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Lucaciu LA, Skamnelos A, Murino A, Lazaridis N, Chacchi Cahuin R, Raymond R, Despott EJ. Life-threatening small-bowel diverticular bleed treated by double-balloon enteroscopy in a patient refusing transfusion. Endoscopy 2024; 56:E69. [PMID: 38262460 PMCID: PMC10805611 DOI: 10.1055/a-2224-7759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Laura A. Lucaciu
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Alexandros Skamnelos
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Alberto Murino
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Rocio Chacchi Cahuin
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Regina Raymond
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Edward J. Despott
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
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Murino A, Cahuin RC, Franzoni L, Lazaridis N, Skamnelos A, Potts J, Fuccio L, Murray CD, Thorburn D, Despott EJ. Endoscopy during the peak of COVID-19 pandemic: impact on activity and financial implications for a tertiary referral center in London. Ann Gastroenterol 2021; 34:829-835. [PMID: 34815649 PMCID: PMC8596210 DOI: 10.20524/aog.2021.0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background COVID-19 pandemic is an unprecedented global medical emergency. National and international gastrointestinal societies recommended that any endoscopic activity during the lockdown phase of the pandemic should be limited to emergency or non-deferrable procedures only. We assessed the financial implications and impact on endoscopy activity of the lockdown phase in a tertiary referral endoscopy unit. Methods The number of endoscopy procedures canceled and performed in our endoscopy unit during our “delay phase” (16-22/03/2020) and “lockdown phase” (23/03-29/05/2020) was reviewed and compared with endoscopy activity conducted during the same period in 2019. The financial impact was subsequently analyzed. Results Between 16/03/2020 and 29/05/2020, 683 procedures were canceled and 365 non-deferrable procedures were performed. In contrast, in 2019, 3437 procedures were performed over the same timeframe, resulting in a revenue contraction of approximately €2,062,857. We estimated that the number of lists required to recuperate the canceled endoscopic activity, ranges from 103-155, depending on the level of personal protective equipment required and mitigating policy relating to COVID-19. Conclusion Our results highlight that COVID-19 pandemic had a substantial negative impact on our endoscopy activity and on the revenue generated by our endoscopy unit.
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Affiliation(s)
- Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK (Alberto Murino, Rocio Chacchi Cahuin, Nikolaos Lazaridis, Alexandros Skamnelos, Jonathan Potts, Charles D. Murray, Douglas Thorburn, Edward J. Despott)
| | - Rocio Chacchi Cahuin
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK (Alberto Murino, Rocio Chacchi Cahuin, Nikolaos Lazaridis, Alexandros Skamnelos, Jonathan Potts, Charles D. Murray, Douglas Thorburn, Edward J. Despott)
| | - Leonardo Franzoni
- Department of Medical and Surgical Sciences DIMEC, University of Bologna, Italy (Leonardo Franzoni, Lorenzo Fuccio)
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK (Alberto Murino, Rocio Chacchi Cahuin, Nikolaos Lazaridis, Alexandros Skamnelos, Jonathan Potts, Charles D. Murray, Douglas Thorburn, Edward J. Despott)
| | - Alexandros Skamnelos
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK (Alberto Murino, Rocio Chacchi Cahuin, Nikolaos Lazaridis, Alexandros Skamnelos, Jonathan Potts, Charles D. Murray, Douglas Thorburn, Edward J. Despott)
| | - Jonathan Potts
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK (Alberto Murino, Rocio Chacchi Cahuin, Nikolaos Lazaridis, Alexandros Skamnelos, Jonathan Potts, Charles D. Murray, Douglas Thorburn, Edward J. Despott)
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences DIMEC, University of Bologna, Italy (Leonardo Franzoni, Lorenzo Fuccio)
| | - Charles D Murray
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK (Alberto Murino, Rocio Chacchi Cahuin, Nikolaos Lazaridis, Alexandros Skamnelos, Jonathan Potts, Charles D. Murray, Douglas Thorburn, Edward J. Despott)
| | - Douglas Thorburn
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK (Alberto Murino, Rocio Chacchi Cahuin, Nikolaos Lazaridis, Alexandros Skamnelos, Jonathan Potts, Charles D. Murray, Douglas Thorburn, Edward J. Despott)
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK (Alberto Murino, Rocio Chacchi Cahuin, Nikolaos Lazaridis, Alexandros Skamnelos, Jonathan Potts, Charles D. Murray, Douglas Thorburn, Edward J. Despott)
