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Scarallo L, Banci E, De Blasi A, Paci M, Renzo S, Naldini S, Barp J, Pochesci S, Fioretti L, Pasquini B, Cavalieri D, Lionetti P. A real-life pediatric experience of Crohn's disease exclusion diet at disease onset and in refractory patients. J Pediatr Gastroenterol Nutr 2024. [PMID: 38962891 DOI: 10.1002/jpn3.12283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES We aimed to appraise the real-life efficacy of Crohn's disease exclusion diet (CDED) coupled with partial enteral nutrition (PEN) in inducing clinical and biochemical remission at disease onset and in patients with loss of response to biologics and immunomodulators. METHODS We retrospectively gathered data of patients aged less than 18 years of age with a diagnosis of Crohn's disease (CD), who received CDED coupled with PEN at a tertiary level pediatric inflammatory bowel disease center. RESULTS Sixty-six patients were identified. Forty (60.6%) started CDED plus PEN at disease onset and 26 (39.4%) received CDED with PEN as add-on therapy. Forty-six (69.7%) patients achieved clinical remission (weighted Pediatric Crohn's Disease Activity Index < 12.5) at the end of Phase 1, 44 (66.7%) normalized c-reactive protein levels (<0.5 mg/dL) and 18 (27.2%) patients normalized calprotectin levels (<150 microg/g). Nine of 19 (47.3%) of patients with clinically severe disease (defined by Physician Global Assessment) achieved clinical remission at the end of Phase I. Patients with extraintestinal manifestations had statistically lower clinical response rates to the dietary regimen (p = 0.018). Among patients who received CDED + PEN as add-on treatment, a previous successful course of Exclusive Enteral Nutrition was associated with statistically higher clinical remission rates at Week 8 (p = 0.026). Clinical response at Week 4 was an independent predictor of clinical remission and fecal calprotectin normalization at Week 8 (p = 0.002). CONCLUSION CDED with PEN confirmed its efficacy in a real-life setting, proving to be effective also in refractory patients and those with severe disease. Early clinical response predicts clinical remission at the end of Phase 1.
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Affiliation(s)
- Luca Scarallo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department NEUROFARBA, University of Florence, Florence, Italy
| | - Elena Banci
- Dietetics Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Alessia De Blasi
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Monica Paci
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Sara Renzo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Sara Naldini
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Jacopo Barp
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Saverio Pochesci
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Lorenzo Fioretti
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Benedetta Pasquini
- Department of Chemistry "U. Schiff", University of Florence, Florence, Italy
| | | | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department NEUROFARBA, University of Florence, Florence, Italy
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Maniscalco V, Scarallo L, Aloi M, Alvisi P, Norsa L, Zuin G, Simonini G, Lionetti P. Prevalence and clinical features of chronic uveitis in pediatric inflammatory bowel diseases: A nationwide study. J Pediatr Gastroenterol Nutr 2024; 78:1305-1309. [PMID: 38594804 DOI: 10.1002/jpn3.12216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/12/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
Inflammatory bowel diseases (IBD) encompass a group of chronic inflammatory disorders primarily affecting the gastrointestinal tract but capable of impacting various organs, including the eye, with uveitis being the most common ocular condition. We assessed uveitis prevalence and clinical features in a nationwide cohort of pediatric IBD. Among 4229 cases, six patients (four Crohn's disease, one ulcerative colitis, and one unclassified IBD) were identified, resulting in an overall prevalence rate of 141.8 per 100,000 patients. Uveitis onset varied: two before IBD, two after, and two concomitantly. Symptomatic uveitis occurred in 2/6 patients, with anterior involvement in all cases. Median follow-up was 3 years (interquartile range 2-4.75 years). At the last follow-up, 5/6 patients exhibited quiescent IBD, while 4/6 had inactive uveitis. One patient had ocular complications. Uveitis is a rare but potentially complicating manifestation of pediatric IBD.
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Affiliation(s)
- Valerio Maniscalco
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children Hospital IRCCS, Florence, Italy
| | - Luca Scarallo
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Pediatrics Department, Maggiore C.A. Pizzardi Hospital, Bologna, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation Unit ASST Papa Giovanni XXIII, Bergamo, Italy
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Giovanna Zuin
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Gabriele Simonini
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children Hospital IRCCS, Florence, Italy
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
- NEUROFARBA Department, University of Florence, Florence, Italy
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Castiglione F, Scarallo L, Nardone OM, Aloi M, Alvisi P, Armuzzi A, Arrigo S, Bodini G, Calabrese E, Ceccarelli L, Fries W, Marseglia A, Martinelli M, Milla M, Orlando A, Rispo A, Rizzello F, Romano C, Caprioli F, Lionetti P. Transition care in patients with IBD: The pediatric and the adult gastroenterologist's perspective. Results from a national survey. Dig Liver Dis 2024; 56:802-809. [PMID: 38072745 DOI: 10.1016/j.dld.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 04/29/2024]
Abstract
BACKGROUND Transition is a crucial process in the care of IBD patients, although it remains largely heterogeneous. AIMS To provide an overview of the transition process in Italy and to investigate the perspective of the paediatric and adult physicians. METHODS An online survey was developed by the Italian Group for Inflammatory Bowel Diseases (IG-IBD) and the Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition (SIGENP). RESULTS 104 physicians (62 paediatric and 42 adult gastroenterologists) participated to the survey. The disease status was ranked with the highest priority among the key elements of the transition process. The age of the patient was perceived with a higher priority by paediatric gastroenterologists than by adult ones (p < 0.01). In most cases, the transition was organized through one or more joint meetings. Only less than 25 % of responders reported to involve other professions during transition. The struggle in leaving paediatric setting was perceived as the main obstacle to an effective transition process. Paediatric IBD gastroenterologists ranked the struggle in leaving the paediatric setting and the attending physician as higher critical point than adult gastroenterologists. CONCLUSIONS The current survey provided a snapshot of the IBD transition process in Italy. The present findings highlight the need to embed transitional care in healthcare policy.
