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Natale P, Palmer SC, Jaure A, Saglimbene V, Iannone A, Sluiter A, Craig J, Strippoli GFM. Blood pressure lowering for kidney transplant recipients: systematic review with network meta-analysis. J Hypertens 2024; 42:848-855. [PMID: 38230619 DOI: 10.1097/hjh.0000000000003663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Hypertension affects 50-90% of kidney transplant recipients and is associated with cardiovascular disease and graft loss. We aimed to evaluate the comparative benefits and harms of blood pressure lowering agents in people with a functioning kidney transplant. METHODS We conducted a systematic review with network meta-analysis of randomized controlled trials (RCTs). We searched MEDLINE, Embase, and CENTRAL through to October 2023. RCTs evaluating blood pressure lowering agents administered for at least 2 weeks in people with a functioning kidney transplant with and without preexisting hypertension were eligible. Two reviewers independently extracted data. The primary outcome was graft loss. Treatment effects were estimated using random effects network meta-analysis, with treatment effects expressed as an odds ratio (OR) for binary outcomes and mean difference (MD) for continuous outcomes together with their 95% confidence interval (CI). Confidence in the evidence was assessed using GRADE for network meta-analysis. RESULTS Ninety-four studies (7547 adults) were included. Two studies were conducted in children. No blood pressure-lowering agent reduced the risk of graft loss, withdrawal because of adverse events, death, cardiovascular or kidney outcomes compared with placebo/other drug class. Angiotensin-converting enzyme inhibitors and angiotensin receptor blocker therapy may incur greater odds of hyperkalemia compared with calcium channel blockers [odds ratio (OR) 5.48, 95% confidence interval (CI) 2.47-12.16; and OR 8.67, 95% CI 2.65-28.36; low certainty evidence, respectively). CONCLUSION The evidentiary basis for the comparative benefits and safety of blood pressure lowering agents in people with a functioning kidney transplant is limited to guide treatment decision-making.
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Affiliation(s)
- Patrizia Natale
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead
| | - Valeria Saglimbene
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari
| | - Andrea Iannone
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari
| | - Amanda Sluiter
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giovanni F M Strippoli
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari
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Losurdo G, Borraccino AV, Aloisio A, Russo F, Riezzo G, Galeano G, Pricci M, Girardi B, Celiberto F, Iannone A, Ierardi E, Di Leo A. Concomitant and Bismuth Quadruple Therapy for Helicobacter pylori Eradication in Southern Italy: Preliminary Data from a Randomized Clinical Trial. Antibiotics (Basel) 2024; 13:348. [PMID: 38667024 PMCID: PMC11047465 DOI: 10.3390/antibiotics13040348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
Concomitant therapy (CT) and bismuth quadruple therapy (BQT) are recommended in geographical areas with high clarithromycin resistance for Helicobacter pylori (H. pylori) eradication. We compared CT and BQT as the first lines of treatment in a randomized controlled trial. Consecutive patients with H. pylori diagnosed by concordance of both a urea breath test and histology were recruited. For BQT, patients received 3 PyleraTM capsules q.i.d.; for CT, 1000 mg of amoxicillin b.i.d, 500 mg of clarithromycin b.i.d and 500 mg of metronidazole b.i.d. As a proton pump inhibitor, 40 mg of pantoprazole b.i.d was administered. Both regimens lasted 10 days. In total, 46 patients received CT and 38 BQT. Both groups were comparable for age (p = 0.27) and sex (p = 0.36). We did not record any drop outs; therefore, the intention to treat and per protocol rates coincided. The most common symptoms were heartburn and post-prandial fullness, which were equally present in both groups. The success rate was 95.6% for CT and 100% for BQT (p = 0.56). Side effects were recorded in 23.9% and 31.6% of patients in the CT and BQT arms, respectively (p = 0.47). The most common ones were abdominal pain (8) and diarrhea (6). In conclusion, CT and BQT are equally effective in our area with high clarithromycin resistance, southern Italy, and showed comparable safety.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (G.L.); (A.V.B.); (A.A.); (F.C.); (A.I.); (E.I.)
| | - Antonia Valeria Borraccino
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (G.L.); (A.V.B.); (A.A.); (F.C.); (A.I.); (E.I.)
| | - Adriana Aloisio
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (G.L.); (A.V.B.); (A.A.); (F.C.); (A.I.); (E.I.)
| | - Francesco Russo
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (G.G.)
| | - Giuseppe Riezzo
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (G.G.)
| | - Grazia Galeano
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (G.G.)
| | - Maria Pricci
- THD s.p.a., 42015 Correggio, Italy; (M.P.); (B.G.)
| | | | - Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (G.L.); (A.V.B.); (A.A.); (F.C.); (A.I.); (E.I.)
- Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (G.L.); (A.V.B.); (A.A.); (F.C.); (A.I.); (E.I.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (G.L.); (A.V.B.); (A.A.); (F.C.); (A.I.); (E.I.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (G.L.); (A.V.B.); (A.A.); (F.C.); (A.I.); (E.I.)
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3
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Losurdo G, Mezzapesa M, Ditonno I, Piazzolla M, Pricci M, Girardi B, Celiberto F, Galeano G, Riezzo G, Russo F, Iannone A, Ierardi E, Di Leo A. Helicobacter pylori Secondary Antibiotic Resistance after One or More Eradication Failure: A Genotypic Stool Analysis Study. Antibiotics (Basel) 2024; 13:336. [PMID: 38667013 PMCID: PMC11047300 DOI: 10.3390/antibiotics13040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/29/2024] Open
Abstract
Helicobacter pylori (H. pylori) antibiotic resistance is the leading cause for unsuccessful eradication therapy. After one or more failures, the chance of encountering secondary antibiotic resistance increases. The aim of this study was to characterize genotypic secondary resistance in a cohort of southern Italian H. pylori patients with at least one previous failure. Such patients collected stool samples using a dedicated kit (THD fecal testTM), and bacterial DNA was extracted and amplified using RT-PCR. Resistance to clarithromycin, amoxicillin, metronidazole, levofloxacin, and tetracycline was assessed using a high-resolution melting curve. We enrolled 50 patients. A total of 72% of patients failed one previous antibiotic course, 16% failed two, 10% failed three, and 2% failed four. The rate of secondary antibiotic resistance was 16% for clarithromycin, 18% for metronidazole, 14% for amoxicillin, 14% for levofloxacin, and 2% for tetracycline. Among the eight clarithromycin-resistant patients, five (62.5%) previously received a clarithromycin-based regimen. The same rate was 33.3% (3/9) for metronidazole. The only tetracycline-resistant patient had received Pylera. In conclusion, our data seem to show that, even though secondary resistance is not very high, resistance to clarithromycin could be very likely related to previous exposure to this antibiotic.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Martino Mezzapesa
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Ilaria Ditonno
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Mariapaola Piazzolla
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | | | | | - Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
- Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Grazia Galeano
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy
| | - Giuseppe Riezzo
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy
| | - Francesco Russo
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
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Kondili LA, Zanetto A, Quaranta MG, Ferrigno L, Panetta V, Calvaruso V, Zignego AL, Brunetto MR, Raimondo G, Biliotti E, Ieluzzi D, Iannone A, Madonia S, Chemello L, Cavalletto L, Coppola C, Morisco F, Barbaro F, Licata A, Federico A, Cerini F, Persico M, Pompili M, Ciancio A, Piscaglia F, Chessa L, Giacometti A, Invernizzi P, Brancaccio G, Benedetti A, Baiocchi L, Gentile I, Coppola N, Nardone G, Craxì A, Russo FP. Predicting de-novo portal vein thrombosis after HCV eradication: A long-term competing risk analysis in the ongoing PITER cohort. United European Gastroenterol J 2024; 12:352-363. [PMID: 38032175 DOI: 10.1002/ueg2.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND & AIMS Sustained virological response (SVR) by direct-acting antivirals (DAAs) may reverse the hypercoagulable state of HCV cirrhosis and the portal vein thrombosis (PVT) risk. We evaluated the incidence and predictive factors of de novo, non-tumoral PVT in patients with cirrhosis after HCV eradication. METHODS Patients with HCV-related cirrhosis, consecutively enrolled in the multi-center ongoing PITER cohort, who achieved the SVR using DAAs, were prospectively evaluated. Kaplan-Meier and competing risk regression analyses were performed. RESULTS During a median time of 38.3 months (IQR: 25.1-48.7 months) after the end of treatment (EOT), among 1609 SVR patients, 32 (2.0%) developed de novo PVT. A platelet count ≤120,000/μL, albumin levels ≤3.5 mg/dL, bilirubin >1.1 mg/dL, a previous liver decompensation, ALBI, Baveno, FIB-4, and RESIST scores were significantly different (p < 0.001), among patients who developed PVT versus those who did not. Considering death and liver transplantation as competing risk events, esophageal varices (subHR: 10.40; CI 95% 4.33-24.99) and pre-treatment ALBI grade ≥2 (subHR: 4.32; CI 95% 1.36-13.74) were independent predictors of PVT. After HCV eradication, a significant variation in PLT count, albumin, and bilirubin (p < 0.001) versus pre-treatment values was observed in patients who did not develop PVT, whereas no significant differences were observed in those who developed PVT (p > 0.05). After the EOT, esophageal varices and ALBI grade ≥2, remained associated with de novo PVT (subHR: 9.32; CI 95% 3.16-27.53 and subHR: 5.50; CI 95% 1.67-18.13, respectively). CONCLUSIONS In patients with HCV-related cirrhosis, a more advanced liver disease and significant portal hypertension are independently associated with the de novo PVT risk after SVR.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Alberto Zanetto
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale - Università Padova, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | | | - Luigina Ferrigno
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Valentina Panetta
- L'altrastatistica srl, Consultancy & Training, Biostatistics Office, Rome, Italy
| | - Vincenza Calvaruso
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
| | - Anna Linda Zignego
- Center for Systemic Manifestations of Hepatitis Viruses, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maurizia R Brunetto
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giovanni Raimondo
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
| | - Elisa Biliotti
- Department of Public Health and Infectious Diseases, "Policlinico Umberto I" Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Iannone
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Salvatore Madonia
- Department of Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Liliana Chemello
- Department of Medicine, Unit of Internal Medicine & Hepatology, University of Padova, Padova, Italy
| | - Luisa Cavalletto
- Department of Medicine, Unit of Internal Medicine & Hepatology, University of Padova, Padova, Italy
| | - Carmine Coppola
- Department of Hepatology, Gragnano Hospital, Gragnano, Italy
| | - Filomena Morisco
- Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesco Barbaro
- Department of Medicine, Infectious Diseases Unit, University Hospital of Padova, Padova, Italy
| | - Anna Licata
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, DIBIMIS, University of Palermo, Palermo, Italy
| | - Alessandro Federico
- Department of Hepato-Gastroenterology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Marcello Persico
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Maurizio Pompili
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessia Ciancio
- Gastroenterology Unit, Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Luchino Chessa
- Liver Unit, University Hospital, Monserrato, Cagliari, Italy
| | - Andrea Giacometti
- Department of Biomedical Sciences & Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy San Gerardo Hospital, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Giuseppina Brancaccio
- Department of Molecular Medicine, Infectious Diseases, University of Padova, Padova, Italy
| | - Antonio Benedetti
- Clinic of Gastroenterology and Hepatology, Polytechnic University of Marche, Ancona, Italy
| | | | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gerardo Nardone
- Hepato-Gastroenterology Unit, University of Naples Federico II, Naples, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
| | - Francesco Paolo Russo
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale - Università Padova, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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Fugazza A, Colombo M, Kahaleh M, Muthusamy VR, Benjamin B, Laleman W, Barbera C, Fabbri C, Nieto J, Al-Lehibi A, Ramchandani M, Tyberg A, Shahid H, Sarkar A, Ehrlich D, Sherman S, Binda C, Spadaccini M, Iannone A, Khalaf K, Reddy N, Anderloni A, Repici A. The outcomes and safety of patients undergoing endoscopic retrograde cholangiopancreatography combining a single-use cholangioscope and a single-use duodenoscope: A multicenter retrospective international study. Hepatobiliary Pancreat Dis Int 2024; 23:71-76. [PMID: 37100688 DOI: 10.1016/j.hbpd.2023.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Duodenoscope-related multidrug-resistant organism (MDRO) infections raise concerns. Disposable duodenoscopes have been recently introduced in the market and approved by regulatory agencies with the aim to reduce the risk of endoscopic retrograde cholangiopancreatography (ERCP) associated infections. The aim of this study was to evaluate the outcome of procedures performed with single-use duodenoscopes in patients with clinical indications to single-operator cholangiopancreatoscopy. METHODS This is a multicenter international, retrospective study combining all patients who underwent complex biliopancreatic interventions using the combination of a single-use duodenoscope and a single-use cholangioscope. The primary outcome was technical success defined as ERCP completion for the intended clinical indication. Secondary outcomes were procedural duration, rate of cross-over to reusable duodenoscope, operator-reported satisfaction score (1 to 10) on performance rating of the single-use duodenoscope, and adverse event (AE) rate. RESULTS A total of 66 patients (26, 39.4% female) were included in the study. ERCP was categorized according to ASGE ERCP grading system as 47 (71.2%) grade 3 and 19 (28.8%) grade 4. The technical success rate was 98.5% (65/66). Procedural duration was 64 (interquartile range 15-189) min, cross-over rate to reusable duodenoscope was 1/66 (1.5%). The satisfaction score of the single-use duodenoscope classified by the operators was 8.6 ± 1.3 points. Four patients (6.1%) experienced AEs not directly related to the single-use duodenoscope, namely 2 post-ERCP pancreatitis (PEP), 1 cholangitis and 1 bleeding. CONCLUSIONS Single-use duodenoscope is effective, reliable and safe even in technically challenging procedures with a non-inferiority to reusable duodenoscope, making these devices a viable alternative to standard reusable equipment.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Michel Kahaleh
- Gastroenterology, Rutgers Robert Wood Johnson; New Brunswick, New Jersey, USA
| | - V Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles School of Medicine at UCLA, Los Angeles, California, USA
| | - Bick Benjamin
- Division of Digestive and Liver Disorders; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Carmelo Barbera
- U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale Giuseppe Mazzini, ASL Teramo, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida, USA
| | - Abed Al-Lehibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Amy Tyberg
- Gastroenterology, Rutgers Robert Wood Johnson; New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Gastroenterology, Rutgers Robert Wood Johnson; New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Gastroenterology, Rutgers Robert Wood Johnson; New Brunswick, New Jersey, USA
| | - Dean Ehrlich
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles School of Medicine at UCLA, Los Angeles, California, USA
| | - Stuart Sherman
- Division of Digestive and Liver Disorders; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Kareem Khalaf
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | | | - Andrea Anderloni
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
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6
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Losurdo G, De Bellis M, Rima R, Palmisano CM, Dell’Aquila P, Iannone A, Ierardi E, Di Leo A, Principi M. Small Intestinal Contrast Ultrasonography (SICUS) in Crohn's Disease: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7714. [PMID: 38137782 PMCID: PMC10744114 DOI: 10.3390/jcm12247714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
The diagnosis of Crohn's Disease (CD) is based on a combination of clinical symptoms, laboratory tests, endoscopy, and imaging data. In Small Intestine Contrast Ultrasonography (SICUS), the ingestion of a macrogol solution as an oral contrast medium may optimize image quality. We performed a meta-analysis to evaluate the diagnostic performance of SICUS for CD. A literature search was performed in August 2023. We selected only studies where SICUS was compared to a technique that allows the assessment of the whole gastrointestinal tract, such as an MRE, a CT scan, or a surgical evaluation. We estimated pooled weighted sensitivity, specificity, and likelihood ratio for positive and negative tests (PLR/NLR) of SICUS. Summary receiver operating characteristic curves (SROC) were drawn, and pooled areas under the curve (AUC) were calculated. Five studies with 325 CD patients were included. SICUS showed a pooled sensitivity for the diagnosis of 95% (95% confidence interval CI 89-99%), a specificity = 77% (95% CI 60-90%), and the AUC was 0.94. SICUS demonstrated a pooled sensitivity for strictures of 78% (95% CI 63-88%) and a specificity = 96% (95% CI 85-99%), with AUC = 0.93. For abscesses, SICUS demonstrated a pooled sensitivity of 100% (95% CI 59-100%) and a specificity of 90% (95% CI 74-98%). Fistulae were detected with a pooled sensitivity of 77% (95% CI 46-95%) and a specificity of 92% (95% CI 75-99%). SICUS demonstrated excellent diagnostic performance compared to the gold standard despite some clinical scenarios (stenosis/fistulae) showing suboptimal diagnostic effectiveness.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Margherita De Bellis
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Raffaella Rima
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Chiara Maria Palmisano
- Internal Medicine Unit “C. Frugoni”, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Paola Dell’Aquila
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
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Barone M, Iannone A, Mezzapesa M, Milella M, Di Gennaro F, Niro G, Cotugno R, Cozzolongo R, Mennea G, Rendina M, Di Leo A. Natural History and Hepatitis B Virus Surface Antigen (HBsAg) Spontaneous Seroclearance in Hepatitis B Virus e-Antigen (HBeAg)-Negative Patients with Inactive Chronic Infection: A Multicenter Regional Study from South Italy. Pathogens 2023; 12:1198. [PMID: 37887714 PMCID: PMC10609832 DOI: 10.3390/pathogens12101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Spontaneous HBsAg seroclearance has been mainly studied in populations from Asia, Australia, the Pacific Islands, and Polynesia. For the first time, we evaluated the spontaneous HBsAg seroclearance and its possible associated factors and the risk of disease progression in HBeAg-negative patients with inactive infection all coming from the same region in South Italy. In this multicenter retrospective study, 146 patients were selected after 18 months of observation and followed for a median of 82 months (IQR 60-107). For our analyses, they were divided into three groups based on their HBsAg levels: <100 IU/mL, 100-1000 IU/mL, and >1000 IU/mL. Crude and adjusted hazard ratios (HRs) for HBsAg seroclearance were determined. During the follow-up period, three patients (2.0%) showed a disease progression with an increased liver stiffness, whereas 17 (11.6%) cleared the HBsAg. Patients with HBsAg levels <100 IU/mL had the highest probability of HBsAg seroclearance compared to the other two groups (p = 0.009). In the multivariate analysis, the HBsAg level <100 IU/mL was the only parameter independently associated with HBsAg seroclearance (adjusted HR = 3.53; CI 1.29-9.69; p = 0.01). In patients with chronic HBV inactive infection, HBsAg levels <100 IU/mL predicted the highest probability of HBsAg seroclearance.
