Oral videoenteroscopy with biopsy is a safe and useful procedure for diagnosis of Crohn's disease in selected patients with suggestive symptoms and can be of great diagnostic value after failure of conventional endoscopic X-ray methods.

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Aim: upper oesophageal pH monitoring may play a significant role in the study of extra-oesophageal GERD, but limited normal data are available to date. Our aim was to develop a large series of normal values of proximal oesophageal acidification.Methods: 155 healthy volunteers (74 male) participated in a multi-centre national study including oesophageal manometry and 24 hours oesophageal pH monitoring using two electrodes individually located 5 cm above the LOS and 3 cm below the UOS.Results: 130 participants with normal manometry completed all the study. Twelve of them were excluded for inadequate pH tests. Twenty-seven subjects had abnormal conventional pH. The remaining 91 subjects (37 M; 18-72 yrs age range) formed the reference group for normality. At the level of the upper oesophagus, the 95 th percentile of the total number of reflux events was 30, after eliminating the meal periods 22, and after eliminating also the pseudo-reflux events 18. Duration of the longest episodes was 5, 4 and 4 min, respectively (3.5 min in upright and 0.5 min in supine). The upper limit for the percentage of acid exposure time was 1.35, 1.05 and 0.95%, respectively. No reflux events were recorded in the upper oesophagus in 8 cases.Conclusion: this is the largest series of normal values of proximal oesophageal reflux that confirm the existence of acid reflux at that level in healthy subjects, in small quantity and unrelated to age or gender. Our data support the convenience of excluding pseudo-reflux events and meal periods from analysis.

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Introduction: Diabetic nephropathy (DN) is a major complication of diabetes Mellitus. Early detection of DN and interventional methods can slow its progression and improves patients' outcome. Albuminuria has been accepted as the earliest marker for DN development. Serum and urine Neutrophil Gelatinase-Associated Lipocalin (sNGAL, uNGAL) as a marker of tubular damage might become useful biomarker for early detection of renal involvement in diabetic patients. The aim of this study is to assess the relationship between the serum and urine levels of NGAL and disease severity in patients with type 2 diabetes mellitus. Methods: In the present cross sectional study we evaluated the levels of NGAL in serum and urine in 148 patients with type 2 diabetes mellitus categorized into three groups (50 diabetics with normoalbuminuria, 58 diabetics with microalbuminuria and 40 diabetics with macroalbuminuria) and 50 control subjects. Results: All diabetics with albuminuria showed increased sNGAL values with respect to normoalbuminurics and control individuals (P<0.01). Serum NGAL increased in parallel with the severity of renal disease, approaching the highest levels in patients with overt diabetic nephropathy. The best cut-off point of sNGAL for macroalbuminuric state was 225.8 ng/ml with a specificity of 74 % and sensitivity of 70%. Urine NGAL showed significantly elevated level only in diabetics with macroalbuminuria compared to other diabetics and control subjects (P¼0.06). The best cut off point of uNGAL for macroalbuminuric state was 71.4 ng/ml with a sensitivity of 60% and specificity of 72%. Conclusions: Serum NGAL increases in diabetic patients with the appearance of albumin in urine, so that its level clearly correlates with severity of DN, while uNGAL increment is observed only in overt albuminuria. Furthermore Serum and urine NGAL measurement could be a useful, noninvasive, easily available test for the evaluation of renal involvement in the course of diabetes.