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Scores in upper GI bleeding (UGIB) are used to stratify death risk and need for hospitalization at admission, but a tool that incorporates dynamic changes during the hospital stay is lacking. We aimed to develop a death risk score that considers changes in clinical status during hospitalization and compare its performance with existing ones.A multicenter cohort study enrolling patients with UGIB in 50 Italian hospitals from January 2014 to December 2015 was conducted. Data were collected and used to develop a risk score using logistic regression analyses. Performance curves (area under the receiver-operating characteristic [AUROC] curves), sensitivities, specificities, positive and negative predictive values, and outcomes classified as low, intermediate, and high death risk were calculated. The score's performance was externally validated and then compared with other scores.We included 1852 patients with nonvariceal UGIB in the development cohort and 912 in the validation cohorts. The new score, which we named the Re.Co.De (rebleeding-comorbidities-deteriorating) score, included 10 variables depicting the changes in clinical conditions while in the hospital. The mortality AUROC curves were .93 (95% confidence interval, .91-.96) in the derivation cohort and .94 (95% confidence interval, .91-.98) in validation cohort. In a comparison of AUROC curves with other scores, the new score showed a significant performance compared with pre- and postendoscopy scores. Patients with low and high scores had 30-day mortality rates of .001% and 48.2%, respectively.The Re.Co.De score has a higher performance for predicting mortality in patients with UGIB compared with other scores, correctly identifying patients at low and high death risk while in the hospital through a dynamic re-evaluation of clinical status.

Purpose To evaluate the pathological complete response (pCR) rate of locally advanced rectal cancer (LARC) after adaptive high-dose neoadjuvant chemoradiation (CRT) based on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT). Methods The primary endpoint was the pCR rate. Secondary endpoints were the predictive value of 18 F-FDG-PET/CT on pathological response and acute and late toxicity. All patients performed 18 F-FDG-PET/CT at baseline (PET0) and after 2 weeks during CRT (PET1). The metabolic PET parameters were calculated both at the PET0 and PET1. The total CRT dose was 45 Gy to the pelvic lymph nodes and 50 Gy to the primary tumor, corresponding mesorectum, and to metastatic lymph nodes. Furthermore, a sequential boost was delivered to a biological target volume defined by PET1 with an additional dose of 5 Gy in 2 fractions. Capecitabine (825 mg/m2 twice daily orally) was prescribed for the entire treatment duration. Results Eighteen patients (13 males, 5 females; median age 55 years [range, 41–77 years]) were enrolled in the trial. Patients underwent surgical resection at 8–9 weeks after the end of neoadjuvant CRT. No patient showed grade > 1 acute radiation-induced toxicity. Seven patients (38.8%) had TRG = 0 (complete regression), 5 (27.0%) showed TRG = 2, and 6 (33.0%) had TRG = 3. Based on the TRG results, patients were classified in two groups: TRG = 0 (pCR) and TRG = 1, 2, 3 (non pCR). Accepting p interim-SUVmax, interim-SUVmean, interim-MTV, interim-TLG, and the MTV reduction were significantly different between the two groups. 18 F-FDG-PET/CT was able to predict the pCR in 77.8% of cases through compared evaluation of both baseline PET/CT and interim PET/CT. Conclusions Our results showed that a dose escalation on a reduced target in the final phase of CRT is well tolerated and able to provide a high pCR rate.

Medline and PubMed databases were searched on epidemiology of Helicobacter pylori for the period of April 2013-March 2014. Several studies have shown that the prevalence of H. pylori is still high in most countries. In north European and North American populations, about one-third of adults are still infected, whereas in south and east Europe, South America, and Asia, the prevalence of H. pylori is often higher than 50%. H. pylori remains highly prevalent in immigrants coming from countries with high prevalence of H. pylori. However, the lower prevalence of infection in the younger generations suggests a further decline of H. pylori prevalence in the coming decades. Low socioeconomic conditions in childhood are confirmed to be the most important risk factors for H. pylori infection. Although the way the infection is transmitted is still unclear, interpersonal transmission appears to be the main route. Finally, H. pylori recurrence after successful eradication can still occur, but seems to be an infrequent event.

