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Sousa P, Patita M, Arroja B, Lago P, Rosa I, de Sousa HT, Ministro P, Mocanu I, Vieira A, Castela J, Moleiro J, Roseira J, Cancela E, Portela F, Correia L, Santiago M, Dias S, Alves C, Afonso J, Dias CC, Magro F. Thiopurines have no impact on outcomes of Crohn's disease patients beyond 12 months of maintenance treatment with infliximab. Dig Liver Dis 2024; 56:737-743. [PMID: 37980274 DOI: 10.1016/j.dld.2023.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND The emergence of new treatments the inflammatory bowel diseases (IBD) raised questions regarding the role of older agents, namely thiopurines. AIMS To clarify the benefits of combination treatment with thiopurines on Crohn's disease (CD) patients in the maintenance phase of infliximab. METHODS In this analysis of the 2-year prospective multicentric DIRECT study, patients were assessed in terms of clinical activity, faecal calprotectin (FC), C-reactive protein (CRP), and infliximab pharmacokinetics. A composite outcome based on clinical- and drug-related items was used to define treatment failure. RESULTS The study included 172 patients; of these, 35.5 % were treated with combination treatment. Overall, 18 % of patients achieved the composite outcome, without statistically significant differences between patients on monotherapy and on combination treatment (21.6% vs 11.5 %, p = 0.098). Median CRP, FC, and infliximab pharmacokinetic parameters were similar in both groups. However, in the sub-analysis by infliximab treatment duration, in patients treated for less than 12 months, the composite outcome was reached in fewer patients in the combination group than in the monotherapy group (7.1% vs 47.1 %, p = 0.021). CONCLUSION In CD patients in maintenance treatment with infliximab, combination treatment does not seem to have benefits over infliximab monotherapy beyond 12 months of treatment duration.
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Affiliation(s)
- Paula Sousa
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Marta Patita
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Bruno Arroja
- Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Paula Lago
- Department of Gastroenterology, Porto Hospital University Centre, Porto, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Helena Tavares de Sousa
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal; ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Irina Mocanu
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Ana Vieira
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Joana Castela
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal; ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Eugenia Cancela
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Coimbra Hospital University Centre, Coimbra, Portugal
| | - Luis Correia
- Department of Gastroenterology, Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Sandra Dias
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Catarina Alves
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Claudia Camila Dias
- Knowledge Management Unit, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Fernando Magro
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Gastroenterology, São João Hospital University Centre, Porto, Portugal; Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal.
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Magro F, Fernandes S, Patita M, Arroja B, Lago P, Rosa I, de Sousa HT, Ministro P, Mocanu I, Vieira A, Castela J, Moleiro J, Roseira J, Cancela E, Sousa P, Portela F, Correia L, Moreira P, Dias S, Afonso J, Danese S, Peyrin-Biroulet L, Vucicevic KM, Santiago M. The influence of subclinical active inflammation on IFX pharmacokinetic modeling and disease progression assessment: findings from a prospective real-world study in inflammatory bowel disease patients. J Crohns Colitis 2024:jjae014. [PMID: 38243908 DOI: 10.1093/ecco-jcc/jjae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND AIMS Effective management of inflammatory bowel disease (IBD) relies on a comprehensive understanding of infliximab (IFX) pharmacokinetics (PK). This study's primary goal was to develop a robust PK model, identifying key covariates influencing IFX clearance (CL), while concurrently evaluating the risk of disease progression during the maintenance phase of IBD treatment. METHODS The multicenter, prospective, real-world DIRECT study was conducted in several care centers, which included 369 IBD patients in the maintenance phase of IFX therapy. A two-compartment population PK model was used to determine IFX CL and covariates. Logistic and Cox regressions were applied to elucidate the associations between disease progression and covariates embedded in the PK model. RESULTS The PK model included the contributions of weight, albumin, antidrug antibody (ADA), and fecal calprotectin (FC). On average, higher ADA, FC concentration and weight, and lower albumin concentration resulted in higher IFX CL. In the multivariate regression analyses, FC levels influenced the odds of disease progression in all its different definitions, when adjusted for several confounding factors. Additionally, alongside FC, both IFX and CL demonstrated a significant impact on the temporal aspect of disease progression. CONCLUSION In this 2-year real-world study, readily available clinical covariates, notably FC, significantly impacted IFX availability in IBD patients. We demonstrated that subclinical active inflammation, as mirrored by FC or CRP, substantially influenced IFX clearance. Importantly, FC emerged as a pivotal determinant, not only of IFX pharmacokinetics but also of disease progression. These findings underscore the need to integrate FC into forthcoming IFX pharmacokinetic models, amplifying its clinical significance.
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Affiliation(s)
- Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, São João Hospital University Centre, Porto, Portugal
- Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Portugal
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Samuel Fernandes
- Department of Gastroenterology, Northern Lisbon University Hospital Centre, Lisbon, Portugal
- Clinica Universitária de Gastrenterologia da Universidade de Medicina de Lisboa, Lisbon, Portugal
| | - Marta Patita
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Bruno Arroja
- Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Paula Lago
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
- Department of Gastroenterology, Porto Hospital University Centre, Porto, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Helena Tavares de Sousa
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal
- ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Paula Ministro
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Irina Mocanu
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Ana Vieira
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Joana Castela
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal
- ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Eugénia Cancela
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Francisco Portela
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
- Department of Gastroenterology, Coimbra Hospital University Centre, Coimbra, Portugal
| | - Luís Correia
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
- Department of Gastroenterology, Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Paula Moreira
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
| | - Sandra Dias
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Joana Afonso
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IBD Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Nancy, France
| | - Katarina M Vucicevic
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Serbia
| | - Mafalda Santiago
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
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Magro F, Estevinho MM, Catalano G, Patita M, Arroja B, Lago P, Rosa I, Tavares de Sousa H, Ministro P, Mocanu I, Vieira A, Castela J, Moleiro J, Roseira J, Cancela E, Sousa P, Portela F, Correia L, Moreira P, Santiago M, Dias S, Afonso J, Danese S, Peyrin-Biroulet L, Dias CC. How many biomarker measurements are needed to predict prognosis in Crohn's disease patients under infliximab?-A prospective study. United European Gastroenterol J 2023. [PMID: 37318072 DOI: 10.1002/ueg2.12420] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/07/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Timely stratification of Crohn's disease (CD) is essential for patients' management. The use of noninvasive accurate biomarkers is key to monitor treatment and to pursue mucosal healing, the ultimate treatment endpoint in CD. OBJECTIVE We aimed to evaluate the performance of readily available biomarkers and develop risk matrices to predict CD progression. METHODS Data from 289 CD patients receiving infliximab (IFX) maintenance therapy for 2 years was collected; those patients were included in DIRECT, a prospective multicenter observational study. Disease progression was evaluated using two composite outcomes incorporating clinical and drug-related factors, the first including IFX dose and/or frequency adjustments. Univariate and multivariable logistic regressions were used to calculate the odds ratios (OR) and to develop risk matrices. RESULTS The isolated presence of anemia at least once during follow-up was a significant predictor of disease progression (OR 2.436 and 3.396 [p ≤ 0.001] for composite outcomes 1 and 2, respectively) regardless of confounding factors. Isolated highly elevated C-reactive protein (CRP; >10.0 mg/L) and fecal calprotectin (FC; >500.0 μg/g) in at least one visit were also significant predictors, while milder elevations (3.1-10.0 mg/L and 250.1-500.0 μg/g) were only relevant when detected in at least two visits (consecutive or not). The combination of biomarkers in risk matrices had good ability to predict progression; patients simultaneously presenting anemia, highly elevated CRP and FC at least once had 42%-63% probability of achieving the composite outcomes. CONCLUSION The combined evaluation of hemoglobin, CRP, and FC in at least one time point and their incorporation into risk matrices seems to be the optimal strategy for CD management, as data from additional visits did not meaningfully influence the predictions and may delay decision-making.
