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Biomedical subjects

F Parente

Publications and source records attributed to F Parente.

At least 73 records · Page 4Linked to original sources
PubMed1997

Prevalence of Helicobacter pylori infection and related upper gastrointestinal lesions in patients with inflammatory bowel diseases. A cross-sectional study with matching.

BACKGROUND: Although a reduced prevalence of Helicobacter pylori infection has been observed in inflammatory bowel disease (IBD) patients, the clinical significance of H. pylori infection in this setting remains unknown. The aim of this study was, therefore, to evaluate the prevalence of H. pylori infection in a large series of IBD patients and the frequency of gastroduodenal lesions in those who agreed to undergo upper GI endoscopy. METHODS: Two hundred and sixteen consecutive IBD patients (123 with Crohn's disease (CD) and 93 with ulcerative colitis (UC)) had their anti-H. pylori IgG titres measured. Two hundred and sixteen blood donors matched for age, sex, place of birth in Italy, and socioeconomic status served as controls. All patients were offered the possibility of undergoing endoscopy with antral and corpus biopsies regardless of their H. pylori status. RESULTS: The overall seroprevalence of H. pylori infection was 48% in IBD patients versus 59% in the control group (P < 0.05), with a significantly lower frequency in CD versus UC patients (41% versus 56%). After adjustment for age, education, and socioeconomic status CD remained associated with a significantly lower risk of H. pylori infection. Previous therapy with sulphasalazine but not with 5-aminosalicylic acid or with steroids/immunosuppressants was associated with a reduced risk of H. pylori infection both in CD and UC patients. One hundred and eighty-nine patients (110 with CD and 79 with UC) underwent endoscopy; the prevalence of peptic ulcer was similar in both groups (5.5% in CD and 5.1% in UC patients); however, 11 more CD patients had gastroduodenal ulcers that were interpreted as CD-related; 7 of these patients had never had foregut symptoms. Two CD patients had granulomatous gastritis at histology, and another 16 patients with CD had H. pylori-negative gastritis. CONCLUSIONS: IBD patients have a reduced prevalence of H. pylori infection as compared with matched healthy controls; this appears mostly attributable to a reduced frequency of H. pylori colonization in CD patients. Previous use of sulphasalazine is associated with a reduced risk of infection both in CD and UC patients. Of CD patients 10% have a gastroduodenal localization of their disease, which is often asymptomatic. Of CD patients 15% also have H. pylori-negative gastritis at histology.

Adolescent↗
PubMed1996

Neurocognitive deficits and social functioning in outpatients with schizophrenia.

Previous studies suggest that neurocognitive factors may contribute to the reduced social functioning of patients with schizophrenia. To assess this relationship, we administered a battery of neurocognitive tests and independently assessed symptoms (PANSS) and social functioning (SFS) in 88 stable outpatients with schizophrenia. We found a significant correlation between neurocognitive and social functioning variables. Patients' performance on aphasia, spatial organization and visual spatial tasks was correlated with their competence at activities of daily living, frequency of social activities and total social functioning. Regression analyses of each social functioning scale revealed different symptom and neurocognitive predictors. Patients' overall social functioning was best predicted by a combination of negative symptoms and aphasia. The results support the potential use of interventions to reduce patients' cognitive deficits as a means to improve their social outcomes.

Adult↗
PubMed1996

Comparison of two lansoprazole-antibiotic combinations (amoxycillin or classical triple therapy) for treatment of H. pylori infection in duodenal ulcer patients.

AIM: To compare the eradicating capacity of two different antibiotic-lansoprazole combinations (amoxycillin vs. standard triple therapy) with that of lansoprazole alone in Helicobacter pylori-positive duodenal ulcer patients. METHODS: Ninety-six out-patients with H. pylori-positive duodenal ulcer were randomly assigned to receive one of the following three antiulcer regimens: (1) lansoprazole 30 mg b.d. for 4 weeks plus amoxycillin 1 g t.d.s. during the last 2 weeks; or (2) lansoprazole 30 mg once daily for 4 weeks plus classical triple therapy (tripotassium dicitratobismuthate 240 mg b.d., amoxycillin 1 g t.d.s. and tinidazole 500 mg b.d.) for the last 2 weeks; or (3) lansoprazole 30 mg once daily for 4 weeks. Endoscopy was repeated at the end of treatment and 1 month later. A rapid urease test and histology were used to determine H. pylori status. RESULTS: Duodenal ulcer healing rates at 4 weeks were 96% after both lansoprazole with amoxycillin, and lansoprazole with triple therapy, and 97% after lansoprazole alone. Eradication of H. pylori was significantly better with lansoprazole with triple therapy than with either lansoprazole with amoxycillin or lansoprazole alone (90% vs. 55% vs. 3%, respectively). CONCLUSION: Classical triple therapy combined with lansoprazole is significantly more effective than the lansoprazole with amoxycillin combination for the eradication of H. pylori in duodenal ulcer patients pre-treated with lansoprazole.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1996

