Maurizio Quatrini

Effect of loperamide and naloxone on mouth-to-caecum transit time evaluated by lactulose hydrogen breath test.

The effect of loperamide and naloxone on mouth-to-caecum transit time was evaluated by the lactulose hydrogen breath test in four men and four women. Each subject underwent tests during the administration of placebo, loperamide (12-16 mg po), naloxone (40 micrograms/kg/h by a three-hour intravenous infusion), and loperamide plus naloxone, carried out at intervals of one or two weeks. The transit time was significantly longer after loperamide, and this effect was antagonised by the concomitant administration of naloxone whereas naloxone administered alone had no effect on mean transit time. No clinically important side effects were reported.

Gluten intolerance: Gender- and age-related differences in symptoms

Objective Gluten intolerance is a common, immunologically mediated disorder with a widely variable clinical presentation that affects genetically predisposed subjects. Women seem to be more frequently affected although data on sex differences are poor. In this study the prevalence of different clinical pictures according to sex and age is analysed in a large series of patients. Material and methods A total of 1436 patients with gluten intolerance were retrospectively considered, diagnosed from January 1975 to August 2001 based on compatible small-bowel biopsy and response to a gluten-free diet, plus immunofluorescent detection of granular IgA in papillary derma for dermatitis herpetiformis. The clinical picture at onset (classic, non-classic, silent) and age at diagnosis (≤2 years, >2 and ≤14 years, >14 years) was recorded; 362 parents of coeliac probands undergoing a familial screening were also studied. The relations among sex, age class and symptoms were analysed using the χ2 test with Yatess correction. Results The overall female/male ratio was 2.3:1 but the inter-sex difference was significant only when the diagnosis was made in adulthood where a significant association between iron-deficiency anaemia as manifestation at onset in adult women (34% versus 7%) was found. Low weight, dyspepsia and hypertransaminasaemia were more common in adult men than women (20%, 14% and 7% versus 13%, 3% and 2%, respectively). Dermatitis herpetiformis was present more frequently in men (16% versus 9%). The prevalence of silent cases was 6% in men and 3% in women. Familial screening showed the same prevalence (9.3%) of current coeliac disease in fathers and mothers. Conclusions Diagnosis of coeliac disease is more frequent in women but physicians’ awareness of sex- and age-related differences in clinical presentation could improve diagnostic performances in men.

Helicobacter pylori prevalence in patients with diabetes and its relationship to dyspeptic symptoms

As available data on Helicobacter pylori infection in patients with diabetes are scattered and discordant, we evaluated the prevalence of H. pylori and its relationship to dyspeptic symptoms in adult patients with diabetes and subjects with dyspepsia. H. pylori infection (evaluated using the 13C urea breath test) and dyspeptic symptoms (nausea, bloating, and epigastric distress) were investigated in 71 consecutive diabetic outpatients; the presence of gross lesions, histologic gastritis, and Helicobacter was verified in the patients with a positive urea test who agreed to undergo upper gastrointestinal tract endoscopy. Seventy-one age-and gender-matched subjects with dyspepsia were used as controls. Helicobacter pylori infection was detected in 49 (69%) patients with diabetes and in 33 (46%) subject with dyspepsia (p = 0.007). Helicobacter pylori was present in 27 (77%) of 35 patients with diabetes with dyspeptic symptoms and in 22 (61%) of 36 patients without dyspeptic symptoms. Endoscopy revealed peptic ulcers in 13 of 23 patients;H. pylori infection was histologically confirmed in the gastric antrum of all patients with diabetes, and in the body of the stomach in 74%. The significantly higher prevalence of H. pylori infection in the patients with diabetes may partially explain their dyspeptic symptoms. The high prevalence of H. pylori infection, esophagitis, and peptic ulcers found in our patients with diabetes (with or without dyspepsia) suggests that this population should be considered “at risk” for H. pylori infection and suitable candidates for treatment.

Possible protective effect of 5-aminosalicylic acid on Helicobacter pylori infection in patients with inflammatory bowel disease.

Goals To evaluate the prevalence of Helicobacter pylori (Hp) infection in a group of inflammatory bowel disease (IBD) outpatients and the possible influence of treatment. Background The low prevalence of Hp infection in these patients is usually attributed to environmental factors; the role of drugs has not been fully investigated. Study Seventy-two consecutive outpatients underwent a C13-urea breath test for Hp: 32 with Crohns disease (13 men; mean age, 48 years; range, 20–72 years) and 40 with ulcerative colitis (25 men; mean age, 49 years; range, 25–71 years). Thirty-one patients were treated with sulfasalazine and 41 with 5-ASA. The control group consisted of 72 age- and sex-matched subjects. Results The prevalence of Hp infection was 47% in the IBD patients and 61% in the controls (p = 0.089; odds ratio = 0.55; 95% CI = 0.283–1.089) with a statistically significant increase for each year of age (p = 0.044; odds ratio = 1.02; 95% CI = 1.001–1.052). Among the IBD patients, age and gender, the type, activity, duration, extent of the disease, or the calendar year of diagnosis, had no influence on Hp infection. H. pylori was detected in 65% of the patients treated with sulfasalazine and in 34% treated with 5-ASA (p = 0.017). Conclusions Although low, the prevalence of Hp infection in our patients was not significantly different from that in the controls. 5-ASA, and not sulfasalazine, may have a protective effect against Hp infection.