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Affiliation(s)
- Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Luca Scarallo
- Gastroenterology and Nutrition Unit, Meyer IRCCS children's Hospital, Florence, Italy; Department NEUROFARBA, University of Florence, Italy
| | - Olga Maria Nardone
- Gastroenterology, Department of Public Health, University Federico II of Naples
| | - Marina Aloi
- Department of Maternal and Child Health, Pediatric Gastroenterology and Liver Unit, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Maggiore Hospital, 40133 Bologna, Italy
| | | | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Giannina Gaslini, Genova, Italy
| | - Giorgia Bodini
- IRCCS Policlinico San Martino, University of Genova, Genova, Italy
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Linda Ceccarelli
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010, Pisa, Italy
| | - Walter Fries
- Inflammatory Bowel Disease Unit, Dept. of Clinical and Experimental Medicine, University of Messina, Messina; Italy
| | - Antonio Marseglia
- Fondazione IRCCS Casa Sollievo della Sofferenza, Division of Pediatrics, San Giovanni Rotondo, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence
| | | | - Antonio Rispo
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Fernando Rizzello
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; DIMEC, University of Bologna, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer IRCCS children's Hospital, Florence, Italy; Department NEUROFARBA, University of Florence, Italy.
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Scarallo L, Knafelz D, Arrigo S, Felici E, Lionetti P. Prevalence and features of chronic nonbacterial osteomyelitis in a cohort of children with inflammatory bowel diseases. Dig Liver Dis 2024; 56:537-539. [PMID: 38233314 DOI: 10.1016/j.dld.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Luca Scarallo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department Neurofarba, University of Florence, Italy
| | - Daniela Knafelz
- Pediatric Gastroenterology Unit, Bambino Gesù Hospital, Rome, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, IRCSS Giannina Gaslini, Genoa, Italy
| | - Enrico Felici
- Pediatrics and Pediatric Emergency Unit, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department Neurofarba, University of Florence, Italy.
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Scarallo L, Fioretti L, Paci M, Naldini S, Renzo S, Barp J, Gissi A, Di Paola M, Villanacci V, Lionetti P. Histological healing as a predictor of sustained clinical remission in paediatric ulcerative colitis. Dig Liver Dis 2024; 56:43-49. [PMID: 37455156 DOI: 10.1016/j.dld.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The study aimed to assess the longitudinal impact of endoscopic healing (EH) and histological healing (HH) in a cohort of paediatric patients affected by ulcerative colitis (UC). METHODS This was a retrospective single-centre longitudinal study. 86 children with UC who underwent endoscopic re-assessment while in clinical and biochemical remission were included. Partial EH was defined as a Mayo Endoscopic Subscore (MES) of 1 and complete EH was defined as a MES of 0. HH was defined as the absence of active inflammation in all biopsies. The cumulative incidence of clinical relapse was evaluated during follow-up. RESULTS At the second endoscopic re-evaluation, 59 (68.6%) patients achieved EH (MES ≤1). Of these patients, 39 (66%) achieved complete EH. 20 of the 39 patients who achieved complete EH attained complete HH. Patients who achieved partial and complete EH showed higher recurrence-free survival rates compared to those who did not (p < 0.01 and p < 0.01, respectively). Amongst patients with complete EH, those who achieved complete HH had lower recurrence rates when compared to patients who still showed microscopic inflammation (p = 0.049). CONCLUSION Achievement of EH and HH is associated with fewer disease relapses, with patients achieving HH showing longer relapse-free survival rates.
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Affiliation(s)
- Luca Scarallo
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy; Department of NEUROFARBA, University of Florence, Italy
| | - Lorenzo Fioretti
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
| | - Monica Paci
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
| | - Sara Naldini
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
| | - Sara Renzo
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
| | - Jacopo Barp
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
| | - Anna Gissi
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
| | - Monica Di Paola
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy
| | | | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy; Department of NEUROFARBA, University of Florence, Italy.
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