Role of Helicobacter pylori in ulcer healing and recurrence of gastric and duodenal ulcers in longterm NSAID users. Response to omeprazole dual therapy.

BACKGROUND: The relation between Helicobacter pylori infection and non-steroidal anti-inflammatory drug (NSAID)-associated peptic ulcers remains unclear; in particular, it is not known whether H pylori plays a part in the healing and recurrence of these ulcers. AIMS: To evaluate prospectively in a consecutive series of arthritis patients receiving longterm NSAID treatment the prevalence of peptic ulcer as well as the effect of H pylori eradication on the healing and recurrence of gastric and duodenal ulcer found. PATIENTS: Some 278 consecutive patients underwent gastroscopy with multiple biopsies of the gastric antrum and corpus for histological examination and rapid urease test. One hundred peptic ulcers (59 gastric ulcers, 39 duodenal ulcers, and two gastric ulcers concomitant with a duodenal ulcer) were found. Seventy per cent of these ulcers were H pylori positive. METHODS: According to their H pylori status, ulcer patients were randomised to one of the following treatments: H pylori negative ulcers received omeprazole 20 mg twice daily for four to eight weeks, whereas H pylori positive lesions were treated with omeprazole 20 mg twice daily plus amoxycillin 1 g twice daily (the second of these for the first two weeks) or omeprazole alone for four to eight weeks while continuing NSAID therapy. Patients with healed ulcers were endoscopically followed up for six months after stopping antiulcer therapy while continuing NSAIDs. RESULTS: Endoscopic healing rates for gastric and duodenal ulcers in the three different groups were similar both at four and eight weeks. H pylori eradication did not influence healing, which occurred in 14 of 20 (70%) of patients in whom H pylori was eradicated, compared with 14 of 17 (82%) of patients with persistent infection. Cumulative recurrence rates at six months did not statistically differ among the three different groups (27% in H pylori negative, 46% in H pylori positive, and 31% in those where H pylori was eradicated during the healing phase), although a numerical trend in favour of a higher recurrence rate in infected patients was evident. CONCLUSIONS: H pylori eradication does not confer any significant advantage on the healing of gastric and duodenal ulcers associated with longterm NSAID use. It remains to be established with certainty whether eradication may be helpful in the reduction of recurrence in a specific subset of NSAID associated ulcer.

Amoxicillin↗
PubMed1996

Prevalence of Helicobacter pylori infection and related gastroduodenal lesions in spouses of Helicobacter pylori positive patients with duodenal ulcer.

BACKGROUND: To date, very few studies have evaluated the risk of infection among spouses of Helicobacter pylori positive patients and their results are conflicting. AIM: To assess the seroprevalence of H pylori infection in spouse of H pylori positive patients with duodenal ulcer as compared with age and sex matched volunteer blood donors, as well as the frequency of endoscopic gastroduodenal lesions in these spouses, according to the presence or absence of gastrointestinal complaints. METHODS: Some 124 spouses (48% males) of patients with duodenal ulcer consecutively seen over a 10 month period were studied. They were all screened for serum IgG anti-H pylori antibodies and asked to complete a questionnaire with particular reference to the presence of chronic or recurrent dyspepsia. Upper gastrointestinal tract endoscopy with antral and corpus biopsy specimens taken for histological examination and urease rapid test was offered to all seropositive spouses. Volunteer blood donors (248), living in Milan and matched for age, sex, north-south origins, and socioeconomic status to the cases, were used as controls. RESULTS: Spouses of patients with duodenal ulcer had a significantly higher seroprevalence of H pylori infection than controls (71% v 58%, p < 0.05); 30 of 88 (34%) H pylori positive spouses complained of dyspeptic symptoms compared with only four of 34 (12%) seronegative spouses (p < 0.02). At endoscopy, H pylori infection was confirmed in 48 of 49 (98%) seropositive spouses. The endoscopic findings in those spouses showed active duodenal ulcer in eight (17%), duodenal scar and cap deformity in two (4%), active gastric ulcer in two (4%), erosive duodenitis in three (6%), antral erosions in two (4%), antral erosions plus duodenitis in one, and peptic oesophagitis in another patient. The prevalence of major endoscopic lesions was significantly higher in symptomatic spouses than in those who had never been symptomatic. CONCLUSIONS: These findings show that being the spouse of an H pylori positive patient with duodenal ulcer may increase the risk of H pylori colonisation and perhaps of peptic ulcer disease, and raises questions as to whether serological screening of cohabiting partners of H pylori positive patients with duodenal ulcer may be indicated.

