1
|
Velho S, Morão B, Gouveia C, Agostinho L, Torres J, Maio R, Baracos V, Cravo M. Body Composition And Crohn’s Disease Behavior: Is Adiposity The Main Game Changer? Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
|
2
|
Portela F, Ministro P, de Deus J, Cravo M, Cotter J, Duque G, Ferreira F, Rosa B, Ferreira PL, Dias CC, Magro F. Health-Related Quality of Life in Patients with Moderate to Severe Ulcerative Colitis: Surgical Intervention versus Immunomodulatory Therapy. Digestion 2021; 101:631-637. [PMID: 31494658 DOI: 10.1159/000501823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/30/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Ulcerative colitis (UC) can be managed with immunomodulation or surgery. We aimed to understand whether these strategies had a different impact on patients' health-related quality of life (HRQoL). METHODS This was a retrospective, cross-sectional study: patients who had a moderate to severe UC episode that prompted the utilization of immunomodulatory drugs or surgery were invited to complete a generic (short form [36] health survey [SF-36]) and a disease-specific (inflammatory bowel disease questionnaire [IBDQ]) survey. RESULTS We included 157 patients, 65 (41.4%) surgically treated. The therapeutic procedure had a minimal impact on HRQoL: only the social dimension of the IBDQ and the physical function component of the SF-36 were significantly different between the study arms - lower for the surgically treated patients. The type of surgery had no impact, but the occurrence of pouchitis, namely, in a chronic form, was associated with a lower HRQoL. Regression analysis confirmed surgery as an independent predictor of lower scores in the social dimension of the IBDQ (-4.646, 95% CI -6.953 to -2.339) and in the physical functioning (-9.622, 95% CI -17.061 to -2.183) and physical role functioning (-3.669, 95% CI -7.339 to 0.001) dimensions of the SF36. CONCLUSIONS Although usually feared by patients, surgery has a limited impact on UC patients HRQoL when compared to medical management with immunomodulatory drugs.
Collapse
Affiliation(s)
- Francisco Portela
- Department of Gastroenterology, Centro-Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Centro-Hospitalar Tondela Viseu, Viseu, Portugal
| | - João de Deus
- Department of Gastroenterology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Marilia Cravo
- Department of Gastroenterology, Instituto Português Oncologia de Lisboa, Lisboa, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,School of Medicine, University of Minho, Braga, Portugal
| | - Gabriela Duque
- Department of Gastroenterology, Hospital Figueira da Foz, Figueira da Foz, Portugal
| | - Frederico Ferreira
- Department of Gastroenterology, Centro-Hospitalar São João, Porto, Portugal
| | - Bruno Rosa
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | | | - Claudia Camila Dias
- Department of Health Information and Decision Sciences, Faculty of Medicine, Porto University, Porto, Portugal.,Center for Health Technology and Services Research, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro-Hospitalar São João, Porto, Portugal, .,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, Porto University, Porto, Portugal, .,MedInUP, Centre for Drug Discovery and Innovative Medicines, Porto University, Porto, Portugal,
| | | |
Collapse
|
3
|
Velho S, Rodrigues S, Moço S, Costa L, Abreu C, Borges A, Clemente S, Godinho J, Faria A, Teixeira J, Maio R, Baracos V, Cravo M. Adherence to a combined exercise and dietary intervention in patients with gastrointestinal cancer undergoing neo-adjuvant therapy. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
4
|
Magro F, Lopes J, Borralho P, Lopes S, Coelho R, Cotter J, Dias de Castro F, Tavares de Sousa H, Salgado M, Andrade P, Vieira AI, Figueiredo P, Caldeira P, Sousa A, Duarte MA, Ávila F, Silva J, Moleiro J, Mendes S, Giestas S, Ministro P, Sousa P, Gonçalves R, Gonçalves B, Oliveira A, Chagas C, Cravo M, Dias CC, Afonso J, Portela F, Santiago M, Geboes K, Carneiro F. Comparing the Continuous Geboes Score With the Robarts Histopathology Index: Definitions of Histological Remission and Response and their Relation to Faecal Calprotectin Levels. J Crohns Colitis 2020; 14:169-175. [PMID: 31504348 DOI: 10.1093/ecco-jcc/jjz123] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The histological status of ulcerative colitis [UC] patients in clinical and endoscopic remission has gained space as an important prognostic marker and a key component of disease monitoring. Our main aims were to compare two histological indexes-the continuous Geboes score [GS] and the Robarts Histopathology index [RHI]-regarding their definitions of histological remission and response, and the ability of faecal calprotectin [FC] levels to discriminate between these statuses. METHODS This was an analysis of three prospective cohorts including 422 patients previously enrolled in other studies. RESULTS The two continuous scores [GS and RHI] were shown to be significantly correlated [correlation coefficient of 0.806, p < 0.001] and particularly close regarding their definition of histological response: 95% and 88% of all patients classified as having/not having [respectively] histological response according to RHI also did so according to GS. Moreover, median FC levels in patients with histological response were lower than those in patients without histological response [GS: 73.00 vs 525.00, p < 0.001; RHI: 73.50 vs 510.00, p < 0.001]; a similar trend was observed when FC levels of patients in histological remission were compared to those of patients with histological activity [GS: 76.00 vs 228.00, p < 0.001; RHI: 73.50 vs 467.00, p < 0.001]. FC levels allowed us to exclude the absence of histological remission [according to RHI] and absence of histological response [according to RHI and GS], with negative predictive values varying from 82% to 96%. However, optimization of the FC cut-off to exclude the absence of histological remission, as for the continuous GS, falls within values that resemble those of the healthy population. CONCLUSION The continuous GS and RHI histological scores are strongly correlated in their definitions of histological response. An absence of histological remission could only be excluded at physiological levels of FC.
Collapse
Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.,Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joanne Lopes
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Paula Borralho
- Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Susana Lopes
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - Helena Tavares de Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve - Portimão Unit, Portimão, Portugal.,ABC - Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Marta Salgado
- Department of Gastroenterology, Centro Hospitalar do Porto, Hospital de Santo António, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Ana Isabel Vieira
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Figueiredo
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Paulo Caldeira
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - A Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - Maria A Duarte
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - Filipa Ávila
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - João Silva
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisbon, Portugal
| | - Sofia Mendes
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sílvia Giestas
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Raquel Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Bruno Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Ana Oliveira
- Department of Gastroenterology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Cristina Chagas
- Department of Gastroenterology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Marilia Cravo
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mafalda Santiago
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Fátima Carneiro
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), University of Porto, Porto, Portugal
| |
Collapse
|
5
|
Guerreiro MM, Santos Z, Carolino E, Correa J, Cravo M, Augusto F, Chagas C, Guerreiro CS. Effectiveness of Two Dietary Approaches on the Quality of Life and Gastrointestinal Symptoms of Individuals with Irritable Bowel Syndrome. J Clin Med 2020; 9:jcm9010125. [PMID: 31906563 PMCID: PMC7019629 DOI: 10.3390/jcm9010125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 12/12/2022] Open
Abstract
To evaluate the effectiveness of a low FODMAP (fermentable oligosaccharides, monosaccharaides, disaccharides and polyols) diet in the relief of symptoms and an improvement of the quality of life in individuals with irritable bowel syndrome in comparison to a standard diet according to the British Dietetic Association's guidelines. A non-randomized clinical trial of adult patients with IBS was compared two diet interventions. An assessment of symptoms, quality of life, and nutritional status was performed before and after the four-week mark of intervention. Individuals from the Low FODMAP Diet (LFD) group were evaluated on a third moment, after the controlled reintroduction of FODMAPs. A total of 70 individuals were divided in two groups: Low FODMAP Diet (LFD; n = 47) and Standard Diet (SD; n = 23). 57 individuals completed the four-week intervention (LFD; n = 39; SD; n = 18). At the completion of four weeks, the symptoms improved in both groups (LFD: p < 0.01; DC: p < 0.05) but LFD led to a higher relief (p < 0.05), primarily with respect to abdominal pain and diarrhoea. Quality of life improved significantly in both groups, with no significant differences between SD vs LFD (p > 0.05). In the LFD group, the relief of symptoms observed at the four-week mark remained constant after reintroduction of FODMAPs. Both interventions seem to be effective for the relief of symptoms and quality of life, however LFD had higher effectiveness in the former. The results with LFD suggest it can be a preferred approach in individuals with diarrhoeal profile.
