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Biomedical subjects

F Pace

Publications and source records attributed to F Pace.

At least 37 records · Page 2Linked to original sources
PubMed2000

Review article: is Helicobacter pylori status relevant in the management of GORD?

There is growing interest in the relationship between H. pylori infection and gastro-oesophageal reflux disease (GORD). However, this relationship is complex, as yet not fully elucidated, and probably based on a multiplicity of factors. The prevalence of H. pylori infection in patients with GORD is similar, more often lower than in matched controls. There is a negative correlation between H. pylori infection and the severity of GORD. There are many hypothetical mechanisms by which H. pylori infection may protect from the development of GORD. Conversely, there are many possible mechanisms by which H. pylori infection could theoretically foster the GORD. Patients after H. pylori eradication may develop GORD, and this seems to suggest a protective role of H. pylori infection, but other possible explanations include weight gain after H. pylori eradication, changes in dietary habits and smoking, and pre-existing GORD. H. pylori infected patients treated by various acid-inhibiting therapies such as proton pump inhibitors (PPIs), H2-receptors antagonists (H2-RA) or vagotomy, have an increase of their corpus gastritis severity, both in the activity of inflammation and in the density of organisms. Long-term therapy of GORD in H. pylori infected may lead to rapid progression of atrophic gastritis intestinal metaplasia and dysplasia, and increase the risk of developing gastric cancer. More recently it has been shown that H. pylori infection may interfere with the acid suppressive therapies used for treating GORD. In our opinion the progression of gastritis depends on the threshold of acid output at which H. pylori can 'flourish'. Recently interest is growing on gastric transitional zones and Helicobacter ecology. Any decrease of acid secretion changes the behaviour of H. pylori: the activity of gastritis improves in the antrum, but it deteriorates in the body. During proton pump inhibitor treatment, H. pylori redistribution occurs within the stomach, from an antral to a corpus or fundus prevalent pattern; corpus-fundus gastritis, exacerbated by PPI therapy, may result both in a diminished acid secretion and gastro-oesophageal reflux. The interest in Barrett's oesophagus is growing due to the associated risk of adenocarcinoma. The literature seems to demonstrate that the prevalence of H. pylori infection of the stomach in Barrett's oesophagus patients is not different from that exhibited by controls, roughly one-third of the subjects. Intestinal metaplasia of the gastric cardia seems to be equally frequent in patients with and without GORD. Finally, it appears unlikely that a causal relationship exists between H. pylori infection and Barrett's-associated adenocarcinoma.

Animals↗
PubMed2000

Should we eradicate Helicobacter pylori in patients with recurrent gastro-oesophageal reflux disease?

The 1998 Guidelines of the American College of Gastroenterology recommend that diagnostic testing for Helicobacter pylori infection should only be performed if treatment is intended, and that testing for H. pylori is not indicated in patients on long-term treatment with a proton pump inhibitor (PPI) for gastro-oesophageal reflux disease (GORD). Moreover, a recent evidence-based workshop evaluating major clinical strategies for the management of GORD reported, with an 'A' category (maximum of evidence), that eradication of H. pylori does not heal or prevent relapse of GORD. In detail, it seems that H. pylori infection per se has no effect on the pathogenic mechanisms determining either reflux or its complications. The relationship between H. pylori and oesophagitis is mediated by the effect of H. pylori on gastric acid secretion; in particular, by the proximal extension of gastritis and related impairment of gastric secretory function. In general, if the corpus is infected, the amount of acid available for reflux is less and the probability of excessive oesophageal acid exposure leading to oesophagitis reduced. However, the clinical relevance of corpus H. pylori infection as a biological antisecretory agent (and of H. pylori eradication) seems small or absent, at least in the long run. Conversely, the previous claim of an increased risk of atrophic gastritis in H. pylori-infected patients treated long term with PPI drugs appears not to be confirmed by subsequent studies. In conclusion, H. pylori infection may, in some circumstances, be moderately favourable and, in other circumstances, it may be neutral, with respect to the management of GORD.

Esophagitis↗
PubMed2000

Prevalence and clinical features of heterotopic gastric mucosa in the upper oesophagus (inlet patch).

