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Iannone A, Ruospo M, Wong G, Principi M, Barone M, Strippoli GFM, Di Leo A. Chromoendoscopy for Surveillance in Ulcerative Colitis and Crohn's Disease: A Systematic Review of Randomized Trials. Clin Gastroenterol Hepatol 2017; 15:1684-1697.e11. [PMID: 27890853 DOI: 10.1016/j.cgh.2016.11.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 07/13/2016] [Revised: 10/24/2016] [Accepted: 11/08/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Key international guideline agencies recommend dysplasia surveillance in inflammatory bowel diseases with chromoendoscopy. We performed a systematic review of randomized trials comparing chromoendoscopy vs other endoscopic techniques for dysplasia surveillance in inflammatory bowel diseases. METHODS We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant studies published through September 2016. We estimated risk ratios (RRs) for dichotomous outcomes (all-cause/colorectal cancer-related mortality, time to interval cancer, patients with dysplasia, total/subtypes of dysplastic lesions, dysplasia detected by targeted biopsies, adverse events), mean differences for continuous outcomes (procedural time, costs, total/targeted biopsies), and their 95% confidence intervals (CIs) using a random-effects model. Subgroup analyses included technique compared with chromoendoscopy, type of disease, and type of dye. We estimated sensitivity and specificity of the techniques with reference to histology. RESULTS We identified 10 randomized trials (n = 1500 participants). There was a higher likelihood of detecting patients with dysplasia with chromoendoscopy compared with other techniques (RR, 1.37; 95% CI, 1.04-1.79). Subgroup analyses confirmed this effect only if chromoendoscopy was compared with standard-definition white-light endoscopy (RR, 2.12; 95% CI, 1.15-3.91). Chromoendoscopy required a significantly longer procedural time compared with other techniques (mean difference, 8.91 min; 95% CI, 1.37-16.45). There was no difference in the likelihood of detecting dysplastic subtypes and dysplasia by targeted biopsies between groups. Test sensitivity and specificity were similar between groups. CONCLUSIONS In surveillance of inflammatory bowel diseases, chromoendoscopy identifies more patients with dysplasia only when compared with standard-definition white-light endoscopy. It is associated with longer procedural time with no direct evidence of effect on preventing all-cause/cancer-specific mortality or time to interval cancer.
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Affiliation(s)
- Andrea Iannone
- Section of Gastroenterology, University of Bari, Bari, Italy.
| | - Marinella Ruospo
- Diaverum Medical Scientific Office, Lund, Sweden; Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | | | - Michele Barone
- Section of Gastroenterology, University of Bari, Bari, Italy
| | - Giovanni F M Strippoli
- Diaverum Medical Scientific Office, Lund, Sweden; Sydney School of Public Health, University of Sydney, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Diaverum Academy, Lund, Sweden
| | - Alfredo Di Leo
- Section of Gastroenterology, University of Bari, Bari, Italy
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Viggiani MT, Lorusso O, Natalizio F, Principi M, Di Leo A, Barone M. Influence of chemotherapy on total energy expenditure in patients with gastrointestinal cancer: A pilot study. Nutrition 2017; 42:7-11. [PMID: 28870482 DOI: 10.1016/j.nut.2017.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/06/2017] [Accepted: 05/08/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Resting energy expenditure (REE) and physical activity (PA) undergo variations during chemotherapy. The aim of this study was to use a metabolic Holter (SenseWear Armband [SWA]) to assess REE, total energy expenditure (TEE), and PA changes in patients undergoing chemotherapy to ensure the appropriate calorie intake. To our knowledge, this is the first study to do so. METHODS Eight patients with gastrointestinal tumors and a Karnofsky performance status of >50 underwent evaluation of the body mass index; REE, TEE, metabolic equivalent, and sleep efficiency were evaluated by SWA. Fat-free mass and fat mass were measured by bioelectrical impedance analysis, muscle strength by handgrip, and dietary intake by food diary. All evaluations were performed before chemotherapy (T0), at mid-treatment (T1), and at the end of treatment (T2). A calorie-equivalent diet to the TEE was recommended to all patients. RESULTS At T0, a body weight loss of 15.1 ± 7.2% in the previous 6 mo was observed in all patients. Two patients did not complete treatment. During chemotherapy, thanks to the nutritional counseling, the remaining patients increased their calorie intake (P = 0.006) and no significant change was observed in other parameters. The REE calculation measured by SWA was correlated to the Harris-Benedict formula (P ≤ 0.002). CONCLUSION The present data excluded significant variations of REE and PA in the course of chemotherapy in patients who do not experience weight loss and who have a Karnofsky performance status of >50. Nutritional counseling based on SWA measurements is useful to support nutritional status in patients undergoing chemotherapy.
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Affiliation(s)
- Maria Teresa Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Orsola Lorusso
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Federica Natalizio
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
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Ranaldo N, Losurdo G, Iannone A, Principi M, Barone M, De Carne M, Ierardi E, Di Leo A. Tailored therapy guided by multichannel intraluminal impedance pH monitoring for refractory non-erosive reflux disease. Cell Death Dis 2017; 8:e3040. [PMID: 28880273 PMCID: PMC5636981 DOI: 10.1038/cddis.2017.436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/04/2017] [Indexed: 02/06/2023]
Abstract
A relevant percentage of non-erosive reflux disease (NERD) is refractory to proton pump inhibitors (PPIs) treatment. Multichannel intraluminal impedance pH (MII-pH) monitoring should give useful pathophysiological information about refractoriness. Therefore, our aim was to assess whether this technique could be useful to guide a 'tailored' therapy in refractory NERD. We retrospectively recruited NERD patients undergoing MII-pH monitoring for unsuccessful treatment. All patients had undergone upper endoscopy, and those with erosive esophagitis were excluded. No patient received PPI during MII-pH monitoring. Subjects were subgrouped into three categories: acid reflux, non-acid reflux and functional heartburn. MII-pH-guided therapy was performed for 4 weeks as follows: patients with acid reflux received PPI at double dose, patients with non-acid reflux PPI at full dose plus alginate four times a day and patients with functional heartburn levosulpiride 75 mg per day. A visual analog scale (VAS) ranging from 0 to 100 mm was administered before and after such tailored therapy to evaluate overall symptoms. Responders were defined by VAS improvement of at least 40%. Sixty-nine patients with refractory NERD were selected (female-male ratio 43 : 26, mean age 47.6±15.2 years). Overall effectiveness of tailored therapy was 84% without statistical difference among subgroups (88.5% acid reflux, 92% non-acid reflux, 66.6% functional heartburn; P=0.06). Univariate analysis showed that therapy failure directly correlated with functional heartburn diagnosis (OR=4.60) and suggested a trend toward a negative correlation with smoking and a positive one with nausea. However, at multivariate analysis, these parameters were not significant. Functional heartburn experienced a lower median percent VAS reduction than acid reflux (52.5% versus 66.6%, P<0.01) even if equal to non-acid reflux (66.6%). In conclusion, a tailored approach to refractory NERD, guided by MII-pH monitoring, demonstrated to be effective and should be promising to cure symptom persistence after conventional therapy failure. Nevertheless, standardized guidelines are advisable.
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Affiliation(s)
- Nunzio Ranaldo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, Piazza Giulio Cesare, University of Bari, Bari, Italy
| | - Giuseppe Losurdo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, Piazza Giulio Cesare, University of Bari, Bari, Italy
| | - Andrea Iannone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, Piazza Giulio Cesare, University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, Piazza Giulio Cesare, University of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, Piazza Giulio Cesare, University of Bari, Bari, Italy
| | - Massimo De Carne
- Gastroenterology Section, IRCCS 'De Bellis', Castellana Grotte (BA), Italy
| | - Enzo Ierardi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, Piazza Giulio Cesare, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, Piazza Giulio Cesare, University of Bari, Bari, Italy
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy. Tel: +39 080 5592577; Fax: +39 080 5593088; E-mail:
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Barone M, Viggiani MT, Avolio AW, Iannone A, Rendina M, Di Leo A. Obesity as predictor of postoperative outcomes in liver transplant candidates: Review of the literature and future perspectives. Dig Liver Dis 2017; 49:957-966. [PMID: 28801180 DOI: 10.1016/j.dld.2017.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 02/14/2017] [Revised: 07/07/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current American and European guidelines consider a pre-transplant BMI ≥40kg/m2 as a relative contraindication for liver transplantation but this recommendation is graded as uncertain and requires further research. Moreover, conflicting results are reported on the predictive value of BMI 30-39.9kg/m2 on post-transplant complication and mortality risk. AIM This study analyzed the data of the literature on the effect of all three BMI classes of obesity on postoperative outcomes in liver transplantation. MATERIALS AND METHODS A PubMed and Cochrane Library search was conducted from inception to October 2015. RESULTS Analysis of the literature demonstrates that discrepancies among studies are mainly either due to limitations of BMI per se, the different BMI cut-offs used to select patients with obesity or reference group and the different outcomes considered. Moreover, the evaluation of visceral adipose tissue and the detrimental effect of muscle mass reduction in presence of obesity are never considered. CONCLUSIONS BMI assessment should be used as a preliminary method to evaluate obesity. Subsequently, the assessment of visceral adipose tissue and muscle mass should complete the preoperative evaluation of liver transplant candidates. This innovative approach could represent a new field of research in liver transplantation.
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Affiliation(s)
- Michele Barone
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy.
| | - Maria Teresa Viggiani
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Alfonso W Avolio
- Transplantation Service, Dept of Surgery, Catholic University, Rome, Italy
| | - Andrea Iannone
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Maria Rendina
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Dept. of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
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Ippolito AM, Milella M, Messina V, Conti F, Cozzolongo R, Morisco F, Brancaccio G, Barone M, Santantonio T, Masetti C, Tundo P, Smedile A, Carretta V, Gatti P, Termite AP, Valvano MR, Bruno G, Fabrizio C, Andreone P, Zappimbulso M, Gaeta GB, Napoli N, Fontanella L, Lauletta G, Cuccorese G, Metrangolo A, Francavilla R, Ciracì E, Rizzo S, Andriulli A. HCV clearance after direct-acting antivirals in patients with cirrhosis by stages of liver impairment: The ITAL-C network study. Dig Liver Dis 2017; 49:1022-1028. [PMID: 28487083 DOI: 10.1016/j.dld.2017.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/26/2016] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sustained virological response (SVR12) rates at 12 weeks after treatment for HCV-infected patients with decompensated cirrhosis are used when referring to those with moderate functional impairment, while few data are available for those with more severe impairment. The use of the cirrhosis staging system proposed by D'Amico might provide new insights on timing for antiviral therapy. METHODS We investigated efficacy (SVR12), safety, and post-treatment variations in clinical and laboratory parameters in 2612 patients with advanced fibrosis (n=575) or cirrhosis (n=2037). Cirrhosis was in the compensated phase (without/with varices) or had previously been in the decompensated stage. Different direct-acting antiviral (DAA) regimens were administered in accordance with scientific guidelines. RESULTS The SVR12 rate was 97.6% in patients with advanced fibrosis. For patients with cirrhosis, the rate was 96.5% in stage 1, 95.1% in stage 2, 100% in stage 3, 95.7% in stage 4, and 93.6% in stage 5. These rates were independent of gender, age, HCV genotype, and treatment schedule. Positive changes in biochemical parameters and CPT classes following therapy were evident in compensated and previously decompensated patients. CONCLUSION Our findings support the use of DAAs in patients with advanced cirrhosis (stages 3-5) who are at greatest risk and have the most to gain from therapy.