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Skamnelos A, Lazaridis N, Vlachou E, Koukias N, Apostolopoulos P, Murino A, Christodoulou D, Despott EJ. The role of small-bowel endoscopy in inflammatory bowel disease: an updated review on the state-of-the-art in 2021. Ann Gastroenterol 2021; 34:599-611. [PMID: 34475730 PMCID: PMC8375652 DOI: 10.20524/aog.2021.0652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/14/2021] [Indexed: 12/11/2022] Open
Abstract
The impact of small-bowel (SB) capsule endoscopy and device-assisted enteroscopy on clinical practice, since their introduction 2 decades ago, has been remarkable. These disruptive technologies have transformed the investigation and management of SB pathology and now have a firmly established place in guidelines and clinical algorithms. Furthermore, recent years have witnessed innovations, driven by the demand of new goals in the management of inflammatory bowel disease (IBD), such as mucosal healing and evolving strategies based on tight monitoring and accelerated escalation of care. These developments in SB endoscopy have also been paralleled by refinement in dedicated radiological SB imaging technologies. This updated review highlights the current state of the art and more recent innovations with a focus on their role in IBD.
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Affiliation(s)
- Alexandros Skamnelos
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott).,Division of Gastroenterology, University Hospital and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Alexandros Skamnelos, Dimitrios Christodoulou)
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott).,Genesis Hospital of Thessaloniki, Thessaloniki, Greece (Nikolaos Lazaridis)
| | - Erasmia Vlachou
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott).,Army Share Funds Hospital (NIMTS), Athens, Greece (Erasmia Vlachou, Periklis Apostolopoulos)
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott).,Department of Gastroenterology, University Hospital of Patras, Patras, Greece (Nikolaos Koukias)
| | - Periklis Apostolopoulos
- Army Share Funds Hospital (NIMTS), Athens, Greece (Erasmia Vlachou, Periklis Apostolopoulos)
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott)
| | - Dimitrios Christodoulou
- Division of Gastroenterology, University Hospital and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Alexandros Skamnelos, Dimitrios Christodoulou)
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott)
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Triantafyllou K, Gkolfakis P, Skamnelos A, Diamantopoulou G, Dagas A, Tziatzios G, Thomopoulos K, Potamianos S, Christodoulou D. Impact of simple, specific, verbal instructions on the quality of bowel preparation in hospitalized patients undergoing colonoscopy: a multicenter randomized controlled trial. Endosc Int Open 2021; 9:E378-E387. [PMID: 33655037 PMCID: PMC7895659 DOI: 10.1055/a-1339-0913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022] Open
Abstract
Background and study aims Bowel preparation for colonoscopy is frequently inadequate in hospitalized patients. We explored the impact of specific verbal instructions on the quality of inpatients bowel preparation and factors associated with preparation failure. Patients and methods Randomized (1:1), two strata (mobilized vs. bedridden; 3:2) trial of consecutive inpatients from four tertiary centers, who received either specific, verbal instructions or the standard of care (SOC) ward instructions about bowel preparation. The rate of adequate bowel preparation (Boston Bowel Preparation Score [BBPS] ≥ 6, no segment < 2) comprised the primary endpoint. Mean BBPS score, good (BBPS score ≥ 7, no segment score < 2) and excellent (BBPS = 9) were among secondary endpoints. Results We randomized 300 inpatients (180 mobile) aged 71.7 ± 15.1 years in the intervention (49.7 %) and SOC (50.3 %) groups, respectively. Overall, more patients in the intervention group achieved adequate bowel preparation, but this difference did not reach statistical significance neither in the intention-to-treat [90/149 (60.4 %) vs. 82/151 (54.3 %); P = 0.29] nor in the per-protocol analysis [90/129 (69.8 %) vs. 82/132 (62.1 %); P = 0.19]. Overall BBPS score did not differ statistical significantly in the two groups, but the provision of specific verbal instructions was associated with significant higher rates of good (58.1 % vs. 43.2 %; P = 0.02) and excellent (31.8 % vs. 16.7 %; P = 0.004) bowel preparation compared to the SOC group. Administration of same-day bowel preparation and patient American Society of Anesthesiologists score > 2 were identified as risk factors for inadequate bowel preparation. Conclusions Provision of specific verbal instructions did not increase the rate of adequate bowel preparation in a population of mobilized and bedridden hospitalized patients.
