years [range: 18-86 years], recovered in ICU of the Sandro Pertini Hospital, underwent PEG. These patients were retrospectively evaluated in terms of complications, indications to the procedures, durability of gastrostomy and mortality. Intravenous antibiotic prophylaxis was administered 1 h before the procedure (ceftriaxone 2gr). The entire PEG was placed in ICU at patient's bed, with the assistance of the anaesthetist. Propofol was used e.v. for sedation and fentanest for analgesia while lidocaine was used for local anesthesia. A 16-Fr or 20-Fr tube was inserted by the "pull method", after a complete upper gastroduodenoscopy., Results: PEG was performed mainly for neurological disorders including cerebrovascular accidents (13), SLA (8), post-traumatic coma (7), post-cardiac arrest coma (7) and dementia (1). Procedure related mortality was 0%. The tube was changed in 4 patients due to clogging. The durability of the tube was a median of 2 months (range: 1-12 months). In 23 patients the placement of the PEG was definitive., Conclusions: Our experience underlines that PEG, in selected critically ill patients, is a safe technique easy to perform even in ICU.

Background: Bleeding peptic ulcer (PU) is the commonest cause of an acute upper gastrointestinal bleed. Aim of this study was to present our data regard the management of acute bleeding from PU during urgent endoscopy (examination performed in 2-6 h by the call)., Materials and Methods: This study is based on an observational retrospective protocol. Records of 259 consecutive patients with PU (92 F, 167 M; median age 71.5 years; range: 19-100 years), attending our GI Unit from February 1st 2004 to July 31st 2007, were analyzed., Results: Out of 259 patients with PU, 170 (65.6%) were treated with endoscopic hemostasis followed by medical therapy (PPI 80 mg bolus within 12 h of endoscopy followed by 8 mg/for 72 h and then an oral PPI , 40 mg once daily for 30 days), while 89 (34.4%) patients received only medical therapy (PPI, 40 mg once daily for 30 days). All ulcerative lesions with endoscopic stigmata of acute bleeding, visible vessels or adherent clot (Forrest Ia-IIb) were treated during the gastroscopy. The endoscopic procedures used were: injection of 1:10000 adrenaline (about 10 mL) around the bleeding lesion in 93 cases (55%); injection therapy and thermal method (argon plasma coagulation) in 53 cases (31%); injection therapy and mechanical method (metallic clips) in 20 cases (12%); only mechanical method (metallic clips) in 4 cases (2%). Endoscopic hemostasis was achieved in 251 pts (97%), while 17 pts (6.5%) required second endoscopy for rebleeding. Three patients (1.16%) required immediate surgery for failure of primary endoscopic hemostasis. The mortality within 30 days from the bleeding episode was 3.9% (10 pts)., Conclusions: The treatment of this condition has made important progress since the introduction of emergency endoscopy and endoscopic techniques for hemostasis. The application of specific protocols, significantly decreases rebleeding and the need for surgery, whereas mortality is still high. Our data are in keeping with previous studies of the literature.

The prevalence of sexually transmitted diseases (STD) has risen in recent years [Brown AE, Sadler KE, Tomkins SE, McGarrigle CA, LaMontagne DS, Goldberg D, et al. Recent trends in HIV and other STIs in the United Kindom: data to the end of 2002. Sex Transm Infect 2004;80:159-66]. Homosexually active men have frequent intestinal and rectal symptoms due to sexually acquired gastrointestinal infections [Surawicz CM, Goodell SE, Quinn TC, Roberts PL, Corey L, Holmes KK, et al. Spectrum of rectal biopsy abnormalities in homosexual men with intestinal symptoms. Gastroenterology 1986;91:651-9]. The number of reported cases of primary syphilis is increasing especially among this group of people [Goh BT. Syphilis in adults. Sex Transm Infect 2005;81:448-52 ]. We herein describe a case of a young man with a primary syphilitic rectal localization mimicking rectal cancer.

