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| 1 | Proton pump inhibitors in cirrhosis:Tradition or evidence based practice?显示文摘Proton Pump Inhibitors (PPI) are very effective in inhibiting acid secretion and are extensively used in many acid related diseases. They are also often used in patients with cirrhosis sometimes in the absence of a specific acid related disease, with the aim of preventing peptic complications in patients with variceal or hypertensive gastropathic bleeding receiving multidrug treatment. Contradicting reports support their use in cirrhosis and evidence of their efficacy in this condition is poor. Moreover there are convincing papers suggesting that acid secretion is reduced in patients with liver cirrhosis. With regard to Helicobacter pylori (H pylori) infection, its prevalence in patients with cirrhosis is largely variable among different studies, and it seems that H pylori eradication does not prevent gastro-duodenal ulcer formation and bleeding. With regard to the prevention and treatment of oesophageal complications after banding or sclerotherapy of oesophageal varices, there is little evidence for a protective role of PPI. Moreover, due to liver metabolism of PPI, the dose of most available PPIs should be reduced in cirrhotics. In conclusion, the use of this class of drugs seems more habit related than evidence- based eventually leading to an increase in health costs. | Francesca Lodato Francesco Azzaroli Maria Di Girolamo Valentina Feletti Paolo Cecinato Andrea Lisotti Davide Festi Enrico Roda Giuseppe Mazzella | 2008 | World Journal of Gastroenterology2008，14，19： | 10 |
| 2 | Hepatocellular carcinoma prevention:A worldwide emergence between the opulence of developed countries and the economic constraints of developing nations显示文摘Hepatocellular carcinoma (HCC) is the fifth most common neoplasm, the major cause of death in patients with liver cirrhosis, and the third most common cause of cancer-related death in the world. The geographic distribution of HCC varies significantly and 80% of cases occur in developing countries (Far East and South Asia) where the prevalence of viral hepatitis is higher. The treatment of HCC is difficult because most patients are diagnosed when the tumour is in an advanced stage and is not amenable to potential curative therapy, thus prevention is the key to reducing HCC and its related morbidity and mortality. HCC is unique among cancers, occurring mostly in patients with a known risk factor. Ninety percent of HCCs develop in the context of chronic liver diseases and mainly in patients with cirrhosis. Viral hepatitis is the most common cause of HCC worldwide, followed by alcoholic liver disease (ALD) and other causes such as non-alcoholic fatty liver disease (NAFLD), genetic haemocromatosis (GH) and primary biliary cirrhosis in an advanced stage (Ⅲ- Ⅴ). In certain areas of the People’s Republic of China, exposure to aflatoxin and HBV infection are thought to be responsible for the extraordinary high risk of HCC. Substantial progresses in the prevention of virusl-related hepatitis (screening of blood units, use of disposable sanitary tools, HBV vaccination) have been achieved in developed countries, but in the same areas, alcohol- and dysmetabolism-related HCCs are emerging problems which require specific interventions in terms of public health measures. In developing countries, economic constraints limit the development of any program for the prevention of viral hepatitis transmission (including health education campaigns, healthcare politics, primary prevention and the improvement of hygienic and sanitary conditions). When viral liver disease is established, only a minority of patients are treated worldwide and benefit a possible preventive effect of medical treatment onHCC development. Thus the real contribution of medical treatment to HCC prevention in patients with chronic viral hepatitis is small. Great efforts are needed to identify more effective medical measures for primary and secondary prevention of HCC. | Francesca Lodato Giuseppe Mazzella Davide Festi Francesco Azzaroli Antonio Colecchia Enrico Roda | 2006 | World Journal of Gastroenterology2006，12，45： | 9 |