Background and study aims Precut papillotomy is considered a risk factor for endoscopic retrograde cholangiopancreatography (ERCP)-related complications; however whether the complication risk is due to precut itself or to the prior prolonged attempts is still debated; therefore, early precut implementation has been suggested to reduce the complication rate. We conducted a meta-analysis of randomized controlled trials (RCTs) comparing cannulation and complication rates of early precut implementation with persistent attempts by the standard approach. Methods RCTs that compared cannulation and complication rates of the early precut implementation and of persistent attempts by the standard approach were included. Summary effect sizes were estimated by odds ratio (OR) with a random-effects model and by Peto OR. Results Six RCTs with a total of 966 subjects met the inclusion criteria. Overall cannulation rates were 90 % in both randomization groups (OR 1.20; 95 % confidence interval [CI] 0.54 - 2.69). Post-ERCP pancreatitis developed in 2.5 % of patients randomized to the early precut groups and in 5.3 % of patients from the persistent attempts groups (OR 0.47; 95 %CI 0.24 - 0.91). The overall complication rates, considering pancreatitis, bleeding, cholangitis, and perforation rates, were 5.0 % in the early precut groups and 6.3 % in the persistent attempts groups (OR 0.78; 95 %CI 0.44 - 1.37). Conclusions RCTs that investigated the issue of timing of the precut procedure were limited. Current evidence suggests that in experienced hands the early implementation of precut and persistent cannulation attempts have similar overall cannulation rates; early precut implementation reduces post-ERCP pancreatitis risk but not the overall complication rate. Further studies are needed to confirm these findings.

Objectives: We aimed to evaluate the prevalence of endoscopic findings and their association with dyspeptic symptoms in the community.Methods: A total of 1,533 inhabitants of two villages were invited to participate in a cross-sectional survey, and 1,033 were recruited. Participants underwent a validated dyspepsia questionnaire, upper gastrointestinal endoscopy, and a 13 C-urea breath test.Results: Endoscopic findings were present in 17.6 of asymptomatic subjects and in 27.4 of those with dyspeptic symptoms. The prevalence of esophagitis and Barrett's esophagus in subjects with dyspeptic symptoms and without prominent reflux symptoms was 8.1 and 1.5, respectively, and was similar to that of asymptomatic subjects (8.5 and 0.7, respectively). Esophagitis was significantly associated with dyspeptic symptoms only in subjects with concomitant prominent reflux symptoms. Peptic ulcer (PU) was present in 8.8 of subjects with dyspeptic symptoms without reflux symptoms and similarly in 9.4 of those with prominent reflux symptoms. Subjects with dyspeptic symptoms and concomitant prominent reflux symptoms had an increased risk of having an underlying PU (odds ratio 2.74, 95 confidence interval 1.30-5.78).Conclustions: Almost three-quarters of subjects with dyspeptic symptoms do not have endoscopic findings and, in addition, esophagitis may not be the cause of dyspeptic symptoms in subjects without prominent reflux symptoms. PU may be the cause of dyspeptic symptoms in a subgroup of subjects with prominent reflux symptoms. © 2010 by the American College of Gastroenterology.

Background The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity model, and its Portsmouth and colorectal modifications are used to predict postoperative mortality and morbidity after colorectal surgery. Aims To compare stent placement as a bridge to surgery vs. emergency surgical resection in patients with acute left-sided colorectal cancer obstruction using P-POSSUM and CR-POSSUM. Methods From January 2008 to December 2009, the physiological and operative scores, morbidity and mortality predicted by the P-POSSUM and CR-POSSUM scores were collected in all consecutive patients with LCCO who underwent surgical resection directly (Group A) or after stent placement (Group B). Results Eighty-six patients were enrolled (Group A-41 and Group B-45). The observed 30-day mortality rate was 9.8% (4/41) in Group A and 2.4% (1/45) in Group B. The 30-day morbidity rate was 61% (25/41) in Group A and 29% (13/45) in Group B. The mean values of P-POSSUM morbidity ( A = 70.5% vs. B = 34.3%; p = 0.001), P-POSSUM mortality ( A = 13.6% vs. B = 2.4%; p = 0.001) and CR-POSSUM mortality ( A = 15.1% vs. B = 4.9%; p = 0.001) were significantly lower in the Group B patients than in the Group A patients. Conclusions Bridge to surgery strategy reduces the surgical risks in LCCO, and P-POSSUM and CR-POSSUM scores represent a good tool for comparing the two strategies.