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Affiliation(s)
- Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens
| | - Alexandros Skamnelos
- Division of Gastroenterology, University Hospital & Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgia Diamantopoulou
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Athanasios Dagas
- Department of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens
| | - Konstantinos Thomopoulos
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Spyros Potamianos
- Department of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Dimitrios Christodoulou
- Division of Gastroenterology, University Hospital & Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Lazaridis N, Skamnelos A, Murino A, Chacchi Cahuin R, Koukias N, Despott EJ. Reply to Letter to the Editor, Reply to Yasri & Wiwanitkit. Endoscopy 2021; 53:97. [PMID: 33212521 PMCID: PMC7869036 DOI: 10.1055/a-1303-9528] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Alexandros Skamnelos
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Rocio Chacchi Cahuin
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Edward J. Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
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Lazaridis N, Skamnelos A, Murino A, Chacchi Cahuin R, Koukias N, Despott EJ. "Double-surgical-mask-with-slit" method: reducing exposure to aerosol generation at upper gastrointestinal endoscopy during the COVID-19 pandemic. Endoscopy 2020; 52:928-929. [PMID: 32967022 PMCID: PMC7516391 DOI: 10.1055/a-1198-5471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Alexandros Skamnelos
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Rocio Chacchi Cahuin
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Edward J. Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
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Skamnelos A, Murino A, Lazaridis N, Cunado L, Despott EJ. Endoscopy during the COVID-19 pandemic: simple construction of a single-use, disposable face shield using inexpensive and readily available materials. VideoGIE 2020; 5:399-401. [PMID: 32420519 PMCID: PMC7224167 DOI: 10.1016/j.vgie.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Alexandros Skamnelos
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Lloyd Cunado
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
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Kosmidou M, Karavasili NT, Saridi M, Skamnelos A, Kavvadias A, Batistatou A, Gartzonika KG, Tsiara S, Katsanos KH, Christodoulou DK. Clostridium Difficile Infection in Patients Impact Suspected Cytomegalovirus Infection in Patients with Inflammatory Bowel Disease. Mater Sociomed 2020; 32:41-45. [PMID: 32410890 PMCID: PMC7219720 DOI: 10.5455/msm.2020.32.41-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Clostridium difficile infection (CDI) has been reported to be a cause of flare-ups in patients with inflammatory bowel disease (IBD). Cytomegalovirus (CMV) infection can cause severe disease and complications in immunocompromised patients in consequence of disease or therapy. Aim Our aim was to describe the prevalence and clinical outcomes of CDI with concomitant CMV infection in IBD patients hospitalized for flare-ups in association with the disease itself and medication used. Methods We prospectively identified consecutive patients referred for CDI management during 2015-2017. Stool samples were tested for Clostridium difficile toxin A and/or B and Glutamate Dehydrogenase in patients with clinical symptoms. CDI patients with IBD history were tested for anti-CMV IgG and IgM antibodies by chemiluminescent microparticle immunoassay and underwent histological analysis for CMV on colon biopsies. Data were collected for demographic characteristics, treatment and outcome. Results 125 patients with CDI were enrolled. Among these patients, 14 (11.2%) were diagnosed with IBD. The mean patient age of IBD patients was 52.5±15.4 years at diagnosis of CDI, 85.7% had UC, 14.3% CD, while the age of patients was shared. Eleven of the total of 14 patients (78.6%) tested positive for anti-CMV IgG. Of these, 3 patients (21.4%) exhibited high CMV IgG avidity, without detectable anti-CMV IgM and biopsy-proven CMV colitis. Of the 14 IBD patients with CDI, 8 patients (57.1%) were receiving anti-tumor necrosis factor (anti-TNF) therapy (21.4 % infliximab or golimumab, 7.1% vedolizumab or adalimumab) and 43.5% of patients were being treated with systemic corticosteroids. Four UC patients (28.6%) on steroids of the 14 CDI patients underwent a colectomy whereas none of the not on steroids patients underwent colectomy (p=0.25). Among them, 1 patient (7.1%) had recurrent CDI after 5 months from the first episode of CDI.These patients were treated with vancomycin, metronidazole and fidaxomicin. The mean age of patients that had a colectomy 65.5±9.32 (n=4) was higher than the mean age of those 47.30±14.49 (n=10) who improved (UMann-Whitney=6. p=0.04). Conclusions Immunosuppressive medications and older age are associated with increased risk of CDI and poor outcome. Although, CMV is a rare colonic pathogen in the immunocompetent patient, it should be included and screened when exacerbation of IBD occurs in patients receiving any type of immunosuppressive therapy.