Aim: Adequate sedation is fundamental for the execution of the endoscopic retrograde cholangiopancreatography (ERCP). Propofol is widely used for gastrointestinal endoscopy because of its rapid recovery profile. The aim of this study was to determine, retrospectively, whether the administration of propofol was safe in patients undergoing ERCP, both diagnostic and therapeutic., Materials and Methods: In our GI Unit, from 1st February 2006 to 23 November 2006, we performed 100 ERCP. All the patients were sedated by using midazolam e.v., as pre-anaesthetic agent, and propofol e.v. During the procedure, vital signs were continuously monitored (oxygen saturation, blood pressure, heart rate). Patients were also divided into two groups: less than 80 years of age (group I) and 80 years of age and older (group II). Cardiorespiratory complications were recorded., Results: Patients were 51 females and 49 males, with a median age of 74 years (range: 23-94 years). Group I was composed by 72 patients (35 F, 37 M) and Group II by 28 patients (16 F, 12 M). There were no episodes of hemodynamic instability or airway obstruction. New ECG changes (1 ischemia, 3 arrhythmias) and 1 significant oxygen desaturation episode (SpO2<90%) occurred in 5% of procedures. If we considered the two groups, the rates of cardiopulmonary complications were 4.1% and 7.1%, respectively in group I and in group II., Conclusions: Propofol seems to be safe and effective sedation for ERCP, with a low complication rate, also in patients aged 80 years or older.

Background and Aim: While, several studies indicate that there is an association between proximal and distal colorectal adenomas, no agreement seems to be between the presence of distal hyperplastic polyps and proximal neoplasia. The aim of this study was to investigate, retrospectively, the possible correlation between the distal hyperplastic polyps and proximal colorectal neoplasia., Materials and Methods: In our GI Unit, from 1st February 2006 to 24 November 2006, we performed 142 polypectomy. Patients were 36 females and 80 males, with a median age of 66 years [range: 38-87 years]. All of the polpys were resected during colonoscopy and sent for histological study. Chi-square test was used for statistical analysis. A probability value of P< or =0.05 was considered to be statistically significant., Results: Histological study showed the following results: 33 hyperplastic polyps (8 F, 21 M; median age 63 years), 100 adenomas (26 F, 61 M; median age 67 years) and 2 inflammatory polpys (2 F, 0 M; median age 71 years). The rectal localization was associated with a significantly higher frequency of hyperplastic polyps (63.6% vs 23.5%), OR: 5.688 (95% C.I. 2.445-13.230) (p<0.0001). Five hyperplastic polyps of the rectum were associated with 5 adenomas located 1 in the rectum, 2 in the sigmoid colon, and 1 in the descendens colon and 1 in the ascendens colon. While, 5 adenomas were associated with 5 adenocarcinoma., Conclusions: Guidelines from the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy do not recommend colonoscopy for patients with distal hyperplastic polyps. Also our study is in keeping with the data of the literature and it confirmed that rectal localization is associated with a higher prevalence of hyperplastic polyps.

Objective: Foreign bodies ingestion is a potentially serious problem. The majority of ingested foreign bodies pass spontaneously, but serious complications, such as bowel perforation and obstruction, can occur. In the present work, we report our experience in the management of ingested foreign bodies., Materials and Methods: The study was observational and retrospective. We included in the study the foreign bodies ingestions occurred during urgent endoscopy (examination performed from 1 to 6 h by the call)., Results: Records of 696 consecutive EGDS performed in urgency at the Unit of Gastroenterology and Digestive Endoscopy of the Hospital Sandro Pertini of Rome, from 01-02-'04 to 18-01-2006, were analyzed retrospectively. Out of these procedures, 21 (3.01%) were performed for suspected foreign bodies ingestion., Conclusions: We present the initial report of our working experience. Objects that have passed the duodenum should be managed conservatively by radiographic surveillance and inspection of stool. Endoscopic or surgical approach is indicated when significant symptoms develop or if the object fails to progress through the gastrointestinal tract. The present data are in keeping with previous studies of the literature.

