Marco Manfredi | University of Parma (original) (raw)

Papers by Marco Manfredi

INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Helicobacter pylori ( H. pylori) infection is a continuous challenge for both gastroenterologists... more Helicobacter pylori ( H. pylori) infection is a continuous challenge for both gastroenterologists and pediatricians. The international guidelines regarding diagnostic and treatment pathways differ between adults and children. The pediatric guidelines are more restrictive because children are rarely affected by serious consequences, particularly in Western countries. Therefore, infected children should be treated only after a careful case-by-case evaluation by a pediatric gastroenterologist. In any case, recent studies are confirming an increasingly all-around pathological role of H. pylori even in asymptomatic children. For these reasons, following the current evidence, we feel that H. pylori-infected children could be treated starting in pre-adolescence, particularly in Eastern countries, because their stomachs have already begun to develop the biomarkers of gastric damage. Therefore, we believe that H. pylori is anyway pathogen in children. Nevertheless, the possible beneficial ro...

Clinical Microbiology: Open Access, 2016

Leishmaniasis may cause visceral, cutaneous and/or mucocutaneous diseases. Cutaneous and mucocuta... more Leishmaniasis may cause visceral, cutaneous and/or mucocutaneous diseases. Cutaneous and mucocutaneous forms are caused by a single celled parasite transmitted by sand fly bites. Although the cutaneous form of the disease is often self-limiting, it results in significant scarring and can spread to more invasive, mucocutaneous disease. Therefore, treatment may be considered to prevent these complications. We describe a case report of cutaneous leishmaniasis contracted in a healthy man in Italy (Emilian Apennines). This cutaneous ulcer healed only with intralesional injection of meglumine antimoniate. After about 18 and 30 months a scar area is still present and no satellite lesion appeared. We have had no side effects or complications due to therapy.

Quality assessment of the included non-randomized studies based on the Newcastle-Ottawa Scale (NO... more Quality assessment of the included non-randomized studies based on the Newcastle-Ottawa Scale (NOS). (DOCX 57 kb)

For thousands of years humans have lived in symbiosis with Helicobacter pylori. This infection is... more For thousands of years humans have lived in symbiosis with Helicobacter pylori. This infection is acquired mainly during childhood and, despite it represents one of the most common infections in humans, only a minority of infected people may develop health issues and life-threatening diseases. For diagnosing Helicobacter pylori infection in children we can use, at first, non-invasive diagnostic tests, if clinical pattern and/or history are of suspicion. Then, invasive tests i.e. gastroscopy are necessary to confirm the infection. As antibiotics are not widely available in children affected by Helicobacter pylori infection, they should be chosen based on individual antibiotic susceptibility testing obtained by gastric biopsy specimens or the local antibiotic resistance pattern, in empirical treatment is chosen. Test and treat strategy in children should be avoided. In this brief review we summarize how and in which children the infection should be investigate and which the most appro...

Usually, non-invasive tests are the first methods for diagnosing Helicobacter pylori (HP) infecti... more Usually, non-invasive tests are the first methods for diagnosing Helicobacter pylori (HP) infection. Among these, serological test, stool antigen research and urea breath test are the most used. Antibodies anti-HP are not recommended in low prevalence population, moreover they cannot reveal an ongoing infection, but they only prove a contact with the bacterium. Also, they can persist for a long time after the eradication of the infection, therefore, they should not be used to verify the success of eradication therapy. Stool antigen research and Urea Breath Test (UBT) are useful both in diagnosis and during follow-up after eradication treatment. The stool antigen test is cheaper than Urea breath test with similar sensitivity and specificity. Non-invasive tests are not able to diagnose the associated complications to HP infection. (www.actabiomedica.it)

