1
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Boeckxstaens G, Elsen S, Belmans A, Annese V, Bredenoord AJ, Busch OR, Costantini M, Fumagalli U, Smout AJPM, Tack J, Vanuytsel T, Zaninotto G, Salvador R. 10-year follow-up results of the European Achalasia Trial: a multicentre randomised controlled trial comparing pneumatic dilation with laparoscopic Heller myotomy. Gut 2024; 73:582-589. [PMID: 38050085 DOI: 10.1136/gutjnl-2023-331374] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/19/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE As achalasia is a chronic disorder, long-term follow-up data comparing different treatments are essential to select optimal clinical management. Here, we report on the 10-year follow-up of the European Achalasia Trial comparing endoscopic pneumodilation (PD) with laparoscopic Heller myotomy (LHM). DESIGN A total of 201 newly diagnosed patients with achalasia were randomised to either a series of PDs (n=96) or LHM (n=105). Patients completed symptom (Eckardt score) and quality-of-life questionnaires, underwent functional tests and upper endoscopy. Primary outcome was therapeutic success defined as Eckardt score <3 at yearly follow-up. Secondary outcomes were the need for retreatment, lower oesophageal sphincter pressure, oesophageal emptying, gastro-oesophageal reflux and the rate of complications. RESULTS After 10 years of follow-up, LHM (n=40) and PD (n=36) were equally effective in both the full analysis set (74% vs 74%, p=0.84) and the per protocol set (74% vs 86%, respectively, p=0.07). Subgroup analysis revealed that PD was superior to LHM for type 2 achalasia (p=0.03) while there was a trend, although not significant (p=0.05), that LHM performed better for type 3 achalasia. Barium column height after 5 min at timed barium oesophagram was significantly higher for patients treated with PD compared with LHM, while other parameters, including gastro-oesophageal reflux, were not different. CONCLUSIONS PD and LHM are equally effective even after 10 years of follow-up with limited risk to develop gastro-oesophageal reflux. Based on these data, we conclude that PD and LHM can both be proposed as initial treatment of achalasia.
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Affiliation(s)
- Guy Boeckxstaens
- Department of Gastroenterology, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Stefanie Elsen
- Department of Gastroenterology, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Ann Belmans
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium
| | - Vito Annese
- Department of Gastroenterology, IRCCS San Donato Policlinic, San Donato Milanese, Vita-Salute San Raffaele University, Milano, Italy
| | - Albert J Bredenoord
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova, Italy
| | - Uberto Fumagalli
- Department of Digestive Surgery, European Institute of Oncology - IRCCS, Milano, Italy
| | - André J P M Smout
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Jan Tack
- Department of Gastroenterology, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Giovanni Zaninotto
- Department of Academic Surgery, St Mary's Hospital, Imperial College London, London, UK
| | - Renato Salvador
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova, Italy
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2
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Nigam GB, Chatten K, Sharara A, Al-Taweel T, Alharbi O, Elamin H, Al Awadhi S, Annese V, Limdi JK. Attitudes, perceptions and barriers in implementing therapeutic drug monitoring for anti-TNFs in inflammatory bowel disease: a survey from the Middle East. Therap Adv Gastroenterol 2024; 17:17562848241230902. [PMID: 38406794 PMCID: PMC10894550 DOI: 10.1177/17562848241230902] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Background A growing body of evidence underscores the beneficial impact of therapeutic drug monitoring (TDM) on the efficacy and cost-effectiveness of anti-tumour necrosis factor (TNF) therapy in patients with inflammatory bowel disease (IBD). Objectives We surveyed clinician attitudes, perceptions and barriers related to TDM in IBD in the Middle East. Design A 15-question survey was distributed through national gastroenterological societies in five Middle Eastern countries (UAE, Saudi Arabia, Kuwait, Lebanon and Egypt). Methods Data on clinician characteristics, demographics, utilization patterns and obstacles related to the adoption of TDM with anti-TNFs were gathered. Logistic regression analysis was used to predict factors influencing the utilization of TDM. Results Among 211 respondents (82% male), 82% were consultants, 8% were physicians with an interest in gastroenterology (GI), and 6% were GI trainees. Of these, 152 met inclusion criteria, treating >5 IBD patients per month and ⩾1 with an anti-TNF per month. TDM was used in clinical practice by 78% (95% CI: 71-85) of respondents. TDM was utilized following the loss of response (LOR) in 93%, for primary non-response (PNR) in 40% and before restarting anti-TNF therapy after a drug holiday in 33% of respondents, while 34% used TDM proactively. No specific factors were associated with the use of TDM. Barriers to TDM use included cost (85%), time lag to results (71%) and lack of insurance reimbursement (65%). Overall knowledge of TDM (70%), interpretation and actioning of results (76%) or awareness of clinical guidelines (57%) were not perceived as barriers. If barriers were removed, 95% would use TDM more frequently; 93% for LOR, 60% for PNR, 50% when restarting after a drug holiday, and 54% would use TDM proactively. Conclusion Most gastroenterologists use TDM for LOR, with cost, time lag and insurance reimbursement being significant barriers. Addressing these barriers would increase the judicious use of reactive and proactive TDM to optimize anti-TNF therapy in IBD.
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Affiliation(s)
- Gaurav B. Nigam
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kelly Chatten
- Northern Care Alliance NHS Foundation Trust, Bury, UK
| | - Ala Sharara
- Division of Gastroenterology and Hepatology, American University of Beirut Medical Center, Beirut, Lebanon
- Duke University Medical Center, Durham, NC, USA
| | - Talal Al-Taweel
- Division of Gastroenterology, Department of Internal Medicine, Jaber Al-Ahmad Hospital, Ministries Area, Kuwait
| | | | | | | | - Vito Annese
- Fakeeh University Hospital, Dubai, United Arab Emirates
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Donato Polyclinic, Milan, Italy
| | - Jimmy K. Limdi
- Northern Care Alliance NHS Foundation Trust, Fairfield General Hospital, Rochdale Old Road, Bury, Greater Manchester BL9 7TD, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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3
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Clerc F, Reiding KR, de Haan N, Koeleman CAM, Hipgrave Ederveen AL, Manetti N, Dotz V, Annese V, Wuhrer M. Immunoglobulin A Glycosylation Differs between Crohn's Disease and Ulcerative Colitis. J Proteome Res 2023; 22:3213-3224. [PMID: 37641533 PMCID: PMC10563165 DOI: 10.1021/acs.jproteome.3c00260] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Indexed: 08/31/2023]
Abstract
Inflammatory bowel diseases (IBD), such as Crohn's disease (CD) and ulcerative colitis (UC), are chronic and relapsing inflammations of the digestive tract with increasing prevalence, yet they have unknown origins or cure. CD and UC have similar symptoms but respond differently to surgery and medication. Current diagnostic tools often involve invasive procedures, while laboratory markers for patient stratification are lacking. Large glycomic studies of immunoglobulin G and total plasma glycosylation have shown biomarker potential in IBD and could help determine disease mechanisms and therapeutic treatment choice. Hitherto, the glycosylation signatures of plasma immunoglobulin A, an important immunoglobulin secreted into the intestinal mucin, have remained undetermined in the context of IBD. Our study investigated the associations of immunoglobulin A1 and A2 glycosylation with IBD in 442 IBD cases (188 CD and 254 UC) and 120 healthy controls by reversed-phase liquid chromatography electrospray-ionization mass spectrometry of tryptic glycopeptides. Differences of IgA O- and N-glycosylation (including galactosylation, bisection, sialylation, and antennarity) between patient groups were associated with the diseases, and these findings led to the construction of a statistical model to predict the disease group of the patients without the need of invasive procedures. This study expands the current knowledge about CD and UC and could help in the development of noninvasive biomarkers and better patient care.
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Affiliation(s)
- Florent Clerc
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center (LUMC), Postbus 9600, Leiden 2300 RC, The Netherlands
| | - Karli R. Reiding
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center (LUMC), Postbus 9600, Leiden 2300 RC, The Netherlands
- Biomolecular
Mass Spectrometry and Proteomics, Bijvoet
Center for Biomolecular Research and Utrecht Institute for Pharmaceutical
Sciences, University of Utrecht, Padualaan 8, Utrecht 3584 CH, The Netherlands
- Netherlands
Proteomics Center, Padualaan
8, Utrecht 3584 CH, The Netherlands
| | - Noortje de Haan
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center (LUMC), Postbus 9600, Leiden 2300 RC, The Netherlands
| | - Carolien A. M. Koeleman
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center (LUMC), Postbus 9600, Leiden 2300 RC, The Netherlands
| | - Agnes L. Hipgrave Ederveen
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center (LUMC), Postbus 9600, Leiden 2300 RC, The Netherlands
| | - Natalia Manetti
- Unit
of Gastroenterology SOD2 (Strutture Organizzative Dipartimentali), Azienda Ospedaliero Universitaria (AOU) Careggi, Florence 50134, Italy
- Gastroenterology
Unit, San Jacopo Hospital, Pistoia 51100, Italy
| | - IBD-BIOM Consortium
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center (LUMC), Postbus 9600, Leiden 2300 RC, The Netherlands
- Biomolecular
Mass Spectrometry and Proteomics, Bijvoet
Center for Biomolecular Research and Utrecht Institute for Pharmaceutical
Sciences, University of Utrecht, Padualaan 8, Utrecht 3584 CH, The Netherlands
- Netherlands
Proteomics Center, Padualaan
8, Utrecht 3584 CH, The Netherlands
- Unit
of Gastroenterology SOD2 (Strutture Organizzative Dipartimentali), Azienda Ospedaliero Universitaria (AOU) Careggi, Florence 50134, Italy
- Gastroenterology
Unit, San Jacopo Hospital, Pistoia 51100, Italy
- Unit of Gastroenterology, IRCCS
(Istituto di Ricovero e Cura a Carattere Scientifico−Casa
Sollievo della Sofferenza) Hospital, San Giovanni Rotondo 71013, Italy
- Vita-Salute
San Raffaele University Faculty of Medicine and Surgery, Milano 20132, Italy
- IRCCS
Policlinico San Danato, San Donato
Milanese 20097, Italy
| | - Viktoria Dotz
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center (LUMC), Postbus 9600, Leiden 2300 RC, The Netherlands
| | - Vito Annese
- Unit
of Gastroenterology SOD2 (Strutture Organizzative Dipartimentali), Azienda Ospedaliero Universitaria (AOU) Careggi, Florence 50134, Italy
- Unit of Gastroenterology, IRCCS
(Istituto di Ricovero e Cura a Carattere Scientifico−Casa
Sollievo della Sofferenza) Hospital, San Giovanni Rotondo 71013, Italy
- Vita-Salute
San Raffaele University Faculty of Medicine and Surgery, Milano 20132, Italy
- IRCCS
Policlinico San Danato, San Donato
Milanese 20097, Italy
| | - Manfred Wuhrer
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center (LUMC), Postbus 9600, Leiden 2300 RC, The Netherlands
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4
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Annese V, Annese M. Precision Medicine in Inflammatory Bowel Disease. Diagnostics (Basel) 2023; 13:2797. [PMID: 37685335 PMCID: PMC10487169 DOI: 10.3390/diagnostics13172797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Ulcerative colitis and Crohn's disease are traditionally defined as the two main subtypes of inflammatory bowel disease. However, a more recent view considers IBD as a spectrum of heterogeneous phenotypes with consistent differences in clinical presentation and behaviors, likely explained by differences in underlying pathogenetic mechanisms. The etiology is still elusive, and the suggested pathogenesis is a complex interplay among genetic predisposition and abnormal immune response at the mucosal intestinal level, activated by only partially identified environmental triggers leading to altered intestinal permeability and impaired handling of gut microbiota. The undeniable continuous progress of medical therapy with more frequent shifts from traditional to more advanced modalities also underlines the actual unmet needs. We are using medications with completely different mechanisms of action, with a lack of predictive factors of outcomes and response and still an unsatisfactory rate of success. In addition, we are missing still valuable and accurate markers to predict disease progression and severity in order to avoid under- or over-treatment. In such a complex scenario, it is undoubtful that the application of artificial intelligence and machine learning algorithms may improve the management and pave the way for precision and eventually personalized medicine in these patients; however, there are still several challenges that will be the focus of this review.
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Affiliation(s)
- Vito Annese
- Department Gastroenterology IRCCS San Donato Policlinic, Vita-Salute San Raffaele University, 20100 Milan, Italy
| | - Monica Annese
- Department Gastroenterology, IRCCS Hospital Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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5
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Kiryluk K, Sanchez-Rodriguez E, Zhou XJ, Zanoni F, Liu L, Mladkova N, Khan A, Marasa M, Zhang JY, Balderes O, Sanna-Cherchi S, Bomback AS, Canetta PA, Appel GB, Radhakrishnan J, Trimarchi H, Sprangers B, Cattran DC, Reich H, Pei Y, Ravani P, Galesic K, Maixnerova D, Tesar V, Stengel B, Metzger M, Canaud G, Maillard N, Berthoux F, Berthelot L, Pillebout E, Monteiro R, Nelson R, Wyatt RJ, Smoyer W, Mahan J, Samhar AA, Hidalgo G, Quiroga A, Weng P, Sreedharan R, Selewski D, Davis K, Kallash M, Vasylyeva TL, Rheault M, Chishti A, Ranch D, Wenderfer SE, Samsonov D, Claes DJ, Akchurin O, Goumenos D, Stangou M, Nagy J, Kovacs T, Fiaccadori E, Amoroso A, Barlassina C, Cusi D, Del Vecchio L, Battaglia GG, Bodria M, Boer E, Bono L, Boscutti G, Caridi G, Lugani F, Ghiggeri G, Coppo R, Peruzzi L, Esposito V, Esposito C, Feriozzi S, Polci R, Frasca G, Galliani M, Garozzo M, Mitrotti A, Gesualdo L, Granata S, Zaza G, Londrino F, Magistroni R, Pisani I, Magnano A, Marcantoni C, Messa P, Mignani R, Pani A, Ponticelli C, Roccatello D, Salvadori M, Salvi E, Santoro D, Gembillo G, Savoldi S, Spotti D, Zamboli P, Izzi C, Alberici F, Delbarba E, Florczak M, Krata N, Mucha K, Pączek L, Niemczyk S, Moszczuk B, Pańczyk-Tomaszewska M, Mizerska-Wasiak M, Perkowska-Ptasińska A, Bączkowska T, Durlik M, Pawlaczyk K, Sikora P, Zaniew M, Kaminska D, Krajewska M, Kuzmiuk-Glembin I, Heleniak Z, Bullo-Piontecka B, Liberek T, Dębska-Slizien A, Hryszko T, Materna-Kiryluk A, Miklaszewska M, Szczepańska M, Dyga K, Machura E, Siniewicz-Luzeńczyk K, Pawlak-Bratkowska M, Tkaczyk M, Runowski D, Kwella N, Drożdż D, Habura I, Kronenberg F, Prikhodina L, van Heel D, Fontaine B, Cotsapas C, Wijmenga C, Franke A, Annese V, Gregersen PK, Parameswaran S, Weirauch M, Kottyan L, Harley JB, Suzuki H, Narita I, Goto S, Lee H, Kim DK, Kim YS, Park JH, Cho B, Choi M, Van Wijk A, Huerta A, Ars E, Ballarin J, Lundberg S, Vogt B, Mani LY, Caliskan Y, Barratt J, Abeygunaratne T, Kalra PA, Gale DP, Panzer U, Rauen T, Floege J, Schlosser P, Ekici AB, Eckardt KU, Chen N, Xie J, Lifton RP, Loos RJF, Kenny EE, Ionita-Laza I, Köttgen A, Julian BA, Novak J, Scolari F, Zhang H, Gharavi AG. Genome-wide association analyses define pathogenic signaling pathways and prioritize drug targets for IgA nephropathy. Nat Genet 2023; 55:1091-1105. [PMID: 37337107 DOI: 10.1038/s41588-023-01422-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/05/2023] [Indexed: 06/21/2023]
Abstract
IgA nephropathy (IgAN) is a progressive form of kidney disease defined by glomerular deposition of IgA. Here we performed a genome-wide association study of 10,146 kidney-biopsy-diagnosed IgAN cases and 28,751 controls across 17 international cohorts. We defined 30 genome-wide significant risk loci explaining 11% of disease risk. A total of 16 loci were new, including TNFSF4/TNFSF18, REL, CD28, PF4V1, LY86, LYN, ANXA3, TNFSF8/TNFSF15, REEP3, ZMIZ1, OVOL1/RELA, ETS1, IGH, IRF8, TNFRSF13B and FCAR. The risk loci were enriched in gene orthologs causing abnormal IgA levels when genetically manipulated in mice. We also observed a positive genetic correlation between IgAN and serum IgA levels. High polygenic score for IgAN was associated with earlier onset of kidney failure. In a comprehensive functional annotation analysis of candidate causal genes, we observed convergence of biological candidates on a common set of inflammatory signaling pathways and cytokine ligand-receptor pairs, prioritizing potential new drug targets.
