Effects of exogenous lactase administration on hydrogen breath excretion and intestinal symptoms in patients presenting lactose malabsorption and intolerance

To establish whether supplementation with a standard oral dose of Beta-Galactosidase affects hydrogen breath excretion in patients presenting with lactose malabsorption. METHODS: Ninety-six consecutive patients positive to H2 Lactose Breath Test were enrolled. Mean peak H2 levels, the time to reach the peak H2, the time to reach the cut-off value of 20 ppm, the cumulative breath H2 excretion, the areas under the curve, and a Visual Analogical 10-point Scale for symptoms were calculated. Genotyping of the C/T-13910 variant was carried out. RESULTS: Following the oral administration of Beta-Galactosidase, in 21.88% of the cases, H2 Lactose Breath Test became negative (Group A), while mean peak H2 levels (74.95 ppm versus 7.85), P < 0.0000, in 17.71% (Group B) were still positive, with the H2 level 20 ppm above the baseline, but the peak H2 levels were significantly lower than those observed at the baseline test (186.7 ppm versus 66.64), P < 0.0000, while in 60.41% (Group C) they were still positive with the peak H2 levels similar to those observed at the baseline test (94.43 versus 81.60 ppm). All 96 individuals tested presented the C/C-13910 genotype nonpersistence. CONCLUSIONS: The response to oral administration of Beta-Galactosidase in patients with symptoms of lactose malabsorption presents a significant variability

Effect of Appendectomy on ClinicalCourse of Diverticulosis

Diverticulitis is a common condition where inflammation seems to play a key role in all forms of the disease. Since diverticular disease, in some cases, exhibits clinical and histopathologic similarities with the idiopathic inflammatory bowel disease, could have in common, with these some environmental risk factors, as appendectomy, that could interfere with the natural history of diverticular disease. Since the prevalence and the role of appendectomy in patients with colonic diverticula has not been defined, the aim of this study was to evaluate the prevalence of appendectomy, both in uncomplicated diverticular disease and in patients with diverticulitis. Two hundred and seven consecutive patients with verified diagnosis of diverticular disease of the colon were enrolled. Diagnosis of diverticulitis was defined by means of clinical, colonoscopic, and computerised tomography criteria. Logistic regression was used to describe the relation between the dependent variable (diverticulitis) and several covariates: sex, age (60), BMI (26), and history of appendectomy (emergency or elective appendectomy). We included the first order interactions in the model to assess the effect of each variable for a particular degree of the others covariates. Statistical analysis was performed using SPSS software. Results: The first order interactions did not show a relevant effect (p>0.10) and therefore were excluded from the logistic model. Sex (p=0.88), BMI (p=0.80), elective appendectomy (p=0.17), age (p=0,11), do not affect significantly, either as an independent variable or as a confounder, the risk of development of diverticulitis, and therefore were also excluded from the model. According to the final model the risk of diverticulitis is 4,94 fold higher (95% confidence interval: 1.98 to 12.37) in patients with history of appendectomy with emergency operative treatment, compared with patients without appendectomy or history of elective resection (p<0.001. Conclusions: The risk of diverticulitis does not increase in patients with elective appendectomy, therefore only patients with emergency appendectomy have an increased risk of diverticuliti

Swarming on Random Graphs II

We consider an individual-based model where agents interact over a random network via first-order dynamics that involve both attraction and repulsion. In the case of all-to-all coupling of agents in Rd this system has a lowest energy state in which an equal number of agents occupy the vertices of the d-dimensional simplex. The purpose of this paper is to sharpen and extend a line of work initiated in [56], which studies the behavior of this model when the interaction between the N agents occurs according to an Erdős-Rényi random graph G(N, p) instead of all-to-all coupling. In particular, we study the effect of randomness on the stability of these simplicial solutions, and provide rigorous results to demonstrate that stability of these solutions persists for probabilities greater than Np = O(logN). In other words, only a relatively small number of interactions are required to maintain stability of the state. The results rely on basic probability arguments together with spectral properties of random graphs.

Effect of gluten-free diet and co-morbidity of irritable bowel syndrome-type symptoms on health-related quality of life in adult coeliac patients.