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Affiliation(s)
- Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, São João Hospital University Centre, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Gaia Catalano
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Patita
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Bruno Arroja
- Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Paula Lago
- Department of Gastroenterology, Porto Hospital University Centre, Porto, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Helena Tavares de Sousa
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal
- ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Irina Mocanu
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Ana Vieira
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Joana Castela
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal
| | - Eugénia Cancela
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Coimbra Hospital University Centre, Coimbra, Portugal
| | - Luís Correia
- Department of Gastroenterology, Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Paula Moreira
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Sandra Dias
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IBD Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Nancy, France
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
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Garcia JL, Rosa I, da Silva JP, Moleiro J, Claro I. Incidence and risk factors for neoplasia in inflammatory bowel disease. Asia Pac J Clin Oncol 2023. [PMID: 36915954 DOI: 10.1111/ajco.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/22/2022] [Accepted: 11/24/2022] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Inflammatory Bowel Disease (IBD) patients may have an increased risk of neoplasia. The aim was to evaluate the incidence of malignant neoplasia in IBD patients, associated risk factors and therapy adjustments. METHODS Unicentric retrospective cohort study. All patients followed for IBD in a tertiary portuguese hospital and oncological centre during 2015-2020 were included. RESULTS 318 patients were included female 55.0%, age at diagnosis = 37.24(±15,28), Crohn's disease 52.5%, Primary Sclerosing Cholangitis n = 7, family history of cancer n = 12, previous diagnosis of neoplasia n = 23(7.2%). 42 cancers were diagnosed in 35 patients (11.0%) - median of 12.0(IQR = 7.5-21.0) years after IBD diagnosis. Most affected organs were the skin (n = 15 in 11 patients; melanoma = 1), colon/rectum (n = 8 in 6 patients), prostate (n = 4), breast (n = 3) and anal canal (n = 2). In those with non-melanoma skin cancer, 6 were under active treatment with azathioprine and 2 had stopped it for more than two years. In the univariate analysis, the occurrence of neoplasia was positively associated with tobacco exposure (p = 0.022), age at IBD diagnosis (p = 0.021), and negatively with infliximab exposure (p = 0.046). In 9 cases, cancer treatment was different because of the IBD, while IBD treatment was changed in 9 patients. In those affected by cancer, in the univariate analysis, its cure/remission was negatively associated with tobacco exposure (p = 0.004) and positively with salicylates use (p = 0.007). CONCLUSION In IBD patients, cancer mostly affected the skin and the lower digestive system. As in the general population, tobacco exposure was a risk factor for the development of neoplasia.
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Affiliation(s)
- Joana Lemos Garcia
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Isadora Rosa
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | - Joana Moleiro
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Isabel Claro
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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Magro F, Magalhães D, Patita M, Arroja B, Lago P, Rosa I, Tavares de Sousa H, Ministro P, Mocanu I, Vieira A, Castela J, Moleiro J, Roseira J, Cancela E, Sousa P, Portela F, Correia L, Santiago M, Dias S, Alves C, Afonso J, Danese S, Peyrin-Biroulet L, Dias CC. Subclinical Persistent Inflammation as Risk Factor for Crohn's Disease Progression: Findings From a Prospective Real-World Study of 2 Years. Clin Gastroenterol Hepatol 2022; 20:2059-2073.e7. [PMID: 34896644 DOI: 10.1016/j.cgh.2021.12.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Subclinical intestinal inflammation is common in Crohn's disease (CD). We aimed to explore its impact in the disease progression of infliximab-treated patients and the usefulness of fecal calprotectin (FC) and C-reactive protein (CRP) as surrogate minimally invasive biomarkers. METHODS The registry-based, prospective, observational, multicenter DIRECT (study to investigate the correlation of fecal calprotectin with serum Drug levels and development of an antI-dRug antibodiEs among adult patients with inflammatory bowel disease reCeiving anti-TNF-alfa treatment or vedoluzimab treatment) study followed infliximab-treated CD patients for 2 years in a tertiary care setting. Persistent inflammation definition was based on FC (>150 μg/g, >250 μg/g, or >350 μg/g) or serum CRP (>3 μg/mL) concentrations over 2 consecutive or at least 3 visits. Patients were categorized according to a composite outcome reflecting disease progression that incorporated surgery; hospitalizations; new fistulae, abscess, or stricture; and treatment escalation. RESULTS Of 322 DIRECT study patients, 180 asymptomatic, infliximab treated on maintenance regimen were included in the analysis. Patients developing the composite endpoint (n = 96) presented higher median levels of FC (205 [interquartile range, 98-515] μg/g; P = .045) but not of CRP (2.50 [interquartile range, 0.80-6.00] μg/mL; P = .895). Biomarker-defined persistent subclinical inflammation prevalence ranged from 24% to 81%. Considering FC >250 μg/g in 2 consecutive visits, prevalence was 50%, odds of achieving the endpoint were increased 3-fold (odds ratio, 2.996 [95% confidence interval, 1.557-5.776]), and time-to-outcome occurrence was significantly lower among subjects with persistent inflammation (median time: 11 months). Both clinical-related and treatment-related components were significantly associated with persistent inflammation. Definitions based on CRP >3 μg/mL, FC >150 μg/g, FC >350 μg/g, double biomarkers (FC >250 μg/g and/or CRP >3 μg/mL), or more visits did not improve predictive ability. CONCLUSIONS Persistent inflammation, defined simply and readily by FC >250 μg/g over 2 consecutive visits, was associated with a significantly higher risk and shorter time to occurrence of a composite outcome reflecting disease progression in asymptomatic infliximab-treated CD patients.
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Affiliation(s)
- Fernando Magro
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Gastroenterology, São João Hospital University Centre, Porto, Portugal; Center for Health Technology and Services Research, Porto, Portugal; Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal; Portuguese Inflammatory Bowel Disease Group, Porto, Portugal.
| | - Diogo Magalhães
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Patita
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Bruno Arroja
- Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Paula Lago
- Department of Gastroenterology, Porto Hospital University Centre, Porto, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Entidade Pública Empresarial, Lisbon, Portugal
| | - Helena Tavares de Sousa
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal; Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Irinia Mocanu
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Ana Vieira
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Joana Castela
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Entidade Pública Empresarial, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Entidade Pública Empresarial, Lisbon, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal
| | - Eugénia Cancela
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Coimbra Hospital University Centre, Coimbra, Portugal
| | - Luís Correia
- Department of Gastroenterology, Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research, Porto, Portugal; Portuguese Inflammatory Bowel Disease Group, Porto, Portugal
| | - Sandra Dias
- Portuguese Inflammatory Bowel Disease Group, Porto, Portugal
| | - Catarina Alves
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Afonso
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; IBD Center, Humanitas Research Hospital, IRCCS, Rozzano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Claudia Camila Dias
- Center for Health Technology and Services Research, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
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Saraiva S, Rosa I, Moleiro J, Pereira da Silva J, Fonseca R, Dias Pereira A. Dysplasia Surveillance in Inflammatory Bowel Disease: A Cohort Study. GE Port J Gastroenterol 2020; 28:97-105. [PMID: 33791396 DOI: 10.1159/000510728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/17/2020] [Indexed: 12/21/2022]
Abstract
Introduction Patients with colonic inflammatory bowel disease (IBD) are at an increased risk for colorectal cancer (CRC), whereby surveillance colonoscopy is recommended. Aim To study the clinical and endoscopic variables associated with dysplasia in IBD patients. Methods A cohort study was conducted on IBD patients who were part of a colonoscopy surveillance program between 2011 and 2016. Results A total of 342 colonoscopies were performed on 162 patients (105 with ulcerative colitis [UC] and 57 with Crohn's disease). Random biopsies were performed at least once on 81.5% of patients; 33.3% of the patients underwent chromoendoscopy (CE) at least once. Endoscopically resectable lesions were detected in 55 patients (34%), and visible lesions deemed unfit for endoscopic resection were found in 5 patients (3.1%). Overall, 62 dysplastic visible lesions (58 with low-grade dysplasia and 3 with high-grade dysplasia) and 1 adenocarcinoma were found in 34 patients. Dysplasia in random biopsies was present in 3 patients, the yield of random biopsies for dysplasia being 1.85%/patient (3/162), 1.75%/colonoscopy (6/342), and 0.25%/biopsy (9/3,637). Dysplasia detected in random biopsies was significantly associated with a personal history of visible dysplasia (p = 0.006). Upon univariate analysis, dysplasia was significantly associated with the type of IBD, the performance of random biopsies, and CE (p = 0.016/0.009/0.05, respectively). On multivariate analysis, dysplasia was associated with duration of disease. Conclusion Our data confirm that patients with long-standing IBD, in particular UC, should be enrolled in dysplasia surveillance programs, and that performing CE and random biopsies seems to help in the detection of colonic neoplastic lesions.