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Affiliation(s)
- Krzysztof Kiryluk
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA.
- Institute for Genomic Medicine, Columbia University, New York City, NY, USA.
| | - Elena Sanchez-Rodriguez
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Xu-Jie Zhou
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Francesca Zanoni
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Lili Liu
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Nikol Mladkova
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Atlas Khan
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Maddalena Marasa
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Jun Y Zhang
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Olivia Balderes
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Simone Sanna-Cherchi
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
- Institute for Genomic Medicine, Columbia University, New York City, NY, USA
| | - Andrew S Bomback
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Pietro A Canetta
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Gerald B Appel
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Jai Radhakrishnan
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Hernan Trimarchi
- Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Ben Sprangers
- Department of Microbiology and Immunology, Laboratory of Molecular Immunology, KU Leuven, Leuven, Belgium
- Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Daniel C Cattran
- Department of Nephrology, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Heather Reich
- Department of Nephrology, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - York Pei
- Department of Nephrology, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Pietro Ravani
- Division of Nephrology, Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Dita Maixnerova
- 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Vladimir Tesar
- 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Benedicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM Clinical Epidemiology Team, Villejuif, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM Clinical Epidemiology Team, Villejuif, France
| | - Guillaume Canaud
- Université de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Maillard
- Nephrology, Dialysis, and Renal Transplantation Department, University North Hospital, Saint Etienne, France
| | - Francois Berthoux
- Nephrology, Dialysis, and Renal Transplantation Department, University North Hospital, Saint Etienne, France
| | | | - Evangeline Pillebout
- Center for Research on Inflammation, University of Paris, INSERM and CNRS, Paris, France
| | - Renato Monteiro
- Center for Research on Inflammation, University of Paris, INSERM and CNRS, Paris, France
| | - Raoul Nelson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Robert J Wyatt
- Division of Pediatric Nephrology, University of Tennessee Health Sciences Center, Memphis, TN, USA
- Children's Foundation Research Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - William Smoyer
- Division of Pediatric Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | - John Mahan
- Division of Pediatric Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Al-Akash Samhar
- Division of Pediatric Nephrology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Guillermo Hidalgo
- Division of Pediatric Nephrology, Department of Pediatrics, HMH Hackensack University Medical Center, Hackensack, NJ, USA
| | - Alejandro Quiroga
- Division of Pediatric Nephrology, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Patricia Weng
- Division of Pediatric Nephrology, Mattel Children's Hospital, Los Angeles, CA, USA
| | - Raji Sreedharan
- Division of Pediatric Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David Selewski
- Division of Pediatric Nephrology, Mott Children's Hospital, Ann Arbor, MI, USA
| | - Keefe Davis
- Division of Pediatric Nephrology, Department of Pediatrics, The Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Mahmoud Kallash
- Division of Pediatric Nephrology, SUNY Buffalo, Buffalo, NY, USA
| | - Tetyana L Vasylyeva
- Division of Pediatric Nephrology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michelle Rheault
- Division of Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
| | - Aftab Chishti
- Division of Pediatric Nephrology, University of Kentucky, Lexington, KY, USA
| | - Daniel Ranch
- Division of Pediatric Nephrology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - Scott E Wenderfer
- Division of Pediatric Nephrology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Dmitry Samsonov
- Division of Pediatric Nephrology, Boston Children's Hospital, Boston, MA, USA
| | - Donna J Claes
- Division of Pediatric Nephrology, Department of Pediatrics, New York Medical College, New York City, NY, USA
| | - Oleh Akchurin
- Division of Pediatric Nephrology, Department of Pediatrics, Weill Cornell Medical College, New York City, NY, USA
| | | | - Maria Stangou
- The Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Judit Nagy
- 2nd Department of Internal Medicine, Nephrological and Diabetological Center, University of Pécs, Pécs, Hungary
| | - Tibor Kovacs
- 2nd Department of Internal Medicine, Nephrological and Diabetological Center, University of Pécs, Pécs, Hungary
| | - Enrico Fiaccadori
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Amoroso
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Cristina Barlassina
- Renal Division, Dipartimento di Medicina, Chirurgia e Odontoiatria, San Paolo Hospital, School of Medicine, University of Milan, Milan, Italy
| | - Daniele Cusi
- Renal Division, Dipartimento di Medicina, Chirurgia e Odontoiatria, San Paolo Hospital, School of Medicine, University of Milan, Milan, Italy
| | | | | | | | - Emanuela Boer
- Division of Nephrology and Dialysis, Gorizia Hospital, Gorizia, Italy
| | - Luisa Bono
- Nephrology and Dialysis, A.R.N.A.S. Civico and Benfratelli, Palermo, Italy
| | - Giuliano Boscutti
- Nephrology, Dialysis and Renal Transplant Unit, S. Maria della Misericordia Hospital, ASUFC, Udine, Italy
| | - Gianluca Caridi
- Division of Nephrology, Dialysis and Transplantation, IRCCS Giannina Gaslini Institute, Genova, Italy
| | - Francesca Lugani
- Division of Nephrology, Dialysis and Transplantation, IRCCS Giannina Gaslini Institute, Genova, Italy
| | - GianMarco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, IRCCS Giannina Gaslini Institute, Genova, Italy
| | - Rosanna Coppo
- Regina Margherita Children's Hospital, Torino, Italy
| | - Licia Peruzzi
- Regina Margherita Children's Hospital, Torino, Italy
| | | | | | | | | | - Giovanni Frasca
- Division of Nephrology, Dialysis and Renal Transplantation, Riuniti Hospital, Ancona, Italy
| | | | - Maurizio Garozzo
- Unità Operativa di Nefrologia e Dialisi, Ospedale di Acireale, Acireale, Italy
| | - Adele Mitrotti
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Simona Granata
- Renal Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University of Verona, Verona, Italy
| | | | - Riccardo Magistroni
- Department of Surgical, Medical, Dental, Oncologic and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Isabella Pisani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Magnano
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Piergiorgio Messa
- Nephrology Dialysis and Kidney Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Renzo Mignani
- Azienda Unità Sanitaria Locale Rimini, Rimini, Italy
| | - Antonello Pani
- Department of Nephrology and Dialysis, G. Brotzu Hospital, Cagliari, Italy
| | | | - Dario Roccatello
- Nephrology and Dialysis Unit, G. Bosco Hub Hospital (ERK-net Member) and University of Torino, Torino, Italy
| | - Maurizio Salvadori
- Division of Nephrology and Renal Transplantation, Carreggi Hospital, Florence, Italy
| | - Erica Salvi
- Renal Division, DMCO (Dipartimento di Medicina, Chirurgia e Odontoiatria), San Paolo Hospital, School of Medicine, University of Milan, Milan, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, AOU G Martino, University of Messina, Messina, Italy
| | - Guido Gembillo
- Unit of Nephrology and Dialysis, AOU G Martino, University of Messina, Messina, Italy
| | - Silvana Savoldi
- Unit of Nephrology and Dialysis, ASL TO4-Consultorio Cirié, Turin, Italy
| | | | | | - Claudia Izzi
- Department of Medical and Surgical Specialties and Nephrology Unit, University of Brescia-ASST Spedali Civili, Brescia, Italy
| | - Federico Alberici
- Department of Medical and Surgical Specialties and Nephrology Unit, University of Brescia-ASST Spedali Civili, Brescia, Italy
| | - Elisa Delbarba
- Department of Medical and Surgical Specialties and Nephrology Unit, University of Brescia-ASST Spedali Civili, Brescia, Italy
| | - Michał Florczak
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Natalia Krata
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Mucha
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Leszek Pączek
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Disease, Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Barbara Moszczuk
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Teresa Bączkowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan Medical University, Poznan, Poland
| | - Przemyslaw Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
| | - Dorota Kaminska
- Clinical Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Clinical Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Izabella Kuzmiuk-Glembin
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Zbigniew Heleniak
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Barbara Bullo-Piontecka
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Liberek
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Alicja Dębska-Slizien
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Hryszko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | | | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Szczepańska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Katarzyna Dyga
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Edyta Machura
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Katarzyna Siniewicz-Luzeńczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Monika Pawlak-Bratkowska
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Dariusz Runowski
- Department of Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Norbert Kwella
- Department of Nephrology, Hypertension and Internal Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Ireneusz Habura
- Department of Nephrology, Karol Marcinkowski Hospital, Zielona Góra, Poland
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Larisa Prikhodina
- Division of Inherited and Acquired Kidney Diseases, Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russia
| | - David van Heel
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bertrand Fontaine
- Sorbonne University, INSERM, Center of Research in Myology, Institute of Myology, University Hospital Pitie-Salpetriere, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service of Neuro-Myology, University Hospital Pitie-Salpetriere, Paris, France
| | - Chris Cotsapas
- Departments of Neurology and Genetics, Yale University, New Haven, CT, USA
| | | | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Vito Annese
- CBP American Hospital, Dubai, United Arab Emirates
| | - Peter K Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institutes for Medical Research, North Shore LIJ Health System, New York City, NY, USA
| | | | - Matthew Weirauch
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leah Kottyan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John B Harley
- US Department of Veterans Affairs Medical Center and Cincinnati Education and Research for Veterans Foundation, Cincinnati, OH, USA
| | - Hitoshi Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shin Goto
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hajeong Lee
- Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yon Su Kim
- Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - BeLong Cho
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Murim Choi
- Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ans Van Wijk
- Amsterdam University Medical Centre, VU University Medical Center (VUMC), Amsterdam, the Netherlands
| | - Ana Huerta
- Hospital Universitario Puerta del Hierro Majadahonda, REDINREN, IISCIII, Madrid, Spain
| | - Elisabet Ars
- Molecular Biology Laboratory and Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autònoma de Barcelona, REDINREN, IISCIII, Barcelona, Spain
| | - Jose Ballarin
- Molecular Biology Laboratory and Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autònoma de Barcelona, REDINREN, IISCIII, Barcelona, Spain
| | - Sigrid Lundberg
- Department of Nephrology, Danderyd University Hospital, and Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laila-Yasmin Mani
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasar Caliskan
- Division of Nephrology, Saint Louis University, Saint Louis, MO, USA
| | - Jonathan Barratt
- John Walls Renal Unit, University Hospitals of Leicester, Leicester, UK
| | | | | | - Daniel P Gale
- Department of Renal Medicine, University College London, London, UK
| | | | - Thomas Rauen
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Pascal Schlosser
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingyuan Xie
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Richard P Lifton
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York City, NY, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Novo Nordisk Foundation Center for Basic Metabolic Research, Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eimear E Kenny
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Genetics and Genomic Sciences, Mount Sinai Health System, New York City, NY, USA
- Center for Population Genomic Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Iuliana Ionita-Laza
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Bruce A Julian
- Departments of Microbiology and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jan Novak
- Departments of Microbiology and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Francesco Scolari
- Department of Medical and Surgical Specialties and Nephrology Unit, University of Brescia-ASST Spedali Civili, Brescia, Italy
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Ali G Gharavi
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA.
- Institute for Genomic Medicine, Columbia University, New York City, NY, USA.
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6
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Burisch J, Zhao M, Odes S, De Cruz P, Vermeire S, Bernstein CN, Kaplan GG, Duricova D, Greenberg D, Melberg HO, Watanabe M, Ahn HS, Targownik L, Pittet VEH, Annese V, Park KT, Katsanos KH, Høivik ML, Krznaric Z, Chaparro M, Loftus EV, Lakatos PL, Gisbert JP, Bemelman W, Moum B, Gearry RB, Kappelman MD, Hart A, Pierik MJ, Andrews JM, Ng SC, D'Inca R, Munkholm P. The cost of inflammatory bowel disease in high-income settings: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2023; 8:458-492. [PMID: 36871566 DOI: 10.1016/s2468-1253(23)00003-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 03/06/2023]
Abstract
The cost of caring for patients with inflammatory bowel disease (IBD) continues to increase worldwide. The cause is not only a steady increase in the prevalence of Crohn's disease and ulcerative colitis in both developed and newly industrialised countries, but also the chronic nature of the diseases, the need for long-term, often expensive treatments, the use of more intensive disease monitoring strategies, and the effect of the diseases on economic productivity. This Commission draws together a wide range of expertise to discuss the current costs of IBD care, the drivers of increasing costs, and how to deliver affordable care for IBD in the future. The key conclusions are that (1) increases in health-care costs must be evaluated against improved disease management and reductions in indirect costs, and (2) that overarching systems for data interoperability, registries, and big data approaches must be established for continuous assessment of effectiveness, costs, and the cost-effectiveness of care. International collaborations should be sought out to evaluate novel models of care (eg, value-based health care, including integrated health care, and participatory health-care models), as well as to improve the education and training of clinicians, patients, and policy makers.
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Affiliation(s)
- Johan Burisch
- Gastro Unit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark.
| | - Mirabella Zhao
- Gastro Unit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Selwyn Odes
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health, Melbourne, VIC, Australia; Department of Medicine, Austin Academic Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - Severine Vermeire
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium; Faculty of Medicine, KU Leuven University, Leuven, Belgium
| | - Charles N Bernstein
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Dana Duricova
- IBD Clinical and Research Centre for IBD, ISCARE, Prague, Czech Republic; Department of Pharmacology, Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hans O Melberg
- Department of Community Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Mamoru Watanabe
- Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Laura Targownik
- Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Valérie E H Pittet
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Vito Annese
- Division of Gastroenterology, Department of Internal Medicine, Fakeeh University Hospital, Dubai, United Arab Emirates
| | - K T Park
- Stanford Health Care, Packard Health Alliance, Alameda, CA, USA; Genentech (Roche Group), South San Francisco, CA, USA
| | - Konstantinos H Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences, Ioannina, Greece
| | - Marte L Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Zagreb, Zagreb, Croatia
| | - María Chaparro
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Montreal, QC, Canada; Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Willem Bemelman
- Department of Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Bjorn Moum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Michael D Kappelman
- Division of Pediatric Gastroenterology, Department of Pediatrics and Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ailsa Hart
- IBD Unit, St Mark's Hospital, Middlesex, UK
| | - Marieke J Pierik
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jane M Andrews
- IBD Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Siew C Ng
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Renata D'Inca
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Pia Munkholm
- Department of Gastroenterology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
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Al-Amrah H, Saadah OI, Mosli M, Annese V, Al-Hindi R, Edris S, Alshehri D, Alatawi H, Alatawy M, Bahieldin A. Composition of the gut microbiota in patients with inflammatory bowel disease in Saudi Arabia: A pilot study. Saudi J Gastroenterol 2023; 29:102-110. [PMID: 36695274 DOI: 10.4103/sjg.sjg_368_22] [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] [Indexed: 01/25/2023] Open
Abstract
CONCLUSIONS The results of this study provide an overview of the variations in microbiota diversity present in Saudi IBD patients compared to healthy controls. RESULTS The key finding was three negative bacterial biomarkers, Paraprevotellaceae, the Muribaculaceae families of Bacteroidetes phylum, and the Leuconostocaceae family of Firmicutes phylum, which had a higher relative abundance in healthy individuals compared to IBD patients. It was also found that primary microbiota signatures at certain genera and species levels, including Prevotella copri, Bifidobacterium adolescentis, Ruminococcus callidus, Coprococcus sp., Ruminococcus gnavus, Dorea formicigenerans, Leuconostoc, Dialister, Catenibacterium, Eubacterium biforme, and Lactobacillus mucosae, were absent in almost all IBD patients, while Veillonella dispar was absent in all healthy individuals. METHODS After obtaining an informed consent, fecal samples were collected from 11 participants with IBD (patients) and 10 healthy individuals (controls). The bacterial components of the microbial population were identified by next-generation sequencing of partial 16S rRNA. Statistically significant dissimilarities were observed between samples for all metrics. BACKGROUND Inflammatory bowel disease (IBD) is a chronic intestinal inflammatory condition attributed to a complex interaction between imbalances in the gut microbiome, environmental conditions, and a deregulated immune response. The aim of the study was to investigate the composition of the gut microbiome of Saudi patients with IBD.
