151
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Affiliation(s)
- Rocío Ferreiro-Iglesias
- Gastroenterology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal.,Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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152
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Domènech E, Panés J, Hinojosa J, Annese V, Magro F, Sturniolo GC, Bossa F, Fernández F, González-Conde B, García-Sánchez V, Dignass A, Herrera JM, Cabriada JL, Guardiola J, Vecchi M, Portela F, Ginard D. Addition of Granulocyte/Monocyte Apheresis to Oral Prednisone for Steroid-dependent Ulcerative Colitis: A Randomized Multicentre Clinical Trial. J Crohns Colitis 2018; 12:687-694. [PMID: 29490024 DOI: 10.1093/ecco-jcc/jjy023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/26/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Steroid-dependency occurs in up to 30% of patients with ulcerative colitis [UC]. In this setting, few drugs have demonstrated efficacy in inducing steroid-free remission. The aim of this study was to evaluate the efficacy and safety of adding granulocyte/monocyte apheresis [GMA] to oral prednisone in patients with steroid-dependent UC. METHODS This was a randomized, multicentre, open trial comparing 7 weekly sessions of GMA plus oral prednisone [40 mg/day and tapering] with prednisone alone, in patients with active, steroid-dependent UC [Mayo score 4-10 and inability to withdraw corticosteroids in 3 months or relapse within the first 3 months after discontinuation]. Patients were stratified by concomitant use of thiopurines at inclusion. A 9-week tapering schedule of prednisone was pre-established in both study groups. The primary endpoint was steroid-free remission [defined as a total Mayo score ≤2, with no subscore >1] at Week 24, with no re-introduction of corticosteroids. RESULTS In all 123 patients were included [63 GMA group, 62 prednisone alone]. In the intention-to-treat analysis, steroid-free remission at Week 24 was achieved in 13% (95% confidence interval [CI] 6-24) in the GMA group and 7% [95% CI 2-16] in the control group [p = 0.11]. In the GMA group, time to relapse was significantly longer (hazard ratio [HR] 1.7 [1.16-2.48], P = 0.005) and steroid-related adverse events were significantly lower [6% vs 20%, P < 0.05]. CONCLUSIONS In a randomized trial, the addition of 7 weekly sessions of GMA to a conventional course of oral prednisone did not increase the proportion of steroid-free remissions in patients with active steroid-dependent UC, though it delayed clinical relapse.
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Affiliation(s)
- Eugeni Domènech
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain, and CIBEREHD, Madrid, Spain
| | - Julián Panés
- Hospital Clínic, Barcelona, Spain and CIBEREHD, Madrid, Spain
| | | | | | - Fernando Magro
- Unit of Pharmacology and Therapeutics, Faculty of Medicine; MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | | | | | | | | | - Valle García-Sánchez
- Hospital Universitario Reina Sofía amd IMIBIC, Córdoba, Spain, and CIBEREHD, Madrid, Spain
| | - Axel Dignass
- Charité-Campus Virchow Klinikum, Berlin, Germany
| | | | | | - Jordi Guardiola
- Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Spain
| | - Maurizio Vecchi
- Department of Biomedical Science for the Health, University of Milan, and IRCCS Policlinico San Donato, Milano, Italy
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153
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Lopes S, Andrade P, Afonso J, Cunha R, Rodrigues-Pinto E, Ramos I, Macedo G, Magro F. Monitoring Crohn's disease activity: endoscopy, fecal markers and computed tomography enterography. Therap Adv Gastroenterol 2018; 11:1756284818769075. [PMID: 29760785 PMCID: PMC5946585 DOI: 10.1177/1756284818769075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/19/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The treatment goal of Crohn's disease (CD) has moved towards achieving mucosal healing, resolution of transmural inflammation, and normalization of biomarkers. The purpose of this study was to evaluate how well computed tomography enterography (CTE) and fecal calprotectin (FC) correlated with endoscopic activity in newly diagnosed patients with CD and after 1 year of therapy. METHODS Consecutive patients with newly diagnosed CD were evaluated by endoscopy, CTE, and FC at diagnosis and 12 months after beginning immunosuppression. Endoscopic severity was assessed using the Simplified Endoscopic Score for Crohn's Disease (SES-CD). Biomarkers, clinical indexes, and FC were recorded on the day of ileocolonoscopy at diagnosis and 1 year after diagnosis. We adapted a CTE score for disease activity based on radiological signs of inflammation (i.e. mural thickness, mural hyperenhancement, mesenteric fat proliferation, mesenteric fat densification, comb sign, presence of strictures, fistulas, abscesses, ascites, and lymphadenopathy). Correlations between endoscopy, CTE, and FC were assessed using Spearman's rank correlation. RESULTS A total of 29 patients (48% women; median age 30 (24.5-35.5) years) were included in this prospective cohort. CTE findings significantly correlated with endoscopic findings. Endoscopic remission (ER) at 1-year follow up significantly correlated with improvement in mural hyperenhancement (p = 0.004), mesenteric fat densification (p = 0.001), comb sign (p = 0.004), and strictures (p = 0.008) in CTE. None of the CTE findings improved in patients without ER. FC correlated with SES-CD (rs = 0.696, p < 0.001) and with CTE features of inflammation (rs = 0.596, p < 0.001). A cut-off of 100 µg/g predicted ER with 92% sensitivity, 65% specificity, and 83% accuracy (area under curve 0.878, p < 0.001). CONCLUSIONS CTE findings and FC levels correlated with endoscopic activity in CD both at diagnosis and at 1-year follow up. These two noninvasive markers of disease activity may be used as an alternative to endoscopy to monitor disease response to therapy.
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Affiliation(s)
| | - Patrícia Andrade
- Gastroenterology Department, University of
Porto, Centro Hospitalar São João, Porto, Portugal
| | - Joana Afonso
- Department of Pharmacology and Therapeutics,
University of Porto, Porto, Portugal
| | - Rui Cunha
- Radiology Department, University of Porto,
Centro Hospitalar São João, Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, University of
Porto, Centro Hospitalar São João, Porto, Portugal
| | - Isabel Ramos
- Radiology Department, University of Porto,
Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, University of
Porto, Centro Hospitalar São João, Porto, Portugal
| | - Fernando Magro
- Gastroenterology Department, Centro Hospitalar
São João, Porto, Portugal Department of Pharmacology and Therapeutics,
University of Porto, Porto, Portugal
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154
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Magro F, Sousa HT. Editorial: ulcerative colitis submucosal fibrosis and inflammation: more than just strictures. Aliment Pharmacol Ther 2018. [PMID: 29512912 DOI: 10.1111/apt.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- F Magro
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - H T Sousa
- Department of Gastroenterology, Centro Hospitalar e Universitário do Algarve - PortimãoUnit, Portimão, Portugal.,Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.,ABC - Algarve Biomedical Centre, University of Algarve, Faro, Portugal
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155
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Miehlke S, Acosta MBD, Bouma G, Carpio D, Magro F, Moreels T, Probert C. Oral budesonide in gastrointestinal and liver disease: A practical guide for the clinician. J Gastroenterol Hepatol 2018; 33:1574-1581. [PMID: 29603368 DOI: 10.1111/jgh.14151] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/26/2018] [Accepted: 03/17/2018] [Indexed: 01/10/2023]
Abstract
Oral budesonide is a second-generation steroid that allows local, selective treatment of the gastrointestinal tract and the liver, minimizing systemic exposure. The results of randomized trials comparing budesonide versus placebo or active comparators have led to expert recommendations that budesonide be used to treat mild or moderate active ileocecal Crohn's disease, microscopic colitis (including both collagenous and lymphocytic colitis), ulcerative colitis, and non-cirrhotic autoimmune hepatitis. The mechanism of budesonide action obviates the need for dose tapering due to safety reasons after induction therapy. Where low-dose budesonide is used to maintain remission, usually in microscopic colitis, it does not appear to have adverse safety implications other than slight reductions in cortisol levels on rare occasions. As a gut-selective and liver-selective corticosteroid, budesonide offers an appealing alternative to conventional systemic glucocorticoids in diseases of these organs.
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Affiliation(s)
- Stephan Miehlke
- Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany
| | - Manuel Barreiro-de Acosta
- Intestinal Inflammatory Disease Unit, Department of Gastroenterology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gerd Bouma
- Department of Gastroenterology, Vrije University Medical Center, Amsterdam, The Netherlands
| | - Daniel Carpio
- Digestive System Service, University Hospital of Pontevedra Complex, Pontevedra, Spain
| | - Fernando Magro
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Tom Moreels
- Hepato-Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Chris Probert
- Department of Gastroenterology, Institute of Translational Medicine, Liverpool, UK
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156
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Vide J, Osório F, Costa-Silva M, Lopes S, Azevedo F, Camila Dias C, Magina S, Magro F. Cutaneous Morbidity Among Inflammatory Bowel Disease Patients: A Cohort Study. J Crohns Colitis 2018; 12:442-451. [PMID: 29300856 DOI: 10.1093/ecco-jcc/jjx178] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/27/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel diseases are prone to cutaneous manifestations. The aim of this study was to investigate their prevalence, type and association to demographic and clinical factors. METHODS This was a cross-sectional study. Information relative to patients of a central Portuguese hospital with a definitive diagnosis of an inflammatory bowel disease, who were prospectively recruited, was collected. RESULTS The final cohort included 342 patients, 62% of whom had Crohn's disease and 38% had ulcerative colitis. Cutaneous extraintestinal manifestations were present in 44.4% of all patients; this prevalence was lower [14.9%] when excluding cutaneous manifestations secondary to nutrition deficiency or drugs. These skin lesions were classified as granulomatous [0.3%], reactive [4.4%], immunologically associated [10.5%] and secondary to nutritional deficiencies [6.4%] or to bowel-related therapy [29.5%]. Excluding those secondary to nutrition or drugs, cutaneous manifestations were significantly associated with females (odds ratio [OR] 3.210 [1.625-6.340], p = 0.001) and younger patients (OR 0.954 [0.924-0.985], p = 0.004). Additionally, their occurrence was related to patients up to 16 years (OR 13.875 [1.332-144.484], p = 0.028) among the Crohn's disease sub-cohort, whereas in the ulcerative colitis sub-cohort they were more likely to occur in patients with extensive colitis (OR 5.317 [1.552-18.214], p = 0.008). CONCLUSIONS Nearly half of the patients analysed had at least one cutaneous extraintestinal manifestation. The fact that certain lesions tend to be more common among patients with defined characteristics should alert the physicians and allow an early diagnosis and, when pertinent, a reference to dermatology.
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Affiliation(s)
- Júlia Vide
- Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Filipa Osório
- Department of Community Medicine Health Information and Decision, Faculty of Medicine of Porto University, Porto, Portugal
| | - Miguel Costa-Silva
- Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Sofia Lopes
- Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Filomena Azevedo
- Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine Health Information and Decision, Faculty of Medicine of Porto University, Porto, Portugal
| | - Sofia Magina
- Department of Biomedicine, Faculty of Medicine of Porto University, Porto, Portugal.,Department of Pharmacology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Fernando Magro
- Department of Biomedicine, Faculty of Medicine of Porto University, Porto, Portugal.,Department of Pharmacology, Faculty of Medicine of Porto University, Porto, Portugal.,Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
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157
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Chaparro M, Verreth A, Lobaton T, Gravito-Soares E, Julsgaard M, Savarino E, Magro F, Biron AI, Lopez-Serrano P, Casanova MJ, Gompertz M, Vitor S, Arroyo M, Pugliese D, Zabana Y, Vicente R, Aguas M, Shitrit BGA, Gutierrez A, Doherty GA, Fernandez-Salazar L, Cadilla MJ, Huguet JM, OʼToole A, Stasi E, Marcos MN, Villoria A, Karmiris K, Rahier JF, Rodriguez C, Palomares DLM, Fiorino G, Benitez JM, Principi M, Naftali T, Taxonera C, Mantzaris G, Sebkova L, Iade B, Lissner D, Bradley FI, Roman LSA, Marin-Jimenez I, Merino O, Sierra M, Van Domselaar M, Caprioli F, Guerra I, Peixe P, Piqueras M, Rodriguez-Lago I, Ber Y, van Hoeve K, Torres P, Gravito-Soares M, Rudbeck-Resdal D, Bartolo O, Peixoto A, Martin G, Armuzzi A, Garre A, Donday MG, de Carpi MFJ, Gisbert JP. Long-Term Safety of In Utero Exposure to Anti-TNFα Drugs for the Treatment of Inflammatory Bowel Disease: Results from the Multicenter European TEDDY Study. Am J Gastroenterol 2018; 113:396-403. [PMID: 29460920 DOI: 10.1038/ajg.2017.501] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 11/26/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The long-term safety of exposure to anti-tumor necrosis factor (anti-TNFα) drugs during pregnancy has received little attention. We aimed to compare the relative risk of severe infections in children of mothers with inflammatory bowel disease (IBD) who were exposed to anti-TNFα drugs in utero with that of children who were not exposed to the drugs. METHODS Retrospective multicenter cohort study. Exposed cohort: children from mothers with IBD receiving anti-TNFα medication (with or without thiopurines) at any time during pregnancy or during the 3 months before conception. Non-exposed cohort: children from mothers with IBD not treated with anti-TNFα agents or thiopurines at any time during pregnancy or the 3 months before conception. The cumulative incidence of severe infections after birth was estimated using Kaplan-Meier curves, which were compared using the log-rank test. Cox-regression analysis was performed to identify potential predictive factors for severe infections in the offspring. RESULTS The study population comprised 841 children, of whom 388 (46%) had been exposed to anti-TNFα agents. Median follow-up after delivery was 47 months in the exposed group and 68 months in the non-exposed group. Both univariate and multivariate analysis showed the incidence rate of severe infections to be similar in non-exposed and exposed children (1.6% vs. 2.8% per person-year, hazard ratio 1.2 (95% confidence interval 0.8-1.8)). In the multivariate analysis, preterm delivery was the only variable associated with a higher risk of severe infection (2.5% (1.5-4.3)). CONCLUSIONS In utero exposure to anti-TNFα drugs does not seem to be associated with increased short-term or long-term risk of severe infections in children.