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Affiliation(s)
- Michele Barone
- Gastroenterology Unit, Department of Precision and Regenerative Medicine—Jonian Area—(DiMePRe-J), University of Bari “Aldo Moro”, Policlinic University Hospital, 70124 Bari, Italy;
| | - Andrea Iannone
- Gastroenterology Unit, Policlinic University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy; (A.I.); (M.M.); (M.R.)
| | - Martino Mezzapesa
- Gastroenterology Unit, Policlinic University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy; (A.I.); (M.M.); (M.R.)
| | - Michele Milella
- Clinic of Infectious Diseases, Policlinic University Hospital, 70124 Bari, Italy;
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine—Jonian Area—(DiMePRe-J), University of Bari “Aldo Moro”, Policlinic University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy;
| | - Grazia Niro
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS ‘Casa Sollievo della Sofferenza’, Viale Cappuccini, snc, 71013 San Giovanni Rotondo, Italy; (G.N.); (R.C.)
| | - Rosa Cotugno
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS ‘Casa Sollievo della Sofferenza’, Viale Cappuccini, snc, 71013 San Giovanni Rotondo, Italy; (G.N.); (R.C.)
| | - Raffaele Cozzolongo
- Gastroenterology Unit, IRCCS “S. De Bellis”, Via Turi 27, 70013 Castellana Grotte, Italy;
| | - Giuseppe Mennea
- Internal Medicine Unit, “L. Bonomo” Hospital, Viale Istria, 76123 Andria, Italy;
| | - Maria Rendina
- Gastroenterology Unit, Policlinic University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy; (A.I.); (M.M.); (M.R.)
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine—Jonian Area—(DiMePRe-J), University of Bari “Aldo Moro”, Policlinic University Hospital, 70124 Bari, Italy;
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Losurdo G, Francioso F, Pricci M, Girardi B, Russo F, Riezzo G, D'Attoma B, Bleve MA, Iannone A, Celiberto F, Ierardi E, DI Leo A. A prospective study on Helicobacter pylori rapid urease test false negativity: is it time for its use in restricted situations? Minerva Gastroenterol (Torino) 2023; 69:382-387. [PMID: 35708038 DOI: 10.23736/s2724-5985.22.03207-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Rapid urease test (RUT) is a diagnostic tool for Helicobacter pylori (H. pylori) diagnosis, based on the ability of the bacterium to produce urease. Despite it is considered simple, fast, and cheap, some conditions may cause false negativity. Therefore, the aim of this study was to compare RUT with currently recommended tests for H. pylori diagnosis. METHODS We enrolled consecutive patients who underwent upper endoscopy with histology, RUT, and urea breath test (UBT). Delta over baseline (DOB) >4% was considered positive for UBT. Diagnosis of infection was achieved when at least two tests were positive. The rate of false positivity of RUT was computed, and DOB value in RUT+ versus RUT- was compared by Mann-Whitney Test. RESULTS One hundred and sixteen consecutive patients with H. pylori infection were recruited. The male/female ratio was 35/81 and the mean age 45.2±13.1. Twenty-five patients (21.5%) were RUT-, despite being positive at both histology and UBT. On the other hand, in only two patients UBT and histology had discordant results. A full concordance of the three tests was observed in 89 patients (76.7%). DOB, additionally, was significantly higher in RUT+ patients (39.2±24.2%) than RUT- ones (26.3±18.5%; P=0.005). CONCLUSIONS RUT shows false negativity rate higher than 20%. Moreover, the RUT-negative patients showed a lower DOB at UBT, which is an indirect indicator of intragastric bacterial load. Therefore, it is presumable that H. pylori low amount may be a concurrent cause of false negativity. This study suggests that RUT-based H. pylori detection should be restricted to some specific conditions.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy -
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy -
| | - Federica Francioso
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | | | - Francesco Russo
- National Institute of Gastroenterology, IRCCS Saverio de Bellis, Castellana Grotte, Bari, Italy
| | - Giuseppe Riezzo
- National Institute of Gastroenterology, IRCCS Saverio de Bellis, Castellana Grotte, Bari, Italy
| | - Benedetta D'Attoma
- National Institute of Gastroenterology, IRCCS Saverio de Bellis, Castellana Grotte, Bari, Italy
| | - Maria A Bleve
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo DI Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Celiberto F, Aloisio A, Girardi B, Pricci M, Iannone A, Russo F, Riezzo G, D’Attoma B, Ierardi E, Losurdo G, Di Leo A. Fibres and Colorectal Cancer: Clinical and Molecular Evidence. Int J Mol Sci 2023; 24:13501. [PMID: 37686308 PMCID: PMC10488173 DOI: 10.3390/ijms241713501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Colorectal cancer (CRC) is one of the leading causes of mortality for cancer in industrialized countries. The link between diet and CRC is well-known, and presumably CRC is the type of cancer which is most influenced by dietary habits. In Western countries, an inadequate dietary intake of fibers is endemic, and this could be a driving factor in the increase of CRC incidence. Indeed, several epidemiologic studies have elucidated an inverse relationship between daily fiber intake and risk of CRC. Long-term prognosis in CRC survivors is also dependent on dietary fibers. Several pathogenetic mechanisms may be hypothesized. Fibers may interfere with the metabolism of bile acids, which may promote colon carcinogenesis. Further, fibers are often contained in vegetables which, in turn, contain large amounts of antioxidant agents like resveratrol, polyphenols, or phytoestrogens. Moreover, fibers can be digested by commensal flora, thus producing compounds such as butyrate, which exerts an antiproliferative effect. Finally, fibers may modulate gut microbiota, whose composition has shown to be associated with CRC onset. In this regard, dietary interventions based on high-fiber-containing diets are ongoing to prevent CRC development, especially in patients with high potential for this type of tumor. Despite the fact that outcomes are preliminary, encouraging results have been observed.
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Affiliation(s)
- Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
- Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Adriana Aloisio
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | | | | | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Francesco Russo
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (B.D.)
| | - Giuseppe Riezzo
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (B.D.)
| | - Benedetta D’Attoma
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (B.D.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
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Losurdo G, Di Leo M, Rizzi S, Lacavalla I, Celiberto F, Iannone A, Rendina M, Ierardi E, Iabichino G, De Luca L, Di Leo A. Familial intestinal polyposis and device assisted enteroscopy: where do we stand? Expert Rev Gastroenterol Hepatol 2023; 17:811-816. [PMID: 37515779 DOI: 10.1080/17474124.2023.2242240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Hereditary polyposis syndromes are a group of inherited disorders associated with a high risk of developing colorectal cancer. The best known ones are familial adenomatous polyposis (FAP), Peutz-Jeghers (PJS), juvenile polyposis and Cowden syndromes, as well as conditions predisposing to cancer, such as Lynch syndrome. Some of them are characterized by an increased risk of small bowel polyps occurrence. AREAS COVERED Literature search in PubMed was performed in November 2022 and a narrative review was carried out. Since performing small bowel polypectomy is important in such patients, device assisted enteroscopy (DAE) is the key for this procedure. A screening strategy for small bowel polyps is recommended only for PJS. Guidelines endorse either magnetic resonance imaging (MRI) or videocapsule endoscopy (VCE) every 1-3 years, according to the phenotype of the disease. Enteroscopy should be considered for therapeutic purpose in patients with a positive VCE or MRI. DAE has a central role in the resection of polyps larger than mm or causing symptoms of subocclusion or intussusception. Both single (SBE) and double balloon enteroscopy (DBE) are indicated and able to resect polyps up to 6-10 cm. American guidelines have restricted the indications to small bowel enteroscopy only to FAP patients with grade IV Spiegelman. EXPERT OPINION Only some groups of patients (PJS, FAP with demonstrated small bowel polyp burden) may benefit from DAE.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, ASST Santi Paolo E Carlo, Milano, Italy
| | - Salvatore Rizzi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Ilaria Lacavalla
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | | | - Luca De Luca
- Digestive Endoscopy Unit, ASST Santi Paolo E Carlo, Milano, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
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Losurdo G, Martino ML, De Bellis M, Celiberto F, Rizzi S, Principi M, Ierardi E, Iannone A, Di Leo A. Effect of Visual Booklets to Improve Bowel Preparation in Colonoscopy: Systematic Review with Meta-Analysis. J Clin Med 2023; 12:4377. [PMID: 37445412 DOI: 10.3390/jcm12134377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
An optimal bowel preparation for colonoscopy is essential to increasing the quality of the examination. Visual booklets have been proposed with conflicting results to enhance bowel preparation. A literature search was performed in March 2023 in the most important databases. Only RCTs were selected. We calculated odd ratios (OR) for dichotomous outcomes. Mean differences (MD) or standardized mean differences (SMD) were used for continuous outcomes. We estimated heterogeneity with the Chi2 and the I2 statistics. In cases of high heterogeneity, a random effect model was used. Six studies were selected, enrolling 1755 patients overall. Adequate bowel preparation was observed in 86.7% of the booklet group versus 77.5% of the control group, with an OR = 2.31 in favor of the booklet. In studies using a 4-L PEG-based preparation, no difference compared to controls was observed, while in non-PEG formulations, preparation with booklets was better than in controls (OR = 5.10, 95% CI 1.82-14.27, p = 0.002). Two studies were performed in an inpatient setting without any differences between booklets and controls, while outpatients receiving booklets had better results (OR = 7.13, 95% CI 5.39-9.45, p < 0.001). The adenoma detection rate was similar between the two groups. In conclusion, booklets are useful to improve bowel preparation. Outpatient settings and preparations not containing PEG could benefit more from booklets.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Maria Ludovica Martino
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Margherita De Bellis
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Precision Medicine Jonic Area, University "Aldo Moro" of Bari, 70124 Bari, Italy
| | - Salvatore Rizzi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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12
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Iannone A, Natale P, Palmer SC, Nicolucci A, Rendina M, Giorgino F, Laviola L, Di Leo A, Strippoli GFM. Clinical outcomes associated with drugs for obesity and overweight: A systematic review and network meta-analysis of randomized controlled trials. Diabetes Obes Metab 2023. [PMID: 37254688 DOI: 10.1111/dom.15138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023]
Abstract
AIM To compare the benefits and harms of drugs approved for weight management in adults with obesity or overweight. MATERIALS AND METHODS We performed a systematic review of drugs approved for treating obesity and overweight. We searched MEDLINE, Embase and CENTRAL through 26 February 2023. Random-effects network meta-analysis was applied. RESULTS A total of 168 trials (97 938 patients) were included. There was no evidence that drugs approved for weight management had different associations with cardiovascular death (69 trials, 59 037 participants). Naltrexone/bupropion was associated with lower cardiovascular mortality than placebo (odds ratio [OR], 0.62 [95% CI: 0.39, 0.99]; low certainty evidence). All drugs were associated with greater weight loss at 12 months than placebo (33 trials, 37 616 participants), mainly semaglutide (mean difference [MD], -9.02 kg [95% CI: -10.42, -7.63]; moderate certainty) and phentermine/topiramate (MD, -8.10 kg [95% CI: -10.14, -6.05]; high certainty); and with greater waist circumference reduction at 12 months than placebo (24 trials, 35 733 participants), mainly semaglutide (MD, -7.84 cm [95% CI: -9.34, -6.34]; moderate certainty) and phentermine/topiramate (MD, -6.20 cm [95% CI: -7.46, -4.94]; high certainty). Semaglutide and phentermine/topiramate were associated with lower or no difference in the odds of treatment withdrawal compared with all other drugs (87 trials, 70 860 participants). CONCLUSIONS Among adults with obesity or overweight, semaglutide and phentermine/topiramate were associated with greater body weight loss and waist circumference reduction at 12 months than all other drugs, and lower or no significant difference in risks of withdrawal. There was no evidence that drugs approved for weight management had different associations with cardiovascular death.
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Affiliation(s)
- Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Patrizia Natale
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Antonio Nicolucci
- Centre for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Luigi Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
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Barone M, Iannone A, Cristofori F, Dargenio VN, Indrio F, Verduci E, Di Leo A, Francavilla R. Risk of obesity during a gluten-free diet in pediatric and adult patients with celiac disease: a systematic review with meta-analysis. Nutr Rev 2023; 81:252-266. [PMID: 35947766 PMCID: PMC10857815 DOI: 10.1093/nutrit/nuac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Obesity is a significant risk factor for many pathological conditions. Whether a gluten-free diet (GFD) is a risk factor for overweight or obesity remains controversial. OBJECTIVE The primary aim of this study was to assess the prevalence of body mass index (BMI) categories at disease presentation and the variation in BMI category from underweight/normal to overweight/obese and vice versa during a GFD. DATA SOURCES PubMed, Scopus, and Web of Science databases were searched through February 2021 for retrospective, cross-sectional, and prospective studies reporting BMI categories at disease diagnosis and during a GFD. DATA EXTRACTION Data were extracted by 2 reviewers independently. Disagreements were resolved by consensus; a third reviewer was consulted, if necessary. Risk of bias was assessed with the Cochrane ROBINS-I tool. DATA ANALYSIS Subgroup analysis based on age (pediatric/adult patients), study design (prospective, cross-sectional, retrospective), and duration of GFD was performed.. Forty-five studies were selected (7959 patients with celiac disease and 20 524 healthy controls). The mean BMI of celiac patients at presentation was significantly lower than that of controls (P < 0.001). During a GFD, the mean BMI increased significantly (mean difference = 1.14 kg/m2 [95%CI, 0.68-1.60 kg/m2]; I2 = 82.8%; P < 0.001), but only 9% of patients (95%CI, 7%-12%; I2 = 80.0%) changed from the underweight/normal BMI category to the overweight/obese category, while 20% (95%CI, 11%-29%; I2 = 85.8%) moved into a lower BMI category. CONCLUSION Most celiac patients had a normal BMI at presentation, although the mean BMI was significantly lower than that of controls. A GFD does not increase the risk of becoming overweight/obese, especially in children. The quality of several studies was suboptimal, with moderate or high overall risk of bias and heterogeneity.