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Affiliation(s)
- Hadba Al-Amrah
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar I Saadah
- Department of Pediatrics, Faculty of Medicine; Department of Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahmoud Mosli
- Department of Inflammatory Bowel Disease Research Group; Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Vito Annese
- Fakeeh University Hospital, Dubai, United Arab Emirates
| | - Rashad Al-Hindi
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sherif Edris
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University; Princess Al Jawhara Albrahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah, Saudi Arabia; Department of Genetics, Ain Shams University, Cairo, Egypt; Al Borg Medical Laboratories, Al Borg Diagnostics, Jeddah, Saudi Arabia
| | - Dikhnah Alshehri
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah; Department of Biological Sciences, College of Science, Univesity of Tabuk, Tabuk, Saudi Arabia
| | - Hanan Alatawi
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah; Department of Biological Sciences, College of Science, Univesity of Tabuk, Tabuk, Saudi Arabia
| | - Marfat Alatawy
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah; Department of Biological Sciences, College of Science, Univesity of Tabuk, Tabuk, Saudi Arabia
| | - Ahmad Bahieldin
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Genetics, Ain Shams University, Cairo, Egypt
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8
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Facciorusso A, Ramai D, Ichkhanian Y, Yadlapati R, Annese V, Wani S, Khashab MA. Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2022; 56:853-862. [PMID: 34608024 PMCID: PMC8977395 DOI: 10.1097/mcg.0000000000001622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is limited evidence on the efficacy of peroral endoscopic myotomy (POEM) in patients with esophageal diverticula. AIMS This meta-analysis aimed to assess the efficacy and safety profile of POEM in patients with Zenker (ZD) and epiphrenic diverticula. METHODS With a literature search through August 2020, we identified 12 studies (300 patients) assessing POEM in patients with esophageal diverticula. The primary outcome was treatment success. Results were expressed as pooled rates and 95% confidence intervals. RESULTS Pooled rate of technical success was 95.9% (93.4%-98.3%) in ZD patients and 95.1% (88.8%-100%) in patients with epiphrenic diverticula. Pooled rate of treatment success was similar for ZD (90.6%, 87.1%-94.1%) and epiphrenic diverticula (94.2%, 87.3%-100%). Rates of treatment success were maintained at 1 year (90%, 86.4%-97.4%) and 2 years (89.6%, 82.2%-96.9%) in ZD patients. Pooled rate of symptom recurrence was 2.6% (0.9%-4.4%) in ZD patients and 0% in patients with epiphrenic diverticula. Pooled rates of adverse events and severe adverse events were 10.6% (4.6%-16.6%) and 3.5% (0%-7.4%) in ZD and 8.4% (0%-16.8%) and 8.4% (0%-16.8%) in epiphrenic diverticula, respectively. CONCLUSION POEM represents an effective and safe therapy for the treatment of esophageal diverticula.
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Affiliation(s)
| | - Daryl Ramai
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Vito Annese
- Valiant Clinic & American Hospital, Dubai, United Arab Emirates
| | - Sachin Wani
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore
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9
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Spinelli A, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, Bachmann O, Bettenworth D, Chaparro M, Czuber-Dochan W, Eder P, Ellul P, Fidalgo C, Fiorino G, Gionchetti P, Gisbert JP, Gordon H, Hedin C, Holubar S, Iacucci M, Karmiris K, Katsanos K, Kopylov U, Lakatos PL, Lytras T, Lyutakov I, Noor N, Pellino G, Piovani D, Savarino E, Selvaggi F, Verstockt B, Doherty G, Raine T, Panis Y. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis 2022; 16:179-189. [PMID: 34635910 DOI: 10.1093/ecco-jcc/jjab177] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This is the second of a series of two articles reporting the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of adult patients with ulcerative colitis [UC]. The first article is focused on medical management, and the present article addresses medical treatment of acute severe ulcerative colitis [ASUC] and surgical management of medically refractory UC patients, including preoperative optimisation, surgical strategies, and technical issues. The article provides advice for a variety of common clinical and surgical conditions. Together, the articles represent an update of the evidence-based recommendations of the ECCO for UC.
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Affiliation(s)
- Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, and Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Johan Burisch
- Gastrounit, Medical Division, and Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Lüneburg, Germany
| | - Michel Adamina
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Zurich.,Department of Biomedical Engineering, Clinical Research and Artificial Intelligence in Surgery, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Vito Annese
- Department of Gastroenterology, Fakeeh University Hospital, Dubai, UAE
| | - Oliver Bachmann
- Department of Internal Medicine I, Siloah St. Trudpert Hospital, Pforzheim.,Hannover Medical School, Hannover, Germany
| | - Dominik Bettenworth
- University Hospital Munster, Department of Medicine B - Gastroenterology and Hepatology, Munster, Germany
| | - Maria Chaparro
- Gastroenterology Unit, IIS-IP, Universidad Autónoma de Madrid [UAM], CIBEREHD, Madrid, Spain
| | - Wladyslawa Czuber-Dochan
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznań University of Medical Sciences, and Heliodor Święcicki University Hospital, Poznań, Poland
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Catarina Fidalgo
- Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal
| | - Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University, and IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | - Paolo Gionchetti
- IBD Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna DIMEC, University of Bologna, Bologna, Italy
| | - Javier P Gisbert
- Gastroenterology Unit, IIS-IP, Universidad Autónoma de Madrid [UAM], CIBEREHD, Madrid, Spain
| | - Hannah Gordon
- Department of Gastroenterology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Charlotte Hedin
- Karolinska Institutet, Department of Medicine Solna, and Karolinska University Hospital, Department of Gastroenterology, Dermatovenereology and Rheumatology, Stockholm, Sweden
| | - Stefan Holubar
- Department of Colon & Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy, University of Birmingham, and Division of Gastroenterology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | | | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, Ioannina, Greece
| | - Uri Kopylov
- Department of Gastroenterology, Tel-HaShomer Sheba Medical Center, Ramat Gan, and Sackler Medical School, Tel Aviv, Israel
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada.,1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Theodore Lytras
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Ivan Lyutakov
- Department of Gastroenterology, University Hospital 'Tsaritsa Yoanna - ISUL', Medical University Sofia, Sofia, Bulgaria
| | - Nurulamin Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania "Luigi Vanvitelli", Naples, Italy, and Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Francesco Selvaggi
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, and Department of Chronic Diseases, Metabolism and Ageing, TARGID - IBD, KU Leuven, Leuven, Belgium
| | - Glen Doherty
- Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Tim Raine
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université of Paris, France
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Raine T, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, Bachmann O, Bettenworth D, Chaparro M, Czuber-Dochan W, Eder P, Ellul P, Fidalgo C, Fiorino G, Gionchetti P, Gisbert JP, Gordon H, Hedin C, Holubar S, Iacucci M, Karmiris K, Katsanos K, Kopylov U, Lakatos PL, Lytras T, Lyutakov I, Noor N, Pellino G, Piovani D, Savarino E, Selvaggi F, Verstockt B, Spinelli A, Panis Y, Doherty G. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis 2022; 16:2-17. [PMID: 34635919 DOI: 10.1093/ecco-jcc/jjab178] [Citation(s) in RCA: 240] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Tim Raine
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Johan Burisch
- Gastrounit, Medical Division, Hvidovre Hospital; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Lüneburg, Germany
| | - Michel Adamina
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
- Department of Biomedical Engineering, Clinical Research and Artificial Intelligence in Surgery, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Vito Annese
- Department of Gastroenterology, Fakeeh University Hospital, Dubai, UAE
| | - Oliver Bachmann
- Department of Internal Medicine I, Siloah St. Trudpert Hospital, Pforzheim; Hannover Medical School, Hannover, Germany
| | - Dominik Bettenworth
- University Hospital Munster, Department of Medicine B - Gastroenterology and Hepatology, Munster, Germany
| | - Maria Chaparro
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Wladyslawa Czuber-Dochan
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Medicine - Poznań University of Medical Sciences; Heliodor Święcicki University Hospital, Poznań, Poland
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Catarina Fidalgo
- Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal
| | - Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University; IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | - Paolo Gionchetti
- IBD Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna DIMEC, University of Bologna, Bologna, Italy
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Hannah Gordon
- Department of Gastroenterology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Charlotte Hedin
- Karolinska Institutet, Department of Medicine Solna; Karolinska University Hospital, Department of Gastroenterology, Dermatovenereology and Rheumatology, Stockholm, Sweden
| | - Stefan Holubar
- Department of Colon & Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy, NIHR Biomedical Research Centre, University of Birmingham; Division of Gastroenterology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | | | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, Ioannina, Greece
| | - Uri Kopylov
- Department of Gastroenterology, Tel-HaShomer Sheba Medical Center, Ramat Gan, and Sackler Medical School, Tel Aviv, Israel
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Theodore Lytras
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Ivan Lyutakov
- Department of Gastroenterology, University Hospital 'Tsaritsa Yoanna - ISUL', Medical University Sofia, Sofia, Bulgaria
| | - Nurulamin Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Francesco Selvaggi
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven; Department of Chronic Diseases, Metabolism and Ageing, TARGID - IBD, Leuven, Belgium
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université of Paris, France
| | - Glen Doherty
- Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
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Annese V, Nathwani R, Alkhatry M, Al-Rifai A, Al Awadhi S, Georgopoulos F, Jazzar AN, Khassouan AM, Koutoubi Z, Taha MS, Limdi JK. Optimizing biologic therapy in inflammatory bowel disease: a Delphi consensus in the United Arab Emirates. Therap Adv Gastroenterol 2021; 14:17562848211065329. [PMID: 34987611 PMCID: PMC8721421 DOI: 10.1177/17562848211065329] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/19/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) are chronic, relapsing-remitting inflammatory conditions with a substantial negative impact on health-related quality of life and work productivity. Treatment of IBD has been revolutionized by the advent of biologic therapies, initially with anti-TNF agents and more recently with multiple alternatives targets, and yet more under development. OBJECTIVES Approximatively one third of patients do not respond to biologic therapy and more importantly a significant proportion experiences partial response or loss of response during treatment. The latter are common clinical situations and paradoxically are not addressed in the commercial drug labels and available guidelines. There is therefore a clinical need for physicians to understand when and how eventually to optimize the biologic therapy. DESIGN This consensus using a Delphi methodology was promoted and supported by the Emirates Society of Gastroenterology and Hepatology to close this gap. DATA SOURCES AND METHODS Following an extensive systematic review of over 60,000 studies, 81 studies with dose escalation and five addressing drug monitoring were selected and in addition five systematic reviews and three guidelines. RESULTS AND CONCLUSION after three rounds of voting 18 statements were selected with agreement ranging from of 80% to 100.
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Affiliation(s)
| | - Rahul Nathwani
- Department of Gastroenterology, Mediclinic City Hospital, Mohammed Bin Rashid University, Dubai, United Arab Emirates
| | - Maryam Alkhatry
- Gastroenterology and Endoscopy Department, Ibrahim Bin Hamad Obaid Allah Hospital, Ministry of Health and Prevention, Ras Al Khaimah, United Arab Emirates
| | - Ahmad Al-Rifai
- Department of Gastroenterology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Sameer Al Awadhi
- Digestive Disease Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Filippos Georgopoulos
- Gastroenterology and Endoscopy Unit, Al Zahra Hospital Dubai, Dubai, United Arab Emirates
| | - Ahmad N. Jazzar
- Gastroenterology Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Zaher Koutoubi
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mazen S. Taha
- Gastroenterology and Hepatology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Jimmy K. Limdi
- Department of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester Academic Health Sciences, University of Manchester, Manchester, UK
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12
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Alatawi H, Mosli M, Saadah OI, Annese V, Al-Hindi R, Alatawy M, Al-Amrah H, Alshehri D, Bahieldin A, Edris S. Attributes of intestinal microbiota composition and their correlation with clinical primary nonresponse to anti-TNF-α agents in inflammatory bowel disease patients. Bosn J Basic Med Sci 2021; 22:412-426. [PMID: 34761733 PMCID: PMC9162754 DOI: 10.17305/bjbms.2021.6436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
The largest microbial aggregation in the human body exists in the gastrointestinal tract. The microbiota in the host gastrointestinal tract comprises a diverse ecosystem, and the intestinal microbiota plays a vital role in maintaining gut homeostasis. This study aims to examine whether the gut microbiota influences unresponsiveness to anti-TNF-α treatments in primary nonresponder patients, and consequently identify the responsible microbes as biomarkers of unresponsiveness. Stool samples were collected from a cohort of patients with an established diagnosis of IBD, either ulcerative colitis (UC) or Crohn's disease (CD), following completion of the induction phase of anti TNF therapy. 16S rRNA sequencing analysis was used to examine the pattern of microbiota communities in fecal samples. The quality and quantity of fecal microbiota were compared in responder and primary nonresponder IBD patients following anti-TNF-α therapy. As per our hypothesis, a difference in gut microbiome composition between the two patient subgroups was observed. A decreased abundance of short-chain fatty acid (SCFA)-producing bacteria, including Anaerostipes, Coprococcus, Lachnospira, Roseburia, and Ruminococcus, was detected in non-responsive patients, which was the hallmark of dysbiosis. Biomarkers of dysbiosis that were identified as predictors of clinical nonresponse, included Klebsiella, Eubacteriaceae, RF32, Bifidobacterium_animalis, and Muribaculaceae-previously known as S24-7. Signature biomarkers showed dramatic alteration in the composition of gut microbiota in patients who demonstrated primary nonresponse to anti-TNF-α agents. Dysbiosis, with features including a dropped biodiversity, augmentation in opportunistic pathogenic microbiota, and a lack of SCFA-producing bacteria, is a prominent feature of the microbiome of primary nonresponders to anti-TNF-α therapy.
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Affiliation(s)
- Hanan Alatawi
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Biological Sciences, College of Science, University of Tabuk, Tabuk, Saudi Arabia
| | - Mahmoud Mosli
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah , Saudi Arabia; Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar I Saadah
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia ; Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Vito Annese
- Fakeeh University Hospital, Dubai, United Arab Emirates
| | - Rashad Al-Hindi
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marfat Alatawy
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; Department of Biological Sciences, College of Science, University of Tabuk, Tabuk, Saudi Arabia
| | - Hadba Al-Amrah
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Dikhnah Alshehri
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; Department of Biological Sciences, College of Science, University of Tabuk, Tabuk, Saudi Arabia
| | - Ahmad Bahieldin
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Genetics, Ain Shams University, Cairo, Egypt
| | - Sherif Edris
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Genetics, Ain Shams University, Cairo, Egypt Princess Al Jawhara Albrahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah, Saudi Arabia
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13
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Orlando A, Mocciaro F, Ventimiglia M, Renna S, Rispo A, Scribano ML, Testa A, Aratari A, Bossa F, Angelucci E, Onali S, Cappello M, Giunta M, Scimeca D, Macaluso FS, Castiglione F, Papi C, Annese V, Biancone L, Kohn A, Di Mitri R, Cottone M. Azathioprine for prevention of clinical recurrence in Crohn's disease patients with severe endoscopic recurrence: an IG-IBD randomized double-blind trial. Eur Rev Med Pharmacol Sci 2021; 24:11356-11364. [PMID: 33215456 DOI: 10.26355/eurrev_202011_23627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The recurrence of Crohn's Disease after ileo-colonic resection is a crucial issue. Severe endoscopic lesions increase the risk of developing early symptoms. Prevention and treatment of post-operative Endoscopic Recurrence (ER) have been studied with conflicting results. We compare effi cacy of azathioprine (AZA) vs. high-dose 5-aminosalicylic acid (5-ASA) in preventing clinical recurrence and treating severe post-operative ER. PATIENTS AND METHODS We performed a 1-year multicenter randomized double-blind double-dummy trial. Primary end-points were endoscopic improvement and therapeutic failure (clinical recurrence or drug discontinuation due to lack of efficacy or adverse events) 12 months after randomization. We also performed a post-trial analysis on symptomatic and endoscopic outcomes 10 years after the beginning of the trial, with a median follow-up of 60 months. RESULTS Therapeutic failure occurred in 8 patients (17.4%) within 12 months from randomization, with no significant difference between patients treated with 5-ASA (20.8%, 5 patients) and those with AZA (13.6%, 3 patients). Therapeutic failure was due to clinical recurrence in the 5-ASA group and to adverse events in the AZA group. Endoscopic improvement at 12 months was observed in 8 patients, 2 (11.8%) in the 5-ASA group and 6 (30%) in the AZA group. No serious adverse event was recorded. At the post-trial analysis (median follow-up 60 months), 47.8% (22/46) of patients experienced clinical recurrence: 54.2% (13/24) in the 5-ASA group and 40.9% (9/22) in the AZA group, p=0.546. Patients treated with AZA had lower risk of drug escalation. Clinical recurrence was associated with smoking (p=0.031) and previous surgery (p=0.003). CONCLUSIONS Our trial indicates that there was no difference in terms of treatment failure between 5-ASA and AZA in patients with severe ER. The main limit of AZA is its less favorable safety profile.