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Affiliation(s)
- M Chaparro
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - A Verreth
- Department of Gastroenterology and Department of Pediatric Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - T Lobaton
- Hospital Universitari Germans Trias i Pujol and CIBEREHD, Badalona, Spain
| | | | - M Julsgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - F Magro
- Centro Hospitalar São João, Porto, Portugal
| | - Avni I Biron
- Gastroenterology Devision, Rabin Medical Center, Petach Tikva, Israel
| | | | - M J Casanova
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - M Gompertz
- Hospital Clinic and CIBEREHD, Barcelona, Spain
| | - S Vitor
- Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - M Arroyo
- Hospital Clinico Universitario Lozano Blesa, IIS Aragon, CIBEREHD, Zaragoza, Spain
| | - D Pugliese
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Roma, Italy
| | - Y Zabana
- Hospital Universitari Mutua de Terrassa and CIBEREHD, Terrassa, Spain
| | - R Vicente
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Aguas
- Hospital Universitario La Fe and CIBEREHD, Valencia, Spain
| | | | - A Gutierrez
- Hospital General Universitario de Alicante and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Alicante, Spain
| | - G A Doherty
- St. Vincents University Hospital, Dublin, Ireland
| | | | | | - J M Huguet
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | - E Stasi
- IRCCS Saverio de Bellis, Castellana Grotte, Italy
| | | | - A Villoria
- Hospital Universitari Parc Taulí.Institut d'Investigació i Innovació Parc Taulí. Departament de Medicina, Universitat Autònoma de Barcelona.CIBERehd, Instituto de Salud Carlos III, Sabadell, Spain
| | - K Karmiris
- Venizeleio General Hospital, Heraklion, Greece
| | | | - C Rodriguez
- Complejo Universitario de Navarra, Pamplona, Spain
| | | | - G Fiorino
- IBD Center, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy and Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - J M Benitez
- Hospital Universitario Reina Sofia and IMIBIC, Córdoba, Spain
| | - M Principi
- Azienda Policlinico Ospedaliero-Universitaria di Bari, Bari, Italy
| | - T Naftali
- Meir Hospital Kfar saba Tel Aviv University, Tel Aviv, Israel
| | - C Taxonera
- Hospital Clínico San Carlos and IdISSC, Madrid, Spain
| | - G Mantzaris
- Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens, Greece
| | - L Sebkova
- Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - B Iade
- Hospital de Clinicas, Montevideo, Uruguay
| | - D Lissner
- Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | | | - I Marin-Jimenez
- Hospital General Universitario Gregorio Marañón and IiSGM, Madrid, Spain
| | - O Merino
- Hospital Universitario de Cruces, Baracaldo, Spain
| | - M Sierra
- Complejo Universitario de León, León, Spain
| | | | - F Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano AND Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - I Guerra
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - P Peixe
- Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - M Piqueras
- Consorci Sanitari de Terrasa, Terrasa, Spain
| | | | - Y Ber
- Hospital San Jorge, Huesca, Spain
| | - K van Hoeve
- Department of Paediatrics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - P Torres
- Hospital Universitari Germans Trias i Pujol and CIBEREHD, Badalona, Spain
| | | | - D Rudbeck-Resdal
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - A Peixoto
- Centro Hospitalar São João, Porto, Portugal
| | - G Martin
- Gastroenterology Devision, Rabin Medical Center, Petach Tikva, Israel
| | - A Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Roma, Italy
| | - A Garre
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - M G Donday
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - J P Gisbert
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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158
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Pita I, Magro F. Advanced imaging techniques for small bowel Crohn's disease: what does the future hold? Therap Adv Gastroenterol 2018; 11:1756283X18757185. [PMID: 29467827 PMCID: PMC5813850 DOI: 10.1177/1756283x18757185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/03/2018] [Indexed: 02/04/2023] Open
Abstract
Treatment of Crohn's disease (CD) is intrinsically reliant on imaging techniques, due to the preponderance of small bowel disease and its transmural pattern of inflammation. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the most widely employed imaging methods and have excellent diagnostic accuracy in most instances. Some limitations persist, perhaps the most clinically relevant being the distinction between inflammatory and fibrotic strictures. In this regard, several methodologies have recently been tested in animal models and human patients, namely US strain elastography, shear wave elastography, contrast-enhanced US, magnetization transfer MRI and contrast dynamics in standard MRI. Technical advances in each of the imaging methods may expand their indications. The addition of oral contrast to abdominal US appears to substantially improve its diagnostic capabilities compared to standard US. Ionizing dose-reduction methods in CT can decrease concern about cumulative radiation exposure in CD patients and diffusion-weighted MRI may reduce the need for gadolinium contrast. Clinical indexes of disease activity and severity are also increasingly relying on imaging scores, such as the recently developed Lémann Index. In this review we summarize some of the recent advances in small bowel CD imaging and how they might affect clinical practice in the near future.
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Affiliation(s)
- Inês Pita
- Department of Gastroenterology, Portuguese Institute of Oncology, Porto, Portugal
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159
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Lopes S, Andrade P, Cunha R, Magro F. Transmural healing in Crohn's disease: Beyond mural findings. Dig Liver Dis 2018; 50:103-104. [PMID: 29089271 DOI: 10.1016/j.dld.2017.09.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/14/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Susana Lopes
- Gastroenterology Department, Faculty of Medicine, University of Porto, Centro Hospitalar São João, Porto, Portugal.
| | - Patricia Andrade
- Gastroenterology Department, Faculty of Medicine, University of Porto, Centro Hospitalar São João, Porto, Portugal
| | - Rui Cunha
- Radiology Department, Faculty of Medicine, University of Porto, Centro Hospitalar São João, Porto, Portugal
| | - Fernando Magro
- Gastroenterology Department, Faculty of Medicine, University of Porto, Centro Hospitalar São João, Porto, Portugal
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160
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Lopes S, Rodrigues-Pinto E, Andrade P, Afonso J, Baron TH, Magro F, Macedo G. Endoscopic balloon dilation of Crohn’s disease strictures-safety, efficacy and clinical impact. World J Gastroenterol 2017; 23:7397-7406. [PMID: 29151693 PMCID: PMC5685845 DOI: 10.3748/wjg.v23.i41.7397] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the incidence of anastomotic strictures after intestinal resection in Crohn’s disease (CD), demonstrate long-term efficacy and safety of endoscopic balloon dilation (EBD) in CD strictures and its impact on the diagnosis of subclinical postoperative endoscopic recurrence.
METHODS Retrospective single tertiary center study based on prospectively collected data between 2010 and 2015 including anastomotic and non-anastomotic strictures.
RESULTS 29% of 162 CD patients included developed an anastomotic stricture. 43 patients with anastomotic strictures and 37 with non-anastomotic strictures underwent EBD; technical success was 97.7% and 100%, respectively, however, 63% and 41% needed repeat dilation during the 4.4-year follow-up. Longer periods between surgery and index colonoscopy and higher lactoferrin levels were associated with the presence of stricture after surgery. Calprotectin levels > 83.35 μg/g and current or past history of smoking were associated with a shorter time until need for dilation (HR = 3.877, 95%CI: 1.480-10.152 and HR = 3.041, 95%CI: 1.213-7.627). Anastomotic strictures had a greater need for repeat dilation (63% vs 41%, P = 0.047). No differences were found between asymptomatic and symptomatic cohorts. Disease recurrence diagnosis was only possible after EBD in a third of patients.
CONCLUSION EBD is an effective and safe alternative to surgery, with a good short and long-term outcome, postponing or even avoiding further surgery. EBD may allow to diagnose disease recurrence in patients with no clinical signs/biomarkers of disease activity.
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Affiliation(s)
- Susana Lopes
- Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto 4200-319, Portugal
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto 4200-319, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto 4200-319, Portugal
| | - Joana Afonso
- Department of Pharmacology and Therapeutics, University of Porto, Porto 4200-319, Portugal
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC 4200, United States
| | - Fernando Magro
- Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto 4200-319, Portugal
- Department of Pharmacology and Therapeutics, University of Porto, Porto 4200-319, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto 4200-319, Portugal
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161
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Estevinho MM, Afonso J, Rosa I, Lago P, Trindade E, Correia L, Dias CC, Magro F. A Systematic Review and Meta-Analysis of 6-Thioguanine Nucleotide Levels and Clinical Remission in Inflammatory Bowel Disease. J Crohns Colitis 2017; 11:1381-1392. [PMID: 28981590 DOI: 10.1093/ecco-jcc/jjx089] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Thiopurines are widely used in the management of inflammatory bowel diseases. However, their minimum effective dose and dose-response relationship remain undefined, and evidence about their use in clinical practice is mostly heterogeneous. This systematic review and meta-analysis aimed: i] to assess the clinical value of 6-thioguanine nucleotide thresholds; and ii] to compare mean 6-thioguanine nucleotide concentrations between patients in clinical remission vs. those with active disease. METHODS A systematic literature search was carried out using four databases. Statistical heterogeneity was assessed with the I2 statistic followed by subgroup and sensitivity analyses. Odds ratios were computed using the random-effects model. RESULTS A total of 1384 records were identified in the systematic search, of which 25 were retained for further analysis: 22 were used in the cut-off comparisons and 12 were used in the 6-thioguanine nucleotide mean differences analysis. The global odds ratio for remission in patients with 6-thioguanine nucleotide levels above the predefined thresholds was 3.95 (95% confidence interval [CI], 2.63-5.94; p < 0.001]. When considering the different thresholds individually, the odd ratios were significant for values above 235 pmol/8 × 108 and 250 pmol/8 × 108 red blood cells [2.25 and 4.71, respectively]. Mean 6-thioguanine nucleotide levels were higher among patients in clinical remission, with a pooled difference of 63.37 pmol/8 × 108 red blood cells [95% CI, 31.81-94.93; p < 0.001]. CONCLUSIONS This study reinforces the link between 6-thioguanine nucleotide levels and clinical remission in inflammatory bowel diseases, also exploring the validity of specific 6-thioguanine nucleotide thresholds to predict clinical outcomes.
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Affiliation(s)
- Maria Manuela Estevinho
- Department of Pharmacology and Therapeutics, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Joana Afonso
- Department of Pharmacology and Therapeutics, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Isadora Rosa
- Gastroenterology Department, Instituto Portugue^s de Oncologia de Lisboa, Lisboa, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Eunice Trindade
- Department of Pediatrics, Centro Hospitalar São João, Porto, Portugal
| | - Luís Correia
- Department of Gastroenterology and Hepatology, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal, and Centre for Health Technology and Services Research, Porto, Portugal
| | - Fernando Magro
- Department of Pharmacology and Therapeutics, Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
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162
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Burisch J, Vegh Z, Katsanos KH, Christodoulou DK, Lazar D, Goldis A, O'Morain C, Fernandez A, Pereira S, Myers S, Sebastian S, Pedersen N, Olse J, Rubek Nielsen K, Schwartz D, Odes S, Almer S, Halfvarson J, Turk N, Cukovic-Cavka S, Nikulina I, Belousova E, Duricova D, Bortlik M, Shonová O, Salupere R, Barros L, Magro F, Jonaitis L, Kupcinskas L, Turcan S, Kaimakliotis I, Ladefoged K, Kudsk K, Andersen V, Vind I, Thorsgaard N, Oksanen P, Collin P, Dal Piaz G, Santini A, Niewiadomski O, Bell S, Moum B, Arebi N, Kjeldsen J, Carlsen K, Langholz E, Lakatos PL, Munkholm P, Gerdes LU, Dahlerup JF. Occurrence of Anaemia in the First Year of Inflammatory Bowel Disease in a European Population-based Inception Cohort-An ECCO-EpiCom Study. J Crohns Colitis 2017; 11:1213-1222. [PMID: 28575481 DOI: 10.1093/ecco-jcc/jjx077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/25/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Anaemia is an important complication of inflammatory bowel disease [IBD]. The aim of this study was to determine the prevalence of anaemia and the practice of anaemia screening during the first year following diagnosis, in a European prospective population-based inception cohort. METHODS Newly diagnosed IBD patients were included and followed prospectively for 1 year in 29 European and one Australian centre. Clinical data including demographics, medical therapy, surgery and blood samples were collected. Anaemia was defined according to the World Health Organization criteria. RESULTS A total of 1871 patients (Crohn's disease [CD]: 686, 88%; ulcerative colitis [UC]: 1,021, 87%; IBD unclassified [IBDU] 164. 81%) were included in the study. The prevalence of anaemia was higher in CD than in UC patients and, overall, 49% of CD and 39% of UC patients experienced at least one instance of anaemia during the first 12 months after diagnosis. UC patients with more extensive disease and those from Eastern European countries, and CD patients with penetrating disease or colonic disease location, had higher risks of anaemia. CD and UC patients in need of none or only mild anti-inflammatory treatment had a lower risk of anaemia. In a significant proportion of patients, anaemia was not assessed until several months after diagnosis, and in almost half of all cases of anaemia a thorough work-up was not performed. CONCLUSIONS Overall, 42% of patients had at least one instance of anaemia during the first year following diagnosis. Most patients were assessed for anaemia regularly; however, a full anaemia work-up was frequently neglected in this community setting.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Konstantinnos H Katsanos
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - Dimitrios K Christodoulou
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - Daniela Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Colm O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | | | - Santos Pereira
- Department of Gastroenterology. Instituto de Investigación Sanitaria Galicia Sur, Estrutura Organizativa de Xestión Integrada de Vigo, Vigo, Spain
| | - Sally Myers
- IBD Unit, Hull & East Yorkshire NHS Trust, Hull, UK
| | | | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jóngerð Olse
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Kári Rubek Nielsen
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Selwyn Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Sven Almer
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Niksa Turk
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb,Zagreb, Croatia
| | - Silvja Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb,Zagreb, Croatia
| | - Inna Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Dana Duricova
- IBD Clinical and Research Centre ISCARE, Charles University, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre ISCARE, Charles University, Prague, Czech Republic.,Institute of Pharmacology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Olga Shonová
- Gastroenterology Department, Hospital Ceské Budejovice, Ceské Budejovice, Czech Republic
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital,Tartu, Estonia
| | - Louisa Barros
- Department of Medicine, Hospital de Vale de Sousa, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Hospital de São João, Porto, Portugal.,Institute of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal.,Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - Laimas Jonaitis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | | | - Karin Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - Karen Kudsk
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Vibeke Andersen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Laboratory Center, Hospital of Southern Jutland, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ida Vind
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Niels Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Giulia Dal Piaz
- Dipartimento Medicina Specialistica Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni - Pierantoni, Forlì, Italy
| | | | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Sally Bell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Naila Arebi
- St Mark's Hospital, Imperial College London, London, UK
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Katrine Carlsen
- Department of Pediatrics, Hvidovre University Hospital,Hvidovre, Denmark
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev Univerisity Hospital, Herlev, Denmark
| | | | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | | | - Jens Frederik Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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163
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Abreu C, Afonso J, Camila Dias C, Ruas R, Sarmento A, Magro F. Serial Tuberculosis Screening in Inflammatory Bowel Disease Patients Receiving Anti-TNFα Therapy. J Crohns Colitis 2017; 11:1223-1229. [PMID: 28605520 DOI: 10.1093/ecco-jcc/jjx080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/03/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS One of the adverse effects of the tumour necrosis factor alpha [[TNFα] monoclonal antibodies for the treatment of immune-mediated inflammatory diseases is a higher propensity for tuberculosis development. The aim of this study was to explore the utility and sensitivity of serial tuberculosis screening during anti-TNFα treatment. METHODS A cohort of 46 inflammatory bowel disease patients receiving infliximab was prospectively recruited and followed for 26 months. During this period of time, a tuberculosis skin test and two different interferon ϒ release assays [QFT-GIT and T-SPOT.TB] were applied at 4-6-month intervals. RESULTS Overall, 16 patients were diagnosed with latent tuberculosis infection after having at least one test conversion: 12 patients had a positive tuberculosis skin test, seven patients had a positive T-SPOT.TB, and two patients had a positive QFT-GIT. Active tuberculosis was excluded in all; 15 were treated with isoniazid. A comparison between tests showed a moderate accuracy [72% to 85%] but low kappa values [0.063 to 0.377]. Concerning association with demographic and clinical characteristics, test conversion was more common among the male gender and those with a longer disease duration. CONCLUSIONS Tuberculosis tests conversions were common in inflammatory bowel disease patients treated with infliximab alone or in association with immunomodulators. In these immunosuppressed individuals, the classical tuberculosis skin test seems to have a higher sensitivity than the modern tests based on the release of interferonϒ.
