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Iacucci M, Bonovas S, Bazarova A, Cannatelli R, Ingram RJM, Labarile N, Nardone OM, Parigi TL, Piovani D, Siau K, Smith SCL, Zammarchi I, Ferraz JGP, Fiorino G, Kiesslich R, Panaccione R, Parra-Blanco A, Principi M, Tontini GE, Uraoka T, Ghosh S. Validation of a new optical diagnosis training module to improve dysplasia characterization in inflammatory bowel disease: a multicenter international study. Gastrointest Endosc 2024; 99:756-766.e4. [PMID: 37993058 DOI: 10.1016/j.gie.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/24/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) increases risk of dysplasia and colorectal cancer. Advanced endoscopic techniques allow for the detection and characterization of IBD dysplastic lesions, but specialized training is not widely available. We aimed to develop and validate an online training platform to improve the detection and characterization of colonic lesions in IBD: OPtical diagnosis Training to Improve dysplasia Characterization in Inflammatory Bowel Disease (OPTIC-IBD). METHODS We designed a web-based learning module that includes surveillance principles, optical diagnostic methods, approach to characterization, and classifications of colonic lesions using still images and videos. We invited gastroenterologists from Canada, Italy, and the United Kingdom with a wide range of experience. Participants reviewed 24 educational videos of IBD colonic lesions, predicted histology, and rated their confidence. The primary endpoint was to improve accuracy in detecting dysplastic lesions after training on the platform. Furthermore, participants were randomized 1:1 to get additional training or not, with a final assessment occurring after 60 days. Diagnostic performance for dysplasia and rater confidence were measured. RESULTS A total of 117 participants completed the study and were assessed for the primary endpoint. Diagnostic accuracy improved from 70.8% to 75.0% (P = .002) after training, with the greatest improvements seen in less experienced endoscopists. Improvements in both accuracy and confidence were sustained after 2 months of assessment, although the group randomized to receive additional training did not improve further. Similarly, participants' confidence in characterizing lesions significantly improved between before and after the course (P < .001), and it was sustained after 2 months of assessment. CONCLUSIONS The OPTIC-IBD training module demonstrated that an online platform could improve participants' accuracy and confidence in the optical diagnosis of dysplasia in patients with IBD. The training platform can be widely available and improve endoscopic care for people with IBD. (Clinical trial registration number: NCT04924543.).
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Affiliation(s)
- Marietta Iacucci
- University of Birmingham, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom; College of Medicine and Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, Cork, Ireland; Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alina Bazarova
- Forschungszentrum Jülich, Jülich Supercomputing Center, Jülich, Germany; Helmholtz AI, Germany
| | - Rosanna Cannatelli
- University of Birmingham, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom; Department of Biochemical and Clinical Sciences "L Sacco," University of Milan ASST Fatebenefratelli Sacco, Milano, Italy
| | - Richard J M Ingram
- University of Birmingham, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom; Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nunzia Labarile
- National Institute of Gastroenterology, IRCSS "Saverio De Bellis", Castellana Grotte, Italy
| | - Olga Maria Nardone
- University of Birmingham, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom; Gastroenterology, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Tommaso Lorenzo Parigi
- University of Birmingham, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom; Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - Samuel C L Smith
- University of Birmingham, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | - Irene Zammarchi
- College of Medicine and Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, Cork, Ireland
| | - Jose G P Ferraz
- Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Gionata Fiorino
- Department of Gastroenterology and Digestive Endoscopy, IRCCS San Raffaele Hospital, Milan Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Ralph Kiesslich
- Helios Horst-Schmidt-Kliniken Hospital, Division of Gastroenterology, Wiesbaden, Germany
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Adolfo Parra-Blanco
- Department of Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Mariabeatrice Principi
- Gastroenterology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari, Italy
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy; Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Subrata Ghosh
- College of Medicine and Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, Cork, Ireland
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Bergamaschi G, Castiglione F, D'Incà R, Astegiano M, Fries W, Milla M, Ciacci C, Rizzello F, Saibeni S, Ciccocioppo R, Orlando A, Bossa F, Principi M, Vernia P, Ricci C, Scribano ML, Bodini G, Mazzucco D, Bassotti G, Riegler G, Buda A, Neri M, Caprioli F, Monica F, Manca A, Villa E, Fiorino G, Aronico N, Lenti MV, Mengoli C, Testa A, Vecchi M, Klersy C, Di Sabatino A. Follow-up evaluation and management of anemia in inflammatory bowel disease: A study by the Italian Group for Inflammatory Bowel Diseases (IG-IBD). Dig Liver Dis 2024:S1590-8658(24)00193-2. [PMID: 38296690 DOI: 10.1016/j.dld.2024.01.176] [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: 11/21/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The RIDART I study found a 13.6% prevalence of anemia in Italian patients with inflammatory bowel disease (IBD); most cases were due to iron-deficiency anemia (IDA). AIMS To evaluate changes in hemoglobin concentration during a 24-week follow-up of anemic patients with IBD. METHODS Follow-up laboratory and clinical data were obtained from RIDART I study patients with anemia. Factors affecting hemoglobin concentration, the impact of anemia on fatigue and quality of life (QoL), and its relationship with treatment, disease activity and disease complications were investigated. RESULTS Hemoglobin was 108 g/L at baseline, increased to 121 g/L at follow-up week 12 (p < 0.001) and then stabilized until week 24, but most patients remained anemic, with IDA, throughout the study. Hemoglobin improvement was greater in patients receiving either oral or parenteral iron supplementation. Following hemoglobin normalization, anemia relapse rate during follow-up was 30%. Oral iron did not cause disease reactivation. Lower follow-up hemoglobin was associated with a higher probability of having active disease, clinical complications, increased fatigue and reduced QoL. CONCLUSIONS In anemic patients with IBD, anemia represents a long-lasting problem, in most cases persisting for up to 24 weeks, with high relapse rate and a negative impact on fatigue and QoL.
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Affiliation(s)
- Gaetano Bergamaschi
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy.
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80138 Naples, Italy
| | - Renata D'Incà
- Inflammatory Bowel disease Unit- AO-University of Padua, 35122 Padova, Italy
| | - Marco Astegiano
- Gastroenterology and Digestive Endoscopy Unit, "Città della Salute e della Scienza" Hospital, 10126 Torino, Italy
| | - Walter Fries
- Gastroenterology and Clinical Unit for inflammatory bowel diseases, Dept. of Clinical and Experimental Medicine; University of Messina, 98122 Messina, Italy
| | - Monica Milla
- Unità operativa complessa di Gastroenterologia clinica, Azienda ospedaliero universitaria Careggi- Firenze, 50134 Firenze, Italy
| | - Carolina Ciacci
- Gastroenterology and Endoscopy Unit, AOU San Giovanni di Dio e Ruggi d'Aragona and University of Salerno, 84084 Salerno, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, 20017 Rho (MI), Italy
| | - Rachele Ciccocioppo
- Gastroenterology Unit, Department of Medicine, A.O.U.I. Policlinico G.B. Rossi & University of Verona, 37134 Verona, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", 90146 Palermo Italy
| | - Fabrizio Bossa
- Department of Gastroenterology and Endoscopy, Fondazione "Casa Sollievo della Sofferenza", IRCCS, 71013 San Giovanni Rotondo, Italy
| | | | - Piero Vernia
- Division of Gastroenterology, Department of Translational and Precision Medicine, "Sapienza" University of Rome and Umberto I Hospital, 00161 Rome, Italy
| | - Chiara Ricci
- Dept of Experimental and Clinical Science, University of Brescia, Gastroenterology Unit,Spedali Civili Hospital, 25123 Brescia. Italy
| | - Maria L Scribano
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; Villa Stuart, Multi-Speciality Clinic, 00135 Rome, Italy
| | - Giorgia Bodini
- Gastroenterology unit, Department of Internal medicine, Policlinico San Martino, Università di Genova, 16132 Genoa, Italy
| | - Dario Mazzucco
- Gastroenterology Unit, ASL TO3, 10097 Rivoli, Torino, Italy
| | - Gabrio Bassotti
- Gastroenterology, Hepatology & Digestive Endoscopy Section, Department of Medicine & Surgery, University of Perugia and Perugia General Hospital, 06129 Perugia, Italy
| | - Gabriele Riegler
- Unit of Gastroenterology - Reference Center for IBD - Second University of Naples, 80138 Naples, Italy
| | - Andrea Buda
- Department of Gastrointestinal Oncological Surgery, Gastroenterology Unit, S. Maria del Prato Hospital, 30032 Feltre, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences and Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66013 Chieti, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, 20122 Milan, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy Unit, Cattinara Academic Hospital, 34149 Trieste, Italy
| | - Aldo Manca
- Department of Gastroenterology and Digestive Endoscopy, S. Croce e Carle Hospital, 12100 Cuneo, Italy
| | - Erica Villa
- UC Gastroenterologia, Dipartimento di Specialità Mediche, Azienda Ospedaliera Universitaria di Modena, 41125 Modena, Italy
| | - Gionata Fiorino
- Department of Gastroenterology and Digestive Endoscopy, San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; IBD Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Nicola Aronico
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy
| | - Marco V Lenti
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy
| | - Caterina Mengoli
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80138 Naples, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, 20122 Milan, Italy
| | - Catherine Klersy
- Servizio di Epidemiologia Clinica & Biometria, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Antonio Di Sabatino
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy.
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Novielli D, Foti C, Principi M, Mortato E, Romita P, Dell'Aquila P, Di Leo A, Ambrogio F. Upadacitinib in concurrent Crohn's disease, atopic dermatitis and alopecia areata: A case report. J Eur Acad Dermatol Venereol 2024; 38:e8-e10. [PMID: 37478286 DOI: 10.1111/jdv.19377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023]
Affiliation(s)
- D Novielli
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - C Foti
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - M Principi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - E Mortato
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - P Romita
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - P Dell'Aquila
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - A Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - F Ambrogio
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
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4
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Andreoli L, Guadagni I, Picarelli G, Principi M. Comprehensive reproductive healthcare for women with immune-mediated inflammatory diseases: Addressing rheumatoid arthritis, spondyloarthritis and inflammatory bowel disease through life's stages. Autoimmun Rev 2023; 23:103507. [PMID: 38142899 DOI: 10.1016/j.autrev.2023.103507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
Immuno-mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis, spondyloarthritis, and inflammatory bowel disease are characterised by pathophysiological mechanisms wherein the immune system erroneously targets the body's own tissues. This review explores the heightened vulnerability of women with IMIDs, influenced by hormonal modulators like estrogen and progesterone. The challenges this poses are multifaceted, encompassing the impact of active disease and medical treatments throughout life stages, including family planning, fertility, and menopause. From the perspectives of rheumatologists and gastroenterologists, we review current management strategies and underscore the need for a multidisciplinary and life-cycle approach to healthcare for women with IMIDs.
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Affiliation(s)
- Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | | | | | - Mariabeatrice Principi
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy
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5
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Cappello M, Barbara G, Bellini M, Consalvo D, Di Sabatino A, Marasco G, Principi M, Savarino EV, Tortora A, Obici L. Identification and management of gastrointestinal manifestations of hereditary transthyretin amyloidosis: Recommendations from an Italian group of experts. Dig Liver Dis 2023:S1590-8658(23)01063-0. [PMID: 38105149 DOI: 10.1016/j.dld.2023.11.025] [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: 10/26/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
Gastrointestinal manifestations are common across all hereditary transthyretin amyloidosis (ATTRv) genotypes. However, they are poorly specific, and their recognition as part of ATTRv is difficult, resulting in misdiagnosis with more common conditions. Moreover, delays in diagnosis occur because of fragmented knowledge, a shortage of centers of excellence and specialists dedicated to ATTRv management, and the scarce involvement of gastroenterologists in multidisciplinary teams. A group of Italian gastroenterologists with experience in the management of ATTRv took part in a project aimed at assessing the awareness of ATTRv among the community of Italian gastroenterologists through an online survey and providing education about practical aspects of ATTRv management. Survey results reported low participation, and very few patients with ATTRv were cared for by gastroenterologists. This highlights the need for greater attention to rare diseases in gastroenterology and emphasizes increasing awareness of ATTRv and diagnostic suspicion. Based on the experts' recommendations, a diagnosis of ATTRv should be suspected when at least one of the 'red flags' is detected. Subsequently, it is suggested to promptly ask for genetic testing and exclude a serum and urinary monoclonal protein, even before the detection of amyloid in biopsy samples, particularly in non-endemic areas.
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Affiliation(s)
- Maria Cappello
- Gastroenterology and Hepatology Section, ProMiSe Department, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, via Massarenti 9, 40138, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Massimo Bellini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Danilo Consalvo
- Department of Gastroenterology and Digestive Endoscopy, AORN ``Antonio Cardarelli'', Via Antonio Cardarelli 9, 80131, Napoli, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Therapeutics, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy; First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Piazzale Golgi 19, 27100 Pavia, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, via Massarenti 9, 40138, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Mariabeatrice Principi
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari, Piazza Umberto I, 70121, Bari, Italy
| | - Edoardo Vincenzo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova, via Nicolò Giustiniani 2, 35100, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, via Nicolò Giustiniani 2, 35100, Italy
| | - Annalisa Tortora
- UOC Gastroenterologia, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale L.A. Scuro, 10, 37134 Verona VR, Italy
| | - Laura Obici
- Rare Diseases Unit and Amyloidosis Research and Treatment Centre, IRCCS San Matteo Hospital Foundation, viale Camillo Golgi 19, 27100, Pavia, Italy
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Losurdo G, De Bellis M, Rima R, Palmisano CM, Dell’Aquila P, Iannone A, Ierardi E, Di Leo A, Principi M. Small Intestinal Contrast Ultrasonography (SICUS) in Crohn's Disease: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7714. [PMID: 38137782 PMCID: PMC10744114 DOI: 10.3390/jcm12247714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
The diagnosis of Crohn's Disease (CD) is based on a combination of clinical symptoms, laboratory tests, endoscopy, and imaging data. In Small Intestine Contrast Ultrasonography (SICUS), the ingestion of a macrogol solution as an oral contrast medium may optimize image quality. We performed a meta-analysis to evaluate the diagnostic performance of SICUS for CD. A literature search was performed in August 2023. We selected only studies where SICUS was compared to a technique that allows the assessment of the whole gastrointestinal tract, such as an MRE, a CT scan, or a surgical evaluation. We estimated pooled weighted sensitivity, specificity, and likelihood ratio for positive and negative tests (PLR/NLR) of SICUS. Summary receiver operating characteristic curves (SROC) were drawn, and pooled areas under the curve (AUC) were calculated. Five studies with 325 CD patients were included. SICUS showed a pooled sensitivity for the diagnosis of 95% (95% confidence interval CI 89-99%), a specificity = 77% (95% CI 60-90%), and the AUC was 0.94. SICUS demonstrated a pooled sensitivity for strictures of 78% (95% CI 63-88%) and a specificity = 96% (95% CI 85-99%), with AUC = 0.93. For abscesses, SICUS demonstrated a pooled sensitivity of 100% (95% CI 59-100%) and a specificity of 90% (95% CI 74-98%). Fistulae were detected with a pooled sensitivity of 77% (95% CI 46-95%) and a specificity of 92% (95% CI 75-99%). SICUS demonstrated excellent diagnostic performance compared to the gold standard despite some clinical scenarios (stenosis/fistulae) showing suboptimal diagnostic effectiveness.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Margherita De Bellis
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Raffaella Rima
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Chiara Maria Palmisano
- Internal Medicine Unit “C. Frugoni”, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Paola Dell’Aquila
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy; (M.D.B.); (P.D.); (A.I.); (E.I.); (A.D.L.); (M.P.)
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7
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Macaluso FS, Principi M, Facciotti F, Contaldo A, Todeschini A, Saibeni S, Bezzio C, Castiglione F, Nardone OM, Spagnuolo R, Fantini MC, Riguccio G, Conforti S, Caprioli F, Viganò C, Felice C, Fiorino G, Correale C, Bodini G, Milla M, Scardino G, Vernero M, Desideri F, Bossa F, Guerra M, Ventimiglia M, Casà A, Rizzo G, Orlando A. Lack of Seroconversion Following COVID-19 Vaccination Is an Independent Risk Factor for SARS-CoV-2 Infection in Patients With Inflammatory Bowel Disease: Data from ESCAPE-IBD, an IG-IBD Study. Inflamm Bowel Dis 2023:izad118. [PMID: 37390400 DOI: 10.1093/ibd/izad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Indexed: 07/02/2023]
Abstract
This prospective study reported 2 key results: (1) lack of seroconversion following 2 doses of COVID-19 vaccines is an independent predictor of SARS-CoV-2 infection; (2) treatments for IBD were not associated with increased risk of SARS-CoV-2 infection.
