Papers by Pasquale Mansueto
Nutrients, 2021
Background: Non-Celiac Wheat Sensitivity (NCWS) is characterized by both intestinal and extra-int... more Background: Non-Celiac Wheat Sensitivity (NCWS) is characterized by both intestinal and extra-intestinal symptoms. The study aims to investigate the frequency of neuropsychiatric manifestations in NCWS patients and identify their clinical and demographic characteristics. Methods: 278 clinical records of NCWS patients, diagnosed by a double-blind placebo-controlled wheat challenge between 2006 and 2020, were retrospectively revised. Fifty-two patients with Celiac Disease (CD) and 54 patients with Irritable Bowel Syndrome (IBS) served as controls. Results: 87% of the NCWS patients had an IBS-like clinical presentation. The NCWS group showed a longer duration of symptoms, a higher frequency of positive serum anti-nuclear antibodies than CD and IBS patients, and a higher frequency of DQ2/DQ8 haplotypes and duodenal mucosa lymphocytosis than IBS controls. In addition, 50% of NCWS patients showed neuropsychiatric manifestations, while lower percentages were observed in CD (25%) and IBS (2...
Background & Aims: Diagnostic delay may represent a relevant problem for autoimmune atrophic gast... more Background & Aims: Diagnostic delay may represent a relevant problem for autoimmune atrophic gastritis (AAG) which, if not promptly diagnosed, can lead to severe or irreversible complications, including pernicious
Nutrients, 2021
Background: Lactose intolerance is the most frequent food intolerance, but many subjects with sel... more Background: Lactose intolerance is the most frequent food intolerance, but many subjects with self-reported milk intolerance (SRMI) are asymptomatic at lactose hydrogen breath test (LHBT). The aim of this study was to evaluate the frequency of lactose intolerance in SRMI patients and their clinical characteristics. Methods: In a retrospective study, the clinical records of 314 SRMI patients (259 females, mean age: 39.1 ± 13.5 years) were reviewed; 102 patients with irritable bowel syndrome (IBS) served as controls. In a prospective study, 42 SRMI patients, negatives at the LHBT, underwent a double-blind, placebo-controlled (DBPC) whole cow’s milk challenge. Results: In the retrospective study, only 178 patients (56%) were lactose maldigesters and intolerant at LHBT; 68% of the subjects with SRMI were suffering from IBS; 74% reported dyspepsia (p = 0.0001 vs. IBS controls); and weight loss was recorded in 62 SRMI patients (20%) (p = 0.01 vs. IBS controls). Duodenal histology showed i...
Nutrients, 2019
Background: Non-Celiac Wheat Sensitivity (NCWS) is still a largely undefined condition, due to th... more Background: Non-Celiac Wheat Sensitivity (NCWS) is still a largely undefined condition, due to the lack of a diagnostic marker. Few data are available about the nutritional characteristics of NCWS patients at diagnosis. Aims: To evaluate the proportion of NCWS patients who were underweight, normal weight, overweight, or obese at diagnosis, and to search for possible correlations between their Body Mass Index (BMI) and other NCWS-related disease characteristics. Patients and Methods: The clinical charts of 145 NCWS patients (125 F, 20 M, mean age 37.1 ± 11.4 years), diagnosed between January 2012 and March 2018, were reviewed. As a comparison, 84 celiac disease (CD) patients (73 F, 11 M, mean age 39.8 ± 13.9 years) were evaluated. All NCWS diagnoses were based on a double-blind placebo-controlled wheat challenge (DBPCWC) method. Results: BMI distribution was similar in the NCWS (6.2% underweight and 15.2% obese subjects) and CD patients (6% underweight and 7.1% obese subjects). Under...
Digestive and Liver Disease, 2019
et al. / Digestive and Liver Disease xxx (2019) xxx-xxx paid particular attention to practical is... more et al. / Digestive and Liver Disease xxx (2019) xxx-xxx paid particular attention to practical issues with the aim to support gastroenterologists in their clinical practice when dealing with patients with anaemia.