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Affiliation(s)
- Cândida Abreu
- Infectious Diseases Service, Centro Hospitalar São João, Porto, Portugal
- I3s, I&D, INEB, Department of Medicine, University of Porto, Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, University of Porto, Porto, Portugal
- Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, University of Porto, Porto, Portugal
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
| | - Rogério Ruas
- Infectious Diseases Service, Centro Hospitalar São João, Porto, Portugal
- I3s, I&D, INEB, Department of Medicine, University of Porto, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Service, Centro Hospitalar São João, Porto, Portugal
- I3s, I&D, INEB, Department of Medicine, University of Porto, Porto, Portugal
| | - Fernando Magro
- Department of Biomedicine, University of Porto, Porto, Portugal
- Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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164
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Magalhães D, Soares-da-Silva P, Magro F. The effect of PRR ligands on the membrane potential of intestinal epithelial cells. Pharmacol Rep 2017; 69:978-984. [DOI: 10.1016/j.pharep.2017.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 02/07/2023]
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165
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Lopes S, Andrade P, Rodrigues-Pinto E, Afonso J, Macedo G, Magro F. Fecal marker levels as predictors of need for endoscopic balloon dilation in Crohn’s disease patients with anastomotic strictures. World J Gastroenterol 2017; 23:6482-6490. [PMID: 29085198 PMCID: PMC5643274 DOI: 10.3748/wjg.v23.i35.6482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/22/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the accuracy and best cut-off value of fecal calprotectin (FC) and fecal lactoferrin (FL) to predict disease recurrence in asymptomatic patients presenting with anastomotic strictures.
METHODS This was a longitudinal single tertiary center study based on prospectively collected data (recorded in a clinical database created for this purpose) performed between March 2010 and November 2014. Crohn’s disease (CD) patients with anastomotic stricture who submitted to postoperative endoscopic evaluation were included. Stools were collected on the day before bowel cleaning for FC and FL. Endoscopic balloon dilation (EBD) was performed if the patient presented an anastomotic stricture not traversed by the colonoscope, regardless of patients’ symptoms. Successful dilation was defined as passage of the colonoscope through the dilated stricture into the neotermimal ileum. Postoperative recurrence was defined as a modified Rutgeerts score of ≥ i2b.
RESULTS In a total of 178 patients who underwent colonoscopy, 58 presented an anastomotic stricture, 86% were asymptomatic, and 48 (54% male; median age of 46.5 years) were successfully dilated. Immediate success rate was 92% and no complications were recorded. FC and FL levels correlated significantly with endoscopic recurrence (P < 0.001) with an optimal cut-off value of 90.85 µg/g (sensitivity of 95.5%, specificity of 69.2%, positive predictive value (PPV) of 72.4%, negative predictive value (NPV) of 94.7% and accuracy of 81%] for FC and of 5.6 µg/g (sensitivity of 77.3%, specificity of 69.2%, PPV of 68%, NPV of 78.4% and accuracy of 72.9%) for FL.
CONCLUSION Fecal markers are good predictors of CD endoscopic recurrence in patients with asymptomatic anastomotic stricture. FC and FL may guide the need for EBD in this context.
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Affiliation(s)
- Susana Lopes
- Gastroenterology Department, Faculty of Medicine, Hospital de São João, 4200-319 Porto, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Faculty of Medicine, Hospital de São João, 4200-319 Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Faculty of Medicine, Hospital de São João, 4200-319 Porto, Portugal
| | - Joana Afonso
- Department of Pharmacology and Therapeutics, University of Porto, 4200-319 Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Hospital de São João, 4200-319 Porto, Portugal
| | - Fernando Magro
- Gastroenterology Department, Faculty of Medicine, Hospital de São João, 4200-319 Porto, Portugal
- Department of Pharmacology and Therapeutics, University of Porto, 4200-319 Porto, Portugal
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166
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Magro F, Afonso J, Lopes S, Coelho R, Gonçalves R, Caldeira P, Lago P, de Sousa HT, Ramos J, Gonçalves AR, Ministro P, Rosa I, Meira T, Andrade P, Soares JB, Carvalho D, Sousa P, Vieira AI, Lopes J, Dias CC, Geboes K, Carneiro F. Clinical performance of an infliximab rapid quantification assay. Therap Adv Gastroenterol 2017; 10:651-660. [PMID: 28932267 PMCID: PMC5598812 DOI: 10.1177/1756283x17722916] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/02/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Therapeutic drug monitoring (TDM)-based algorithms can be used to guide infliximab (IFX) adjustments in inflammatory bowel disease (IBD) patients. This study aimed to explore a rapid IFX-quantification test from a clinical perspective. METHODS This manuscript describes a prospective cohort study involving 110 ulcerative colitis (UC) patients on the maintenance phase of IFX. IFX trough levels were quantified using a rapid quantification assay and a commonly-used reference kit. RESULTS Irrespective of the assay used to measure IFX, its through levels were statistically different between patients with and without endoscopic remission (Mayo endoscopic score = 0), as well as between patients stratified by their faecal calprotectin (FC) levels. Despite the fact that the two methods correlated well with each other [Spearman's rank correlation coefficient = 0.843, p < 0.001; intraclass correlation coefficients = 0.857, 95% confidence interval (CI): 0.791-0.903], there was a discernible systematic variation; values obtained with the reference kit were on average 2.62 units higher than those obtained with the rapid assay. Notwithstanding, 3 µg/ml was shown to be an acceptable cut-off to assess endoscopic status and inflammatory burden levels using both assays. The percentage of patients that had a positive outcome when the IFX concentration measured by the rapid assay ranked above 3 µg/ml was 88% both for a Mayo endoscopic score ⩽ 1 and for an FC concentration <250 µg/g. CONCLUSIONS Based on this study, we concluded that using the rapid IFX assessment system with a 3 µg/ml threshold is a reliable alternative to the time-consuming enzyme-linked immunosorbent assays in patients on the maintenance phase of IFX.
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Affiliation(s)
| | - Joana Afonso
- Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Susana Lopes
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Paulo Caldeira
- Gastroenterology Department, Centro Hospitalar do Algarve, Faro, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Helena Tavares de Sousa
- Gastroenterology Department, Centro Hospitalar do Algarve, Portimão, Portugal Department of Medical Biosciences and Medicine, University of Algarve, Faro, Portugal,Algarve Biomedical Centre (ABC), University of Algarve, Portugal
| | - Jaime Ramos
- Gastroenterology Department, Centro Hospitalar de Lisboa, Lisboa, Portugal
| | - Ana Rita Gonçalves
- Gastroenterology Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Paula Ministro
- Gastroenterology Department, Hospital de S. Teotónio, Viseu, Portugal
| | - Isadora Rosa
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Tânia Meira
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Diana Carvalho
- Gastroenterology Department, Centro Hospitalar de Lisboa, Lisboa, Portugal
| | - Paula Sousa
- Gastroenterology Department, Hospital de S. Teotónio, Viseu, Portugal
| | - Ana Isabel Vieira
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Joanne Lopes
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Portugal,CINTESIS, Centre for Health Technology and Services Research, Porto, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Fátima Carneiro
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal,Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], Porto, Portugal
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167
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Estevinho MM, Afonso J, Rosa I, Lago P, Trindade E, Correia L, Dias CC, Magro F. Levels of 6-thioguanine nucleotides and clinical remission in inflammatory bowel disease - A systematic review and meta-analysis: PS083. Porto Biomed J 2017; 2:198-199. [PMID: 32258666 DOI: 10.1016/j.pbj.2017.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- M M Estevinho
- Department of Pharmacology and Therapeutics, Faculty of Medicine of the University of Porto, Portugal
| | - J Afonso
- Department of Pharmacology and Therapeutics, Faculty of Medicine of the University of Porto, Portugal
| | - I Rosa
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - P Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - E Trindade
- Department of Pediatrics, Centro Hospitalar São João, Porto, Portugal
| | - L Correia
- Department of Gastroenterology and Hepatology, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - C C Dias
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine of the University of Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - F Magro
- Department of Pharmacology and Therapeutics, Faculty of Medicine of the University of Porto, Portugal.,Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
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168
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Afonso J, de Sousa HT, Rosa I, Carvalho J, Dias CC, Magro F. Therapeutic drug monitoring of CT-P13: a comparison of four different immunoassays. Therap Adv Gastroenterol 2017; 10:661-671. [PMID: 28932268 PMCID: PMC5598811 DOI: 10.1177/1756283x17722915] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/01/2017] [Accepted: 06/15/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The commercialization of CT-P13, an infliximab (IFX) biosimilar, has the potential to decrease health-related costs and enhance access to biological therapies. This study aimed to address the accuracy and inter-assay agreement of the CT-P13 quantification using four different assays initially developed to assess IFX. METHODS The four different methods, one in-house method and three commercially available kits, were used to quantify exogenously-spiked samples and the sera from 185 inflammatory bowel disease (IBD) patients on CT-P13 therapy. RESULTS The quantification of the spiked samples unveiled a consistent and accurate behaviour of three of the tested methods, with average percentage recoveries of 90%, 102% and 109%. Results from the clinical samples demonstrated that these three assays were also highly correlated, both concerning Spearman's rank coefficients (range 0.890-0.947) and intraclass correlation coefficients (range 0.907-0.935). There were a few systematic deviations among them, but their impact in the clinical stratification of the patients using different cut-offs was minimal, particularly when these cut-offs were in the 3-4 µg/ml range, for which the strength of agreement (as assessed by the Kappa statistics that ranged from 0.732 to 0.902) was substantial to almost perfect. CONCLUSIONS Our results indicate that three of the tested IFX quantification methods can be used to accurately quantify CT-P13 without any adjustments.
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Affiliation(s)
- Joana Afonso
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, 4200 Porto, Portugal
| | - Helena Tavares de Sousa
- Gastroenterology Department, Algarve Hospital Centre, Portugal,Biomedical Sciences and Medicine Department, University of Algarve, Portugal,ABC (Algarve Biomedical Centre), University of Algarve, Portugal
| | - Isadora Rosa
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - João Carvalho
- Department of Gastroenterology and Hepatology, Centro Hospitalar de Gaia, Gaia, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences,Faculty of Medicine of the University of Porto, Portugal,CINTESIS, Centre for Health Technology and Services Research, Porto, Portugal
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Kopylov U, Papamichael K, Katsanos K, Waterman M, Bar-Gil Shitrit A, Boysen T, Portela F, Peixoto A, Szilagyi A, Silva M, Maconi G, Har-Noy O, Bossuyt P, Mantzaris G, Barreiro de Acosta M, Chaparro M, Christodoulou DK, Eliakim R, Rahier JF, Magro F, Drobne D, Ferrante M, Sonnenberg E, Siegmund B, Muls V, Thurm T, Yanai H, Dotan I, Raine T, Levin A, Israeli E, Ghalim F, Carbonnel F, Vermeire S, Ben-Horin S, Roblin X. Impact of Infliximab and Cyclosporine on the Risk of Colectomy in Hospitalized Patients with Ulcerative Colitis Complicated by Cytomegalovirus-A Multicenter Retrospective Study. Inflamm Bowel Dis 2017; 23:1605-1613. [PMID: 28590343 DOI: 10.1097/mib.0000000000001160] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is frequently detected in patients with ulcerative colitis (UC). The impact of CMV infection on the outcome of UC exacerbation remains unclear. The benefit of combining antiviral with anti-inflammatory treatment has not been evaluated yet. The aim of this study was to compare the outcome of CMV-positive hospitalized patients with UC treated with antiviral therapy either alone or combined with salvage anti-inflammatory therapy (infliximab [IFX] or cyclosporine A [CsA]). METHODS This was a multicenter retrospective study of hospitalized CMV-positive patients with UC. The patients were classified into 2 groups: antiviral-if treated with antivirals alone; combined-if treated with both antiviral and anti-inflammatory therapy. The outcomes included the rate of colectomy in both arms during the course of hospitalization and after 3/12 months. RESULTS A total of 110 patients were included; 47 (42.7%) patients did not receive IFX nor CsA; 36 (32.7%) received IFX during hospitalization or within 1 month before hospitalization; 20 (18.1%) patients received CsA during hospitalization; 7 (6.4%) were exposed to both IFX and CsA. The rate of colectomy was 14.5% at 30 days, 20.0% at 3 months, and 34.8% at 12 months. Colectomy rates were similar across treatment groups. No clinical and demographic variables were independently associated with the risk of colectomy. CONCLUSIONS IFX or cyclosporine therapy is not associated with additional risk for colectomy over antiviral therapy alone in hospitalized CMV-positive patients with UC.