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Affiliation(s)
| | | | - Federica Facciotti
- Istituto Europeo di Oncologia IRCCS, Dipartimento di Oncologia Sperimentale, Milan, Italy
| | - Antonella Contaldo
- Gastroenterology 2 Unit, IRCCS "S. De Bellis", Castellana Grotte, Bari, Italy
| | - Alessia Todeschini
- IBD Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Milan, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Milan, Italy
| | - Fabiana Castiglione
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - Olga Maria Nardone
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - Rocco Spagnuolo
- U.O. Gastroenterologia ed Endoscopia Digestiva, A.O.U. "Mater Domini," Catanzaro, Italy
- Dipartimento di Medicina Sperimentale e Clinica, Università "Magna Graecia" Catanzaro, Italy
| | - Massimo Claudio Fantini
- AOU Policlinico Monserrato, Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Italy
| | - Gaia Riguccio
- UOSD Malattie Infiammatorie Croniche intestinali, Ospedale Santa Maria del Prato, Feltre, Italy
| | - Simone Conforti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Carla Felice
- UOC Gastroenterologia, Ospedale Ca'Foncello, Treviso, Italy
| | - Gionata Fiorino
- Dipartimento di Gastroenterologia ed Endoscopia Digestiva, IRCCS Ospedale San Raffaele e Università Vita-Salute San Raffaele, Milano, Italia
| | - Carmen Correale
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Giorgia Bodini
- IRCCS Policlinico San Martino, Università di Genova, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Scardino
- Dipartimento di Gastroenterologia, Ospedale Valduce, Como, Italy
| | - Marta Vernero
- Gastroenterology Unit, Department of Medical Sciences, University of Pavia, Pavia, Italy
| | | | - Fabrizio Bossa
- Division of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Maria Guerra
- Division of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service; Italian Ministry of Health, Rome, Italy
| | - Angelo Casà
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Giuseppe Rizzo
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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8
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Losurdo G, Martino ML, De Bellis M, Celiberto F, Rizzi S, Principi M, Ierardi E, Iannone A, Di Leo A. Effect of Visual Booklets to Improve Bowel Preparation in Colonoscopy: Systematic Review with Meta-Analysis. J Clin Med 2023; 12:4377. [PMID: 37445412 DOI: 10.3390/jcm12134377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
An optimal bowel preparation for colonoscopy is essential to increasing the quality of the examination. Visual booklets have been proposed with conflicting results to enhance bowel preparation. A literature search was performed in March 2023 in the most important databases. Only RCTs were selected. We calculated odd ratios (OR) for dichotomous outcomes. Mean differences (MD) or standardized mean differences (SMD) were used for continuous outcomes. We estimated heterogeneity with the Chi2 and the I2 statistics. In cases of high heterogeneity, a random effect model was used. Six studies were selected, enrolling 1755 patients overall. Adequate bowel preparation was observed in 86.7% of the booklet group versus 77.5% of the control group, with an OR = 2.31 in favor of the booklet. In studies using a 4-L PEG-based preparation, no difference compared to controls was observed, while in non-PEG formulations, preparation with booklets was better than in controls (OR = 5.10, 95% CI 1.82-14.27, p = 0.002). Two studies were performed in an inpatient setting without any differences between booklets and controls, while outpatients receiving booklets had better results (OR = 7.13, 95% CI 5.39-9.45, p < 0.001). The adenoma detection rate was similar between the two groups. In conclusion, booklets are useful to improve bowel preparation. Outpatient settings and preparations not containing PEG could benefit more from booklets.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Maria Ludovica Martino
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Margherita De Bellis
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Precision Medicine Jonic Area, University "Aldo Moro" of Bari, 70124 Bari, Italy
| | - Salvatore Rizzi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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9
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Principi M, Macaluso FS, Todeschini A, Facciotti F, Contaldo A, Castiglione F, Nardone OM, Spagnuolo R, Doldo P, Riguccio G, Conforti FS, Viganò C, Ascolani M, Fiorino G, Correale C, Bodini G, Milla M, Scardino G, Vernero M, Desideri F, Caprioli F, Mannino M, Rizzo G, Orlando A. Safety, hesitancy of coronavirus disease 2019 vaccination and pandemic burden in patients with inflammatory bowel disease: data of a national study (ESCAPE-IBD). Eur J Gastroenterol Hepatol 2023; 35:629-634. [PMID: 37115976 DOI: 10.1097/meg.0000000000002550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND AND AIMS The purpose of this study was to present data on the safety of anti- severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in a cohort of inflammatory bowel disease (IBD) patients of an ongoing multicenter study (ESCAPE-IBD) sponsored by the Italian Group for the study of Inflammatory Bowel Disease (ClinicalTrials.gov Identifier: NCT04769258). METHODS Anti-SARS-CoV-2 vaccination was administrated to 809 IBD patients. Interviews were conducted to report adverse events related to vaccination. Of these 809, 346 patients were surveyed on the pandemic burden and the main reason for hesitancy in coronavirus disease 2019 vaccination. The chi-square test was used to compare categorical variables. Logistic regression was used to assess the relationship between disease-related characteristics and the onset of adverse events. RESULTS About 45% of patients had at least one side effect, following the first dose (10%), the second (15%), and both doses (19%). All the adverse events were mild and lasted only a few days. Logistic regression analysis revealed that female sex ( P < 0.001), younger age ( P = 0.001), seroconversion ( P = 0.002), and comorbidity ( P < 0.001) were significantly associated with adverse events. The survey showed that the main concerns were the possibility of adverse event (33%). Almost all patients (99%) felt safer having been vaccinated at their IBD reference center. CONCLUSION The vaccine reactions experienced in IBD patients were mostly self-limited. We found high acceptance and good safety of SARS-CoV-2 vaccination in our cohort.
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Affiliation(s)
| | | | | | - Federica Facciotti
- Dipartimento di Oncologia Sperimentale, Istituto Europeo di Oncologia IRCCS, Milan
| | | | - Fabiana Castiglione
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Napoli
| | - Olga Maria Nardone
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Napoli
| | - Rocco Spagnuolo
- Dipartimento di Medicina Sperimentale e Clinica, Università 'Magna Graecia' Catanzaro, U.O. Gastroenterologia ed Endoscopia Digestiva, A.O.U. 'Mater Domini', Catanzaro
| | - Patrizia Doldo
- Dipartimento di Medicina Sperimentale e Clinica, Università 'Magna Graecia' Catanzaro, U.O. Gastroenterologia ed Endoscopia Digestiva, A.O.U. 'Mater Domini', Catanzaro
| | - Gaia Riguccio
- UOSD Malattie Infiammatorie Croniche intestinali, Ospedale Santa Maria del Prato, Feltre
| | - Francesco Simone Conforti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan
| | - Chiara Viganò
- Department of Medicine and Surgery, Division of Gastroenterology and Center for Autoimmune Liver Diseases, University of Milano-Bicocca, Monza
| | | | - Gionata Fiorino
- Dipartimento di Gastroenterologia ed Endoscopia Digestiva, IRCCS Ospedale San Raffaele e Università Vita-Salute San Raffaele, Milano
| | | | - Giorgia Bodini
- IRCCS Policlinico San Martino, Università di Genova, Genoa
| | - Monica Milla
- IBD Referral Center, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence
| | | | - Marta Vernero
- Department of Medical Sciences, Gastroenterology Unit, University of Pavia, Pavia
| | | | - Flavio Caprioli
- Department of Medicine and Surgery, Division of Gastroenterology and Center for Autoimmune Liver Diseases, University of Milano-Bicocca, Monza
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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10
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Macaluso FS, Principi M, Facciotti F, Contaldo A, Todeschini A, Saibeni S, Bezzio C, Castiglione F, Nardone OM, Spagnuolo R, Fantini MC, Riguccio G, Caprioli F, Viganò C, Felice C, Fiorino G, Correale C, Bodini G, Milla M, Scardino G, Vernero M, Desideri F, Mannino M, Rizzo G, Orlando A. Reduced humoral response to two doses of COVID-19 vaccine in patients with inflammatory bowel disease: Data from ESCAPE-IBD, an IG-IBD study. Dig Liver Dis 2023; 55:154-159. [PMID: 36127228 PMCID: PMC9420701 DOI: 10.1016/j.dld.2022.08.027] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients on immunosuppressive drugs have been excluded from COVID-19 vaccines trials, creating concerns regarding their efficacy. AIMS To explore the humoral response to COVID-19 vaccines in patients with inflammatory bowel disease (IBD) METHODS: Effectiveness and Safety of COVID-19 Vaccine in Patients with Inflammatory Bowel Disease (IBD) Treated with Immunomodulatory or Biological Drugs (ESCAPE-IBD) is a prospective, multicentre study promoted by the Italian Group for the study of Inflammatory Bowel Disease. We present data on serological response eight weeks after the second dose of COVID-19 vaccination in IBD patients and healthy controls (HCs). RESULTS 1076 patients with IBD and 1126 HCs were analyzed. Seropositivity for anti-SARS-CoV-2 IgG was reported for most IBD patients, even if with a lesser rate compared with HCs (92.1% vs. 97.9%; p<0.001). HCs had higher antibody concentrations (median OD 8.72 [IQR 5.2-14-2]) compared to the whole cohort of IBD patients (median OD 1.54 [IQR 0.8-3.6]; p<0.001) and the subgroup of IBD patients (n=280) without any treatment or on aminosalicylates only (median OD 1.72 [IQR 1.0-4.1]; p<0.001). CONCLUSIONS Although most IBD patients showed seropositivity after COVID-19 vaccines, the magnitude of the humoral response was significantly lower than in HCs. Differently from other studies, these findings seem to be mostly unrelated to the use of immune-modifying treatments (ClinicalTrials.govID:NCT04769258).
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Affiliation(s)
| | | | - Federica Facciotti
- Department of Experimental Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Antonella Contaldo
- Gastroenterology 2 Unit, IRCCS "S. De Bellis", Castellana Grotte, Bari, Italy
| | | | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Milan, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Milan, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Olga Maria Nardone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rocco Spagnuolo
- Gastroenterology and Endoscopy Unit, "Mater Domini" University Hospital, Catanzaro, Italy; Department of Experimental Medicine and Clinic, "Magna Graecia" University, Catanzaro, Italy
| | - Massimo Claudio Fantini
- Policlinico Monserrato University Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Gaia Riguccio
- IBD Unit, "Santa Maria del Prato" Hospital, Feltre, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Carla Felice
- GastroenterologY Unit, "Ca'Foncello" Hospital, Treviso, Italy
| | - Gionata Fiorino
- Department of Gastroenterology and Endoscopy, IRCCS "San Raffaele" Hospital and "Università Vita-Salute San Raffaele", Milan, Italia
| | - Carmen Correale
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Giorgia Bodini
- IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Unit, University Hospital "Careggi", Florence, Italy
| | - Giulia Scardino
- Gastroenterology Department, "Valduce" Hospital, Como, Italy
| | - Marta Vernero
- Gastroenterology Unit, Department of Medical Sciences, University of Pavia, Pavia, Italy
| | | | | | - Giuseppe Rizzo
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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11
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Bergamaschi G, Castiglione F, D'Incà R, Astegiano M, Fries W, Milla M, Ciacci C, Rizzello F, Saibeni S, Ciccocioppo R, Orlando A, Bossa F, Principi M, Vernia P, Ricci C, Scribano ML, Bodini G, Mazzucco D, Bassotti G, Riegler G, Buda A, Neri M, Caprioli F, Monica F, Manca A, Villa E, Fiorino G, Comberlato M, Aronico N, Della Corte C, Caccaro R, Gionchetti P, Giuffrida P, Iovino P, Lenti MV, Mengoli C, Pellegrini L, Pieraccini A, Ribaldone D, Testa A, Ubezio C, Viola A, Vecchi M, Klersy C, Di Sabatino A. Prevalence, Pathogenesis and Management of Anemia in Inflammatory Bowel Disease: An IG-IBD Multicenter, Prospective, and Observational Study. Inflamm Bowel Dis 2023; 29:76-84. [PMID: 35366312 DOI: 10.1093/ibd/izac054] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD), with a 6% to 74% prevalence and a negative impact on patient survival and quality of life, although the prevalence is apparently declining due to improved disease treatment. We aimed to investigate the prevalence, pathogenesis, and clinical correlates of anemia in Italian patients with IBD. METHODS A multicenter, prospective, observational study, involving 28 Italian gastroenterology centers, was conducted to investigate the epidemiology and consequences of IBD-associated anemia. Clinical and laboratory data of anemic patients were obtained at study enrolment. RESULTS Anemia was diagnosed in 737 of 5416 adult IBD outpatients (prevalence 13.6%); females were more commonly affected than males (odds ratio, 1.5; 95% confidence interval [CI], 1.2-1.7) and had more severe anemia. In the majority of cases, anemia was due to iron deficiency (62.5% of cases; 95% CI, 58.3%-66.6%), either isolated or in association with inflammation and/or vitamin deficiencies; anemia of inflammation accounted for only 8.3% of cases. More severe anemia was associated with increasing fatigue and worse quality of life. Only 68.9% of anemic patients with iron deficiency (95% CI, 63.4%-73.8%) and 34.6% of those with vitamin deficiencies (95% CI, 26.2%-44.2%) were properly treated with supplementation therapy. CONCLUSIONS In Italy, the prevalence of IBD-associated anemia is lower than previously reported. Anemia of IBD is most commonly due to iron deficiency and contributes to fatigue and poor quality of life, but remains untreated in a large proportion of patients with iron and/or vitamin deficiencies. This study is registered at clinicaltrials.gov as NCT02872376.
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Affiliation(s)
- Gaetano Bergamaschi
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Renata D'Incà
- Inflammatory Bowel Disease Unit-Azienda Ospedaliera-University of Padua, Padua, Italy
| | - Marco Astegiano
- Gastroenterology and Digestive Endoscopy Unit, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Walter Fries
- Gastroenterology and Clinical Unit for Inflammatory Bowel Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Monica Milla
- Unità Operativa Complessa di Gastroenterologia Cinica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Carolina Ciacci
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona and University of Salerno, Salerno, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, Azienda Socio-Sanitaria Territoriale Rhodense, Rho (MI), Italy
| | - Rachele Ciccocioppo
- Unità Operativa Complessa Gastroenterologia B, Azienda Ospedaliera Universitaria Integrata Policlinico G.B. Rossi & Dipartimento di Medicina, Università di Verona, Verona, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Azienda Ospedaliera Ospedali Riuniti "Villa Sofia-Cervello" Palermo, Palermo, Italy
| | - Fabrizio Bossa
- Department of Gastroenterology and Endoscopy, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Mariabeatrice Principi
- Gastroenterology Unit (Department of Emergency and Organ transplantation), University of Bari, Bari, Italy
| | - Piero Vernia
- Division of Gastroenterology, Department of Translational and Precision Medicine, "Sapienza" University of Rome and Umberto I Hospital, Rome, Italy
| | - Chiara Ricci
- Gastroenterology Unit, Spedali Civili di Brescia and Department of Clinical and Sperimental Sciences, University of Brescia, Brescia, Italy
| | - Maria L Scribano
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, Policlinico San Martino, Università di Genova, Genoa, Italy
| | - Dario Mazzucco
- Gastroenterology Unit, ASL Torino 3, Rivoli, Torino, Italy
| | - Gabrio Bassotti
- Gastroenterology & Hepatology Unit, Perugia General Hospital and University of Perugia, Perugia, Italy
| | - Gabriele Riegler
- Unit of Gastroenterology-Reference Center for IBD-Second University of Naples, Naples, Italy
| | - Andrea Buda
- Unità Operativa Complessa Gastroenterologia, Ospedale S. Maria del Prato, Azienda - Unità Locale Socio Sanitaria 1 Dolomiti, Feltre, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences and Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy Unit, Azienda sanitaria universitaria Giuliano Isontina, Cattinara Academic Hospital, Trieste, Italy
| | - Aldo Manca
- Department of Gastroenterology and Digestive Endoscopy, S. Croce e Carle Hospital, Cuneo, Italy
| | - Erica Villa
- UC Gastroenterologia, Dipartimento di Specialità Mediche, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Gionata Fiorino
- Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Michele Comberlato
- Gastroenterologia, Fisiopatologia ed Endoscopia Digestiva, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Nicola Aronico
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Cristina Della Corte
- Gastroenterology Unit, Rho Hospital, Azienda Socio-Sanitaria Territoriale Rhodense, Rho (MI), Italy
| | - Roberta Caccaro
- Inflammatory Bowel Disease Unit-Azienda Ospedaliera-University of Padua, Padua, Italy
| | - Paolo Gionchetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Giuffrida
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Paola Iovino
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona and University of Salerno, Salerno, Italy
| | - Marco V Lenti
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Caterina Mengoli
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Lucienne Pellegrini
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Alberto Pieraccini
- Unità Operativa Complessa di Gastroenterologia Cinica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Davide Ribaldone
- Gastroenterology and Digestive Endoscopy Unit, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Cristina Ubezio
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Anna Viola
- Gastroenterology and Clinical Unit for Inflammatory Bowel Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Catherine Klersy
- Servizio di Epidemiologia Clinica & Biometria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Sabatino
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
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12
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Pugliese D, Privitera G, Crispino F, Mezzina N, Castiglione F, Fiorino G, Laterza L, Viola A, Bertani L, Caprioli F, Cappello M, Barberio B, Ricci C, Balestrieri P, Daperno M, Pluchino D, Rizzello F, Scribano ML, Sablich R, Pastorelli L, Manguso F, Variola A, Di Sario A, Grossi L, Armuzzi A, Biscaglia G, Buda A, Mocci G, Viscido A, Di Paolo MC, Onali S, Rodino S, Coletta M, Principi M, Miranda A, Amato A, Bezzio C, Petruzzellis C, Mazzuoli S, Festa S, Sartini A, Checchin D, Fanigliulo L, Gallina S, Cesarini M, Bodini G, Stradella D, Spagnuolo R, Guidi L, Savarino E, Scrivo B, Soru P, Costa F, Fries W, Scaldaferri F, Allocca M, Pellegrini L, Massari A, Orlando A. Effectiveness and safety of vedolizumab in a matched cohort of elderly and nonelderly patients with inflammatory bowel disease: the IG-IBD LIVE study. Aliment Pharmacol Ther 2022; 56:95-109. [PMID: 35876062 PMCID: PMC9324100 DOI: 10.1111/apt.16923] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/13/2022] [Accepted: 03/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vedolizumab registration trials were the first to include elderly patients with moderate-to-severe ulcerative colitis (UC) or Crohn's disease (CD), but few real-life data have been reported in this population. AIMS We investigated the effectiveness and safety of vedolizumab in matched cohorts of elderly and nonelderly UC and CD patients. METHODS The Long-term Italian Vedolizumab Effectiveness (LIVE) study is a retrospective-prospective study including UC and CD patients who started vedolizumab from April 2016 to June 2017. Elderly patients (≥65 years) were matched clinically 1:2 to nonelderly patients (18-64 years); the 2 groups were followed until drug discontinuation or June 2019. RESULTS The study included 198 elderly (108 UC, 90 CD) and 396 matched nonelderly patients (205 UC, 191 CD). Nonelderly UC patients had a significantly higher persistence on vedolizumab compared to elderly patients (67.6% vs. 51.4%, p = 0.02). No significant difference in effectiveness was observed between elderly and nonelderly CD patients (59.4% vs. 52.4%, p = 0.32). Age ≥65 years was associated with lower persistence in UC; for CD, previous exposure to anti-TNF-α agents, Charlson comorbidity index >2 and moderate-to-severe clinical activity at baseline were associated with lower persistence. There were recorded 130 adverse events, with comparable rates between the two groups. A Charlson comorbidity index >2 was associated with an increased risk of adverse events. CONCLUSION Vedolizumab can be considered a safe option in elderly IBD patients. Its effectiveness in elderly UC patients may be reduced, while no age-dependent effect on effectiveness was observed in CD.
