1,720,977 research outputs found
Effects of modified wheat gluten aministration in patioents with celiac disease:results of a double-blindgluten-controlled clinical trial
No full textNew insights in IBS-like disorders: Pandora's box has been opened; a review
No full textThe most complained gastrointestinal symptoms are chronic diarrhea, bloating and abdominal pain. Once malignancies and inflammatory bowel diseases are excluded, irritable bowel syndrome (IBS) and the so called "IBS-like disorders" should be taken into account. The relationship between IBS as defined by Rome IV criteria and these clinical conditions is sometimes obscure, since many IBS patients identify food as a possible trigger for their symptoms. Here, we discuss IBS and the most common IBS-like disorders (celiac disease, non-celiac gluten sensitivity, fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), lactose intolerance, small intestinal bacterial overgrowth (SIBO), α-amylase/trypsin inhibitor (ATIs), nickel allergic contact mucositis), focusing on epidemiologic, clinical, diagnostic and therapeutic aspects. Given the lack of specificity of symptoms, clinical investigation will be facilitated by awareness of these disorders as well as new specific diagnostic tools
Robotic colonoscopy: efficacy, tolerability and safety. Preliminary clinical results from a pilot study
No full textBACKGROUND: Robotic colonoscopy (RC) is a pneumatically-driven self-propelling platform (Endotics System®) able to investigate the colon, in order to reduce pain and discomfort. AIMS: (1) to describe the progress in gaining experience and skills of a trainee in RC; (2) to show the clinical outcomes of RC. METHODS: Pilot study. An experienced endoscopist started a training on RC whose progress was assessed comparing the results of 2 consecutive blocks of 27 (Group A) and 28 (Group B) procedures. CIR (Cecal Intubation Rate), CIT (Cecal Intubation Time) and Withdrawal Time (WT) were measured. Polyp Detection Rate (PDR), Adenoma Detection Rate (ADR) and Advanced Neoplasia Detection Rate (ANDR) were calculated. Possible adverse events were recorded. At the end of the procedure all patients completed a visual analog scale (VAS) to measure their perceived pain during RC and reported their willingness to repeat RC. RESULTS: General CIR was 92.7%, reaching 100% in Group B. Comparing the two groups, CIT significantly decreased from 55 to 22 min (p value 0.0007), whereas procedures with CIT ≤ 20 min increased (p value 0.037). WT significatively reduced from 21 to 16 min (p value 0.0186). PDR was 40% (males 62.5%, females 14.3%). ADR was 26.7% (males 27.5%, females 14.3%). Most of patients judged the procedure as mild or no distress, with high willingness-to-repeat the RC (92.7%). CONCLUSIONS: Our results about RC are encouraging as preliminary experience, with clear individual learning progress, accurate diagnosis in a painless or comfortable procedure and with possibility to remove polypoid lesions. Studies with larger populations are needed to confirm obtained results
Results of 12-month rescue treatment with teduglutide in severely active and parenteral nutrition-dependent Crohn's disease
No full textShort bowel syndrome (SBS) is caused by the loss of extensive segments of the small intestine as seen in Crohn’s disease (CD) (1,2) and is characterized by malnutrition; thus, patients with SBS often require parenteral nutrition (PN) (3). Alternatives can maximize the remnant intestinal absorptive capacity, e.g., glucagonlike peptide 2 analog teduglutide. It inhibits gastric acid secretion and motility, stimulates intestinal blood flow, increases the intestinal barrier, and enhances absorption (4). Teduglutide has a safety profile (5), but adverse events are mostly related to hyperplastic and hypertrophic
effects. Thus, patients with SBS having fluctuations in disease activity, e.g., in active CD, have always been excluded from treatment with teduglutide.
For the first time, we report the results of 12-month treatment with teduglutide in a 42-year-old Caucasian woman affected by severely active CD with SBS. Informed consent was obtained.
The patient underwent total colectomy in 1991 because of supposed ulcerative colitis. Then, CD was diagnosed, and since 2010, she underwent many intestinal resections. Many treatments had been unsuccessfully attempted (corticosteroids, infliximab, azathioprine, adalimumab, methotrexate, and certolizumab).
Given her precarious clinical conditions, treatment with 0.05 mg/kg/day teduglutide was started in August 2015. Before treatment, she was in a poor condition.
