1
|
Neri B, Scarozza P, Giannarelli D, Sena G, Mossa M, Lolli E, Calabrese E, Biancone L, Grasso E, Di Iorio L, Troncone E, Monteleone G, Paoluzi OA, Del Vecchio Blanco G. Efficacy and tolerability of very low-volume bowel preparation in patients with inflammatory bowel diseases. Eur J Gastroenterol Hepatol 2021; 33:977-982. [PMID: 34034275 DOI: 10.1097/meg.0000000000002167] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES An adequate bowel preparation is essential for a quality colonoscopy. Patients with inflammatory bowel disease (IBD) show low compliance with bowel preparation due to the large volume of lavage solution to be ingested, especially if active symptoms are present, and the frequency of having a colonoscopy. We evaluated the efficacy and tolerability of a very low-volume (VLV) polyethylene glycol (PEG)-based solution in patients with IBD. METHODS A cohort of 103 consecutive patients, 56 with Crohn's disease and 47 with ulcerative colitis, received a 1-L PEG-based bowel preparation divided into two 500-mL doses taken the evening before and the morning of the colonoscopy, each dose followed by at least another 500-mL of clear fluids. Colon cleansing was scored according to the Boston Bowel Preparation Scale (BBPS) and evaluated in relation to influencing variables. RESULTS Bowel cleansing was adequate (BBPS ≥ 6) in 88 patients (85.4%). The time interval between the end of bowel preparation and the beginning of colonoscopy and the disease activity significantly affected colon cleansing. Most patients declared a complete intake of lavage solution (99%), the willingness to repeat the same bowel preparation in a future colonoscopy (86.4%), and a good taste assessment. CONCLUSION The VLV PEG-based bowel preparation is effective and well accepted by IBD patients. As minimizing the volume of lavage solution required, the VLV-bowel preparation here tested could be of choice in subjects who perform periodically colonoscopy or in those who do not tolerate a larger amount of liquids.
Collapse
Affiliation(s)
- Benedetto Neri
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Patrizio Scarozza
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Diana Giannarelli
- Department of Biostatistics and Bioinformatics, UOSD Clinical Trial Center, Regina Elena National Cancer Institute IRCCS of Rome, Rome, Italy
| | - Giorgia Sena
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Michelangela Mossa
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Elisabetta Lolli
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Livia Biancone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Enrico Grasso
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Laura Di Iorio
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Edoardo Troncone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | | | | |
Collapse
|
2
|
Marafini I, Salvatori S, Rocchetti I, Alfieri N, Scarozza P, Calabrese E, Biancone L, Monteleone G. Natural History of Ulcerative Colitis with Coexistent Colonic Diverticulosis. J Clin Med 2021; 10:jcm10061192. [PMID: 33809208 PMCID: PMC8001479 DOI: 10.3390/jcm10061192] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
Ulcerative colitis (UC) and colonic diverticulosis can co-exist in some patients. However, the natural history of UC associated with colonic diverticulosis is not well known. We here compared the disease characteristics and outcome of UC patients with and without concomitant colonic diverticulosis. Medical records of 347 UC patients were included in an observational, retrospective, nested-matched case-control study. Cases were 92 patients with UC and concomitant colonic diverticulosis, while controls were 255 UC patients without concomitant colonic diverticulosis. A propensity score matching (PSM) was used to homogenate cases (n = 92) and controls (n = 153) for age. UC patients with concomitant colonic diverticulosis were less likely to have an extensive disease (25/92, 27.1%) and to experience steroid dependence (8/92, 8.6%) compared to patients without concomitant colonic diverticulosis (70/153, 45.7% and 48/153, 31.3%, respectively; p < 0.001). The use of immunosuppressants (9/92, 9.7% vs. 37/153, 24.1%; p = 0.007) or biologics (3/92, 3.2% vs. 26/153, 16.9%, p < 0.001) was significantly lower in UC patients with concomitant diverticulosis compared to the control group. On multivariate analysis, steroid dependence and extensive colitis were significantly less frequent in UC patients with concomitant colonic diverticulosis compared to UC patients without diverticula. UC patients with coexisting colonic diverticulosis are less likely to have an extensive disease and to be steroid-dependent.