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Affiliation(s)
- Antonio Massimo Ippolito
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
| | - Michele Milella
- Clinics of Infectious Diseases, University of Bari, Bari, Italy
| | - Vincenzo Messina
- Infectious and Tropical Diseases Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy
| | - Fabio Conti
- Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Raffaele Cozzolongo
- Division of Gastroenterology, "De Bellis" Hospital, IRCCS, Castellana Grotte, Italy
| | - Filomena Morisco
- Division of Gastroenterology, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | | | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | | | - Chiara Masetti
- Hepatology and Liver Transplantation Unit, University of Tor Vergata, Rome, Italy
| | - Paolo Tundo
- Division of Infectious Diseases, "S. Caterina Novella" Hospital, Galatina, Italy
| | - Antonina Smedile
- Department of Medical Sciences, University of Turin and Department of Gastroenterology and Hepatology, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - Vito Carretta
- Liver Unit, Department of Internal Medicine, Hospital of Venosa, Venosa, Italy
| | - Pietro Gatti
- Internal Medicine, Hospital of Ostuni, Ostuni, Italy
| | | | - Maria Rosa Valvano
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Giuseppe Bruno
- Clinics of Infectious Diseases, University of Bari, Bari, Italy
| | | | - Pietro Andreone
- Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Marianna Zappimbulso
- Division of Gastroenterology, "De Bellis" Hospital, IRCCS, Castellana Grotte, Italy
| | | | - Nicola Napoli
- Clinica Medica "C. Frugoni", University of Bari, Bari, Italy
| | - Luca Fontanella
- Centre for Liver Disease, Fatebenefratelli Hospital, Naples, Italy
| | | | - Giuseppe Cuccorese
- Division of Internal Medicine, "Monsignor Di Miccoli" Hospital, Barletta, Italy
| | | | | | | | - Salvatore Rizzo
- Division of Internal Medicine, Hospital of Martina Franca, Martina Franca, Italy
| | - Angelo Andriulli
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
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Barone M, Viggiani MT, Losurdo G, Principi M, Leandro G, Di Leo A. Systematic review with meta-analysis: post-operative complications and mortality risk in liver transplant candidates with obesity. Aliment Pharmacol Ther 2017; 46:236-245. [PMID: 28488418 DOI: 10.1111/apt.14139] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/13/2016] [Accepted: 04/17/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND International guidelines rate class III (morbid) obesity (body mass index [BMI]≥40 kg/m2 ) as a relative contraindication for liver transplantation (LT) requiring further research. Moreover, data on the mortality risk in candidates with a BMI: 30-34.9 and 35-39.9 kg/m2 (class I and class II obesity, respectively) are weak. AIM To compare post-operative complications and mortality risks in all obese candidates vs candidates with a BMI: 18.5-29.9 (normal/overweight) assumed as controls. METHODS We searched the Cochrane library, PubMed, Scopus, Web-of-Science and article reference lists, restricted to the English language, and selected cohort studies analysing the following outcomes: all-causes mortality (at 30 days, 1-2-3-5 years), post-operative and cardiopulmonary complications, hospital and intensive care unit (ICU) length of stay. Two reviewers independently extracted the studies data and a third one resolved discrepancies. RESULTS Twenty-four studies comprising 132 162 patients met the inclusion criteria. As compared to controls, mortality risk was increased at all time-periods (except at 3 years) for a BMI≥40, at 30 days for a BMI: 30-34.9 and in none of the considered time-periods for a BMI: 35-39.9. Post-operative complications were significantly higher for a BMI>30 and 30-34.9. Due to the shortage/absence of data, we evaluated cardiopulmonary complications, hospital and ICU length of stay only in the BMI≥30 category. In these patients, only cardiopulmonary complications were increased as compared to controls. CONCLUSIONS Morbid obesity has an impact on patients' survival after LT. However, since even a BMI>30 increases post-transplant complications, new strategies should be included in the LT programme to favour weight loss in all obese candidates.
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Affiliation(s)
- M Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - M T Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - G Losurdo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - M Principi
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - G Leandro
- Gastroenterology unit, I.R.C.C.S. "De Bellis", Castellana Grotte, Bari, Italy
| | - A Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
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Barone M, Viggiani MT, Losurdo G, Principi M, Leandro G, Di Leo A. Editorial: liver transplantation in patients with non-alcoholic fatty liver disease and obesity-authors' reply. Aliment Pharmacol Ther 2017; 46:460-461. [PMID: 28707799 DOI: 10.1111/apt.14195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - M T Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - G Losurdo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - M Principi
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - G Leandro
- Gastroenterology unit, I.R.C.C.S. "De Bellis", Castellana Grotte, Bari, Italy
| | - A Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
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Petta S, Marzioni M, Russo P, Aghemo A, Alberti A, Ascione A, Antinori A, Bruno R, Bruno S, Chirianni A, Gaeta GB, Giannini EG, Merli M, Messina V, Montilla S, Perno CF, Puoti M, Raimondo G, Rendina M, Silberstein FC, Villa E, Zignego AL, Pani L, Craxì A. Ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin for patients with hepatitis C virus genotype 1 or 4 infection with cirrhosis (ABACUS): a prospective observational study. Lancet Gastroenterol Hepatol 2017; 2:427-434. [PMID: 28497758 DOI: 10.1016/s2468-1253(17)30048-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/23/2016] [Accepted: 01/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND We ran a compassionate use nationwide programme (ABACUS) to provide access to ombitasvir, paritaprevir, and ritonavir, with dasabuvir, plus ribavirin for hepatitis C virus (HCV) genotype 1 infection and ombitasvir, paritaprevir, and ritonavir, plus ribavirin for HCV genotype 4 infection in patients with cirrhosis at high risk of decompensation while approval of these regimens was pending in Italy. METHODS In this prospective observational study, we collected data from a compassionate use nationwide programme from March 17, 2014, to May 28, 2015. Patients with HCV genotype 1 infection and cirrhosis at high risk of decompensation were given coformulated ombitasvir (25 mg), paritaprevir (150 mg), and ritonavir (100 mg) once daily and dasabuvir (250 mg) twice daily for 12 weeks (patients with HCV genotype 1b infection) or 24 weeks (patients with HCV genotype 1a infection). Patients with HCV genotype 4 infection were given coformulated ombitasvir (25 mg), paritaprevir (150 mg), and ritonavir (100 mg) once per day for 24 weeks. All patients were given weight-based ribavirin. The primary efficacy endpoint was sustained virological response at week 12 after the end of treatment (SVR12), analysed by intention-to-treat. Univariate and multivariate logistic regression analyses were used to identify baseline characteristics associated with SVR12. Adverse events were recorded throughout the study. FINDINGS 728 (96%) of 762 patients with cirrhosis who were given ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin therapy for 12 or 24 weeks achieved SVR12. Logistic regression analyses identified that bilirubin concentrations of less than 2 mg/dL were associated with SVR12 (odds ratio [OR] 4·76 [95% CI 1·83-12·3]; p=0·001). 166 (23%) of 734 patients included in safety analyses had an adverse event. 25 (3%) patients discontinued treatment because of adverse events. Asthenia was the most commonly reported adverse event, occurring in 36 (5%) patients. INTERPRETATION Our findings suggest that the safety and effectiveness of ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin in patients with HCV genotype 1 or 4 infection and cirrhosis at high risk of decompensation in a real-life setting are similar to those reported in clinical trials. The concordance with clinical trials provides reassurance that the reported efficacy of this treatment in clinical trials will translate to its use in routine clinical practice. FUNDING Dipartimento Biomedico di Medicina Interna e Specialistica dell'Universita di Palermo.
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Affiliation(s)
- Salvatore Petta
- Section of Gastroenterology and Hepatology, Biomedical Department of Internal and Specialized Medicine (DiBiMIS), University of Palermo, Palermo, Italy.
| | - Marco Marzioni
- Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ancona, Italy
| | | | - Alessio Aghemo
- L'Unità Operativa Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alfredo Alberti
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Antonio Ascione
- Centro per le malattie del Fegato, Ospedale Fatebenefratelli, Napoli, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases, "Lazzaro Spallanzani" Istituto di Ricovero e Cura a Carattere Scientific (IRCCS), Rome, Italy
| | - Raffaele Bruno
- Dipartimento Malattie Infettive, Fondazione IRCCS Policlinico San Matteo Pavia Italia, Università degli studi di Pavia, Pavia, Italy
| | - Savino Bruno
- Humanitas University and Humanitas Research Hospital Rozzano, Milan, Italy
| | - Antonio Chirianni
- UOC Infezioni sistemiche e dell'immunodepresso, AO Ospedali dei Colli Napoli, Napoli, Italy
| | | | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Manuela Merli
- Gastroenterology Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Messina
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | | | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, AO Niguarda Ca' Granda, Milan, Italy
| | - Giovanni Raimondo
- Division of Clinical and Molecular Hepatology, Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Maria Rendina
- Gastroenterology and Digestive Endoscopy, University Hospital Policlinico Bari, Bari, Italy
| | | | - Erica Villa
- Division of Gastroenterology, Azienda Ospedaliero, Universitaria Policlinico di Modena, Italy Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Anna Linda Zignego
- Interdepartmental Centre MASVE, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luca Pani
- Italian Medicines Agency, Rome, Italy
| | - Antonio Craxì
- Section of Gastroenterology and Hepatology, Biomedical Department of Internal and Specialized Medicine (DiBiMIS), University of Palermo, Palermo, Italy
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Losurdo G, Marra A, Shahini E, Girardi B, Giorgio F, Amoruso A, Pisani A, Piscitelli D, Barone M, Principi M, Di Leo A, Ierardi E. Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled-data analysis. Neurogastroenterol Motil 2017; 29. [PMID: 28191721 DOI: 10.1111/nmo.13028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 10/13/2016] [Accepted: 12/20/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND A link between small intestinal bacterial overgrowth (SIBO) and celiac disease (CD) has been hypothesized. METHODS Literature search was performed in main medical databases. Methods of analysis/inclusion criteria were based on Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations. The end-point was to estimate, by a pooled-data analysis, SIBO prevalence in CD. Proportions/percentages and their 95% confidence intervals (CI) were calculated by inverse variance method, whereas odd ratios (OR) and their 95% CI were estimated, where available, based on the Mantel-Haenszel method. Data were entered into the RevMan 5.3 software. KEY RESULTS Eleven articles fulfilled considered criteria. The pooled mean prevalence of SIBO in CD was 20% (95% CI of 10%-30%). In comparison to asymptomatic controls, CD was associated to higher risk of SIBO, with an OR of 10.52 (95% CI 2.69-41.21, P=.0007). Jejunal aspirate culture assessed SIBO prevalence of 11% (95% CI 3%-19%) in CD, whereas breath tests detected a higher value (23%, 95% CI 10%-37%). The pooled prevalence of SIBO in CD patients who were symptomatic despite a GFD was 28% (95% CI 10%-47%), higher than in asymptomatic celiac patients (pooled prevalence of 10%, with a 95% CI of 3%-16%), despite not statistically significant (P=.06). When GFD-unresponsive CD was defined only by clinical persistence of symptoms, the prevalence of SIBO was higher than in the case of villous atrophy association (31% vs 16% P=.33). CONCLUSIONS The heterogeneity of available studies may not support a relationship SIBO-CD. Nevertheless, SIBO could be more common in CD when symptoms do not improve after GFD.
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Affiliation(s)
- G Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - A Marra
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - E Shahini
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - B Girardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - F Giorgio
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - A Amoruso
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - A Pisani
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - D Piscitelli
- Section of Pathology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - M Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - M Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - A Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
| | - E Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy
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Shahini E, Iannone A, Giangaspero A, Castellaneta NM, Losurdo G, Principi M, Barone M, Ierardi E, Di Leo A. Epstein-Barr Virus-Related Hyperacute Hepatitis: May Intravenous Steroids be an Effective Approach? AIA 2017. [DOI: 10.2174/2211352514666160923161105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ierardi E, Giorgio F, Iannone A, Losurdo G, Principi M, Barone M, Pisani A, Di Leo A. Noninvasive molecular analysis of Helicobacter pylori: Is it time for tailored first-line therapy? World J Gastroenterol 2017; 23:2453-2458. [PMID: 28465629 PMCID: PMC5394508 DOI: 10.3748/wjg.v23.i14.2453] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 12/16/2016] [Revised: 02/21/2017] [Accepted: 03/20/2017] [Indexed: 02/06/2023] Open
Abstract
The main problem of Helicobacter pylori (H. pylori) infection management is linked to antibiotic resistances. This phenomenon has grown in the last decade, inducing a dramatic decline in conventional regimen effectiveness. The causes of resistance are point mutations in bacterial DNA, which interfere with antibiotic mechanism of action, especially clarithromycin and levofloxacin. Therefore, international guidelines have recently discouraged their use in areas with a relevant resistance percentage, suggesting first-line schedules with expected high eradication rates, i.e., bismuth containing or non-bismuth quadruple therapies. These regimens require the daily assumption of a large number of tablets. Consequently, a complete adherence is expected only in subjects who may be motivated by the presence of major disorders. However, an incomplete adherence to antibiotic therapies may lead to resistance onset, since sub-inhibitory concentrations could stimulate the selection of resistant mutants. Of note, a recent meta-analysis suggests that susceptibility tests may be more useful for the choice of first than second-line or rescue treatment. Additionally, susceptibility guided therapy has been demonstrated to be highly effective and superior to empiric treatments by both meta-analyses and recent clinical studies. Conventional susceptibility test is represented by culture and antibiogram. However, the method is not available everywhere mainly for methodology-related factors and fails to detect hetero-resistances. Polymerase chain reaction (PCR)-based, culture-free techniques on gastric biopsy samples are accurate in finding even minimal traces of genotypic resistant strains and hetero-resistant status by the identification of specific point mutations. The need for an invasive endoscopic procedure has been the most important limit to their spread. A further step has, moreover, been the detection of point mutations in bacterial DNA fecal samples. Few studies on clarithromycin susceptibility have shown an overall high sensitivity and specificity when compared with culture or PCR on gastric biopsies. On these bases, two commercial tests are now available although they have shown some controversial findings. A novel PCR method showed a full concordance between tissue and stool results in a preliminary experience. In conclusion, despite poor validation, there is increasing evidence of a potential availability of noninvasive investigations able to detect H. pylori resistances to antibiotics. These kinds of analysis are currently at a very early phase of development and caution should be paid about their clinical application. Only further studies aimed to evaluate their sensitivity and specificity will afford novel data for solid considerations. Nevertheless, noninvasive molecular tests may improve patient compliance, time/cost of infection management and therapeutic outcome. Moreover, the potential risk of a future increase of resistance to quadruple regimens as a consequence of their use on large scale and incomplete patient adherence could be avoided.