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Affiliation(s)
- A Orlando
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy.
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Saadah OI, Annese V, Mosli MH. Prevalence and Predictors of Reduced Bone Density in Child and Adolescent Patients With Crohn's Disease. J Clin Densitom 2021; 24:252-258. [PMID: 32553268 DOI: 10.1016/j.jocd.2020.05.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
Reduced bone mineral density (BMD) has broadly been found to be associated with inflammatory bowel disease across a number of geographical locations and cultures. We aimed to estimate the prevalence of reduced BMD and identify clinical predictors in a cohort of Crohn's disease patients (CD) in Saudi Arabia. We conducted a retrospective study involving children and adolescents with CD between 2013 and 2018. BMD was evaluated using dual-energy X-ray absorptiometry scans of the spine and body. A multivariate analysis was performed for the detection of predictors of low BMD. Sixty-four patients were enrolled. The median age was 16 years (range, 8-19 years) and 55% of patients were males. Total body BMD scanning identified 25 patients (39%) with osteoporosis. Twenty patients (31.3%) were found to have z scores consistent with osteopenia. A multivariate regression analysis identified a low weight-for-age z score (B coefficient = 0.347, 95% confidence interval [CI] = 0.211-0.482, p < 0.001 for Spine BMD and B coefficient = 0.321, 95% CI = 0.170-0.472, p < 0.001 for total body BMD), a low height-for-age z score (B coefficient = 0.187, 95% CI = 0.035-0.338, p = 0.017 for spine BMD and B coefficient = 0.0.258, 95% CI = 0.089-0.427, p = 0.004 for total body BMD), a low 25-hyroxyvitamin D level (B coefficient = 0.026, 95% CI = 0.013-0.038, p < 0.001 for spine BMD and B coefficient = 0.016, 95% CI = 0.002-0.031, p = 0.026 for total body BMD), and a higher number of corticosteroid induction courses (B coefficient = -0.567, 95% CI = -0.923 to -0.212, p = 0.003 for spine BMD and B coefficient = -0.566, 95% CI = 0.963-0.169, p = 0.007 for total body BMD) as predictors of low BMD. In the spine BMD analysis, older age at the time of presentation was identified as a significant predictor for low bone density (B coefficient = 0.254, 95% CI = 0.141-0.368, p < 0.001). In conclusion, Saudi Arabian children and adolescents with CD have a high prevalence rate of low bone density compared to Western populations. Several clinical characteristics are identified as significant predictors for low BMD.
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Affiliation(s)
- Omar I Saadah
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Vito Annese
- Valiant Clinic & American Hospital, Dubai, United Arab Emirates
| | - Mahmoud H Mosli
- Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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15
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Meserve J, Facciorusso A, Holmer AK, Annese V, Sandborn WJ, Singh S. Systematic review with meta-analysis: safety and tolerability of immune checkpoint inhibitors in patients with pre-existing inflammatory bowel diseases. Aliment Pharmacol Ther 2021; 53:374-382. [PMID: 33314269 PMCID: PMC8041067 DOI: 10.1111/apt.16217] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/13/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors may variably impact patients with pre-existing autoimmune diseases. AIMS To evaluate the risks and outcomes of adverse events in patients with pre-existing inflammatory bowel diseases treated with immune checkpoint inhibitors. METHODS Through a systematic literature review up until July 31, 2020, we identified 12 studies reporting the impact of immune checkpoint inhibitors in 193 patients with inflammatory bowel disease. Outcomes of interest were relapse of inflammatory bowel disease, need for corticosteroids and/or biologics to manage inflammatory bowel disease relapse, and discontinuation of immune checkpoint inhibitors. We calculated pooled rates (with 95% confidence intervals [CI]) using random effects meta-analysis, and examined risk factors associated with adverse outcomes through qualitative synthesis of individual studies. RESULTS On meta-analysis, 40% patients (95% CI, 26%-55%) experienced relapse of inflammatory bowel disease with immune checkpoint inhibitors. Among patients who experienced relapse, 76% (95% CI, 65%-85%) required corticosteroids, and 37% (95% CI, 22%-53%) required biologic therapy. Overall, 35% patients (95% CI, 17%-57%) with inflammatory bowel disease discontinued immune checkpoint inhibitors. Gastrointestinal perforation and abdominal surgery due to immune checkpoint inhibitor complications occurred in <5% patients. In a large study, inhibitors of cytotoxic T-lymphocyte antigen-4 (CTLA-4) were associated with a higher risk of relapse than programmed cell death 1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors. CONCLUSIONS Approximately 40% of patients with pre-existing inflammatory bowel diseases experience relapse with immune checkpoint inhibitors, with most relapsing patients requiring corticosteroids and one-third requiring biologics. CTLA-4 inhibitors may be associated with higher risk of relapse.
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Affiliation(s)
- Joseph Meserve
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | | | - Ariela K. Holmer
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Vito Annese
- Valiant Clinic & American Hospital, Dubai, United Arab Emirates
| | - William J. Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA,Division of Biomedical Informatics, University of California San Diego, La Jolla, California
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16
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Grazie ML, Bagnoli S, Dragoni G, Caini S, Annese V, Innocenti T, Deiana S, Manetti N, Milani S, Galli A, Milla M. Infliximab is more effective than cyclosporine as a rescue therapy for acute severe ulcerative colitis: a retrospective single-center study. Ann Gastroenterol 2021; 34:370-377. [PMID: 33948062 PMCID: PMC8079874 DOI: 10.20524/aog.2021.0584] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
Background Acute severe ulcerative colitis (ASUC) is a potentially life-threatening disease, and the best option in cases of steroid-refractory disease is still debated. We compared the early- and long-term efficacy and safety of the 2 available “rescue therapies”, infliximab (IFX) and cyclosporine (CYS), in this setting. Methods We retrospectively evaluated patients admitted for ASUC and treated with “rescue therapy”. The primary endpoint was early colectomy-free survival (30 days) and colectomy-free survival until the end of follow up. The secondary endpoints were predictors of colectomy and long-term maintenance of the treatment strategy over time. Results Of 129 patients admitted, 68 received rescue therapy (47 with IFX), whereas 7 underwent early colectomy (10.3%). At 30 days, fewer patients treated with IFX showed a need for colectomy (8.5% vs. 14.3%) compared to those in the CYS group, though the difference was non-significant (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.10-4.69; P=0.47). No severe side effects due to IFX and CYS were observed. During a mean follow up of 40 months, 23 additional patients (37.7%) underwent colectomy, and the rate was significantly lower in the IFX group (25.6%) than in the CYS group (66.7%) (hazard ratio 0.25, 95%CI 0.10-0.61; P=0.003). Colectomy-free survival was significantly higher in the IFX group than in the CYS group (P=0.018) at 12 months. Conclusions In our setting, the early outcomes of IFX and CYS for ASUC were comparable. IFX was associated with significantly lower colectomy rates during the observation period and had a similar safety profile to CYS.
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Affiliation(s)
- Marco Le Grazie
- IBD Referral Center, Department of Gastroenterology, AOU Careggi Hospital, Florence, Italy (Marco Le Grazie, Siro Bagnoli, Gabriele Dragoni, Tommaso Innocenti, Stefano Milani, Andrea Galli, Monica Milla)
| | - Siro Bagnoli
- IBD Referral Center, Department of Gastroenterology, AOU Careggi Hospital, Florence, Italy (Marco Le Grazie, Siro Bagnoli, Gabriele Dragoni, Tommaso Innocenti, Stefano Milani, Andrea Galli, Monica Milla)
| | - Gabriele Dragoni
- IBD Referral Center, Department of Gastroenterology, AOU Careggi Hospital, Florence, Italy (Marco Le Grazie, Siro Bagnoli, Gabriele Dragoni, Tommaso Innocenti, Stefano Milani, Andrea Galli, Monica Milla).,Gastroenterology Research Unit, Department of Experimental and Clinical Biochemical Sciences "Mario Serio", University of Florence, Italy (Gabriele Dragoni, Stefano Milani, Andrea Galli)
| | - Saverio Caini
- C.S. Epidemiology of Risk Factors and Lifestyle, Institute for Oncologic Study, Prevention and Networking (ISPRO), Florence, Italy (Saverio Caini)
| | - Vito Annese
- Valiant Clinic, Dubai, United Arab Emirates (Vito Annese)
| | - Tommaso Innocenti
- IBD Referral Center, Department of Gastroenterology, AOU Careggi Hospital, Florence, Italy (Marco Le Grazie, Siro Bagnoli, Gabriele Dragoni, Tommaso Innocenti, Stefano Milani, Andrea Galli, Monica Milla)
| | - Simona Deiana
- Gastroenterology and Digestive Endoscopy, Ramazzini Hospital, Carpi - AUSL Modena, Modena, Italy (Simona Deiana)
| | - Natalia Manetti
- Gastroenterology and Digestive Endoscopy, San Jacopo Hospital, Pistoia, Usl Centro Toscana, Italy (Natalia Manetti)
| | - Stefano Milani
- IBD Referral Center, Department of Gastroenterology, AOU Careggi Hospital, Florence, Italy (Marco Le Grazie, Siro Bagnoli, Gabriele Dragoni, Tommaso Innocenti, Stefano Milani, Andrea Galli, Monica Milla).,Gastroenterology Research Unit, Department of Experimental and Clinical Biochemical Sciences "Mario Serio", University of Florence, Italy (Gabriele Dragoni, Stefano Milani, Andrea Galli)
| | - Andrea Galli
- IBD Referral Center, Department of Gastroenterology, AOU Careggi Hospital, Florence, Italy (Marco Le Grazie, Siro Bagnoli, Gabriele Dragoni, Tommaso Innocenti, Stefano Milani, Andrea Galli, Monica Milla).,Gastroenterology Research Unit, Department of Experimental and Clinical Biochemical Sciences "Mario Serio", University of Florence, Italy (Gabriele Dragoni, Stefano Milani, Andrea Galli)
| | - Monica Milla
- IBD Referral Center, Department of Gastroenterology, AOU Careggi Hospital, Florence, Italy (Marco Le Grazie, Siro Bagnoli, Gabriele Dragoni, Tommaso Innocenti, Stefano Milani, Andrea Galli, Monica Milla)
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17
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Alkhatry M, Al-Rifai A, Annese V, Georgopoulos F, Jazzar AN, Khassouan AM, Koutoubi Z, Nathwani R, Taha MS, Limdi JK. First United Arab Emirates consensus on diagnosis and management of inflammatory bowel diseases: A 2020 Delphi consensus. World J Gastroenterol 2020; 26:6710-6769. [PMID: 33268959 PMCID: PMC7684461 DOI: 10.3748/wjg.v26.i43.6710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/15/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis and Crohn’s disease are the main entities of inflammatory bowel disease characterized by chronic remittent inflammation of the gastrointestinal tract. The incidence and prevalence are on the rise worldwide, and the heterogeneity between patients and within individuals over time is striking. The progressive advance in our understanding of the etiopathogenesis coupled with an unprecedented increase in therapeutic options have changed the management towards evidence-based interventions by clinicians with patients. This guideline was stimulated and supported by the Emirates Gastroenterology and Hepatology Society following a systematic review and a Delphi consensus process that provided evidence- and expert opinion-based recommendations. Comprehensive up-to-date guidance is provided regarding diagnosis, evaluation of disease severity, appropriate and timely use of different investigations, choice of appropriate therapy for induction and remission phase according to disease severity, and management of main complications.
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Affiliation(s)
- Maryam Alkhatry
- Gastroenterology and Endoscopy Department, Ibrahim Bin Hamad Obaid Allah Hospital, Ministry of Health and Prevention, Ras Al Khaiman, United Arab Emirates
| | - Ahmad Al-Rifai
- Department of Gastroenterology, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic, Dubai, United Arab Emirates
- Department of Gastroenterology and Endoscopy, American Hospital, Dubai, United Arab Emirates
| | | | - Ahmad N Jazzar
- Gastroenterology Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Ahmed M Khassouan
- Digestive Disease Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Zaher Koutoubi
- Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Rahul Nathwani
- Department of Gastroenterology, Mediclinic City Hospital, Dubai, United Arab Emirates
- Department of Gastroenterology, Mohammed Bin Rashid University, Dubai, United Arab Emirates
| | - Mazen S Taha
- Gastroenterology and Hepatology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Jimmy K Limdi
- Department of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester Academic Health Sciences, University of Manchester, Manchester M8 5RB, United Kingdom
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18
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Štambuk J, Nakić N, Vučković F, Pučić-Baković M, Razdorov G, Trbojević-Akmačić I, Novokmet M, Keser T, Vilaj M, Štambuk T, Gudelj I, Šimurina M, Song M, Wang H, Salihović MP, Campbell H, Rudan I, Kolčić I, Eller LA, McKeigue P, Robb ML, Halfvarson J, Kurtoglu M, Annese V, Škarić-Jurić T, Molokhia M, Polašek O, Hayward C, Kibuuka H, Thaqi K, Primorac D, Gieger C, Nitayaphan S, Spector T, Wang Y, Tillin T, Chaturvedi N, Wilson JF, Schanfield M, Filipenko M, Wang W, Lauc G. Global variability of the human IgG glycome. Aging (Albany NY) 2020; 12:15222-15259. [PMID: 32788422 PMCID: PMC7467356 DOI: 10.18632/aging.103884] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022]
Abstract
Immunoglobulin G (IgG) is the most abundant serum antibody which structural characteristics and effector functions are modulated through the attachment of various sugar moieties called glycans. Composition of the IgG N-glycome changes with age of an individual and in different diseases. Variability of IgG glycosylation within a population is well studied and is known to be affected by both genetic and environmental factors. However, global inter-population differences in IgG glycosylation have never been properly addressed. Here we present population-specific N-glycosylation patterns of IgG, analyzed in 5 different populations totaling 10,482 IgG glycomes, and of IgG’s fragment crystallizable region (Fc), analyzed in 2,579 samples from 27 populations sampled across the world. Country of residence associated with many N-glycan features and the strongest association was with monogalactosylation where it explained 38% of variability. IgG monogalactosylation strongly correlated with the development level of a country, defined by United Nations health and socioeconomic development indicators, and with the expected lifespan. Subjects from developing countries had low levels of IgG galactosylation, characteristic for inflammation and ageing. Our results suggest that citizens of developing countries may be exposed to environmental factors that can cause low-grade chronic inflammation and the apparent increase in biological age.
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Affiliation(s)
- Jerko Štambuk
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Natali Nakić
- Department of Neuroscience, Scuola Internazionale Superiore di Studi Avanzati (SISSA), Trieste, Italy
| | | | | | | | | | | | - Toma Keser
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Marija Vilaj
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Tamara Štambuk
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ivan Gudelj
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Mirna Šimurina
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Manshu Song
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.,School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Hao Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.,School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | | | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ivana Kolčić
- School of Medicine, University of Split, Split, Croatia
| | - Leigh Anne Eller
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Paul McKeigue
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Merlin L Robb
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Metin Kurtoglu
- Department of Oncology, Koç University School of Medicine, Istanbul, Turkey
| | - Vito Annese
- Careggi University Hospital, Florence, Italy
| | | | - Mariam Molokhia
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Ozren Polašek
- School of Medicine, University of Split, Split, Croatia
| | - Caroline Hayward
- MRC Human Genetics Unit, MRC Institute for Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Kujtim Thaqi
- Institute of Clinical Biochemistry, Priština, Kosovo
| | | | - Christian Gieger
- Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Tim Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.,School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Therese Tillin
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, London, United Kingdom
| | - Nish Chaturvedi
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, London, United Kingdom
| | - James F Wilson
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.,MRC Human Genetics Unit, MRC Institute for Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Moses Schanfield
- Department of Forensic Sciences, George Washington University, Washington, DC 20007, USA
| | - Maxim Filipenko
- Institute of Chemical Biology and Fundamental Medicine, Novosibirsk, Russia
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.,School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Gordan Lauc
- Genos Glycoscience Research Laboratory, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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19
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Annese V, Lakatos PL. A further "stri(v)de" in IBD management. Dig Liver Dis 2020; 52:721-722. [PMID: 32197889 DOI: 10.1016/j.dld.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Vito Annese
- Valiant Clinic & American Hospital, Dubai, United Arab Emirates
| | - Peter L Lakatos
- McGill University Health Centre, Montreal, Canada; Semmelweis University, Budapest, Hungary
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20
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Abstract
Inflammatory bowel diseases (IBD) are chronic intermittent inflammatory disorders of the gastrointestinal tract of unknown etiology but a clear genetic predisposition. Prompted by the first investigations on IBD families and twins, the genetic and epigenetic studies have produced an unprecedented amount of information in comparison with other immune-mediated or complex diseases. New inflammatory pathways and possible mechanisms of action have been disclosed, potentially leading to new-targeted therapy. However, the identification of genetic markers due to the great disease heterogeneity and the overwhelming contribution of environmental risk factors has not modified yet the disease management. The possibility for the future of a better prediction of disease course, response to therapy and therapy-related adverse events may allow a more efficient and personalized strategy. This review will focus on more recent discoveries that may potentially be of relevance in daily clinical practice.