Collapse
Affiliation(s)
- Irene Marafini
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (I.M.); (S.S.); (N.A.); (P.S.); (E.C.); (L.B.)
| | - Silvia Salvatori
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (I.M.); (S.S.); (N.A.); (P.S.); (E.C.); (L.B.)
| | - Irene Rocchetti
- Statistical Office, Superior Council of Judiciary, 00185 Rome, Italy;
| | - Norma Alfieri
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (I.M.); (S.S.); (N.A.); (P.S.); (E.C.); (L.B.)
| | - Patrizio Scarozza
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (I.M.); (S.S.); (N.A.); (P.S.); (E.C.); (L.B.)
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (I.M.); (S.S.); (N.A.); (P.S.); (E.C.); (L.B.)
| | - Livia Biancone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (I.M.); (S.S.); (N.A.); (P.S.); (E.C.); (L.B.)
| | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (I.M.); (S.S.); (N.A.); (P.S.); (E.C.); (L.B.)
- Correspondence: ; Tel.: +39-06-20903702
| |
Collapse
|
3
|
Mossa M, Neri B, Scarozza P, Del Vecchio Blanco G, Giannelli M, Argirò R, Di Carlo S, Monteleone G, Petruzziello C. Super selective arterial embolization to treat radiation-induced hemorrhagic gastritis: a case report and review of the literature. Scand J Gastroenterol 2021; 56:118-121. [PMID: 33380231 DOI: 10.1080/00365521.2020.1853219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Radiation-induced hemorrhagic gastritis (RIHG) is a rare but potentially fatal event following radiotherapy for locally advanced gastric cancer; the treatment of this condition is not standardized. Only few cases of RIHG have been reported, treated with different therapeutic approaches. Here we report the case of a 79-year-old patient who underwent subtotal gastrectomy for gastric cancer, followed by adjuvant chemo-radiotherapy. Approximately 3 months after the end of the treatment, she developed recurrent diffuse bleeding originating from the entire mucosa of the gastric pouch and from a marginal ulcer. As the bleeding was refractory to several endoscopic treatments and surgery was not indicated, the patient underwent two sessions of transcatheter selective arterial embolization, with resolution of bleeding. Arterial embolization has already been reported for the treatment of hemorrhagic cystitis, developing after irradiation of the pelvis for prostate, bladder, rectum, and cervix cancer. However, to our knowledge, it has never been reported as a treatment for hemorrhagic gastritis. Based on this case, we suggest arterial embolization as an option in the management of RIHG, when standard endoscopic treatment fails.
Collapse
Affiliation(s)
- Michelangela Mossa
- Department of Systems Medicine, GI Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Benedetto Neri
- Department of Systems Medicine, GI Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Patrizio Scarozza
- Department of Systems Medicine, GI Unit, University "Tor Vergata" of Rome, Rome, Italy
| | | | - Mario Giannelli
- Department of Systems Medicine, GI Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Renato Argirò
- Department of Diagnostic and Interventional Radiology, University "Tor Vergata" of Rome, Rome, Italy
| | - Sara Di Carlo
- Department of Surgery, Minimally Invasive and GI Surgery, University "Tor Vergata" of Rome, Rome, Italy
| | - Giovanni Monteleone
- Department of Systems Medicine, GI Unit, University "Tor Vergata" of Rome, Rome, Italy
| | | |
Collapse
|
4
|
Marafini I, Salvatori S, Troncone E, Scarozza P, Fantini E, Monteleone G. No effect of a liquid diet in the management of patients with stricturing Crohn's disease. Int J Colorectal Dis 2020; 35:1881-1885. [PMID: 32504336 DOI: 10.1007/s00384-020-03650-7] [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] [Accepted: 05/20/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with stricturing Crohn's disease (CD) may experience episodes of intestinal sub-occlusions, which in many cases lead to surgery. The aim of this study was to examine whether adding a liquid diet to medical therapy could improve the management of patients with stricturing CD. METHODS Medical records of CD outpatients with a small bowel stricture, either receiving (group 1) or not (group 2) a 24-h liquid diet every 10-14 days, were retrospectively analyzed. Number of sub-occlusive episodes, frequency, and timing of intestinal resections for strictures were analyzed. RESULTS During the 12-month follow-up, there was no significant difference in the occurrence of new sub-occlusive episodes between the 2 groups (10/37 patients (27%) in group 1 vs 9/45 patients (20%) in group 2). Similarly, the number of patients undergoing bowel resections for sub-occlusive episodes non-responsive to medical therapy did not statistically differ between the two groups (9 patients (24.3%) in group 1 vs 7 patients (15.5%) in group 2). In group 1, surgeries were equally distributed along the 12-months of follow-up, while 85.7% of patients in group 2 underwent intestinal resection within the first 3 months of follow-up. CONCLUSION Adding a liquid diet to medical therapy does not help management of patients with stricturing CD.