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Affiliation(s)
- Sofia Saraiva
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG), Lisbon, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG), Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG), Lisbon, Portugal
| | - João Pereira da Silva
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG), Lisbon, Portugal
| | - Ricardo Fonseca
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG), Lisbon, Portugal
| | - António Dias Pereira
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG), Lisbon, Portugal
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7
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Rosa I, Silva P, da Mata S, Magro F, Carneiro F, Peixoto A, Silva M, Sousa HT, Roseira J, Parra J, Barosa R, Vieira A, Brito MJ, Lago P, Coelho A, Moleiro J, Pereira da Silva J, Fonseca R, Albuquerque C, Dias Pereira A. Methylation patterns in dysplasia in inflammatory bowel disease patients. Scand J Gastroenterol 2020; 55:646-655. [PMID: 32456486 DOI: 10.1080/00365521.2020.1766552] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aims: Inflammatory Bowel Disease (IBD) with colonic involvement increases colorectal cancer risk. However, the distinction between IBD related and sporadic dysplasia in IBD patients is difficult. Some data favors the importance of abnormal DNA methylation in IBD-related carcinogenesis. We aimed to define methylation patterns in patients with colonic cancer or dysplasia diagnosis following an IBD diagnosis.Methods: Multicentric cross-sectional study-91 samples from colonic mucosa with/without dysplasia from 9 patients with IBD-related dysplasia/cancer and 26 patients with IBD and sporadic dysplasia/cancer were included. Methylation patterns of CpG islands in the promoter regions of 67 genes were studied by Methylation-specific Multiplex Ligation-dependent Probe Amplification.Results: Mean age at IBD diagnosis: 42 ± 16 years;at dysplasia diagnosis: 56 ± 14 years. Twenty-ninepatients had ulcerative colitis. Twenty-five patients had at least 1 lesion endoscopically described as adenoma-like, 4 at least 1 non-adenoma like, 3 had cancer and 3 had dysplasia in flat mucosa. No patient had both adenoma-like and non-adenoma-like lesions. Patients with an IBD-related lesion were significantly younger at IBD diagnosis (p = .003) and at dysplasia/cancer diagnosis (p = .039). Promoter methylation of IGF2, RARB, ESR1, CHFR, CDH13, WT1, GATA5, WIF1genes was significantly associated to dysplasia/cancer; methylation of MSH6, TIMP3 was significantly associated to IBD-related dysplasia/cancer. Promoter methylation of MSH6, MSH3, RUNX3, CRABP1, TP73, RARB, CDH13, PAX5, WT1, THBS1, TP53, SFRP1, WIF1, APAF1, BCL2 genes was significantly associated to active IBD.Conclusions: Methylation analysis, namely of MSH6, may contribute to the classification of dysplastic lesions in IBD- to be further tested in prospective studies.
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Affiliation(s)
- Isadora Rosa
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal
| | - Patrícia Silva
- Molecular Pathobiology Investigation Unit, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal
| | - Sara da Mata
- Pathology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal
| | - Fernando Magro
- Gastroenterology Department, Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Fátima Carneiro
- Pathology Department, Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Helena T Sousa
- Gastroenterology Department, Centro Hospitalar Universitário do Algarve, EPE, Unidade de Portimão, Portimão, Portugal.,Algarve Biomedical Center, Campus Gambelas - Universidade do Algarve, Faro, Portugal
| | - Joana Roseira
- Gastroenterology Department, Centro Hospitalar Universitário do Algarve, EPE, Unidade de Portimão, Portimão, Portugal.,Algarve Biomedical Center, Campus Gambelas - Universidade do Algarve, Faro, Portugal
| | - José Parra
- Pathology Department, Centro Hospitalar Universitário do Algarve, EPE, Unidade de Portimão, Portimão, Portugal
| | - Rita Barosa
- Gastroenterology Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Ana Vieira
- Gastroenterology Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Maria José Brito
- Pathology Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, EPE - Hospital de Santo António, Porto, Portugal
| | - André Coelho
- Portuguese Inflammatory Bowel Diseases Study Group, Porto, Portugal
| | - Joana Moleiro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal
| | - João Pereira da Silva
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal
| | - Ricardo Fonseca
- Pathology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal
| | - Cristina Albuquerque
- Molecular Pathobiology Investigation Unit, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal
| | - A Dias Pereira
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal
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- Portuguese Inflammatory Bowel Diseases Study Group, Porto, Portugal
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8
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Eliadou E, Moleiro J, Ribaldone DG, Astegiano M, Rothfuss K, Taxonera C, Ghalim F, Carbonnel F, Verstockt B, Festa S, Maia L, Berrozpe A, Zagorowicz E, Savarino E, Ellul P, Vavricka SR, Calvo M, Koutroubakis I, Hoentjen F, Salazar LF, Callela F, Cañete Pizarro F, Soufleris K, Sonnenberg E, Cavicchi M, Wypych J, Hommel C, Ghiani A, Fiorino G. Interstitial and Granulomatous Lung Disease in Inflammatory Bowel Disease Patients. J Crohns Colitis 2020; 14:480-489. [PMID: 31602473 DOI: 10.1093/ecco-jcc/jjz165] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Interstitial lung [ILD] disease and granulomatous lung disease [GLD] are rare respiratory disorders that have been associated with inflammatory bowel disease [IBD]. Clinical presentation is polymorphic and aetiology is unclear. METHODS This was an ECCO-CONFER project. Cases of concomitant ILD or GLD and IBD, or drug-induced ILD/GLD, were collected. The criteria for diagnosing ILD and GLD were based on definitions from the American Thoracic Society and the European Respiratory Society and on the discretion of reporting clinician. RESULTS We identified 31 patients with ILD. The majority had ulcerative colitis [UC] [n = 22]. Drug-related ILD was found in 64% of these patients, 25 patients [80.6%] required hospitalisation, and one required non-invasive ventilation. The causative drug was stopped in all drug-related ILD, and 87% of patients received systemic steroids. At follow-up, 16% of patients had no respiratory symptoms, 16% had partial improvement, 55% had ongoing symptoms, and there were no data in 13%. One patient was referred for lung transplantation, and one death from lung fibrosis was reported. We also identified 22 GLD patients: most had Crohn's disease [CD] [n = 17]. Drug-related GLD was found in 36% of patients and 10 patients [45.4%] required hospitalisation. The causative drug was stopped in all drug-related GLD, and 81% of patients received systemic steroids. Remission of both conditions was achieved in almost all patients. CONCLUSIONS ILD and GLD, although rare, can cause significant morbidity. In our series, over half of cases were drug-related and therefore focused pharmacovigilance is needed to identify and manage these cases.