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Affiliation(s)
- Michele Barone
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Andrea Iannone
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Fernanda Cristofori
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
| | - Vanessa Nadia Dargenio
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
| | - Flavia Indrio
- is with the Department of Pediatrics, Scientific Institute “Casa Sollievo della Sofferenza,” Foggia, Italy
| | - Elvira Verduci
- is with the Department of Pediatrics, Ospedale dei Bambini “Vittore Buzzi,” Milan, Italy
| | - Alfredo Di Leo
- are with the Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro,” Bari, Italy
| | - Ruggiero Francavilla
- are with the Interdisciplinary Department of Medicine, Pediatric Section, University of Bari “Aldo Moro,” Bari, Italy
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Kondili LA, Quaranta MG, Cavalletto L, Calvaruso V, Ferrigno L, D'Ambrosio R, Simonelli I, Brancaccio G, Raimondo G, Brunetto MR, Zignego AL, Coppola C, Iannone A, Biliotti E, Verucchi G, Massari M, Licata A, Barbaro F, Persico M, Russo FP, Morisco F, Pompili M, Viganò M, Puoti M, Santantonio T, Villa E, Craxì A, Chemello L. Profiling the risk of hepatocellular carcinoma after long-term HCV eradication in patients with liver cirrhosis in the PITER cohort. Dig Liver Dis 2023:S1590-8658(23)00164-0. [PMID: 36775720 DOI: 10.1016/j.dld.2023.01.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/15/2022] [Accepted: 01/16/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND AIMS Severe liver disease markers assessed before HCV eradication are acknowledged to usually improve after the SVR. We prospectively evaluated, in the PITER cohort, the long-term HCC risk profile based on predictors monitored after HCV eradication by direct-acting antivirals in patients with cirrhosis. METHODS HCC occurrence was evaluated by Kaplan-Meier analysis. Cox regression analysis identified the post-treatment variables associated with de-novo HCC; their predictive power was presented in a nomogram. RESULTS After the end of therapy (median follow-up:28.47 months), among 2064 SVR patients, 119 (5.8%) developed de-novo HCC. The HCC incidence was 1.90%, 4.21%, 6.47% at 12-, 24- and 36-months from end-of-therapy, respectively (incidence rate 2.45/100 person-years). Age, genotype 3, diabetes, platelets (PLT)≤120,000/µl and albumin ≤3.5g/dl levels were identified as pre-treatment HCC independent predictors. Adjusting for age, the post-treatment PLT≤120,000/µl (AdjHR 1.92; 95%CI:1.06-3.45) and albumin≤3.5g/dl (AdjHR 4.38; 95%CI 2.48-7.75) values were independently associated with HCC occurrence. Two different risk profiles were identified by combining long-term post-therapy evaluation of PLT ≤ vs. >120,000/µl and albumin ≤ vs. >3.5g/dl showing a significant different HCC incidence rate of 1.35 vs. 3.77/100 p-y, respectively. CONCLUSIONS The nomogram score based on age, PLT and albumin levels after SVR showed an accurate prediction capability and may support the customizing management for early HCC detection.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore Di Sanità (ISS), Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
| | | | - Luisa Cavalletto
- Department of Medicine-DIMED, Padua University, University Hospital, Clinica Medica 5, Refering Regional Center for Liver Diseases, Padova, Italy
| | - Vincenza Calvaruso
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
| | - Luigina Ferrigno
- Center for Global Health, Istituto Superiore Di Sanità (ISS), Rome, Italy
| | - Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Simonelli
- L'altrastatistica srl, Consultancy & Training, Biostatistics Office, Rome, Italy
| | - Giuseppina Brancaccio
- Department of Molecular Medicine, Infectious Diseases Unit, University of Padua, Padua, Italy
| | - Giovanni Raimondo
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
| | - Maurizia R Brunetto
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Centre MASVE, University of Florence, Florence, Italy
| | - Carmine Coppola
- Department of Hepatology, Gragnano Hospital, Gragnano, NA, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Elisa Biliotti
- Infectious and Tropical Medicine Unit, Department of Public Health and Infectious Diseases, "Policlinico Umberto I" Hospital, Sapienza University of Rome, Rome, Italy
| | - Gabriella Verucchi
- Clinic of Infectious Diseases and Microbiology Unit, Alma Mater Studiorum, Bologna University, Bologna, Italy
| | - Marco Massari
- Malattie Infettive, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Licata
- Infectious Diseases Unit, DIBIMIS, University of Palermo, Palermo, Italy
| | - Francesco Barbaro
- Department of Medicine, Infectious Diseases Unit, University of Padua, Padua, Italy
| | - Marcello Persico
- Internal Medicine and Hepatology Division, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, Padua, Italy
| | | | - Maurizio Pompili
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, Rome, Italy
| | - Mauro Viganò
- Hepatology Unit, San Giuseppe Hospital, Milan, Italy
| | - Massimo Puoti
- Infectious Disease Unit, Niguarda Hospital, Milan, Italy; Università degli Studi di Milano-Bicocca, School of Medicine, Milan, Italy
| | - Teresa Santantonio
- Infectious Diseases Unit, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Erica Villa
- Gastroenterology Unit, Department of Medical Specialties, University of Modena & Reggio Emilia and Modena University-Hospital, Modena, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
| | - Liliana Chemello
- Department of Medicine-DIMED, Padua University, University Hospital, Clinica Medica 5, Refering Regional Center for Liver Diseases, Padova, Italy.
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Borraccino AV, Celiberto F, Pricci M, Girardi B, Iannone A, Rendina M, Ierardi E, Di Leo A, Losurdo G. Rifabutin as salvage therapy for Helicobacter pylori eradication: Cornerstones and novelties. World J Gastroenterol 2022; 28:6356-6362. [PMID: 36533106 PMCID: PMC9753051 DOI: 10.3748/wjg.v28.i45.6356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/25/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
When several Helicobacter pylori eradication treatments fail, guidelines recommend a cultured guided approach; however, culture is not widely available. Therefore, a rifabutin based regimen could be the best solution. Rifabutin indeed shows a low rate of antibiotic resistance. Rifabutin is generally used in combination with amoxicillin in a triple therapy, with eradication rates about 80% in third-line regimens. The ideal duration of this therapy should range between 10 and 12 d. Combinations with antibiotics other than amoxicillin have demonstrated even better results, such as vonoprazan, which is a type of novel acid suppressor drug. Finally, a new formulation of triple therapy in a single capsule is under investigation, which is a field that deserves further investigation. Some notes of caution about rifabutin should be mentioned. This drug is used to treat tuberculosis or atypical mycobacteria; therefore, before starting a rifabutin-based eradication regimen, Mycobacterium tuberculosis infection should be thoroughly tested, since its use could promote the development of antibiotic resistance, thus affecting its effectiveness against Koch’s bacillus. Additionally, some serious side effects must be evaluated before starting any rifabutin-based therapy. Adverse effects include fever, nausea, vomiting and bone marrow suppression. For this reason, full blood count surveillance is required.
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Affiliation(s)
- Antonia Valeria Borraccino
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | | | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Occhipinti C, Carnevale A, Briguglio L, Iannone A, Bisconti P. SAT: a methodology to assess the social acceptance of innovative AI-based technologies. JICES 2022. [DOI: 10.1108/jices-09-2021-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose
The purpose of this paper is to present the conceptual model of an innovative methodology (SAT) to assess the social acceptance of technology, especially focusing on artificial intelligence (AI)-based technology.
Design/methodology/approach
After a review of the literature, this paper presents the main lines by which SAT stands out from current methods, namely, a four-bubble approach and a mix of qualitative and quantitative techniques that offer assessments that look at technology as a socio-technical system. Each bubble determines the social variability of a cluster of values: User-Experience Acceptance, Social Disruptiveness, Value Impact and Trust.
Findings
The methodology is still in development, requiring further developments, specifications and validation. Accordingly, the findings of this paper refer to the realm of the research discussion, that is, highlighting the importance of preventively assessing and forecasting the acceptance of technology and building the best design strategies to boost sustainable and ethical technology adoption.
Social implications
Once SAT method will be validated, it could constitute a useful tool, with societal implications, for helping users, markets and institutions to appraise and determine the co-implications of technology and socio-cultural contexts.
Originality/value
New AI applications flood today’s users and markets, often without a clear understanding of risks and impacts. In the European context, regulations (EU AI Act) and rules (EU Ethics Guidelines for Trustworthy) try to fill this normative gap. The SAT method seeks to integrate the risk-based assessment of AI with an assessment of the perceptive-psychological and socio-behavioural aspects of its social acceptability.
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Losurdo G, Pricci M, De Bellis M, Celiberto F, Russo F, Riezzo G, D'attoma B, Iannone A, Rendina M, Ierardi E, Di Leo A. Effect of metronidazole resistance on Helicobacter pylori eradication regimens. J Dig Dis 2022; 23:561-567. [PMID: 36321440 DOI: 10.1111/1751-2980.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/14/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Guidelines suggest bismuth-containing quadruple therapy (BQT) or concomitant therapy (CT) as first-line therapy in our geographic area. Both schedules contain metronidazole. We aimed to evaluate the effect of metronidazole resistance to Helicobacter pylori (H. pylori) eradication therapy. METHODS We recruited treatment-naïve subjects with H. pylori infection who received either CT or BQT during January 2020 and December 2021. Before therapy, a fecal sample was collected using the THD fecal test device from each patient. H. pylori DNA was extracted and mutations of rdxA and frxA genes and A2143G for metronidazole and clarithromycin resistance were investigated using real-time polymerase chain reaction with a high-resolution melting curve. RESULTS Ninety-six patients were enrolled, including 29 received BQT and 67 received CT. The overall eradication rate was 94.8% (100% for BQT and 92.5% for CT). Metronidazole resistance was found in 18 (18.8%) subjects, while clarithromycin resistance was found in 19 (19.8%). All 18 patients with metronidazole resistance achieved successful eradication (five treated with BQT and 13 with CT). The eradication rate in metronidazole-sensitive strains was 93.6%. Of these, 24 received BQT with 100% success, and 54 had CT with five failures (successful eradication in 90.7%). Two patients with treatment failure were resistant to clarithromycin, and the remaining three were susceptible to both clarithromycin and metronidazole. No statistical significance was observed in the eradication rate between metronidazole-resistant and -sensitive strains (100% vs 93.6%, P = 0.58). CONCLUSION Metronidazole resistance does not influence the eradication rate of BQT and CT regimens in our geographical area, even if such results need to confirmed in a larger sample.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy.,PhD Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | | | - Margherita De Bellis
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy.,PhD Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Francesco Russo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Giuseppe Riezzo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Benedetta D'attoma
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
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Rendina M, Paoletti E, Labarile N, Marra A, Iannone A, Castellaneta A, Bussalino E, Ravera M, Schena A, Castellaneta NM, Barone M, Simone S, Gesualdo L, Di Leo A. HCV-positive kidney transplant patients treated with direct-acting antivirals maintain stable medium-term graft function despite persistent reduction in tacrolimus trough levels. Ther Adv Chronic Dis 2022; 13:20406223221117975. [PMID: 36147292 PMCID: PMC9486264 DOI: 10.1177/20406223221117975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background/aim: Direct-acting antivirals (DAAs) have improved the treatment of HCV-positive
kidney transplant recipients (KTRs). However, their medium-term follow-up
effects on graft function are conflicting. This study aimed to analyze how
the interplay between DAAs, calcineurin inhibitors (CNI), and HCV
eradication impacts 12-month kidney graft function. Methods: This double-center retrospective study with a prospective follow-up enrolled
35 KTRs with HCV treated with DAAs for 12 weeks. We compared three
parameters: estimated glomerular filtration rate (eGFR), 24-h proteinuria,
and CNI trough levels at three time points: baseline, end of treatment
(EOT), and 12 months later. Results: Kidney allograft function remained stable when comparing baseline and
12-month post-treatment values of eGFR (60.7 versus
57.8 ml/min; p = 0.28) and 24-h proteinuria (0.3
versus 0.2 g/24 h; p = 0.15), while
tacrolimus (Tac) trough levels underwent a statistically significant decline
(6.9 versus 5.4 ng/ml; p = 0.004). Using
an ongoing triple Tac-based maintenance therapy as a conservative measure, a
dose escalation of Tac was applied only in seven patients. No variation in
CyA and mTOR levels was detected. Conclusion: DAA therapy is safe and effective in HCV-positive KTRs. It also produces a
persistent significant reduction in Tac trough levels that does not
influence graft function at 12 months.
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Affiliation(s)
- Maria Rendina
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| | - Ernesto Paoletti
- Nephrology, Dialysis, and Transplantation, University of Genova and Policlinico San Martino, Genova, Italy
| | - Nunzia Labarile
- Gastroenterology Unit, National Institute of Gastroenterology IRCCS "Saverio de Bellis', Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Antonella Marra
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| | - Andrea Iannone
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| | | | - Elisabetta Bussalino
- Nephrology, Dialysis, and Transplantation, University of Genova and Policlinico San Martino, Genova, Italy
| | - Maura Ravera
- Nephrology, Dialysis, and Transplantation, University of Genova and Policlinico San Martino, Genova, Italy
| | - Antonio Schena
- Nephrology, Dialysis and Transplantation, University of Bari, Bari, Italy
| | | | - Michele Barone
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
| | - Simona Simone
- Nephrology, Dialysis and Transplantation, University of Bari, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy
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Kondili LA, Monti M, Quaranta MG, Gragnani L, Panetta V, Brancaccio G, Mazzaro C, Persico M, Masarone M, Gentile I, Andreone P, Madonia S, Biliotti E, Filomia R, Puoti M, Fracanzani AL, Laccabue D, Ieluzzi D, Coppola C, Rumi MG, Benedetti A, Verucchi G, Coco B, Chemello L, Iannone A, Ciancio A, Russo FP, Barbaro F, Morisco F, Chessa L, Massari M, Blanc P, Zignego AL. A prospective study of direct-acting antiviral effectiveness and relapse risk in HCV cryoglobulinemic vasculitis by the Italian PITER cohort. Hepatology 2022; 76:220-232. [PMID: 34919289 PMCID: PMC9305531 DOI: 10.1002/hep.32281] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/27/2021] [Accepted: 12/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Mixed cryoglobulinemia is the most common HCV extrahepatic manifestation. We aimed to prospectively evaluate the cryoglobulinemic vasculitis (CV) clinical profile after a sustained virologic response (SVR) over a medium-term to long-term period. APPROACH AND RESULTS Direct-acting antiviral-treated cryoglobulinemic patients, consecutively enrolled in the multicentric Italian Platform for the Study of Viral Hepatitis Therapy cohort, were prospectively evaluated. Cumulative incidence Kaplan-Meier curves were reported for response, clinical deterioration, relapse and relapse-free survival rates. Cox regression analysis evaluated factors associated with different outcomes. A clinical response was reported in at least one follow-up point for 373 of 423 (88%) patients with CV who achieved SVR. Clinical response increased over time with a 76% improvement rate at month 12 after the end of treatment. A full complete response (FCR) was reached by 164 (38.8%) patients in at least one follow-up point. CV clinical response fluctuated, with some deterioration of the initial response in 49.6% of patients (median time of deterioration, 19 months). In patients who achieved FCR and had an available follow-up (137 patients) a relapse was observed in 13% and it was transient in 66.7% of patients. The rate of patients without any deterioration was 58% and 41% at 12 and 24 months, respectively. After achieving SVR, a clinical nonresponse was associated with older age and renal involvement; a clinical deterioration/relapse was associated with high pretreatment rheumatoid factor values, and FCR was inversely associated with age, neuropathy, and high cryocrit levels. CONCLUSION In patients with CV, HCV eradication may not correspond to a persistent clinical improvement, and clinical response may fluctuate. This implies an attentive approach to post-SVR evaluation through prognostic factors and tailored treatment.