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Affiliation(s)
- Daniela Pugliese
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCSRomeItaly
| | - Giuseppe Privitera
- Dipartimento Universitario di Medicina e Chirurgia TraslazionaleUniversità Cattolica del Sacro CuoreRomeItaly
| | - Federica Crispino
- Riuniti Villa Sofia–Cervello Hospital, Internal Medicine e 2IBD Unit PalermoPalermoItaly
| | - Nicolò Mezzina
- Department of Biochemical and Clinical Science “L. Sacco” ASST Fatebenefratelli Sacco–University of MilanMilanItaly
| | | | - Gionata Fiorino
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy¸ Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Lucrezia Laterza
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCSRomeItaly
| | - Anna Viola
- UOSD Malattie Intestinali Croniche, Dip. di Medicina Clinica e SperimentalePoliclinico MessinaSicilyItaly
| | - Lorenzo Bertani
- Gastroenterology and Digestive Endoscopy Department of Medical Specialties Apuane HospitalTuscany North‐West ASLMassaItaly
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Department of Pathophysiology and TransplantationUniversity of MilanMilanLombardiaItaly
| | - Maria Cappello
- Head IBD Clinic, Gastroenterology Section, PromiseUniversity of PalermoSicilyItaly
| | - Brigida Barberio
- Gastroenterology Unit, Department of Surgery, Oncology and GastroenterologyUniversity of PaduaPaduaItaly
| | - Chiara Ricci
- Gastroenterology Unit, Spedali Civili Hospital, Department of Experimental and Clinical SciencesUniversity of BresciaBresciaItaly
| | - Paola Balestrieri
- Unit of Digestive Disease of Campus Bio Medico University of RomeItaly
| | - Marco Daperno
- Gastroenterology UnitAzienda Ospedaliera Ordine Mauriziano di TorinoTorinoPiemonteItaly
| | - Dario Pluchino
- Gastroenterology UnitA.O.U. Policlinico "Vittorio Emanuele"CataniaItaly
| | - Fernando Rizzello
- Department of Internal Medicine and GastroenterologyPoliclinico Sant’Orsola MalpighiBolognaItaly
| | | | - Renato Sablich
- Gastroenterology UnitSanta Maria degli Angeli HospitalPordenoneItaly
| | - Luca Pastorelli
- Gastroenterology UnitIRCCS Policlinico San Donato Research HospitalMilanItaly
| | - Francesco Manguso
- Gastoenterology UnitAO A. CardarelliVia A. Cardarelli, 5Naples80131Italy
| | - Angela Variola
- IBD Unit, IRCCS Sacro Cuore Don CalabriaNegrar di ValpolicellaVeronaItaly
| | - Antonio Di Sario
- Clinica di GastroenterologiaUniversità Politecnica delle MarcheAnconaItaly,IBD‐UNIT, and Dipartimento Gastroenterologico e dei TrapiantiPolo Ospedaliero‐Universitario "Umberto I‐G.M. Lancisi‐ G. Salesi"AnconaItaly
| | - Laurino Grossi
- G. D’Annunzio University‐Digestive Physiopathology Ospedale Spirito Santo PescaraPescaraItaly
| | - Alessandro Armuzzi
- IBD CenterIRCCS Humanitas Research HospitalMilanItaly,Department of Biomedical Sciences, Humanitas UniversityPieve EmanueleMilanItaly
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13
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Vitello A, Grova M, Pugliese D, Rizzello F, Lanzarotto F, Lavagna A, Caccaro R, Cappello M, Viola A, Ribaldone DG, Principi M, Stasi E, Scribano ML, Maida M, Soriano A, Bezzio C, Bodini G, Mocciaro F, Privitera AC, Simondi D, Giuffrida E, D'Incà R, Ricci C, Gionchetti P, Armuzzi A, Orlando A, Daperno M. Effectiveness of adalimumab for ulcerative colitis: A multicentre, retrospective study of clinical practice in Italy. Dig Liver Dis 2022; 54:352-357. [PMID: 34538764 DOI: 10.1016/j.dld.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/12/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Adalimumab is used to treat ulcerative colitis, but additional effectiveness and safety data are needed. PATIENTS AND METHODS This retrospective study considered adults with ulcerative colitis treated with adalimumab at 19 hospitals. Clinical data were collected from the start of treatment, after 2, 6 and 12 months, and at the last visit. Outcome measures of effectiveness were treatment duration, reasons for discontinuation and colectomy. RESULTS We studied 381 patients treated with adalimumab for a median of 12.1 months. Disease activity at the start of treatment was moderate to severe in 262 cases (68.8%) and endoscopic activity was moderate to severe in 339 cases (89.0%). At week 8, clinical responses were observed in 177 cases (46.5%) and clinical remission in 136 cases (35.7%). At 12 months, remission was observed in 128 cases (33.6%). Overall, 44 patients required colectomy, and 170 patients (44.6%) were still taking adalimumab when data were collected. Variables associated with adalimumab discontinuation were concomitant steroid treatment, severe clinical-endoscopic activity at baseline, need for adalimumab intensification and drug-related adverse events. Variables associated with colectomy were concomitant steroid treatment and high baseline C-reactive protein. CONCLUSION Adalimumab is safe and effective for the treatment of ulcerative colitis.
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Affiliation(s)
- Alessandro Vitello
- Gastroenterology Unit, Sant'Elia-Raimondi Hospital, Caltanissetta, Italy; Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Mauro Grova
- IBD Unit, Internal Medicine, Villa Sofia-Cervello Hospitals, Palermo, Italy
| | - Daniela Pugliese
- Gastroenterology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fernando Rizzello
- DIMEC, Università di Bologna, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | | | | | - Roberta Caccaro
- Gastroenterology Unit, Padua University Hospital, Padua, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Anna Viola
- IBD Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Elisa Stasi
- Gastroenterology Unit, Saverio De Bellis IRCCS Hospital, Castellana Grotte, Italy
| | | | - Marcello Maida
- Gastroenterology Unit, Sant'Elia-Raimondi Hospital, Caltanissetta, Italy
| | | | | | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Policlinico San Martino, University of Genoa, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo, Italy
| | | | - Daniele Simondi
- Gastroenterology Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Enrica Giuffrida
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy; Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Renata D'Incà
- Gastroenterology Unit, Padua University Hospital, Padua, Italy
| | - Chiara Ricci
- Internal Medicine, Spedali Civili, Brescia, Italy
| | - Paolo Gionchetti
- DIMEC, Università di Bologna, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Alessandro Armuzzi
- Gastroenterology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ambrogio Orlando
- IBD Unit, Internal Medicine, Villa Sofia-Cervello Hospitals, Palermo, Italy
| | - Marco Daperno
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy.
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14
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Armuzzi A, Bortoli A, Castiglione F, Contaldo A, Daperno M, D'Incà R, Labarile N, Mazzuoli S, Onali S, Milla M, Orlando A, Principi M, Pugliese D, Renna S, Rizzello F, Scribano ML, Todeschini A. Female reproductive health and inflammatory bowel disease: A practice-based review. Dig Liver Dis 2022; 54:19-29. [PMID: 34120858 DOI: 10.1016/j.dld.2021.05.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 03/17/2021] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel diseases, namely ulcerative colitis and Crohn's disease, occur worldwide and affect people of all ages, with a high impact on their quality of life. Sex differences in incidence and prevalence have been reported, and there are also gender-specific issues that physicians should recognize. For women, there are multiple, important concerns regarding issues of body image and sexuality, menstruation, contraception, fertility, pregnancy, breastfeeding and menopause. This practice-based review focuses on the main themes that run through the life of women with inflammatory bowel diseases from puberty to menopause. Gastroenterologists who specialize in inflammatory bowel diseases and other physicians who see female patients with inflammatory bowel diseases should provide support for these problems and offer adequate therapy to ensure that their patients achieve the same overall well-being and health as do women without inflammatory bowel diseases.
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Affiliation(s)
| | - Alessandro Armuzzi
- CEMAD - IBD Unit, Department of Medical and Surgical Sciences, A Gemelli University Hospital, Rome, Italy
| | | | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Antonella Contaldo
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy
| | - Marco Daperno
- Gastroenterology and Endoscopic Unit, Umberto I Mauriziano Hospital, Turin, Italy
| | - Renata D'Incà
- Gastroenterology Unit, Padua University Hospital, Padua, Italy
| | - Nunzia Labarile
- Gastroenterology Unit, Ospedale Santissima Annunziata, Taranto, Italy
| | - Silvia Mazzuoli
- Gastroenterology and Artificial Nutrition Department, "Mons. Dimiccoli " Barletta, Italy
| | - Sara Onali
- Gastroenterology Unit, Department of Science and Public Health, University Hospital of Cagliari, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Clinic, Careggi University Hospital, Florence, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Mariabeatrice Principi
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy.
| | - Daniela Pugliese
- CEMAD - IBD Unit, Department of Medical and Surgical Sciences, A Gemelli University Hospital, Rome, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Alessia Todeschini
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy
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Todeschini A, Loconte I, Contaldo A, Ierardi E, Di Leo A, Principi M. Small Bowel Metastatic Melanoma: An Emblematic “Coal-Black” Appearance at Videocapsule Endoscopy. Medicina (B Aires) 2021; 57:medicina57121313. [PMID: 34946258 PMCID: PMC8707397 DOI: 10.3390/medicina57121313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
A 80-year-old woman underwent vulvar melanoma resection and segmental lung resection for pulmonary metastasis. Immunotherapy with Nivolumab was performed. One year later, the patient was admitted for gastrointestinal (GI) recurrent bleeding and severe anemia. Esophagoastroduodenoscopy and colonoscopy did not show any abnormality, while videocapsule endoscopy (VCE) revealed an irregular and exophytic whitish area with a “coal-black” central depression. Small bowel resection was performed and histological examination revealed S100 protein strongly positive melanoma metastasis. The patient died six months later from disease progression. A “coal-black” appearance of intestinal metastatic melanoma has been described only twice before this report. In one case the patient had been treated by immunotherapy with interferon A and dendritic cell-based vaccination. In our patient, it is presumable that the picture we observed was a consequence of Nivolumab treatment inducing the disappearance of melanocytes in the area surrounding the metastasis with the onset of the central coal-black lesion encircled by whitish tissue. This picture should be emblematic of intestinal metastatic melanoma in subjects treated with immunotherapy showing occult/obscure bleeding.
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Losurdo G, Brescia IV, Lillo C, Mezzapesa M, Barone M, Principi M, Ierardi E, Di Leo A, Rendina M. Liver involvement in inflammatory bowel disease: What should the clinician know? World J Hepatol 2021; 13:1534-1551. [PMID: 34904028 PMCID: PMC8637677 DOI: 10.4254/wjh.v13.i11.1534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/06/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) may show a wide range of extraintestinal manifestations. In this context, liver involvement is a focal point for both an adequate management of the disease and its prognosis, due to possible serious comorbidity. The association between IBD and primary sclerosing cholangitis is the most known example. This association is relevant because it implies an increased risk of both colorectal cancer and cholangiocarcinoma. Additionally, drugs such as thiopurines or biologic agents can cause drug-induced liver damage; therefore, this event should be considered when planning IBD treatment. Additionally, particular consideration should be given to the evidence that IBD patients may have concomitant chronic viral hepatitis, such as hepatitis B and hepatitis C. Chronic immunosuppressive regimens may cause a hepatitis flare or reactivation of a healthy carrier state, therefore careful monitoring of these patients is necessary. Finally, the spread of obesity has involved even IBD patients, thus increasing the risk of non-alcoholic fatty liver disease, which has already proven to be more common in IBD patients than in the non-IBD population. This phenomenon is considered an emerging issue, as it will become the leading cause of liver cirrhosis.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Irene Vita Brescia
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Chiara Lillo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Martino Mezzapesa
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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17
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Festa S, Scribano ML, Pugliese D, Bezzio C, Principi M, Ribaldone DG, Allocca M, Mocci G, Bodini G, Spagnuolo R, Vernia P, Mazzuoli S, Costa F, Barberio B, Cosintino R, Zerboni G, Aratari A, Armuzzi A, Papi C. Long-term outcomes of acute severe ulcerative colitis in the rescue therapy era: A multicentre cohort study. United European Gastroenterol J 2021; 9:507-516. [PMID: 33259773 PMCID: PMC8259429 DOI: 10.1177/2050640620977405] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/05/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The long-term course of ulcerative colitis after a severe attack is poorly understood. Second-line rescue therapy with cyclosporine or infliximab is effective for reducing short-term colectomy but the impact in the long-term is controversial. OBJECTIVE The purpose of this study was to evaluate the long-term course of acute severe ulcerative colitis patients who avoid early colectomy either because of response to steroids or rescue therapy. METHODS This was a multicentre retrospective cohort study of adult patients with acute severe ulcerative colitis admitted to Italian inflammatory bowel disease referral centres from 2005 to 2017. All patients received intravenous steroids, and those who did not respond received either rescue therapy or colectomy. For patients who avoided early colectomy (within 3 months from the index attack), we recorded the date of colectomy, last follow-up visit or death. The primary end-point was long-term colectomy rate in patients avoiding early colectomy. RESULTS From the included 372 patients with acute severe ulcerative colitis, 337 (90.6%) avoided early colectomy. From those, 60.5% were responsive to steroids and 39.5% to the rescue therapy. Median follow-up was 44 months (interquartile range, 21-85). Colectomy-free survival probability was 93.5%, 81.5% and 79.4% at 1, 3 and 5 years, respectively. Colectomy risk was higher among rescue therapy users than in steroid-responders (log-rank test, p = 0.02). At multivariate analysis response to steroids was independently associated with a lower risk of long-term colectomy (adjusted odds ratio = 0.5; 95% confidence interval, 0.2-0.8), while previous exposure to antitumour necrosis factor-α agents was associated with an increased risk (adjusted odds ratio = 3.0; 95% confidence interval, 1.5-5.7). Approximately 50% of patients required additional therapy or new hospitalisation within 5 years due to a recurrent flare. Death occurred in three patients (0.9%). CONCLUSIONS Patients with acute severe ulcerative colitis avoiding early colectomy are at risk of long-term colectomy, especially if previously exposed to antitumour necrosis factor-α agents or if rescue therapy during the acute attack was required because of steroid refractoriness.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Giorgia Bodini
- Department of Internal MedicineUniversity of GenoaGenoaItaly
| | | | - Piero Vernia
- Division of GastroenterologySapienza University of RomeRomeItaly
| | - Silvia Mazzuoli
- Gastroenterology UnitMonsignor Raffaele Dimiccoli HospitalBarlettaItaly
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Principi M, Scicchitano P, Carparelli S, Nitti R, Ruggieri R, Bellino MC, Cecere A, Manca F, DI Leo A, Ciccone MM. Influence of systemic manifestations of inflammatory bowel diseases on endothelial function and cardiovascular risk. Minerva Med 2021; 113:291-299. [PMID: 33913656 DOI: 10.23736/s0026-4806.21.06970-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) may be complicated by extraintestinal manifestations (EIM). Both conditions may be implicated in the overall increase of cardiovascular (CV) risk profile of the patients. The study aimed to assess CV risk in IBD patients with EIMs in relation to the stages of both diseases. METHODS A total of 70 (38 men, mean age 51.7±12.4 years) patients with IBD and 22 controls (12 men, mean age 49.2±13.6 years) were enrolled. All patients and controls were screened for extraintestinal manifestations and underwent physical and anthropometric examinations, standard laboratory investigations, ultrasound evaluation of carotid arteries and flow-mediated vasodilatation (FMD). Patients were divided into four groups in relation to their active or remission stage of disease: 1. IBD+ EIM+; 2. IBD+ EIM-; 3. IBD- EIM+; 4. IBD- EIM-. RESULTS The groups were homogenous according to their clinical characteristics. Patients with both IBD and EIM in active phase showed significantly lower values in FMD than controls (p=0.024). Carotid intima-media thickness values (cIMT) were similar among groups. Patients with active phases of IBD and/or EIM showed statistically significant lower values in FMD measurements (p=0.0008 and p=0.0011, respectively). Multivariate regression did not reveal any independent predictors for FMD values. CONCLUSIONS The active phase of IBD or EIM or both may promote endothelial dysfunction in patients, thus increasing their CV risk profile. Patients in remission phase showed endothelial function similar at controls.
