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Melotti L, Dussias NK, Salice M, Calabrese C, Baldoni M, Scaioli E, Belluzzi A, Mazzotta E, Gionchetti P, Rizzello F. Effectiveness of swapping to ustekinumab after vedolizumab failure in patients with multi-refractory Crohn's disease. Dig Liver Dis 2023; 55:230-234. [PMID: 35879185 DOI: 10.1016/j.dld.2022.06.029] [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: 04/22/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ustekinumab (UST) and vedolizumab (VDZ) are biologic therapies for moderate-to-severe Crohn's disease (CD) in patients who failed or had contraindication to anti-TNF treatment. AIMS To evaluate ustekinumab efficacy as third-line treatment after swapping from VDZ for failure. METHODS We conducted a monocentric, retrospective, observational study where CD patients were followed for 12 months from the beginning of UST therapy. We assessed clinical activity (HBI) and laboratory markers (CRP) at the initiation of UST therapy (T0) and after 2(T2), 6(T6) and 12(T12) months. Endoscopic activity was recorded at T0 and T12. We registered data regarding their clinical history and previous biologic treatments. Steroid-free clinical remission was defined as HBI ≤ 4 without need for steroids. Clinical response was defined as HBI reduction of at least three points or the suspension of steroids. RESULTS 27 CD patients treated with UST after VDZ failure had a minimum follow up of 12 months and were included. All patients had previously been treated with anti-TNF agents. After 12 months, steroid-free clinical remission was evident in 15 (55.5%) patients, 5 (18.5%) had clinical response, while 7 (26%) had suspended for failure or persisted on treatment after optimization. CONCLUSIONS Ustekinumab should be considered as third-line biologic treatment in multi-refractory CD patients.
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Affiliation(s)
- Laura Melotti
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
| | - Nikolas Konstantine Dussias
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
| | - Marco Salice
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Carlo Calabrese
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
| | - Monia Baldoni
- DIMEC, sezione Gastroenterologia, Università degli studi di Perugia, Italy
| | - Eleonora Scaioli
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Andrea Belluzzi
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Elena Mazzotta
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Paolo Gionchetti
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy.
| | - Fernando Rizzello
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
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Hao Y, Yzet C, McBride RB, Stock A, Tiratterra E, D'Errico A, Belluzzi A, Scaioli E, Gionchetti P, Roda G, Ungaro R, Colombel JF, Harpaz N, Ko HM. Baseline Histological Findings Do Not Predict the Risk of Subsequent Extension in Patients with Limited Ulcerative Colitis. Dig Dis Sci 2022; 67:1311-1319. [PMID: 33934255 DOI: 10.1007/s10620-021-06970-y] [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: 08/21/2020] [Accepted: 03/24/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Among patients with limited ulcerative colitis (UC), 30% ultimately extend to pancolitis and are at increased risk of adverse clinical outcomes. Risk of endoscopic extension has been found to correlate with clinical features such as early age of onset. AIMS We sought to determine whether histologic features correlate with disease extension. METHODS The study population consisted of 40 patients with UC from two large academic centers diagnosed between 2006 and 2017. Eligible cases had a diagnosis of endoscopically limited UC (Montreal E1 or E2) at baseline and ≥ 2 subsequent endoscopic examinations with biopsies. Severity of inflammation was scored using both the Mount Sinai Activity Index and Nancy Histological Index. RESULTS Patients were divided into two cohorts: those who progressed to pancolitis (Montreal E3) were defined as "Extenders" (n = 21), whereas "Non-extenders" (n = 19) were cases without progression in the follow-up period. The median follow-up time was 58.4 months. The histologic scores in the endoscopically involved mucosa of the index biopsies were not associated with subsequent extension of disease, overall. However, among extender cohort, the index histology scores correlated with biopsy scores at extension (r = 0.455, P = 0.044) and index severity was associated with a shorter time to extension (r = - 0.611, P = 0.003). Furthermore, female patients had a shorter time to extension (P = 0.013). CONCLUSIONS Histological severity of limited UC is not an independent predictor of extension in UC. However, among patients who subsequently extend, severe inflammation at baseline correlates with shorter progression time and severe inflammation when extension occurs. Patients with limited UC but severe histologic inflammation may warrant more frequent endoscopic surveillance.
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Affiliation(s)
- Yansheng Hao
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clara Yzet
- Department of Gastroenterology, Amiens University Hospital, Picardie University, Amiens, France
| | - Russell B McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aryeh Stock
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elisa Tiratterra
- Department of Medical and Surgical Sciences (DIMEC), Gastroenterology and Endoscopy Unit, Sant'Orsola University Hospital, University of Bologna, Bologna, Italy
| | - Antonietta D'Errico
- 'F Addarii'' Institute of Oncology and Transplantation Pathology, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Andrea Belluzzi
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Gionchetti
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Roda
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Clinical and Research Center -IRCCS, Milan, Italy
| | - Ryan Ungaro
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean-Frederic Colombel
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noam Harpaz
- Departments of Pathology and Medicine (Gastroenterology), Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Huaibin Mabel Ko
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA.
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Rizzello F, Calabrese C, Salice M, Calandrini L, Privitera H, Melotti L, Peruzzi G, Dussias N, Belluzzi A, Scaioli E, Decorato A, Siniscalchi A, Filippone E, Laureti S, Rottoli M, Poggioli G, Gionchetti P. COVID-19 in IBD: The experience of a single tertiary IBD center. Dig Liver Dis 2021; 53:271-276. [PMID: 33451910 PMCID: PMC7764386 DOI: 10.1016/j.dld.2020.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 09/26/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Italy has been one of the most affected countries in the world by COVID-19. There has been increasing concern regarding the impact of COVID-19 on patients with inflammatory bowel disease (IBD), particularly in patients treated with immunosuppressants or biologics. The aim of our study is to understand the incidence of COVID-19 in a large cohort of patients with IBD. Furthermore, we analyzed possible risk factors for infection and severity of COVID-19. METHODS This was an observational study evaluating the impact of COVID-19 on IBD patients in a single tertiary center. A 23 multiple-choice-question anonymous survey was administered to 1200 patients with IBD between March 10th and June 10th 2020. RESULTS 1158 questionnaires were analyzed. The majority of patients had Crohn's disease (CD) (60%) and most of them were in clinical remission. Among the 26 patients (2.2%) who tested positive for COVID-19, only 5 (3CD) were on biological treatment and none required hospitalization. Two patients died and were on treatment with mesalazine only. Of the 1158 patients, 521 were on biological therapy, which was discontinued in 85 (16.3%) and delayed in 195 patients (37.4%). A worsening of IBD symptoms was observed in 200 patients on biological therapy (38.4%). Most of these patients, 189 (94.5%), had stopped or delayed biological treatment, while 11 (5.5%) had continued their therapy regularly (p<0.001). CONCLUSIONS Our data are in line with the current literature and confirm a higher incidence compared to the general population. Biological therapy for IBD seems to not be a risk factor for infection and should not be discontinued in order to avoid IBD relapse.
