1,721,018 research outputs found
Mesalamine (5-ASA) for the Prevention of Recurrent Diverticulitis (Review)
No full textBackground Mesalamine, or 5-aminosalicylic acid (5-ASA) has been studied for the prevention of recurrent diverticulitis. Objectives To evaluate the efficacy of mesalamine (5-ASA) for the prevention of recurrent diverticulitis. Search methods We searched databases from 2010 to September 2017. In addition, we scanned reference lists from eligible publications, and we contacted corresponding authors to ask about additional trials. Selection criteria We included randomized controlled clinical trials comparing the efficacy of 5-ASA versus placebo or another active drug for the prevention of recurrent diverticulitis. Main results We included in this review seven studies with a total of 1805 participants. We judged all seven studies to have unclear or high risk of bias. Investigators found no evidence of an effect when comparing 5-ASA versus control for the prevention of recurrent diverticulitis (31.3% vs 29.8%; RR 0.69, 95% confidence interval (CI) 0.43–1.09); very low quality of evidence). Five of the seven studies provided data on adverse events of 5-ASA therapy. The most commonly reported side effects were gastrointestinal symptoms (epigastric pain, nausea, and diarrhea). No significant difference was seen between 5-ASA and control (67.8% vs 64.6%; RR 0.98, 95% CI 0.91–1.06; P = 0.63; moderate quality of evidence), nor was significant heterogeneity observed (I2 = 0%; P = 0.50). Authors’ conclusion The effects of 5-ASA on recurrence of diverticulitis are uncertain owing to the small number of heterogenous trials included in this review. Rates of recurrent diverticulitis were similar among participants using
5-ASA and control participants. Effective medical strategies for the prevention of recurrent diverticulitis are needed, and further randomized, double-blinded, placebo-controlled trials of rigorous design are warranted to specify the effects of 5-ASA (mesalamine) in the management of diverticulitis
Italian guidelines of Diverticular Disease
No full textDiverticular disease (DD) is a widespread condition, however limited evidences are available about its management and complications. In the last years, an Italian Consensus Conference promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) and a Guideline, by Italian Society of Colorectal Surgery (SICCR) were published. The aim of the Consensus was to provide clinical recommendation for appropriate definition, diagnosis, and management of DD, in particular 4 areas of interest were identified, namely: (i) definition and epidemiology, (ii) pathophysiology, (iii) diagnosis, and (iv) medical and surgical treatment. A total of 55 statements graded according to different level of evidence and strength of recommendation were approved. However, if we consider the grade of recommendation, their strength remains suboptimal, with only 3 statements with grade of evidence A in the area of diagnosis. The Clinical guidelines by SICCR focus mainly on acute diverticulitis, and surgical treatment of complicated DD. One of the main topic analyzed, is represented by the management of the acute uncomplicated diverticulitis, in particular about the use of antibiotics and need of hospitalization. Despite the presence of many recent European and western country guidelines, there is a lack of robust data on epidemiology, risk factors, and medical and surgical management of DD, calling the need of further studies aimed to obtain an evidence-based approach in this condition
Why get anxious about the use of proton pump inhibitors: are they just "gastroprotectors"?
No full textThe long-term use of proton pump inhibitors
(PPIs) for the treatment of acid-related disorders
is becoming increasingly common. Although these
drugs are generally considered safe and impro-
perly called “gastro-protectors”, in the last years
several data on their side effects are emerging.
However, data are conflicting and few evidences
on their adverse effects are available. In this re-
view we aimed to analyze the side effects related
to prolonged acid suppression as well as the po-
tential idiosyncrasic diseases induced by PPIs
Upper Gastrointestinal Diseases Before and After Bariatric Surgery.
No full textObesity represents an important risk factor for the development of gastrointestinal (GI) disorders, most notably gastroesophageal
reflux disease (GERD), but also dyspepsia, as well as other symptoms such as nausea, vomiting, and
upper abdominal pain. However, the prevalence of proximal abdominal diseases and their relative complications are difficult
to assess just on clinical evaluation; the presence of motor and endoscopic alterations are often asymptomatic,
probably due to a dysfunction of the autonomic nervous system, which determines an impaired visceral sensation [1,2].