Nutritional deficiency and electrolyte imbalance were present. PN was initiated 24 h/day and 7 days/week, with a total of 1600 kcal/day per 3000 mL/day. After 12 months, teduglutide played a key role in ameliorating her severe nutritional deficiencies and ensuring her survival with good quality of life. Without teduglutide, her life would have been seriously compromised.
Our patient was unable to totally wean from PN and reduce the number of days of infusion, but the PN volume has been progressively reduced to 2500 mL/day (an almost 20% reduction), with occasional exceptions.
Moreover, total PN calories have been reduced from 1600 to 1400 kcal. An increase was observed in her body weight and BMI (from 17.5 to 24.5 kg/m2). We are confident that more positive goals in PN reduction may be achieved with further therapy.
Crohn’s disease complications and treatment side effects were excluded on close clinical, laboratory, and imaging (US, CT, and MRI) surveillance.
More studies with a larger number of patients and prolonged treatment are necessary to confirm the usefulness and safety of teduglutide in those with severely active CD. Our experience provides elements to support its efficacy and may pave the way for future research on teduglutide, even in other gastrointestinal diseases with fluctuating activities
Culture of gastric biopsies in celiac disease and its relationship with gastritis and Helicobacter pylori infection
No full textBACKGROUND: Celiac disease (CD) is a gluten-related multisystemic disorder. Duodenal biopsy organ culture is a reliable supporting tool for CD diagnosis and can reveal specific immunological activation in many intestinal tracts.
AIM: we investigated the gastric gluten-dependent immunological activation in CD, compared to duodenum. Gastric cultural results were also compared with histology and HP findings.
METHODS: 18 patients with suspected CD and HP infection underwent EGD. Biopsies from duodenum (bulb and second portion) and gastric antrum were collected for histology and organ culture system.
RESULTS: all patients were diagnosed with CD and gastritis. Nine out of 18 (50%) patients were HP-positive. EMA and anti-tTG were positive in 18/18 (100%) cultures from duodenum, as well as in 17/18 (94.4%) gastric cultures. Anti-tTG were higher in duodenal cultures than in gastric ones (p <0.05). Anti-tTG in gastric cultures were similar in HP-positive and HP-negative patients. Nine out of 17 (53%) patients with positive EMA in gastric culture were HP-positive and 8/17 (47%) were HP-negative. No significant difference in EMA gastric culture results was observed between HP-positive and HP-negative patients.
CONCLUSIONS: Our data reveal an involvement also of stomach in CD. HP seems to not affect anti-tTG and EMA results in gastric cultures
Relationship between nickel allergic contact mucositis and nickel-rich diet in symptomatic women suffering from endometriosis
No full textBACKGROUND: Nickel (Ni) is a ubiquitous element in nature and the gastrointestinal tract is an important route of exposure for humans. Once ingested, alimentary Ni often results in the allergic contact mucositis (ACM). Ni ACM is an emerging gastrointestinal disorder involving a type IV delayed hypersensitivity reaction and has an estimated prevalence that exceeds 30% of the general population. The resulting Ni-induced low-grade inflammation may present with both IBS-like symptoms and extra-intestinal manifestations. Gastrointestinal symptoms are also present in many women with endometriosis and Ni allergic contact dermatitis has already been observed in these women. Therefore, intestinal and extra-intestinal symptoms complained in endometriosis may depend on a Ni ACM. What is more, a low-Ni diet could suggestively improve symptoms.
AIM: We wanted to study the prevalence of Ni ACM in women with symptomatic endometriosis and focus on the effects of a low-Ni diet on gastrointestinal, extra-intestinal and gynecological symptoms in these patients.
MATERIALS AND METHODS: We consecutively recruited 34 women of fertile age (range 23-47 years, mean age 35 years) with endometriosis, symptomatic for gastrointestinal disorders. Sixteen out of 34 patients completed the study. They underwent Ni oral mucosa patch test (omPT), low-Ni diet and questionnaire for intestinal, extra-intestinal and gynecological symptoms. Clinical evaluation was performed at baseline (T0) and after 3 months (T1).