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Affiliation(s)
- Mariabeatrice Principi
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Pietro Scicchitano
- Cardiovascular Diseases Section, Hospital F. Perinei, Altamura, Bari, Italy - .,Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Sonia Carparelli
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Rosa Nitti
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Roberta Ruggieri
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Maria Consiglia Bellino
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Annagrazia Cecere
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Fabio Manca
- Department of Science of Educational, Psychology, and Communication, University of Bari, Bari, Italy
| | - Alfredo DI Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Marco M Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
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Loconte I, Principi M, Ingravallo G, Castellaneta N, Ierardi E, Di Leo A. Recurrent Overt Gastrointestinal Bleeding from Ulcerated Gastric Elastofibroma: Unprecedented Presentation of a Rare Condition. J Gastrointest Cancer 2021; 51:1074-1076. [PMID: 32385726 DOI: 10.1007/s12029-020-00412-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ilaria Loconte
- Department of Emergency and Organ Transplantation Section of Gastroenterology, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Mariabeatrice Principi
- Department of Emergency and Organ Transplantation Section of Gastroenterology, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giuseppe Ingravallo
- Department of Emergency and Organ Transplantation Section of Gastroenterology, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Nicola Castellaneta
- Department of Emergency and Organ Transplantation Section of Gastroenterology, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Enzo Ierardi
- Department of Emergency and Organ Transplantation Section of Gastroenterology, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Alfredo Di Leo
- Department of Emergency and Organ Transplantation Section of Gastroenterology, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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Pugliese D, Privitera G, Rogai F, Variola A, Viola A, Laterza L, Privitera AC, Allocca M, Bossa F, Cappello M, Daperno M, Lorenzon G, Mazzuoli S, Principi M, Sablich R, Moser L, Ferronato A, Traini S, Tapete G, Bodini G, Di Girolamo M, Grossi L, Mocci G, Ricci C, Saibeni S, Festa S, Spagnuolo R, Cortelezzi CC, Mocciaro F, Rizzello F, Armuzzi A. Two-year effectiveness and safety of golimumab in ulcerative colitis: An IG-IBD study. United European Gastroenterol J 2021; 9:102-109. [PMID: 33203342 PMCID: PMC8259241 DOI: 10.1177/2050640620974308] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/16/2020] [Indexed: 01/21/2023] Open
Abstract
Background Few data exist regarding the long‐term effectiveness of golimumab in ulcerative colitis. No data have been reported on real‐world continuous clinical response. Objective This study aimed to describe the long‐term outcomes in a large cohort of patients on golimumab who had ulcerative colitis. Methods Consecutive patients with active ulcerative colitis, started on golimumab, were enrolled and prospectively followed up. The primary end point was to evaluate the long‐term persistence on golimumab therapy. Results A total of 173 patients with ulcerative colitis were studied. Of these, 79.2% were steroid dependent, and 46.3% were naïve to anti‐tumour necrosis factor alpha agents. The median duration of golimumab therapy was 52 weeks (range: 4–142 weeks). The cumulative probability of maintaining golimumab treatment was 47.3% and 22.5% at 54 and 108 weeks, respectively. Biological‐naïve status (odds ratio [OR] = 3.02, 95% confidence interval [CI]: 1.44–6.29; p = 0.003) and being able to discontinue steroids at Week 8 (OR = 3.32, 95% CI: 1.34–8.30; p = 0.010) and Week 14 (OR = 2.94, 95% CI: 1.08–8.02; p = 0.036) were associated with longer persistence on therapy. At Week 54, 65/124 (52.4%) postinduction responders were in continuous clinical response. A continuous clinical response was associated with a lower likelihood of golimumab discontinuation throughout the subsequent year of therapy (p < 0.01). Overall, 40 (23.1%) patients were in clinical remission at the last follow‐up visit. Twenty‐six adverse events were recorded, leading to golimumab withdrawal in 9.2% of patients. Conclusions : Biological‐naïve status and not requiring steroids at Weeks 8 and 14 seem to be associated with a longer persistence on golimumab therapy in ulcerative colitis.
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Affiliation(s)
- Daniela Pugliese
- CEMAD - IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Privitera
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Rogai
- Gastroenterology Department, IBD Referral Centre, Careggi University Hospital, Florence, Italy
| | | | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Lucrezia Laterza
- CEMAD - IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Fabrizio Bossa
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maria Cappello
- AO Ordine Mauriziano, SC Gastroenterologia, Turin, Italy
| | - Marco Daperno
- Gastroenterology and Hepatology Section, DIBIMIS, University of Palermo School of Medicine, Palermo, Italy
| | - Greta Lorenzon
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, Padua, Italy
| | - Silvia Mazzuoli
- Gastroenterology and Artificial Nutrition Department, 'San Nicola Pellegrino' Hospital, Trani, Italy
| | - Mariabeatrice Principi
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy
| | - Renato Sablich
- Gastroenterology Unit, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Luisa Moser
- Gastroenterology Unit, Department of Medicine, University of Verona, Policlinico G.B. Rossi, Verona, Italy
| | | | - Sara Traini
- UOC Gastroenterologia ed Endoscopia Digestiva Ospedale Civile A, Murri, Italy
| | - Gherardo Tapete
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Maria Di Girolamo
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Laurino Grossi
- Gastroenterology Unit, University of Pescara, Pescara, Italy
| | - Giammarco Mocci
- Division of Gastroenterology, 'Brotzu' Hospital, Cagliari, Italy
| | - Chiara Ricci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Garbagnate, Milanese, Italy
| | | | - Rocco Spagnuolo
- Gastroenterology and Digestive Endoscopy Department, University of Catanzaro, Catanzaro, Italy
| | | | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S Civico-Di Cristina- Benfratelli Hospital, Palermo, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Armuzzi
- CEMAD - IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
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Losurdo G, Fortezza RFL, Iannone A, Contaldo A, Barone M, Ierardi E, Leo AD, Principi M. Prevalence and associated factors of obesity in inflammatory bowel disease: A case-control study. World J Gastroenterol 2020; 26:7528-7537. [PMID: 33384552 PMCID: PMC7754553 DOI: 10.3748/wjg.v26.i47.7528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, an increasing prevalence of obesity in inflammatory bowel disease (IBD) has been observed. Obesity, moreover, has been directly correlated with a more severe clinical course and loss of response to treatment.
AIM To assess the prevalence and associated factors of obesity in IBD.
METHODS We collected data about IBD disease pattern and activity, drugs and laboratory investigations in our center. Anthropometric measures were retrieved and obesity defined as a body mass index (BMI) > 30. Then, we compared characteristics of obese vs non obese patients, and Chi-squared test and Student’s t test were used for discrete and continuous variables, respectively, at univariate analysis. For multivariate analysis, we used binomial logistic regression and estimated odd ratios (OR) and 95% confidence intervals (CI) to ascertain factors associated with obesity.
RESULTS We enrolled 807 patients with IBD, either ulcerative colitis (UC) or Crohn’s disease (CD). Four hundred seventy-four patients were male (58.7%); the average age was 46.2 ± 13.2 years; 438 (54.2%) patients had CD and 369 (45.8%) UC. We enrolled 378 controls, who were comparable to IBD group for age, sex, BMI, obesity, diabetes and abdominal circumference, while more smokers and more subjects with hypertension were observed among controls. The prevalence of obesity was 6.9% in IBD and 7.9% in controls (not statistically different; P = 0.38). In the comparison of obese IBD patients and obese controls, we did not find any difference regarding diabetes and hypertension prevalence, nor in sex or smoking habits. Obese IBD patients were younger than obese controls (51.2 ± 14.9 years vs 60.7 ± 12.1 years, P = 0.03). At univariate analysis, obese IBD were older than normal weight ones (51.2 ± 14.9 vs 44.5 ± 15.8, P = 0.002). IBD onset age was earlier in obese population (44.8 ± 13.6 vs 35.6 ± 15.6, P = 0.004). We did not detect any difference in disease extension. Obese subjects had consumed more frequently long course of systemic steroids (66.6% vs 12.5%, P = 0.02) as well as antibiotics such as metronidazole or ciprofloxacin (71.4% vs 54.7%, P = 0.05). No difference about other drugs (biologics, mesalazine or thiopurines) was observed. Disease activity was similar between obese and non obese subjects both for UC and CD. Obese IBD patients suffered more frequently from arterial hypertension, type 2 diabetes, non-alcoholic fatty liver disease. Regarding laboratory investigations, obese IBD patients had higher levels of triglyceridemia, fasting blood glucose, gamma-glutamyl-transpeptidase. On multivariate analysis, however, the only factor that appeared to be independently linked to obesity in IBD was the high abdominal circumference (OR = 16.3, 95%CI: 1.03-250, P = 0.04).
CONCLUSION Obese IBD patients seem to have features similar to general obese population, and there is no disease-specific factor (disease activity, extension or therapy) that may foster obesity in IBD.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Rosa Federica La Fortezza
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Losurdo G, Iannone A, Contaldo A, Barone M, Ierardi E, Di Leo A, Principi M. Trends of Liver Stiffness in Inflammatory Bowel Disease with Chronic Hepatitis C. Diagnostics (Basel) 2020; 10:diagnostics10121037. [PMID: 33276638 PMCID: PMC7761525 DOI: 10.3390/diagnostics10121037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
Concomitant inflammatory bowel disease (IBD) and hepatitis C virus (HCV) infection is a relevant comorbidity since IBD itself exposes to a high risk of liver damage. We aimed to evaluate liver stiffness (LS) in IBD-HCV after antiviral treatment. We enrolled IBD patients with HCV. All patients at baseline underwent LS measurement by elastography. Patients who were eligible for antiviral therapy received direct antiviral agents (DAAs) and sustained viral response was evaluated at the 12th week. A control group was selected within IBD patients without HCV. One year later, all IBD-HCV patients and controls repeated LS measurement. Twenty-four IBD-HCV patients and 24 IBD controls entered the study. Only twelve out of 24 received DAAs and all achieved sustained viral response (SVR). All IBD subjects were in remission at enrollment and maintained remission for one year. After one year, IBD patients who eradicated HCV passed from a liver stiffness of 8.5 ± 6.2 kPa to 7.1 ± 3.9, p = 0.13. IBD patients who did not eradicate HCV worsened liver stiffness: from 7.6 ± 4.4 to 8.6 ± 4.6, p = 0.01. In the IBD control group, stiffness decreased from 7.8 ± 4.4 to 6.0 ± 3.1, p < 0.001. In conclusion, HCV eradication is able to stop the evolution of liver fibrosis in IBD, while failure to treat may lead to its progression. A stable IBD remission may improve LS even in non-infected subjects.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
- Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
- Correspondence: ; Tel.: +39-080-5593452; Fax: +39-080-5593088
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
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Losurdo G, Iannone A, Contaldo A, Barone M, Ierardi E, Di Leo A, Principi M. Chronic Viral Hepatitis in a Cohort of Inflammatory Bowel Disease Patients from Southern Italy: A Case-Control Study. Pathogens 2020; 9:pathogens9110870. [PMID: 33113974 PMCID: PMC7690684 DOI: 10.3390/pathogens9110870] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
We performed an epidemiologic study to assess the prevalence of chronic viral hepatitis in inflammatory bowel disease (IBD) and to detect their possible relationships. Methods: It was a single centre cohort cross-sectional study, during October 2016 and October 2017. Consecutive IBD adult patients and a control group of non-IBD subjects were recruited. All patients underwent laboratory investigations to detect chronic hepatitis B (HBV) and C (HCV) infection. Parameters of liver function, elastography and IBD features were collected. Univariate analysis was performed by Student's t or chi-square test. Multivariate analysis was performed by binomial logistic regression and odds ratios (ORs) were calculated. We enrolled 807 IBD patients and 189 controls. Thirty-five (4.3%) had chronic viral hepatitis: 28 HCV (3.4%, versus 5.3% in controls, p = 0.24) and 7 HBV (0.9% versus 0.5% in controls, p = 0.64). More men were observed in the IBD-hepatitis group (71.2% versus 58.2%, p < 0.001). Patients with IBD and chronic viral hepatitis had a higher mean age and showed a higher frequency of diabetes, hypertension and wider waist circumference. They suffered more frequently from ulcerative colitis. Liver stiffness was greater in subjects with IBD and chronic viral hepatitis (7.0 ± 4.4 versus 5.0 ± 1.2 KPa; p < 0.001). At multivariate analysis, only old age directly correlated with viral hepatitis risk (OR = 1.05, 95%CI 1.02-1.08, p < 0.001). In conclusion, the prevalence of HBV/HCV in IBD is low in our region. Age may be the only independent factor of viral hepatitis-IBD association. Finally, this study firstly measured liver stiffness in a large scale, showing higher values in subjects with both diseases.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
- Correspondence: ; Tel.: +39-080-559-2925
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (A.I.); (A.C.); (M.B.); (E.I.); (M.P.)
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Losurdo G, Giorgio F, Pricci M, Girardi B, Russo F, Riezzo G, Martulli M, Piazzolla M, Cocomazzi F, Abbruzzi F, Parente E, Paolillo R, Mileti A, Iannone A, Principi M, Ierardi E, Di Leo A. Helicobacter pylori Primary and Secondary Genotypic Resistance to Clarithromycin and Levofloxacin Detection in Stools: A 4-Year Scenario in Southern Italy. Antibiotics (Basel) 2020; 9:antibiotics9100723. [PMID: 33096925 PMCID: PMC7589162 DOI: 10.3390/antibiotics9100723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Antibiotic resistance has become an emerging problem for treating Helicobacter pylori (H. pylori) infection. Clarithromycin and levofloxacin are two key antibiotics used for its eradication. Therefore, we reviewed our experience with genotypic resistance analysis in stools to both clarithromycin and levofloxacin in the last four years to evaluate time trends, both in naive and failure patients. Patients collected a fecal sample using the THD fecal test device. Real-time polymerase chain reaction was performed to detect point mutations conferring resistance to clarithromycin (A2142C, A2142G, and A2143G in 23S rRNA) and levofloxacin (substitutions at amino acid position 87 and 91 of gyrA). One hundred and thirty-five naive patients were recruited between 2017-2020. Clarithromycin resistance was detected in 37 (27.4%). The time trend did not show any significant variation from 2017 to 2020 (p = 0.33). Primary levofloxacin resistance was found in 26 subjects (19.2%), and we observed a dramatic increase in rates from 2017 (10%) to 2018 (3.3%), 2019 (20%), and 2020 (37.8%). Ninety-one patients with at least one eradication failure were recruited. Secondary resistance to clarithromycin and levofloxacin was found in 59 (64.8%) and 45 patients (59.3%), respectively. In conclusion, our geographic area has a high risk of resistance to clarithromycin. There is also a progressive spreading of levofloxacin-resistant strains.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
- Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | | | - Maria Pricci
- THD SpA, 42015 Correggio, Italy; (F.G.); (M.P.); (B.G.)
| | - Bruna Girardi
- THD SpA, 42015 Correggio, Italy; (F.G.); (M.P.); (B.G.)
| | - Francesco Russo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (M.M.)
| | - Giuseppe Riezzo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (M.M.)
| | - Manuela Martulli
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (M.M.)
| | - Mariano Piazzolla
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Francesco Cocomazzi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Francesco Abbruzzi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Elisabetta Parente
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Rosa Paolillo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Alessia Mileti
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
- Correspondence: ; Tel.: +39-80-559-2925
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Viscido A, Buda A, Caprioli F, Principi M, Daperno M, Armuzzi A. Use of biosimilars in inflammatory bowel diseases: A survey among the clinicians members of the Italian Group for the Study of Inflammatory Bowel Disease (IGIBD). Dig Liver Dis 2020; 52:928-930. [PMID: 32616462 DOI: 10.1016/j.dld.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy.
| | - Andrea Buda
- Gastroenterology Unit, Department of Gastrointestinal Oncological Surgery, S. Maria del Prato Hospital, Feltre, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
| | | | - Marco Daperno
- Division of Gastroenterology, Ospedale Ordine Mauriziano di Torino, Turin, Italy
| | - Alessandro Armuzzi
- IBD Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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Girardi B, Pricci M, Giorgio F, Piazzolla M, Iannone A, Losurdo G, Principi M, Barone M, Ierardi E, Di Leo A. Silymarin, boswellic acid and curcumin enriched dietetic formulation reduces the growth of inherited intestinal polyps in an animal model. World J Gastroenterol 2020; 26:1601-1612. [PMID: 32327909 PMCID: PMC7167411 DOI: 10.3748/wjg.v26.i14.1601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/06/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Some substances of plant origin have been reported to exert an effect in reducing intestinal neoplasm development, especially in animal models. Adenomatous polyposis coli multiple intestinal neoplasia - ApcMin/+ is the most studied murine model of genetic intestinal carcinogenesis.
