Mariagrazia Scaffidi

Depression, Anxiety and Anger in Subtypes of Irritable Bowel Syndrome Patients

The present study aimed to elucidate the differences in depression, anxiety, anger, and quality of life in a sample of non-psychiatric IBS patients, starting from the hypothesis that IBS subtypes may have different symptomatic expressions of negative emotions with different outcomes on quality of life measures. Forty-two constipation-predominant IBS (C-IBS) subjects and 44 diarrhea-predominant IBS (D-IBS) subjects, after an examination by a gastroenterologist and a total colonoscopy, underwent a clinical interview and psychometric examination for the assessment of depression, anxiety, anger and quality of life. IBS subtypes showed different symptomatic profiles in depression, anxiety and anger, with C-IBS patients more psychologically distressed than D-IBS subjects. Affective and emotional symptoms should be considered as specific and integral to the syndrome, and recognizing the differences between IBS subtypes may have relevant implications for treatment options and clinical outcome.

Optical coherence tomography evaluation of ulcerative colitis: the patterns and the comparison with histology.

HYPOTHESIS:The optical coherence tomography (OCT) is an imaging modality based on infrared light backscattering properties of tissues. OCT studies documented the disappearance of crypts and the alteration in light backscattering as features of ulcerative colitis (UC) in human colon. This technique should be more and more able to identify tissue microstructures with a resolution that is nearly that of histology (optical biopsy).AIM:To evaluate whether there are OCT patterns specific for UC and to compare the overall technique performance with the histology.METHODS:A total of 27 patients (20–76 yr) with UC underwent OCT imaging during a total colonoscopy. The OCT images were collected both from affected and normal sites in active UC or disease in remission. Two biopsies of the same sites were acquired. The OCT images were separately scored. Two pathologists blinded to the endoscopic and OCT patterns scored the samples.RESULTS:Three OCT patterns were identified: the mucosal backscattering alteration (MBA), the delimited dark areas (DDA), and the layered colonic wall (LCW). In colon affected segments of active and UC in remission, these patterns showed a good correspondence with the histology. Moreover, in 14/25 (56%) normal sites above the affected segment, the OCT documented the pathological features, confirmed only in 10/14 by the histology. Thus, the assessed sensitivity and specificity of OCT in normal segments of UC patients have been 100% and 69%, respectively.CONCLUSIONS:The in vivo OCT correctly detected disease features in endoscopically affected colon segments, but even in apparently normal segments of UC patients.

An endoscopic approach to the management of surgical bile duct injuries: nine years’ experience

BACKGROUND The evaluation of the endoscopic treatment of surgical bile duct injuries, especially in the management of post-operative strictures, remains controversial. AIM The aim of this study was to evaluate the feasibility of using endoscopic management from a study of the clinical reports of two of the main endoscopy units in Sicily. PATIENTS AND METHODS A total of 137 consecutive patients were selected. There were 85 simple biliary fistulas: 64 from the cystic duct stump; 19 from the gall bladder bed; and two from intra-hepatic bile ducts. There were 52 biliary lesions: 15 complete transections; 12 incomplete lesions of the common bile duct with six associated strictures; five complete or incomplete sections of the right antero-medial duct; and 20 incomplete strictures (without leak). RESULTS The success rate was 96.3% for simple biliary fistulas. Endoscopic therapy was feasible only in 40.6% of lesions of the common bile duct or the right antero-medial duct (13/32), but with 100% success. In the case of strictures (with or without associated leak), there was a good outcome in 88.2% of patients who completed the therapeutic procedure. CONCLUSIONS Endoscopic management of simple biliary fistulas and incomplete lesions of the common bile duct is the preferred approach. If continued for 12-24 months, with the placement of three or more 10F stents, the management of stenoses is guaranteed to yield good results.