Chapters authored
The Clinical Relevance of Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux in Clinical Practice
Gastric reflux may be considered a para-physiological event that may occur up to 50 times a day. It usually happens when gas (less commonly liquids) flow back from stomach into esophagus. However, when defense mechanisms leave, disease may progress. If the esophagus is the trigger, gastroesophageal reflux disease (GERD) emerges. The prevalence of GERD in the primary care setting seems to be even more evident when one considers that, in the United States, 4.6 million office encounters annually are primarily for GERD, whereas 9.1 million encounters include GERD in the top 3 diagnoses for the encounter. GERD constitutes also the most frequently first-listed gastrointestinal diagnosis in ambulatory care visits. In addition, the extraesophageal manifestations of reflux, including LPR, asthma, and chronic cough, have been estimated to cost $5438 per patient in direct medical expenses in the first year after presentation and $13,700 for 5 years. Presently, the newest alginate compounds renowned the interest in this attracting and stimulating area. In this regard, a new medical device (Marial®), unique still now possessing the indication for both GERD and LPR, has been recently launched in the Italian market, two large surveys were conducted in Italy: RELIEF, involving 86 otolaryngologists, and EMERGE, involving 56 gastroenterologists. The aims of these surveys were: (1) to define clinical characteristics, including previous treatment, of the patients referred to consultation; (2) to evaluate the reliability of RFS, GIS, and RSI questionnaires in real-world settings, such as specialist office; and (3) to investigate the patients’ perception of efficacy of the prescribed therapy, based on the best practice and considering also the new medical device Comparing the patients’ perception of treatment efficacy, reduction in RSI values for each single symptom before and after a 4 week-treatment with Marial® alone or with PPI in add-on in EMERGE and RELIEF patients are reported. Marial® alone treatment induced a statistically significant higher reduction in each single symptom in RELIEF patients than in EMERGE patients, with the exception of heartburn, chest pain, indigestion, or stomach acid coming up. Similar results were obtained evaluating the reduction in RSI values in patients treated with PPI in add-on that was able to determine a higher statistically significant decrease in RELIEF than in EMERGE patients in each single symptom, with the exception of heartburn, chest pain, indigestion, or stomach acid coming up.
Part of the book: Esophageal Cancer and Beyond
From Tissue Repair to Tissue Regeneration
In Regeneration 3.0, the priority is to combine the anti-inflammatory activity of the nine proteins acting as growth factors in the bovine colostrum, the homeostatic, angiogenic and reorganizational activities of the matrix, the modulation of collagen synthesis and the remodeling of the epithelium. The choice of bovine colostrum and its associated properties was the basis for the design of devices that could also offer those properties: barrier action, anti-inflammatory action and pain reduction, reduction and absorption of exudates, combating of bacterial and fungal proliferation, antioxidant action and hydration and protection against skin diseases and dermatosis. We now know the key players in the wound healing process and we have new molecules available to act on them, but the future must necessarily lie in the transfer of molecules and information between the endothelium, ECM and cell membrane, which can be directed toward tissue regeneration if the resident stem cells have the chance of communicating and interacting with new therapeutic models, all this without forgetting that the human being is at the center of research and scientific evolution.
Part of the book: Wound Healing