[Gastric MALT lymphoma and Helicobacter pylori]. / MALT-linfoma gastrico ed Helicobacter-pylori.

Aim of this paper is to evaluate the effects of eradicating Helicobacter pylori (Hp) on the course of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. A total of 13 consecutive patients, 7 males and 6 females (median age 54 years) Hp-positive were included, all affected by low-grade B-cell gastric MALT lymphoma, stage I using established criteria; histologic assessment by gastric biopsies was performed. Each patient received anti-Hp therapy with standard protocol for 7 days and underwent endoscopy and histology every 3-6 months. Complete eradication was obtained in all patients (100%); on histology 9 patients showed complete regression, but in one of these lymphoma relapsing after 12 months was observed. Our findings confirm recent cooperative reports of Hp eradication rate and regression of gastric tumour (about 70%). In conclusion, the indolent clinical course of the disease justifies a first-line conservative approach with Hp eradication therapy.

[The duodenum and non-steroidal anti-inflammatory agents]. / Duodeno e farmaci anti-infiammatori non steroidei.

We have carried out a longitudinal study in order to confirm our preliminary data on the heavier involvement of the duodenum compared to the stomach after non aspirin non-steroidal anti-inflammatory drugs (NSAIDs). 53 patients with upper digestive haemorrhage due to recent intake of NSAIDs without preexisting known peptic pathology -28 p. from aspirin and 25 p. from NSAIDs other than aspirin--were selected. Aspirin and its derivatives mainly affected gastric mucosa whereas non aspirin NSAIDs the duodenum. 42 of these patients have been observed for two more years; independently of the treatment, ranitidine 150 mg daily vs antacids if needed, the annual rate of recurrence has been very low. These findings have further confirmed the accurate selection of our patients without previous peptic pathology (in this case the rate of recurrence would have been much higher) and also suggest a more rational diagnostic and therapeutic approach to these patients. We then observed a consecutive series of 107 patients affected with duodenal ulcer bleeding: 51 by NSAIDs and 56 not by NSAIDs; both groups were given H2-antagonists and blood transfusions if needed. The short term prognosis has been rather positive mainly for the NSAIDs group, in which no mortality has been observed, independently of the number of blood transfusions and length of hospitalization. In our experience the high percentage of NSAIDs duodenal ulcers (about 50%), shows an increase of this pathology, less severe than peptic one, even if expressed by a serious event as digestive bleeding. It is our opinion that these percentages and prognostic evaluations should be considered in therapeutic decision, limiting thus surgical and aggressive endoscopic procedures.

Epidemiological study of duodenal erosive disease; its prevalence and nosological position in relation to ulcerative peptic disease.

The prevalence of erosive lesions was found to be 27.5% in 11838 cases examined during the last 10 years. In almost 66% of the cases, erosive lesions were localized in the duodenal bulb but mainly isolated and less often in the antro-pyloric area. In 55% of the cases, duodenal erosions coexist with ulcerative peptic disease, 20% in "active" phase and 35% in "inactive" phase. Erosive lesions, appeared autonomously in 45% of the cases. Morphologically, they can be divided in: a) periulcerative marginal erosions closely connected with activity of the ulcers; b) clustered, complete or incomplete erosions, which may or may not be associated with the ulcerative disease and often have a prolonged acyclic behaviour; c) scattered flat erosions which can at times be associated with the ulcerative peptic disease but are always related to a chronic widespread duodenitis. An epidemiological study was performed on 564 cases which were divided into 3 groups: a) cases with autonomous erosive disease; b) those with erosions associated with post-ulcerative scars; and c) those with erosions associated with active ulcers. The control group of 111 cases was characterised by duodenal active ulcers with no erosions. Statistical evaluation of the percentage differences between the 4 groups revealed that in duodenal erosive disease predisposing factors such as psychic temper, environmental and work conditions and eating habits are evident. In autonomous disease drug intake and spices and, to a less extent, alcohol and/or stress situations play a more important role. In erosions associated with an active ulcer, a dominant obsessive temper facilitated by a difficult family situation, bad eating habits and a great amount of smoking are prominent factors.(ABSTRACT TRUNCATED AT 250 WORDS)