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Affiliation(s)
| | - Monica Monti
- Center for Systemic Manifestations of Hepatitis VirusesDepartment of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | | | - Laura Gragnani
- Center for Systemic Manifestations of Hepatitis VirusesDepartment of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Valentina Panetta
- L'altrastatistica srlConsultancy & Training, Biostatistics officeRomeItaly
| | | | - Cesare Mazzaro
- Clinical and Experimental Onco‐Haematology UnitIRCCS Centro di Riferimento OncologicoAviano, PordenoneItaly
| | - Marcello Persico
- Internal Medicine and Hepatology UnitSalerno UniversitySalernoItaly
| | - Mario Masarone
- Internal Medicine and Hepatology UnitSalerno UniversitySalernoItaly
| | - Ivan Gentile
- Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
| | - Pietro Andreone
- Department of Internal MedicineUniversity of Modena and Reggio EmiliaModenaItaly
| | - Salvatore Madonia
- Department of Internal MedicineVilla Sofia‐Cervello HospitalPalermoItaly
| | - Elisa Biliotti
- Infectious and Tropical Diseases UnitUmberto I Hospital‐“Sapienza” UniversityRomeItaly
| | - Roberto Filomia
- Department of Internal MedicineUniversity Hospital of MessinaMessinaItaly
| | | | - Anna Ludovica Fracanzani
- General Medicine and Metabolic DiseasesFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanItaly
| | - Diletta Laccabue
- Laboratory of Viral Immunopathology, Unit of Infectious Diseases and HepatologyAzienda Ospedaliero‐Universitaria di ParmaUniversity of ParmaParmaItaly
| | | | - Carmine Coppola
- Department of HepatologyGragnano HospitalGragnano, NaplesItaly
| | | | - Antonio Benedetti
- Clinic of Gastroenterology and HepatologyUniversità Politecnica delle MarcheAnconaItaly
| | - Gabriella Verucchi
- Clinic of Infectious Diseases and Microbiology UnitAlma Mater Studiorum Bologna UniversityBolognaItaly
| | - Barbara Coco
- Hepatology and Liver Physiopathology Laboratory and Internal MedicineDepartment of Clinical and Experimental MedicineUniversity Hospital of PisaPisaItaly
| | - Liliana Chemello
- Unit of Internal Medicine and Hepatology–Clinica Medica 5Department of Medicine‐DIMEDUniversity of PaduaPaduaItaly
| | | | - Alessia Ciancio
- Gastroenterology UnitCittà della Salute e della Scienza of TurinUniversity HospitalTurinItaly
| | - Francesco Paolo Russo
- Gastroenterology UnitDepartment of Surgery, Oncology and GastroenterologyUniversity of PaduaPaduaItaly
| | | | | | | | - Marco Massari
- Infectious Diseases UnitAzienda Unità Sanitaria Locale–IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Pierluigi Blanc
- Infectious Disease UnitSanta Maria Annunziata HospitalFlorenceItaly
| | - Anna Linda Zignego
- Center for Systemic Manifestations of Hepatitis VirusesDepartment of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
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Spinella A, Toss A, Isca C, De Pinto M, Vacchi C, Magnani L, Lumetti F, Macripo’ P, Ficarra G, Fabbiani L, Iannone A, Gasparini E, Piana S, Cortesi L, De Santis G, Maiorana A, Dominici M, Salvarani C, Giuggioli D. POS0919 MOLECULAR AND BIOLOGICAL PATHWAYS OF BREAST CANCER IN PATIENTS WITH SYSTEMIC SCLEROSIS: IMMUNOHISTOCHEMICAL INVESTIGATIONS FROM THE SCLERO-BREAST STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSystemic Sclerosis (SSc) is a life-threatening connective tissue disease characterized by endothelial dysfunction, autoimmune abnormalities and aberrant fibrosis. Several reports showed an increased risk of cancer in SSc compared to general population, including breast cancer (BC). The relationship between BC and SSc has long been discussed with contradictory results. In our recent Sclero-Breast study we analyzed clinical-pathological features of BC in SSc; we finally observed the development of BC with early stages and good prognosis among these patients.ObjectivesThe aim of this project was to explore the immunohistochemical (IHC) expression of potential biomarkers involved in the molecular pathways at the basis of SSc and BC etiophatogenesis as update analysis from the Sclero-Breast study.MethodsOur observational multicenter retrospective study, performed at Modena University Hospital and Reggio Emilia Hospital in northern Italy, enrolled 33 SSc women with a personal history of BC between January 2017 and December 2019. Clinical and pathological characteristics of BC and SSc were collected. For 22 patients, BC tissues were available and IHC analysis was performed using specific antibodies to evaluate biomarkers and pathways potentially involved. The antibodies used included: PI3K/mTOR/TGFβ/PDGFRα/PDGFRβ/VEGF/EGFR/IL-6/CTLA-4/PDL1. We also reported TILs percentage (stromal tumor-infiltrating lymphocytes) of each sample. The following scores were assigned for general IHC analysis: (-) negative, (1+) positive tumor cells <20%, (2+) positive tumor cells 20-50%, (3+) positive tumor cells >50%. For PDL1 we considered a positivity in case of PD-L1 expression ≥1% in infiltrating inflammatory cells. For TILs quantification we applied the score: 0 (negative), ≤ 50% (low-median expression), >50% (high expression).ResultsThe first IHC analysis was performed on the samples of invasive BC patients (20 pts) and showed a prevalence of high PI3K expression (score of 3+ in 55% of cases) with mTOR overexpression in 45%. A PDL1 positivity was detected in 30%, with high TILs expression in 30%. Biopsies from the 2 pts with ductal carcinoma in situ were characterized by a negativity of almost all parameters, except for a medium-high TILs expression reported (40%/90% respectively). See Figure 1. IHC analysis was also performed according to BC subtypes. The group of HR+/HER2 negative showed high PI3K expression (score 3+) in most of cases (59%) with mTOR overexpression in 50%. CTLA-4 and PDL1 were positive in 25%, with high TILs expression in 25%. HER2 positive patients showed a high PI3K positivity in 50% of cases with mTOR positivity (score 3+) in 25% and high TGFβ expression (score 3+) in 25%. PDL1 was positive in 50% with high TILs expression in 25%. In Triple Negative group, PI3K overexpression was found in 75% of pts with half of cases represented by mTOR score 3+. PDL1 was positive in 50% with high TILs representation (80% of total cell count) in 50% of pts.Figure 1.IHC analysis and TILs% expression in histological samples of SSc patients with invasive BC.ConclusionAccording to our results, SSc patients with BC showed high positivity for PDL1 and high TILs representations in all subtypes. Furthermore, the high expression of PI3K, did not always correlate with mTOR overexpression. Further investigations on larger numbers are needed; however, these aspects seem to confirm that SSc subjects might develop BC at good prognosis, suggesting again a de-escalation strategy of cancer therapies. Finally, the possibility to personalize oncological targeted treatments in this subset of fragile patients could be promising.Disclosure of InterestsNone declared
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Barone M, Losurdo G, Iannone A, Leandro G, Leo AD, Trerotoli P. ASSESSMENT OF BODY COMPOSITION: INTRINSIC METHODOLOGICAL LIMITATIONS AND STATISTICAL PITFALLS. Nutrition 2022; 102:111736. [DOI: 10.1016/j.nut.2022.111736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
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Fugazza A, Troncone E, Amato A, Tarantino I, Iannone A, Donato G, D'Amico F, Mogavero G, Amata M, Fabbri C, Radaelli F, Occhipinti P, Repici A, Anderloni A. Difficult biliary cannulation in patients with distal malignant biliary obstruction: An underestimated problem? Dig Liver Dis 2022; 54:529-536. [PMID: 34362708 DOI: 10.1016/j.dld.2021.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Failed biliary cannulation still poses a major challenge in patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP). To date, there is a lack of data on rates of Difficult Biliary Cannulation (DBC) in patients with distal malignant biliary obstruction (DMBO). MATERIALS This was a retrospective study (09/2015 to 02/2019) of consecutive patients with DMBO that underwent ERCP in four Italian centers. The primary outcome was to evaluate the rate of DBC. Secondary outcomes were: cannulation failure, rate of adverse events (AEs), the predictive factors for DBC as well as for AEs. RESULTS A total of 622 patients with DMBO, were included in the study, with 351(56,4%) matching the definition of DBC. One-hundred and two ERCP-related AEs occurred in 97 of 622 patients (15,6%). Subjects with DBC showed a higher risk for AEs (p = 0.02). The lack of pancreatitis prophylaxis (p = 0.03), diagnosis of cholangiocarcinoma (p = 0.02), the use of papillotomy (OR=1.98; 95%CI = 1.14-3.45) and the combination of two or more techniques for cannulation (OR = 2.88; 95%CI = 1.04-7.97) were associated with the occurrence of AEs. CONCLUSIONS According to the results of this study, patients with DMBO carries a higher rate of DBC thus requiring alternative techniques for biliary drainage. Furthermore, DBC carries a high risk for AEs. Further prospective multicentric studies are needed to confirm these data in this specific subgroup of patients.
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Affiliation(s)
- Alessandro Fugazza
- Digestive Endoscopy Unit, Departement of Gastroenterology, Humanitas Research Hospital-IRCCS, Rozzano, Italy.
| | - Edoardo Troncone
- Department of Systems Medicine, University of Rome ``Tor Vergata'', Rome 00133, Italy
| | - Arnaldo Amato
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Ilaria Tarantino
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giulio Donato
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Ferdinando D'Amico
- Digestive Endoscopy Unit, Departement of Gastroenterology, Humanitas Research Hospital-IRCCS, Rozzano, Italy
| | - Giuseppe Mogavero
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Michele Amata
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Medical Department, Forlì-Cesena Hospitals, AUSL Romagna
| | - Franco Radaelli
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Pietro Occhipinti
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Departement of Gastroenterology, Humanitas Research Hospital-IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Departement of Gastroenterology, Humanitas Research Hospital-IRCCS, Rozzano, Italy
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Spadaccini M, Di Leo M, Iannone A, von den Hoff D, Fugazza A, Galtieri PA, Pellegatta G, Maselli R, Anderloni A, Colombo M, Siersema PD, Carrara S, Repici A. Endoscopic ultrasound-guided ablation of solid pancreatic lesions: A systematic review of early outcomes with pooled analysis. World J Gastrointest Oncol 2022; 14:533-542. [PMID: 35317325 PMCID: PMC8918998 DOI: 10.4251/wjgo.v14.i2.533] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/03/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a complementary therapeutic approach for pancreatic solid masses. However, results of published data are difficult to interpret because of a retrospective design and small sample size.
AIM To systematically review data on EUS-RFA for solid lesions and to pool the results of the different experiences in order to provide more consistent evidence in terms of safety and efficacy.
METHODS A comprehensive systematic literature search on the main databases was performed to identify articles in which patients with pancreatic solid lesions underwent EUS-RFA. The primary outcomes were procedure-related adverse events (AEs) and mortality. Secondary outcomes were the technical success rate and the effects on primary tumor growth. Statistical analyses were performed using Stata version 14.0.
RESULTS In total, 14 studies were included, with 120 patients undergoing 153 ablations of 129 solid pancreatic lesions. The STARmed technology was used in seven studies, the Habib system in six studies, and the HybridTherm probe in one study. The pooled technical success rate was 99.0% (I2: 25.82%). The pooled overall AE rate was 8.0% (I2: 11.46%). Excluding mild AEs, the pooled rates of serious AEs was 1.0% (I2: 0%). No mortality related to the procedure was reported.
CONCLUSION The present pooled analysis confirms the safety and feasibility of EUS-RFA.
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Affiliation(s)
- Marco Spadaccini
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milan, Italy
| | - Milena Di Leo
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
| | - Andrea Iannone
- Endoscopy Unit, Azienda Ospedale Policlinico, Bari 70124, Italy
| | - Daan von den Hoff
- Endoscopy Unit, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands
| | - Alessandro Fugazza
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
| | - Piera Alessia Galtieri
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
| | - Gaia Pellegatta
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
| | - Roberta Maselli
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milan, Italy
| | - Andrea Anderloni
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
| | - Matteo Colombo
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
| | - Peter D Siersema
- Endoscopy Unit, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands
| | - Silvia Carrara
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
| | - Alessandro Repici
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milan, Italy
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24
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Spadaccini M, Bourke MJ, Maselli R, Pioche M, Bhandari P, Jacques J, Haji A, Yang D, Albéniz E, Kaminski MF, Messmann H, Herreros de Tejada A, Sferrazza S, Pekarek B, Rivory J, Geyl S, Gulati S, Draganov P, Shahidi N, Hossain E, Fleischmann C, Vespa E, Iannone A, Alkandari A, Hassan C, Repici A. Clinical outcome of non-curative endoscopic submucosal dissection for early colorectal cancer. Gut 2022; 71:gutjnl-2020-323897. [PMID: 35058275 DOI: 10.1136/gutjnl-2020-323897] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/08/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Endoscopic submucosal dissection (ESD) in a curative intent for submucosa-invasive early (T1) colorectal cancers (T1-CRCs) often leads to subsequent surgical resection in case of histologic parameters indicating higher risk of nodal involvement. In some cases, however, the expected benefit may be offset by the surgical risks, suggesting a more conservative approach. DESIGN Retrospective analysis of consecutive patients with T1-CRC who underwent ESD at 13 centres ending inclusion in 2019 (n=3373). Cases with high risk of nodal involvement (non-curative ESD: G3, submucosal invasion>1000 µm, lymphovascular involvement, budding or incomplete resection/R1) were analysed if follow-up data (endoscopy/imaging) were available, regardless of the postendoscopic management (follow-up vs surgery) selected by the multidisciplinary teams in these institutions. Comorbidities were classified according to Charlson Comorbidity Index (CCI). Outcomes were disease recurrence, death and disease-related death rates in the two groups. Rate of residual disease (RD) at both the previous resection site and regional lymph nodes was assessed in the surgical cases as well as from follow-up in the follow-up group. RESULTS Of 604 patients treated by colorectal ESD for submucosally invasive cancer, 207 non-curative resections (34.3%) were included (138 male; mean age 67.6±10.9 years); in 65.2% of cases, no complete resection was achieved (R1). Of the 207 cases, 60.9% (n=126; median CCI: 3; IQR: 2-4) underwent surgical treatment with RD in 19.8% (25/126), while 39.1% (n=81, median CCI: 5; IQR: 4-6) were followed up by endoscopy in all cases. Patients in the follow-up group had a higher overall mortality (HR=3.95) due to non-CRC causes (n=9, mean survival after ESD 23.7±13.7 months). During this follow-up time, tumour recurrence and disease-specific survival rates were not different between the groups (median follow-up 30 months; range: 6-105). CONCLUSION Following ESD for a lesion at high risk of RD, follow-up only may be a reasonable choice in patients at high risk for surgery. Also, endoscopic resection quality should be improved. TRIAL REGISTRATION NUMBER NCT03987828.
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Affiliation(s)
- Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Italy
| | - Michael J Bourke
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Italy
| | - Marhieu Pioche
- Endoscopy unit, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | | | | | - Amyn Haji
- Endoscopy unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Dennis Yang
- Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Eduardo Albéniz
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Michal Filip Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Centre fo Postgraduate Education, Warsaw, Poland
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | | | - Sandro Sferrazza
- Endoscopy unit, Ospedale di Trento, Trento, Trentino-Alto Adige, Italy
| | - Boris Pekarek
- University Hospital Bratislava, Bratislava, Slovakia
| | - Jerome Rivory
- Endoscopy unit, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Sophie Geyl
- Gastroenterology, Hospital Dupuytren, Limoges, France
| | - Shraddha Gulati
- Endoscopy unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Peter Draganov
- Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Neal Shahidi
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ejaz Hossain
- Endoscopy unit, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Carola Fleischmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | - Edoardo Vespa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Italy
| | - Andrea Iannone
- U.O. Gastroenterologia Universitaria, Policlinico di Bari, Bari, Italy
| | - Asma Alkandari
- Gastroenterology, Amiri Hospital, Kuwait City, Kuwait
- Gastroenterology, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Italy
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25
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Maselli R, Spadaccini M, Belletrutti PJ, Galtieri PA, Attardo S, Carrara S, Anderloni A, Fugazza A, Ferrara EC, Pellegatta G, Iannone A, Hassan C, Repici A. Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence. Endosc Int Open 2022; 10:E127-E134. [PMID: 35047343 PMCID: PMC8759944 DOI: 10.1055/a-1551-3058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/09/2021] [Indexed: 12/17/2022] Open
Abstract
Background and study aims The role of endoscopic submucosal dissection (ESD) for colorectal lesions in Western communities is unclear and its adoption is still limited. The aim of this study is to assess the long-term outcomes of a large cohort of patients treated with colorectal ESD in a tertiary Western center. Patients and methods A retrospective analysis was conducted on patients treated by ESD for superficial colorectal lesions between February 2011 and November 2019. The primary outcome was the recurrence rate. Secondary outcomes were en-bloc and R0 resection rates, procedural time, adverse events (AEs), and need for surgery. The curative resection rate was assessed for submucosal invasive lesions. Results A total of 327 consecutive patients, median age 69 years (IQR 60-76); 201 men (61.5 %) were included in the analysis. Of the lesions, 90.8 % were resected in an en-bloc fashion. The rate of R0 resection was 83.1 % (217/261) and 44.0 % (29/66) for standard and hybrid ESD techniques, respectively. Submucosal invasion and piecemeal resection independently predicted R1 resections. A total of 18(5.5 %) intra-procedural AEs (perforation:11, bleeding:7) and 12(3.7 %) post-procedural AEs occurred (perforation:2, bleeding: 10). Eighteen adenoma recurrences per 1,000 person-years (15cases, 5.6 %) were detected after a median follow-up time of 36 months. All recurrences were detected within 12 months. No carcinoma recurrences were observed. R1 resection status and intra-procedural AEs independently predicted recurrences with seven vs 150 recurrences per 1,000 person-years in the R0 vs R1 group, respectively. Conclusions Colorectal ESD is a safe and effective option for managing superficial colorectal neoplasia in a Western setting, with short and long-terms outcomes comparable to Eastern studies. En-bloc R0 resection and absence of intra-procedural AEs are associated with reduced risk of recurrence.
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Affiliation(s)
- Roberta Maselli
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy,Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy
| | - Marco Spadaccini
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy,Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy
| | - Paul J. Belletrutti
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy
| | | | - Simona Attardo
- Gastroenterology Unit, Ospedale Maggiore della Carità, Novara, Italy
| | - Silvia Carrara
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy
| | - Andrea Anderloni
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy
| | - Alessandro Fugazza
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy
| | - Elisa Chiara Ferrara
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy
| | - Gaia Pellegatta
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy,Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy
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26
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Di Leo M, Iannone A, Arena M, Losurdo G, Palamara MA, Iabichino G, Consolo P, Rendina M, Luigiano C, Di Leo A. Novel frontiers of agents for bowel cleansing for colonoscopy. World J Gastroenterol 2021; 27:7748-7770. [PMID: 34963739 PMCID: PMC8661374 DOI: 10.3748/wjg.v27.i45.7748] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’ acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’ tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.
