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Ellul P, Schembri J, Baldacchino VA, Molnar T, Resal T, Allocca MA, Furfaro F, Dal Buono, Theodoropoulou A, Fragaki M, Tsoukali E, Mantzaris GJ, Phillips F, Radford S, Moran G, Gonzalez HA, Sebastian S, Fousekis F, Christodoulou D, Snir Y, Lerner Z, Yanai H, Michalopoulos G, Tua J, Camilleri L, Papamichael K, Karmiris K, Katsanos K. Post-inflammatory polyps burden as a prognostic marker of disease-outcome in patients with inflammatory bowel disease. J Crohns Colitis 2022; 17:489-496. [PMID: 36322687 DOI: 10.1093/ecco-jcc/jjac169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND AIM Post-inflammatory polyps (PIPs) are considered as indicators of previous episodes of severe inflammation and mucosal ulceration. Inflammatory bowel disease (IBD), namely Crohn's disease (CD) and ulcerative colitis (UC), exhibit a perpetuating, relapsing, and remitting pattern and PIPs is a frequent sequela of chronicity. The aim of this study was to determine whether a high PIPs burden is associated with a more severe disease course in patients with IBD. METHODS This was a multinational, multicentre, retrospective study. IBD patients previously diagnosed with PIPs were retrieved from the endoscopic database of each centre. PIPs burden was evaluated and associated with demographic and clinical data as well as factors indicating a more unfavorable disease course. RESULTS A total of 504 IBD patients with PIPs were recruited (male: 61.9%). The mean age at IBD diagnosis was 36.9 (±16.8) years. Most patients (74.8%) were diagnosed with UC. A high PIPs burden was present in 53.4% of patients. On multivariable Cox regression analysis, high PIPs burden was independently associated with treatment escalation (HR 1.35, 95% CI 1.04-1.75; P=0.024), hospitalization (HR 1.90; 95% CI 1.24 - 2.90; P=0.003), need for surgery (HR 2.28; 95% CI 1.17-4.44, P=0.02) and younger age at diagnosis (HR 0.99, 95% CI 0.98-0,99; p=0.003). CONCLUSION PIPs burden was associated with a more severe outcome. Future prospective studies should focus on the characterisation of PIPs burden as to further risk stratify this patient cohort.
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Affiliation(s)
- P Ellul
- Division of Gastroenterology, Mater Dei hospital, Malta
| | - J Schembri
- Division of Gastroenterology, Mater Dei hospital, Malta
| | | | - T Molnar
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Hungary
| | - T Resal
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Hungary
| | - M A Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - F Furfaro
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Dal Buono
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Theodoropoulou
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - M Fragaki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - E Tsoukali
- Department of Gastroenterology, GHA "Evangelismos-Polykliniki', Athens, Greece
| | - G J Mantzaris
- Department of Gastroenterology, GHA "Evangelismos-Polykliniki', Athens, Greece
| | - F Phillips
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | - S Radford
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | - G Moran
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | | | - S Sebastian
- Hull University Teaching Hospitals, Hull, UK
| | - F Fousekis
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - D Christodoulou
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Y Snir
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Z Lerner
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - H Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - G Michalopoulos
- Gastroenterology department "Tzaneion" General Hospital of Piraeus, Greece
| | - J Tua
- Division of Gastroenterology, Mater Dei hospital, Malta
| | - L Camilleri
- Faculty of Science, University of Malta, Malta
