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Binda C, Coluccio C, Vizzuso A, Sartini A, Sbrancia M, Cucchetti A, Giampalma E, Fabbri S, Ercolani G, Fabbri C. Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device. Diagnostics (Basel) 2023; 13:2321. [PMID: 37510064 PMCID: PMC10378507 DOI: 10.3390/diagnostics13142321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this purpose largely affects the possibility of safely performing DEN which increases the risk of complications. We present the case of a 63 years-old man who underwent an endoscopic ultrasound (EUS)-guided drainage of a WOPN, and who was readmitted one month after stent removal with clinical, endoscopic, and radiological signs of infected necrosis involving the splenic artery. A second EUS-guided drainage was performed, with clear visualization of the arterial vessel in the midst of a large amount of solid necrosis. Due to the high risk of major bleeding during DEN, a hybrid procedure in the angiographic room was performed, in order to identify and avoid, under fluoroscopic control, the splenic artery during the entire procedure guide, which was successfully performed using the EndoRotor system. We hereby review the current literature regarding DEN using the EndoRotor system. The case reported, with a literature overview, may help the management of these patients affected by benign but life-threatening conditions which involve a multidisciplinary setting.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy
| | - Antonio Vizzuso
- Radiology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy
| | - Alessandro Sartini
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy
| | - Emanuela Giampalma
- Radiology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy
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Pugliese D, Privitera G, Crispino F, Mezzina N, Castiglione F, Fiorino G, Laterza L, Viola A, Bertani L, Caprioli F, Cappello M, Barberio B, Ricci C, Balestrieri P, Daperno M, Pluchino D, Rizzello F, Scribano ML, Sablich R, Pastorelli L, Manguso F, Variola A, Di Sario A, Grossi L, Armuzzi A, Biscaglia G, Buda A, Mocci G, Viscido A, Di Paolo MC, Onali S, Rodino S, Coletta M, Principi M, Miranda A, Amato A, Bezzio C, Petruzzellis C, Mazzuoli S, Festa S, Sartini A, Checchin D, Fanigliulo L, Gallina S, Cesarini M, Bodini G, Stradella D, Spagnuolo R, Guidi L, Savarino E, Scrivo B, Soru P, Costa F, Fries W, Scaldaferri F, Allocca M, Pellegrini L, Massari A, Orlando A. Effectiveness and safety of vedolizumab in a matched cohort of elderly and nonelderly patients with inflammatory bowel disease: the IG-IBD LIVE study. Aliment Pharmacol Ther 2022; 56:95-109. [PMID: 35876062 PMCID: PMC9324100 DOI: 10.1111/apt.16923] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/13/2022] [Accepted: 03/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vedolizumab registration trials were the first to include elderly patients with moderate-to-severe ulcerative colitis (UC) or Crohn's disease (CD), but few real-life data have been reported in this population. AIMS We investigated the effectiveness and safety of vedolizumab in matched cohorts of elderly and nonelderly UC and CD patients. METHODS The Long-term Italian Vedolizumab Effectiveness (LIVE) study is a retrospective-prospective study including UC and CD patients who started vedolizumab from April 2016 to June 2017. Elderly patients (≥65 years) were matched clinically 1:2 to nonelderly patients (18-64 years); the 2 groups were followed until drug discontinuation or June 2019. RESULTS The study included 198 elderly (108 UC, 90 CD) and 396 matched nonelderly patients (205 UC, 191 CD). Nonelderly UC patients had a significantly higher persistence on vedolizumab compared to elderly patients (67.6% vs. 51.4%, p = 0.02). No significant difference in effectiveness was observed between elderly and nonelderly CD patients (59.4% vs. 52.4%, p = 0.32). Age ≥65 years was associated with lower persistence in UC; for CD, previous exposure to anti-TNF-α agents, Charlson comorbidity index >2 and moderate-to-severe clinical activity at baseline were associated with lower persistence. There were recorded 130 adverse events, with comparable rates between the two groups. A Charlson comorbidity index >2 was associated with an increased risk of adverse events. CONCLUSION Vedolizumab can be considered a safe option in elderly IBD patients. Its effectiveness in elderly UC patients may be reduced, while no age-dependent effect on effectiveness was observed in CD.
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Affiliation(s)
- Daniela Pugliese
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCSRomeItaly
| | - Giuseppe Privitera
- Dipartimento Universitario di Medicina e Chirurgia TraslazionaleUniversità Cattolica del Sacro CuoreRomeItaly
| | - Federica Crispino
- Riuniti Villa Sofia–Cervello Hospital, Internal Medicine e 2IBD Unit PalermoPalermoItaly
| | - Nicolò Mezzina
- Department of Biochemical and Clinical Science “L. Sacco” ASST Fatebenefratelli Sacco–University of MilanMilanItaly
| | | | - Gionata Fiorino
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy¸ Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Lucrezia Laterza
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCSRomeItaly
| | - Anna Viola
- UOSD Malattie Intestinali Croniche, Dip. di Medicina Clinica e SperimentalePoliclinico MessinaSicilyItaly
| | - Lorenzo Bertani
- Gastroenterology and Digestive Endoscopy Department of Medical Specialties Apuane HospitalTuscany North‐West ASLMassaItaly
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Department of Pathophysiology and TransplantationUniversity of MilanMilanLombardiaItaly
| | - Maria Cappello
- Head IBD Clinic, Gastroenterology Section, PromiseUniversity of PalermoSicilyItaly
| | - Brigida Barberio
- Gastroenterology Unit, Department of Surgery, Oncology and GastroenterologyUniversity of PaduaPaduaItaly
| | - Chiara Ricci
- Gastroenterology Unit, Spedali Civili Hospital, Department of Experimental and Clinical SciencesUniversity of BresciaBresciaItaly
| | - Paola Balestrieri
- Unit of Digestive Disease of Campus Bio Medico University of RomeItaly
| | - Marco Daperno
- Gastroenterology UnitAzienda Ospedaliera Ordine Mauriziano di TorinoTorinoPiemonteItaly
| | - Dario Pluchino
- Gastroenterology UnitA.O.U. Policlinico "Vittorio Emanuele"CataniaItaly
| | - Fernando Rizzello
- Department of Internal Medicine and GastroenterologyPoliclinico Sant’Orsola MalpighiBolognaItaly
| | | | - Renato Sablich
- Gastroenterology UnitSanta Maria degli Angeli HospitalPordenoneItaly
| | - Luca Pastorelli
- Gastroenterology UnitIRCCS Policlinico San Donato Research HospitalMilanItaly
| | - Francesco Manguso
- Gastoenterology UnitAO A. CardarelliVia A. Cardarelli, 5Naples80131Italy
| | - Angela Variola
- IBD Unit, IRCCS Sacro Cuore Don CalabriaNegrar di ValpolicellaVeronaItaly
| | - Antonio Di Sario
- Clinica di GastroenterologiaUniversità Politecnica delle MarcheAnconaItaly,IBD‐UNIT, and Dipartimento Gastroenterologico e dei TrapiantiPolo Ospedaliero‐Universitario "Umberto I‐G.M. Lancisi‐ G. Salesi"AnconaItaly
| | - Laurino Grossi
- G. D’Annunzio University‐Digestive Physiopathology Ospedale Spirito Santo PescaraPescaraItaly
| | - Alessandro Armuzzi
- IBD CenterIRCCS Humanitas Research HospitalMilanItaly,Department of Biomedical Sciences, Humanitas UniversityPieve EmanueleMilanItaly
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Gibiino G, Sartini A, Gitto S, Binda C, Sbrancia M, Coluccio C, Sambri V, Fabbri C. The Other Side of Malnutrition in Inflammatory Bowel Disease (IBD): Non-Alcoholic Fatty Liver Disease. Nutrients 2021; 13:nu13082772. [PMID: 34444932 PMCID: PMC8398715 DOI: 10.3390/nu13082772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/26/2022] Open
Abstract
Steatohepatitis and hepatobiliary manifestations constitute some of the most common extra-intestinal manifestations of Inflammatory Bowel Disease (IBD). On the other hand, non-alcoholic fatty liver disease (NAFLD) affects around 25% of the world’s population and is attracting ever more attention in liver transplant programs. To outline the specific pathways linking these two conditions is a pressing task for 21st-century researchers. We are accustomed to expecting the occurrence of fatty liver disease in obese people, but current evidence suggests that there are several different pathways also occurring in underweight patients. Genetic factors, inflammatory signals and microbiota are key players that could help in understanding the entire pathogenesis of NAFLD, with the aim of defining the multiple expressions of malnutrition. In the current review, we summarize the most recent literature regarding the epidemiology, pathogenesis and future directions for the management of NAFLD in patients affected by IBD.