AIM To assess whether an enriched nutritional formulation (silymarin, boswellic acid and curcumin) with proven “in vitro” and “in vivo” anti-carcinogenetic properties may prevent inherited intestinal cancer in animal model.
METHODS Forty adenomatous polyposis coli multiple intestinal neoplasia - ApcMin/+ mice were used for the study of cancer prevention. They were divided into two groups: 20 assumed standard and 20 enriched diet. At the 110th d animals were sacrificed. In each group, four subgroups received intraperitoneal bromodeoxyuridine injection at different times (24, 48, 72 and 96 h before the sacrifice) in order to assess epithelial turnover. Moreover, we evaluated the following parameters: Intestinal polypoid lesion number and size on autoptic tissue, dysplasia and neoplasia areas by histological examination of the whole small intestine, inflammation by histology and cytokine mRNA expression by real-time polymerase chain reaction, bromodeoxyuridine and TUNEL immuno-fluorescence for epithelial turnover and apoptosis, respectively. Additionally, we performed western blotting analysis for the expression of estrogen alpha and beta receptors, cyclin D1 and cleaved caspase 3 in normal and polypoid tissues.
RESULTS Compared to standard, enriched diet reduced the total number (203 vs 416) and the mean ± SD/animal (12.6 ± 5.0 vs 26.0 ± 8.8; P < 0.001) of polypoid lesions. In enriched diet group a reduction in polyp size was observed (P < 0.001). Histological inflammation and pro-inflammatory cytokine expression were similar in both groups. Areas of low-grade dysplasia (P < 0.001) and intestinal carcinoma (IC; P < 0.001) were significantly decreased in enriched diet group. IC was observed in 100% in standard and 85% in enriched formulation assuming animals. Enriched diet showed a faster epithelial migration and an increased apoptosis in normal mucosa and low-grade dysplasia areas (P < 0.001). At western blotting, estrogen receptor beta protein was well expressed in normal mucosa of enriched and standard groups, with a more marked trend associated to the first one. Estrogen receptor alpha was similarly expressed in normal and polypoid mucosa of standard and enriched diet group. Cleaved caspase 3 showed in normal mucosa a stronger signal in enriched than in standard diet. Cyclin D1 was more expressed in standard than enriched diet group of both normal and polypoid tissue.
CONCLUSION Our results are suggestive of a chemo-preventive synergic effect of the components (silymarin, boswellic acid and curcumin) of an enriched formulation in inherited IC. This effect may be mediated by the reduction of epithelial proliferation, the increase of apoptosis and the acceleration of villous cell renewal due to dietary formulation intake.
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Affiliation(s)
| | | | | | - Mariano Piazzolla
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Andrea Iannone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Giuseppe Losurdo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Mariabeatrice Principi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Michele Barone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Principi M, Contaldo A, Bianchi FP, Losurdo G, Iannone A, Ierardi E, Tafuri S, Di Leo A. Inter-Observer Agreement of a New Endoscopic Score for Ulcerative Colitis Activity: Preliminary Experience. Diagnostics (Basel) 2020; 10:diagnostics10040213. [PMID: 32290549 PMCID: PMC7236596 DOI: 10.3390/diagnostics10040213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/23/2023] Open
Abstract
Ulcerative colitis (UC) endoscopic scores translate mucosal damage into values standardizing image analysis. Due to potential limits of current endoscopic activity indexes, we have elaborated on a new score, the “Extended Mayo Endoscopic Score (EMES),” and evaluated its inter-observer agreement in a multicenter endoscopy team, comparing concordance with the Mayo subscore. Sixteen UC consecutive patients underwent follow-up colonoscopy. Recorded videos were anonymously loaded on a web platform. Thirteen expert endoscopists evaluated UC activity using both Mayo and EMES. EMES was described in every colon segment: erythema (0: absent, 1: mild, 2: moderate, 3: severe), vascular pattern (0: normal, 1: reduction, 2: disappearance), erosions and ulcers (0: absent, 1: from 1 to 5, 2: 6 to 10, 3: >10). Weighted Fleiss’ kappa with 95% confidence interval (CI) and p-value defined inter-rater agreement. Global inter-observer agreement of EMES was moderate (kappa = 0.56, 95% CI = 0.46–0.67, p < 0.001). The evaluation of each colonic segment showed moderate agreement for all segments: ascending (kappa = 0.46, 95% CI = 0.32–0.60, p < 0.001), transverse (kappa = 0.48, 95% CI = 0.29–0.67, p < 0.001); descending (kappa = 0.49, 95% CI = 0.35–0.64, p < 0.001), sigmoid (kappa = 0.52, 95% CI = 0.39–0.65, p < 0.001) and rectum (kappa = 0.55, 95% CI = 0.42–0.69, p < 0.001). Mayo subscore agreement was similar to global EMES (kappa = 0.53, 95% CI = 0.39–0.66, p = 0.001). Therefore, our report emphasizes the importance of assessing inter-observer agreement for EMES, but also for other known scoring systems, including the Mayo subscore.
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Affiliation(s)
- Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
- Correspondence: ; Tel.: +39-08-0559-3452; Fax: +39-08-0559-3088
| | - Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
| | - Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.P.B.); (S.T.)
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
- PhD Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.P.B.); (S.T.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (A.C.); (G.L.); (A.I.); (E.I.); (A.D.L.)
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Losurdo G, Leandro G, Ierardi E, Perri F, Barone M, Principi M, Di Leo A. Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis. J Neurogastroenterol Motil 2020; 26:16-28. [PMID: 31743632 PMCID: PMC6955189 DOI: 10.5056/jnm19113] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/29/2019] [Accepted: 09/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIMS Small intestinal bacterial overgrowth (SIBO) diagnosis is usually based on non-invasive breath tests (BTs), namely lactulose BT (LBT) and glucose BT (GBT). However, divergent opinions and problems of parameter standardization are still controversial aspects. We aim to perform a meta-analysis to analyze diagnostic performance of LBT/GBT for SIBO diagnosis. METHODS We searched in main literature databases articles in which SIBO diagnosis was achieved by LBT/GBT in comparison to jejunal aspirate culture (reference gold standard). We calculated pooled sensitivity, specificity, positive, and negative likelihood ratios and diagnostic odd ratios. Summary receiver operating characteristic curves were drawn and pooled areas under the curve were calculated. RESULTS We selected 14 studies. Pooled sensitivity of LBT and GBT was 42.0% and 54.5%, respectively. Pooled specificity of LBT and GBT was 70.6% and 83.2%, respectively. When delta over baseline cut-off > 20 H2 parts per million (ppm) was used, GBT sensitivity and specificity were 47.3% and 80.9%; when the cutoff was other than and lower than > 20 ppm, sensitivity and specificity were 61.7% and 86.0%. In patients with abdominal surgery history, pooled GBT sensitivity and specificity gave the impression of having a better performance (81.7% and 78.8%) compared to subjects without any SIBO predisposing condition (sensitivity = 40.6% and specificity = 84.0%). CONCLUSIONS GBT seems to work better than LBT. A cut-off of delta H2 expired other than and lower than > 20 ppm shows a slightly better result than > 20 ppm. BTs demonstrate the best effectiveness in patients with surgical reconstructions of gastrointestinal tract.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari,
Italy
| | - Gioacchino Leandro
- Gastroenterology Unit, National Institute of Research for Gastroenterology “Saverio De Bellis”, Castellana Grotte, Bari,
Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari,
Italy
| | - Francesco Perri
- Digestive Endoscopy Unit, National Institute of Research “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia,
Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari,
Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari,
Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari,
Italy
- Correspondence: Alfredo Di Leo, MD, PhD, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy, Tel: +39-080-559-3452, Fax: +39-080-559-3088, E-mail:
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Iannone A, Ruospo M, Palmer SC, Principi M, Barone M, Di Leo A, Strippoli GFM. Systematic review with network meta-analysis: endoscopic techniques for dysplasia surveillance in inflammatory bowel disease. Aliment Pharmacol Ther 2019; 50:858-871. [PMID: 31502284 DOI: 10.1111/apt.15493] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/08/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND International guidelines recommend dysplasia surveillance in IBD. AIM To compare endoscopic techniques for dysplasia surveillance METHODS: We searched MEDLINE, Embase, CENTRAL for randomised trials through May 2019. We estimated odds ratios (ORs) for binary and mean differences (MDs) for continuous outcomes, using frequentist random-effects network meta-analysis. We assessed study risk of bias and appraised evidence certainty using GRADE. RESULTS Eighteen trials (2638 participants) were included. Standard definition white-light endoscopy (OR 0.44, 95% CI 0.26-0.73; high certainty) and i-SCAN (OR 0.47, 95% CI 0.25-0.90; moderate certainty) had lower odds of detecting neoplasia than chromoendoscopy. Fujinon intelligent colour enhancement (FICE), standard definition white-light endoscopy and i-SCAN had lower odds for this outcome than full spectrum high definition white-light endoscopy (ORs 0.02 to 0.15; low certainty). Standard definition white-light endoscopy had lower odds of detecting nonpolypoid neoplasia than full spectrum high definition white-light endoscopy, narrow band imaging, chromoendoscopy and high definition white-light endoscopy (ORs 0.01-0.14; moderate certainty). Full spectrum high definition white-light endoscopy ranked as the best technique for both outcomes (moderate certainty). Standard definition white-light endoscopy had lower odds of detecting neoplasia by target biopsy (OR 0.27, 95% CI 0.08-0.91) and had shorter procedure time (MD -14.81 minutes, 95% CI -25.03, -4.06) than chromoendoscopy (moderate certainty). CONCLUSIONS Chromoendoscopy, high definition white-light endoscopy, narrow band imaging, autofluorescence, FICE and full spectrum high definition white-light endoscopy may be comparable for dysplasia surveillance. Standard definition white-light endoscopy and i-SCAN probably provide lower yields for neoplasia identification. Full spectrum high definition white-light endoscopy may represent the first-line approach.
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Affiliation(s)
- Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Abbruzzi F, Loconte I, Carparelli S, Ierardi E, Di Leo A, Principi M. Olmesartan Associated Enteropathy: Usefulness of Video Capsule Endoscopy in a Case With Doubtful Upper Endoscopic/Histological Picture. Curr Drug Saf 2019; 15:65-68. [PMID: 31549594 DOI: 10.2174/1574886314666190923161406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Olmesartan, an antihypertensive drug, may be associated with a severe "sprue-like enteropathy". OBJECTIVES To report a case of Olmesartan enteropathy demonstrated by video capsule endoscopy distally from the second duodenum along with the whole small bowel before and after drug withdrawal. CASE PRESENTATION A 81-years-old man was referred for asthenia, chronic watery diarrhea and anasarca (ascites, pleural effusion and edemas of superior and inferior limb). The only comorbidity was hypertension treated with Olmesartan. All causes of infective and inflammatory chronic diarrhea were investigated and excluded. Upper endoscopy was normal; histological examination of the second portion of the duodenum showed moderate and patchy infiltration of lymphocytes at mucosal and intra-epithelial level with intermittent partial villous atrophy. The possibility of adverse drug reaction, estimated by Naranjo scale, showed a score of 7, indicating a strong probability. Olmesartan was then withdrawn. However, because of severe clinical general condition, we preferred to corroborate our diagnostic work-up by a non-invasive investigation, i.e. video capsule endoscopy, which showed jejunal and ileal mucosal alterations (mosaic pattern, diffuse hyperemia, severe edema, consequent apparent reduced lumen, diffuse thickening of intestinal folds, multiple erosions, patchy lymphangectasia). After 14 days, the resolution of anasarcatic state and hydroelectrolytic imbalances was observed. Nine months later, small-bowel video-capsule demonstrated mild mucosal hyperaemia and mosaic pattern. CONCLUSION Our case could give new insights in the field of Olmesartan associated enteropathy by highlighting the possibility of distally main lesion location and, therefore, the usefulness of video capsule endoscopy in the presence of doubtful diagnostic features.
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Affiliation(s)
- Francesco Abbruzzi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Ilaria Loconte
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Sonia Carparelli
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Ierardi E, Losurdo G, Fortezza RFL, Principi M, Barone M, Leo AD. Optimizing proton pump inhibitors in Helicobacter pylori treatment: Old and new tricks to improve effectiveness. World J Gastroenterol 2019; 25:5097-5104. [PMID: 31558859 PMCID: PMC6747288 DOI: 10.3748/wjg.v25.i34.5097] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/26/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023] Open
Abstract
The survival and replication cycle of Helicobacter pylori (H. pylori) is strictly dependant on intragastric pH, since H. pylori enters replicative phase at an almost neutral pH (6-7), while at acid pH (3-6) it turns into its coccoid form, which is resistant to antibiotics. On these bases, it is crucial to increase intragastric pH by proton pump inhibitors (PPIs) when an antibiotic-based eradicating therapy needs to be administered. Therefore, several tricks need to be used to optimize eradication rate of different regimens. The administration of the highest dose as possible of PPI, by doubling or increasing the number of pills/day, has shown to be able to improve therapeutic outcome and has often proposed in rescue therapies, even if specific trials have not been performed. A pre-treatment with PPI before starting antibiotics does not seem to be effective, therefore it is discouraged. However, the choice of PPI molecule could have a certain weight, since second-generation substances (esomeprazole, rabeprazole) are likely more effective than those of first generation (omeprazole, lansoprazole). A possible explanation is due to their metabolism, which has been proven to be less dependent on cytochrome P450 (CYP) 2C19 genetic variables. Finally, vonoprazan, a competitive inhibitor of H+/K+-ATPase present on luminal membrane of gastric parietal cells has shown the highest efficacy, due to both its highest acid inhibition power and rapid pharmacologic effect. However current data come only from Eastern Asia, therefore its strong power needs to be confirmed outside this geographic area in Western countries as well as related to the local different antibiotic resistance rates.
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Affiliation(s)
- Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Rosa Federica La Fortezza
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Barone M, Viggiani MT, Losurdo G, Principi M, Leo AD. Systematic review: Renin-angiotensin system inhibitors in chemoprevention of hepatocellular carcinoma. World J Gastroenterol 2019; 25:2524-2538. [PMID: 31171895 PMCID: PMC6543242 DOI: 10.3748/wjg.v25.i20.2524] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/06/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neoangiogenesis is one of the key pathogenetic mechanisms in hepatocellular carcinoma (HCC). Modulation of the renin-angiotensin system (RAS) by angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) seems to be a possible adjuvant therapy for HCC, due to the anti-angiogenic and anti-fibrogenic activity of these drugs.
AIM To elucidate the role of ARBs and ACE-Is in HCC.
METHODS We performed an electronic search of the literature using the most accessed online databases (PubMed, Cochrane library, Scopus and Web of Science), entering the query terms "angiotensin-converting enzyme inhibitors" OR "ACE inhibitors" OR "ACE-I" AND "hepatocarcinoma*" OR "hepatocellular carcinoma; moreover "angiotensin II type 1 receptor blockers" OR "ARBs" AND "hepatocarcinoma*" OR "hepatocellular carcinoma". Eligibility criteria were: (1) prospective or retrospective clinical studies; (2) epidemiological studies; and (3) experimental studies conducted in vivo or in vitro. Abstracts, conference papers, and reviews were excluded a priori. We limited our literature search to articles published in English, in peer-reviewed journals.