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Affiliation(s)
- Fernando Rizzello
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Carlo Calabrese
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Marco Salice
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Lucia Calandrini
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Hana Privitera
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Laura Melotti
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Giulia Peruzzi
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Nikolas Dussias
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Andrea Belluzzi
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Eleonora Scaioli
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Anastasio Decorato
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Antonio Siniscalchi
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Eleonora Filippone
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Silvio Laureti
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Matteo Rottoli
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gilberto Poggioli
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Paolo Gionchetti
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
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Belluzzi A, Scaioli E, Ricciardiello L, Marasco G, Belluzzi C. Eicosapentaenoic free fatty acid to treat patients with SARS-Cov2 infection. Med Hypotheses 2020; 143:110095. [PMID: 32679430 DOI: 10.1016/j.mehy.2020.110095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/08/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Andrea Belluzzi
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
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Guglielmo A, Bertuzzi C, Scaioli E, Belluzzi A, Sabattini E, Patrizi A, Pileri A. Iatrogenic Kaposi sarcoma during tumor necrosis factor alpha inhibitors. Ital J Dermatol Venerol 2020; 156:113-114. [PMID: 32545944 DOI: 10.23736/s2784-8671.20.06595-5] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alba Guglielmo
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy -
| | - Clara Bertuzzi
- Unit of Hematopathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences DIMEC, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Belluzzi
- Department of Medical and Surgical Sciences DIMEC, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elena Sabattini
- Unit of Hematopathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Pileri
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Barbaro MR, Cremon C, Fuschi D, Scaioli E, Veneziano A, Marasco G, Festi D, Stanghellini V, Barbara G. Nerve fiber overgrowth in patients with symptomatic diverticular disease. Neurogastroenterol Motil 2019; 31:e13575. [PMID: 30838745 DOI: 10.1111/nmo.13575] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/10/2019] [Accepted: 02/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colonic diverticulosis is a common condition in industrialized countries. Up to 25% of patients with diverticula develop symptoms, a condition termed symptomatic uncomplicated diverticular disease (SUDD). The aim of the present study was to characterize neuroimmune interactions and nerve fiber plasticity in the colonic mucosa of patients with diverticula. METHODS Controls, patients with diverticulosis and with SUDD were enrolled in the study. Mucosal biopsies were obtained close to diverticula (diverticular region) and in a normal mucosa (distant site), corresponding to sigmoid and descending colon in the controls. Quantitative immunohistochemistry was used to assess mast cells, T cells, macrophages, nerve fibers, and neuronal outgrowth (growth-associated protein 43, GAP43+fibers). KEY RESULTS No difference emerged in mast cells and T cells among the three groups. Macrophages were increased in patients with SUDD and diverticulosis as compared to controls. Nerve fibers were enhanced in patients with SUDD and diverticulosis in comparison with controls in the diverticular region. GAP43+ fibers were increased only in patients with SUDD as compared to controls and to patients with diverticulosis in the diverticular region. In patients with SUDD, GAP43 density was increased in the diverticular region compared to distant site. Macrophages close to GAP43+ fibers were increased in the diverticular region of patients with SUDD. Significant correlations were found between GAP43+ fibers and immune cells. CONCLUSIONS AND INFERENCES Patients with diverticula are characterized by increased macrophage counts, while nerve fiber sprouting is increased only in the diverticular region of patients with SUDD suggesting a role in symptom generation.
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Affiliation(s)
- Maria Raffaella Barbaro
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Daniele Fuschi
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Alberto Veneziano
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vincenzo Stanghellini
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
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Scaioli E, Belluzzi A, Ricciardiello L, Del Rio D, Rotondo E, Mena P, Derlindati E, Danesi F. Pomegranate juice to reduce fecal calprotectin levels in inflammatory bowel disease patients with a high risk of clinical relapse: Study protocol for a randomized controlled trial. Trials 2019; 20:327. [PMID: 31171016 PMCID: PMC6554985 DOI: 10.1186/s13063-019-3321-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 03/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) is a chronic condition characterized by recurrent episodes of intestinal inflammation and is thought to be related to an autoimmune reaction to genetic and environmental factors. Although evidence indicates that a polyphenolic-rich diet plays an important role in modulating aspects of chronic inflammation, few studies have focused on the effect of ellagitannin (ET)-rich food consumption on long-term remission maintenance in IBD patients with a high risk of clinical relapse. Therefore, we hypothesize that supplementation with a pomegranate juice, a naturally rich source of ETs, could significantly modulate the markers of mucosal and systemic inflammation relative to a control group receiving a placebo. Methods/design This double-blind, randomized controlled trial includes patients with IBD involving the colorectum who have been in stable therapy for at least the three previous months and have a high risk of clinical relapse. Participants are randomly allocated to one of two groups: active supplementation (125 mL of cv. Wonderful pomegranate juice) or placebo (125 mL) taken twice daily for 12 weeks. The primary outcome is changes in the fecal neutrophil-derived protein calprotectin, a surrogate marker of mucosal improvement, between the two groups from baseline to 12 weeks later. The secondary outcomes include transcriptomic changes in peripheral blood mononuclear cells and intestinal biopsies and changes in circulating inflammatory markers and trimethylamine-N-oxide levels. Pomegranate ET-derived metabolites are identified and quantified in plasma and urine samples. Discussion The results will provide information on the possible reduction of fecal calprotectin levels following the consumption of pomegranate juice. The findings will also show the in vivo metabolism of pomegranate ETs. Finally, the effect of 12-week pomegranate juice consumption on local and systemic inflammatory markers will be elucidated, which will likely provide additional insights into the maintenance of remission in IBD patients. Trial registration ClinicalTrials.gov, NCT03000101. Registered on 21 December 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3321-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eleonora Scaioli
- Gastroenterological Unit, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Andrea Belluzzi
- Gastroenterological Unit, St. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Luigi Ricciardiello
- Gastroenterological Unit, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Daniele Del Rio
- Department of Veterinary Science, University of Parma, Strada del Taglio, 10, 43126, Parma, Italy
| | - Enrica Rotondo
- Human Nutrition Unit, Department of Agricultural and Food Sciences, Campus of Food Science, University of Bologna, Piazza Goidanich, 60, 47521, Cesena, FC, Italy
| | - Pedro Mena
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Medical School, Building C, Via Volturno 39, 43125, Parma, Italy
| | - Eleonora Derlindati
- Human Nutrition Unit, Department of Agricultural and Food Sciences, Campus of Food Science, University of Bologna, Piazza Goidanich, 60, 47521, Cesena, FC, Italy.,Endocrinology and Metabolism Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Francesca Danesi
- Human Nutrition Unit, Department of Agricultural and Food Sciences, Campus of Food Science, University of Bologna, Piazza Goidanich, 60, 47521, Cesena, FC, Italy.
