Giuseppe Sabatino

Colonic mast cells in controls and slow transit constipation patients.

Aliment Pharmacol Ther 2011; 34: 92–99

Is hyperhomocysteinemia relevant in patients with celiac disease

AIM To investigate whether this might be related to the presence of hyperhomocysteinemia. METHODS From January 1998 to December 2008, we evaluated the presence of hyperhomocysteinemia in a series of 165 adult celiac disease (CD) patients (138 females and 27 males, mean age 43 years). RESULTS Hyperhomocysteinemia was evident in 32 patients (19.3%), although most of them had moderate levels (mean value 25 mcg/ml; range 15-30). Only one patient had a history of myocardial infarction (heterozygosis for N5-N10-metil tetrahydrofolate reductase mutation). CONCLUSION The systematic assessment of hyperhomocysteinemia seems, at present, unjustified in CD patients.

Small intestinal bacterial overgrowth and warfarin dose requirement variability

The dose of warfarin needed to obtain a therapeutic anticoagulation level varies widely among patients and can undergo abrupt changes for unknown reasons. Drug interactions and genetic factors may partially explain these differences. Intestinal flora produces vitamin K2 (VK2) and patients with small intestinal bacterial overgrowth (SIBO) rarely present reduced INR values due to insufficient dietary vitamin K. The present study was undertaken to investigate whether SIBO occurrence may affect warfarin dose requirements in anticoagulated patients. Based on their mean weekly dose of warfarin while on stable anticoagulation, 3 groups of 10 patients each were defined: low dose (LD, <or=17.5 mg/wk of warfarin); high dose (HD, from 35-70 mg/wk); and very high dose (VHD>or=70 mg/wk). Each patient underwent a lactulose breath test to diagnose SIBO. Plasma levels of warfarin and vitamin K-analogues were also assessed. Patients with an altered breath test were 50% in the VHD group, 10% in the HD group, and none in the LD group (P=0.01). Predisposing factors to SIBO were more frequent in the VHD group, while warfarin interfering variables were not. VHD patients were younger and had a higher plasma vitamin K1 (VK1) concentration (P>0.05). On the contrary, the plasma VK2 levels tended to be lower. This pilot study suggests that SIBO may increase a patients warfarin dose requirement by increasing dietary VK1 absorption through the potentially damaged intestinal mucosa rather than increasing intestinal VK2 biosynthesis. Larger studies are needed to confirm these preliminary data and to evaluate the effects of SIBO decontamination on warfarin dosage.

A simplified method for anal ultrasonography: preliminary report.

Background Anal endosonography (AES) is able to reliably visualize and identify anal sphincter abnormalities. However, dedicated probes are quite expensive. Aim We describe a simple and less costly method to perform AES in a unit that already has echoendoscopes available by inserting the endoscope through a disposable anoscope filled with standard ultrasound gel. Patients Subjects without anal abnormalities and patients with anal disease (abscesses, fistulas) were evaluated. Results Good-quality images were obtained in both controls and patients, with optimal visualization of the anatomic structures and pathologic features. The latter (abscesses, fistulas) were always confirmed by magnetic resonance imaging. Conclusions This simple and less costly method allows to perform good-quality AES in units having echoendoscopes availability, without the need of a more expensive dedicated probe.

A simplified method for anal ultrasonography: assessment of patient satisfaction and the simplicity of the procedure

BackgroundAnal endosonography reliably visualizes and identifies anal sphincter abnormalities. However, dedicated probes are quite expensive. We evaluated a simple and less-costly procedure for anal endosonography involving the insertion of the endoscope through a disposable anoscope filled with standard ultrasound gel in terms of patient satisfaction and the simplicity of the procedure in comparison with the standard technique in a unit that already had echoendoscopes available.MethodsThe two techniques were used in 35 subjects without anal abnormalities and data on the simplicity of the procedures, patient discomfort, the quality of images, and the time needed to perform the procedures were compared.ResultsAll the variables under investigation scored significantly better with the modified technique compared to the standard one. No differences in thickness of either the internal or the external anal sphincter were found between the two methods.ConclusionsThis simple and less-costly adaptation of anal ultrasonography allows good quality examinations to be performed with better patient comfort in units with echoendoscopes already available, avoiding the need for a more expensive dedicated probe.