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Affiliation(s)
- Milena Di Leo
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Monica Arena
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | | | - Pierluigi Consolo
- Unit of Digestive Endoscopy, University of Messina, Hospital "G. Martino", Messina 98121, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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27
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Spadaccini M, Iannone A, Maselli R, Badalamenti M, Desai M, Chandrasekar VT, Patel HK, Fugazza A, Pellegatta G, Galtieri PA, Lollo G, Carrara S, Anderloni A, Rex DK, Savevski V, Wallace MB, Bhandari P, Roesch T, Gralnek IM, Sharma P, Hassan C, Repici A. Computer-aided detection versus advanced imaging for detection of colorectal neoplasia: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol 2021; 6:793-802. [PMID: 34363763 DOI: 10.1016/s2468-1253(21)00215-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Computer-aided detection (CADe) techniques based on artificial intelligence algorithms can assist endoscopists in detecting colorectal neoplasia. CADe has been associated with an increased adenoma detection rate, a key quality indicator, but the utility of CADe compared with existing advanced imaging techniques and distal attachment devices is unclear. METHODS For this systematic review and network meta-analysis, we did a comprehensive search of PubMed/Medline, Embase, and Scopus databases from inception to Nov 30, 2020, for randomised controlled trials investigating the effectiveness of the following endoscopic techniques in detecting colorectal neoplasia: CADe, high definition (HD) white-light endoscopy, chromoendoscopy, or add-on devices (ie, systems that increase mucosal visualisation, such as full spectrum endoscopy [FUSE] or G-EYE balloon endoscopy). We collected data on adenoma detection rates, sessile serrated lesion detection rates, the proportion of large adenomas detected per colonoscopy, and withdrawal times. A frequentist framework, random-effects network meta-analysis was done to compare artificial intelligence with chromoendoscopy, increased mucosal visualisation systems, and HD white-light endoscopy (the control group). We estimated odds ratios (ORs) for the adenoma detection rate, sessile serrated lesion detection rate, and proportion of large adenomas detected per colonoscopy, and calculated mean differences for withdrawal time, with 95% CIs. Risk of bias and certainty of evidence were assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. FINDINGS 50 randomised controlled trials, comprising 34 445 participants, were included in our main analysis (six trials of CADe, 18 of chromoendoscopy, and 26 of increased mucosal visualisation systems). HD white-light endoscopy was the control technique in all 50 studies. Compared with the control technique, the adenoma detection rate was 7·4% higher with CADe (OR 1·78 [95% CI 1·44-2·18]), 4·4% higher with chromoendoscopy (1·22 [1·08-1·39]), and 4·1% higher with increased mucosal visualisation systems (1·16 [1·04-1·28]). CADe ranked as the superior technique for adenoma detection (with moderate confidence in hierarchical ranking); cross-comparisons of CADe with other imaging techniques showed a significant increase in the adenoma detection rate with CADe versus increased mucosal visualisation systems (OR 1·54 [95% CI 1·22-1·94]; low certainty of evidence) and with CADe versus chromoendoscopy (1·45 [1·14-1·85]; moderate certainty of evidence). When focusing on large adenomas (≥10 mm) there was a significant increase in the detection of large adenomas only with CADe (OR 1·69 [95% CI 1·10-2·60], moderate certainty of evidence) when compared to HD white-light endoscopy; CADe ranked as the superior strategy for detection of large adenomas. CADe also seemed to be the superior strategy for detection of sessile serrated lesions (with moderate confidence in hierarchical ranking), although no significant increase in the sessile serrated lesion detection rate was shown (OR 1·37 [95% CI 0·65-2·88]). No significant difference in withdrawal time was reported for CADe compared with the other techniques. INTERPRETATION Based on the published literature, detection rates of colorectal neoplasia are higher with CADe than with other techniques such as chromoendoscopy or tools that increase mucosal visualisation, supporting wider incorporation of CADe strategies into community endoscopy services. FUNDING None.
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Affiliation(s)
- Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
| | - Andrea Iannone
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, Italy
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Matteo Badalamenti
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Madhav Desai
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO, USA
| | | | - Harsh K Patel
- Endoscopy Unit, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Alessandro Fugazza
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Gaia Pellegatta
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | - Gianluca Lollo
- Department of Gastroenterology and Hepatology, Università della Svizzera Italiana, Lugano, Switzerland
| | - Silvia Carrara
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Andrea Anderloni
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Victor Savevski
- Artificial Intelligence Research, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Michael B Wallace
- Endoscopy Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Thomas Roesch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ian M Gralnek
- Institute of Gastroenterology and Liver Diseases, Ha'Emek Medical Center, Afula, Israel
| | - Prateek Sharma
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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D'Amico F, Amato A, Iannone A, Trovato C, Romana C, Angeletti S, Maselli R, Radaelli F, Fiori G, Viale E, Di Giulio E, Soriani P, Manno M, Rondonotti E, Galtieri PA, Anderloni A, Fugazza A, Ferrara EC, Carrara S, Di Leo M, Pellegatta G, Spadaccini M, Lamonaca L, Craviotto V, Belletrutti PJ, Hassan C, Repici A. Risk of Covert Submucosal Cancer in Patients With Granular Mixed Laterally Spreading Tumors. Clin Gastroenterol Hepatol 2021; 19:1395-1401. [PMID: 32687977 DOI: 10.1016/j.cgh.2020.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Granular mixed laterally spreading tumors (GM-LSTs) have an intermediate level of risk for submucosal invasive cancer (SMICs) without clear signs of invasion (covert); the optimal resection method is uncertain. We aimed to determine the risk of covert SMIC in GM-LSTs based on clinical and endoscopic factors. METHODS We collected data from 693 patients (50.6% male; median age, 69 years) with colorectal GM-LSTs, without signs of invasion, who underwent endoscopic resection (74.2%) or endoscopic submucosal dissection (25.2%) at 7 centers in Italy from 2016 through 2019. We performed multivariate and univariate analyses to identify demographic and endoscopic factors associated with risk of SMIC. We developed a multivariate model to calculate the number needed to treat (NNT) to detect 1 SMIC. RESULTS Based on pathology analysis, 66 patients (9.5%) had covert SMIC. In multivariate analyses, increased risk of covert SMIC were independently associated with increasing lesion size (odds ratio per mm increase, 1.02, 95% CI, 1.01-1.03; P = .003) and rectal location (odds ratio, 3.08; 95% CI, 1.62-5.83; P = .004). A logistic regression model based on lesion size (with a cutoff of 40 mm) and rectal location identified patients with covert SMIC with 47.0% sensitivity, 82.6% specificity, and an area under the curve of 0.69. The NNT to identify 1 patient with a nonrectal SMIC smaller than 4 cm was 20; the NNT to identify 1 patient with a rectal SMIC of 4 cm or more was 5. CONCLUSIONS In an analysis of data from 693 patients, we found the risk of covert SMIC in patients with GM-LSTs to be approximately 10%. GM-LSTs of 4 cm or more and a rectal location are high risk and should be treated by en-bloc resection. ClinicalTrials.gov, Number: NCT03836131.
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Affiliation(s)
| | - Arnaldo Amato
- Gastroenterology Department, Valduce Hospital, Como, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Cristina Trovato
- Division of Endoscopy, Istituto di Ricovero e Cura a Carattere Scientifico, European Institute of Oncology, Milan, Italy
| | - Chiara Romana
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Stefano Angeletti
- Digestive Endoscopy Unit, Azienda Ospedaliera Sant'Andrea, Sapienza Università di Roma, Rome, Italy
| | - Roberta Maselli
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | | | - Giancarla Fiori
- Division of Endoscopy, Istituto di Ricovero e Cura a Carattere Scientifico, European Institute of Oncology, Milan, Italy
| | - Edi Viale
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology, Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emilio Di Giulio
- Digestive Endoscopy Unit, Azienda Ospedaliera Sant'Andrea, Sapienza Università di Roma, Rome, Italy
| | - Paola Soriani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Carpi Hospital, Carpi, Italy
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Carpi Hospital, Carpi, Italy
| | | | - Piera Alessia Galtieri
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Elisa Chiara Ferrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Gaia Pellegatta
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Laura Lamonaca
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Paul J Belletrutti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Cesare Hassan
- Division of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy.
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Spinella A, Toss A, Isca C, Vacchi C, Iannone A, Magnani L, Castrignanò P, De Pinto M, Laura C, Maiorana A, Salvarani C, Dominici M, Giuggioli D. AB0425 CLINICAL AND PATHOLOGICAL FEATURES OF BREAST CANCER IN PATIENTS WITH SYSTEMIC SCLEROSIS: PRELIMINARY DATA FROM THE SCLERO-BREAST STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic Sclerosis (SSc) is a rare and life-threatening connective tissue disease characterized by vascular dysfunction, specific autoimmune abnormalities and fibrosis of the skin and internal organs. Previous studies have shown a 1.5-fold increase in cancer risk in SSc patients compared with the general population, including breast cancer (BC). The relationship between BC and SSc has long been discussed but past research has been contradictory and inconclusive on this topic.Objectives:The aim of our project was to analyze clinical and pathological characteristics of BC developed by SSc subjects and possible correlations with scleroderma features. Here we present the preliminary data from the Sclero-Breast study.Methods:Our observational retrospective multicenter study enrolled 33 SSc women with a personal history of BC identified at two Rheumatology/SSc Units in the north of Italy between January 2017 and December 2019 (lc/dcSSc 23/9, 1 unknown; mean age at SSc onset 57 years, range 32-73). All patients underwent general and instrumental assessment: smoking habits; presence of skin ulcers, calcinosis, teleangectasia; presence of gastro-intestinal and kidney involvement; interstitial lung disease (at HR-CT); pulmonary function tests; ECG abnormalities; echocardiographic assessment of pulmonary arterial hypertension (PAH); videocapillaroscopic pattern; autoantibody profile; exposure to immunosuppressive and vasoactive therapies; status at last follow-up evaluation and cause of death. Clinical and pathological characteristics of BC were also evaluated: age at diagnosis; menopausal status; histotype; hormone receptor status; MIB1, HER2 expression; clinical and pathological stage at diagnosis; metastatic sites; type of loco-regional treatment (surgery and radiotherapy); type of systemic treatment (neoadjuvant/adjuvant chemotherapy and endocrine treatment); other cancers and time from diagnosis of the first disorder to the second one.Results:A total of 54.5% of subjects developed BC before SSc (median interval of 5 years), whereas 45.5% of patients developed BC after SSc (median delay of 8 years). 54.5% of patients showed interstitial lung disease and the cause of death of the 6 deceased subjects was PAH. A significant association (p<0.05) was observed between the use of immunosuppressive therapy and diffuse skin extension, negative ACA, positive Anti-Scl-70 and interstitial lung disease, but not with BC status. 93.1% of patients were diagnosed with an early-stage tumor, 70.8% of invasive carcinomas with a low MIB-1, 8.3% with a tubular histotype, while 42.8% presented with a Luminal A-like tumor. 66.6% underwent breast conserving surgery and 55.5% RT after surgery. 40% of patients developed interstitial lung disease after RT and 20% dcSSc.Conclusion:According to our preliminary data, SSc patients developed BC at good prognosis, suggesting a de-escalation strategy of cancer therapies. On these grounds, a proper screening is mandatory in order to allow for early cancer detection in SSc patients. Further investigations on larger numbers of patients are needed. First of all, they would further clarify the intriguing relationship between BC and SSc. Secondly, they would help to explore the common biological and molecular pathways at the basis of these two disorders, with the aim to improve BC diagnosis and prognosis and to personalize oncological targeted treatments in this subset of fragile patients.Disclosure of Interests:None declared
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Binder S, Iannone A, Leibner C. Biometric technology in "no-gate border crossing solutions" under consideration of privacy, ethical, regulatory and social acceptance. Multimed Tools Appl 2020; 80:23665-23678. [PMID: 33390767 PMCID: PMC7770384 DOI: 10.1007/s11042-020-10266-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/08/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
Biometric technologies have become the main focus in the design of state-of-the-art border security solutions. While respective research in the field of multimedia vision has been centred around improving quality and accuracy of identity recognition, the impact of such technologies upon society and legal regulations still remains a topic unaddressed, specifically within the engineering community. Research in technology can and in some respect must include collaboration with social sciences and social practice. Building on participation in the EU funded research project PERSONA [18] (Privacy, Ethical, Regulatory and SOcial No-gate crossing point solutions Acceptance), authors of this paper look at the challenges associated with biometrics-based solutions in no-gate border crossing point scenarios. This included the procedures needed for the assessment of their social, ethical, privacy and regulatory acceptance, particularly in view of the impact on both, the passengers and border control authorities as well as the potential pitfalls of biometric technology due to fraudulent activities. In consultation with the collaborating border control authorities, the paper reports on the formal assessment of biometric technologies for real-world acceptance to cope with the increasing demand of global travellers crossing state borders.
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Affiliation(s)
- Susanne Binder
- MultiMedia and Visions Lab, London, E1 4NS UK
- Queen Mary University of London, London, UK
| | - Andrea Iannone
- CyberEthicsLab, Via Antonio Salandra, 18, 00187 Rome, Italy
| | - Chad Leibner
- Ministry of Public Security, Ba’alei Hamelacha 41, 72558 Ramle, Israel
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Losurdo G, Fortezza RFL, Iannone A, Contaldo A, Barone M, Ierardi E, Leo AD, Principi M. Prevalence and associated factors of obesity in inflammatory bowel disease: A case-control study. World J Gastroenterol 2020; 26:7528-7537. [PMID: 33384552 PMCID: PMC7754553 DOI: 10.3748/wjg.v26.i47.7528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, an increasing prevalence of obesity in inflammatory bowel disease (IBD) has been observed. Obesity, moreover, has been directly correlated with a more severe clinical course and loss of response to treatment.
AIM To assess the prevalence and associated factors of obesity in IBD.
METHODS We collected data about IBD disease pattern and activity, drugs and laboratory investigations in our center. Anthropometric measures were retrieved and obesity defined as a body mass index (BMI) > 30. Then, we compared characteristics of obese vs non obese patients, and Chi-squared test and Student’s t test were used for discrete and continuous variables, respectively, at univariate analysis. For multivariate analysis, we used binomial logistic regression and estimated odd ratios (OR) and 95% confidence intervals (CI) to ascertain factors associated with obesity.
RESULTS We enrolled 807 patients with IBD, either ulcerative colitis (UC) or Crohn’s disease (CD). Four hundred seventy-four patients were male (58.7%); the average age was 46.2 ± 13.2 years; 438 (54.2%) patients had CD and 369 (45.8%) UC. We enrolled 378 controls, who were comparable to IBD group for age, sex, BMI, obesity, diabetes and abdominal circumference, while more smokers and more subjects with hypertension were observed among controls. The prevalence of obesity was 6.9% in IBD and 7.9% in controls (not statistically different; P = 0.38). In the comparison of obese IBD patients and obese controls, we did not find any difference regarding diabetes and hypertension prevalence, nor in sex or smoking habits. Obese IBD patients were younger than obese controls (51.2 ± 14.9 years vs 60.7 ± 12.1 years, P = 0.03). At univariate analysis, obese IBD were older than normal weight ones (51.2 ± 14.9 vs 44.5 ± 15.8, P = 0.002). IBD onset age was earlier in obese population (44.8 ± 13.6 vs 35.6 ± 15.6, P = 0.004). We did not detect any difference in disease extension. Obese subjects had consumed more frequently long course of systemic steroids (66.6% vs 12.5%, P = 0.02) as well as antibiotics such as metronidazole or ciprofloxacin (71.4% vs 54.7%, P = 0.05). No difference about other drugs (biologics, mesalazine or thiopurines) was observed. Disease activity was similar between obese and non obese subjects both for UC and CD. Obese IBD patients suffered more frequently from arterial hypertension, type 2 diabetes, non-alcoholic fatty liver disease. Regarding laboratory investigations, obese IBD patients had higher levels of triglyceridemia, fasting blood glucose, gamma-glutamyl-transpeptidase. On multivariate analysis, however, the only factor that appeared to be independently linked to obesity in IBD was the high abdominal circumference (OR = 16.3, 95%CI: 1.03-250, P = 0.04).
