BACKGROUND:Oesophageal eosinophilia (EE) is encountered in clinical practice as oesophageal biopsies are being obtained in patients with GI symptoms other than classical symptoms of eosinophilic oesophagitis (EoE). The prevalence, determinants and clinical relevance of EE identified irrespective of symptoms are unclear.AIM:To determine the prevalence and risk factors of EE with or without EoE in a nonselected group of patients undergoing endoscopy and in primary care patients.METHODS:A cross-sectional study in a single VA centre in which we obtained at least one oesophageal biopsy from patients presenting to elective endoscopy, as well as a sample of patients eligible for screening colonoscopy recruited from primary care clinics. EE was defined by >15 eosinophils in a single HPF; and EoE was defined as definite, probable or none depending on the presence of EE, acid-suppressive therapy and oesophageal symptoms.RESULTS:EE was identified in 33 of 1357 patients (2.4%, 95% CI: 1.7-3.4); of whom 9 had definite EoE (0.66%, 95% CI: 0.23-1.10), 17 had probable EoE (1.25%), and the only 7 patients had EE without EoE. The prevalence of EE was 2.3% among patients undergoing elective endoscopy and 0.1% among patients eligible for screening colonoscopy. Seasonal allergies (adjusted OR: 2.78; 95% CI: 1.26-6.11) and oesophageal strictures (4.50; 0.90-22.40) were associated with EE.CONCLUSIONS:The prevalence of EE was 2.3% among unselected patients presenting to endoscopy most of whom have EoE. EE was present in 0.1% in primary care patients none of whom had EoE.

BACKGROUND:Advanced glycation end-products (AGEs) are found in high quantity in high-fat foods and meat cooked at high temperature. AGEs have been shown to contribute to chronic inflammation and oxidative stress in humans.AIM:To investigate the associations between consumption of meat, fat and AGEs, and the risk of Barrett's oesophagus (BO).METHODS:We conducted a case-control study using data from the patients who were scheduled for elective esophagogastroduodenoscopy (EGD) and from a random sample of patients who were identified at primary care clinics. Daily consumption of meat, fat and Nε-(carboxymethyl) lysine (CML), a major type of AGEs, was derived from the food frequency questionnaire (FFQ). Multivariate logistic regression models were used to estimate the odds ratio (OR) and its 95% confidence interval (CI) for BO.RESULTS:A total of 151 cases with BO and 777 controls without BO completed the FFQ. The multivariate OR (95% CI) for BO was 1.91 (1.07-3.38) for total meat, 1.80 (1.02-3.16) for saturated fat and 1.63 (0.96-2.76) for CML-AGE, when the highest tertile of intake was compared with the lowest. The association for total meat was attenuated to 1.61 (0.82-3.16), and that for saturated fat to 1.54 (0.81-2.94) after adjusting for CML-AGE.CONCLUSIONS:Higher consumption of total meat, saturated fat or possibly CML-AGE was associated with an increased risk of Barrett's oesophagus. CML-AGE may partly explain the association between total meat and saturated fat consumption and the risk of Barrett's oesophagus.

respectively. Both items were associated with inadequate bowel cleansing at univariate analysis. Conclusions: This study identified multiple factors affecting the quality of colonic preparation, some of which can be modified to achieve a higher degree of bowel cleansing. Important non-modifiable factors may be valuable in identifying subjects for whom more aggressive cleansing protocols should be considered.

Conclusions: The present study confirms our previous results, regarding the reduction of epithelial proliferation activity of ERD respect to NERD patients. Moreover, our study reinforces the idea that individuals who develop ERD could be genetically characterised by a weaker proliferating epithelial cell capability. On the other hand, patients with more efficient epithelial proliferation capability could have a lower probability of developing macroscopic mucosal lesions when stressed by acid and pepsin.

Background and aim: There is no accepted gold standard for the diagnosis of gastroesophageal reflux disease (GERD).The aim of our study is to assess the optimal cut-off value and duration of proton pump inhibitor (PPI) test in GERD patients with and without esophagitis.Material and methods: Prospective study of 544 patients, endoscopically investigated and treated for 2 weeks with PPI at double dose, and for 3 additional months at standard dose.The status of the patient at study end was used as an independent diagnostic standard.Results: Esophagitis was present in 55.8% and absent in 44.2% (nonerosive reflux disease, NERD).The test was positive in 89.7% to 97.8% of the patients according to the cut-off or duration of test used.The sensitivity of PPI test was excellent, ranging from 95.5% to 98.8%, whereas the specificity was poor, not exceeding 36.3%.EE patients responded more favorably to PPI test and to subsequent PPI therapy compared with NERD patients.Conclusions: PPI test is a sensitive but less specific test.Its optimal duration is one week, and the optimal cut-off value is a decrease of heartburn score = 75%.

