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Bressler B, Yarur A, Silverberg MS, Bassel M, Bellaguarda E, Fourment C, Gatopoulou A, Karatzas P, Kopylov U, Michalopoulos G, Michopoulos S, Navaneethan U, Rubin DT, Siffledeen J, Singh A, Soufleris K, Stein D, Demuth D, Mantzaris GJ. Vedolizumab and Anti-Tumour Necrosis Factor α Real-World Outcomes in Biologic-Naïve Inflammatory Bowel Disease Patients: Results from the EVOLVE Study. J Crohns Colitis 2021; 15:1694-1706. [PMID: 33786600 PMCID: PMC8495488 DOI: 10.1093/ecco-jcc/jjab058] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS This study aimed to compare real-world clinical effectiveness and safety of vedolizumab, an α4β7-integrin inhibitor, and anti-tumour necrosis factor-α [anti-TNFα] agents in biologic-naïve ulcerative colitis [UC] and Crohn's disease [CD] patients. METHODS This was a 24-month retrospective medical chart study in adult UC and CD patients treated with vedolizumab or anti-TNFα in Canada, Greece and the USA. Inverse probability weighting was used to account for differences between groups. Primary outcomes were cumulative rates of clinical effectiveness [clinical response, clinical remission, mucosal healing] and incidence rates of serious adverse events [SAEs] and serious infections [SIs]. Secondary outcomes included cumulative rates of treatment persistence [patients who did not discontinue index treatment during follow-up] and dose escalation and incidence rates of disease exacerbations and disease-related surgeries. Adjusted analyses were performed using inverse probability weighting. RESULTS A total of 1095 patients [604 UC, 491 CD] were included. By 24 months, rates of clinical effectiveness were similar between groups, but incidence rates of SAEs (hazard ratio [HR] = 0.42 [0.28-0.62]) and SIs (HR = 0.40 [0.19-0.85]) were significantly lower in vedolizumab vs anti-TNFα patients. Rates of treatment persistence [p < 0.01] by 24 months were higher in vedolizumab patients with UC. Incidence rates of disease exacerbations were lower in vedolizumab patients with UC (HR = 0.58 [0.45-0.76]). Other outcomes did not significantly differ between groups. CONCLUSION In this real-world setting, first-line biologic therapy in biologic-naïve patients with UC and CD demonstrated that vedolizumab and anti-TNFα treatments were equally effective at controlling disease symptoms, but vedolizumab has a more favourable safety profile.
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Affiliation(s)
- Brian Bressler
- St. Paul’s Hospital, British Columbia, Canada,Corresponding author: Dr Brian Bressler MD, MS, FRCPC, Founder, The IBD Centre of BC, Director, Advanced IBD Training Program Clinical Associate Professor of Medicine, Division of Gastroenterology, University of British Columbia, 770-1190 Hornby Street, Vancouver, BC Canada V6Z 2K5. Tel: 604.688.6332; Fax: 604.689.2004;
| | | | | | | | | | | | - Anthie Gatopoulou
- Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - Uri Kopylov
- Sheba Medical Center Ramat Gan and Sackler School of Medicine, Tel Aviv, Israel
| | | | | | | | - David T Rubin
- The University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Jesse Siffledeen
- Covenant Health Grey Nuns Community Hospital, Division of Gastroenterology, EdmontonCanada
| | | | | | | | - Dirk Demuth
- Takeda Pharmaceuticals International – Singapore, Singapore
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Katsinelos P, Kountouras J, Chatzimavroudis G, Lazaraki G, Terzoudis S, Gatopoulou A, Mimidis K, Maris T, Paroutoglou G, Anastasiadou K, Georgakis N. Factors predicting a positive capsule endoscopy in past overt obscure gastrointestinal bleeding: a multicenter retrospective study. Hippokratia 2016; 20:127-132. [PMID: 28416909 PMCID: PMC5388513] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Capsule endoscopy (CE) remains the examination of choice for the investigation of obscure gastrointestinal bleeding. Although the factors predicting positive CE findings in the overall obscure gastrointestinal bleeding have been investigated, the clinical characteristics that predict a positive CE in patients with past overt obscure gastrointestinal bleeding (OOGIB) have not been systematically studied. METHODS Between September 2004 and December 2013, 262 patients underwent CE for evaluation of past OOGIB after negative upper and lower endoscopy, and other diagnostic modalities. Patients' records were retrospectively reviewed to assess the factors that could possibly predict positive CE findings. RESULTS Two hundred and twenty four patients with a median age of 70 years (range: 17-87) were enrolled in the final analysis and were divided into two groups; those who had positive (group A: 118 patients) and those who had negative CE findings (group B: 106 patients). The overall diagnostic yield of CE was 52.68 %. Multivariate analysis demonstrated that age >65 years, anticoagulant use, antiplatelet use, and non-steroidal anti-inflammatory drugs use were independent predictive factors for positive findings on CE. Of the 118 patients with positive CE, therapeutic interventions were performed in 56 patients (47.46 %). Recurrence of bleeding presented in nine patients of group B compared with 39 patients of group A (p <0.001). CONCLUSIONS Certain clinical characteristics predict a positive CE in patients with past OOGIB. Patients with OOGIB and negative CE had a considerably lower rebleeding rate, and further invasive investigational procedures may be adjourned or may not be required, though such recommendation warrants further validation. Hippokratia 2016, 20(2): 127-132.