BACKGROUND & AIMS: Population-based endoscopic studies are needed to assess the epidemiology of functional dyspepsia (FD) and the newly suggested subgroups of meal-related symptoms and epigastric pain. We evaluated the prevalence of, and risk factors for, FD in the Italian general population. METHODS: A total of 1533 inhabitants of 2 villages were invited to undergo symptom evaluation using a validated questionnaire, esophagogastroduodenoscopy, and (13)C-urea breath test; 1033 subjects (67.4%) took part. RESULTS: Of the 1033 subjects, 156 (15.1%; 95% confidence interval [CI], 12.9-17.3) had dyspepsia, and of these 114 (11%; 95% CI, 9.2-12.9) had FD. Of the 114 subjects with FD, 77 (67.5%) had meal-related symptoms (postprandial fullness and/or early satiation) and 55 (48.2%) had epigastric pain. Only 18 subjects (15.8%) had both meal-related symptoms and epigastric pain; this was fewer than expected by chance alone (P < .001). Unemployment (odds ratio [OR], 5.80; 95% CI, 1.56-21.60), divorce (OR, 2.76; 95% CI, 1.10-6.91), smoking (OR, 1.74; 95% CI, 1.11-2.70), and irritable bowel syndrome (OR, 3.38; 95% CI, 1.85-6.19) were significantly associated with FD. Unemployment, divorce, and irritable bowel syndrome were associated with both meal-related symptoms and epigastric pain, while smoking was associated only with meal-related symptoms. CONCLUSIONS: FD is present in 11% of the Italian general population. Unemployment and divorce seem to increase the risk of FD, and smoking seems to be associated with meal-related symptoms. Two distinct subgroups of FD, as suggested by Rome III, seem to exist in the general population.

OBJECTIVES: The most common technique used to achieve primary deep biliary cannulation is the standard contrast-assisted method. To increase the success rate and reduce the risk of complications, a wire-guided cannulation strategy has been proposed. Prospective studies provided conflicting results as to whether the wire-guided cannulation technique increases the cannulation rate and reduces post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis risk compared with the standard method. The objective of this study was to carry out a meta-analysis of randomized controlled trials (RCTs) that compares primary biliary cannulation and post-ERCP pancreatitis rates with the wire-guided method and the standard cannulation technique. METHODS: Literature searches of electronic databases and online clinical trial registers up to March 2009 were conducted to identify RCTs comparing primary cannulation and post-ERCP pancreatitis rates with the wire-guided method and the standard cannulation technique. A meta-analysis of these clinical trials was performed. RESULTS: Five RCTs were included. Overall, the primary cannulation rates reported with the wire-guided cannulation technique and the standard method were 85.3 and 74.9%, respectively. The pooled analysis of all the selected studies comparing the wire-guided cannulation technique with the standard method yielded an odds ratio (OR) of 2.05 (95% confidence interval (CI): 1.27-3.31). The pooled analysis comparing the post-ERCP pancreatitis rates for the wire-guided-cannulation groups with those for the standard-method groups yielded an OR of 0.23 (95% CI: 0.13-0.41). CONCLUSIONS: This meta-analysis shows that the wire-guided technique increases the primary cannulation rate and reduces the risk of post-ERCP pancreatitis compared with the standard contrast-injection method. Further large, well-performed, randomized controlled studies are needed to confirm these findings.