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Affiliation(s)
- Uri Kopylov
- 1Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 2Department of Gastroenterology, Evaggelismos Hospital, Athens, Greece; 3Department of Clinical and Experimental Medicine, KU Leuven, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium; 4Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece; 5Department of Gastroenterology, Rambam Health Care Campus, B. Rappaport Faculty of Medicine, the Technion, Haifa, Israel; 6Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem, Israel; 7Department of Gastroenterology, Herlev University Hospital, Herlev, Denmark; 8Department of Gastroenterology, Hospital Universidade Coimbra, Coimbra, Portugal; 9Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal; 10Department of Gastroenterology, Jewish General Hospital, Montreal, Québec, Canada; 11Department of Gastroenterology, Luigi Sacco' University Hospital, Milan, Italy; 12Department of Gastroenterology, Imelda GI Clinical Research Center, Bonheiden, Belgium; 13IBD Unit, Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; 14Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain; 15Department of Gastroenterology, CHU Dinant Godinne, UCL Namur, Yvoir, Belgium; 16Department of Gastroenterology, University Medical Centre Ljubljana, Slovenia; 17Department of Medicine (Gastroenterology, Infectious Diseases, Rheumatology), Charité-Universitätsmedizin Berlin, Berlin, Germany; 18Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; 19Department of Gastroenterology and Liver Diseases, IBD Center, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; 20Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom; 21Department of Gastroenterology, Hadassah Medical Center, Jerusalem, Israel; 22Service de Gastroentérologie, Hôpital Universitaire de Bicêtre, Université Paris Sud, Assistance Publique-Hôpitaux de Paris, le Kremlin Bicêtre, Paris, France; and 23Department of Gastroenterology, CHU de Saint-Etienne, Saint Etiennne, France
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Lemos V, de Oliveira RM, Naia L, Szegö É, Ramos E, Pinho S, Magro F, Cavadas C, Rego AC, Costa V, Outeiro TF, Gomes P. The NAD+-dependent deacetylase SIRT2 attenuates oxidative stress and mitochondrial dysfunction and improves insulin sensitivity in hepatocytes. Hum Mol Genet 2017; 26:4105-4117. [DOI: 10.1093/hmg/ddx298] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/23/2017] [Indexed: 01/11/2023] Open
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Magro F, Afonso J, Lopes S, Coelho R, Gonçalves R, Caldeira P, Lago P, de Sousa HT, Ramos J, Gonçalves AR, Ministro P, Rosa I, Vieira AI, Andrade P, Soares JB, Carvalho D, Sousa P, Meira T, Lopes J, Moleiro J, Dias CC, Falcão A, Geboes K, Carneiro F. Calprotectin and the Magnitude of Antibodies to Infliximab in Clinically-stable Ulcerative Colitis Patients are More Relevant Than Infliximab Trough Levels and Pharmacokinetics for Therapeutic Escalation. EBioMedicine 2017; 21:123-130. [PMID: 28629912 PMCID: PMC5514398 DOI: 10.1016/j.ebiom.2017.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/23/2017] [Accepted: 06/03/2017] [Indexed: 01/01/2023] Open
Abstract
Although infliximab (IFX) is an efficient therapy for ulcerative colitis (UC) patients, a considerably high rate of therapeutic failures still occurs. This study aimed at a better understanding of IFX pharmacokinetics and pharmacodynamics among clinically-asymptomatic UC patients. This was a multicentric and prospective study involving 65 UC patients in the maintenance phase of IFX therapy. There were no significant differences between patients with positive and negative clinical, endoscopic and histological outcomes concerning their IFX trough levels (TLs), area under the IFX concentration vs. time curve (AUC), clearance and antibodies to infliximab (ATI) levels. However, the need to undergo therapeutic escalation later in disease development was significantly associated with higher ATI levels (2.62μg/mL vs. 1.15μg/mL, p=0.028). Moreover, and after adjusting for disease severity, the HR (hazard ratio) for therapeutic escalation was significantly decreased for patients with an ATI concentration below 3μg/mL (HR=0.119, p=0.010), and increased for patients with fecal calprotectin (FC) level above 250μg/g (HR=9.309, p=0.018). In clinically-stable UC patients, IFX pharmacokinetic features cannot predict therapeutic response on a short-term basis. However, high levels of ATIs or FC may be indicative of a future therapeutic escalation.
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Affiliation(s)
- Fernando Magro
- Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, 4200 Porto, Portugal; Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.
| | - Joana Afonso
- MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, 4200 Porto, Portugal
| | - Susana Lopes
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Paulo Caldeira
- Gastroenterology Department, Centro Hospitalar do Algarve, Faro, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Helena Tavares de Sousa
- Gastroenterology Department, Centro Hospitalar do Algarve, Portimão, Portugal; Biomedical Sciences and Medicine Department, University of Algarve, Faro, Portugal; ABC-Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Jaime Ramos
- Gastroenterology Department, Centro Hospitalar de Lisboa, Lisboa, Portugal
| | - Ana Rita Gonçalves
- Gastroenterology Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Paula Ministro
- Gastroenterology Department, Hospital de S. Teotónio, Viseu, Portugal
| | - Isadora Rosa
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Ana Isabel Vieira
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Diana Carvalho
- Gastroenterology Department, Centro Hospitalar de Lisboa, Lisboa, Portugal
| | - Paula Sousa
- Gastroenterology Department, Hospital de S. Teotónio, Viseu, Portugal
| | - Tânia Meira
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Joanne Lopes
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Joana Moleiro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Amílcar Falcão
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; CNC - Centre for Neuroscience and Cellular Biology, Coimbra, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Fatima Carneiro
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal; Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], University of Porto, Porto, Portugal
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Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, Burisch J, Gecse KB, Hart AL, Hindryckx P, Langner C, Limdi JK, Pellino G, Zagórowicz E, Raine T, Harbord M, Rieder F. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis 2017; 11:649-670. [PMID: 28158501 DOI: 10.1093/ecco-jcc/jjx008] [Citation(s) in RCA: 1094] [Impact Index Per Article: 156.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/01/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Fernando Magro
- Department of Pharmacology and Therapeutics, University of Porto; MedInUP, Centre for Drug Discovery and Innovative Medicines; Centro Hospitalar São João, Porto, Portugal
| | | | - Rami Eliakim
- Department of Gastroenterology and Hepatology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Sandro Ardizzone
- Gastrointestinal Unit ASST Fatebenefratelli Sacco-University of Milan-Milan, Italy
| | - Alessandro Armuzzi
- IBD Unit Complesso Integrato Columbus, Gastroenterological and Endocrino-Metabolical Sciences Department, Fondazione Policlinico Universitario Gemelli Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Manuel Barreiro-de Acosta
- Department of Gastroenterology, IBD Unit, University Hospital Santiago De Compostela (CHUS), A Coruña, Spain
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Krisztina B Gecse
- First Department of Medicine, Semmelweis University, Budapest,Hungary
| | | | - Pieter Hindryckx
- Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
| | - Cord Langner
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust; Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Gianluca Pellino
- Unit of General Surgery, Second University of Naples,Napoli, Italy
| | - Edyta Zagórowicz
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Department of Oncological Gastroenterology Warsaw; Medical Centre for Postgraduate Education, Department of Gastroenterology, Hepatology and Clinical Oncology, Warsaw, Poland
| | - Tim Raine
- Department of Medicine, University of Cambridge, Cambridge,UK
| | - Marcus Harbord
- Imperial College London; Chelsea and Westminster Hospital, London,UK
| | - Florian Rieder
- Department of Pathobiology /NC22, Lerner Research Institute; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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173
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Dias CC, Rodrigues PP, Coelho R, Santos PM, Fernandes S, Lago P, Caetano C, Rodrigues Â, Portela F, Oliveira A, Ministro P, Cancela E, Vieira AI, Barosa R, Cotter J, Carvalho P, Cremers I, Trabulo D, Caldeira P, Antunes A, Rosa I, Moleiro J, Peixe P, Herculano R, Gonçalves R, Gonçalves B, Sousa HT, Contente L, Morna H, Lopes S, Magro F. Erratum: Development and Validation of Risk Matrices for Crohn's Disease Outcomes in Patients Who Underwent Early Therapeutic Interventions. J Crohns Colitis 2017; 11:515. [PMID: 27927719 DOI: 10.1093/ecco-jcc/jjw207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Cláudia Camila Dias
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Pedro Pereira Rodrigues
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Hospital São João, Porto, Portugal
| | - Paula Moura Santos
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Samuel Fernandes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Cidalina Caetano
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Ângela Rodrigues
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Francisco Portela
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Oliveira
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela e Viseu, Portugal
| | - Eugénia Cancela
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela e Viseu, Portugal
| | - Ana Isabel Vieira
- Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal
| | - Rita Barosa
- Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Pedro Carvalho
- Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Isabelle Cremers
- Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital São Bernardo, Setúbal, Portugal
| | - Daniel Trabulo
- Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital São Bernardo, Setúbal, Portugal
| | - Paulo Caldeira
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.,Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Artur Antunes
- Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Isadora Rosa
- Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Joana Moleiro
- Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Paula Peixe
- Gastroenterology Department, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal
| | - Rita Herculano
- Gastroenterology Department, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal
| | | | - Bruno Gonçalves
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Helena Tavares Sousa
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.,Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Luís Contente
- Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Henrique Morna
- Gastroenterology Department, Hospital Nélio Mendonça, Funchal, Portugal
| | - Susana Lopes
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fernando Magro
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,Institute of Pharmacology and Therapeutics Faculty of Medicine of the University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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Dias CC, Rodrigues PP, Coelho R, Santos PM, Fernandes S, Lago P, Caetano C, Rodrigues Â, Portela F, Oliveira A, Ministro P, Cancela E, Vieira AI, Barosa R, Cotter J, Carvalho P, Cremers I, Trabulo D, Caldeira P, Antunes A, Rosa I, Moleiro J, Peixe P, Herculano R, Gonçalves R, Gonçalves B, Sousa HT, Contente L, Morna H, Lopes S, Magro F. Development and Validation of Risk Matrices for Crohn's Disease Outcomes in Patients Who Underwent Early Therapeutic Interventions. J Crohns Colitis 2017; 11:445-453. [PMID: 27683799 DOI: 10.1093/ecco-jcc/jjw171] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/22/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The establishment of prognostic models for Crohn's disease [CD] is highly desirable, as they have the potential to guide physicians in the decision-making process concerning therapeutic choices, thus improving patients' health and quality of life. Our aim was to derive models for disabling CD and reoperation based solely on clinical/demographic data. METHODS A multicentric and retrospectively enrolled cohort of CD patients, subject to early surgery or immunosuppression, was analysed in order to build Bayesian network models and risk matrices. The final results were validated internally and with a multicentric and prospectively enrolled cohort. RESULTS The derivation cohort included a total of 489 CD patients [64% with disabling disease and 18% who needed reoperation], while the validation cohort included 129 CD patients with similar outcome proportions. The Bayesian models achieved an area under the curve of 78% for disabling disease and 86% for reoperation. Age at diagnosis, perianal disease, disease aggressiveness and early therapeutic decisions were found to be significant factors, and were used to construct user-friendly matrices depicting the probability of each outcome in patients with various combinations of these factors. The matrices exhibit good performance for the most important criteria: disabling disease positive post-test odds = 8.00 [2.72-23.44] and reoperation negative post-test odds = 0.02 [0.00-0.11]. CONCLUSIONS Clinical and demographical risk factors for disabling CD and reoperation were determined and their impact was quantified by means of risk matrices, which are applicable as bedside clinical tools that can help physicians during therapeutic decisions in early disease management.
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Affiliation(s)
- Cláudia Camila Dias
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Pedro Pereira Rodrigues
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Hospital São João, Porto, Portugal
| | - Paula Moura Santos
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Samuel Fernandes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Cidalina Caetano
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Ângela Rodrigues
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Francisco Portela
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Oliveira
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela e Viseu, Portugal
| | - Eugénia Cancela
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela e Viseu, Portugal
| | - Ana Isabel Vieira
- Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal
| | - Rita Barosa
- Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Pedro Carvalho
- Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Isabelle Cremers
- Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital São Bernardo, Setúbal, Portugal
| | - Daniel Trabulo
- Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital São Bernardo, Setúbal, Portugal
| | - Paulo Caldeira
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.,Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Artur Antunes
- Gastroenterology Department, Hospital de Faro, Faro, Portugal
| | - Isadora Rosa
- Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Joana Moleiro
- Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Paula Peixe
- Gastroenterology Department, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal
| | - Rita Herculano
- Gastroenterology Department, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal
| | | | - Bruno Gonçalves
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Helena Tavares Sousa
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.,Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Luís Contente
- Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Henrique Morna
- Gastroenterology Department, Hospital Nélio Mendonça, Funchal, Portugal
| | - Susana Lopes
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fernando Magro
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,Institute of Pharmacology and Therapeutics Faculty of Medicine of the University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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Portela F, Dias CC, Caldeira P, Cravo M, Deus J, Gonçalves R, Lago P, Morna H, Peixe P, Ramos J, Sousa H, Tavares L, Vasconcelos H, Magro F, Ministro P. The who-when-why triangle of CAM use among Portuguese IBD patients. Dig Liver Dis 2017; 49:388-396. [PMID: 28117198 DOI: 10.1016/j.dld.2016.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases. AIM This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients. METHODS Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines. RESULTS Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication and periodical examination, respectively. Steroids prescription (OR=2.880) and a higher instruction level (OR=3.669) were predictors of complementary and alternative medicines use in this cohort. CONCLUSIONS Roughly a third of Portuguese IBD patients had used CAM. Steroid treatment and an academic degree are associated with CAM use. Given the potential side effects and interactions, patient information about the benefits and limitations of conventional and complementary treatments should be reinforced.