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Affiliation(s)
- Elena Eliadou
- Gastroenterology Department, Manchester Royal Infirmary, Manchester UK
| | - Joana Moleiro
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | - Marco Astegiano
- Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Katja Rothfuss
- Robert-Bosch Hospital, Department of Gastroenterology, Hepatology and Endocrinology, Stuttgart, Germany
| | - Carlos Taxonera
- Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - Fahd Ghalim
- Gastroenterology Department, Kremlin Bicêtre Hospital, University Paris Sud, Paris, France
| | - Franck Carbonnel
- Gastroenterology Department, Kremlin Bicêtre Hospital, University Paris Sud, Paris, France
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, and Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Stefano Festa
- Ospedale San Filippo Neri, UOS Malattie Infiammatorie Croniche Intestinali Porto, Portugal
| | - Luís Maia
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Berrozpe
- IBD Unit, Bellvitge's Hospital, Barcelona, SpainWarsaw, Poland
| | - Edyta Zagorowicz
- Maria Sklodowska Curie Memorial Cancer Centre and Institute of Oncology, Department of Gastroenterology,Warsaw, Poland
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology,University of Padua, Padua, Italy
| | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Valleta, Malta
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, Center for Gastroenterology and Hepatology, Zurich, Switzerland
| | - Marta Calvo
- Gastroenterology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Frank Hoentjen
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Francesca Callela
- UOC Gastroenterologia, Ospedale San Giuseppe, Empoli, Firenze, Italy
| | | | - Konstantinos Soufleris
- Department of Gastroenterology, Theagenion Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Maryan Cavicchi
- Department of Gatroenterology, Clinique de Bercy, Creteil, France
| | - Joanna Wypych
- Surgery & Gastroenterology Department, Copernicus Hospital, Gdansk, Poland
| | - Christophe Hommel
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Yvoir, Belgium,Catholic University of Louvain, Brussels, Belgium
| | - Alessandro Ghiani
- Schillerhoehe Lung Clinic [Robert-Bosch-Hospital], Department of Pneumology and Respiratory Medicine, Gerlingen, Germany
| | - Gionata Fiorino
- Humanitas Clinical and Research Center, Gastroenterology Department, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy
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9
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Roseira J, Mão de Ferro S, Moleiro J, Currais P, Lemos J, Dionísio J, Ferreira S, Rosa I, Lage P, Szantho A, Duro da Costa J, Dias Pereira A. Utility of stent double palliation for esophageal cancer with airway involvement: the extremis of care. Dis Esophagus 2020; 33:5588491. [PMID: 31617893 DOI: 10.1093/dote/doz087] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 07/24/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
Abstract
Primary esophageal cancer (EC) frequently presents as a locally advanced disease with airway involvement. Placement of combined esophageal and airway stents has been reported in small series to be an effective palliation strategy. Our aims are to present the largest cohort of EC patients who underwent double stent palliation and to evaluate the safety and efficacy of this approach. Longitudinal cohort study of patients with primary EC undergoing two-stage esophageal and airway stent placement at an oncology referral institute (January 2000-January 2019). Assessments: baseline demographics and clinical variables; baseline and week 2 dysphagia, dyspnea and performance status (PS) scores; baseline and week 8 body mass index (BMI); overall survival. Statistics: paired t-test; Kaplan-Meier method. Seventy patients (89% men, mean age 60.20 ± 8.41) underwent double stenting. Esophageal stent was placed for esophageal stenosis and dysphagia (n = 41; placement of a second stent due to recurrence in nine cases) or esophagorespiratory fistulas (ERFs) (n = 29); airway stent was required for ERF sealing (n = 29 + 7 new ERFs after esophageal stent) and to ensure airway patency due to malignant stenosis (n = 29; placement of a second stent due to recurrence in 13 cases) or compression (n = 5). There were 13, endoscopically managed, major complications after esophageal stent [hemorrage (n = 1), migration (n = 5) and new fistulas (n = 7)]. As for airway stents, four major complications were recorded [hemorrage (n = 1) and three deaths due to respiratory infection and ultimately respiratory failure 3-7 days after the procedure]. Overall, patients showed significant improvement in dysphagia and dyspnea symptoms (3.21 vs. 1.31 e 15.56 vs. 10.87; P < 0.001). There was a PS improvement for 89.2% (n = 58) of the patients. BMI at week 8 was comparable to baseline records. Mean survival was 137.83 ± 24.14 days (95% CI: 90.51-185.15). Survival was longer for better PS (PS1, 249.95 days; PS2, 83.74 days; PS3, 22.43 days; PS4, 30.00 days). This is the largest comprehensive assessment of double stent palliation in advanced incurable EC. For both esophageal or airway stenosis and fistula, placement of combined esophageal and airway stents was a feasible, effective, fast-acting and safe modality for symptom palliation and body mass maintenance. Patient autonomy followed symptom improvement. Since it is impossible to provide treatment for cure in most of these cases, this endoscopic strategy, performed in differentiated units with the required technical capacity, may guarantee treatment for the relief of palliative EC.
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Affiliation(s)
- J Roseira
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal.,Gastroenterology Department, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - S Mão de Ferro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - J Moleiro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - P Currais
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - J Lemos
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - J Dionísio
- Pneumology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - S Ferreira
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - I Rosa
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - P Lage
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - A Szantho
- Pneumology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - J Duro da Costa
- Pneumology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - A Dias Pereira
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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10
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Magro F, Lopes J, Borralho P, Lopes S, Coelho R, Cotter J, Dias de Castro F, Tavares de Sousa H, Salgado M, Andrade P, Vieira AI, Figueiredo P, Caldeira P, Sousa A, Duarte MA, Ávila F, Silva J, Moleiro J, Mendes S, Giestas S, Ministro P, Sousa P, Gonçalves R, Gonçalves B, Oliveira A, Chagas C, Cravo M, Dias CC, Afonso J, Portela F, Santiago M, Geboes K, Carneiro F. Comparing the Continuous Geboes Score With the Robarts Histopathology Index: Definitions of Histological Remission and Response and their Relation to Faecal Calprotectin Levels. J Crohns Colitis 2020; 14:169-175. [PMID: 31504348 DOI: 10.1093/ecco-jcc/jjz123] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The histological status of ulcerative colitis [UC] patients in clinical and endoscopic remission has gained space as an important prognostic marker and a key component of disease monitoring. Our main aims were to compare two histological indexes-the continuous Geboes score [GS] and the Robarts Histopathology index [RHI]-regarding their definitions of histological remission and response, and the ability of faecal calprotectin [FC] levels to discriminate between these statuses. METHODS This was an analysis of three prospective cohorts including 422 patients previously enrolled in other studies. RESULTS The two continuous scores [GS and RHI] were shown to be significantly correlated [correlation coefficient of 0.806, p < 0.001] and particularly close regarding their definition of histological response: 95% and 88% of all patients classified as having/not having [respectively] histological response according to RHI also did so according to GS. Moreover, median FC levels in patients with histological response were lower than those in patients without histological response [GS: 73.00 vs 525.00, p < 0.001; RHI: 73.50 vs 510.00, p < 0.001]; a similar trend was observed when FC levels of patients in histological remission were compared to those of patients with histological activity [GS: 76.00 vs 228.00, p < 0.001; RHI: 73.50 vs 467.00, p < 0.001]. FC levels allowed us to exclude the absence of histological remission [according to RHI] and absence of histological response [according to RHI and GS], with negative predictive values varying from 82% to 96%. However, optimization of the FC cut-off to exclude the absence of histological remission, as for the continuous GS, falls within values that resemble those of the healthy population. CONCLUSION The continuous GS and RHI histological scores are strongly correlated in their definitions of histological response. An absence of histological remission could only be excluded at physiological levels of FC.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.,Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joanne Lopes
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Paula Borralho
- Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Susana Lopes
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - Helena Tavares de Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve - Portimão Unit, Portimão, Portugal.,ABC - Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Marta Salgado
- Department of Gastroenterology, Centro Hospitalar do Porto, Hospital de Santo António, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Ana Isabel Vieira
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Figueiredo
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Paulo Caldeira
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - A Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - Maria A Duarte
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - Filipa Ávila
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - João Silva
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisbon, Portugal
| | - Sofia Mendes
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sílvia Giestas
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Raquel Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Bruno Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Ana Oliveira
- Department of Gastroenterology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Cristina Chagas
- Department of Gastroenterology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Marilia Cravo
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mafalda Santiago
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Fátima Carneiro
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), University of Porto, Porto, Portugal
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11