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Affiliation(s)
- Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
- Correspondence: ; Tel.: +39-3488609557
| | - Alessandro Sartini
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy;
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
| | - Vittorio Sambri
- Unit of Microbiology, The Great Romagna Hub Laboratory, 47522 Pievesestina, Italy;
- Unit of Microbiology, DIMES, University of Bologna, 40125 Bologna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
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4
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Saibeni S, Scucchi L, Dragoni G, Bezzio C, Miranda A, Ribaldone DG, Bertani A, Bossa F, Allocca M, Buda A, Mocci G, Soriano A, Mazzuoli S, Bertani L, Baccini F, Loddo E, Privitera AC, Sartini A, Viscido A, Grossi L, Casini V, Gerardi V, Ascolani M, Ruscio MD, Casella G, Savarino E, Stradella D, Pumpo R, Cortelezzi CC, Daperno M, Ciardo V, Nardone OM, Caprioli F, Vitale G, Cappello M, Comberlato M, Alvisi P, Festa S, Campigotto M, Bodini G, Balestrieri P, Viola A, Pugliese D, Armuzzi A, Fantini MC, Fiorino G. Activities related to inflammatory bowel disease management during and after the coronavirus disease 2019 lockdown in Italy: How to maintain standards of care. United European Gastroenterol J 2020; 8:1228-1235. [PMID: 33070758 DOI: 10.1177/2050640620964132] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND AIMS Restructuring activities have been necessary during the lockdown phase of the coronavirus disease 2019 (COVID-19) pandemic. Few data are available on the post-lockdown phase in terms of health-care procedures in inflammatory bowel disease (IBD) care, and no data are available specifically from IBD units. We aimed to investigate how IBD management was restructured during the lockdown phase, the impact of the restructuring on standards of care and how Italian IBD units have managed post-lockdown activities. METHODS A web-based online survey was conducted in two phases (April and June 2020) among the Italian Group for IBD affiliated units within the entire country. We investigated preventive measures, the possibility of continuing scheduled visits/procedures/therapies because of COVID-19 and how units resumed activities in the post-lockdown phase. RESULTS Forty-two referral centres participated from all over Italy. During the COVID-19 lockdown, 36% of first visits and 7% of follow-up visits were regularly done, while >70% of follow-up scheduled visits and 5% of first visits were done virtually. About 25% of scheduled endoscopies and bowel ultrasound scans were done. More than 80% of biological therapies were done as scheduled. Compared to the pre-lockdown situation, 95% of centres modified management of outpatient activity, 93% of endoscopies, 59% of gastrointestinal ultrasounds and 33% of biological therapies. Resumption of activities after the lockdown phase may take three to six months to normalize. Virtual clinics, implementation of IBD pathways and facilities seem to be the main factors to improve care in the future. CONCLUSION Italian IBD unit restructuring allowed quality standards of care during the COVID-19 pandemic to be maintained. A return to normal appears to be feasible and achievable relatively quickly. Some approaches, such as virtual clinics and identified IBD pathways, represent a valid starting point to improve IBD care in the post-COVID-19 era.
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Affiliation(s)
- Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Milan, Italy
| | - Ludovica Scucchi
- Department of Systems Medicine, GI Unit, Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
| | - Gabriele Dragoni
- Gastroenterology Unit, Careggi University Hospital Florence, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Milan, Italy
| | - Agnese Miranda
- Gastroenterology and Endoscopy Unit, University of Campania 'L. Vanvitelli', Naples, Italy
| | | | - Angela Bertani
- Department of Gastroenterology, IBD Unit, Policlinico Hospital, Modena, Italy
| | - Fabrizio Bossa
- Division of Gastroenterology, IRCCS "Casa Sollievo della Sofferenza" Foundation, San Giovanni Rotondo, Italy
| | - Mariangela Allocca
- IBD Centre, Gastroenterology, Humanitas Clinical and Research Centre - IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andrea Buda
- Department of Gastrointestinal Oncological Surgery, Gastroenterology and Endoscopy Unit, S. Maria del Prato Hospital, Feltre, Italy
| | | | - Alessandra Soriano
- Gastroenterology Division, Azienda USL Arcispedale S. Maria Nuova - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Mazzuoli
- Gastroenterology and Artificial Nutrition Unit, Monsignor R. Dimiccoli Hospital, ASL BT, Barletta, Italy
| | - Lorenzo Bertani
- Gastroenterology and Digestive Endoscopy Department of Medical Specialties Apuane Hospital - Tuscany North-West ASL, Massa, Italy
| | - Flavia Baccini
- Digestive Disease Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Erika Loddo
- Gastroenterology Unit, University Hospital, AOU Cagliari, Cagliari, Italy.,Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Alessandro Sartini
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena, AUSL della Romagna, Rimini, Italy
| | - Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Laurino Grossi
- G. D'Annunzio University - Digestive Physiopathology, Ospedale Spirito Santo, Pescara, Italy
| | - Valentina Casini
- A.S.S.T. Bergamo EST, Gastroenterology Unit, Seriate Hospital, Bergamo, Italy
| | - Viviana Gerardi
- Department of Medicine, Gastroenterology and Endoscopy, Poliambulanza foundation, Brescia, Italy
| | - Marta Ascolani
- Gastroenterology Unit, Santa Maria di Ca Foncello Hospital, Treviso, Italy
| | | | | | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Davide Stradella
- Gastroenterology Unit, A.O.U. Maggiore della Caritá, Novara, Italy
| | | | | | - Marco Daperno
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Valeria Ciardo
- Gastroenterology Unit, S. Antonio Hospital, San Daniele del Friuli, Italy
| | - Olga Maria Nardone
- Gastroenterology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico Foundation, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanna Vitale
- Gastroenterology and Endoscopy Unit, 'San Carlo' Hospital, Potenza, Italy
| | - Maria Cappello
- IBD Clinic, Gastroenterology Section, Promise, University of Palermo, Palermo, Italy
| | | | - Patrizia Alvisi
- Paediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy
| | | | - Michele Campigotto
- Academic Surgical and Health Sciences Department, Trieste University, Trieste, Italy
| | - Giorgia Bodini
- Gastroenterology chair, Internal Medicine Department, Genoa University, Italy
| | - Paola Balestrieri
- Unit of Digestive Disease of Campus Bio Medico, University of Rome, Rome, Italy
| | - Anna Viola
- IBD Unit, Department Clinical and experimental Medicine, Policlinico Messina, Messina, Italy
| | - Daniela Pugliese
- CEMAD - IBD Unit, Internal and Gastroenterology Unit, Academic Policlinic Foundation 'A. Gemelli' IRCCS, Rome, Italy
| | - Alessandro Armuzzi
- CEMAD - IBD Unit, Internal and Gastroenterology Unit, Academic Policlinic Foundation 'A. Gemelli' IRCCS, Rome, Italy
| | - Massimo C Fantini
- Gastroenterology Unit, University Hospital, AOU Cagliari, Cagliari, Italy.,Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Gionata Fiorino
- IBD Centre, Gastroenterology, Humanitas Clinical and Research Centre - IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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5
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Fantini MC, Biancone L, Dragoni G, Bezzio C, Miranda A, Ribaldone DG, Bertani A, Bossa F, Allocca M, Buda A, Mocci G, Soriano A, Guglielmi FW, Bertani L, Baccini F, Loddo E, Privitera AC, Sartini A, Viscido A, Grossi L, Casini V, Gerardi V, Ascolani M, Di Ruscio M, Casella G, Savarino E, Stradella D, Pumpo R, Cortelezzi CC, Daperno M, Ciardo V, Nardone OM, Caprioli F, Vitale G, Cappello M, Comberlato M, Alvisi P, Festa S, Campigotto M, Bodini G, Balestrieri P, Viola A, Pugliese D, Armuzzi A, Saibeni S, Fiorino G. Telemedicine and Remote Screening for COVID-19 in Inflammatory Bowel Disease Patients: Results From the SoCOVID-19 Survey. Inflamm Bowel Dis 2020; 26:e134-e136. [PMID: 33029612 PMCID: PMC7797727 DOI: 10.1093/ibd/izaa254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Massimo Caludio Fantini
- Gastroenterology Unit, University Hospital, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy,Address correspondence to: Massimo C. Fantini, MD, PhD, Department of Medical Sciences and Public Health, University of Cagliari, Italy; AOU Cagliari Presidio Ospedaliero Monserrato, Cagliari, Italy. E-mail:
| | - Livia Biancone
- Gastroenterology Unit, Policlinico Tor Vergata. Department of Systems Medicine, University of Rome, Rome, Italy
| | - Gabriele Dragoni
- Gastroenterology Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
| | - Agnese Miranda
- Gastroenterology and Endoscopy Unit, University of Campania “L. Vanvitelli” Naples, Italy
| | | | - Angela Bertani
- Department of Gastroenterology, IBD Unit, Policlinico Hospital, Modena, Italy
| | - Fabrizio Bossa
- Division of Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | - Mariangela Allocca
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andrea Buda
- Department of Gastrointestinal Oncological Surgery, Gastroenterology and Endoscopy Unit, S. Maria del Prato Hospital, Feltre, Italy
| | | | - Alessandra Soriano
- Gastroenterology Division, Azienda USL Arcispedale S. Maria Nuova, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Lorenzo Bertani
- Gastroenterology and Digestive Endoscopy Department of Medical Specialties Apuane Hospital, Tuscany North-West ASL, Massa, Italy
| | - Flavia Baccini
- Digestive Disease Unit, Sant’Andrea University Hospital, Rome, Italy
| | - Erica Loddo
- Gastroenterology Unit, University Hospital, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Alessandro Sartini