OBJECTIVE: Existing endoscopy-based data on gastro-oesophageal reflux disease (GORD) in the general population are scarce. This study aimed to evaluate typical symptoms and complications of GORD, and their associated risk factors, in a representative sample of the Italian population. METHODS: 1533 adults from two Italian villages were approached to undergo symptom assessment using a validated questionnaire and upper gastrointestinal endoscopy. Data were obtained from 1033 individuals (67.4% response rate). RESULTS: The prevalence of reflux symptoms was 44.3%; 23.7% of the population experienced such symptoms on at least 2 days per week (frequent symptoms). The prevalence rates of oesophagitis and Barrett's oesophagus in the population were 11.8% and 1.3%, respectively. Both frequent (relative risk (RR) 2.6; 95% confidence interval (CI) 1.7 to 3.9) and infrequent (RR 1.9; 95% CI 1.2 to 3.0) reflux symptoms were associated with the presence of oesophagitis. No reflux symptoms were reported by 32.8% of individuals with oesophagitis and 46.2% of those with Barrett's oesophagus. Hiatus hernia was associated with frequent reflux symptoms and oesophagitis, and was present in 76.9% of those with Barrett's oesophagus. We found no association between body mass index and reflux symptoms or oesophagitis. CONCLUSIONS: GORD is common in Italy, but the prevalence of Barrett's oesophagus in the community is lower than has been reported in selected populations. Both frequent and infrequent reflux symptoms are associated with an increased risk of oesophagitis. Individuals with oesophagitis and Barrett's oesophagus often have no reflux symptoms.

BACKGROUND: Proton-pump inhibitor (PPI)-based triple therapy is the recommended first-line treatment for Helicobacter pylori infection. A consensus on treatment duration is lacking. PURPOSE: To summarize the benefits and harms of different durations of PPI-based triple therapy. DATA SOURCES: PubMed, EMBASE, the Cochrane Library, and proceedings of major meetings through May 2007. STUDY SELECTION: English-language reports of randomized, controlled trials that compared duration (7, 10, or 14 days) of triple therapy and in which adequate testing confirmed the initial H. pylori infection and its eradication. DATA EXTRACTION: Two authors independently extracted data on study design, treatment, number of patients enrolled and number of patients with successful eradication, disease at enrollment, testing, adverse effects, year of publication, publication format, and country. DATA SYNTHESIS: Of 21 included studies, 11 compared 7-day therapy with 10-day therapy, and 13 compared 7-day therapy with 14-day therapy. Meta-analysis yielded relative risks (RRs) for eradication of 1.05 (95% CI, 1.01 to 1.10) for 7-day compared with 10-day amoxicillin-containing triple therapy (10 studies) and 1.07 (CI, 1.02 to 1.12) for 7-day compared with 14-day therapy (11 studies). Meta-analysis of the 3 studies that compared 7-day with 14-day metronidazole-containing therapy yielded an RR of 1.08 (CI, 0.96 to 1.22). The 7-day versus 10-day comparisons yielded RRs of 1.03 (CI, 0.97 to 1.10) for peptic ulcer disease and 1.10 (CI, 1.02 to 1.20) for nonulcer dyspepsia. For the 7-day versus 14-day comparisons, the RRs were 1.04 (CI, 0.99 to 1.09) and 1.03 (CI, 0.88 to 1.20), respectively. The RRs for frequency of adverse events were 0.98 (CI, 0.85 to 1.14) and 1.08 (CI, 0.84 to 1.40) for 7-day therapy compared with 10- and 14-day therapy, respectively. Diarrhea and taste disturbance were the most frequently reported adverse events (5%). LIMITATIONS: Subgroup analyses were limited by the few studies evaluating different drug regimens and disease at enrollment. Seventeen of the included studies had poor methodological quality or inadequate reporting. CONCLUSION: Available data suggest that extending triple therapy beyond 7 days is unlikely to be a clinically useful strategy.

BACKGROUND: Helicobacter pylori is recognized as one of the most significant risk factors for gastric cancer, and H. pylori eradication has been proposed as a possible primary chemo-preventive strategy to reduce gastric cancer incidence. AIM: To evaluate the available evidence on the efficacy of H. pylori eradication in the prevention of gastric cancer. METHODS: Epidemiological, observational and interventional studies, as well as decisional models, were taken into account in this review. RESULTS: Large-scale epidemiological studies clearly link H. pylori infection with non-cardia gastric cancer. Current evidence suggests that, in a subpopulation of treated subjects, H. pylori eradication prevents the progression of preneoplastic lesions. Studies that have attempted to evaluate the effect of H. pylori eradication on the incidence of gastric cancer have not provided definitive answers. H. pylori eradication seems to reduce the incidence of gastric cancer in patients without baseline precancerous gastric lesions. Decisional models suggest that H. pylori screening could be cost-effective, but there is not yet sufficient evidence to support the setting up of a general screening programme. CONCLUSION: Helicobacter pylori eradication is a plausible intervention for gastric cancer prevention; however, it seems to be relevant in only a subset of subjects.