CONCLUSION Obese IBD patients seem to have features similar to general obese population, and there is no disease-specific factor (disease activity, extension or therapy) that may foster obesity in IBD.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Rosa Federica La Fortezza
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Losurdo G, Iannone A, Contaldo A, Barone M, Ierardi E, Di Leo A, Principi M. Trends of Liver Stiffness in Inflammatory Bowel Disease with Chronic Hepatitis C. Diagnostics (Basel) 2020; 10:diagnostics10121037. [PMID: 33276638 PMCID: PMC7761525 DOI: 10.3390/diagnostics10121037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
Concomitant inflammatory bowel disease (IBD) and hepatitis C virus (HCV) infection is a relevant comorbidity since IBD itself exposes to a high risk of liver damage. We aimed to evaluate liver stiffness (LS) in IBD-HCV after antiviral treatment. We enrolled IBD patients with HCV. All patients at baseline underwent LS measurement by elastography. Patients who were eligible for antiviral therapy received direct antiviral agents (DAAs) and sustained viral response was evaluated at the 12th week. A control group was selected within IBD patients without HCV. One year later, all IBD-HCV patients and controls repeated LS measurement. Twenty-four IBD-HCV patients and 24 IBD controls entered the study. Only twelve out of 24 received DAAs and all achieved sustained viral response (SVR). All IBD subjects were in remission at enrollment and maintained remission for one year. After one year, IBD patients who eradicated HCV passed from a liver stiffness of 8.5 ± 6.2 kPa to 7.1 ± 3.9, p = 0.13. IBD patients who did not eradicate HCV worsened liver stiffness: from 7.6 ± 4.4 to 8.6 ± 4.6, p = 0.01. In the IBD control group, stiffness decreased from 7.8 ± 4.4 to 6.0 ± 3.1, p < 0.001. In conclusion, HCV eradication is able to stop the evolution of liver fibrosis in IBD, while failure to treat may lead to its progression. A stable IBD remission may improve LS even in non-infected subjects.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
- Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
- Correspondence: ; Tel.: +39-080-5593452; Fax: +39-080-5593088
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
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Rubartelli P, Bruzzone M, Ariel Sanchez F, Bologna E, Iannone A, Fedele M, Bellotti S, Bartolini D, Boasi V, Cannarile P, Vercellino M. Effect of pre-existing chronic kidney disease, anaemia and diabetes mellitus on mid-term mortality in patients with STEMI treated with primary PCI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The negative prognostic effect of chronic kidney disease (CKD), anaemia and diabetes in patients with acute coronary syndromes is well known. However, data about the prevalence and the prognostic importance of these comorbidities in unselected, contemporary STEMI patients treated with primary PCI are limited.
Purpose
We sought to investigate the prevalence of CKD, anaemia and diabetes mellitus in this patient population, as well as possible interactions between these comorbidities.
Methods
Between January 2006 and December 2018, 3395 consecutive patients with STEMI underwent primary PCI in two centres. Hb and creatinine were determined on a blood test obtained immediately upon the arrival at the Hospital and eGFR was estimated with the CKD-EPI equation. Renal impairment (RI) was defined as stage 3B or worse CKD (eGFR ≤44 ml/min/1.73m2). Anaemia was defined as Hb <13 g/dl in males and <12 g/dl in females. The outcome measure was overall mortality at a median follow-up of 1.9 years.
Results
The age of patients was (mean±SD) 67.2±12.9 years and 27.3% of them were females. Diabetes was present in 22.1%, anaemia in 18.1%, and RI in 9.8% of patients. The presence of diabetes, anemia or RI, individually or in various combination, was associated with higher mortality (see figure). Interestingly, these comorbidities presented an addictive, but non synergistic, effect (P for interaction = NS for all combinations). The covariates associated with mortality are shown in the Table. Notably, female gender was independently associated with lower mortality.
Conclusions
In contemporary patients treated with primary PCI, diabetes, anaemia and RI are frequently present, individually or in combination. All these comorbidities are strong independent predictors of mortality, and the coexistence of more conditions has addictive, but not synergistic, effect. The identification of patients at higher risk could promote a closer follow-up and more stringent measures of secondary prevention.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - M Bruzzone
- Ospedale Policlinico San Martino, Genoa, Italy
| | | | - E Bologna
- ASL3 Villa Scassi Hospital, Genoa, Italy
| | - A Iannone
- ASL3 Villa Scassi Hospital, Genoa, Italy
| | - M Fedele
- ASL3 Villa Scassi Hospital, Genoa, Italy
| | - S Bellotti
- ASL3 Villa Scassi Hospital, Genoa, Italy
| | | | - V Boasi
- Sanremo Hospital, Sanremo, Italy
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Losurdo G, Iannone A, Contaldo A, Barone M, Ierardi E, Di Leo A, Principi M. Chronic Viral Hepatitis in a Cohort of Inflammatory Bowel Disease Patients from Southern Italy: A Case-Control Study. Pathogens 2020; 9:pathogens9110870. [PMID: 33113974 PMCID: PMC7690684 DOI: 10.3390/pathogens9110870] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
We performed an epidemiologic study to assess the prevalence of chronic viral hepatitis in inflammatory bowel disease (IBD) and to detect their possible relationships. Methods: It was a single centre cohort cross-sectional study, during October 2016 and October 2017. Consecutive IBD adult patients and a control group of non-IBD subjects were recruited. All patients underwent laboratory investigations to detect chronic hepatitis B (HBV) and C (HCV) infection. Parameters of liver function, elastography and IBD features were collected. Univariate analysis was performed by Student's t or chi-square test. Multivariate analysis was performed by binomial logistic regression and odds ratios (ORs) were calculated. We enrolled 807 IBD patients and 189 controls. Thirty-five (4.3%) had chronic viral hepatitis: 28 HCV (3.4%, versus 5.3% in controls, p = 0.24) and 7 HBV (0.9% versus 0.5% in controls, p = 0.64). More men were observed in the IBD-hepatitis group (71.2% versus 58.2%, p < 0.001). Patients with IBD and chronic viral hepatitis had a higher mean age and showed a higher frequency of diabetes, hypertension and wider waist circumference. They suffered more frequently from ulcerative colitis. Liver stiffness was greater in subjects with IBD and chronic viral hepatitis (7.0 ± 4.4 versus 5.0 ± 1.2 KPa; p < 0.001). At multivariate analysis, only old age directly correlated with viral hepatitis risk (OR = 1.05, 95%CI 1.02-1.08, p < 0.001). In conclusion, the prevalence of HBV/HCV in IBD is low in our region. Age may be the only independent factor of viral hepatitis-IBD association. Finally, this study firstly measured liver stiffness in a large scale, showing higher values in subjects with both diseases.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
- Correspondence: ; Tel.: +39-080-559-2925
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
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Losurdo G, Giorgio F, Pricci M, Girardi B, Russo F, Riezzo G, Martulli M, Piazzolla M, Cocomazzi F, Abbruzzi F, Parente E, Paolillo R, Mileti A, Iannone A, Principi M, Ierardi E, Di Leo A. Helicobacter pylori Primary and Secondary Genotypic Resistance to Clarithromycin and Levofloxacin Detection in Stools: A 4-Year Scenario in Southern Italy. Antibiotics (Basel) 2020; 9:antibiotics9100723. [PMID: 33096925 PMCID: PMC7589162 DOI: 10.3390/antibiotics9100723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Antibiotic resistance has become an emerging problem for treating Helicobacter pylori (H. pylori) infection. Clarithromycin and levofloxacin are two key antibiotics used for its eradication. Therefore, we reviewed our experience with genotypic resistance analysis in stools to both clarithromycin and levofloxacin in the last four years to evaluate time trends, both in naive and failure patients. Patients collected a fecal sample using the THD fecal test device. Real-time polymerase chain reaction was performed to detect point mutations conferring resistance to clarithromycin (A2142C, A2142G, and A2143G in 23S rRNA) and levofloxacin (substitutions at amino acid position 87 and 91 of gyrA). One hundred and thirty-five naive patients were recruited between 2017-2020. Clarithromycin resistance was detected in 37 (27.4%). The time trend did not show any significant variation from 2017 to 2020 (p = 0.33). Primary levofloxacin resistance was found in 26 subjects (19.2%), and we observed a dramatic increase in rates from 2017 (10%) to 2018 (3.3%), 2019 (20%), and 2020 (37.8%). Ninety-one patients with at least one eradication failure were recruited. Secondary resistance to clarithromycin and levofloxacin was found in 59 (64.8%) and 45 patients (59.3%), respectively. In conclusion, our geographic area has a high risk of resistance to clarithromycin. There is also a progressive spreading of levofloxacin-resistant strains.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
- Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | | | - Maria Pricci
- THD SpA, 42015 Correggio, Italy; (F.G.); (M.P.); (B.G.)
| | - Bruna Girardi
- THD SpA, 42015 Correggio, Italy; (F.G.); (M.P.); (B.G.)
| | - Francesco Russo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (M.M.)
| | - Giuseppe Riezzo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (M.M.)
| | - Manuela Martulli
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (M.M.)
| | - Mariano Piazzolla
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Francesco Cocomazzi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Francesco Abbruzzi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Elisabetta Parente
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Rosa Paolillo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Alessia Mileti
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
- Correspondence: ; Tel.: +39-80-559-2925
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Hassan C, Badalamenti M, Maselli R, Correale L, Iannone A, Radaelli F, Rondonotti E, Ferrara E, Spadaccini M, Alkandari A, Fugazza A, Anderloni A, Galtieri PA, Pellegatta G, Carrara S, Di Leo M, Craviotto V, Lamonaca L, Lorenzetti R, Andrealli A, Antonelli G, Wallace M, Sharma P, Rösch T, Repici A. Computer-aided detection-assisted colonoscopy: classification and relevance of false positives. Gastrointest Endosc 2020; 92:900-904.e4. [PMID: 32561410 DOI: 10.1016/j.gie.2020.06.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/01/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS False positive (FP) results by computer-aided detection (CADe) hamper the efficiency of colonoscopy by extending examination time. Our aim was to develop a classification of the causes and clinical relevance of CADe FPs, and to assess the relative distribution of FPs in a real-life setting. METHODS In a post-hoc analysis of a randomized trial comparing colonoscopy with and without CADe (NCT: 04079478), we extracted 40 CADe colonoscopy videos. Using a modified Delphi process, 4 expert endoscopists identified the main domains for the reasons and clinical relevance of FPs. Then, 2 expert endoscopists manually examined each FP and classified it according to the proposed domains. The analysis was limited to the withdrawal phase. RESULTS The 2 main domains for the causes of CADe FPs were identified as artifacts due to either the mucosal wall or bowel content, and clinical relevance was defined as the time spent on FPs and the FP rate per minute. The mean number of FPs per colonoscopy was 27.3 ± 13.1, of which 24 ± 12 (88%) and 3.2 ± 2.6 (12%) were due to artifacts in the bowel wall and bowel content, respectively. Of the 27.3 FPs per colonoscopy, 1.6 (5.7%) required additional exploration time of 4.8 ± 6.2 seconds per FP (ie, 0.7% of the mean withdrawal time). In detail, 15 (24.2%), 33 (53.2%), and 14 (22.6%) FPs were classified as being of mild, moderate, or severe clinical relevance. The rate of FPs per minute of withdrawal time was 2.4 ± 1.2, and was higher for FPs due to artifacts from the bowel wall than for those from bowel content (2.4 ± 0.6 vs 0.3 ± 0.2, P < .001). CONCLUSIONS FPs by CADe are primarily due to artifacts from the bowel wall. Despite a high frequency, FPs result in a negligible 1% increase in the total withdrawal time because most of them are immediately discarded by the endoscopist.
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Affiliation(s)
- Cesare Hassan
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome
| | - Matteo Badalamenti
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan
| | - Roberta Maselli
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan
| | - Loredana Correale
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of "Aldo Moro" of Bari, Bari
| | | | | | - Elisa Ferrara
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan
| | - Marco Spadaccini
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Asma Alkandari
- Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait City, Kuwait
| | - Alessandro Fugazza
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan
| | - Andrea Anderloni
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan
| | - Piera Alessia Galtieri
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan
| | - Gaia Pellegatta
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan
| | - Silvia Carrara
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan
| | - Milena Di Leo
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan
| | - Vincenzo Craviotto
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Laura Lamonaca
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | | | | | | | | | - Prateek Sharma
- Kansas City Veterans Affairs Hospital, Kansas City, Kansas, USA
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Repici
- Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
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Girardi B, Pricci M, Giorgio F, Piazzolla M, Iannone A, Losurdo G, Principi M, Barone M, Ierardi E, Di Leo A. Silymarin, boswellic acid and curcumin enriched dietetic formulation reduces the growth of inherited intestinal polyps in an animal model. World J Gastroenterol 2020; 26:1601-1612. [PMID: 32327909 PMCID: PMC7167411 DOI: 10.3748/wjg.v26.i14.1601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/06/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Some substances of plant origin have been reported to exert an effect in reducing intestinal neoplasm development, especially in animal models. Adenomatous polyposis coli multiple intestinal neoplasia - ApcMin/+ is the most studied murine model of genetic intestinal carcinogenesis.
AIM To assess whether an enriched nutritional formulation (silymarin, boswellic acid and curcumin) with proven “in vitro” and “in vivo” anti-carcinogenetic properties may prevent inherited intestinal cancer in animal model.
METHODS Forty adenomatous polyposis coli multiple intestinal neoplasia - ApcMin/+ mice were used for the study of cancer prevention. They were divided into two groups: 20 assumed standard and 20 enriched diet. At the 110th d animals were sacrificed. In each group, four subgroups received intraperitoneal bromodeoxyuridine injection at different times (24, 48, 72 and 96 h before the sacrifice) in order to assess epithelial turnover. Moreover, we evaluated the following parameters: Intestinal polypoid lesion number and size on autoptic tissue, dysplasia and neoplasia areas by histological examination of the whole small intestine, inflammation by histology and cytokine mRNA expression by real-time polymerase chain reaction, bromodeoxyuridine and TUNEL immuno-fluorescence for epithelial turnover and apoptosis, respectively. Additionally, we performed western blotting analysis for the expression of estrogen alpha and beta receptors, cyclin D1 and cleaved caspase 3 in normal and polypoid tissues.
RESULTS Compared to standard, enriched diet reduced the total number (203 vs 416) and the mean ± SD/animal (12.6 ± 5.0 vs 26.0 ± 8.8; P < 0.001) of polypoid lesions. In enriched diet group a reduction in polyp size was observed (P < 0.001). Histological inflammation and pro-inflammatory cytokine expression were similar in both groups. Areas of low-grade dysplasia (P < 0.001) and intestinal carcinoma (IC; P < 0.001) were significantly decreased in enriched diet group. IC was observed in 100% in standard and 85% in enriched formulation assuming animals. Enriched diet showed a faster epithelial migration and an increased apoptosis in normal mucosa and low-grade dysplasia areas (P < 0.001). At western blotting, estrogen receptor beta protein was well expressed in normal mucosa of enriched and standard groups, with a more marked trend associated to the first one. Estrogen receptor alpha was similarly expressed in normal and polypoid mucosa of standard and enriched diet group. Cleaved caspase 3 showed in normal mucosa a stronger signal in enriched than in standard diet. Cyclin D1 was more expressed in standard than enriched diet group of both normal and polypoid tissue.
CONCLUSION Our results are suggestive of a chemo-preventive synergic effect of the components (silymarin, boswellic acid and curcumin) of an enriched formulation in inherited IC. This effect may be mediated by the reduction of epithelial proliferation, the increase of apoptosis and the acceleration of villous cell renewal due to dietary formulation intake.
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Affiliation(s)
| | | | | | - Mariano Piazzolla
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Andrea Iannone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Giuseppe Losurdo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Mariabeatrice Principi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Michele Barone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Principi M, Contaldo A, Bianchi FP, Losurdo G, Iannone A, Ierardi E, Tafuri S, Di Leo A. Inter-Observer Agreement of a New Endoscopic Score for Ulcerative Colitis Activity: Preliminary Experience. Diagnostics (Basel) 2020; 10:diagnostics10040213. [PMID: 32290549 PMCID: PMC7236596 DOI: 10.3390/diagnostics10040213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/23/2023] Open
Abstract
Ulcerative colitis (UC) endoscopic scores translate mucosal damage into values standardizing image analysis. Due to potential limits of current endoscopic activity indexes, we have elaborated on a new score, the “Extended Mayo Endoscopic Score (EMES),” and evaluated its inter-observer agreement in a multicenter endoscopy team, comparing concordance with the Mayo subscore. Sixteen UC consecutive patients underwent follow-up colonoscopy. Recorded videos were anonymously loaded on a web platform. Thirteen expert endoscopists evaluated UC activity using both Mayo and EMES. EMES was described in every colon segment: erythema (0: absent, 1: mild, 2: moderate, 3: severe), vascular pattern (0: normal, 1: reduction, 2: disappearance), erosions and ulcers (0: absent, 1: from 1 to 5, 2: 6 to 10, 3: >10). Weighted Fleiss’ kappa with 95% confidence interval (CI) and p-value defined inter-rater agreement. Global inter-observer agreement of EMES was moderate (kappa = 0.56, 95% CI = 0.46–0.67, p < 0.001). The evaluation of each colonic segment showed moderate agreement for all segments: ascending (kappa = 0.46, 95% CI = 0.32–0.60, p < 0.001), transverse (kappa = 0.48, 95% CI = 0.29–0.67, p < 0.001); descending (kappa = 0.49, 95% CI = 0.35–0.64, p < 0.001), sigmoid (kappa = 0.52, 95% CI = 0.39–0.65, p < 0.001) and rectum (kappa = 0.55, 95% CI = 0.42–0.69, p < 0.001). Mayo subscore agreement was similar to global EMES (kappa = 0.53, 95% CI = 0.39–0.66, p = 0.001). Therefore, our report emphasizes the importance of assessing inter-observer agreement for EMES, but also for other known scoring systems, including the Mayo subscore.