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Barone M, Shahini E, Di Leo A. Letter: can transient elastography and body mass index predict fibrosis regression in HBV patients on long-term nucleoside therapy? Aliment Pharmacol Ther 2017; 45:765-766. [PMID: 28150458 DOI: 10.1111/apt.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - E Shahini
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - A Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Losurdo G, Iannone A, Giorgio F, Barone M, Principi M, Ierardi E, Leo A. Sequential Therapy For Helicobacter pylori in Elderly Patients: Effectiveness, Safety and Predictors of Success. LETT DRUG DES DISCOV 2017. [DOI: 10.2174/1570180813666160922113541] [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: 02/07/2023]
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Giannitti C, Lopalco G, Vitale A, Rigante D, Anelli MG, Fabbroni M, Manganelli S, Galeazzi M, Frediani B, Barone M, Lapadula G, Iannone F, Cantarini L. Long-term safety of anti-TNF agents on the liver of patients with spondyloarthritis and potential occult hepatitis B viral infection: an observational multicentre study. Clin Exp Rheumatol 2017; 35:93-97. [PMID: 27974094 DOI: pmid/27974094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/11/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of the study was to retrospectively evaluate the long-term safety profile of anti-tumour necrosis factor (TNF)-α agents on the liver of patients with spondyloarthritis (SpA) and a previously resolved hepatitis B virus (HBV) infection. METHODS Medical records from 992 consecutive outpatients receiving anti-TNF-α therapy between 2007 and 2015 were retrospectively reviewed. HBV infection was assessed evaluating HBV surface antigen (HBsAg), antibodies to HBsAg (anti-HBs), antibodies to hepatitis B core (anti-HBc), and HBV-DNA levels. In patients with a previously resolved HBV infection, serum levels of aminotransferase (AST/ALT) were also assessed every three months, while HBsAg and HBV-DNA every six months. RESULTS We identified 131 consecutive patients (70 males, 61 females) with SpA and resolved HBV infection. At baseline none of the patients were positive for HBV-DNA, and AST/ALT levels were within the normal range with no subsequent increase during the observational treatment period. None received antiviral therapy prior to or during anti-TNF drug administration. At the end of the follow-up period (75.50±33.37 months) no viral reactivation was observed in anti-HBc positive patients, regardless of anti-HBs positivity. During the whole follow-up, HBV-DNA was undetectable in all patients, HBsAg remained negative, and it was not necessary to discontinue biologic therapy because of liver damage. CONCLUSIONS Our results confirm that pre-emptive antiviral prophylaxis may not be necessary routine, but strict monitoring for AST/ALT levels, as well as for changes in HBV serology and HBV-DNA remain necessary and seem a realistic and cost-effective approach to identify early viral reactivation.
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Affiliation(s)
- Chiara Giannitti
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Giuseppe Lopalco
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Vitale
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Donato Rigante
- Institute of Paediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Maria Grazia Anelli
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari Aldo Moro, Bari, Italy
| | - Marta Fabbroni
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Stefania Manganelli
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Mauro Galeazzi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Italy
| | - Giovanni Lapadula
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari Aldo Moro, Bari, Italy
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari Aldo Moro, Bari, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy.
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Lopalco G, Rigante D, Venerito V, Fabiani C, Franceschini R, Barone M, Lapadula G, Galeazzi M, Frediani B, Iannone F, Cantarini L. Update on the Medical Management of Gastrointestinal Behçet's Disease. Mediators Inflamm 2017; 2017:1460491. [PMID: 28210071 PMCID: PMC5292121 DOI: 10.1155/2017/1460491] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/04/2017] [Indexed: 02/07/2023] Open
Abstract
Behçet's disease (BD) is a multisystemic disorder of unknown etiology mainly defined by recurrent oral aphthosis, genital ulcers, and chronic relapsing bilateral uveitis, all of which represent the "stigmata" of disease. However, many other organs including the vascular, neurological, musculoskeletal, and gastrointestinal systems can be affected. The gastrointestinal involvement in Behçet's disease (GIBD), along with the neurological and vascular ones, represents the most feared clinical manifestation of BD and shares many symptoms with inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. Consequently, the differential diagnosis is often a daunting task, albeit the presence of typical endoscopic and pathologic findings may be a valuable aid to the exact diagnosis. To date, there are no standardized medical treatments for GIBD; therefore therapy should be tailored to the single patient and based on the severity of the clinical features and their complications. This work provides a digest of all current experience and evidence about pharmacological agents suggested by the medical literature as having a potential role for managing the dreadful features of GIBD.
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Affiliation(s)
- Giuseppe Lopalco
- 1Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Donato Rigante
- 2Institute of Pediatrics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Vincenzo Venerito
- 1Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Claudia Fabiani
- 3Department of Ophthalmology, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Rossella Franceschini
- 4Ophthalmology and Neurosurgery Department, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Michele Barone
- 5Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giovanni Lapadula
- 1Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Mauro Galeazzi
- 6Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Bruno Frediani
- 6Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Florenzo Iannone
- 1Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Luca Cantarini
- 6Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 1, 53100 Siena, Italy
- *Luca Cantarini:
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Ierardi E, Losurdo G, Iannone A, Piscitelli D, Amoruso A, Barone M, Principi M, Pisani A, Di Leo A. Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored? Ann Gastroenterol 2017; 30:380-392. [PMID: 28655974 PMCID: PMC5479990 DOI: 10.20524/aog.2017.0165] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/12/2017] [Accepted: 05/10/2017] [Indexed: 02/07/2023] Open
Abstract
Microscopic enteritis (ME) is characterized by abnormal infiltration of intraepithelial lymphocytes in intestinal mucosa. It was described as duodenal lymphocytosis or lymphocytic duodenitis until the dedicated Consensus Conference of 2015. ME represents a common feature of several gluten-mediated and non-gluten related diseases; therefore, it is an umbrella term embracing several conditions. The most frequent causes of ME are gluten-related disorders (celiac disease, non-celiac gluten sensitivity, wheat allergy), Helicobacter pylori infection and drug-related damages. Less frequently, ME may be secondary to inflammatory bowel disease, some autoimmune conditions, immunoglobulin deficiencies, blood malignancies, infections and irritable bowel syndrome. Therefore, the differential diagnosis of ME may be challenging. The diagnosis of ME needs to be driven by predominant symptoms and patient history. However, it is often difficult to achieve an immediate identification of the underlying condition, and a broad variety of diagnostic tests may be required. Ultimately, long-term surveillance is needed for a final diagnosis in many cases, since a hidden or quiescent condition may be disclosed after a period of latency. In any case, strict collaboration between the clinician and the pathologist is pivotal. The treatment of ME should be personalized, depending on the underlying disease. For gluten-related conditions (celiac disease, gluten sensitivity, wheat allergy, dermatitis herpetiformis), a gluten-free diet may be proposed. For other conditions, a targeted etiologic treatment is necessary. In conclusion, ME represents a novel entity that is attracting increasing interest. The growing epidemiologic trend confirms that it will become a common condition in clinical practice.
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Affiliation(s)
- Enzo Ierardi
- Section of Gastroenterology (Enzo Ierardi, Giuseppe Losurdo, Andrea Iannone, Annacinzia Amoruso, Michele Barone, Mariabeatrice Principi, Antonio Pisani, Alfredo Di Leo)
- Correspondence to: Prof. Enzo Ierardi, Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, Piazza Giulio Cesare, Bari, University of Bari, Italy, Tel.: +39 080 5594033, Fax: +39 080 5593088, e-mail:
| | - Giuseppe Losurdo
- Section of Gastroenterology (Enzo Ierardi, Giuseppe Losurdo, Andrea Iannone, Annacinzia Amoruso, Michele Barone, Mariabeatrice Principi, Antonio Pisani, Alfredo Di Leo)
| | - Andrea Iannone
- Section of Gastroenterology (Enzo Ierardi, Giuseppe Losurdo, Andrea Iannone, Annacinzia Amoruso, Michele Barone, Mariabeatrice Principi, Antonio Pisani, Alfredo Di Leo)
| | - Domenico Piscitelli
- Section of Pathology (Domenico Piscitelli), Department of Emergency and Organ Transplantation, AOU Policlinico, Piazza Giulio Cesare, Bari, University of Bari, Italy
| | - Annacinzia Amoruso
- Section of Gastroenterology (Enzo Ierardi, Giuseppe Losurdo, Andrea Iannone, Annacinzia Amoruso, Michele Barone, Mariabeatrice Principi, Antonio Pisani, Alfredo Di Leo)
| | - Michele Barone
- Section of Gastroenterology (Enzo Ierardi, Giuseppe Losurdo, Andrea Iannone, Annacinzia Amoruso, Michele Barone, Mariabeatrice Principi, Antonio Pisani, Alfredo Di Leo)
| | - Mariabeatrice Principi
- Section of Gastroenterology (Enzo Ierardi, Giuseppe Losurdo, Andrea Iannone, Annacinzia Amoruso, Michele Barone, Mariabeatrice Principi, Antonio Pisani, Alfredo Di Leo)
| | - Antonio Pisani
- Section of Gastroenterology (Enzo Ierardi, Giuseppe Losurdo, Andrea Iannone, Annacinzia Amoruso, Michele Barone, Mariabeatrice Principi, Antonio Pisani, Alfredo Di Leo)
| | - Alfredo Di Leo
- Section of Gastroenterology (Enzo Ierardi, Giuseppe Losurdo, Andrea Iannone, Annacinzia Amoruso, Michele Barone, Mariabeatrice Principi, Antonio Pisani, Alfredo Di Leo)
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Licinio R, Losurdo G, Carparelli S, Iannone A, Giorgio F, Barone M, Principi M, Ierardi E, Di Leo A. Helicobacter pylori, liver cirrhosis, and portal hypertension: an updated appraisal. Immunopharmacol Immunotoxicol 2016; 38:408-413. [PMID: 27788611 DOI: 10.1080/08923973.2016.1247855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Helicobacter pylori (H. pylori) is the most common cause of gastritis and peptic ulcer. However, H. pylori is even involved in extragastric diseases, and it has been hypothesized that H. pylori could be a risk factor for several hepatic diseases. For instance, a direct involvement of H. pylori in the development of portal hypertension (PH) in cirrhotic patients has been postulated. METHODS We performed a literature search in major databases to elucidate the relationship between H. pylori, portal hypertension, and liver cirrhosis. RESULTS The effect of H. pylori on PH may be multifactorial. Endothelial dysfunction, alterations in the vasodilating dynamics, and neoangiogenesis are the most appealing theories about this issue, but the proofs come mainly from experimental studies, therefore a solid pathophysiological basis is still to be demonstrated. Congestive gastropathy (CG) and gastric antral vascular ectasia (GAVE) are two common endoscopic entities responsible for acute/chronic upper gastrointestinal bleeding, and a link with H. pylori has been hypothesized: the gastric mucosa, exposed to H. pylori, could develop both inflammatory microcirculatory alterations and thrombi, resembling the histologic pattern of GAVE. CONCLUSIONS Despite clues for an association between H. pylori and PH have been shown, these evidences are mostly experimental, therefore, in the absence of a direct proof on human beings, the role of H. pylori in the development of PH is uncertain. However, since this germ may be a cause of peptic ulcer, it should be found and eradicated in cirrhotic patients to reduce the risk of blood loss anemia.
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Affiliation(s)
- Raffaele Licinio
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Giuseppe Losurdo
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Sonia Carparelli
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Andrea Iannone
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Floriana Giorgio
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Michele Barone
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Mariabeatrice Principi
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Enzo Ierardi
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Alfredo Di Leo
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
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Giorgio F, Ierardi E, Sorrentino C, Principi M, Barone M, Losurdo G, Iannone A, Giangaspero A, Monno R, Di Leo A. Helicobacter pylori DNA isolation in the stool: an essential pre-requisite for bacterial noninvasive molecular analysis. Scand J Gastroenterol 2016; 51:1429-1432. [PMID: 27687850 DOI: 10.1080/00365521.2016.1216592] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Real-time polymerase chain reaction (RT-PCR) is a widely used technique for bacterial and viral infection diagnosis. Herein, we report our preliminary experience in retrieving H. pylori genetic sequences in stools and analyzing genotypic clarithromycin resistance by RT-PCR (noninvasive), with the aim of comparing this procedure with that performed on biopsy samples (invasive). MATERIALS AND METHODS After 'in vitro' demonstration of H. pylori DNA detection from pure and stool-mixed bacteria, 52 consecutive patients at the first diagnosis of infection were investigated. DNA was extracted from biopsy tissue and stool samples (THD® Fecal Test, Italy). RT-PCR was performed to detect 23S rRNA encoding bacterial subunit gene and search A2143G, A2142C, A2142G point mutations for clarithromycin resistance assessment. RESULTS RT-PCR showed H. pylori positive DNA in all infected patients with full concordance between tissue and stool detection (100%). We found A2143G mutation in 10 (19.2%), A2142G in 4 (7.7%) and A2142C in 5 (9.6%) patients; there was a full agreement between biopsy and fecal samples. A2143G was found in all the four A2142G positive cases and in three out of the five A2142C positive strains. Overall clarithromycin resistance rate in our series was 23%. CONCLUSIONS Despite the need of confirmation on large sample, stool RT-PCR analysis could represent a feasible tool to detect H. pylori DNA sequences and antibiotic resistance point mutations. As compared to tissue molecular analysis, this technique is noninvasive, with potential advantages such as improvement of patient compliance, reduction of diagnostic procedure time/cost and improvement of therapeutic outcome.