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Scaioli E, Belluzzi A. Endoscopic and Histological Normalization as a Target to Prevent Clinical Relapse in Ulcerative Colitis Patients. Inflamm Bowel Dis 2019; 25:e67. [PMID: 30462287 DOI: 10.1093/ibd/izy355] [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: 12/09/2022]
Affiliation(s)
- Eleonora Scaioli
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andrea Belluzzi
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
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Sartini A, Scaioli E, Liverani E, Bellanova M, Ricciardiello L, Bazzoli F, Belluzzi A. Retention Rate, Persistence and Safety of Adalimumab in Inflammatory Bowel Disease: A Real-Life, 9-Year, Single-Center Experience in Italy. Dig Dis Sci 2019; 64:863-874. [PMID: 30334112 DOI: 10.1007/s10620-018-5329-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/26/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND "Real-life" data of retention rate and persistence of adalimumab in inflammatory bowel disease are still limited. AIMS To analyze retention rate, persistence, and safety of adalimumab in a 9-year real-life cohort of inflammatory bowel disease patients. METHODS In this observational, retrospective single-center study, all adult patients treated with adalimumab as the first- and second-line biological treatment for steroid-dependent or refractory inflammatory bowel disease between March 2008 and March 2017 were included. Primary outcomes were persistence, retention rate, and adverse events; the secondary outcome was the identification of predictors of withdrawal. RESULTS Ninety-six out of 181 patients (53%) withdrew their first course of adalimumab. The retention rate was 47% and 46.9% in Crohn's disease and ulcerative colitis patients, respectively; median persistence was 26 and 24 months in CD and UC patients, respectively. The cumulative probability of treatment persistence was 80.2%, 54.5%, and 29.6% and 69.6%, 40.4%, and 21.5% in CD and UC patients, respectively. The incidence rate of any adverse event was 12.5/100 patients-year; severe adverse events were 1.7/100 patients-year. The Cox regression revealed that CD patients with baseline disease duration > 72 months have a higher likelihood for withdrawal due to failure and/or adverse events (HR 1.62, 95% CI 1-2.62, p = 0.04); no predictors of discontinuation were found in UC. CONCLUSIONS Adalimumab showed a great persistence in the first 12 months of therapy and excellent safety profile. Early treatment of CD patients could increase efficacy and reduce the adverse event rate.
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Affiliation(s)
- Alessandro Sartini
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Elisa Liverani
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Matteo Bellanova
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Andrea Belluzzi
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
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Marasco G, Scaioli E, Zagari RM, Belluzzi A. Aortic thrombosis recurrence in a Crohn's disease patient. Acta Gastroenterol Belg 2018; 81:546. [PMID: 30645932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- G Marasco
- University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italia
| | - E Scaioli
- University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italia
| | - R M Zagari
- University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italia
| | - A Belluzzi
- University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italia
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11
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Scaioli E, Sartini A, Bellanova M, Campieri M, Festi D, Bazzoli F, Belluzzi A. Eicosapentaenoic Acid Reduces Fecal Levels of Calprotectin and Prevents Relapse in Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol 2018; 16:1268-1275.e2. [PMID: 29391271 DOI: 10.1016/j.cgh.2018.01.036] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 08/21/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS High fecal levels of calprotectin indicate mucosal inflammation and have been shown to predict relapse in patients with ulcerative colitis (UC). Eicosapentaenoic acid (EPA), the major component of n-3 fish oil, has anti-inflammatory properties in patients with chronic inflammatory disorders. We performed a placebo-controlled trial of patients with UC at risk of relapse to determine the ability of the free fatty acid form of EPA (EPA-FFA) to reduce intestinal inflammation, using fecal level of calprotectin as a marker. METHODS From June 2014 to May 2016, 60 patients with UC with a partial Mayo score < 2 and fecal calprotectin ≥150 μg/g, in stable therapy for at least the 3 previous months, were randomly assigned to groups (1:1) given either EPA-FFA (500 mg, twice daily) or placebo for 6 months. A colonoscopy was performed at baseline. Clinical assessments and measurements of fecal calprotectin were made at baseline, at study months 3 and 6, or the time of clinical relapse. Patients with a relapse of UC underwent a second colonoscopy. The primary end point was a 100-point reduction in fecal levels of calprotectin at 6 months from the baseline value; the secondary end point was maintenance of clinical remission at 6 months. RESULTS The primary end point was achieved by 19 of 30 patients (63.3%) in the EPA-FFA group vs 4 of 30 patients (13.3%) in the placebo group (odds ratio, 12.0; 95% CI, 3.12-46.24; P < .001). The secondary end point was achieved by 23 of 30 patients (76.7%) in the EPA-FFA group vs 15 of 30 (50%) patients in the placebo group (OR, 3.29; 95% CI, 1.08-9.95; P = .035). No serious adverse events were observed. CONCLUSIONS In a placebo-controlled trial of 60 patients with UC, we found 6 months' administration of EPA-FFA to reduce fecal levels of calprotectin with no serious adverse events. This agent might be used to induce and maintain symptom-free remission in patients with UC. ClinicalTrials.gov number: NCT02179372.
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Affiliation(s)
- Eleonora Scaioli
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Sartini
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Bellanova
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Massimo Campieri
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Belluzzi
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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12
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Prossomariti A, Scaioli E, Piazzi G, Fazio C, Bellanova M, Biagi E, Candela M, Brigidi P, Consolandi C, Balbi T, Chieco P, Munarini A, Pariali M, Minguzzi M, Bazzoli F, Belluzzi A, Ricciardiello L. Short-term treatment with eicosapentaenoic acid improves inflammation and affects colonic differentiation markers and microbiota in patients with ulcerative colitis. Sci Rep 2017; 7:7458. [PMID: 28785079 PMCID: PMC5547132 DOI: 10.1038/s41598-017-07992-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 04/10/2017] [Accepted: 07/04/2017] [Indexed: 12/21/2022] Open
Abstract
Patients with long-standing ulcerative colitis (UC) have an increased colorectal cancer (CRC) risk. In this pilot study we evaluated the effect of Eicosapentaenoic acid as free fatty acid (EPA-FFA) supplementation on mucosal disease activity, colonic differentiation markers and microbiota composition in UC patients. Twenty long-standing UC patients in stable clinical remission and with fecal calprotectin (FC) > 150 µg/g were enrolled (T0) and supplemented with EPA-FFA 2 g/daily for 90 days (T3). Endoscopic and histologic disease activities were measured by Mayo and Geboes scores, respectively. HES1, KLF4, STAT3, IL-10 and SOCS3 levels were determined using western blotting and qRT-PCR, while phospho-STAT3 levels were assessed by western blotting. Goblet cells were stained by Alcian blue. Microbiota analyses were performed on both fecal and colonic samples. Nineteen patients completed the study; seventeen (89.5%) were compliant. EPA-FFA treatment reduced FC levels at T3. Patients with FC > 150 µg/g at T3 (n = 2) were assumed as non-responders. EPA-FFA improved endoscopic and histological inflammation and induced IL-10, SOCS3, HES1 and KLF4 in compliant and responder patients. Importantly, long-term UC-driven microbiota composition was partially redressed by EPA-FFA. In conclusion, EPA-FFA supplementation reduced mucosal inflammation, promoted goblet cells differentiation and modulated intestinal microbiota composition in long-standing UC patients.