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena, AUSL della Romagna, Italy
| | - Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Laurino Grossi
- G. D’Annunzio University-Digestive Physiopathology Ospedale Spirito Santo Pescara, Pescara, Italy
| | - Valentina Casini
- ASST BERGAMO EST, Ospedale Seriate, UOC Gastroenterologia ed Endoscopia Digestiva, Bergamo, Italy
| | - Viviana Gerardi
- Department of Medicine, Gastroenterology and Endoscopy, Fondazione Poliambulanza, Brescia, Italy
| | - Marta Ascolani
- Gastroenterology Unit, Ospedale Santa Maria di Ca Foncello, Treviso, Veneto, Italy
| | - Mirko Di Ruscio
- IBD Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Giovanni Casella
- Gastroenterologist, General Practitioner, Limbiate (Monza Brianza), ATS Lecco Brianza, Lombardia, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Davide Stradella
- Gastroenterologia, A.O.U Maggiore della Caritá di Novara, Piemonte, University of Eastern Piedmont Amedeo Avogadro, Italy
| | - Rossella Pumpo
- Endoscopia Digestiva, P.O. S.G. Bosco, ASLNA1, Napoli, Campania, Italy
| | - Claudio Camillo Cortelezzi
- SC di Gastroneterologia ed Endoscopia Digestiva Ospedale di Circolo Fondazione Macchi ASST Sette Laghi Varese, Italy
| | - Marco Daperno
- Gastroenterology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Valeria Ciardo
- Struttura Operativa Semplice Dipartimentale (SOSD) di Gastroenterologia, AAS3 Alto Friuli Collinare e Medio Friuli, Ospedale di San Daniele del Friuli, Italy
| | - Olga Maria Nardone
- Gastroenterology, Federico II University Hospital, Napoli, Campania, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milano, Lombardia, Italy
| | - Giovanna Vitale
- Gastroenterology and Endoscopy Unit, “San Carlo” Hospital, Potenza, Italy
| | - Maria Cappello
- Head IBD Clinic, Gastroenterology Section, Promise, University of Palermo, Sicily, Italy
| | - Michele Comberlato
- Divisione di Gastrenterologia e Servizio di Fisiopatologia ed Endoscopia digestiva Ambulatorio interdisciplinare per le malattie infiammatorie croniche intestinali, Ospedale provinciale – Bolzano, Italy
| | | | - Stefano Festa
- S. Filippo Neri Hospital, IBD Unit, Rome, Lazio, Italy
| | - Michele Campigotto
- Diparimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | - Giorgia Bodini
- Cattedra di Gastroenterologia, Diparti-mento di Medicina Interna, Universita`di Genova, Genova, Italy
| | - Paola Balestrieri
- Unit of Digestive Disease of Campus Bio Medico University of Rome, Italy
| | - Anna Viola
- UOSD Malattie Intestinali Croniche, Dip. di Medicina Clinica e Sperimentale, Policlinico Messina, Sicily, Italy
| | - Daniela Pugliese
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Alessandro Armuzzi
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
| | - Gionata Fiorino
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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6
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Burisch J, Bergemalm D, Halfvarson J, Domislovic V, Krznaric Z, Goldis A, Dahlerup JF, Oksanen P, Collin P, de Castro L, Hernandez V, Turcan S, Belousova E, D'Incà R, Sartini A, Valpiani D, Giannotta M, Misra R, Arebi N, Duricova D, Bortlik M, Gatt K, Ellul P, Pedersen N, Kjeldsen J, Andersen KW, Andersen V, Katsanos KH, Christodoulou DK, Sebastian S, Barros L, Magro F, Midjord JM, Nielsen KR, Salupere R, Kievit HA, Kiudelis G, Kupčinskas J, Fumery M, Gower-Rousseau C, Kaimakliotis IP, Schwartz D, Odes S, Lakatos L, Lakatos PL, Langholz E, Munkholm P. The use of 5-aminosalicylate for patients with Crohn's disease in a prospective European inception cohort with 5 years follow-up - an Epi-IBD study. United European Gastroenterol J 2020; 8:949-960. [PMID: 32715989 DOI: 10.1177/2050640620945949] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The lack of scientific evidence regarding the effectiveness of 5-aminosalicylate in patients with Crohn's disease is in sharp contrast to its widespread use in clinical practice. AIMS The aim of the study was to investigate the use of 5-aminosalicylate in patients with Crohn's disease as well as the disease course of a subgroup of patients who were treated with 5-aminosalicylate as maintenance monotherapy during the first year of disease. METHODS In a European community-based inception cohort, 488 patients with Crohn's disease were followed from the time of their diagnosis. Information on clinical data, demographics, disease activity, medical therapy and rates of surgery, cancers and deaths was collected prospectively. Patient management was left to the discretion of the treating gastroenterologists. RESULTS Overall, 292 (60%) patients with Crohn's disease received 5-aminosalicylate period during follow-up for a median duration of 28 months (interquartile range 6-60). Of these, 78 (16%) patients received 5-aminosalicylate monotherapy during the first year following diagnosis. Patients who received monotherapy with 5-aminosalicylate experienced a mild disease course with only nine (12%) who required hospitalization, surgery, or developed stricturing or penetrating disease, and most never needed more intensive therapy. The remaining 214 patients were treated with 5-aminosalicylate as the first maintenance drug although most eventually needed to step up to other treatments including immunomodulators (75 (35%)), biological therapy (49 (23%)) or surgery (38 (18%)). CONCLUSION In this European community-based inception cohort of unselected Crohn's disease patients, 5-aminosalicylate was commonly used. A substantial group of these patients experienced a quiescent disease course without need of additional treatment during follow-up. Therefore, despite the controversy regarding the efficacy of 5-aminosalicylate in Crohn's disease, its use seems to result in a satisfying disease course for both patients and physicians.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Daniel Bergemalm
- Department of Gastroenterology, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Örebro University, Örebro, Sweden
| | - Viktor Domislovic
- Department of Gastroenterology, Hepatology and Nutrition, 162072University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, 162072University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Jens F Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Collin
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Luisa de Castro
- Digestive Diseases Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain.,Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Vicent Hernandez
- Digestive Diseases Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain.,Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova, Italy
| | - Alessandro Sartini
- UO Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Daniela Valpiani
- UO Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Martina Giannotta
- Department of Gastroenterology, Azienda USL Toscana Centro, Florence, Italy
| | - Ravi Misra
- IBD Department, Imperial College London, London, UK
| | - Naila Arebi
- IBD Department, Imperial College London, London, UK
| | - Dana Duricova
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.,Institute of Pharmacology, Charles University in Prague, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.,Institute of Pharmacology, Charles University in Prague, Prague, Czech Republic
| | - Kelly Gatt
- Division of Gastroenterology, 223089Mater Dei Hospital, Msida, Malta
| | - Pierre Ellul
- Division of Gastroenterology, 223089Mater Dei Hospital, Msida, Malta
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | - Karina W Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Vibeke Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | | | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, UK.,Hull York Medical School, Hull, UK
| | - Luisa Barros
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal.,Department of Biomedicine, Porto University, Porto, Portugal
| | - Jóngerð Mm Midjord
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Kári R Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Riina Salupere
- Division of Gastroenterology, University of Tarty, Tartu, Estonia
| | | | - Gediminas Kiudelis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Juozas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mathurin Fumery
- Gastroenterology Unit, 26993Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Lille University and Hospital, Lille, France.,Institute for Translational Research in Inflammation (Infinite), Lille University, Lille, France
| | | | - Doron Schwartz
- Department of Gastroenterology and Liver Diseases, 26732Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Selwyn Odes
- Department of Internal Medicine, 26732Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Laszlo Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.,Division of Gastroenterology, McGill University Health Center, Montreal, Canada
| | - Ebbe Langholz
- Department of Gastroenterology, 53176Herlev Hospital, University of Copenhagen, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
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7
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Bezzio C, Saibeni S, Variola A, Allocca M, Massari A, Gerardi V, Casini V, Ricci C, Zingone F, Amato A, Caprioli F, Lenti MV, Viganò C, Ascolani M, Bossa F, Castiglione F, Cortelezzi C, Grossi L, Milla M, Morganti D, Pastorelli L, Ribaldone DG, Sartini A, Soriano A, Manes G, Danese S, Fantini MC, Armuzzi A, Daperno M, Fiorino G. Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study. Gut 2020; 69:1213-1217. [PMID: 32354990 PMCID: PMC7242872 DOI: 10.1136/gutjnl-2020-321411] [Citation(s) in RCA: 247] [Impact Index Per Article: 61.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES COVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear. DESIGN This Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death). RESULTS Between 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death. CONCLUSIONS Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.