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Affiliation(s)
- Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
- Correspondence: ; Tel.: +39-08-0559-3452; Fax: +39-08-0559-3088
| | - Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
| | - Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.P.B.); (S.T.)
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
- PhD Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.P.B.); (S.T.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
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Quaranta MG, Ferrigno L, Monti M, Filomia R, Biliotti E, Iannone A, Migliorino G, Coco B, Morisco F, Vinci M, D'Ambrosio R, Chemello L, Massari M, Ieluzzi D, Russo FP, Blanc P, Verucchi G, Puoti M, Rumi MG, Barbaro F, Santantonio TA, Federico A, Chessa L, Gentile I, Zuin M, Parruti G, Morsica G, Kondili LA. Advanced liver disease outcomes after hepatitis C eradication by human immunodeficiency virus infection in PITER cohort. Hepatol Int 2020; 14:362-372. [PMID: 32279177 PMCID: PMC7220859 DOI: 10.1007/s12072-020-10034-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/18/2020] [Indexed: 02/06/2023]
Abstract
Background Liver disease progression after Hepatitis C Virus (HCV) eradication following direct-acting antiviral (DAA) treatment in the real-life setting according to Human Immunodeficiency Virus (HIV) coinfection was evaluated. Methods Patients consecutively enrolled in PITER between April 2014 and June 2019 and with at least 12-weeks follow-up following treatment were analysed. Cox regression analysis were used to evaluate HIV coinfection and factors independently associated with liver disease outcomes following viral eradication in DAA treated patients with pre-treatment liver cirrhosis. Results 93 HIV/HCV coinfected and 1109 HCV monoinfected patients were evaluated during a median follow-up of 26.7 (range 6–44.6) and 24.6 (range 6.8–47.3) months, respectively. No difference in the cumulative HCC incidence and hepatic decompensation was observed between coinfected and monoinfected patients. Age (Hazard Ratio [HR] = 1.08; 95% CI 1.04–1.13), male sex (HR = 2.76; 95% CI 1.28–5.96), lower albumin levels (HR = 3.94; 95% CI 1.81–8.58), genotype 3 (HR = 5.05; 95% CI 1.75–14.57) and serum anti-HBc positivity (HR = 1.99, 95% CI 1.01–3.95) were independently associated with HCC incidence. Older age (HR = 1.03; 95% CI 1.00–1.07), male sex (HR = 2.13; 95% CI 1.06–4.26) and lower albumin levels (HR = 3.75; 95% CI 1.89–7.46) were independently associated with the appearance of a decompensating event after viral eradication. Conclusion Different demographic, clinical and genotype distribution between HIV coinfected vs those monoinfected, was observed in a representative cohort of HCV infected patients in Italy. Once liver cirrhosis is established the disease progression is decreased, but still persists regardless of viral eradication in both coinfected and monoinfected patients. In patients with cirrhosis, HIV coinfection was not associated with a higher probability of liver complications, after viral eradication.
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Affiliation(s)
| | - Luigina Ferrigno
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Monica Monti
- Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Roberto Filomia
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy
| | - Elisa Biliotti
- Department of Clinical Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Andrea Iannone
- Department of Emergency and Organ Transplantation, Gastroenterology Unit, University of Bari, Bari, Italy
| | | | - Barbara Coco
- Hepatology and Liver Physiopathology Laboratory and Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Filomena Morisco
- Gastroenterology and Hepatology Unit, Federico II University Hospital, Naples, Italy
| | - Maria Vinci
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - Roberta D'Ambrosio
- Gastroenterology and Hepatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Liliana Chemello
- Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Marco Massari
- Infectious Diseases, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesco Paolo Russo
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Pierluigi Blanc
- Infectious Disease Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Gabriella Verucchi
- Department of Medical and Surgical Sciences, Infectious Disease Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Massimo Puoti
- Department of Infectious Disease, Niguarda Hospital, Milan, Italy
| | - Maria Grazia Rumi
- Hepatology Unit, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Francesco Barbaro
- Infectious and Tropical Diseases Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | | | - Alessandro Federico
- Department of Hepato-Gastroenterology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luchino Chessa
- Liver Unit, University Hospital, Monserrato, Cagliari, Italy
| | - Ivan Gentile
- Infectious Disease Unit, Federico II University Hospital, Naples, Italy
| | - Massimo Zuin
- Gastroenterology and Hepatology Unit, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giustino Parruti
- Infectious Disease Unit, Spirito Santo General Hospital, Pescara, Italy
| | - Giulia Morsica
- Department of Infectious Diseases, San Raffaele Hospital, Milan, Italy
| | - Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
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Barone M, Gemello E, Viggiani MT, Cristofori F, Renna C, Iannone A, Di Leo A, Francavilla R. Evaluation of Non-Celiac Gluten Sensitivity in Patients with Previous Diagnosis of Irritable Bowel Syndrome: A Randomized Double-Blind Placebo-Controlled Crossover Trial. Nutrients 2020; 12:nu12030705. [PMID: 32155878 PMCID: PMC7146412 DOI: 10.3390/nu12030705] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background. To date, there is no reliable marker for the diagnosis of non-celiac gluten sensitivity (NCGS), which benefits from a gluten-free diet (GFD). This condition is characterized by functional gastrointestinal symptoms similar to those occurring in the course of irritable bowel syndrome (IBS). However, IBS has a higher prevalence, and often benefits from the administration of a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet. The overlap of symptoms between these two pathologies has led to an overestimation of self-made diagnosis NCGS. Aims. To better identify NCGS in subjects with a previous diagnosis of IBS. Methods. All subjects received a low FODMAP diet that was also gluten-free (low FODMAP-GFD), and those presenting an improvement of symptoms were exposed to gluten or placebo (double-blind challenge with wash-out and crossover). The response to dietary treatments was evaluated by visual analogue scale (VAS). Results. Of 30 patients (23 women, seven men, aged 42.2 ± 12.5 years, body mass index (BMI ) 24.7 ± 4.1 kg/m2), 26 benefited from the administration of low FODMAP-GFD and were exposed to the gluten/placebo challenge. After the challenge, using an increase of visual analogue scale VAS (Δ-VAS) ≥30%, 46.1% of the patients were NCGS+. However, this percentage became only 19.2% using a different method (mean ∆-VAS score plus two standard deviations). Conclusions. FODMAP intolerance could hide the response to a challenge test with gluten for the identification of NCGS in IBS patients. A low FODMAP-GFD followed by gluten/placebo challenge is able to identify patients with NCGS better. ClinicalTrials.gov registration number NCT04017585.
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Affiliation(s)
- Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70100 Bari, Italy; (M.T.V.); (A.I.); (A.D.L.)
- Correspondence: ; Tel.: +39-080-5593514; Fax: +39-080-5593177
| | - Eugenio Gemello
- Center for the Study and Treatment of Eating Disorders ASL/LE, 73100 Lecce, Italy; (E.G.); (C.R.)
| | - Maria Teresa Viggiani
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70100 Bari, Italy; (M.T.V.); (A.I.); (A.D.L.)
| | - Fernanda Cristofori
- Interdisciplinary Department of Medicine, Paediatric Section, University of Bari “Aldo Moro”, 70100 Bari, Italy; (F.C.); (R.F.)
| | - Caterina Renna
- Center for the Study and Treatment of Eating Disorders ASL/LE, 73100 Lecce, Italy; (E.G.); (C.R.)
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70100 Bari, Italy; (M.T.V.); (A.I.); (A.D.L.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70100 Bari, Italy; (M.T.V.); (A.I.); (A.D.L.)
| | - Ruggiero Francavilla
- Interdisciplinary Department of Medicine, Paediatric Section, University of Bari “Aldo Moro”, 70100 Bari, Italy; (F.C.); (R.F.)
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Barone M, Viggiani MT, Introna A, D'errico E, Scarafino A, Iannone A, Di Leo A, Simone IL. Nutritional prognostic factors for survival in amyotrophic lateral sclerosis patients undergone percutaneous endoscopic gastrostomy placement. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:490-496. [PMID: 31347407 DOI: 10.1080/21678421.2019.1643374] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: There are conflicting data on nutritional factors influencing survival in amyotrophic lateral sclerosis (ALS) patients after percutaneous endoscopic gastrostomy (PEG) placement. We performed an observational cross-sectional study evaluating body mass index (BMI) categories and cholesterol levels as prognostic factors for survival after PEG. Moreover, we assessed body composition in a subgroup of patients to better explain the influence of BMI on survival. Methods: Neurological and nutritional parameters were evaluated at the time of PEG implantation in 47 consecutive patients. Moreover, body composition was evaluated in a subgroup of 22 patients by bioelectrical impedance analysis. Survival was calculated as the time from the PEG placement to death. Results: Underweight patients had a significantly increased risk of death as compared to normal-weight patients using Cox regression analysis [HR = 3.37 (1.29-8.81); p = 0.04]. Similarly, older age at the onset of symptoms significantly increased the risk of death [HR = 1.07 (1.02-1.12); p = 0.001]. Neither overweight/obesity nor hypercholesterolemia affected survival. All ALS patients showed an altered body composition compared to the general population. In addition, a BMI <18.5 kg/m2 identified patients with a significant reduction of body cell mass (BCM) and phase angle (PhA) compared to patients with normal BMI taken as the reference value. Conclusions: In the later stages of the disease, only a BMI < 18.5 kg/m2 and older age at symptom onset had a prognostic value on survival. Dyslipidemia did not affect survival. The low BCM and PhA characterizing underweight patients support the role of BMI as a predictor of survival.
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Affiliation(s)
- Michele Barone
- Department of Emergency and Organ Transplantation, Gastroenterology Unit, University of Bari , Bari , Italy
| | - Maria Teresa Viggiani
- Department of Emergency and Organ Transplantation, Gastroenterology Unit, University of Bari , Bari , Italy
| | - Alessandro Introna
- Neurological ALS Tertiary Centre, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari , Bari , Italy
| | - Eustachio D'errico
- Neurological ALS Tertiary Centre, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari , Bari , Italy
| | - Antonio Scarafino
- Neurological ALS Tertiary Centre, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari , Bari , Italy
| | - Andrea Iannone
- Department of Emergency and Organ Transplantation, Gastroenterology Unit, University of Bari , Bari , Italy
| | - Alfredo Di Leo
- Department of Emergency and Organ Transplantation, Gastroenterology Unit, University of Bari , Bari , Italy
| | - Isabella Laura Simone
- Neurological ALS Tertiary Centre, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari , Bari , Italy
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Iannone A, Ruospo M, Palmer SC, Principi M, Barone M, Di Leo A, Strippoli GFM. Systematic review with network meta-analysis: endoscopic techniques for dysplasia surveillance in inflammatory bowel disease. Aliment Pharmacol Ther 2019; 50:858-871. [PMID: 31502284 DOI: 10.1111/apt.15493] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/08/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND International guidelines recommend dysplasia surveillance in IBD. AIM To compare endoscopic techniques for dysplasia surveillance METHODS: We searched MEDLINE, Embase, CENTRAL for randomised trials through May 2019. We estimated odds ratios (ORs) for binary and mean differences (MDs) for continuous outcomes, using frequentist random-effects network meta-analysis. We assessed study risk of bias and appraised evidence certainty using GRADE. RESULTS Eighteen trials (2638 participants) were included. Standard definition white-light endoscopy (OR 0.44, 95% CI 0.26-0.73; high certainty) and i-SCAN (OR 0.47, 95% CI 0.25-0.90; moderate certainty) had lower odds of detecting neoplasia than chromoendoscopy. Fujinon intelligent colour enhancement (FICE), standard definition white-light endoscopy and i-SCAN had lower odds for this outcome than full spectrum high definition white-light endoscopy (ORs 0.02 to 0.15; low certainty). Standard definition white-light endoscopy had lower odds of detecting nonpolypoid neoplasia than full spectrum high definition white-light endoscopy, narrow band imaging, chromoendoscopy and high definition white-light endoscopy (ORs 0.01-0.14; moderate certainty). Full spectrum high definition white-light endoscopy ranked as the best technique for both outcomes (moderate certainty). Standard definition white-light endoscopy had lower odds of detecting neoplasia by target biopsy (OR 0.27, 95% CI 0.08-0.91) and had shorter procedure time (MD -14.81 minutes, 95% CI -25.03, -4.06) than chromoendoscopy (moderate certainty). CONCLUSIONS Chromoendoscopy, high definition white-light endoscopy, narrow band imaging, autofluorescence, FICE and full spectrum high definition white-light endoscopy may be comparable for dysplasia surveillance. Standard definition white-light endoscopy and i-SCAN probably provide lower yields for neoplasia identification. Full spectrum high definition white-light endoscopy may represent the first-line approach.
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Affiliation(s)
- Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Warren L, Iannone A, Punglia R, Wong J, Garber J, Bellon J. Radiation-Related Toxicities in Patients with Known Pathogenic Mutations in Cancer Susceptibility Genes Treated Definitively for Breast Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Radaelli F, Fuccio L, Paggi S, Hassan C, Repici A, Rondonotti E, Semeraro R, Di Leo M, Anderloni A, Amato A, Trovato C, Bravi I, Buda A, de Bellis M, D'Angelo V, Segato S, Tarantino O, Musso A, Fasoli R, Frazzoni L, Liverani E, Fabbri C, Di Giulio E, Esposito G, Pigò F, Iannone A, Dentali F. Periendoscopic management of direct oral anticoagulants: a prospective cohort study. Gut 2019; 68:969-976. [PMID: 30064986 DOI: 10.1136/gutjnl-2018-316385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/10/2018] [Accepted: 07/14/2018] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To assess the frequency of adverse events associated with periendoscopic management of direct oral anticoagulants (DOACs) in patients undergoing elective GI endoscopy and the efficacy and safety of the British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) recommendations (NCT02734316). DESIGN Consecutive patients on DOACs scheduled for elective GI endoscopy were prospectively included. The timing of DOAC interruption and resumption before and after the procedures were recorded, along with clinical and procedural data. Procedures were stratified into low-risk and high-risk for GI-related bleeding, and patients into low-risk and high-risk for thromboembolic events. Patients were followed-up for 30 days for major and clinically relevant non-major bleeding events (CRNMB), arterial and venous thromboembolism and death. RESULTS Of 529 patients, 38% and 62% underwent high-risk and low-risk procedures, respectively. There were 45 (8.5%; 95% CI 6.3% to 11.2%) major or CRNMB events and 2 (0.4%; 95% CI 0% to 1.4%) thromboembolic events (transient ischaemic attacks). Overall, the incidence of bleeding events was 1.8% (95% CI 0.7% to 4%) and 19.3% (95% CI 14.1% to 25.4%) in low-risk and high-risk procedures, respectively. For high-risk procedures, the incidence of intraprocedural bleeding was similar in patients who interrupted anticoagulation according to BSG/ESGE guidelines or earlier (10.3%vs10.8%, p=0.99), with a trend for a lower risk as compared with those who stopped anticoagulation later (10.3%vs25%, p=0.07). The incidence of delayed bleeding appeared similar in patients who resumed anticoagulation according to BSG/ESGE guidelines or later (6.6%vs7.7%, p=0.76), but it tended to increase when DOAC was resumed earlier (14.4%vs6.6%, p=0.27). The risk of delayed major bleeding was significantly higher in patients receiving heparin bridging than in non-bridged ones (26.6%vs5.9%, p=0.017). CONCLUSION High-risk procedures in patients on DOACs are associated with a substantial risk of bleeding, further increased by heparin bridging. Adoption of the BSG/ESGE guidelines in periendoscopic management of DOACs seems to result in a favourable benefit/risk ratio. TRIAL REGISTRATION NUMBER NCT02734316; Pre-results.
