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[15/27] A Validation of Questionnaire for Measuring the Presence and Severity of Dyspepsia Background: There is not currently validated questionnaire to assess presence and severity of dyspepsia. Aim: evaluate reproducibility, [...]

F. Bazzoli [1] R. Zagari [1] R. Albanese [2] P. Pozzato [1] S. Fossi [1] D. Berretti [1] C. Martuzzi [1] V. Lunedei [1] F. Antonini [1] E. Roda [1] [...]

F. Bazzoli [1] M. De Rosa [2] R. Zagari [1] E. Rossi [2] V. Lunedei [1] F. Antonini [1] E. Roda [1] [11/07] Pharmacoepidemiology Profile of Helicobacter pylori Regimens in [...]

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

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

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

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

Background: We present a retrospective analysis of metronomic capecitabine in metastatic gastroenteropancreatic neuroendrocrine tumors (GEP-NETs). A review of the literature is also presented., Methods: From January 2007 to December 2013, ten patients with metastatic GEP-NETs (four pancreatic and six ileal) who progressed after treatment with somatostatin analogs and other cytotoxic agents received oral capecitabine 1,500 mg/day continuously. The median patient age was 68 (range 29-82) years. The median treatment duration was 8 months., Results: Five (50%) patients achieved a partial radiographic response, four (40%) showed stable disease, and one (10%) progressed. Median overall survival was 56 months. Three of the four pancreatic patients achieved a partial radiographic response that lasted for a median of 15.5 months; overall survival and progression-free survival in this subgroup was 58 and 6 months, respectively., Conclusion: Data in the literature show that capecitabine has only occasionally been used as a single agent, with increased toxicity. Only one study using single-agent capecitabine reported a progression-free survival of 9.9 months and overall survival of 36.5 months, without an objective response or major toxicity. In our experience, metronomic capecitabine was well tolerated, although minor side effects may have been underestimated due to the retrospective nature of our study. This regimen also seems to be feasible in elderly people. Although high response rates and prolonged response duration indicate the potential efficacy of this treatment, our results should be interpreted cautiously because of the small number of patients involved. Capecitabine was most effective in the pancreatic subgroup, which would seem to be more sensitive to chemotherapy.

The first-degree relatives of patients affected by colorectal cancer, who do not belong to familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer families, have a doubled risk of developing tumors of the large intestine. We have previously demonstrated that subjects with a single first-degree relative (SFDR) with colon cancer have a doubled risk for developing colorectal adenomas, and in these cases, polyps recur more frequently. The mechanism underlying this predisposition has not been clarified. In this study, we evaluated the frequency of microsatellite instability (MSI) using the five markers suggested by the National Cancer Institute workshop, target gene mutations, hMLH1 and hMSH2 expression, and hMLH1 promoter hypermethylation in the adenomas of patients with and without a SFDR affected by colon cancer. Seventy polyps were obtained from 70 patients: 27 with a single FDR with colon cancer and 43 without such a history. Of the 70 polyps, 12 were MSI-H (17.1%), 20 were MSI-L (28.6%), and 30 were microsatellite stable (42.9%). Of the 27 patients with positive family history, 8 polyps (29.6%) were MSI-H compared with those with negative history in which 4 polyps (9.3%) were MSI-H (P < 0.02). Of the 12 MSI-H polyps, all of the polyps obtained from patients with positive family history had loss of hMLH1 immunostaining versus one with negative family history (P < 0.02). Of the MSI-H polyps, 2 had a somatic frameshift mutation of the MBD4 gene, 1 of MSH6, 1 of BAX, and 2 of transforming growth factor betaRII. Furthermore, 6 of 8 polyps from patients with positive family history with MSI-H and loss of MLH1 had hypermethylation of the MLH1promoter versus none of the MSI-H with negative family history (P < 0.02). All 6 polyps of the 27 from SFDR positive subjects, with hMLH1 promoter hypermethylation loss of hMLH1 and MSI, were located in the right colon (P < 0.02). Hypermethylation of the promoter of hMLH1, consequent loss of hMLH1 expression, and MSI are at the basis of approximately 25% of adenomatous polyps developed in subjects with a SFDR affected by colorectal cancer.

Barrett's esophagus (BE), a complication of chronic gastroesophageal reflux disease (GORD), is a condition that is premalignant for adenocarcinoma of the esophagus and esophagogastric junction. Esophageal adenocarcinoma, once an uncommon entity, has been growing rapidly in incidence over the last two decades in several parts of the world. Barrett's esophagus is a change in the esophageal epithelium of any length that can be recognized at endoscopy and is confirmed to have intestinal metaplasia by biopsy (American College of Gastroenterology guidelines). Because of its premalignant nature, it is recommended that patients with BE undergo regular endoscopic surveillance. The recommendation for endoscopic surveillance is based on unproved and controversial assumptions including: 1) the assumption that Barrett's esophagus adversely influences survival; 2) the assumption that endoscopic surveillance can reliably detect early, curable neoplasia in the columnar lined esophagus. Moreover, the low incidence of adenocarcinoma (reported cancer incidence rates in prospective studies on BE range between 0.5% and 1.9%) is used to support an approach of not surveying patients with Barrett's esophagus. Despite these not convincing data, endoscopic surveillance is considered ''reasonable'' and ''desirable'' by the gastroenterological associations and consensus meetings. Endoscopic surveillance for cancer in Barrett's esophagus (BE) is performed primarily to seek dysplasia, to prevent the progression to invasive malignancy; however, one of the limitations of using dysplasia is a lack of understanding of its natural history. The efficacy of endoscopic surveillance for Barrett's esophagus is likely to remain unclear for a long time. The American College of Gastroenterology has recommended the following practice guidelines: a) for patients with no dysplasia, surveillance endoscopy is recommended at an interval of every 2 to 3 years; b) for patients with low grade dysplasia, surveillance endoscopy every 6 months for the first year is recommended, followed by yearly endoscopy if the dysplasia has not progressed in severity; c) for patients with high grade dysplasia, two alternatives are proposed after the diagnosis has been confirmed by an expert gastrointestinal pathologist. One alternative is intensive endoscopic surveillance until intramucosal cancer is detected at an interval of every 3-6 months. The other alternative is esophageal resection. In the situation of indeterminate dysplasia, whereas the pathologist can not come to definite diagnosis, control biopsies are proposed after 2 months of adequate acid suppression by means of proton pump inhibition. In all cases, the technique of random, four quadrant biopsies taken every 2 cm in the columnar-lined esophagus for standard histologic evaluation is recommended. Any grossly abnormal areas may be biopsied too. One can expect however that during the next future these protocol will change considering new data on dysplasia detection (biochemical markers, flow cytometry), new techniques to identify dysplasia (chromoendoscopy, endosonography, coherence optical tomography, fluorescence techniques) and development of better ablative techniques. At present a marker other than dysplasia identifying a high risk group for cancer on which to focus endoscopic surveillance has not yet been established.