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| 1 | Follow-up of intestinal metaplasia in the stomach: When, how and why显示文摘Gastric cancer remains the second most frequent cause of cancer-related mortality in the world. Screening programs in some Asian countries are impractical in the majority of other countries worldwide. Therefore, follow-up of precancerous lesions is advisable for secondary gastric cancer prevention. Intestinal metaplasia (IM) is recognized as a precancerous lesion for gastric cancer, increasing the risk by 6-fold. IM is highly prevalent in the general population, being detected in nearly 1 of every 4 patients undergoing upper endoscopy. The IM prevalence rate is significantly higher in patients with Helicobacter pylori (H. pylori) infection, in first-degree relatives of gastric cancer patients, in smokers and it increases with patient age. IM is the 'breaking point' in the gastric carcinogenesis cascade and does not appear to regress following H. pylori eradication, although the cure of infection may slow its progression. Gastric cancer risk is higher in patients with incomplete-type IM, in those with both antral and gastric body involvement, and the risk significantly increases with IM extension over 20% of the gastric mucosa. Scheduled endoscopic control could be cost-effective in IM patients, depending on the yearly incidence of gastric cancer in IM patients, the stage of gastric cancer at diagnosis discovered at surveillance, and the cost of endoscopy. As a pragmatic behavior, yearly endoscopic control would appear justified in all IM patients with at least one of these conditions: (1) IM extension > 20%; (2) the presence of incomplete type IM; (3) first-degree relative of gastric cancer patients; and (4) smokers. In the remaining IM patients, a less intensive (2-3 years) could be proposed. | Angelo Zullo Cesare Hassan Adriana Romiti Michela Giusto Carmine Guerriero Roberto Lorenzetti Salvatore MA Campo Silverio Tomao | 2012 | World Journal of Gastrointestinal Oncology2012，4，3： | 25 |
| 2 | Gastric low-grade mucosal-associated lymphoid tissue-lymphoma: Helicobacter pylori and beyond显示文摘The stomach is the most frequently involved site for extranodal lymphomas,accounting for nearly two-thirds of all gastrointestinal cases.It is widely accepted that gastric B-cell,low-grade mucosal-associated lymphoid tissue(MALT)-lymphoma is caused by Helicobacter pylori(H.pylori)infection.MALT-lymphomas may engender different clinical and endoscopic patterns.Often,diagnosis is confirmed in patients with only vague dyspeptic symptoms and without macroscopic lesions on gastric mucosa.H.pylori eradication leads to lymphoma remission in a large number of patients when treatment occurs at an early stage(Ⅰ-Ⅱ1).Neoplasia confined to the submucosa,localized in the antral region of the stomach,and without API2-MALT1 translocation,shows a high probability of remission following H.pylori eradication.When both bacterial infection and lymphoma recur,further eradication therapy is generally effective.Radiotherapy,chemotherapy and,in selected cases,surgery are the available therapeutic options with a high success rate for those patients who fail to achieve remission,while data on immunotherapy with monoclonal antibodies (rituximab)are still scarce.The 5-year survival rate is higher than 90%,but careful,long-term follow-up is required in these patients since lymphoma recurrence has been reported in some cases. | Angelo Zullo Cesare Hassan Francesca Cristofari Francesco Perri Sergio Morini | 2010 | World Journal of Gastrointestinal Oncology2010，2，4： | 21 |
| 3 | Mechanisms of Helicobacter pylori antibiotic resistance:An updated appraisal显示文摘Helicobacter pylori(H. pylori) antibiotic resistance is the main factor affecting the efficacy of the current eradicating therapies. The aim of this editorial is to report on the recent information about the mechanisms accounting for the resistance to the different antibiotics currently utilized in H. pylori eradicating treatments. Different mechanisms of resistance to clarithromycin,metronidazole,quinolones,amoxicillin and tetracycline are accurately detailed(point mutations,redox intracellular potential,pump efflux systems,membrane permeability) on the basis of the most recent data available from the literature. The next hope for the future is that by improving the knowledge of resistance mechanisms,the elaboration of rational and efficacious associations for the treatment of the infection will be possible. Another auspicious progress might be the possibility of a cheap,feasible and reliable laboratory test to predict the outcome of a therapeutic scheme. | Vincenzo De Francesco Angelo Zullo Cesare Hassan Floriana Giorgio Rosa Rosania Enzo Ierardi | 2011 | World Journal of Gastrointestinal Pathophysiology2011，2，3： | 10 |