| | - K Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - K Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - K Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Bamias G, Kokkotis G, Gizis M, Kapizioni C, Karmiris K, Koureta E, Kyriakos N, Leonidakis G, Makris K, Markopoulos P, Michalopoulos G, Michopoulos S, Papaconstantinou I, Polymeros D, Siakavellas SI, Triantafyllou K, Tsironi E, Tsoukali E, Tzouvala M, Viazis N, Xourafas V, Zacharopoulou E, Zampeli E, Zografos K, Papatheodoridis G, Mantzaris G. Predictors of Response to Vedolizumab in Patients with Ulcerative Colitis: Results from the Greek VEDO-IBD Cohort. Dig Dis Sci 2022; 67:1007-1017. [PMID: 33751325 PMCID: PMC7942521 DOI: 10.1007/s10620-021-06907-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Optimization of treatment with biologics is currently an unmet need for patients with ulcerative colitis (UC). Real-world studies provide neutral estimates of drug efficacy and safety within unselected patient populations and allow for the recognition of specific characteristics that affect response to therapy. AIMS We aimed to depict the efficacy of vedolizumab in patients with UC in a real-world setting and identify prognosticators of improved outcomes. METHODS Patients with active UC who commenced treatment with vedolizumab were prospectively followed up. Patient-reported outcomes (PROs) and clinical/endoscopic-reported outcomes were recorded at baseline and at weeks 14 and 54. Predefined endpoints of early and persistent efficacy were analyzed against clinical characteristics to identify prognostic factors for response. RESULTS We included 96 patients (anti-TNF-exposed = 38.5%). At week 14, 73 patients (76%) had clinical response and 54 (56.3%) clinical remission. At week 54, the primary endpoint of vedolizumab persistence was met by 72 patients (75%), whereas steroid-free clinical remission by 59.4%. Among patients who had endoscopy, rates for mucosal healing (Mayo endoscopic score of 0) were 29.8% at week 14 and 44.6% at week 54, respectively. Vedolizumab treatment led to significant improvements in quality of life. Corticosteroid-refractory or anti-TNF-refractory disease, articular manifestations, and high baseline UC-PRO2 were associated with decreased efficacy of vedolizumab in the primary and secondary outcomes. CONCLUSIONS Vedolizumab is characterized by high efficacy and long-term treatment persistence in UC. More aggressive disease, as indicated by refractoriness to steroids or anti-TNFs and elevated baseline PROs, may predict suboptimal response and help pre-treatment prognostic stratification of patients.
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Affiliation(s)
- Giorgos Bamias
- GI Unit, 3Rd Department of Internal Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Messogeion 152, 11527 Athens, Greece
| | - Georgios Kokkotis
- GI Unit, 3Rd Department of Internal Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Messogeion 152, 11527 Athens, Greece
| | - Michalis Gizis
- GI Unit, 3Rd Department of Internal Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Messogeion 152, 11527 Athens, Greece
| | - Christina Kapizioni
- Department of Gastroenterology, Tzaneion General Hospital, Leoforos Afentouli, 18536 Piraeus, Greece
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Leoforos Knosou 44, 71409 Heraklion, Greece
| | - Evgenia Koureta
- Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527 Athens, Greece
| | - Nikolaos Kyriakos
- Department of Gastroenterology, 401 General Military Hospital of Athens, Leoforos Panagioti Kanellopoulou, 11525 Athens, Greece
| | - Georgios Leonidakis
- Department of Gastroenterology, Alexandra General Hospital, Lourou 4-2, 11528 Athens, Greece
| | - Konstantinos Makris
- Department of Gastroenterology, Tzaneion General Hospital, Leoforos Afentouli, 18536 Piraeus, Greece
| | - Panagiotis Markopoulos
- Department of Gastroenterology, Metaxa Memorial General Hospital, Mpotasi 51, 18537 Piraeus, Greece
| | - Georgios Michalopoulos
- Department of Gastroenterology, Tzaneion General Hospital, Leoforos Afentouli, 18536 Piraeus, Greece
| | - Spyridon Michopoulos
- Department of Gastroenterology, Alexandra General Hospital, Lourou 4-2, 11528 Athens, Greece
| | - Ioannis Papaconstantinou