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Magro F, Lopes J, Borralho P, Lopes S, Coelho R, Cotter J, Castro FDD, Sousa HTD, Salgado M, Andrade P, Vieira AI, Figueiredo P, Caldeira P, Sousa A, Duarte MA, Ávila F, Silva J, Moleiro J, Mendes S, Giestas S, Ministro P, Sousa P, Gonçalves R, Gonçalves B, Oliveira A, Rosa I, Rodrigues M, Chagas C, Dias CC, Afonso J, Geboes K, Carneiro F. Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels. Gut 2019; 68:594-603. [PMID: 29437913 DOI: 10.1136/gutjnl-2017-315545] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Histological remission is being increasingly acknowledged as a therapeutic endpoint in patients with UC. The work hereafter described aimed to evaluate the concordance between three histological classification systems-Geboes Score (GS), Nancy Index (NI) and RobartsHistopathologyIndex (RHI), as well as to evaluate their association with the endoscopic outcomes and the faecal calprotectin (FC) levels. DESIGN Biopsy samples from 377 patients with UC were blindly evaluated using GS, NI and RHI. The results were compared with the patients' Mayo Endoscopic Score and FC levels. RESULT GS, NI and RHI have a good concordance concerning the distinction between patients in histological remission or activity. RHI was particularly close to NI, with 100% of all patients classified as being in remission with NI being identified as such with RHI and 100% of all patients classified as having activity with RHI being identified as such with NI. These scores could also predict the Mayo Endoscopic Score and the FC levels, with their sensitivity and specificity levels depending on the chosen cut-offs. Moreover, higher FC levels were statistically associated with the presence of neutrophils in the epithelium, as well as with ulceration or erosion of the intestinal mucosa. CONCLUSIONS GS, NI and RHI histopathological scoring systems are comparable in what concerns patients' stratification into histological remission/activity. Additionally, FC levels are increased when neutrophils are present in the epithelium and the intestinal mucosa has erosions or ulcers. The presence of neutrophils in the epithelium is, indeed, the main marker of histological activity.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.,Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joanne Lopes
- Department of Pathology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Paula Borralho
- Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Susana Lopes
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - Helena Tavares de Sousa
- Department of Gastroenterology, Centro Hospitalar e Universitário do Algarve-Portimão Unit, Portimão, Portugal.,Department of Medicine and Medical Biosciences, University of Algarve, Faro, Portugal
| | - Marta Salgado
- Department of Gastroenterology, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Ana Isabel Vieira
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Figueiredo
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Paulo Caldeira
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - A Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - Maria A Duarte
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - Filipa Ávila
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - João Silva
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
| | - Sofia Mendes
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sílvia Giestas
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Raquel Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Bruno Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Ana Oliveira
- Department of Gastroenterology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
| | - Marta Rodrigues
- Department of Pathology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Cristina Chagas
- Department of Gastroenterology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS- Centre for Health Technology and Services Research, Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Fátima Carneiro
- Department of Pathology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Instituto de Investigação e Inovação na Saúde (I3S), University of Porto, Porto, Portugal
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Saraiva S, Cortez-Pinto J, Barosa R, Castela J, Moleiro J, Rosa I, da Siva JP, Dias Pereira A. Evaluation of fatigue in inflammatory bowel disease - a useful tool in daily practice. Scand J Gastroenterol 2019; 54:465-470. [PMID: 31012338 DOI: 10.1080/00365521.2019.1602669] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Fatigue is a common symptom reported in inflammatory bowel disease (IBD) patients. It can be severe and modify the self-perception of disease. Objective: To evaluate the contribution of clinical and demographic factors to the level of fatigue in IBD patients. Methods: Patients consecutively observed in an outpatient IBD clinic during a 9-month period were studied. Demographic and clinical data were collected. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). A FACIT-F score <30 was considered as severe fatigue. Results: One hundred and five patients were evaluated. Of them, 57.1% had Crohn´s Disease (CD) and 42.9% had Ulcerative Colitis. Also 85.0% and 77.8% were in clinical remission, respectively. The mean FACIT-F score was 39.63 ± 9.67. Severe fatigue was observed in 17.1% of patients. Female gender and active CD were significantly associated with a severe level of fatigue (p = .05 and p = .04). There was no significant correlation between the level of fatigue (severe vs. non-severe) and type of IBD, hemoglobin, C-reactive protein, ferritin levels or previous surgeries. Patients under biological therapy had a significantly higher level of fatigue and a higher rate of previous hospitalizations (p = .02). Conclusions: Fatigue level is a simple and useful tool to evaluate the disease's impact in patients' life, and it should, therefore, be included in clinical practice. Biological therapy was associated to higher levels of fatigue. Future studies should evaluate the impact of therapy on the level of fatigue.
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Affiliation(s)
- Sofia Saraiva
- a Department of Gastroenterology , Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG) , Lisbon , Portugal
| | - João Cortez-Pinto
- a Department of Gastroenterology , Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG) , Lisbon , Portugal
| | - Rita Barosa
- b Department of Gastroenterology , Hospital Garcia de Orta , Almada , Portugal
| | - Joana Castela
- a Department of Gastroenterology , Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG) , Lisbon , Portugal
| | - Joana Moleiro
- a Department of Gastroenterology , Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG) , Lisbon , Portugal
| | - Isadora Rosa
- a Department of Gastroenterology , Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG) , Lisbon , Portugal
| | - João Pereira da Siva
- a Department of Gastroenterology , Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG) , Lisbon , Portugal
| | - António Dias Pereira
- a Department of Gastroenterology , Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E. (IPOLFG) , Lisbon , Portugal
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13
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Castela J, Mão de Ferro S, Rosa I, Lage P, Ferreira S, Pereira Silva J, Cortez Pinto J, Vale Rodrigues R, Moleiro J, Claro I, Esteves S, Dias Pereira A. Real-Time Optical Diagnosis of Colorectal Polyps in the Routine Clinical Practice Using the NICE and WASP Classifications in a Nonacademic Setting. GE Port J Gastroenterol 2019; 26:314-323. [PMID: 31559322 DOI: 10.1159/000495258] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/02/2018] [Indexed: 01/01/2023]
Abstract
Background Narrow-band imaging (NBI) allows "in vivo" classification of colorectal polyps. Objectives We evaluated the optical diagnosis by nonexpert community-based endoscopists in routine clinical practice, the impact of training, and whether the endoscopists could achieve the threshold for the "do not resect" policy. Methods This was an observational study performed in two periods (P1 and P2). Endoscopists had no prior experience in NBI in P1 and applied the technique on a daily basis for 1 year before participation in P2. Lesions were classified by applying the NBI International Colorectal Endoscopic (NICE) and Workgroup serrAted polypS and Polyposis (WASP) classifications, simultaneously. Results A total of 290 polyps were analyzed. The overall accuracy of optical diagnosis was 0.75 (95% CI 0.68-0.81) in P1, with an increase to 0.82 (95% CI 0.73-0.89) in P2 (p = 0.260). The accuracy of the NICE/WASP classifications to differentiate adenomatous from nonadenomatous histology was 0.78 (95% CI 0.72-0.84) in P1 and 0.86 (95% CI 0.77-0.92) in P2 (p = 0.164); assignments made with a high confidence level achieved statistical significance (13% improvement, 95% CI 3-22%; p = 0.022). The negative predictive value for adenomatous histology of diminutive rectosigmoid polyps was 81% (95% CI 64-93%) and 80% (95% CI 59-93%) in P1 and P2, respectively. Conclusions Nonexpert endoscopists achieved moderate accuracy for real-time optical diagnosis of colorectal lesions with the NICE/WASP classifications. The overall performance of the endoscopists improved after sustained use of optical diagnosis, but did not achieve the standards for the implementation of the "do not resect" strategy.
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Affiliation(s)
- Joana Castela
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Susana Mão de Ferro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Pedro Lage
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Sara Ferreira
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - João Pereira Silva
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - João Cortez Pinto
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Rita Vale Rodrigues
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Isabel Claro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Susana Esteves
- Clinical Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - António Dias Pereira
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
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14
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Moleiro J, Mão de Ferro S, Ferreira S, Serrano M, Silveira M, Dias Pereira A. Efficacy of Long-Term Oral Vitamin B12 Supplementation after Total Gastrectomy: Results from a Prospective Study. GE Port J Gastroenterol 2018; 25:117-122. [PMID: 29761147 PMCID: PMC5939650 DOI: 10.1159/000481860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/14/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/OBJECTIVES Vitamin B12 (VB12) deficiency is a common complication after total gastrectomy which may be associated with megaloblastic anemia and potentially irreversible neurologic symptoms. Intramuscular supplementation of VB12 has been considered the standard treatment, although it is associated with high costs and patient discomfort. PATIENTS/METHODS We performed a prospective uncontrolled study (ACTRN12614000107628) in order to evaluate the clinical and laboratory efficacy of long-term oral VB12 supplementation in patients submitted to total gastrectomy. All patients received daily oral VB12 (1 mg/day) and were evaluated every 3 months (clinical and laboratory evaluation: hemoglobin, VB12, total iron, ferritin, and folate). RESULTS A total of 26 patients were included with a mean age of 64 years (29-79). Patients were included with a mean period of 65 months (3-309) after total gastrectomy. At inclusion time, 17/26 patients were under intramuscular VB12, and 9 had not started supplementation yet. There were normal serum VB12 levels in 25/26 patients (mean VB12 serum levels: 657 pg/mL). The mean follow-up period was 20 (8.5-28) months. During follow-up, all patients had normal VB12 levels and there was no need for intramuscular supplementation. The patient with low VB12 levels had an increase to adequate levels, which remained stable. There were no differences with statistical significance among VB12 levels at 6 (867 pg/mL), 12 (1,008 pg/mL), 18 (1,018 pg/mL), and 24 (1,061 pg/mL) months. Iron and folate supplementation was necessary in 21 and 7 patients, respectively. CONCLUSIONS Oral VB12 supplementation is effective and safe in patients who underwent total gastrectomy and should be considered the preferential form of supplementation.