RESULTS Thirty-one studies were selected. Three interventional studies showed that ACE-Is had a significant protective effect on HCC recurrence only when used in combination with vitamin K or branched chain aminoacids, without a significant increase in overall survival. Of six retrospective observational studies, mainly focused on overall survival, only one demonstrated a prolonged survival in the ACE-Is group, whereas the two that also evaluated tumor recurrence showed conflicting results. All experimental studies displayed beneficial effects of RAS inhibitors on hepatocarcinogenesis. Numerous experimental studies, conducted either on animals and cell cultures, demonstrated the anti-angiogenetic and antifibrotic effect of ACE-Is and ARBs, thanks to the suppression of some cytokines such as vascular endothelial growth factor, hypoxia-inducible factor-1a, transforming growth factor-beta and tumor necrosis factor alpha. All or parts of these mechanisms were demonstrated in rodents developing fewer HCC and preneoplastic lesions after receiving such drugs.
CONCLUSION In humans, RAS inhibitors - alone or in combination - significantly suppressed the cumulative HCC recurrence, without prolonging patient survival, but some limitations intrinsic to these studies prompt further investigations.
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Affiliation(s)
- Michele Barone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari 70124, Italy
| | - Maria Teresa Viggiani
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari 70124, Italy
| | - Giuseppe Losurdo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari 70124, Italy
| | - Mariabeatrice Principi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari 70124, Italy
| | - Alfredo Di Leo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari 70124, Italy
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Fiorino G, Caprioli F, Daperno M, Mocciaro F, Principi M, Viscido A, Fantini MC, Orlando A, Papi C, Annese V, Danese S, Vecchi M, Rizzello F, Armuzzi A, Previtali E, Aloi M, Alvisi P, Antonelli E, Ardizzone S, Astegiano M, Baldoni M, Beltrami M, Biancone L, Bodini G, Buda A, Bossa F, Bracci F, Calabrese E, Cappello M, Castiglione F, Ciacci C, Cicala M, Ciccocioppo R, Comberlato M, Cortelezzi CC, Cosintino R, Costa F, Costantino G, Cucchiara S, Cuomo A, D’Incà R, Di Paolo MC, Di Sabatino A, Di Sario A, Frieri G, Fries W, Gasbarrini A, Geccherle A, Gionchetti P, Graziani MG, Grossi L, Guidi L, Imperiali G, Latella G, Lionetti P, Inserra G, Maconi G, Manguso F, Marino M, Mastronardi M, Mazzuoli S, Meucci G, Mendolaro M, Milla M, Mocci G, Monteleone G, Bortoluzzi FN, Pagnini C, Pastorelli L, Pica R, Piergallini S, Privitera A, Renna S, Ribaldone DG, Ricci C, Rispo A, Rocca R, Romano C, Romano M, Russo G, Sablich R, Saibeni S, Savarino E, Scribano ML, Spagnuolo R, Stasi E, Terpin MM, Testa A, Valpiani D, Variola A, Vernia P, Vitale G, Zoli G. Use of biosimilars in inflammatory bowel disease: a position update of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Dig Liver Dis 2019; 51:632-639. [PMID: 30872085 DOI: 10.1016/j.dld.2019.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
The first infliximab biosimilar for the treatment of inflammatory bowel disease (IBD) was introduced in 2013, and today eight anti-TNF alpha biosimilars (three for infliximab and five for adalimumab) have been approved and licensed by the European Medicines Agency. Biosimilars present great potential in terms of cost saving and possible consequential reinvestment in the health care system. The increasing knowledge about the process of biosimilar development and use in IBD and the publication of many prospective clinical studies and real-life clinical experiences have progressively changed the point of view of IBD physicians. In the present position paper, the Italian Group for the Study of Inflammatory Bowel Disease present and discuss their updated statements and positions on this topic, with emphasis on the concepts of biosimilarity and extrapolation across indications, safety and immunogenicity, interchangeability and switching, automatic substitution, and, finally, patient education about biosimilars.
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Affiliation(s)
- Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | - Marco Daperno
- Division of Gastroenterology, Ospedale Ordine Mauriziano di Torino, Turin, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Mariabeatrice Principi
- Gastroenterology Unit, Department of Organ Transplantation (DETO), Policlinico Universitario, Bari, Italy
| | - Angelo Viscido
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Ambrogio Orlando
- IBD Unit, A.O. Osp. Riuniti "Villa Sofia-Cervello", Palermo, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | | | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | | | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
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Contaldo A, Losurdo G, Albano F, Iannone A, Barone M, Ierardi E, Di Leo A, Principi M. The Spectrum of Small Intestinal Lesions in Patients with Unexplained Iron Deficiency Anemia Detected by Video Capsule Endoscopy. Medicina (Kaunas) 2019; 55:medicina55030059. [PMID: 30818850 PMCID: PMC6473446 DOI: 10.3390/medicina55030059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/16/2019] [Accepted: 02/21/2019] [Indexed: 02/07/2023]
Abstract
Background and objectives: Video-capsule endoscopy (VCE) has shown a large range (38⁻83%) of diagnostic yield in unexplained iron deficiency anemia (IDA) and obscure-occult bleeding. Therefore, we retrospectively investigated the VCE-detected spectrum and the prevalence of small bowel injuries and associated risk factors in inpatients with both of the above reported conditions. Methods: We selected inpatients with IDA (hemoglobin <12 g/dL in women, <13 g/dL in men) and obscure-occult bleeding. We excluded VCE indications other than IDA. Complete medical histories and laboratory tests were collected. All subjects underwent PillCam SB2/SB3. The VCE feature Lewis score was calculated when appropriate. We used the t-test and Fisher's exact test for continuous and categorical variables, respectively, in univariate analysis. For multivariate analysis, we used binomial logistic regression. Results: We retrieved 109 patients (female:male ratio of 53:56; age 63.4 ± 18.9 years). Eighty patients (73.4%) showed ≥1 small bowel lesions. The Lewis score was calculated in 41 patients: 13 (31.7%) showed a mild (<135) and 28 (68.3%) a moderate-severe (135⁻790 and >790, respectively) score. In univariate analysis, the small bowel transit time (6.2 ± 2.9 versus 5.2 ± 2.1 h; p = 0.049) and non-steroidal anti-inflammatory drug use for at least two weeks (17.5% versus 0%; p = 0.01) were significantly higher in subjects with injuries. These associations were not confirmed at multivariate analysis. The severity of a lesion directly correlated with proton pump inhibitor (PPI) use and duration (not confirmed in multivariate analysis). VCE can reveal the source of obscure-occult bleeding in a high percentage of unexplained IDAs. A wide spectrum of endoscopic pictures may be found. Known as well as supposed risk factors for small bowel lesions may be detected.
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Affiliation(s)
- Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Francesca Albano
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
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Armuzzi A, Fiorino G, Variola A, Manetti N, Fries W, Orlando A, Maconi G, Bossa F, Cappello M, Biancone L, Cantoro L, Costa F, D'Incà R, Lionetti P, Principi M, Castiglione F, Annunziata ML, Di Sabatino A, Di Girolamo M, Terpin MM, Cortelezzi CC, Saibeni S, Amato A, Ardizzone S, Guidi L, Danese S, Massella A, Ventra A, Rizzuto G, Massari A, Perri F, Annese V, Tari R, Petruzzellis C, Meucci G, Imperiali G, Guglielmi FW, Mazzuoli S, Caserta L, Caterina Parodi M, Colli A, Ronchetti A, Pugliese D, Geccherle A, Rogai F, Milani S, Renna S, Cassinotti A, Andriulli A, Martino G, Scrivo B, Troncone E, Kohn A, Bertani L, Lorenzon G, Ghione S, Nardone O, Vecchi M, Bertani A, Bosani MA, Bezzio C, Salerno R. The PROSIT Cohort of Infliximab Biosimilar in IBD: A Prolonged Follow-up on the Effectiveness and Safety Across Italy. Inflamm Bowel Dis 2019; 25:568-579. [PMID: 30137352 DOI: 10.1093/ibd/izy264] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND We report a prospective, nationwide cohort evaluating the safety and effectiveness of CT-P13. METHODS A structured database was used to record serious adverse events (SAEs), clinical remission/response, inflammatory biomarkers (CRP and calprotectin), and endoscopic findings. RESULTS Eight hundred ten patients with inflammatory bowel disease (IBD) (452 Crohn's disease [CD]) were enrolled. Four hundred fifty-nine patients were naïve to anti-TNFα (group A), 196 had a previous exposure (group B), and the remaining 155 were switched to CT-P13 (group C). All patients were included in the safety evaluation with a mean follow-up of 345 ± 215 days and a total number of 6501 infusions. One hundred fifty-four SAEs were reported (19%), leading to cessation of the biosimilar in 103 subjects (12.7%). Infusion reactions were 71, leading to cessation of the biosimilar in 53 subjects (6.5%), being significantly more frequent in patients pre-exposed to anti-TNFα (P = 0.017). The efficacy of therapy was calculated in 754 IBD patients, with a mean follow-up of 329 ± 202 days. Forty-eight patients had a primary failure (6.4%), and 188 (25.6%) lost response during follow-up. Six hundred twenty-eight (364 CD) and 360 IBD patients (222 CD) completed the follow-up at 6 and 12 months, respectively. At 12 months, patients without loss of response were 71%, 64%. and 82% in groups A, B, and C, respectively (log rank P = 0.01). Clinical/endoscopic scores and inflammatory biomarkers dropped significantly in CD and UC patients (P = 0.01 and P < 0.0001) compared with baseline. CONCLUSIONS In this large prospective cohort, no further signals of difference in safety and effectiveness of CT-P13 in IBD has been observed.
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Affiliation(s)
- Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Gionata Fiorino
- Humanitas Research Hospital and University, Gastroenterology and IBD Center, Rozzano, Italy
| | - Angela Variola
- Centro Malattie retto-intestinali, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Walter Fries
- University of Messina, Clinical Unit for Chronic Bowel Disorders, Messina, Italy
| | - Ambrogio Orlando
- Riuniti Villa Sofia-Cervello Hospital, Internal Medicine 2, IBD Unit Palermo, Italy
| | - Giovanni Maconi
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Fabrizio Bossa
- IRCCS-CSS Hospital, Gastroenterology, San Giovanni Rotondo, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, DiBiMis, University of Palermo, Palermo, Italy
| | - Livia Biancone
- University of Rome Tor Vergata, Department of Systems Medicine, Gastroenterology, Roma
| | - Laura Cantoro
- S. Camillo-Forlanini Hospital, Gastroenterology, Rome, Italy
| | | | - Renata D'Incà
- University of Padova, Gastroenterology, Padova, Italy
| | - Paolo Lionetti
- Meyer Children's Hospital, Gastroenterology and Nutrition, Florence, Italy
| | | | | | | | - Antonio Di Sabatino
- First Department of Medicine, S. Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Maria M Terpin
- U.O.C. Gastroenterologia ed Endoscopia Digestiva ASST Ovest Milanese, Legnano, Italy
| | | | - Simone Saibeni
- ASST Rhodense, Rho Hospital, Gastroenterology Unit, Rho, Italy
| | | | - Sandro Ardizzone
- Department of Biochemical and Clinical Science "L. Sacco" ASST Fatebenefratelli Sacco-University of Milan, Italy
| | - Luisa Guidi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Silvio Danese
- Humanitas Research Hospital and University, Gastroenterology and IBD Center, Rozzano, Italy
| | - Arianna Massella
- Centro Malattie retto-intestinali, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Agostino Ventra
- University of Messina, Clinical Unit for Chronic Bowel Disorders, Messina, Italy
| | - Giulia Rizzuto
- Riuniti Villa Sofia-Cervello Hospital, Internal Medicine 2, IBD Unit Palermo, Italy
| | - Alessandro Massari
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Francesco Perri
- IRCCS-CSS Hospital, Gastroenterology, San Giovanni Rotondo, Italy
| | - Vito Annese
- AOU Careggi, Gastroenterology, Florence, Italy
| | | | | | - Carlo Petruzzellis
- Istituto Fondazione Poliambulanza Hospital, Department of Medicine, Gastroenterology and Digestive Endoscopy, Brescia, Italy
| | | | | | | | | | - Luigi Caserta
- IRCCS AOU San Martino IST Gastroenterology Genova, Italy
| | | | | | | | - Daniela Pugliese
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Andrea Geccherle
- Centro Malattie retto-intestinali, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | | | - Sara Renna
- Riuniti Villa Sofia–Cervello Hospital, Internal Medicine 2, IBD Unit Palermo, Italy
| | - Andrea Cassinotti
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Angelo Andriulli
- IRCCS-CSS Hospital, Gastroenterology, San Giovanni Rotondo, Italy
| | | | - Barbara Scrivo
- Gastroenterology and Hepatology Section, DiBiMis, University of Palermo, Palermo, Italy
| | - Edoardo Troncone
- University of Rome Tor Vergata, Department of Systems Medicine, Gastroenterology, Roma
| | - Anna Kohn
- S. Camillo-Forlanini Hospital, Gastroenterology, Rome, Italy
| | | | | | - Silvia Ghione
- Meyer Children’s Hospital, Gastroenterology and Nutrition, Florence, Italy
| | - Olga Nardone
- University of Bari, Gastroenterology, Bari, Italy
| | - Maurizio Vecchi
- Federico II University, Gastroenterology, Naples, Italy
- Gastroenterology and Endoscopy Unit, IRCCS Ca’ Granda Ospedale Maggiore Foundation, Milan, Itay
| | | | - Matteo A Bosani
- U.O.C. Gastroenterologia ed Endoscopia Digestiva ASST Ovest Milanese, Legnano, Italy
| | - Cristina Bezzio
- ASST Rhodense, Rho Hospital, Gastroenterology Unit, Rho, Italy
| | - Raffaele Salerno
- Department of Biochemical and Clinical Science “L. Sacco” ASST Fatebenefratelli Sacco–University of Milan, Italy
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Lovero R, Losurdo G, Mastromauro M, Castellaneta NM, Mongelli A, Gentile A, Di Leo A, Principi M. A Case of Severe Transaminase Elevation Following a Single Ustekinumab Dose with Remission After Drug Withdrawal. Curr Drug Saf 2019; 13:221-223. [PMID: 30027852 DOI: 10.2174/1574886313666180719165212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ustekinumab is a fully human monoclonal antibody which binds Interleukin (IL)-12/23. It is indicated for the treatment of moderate-severe psoriasis and active psoriatic arthritis. Few data are available about the possibility of an interaction between ustekinumab and the liver. CASE DESCRIPTION We reported a case of a 61-year old woman admitted to our Unit for severe transaminase elevation (aspartate transaminase 756 IU/l, alanine transaminase 1212 IU/l) occurred after a single Ustekinumab infusion for psoriasis. All other possible causes of liver damage, including drugs, hepatitis viruses, auto-antibodies and metabolic disorders were excluded. Liver biopsy showed lymphocytic infiltration, biliary duct damage and piecemeal necrosis. On the bases of the nonspecific histological picture and Rucam score, we accomplished the diagnosis of "liver injury of iatrogenic origin". After drug withdrawal, a spontaneous normalization of liver enzymes occurred within six months.