American Journal of Gastroenterology, 2015

Prolonged use of CS (combined UC and CD) was the lowest in Kentucky (Odds Ratio [OR]=0.71; p≤.001... more Prolonged use of CS (combined UC and CD) was the lowest in Kentucky (Odds Ratio [OR]=0.71; p≤.001) and the highest in South Dakota (OR=2.03; p =.005) (Figures 1A-B); CS-sparing therapy use was the lowest in Delaware (OR=0.51; p=.001) and the highest in Minnesota(OR=1.44; p=.046). Among UC patients, Virginia (OR=1.72; p=.030) and Arizona (OR=1.83; p=.049) had bone loss assessment rates that were higher than the rest of the country (Figure 1C). Bone loss assessment rate was the lowest in Mississippi (OR=0.52; p=.037) and the highest in Texas (OR=1.51; p≤.001) for CD patients (Figure 1D). Conclusion: Th is fi rst nationwide assessment of established quality indicators in IBD identifi ed substantial non-compliance related to steroid use and avoidance. Regional variations likely represent prescriber variation, but disease type may also factor into these fi ndings. Th is information will inform future quality improvement eff orts.

Gastrointestinal bleeding (GIB) is a very common condition at all ages, with high rates of morbid... more Gastrointestinal bleeding (GIB) is a very common condition at all ages, with high rates of morbidity and mortality, especially in case of acute presentation. The optimal management of acute GIB requires a timely overview of vital signs and clinical presentation to stabilize the patient if necessary and set up the most adequate diagnostic and therapeutic approach, based on the suspected etiology. Endoscopy plays a major role both in diagnosis and treatment of acute GIB, as allows the application of several hemostasis techniques during the diagnostic session, which should preferably be performed within 24 hours from the acute event. The hemostasis technique should be chosen based on type, etiology of the bleeding and the operator preference and expertise. Nevertheless, several challenging cases need the cooperation of radiology especially in the diagnostic phase, and even in the therapeutic phase for those bleedings in which medical and endoscopic techniques have failed. Imaging diagn...

Acta bio-medica : Atenei Parmensis, 2018

Helicobacter pylori (H. pylori) infection is one of the most common infection in humans, affectin... more Helicobacter pylori (H. pylori) infection is one of the most common infection in humans, affecting more than half of the population. The prevalence of the infection varies widely in rural developing areas (more than 80%) compared to urban developed ones (less than 40%), as a consequence of different socioeconomic and hygienic conditions. H. pylori infection is usually acquired during childhood; infected people usually remain asymptomatic, but about 30% of individuals may develop mild to severe upper gastrointestinal diseases such as gastritis, peptic ulcer, gastric cancer or MALT lymphoma. The transmission route is not clear yet; the person-to-person transmission, especially within the same family appears to be prevalent, but also environmental contamination is possible. The eradication without a specific therapeutic regimen is very unlikely and the reinfection rate after an effective eradication therapy is quite rare. The reinfection rate will increase if there are family members a...

World Journal of Emergency Surgery, 2017

Gastroenterology Research and Practice, 2015

The eradication therapy ofHelicobacter pylori(H. pylori) infection is still a challenge for gastr... more The eradication therapy ofHelicobacter pylori(H. pylori) infection is still a challenge for gastroenterologists. One of the main causes of failure inH. pylorieradication is the antibiotic resistance mainly to clarithromycin. Culture from biopsies is maybe the most used method among the antimicrobial susceptibility techniques. In this study, we compared the antimicrobial susceptibility changes in children withH. pyloriinfection over 13 years and we confirmed that clarithromycin resistance has been increased (16% versus 26%) though with no statistically signficant value. Therefore, clarithromycin should not be used in empiric treatment ofH. pylorieradication therapy in children, but its use should be limited only to children with known antimicrobial susceptibility. On the other hand, metronidazole resistance has decreased over this time period in statistically significant manner (56% versus 33%,p=0.014). Furthermore, ampicillin resistance has been confirmed to be very rare (3% versus ...

Indicazione all'indagine L'Urea Breath Test (UBT) è un test semplice, sicuro, non invasiv... more Indicazione all'indagine L'Urea Breath Test (UBT) è un test semplice, sicuro, non invasivo, largamente disponibile nella diagnosi e nel follow-up dell'infezione da H. pylori, facilmente utilizzabile negli adulti, nei bambini con più di 6 anni di età e nelle donne in gravidanza (1). Descrizione della tecnica Si basa sulla somministrazione di urea marcata con 13C o 14C che una volta ingerita è idrolizzata dall'ureasi batterica in ammonio e anidride carbonica (CO 2) marcata, quest'ultima poi escreta nel respiro. La presenza di CO 2 marcata nell'aria espirata alveolare indica la presenza del-l'H. pylori nello stomaco. Solitamente l'isotopo 13C è preferito per la sua stabilità, non-radioattività e sicurezza rispetto all'isotopo 14C. I soggetti sani non hanno la capacità di degradare l'urea che pertanto viene L'UBT si effettua dopo un periodo di digiuno di almeno 6 ore. Inizialmente si raccoglie un campione di respiro basale (tempo 0), quindi il...