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Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - J Kountouras
- 2 Department of Internal Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Chatzimavroudis
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - G Lazaraki
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - S Terzoudis
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - A Gatopoulou
- 2 Department of Internal Medicine, University Hospital of Alexandroupoli, Democritus University of Thrace, Greece
| | - K Mimidis
- 1 Department of Internal Medicine, University Hospital of Alexandroupoli, Democritus University of Thrace, Greece
| | - T Maris
- Department of Gastroenterology, G.Papanikolaou General Hospital, Thessaloniki, Greece
| | - G Paroutoglou
- Department of Gastroenterology, University Hospital of Thessaly, Larissa, Greece
| | - K Anastasiadou
- 2 Department of Internal Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Georgakis
- 2 Department of Internal Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Gatopoulou A, Papanas N, Maltezos E. Diabetic gastrointestinal autonomic neuropathy: current status and new achievements for everyday clinical practice. Eur J Intern Med 2012; 23:499-505. [PMID: 22863425 DOI: 10.1016/j.ejim.2012.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 02/13/2012] [Revised: 02/27/2012] [Accepted: 03/01/2012] [Indexed: 12/14/2022]
Abstract
Gastrointestinal symptoms occur frequently among patients with diabetes mellitus and are associated with considerable morbidity. Diabetic gastrointestinal autonomic neuropathy represents a complex disorder with multifactorial pathogenesis, which is still not well understood. It appears to involve a spectrum of metabolic and cellular changes that affect gastrointestinal motor and sensory control. It may affect any organ in the digestive system. Clinical manifestations are often underestimated, and therefore autonomic neuropathy should be suspected in all diabetic patients with unexplained gastrointestinal symptoms. Advances in technology have now enabled assessment of gastrointestinal motor function. Moreover, novel pharmacological approaches, along with endoscopic and surgical treatment options, contribute to improved outcomes. This review summarises the progress achieved in diabetic gastrointestinal autonomic neuropathy during the last years, focusing on clinical issues of practical importance to the everyday clinician.
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Affiliation(s)
- A Gatopoulou
- Second Department of Internal Medicine, Democritus University of Thrace, Greece.
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Paikos D, Gatopoulou A, Moschos J, Koulaouzidis A, Bhat S, Tzilves D, Soufleris K, Tragiannidis D, Katsos I, Tarpagos A. Banding hemorrhoids using the O'Regan Disposable Bander. Single center experience. J Gastrointestin Liver Dis 2007; 16:163-5. [PMID: 17592563] [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] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
BACKGROUND Hemorrhoids are the most common anorectal disorder in the Western World and are a major cause of active, relapsing or chronic rectal bleeding. Many treatment options have been proposed and tried for early-stage hemorrhoids. There is general agreement that rubber banding ligation (RBL) is safe and effective. AIMS To evaluate the effectiveness and complications associated with RBL performed in outpatients for symptomatic hemorrhoids using the O'Regan Disposable Bander device. RESULTS Sixty consecutive patients underwent hemorrhoid banding with the O'Regan Disposable Bander. The mean time required for one session was 6.2 min; the longest was 10 min. No major complications were noted. Minor early and late bleeding was reported in 10% and 6.7% respectively, but none was severe. Pain occurred in 6.7% but was not severe. In all cases, clinical and endoscopic (range and form scores) improvement was observed and patients of all ages, including the elderly, were found to be tolerant to the procedure. CONCLUSION RBL performed in outpatients for symptomatic hemorrhoids using the O'Regan Disposable Bander device is associated with a good response and low complication rate. We recommend the technique as a safe and reliable treatment option.