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Affiliation(s)
- Rosa Lovero
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Marcella Mastromauro
- Section of Pathology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Nicola Maurizio Castellaneta
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Antonio Mongelli
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Antonietta Gentile
- Section of Pathology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
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Losurdo G, Principi M, Iannone A, Giangaspero A, Piscitelli D, Ierardi E, Di Leo A, Barone M. Predictivity of Autoimmune Stigmata for Gluten Sensitivity in Subjects with Microscopic Enteritis: A Retrospective Study. Nutrients 2018; 10:nu10122001. [PMID: 30567296 PMCID: PMC6315522 DOI: 10.3390/nu10122001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 02/07/2023] Open
Abstract
Non-celiac gluten sensitivity (NCGS) is an emerging gluten-related condition. We investigated whether the presence of autoimmune stigmata in a group of patients with clinical suspicion of NCGS and a histological picture of microscopic enteritis (ME) could be a predictive factor of NCGS. Patients with ME were followed up by periodical examinations. At baseline, we collected data about previous clinical history, including autoimmune diseases. NCGS was diagnosed according to Salerno criteria; other causes of ME were diagnosed according to well-established protocols. Patients with celiac disease were excluded. Student's and chi-square tests were used in univariate analysis. Kaplan-Meier curves and Cox regression were used to estimate hazard ratios (HR). Sixty-three patients were included. Twenty-two had a final diagnosis of NCGS; the remaining 41 had non-gluten-related causes of ME. Prevalence of autoimmune thyroiditis was higher among NCGS patients (40.1%) than in other ME (14.6%; p = 0.03). NCGS showed higher positivity rate for anti-gliadin (27.3% versus 2.5%; p = 0.006) and anti-nucleus (45.4% versus 12.2%; p = 0.005). Autoimmune thyroiditis had a non-significant trend (p = 0.06) for NCGS diagnosis, (HR = 2.4). Both anti-gliadin (HR = 2.4; p = 0.04) and anti-nucleus (HR = 2.7; p = 0.04) were directly associated with NCGS diagnosis. In conclusion, NCGS may have a cohort of autoimmune stigmata that can precede its diagnosis.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Antonio Giangaspero
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Domenico Piscitelli
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
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Shahini E, Iannone A, Romagno D, Armandi A, Carparelli S, Principi M, Viggiani MT, Ierardi E, Di Leo A, Barone M. Clinical relevance of serum non-organ-specific antibodies in patients with HCV infection receiving direct-acting antiviral therapy. Aliment Pharmacol Ther 2018; 48:1138-1145. [PMID: 30375693 DOI: 10.1111/apt.14999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/26/2018] [Accepted: 09/05/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is associated with production of different serum non-organ-specific antibodies (NOSA) and risk for developing autoimmune disorders. The clinical significance of these phenomena is not fully understood. AIM To assess non-organ-specific antibodies before and 24 weeks after the end of therapy with direct-acting antivirals in patients with HCV-related infection, to better clarify the clinical relevance of these antibodies in terms of treatment response and prognostic value. METHODS Patients enrolled (191) were considered non-organ-specific antibody-positive for titres ≥1:40 on at least two determinations before treatment. RESULTS At baseline, 46 patients were positive and 145 were negative for autoantibodies. The prevalence of autoimmune thyroiditis was significantly higher in non-organ-specific antibody-positive group than non-organ-specific antibody-negative group (P = 0.02). HCV-RNA 24 weeks after the end of antiviral therapy was 100% negative in patients with antibodies positivity and 98.6% in antibody-negative patients (P = 1.0). In the former group, autoantibodies disappeared in 30 of 46 patients (65.2%). On multivariate analysis, non-organ-specific antibody-negativity was significantly reduced in patients with hepatic hilar lymphadenopathy (OR = 0.17; 95% CI 0.02-0.94, P = 0.04). None of the adverse events occurring during antiviral therapy was related to autoimmune disorders. CONCLUSIONS Hepatitis C virus clearance frequently reduces non-organ-specific antibody positivity suggesting that they represent an epiphenomenon of the viral infection. However, in patients who did not become negative, long-term monitoring would establish whether they could hide an underlying process that may progress into a clear autoimmune or rheumatologic disease. (Trial registration number: NCT03566966).
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Affiliation(s)
- Endrit Shahini
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Andrea Iannone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Domenico Romagno
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Angelo Armandi
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Sonia Carparelli
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Maria Teresa Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Enzo Ierardi
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
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Girardi B, Principi M, Pricci M, Giorgio F, Iannone A, Losurdo G, Ierardi E, Di Leo A, Barone M. Chemoprevention of inflammation-related colorectal cancer by silymarin-, acetyl-11-keto-beta-boswellic acid-, curcumin- and maltodextrin-enriched dietetic formulation in animal model. Carcinogenesis 2018; 39:1274-1282. [PMID: 30084990 DOI: 10.1093/carcin/bgy104] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/31/2018] [Indexed: 02/07/2023] Open
Abstract
On the basis of preliminary in vitro experience, we assessed whether an enriched nutritional formulation with estrogen receptor (ER)-beta agonist and anti-inflammatory properties may prevent inflammation-associated colorectal cancer (CRC) in an animal model. Study sample enclosed 110 C57BL/6J male mice. Forty underwent dietary supplement safety assessment (20 standard diet and 20 enriched formulation). Seventy were treated with azoxymethane (AOM)/dextran sulfate sodium and divided into two groups: 35 received standard diet and 35 enriched formulation (curcumin, boswellic acids, silymarin and maltodextrins). Miniature colonoscopy demonstrated colitis and solid lesion development in five mice/group 100 days after first AOM injection. Mice were killed after 10 days. In each group, four subgroups received intraperitoneal bromodeoxyuridine (BrdU) injection at 24th/48th/72nd/96th hour before killing. Anti-inflammatory effect and chemoprevention were evaluated by lesion number/size, histological inflammation/dysplasia/neoplasia assessment, pro-inflammatory cytokine messenger RNA (mRNA), ER-beta/ER-alpha/BrdU immunohistochemistry and TUNEL immunofluorescence. Standard formulation assumption was associated with colon shortening compared with enriched one (P = 0.04), which reduced solid lesion number and size (P < 0.001 for both), histological inflammation score (P = 0.04), pro-inflammatory cytokine mRNA expression (P < 0.001), number of low-grade dysplasia (LGD; P = 0.03) and high-grade dysplasia (P < 0.001) areas. CRC was observed in 69.6% in standard and 23.5% in enriched formulation assuming animals (P < 0.001). Enriched formulation induced lower ER-alpha expression in CRC (P < 0.001) and higher ER-beta expression in LGD (P < 0.001) being associated to higher epithelial turnover (BrdU; P<0.001) in normal mucosa and increased apoptosis in LGD and CRC (P < 0.001 for both). Our results are promising for a successful anti-inflammatory and chemopreventive effect of enriched formulation in CRC arising from inflamed tissue.
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Affiliation(s)
| | - Mariabeatrice Principi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | | | - Andrea Iannone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Losurdo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Iannone A, Giorgio F, Russo F, Riezzo G, Girardi B, Pricci M, Palmer SC, Barone M, Principi M, Strippoli GFM, Di Leo A, Ierardi E. New fecal test for non-invasive Helicobacter pylori detection: A diagnostic accuracy study. World J Gastroenterol 2018; 24:3021-3029. [PMID: 30038469 PMCID: PMC6054951 DOI: 10.3748/wjg.v24.i27.3021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/12/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the diagnostic accuracy of a new fecal test for detecting Helicobacter pylori (H. pylori), using13C-urea breath test as the reference standard, and explore bacterial antibiotic resistance.
METHODS We conducted a prospective two-center diagnostic test accuracy study. We enrolled consecutive people≥ 18 years without previous diagnosis of H. pylori infection, referred for dyspepsia between February and October 2017. At enrollment, all participants underwent 13C-urea breath test. Participants aged over 50 years were scheduled to undergo upper endoscopy with histology. Participants collected stool samples 1-3 d after enrollment for a new fecal investigation (THD fecal test). The detection of bacterial 23S rRNA subunit gene indicated H. pylori infection. We also used the index diagnostic test to examine mutations conferring resistance to clarithromycin and levofloxacin. Independent investigators analyzed index test and reference test standard results blinded to the other test findings. We estimated sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, diagnostic accuracy, positive and negative likelihood ratio (LR), together with 95% confidence intervals (CI).
RESULTS We enrolled 294 consecutive participants (age: Median 37.0 years, IQR: 29.0-46.0 years; men: 39.8%). Ninety-five (32.3%) participants had a positive13C-urea breath test. Twenty-three (7.8%) participants underwent upper endoscopy with histology, with a full concordance between 13C-urea breath test and histology in detecting H. pylori infection. Four (1.4%) out of the 294 participants withdrew from the study after the enrollment visit and did not undergo THD fecal testing. In the 290 participants who completed the study, the THD fecal test sensitivity was 90.2% (CI: 84.2%-96.3%), specificity 98.5% (CI:96.8%-100%), PPV 96.5% (CI: 92.6%-100%), NPV 95.6% (CI: 92.8%-98.4%), accuracy 95.9% (CI: 93.6%-98.2%), positive LR 59.5(CI: 19.3-183.4), negative LR 0.10 (CI: 0.05-0.18). Out of 83 infected participants identified with the THD fecal test, 34 (41.0%) had bacterial genotypic changes consistent with antibiotic-resistant H. pylori infection. Of these, 27 (32.5%) had bacterial strains resistant to clarithromycin, 3 (3.6%) to levofloxacin, and 4 (4.8%) to both antibiotics.
CONCLUSION The THD fecal test has high performance for the non-invasive diagnosis of H. pylori infection while additionally enabling the assessment of bacterial antibiotic resistances.
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Affiliation(s)
- Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
- Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | - Francesco Russo
- National Institute of Gastroenterology, “S De Bellis” Research Hospital, CastellanaGrotte (Bari) 70013, Italy
| | - Giuseppe Riezzo
- National Institute of Gastroenterology, “S De Bellis” Research Hospital, CastellanaGrotte (Bari) 70013, Italy
| | | | | | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch 8011, New Zealand
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Giovanni FM Strippoli
- Diaverum Academy, Lund 22229, Sweden
- Diaverum Medical Scientific Office, Lund 22229, Sweden
- Sydney School of Public Health, University of Sydney, Sydney NSW-2000, Australia
- Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Principi M, Losurdo G, Iannone A, Contaldo A, Deflorio V, Ranaldo N, Pisani A, Ierardi E, Di Leo A, Barone M. Differences in dietary habits between patients with inflammatory bowel disease in clinical remission and a healthy population. Ann Gastroenterol 2018; 31:469-473. [PMID: 29991892 PMCID: PMC6033751 DOI: 10.20524/aog.2018.0273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/05/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although patients with active inflammatory bowel disease (IBD) change their dietary habits according to suggestions from their healthcare team, no restriction is required in the remission phase. Accordingly, we compared eating patterns in IBD patients with drug-induced clinical remission with those in healthy subjects. METHODS A total of 150 IBD patients, 84 with Crohn's disease (CD) and 66 with ulcerative colitis (UC), in clinical remission, receiving immunomodulator/biologic therapy, and 100 healthy volunteers (controls) were enrolled. The IBD diagnosis had previously been established by a combined assessment of symptoms, endoscopy, histology and abdominal imaging. Clinical remission was defined as a Harvey Bradshaw index <5 for CD and a partial Mayo score <2 for UC. An experienced nutritionist guided the compilation of a food diary for 7 days according to current guidelines. Macronutrient and fiber intake was evaluated using dedicated software. Comparison between continuous variables was performed using Student's t-test or analysis of variance plus Bonferroni post-hoc analysis. Categorical variables were tested with the χ2 test. RESULTS No difference in protein and carbohydrate intake was observed. IBD patients ate more calories (1970.7±348.4 vs. 1882.1±280.2 kcal/day, P=0.03), more lipids (68.9±15.2 vs. 59.4±19.0 g/day, P<0.001) and less fibers (11.9±4.7 vs. 15.5±8.3 g/day, P<0.001) than controls. No significant difference in total calories, proteins, lipids, carbohydrates or fibers was seen between CD and UC patients. CONCLUSION IBD patients have a different macronutrient and fiber intake compared to healthy subjects, even when clinical remission and no symptoms do not dictate dietary restrictions. Therefore, psychological issues may be involved.
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Affiliation(s)
- Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Italy
| | - Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Italy
| | - Valentina Deflorio
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Italy
| | - Nunzio Ranaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Italy
| | - Antonio Pisani
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Italy
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Principi M, Iannone A, Losurdo G, Mangia M, Shahini E, Albano F, Rizzi SF, La Fortezza RF, Lovero R, Contaldo A, Barone M, Leandro G, Ierardi E, Di Leo A. Nonalcoholic Fatty Liver Disease in Inflammatory Bowel Disease: Prevalence and Risk Factors. Inflamm Bowel Dis 2018; 24:1589-1596. [PMID: 29688336 DOI: 10.1093/ibd/izy051] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is common in inflammatory bowel diseases (IBD). Herein, NAFLD prevalence and risk factors in a large IBD cohort were evaluated and compared to that of a non-IBD sample. METHODS Crohn's disease/ulcerative colitis outpatients referred to IBD service of our Gastroenterology Unit were enrolled. Subjects affected by functional and motor gastrointestinal disorders, in whom IBD was ruled out, referred to general outpatient service in the same area, were considered as nonIBD group. Exclusion criteria were based on previous diagnosis of nonNAFLD chronic liver diseases and secondary causes of fat liver overload. Characteristics of IBD and liver status were collected. Risk factors for metabolic syndrome were analyzed. Ultrasonographic presence and degree of steatosis were assessed. Data were examined by univariate and multivariate analyses. RESULTS For this study 465 IBD and 189 non-IBD subjects were consecutively enrolled. NAFLD was found in 28.0% and 20.1% in IBD and non-IBD subjects, respectively (P = 0.04). IBD patients with NAFLD were younger than non-IBD ones. There was no significant difference in steatosis grade and association between NAFLD and IBD behavior, extension, activity, and drugs. In the IBD group, multivariate analysis demonstrated that NAFLD was independently associated to metabolic syndrome (OR=2.24, 95%CI 1.77-28.81), diabetes (OR=1.71, 95%CI 1.43-12.25), fasting blood glucose (OR=1.36, 95%CI 1.13-1.68), and abdominal circumference (OR=1.68, 95%CI 1.15-14.52). CONCLUSIONS NAFLD is more common and occurs at a younger age in IBD than in nonIBD subjects. However, further investigation is required to ascertain possible NAFLD pathogenic IBD-related factors other than conventional/metabolic ones. 10.1093/ibd/izy051_video1izy051.video15774874877001.
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Affiliation(s)
- Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Michela Mangia
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Endrit Shahini
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Francesca Albano
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Salvatore Fabio Rizzi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Rosa Federica La Fortezza
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Rosa Lovero
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Antonella Contaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Gioacchino Leandro
- National Institute of Gastroenterology, "S De Bellis" Research Hospital, Castellana Grotte, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
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Barone M, Shahini E, Iannone A, Viggiani MT, Corvace V, Principi M, Di Leo A. Critical flicker frequency test predicts overt hepatic encephalopathy and survival in patients with liver cirrhosis. Dig Liver Dis 2018. [PMID: 29530628 DOI: 10.1016/j.dld.2018.01.133] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A critical flicker frequency (CFF) ≤39 Hz identifies cirrhotic patients with minimal hepatic encephalopathy (mHE) and predicts the risk of both overt hepatic encephalopathy (oHE) and mortality in patients with previous episodes of decompensation and/or oHE. AIMS Herein, we evaluated the effectiveness of CFF in predicting the first episode of oHE and survival in cirrhotics who had never experienced an episode of oHE. METHODS Our cohort study of 134 patients and 150 healthy subjects were examined. A CFF > 39 Hz was considered normal and pathological when ≤39 Hz. The median follow up was 36 months. RESULTS At baseline, all controls had CFF > 39 Hz. Ninety-three patients had a CFF > 39 Hz and 41 had a CFF ≤ 39 Hz. The prevalence of CFF ≤ 39 Hz significantly increased with the progression of the Child-Pugh class (p = 0.003). Moreover, the risk of oHE was increased by CFF ≤ 39 (p < 0.001, by log-rank test) [HR = 7.57; CI(3.27-17.50); p < 0.0001, by Cox model] and ammonia [HR = 1.02 CI(1.01-1.03), p = 0.0009]. Both a CFF value ≤ 39 Hz and Child-Pugh class were independent predictors of mortality by Cox model [HR = 1.97; CI(1.01-3.95), p = 0.049; HR = 3.85 CI(1.68-8.83), p = 0.003]. CONCLUSIONS CFF predicts the first episode of oHE in cirrhotics that had never experienced oHE, and predicts mortality risk. These findings suggest that cirrhotic patients should be routinely screened by CFF.
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Affiliation(s)
- Michele Barone
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Italy
| | - Endrit Shahini
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Italy
| | - Andrea Iannone
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Italy
| | - Maria Teresa Viggiani
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Italy
| | | | - Mariabeatrice Principi
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Italy.