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Affiliation(s)
- Francisco Portela
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
| | - Camila C Dias
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Paulo Caldeira
- Gastroenterology Department, Centro Hospitalar do Algarve, Portugal
| | - Marilia Cravo
- Serviço de Gastrenterologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Deus
- Serviço de Gastrenterologia, Hospital Fernandes da Fonseca, Amadora, Portugal
| | | | - Paula Lago
- Gastroenterology Department, Centro Hospitalar Porto-Hospital Santo António, Portugal
| | - Henrique Morna
- Serviço de Gastrenterologia, Hospital do Funchal, Funchal, Portugal
| | - Paula Peixe
- Serviço de Gastrenterologia, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Jaime Ramos
- Serviço de Gastrenterologia, Hospital dos Capuchos, Lisboa, Portugal
| | - Helena Sousa
- Gastroenterology Department, Centro Hospitalar do Algarve, Portugal; Biomedical Sciences and Medicine Department, University of Algarve, Portugal
| | - Lurdes Tavares
- Serviço de Gastrenterologia, Hospital de Santa Maria, Lisboa, Portugal
| | | | - Fernando Magro
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal; MedInUP - Centre for Drug Discovery and Innovative Medicines, University of Porto, Portugal
| | - Paula Ministro
- Serviço Gastrenterologia, Centro Hospitalar de Tondela - Viseu, Viseu, Portugal
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Magro F, Lopes S, Coelho R, Cotter J, Dias de Castro F, Tavares de Sousa H, Salgado M, Andrade P, Vieira AI, Figueiredo P, Caldeira P, Sousa A, Duarte MA, Ávila F, Silva J, Moleiro J, Mendes S, Giestas S, Ministro P, Sousa P, Gonçalves R, Gonçalves B, Oliveira A, Chagas C, Torres J, Dias CC, Lopes J, Borralho P, Afonso J, Geboes K, Carneiro F. Accuracy of Faecal Calprotectin and Neutrophil Gelatinase B-associated Lipocalin in Evaluating Subclinical Inflammation in UlceRaTIVE Colitis-the ACERTIVE study. J Crohns Colitis 2017; 11:435-444. [PMID: 27664275 DOI: 10.1093/ecco-jcc/jjw170] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B-associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients. METHODS This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers. RESULTS Macroscopic lesions [i.e. endoscopic Mayo score ≥1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of Severity. Moreover, 21% presented with histological inflammation according to the Geboes index, whereas 15% and 5% presented with focal and diffuse basal plasmacytosis, respectively. The faecal levels of calprotectin and neutrophil gelatinase B-associated lipocalin were statistically higher for patients with endoscopic lesions and histological activity. A receiver operating characteristic-based analysis revealed that both biomarkers were able to indicate mucosal healing and histological remission with an acceptable probability, and cut-off levels of 150-250 μg/g for faecal calprotectin and 12 μg/g for neutrophil gelatinase B-associated lipocalin were proposed. CONCLUSIONS Faecal calprotectin and neutrophil gelatinase B-associated lipocalin levels are a valuable addition for assessment of disease activity in asymptomatic ulcerative colitis patients. Biological levels of the analysed biomarkers below the proposed thresholds can rule out the presence of macroscopic and microscopic lesions with a probability of 75-93%. However, caution should be applied whenever interpreting positive results, as these biomarkers present consistently low positive predictive values.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.,Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Susana Lopes
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - Helena Tavares de Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve - Portimão Unit, Portimão, Portugal.,Departament of Medicine and Medical Biosciences, University of Algarve, Faro, Portugal
| | - Marta Salgado
- Department of Gastroenterology, Centro Hospitalar do Porto, Hospital de Santo António, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Ana Isabel Vieira
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Figueiredo
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Paulo Caldeira
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - A Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - Maria A Duarte
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - Filipa Ávila
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - João Silva
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
| | - Sofia Mendes
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sílvia Giestas
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Raquel Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Bruno Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Ana Oliveira
- Department of Gastroenterology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Cristina Chagas
- Department of Gastroenterology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Joana Torres
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Cláudia Camila Dias
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS, Center for Health Technology and Services Research, Porto, Portugal
| | - Joanne Lopes
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Paula Borralho
- Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joana Afonso
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Fátima Carneiro
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], University of Porto, Porto, Portugal
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Portela F, Lago P, Cotter J, Gonçalves R, Vasconcelos H, Ministro P, Lopes S, Eusébio M, Morna H, Cravo M, Peixe P, Cremmers I, Sousa H, Deus J, Duarte M, Magro F. Anaemia in Patients with Inflammatory Bowel Disease - A Nationwide Cross-Sectional Study. Digestion 2017; 93:214-20. [PMID: 27022722 DOI: 10.1159/000443927] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/08/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anaemia is the most common complication in patients with inflammatory bowel disease (IBD). This study aims to assess the prevalence of anaemia in IBD patients and to know its characteristics with regard to the main IBD clinical features. METHODS An observational cross-sectional multicentre study was conducted. We included all patients who had an appointment at the 15 participating centres during the period of 1 month, and who met the following selection criteria: age ≥18, diagnosis of IBD. Disease activity was evaluated by Harvey-Bradshaw Index (HBI) for Crohn's disease (CD), and by Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC). RESULTS One thousand three hundred and thirteen patients, were included: 54.8% female, mean age 42.8 (interquartile range (25th-75th): 31-53 years), 59% had a diagnosis of CD, 39% of UC and 2% IBD unclassified. The median follow-up since diagnosis was 7 years. The ongoing treatment was aminosalicylates (63.1%), corticosteroids (11.6%), immunomodulators (36.4%) and anti-tumour necrosis factor (27.3%). Anaemia was identified in 244 patients, representing a prevalence of 18.6% (95% CI 16.6-20.9). A majority of cases (90%) have mild/moderate anaemia (mean haemoglobin 11.3 ± 0.8 g/dl). Anaemia was significantly higher in females (p = 0.006), but there were no differences between CDs (19.1%) and UCs (17.7%; p = 0.688). Anaemia was more frequent in patients with active disease (HBI >4; SCCAI >2) than in those in clinical remission (33.6 vs. 15.6%, p < 0.001) and in patients on steroids (36.8%) vs. other treatments (p < 0.001). Only 47% of patients with anaemia were under any specific treatment (oral iron 67%; intravenous iron 41%). CONCLUSION Anaemia was more frequent in patients with active disease and in those on corticosteroids. The treatment of anaemia still seems undervalued, whereas more than half of anaemic patients were not receiving any specific treatment and the use of oral iron prevails contrarily to current recommendations.
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178
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Dias CC, Pereira Rodrigues P, Fernandes S, Portela F, Ministro P, Martins D, Sousa P, Lago P, Rosa I, Correia L, Moura Santos P, Magro F. The risk of disabling, surgery and reoperation in Crohn's disease - A decision tree-based approach to prognosis. PLoS One 2017; 12:e0172165. [PMID: 28225800 PMCID: PMC5321294 DOI: 10.1371/journal.pone.0172165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/17/2017] [Indexed: 01/27/2023] Open
Abstract
Introduction Crohn’s disease (CD) is a chronic inflammatory bowel disease known to carry a high risk of disabling and many times requiring surgical interventions. This article describes a decision-tree based approach that defines the CD patients’ risk or undergoing disabling events, surgical interventions and reoperations, based on clinical and demographic variables. Materials and methods This multicentric study involved 1547 CD patients retrospectively enrolled and divided into two cohorts: a derivation one (80%) and a validation one (20%). Decision trees were built upon applying the CHAIRT algorithm for the selection of variables. Results Three-level decision trees were built for the risk of disabling and reoperation, whereas the risk of surgery was described in a two-level one. A receiver operating characteristic (ROC) analysis was performed, and the area under the curves (AUC) Was higher than 70% for all outcomes. The defined risk cut-off values show usefulness for the assessed outcomes: risk levels above 75% for disabling had an odds test positivity of 4.06 [3.50–4.71], whereas risk levels below 34% and 19% excluded surgery and reoperation with an odds test negativity of 0.15 [0.09–0.25] and 0.50 [0.24–1.01], respectively. Overall, patients with B2 or B3 phenotype had a higher proportion of disabling disease and surgery, while patients with later introduction of pharmacological therapeutic (1 months after initial surgery) had a higher proportion of reoperation. Conclusions The decision-tree based approach used in this study, with demographic and clinical variables, has shown to be a valid and useful approach to depict such risks of disabling, surgery and reoperation.
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Affiliation(s)
- Cláudia Camila Dias
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine of the University of Porto, Porto, Portugal
- CINTESIS – Center for Health Tecnology and Services Research, Porto, Portugal
| | - Pedro Pereira Rodrigues
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine of the University of Porto, Porto, Portugal
- CINTESIS – Center for Health Tecnology and Services Research, Porto, Portugal
| | - Samuel Fernandes
- Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Francisco Portela
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Viseu, Portugal
| | - Diana Martins
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Viseu, Portugal
| | - Paula Sousa
- Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Viseu, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | | | - Luis Correia
- Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Paula Moura Santos
- Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Fernando Magro
- Gastroenterology Department, Hospital São João, Porto, Portugal
- Institute of Pharmacology and Therapeutics Faculty of Medicine of the University of Porto, Porto, Portugal
- MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
- * E-mail:
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Costa Pereira C, Durães C, Coelho R, Grácio D, Silva M, Peixoto A, Lago P, Pereira M, Catarino T, Pinho S, Teixeira JP, Macedo G, Annese V, Magro F. Association between Polymorphisms in Antioxidant Genes and Inflammatory Bowel Disease. PLoS One 2017; 12:e0169102. [PMID: 28052094 PMCID: PMC5215755 DOI: 10.1371/journal.pone.0169102] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 12/14/2022] Open
Abstract
Inflammation is the driving force in inflammatory bowel disease (IBD) and its link to oxidative stress and carcinogenesis has long been accepted. The antioxidant system of the intestinal mucosa in IBD is compromised resulting in increased oxidative injury. This defective antioxidant system may be the result of genetic variants in antioxidant genes, which can represent susceptibility factors for IBD, namely Crohn's disease (CD) and ulcerative colitis (UC). Single nucleotide polymorphisms (SNPs) in the antioxidant genes SOD2 (rs4880) and GPX1 (rs1050450) were genotyped in a Portuguese population comprising 436 Crohn's disease and 367 ulcerative colitis patients, and 434 healthy controls. We found that the AA genotype in GPX1 is associated with ulcerative colitis (OR = 1.93, adjusted P-value = 0.037). Moreover, we found nominal significant associations between SOD2 and Crohn's disease susceptibility and disease subphenotypes but these did not withstand the correction for multiple testing. These findings indicate a possible link between disease phenotypes and antioxidant genes. These results suggest a potential role for antioxidant genes in IBD pathogenesis and should be considered in future association studies.
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Affiliation(s)
- Cristiana Costa Pereira
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Oporto, Portugal
- MedInUP – Centre for Drug Discovery and Innovative Medicines, University of Porto, Oporto, Portugal
- EPIUnit – Institute of Public Health, University of Porto, Oporto, Portugal
| | - Cecília Durães
- Ipatimup – Institute of Molecular Pathology and Immunology of the University of Porto, Oporto, Portugal
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Oporto, Portugal
| | - Rosa Coelho
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Daniela Grácio
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Oporto, Portugal
| | - Marco Silva
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Armando Peixoto
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Paula Lago
- Department of Gastroenterology, HSA – Centro Hospitalar do Porto, Oporto, Portugal
| | - Márcia Pereira
- Ipatimup – Institute of Molecular Pathology and Immunology of the University of Porto, Oporto, Portugal
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Oporto, Portugal
- Institute for the Biomedical Sciences Abel Salazar, University of Porto, Oporto, Portugal
| | - Telmo Catarino
- Ipatimup – Institute of Molecular Pathology and Immunology of the University of Porto, Oporto, Portugal
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Oporto, Portugal
| | - Salomé Pinho
- Ipatimup – Institute of Molecular Pathology and Immunology of the University of Porto, Oporto, Portugal
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Oporto, Portugal
| | - João Paulo Teixeira
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Oporto, Portugal
- EPIUnit – Institute of Public Health, University of Porto, Oporto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Vito Annese
- Emergency Department, Gastroenterology Unit, AOU Careggi, Florence, Italy
| | - Fernando Magro
- MedInUP – Centre for Drug Discovery and Innovative Medicines, University of Porto, Oporto, Portugal
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Oporto, Portugal
- * E-mail:
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181
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Abreu C, Almeida F, Ferraz R, Dias CC, Sarmento A, Magro F. The tuberculin skin test still matters for the screening of latent Tuberculosis infections among Inflammatory Bowel Disease patients. Dig Liver Dis 2016; 48:1438-1443. [PMID: 27599804 DOI: 10.1016/j.dld.2016.08.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS There is a high risk of Tuberculosis among patients medicated with anti-tumour necrosis factor α (anti-TNFα) that can be mitigated by treating latent Tuberculosis infections (LTI). This study aimed to evaluate the performance of Tuberculin Skin test (TST) and Quantiferon-TB Gold in Tube (QFT-GIT) in a population of patients suffering from Inflammatory Bowel Diseases. METHODS The cohort analyzed in this study consisted of 250 patients, of whom 15% were therapy-naïve and 85% were medicated: 70% under immunosuppressive therapy and 30% on anti-TNFα. A LTBI was diagnosed following a positive result in either of the tests and their performance and concordance were evaluated. RESULTS Fifty-eight and 24 patients had a positive TST and QFT-GIT, respectively. In 72 (29%) patients LTBI was diagnosed, of whom 8 (21%) were therapy-naïve. TST had an overall higher sensitivity (81% vs. 35%) and a higher Negative Predictive Value (93% vs. 80%) when compared to QFT-GIT test; this superiority was consistently maintained irrespective of the presence and kind of backbone immunosuppressive therapies. The concordance between both tests was weak. CONCLUSIONS Our results underscore the need to maintain the TST on LTBI diagnosis in patients about to start or switch anti-TNFα therapy in an intermediate Tuberculosis incidence context.
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Affiliation(s)
- Cândida Abreu
- Instituto de Inovação e Investigação em Saúde (I3S), Portugal.
| | | | - Rita Ferraz
- Instituto de Inovação e Investigação em Saúde (I3S), Portugal.
| | | | | | - Fernando Magro
- Instituto Nacional de Engenharia Biomédica (INEB), Portugal.