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Affiliation(s)
- Floriana Giorgio
- a Section of Gastroenterology, Department of Emergency and Organ Transplantation , University of Bari , Bari , Italy
| | - Enzo Ierardi
- a Section of Gastroenterology, Department of Emergency and Organ Transplantation , University of Bari , Bari , Italy
| | - Claudia Sorrentino
- a Section of Gastroenterology, Department of Emergency and Organ Transplantation , University of Bari , Bari , Italy
| | - Mariabeatrice Principi
- a Section of Gastroenterology, Department of Emergency and Organ Transplantation , University of Bari , Bari , Italy
| | - Michele Barone
- a Section of Gastroenterology, Department of Emergency and Organ Transplantation , University of Bari , Bari , Italy
| | - Giuseppe Losurdo
- a Section of Gastroenterology, Department of Emergency and Organ Transplantation , University of Bari , Bari , Italy
| | - Andrea Iannone
- a Section of Gastroenterology, Department of Emergency and Organ Transplantation , University of Bari , Bari , Italy
| | - Antonio Giangaspero
- a Section of Gastroenterology, Department of Emergency and Organ Transplantation , University of Bari , Bari , Italy
| | - Rosa Monno
- b Section of Microbiology, Department of Basic Medical Science, Neuroscience and Sense Organs , University of Bari , Bari , Italy
| | - Alfredo Di Leo
- a Section of Gastroenterology, Department of Emergency and Organ Transplantation , University of Bari , Bari , Italy
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Losurdo G, Giorgio F, Iannone A, Principi M, Barone M, Di Leo A, Ierardi E. Role of concomitant therapy for Helicobacter pylori eradication: A technical note. World J Gastroenterol 2016; 22:8638-8640. [PMID: 27784977 PMCID: PMC5064046 DOI: 10.3748/wjg.v22.i38.8638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/11/2016] [Revised: 08/27/2016] [Accepted: 09/12/2016] [Indexed: 02/06/2023] Open
Abstract
We read with interest the recent meta-analysis by Lin et al who evaluated the effectiveness of concomitant regimen for Helicobacter pylori (H. pylori) in Chinese regions. They found that 7-d concomitant regimen is undoubtedly superior to 7-d triple therapy (91.2% vs 77.9%, P < 0.0001). However, it is a common belief that a triple therapy lasting 7 d should be definitively removed from the clinical practice for its ineffectiveness. Only its prolongation to 14 d may give satisfactory success rate. Thus, the assessment of an old and outdated treatment versus a more recent and successful one does not seem to bring novel and useful information. Moreover, a 7-d duration has not been ascertained for concomitant regimen, as main guidelines recommend a 10-d schedule for this scheme. Therefore, only studies comparing 10-d concomitant versus 14-d triple seem to be appropriate according to current Guidelines and would clarify which regimen is the most suitable worldwide. Additionally, in this meta-analysis concomitant and sequential therapy showed similar performances, despite it is common opinion that sequential is more prone than concomitant therapy to fail when metronidazole resistance occurs, and China is characterized by high rate of resistance to this antibiotic. None of the included studies evaluated a priori antibiotic resistances, and the lack of this detail hampers the unveiling of this apparent contradiction. In conclusion, the lack of the evaluation of the quality of included trials as well as their high heterogeneity constitute a burdensome limit to draw solid conclusions in this meta-analysis. On the bases of these considerations and the low number of examined trials, we believe that further studies and the knowledge of antibiotic resistances will support with high quality evidence which is the best regimen and its optimal duration.
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Losurdo G, Giorgio F, Piscitelli D, Montenegro L, Covelli C, Fiore MG, Giangaspero A, Iannone A, Principi M, Amoruso A, Barone M, Di Leo A, Ierardi E. May the assessment of baseline mucosal molecular pattern predict the development of gluten related disorders among microscopic enteritis? World J Gastroenterol 2016; 22:8017-8025. [PMID: 27672296 PMCID: PMC5028815 DOI: 10.3748/wjg.v22.i35.8017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/05/2016] [Revised: 06/30/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate mucosal baseline mRNA expression of tissue transglutaminase 2 (tTG2), interferon gamma (IFNγ), toll-like receptor 2 (TLR2) and Myeloid Differentiation factor 88 (MyD88) in patients with microscopic enteritis (ME).
METHODS We retrospectively enrolled 89 patients with ME of different etiology, which was defined within a 2-year mean period of follow-up. Baseline histological examination was performed on Hematoxylin-Eosin stained sections and CD3 lymphocyte immunohistochemistry was used for intraepithelial lymphocyte count (IELs). ME was defined according to the criteria of Bucharest Consensus Conference. For each patient, formalin embedded biopsy samples of the duodenum referred to the period of ME diagnosis were retrieved. Real-time polymerase chain reaction (RT-PCR) was used to detect the amount of mRNA coding for tTG2, IFNγ, TLR2 and MyD88, and the quantity was expressed as fold change compared to controls. Control group was represented by duodenal normal specimens from 15 healthy subjects undergoing endoscopy for functional symptoms. Comparisons among continuous variables were performed by One way analysis of variance (ANOVA) and Bonferroni’s test. The χ2 test was used for categorical variables. Pearson’s test was used to evaluate correlations. Receiver operating curves were drawn for all four markers to estimate sensitivity and specificity in discriminating the development of CD and GS.
RESULTS After a period of follow up of 21.7 ± 11.7 mo, the following diagnoses were achieved: gluten related disorders in 48 subjects (31 CD; 17 GS) and non-gluten related ones in 41 (29 Irritable Bowel Syndrome - IBS; 12 Others). CD patients had the highest tTG2 levels (8.3 ± 4.5). The ANOVA plus Bonferroni analysis showed that CD > Other ME > GS = IBS > negative controls. A cut off value of 2.258 was able to discriminate between CD and GS with a sensitivity of 52.94% and a specificity of 87.1%. Additionally, CD patients had the highest IFNγ levels (8.5 ± 4.1). ANOVA plus Bonferroni demonstrated CD > Other ME > GS = IBS > negative controls. A cut off of 1.853 was able to differentiate CD and GS with a sensitivity of 47.06% and a specificity of 96.77%. Patients with non gluten-related causes of ME exhibited the highest TLR2 levels (6.1 ± 1.9) as follows: Other ME > CD = GS = IBS > negative controls. TLR2 was unable to discriminate CD from GS. Patients with CD overexpressed MyD88 levels similarly to non gluten-related causes of DL (7.8 ± 4.9 and 6.7 ± 2.9), thus CD = Other ME > GS = IBS > negative controls. A cut off of 3.722 was able to differentiate CD from GS with a sensitivity of 52.94% and a specificity of 74.19%. IELs count (15-25 and more than 25/100 enterocytes) strongly correlated with mRNA levels of all tested molecules (P < 0.0001).
CONCLUSION Our results confirm that a single marker is unable to predict a discrimination among ME underlying conditions as well as between CD and GS. Mucosal high levels of tTG and IFNγ mRNA may predict the development of CD more than GS with high specificity, despite an expected low sensitivity. TLR2 does not discriminate the development of CD from GS. MyD88 levels indicate that intestinal permeability is more increased when a severe intestinal damage underlies ME in both gluten related and unrelated conditions. Therefore, the results of the present paper do not seem to show a clear translational value.
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Iannone A, Principi M, Barone M, Losurdo G, Ierardi E, Di Leo A. Gastrointestinal bleeding from vascular malformations: Is octreotide effective to rescue difficult-to-treat patients? Clin Res Hepatol Gastroenterol 2016; 40:373-7. [PMID: 27595456 DOI: 10.1016/j.clinre.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/15/2016] [Accepted: 02/09/2016] [Indexed: 02/07/2023]
Abstract
Gastrointestinal vascular malformations are responsible for 2-8% of all cases of bleeding and 30-40% of all obscure hemorrhages, being the most frequent cause of occult bleeding in older people. The aim of this review was to provide an up-to-date report about the use of octreotide in bleeding from both hereditary and acquired vascular malformations of the gastrointestinal tract. A systematic literature search was performed, using the keywords "gastrointestinal vascular malformation", "octreotide", "angiodysplasia", "portal hypertensive gastropathy", "gastric antral vascular ectasia", and "hereditary vascular malformations". The first line therapy of acute/chronic bleeding from digestive vascular malformations is endoscopy, followed by angiographic embolization and surgical resection when this is unsuccessful. In the setting of difficult-to-treat patients, octreotide has been proposed as an alternative therapeutic strategy. Studies reported in the literature show a high efficacy and safety of octreotide, but described only a small number of enrolled patients, heterogeneous therapeutic schedules and short-term follow-up, with the exception of acute bleeding from esophageal varices. As a consequence, the use of octreotide is not approved in this setting and it is currently still prescribed as an off-label drug. Studies in larger populations are needed to confirm the promising results observed in the small case series reports, so as to provide physicians with a treatment option for patients without available alternatives. Octreotide could also determine a strong decrease in the management costs of these clinical conditions, and especially, could dramatically reduce hospital admission costs.
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Affiliation(s)
- Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Notarnicola M, Barone M, Francavilla A, Tutino V, Bianco G, Tafaro A, Minoia M, Polimeno L, Napoli A, Scavo MP, Caruso MG. Lovastatin, but not orlistat, reduces intestinal polyp volume in an ApcMin/+ mouse model. Oncol Rep 2016; 36:893-9. [PMID: 27277576 DOI: 10.3892/or.2016.4856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/21/2016] [Indexed: 02/07/2023] Open
Abstract
The statins, inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCoAR) and orlistat, an inhibitor of fatty acid synthase (FAS), inhibit tumor cell growth by restricting cholesterol and fatty acid synthesis, respectively. We previously demonstrated that an omega (ω)-3 polyunsaturated fatty acid (PUFA)- or olive oil-enriched diet reduced the polyp number and volume in ApcMin/+ mice. This phenomenon was associated with a significant inhibition of FAS and HMGCoAR, as well as an increase in the estrogen receptor (ER)β/α ratio. Herein, we evaluated the effect of lovastatin and orlistat on polyp development and ER expression in ApcMin/+ mice, in order to confirm previous data obtained with ω‑3-PUFAs and olive oil. As expected, the use of lovastatin and orlistat significantly reduced HMGCoAR and FAS enzymatic activities and gene expression in colonic tissues, but did not affect the number of intestinal polyps, while there was a statistically significant reduction in polyp volume only in the mouse group treated with lovastatin. In the mice receiving orlistat, we observed a significant increase in cell proliferation in the polyp tissue, as well as enhanced expression of ERα. Moreover, the overexpression of ERα was associated with a statistically significant increase in PES1, Shh and Gli1 protein levels, considered ERα-related molecular targets.
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Affiliation(s)
- Maria Notarnicola
- Laboratory of Nutritional Biochemistry, National Institute for Digestive Diseases 'S. de Bellis', Castellana Grotte, Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Antonio Francavilla
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Valeria Tutino
- Laboratory of Nutritional Biochemistry, National Institute for Digestive Diseases 'S. de Bellis', Castellana Grotte, Bari, Italy
| | - Giusy Bianco
- Animal Facility, National Institute for Digestive Diseases 'S. de Bellis', Castellana Grotte, Bari, Italy
| | - Angela Tafaro
- Animal Facility, National Institute for Digestive Diseases 'S. de Bellis', Castellana Grotte, Bari, Italy
| | - Mario Minoia
- Animal Facility, National Institute for Digestive Diseases 'S. de Bellis', Castellana Grotte, Bari, Italy
| | - Lorenzo Polimeno
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Anna Napoli
- Pathology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Principia Scavo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Gabriella Caruso
- Laboratory of Nutritional Biochemistry, National Institute for Digestive Diseases 'S. de Bellis', Castellana Grotte, Bari, Italy
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Facciorusso A, Del Prete V, Muscatiello N, Crucinio N, Barone M. Prognostic role of 25-hydroxyvitamin D in patients with liver metastases from colorectal cancer treated with radiofrequency ablation. J Gastroenterol Hepatol 2016; 31:1483-8. [PMID: 26896637 DOI: 10.1111/jgh.13326] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/09/2016] [Accepted: 02/13/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Vitamin D is implicated in the etiology of several neoplastic diseases, but its relationship with colorectal cancer survival is still unclear. Aim of this study was to determine whether vitamin D levels influence survival outcomes in colorectal cancer liver metastases patients treated with percutaneous radiofrequency ablation. METHODS We measured 25-hydroxyvitamin D levels in 143 patients with 215 colorectal liver metastases who underwent radiofrequency ablation between 1999 and 2011 at our institution. The influence of 25-hydroxyvitamin D levels on overall survival and time to recurrence was evaluated in univariate and multivariate Cox analyses. RESULTS Median age was 68 years (range 41-85), and median number of nodules was 2 (1-3) with a median maximum diameter of 26 mm (10-48). Median survival was 44 months (36-62), and survival rate was 91.4%, 46.5%, and 42.2% at 1, 4, and 5 years in the whole cohort. Median survival was 65 months (52-74) if 25-hydroxyvitamin D >20 ng/mL and 34 months (24-41) if ≤20 ng/mL (P < 0.001). In the whole cohort, median time to recurrence was 34 months (26-47), 50 months (36-62) in the case of 25-hydroxyvitamin D >20 ng/mL and 24 months (20-32) if ≤20 ng/mL (P < 0.001). Nodule size and 25-hydroxyvitamin D resulted as significant predictors of both overall survival and time to recurrence in multivariate analysis. CONCLUSIONS Our study provides support for the use of 25-hydroxyvitamin D as a new predictor of outcome for colorectal liver metastases patients.