Collapse
Affiliation(s)
- Maria Margarida Guerreiro
- Universidade de Lisboa, Faculdade de Medicina, Laboratório de Nutrição, 1649-045 Lisboa, Portugal; (M.M.G.); (J.C.)
- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal;
| | - Zélia Santos
- Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, 1349-019 Lisboa, Portugal; (Z.S.); (C.C.)
| | - Elisabete Carolino
- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal;
| | - Julieta Correa
- Universidade de Lisboa, Faculdade de Medicina, Laboratório de Nutrição, 1649-045 Lisboa, Portugal; (M.M.G.); (J.C.)
| | - Marilia Cravo
- Hospital Beatriz Ângelo, Serviço de Gastrenterologia, 2674-514 Loures, Portugal;
| | - Fátima Augusto
- Hospital da Luz Setúbal – Serviço de Gastrenterologia, 2900-722 Setúbal, Portugal;
| | - Cristina Chagas
- Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, 1349-019 Lisboa, Portugal; (Z.S.); (C.C.)
| | - Catarina Sousa Guerreiro
- Universidade de Lisboa, Faculdade de Medicina, Laboratório de Nutrição, 1649-045 Lisboa, Portugal; (M.M.G.); (J.C.)
- Correspondence: ; Tel.: +351-937-299-988
| |
Collapse
|
6
|
Magro F, Lopes S, Silva M, Coelho R, Portela F, Branquinho D, Correia L, Fernandes S, Cravo M, Caldeira P, Sousa HT, Patita M, Lago P, Ramos J, Afonso J, Redondo I, Machado P, Cornillie F, Lopes J, Carneiro F. Low Golimumab Trough Levels at Week 6 Are Associated With Poor Clinical, Endoscopic and Histological Outcomes in Ulcerative Colitis Patients: Pharmacokinetic and Pharmacodynamic Sub-analysis of the Evolution Study. J Crohns Colitis 2019; 13:1387-1393. [PMID: 30989180 DOI: 10.1093/ecco-jcc/jjz071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Golimumab has an established exposure-response relationship in patients with ulcerative colitis [UC]. However, the association of serum golimumab trough levels [TL] with objective markers of disease activity, such as endoscopic and histological activity scores and concentrations of biomarkers, remains less understood. This report describes the relationship of serum golimumab TL at the end of the induction period [Week 6] with clinical, endoscopic, histological, and biomarker parameters. METHODS This was an open-label, uncontrolled, prospective and interventional study. Moderate to severely active UC patients naïve to biologic therapy were treated with golimumab. Serum golimumab TL and faecal calprotectin levels were measured at baseline [Week 0 of induction] and Week 6. RESULTS A total of 34 patients completed the induction phase [Week 6] and were included in this analysis. Overall, 47.1% and 14.7% of patients achieved clinical response and remission with significantly higher serum golimumab TL in patients with early response or remission [3.7 μg/mL vs 1.3 μg/mL, p = 0.0013; and 3.1 μg/mL vs 1.7 μg/mL, p = 0.0164, respectively]. In addition, golimumab TL were significantly higher in patients achieving histological remission [4.2 μg/mL vs 1.7 μg/mL, p = 0.0049]. Week 6 golimumab TL were inversely correlated with the total Mayo score [rs = -0.546; p = 0.0008], the Mayo endoscopic subscore [rs = -0.381; p = 0.0262], the Geboes histological activity score [rs = -0.464; p = 0.0057], and faecal calprotectin levels [rs = -0.497; p = 0.0044]. CONCLUSIONS A higher early exposure to golimumab is associated with a better objective response in active UC patients and appears to drive the outcome at Week 6.
Collapse
Affiliation(s)
- F Magro
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - S Lopes
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal
| | - M Silva
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal
| | - R Coelho
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal
| | - F Portela
- Centro Hospitalar Universitário de Coimbra, Departamento de Gastrenterologia, Coimbra, Portugal
| | - D Branquinho
- Centro Hospitalar Universitário de Coimbra, Departamento de Gastrenterologia, Coimbra, Portugal
| | - L Correia
- Centro Hospitalar Lisboa Norte, Departamento de Gastrenterologia, Lisboa, Portugal
| | - S Fernandes
- Centro Hospitalar Lisboa Norte, Departamento de Gastrenterologia, Lisboa, Portugal
| | - M Cravo
- Hospital Beatriz Ângelo, Departamento de Gastrenterologia, Loures, Portugal
| | - P Caldeira
- Centro Hospitalar Universitário do Algarve, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Algarve Biomedical Centre, Universidade do Algarve, Faro, Portugal
| | - H T Sousa
- Centro Hospitalar Universitário do Algarve, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Algarve Biomedical Centre, Universidade do Algarve, Faro, Portugal
| | - M Patita
- Hospital Garcia de Orta, Departamento de Gastrenterologia, Almada, Portugal
| | - P Lago
- Centro Hospitalar do Porto, Departamento de Gastrenterologia, Porto, Portugal
| | - J Ramos
- Centro Hospitalar Lisboa Central, Departamento de Gastrenterologia, Lisboa, Portugal
| | - J Afonso
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - I Redondo
- MSD Portugal, Medical Affairs, Paço de Arcos, Portugal
| | - P Machado
- MSD Portugal, Medical Affairs, Paço de Arcos, Portugal
| | | | - J Lopes
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - F Carneiro
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Instituto de Patologia e Imunologia Molecular da Universidade do Porto [Ipatimup], i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | | |
Collapse
|
7
|
Velho S, Santos M, Cunha C, Agostinho L, Cruz R, Costa F, Garcia M, Oliveira P, Maio R, Baracos V, Cravo M. MON-PO603: Body Composition Influences Major Post-Operative Complications, 90-Day and Overall Survival in Pancreatic Surgery Patients. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
8
|
Costa Santos M, Cunha C, Velho S, Ferreira AO, Costa F, Ferreira R, Loureiro R, Santos AA, Maio R, Cravo M. Preoperative biliary drainage in patients performing pancreaticoduodenectomy : guidelines and real-life practice. Acta Gastroenterol Belg 2019; 82:389-395. [PMID: 31566326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND AIM Preoperative biliary drainage (PBD) in patients with pancreatic cancer remains debatable. The aim of this study was to analyse the indications for PBD in patients performing pancreaticoduodenectomy (PD) and to evaluate the impact of this procedure on postoperative outcome. METHODS Observational retrospective cohort study of patients undergoing PD for pancreatic cancer. Clinical data and postoperative outcome, namely complications and 90-day mortality, were prospectively collected and compared between patients performing PBD or direct surgery (DS). RESULTS Eighty-two patients were included: 40 underwent PBD and 42 performed DS. Major complications (27.5% vs 33.3%, P=0.156) and 90-day mortality (10% vs 16.7%, P=0.376) were similar between the two groups. There was a trend for higher mean total bilirubin in patients with PBD (P=0.073). The indication for PBD was suspicion of cholangitis/choledocholithiasis or need to perform neoadjuvant chemotherapy in 24 (60%) patients. In the remaining, elevated bilirubin was probably the only reason to perform PBD. Length of hospital stay was longer in PBD group (P=0.003). On multiple logistic regression, 90-day mortality was not related with preoperative bilirubin levels, biliary drainage or its indication, but solely with age (OR 1.15, 95%CI 1.05-1.31, P=0.008). CONCLUSIONS PBD is often performed in patients undergoing PD without a formal indication, mainly due to high bilirubin levels. No increased morbidity/mortality was observed but length of hospital stay was prolonged in patients performing PBD.