Adult↗
PubMed1996

Abdominal ultrasound in the assessment of extent and activity of Crohn's disease: clinical significance and implication of bowel wall thickening.

AIMS: The aim of this study was to evaluate the relevance of ultrasound (US) in assessing disease extent and activity in a series of patients with quiescent or active Crohn's disease (CD). In particular, the study was aimed at evaluating whether US may be useful in distinguishing between active disease and bowel wall thickening (BWT) due to fibrosis. PATIENTS AND METHODS: A series of consecutive patients with ileal, ileo-colonic, or colonic CD previously studied with x-ray and/or endoscopy, underwent abdominal US. The following parameters were also determined in these patients: CD activity index (CDAI), erythrocyte sedimentation rate, C reactive protein, length of disease, previous surgical resection, and number of recurrences. The relationship between BWT and the aforesaid parameters was assessed by means of univariate and multiple regression analysis. RESULTS: Overall sensitivity and specificity of US for the assessment of anatomical distribution of CD were 89% and 94%, respectively, and there was also a significant correlation between the extent of ileal disease measured by US and that determined by small bowel x-ray. By univariate analysis, statistically significant correlations were found between BWT, CDAI, and biological indices of inflammation (erythrocyte sedimentation rate and C reactive protein), although all the correlation coefficients were low with values not exceeding 0.40, and among these, backward multiple regression analysis identified only CDAI, along with ileo-colonic localization, as the subset of predictive variables of bowel wall thickness. However, both predictions were rather weak and accounted for only 20% of the variability of the BWT. In addition, a significant relationship was found between disease US extent and clinical or biochemical disease activity. However, in a subgroup of patients characterized by quiescent disease and high BWT, CD was complicated by higher prevalence of strictures, as detected by radiological and endoscopic examinations, and more frequent surgical outcome than others. CONCLUSIONS: Abdominal US is an accurate method for determining the abdominal distribution of CD and appears to be accurate in detecting and evaluating the disease length of ileal lesions. In contrast, despite a weak but significant correlation between BWT and clinical and biochemical parameters, the usefulness of US as an index of disease activity seems to be fairly limited. However, a high BWT in quiescent patients suggests the presence of fibrosis, which is poorly responsive to steroid treatment.

Adult↗
PubMed1995

Nature of non-ulcer dyspepsia and related conditions.

To date, the precise role of Helicobacter pylori in the pathogenesis of NUD remains uncertain. There is some evidence to suggest that the organism is implicated in specific subgroups (mostly the ulcer-like form), but it is not enough for any firm conclusions to be drawn as to the importance of the bacterium as a cause of dyspeptic symptoms or as to the efficacy of anti-infective regimens in the treatment of NUD. Large, well-designed prospective studies with a long-term follow-up are needed to establish which subgroups of dyspeptic patients may benefit most from eradication of H. pylori.

Chronic Disease↗
PubMed1995

The watermelon stomach: clinical, endoscopic, endosonographic, and therapeutic aspects in three cases.

