V. De Francesco

High eradication rates of Helicobacter pylori with a new sequential treatment

Background : Eradication rates of Helicobacter pylori with standard triple therapy are disappointing, and studies from several countries confirm this poor performance.

A 10-day levofloxacin-based triple therapy in patients who have failed two eradication courses

Background : A standard third‐line treatment is lacking, and European guidelines recommend performing culture in these patients. However, the use of this procedure as ‘routine practice’ is definitively not feasible.

Sequential treatment for Helicobacter pylori does not share the risk factors of triple therapy failure.

Background : Predicting factors for the outcome of conventional Helicobacter pylori triple therapy have been identified. Of these, the presence of the CagA gene is a strong predictor of successful treatment. Our preliminary data show that this factor becomes irrelevant when sequential therapy is used.

High rate of Helicobacter pylori eradication with sequential therapy in elderly patients with peptic ulcer: a prospective controlled study

Background : Helicobacter pylori eradication rates with triple therapies are decreasing, and few data in elderly patients are available. A 10‐day sequential regimen succeeded in curing such H. pylori infection in unselected patients.

Effectiveness and pharmaceutical cost of sequential treatment for Helicobacter pylori in patients with non‐ulcer dyspepsia

Background : A novel 10‐day sequential treatment regimen recently achieved a significantly higher eradication rate than standard 7‐day therapy in both peptic ulcer disease and non‐ulcer dyspepsia. Its higher performance has recently been confirmed using a halved clarithromycin dose in peptic ulcer disease.

Diverticular disease as a risk factor for sigmoid colon adenomas

BACKGROUND Diverticular disease and colorectal neoplasia share similar epidemiological features and risk factors. AIM To evaluate a possible association between diverticular disease and both adenomas and colorectal cancer in patients undergoing total colonoscopy. METHODS Overall, 630 consecutive patients were recruited from the 3 Units. Inclusion criteria were age over 45 years and the performance of total colonoscopy. Demographic and clinical data were recorded. Adenomas were defined as advanced when their size was >1 cm in diameter, and/or the percentage of the villous component was >30% and/or high grade dysplasia was present. RESULTS At endoscopy, 291 (47%) out of 630 patients presented evidence of diverticular disease. Adenomas were found in 92 (31.9%) patients with diverticular disease and in 98 (28.9%) patients without [p=ns]. The prevalence of adenomas located in the sigmoid colon was significantly higher in patients with diverticula than in controls (64.1% vs 41.8%; p<0.05). Similarly, the detection of advanced adenomas located in the sigmoid colon was more likely in patients with diverticula than in controls (59.6% vs 37.5%; p<0.05). Colorectal cancer prevalence was similar in patients with and without diverticula (8.3% vs 7.1%; p=ns), and no difference was detected regarding site, between the two groups. CONCLUSIONS Patients with diverticular disease have a higher risk of harbouring adenomas and advanced adenomas in the sigmoid colon. This observation should be taken into account in screening and surveillance programmes for colorectal neoplasia.

DNA sequences and proteic antigens of H. pylori in cholecystic bile and tissue of patients with gallstones

Background : Although Helicobacter pylori DNA sequences have been detected in cholecystic bile and tissue of patients with gallstones, controversial results are reported from different geographic areas.

Furazolidone-based therapies for Helicobacter pylori infection: a pooled-data analysis

Background/Aim: Furazolidone-based therapies are used in developing countries to cure Helicobacter pylori infection due to its low cost. The low bacterial resistance toward furazolidone may render appealing the use of this drug even in developed countries. However, some relevant safety concerns do exist in using furazolidone. Patients and Methods: This was a systematic review with pooled-data analysis of data regarding both eradication rate and safety of furazolidone-based therapies for H. pylori infection. Intention-to-treat (ITT) and per-protocol (PP) eradication rates were calculated. Results: Following furazolidone-based first-line therapy, H. pylori eradication rates were 75.7% and 79.6% at ITT and PP analysis, respectively (P<0.001). The overall incidence of side effects and severe side effects were 33.2% and 3.8%, respectively. At multivariate analysis, only high-dose furazolidone was associated with increased therapeutic success (OR: 1.5, 95% CI: 1.3-2.7; P<0.001), while occurrence of side effects was relevant following treatment for a long duration (OR: 2.9, 95% CI: 2.2-4.1; P<0.001), high-dose furazolidone (OR: 2.3, 95% CI: 1.7-3.2; P<0.001) and bismuth-containing regimens (OR: 2.1, 95% CI: 1.5-2.8; P<0.001). Conclusions: Furazolidone-based regimens usually achieve low eradication rates. Only a high-dose regimen improves the cure rate, but simultaneously increases the incidence of severe side effects. Therefore, we suggest that patients have to be clearly informed about the possible genotoxic and carcinogenetic effects for which furazolidone use is not approved in developed countries.

Helicobacter pylori strains and histologically-related lesions affect the outcome of triple eradication therapy: a study from southern Italy

Background : Certain evidence suggests that Helicobacter pylori strains expressing genes for cytotoxin production show a higher sensitivity than non‐cytotoxic organisms to eradication treatment. No data are available on the involvement of bacterium‐related lesions in different therapeutic outcomes.

Segmental colitis associated with diverticula: a rare clinical entity and a new challenge for the gastroenterologist

BACKGROUND AND AIM Segmental colitis associated with diverticula (SCAD) has recently drawn a particular attention in the field of rare forms of colitis because of some peculiarities suggesting both its autonomy as a clinical entity and a resemblance with the most relevant forms of inflammatory bowel diseases (IBD). Aim of this review was to report the state of art on this topic. METHODS Epidemiological, clinical, endoscopic/histological and diagnostic features are described. Moreover, from both the pathogenetic and therapeutic point of view, new relevant information is highlighted regarding the possible role of tumour necrosis factor alpha (TNF-alpha) in mucosal inflammation. RESULTS SCAD would appear as a rare autonomous clinical entity distinctive of old age, although it is still not well defined. It is likely that prevalence of SCAD could have been underestimated in the past since its main clinical presentation (namely bleeding without pain) is often found in elderly patients with diverticula. Endoscopy and histology could be helpful to discriminate it from infectious diverticulitis. Increasing evidence encourages the concept that SCAD includes pathogenetic and therapeutic aspects peculiar of IBD. This could be relevant for clinical management of SCAD. Indeed, the resolution of a severe, refractory case of SCAD has been recently reported with biological drugs used for IBD therapy. This observation could encourage, in the near future, the use of biological therapy in severe forms of SCAD as an alternative to surgery.