Collapse
Affiliation(s)
- M Costa Santos
- Gastroenterology Service, Hospital Beatriz Ângelo, Loures, Portugal
| | - C Cunha
- Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - S Velho
- Nutrition Service, Hospital Beatriz Ângelo, Loures, Portugal
| | - A O Ferreira
- Gastroenterology Service, Hospital Beatriz Ângelo, Loures, Portugal
| | - F Costa
- Oncology Service, Hospital da Luz, Lisboa, Portugal
| | - R Ferreira
- Gastroenterology Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - R Loureiro
- Gastroenterology Service, Hospital Beatriz Ângelo, Loures, Portugal
| | - A A Santos
- Gastroenterology Service, Hospital Beatriz Ângelo, Loures, Portugal
| | - R Maio
- Head of Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - M Cravo
- Head of Gastroenterology Service, Hospital Beatriz Ângelo, Loures, Portugal
| |
Collapse
|
9
|
Guerreiro M, Guerreiro C, Cravo M, Santos Z, Chagas C, Augusto F. Effectiveness of two dietary approaches in improving symptoms and quality of life of individuals with irritable bowel syndrome: Low fodmap diet versus standard diet. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
Ferreira A, Costa M, Palmela C, Velho S, Torres J, Ouro S, Luisa G, Cravo M. SUN-P264: The Impact of Preoperative Exclusive Enteral Nutrition in Malnourished Patients With Crohn’s Disease. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
11
|
Torres J, Palmela C, Brito H, Bao X, Ruiqi H, Moura-Santos P, Pereira da Silva J, Oliveira A, Vieira C, Perez K, Itzkowitz SH, Colombel JF, Humbert L, Rainteau D, Cravo M, Rodrigues CM, Hu J. The gut microbiota, bile acids and their correlation in primary sclerosing cholangitis associated with inflammatory bowel disease. United European Gastroenterol J 2017; 6:112-122. [PMID: 29435321 DOI: 10.1177/2050640617708953] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [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: 10/14/2016] [Accepted: 04/12/2017] [Indexed: 12/16/2022] Open
Abstract
Background Patients with primary sclerosing cholangitis associated with inflammatory bowel disease (PSC-IBD) have a very high risk of developing colorectal neoplasia. Alterations in the gut microbiota and/or gut bile acids could account for the increase in this risk. However, no studies have yet investigated the net result of cholestasis and a potentially altered bile acid pool interacting with a dysbiotic gut flora in the inflamed colon of PSC-IBD. Aim The aim of this study was to compare the gut microbiota and stool bile acid profiles, as well as and their correlation in patients with PSC-IBD and inflammatory bowel disease alone. Methods Thirty patients with extensive colitis (15 with concomitant primary sclerosing cholangitis) were prospectively recruited and fresh stool samples were collected. The microbiota composition in stool was profiled using bacterial 16S rRNA sequencing. Stool bile acids were assessed by high-performance liquid chromatography tandem mass spectrometry. Results The total stool bile acid pool was significantly reduced in PSC-IBD. Although no major differences were observed in the individual bile acid species in stool, their overall combination allowed a good separation between PSC-IBD and inflammatory bowel disease. Compared with inflammatory bowel disease alone, PSC-IBD patients demonstrated a different gut microbiota composition with enrichment in Ruminococcus and Fusobacterium genus compared with inflammatory bowel disease. At the operational taxonomic unit level major shifts were observed within the Firmicutes (73%) and Bacteroidetes phyla (17%). Specific microbiota-bile acid correlations were observed in PSC-IBD, where 12% of the operational taxonomic units strongly correlated with stool bile acids, compared with only 0.4% in non-PSC-IBD. Conclusions Patients with PSC-IBD had distinct microbiota and microbiota-stool bile acid correlations as compared with inflammatory bowel disease. Whether these changes are associated with, or may predispose to, an increased risk of colorectal neoplasia needs to be further clarified.
Collapse
Affiliation(s)
- J Torres
- Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal.,Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - C Palmela
- Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - H Brito
- Research Institute for Medicines (iMed.ULisboa), Universidade de Lisboa, Lisbon, Portugal
| | - X Bao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - H Ruiqi
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - P Moura-Santos
- Gastroenterology and Hepatology Division, Hospital de Santa Maria, Lisboa, Portugal
| | - J Pereira da Silva
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa, Portugal
| | - A Oliveira
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - C Vieira
- Department of Gastroenterology, Centro Hospitalar Barreiro Montijo, Portugal
| | - K Perez
- INSERM ERL1157, Sorbonne Université - UPMC Univ Paris 06, Paris, France
| | - S H Itzkowitz
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - J F Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - L Humbert
- INSERM ERL1157, Sorbonne Université - UPMC Univ Paris 06, Paris, France
| | - D Rainteau
- INSERM ERL1157, Sorbonne Université - UPMC Univ Paris 06, Paris, France
| | - M Cravo
- Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - C M Rodrigues
- Research Institute for Medicines (iMed.ULisboa), Universidade de Lisboa, Lisbon, Portugal
| | - J Hu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
12
|
Portela F, Dias CC, Caldeira P, Cravo M, Deus J, Gonçalves R, Lago P, Morna H, Peixe P, Ramos J, Sousa H, Tavares L, Vasconcelos H, Magro F, Ministro P. The who-when-why triangle of CAM use among Portuguese IBD patients. Dig Liver Dis 2017; 49:388-396. [PMID: 28117198 DOI: 10.1016/j.dld.2016.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases. AIM This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients. METHODS Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines. RESULTS Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication and periodical examination, respectively. Steroids prescription (OR=2.880) and a higher instruction level (OR=3.669) were predictors of complementary and alternative medicines use in this cohort. CONCLUSIONS Roughly a third of Portuguese IBD patients had used CAM. Steroid treatment and an academic degree are associated with CAM use. Given the potential side effects and interactions, patient information about the benefits and limitations of conventional and complementary treatments should be reinforced.