BACKGROUND AND STUDY AIMS: To date, the endosonographic (EUS) appearance of watermelon stomach is unknown, and few reports have described the effectiveness of Nd:YAG lasers in the treatment of this condition. This study reports on the first EUS description of watermelon stomach, as well as the clinical, endoscopic, and EUS response to Nd:YAG laser therapy. PATIENTS AND METHODS: Three patients with watermelon stomach, diagnosed by endoscopy and histology, were studied with EUS before and after Nd:YAG laser treatment. RESULTS: On EUS, a thickened antral wall with a spongy appearance in the second and third layer in the areas of vascular structures was seen in all three cases, whereas the muscularis propria was well preserved. This appearance vanished after complete laser ablation of the lesions. CONCLUSIONS: EUS may be useful in the diagnosis of watermelon stomach, as well as in evaluating the completeness of laser ablation treatment for the condition.

Aged↗
PubMed1995

Behaviour of acid secretion, gastrin release, serum pepsinogen I, and gastric emptying of liquids over six months from eradication of helicobacter pylori in duodenal ulcer patients. A controlled study.

The behaviour of basal and stimulated acid secretion, gastrin release, serum pepsinogen I, and gastric emptying of liquids was studied in 19 consecutive patients with Helicobacter pylori positive duodenal ulcer, over a follow up period of six months. Eleven patients were studied before and at three and six months after eradication with lansoprazole plus amoxicillin and tinidazole (case group), whereas the remainder, with persistent H pylori infection, were studied before and after three and six months from ulcer healing, thus constituting the control group. In the case group, three months after eradication, fasting serum pepsinogen I fell from (mean (SEM)) 91.9 (6.9) (pretreatment) to 72.2 (5.1) ng/l and the integrated gastrin response to a meal reduced from 11,470 (1174) (pretreatment) to 8130 (608) pg/ml/h (p < 0.05). Fasting serum gastrin concentrations and maximal acid output reduced significantly only six months after eradication. In contrast, no significant change of any of these measurements was seen in the control group either at three or six months from healing compared with the pretreatment values. Gastric emptying of liquids did not change over the entire period of follow up in both study groups. In conclusion, eradication of H pylori in duodenal ulcer patients is accompanied by a rapid fall in serum pepsinogen I and plasma gastrin concentrations, whereas a slight but significant reduction of maximal acid secretion takes place later on. In contrast, gastric emptying of liquids does not seem to be influenced by H pylori status.

Adult↗
PubMed1995

Double-blind randomized, multicenter study comparing aluminium phosphate gel with rantitidine in the short-term treatment of duodenal ulcer.

The efficacy and safety of aluminium phosphate and ranitidine in the short-term treatment of duodenal ulcer were compared in a multicenter, randomized, double-blind study. A total of 304 patients with endoscopically proven active duodenal ulcer were recruited: 153 received 11 g of aluminium phosphate gel five times a day (equivalent to a daily acid buffering capacity of 182 mEq/HC1) and 151 rantitidine 300 mg once daily for 6 weeks. At the end of the treatment period, 74 out of 113 patients (65%) treated with aluminium phosphate and 84 out of 105 patients (80%) treated with rantitidine showed ulcer healing at endoscopy (p = 0.02). Ulcer symptoms, identified as frequency and intensity of daytime and nocturnal epigastric pain, were significantly reduced by both treatments, but rantitidine proved more effective than aluminium phosphate in reducing the frequency of daytime pain (p < 0.01) and its severity (p < 0.01); in contrast, no significant differences were found with regard to frequency and severity of nocturnal pain. The incidence of unwanted effects was significantly higher in the aluminium phosphate group. The main adverse event observed was constipation which, however, was hardly ever severe enough to warrant discontinuing treatment.

Administration, Oral↗
PubMed1994

Acid inhibitory characteristics of nizatidine in man: an overview.

The antisecretory activity of nizatidine, an H2-receptor antagonist, has been extensively investigated in man both by quantitative acid secretory tests and by means of 24-h continuous ambulatory pH monitoring. Studies have shown that nizatidine is a potent inhibitor of basal, nocturnal and stimulated acid secretion. Particular modalities of nizatidine administration, such as early evening intake with supper or morning dosing, have been recently defined. Further studies are needed to clarify if rebound nocturnal acid hypersecretion may develop after abrupt withdrawal of nizatidine or if tolerance may develop during prolonged administration.

Circadian Rhythm↗
PubMed1994

Severe abdominal pain in patients with AIDS: frequency, clinical aspects, causes, and outcome.