- Second Department of Surgery, National and Kapodistrian University of Athens, Medical School, Aretaieion University Hospital, Leoforos Vasilissis Sofias 76, 11528 Athens, Greece
| | - Dimitrios Polymeros
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Rimini 1, 12462 Athens, Greece
| | - Spyros I. Siakavellas
- Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527 Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Rimini 1, 12462 Athens, Greece
| | - Eftychia Tsironi
- Department of Gastroenterology, Metaxa Memorial General Hospital, Mpotasi 51, 18537 Piraeus, Greece
| | - Emmanouela Tsoukali
- Department of Gastroenterology, GHA Evaggelismos- Opthalmiatreion Athinon-Polykliniki, Ipsilantou 45-47, 10676 Athens, Greece
| | - Maria Tzouvala
- Department of Gastroenterology, General Hospital Nikaias-Piraeus “Agios Panteleimon” -General Hospital Dytikis Attikis “Agia Varvara”, Dim. Mantouvalou 3, 18454 Athens, Greece
| | - Nikos Viazis
- Department of Gastroenterology, GHA Evaggelismos- Opthalmiatreion Athinon-Polykliniki, Ipsilantou 45-47, 10676 Athens, Greece
| | - Vassileios Xourafas
- GI Unit, 3Rd Department of Internal Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Messogeion 152, 11527 Athens, Greece
| | - Eirini Zacharopoulou
- Department of Gastroenterology, General Hospital Nikaias-Piraeus “Agios Panteleimon” -General Hospital Dytikis Attikis “Agia Varvara”, Dim. Mantouvalou 3, 18454 Athens, Greece
| | - Evanthia Zampeli
- Department of Gastroenterology, Alexandra General Hospital, Lourou 4-2, 11528 Athens, Greece
| | - Konstantinos Zografos
- GI Unit, 3Rd Department of Internal Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Messogeion 152, 11527 Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527 Athens, Greece
| | - Gerasimos Mantzaris
- Department of Gastroenterology, GHA Evaggelismos- Opthalmiatreion Athinon-Polykliniki, Ipsilantou 45-47, 10676 Athens, Greece
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Mantaka A, Tsoukali E, Fragkaki M, Karmiris K, Viazis N, Mantzaris GJ, Koutroubakis IE. Is there any role of renin-angiotensin system inhibitors in modulating inflammatory bowel disease outcome? Eur J Gastroenterol Hepatol 2021; 33:364-371. [PMID: 32925506 DOI: 10.1097/meg.0000000000001912] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have been associated with improved outcomes in inflammatory bowel disease. We aimed to investigate any possible effect of antihypertensive medications on inflammatory bowel disease course. METHODS One hundred and fifty inflammatory bowel disease patients with hypertension were compared using a 1:1 ratio with age- and gender-matched control patients with inflammatory bowel disease. The class of antihypertensive medication, traditional risk factors for atherosclerosis, inflammatory bowel disease characteristics, and history (surgery, hospitalizations, and treatment) were retrospectively analyzed. RESULTS Of 150 (44.7% Crohn's disease) patients with hypertension, 46.7% were on angiotensin receptor blockers, 30.6% on angiotensin-converting enzyme inhibitors, 40% on β-blockers, and 40.7% on calcium channel blockers. Univariate analysis revealed significantly higher rates of traditional risk factors for atherosclerosis among antihypertensive users. When analyzing by class of antihypertensive medication, angiotensin receptor blockers were significantly associated with milder course as indicated by less frequent immunomodulator (P = 0.039) and steroid use (P = 0.041). Rates of lifetime steroids were statistically significantly lower among angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (odds ratio = 1.191, 95% confidence interval, 1.005-1.411). After adjustment with confounding factors, only angiotensin receptor blockers were associated with milder inflammatory bowel disease course (P = 0.037) and lower rates of immunomodulator use (P = 0.038). CONCLUSIONS Our study suggests a possible protective effect of angiotensin receptor blockers on overall inflammatory bowel disease course by targeting the renin-angiotensin system. Their effect on inflammatory bowel disease needs to be studied in larger cohorts.