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Affiliation(s)
- Maria Kosmidou
- 1st Division of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Maria Saridi
- General Hospital of Corinth. Scientific Department of Social and Educational Policy, University of Peloponnese, Corinth. Hellenic Open University, Corinth, Greece
| | - Alexandros Skamnelos
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Athanasios Kavvadias
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Anna Batistatou
- Pathology Laboratory, Chair of Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantina G Gartzonika
- Microbiology Laboratory, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Stavroula Tsiara
- 2nd Division of Internal Medicine, Chair of Infection Control Committee, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos H Katsanos
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Roda G, Porru E, Katsanos K, Skamnelos A, Kyriakidi K, Fiorino G, Christodoulou D, Danese S, Roda A. Serum Bile Acids Profiling in Inflammatory Bowel Disease Patients Treated with Anti-TNFs. Cells 2019; 8:cells8080817. [PMID: 31382518 PMCID: PMC6721523 DOI: 10.3390/cells8080817] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/24/2019] [Accepted: 08/01/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Inflammatory bowel diseases (IBD), ulcerative colitis (UC), and Crohn’s disease (CD), represent systematic chronic conditions with a deficient intestinal absorption. We first attempt to investigate the serum bile acids (sBAs) profile in a large cohort of IBD patients to evaluate changes under anti-TNF alpha treatment. Methods: Forty CD and 40 UC patients were enrolled and BAs were quantified by high-pressure liquid chromatography-electrospray-tandem mass spectrometry (HPLC-ES-MS/MS). Up to 15 different sBAs concentrations and clinical biomarkers where added to a Principal Component Analysis (PCA) to discriminate IBD from healthy conditions and treatment. Results: PCA allowed a separation into two clusters within CD (biologic-free patients and patients treated with anti-TNF alpha drugs and healthy subjects) but not UC. The first included CD. CD patients receiving anti-TNF alpha have an increase in total sBAs (4.11 ± 1.23 μM) compared to patients not exposed. Secondary BAs significantly increase after anti-TNF alpha treatment (1.54 ± 0.83 μM). Furthermore, multivariate analysis based on sBA concentration highlighted a different qualitative sBAs profile for UC and CD patients treated with conventional therapy. Conclusion: According to our results, anti-TNF alpha in CD restores the sBA profile by re-establishing the physiological levels. These findings indicate that, secondary BAs might serve as an indirect biomarker of the healing process.
