Fabio Baldi

Gastric secretion and emptying of liquids in reflux esophagitis

We have investigated the gastric secretory activity and the emptying half-time of a liquid meal in 17 selected patients with reflux esophagitis compared to 10 controls. The basal acid output and the basal and maximal secretory volume were higher in the patient group (P<0.05,P=0.05, andP<0.01, respectively), while the maximal acid output and the basal and maximal acid concentration were not different in the two groups. The gastric emptying half-time of a liquid meal was higher in the patient group (P<0.001). Our results show that gastric function may be altered in reflux esophagitis patients and suggest particularly that a delayed emptying of liquids may play a role in the pathogenesis of the disease in some patients.

Non-cardiac chest pain: a real clinical problem.

Non-cardiac chest pain is a frequent clinical problem. Between 10 and 50% of patients with anginal pain who are referred for arteriography are found to have normal coronary arteries. An oesophageal source of non-cardiac chest pain is reported in up to 60% of cases, most of which are attributable to gastro-oesophageal reflux disease. The exclusion of heart disease and the identification of an oesophageal origin of the pain may require an extensive work-up. The outcome in patients with non-cardiac chest pain is influenced by both the underlying diagnosis and the patients perception of his or her symptom.

Antral G Cells and Mucosal Gastrin Concentration in Normal Subjects and in Patients with Duodenal Ulcer

The increase of serum gastrin after a protein rich meal,1–2 insulin hypoglycaemia3 and sham feeding4 is higher in duodenal ulcer patients than in normal subjects. This may result from an increased number of antral G cells and/or from an increased antral gastrin content. Previous reports in this field have led to contradictory results. From a methodological point of view, it is still questionable if the antral gastrin content or the G cell count determined from a few antral bipsy specimens can be representative of the whole endocrine area of the antrum.

PPI-Refractory GERD: an Intriguing, Probably Overestimated, Phenomenon

Proton-pump inhibitors (PPIs) are still a cornerstone of pharmacologic treatment for gastroesophageal reflux disease (GERD) because of their unquestionable efficacy in reducing the acid component of refluxate. However, their extensive use in the general population has revealed a subset of patients who are unsatisfied with these agents. These patients are considered unresponsive to PPIs, and this emerging phenomenon, defined as refractoriness to PPIs, may have a prevalence ranging from 10 to 40 % [1, 2]. Several drug-related variables, such as daily dosage and duration of therapy, clearly may be responsible for these numbers, and recently, it was proposed that the term PPI refractory be used only for patients unresponsive to a 12-week twice-daily course of PPI therapy [3•]. However, the greatest factor influencing PPI response likely is the type of patient to whom the drug is prescribed. It is now well established that the mechanisms underlying the symptoms in patients with GERD are related not only to esophageal acid exposure, especially in those without mucosal erosions (i.e., with nonerosive reflux disease (NERD)) who have a possibly normal but still symptomatic acid reflux (i.e., hypersensitive esophagus (HE)). In all these patients, who represent a large proportion of the GERD population, another very important mechanism for symptom occurrence is enhanced esophageal sensitivity, which also may be associated with central sensitization. We can speculate that the two mechanisms—acid exposure and hypersensitivity—each might play a different role throughout the spectrum of GERD phenotypes. Acid exposure is a predominant factor in patients with erosive disease but is less important in those without mucosal lesions; on the contrary, hypersensitivity is the major mechanism in patients without lesions and with normal reflux (Fig. 1). Despite this heterogeneous pathogenesis, however, we treat our GERD patients with drugs—PPIs—characterized by a very selective mechanism of action, i.e., the inhibition of acid secretion. It thus is reasonable to expect that the efficacy of this therapy is related directly and proportionally to the role of acid exposure in the individual patient, and this is exactly what occurs in clinical practice. A recently published paper [4••] provides an elegant summary of PPI efficacy in patients with different manifestations of GERD. The authors analyzed randomized controlled trials and evaluated the placebo effect and therapeutic gain for each patient category. Their data clearly indicate that the greatest PPI success—75 % or more—occurred in patients with esophagitis or typical reflux symptoms, such as heartburn or reflux-induced chest pain. On the contrary, patients with regurgitation as their main symptom or with laryngeal manifestations such as hoarseness or chronic cough showed a poor response to PPIs, with * Fabio Baldi fa.baldi@libero.it; fabio.baldi@unibo.it