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182
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Magro F, Lopes SI, Lopes J, Portela F, Cotter J, Lopes S, Moreira MJ, Lago P, Peixe P, Albuquerque A, Rodrigues S, Silva MR, Monteiro P, Lopes C, Monteiro L, Macedo G, Veloso L, Camila C, Afonso J, Geboes K, Carneiro F. Histological Outcomes and Predictive Value of Faecal Markers in Moderately to Severely Active Ulcerative Colitis Patients Receiving Infliximab. J Crohns Colitis 2016; 10:1407-1416. [PMID: 27226417 DOI: 10.1093/ecco-jcc/jjw112] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Histological healing has emerged as a promising therapeutic goal in ulcerative colitis. This is especially important in the context of biological therapies. The objectives of the present study were to investigate the ability of infliximab to induce histological remission in ulcerative colitis [UC] patients and to explore the utility of faecal calprotectin and lactoferrin in predicting histological activity. METHODS Multi-centre, single-cohort, open-label, 52-week trial including moderately to severely biological-naïve UC patients receiving intravenous infliximab [5mg/kg]. The primary outcome was the proportion of patients with histological remission [Geboes index ≤ 3.0] after 8 weeks of treatment, scored by two independent pathologists. RESULTS Twenty patients were included. The rate of histological remission increased from 5% at baseline to 15% and 35% at Week 8 and Week 52, respectively. At Week 8, 40% of patients were in clinical remission [Mayo ≤ 2] and 45% achieved mucosal healing [Mayo endoscopy subscore 0-1]. At Week 52, 25% of patients had clinical, endoscopic and histological remission. Faecal calprotectin and lactoferrin showed the highest correlation with histological activity at Week 8 (area under the curve [AUC] 94%, p = 0.017; and 96%, p = 0.013, respectively) and both markers revealed an excellent positive predictive value for this outcome at this time point [100%, p = 0.017; and 94%, p = 0.013, respectively]. CONCLUSIONS Infliximab was able to induce histological remission. There was a good agreement between histology and faecal biomarkers. Faecal calprotectin and lactoferrin were good predictors of histological remission. Our data support inclusion of histology as a treatment target complementary to endoscopy in clinical trials when evaluating therapeutic response in UC.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal .,Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Susana Isabel Lopes
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Joanne Lopes
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - José Cotter
- Department of Gastroenterology, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Sandra Lopes
- Department of Gastroenterology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Maria João Moreira
- Department of Gastroenterology, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Paula Lago
- Department of Gastroenterology, Centro Hospitalar do Porto, Porto, Portugal
| | - Paula Peixe
- Department of Gastroenterology, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal
| | - Andreia Albuquerque
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Susana Rodrigues
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Mário Rui Silva
- Department of Pathology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Monteiro
- Department of Pathology, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Castro Lopes
- Department of Pathology, Centro Hospitalar do Porto, Porto, Portugal
| | - Lucília Monteiro
- Department of Pathology, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Luís Veloso
- Clinical Data Unit, Eurotrials Scientific Consultants, Lisboa, Portugal
| | - Claudia Camila
- CIDES Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS, Center for Health Technology and Services Research, Porto, Portugal
| | - J Afonso
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Fátima Carneiro
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], University of Porto, Porto, Portugal
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Abstract
BACKGROUND Entero-urinary fistulas (EUF) are observed in only 2-8% of Crohn's disease (CD) patients. AIM To compare the outcome of patients with EUF, after surgical treatment, with those with non-penetrating and non-stenosing, penetrating, and stenosing phenotypes (B1, B2, and B3 phenotypes). METHODS Case-control study of 21 CD patients with EUF submitted to surgical treatment. Each patient with EUF was compared with six patients, two of each group: B1, B2, and B3 phenotypes. They were randomly selected from inflammatory bowel disease database and had the same extent of disease, smoking status, perianal disease, and age at diagnosis. RESULTS One hundred and forty-seven patients were included (n = 21 EUF; n = 42 of each group B1, B2, and B3). Comparing B3 group with EUF, the former was more steroid-dependent and resistant (54.8% versus 19.0%, p = 0.037) and needed anti-TNF therapy more frequently (59.5% versus 23.8%, p = 0.004). Moreover, B3 patients had a poorer response to anti-TNF therapy without remission free of steroid therapy in comparison with EUF patients (45.2% versus 95.2%, p < 0.001). EUF patients did not differ from B2 group regarding anti-TNF therapy (p = 0.956) and steroid-dependence or resistance (p = 0.141). Surgery rate after index surgery was inferior in EUF in comparison with B2 and B3 groups. Hospital admission rate of patients with EUF was also lower than the B3 group. CONCLUSION Early surgery seems to be a good choice for patients with EUF as their response to surgery appears not to differ from B2 patients and had a better prognosis than phenotype B3 patients.
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Affiliation(s)
- Rosa Coelho
- a Gastroenterology Department , Faculty of Medicine, Centro Hospitalar São João , Porto , Portugal
| | - Fernando Magro
- a Gastroenterology Department , Faculty of Medicine, Centro Hospitalar São João , Porto , Portugal ;,b Department of Pharmacology and Therapeutics , Faculty of Medicine, University of Porto , Porto , Portugal ;,c MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto , Porto , Portugal
| | - Marco Silva
- a Gastroenterology Department , Faculty of Medicine, Centro Hospitalar São João , Porto , Portugal
| | - Guilherme Macedo
- a Gastroenterology Department , Faculty of Medicine, Centro Hospitalar São João , Porto , Portugal
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184
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Afonso J, Lopes S, Gonçalves R, Caldeira P, Lago P, Tavares de Sousa H, Ramos J, Gonçalves AR, Ministro P, Rosa I, Vieira AI, Coelho R, Tavares P, Soares J, Sousa AL, Carvalho D, Sousa P, da Silva JP, Meira T, Silva Ferreira F, Dias CC, Chowers Y, Ben-Horin S, Magro F. Detection of anti-infliximab antibodies is impacted by antibody titer, infliximab level and IgG4 antibodies: a systematic comparison of three different assays. Therap Adv Gastroenterol 2016; 9:781-794. [PMID: 27803733 PMCID: PMC5076767 DOI: 10.1177/1756283x16658223] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND There is scant information on the accuracy of different assays used to measure anti-infliximab antibodies (ADAs), especially in the presence of detectable infliximab (IFX). We thus aimed to evaluate and compare three different assays for the detection of IFX and ADAs and to clarify the impact of the presence of circulating IFX on the accuracy of the ADA assays. METHODS Blood samples from 79 ulcerative colitis (UC) patients treated with infliximab were assessed for IFX levels and ADAs using three different assays: an in-house assay and two commercial kits, Immundiagnostik and Theradiag. Sera samples with ADAs and undetectable levels of IFX were spiked with exogenous IFX and analyzed for ADAs. RESULTS The three assays showed 81-96% agreement for the measured IFX level. However, the in-house assay and Immundiagnostik assays detected ADAs in 34 out of 79 samples, whereas Theradiag only detected ADAs in 24 samples. Samples negative for ADAs with Theradiag, but ADA-positive in both the in-house and Immundiagnostik assays, were positive for IFX or IgG4 ADAs. In spiking experiments, a low concentration of exogenous IFX (5 µg/ml) hampered ADA detection with Theradiag in sera samples with ADA levels of between 3 and 10 µg/ml. In the Immundiagnostik assay detection interference was only observed at concentrations of exogenous IFX higher than 30 µg/ml. However, in samples with high levels of ADAs (>25 µg/ml) interference was only observed at IFX concentrations higher than 100 µg/ml in all three assays. Binary (IFX/ADA) stratification of the results showed that IFX+/ADA- and IFX-/ADAs+ were less influenced by the assay results than the double-positive (IFX+/ADAs+) and double-negative (IFX-/ADAs-) combination. CONCLUSIONS All three methodologies are equally suitable for measuring IFX levels. However, erroneous therapeutic decisions may occur when patients show double-negative (IFX-/ADAs-) or double-positive (IFX+/ADAs+) status, since agreement between assays is significantly lower in these circumstances.
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Affiliation(s)
- Joana Afonso
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, 4200 Porto, Portugal
| | - Susana Lopes
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Paulo Caldeira
- Gastroenterology Department, Centro Hospitalar do Algarve, Faro, Portugal
| | - Paula Lago
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Helena Tavares de Sousa
- Gastroenterology Department, Centro Hospitalar do Algarve, Portimão, Portugal Departament of Medicine e Medical Biosciences, University of Algarve, Faro, Portugal
| | - Jaime Ramos
- Gastroenterology Department, Centro Hospitalar de Lisboa, Lisboa, Portugal
| | - Ana Rita Gonçalves
- Gastroenterology Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Paula Ministro
- Gastroenterology Department, Hospital de S. Teotónio, Viseu, Portugal
| | - Isadora Rosa
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Ana Isabel Vieira
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Patrícia Tavares
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - João Soares
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Ana Lúcia Sousa
- Gastroenterology Department, Centro Hospitalar do Algarve, Faro, Portugal
| | - Diana Carvalho
- Gastroenterology Department, Centro Hospitalar de Lisboa, Lisboa, Portugal
| | - Paula Sousa
- Gastroenterology Department, Hospital de S. Teotónio, Viseu, Portugal
| | - João Pereira da Silva
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Tânia Meira
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Filipa Silva Ferreira
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, 4200 Porto, Portugal
| | - Cláudia Camila Dias
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Yehuda Chowers
- Gastroenterology Department, Rambam Health Care Campus and Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Israel
| | - Shomron Ben-Horin
- IBD Service, Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Israel
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185
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Pereira C, Coelho R, Grácio D, Dias C, Silva M, Peixoto A, Lopes P, Costa C, Teixeira JP, Macedo G, Magro F. DNA Damage and Oxidative DNA Damage in Inflammatory Bowel Disease. J Crohns Colitis 2016; 10:1316-1323. [PMID: 27095753 DOI: 10.1093/ecco-jcc/jjw088] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Inflammation has long been regarded as a major contributor to cellular oxidative damage and to be involved in the promotion of carcinogenesis. METHODS We aimed to investigate the oxidative damage in inflammatory bowel disease [IBD] patients through a case-control and prospective study involving 344 IBD patients and 294 healthy controls. DNA damage and oxidative DNA damage were measured by comet assay techniques, and oxidative stress by plasmatic lipid peroxidation, protein carbonyls, and total antioxidant capacity. RESULTS Higher DNA damage [p < 0.001] was found both in Crohn's disease [CD] (9.7 arbitrary units [AU]; interquartile range [IQR]: 6.2-14.0) and ulcerative colitis [UC] [7.1 AU; IQR: 4.4-11.7], when compared with controls [5.4 AU; IQR: 3.8-6.8], and this was also the case with oxidative DNA damage [p < 0.001] [CD: 3.6 AU; IQR: 1.8-6.8; UC: 4.6 AU; IQR: 2.4-8.1], when compared with controls: 2.3 AU; IQR: 1.2-4.2]. Stratifying patients into groups according to therapy (5-aminosalicylic acid [5-ASA], azathioprine, anti-TNF, and combined therapy [azathioprine and anti-TNF]) revealed significant between-group differences in the level of DNA damage, both in CD and UC, with the combined therapy exhibiting the highest DNA damage levels [11.6 AU; IQR: 9.5-14.3, and 12.4 AU; IQR: 10.6-15.0, respectively]. Among CD patients, disease behaviour [B1 and B2], and age at diagnosis over 40 years [A3] stand as risk factors for DNA damage. For UC patients, the risk factors found for DNA damage were disease activity, treatment, age at diagnosis under 40 years [A1 + A2] and disease locations [E2 and E3]. CONCLUSIONS In IBD there is an increase in DNA damage, and treatment, age at diagnosis and inflammatory burden seem to be risk factors.
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Affiliation(s)
- Cristiana Pereira
- National Institute of Health - Environmental Health Department, Oporto, Portugal.,MedInUP - Centre for Drug Discovery and Innovative Medicines, University of Oporto, Oporto, Portugal.,EPIUnit - Institute of Public Health, University of Oporto, Oporto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Daniela Grácio
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Oporto, Portugal
| | - Cláudia Dias
- Health Information and Decision Sciences Department, Faculty of Medicine, University of Oporto, Oporto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Oporto, Portugal
| | - Marco Silva
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Armando Peixoto
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Pedro Lopes
- Department of Internal Medicine, Faculty of Medicine, University of Porto and Centro Hospitalar São João, Porto, Portugal
| | - Carla Costa
- National Institute of Health - Environmental Health Department, Oporto, Portugal.,EPIUnit - Institute of Public Health, University of Oporto, Oporto, Portugal
| | - João Paulo Teixeira
- National Institute of Health - Environmental Health Department, Oporto, Portugal.,EPIUnit - Institute of Public Health, University of Oporto, Oporto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Fernando Magro
- MedInUP - Centre for Drug Discovery and Innovative Medicines, University of Oporto, Oporto, Portugal .,Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal.,Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Oporto, Portugal
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186
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Afonso J, Lopes S, Gonçalves R, Caldeira P, Lago P, Tavares de Sousa H, Ramos J, Gonçalves AR, Ministro P, Rosa I, Vieira AI, Dias CC, Magro F. Proactive therapeutic drug monitoring of infliximab: a comparative study of a new point-of-care quantitative test with two established ELISA assays. Aliment Pharmacol Ther 2016; 44:684-92. [PMID: 27507790 DOI: 10.1111/apt.13757] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/09/2016] [Accepted: 07/18/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Therapeutic drug monitoring is a powerful strategy known to improve the clinical outcomes and to optimise the healthcare resources in the treatment of autoimmune diseases. Currently, most of the methods commercially available for the quantification of infliximab (IFX) are ELISA-based, with a turnaround time of approximately 8 h, and delaying the target dosage adjustment to the following infusion. AIM To validate the first point-of-care IFX quantification device available in the market - the Quantum Blue Infliximab assay (Buhlmann, Schonenbuch, Switzerland) - by comparing it with two well-established methods. METHODS The three methods were used to assay the IFX concentration of spiked samples and of the serum of 299 inflammatory bowel diseases (IBD) patients undergoing IFX therapy. RESULTS The point-of-care assay had an average IFX recovery of 92%, being the most precise among the tested methods. The Intraclass Correlation Coefficients of the point-of-care IFX assay vs. the two ELISA-based established methods were 0.889 and 0.939. Moreover, the accuracy of the point-of-care IFX compared with each of the two reference methods was 77% and 83%, and the kappa statistics revealed a substantial agreement (0.648 and 0.738). CONCLUSIONS The Quantum Blue IFX assay can successfully replace the commonly used ELISA-based IFX quantification kits. This point-of-care IFX assay is able to deliver the results within 15 min makes it ideal for an immediate target concentration adjusted dosing. Moreover, it is a user-friendly desktop device that does not require specific laboratory facilities or highly specialised personnel.