| 3 | Systemic lupus erythematosus following virological response to peginterferon alfa-2b in a transplanted patient with chronic hepatitis C recurrence显示文摘自体免疫的表明在丙肝病毒长期地感染的病人,并且在为非自体免疫的疾病移植的病人是普通的。在干扰素之间的关联基于治疗和自体免疫的疾病或自身抗体的发展很好在非移植的病人被建立,但是很少数据关于移植病人是可得到的。干扰素是否可以增加尖锐细胞的拒绝的发生,是不清楚的,在肝以后的移植干扰素或 pegylated 干扰素治疗期间在不正常的自体免疫的表明的发展有很少报告。我们与长期的丙肝的复发在一个移植病人与 pegylated 干扰素 alfa-2b 描述全身性红斑狼疮追随者治疗的一个案例。我们的经验建议那 pegylated 干扰素可以在免疫导致自体免疫的疾病压制的主人,与为到在干扰素期间,在肝的基于的治疗移植了的可能的自体免疫的混乱开发的大注意的尖锐细胞的拒绝和电话不同病人。 | Francesca Lodato Maria Rosa Tamé Antonio Colecchia Chiara Racchini Francesco Azzaroli Antonia D'Errico Silvia Casanova Antonio Pinna Enrico Roda Giuseppe Mazzella | 2006 | World Journal of Gastroenterology2006，12，26： | 2 |
| 4 | G-CSF in Peg-IFN induced neutropenia in liver transplanted patients with HCV recurrence显示文摘AIM:To evaluate the efficacy of granulocyte colony stimulating factors(G-CSF)in liver transplanted patients with hepatitis C(HCV)recurrence and Pegylated-IFN α-2b induced neutropenia,and to evaluate the impact of G-CSF administration on virological response. METHODS:Sixty-eight patients undergoing antiviral treatment for post-liver transplantation(OLT)HCV recurrence were enrolled.All patients developing neutropenia received G-CSF. RESULTS:Twenty three(34%)received G-CSF.Mean neutrophil count at the onset of neutropenia was 700/mmc(range 400-750/mmc);after 1 mo of G-CSF it increased to 1210/mmc(range 300-5590/mmc) (P<0.0001).Three patients did not respond to G-CSF. Treatment duration was similar in neutropenic and non-neutropenic patients.No differences in the rate of discontinuation,infections or virological response were observed between the two groups.G-CSF was protective for the onset of de novo autoimmune hepatitis(P<0.003). CONCLUSION:G-CSF administration is effective in the case of Peg-IFN induced neutropenia increasingneutrophil count,prolonging treatment and leading to sustained virological response(SVR)rates comparable to non-neutropenic patients.It prevents the occurrence of de novo autoimmune hepatitis. | Francesca Lodato Francesco Azzaroli Maria Rosa Tamè Maria Di Girolamo Federica Buonfiglioli Natalia Mazzella Paolo Cecinato Enrico Roda Giuseppe Mazzella | 2009 | World Journal of Gastroenterology2009，15，43： | 1 |
| 5 | Interferon plus ribavirin and interferon alone in preventing hepatocellular carcinoma: A prospective study on patients with HCV related cirrhosis显示文摘AIM: To determine the role of interferon (IFN) with or without ribavirin in preventing or delaying hepatocellular carcinoma (HCC) development in patients with hepatitis C virus (HCV) related cirrhosis. Data on the preventive effect of IFN plus ribavirin treatment are lacking.METHODS: A total of 101 patients (62 males and 39 females, mean age 55.1:1:1.4 years) with histologically proven HCV related liver cirrhosis plus compatible biochemistry and ultrasonography were enrolled in the study. Biochemistry and ultrasonography were performed every 6 too. Ultrasound guided liver biopsy was performed on all detected focal lesions. Follow-up lasted for 5 years. Cellular proliferation, evaluated by measuring Ag-NOR proteins in hepatocytes nuclei, was expressed as AgNOR-Proliferative index (AgNOR-PI) (cut-off = 2.5). Forty-one patients (27 males, 14 females) were only followed up after the end of an yearly treatment with IFN-alpha2b (old treatment control group = OTCG). Sixty naive patients were stratified according to sex and AgNOR-PI and then randomized in two groups: 30 were treated with IFN-alpha2b + ribavirin (treatment group=TG), the remaining were not treated (control group=CG). Nonresponders (NR) or relapsers in the TG received further IFN/ribavirin treatments after a 6 mo of withdrawal. RESULTS: AgNOR-PI was significantly lowered by IFN (P<0.001). HCC incidence was higher in patients with AgNOR-PI>2.5 (26% vs3%, P<0.01). Two NR in the OTCG, none in the TG and 9 patients in the CG developed HCC during follow-up. The Kaplan-Mayer survival curves showed statistically significant differences both between OTCG and CG (P<0.004) and between TG and CG (P<0.003). CONCLUSION: IFN/ribavirin treatment associated with retreatment courses of NR seems to produce the best results in terms of HCC prevention. AgNOR-PI is a useful marker of possible HCC development. | Francesco Azzaroli Esterita Accogli Giovanni Nigro Davide Trerè Silvia Giovanelli Anna Miracolo Francesca Lodato Marco Montagnani Mariarosa Tamé Antonio Cloecchia Constance Mwangemi Davide Festi Enrico Roda Massimo Derenzini Giuseppe Mazzella | 2004 | World Journal of Gastroenterology2004，10，21： | 0 |
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