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Losurdo G, Principi M, Iannone A, Amoruso A, Ierardi E, Di Leo A, Barone M. Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm. World J Gastroenterol 2018; 24:1521-1530. [PMID: 29662290 PMCID: PMC5897856 DOI: 10.3748/wjg.v24.i14.1521] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 02/06/2023] Open
Abstract
Non celiac gluten sensitivity (NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not affected by celiac disease (CD) or wheat allergy. The possibility of systemic manifestations in this condition has been suggested by some reports. In most cases they are characterized by vague symptoms such as ‘foggy mind’, headache, fatigue, joint and muscle pain, leg or arm numbness even if more specific complaints have been described. NCGS has an immune-related background. Indeed there is a strong evidence that a selective activation of innate immunity may be the trigger for NCGS inflammatory response. The most commonly autoimmune disorders associated to NCGS are Hashimoto thyroiditis, dermatitis herpetiformis, psoriasis and rheumatologic diseases. The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported; it could be a characteristic feature that could help the diagnosis and be simultaneously managed. A possible neurological involvement has been underlined by NCGS association with gluten ataxia, gluten neuropathy and gluten encephalopathy. NCGS patients may show even psychiatric diseases such as depression, anxiety and psychosis. Finally, a link with functional disorders (irritable bowel syndrome and fibromyalgia) is a topic under discussion. In conclusion, the novelty of this matter has generated an expansion of literature data with the unavoidable consequence that some reports are often based on low levels of evidence. Therefore, only studies performed on large samples with the inclusion of control groups will be able to clearly establish whether the large information from the literature regarding extra-intestinal NCGS manifestations could be supported by evidence-based agreements.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari 70124, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari 70124, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari 70124, Italy
| | - Annacinzia Amoruso
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari 70124, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari 70124, Italy
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Chaparro M, Verreth A, Lobaton T, Gravito-Soares E, Julsgaard M, Savarino E, Magro F, Biron AI, Lopez-Serrano P, Casanova MJ, Gompertz M, Vitor S, Arroyo M, Pugliese D, Zabana Y, Vicente R, Aguas M, Shitrit BGA, Gutierrez A, Doherty GA, Fernandez-Salazar L, Cadilla MJ, Huguet JM, OʼToole A, Stasi E, Marcos MN, Villoria A, Karmiris K, Rahier JF, Rodriguez C, Palomares DLM, Fiorino G, Benitez JM, Principi M, Naftali T, Taxonera C, Mantzaris G, Sebkova L, Iade B, Lissner D, Bradley FI, Roman LSA, Marin-Jimenez I, Merino O, Sierra M, Van Domselaar M, Caprioli F, Guerra I, Peixe P, Piqueras M, Rodriguez-Lago I, Ber Y, van Hoeve K, Torres P, Gravito-Soares M, Rudbeck-Resdal D, Bartolo O, Peixoto A, Martin G, Armuzzi A, Garre A, Donday MG, de Carpi MFJ, Gisbert JP. Long-Term Safety of In Utero Exposure to Anti-TNFα Drugs for the Treatment of Inflammatory Bowel Disease: Results from the Multicenter European TEDDY Study. Am J Gastroenterol 2018; 113:396-403. [PMID: 29460920 DOI: 10.1038/ajg.2017.501] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 11/26/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The long-term safety of exposure to anti-tumor necrosis factor (anti-TNFα) drugs during pregnancy has received little attention. We aimed to compare the relative risk of severe infections in children of mothers with inflammatory bowel disease (IBD) who were exposed to anti-TNFα drugs in utero with that of children who were not exposed to the drugs. METHODS Retrospective multicenter cohort study. Exposed cohort: children from mothers with IBD receiving anti-TNFα medication (with or without thiopurines) at any time during pregnancy or during the 3 months before conception. Non-exposed cohort: children from mothers with IBD not treated with anti-TNFα agents or thiopurines at any time during pregnancy or the 3 months before conception. The cumulative incidence of severe infections after birth was estimated using Kaplan-Meier curves, which were compared using the log-rank test. Cox-regression analysis was performed to identify potential predictive factors for severe infections in the offspring. RESULTS The study population comprised 841 children, of whom 388 (46%) had been exposed to anti-TNFα agents. Median follow-up after delivery was 47 months in the exposed group and 68 months in the non-exposed group. Both univariate and multivariate analysis showed the incidence rate of severe infections to be similar in non-exposed and exposed children (1.6% vs. 2.8% per person-year, hazard ratio 1.2 (95% confidence interval 0.8-1.8)). In the multivariate analysis, preterm delivery was the only variable associated with a higher risk of severe infection (2.5% (1.5-4.3)). CONCLUSIONS In utero exposure to anti-TNFα drugs does not seem to be associated with increased short-term or long-term risk of severe infections in children.
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Affiliation(s)
- M Chaparro
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - A Verreth
- Department of Gastroenterology and Department of Pediatric Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - T Lobaton
- Hospital Universitari Germans Trias i Pujol and CIBEREHD, Badalona, Spain
| | | | - M Julsgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - F Magro
- Centro Hospitalar São João, Porto, Portugal
| | - Avni I Biron
- Gastroenterology Devision, Rabin Medical Center, Petach Tikva, Israel
| | | | - M J Casanova
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - M Gompertz
- Hospital Clinic and CIBEREHD, Barcelona, Spain
| | - S Vitor
- Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - M Arroyo
- Hospital Clinico Universitario Lozano Blesa, IIS Aragon, CIBEREHD, Zaragoza, Spain
| | - D Pugliese
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Roma, Italy
| | - Y Zabana
- Hospital Universitari Mutua de Terrassa and CIBEREHD, Terrassa, Spain
| | - R Vicente
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Aguas
- Hospital Universitario La Fe and CIBEREHD, Valencia, Spain
| | | | - A Gutierrez
- Hospital General Universitario de Alicante and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Alicante, Spain
| | - G A Doherty
- St. Vincents University Hospital, Dublin, Ireland
| | | | | | - J M Huguet
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | - E Stasi
- IRCCS Saverio de Bellis, Castellana Grotte, Italy
| | | | - A Villoria
- Hospital Universitari Parc Taulí.Institut d'Investigació i Innovació Parc Taulí. Departament de Medicina, Universitat Autònoma de Barcelona.CIBERehd, Instituto de Salud Carlos III, Sabadell, Spain
| | - K Karmiris
- Venizeleio General Hospital, Heraklion, Greece
| | | | - C Rodriguez
- Complejo Universitario de Navarra, Pamplona, Spain
| | | | - G Fiorino
- IBD Center, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy and Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - J M Benitez
- Hospital Universitario Reina Sofia and IMIBIC, Córdoba, Spain
| | - M Principi
- Azienda Policlinico Ospedaliero-Universitaria di Bari, Bari, Italy
| | - T Naftali
- Meir Hospital Kfar saba Tel Aviv University, Tel Aviv, Israel
| | - C Taxonera
- Hospital Clínico San Carlos and IdISSC, Madrid, Spain
| | - G Mantzaris
- Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens, Greece
| | - L Sebkova
- Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - B Iade
- Hospital de Clinicas, Montevideo, Uruguay
| | - D Lissner
- Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | | | - I Marin-Jimenez
- Hospital General Universitario Gregorio Marañón and IiSGM, Madrid, Spain
| | - O Merino
- Hospital Universitario de Cruces, Baracaldo, Spain
| | - M Sierra
- Complejo Universitario de León, León, Spain
| | | | - F Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano AND Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - I Guerra
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - P Peixe
- Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - M Piqueras
- Consorci Sanitari de Terrasa, Terrasa, Spain
| | | | - Y Ber
- Hospital San Jorge, Huesca, Spain
| | - K van Hoeve
- Department of Paediatrics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - P Torres
- Hospital Universitari Germans Trias i Pujol and CIBEREHD, Badalona, Spain
| | | | - D Rudbeck-Resdal
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - A Peixoto
- Centro Hospitalar São João, Porto, Portugal
| | - G Martin
- Gastroenterology Devision, Rabin Medical Center, Petach Tikva, Israel
| | - A Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Roma, Italy
| | - A Garre
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - M G Donday
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - J P Gisbert
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Losurdo G, Cubisino R, Barone M, Principi M, Leandro G, Ierardi E, Di Leo A. Probiotic monotherapy and Helicobacter pylori eradication: A systematic review with pooled-data analysis. World J Gastroenterol 2018; 24:139-149. [PMID: 29358890 PMCID: PMC5757118 DOI: 10.3748/wjg.v24.i1.139] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To define probiotic monotherapy effect on Helicobacter pylori (H. pylori) status by performing a systematic review.
METHODS Methods of analysis and inclusion criteria were based on PRISMA recommendations. Relevant publications were identified by searching PubMed, MEDLINE, Science Direct, and EMBASE. The end-point was to estimate eradication rate and urea breath test delta value before and after probiotic monotherapy across all studies and, overall, with a pooled data analysis. Adverse events of probiotic therapy were evaluated. The data were expressed as proportions/percentages, and 95%CIs were calculated. For continuous variables, we evaluated the weighted mean difference. Odd ratios (ORs) were calculated according to the Peto method for the comparison of eradication rates between probiotics and placebo.
RESULTS Eleven studies were selected. Probiotics eradicated H. pylori in 50 out of 403 cases. The mean weighted eradication rate was 14% (95%CI: 2%-25%, P = 0.02). Lactobacilli eradicated the bacterium in 30 out of 235 patients, with a mean weighted rate of 16% (95%CI: 1%-31%). Saccharomyces boulardii achieved eradication in 6 out of 63 patients, with a pooled eradication rate of 12% (95%CI: 0%-29%). Multistrain combinations were effective in 14 out of 105 patients, with a pooled eradication rate of 14% (95%CI: 0%-43%). In the comparison of probiotics vs placebo, we found an OR of 7.91 in favor of probiotics (95%CI: 2.97-21.05, P < 0.001). Probiotics induced a mean reduction in delta values higher than placebo (8.61% with a 95%CI: 5.88-11.34, vs 0.19% for placebo, P < 0.001). Finally, no significant difference in adverse events was found between probiotics and placebo (OR = 1, 95%CI: 0.06-18.08).
CONCLUSION Probiotics alone show a minimal effect on H. pylori clearance, thus suggesting a likely direct role.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
| | - Rossella Cubisino
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
| | - Gioacchino Leandro
- National Institute of Gastroenterology, “S De Bellis” Research Hospital, Via Turi, Castellana Grotte (BA) 70013, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
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Ierardi E, Losurdo G, Piscitelli D, Giorgio F, Amoruso A, Iannone A, Principi M, Di Leo A. Biological markers for non-celiac gluten sensitivity: a question awaiting for a convincing answer. Gastroenterol Hepatol Bed Bench 2018; 11:203-208. [PMID: 30013743 PMCID: PMC6040034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Non Celiac Gluten Sensitivity (NCGS) is characterized by immunological, morphological or symptomatic manifestations precipitated by gluten ingestion in individuals without celiac disease (CD). The most important challenge in NCGS is the diagnosis, currently based only on clinical observation. The "Salerno criteria" have been pointed out to achieve a reliable diagnosis even if they lack immediacy and practicality, thus making questionable patient's adherence. Therefore, biological indicators supporting the clinical diagnosis of NCGS are advisable. For these reasons, many attempts have been performed in order to identify possible serological, immunological, histopathological, immunohistochemical and pathophysiological aspects characterizing this condition with the aim of using them for diagnostic purposes. In the present narrative review, we carried out an update of the current scenario of potential markers of NCGS. The main fault of available studies is that, in most cases investigations have been pointed out towards molecules, which cannot be searched in the current laboratories of clinical analysis. Therefore, the matter has been confined within basic research. Additionally, in these studies, sensitivity and specificity of biological markers were not computable. This is a relevant limit, since an ideal test for NCGS should have a good discriminative power against both CD and other causes of microscopic enteritis. Until now, serological tests have failed, while the search for a soluble marker indicative of activation of innate immune system as well as immunohistochemistry could be the promising bases for the development of appropriate investigations in the future.
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Affiliation(s)
- Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Italy
| | - Domenico Piscitelli
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Italy
| | - Floriana Giorgio
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Italy
| | - Annacinzia Amoruso
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Italy
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Iannone A, Ruospo M, Wong G, Barone M, Principi M, Di Leo A, Strippoli GFM. Mesalazine for People with Diverticular Disease: A Systematic Review of Randomized Controlled Trials. Can J Gastroenterol Hepatol 2018; 2018:5437135. [PMID: 30320044 PMCID: PMC6167594 DOI: 10.1155/2018/5437135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/12/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diverticular disease treatment is limited to fibres, antibiotics, and surgery. There is conflicting evidence on mesalazine benefits and harms. AIM We systematically reviewed current evidence on benefits and harms of mesalazine versus all other treatments in people with diverticular disease. METHODS We searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov for studies published to July 2018. We estimated risk ratios (RR) for dichotomous outcomes (disease remission/recurrence, acute diverticulitis in symptomatic uncomplicated diverticular disease, need for surgery/hospitalization, all-cause/disease-related mortality, adverse events), mean differences (MD) or standardized MD (SMD) for continuous outcomes (quality of life, symptoms score, time to recurrence/remission), and their 95% confidence intervals (CI) using random-effects models. We quantified heterogeneity by Chi2 and I2 tests. We performed subgroup analyses by disease subtype, comparator, follow-up duration, mesalazine dose, and mode of administration. RESULTS We identified 13 randomized trials (n=3028 participants). There was a higher likelihood of disease remission with mesalazine than controls in acute uncomplicated diverticulitis (1 trial, 81 participants, RR=2.67, 95%CI=1.05-6.79), but not in symptomatic uncomplicated diverticular disease (1 trial, 123 participants, RR=1.04, 95%CI=0.81-1.34). There was a lower likelihood of disease recurrence with mesalazine than controls in symptomatic uncomplicated diverticular disease (2 trials, 216 participants, RR=0.52, 95%CI=0.28-0.97), but not in acute uncomplicated diverticulitis (7 trials, 2196 participants, RR=0.90, 95%CI=0.61-1.33). There was no difference in the likelihood of developing acute diverticulitis in symptomatic uncomplicated diverticular disease between the two groups (3 trials, 484 participants, RR=0.26, 95%CI=0.06-1.20). There was a higher global symptoms score reduction with mesalazine than controls in symptomatic uncomplicated diverticular disease (2 trials, 326 participants, SMD=-1.01, 95%CI=-1.51,-0.52) and acute uncomplicated diverticulitis (2 trials, 153 participants, SMD=-0.56, 95%CI=-0.88,-0.24). CONCLUSIONS Mesalazine may reduce recurrences in symptomatic uncomplicated diverticular disease. There is uncertainty on the effect of mesalazine in achieving diverticular disease remission. Mesalazine may not prevent acute diverticulitis in symptomatic uncomplicated diverticular disease.
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Affiliation(s)
- Andrea Iannone
- 1Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Marinella Ruospo
- 2Diaverum Medical Scientific Office, Lund, Sweden
- 3Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Germaine Wong
- 4Sydney School of Public Health, University of Sydney, Australia
- 5Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - Michele Barone
- 1Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Mariabeatrice Principi
- 1Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Alfredo Di Leo
- 1Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Giovanni F. M. Strippoli
- 2Diaverum Medical Scientific Office, Lund, Sweden
- 4Sydney School of Public Health, University of Sydney, Australia
- 6Diaverum Academy, Lund, Sweden
- 7Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Italy
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49
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Losurdo G, Principi M, Girardi B, Pricci M, Barone M, Ierardi E, Di Leo A. Histamine and Histaminergic Receptors in Colorectal Cancer: From Basic Science to Evidence-based Medicine. Anticancer Agents Med Chem 2018; 18:15-20. [PMID: 26996193 DOI: 10.2174/1871520616666160321115349] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/10/2016] [Accepted: 03/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Histamine is an imidazolic compound performing a crucial function in the pathogenesis of inflammation. Several studies have also emphasized its pro-carcinogenic effect in colorectal cancer (CRC). OBJECT In fact, increased histamine levels have been observed in CRC and a decreased catabolism of this molecule is typical of colorectal adenomas. Additional data have demonstrated that CRC is characterized by an altered balance of histamine receptors (HRs); in fact, HR1 and HR4 are down-regulated in CRC, while HR2 is overexpressed. METHOD Based on this evidence, we reviewed several studies investigating the role of HR2 antagonists (HR2A), such as cimetidine in CRC. RESULTS From a clinical point of view, HR2A may prolong the survival rates of patients with CRC, and a recent meta-analysis seems to confirm this finding. From a biological perspective, it has been demonstrated that HR2A could have a beneficial effect on CRC for many reasons: i) promotion of peri-tumoral lymphocyte growth and improvement of immune response against the tumor, ii) suppression of adhesion molecules which might favor metastasis, iii) anti-angiogenetic activity (reduction of VEGF), iv) increased production of some cytokines which may counteract tumor growth, such as tumor necrosis factor (TNF) alpha, interleukin (IL)-10 and IL-15. On the contrary, HR1 antagonists did not demonstrate any beneficial effect on CRC. Therefore, it is presumable that histamine could be a relevant player in the development of CRC, but its effect might be mediated by an imperfect homeostasis of its receptors. CONCLUSION In this scenario, HR2A could inhibit carcinogenesis whereas HR2 might act as a pro-carcinogenetic, while HR1 and HR4, being suppressed in CRC, may antagonize neoplastic development.
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Affiliation(s)
- Giuseppe Losurdo
- Gastroenterology Division, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Gastroenterology Division, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Bruna Girardi
- Gastroenterology Division, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Pricci
- Gastroenterology Division, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Division, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Gastroenterology Division, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Division, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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50
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Barone M, Viggiani MT, Losurdo G, Principi M, Leandro G, Di Leo A. Letter: dose-response analysis revealed closer relationship between obesity and perioperative outcomes in patients after liver transplantation-Authors' reply. Aliment Pharmacol Ther 2018; 47:312-313. [PMID: 29265461 DOI: 10.1111/apt.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M Barone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, BA, Italy
| | - M T Viggiani
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, BA, Italy
| | - G Losurdo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, BA, Italy
| | - M Principi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, BA, Italy
| | - G Leandro
- Gastroenterology, S de Bellis Hospital, castellana grotte, BA, Italy
| | - A Di Leo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, BA, Italy
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