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Real-time polymerase chain reaction (RT-PCR) is a widely used technique for bacterial and viral infection diagnosis. Herein, we report our preliminary experience in retrieving H. pylori genetic sequences in stools and analyzing genotypic clarithromycin resistance by RT-PCR (noninvasive), with the aim of comparing this procedure with that performed on biopsy samples (invasive).After 'in vitro' demonstration of H. pylori DNA detection from pure and stool-mixed bacteria, 52 consecutive patients at the first diagnosis of infection were investigated. DNA was extracted from biopsy tissue and stool samples (THDRT-PCR showed H. pylori positive DNA in all infected patients with full concordance between tissue and stool detection (100%). We found A2143G mutation in 10 (19.2%), A2142G in 4 (7.7%) and A2142C in 5 (9.6%) patients; there was a full agreement between biopsy and fecal samples. A2143G was found in all the four A2142G positive cases and in three out of the five A2142C positive strains. Overall clarithromycin resistance rate in our series was 23%.Despite the need of confirmation on large sample, stool RT-PCR analysis could represent a feasible tool to detect H. pylori DNA sequences and antibiotic resistance point mutations. As compared to tissue molecular analysis, this technique is noninvasive, with potential advantages such as improvement of patient compliance, reduction of diagnostic procedure time/cost and improvement of therapeutic outcome.

The APC gene mutation triggers familial adenomatous polyposis (FAP) and approximately 80% of sporadic colorectal cancers. FAP summarizes the natural history of colorectal cancer because low- and high-grade dysplastic lesions and adenocarcinoma are simultaneously present in the same patients free from individual and environmental variability factors. Estrogen receptor beta (ERβ) has recently been suggested as the most likely mediator of estrogen-related anti-carcinogenic effects in Apc(Min-/+) mice and humans. In this study we assessed the ERβ expression in the intestinal mucosa of FAP patients to verify its possible involvement in tumor progression in colorectal cancer.ERβ and ERα expression, cell proliferation (Ki-67) and apoptosis (TUNEL), were evaluated on archival biopsy material from six patients with FAP who underwent colectomy.A progressive significant decrease of ERβ expression was observed in the different stages of the disease as compared to normal mucosa (p0.001). Interestingly, a decreased ERβ expression was directly correlated with apoptosis (r = 0.76, p0.001), and inversely correlated with cell proliferation (r = 0.54, p0.05).ERβ expression is related to the severity of the disease, supporting the role of ERβ as a relevant biomarker of tumor progression and possible chemopreventive target in patients at risk of colonic neoplasia.

Data in the literature suggest the possibility of using ultrasonography to diagnose sliding gastric hiatal hernia. The aim of this study was to confirm the diagnostic accuracy of transabdominal ultrasonography for the diagnosis of sliding gastric hiatal hernia, using endoscopy as the reference test. The latter procedure was used since it also recognizes the presence of esophagitis and/or varices, two pathological conditions that could per se influence ultrasonographic evaluation, based on measurement of the esophageal diameter.A total of 180 consecutive patients, admitted to our hospital for endoscopy, were examined. Of these, 12 patients were not included in the final study. After fasting, the remaining 168 patients were first evaluated by ultrasonography and later by endoscopy. Esophageal diameter was measured by ultrasonography at the level of the diaphragmatic hiatus.Using a diameteror = 18 mm as the sensitivity threshold, 29 patients potentially affected by hiatal hernia were identified by ultrasonography. Upper endoscopy examination confirmed the presence of hiatal hernia in 24 of these patients and documented 4 additional hernias in the group of patients with a transdiaphragmatic esophageal diameter18 mm (positive and negative predictive values were 82.7% and 97%, respectively). Analysis of the distribution of esophageal varices and esophagitis in all 168 excluded the possibility that these pathological conditions could influence the esophageal diameter.Ultrasonography represents a simple and well-tolerated diagnostic approach in sliding gastric hiatal hernia. The good diagnostic accuracy suggests its potential use in clinical and epidemiological settings.

Sir,Colorectal carcinoma (CRC) is the main cause of death in inflammatory bowel diseases (IBD), and long-lasting IBD is the most negative prognostic factor for CRC [1–3].The demonstration of two ty...

Despite the clear demonstration that an increase in faecal bile salt concentration can augment colonocyte proliferation, it is still controversial whether bile salts act on these cells as direct mitogens or by inducing a damage-related proliferative response. The goal of this study was to define the mechanism mediating the proliferative effect of bile salts on rat colonocytes.Faecal bile salt concentration was increased by feeding rats on diets enriched with either bile salts or fats. Colonic mucosa proliferating cell nuclear antigen (PCNA) expression, histology and apoptosis, and faecal water cytolytic activity were evaluated to assess proliferation and direct or indirect signs of mucosal damage.Compared to standard diet, chenodeoxycholate-, deoxycholate- and fat-enriched diets produced a significant increase in both faecal water total bile salt concentration (46.0 versus 124.1, 145.9 and 498.5 micromol/L, respectively) and percentage of PCNA-positive nuclei (30.5, versus 37.7, 33.9 and 47.1, respectively) that appeared significantly correlated (r = 0.8; P0.001). Chenodeoxycholate and deoxycholate fed animals showed colonic mucosa histology and faecal water cytolytic activity similar to controls, with a significantly reduced apoptotic index. Rats fed on high fat diet, however, showed a mild inflammatory infiltrate associated with an increased apoptosis and faecal water cytolytic activity, all conditions not apparently determined by the increased faecal water total bile salt concentration.The results obtained in this study demonstrate that bile salts act as direct mitogens on colonic epithelial cells.