BACKGROUND: Triple therapy is recommended for Helicobacter pylori eradication, yet consensus on the duration of treatment is lacking. AIM: To compare the efficacy and safety of 1- and 2-week regimens of omeprazole, amoxicillin and clarithromycin in a large, multicentre, double-blind and randomised study. METHODS: A total of 909 H pylori-positive patients with duodenal ulcer, enrolled in 81 endoscopy units in Italy, were randomised to receive omeprazole, amoxicillin and clarithromycin for either 1 week (OAC1W) or 2 weeks (OAC2W) or omeprazole and amoxicillin for 2 weeks. H pylori eradication was assessed by histological examination and carbon-13 urea breath test 4 weeks after treatment. RESULTS: Both the intention-to-treat (ITT; n = 907) and per protocol (PP; n = 661) analyses showed no significant differences between the eradication rates of OAC1W (ITT 79.7%; PP 83.6%) and OAC2W (ITT 81.7%; PP 84.9%; ITT p = 0.53; PP p = 0.71). Both triple omeprazole, amoxicillin and clarithromycin regimens gave significantly higher eradication rates compared with omeprazole and amoxicillin treatment (ITT 44.6%; PP 42.8%; p

The eradication of Helicobacter pylori infection is still a challenge for clinicians. Approximately 5% of patients who undergo two courses of eradication therapy remain infected. The authors of this Viewpoint article discuss the available options for salvage therapy in these patients and the role of antimicrobial susceptibility testing in this setting.

Helicobacter pylori Eradication Treatment Reduces but Does Not Abolish the Risk of Gastric Cancer

Around 25-40% of adults have chronic and recurrent dyspeptic symptoms Most patients have no structural lesions and malignancy is rare, especially in Western populations Two empirical strategies show results—a non-invasive test for H pylori and treatment of H pylori positive patients with eradication therapy (test and treat), and empirical treatment with proton pump inhibitors The 13C-urea breath test and stool antigen test are the recommended non-invasive tests for H pylori infection. Patients should stop proton pump inhibitors two weeks before and antibiotics four weeks before performing either of these tests

BACKGROUND: Helicobacter pylori infection is associated with gastric cancer, but the effect of eradication treatment on gastric cancer risk is not well defined. PURPOSE: To determine whether H. pylori eradication treatment can reduce the risk for gastric cancer. DATA SOURCES: PubMed, EMBASE, Cochrane Library, Google Scholar, and online clinical trial registers through 31 January 2009, without language restrictions. STUDY SELECTION: Randomized trials that compared eradication treatment with no treatment in H. pylori-positive patients and that assessed gastric cancer or progression of preneoplastic lesions during follow-up. DATA EXTRACTION: Two authors independently reviewed articles and extracted data. DATA SYNTHESIS: Seven studies met inclusion criteria, 1 of which was excluded from pooled analysis because of clinical and methodological heterogeneity. All studies were performed in areas with high incidence of gastric cancer, mostly in Asia. Overall, 37 of 3388 (1.1%) treated patients developed gastric cancer compared with 56 of 3307 (1.7%) untreated (control) participants. In a pooled analysis of 6 studies with a total of 6695 participants followed from 4 to 10 years, the relative risk for gastric cancer was 0.65 (95% CI, 0.43 to 0.98). LIMITATIONS: All studies but 1 were performed in Asia. Only 2 assessed gastric cancer incidence, and only 2 were double-blinded. CONCLUSION: Helicobacter pylori eradication treatment seems to reduce gastric cancer risk.

[This corrects the article DOI: 10.3389/fmed.2022.868449.]., (Copyright © 2024 Zagari, Frazzoni, Fuccio, Bertani, Crinò, Magarotto, Dajti, Tringali, Da Massa Carrara, Cengia, Ciliberto, Conigliaro, Germanà, Lamazza, Pisani, Spinzi, Capelli, Bazzoli and Pasquale.)