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Affiliation(s)
- J Afonso
- Department of Pharmacology and Therapeutics, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, Porto, Portugal
| | - S Lopes
- Centro Hospitalar São João, Porto, Portugal
| | | | - P Caldeira
- Centro Hospitalar do Algarve, Faro, Portugal
| | - P Lago
- Centro Hospitalar do Porto, Porto, Portugal
| | - H Tavares de Sousa
- Centro Hospitalar do Algarve, Portimão, Portugal.,University of Algarve, Faro, Portugal
| | - J Ramos
- Centro Hospitalar de Lisboa, Lisboa, Portugal
| | | | - P Ministro
- Hospital de S. Teotónio, Viseu, Portugal
| | - I Rosa
- Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - A I Vieira
- Hospital Garcia de Orta, Almada, Portugal
| | - C C Dias
- Health Information and Decision Sciences Department, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research, Porto, Portugal
| | - F Magro
- Department of Pharmacology and Therapeutics, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, Porto, Portugal.,Centro Hospitalar São João, Porto, Portugal
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187
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Fiorino G, Cortes PN, Ellul P, Felice C, Karatzas P, Silva M, Lakatos PL, Bossa F, Ungar B, Sebastian S, Furfaro F, Karmiris K, Katsanos KH, Muscat M, Christodoulou DK, Maconi G, Kopylov U, Magro F, Mantzaris GJ, Armuzzi A, Boscà-Watts MM, Ben-Horin S, Bonovas S, Danese S. Discontinuation of Infliximab in Patients With Ulcerative Colitis Is Associated With Increased Risk of Relapse: A Multinational Retrospective Cohort Study. Clin Gastroenterol Hepatol 2016; 14:1426-1432.e1. [PMID: 27317850 DOI: 10.1016/j.cgh.2016.05.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/15/2016] [Accepted: 05/31/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Infliximab is a safe and effective therapy for ulcerative colitis (UC). We conducted a multicenter retrospective cohort study that included 7 European countries and Israel to examine whether infliximab discontinuation can be considered for patients who achieve sustained remission. METHODS We performed a retrospective cohort study, collecting medical records from 13 tertiary care referral inflammatory bowel disease centers of all patients with UC treated with infliximab (n = 193). We compared the disease course of patients with at least 12 months of clinical remission who discontinued infliximab (n = 111) with that of patients who continued scheduled treatment (controls, n = 82). We examined the incidence rates of relapse, hospitalization and colectomy, the comparative effectiveness of different therapeutic strategies after discontinuation, and assessed the rates of response, remission, and adverse effects after infliximab re-initiation. Statistical analyses used time-to-event methods. RESULTS In the entire cohort, 67 patients (34.7%) relapsed during the follow-up period. The incidence rate of relapse was significantly higher after discontinuation (23.3 per 100 person-years) compared with the control group (7.2 per 100 person-years) in univariable analysis (log-rank P < .001; hazard ratio, 3.41; 95% confidence interval, 1.88-6.20) and multivariable analysis (hazard ratio, 3.70; 95% confidence interval, 2.02-6.77). Rates of hospitalization and colectomy did not differ between groups. Thiopurines appeared to be the best treatment option after infliximab discontinuation (incidence of relapse: 15.0 per 100 person-years for thiopurines, 27.4 per 100 person-years for thiopurines plus aminosalicylates, and 31.2 per 100 person-years for aminosalicylates alone; log-rank P = .032). Response was regained in 77.1% of patients and remission in 51.4% of patients who re-initiated infliximab. However, 17.1% had infusion reactions and 17.1% reported other adverse events. CONCLUSIONS In a multinational retrospective cohort study of patients with UC in sustained clinical remission, we associated discontinuation of infliximab with an increased risk of relapse. Treatment re-initiation is effective and safe.
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Affiliation(s)
- Gionata Fiorino
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Pablo Navarro Cortes
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, University Clinic Hospital, Valencia, Spain
| | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Carla Felice
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Gemelli Hospital Catholic University, Rome, Italy
| | - Pantelis Karatzas
- Department of Gastroenterology, Evangelismos Hospital, Athens, Greece
| | - Marco Silva
- Department of Gastroenterology, Hospital de São João, Porto, Portugal
| | - Peter L Lakatos
- Semmelweiss University, 1st Department of Internal Medicine, Budapest, Hungary
| | - Fabrizio Bossa
- Unità di Gastroenterologia ed Endoscopia Digestiva, Ospedale Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico San Giovanni Rotondo (FG), Italy
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Shaji Sebastian
- Inflammatory Bowel Disease Unit, Hull and East Yorkshire National Health Service Trust, Hull, United Kingdom
| | - Federica Furfaro
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
| | | | - Martina Muscat
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | | | - Giovanni Maconi
- Division of Gastroenterology, Department of Biomedical and Clinical Sciences, Luigi Sacco University Hospital, Milan, Italy
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Fernando Magro
- Department of Gastroenterology, Hospital de São João, Porto, Portugal; Department of Pharmacology and Therapeutics, Porto Medical School, Porto, Portugal
| | | | - Alessandro Armuzzi
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Gemelli Hospital Catholic University, Rome, Italy
| | - Marta Maia Boscà-Watts
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, University Clinic Hospital, Valencia, Spain
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Stefanos Bonovas
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Silvio Danese
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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188
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Rieder F, Latella G, Magro F, Yuksel ES, Higgins PDR, Di Sabatino A, de Bruyn JR, Rimola J, Brito J, Bettenworth D, van Assche G, Bemelman W, d'Hoore A, Pellino G, Dignass AU. European Crohn's and Colitis Organisation Topical Review on Prediction, Diagnosis and Management of Fibrostenosing Crohn's Disease. J Crohns Colitis 2016; 10:873-85. [PMID: 26928961 DOI: 10.1093/ecco-jcc/jjw055] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/16/2016] [Indexed: 01/24/2023]
Abstract
This ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focused on prediction, diagnosis, and management of fibrostenosing Crohn's disease [CD]. The objective was to achieve evidence-supported, expert consensus that provides guidance for clinical practice.
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Affiliation(s)
- Florian Rieder
- Department of Pathobiology, Lerner Research Institute, Cleveland, OH, USA Department of Gastroenterology, Hepatology & Nutrition, Lerner Research Institute, Cleveland, OH, USA
| | - Giovanni Latella
- Department of Life, Health and Environmental Sciences, Gastroenterology Unit, University of L'Aquila, L'Aquila, Italy
| | - Fernando Magro
- Department of Pharmacology & Therapeutics, Department of Gastroenterology, Faculty of Medicine University of Porto, Porto, Portugal
| | - Elif S Yuksel
- Department of Gastroenterology, Izmir Ataturk Teaching and Research Hospital-Katip Celebi University, Izmir, Turkey
| | - Peter D R Higgins
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Antonio Di Sabatino
- First Department of Internal Medicine, St Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Jessica R de Bruyn
- Academic Medical Center Amsterdam, Tytgat Institute for Liver and Intestinal Research, Amsterdam, The Netherlands
| | - Jordi Rimola
- Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jorge Brito
- Department of Radiology, Centro Hospitalar do Algarve, Lagos, Portugal
| | | | - Gert van Assche
- Division of Gastroenterology, University of Leuven, Leuven, Belgium
| | - Willem Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Andre d'Hoore
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Gianluca Pellino
- Department of Medicine 1, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Axel U Dignass
- Department of Pathobiology, Lerner Research Institute, Cleveland, OH, USA
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189
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Coelho R, Peixoto A, Amil-Dias J, Trindade E, Campos M, Magina S, Charbit-Henrion F, Lenoir C, Latour S, Magro F, Macedo G. Refractory monogenic Crohn's disease due to X-linked inhibitor of apoptosis deficiency. Int J Colorectal Dis 2016; 31:1235-6. [PMID: 26584814 DOI: 10.1007/s00384-015-2442-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Rosa Coelho
- Department of Gastrenterology, Centro Hospitalar São João, Porto, Portugal
| | - Armando Peixoto
- Department of Gastrenterology, Centro Hospitalar São João, Porto, Portugal
| | - Jorge Amil-Dias
- Department of Pediatrics, Centro Hospitalar São João, Porto, Portugal
| | - Eunice Trindade
- Department of Pediatrics, Centro Hospitalar São João, Porto, Portugal
| | - Miguel Campos
- Department of Pediatric Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Sofia Magina
- Department of Dermatology, Centro Hospitalar São João, Porto, Portugal
| | - Fabienne Charbit-Henrion
- Laboratory of Intestinal Immunity, Inserm UMR 1163, University Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France.,GENIS group (GENetically ImmUne mediated enteropathieS) from ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition), Petersfield, UK
| | - Christelle Lenoir
- Laboratory of "Lymphocyte Activation and Susceptibility to EBV Infection", Inserm UMR 1163, University Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Sylvain Latour
- Laboratory of "Lymphocyte Activation and Susceptibility to EBV Infection", Inserm UMR 1163, University Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Fernando Magro
- Department of Gastrenterology, Centro Hospitalar São João, Porto, Portugal. .,Department of Pharmacology and Therapeutics, Porto Medical School, Porto, Portugal.
| | - Guilherme Macedo
- Department of Gastrenterology, Centro Hospitalar São João, Porto, Portugal
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190
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Magro F, Coelho R, Guimarães LS, Silva M, Peixoto A, Lopes S, Macedo G. Anti-TNF therapy and radiation exposure in Crohn's disease: chicken or egg? Scand J Gastroenterol 2016; 51:511-2. [PMID: 26523855 DOI: 10.3109/00365521.2015.1105287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Fernando Magro
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal.,b Department of Pharmacology and Therapeutics, Faculty of Medicine , University of Porto , Porto , Portugal.,c MedInUP - Center for Drug Discovery and Innovative Medicines , University of Oporto , Oporto , Portugal
| | - Rosa Coelho
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
| | - Luís S Guimarães
- d Radiology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
| | - Marco Silva
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
| | - Armando Peixoto
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
| | - Susana Lopes
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
| | - Guilherme Macedo
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
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191
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Magro F, Coelho R, Guimarães LS, Silva M, Peixoto A, Lopes S, Macedo G. Ionizing radiation exposure is still increasing in Crohn's disease: Who should be blamed? Scand J Gastroenterol 2016; 50:1214-25. [PMID: 25881793 DOI: 10.3109/00365521.2015.1037344] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Crohn's disease (CD) patients undergo many radiological studies employing ionizing radiation for diagnosis and management purposes. Our aim was to assess the total radiation exposure of our patients over the years, to estimate the risk factors for exposure to high doses, and to correlate radiation exposure to immunosuppression. METHODS The cumulative effective dose of radiation (CEDR) was calculated multiplying the number of imaging studies by the effective dose of each examination. RESULTS A total of 451 patients with CD (226 female) were followed during 11.0 years (interquartile range [IQR]: 6.0-16.0), with 52.1% of the patients being classified with penetrating (B3) and 38.6% being steroid-dependent. About 16% were exposed to high-radiation dose levels (CEDR >50 mSv) and 4% were exposed to CEDR >100 mSv. The mean CEDR between age 26 and 35 years was 12.539 mSv and a significant dose of radiation (over 50 mSv) was achieved at a median age of 40 (IQR: 29.0-47.0). Abdominal-pelvic computed tomography scan was the examination that contributed the most for CEDR. Patients with B3 phenotype, previous surgery, azathioprine, and anti-tumor necrosis factor (TNF)-α therapy were exposed earlier on the course of the disease to CEDR >50 mSv (p < 0.001). The value of CEDR in the patients under immunosuppression mainly increased in the first year of immunosuppression. CONCLUSION Penetrating phenotype, abdominal surgery, steroid resistance or steroid dependence, and treatment with anti-TNF-α and azathioprine were predictive factors for high CEDR. It was also demonstrated that immunosuppression and anti-TNF-α treatment were followed by a sustained increment of radiation exposure and that a significant dose of radiation was achieved <40 years of age.
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Affiliation(s)
- Fernando Magro
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João , Oporto , Portugal
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Coelho R, Silva M, Gaspar R, Silva R, Paiva D, Lopes J, Lopes S, Lopes JM, Magro F, Macedo G. "A book should not be judged by its cover": two cases of intestinal adenocarcinoma as the first manifestation of Crohn's disease. Int J Colorectal Dis 2016; 31:1061-1062. [PMID: 26410262 DOI: 10.1007/s00384-015-2389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Roberto Silva
- Patholology Department, Centro Hospitalar São João, Porto, Portugal
| | - David Paiva
- Patholology Department, Centro Hospitalar São João, Porto, Portugal
| | - Joanne Lopes
- Patholology Department, Centro Hospitalar São João, Porto, Portugal
| | - Susana Lopes
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - José Manuel Lopes
- Patholology Department, Centro Hospitalar São João, Porto, Portugal.,Pathology and Oncology Department, Faculty of Medicine, Porto University, Porto, Portugal
| | - Fernando Magro
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.,Department of Pharmacology, Faculty of Medicine, Porto University, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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193
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Magalhães D, Cabral JM, Soares-da-Silva P, Magro F. Role of epithelial ion transports in inflammatory bowel disease. Am J Physiol Gastrointest Liver Physiol 2016; 310:G460-76. [PMID: 26744474 DOI: 10.1152/ajpgi.00369.2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/02/2016] [Indexed: 02/06/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder with a complex pathogenesis. Diarrhea is a highly prevalent and often debilitating symptom of IBD patients that results, at least in part, from an intestinal hydroelectrolytic imbalance. Evidence suggests that reduced electrolyte absorption is more relevant than increased secretion to this disequilibrium. This systematic review analyses and integrates the current evidence on the roles of epithelial Na(+)-K(+)-ATPase (NKA), Na(+)/H(+) exchangers (NHEs), epithelial Na(+) channels (ENaC), and K(+) channels (KC) in IBD-associated diarrhea. NKA is the key driving force of the transepithelial ionic transport and its activity is decreased in IBD. In addition, the downregulation of apical NHE and ENaC and the upregulation of apical large-conductance KC all contribute to the IBD-associated diarrhea by lowering sodium absorption and/or increasing potassium secretion.
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Affiliation(s)
- Diogo Magalhães
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Porto, Portugal; and MedInUP-Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - José Miguel Cabral
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Porto, Portugal; and MedInUP-Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Patrício Soares-da-Silva
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Porto, Portugal; and MedInUP-Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Fernando Magro
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Porto, Portugal; and MedInUP-Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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194
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Magro F, Ramos J, Correia L, Lago P, Peixe P, Gonçalves AR, Rodrigues Ã, Vieira C, Ferreira D, Pereira Silva J, Túlio MA, Salgueiro P, Fernandes S. [Portuguese Consensus on the Diagnosis, Prevention and Treatment of Anaemia in Inflammatory Bowel Disease]. ACTA MEDICA PORT 2016; 29:144-56. [PMID: 27234956 DOI: 10.20344/amp.6058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/16/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Anaemia can be considered the most common extra-intestinal manifestation in inflammatory bowel disease. Nevertheless, anaemia is often under-diagnosed and under-treated both in adults and children with inflammatory bowel disease. Herein, we report the consensus statements on the management of anaemia in inflammatory bowel disease developed by the Portuguese Working Group on Inflammatory Bowel Disease (known as Grupo de Estudo da Doença Inflamatória Intestinal - GEDII) to aid clinicians in daily management of inflammatory bowel disease patients. MATERIAL AND METHODS A comprehensive literature review was conducted in order to prepare consensus statements on the following topics: (1) prevalence and diagnosis of anaemia in inflammatory bowel disease, (2) iron supplementation for the prevention of anaemia in inflammatory bowel disease and (3) treatment of anaemia in inflammatory bowel disease. The final statements for each topic were discussed at a consensus meeting and rated according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. CONSENSUS It was concluded that anaemia has a high incidence and prevalence in inflammatory bowel disease, particularly in those with active disease and hospitalised. Patients with anaemia had decreased quality of life and frequently complained of fatigue. Absolute indications for intravenous therapy should be considered: (1) moderate to severe anaemia (haemoglobin < 10.5 g/dL) or clearly symptomatic anaemia; (2) previous intolerance to oral iron supplements; (3) inappropriate response to oral iron; (4) active severe intestinal disease; (5) need for a quick therapeutic response (e.g. surgery in the short term); (6) concomitant therapy with erythropoiesis-stimulating agent; and (7) patient's preference.