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Affiliation(s)
- Vito Annese
- Head of Gastroenterology and Medical Director, Valiant Clinic, Dubai, United Arab Emirates; CBP American Hospital, Dubai, United Arab Emirates; Aggregate Professor United Arabian Emirates University, College of Medicine & Health Science, Al Ain, United Arab Emirates.
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21
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Affiliation(s)
- Vito Annese
- Department of Gastroenterology Valiant Clinic & American Hospital, Dubai, UAE
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22
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Affiliation(s)
- Vito Annese
- Valiant Clinic & American Hospital, Dubai, United Arab Emirates.
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23
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Pellino G, Keller DS, Sampietro GM, Annese V, Carvello M, Celentano V, Coco C, Colombo F, Cracco N, Di Candido F, Franceschi M, Laureti S, Mattioli G, Pio L, Sciaudone G, Sica G, Villanacci V, Zinicola R, Leone S, Danese S, Spinelli A, Delaini G, Selvaggi F. Inflammatory bowel disease (IBD) position statement of the Italian Society of Colorectal Surgery (SICCR): general principles of IBD management. Tech Coloproctol 2020; 24:105-126. [PMID: 31983044 DOI: 10.1007/s10151-019-02145-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/23/2019] [Indexed: 02/08/2023]
Abstract
The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a Position Statement of Italian colorectal surgeons to address the surgical aspects of inflammatory bowel disease management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the general principles of surgical treatment of inflammatory bowel disease. The committee was able to identify some points of major disagreement and suggested strategies to improve quality of available data and acceptance of guidelines.
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Affiliation(s)
- G Pellino
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy.
| | - D S Keller
- Division of Colon and Rectal Surgery, Department of Surgery, NewYork-Presbyterian, Columbia University Medical Center, New York, USA
| | | | - V Annese
- Gastroenterology Unit, DEA-Medicina E Chirurgia Generale E D'Urgenza, University Hospital Careggi, Firenze, Italy
| | - M Carvello
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - V Celentano
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
- University of Portsmouth, Portsmouth, UK
| | - C Coco
- UOC Chirurgia Generale 2, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - F Colombo
- L. Sacco University Hospital Milano, Milan, Italy
| | - N Cracco
- Department of General Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - F Di Candido
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Franceschi
- IBD Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Laureti
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G Mattioli
- Pediatric Surgery Unit, Istituto Giannina Gaslini, and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - L Pio
- Pediatric Surgery Department, Hôpital Robert-Debré and Université de Paris, Paris, France
| | - G Sciaudone
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy
| | - G Sica
- Minimally Invasive and Gastro-Intestinal Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - V Villanacci
- Institute of Pathology, Spedali Civili Brescia, Brescia, Italy
| | - R Zinicola
- Department of Emergency Surgery, University Hospital Parma, Parma, Italy
| | - S Leone
- CEO, Associazione Nazionale Per Le Malattie Infiammatorie Croniche Dell'Intestino "A.M.I.C.I. Onlus", Milan, Italy
| | - S Danese
- Division of Gastroenterology, IBD Center, Humanitas University, Rozzano, Milan, Italy
| | - A Spinelli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - G Delaini
- Department of Surgery, "Pederzoli" Hospital, Peschiera del Garda, Verona, Italy
| | - F Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy
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24
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Annese V. TDM of Anti-TNF Agents: The Importance of Being Active! Inflamm Bowel Dis 2020; 26:271-272. [PMID: 31247072 DOI: 10.1093/ibd/izz132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Indexed: 12/09/2022]
Abstract
Therapeutic drug monitoring (TDM) for anti-TNFα agents hass gained an increased momentum; although it is surely recommended in case of loss of response, its usefulness during maintenance therapy is still debated. Fernandes et al have added useful information in this regard.
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Affiliation(s)
- Vito Annese
- Valiant Clinic & American Hospital, Dubai, United Arab Emirates
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25
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Affiliation(s)
- Vito Annese
- Department of Gastroenterology, Valiant Clinic and American Hospital, Dubai, UAE
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26
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Annese V. Biosimilars in IBD: Similarity Breeds Contented Patients. Dig Dis Sci 2019; 64:1399-1400. [PMID: 30725297 DOI: 10.1007/s10620-019-05499-5] [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: 12/09/2022]
Affiliation(s)
- Vito Annese
- Valiant Clinic & American Hospital, Dubai, UAE.
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27
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Domènech E, Panés J, Hinojosa J, Annese V, Magro F, Sturniolo GC, Bossa F, Fernández F, González-Conde B, García-Sánchez V, Dignass A, Herrera JM, Cabriada JL, Guardiola J, Vecchi M, Portela F, Ginard D. Corrigendum: Addition of Granulocyte/Monocyte Apheresis to Oral Prednisone for Steroid-dependent Ulcerative Colitis: A Randomized Multicentre Clinical Trial. J Crohns Colitis 2019; 13:814. [PMID: 30951596 DOI: 10.1093/ecco-jcc/jjy211] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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28
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Fiorino G, Caprioli F, Daperno M, Mocciaro F, Principi M, Viscido A, Fantini MC, Orlando A, Papi C, Annese V, Danese S, Vecchi M, Rizzello F, Armuzzi A, Previtali E, Aloi M, Alvisi P, Antonelli E, Ardizzone S, Astegiano M, Baldoni M, Beltrami M, Biancone L, Bodini G, Buda A, Bossa F, Bracci F, Calabrese E, Cappello M, Castiglione F, Ciacci C, Cicala M, Ciccocioppo R, Comberlato M, Cortelezzi CC, Cosintino R, Costa F, Costantino G, Cucchiara S, Cuomo A, D’Incà R, Di Paolo MC, Di Sabatino A, Di Sario A, Frieri G, Fries W, Gasbarrini A, Geccherle A, Gionchetti P, Graziani MG, Grossi L, Guidi L, Imperiali G, Latella G, Lionetti P, Inserra G, Maconi G, Manguso F, Marino M, Mastronardi M, Mazzuoli S, Meucci G, Mendolaro M, Milla M, Mocci G, Monteleone G, Bortoluzzi FN, Pagnini C, Pastorelli L, Pica R, Piergallini S, Privitera A, Renna S, Ribaldone DG, Ricci C, Rispo A, Rocca R, Romano C, Romano M, Russo G, Sablich R, Saibeni S, Savarino E, Scribano ML, Spagnuolo R, Stasi E, Terpin MM, Testa A, Valpiani D, Variola A, Vernia P, Vitale G, Zoli G. Use of biosimilars in inflammatory bowel disease: a position update of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Dig Liver Dis 2019; 51:632-639. [PMID: 30872085 DOI: 10.1016/j.dld.2019.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
The first infliximab biosimilar for the treatment of inflammatory bowel disease (IBD) was introduced in 2013, and today eight anti-TNF alpha biosimilars (three for infliximab and five for adalimumab) have been approved and licensed by the European Medicines Agency. Biosimilars present great potential in terms of cost saving and possible consequential reinvestment in the health care system. The increasing knowledge about the process of biosimilar development and use in IBD and the publication of many prospective clinical studies and real-life clinical experiences have progressively changed the point of view of IBD physicians. In the present position paper, the Italian Group for the Study of Inflammatory Bowel Disease present and discuss their updated statements and positions on this topic, with emphasis on the concepts of biosimilarity and extrapolation across indications, safety and immunogenicity, interchangeability and switching, automatic substitution, and, finally, patient education about biosimilars.
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Affiliation(s)
- Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | - Marco Daperno
- Division of Gastroenterology, Ospedale Ordine Mauriziano di Torino, Turin, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Mariabeatrice Principi
- Gastroenterology Unit, Department of Organ Transplantation (DETO), Policlinico Universitario, Bari, Italy
| | - Angelo Viscido
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Ambrogio Orlando
- IBD Unit, A.O. Osp. Riuniti "Villa Sofia-Cervello", Palermo, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | | | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | | | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
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Abstract
Extraintestinal manifestations (EIMs) are common in inflammatory bowel disease (IBD), in both Crohn's disease and ulcerative colitis. Almost any organ system can be affected, including the musculoskeletal, dermatologic, renal, hepatopancreatobiliary, pulmonary and ocular systems. However, the musculoskeletal and dermatologic systems are the most commonly involved sites of manifestations. While some manifestations such as peripheral arthritis and erythema nodosum have an association with IBD activity, others such as axial arthropathy, pyoderma gangrenosum and primary sclerosing cholangitis have an independent disease course. This review provides a summary of the most common EIMs in IBD and their prevalence and management.
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Affiliation(s)
- Vito Annese
- Department of Gastroenterology, Valiant Clinic, Dubai, United Arab Emirates
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30
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Sturm A, Maaser C, Calabrese E, Annese V, Fiorino G, Kucharzik T, Vavricka SR, Verstockt B, van Rheenen P, Tolan D, Taylor SA, Rimola J, Rieder F, Limdi JK, Laghi A, Krustiņš E, Kotze PG, Kopylov U, Katsanos K, Halligan S, Gordon H, González Lama Y, Ellul P, Eliakim R, Castiglione F, Burisch J, Borralho Nunes P, Bettenworth D, Baumgart DC, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis 2019; 13:273-284. [PMID: 30137278 DOI: 10.1093/ecco-jcc/jjy114] [Citation(s) in RCA: 207] [Impact Index Per Article: 41.4] [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: 12/15/2022]
Affiliation(s)
- Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | - Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | | | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Belgium
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza - University of Rome, Rome, Italy
| | - Eduards Krustiņš
- Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná PUCPR, Curitiba, Brazil
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Hannah Gordon
- Section of Gastroenterology & Hepatology, Royal London Hospital, London, UK
| | - Yago González Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda Madrid, Spain
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center AMC, University of Amsterdam, Amsterdam, The Netherlands
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31
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Marsico M, Gabbani T, Lunardi S, Lei B, Lucarini M, Cuffari B, Curatolo A, Biagini MR, Annese V. Computed tomography or contrast-enhanced ultrasonography for follow-up of liver metastases after Cyberknife therapy?: A prospective pilot study. J Ultrasound Med 2019; 38:649-655. [PMID: 30182490 DOI: 10.1002/jum.14734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Contrast-enhanced ultrasonography (CEUS) allows the study of vascularization of secondary liver lesions. The Cyberknife (Accuray, Inc, Sunnyvale, CA) is a therapeutic method that allows a tumor target to be subjected to a high radiant dose gradient. This prospective pilot study aimed to demonstrate the concordance of CEUS versus contrast-enhanced computed tomography (CECT) in determining the stability or disease progression of secondary liver lesions after treatment with the Cyberknife. METHODS Twenty-four patients were consecutively enrolled, and 3 different operators evaluated the CEUS images and the intermodality concordance with CECT. All patients received CEUS at 1 and 2 months after the Cyberknife therapy. The intermodality agreement was evaluated by the Cohen κ coefficient and a multivariate analysis according to the method of Janson and Olsson (Educ Psychol Meas 2001; 61:277-289). RESULTS Forty secondary liver lesions were detected and treated. Forty-one CECT and 51 CEUS examinations were performed without any adverse events in the 24 patients. The intermodality agreement rates, calculated for the operators as Cohen κ values, were κ = 1.00, 0.881, and 0.767, respectively. The multivariate analysis of intermodality agreement showed an almost perfect value (ι = 0.841). CONCLUSIONS This pilot study found excellent diagnostic correspondence between CEUS and CECT in the evaluation of local disease stability or progression after Cyberknife therapy in liver metastases. These findings suggest that CEUS could play an important role in the surveillance of these patients because of its high accuracy and reproducibility, thus reducing the need for CECT.
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Affiliation(s)
- Maria Marsico
- Gastroenterology Unit, Modena University Hospital, Modena, Italy
| | - Tommaso Gabbani
- Digestive Endoscopy Unit, Carpi Hospital, Azienda Unità Sanitaria Locale, Modena, Italy
| | - Sarah Lunardi
- General Cardiology Unit, Azienda Ospedaliera Universitaria Careggi Hospital, Florence, Italy
| | - Barbara Lei
- Gastroenterology Unit, Modena University Hospital, Modena, Italy
| | - Matteo Lucarini
- Gastroenterology Unit, Modena University Hospital, Modena, Italy
| | - Biagio Cuffari
- Gastroenterology Unit, Modena University Hospital, Modena, Italy
| | - Angela Curatolo
- Gastroenterology Unit, Modena University Hospital, Modena, Italy
| | - Maria Rosa Biagini
- Gastroenterology Unit, Azienda Ospedaliera Universitaria Careggi Hospital, Florence, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic, Dubai, United Arab Emirates
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32
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Walker GJ, Harrison JW, Heap GA, Voskuil MD, Andersen V, Anderson CA, Ananthakrishnan AN, Barrett JC, Beaugerie L, Bewshea CM, Cole AT, Cummings FR, Daly MJ, Ellul P, Fedorak RN, Festen EAM, Florin TH, Gaya DR, Halfvarson J, Hart AL, Heerasing NM, Hendy P, Irving PM, Jones SE, Koskela J, Lindsay JO, Mansfield JC, McGovern D, Parkes M, Pollok RCG, Ramakrishnan S, Rampton DS, Rivas MA, Russell RK, Schultz M, Sebastian S, Seksik P, Singh A, So K, Sokol H, Subramaniam K, Todd A, Annese V, Weersma RK, Xavier R, Ward R, Weedon MN, Goodhand JR, Kennedy NA, Ahmad T. Association of Genetic Variants in NUDT15 With Thiopurine-Induced Myelosuppression in Patients With Inflammatory Bowel Disease. JAMA 2019; 321:773-785. [PMID: 30806694 PMCID: PMC6439872 DOI: 10.1001/jama.2019.0709] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Use of thiopurines may be limited by myelosuppression. TPMT pharmacogenetic testing identifies only 25% of at-risk patients of European ancestry. Among patients of East Asian ancestry, NUDT15 variants are associated with thiopurine-induced myelosuppression (TIM). OBJECTIVE To identify genetic variants associated with TIM among patients of European ancestry with inflammatory bowel disease (IBD). DESIGN, SETTING, AND PARTICIPANTS Case-control study of 491 patients affected by TIM and 679 thiopurine-tolerant unaffected patients who were recruited from 89 international sites between March 2012 and November 2015. Genome-wide association studies (GWAS) and exome-wide association studies (EWAS) were conducted in patients of European ancestry. The replication cohort comprised 73 patients affected by TIM and 840 thiopurine-tolerant unaffected patients. EXPOSURES Genetic variants associated with TIM. MAIN OUTCOMES AND MEASURES Thiopurine-induced myelosuppression, defined as a decline in absolute white blood cell count to 2.5 × 109/L or less or a decline in absolute neutrophil cell count to 1.0 × 109/L or less leading to a dose reduction or drug withdrawal. RESULTS Among 1077 patients (398 affected and 679 unaffected; median age at IBD diagnosis, 31.0 years [interquartile range, 21.2 to 44.1 years]; 540 [50%] women; 602 [56%] diagnosed as having Crohn disease), 919 (311 affected and 608 unaffected) were included in the GWAS analysis and 961 (328 affected and 633 unaffected) in the EWAS analysis. The GWAS analysis confirmed association of TPMT (chromosome 6, rs11969064) with TIM (30.5% [95/311] affected vs 16.4% [100/608] unaffected patients; odds ratio [OR], 2.3 [95% CI, 1.7 to 3.1], P = 5.2 × 10-9). The EWAS analysis demonstrated an association with an in-frame deletion in NUDT15 (chromosome 13, rs746071566) and TIM (5.8% [19/328] affected vs 0.2% [1/633] unaffected patients; OR, 38.2 [95% CI, 5.1 to 286.1], P = 1.3 × 10-8), which was replicated in a different cohort (2.7% [2/73] affected vs 0.2% [2/840] unaffected patients; OR, 11.8 [95% CI, 1.6 to 85.0], P = .03). Carriage of any of 3 coding NUDT15 variants was associated with an increased risk (OR, 27.3 [95% CI, 9.3 to 116.7], P = 1.1 × 10-7) of TIM, independent of TPMT genotype and thiopurine dose. CONCLUSIONS AND RELEVANCE Among patients of European ancestry with IBD, variants in NUDT15 were associated with increased risk of TIM. These findings suggest that NUDT15 genotyping may be considered prior to initiation of thiopurine therapy; however, further study including additional validation in independent cohorts is required.