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Affiliation(s)
- Anna Prossomariti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (CRBA), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giulia Piazzi
- Center for Applied Biomedical Research (CRBA), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Chiara Fazio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (CRBA), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Bellanova
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elena Biagi
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Marco Candela
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Patrizia Brigidi
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Clarissa Consolandi
- Institute of Biomedical Technologies-National Research Council (ITB-CNR), Segrate, Milan, Italy
| | - Tiziana Balbi
- Pathology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Pasquale Chieco
- Center for Applied Biomedical Research (CRBA), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandra Munarini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (CRBA), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Milena Pariali
- Center for Applied Biomedical Research (CRBA), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Manuela Minguzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (CRBA), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrea Belluzzi
- Gastroenterology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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13
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Barbara G, Scaioli E, Barbaro MR, Biagi E, Laghi L, Cremon C, Marasco G, Colecchia A, Picone G, Salfi N, Capozzi F, Brigidi P, Festi D. Gut microbiota, metabolome and immune signatures in patients with uncomplicated diverticular disease. Gut 2017; 66:1252-1261. [PMID: 27618836 DOI: 10.1136/gutjnl-2016-312377] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [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: 06/06/2016] [Revised: 08/19/2016] [Accepted: 08/20/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The engagement of the gut microbiota in the development of symptoms and complications of diverticular disease has been frequently hypothesised. Our aim was to explore colonic immunocytes, gut microbiota and the metabolome in patients with diverticular disease in a descriptive, cross-sectional, pilot study. DESIGN Following colonoscopy with biopsy and questionnaire phenotyping, patients were classified into diverticulosis or symptomatic uncomplicated diverticular disease; asymptomatic subjects served as controls. Mucosal immunocytes, in the diverticular region and in unaffected sites, were quantified with immunohistochemistry. Mucosa and faecal microbiota were analysed by the phylogenetic platform high taxonomic fingerprint (HTF)-Microbi.Array, while the metabolome was assessed by 1H nuclear magnetic resonance. RESULTS Compared with controls, patients with diverticula, regardless of symptoms, had a >70% increase in colonic macrophages. Their faecal microbiota showed depletion of Clostridium cluster IV. Clostridium cluster IX, Fusobacterium and Lactobacillaceae were reduced in symptomatic versus asymptomatic patients. A negative correlation was found between macrophages and mucosal Clostridium cluster IV and Akkermansia. Urinary and faecal metabolome changes in diverticular disease involved the hippurate and kynurenine pathways. Six urinary molecules allowed to discriminate diverticular disease and control groups with >95% accuracy. CONCLUSIONS Patients with colonic diverticular disease show depletion of microbiota members with anti-inflammatory activity associated with mucosal macrophage infiltration. Metabolome profiles were linked to inflammatory pathways and gut neuromotor dysfunction and showed the ability to discriminate diverticular subgroups and controls. These data pave the way for further large-scale studies specifically aimed at identifying microbiota signatures with a potential diagnostic value in patients with diverticular disease.
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Affiliation(s)
- Giovanni Barbara
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Raffaella Barbaro
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elena Biagi
- Department of Pharmacy and Biotechnology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Laghi
- Department of Agri-Food Sciences and Technologies, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Colecchia
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Gianfranco Picone
- Department of Agri-Food Sciences and Technologies, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nunzio Salfi
- Pathology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Capozzi
- Department of Agri-Food Sciences and Technologies, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Patrizia Brigidi
- Department of Pharmacy and Biotechnology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Sartini A, Scaioli E, Belluzzi A. Is Early Endoscopy-Based Therapy the Best Strategy to Prevent All Crohn's Disease Postoperative Recurrence? Gastroenterology 2016; 151:1040-1041. [PMID: 27702633 DOI: 10.1053/j.gastro.2016.08.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/16/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Alessandro Sartini
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andrea Belluzzi
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
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15
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Marasco G, Di Biase AR, Schiumerini R, Eusebi LH, Iughetti L, Ravaioli F, Scaioli E, Colecchia A, Festi D. Gut Microbiota and Celiac Disease. Dig Dis Sci 2016; 61:1461-72. [PMID: 26725064 DOI: 10.1007/s10620-015-4020-2] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [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: 06/30/2015] [Accepted: 12/20/2015] [Indexed: 12/18/2022]
Abstract
Recent evidence regarding celiac disease has increasingly shown the role of innate immunity in triggering the immune response by stimulating the adaptive immune response and by mucosal damage. The interaction between the gut microbiota and the mucosal wall is mediated by the same receptors which can activate innate immunity. Thus, changes in gut microbiota may lead to activation of this inflammatory pathway. This paper is a review of the current knowledge regarding the relationship between celiac disease and gut microbiota. In fact, patients with celiac disease have a reduction in beneficial species and an increase in those potentially pathogenic as compared to healthy subjects. This dysbiosis is reduced, but might still remain, after a gluten-free diet. Thus, gut microbiota could play a significant role in the pathogenesis of celiac disease, as described by studies which link dysbiosis with the inflammatory milieu in celiac patients. The use of probiotics seems to reduce the inflammatory response and restore a normal proportion of beneficial bacteria in the gastrointestinal tract. Additional evidence is needed in order to better understand the role of gut microbiota in the pathogenesis of celiac disease, and the clinical impact and therapeutic use of probiotics in this setting.
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Affiliation(s)
- Giovanni Marasco
- Department of Medical and Surgical Science, University of Bologna, 40138, Bologna, Italy.
| | | | - Ramona Schiumerini
- Department of Medical and Surgical Science, University of Bologna, 40138, Bologna, Italy
| | - Leonardo Henry Eusebi
- Department of Medical and Surgical Science, University of Bologna, 40138, Bologna, Italy
| | - Lorenzo Iughetti
- Department of Pediatrics, University of Modena, 41124, Modena, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Science, University of Bologna, 40138, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Science, University of Bologna, 40138, Bologna, Italy
| | - Antonio Colecchia
- Department of Medical and Surgical Science, University of Bologna, 40138, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Science, University of Bologna, 40138, Bologna, Italy
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16
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Festi D, Schiumerini R, Marasco G, Scaioli E, Pasqui F, Colecchia A. Non-invasive diagnostic approach to non-alcoholic fatty liver disease: current evidence and future perspectives. Expert Rev Gastroenterol Hepatol 2016; 9:1039-53. [PMID: 25993881 DOI: 10.1586/17474124.2015.1049155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Indexed: 02/06/2023]
Abstract
Non-alcoholic fatty liver disease is a new epidemic liver disease, thus, its early diagnosis and the identification of those patients with the worst prognosis is mandatory. Liver biopsy is still the diagnostic gold standard, even if it is associated to a significant rate of complications; moreover, the interpretation of histological samples is not always univocal. Several non-invasive alternative scores have been proposed for the diagnostic approach to non-alcoholic fatty liver disease. This article evaluates the performance of the currently available non-invasive diagnostic strategies. The authors also suggest a potential diagnostic algorithm, with two or more non-invasive techniques, to increase the overall accuracy for identifying patients with worst prognosis, and to minimize the recourse to liver biopsy.
