1,721,107 research outputs found
Proactive Measures Aimed at Improving Appropriateness of Use of Proton Pump Inhibitors in Clinical Practice
No full textComment on "impairment of chemical clearance is relevant to the pathogenesis of refractory reflux oesophagitis" by Marzio Frazzoni et al. [Digestive and Liver Disease 2014;46:596-602].
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Anti-TNF Antibodies For Prevention of Crohn's Disease Recurrence After Surgery: More Than An Hope.
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Comment on "Impairment of chemical clearance is relevant to the pathogenesis of refractory reflux oesophagitis" by Marzio Frazzoni et al. [Digestive and Liver Disease 2014;46:596-602]
No full textWe read with great interest the paper by Frazzoni et al. [1] on the role of chemical clearance in the pathogenesis of proton pump inhibitor (PPI)-refractory reflux oesophagitis (RRO). Indeed, the authors using the state-of-the-art technique to assess gastroesophageal reflux, that is impedance-pH monitoring, investigated 29 patients with RRO, 18 with healed oesophagitis (HRO) and 49 with well-defined non-erosive reflux disease (NERD) according to the more recent guidelines [2] and [3], and found that gastric acid exposure time, oesophageal acid exposure time, the number of total, acid and weakly acidic refluxes, bolus exposure and clearance time did not differ among RRO, HRO, and NERD patients. Moreover, they observed that only a new impedance parameter, the postreflux swallow-induced peristaltic wave (PSPW) index, was significantly lower in RRO patients than in either HRO or NERD patients. This data emphasized that impairment of chemical clearance is relevant to the pathogenesis of RRO.
We congratulate with the authors as they provide novel insights in the PPI-resistance area, which represents one the most important challenges in our clinical practice. Moreover, they provide convincing data on a further important topic, that is the diagnosis and classification of NERD patients [4] and [5]. However, although this study is very accurate and clear, some data were not reported. Indeed, data on mean acid clearance time (MACT) in the different groups of studied patients are lacking. MACT reflects the ability of the oesophagus to clear its content after multiple acidic reflux events have occurred and, thus, its value may be associated to that of PSPW, although its significance is limited to the evaluation of acidic refluxate. Moreover, information on manometric patterns (i.e. frequency of ineffective oesophageal motility) are lacking and should be provided given the suggested importance of chemical clearance and therefore of peristalsis integrity in RRO patients. Thus, are the data regarding the MACTs and manometric patterns in the different groups available for comparison in order to corroborate the novel findings observed by the authors
Anti-Tumor Necrosis Factor Antibodies for Prevention of Crohn's Disease Recurrence After Surgery: More Than a Hope
No full textWe have read with interest the article by Sartor1 illustrating the different options to improve our current management of postoperative recurrence of Crohn’s disease (CD). Sartor1 reported that to date only anti–tumor
necrosis factor (TNF) antibodies, 6-mercaptopurine/ azathioprine, and 3-month administration of metronidazole or ornidazole have shown promising effects.2 In particular, Sartor1 underlined that data on anti-TNF antibody efficacy is based only on a small pilot study reporting extremely impressive results of infliximab,3 with a large multicenter international study to be reported soon.
However, we believe that not all the data available in the literature have been quoted and information on antiTNF antibody effectiveness has been largely underestimated. Indeed, in 2014 Regueiro et al4 published the
continuation of their previous randomized, 2-armed trial (infliximab vs placebo) and they found in an open-label study that patients on long-term infliximab therapy, irrespective of original assignment to infliximab or placebo, presented with a higher rate of endoscopic remission and a lower rate of surgical recurrence compared with other patients during a 5-year follow-up period. In 2013, after our first experience reported in a case series,5 we provided evidence of a similar great result achievable with adalimumab, administered within 4 weeks after resective surgery for CD. In our randomized, 3-armed, 2-year, follow-up study we observed that only
1 patient (6.3%) of the 16 patients in the Adalimumab treatment group had endoscopic recurrence, compared with 11 of 17 patients (64.7%) in the azathioprine group and 15 of 18 patients (83.3%) in the mesalamine group.6 Moreover, similar results were obtained in terms of clinical and radiologic recurrence at 1 and 2 years. Thus, we provide additional strong data confirming that starting anti-TNFa immediately after surgery or shortly
after endoscopic recurrence provides a low recurrence rate in the long term.
These data corroborate the findings already published in retrospective or open-label studies and emphasize that starting anti-TNFa drugs immediately or shortly after surgery, in particular in patients with risk factors for disease recurrence and additional surgery, represents a valid and effective approach for preventing postsurgical CD recurrence, although further data and cost-related analysis are needed
Refractoriness to Treatment Suggests That Clinical Evaluation Should Go Beyond the Diagnosis of Reflux Disease
No full textApplicability of Parameters for the Non-Invasive Diagnosis of Esophageal Varices Needing Treatment to Cured HCV Patients
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