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Affiliation(s)
- Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy
| | - Angela Variola
- IBD Unit, Don Calabria Sacred Heart Hospital, Negrar, Veneto, Italy
| | - Mariangela Allocca
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Massari
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Milano, Lombardia, Italy
| | - Viviana Gerardi
- Medicine, Gastroenterology and Digestive Endoscopy Department, Poliambulanza Brescia Hospital, Brescia, Lombardia, Italy
| | - Valentina Casini
- UOC Gastroenterology and Digestive Endoscopy, ASST Bergamo Est, Seriate, Lombardia, Italy
| | - Chiara Ricci
- Gastroenterology Unit, ASST Spedali Civili di Brescia, Brescia, Lombardia, Italy
| | - Fabiana Zingone
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova, Veneto, Italy
| | - Arnaldo Amato
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Lombardia, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Lombardia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | - Chiara Viganò
- Gastroenterology Unit, Azienda Ospedaliera San Gerardo, Monza, Lombardia, Italy
| | - Marta Ascolani
- Gastroenterology Unit, Ospedale Santa Maria di Ca Foncello, Treviso, Veneto, Italy
| | - Fabrizio Bossa
- Division of Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | | | | | - Laurino Grossi
- Department of Medicine and Aging Science, University Gabriele d'Annunzio of Chieti and Pescara, Chieti, Abruzzo, Italy
| | - Monica Milla
- Gastroenterology Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy
| | - Daniela Morganti
- Gastreonterology Unit, ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
| | - Luca Pastorelli
- Gastroenterology Unit, IRCCS Policlinico San Danato, San Donato Milanese, Lombardia, Italy
| | - Davide Giuseppe Ribaldone
- Division of Gastroenterology, Department of Medical Sciences, University of Turin, Torino, Piemonte, Italy
| | - Alessandro Sartini
- Internal Medicine, Gastroenterology Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
| | - Alessandra Soriano
- Gastroenterology Division, Arcispedale S Maria Nuova, Reggio Emilia, Emilia-Romagna, Italy
| | - Gianpiero Manes
- Gastroenterology Unit, ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
| | - Silvio Danese
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Massimo Claudio Fantini
- Unit of Gastroenterology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Sardegna, Italy
| | - Alessandro Armuzzi
- IBD Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Lazio, Italy
| | - Marco Daperno
- Gastroenterology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Gionata Fiorino
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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8
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Burisch J, Vardi H, Schwartz D, Friger M, Kiudelis G, Kupčinskas J, Fumery M, Gower-Rousseau C, Lakatos L, Lakatos PL, D'Incà R, Sartini A, Valpiani D, Giannotta M, Arebi N, Duricova D, Bortlik M, Chetcuti Zammit S, Ellul P, Pedersen N, Kjeldsen J, Midjord JMM, Nielsen KR, Winther Andersen K, Andersen V, Katsanos KH, Christodoulou DK, Domislovic V, Krznaric Z, Sebastian S, Oksanen P, Collin P, Barros L, Magro F, Salupere R, Kievit HAL, Goldis A, Kaimakliotis IP, Dahlerup JF, Eriksson C, Halfvarson J, Fernandez A, Hernandez V, Turcan S, Belousova E, Langholz E, Munkholm P, Odes S. Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up: a population-based study. Lancet Gastroenterol Hepatol 2020; 5:454-464. [PMID: 32061322 DOI: 10.1016/s2468-1253(20)30012-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [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: 11/13/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) places a significant burden on health-care systems because of its chronicity and need for expensive therapies and surgery. With increasing use of biological therapies, contemporary data on IBD health-care costs are important for those responsible for allocating resources in Europe. To our knowledge, no prospective long-term analysis of the health-care costs of patients with IBD in the era of biologicals has been done in Europe. We aimed to investigate cost profiles of a pan-European, community-based inception cohort during 5 years of follow-up. METHODS The Epi-IBD cohort is a community-based, prospective inception cohort of unselected patients with IBD diagnosed in 2010 at centres in 20 European countries plus Israel. Incident patients who were diagnosed with IBD according to the Copenhagen Diagnostic Criteria between Jan 1, and Dec 31, 2010, and were aged 15 years or older the time of diagnosis were prospectively included. Data on clinical characteristics and direct costs (investigations and outpatient visits, blood tests, treatments, hospitalisations, and surgeries) were collected prospectively using electronic case-report forms. Patient-level costs incorporated procedures leading to the initial diagnosis of IBD and costs of IBD management during the 5-year follow-up period. Costs incurred by comorbidities and unrelated to IBD were excluded. We grouped direct costs into the following five categories: investigations (including outpatient visits and blood tests), conventional medical treatment, biological therapy, hospitalisation, and surgery. FINDINGS The study population consisted of 1289 patients with IBD, with 1073 (83%) patients from western Europe and 216 (17%) from eastern Europe. 488 (38%) patients had Crohn's disease, 717 (56%) had ulcerative colitis, and 84 (6%) had IBD unclassified. The mean cost per patient-year during follow-up for patients with IBD was €2609 (SD 7389; median €446 [IQR 164-1849]). The mean cost per patient-year during follow-up was €3542 (8058; median €717 [214-3512]) for patients with Crohn's disease, €2088 (7058; median €408 [133-1161]) for patients with ulcerative colitis, and €1609 (5010; median €415 [92-1228]) for patients with IBD unclassified (p<0·0001). Costs were highest in the first year and then decreased significantly during follow-up. Hospitalisations and diagnostic procedures accounted for more than 50% of costs during the first year. However, in subsequent years there was a steady increase in expenditure on biologicals, which accounted for 73% of costs in Crohn's disease and 48% in ulcerative colitis, in year 5. The mean annual cost per patient-year for biologicals was €866 (SD 3056). The mean yearly costs of biological therapy were higher in patients with Crohn's disease (€1782 [SD 4370]) than in patients with ulcerative colitis (€286 [1427]) or IBD unclassified (€521 [2807]; p<0·0001). INTERPRETATION Overall direct expenditure on health care decreased over a 5-year follow-up period. This period was characterised by increasing expenditure on biologicals and decreasing expenditure on conventional medical treatments, hospitalisations, and surgeries. In light of the expenditures associated with biological therapy, cost-effective treatment strategies are needed to reduce the economic burden of inflammatory bowel disease. FUNDING Kirsten og Freddy Johansens Fond and Nordsjællands Hospital Forskningsråd.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark.
| | - Hillel Vardi
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Schwartz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Liver Diseases, Soroka Medical Centre, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gediminas Kiudelis
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Juozas Kupčinskas
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University, Lille, France; Lille Inflammation Research International Center LIRIC, Lille University, Lille, France
| | - Laszlo Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - Renata D'Incà
- Department of Surgical, Oncological, and Gastroenterological Sciences, Azienda, University of Padua, Padua, Italy
| | - Alessandro Sartini
- Gastroenterology Unit, Bufalini Hospital Cesena, AUSL della Romagna, Rimini, Italy
| | - Daniela Valpiani
- UO Gastroenterologia ed Endoscopia Digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | | | - Naila Arebi
- Inflammatory Bowel Disease Department, Imperial College London, London, UK
| | - Dana Duricova
- Inflammatory Bowel Disease Clinical and Research Centre, ISCARE, Prague, Czech Republic
| | - Martin Bortlik
- Inflammatory Bowel Disease Clinical and Research Centre, ISCARE, Prague, Czech Republic; Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | | | - Kári Rubek Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | | | - Vibeke Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark; Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Konstantinos H Katsanos
- Division of Gastroenterology, School of Health Sciences, University Hospital and University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, School of Health Sciences, University Hospital and University of Ioannina, Ioannina, Greece
| | - Viktor Domislovic
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, UK; Hull York Medical School, Hull, UK
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Collin
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Luisa Barros
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal; Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine, Porto University, Porto, Portugal
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | | | - Adrian Goldis
- Clinic of Gastroenterology, Victor Babeş University of Medicine, Timisoara, Romania
| | | | - Jens F Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Vicent Hernandez
- Department of Gastroenterology, Instituto de Investigación Sanitaria Galicia Sur, Hospital Alvaro Cunqueiro, Xerencia Xestion Integrada de Vigo, Vigo, Spain
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Moldova
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Selwyn Odes
- Department of Internal Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
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9
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Pugliese D, Daperno M, Fiorino G, Savarino E, Mosso E, Biancone L, Testa A, Sarpi L, Cappello M, Bodini G, Caprioli F, Festa S, Laino G, Maconi G, Mazzuoli S, Mocci G, Sartini A, D'Amore A, Alivernini S, Gremese E, Armuzzi A. Real-life effectiveness of ustekinumab in inflammatory bowel disease patients with concomitant psoriasis or psoriatic arthritis: An IG-IBD study. Dig Liver Dis 2019; 51:972-977. [PMID: 30992173 DOI: 10.1016/j.dld.2019.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/18/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few data exist regarding the effectiveness of ustekinumab in inflammatory bowel disease (IBD) patients treated for concomitant psoriasis or psoriatic arthritis. AIMS to describe the outcomes of IBD patients who received subcutaneous ustekinumab through a dermatological or rheumatological prescription. METHODS This multicenter, retrospective study included all IBD patients who were started on ustekinumab for concomitant active psoriasis/ psoriatic arthritis, irrespective of IBD activity. The primary endpoint was overall ustekinumab persistence, defined as the maintenance of therapy because of sustained clinical benefit for IBD. RESULTS Seventy patients (64 Crohn's disease / 6 ulcerative colitis) were enrolled. The median follow-up on ustekinumab therapy was 10.7 months (range, 1.4-67.3). Twelve patients (17.1%) withdrew the treatment after a median of 7.4 months (range, 0.9-23.8). The cumulative probability of maintaining ustekinumab treatment was 97.1% at 6 months and 77.1% at 12 months. Among the 56 patients with baseline active IBD, 34 (60.7%) were in clinical remission at the last follow-up visit. Their cumulative probability of achieving clinical remission was 84.7% and 63.9% at 6 and 12 months, respectively. Two patients stopped ustekinumab for an adverse event. CONCLUSIONS Subcutaneous ustekinumab had a good effectiveness profile for IBD patients treated for concomitant dermatological or rheumatological conditions.
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Affiliation(s)
- Daniela Pugliese
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Daperno
- Gastroenterology Unit, A.O. Ordine Mauriziano, Turin, Italy
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department Surgery, Oncology and Gastroenterology, University of Padua, Italy
| | - Elena Mosso
- General and Specialistic Medicine/Gastroenterology, Città della Salute e della Scienza di Torino, Italy
| | - Livia Biancone
- University of Rome Tor Vergata, Department of Systems Medicine, Gastroenterology, Rome, Italy
| | - Anna Testa
- Federico II University, Gastroenterology, Naples, Italy
| | - Lucio Sarpi
- Gastroenterologia ed Endoscopia Digestiva Aziendale USL Umbria1, Perugia, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, DiBiMis, University of Palermo, Palermo, Italy
| | - Giorgia Bodini
- Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, University of Milan and Gastroenterology and Endoscopy Unit, IRCCS Cà Granda, IRCCS Policlinico Hospital, Milan, Italy
| | | | - Gabriella Laino
- Department of New Technologies and Translational Research in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Maconi
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Silvia Mazzuoli
- Gastroenterology Unit, San Nicola Pellegrino Hospital, Trani, Italy
| | - Giammarco Mocci
- Division of Gastroenterology, "Brotzu" Hospital, Cagliari, Italy
| | - Alessandro Sartini
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra D'Amore
- Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
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10
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Sartini A, Scaioli E, Liverani E, Bellanova M, Ricciardiello L, Bazzoli F, Belluzzi A. Retention Rate, Persistence and Safety of Adalimumab in Inflammatory Bowel Disease: A Real-Life, 9-Year, Single-Center Experience in Italy. Dig Dis Sci 2019; 64:863-874. [PMID: 30334112 DOI: 10.1007/s10620-018-5329-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/26/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND "Real-life" data of retention rate and persistence of adalimumab in inflammatory bowel disease are still limited. AIMS To analyze retention rate, persistence, and safety of adalimumab in a 9-year real-life cohort of inflammatory bowel disease patients. METHODS In this observational, retrospective single-center study, all adult patients treated with adalimumab as the first- and second-line biological treatment for steroid-dependent or refractory inflammatory bowel disease between March 2008 and March 2017 were included. Primary outcomes were persistence, retention rate, and adverse events; the secondary outcome was the identification of predictors of withdrawal. RESULTS Ninety-six out of 181 patients (53%) withdrew their first course of adalimumab. The retention rate was 47% and 46.9% in Crohn's disease and ulcerative colitis patients, respectively; median persistence was 26 and 24 months in CD and UC patients, respectively. The cumulative probability of treatment persistence was 80.2%, 54.5%, and 29.6% and 69.6%, 40.4%, and 21.5% in CD and UC patients, respectively. The incidence rate of any adverse event was 12.5/100 patients-year; severe adverse events were 1.7/100 patients-year. The Cox regression revealed that CD patients with baseline disease duration > 72 months have a higher likelihood for withdrawal due to failure and/or adverse events (HR 1.62, 95% CI 1-2.62, p = 0.04); no predictors of discontinuation were found in UC. CONCLUSIONS Adalimumab showed a great persistence in the first 12 months of therapy and excellent safety profile. Early treatment of CD patients could increase efficacy and reduce the adverse event rate.
