Foto del docente

Carlo Calabrese

Assistant professor

Department of Medical and Surgical Sciences

Academic discipline: MED/09 Internal Medicine

Research

Familial Adenomatous Polyposis (FAP).

Chronic inflammatory intestinal diseases.

IFN therapy in patients with HCV-related cirrhosis and the role of the natural history markers correlate HCV.

Treatment of microscopic colitis.

Gastric Infection by Helicobacter pylori infection: the role of endoscopy and treatment protocols.

Gastroesophageal reflux disease: physiopathogenesis aspects, diagnosis and therapy.

Biochemical indicators of gastrointestinal mucosa human tumor and normal.

Capsule Endoscopy.



Familial Adenomatous Polyposis (FAP). From 20 to 90% of patients with FAP develop a cancer of the duodenum. Since colectomy prevents the development of colorectal cancer developing cancer elsewhere is of great importance in these young patients. The identification of abnormal cell at the duodenal mucosa in patients at high risk is therefore both diagnostic value both in terms of chemoprevention therapeutic strategies. Initially, we showed the presence of a high proliferative capacity of cells duodenal in FAP patients with a normal macroscopic. Then, we assessed the proliferative indices and ultrastructural appearance (scanning electron microscopy and transmission) in patients suffering from FAP with microscopically normal mucosa and those with polyps. These studies showed that the duodenal mucosa of patients with FAP increased cell proliferation and reduced intercellular interaction are to be considered as potential markers of neoplastic transformation.

 

Chronic inflammatory intestinal diseases. It was suggested that the risk of colorectal cancer in patients with ulcerative colitis is related to a reduced bioavailability of folate. We then conducted a study that evaluated the effects of folate supplementation on the proliferative cells of colorectal in patients suffering from long-CU. The results suggested that folate may represent a valuable chemoprevention agent against colorectal  malignancy in these patients. In patients suffering from RCU was conducted a prospective study that included surveillance in 65 patients performing colitis annually or every two years during which multiple biopsies were performed series searching for histological changes (dysplasia low, medium, high degree or carcinoma). Despite well in 8 patients were diagnosed relevance of surgical lesions, the results of the study are unfortunately not significant given the high number of drop-outs (29 patients, equal to 44.6% have left the study), even if there are confirmations previous observations such as the onset of colorectal cancer appears more related to the duration of the disease, with an average age of onset similar to that of the general population; the low-grade dysplasia or grade undefined, finally not appeared lesions

 

IFN therapy in patients with HCV-related cirrhosis. The goal of therapy with IFN in HCV-related chronic hepatitis is to prevent or delay the emergence of cirrhosis and the. In cirrhotic patients undergoing initial treatment with IFN should aim to slow the progression of the disease by improving the survival and quality of life. In order to assess the efficacy and tolerability of IFN- alpha in patients with compensated liver cirrhosis HCV positive, we conducted a prospective clinical study using a non-conventional treatment involving the use of progressively increasing doses for 12 months . The results at the end of treatment showed that the IFN-alpha is able to induce a primary response in over 30% of cases.  In patients with HCV related hepatitis response to therapy with IFN-alpha is closely related to both levels is at histology  Gamma-glutamil transferase liver, in particular, the higher the levels of GGT and the presence of cirrhosis are independent predictive values not therapy response to the common strengths of INF- alpha.

The role of the natural history markers correlate HCV has long been controversy. We conducted a prospective non-randomized controlled the maximum duration of 58 months on 144 patients, half of whom have been treated with IFN. During the follow-up were assessed the appearance of clinical complications (ascites, varices from bleeding, jaundice, encephalopathy, and exitus HCC). The study concluded that treatment with IFN does not seem to improve the survival of cirrhotic patients while being able to prevent or delay the development. Patients with clinical response to IFN did not develop any complication during the follow-up.

 

Treatment of microscopic colitis. The microscopic colitis is a syndrome characterized by chronic watery diarrhea with normal macroscopic and radiological, and some histological abnormality. There have been some studies conducted on the treatment of this condition, but not conclusive. We conducted a prospective randomized study on the treatment of colitis mesalazine with microscopic and the possible association with cholestyramine. This study showed that treatment with mesalazine  alone is able to induce healing in more than 85% of patients with lymphocytic colitis and the association with cholestyramine increases in the percentage of healing colitis collagenosic up to 91%.