Effect of Various Stimulants and Inhibitors of Gastric Acid Secretion on Mucosal Potential Difference in Man

Pentagastrin and histamine in doses effective in stimulating gastric acid secretion (5 microgram/kg/h intravenously and 25 microgram/kg intramuscularly, respectively) produce a significant decrease in the gastric mucosal potential difference (PD) in man. In contrast, atropine and cimetidine (2 mg/30 min intravenously and 4.5 mg/kg/h intravenously respectively) cause a significant increase in gastric PD. The subsequent or simultaneous administration of cimetidine reverses the effect of the stimulating agents on gastric PD and pH. Similarly, the subsequent administration of pentagastrin reverses the effect of atropine. The intragastric instillation of 100 c HCl 0.1 N increases significantly the gastric PD valuesp in this case the patterns of PD and pH changes are dissimilar. This study indicates that substances that modify gastric acid secretion also induce changes in gastric PD; this last effect does not seem to depend on variations of the intragastric pH. Therefore, in the clinical evaluation of the gastric PD in man, its multifactorial origin must alway be considered.

Nizatidine in the treatment of reflux oesophagitis: an Italian multicentre studyt

Objective To evaluate the various doses and administration schedules of nizatidine in the treatment of reflux oesophagitis. Design and methods Two hundred and forty patients with erosive-ulcerative oesophagitis were randomly allocated to a 6-week treatment regimen with nizatidine 150 mg three times daily (group A, n = 79), 150 + 150 + 300 mg (group B, n = 79) and 300 mg twice daily (group C, n = 82). Clinical evaluation was performed at entry and after 3 and 6 weeks, whereas endoscopy and laboratory tests were performed only at entry and at the end of the study. Results Reflux symptoms were significantly reduced in all three groups after 6 weeks. The patients on three times daily regimens (groups A and B) improved some of their symptoms faster than those in group C. Oesophagitis healed with similar frequency in the three groups (A = 81.1%, B = 79.2% and C = 67.6%). Adverse events were rare and mild. Conclusions High-dose nizatidine is safe and effective in relieving the symptoms and healing the lesions of oesophagitis.

XII AIST 2018 Conference: “The thousand faces of cough: clinical and therapeutic updates”

This paper summarizes the presentations submitted for publication of the 12th AIST National Congress (Associazione Italiana Studio Tosse/Italian Association for Cough Study) entitled “The thousand facets of cough. A clinical and therapeutic update”, which occurred last February 2nd-3rd, 2018 in Bologna (Italy). It summarizes the contributions from leading experts of the sector, who, as in the previous editions, also this year have analyzed a problem too often underestimated which still has many dark sides as regards both the diagnosis and the therapy of cough. The Scientific Committee has chosen topics that had less space in previous editions and these are topical subjects representing a concrete opportunity for learning and comparison of opinions, as well as indispensable elements for the correct management of the symptoms.Hereby we report the abstracts of the works submitted for publication in this Meeting report.The main topics have covered Cough relationship with nerve vagus, ATP, air pollution, GERD, imaging, COPD, pediatric and therapy. Of particular interest it is the preliminary data on cough hydration ratio that shows a highly significant correlation between dehydration and cough.

Etude de la prolifération cellulaire de la muqueuse rectale à différents stades évolutifs de la colite ulcéreuse

RésuméLes biopsies rectales de 12 patients atteints de colite ulcéreuse (UC) et de 3 sujets contrôle témoins ont été incubées in vitro avec un précurseur marqué du DNA dans le but d’observer les modifications des paramètres de prolifération cellulaire décrits par d’autres auteurs à différents stades évolutifs de la maladie. Nos résultats indiquent que les paramètres de la cinétique cellulaire observés sont en relation avec le degré de sévérité de l’inflammation. Une extension du compartiment prolifératif vers la surface muqueuse a été observé dans tous les cas de colite ulcéreuse en phase active (modérée ou sévère) et dans un cas de colite quiescente.SummaryRectal biopsies from 12 ulcerative colitis (UC) patients and three controls were incubated in vitro with a labelled precursor of the DNA in order to see if the changes of proliferation patterns described by other Authors vary in different stages of the disease. Our results indicate that kinetic parameters of mucous cells seen to be correlated to the severity of inflammation. It was also observed an upward extension of the proliferative compartment in all cases of active (moderate or sevare) colitis and in one case of quiescent colitis.