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Affiliation(s)
- Gareth J. Walker
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, England
- IBD Pharmacogenetics Group, University of Exeter, Exeter, England
| | | | - Graham A. Heap
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, England
- IBD Pharmacogenetics Group, University of Exeter, Exeter, England
| | - Michiel D. Voskuil
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Vibeke Andersen
- Medical Department, Regional Hospital Viborg, Viborg, Denmark
| | | | | | | | - Laurent Beaugerie
- Department of Gastroenterology, Saint-Antoine Hospital and Sorbonne Universite, Paris, France
| | | | - Andy T. Cole
- Derby Digestive Diseases Centre, Royal Derby Hospital, Derby Teaching Hospitals NHS Foundation Trust, Derby, England
| | - Fraser R. Cummings
- Department of Gastroenterology, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Mark J. Daly
- Broad Institute, Harvard University, Cambridge, Massachusetts
| | - Pierre Ellul
- Department of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | | | - Eleonora A. M. Festen
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Timothy H. Florin
- Mater Research Institute, University of Queensland, South Brisbane, Australia
| | - Daniel R. Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | | | - Ailsa L. Hart
- Department of Gastroenterology, St Mark’s Hospital, London North West Healthcare NHS Trust, Harrow, England
| | - Neel M. Heerasing
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, England
- IBD Pharmacogenetics Group, University of Exeter, Exeter, England
| | - Peter Hendy
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, England
- IBD Pharmacogenetics Group, University of Exeter, Exeter, England
| | - Peter M. Irving
- Department of Gastroenterology, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | | | - Jukka Koskela
- Broad Institute, Harvard University, Cambridge, Massachusetts
| | - James O. Lindsay
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, England
| | - John C. Mansfield
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England
| | - Dermot McGovern
- F. Widjaja Foundation Inflammatory Bowel Disease and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Miles Parkes
- Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | - Richard C. G. Pollok
- Department of Gastroenterology, St George’s Healthcare NHS Trust, Tooting, England
| | - Subramaniam Ramakrishnan
- Gastrointestinal and Liver Services, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, England
| | - David S. Rampton
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, England
| | - Manuel A. Rivas
- Broad Institute, Harvard University, Cambridge, Massachusetts
| | - Richard K. Russell
- Department of Paediatric Gastroenterology, Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | | | - Shaji Sebastian
- Gastroenterology and Hepatology, Hull and East Yorkshire Hospitals NHS Trust, Hull, England
| | - Philippe Seksik
- Department of Gastroenterology, Saint-Antoine Hospital and Sorbonne Universite, Paris, France
| | - Abhey Singh
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, England
| | - Kenji So
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, England
| | - Harry Sokol
- Department of Gastroenterology, Saint-Antoine Hospital and Sorbonne Universite, Paris, France
| | | | - Anthony Todd
- Department of Haematology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, England
| | - Vito Annese
- Division of Gastroenterology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Rinse K. Weersma
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Ramnik Xavier
- Broad Institute, Harvard University, Cambridge, Massachusetts
| | - Rebecca Ward
- University of Exeter Medical School, Exeter, England
| | | | - James R. Goodhand
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, England
- IBD Pharmacogenetics Group, University of Exeter, Exeter, England
| | - Nicholas A. Kennedy
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, England
- IBD Pharmacogenetics Group, University of Exeter, Exeter, England
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, England
- IBD Pharmacogenetics Group, University of Exeter, Exeter, England
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Armuzzi A, Fiorino G, Variola A, Manetti N, Fries W, Orlando A, Maconi G, Bossa F, Cappello M, Biancone L, Cantoro L, Costa F, D'Incà R, Lionetti P, Principi M, Castiglione F, Annunziata ML, Di Sabatino A, Di Girolamo M, Terpin MM, Cortelezzi CC, Saibeni S, Amato A, Ardizzone S, Guidi L, Danese S, Massella A, Ventra A, Rizzuto G, Massari A, Perri F, Annese V, Tari R, Petruzzellis C, Meucci G, Imperiali G, Guglielmi FW, Mazzuoli S, Caserta L, Caterina Parodi M, Colli A, Ronchetti A, Pugliese D, Geccherle A, Rogai F, Milani S, Renna S, Cassinotti A, Andriulli A, Martino G, Scrivo B, Troncone E, Kohn A, Bertani L, Lorenzon G, Ghione S, Nardone O, Vecchi M, Bertani A, Bosani MA, Bezzio C, Salerno R. The PROSIT Cohort of Infliximab Biosimilar in IBD: A Prolonged Follow-up on the Effectiveness and Safety Across Italy. Inflamm Bowel Dis 2019; 25:568-579. [PMID: 30137352 DOI: 10.1093/ibd/izy264] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND We report a prospective, nationwide cohort evaluating the safety and effectiveness of CT-P13. METHODS A structured database was used to record serious adverse events (SAEs), clinical remission/response, inflammatory biomarkers (CRP and calprotectin), and endoscopic findings. RESULTS Eight hundred ten patients with inflammatory bowel disease (IBD) (452 Crohn's disease [CD]) were enrolled. Four hundred fifty-nine patients were naïve to anti-TNFα (group A), 196 had a previous exposure (group B), and the remaining 155 were switched to CT-P13 (group C). All patients were included in the safety evaluation with a mean follow-up of 345 ± 215 days and a total number of 6501 infusions. One hundred fifty-four SAEs were reported (19%), leading to cessation of the biosimilar in 103 subjects (12.7%). Infusion reactions were 71, leading to cessation of the biosimilar in 53 subjects (6.5%), being significantly more frequent in patients pre-exposed to anti-TNFα (P = 0.017). The efficacy of therapy was calculated in 754 IBD patients, with a mean follow-up of 329 ± 202 days. Forty-eight patients had a primary failure (6.4%), and 188 (25.6%) lost response during follow-up. Six hundred twenty-eight (364 CD) and 360 IBD patients (222 CD) completed the follow-up at 6 and 12 months, respectively. At 12 months, patients without loss of response were 71%, 64%. and 82% in groups A, B, and C, respectively (log rank P = 0.01). Clinical/endoscopic scores and inflammatory biomarkers dropped significantly in CD and UC patients (P = 0.01 and P < 0.0001) compared with baseline. CONCLUSIONS In this large prospective cohort, no further signals of difference in safety and effectiveness of CT-P13 in IBD has been observed.
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Affiliation(s)
- Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Gionata Fiorino
- Humanitas Research Hospital and University, Gastroenterology and IBD Center, Rozzano, Italy
| | - Angela Variola
- Centro Malattie retto-intestinali, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Walter Fries
- University of Messina, Clinical Unit for Chronic Bowel Disorders, Messina, Italy
| | - Ambrogio Orlando
- Riuniti Villa Sofia-Cervello Hospital, Internal Medicine 2, IBD Unit Palermo, Italy
| | - Giovanni Maconi
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Fabrizio Bossa
- IRCCS-CSS Hospital, Gastroenterology, San Giovanni Rotondo, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, DiBiMis, University of Palermo, Palermo, Italy
| | - Livia Biancone
- University of Rome Tor Vergata, Department of Systems Medicine, Gastroenterology, Roma
| | - Laura Cantoro
- S. Camillo-Forlanini Hospital, Gastroenterology, Rome, Italy
| | | | - Renata D'Incà
- University of Padova, Gastroenterology, Padova, Italy
| | - Paolo Lionetti
- Meyer Children's Hospital, Gastroenterology and Nutrition, Florence, Italy
| | | | | | | | - Antonio Di Sabatino
- First Department of Medicine, S. Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Maria M Terpin
- U.O.C. Gastroenterologia ed Endoscopia Digestiva ASST Ovest Milanese, Legnano, Italy
| | | | - Simone Saibeni
- ASST Rhodense, Rho Hospital, Gastroenterology Unit, Rho, Italy
| | | | - Sandro Ardizzone
- Department of Biochemical and Clinical Science "L. Sacco" ASST Fatebenefratelli Sacco-University of Milan, Italy
| | - Luisa Guidi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Silvio Danese
- Humanitas Research Hospital and University, Gastroenterology and IBD Center, Rozzano, Italy
| | - Arianna Massella
- Centro Malattie retto-intestinali, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Agostino Ventra
- University of Messina, Clinical Unit for Chronic Bowel Disorders, Messina, Italy
| | - Giulia Rizzuto
- Riuniti Villa Sofia-Cervello Hospital, Internal Medicine 2, IBD Unit Palermo, Italy
| | - Alessandro Massari
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Francesco Perri
- IRCCS-CSS Hospital, Gastroenterology, San Giovanni Rotondo, Italy
| | - Vito Annese
- AOU Careggi, Gastroenterology, Florence, Italy
| | | | | | - Carlo Petruzzellis
- Istituto Fondazione Poliambulanza Hospital, Department of Medicine, Gastroenterology and Digestive Endoscopy, Brescia, Italy
| | | | | | | | | | - Luigi Caserta
- IRCCS AOU San Martino IST Gastroenterology Genova, Italy
| | | | | | | | - Daniela Pugliese
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Andrea Geccherle
- Centro Malattie retto-intestinali, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | | | - Sara Renna
- Riuniti Villa Sofia–Cervello Hospital, Internal Medicine 2, IBD Unit Palermo, Italy
| | - Andrea Cassinotti
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Angelo Andriulli
- IRCCS-CSS Hospital, Gastroenterology, San Giovanni Rotondo, Italy
| | | | - Barbara Scrivo
- Gastroenterology and Hepatology Section, DiBiMis, University of Palermo, Palermo, Italy
| | - Edoardo Troncone
- University of Rome Tor Vergata, Department of Systems Medicine, Gastroenterology, Roma
| | - Anna Kohn
- S. Camillo-Forlanini Hospital, Gastroenterology, Rome, Italy
| | | | | | - Silvia Ghione
- Meyer Children’s Hospital, Gastroenterology and Nutrition, Florence, Italy
| | - Olga Nardone
- University of Bari, Gastroenterology, Bari, Italy
| | - Maurizio Vecchi
- Federico II University, Gastroenterology, Naples, Italy
- Gastroenterology and Endoscopy Unit, IRCCS Ca’ Granda Ospedale Maggiore Foundation, Milan, Itay
| | | | - Matteo A Bosani
- U.O.C. Gastroenterologia ed Endoscopia Digestiva ASST Ovest Milanese, Legnano, Italy
| | - Cristina Bezzio
- ASST Rhodense, Rho Hospital, Gastroenterology Unit, Rho, Italy
| | - Raffaele Salerno
- Department of Biochemical and Clinical Science “L. Sacco” ASST Fatebenefratelli Sacco–University of Milan, Italy
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34
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Maaser C, Sturm A, Vavricka SR, Kucharzik T, Fiorino G, Annese V, Calabrese E, Baumgart DC, Bettenworth D, Borralho Nunes P, Burisch J, Castiglione F, Eliakim R, Ellul P, González-Lama Y, Gordon H, Halligan S, Katsanos K, Kopylov U, Kotze PG, Krustinš E, Laghi A, Limdi JK, Rieder F, Rimola J, Taylor SA, Tolan D, van Rheenen P, Verstockt B, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 2019; 13:144-164. [PMID: 30137275 DOI: 10.1093/ecco-jcc/jjy113] [Citation(s) in RCA: 799] [Impact Index Per Article: 159.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | | | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Yago González-Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda [Madrid], Spain
| | - Hannah Gordon
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná [PUCPR], Curitiba, Brazil
| | - Eduards Krustinš
- Department of of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center [AMC], University of Amsterdam, Amsterdam, The Netherlands
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Salomone G, Ricci S, Rossi F, Turazzini M, Annese V, Del Colle R, Polo A. Electrophysiological assessment of lower cranial nerve palsy triggered by spontaneous extracranial carotid dissection. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.070] [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: 11/28/2022]
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Clerc F, Novokmet M, Dotz V, Reiding KR, de Haan N, Kammeijer GSM, Dalebout H, Bladergroen MR, Vukovic F, Rapp E, Targan SR, Barron G, Manetti N, Latiano A, McGovern DPB, Annese V, Lauc G, Wuhrer M. Plasma N-Glycan Signatures Are Associated With Features of Inflammatory Bowel Diseases. Gastroenterology 2018; 155:829-843. [PMID: 29792883 DOI: 10.1053/j.gastro.2018.05.030] [Citation(s) in RCA: 57] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/07/2018] [Accepted: 05/15/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Biomarkers are needed for early detection of Crohn's disease (CD) and ulcerative colitis (UC) or to predict patient outcomes. Glycosylation is a common and complex posttranslational modification of proteins that affects their structure and activity. We compared plasma N-glycosylation profiles between patients with CD or UC and healthy individuals (controls). METHODS We analyzed the total plasma N-glycomes of 2635 patients with inflammatory bowel diseases and 996 controls by mass spectrometry with a linkage-specific sialic acid derivatization technique. Plasma samples were acquired from 2 hospitals in Italy (discovery cohort, 1989 patients with inflammatory bowel disease [IBD] and 570 controls) and 1 medical center in the United States (validation cohort, 646 cases of IBD and 426 controls). Sixty-three glycoforms met our criteria for relative quantification and were extracted from the raw data with the software MassyTools. Common features shared by the glycan compositions were combined in 78 derived traits, including the number of antennae of complex-type glycans and levels of fucosylation, bisection, galactosylation, and sialylation. Associations of plasma N-glycomes with age, sex, CD, UC, and IBD-related parameters such as disease location, surgery and medication, level of C-reactive protein, and sedimentation rate were tested by linear and logistic regression. RESULTS Plasma samples from patients with IBD had a higher abundance of large-size glycans compared with controls, a decreased relative abundance of hybrid and high-mannose structures, lower fucosylation, lower galactosylation, and higher sialylation (α2,3- and α2,6-linked). We could discriminate plasma from patients with CD from that of patients with UC based on higher bisection, lower galactosylation, and higher sialylation (α2,3-linked). Glycosylation patterns were associated with disease location and progression, the need for a more potent medication, and surgery. These results were replicated in a large independent cohort. CONCLUSIONS We performed high-throughput analysis to compare total plasma N-glycomes of individuals with vs without IBD and to identify patterns associated with disease features and the need for treatment. These profiles might be used in diagnosis and for predicting patients' responses to treatment.
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Affiliation(s)
- Florent Clerc
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | | | - Viktoria Dotz
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Karli R Reiding
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Noortje de Haan
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Guinevere S M Kammeijer
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Hans Dalebout
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Marco R Bladergroen
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Frano Vukovic
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Erdmann Rapp
- Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany; glyXera GmbH, Magdeburg, Germany
| | | | - Stephan R Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gildardo Barron
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Natalia Manetti
- Unit of Gastroenterology SOD2 (Strutture Organizzative Dipartimentali), Azienda Ospedaliero Universitaria (AOU) Careggi, Florence, Italy
| | - Anna Latiano
- Unit of Gastroenterology, IRCCS-CSS (Istituto di Ricovero e Cura a Carattere Scientifico-Casa Sollievo della Sofferenza) Hospital, San Giovanni Rotondo, Italy
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Vito Annese
- Unit of Gastroenterology SOD2 (Strutture Organizzative Dipartimentali), Azienda Ospedaliero Universitaria (AOU) Careggi, Florence, Italy; Unit of Gastroenterology, IRCCS-CSS (Istituto di Ricovero e Cura a Carattere Scientifico-Casa Sollievo della Sofferenza) Hospital, San Giovanni Rotondo, Italy
| | - Gordan Lauc
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
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Domènech E, Panés J, Hinojosa J, Annese V, Magro F, Sturniolo GC, Bossa F, Fernández F, González-Conde B, García-Sánchez V, Dignass A, Herrera JM, Cabriada JL, Guardiola J, Vecchi M, Portela F, Ginard D. Addition of Granulocyte/Monocyte Apheresis to Oral Prednisone for Steroid-dependent Ulcerative Colitis: A Randomized Multicentre Clinical Trial. J Crohns Colitis 2018; 12:687-694. [PMID: 29490024 DOI: 10.1093/ecco-jcc/jjy023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 10/08/2017] [Accepted: 02/26/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Steroid-dependency occurs in up to 30% of patients with ulcerative colitis [UC]. In this setting, few drugs have demonstrated efficacy in inducing steroid-free remission. The aim of this study was to evaluate the efficacy and safety of adding granulocyte/monocyte apheresis [GMA] to oral prednisone in patients with steroid-dependent UC. METHODS This was a randomized, multicentre, open trial comparing 7 weekly sessions of GMA plus oral prednisone [40 mg/day and tapering] with prednisone alone, in patients with active, steroid-dependent UC [Mayo score 4-10 and inability to withdraw corticosteroids in 3 months or relapse within the first 3 months after discontinuation]. Patients were stratified by concomitant use of thiopurines at inclusion. A 9-week tapering schedule of prednisone was pre-established in both study groups. The primary endpoint was steroid-free remission [defined as a total Mayo score ≤2, with no subscore >1] at Week 24, with no re-introduction of corticosteroids. RESULTS In all 123 patients were included [63 GMA group, 62 prednisone alone]. In the intention-to-treat analysis, steroid-free remission at Week 24 was achieved in 13% (95% confidence interval [CI] 6-24) in the GMA group and 7% [95% CI 2-16] in the control group [p = 0.11]. In the GMA group, time to relapse was significantly longer (hazard ratio [HR] 1.7 [1.16-2.48], P = 0.005) and steroid-related adverse events were significantly lower [6% vs 20%, P < 0.05]. CONCLUSIONS In a randomized trial, the addition of 7 weekly sessions of GMA to a conventional course of oral prednisone did not increase the proportion of steroid-free remissions in patients with active steroid-dependent UC, though it delayed clinical relapse.