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Affiliation(s)
- Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Hospital, Via Massarenti 9, 40138 Bologna, Italy
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Liverani E, Scaioli E, Digby RJ, Bellanova M, Belluzzi A. How to predict clinical relapse in inflammatory bowel disease patients. World J Gastroenterol 2016; 22:1017-1033. [PMID: 26811644 PMCID: PMC4716017 DOI: 10.3748/wjg.v22.i3.1017] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/07/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases have a natural course characterized by alternating periods of remission and relapse. Disease flares occur in a random way and are currently unpredictable for the most part. Predictors of benign or unfavourable clinical course are required to facilitate treatment decisions and to avoid overtreatment. The present article provides a literature review of the current evidence on the main clinical, genetic, endoscopic, histologic, serologic and fecal markers to predict aggressiveness of inflammatory bowel disease and discuss their prognostic role, both in Crohn’s disease and ulcerative colitis. No single marker seems to be reliable alone as a flare predictor, even in light of promising evidence regarding the role of fecal markers, in particular fecal calprotectin, which has reported good results recently. In order to improve our daily clinical practice, validated prognostic scores should be elaborated, integrating clinical and biological markers of prognosis. Finally, we propose an algorithm considering clinical history and biological markers to intercept patients with high risk of clinical relapse.
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18
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Scaioli E, Cardamone C, Scagliarini M, Zagari RM, Bazzoli F, Belluzzi A. Can fecal calprotectin better stratify Crohn's disease activity index? Ann Gastroenterol 2015; 28:247-252. [PMID: 25831217 PMCID: PMC4367215] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/16/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) activity index (CDAI) is still widely used for monitoring clinical activity in CD patients, but is of little value as indicator of persistent inflammation in symptomless patients. Fecal calprotectin levels ≥150 µg/g are strongly indicative of endoscopically and/or histologically active disease. Our aim was to study, in a large cohort of CD patients, the relationship between CDAI and fecal calprotectin levels. METHODS CDAI and fecal calprotectin levels were evaluated in consecutive patients from a CD outpatient clinic. RESULTS We enrolled 193 CD patients, of whom 38% with CDAI <150 had a calprotectin value ≥150 µg/g, suggestive of active disease. A logistic regression model showed that for CDAI levels between 100 and 150, the estimated logistic probability of calprotectin ≥150 µg/g increased progressively to 76%, reaching 94% where disease activity was localized in the colon. With a CDAI cut-off >120, we found a high diagnostic accuracy of 72%, with 88% specificity and 50% sensitivity (positive predictive value: 76%, negative predictive value: 71%) to identify a calprotectin value ≥150 µg/g. CONCLUSION CDAI scores between 100 and 150 display an acceptable ability to quantify the risk of persistent inflammation as expressed by the high calprotectin level.
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Affiliation(s)
- Eleonora Scaioli
- Gastroenterology Unit, Sant’Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna (Eleonora Scaioli, Carla Cardamone, Rocco Maurizio Zagari, Franco Bazzoli, Andrea Belluzzi), Italy
| | - Carla Cardamone
- Gastroenterology Unit, Sant’Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna (Eleonora Scaioli, Carla Cardamone, Rocco Maurizio Zagari, Franco Bazzoli, Andrea Belluzzi), Italy
| | - Michele Scagliarini
- Department of Statistical Sciences, University of Bologna, Bologna (Michele Scagliarini), Italy
| | - Rocco Maurizio Zagari
- Gastroenterology Unit, Sant’Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna (Eleonora Scaioli, Carla Cardamone, Rocco Maurizio Zagari, Franco Bazzoli, Andrea Belluzzi), Italy
| | - Franco Bazzoli
- Gastroenterology Unit, Sant’Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna (Eleonora Scaioli, Carla Cardamone, Rocco Maurizio Zagari, Franco Bazzoli, Andrea Belluzzi), Italy
| | - Andrea Belluzzi
- Gastroenterology Unit, Sant’Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna (Eleonora Scaioli, Carla Cardamone, Rocco Maurizio Zagari, Franco Bazzoli, Andrea Belluzzi), Italy,
Correspondence to: Andrea Belluzzi, MD, Gastroenterology Unit, Sant’Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, via Massarenti 9, 40138 Bologna, Italy, Tel.-Fax: +39 0516 363873, e-mail:
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Liverani E, Scaioli E, Cardamone C, Monte PD, Belluzzi A. Mycobacterium avium subspecies paratuberculosis in the etiology of Crohn’s disease, cause or epiphenomenon? World J Gastroenterol 2014; 20:13060-13070. [PMID: 25278700 PMCID: PMC4177485 DOI: 10.3748/wjg.v20.i36.13060] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/30/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
The origin of inflammatory bowel disease is unknown. Attempts have been made to isolate a microorganism that could explain the onset of inflammation, but no pathological agent has ever been identified. Johne’s disease is a granulomatous chronic enteritis of cattle and sheep caused by Mycobacterium avium subspecies paratuberculosis (MAP) and shows some analogies with Crohn’s disease (CD). Several studies have tried to clarify if MAP has a role in the etiology of CD. The present article provides an overview of the evidence in favor and against the “MAP-hypothesis”, analyzing the methods commonly adopted to detect MAP and the role of antimycobacterial therapy in patients with inflammatory bowel disease. Studies were identified through the electronic database, MEDLINE, and were selected based on their relevance to the objective of the review. The presence of MAP was investigated using multiple diagnostic methods for MAP detection and in different tissue samples from patients affected by CD or ulcerative colitis and in healthy controls. On the basis of their studies, several authors support a close relationship between MAP and CD. Although increasing evidence of MAP detection in CD patients is unquestionable, a clear etiological link still needs to be proven.