Clinical and laboratory features that may predict safety and efficacy of current standard antiviral therapy for HCV infection in patients with liver cirrhosis and portal hypertension have not been fully determinated. From April 2001 to March 2006, we submitted to a standard course of pegylated-interferon alfa-2b (1.5 mcg/kg/week) and ribavirin (>10.6 mg/kg/day) combination therapy 35 HCV cirrhotics: mean age 51.8; twenty-one males; twenty-one genotype 1–4; 18 naïves; child-pugh score (CPS) 8.7 (from 5 to 12). All patients had features of portal hypertension: platelet count 77.520 ± 12.350/μL; spleen diameter 15.9 cm (from 14 to 18); oesophageal varices F1 in 9 patients, F2 in 7, and gastric varices in 2; hypertensive gastropathy in 14 patients. Patients with risk of intestinal haemorrhage, hepatic encephalopathy (HE), refractory ascites and CPS ≥ 13 were excluded. Adverse events during therapy were: thrombocytopenia (<30.000/μL) in 15 patients, neutropenia (<700/μL) in 13, anemia (Hb < 8.5 g/dL) in 4, grade III-IV HE in 2, pelvic infection in 1, severe recurrent urinary infections in 2, variceal haemorrhage in 1, HCC occurrence in 1, occurrence or worsening of ascites in 4. Adverse events caused treatment withdrawal in 9 patients (25.7%), ribavirin and/or pegylated-interferon dose reduction in 19 (54.3%). Early virological response (VR) was obtained in 23 subjects (65.7%), end-of-treatment VR in 12 (34%). Sustained VR (SVR) occurred in 7 (20%) of all patients, 54.5% of those with genotype 2 and 33.3% of those with genotype 3. None of patients with genotype 1 or 4 obtained SVR. None of patients with SVR had CPS ≥ 8, ascites, need of diuretics, oesophageal varices ≥ F2. Age, sex, previous therapy, viral load, platelet count, neutrophil count, spleen diameter did not show significant differences between patients with SVR and non-responders. All patients with life-threatening adverse events had CPS ≥ 9. No other predictive factors of severe adverse events were found. In cirrhotic patients with portal hypertension and chronic 2 or 3 HCV infection submitted to standard antiviral therapy, hepatic function (expressed as CPS) seems to be an important predictive factor of efficacy (SVR) and safety (absence of severe adverse events).

Available data about standard interferon and ribavirin treatment of hepatitis C virus (HCV) infection in decompensated cirrhotics, show low virological response (VR) in front of many life-treatening adverse events. However, a successfull treatment can prevent post-transplant reinfection and the use of pegylated-interferon (PEG-IFN) instead of standard IFN might ameliorate VR, making the risk-to-benefit ratio of therapy more favourable in patients on waiting list.

Mixed cryoglobulinaemia is the most common extrahepatic manifestation of chronic hepatitis C virus (HCV) infection, complicating >50% of cases [ [1] Medina J. et al. Review article: hepatitis C virus-related extra-hepatic disease-aetiopathogenesis and management. Aliment Pharmacol Ther. 2004; 20: 129-141 Crossref PubMed Scopus (31) Google Scholar ]. It is a lymphoproliferative disorder characterised by purpura and arthralgia due to the deposition of circulating immune complexes in small and medium blood vessels. Systemic vasculitis, glomerulonephritis, neuropathies can further complicate long-standing disease.

We report the case of a 61-year-old woman who presented a recurrent myxoid synovial sarcoma involving the right ankle and foot. This tumor, defined as a synovial sarcoma showing more than 50% myxoid change in the stroma, has only recently been described as a rare histological variant. The histological diagnosis is particularly difficult in such cases, as the one we are describing, where the tumor is entirely myxoid and monophasic raising the possibility of other myxoid soft tissue neoplasms, such as extraskeletal myxoid chondrosarcoma, malignant peripheral nerve sheath tumor or leiomyosarcoma. On the basis of morphological and immunophenotypical findings, the diagnosis of myxoid synovial sarcoma should be properly established, especially in view of its unusual clinical course and treatment. Furthermore, we will discuss the clinicopathological and immunohistochemical features observed in our case.