Collapse
Affiliation(s)
- Francisco Portela
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
| | - Camila C Dias
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Paulo Caldeira
- Gastroenterology Department, Centro Hospitalar do Algarve, Portugal
| | - Marilia Cravo
- Serviço de Gastrenterologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Deus
- Serviço de Gastrenterologia, Hospital Fernandes da Fonseca, Amadora, Portugal
| | | | - Paula Lago
- Gastroenterology Department, Centro Hospitalar Porto-Hospital Santo António, Portugal
| | - Henrique Morna
- Serviço de Gastrenterologia, Hospital do Funchal, Funchal, Portugal
| | - Paula Peixe
- Serviço de Gastrenterologia, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Jaime Ramos
- Serviço de Gastrenterologia, Hospital dos Capuchos, Lisboa, Portugal
| | - Helena Sousa
- Gastroenterology Department, Centro Hospitalar do Algarve, Portugal; Biomedical Sciences and Medicine Department, University of Algarve, Portugal
| | - Lurdes Tavares
- Serviço de Gastrenterologia, Hospital de Santa Maria, Lisboa, Portugal
| | | | - Fernando Magro
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal; MedInUP - Centre for Drug Discovery and Innovative Medicines, University of Porto, Portugal
| | - Paula Ministro
- Serviço Gastrenterologia, Centro Hospitalar de Tondela - Viseu, Viseu, Portugal
| |
Collapse
|
13
|
Portela F, Lago P, Cotter J, Gonçalves R, Vasconcelos H, Ministro P, Lopes S, Eusébio M, Morna H, Cravo M, Peixe P, Cremmers I, Sousa H, Deus J, Duarte M, Magro F. Anaemia in Patients with Inflammatory Bowel Disease - A Nationwide Cross-Sectional Study. Digestion 2017; 93:214-20. [PMID: 27022722 DOI: 10.1159/000443927] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/08/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anaemia is the most common complication in patients with inflammatory bowel disease (IBD). This study aims to assess the prevalence of anaemia in IBD patients and to know its characteristics with regard to the main IBD clinical features. METHODS An observational cross-sectional multicentre study was conducted. We included all patients who had an appointment at the 15 participating centres during the period of 1 month, and who met the following selection criteria: age ≥18, diagnosis of IBD. Disease activity was evaluated by Harvey-Bradshaw Index (HBI) for Crohn's disease (CD), and by Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC). RESULTS One thousand three hundred and thirteen patients, were included: 54.8% female, mean age 42.8 (interquartile range (25th-75th): 31-53 years), 59% had a diagnosis of CD, 39% of UC and 2% IBD unclassified. The median follow-up since diagnosis was 7 years. The ongoing treatment was aminosalicylates (63.1%), corticosteroids (11.6%), immunomodulators (36.4%) and anti-tumour necrosis factor (27.3%). Anaemia was identified in 244 patients, representing a prevalence of 18.6% (95% CI 16.6-20.9). A majority of cases (90%) have mild/moderate anaemia (mean haemoglobin 11.3 ± 0.8 g/dl). Anaemia was significantly higher in females (p = 0.006), but there were no differences between CDs (19.1%) and UCs (17.7%; p = 0.688). Anaemia was more frequent in patients with active disease (HBI >4; SCCAI >2) than in those in clinical remission (33.6 vs. 15.6%, p < 0.001) and in patients on steroids (36.8%) vs. other treatments (p < 0.001). Only 47% of patients with anaemia were under any specific treatment (oral iron 67%; intravenous iron 41%). CONCLUSION Anaemia was more frequent in patients with active disease and in those on corticosteroids. The treatment of anaemia still seems undervalued, whereas more than half of anaemic patients were not receiving any specific treatment and the use of oral iron prevails contrarily to current recommendations.
Collapse
|
14
|
Cravo M, Velho S, Santos M, Palmela C, Cruz R, Strecht J, Torres J, Baracos V. MON-P047: Lower Skeletal Muscle Radiation Attenuation is Associated with Stricturing or Penetrating Phenotype in Patients with Crohn's Disease (CD): An Exploratory Study. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Santos T, Cravo M. MON-P107: Nutritional Assessment of Elderly People with Pressure Ulcer in Hospital Environment. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
16
|
Velho S, Ferreira A, Luz G, Lopes F, Cruz R, Agostinho L, Strecht J, Gargaté L, Coelho JP, Maio R, Baracos V, Cravo M. MON-P243: Skeletal Mass Index and Visceral Mass Index as Predictors of Length of Hospital Stay of Surgical Gastrointestinal Cancer Patients. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30877-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Barata A, Santos C, Cravo M, Vinhas M, Morais C, Carolino E, Roldão Vieira J, Fonseca J. MON-LB013: Handgrip Dynamometry and Patient-Generated Subjective Global Assessment in Patients With Non-Resectable Lung Cancer. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30777-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
18
|
Moço S, Velho S, Agostinho L, Cruz R, Lopes F, Luz G, Rodrigues T, Teixeira J, Strecht J, Coelho J, Baracos V, Maio R, Cravo M. MON-LB011: Predictors of Sarcopenia in Patients With Gastrointestinal Cancer. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Amaral O, Sousa Guerreiro C, Almeida A, Cravo M. SUN-LB028: Effect of Bread Containing High Level of Resistant Starch on Glucose and Insulin Responses. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
20
|
Ferreira A, Cravo M, Maio R, Garrido R, Luz G. MON-PP142: Nutritional Assessment in Surgical Underwent Gastrectomy Patients. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
21
|
Abstract
Inflammatory bowel disease (IBD) is a chronic idiopathic inflammatory disease of the gastrointestinal (GI) tract. In the past decade a shift in the treatment paradigm of IBD has ensued. The availability of drugs capable of inducing mucosal healing, combined with the recognition that IBD is not an intermittent disease, but rather a progressive one causing bowel damage and disability, led us to a more stringent strategy. Tailored therapy with more aggressive treatment in high-risk patients, treating beyond symptoms, intervening early before damage occurs, optimizing therapeutic regimens, and actively pursuing sustained remission and sustained control of inflammation are strategies that are slowly being incorporated in our clinical practice. Furthermore, new drugs targeting different immunological pathways, such as vedolizumab, have recently been approved and therefore more therapeutic resources for patients failing anti-tumour necrosis factor alpha (anti-TNFα) agents will be available. The future years look promising for IBD. Hopefully the new trends in IBD management, combined with new drugs, will make possible to change the course of disease and provide better therapy and quality of life for patients suffering from this disabling disease.
Collapse
Affiliation(s)
| | | | - Marilia Cravo
- Gastroenterology Department, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| |
Collapse
|
22
|
Kluk J, Moonim M, Duran A, Costa Rosa J, Cabeçadas J, Alvarez R, Cravo M, Whittaker S, Robson A. Cutaneous Richter syndrome: a better place to transform? Br J Dermatol 2014; 172:513-21. [PMID: 24935194 DOI: 10.1111/bjd.13193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2014] [Indexed: 11/30/2022]
Abstract
The development of high-grade lymphoma in patients with chronic lymphocytic leukaemia is known as Richter syndrome (RS) and is associated with a grave prognosis, with a mean survival of 8 months despite treatment. Cutaneous RS has been described in a handful of cases and may be associated with a better outcome than the more common extracutaneous variants. We review the literature with particular emphasis on pathogenesis, treatment and survival of RS. We postulate that the absence of B symptoms and a normal lactate dehydrogenase level, presumably reflecting localized or limited disease, and a lower tumour burden, may explain the apparently better survival in some patients with cutaneous RS than with extracutaneous variants.
