Mario Grassini

Symptom patterns can distinguish diverticular disease from irritable bowel syndrome

Diverticular disease (DD) and irritable bowel syndrome (IBS) share a similar symptom pattern. However, comparative studies are flawed by different age at onset of symptoms. We aimed to verify whether clinical features distinguish DD from IBS.

Ski/SnoN expression in the sequence metaplasia-dysplasia-adenocarcinoma of Barrett's esophagus☆

Barretts esophagus (BE) is a precancerous condition. However, the mechanisms underlying the transformation from metaplastic to dysplastic to adenocarcinomatous epithelium are still poorly understood. As loss of transforming growth factor-beta growth inhibition is considered a hallmark of several human neoplasms, we evaluated the expression of Ski and SnoN (proteins that antagonize transforming growth factor-beta signaling through physical interaction with Smad complex and by recruiting histone deacetylases), as markers of the transforming growth factor-beta signaling pathway, in BE with and without dysplasia. Biopsy samples from 37 patients (26 men, aged 60 +/- 8 years) with histologically proven BE were evaluated; 10 patients had concomitant low-grade dysplasia, 7 high-grade dysplasia (HGD), and 6 HGD associated with adenocarcinoma. Ski and SnoN expression was assessed immunohistochemically. Neither Ski nor SnoN was expressed in normal esophageal epithelium, but both were strongly expressed in BE tissue, with intense cytoplasmic positivity. Expression of these proteins decreased markedly in dysplastic areas in patients with low-grade dysplasia and was absent in those with HGD or HGD/adenocarcinoma. Ski and SnoN proteins are overexpressed in BE and may be involved in abnormal signaling elicited by transforming growth factor-beta in this epithelium, enhancing the tumorigenesis process. These observations might help to elucidate the molecular mechanisms involved in the BE tumorigenesis process.

I-SCAN targeted versus random biopsies in Barrett's oesophagus

BACKGROUND The accuracy and effectiveness of targeted oesophageal biopsies in Barretts oesophagus to detect dysplasia using new magnification techniques are unknown. Aim of this study was to investigate whether the combined use of acetic acid, magnification and electronic filters allows the same accuracy as the four-quadrant random biopsies pattern; pathologist interobserver agreement both in low grade and high grade dysplasia was also assessed. METHODS Fifty-four consecutive patients newly diagnosed with Barretts oesophagus were enrolled in a prospective study from a single endoscopy unit. Biopsies were evaluated by the local pathologist and by an expert pathologist from another pathology unit. MAIN OUTCOME MEASUREMENT Dysplasia detection rate and interobserver agreement for the histologic diagnosis of dysplasia. RESULTS The use of acetic acid, magnification and electronic filters showed an unacceptably low dysplasia detection rate by the two pathologists (9.2% and 5.5% for targeted biopsies, respectively). The interobserver agreement for low grade dysplasia between pathologists was low (Cohens K weighted=0.45). CONCLUSIONS In an average setting, the standard four-quadrant method should still be preferred, along with the implementation of a routine second evaluation by an expert pathologist.

CLINICAL PATTERNS CAN DISTINGUISH DIVERTICULAR DISEASE FROM IRRITABLE BOWEL SYNDROME: A CASE-CASE MATCHING STUDY

Background and Aim: Colonic diverticulitis shows an high recurrence rate. Since no conclusive data are available about the optimal strategy in preventing diverticulitis recurrence, aim of our study was to assess three different therapeutic strategies in preventing diverticulitis recurrence Methods: 130 patients suffering from Acute Uncomplicated Diverticulitis (AUD) (81 Males, 49 Females, mean age 64.71 years, range 40-85) were prospectively assessed during a 2-year follow-up. After obtaining remission, the patients were treatedwithmesalazine 1.6 grams every day (59 patients, group A), or rifaximin 800 mg/day for 7 days every month (52 patients, group B), or did not take any therapy (19 patients, group C). Clinical, endoscopic and histological follow-up was performed after six, 12 and therefore every 12 months after diagnosis of AUD. Results: Fifty-four patients were excluded from final evaluation (see figure 1): 17 patients died; 21 were excluded due to taking unprescribed drugs during the scheduled treatment; 16 were lost to follow-up or were excluded because not compliant. Forty-four group A patients, 23 group B patients, 9 group C patients were available for the final assessment. Sustained remission was statistically higher in group A (93.18%) than group B (56.52%) and group C (44.44%) (A vs B: p=0.01; A vs C: p=0.03; B vs C: p=0.072). Persistence of endoscopic and histological damage were the only factors affecting diverticulitis recurrence. Conclusions: Patients taking mesalazine have lower risk of diverticulitis recurrence than patients taking rifaximin or taking no therapy, thanks to lower prevalence of persisting endoscopic and histological inflammation than in patients taking rifaximin or taking no therapy

P.1.110: CLINICAL PATTERNS CAN DISTINGUISH DIVERTICULAR DISEASE FROM IRRITABLE BOWEL SYNDROME: A CASE-CASE MATCHING STUDY

Background and Aim: Colonic diverticulitis shows an high recurrence rate. Since no conclusive data are available about the optimal strategy in preventing diverticulitis recurrence, aim of our study was to assess three different therapeutic strategies in preventing diverticulitis recurrence Methods: 130 patients suffering from Acute Uncomplicated Diverticulitis (AUD) (81 Males, 49 Females, mean age 64.71 years, range 40-85) were prospectively assessed during a 2-year follow-up. After obtaining remission, the patients were treatedwithmesalazine 1.6 grams every day (59 patients, group A), or rifaximin 800 mg/day for 7 days every month (52 patients, group B), or did not take any therapy (19 patients, group C). Clinical, endoscopic and histological follow-up was performed after six, 12 and therefore every 12 months after diagnosis of AUD. Results: Fifty-four patients were excluded from final evaluation (see figure 1): 17 patients died; 21 were excluded due to taking unprescribed drugs during the scheduled treatment; 16 were lost to follow-up or were excluded because not compliant. Forty-four group A patients, 23 group B patients, 9 group C patients were available for the final assessment. Sustained remission was statistically higher in group A (93.18%) than group B (56.52%) and group C (44.44%) (A vs B: p=0.01; A vs C: p=0.03; B vs C: p=0.072). Persistence of endoscopic and histological damage were the only factors affecting diverticulitis recurrence. Conclusions: Patients taking mesalazine have lower risk of diverticulitis recurrence than patients taking rifaximin or taking no therapy, thanks to lower prevalence of persisting endoscopic and histological inflammation than in patients taking rifaximin or taking no therapy