AIM: To determine the prevalence of heterotopic gastric mucosa in the upper oesophagus (inlet patch) and the factors that may influence its finding. To study its macroscopic and microscopic characteristics and its relationship with symptoms and oesophago-gastroduodenal diseases. PATIENTS AND METHODS: The study was carried out in two different prospective series of consecutive patients undergoing oesophagogastroduodenoscopy. The first 791 patients were examined by one medical practitioner who was aware of the existence of inlet patch entity and aimed to evaluate the prevalence of inlet patch. The second series of 687 patients was examined by another investigator who was aware of the existence of inlet patch entity and who was requested to refer all patients with inlet patch, but he was unaware of the existence of a study aimed at evaluating the prevalence of inlet patch. The heterotopic gastric mucosal patches identified in the upper oesophagus were photographed, biopsied and analysed according to the Sydney system score. RESULTS: The presence of an inlet patch was found in 0.29% (operator unaware) and 2.27% (operator aware) of prospectively evaluated patients. Inlet patches appeared as single areas in 12 patients, as twin areas in five, and as multiple areas in one patient. Their diameters ranged approximately from 3 to 25 mm. The average age of the patients (13 men) was 52.5 +/- 16.8 years. Five patients had an active or healed peptic ulcer and only one patient had reflux oesophagitis. Dysphagia or throat discomfort/heartburn represented the symptoms leading to upper endoscopy in only one patient. Six of seven patients with Helicobacter pylori infection in the stomach also presented the infection in the heterotopic gastric mucosa. CONCLUSION: Heterotopic gastric mucosa in the upper oesophagus is not a rare condition. The frequency with which this condition is found during routine endoscopic examination is likely due to the reduced awareness of the examiner. The presence of inlet patches is scarcely correlated with specific symptoms and the patches are often infected by H. pylori, in patients with H. pylori positive gastritis.

Adult↗
PubMed2000

Nongastrointestinal disorders in the irritable bowel syndrome.

A large proportion of irritable bowel syndrome (IBS) patients also complain of other functional disorders, such as headache, noncardiac chest pain, low back pain, and dysuria. Some of these features, particularly headache, may have a negative influence on the outcome of IBS. In a large proportion of female IBS patients, sexual intercourse triggers the symptoms, and frequently IBS symptoms exacerbate during menses. These gynecological-type symptoms often mislead the patients to the gynecological clinic, which may imply unnecessary investigations and inappropriate treatments. The diagnostic criteria of the fibromyalgia syndrome include IBS, and hence, the apparent relationship of both syndromes is difficult to analyze. On the other hand, no convincing evidence has been produced to date to sustain an association between IBS and the chronic fatigue syndrome.

Adult↗
PubMed2000

Sonography of lacrimal glands in Sjögren syndrome.

This study evaluates the potential role of high resolution sonography and color Doppler sonography in the evaluation of the lacrimal glands in Sjögren syndrome. We examined 15 women (age range, 52-73 years) affected by Sjogren syndrome and 15 women with no history and signs of lacrimal disease (age range, 47-75 years). The lacrimal glands were visualized bilaterally in 6 of 15 patients. The lacrimal artery was detectable in all patients; the resistive index was higher than normal (0.72+/-0.04). An abnormal Schirmer test was present in six of six patients with visible glands and in two of nine patients with invisible glands; xerophthalmia was present in six of six patients with visible glands and in four of nine patients with invisible glands; high levels of serum immunoglobulins were present in six of six patients with visible glands and in three of nine patients with invisible glands. Sonography is able to provide noninvasively much of the information needed by the clinician.

Aged↗
PubMed1999

Retinopathy in systemic lupus erythematosus: pathogenesis and approach to therapy.

