RESUMO
BACKGROUND: Texture and color enhancement imaging (TXI) was recently proposed as a substitute for standard high definition white-light imaging (WLI) to increase lesion detection during colonoscopy. This international, multicenter randomized trial assessed the efficacy of TXI in detection of colorectal neoplasia. METHODS: Consecutive patients aged ≥â40 years undergoing screening, surveillance, or diagnostic colonoscopies at five centers (Italy, Germany, Japan) between September 2021 and May 2022 were enrolled. Patients were randomly assigned (1:1) to TXI or WLI. Primary outcome was adenoma detection rate (ADR). Secondary outcomes were adenomas per colonoscopy (APC) and withdrawal time. Relative risks (RRs) adjusted for age, sex, and colonoscopy indication were calculated. RESULTS: We enrolled 747 patients (mean age 62.3 [SD 9.5] years, 50.2â% male). ADR was significantly higher with TXI (221/375, 58.9â%) vs. WLI (159/372, 42.7â%; adjusted RR 1.38 [95â%CI 1.20-1.59]). This was significant for ≤â5âmm (RR 1.42 [1.16-1.73]) and 6-9âmm (RR 1.36 [1.01-1.83]) adenomas. A higher proportion of polypoid (151/375 [40.3â%] vs. 104/372 [28.0â%]; RR 1.43 [1.17-1.75]) and nonpolypoid (136/375 [36.3â%] vs. 102/372 [27.4â%]; RR 1.30 [1.05-1.61]) adenomas, and proximal (143/375 [38.1â%] vs. 111/372 [29.8â%]; RR 1.28 [1.05-1.57]) and distal (144/375 [38.4â%] vs. 98/372 [26.3â%]; RR 1.46 [1.18-1.80]) lesions were found with TXI. APC was higher with TXI (1.36 [SD 1.79] vs. 0.89 [SD 1.35]; incident rate ratio 1.53 [1.25-1.88]). CONCLUSIONS: TXI increased ADR and APC among patients undergoing colonoscopy for various indications. TXI increased detection of polyps <â10âmm, both in the proximal and distal colon, and may help to improve colonoscopy quality indicators.
Assuntos
Adenoma , Pólipos do Colo , Neoplasias Colorretais , Pólipos , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Colonoscopia/métodos , Pólipos/diagnóstico , Adenoma/diagnóstico por imagem , Adenoma/patologia , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/patologiaRESUMO
AIM: To evaluate a levofloxacin-doxycycline-based triple therapy with or without a susceptibility culture test in non-responders to Helicobacter pylori (H. pylori) eradication. METHODS: A total of 142 (99 women, 43 men; mean 53.0 ± 12.7 years) non-responders to more than two H. pylori eradication therapies underwent susceptibility culture tests or were treated with a seven-day triple therapy consisting of esomeprazole, 20 mg b.i.d., levofloxacin, 500 mg b.i.d., and doxycycline, 100 mg b.i.d., randomly associated with (n = 71) or without (n = 71) Lactobacillus casei DG. H. pylori status was checked in all patients at enrollment and at least 8 wk after the end of therapy. Compliance and tolerability of regimens were also assessed. RESULTS: H. pylori eradication was achieved in < 50% of patients [per prototol (PP) = 49%; intention to treat (ITT) = 46%]. Eradication rate was higher in patients administered probiotics than in those without (PP = 55% vs 43%; ITT = 54% vs 40%). Estimated primary resistance to levofloxacin was 18% and multiple resistance was 31%. Therapy was well tolerated, and side effects were generally mild, with only one patient experiencing severe effects. CONCLUSION: Third-line levofloxacin-doxycycline triple therapy had a low H. pylori eradication efficacy, though the success and tolerability of this treatment may be enhanced with probiotics.