BACKGROUND: The exact prevalence of abdominal pain in AIDS patients, as well as the entire spectrum of causative disorders, has not yet been well defined. In addition, the existing data derive almost exclusively from surgical series describing only those patients who have undergone emergency surgical procedures. METHODS: We reviewed our experience with patients presenting with severe abdominal pain from a large series of non-selected consecutive AIDS patients seen at our institution over a period of 4 years. RESULTS: Of 458 patients, 71 (15%) had severe abdominal pain, and its occurrence was associated with a reduced patient survival. Specific diagnoses were made premortem in 42 patients (59%), potential causes of pain were identified at postmortem examination in 23 patients (33%), whereas no specific causes were found in 6 patients (8%). Most of the causative disorders (65%) were AIDS-related, whereas HIV-independent pathologic conditions were found in only 18% of the patients. The predominant site of pain, combined with a few key symptoms, had a high predictive diagnostic value in nearly half of the patients. The indications for emergency laparotomy were limited and substantially similar to those of the non-HIV population. CONCLUSIONS: Severe abdominal pain frequently complicates the course of AIDS, and its occurrence is associated with reduced survival. In most patients it is due to disorders closely associated with the HIV infection. Specific causes of pain may be identified in most of the cases by an appropriate diagnostic evaluation.

AIDS-Related Complex↗
PubMed1994

[Pulmonary valve endocarditis caused by Streptococcus bovis].

The authors report a case of isolated infective endocarditis of the pulmonary valve due to Streptococcus bovis in a 62-year-old male presented with delayed fever of unknown origin. There were no predisposing factors such as i.v. drug abuse or congenital heart disease. The clinical course was complicated with an epidose of pulmonary emboli occurring after the onset of treatment. The patient responded to the appropriate antibiotics without requiring valve surgery. The association of Streptococcus bovis endocarditis and bacteremia with colonic neoplasia has been reported in the literature. In this case the evaluation of the colon was negative.

Endocarditis, Bacterial↗
PubMed1994

Prevention of symptomatic recurrences of esophageal candidiasis in AIDS patients after the first episode: a prospective open study.

OBJECTIVES: To evaluate the efficacy and safety of low-dose antifungals as prophylaxis of recurrent esophageal candidiasis after the first episode in patients with AIDS. METHODS: After the first episode of esophageal candidiasis, 122 consecutive AIDS patients were randomly assigned to two different regimens of continuous long-term antifungal prophylaxis (ketoconazole 200 mg or fluconazole 50 mg/day p.o.) or no antifungal therapy over a period of 2 yr. Patients were followed up by monthly clinical controls and upper GI endoscopy in the case of recurrence of esophageal symptoms. RESULTS: One hundred and six patients were clinically evaluable over a mean observation time of 7.5 months. Prophylaxis with oral antifungals significantly reduced symptomatic relapses of esophageal candidiasis, the cumulative probability of relapse at 12 months being 38% in the prophylaxis group, compared with 84% in the untreated group. Both antifungals were sufficiently safe and well tolerated. The clinical response of a second episode of candidiasis to the reintroduction of standard oral antifungals was markedly worse in patients on prophylaxis (especially with ketoconazole) than in untreated patients, presumably due to the development of resistance to the antifungal. CONCLUSIONS: Continuous prophylaxis with both-fluconazole and ketoconazole is effective in preventing recurrences of Candida esophagitis in AIDS patients; however, the possible emergence of strains resistant to these antifungals, as well as the high cost of the therapy, should raise doubts as to whether or not this type of prophylaxis should be extended to all AIDS patients with Candida esophagitis, rather than to limit its use to specific subgroups of patients, such as those with frequent symptomatic relapses.

AIDS-Related Opportunistic Infections↗
PubMed1993

Opportunistic infections of the oesophagus in AIDS patients: clinical and therapeutic problems.

The gastrointestinal tract is frequently involved in the acquired immunodeficiency syndrome. One of the most common digestive manifestations is dysphagia/odynophagia which constitutes the presenting feature of the syndrome in a number of patients and occurs in many others during the subsequent phases of the illness. In the majority of cases it is due to an oesophageal infection by opportunistic pathogens (fungi or viruses or both) and may be successfully treated, at least temporarily, by specific antimicrobials. The present article examines the most recent acquisitions in terms of diagnosis and treatment of such common clinical problem.

AIDS-Related Opportunistic Infections↗