The starting point in the assessment of SLE-retinopathy is the clinical examination by ophthalmoscopy and retinal fluorescein angiography. It is noted that two major clinical forms of retinopathy may occur in SLE; (1st) the "classic" type characterized by cotton-wool spots with or without intraretinal hemorrhages, and (2nd) the thrombosis of larger retinal blood vessels, such as central or branch arteries/veins. However, a well-defined pathogenetic classification of SLE-retinopathy has still not been proposed as yet. A practical classification based on the pathogenesis could be of aid to commence a more appropriate treatment. The aims of this paper are; (1st) to focus on the most implicate mechanisms of retinal vascular disease in SLE, (2nd) to mention the most common features associated with the different forms of retinopathy, and finally (3rd) to assess the prevalence of retinopathy in SLE. In our opinion, it seems that two major types of retinopathy exist in SLE: firstly, the Hughes' retinopathy due to antiphospholipid-induced retinal vascular thrombosis, for which anticoagulation is the best treatment, and secondly, the "classic" retinopathy in which at least two major causes could be associated; vasculitis and accelerated atherosclerosis. In patients with "classic" retinopathy, the most appropriate treatment still needs to be established. If "classic" retinopathy is due to vasculitis, immunosuppressive drugs should be administered, while if atherosclerosis play an etiologic role, a prophylaxis with antioxidants or the use of low-dose aspirin should be assessed.

Adolescent↗
PubMed1999

Gastroesophageal reflux: the features in elderly patients.

AIM:To compare the features of gastroesophageal reflux disease between elderly and younger patients.METHODS:Twenty-four hour pH-monitoring and endoscopy were performed for the 66 elderly patients with typical gastroesophageal reflux symptoms, and the results were compared with 112 symptomatic younger patients.RESULTS:The results of 24-h pH-monitoring and endoscopy showed that the elderly patients had pathological reflux and reflux esophagitis more frequently than the younger patients. Percentage time with pH < 4 in elderly patients with reflux esophagitis was 32.5% in 24 hours, as compared with 12.9%in the younger patients with reflux esophagitis (P < 0.05). The elderly patients with reflux esophagitis have longer periods of acid reflux in both upright and supine-positions than the younger patients. Endoscopy showed that 20.8% of elderly patients had grade III/IV esophagitis, whereas only 3.4% of younger patients had grade III/IV esophagitis (P <0.002). Percentages of grades I/IIesophagitis in the two groups were 12.5% and 26.5%, respectively (P <0.002).CONCLUSION: Elderly patients, as compared with younger patients, have more severe gastroesophageal reflux and esophageal lesions. The incompetence of lower esophageal sphincter and the presence of hiatal hernia may be important factors leading to the difference in incidence and severity of reflux esoph agitis between elderly and younger patients.

Journal Article↗
PubMed1998

Pathogenetic factors affecting gastroesophageal reflux in patients with esophagitis and concomitant duodenal ulcer: a multivariate analysis.

AIM:To assess the relationship between gastric acid output (GAO) and both pattern of gastroesophageal reflux (GER) and esophageal lesions,and to evaluate the role of GAO and other potential pathogenetic factors in the development of esophagitis.METHODS:Gastric acid secretory testing and 24h intraesophageal pH monitoring were performed in 31 patients with esophagitis and concomitant duodenal ulcer (E+DU) and compared with those of 72 patients with esophagitis (E) alone.RESULTS: The GAO in patients with E+DU was significantly higher than in patients with E (P <0.05). There was no significant difference between the two groups of patients as to endoscopicl findings and parameters of GER (P >0.05). A multiple regression analysis with stepwise deletion showed that the pre-sence of hiatal hernia (HH), GER in upright position and age appeared to correlate significantly with the presence of esophagitis.CONCLUSION:No parallel relationship between GAO and severity of GER or esophageal lesions exists in patients with E+DU, and that GAO is not a major pathogenetic factor in GER disease.

Journal Article↗
PubMed1998

Gastro-oesophageal reflux and Helicobacter pylori.

The nature of the relationship between Helicobacter pylori infection and reflux oesophagitis is still not completely understood. To review the available evidence from the literature concerning the relationship between Helicobacter pylori infection and reflux oesophagitis with or without Barrett's metaplasia, we performed a Medline search to discover all published reports available in this field since the first description of Helicobacter pylori (1984) to April 1998. A total of 37 papers were found addressing the issue. From the available data, it can be concluded that Hp infection has probably only a minor protective role against the development of reflux oesophagitis. The related mechanisms are, however, still to be clarified. The presence of Helicobacter pylori infection is also likely to increase the efficacy of PPI drugs and, conversely, the eradication of the bacterium decreases the drug effect. The bacterial production of ammonia is the most likely factor explaining this observation. Furthermore, it is now sufficiently clear that patients placed on long-term PPI therapy develop atrophic gastritis only if Helicobacter pylori infection is not eradicated. Finally, both the development of metaplastic changes and the progression to severe dysplasia and adenocarcinoma in Barrett's oesophagus patients are phenomena not related to the presence of Helicobacter pylori antral or oesophageal colonization.

