Evaluation of Antibiotic Resistance of Helicobacter pylori Strains Isolated in Bari, Southern Italy, in 2017-2018 by Phenotypic and Genotyping Methods.

Objective: Helicobacter pylori antibiotic resistance is a constantly evolving process and local surveillance is warranted to guide clinicians in the choice of therapy. Materials and Methods: Antibiotic susceptibility testing was performed by E-test on 92 H. pylori strains, and resistance to clarithromycin and levofloxacin was also evaluated using a commercially available genotyping method. Results: In naïve patients the resistance to clarithromycin, levofloxacin, and metronidazole was 37.7%, 26.2%, and 16.4%, respectively, significantly lower than the percentage found in treated patients. Concomitant resistance to ≥2 antibiotics was also observed in naïve patients. The A2143G mutation of the 23S-rRNA gene was the most frequently detected, also in naïve patients. The highest minimum inhibitory concentration (MIC)50 value (256 mg/L) was associated with A2142 mutations in all the patients carrying them. For levofloxacin resistance a mutation in codon 87 was detected in 63.9% and in codon 91 in 36.1% of the H. pylori strains, without significant differences in the patients groups. A mutation in codon 87 was associated with the highest MIC50 value (32 mg/L). Conclusions: In our area, a high prevalence of H. pylori primary resistance was detected; these rates were higher in patients who had experienced failure of several courses of therapy. A better knowledge of the local epidemiology of resistance, and the genotypes responsible, will improve the H. pylori eradication rates.

Administration Timing Is the Best Clinical Outcome Predictor for Adalimumab Administration in Crohn's Disease.

Biological intervention for Crohn's Disease (CDs) patients, mainly using anti-TNF antibodies, is often an efficient therapeutic solution. Nonetheless, data defining the administration timing to maximize the chances of clinical remission are lacking. The objective of this "real-life" retrospective study was to evaluate if early Adalimumab (ADA) administration (<12 months) was an efficient strategy to improve patients' clinical outcome. This single center study included 157 CD patients, of which 80 received the first ADA administration within the first 12 months from the diagnosis. After 1 year of therapy, clinical remission was observed in 50.32% of patients, mucosal healing in 37.58%. Clinical remission was observed in 66.25% of the early ADA administration patients vs. 33.77% of the late (>12 months) (p < 0.001); mucosal healing was observed in 53.75% of the early vs. 20.78% of the late (p < 0.001). Dose escalation was required for 30.00% of the early vs. 66.23% of the late (<0.01). In the early ADA administration group, 7.50% patients were considered non-responders at the end of the follow-up vs. 22.08% patients in the late administration group. These findings highlighted that early ADA administration (within 1 year of diagnosis) improves the clinical response and mucosal healing, and reduces the loss of response rate and need for dose escalation.

A case report of esophageal actinomycosis in an immunocompetent patient and review of the literature.

Actinomycosis is a rare, chronic and slowly progressive granulomatous disease caused by Actinomyces spp., a Gram-positive anaerobic bacterium that rarely affects the esophagus. Although this infection is uncommon, it has been reported in both immunocompromised and immunocompetent individuals. The infection is often misdiagnosed because it can mimic other pathological conditions (like neoplasms and candidiasis), and Actinomyces is difficult to isolate because it requires specific growth conditions. However, actinomycosis has a favorable course if the microbiological diagnosis is timely. We report a case of esophageal actinomycosis in an immunocompetent 23-year-old man. The patient was admitted with symptoms of gastro-esophageal reflux disease (GERD), that had subsequently worsened. Histological and microbiological investigations revealed the presence of Actinomyces spp. A review of the literature regarding the clinical features, diagnosis, and management of this infection is also discussed.

Approach of primary care physicians to hepatitis C: an educational survey from a Southern Italian area.

OBJECTIVES: To assess knowledge, attitudes and practices towards hepatitis C of primary care physicians (PCPs) working in a Southern Italian area. METHODS: A questionnaire exploring the basic knowledge on risk factors and the management of hepatitis C virus infection was administered in two occasions to a sample of PCPs before and 2 months later the presentation of the EASL guidelines on the management of HCV infection. RESULTS: At the first survey, drug addiction, transfusion in 1982 and sexual contact with multiple partners were listed as the most common risk factors for acquiring HCV infection. As many as 27% of PCPs believed that blood transfusion after 1994 was still an important risk factor for this infection. Only 38% of PCPs would refer HCV positive subject with abnormal ALT levels to a gastroenterologist. Some points showed a definite improvement when first and second survey were compared: the more frequent use of qualitative instead of quantitative HCV-RNA testing for diagnostic purpose and the selection of IFN plus ribavirin as the regimen of choice for active disease. CONCLUSIONS: The general practice management of hepatitis C may be improved using educational activities involving directly and interactively PCPs.

The treatment of chronic hepatitis C not responding to interferon.

Approximately 60% of all patients with chronic hepatitis C (C-HCV) treated with standard interferon (IFN) treatment, i.e. combination of recombinant alpha IFN and ribavirin (RBV), are refractory to treatment. Many factors should be responsible for HCV persistence after antiviral treatment. Beside the well-known importance of some factors such as viral heterogeneity, co-infections with Hepatitis B Virus (HBV) or Human Immunodeficiency Virus (HIV), presence or absence of fibrosis, age, sex, iron overload, a greater attention is being paid to the study of viral kinetics. Observing the trend of the slope of viral decline, already after a few hours antiviral administration, it is possible to predict the sustained virologic response and therefore to optimize therapy. As for alternative therapeutics, re-treatment with IFN alone was excluded considering the very disappointing results, whereas it seemed that the combination IFN plus RBV could recover up to 30% of the patients. Later both randomized trials and two metanalyses have demonstrated that this option is disadvantageous from the cost-effectiveness point of view since 14 patients need to be treated to obtain one responsive. The treatment combining IFN plus RBV and amantadine seems more promising. Recently trials with pegylated IFN have started with the aim to increase the therapeutical response in this category of HCV-positive patients.