European Journal of Inflammation, 2021

Every new pandemic forces us to start new specific behaviors both in the civil life and within th... more Every new pandemic forces us to start new specific behaviors both in the civil life and within the hospitals trying to contain the spreading of the infection and preserve the more fragile people. I...

In the human digestive system reside more than 100 trillion of microbes, 10 fold the number of eu... more In the human digestive system reside more than 100 trillion of microbes, 10 fold the number of eukaryotic cells of the human body, subdivided into about 1000 different types of bacteria, 100-fold more genes than the human genome [1]. This enormous quantity of bacteria gradually increases from the esophagus to the colon and composes our intestinal microbiota which helps keep the intestines healthy and assists in digesting food. Moreover it can also enhance the immune system [2,3]. We are being colonized immediately after birth and obviously the microbiota of born by spontaneous delivery is different from neonate born by caesarean one. The first microrganisms that colonize the digestive system are facultative anaerobic bacteria including Enterococci and Lactobacilli. Then anaerobes such as Bifidobacteria, Bacteoides, and Clostridium gradually increase, causing a progressive decrease of the facultative anaerobes. These gradual changes are completed around the age of three when the inte...

Biology and Medicine, 2017

Background and Aims: Helicobacter pylori infection is one of the most common gastrointestinal inf... more Background and Aims: Helicobacter pylori infection is one of the most common gastrointestinal infections in humans; it affects about 30% of people in developed countries and about 80% in developing ones. The majority of patients acquire the infection during childhood and the intrafamilial transmission is considered one of the most important routes of infection. The aim of this study was to assess the intrafamilial transmission rate among family members of index subjects. Methods: We have suggested all patients H. pylori-positive (99 patients, symptomatic index subjects) diagnosed during 18 months (Sep 2011-Dec 2012) to screen their family members by stool antigen test (SAT) and, when positive, to perform upper gastrointestinal endoscopy. Results: Through SAT we identified 126 patients belonging to 41 households of 99 initial index subjects, therefore 41 index subjects (41.4%) had at least one family member affected. The entire population studied included 225 H. pylori-positive patients: 99 index subjects (symptomatic) and 126 family members diagnosed by SAT screening and histological examination by gastroscopy. Of these, 103 patients (81.7%) were considered slightly symptomatic (mild clinical history until then not important enough to perform further diagnostic study) and 23 patients (18.3%) were totally asymptomatic. Conclusions: In the spread of H. pylori infection, the intrafamilial transmission is an important route of contamination; besides the known mother-to-child dyad, also the transmission among family members plays a considerable role and it should be always verified.

Biomedical Journal of Scientific & Technical Research

Although its progressive decline over the years, the prevalence of Helicobacter pylori (H. pylori... more Although its progressive decline over the years, the prevalence of Helicobacter pylori (H. pylori) is still high in most countries. Epidemiological studies report that in North European and North American populations, about one-third of adults are infected, whereas in south and east Europe, South America, and Asia, the prevalence of H. pylori is often higher than 50% [1]. Nevertheless, the prevalence in paediatric age ranges from 11% to 66.5% in Western Europe [1]. H. pylori infection is typically acquired during childhood and persists throughout life in absence of specific treatments. The epidemiological interest related to H. pylori is due to its major role in the pathogenesis of several gastrointestinal diseases, from chronic gastritis to gastric adenocarcinoma [2]. Gastric malignancies are mainly observed in adulthood, whereas few cases of lymphomas are also described in children [3,4]. However, the eradication of H. pylori is advised despite the age of the patient because it represents an appropriate primary chemoprevention of gastric cancer, especially among younger people, as well as of the development of atrophic gastritis and intestinal metaplasia [5], which are well Known precursors of malignancy [5]. Since the discovery of H. pylori, many therapeutic