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Cecinato P, Scaioli E, Leonardi F, Liverani E, Cardamone C, Rosati G, Balbi T, Belluzzi A. A rare case of giant pseudopolyp and colitis cystica profunda coexistence in an ulcerative colitis patient. Rev Esp Enferm Dig 2014; 106:297-298. [PMID: 25075667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Festi D, Schiumerini R, Scaioli E, Colecchia A. Letter: FibroTest for staging fibrosis in non-alcoholic fatty liver disease - authors' reply. Aliment Pharmacol Ther 2013; 37:656-7. [PMID: 23406410 DOI: 10.1111/apt.12228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/10/2013] [Indexed: 02/06/2023]
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22
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Festi D, Schiumerini R, Marzi L, Di Biase AR, Mandolesi D, Montrone L, Scaioli E, Bonato G, Marchesini-Reggiani G, Colecchia A. Review article: the diagnosis of non-alcoholic fatty liver disease -- availability and accuracy of non-invasive methods. Aliment Pharmacol Ther 2013; 37:392-400. [PMID: 23278163 DOI: 10.1111/apt.12186] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [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: 06/22/2012] [Revised: 08/09/2012] [Accepted: 11/26/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of clinical conditions, actually representing an emerging disease of great clinical interest. Currently, its diagnosis requires liver biopsy, an invasive procedure not free from potential complications. However, several non-invasive diagnostic strategies have been proposed as potential diagnostic alternatives, each with different sensitivities and accuracies. AIM To review non-invasive diagnostic parameters and tools for NAFLD diagnosis and to formulate a diagnostic and prognostic algorithm for a better classification of patients. METHODS A literature search was carried out on MEDLINE, EMBASE, Web of Science and Scopus for articles and abstracts in English. The search terms used included 'NAFLD', 'non invasive method and NAFLD', 'transient elastography' and 'liver fibrosis'. The articles cited were selected based on their relevancy to the objective of the review. RESULTS Ultrasonography still represents the first-line diagnostic tool for simple liver steatosis; its sensitivity could be enhanced by the complex biochemical score SteatoTest. Serum cytokeratin-18 is a promising and accurate non-invasive parameter (AUROCs: 0.83; 0.91) for the diagnosis of non-alcoholic steatohepatitis (NASH). The staging of liver fibrosis still represents the most important prognostic problem: the most accurate estimating methods are FibroMeter, FIB-4, NAFLD fibrosis score (AUROCs: 0.94; 0.86; 0.82) and transient elastography (AUROC: 0.84-1.00). CONCLUSIONS Different non-invasive parameters are available for the accurate diagnosis and prognostic stratification of non-alcoholic fatty liver disease which, if employed in a sequential algorithm, may lead to a reduced use of invasive methods, i.e. liver biopsy.
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Affiliation(s)
- D Festi
- Department of Medical and Surgical Science, University of Bologna, Department of Pediatrics, University of Modena, Italy.
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Colecchia A, Montrone L, Scaioli E, Bacchi-Reggiani ML, Colli A, Casazza G, Schiumerini R, Turco L, Di Biase AR, Mazzella G, Marzi L, Arena U, Pinzani M, Festi D. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. Gastroenterology 2012; 143:646-654. [PMID: 22643348 DOI: 10.1053/j.gastro.2012.05.035] [Citation(s) in RCA: 338] [Impact Index Per Article: 28.2] [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: 09/12/2011] [Revised: 05/03/2012] [Accepted: 05/19/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The hepatic vein pressure gradient (HVPG) is the standard used to determine the degree of portal hypertension (PH) and an important prognostic factor for patients with cirrhosis; HVPG values correlate with the presence of esophageal varices (EV). However, HVPG can only be accurately determined at specialized centers; noninvasive methods are needed to predict HVPG values and the presence of EV. We compared the diagnostic performance of spleen stiffness (SS) measurement by transient elastography with that of liver stiffness (LS) and of other recently proposed noninvasive tests. METHODS We measured SS and LS in 100 consecutive patients with hepatitis C virus-induced cirrhosis. Patients were also assessed by FibroScan, HVPG, esophagogastroduodenoscopy, and liver biopsy. We also analyzed LS-spleen diameter to platelet ratio score and platelet count to spleen diameter. RESULTS SS and LS were more accurate than other noninvasive parameters in identifying patients with EV and different degrees of PH. A linear model that included SS and LS accurately predicted HVPG values (R(2) = 0.85). The results were internally validated using bootstrap analysis. CONCLUSIONS Measurement of SS can be used for noninvasive assessment and monitoring of PH and to detect EV in patients with hepatitis C virus-induced cirrhosis.
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Affiliation(s)
- Antonio Colecchia
- Department of Clinical Medicine, University of Bologna, Bologna, Italy.
| | - Lucia Montrone
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | - Eleonora Scaioli
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | | | - Agostino Colli
- Department of Medicine, A. Manzoni Hospital, Lecco, Italy
| | - Giovanni Casazza
- Department of Clinical Science, University of Milan, Milan, Italy
| | | | - Laura Turco
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | | | - Giuseppe Mazzella
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | - Luca Marzi
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | - Umberto Arena
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - Massimo Pinzani
- Department of Internal Medicine, University of Florence, Florence, Italy; Centre for Research, High Education and Transfer "DENOThe", University of Florence, Florence, Italy
| | - Davide Festi
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
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Festi D, Schiumerini R, Birtolo C, Marzi L, Montrone L, Scaioli E, Di Biase AR, Colecchia A. Gut microbiota and its pathophysiology in disease paradigms. Dig Dis 2011; 29:518-24. [PMID: 22179206 DOI: 10.1159/000332975] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [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: 02/02/2023]
Abstract
The gut flora carries out important functions for human health, although most of them are still unknown, and an alteration of any of them, due to a condition of dysbiosis, can lead to relevant pathological implications. Commensal bacteria in the gut are essential for the preservation of the integrity of the mucosal barrier function and an alteration in the anatomic functional integrity of this barrier has been implicated in the pathophysiologic process of different diseases. The gut microflora plays a role in modulating the intestinal immune system; in fact, it is essential for the maturation of gut-associated lymphatic tissue, the secretion of IgA and the production of antimicrobial peptides. The enteric flora represents a potent bioreactor which controls several metabolic functions, even if most of them are still unknown. The main metabolic functions are represented by the fermentation of indigestible food substances into simple sugars, absorbable nutrients, and short-chain fatty acids. Furthermore, the gut microbiota exerts important trophic and developmental functions on the intestinal mucosa. This overview focuses briefly on the physiological role of the gut microbiota in maintaining a healthy state and the potential role played by disturbances of both the function and composition of the gut microbiota in determining important pathological conditions, such as irritable bowel syndrome, inflammatory bowel disease, metabolic syndrome, obesity, and cancer.