| 4 | 主要 clarithromycin 抵抗到 Helicobacter pylori : 这是为三倍的治疗失败的主要原因?显示文摘 Conventional triple therapies for Helicobacter pylori (H. pylori ) eradication have recently shown a disappointing reduction in effectiveness in many countries. The main reason for failure was found to be bacterial resistance to one of the most commonly used antibiotics, clarithromycin. An additional problem for conventional triple therapy is the high rate of resistance to metronidazole found in Europe, America and Asia. In Italy, in the last 15 years a 2-fold increase in resistance has occurred. A recent study of the whole of Italy included about 20 patients from each region at the first endoscopic diagnosis of H. pylori infection. The most surprising result was the patchy distribution of resistance, which was almost absent in two regions (one northern and one southern), although the highest prevalence was found in some regions of the South. In the paediatricpopulation we found a 25% prevalence of resistance in a sample of H. pylori positive children observed between 2002 and 2007, mirroring data obtained in southern European countries. Clarithromycin resistance assessment is currently based on phenotypic detection performed after culture the agar dilution method or E-test, and genotypic methods based on polymerase chain reaction (PCR). In a recent comparative study we found a 71.2% agreement between the two methods. Culture-free techniques are highly accurate in finding even minimal traces of genotypically resistant strains. Moreover, PCR-based tools are accurate in detecting a heteroresistant status, defined as the co-existence of some strains that are susceptible and some resistant to the same antibiotic in an individual patient. Three point mutations, namely A2143G , A2142G and A2142C , are responsible for 90% of cases of primary clarithromycin resistance in H. pylori strains isolated in Western countries, although we previously demonstrated that the presence of the A2143G mutation, but not A2142G or A2142C , significantly lowered the H. pylori eradication rate. Treatment failure has considerable cost/benefit implications because of 'waste' of National Health System and patient resources, in terms of drugs, further diagnostic tests and medical examination expenses. Therefore, in future it would be very useful to be able to test for clarithromycin resistance before starting conventional triple therapy. Hopefully, fast, effective noninvasive tests may soon be devised to determine this condition. | Floriana Giorgio Mariabeatrice Principi Vincenzo De Francesco Angelo Zullo Giuseppe Losurdo Alfredo Di Leo Enzo Ierardi | 2013 | World Journal of Gastrointestinal Pathophysiology2013，4，3： | 10 |
| 5 | Helicobacter pylori and functional dyspepsia: An unsolved issue?显示文摘Patients with Helicobacter pylori(H. pylori) infection may complain of dyspeptic symptoms without presence of macroscopic lesions on gastroduodenal mucosa. Such a condition is usually recognized as functional dyspepsia, and different pathogenetic mechanisms are involved. The role of H. pylori in these patients is controversial. Several trials assessed the potential role of H. pylori eradication in improving dyspeptic symptoms, and data of some meta-analyses demonstrated that cure of infection is associated with a small(10%), but significant therapeutic gain as compared to placebo. The reason for which dyspeptic symptoms regress in some patients following bacterial eradication, but persist in others remains unclear. Regrettably, trials included in the meta-analyses are somewhat different for study design, definition of symptoms, assessment of symptoms changes, and some may be flawed by potential pitfalls. Consequently, the information could be not consistent. We critically reviewed the main available trials, attempting to address future research in this | Angelo Zullo Cesare Hassan Vincenzo De Francesco Alessro Repici Raffaele Manta Silverio Tomao Bruno Annibale Dino Vaira | 2014 | World Journal of Gastroenterology2014，20，27： | 8 |
| 6 | Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline显示文摘 | C. Hassan M. Bretthauer M. Kaminski M. Polkowski B. Rembacken B. Saunders R. Benamouzig O. Holme S. Green T. Kuiper R. Marmo M. Omar L. Petruzziello C. Spada A. Zullo J. Dumonceau | 2013 | Endoscopy2013，，02： | 7 |
| 7 | Helicobacter pylori therapy:Present and future显示文摘Helicobacter pylori(H.pylori) plays a crucial role in the pathogenesis of chronic active gastritis,peptic ulcer and gastric mucosa-associated lymphoid tissue-lymphoma,and is also involved in carcinogenesis of the stomach.H.pylori treatment still remains a challenge for physicians,since no current first-line therapy is able to cure the infection in all treated patients.Several factors may help in the eradication of therapy failure.We reviewed both bacterial and host factors involved in therapeutic management of the H.pylori infection.In addition,we evaluated data on the most successful therapy regimens-sequential and concomitant therapies-currently available for H.pylori eradication. | Vincenzo De Francesco Enzo Ierardi Cesare Hassan Angelo Zullo | 2012 | World Journal of Gastrointestinal Pharmacology and Therapeutics2012，3，4： | 7 |