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Affiliation(s)
- Aikaterini Mantaka
- Faculty of Medicine, University of Crete, Heraklion
- Department of Gastroenterology, University Hospital of Heraklion, Crete
| | - Emmanouela Tsoukali
- Faculty of Medicine, University of Crete, Heraklion
- Department of Gastroenterology, General Hospital of Athens 'Evangelismos-Ophthalmiatreion Athinon-Polykliniki', Athens
| | - Maria Fragkaki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete Greece
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete Greece
| | - Nikos Viazis
- Department of Gastroenterology, General Hospital of Athens 'Evangelismos-Ophthalmiatreion Athinon-Polykliniki', Athens
| | - Gerassimos J Mantzaris
- Department of Gastroenterology, General Hospital of Athens 'Evangelismos-Ophthalmiatreion Athinon-Polykliniki', Athens
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Mantaka A, Tsoukali E, Fragkaki M, Karmiris K, Viazis N, Mantzaris GJ, Koutroubakis IE. The role of coexisting cardiovascular disease on disease severity in patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol 2020; 32:581-587. [PMID: 31922975 DOI: 10.1097/meg.0000000000001674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Chronic inflammation has been implicated in the pathogenesis of atherosclerosis and cardiovascular disease. Data linking the severity of inflammatory bowel disease to coexisting cardiovascular disease are scarce. The aim of the present study was to investigate whether inflammatory bowel disease patients with coexistent cardiovascular disease have more severe disease. METHODS We included 103 inflammatory bowel disease patients with coexisting cardiovascular disease compared to 206 age- and sex-matched inflammatory bowel disease patients without cardiovascular disease derived from three referral inflammatory bowel disease Centers. Traditional cardiovascular disease factors and parameters of inflammatory bowel disease severity were compared between the two groups. RESULTS Cardiovascular disease was diagnosed after the inflammatory bowel disease diagnosis in 56.6% of cases. No significant difference was found in the prevalence of surrogate markers of severity (inflammatory bowel disease-related surgeries, hospitalizations, biologics or immunosuppressants' use, and persistent CRP elevation) between inflammatory bowel disease patients with and without cardiovascular disease. There was no difference between cardiovascular disease patients diagnosed before and after inflammatory bowel disease onset. All traditional risk factors (hypertension, dyslipidemia, smoking, obesity, diabetes mellitus) were significantly more common in cardiovascular disease patients. Cardiovascular disease patients had a trend for lower rates of multiple hospitalizations (16.5% vs. 24.3%, P = 0.05) and inflammatory bowel disease-related surgeries (P = 0.09). CONCLUSION The inflammatory burden possibly plays a less important role in the development of cardiovascular disease in inflammatory bowel disease patients but future larger prospective studies are needed.
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Affiliation(s)
- Aikaterini Mantaka
- Faculty of Medicine, University of Crete, Heraklion.,Department of Gastroenterology, University Hospital of Heraklion, Crete
| | - Emmanouela Tsoukali
- Faculty of Medicine, University of Crete, Heraklion.,Department of Gastroenterology, General Hospital of Athens 'Evangelismos-Ophthalmiatreion Athinon-Polykliniki', Athens
| | - Maria Fragkaki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Nikos Viazis
- Department of Gastroenterology, General Hospital of Athens 'Evangelismos-Ophthalmiatreion Athinon-Polykliniki', Athens
| | - Gerassimos J Mantzaris
- Department of Gastroenterology, General Hospital of Athens 'Evangelismos-Ophthalmiatreion Athinon-Polykliniki', Athens
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Mari A, Tsoukali E, Yaccob A. Eosinophilic Esophagitis in Adults: A Concise Overview of an Evolving Disease. Korean J Fam Med 2020; 41:75-83. [PMID: 32062959 PMCID: PMC7093678 DOI: 10.4082/kjfm.18.0162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022] Open
Abstract
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that encompasses esophageal symptoms along with eosinophilic infiltration of the esophageal epithelium. EoE is an evolving disease that has been a subject of interest to many researchers since the first studies recognized this condition as a new and distinct clinicopathological entity 25 years ago. Clinical presentation in adult patients may include dysphagia, food impaction, vomiting, and reflux symptoms. The diagnosis of EoE is based on the combination of clinical history suggestive of esophageal dysfunction, endoscopic features indicative of the disease, and histology revealing eosinophilic infiltration of the esophageal epithelium that persists after a trial of proton pump inhibitor therapy along with the exclusion of other disorders that may be associated with esophageal tissue eosinophilia. The interplay between EoE and gastroesophageal reflux disease (GERD) is complex, and differentiating these two conditions continues to be difficult and challenging in clinical practice. The mainstay treatment includes dietary modification, topical steroids, and/or endoscopic dilation. The primary care physician (PCP) plays an important role in improving patient care and quality of life by ensuring early referral and participating in management and follow-up. This article provides an overview of the current knowledge base regarding the disease including epidemiology, genetics, pathogenesis, common clinical presentations, the interplay between EoE and GERD, diagnostic approaches, and therapeutic options available to the PCP.