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Affiliation(s)
- Davide Festi
- Department of Clinical Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
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Colecchia A, Di Biase AR, Scaioli E, Predieri B, Iughetti L, Reggiani MLB, Montrone L, Ceccarelli PL, Vestito A, Viola L, Paolucci P, Festi D. Non-invasive methods can predict oesophageal varices in patients with biliary atresia after a Kasai procedure. Dig Liver Dis 2011; 43:659-63. [PMID: 21596631 DOI: 10.1016/j.dld.2011.04.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [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: 10/29/2010] [Revised: 01/28/2011] [Accepted: 04/10/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND After a Kasai procedure, 70% of patients with biliary atresia develop chronic liver disease with portal hypertension and oesophageal varices. AIMS To investigate the role of new non-invasive parameters in predicting the presence of varices in patients with biliary atresia after a Kasai procedure and to identify the cut-off values of these parameters in predicting the presence of varices. METHODS 31 patients with biliary atresia who had undergone a Kasai portoenterostomy were studied. Clinical, biochemical and abdominal ultrasound examination, liver stiffness measurement (LSM), LSM-spleen diameter to platelet ratio score (LSPS) and upper digestive endoscopy were performed. RESULTS 15 (47%) patients had oesophageal varices (Group A) and 16 had no varices (Group B). Median values of LSM (kPa) and LSPS were significantly higher in Group A than in Group B (LSM: 17.0 vs. 7.5, respectively; p=0.0001; LSPS: 19.62 vs. 2.94, respectively; p=0.0001). The optimal cut-offs for predicting oesophageal varices were: LSM>10.6 kPa (sensitivity: 87%, specificity: 87.5%, PPV: 87%, NPV: 87.5%, and AUC: 0.92) and LSPS ≥9.2 (sensitivity: 91%, specificity: 92%, PPV: 91%, NPV: 92%, and AUC: 0.96). CONCLUSIONS Non-invasive methods can predict the presence of oesophageal varices in patients with biliary atresia; the sequential use of two non-invasive methods improves accuracy.
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Colecchia A, Montrone L, Scaioli E, Festi D. Percutaneous liver biopsy in the clinical management of hepatocellular carcinoma: back to the future. Hepatology 2011; 53:2147. [PMID: 21472742 DOI: 10.1002/hep.24130] [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: 12/07/2022]
Affiliation(s)
- Antonio Colecchia
- Department of Clinical Medicine University of Bologna Bologna, Italy
| | - Lucia Montrone
- Department of Clinical Medicine University of Bologna Bologna, Italy
| | - Eleonora Scaioli
- Department of Clinical Medicine University of Bologna Bologna, Italy
| | - Davide Festi
- Department of Clinical Medicine University of Bologna Bologna, Italy
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Colecchia A, Di Biase AR, Scaioli E, Festi D. Coeliac disease and autoimmune hepatitis: Gluten-free diet can influence liver disease outcome. Dig Liver Dis 2011; 43:247. [PMID: 21145795 DOI: 10.1016/j.dld.2010.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 09/30/2010] [Indexed: 12/11/2022]
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Colecchia A, Scaioli E, Montrone L, Vestito A, Di Biase AR, Pieri M, D'Errico-Grigioni A, Bacchi-Reggiani ML, Ravaioli M, Grazi GL, Festi D. Pre-operative liver biopsy in cirrhotic patients with early hepatocellular carcinoma represents a safe and accurate diagnostic tool for tumour grading assessment. J Hepatol 2011; 54:300-5. [PMID: 21056498 DOI: 10.1016/j.jhep.2010.06.037] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [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: 02/06/2010] [Revised: 06/09/2010] [Accepted: 06/18/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Knowledge of pre-operative tumour grade is crucial in the management of hepatocellular carcinoma (HCC) because it can influence recurrence and survival after surgery. The accuracy of pre-operative needle core biopsy (NCB) in tumour grading has been assessed in only a few studies with conflicting results. Our aim was to determine the long-term safety and the overall accuracy of NCB in assessing tumour grading in subjects who had undergone liver resection for a single HCC. METHODS Eighty-one cirrhotic patients with HCC who had undergone NCB before liver resection were selected. Only patients with a single HCC and with at least a five-year-follow-up were included. Tumour grading was scored according to a modified Edmondson-Steiner classification: well/moderately (low grade) vs poorly-differentiated (high grade). RESULTS In the 81 patients with a solitary HCC (mean size 4.1 ± 2.3cm) tumour grade was correctly identified by NCB in 74 out of 81 (91.4%) HCCs. NCB overall sensitivity and specificity were 65% and 98.1%, respectively, with a PPV of 92% and an NPV of 91%. No major complications (in particular tumour seeding) were observed. The overall survival rates at 1, 3, and 5 years were 83%, 62%, and 44%, respectively; the recurrence rate after a 5-year-follow-up was 56.2% for low grade and 82.3% for high grade tumours (p<0.007). CONCLUSIONS Pre-operative NCB can be performed on early (<5 cm) HCC cirrhotic patients because it provides histologically useful information for HCC management with good accuracy and a low complication rate.
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Festi D, Reggiani MLB, Attili AF, Loria P, Pazzi P, Scaioli E, Capodicasa S, Romano F, Roda E, Colecchia A. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 2010; 25:719-24. [PMID: 20492328 DOI: 10.1111/j.1440-1746.2009.06146.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The knowledge of natural history is essential for disease management. We evaluated the natural history (e.g. frequency and characteristics of symptoms and clinical outcome) of gallstones (GS) in a population-based cohort study. METHODS A total of 11 229 subjects (6610 men, 4619 women, age-range: 29-69 years, mean age: 48 years) were studied. At ultrasonography, GS were present in 856 subjects (338 men, 455 women) (7.1%). GS were followed by means of a questionnaire inquiring about the characteristics of specific biliary symptoms. RESULTS At enrollment, 580 (73.1%) patients were asymptomatic, 94 (11.8%) had mild symptoms and 119 (15.1%) had severe symptoms. GS patients were followed up for a mean period of 8.7 years; 63 subjects (7.3%) were lost to follow up. At the end of the follow up, of the asymptomatic subjects, 453 (78.1%) remained asymptomatic; 61 (10.5%) developed mild symptoms and 66 (11.4%) developed severe symptoms. In subjects with mild symptoms, the symptoms disappeared in 55 (58.5%), became severe in 23 (24.5%), remained stable in 16 (17%); in subjects with severe symptoms, the symptoms disappeared in 62 (52.1%), became mild in 20 (16.8%) and remained stable in 37 (31.1%). A total of 189 cholecystectomies were performed: 41.3% on asymptomatic patients, 17.4% on patients with mild symptoms and 41.3% on patients with severe symptoms. CONCLUSIONS This study indicates that: (i) asymptomatic and symptomatic GS patients have a benign natural history; (ii) the majority of GS patients with severe or mild symptoms will no longer experience biliary pain; and (iii) a significant proportion of cholecystectomies are performed in asymptomatic patients. Expectant management still represents a valid therapeutic approach in the majority of patients.
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Affiliation(s)
- Davide Festi
- Department of Clinical Medicine, University of Bologna, Bologna, Italy.
