Long-term treatment with mesalazine in patients with symptomatic uncomplicated diverticular disease.

The aim of this work was to compare the recurrence of diverticulitis during a 5-year follow-up in a population of patients affected by symptomatic uncomplicated diverticular disease (SUDD), taking either 800 mg of mesalamine b.i.d for 10 days every month or no 5-ASA. Sixty-seven consecutive patients affected by SUDD followed-up every 6 months for 5 years. All patients in this group (M-group) were requested to consume mesalamine 800 mg b.i.d for 10 days every month. A control group (C-group) of 82 subjects with SUDD allocated in an institution for the elderly and taking no 5-ASA medications was also followed-up for the same period. As a result in the M-group 14.9% of patients did not complete the follow-up, and diverticulitis developed in two patients (4%; 95% CI 1.1-13.5). In the C-group 6.1% patients did not complete the follow-up, and diverticulitis developed in 8 patients (10.4%; 95% CI 5.4-19.2). The difference between the two groups was not significant (difference = -6.4%; 95% CI -15.6 to 4.3; log rank test: p = 0.1256). Cyclic treatment with mesalazine seems to be clinical, although not statistically effective in reducing the incidence of diverticulitis. In future well-designed RCTs are necessary to demonstrate the therapeutic gain of the use of mesalazine, if any, in the management of patients with SUDD.

Helicobacter pylori eradication: are we really all equal? A controlled study in native and immigrant population.

Italy's shift to a tertiary economy has modified the working market, concentrating demand also on unqualified one, which includes most immigrants. It is also well established that low socio-economical conditions are associated with an increased prevalence of H. pylori infection. The aims of this study were to compare: (1) the efficacy of a 7 days triple therapy in immigrant and in Italian patients; (2) the prevalence of PUD between these two groups of patients. A total of 116 consecutive immigrant and 112 Italian H. pylori infected patients were recruited between 2007 and 2008. Patients underwent (13)C-UBT, endoscopy with biopsies, and were offered a 7-day triple therapy. Eradication rate (ER) was assessed 8 weeks after the end of the treatment using (13)C-UBT. The two populations differed for median age (p < 0.01), prevalence of PUD (p < 0.01), and smoking status (p < 0.01). The ER according to the ITT analysis was 70% for Italian and 48.3% for immigrant (p < 0.01). Multivariate analysis including country of origin, sex, age, PUD, smoking, and alcohol status found that immigrant had an adjusted OR for not eradicating of 2.14 (p = 0.03). In immigrant patients resident in Italy, performance of triple therapy was lower than expected. Further studies are demanded to confirm and clarify these intriguing results.

Quantification of serum levels of pepsinogens and gastrin to assess eradication of Helicobacter pylori.

BACKGROUND & AIMS: We investigated whether serum levels of pepsinogen (sPG)I and sPGII, the ratio of sPGI to sPGII, or serum levels of gastrin-17 (sG17), can be used to assess eradication of Helicobacter Pylori 8 weeks after treatment. METHODS: We performed a prospective study of 228 consecutive patients with H pylori infections. At the start of the trial (baseline), patients were assessed using the (13)C-urea breath test ((13)C-UBT) and endoscopy, and serum levels of pepsinogens and gastrin levels were measured. Patients were offered a 7-day triple therapy and asked to return 8 weeks after treatment for another (13)C-UBT and measurements of serum levels of sG17, sPGI, and sPGII (175 patients completed the study). RESULTS: The eradication rate of H pylori was 67%. Percentage variation in levels of sPGI and sPGII, the ratio of sPGI to sPGII, and in levels of sG17 resulted in area under the curve values of 0.858, 0.973, 0.940, and 0.810, respectively, for H pylori eradication. A decrease of 22.7% or greater in the level of sPGII detected H pylori eradication with 100% sensitivity and 96.6% specificity. Spectrum analysis did not identify differences in accuracy. CONCLUSIONS: Percentage variation of sPGII levels 8 weeks after therapy for H pylori infection correlates with eradication. Additional studies are needed to confirm these results.

A validation study of the Italian Short-Form Leeds Dyspepsia Questionnaire.

Assessment of symptoms should be one of the main outcome measures in dyspepsia clinical trials. This requires a reliable, valid and responsive questionnaire that measures the frequency and severity of dyspeptic symptoms. The Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) has been proven to fulfil these criteria in its original version in the English language. The aim of the study was to assess the internal consistency, reliability, validity and responsiveness of the Italian version of the SF-LDQ in primary and secondary care. Unselected primary and secondary care patients completed the Italian version of the SF-LDQ. Test-retest reliability was assessed after 2 days. Validity was measured by comparison with diagnosis made by physicians. Responsiveness was determined before and after treatment for endoscopically proven disease. The SF-LDQ was administered to 311 patients in primary care and 179 in secondary care patients. Internal consistency, as judged by the Cronbach's α, was 0.90. Pearson's correlation coefficient for test-retest reliability was 0.92. The SF-LDQ had a sensitivity of 80% and a specificity of 82%. A highly significant response to change was also observed (p = 0.001). The Italian SF-LDQ is a reliable, valid and responsive self-completed outcome measure for quantifying the frequency and severity of dyspeptic symptoms.