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Affiliation(s)
- Eugeni Domènech
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain, and CIBEREHD, Madrid, Spain
| | - Julián Panés
- Hospital Clínic, Barcelona, Spain and CIBEREHD, Madrid, Spain
| | | | | | - Fernando Magro
- Unit of Pharmacology and Therapeutics, Faculty of Medicine; MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | | | | | | | | | - Valle García-Sánchez
- Hospital Universitario Reina Sofía amd IMIBIC, Córdoba, Spain, and CIBEREHD, Madrid, Spain
| | - Axel Dignass
- Charité-Campus Virchow Klinikum, Berlin, Germany
| | | | | | - Jordi Guardiola
- Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Spain
| | - Maurizio Vecchi
- Department of Biomedical Science for the Health, University of Milan, and IRCCS Policlinico San Donato, Milano, Italy
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Šimurina M, de Haan N, Vučković F, Kennedy NA, Štambuk J, Falck D, Trbojević-Akmačić I, Clerc F, Razdorov G, Khon A, Latiano A, D'Incà R, Danese S, Targan S, Landers C, Dubinsky M, McGovern DPB, Annese V, Wuhrer M, Lauc G. Glycosylation of Immunoglobulin G Associates With Clinical Features of Inflammatory Bowel Diseases. Gastroenterology 2018; 154:1320-1333.e10. [PMID: 29309774 PMCID: PMC5880750 DOI: 10.1053/j.gastro.2018.01.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/15/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Causes of inflammatory bowel diseases are not well understood and the most prominent forms, Crohn's disease (CD) and ulcerative colitis (UC), are sometimes hard to distinguish. Glycosylation of IgG has been associated with CD and UC. IgG Fc-glycosylation affects IgG effector functions. We evaluated changes in IgG Fc-glycosylation associated with UC and CD, as well as with disease characteristics in different patient groups. METHODS We analyzed 3441 plasma samples obtained from 2 independent cohorts of patients with CD (874 patients from Italy and 391 from the United States) or UC (1056 from Italy and 253 from the US and healthy individuals [controls]; 427 in Italy and 440 from the United States). IgG Fc-glycosylation (tryptic glycopeptides) was analyzed by liquid chromatography coupled to mass spectrometry. We analyzed associations between disease status (UC vs controls, CD vs controls, and UC vs CD) and glycopeptide traits, and associations between clinical characteristics and glycopeptide traits, using a logistic regression model with age and sex included as covariates. RESULTS Patients with CD or UC had lower levels of IgG galactosylation than controls. For example, the odds ratio (OR) for IgG1 galactosylation in patients with CD was 0.59 (95% confidence interval [CI], 0.51-0.69) and for patients with UC was 0.81 (95% CI, 0.71-0.92). Fucosylation of IgG was increased in patients with CD vs controls (for IgG1: OR, 1.27; 95% CI, 1.12-1.44), but decreased in patients with UC vs controls (for IgG23: OR, 0.72; 95% CI, 0.63-0.82). Decreased galactosylation associated with more severe CD or UC, including the need for surgery in patients with UC vs controls (for IgG1: OR, 0.69; 95% CI, 0.54-0.89) and in patients with CD vs controls (for IgG23: OR, 0.78; 95% CI, 0.66-0.91). CONCLUSIONS In a retrospective analysis of plasma samples from patients with CD or UC, we associated levels of IgG Fc-glycosylation with disease (compared to controls) and its clinical features. These findings could increase our understanding of mechanisms of CD and UC pathogenesis and be used to develop diagnostics or guide treatment.
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Affiliation(s)
- Mirna Šimurina
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Noortje de Haan
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Frano Vučković
- Genos Glycoscience Research Laboratory, BIOCentar, Zagreb, Croatia
| | | | - Jerko Štambuk
- Genos Glycoscience Research Laboratory, BIOCentar, Zagreb, Croatia
| | - David Falck
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Florent Clerc
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Genadij Razdorov
- Genos Glycoscience Research Laboratory, BIOCentar, Zagreb, Croatia
| | - Anna Khon
- Division of Gastroenterology, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense, Rome, Italy
| | - Anna Latiano
- Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - Renata D'Incà
- Division of Gastroenterology, University Hospital, Padua, Italy
| | - Silvio Danese
- Humanitas University, Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Clinical and Research Hospital, Milan, Italy
| | - Stephan Targan
- F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carol Landers
- F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marla Dubinsky
- F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dermot P B McGovern
- F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Vito Annese
- Division of Gastroenterology, University Hospital Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Valiant Clinic, Dubai, United Arab Emirates
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Gordan Lauc
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia; Genos Glycoscience Research Laboratory, BIOCentar, Zagreb, Croatia.
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Gabbani T, Marsico M, Bernini P, Lorefice E, Grappone C, Biagini MR, Milani S, Annese V. Metabolomic analysis with 1H-NMR for non-invasive diagnosis of hepatic fibrosis degree in patients with chronic hepatitis C. Dig Liver Dis 2017. [PMID: 28625405 DOI: 10.1016/j.dld.2017.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The assessment of fibrosis degree in liver diseases is based on several non-invasive techniques, but none has been accurate. AIM This study employed proton nuclear magnetic resonance spectroscopy to identify metabolic profiles in serum and urine, specific for different fibrosis degree in chronic hepatitis C patients. METHOD 71 plasma, 73 serum, and 578 urine samples were collected. All samples were analyzed using 1H-NMR spectroscopy technique and three different NMR spectra were acquired for each serum/plasma sample. The data analyses were performed by partial least square regression, principal component analysis, and Monte Carlo cross-validation in a supervised methodology. RESULTS The cross-validation test correctly assigned each sample to its specific donor with 98.44% accuracy for urine samples and 65% for serum/plasma samples. Advanced fibrosis and cirrhosis were recognized with 71% sensitivity for CPMG plasma spectra and 69% specificity for NOESY serum spectra. Accuracy for NOESY serum spectra was 68%. Noesy spectra recognized advanced fibrosis and cirrhosis with 71% sensitivity, 30% specificity, and 50% accuracy in urine samples. CONCLUSION Metabolomic analysis of urine spectra using 1H-NMR spectroscopy can recognize a specific individual profile in all patients with chronic hepatitis C. However, this method cannot yet differentiate with sufficient accuracy, patients with advanced fibrosis from patients with milder disease.
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Affiliation(s)
- Tommaso Gabbani
- Gastroenterology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy.
| | - Maria Marsico
- Gastroenterology Unit, Modena University Hospital, Modena, Italy
| | - Patrizia Bernini
- CERM, Chemistry Department, Florence University, Sesto Fiorentino, Italy
| | | | - Cecilia Grappone
- Gastroenterology SOD, AOU Careggi University Hospital, Florence, Italy
| | | | - Stefano Milani
- Gastroenterology SOD, AOU Careggi University Hospital, Florence, Italy
| | - Vito Annese
- Gastroenterology Department, Valiant Clinic, Dubai, UAE
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Russo E, Lombardelli L, Giudici F, Cavalli T, Ficari F, Fazi M, Scaringi S, Biancone L, Logiodice F, Nesi M, Latiano A, Annese V, Torcia MG, Bechi P, Tonelli F, Piccinni MP, Malentacchi C. Crohn's Colitis: Development of a multiplex gene expression assay comparing mRNA levels of susceptibility genes. Clin Res Hepatol Gastroenterol 2017; 41:435-444. [PMID: 28365139 DOI: 10.1016/j.clinre.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/28/2017] [Indexed: 02/04/2023]
Abstract
Crohn's disease (CD) is a multifactorial immunologically mediated disease. In this study we explored, for the first time, the efficacy of the Multiplex Gene Assay technology for detecting mRNA expression profile of 24 selected CD related genes in endoscopic biopsies and surgical specimens from CD patients with colonic localization of the disease. The polymorphisms of genes most frequently associated with CD were also analysed in DNA samples from the same patients. The analysis of endoscopic samples showed increased expression of 7 genes in inflamed mucosa compared to non-inflamed mucosa and suggests the activation of the autophagy process and of a Th17 adaptive response. The analysis of surgical specimens showed increased expression of 16 genes in inflamed tissue compared to non-inflamed internal controls and revealed the activation of immune-adaptive Th17 response in association with a Th1 response. Furthermore, an increased expression of genes involved in ionic transport and signal transduction was found in inflamed mucosa compared to non-inflamed internal controls. This study confirms the activation of Th17 and Th1 adaptive-immune response also in colonic CD. It should be stressed that these responses have been disclosed in biopsy tissue, while only Th17 differentiation is revealed in endoscopic tissue. Interestingly, the polymorphisms analysis revealed that a homozygous genotype is associated to a more complicated clinical course.
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Affiliation(s)
- Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Letizia Lombardelli
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Francesco Giudici
- Department of Surgery and Translational Medicine (DCMT), Section of Surgery, University of Florence, Florence, Italy
| | - Tiziana Cavalli
- Department of Surgery and Translational Medicine (DCMT), Section of Surgery, University of Florence, Florence, Italy
| | - Ferdinando Ficari
- Department of Surgery and Translational Medicine (DCMT), Section of Surgery, University of Florence, Florence, Italy
| | - Marilena Fazi
- Department of Surgery and Translational Medicine (DCMT), Section of Surgery, University of Florence, Florence, Italy
| | - Stefano Scaringi
- Department of Surgery and Translational Medicine (DCMT), Section of Surgery, University of Florence, Florence, Italy; Gastroenterology Unit SOD2, AOUC Careggi, Florence, Italy
| | - Livia Biancone
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Federica Logiodice
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Mariateresa Nesi
- Department of Experimental and Clinical Biomedical Sciences (SBSC) "Mario Serio", University of Florence, Florence, Italy
| | - Anna Latiano
- Division of Gastroenterology, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Vito Annese
- Gastroenterology Unit SOD2, AOUC Careggi, Florence, Italy
| | - Maria Gabriella Torcia
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Paolo Bechi
- Department of Surgery and Translational Medicine (DCMT), Section of Surgery, University of Florence, Florence, Italy
| | - Francesco Tonelli
- Department of Surgery and Translational Medicine (DCMT), Section of Surgery, University of Florence, Florence, Italy
| | - Marie-Pierre Piccinni
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Cecilia Malentacchi
- Department of Experimental and Clinical Biomedical Sciences (SBSC) "Mario Serio", University of Florence, Florence, Italy
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Maaser C, Langholz E, Gordon H, Burisch J, Ellul P, Ramirez VH, Karakan T, Katsanos KH, Krustins E, Levine A, Mantzaris GJ, O'Morain C, Strid H, Yuksel ES, Annese V. European Crohn's and Colitis Organisation Topical Review on Environmental Factors in IBD. J Crohns Colitis 2017; 11:905-920. [PMID: 28039310 DOI: 10.1093/ecco-jcc/jjw223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 02/08/2023]
Abstract
This ECCO Topical Review of the European Crohn's and Colitis Organisation [ECCO] focuses on the role of environmental factors with respect to the development of inflammatory bowel disease [IBD] as well as their influence on the course of established IBD. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice.
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Affiliation(s)
- Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Ebbe Langholz
- Gastroenterology Section, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Hannah Gordon
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Pierre Ellul
- Department of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | | | - Tarkan Karakan
- Department of Gastroenterology, Ankara, Gazi University Faculty of Medicine, Besevler, Turkey
| | - Konstantinos H Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Eduards Krustins
- Department of Gastroenterology, Hepatology and Nutrition Therapy, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Arie Levine
- Wolfson Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Colm O'Morain
- Department of Gastroenterology, Beacon Consultants Clinic, Dublin, Ireland
| | - Hans Strid
- Department of Internal Medicine, Södra Älvsborgs Hospital, Borås, Sweden
| | - Elif Saritas Yuksel
- Department of Gastroenterology, Izmir Katip Celebi University Ataturk Teaching and Research Hospital, Izmir, Turkey
| | - Vito Annese
- Division of Gastroenterology, University Hospital Careggi, Florence, Italy
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Abstract
The introduction of biological agents has revolutionized the management of many life-threatening and debilitating immune-mediated diseases. Because of the high cost of biological drugs and their patent expiration, the market has opened to biosimilar agents, copy versions of the originators, which can lead to reduced health care expenditure and increase treatment access worldwide. CT-P13 is the first biosimilar of infliximab (IFX) and has been approved for the same indications as its originator drug. It obtained regulatory approval by the European Medicines Agency in September 2013 and by the US Food and Drug Administration in April 2016. The Phase I and Phase III clinical trials conducted in ankylosing spondylitis and rheumatoid arthritis have demonstrated pharmacokinetic and efficacy equivalence with comparable safety and immunogenicity to IFX. For these reasons, the use of CT-P13 has been extrapolated also to inflammatory bowel disease. There have been some initial concerns regarding the use of CT-P13 in inflammatory bowel disease patients, because of the lack of randomized controlled trials. However, emerging real-world data have further confirmed the comparability between CT-P13 and its reference product in terms of efficacy, safety, and immunogenicity, in patients naïve to the anti-tumor necrosis factor alpha agents and after switching from IFX, and will be summarized in this review.
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Affiliation(s)
- Tommaso Gabbani
- Gastroenterology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì
| | - Simona Deiana
- Division of Gastroenterology, AOU Careggi University Hospital, Florence, Italy
| | - Vito Annese
- Gastroenterology Department, Valiant Clinic, Dubai, UAE
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Marsico M, Gabbani T, Lunardi S, Galli A, Biagini MR, Annese V. Percutaneous ultrasound-guided fiducial marker placement for liver cancer robotic stereotactic radio-surgery treatment: A comparative analysis of three types of markers and needles. Arab J Gastroenterol 2017; 18:83-86. [PMID: 28579341 DOI: 10.1016/j.ajg.2017.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/08/2017] [Accepted: 05/07/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Maria Marsico
- Gastroenterology UO, Bellaria-Maggiore Hospital, Bologna, Italy.
| | - Tommaso Gabbani
- Gastroenterology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Sarah Lunardi
- Division of Internal Medicine 4, AOU Careggi University Hospital, Florence, Italy
| | - Andrea Galli
- Clinical Gastroenterology Unit, AOU Careggi University Hospital, Florence, Italy
| | - Maria Rosa Biagini
- Clinical Gastroenterology Unit, AOU Careggi University Hospital, Florence, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic, Dubai, United Arab Emirates
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Gionchetti P, Rizzello F, Annese V, Armuzzi A, Biancone L, Castiglione F, Comberlato M, Cottone M, Danese S, Daperno M, D'Incà R, Fries W, Kohn A, Orlando A, Papi C, Vecchi M, Ardizzone S. Use of corticosteroids and immunosuppressive drugs in inflammatory bowel disease: Clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease. Dig Liver Dis 2017; 49:604-617. [PMID: 28254463 DOI: 10.1016/j.dld.2017.01.161] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 09/26/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
Abstract
The two main forms of intestinal bowel disease, namely ulcerative colitis and Crohn's disease, are not curable but can be controlled by various medical therapies. The Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) has prepared clinical practice guidelines to help physicians prescribe corticosteroids and immunosuppressive drugs for these patients. The guidelines consider therapies that induce remission in patients with active disease as well as treatment regimens that maintain remission. These guidelines complement already existing guidelines from IG-IBD on the use of biological drugs in patients with inflammatory bowel diseases.