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Affiliation(s)
- Giulia Roda
- IBD Unit, Humanitas Research Hospital, 20089 Milan, Italy
| | - Emanuele Porru
- Department of Chemistry G. Ciamician, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy
| | - Konstantinos Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences 45110 Ioannina, Greece
| | - Alexandros Skamnelos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences 45110 Ioannina, Greece
| | - Kallirroi Kyriakidi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences 45110 Ioannina, Greece
| | - Gionata Fiorino
- IBD Unit, Humanitas Research Hospital, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy
| | - Dimitrios Christodoulou
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences 45110 Ioannina, Greece
| | - Silvio Danese
- IBD Unit, Humanitas Research Hospital, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy
| | - Aldo Roda
- Department of Chemistry G. Ciamician, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy
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Fousekis FS, Theopistos VI, Mitselos IV, Skamnelos A, Kavvadias A, Katsanos KH, Christodoulou DK. Specific Features of Patients With Inflammatory Bowel Disease and Primary Sclerosing Cholangitis. J Clin Med Res 2019; 11:81-88. [PMID: 30700999 PMCID: PMC6340671 DOI: 10.14740/jocmr3680] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022] Open
Abstract
Primary sclerosing cholangitis (PSC) is a chronic and progressive disease of the biliary tract. PSC is strongly associated with inflammatory bowel disease (IBD), mainly with ulcerative colitis, and most PSC patients have underlying IBD. The pathophysiological interactions between IBD and PSC are unclear, although it seems that the patients with IBD and PSC have a distinct phenotype. IBD with coexisting PSC is more extensive and is characterized by milder activity compared to IBD alone. The coexistence of PSC increases the risk for colorectal cancer in IBD patients and lifelong annual surveillance colonoscopy is recommended. Also, liver transplantation (LT) for PSC may affect the course of IBD. In addition, the management of IBD after LT includes many specific problems. On the other hand, the effect of IBD on the natural history of PSC appears to be milder. However, IBD may increase the risk of postsurgical complications after LT and is a risk factor for recurrent PSC after LT. Overall, the coexistence of IBD with PSC changes the management, natural history and prognosis of both diseases.
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Affiliation(s)
- Fotios S. Fousekis
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasileios I. Theopistos
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioannis V. Mitselos
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Alexandros Skamnelos
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Athanasios Kavvadias
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Konstantinos H. Katsanos
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios K. Christodoulou
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
- Corresponding Author: Dimitrios K. Christodoulou, Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Ioannina, Ioannina 45100, Greece.
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Chetcuti Zammit S, Schembri J, Pisani A, Vella S, Azzopardi M, Skamnelos A, Christodoulou DK, Katsanos KH, Ellul P. Vitamin D and Ulcerative Colitis: Is There a Relationship with Disease Extent? Dig Dis 2018; 37:208-213. [PMID: 30384373 DOI: 10.1159/000494439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/11/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with ulcerative colitis (UC) can suffer from low serum vitamin D that can result in complications such as low bone mineral density. It can also reflect underlying disease severity. METHODS One hundred and ninety-seven patients previously diagnosed with UC from 2 European centers were prospectively recruited through the out-patient clinics. Clinical features (Montreal Classification, age, gender, previous and current medications, surgery), disease activity (Simple Clinical Colitis Activity Index [SCCAI]), blood investigations including serum inflammatory markers, and serum vitamin D were analyzed. The vitamin D levels were compared to a group of age- and gender-matched healthy controls. RESULTS Mean vitamin D levels were lower in patients with UC (54.6 nmol/L) than in controls (80.7 nmol/L; p = 0.0001). Mean vitamin D levels was lowest in patients with extensive UC (E3; p = 0.0001). Serum vitamin D was not significantly different across treatment groups (p = 0.876). There was no statistical difference in vitamin D levels across patients receiving calcium and vitamin D supplements (p = 0.35) and there was no statistical correlation with SCCAI (p = 0.22). CONCLUSIONS This study confirms the existence of low serum vitamin D in patients with UC when compared to healthy controls. It also provides evidence of an existing relationship between disease extent and serum vitamin D.