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Affiliation(s)
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Silvia Paggi
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Milan, Italy
| | | | - Rossella Semeraro
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Milan, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Milan, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Milan, Italy
| | - Arnaldo Amato
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - Cristina Trovato
- Digestive Endoscopy Unit, European Institute of Oncology, Milan, Italy
| | - Ivana Bravi
- Digestive Endoscopy Unit, European Institute of Oncology, Milan, Italy
| | - Andrea Buda
- Gastroenterology Unit, Santa Maria del Prato Hospital, Feltre, Italy
| | - Mario de Bellis
- Gastroenterology and Endoscopy Unit, Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Valentina D'Angelo
- Gastroenterology and Endoscopy Unit, Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sergio Segato
- Gastroenterology and GI Endoscopy Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Alessandro Musso
- Gastroenterology Unit, Città della Salute e della Scienza, Turin, Italy
| | - Renato Fasoli
- Digestive Endoscopy Unit, ASL 1 Liguria, Imperia Hospital, Imperia, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisa Liverani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Emilio Di Giulio
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, S. Agostino-Estense Hospital, Modena, Italy
| | | | - Francesco Dentali
- Department of Clinical Medicine, University of Insubria, Varese, Italy
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Contaldo A, Losurdo G, Albano F, Iannone A, Barone M, Ierardi E, Di Leo A, Principi M. The Spectrum of Small Intestinal Lesions in Patients with Unexplained Iron Deficiency Anemia Detected by Video Capsule Endoscopy. Medicina (Kaunas) 2019; 55:medicina55030059. [PMID: 30818850 PMCID: PMC6473446 DOI: 10.3390/medicina55030059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/16/2019] [Accepted: 02/21/2019] [Indexed: 02/07/2023]
Abstract
Background and objectives: Video-capsule endoscopy (VCE) has shown a large range (38⁻83%) of diagnostic yield in unexplained iron deficiency anemia (IDA) and obscure-occult bleeding. Therefore, we retrospectively investigated the VCE-detected spectrum and the prevalence of small bowel injuries and associated risk factors in inpatients with both of the above reported conditions. Methods: We selected inpatients with IDA (hemoglobin <12 g/dL in women, <13 g/dL in men) and obscure-occult bleeding. We excluded VCE indications other than IDA. Complete medical histories and laboratory tests were collected. All subjects underwent PillCam SB2/SB3. The VCE feature Lewis score was calculated when appropriate. We used the t-test and Fisher's exact test for continuous and categorical variables, respectively, in univariate analysis. For multivariate analysis, we used binomial logistic regression. Results: We retrieved 109 patients (female:male ratio of 53:56; age 63.4 ± 18.9 years). Eighty patients (73.4%) showed ≥1 small bowel lesions. The Lewis score was calculated in 41 patients: 13 (31.7%) showed a mild (<135) and 28 (68.3%) a moderate-severe (135⁻790 and >790, respectively) score. In univariate analysis, the small bowel transit time (6.2 ± 2.9 versus 5.2 ± 2.1 h; p = 0.049) and non-steroidal anti-inflammatory drug use for at least two weeks (17.5% versus 0%; p = 0.01) were significantly higher in subjects with injuries. These associations were not confirmed at multivariate analysis. The severity of a lesion directly correlated with proton pump inhibitor (PPI) use and duration (not confirmed in multivariate analysis). VCE can reveal the source of obscure-occult bleeding in a high percentage of unexplained IDAs. A wide spectrum of endoscopic pictures may be found. Known as well as supposed risk factors for small bowel lesions may be detected.
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Affiliation(s)
- Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Francesca Albano
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
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Losurdo G, Principi M, Iannone A, Giangaspero A, Piscitelli D, Ierardi E, Di Leo A, Barone M. Predictivity of Autoimmune Stigmata for Gluten Sensitivity in Subjects with Microscopic Enteritis: A Retrospective Study. Nutrients 2018; 10:nu10122001. [PMID: 30567296 PMCID: PMC6315522 DOI: 10.3390/nu10122001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 02/07/2023] Open
Abstract
Non-celiac gluten sensitivity (NCGS) is an emerging gluten-related condition. We investigated whether the presence of autoimmune stigmata in a group of patients with clinical suspicion of NCGS and a histological picture of microscopic enteritis (ME) could be a predictive factor of NCGS. Patients with ME were followed up by periodical examinations. At baseline, we collected data about previous clinical history, including autoimmune diseases. NCGS was diagnosed according to Salerno criteria; other causes of ME were diagnosed according to well-established protocols. Patients with celiac disease were excluded. Student's and chi-square tests were used in univariate analysis. Kaplan-Meier curves and Cox regression were used to estimate hazard ratios (HR). Sixty-three patients were included. Twenty-two had a final diagnosis of NCGS; the remaining 41 had non-gluten-related causes of ME. Prevalence of autoimmune thyroiditis was higher among NCGS patients (40.1%) than in other ME (14.6%; p = 0.03). NCGS showed higher positivity rate for anti-gliadin (27.3% versus 2.5%; p = 0.006) and anti-nucleus (45.4% versus 12.2%; p = 0.005). Autoimmune thyroiditis had a non-significant trend (p = 0.06) for NCGS diagnosis, (HR = 2.4). Both anti-gliadin (HR = 2.4; p = 0.04) and anti-nucleus (HR = 2.7; p = 0.04) were directly associated with NCGS diagnosis. In conclusion, NCGS may have a cohort of autoimmune stigmata that can precede its diagnosis.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Antonio Giangaspero
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Domenico Piscitelli
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
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Kondili LA, Robbins S, Blach S, Gamkrelidze I, Zignego AL, Brunetto MR, Raimondo G, Taliani G, Iannone A, Russo FP, Santantonio TA, Zuin M, Chessa L, Blanc P, Puoti M, Vinci M, Erne EM, Strazzabosco M, Massari M, Lampertico P, Rumi MG, Federico A, Orlandini A, Ciancio A, Borgia G, Andreone P, Caporaso N, Persico M, Ieluzzi D, Madonia S, Gori A, Gasbarrini A, Coppola C, Brancaccio G, Andriulli A, Quaranta MG, Montilla S, Razavi H, Melazzini M, Vella S, Craxì A. Forecasting Hepatitis C liver disease burden on real-life data. Does the hidden iceberg matter to reach the elimination goals? Liver Int 2018; 38:2190-2198. [PMID: 29900654 PMCID: PMC6282782 DOI: 10.1111/liv.13901] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Advances in direct-acting antiviral treatment of HCV have reinvigorated public health initiatives aimed at identifying affected individuals. We evaluated the possible impact of only diagnosed and linked-to-care individuals on overall HCV burden estimates and identified a possible strategy to achieve the WHO targets by 2030. METHODS Using a modelling approach grounded in Italian real-life data of diagnosed and treated patients, different linkage-to-care scenarios were built to evaluate potential strategies in achieving the HCV elimination goals. RESULTS Under the 40% linked-to-care scenario, viraemic burden would decline (60%); however, eligible patients to treat will be depleted by 2025. Increased case finding through a targeted screening strategy in 1948-1978 birth cohorts could supplement the pool of diagnosed patients by finding 75% of F0-F3 cases. Under the 60% linked-to-care scenario, viraemic infections would decline by 70% by 2030 but the patients eligible for treatment will run out by 2028. If treatment is to be maintained, a screening strategy focusing on 1958-1978 birth cohorts could capture 55% of F0-F3 individuals. Under the 80% linked-to-care scenario, screening limited in 1968-1978 birth cohorts could sustain treatment at levels required to achieve the HCV elimination goals. CONCLUSION In Italy, which is an HCV endemic country, the eligible pool of patients to treat will run out between 2025 and 2028. To maintain the treatment rate and achieve the HCV elimination goals, increased case finding in targeted, high prevalence groups is required.
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Affiliation(s)
| | - Sarah Robbins
- Center for Disease AnalysisCDA Foundation | Polaris ObservatoryLafayetteCOUSA
| | - Sarah Blach
- Center for Disease AnalysisCDA Foundation | Polaris ObservatoryLafayetteCOUSA
| | - Ivane Gamkrelidze
- Center for Disease AnalysisCDA Foundation | Polaris ObservatoryLafayetteCOUSA
| | - Anna L. Zignego
- Department of Experimental and Clinical MedicineInterdepartmental Centre MASVEUniversity of FlorenceFlorenceItaly
| | - Maurizia R. Brunetto
- Internal MedicineDepartment of Clinical and Experimental Medicine University of Pisa and Liver UnitPisa University HospitalPisaItaly
| | - Giovanni Raimondo
- Department of Internal MedicineUniversity Hospital of MessinaMessinaItaly
| | - Gloria Taliani
- Infectious and Tropical Diseases UnitUmberto I HospitalSapienza UniversityRomeItaly
| | - Andrea Iannone
- Department of GastroenterologyUniversity Hospital of BariBariItaly
| | | | | | - Massimo Zuin
- Liver and Gastroenterology UnitASST Santi Paolo e CarloMilanItaly
| | | | - Pierluigi Blanc
- Department of Infectious DiseaseS.M. Annunziata HospitalFlorenceItaly
| | - Massimo Puoti
- Department of Infectious DiseaseNiguarda HospitalMilanItaly
| | | | - Elke M. Erne
- Department of Infectious DiseaseUniversity Hospital of PaduaPaduaItaly
| | | | - Marco Massari
- Department of Infectious DiseaseArcispedale Santa Maria NuovaReggio EmiliaItaly
| | - Pietro Lampertico
- Department of Gastroenterology and HepatologyFondazione IRCCS Cà Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly
| | - Maria G. Rumi
- Department of Gastroenterology and HepatologySan Giuseppe HospitalMilanItaly
| | - Alessandro Federico
- Department of Hepatology and GastroenterologyUniversità della Campania Luigi VanvitelliNaplesItaly
| | | | - Alessia Ciancio
- Gastoenterology UnitCittà della Salute e della Scienza‐Ospedale MolinetteTurinItaly
| | - Guglielmo Borgia
- Department of Infectious DiseaseFederico II UniversityNaplesItaly
| | | | | | - Marcello Persico
- Department of Internal Medicine and HepatologyUniversity of SalernoSalernoItaly
| | | | | | - Andrea Gori
- Department of Infectious DiseaseSan Gerardo HospitalMonzaItaly
| | - Antonio Gasbarrini
- Department of Internal Medicine and GastroenterologyCatholic University of RomeRomeItaly
| | | | - Giuseppina Brancaccio
- Infectious DiseasesDepartment of Mental and Physical Health and Preventive MedicineUniversità della Campania Luigi VanvitelliNaplesItaly
| | - Angelo Andriulli
- Division of GastroenterologyIstituto di Ricovero e Cura a Carattere ScientificoCasa Sollievo Sofferenza HospitalSan Giovanni Rotondo, FoggiaItaly
| | | | | | - Homie Razavi
- Center for Disease AnalysisCDA Foundation | Polaris ObservatoryLafayetteCOUSA
| | | | - Stefano Vella
- Center for Global HealthIstituto Superiore di SanitàRomeItaly
| | - Antonio Craxì
- Gastroenterolgy and Liver UnitDiBiMISUniversity of PalermoPalermoItaly
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Shahini E, Iannone A, Romagno D, Armandi A, Carparelli S, Principi M, Viggiani MT, Ierardi E, Di Leo A, Barone M. Clinical relevance of serum non-organ-specific antibodies in patients with HCV infection receiving direct-acting antiviral therapy. Aliment Pharmacol Ther 2018; 48:1138-1145. [PMID: 30375693 DOI: 10.1111/apt.14999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/26/2018] [Accepted: 09/05/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is associated with production of different serum non-organ-specific antibodies (NOSA) and risk for developing autoimmune disorders. The clinical significance of these phenomena is not fully understood. AIM To assess non-organ-specific antibodies before and 24 weeks after the end of therapy with direct-acting antivirals in patients with HCV-related infection, to better clarify the clinical relevance of these antibodies in terms of treatment response and prognostic value. METHODS Patients enrolled (191) were considered non-organ-specific antibody-positive for titres ≥1:40 on at least two determinations before treatment. RESULTS At baseline, 46 patients were positive and 145 were negative for autoantibodies. The prevalence of autoimmune thyroiditis was significantly higher in non-organ-specific antibody-positive group than non-organ-specific antibody-negative group (P = 0.02). HCV-RNA 24 weeks after the end of antiviral therapy was 100% negative in patients with antibodies positivity and 98.6% in antibody-negative patients (P = 1.0). In the former group, autoantibodies disappeared in 30 of 46 patients (65.2%). On multivariate analysis, non-organ-specific antibody-negativity was significantly reduced in patients with hepatic hilar lymphadenopathy (OR = 0.17; 95% CI 0.02-0.94, P = 0.04). None of the adverse events occurring during antiviral therapy was related to autoimmune disorders. CONCLUSIONS Hepatitis C virus clearance frequently reduces non-organ-specific antibody positivity suggesting that they represent an epiphenomenon of the viral infection. However, in patients who did not become negative, long-term monitoring would establish whether they could hide an underlying process that may progress into a clear autoimmune or rheumatologic disease. (Trial registration number: NCT03566966).
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Affiliation(s)
- Endrit Shahini
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Andrea Iannone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Domenico Romagno
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Angelo Armandi
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Sonia Carparelli
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Maria Teresa Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Enzo Ierardi
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
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Girardi B, Principi M, Pricci M, Giorgio F, Iannone A, Losurdo G, Ierardi E, Di Leo A, Barone M. Chemoprevention of inflammation-related colorectal cancer by silymarin-, acetyl-11-keto-beta-boswellic acid-, curcumin- and maltodextrin-enriched dietetic formulation in animal model. Carcinogenesis 2018; 39:1274-1282. [PMID: 30084990 DOI: 10.1093/carcin/bgy104] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/31/2018] [Indexed: 02/07/2023] Open
Abstract
On the basis of preliminary in vitro experience, we assessed whether an enriched nutritional formulation with estrogen receptor (ER)-beta agonist and anti-inflammatory properties may prevent inflammation-associated colorectal cancer (CRC) in an animal model. Study sample enclosed 110 C57BL/6J male mice. Forty underwent dietary supplement safety assessment (20 standard diet and 20 enriched formulation). Seventy were treated with azoxymethane (AOM)/dextran sulfate sodium and divided into two groups: 35 received standard diet and 35 enriched formulation (curcumin, boswellic acids, silymarin and maltodextrins). Miniature colonoscopy demonstrated colitis and solid lesion development in five mice/group 100 days after first AOM injection. Mice were killed after 10 days. In each group, four subgroups received intraperitoneal bromodeoxyuridine (BrdU) injection at 24th/48th/72nd/96th hour before killing. Anti-inflammatory effect and chemoprevention were evaluated by lesion number/size, histological inflammation/dysplasia/neoplasia assessment, pro-inflammatory cytokine messenger RNA (mRNA), ER-beta/ER-alpha/BrdU immunohistochemistry and TUNEL immunofluorescence. Standard formulation assumption was associated with colon shortening compared with enriched one (P = 0.04), which reduced solid lesion number and size (P < 0.001 for both), histological inflammation score (P = 0.04), pro-inflammatory cytokine mRNA expression (P < 0.001), number of low-grade dysplasia (LGD; P = 0.03) and high-grade dysplasia (P < 0.001) areas. CRC was observed in 69.6% in standard and 23.5% in enriched formulation assuming animals (P < 0.001). Enriched formulation induced lower ER-alpha expression in CRC (P < 0.001) and higher ER-beta expression in LGD (P < 0.001) being associated to higher epithelial turnover (BrdU; P<0.001) in normal mucosa and increased apoptosis in LGD and CRC (P < 0.001 for both). Our results are promising for a successful anti-inflammatory and chemopreventive effect of enriched formulation in CRC arising from inflamed tissue.
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Affiliation(s)
| | - Mariabeatrice Principi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | | | - Andrea Iannone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Losurdo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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50
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Buratti S, Crimi G, Somaschini A, Cornara S, Camporotondo R, Gnecchi M, Ferlini M, Fedele M, Belotti S, Iannone A, Beccaria F, Bartolini D, Oltrona Visconti L, Rubartelli P, De Ferrari GM. 2166STEMI in women undergoing primary PCI: time to make a (gender) difference. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Buratti
- Coronary Care Unit – Fondazione IRCCS Policlinico San Matteo and University of Pavia, Department of Molecular Medicine, Pavia, Italy
| | - G Crimi
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - A Somaschini
- Coronary Care Unit – Fondazione IRCCS Policlinico San Matteo and University of Pavia, Department of Molecular Medicine, Pavia, Italy
| | - S Cornara
- Coronary Care Unit – Fondazione IRCCS Policlinico San Matteo and University of Pavia, Department of Molecular Medicine, Pavia, Italy
| | - R Camporotondo
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Gnecchi
- Coronary Care Unit – Fondazione IRCCS Policlinico San Matteo and University of Pavia, Department of Molecular Medicine, Pavia, Italy
| | - M Ferlini
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - M Fedele
- ASL3 Genovese Villa Scassi Hospital, Department of Cardiology, Genoa, Italy
| | - S Belotti
- ASL3 Genovese Villa Scassi Hospital, Department of Cardiology, Genoa, Italy
| | - A Iannone
- ASL3 Genovese Villa Scassi Hospital, Department of Cardiology, Genoa, Italy
| | - F Beccaria
- ASL3 Genovese Villa Scassi Hospital, Department of Cardiology, Genoa, Italy
| | - D Bartolini
- ASL3 Genovese Villa Scassi Hospital, Department of Cardiology, Genoa, Italy
| | - L Oltrona Visconti
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - P Rubartelli
- ASL3 Genovese Villa Scassi Hospital, Department of Cardiology, Genoa, Italy
| | - G M De Ferrari
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
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