Both coeliac disease and irritable bowel syndrome show impaired health-related quality of life, however, the impact of irritable bowel syndrome-type symptoms on health-related quality of life in coeliac disease is unclear. AIM: To evaluate the effect of gluten-free diet adherence and irritable bowel syndrome-type symptoms co-morbidity on health-related quality of life in adult coeliac disease patients. PATIENTS AND METHODS: A total of 1130 adults were enrolled in the study comprising 1001 controls from the general population and 129 diagnosed coeliac disease patients from the University Clinic in Cagliari. Irritable bowel syndrome-type symptoms and health-related quality of life were assessed using the Rome II and the SF-36 questionnaires, respectively. RESULTS: Irritable bowel syndrome-type symptoms prevalence in controls was 10.1% (102/1001) and 55% (71/129) in the coeliac disease patients. Irritable bowel syndrome-type symptom controls and coeliac disease patients both presented significantly lower health-related quality of life (p<or=0.05) compared to healthy controls. Strict diet coeliac disease patients, compared to partial diet patients, showed significantly (p<or=0.05) better scores in all domains, except physical functioning, physical-role and bodily pain. The lowest scores were found in partial diet coeliac disease patients with irritable bowel syndrome-type symptoms. CONCLUSIONS: The present results confirm the burden of irritable bowel syndrome-type symptoms and coeliac disease on health-related quality of life. Moreover, these data show that health-related quality of life in coeliac disease is impaired by poor compliance and by co-morbidity with irritable bowel syndrome-type symptoms

Effect of gluten-free diet and co-morbidity of irritable bowel syndrome-type symptoms on health-related quality of life in adult coeliac patients

Background. Both coeliac disease and irritable bowel syndrome show impaired health-related quality of life, however, the impact of irritable bowel syndrome-type symptoms on health-related quality of life in coeliac disease is unclear. Aim. To evaluate the effect of gluten-free diet adherence and irritable bowel syndrome-type symptoms co-morbidity on health-related quality of life in adult coeliac disease patients. Patients and methods. A total of 1130 adults were enrolled in the study comprising 1001 controls from the general population and 129 diagnosed coeliac disease patients from the University Clinic in Cagliari. Irritable bowel syndrome-type symptoms and health-related quality of life were assessed using the Rome II and the SF-36 questionnaires, respectively. Results. Irritable bowel syndrome-type symptoms prevalence in controls was 10.1% (102/1001) and 55% (71/129) in the coeliac disease patients. Irritable bowel syndrome-type symptom controls and coeliac disease patients both presented significantly lower health-related quality of life (p≤0.05) compared to healthy controls. Strict diet coeliac disease patients, compared to partial diet patients, showed significantly (p≤0.05) better scores in all domains, except physical functioning, physical-role and bodily pain. The lowest scores were found in partial diet coeliac disease patients with irritable bowel syndrome-type symptoms. Conclusions. The present results confirm the burden of irritable bowel syndrome-type symptoms and coeliac disease on health-related quality of life. Moreover, these data show that health-related quality of life in coeliac disease is impaired by poor compliance and by co-morbidity with irritable bowel syndrome-type symptoms

L’iperplasia delle cellule “c” parafollicolari senza mutazione del protooncogene ret: descrizione e implicazioni diagnostiche di alcuni casi clinici.

Obiettivo: Rivalutare le peculiari caratteristiche clinico-diagnostiche di una casistica di 6 pazienti con noduli tiroidei associati a valori elevati di calcitonina e presenza all’istologia di iperplasia delle cellule “C” parafollicolari (CHH). Soggetti e metodi: Sei pazienti con noduli tiroidei (caratteri ecografici classificati con il TI-RADS system; Maia F.R.et al, Clin. Endocr 2014), con valori elevati di calcitonina basale (v.n.<11 pg/ml nella donna e <8 pg/ml nell’uomo) e dopo stimolo con calcio gluconato, sono stati sottoposti ad esame citologico, dosaggio della calcitonina nel liquido di lavaggio dell’agoaspirato (CT-FNAB), a ricerca delle mutazioni del protooncogene RET e tutti sono stati operati di tiroidectomia totale. Risultati: Si riscontravano valori elevati di CT-FNAB in 3 pazienti (un caso con > 2000 pg/ml, corrispondeva ad un’area di tiroidite focale; due casi > 250 pg/ml, corrispondevano uno a PTC variante follicolare e l’altro a nodulo iperplastico). Nei rimanenti 3 casi i valori di CT-FNAB erano indosabili. Tutti i pazienti erano risultati negativi per mutazioni del protooncogene RET. L’esame istologico documentava CHH diffusa e florida con cellule “C” strettamente contigue al nodulo esaminato solo nei casi con valori elevati di CT-FNAB, mentre risultava focale con poche cellule “C” vicine al nodulo nei casi con valori di CT-FNAB indosabili; in nessun caso erano presenti cellule di carcinoma midollare della tiroide. Conclusioni: La presenza di CHH diffusa e florida in associazione ai noduli tiroidei può essere responsabile di falsi positivi del CT-FNAB. Pertanto, in presenza di noduli tiroidei associati a valori elevati di calcitonina ematica e di CT-FNAB, si devono sempre considerare le caratteristiche ecografiche e l’esame citologico prima dell’intervento