Collapse
Affiliation(s)
- Irene Marafini
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Via Montpellier, 1, 00133, Rome, Italy
| | - Silvia Salvatori
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Via Montpellier, 1, 00133, Rome, Italy
| | - Edoardo Troncone
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Via Montpellier, 1, 00133, Rome, Italy
| | - Patrizio Scarozza
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Via Montpellier, 1, 00133, Rome, Italy
| | - Elisa Fantini
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Via Montpellier, 1, 00133, Rome, Italy
| | - Giovanni Monteleone
- Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Via Montpellier, 1, 00133, Rome, Italy.
| |
Collapse
|
5
|
Schmitt H, Ulmschneider J, Billmeier U, Vieth M, Scarozza P, Sonnewald S, Reid S, Atreya I, Rath T, Zundler S, Langheinrich M, Schüttler J, Hartmann A, Winkler T, Admyre C, Knittel T, Dieterich Johansson C, Zargari A, Neurath MF, Atreya R. The TLR9 Agonist Cobitolimod Induces IL10-Producing Wound Healing Macrophages and Regulatory T Cells in Ulcerative Colitis. J Crohns Colitis 2020; 14:508-524. [PMID: 31630153 PMCID: PMC7242005 DOI: 10.1093/ecco-jcc/jjz170] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The topically applied Toll-like receptor 9 [TLR9] agonist cobitolimod is a first-in-class DNA-based oligonucleotide with demonstrated therapeutic efficacy in clinical trials with ulcerative colitis [UC] patients. We here characterized its anti-inflammatory mechanism in UC. METHODS Luminal cobitolimod administration was evaluated in an experimental dextran sodium sulfate [DSS]-induced colitis model. Cultured blood and mucosal cells from UC patients were treated with cobitolimod and analysed via microarray, quantitative real-time PCR, ELISA and flow cytometry. Intestinal slides of cobitolimod-treated UC patients were analysed by immunohistochemistry. RESULTS Cobitolimod administration markedly suppressed experimental colitis activity, and microarray analyses demonstrated mucosal IL10 upregulation and suppression of IL17 signalling pathways. Cobitolimod treatment was associated with significant induction of mucosal IL10+Tr1 and Treg cells and suppression of Th17 cells. TLR9 knockout mice indicated that cobitolimod requires TLR9 signalling for IL10 induction. In UC patients, mucosal TLR9 levels correlated with severity of inflammation. Cobitolimod inhibited IL17A and IL17F, but increased IL10 and FoxP3 expression in cultured intestinal UC T cells. Cobitolimod-mediated suppression of intestinal IL17+T cells was abrogated by IL10 blockade. Furthermore, cobitolimod led to heightened IL10 production by wound healing macrophages. Immunohistochemistry in intestinal biopsies of cobitolimod-treated UC patients indicated increased presence of IL10+mononuclear and regulatory T cells, as well as reduction of IL17+cells. CONCLUSION Activation of TLR9 via cobitolimod might represent a novel therapeutic approach in UC, as it suppresses Th17 cells and induces anti-inflammatory IL10+macrophages and regulatory T cells, thereby modifying the dysregulated intestinal cytokine balance. PODCAST This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
Collapse
Affiliation(s)
- Heike Schmitt
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Ulmschneider
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrike Billmeier
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Patrizio Scarozza
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany,Internal Medicine Department, University Tor Vergata, Rome, Italy
| | - Sophia Sonnewald
- Department of Biology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stephen Reid
- Department of Biology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Imke Atreya
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Timo Rath
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Zundler
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Melanie Langheinrich
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Schüttler
- Department for Anesthesiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Department of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Winkler
- Department of Biology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | | | | - Markus F Neurath
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Raja Atreya
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany,Corresponding author: Prof. Raja Atreya, MD, First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany. Tel: 49 9131 85 35115; Fax: 49 9131 85 35116;
| |
Collapse
|
6
|