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Affiliation(s)
- Alessandro Sartini
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Elisa Liverani
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Matteo Bellanova
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Andrea Belluzzi
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
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Scaioli E, Sartini A, Bellanova M, Campieri M, Festi D, Bazzoli F, Belluzzi A. Eicosapentaenoic Acid Reduces Fecal Levels of Calprotectin and Prevents Relapse in Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol 2018; 16:1268-1275.e2. [PMID: 29391271 DOI: 10.1016/j.cgh.2018.01.036] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS High fecal levels of calprotectin indicate mucosal inflammation and have been shown to predict relapse in patients with ulcerative colitis (UC). Eicosapentaenoic acid (EPA), the major component of n-3 fish oil, has anti-inflammatory properties in patients with chronic inflammatory disorders. We performed a placebo-controlled trial of patients with UC at risk of relapse to determine the ability of the free fatty acid form of EPA (EPA-FFA) to reduce intestinal inflammation, using fecal level of calprotectin as a marker. METHODS From June 2014 to May 2016, 60 patients with UC with a partial Mayo score < 2 and fecal calprotectin ≥150 μg/g, in stable therapy for at least the 3 previous months, were randomly assigned to groups (1:1) given either EPA-FFA (500 mg, twice daily) or placebo for 6 months. A colonoscopy was performed at baseline. Clinical assessments and measurements of fecal calprotectin were made at baseline, at study months 3 and 6, or the time of clinical relapse. Patients with a relapse of UC underwent a second colonoscopy. The primary end point was a 100-point reduction in fecal levels of calprotectin at 6 months from the baseline value; the secondary end point was maintenance of clinical remission at 6 months. RESULTS The primary end point was achieved by 19 of 30 patients (63.3%) in the EPA-FFA group vs 4 of 30 patients (13.3%) in the placebo group (odds ratio, 12.0; 95% CI, 3.12-46.24; P < .001). The secondary end point was achieved by 23 of 30 patients (76.7%) in the EPA-FFA group vs 15 of 30 (50%) patients in the placebo group (OR, 3.29; 95% CI, 1.08-9.95; P = .035). No serious adverse events were observed. CONCLUSIONS In a placebo-controlled trial of 60 patients with UC, we found 6 months' administration of EPA-FFA to reduce fecal levels of calprotectin with no serious adverse events. This agent might be used to induce and maintain symptom-free remission in patients with UC. ClinicalTrials.gov number: NCT02179372.
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Affiliation(s)
- Eleonora Scaioli
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Sartini
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Bellanova
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Massimo Campieri
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Belluzzi
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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12
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Bianchini M, Cavani G, Bonaccorso A, Turco L, Vizzutti F, Sartini A, Gitto S, Merighi A, Banchelli F, Villa E, Schepis F. Low molecular weight heparin does not increase bleeding and mortality post-endoscopic variceal band ligation in cirrhotic patients. Liver Int 2018; 38:1253-1262. [PMID: 29469184 DOI: 10.1111/liv.13728] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 10/12/2017] [Accepted: 02/12/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Anticoagulants are commonly indicated in cirrhotic patients due to high rate of (pro)thrombotic conditions. Low molecular weight heparin (LMWH) is safe in patients with esophageal varices. However, the safety of LMWH is unknown in patients undergoing prophylactic endoscopic variceal ligation (EVL). To define the 4-week risk of bleeding and death after prophylactic EVL in cirrhotic patients continuously treated with LMWH. METHODS All EVLs performed at a tertiary Italian Center from 2009 to 2016 were retrospectively reviewed. Patients treated with LMWH were classified as on-LMWH; the remaining as no-LMWH. Endoscopic characteristics at first and index EVL (that preceding an endoscopy either showing a bleeding episode or the absence of further treatable varices) and clinical events within 4 weeks from the procedures were recorded. RESULTS AND CONCLUSIONS Five hundred fifty-three EVLs were performed in 265 patients (in 215 as a primary prophylaxis): 169 EVLs in 80 on-LMWH and 384 in 185 no-LMWH (4.9 ± 1.1 vs 4.8 ± 1.0 bands/session, respectively; P = .796). Six patients bled (2.2%) without between-groups difference (3.8% on-LMWH vs 1.6% no-LMWH, Log-rank P = .291). Large varices with red marks (100% vs 51.4%, P = .032), number of bands (5.6 ± 0.5 vs 4.6 ± 1.2, P = .004), underlying portal vein thrombosis (66.7% vs 23.6%, P = .033), and creatinine (2.2 ± 2.7 vs 1.0 ± 0.8 mg/dL, P = .001) at index EVL were significantly different between bleeders and non-bleeders. Six patients died within 4-week from index EVL, without between-groups difference (2.5% on-LMWH vs 2.2% no-LMWH, Log-rank P = .863). LMWH does not increase the risk of post-procedural bleeding and does not affect survival of cirrhotic patients undergoing prophylactic EVL.
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Affiliation(s)
- Marcello Bianchini
- Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Cavani
- Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Ambra Bonaccorso
- Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Turco
- Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Vizzutti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Sartini
- Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Gitto
- Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Merighi
- Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Banchelli
- Statistics Unit, Department of Clinical, Diagnostic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Villa
- Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Schepis
- Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
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13
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Gitto S, Guarneri V, Sartini A, Andreone P. The use of obeticholic acid for the management of non-viral liver disease: current clinical practice and future perspectives. Expert Rev Gastroenterol Hepatol 2018; 12:165-171. [PMID: 29082798 DOI: 10.1080/17474124.2018.1399060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/15/2022]
Abstract
Farnesoid X nuclear receptor is involved in the regulation of lipid and glucose metabolism, though mainly in the homeostasis of bile acids. Indeed, the agonists of farnesoid X nuclear receptor represent promising drugs. Areas covered: Obeticholic acid, a novel semisynthetic analogue of the naturally occurring bile acid, has led to encouraging preliminary results in both cholestatic and metabolic liver disease. In patients with primary biliary cholangitis, obeticholic acid determines a significant biochemical improvement although the effects on liver fibrosis are lacking. Obeticholic acid has been suggested for the treatment of nonalcoholic liver disease with good laboratory results. In cirrhotic animal models, the drug seems to reduce both portal hypertension and gut bacterial translocation. Expert commentary: The use of obeticholic acid for the treatment of primary biliary cholangitis shows satisfying results. However, some open questions remain unresolved. Herein, we provide an overview of the current knowledge about the use of obeticholic acid in the field of nonviral chronic liver diseases. We tried to give a global point of view using a translational approach.
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Affiliation(s)
- Stefano Gitto
- a Department of Medical and Surgical Sciences , University of Bologna and Azienda Ospedaliero-Universitaria di Bologna , Bologna , Italy.,b Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche , University of Bologna , Bologna , Italy
| | - Valeria Guarneri
- a Department of Medical and Surgical Sciences , University of Bologna and Azienda Ospedaliero-Universitaria di Bologna , Bologna , Italy.,b Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche , University of Bologna , Bologna , Italy
| | - Alessandro Sartini
- c Department of Gastroenterology , University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena , Modena , Italy
| | - Pietro Andreone
- a Department of Medical and Surgical Sciences , University of Bologna and Azienda Ospedaliero-Universitaria di Bologna , Bologna , Italy.,b Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche , University of Bologna , Bologna , Italy
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14
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Sartini A, Gitto S, Bianchini M, Verga MC, Di Girolamo M, Bertani A, Del Buono M, Schepis F, Lei B, De Maria N, Villa E. Non-alcoholic fatty liver disease phenotypes in patients with inflammatory bowel disease. Cell Death Dis 2018; 9:87. [PMID: 29367619 PMCID: PMC5833704 DOI: 10.1038/s41419-017-0124-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) can be detected in up to 33.6% of inflammatory bowel disease (IBD) patients, often in absence of metabolic risk factors. Nevertheless, most of previous studies on such issue were conducted within the IBD population only. The primary aim of this study was to compare clinical and metabolic features of NAFLD in patients with and without IBD (w/o IBD) and to identify specific NAFLD phenotypes within the IBD population. Among 223 NAFLD patients, 78 patients with IBD were younger compared to 145 without (w/o) IBD, were less likely to have altered liver enzymes, had lower mean body weight, smaller waist circumference and lower body mass index (BMI); at the same time, MetS was more prevalent among patients w/o IBD (56.6 vs. 23.1%, p < 0.001). Within IBD population, patients with severe IBD showed more often severe steatosis (S3) at ultrasound (US) (32.1 vs. 16.6%, p = 0.01), compared to mild-to-moderate disease. Independent risk factors for S3 US steatosis in IBD patients at the multivariate logistic regression analysis were: more than 1 IBD relapse per year during disease history (OR 17.3, 95% CI 3.6-84), surgery for IBD (OR 15.1, 95% CI 3.1-73.7) and more extensive intestinal involvement (OR 19.4, 95% CI 3.4-110.9); the ongoing anti-Tumor Necrosis Factor alpha (antiTNFα) therapy was the only independent factor which protect toward the presence of altered liver enzymes (OR 0.15, 95% CI 0-0.8, p = 0.02). In conclusion, NAFLD in IBD patients is different from that in patients w/o IBD, who seem to develop different NAFLD phenotypes according to intestinal disease clinical course. More severe IBD seem to predict the presence of more severe steatosis. Therapy with antiTNFα antibodies could prevent alteration of liver enzymes in such population.