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 20, 2018
Studies of non-celiac gluten or wheat sensitivity (NCGWS) have increased but there are no biomark... more Studies of non-celiac gluten or wheat sensitivity (NCGWS) have increased but there are no biomarkers of this disorder. We aimed to evaluate histologic features of colon and rectal tissues from patients with NCGWS. We performed a prospective study of 78 patients (66 female; mean age, 36.4 years) diagnosed with NCGWS by double-blind wheat challenge at 2 tertiary care centers in Italy, from January 2015 through September 2016. Data were also collected from 55 patients wither either celiac disease or self-reported NCGWS but negative results from the wheat-challenge test (non-NCGWS controls). Duodenal and rectal biopsies were collected and analyzed by immunohistochemistry to quantify intra-epithelial CD3+ T cells, lamina propria CD45+ cells, CD4+ and CD8+ T cells, mast cells, and eosinophils and to determine the presence and size of lymphoid nodules in patients with NCGWS vs patients with celiac disease or non-NCGWS controls. Duodenal tissues from patients with NCGWS had significantly hi...
Gastroenterology, Jul 1, 2017
We investigated how many patients with a diagnosis of nonceliac wheat sensitivity (NCWS) still ex... more We investigated how many patients with a diagnosis of nonceliac wheat sensitivity (NCWS) still experienced wheat sensitivity after a median follow-up time of 99 months. We collected data from 200 participants from a previous study of NCWS, performed between July and December 2016 in Italy; 148 of these individuals were still on a strict wheat-free diet. In total, 175 patients (88%) improved (had fewer symptoms) after a diagnosis of NCWS; 145 of 148 patients who adhered strictly to a gluten-free diet (98%) had reduced symptoms, compared with 30 of 52 patients who did not adhere to a gluten-free diet (58%) (P < .0001). Of the 22 patients who repeated the double-blind, placebo-controlled challenge, 20 reacted to wheat. We conclude that NCWS is a persistent condition. Clinicaltrials.gov registration number: NCT02823522.
Nutrients, Jan 19, 2017
Non-Celiac Wheat Sensitivity (NCWS) has recently been included among the gluten-related disorders... more Non-Celiac Wheat Sensitivity (NCWS) has recently been included among the gluten-related disorders. As no biomarkers of this disease exist, its frequency has been estimated based on self-reported symptoms, but to date no data are available about self-reported NCWS in teenagers. To explore the prevalence of self-reported NCWS in a group of high school students and to study their demographic and clinical characteristics. The study was performed between April 2015 and January 2016 in two high schools of a coastal town in the south of Sicily (Italy). A total of 555 students (mean age 17 years, 191 male, 364 female) completed a modified validated questionnaire for self-reported NCWS. The subjects who self-reported NCWS were then compared with all the others. Seven individuals (1.26%) had an established diagnosis of CD. The prevalence of self-reported NCWS was 12.2%, and 2.9% were following a gluten-free diet (GFD). Only 15 out of 68 (23%) NCWS self-reporters had consulted a doctor for thi...
Italian Journal of Medicine, 2016
Mediterranean spotted fever (MSF) is an infectious disease endemic in the southern regions of Ita... more Mediterranean spotted fever (MSF) is an infectious disease endemic in the southern regions of Italy, with an incidence of about 400 cases/year. The bacteria responsible of the disease is <em>Rickettsia conorii</em>, transmitted to humans by <em>Rhipicephalus sanguineus</em>, the common dog tick. The infection usually manifests with a characteristic symptomatologic triad: fever, exanthema and the so called <em>tache noire</em>, which is the typical eschar at the site of the tick bite. Immunoglobulin M (IgM) and IgG enzymelinked immunosorbent assay and the gold standard micro-immunofluorescent assay, allow serological diagnosis. We report the case of a man suffering from MSF, whose atypical presentation and false-negative diagnostic tests delayed consistently diagnosis and therapy. Afterwards we review the literature about this topic.