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Affiliation(s)
| | | | | | | | - Michele Barone
- Gastroenterology Unit, University of Foggia, Foggia, Italy
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Iannone A, Losurdo G, Pricci M, Girardi B, Massaro A, Principi M, Barone M, Ierardi E, Di Leo A. Stool Investigations for Colorectal Cancer Screening: From Occult Blood Test to DNA Analysis. J Gastrointest Cancer 2016; 47:143-51. [PMID: 26922358 DOI: 10.1007/s12029-016-9810-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE We report an update of current methods for colorectal cancer (CRC) screening based on fecal sample analysis. METHODS A systematic review of the literature was performed in MEDLINE, EMBASE, and Science Direct electronic databases. RESULTS Blood in the stools is the first and most used strategy. Fecal occult blood test (FOBT) and fecal immunochemical test (FIT) are the main methods. Both are economic, easy to perform with high specificity, and low sensitivity. Based on CRC multi-step process with genetic and epigenetic alterations in large bowel cell DNA, single mutations or panels of alterations have been detected. These tests have the advantage of a marked improvement of the sensitivity when compared to fecal blood. However, high costs, poor availability, and correct choice of marker panel represent the major limits. A specific sDNA panel including aberrantly methylated BMP3 and NDRG4 promoter regions, mutant k-ras and β-actin (a reference gene for human DNA quantity), and an immunochemical assay for human hemoglobin has been recently approved by Food and Drug Administration. Novel promising biomarkers for CRC screening are represented by microRNAs (miRNAs), a group of 18-25 nucleotide non-coding RNA molecules that regulate gene expression. Reports on these fecal biomarkers are case-control studies, and each of them evaluates single miRNAs or multi-target panels. On the other hand, some fecal proteins have been studied as possible CRC screening markers, even though they demonstrated poor results. Finally, alterations of estrogen receptor-beta (i.e., dramatic reduction in the early stage of CRC) have been demonstrated in tissue samples. CONCLUSIONS Specific investigations are warranted in order to add further noninvasive markers to the panel of CRC screening tools.
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Affiliation(s)
- Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Pricci
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Bruna Girardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Antonio Massaro
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
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Principi M, Cassano N, Contaldo A, Iannone A, Losurdo G, Barone M, Mastrolonardo M, Vena GA, Ierardi E, Di Leo A. Hydradenitis suppurativa and inflammatory bowel disease: An unusual, but existing association. World J Gastroenterol 2016; 22:4802-4811. [PMID: 27239107 PMCID: PMC4873873 DOI: 10.3748/wjg.v22.i20.4802] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 03/18/2016] [Revised: 04/11/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) could be associated with several extra-intestinal manifestations (EIMs) involving musculoskeletal, hepatopancreatobiliary, ocular, renal, and pulmonary systems, as well as the skin. In the last years, hidradenitis suppurativa (HS) is acquiring an increasing interest. IBD, especially Crohn’s disease (CD), is among the most reported associated diseases in HS patients. The aim of this paper is to give a brief overview of data showing a possible epidemiologic and pathogenetic association between IBD and HS. We performed a pooled-data analysis of four studies and pooled prevalence of HS in IBD patients was 12.8%, with a 95%CI of 11.7%-13.9%. HS was present in 17.3% of subjects with CD (95%CI: 15.5%-19.1%) and in 8.5% of UC patients (95%CI: 7.0%-9.9%). Some items, especially altered immune imbalance, are generally involved in IBD pathogenesis as well as invoked by HS. Smoking is one of the most relevant risk factors for both disorders, representing a predictor of their severity, despite, actually, there being a lack of studies analyzing a possible shared pathway. A role for inheritance in HS and CD pathogenesis has been supposed. Despite a genetic susceptibility having been demonstrated for both diseases, further studies are needed to investigate a genetic mutual route. Although the pathogenesis of IBD and HS is generally linked to alterations of the immune response, recent findings suggest a role for intestinal and skin microbiota, respectively. In detail, the frequent finding of Staphylococcus aureus and coagulase-negative staphylococci on HS cutaneous lesions suggests a bacterial involvement in disease pathogenesis. Moreover, microflora varies in the different cutaneous regions of the body and, consequently, two different profiles of HS patients have been identified on these bases. On the other hand, it is well-known that intestinal microbiota may be considered as “the explosive mixture” at the origin of IBD despite the exact relationship having not been completely clarified yet. A better comprehension of the role that some bacterial species play in the IBD pathogenesis may be essential to develop appropriate management strategies in the near future. A final point is represented by some similarities in the therapeutic management of HS and IBD, since they may be controlled by immunomodulatory drugs. In conclusion, an unregulated inflammation may cause the lesions typical of both HS and IBD, particularly when they coexist. However, this is still a largely unexplored field.
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Losurdo G, Iannone A, Principi M, Barone M, Ranaldo N, Ierardi E, Di Leo A. Acute pancreatitis in elderly patients: A retrospective evaluation at hospital admission. Eur J Intern Med 2016; 30:88-93. [PMID: 26806437 DOI: 10.1016/j.ejim.2016.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 10/06/2015] [Revised: 01/08/2016] [Accepted: 01/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Acute pancreatitis (AP) in elderly may have an aggressive course due to co-morbidity high rate and severe presentation. We retrospectively evaluated AP severity and its underlying factors in a group of elderly patients compared with an adult population sample. METHODS Forty-two elderly patients (65-102years) and 48 controls (19-64years) admitted at our Unit for biliary or alcoholic AP were retrospectively enrolled. AP severity was evaluated by the Atlanta classification and Ransom score. Laboratory investigations and demographic data were collected. Comparison between the two groups was performed by t-test, ANOVA or Fisher's exact test. A multinomial logistic regression was used to determine factors affecting AP severity. RESULTS Elderly patients showed more severe Atlanta (1.81±0.75 vs 1.29±0.46; p=0.007) and higher Ransom (2.52±1.57 vs 0.75±0.73; p<0.0001) scores. No death was observed. Elderly patients consumed more drugs than controls, had higher rates of cardiovascular, pulmonary and renal co-morbidity, showed higher creatinine (1.09±0.41 vs 0.81±0.18; p=0.004) and lower calcium levels (8.43±0.48 vs 8.88±0.44; p=0.002). We observed only one case of fluid necrosis in an old patient. Non-necrotic fluid collections were more common in the elderly (40.5% vs 12.5%; p=0.003). At multivariate analysis, AP severity was influenced by white blood cell-count (WBC: OR=1.94; p=0.048), aspartate-transaminase-levels (AST: OR=1.97; p=0.02), serum lactate-dehydrogenase (LDH: OR=1.07; p=0.047) and Ransom score (OR=70.4; p=0.036) in elderly, while only Ransom score correlated in controls (OR=66.04; p<0.001). The etiology (biliary/alcoholic) did not influence the severity. CONCLUSIONS Elderly patients usually undergo a severe AP course, but without increase of mortality. High WBC, LDH, AST and Ransom score at the onset may predict AP severity.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Nunzio Ranaldo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy.
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
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Facciorusso A, Mariani L, Sposito C, Spreafico C, Bongini M, Morosi C, Cascella T, Marchianò A, Camerini T, Bhoori S, Brunero F, Barone M, Mazzaferro V. Drug-eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma. J Gastroenterol Hepatol 2016; 31:645-53. [PMID: 26331807 DOI: 10.1111/jgh.13147] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [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: 05/29/2015] [Revised: 07/30/2015] [Accepted: 08/21/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Solid demonstrations of superior efficacy of drug-eluting beads transarterial chemoembolization with respect to conventional chemoembolization in hepatocellular carcinoma patients are lacking. The aim of the study was to compare these two techniques in two large cohorts of unresectable hepatocellular carcinoma patients. METHODS A single center series of 249 early/intermediate hepatocellular carcinoma patients who underwent "on demand" chemoembolization in the period 2007-2011 was analyzed. Overall survival, time to progression, tumor response rate, and safety were compared between 104 patients who underwent conventional chemoembolization and 145 who underwent drug-eluting beads chemoembolization. Time-to-event data were analyzed using the Cox univariate and multivariate regression. RESULTS The two cohorts resulted balanced for liver function and tumor stages. Objective response rate was 85.3% after conventional and 74.8% after drug-eluting beads chemoembolization (P = 0.039), and median time to progression was 17 (95% confidence interval: 14-21) versus 11 months (9-12), respectively (P < 0.001). Treatment regimen was the sole independent predictor of progression at multivariate analysis (hazard ratio = 2.01; 1.45-2.80; P < 0.001). Median survival was 39 (32-47) and 32 (24-39) months in the two groups, respectively (hazard ratio = 1.33; 0.94-1.87; P = 0.10), but conventional chemoembolization was significantly associated with a survival advantage in patients with bilobar neoplasia, portal hypertension and alpha fetoprotein above normal limits. No significant differences in severe adverse events were found. CONCLUSION In a large series of Western hepatocellular carcinoma patients, drug-eluting beads chemoembolization with 100-300 µm particles did not seem to improve survival in comparison with conventional chemoembolization, which in turn provided better tumor responses and time to progression.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology, Surgery and Liver Transplantation Unit, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Luigi Mariani
- Trial Office and Biomedical Statistics, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Carlo Sposito
- Gastroenterology, Surgery and Liver Transplantation Unit, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Carlo Spreafico
- Department of Interventional Radiology, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Marco Bongini
- Gastroenterology, Surgery and Liver Transplantation Unit, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Carlo Morosi
- Department of Interventional Radiology, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Tommaso Cascella
- Department of Interventional Radiology, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Alfonso Marchianò
- Department of Interventional Radiology, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Tiziana Camerini
- Trial Office and Biomedical Statistics, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Sherrie Bhoori
- Gastroenterology, Surgery and Liver Transplantation Unit, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Federica Brunero
- Trial Office and Biomedical Statistics, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
| | - Michele Barone
- Department of Gastroenterology, University of Bari, Bari, Italy
| | - Vincenzo Mazzaferro
- Gastroenterology, Surgery and Liver Transplantation Unit, Fondazione Istituto Nazionale Tumori IRCCS-National Cancer Institute, Milan, Italy
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Barone M, Della Valle N, Rosania R, Facciorusso A, Trotta A, Cantatore FP, Falco S, Pignatiello S, Viggiani MT, Amoruso A, De Filippis R, Di Leo A, Francavilla R. A comparison of the nutritional status between adult celiac patients on a long-term, strictly gluten-free diet and healthy subjects. Eur J Clin Nutr 2016; 70:23-7. [PMID: 26173865 DOI: 10.1038/ejcn.2015.114] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/20/2015] [Accepted: 05/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES There are conflicting data on the effect of a gluten-free diet (GFD) on the nutritional status of celiac patients. In the present study, we evaluated, in adult celiac patients, the influence of a long-term, strictly GFD on their nutritional status and compared it with matched healthy volunteers. SUBJECTS/METHODS Our study included 39 celiac patients and 39 healthy volunteers. The body mass index (BMI) of patients and controls was evaluated at enrollment, while the patients' BMI before the GFD was retrieved from clinical records. In addition, at enrollment, in both groups, we compared BMI, fat mass (FM), bone mineral density (BMD), as well as their dietary intake, recorded on a 7-day diary. RESULTS At the time of diagnosis, the majority of celiac patients (82.0%) had a normal BMI or were overweight, while 10.3% were malnourished. After the GFD, patients with a normal BMI showed a significant weight increase (P=0.002), but none of them switched in the overweight or obese category. Two (50%) of the four malnourished patients achieved a normal BMI. Controls and patients on a GFD had a similar BMI, FM, BMD and total calorie intake, but the amount of lipids and fiber intake was significantly different in the two groups (P=0.003 and P<0.0001, respectively). CONCLUSIONS Our study demonstrates that a GFD is able to improve the nutritional status of celiac patients without inducing overweight or obesity. Our findings are related to a celiac population adopting a GFD based on a Mediterranean-type diet.