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Affiliation(s)
- Amir Mari
- Gastroenterology Institute, Nazareth EMMS Hospital, Nazareth, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Emmanouela Tsoukali
- Gastroenterology and Hepatology Department, Evangelismos General Hospital of Athens, Athens, Greece
| | - Afif Yaccob
- Gastroenterology and Liver Disease Department, Rambam Healthcare Campus, Haifa, Israel
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Galanopoulos M, Tsoukali E, Gkeros F, Vraka M, Karampekos G, Matzaris GJ. Screening and surveillance methods for dysplasia in inflammatory bowel disease patients: Where do we stand? World J Gastrointest Endosc 2018; 10:250-258. [PMID: 30364842 PMCID: PMC6198309 DOI: 10.4253/wjge.v10.i10.250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/24/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with long-standing ulcerative colitis (UC) and extensive Crohn’s colitis (CC) are at increased risk for dysplasia and colorectal cancer (CRC). Several studies have shown that UC extending proximal to the rectum, CC involving at least 1/3 of the colon, co-existence of primary sclerosing cholangitis, undetermined or unclassified colitis, family history of CRC and young age at diagnosis appear to be independent risk factors for inflammatory bowel disease (IBD) - related CRC. Therefore, screening and surveillance for CRC in IBD patients is highly recommended by international and national guidelines, whilst colonoscopy remains the unequivocal tool in order to detect potentially resectable dysplastic lesions or CRC at an early stage. Although the importance of screening and surveillance is widely proven, there is a controversy regarding the time of the first colonoscopy and the criteria of who should undergo surveillance. In addition, there are different recommendations among scientific societies concerning which endoscopic method is more efficient to detect dysplasia early, as well as the terminology for reporting visible lesions and the management of those lesions. This article concisely presents the main endoscopic methods and techniques performed for detecting dysplasia and CRC surveillance in patients with IBD focusing on their evidence-based accuracy and efficiency, as well as their cost-effectiveness. Finally, newer methods are mentioned, highlighting their applicability in daily endoscopic practice.
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Affiliation(s)
- Michail Galanopoulos
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
| | - Emmanouela Tsoukali
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
| | - Filippos Gkeros
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
| | - Marina Vraka
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
| | - Georgios Karampekos
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
| | - Gerassimos J Matzaris
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
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7
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Kopylov U, Verstockt B, Biedermann L, Sebastian S, Pugliese D, Sonnenberg E, Steinhagen P, Arebi N, Ron Y, Kucharzik T, Roblin X, Ungar B, Shitrit ABG, Ardizzone S, Molander P, Coletta M, Peyrin-Biroulet L, Bossuyt P, Avni-Biron I, Tsoukali E, Allocca M, Katsanos K, Raine T, Sipponen T, Fiorino G, Ben-Horin S, Eliakim R, Armuzzi A, Siegmund B, Baumgart DC, Kamperidis N, Maharshak N, Maaser C, Mantzaris G, Yanai H, Christodoulou DK, Dotan I, Ferrante M. Effectiveness and Safety of Vedolizumab in Anti-TNF-Naïve Patients With Inflammatory Bowel Disease-A Multicenter Retrospective European Study. Inflamm Bowel Dis 2018; 24:2442-2451. [PMID: 29788318 DOI: 10.1093/ibd/izy155] [Citation(s) in RCA: 39] [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] [Received: 01/27/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vedolizumab (VDZ) is effective for treatment of ulcerative colitis (UC) and Crohn's disease (CD). In GEMINI trials, anti-tumor necrosis factor (anti-TNF)-naïve patients had a superior response compared with anti-TNF-exposed patients. In real-world experience (RWE), the number of included anti-TNF-naïve patients was low. We aimed to evaluate the effectiveness and safety of VDZ in anti-TNF-naïve patients in an RWE setting. METHODS This retrospective multicenter European pooled cohort study included consecutive active anti-TNF-naïve IBD patients treated with VDZ. The primary end point was clinical response at week 14. Patients with follow-up beyond week 14 and those discontinuing VDZ at any time were included for maintenance outcomes analysis. RESULTS Since January 2015, 184 anti-TNF-naïve patients from 23 centers initiated VDZ treatment (Crohn's disease [CD], 50; ulcerative colitis [UC], 134). In CD, 42/50 (82%) patients responded by week 14 and 32 (64%) were in clinical remission; 26/50 (52%) achieved corticosteroid-free remission (CSFR). At last follow-up (44 weeks; interquartile range [IQR], 30-52 weeks), 27/35 (77.1%) patients with available data responded to treatment; 24/35 (68.6%) were in clinical remission, 21/35 (60%) were in CSFR. For UC, 116/134 (79.1%) responded to treatment by week 14, including 53 (39.5%) in clinical remission; 49/134 (36.6%) achieved CSFR. At last follow-up (42.5 weeks; IQR, 30-52 weeks), 79/103 (76.7%) patients responded to treatment, 69/103 (67.0%) were in remission, and 61/103 (59.2%) were in CSFR. Adverse effects were reported in 20 (11%) of the patients, leading to treatment discontinuation in 6 (3.3%). CONCLUSIONS VDZ is similarly effective in ant-TNF-naïve CD and UC patients. The efficacy is higher than reported in anti-TNF-experienced patients and is comparable to that of anti-TNF biologics in this population.