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Affiliation(s)
- Joana Moleiro
- Department of Gastroenterology, Instituto Portugu's do Oncologia de Lisboa Francisco Gentil E.P.E., Lisbon, Portugal
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15
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Magro F, Afonso J, Lopes S, Coelho R, Gonçalves R, Caldeira P, Lago P, de Sousa HT, Ramos J, Gonçalves AR, Ministro P, Rosa I, Vieira AI, Andrade P, Soares JB, Carvalho D, Sousa P, Meira T, Lopes J, Moleiro J, Dias CC, Falcão A, Geboes K, Carneiro F. Calprotectin and the Magnitude of Antibodies to Infliximab in Clinically-stable Ulcerative Colitis Patients are More Relevant Than Infliximab Trough Levels and Pharmacokinetics for Therapeutic Escalation. EBioMedicine 2017; 21:123-130. [PMID: 28629912 PMCID: PMC5514398 DOI: 10.1016/j.ebiom.2017.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/23/2017] [Accepted: 06/03/2017] [Indexed: 01/01/2023] Open
Abstract
Although infliximab (IFX) is an efficient therapy for ulcerative colitis (UC) patients, a considerably high rate of therapeutic failures still occurs. This study aimed at a better understanding of IFX pharmacokinetics and pharmacodynamics among clinically-asymptomatic UC patients. This was a multicentric and prospective study involving 65 UC patients in the maintenance phase of IFX therapy. There were no significant differences between patients with positive and negative clinical, endoscopic and histological outcomes concerning their IFX trough levels (TLs), area under the IFX concentration vs. time curve (AUC), clearance and antibodies to infliximab (ATI) levels. However, the need to undergo therapeutic escalation later in disease development was significantly associated with higher ATI levels (2.62μg/mL vs. 1.15μg/mL, p=0.028). Moreover, and after adjusting for disease severity, the HR (hazard ratio) for therapeutic escalation was significantly decreased for patients with an ATI concentration below 3μg/mL (HR=0.119, p=0.010), and increased for patients with fecal calprotectin (FC) level above 250μg/g (HR=9.309, p=0.018). In clinically-stable UC patients, IFX pharmacokinetic features cannot predict therapeutic response on a short-term basis. However, high levels of ATIs or FC may be indicative of a future therapeutic escalation.
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Affiliation(s)
- Fernando Magro
- Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, 4200 Porto, Portugal; Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.
| | - Joana Afonso
- MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, 4200 Porto, Portugal
| | - Susana Lopes
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Paulo Caldeira
- Gastroenterology Department, Centro Hospitalar do Algarve, Faro, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Helena Tavares de Sousa
- Gastroenterology Department, Centro Hospitalar do Algarve, Portimão, Portugal; Biomedical Sciences and Medicine Department, University of Algarve, Faro, Portugal; ABC-Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Jaime Ramos
- Gastroenterology Department, Centro Hospitalar de Lisboa, Lisboa, Portugal
| | - Ana Rita Gonçalves
- Gastroenterology Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Paula Ministro
- Gastroenterology Department, Hospital de S. Teotónio, Viseu, Portugal
| | - Isadora Rosa
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Ana Isabel Vieira
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Diana Carvalho
- Gastroenterology Department, Centro Hospitalar de Lisboa, Lisboa, Portugal
| | - Paula Sousa
- Gastroenterology Department, Hospital de S. Teotónio, Viseu, Portugal
| | - Tânia Meira
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Joanne Lopes
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Joana Moleiro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Amílcar Falcão
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; CNC - Centre for Neuroscience and Cellular Biology, Coimbra, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Fatima Carneiro
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal; Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], University of Porto, Porto, Portugal
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Moleiro J, Ilie M, Fitzgerald R. Leadership roles for women in gastroenterology: New initiatives for the new generation of gastroenterologists. United European Gastroenterol J 2017; 4:815. [PMID: 28409000 DOI: 10.1177/2050640616669653] [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] [Indexed: 11/15/2022] Open
Affiliation(s)
- Joana Moleiro
- Gastroenterology, Emergency Hospital, Bucharest, Romania
| | - Madalina Ilie
- Gastroenterology, Emergency Hospital, Bucharest, Romania.,UEG's Young Talent Group (YTG)
| | - Rebecca Fitzgerald
- Medical Research Council Cancer Unit, University of Cambridge, Cambridge, UK
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17
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Dias CC, Rodrigues PP, Coelho R, Santos PM, Fernandes S, Lago P, Caetano C, Rodrigues Â, Portela F, Oliveira A, Ministro P, Cancela E, Vieira AI, Barosa R, Cotter J, Carvalho P, Cremers I, Trabulo D, Caldeira P, Antunes A, Rosa I, Moleiro J, Peixe P, Herculano R, Gonçalves R, Gonçalves B, Sousa HT, Contente L, Morna H, Lopes S, Magro F. Erratum: Development and Validation of Risk Matrices for Crohn's Disease Outcomes in Patients Who Underwent Early Therapeutic Interventions. J Crohns Colitis 2017; 11:515. [PMID: 27927719 DOI: 10.1093/ecco-jcc/jjw207] [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] [Indexed: 02/08/2023]
Affiliation(s)
- Cláudia Camila Dias
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Pedro Pereira Rodrigues
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Hospital São João, Porto, Portugal
| | - Paula Moura Santos
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Samuel Fernandes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Cidalina Caetano
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Ângela Rodrigues
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Francisco Portela
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Oliveira
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela e Viseu, Portugal
| | - Eugénia Cancela
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela e Viseu, Portugal
| | - Ana Isabel Vieira
- Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal
| | - Rita Barosa
- Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Pedro Carvalho
- Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Isabelle Cremers
- Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital São Bernardo, Setúbal, Portugal
| | - Daniel Trabulo
- Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital São Bernardo, Setúbal, Portugal
| | - Paulo Caldeira
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.,Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Artur Antunes
- Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Isadora Rosa
- Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Joana Moleiro
- Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Paula Peixe
- Gastroenterology Department, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal
| | - Rita Herculano
- Gastroenterology Department, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal
| | | | - Bruno Gonçalves
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Helena Tavares Sousa
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.,Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Luís Contente
- Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Henrique Morna
- Gastroenterology Department, Hospital Nélio Mendonça, Funchal, Portugal
| | - Susana Lopes
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fernando Magro
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,Institute of Pharmacology and Therapeutics Faculty of Medicine of the University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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18
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Dias CC, Rodrigues PP, Coelho R, Santos PM, Fernandes S, Lago P, Caetano C, Rodrigues Â, Portela F, Oliveira A, Ministro P, Cancela E, Vieira AI, Barosa R, Cotter J, Carvalho P, Cremers I, Trabulo D, Caldeira P, Antunes A, Rosa I, Moleiro J, Peixe P, Herculano R, Gonçalves R, Gonçalves B, Sousa HT, Contente L, Morna H, Lopes S, Magro F. Development and Validation of Risk Matrices for Crohn's Disease Outcomes in Patients Who Underwent Early Therapeutic Interventions. J Crohns Colitis 2017; 11:445-453. [PMID: 27683799 DOI: 10.1093/ecco-jcc/jjw171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/21/2016] [Accepted: 09/22/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The establishment of prognostic models for Crohn's disease [CD] is highly desirable, as they have the potential to guide physicians in the decision-making process concerning therapeutic choices, thus improving patients' health and quality of life. Our aim was to derive models for disabling CD and reoperation based solely on clinical/demographic data. METHODS A multicentric and retrospectively enrolled cohort of CD patients, subject to early surgery or immunosuppression, was analysed in order to build Bayesian network models and risk matrices. The final results were validated internally and with a multicentric and prospectively enrolled cohort. RESULTS The derivation cohort included a total of 489 CD patients [64% with disabling disease and 18% who needed reoperation], while the validation cohort included 129 CD patients with similar outcome proportions. The Bayesian models achieved an area under the curve of 78% for disabling disease and 86% for reoperation. Age at diagnosis, perianal disease, disease aggressiveness and early therapeutic decisions were found to be significant factors, and were used to construct user-friendly matrices depicting the probability of each outcome in patients with various combinations of these factors. The matrices exhibit good performance for the most important criteria: disabling disease positive post-test odds = 8.00 [2.72-23.44] and reoperation negative post-test odds = 0.02 [0.00-0.11]. CONCLUSIONS Clinical and demographical risk factors for disabling CD and reoperation were determined and their impact was quantified by means of risk matrices, which are applicable as bedside clinical tools that can help physicians during therapeutic decisions in early disease management.