Collapse
Affiliation(s)
- J Kluk
- Skin Tumour Unit, 2nd Floor, Block C, South Wing, St. John's Institute of Dermatology, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Velho S, Santos M, Castro A, Cravo M, Passos Coelho J. LB012-MON: Nutrition Support in Head and Neck Cancer Patients. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50670-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
24
|
Cravo M, Rodrigues T, Ouro S, Ferreira A, Féria L, Maio R. Management of rectal cancer: Times they are changing. GE Portuguese Journal of Gastroenterology 2014. [DOI: 10.1016/j.jpg.2014.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
25
|
Guerreiro C, Coelho V, Cravo M, Alexandre D, Dias-Pereira A, Mendes L. PP149-SUN: Compliance with Mediterranean Diet by Crohn’s Patients. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Cravo M, Ferreira P, Sousa P, Moura-Santos P, Velho S, Tavares L, Deus JR, Ministro P, da Silva JP, Correia L, Velosa J, Maio R, Brito M. Clinical and genetic factors predicting response to therapy in patients with Crohn's disease. United European Gastroenterol J 2014; 2:47-56. [PMID: 24918007 PMCID: PMC4040806 DOI: 10.1177/2050640613519626] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/14/2013] [Indexed: 12/18/2022] Open
Abstract
AIM To identify clinical and/or genetic predictors of response to several therapies in Crohn's disease (CD) patients. METHODS We included 242 patients with CD (133 females) aged (mean ± standard deviation) 39 ± 12 years and a disease duration of 12 ± 8 years. The single-nucleotide polymorphisms (SNPs) studied were ABCB1 C3435T and G2677T/A, IL23R G1142A, C2370A, and G9T, CASP9 C93T, Fas G670A and LgC844T, and ATG16L1 A898G. Genotyping was performed with real-time PCR with Taqman probes. RESULTS Older patients responded better to 5-aminosalicylic acid (5-ASA) and to azathioprine (OR 1.07, p = 0.003 and OR 1.03, p = 0.01, respectively) while younger ones responded better to biologicals (OR 0.95, p = 0.06). Previous surgery negatively influenced response to 5-ASA compounds (OR 0.25, p = 0.05), but favoured response to azathioprine (OR 2.1, p = 0.04). In respect to genetic predictors, we observed that heterozygotes for ATGL16L1 SNP had a significantly higher chance of responding to corticosteroids (OR 2.51, p = 0.04), while homozygotes for Casp9 C93T SNP had a lower chance of responding both to corticosteroids and to azathioprine (OR 0.23, p = 0.03 and OR 0.08, p = 0.02,). TT carriers of ABCB1 C3435T SNP had a higher chance of responding to azathioprine (OR 2.38, p = 0.01), while carriers of ABCB1 G2677T/A SNP, as well as responding better to azathioprine (OR 1.89, p = 0.07), had a lower chance of responding to biologicals (OR 0.31, p = 0.07), which became significant after adjusting for gender (OR 0.75, p = 0.005). CONCLUSIONS In the present study, we were able to identify a number of clinical and genetic predictors of response to several therapies which may become of potential utility in clinical practice. These are preliminary results that need to be replicated in future pharmacogenomic studies.
Collapse
Affiliation(s)
- Marilia Cravo
- Hospital Beatriz Angelo, Loures, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Paula Ferreira
- Escola Superior de Tecnologias da Saude, Lisbon, Portugal
| | | | - Paula Moura-Santos
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Hospital Santa Maria, Lisboa, Portugal
| | | | | | | | | | | | - Luis Correia
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Hospital Santa Maria, Lisboa, Portugal
| | - Jose Velosa
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Hospital Santa Maria, Lisboa, Portugal
| | - Rui Maio
- Hospital Beatriz Angelo, Loures, Portugal
| | - Miguel Brito
- Escola Superior de Tecnologias da Saude, Lisbon, Portugal
| |
Collapse
|
27
|
Cabral M, Batalha S, Nunes J, Jotta R, Cravo M, Oom P. PReS-FINAL-2080: Overlap syndrome between primary sclerosing cholangitis and autoimmune hepatitis associated with ulcerative colitis - a case of unusual presentation in a patient with systemic juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044478 DOI: 10.1186/1546-0096-11-s2-p92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
28
|
Cravo M, Sousa P, Tavora I, Zozimo N, Velosa J. Endoscopic appearance of sclerosing mesenteritis in the colon. Endoscopy 2012; 44 Suppl 2 UCTN:E60. [PMID: 22396281 DOI: 10.1055/s-0031-1291563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M Cravo
- Department of Gastroenterology, Hospital de Santa Maria, Lisbon, Portugal.
| | | | | | | | | |
Collapse
|
29
|
Cravo M, Silva R, Serrano M. Autoimmune hepatitis induced by infliximab in a patient with Crohn's disease with no relapse after switching to adalimumab. BioDrugs 2011; 24 Suppl 1:25-7. [PMID: 21175232 DOI: 10.2165/11586210-000000000-00000] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Infliximab and adalimumab are anti-tumor necrosis factor (TNF) alpha agents used for treating Crohn's disease. Autoimmune hepatitis (AIH) is a rare complication of treatment with these drugs. We report on a case of AIH in a patient with Crohn's disease treated with infliximab who fully recovered after drug withdrawal. More interestingly, because there were no other treatment options, the patient was then treated with adalimumab without recurrence of the liver disease and with control of the intestinal disease.
Collapse
Affiliation(s)
- Marilia Cravo
- Gastroenterology Department, Instituto Portugus de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
| | | | | |
Collapse
|
30
|
|
31
|
Azevedo LF, Magro F, Portela F, Lago P, Deus J, Cotter J, Cremers I, Vieira A, Peixe P, Caldeira P, Lopes H, Gonçalves R, Reis J, Cravo M, Barros L, Ministro P, Lurdes M, Duarte A, Campos M, Carvalho L, Costa-Pereira A. Estimating the prevalence of inflammatory bowel disease in Portugal using a pharmaco-epidemiological approach. Pharmacoepidemiol Drug Saf 2010; 19:499-510. [DOI: 10.1002/pds.1930] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
32
|
Cardoso JC, Cravo M, Cardoso R, Brites MM, Reis JP, Tellechea O, Eloy C, Figueiredo A. Langerhans cell histiocytosis in an adult: good response of cutaneous lesions to acitretin. Clin Exp Dermatol 2010; 35:627-30. [DOI: 10.1111/j.1365-2230.2010.03784.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Magro F, Portela F, Lago P, Deus J, Cotter J, Cremers I, Vieira A, Peixe P, Caldeira P, Lopes H, Gonçalves R, Reis J, Cravo M, Barros L, Ministro P, Lurdes Tavares M, Duarte A, Campos M, Carvalho L. Inflammatory bowel disease: a patient's and caregiver's perspective. Dig Dis Sci 2009; 54:2671-9. [PMID: 19130226 DOI: 10.1007/s10620-008-0658-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Accepted: 11/28/2008] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to conduct a survey examining the impact of inflammatory bowel disease (IBD) on patients' and their caregivers' daily activities. Questionnaires were distributed to patients registered in the APDI (Portuguese Association for IBD) database and their respective caregivers in 2007. Of 422 patient respondents, 251 had Crohn's disease (CD) and 171 had ulcerative colitis (UC), with the majority of patients being women (58.1%) and aged over 40 years (37.4%). The number of disease flares experienced by IBD patients was slightly higher for patients with CD than for patients with UC (2.64 vs. 2.34), and surgery was more often required in CD patients as compared to UC patients (42.4 vs. 7%). Sixty percent (60%) of patients reported having no problems with mobility, daily activities, or personal hygiene; however, over half of all patients experienced some pain and anxiety. Adult patients and children and adolescents respectively experienced time off work or school due to their disease but caregivers were not affected in this regard. The caregivers life (N=324) was affected by anxiety, with the major concern reported as the risk of the patient developing cancer. Both IBD patients and caregivers thought that the provision of information on new drugs and contact time with a doctor would have the biggest impact on improving care. The symptoms and complications of IBD have a considerable impact on the lives of patients and their caregivers, and several actions could be taken to improve their care.