Scarozza P, Schmitt H, Monteleone G, Neurath MF, Atreya R. Oligonucleotides-A Novel Promising Therapeutic Option for IBD. Front Pharmacol 2019; 10:314. [PMID: 31068803 PMCID: PMC6491809 DOI: 10.3389/fphar.2019.00314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 10/15/2018] [Accepted: 03/14/2019] [Indexed: 12/12/2022] Open
Abstract
Inflammatory Bowel Diseases (IBD), whose denomination comprehends Crohn's Disease (CD) and Ulcerative Colitis (UC), are intestinal chronic diseases that often require lifelong medical therapy. In the last two decades monoclonal antibodies against the cytokine TNF have become integral parts in the treatment of IBD patients, however there are unwanted side-effects and one third of patients show primary non-response while another subgroup loses response over time. Finding novel drugs which could act as therapies against precise pro-inflammatory molecular targets to avoid unwanted systemic side effects and additionally the process of immunization, represents an important aim for subsequent therapeutic approaches. Oligonucleotide based therapies represent a promising novel concept for the treatment of IBD. The molecular action of oligonucleotides ranges from inhibition of the translational process of mRNA transcripts of pro-inflammatory molecules, to mimicking bacterial DNA which can activate cellular targets for immunomodulation. Alicaforsen, selectively targets ICAM-1 mRNA. ICAM-1 is an adhesion molecule which is upregulated on endothelial cells during IBD, thereby mediating the adhesion and migration of leucocytes from blood to sites of active inflammation. In CD parenteral application of alicaforsen did not show therapeutic efficacy in phase II trials, but it demonstrated an improved efficacy as a topical enema in distal UC. Topical application of alicaforsen might represent a therapeutic perspective for refractory pouchitis as well. SMAD7 is a protein that inhibits the signaling of TGFβ, which is the mainstay of a regulatory counterpart in cellular immune responses. An antisense oligonucleotide against SMAD7 mRNA (mongersen) demonstrated pre-clinical and phase II efficacy in CD, but a phase III clinical trial was stopped due to lack of efficacy. Cobitolimod is a single strand oligonucleotide, which mimics bacterial DNA as its CpG dinucleotide sequences can be recognized by the Toll-like receptor 9 on different immune cells thereby causing induction of different cytokines, for example IL10 and IFNα. Topical application of cobitolimod was studied in UC patients. We will also discuss two other novel oligonucleotides which act on the GATA3 transcription factor (SB012) and on carbohydrate sulfotransferase 15 (STNM01), which could both represent novel promising therapeutic options for the treatment of UC.
Collapse
Affiliation(s)
- Patrizio Scarozza
- Department of Systems Medicine, Gastroenterology, University of Tor Vergata, Rome, Italy.,Department of Medicine 1, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Heike Schmitt
- Department of Medicine 1, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Giovanni Monteleone
- Department of Systems Medicine, Gastroenterology, University of Tor Vergata, Rome, Italy
| | - Markus F Neurath
- Department of Medicine 1, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Raja Atreya
- Department of Medicine 1, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
7
|
Lolli E, Saraceno R, Calabrese E, Ascolani M, Scarozza P, Chiricozzi A, Onali S, Petruzziello C, Chimenti S, Pallone F, Biancone L. Psoriasis Phenotype in Inflammatory Bowel Disease: A Case-Control Prospective Study. J Crohns Colitis 2015; 9:699-707. [PMID: 25908719 DOI: 10.1093/ecco-jcc/jjv068] [Citation(s) in RCA: 24] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 04/14/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Whether inflammatory bowel disease [IBD] is associated with specific psoriasis phenotypes is undefined. In a case-control prospective study, we aimed to assess the severity and phenotype of psoriasis in IBD vs matched non-IBD controls with psoriasis [non-IBD]. METHODS From 2011 to 2013, dermatological assessment was performed in all IBD patients showing lesions requiring characterisation. In patients with psoriasis, assessment included: presence, characteristics, and severity. Each IBD patient with psoriasis was matched [gender, ethnicity, age ± 5 years] with one non-IBD patient with psoriasis. STATISTICAL ANALYSIS data were expressed as median [range], chi-square, Student's t test. RESULTS Dermatological assessment was performed in 251 IBD patients [115 females, age 47 [16-85]; IBD duration 9 years [1-46]]: 158 Crohn's disease [CD] [63%], 