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Affiliation(s)
| | - John Schembri
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Anthea Pisani
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Sarah Vella
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | | | | | | | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
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Katsanos KH, Kyriakidi K, Skamnelos A, Christodoulou DK. Asymptomatic hyperCKemia During Infliximab Therapy in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:1272-1273. [PMID: 29718259 DOI: 10.1093/ibd/izy089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Konstantinos H Katsanos
- Division of Gastroenterology, University Hospital and Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Kallirroi Kyriakidi
- Division of Gastroenterology, University Hospital and Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Alexandros Skamnelos
- Division of Gastroenterology, University Hospital and Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, University Hospital and Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
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D'Hooghe T, Kyriakidi K, Karassa FB, Politis D, Skamnelos A, Christodoulou DK, Katsanos KH. Biomarker Development in Chronic Inflammatory Diseases. Biomarkers for Endometriosis 2017. [PMCID: PMC7122305 DOI: 10.1007/978-3-319-59856-7_3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic inflammatory diseases, such as inflammatory bowel disease—namely, Crohn’s disease and ulcerative colitis—psoriasis, multiple sclerosis, rheumatoid arthritis, and many others affect millions of people worldwide, causing a high burden of disease, socioeconomic impact, and healthcare cost. These diseases have common features including autoimmune pathogenesis and frequent co morbidity. The treatment of these chronic inflammatory diseases usually requires long-term immunosuppressive therapies with undesirable side effects. The future of chronic inflammatory disease prevention, detection, and treatment will be greatly influenced by the use of more effective biomarkers with enhanced performance. Given the practical issues of collecting tissue samples in inflammatory diseases, biomarkers derived from body fluids have great potential for optimized patient management through the circumvention of the abovementioned limitations. In this chapter, peripheral blood, urine, and cerebrospinal fluid biomarkers used in chronic inflammatory conditions are reviewed. In detail, this chapter reviews biomarkers to fore used or emerging to be used in patients with chronic inflammatory conditions. Those include inflammatory bowel diseases, chronic inflammatory conditions of the liver, biliary tract, pancreas, psoriasis, atopic disease, inflammatory skin diseases, rheumatic diseases, demyelination, and also the chronic inflammatory component of various other diseases in general medicine—including diabetes, cardiovascular disease, renal disease, and chronic obstructive pulmonary disease. Development of personalized medicine is closely linked to biomarkers, which may serve as the basis for diagnosis, drug discovery, and monitoring of diseases.
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Affiliation(s)
- Thomas D'Hooghe
- 0000 0001 0668 7884grid.5596.fDepartment of Development and Regeneration Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
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Roda G, Narula N, Pinotti R, Skamnelos A, Katsanos KH, Ungaro R, Burisch J, Torres J, Colombel JF. Systematic review with meta-analysis: proximal disease extension in limited ulcerative colitis. Aliment Pharmacol Ther 2017; 45:1481-1492. [PMID: 28449361 PMCID: PMC6350510 DOI: 10.1111/apt.14063] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/22/2016] [Accepted: 03/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Disease extent in ulcerative colitis is one of the major factors determining prognosis over the long-term. Disease extent is dynamic and a proportion of patients presenting with limited disease progress to more extensive forms of disease over time. AIM To perform a systematic review and meta-analysis of epidemiological studies reporting on extension of ulcerative colitis to determine frequency of disease extension in patients with limited ulcerative colitis at diagnosis. METHODS We performed a systematic literature search to identify studies on disease extension of ulcerative colitis (UC) and predictors of disease progression. RESULTS Overall, 41 studies were eligible for systematic review but only 30 for meta-analysis. The overall pooled frequency of UC extension was 22.8% with colonic extension being 17.8% at 5 years and 31% at 10 years. Extension was 17.8% (95% CI 11.2-27.3) from E1 to E3, 27.5% (95% CI 7.6-45.6) from E2 to E3 and 20.8% (95% CI 11.4-26.8) from E1 to E2. Rate of extension was significantly higher in patients younger than 18 years (29.2% (CI 6.4-71.3) compared to older patients (20.2% (CI 13.0-30.1) (P<.0001). Risk of extension was significantly higher in patients from North America (37.8%) than from Europe (19.6%) (P<.0001). CONCLUSIONS In this meta-analysis, approximately one quarter of patients with limited UC extend over time with most extension occurring during the first 10 years. Rate of extension depends on age at diagnosis and geographic origin. Predicting those at high risk of disease extension from diagnosis could lead to personalised therapeutic strategies.