Clinical and Translational Gastroenterology, 2016
OBJECTIVES: Non-celiac wheat sensitivity (NCWS) is defined as a reaction to ingested wheat after ... more OBJECTIVES: Non-celiac wheat sensitivity (NCWS) is defined as a reaction to ingested wheat after exclusion of celiac disease and wheat allergy. As its pathogenesis is incompletely understood, we evaluated the inflammatory response in the rectal mucosa of patients with well-defined NCWS. METHODS: The prospective study included 22 patients with irritable bowel syndrome (IBS)-like clinical presentation, diagnosed with NCWS by double-blind placebo-controlled challenge. Eight IBS patients not improving on wheat-free diet were used as controls. Two weeks after oral challenge was performed with 80 grams of wheat daily, cells were isolated from rectal biopsies and thoroughly characterized by fluorescence-activated cell sorting analysis for intracellular cytokines and surface markers. RESULTS: Rectal biopsies from wheat-challenged NCWS patients showed that a significant mucosal CD45 + infiltrate consisted of CD3 + and CD3 − lymphocytes, with the latter spontaneously producing more interferon (IFN)-γ than IBS controls. About 30% of IFN-γ-producing CD45 + cells were T-bet + , CD56 − , NKP44 − , and CD117 − , defining them as a type-1 innate lymphoid cells (ILC1). IFN-γ-producing ILC1 cells significantly decreased in 10 patients analyzed 2 weeks after they resumed a wheat-free diet. CONCLUSIONS: These data indicate that, in patients with active NCWS, IFN-γ-producing ILC1 cells infiltrate rectal mucosa and support a role for this innate lymphoid cell population in the pathogenesis of NCWS.
Human Nutrition from the Gastroenterologist’s Perspective, 2016
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases in the general... more Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases in the general population, with a prevalence ranging from 12 % to 30 %, mainly affecting younger patients (i.e., <50 years of age) and women [ 1 ]. As in other chronic functional gastrointestinal disorders, abdominal discomfort or pain, abnormal bowel habits, and often bloating and abdominal distension are the main clinical features. Their diagnosis is based on symptom patterns (i.e., the Rome III criteria), which also allow categorization in diarrhea-predominant (D-IBS), constipationpredominant (C-IBS), mixed diarrhea and constipation (M-IBS), and unclassifi ed (U-IBS) IBS [ 2 ]. Symptom severity ranges from tolerable to severe, both between different patients and in the same patient, affecting patients' quality of life considerably as in some major chronic diseases [ 3 ]. Depending on whether diarrhea or constipation is the predominant disorder, antispasmodics, antidepressants, and medications modifying bowel habit represent the main conventional IBS treatments. Unfortunately, most patients report long-term inadequacy of current drug therapy and a tendency to seek a variety of alternative remedies, especially of a dietary nature (up to 65 % of them attribute their symptoms to adverse food reactions) [ 4 ]. However, the relationship between IBS symptoms and diet is still controversial,
World Journal of Gastroenterology, 2006
Schistosomiasis is a chronic worm infection caused by a species of trematodes, the Schistosomes. ... more Schistosomiasis is a chronic worm infection caused by a species of trematodes, the Schistosomes. We may distinguish a urinary form from Schistosomes haematobium and an intestinal-hepatosplenic form mainly from Schistosomes mansoni characterized by nausea, meteorism, abdominal pain, bloody diarrhea, rectal tenesmus, and hepatosplenomegaly. These infections represent a major health issue in Africa, Asia, and South America, but recently S mansoni has
World journal of gastroenterology : WJG, Jan 21, 2015
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, having a pre... more Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, having a prevalence of 12%-30% in the general population. Most patients with IBS attribute their symptoms to adverse food reactions. We review the role of diet in the pathogenesis of IBS and the importance of dietary factors in the management of these patients. The MEDLINE electronic database (1966 to Jan 2015) was searched using the following keywords: "food", "diet", "food allergy", "food hypersensitivity", "food intolerance", "IBS", "epidemiology", "pathogenesis", "pathophysiology", "diagnosis", "treatment". We found 153 eligible papers; 80 were excluded because: not written in English, exclusive biochemical and experimental research, case reports, reviews, and research otherwise not relevant to our specific interest. We selected 73 papers: 43 original papers, 26 reviews and 4 letters to ...