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Affiliation(s)
- M Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - N Della Valle
- Gastroenterology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - R Rosania
- Gastroenterology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - A Facciorusso
- Gastroenterology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - A Trotta
- Rheumatology Units, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - F P Cantatore
- Rheumatology Units, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - S Falco
- Gastroenterology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - S Pignatiello
- Gastroenterology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - M T Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - A Amoruso
- Gastroenterology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - R De Filippis
- Gastroenterology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - A Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - R Francavilla
- Department of Biomedicina dell'Età Evolutiva, University of Bari, Bari, Italy
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Scavo MP, Gentile E, Wolfram J, Gu J, Barone M, Evangelopoulos M, Martinez JO, Liu X, Celia C, Tasciotti E, Vilar E, Shen H. Multistage vector delivery of sulindac and silymarin for prevention of colon cancer. Colloids Surf B Biointerfaces 2015; 136:694-703. [PMID: 26513752 DOI: 10.1016/j.colsurfb.2015.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/09/2015] [Accepted: 10/04/2015] [Indexed: 02/07/2023]
Abstract
Familial adenomatous polyposis (FAP) is an inherited condition secondary to germline mutations in the APC gene, thus resulting in the formation of hundreds of colonic adenomas that eventually progress into colon cancer. Surgical removal of the colon remains the only treatment option to avoid malignancy, as long-term exposure to chemopreventive agents such as sulindac (a non-steroidal anti-inflammatory drug) and silymarin (phytoestrogen) is not feasible. Here, we have developed a multistage silicon-based drug delivery platform for sulindac and silymarin that preferentially interacts with colon cancer cells as opposed to normal intestinal mucosa. Preferential binding and internalization of these drugs into colon cancer cells was obtained using a targeting strategy against the protein meprin A, which we demonstrate is overexpressed in human colon cancer cells and in the small intestine of Apc(Min/+) mice. We propose that this delivery system could potentially be used to reduce drug-induced side effects in FAP patients, thus enabling long-term prevention of adenoma formation.
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Affiliation(s)
- Maria Principia Scavo
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA.
| | - Emanuela Gentile
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA; Department of Thoracic & Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joy Wolfram
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA; CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, National Center for Nanoscience & Technology of China, Beijing 100190, China
| | - Jianhua Gu
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Michele Barone
- Gastroentrology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari 70121, Italy
| | - Michael Evangelopoulos
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Jonathan O Martinez
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Xuewu Liu
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Christian Celia
- Department of Pharmacy, University G. d'Annunzio of Chieti, Pescara 66013, Italy
| | - Ennio Tasciotti
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Eduardo Vilar
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Haifa Shen
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA; Department of Cell and Developmental Biology, Weill Cornell Medical College, New York, NY 10065, USA
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80
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Facciorusso A, Del Prete V, Crucinio N, Muscatiello N, Carr BI, Di Leo A, Barone M. Angiotensin receptor blockers improve survival outcomes after radiofrequency ablation in hepatocarcinoma patients. J Gastroenterol Hepatol 2015; 30:1643-50. [PMID: 25974743 DOI: 10.1111/jgh.12988] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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] [Accepted: 04/18/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Inhibition of angiotensin II synthesis seems to decrease hepatocellular carcinoma recurrence after radical therapies; however, data on the adjuvant role of angiotensin II receptor 1 blockers (sartans) are still lacking. The aim of the study was to evaluate whether sartans delay time to recurrence and prolong overall survival in hepatocellular carcinoma patients after radiofrequency ablation. METHODS Data on 153 patients were reviewed. The study population was classified into three groups: 73 (47.8%) patients who received neither angiotensin-converting enzyme inhibitors nor sartans (group 1), 49 (32%) patients treated with angiotensin-converting enzyme inhibitors (group 2), and 31 (20.2%) patients treated with sartans (group 3). Survival outcomes were analysed by means of Kaplan-Meier analysis and compared with log-rank test. RESULTS In the whole study population, 85.6% of patients were in Child-Pugh A class and 89.6% in Barcelona Clinic Liver Cancer A stage. Median maximum tumor diameter was 30 mm (10-40) and alpha fetoprotein was 25 (1.1-2100) UI/mL. No differences in baseline characteristics among the three groups were reported. Median overall survival was 48 months (95% confidence interval: 31-58) in group 1, 72 months (49-89) in group 2, and 84 months (58-92) in group 3 (P = 0.02). Median time to recurrence was 26 (15-42), 44 (33-72), and 69 (44-74) months in the three groups, respectively (P = 0.02). Sartan therapy was a significant predictor of longer overall survival and delayed time to recurrence on multivariate analysis. CONCLUSION Sartans significantly improved overall survival and time to recurrence after radiofrequency ablation in hepatocellular carcinoma patients.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Valentina Del Prete
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Nicola Crucinio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Brian I Carr
- Laboratory of Biochemistry and Tumor Biology, National Institute for Digestive Diseases, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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81
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Facciorusso A, Del Prete V, Antonino M, Neve V, Amoruso A, Crucinio N, Di Leo A, Barone M. Conditional survival analysis of hepatocellular carcinoma patients treated with radiofrequency ablation. Hepatol Res 2015; 45:E62-72. [PMID: 25472869 DOI: 10.1111/hepr.12458] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 02/05/2023]
Abstract
AIM Survival estimates are commonly reported as survival from the first observation, but future survival probability changes based on the survival time already accumulated after therapy, otherwise known as conditional survival (CS). The aim of the study was to describe CS according to different prognostic variables in hepatocellular carcinoma (HCC) patients treated with radiofrequency ablation (RFA). METHODS Data on 125 very early/early HCC patients treated with RFA between 1999 and 2007 were analyzed. Actuarial survival estimates were computed by means of Kaplan-Meier method and compared by log-rank test. The 5-year CS was calculated with stratification by several predictors for patients who had already survived up to 5 years from diagnosis. RESULTS Median overall survival (OS) was 72 months (95% confidence interval [CI], 58-86). Age, Child-Pugh (CP), α-fetoprotein (AFP), Cancer of the Liver Italian Program (CLIP) score and type of recurrence (early vs late) were significant predictors of OS. The 5-year CS rates of the entire study cohort assessed at 1, 2, 3 and 5 years from the treatment were 49%, 48%, 30% and 34%, respectively. Subgroup analysis confirmed age and CP as significant predictors of CS at all time points, while the CS of subgroups stratified by AFP and CLIP did not differ significantly from the 3rd year after RFA onward, as more advanced patients had probably escaped early recurrence. CONCLUSION CS analysis showed that the impact of different variables influencing OS is not linear over time after RFA. Information derived from the study can improve the current management of HCC patients.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Ospedali Riuniti Foggia, Italy
| | - Valentina Del Prete
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Ospedali Riuniti Foggia, Italy
| | - Matteo Antonino
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Ospedali Riuniti Foggia, Italy
| | - Viviana Neve
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Ospedali Riuniti Foggia, Italy
| | - Annabianca Amoruso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Ospedali Riuniti Foggia, Italy
| | - Nicola Crucinio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Ospedali Riuniti Foggia, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Ospedali Riuniti Foggia, Italy
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Facciorusso A, Maso MD, Barone M, Muscatiello N. Echoendoscopic ethanol ablation of tumor combined to celiac plexus neurolysis improved pain control in a patient with pancreatic adenocarcinoma. Endosc Ultrasound 2015; 4:342-4. [PMID: 26643704 PMCID: PMC4672594 DOI: 10.4103/2303-9027.170428] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A 75-year-old man suffering from opioid-refractory due to an advanced pancreatic adenocarcinoma was treated with endoscopic ultrasound (EUS)-guided celiac plexus neurolysis (CPN) combined to EUS-guided tumor ablation. No major complications were recorded during the procedure. In the days following the procedure, mild diarrhea and fever were the only minor complications experienced by the patient. Complete tumor devascularization was assessed by means of computed tomography (CT) 48 h after the procedure. The patient remained pain-free without need of opioid, and was treated only with paracetamol for 20 weeks. Our results were optimal in terms of pain relief and immediate tumor response (assessed by means of CT and tumor marker levels). The present case demonstrates that the combined approach (EUS-guided ethanol ablation and CPN) may be a valuable option in patients with pancreatic cancer. Randomized-controlled trials are needed to confirm this result.
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Affiliation(s)
- Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
- Address for correspondence Dr. Antonio Facciorusso, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, AOU Ospedali Riuniti, Viale Pinto, 1, 71100 Foggia, Italy. E-mail:
| | - Marianna Di Maso
- Department of Medical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
| | - Michele Barone
- Department of Medical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
| | - Nicola Muscatiello
- Department of Medical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
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Giorgio F, Principi M, Losurdo G, Piscitelli D, Iannone A, Barone M, Amoruso A, Ierardi E, Di Leo A. Seronegative Celiac Disease and Immunoglobulin Deficiency: Where to Look in the Submerged Iceberg? Nutrients 2015; 7:7486-504. [PMID: 26371035 PMCID: PMC4586545 DOI: 10.3390/nu7095350] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/27/2015] [Accepted: 09/02/2015] [Indexed: 02/06/2023] Open
Abstract
In the present narrative review, we analyzed the relationship between seronegative celiac disease (SNCD) and immunoglobulin deficiencies. For this purpose, we conducted a literature search on the main medical databases. SNCD poses a diagnostic dilemma. Villous blunting, intraepithelial lymphocytes (IELs) count and gluten "challenge" are the most reliable markers. Immunohistochemistry/immunofluorescence tissue transglutaminase (tTG)-targeted mucosal immunoglobulin A (IgA) immune complexes in the intestinal mucosa of SNCD patients may be useful. In our experience, tTG-mRNA was similarly increased in seropositive celiac disease (CD) and suspected SNCD, and strongly correlated with the IELs count. This increase is found even in the IELs' range of 15-25/100 enterocytes, suggesting that there may be a "grey zone" of gluten-related disorders. An immune deregulation (severely lacking B-cell differentiation) underlies the association of SNCD with immunoglobulin deficiencies. Therefore, CD may be linked to autoimmune disorders and immune deficits (common variable immunodeficiency (CVID)/IgA selective deficiency). CVID is a heterogeneous group of antibodies dysfunction, whose association with CD is demonstrated only by the response to a gluten-free diet (GFD). We hypothesized a familial inheritance between CD and CVID. Selective IgA deficiency, commonly associated with CD, accounts for IgA-tTG seronegativity. Selective IgM deficiency (sIgMD) is rare (<300 cases) and associated to CD in 5% of cases. We diagnosed SNCD in a patient affected by sIgMD using the tTG-mRNA assay. One-year GFD induced IgM restoration. This evidence, supporting a link between SNCD and immunoglobulin deficiencies, suggests that we should take a closer look at this association.
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Affiliation(s)
- Floriana Giorgio
- Section of Gastroenterology, University Hospital Policlinico, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
| | - Mariabeatrice Principi
- Section of Gastroenterology, University Hospital Policlinico, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
| | - Giuseppe Losurdo
- Section of Gastroenterology, University Hospital Policlinico, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
| | - Domenico Piscitelli
- Section of Pathology, University Hospital Policlinico, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
| | - Andrea Iannone
- Section of Gastroenterology, University Hospital Policlinico, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
| | - Michele Barone
- Section of Gastroenterology, University Hospital Policlinico, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
| | - Annacinzia Amoruso
- Section of Gastroenterology, University Hospital Policlinico, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
| | - Enzo Ierardi
- Section of Gastroenterology, University Hospital Policlinico, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
| | - Alfredo Di Leo
- Section of Gastroenterology, University Hospital Policlinico, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
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Facciorusso A, Licinio R, Muscatiello N, Di Leo A, Barone M. Transarterial chemoembolization: Evidences from the literature and applications in hepatocellular carcinoma patients. World J Hepatol 2015; 7:2009-2019. [PMID: 26261690 PMCID: PMC4528274 DOI: 10.4254/wjh.v7.i16.2009] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 06/26/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023] Open
Abstract
Transarterial chemoembolization (TACE) is the current standard of care for patients with large or multinodular hepatocellular carcinoma (HCC), preserved liver function, absence of cancer-related symptoms and no evidence of vascular invasion or extrahepatic spread (i.e., those classified as intermediate stage according to the Barcelona Clinic Liver Cancer staging system). The rationale for TACE is that the intra-arterial injection of a chemotherapeutic drug such as doxorubicin or cisplatin followed by embolization of the blood vessel will result in a strong cytotoxic effect enhanced by ischemia. However, TACE is a very heterogeneous operative technique and varies in terms of chemotherapeutic agents, treatment devices and schedule. In order to overcome the major drawbacks of conventional TACE (cTACE), non-resorbable drug-eluting beads (DEBs) loaded with cytotoxic drugs have been developed. DEBs are able to slowly release the drug upon injection and increase the intensity and duration of ischemia while enhancing the drug delivery to the tumor. Unfortunately, despite the theoretical advantages of this new device and the promising results of the pivotal studies, definitive data in favor of its superiority over cTACE are still lacking. The recommendation for TACE as the standard-of-care for intermediate-stage HCC is based on the demonstration of improved survival compared with best supportive care or suboptimal therapies in a meta-analysis of six randomized controlled trials, but other therapeutic options (namely, surgery and radioembolization) proved competitive in selected subsets of intermediate HCC patients. Other potential fields of application of TACE in hepato-oncology are the pre-transplant setting (as downstaging/bridging treatment) and the early stage (in patients unsuitable to curative therapy). The potential of TACE in selected advanced patients with segmental portal vein thrombosis and preserved liver function deserves further reports.