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Affiliation(s)
- Cláudia Camila Dias
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Pedro Pereira Rodrigues
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Hospital São João, Porto, Portugal
| | - Paula Moura Santos
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Samuel Fernandes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Cidalina Caetano
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Ângela Rodrigues
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Francisco Portela
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Oliveira
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela e Viseu, Portugal
| | - Eugénia Cancela
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela e Viseu, Portugal
| | - Ana Isabel Vieira
- Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal
| | - Rita Barosa
- Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Pedro Carvalho
- Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Isabelle Cremers
- Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital São Bernardo, Setúbal, Portugal
| | - Daniel Trabulo
- Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital São Bernardo, Setúbal, Portugal
| | - Paulo Caldeira
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.,Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Artur Antunes
- Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Isadora Rosa
- Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Joana Moleiro
- Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Paula Peixe
- Gastroenterology Department, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal
| | - Rita Herculano
- Gastroenterology Department, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal
| | | | - Bruno Gonçalves
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Helena Tavares Sousa
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.,Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Luís Contente
- Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Henrique Morna
- Gastroenterology Department, Hospital Nélio Mendonça, Funchal, Portugal
| | - Susana Lopes
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fernando Magro
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,Institute of Pharmacology and Therapeutics Faculty of Medicine of the University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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19
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Magro F, Lopes S, Coelho R, Cotter J, Dias de Castro F, Tavares de Sousa H, Salgado M, Andrade P, Vieira AI, Figueiredo P, Caldeira P, Sousa A, Duarte MA, Ávila F, Silva J, Moleiro J, Mendes S, Giestas S, Ministro P, Sousa P, Gonçalves R, Gonçalves B, Oliveira A, Chagas C, Torres J, Dias CC, Lopes J, Borralho P, Afonso J, Geboes K, Carneiro F. Accuracy of Faecal Calprotectin and Neutrophil Gelatinase B-associated Lipocalin in Evaluating Subclinical Inflammation in UlceRaTIVE Colitis-the ACERTIVE study. J Crohns Colitis 2017; 11:435-444. [PMID: 27664275 DOI: 10.1093/ecco-jcc/jjw170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/20/2016] [Accepted: 09/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B-associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients. METHODS This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers. RESULTS Macroscopic lesions [i.e. endoscopic Mayo score ≥1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of Severity. Moreover, 21% presented with histological inflammation according to the Geboes index, whereas 15% and 5% presented with focal and diffuse basal plasmacytosis, respectively. The faecal levels of calprotectin and neutrophil gelatinase B-associated lipocalin were statistically higher for patients with endoscopic lesions and histological activity. A receiver operating characteristic-based analysis revealed that both biomarkers were able to indicate mucosal healing and histological remission with an acceptable probability, and cut-off levels of 150-250 μg/g for faecal calprotectin and 12 μg/g for neutrophil gelatinase B-associated lipocalin were proposed. CONCLUSIONS Faecal calprotectin and neutrophil gelatinase B-associated lipocalin levels are a valuable addition for assessment of disease activity in asymptomatic ulcerative colitis patients. Biological levels of the analysed biomarkers below the proposed thresholds can rule out the presence of macroscopic and microscopic lesions with a probability of 75-93%. However, caution should be applied whenever interpreting positive results, as these biomarkers present consistently low positive predictive values.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.,Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Susana Lopes
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - Helena Tavares de Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve - Portimão Unit, Portimão, Portugal.,Departament of Medicine and Medical Biosciences, University of Algarve, Faro, Portugal
| | - Marta Salgado
- Department of Gastroenterology, Centro Hospitalar do Porto, Hospital de Santo António, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Ana Isabel Vieira
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Figueiredo
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Paulo Caldeira
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - A Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - Maria A Duarte
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - Filipa Ávila
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - João Silva
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
| | - Sofia Mendes
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sílvia Giestas
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Raquel Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Bruno Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Ana Oliveira
- Department of Gastroenterology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Cristina Chagas
- Department of Gastroenterology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Joana Torres
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Cláudia Camila Dias
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS, Center for Health Technology and Services Research, Porto, Portugal
| | - Joanne Lopes
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Paula Borralho
- Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joana Afonso
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Fátima Carneiro
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], University of Porto, Porto, Portugal
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20
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Moleiro J. UEG Visiting Fellowship Programme - my experience with the Visiting Fellowship for Clinicians Award. United European Gastroenterol J 2016; 4:719. [PMID: 27733917 DOI: 10.1177/2050640616669650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Joana Moleiro
- Fellowship ProgrammeGastroenterology DepartmentInstituto Português de Oncologia de LisboaRua Professor Luís Reis Santos, Bloco 73A1600‐640LisbonPortugal
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21
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Ferreira AO, Moleiro J, Torres J, Dinis-Ribeiro M. Solutions for submucosal injection in endoscopic resection: a systematic review and meta-analysis. Endosc Int Open 2016; 4:E1-E16. [PMID: 26793777 PMCID: PMC4713187 DOI: 10.1055/s-0034-1393079] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 08/11/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Submucosal injection is standard practice in endoscopic mucosal resection of gastrointestinal lesions. Several solutions are used. Our aim was to systematically review their efficacy and safety. PATIENTS AND METHODS We performed a systematic review and meta-analysis using a random effects model of randomized controlled trials (RCTs) from MEDLINE. Studies in animal models were qualitatively assessed for efficacy and safety. RESULTS In total, 54 studies were qualitatively assessed. Eleven RCTs were analyzed, two of which were on endoscopic submucosal dissection (ESD). The quantitative synthesis included nine RCTs on endoscopic mucosal resection (EMR), comprising 792 subjects and 793 lesions. Mean lesion size was 20.9 mm (range 8.5 - 46 mm). A total of 209 lesions were randomized to sodium hyaluronate (SH) vs normal saline (NS), 72 to 50 % dextrose (D50) vs NS, 82 to D50 vs SH, 43 to succinylated gelatin, 25 to hydroxyethyl starch and 36 to fibrinogen. In total, 385 were randomized to NS as controls. NS and SH are the best studied solutions and seem to be equally effective in achieving complete resection (OR 1.09; 95 %CI 0.82, 1.45). No solution was proven to be superior in complete resection rate, post-polypectomy bleeding or coagulation syndrome/perforation incidence. Many solutions have been tested in animal studies and most seem more effective for mucosal elevation than NS. CONCLUSIONS There are several solutions in clinical use and many more under research, but most are poorly studied. SH seems to be clinically equivalent to NS. There are no significant differences in post-polypectomy complications. Larger RCTs are needed to determine any small differences that may exist between solutions.