| 8 | Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy显示文摘AIM: To investigate in a prospective study whether a simplifi ed clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy. METHODS: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were strati- fied according to a simple clinical score (T-score), including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis. RESULTS: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2, and 175 (40%) T3. Overall, stigmata of recent haem-orrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in T1 patients than in T2/T3 cases (85% vs 3.2%; χ2 = 304.5309, P < 0.001). Older age (t=3.311; P < 0.01) and presence of comor-bidities (χ2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients. CONCLUSION: Our simplifi ed clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further,randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients. | Leonardo Tammaro Maria Carla Di Paolo Angelo Zullo Cesare Hassan Sergio Morini SebastianoCaliendo Lorella Pallotta | 2008 | World Journal of Gastroenterology2008，14，32： | 6 |
| 9 | Furazolidone therapy for Helicobacter pylori:Is it effective and safe?显示文摘Some aspects related with the use of furazolidone as a rescue therapy for Helicobacter pylori(H pylori) infection should be remarked,especially regarding its potential oncologic risk.The inclusion of furazolidone in a treatment regimen for H pylori infection is,at least,controversial,and it does not appear to be safe. | Vincenzo De Francesco Enzo Ierardi Cesare Hassan Angelo Zullo | 2009 | World Journal of Gastroenterology2009，15，15： | 6 |
| 10 | Concomitant, sequential, and hybrid therapy for H. pylori eradication: a pilot study.显示文摘 | Angelo Zullo Giuseppe Scaccianoce Vincenzo De Francesco Valentina Ruggiero Pasquale D’Ambrosio Luigi Castorini Leonilde Bonfrate Lucy Vannella Cesare Hassan Piero Portincasa | 2013 | Clinics and Research in Hepatology and Gastroenterology2013，，： | 4 |
| 11 | Vesical dysfunctions after radical hysterectomy for cervical cancer: a critical review显示文摘 | Marzio Angelo Zullo Natalina Manci Roberto Angioli Ludovico Muzii Pierluigi Benedetti Panici | 2003 | Critical Reviews in Oncology and Hematology2003，，3： | 4 |
| 12 | Helicobacter pylori eradication and reflux disease onset:Did gastric acid get 'crazy'?显示文摘Gastroesophageal reflux disease (GORD) is highly prevalent in the general population.In the last decade,a potential relationship between Helicobacter pylori (H.pylori) eradication and GORD onset has been claimed.The main putative mechanism is the gastric acid hypersecretion that develops after bacterial cure in those patients with corpus-predominant gastritis.We performed a critical reappraisal of the intricate pathogenesis and clinical data available in this field.Oesophagitis onset after H.pylori eradication in duodenal ulcer patients has been ascribed to a gastric acid hypersecretion,which could develop following body gastritis healing.However,the absence of an acid hypersecretive status in these patients is documented by both pathophysiology and clinical studies.Indeed,duodenal ulcer recurrence is virtually abolished followingH.pylori eradication.In addition,intra-oesophageal pH recording studies failed to demonstrated increased acid reflux following bacterial eradication.Moreover,oesophageal manometric studies suggest that H.pylori eradication would reduce-rather than favor-acid reflux into the oesophagus.Finally,data of clinical studies would suggest that H.pylori eradication is not significantly associated with eitherreflux symptoms or erosive oesophagitis onset,some data suggesting also an advantage in curing the infection when oesophagitis is already present.Therefore,the legend of 'crazy acid' remains-as all the others a fascinating,but imaginary tale. | Angelo Zullo Cesare Hassan Alessandro Repici Vincenzo Bruzzese | 2013 | World Journal of Gastroenterology2013，19，6： | 4 |
| 13 | Effects of Helicobacter pylori Eradication on Early Stage Gastric Mucosa–Associated Lymphoid Tissue Lymphoma显示文摘 | Angelo Zullo Cesare Hassan Francesca Cristofari Alessandro Andriani Vincenzo De Francesco Enzo Ierardi Silverio Tomao Manfred Stolte Sergio Morini Dino Vaira | 2010 | Clinical Gastroenterology and Hepatology2010，，2： | 3 |
| 14 | Focus on genetic and epigenetic events of colorectal cancer pathogenesis: implications for molecular diagnosis显示文摘 | Federica Zoratto Luigi Rossi Monica Verrico Anselmo Papa Enrico Basso Angelo Zullo Luigi Tomao Adriana Romiti Giuseppe Lo Russo Silverio Tomao | 2014 | Tumor Biology2014，，7： | 3 |