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Tzilves D, Gatopoulou A, Zervas K, Katodritou E, Patakiouta F, Tarpagos A, Katsos I. Development of multiple myeloma in a patient with gastrointestinal stromal tumor treated with imatinib mesylate: A case report. World J Gastroenterol 2007; 13:2011-3. [PMID: 17461509 PMCID: PMC4146985 DOI: 10.3748/wjg.v13.i13.2011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumors, which represent approximately 1% of the neoplasms of the gastrointestinal tract. These tumors rarely give extra-abdominal metastases. However, their clinical outcome is potentially adverse. In some rare cases, co-existance of GISTs with other malignancies has been reported. Here we present a case of a 74-year old male with GIST, which was managed by surgical resection. Fourteen months later, the patient presented with liver metastases and imatinib mesylated was administered. During treatment, the patient reported skeletal pain and plane X-rays revealed osteolytic bone lesions. Further investigation revealed the presence of multiple myeloma. To the best of our knowledge, this is the first report of the co-existence of multiple myeloma (MM) with GIST.
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Affiliation(s)
- D Tzilves
- Department of Gastroenterology, Theagenio Cancer Hospital, 2, Al. Simeonidi 54007, Thessaloniki, Greece
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Soufleris K, Pilpilidis I, Tzilves D, Moschos J, Gatopoulou A, Patakiouta F, Tarpagos A, Katsos I. A case of early gastric cancer with bone metastases: are bone marrow micrometastases significant? Acta Gastroenterol Belg 2007; 70:231-4. [PMID: 17715641] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Gastric adenocarcinoma is currently the 14th cause of death worldwide. Early gastric cancer, defined as cancer not penetrating deeper than the submucosa, is considered to carry an excellent prognosis with 5-year survival rates reaching more than 90%. Cases of bone metastases due to intramucosal gastric cancer are very rarely described. A case of a 70-year old male presenting with confirmed bone metastases 7 years after a curative resection for a mucosal gastric carcinoma is discussed. The patient was investigated with bone marrow biopsy and bone scan and showed no other signs of disease. The clinicopathologic features included poor differentiation, signet ring cells presence, no lymph node involvement and a negative second laparotomy two years after the initial surgery. Studies concerning the presence of residual disease in the form of bone marrow micrometastases are briefly reviewed emphasizing that intramucosal gastric cancer still carries the p sibility for metastasis, many years after a curative resection, mandating long term alertness from the attending physician.
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Affiliation(s)
- K Soufleris
- Gastroenterology Department, Theagenion Anticancer Hospital, Thessaloniki, Greece.
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Vlachou M, Garantziotou D, Kaleyias J, Galanopoulou L, Rouli V, Apostolaki T, Koureli O, Spiliopoulou A, Gatopoulou A. P1543 Anaerobic microbiology of peritoneal cavity specimens in childhood. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71382-1] [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: 11/26/2022]
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Katsinelos P, Paikos D, Kountouras J, Chatzimavroudis G, Paroutoglou G, Moschos I, Gatopoulou A, Beltsis A, Zavos C, Papaziogas B. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness. Surg Endosc 2006; 20:1587-93. [PMID: 16897286 DOI: 10.1007/s00464-005-0778-1] [Citation(s) in RCA: 57] [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: 11/16/2005] [Accepted: 04/02/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Stent clogging is the major limitation of palliative treatment for malignant biliary obstruction. Metal stents have much better patency than plastic stents, but are more expensive. Preliminary data suggest that the recently designed plastic (Tannenbaum) stent has better duration of patency than the polyethylene stent. This study aimed to compare the efficacy and cost effectiveness between the Tannenbaum stent without side holes and the uncovered metal stent for patients with malignant distal common bile duct obstruction. METHODS In this study, 47 patients (median age, 73 years, range, 56-86 years) with inoperable malignant distal common bile duct strictures were prospectively randomized to receive either a Tannenbaum stent (n = 24) or an uncovered self-expandable metal stent (n = 23). The patients were clinically evaluated, and biochemical tests were analyzed if necessary until their death or surgery for gastric outlet obstruction. Cumulative first stent patency and patient survival were compared between the two groups. Cost-effectiveness analysis also was performed for the two study groups. RESULTS The two groups were comparable in terms of age, gender, and diagnosis. The median first stent patency was longer in the metal group than in the Tannenbaum stent group (255 vs 123.5 days; p = 0.002). There was no significant difference in survival between the two groups. The total cost associated with the Tannenbaum stents was lower than for the metal stents (17,700 vs 30,100 euros; p = 0.001), especially for patients with liver metastases (3,000 vs 6,900 euros; p < 0.001). CONCLUSIONS Metal stent placement is an effective treatment for inoperable malignant distal common bile duct obstruction, but Tannenbaum stent placement is a cost-saving strategy, as compared with metal stent placement, especially for patients with liver metastases and expected short survival time.