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Affiliation(s)
- Alessandro Sartini
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Gitto
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcello Bianchini
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Chiara Verga
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Di Girolamo
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Angela Bertani
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Mariagrazia Del Buono
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Schepis
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Lei
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola De Maria
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Villa
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy.
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15
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Agostini A, Ballotta D, Righi S, Moretti M, Bertani A, Scarcelli A, Sartini A, Ercolani M, Nichelli P, Campieri M, Benuzzi F. Stress and brain functional changes in patients with Crohn's disease: A functional magnetic resonance imaging study. Neurogastroenterol Motil 2017; 29:1-10. [PMID: 28560758 DOI: 10.1111/nmo.13108] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 12/10/2016] [Accepted: 04/17/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND In Crohn's disease (CD) patients, stress is believed to influence symptoms generation. Stress may act via central nervous system pathways to affect visceral sensitivity and motility thus exacerbating gastrointestinal symptoms. The neural substrate underpinning these mechanisms needs to be investigated in CD. We conducted an explorative functional magnetic resonance imaging (fMRI) study in order to investigate potential differences in the brain stress response in CD patients compared to controls. METHODS 17 CD patients and 17 healthy controls underwent a fMRI scan while performing a stressful task consisting in a Stroop color-word interference task designed to induce mental stress in the fMRI environment. KEY RESULTS Compared to controls, in CD patients the stress task elicited greater blood oxygen level dependent (BOLD) signals in the midcingulate cortex (MCC). CONCLUSIONS & INFERENCES The MCC integrate "high" emotional processes with afferent sensory information ascending from the gut. In light of these integrative functions, the stress-evoked MCC hyperactivity in CD patients might represent a plausible neural substrate for the association between stress and symptomatic disease. The MCC dysfunction might be involved in mechanisms of central disinhibition of nociceptive inputs leading to amplify the visceral sensitivity. Finally, the stress-evoked MCC hyperactivity might affect the regulation of intestinal motility resulting in exacerbation of disease symptoms and the autonomic and neuroendocrine regulation of inflammation resulting in enhanced inflammatory activity.
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Affiliation(s)
- A Agostini
- Department of Experimental, Diagnostic, and Specialty Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Department of Psychology, University of Bologna, Bologna, Italy
| | - D Ballotta
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - S Righi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - M Moretti
- Department of Experimental, Diagnostic, and Specialty Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A Bertani
- Department of Gastroenterology, IBD Unit, Policlinico Hospital, Modena, Italy
| | - A Scarcelli
- Department of Gastroenterology, IBD Unit, Policlinico Hospital, Modena, Italy
| | - A Sartini
- Department of Gastroenterology, IBD Unit, Policlinico Hospital, Modena, Italy
| | - M Ercolani
- Department of Experimental, Diagnostic, and Specialty Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Department of Psychology, University of Bologna, Bologna, Italy
| | - P Nichelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - M Campieri
- Department of Clinical Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - F Benuzzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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16
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Di Girolamo M, Sartini A, Critelli R, Bertani A, Merighi A, Villa E. Efficacy of a Novel Granulocyte Monocyte Apheresis Adsorber Device in the Treatment of Inflammatory Bowel Diseases: A Pilot Study. Ther Apher Dial 2016; 20:668-676. [PMID: 27921374 DOI: 10.1111/1744-9987.12453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/10/2016] [Accepted: 05/16/2016] [Indexed: 12/22/2022]
Abstract
Granulocyte monocyte apheresis (GMA) is a non-pharmacological treatment for inflammatory bowel disease. In our study, we tested a novel GMA adsorber device in terms of clinical efficacy and safety in patients' non-response to pharmacological therapy. Secondary outcomes were the evaluation of adsorber's technical performance, the reduction of inflammatory markers and the improvement of patients' life quality. The prospective study included 18 patients enrolled from 2011 to 2012 with a monitoring of 48 weeks. All patients with Crohn's disease achieved a clinical remission after GMA treatments, sustained until the end of follow up, while 80% of ulcerative colitis patients obtained a clinical benefit, maintained after 48 weeks of monitoring. Leukocytes, neutrophils, monocytes and platelets, compared to erythrocytes and lymphocytes, were effectively removed from peripheral blood. There was no statistically significant result about serological markers of inflammation. A consistent improvement of the patients' quality of life was observed up to the end of follow up. No significant side-effects were recorded. Our study underlines the efficacy and the safety of this novel GMA adsorber device; a prospective randomized clinical trial with adequate sample size should be performed.
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Affiliation(s)
- Maria Di Girolamo
- Department of Internal Medicine, Gastroenterology Unit, University Hospital of Modena, Modena, Italy
| | - Alessandro Sartini
- Department of Internal Medicine, Gastroenterology Unit, University Hospital of Modena, Modena, Italy
| | - Rosina Critelli
- Department of Internal Medicine, Gastroenterology Unit, University Hospital of Modena, Modena, Italy
| | - Angela Bertani
- Department of Internal Medicine, Gastroenterology Unit, University Hospital of Modena, Modena, Italy
| | - Alberto Merighi
- Department of Internal Medicine, Gastroenterology Unit, University Hospital of Modena, Modena, Italy
| | - Erica Villa
- Department of Internal Medicine, Gastroenterology Unit, University Hospital of Modena, Modena, Italy
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Sartini A, Scaioli E, Belluzzi A. Is Early Endoscopy-Based Therapy the Best Strategy to Prevent All Crohn's Disease Postoperative Recurrence? Gastroenterology 2016; 151:1040-1041. [PMID: 27702633 DOI: 10.1053/j.gastro.2016.08.058] [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] [Received: 07/04/2016] [Accepted: 08/16/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Alessandro Sartini
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andrea Belluzzi
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
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Bedini A, De Maria N, Del Buono M, Bianchini M, Mancini M, Binda C, Brasacchio A, Orlando G, Franceschini E, Meschiari M, Sartini A, Zona S, Paioli S, Villa E, Gyssens IC, Mussini C. Antimicrobial stewardship in a Gastroenterology Department: Impact on antimicrobial consumption, antimicrobial resistance and clinical outcome. Dig Liver Dis 2016; 48:1142-7. [PMID: 27453168 DOI: 10.1016/j.dld.2016.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 05/04/2016] [Revised: 06/04/2016] [Accepted: 06/20/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials. AIMS To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program in an Italian Gastroenterology Department. METHODS Between October 2014 and September 2015 (period B), a specialist in infectious diseases (ID) controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists. The defined daily doses of antimicrobials (DDDs), incidence of MDR-infections, mean length of stay and overall in-hospital mortality rate were compared with those of the same period in the previous 12-months (period A). RESULTS During period B, the ID specialist performed 304 consultations: antimicrobials were continued in 44.4% of the cases, discontinued in 13.8%, not recommended in 12.1%, de-escalated 9.9%, escalated in 7.9%, and started in 4.0%. Comparing the 2 periods, we observed a decreased of antibiotics consumption (from 109.81 to 78.45 DDDs/100 patient-days, p=0.0005), antifungals (from 41.28 to 24.75 DDDs/100pd, p=0.0004), carbapenems (from 15.99 to 6.80 DDDsx100pd, p=0.0032), quinolones (from 35.79 to 17.82 DDDsx100pd, p=0.0079). No differences were observed in incidence of MDR-infections, length of hospital stay (LOS), and mortality rate. CONCLUSIONS ASP program had a positive impact on reducing the consumption of antimicrobials, without an increase in LOS and mortality.
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Affiliation(s)
- Andrea Bedini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
| | - Nicola De Maria
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Mariagrazia Del Buono
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Marcello Bianchini
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Mauro Mancini
- Pharmaceutical Department, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Cecilia Binda
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Andrea Brasacchio
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Gabriella Orlando
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Erica Franceschini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Marianna Meschiari
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Alessandro Sartini
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Stefano Zona
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Serena Paioli
- Pharmaceutical Department, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Erica Villa
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Inge C Gyssens
- Department of Infectious Diseases, Hasselt University, Belgium
| | - Cristina Mussini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
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Sartini A, Verga MC, Marzi L, De Maria N, Villa E. BactDNA as an Independent Risk Factor for Short-Term Crohn's Disease Recurrence. Am J Gastroenterol 2016; 111:1500-1501. [PMID: 27694860 DOI: 10.1038/ajg.2016.333] [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: 12/11/2022]
Affiliation(s)
- Alessandro Sartini
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria di Modena, Policlinico, Modena, Italy
| | - Maria Chiara Verga
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria di Modena, Policlinico, Modena, Italy
| | - Luca Marzi
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria di Modena, Policlinico, Modena, Italy
| | - Nicola De Maria
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria di Modena, Policlinico, Modena, Italy
| | - Erica Villa
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria di Modena, Policlinico, Modena, Italy
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Sartini A, Bianchini M, Schepis F, Marzi L, De Maria N, Villa E. Complete resolution of non-necrotizing lung granuloma and pyoderma gangrenosum after restorative proctocolectomy in a woman with severe ulcerative colitis and cytomegalovirus infection. Clin Case Rep 2016; 4:195-202. [PMID: 26862424 PMCID: PMC4736519 DOI: 10.1002/ccr3.464] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 12/13/2022] Open
Abstract
Here, we report the unusual case of an ulcerative colitis female patient presenting together with cytomegalovirus infection, pyoderma gangrenosum and a noncaseating lung granuloma, both resistant to immunomodulatory drugs which dramatically obtained a clinical stable remission after restorative proctocolectomy.