Recurrent abdominal pain (RAP), surely one of the most frequent causes of medical intervention, is frequently present in many gastrointestinal disease. Usually no structural and/or biochemical alterations can be demonstrated. This condition is, therefore, considered to be due to functional disorders such as irritable bowel syndrome (IBS) or functional dyspepsia. Previous observations suggest the presence of a rare alteration of celiac vessels among the possible causes of RAP. This pathological condition was known as Dunbar syndrome. We report 2 cases of chronic abdominal pain. The former reported weight loss and the latter anemia with iron deficiency. It is remarkable that patients with initial diagnosis of IBS can be affected by celiac disease (CD), which is the cause of their abdominal pain. Our patients were tested for CD; the former was negative and IBS was diagnosed, the latter was positive and a gluten free diet was prescribed. The presence of an epigastric bruit, accentuated during expiration, suggested a possible vascular alteration known as tripod celiac artery compression syndrome. Duplex Doppler sonography suggests the diagnosis of celiac arterial constriction due the diaphragmatic ligament. These cases show that tripod celiac artery compression syndrome might be a cause of RAP and that it may be evaluated and investigated when the clinical examination discloses an abdominal systolic bruit.

Gastroduodenal obstruction is a preterminal event in patients with advanced malignancies of the stomach, pancreas and duodenum. Surgical gastrojejunostomy has been considered the traditional palliative treatment. The use of metallic stents is intended not to be curative but to provide nonsurgical palliation for the symptoms of obstruction. The advantages of this technique are the minor invasivity, the decrease in morbidity and mortality respect the surgical approach, the patient that can be discharged the day of or the day after the procedure and the better life expectation.

Hydatid cyst disease still is a serious public-health problem in endemic areas. It is a tissue infestation caused by the larval stage of a parasite, Echinococcus granulosus. Although liver and lung are the most commonly involved organs, hydatid disease can occur in all viscera and soft tissues. In 10% of cases, hydatid disease arises in the viscera: mainly in the spleen (0.9-8%), but also in kidney, bone, heart and peritoneal cavity (0.5-5%). Other rare locations such as muscles have been described in less than 1% of cases of hydatid disease. We report magnetic resonance imaging findings of a case of diffuse abdominal hydatidosis.

Background: The continuous demand for sanitary care from the imprisoned patients to the general public hospitals has carried to the creation of dedicated structures like the Complex Protected Medicine Structure (SCMP) at the Hospital Sandro Pertini of Rome. Aim of this study was to present the preliminary epidemiologic-clinical data gathered from July 26th 2006 to March 1st, 2006 in our SCMP., Material and Methods: This study is based on an observational retrospective protocol. Patients characteristics included sex, age, alcohol, smoke and drug abuse, serology for viral hepatitis and AIDS, and treatment with benzodiazepine., Results: The records of 200 consecutive patients (18 F, 182 M; median age 46 years; range: 20-84 years), attending our Unit were analyzed retrospectively. Out of these patients, 40 (20%) were foreigners, 43 (21.5%) alcohol abusers, and 141 (70.5%) smokers. Forty-eight patients (24%) had a recent or last history of drug addiction (heroin and/or cocaine). The HIV antibodies have been assayed only on 28 patients, turning out positive in 10 (35.71%). Twenty-five patients were positive for HBsAg (12.5%) and 57 (28.5%) for HCV. A consumption of benzodiazepine (BZD) was present in 71 (35.5%) of the patients., Conclusions: The essential elements of medical attendance of our structure are described in the article. We present the initial report of our working experience. The present data are in keeping with previous studies of the literature. We hope that our experience coul be extended to all italian Countries.

Background: Proton pump inhibitor (PPI)-based triple therapies are considered the standard regimens for Helicobacter pylori eradication, but the optimal duration of these regimens is still controversial. The aim of this study was to compare the efficacy of 1-week versus 2-week triple therapies in H. pylori-positive patients., Materials and Methods: A total of 486 consecutive H. pylori-positive patients were randomized to receive omeprazole, 20 mg b.i.d., clarithromycin 500 mg b.i.d., and either amoxicillin 1 g b.i.d. or metronidazole 500 mg b.i.d. for 1 or 2 weeks. Upper gastrointestinal endoscopy and histology were performed at entry and 2 months after the end of therapy. H. pylori status was defined according to histology and urea breath test., Results: At intention-to-treat analysis, 2-week therapy with omeprazole, amoxicillin, and clarithromycin achieved a significantly higher eradication rate than 1- or 2-week regimens with metronidazole (70% versus 52%, p = .003, versus 56%, p < .01) and the same therapy for 1-week (70% versus 57%, p = .05). At per-protocol analysis, 2-week therapy with omeprazole, amoxicillin, and clarithromycin showed a significantly higher eradication rate than 1-week of amoxicillin and metronidazole (77% versus 62%; p = .03) but no difference with 1-week same regimen (66%) or 2-week metronidazole and clarithromycin regimen (72%). Compliance and tolerability were good for all regimens., Conclusions: Two-week therapies, independently of antibiotic combination, lead to a significant increase of H. pylori eradication rate compared to 1-week therapies, with same compliance and tolerability, even if, taking account of low-eradication rates, one must question whether the triple therapy should still be used.