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Affiliation(s)
- Uri Kopylov
- Sheba Medical Center, Gastroenterology, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Luc Biedermann
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Shaji Sebastian
- IBD Unit, Hull & East Yorkshire Hospitals NHS Trust, Hull, United Kingdom
| | - Daniela Pugliese
- IBD Unit, Presidio Columbus Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Elena Sonnenberg
- Department of Medicine (Gastroenterology, Infectious DIseases, Rheumatology), Campus Benjamin Franklin, Charité-Universitätsmedizin, Berlin, Germany
| | - Peter Steinhagen
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Naila Arebi
- Department of Inflammatory Bowel Disease, St Mark's Hospital, Harrow, London, United Kingdom
| | - Yulia Ron
- IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Lüneburg, Germany
| | - Xavier Roblin
- CHU de Saint-Etienne, Gastroenterology, Saint Etiennne, France
| | - Bella Ungar
- Sheba Medical Center, Gastroenterology, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Sandro Ardizzone
- Department of Gastroenterology, DIBIC, ASST Fatebenefratelli Sacco, Milan University, Milan, Italy
| | - Pauliina Molander
- Department of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marina Coletta
- Department of Pathophysiology and Transplantation, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico,Università degli Studi di Milano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepatogastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Peter Bossuyt
- Imelda GI Clinical Research Center, Gastroenterology, Bonheiden, Belgium
| | - Irit Avni-Biron
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Emmanouela Tsoukali
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Konstantinos Katsanos
- Division of Gastroenterology, School of Health Sciences and Univeristy Hospital of Ioannina, Ioannina, Greece
| | - Tim Raine
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Taina Sipponen
- Department of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Shomron Ben-Horin
- Sheba Medical Center, Gastroenterology, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Rami Eliakim
- Sheba Medical Center, Gastroenterology, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Britta Siegmund
- Department of Medicine (Gastroenterology, Infectious DIseases, Rheumatology), Campus Benjamin Franklin, Charité-Universitätsmedizin, Berlin, Germany
| | - Daniel C Baumgart
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Nikolaos Kamperidis
- Department of Inflammatory Bowel Disease, St Mark's Hospital, Harrow, London, United Kingdom
| | - Nitsan Maharshak
- IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Christian Maaser
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Lüneburg, Germany
| | - Gerassimos Mantzaris
- Department of Gastroenterology, "Evaggelismos-Ophthalmiatreion Athinon-Polycliniki, Athens, Greece
| | - Henit Yanai
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Dimitrious K Christodoulou
- Division of Gastroenterology, School of Health Sciences and Univeristy Hospital of Ioannina, Ioannina, Greece
| | - Iris Dotan
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Prantsidis A, Raikos N, Pantelakis Ι, Spagou K, Tsoukali E. Unusual mercury poisoning from tattoo dye. Hippokratia 2017; 21:197-200. [PMID: 30944512 PMCID: PMC6441351] [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: 06/09/2023]
Abstract
BACKGROUND Tattoos have become very popular in modern societies due to the gradual change in aesthetics and psychosocial acceptability. Consequently, tattoo reactions are seen more commonly than in the past. Cutaneous lesions associated with tattoos can be divided into three major groups: allergic/granulomatous/lichenoid, infectious, and coincidental lesions. Early identification and proper treatment of these skin lesions is challenging and necessitates close coοperation of different medical specialties. CASE DESCRIPTION We report an unusual case of mercury poisoning in a young person manifested with local skin reactions following amateur tattooing. The tattoo induced inflammatory foreign body reactions and required multiple surgical excisions to be removed. The unique feature of this case is the use of the elemental form of mercury in the tattoo dye and the resulting mercury poisoning. The poisoning was confirmed by detection of mercury in blood, urine, and hair samples. CONCLUSION This is a rare case of tattoo-associated skin reaction and mercury poisoning by the elemental form of mercury contained in the tattoo dye. In the literature, many conditions have been documented in association with tattoos and the process of tattoo application, especially when red dyes are used, but no similar cases of elemental mercury poisoning from the tattoo dye exist. HIPPOKRATIA 2017, 21(4): 197-200.