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Affiliation(s)
- Alessandro Sartini
- Gastroenterology Unit Policlinico di Modena Via Del Pozzo 71 41124 Modena Italy
| | - Marcello Bianchini
- Gastroenterology Unit Policlinico di Modena Via Del Pozzo 71 41124 Modena Italy
| | - Filippo Schepis
- Gastroenterology Unit Policlinico di Modena Via Del Pozzo 71 41124 Modena Italy
| | - Luca Marzi
- Gastroenterology Unit Policlinico di Modena Via Del Pozzo 71 41124 Modena Italy
| | - Nicola De Maria
- Gastroenterology Unit Policlinico di Modena Via Del Pozzo 71 41124 Modena Italy
| | - Erica Villa
- Gastroenterology Unit Policlinico di Modena Via Del Pozzo 71 41124 Modena Italy
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Sartini A, Leonardi F, Gitto S, Di Girolamo M, Villa E. Letter: TNFα inhibitors and prevalence of fatty liver disease in chronic inflammatory diseases. Aliment Pharmacol Ther 2015; 42:489. [PMID: 26179764 DOI: 10.1111/apt.13277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
- A Sartini
- Gastroenterology Unit, Policlinico di Modena, Modena, Italy.
| | - F Leonardi
- Gastroenterology Unit, Policlinico di Modena, Modena, Italy
| | - S Gitto
- Gastroenterology Unit, Policlinico di Modena, Modena, Italy
| | - M Di Girolamo
- Gastroenterology Unit, Policlinico di Modena, Modena, Italy
| | - E Villa
- Gastroenterology Unit, Policlinico di Modena, Modena, Italy
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22
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Sartini A, Di Girolamo M, Scarcelli A, Bertani A, Marzi L, Lasagni C, Merighi A, Villa E. Letter: TNFα blockers and psoriasis: a 'reasonable paradox' - the role of TH-17 cells. Aliment Pharmacol Ther 2014; 39:1244-6. [PMID: 24735146 DOI: 10.1111/apt.12705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 02/23/2014] [Accepted: 02/25/2014] [Indexed: 02/07/2023]
Affiliation(s)
- A Sartini
- Gastroenterology Unit, Policlinico di Modena, Modena, Italy.
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Di Girolamo M, Bertani A, Scarcelli A, Longobardi P, Sartini A, Boarino V, Primerano A, Merighi A, Villa E. P.08.11 HYPERBARIC OXIGEN (HBO) THERAPY IN CROHN'S CUTANEOUS DISEASE (CCD): OUR EXPERIENCE IN PATIENTS NON RESPONDER AT BIOLOGICAL THERAPY. Dig Liver Dis 2013. [DOI: 10.1016/s1590-8658(13)60411-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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24
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Roda G, Caponi A, Sartini A, Cevenini M, Colliva C, Roda A. Update on current applications of proteomic in the study of inflammatory bowel disease. Ann Gastroenterol 2012; 25:303-308. [PMID: 24714261 PMCID: PMC3959427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 05/15/2012] [Indexed: 11/23/2022] Open
Abstract
Ulcerative colitis and Crohn's disease are relapsing and remitting chronic disorders. So far, endoscopy is the gold standard for their diagnosis, but less invasive diagnostic biomarkers are needed. Many authors have developed techniques to individuate biomarkers such as genetic testing factor or proteins in biological samples such as serum, plasma, and cellular subpopulations. A protein fingerprint pattern, patient-unique, specific for the diagnosis of inflammatory bowel disease (IBD) and potentially able to predict the future patterns of disease and to help in diagnosis, treatment, and prognosis is of increasing interest among researchers. Nowadays, a proteomic approach may be used in the identification of major alterations of proteins in IBD, but there is still a lack in the identification of a panel of biomarkers among a significant number of patients in large clinical trials. In this review, we analyze and report the current knowledge in proteomic application and strategies in the study of IBD.
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Affiliation(s)
- Giulia Roda
- Gastroenterology Unit, S. Orsola-Malpighi Hospital (Giulia Roda, Alessandra Caponi, Alessandro Sartini),Correspondence to: Prof. Aldo Roda, Department of Pharmaceutical Sciences, University of Bologna, Via Belmeloro 6, I-40126, Italy, e-mail:
| | - Alessandra Caponi
- Gastroenterology Unit, S. Orsola-Malpighi Hospital (Giulia Roda, Alessandra Caponi, Alessandro Sartini)
| | - Alessandro Sartini
- Gastroenterology Unit, S. Orsola-Malpighi Hospital (Giulia Roda, Alessandra Caponi, Alessandro Sartini)
| | - Monica Cevenini
- Department of Clinical Medicine, University of Bologna, S. Orsola Hospital (Monica Cevenini)
| | - Carolina Colliva
- Department of Pharmaceutical Sciences, University of Bologna (Carolina Collina, Aldo Roda), Bologna, Italy
| | - Aldo Roda
- Department of Pharmaceutical Sciences, University of Bologna (Carolina Collina, Aldo Roda), Bologna, Italy
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25
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Tuci A, Tonon F, Castellani L, Sartini A, Roda G, Marocchi M, Caponi A, Munarini A, Rosati G, Ugolini G, Fuccio L, Scagliarini M, Bazzoli F, Belluzzi A. Fecal detection of Mycobacterium avium paratuberculosis using the IS900 DNA sequence in Crohn's disease and ulcerative colitis patients and healthy subjects. Dig Dis Sci 2011; 56:2957-62. [PMID: 21484317 DOI: 10.1007/s10620-011-1699-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [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: 01/10/2011] [Accepted: 03/25/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Despite the increasing evidence of MAP/DNA isolation in Crohn's disease (CD), its potential pathogenetic role remains unclear. To further clarify the possible relationship between MAP and CD, we investigated the presence of IS900 DNA fragment in feces from Crohn's disease and ulcerative colitis (UC) patients and from healthy controls (HC). METHODS Stool samples were collected from 31 CD, 20 UC, and 23 HC and stored at -20°C in 200-mg aliquots. DNA was extracted. MAP presence was detected with a specific PCR amplifying a 409-bp fragment from IS900. The specificity of PCR for IS900 was confirmed sequencing three positive products. Statistical analysis was performed using the Chi-square test. RESULTS Twenty-one of 31 CD (68%), 13 of 20 UC (65%) and 11 of 23 HC (48%) were MAP-positive (CD vs. HC: p = ns; UC vs. HC: p = ns). With the limits of a small sample size, the IS900-positive percentage in CD and UC was higher than HC, although the difference was not statistically significant. CONCLUSIONS The possibility to track the MAP presence in human feces represents a new approach to the "MAP hypothesis". Detection of MAP DNA in feces is very common, reaching very high prevalence both in CD and in UC and even in HC. Our findings seem consistent with a high prevalence of MAP asymptomatic infection among the general population and so the possible involvement of MAP in CD pathogenesis could be linked to a specific immune defective response.
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Affiliation(s)
- Anna Tuci
- Department of Internal Medicine and Gastroenterology, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
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Castellani L, Sartini A, Marocchi M, Balbi T, Belluzzi A. Splenic granulomas in a patient with severe Crohn's disease associated with multiple extraintestinal manifestations. Inflamm Bowel Dis 2011; 17:E35-7. [PMID: 21319276 DOI: 10.1002/ibd.21665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 01/06/2011] [Indexed: 02/06/2023]
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Sartini A, Castellani L, Buonfiglioli F, Roda G, Belluzzi A, Roda E. Update on Crohn's disease: a polymorphic entity. MINERVA GASTROENTERO 2011; 57:89-96. [PMID: 21372773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Crohn's disease is a chronic transmural inflammatory disease that most commonly affects the intestinal wall, but may also occur in any part of the gastrointestinal tract; its incidence is higher in industrialized countries, urban areas and upper socioeconomic classes. Various environmental risk factors have been associated with the pathogenesis of Crohn's disease and possible infectious agents (viruses, bacteria, yeasts) have also been considered. However, none of these factors alone leads to the development of the disease, which may occur only when there is a genetic predisposition and/or an abnormal function of the intestinal immune system. Histopathology demonstrates mucosal hyperemia, with small superficial ulcers in mild forms of the disease; in moderate-to-severe forms, serpiginous ulcerations demarcating areas of edematous mucosa produce the characteristic "cobblestone" appearance. The earliest microscopic lesions appear as neutrophil-mediated cryptic damage, with the formation of focal cryptic abscesses and granulomas throughout the layers of the intestinal wall. In addition to weight loss, patients mainly refer chronic diarrhea and recurrent right iliac fossa abdominal pain. Extraintestinal manifestations include ocular or articular complications. There are several drugs classes available for treating Crohn's disease, but the therapeutic approach depends on the clinical picture and differs from patient to patient. The broad clinical and the histopathological features of Crohn's disease make it a highly polymorphic entity. Diagnostic tests and a thorough knowledge of its various aspects are essential for guiding diagnosis and treatment.
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Affiliation(s)
- A Sartini
- Department of Clinical Medicine, University of Bologna, Bologna, Italy.