A follow-up study of patients with Zollinger-Ellison syndrome in the period 1966-2002: Effects of surgical and medical treatments on long-term survival

Aim: To evaluate the clinical history of a series of patients with Zollinger-Ellison syndrome (ZES) in the period 1966 to 2002, before and after the introduction of the current antisecretive H2 receptor antagonists and proton pump inhibitors into clinical practice. Patients and Methods: The study involved 18 ZES patients (9 males; mean age, 43 years; range, 12-70 years), 8 with Type 1 multiple endocrine neoplasia (MEN-1), diagnosed on the basis of standard criteria. We considered the type, number and effectiveness of surgical interventions before and after appropriate treatment, the localization of the gastrinoma, the presence of associated diseases, the causes of death, and the duration of survival. Results: Total gastrectomy (but not antrectomy and vagotomy) and full compliance to antisecretory treatment reduced the number of operations from 29 to 9. One patient was cured (5.5%), whereas relapsing gastrinomas occurred in 4 patients and associated diseases or complications in ten. Death was related to ZES in 5 patients and to other causes in 4. Conclusions: Curing gastrinoma or appropriately inhibiting gastric acid hypersecretion in ZES patients prevent death and favors long-term survival, regardless of gastrin levels and the size or number of tumors.

Mesenteric Lymph Node Cavitation: A Rare Hallmark of Celiac Disease

The cavitation of mesenteric lymph nodes represents a rare complication of celiac disease (only 30 reported cases) whose pathogenesis remains to be clarified. We here report the case of a 67-year-old woman referred to us because of a malabsorption syndrome lasting for 2 years; massive lymph node enlargement and cavitation were detected by means of ultrasonography and a computed tomography scan. Celiac disease was definitely diagnosed by means of duodenal histology, and a laparotomy was performed to exclude an underlying T-cell lymphoma. The adoption of a gluten-free diet led to a rapid and dramatic improvement in the clinical and histologic picture and normalization of the size of the lymph nodes. Celiac disease should be considered in the differential diagnosis of all patients with mesenteric lymph node cavitation.

Re: Oxentenko et al.--Endoscopic markers in celiac disease.

Gram-positive cocci. Of course, our findings do not provide clues to the actual role of Gram-positive cocci in the process of stone formation. However, considering that persons with cholesterol supersaturation of bile do not always develop cholesterol stones in the gallbladder, even though cholesterol supersaturation of bile is necessary for the formation of cholesterol stones (3), there must be additional factors, such as bacterial infection, that initiate or promote the formation of pure cholesterol stones. In fact, JaeWoon et al. have proposed that bile infection is associated with hypersecretion of mucin and that lipopolysaccharide from Escherichia coli stimulates mucin secretion from gallbladder epithelial cells (4). Moreover, it has been reported that hypersecretion of mucin, which promotes the nucleation of cholesterol crystals in bile, is regarded as an important factor in gallstone formation (5). Cariati and Cetta (1) insisted that the presence of Grampositive cocci in these gallstones is secondary to bacterial migration and it must be a contamination from bile. However, our newer data showed that bacteria in five gallstones differed from those in bile using DNA sequencing of polymerase chain reaction products (manuscript in preparation). Moreover, in six of 12 pure cholesterol stones, bacterial 16S ribosomal RNA was amplified only from the core portion of stones, not from bile in gallbladder. In another study, bacterial DNA was detected only in the core portions, and not from the surfaces of mixed cholesterol stones. Although further studies are necessary to clarify the biological roles of Gram-positive cocci in the formation of pure cholesterol stones, our data suggest that bacteria are not merely present in gallstones but play an important role on the formation of pure cholesterol stones.

Effect of Ascorbic Acid on Desferrioxamine-Induced Urinary Iron Excretion in Idiopathic Hemochromatosis

The effect on urinary iron excretion (UIE) of vitamin C administered orally 2 h after the start of an 8-hour desferrioxamine (DF) i.v. infusion was studied in 12 patients with untreated idiopathic hemochromatosis (IH). Mean +/- SEM basal UIE of 324.6 +/- 84.6 micrograms/24 h increased after a 1-gram i.v. DF infusion to 8,778.5 +/- 1,191.4 micrograms/24 h; when vitamin C 1 or 2 g were added to DF i.v. infusion, there were further increases to 11,241.5 +/- 1,486.1 (p less than 0.01) and 13,531.2 +/- 1,697.2 micrograms/24 h (p less than 0.05 versus the last value), respectively. Basal UIE did not significantly increase after oral vitamin C administration alone. No side effects were observed.