Collapse
Affiliation(s)
- F Magro
- GEDII--Portuguese Group of Studies of IBD, Porto, Portugal.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Filipe B, Baltazar C, Albuquerque C, Fragoso S, Lage P, Vitoriano I, Mão de Ferro S, Claro I, Rodrigues P, Fidalgo P, Chaves P, Cravo M, Nobre Leitão C. APCorMUTYHmutations account for the majority of clinically well-characterized families with FAP and AFAP phenotype and patients with more than 30 adenomas. Clin Genet 2009; 76:242-55. [DOI: 10.1111/j.1399-0004.2009.01241.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
35
|
|
36
|
|
37
|
Magro F, Portela F, Lago P, Deus J, Vieira A, Peixe P, Cotter J, Cremers I, Cravo M, Tavares L, Reis J, Gonçalves R, Caldeira P, Lopes H, Ministro P. P099 A PHARMACO-EPIDEMIOLOGICAL APPROACH TO ESTIMATE IBD PREVALENCE AND INCIDENCE IN PORTUGAL. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1873-9954(08)70110-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Salazar M, Barata A, André S, Venâncio J, Francisco I, Cravo M, Nobre-Leitão C. First report of a complete pathological response of a pelvic GIST treated with imatinib as neoadjuvant therapy. Gut 2006; 55:585-6. [PMID: 16531543 PMCID: PMC1856177 DOI: 10.1136/gut.2005.086744] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
|
39
|
Cravo M. Alcohol, methylenetetrahydrofolate 677C->T genotype, and low folate intake: concurrent causes for hyperhomocysteinemia. Am J Clin Nutr 2005; 82:3-4. [PMID: 16002792 DOI: 10.1093/ajcn.82.1.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
40
|
Affiliation(s)
- Marilia Cravo
- From the Serviço de Gastrenterologia, Instituto Português de Oncologia Francisco Gentil, Centro Regional Oncológico Sul–Sociedade Anónima, Lisbon, Portugal
| |
Collapse
|
41
|
Lage P, Cravo M, Sousa R, Chaves P, Salazar M, Fonseca R, Claro I, Suspiro A, Rodrigues P, Raposo H, Fidalgo P, Nobre-Leitão C. Management of Portuguese patients with hyperplastic polyposis and screening of at-risk first-degree relatives: a contribution for future guidelines based on a clinical study. Am J Gastroenterol 2004; 99:1779-84. [PMID: 15330918 DOI: 10.1111/j.1572-0241.2004.30178.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hyperplastic polyposis (HP) is a rare condition characterized by the presence of multiple hyperplastic polyps in the colon, which has been associated to an increased risk of colorectal cancer (CRC). Guidelines for management of this disease remain, so far, undefined. AIMS To evaluate, in symptomatic patients with HP, phenotypic characteristics as well as results of a screening program in their at-risk first-degree relatives. PATIENTS Pedigree information and clinical and endoscopic data of 14 patients with HP was studied. SEVENTEEN AND METHODS: at-risk first-degree relatives from six families were also invited to perform screening colonoscopy. RESULTS Twelve of fourteen (86%) patients had fewer than 100 colorectal polyps. Polyps' sizes ranged from 2 to 25 mm and were uniformly distributed through the whole colon in 43% of the patients. Hyperplastic polyps predominated, but 11/14 (79%) patients also harbored serrated as well as classic adenomatous polyps. CRC was present in 6/14 (43%) of the patients at the time of diagnosis. Familial history of CRC/polyps was positive in 6/12 (50%) of cases. Colonoscopy in at-risk relatives disclosed polyps in 10/17 (59%) of cases with at least one additional patient having criteria for HP. CONCLUSIONS Although small, this series demonstrates that a high level of suspicion is needed to diagnose the HP syndrome, in which serrated adenomas seem to be the hallmark. Although an elevated percentage of CRC was observed in this series of symptomatic patients with HP, prospective studies in asymptomatic individuals are needed to clearly quantify the risk of CRC in patients with HP. Because familial aggregation of HP was present in 3/12 (25%) of kindreds, screening colonoscopy should be offered to first-degree relatives.
Collapse
Affiliation(s)
- P Lage
- Instituto Português de Oncologia Francisco Gentil, CRL, SA, Rua Prof. Lima Basto, 1099-023 Lisbon, Portugal.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Albuquerque C, Cravo M, Cruz C, Lage P, Chaves P, Fidalgo P, Suspiro A, Nobre Leitão C. Genetic characterisation of patients with multiple colonic polyps. J Med Genet 2002; 39:297-302. [PMID: 11950865 PMCID: PMC1735100 DOI: 10.1136/jmg.39.4.297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
43
|
Cravo M, Afonso AJ, Lage P, Albuquerque C, Maia L, Lacerda C, Fidalgo P, Chaves P, Cruz C, Nobre-Leitão C. Pathogenicity of missense and splice site mutations in hMSH2 and hMLH1 mismatch repair genes: implications for genetic testing. Gut 2002; 50:405-12. [PMID: 11839723 PMCID: PMC1773142 DOI: 10.1136/gut.50.3.405] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [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: 01/01/2023]
Abstract
BACKGROUND In hereditary non-polyposis colorectal cancer, over 90% of the identified mutations are in two genes, hMSH2 and hMLH1. A large proportion of the mutations detected in these genes are of the missense type which may be either deleterious mutations or harmless polymorphisms. AIM To investigate whether nine missense and one splice site mutation of hMLH1 and hMSH2, in 10 kindreds with a familial history of colorectal cancer or young age of onset, could be interpreted as pathogenic. METHODS Clinical and genetic characteristics were collected: (i) evolutionary conservation of the codon involved; (ii) type of amino acid change; (iii) occurrence of mutation in healthy controls; (iv) cosegregation of mutation with disease phenotype; (v) functional consequences of gene variant; and (vi) microssatellite instability and immunoexpression of hMSH2 and hMLH1 analysis. RESULTS Seven different missense and one splice site mutation were identified. Only 1/8 was found in the control group, 2/7 occurred in conserved residues, and 5/7 resulted in non-conservative changes. Functional studies were available for only 2/8 mutations. Segregation of the missense variant with disease phenotype was observed in three kindreds. CONCLUSION In the majority of families included, there was no definitive evidence that the missense or splice site alterations were causally associated with an increased risk of developing colorectal cancer. Until further evidence is available, these mutational events should be regarded and interpreted carefully and genetic diagnosis should not be offered to these kindreds.