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Abstract
The pathogenesis of inflammatory bowel diseases (IBDs) seems to involve a primary defect in one or more of the elements responsible for the maintenance of intestinal homeostasis and oral tolerance. The most important element is represented by the intestinal barrier, a complex system formed mostly by intestinal epithelial cells (IECs). IECs have an active role in producing mucus and regulating its composition; they provide a physical barrier capable of controlling antigen traffic through the intestinal mucosa. At the same time, they are able to play the role of non-professional antigen presenting cells, by processing and presenting antigens directly to the cells of the intestinal immune system. On the other hand, immune cells regulate epithelial growth and differentiation, producing a continuous bi-directional cross-talk within the barrier. Several alterations of the barrier function have been identified in IBD, starting from mucus features up to its components, from epithelial junctions up to the Toll-like receptors, and altered immune responses. It remains to be understood whether these defects are primary causes of epithelial damage or secondary effects. We review the possible role of the epithelial barrier and particularly describe the role of IECs in the pathogenesis of IBD.
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Abstract
To our knowledge, this is the first case reported in the literature of umbilical endometriosis in a pregnant woman. We report a case of umbilical endometriosis in a pregnant woman at 16 weeks of gestation. The patient revealed a reddish-brown polypoid nodule within the umbilical depression, with the typical history of monthly bleeding from the umbilicus. A nodule biopsy, testing of serum levels of CA-125 and a transabdominal ultrasound examination were performed. The diagnosis of endometriosis was confirmed by pathological examination. Serum levels of CA-125 were slightly increased and the pelvic ultrasound examination did not identify ovarian cysts of a possible endometriotic nature. The patient was also examined at 24 weeks' gestation, after delivery and in the late postpartum period. No therapy was given and the lesion resolved spontaneously 2 months after the biopsy was taken.
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Affiliation(s)
- S Razzi
- Department of Pediatrics, Obstetrics and Reproductive Medicine, Chair of Obstetrics and Gynecology, University of Siena, Italy
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Ghizzani A, Razzi S, Fava A, Sartini A, Picucci K, Petraglia F. Management of sexual dysfunctions in women. J Endocrinol Invest 2003; 26:137-8. [PMID: 12834041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The deeper understanding of female physiology changed the perspective used to evaluate sexual difficulties. Systems like: vascular, neurological, biochemical, and endocrine are investigated as their modifications for aging or medical conditions may alter the sexual responsivity of women. New data imply that pharmacological interventions may become suitable for women. Gonadal steroids influence mood, wellbeing, and genital physiology but evidence of actions is controversial. Hormone imbalance provokes symptoms that may also derive from other conditions. Clinicians must exclude dismetabolism, depression and family crisis before diagnosing gonadal problems. The female androgen insufficiency syndrome was defined in July 2001 as altered mood, memory and wellbeing, and loss of desire. Estrogen maintains wellbeing and healthy genitals, influencing mood and sexuality. Progesterone provokes tension and nervousness, causing premenstrual syndrome. Hormone replacement is indicated in the treatment of endocrine deficiency. In research projects women receiving one preparation containing androgen reported improvement of mood, and arousal. Sildenafil cures approximately 25% of sexually dysfunctional, menopausal patients; being more effective with hormone replacement therapy (HRT) and consistently active against the block of antidepressants on orgasm. Added to psychiatric regimens, sildenafil ameliorates excitement. Sex therapy helps patients change behavior, overcome anger, communicate needs and redefine sex. We strongly believe that such crucial aspects must be addressed in therapy, even when the etiology is organic.
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Affiliation(s)
- A Ghizzani
- Policlinico Universitario, Dipartimento di Ostetricia e Ginecologia, Università di Siena, Siena, Italy
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31
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Marchesini G, Natale S, Chierici S, Manini R, Besteghi L, Di Domizio S, Sartini A, Pasqui F, Baraldi L, Forlani G, Melchionda N. Effects of cognitive-behavioural therapy on health-related quality of life in obese subjects with and without binge eating disorder. Int J Obes (Lond) 2002; 26:1261-7. [PMID: 12187405 DOI: 10.1038/sj.ijo.0802073] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2001] [Revised: 03/19/2002] [Accepted: 04/18/2002] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To measure the effects of cognitive-behavioural therapy on health-related quality of life (HRQL) in obese patients, in relation to binge eating disorder. DESIGN Longitudinal, clinical intervention study consisting of structured sessions of cognitive-behavioural therapy, preceded by sessions chaired by a psychologist in subjects with binge eating. SUBJECTS Two groups of obese patients (92 treated by cognitive-behavioural therapy (77 females); 76 untreated controls (67 female), selected from the waiting list (control group)). Of 92 treated patients, 46 had a binge eating disorder at psychometric testing and structured clinical interview. MEASUREMENTS Health-related quality of life by means of Short-Form 36 questionnaire at baseline and after 3-5 months. RESULTS Cognitive-behavioural treatment produced an average weight loss of 9.4+/-7.5 kg, corresponding to a BMI reduction of 3.48+/-2.70 kg/m(2). No changes were observed in the control group. All scales of HRQL improved in treated subjects (by 5-19%). In obese subjects with binge eating weight loss was lower in comparison to non-bingers (7.7+/-8.1 vs 11.1+/-6.6; P=0.034). However, the improvement in HRQL was on average larger, and significantly so for Role Limitation-Physical (P=0.006), Role Limitation-Emotional (P=0.002), Vitality (P=0.003), Mental Health (P=0.032) and Social Functioning (P=0.034). Bodily Pain was the sole scale whose changes paralleled changes in body weight. CONCLUSIONS The positive effects of cognitive-behavioural therapy, mainly in subjects with binge eating, largely outweigh the effects on body weight, resulting in a significant change in self-perceived health status.
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Affiliation(s)
- G Marchesini
- Unit of Metabolic Diseases, Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
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Salaffi F, Carotti M, Sartini A, Cervini C. A prospective study of the long-term efficacy and toxicity of low-dose methotrexate in rheumatoid arthritis. Clin Exp Rheumatol 1995; 13:23-8. [PMID: 7774099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the long-term efficacy and safety of weekly low-dose methotrexate (MTX) in rheumatoid arthritis (RA). METHODS Fifty-one patients receiving MTX for RA were prospectively studied over a mean treatment period of 36 months. Standard clinical and laboratory measures of disease activity were assessed by the same investigator at baseline, and at 3, 6, 12, 24 and 36 months. RESULTS The overall probability of continuing to take MTX was 80.3% at 12 months, 74.5% at 24 months, and 70.5% at 36 months. Of the 36 patients who completed 36 months of therapy, a significant improvement was noted compared to baseline in all of the clinical disease variables and acute phase reactants, with a steroid-sparing effect. There were no significant differences in these parameters between the 36-month visit and the 24- or 12-month visit. Adverse events occurred frequently (80.3%), but only 15.6% of the patients discontinued MTX permanently. Four patients (7.9%) withdrew due to a lack of efficacy. CONCLUSION Our findings indicate that MTX remains effective over 36 months of therapy, with an acceptable toxicity profile.
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Affiliation(s)
- F Salaffi
- Department of Rheumatology, University of Ancona, Italy
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33
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Carotti M, Salaffi F, Ferraccioli GF, Binci MC, Sartini A, Cervini C. Soluble interleukin-2 receptor in sera and synovial fluids of rheumatoid patients: correlations with disease activity. Rheumatol Int 1994; 14:47-52. [PMID: 7824835 DOI: 10.1007/bf00300246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The measurement of serum soluble interleukin-2 receptor (sIL-2R), a sensitive marker of lymphocyte activation, has been proposed as an indicator of disease activity and "outcome" in patients with inflammatory diseases characterized by the activation of immune cells. Serum sIL-2R levels have been reported higher in rheumatoid patients than in controls. Using an enzyme-linked immunoabsorbent assay (ELISA), we evaluated soluble IL-2R levels in the serum of 34 patients with RA and in the synovial fluid of 25 of these patients and we compared it with levels found in the serum of 13 healthy controls. Serum sIL-2R levels were significantly elevated in RA patients compared with the healthy age-matched control group (P < 0.005). The mean level of soluble IL-2R in synovial fluids was significantly higher than the mean sera levels in RA patients (P < 0.0001). Moreover, we examined the correlation between serum and synovial fluid sIL-2R levels and disease activity measures. Serum sIL-2R correlated only with ESR (P < 0.04). The synovial fluid sIL-2R correlated with ESR (P < 0.02) and a visual analogue scale (VAS) pain score (P < 0.04). Both serum and synovial fluid sIL-2R levels correlated with the chronic arthritis systemic index (CASI; P < 0.04 and P < 0.005, respectively). Our data suggested that in RA the measurement of sIL-2R may certainly mirror the degree of chronic inflammation and the continuous activation of the immune cells in the joint, although the role of this molecule in the immune response is still unclear.
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Affiliation(s)
- M Carotti
- Department of Rheumatology, University of Ancona, Ospedale A. Murri, Jesi Ancona, Italy
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Abstract
A multi-centre uncontrolled clinical trial was performed in 42 Italian hospitals to evaluate the efficacy and tolerance of an instant suspension of naproxen, a well known anti-inflammatory drug. A total of 390 adults of all ages with musculoskeletal rheumatic diseases or minor traumatic injuries entered the trial. Patients received 500 mg naproxen instant suspension twice daily after meals, for 1-4 weeks. Assessment of signs and symptoms was made before starting the therapy, after 3 days and at the end of the treatment period. The drug produced a rapid and progressive relief of pain and articular symptoms in most patients and was equally effective in all the diagnostic sub-groups. The efficacy of treatment was 'excellent' or 'good' in about 85% of patients, 'moderate' in 10% and 'minimal' or 'absent' in about 5%. Almost 90% of patients had no side-effects; 5% were withdrawn because of unwanted effects. No correlation between incidence or intensity of side-effects and age of the patients or duration of therapy was observed. The complaints reported are common to other anti-rheumatic drugs, e.g. epigastric pain, pyrosis, nausea, vomiting and headache. In conclusion, naproxen instant suspension is highly effective and well tolerated.
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Affiliation(s)
- C I Cordaro
- Medical Department, Recordati SpA, Milan, Italy
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