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Affiliation(s)
- Fernando Magro
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Departamento de Farmacologia e Terapêutica. Faculdade de Medicina. Universidade do Porto. Porto. Serviço de Gastrenterologia. Centro Hospitalar de São João. Porto
| | - Jaime Ramos
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital de Santo António dos Capuchos. Centro Hospitalar de Lisboa Central. Lisboa
| | - Luís Correia
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa
| | - Paula Lago
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital de Santo António. Centro Hospitalar do Porto. Porto
| | - Paula Peixe
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa
| | - Ana Rita Gonçalves
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa
| | - Ãngela Rodrigues
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital de Santo António. Centro Hospitalar do Porto. Porto
| | - Catarina Vieira
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa
| | - Daniela Ferreira
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital de Santo António. Centro Hospitalar do Porto. Porto
| | - João Pereira Silva
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Instituto Português de Oncologia de Francisco Gentil de Lisboa. Lisboa
| | - Maria Ana Túlio
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa
| | - Paulo Salgueiro
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital de Santo António. Centro Hospitalar do Porto. Porto
| | - Samuel Fernandes
- Grupo de Estudo da Doença Inflamatória Intestinal. Lisboa. Serviço de Gastrenterologia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa
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195
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Abreu C, Sarmento A, Magro F. Reintroduction of Anti-TNFα Therapy After (or even During) Anti-TNFα-associated Tuberculosis in Immune-mediated Diseases. J Crohns Colitis 2016; 10:120-1. [PMID: 26417047 DOI: 10.1093/ecco-jcc/jjv172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/11/2015] [Indexed: 02/08/2023]
Affiliation(s)
- C Abreu
- Department of Infectious Diseases, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infecciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - A Sarmento
- Department of Infectious Diseases, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infecciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - F Magro
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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196
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Soares-da-Silva P, Cabral JM, Magalhães D, Fraga S, Magro F. Amine neurotransmitters, inflammation and epithelial sodium transport. Exp Physiol 2015; 101:459-64. [PMID: 26548358 DOI: 10.1113/ep085284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 11/02/2015] [Indexed: 12/13/2022]
Abstract
NEW FINDINGS What is the topic of this review? The present work reviews the roles of renal and intestinal dopamine and 5-HT in the maintenance of fluid and electrolyte homeostasis. The role of inflammatory agents at the intestinal level that affect fluid and electrolyte homeostasis is also addressed. What advances does it highlight? General mechanisms of epithelial cell ion transport in the gastrointestinal tract and kidney share considerable similarities, particularly with regard to basolateral Na(+) ,K(+-) ATPase as a driving force for the movement of numerous substrates across the cell membrane. The physiological importance of the renal actions of monoamines (dopamine, noradrenaline and 5-HT) mainly depends on the sources of the amines in the kidney and on their availability to activate the amine-specific receptors. Dopamine and 5-HT are also relatively abundant in the mucosal cell layer of the intestine, and recent evidence suggests their physiological relevance in regulating electrolyte transport. The gastrointestinal tract can be an important site for the loss of water and electrolytes, in the presence of intestinal inflammation. General mechanisms of epithelial cell ion transport in the gastrointestinal tract and kidney share considerable similarities with regard to basolateral Na(+) ,K(+) -ATPase as a driving force for the movement of numerous substrates across the cell membrane. The present work reviews the roles of renal and intestinal dopamine and 5-HT in the maintenance of fluid and electrolyte homeostasis. The role of inflammatory agents at the intestinal level that affect fluid and electrolyte homeostasis is also addressed.
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Affiliation(s)
- Patrício Soares-da-Silva
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - José Miguel Cabral
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diogo Magalhães
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sónia Fraga
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Fernando Magro
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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197
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Abreu C, Santos L, Magro F. Varicella Complicated by Severe Pneumonia and Shock in an Immunosuppressed Crohn's Disease Patient Under Azathioprine and Anti-Tumour Necrosis Factor Alpha. J Crohns Colitis 2015; 9:1176-8. [PMID: 26351378 DOI: 10.1093/ecco-jcc/jjv143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Cândida Abreu
- Department of Infectious Diseases, Faculty of Medicine, Centro Hospitalar S, João, Porto, Portugal Instituto de Inovação e Investigação em Saúde [I3S], Grupo de I&D em Nefrologia e Doenças Infecciosas, Instituto Nacional de Engenharia Biomédica [INEB], Porto, Portugal
| | - Lurdes Santos
- Department of Infectious Diseases, Faculty of Medicine, Centro Hospitalar S, João, Porto, Portugal Instituto de Inovação e Investigação em Saúde [I3S], Grupo de I&D em Nefrologia e Doenças Infecciosas, Instituto Nacional de Engenharia Biomédica [INEB], Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S, João, Porto, Portugal MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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198
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Cabral JM, Grácio D, Soares-da-Silva P, Magro F. Short- and long-term regulation of intestinal Na+/H+ exchange by Toll-like receptors TLR4 and TLR5. Am J Physiol Gastrointest Liver Physiol 2015; 309:G703-15. [PMID: 26294670 DOI: 10.1152/ajpgi.00124.2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/13/2015] [Indexed: 01/31/2023]
Abstract
Inappropriate activation of pattern recognition receptors has been described as a potential trigger in the development of inflammatory bowel disease (IBD). In this study, we evaluated the activity and expression of Na(+)/H(+) exchanger (NHE) subtypes in T84 intestinal epithelial cells during Toll-like receptor 4 (TLR4) activation by monophosphoryl lipid A and TLR5 by flagellin. NHE activity and intracellular pH were evaluated by spectrofluorescence. Additionally, kinase activities were evaluated by ELISA, and siRNA was used to specifically inhibit adenylyl cyclase (AC). Monophosphoryl lipid A (MPLA) (0.01-50.00 μg/ml) and flagellin (10-500 ng/ml) inhibited NHE1 activity in a concentration-dependent manner (MPLA short term -25.2 ± 5.0%, long term -31.9 ± 4.0%; flagellin short term -14.9 ± 2.0%, long term -19.1 ± 2.0%). Both ligands triggered AC3, PKA, PLC, and PKC signal molecules. Long-term exposure to flagellin and MPLA induced opposite changes on NHE3 activity; flagellin increased NHE3 activity (∼10%) with overexpression of membrane protein, whereas MPLA decreased NHE3 activity (-17.3 ± 3.0%). MPLA and flagellin simultaneously had synergistic effects on NHE activity. MPLA and flagellin impaired pHi recovery after intracellular acidification. The simultaneous exposure to MPLA and flagellin induced a substantial pHi reduction (-0.55 ± 0.03 pH units). Activation of TLR4 and TLR5 exerts marked inhibition of NHE1 activity in intestinal epithelial cells. Transduction mechanisms set into motion during TLR4-mediated and long-term TLR5-mediated inhibition of NHE1 activity involve AC3, PKA, PLC, and PKC. However, short- and long-term TLR4 activation and TLR5 activation might use different signaling pathways. The physiological alterations on intestinal epithelial cells described here may be useful in the development of better IBD therapeutics.
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Affiliation(s)
- José Miguel Cabral
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Porto, Portugal
| | - Daniela Grácio
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Porto, Portugal
| | - Patrício Soares-da-Silva
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Porto, Portugal; MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Fernando Magro
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Porto, Portugal; MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal; Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
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199
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Vegh Z, Burisch J, Pedersen N, Kaimakliotis I, Duricova D, Bortlik M, Vinding KK, Avnstrøm S, Olsen J, Nielsen KR, Katsanos KH, Tsianos EV, Lakatos L, Schwartz D, Odes S, D'Incà R, Beltrami M, Kiudelis G, Kupcinskap L, Jucov A, Turcan S, Barros LF, Magro F, Lazar D, Goldis A, de Castro L, Hernandez V, Niewiadomski O, Bell S, Langholz E, Munkholm P, Lakatos PL. Treatment Steps, Surgery, and Hospitalization Rates During the First Year of Follow-up in Patients with Inflammatory Bowel Diseases from the 2011 ECCO-Epicom Inception Cohort. J Crohns Colitis 2015; 9:747-53. [PMID: 26055976 DOI: 10.1093/ecco-jcc/jjv099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/28/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS The ECCO-EpiCom study investigates the differences in the incidence and therapeutic management of inflammatory bowel diseases [IBD] between Eastern and Western Europe. The aim of this study was to analyse the differences in the disease phenotype, medical therapy, surgery, and hospitalization rates in the ECCO-EpiCom 2011 inception cohort during the first year after diagnosis. METHODS Nine Western, five Eastern European centres and one Australian centre with 258 Crohn's disease [CD], 380 ulcerative colitis [UC] and 71 IBD unclassified [IBDU] patients [female/male: 326/383; mean age at diagnosis: 40.9 years, SD: 17.3 years] participated. Patients' data were registered and entered in the web-based ECCO-EpiCom database [www.epicom-ecco.eu]. RESULTS In CD, 36 [19%] Western Europe/Australian and 6 [9%] Eastern European patients received biological therapy [p = 0.04], but the immunosuppressive [IS] use was equal and high in these regions [Eastern Europe vs Western Europe/Australia: 53% vs 45%; p = 0.27]. Surgery was performed in 17 [24%] CD patients in Eastern Europe and 13 [7%] in Western Europe/Australia [p < 0.001, pLogRank = 0.001]. Of CD patients from Eastern Europe, 24 [34%] were hospitalized, and 39 [21%] from Western Europe/Australia, [p = 0.02, pLogRank = 0.01]. In UC, exposure to biologicals and colectomy rates were low and hospitalization rates did not differ between these regions during the 1-year follow-up period [16% vs 16%; p = 0.93]. CONCLUSIONS During the first year after diagnosis, surgery and hospitalization rates were significantly higher in CD patients in Eastern Europe compared with Western Europe/Australia, whereas significantly more CD patients were treated with biologicals in the Western Europe/Australian centres.
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Affiliation(s)
- Z Vegh
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - J Burisch
- Gastrounit, Medical Section, Hvidovre University Hospital, Hvidovre, Denmark
| | - N Pedersen
- Gastroenterology Department, Slagelse University Hospital, Slagelse, Denmark
| | | | - D Duricova
- IBD Centre ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Centre ISCARE, Charles University, Prague, Czech Republic
| | - K Kofod Vinding
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - S Avnstrøm
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - J Olsen
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - K R Nielsen
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - K H Katsanos
- First Division of Internal Medicine and Division of Gastroenterology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - E V Tsianos
- First Division of Internal Medicine and Division of Gastroenterology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - L Lakatos
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - D Schwartz
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Centre and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - R D'Incà
- UO Gastroenterologia, Azienda Ospedaliera-Università di Padova, Padova, Italy On behalf of the EpiCom Northern Italy centre based in Crema, Cremona, Firenze, Forlì & Padova and Reggio Emilia, Italy
| | - M Beltrami
- Degenza Breve Internistica e Centro M.I.C.I.-Azienda Ospedaliera Arcispedale S Maria Nuova, Reggio Emilia, Italy On behalf of the EpiCom Northern Italy centre based in Crema, Cremona, Firenze, Forlì & Padova and Reggio Emilia, Italy
| | - G Kiudelis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - L Kupcinskap
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - A Jucov
- Department of Gastroenterology, State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - S Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - L F Barros
- Hospital de Vale de Sousa, Porto, Portugal
| | - F Magro
- Department of Gastroenterology, Hospital de São João, Porto, Portugal Department of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal MedInUP-Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - D Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - A Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - L de Castro
- Department of Gastroenterology, Grupo de Investigación en Patología Digestiva, Instituto de Investigación Biomedica [IBI], Xerencia de Xestión Integrada de Vigo, SERGAS, Vigo, Spain
| | - V Hernandez
- Department of Gastroenterology, Grupo de Investigación en Patología Digestiva, Instituto de Investigación Biomedica [IBI], Xerencia de Xestión Integrada de Vigo, SERGAS, Vigo, Spain
| | - O Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - S Bell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Langholz
- Department C, Gastroenterology Section, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - P Munkholm
- Gastro Unit, Medical Section, North Zealand Hospital, University of Copenhagen, Denmark
| | - P L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary
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200
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Hindryckx P, Baert F, Hart A, Magro F, Armuzzi A, Peyrin-Biroulet L. Clinical trials in ulcerative colitis: a historical perspective. J Crohns Colitis 2015; 9:580-8. [PMID: 25913641 DOI: 10.1093/ecco-jcc/jjv074] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/22/2015] [Indexed: 02/08/2023]
Abstract
The clinical trial landscape in ulcerative colitis has evolved significantly in recent decades. Study endpoints have been shifting from mere clinical response to mucosal healing. It has become clear that the choice of combined clinical and endoscopic outcome criteria leads to a reduction in placebo responses, especially when central reading of the endoscopic images is performed. Accumulating evidence suggests that histological remission yields better long-term outcomes for ulcerative colitis patients than mucosal healing alone, and clinical trials with prolonged follow-up will have to address whether histological remission should be the ultimate treatment goal in ulcerative colitis. In recent years there has also been increasing interest in the implementation of patient-reported outcomes in clinical practice and research, and the regulatory authorities have set up guidelines for the development of such outcomes. This paper aims to provide a comprehensive review of historical aspects of clinical trials in ulcerative colitis and to discuss challenges and perspectives for clinical trials in the near future. A thorough analysis of all available landmark literature (both original papers and reviews) on clinical trials in ulcerative colitis was performed.
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Affiliation(s)
- Pieter Hindryckx
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - Ailsa Hart
- IBD Unit, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK
| | - Fernando Magro
- Department of Pharmacology and Therapeutics, Division of Gastroenterology, Hospital de Sao Joao, University of Porto, Porto, Portugal
| | - Alessandro Armuzzi
- IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Laurent Peyrin-Biroulet
- Inserm U 954 and Department of Hepato-Gastroenterology, University Hospital of Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
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