Effectiveness of different therapeutic strategies in preventing diverticulitis recurrence.

BACKGROUND: Colonic diverticulitis shows a high recurrence rate. AIMS: To assess the efficacy of three different therapeutic strategies in preventing diverticulitis recurrence. MATERIALS AND METHODS: One hundred thirty patients suffering from Acute Uncomplicated Diverticulitis (AUD) (81 males, 49 females, mean age 64.71 years, range 40-85) were prospectively assessed. After obtaining remission, considered present when both endoscopic and histological damage were absent, the patients were treated with mesalazine 1.6 g/day (59 patients, group A), or rifaximin 800 mg/day for 7 days every month (52 patients, group B). Clinical, endoscopic and histological follow-up was performed after 6, 12 and thereafter every 12 months after diagnosis of AUD. RESULTS: Seven patients were excluded from final evaluation because they were lost to follow-up. Fifty-five group A patients and 49 group B patients patients were available for the final assessment at the end of a 24-month follow-up. Sustained remission was significantly higher in group A with respect to group B. CONCLUSIONS: Patients taking mesalazine have lower risk of diverticulitis recurrence than patients taking rifaximin because of the lower prevalence of persisting endoscopic and histological inflammation.

The endoscopic spectrum of segmental colitis associated with diverticulosis.

OBJECTIVE: An endoscopic classification of 'Segmental colitis associated with diverticulosis' (SCAD) is lacking. Our aim was therefore to assess the endoscopic spectrum of SCAD, comparing it with the histological and clinical features. METHOD: A prospective study was performed from January 2004 to October 2007. Diagnosis of SCAD was made on the basis of specific endoscopic and histological patterns. RESULTS: A total of 6230 consecutive colonoscopies were performed during the study period. SCAD was diagnosed in 92 (1.48%) patients, with four endoscopic patterns: pattern A, 'crescentic fold disease' (52.20%); pattern B, 'Mild-to moderate ulcerative colitis-like' pattern (30.40%); pattern C, 'Crohn's disease colitis-like' pattern (10.90%); pattern D, 'Severe ulcerative colitis-like' pattern (6.50%). Most patients with patterns A (58.33%, P < 0.018) and B (89.29%, P < 0.00001) showed histological alterations resembling moderate ulcerative colitis (UC). In pattern C, larger histological variability was found (P < 0.01). All patients showing pattern D showed the typical histological alteration changes of severe UC (P < 0.0001). In pattern A (60.42%, P = n.s.) and pattern B (46.43%, P = n.s.), diarrhoea was the most common symptom whilst abdominal pain was the most frequent in pattern C (50%, P = n.s.) and pattern D (83.33%, P = n.s.) patients. CONCLUSIONS: Endoscopic patterns of SCAD may range from mild to severe inflammation. The histopathological findings but not clinical features showed a statistically significant association with the degree of endoscopic severity.

Prevalence of celiac disease and symptoms in relatives of patients with celiac disease.

BACKGROUND AND OBJECTIVES: We determined the prevalence and clinical features of celiac disease (CD) in family-members (FMs) of a population-based cohort of index cases. MATERIALS AND METHODS: We recruited 108 CD index cases: mean age at diagnosis, 23.0 years (range, 1.5-45.2 years); 81 (75%) female. Three-hundred twelve (mean age, 41.6 years; 219 [70%] female) of FMs were analyzed. 153 (49%) were parents, 24 (7.7%) were children, 69 (22.2%) were siblings, 66 (21.1%) were second degree FMs. RESULTS: CD was diagnosed in 63 subjects (20.1%, 21 males and 42 females, mean age 34.24 years, range 2-81 years). Classic, subclinical, and silent forms of CD were recognized in 18 [28.6% (6 siblings, 6 parents, 3 child, 3 second-degree FMs)], in 27 [45.8% (9 siblings, 3 parent, 15 second-degree FMs)], and in 18 [28.6% (6 siblings, 6 parents, 6 second-degree FMs)] cases, respectively. Most of patients suffering from "classical" (18/63 patients, 28.7%) and "subclinical" (27/63 patients, 42.9%) form of CD were older than patients suffering from "silent " CD (18/63 patients, 28.7%) (p=0.01). Most of patients suffering from subclinical disease showed autoimmune diseases (Hashimoto's thyroiditis, and psoriasis), and other atypical symptoms, as gastroesophageal reflux disease (GERD), were also recorded. CONCLUSIONS: We found an high-prevalence of CD between CD FMs, and most of them were olygo- or asymptomatic.

Concomitant intraductal papillary mucinous neoplasm and pancreatic endocrine tumour: Report of two cases and review of the literature.

It has been suggested that the occurrence of intraductal papillary mucinous neoplasms in association with pancreatic endocrine tumours is more frequent than expected [Goh BK, Ooi LL, Kumarasinghe MP, Tan YM, Cheow PC, Chow PK, et al. Clinicopathological features of patients with concomitant intraductal papillary mucinous neoplasm of the pancreas and pancreatic endocrine neoplasm. Pancreatology 2006;6:520-6]. Up to now, 10 patients with concomitant intraductal papillary mucinous neoplasms and pancreatic endocrine tumours have been reported [Goh BK, Ooi LL, Kumarasinghe MP, Tan YM, Cheow PC, Chow PK, et al. Clinicopathological features of patients with concomitant intraductal papillary mucinous neoplasm of the pancreas and pancreatic endocrine neoplasm. Pancreatology 2006;6:520-6; Zhao X, Stabile BE, Mo J, Wang J, French SW. Nesidioblastosis coexisting with islet cell tumor and intraductal papillary mucinous hyperplasia. Arch Pathol Lab Med 2001;125:1344-7; Marrache F, Cazals-Hatem D, Kianmanesh R, Palazzo L, Couvelard A, O'Toole D, et al. Endocrine tumor and intraductal papillary mucinous neoplasm of the pancreas: a fortuitous association? Pancreas 2005;31:79-83]. In most cases the synchronous existence of both tumours was incidentally discovered after the examination of the surgical specimen. We report two additional patients with intraductal papillary mucinous neoplasms and pancreatic endocrine tumours, in whom both tumours were diagnosed before surgery.