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Facciorusso A, Di Maso M, Antonino M, Del Prete V, Panella C, Barone M, Muscatiello N. Polidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis. Gastrointest Endosc 2015; 82:350-358.e2. [PMID: 25910664 DOI: 10.1016/j.gie.2015.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/01/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND EMR is the standard of care for the resection of large polyps. OBJECTIVE To compare the efficacy and safety profile of submucosal polidocanol injection with epinephrine-saline solution injection for colon polypectomy with a diathermic snare. DESIGN After 1-to-1 propensity score caliper matching, comparison of submucosal epinephrine injection was performed with polidocanol injection. SETTING Endoscopic suite at the University of Foggia between 2005 and 2014. PATIENTS Of 711 patients who underwent endoscopic resection of colon sessile polyps 20 mm or larger, 612 were analyzed after matching. INTERVENTIONS Submucosal epinephrine injection in 306 patients and polidocanol injection in 306 patients. MAIN OUTCOME MEASUREMENTS Univariate and multivariate logistic regression models aimed at identifying independent predictors of postpolypectomy bleeding (PPB). RESULTS The 2 groups presented similar baseline clinical parameters and lesion characteristics. All patients had a single polyp 20 mm or larger; the median size was 32 mm (interquartile range [IQR], 25-38) in the polidocanol group and 32 (IQR, 24-38) in the epinephrine group (P=.7). Polidocanol was more effective in preventing both immediate and delayed PPB (P<.001 and P=.003, respectively), and its efficacy was confirmed in almost all of the subgroups, regardless of polyp size and histology. Postprocedure perforation was observed in 2 patients (0.3%), both in the epinephrine group (P=.49). The 2 groups did not differ in the number of snare resections of lesions or the procedure duration (P=.24 and .6, respectively). LIMITATIONS Absence of randomization. CONCLUSION The submucosal injection of polidocanol for colon EMR is effective and significantly lowers the PPB rate.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Marianna Di Maso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Antonino
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Valentina Del Prete
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Carmine Panella
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
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Barone M, Notarnicola A, Lopalco G, Viggiani MT, Sebastiani F, Covelli M, Iannone F, Avolio AW, Di Leo A, Cantarini L, Lapadula G. Safety of long-term biologic therapy in rheumatologic patients with a previously resolved hepatitis B viral infection. Hepatology 2015; 62:40-6. [PMID: 25613809 DOI: 10.1002/hep.27716] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/18/2015] [Indexed: 02/05/2023]
Abstract
UNLABELLED European and Asian studies report conflicting data on the risk of hepatitis B virus (HBV) reactivation in rheumatologic patients with a previously resolved HBV (prHBV) infection undergoing long-term biologic therapies. In this patient category, the safety of different immunosuppressive biologic therapies, including rituximab, was assessed. A total of 1218 Caucasian rheumatologic patients, admitted consecutively as outpatients between 2001 and 2012 and taking biologic therapies, underwent evaluation of anti-HCV and HBV markers as well as liver amino transferases every 3 months. Starting from January 2009, HBV DNA monitoring was performed in patients with a prHBV infection who had started immunosuppressive biologic therapy both before and after 2009. Patients were considered to have elevated aminotransferase levels if values were >1× upper normal limit at least once during follow-up. We found 179 patients with a prHBV infection (14 treated with rituximab, 146 with anti-tumor necrosis factor-alpha, and 19 with other biologic therapies) and 959 patients without a prHBV infection or other liver disease (controls). The mean age in the former group was significantly higher than the controls. Patients with a prHBV infection never showed detectable HBV DNA serum levels or antibody to hepatitis B surface antigen/hepatitis B surface antigen seroreversion. However, when the prevalence of elevated amino transferases in patients with prHBV infection was compared to controls, it was significantly higher in the former group only for aminotransferase levels >1× upper normal limit but not when aminotransferase levels >2× upper normal limit were considered. CONCLUSION Among patients with a prHBV infection and rheumatologic indications for long-term biologic therapies, HBV reactivation was not seen; this suggests that universal prophylaxis is not justified and is not cost-effective in this clinical setting.
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Affiliation(s)
- Michele Barone
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Giuseppe Lopalco
- Rheumatology Unit, Medical School, University of Bari, Bari, Italy
| | - Maria Teresa Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Francesco Sebastiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Covelli
- Rheumatology Unit, Medical School, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Medical School, University of Bari, Bari, Italy
| | - Alfonso W Avolio
- Department of Surgery-Transplantation Service, Catholic University of Rome, Rome, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department Research Center of Systemic Autoimmune and Autoinflammatory Diseases, University of Siena, Siena, Italy
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Abstract
Sorafenib is the only approved systemic treatment for advanced hepatocellular carcinoma patients and all the recently published randomized controlled trials on new systemic drugs have been unsuccessful. This is likely due to a lack of understanding of tumor progression, molecular drivers, and liver toxicity, as well as flaws in trial design. An important signaling pathway in hepatocarcinogenesis is the MEK cascade involved in various cellular responses, including adaptation and survival. A key role in this cascade is played by MEK, of which MEK 1/2 represent the prototypes and an interesting target for new oncological drugs. This review analyzes recent developments and future perspectives on the role of MEK inhibitors in hepatocellular carcinoma treatment.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Ospedali Riuniti Foggia, Italy
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Facciorusso A, Antonino M, Di Maso M, Barone M, Muscatiello N. Non-polypoid colorectal neoplasms: Classification, therapy and follow-up. World J Gastroenterol 2015; 21:5149-5157. [PMID: 25954088 PMCID: PMC4419055 DOI: 10.3748/wjg.v21.i17.5149] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 12/10/2014] [Revised: 02/03/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
In the last years, an increasing interest has been raised on non-polypoid colorectal tumors (NPT) and in particular on large flat neoplastic lesions beyond 10 mm tending to grow laterally, called laterally spreading tumors (LST). LSTs and large sessile polyps have a greater frequency of high-grade dysplasia and local invasiveness as compared to pedunculated lesions of the same size and usually represent a technical challenge for the endoscopist in terms of either diagnosis and resection. According to the Paris classification, NPTs are distinguished in slightly elevated (0-IIa, less than 2.5 mm), flat (0-IIb) or slightly depressed (0-IIc). NPTs are usually flat or slightly elevated and tend to spread laterally while in case of depressed lesions, cell proliferation growth progresses in depth in the colonic wall, thus leading to an increased risk of submucosal invasion (SMI) even for smaller neoplasms. NPTs may be frequently missed by inexperienced endoscopists, thus a careful training and precise assessment of all suspected mucosal areas should be performed. Chromoendoscopy or, if possible, narrow-band imaging technique should be considered for the estimation of SMI risk of NPTs, and the characterization of pit pattern and vascular pattern may be useful to predict the risk of SMI and, therefore, to guide the therapeutic decision. Lesions suitable to endoscopic resection are those confined to the mucosa (or superficial layer of submucosa in selected cases) whereas deeper invasion makes endoscopic therapy infeasible. Endoscopic mucosal resection (EMR, piecemeal for LSTs > 20 mm, en bloc for smaller neoplasms) remains the first-line therapy for NPTs, whereas endoscopic submucosal dissection in high-volume centers or surgery should be considered for large LSTs for which en bloc resection is mandatory and cannot be achieved by means of EMR. After piecemeal EMR, follow-up colonoscopy should be performed at 3 mo to assess resection completeness. In case of en bloc resection, surveillance colonoscopy should be scheduled at 3 years for adenomatous lesions ≥ 1 cm, or in presence of villous features or high-grade dysplasia patients (regardless of the size), while less intensive surveillance (colonoscopy at 5-10 years) is needed in case of single (or two) NPT < 1 cm presenting tubular features or low-grade dysplasia at histology.
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Facciorusso A, Muscatiello N, Di Leo A, Barone M. Combination therapy with sorafenib and radiofrequency ablation for hepatocellular carcinoma: a glimmer of light after the storm trial? Am J Gastroenterol 2015; 110:770-1. [PMID: 25942304 DOI: 10.1038/ajg.2015.80] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Barone M, Iannone A, Brunetti ND, Sebastiani F, Cecere O, Berardi E, Antonica G, Di Leo A. Liver stiffness and portal blood flow modifications induced by a liquid meal consumption: pathogenetic mechanisms and clinical relevance. Scand J Gastroenterol 2015; 50:560-6. [PMID: 25614991 DOI: 10.3109/00365521.2014.1003396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The correlation between liver stiffness (LS) variations and portal blood flow (PBF) modifications induced by a standardized liquid meal consumption and the clinical relevance of this matter are two aspects not yet fully elucidated. Herein, we evaluated the variations of LS and PBF after a standardized liquid meal intake in patients with chronic liver disease. MATERIAL AND METHODS PBF and LS were determined after an overnight fasting period in 54 patients. They were divided in three groups according to baseline LS (absent, moderate, and severe). They consumed 200 ml of water and a standardized liquid meal (300 Kcal/200 ml) after 60 min. PBF and LS were measured at 30 min after water and liquid meal consumption. RESULTS In all groups, LS and PBF values significantly increased only after meal consumption. A significant correlation between baseline LS values and post-meal increase of LS was observed. Moreover, higher basal stiffness values were associated to a larger increase of LS variation after meal consumption. The effect of the meal on LS remained statistically significant after multiple regression analysis. A significant correlation between increase of LS and PBF was found in patients with absent and moderate baseline LS. Nine patients (17%) switched from a lower to a higher level of LS after meal consumption. CONCLUSION A low calories/low-volume meal is capable of significantly increasing LS regardless of the grade of stiffness, determining a reclassification rate of 17%. In presence of minimal or moderate stiffness, the increase of LS is significantly correlated with the augment of PBF.
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Affiliation(s)
- Michele Barone
- Department of Medical and Surgical Science, Gastroenterology Unit, University of Foggia , Foggia , Italy
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Affiliation(s)
- Michele Barone
- Chief of Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Facciorusso A, Muscatiello N, Barone M. Letter: prognostic scoring systems for hepatocellular carcinoma patients--the jury is still out. Aliment Pharmacol Ther 2015; 41:596-7. [PMID: 25659216 DOI: 10.1111/apt.13078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 02/05/2023]
Affiliation(s)
- A Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
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Facciorusso A, Antonino M, Del Prete V, Amoruso A, Neve V, Barone M. Medical Systemic Therapies for Hepatocellular Carcinoma: Clinical Perspectives and Safety Profile. Curr Drug Saf 2015; 10:202-7. [PMID: 25994808 DOI: 10.2174/1574886310666150521124222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 02/07/2023]
Abstract
A multidisciplinary approach based on clinical expertise and knowledge of molecular processes involved in hepatocarcinogenesis is needed for the proper management of hepatocellular carcinoma (HCC) patients. Such information must be considered in the context of pathobiology of the underlying liver disease. New drugs targeting specific molecular steps in pathways involved in HCC growth and development bear the promise to radically modify the pharmacological therapies currently in use in hepatooncology. Sorafenib was the first drug approved in the setting of advanced HCC, but although it produces some improvement in survival, the responses are not durable. In addition, there are significant side effects. Other angiogenesis inhibitors are in development to treat HCC both in the first-line setting and after progression following sorafenib failure; among them, tivantinib, an inhibitor of cMET receptor, showed interesting results in a recent phase-II study. Additional agents currently studied for the treatment of HCC patients are briefly examined in this review. Aim of this paper is to discuss the state of the art in the management of advanced HCC patients, with a particular interest for the description of their side effects.
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Affiliation(s)
| | | | | | | | | | - Michele Barone
- Gastroenterology Section, Department of Medical Sciences, University of Foggia, AOU Ospedali Riuniti, Viale Pinto, 71100 Foggia, Italy.
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Barone M, Viggiani MT, Amoruso A, Schiraldi S, Zito A, Devito F, Cortese F, Gesualdo M, Brunetti N, Di Leo A, Scicchitano P, Ciccone MM. Endothelial dysfunction correlates with liver fibrosis in chronic HCV infection. Gastroenterol Res Pract 2015; 2015:682174. [PMID: 26000012 PMCID: PMC4426818 DOI: 10.1155/2015/682174] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/31/2015] [Indexed: 02/07/2023] Open
Abstract
Background. Hepatitis C virus (HCV) infection can exert proatherogenic activities due to its direct action on vessel walls and/or via the chronic inflammatory process involving the liver. Aims. To clarify the role of HCV in atherosclerosis development in monoinfected HCV patients at different degrees of liver fibrosis and with no risk factors for coronary artery disease. Methods. Forty-five patients were included. Clinical, serological, and anthropometric parameters, liver fibrosis (transient liver elastometry (fibroscan) and aspartate aminotransferase to platelet ratio index (APRI)), carotid intima-media thickness (c-IMT), and brachial artery flow-mediated vasodilatation (FMD) were assessed. Patients were divided into 3 tertiles according to fibroscan values. Results. Patients in the third tertile (fibroscan value >11.5 KPa) showed FMD values were significantly lower than second and first tertiles (4.7 ± 1.7% versus 7.1 ± 2.8%, p = 0.03). FMD values were inversely related to liver elastomeric values. c-IMT values were normal. The risk for endothelial dysfunction development in the third tertile (p = 0.02) was 6.9 higher than the first tertile. A fibroscan value >11.5 KPa had a positive predictive power equal to 79% for endothelial dysfunction. Conclusions. HCV advanced liver fibrosis promotes atherosclerosis by inducing endothelial dysfunction independently of common cardiovascular risk factors.