Assuntos
Antibacterianos/administração & dosagem , Doxiciclina/administração & dosagem , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Levofloxacino/administração & dosagem , Adolescente , Adulto , Idoso , Antibacterianos/efeitos adversos , Doxiciclina/efeitos adversos , Esquema de Medicação , Farmacorresistência Bacteriana Múltipla , Quimioterapia Combinada , Esomeprazol/administração & dosagem , Feminino , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Helicobacter pylori/patogenicidade , Humanos , Itália , Lacticaseibacillus casei/crescimento & desenvolvimento , Levofloxacino/efeitos adversos , Masculino , Adesão à Medicação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Probióticos/uso terapêutico , Inibidores da Bomba de Prótons/administração & dosagem , Indução de Remissão , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a useful tool for the diagnosis of suspected abdominal or mediastinal neoplastic lesions. AIM: To evaluate the impact of EUS-FNA and multidisciplinary approach on the diagnostic work-up and therapeutic management of patients with abdominal or mediastinal neoplastic lesions. PATIENTS AND METHODS: One hundred and twenty patients (69 men, median age 65 years) with a suspected abdominal or mediastinal neoplastic mass at computed tomography or MRI underwent EUS-FNA. All EUS-FNA findings and clinical data were evaluated by a multidisciplinary team (oncologists, surgeons, and gastroenterologists). EUS-FNA findings were compared with the final diagnosis made by histological evaluation of the surgical specimen or clinical outcome at follow-up. RESULTS: A correct diagnosis was obtained by EUS-FNA in 96/120 patients (80%), indicating benignancy of the lesion in 21 (18%) cases and confirming malignancy in 75 (62%). On the basis of EUS-FNA findings, chemotherapy was tailored in 57/75 (76%) patients with malignancy whereas the surgical strategy was changed in 21/120 (18%) of patients. Overall, the diagnostic accuracy of EUS-FNA was 85%. A multidisciplinary team approach enabled a correct diagnosis in patients in whom EUS-FNA was nondiagnostic and to identify five cases with false-negative EUS-FNA findings. CONCLUSION: EUS-FNA has a relevant impact on the management of suspected abdominal or mediastinal neoplastic lesions. A multidisciplinary team approach enables to overcome the EUS-FNA methodological limitations. The combination of EUS-FNA and multidisciplinary team approach could help to diagnose and tailor therapeutic options in such patients.
Assuntos
Neoplasias Abdominais/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias do Mediastino/patologia , Equipe de Assistência ao Paciente , Neoplasias Abdominais/diagnóstico por imagem , Neoplasias Abdominais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comportamento Cooperativo , Reações Falso-Negativas , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/terapia , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , PrognósticoRESUMO
The relationship between motility and inflammatory gastrointestinal disorders is at the same time complex and intriguing since these conditions might share some genetic, environmental, immunological and microbial predisposing factors. In addition, significant symptom overlapping may occur, muddling the waters within the clinical context. Although on one hand this represents a challenge for the clinician for a potential under- or over-treatment and diagnostic delay, on the other hand it possibly represents an opportunity for the researcher to better disclose the intimate relationship between chronic (often low-grade) inflammation, motor disorders and deranged sensory function. The best example is probably represented by Crohn's disease and ulcerative colitis. In fact, a number of gastrointestinal motor disorders have been described in association with these diseases, disorders which span from the esophagus to the anorectum, and which will be extensively covered in this review. It is conceivable that at least part of this derangement is strictly related to inflammatory cytokine trafficking and neuromuscular changes; however, given the high prevalence of functional gastrointestinal disorders in the general population, this overlap might also be serendipitous. However, it is worth noting that literature data on this topic are relatively scarce, sometimes quite outdated, and mostly focused on the interplay between irritable bowel syndrome and inflammatory bowel disease. Nevertheless, both researchers and clinicians must be aware that symptoms related to gastrointestinal motility disorders may be highly prevalent in both active and inactive inflammatory bowel disease, correlate with greater psychological comorbidity and poorer quality of life, and may negatively influence the therapeutic approaches.
Assuntos
Gastroenteropatias/etiologia , Motilidade Gastrointestinal , Trato Gastrointestinal/fisiopatologia , Doenças Inflamatórias Intestinais/complicações , Animais , Gastroenteropatias/diagnóstico , Gastroenteropatias/imunologia , Gastroenteropatias/fisiopatologia , Gastroenteropatias/terapia , Trato Gastrointestinal/imunologia , Trato Gastrointestinal/inervação , Humanos , Mediadores da Inflamação/metabolismo , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/imunologia , Doenças Inflamatórias Intestinais/fisiopatologia , Doenças Inflamatórias Intestinais/terapia , Prognóstico , Transdução de SinaisRESUMO
Crohn's disease (CD) is an inflammatory bowel disease whose precise etiology is still unknown, and therefore a causal therapy is not yet available. Studies showing the overexpression of IL-12 and IL-23, polymorphisms in genes encoding those cytokines and their receptors and genome-wide association studies have linked Crohn's pathogenesis with IL-12/23 pathway. Ustekinumab is a novel therapeutic IgG1 kappa monoclonal antibody that modulates Th1 and Th17 function, by blocking the p40 subunit of both IL-12 and IL-23 and preventing the interaction with their receptors on T cells, natural killer cells and antigen-presenting cells with established efficacy in psoriasis. This review will mainly focus on the available evidence on the role of ustekinumab in moderate-to-severe CD. The potential role of this biologic in the armamentarium of CD therapy is discussed.