| 15 | Culture-Based Selection Therapy for Patients Who Did Not Respond to Previous Treatment for Helicobacter pylori Infection显示文摘 | Giulia Fiorini Nimish Vakil Angelo Zullo Ilaria M. Saracino Valentina Castelli Chiara Ricci Cristina Zaccaro Luigi Gatta Dino Vaira | 2012 | Clinical Gastroenterology and Hepatology2012，，： | 3 |
| 16 | Intestinal metaplasia surveillance:Searching for the roadmap显示文摘Atrophic gastritis and intestinal metaplasia(IM) of the stomach are common and are associated with an increased risk for gastric cancer.In the absence of guidelines,a pragmatic management has been performed in Western countries in patients with these premalignant conditions.Recently,formal European guidelines have been delivered on this topic.Basically,it has been recommended that patients with extensive atrophic gastritis(AG) and/or extensive IM should be offered endoscopic surveillance every 3 years.On the contrary,no scheduled endoscopic/histological control has been advised for those patients with precancerous conditions confined to the antrum.In this commentary,we highlighted some potential weaknesses in the management formally recommended by the new guidelines.In detail,we discussed that AG and IM patients do not share the same gastric cancer risk,at least in Western countries,deserving a different approach.Some factors significantly associated with gastric cancer risk,such as IM type,first-degree family history of gastric cancer,and smoking habit have not been considered in tailoring the endoscopic follow-up.Finally,some data would suggest that a 3-year follow-up in patients with extensive gastric precancerous conditions could result in an inadequate secondary prevention. | Angelo Zullo Cesare Hassan Alessandro Repici Bruno Annibale | 2013 | World Journal of Gastroenterology2013，19，10： | 2 |
| 17 | Balanced propofol sedation administered by nonanesthesiologists:The first Italian experience显示文摘AIM:To assess the efficacy and safety of a balanced approach using midazolam in combination with propofol,administered by nonanesthesiologists,in a large series of diagnostic colonoscopies.METHODS:Consecutive patients undergoing diagnostic colonoscopy were sedated with a single dose of midazolam(0.05 mg/kg)and lowdose propofol(starter bolus of 0.5 mg/kg and repeated boluses of 10 to 20 mg).Induction time and deepest level of sedation,adverse and serious adverse events,as well as recovery times,were prospectively assessed.Cecal intubation and adenoma detection rates were also collected.RESULTS:Overall,1593 eligible patients were included.The median dose of propofol administered was 70 mg(range:40120 mg),and the median dose of midazolam was 2.3 mg(range:24 mg).Median induction time of sedation was 3 min(range:14 min),and median recovery time was 23 min(range:1040 min).A moderate level of sedation was achieved in 1561(98%) patients,whilst a deep sedation occurred in 32(2%) cases.Transient oxygen desaturation requiring further oxygen supplementation occurred in 8(0.46%;95% CI:0.2%0.8%)patients.No serious adverse event was observed.Cecal intubation and adenoma detection rates were 93.5%and 23.4%(27.8%for male and 18.5%for female,subjects),respectively.CONCLUSION:A balanced sedation protocol provided a minimalization of the dose of propofol needed to target a moderate sedation for colonoscopy,resulting in a high safety profile for nonanesthesiologist propofol sedation. | Alessandro Repici Nico Pagano Cesare Hassan Alessandra Carlino Giacomo Rando Giuseppe Strangio Fabio Romeo Angelo Zullo Elisa Ferrara Eva Vitetta Daniel de Paula Pessoa Ferreira Silvio Danese Massimo Arosio Alberto Malesci | 2011 | World Journal of Gastroenterology2011，17，33： | 2 |
| 18 | Safety of cold polypectomy for < 10 mm polyps at colonoscopy: a prospective multicenter study显示文摘 | A. Repici C. Hassan E. Vitetta E. Ferrara G. Manes G. Gullotti A. Princiotta P. Dulbecco N. Gaffuri E. Bettoni N. Pagano G. Rando G. Strangio A. Carlino F. Romeo D. de Paula Pessoa Ferreira A. Zullo L. Ridola A. Malesci | 2012 | Endoscopy2012，，01： | 2 |
| 19 | Endoscopic submucosal dissection of early gastric neoplastic lesions: a western series显示文摘 | Alessandro Repici Angelo Zullo Cesare Hassan Paola Spaggiari Giuseppe Strangio Eva Vitetta Elisa Ferrara Alberto Malesci | 2013 | European Journal of Gastroenterology & Hepatology2013，，11： | 2 |
| 20 | A randomized controlled trial evaluating a new 2-L PEG solution plus ascorbic acid vs 4-L PEG for bowel cleansing prior to colonoscopy显示文摘 | Flavio Valiante Stefano Pontone Cesare Hassan Angelo Bellumat Manuela De Bona Angelo Zullo Vincenzo de Francesco Michele De Boni | 2011 | Digestive and Liver Disease2011，，3： | 2 |
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