Malignant obstruction of the gastric outlet and duodenum is frequently due to extrinsic involvement by tumors from contiguous organs, in particular from pancreas and gallbladder. The treatment of malignant gastroduodenal stenoses is difficult. Many patients have advanced malignant disease and are too ill to undergo surgical approach. Surgical gastrojejunostomy has been considered the palliative treatment of choice. Metallic stents can be useful in this condition with adequate palliation obtained in most cases. We report a case in which self-expanding metallic stents were placed for stenoses of the gastric outlet and duodenum due to a colon cancer.

Although the association between inflammatory bowel disease and gastrointestinal infections has been suggested, the mechanisms involved in the pathogenesis of Crohn's disease (CD) are still undetermined. We report the case of a man, who presented with mesenteric adenitis initially due to a Yersinia pseudotubercolosis infection, who was later diagnosed with Crohn's disease. This case is in keeping with recent evidence in the literature which suggests that CD is a disease linked to abnormal immune responses to enteric bacteria in genetically susceptible individuals.

A small but significant excess of deaths for tumors of the digestive system has been described in Crohn's disease. In a study analyzing all cancers of the small intestine within a defined population, Crohn's disease was the major underlying factor for cancer of the small intestine. Areas of the small intestine containing strictures are unusually prone to malignant transformation. We report the rare case of a patient in whom surgery for intestinal occlusion disclosed Crohn's disease of the distal ileum complicated by two adenocarcinomas arising within distinct areas of the inflamed bowel.

The introduction and rapid diffusion of biological agents in the treatment of inflammatory bowel disease had led us to believe that the old immunosuppressive drugs were destined to disappear. However, despite a decade of clinical experience in the use of biological agents, the old immunosuppressive drugs continue to play a pivotal role in the management of inflammatory bowel disease. Various factors may account for this change of view. Aim of the present review was to summarise key information currently available regarding the use of immunosuppressive drugs in the treatment of inflammatory bowel disease.

Background and Aims: We examined the efficacy of cyclic long-term administration of rifaximin, a broad spectrum, poorly absorbable antibiotic, in obtaining symptom relief in a large series of patients with uncomplicated diverticular disease, and compared the incidence of episodes of diverticulitis in the group treated with rifaximin to that in a group receiving fiber supplementation only., Patients and Methods: In a multicenter, prospective, open trial, 968 outpatients with uncomplicated symptomatic diverticular disease were randomized to either fiber supplementation with 4 g/day glucomannan plus 400 mg rifaximin twice daily for 7 days every month ( n=558) or 4 g/day glucomannan alone ( n=346). Clinical evaluation was performed on admission and at 4-month intervals for 12 months., Results: After 12 months the group treated with glucomannan + rifaximin showed fewer symptoms (abdominal pain/discomfort, bloating, tenesmus, diarrhea, abdominal tenderness) and a lower global symptomatic score. Overall 56.5% of the patients treated with glucomannan + rifaximin and 29.2% of those treated with glucomannan alone were asymptomatic at 12 months ( P<0.001). The rate of complications (diverticulitis and rectal bleeding) was 1.34% in the rifaximin + glucomannan group and 3.22% in the glucomannan alone group ( P<0.05)., Conclusion: Cyclic administration of rifaximin is effective in obtaining symptom relief in uncomplicated diverticular disease of the colon. The incidence of episodes of diverticulitis in the group treated with rifaximin was lower than that in the group treated with glucomannan alone.