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Affiliation(s)
- A Prantsidis
- Dermatology Department, Army Share Fund hospital, Athens, Greece
| | - N Raikos
- Forensic and Toxicological Laboratory, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - K Spagou
- Forensic and Toxicological Laboratory, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Tsoukali
- Forensic and Toxicological Laboratory, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Viazis N, Katopodi K, Karamanolis G, Denaxas K, Varytimiadis L, Galanopoulos M, Tsoukali E, Kamberoglou D, Christidou A, Karamanolis DG, Papatheodoridis G, Mantzaris GJ. Proton pump inhibitor and selective serotonin reuptake inhibitor therapy for the management of noncardiac chest pain. Eur J Gastroenterol Hepatol 2017. [PMID: 28628496 DOI: 10.1097/meg.0000000000000925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/14/2023]
Abstract
INTRODUCTION Although gastroesophageal reflux disease is the main cause of noncardiac chest pain (NCCP), proton pump inhibitors (PPIs) benefit a minority of patients. Our prospective study evaluated the effect of PPI and selective serotonin reuptake inhibitors on the different subtypes of NCCP characterized by impedance-pH monitoring. METHODS All NCCP patients underwent impedance-pH monitoring and on the basis of the results, those with abnormal distal esophageal acid exposure received PPIs twice daily (group A), those with a positive symptom index for chest pain received citalopram 20 mg and PPI once daily (group B), and those with a negative symptom index for chest pain received citalopram 20 mg once daily (group C). Therapy was administered for 12 weeks and treatment success was defined as complete disappearance of chest pain. RESULTS From March 2015 to March 2016, 63 patients were included (group A=9, group B=18, group C=36). After 12 weeks of therapy, complete resolution of chest pain was noted in 8/9 (88.9%) group A, 13/18 (72.2%) group B, and 24/36 (66.7%) group C patients. CONCLUSION Combined impedance-pH monitoring identifies different subtypes of NCCP patients who can receive tailored management. Targeted therapy with PPIs and/or citalopram offers complete symptom relief in the great majority of them.
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Affiliation(s)
- Nikos Viazis
- aDepartment of Gastroenterology, Evangelismos Hospital bAcademic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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10
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Tsoukali E, Sifrim D. Investigation of extraesophageal gastroesophageal reflux disease. Ann Gastroenterol 2013; 26:290-295. [PMID: 24714277 PMCID: PMC3959476] [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] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/17/2013] [Indexed: 10/25/2022] Open
Abstract
The most common extraesophageal manifestations of gastroesophageal reflux disease (GERD) include chronic cough, asthma and laryngitis. There are two mechanisms proposed to explain extraesophageal syndromes caused by GERD. The first one is a direct way via irritation and/or microaspiration and the second one is an indirect, vagally mediated way. The investigation of extraesophageal manifestations of GERD is difficult and the empirical therapy with proton pump inhibitors usually double dose for at least three months is still the most common approach.