Collapse
Affiliation(s)
- M Cravo
- Serviço de Gastrenterologia and Centro de Investigação de Patobiologia Molecular, Instituto Português de Oncologia Francisco Gentil, 1093 Lisboa Codex, Portugal.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Chaves P, Cruz C, Lage P, Claro I, Cravo M, Leitão CN, Soares J. Immunohistochemical detection of mismatch repair gene proteins as a useful tool for the identification of colorectal carcinoma with the mutator phenotype. J Pathol 2000. [PMID: 10918209 DOI: 10.1002/1096-9896(2000)9999:9999<::aid-path644>3.0.co;2-t] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There are two well-defined pathways for colorectal carcinogenesis, the suppressor and the mutator pathways. The latter is characteristic of hereditary non-polyposis colorectal cancer (HNPCC), but can also be found in a subset of sporadic colorectal cancer (SCC) possessing distinctive clinical and pathological features, namely early age of onset, location in the right colon, poor differentiation, and a predominant mucinous component. This mutator pathway results from inactivation of mismatch repair (MMR) genes, namely MSH2 and MLH1. The aim of this study was to ascertain if abnormal MMR protein gene expression is a good indicator for identifying tumours from the mutator pathway. Seventy-six cases of SCC were studied by immunohistochemistry using two monoclonal mouse antibodies that react against MSH2 and MLH1 protein gene products. Immunoexpression was assessed both in tumour and in non-neoplastic, adjacent and distant mucosa. Microsatellite instability (MSI) was detected by evaluating the length of poly(CA) repeated sequences at seven loci, or by the detection of small unstable alleles in a poly(A) repeat - BAT-26. Except for BAT-26, in which only tumour DNA was used, MSI analysis was performed in both tumour and normal mucosal DNA. MSI was classified as high (MSI-H), low (MSI-L) or stable (MSS). Abnormal protein expression was found in 9/76 (12%) tumours. Immunohistochemistry for hmlh1 and hmsh2 detected 75% of MSI-H. There was also a highly significant correlation between the observed immunoexpression and several clinical and pathological characteristics described as the phenotypic profile of the mutator pathway, such as right-sided location (p=0.003), mucin production (p=0.008), and a peritumoural lymphoid infiltrate (p=0.009). Non-neoplastic adjacent mucosa showed normal hMSH2 expression in all cases, but in ten cases there was no hMLH1 expression in this transitional mucosa, which is known to display an alterated mucin pattern and a high proliferative rate. These results demonstrated a good correlation between hMLH1 and hMSH2 gene immunoexpression and the clinico-pathological features characteristic of the mutator phenotype and support the use of this method as a rapid and efficient way to detect tumours arising from this pathway.
Collapse
Affiliation(s)
- P Chaves
- Department of Pathology, Instituto Português de Oncologia de Francisco Gentil, Lisboa, Portugal
| | | | | | | | | | | | | |
Collapse
|
45
|
Chaves P, Cruz C, Lage P, Claro I, Cravo M, Leitão CN, Soares J. Immunohistochemical detection of mismatch repair gene proteins as a useful tool for the identification of colorectal carcinoma with the mutator phenotype. J Pathol 2000; 191:355-60. [PMID: 10918209 DOI: 10.1002/1096-9896(2000)9999:9999<::aid-path644>3.0.co;2-t] [Citation(s) in RCA: 72] [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] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There are two well-defined pathways for colorectal carcinogenesis, the suppressor and the mutator pathways. The latter is characteristic of hereditary non-polyposis colorectal cancer (HNPCC), but can also be found in a subset of sporadic colorectal cancer (SCC) possessing distinctive clinical and pathological features, namely early age of onset, location in the right colon, poor differentiation, and a predominant mucinous component. This mutator pathway results from inactivation of mismatch repair (MMR) genes, namely MSH2 and MLH1. The aim of this study was to ascertain if abnormal MMR protein gene expression is a good indicator for identifying tumours from the mutator pathway. Seventy-six cases of SCC were studied by immunohistochemistry using two monoclonal mouse antibodies that react against MSH2 and MLH1 protein gene products. Immunoexpression was assessed both in tumour and in non-neoplastic, adjacent and distant mucosa. Microsatellite instability (MSI) was detected by evaluating the length of poly(CA) repeated sequences at seven loci, or by the detection of small unstable alleles in a poly(A) repeat - BAT-26. Except for BAT-26, in which only tumour DNA was used, MSI analysis was performed in both tumour and normal mucosal DNA. MSI was classified as high (MSI-H), low (MSI-L) or stable (MSS). Abnormal protein expression was found in 9/76 (12%) tumours. Immunohistochemistry for hmlh1 and hmsh2 detected 75% of MSI-H. There was also a highly significant correlation between the observed immunoexpression and several clinical and pathological characteristics described as the phenotypic profile of the mutator pathway, such as right-sided location (p=0.003), mucin production (p=0.008), and a peritumoural lymphoid infiltrate (p=0.009). Non-neoplastic adjacent mucosa showed normal hMSH2 expression in all cases, but in ten cases there was no hMLH1 expression in this transitional mucosa, which is known to display an alterated mucin pattern and a high proliferative rate. These results demonstrated a good correlation between hMLH1 and hMSH2 gene immunoexpression and the clinico-pathological features characteristic of the mutator phenotype and support the use of this method as a rapid and efficient way to detect tumours arising from this pathway.
Collapse
Affiliation(s)
- P Chaves
- Department of Pathology, Instituto Português de Oncologia de Francisco Gentil, Lisboa, Portugal
| | | | | | | | | | | | | |
Collapse
|
46
|
Cravo M, Lage P, Albuquerque C, Chaves P, Claro I, Gomes T, Gaspar C, Fidalgo P, Soares J, Nobre-Leitão C. BAT-26 identifies sporadic colorectal cancers with mutator phenotype: a correlative study with clinico-pathological features and mutations in mismatch repair genes. J Pathol 2000. [PMID: 10419591 DOI: 10.1002/(sici)1096-9896(199907)188:3<252::aid-path354>3.0.co;2-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Microsatellite instability (MSI) is present in most colorectal cancers (CRC) associated with hereditary nonpolyposis colorectal cancer (HNPCC). MSI testing in so-called sporadic forms of CRC may become a useful tool in identifying new HNPCC kindred. The aim of this study was to analyse the utility of BAT-26 as a marker to identify CRCs with MSI and to investigate whether sporadic CRCs with MSI have a phenotypic expression similar to HNPCC cases. MSI was detected using two methods, an association of 7 poly(CA) repeats and a poly(A) repeat alone, BAT-26, in a series of 62 patients with apparently sporadic forms of CRC. Germ-line and somatic mutations in the hMSH2, hMLH1, and hMSH6 genes were analysed in patients with MSI+ tumours. Patients with MSI+ at poly(CA) loci and at BAT-26 were younger (p=0.024 and p=0.002), had tumours more frequently right sided (p=0.017 and p=0.0001) and more often mucinous (p=0.037 and p=0.005, respectively) than patients with MSI negative tumours. Mutation analysis allowed the identification of two patients carrying germ-line mutations in the hMLH1 gene (both were BAT-26+) and two other patients who had somatic mutation in the hMSH2 and in hMLH1 genes. In conclusion, the detection of MSI using poly(CA) repeats or BAT-26 alone allowed the identification of a subset of patients with clinico-pathological characteristics similar to those associated to HNPCC. BAT-26 has the advantage of being a simple and less expensive method that might be used as a screening procedure before mutation analysis.