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Di Biase AR, Colecchia A, Scaioli E, Berri R, Viola L, Vestito A, Balli F, Festi D. Autoimmune liver diseases in a paediatric population with coeliac disease - a 10-year single-centre experience. Aliment Pharmacol Ther 2010; 31:253-60. [PMID: 19878151 DOI: 10.1111/j.1365-2036.2009.04186.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 12/14/2022]
Abstract
BACKGROUND Coeliac disease (CD) can be associated with liver disease. Gluten-free diet (GFD) normalizes cryptogenic forms, but most likely not autoimmune hepatitis (AIH). For this condition, immunosuppressants represent the treatment. However, when these are stopped, AIH generally relapses. AIM To determine in CD children liver test abnormality frequency, the effect of GFD alone, or plus prolonged immunosuppressants on AIH course. METHODS Coeliac disease patients with abnormal transaminases were selected; if transaminases <5 x UNL (upper normal limits), GFD alone was administered; if >5 x UNL, liver examinations and biopsy were performed. In AIH, immunosuppressants were administered (5 years). Treatment was stopped only if patients remained in remission during the entire maintenance period and normalized liver histology. RESULTS A total of 140 out of 350 CD children had hypertransaminaemia: 133 cryptogenic disease, 7 AIH. GFD normalized only cryptogenic hepatitis. During treatment, all AIH persistently normalized clinical and biochemical parameters; after withdrawal, six patients maintained a sustained remission (follow-up range: 12-63 months), while one relapsed. CONCLUSIONS In CD children with AIH, only GFD plus immunosuppressants determines a high remission rate. When clinical remission is reached, a prolonged immunosuppressive regimen induces a high sustained remission rate after treatment withdrawal, indicating that this regimen may prevent early relapse.
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Affiliation(s)
- A R Di Biase
- Department of Pediatrics, University of Modena and Reggio Emilia, Italy
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Festi D, Colecchia A, Pini S, Scaioli E, Maffeis C, Coccheri S, Petroni ML. Development and application of a simple and powerful tool for nutrition and lifestyle education for the Italian general population by general practitioners and family paediatricians. Mediterranean Journal of Nutrition and Metabolism 2009. [DOI: 10.3233/s12349-009-0047-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Davide Festi
- Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
| | - Antonio Colecchia
- Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
| | - Susy Pini
- Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
| | - Eleonora Scaioli
- Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
| | - Claudio Maffeis
- Department of Pediatrics, University of Verona, Verona, Italy
| | - Sergio Coccheri
- Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
| | - M. Letizia Petroni
- IRCCS Istituto Auxologico Italiano, Via Cadorna 90, 28044 Piancavallo (VB), Italy. e-mail:
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Festi D, Scaioli E, Baldi F, Vestito A, Pasqui F, Biase ARD, Colecchia A. Body weight, lifestyle, dietary habits and gastroesophageal reflux disease. World J Gastroenterol 2009; 15:1690-701. [PMID: 19360912 PMCID: PMC2668774 DOI: 10.3748/wjg.15.1690] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
While lifestyle modifications are currently used as first-line treatment for subjects with gastroesophageal reflux disease (GERD), the pathogenetic role of lifestyle factors and consequently, the efficacy of lifestyle measures is controversial. Our aim was to systematically review the pathogenetic link between overweight/obesity, dietary habits, physical activity and GERD, and the beneficial effect of specific recommended changes, by means of the available literature from the 1999 to the present. Obesity, in particular, abdominal obesity, plays a key role in determining GERD symptoms and complications through mechanical and metabolic effects. Controlled weight loss (by diet or surgery) is effective in improving GERD symptoms. No definitive data exist regarding the role of diet and, in particular, of specific foods or drinks, in influencing GERD clinical manifestations. Moderate physical activity seems to be beneficial for GERD, while vigorous activity may be dangerous in predisposed individuals. In conclusion, being obese/overweight and GERD-specific symptoms and endoscopic features are related, and weight loss significantly improves GERD clinical-endoscopic manifestations. The role of dietary behavior, mainly in terms of specific dietary components, remains controversial. Mild routine physical activity in association with diet modifications, i.e. a diet rich in fiber and low in fat, is advisable in preventing reflux symptoms.
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Colecchia A, Larocca A, Scaioli E, Bacchi-Reggiani ML, Di Biase AR, Azzaroli F, Gualandi R, Simoni P, Vestito A, Festi D. Natural history of small gallbladder polyps is benign: evidence from a clinical and pathogenetic study. Am J Gastroenterol 2009; 104:624-9. [PMID: 19209165 DOI: 10.1038/ajg.2008.99] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [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: 12/11/2022]
Abstract
OBJECTIVES Little is known about the natural history and pathogenesis of small gallbladder polyps (<10 mm, usually of the cholesterol type), particularly in Western populations. It is unclear if these polyps and gallstones represent different aspects of the same disease. The aim of this study was to characterize the natural history and pathogenesis of small gallbladder polyps. METHODS Fifty-six Caucasian patients with small gallbladder polyps, 30 matched gallstone patients, and 30 controls were enrolled in this 5-year prospective study. Patients underwent a symptomatic questionnaire, abdominal ultrasonography, and ultrasonographic evaluation of gallbladder motility at baseline and yearly intervals for 5 years. Cholesterol saturation index, cholesterol crystals in bile, and apolipoprotein E genotype were also determined. RESULTS Most patients with polyps (mean size: 5.3 mm) were men (61%), asymptomatic, and had multiple polyps (57%). Polyps did not change in 91% of patients during follow-up. No subject experienced biliary pain or underwent cholecystectomy; four developed gallstones. Cholesterol saturation index was higher in patients with polyps or gallstones than in controls (P<0.05). Cholesterol crystals were more frequent in patients with polyps than in controls (P<0.0001) but less common than in gallstone patients (P<0.0001). Polyps and gallstones were associated with nonapolipoprotein E4 phenotypes. CONCLUSIONS The natural history of small gallbladder polyps was benign, as no patient developed specific symptoms and/or morphological changes in polyps. Consequently, a "wait and see" policy is advisable in these patients. Polyps have some pathogenetic mechanisms in common with gallstones, but few patients developed gallstones.
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Affiliation(s)
- Antonio Colecchia
- Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
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Crosta P, Porro F, Scaioli E, Wagner V. Impact toughness of AISI 4340 steel versus non-metallic inclusion distribution. Ultramicroscopy 1983. [DOI: 10.1016/0304-3991(83)90355-8] [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: 11/17/2022]
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Bettega D, Conti AMF, Gariboldi L, Pelucchi MT, Scaioli E, Lombardi LT. Age Response of EUE Cells Exposed to 31-MeV Protons. Radiat Res 1982. [DOI: 10.2307/3575885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Bettega D, Fuhrman Conti AM, Gariboldi L, Pelucchi MT, Scaioli E, Tallone Lombardi L. Age response of EUE cells exposed to 31-MeV protons. Radiat Res 1982; 91:457-67. [PMID: 6289371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Bettega D, Fuhrman Conti AM, Rovida E, Scaioli E, Tallone Lombardi L. [Parameters of a cell population synchronized for radiosensitivity studies (author's transl)]. Radiol Med 1981; 67:749-55. [PMID: 6275463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Human cultured cells (EUE) were synchronized by the method of the mitotic harvest and the degree of synchronization, during the first duplication interval, determined by various tests which include growth curves, mitotic index cell-size distributions. Values of synchronization index initially greater than 90% and desynchronization rate of about 2%/hour were evaluated. The survival after 1.75 Gy of 31 MeV protons irradiation shows a sensitive period in the late G1 followed by an increase in radioresistance to a maximum in S.
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