Adenocarcinoma↗
PubMed1998

Audit of reflux oesophagitis at 4 years.

BACKGROUND: Data on the natural history of reflux oesophagitis are few and conflicting: it is not clear whether in the long-term, patients still require therapy for controlling symptoms and preventing endoscopic relapse. AIMS: To assess, in reflux oesophagitis patients followed up for a median period of 4 years: a) clinical conditions throughout follow-up period (i.e., frequency of relapses, need and type of treatment, satisfaction with therapy; b) present state, including quality of life, mode of treatment, presence of residual symptoms or invalidity. PATIENTS: A series of 288 consecutive outpatients, diagnosed as having reflux oesophagitis during the period 1986-1990, and followed up for at least 48 months. METHODS: The study was carried out in two parts. The first, retrospective, assessing the outcome throughout follow-up during which it was suggested that patients assume a maintenance therapy with H2-receptor antagonists, proton pump inhibitors or other drugs for the first year, and to continue only if desired. Patients returned for follow-up every six months, and endoscopy was repeated after the first year or in the case of symptom recurrence. In the second part, after a median follow-up of 4 years, patients were submitted to a telephone interview by means of a structured questionnaire, assessing type and severity of current symptoms (if any), type of current therapy, degree of satisfaction with treatment, and overall evaluation of quality of life. RESULTS: Data are available from 132 patients (M/F = 85/47) of whom 119 (90%) were still on treatment and 31% still presented symptoms. During follow-up, 21% had more than 3 endoscopic relapses, 23% between 2 and 3, 28% one, and 28% zero, respectively and 79% were still adopting non-pharmacological measures (diet, posture, etc.). Only two (1.5%) had been submitted to surgery to control untractable symptoms/mucosal lesions. Finally, 64% and 11%, respectively, considered the present quality of life as good or excellent. CONCLUSIONS: Contrary to many reports, the prognosis of reflux oesophagitis is not favourable showing a marked trend to chronicity; the disease leads to almost continuous drug assumption for symptom control, and is associated with a high relapse risk after treatment withdrawal. Despite (or due to) these unfavourable features, patient compliance to both pharmacological and non-pharmacological therapy is excellent and, correspondingly, also the quality of life is acceptable or improved.

Adult↗
PubMed1997

Gastro-oesophageal reflux disease: medical or surgical treatment? Report of an interactive workshop.

Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper.

Barrett Esophagus↗
PubMed1997

Short and long latency cortical potentials evoked by electrical stimulation of the oesophageal mucosa in normal alert humans.

Cerebral responses from the oesophagus were investigated in 16 normal male and female volunteers ranging in age from 20 to 54 years. The stimulus was applied by a naso-oesophageal probe equipped with bipolar ring electrodes. Short and long latency EP (SLEP and LLEP) were observed in all the subjects examined. SLEP consisted in a low threshold potential of 30 to 70 microV amplitude, biphasic or triphasic in shape and of approximately 5 to 10 ms duration; mean latency at the largest peak was 4.5 +/- 1.7 at 25 cm from the nostrils. Early components at about 2.5-3.5 ms and of small amplitude are also present. Recording from the neck at C7 with a common non-cephalic reference, SLEP components occurred from 2 to 6 ms earlier than that from the scalp, suggesting an oligo-synaptic transmission of the excitement via ganglion and lemniscal pathways to the cortex. SLEP was always followed by a complex potential formed of a succession of negative and positive waves with latencies ranging from 20 to 300 ms: the LLEP. This LLEP was usually not very stable and reproducible during the course of successive recordings and in the same subject because it tended to adjust. Preliminary observations concerning the topographical cortical distribution of oesophageal evoked potentials show a circumscribed localization of the SLEP in the parieto-temporal region of the hemisphere whereas LLEP was more widespread. It is the authors' opinion that oesophageal evoked potentials are generated both by the excitation of myelinic fibres with a wide range of conduction speed and of amyelinic fibres from the oesophageal mucosa and the paraoesophageal peripheral nerves of vagal origin.

Adult↗