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Affiliation(s)
- Paolo Gionchetti
- Department of Medical and Surgical Sciences, IBD Unit, University of Bologna, Bologna, Italy.
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, IBD Unit, University of Bologna, Bologna, Italy
| | - Vito Annese
- AOU Gastroenterology, Careggi University Hospital, Florence, Italy
| | - Alessandro Armuzzi
- IBD Unit Complesso Integrato Columbus-Gemelli Hospital Catholic University Foundation, Rome, Italy
| | - Livia Biancone
- University "Tor Vergata", Department of Systems Medicine, Rome, Italy
| | | | | | - Mario Cottone
- Department of Medicine, Pneumology and Nutrition Clinic, V. Cervello Hospital, Ospedali Riuniti Villa Sofia-Cervello University of Palermo, Palermo, Italy
| | - Silvio Danese
- IBD Center, Humanitas Clinical and Research Centre, Milan, Italy
| | - Marco Daperno
- Gastroenterology Unit, A.O. Ordine Mauriziano Hospital, Turin, Italy
| | - Renata D'Incà
- Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Walter Fries
- Clinical Unit for Chronic Bowel Disorders, Department of Internal Medicine, IBD Unit Messina, University of Messina, Messina, Italy
| | - Anna Kohn
- Department of Gastroenterology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Ambrogio Orlando
- Department of Medicine, Pneumology and Nutrition Clinic, V. Cervello Hospital, Ospedali Riuniti Villa Sofia-Cervello University of Palermo, Palermo, Italy
| | - Claudio Papi
- Gastroenterology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Maurizio Vecchi
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Donato Hospital, San Donato Milanese, Italy
| | - Sandro Ardizzone
- Gastroenterology and Digestive Endoscopy, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
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Biancone L, Annese V, Ardizzone S, Armuzzi A, Calabrese E, Caprioli F, Castiglione F, Comberlato M, Cottone M, Danese S, Daperno M, D'Incà R, Frieri G, Fries W, Gionchetti P, Kohn A, Latella G, Milla M, Orlando A, Papi C, Petruzziello C, Riegler G, Rizzello F, Saibeni S, Scribano ML, Vecchi M, Vernia P, Meucci G, Bossa F, Cappello M, Cassinotti A, Chiriatti A, Fiorino G, Formica V, Guidi L, Losco A, Mocciaro F, Onali S, Pastorelli L, Pica R, Principi M, Renna S, Ricci C, Rispo A, Rogai F, Sarmati L, Scaldaferri F, Spina L, Tambasco R, Testa A, Viscido A. Safety of treatments for inflammatory bowel disease: Clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Dig Liver Dis 2017; 49:338-358. [PMID: 28161290 DOI: 10.1016/j.dld.2017.01.141] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 10/09/2016] [Revised: 12/19/2016] [Accepted: 01/07/2017] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel diseases are chronic conditions of unknown etiology, showing a growing incidence and prevalence in several countries, including Italy. Although the etiology of Crohn's disease and ulcerative colitis is unknown, due to the current knowledge regarding their pathogenesis, effective treatment strategies have been developed. Several guidelines are available regarding the efficacy and safety of available drug treatments for inflammatory bowel diseases. Nevertheless, national guidelines provide additional information adapted to local feasibility, costs and legal issues related to the use of the same drugs. These observations prompted the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) to establish Italian guidelines on the safety of currently available treatments for Crohn's disease and ulcerative colitis. These guidelines discuss the use of aminosalicylates, systemic and low bioavailability corticosteroids, antibiotics (metronidazole, ciprofloxacin, rifaximin), thiopurines, methotrexate, cyclosporine A, TNFα antagonists, vedolizumab, and combination therapies. These guidelines are based on current knowledge derived from evidence-based medicine coupled with clinical experience of a national working group.
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Affiliation(s)
- Livia Biancone
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy.
| | - Vito Annese
- AOU Careggi, Gastroenterology, Florence, Italy
| | - Sandro Ardizzone
- Gastrointestinal Unit, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Emma Calabrese
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, University of Milan and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda,Ospedale Policlinico di Milano, Milan, Italy
| | | | - Michele Comberlato
- Department of Gastroenterology and Digestive Endoscopy, Central Hospital, Bolzano, Italy
| | - Mario Cottone
- Division of Internal Medicine 2, IBD Unit, Hospital "Riuniti Villa Sofia-Cervello", Palermo, Italy
| | - Silvio Danese
- Humanitas Research Hospital and Humanitas University, Rozzano (Milan), Italy
| | - Marco Daperno
- Hospital "Ordine Mauriziano di Torino", Turin, Italy
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Italy
| | - Giuseppe Frieri
- University of L'Aquila, Gastroenterology Unit, L'Aquila, Italy
| | - Walter Fries
- Department of Clinical and Experimental Medicine, Clinical Unit for Chroric Bowel Disorders, University of Messina, Messina, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Anna Kohn
- San Camillo-Forlanini Hospital, IBD Unit, Rome, Italy
| | | | | | - Ambrogio Orlando
- Division of Internal Medicine 2, IBD Unit, Hospital "Riuniti Villa Sofia-Cervello", Palermo, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | - Carmelina Petruzziello
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy
| | - Gabriele Riegler
- U.O. of Gastroenterology C.S. - University della Campania "Luigi Vanvitelli", Naples, Italy
| | - Fernando Rizzello
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | | | - Maurizio Vecchi
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato and University of Milan, San Donato Milanese, Milan, Italy
| | - Piero Vernia
- Gastroenterology Unit, Sapienza, University of Rome, Rome, Italy
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Abstract
INTRODUCTION The pathogenesis of Inflammatory bowel diseases (IBD) is multifactorial, with interactions between genetic and environmental factors. Despite the existence of genetic factors being largely demonstrated by epidemiological data and several genetic studies, only a few findings have been useful in term of disease prediction, disease progression and targeting therapy. Areas covered: This review summarizes the results of genome-wide association studies in Crohn's disease, the role of epigenetics and the recent discovery by genetic studies of new pathogenetic pathways. Furthermore, it focuses on the importance of applying genetic data to clinical practice, and more specifically how to better target therapy and predict potential drug-related toxicity. Expert opinion: Some genetic markers identified in Crohn`s disease have allowed investigators to hypothesize about, and in some cases, prove the usefulness of new specific therapeutic agents. However, the heterogeneity and complexity of this disease has so far limited the daily clinical use of genetic information. Finally, the study of the implications of genetics on therapy, either to predict efficacy or avoid toxicity, is considered still to be in its infancy.
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Affiliation(s)
- Tommaso Gabbani
- a Gastroenterology UO , Azienda Unita Sanitaria Locale della Romagna , Forlì , Italy
| | - Simona Deiana
- b Division of Gastroenterology , AOU Careggi University Hospital , Florence , Italy
| | - Margherita Marocchi
- c Division of Gastroenterology , AOU Modena University Hospital , Modena , Italy
| | - Vito Annese
- d Department of Gastroenterology , Valiant Clinic , Dubai , UAE
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Deiana S, Gabbani T, Annese V. Biosimilars in inflammatory bowel disease: A review of post-marketing experience. World J Gastroenterol 2017; 23:197-203. [PMID: 28127193 PMCID: PMC5236499 DOI: 10.3748/wjg.v23.i2.197] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/01/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023] Open
Abstract
Biologic compounds are obtained from living organisms or cell cultures by means of biotechnology methods. A similar biologic drug, commonly called biosimilar, is a product copied by a native approved biologic drug whose license has expired. Biosimilar drugs usually are marketed at a lower price and provide important financial savings for public healthcare systems. Some differences between biosimilars and original biologic drugs might exist but they are acceptable if they fall within defined “boundaries of tolerance”: differences in some features between the two molecules are considered important only if clinical relevant. Considering that the efficacy of the innovator biologic drug has already been established, the clinical studies required for approval of a biosimilar could be reduced compared with those required for the approval of the originator. In this review, real life data available in inflammatory bowel disease patients treated with biosimilars are reported, documenting in general satisfactory outcomes, sustained efficacy and no sign of increased immunogenicity, although, further controlled data are awaited.
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48
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Costa Pereira C, Durães C, Coelho R, Grácio D, Silva M, Peixoto A, Lago P, Pereira M, Catarino T, Pinho S, Teixeira JP, Macedo G, Annese V, Magro F. Association between Polymorphisms in Antioxidant Genes and Inflammatory Bowel Disease. PLoS One 2017; 12:e0169102. [PMID: 28052094 PMCID: PMC5215755 DOI: 10.1371/journal.pone.0169102] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 12/14/2022] Open
Abstract
Inflammation is the driving force in inflammatory bowel disease (IBD) and its link to oxidative stress and carcinogenesis has long been accepted. The antioxidant system of the intestinal mucosa in IBD is compromised resulting in increased oxidative injury. This defective antioxidant system may be the result of genetic variants in antioxidant genes, which can represent susceptibility factors for IBD, namely Crohn's disease (CD) and ulcerative colitis (UC). Single nucleotide polymorphisms (SNPs) in the antioxidant genes SOD2 (rs4880) and GPX1 (rs1050450) were genotyped in a Portuguese population comprising 436 Crohn's disease and 367 ulcerative colitis patients, and 434 healthy controls. We found that the AA genotype in GPX1 is associated with ulcerative colitis (OR = 1.93, adjusted P-value = 0.037). Moreover, we found nominal significant associations between SOD2 and Crohn's disease susceptibility and disease subphenotypes but these did not withstand the correction for multiple testing. These findings indicate a possible link between disease phenotypes and antioxidant genes. These results suggest a potential role for antioxidant genes in IBD pathogenesis and should be considered in future association studies.
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Affiliation(s)
- Cristiana Costa Pereira
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Oporto, Portugal
- MedInUP – Centre for Drug Discovery and Innovative Medicines, University of Porto, Oporto, Portugal
- EPIUnit – Institute of Public Health, University of Porto, Oporto, Portugal
| | - Cecília Durães
- Ipatimup – Institute of Molecular Pathology and Immunology of the University of Porto, Oporto, Portugal
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Oporto, Portugal
| | - Rosa Coelho
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Daniela Grácio
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Oporto, Portugal
| | - Marco Silva
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Armando Peixoto
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Paula Lago
- Department of Gastroenterology, HSA – Centro Hospitalar do Porto, Oporto, Portugal
| | - Márcia Pereira
- Ipatimup – Institute of Molecular Pathology and Immunology of the University of Porto, Oporto, Portugal
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Oporto, Portugal
- Institute for the Biomedical Sciences Abel Salazar, University of Porto, Oporto, Portugal
| | - Telmo Catarino
- Ipatimup – Institute of Molecular Pathology and Immunology of the University of Porto, Oporto, Portugal
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Oporto, Portugal
| | - Salomé Pinho
- Ipatimup – Institute of Molecular Pathology and Immunology of the University of Porto, Oporto, Portugal
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Oporto, Portugal
| | - João Paulo Teixeira
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Oporto, Portugal
- EPIUnit – Institute of Public Health, University of Porto, Oporto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Vito Annese
- Emergency Department, Gastroenterology Unit, AOU Careggi, Florence, Italy
| | - Fernando Magro
- MedInUP – Centre for Drug Discovery and Innovative Medicines, University of Porto, Oporto, Portugal
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Oporto, Portugal
- * E-mail:
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49
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Fries W, Viola A, Manetti N, Frankovic I, Pugliese D, Monterubbianesi R, Scalisi G, Aratari A, Cantoro L, Cappello M, Samperi L, Saibeni S, Casella G, Mocci G, Rea M, Furfaro F, Contaldo A, Magarotto A, Calella F, Manguso F, Inserra G, Privitera AC, Principi M, Castiglione F, Caprioli F, Ardizzone S, Danese S, Papi C, Bossa F, Kohn A, Armuzzi A, D'Incà R, Annese V, Alibrandi A, Bonovas S, Fiorino G. Disease patterns in late-onset ulcerative colitis: Results from the IG-IBD "AGED study". Dig Liver Dis 2017; 49:17-23. [PMID: 27717794 DOI: 10.1016/j.dld.2016.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 05/01/2016] [Revised: 08/13/2016] [Accepted: 09/11/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Late-onset UC represents an important issue for the near future, but its outcomes and relative therapeutic strategies are yet poorly studied. AIM To better define the natural history of late-onset ulcerative colitis. METHODS In a multicenter retrospective study, we investigated the disease presentation and course in the first 3 years in 1091 UC patients divided into 3 age-groups: diagnosis ≥65years, 40-64 years, and <40years. Disease patterns, medical and surgical therapies, and risk factors for disease outcomes were analyzed. RESULTS Chronic active or relapsing disease accounts for 44% of patients with late-onset UC. Across all age-groups, these disease patterns require 3-6 times more steroids than remitting disease, but immunomodulators and, to a lesser extent, biologics are less frequently prescribed in the elderly. Advanced age, concomitant diseases and related therapies were found to be inversely associated with the use of immunomodulators or biologics, but not with surgery. CONCLUSIONS The conclusion that late-onset UC follows a mild course may apply only to a subset of patients. an important percentage of elderly patients present with more aggressive disease. Since steroid use and surgery rates did not differ in this subgroup, lower use of immunosuppressive therapy and biologics may reflect concerns in prescribing these therapies in the elderly.
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Affiliation(s)
- Walter Fries
- Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Anna Viola
- Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Natalia Manetti
- Gastroenterology Unit, University Hospital Careggi, Florence, Italy
| | - Iris Frankovic
- Gastroenterology Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Daniela Pugliese
- IBD Unit Complesso Integrato Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | | | - Giuseppe Scalisi
- Div. of Gastroenterology, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | | | - Laura Cantoro
- Gastroenterology Unit, Campus BioMedico, University of Rome, Rome, Italy
| | - Maria Cappello
- UOC Gastroenterologia ed Epatologia, A.O.U. Policlinico, Palermo, Italy
| | - Leonardo Samperi
- Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
| | - Simone Saibeni
- U.O. Gastroenterologia, Ospedale di Rho, ASST Rhodense, Italy
| | - Giovanni Casella
- Dipartimento di Medicina Ospedale Desio, Dipartimento di Medicina, Desio, MB, Italy
| | | | - Matilde Rea
- Gastroenterology, "Federico II" University, Naples, Italy
| | - Federica Furfaro
- Gastroenterology and IBD-Unit, Luigi Sacco University Hospital, Milan, Italy
| | | | - Andrea Magarotto
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Calella
- Gastroenterology, Ospedale San Giuseppe, Azienda USL11, Empoli, Firenze, Italy
| | - Francesco Manguso
- UOSC of Gastroenterology and Endoscopy, AORN "A. Cardarelli", Naples, Italy
| | - Gaetano Inserra
- Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
| | | | | | | | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Sandro Ardizzone
- Gastroenterology and Digestive Endoscopy, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Claudio Papi
- Gastroenterology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Fabrizio Bossa
- Div. of Gastroenterology, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Anna Kohn
- Gastroenterology Unit, A.O. San Camillo Forlanini, Rome, Italy
| | - Alessandro Armuzzi
- IBD Unit Complesso Integrato Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Renata D'Incà
- Gastroenterology Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Vito Annese
- Gastroenterology Unit, University Hospital Careggi, Florence, Italy
| | | | - Stefanos Bonovas
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
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50
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Gomollón F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, Peyrin-Biroulet L, Cullen GJ, Daperno M, Kucharzik T, Rieder F, Almer S, Armuzzi A, Harbord M, Langhorst J, Sans M, Chowers Y, Fiorino G, Juillerat P, Mantzaris GJ, Rizzello F, Vavricka S, Gionchetti P. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis 2017; 11:3-25. [PMID: 27660341 DOI: 10.1093/ecco-jcc/jjw168] [Citation(s) in RCA: 1276] [Impact Index Per Article: 182.3] [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: 09/01/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 02/08/2023]
Abstract
This paper is the first in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the methodology of the consensus process, and the classification, diagnosis and medical management of active and quiescent Crohn's disease. Surgical management as well as special situations including management of perianal Crohn's disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016].
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Affiliation(s)
- Fernando Gomollón
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Axel Dignass
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Vito Annese
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Herbert Tilg
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Gert Van Assche
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - James O Lindsay
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Laurent Peyrin-Biroulet
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Garret J Cullen
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Marco Daperno
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Torsten Kucharzik
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Florian Rieder
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Sven Almer
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Alessandro Armuzzi
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Marcus Harbord
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Jost Langhorst
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Miquel Sans
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Yehuda Chowers
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Gionata Fiorino
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Pascal Juillerat
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Gerassimos J Mantzaris
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Fernando Rizzello
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Stephan Vavricka
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Paolo Gionchetti
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
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