G. Leonardi

Helicobacter pylori Eradication: A Randomized Prospective Study of Triple Therapy Versus Triple Therapy Plus Lactoferrin and Probiotics

OBJECTIVES:Helicobacter pylori is causally associated with gastritis and peptic ulcer diseases. Recent data (meta-analysis) have demonstrated that triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor has an eradication rate of only 74–76% and new therapeutic protocols may be necessary. The aim of this study was to examine whether adding bovine lactoferrin (bLf) and probiotics (Pbs) to the standard triple therapy for H. pylori infection could improve the eradication rate and reduce side effects.METHODS:H. pylori infection was diagnosed in 206 patients: in 107 based on an upper endoscopy exam and a rapid urease test, and in 99 by means of the H. pylori stool antigen-test and the C13 urea breath test (C13 UBT). The patients were randomized into two groups: 101 patients (group A) underwent standard triple eradication therapy (esomeprazole, clarithromycin, amoxicillin), while 105 patients (group B) underwent a modified eradication therapy (standard triple eradication therapy plus bLf and Pb). Successful eradication therapy was defined as a negative C13 UBT 8 wk after completion of the treatment. Results were evaluated by intention-to-treat (ITT) and per-protocol (PP) analysis. Data were evaluated and considered positive when P < 0.05.RESULTS:At the end of the study 175/206 patients showed negative C13 UBT results. According to intention-to-treat analysis, the infection was eradicated in 73/101 patients from Group A and in 93/105 from Group B. PP analysis showed 73/96 patients from Group A and 93/101 from Group B to have been successfully treated. More patients from group A than from group B reported side effects from their treatment (P < 0.05).CONCLUSIONS:The results of our study suggest that the addition of bLf and Pbs could improve the standard eradication therapy for H. pylori infection—bLf serving to increase the eradication rate and Pbs to reduce the side effects of antibiotic therapy.

Randomised clinical trial: twice daily esomeprazole 40 mg vs. pantoprazole 40 mg in Barrett's oesophagus for 1 year

Aliment Pharmacol Ther 2011; 33: 1019–1027

“PancPro” as a tool for selecting families eligible for pancreatic cancer screening: An Italian study of incident cases

BACKGROUND PancPRO is a computer program that estimates the risk of pancreatic cancer for asymptomatic individuals based on a genetic model of susceptibility and the familial incidence of cancer. AIM To evaluate the distribution of the familial risk in a series of incident cases of pancreatic adenocarcinoma. MATERIALS AND METHODS The lifetime risk of pancreatic cancer was calculated by PancPro for a hypothetical 40-year-old son of 570 consecutive probands with pancreatic cancer. RESULTS The 570 risk values were included between 1% and 13%. The distribution was bimodal, with the antimode located at risk=7.5%. Considering a 10-fold risk over the general population as a threshold for including a subject in a surveillance program, 19 families (3.3%) would be selected, totalling 92 first-degree relatives with age >40 years. CONCLUSIONS PancPro is a valid instrument to rank families based on risk of pancreatic cancer.

Intestinal pseudo-obstruction in inactive systemic lupus erythematosus: An unusual finding

Chronic intestinal pseudo-obstruction (CIP) is an infrequent complication of an active systemic lupus erythematosus (SLE). We illustrate a case of SLE inactive-related CIP. A 51-year old female with inactive SLE (ECLAM score 2) was hospitalized with postprandial fullness, vomiting, abdominal bloating and abdominal pain. She had had no bowel movements for five days. Plain abdominal X-ray revealed multiple fluid levels and dilated small and large bowel loops with air-fluid levels. Intestinal contrast radiology detected dilated loops. CIP was diagnosed. The patient was treated with prokinetics, octreotide, claritromycin, rifaximin, azathioprine and tegaserod without any clinical improvement. Then methylprednisolone (500 mg iv daily) was started. After the first administration, the patient showed peristaltic movements. A bowel movement was reported after the second administration. A plain abdominal X-ray revealed no air-fluid levels. Steroid therapy was slowly reduced with complete resolution of the symptoms. The patient is still in a good clinical condition. SLE-related CIP is generally reported as a complication of an active disease. In our case, CIP was the only clinical demonstration of the SLE.

P.1.59: DIAGNOSIS OF NERD IN A POPULATION OF PATIENTS WITH AND WITHOUT IBS: A PH-MII STUDY

case/control status, counted intraepithelial lymphocites, eosinophils, presence of metaplasia, mucosal inflammation and pathogens, including Helicobacter pylori. Results: We collected biopsies of 53 pts. Biopsies of 37 pts (40.5% male, 59.5% female, age 50.3±17.1 years) were examinated. Biopsies of the remaining 16 pts were considered too small for the study.The FD group was constituted by 21 pts, while the control group by 16 pts. No significant differences in demographic and clinical data of the two groups were recorded. Statistical analysis showed a significant increase in DEC in FD pts compared to controls (D1: 76.2%of FD pts had=22 eosinophils/hpf vs 37.5% of controls; OR=5.3, p=0.02. D2: 71.4% of FD pts had=17 eosinophils/hpf vs 31.3% of controls; OR=5.5, p=0.01). Conclusions: Our study confirms a significant increase in DEC in pts with FD. Whether duodenal eosinophilia is cause or effect is unknown. It is possible that some local environmental or genetic factor account for the present observations. We didn’t find evidence of parasite infestation, atopy or malignancy to explain eosinophilia. We suppose that eosinophil migration in the duodenal mucosa is promoted by mast cells within eosinophil–mast cell–nerve GUT axis, as described in functional GUT disorders.Thus DEC may be a useful marker of FD and may represent a new possible target of therapy.

P.1.30: SECONDARY CANCERS IN PATIENTS WITH INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM OF THE PANCREAS (IPMN): PRELIMINARY RESULTS OF A PROSPECTIVE MULTICENTRE ITALIAN STUDY

and moderate-severe steatosis (OR 2.1; 95%CI, 1.1-4.1; p=0.03). SVR rates were not related to HOMA in the overall population [63% (220/351) vs 60% (29/48), p=0.75], nor in subgroup analysis by virus genotype [genotype 1: 43% (61/143) for ≤ 2 HOMA vs 53% (9/17) for > 2 HOMA (p=0.45); genotype 2 and 3: 83% (143/173) vs 80% (20/25), p=0.78, respectively]. In SVR patients, baseline and follow up HOMA values were similar (1.12±0.82 vs 1.17±1.1, p=0.25). Conversely, nonresponders had increased HOMA values trough 18 months follow up (from 1.17±0.7 to 1.49±1.3, p=0.007); IR de-novo occurred more frequently in non-SVR than in SVR patients [24% (25/106) vs 8% (16/198), p=0.0003]. Conclusions: While the outcome of Peg-IFN/Rbv therapy is not influenced by IR, the latter is prevented once SVR is achieved.