RESULTS: Fourteen out 16 (87.5%) patients showed Ni omPT positive results, with Ni ACM diagnosis, whereas 2 out of 16 (12.5%) patients showed negative Ni omPT. After 3 months of low-Ni diet, all gastrointestinal, extra-intestinal and gynecological symptoms showed a statistically significant reduction (p <0.05) or a downward trend.
CONCLUSIONS: Given the resulting high prevalence of Ni sensitivity and the significant clinical benefit obtained from a low-Ni diet, Ni-rich foods may be triggers of gastrointestinal, extra-intestinal and gynecological symptoms complained by women with endometriosis
Nickel-Related Intestinal Mucositis in IBS-Like Patients: Laser Doppler Perfusion Imaging and Oral Mucosa Patch Test in Use
No full textNickel (Ni) is often the trigger of irritable bowel syndrome (IBS)-like gastrointestinal disorders: its ingestion may cause allergic contact mucositis, identifiable by means of oral mucosa patch test (omPT). OmPT effectiveness has been proven, but it is still an operator-dependent method. Laser Doppler perfusion imaging (LDPI) was tested to support omPT in Ni allergic contact mucositis diagnosis. Group A: 22 patients with intestinal/systemic symptoms related to the ingestion of Ni-containing foods. Group B: 12 asymptomatic volunteers. Ni-related symptoms and their severity were tested by a questionnaire. All patients underwent Ni omPT with clinical evaluation at baseline (T0), after 30 min (T1), after 2 h (T2), and after 24-48 h (T3). LDPI was performed to evaluate the mean mucosal perfusion at T0, T1, and T2. Statistical analysis was performed by ANOVA test and Bonferroni multiple-comparison test. All 22 Ni-sensitive patients (group A) presented oral mucosa hyperemia and/or edema at T2. Eight out of the same 22 patients presented a local delayed vesicular reaction at T3 (group A1), unlike the remaining 14 out of 22 patients (group A2). All 12 patients belonging to control group B did not show any alteration. The mean mucosal perfusion calculated with LDPI showed an increase in both subgroups A1 and A2. In group B, no significant perfusion variations were observed. LDPI may support omPT for diagnostic purposes in Ni allergic contact mucositis. This also applies to symptomatic Ni-sensitive patients without aphthous stomatitis after 24-48 h from omPT and that could risk to miss the diagnosis
Extension of the celiac intestinal antibody (CIA) pattern through eight antibody assessments in fecal supernatants from patients with celiac disease
No full textBackground: Detection of anti-transglutaminase, anti-endomysium and anti-gliadin antibodies is commonly used to screen celiac disease patients. Besides that in serum, these antibodies are detectable in culture supernatants of oral, duodenal and colonic biopsy samples, saliva, gut lavage fluid samples, and fecal supernatants. Our aim was to extend the intestinal antibody pattern in fecal supernatants from patients with celiac disease.
Methods: The fecal supernatants obtained from 25 celiac disease patients and 12 healthy volunteers were used to determine IgA and IgG1 anti-endomysium by immunofluorescence analysis, IgA and IgG anti-transglutaminase, IgA and IgG anti-deamidated gliadin peptides, IgA/IgG anti-transglutaminase/deamidated gliadin peptides and IgA anti-actin by enzyme-linked immunosorbent assay.
Results: IgA anti-endomysium were found in 11 of 25 (44.0%) celiac disease patients and in none of healthy volunteers (p=0.0066). The levels of IgA anti-transglutaminase, IgA anti-deamidated gliadin peptides, IgA/IgG anti-transglutaminase/deamidated gliadin peptides and IgA anti-actin determined in celiac disease patients were significantly higher (p=0.0005, p=0.0018, p=0.0061 and p=0.0477, respectively) than those measured in healthy volunteers. The ROC curve analysis showed a diagnostic significance in IgA anti-transglutaminase (AUC=0.862, p<0.0001), IgA anti-deamidated gliadin peptides (AUC=0.822, p<0.0001) and IgA/IgG anti-transglutaminase/deamidated gliadin peptides (AUC=0.783, p=0.0003) fecal tests.
Conclusions: Our data extend the intestinal antibody pattern detectable in fecal supernatants, thus increasing the knowledge in the humoral immunity of celiac disease. Further studies are needed to better evaluate the role of fecal antibody tests in identifying celiac disease patients
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