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Affiliation(s)
- Michele Barone
- 1Gastroenterology Unit, Department of Medical and Surgical Science, University of Foggia, OO. RR. Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Maria Teresa Viggiani
- 2Gastroenterology Unit, Department of Emergency and Organ Transplantation, Ospedale Policlinico, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Annabianca Amoruso
- 1Gastroenterology Unit, Department of Medical and Surgical Science, University of Foggia, OO. RR. Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Serafina Schiraldi
- 2Gastroenterology Unit, Department of Emergency and Organ Transplantation, Ospedale Policlinico, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Annapaola Zito
- 3Cardiology Unit, Department of Emergency and Organ Transplantation, Ospedale Policlinico, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Fiorella Devito
- 3Cardiology Unit, Department of Emergency and Organ Transplantation, Ospedale Policlinico, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Francesca Cortese
- 3Cardiology Unit, Department of Emergency and Organ Transplantation, Ospedale Policlinico, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Michele Gesualdo
- 3Cardiology Unit, Department of Emergency and Organ Transplantation, Ospedale Policlinico, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Natale Brunetti
- 4Cardiology Unit, Department of Medical and Surgical Science, University of Foggia, OO. RR. Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Alfredo Di Leo
- 2Gastroenterology Unit, Department of Emergency and Organ Transplantation, Ospedale Policlinico, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Pietro Scicchitano
- 3Cardiology Unit, Department of Emergency and Organ Transplantation, Ospedale Policlinico, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
- *Pietro Scicchitano:
| | - Marco Matteo Ciccone
- 3Cardiology Unit, Department of Emergency and Organ Transplantation, Ospedale Policlinico, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
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Barone M, Scavo MP, Licinio R, Piombino M, De Tullio N, Mallamaci R, Di Leo A. Role of Bone Marrow-Derived Stem Cells in Polyps Development in Mice with Apc(Min/+) Mutation. Stem Cells Int 2015; 2015:354193. [PMID: 26167184 PMCID: PMC4488009 DOI: 10.1155/2015/354193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/30/2015] [Indexed: 02/07/2023] Open
Abstract
We explored the hypothesis that an altered microenvironment (intestinal adenomatous polyp) could modify the differentiation program of bone marrow-derived stem cells (BMSCs), involving them in colon carcinogenesis. Sublethally irradiated 8-week-old female Apc(Min/+) mice were transplanted with bone marrow (BM) cells obtained from either male age-matched Apc(Min/+) (Apc-Tx-Apc) or wild type (WT) (WT-Tx-Apc) mice. At 4 and 7 weeks after transplantation, BM-derived colonocytes were recognized by colocalization of Y-chromosome and Cdx2 protein (specific colonocyte marker). Polyp number, volume, and grade of dysplasia were not influenced by irradiation/transplantation procedures since they were similar in both untreated female Apc(Min/+) and Apc-Tx-Apc mice. At 4 and 7 weeks after transplantation, a progressive significant reduction of polyp number and volume was observed in WT-Tx-Apc mice. Moreover, the number of WT-Tx-Apc mice with a high-grade dysplastic polyps significantly decreased as compared to Apc-Tx-Apc mice. Finally, at 4 and 7 weeks after transplantation, WT-Tx-Apc mice showed a progressive significant increase of Y+/Cdx2+ cells in "normal" mucosa, whereas, in the adenomatous tissue, Y+/Cdx2+ cells remained substantially unvaried. Our findings demonstrate that WT BMSCs do not participate in polyp development but rather inhibit their growth. The substitution of genotypically altered colonocytes with Y+/Cdx2+ cells probably contributes to this process.
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Affiliation(s)
- Michele Barone
- 1Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Maria Principia Scavo
- 1Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
- 2Methodist Research Institute, 6670 Bertner Avenue, Houston, TX 77030, USA
| | - Raffaele Licinio
- 1Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Michele Piombino
- 3Radiotherapy Unit, Diagnostic Imaging Department, Polyclinic Hospital, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Nicola De Tullio
- 1Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Rosanna Mallamaci
- 4Department of Bioscience, Biotechnology and Biopharmaceutics, University of Bari, Via E. Orabona 4, 70124 Bari, Italy
| | - Alfredo Di Leo
- 1Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
- *Alfredo Di Leo:
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Facciorusso A, Amoruso A, Neve V, Antonino M, Prete VD, Barone M. Role of vaptans in the management of hydroelectrolytic imbalance in liver cirrhosis. World J Hepatol 2014; 6:793-799. [PMID: 25429317 PMCID: PMC4243153 DOI: 10.4254/wjh.v6.i11.793] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/08/2014] [Accepted: 10/10/2014] [Indexed: 02/06/2023] Open
Abstract
Ascites and hyponatremia are the most common complications in patients with liver cirrhosis and develop as a consequence of a severe impairment of liver function and portal hypertension. Increasing evidences support the central role of renal function alterations in the pathogenesis of hydroelectrolytic imbalances in cirrhotic patients, thus implying a dense cross-talk between liver and kidney in the systemic and splanchnic vascular homeostasis in such subjects. Since Arginin Vasopressin (AVP) hyperincretion occurs at late stage of cirrhosis and plays an important role in the development of refractory ascites, dilutional hyponatremia and finally hepato-renal syndrome, selective antagonists of AVP receptors V2 (vaptans) have been recently introduced in the therapeutic algorithm of advanced cirrhotic patients. Despite the promising results of earlier phase-two studies, randomized controlled trials failed to find significant results in terms of efficacy of such drugs both in refractory ascites and hyponatremia. Moreover, concerns on their safety profile arise, due to the number of potentially severe side effects of vaptans in the clinical setting, such as hypernatremia, dehydration, renal impairment, and osmotic demyelination syndrome. More robust data from randomized controlled trials are needed in order to confirm the potential role of vaptans in the management of advanced cirrhotic patients.
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97
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Barone M, Viggiani MT, Amoruso A, Licinio R, Iannone A, Montenegro L, Scavo MP, Addante I, Di Leo A. Influence of age and type of underlying disease on complications related to home enteral nutrition: a single Italian center experience. JPEN J Parenter Enteral Nutr 2014; 38:991-5. [PMID: 23934935 DOI: 10.1177/0148607113498422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND No data about the influence of age and underlying diseases on home enteral nutrition (HEN)-related complications are reported in the literature. Herein, we retrospectively investigated this issue by analyzing HEN-related complications in a cohort of consecutive patients grouped according to the underlying disease and age. MATERIAL AND METHODS We reviewed the medical records of 101 patients referring to our team in 2007-2010 to obtain patients' demographic data, age, nutrition status, duration of HEN treatment, and type of HEN-related complications. They were divided in cancer and neurologic patients and subgrouped on the basis of their age. HEN-related complications were expressed as complication rates. RESULTS Patients with neurological diseases suffered a significantly higher number of complications as compared with cancer patients (P = .04). Age did not significantly influence complication rates. The mechanical complications were the most frequent. The majority of HEN-related complications were resolved at home. CONCLUSION Our data strongly suggest that HEN-related complications are influenced by underlying diseases and not by age. In neurologic patients, dementia, loss of autonomy, and the different therapies administered by PEG probably play an important role in increasing the number of HEN-related complications as compared with cancer patients. The most frequent complications can be managed at home, reducing the costs of hospitalizations and discomfort for the patient.
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Affiliation(s)
- Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Teresa Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Annabianca Amoruso
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Raffaele Licinio
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Andrea Iannone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Lucia Montenegro
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Principia Scavo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Irene Addante
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Facciorusso A, Del Prete V, Antonino M, Crucinio N, Neve V, Di Leo A, Carr BI, Barone M. Post-recurrence survival in hepatocellular carcinoma after percutaneous radiofrequency ablation. Dig Liver Dis 2014; 46:1014-9. [PMID: 25085684 DOI: 10.1016/j.dld.2014.07.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/05/2014] [Accepted: 07/12/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Overall survival in hepatocellular carcinoma patients treated with percutaneous radiofrequency ablation is influenced by both recurrence and successive treatments. We investigated post-recurrence survival after radiofrequency ablation. METHODS Data on 103 early/intermediate patients initially treated with radiofrequency ablation and followed for a median of 78 months (range 68-82) were retrospectively analysed. If intrahepatic disease recurrence occurred within or contiguous to the previously treated area it was defined as local, otherwise as distant; recurrence classified as Barcelona Clinic Liver Cancer stage C was defined by neoplastic portal vein thrombosis or metastases. RESULTS A total of 103 patients were included (82.5% male; median age 70 years, range 39-86). During follow-up, 64 recurrences were observed. Median overall survival was 62 months (95% confidence interval: 54-78) and survival rates were 97%, 65% and 52% at 1, 4 and 5 years, respectively. Median post-recurrence survival was 22 months (95% confidence interval: 16-35). Child-Pugh score, performance status, sum of tumour diameters at recurrence and recurrence patterns were independent predictors of post-recurrence survival. CONCLUSIONS In patients with hepatocellular carcinoma after radiofrequency ablation, clinical and tumour parameters assessed at relapse, in particular the type of recurrence pattern, influence post-recurrence survival.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| | - Valentina Del Prete
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Matteo Antonino
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Nicola Crucinio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Viviana Neve
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Brian I Carr
- Laboratory of Biochemistry and Tumour Biology, National Institute for Digestive Diseases, IRCCS 'Saverio de Bellis', Castellana Grotte, BA, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
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Facciorusso A, Del Prete V, Antonino M, Neve V, Crucinio N, Di Leo A, Carr BI, Barone M. Serum ferritin as a new prognostic factor in hepatocellular carcinoma patients treated with radiofrequency ablation. J Gastroenterol Hepatol 2014; 29:1905-10. [PMID: 24731153 DOI: 10.1111/jgh.12618] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Hepatic iron accumulation is considered to be a cofactor that influences liver injury and hepatocarcinogenesis. Aim of this study is to determine whether serum ferritin (SF) levels relate to overall survival (OS) and time to recurrence (TTR) in hepatocellular carcinoma (HCC) patients treated with percutaneous radiofrequency ablation (RFA). METHODS We measured SF levels in 103 HCC patients (median age 70, M/F = 82.5%/17.5%) who underwent RFA between 2005 and 2010. Correlation between SF and other prognostic factors at baseline was analyzed. SF levels were entered into a Cox model and their influence on OS and TTR was evaluated in univariate and multivariate analyses. RESULTS SF did not correlate with α-fetoprotein (rho: -0.12, P = 0.22), neutrophil/lymphocyte ratio (rho: -0.1020, P = 0.30), Model for End-Stage Liver Disease (rho: 0.18, P = 0.06), Child-Pugh score (P = 0.5), or Barcelona Cancer of the Liver Clinic stage (P = 0.16). A log-rank test found the value of 244 ng/mL as the optimal prognostic cut-off point for SF. Median OS was 62 months (54-78) and survival rate was 97%, 65%, and 52% at 1, 4, and 5 years, respectively. Performance status and SF were the only predictors of OS at multivariate analysis. Median TTR was 38 months (34-49) with a recurrence-free survival rate of 82.5%, 26.2%, and 23.3% at 1, 4, and 5 years, respectively, while SF and age were the only predictors of TTR. CONCLUSIONS SF level, possibly reflecting the degree of hepatic inflammation and fibrosis, is a negative risk factor for survival and recurrence after percutaneous RFA in HCC patients.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Ospedali Riuniti Foggia, Italy
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Palmieri O, Ippolito AM, Margaglione M, Valvano MR, Gioffreda D, Fasano M, D'Andrea G, Corritore G, Milella M, Andriulli N, Morisco F, Giannitrapani L, Latiano A, Fontana R, Gatti P, Tundo P, Barone M, Cozzolongo R, Santantonio T, Andriulli A. Variation in genes encoding for interferon λ-3 and λ-4 in the prediction of HCV-1 treatment-induced viral clearance. Liver Int 2014; 34:1369-77. [PMID: 25283962 DOI: 10.1111/liv.12411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/16/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS In patients with chronic HCV-1 infection, recent evidences indicate that determination of a dinucleotide polymorphism (ss469415590, ΔG/TT) of a new gene, designated IFN λ-4, might be more accurate than the 12979860CC type of the IL28B locus in predicting sustained virological response (SVR) following peg-interferon and ribavirin. In addition, combined genotyping of different SNPs of the IL28B locus was shown to help dissect patients most prone to SVR among those with rs12979860CT. We examined whether single or combined genotyping of two IL28B SNPs, rs12979860 and rs8099917, and ss469415590 variation might improve the prediction of SVR. RESULTS In the study cohort of 539 patients, 38% had SVR. The SNPs 12979860CC, rs8099917TT, and rs469415590TT/TT correlated significantly with SVR (68%, 50%, and 67%). Carriers of either the triplotype rs12979860CC_ss469415590TT/TT_rs8099917TT or the diplotype rs12979860CC_ss469415590TT/TT had the highest SVR rate (72%). In carriers of the rs12979860 T allele, neither the rs8099917 nor the ss469415590 improved the response prediction. After pooling this finding with data from previous studies, in rs12979860 T heterozygous individuals the co-presence of the rs8099917TT SNP was associated with improved response prediction. CONCLUSION In HCV-1 patients, the rs12979860 polymorphism appeared as the hit SNP better predicting response following peg-interferon and ribavirin treatment. Additional ss469415590 or rs8099917 genotyping had no added benefit for response prediction. In the subset of carriers of the rs12979860 T allele, genotyping of the rs8099917 SNP was unhelpful in the present investigation, but may inform clinical prediction of treatment response when our data were pooled with previous investigations.
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Affiliation(s)
- Orazio Palmieri
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
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