SPECIFIC DYSPEPTIC SYMPTOMS ARE ASSOCIATED WITH POOR RESPONSE TO THERAPY IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

Background: In gastroesophageal reflux disease (GORD) patients, coexistence of functional dyspepsia (FD) is known to be associated with poor response to proton pump inhibitors (PPIs), but the contribution of specific dyspepsia symptoms has not been systematically investigated yet. Objective: To characterize the impact of dyspepsia symptoms on PPIs response in GORD patients. Methods:. The enrolled subjects were 100 patients with diagnosis of GORD. All patients underwent a 24 hour pH-impedance test, while on PPIs-therapy. Patients were divided into two groups, refractory and responders, according to the persistence of GORD symptoms. A standardized questionnaire for FD was also administered to assess presence of dyspepsia symptoms. Results: In the subgroup of refractory patients FD was more prevalent than in responder ones, with postprandial fullness, nausea, vomiting, early satiation and epigastric pain being significantly prevalent in refractory GORD-patients. In the multivariate analysis only early satiation and vomiting were significantly associated with poor response to PPIs Conclusion: Coexistence of FD is associated with refractory-GORD. We showed that only early satiation and vomiting are risk factors for poor response to PPIs therapy. Our findings suggest that symptoms of early satiation and vomiting would help to identify the subset of PPIs-refractory GORD patients

Increased sleep fragmentation is associated with non-dipping pattern in resistant hypertensive patients

Non-dipping pattern and elevated nighttime blood pressure(BP) are very common in treatment-resistant hypertension (RH), for unknown reasons. Aim of the study is to identify whether sleep disorders are associated with non-dipping in RH

PREVALENCE OF RESTLESS LEGS SYNDROME IN PATIENTS WITH RESISTANT HYPERTENSION: A CROSS-SECTIONAL, BI-CENTRIC COHORT STUDY

Objective: Though obstructive sleep apnea syndrome (OSAS) is common in patients with resistant hypertension (RH), the prevalence of other sleep disorders, such as restless legs syndrome (RLS) is unknown. We aimend at investigating the prevalence of OSAS and RLS in a cohort of patients with RH recruited in two centres. Design and method: By using the ESC/ESH definition we consecutively recruited 63 patients with RH (age 63 ± 12 years, BMI 32 ± 6 kg/mq, 24% women, 31% patients with previous CV events, 31% diabetic), undergoing a polisomnographic study. RLS rating scale, Epworth Sleepiness Scale (ESS), past medical history and office BP were obtained. Sleep stages were scored according to 2007 AASM modified criteria. Results: Moderate-severe OSAS (AHI>15/h) was diagnosed in 34 RH patients (54%), RLS in 26 (41%): 13 patients presented both conditions. Only 16 patients (25%) had neither OSAS nor RLS. Periodic limb movements (PLM Index>15/h) were present in 31% of the studied population. OSAS+RLS- and OSAS+RLS+ patients were older than OSAS-RLS- and OSAS-RLS+. None among OSAS-RLS- had diabetes. OSAS+RLS- patients had a reduced total sleep time, sleep and REM latency and sleep efficiency in comparison to OSAS-RLS-. Conversely, slow wave sleep was reduced only in OSAS+RLS+. PLM index was increased in OSAS-RLS+ [18 (0–36)] but not in OSAS+RLS+ [2 (0–25), p < 0.05]. Conclusions: OSAS and RLS are common in RH patients, often co-occurring. BMI or daily sleepiness are not useful to identify RH patients with sleep disorders, suggesting that all RH patients should undergo polisomnography. Diabetes seems to be a feature of RH patients with sleep disorders. When coexisting with OSAS, RLS is not associated with PLM, suggesting a different pathophysiology. However, the presence of OSAS together with RLS is associated with shorter slow wave sleep, a phenomenon that can possibly lead to severe cardiovascular and cognitive complications in this subgroup

Italian nationwide survey of pharmacologic treatments in diverticular disease: Results from the REMAD registry

Background: Although diverticular disease is a common condition, its effective treatment is challenging in clinical practice. Objective: The objective of this article is to assess pharmacological management in different clinical settings of diverticular disease and factors associated with treatment using the Italian registry Registro Malattia Diverticolare (REMAD). Methods: At study enrolment, patients were categorised into subgroups: diverticulosis, symptomatic uncomplicated diverticular disease and previous diverticulitis. We registered demographic, clinical and lifestyle factors, quality of life and the use of treatments for diverticular disease in the last year. Logistic regression analysis assessed the association between clinical factors and treatment consumption. Results: A total of 500 of the 1206 individuals included had had at least one treatment for diverticular disease in the last year: 23.6% (166/702) of patients with diverticulosis, 55.9% (165/295) of patients with symptomatic diverticular disease, and 80.9% (169/209) of patients with previous diverticulitis (p &lt; 0.001). In multivariate analysis, the following factors were significantly associated with treatment use: female gender, family history of colonic diverticula, organic digestive comorbidity and impaired physical quality of life components. Conclusion: Individuals with diverticular disease take medications based on the different clinical settings of disease. We identified different features associated with treatment use in the distinct clinical entities of diverticular disease. ClinicalTrial.gov Identifier: NCT03325829

Distinguishing features between patients with acute diverticulitis and diverticular bleeding: Results from the REMAD registry

Background: Pathogenesis of acute diverticulitis and diverticular bleeding remains poorly defined, and few data compare directly risk factors for these complications. Aims: to assess differences in clinical features, lifestyles factors and concurrent drug use in patients with acute diverticulitis and those with diverticular bleeding. Methods: Data were obtained from the REMAD Registry, an ongoing 5-year prospective, observational, multicenter, cohort study conducted on 1,217 patients. Patient- and clinical- related factors were compared among patients with uncomplicated diverticular disease, patients with previous acute diverticulitis, and patients with previous diverticular bleeding. Results: Age was significantly lower (OR 0.48, 95% CI: 0.34-0.67) and family history of diverticular disease was significantly higher (OR 1.60, 95% CI: 1.11-2.31) in patients with previous diverticulitis than in patients with uncomplicated diverticular disease, respectively. Chronic obstructive pulmonary disease was significantly higher in patients with previous diverticular bleeding as compared with both uncomplicated diverticular disease (OR 8.37, 95% CI: 2.60-27.0) and diverticulitis (OR 4.23, 95% CI: 1.11-16.1). Conclusion: This ancillary study from a nationwide Registry showed that some distinctive features identify patients with acute diverticulitis and diverticular bleeding. These information might improve the assessment of risk factors for diverticular complications