The preoperative GI setting is dramatically changed after bariatric surgery, affecting both gut anatomy and physiology,
and influencing the outcomes of GI diseases
Symptomatic uncomplicated diverticular disease: a critical appraisal
No full textIntroduction:Symptomatic uncomplicated diverticular disease (SUDD) is a clinical condition included in the spectrum of symptomatic diverticular disease. The symptom profile associated with SUDD is highly heterogeneous, as there are currently discordant definitions, that encompass many clinical scenarios.Areas covered:We conducted a narrative review to assess the symptom profile and diagnostic criteria of SUDD based on the available evidence. A thorough literature search was performed on PubMed following the SANRA scale. Abdominal pain, regardless of its duration and location, emerges as the cardinal symptom of SUDD, suggesting that it should be central to its diagnosis. Although abdominal bloating and changes in bowel habits are commonly reported, they do not appear to be specifically attributable to SUDD. Other issues considered are the possible overlap with irritable bowel syndrome and the identification of a subcategory of SUDD patients with chronic symptoms following an episode of acute diverticulitis.Expert opinion: The future agenda should include the development of shared diagnostic criteria for SUDD, including well-defined inclusion and exclusion clinical features and symptom patterns
Role of fiber in symptomatic uncomplicated diverticular disease. A systematic review
Full text linkSymptomatic uncomplicated diverticular disease (SUDD) is a syndrome characterized by recurrent abdominal symptoms in patients with colonic diverticula. There is some evidence that a high-fiber diet or supplemental fibers may reduce symptoms in SUDD patients and a high-fiber diet is commonly suggested for these patients. This systematic review aims to update the evidence on the efficacy of fiber treatment in SUDD, in terms of a reduction in symptoms and the prevention of acute diverticulitis. According to PRISMA, we identified studies on SUDD patients treated with fibers (PubMed and Scopus). The quality of these studies was evaluated by the Jadad scale. The main outcome measures were a reduction of abdominal symptoms and the prevention of acute diverticulitis. Nineteen studies were included, nine with dietary fiber and 10 with supplemental fiber, with a high heterogeneity concerning the quantity and quality of fibers employed. Single studies suggest that
fibers, both dietary and supplemental, could be beneficial in SUDD, even if the quality is very low, with just one study yielding an optimal score. The presence of substantial methodological limitations, the heterogeneity of the therapeutic regimens employed, and the lack of ad hoc designed studies, did not permit a summary of the outcome measure. Thus, the benefit of dietary or supplemental fiber in SUDD patients still needs to be established
Common diagnostic challenges and pitfalls in segmental colitis associated with diverticulosis (SCAD)
Full text linkSegmental colitis associated with diverticulosis (SCAD) is characterized by inflammation involving the sigmoid inter-diverticular mucosa, sparing the proximal colon and rectum. Due to the heterogeneity of clinical manifestations and endoscopic and histological findings, SCAD diagnosis might be challenging in clinical practice. This narrative review aimed to report the SCAD diagnostic criteria adopted in different studies, highlighting the current challenges and main pitfalls in its diagnosis. We analysed fourteen studies, mainly prospective observational studies. Haematochezia and rectal bleeding were the main complaints leading to diagnosis, followed by diarrhoea. An accurate endoscopic description was performed in 86% of studies, while a standardised biopsy sampling protocol (sigma, proximal colon and rectum) was scarcely adopted, being complete only in 28.5% of studies. The evaluation of concomitant drugs potentially inducing colitis was carried out in only 57% of studies. Great heterogeneity in sigmoid endoscopic (edema, erythema, erosions, ulcers, mucosal friability) and histological findings (chronic and/or acute inflammatory infiltrate) was observed. We showed that SCAD diagnosis is often based on not fully adequate macroscopic colonic description and scant biopsy protocol sampling. An accurate clinical and endoscopic evaluation, with an adequate sampling biopsy protocol, with attention to differential diagnosis, seemed to be crucial for a prompt SCAD diagnosis
Upper gastrointestinal symptoms in autoimmune gastritis. A cross-sectional study
Full text linkAutoimmune gastritis is often suspected for its hematologic findings, and rarely the diagnosis is made for the presence of gastrointestinal symptoms. Aims of this cross-sectional study were to assess in a large cohort of patients affected by autoimmune gastritis the occurrence and the pattern of gastrointestinal symptoms and to evaluate whether symptomatic patients are characterized by specific clinical features. Gastrointestinal symptoms of 379 consecutive autoimmune gastritis patients were systematically assessed and classified following Rome III Criteria. Association between symptoms and anemia pattern, positivity to gastric autoantibodies, Helicobacter pylori infection, and concomitant autoimmune disease were evaluated. In total, 70.2% of patients were female, median age 55 years (range 17-83). Pernicious anemia (53.6%), iron deficiency anemia (34.8%), gastric autoantibodies (68.8%), and autoimmune disorders (41.7%) were present. However, 56.7% of patients complained of gastrointestinal symptoms, 69.8% of them had exclusively upper symptoms, 15.8% only lower and 14.4% concomitant upper and lower symptoms. Dyspepsia, subtype postprandial distress syndrome was the most represented, being present in 60.2% of symptomatic patients. Univariate and multivariate analyses showed that age <55 years (OR 1.6 [CI:1-2.5]), absence of smoking habit (OR 2.2 [CI:1.2-4]), and absence of anemia (OR 3.1 [CI:1.5-6.4]) were independent factors associated to dyspepsia. Autoimmune gastritis is associated in almost 60% of cases with gastrointestinal symptoms, in particular dyspepsia. Dyspepsia is strictly related to younger age, no smoking, and absence of anemia. © 2017 the Author(s). Published by Wolters Kluwer Health, Inc
A case of Barrett's oesophagus in pernicious anaemia: acid is not the only culprit!
Full text linkA 46-year-old female presented at our department
with the onset of episodic dyspeptic symptoms,
mainly postprandial fullness and bloating,
as well as paresthesia. A blood test revealed
the presence of mild macrocytic anaemia (haemoglobin
11.3 g/dl; mean corpuscular volume 119
fl), a reduced level of vitamin B12 (60 pmol/l;
normal 200–750 pmol/l), hypergastrinaemia
(1363 pg/ml; normal for female <100 pg/ml), a
low level of pepsinogen I (<2.6 pg/ml; normal
30–100 pg/ml), and positivity for antibodies
against parietal cells (>1:100). The upper endoscopy
showed in oesophagus a single linear erosion
(grade A according to Los Angeles Classification),
with an absence of macroscopic gastric abnormalities.
At histology, mucosal severe atrophy with
moderate intestinal metaplasia was found in fundus
and gastric corpus with spared antrum, in the
absence of Helicobacter pylori infection. A diagnosis
of autoimmune gastritis with pernicious anaemia
was therefore made, and the patient started
vitamin B12 intramuscular injections. Due to the
absence of specific symptoms such as heartburn
and/or regurgitation and to the presence of autoimmune
gastritis, the erosive oesophagitis was not
treated. After 4 weeks of treatment with vitamin
B12, the haemoglobin, mean corpuscular volume
and vitamin B12 values were restored, paresthesia
improved, while dyspepsia remained stable, with
sporadic symptoms about once a week
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