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Affiliation(s)
- Alexandre Oliveira Ferreira
- Department of Gastroenterology, Hospital Beatriz Ângelo, Lisboa, Portugal
- Corresponding author Alexandre Oliveira Ferreira, MD Hospital Beatriz ÂngeloDepartment of GastroenterologyAvenida Carlos Teixeira 32674-514 LouresPortugal+351-21-9847209
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
| | - Joana Torres
- Department of Gastroenterology, Hospital Beatriz Ângelo, Lisboa, Portugal
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Instituto Português do Oncologia do Porto, Porto, Portugal
- CIDES/CINTESIS, Faculty of Medicine – University of Porto, Porto, Portugal
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Moleiro J, Ferreira S, Lage P, Dias Pereira A. Gastric malt lymphoma: Analysis of a series of consecutive patients over 20 years. United European Gastroenterol J 2015; 4:395-402. [PMID: 27403306 DOI: 10.1177/2050640615612934] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 07/27/2015] [Accepted: 09/28/2015] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION AND AIMS Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is closely associated with Helicobacter pylori (HP) infection. Our aim was to evaluate demographic, clinical and endoscopic characteristics of gastric MALT lymphoma patients, as well as to analyse response to treatment and factors that affect complete remission (CR) and relapse. We also assessed the long-term prognosis. METHODS The study involved a retrospective evaluation of consecutive patients admitted with gastric MALT lymphoma (1993-2013). RESULTS A total of 144 patients (76 men; mean age 56) were included. At stage EI, 94/103 patients (92%) received HP eradication and 78 (83%) achieved CR after a mean period of 7 months (2-63 months) and 67 (86%) remained in CR after a mean follow-up time of 105 months. HP infection status (p = 0.004) and lymphoma localisation to the antrum plus body (p = 0.016) were associated with higher and lower CR rates, respectively. Relapse occurred in 11/78 (14%) patients after a mean period of 21 months. The absence of HP re-infection (p = 0.038), the need of only one eradication regimen (p = 0.009) and antrum lymphomas (p = 0.031) correlated with lower relapse rates. At stage EII, HP eradication was performed in 17/24 patients but only five experienced CR (30%). Among 16 patients diagnosed at stage EIV, nine achieved CR after chemotherapy ± surgery and 3/7 without remission died due to disease progression. The 5- and 10-year overall disease free survival rates were 90.5% and 79.1%, respectively. CONCLUSIONS Most patients were diagnosed at an early stage. Eradication therapy was highly effective in inducing complete remission. Long-term evaluation showed that the long-term prognosis was very favourable.
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Affiliation(s)
- Joana Moleiro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Portugal
| | - Sara Ferreira
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Portugal
| | - Pedro Lage
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Portugal
| | - A Dias Pereira
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Portugal
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Areia M, Alves S, Brito D, Cadime AT, Carvalho R, Saraiva S, Ferreira S, Moleiro J, Pereira AD, Carrasquinho J, Lopes L, Ramada J, Marcos-Pinto R, Pedroto I, Contente L, Eliseu L, Vieira AM, Sampaio M, Sousa HT, Almeida N, Gregório C, Portela F, Sofia C, Braga V, Baginha E, Bana e Costa T, Chagas C, Mendes LL, Magalhães-Costa P, Matos L, Gonçalves FR, Dinis-Ribeiro M. Health-related quality of life and utilities in gastric premalignant conditions and malignant lesions: a multicentre study in a high prevalence country. J Gastrointestin Liver Dis 2015; 23:371-8. [PMID: 25531994 DOI: 10.15403/jgld.2014.1121.234.hrq] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS A recent review of economic studies relating to gastric cancer revealed that authors use different tests to estimate utilities in patients with and without gastric cancer. Our aim was to determine the utilities of gastric premalignant conditions and adenocarcinoma with a single standardized health measure instrument. METHODS Cross-sectional nationwide study of patients undergoing upper endoscopy (n=1,434) using the EQ-5D-5L quality of life (QoL) questionnaire. RESULTS According to EQ-5D-5L, utilities in individuals without gastric lesions were 0.78 (95% confidence interval: 0.76-0.80), with gastric premalignant conditions 0.79 (0.77-0.81), previously treated for gastric cancer 0.77 (0.73-0.81) and with present cancer 0.68 (0.55-0.81). Self-reported QoL according to the visual analogue scale (VAS) for the same groups were 0.67 (0.66-0.69), 0.67 (0.66-0.69), 0.62 (0.59-0.65) and 0.62 (0.54-0.70) respectively. Utilities were consistently lower in women versus men (no lesions 0.71 vs. 0.78; premalignant conditions 0.70 vs. 0.82; treated for cancer 0.72 vs. 0.78 and present cancer 0.66 vs. 0.70). CONCLUSION The health-related QoL utilities of patients with premalignant conditions are similar to those without gastric diseases whereas patients with present cancer show decreased utilities. Moreover, women had consistently lower utilities than men. These results confirm that the use of a single standardized instrument such as the EQ-5D-5L for all stages of the gastric carcinogenesis cascade is feasible and that it captures differences between conditions and gender dissimilarities, being relevant information for authors pretending to conduct further cost-utility analysis.
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Affiliation(s)
- Miguel Areia
- Center for Research in Health Technologies and Information Systems, Faculty of Medicine,Porto University; Gastroenterology Dept., Portuguese Oncology Institute of Coimbra,Portugal.
| | - Susana Alves
- Gastroenterology Dept., Portuguese Oncology Institute of Coimbra, Portugal
| | - Daniel Brito
- Gastroenterology Dept., Portuguese Oncology Institute of Coimbra, Portugal
| | - Ana Teresa Cadime
- Gastroenterology Dept., Portuguese Oncology Institute of Coimbra, Portugal
| | - Rita Carvalho
- Gastroenterology Dept., Portuguese Oncology Institute of Coimbra, Portugal
| | - Sandra Saraiva
- Gastroenterology Dept., Portuguese Oncology Institute of Coimbra, Portugal
| | - Sara Ferreira
- Gastroenterology Dept., Portuguese Oncology Institute of Lisbon, Portugal
| | - Joana Moleiro
- Gastroenterology Dept., Portuguese Oncology Institute of Lisbon, Portugal
| | | | - João Carrasquinho
- Gastroenterology Dept., Santa Luzia Hospital - Viana do Castelo (Local Health Unit of Alto Minho), Portugal
| | - Luís Lopes
- Gastroenterology Dept., Santa Luzia Hospital - Viana do Castelo (Local Health Unit of Alto Minho), Portugal
| | - José Ramada
- Gastroenterology Dept., Santa Luzia Hospital - Viana do Castelo (Local Health Unit of Alto Minho), Portugal
| | - Ricardo Marcos-Pinto
- Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University; Gastroenterology Dept., Santo António General Hospital, Hospital Centre of Porto; Institute of Biomedical Sciences Abel Salazar, University of Porto, Portugal
| | - Isabel Pedroto
- Gastroenterology Dept., Santo António General Hospital, Hospital Centre of Porto; Institute of Biomedical Sciences Abel Salazar,University of Porto, Portugal
| | - Luís Contente
- Gastroenterology Dept., Hospital Unit of Portimão (Hospital Center of Western Algarve), Portugal
| | - Liliana Eliseu
- Gastroenterology Dept., Hospital Unit of Portimão (Hospital Center of Western Algarve), Portugal
| | - Ana Margarida Vieira
- Gastroenterology Dept., Hospital Unit of Portimão (Hospital Center of Western Algarve), Portugal
| | - Margarida Sampaio
- Gastroenterology Dept., Hospital Unit of Portimão (Hospital Center of Western Algarve), Portugal
| | - Helena Tavares Sousa
- Gastroenterology Dept., Hospital Unit of Portimão (Hospital Center of Western Algarve), Portugal
| | - Nuno Almeida
- Gastroenterology Dept., Coimbra University Hospital Center; Portugal
| | - Carlos Gregório
- Gastroenterology Dept., Coimbra University Hospital Center; Portugal
| | - Francisco Portela
- Gastroenterology Dept., Coimbra University Hospital Center; Portugal
| | - Carlos Sofia
- Gastroenterology Dept., Coimbra University Hospital Center; Portugal
| | - Vânia Braga
- Gastroenterology Dept., Portuguese Oncology Institute of Porto, Portugal
| | - Elisabete Baginha
- Gastroenterology Dept., West Lisbon Hospital Centre, Lisbon, Portugal
| | | | - Cristina Chagas
- Gastroenterology Dept., West Lisbon Hospital Centre, Lisbon, Portugal
| | - Luís Lebre Mendes
- Gastroenterology Dept., West Lisbon Hospital Centre, Lisbon, Portugal
| | | | - Leopoldo Matos
- Gastroenterology Dept., West Lisbon Hospital Centre, Lisbon, Portugal
| | - Francisco Rocha Gonçalves
- Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University; Gastroenterology Dept., Portuguese Oncology Institute of Porto, Portugal
| | - Mário Dinis-Ribeiro
- Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University; Gastroenterology Dept., Portuguese Oncology Institute of Porto, Portugal
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Moleiro J, Mão de Ferro S, Ferreira S. Parasitose intestinal: causa rara de hemorragia digestiva. GE Portuguese Journal of Gastroenterology 2014; 21:261-262. [DOI: 10.1016/j.jpge.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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