Collapse
Affiliation(s)
- M Cravo
- Serviço de Gastrenterologia, Instituto Português de Oncologia Francisco Gentil, 1093 Lisboa Codex, Portugal.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Fidalgo P, Almeida MR, West S, Gaspar C, Maia L, Wijnen J, Albuquerque C, Curtis A, Cravo M, Fodde R, Leitao CN, Burn J. Detection of mutations in mismatch repair genes in Portuguese families with hereditary non-polyposis colorectal cancer (HNPCC) by a multi-method approach. Eur J Hum Genet 2000; 8:49-53. [PMID: 10713887 DOI: 10.1038/sj.ejhg.5200393] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Mutation searching was performed in the hMSH2 and hMLH1 genes in 20 Portuguese families representing 124 registered affected individuals. Of the 20, 16 fulfilled the classic 'Amsterdam' criteria for HNPCC, whereas the remaining four families satisfied a modified set of criteria. These criteria required a CRC diagnosed before age 50 years and cancers diagnosed in two other relatives within the HNPCC spectrum. A multi-method approach was performed using the protein truncation test (PTT), single strand conformation polymorphism (SSCP) with two different sets of conditions, heteroduplex analysis (HA) and denaturing gradient gel electrophoresis (DGGE). Putative phenotype-genotype correlations were also explored. Ten different germline mutations were identified. Six of these were found in hMLH1 in seven families and four in hMSH2 in four families. SSCP and DGGE had the highest diagnostic yields with the percentage of variants detected above 67% and together HA and PTT had the lowest. No single technique detected all variants. Trends for the absence of extracolonic manifestations were observed in families carrying hMLH1 germline mutations (four of seven in hMLH1 vs one of four in hMSH2). Most of the families with rectal cancer were associated with hMLH1 (six of seven in hMLH1 vs two of four in hMSH2). A multi-technique approach is necessary to identify a high percentage of germline mutations. Seven novel mutations were found in this Portuguese population.
Collapse
Affiliation(s)
- P Fidalgo
- Gastroenterology Department, Instituto Portugues de Oncologia, Lisbon, Portugal
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Cravo M, Lage P, Albuquerque C, Chaves P, Claro I, Gomes T, Gaspar C, Fidalgo P, Soares J, Nobre-Leitão C. BAT-26 identifies sporadic colorectal cancers with mutator phenotype: a correlative study with clinico-pathological features and mutations in mismatch repair genes. J Pathol 1999; 188:252-7. [PMID: 10419591 DOI: 10.1002/(sici)1096-9896(199907)188:3<252::aid-path354>3.0.co;2-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Microsatellite instability (MSI) is present in most colorectal cancers (CRC) associated with hereditary nonpolyposis colorectal cancer (HNPCC). MSI testing in so-called sporadic forms of CRC may become a useful tool in identifying new HNPCC kindred. The aim of this study was to analyse the utility of BAT-26 as a marker to identify CRCs with MSI and to investigate whether sporadic CRCs with MSI have a phenotypic expression similar to HNPCC cases. MSI was detected using two methods, an association of 7 poly(CA) repeats and a poly(A) repeat alone, BAT-26, in a series of 62 patients with apparently sporadic forms of CRC. Germ-line and somatic mutations in the hMSH2, hMLH1, and hMSH6 genes were analysed in patients with MSI+ tumours. Patients with MSI+ at poly(CA) loci and at BAT-26 were younger (p=0.024 and p=0.002), had tumours more frequently right sided (p=0.017 and p=0.0001) and more often mucinous (p=0.037 and p=0.005, respectively) than patients with MSI negative tumours. Mutation analysis allowed the identification of two patients carrying germ-line mutations in the hMLH1 gene (both were BAT-26+) and two other patients who had somatic mutation in the hMSH2 and in hMLH1 genes. In conclusion, the detection of MSI using poly(CA) repeats or BAT-26 alone allowed the identification of a subset of patients with clinico-pathological characteristics similar to those associated to HNPCC. BAT-26 has the advantage of being a simple and less expensive method that might be used as a screening procedure before mutation analysis.
Collapse
Affiliation(s)
- M Cravo
- Serviço de Gastrenterologia, Instituto Português de Oncologia Francisco Gentil, 1093 Lisboa Codex, Portugal.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Pinto A, Fidalgo P, Cravo M, Midões J, Chaves P, Rosa J, dos Anjos Brito M, Leitão CN. Short chain fatty acids are effective in short-term treatment of chronic radiation proctitis: randomized, double-blind, controlled trial. Dis Colon Rectum 1999; 42:788-95; discussion 795-6. [PMID: 10378604 DOI: 10.1007/bf02236937] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [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: 02/08/2023]
Abstract
PURPOSE Short chain fatty acids are the main energy source of colonocytes and their use may be impaired in chronic radiation proctitis. The aim of the present study was to evaluate the therapeutic effect of short chain fatty acid enemas in patients with chronic radiation proctitis. METHODS A prospective, randomized, double-blind trial comparing short chain fatty acid enemas with placebo was conducted in 19 patients with chronic radiation proctitis. Short chain fatty acid enemas contained 60 mM sodium acetate, 30 mM sodium propionate, and 40 mM sodium butyrate. The treatment period lasted five weeks and patients were followed up for six months. RESULTS On admission, both groups were similar regarding all parameters evaluated. After five weeks short chain fatty acid-treated patients showed a significant decrease in the number of days with rectal bleeding from the previous week (4.4+/-1.8 to 1.4+/-2.2; P = 0.001) and an improvement of endoscopic score (4.8+/-1.4 to 2.2+/-1.2; P = 0.001). Hemoglobin values were also significantly higher in short chain fatty acid-treated patients (13.1+/-0.9 g/dl vs. 10.7+/-2.1 g/dl; P = 0.02). Mucosal DNA and protein concentrations decreased in both groups but significantly so only in placebo-treated patients (P = 0.05). Changes in histologic parameters were not significant in either group. Although short chain fatty acid-treated patients did not get worse in the next six months, placebo-treated ones gradually improved, and at the end of six months, differences between the two groups were no longer observed. CONCLUSIONS Short chain fatty acid enemas can accelerate the process of healing in chronic radiation proctitis, but treatment has to be continuous if a complete and sustained clinical, endoscopic, and histologic response is to be obtained.
Collapse
Affiliation(s)
- A Pinto
- Serviço de Gastrenterologia, Lisboa, Portugal
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
BACKGROUND The global DNA methylation of 136 breast lesions (117 primary invasive carcinomas, 5 benign phyllodes tumors, 11 fibroadenomas, and 3 sclerosing adenosis) and their respective adjacent parenchyma was analyzed using an in vitro enzyme assay. METHODS In the group of patients with breast carcinoma, DNA hypomethylation was correlated with clinical and pathologic parameters known to affect disease prognosis. Histopathologic type, disease stage, and tumor grade were evaluated according to the World Health Organization classification, the TNM system, and the criteria of Elston and Ellis' criteria, respectively. DNA flow cytometry was performed in fresh/frozen samples stained with propidium iodide. Hormone receptor (estrogen and progesterone receptor) status was determined by immunocytochemistry. RESULTS The comparative study of DNA methylation showed that the DNA of breast carcinomas was statistically significantly less methylated than the DNA of the respective adjacent parenchyma (P=0.0001), the DNA of breast benign lesions (P=0.0002), and the DNA of normal parenchyma (P < 0.0001). A statistically significant correlation was found between the global DNA hypomethylation and the disease stage (P=0.0009), tumor size (P=0.0026), and histologic grade (P=0.0097) of malignant neoplasms. A trend for DNA from breast carcinomas with positive axillary lymph nodes (N1) to be more hypomethylated than those without nodal involvement (NO) (P=0.055) was verified. In contrast, no significant association was found between DNA methylation and histologic type of tumors, hormone receptors, DNA ploidy, and S-phase fraction. CONCLUSIONS The current shows that DNA hypomethylation is increased in breast carcinomas, playing a potentially important role in tumor development. These findings also suggest that DNA methylation status may be a biologic marker with prognostic significance in this group of neoplasms.
Collapse
Affiliation(s)
- J Soares
- Departamento de Patologia Morfológica, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | | | | | | | | | | | | |
Collapse
|