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Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, Central Hospital, 41 Ethnikis Aminis St., Thessaloniki, 546 35, Greece
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Mimidis K, Papadopoulos V, Margaritis V, Thomopoulos K, Gatopoulou A, Nikolopoulou V, Kartalis G. Predisposing factors and clinical symptoms in HIV-negative patients with Candida oesophagitis: are they always present? Int J Clin Pract 2005; 59:210-3. [PMID: 15854199 DOI: 10.1111/j.1742-1241.2004.00249.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 12/01/2022] Open
Abstract
Candida oesophagitis (CO) is scarce among immunocompetent patients. This study aimed at evaluating predisposing factors, clinical symptoms and endoscopic findings in this group. We retrospectively reviewed 55 patients diagnosed as CO endoscopically (whitish plaques) and cytologically (fungal mycelia on brush cytology). Carcinoma, diabetes, acid suppression, steroids, gastric surgery and oesophageal motility disorders were considered as predisposing factors. Twenty of 55 patients lacked any predisposing factor for CO. These patients were more frequently asymptomatic (8/20) when compared with those with known predisposing factors (5/35) (p = 0.031). Moreover, dysphagia was more prevalent in the latter group (24/35 vs. 8/20; p = 0.039). Endoscopic findings correlated with the presence of neither predisposing factors nor symptoms (Wilcoxon p > 0.05). Thus, CO can be discovered in patients without apparent predisposing risk factors and clinical symptoms. Further studies are needed to elucidate the mechanisms of transition from colonisation to infection.
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Affiliation(s)
- K Mimidis
- Department of Internal Medicine, Endoscopy Unit, Democritus University of Thrace, Alexandroupolis, Greece.
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Gatopoulou A, Mimidis K, Giatromanolaki A, Polichronidis A, Lirantzopoulos N, Sivridis E, Minopoulos G. Impact of Helicobacter pylori infection on histological changes in non-erosive reflux disease. World J Gastroenterol 2004; 10:1180-2. [PMID: 15069722 PMCID: PMC4656357 DOI: 10.3748/wjg.v10.i8.1180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: The evidence for an association between Helicobacter pylori (H pylori) and gastroesophageal reflux disease, either in non- erosive (NERD) or erosive esophagitis (ERD) remains uncertain. The available data on the histological changes in NERD and the effect on H pylori infection on them are elusive. The aim of this study therefore was to prospectively evaluate the histological findings and the impact of H pylori infection on a group of symptomatic patients with NERD.
METHODS: Fifty consecutive patients were prospectively evaluated for symptoms compatible with GORD. In all cases, routine endoscopy and lugol directed biopsies were performed and assessed histologically in a blinded manner.
RESULTS: The overall prevalence of H pylori infection was 70%. Twenty-nine patients out of 50 (58%) were NERD patients. No statistical significance was observed between the H pylori status and NERD. The remaining 21 (42%) were diagnosed as follows: 13 (26%), 6 (12%), 2(4%) with esophagitis grade A, B and C respectively. A statistically significant correlation was observed between the H pylori+ and esophagitis grade A, as well as between H pylori- and grade B. Biopsies from 2 patients were not included because of insufficient materials. Histologically, a basal zone hyperplasia was found in 47 (97.91%) patients, alterations of glycogen content in 47 (97.91%), papillae elongation in 33 (68.75%), blood vessels dilatation in 35(72.91%), chronic inflammation in 21 (43.75%), infiltration with eosinophils, neutophils and T-lymphocytes in 4 (8.33%), 6 (12.5%) and 39 (81.25%) respectively. No correlation was observed between the H pylori status and the histological parameters studied either in NERD or GERD.
CONCLUSION: Histological assessment can not differentiate symptomatic patients with erosive versus non-erosive reflux disease. Moreover, H pylori infection may not act as an important factor in patients with NERD.
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Affiliation(s)
- Anthie Gatopoulou
- Gastroenterologist, Lecturer in Internal Medicine, Chrisostomou Smirnis 8, 68100 Alexandroupolis, Greece
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