Gastroenterology, 2015
BACKGROUND & AIMS: There is much interest in wheat sensitivity among people without celiac diseas... more BACKGROUND & AIMS: There is much interest in wheat sensitivity among people without celiac disease (CD), but little is known about any risks associated with the condition. We evaluated the prevalence of autoimmune diseases (ADs) among patients with nonceliac wheat sensitivity (NCWS), and investigated whether they carry antinuclear antibodies (ANA). METHODS: We performed a retrospective study of 131 patients diagnosed with NCWS (121 female; mean age, 29.1 years) at 2 hospitals in Italy from January 2001 through June 2011. Data were also collected from 151 patients with CD or irritable bowel syndrome (IBS) (controls). Patient medical records were reviewed to identify those with ADs. We also performed a prospective study of 42 patients (38 female; mean age, 34 years) diagnosed with NCWS from July 2011 through March 2014 at 3 hospitals in Italy. One hundred age-and sex-matched subjects with CD or IBS served as controls. Serum samples were collected from all subjects and ANA levels were measured by immunofluorescence analysis. Participants completed a questionnaire and their medical records were reviewed to identify those with ADs. RESULTS: In the retrospective analysis, similar portions of subjects with NCWS (29%) and CD (29%) developed ADs (mainly Hashimoto's thyroiditis, 29 cases), compared with a smaller proportion of subjects with IBS (4%) (P < .001). In the prospective study, 24% of subjects with NCWS, 20% of subjects with CD, and 2% of subjects with IBS developed ADs (P < .001). In the retrospective study, serum samples tested positive for ANA in 46% of subjects with NCWS (median titer, 1:80), 24% of subjects with CD (P < .001), and 2% of subjects IBS (P < .001); in the prospective study, serum samples were positive for ANA in 28% of subjects with NCWS, 7.5% of subjects with CD (P ¼ .02), and 6% of subjects with IBS (P ¼ .005 vs patients with NCWS). ANA positivity was associated with the presence of the HLA DQ2/DQ8 haplotypes (P < .001). CONCLUSIONS: Higher proportions of patients with NCWS or CD develop autoimmune disorders, are ANA positive, and showed DQ2/DQ8 haplotypes compared with patients with IBS.
American Journal of Gastroenterology, 2012
Non-celiac wheat sensitivity (WS) is considered a new clinical entity. An increasing percentage o... more Non-celiac wheat sensitivity (WS) is considered a new clinical entity. An increasing percentage of the general population avoids gluten ingestion. However, the real existence of this condition is debated and specifi c markers are lacking. Our aim was thus to demonstrate the existence of WS and defi ne its clinical, serologic, and histological markers. METHODS: We reviewed the clinical charts of all subjects with an irritable bowel syndrome (IBS)-like presentation who had been diagnosed with WS using a double-blind placebo-controlled (DBPC) challenge in the years 2001-2011. One hundred celiac disease (CD) patients and fi fty IBS patients served as controls. RESULTS: Two hundred and seventy-six patients with WS, as diagnosed by DBPC challenge, were included. Two groups showing distinct clinical characteristics were identifi ed: WS alone (group 1) and WS associated with multiple food hypersensitivity (group 2). As a whole group, the WS patients showed a higher frequency of anemia, weight loss, self-reported wheat intolerance, coexistent atopy, and food allergy in infancy than the IBS controls. There was also a higher frequency of positive serum assays for IgG / IgA anti-gliadin and cytometric basophil activation in " in vitro " assay. The main histology characteristic of WS patients was eosinophil infi ltration of the duodenal and colon mucosa. Patients with WS alone were characterized by clinical features very similar to those found in CD patients. Patients with multiple food sensitivity were characterized by clinical features similar to those found in allergic patients. CONCLUSIONS: Our data confi rm the existence of non-celiac WS as a distinct clinical condition. We also suggest the existence of two distinct populations of subjects with WS: one with characteristics more similar to CD and the other with characteristics pointing to food allergy.