93 ulcerative colitis [UC] [37%]. Psoriasis was detected in 62 [25%] IBD patients: 36 [58%] CD, 26 UC [42%; p = 0.44]. Clinical characteristics were comparable between IBD patients with or without psoriasis: age 50 [23-72] vs 47 [16-85]; IBD duration 9.5 [1-46] vs 9 [1-41]; p = non-significant]. The non-IBD group included 62 patients with psoriasis: 35 male; age 47 [18-75]. Mild psoriasis was more frequent in IBD vs non-IBD [87% vs 53%; p < 0.0001], whereas moderate and severe psoriasis were more frequent in non-IBD vs IBD [37% vs 13%, p = 0.004; 10% vs 0%; p = 0.036]. Plaque-type psoriasis was the most common phenotype in both IBD and non-IBD [p < 0.0001 vs others phenotypes].The frequency of plaque-type, nail psoriasis and psoriatic arthritis was lower in IBD vs non-IBD [p = 0.008; p < 0.0001; p = 0.006]. Psoriasis occurred after anti-tumour necrosis factor [TNF]α treatment in six CD patients [7%]. CONCLUSIONS Severity and phenotypes of psoriasis may differ between patients with IBD and their matched non-IBD controls.
Collapse
Affiliation(s)
- Elisabetta Lolli
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Rosita Saraceno
- Department of Dermatology, University of Rome Tor Vergata, Italy
| | - Emma Calabrese
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Marta Ascolani
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Patrizio Scarozza
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | | | - Sara Onali
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | | | - Sergio Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Italy
| | - Francesco Pallone
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Livia Biancone
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| |
Collapse
|
8
|
Zorzi F, Stasi E, Bevivino G, Scarozza P, Biancone L, Zuzzi S, Rossi C, Pallone F, Calabrese E. A sonographic lesion index for Crohn's disease helps monitor changes in transmural bowel damage during therapy. Clin Gastroenterol Hepatol 2014; 12:2071-7. [PMID: 24813174 DOI: 10.1016/j.cgh.2014.04.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 01/29/2014] [Revised: 04/08/2014] [Accepted: 04/15/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Therapeutic antibodies against tumor necrosis factor α (anti-TNF) are effective in patients with Crohn's disease (CD). Mucosal healing is a surrogate marker of efficacy, but little is known about the effects of anti-TNF agents on structural damage in the intestine. Small-intestine contrast ultrasonography (SICUS) is a valuable tool for assessing CD lesions. A new sonographic quantitative index (the sonographic lesion index for CD [SLIC]) was developed to quantify changes in CD lesions detected by SICUS. We explored whether the SLIC can be used to monitor transmural bowel damage in CD patients during anti-TNF therapy. METHODS We performed a prospective study of 29 patients with ileal or ileocolonic CD treated with anti-TNF agents; patients underwent SICUS before and after scheduled induction and maintenance therapy. To determine whether changes that can be detected by SICUS occur independently of anti-TNF therapy, 7 patients with ileal CD treated with mesalamine were enrolled as controls. A clinical response was defined as steroid-free remission, with CD activity index scores less than 150. RESULTS We observed significant improvements in SLIC scores and subscores after induction and maintenance therapy with anti-TNFs, compared with before therapy. SLIC scores and subscores and index classes were improved significantly in patients with vs without clinical responses. Controls had no improvements in terms of CD activity index or SLIC scores, or index classes. CONCLUSIONS Sonographic assessment using the quantitative index SLIC can be used to monitor changes in transmural bowel damage during anti-TNF therapy for CD.
Collapse
Affiliation(s)
- Francesca Zorzi
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Elisa Stasi
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Gerolamo Bevivino
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Patrizio Scarozza
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Livia Biancone
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Sara Zuzzi
- Interdepartmental Center of Biostatistics and Bioinformatics, University of Rome "Tor Vergata," Rome, Italy
| | - Carla Rossi
- Interdepartmental Center of Biostatistics and Bioinformatics, University of Rome "Tor Vergata," Rome, Italy
| | - Francesco Pallone
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Emma Calabrese
- Gastrointestinal Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy.
| |
Collapse
|