 

Gastric Infection by Helicobacter pylori infection: the role of endoscopy and treatment protocols. The gastric infection by Helicobacter pylori induces paintings of histological inflammation with different expression of mucosal damage. However, the correlation between a specific framework macroscopic and the infection itself is widely debated in the literature. To this end, we conducted a prospective randomized study on a large series of patients undergoing endoscopy of the upper digestive tract on which were performed biopsies for histological evaluation and for the presence of H. Pylori. The panel found endoscopic antral were assigned to 1 of 5 categories provided by endoscopic classification of Sydney. The study showed the presence of a statistically significant correlation between the frame of modularity antral and infection by H. Pylori. However, the predictive value of disease was 70%, even for the high presence of paintings histologically normal despite co-existing infection. This involves the inability to use the framework as endoscopic predictive of disease and the need to search through other methods (13C-UBT, Test with rapid, Histology). During the last decade many have been conducted research to identify the key therapeutic ideal for eradication. Helicobacter pylori, which should be simple or short-term, effective and limited side effects. Therefore, we conducted a prospective randomized study in 100 patients with infection by H. Helicobacter pylori, randomly assigned to one of two treatment schedules that included the use of Azitromicyne and Tinidazole for 3 days with or without pretreatment with Pantoprazole. The percentage of eradication was excellent (88%) and no differences were noted between the two treatment groups.

 

Gastroesophageal reflux disease: physiopathogenesis aspects, diagnosis and therapy. The GERD is a common disease whose definition is complex, a wide spectrum of severity, in which the symptomatic patients with non-erosive disease, representing about two thirds. Studies physio-pathogenesis and ultrastructural morphology, conducted on rabbits have shown in the expansion of spaces a marker of disease. We conducted a clinical study, functional, and ultrastructural morphometric on 38 patients and 12 healthy volunteers. We showed that the expansion of spaces, in animals as in humans, is the marker of disease. Later we assessed the ability of proton pump inhibitors to induce healing symptomatic, endoscopic and ultrastructural both in acid-peptic reflux disease or without bile. We also assessed the proliferative capacity of being esophageal reflux disease and erosive gastro-esophageal not. Assuming that the development of different macroscopic pattern with the same underlying event physiopathological what is gastro-esophageal reflux, are from a different proliferative capacity expressed from esophageal probably intrinsic to the same cells and therefore genetically determined.  In addition, they have been assessed and validated two questionnaires on the quality of life in the course of gastro-esophageal reflux disease and dyspepsia. Finally, it was assessed the effect of pantoprazole used a double dose and for six months in the course of asthma related to reflux disease.

Biochemical indicators of gastrointestinal mucosa human tumor and normal. The research for possible mediators in carcinogenesis gastrointestinal showed production of molecules that can be used as a biochemical marker. These may provide a means of early diagnosis, before the development of macroscopic lesions. Moreover, contrary to histological markers, any molecular markers can be sought in biological fluids, such as blood or stool. Therefore, a better understanding of the biochemical composition of normal human tissues and pathological can provide information on the presence of molecular changes pre-morphologic. This is a necessary condition for a clinical application of modern methods and innovative non-invasive such as magnetic resonance spectroscopic achieved in vivo directly on the patient whose feasibility is based on the identification of molecular markers. The objectives of the project were: characterization of biochemical composition of gastrointestinal tissue; Better understanding of the development of cancer at the molecular level; Identification of biochemical indicators of an altered metabolic state in order to develop diagnostic methods in vivo.

 

Capsule Endoscopy. The pouchitis is a frequent complication of IPAA for ulcerative colitis. The refractory pouchitis is a chronic condition resistant to treatment with a frequency of approximately 15% of patients. The purpose of this study was to evaluate the possibility of an involvement by the CE. The presence of chronic refractory pouchitis may suggest the involvement of an inflammatory disease of unknown.