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Affiliation(s)
- Emmanouela Tsoukali
- Department of Internal Medicine, Athens General Hospital Elpis, Greece (Emmanouela Tsoukali)
| | - Daniel Sifrim
- Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, UK (Daniel Sifrim)
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Tsoukali E, Gouvas N, Tsiaoussis J, Pechlivanides G, Zervakis N, Mantides A, Xynos E. Specific esophagogram to assess functional outcomes after Heller's myotomy and Dor's fundoplication for esophageal achalasia. Dis Esophagus 2011; 24:451-7. [PMID: 21385281 DOI: 10.1111/j.1442-2050.2011.01178.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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] [Indexed: 12/11/2022]
Abstract
Esophageal emptying assessed at the 'timed barium' esophagogram correlates well with symptomatic outcomes after pneumatic dilation for esophageal achalasia, although 30% of patients with satisfactory outcome exhibit partial improvement in emptying. The aim of the study was to investigate any correlation of esophageal emptying to symptomatic response after laparoscopic Heller's myotomy and Dor's fundoplication. 'Bread and barium' (transit time of a barium opaque bread bolus) and 'timed barium' (height of esophageal barium column 5 minutes after ingestion of 200-250 mL of barium suspension) esophagogram was used to assess esophageal emptying in 73 patients with esophageal achalasia before 1 and 5 years (31 cases) after laparoscopic myotomy and anterior fundoplication. Symptoms assessment was based to a specific score. At 1-year follow-up, excellent and good symptomatic results were obtained in 95% of the cases. Esophageal maximum diameter, esophageal transit time, and esophageal barium column were significantly correlated to each other and to symptom score postoperatively (P < 0.001). Complete and partial (<90% and 50-90% postoperative reduction in barium column, respectively) emptying was seen in 55% and 31% of patients with excellent result. Patients with a pseudodiverticulum postoperatively had a more delayed esophageal emptying than those without. Symptomatic outcome and esophageal emptying did not deteriorate at 5-year follow-up. Esophageal emptying assessed by 'barium and bread' and 'timed barium' esophagogram correlated well with symptomatic outcome after laparoscopic myotomy for esophageal achalasia. Complete symptomatic relief does not necessarily reflect complete esophageal emptying. Outcomes do not deteriorate by time. Because of wide availability, esophagogram can be applied in follow-up of postmyotomy patients in conjunction with symptomatic evaluation.
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Affiliation(s)
- E Tsoukali
- Unit of Gastrointestinal Motility, Medical School, University of Crete, Crete, Greece
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Tsoukali E, Sifrim D. The role of weakly acidic reflux in proton pump inhibitor failure, has dust settled? J Neurogastroenterol Motil 2010; 16:258-64. [PMID: 20680164 PMCID: PMC2912118 DOI: 10.5056/jnm.2010.16.3.258] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 06/15/2010] [Accepted: 06/24/2010] [Indexed: 12/11/2022] Open
Abstract
Patients that do not respond satisfactorily to standard proton pump inhibitor (PPI) treatment have become the most common presentation of gastro-esophageal reflux disease (GERD) in third referral gastrointestinal practices. The causes of refractory GERD include lack of compliance with treatment, residual acid reflux and weakly acidic reflux, esophageal hypersensitivity and persistent symptoms not associated with reflux. A role for weakly acidic reflux in symptom generation has been proposed since the availability of impedance-pH monitoring. The possible mechanisms by which persistent weakly acidic reflux might contribute to persistent symptoms in patients under PPI treatment may include esophageal distension by increased reflux volume, persistent impaired mucosal integrity (ie, dilation of intercellular spaces) and/or esophageal hypersensitivity to weakly acidic reflux events. To establish a definite role of weakly acidic reflux in refractory GERD, outcome studies targeting this type of reflux are still lacking. Treatment strategies to reduce the number or effect of weakly acidic reflux could involve drugs that decrease transient lower esophageal sphincter relaxations (ie, baclofen or similar), improve oesophageal mucosa resistance or visceral pain modulators. Finally, anti-reflux surgery can be considered, only if a clear symptom-weakly acidic reflux association was demonstrated.
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Affiliation(s)
- Emmanouela Tsoukali
- Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, UK
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Vlachos K, Kovatsis A, Tsoukali E, Kotsaki V. [Isolation, identification, and biological effect of bull semen prostaglandins]. Dtsch Tierarztl Wochenschr 1973; 80:100-2. [PMID: 4572493] [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: 01/11/2023]
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