Nutrition in Clinical Practice, 2015
Irritable bowel syndrome (IBS) is a clinical condition characterized by abdominal pain, bloating,... more Irritable bowel syndrome (IBS) is a clinical condition characterized by abdominal pain, bloating, flatus, and altered bowel habits. 1,2 Several studies conducted using barostat and similar devices indicate that these symptoms may be induced by luminal distension in association with visceral hypersensitivity. This suggests that dietary factors could modify intestinal luminal distension by increasing water and gas volume and thus may be suitable targets for therapy. 1,2 The role of dietary components in inducing IBS symptoms is difficult to explore. Several studies have suggested a possible role for food allergy or food intolerance in IBS pathogenesis. 1,3 Food allergy is defined as a reproducible adverse reaction arising from specific immune responses occurring on exposure to specific food antigens. Whenever similar reactions occur without evidence of immunologic mechanisms, they are named "food intolerance." 3 The latter has been considered in IBS pathogenesis, but questionable outcomes have been obtained due to issues surrounding diagnostic tools and difficulties in conducting well-designed dietary trials. In addition, accurate identification of the foods contributing to symptoms is difficult to achieve and fraught with complexity, given that meals are often complex mixtures of dietary components, and the timing of symptom onset can vary, both with different foods and with the same food in different patients. 4-8 However, recent evidence has suggested that foods do not seem to be the cause of the condition, only the triggering factors of symptom onset. 9 As aforesaid, identification of trigger foods could be extremely difficult, especially in the case of food intolerance. 3 Many published studies report specific food intolerance using patient questionnaires, although this is an unreliable method given the mix of foods included in meals and snacks and the likelihood of pinpointing the wrong culprit. 10,11 At the same time, there is a consistent lack of clear evidence for "food allergy" in IBS and also on rechallenge with suspect trigger foods, which has not been successful in identifying reliable immunologic markers. 12 569886N CPXXX10.
Travel Medicine and Infectious Disease, 2014
Leishmaniasis is a vector-borne protozoan infection whose clinical spectrum ranges from asymptoma... more Leishmaniasis is a vector-borne protozoan infection whose clinical spectrum ranges from asymptomatic infection to fatal visceral leishmaniasis. Over the last decades, an increase in imported leishmaniasis cases in developed, non-endemic countries, have been pointed-out from a review of the international literature. Among the possible causes are increasing international tourism, influx of immigrants from endemic regions and military operations. The main area for the acquisition of cutaneous leishmaniasis, especially for adventure travelers on long-term trips in highly-endemic forested areas, is represented from South America, whereas popular Mediterranean destinations are emerging as the main areas to acquire visceral variant. Leishmaniasis should be considered in the diagnostic assessment of patients presenting with a compatible clinical syndrome and a history of travel to an endemic area, even if this occurred several months or years before. Adventure travelers, researchers, military personnel, and other groups of travelers likely to be exposed to sand flies in endemic areas, should receive counseling regarding leishmaniasis and appropriate protective measures.
Case Reports, 2012
Cobalamin (vitamin B 12) deficiency occurs with several disorders, involving different organs and... more Cobalamin (vitamin B 12) deficiency occurs with several disorders, involving different organs and systems, including blood, bowel, nervous system and eyes. Although the most important features are usually haematological ones, presence of neurological involvement, in the absence of blood count alterations, has just been described in the literature. Here we report the case of a 48-year-old man, suffering from coeliac disease for approximately 5 years, vegetarian, who was admitted to our department, referring dysaesthesia of the left lower limb, decreased libido and erectile dysfunction. Vitamin B 12 deficiency was proved, even in the absence of blood count alteration, and treated with a vitamin supplement, resulting in complete remission.
The American Journal of Gastroenterology, 2013
Letters to the Editor 451 or ongoing biliary obstruction. We are grateful to Drs Tse and Yuan for... more Letters to the Editor 451 or ongoing biliary obstruction. We are grateful to Drs Tse and Yuan for the publication of their Cochrane Review, as this is an area that warrants ongoing analysis. CONFLICT OF INTEREST Th e authors declare no confl ict of interest. REFERENCES 1. Tse F , Yuan Y. Early endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. Am J Gastroenterol 2013;108:450 (this issue). 2. Fisher JM , Gardner TB. Th e " golden hours " of management in acute pancreatitis. Am J Gastroenterol 2012 ; 107 : 1146-50. 3. Tse F , Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev 2012 ; 5 : CD00977 .
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Papers by Pasquale Mansueto