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Affiliation(s)
- G Roda
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Narula
- Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - R Pinotti
- Gustave L. and Janet W. Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Skamnelos
- Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - K H Katsanos
- Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - R Ungaro
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Burisch
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Torres
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J-F Colombel
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Tsianos EV, Tsianou K, Tsipouras MG, Giannakeas N, Skamnelos A, Katsanos KH, Tatsioni A, Karvounis EC, Tsianos V, Tzallas AT, Vlcek J. Beliefs about Medicines Questionnaire (BMQ) in inflammatory bowel disease patients in Greece. Ιs this useful? ACTA ACUST UNITED AC 2016. [DOI: 10.5750/ejpch.v4i1.1067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background and Aims: The aim of this study is the revalidation of the Beliefs about Medicine Questionnaire (BMQ) in outpatient gastroenterology clinic patients, in Greece. Methods: A cohort of 163 patients diagnosed with inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn’s disease (CD) was included in the study, with the majority of them being in the remission phase. Diagnosis of IBD was established using standard diagnostic criteria. Statistical analysis included descriptive statistics and frequency analysis, Pearson's correlation and analysis of variance (ANOVA). Results: Internal consistency of the BMQ validated with Cronbach's α, being 0.757 in overall and 0.795 and 0.691 for the specific and general parts, respectively. The data adequacy for factor analysis was determined with Kaiser-Meyer-Olkin (KMO) measure > 0.5, while inter-item correlations were found to be significant in all cases. Conclusions: The Greek version of BMQ presented satisfactory psychometric/measurement properties indicating its reliability for use in patients with IBD who receive care in an outpatient hospital clinic.
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Katsanos KH, Koutroumpakis E, Giagkou E, Malakos Z, Almpani E, Skamnelos A, Christodoulou DK. Fast-track drug approval in inflammatory bowel diseases. Ann Gastroenterol 2016; 29:439-444. [PMID: 27708508 PMCID: PMC5049549 DOI: 10.20524/aog.2016.0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/26/2016] [Indexed: 12/22/2022] Open
Abstract
Fast-track drug designation of safe regimens represents an emerging method of development and approval of new medications targeting debilitating diseases including inflammatory bowel diseases (IBD). The goal of accelerated drug approval pathways is to shorten the time between application and approval of therapies that treat diseases with significant morbidity and mortality. Recently, fast-track drug approval approaches were supported by data deriving from central reading of images, a method of clinical data interpretation that has significantly benefited patients with gastrointestinal disorders. Biological agents and other emerging therapies in IBD represent “game-changing” or “treat-to-target” drugs and have satisfied quite successfully some of the patients’ unmet needs. The development of biosimilars is an area where the Federal Drug Administration and the European Agency for Evaluation of Medicinal Products seem to have different approval processes. Biosimilars, including those for IBD, promise cost reductions and wide access to biologic therapies by patients, advantages similar to those already offered by generic drugs. Given the rapid development of IBD drugs and patients’ needs, a consensus among the academic community, clinicians, researchers, sponsors, patients and regulatory authorities is required to standardize better the IBD trials and create a productive environment for fast-track approval of any “changing-game” IBD drug.
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Affiliation(s)
- Konstantinos H Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Ioannina School of Medical Sciences, Ioannina, Greece (Konstantinos H. Katsanos, Eftychia Giagkou, Zikos Malakos, Eleni Almpani, Alexandros Skamnelos, Dimitrios K. Christodoulou)
| | - Efstratios Koutroumpakis
- Department of Internal Medicine, Albany Medical College, Albany, New York, USA (Efstratios Koutroumpakis)
| | - Eftychia Giagkou
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Ioannina School of Medical Sciences, Ioannina, Greece (Konstantinos H. Katsanos, Eftychia Giagkou, Zikos Malakos, Eleni Almpani, Alexandros Skamnelos, Dimitrios K. Christodoulou)
| | - Zikos Malakos
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Ioannina School of Medical Sciences, Ioannina, Greece (Konstantinos H. Katsanos, Eftychia Giagkou, Zikos Malakos, Eleni Almpani, Alexandros Skamnelos, Dimitrios K. Christodoulou)
| | - Eleni Almpani
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Ioannina School of Medical Sciences, Ioannina, Greece (Konstantinos H. Katsanos, Eftychia Giagkou, Zikos Malakos, Eleni Almpani, Alexandros Skamnelos, Dimitrios K. Christodoulou)
| | - Alexandros Skamnelos
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Ioannina School of Medical Sciences, Ioannina, Greece (Konstantinos H. Katsanos, Eftychia Giagkou, Zikos Malakos, Eleni Almpani, Alexandros Skamnelos, Dimitrios K. Christodoulou)
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Ioannina School of Medical Sciences, Ioannina, Greece (Konstantinos H. Katsanos, Eftychia Giagkou, Zikos Malakos, Eleni Almpani, Alexandros Skamnelos, Dimitrios K. Christodoulou)
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